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ID PMID Title PublicationDate abstract
21515392 Rheumatoid arthritis and periodontitis; a possible link via citrullination. 2011 Aug Rheumatoid Arthritis (RA) and chronic and aggressive periodontitis are chronic inflammatory disorders characterized by deregulation of the host inflammatory response. Increased secretion of pro-inflammatory mediators results in soft and hard tissue destruction of the synovium and periodontium respectively. Both diseases share risk factors and have pathological pathways in common, resulting in loss of function and disability as a final clinical outcome. This article discusses possible interactions, particularly related to the periodontal pathogen Porphyromonas gingivalis, which could explain the observed association between these two prevalent diseases.
22374446 [Role of microRNA in rheumatoid arthritis]. 2012 MicroRNAs (miRNAs) are endogenous non-coding small RNAs of approximately 22 nucleotides in length. miRNAs repress expression of target genes at the posttranscription level. Biological relevance of miRNAs have been investigated in physiological and pathological conditions, revealing their involvement in fine tuning of the biological events, such as cell proliferation, differentiation and cell death. In 2008, miR-146a and miR-155 were reported to be involved in the pathology of rheumatoid arthritis. Subsequently, expression and function of other miRNAs in rheumatoid arthritis have been reported. These reports suggest that miRNAs could be novel candidates for the therapeutic target or biomarker of rheumatoid arthritis. Further investigations are required to identify, characterize and modulate the key miRNA in the pathology of rheumatoid arthritis.
23090375 Imaging diagnosis of early rheumatoid arthritis. 2012 Oct Early diagnosis of rheumatoid arthritis is essential for its proper management. Currently, the initial phase of rheumatoid arthritis is known to provide a window of therapeutic opportunity. Although the diagnosis is primarily clinical, the development and improvement of laboratory and imaging methods have contributed to earlier diagnosis and determination of procedures in early rheumatoid arthritis. In this article, the authors review the role of the major imaging methods used for assessing early rheumatoid arthritis, especially conventional radiography, ultrasonography, and magnetic resonance imaging.
21271482 [Rheumatoid arthritis: milestones in classification and treatment]. 2011 Feb New classification criteria of rheumatoid arthritis (RA) by the American College of Rheumatology and the European League Against Rheumatism (EULAR) allow the early assignment of arthritides as RA and thus early start of therapy. This is an important step towards early diagnosis and treatment. The EULAR recommendations for the treatment of RA for the first time define the value of biologicals by means of therapeutic algorithms based on extensive scientific evidence and taking into account cost-effectiveness. As a result biologicals can be used after the first failure of disease-modifying anti-rheumatic drugs (DMARDs), if there are unfavourable prognostic factors. Methotrexate is, as a DMARD, at the centre of treatment.
22067836 Rheumatoid arthritis: treating to target with disease-modifying drugs. 2011 Oct 28 Treating to target is an established concept in a number of long-term conditions, which aims to improve outcomes and prevent disease progression. Treatment targets in rheumatoid arthritis (RA) are to control the signs and symptoms of significant inflammatory disease activity, with the ultimate goal of remission from disease. Assessment of patients' disease activity includes clinical examination of the number of swollen and tender joints, combined with measurement of inflammatory markers and visual analogue scales of patients' overall wellbeing and symptoms. Early initiation and rapid dose escalation of disease-modifying anti-rheumatic drugs (DMARDs) has been shown to be crucial to optimizing disease control, protecting joints from destruction and preserving health-related quality of life. Corticosteroids can be prescribed for oral use but are often given by intra-muscular or joint injection in times of flare to minimize the risks of side effects. The rational use of non-steroidal anti-inflammatory drugs and analgesia remains important to symptom management throughout the patient journey. In part two of this three-part series, the concept of treating to target in rheumatoid arthritis is outlined, including the role of the nurse in optimizing outcomes and an overview of treatment options using conventional DMARDs. Part three will cover the use of biologic agents, which have increased treatment options for RA, but their use is reserved for patients with severe disease activity who have failed to respond to adequate trials of DMARDs.
22085506 [Early recognition of rheumatoid arthritis]. 2011 Target to treat within the first 12 weeks. The rheumatoid arthritis (RA) disease process may be modulated best in the very early phase of the disease, therefore the period of the first 12 weeks of the disease is called the "window of opportunity". Patients in whom treatment is started within 12 weeks of onset of symptoms develop less severe joint damage and have a better chance of remission. At present only 31% of Dutch new RA patients are assessed by a rheumatologist within 12 weeks of symptom onset. Arthritis is identified by joint palpation; in order to detect subtle arthritis of minor joints, experience in carrying out this joint examination is required. In order to distinguish patients with early RA from other patients with recent onset arthritis, several prediction models have been developed. Early recognition of arthritis and RA is mandatory for early treatment of RA and improvement of the prospects of RA patients.
22819086 Initial management of rheumatoid arthritis. 2012 May The prognosis for the patient with newly diagnosed rheumatoid arthritis (RA) has dramatically changed over the last two decades. If a patient is diagnosed and treated early by a rheumatologist with the goal of remission or low disease activity, half of patients can expect to achieve remission while taking their disease-modifying antirheumatic drugs. This article discusses the initial therapy in early RA and reviews the studies and trials available in the literature.
22265267 Immune modulation of rheumatoid arthritis. 2011 Dec The approval - several years ago - of the first tumour necrosis factor-α (TNF-α) inhibitor for the management of rheumatoid arthritis launched a new era in the therapeutics of rheumatology. Since then an almost cataclysmic discovery of new treatment targets and corresponding biologic agents ensued. Nowadays, the rheumatologist and the rheumatologic patient have the luxury of several immune modulators available to successfully treat the majority of patients with RA or other inflammatory arthritides and conditions. In this review we focus on a discussion of the approved immune modulators/biologic agents available for the treatment of rheumatoid arthritis. We also present an overview of agents under development. For the immune modulators discussed, we describe their mechanism of action and summarise initial data and recent updates on efficacy and safety.
22567816 [Effect of periodontal treatment on rheumatoid arthritis and vice versa]. 2012 Apr The pathogenesis of periodontitis and of rheumatoid arthritis show remarkable similarities. There is a distinct degree of co-existence between the 2 diseases. The prevalence of periodontitis is more pronounced in rheumatoid arthritis patients and the prevalence of rheumatoid arthritis is more pronounced in periodontitis patients. At present, a positive influence of periodontal treatment on the rheumatoid arthritis disease activity or of rheumatoid arthritis drug treatment on periodontitis is not sufficiently supported by clinical research. Periodontitis may play a role in unsatisfactory therapy response in some rheumatoid arthritis patients.
22284683 [Rheumatoid arthritis and cardiovascular disease: what is known about this relationship an 2012 Mar There is increasing interest in autoimmune diseases, especially their relationship with cardiovascular disease. Rheumatoid arthritis in particular has been considered an independent risk factor for coronary artery disease in recent years. Various studies have aimed to clarify important aspects of risk stratification and treatment options in patients with rheumatoid arthritis, and specific therapies are being studied that promise to reduce their long-term cardiovascular risk. We performed a wide-ranging review of the literature to highlight the importance of atherosclerotic and inflammatory mechanisms in coronary artery disease. We also suggest strategies for risk stratification and treatment of cardiovascular disease in patients with rheumatoid arthritis.
22367980 Fibroblasts as therapeutic targets in rheumatoid arthritis and cancer. 2012 Rheumatoid arthritis is a common chronic inflammatory disease that causes progressive synovial inflammation resulting in irreversible joint destruction, chronic disability and premature mortality. Although it is recognised that in rheumatoid arthritis, inflammation and its persistence result from complex interactions between haematopoietic and stromal cells, research into the pathogenesis of the disease has traditionally concentrated on cells and cytokines of the immune system, neglecting the role of stromal cells. As a consequence, new biologic treatments have been developed, which have led to a step-change in the management of the disease. Nevertheless, these treatments do not reverse tissue damage or lead to disease cure and are not effective for all patients. Furthermore, at best they induce a significant clinical response (ACR70) in less than 60% of patients, most of whom will relapse on treatment withdrawal, suggesting that additional therapeutic targets, responsible for complete resolution of inflammation, remain to be discovered. An increasing body of evidence implicates rheumatoid arthritis synovial fibroblasts in driving the persistent, destructive characteristics of the disease. In this paper, we discuss the evidence implicating synovial fibroblasts in the pathogenesis of rheumatoid arthritis and explore their role as therapeutic targets.
22035390 A quantitative approach to early rheumatoid arthritis. 2011 The prognosis of patients with recent onset arthritis may vary from self-limiting disease to severe destructive rheumatoid arthritis (RA). In order to improve outcomes, a great deal of effort has been put into applying a diagnosis that will allow rapid initiation of treatment. The diagnosis of undifferentiated arthritis (UA) for these patients as well as the new ACR-EULAR 2010 criteria for rheumatoid arthritis (RA) are reviewed in the context of pathogenetic and clinical data available from this group of patients.
22717935 To B or not to B the conductor of rheumatoid arthritis orchestra. 2012 Dec Rheumatoid arthritis (RA) is a chronic, systemic immune-mediated inflammatory disorder that mainly targets the joints. Several lines of evidence have pointed to B cell function as a critical factor in the development of RA. B cells play several roles in the pathogenesis of RA, such as autoantibody production, antigen presentation and T cell activation, cytokine release, and ectopic lymphoid organogenesis. The success of B cell depletion therapy in RA further supports the relevance of these cells in RA progression. In addition, recent studies have also highlighted the B cell role in the first weeks of RA onset. The present article is a review focused in the immunopathogenic B cell-dependent mechanisms associated with RA development and chronicity and the importance of the recent discoveries documented in untreated very early RA patients with less than 6 weeks of disease duration.
22410543 Patient-reported outcomes in rheumatoid arthritis. 2012 May PURPOSE OF REVIEW: In recent years, there has been increasing interest, as indicated by a growing number of citations in the medical literature, on the assessment of outcomes in patients with rheumatoid arthritis (RA) focusing on the patient's perspective. This article describes the domains of patient-reported outcomes (PROs), instruments for measuring responses, as well as the use of PRO in clinical trials with newer agents, including biologic agents. RECENT FINDINGS: At the 10th Outcome Measure in Rheumatology Clinical Trials (OMERACT) conference, several methodological issues about the choice of PRO domains, the development of instruments measuring these domains, and the methods for assessing response criteria were addressed. Composite domains like the RA impact of disease (RAID) score and core outcomes for the RA patient priorities for pharmacologic interventions (RAPP-PI) were introduced. Minimally clinically important differences in various PROs have been used to measure responsiveness to change in clinical trials. Many randomized clinical trials show significant improvements in PRO, such as the health assessment questionnaire disability index, and the medical outcomes study short form with effective treatment. SUMMARY: PRO has become an essential part when assessing patients with RA. This trend will likely continue into the future, in both clinical trials as well as clinical practice.
22527950 Bone loss in rheumatoid arthritis: systemic, periarticular, and focal. 2012 Jun Rheumatoid arthritis is a chronic inflammatory disease that results in generalized bone loss and increased fracture risk. Characteristic radiologic features of rheumatoid arthritis include periarticular osteopenia and marginal erosions. An emerging literature highlights the importance of osteoclasts as mediators of the erosive process, with an impairment of bone formation by inhibition of the Wnt signaling pathway as a cause of lack of repair of erosions. MRI has demonstrated the importance of inflammation in the bone marrow compartment as a cause of periarticular osteopenia. The term osteoimmunology has evolved to highlight the association between cells and cytokines of the immune system and their relationship to bone metabolism in rheumatoid arthritis and other forms of chronic inflammatory arthritis.
22078702 [Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?]. 2011 Nov The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.
21176802 Rheumatoid thumb. 2011 Feb The hand is the main tactile sensory organ and is uniquely designed for fine motor activities. Any deviation from the normal architecture or limitation from a painful condition may lead to disability. Rheumatoid arthritis (RA) is fundamentally an inflammatory disease of the soft tissues. Deformities of the thumb arise from abnormal stretching of ligament and capsular structures as well as from ruptures and subluxations of the tendons. This article provides an overview of the types of deformities associated with, and surgical management of, RA of the thumb.
21346575 Nonpharmacological treatment of rheumatoid arthritis. 2011 May PURPOSE OF REVIEW: To summarize recent literature on nonpharmacological and nonsurgical interventions in patients with rheumatoid arthritis (RA). RECENT FINDINGS: Recent systematic reviews and individual studies substantiate the effectiveness of aerobic and strength exercise programmes in RA. The evidence for the promotion of physical activity according to public health recommendations is scarce, and implementation research found that the reach and maintenance of exercise or physical activity programmes in RA patients are suboptimal. For self-management interventions, characteristics that increase their effectiveness were identified, including the use of cognitive behavioural approaches and approaches derived from the self-regulation theory. A limited number of recent individual trials substantiate the effectiveness of comprehensive occupational therapy, foot orthoses, finger splints and wrist working splints, but not of wrist resting splints. Overall, the evidence for the effectiveness of assistive devices and dietary interventions is scanty. SUMMARY: For exercise and physical activity programmes and self-management interventions in RA, research is increasingly directed towards the optimization of their content, intensity, frequency, duration and mode of delivery and effective implementation strategies. A number of studies substantiate the effectiveness of comprehensive occupational therapy, wrist working splints and finger splints. More research into the effectiveness of assistive devices, foot orthoses and dietary interventions is needed.
21532483 Infection and rheumatoid arthritis: still an open question. 2011 Jul PURPOSE OF REVIEW: This review focuses on recent research that explores the role of infectious organisms in the development of autoimmunity and rheumatoid arthritis (RA). RECENT FINDINGS: Human and animal studies provide further evidence supporting a role for the periodontal pathogen, Porphyromonas gingivalis, in the development of RA. The microbiome plays a key role in the developing immune system. Alterations in the bowel microbiome lead to altered innate and adaptive immune responses potentially relevant to the development or persistence of RA. SUMMARY: Microbes and the host response to microbes are important factors in the maintenance of health. Abnormalities or imbalances in these responses can lead to the development of autoimmune inflammatory conditions such as RA.
22357455 Current understanding of rheumatoid arthritis therapy. 2012 Apr Progress in understanding the cellular and molecular mechanisms of rheumatoid arthritis (RA), together with the availability of new therapies, has changed the way we think about RA. The paradigm shift in RA therapy has been from controlling symptoms to controlling the disease process with the abrogation of inflammation. Challenges that are still unresolved include the issues in disease prevention, treatment specificity to restore tolerance, approaches to facilitate tissue repair, and treatment optimization to fit the individual patient's disease phenotype and comorbidity context. This review summarizes the pathogenesis-related rationales for the current therapeutic strategies in RA and for emerging therapies and potential approaches to restoring immune tolerance in RA.