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ID PMID Title PublicationDate abstract
23083035 Performance of the 2010 Rheumatoid Arthritis Classification Criteria. 2012 Oct OBJECTIVES: Rheumatoid arthritis (RA) needs early treatment to improve clinical outcome by reducing joint damage, radiographic progression and disability. The aim of this study was to evaluate the 2010 Rheumatoid Arthritis Classification Criteria for its ability to classify RA patients, in their early stages, not exceeding 12 months of disease progression. METHODS: Rheumatoid arthritis (RA) patients were selected from August to December 2010, among those coming for their follow-up. The inclusion criteria were patients with not more than 12 months of disease progression at their first evaluation. Patients were selected from four rheumatology subspecialty clinics. RESULTS: Nine hundred and ninety-seven patients with a confirmed diagnosis of RA entered the study. The female-to-male ratio was 4.3/1.0. Mean age was 46.4 years. Mean disease progression at first visit was 6.3 months. The mean follow-up of their disease was 5.9 years. The 1987 American College of Rheumatology (ACR) criteria were fulfilled for 74% of patients. The ACR/EULAR (European League Against Rheumatism) criteria were fulfilled for 69% of patients. Ten percent had involvement of 2-10 large joints, 29% 1-3 small joints, 25% 4-10 small joints and 32% more than 10 joints. Low rheumatoid factor (RF)/anticytoplasmic antibodies (ACPA) were discovered in 30%, high RF/ACPA in 37%; high erythrocyte sedimentation rate/C-reactive protein in 77%, and duration of 6 weeks or more in 92% of patients. There was no significant difference between men and women. CONCLUSIONS: The 2010 ACR/EULAR criteria have good performance: sensitivity of 69% in early disease (first year), with the same sensitivity in both genders.
21176794 Historical perspective on the etiology of rheumatoid arthritis. 2011 Feb Contributions of historical analyses to the development of a cogent etiologic theory of rheumatoid arthritis (RA) have been limited to date. In this article, the authors analyze this literature with respect to the types and conclusions of the research that has been conducted, present the major points of evidence and conclusions that have been drawn, and trace the evolution of 3 historical theories of RA. The authors combine a comprehensive overview of paintings and paleopathological investigations with consideration of contemporary immunologic and genetic studies.
21875421 Radiographic estimation in seropositive and seronegative rheumatoid arthritis. 2011 Aug Long since it have been suggested that a subpopulation of patients with rheumatoid arthritis, diagnosed with negative rheumatoid factor tests, represents a clinical entity quite distinct from that of seropositive rheumatoid arthritis (RA). Our aim was to establish a scientific comparative analysis between seronegative and seropositive rheumatoid arthritis, regarding some radiological and clinical parameters, applied for the first time on patients from Kosovo. Two hundred fifty patients with rheumatoid arthritis according to the American College of Rheumatology criteria were retrospectively studied by analysis the radiographic damage and clinical parameters of the disease, using a data base. All examinees were between 25-60 years of age (Xb=49.96, SD=10.37) with disease duration between 1-27 years (Xb = 6.41, SD=6.47). All patients underwent a standardised evaluation radiographs. Baseline standardised poster anterior radiographs of hands and feet and radiographs of other joints, depending on indications, were assessed. Erythrocyte sedimentation rate values correlated with the radiological damages and statistical difference was found for seronegative subset (r=0.24, p<0.01). Longer duration of the disease resulted in the increase of radiological changes in both subsets (r=0.66, p<0.01) seronegative, (r=0.49, p<0.01) seropositive. Anatomic changes of IInd and IIIrd level were nearly equally distributed in both subsets, 76 (60.8%) seronegative, 75 (60%) seropositive. Radiological damages are nearly equal in both subsets, elevate in relation to the duration of the disease and correlate with ESR values. Regarding the sero-status, differences within sex, with some exceptions, are not relevant. Although there are some definite quantitative and qualitative differences regarding sero-status, obviously there is a great deal of overlap between the two groups.
21094920 Stress and autoimmunity. 2011 Feb Stress reduction interventions can have a positive therapeutic effect in autoimmune disease patients. Physicians and patients must recognize the potential for stress to impact autoimmune diseases and how stress management should be considered in a multidimensional treatment approach. This article evaluates the effects of stress as a trigger and a modulator, and stress reduction as a treatment option in rheumatoid arthritis.
22712188 Cervical spondylosis, stenosis, and rheumatoid arthritis. 2012 Apr The majority of patients with rheumatoid arthritis involving the cervical spine can be managed non-operatively. These patients should be monitored closely by the treating physician for the development of neurologic symptoms or subluxation on radiographs. Non-surgical treatment in the majority of patients has a definite role. Several studies now suggest early surgical intervention in patients with progressive instability and neurologic deficit is indicated to prevent significant morbidity and mortality in these patients.
21387224 Anti-CCP antibodies, rheumatoid factors and anti-keratin antibodies: clinical value in est 2011 Mar BACKGROUND: It is well documented that in early rheumatoid arthritis, anti-CCP antibodies have better diagnostic value than rheumatoid factors and anti-keratin antibodies. However, their role is less well defined in patients with established or long duration disease. AIM: To evaluate and to compare diagnostic performances of anti- CCP, anti-keratin, IgM and IgA rheumatoid factors in established rheumatoid arthritis. METHODS: In a cross-sectional study, 90 patients with established rheumatoid arthritis and 100 controls were tested for these autoantibodies. The association of these markers with disease activity and severity was investigated. The sensitivity and specificity were calculated for each of four tests, using the clinical diagnosis as the gold standard. RESULTS: The anti-CCP and IgM rheumatoid factor exhibited the best diagnostic value. None of the tested antibodies had any significant association with the disease activity score (DAS28). After adjustment by multiple linear regression, only anti-CCP positivity was found to be significantly associated with erosive disease. CONCLUSION: In long duration rheumatoid arthritis, anti-CCP and IgM rheumatoid factor have similar diagnostic value. However anti- CCP are useful in seronegative patients. They are also a reliable marker of severe erosive disease.
22451023 IRAK1 rs3027898 C/A polymorphism is associated with risk of rheumatoid arthritis. 2013 Feb IRAK1 and miR-499 play an important role in the etiology of rheumatoid arthritis. Few studies to date have focused on the influence of the IRAK1 rs3027898 C/A and hsa-mir-499 rs3746444 T/C polymorphisms in the susceptibility of the Chinese population to rheumatoid arthritis. We hypothesized that these polymorphisms may contribute to rheumatoid arthritis susceptibility. We studied IRAK1 rs3027898 C/A and hsa-mir-499 rs3746444 T/C gene polymorphisms in 214 rheumatoid arthritis cases and 478 controls in a Chinese population. Genotyping was performed by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). When the IRAK1 rs3027898 CC homozygote genotype was used as the reference group, the AA genotype was associated with significantly increased risk of rheumatoid arthritis (odds ratio (OR) = 1.91, 95 % confidence interval (CI) = 1.12-3.26, p = 0.017). A significantly increased risk of RA associated with the IRAK1 rs3027898 AA genotype was more evident among females, younger patients, CRP negative patients and both anti-CCP positive and negative patients compared with the IRAK1 rs3027898 CC/CA genotypes. The hsa-mir-499 rs3746444 T/C single nucleotide polymorphism (SNP) was not significantly associated with the risk for rheumatoid arthritis. Our findings suggest that the functional SNP IRAK1 rs3027898 C/A variant allele is associated with the development of rheumatoid arthritis. However, the hsa-mir-499 rs3746444 T/C polymorphism may not be associated with susceptibility to rheumatoid arthritis.
22836384 [Anemia in patients with rheumatoid arthritis]. 2012 Dec One of the most frequent extra-articular organ manifestations in rheumatoid arthritis (RA) is anemia. As anemia in RA patients may result in severe symptoms and aggravation of other disease manifestations (e.g. arteriosclerosis), the influence on the course of RA is profound. However, the importance of anemia in RA patients is frequently underestimated. The etiology of anemia in RA is complex. Anemia of inflammation (AI) and iron deficiency anemia, alone or in combination are the most frequent forms of anemia in RA. Changes in iron metabolism are the leading causes of anemia in RA patients and mainly induced by the altered synthesis and function of hepcidin and ferroportin. Hepcidin, a peptide produced in the liver and immunocompetent cells, impairs the expression of ferroportin on iron-secreting cells, thus reducing iron bioavailability. The typical changes of iron metabolism and hepcidin synthesis in RA are induced by proinflammatory cytokines, primarily interleukin-6. Hence, the treatment of RA with cytokine antagonists has significant therapeutic implications on anemia in the context of inflammation and impaired iron metabolism.
23212870 Rheumatology and rheumatoid arthritis in the twenty-first century. 2012 Nov Rheumatoid arthritis (RA) has historically been a disabling and life-threatening disease. Features include joint pain, stiffness and swelling, joint damage, fatigue, loss of function, and loss of employment. Recent advances in treatment, particularly the use of conventional disease-modifying therapies earlier and in combination, and the advent of biological therapies, ensures that modern rheumatologists expect to help patient attain remission, with advantages of early presentation and effective therapies used in a "treatment to target" strategy. Adherence to UK National Institute for Health and Clinical Excellence guidance for RA, including early identification of disease, early and aggressive use of disease-modifying antirheumatic therapies, in combination or with biological agents, allows for much better disease control and perhaps remission. Delays to diagnosis will therefore become increasingly important, and the necessity for accurate diagnosis becomes crucial. The strategy of tight disease control may be more important than the contribution of individual drugs, even biological agents. Future prospects include the use of better outcome measures to define remission, better prediction of outcome, and thus better targeting of therapies. There is an urgent need for better individualized prognostic predictors. We must not forget the management of patients with pain owing to damage from advanced disease. Rheumatologists and radiologists must work together to appreciate the opportunities for patients from a greater understanding of disease measurement.
23654143 [The usefulness of the latest diagnostic and therapeutic criteria ACR/EULAR in the treatme 2012 In Poland nearly 400 thousand people are treated for rheumatoid arthritis and each year there are about 8 to 16 thousand new patients with this disease. Rheumatoid diseases constitute and enormous health problem which statistically encounters every the third person of the population. The condition for effective treatment of rheumatoid arthritis is early diagnosis and aggressive treatment of disease. So it became necessary to develop in 2010, the new ACR/ EULAR, much simpler than the ACR criteria of 1987, intended to enable the rapid implementation of appropriate intensive treatment, both conventional disease modifying drugs and biologicals.
21780653 [Current knowledge about pathogenesis and treatment of arterial hypertension in rheumatoid 2011 Rheumatoid arthritis (RA) is a chronic autoimmune disease with a proved high risk of cardiovascular diseases (CVD). An increase of this risk is mainly due to accumulation of conventional factors of CVD development (arterial hypertension - AH), dislipidemia, et cet). Causes of high prevalence of AH in RA, the role of chronic inflammation, effects of antirheumatic drugs with potentially hypertensive effects are outlined and recommendations on AH prevention and treatment in RA patients are given.
21176796 Controversy in the surgical treatment of the rheumatoid hand. 2011 Feb The clinical picture of rheumatoid arthritis (RA) is best viewed as a combination of systemic symptoms associated with the inflammatory process and articular symptoms related both to potentially reversible synovitis and structural damage brought on by inflammation. In simple terms, the treatment of inflammation is medical, and structural lesions often require surgical solutions. The prime indications for surgery in patients with RA are essentially determined by the patient and consist of a desire to obtain pain relief and/or functional improvement. Pain is difficult to quantify. Essential concepts regarding surgical intervention are that surgery is elective in all but a few rare situations and always requires local therapy. Any evaluation of surgical intervention must be based on its total effect on the patient. Although there have been immense advances in the surgical options for patients with rheumatoid arthritis over the last several decades, the role of specific procedures in the total picture has many areas of uncertainty and controversy.
23882972 Rheumatoid arthritis and anemia: the impact of different anti-inflammatory therapies on he 2012 Apr Rheumatoid Arthritis (RA) has been associated with anemia. The treatment of anemia in RA includes blood transfusions, erythropoietic agents and iron supplements. Our observations suggest that the treatment of the inflammatory disease is associated with an improvement of hemoglobin (Hgb) levels in RA patients. METHODS: Record review, analyzing anemic RA patients and hemoglobin level changes after intensification of RA therapy. Three initial regimes were identified: corticosteroid (Prednisone), Disease Modifying Anti-rheumatic Drugs (DMARD's) plus Prednisone and for patients with no initial treatment with the initiation of Prednisone and or TNF a inhibitors (Etanercept). RESULTS: 8 female and 2 male patients with average age 59.7 + 14 years were selected. The results for the group treated with Prednisone initially N=4; showed a 0.9 g/dL increase in Hgb and Hct increase of 3% after addition of Etanercept. Those with DMARDs and corticosteroid regime had an Hgb and Hct increase of 1.2 g/dL and 3.5% after addition of Etanercept. The group with no initial treatment was further divided in two groups. The first was treated with Etanercept and the second was treated with Prednisone, resulting in average Hgb increases of 1.9 g/dl Hgb and 1.8 g/dL, and HCT increase 4% and 3.9% respectively. The global average change in Hgb was 1.3g/dL and HCT increase 3.2%. CONCLUSION: The intensity of treatment of RA including Etanercept and Prednisone improved cases of mild anemia in rheumatoid arthritis.
22830204 [Rheumatoid arthritis: problems and significance of personalized medicine]. 2012 The last decade is prominent for significant progress in research in the field of mechanisms underlying development of rheumatoid arthritis (RA) opening new prospects in pathogenetic treatment of this disease. A great success of RA pharmacotherapy during the last 10 year period is design of novel genetically engineered biological medicines. Achievements of molecular biology, pharmacological genetics and biological infornmation science promote an individual approach to treatment of RA patients within a new conception of individual medicine which considers personal aspects of genomic and proteomic sciences. This novel approach to treatment of RA patients can improve RA outcomes and noticeably reduce cost of the treatmnent.
22891014 Leprosy and rheumatoid arthritis: consequence or association? 2012 Aug 13 Leprosy or Hansen's disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae with a high prevalence in some developing countries however, it is rarely seen in non-endemic regions. Arthritis has been described in all types of Hansen's disease. Chronic arthritis is known to exist even in paucibacillary forms, resolved or treated disease and in patients without reaction, suggesting a perpetuated inflammatory process. In these cases leprosy can mimic some autoimmune diseases such as rheumatoid arthritis. When a patient with a history of leprosy presents with a symmetric, distal, polyarthritis the diagnosis may not be linear. Possibly it is a rheumatoid-like leprous arthritis with M leprae acting as the trigger element for the chronic process or it is an overlap condition, with a concomitant rheumatoid arthritis? A case report of a patient with a chronic inflammatory arthritis with 10 years of evolution is presented. The differential diagnosis between leprous and rheumatoid arthritis is discussed.
23274756 Suboptimal management of rheumatoid arthritis in the Middle East and Africa: could the EUL 2013 Feb Although the prevalence of RA in the Middle East and Africa is comparable with that in other parts of the world, evidence indicates that its management in this region is suboptimal for a variety of reasons, including misconceptions and misunderstandings about the disease's prevalence and severity in the region, compounded by the lack of local epidemiological and health-economic data around the disease; the perception that RA is a low priority compared with other more prevalent conditions; delayed diagnosis, referral and treatment; and a lack of a region-specific, evidence-based management approach. In the absence of such an approach, the EULAR treatment recommendations may provide a useful starting point for the creation of guidelines to suit local circumstances. However, although agreement with the EULAR recommendations is high, many barriers prevent their implementation in clinical practise, including lack of timely referral to rheumatologists; suboptimal use of synthetic DMARDs; poor access to biologics; lack of awareness of the burden of RA among healthcare professionals, patients and payers; and lack of appropriate staffing levels.To optimise the management of RA in the Middle East and Africa, will require a multi-pronged approach from a diverse group of stakeholders-including local, national and regional societies, such as the African League of Associations in Rheumatology and International League of Associations for Rheumatology, and service providers-to collect data on the epidemiology and burden of the disease; to increase awareness of RA and its burden among healthcare professionals, payers and patients through various educational programmes; to encourage early referral and optimise use of DMARDs by promoting the EULAR treatment recommendations; to encourage the development of locally applicable guidelines based on the EULAR treatment recommendations; and to facilitate access to drugs and the healthcare professionals who can prescribe and monitor them.
21176801 Current concepts and treatment for the rheumatoid wrist. 2011 Feb Wrist involvement in rheumatoid arthritis (RA) is common. Within 2 years of diagnosis, more than half of patients will have wrist pain, and more than 90% will have wrist disease by 10 years. Although wrist involvement is generally thought to be less disabling than RA of the fingers and hand, it can be a significant cause of pain and disability. Severe disease with bony destruction and synovitis in the wrist can also result in soft-tissue problems including tendon ruptures. In addition to musculoskeletal involvement, systemic manifestations of RA can occur. Felty syndrome can result in a low white blood count and splenomegaly in association with RA. New generation, disease-modifying pharmacologic agents offer promise in controlling the disease progression. Surgical treatments for the diseased wrist are aimed at relieving pain and restoring function. Common procedures include: synovectomy and tenosynovectomy, tendon reconstruction, distal ulnar resection and/or distal radioulnar joint reconstruction, partial and full wrist arthrodesis, and total wrist arthroplasty.
21972039 DAS28 and Rheumatoid Arthritis: The Need for Standardization. 2011 Dec Disease Activity Score in 28 Joints (DAS28) scoring in rheumatoid arthritis (RA) is now recommended as a basis for clinical decisions about treatment initiation and alteration. The British Society of Rheumatology suggests that most RA patients should have a DAS28 assessment at every clinic visit, to monitor disease activity and the impact of therapy. Establishing an accurate baseline assessment of DAS28, with regular re-evaluation, is considered crucial, so that progress towards a defined target of remission (or low disease activity) can be measured. The Treat-to-Target initiative, launched in March 2010, is now impacting on clinical practice throughout the UK and Europe. One of its key recommendations is that patients should be regularly monitored using validated composite measures of disease activity that include joint assessments. DAS28 is recommended as one of the most useful of these methods but, although it is becoming more widely adopted and training is ongoing, supported by materials produced by the European League Against Rheumatism (EULAR), the variability inherent in the four components of DAS28 means that standardization of practice methods is now an important issue. This short report details some of the pitfalls that can occur when applying DAS28 in clinical practice and suggests some workable solutions to enable departments to set up their own standard operating procedure.
22239019 Evaluation of anti-CCP antibody for diagnosis of rheumatoid arthritis. 2011 BACKGROUND: Rheumatoid arthritis is a common, world wide, systemic disease that affects mainly joints. Rheumatoid factor is the only marker to diagnose rheumatoid arthritis; however these antibodies are present in other disorders and even in up to 15% of the healthy population. Many auto antibodies have been reported to diagnose rheumatoid arthritis e.g. APF and AKA, etc. but they are not specific and due to tedious laboratory procedure, they have not been generally adopted. Anti-CCP antibodies have been reported for their high sensitivity and specificity. This study was planed to determine the prevalence of anti-CCP antibodies and RA factor in clinically diagnosed patients of rheumatoid arthritis. METHODS: Anti-CCP antibody was determined by ELISA technique and RA-factor was done by latex agglutination method. RESULTS: Forty five patients, 36 female and 9 male, were recruited for this study. Twenty-five (55.6%) patents were positive for anti-CCP antibodies while 20 patients were negative for anti-CCP antibodies and comparison between anti-CCP positive and anti-CCP negative was statistically significant (p = < 0.01). Thirty-one (68%) patients were seropositive (SPRA) for RA while 14 (31%) patients were seronegative (SNRA). Among SPRA patients, 18 were positive for anti-CCP antibody and among 14 SNRA patients, 7 patients had anti-CCP antibody and the difference between these two groups was not statistically significant. CONCLUSIONS: Anti-CCP antibody and RA-factor should be used concomitantly to diagnose RA.
22798565 Rheumatoid factor determines structural progression of rheumatoid arthritis dependent and 2013 Jun BACKGROUND: Rheumatoid factor (RF) is prototypic for rheumatoid arthritis (RA) and serves diagnostic and prognostic purposes. RF is associated with joint destruction, but the role of disease activity as a potential mediator of these effects has not been clearly elucidated yet. OBJECTIVE: To investigate if higher radiographic progression (Sharp score, ΔTSS) in RF+ patients is dependent or independent of disease activity. METHODS: The authors performed a cross-sectional multivariate analysis at baseline and a matched cohort study in patients from five RA clinical trials. The authors pooled methotrexate treatment arms and compared ΔTSS in RF+ and RF- patients before and after matching for other associated variables. RESULTS: Among 686 patients, 124 were RF- and 562 RF+, 343 having high (>160 U/ml) RF. ΔTSS was 1.03±5.83, 3.23±8.10 and 3.58±8.18 (p<0.0001), respectively, and similarly for erosions and joint space narrowing (JSN). After matching for other prognostically important variables, ΔTSS still was lower among 61 RF- versus 61 RF high+ patients (0.52±2.47 vs 3.09±8.28; p=0.028), mainly related to differences in erosion score (0.31±1.88 vs 2.07±5.62; p=0.035), but not JSN (0.21±1.26 vs 1.02±3.31; p=0.162). CONCLUSIONS: The data reveal that damage progression in seropositive RA patients is related to higher levels of disease activity and to independent effects of RF, particularly on bone damage. This calls for consideration of RF status irrespective of disease activity.