Browse

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

ID PMID Title PublicationDate abstract
21372194 Parity, time since last live birth and long-term functional outcome: a study of women part 2011 Apr OBJECTIVE: To investigate the relationship between pre-symptom onset live births and functional outcome in women with inflammatory polyarthritis (IP). METHODS: 1872 women with no subsequent pregnancies were registered with the Norfolk Arthritis Register between 1990 and 2004 and followed-up for a median of 5 years. Functional disability over time was assessed by Health Assessment Questionnaire (HAQ). The number and calendar year of past live births were recorded. Differences in HAQ score over time by parity and time since last live birth (latency), adjusted for age and symptom duration, were examined using linear random effects models. The results were then adjusted for a number of potential confounders. RESULTS: 1553 women (83%) had ≥1 live births before symptom onset. The median latency was 26 years (IQR 16-35). Parous women had significantly lower HAQ scores over time than nulliparous women (-0.19, 95% CI -0.32 to -0.06). Increasing latency was associated with increasing HAQ score; the mean HAQ score of women with a latency of approximately 32 years was the same as for nulliparous women. This was independent of autoantibody status, socioeconomic status, smoking history and comorbidity. CONCLUSION: Parous women who develop IP have better functional outcome over time than nulliparous women who develop IP. The beneficial effect of parity diminishes with time.
21120560 Decreased need of large joint replacement in patients with rheumatoid arthritis in a speci 2011 Apr Disease-modifying antirheumatic biological and non-biological therapies are associated with reduced disease progression and joint destruction. Suggestions have been made that total knee and hip joint arthroplasty indications are decreasing as a beneficial effect of the new forms of therapy for rheumatoid arthritis. We present findings of our institution on the incidence of joint arthroplasty in the past few years in patients with rheumatoid arthritis and the increase in the numbers of procedures not associated with inflammatory arthritis.
21671833 Experiences and needs for work participation in employees with rheumatoid arthritis treate 2011 PURPOSE: To investigate the experiences and needs with respect to work participation of employees with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy. METHOD: Face-to-face interviews in 14 employees with RA on anti-TNF therapy focused on experiences, offered support and needs with respect to work participation. RESULTS: Experiences regarding work participation varied and ranged from fatigue at work, having no job control, not being understood by the work environment or difficulty dealing with emotions as a result of interaction within the work environment. Support by health care professionals for work participation was considered important, especially concerning social or psychological issues. Advice in becoming aware of one's changes in abilities was highly appreciated, as was the availability of professional advice in times of an urgent work issue due to RA. Employees mentioned an increase in social support at work and job control as important facilitating factors for work participation. CONCLUSION: Although patients with RA report improvement in their work functioning after starting anti-TNF therapy, employees continue facing challenges in working life due to RA. For support concerning work participation, it is recommended that health care professionals are more aware of work-related problems in patients with RA treated with anti-TNF therapy.
21874405 Serum and synovial fluid levels of interleukin-17 in correlation with disease activity in 2011 Sep The aim of this study was to evaluate serum and synovial levels of IL-17A by ELISA in rheumatoid arthritis (RA) and find out the correlations between IL-17A levels and various clinical, laboratory parameters and RA disease activity and severity indices. Group I consists of 30 adult active RA patients fulfilling the ARA 1987 revised criteria, with knee effusion and receiving basic therapy, and with a mean age of 41.47±11.49 years and mean disease duration of 9.5±4.16 years. Group II consisted of 13 healthy volunteers, age- and sex-matched, with a mean age of 39.08±14.19 years. RA patients showed significantly higher mean serum IL-17A levels than controls (11.25±9.67 vs. 0.6±1.4 pg/mL, respectively, p=0.0002). Synovial IL-17A levels showed a significant positive correlation with serum IL-17A levels (r=0.5 and p=0.005). RA patients with negative rheumatoid factor (RF) had non-significantly higher mean serum IL-17A levels (12±9.86 pg/mL) compared to those with positive RF (10.82±9.81 pg/mL); however, the mean synovial IL-17A levels were nearly the same. Significant positive correlations were found between both serum and synovial IL-17A levels and DAS-28 scores (r=0.556, 0.392 and p=0.001, 0.032, respectively). RA patients with class III functional status showed significantly higher mean serum IL-17A levels (17.53±13.43 pg/mL) than classes I and II (8.97±6.97 pg/mL, p=0.009). These led us to conclude that the elevated serum and synovial IL-17A levels in RA patients parallel the degree of disease activity and severity. This may highlight the usefulness of IL-17 (especially serum level) as a possible marker for more aggressive joint involvement and damage.
20972869 Isolated intra-articular pseudorheumatoid nodule of the knee. 2011 Apr The authors describe a case of an isolated intra-articular pseudorheumatoid nodule of the knee in an 18-year-old male patient without a diagnosis of rheumatoid arthritis. The patient initially presented with a 3 year history of anterior knee pain and was found to have a 2.8 × 2.1 cm lobulated soft-tissue mass. Histologic findings showed fibrinoid necrosis and chronic inflammatory changes that were consistent with those of a pseudorheumatoid or rheumatoid nodule, and surgical excision of the nodule was curative. A review of the literature revealed no prior cases of an intra-articular pseudorheumatoid nodule or rheumatoid nodule in a patient without clinical or serologic evidence of rheumatoid arthritis.
21406455 How large are the productivity losses in contemporary patients with RA, and how soon in re 2011 Jun OBJECTIVE: To estimate the sick leave and disability pension trajectory in patients diagnosed with early rheumatoid arthritis (RA) 1999-2007, and in prevalent patients in 2007. METHODS: Individuals aged 19-59 years diagnosed with early RA were identified in the Swedish Rheumatology Quality Register (1999-2007; n=3029; 47 years; 73% women). Additionally, prevalent patients in 2007 were identified in the National Patient Register (n=25,922; 52 years; 73% women). For each patient, five age-, sex-, education- and county-matched general population comparators were sampled. Sick leave and disability pension days were retrieved from national registers. RESULTS: Sick leave and disability pension increased from a mean 43 to 77 days/year from 2 to 1 years before RA diagnosis. A further increase to 147 days/year was observed the next year, followed by a rebound to 116 days/year 4 years after diagnosis. During the 4 years following diagnosis, sick leave decreased from a mean 118 to 35 and disability pension increased from 29 to 81 days/year. In the prevalent RA population, patients had a mean 158 annual days of sick leave and disability pension compared to 71 in comparators. Large variations existed across age, sex and education level, but RA patients had consistently higher levels. In 2007, the costs associated with sick leave and disability pension were €16,000 per patient with €9,000 attributable to RA. CONCLUSION: Despite better drugs and improved treatment strategies, data from contemporary patients with early and established RA continue to indicate large unmet needs.
21655943 Metal chelation therapy in rheumathoid arthritis: a case report. Successful management of 2011 Dec Toxic metals are involved in the pathogenesis of some neurodegenerative and vascular diseases and are known to impair the immune system functions. We report here the case of a patient affected by heavy metal intoxication, who had developed an autoimmune disease. There was evidence of aluminium, cadmium and lead intoxication in a 63-year old Italian woman affected by rheumatoid arthritis (RA). We treated the patient with calcium disodium edetate (EDTA) once a week for a year in order to remove traces of heavy metal intoxication. Oxidative status profile was carried out at the beginning and after 6 months' EDTA chelation. At the end of the treatment, the patient did not show any signs of metal intoxication, RA symptoms and oxidative status improved.
22994096 [Single-photon emission computed tomography in the diagnosis of myocardial perfusion abnor 2012 Increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA) may be attributed to the fact that a systemic inflammation existing in this disease may trigger the development of atherosclerosis. 99mTC-MIBI (4,2-methoxyisobutyl isonitrile) is a compound that permits myocardial perfusion to be visualized and has been proposed for the evaluation of the latter in patients with RA. Analysis of the results of the studies revealed transient myocardial ischemia areas in patients who did not take methotrexate while those who used it were found to have diminished perfusion areas that were, however, clinical insignificant.
22438306 Reliability of the novel 7-joint ultrasound score: results from an inter- and intraobserve 2012 Aug OBJECTIVE: To assess the inter- and intraobserver reliability of 26 rheumatologists when performing the 7-joint ultrasound score (US7). METHODS: Six patients with rheumatoid arthritis were examined by 26 sonographers in 12 rater groups who performed the US7 score. The US7 score includes the clinically dominant wrist, the second and third metacarpophalangeal (MCP) and proximal interphalangeal joints, and the second and fifth metatarsophalangeal (MTP) joints, which were evaluated for synovitis, tenosynovitis/paratenonitis, and erosions from the dorsal side and palmar/plantar aspects by gray-scale and power Doppler (PD) ultrasound. Additional lateral scans were performed at the MCP2 and MTP5 joints. All of the groups repeated the examination in 4 patients in order to calculate the intraobserver reliability. The results of one group that included 2 expert sonographers were considered as the reference standard. Kappa values, median agreement rates (interobserver), and P values (intraobserver evaluation) were calculated. RESULTS: The median overall kappa value for detecting synovitis was 0.51, for tenosynovitis/paratenonitis was 0.57, and for erosions was 0.45. In detail, the best interobserver results were found for the detection of erosions in the MTP2 joint from the plantar aspect (κ = 1; median agreement rate 89.4%) and for PD signal detection in the palmar wrist region (κ = 0.79; median agreement rate 78.8%). Good agreement was found for detecting erosions in the MCP2 joint from the radial side (κ = 0.67; median agreement rate 77.3%). CONCLUSION: The inter- and intraobserver reliability of the US7 score shows moderate to substantial kappa values and good agreements. Therefore, this ultrasound score has the potential to be an important imaging tool, including multicenter analysis to assess structural changes.
22736085 Near misses of ACR/EULAR criteria for remission: effects of patient global assessment in B 2012 Oct BACKGROUND: The American College of Rheumatology/European League Against Rheumatism remission criteria for rheumatoid arthritis (RA) have been published recently. OBJECTIVE: To quantify the proportions of patients fulfilling only three of the four Boolean criteria and the relevance of patient global assessment (PGA) in context of remission. METHODS: From an observational prospective RA database the first visit of patients, fulfilling just three of the four Boolean criteria was identified. Logistic regression and descriptive analyses were processed, also defining remission by index-based (Simplified Disease Activity Index (SDAI)) definition and comparing outcomes with the evaluator global assessment (EGA). RESULTS: 52% had at least one visit, fulfilling just three criteria (not fulfilled were: PGA 61%; swollen joints 20%; tender joints 13%; C-reactive-protein 7%). 67% of patients not fulfilling the PGA criterion had an EGA≤1 cm, 25% of those fulfilled the SDAI definition. Increased pain (OR=1.28), EGA (OR=1.10) and discrepancy towards higher PGA than EGA (OR=1.28) could explain PGA failure to reach remission. CONCLUSIONS: PGA is often the limiting factor for reaching remission; index-based remission showed balancing effects by adjusting for elevated variables in the summative score.
21334623 A randomised, controlled study of outcome and cost effectiveness for RA patients attending 2011 Aug BACKGROUND: The rise in the number of patients with arthritis coupled with understaffing of medical services has seen the deployment of Clinical Nurse Specialists in running nurse-led clinics alongside the rheumatologist clinics. There are no systematic reviews of nurse-led care effectiveness in rheumatoid arthritis. Few published RCTs exist and they have shown positive results for nurse-led care but they have several limitations and there has been no economic assessment of rheumatology nurse-led care in the UK. OBJECTIVE: This paper outlines the study protocol and methodology currently being used to evaluate the outcomes and cost effectiveness for patients attending rheumatology nurse-led clinics. DESIGN AND METHODS: A multi-centred, pragmatic randomised controlled trial with a non-inferiority design; the null hypothesis being that of 'inferiority' of nurse-led clinics compared to physician-led clinics. The primary outcome is rheumatoid arthritis disease activity (measured by DAS28 score) and secondary outcomes are quality of life, self-efficacy, disability, psychological well-being, satisfaction, pain, fatigue and stiffness. Cost effectiveness will be measured using the EQ-5D, DAS28 and cost profile for each centre. POWER CALCULATIONS: In this trial, a DAS28 change of 0.6 is considered to be the threshold for clinical distinction of 'inferiority'. A sample size of 180 participants (90 per treatment arm) is needed to reject the null hypothesis of 'inferiority', given 90% power. Primary analysis will focus on 2-sided 95% confidence interval evaluation of between-group differences in DAS28 change scores averaged over 4 equidistant follow up time points (13, 26, 39 and 52 weeks). Cost effectiveness will be evaluated assessing the joint parameterisation of costs and effects. RESULTS: The study started in July 2007 and the results are expected after July 2011. TRIAL REGISTRATION: The International Standard Randomised Controlled Trial Number ISRCTN29803766.
22704895 Comparison of the 1987 ACR criteria and the 2010 ACR/EULAR criteria in an inception cohort 2012 May OBJECTIVES: To compare the performance of the 1987 American College of Rheumatology (ACR) and the 2010 ACR/European League Against Rheumatism criteria for the classification of rheumatoid arthritis (RA). METHODS: Two-hundred and one patients aged 16 years or older with a 4-week to 12-month history of swelling of at least two joints and not previously treated with corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs) were studied. The fulfilment of the 1987 and 2010 criteria was determined at baseline and at the end of the 1-year follow-up period. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy of both sets of criteria were determined against three outcome measures: initiation of therapy with either methotrexate or any DMARD within the first year of follow-up, and clinical diagnosis according to physician's opinion after one year. RESULTS: At presentation, 145 patients fulfilled the 2010 criteria, and 108 the 1987 criteria for RA. The sensitivity, specificity and accuracy of the 2010 criteria were 0.80, 0.62 and 0.77 (0.58, 0.64 and 0.59 for the 1987 criteria) against the initiation of methotrexate therapy, 0.75, 0.73 and 0.75 (0.56, 0.91; 0.58 for the 1987 criteria) against the initiation of any DMARD therapy, and 0.87, 0.73 and 0.84 (0.69, 0.94; 0.75 for the 1987 criteria) against clinical diagnosis. CONCLUSIONS: Compared with the 1987 criteria, the 2010 criteria are more sensitive and accurate, but less specific against two of the three outcome measures used, and classify more patients with RA at earlier stages of the disease.
21285168 Do we need core sets of fibromyalgia domains? The assessment of fibromyalgia (and other rh 2011 Jun OBJECTIVE: An OMERACT consensus process recommended domains for investigation in fibromyalgia (FM) clinical trials. We used patient data to investigate variable importance in the determination of patient global and health-related quality of life (HRQOL) in FM and non-FM patients to determine whether variables were valued differently in FM compared with non-FM states. METHODS: We used ACR 2010 diagnostic FM criteria modified for epidemiological and clinical research to identify patients with rheumatoid arthritis (RA; N = 5884) with and without FM, and also characterized previously diagnosed patients with FM (N = 808) as to current criteria status. We measured variable importance by multivariable regression, decomposing regression variance by averaging over model orderings. We examined the distributions of key variables in the various disorders, and the distributions as a function of a FM severity index (fibromyalgianess). RESULTS: Out of 9 measures, pain, Health Assessment Questionnaire disability index, and fatigue explained more than 50% of explainable variance (50.49%-56.59%). Explained variance was similar across all disorders and diagnostic groups. In addition, the SF-36 physical component summary score varied across disorders as a function of fibromyalgianess. CONCLUSION: The main determinants of global severity and HRQOL in FM are pain, function, and fatigue. But these variables are also the main determinants in RA and other rheumatic diseases. The content and impact of FM, whether measured by discrete variables or a fibromyalgianess scale, seems to be independent of diagnosis. These data argue for a common set of variables rather than disease-specific variables. Clinical use is supported and enhanced by simple measures.
22120459 Modifiable risk factors for RA: prevention, better than cure? 2012 Mar OBJECTIVE: To perform a meta-synthesis of the evidence for modifiable lifestyle risk factors for inflammatory polyarthritis (IP) and RA. METHODS: We performed a MEDLINE literature search. Case-control and cohort studies and systematic reviews published from 1948 through February 2011 and studying modifiable risk factors for RA were retrieved. The main outcome measure was diagnosis of RA according to the standard criteria. RESULTS: Smoking contributes up to 25% of the population burden of RA. The risk is dose related, stronger in males and especially strong for anti-citrullinated peptide antibody positive (ACPA(+)) RA through an interaction with the shared epitope. After smoking cessation, there is, however, a latency of up to 20 years to return to baseline risk. Other associations are less definitive; however, prospective studies suggest that dietary antioxidants and breastfeeding may be protective and that high coffee consumption may increase RA risk. An inverse association with alcohol intake (especially in smokers) and with education/social class (especially seropositive RA) and an increased risk with obesity (seronegative RA) is also noted. CONCLUSION: There is a need for further large-scale prospective studies with a consistent definition of RA phenotype (undifferentiated IP through to ACPA(+)/RF(+) disease). This will ultimately afford the opportunity to evaluate preventative population strategies for RA akin to the well-established programmes for cardiovascular disease and cancer, targeting common risk factors.
22129036 Multiplex, megaplex, index, and complex: the present and future of laboratory diagnostics 2011 In a recent issue of Arthritis Research & Therapy, Chandra and colleagues described the use of multiple multiplex immunoassays and complex computer algorithms to investigate the possibility of improved laboratory diagnosis and novel classification of rheumatoid arthritis on the basis of biomarkers. Such complex predictive tools in rheumatology can be guided by the experience of multiplex testing in oncology, which has demonstrated the importance of uniform specimen handling and prospectively collected specimen repositories. Although there are high expectations for these complex approaches, they require careful evaluation.
22035387 A critical look at diagnostic criteria: time for a change? 2011 There are certain thought barriers involved in making diagnostic-classification criteria in diseases of unknown origin. Among these are a lack of appreciation of the issue of circular logic, the basic oneness of diagnostic and classification criteria, the lack of appreciation as to why we make such criteria in the first place, and the lack of importance informing our patients that we do as well as should treat them without a frm diagnosis in many instances. The relevance of these thought barriers to the new American College of Rheumatology/European Union League Against Rheumatism (ACR/EULAR) Rheumatoid Arthritis (RA) classification criteria are also discussed.
21597994 Spontaneous bilateral distal ulna fracture: an unusual complication in a rheumatoid patien 2011 Jun Bilateral ulna stress fractures are extremely rare. Patients with rheumatoid arthritis have osteopenic bone secondary to a variety of causes. We report a case of bilateral stress fractures of the ulna in an elderly patient with rheumatoid arthritis, and literature on this condition is reviewed. Prompt recognition and activity modification are essential to treat this rare injury. Recovery can take up to 12 weeks.
23063507 Rhupus syndrome: assessment of its prevalence and its clinical and instrumental characteri 2013 Feb The term "rhupus" is traditionally used to describe patients with coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The aim of the present work was to investigate prevalence, clinical and radiological picture as well as the serological profile of a series of rhupus patients; SLE patients and RA patients from our Unit were used as disease control groups. A total of 103 consecutive SLE patients were screened; among the entire cohort, 10 patients (9.7%) were classified as "rhupus". In our rhupus patients SLE features preceded the onset of arthritis in 5 patients (50%) while in the remaining patients arthritis appeared before or simultaneously (3 and 2 patients respectively). As compared with SLE patients, rhupus patients have significantly less kidney involvement (p=0.01) while no differences were observed between neuropsychiatric, cutaneous, hematological involvement or serositis. At our physical examination, 9 (90%) rhupus patients were presenting active joint involvement; CRP positivity and ESR levels resulted significantly higher than in SLE (p=0.006) patients while no differences were observed with respect to RA patients. In all rhupus patients, at least one pathological finding was revealed by ultrasound (US) examination at wrist and/or hand joints; overall, rhupus patients presented higher scores in all the US parameters with respect to SLE patients, especially at hands; no statistically significant differences have been observed with respect to RA patients. Magnetic resonance (MR) revealed erosions in all rhupus patients with a concomitant bone edema in five patients. The cumulative erosive burden in rhupus patients was significantly higher than in SLE patients and similar to RA patients (SLE vs rhupus p=0.005); bone pathology distribution was also similar between rhupus patients and RA patients. These data suggest the importance of assessing joint involvement in SLE with advanced imaging techniques and of evaluating the presence of prognostic factors for joint disease severity in order to establish adequate disease monitoring and to institute early appropriate therapies to avoid late consequences of unrecognized concomitant rheumatoid arthritis (Amezcua-Guerra et al., 2006 [25]; Zhao et al., 2009 [26]).
22460147 Remission by imaging in rheumatoid arthritis: should this be the ultimate goal? 2012 Apr Remission is often selected as the 'treat to target'. There is a plea to include imaging. Imaging remission can apply to structural damage and/or inflammation. For structural damage, radiographs are mostly used. A definition is needed which could be either strict, with no progression occurring, or which takes measurement error into account and uses the smallest detectable change. Mostly imaging remission refers to inflammation as assessed by ultrasound or MRI. The reason for arguing that imaging remission should be included for inflammation is that inflammation may still be present in patients who are in clinical remission. The level of inflammation depends on the clinical remission definition that is used. Bone marrow oedema is the feature that is most predictive of radiographic progression. However, before imaging remission can be implemented as a recommendation, a definition of remission by imaging needs to be established. A choice has to be made about the level of inflammation that can be tolerated and how this needs to be assessed (which imaging method, which feature, which joints, which cut-off point). Moreover, imaging remission should only be selected as a target if it can be proved that it can be treated and that the outcome of the patients will be improved by trying to achieve imaging remission in addition to clinical remission. This proof is not yet available, and too many unanswered questions remain to recommend including imaging remission of inflammation in a definition of remission.
22055540 Ultrasound-defined remission and active disease in rheumatoid arthritis: association with 2012 Jun OBJECTIVE: To assess the association of clinical and/or serological parameters with ultrasound-defined disease activity in rheumatoid arthritis (RA). METHODS: Retrospective analysis of 149 consecutive RA patients routinely assessed by sonography of the wrists, metacarpo-phalangeal, and proximal interphalangeal joints. Semiquantitative scoring of synovial hypertrophy/effusion and power Doppler (PD) signals was performed. Sonographic remission was defined by the absence of PD signals. Number of tender and swollen joints, global assessment of disease activity by the physician (VAS-phys) and patient (VAS-pt), C-reactive protein (CRP), erythrocyte sedimentation rate, duration of morning stiffness (MS), simplified disease activity index, disease activity score for 28 joints, clinical disease activity index, and health assessment questionnaires were recorded. RESULTS: PD signals as a sign of active disease were observed in 117 (78.5%) RA patients. CRP, erythrocyte sedimentation rate, and MS were higher in patients with PD signals than in patients in remission. CRP >5.0 mg/L (normal values 0-5.0 mg/L), MS >15 minutes, or the combination of both revealed odds ratios of 5.0, 3.0, or 18.9, respectively, to indicate sonography-defined active disease. The other parameters showed no association with the presence or absence of PD-signals. CONCLUSIONS: Sonography-defined disease activity is associated with CRP and MS, whereas current composite scores and its clinical components did not match this definition.