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ID PMID Title PublicationDate abstract
22752256 [Rheumatoid arthritis: diagnostics and therapy 2012]. 2012 Jul Rheumatoid Arthritis (RA) should be suspected if patients do not only complain of joint pain, but suffer from joint swelling, sensation of heat, hyperemia and warmth around the joints. An arthritic joint pain should be most prominent at night time or early in the morning and cause morning stiffness (> 30 min) of the joint, exercise will improve the symptoms. Diagnosis of RA will be even more likely if wrists, MCP- or PIP joints are affected. Serologic procedures will test for rheumatoid factor or anti-citrullinated antibodies (CCP Ab). One needs to keep in mind that positive results for rheumatoid factor or CCP Ab alone never proves the diagnosis of RA. After diagnosis therapy should be started immediately, recruiting physiotherapy, pain medication, corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs), primarily methotrexate. At the latest after failure of two DMARDs biologics like TNF-α-blockers, an Interleukin-6-Receptor-antibody, a B-cell-specific antibody or a rather T-cell-specific biologic will be initiated. Aim of therapy is freedom of symptoms of an ongoing arthritis, low dosage of immunosuppressants (especially corticosteroids maximally 5 mg/day), stop of radiological progression and prevention of long term consequences of inflammation like myocardial infarction, stroke or lymphoma.
23259626 Predictors of response to TNF inhibitors in rheumatoid arthritis - do we have new tools fo 2012 The use of biological agents in the treatment of rheumatoid arthritis (RA) has grown constantly since the approval of the first therapeutic monoclonal antibody against tumor necrosis factor-alpha (TNF) in 1996. While these agents transformed RA treatment, not all patients respond to these agents. Moreover, the cost of these agents is high, and some patients may suffer from adverse events. Thus, the prediction of individual response to biological treatment has become a major clinical challenge in RA. Recent studies have provided evidence that biomarkers may be identified predictive of the response to therapy with these agents. This article will review some of the recent advances in the biomarkers and therapeutic drug monitoring as predictors of response to TNF inhibitor therapies in patients with RA.
21752870 Cardiovascular risk and rheumatoid arthritis--the next step: differentiating true soluble 2011 Nov In the past decade, there has been a surge of interest in the examination of cardiovascular (CV) outcomes in RA, where it is widely accepted that there is an enhanced risk of CV disease (CVD). In recent years, a number of novel soluble biomarkers of CV risk have been examined in the general population to investigate whether any value is added to the routine measurement of traditional (Framingham) CV risk factors. We briefly review these novel markers and identify those markers that appear distinct to systemic inflammation, which may then be applicable to evaluation in patients with RA. We then investigate whether any of the soluble CV biomarkers provide additional information on the risk of developing subclinical CVD or cardiac events in an individual patient with RA, or whether they may only provide a surrogate measure of the systemic inflammatory load experienced by such patients.
22897128 The relationship between cognitive and physical function in older adults with rheumatoid a 2012 Sep Intact cognitive function is a crucial underpinning for the performance of daily activities in people with chronic diseases, including rheumatoid arthritis (RA). Older adults with RA may have the increased burden of physical function difficulties due to the impact of both age-related cognitive decline and RA-related impairment. Population-based studies reviewed in this article found significant cross-sectional and longitudinal relationships between cognitive function and physical function in older adults with and without comorbid health conditions. Although no study specifically examined this relationship in older adults with RA, interventions designed to enhance functional capacity by minimizing cognitive impairment may benefit older adults with RA. More studies are needed that investigate the relationship between cognitive and physical function in older adults with RA to eventually improve functional status and quality of life.
22350577 Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review 2012 Nov A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.
22272912 Potential effect of anti-inflammatory treatment on reducing the cardiovascular risk in rhe 2012 Sep Rheumatoid arthritis (RA) is a chronic inflammatory polyarthritis with increased mortality largely attributable to cardiovascular disease. There is extensive evidence that patients with RA experience accelerated atherosclerosis, which is considered as the main responsible of this increased cardiovascular burden. Nowadays atherosclerosis is regarded as an inflammatory condition: hence, the cumulative inflammation of RA, with the abundant synthesis of proinflammatory cytokines, contributes directly to the early formation of the atheromatic plaque. It is therefore reasonable to postulate that, by alleviating inflammation, drugs commonly used in RA treatment may ameliorate the cardiovascular profile of these patients. Here we provide an extensive review of the literature, focusing on the effects of the available anti-rheumatic agents on cardiovascular mortality, and morbidity among RA sufferers.
22891452 [Identification of new diagnostic and therapeutic markers in rheumatoid arthritis]. 2011 Our work aims at the identification of new diagnostic and prognostic markers in rheumatoid arthritis (RA), using synovial biopsies in patients. We first demonstrated that the molecular signatures identified in these biopsies enable us to differentiate patients with early RA from patients suffering from other inflammatory conditions. Next, we performed transcriptomic studies in synovial biopsies harvested from patients with severe RA before and twelve weeks after initiation of TNF blocking or rituximab (depleting anti-CD20 antibody) therapy. These studies enabled us to identify specific molecular signatures targeted by these therapies in the synovium, and novel markers of response to therapy. Our results open interesting perspectives in terms of potential biomarkers, which could be used in order to improve diagnostic performances and therapeutic decisions based on individual molecular characteristics of the patients.
21537282 Homeostasis 6: nurses as external control agents in rheumatoid arthritis. 2011 Apr 28 All disorders involve a disturbance of cellular and hence chemical function in the body. Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that usually attacks synovial joints and surrounding ligaments, muscles and their tendons and blood vessels. This article applies the concept of health professionals operating as external agents of homeostatic control (Clancy and McVicar, 20011a; 2011b) to RA and to the care of affected patients, using a case scenario to illustrate attempts to minimize homeostatic imbalances. After reading the article, nurses should be able to understand: how the principles of homeostatic theory apply to skeletomuscular function, in particular to synovial joint function; the skeletomuscular homeostatic role in movement; and that homeostatic failure of reduced mobility, as in RA, is a result of nature-nurture interaction; that illness arises from a cellular, hence chemical, homeostatic imbalance(s) (Clancy and McVicar, 2011a; 2011b; 2011c; 2011d; 2011e). RA is considered a cellular (B-lymphocyte) hence chemical (autoantibody) imbalance that causes the homeostatic imbalances (inflammatory pain, reduced mobility, reduced activities of daily living) associated with the condition. Health professionals are able at act as external agents of homeostatic control to only a limited extent when caring for people with RA because, as with any progressive disorder, they will only be managing signs and symptoms to improve patients' quality of life.
22128079 The relationship between joint damage and functional disability in rheumatoid arthritis: a 2012 Jun OBJECTIVE: To summarise the relationship between joint damage and functional disability in rheumatoid arthritis (RA) patients. METHODS: A systematic review of the literature from 1990 to 2008 was conducted using MEDLINE and EMBASE databases. The search strategy focused on RA, joint damage and disability. Only longitudinal studies or randomised clinical trials with 1 year or more of follow-up containing data correlating joint damage and disability were included. The comparisons were categorised in four ways: baseline damage versus disability at end of follow-up (correlation A); damage versus disability measured cross-sectionally at each of several time points (correlation B); changes in damage versus final disability (correlation C) and changes in damage versus changes in disability (correlation D). RESULTS: From a total of 1902 abstracts, 42 studies met the inclusion/exclusion criteria. More than 50% of the studies that measured baseline damage to later disability (A) reported a statistically significant association. Correlation was significant when measured at multiple time points over time (B; 16/19 studies). Statistically significant associations between changes in damage and either disability at end of follow-up or changes in disability were also found (C and D; 11/13 studies). CONCLUSIONS: While many of the studies did not include multivariate analysis with confounder adjustment, the published evidence indicates a link between joint damage and functional disability and that an increase in joint damage is associated with an increase in disability over time. Treatments to limit progressive joint damage may lead to better joint function and improved patient outcome with less disability.
21245074 Quantifying the economic burden of productivity loss in rheumatoid arthritis. 2011 Jun OBJECTIVE: In light of the large number of recent studies and systematic reviews investigating the cost of RA, this article examines the methods used to assess the impact of RA on employment and work productivity, and provides an overview of the issues surrounding work productivity loss in the RA population. METHODS: A review of the published literature was conducted in order to identify relevant articles. These articles were then reviewed and their methodologies compared. The various methods used to calculate economic loss were then explained and discussed. RESULTS: We found that although methods of lost productivity and associated costs varied between studies, all suggest that RA is associated with significant burden of illness. Economic analyses that exclude indirect costs will therefore underestimate the full economic impact of RA. However, the methods used to calculate productivity loss have a significant impact on the results of indirect cost analyses, and should be selected carefully when designing such studies. Several factors relating to the disease, the job and socio-demographics have been found to predict work disability. CONCLUSIONS: Consideration of these factors is vital when measuring the extent of both absenteeism and presenteeism, and will allow for more accurate estimation of the impact of RA on work productivity. This information may also guide interventions aiming to prevent or postpone work disability and job loss.
21680221 Evaluating disease activity in rheumatoid arthritis: which composite index is best? A syst 2012 Mar OBJECTIVES: To evaluate and compare four composite indices for assessing the activity of rheumatoid arthritis (RA). METHODS: We conducted a systematic literature review by searching Medline via PubMed and Embase and Cochrane databases for articles published up to March 2009. We selected studies that directly compared at least two of the four composite indices. The DAS (Disease Activity Score), DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) were evaluated in terms of reproducibility, construct validity, discriminative performance, and sensitivity to change. RESULTS: We included 61 articles. The only study that directly compared the intraobserver reproducibility of the DAS28, SDAI, and CDAI found comparable intraclass correlation coefficients ranging from 0.85 to 0.89. Concordance among indices was good (kappa values of ∼0.7), except between the DAS28 and the other indices in definition of remission (kappa 0.48-0.63). The indices had good construct validity by their similar fair-to-good correlations with the Health Assessment Questionnaire (HAQ) score and structural damage. Discriminative performance was comparable and satisfactory for treatment changes or remission according to the American College of Rheumatology (ACR). Two studies evaluated the sensitivity to change of the SDAI and CDAI; both indices detected a difference between responders and non-responders according to ACR definitions. CONCLUSION: The DAS, DAS28, SDAI, and CDAI are valid tools for evaluating the activity of RA. The DAS28 is less conservative in defining remission than are the other three indices. Longitudinal studies of individual patients are needed to confirm these results.
22510168 Genetic polymorphism of glutathione S-transferase T1 and the risk of rheumatoid arthritis: 2012 Sep OBJECTIVES: Reports investigating the association between the genetic polymorphism of glutathione S-transferase T1 (GSTT1) and the risk of rheumatoid arthritis (RA) have revealed conflicting results. To clarify the effect of GSTT1 polymorphism on the risk of developing RA, we carried out a meta-analysis using published data. METHODS: Electronic searches were conducted to select studies. Reports were included if they were observational studies investigating the link between GSTT1 genotype and the risk of RA. The principal outcome measure was the odds ratio (OR) with 95% confidence interval (CI) for the risk of RA with GSTT1 null genotype. RESULTS: We identified 7 eligible studies including 2652 cases and 4117 controls. The combined results showed that there was not a statistically significant link between GSTT1 null genotype and RA. However, we observed an increased risk in heavy smokers (cigarette consumption >10 pack-years) with GSTT1 null polymorphism compared with never or light smokers (cigarette consumption ≤10 pack-years) with GSTT1 present. Moreover, compared to GSTT1 positive polymorphism with seronegative results, there was an increased risk in GSTT1 null polymorphism with seropositive results. CONCLUSIONS: The results from this meta-analysis suggested that GSTT1 null genotype is not association with an increased susceptibility to RA. However, GSTT1 null polymorphism may increase the risk of RA in relation to heavy smokers or seropositive results. Whether GSTT1 polymorphism may act in synergy with other genes or environmental factors remains to be studied more in depth.
23227604 [Pathophysiology of rheumatoid arthritis]. 2012 Oct These last years were especially marked by the best understanding of the physiopathological mechanisms at the onset of rheumatoid arthritis (RA) and in the processes of joint inflammation and joint destruction. RA is more and more considered as a syndrome with at least two clinical entities with different phenotype and profiles: seronegative RA and seropositive RA. In RA with ACPA, it is the process of immunization, that is the immunological reaction against citrullinated peptides, that leads to the disease. The peptide citrullination is directly favored by environmental factors such as tobacco, infection to Porphyromonas gingivalis and alcohol. The immunization supposes a genetic predisposition including approximately 22 genetic factors including the molecules of the major histocompatibility complex (MHC) and PTPN22. Finally, joint damage result at the same time from an excess of destruction (RANK/RANKL, TNFalpha) and from a defect of bone reparation by the way Wnt/Frizzled. It is thanks to the best understanding of RA physiopathology that leads to development of targeted treatments and specially processing for this disease.
20730549 An overview of commonly used radiographic scoring methods in rheumatoid arthritis clinical 2011 Jan Despite the advent of magnetic resonance imaging and musculoskeletal ultrasound, the plain radiographs of the hands and feet remain an important tool for a practising rheumatologist both in clinical and research settings. This review focuses on providing a historical overview of commonly used methods of scoring radiographs in rheumatoid arthritis and discusses technical issues related to radiographic scoring, limitations and advantages of radiographs, and current recommendations regarding reporting radiographic data in clinical trials.
22164360 Rheumatoid arthritis: diagnosis and multidisciplinary management. 2011 Oct 13 Rheumatoid arthritis is a long-term condition involving inflammation of the synovial joints, systemic features and the potential for organ involvement (Scott et al, 2010). Diagnosis is made based on clinical features and investigations, according to established classification criteria ( Arnett et al, 1988; Aletaha et al, 2010). Early diagnosis is important to initiate disease-modifying treatment and optimize outcomes. The role of the specialist nurse includes assessing and treating disease activity, providing patient education to support self-care, facilitating access to multidisciplinary team, and assessing and addressing associated psychosocial issues.
21327427 Metastatic lymph node 51 and fibroblast-like synoviocyte hyperproliferation in rheumatoid 2011 Jul One of the varied characteristic features of the pathogenesis of rheumatoid arthritis (RA) is synovial hyperplasia. Fibroblast-like synoviocytes (FLSs) play a key role in the development of sustained inflammation in arthritic joints. We have reported previously that metastatic lymph node 51 (MLN51) is involved in the proliferation of FLSs in the pathogenesis of RA. Interestingly, the overexpression of MLN51 was observed only in RA FLSs, but not in osteoarthritis FLSs, possibly expecting that MLN51 may be a RA-specific marker. Additionally, we found that granulocyte-macrophage colony-stimulating factor signaling activates mitogen-activated protein kinase, followed by the upregulation of MLN51 and FLICE-inhibitory protein, resulting in FLS hyperplasia in RA. Based on these studies, we could be firm that MLN51 is a key factor in FLS hyperplasia of RA patients.
23236191 The temporal relationship between depression and rheumatoid arthritis disease activity, tr 2013 Oct OBJECTIVE: To determine whether depression has a temporal association with RA disease activity, treatment persistence and response to therapy. METHODS: We performed a systematic review encompassing an electronic database search of all published literature since the availability of biologic response modifiers (beginning in 1998) investigating the impact of depression on downstream RA disease progression and treatment. RESULTS: Only seven articles that evaluated temporal relationships between depression and RA outcomes comprising disease activity, treatment persistence and response to therapy, were included in the review. Results from these studies suggest that depression may exacerbate pain and disease activity and decrease the efficacy of pharmacological (i.e. biologic and non-biologic DMARDs) and some non-pharmacological (e.g. cognitive behavioural therapy) RA treatments. CONCLUSION: Given the available evidence, depression probably has a temporal influence on RA disease progression and treatment. However, it is unclear whether these observed effects are due to a response tendency on patient-reported outcomes created from negative cognitive perceptions, immunologically mediated processes that increase inflammation or behavioural changes that lead to decreased physical activity and a greater sensitivity to pain.
22267329 Effect of TNF inhibitors on lipid profile in rheumatoid arthritis: a systematic review wit 2012 Jun BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Lipid changes related to inflammation have been described in RA. Tumour necrosis factor α (TNFα) inhibitor (TNFi) treatment is effective in controlling inflammation and decreasing the number of cardiovascular events. OBJECTIVE: To assess the change in lipid levels with TNFi treatment in patients with RA by systematic review and meta-analysis. METHODS: A Medline search was performed for articles published up to March 2011. Reports describing values for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), atherogenic index (AI) and apolipoprotein B/A (apoB/A) collected before and after TNFi initiation were included. Data were analysed according to short-, mid- and long-term treatment. Statistical analysis of pre-post data was performed by comprehensive meta-analysis. A random effects model was used when there was evidence of heterogeneity. RESULTS: The search retrieved 32 articles, of which 13 prospective before/after studies were analysed. Long-term TNFi treatment was associated with increased levels of HDL (+0.27 mmol/l, p<0.0001) and TC (+0.27 mmol/l, p=0.03), whereas LDL levels and AI remained unchanged. After long-term treatment, TG levels increased (+0.28 mmol/l, p<0.001) and apoB/A decreased (-0.3, p<0.0001). CONCLUSION: The presumed cardioprotective effects of TNFi in RA do not seem to be explained by quantitative lipid changes since long-term treatment has no effect on LDL levels or on AI. Increased HDL levels could have some beneficial effects, but this needs to be confirmed by prospective studies with long-term follow-up.
22376983 [Rheumatoid arthritis and meningeal nodules]. 2012 Apr INTRODUCTION: Rheumatoid nodules are possible extra-articular manifestations of rheumatoid arthritis. These lesions are mainly located in subcutaneous tissues but may also rarely affect deep organs, exceptionally the meninges. CASE REPORT: We report herein a case of meningeal nodules observed in a 52-year-old man with rheumatoid arthritis who underwent brain MRI to explore an acute visual impairment. Subsequent MRIs showed similar new lesions contrasting with total regression of the initially observed lesions. The final control brain MRI performed four years after the onset of the ocular symptoms disclosed total involution of all the extra-axial nodular lesions, a course highly suggestive of meningeal rheumatoid nodules. CONCLUSION: During the follow-up period of this case, the patient was treated with methotrexate at doses too low to cross the blood brain barrier. Consequently, it is most likely that the meningeal lesions developed during the natural course of the disease. Despite the non-specific features of the first imaging findings, the radiological changes observed over time were consistent with the final diagnosis of rheumatoid nodules.
22101696 The potential role of Chinese medicine in ameliorating extra-articular manifestations of r 2011 Oct Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease chiefly affecting synovial membranes of multiple joints. The clinical manifestations are highly variable. Besides joint affection, extra-articular manifestations always occur in RA patients, such as lung, blood vessel, heart, endocrine glands, hematological system, and nervous system affections. In addition to Western medicine therapy, Chinese medicine also plays a significant role in the treatment of RA with good efficacy and less adverse reactions. This paper summarizes the effects of xinfeng capsule, a Chinese medicine, and the mechanisms of its action in ameliorating the extra-articular manifestations based on a series of clinical and experimental researches.