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ID PMID Title PublicationDate abstract
20309701 [Spondyloarthritis and quality of life]. 2010 May To measure the disease activity of spondyloarthritides (SpA), quality of life is assessed in addition to inflammation and functional impairment. To measure quality of life in ankylosing spondylitis (AS), the generic measurement instruments SF-36, SF-12 and EQ-5D are available in German, whereby the SF-36 is the instrument primarily used in clinical investigations. Compared to the normal population, AS patients experience a reduced quality of life. In woman and patients with a poor educational background, quality of life was particularly reduced.Measuring quality of life is also a generally recognised part of evaluating psoriasis arthritis (PsA), for which only SF-36 and EQ-5D are available in German-speaking countries. The instrument most frequently used in clinical studies is SF-36. The quality of life in PsA patients, in terms of both physical and mental components, was found to be significantly lower than in the normal population. Although PsA patients shared a similar reduction in quality of life to AS patients, they nevertheless enjoyed a better quality of life than rheumatoid arthritis patients.
21175420 Microencapsulation: an acclaimed novel drug-delivery system for NSAIDs in arthritis. 2010 Arthritis refers to different medical conditions associated with disorders of the primary structures that determine joint functioning, such as bones, cartilage, and synovial membranes. Drug discovery and delivery to retard the degeneration of joint tissues are challenging. Current treatment of different types of arthritis such as osteoarthritis, rheumatoid arthritis, septic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis involves the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac, aceclofenac, ibuprofen, flurbiprofen, indomethacin piroxicam, dexibuprofen, ketoprofen, nabumetone, nimesulide, and naproxen, mainly by the oral, parenteral, or topical route. However, the frequent dosing that is required with NSAIDs often leads to patient noncompliance, so drug-delivery technologies should be developed to reduce the frequency of dosing and to allow sustained release of medications. Microencapsulation is one of the novel drug-delivery technologies employed to sustain drug release. This method reduces dosing and eliminates gastrointestinal irritation, thus ultimately improving patient compliance in the pharmacotherapy of arthritis. We provide a comprehensive overview of several microencapsulation technologies used in the treatment of arthritis that may reduce the dose-related adverse effects caused by NSAIDs.
20120164 [Spa therapy in rheumatology. Indications based on the clinical guidelines of the French N 2009 Jun The objective of this work was to update the rheumatologic indications of spa therapy, based on clinical practice guidelines published by the French National Authority for Health (HAS) and the European League Against Rheumatism (EULAR), and on the results of randomized clinical trials (RCT) METHODOLOGY: We first examined the indications for which spa therapy is mentioned and/or recommended in HAS and EULAR guidelines. We then identified RCTs in spa therapy and rheumatology by using the key words spa therapy, balneology, balneotherapy, hydrotherapy, mud therapy and mineral water in the Pubmed, Pascal and Embase databases. Only RCTs including a statistical analysis of between-group outcomes were retained We also examined the possible contribution of RCTs not listed in the bibliography of the guidelines. RECOMMENDATIONS: spa therapy is recommended by HAS for chronic lower back pain, rank B and for stabilized rheumatoid arthritis, rank C. In ankylosing spondylitis, EULAR classifies spa therapy along with physiotherapy, rank A. In fibromyalgia, EULAR recommends hot-water balneology, an important component of spa therapy, rank B, based on five RCTs, of which three were carried out in thermal springs. Nineteen RCTs that comprised a statistical comparison of between-group outcomes were identified Sixteen studies indicated a persistent improvement (at least twelve weeks) in pain, analgesic and non-steroidal antiinflammatory drug consumption, functional capacity and/or quality of life, in the following indications: chronic lower back pain, knee osteoarthritis, hand osteoarthritis, fibromyalgia, ankylosing spondylitis andrheumatoidarthritis (PR). CONCLUSION: Spa therapy, or hot-water balneology, appears to be indicated for chronic low back pain, stabilized rheumatoid arthritis, ankylosing spondylitis and fibromyalgia. RCT findings suggest that patients with knee and hand osteoarthritis might also benefit.
20042581 Mammalian clock gene Cryptochrome regulates arthritis via proinflammatory cytokine TNF-alp 2010 Feb 1 The mammalian clock genes, Period and Cryptochrome (Cry), regulate circadian rhythm. We show that circadian rhythmicity and rhythmic expression of Period in the nuclei of inflammatory synovial cells and spleen cells are disturbed in mouse models of experimental arthritis. Expressions of other clock genes, Bmal1 and Dbp, are also disturbed in spleen cells by arthritis induction. Deletion of Cry1 and Cry2 results in an increase in the number of activated CD3(+) CD69(+) T cells and a higher production of TNF-alpha from spleen cells. When arthritis is induced, Cry1(-/-)Cry2(-/-) mice develop maximal exacerbation of joint swelling, and upregulation of essential mediators of arthritis, including TNF-alpha, IL-1beta and IL-6, and matrix metalloproteinase-3. Wee-1 kinase is solely upregulated in Cry1(-/-)Cry2(-/-) mice, in line with upregulation of c-Fos and Wee-1 kinase in human rheumatoid arthritis. The treatment with anti-TNF-alpha Ab significantly reduced the severity and halted the progression of the arthritis of Cry1(-/-)Cry2(-/-) mice and vice versa, ectopic expression of Cry1 in the mouse embryonic fibroblast from Cry1(-/-)Cry2(-/-) mice significantly reduced the trans activation of TNF-alpha gene. Thus, the biological clock and arthritis influence each other, and this interplay can influence human health and disease.
19535609 Inactive disease in polyarticular juvenile idiopathic arthritis: current patterns and asso 2009 Aug OBJECTIVES: To describe the achievement of inactive disease (ID) and remission in polyarticular juvenile idiopathic arthritis (JIA) and to measure the associations among patient characteristics, imaging results and these outcomes. METHODS: We performed a retrospective cohort study of children with polyarticular JIA diagnosed and treated at Seattle Children's Hospital between 1 January 2000 and 31 December 2006. Each patient's disease status (active disease vs ID) was determined for every clinic visit. Adjusted relative risk estimates were obtained using Mantel-Haenszel methods. RESULTS: One hundred and four children were included. Patients were followed up for an average of 30 months. Patients achieved 138 episodes of ID. Fifty-one patients achieved 69 episodes of clinical remission on medication. When duration of active disease was summed over each patient's follow-up, patients spent a mean of 66.3% of their follow-up with active disease. Patients with evidence of joint damage on imaging studies obtained within 6 months of their first clinic visit spent a mean of 79% of their follow-up with active disease. Patients without these findings spent a mean of 58.5% of their follow-up with active disease (P < 0.001). Children who were RF(+) and children with early evidence of joint damage tended to have a higher prevalence of active disease during the follow-up period. CONCLUSIONS: In this cohort, children with polyarticular JIA spent the majority of their follow-up with active disease. Because children with early radiographic evidence of joint damage and children who were RF(+) tended to have the most active disease, improving outcomes for these subgroups may be an important goal for prospective study.
21123320 Disease activity, smoking, and reproductive-related predictors of poor prognosis in patien 2011 Mar OBJECTIVE: To identify disease activity, smoking, and reproductive-related predictors of a poor prognosis in patients with very early inflammatory polyarthritis (IP). METHODS: Patients with very early IP (symptom duration 4-11 weeks) included in our study were participants in the STIVEA (Steroids In Very Early Arthritis) randomized placebo-controlled trial. At baseline, disease-related variables were measured and patients were asked to complete a questionnaire covering smoking status and reproductive questions. Baseline predictors of poor prognosis [i.e., the need to start disease-modifying antirheumatic drug (DMARD) therapy by 6 months or the clinical diagnosis of rheumatoid arthritis (RA) at 12 months] were identified, applying logistic regression analyses adjusted for treatment group. RESULTS: Rheumatoid factor (RF) positivity was one of the strongest clinical predictors of a poor prognosis: OR for DMARD therapy at 6 months, 4.00 (95% CI 2.00-8.00) and OR for a diagnosis of RA at 12 months, 9.48 (95% CI 4.48-20.07). There was a significant association between current smoking at baseline compared to never smoking and a diagnosis of RA at 12 months (OR 3.15, 95% CI 1.16-8.56). CONCLUSION: About 6 in 7 patients with very early RF-positive IP were diagnosed with RA 1 year later. In addition, 1 in 4 IP patients who smoke will develop RA later. It is recommended to treat RF-positive patients who have IP with DMARD at presentation and to advise patients to stop smoking.
20414126 Risedronate-induced arthritis. 2010 Jun In most cases bisphosphonates are the first choice therapy for osteoporosis. We present a case of acute arthritis associated with once-weekly risedronate in a 58-year-old woman with osteoporosis. She developed arthritis 48 hours after the second dose of oral risedronate with elevated serum acute-phase reactants. There was no evidence of rheumatoid arthritis or seronegative arthritis. Her symptoms resolved rapidly with rest, however, recurred after the patient was rechallenged with the same drug 1 week later. Although the mechanism of this potential side effect remains speculative, it is thought to be as a result of the proinflammatory properties of aminobisphosphonates. With the increasing use of bisphosphonates in the treatment and prevention of osteoporosis, physicians should be well aware of this possible side effect of these drugs.
19889287 Update on the management of pain in arthritis and the use of cyclooxygenase-2 inhibitors. 2009 Dec Chronic pain from arthritis continues to be one of the biggest causes of disability and loss of function in the United States today. This is still the case despite many new insights into the pathophysiology of pain, effective treatment approaches, and new, safer medications that can be used long-term. There are many different types of arthritic problems. New disease-modifying agents that are available for some of these types of arthritic diseases, such as rheumatoid arthritis, have the potential to have a substantial impact on improvement in the long-term prognosis. Despite this optimistic outlook, pain often is a significant problem and should be treated whenever it becomes a barrier to function. To complicate treatment for this condition, the most widely used group of medications is under new scrutiny because of concerns regarding long-term detrimental side effects. A complete understanding of the risk factors for NSAIDs, specifically cyclooxygenase-2 inhibitors, is still not available. But published data and new clinical guidelines still suggest that treatment for this large category of diseases can be effective and safe.
19570240 Effects of triptolide from Radix Tripterygium wilfordii (Leigongteng) on cartilage cytokin 2009 Jul 2 BACKGROUND: Triptolide, an active compound of Radix Tripterygium wilfordii, is immunosuppressive, cartilage protective and anti-inflammatory both in human and animal studies of various inflammatory and autoimmune diseases, including rheumatoid arthritis, but its therapeutic mechanism remains unclear. The aim of this study is to investigate the effects of triptolide on cartilage cytokines in the CIA model. METHODS: Sprague Dawley rats were immunized with type II collagen and orally administered with triptolide. The arthritic scores and incidence changes of the rats were observed. The expression of TNF-alpha, IL-6, COX-2 and NF-kappaB in paw cartilage was studied with immunohistochemical staining. RESULTS: Triptolide, at both high and low doses, significantly lowered the arthritic scores, delayed the onset of arthritis and lowered the arthritis incidence. Triptolide treatment at both high and low doses lowered the expression of TNF-alpha, IL-6, COX-2 and NF-kappaB in paw cartilage in arthritic rats. CONCLUSION: Triptolide lowers the arthritic scores, delays the onset of collagen induced arthritis and reduces the expressions of TNF-alpha, IL-6, NF-kappaB and COX-2 in paw cartilage in arthritic rats.
19365707 Severe erosive arthropathy requiring surgical treatments in systemic lupus erythematosus. 2009 We report a case of 43-year-old woman with an overlap syndrome of systemic lupus erythematosus (SLE) and dermatomyositis who developed erosive arthritis with extracapsular cysts involving multiple joints. An extensive synovectomy for the left wrist joint and a total joint replacement for the right hip joint were required to achieve complete symptom relief. She was not diagnosed with rheumatoid arthritis (RA). This was a rare case of SLE manifesting non-RA erosive arthritis that required surgical interventions.
19265344 Community-based study to estimate prevalence and burden of illness of rheumatic diseases i 2009 Mar OBJECTIVE: To estimate the prevalence, burden of illness, and help-seeking behavior of patients with musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and bone fractures not related to trauma among the adult population in a urban community in Havana City. METHODS: Home survey of adults validated against physical examination. Forty-eight trained family doctors and 3 rheumatologists supervised the interviews and confirmed diagnoses. Family doctors applied a validated Community Oriented Program for the Control of Rheumatic Diseases core questionnaire. A diagnosis using American College of Rheumatology criteria was established. Analysis was based on descriptive statistics and point prevalence estimates with 95% confidence intervals (CIs) of most common diseases and associated disability rate. RESULTS: One thousand two hundred thirty-eight men and 1917 women were included. Prevalence of musculoskeletal pain was estimated in 43.9% (95% CI: 42.2-45.7). The knees were the most affected area (11.7%; 95% CI: 10.6-12) followed by low back pain (11.6%; 95% CI: 10.5-12.8). Point prevalence and 95% CI were as follows: osteoarthritis, 20.4% (95% CI: 19-21.8); gout, 0.38% (95% CI: 0.2-0.6); fibromyalgia, 0.22% (95% CI: 0.09-0.4); systemic lupus erythematosus, 0.06% (95% CI: 0.01-0.25); spondyloarthropathies, 0.19% (95% CI: 0.07-0.4); and rheumatoid arthritis,1.24% (95% CI: 0.8-1.7). Bone fractures not related to trauma were found in 1.14%, hip fracture being the most common (30.5%). Most patients were seen by the general practitioner (65.4%) and 6.2% described some disability. CONCLUSIONS: Musculoskeletal pain is highly prevalent in Cuba. Prevalence estimates are similar to those described in other surveys except for rheumatoid arthritis that seems more prevalent in Cuba and fibromyalgia less prevalent.
27022509 LIMPING IN CHILDREN. 2009 Jan Limping in children is a common complaint at pediatric, pediatric orthopaedic offices and in emergency rooms. There are several causes for this condition, and identifying them is a challenge. The older the patient, the better the anamnesis and more detailed the physical examination will be, enabling an easier medical assessment for searching the source of the disorder. In order to make the approach easier, three age groups can and should be considered. Among infants (1 to 3 years old), diagnosis will most likely be: transitory synovitis, septic arthritis, neurological disorders (mild brain palsy (BP) and muscular dystrophy), congenital hip dislocation (CHD), varus thigh, juvenile rheumatoid arthritis (JRA) and neoplasias (osteoid osteoma, leukemia); in the scholar age group, between 4 and 10 years old, in addition to the diagnoses above, Legg-Calvé-Perthes disease, discoid meniscus, inferior limbs discrepancy and unspecific muscular pain; in adolescents (11 to 15 years old): slipped capital femoral epiphysis, congenital hip dislocation, chondrolysis, overuse syndromes, dissecans osteochondritis, and tarsal coalition. The purpose of this study is to provide an update on how to approach pediatric patients presenting with limping, and to discuss its potential causes.
18982329 The destruction evaluation in different foot joints: new ideas in collagen-induced arthrit 2009 Apr Collagen-induced arthritis (CIA) has been widely used as the animal model of rheumatoid arthritis since 1977, while till now, no paper has depicted the destruction characteristics in different foot joints. In this study, we observed the differences among the foot joint destruction process of CIA to elucidate further the pathological process of this model. CIA was induced in male Wistar rat immunized with bovine type II collagen and Freund's incomplete adjuvant. Radiological studies were performed 1, 2, 4, 6, and 8 months after the second immunization to follow the development of disease. At last, all the animals were killed and histological research was performed. In the histological observation, three main types of joint destructions such as subchondral side erosion, external joint erosion and the cartilaginous fusion of articular cartilage were identified. All these destruction forms exist in one joint or several different joints. Furthermore, we found that tartrate-resistant acid phosphatase (TRAP) stain-positive cells participated in the destruction of articular cartilage. These new findings showed that in the disease process of the CIA model, different foot joints show different destruction characteristics and cartilaginous fusion of foot joints is another typical pathological characteristic.
21220091 Role of diet in rheumatic disease. 2011 Feb Millions of people suffer from rheumatic diseases such as gout, fibromyalgia, osteoarthritis, and rheumatoid arthritis. These can be incapacitating and detrimental to quality of life. Diet, nutrition, and weight loss have shown promise in alleviating some of this disease burden. These lifestyle changes may give patients a feeling of control and ownership over their disease as well as a nonpharmacologic means of treatment. This article reviews the available research on the effects of diet and nutrition on rheumatoid disease.
21035088 Therapeutic considerations in spondyloarthritis patients who fail tumour necrosis factor a 2010 Oct The tumour necrosis factor (TNF) antagonists have significantly improved quality of life and functional status in patients with spondyloarthritis (SpA). The excitement regarding the remarkable success of these agents is justified but challenges remain. In particular, alternative systemic therapies with proven efficacy for patients who fail TNF antagonists have been developed in rheumatoid arthritis but are not yet available in SpA. In this article, the approach to patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) who fail TNF antagonists will be discussed with the goal of providing a path to the clinician, who must manage these patients amidst uncertainty. Three central questions will be addressed. Why does a particular SpA patient not respond to a TNF antagonist? How can the clinician improve the probability of treatment response in patients who fail a TNF antagonist? What specific approaches can be taken to control disease activity in PsA or AS following treatment failure with a TNF antagonist? Data from controlled trials, registries and pilot studies will be combined with expert opinion to address these important questions.
19077719 Diabetes and rheumatic diseases. 2009 Jan PURPOSE OF REVIEW: This review summarizes recent advances in the field of diabetes and rheumatic disease. These conditions exert a significant healthcare burden on our society and much remains to be learned regarding their pathophysiology and treatment. RECENT FINDINGS: We summarize new insights into diabetes and its association with osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, osteoporosis, diffuse idiopathic skeletal hyperostosis, crystalline arthropathy, neuropathic arthropathy, and tendinopathy. Diabetes has major effects on connective tissues, which have significant impact on both the development and outcome of these diseases of cartilage, bone, ligament, and tendon. An improved understanding of the mechanisms through which diabetes alters connective tissue metabolism should lead to better preventive and therapeutic interventions. SUMMARY: Incremental progress has been made in understanding the interactions between diabetes and common musculoskeletal syndromes. Although this review highlights exciting areas of future interest, more work in this field is certainly warranted.
22076177 Rationale for Targeting CD6 as a Treatment for Autoimmune Diseases. 2010 CD6 is a 105-130 kDa surface glycoprotein expressed on the majority of T cells and a subset of B cells. The human cd6 gene maps to chromosome 11, and the expression of its protein product is tightly regulated. CD6 mediates cellular adhesion migration across the endothelial and epithelial cells. In addition, it participates in the antigen presentation by B cells and the subsequent proliferation of T cells. CD6 may bind in trans to surface glycoproteins (such as ALCAM and 3A11), or to microbial lipopolysaccharides, and may bind in cis to endogenous ligands (such as CD3 and CD5), and thereby deliver a costimulatory signal. Transinteractions are reinforced during autoimmune diseases (e.g., rheumatoid arthritis (RA), Sjögren's syndrome, and multiple sclerosis) and some cancers. Based on experimental data and on clinical results in RA and psoriasis, we believe that the recent humanized anti-CD6-specific mAb T1h may act as a regulator of the immunological response in addition to its function as an anti-T- and -B cell agent.
20477007 Discussion: DMARDs and biologic therapies in the management of inflammatory joint diseases 2009 May Therapy for inflammatory joint diseases, such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, includes various conventional disease-modifying antirheumatic drugs (DMARDs). These therapeutic agents are termed DMARDs because they have the potential to reduce or prevent joint damage and preserve joint integrity and function. Conventional DMARDs are used as monotherapy or in combination and include methotrexate, leflunomide, azathioprine, ciclosporin, hydroxychloroquine, sulfasalazine, gold and minocycline. Biologic response modifiers, which are based on proteins made by living cells, are newer agents available for the treatment of various inflammatory joint diseases. Biologic therapies now approved for use in inflammatory joint diseases are TNF inhibitors, T-cell modulators and B-cell depleters. They have all been shown to have clinical efficacy and are able to retard structural damage. However, all current immune-modulating therapies also have potential side effects, and the decision to use a particular agent for treatment should be based on a thorough discussion of the benefits and risks with the patient. Newer biologic response modifiers and other immunologic therapies are currently being developed for the treatment of inflammatory joint diseases and are discussed in this review.
18519150 The development of inflammatory arthritis and other rheumatic diseases following stem cell 2009 Aug OBJECTIVES: Despite the use of stem cell transplantation (SCT) to treat inflammatory arthritis and other rheumatic diseases, case reports of the paradoxical development of these diseases after SCT are appearing. Three cases of inflammatory arthritis developing after SCT were seen at our institution, leading to a literature review to determine the association between SCT and the de novo development of rheumatic conditions. METHODS: Using PubMed and manual searches of references from pertinent articles, the literature pertaining to the onset of rheumatic conditions following SCT was identified. RESULTS: Case reports detailing the onset of rheumatoid arthritis, HLA-B27-related spondyloarthropathy, psoriatic arthritis, systemic lupus erythematosus, vasculitis, eosinophilic fasciitis, antiphospholipid antibody syndrome, as well as polyarthritis related to intercedent viral infection were identified. Failure of transmission of autoimmune disease from donor to recipient in 2 case reports is also summarized. CONCLUSIONS: The incidence of rheumatic disease development after SCT is unknown, and reported cases may simply reflect those patients who were predisposed to disease development in the first place. However, immunologic manipulation during the SCT process raises the question of whether there is an increased propensity to develop autoimmune disease posttransplant. Clinical vigilance in the recognition of phenotypic changes and clinical events occurring after SCT which may represent new autoimmune phenomena is required.
23407688 Anti-Arthritic Activity of Premna serratifolia Linn., Wood against Adjuvant Induced Arthri 2010 Apr Adjuvant induced arthritis is a chronic crippling, skeleton-muscular disorder having nearest approximation to human rheumatoid arthritis for which there is currently no medicine available effecting a permanent cure. Even modern drugs used for the amelioration of the symptoms, offer only temporary relief and also produce severe side effects. In the indigenous system of medicine, wood of Premna serratifolia Linn., is reported to be useful in the treatment of arthritis. It is a large shrub, distributed throughout Asia, used against a wide variety of diseases. However, no systematic study has been reported regarding its anti-arthritic activity. This work was aimed at the scientific validation of the ethno-pharmacological claim about its anti-arthritic property. In the present study, anti-arthritic activity of ethanol extract of Premna serratifolia Linn., wood is done by Freund's adjuvant induced arthritis model. Loss in body weight during arthritis condition was corrected on treatment with ethanol extract and standard drug, indomethacin. Biochemical parameters such as hemoglobin content, total WBC, RBC, erythrocyte and sedimentation rate were also estimated. The ethanol extract at the dose of 300 mg/kg body weight inhibited the rat paw edema by 68.32% which is comparable with standard drug indomethacin 74.87% inhibition of rat paw edema after 21 days. The results of the current investigation concluded, ethanol extract of Premna serratifolia Linn., wood possess a significant anti-arthritic activity against adjuvant induced arthritis and justifying its therapeutic role in arthritic condition. The observed anti-arthritic activity may be due to the presence of phytoconstituents such as irridiod glycosides, alkaloids, phenolic compounds and flavonoids.