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ID PMID Title PublicationDate abstract
23221588 ACR/EULAR 2010 rheumatoid arthritis classification criteria. 2012 Dec Advances in our understanding of the pathogenesis of RA over the past two decades, particularly the identification of cytokines that promote synovial inflammation (e.g. TNF-α, IL-1 and IL-6), have led to treatment courses that affect the disease process itself, beyond alleviation of symptoms. In turn, emphasis has shifted to intervention early enough in the disease course to prevent the joint destruction that follows inflammation. Accordingly, in 2010 the ACR and the European League Against Rheumatism (EULAR) put forward revised classification criteria emphasizing RA characteristics that emerge early in the disease course, including ACPAs, a biomarker that predicts aggressive disease. These were in contrast with the 1987 ARA criteria, which distinguished established RA patients from those with other forms of arthritis, and identified patients with later disease. The categories of the 2010 ACR/EULAR criteria are grouped into four classifications, with point scores for each: joint symptoms; serology (including RF and/or ACPA); symptom duration, whether <6 weeks or >6 weeks; and acute-phase reactants (CRP and/or ESR). The criteria were developed in a three-phase process, beginning with an analysis of patient cohorts to determine what disease characteristics had persuaded clinicians to initiate MTX therapy, followed by consensus-based decisions and the creation of a scoring system that would predict which patients would go on to develop persistent and/or erosive disease.
21927056 Painful rheumatoid arthritis. 2011 Sep Rheumatoid arthritis is a crippling disease that is often associated with severe pain, suffering, and diminished function, thereby detracting from an optimal quality of life. Over the past decade a greater appreciation of the pathophysiology of rheumatoid arthritis has been gained. In the past "decade of pain research," biologic agents which may modify rheumatoid arthritis have emerged as potent therapeutic antirheumatic drugs. Biologic agents include 5 tumor necrosis factor alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab pegol), interleukin-1 blockers (anakinra), monocloncal antibodies against B cells (rituximab), T cell costimulation blocker (abatacept), and interleukin-6 inhibitors (tocilizumab). Currently, utilizing therapy aimed at targeting various abnormalities of rheumatoid arthritis may be possible. It appears that the combined use of etanercept and methotrexate may improve the imbalance of Th1/Th2 and Th17/regulatory T cells (Treg) (and related cytokines) often seen in rheumatoid arthritis. Furthermore, this improvement in Tcell ratios/cytokines is also associated with improvement in clinical indicators of rheumatoid arthritis severity. Although rheumatologists are generally the specialists "called on" to manage complex patients with rheumatoid arthritis, pain specialists may be asked to join interdisciplinary teams managing patients with advanced refractory rheumatoid arthritis with severe pain since one of the most common and debilitating symptoms of rheumatoid arthritis is pain. Thus, pain specialists should have some appreciation of the current thoughts regarding rheumatoid arthritis pathophysiology and treatment. This narrative review of rheumatoid arthritis is intended to familiarize the interventional pain specialist with current concepts surrounding rheumatoid arthritis.
21427576 Monitoring rheumatoid arthritis. 2011 May PURPOSE OF REVIEW: The approach to treating rheumatoid arthritis has changed over the last decade not only because of new therapeutic agents but also because of new treatment strategies. These strategies involve aiming at a treatment target, usually remission or low disease activity and monitoring patients regularly to attain this goal. Here we review the most recent insights related to monitoring of rheumatoid arthritis. RECENT FINDINGS: New insights were gained into the advantages and limitations of patient global assessment of disease severity and self-reported joint counts. The stringency of defining remission by the simplified disease activity index when compared with other instruments was confirmed by ultrasonography. Sensitivity to change and similarity to clinical assessments were shown for ultrasonographic indices; a simplified score for assessing joint damage by magnetic resonance imaging was presented. Physical function and working capacity continue to be impaired in the most recent decade. The evidence-based treat-to-target recommendations, developed by an international task force, are means to improve this situation. The American College of Rheumatology and the European League Against Rheumatism have most recently developed a stringent definition of remission for trials and practice. SUMMARY: The recent data provide compelling evidence for the importance of monitoring to attain the treatment targets in rheumatoid arthritis.
22070585 Rheumatoid arthritis and anaesthesia. 2011 Dec There has been a great deal of progress in our understanding and management of rheumatoid arthritis in recent years. The peri-operative management of rheumatoid arthritis patients can be challenging and anaesthetists need to be familiar with recent developments and potential risks of this multi system disease.
23480004 [Rheumatoid arthritis: psychosomatic aspects]. 2012 The review considers the results of studies of the psychosomatic aspects of rheumatoid arthritis (RA), which have been published in the past 5 years. In particular, there is evidence for the impact of chronic pain on the psychological status of patients with RA, for that of the disease on quality of life in the patients, their sociopsychological and interpersonal relationships; trials of the efficiency of additional treatment options for RA are given.
21862794 Rheumatoid arthritis: ultrasound versus MRI. 2011 Sep OBJECTIVE: Rheumatoid arthritis is a predominantly joint-based disease affecting approximately 1% of the world's population. This article will address the increasing use of both ultrasound and MRI in the diagnosis and monitoring of rheumatoid arthritis and will highlight both the strengths and weaknesses of these two imaging modalities, with particular reference to bone erosions and synovitis. CONCLUSION: Because they can detect early disease, both ultrasound and MRI will become increasingly important in the diagnosis and management of rheumatoid arthritis. Future studies with increased patient numbers will be necessary if one of these two modalities is to emerge as a clear winner as the imaging modality of choice.
23177913 When and where does rheumatoid arthritis begin? 2012 Dec The major strides accomplished in elucidating the pathophysiology of rheumatoid arthritis (RA) have translated into therapeutic breakthroughs in clinical practice. However, currently available treatments work only for as long as they are taken. The development of curative treatments will probably require a better understanding of the earliest phases of RA and perhaps the identification of the etiological factors, which are probably numerous. These objectives are being pursued in studies of preclinical RA. The literature review presented herein indicates that the immunological conflict probably originates outside the joints, at mucous membrane sites and, more specifically, in the upper aerodigestive tract. The preclinical phase of RA can last for many years, and some patients probably never progress to arthritis. An immunological conflict develops then spins out of control, causing increases in autoantibody titers and subsequently in levels of serum markers for inflammation, before the development of the first joint symptoms. Improved knowledge of the preclinical phase, together with information from genetic markers, will allow the identification of profiles associated with susceptibility to RA and perhaps, in the future, the development of preventive strategies.
23109051 Pain in rheumatoid arthritis. 2012 Dec Rheumatoid arthritis (RA) is an inflammatory disease of synovial joints, and pain is the predominant problem for people with RA. Pain in RA is distressing in its own right and adversely affects disability and psychosocial outcomes. RA pain may be due to joint inflammation and also augmented by central sensitization and structural joint damage. Noninflammatory pain mechanisms may confound the assessment of disease activity in RA, and treatment should aim to both suppress inflammatory disease and relieve pain symptoms. Effective treatment stratification requires a full assessment of pain mechanisms by clinical history and examination, as well as objective assessment of synovitis and joint damage. Biologic therapies and joint replacement surgery have major impacts on RA pain, but may only be available to those with most severe or advanced disease. Holistic approaches to pain management are indicated, including pharmacologic analgesia where randomized controlled trials (RCTs) offer evidence of efficacy.
23256829 [Rheumatoid arthritis - an independent risk factor for cardiovascular disease]. 2012 Nov Mortality in patients with rheumatoid arthritis compared with general population is increased and approximately one-half of the premature death is due to increased cardiovascular mortality. Traditional cardiovascular risk factors only partly explain increased risk of cardiovascular disease in patients with rheumatoid arthritis. The risk of cardiovascular disease associated with rheumatoid arthritis equals that of diabetes mellitus. Rheumatoid arthritis should be regarded as a strong independent cardiovascular risk factor as diabetes mellitus. The presence of chronic inflammation implicated in pathogenesis of rheumatoid arthritis and atherosclerosis could be the key mechanism that contributes to increased cardiovascular risk. Traditional cardiovascular risk factors reduction combined with tight disease control is recommended to reduce the risk of cardiovascular disease.
22137925 Imaging in rheumatoid arthritis. 2011 Aug The optimal management of rheumatoid arthritis (RA) requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis and responsive monitoring of therapeutic outcomes. Conventional radiography has been widely used in both clinical and research settings to assess RA joint damage due to its feasibility, but it has limitations in early disease detection and difficulty distinguishing between active treatments in modern trials. Imaging modalities such as magnetic resonance imaging (MRI) and ultrasound (US) have the advantage of detecting both joint inflammation and damage and hence they can provide additional and unique information. This can be especially useful in the context of early and/or undifferentiated joint disease when detection of soft tissue and bone marrow abnormalities is desirable. This review focusses on the recent literature concerning modern imaging, and provides clinicians with an insight into the role of imaging in modern RA diagnosis, prognosis and monitoring.
21794768 [Biomarkers in rheumatoid arthritis]. 2011 Mar The search for biomarkers in rheumatoid arthritis (RA) has been the object of interesting research in the past few years, although results have not always been relevant. Several biomarkers, from several different locations (blood, urine, synovial fluid, synovial tissue) and of different nature (autoantibodies, genetic markers, joint remodeling markers), and related to different outcomes, diagnostic and prognostic markers (joint destruction, disability, lack of remission, mortality, response to anti-rheumatic treatment, etc.) have been studied. The present article reviews research only on soluble biomarkers, mainly those in serum, related to the diagnosis and joint destruction in RA.
22364129 Rheumatoid arthritis: cardiovascular manifestations, pathogenesis, and therapy. 2012 Rheumatoid Arthritis (RA) is a chronic progressive inflammatory joint disorder that affects 0.5% - 1% of the general population. This review article discusses cardiovascular manifestations of rheumatoid arthritis, pathogenesis of these manifestations, and therapy. This disease not only affects the joints, but it also involves other organ systems. The majority of these patients suffer significant morbidity and mortality from cardiovascular disease. Cardiovascular manifestations of RA include predilection for accelerated atherosclerosis and endothelial dysfunction resulting in coronary artery disease (CAD), stroke, congestive heart failure, and peripheral arterial disease. Some studies have shown that the risk of developing CAD in RA patients is the same as for patients with diabetes mellitus. These patients should be treated with aggressive medical therapy such as disease modifying antirheumatic drugs, tumor necrosis factor alpha inhibitors, and corticosteroids and with appropriate control of risk factors such as smoking, dyslipidemia, hypertension, and obesity. Other manifestations include pericarditis, myocarditis, and vasculitis.
22709486 Measures in rheumatoid arthritis: are we measuring too many parameters. 2012 Jun The disease activity measures in rheumatoid arthritis (RA) have a lot of unmet need for current clinical demand. With available biological and aggressive disease modifying anti-rheumatic drug therapy, the goal of RA treatment has moved toward remission or at least tighter control. The current measures lose their ability to discriminate further once the patient gets into minimal disease or tight control. There are more numbers of parameters, measured to assess disease activity, like joint counts, perception scales and laboratory parameters. There are different composite scores like Disease Activity Score, American College of Rheumatology criteria and clinical disease activity index. In this review we have reviewed the evolution of and changing need for these measures. The relevance of some measures and their use and limitations with reference to various characteristics are presented. Inflammation measures to quantify the RA process is the best way to monitor RA disease activity. C-reactive protein alone or with other biomarkers to specify RA, appear to be good prospective measures.
22766086 My treatment approach to rheumatoid arthritis. 2012 Jul The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival.
21570496 Rheumatoid arthritis: what is refractory disease and how to manage it? 2011 Sep Despite the enthusiastic progresses in the field of rheumatoid arthritis pharmacotherapy the presence of prognostic factors associated with an unfavorable outcome and the inappropriate and/or delayed initiation of DMARDs can diminish the likelihood of achieving remission and increase the probability of refractoriness to treatment. During the last decade we have experience exciting developments regarding the approval of new treatment options but few patients are reaching sustained remission and refractory patients continue to be a problem. Thus, it is critical to understand how clinicians can decrease the risk of refractoriness by close monitoring disease activity, using well defined and accepted composite measures, and by early and optimized use of DMARDs, including biologics. The goal of this review paper is to offer an evidence based roadmap to prevent and to deal with refractory RA.
21627047 Epigenetic deregulation in rheumatoid arthritis. 2011 In this chapter, we discuss the current understanding of the possible epigenetics changes that occur in rheumatoid arthritis. In particular, we describe that deregulation ofDNA methylation and histone modifications can occur in the immune system and lead to rheumatoid arthritis. In addition, we discuss the role of rheumatoid arthritis synovial fibroblasts in autoimmunity. Examples of changes in DNA methylation and histone modification occurring in synovial fibroblasts during the disease process are reviewed in this chapter. In conclusion, we discuss the possible use of epigenetic therapy and describe future experiments that can elucidate further the epigenetic changes observed in the disease.
21308151 HDAC inhibition in rheumatoid arthritis and juvenile idiopathic arthritis. 2011 May Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are heterogeneous autoimmune diseases characterized by chronic joint inflammation. Methotrexate is used as the gold standard to treat rheumatoid arthritis, yet there are many patients in whom the disease cannot be controlled or who experience unacceptable intolerance. Most of the biologics currently used are effective, but mostly if combined with methotrexate. Long-term possible side effects, such as impaired host defense mechanisms against infection and lymphoma, are distinct disadvantages and a major concern of anticytokine therapies. Parenteral administration is a problem, particularly in children. Thus, there is a need to explore new treatment options. Here we review the properties of histone deacetylase inhibitors (HDACi) as they apply to rheumatoid arthritis by looking at effects on cytokine production, T-cell differentiation and the function of macrophages, dendritic cells, osteoblasts, osteoclasts and synovial fibroblasts. We also review the safety and efficacy of givinostat (ITF 2357) in the treatment of systemic onset juvenile idiopathic arthritis (SOJIA) and its influence on the cytokine networks in SOJIA. Givinostat is an orally active HDACi which was given to children with SOJIA. After 12 wk of treatment, there were significant benefits, particularly in reducing the pain and arthritic component of the disease and decreasing the neutrophilia. CD40L, IL-1α and IFNγ in whole blood lysates decreased at wks 2 and 4 compared with baseline levels. The clinical data are consistent with those from animal models of rheumatoid arthritis and suggest that trials with HDACi are promising as a safe oral alternative to anticytokines and methotrexate.
22035393 Rheumatoid arthritis of the cervical spine--clinical considerations. 2011 Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder affecting multiple organ systems, joints, ligaments, and bones and commonly involves the cervical spine. Chronic synovitis may result in bony erosion and ligamentous laxity that result in instability and subluxation. Anterior atlantoaxial subluxation (AAS) is the most frequently occurring deformity, due to laxity of the primary and secondary ligamentous restraints. Additional manifestations of RA include cranial settling, subaxial subluxation, or a combination of these. Although clinical findings can be confounded by the severity of multifocal joint and systemic involvement, a careful history is critical to identify symptoms of cervical disease; serial physical examination is the best noninvasive diagnostic tool. Thorough physical and neurologic examinations should be performed in all patients and serial functional assessments charted. Radiographs of the cervical spine with lateral flexion-extension dynamic views should be obtained periodically and used to "clear" the cervical spine before elective surgery requiring general anesthesia. Advanced imaging, such as magnetic resonance imaging (MRI) or myelography and computed tomography (CT), may be necessary to evaluate the neuraxis. Early initiation of pharmacotherapy may slow progression of rheumatoid cervical disease. Operative intervention before the onset of advanced myelopathy results in improved outcomes compared to the surgical stabilization of patients whose conditions are more advanced. A multidisciplinary approach involving rheumatology, surgery, and rehabilitation is beneficial to optimize outcomes.
22364085 Rheumatoid arthritis: a review and dental care considerations. 2011 Jun Rheumatoid arthritis (RA), is a chronic multisystem disease of presumed autoimmune etiology. Medical complications due to RA and its treatment may affect the provision of oral health care. Associated syndromes may contribute to a patient's susceptibility to infections and impaired hemostasis. Therefore oral health care providers need to recognize and identify modificationsof dental care based on the medical status of patients with RA. As with many other chronic conditions, early intervention can reduce the severity of the disease. Furthermore, oral health care providers play an important role in the overall care of these patients as it relates to early recognition, as well as control of the disease.
22907289 Pre-rheumatoid arthritis: predisposition and transition to clinical synovitis. 2012 Oct Multiple proven and potential risk factors for the development of rheumatoid arthritis (RA) have been identified, and represent interactions between genes and the environment. Proven risk factors include genetic influences on the function of the innate and adaptive immune systems, smoking, anti-citrullinated protein antibodies (ACPAs), and rheumatoid factors (RF). Potential risk factors include epigenetic control of gene expression, the microbiome and other environmental factors, Toll-like receptors, cytokines, and Fc receptors. Preclinical abnormalities such as circulating RF and ACPAs may occur more than 10 years prior to the onset of clinical disease. However, the precise mechanisms whereby these risk factors lead to clinical disease remain unclear. It is possible that, combined with activation of the innate immune system, a subset of ACPAs initiates the disease in the cartilage or synovium after binding to endogenous citrullinated proteins. Subsequent engagement of Fc receptors and complement activation would lead to secondary inflammation in the synovium with induction of a perpetuating cycle of chronic synovitis.