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ID PMID Title PublicationDate abstract
21893001 [Methotrexate treatment of rheumatoid arthritis in Denmark]. 2011 Sep 5 In the recommended early, aggressive and continuous treatment strategy of rheumatoid arthritis (RA), methotrexate (MTX) is the anchor drug, and although generally well tolerated approximately 50% of the RA patients discontinue MTX treatment within five years. In a large Danish cohort study among newly diagnosed patients with RA only 21% had started MTX treatment within 90 days after referral to hospital and the median time-to-treatment initiation was 120 days. Furthermore, MTX compliance is considered generally high among Danish RA patients and the patients have strong beliefs about MTX necessity.
21479881 High frequencies and co-existing of myositis-specific autoantibodies in patients with idio 2012 Jul A small proportion of patients with rheumatoid arthritis (RA) develop idiopathic inflammatory myopathies (IIM); however, the clinical and immunological characteristics of these patients have not been elucidated. In the present study, we evaluate the frequency of autoantibodies and the accompanying clinical features in patients with IIM overlapped to RA (IIM-RA) and in patients with IIM without RA. Twelve patients with IIM-RA were selected from 142 patients with IIM who were admitted to our hospital. Clinical and laboratory data, including autoantibody test results, were collected from patient medical records. Myositis-specific antibodies (MSAs) were analyzed by immunoprecipitation. Clinically, patients with IIM-RA were more likely to be male, to have polymyositis, and to be older at the time of IIM onset than patients with IIM without RA. Patients with IIM-RA had been treated for 2-25 years prior to the onset of IIM with more than two disease-modifying antirheumatic drugs (DMARDs). Patients with IIM-RA had a high frequency (75.0%) of positivity for MSAs, including anti-Jo-1, anti-PL-7, anti-PL-12, or anti-signal recognition particle (SRP) antibodies; anti-Jo-1 antibody was detected in 4 patients (33.3%). In addition, 2 out of 12 patients with IIM-RA were concurrently positive for two different MSAs, anti-Jo-1, and anti-PL-7 antibodies. In 3 other patients with IIM-RA, anti-Jo-1 antibody, or anti-PL-7 antibody was detected in serum samples collected 6-18 months prior to development of myositis. High frequency and coexistence of MSAs were detected in patients with IIM-RA. MSAs detected in patients with RA even without symptoms of myositis may indicate possible future development of myositis.
22261011 Range of motion of the metacarpophalangeal joint in rheumatoid patients, with and without 2012 Jun BACKGROUND: The metacarpophalangeal is commonly affected by rheumatoid arthritis. This may lead to joint replacement with a flexible prosthesis. The aims of this study were to determine the effects of rheumatoid arthritis on joint motion and to determine whether joint replacement needs to restore the full range of motion. METHODS: Three-dimensional motion analysis was used to measure the range of motion of the metacarpophalangeal joint in rheumatoid patients with and without a flexible silicone arthroplasty, when performing pinch and key grips, when making a fist and when spreading the fingers. The results were compared with those from younger and older normal subjects. FINDINGS: There appeared to be a trend for a decrease in range of motion from younger normal to older normal to rheumatoid (no prosthesis) to rheumatoid (with prosthesis) subject groups. However, statistically different (p<0.05) results were only observed for some movements (mostly involved in making a fist), in some fingers and between some subject groups. The only exception to this apparent trend was in flexion/extension when spreading the fingers into abduction. INTERPRETATION: Making a fist is the most sensitive simple measure of range of motion in the metacarpophalangeal joint. Successful replacement of the metacarpophalangeal joint in patients with rheumatoid arthritis need not restore the normal range of motion.
22093930 [A 2-year follow-up results of knee arthroscopic synovectomy plus disease modifying antirh 2011 Aug 9 OBJECTIVE: To evaluate the clinical efficacy of knee arthroscopic synovectomy plus disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA) patients. METHODS: A total of 97 RA patients were treated with knee arthroscopic synovectomy plus DMARD after arthroscopy. The control group received only DMARD. The patients were assessed at pre-treatment and 1, 6, 12, 24 month post-treatment. Tender joint count, swollen joint count, morning stiffness, resting pain, patient global assessment, physician global assessment, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and disease activity score (DAS) 28 were observed. RESULTS: Tender joint count, swollen joint count, morning stiffness, resting pain, patient global assessment, physician global assessment and DAS 28 score improved significantly at 1, 6 month post-treatment in the combined treatment group versus the control group. At 2 years post-treatment, there was still significant difference in DAS28 between two groups. CONCLUSION: The combined treatment of knee arthroscopic synovectomy and disease modifying antirheumatic drugs can control the disease activity of RA during an early period. And a long-term efficacy may be maintained.
21125279 Eruptive molluscum contagiosums in a patient with rheumatoid arthritis and lung cancer. 2011 Aug A 67-year-old woman with rheumatoid arthritis (RA) treated with systemic prednisolone and methotrexate over 20 years developed eruptive molluscum contagiosums on the trunk and extremities. Investigation revealed lung cancer 2 years later. Newly development of molluscum contagiosums ceased after the surgical operation of lung cancer. Immunologic dysfunctions have been shown in RA, and especially patients under long-term methotrexate therapy are susceptible to miscellaneous skin conditions. Eruptive molluscum contagiosums are induced in association with hematologic malignancies such as lymphoma, leukemia, and HIV infection; however, it is important to investigate internal malignancies, not only hematologic malignancies but also solid cancers, when patients with RA under immunosuppressive therapies presented eruptive or disseminated molluscum contagiosums.
23745471 [Role of diagnostic ultrasound in assessment of disease activity in rheumatoid arthritis]. 2012 Since biologics have been introduced for the treatment of rheumatoid arthritis a need for reliable imaging modality to assess treatment efficacy have been opened. In the last years through technological advances diagnostic ultrasound has become highly sensitive and specific method for detection of inflammatory and destructive changes in rheumatoid arthritis. Thus, high resolution ultrasound enhanced by power Doppler has been recognized in clinical studies and in every day work as useful method for assessment of disease activity. Here we give special interest in application of diagnostic ultrasound enhanced by power Doppler for assessment of inflammatory activity, therapeutic decision and monitoring to attain remission in rheumatoid arthritis patients.
21626027 Association of CD4 enhancer gene polymorphisms with rheumatoid arthritis in Egyptian femal 2012 Aug CD4 is a candidate gene in autoimmune diseases, including rheumatoid arthritis (RA). Because the CD4 receptor is crucial for appropriate antigen responses of CD4+ T cells, changes in CD4 expression and CD4+ T-cell activity may influence tolerance or tissue destruction in autoimmune diseases and contribute to their risk. We analyzed two polymorphisms of the CD4 in 172 female Egyptian patients with RA and in 112 matched healthy control. Genotyping of CD4-11743 and CD4-10845 was determined by restriction fragment length polymorphism-polymerase chain reaction (PCR-RFLP). Subjects with the CC genotype of CD4-11743 were significantly more likely to develop RA (OR = 2.7, P = 0.03) and more likely to have sever RA (OR = 2.7, P = 0.024). Carrier of A allele of CD4-10845 was significantly more likely to develop sever RA (OR = 3.7, P = 0.000). CD4-11743 genetic polymorphisms are associated with the susceptibility and severity of RA, and CD4-10845 genetic polymorphisms are associated with the severity of RA.
22392813 Disease activity and disability in women and men with early rheumatoid arthritis (RA): an 2012 Aug OBJECTIVE: To compare women and men regarding the course of disease activity and disability over 8 years from diagnosis of recent-onset rheumatoid arthritis (RA). METHODS: A total of 149 patients were followed in the Swedish TIRA study (Early Intervention in RA) for 8 years from RA diagnosis (1996-1998) regarding 28-joint count Disease Activity Score (DAS28), pain (visual analog scale), grip force, Grip Ability Test (GAT), Signals of Functional Impairment (SOFI; hand, upper/lower extremity), walking speed, activity limitation (Health Assessment Questionnaire [HAQ]), and prescribed disease-modifying antirheumatic drugs (DMARDs). RESULTS: Disease activity pattern over time was similar in women and men, showing improvement during the first year and a stable situation during 6 years thereafter. However, at the 7- and 8-year followup times, deterioration was seen with a less favorable course in women. HAQ score did not differ between sexes at diagnosis, but at all followup times women had significantly higher scores than men. Women also had lower grip force and lower walking speed, but higher upper extremity mobility. DMARD prescription was similar for both sexes. Over 8 years, disease duration, sex, biologic agents, grip force, SOFI hand, and pain intensity together explained 43% of the variation in DAS28, whereas grip force, SOFI lower extremity, GAT, and pain intensity could together explain 55% of variations in HAQ score. CONCLUSION: Disease activity was fairly well managed, but disability gradually worsened. Despite similar medication, women had more disability than men. The discrepancy between disease activity and disability indicates unmet needs for multiprofessional interventions to prevent progressing disability, and patients at risk for disability need to be identified early in the process.
20403067 Disease-modifying anti-rheumatic drug usage, prescribing patterns and disease activity in 2011 Jun AIMS: Our aim was to examine the spectrum of disease activity and usage of disease-modifying anti-rheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients seen over a period of 12 months in community-based rheumatology practice. METHODS: Data were prospectively collected on 1059 consecutive RA patients who attended two private, community-based rheumatology clinics from 1 May 2007 to 1 May 2008. Information on patient demographics, medication history and disease activity was collected. Life table graphs were developed to track medication retention over time. Statistical significance was determined by log-rank tests. RESULTS: One thousand and fifty-nine patients with RA were entered into the database over a 12-month period. Eight hundred and twenty-six patients (85%) were treated with single or combination conventional DMARD compared with 159 patients (15%) on a biologic DMARD either alone or in combination. Methotrexate monotherapy was the most commonly prescribed DMARD, used in 41% of patients studied. Almost half (47%) were on combination DMARD therapy. Methotrexate and tumour necrosis factor inhibitors had the highest retention rate over 12 and 30 months since first prescription. A large proportion of patients (47%) had moderate disease activity. CONCLUSION: Rates of biologic DMARD usage were similar to other studies and the predominance of methotrexate use was also in keeping with current recommendations for management of RA. There appears to be a significant unmet need for improved disease control among RA patients with moderate disease activity, which requires further investigation.
22965776 Health-related quality of life in young adult patients with rheumatoid arthritis in Iran: 2013 Jan The objective of the present study was to determine the reliability and validity of the Persian translation of the Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scales Young Adult Version in an Iranian sample of young adult patients with rheumatoid arthritis (RA). One hundred ninety-seven young adult patients with RA completed the 23-item PedsQL™ and the 36-item Short-Form Health Survey (SF-36). Disease activity based on Disease Activity Score 28 was also measured. Internal consistency and test-retest reliability, as well as construct, discriminant, and convergent validity, were tested. Confirmatory factor analysis (CFA) was used to verify the original factor structure of the PedsQL™. Also, responsiveness to change in PedsQL™ scores over time was assessed. Cronbach's alpha coefficients ranged from α = 0.82 to α = 0.91. Test-retest reproducibility was satisfactory for all scales and the total scale score. The PedsQL proved good convergent validity with the SF-36. The PedsQL distinguished well between young adult patients and healthy young adults and also RA groups with different comorbidities. The CFA did not confirm the original four-factor model, instead, analyses revealed a best-fitting five-factor model for the PedsQL™ Young Adult Version. Repeated measures analysis of variance indicated that the PedsQL scale scores for young adults increased significantly over time. The Persian translation of the PedsQL™ 4.0 Generic Core Scales Young Adult Version demonstrated good psychometric properties in young adult patients with RA and can be recommended for the use in RA research in Iran.
22276473 [Epidemiologic and functional aspects of rheumatoid arthritis in patients attending the Ho 2011 Oct The aim of this study was to assess the epidemiological data on the rheumatoid arthritis in IaÅŸi, Romania and in North East Romania. These data are useful for informing the policy makers, the public and above all the practitioners regarding such a disabilitating disease. The epidemiology plays an important role in understanding the etiology of the rheumatoid arthritis because there are notable differences in incidence between various populations. MATERIAL AND METHODS: This retrospective study followed 517 patients in 2009 and 499 patients in 2010 at the Rheumatology Clinic of the Rehabilitation Hospital, IaÅŸi, Romania, based on the following parameters: sex, age, rheumatoid factor, anti-CCP antibodies, the Steinbrocker functional classification, the stage of the disease. RESULTS: The highest rates of rheumatoid arthritis were recorded in the age group of 69-60 years, followed by the age group of 59-50 years. Most of the patients were in the third stage of the disease, with limited functional capacity. CONCLUSIONS: The clinical and evolutive data of the patients with rheumatoid arthritis at the Rheumatology Clinic of the Rehabilitation Hospital, IaÅŸi, Romania in the time interval 2009-2010 correspond to the European data in this field.
22232955 [The value of sonography and power Doppler in the detection of early arthritis]. 2011 Magnetic resonance imaging (MRI) of small joints of the hands and feetis still "the gold standard" in detecting early inflammatory changes in the patients with rheumatoid arthritis (RA). Radiographic assessment has only limited value in early diagnostic of RA. The limited accessibility of MRI makes both ultrasound (US) and Power Doppler (PD) of small joints of hands and feet equally useful tools as they give the same results as MRI in evaluating some of the pathologies such as: bone erosions, intraarticular effusions and changes of tendons. Power Doppler can detect subclinically synovitis of the small joints in the early phase of RA. Nowdays, in the field of rheumatology we talk about US and PD as "a rheumatologist's prolonged finger" or as " a rheumatological stetoscope", exactly because of their accessibility and possibility of getting quick and useful information about the patient himself. Since US and PD are inexpensive and non-invasive procedures, they can greatly improve diagnostics in RA and especially the assessment of the early phase of the inflammatory diseases, which can serve as a reliable indicator of the overal progression of the disease. Some new data show possibility of monitoring patients with RA and their response on disease modifying antirheumatic drugs (DMARDs) or biologicals by US and PD.
22830206 [Frax-assisted prediction of fractures in patients with rheumatoid arthritis]. 2012 AIM: To determine an absolute risk of fractures in patients with rheumatoid arthritis (RA) with the FRAX procedure (fracture risk assessment tool) for choice of further prophylactic, therapeutic and rehabilitative measures. MATERIAL AND METHODS: The trial included 611 RA females over 49 years of age of 834 RA patients from 2004 data base RA entrees. All the patients were assessed for fracture risk with FRAX basing on clinical data without densitometry. Distribution into fracture risk groups was made by a graphic age-risk scheme. RESULTS: High or moderate fracture risk was registered in 58.6% RA examinees. These patients were older than those with a low fracture risk, they had lower body mass index, longer menopause, higher disease activity more often had extra-articular manifestations of the disease. Therefore, duration of their glucocorticosteroid treatment was longer Patients with high and moderate fracture risks more frequently had functional insufficiency of the third degree, fractures of skeletal bones in the past. CONCLUSION: The FRAX method for assessment of an absolute fracture risk in RA patients detects subjects with elevated risk of fractures. This facilitates timely and qualitative administration of medical care, lowers costs of examination, improves treatment and rehabilitation of patients with osteoporosis and its complications.
21496414 Therapeutic effectiveness of minimal doses of rituximab in a patient with rheumatoid arthr 2011 Jan We report the case of a man suffering from rheumatoid arthritis, resistant to common DMARDs and anti-TNF-alpha, who received an excellent response, in terms of effectiveness and depletion of CD20 positive B-lymphocytes, to minimal doses of anti-CD20 monoclonal antibody (rituximab). The dose used was only 100 mg, repeated after 2 weeks. Already after the first infusion of rituximab, a profound depletion of CD20 B-lymphocytes and an improvement of clinical symptoms were evident. The patient, after 4 months from the first two infusions, maintained an accentuated lymphocyte depletion and obtained a low disease activity, passing from an initial DAS28 of 6.3 to a DAS28 of 2.8. The possible practical implications of this observation are taken into consideration.
22749253 Case of interstitial lung disease with anti-EJ and anti-CCP antibodies preceding rheumatoi 2012 Jun Autoantibodies against aminoacyl-tRNA synthetases (ARSs) are highly specific for myositis and/or interstitial lung disease. We report a rare case of double positive antibodies (anti-EJ antibody, the least common among anti-aminoacyl-tRNA synthetase antibodies, and anti-cyclic citrullinated peptide antibody, reported to be specific for rheumatoid arthritis) in a patient who presented with interstitial lung disease and later developed rheumatoid arthritis. The patient did not have clinically apparent myositis over a period of careful follow-up of several years. The initial pulmonary pathologic findings showed a nonspecific interstitial pneumonia pattern, with the formation of lymphoid follicles, which should be recognized as the first manifestation of rheumatoid arthritis.
21398333 Assessing health-related quality of life in hand osteoarthritis: a literature review. 2011 Jun BACKGROUND: Hand osteoarthritis (HOA) is a common disease that affects up to 40% of adults and may severely impair their health-related quality of life (HRQL). OBJECTIVES: To assess how HRQL has been evaluated in HOA, focusing on a comparison of HRQL impairment in HOA and rheumatoid arthritis (RA), differences between erosive and non-erosive HOA and differences between OA of the thumb base (TB) and interphalangeal (IP) OA. METHODS: A systematic review of the literature. RESULTS: The authors screened 167 articles and retained 33. The outcome subsets usually reported were pain, function and stiffness. Overall HRQL was rarely assessed and the tools used differed greatly. Aesthetic damage was never studied in published articles, although this is a major complaint in daily practice. Three articles compared symptomatic HOA and RA; whereas pain and subjective health did not differ significantly, there is conflicting evidence of the difference between disability and stiffness between these groups. Two papers compared erosive and non-erosive HOA and found divergent elements concerning functional impairment; patients with erosive HOA reported more aesthetic damage. Three papers compared TB and IP OA with divergent results in terms of pain and function. CONCLUSION: Overall HRQL is a broad concept involving domains beyond pain, function and stiffness. Few data are presently available on HOA, but it seems to have almost as great an impact as RA on HRQL. Further studies on HRQL in patients with HOA are required. Aesthetic damage should also be assessed with specifically designed tools.
21267736 [Perioperative use of biologicals in rheumatoid arthritis]. 2011 Jan The high prevalence of patients with rheumatoid arthritis (RA) treated with biologics and the high proportion of RA patients requiring elective orthopaedic surgery indicates that the question of whether to continue or to interrupt biologic therapy in the context of a surgical procedure is a clinically relevant problem. Few data are available and the quality of the studies performed is somewhat limited. Thus, a straightforward recommendation on how this problem should be handled cannot be given on this basis. Therefore, individualized management based on risk stratification for postoperative complications seems currently to be the best solution.
22460407 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis 2012 Mar OBJECTIVE: To elaborate recommendations for the treatment of rheumatoid arthritis in Brazil. METHOD: Literature review with articles' selection based on evidence and the expert opinion of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology. RESULTS AND CONCLUSIONS: 1) The therapeutic decision should be shared with the patient; 2) immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission; 3) treatment should be conducted by a rheumatologist; 4) the initial treatment includes synthetic DMARDs; 5) methotrexate is the drug of choice; 6) patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs; 7) exceptionally, biologic DMARDs can be considered earlier; 8) anti-TNF agents are preferentially recommended as the initial biologic therapy; 9) after therapeutic failure of a first biologic DMARD, other biologics can be used; 10) cyclophosphamide and azathioprine can be used in severe extra-articular manifestations; 11) oral corticoid is recommended at low doses and for short periods of time; 12) non-steroidal anti-inflammatory drugs should always be prescribed in association with a DMARD; 13) clinical assessments should be performed on a monthly basis at the beginning of treatment; 14) physical therapy, rehabilitation, and occupational therapy are indicated; 15) surgical treatment is recommended to correct sequelae; 16) alternative therapy does not replace traditional therapy; 17) family planning is recommended; 18) the active search and management of comorbidities are recommended; 19) the patient's vaccination status should be recorded and updated; 20) endemic-epidemic transmissible diseases should be investigated and treated.
22825632 Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior sc 2012 Dec PURPOSE: Literature has described a risk for subsequent vertical subluxation (VS) and subaxial subluxation (SAS) following atlantoaxial subluxation in rheumatoid patients; however, the interaction of each subluxation and the radiographic findings for atlantoaxial fixation has not been described. The purpose of this study was to evaluate the effects of two different posterior atlantoaxial screw fixation on the development of subluxation in patients with rheumatoid atlantoaxial subluxation. METHODS: Between 1996 and 2006, rheumatoid patients treated with transarticular fixation and posterior wiring (TA) or C1 lateral mass-C2 pedicle screw fixations (SR) in the Nagoya Spine Group hospitals, a multicenter cooperative study group, were included in this study. VS, SAS, craniocervical sagittal alignment, and range of motion (ROM) at the atlantoaxial adjacent segments were investigated to determine whether posterior atlantoaxial screw fixation is a prophylactic or a risk factor for the development of VS and SAS. RESULTS: The mean follow-up was 7.2 years (4-12). No statistically significant difference was observed among the patients treated with either of the procedure during the follow-up period. Of 34 patients who underwent posterior atlantoaxial screw fixation, SAS was observed in 26.5 % during the follow-up period; however, VS was not observed. Postoperative C2-7 angle, and Oc-C1 and C2-3 ROM were significantly different between patients with and without postoperative SAS. The incidence of SAS was 38.9 % for TA and 12.5 % for SR; statistically significant differences were observed in the postoperative C1-2 and C2-7 angles, and C2-3 ROM. CONCLUSIONS: Atlantoaxial posterior screw fixation may be an appropriate prophylactic intervention for VS and SAS if the atlantoaxial joint develops bony fusion following physiological alignment. Compared to TA, SR provided optimal atlantoaxial angle and prevented lower adjacent segment degeneration, thereby reducing SAS.
21750529 Ultrasonography in inflammatory rheumatic disease: an overview. 2011 Jul 12 Modern ultrasonography enables clinicians to sensitively assess the progression of inflammatory joint and tendon disease, and to investigate vasculitides, connective tissue diseases and nerve lesions. Despite the advantages of musculoskeletal ultrasonography for diagnostic, prognostic and monitoring purposes, fewer than 10% of European rheumatologists use this technique in routine clinical practice. The reliability and limitations of rheumatic ultrasonography remain a concern, although good interobserver and intraobserver agreement in results from ultrasonography have been demonstrated among experienced sonographers. International recommendations for assessments and ultrasonography training courses are available, and will improve the standardization of the use of these techniques. In clinical practice, ultrasonography can complement the diagnostic evaluation of patients with rheumatic disease and might have value in confirming and extending clinical findings. Musculoskeletal ultrasonography can also be a valuable follow-up tool to monitor disease activity and support treatment decisions for specific patients. Furthermore, ultrasonography-guided articular injections provide better precision and a higher success rate for synovial fluid aspiration than clinically-guided injections. In the future, three-dimensional ultrasonography techniques, the fusion of ultrasonography and other imaging methods, and real time sonoelastography will be interesting new fields of investigation.