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ID PMID Title PublicationDate abstract
22300992 Strategies for the management of rheumatoid arthritis. 2012 Feb Rheumatoid arthritis is a chronic, systemic inflammatory autoimmune disease that, untreated, can lead to permanent joint damage, decrease in quality of life, and disability. Health care professionals play a vital role in caring for patients with rheumatoid arthritis. The therapeutic possibilities in the management of rheumatoid arthritis have changed, with newer biologic therapies that target the inflammatory cascade seen in rheumatoid arthritis. As new treatments become increasingly available, it is important for health care professionals to stay informed. This article provides physicians with a review of biologic therapies currently used for the treatment of rheumatoid arthritis and describe how those therapies are used to manage rheumatoid arthritis.
23103816 [Genomic approach to pathophysiology of rheumatoid arthritis]. 2012 Nov Genetic studies identified multiple genes and polymorphisms that increase risk to develop rheumatoid arthritis. Genomic approach is characterized with its integrative style using mathematical and statistical models. Its main targets include (1)combinatorial effect of multiple genetic and environmental factors, (2)heterogeneity of pathological states and its individuality, and (3)their chronological heterogeneity. Genomic approach will clarify pathophysiology of various diseases along with the progresses in molecular biology and other researches on individual molecules.
22791879 Pierre-Auguste Renoir (1841-1919) and rheumatoid arthritis. 2012 May Pierre-Auguste Renoir (1841-1919), one of the world's most celebrated impressionist painters, suffered from rheumatoid arthritis for most of his life. His symptoms developed when he was in his 50s and they became aggressive at about the age of 60 years that led to almost complete disability when he was 70 years old. Although the deformities he suffered because of the rheumatoid arthritis were disabling, Renoir never stopped painting nor decreased the quality of his work. The transition between styles adopted by the painter (Impressionist, Dry and Pearly periods) bear no relationship to the stages of flare-ups or the establishment of joint deformities due to rheumatoid arthritis. His work shows aspects of the body's ability to overcome pain and physical limitation.
21049278 Cutaneous nodules in patients with rheumatoid arthritis: a case report and review of liter 2011 May We report a case of 57-year-old Japanese woman with an overlap syndrome of both rheumatoid arthritis (RA) and autoimmune hepatitis, who developed multiple skin nodules. An extensive biopsies of the nodules revealed rheumatoid neutrophilic dermatitis, showing panniculitis without vasculitis, combining with granulomatous formation histopathologically. Since cutaneous nodules in patients with RA are very complex, differential diagnosis should be done according to disease activities, medications used, and pathological findings. We suggest that the differences in histopathological findings of cutaneous nodules in patients with RA depend on their immunological conditions based on disease activities including therapeutic effects.
22298078 [Replacement arthroplasty for patients with rheumatoid arthritis]. 2012 Feb Replacement arthroplasty is an excellent method to improve activities of daily living (ADL) and quality of life (QOL) in patients with rheumatoid arthritis (RA) . In many cases of RA, prosthetic surgery is carried out on multiple joints. When prosthetic surgery is performed in cases with severe knee contracture or joint destruction, surgical invasion can be extensive. Regarding timing of surgery, it is better while the joint is still somewhat intact, and as long as the operability conditions can be met, age is irrelevant. It is important not to delay the timing of surgery. This article mainly considers total knee arthroplasty (TKA).
22963081 Rheumatoid arthritis and sexuality: a patient survey in France. 2012 Sep 10 BACKGROUND: The objective of this study was to evaluate the impact of rheumatoid arthritis (RA) on patients' sexuality and identify disease and other factors such as fatigue that most influence sexual relationships. METHODS: A specific pretested questionnaire was sent to all members of a French patient association (ANDAR). Questions related to demographics, disease status, quality of life (utility, EQ-5D), pain, psychological status (mood), fatigue and emotional and sexual relationships. To isolate the impact of RA, an attempt was made to include a matched sample from the general population. RESULTS: The analysis included 1271 patients, but only 70 controls agreed to participate and comparisons should therefore be considered with caution. The two groups were similar in terms of age, gender distribution, living conditions and diseases other than RA. However, patients scored worse for global health, mood, fatigue, had a lower utility (0.55 versus 0.65). Controls were more active sexually (69% versus 63%), in particular women (71% versus 60%). Age, gender, living alone, physical function and mood were significant predictors for being sexually active for patients; for controls, age and overall quality of life (utility) were significant predictors. CONCLUSIONS: While it is known that RA has a negative impact on patients' sexuality, there have been few attempts to quantify the problem. Our study highlights the negative impact of RA on patients' sexuality, and triggers the question how to include this aspect into care.
21176805 Tendon reconstruction for the rheumatoid hand. 2011 Feb Tendon involvement in rheumatoid arthritis is frequent and might even be the first sign of the disease. In long-standing untreated conditions, especially in combination with bony erosions, tenosynovitis may lead to tendon fraying and finally tendon rupture. Tendon reconstruction includes tendon grafting and tendon transfer. Direct repair is almost never possible in patients with rheumatoid arthritis, because the inflammatory process produces extensive tendon damage over a long distance. In patients with significant impaired joint function, additional joint treatment should be planned at the same time as tendon reconstruction.
22647779 Rheumatoid arthritis. Evidence for a genetic component to disease severity in RA. 2012 May 31 Rheumatoid arthritis (RA) is partly heritable; genetic and serological markers are known to confer risk of developing pathology. But given clinical heterogeneity in RA, can we predict who will develop severe disease? Substantial heritability of erosive progression rates has now been identified, but better prognostic biomarkers remain wanting.
21792748 Advances in rheumatoid arthritis animal models. 2011 Oct Experimental models of rheumatoid arthritis have contributed immensely to our understanding of the pathogenesis as well as the treatment of this debilitating autoimmune disease. Significant progress has been made in the past few years in defining the role of newer cytokines and regulatory T cells, of inflammation-mediated bone and cartilage damage, and of the cholinergic anti-inflammatory pathway in modulating the disease process in arthritis. Furthermore, new therapeutic targets, including specific tyrosine kinases and proteasome subunits, have been explored. These advances offer renewed optimism for continued improvements in the management of rheumatoid arthritis.
22997714 [Small molecules--principal participants of pathogenesis of rheumatoid arthritis]. 2012 Poorly known pathogenetic mechanisms of rheumatoid arthritis (RA) including apoptosis and aging are considered with special reference to dysregulation of the p53 protein system. The main p53 regulators, p21 and PUMA proteins, as well as p53 antagonist, Mdm22 are described. The intensity of apoptosis varies throughout RA evolution from low to high at the early and late stages of the pathological process respectively. These variations are responsible for the hyperproliferative status of the synovial membrane. New PUMA-induced p53-independent mechanisms of apoptosis are described. Mdm2 may decrease activity of apoptosis of synovial cells. The role of aging in RA pathogenesis is due to impaired activity of p21 associated with increased invasive potential of synovial cells. It is concluded that induction of apoptosis of synovial membrane cells may be a relevant therapeutic strategy for RA which implies the necessity of further studying the role of small molecules, viz. p53, p21 and PUMA, in its pathogenesis.
22885417 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in pat 2012 Aug OBJECTIVE: To elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR) to manage comorbidities in rheumatoid arthritis (RA). METHODS: To review the literature and the opinions of the SBR RA Committee experts. RECOMMENDATIONS: 1) Early diagnosis and proper treatment of comorbidities are recommended; 2) The specific treatment of RA should be adapted to the presence of comorbidities; 3) Angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers are preferred to treat systemic arterial hypertension; 4) In patients diagnosed with rheumatoid arthritis and diabetes mellitus, the continuous use of a high cumulative dose of corticoids should be avoided; 5) Statins should be used to maintain LDL cholesterol levels under 100 mg/dL and the atherosclerotic index lower than 3.5 in patients with RA who have other comorbidities; 6) Metabolic syndrome should be treated; 7) Performing non-invasive tests to investigate subclinical atherosclerosis is recommended; 8) Greater surveillance for the early diagnosis of occult malignancy is recommended; 9) Preventive measures of venous thrombosis are suggested; 10) Bone densitometry is recommended in RA patients over the age of 50 years and in younger patients on corticoid therapy at a dose greater than 7.5 mg for over three months; 11) Patients with RA and osteoporosis should be instructed to avoid falls, to increase their dietary calcium intake and sun exposure, and to exercise; 12) Calcium and vitamin D supplementation is suggested. Bisphosphonates are suggested for patients with T score < -2.5 on bone densitometry; 13) A multidisciplinary team, with the active participation of a rheumatologist, is recommended to treat comorbidities.
21881200 [Bone and calcium metabolism in patients with rheumatoid arthritis]. 2011 Sep Rheumatoid arthritis (RA) is an autoimmune disease that is more common in women than in men. The peak incidence in females coincides with menopause when the production of estrogen drops markedly. Disease activity in patients with RA decreases during pregnancy and increases postpartum. RA is characterized by skeletal manifestations where production of pro-inflammatory mediators, connected to the inflammation in the joint, leads to bone loss. Animal studies have revealed beneficial effects of estrogen and raloxifene on arthritis and a positive effect of hormone replacement therapy has been reported in women with postmenopausal RA. This review will focus on the influence of estrogen in the pathogenesis and progression of RA.
22037115 Early treatment in early undifferentiated arthritis. 2012 Jun The early diagnosis of new-onset rheumatoid arthritis (RA) has become a major objective for rheumatologists in order to identify a management strategy able to change the natural history of the disease and to prevent joint damage and functional impairment. Emergent evidence emphasizes the benefits of early aggressive therapy of RA. By the nineties, early arthritis cohorts have been collected throughout the world with the aim to increase the early referral of patients with early onset disease by the general practitioners and to collect data on the development of full-blown RA. The frequency of undifferentiated arthritis (UA) ranged from 23% to 81% in these early cohorts with most of them reporting a rate of 30%. The transition rate from UA to RA was between 13% and 54%. A percentage of 20-60% of patients with UA had a self-limiting disease. Our article deals with the controversy existing in the management of UA. Should every patient with UA be treated? Could patients with a favorable disease course be exposed to unnecessary risk with initiation of aggressive therapy with synthetic disease-modifying anti-rheumatic drugs (DMARDs) or biologic agents? The pros and cons of treating patients with UA are examined.
22032595 Reconstruction of the rheumatoid hand. 2011 Oct Previous studies have shown large variation in the rate of common surgical procedures performed for the rheumatoid hand. This article provides a comprehensive overview of each surgical treatment option for rheumatoid hand reconstruction.
22935200 Comparative study of elderly-onset rheumatoid arthritis and young-onset rheumatoid arthrit 2013 Jan OBJECTIVES: Elderly-onset rheumatoid arthritis (EORA) is considered to have different features in relation to young-onset rheumatoid arthritis (YORA). However, results from different evaluated populations worldwide have been inconsistent and in Colombia there are no known descriptions of the differences between these pathologies. The aim of this paper is to compare the clinical, laboratory and immunogenetic features in a Colombian population suffering with EORA and YORA. METHODS: EORA (≥65, n=104) and YORA (<65, n=96) patients were compared regarding clinical, laboratory and HLA-DRB1 alleles features. A control group without rheumatoid arthritis over 65 (n=179) was used to compare the HLA-DRB1 alleles. All patients met the ACR/1987 criteria for rheumatoid arthritis and the clinimetric index was calculated. RESULTS: The gender ratio (female/male) was 1.8:1 in EORA. In both groups, the main onset pattern of disease was an insidious polyarticular onset (p=0.35). EORA was characterised by more distal-proximal joint involvement in comparison to YORA (p=0.0007). In EORA, the rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies frequency was close to 50%, lower than in YORA (63%). In both groups, the DAS28 and HAQ-DI score was higher than 6 and 1, respectively. The HLA-DRB1*0403 and *1402 frequency was significantly higher in EORA than in YORA. Also, the shared epitope (p=0.0392), HLA-DRB1*01 (p=0.0068) and *0101 (p=0.0151) were associated with an anti-CCP positivity and the HLA-DRB1*0403 is protective for the anti-CCP presence in EORA (p=0.0201). CONCLUSIONS: EORA is characterised by a different clinical presentation and HLA-DRB1 alleles with respect to YORA. HLA-DRB1*0403 and *1402 are significantly more frequent in EORA compared to YORA.
23227602 [Classification criteria for rheumatoid arthritis]. 2012 Oct The 1987 ACR criteria were developed to separate rheumatoid arthritis (RA) patients with non-RA rheumatic disease control subjects. They are not adapted to diagnosis of early RA. The current challenge is to identify, among patients with early arthritis, which patient will develop persistent or erosive disease, to propose them a disease modifying antirheumatic drug. Therefore, the gold standard for the 2010 ACR/EULAR classification criteria for RA was treatment with methotrexate during the first year after enrolment. Classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints, serologic abnormality, elevated acute-phase response, and symptom duration.
23259630 Kinase inhibitors for the treatment of rheumatoid arthritis. 2012 Kinase inhibitors have now been shown to work in various types of patients and have potential to be additional weapons in our armamentarium in rheumatoid arthritis treatment. This review will go over the currently available data and discuss potential uses for these new agents.
23240033 A systems approach to rheumatoid arthritis. 2012 Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily attacks synovial joints. Despite the advances in diagnosis and treatment of RA, novel molecular targets are still needed to improve the accuracy of diagnosis and the therapeutic outcomes. Here, we present a systems approach that can effectively 1) identify core RA-associated genes (RAGs), 2) reconstruct RA-perturbed networks, and 3) select potential targets for diagnosis and treatments of RA. By integrating multiple gene expression datasets previously reported, we first identified 983 core RAGs that show RA dominant differential expression, compared to osteoarthritis (OA), in the multiple datasets. Using the core RAGs, we then reconstructed RA-perturbed networks that delineate key RA associated cellular processes and transcriptional regulation. The networks revealed that synovial fibroblasts play major roles in defining RA-perturbed processes, anti-TNF-α therapy restored many RA-perturbed processes, and 19 transcription factors (TFs) have major contribution to deregulation of the core RAGs in the RA-perturbed networks. Finally, we selected a list of potential molecular targets that can act as metrics or modulators of the RA-perturbed networks. Therefore, these network models identify a panel of potential targets that will serve as an important resource for the discovery of therapeutic targets and diagnostic markers, as well as providing novel insights into RA pathogenesis.
22262414 Living well with rheumatoid arthritis. 2012 Sep PURPOSE: The overall aim of this study was to understand the occupational lives of people with rheumatoid arthritis. Further aims were to identify the creative agency that occurs while performing these occupations and to understand the socio-cultural aspects of engaging in valued occupations. METHODS: Five participants were recruited and various qualitative methods of data collection were engaged, including open interviews, participant observation and gathering occupational diaries. A combination of thematic and narrative analysis was performed. RESULTS: Findings uncovered six themes, including; changing occupations; environmental factors count; taking control over occupations; being or becoming normal; people and objects are important; hopes and dreams matter. Subthemes uncovered how individuals constantly adapt and alter their occupations; some radically changing lifestyles for the better, while others work towards regaining occupational control. Meaning of occupations became apparent. People were creative agents. Work and leisure occupations featured strongly. Objects and other individuals were significant factors to individuals when engaging in occupations. People strived to be 'normal' in their occupational worlds. CONCLUSION: The implication of these results in relation to professional practice for therapists is that attention should be refocused on the occupational narratives of clients, working with the positive, creative aspects that people are already employing and building on these in areas that might not been seen as traditional, such as work and leisure.
22022685 Perspectives on rheumatoid arthritis for the orthopedic surgeon: overview of early diagnos 2011 Sep Rheumatoid arthritis (RA) is the most common inflammatory arthritis in the United States. As part of ongoing efforts to halt joint damage, preserve function, and reduce associated mortality, the current emphasis in RA management is on prompt diagnosis and the early use of disease modifying antirheumatic drug (DMARD) therapy. Improved serologic tests and updated classification criteria are now available to assist in making an earlier diagnosis of RA. As a therapeutic class, tumor necrosis factor antagonists are widely used by rheumatologists and provide significant benefits to patients who have an incomplete response to methotrexate or other DMARDs. With the reported low concordance between orthopedic surgeons and rheumatologists regarding the potential benefits of surgery to treat RA, there is an opportunity for improved collaboration between these specialties in the care of RA patients. Updates on diagnosis and medical therapy of RA may help orthopedic surgeons appreciate the rheumatologist's approach to this disease.