Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
21713521 Distal radius fracture after Sauvé-Kapandji procedure in a rheumatoid arthritis patient. 2012 Apr We report a case of distal radius fracture after a Sauvé-Kapandji procedure combined with synovectomy and tendon transfer in a rheumatoid arthritis patient. This case shared several unusual features that were also seen in a previously reported case. Based on these features, we discuss favorable surgical treatment for the rheumatoid wrist with extensor tendon rupture, and also the optimal treatment for distal radius fracture after such procedures.
19851770 Anaplastic large cell lymphoma in a patient with rheumatoid arthritis. 2011 Apr It is known that patients with rheumatoid arthritis (RA) have an increased risk for non-Hodgkin's lymphomas in comparison with the general population. Although increased risk of lymphoma is attributed to the disease activity, the drugs used in the therapy of RA may also cause increased risk of malignancy. Herein, we report on an RA patient who developed non-Hodgkin's lymphoma after methotrexate therapy and review the literature about it. A 74-year-old man with RA had been treated with low-dose methotrexate and subsequently developed anaplastic large cell lymphoma of the T-cell phenotype. Anaplastic large cell lymphoma has been reported rarely in rheumatoid arthritis.
23018349 Probing the use of fluorescence spectroscopy as a novel diagnostic tool in patients with r 2012 Oct BACKGROUND: Secondary amyloidosis is a frequently reported complication of rheumatoid arthritis. Currently, accepted diagnostic protocols for secondary amyloidosis involve histopathological and histochemical examinations of collected tissue specimens. The purpose of the current report was to evaluate the value of fluorescence spectroscopy as a supplementary tool in the diagnosis of secondary amyloidosis. MATERIAL/METHODS: Tissue specimens were collected from abdominal folds, gingiva or rectal mucosa of 99 patients affected with rheumatoid arthritis. Tissue samples were subjected to preliminary clinical observations, histopathological examinations and laboratory tests. These procedures were used to subdivide tissue samples into either amyloid-containing or amyloid-free control subgroups. All collected tissue samples were examined with the use of a designated spectrofluorometer and fluorescence spectral images were generated. RESULTS: It was found that fluorescence spectra for amyloid-containing tissues were typically characterized by a double emittance peak. In contrast, amyloid-free samples were characterized by fluorescence spectra with a single λmax value. Specimen collection site, age and sex did not appear to influence the morphology of electromagnetic spectra, which were generated for both amyloid-containing and amyloid-free tissue samples. The sensitivity of the fluorometric approach was ~78% and the specificity was 100%. Possible shortcomings of the technique may be due to the limit of detection of the instrument used. CONCLUSIONS: Fluorescence spectroscopy may potentially be used as an effective, instantaneous and low-cost diagnostic tool for suspected secondary amyloidosis in patients affected with rheumatoid arthritis.
21529305 How much is a reduction in morning stiffness worth to patients with rheumatoid arthritis? 2011 OBJECTIVE: The aim of this study was to determine the monetary equivalent of the emotional and functional impact of morning stiffness (MS) in patients with rheumatoid arthritis (RA), using alternative valuing methods. METHODS: Telephone interviews were conducted among 166 patients with RA to assess utility and clinical symptoms, including MS. Three standard economic methods were used: the human capital approach (HCA), marginal value of time (MVT), and willingness-to-pay (WTP). RESULTS: The monetary equivalent of the impact of MS varied with the method used (from EUR 5.74 to EUR 17.87 per patient per day) and severity of MS (5-8-fold higher in patients with severe MS compared with mild MS). Patients placed considerable value on a reduction in duration and severity of MS. Patients with MS lasting an hour or more were willing to pay EUR 21.74/day to stop the symptom and EUR 10.63/day to halve the duration. Patients with severe MS were willing to pay EUR 47.86/day to stop the symptom and EUR 21.68/day to halve the severity. CONCLUSIONS: The observed variation in the monetary equivalent of the impact of MS obtained with the three estimation methods indicates that the findings of studies using different valuing methods should not be compared directly. The study demonstrates that a reduction in MS is worth a considerable amount to patients with RA, particularly those with severe or prolonged MS. These findings suggest that clinical treatment decisions to improve patients' quality of life should also incorporate therapy that reduces MS.
22771180 [Senile scleral plaque associated with scleritis in a patient with rheumatoid arthritis]. 2012 Oct Senile scleral plaque is an age-related, commonly asymptomatic hyaline degeneration of the sclera. We report a case of calcific scleral plaque associated with anterior scleritis in an elderly patient with rheumatoid arthritis. Response to anti-inflammatory treatment was favorable.
21805365 Selection of items for a computer-adaptive test to measure fatigue in patients with rheuma 2012 Jun PURPOSE: Computer-adaptive tests (CATs) can measure precisely at individual level with few items selected from an item bank. Our aim was to select fatigue items to develop a CAT for rheumatoid arthritis (RA) and include expert opinions that are important for content validity of measurement instruments. METHODS: Items were included from existing fatigue questionnaires and generated from interview material. In a Delphi procedure, rheumatologists, nurses, and patients evaluated the initial pool of 294 items. Items were selected for the CAT development if rated as adequate by at least 80% of the participants (when 50% or less agreed, they were excluded). Remaining items were adjusted based on participants' comments and re-evaluated in the next round. The procedure stopped when all items were selected or rejected. RESULTS: A total of 10 rheumatologists, 20 nurses, and 15 rheumatoid arthritis patients participated. After the first round, 96 of 294 items were directly selected. Nine items were directly excluded, and remaining items were adjusted. In the second round, 124 items were presented for re-evaluation. Ultimately, 245 items were selected. CONCLUSION: This study revealed a qualitatively evaluated item pool to be used for the item bank/CAT development. The Delphi procedure is a beneficial approach to select adequate items for measuring fatigue in RA.
22265461 Pulmonary rheumatoid nodules: presentation, methods, diagnosis and progression in referenc 2012 Jul Rheumatoid nodules are a rare manifestation of lung disease associated with rheumatoid arthritis (RA). Their emergence and evolution in the course of the disease is variable. The diagnosis of pulmonary rheumatoid nodules may be suggested if they have a typical appearance in an appropriate clinical context, but an accurate diagnosis cannot be made based only on imaging tests. It is recommended to follow nodules and may be necessary to histologically differentiate them from tumors.
22460141 How do contemporary imaging techniques contribute to basic and clinical rheumatology? 2012 Apr Recent major advances in biomedical imaging techniques have allowed us to visualise a variety of previously unseen biological phenomena. In particular, advanced fluorescent microscopy and radioimaging have enabled us to visualise cellular and molecular dynamics in living animals and humans. These new technologies have identified novel therapeutic targets against a wide array of diseases and have provided novel diagnostic tools for the evaluation of several disease conditions. In this brief review, the author outlines the contemporary imaging techniques used in the fields of immunology and rheumatology, with special focus on intravital fluorescent microscopy, and discusses how these cutting-edge methodologies contribute to clinical practice for patients with rheumatism.
21442168 A tumor endoprosthesis is useful in elderly rheumatoid arthritis patient with acute interc 2012 May The purpose of this paper is to report the use of total knee arthroplasty using a tumor prosthesis in the treatment of elderly patients with an intercondylar fracture of the distal femur. Supracondylar fractures of the femur in patients with rheumatoid arthritis are difficult to treat due to joint deformity. We present outcomes for treating intercondylar fractures of the distal femur in rheumatoid arthritis patient using a tumor endoprosthesis. This technique allows early mobilization of the patient, with restoration of a good range of knee motion. A tumor prosthesis appears to be a viable treatment option for intercondylar femoral fractures in elderly patients. It is well tolerated and permits early ambulation and return to activities of daily living.
22139206 [Insufficiency fractures of the feet and lower limbs in rheumatoid arthritis]. 2011 Dec BACKGROUND: Insufficiency fractures are generally a rare event, especially of the hindfoot. These are often overlooked in the initial stage, however, they must be regarded as a differential diagnosis in the range of possible causes in patients with rheumatoid arthritis and unclear complaints. MATERIAL AND METHODS: Outpatients in an arthritis care unit from 2009-2011 were analyzed for fractures of the hindfoot and distal tibia. RESULTS: A total of six patients with seven fractures without adequate trauma were found in the cohort. All patients had received disease modifying therapy and corticosteroids. All fractures could be successfully treated without surgery. CONCLUSION: Insufficiency fractures in patients with rheumatoid arthritis are a typical finding after several years of the disease. They are directly related to the disease and medication and can usually be successfully treated conservatively.
23052557 [Postoperative management of hip and knee endoprostheses]. 2012 Oct Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.
21296193 Does polymorphysm of genes coding for pro-inflammatory mediators predict the clinical resp 2011 Jun Tumor necrosis factor-α (TNF-α) has a key role in the pathogenesis of rheumatoid arthritis (RA) and the introduction of anti-TNFα biological therapies has dramatically altered the treatment of RA. Anti-TNFα agents display good clinical efficacy in patients resistant to traditional disease-modifying antirheumatic drugs and superior efficacy in the suppression of erosive joint damage, even if a significant non-response rate has been reported (30-40%). Because anti-TNFα therapy is associated with expensive treatment costs, leading to restrictions in the numbers of patients who may be treated, the identification of predictors of treatment outcome may improve the cost-effectiveness of anti-TNFα therapies. Several candidate gene studies have addressed this topic, but they have had limited success in identifying predictors. It is not clear whether the response to anti-TNFα treatment will be conferred through a number of genes, each with a small effect size, or whether genes may predict the outcome of the treatment.
22085517 [The patient with arthritis: care by both general practitioners and rheumatologists]. 2011 Early aggressive treatment of rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs such as TNF inhibitors prevents joint damage and improves the quality of life. There is increasing insight regarding the cardiovascular risks of patients suffering from RA or gout. These aspects and others are considered in this paper with respect to early diagnosis, treatment and prognosis of patients with arthritis, in particular RA or gout. In the Netherlands approximately 8900 general practitioners (GPs) and 230 rheumatologists, working in different settings (primary care and hospitals), are together responsible for the care of patients with arthritis. They must communicate and co-operate at a national, regional and local level to organize this care--the aim being to reach mutual agreement regarding the responsibility for each part of the diagnosis and management at each stage of the disease.
22612739 Anti citrullinated protein antibodies and mechanism of action of common disease modifying 2012 The increasing understanding of autoimmune mechanisms continuously leads to new therapeutic targets and development of novel diagnostic tools in rheumatology. On the other hand, an improved comprehension of mechanisms of action of many drugs and the daily utilization in rheumatology leads to a better understanding of the underlying autoimmune processes. An example for the latter is Bcell depletion using anti-CD20 antibodies, which leads to the concept of B cells not only playing a role as antibody secreting cells but also as important cellular components of autoimmune processes, acting as antigen presenting and cytokine producing cells. Another example is the conventional disease modifying anti-rheumatic drug methotrexate, which has also been used successfully in the clinic first and then, while trying to understand its mechanism of action, led to knew insights in autoimmune mechanisms e.g. revealing the strong anti-inflammatory potential of adenosine. But not only the mechanism of action of different drugs, but also the identification of antibodies against citrullinated proteins (ACPA) as a valuable diagnostic tool resulted in novel concepts regarding the pathophysiology of rheumatoid arthritis. The following review first explains the value of ACPA in the diagnosis of rheumatoid arthritis (RA) and then summarizes the application and mechanism of action of several important substances used in the management of autoimmune disorders. Based on these insights, the authors explain their understanding of the autoimmune process as a continuous repeat of autoantigen presentation - autoreactive effector cell activation - destruction of tissue - liberation of new autoantigens - and again autoantigen presentation, which closes the vicious circle.
21276397 [Excess mortality from cardiovascular disease in patients with rheumatoid arthritis]. 2011 Jan 31 The cardiovascular morbidity and mortality are increased in rheumatoid arthritis and probably equal those of patients with type 2 diabetes mellitus. The European League Against Rheumatism has recently provided evidence-based guidelines for cardiovascular risk management in patients with rheumatoid arthritis and we here briefly summarise these guidelines and other recent data in this area of research.
22390506 A public health approach to addressing arthritis in older adults: the most common cause of 2012 Mar Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors (e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions.
21807791 Patient perspective: choosing or developing instruments. 2011 Aug Previous Outcome Measures in Rheumatology (OMERACT) meetings recognized that patients view outcomes of intervention from a different perspective. This preconference position paper briefly sets out 2 patient-reported outcome (PRO) instrument approaches, the PROMISE computer adaptive testing (CAT) system and development of a rheumatoid arthritis-specific questionnaire to measure fatigue; a tentative proposal for a PRO instrument development pathway is also made.
21680056 [The value of corticosteroids in the treatment of sterile ulcer in rheumatoid arthritis: a 2011 Dec Ocular manifestations of rheumatoid arthritis are mainly dry eye syndrome, scleritis, and keratitis. The occurrence of corneal ulceration in the course of this disease is a rare complication but can lead to ocular perforation. We report the case of a woman followed for rheumatoid arthritis who presented a bilateral sterile paracentral ulcer that responded well to medical treatment.
20851679 A clinico-pathological conference on constrictive pericarditis secondary to rheumatoid art 2011 Jan Constrictive pericarditis is the commonest cardiac complication of rheumatoid arthritis (RA). Two percent of patients with RA develop significant clinical symptoms of pericarditis, which may not correlate with joint disease duration or severity. Symptoms are often vague and non-specific, which frequently delays the diagnosis and subsequent management. Surgical excision of the pericardium is the only definitive treatment option. We present the case of a 60 year-old lady with RA who presented with symptoms due to pericardial constriction and underwent radical pericardectomy.
23221582 The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. 2012 Dec As more effective treatments for RA have become available, studies have demonstrated that in patients who attained remission, defined as a simplified disease activity index (SDAI) ≤3.3, not only disease activity but radiographic progression was reduced. The feasibility and the benefit of attaining remission led to the development of the ACR/European League Against Rheumatism (EULAR) 2011 remission criteria. These criteria employ either a Boolean definition, including tender and swollen joint counts ≤1, and CRP ≤1 mg/dl, or an index-based definition, SDAI ≤3.3, in combination with patient-reported outcomes on a scale of 0-10. It is expected that the ACR/EULAR criteria will be used as secondary outcomes in clinical trials. Some questions about the implementation of the new criteria include the availability of CRP values, and the possibility that patient-reported outcomes may skew the outcome if patients cannot distinguish other musculoskeletal conditions from RA. Several issues require further study, including the role of imaging, fatigue and the impact of the involvement of joints other than the 28 counted in the ACR/EULAR criteria.