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ID PMID Title PublicationDate abstract
20632149 Observational study of switching anti-TNF agents in ankylosing spondylitis and psoriatic a 2010 May Anti-TNF agents like infliximab, etanercept and adalimumab are efficacious in the treatment of ankylosing spondylitis (AS), psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Lack of efficacy, side effects and loss of efficacy over time may be reasons for switching to a second anti-TNF agent and sometimes switching to a third anti-TNF agent may be useful. Effects of switching may be different in patients with AS, PsA and RA. We analysed data of 301 patients with rheumatic diseases treated with anti-TNF agents. Forty-six patients had AS, 63 PsA and 192 RA. Totally 38% of these patients received more than one anti-TNF agent. Switching to a second anti-TNF agent was necessary in 115 (38%) of our patients, in detail in 11 of our AS patients, in 21 of PsA patients and in 83 of RA patients. Patient with PsA showed the best response rate to the second anti-TNF agent. Finally, 46 patients, 5 with SPA, 3 with PsA and 38 with RA received a third anti-TNF agent. We conclude that anti-TNF switching in AS and PsA is less frequent than in RA patients. Survival of anti-TNF agents in AS (p = 0.025) and also in PsA (n.s., p = 0.215) seems to be better than in RA. Switching anti-TNF agents for loss of efficacy over time may have the best effect in patients with AS, PsA and predominantly in RA. Our data suggest that switching for lack of efficacy in RA patients cannot be recommended, but may be an alternative in patients with AS and PsA. Switching to a second anti-TNF agent for side effects may be reasonable, switching to a third anti-TNF agent again for side effects cannot be recommended.
19571519 Preliminary study to identify the predictive factors for the response to methotrexate ther 2009 Jul To identify the major factors predicting the response to Methotrexate (MTX) therapy in rheumatoid arthritis (RA) patients, we evaluated the relationship between the response to MTX and factors such as the concentration of MTX-polyglutamates (MTX-PGs) in erythrocytes (RBCs), genotypes of thymidylate synthase (TYMS) 5'-UTR (2R/3R) and 3'-UTR (-6/+6), 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, and other patient-related factors. Thirty-six Japanese RA patients were enrolled in this cohort study. The concentrations of MTX-PGs in RBCs were measured, and polymorphisms were determined using PCR-RFLP method. As an indicator of the accumulated capacity of MTX-PGs in the RBCs of each patient, the MTX dose/MTX-PGs (AC-MPG, l/week) was calculated. The response to MTX therapy was assessed using the MTX dose for a>or=50% decrease in CRP level (MTX dose for 50%CRP, mg/week), and the relationships between MTX dose for 50%CRP and various other factors were evaluated using multiple linear regression analysis. The MTX dose was 6.9+/-0.3 mg/week and the MTX-PGs concentration in RBCs was 97.3+/-8.1 nmol/l (n=36, blood samples=95, mean+/-S.D.). The range of MTX dose for 50%CRP was 2.0-13.0 mg/week. Most individual AC-MPG levels showed no change during the evaluation period (coefficient of variation=5.9%). Based on the results of multiple linear regression analysis, AC-MPG, TYMS 3'-UTR (-6/+6), and ESR at the start of MTX therapy were associated with the MTX dose for 50%CRP. AC-MPG, TYMS 3'-UTR (-6/+6), and ESR might be the major predictive factors for the response to MTX therapy in Japanese RA patients.
21211205 [A randomized, single-blind, parallel, controlled clinical study on single intra-articular 2010 Nov OBJECTIVE: To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis. METHODS: This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. RESULTS: Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ± 11.1 (P < 0.0001), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5 (P = 0.0015). A mean (34.9 ± 38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while (17.9 ± 24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P = 0.0467). Adverse events were observed in eight patients (19.0%) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. CONCLUSIONS: Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.
19136378 Infliximab and the TNF-alpha system. 2009 Mar Infliximab, a chimeric monoclonal antibody against TNF-alpha, is efficacious in Crohn's disease (CD) and rheumatoid arthritis (RA). Its main mechanism of action is thought to be the induction of apoptosis. The present study evaluates in detail the effects of infliximab on the TNF-alpha system using peripheral blood monocytes and T cells as well as lamina propria lymphocytes from normal individuals and patients with CD, ulcerative colitis, and RA. Lymphocytes were studied in the resting state in the absence of strong stimuli that may obscure subtle findings. Infliximab did not change the numbers of viable cells. Rather, it caused monocytes to increase their release of soluble TNFR2, which serves to neutralize TNF-alpha, potentiating the action of infliximab. It reduced TNFR2 expression, thereby decreasing TNF-alpha responsiveness. These changes were due to upregulated production of TNFR2 rather than increased shedding. Infliximab did not cause rebound production of TNF-alpha transcripts that would counteract its effects. It specifically enhanced production of IL-10 but not proinflammatory cytokines secreted by leukocytes, thereby promoting an anti-inflammatory microenvironment. In addition, infliximab caused a rise in c-Jun amino-terminal kinase phosphorylation by monocytes. Thus infliximab manipulates the TNF-alpha system to promote its anti-TNF-alpha effects.
20849588 Association of TNFAIP3 interacting protein 1, TNIP1 with systemic lupus erythematosus in a 2010 INTRODUCTION: TNFAIP3 interacting protein 1, TNIP1 (ABIN-1) is involved in inhibition of nuclear factor-κB (NF-κB) activation by interacting with TNF alpha-induced protein 3, A20 (TNFAIP3), an established susceptibility gene to systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Recent genome-wide association studies revealed association of TNIP1 with SLE in the Caucasian and Chinese populations. In this study, we investigated whether the association of TNIP1 with SLE was replicated in a Japanese population. In addition, association of TNIP1 with RA was also examined. METHODS: A case-control association study was conducted on the TNIP1 single nucleotide polymorphism (SNP) rs7708392 in 364 Japanese SLE patients, 553 RA patients and 513 healthy controls. RESULTS: Association of TNIP1 rs7708392C was replicated in Japanese SLE (allele frequency in SLE: 76.5%, control: 69.9%, P = 0.0022, odds ratio [OR] 1.40, 95% confidence interval [CI] 1.13-1.74). Notably, the risk allele frequency in the healthy controls was considerably greater in Japanese (69.9%) than in Caucasians (24.3%). A tendency of stronger association was observed in the SLE patients with renal disorder (P = 0.00065, OR 1.60 [95%CI 1.22-2.10]) than in all SLE patients (P = 0.0022, OR 1.40 [95%CI 1.13-1.74]). Significant association with RA was not observed, regardless of the carriage of human leukocyte antigen DR β1 (HLA-DRB1) shared epitope. Significant gene-gene interaction between TNIP1 and TNFAIP3 was detected neither in SLE nor RA. CONCLUSIONS: Association of TNIP1 with SLE was confirmed in a Japanese population. TNIP1 is a shared SLE susceptibility gene in the Caucasian and Asian populations, but the genetic contribution appeared to be greater in the Japanese and Chinese populations because of the higher risk allele frequency. Taken together with the association of TNFAIP3, these observations underscore the crucial role of NF-κB regulation in the pathogenesis of SLE.
20347713 Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. 2010 Apr The results of revision total hip arthroplasty (THA) for ceramic head fracture have generally been disappointing, largely due to third body wear after incomplete synovectomy. We have followed 8 patients who sustained ceramic head fractures and were subsequently revised to a metal-on-polyethylene articulation. There were no revisions for osteolysis or aseptic loosening at a mean follow-up of 10.5 years. The yearly wear rates of each of 5 of these THAs after revision were compared with 6 matched metal-on-polyethylene THAs; there were no significant differences in wear rates. Greater than 10-year survivorship with a metal-on-polyethylene bearing couple is possible after revision THA for a ceramic head fracture if a complete and thorough synovectomy can be performed. Our technique of synovectomy will be described.
20347257 Association between deep vein thrombosis and the temperature at the popliteal fossa during 2011 Apr The temperature at the popliteal fossa during cement curing and its relationship with deep vein thrombosis (DVT) in total knee arthroplasty (TKA) has not been investigated. Fifty-six consecutive patients who underwent primary TKA were recruited. The temperatures at the popliteal fossa were measured during bone cement exothermic polymerization. Postoperative operated leg ascending venographies were performed 5 days after TKA for screening of DVT. The maximum temperatures were 32.5°C ± 1.0°C at the popliteal fossa during cement curing. No significant difference was found of the maximum temperatures in the popliteal fossa between the non-DVT and DVT groups. The present study indicated that the heat resulting from polymerization of the cement may not be a possible cause of damage to the veins surrounding the knee, and it may have no relationship with DVT.
20184554 Latest insights into the anticancer activity of gold(III)-dithiocarbamato complexes. 2010 May In this review paper we aim at giving a detailed overview on our research work devoted to the design of gold-based anticancer agents. In particular, during the last decade, we have been developing some gold(III)-dithiocarbamato derivates showing outstanding in vitro and in vivo antitumor properties and reduced, or even no, systemic and renal toxicity, compared to the reference clinically-established anticancer drug cisplatin. Starting from the rationale behind our investigations, we here summarize the results achieved so far, focusing on the latest in-depth mechanistic studies that have recently provided insights into their mechanism of action, thus opening up new prospects for further pharmacological testing and, hopefully, to enter clinical trials.
20020139 A case of cellulitis causing tissue defect during etanercept therapy. 2012 Jan Tumor necrosis factor-alpha (TNF-α) antagonists are employed increasingly during recent years in patients with active rheumatoid arthritis who do not respond to disease-modifying anti-rheumatic drugs. Contraindications such as infections, auto-antibody formation and hypersensitive reactions can be observed during the treatment with TNF-α antagonist drugs. Our case was a 52-year-old woman, followed by several centers for a period of 21 years with a seropositive, erosive and nodular RA diagnosis. Anti TNF-α treatment was commenced due to the failure to control the disease. During the treatment, a serious cellulite developed, which required hospitalization and surgical debridement as well as intravenous antibiotics treatment. Through the present case, we aimed to draw attention to the skin infection during the use of etanercept in a patient with RA.
21078627 Risk of adverse events including serious infections in rheumatoid arthritis patients treat 2011 Mar OBJECTIVE: To assess the risk of adverse events (AEs) in patients with RA treated with tocilizumab, an IL-6 receptor antibody, in published randomized controlled trials (RCTs). METHODS: A systematic literature search was conducted using the Cochrane library, PUBMED and EMBASE for all RCTs (of the use of tocilizumab for RA) until September 2009. Fixed effect meta-analyses were conducted to compare the incidence of AEs after treatment with tocilizumab 8 and 4 mg/kg in combination with MTX, and 8 mg/kg tocilizumab monotherapy, with controls. Pooled summary odds ratios (ORs) were calculated using the Mantel-Haenszel method. RESULTS: Six trials were analysed (four trials included 8 mg/kg tocilizumab and MTX combination therapy, three of which also assessed the 4 mg/kg dose). Three studies assessed tocilizumab monotherapy at 8 mg/kg. Pooled ORs revealed statistical significance for an increased risk of AEs in the 8 mg/kg combination group compared with controls (OR = 1.53; 95% CI 1.26, 1.86). The risk of infection was significantly higher in the 8 mg/kg combination group compared with controls (OR = 1.30; 95% CI 1.07, 1.58). No increased incidence of malignancy, tuberculosis reactivation or hepatitis was seen. CONCLUSION: Tocilizumab in combination with MTX as a treatment for RA is associated with a small but significantly increased risk of AEs, which is comparable with that of other biologics. Vigilance for untoward effects is, therefore, imperative in any patient treated with these immuno-suppressive agents.
21365941 [Adverse effects of cyclosporin a observed in rheumatoid arthritis and psoriatic arthritis 2010 INTRODUCTION: Rheumatoid arthritis (RA) and psoriatic arthritis (PA) represent diseases which often demand aggressive therapy in order to control the process and inhibit lesion formation in joints and organs. This kind of therapy can be achieved with cyclosporin A (CsA), particularly when combined with methotrexate (MTX). This combination is far more effective than single-drug therapy and is capable of significantly reducing the number of articular lesions. Considering the fact that monotherapy is associated with many adverse effects, it is feared that both drugs in combination may produce cumulative toxicity. The aim of this work was to determine the frequency of adverse effects caused by CsA in patients treated for RA and PA at the Outpatient Rheumatology Clinic of the First Public Hospital in Szczecin. MATERIAL AND METHODS: Our study group consisted of 61 patients, including 47 with RA--35 females, mean age 51 yrs (range: 21-69 yrs), mean disease duration 9.9 yrs (range: 2-23 yrs); 12 males, mean age 51.8 yrs (range: 33-74 yrs), mean disease duration 8 yrs (range: 3-14 yrs) and 14 with PA--6 females, mean age 41.1 yrs (range: 33-55 yrs), mean disease duration 7.8 yrs (range: 2-16 yrs); 8 males, mean age 42.9 yrs (range: 35-50 yrs), mean disease duration 7.0 yrs (range: 0.5-21 yrs). All patients were on MTX. During 11 years of follow-up, CsA was withdrawn due to adverse effects in 20 patients (32.8%). The following adverse effects were observed: arterial hypertension (n=19), hand tremor (n=11), hirsutism (n=7), elevated creatinine (n=17), gingival hypertrophy (n=9), abnormal appetite (n=2), peripheral neuropathy (n=1), lymphocytosis (n=1), skin lesions (n=1), diarrhea (n=2), recurrent infections (n=1), candidiasis (n=1), zoster (n=1), and neoplasm (n=2). Adverse effects responsible for withdrawal of CsA in 14 patients (23%) appeared more frequently during the first 12 months of therapy. Our observations indicate that CsA is well tolerated. The majority of adverse effects subsided after dose reduction or temporary withdrawal of the drug.
20471890 Influence of anti-infliximab antibodies and residual infliximab concentrations on the occu 2010 Jul BACKGROUND: Infliximab (IFX) can be immunogenic for humans and lead to the formation of antibodies against IFX (anti-IFX Ab), which could induce acquired IFX resistance. OBJECTIVE: To test whether the presence of anti-IFX Ab and residual circulating IFX levels are associated with acquired IFX resistance in RA. METHODS: A multivariate logistic regression was used to analyze the relationship between anti-IFX Ab, residual IFX concentrations, and acquired IFX resistance in a nested cohort within the Swiss RA registry (SCQM-RA). RESULTS: Sixty-four RA patients on longstanding IFX therapy were included; 24 with an acquired therapeutic resistance to IFX and 40 with continuous good response to IFX. The two groups had similar disease characteristics, but patients with acquired IFX resistance required significantly higher dosage of IFX (5.4 mg/kg versus 4.3 mg/kg, p=0.02) and shorter infusion intervals (7.1 versus 8.7 weeks, p=0.01) than long-term good responders. The presence of residual IFX tended to be associated with a decreased risk of acquired therapeutic resistance (OR 0.4 [95% CI: 0.1-1.5]), while the presence of anti-IFX Ab tended to be associated with an increased risk of acquired therapeutic resistance (OR: 1.8 [95% CI: 0.4 - 9.0]). The presence of either high anti-IFX Ab levels or low residual IFX concentrations was strongly associated with acquired therapeutic resistance to IFX (OR 5.9, 95% CI 1.3 - 26.6). However, just 42% of patients with acquired IFX resistance had either low IFX or high anti-IFX Ab levels. CONCLUSION: These results suggest that the assessment of anti-IFX Ab and residual IFX levels is of limited value for individual patients in routine clinical care.
20232340 Immunodominant T-cell epitopes of hnRNP-A2 associated with disease activity in patients wi 2010 Jun The heterogeneous nuclear ribonucleoprotein A2 (hnRNP-A2) has been described as an important autoantigen in rheumatoid arthritis (RA) since it is targeted by autoantibodies, autoreactive T cells, and is aberrantly expressed in synovial cells in patients. To identify hnRNP-A2-specific T-cell epitopes possibly associated with pathogenicity, we used an innovative approach. We first scanned 280 overlapping hnRNP-A2 peptides for binding to the RA-associated class II molecules HLA-DR4 and HLA-DR1, leading to a comprehensive selection of binders. The selected peptides were tested in IFN-gamma-specific ELISPOT assay: PBMC from 18% of RA patients showed a significant IFN-gamma response to hnRNP-A2 peptides, 15% to the overlapping sequences 117-133 and/or 120-133, whereas PBMC from healthy individuals tested negative. We measured proliferative responses to these two peptides in another cohort of patients with RA or osteoarthritis: positive responses were found in 28% of RA, but also in 11% of osteoarthritis patients and these responses could be blocked by anti-MHC class II Ab. Remarkably, the presence of 117/120-133-specific T cells was significantly associated with active disease in RA patients, and bone erosion appeared to be more common in T-cell positive patients. These data suggest involvement of hnRNP-A2 specific cellular autoimmune responses in RA pathogenesis.
19402861 Methotrexate: long-term safety and efficacy in an Australian consultant rheumatology pract 2009 Apr BACKGROUND: The aim of this study was to evaluate the rate and cause of methotrexate (MTX) termination in clinical practice, describe the types of toxicities noted, assess the incidence of achieving remission in rheumatoid arthritis (RA) patients and review the appropriateness of current clinical guidelines for monitoring MTX treatment. METHODS: A retrospective, case review of patients seen in a private rheumatology practice attached to a major Sydney Teaching Hospital was undertaken over an 18-year period. The primary outcome was time to cessation of MTX. RESULTS: Seven hundred and ninety patients satisfied the inclusion criteria. MTX was terminated in 272 patients (34.4%). Toxicity-related discontinuation occurred in 93 patients (11.8%) and due to non-adverse reactions in 179 patients. The median duration of therapy in these two groups was 2.0 and 2.9 years, respectively. There was no difference in the average maximum weekly dose of MTX. Of patients with RA, 47.5% were in remission at last follow up. Cox proportional hazards analyses showed that those of the female sex remained on treatment significantly longer than the male sex (hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.57-0.96; P = 0.014); patients with RA remained on treatment significantly longer than patients with seronegative arthritis (HR 0.56, 95%CI 0.42-0.74; P < 0.001). Being of the male sex aged more than 60 years and having a non-RA diagnosis predisposed to stopping MTX earlier. CONCLUSION: MTX is a safe and effective medication. Notable remission rates are achievable in patients with RA with current conventional treatment protocols. MTX has a low toxicity profile and this study stresses the need to re-evaluate and revise the current monitoring guidelines.
20404765 Skeletal muscle properties in rheumatoid arthritis patients. 2010 Dec PURPOSE: Disability in patients with rheumatoid arthritis (RA) is a multifactorial process involving various unaccounted factors. Loss of lean body mass plays an important role in impaired physical function, and exercise studies in RA have shown promising results in restoring muscle mass, strength, and function. However, no comprehensive assessment of the muscle characteristics has been undertaken to determine whether qualitative changes in muscle also contribute to RA disability. This study explores the physiological muscle properties of a community-based population with stable RA. METHODS: Vastus lateralis (VL) force and physiological cross-sectional area (PCSA), voluntary muscle activation capacity, and contractile properties were assessed in 23 patients with stable RA (age = 60 ± 2 yr (mean ± SEM); 16 women) and age- and sex-matched healthy controls (age = 60 ± 3 yr). Measurements with EMG were obtained during maximal isometric knee extension contractions, with resting and superimposed electrical stimulations. Concentric knee extension contractions were also assessed. Pennation angle and VL volume were measured with ultrasound to determine fiber fascicle length and PCSA. Muscle-specific force was calculated (VL force/VL PCSA). Body composition using dual-energy x-ray absorptiometry and objective physical function were also measured. RESULTS: The patients displayed typical features of RA with reduced physical function (P = 0.001-0.09), a trend toward lower appendicular lean mass (P = 0.09) and increased total body fat (P < 0.05) relative to controls. However, there were no differences in specific force, contractile properties, voluntary activation capacity, and contraction velocity (P = 0.41-0.99). VL PCSA was reduced (P < 0.05) with minor architectural changes in patients with RA. CONCLUSIONS: Physiological properties of muscle that determine specific force are not compromised in patients with stable RA despite deficits in physical function.
19572829 Adaptive transmission disequilibrium test for family trio design. 2009 The transmission disequilibrium test (TDT) is a standard method to detect association using family trio design. It is optimal for an additive genetic model. Other TDT-type tests optimal for recessive and dominant models have also been developed. Association tests using family data, including the TDT-type statistics, have been unified to a class of more comprehensive and flexable family-based association tests (FBAT). TDT-type tests have high efficiency when the genetic model is known or correctly specified, but may lose power if the model is mis-specified. Hence tests that are robust to genetic model mis-specification yet efficient are preferred. Constrained likelihood ratio test (CLRT) and MAX-type test have been shown to be efficiency robust. In this paper we propose a new efficiency robust procedure, referred to as adaptive TDT (aTDT). It uses the Hardy-Weinberg disequilibrium coefficient to identify the potential genetic model underlying the data and then applies the TDT-type test (or FBAT for general applications) corresponding to the selected model. Simulation demonstrates that aTDT is efficiency robust to model mis-specifications and generally outperforms the MAX test and CLRT in terms of power. We also show that aTDT has power close to, but much more robust, than the optimal TDT-type test based on a single genetic model. Applications to real and simulated data from Genetic Analysis Workshop (GAW) illustrate the use of our adaptive TDT.
19052752 Synovial fluid RANKL and matrix metalloproteinase levels in enthesitis related arthritis s 2009 Jun In chronic arthritis cartilage and bone destruction occur as a consequence of synovial inflammation. It is mainly mediated by matrix metalloproteinases and RANKL-OPG pathways. Data on synovial fluid levels of these mediators in enthesitis related arthritis subtype (ERA) of JIA are not available. MMP-1, MMP-3, TIMP, sRANKL and OPG levels were measured in synovial fluid from patients with ERA and compared with other arthritides, polyarticular (Poly) JIA, RA and osteoarthritis (OA). sRANKL was detectable in 25/41 of ERA patients, 4/16 of Poly JIA patients. Median SF sRANKL level in patients with ERA was higher as compared to OA (p < 0.001) and poly JIA (p < 0.05) but were comparable to RA. The median OPG level in ERA was lower as compared to OA (p < 0.001), comparable to RA but was higher than poly JIA (p < 0.001). sRANKL/OPG ratio was significantly higher in ERA and Poly JIA compared to OA (p < 0.0001, p < 0.0001 respectively). The median MMP3 levels in ERA (74 microg/ml) was lower as compared to poly JIA (410 microg/ml; p < 0.0001) and RA (340 ug/ml; p < 0.0001) but was comparable to OA (107 microg/ml). The median level of ProMMP1 in ERA (0.70 microg/ml) was lower as compared to RA (2.9 microg/ml; p < 0.0001) and poly JIA but was elevated as compared to OA patients (0.1 microg/ml; p < 0.0001). TIMP1 levels in ERA were higher than poly JIA and RA patients. MMP3/TIMP1 ratio was lower in ERA compared to polyarticular JIA patients (p < 0.05). Ours is the first study reporting elevated sRANKL and reduced OPG levels and elevated sRANKL/OPG ratio in SF of children with JIA resulting in a mileu associated with bone loss. In addition, ERA patients had lower MMP level as well as MMP/TIMP ratio as compared to poly JIA which may partly explain lesser degree of joint damage seen in ERA as compared to poly JIA.
19171462 The evidence provided by a single trial is less reliable than its statistical analysis sug 2009 Jul OBJECTIVE: To investigate whether a single trial can provide sufficiently robust evidence to warrant clinical implementation of its results. Trial-specific factors, such as subject selection, study design, and execution strategy, have an impact on the outcome of trials. In multiple trials, they may lead to heterogeneity that can be taken into account in the (random effects) meta-analysis. Single trials lack this method of estimating the impact of such factors, and this affects the credibility of the results. STUDY DESIGN AND SETTING: To indicate how much the precision of the results of a single trial might be overestimated, we calculated the ratio of the widths of the confidence intervals when heterogeneity was taken into account and when it was not. RESULTS: The ratios of the widths of the confidence intervals with and without between-study variability were 1.15, 1.41, and 2.00, when the heterogeneity I(2) values were 0.25, 0.50, and 0.75, respectively. CONCLUSION: The results of a single trial should be interpreted with caution. When it is difficult to predict or determine how trial-specific factors influence the results, the best way to evaluate the performance of a treatment is to use multiple, possibly smaller, trials.
20033415 Vitamin D level: is it related to disease activity in inflammatory joint disease? 2011 Apr The objectives of this study are to assess the vitamin D status in patients (pts) with inflammatory joint diseases (IJD), and its correlation with disease activity. 121 consecutive pts (85 rheumatoid arthritis (RA), 22 psoriatic arthritis (PSA), 14 ankylosing spondylitis (AS)) underwent clinical and laboratory evaluation which included kidney and liver function tests, serum calcium and phosphor levels, 25(OH)D and parathyroid hormone (PTH). Disease activity was assessed by DAS 28 in RA and PSA pts and by BASDAI in AS pts, sedimentation rate (ESR) and CRP. According to activity indexes, pts were divided into subgroups with low (DAS28 < 3.2 and BASDAI < 4), and moderate-to-high disease activity (DAS28 > 3.2 and BASDAI > 4). Associations between serum levels of 25(OH)D and age, gender, ethnicity, type and disease duration, treatment, (anti-tumor necrosis factorα (TNFα) agents or DMARDs), seasonal variations, and disease activity were assessed. Vitamin D deficiency was found in 51 pts (42.1%). The incidence was higher among Arab pts (76.7%) compared to Jews (23%). The difference of 25(OH)D levels between Arabs (mean 9.4 ± 4.2 ng/ml) and Jews (mean 17.8 ± 8.4 ng/ml) was statistically significant (p < 0.0001). We did not find correlation between vitamin D levels and the other evaluated factors. A surprisingly high incidence of vitamin D deficiency was found in IJD patients in a sunny Mediterranean country. This finding justifies the inclusion of vitamin D in the routine lab work-up of pts with IJD. The only statistical significant correlation was found between vitamin D level and ethnic origin. Further studies are needed to look for genetic polymorphism of vitamin D receptors.
20195701 Coexistence between meningioma and tuberculosis: case report. 2010 Sep Intracranial tuberculoma generally presents as either solitary or multiple lesions in the brain parenchyma. These are characterized by a ring-enhancing area on either computerized tomography scans or magnetic resonance images. A 66 year-old female with a history of breast carcinoma at 41 years, treated with radical mastectomy and radio and chemotherapy, and rheumatoid arthritis, treated in the last 10 years, presented two months ago with occipital headache, nausea, cerebellar syndrome, alterations of speech, and memory loss. The TC scan showed occipital enhancement by contrast and surrounded by oedema, suggesting metastasis. Histology showed a benign meningioma with many multinuclear giant cells, granulomas, and central caseating necrosis. In addition, some classic plasma cells, mastocytes, and lymphocytes were also detected. The authors describe the unusual case of coexistence between an occipital meningioma and tuberculosis in the same area that resembled metastasis.