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ID PMID Title PublicationDate abstract
21389043 The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish 2011 Jun OBJECTIVES: To examine in a nationwide cohort whether the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) is comparable to the risk in patients with diabetes mellitus (DM). METHODS: The study included the entire Danish population followed from 1 January 1997 until 31 December 2006. Through individual level-linkage of nationwide administrative registers, the authors identified subjects who developed RA and DM. The risk of MI was analysed using multivariable Poisson regression models including data on cardioprotective drugs, comorbidity and socioeconomic status. RESULTS: From a total of 4,311,022 individuals included in the cohort, 10,477 and 130,215 individuals developed RA and DM respectively. The overall incidence rate ratio (IRR) of MI in RA was 1.7 (95% CI 1.5 to 1.9), which was similar to the risk in DM (1.7 (1.6 to 1.8); p=0.64 for difference). The risk was significantly increased in all groups when stratifying on age and gender, with higher RRs in younger patients. This was especially pronounced in women <50 years with RA or DM, who were subject to a sixfold increase in RR. The RA-related risk of MI was unaffected by the duration of pharmacological RA treatment and corresponded to the overall risk of MI observed in non-RA subjects, who were on the average 10 years older. CONCLUSIONS: RA is associated with the same risk of MI as DM, and the risk of MI in RA patients generally corresponded to the risk in non-RA subjects 10 years older.
21288959 Remission is the goal for cardiovascular risk management in patients with rheumatoid arthr 2011 May OBJECTIVES: To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls. METHODS: 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations. RESULTS: Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers. CONCLUSION: Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.
21994423 Arthritic joint-targeting small interfering RNA-encapsulated liposome: implication for tre 2012 Jan RNA interference, mediated by small interfering RNA (siRNA), is effective in silencing genes with a high degree of specificity. To explore the therapeutic potential of systemically administered siRNA for rheumatoid arthritis (RA), we tested the complex of siRNA and the recently developed wrapsome (siRNA/WS) containing siRNA-encapsulated liposome in mice with collagen-induced arthritis (CIA). Mice with CIA received an intravenous injection of Cy5-labeled siRNA/WS. Fluorescence stereoscopic microscopy and flow cytometry were used to assess the siRNA/WS tissue distribution. The efficacy of siRNA-targeting tumor necrosis factor (TNF)-α/WS in CIA was evaluated by arthritis score. TNF-α mRNA levels in the joints were measured by real-time reverse transcriptase-polymerase chain reaction. The intensity of Cy5 fluorescence was higher in arthritic joints than in nonarthritic sites in Cy5-siRNA/WS-treated mice and remained higher up to 48 h after injection, compared with that in naked Cy5-siRNA-treated mice. Cy5 fluorescence intensity was higher in synovial cells than in splenocytes, bone marrow cells, and peripheral blood leukocytes. The majority of Cy5-positive synovial cells were CD11b⁺ with only a few CD3⁺ cells. Treatment with TNF-α siRNA/WS resulted in significant decreases in severity of arthritis and TNF-α mRNA level in the joints compared with control siRNA/WS. In conclusion, the use of our WS allowed efficient and targeted delivery of siRNAs to arthritic joints. The siRNA/WS was mainly incorporated into CD11b⁺ cells, including macrophages and neutrophils, in the inflamed synovium, suggesting its potential therapeutic effects in RA by silencing the expression of inflammatory molecules produced by these cells.
21373785 Killer immunoglobulin-like receptor and human leukocyte antigen-C genotypes in rheumatoid 2012 Jun The identification of patients who will respond to anti-tumor necrosis factor alpha (anti-TNF-α) therapy will improve the efficacy, safety, and economic impact of these agents. We investigated whether killer cell immunoglobulin-like receptor (KIR) genes are related to response to anti-TNF-α therapy in patients with rheumatoid arthritis (RA). Sixty-four RA patients and 100 healthy controls were genotyped for 16 KIR genes and human leukocyte antigen-C (HLA-C) group 1/2 using polymerase chain reaction sequence-specific oligonucleotide probes (PCR-SSOP). Each patient received anti-TNF-α therapy (adalimumab, etanercept, or infliximab), and clinical responses were evaluated after 3 months using the disease activity score in 28 joints (DAS28). We investigated the correlations between the carriership of KIR genes, HLA-C group 1/2 genes, and clinical data with response to therapy. Patients responding to therapy showed a significantly higher frequency of KIR2DS2/KIR2DL2 (67.7% R vs. 33.3% NR; P = 0.012). A positive clinical outcome was associated with an activating KIR-HLA genotype; KIR2DS2 (+) HLA-C group 1/2 homozygous. Inversely, non-response was associated with the relatively inhibitory KIR2DS2 (-) HLA-C group 1/2 heterozygous genotype. The KIR and HLA-C genotype of an RA patient may provide predictive information for response to anti-TNF-α therapy.
21932563 [Colonic microbial biocenosis in rheumatoid arthritis]. 2011 The aim of the work was to study colonic microbial biocenosis and colonizing ability of opportunistic bacteria in 32 patients with rheumatoid arthritis (RA) and 30 healthy subjects. RA was diagnosed based on the American Rheumatism Association criteria (1987). Qualitative and quantitative composition of the microflora was detected by a bacteriological method. StatSoft Statistics 6.0 was used to treat the data obtained. RA was associated with significant modification of the intestinal flora, viz. decrease in lactobacteria and significant increase of enterococci, clostridia, colibacteria showing reduced enzymatic activity, and opportunistic species. Also, symbiotic relationships between microorganisms altered. The fraction of bifidobacteria, bacteroids, and lactopositive colibacteria reduced while the abundance of opportunistic enterobacteria and staphylococci was elevated. Opportunistic Enterobacteriaceae were present in urine and nasal mucosa which suggested their translocation from the intestines. It is concluded that changes in intestinal microflora and colonization by opportunistic bacteria enhance the risk of development of co-morbid conditions in patients with RA.
21298625 The value of routine histopathology during hip arthroplasty in patients with degenerative 2011 Jan The purpose of this study was to evaluate the effectiveness of routine pathological examination of operative specimens obtained during primary total hip arthroplasty (THA) performed for osteoarthritis (OA) and rheumatoid arthritis (RA). 100 consecutive patients (50 OA, 50 RA) were prospectively evaluated. A radiological score (Kellgren-Lawrence/Larsen) and a clinical score (Harris Hip Score) were calculated in each case. Specimens of bone and cartilage from the femoral head as well as capsule were obtained intraoperatively. A histological grading (Mankin score) was obtained, and additional histological findings were also reported. In patients with RA the clinical and pathological diagnoses were concordant in 37 (74%) and discrepant in 13 patients (26%). In patients with OA there was concordance in 30 (60%) and discrepancy in 20 patients (40%). Discrepancies were additional findings such as focal osteonecrosis amyloidosis or crystal deposits. Discordance (management alteration) did not occur in any case. Histological evaluation of the capsule and the synovium was more informative than evaluation of bone. Calcium pyrophosphate (CPPD) and amyloid was frequently found in OA suggesting that these substances may contribute to joint damage, and control of their production by therapeutic means may prevent degeneration.
21418828 [The significance of serum peptidylarginine deiminase 4 in rheumatoid arthritis]. 2011 Feb OBJECTIVE: To detect the levels of serum peptidylarginine deiminase (PADI)4 and explore its significance in rheumatoid arthritis (RA). METHODS: The presence of PADI4, anti-PADI4 antibodies and anti-cyclic citrullinated peptide (CCP) antibodies levels were examined by enzyme-linked immunosorbent assay (ELISA). Serum samples were obtained from 100 patients with RA, 23 patients with other rheumatic diseases, and 24 healthy controls. The associations between PADI4 and the disease activity score using 28 joint counts (DAS28) score, anti-CCP antibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), PADI4-94 (rs 2240340) and PADI-104 (rs 1748033) gene polymorphisms and other indexes were analyzed in RA. RESULTS: The levels of PADI4 in RA patients were significantly higher than in other rheumatic diseases and healthy controls (F = 8.75, P < 0.001). There was no significantly difference in levels of PADI4 among ADI4-94 (rs 2240340)/PADI-104 (rs 1748033) genotypes. CONCLUSIONS: PADI4 is associated with disease activity involved in the RA pathogenesis and may be a RA pathogenic antigen.
21193352 Repeated vertebrobasilar thromboembolism in a patient with severe upper cervical instabili 2011 Feb BACKGROUND CONTEXT: Although many reports have examined upper cervical rheumatoid arthritis (RA) and spinal cord disorders resulting from RA lesions, few cases of thromboembolic events in the vertebrobasilar system associated with RA lesions of the upper cervical spine have been reported. PURPOSE: We encountered a rare case of repeated vertebrobasilar thromboembolism with severe upper cervical instability resulting from RA. Furthermore, we obtained clinical images of the vertebrobasilar system just before and after the first thromboembolic event. We thus present the case of a patient with RA who recovered without surgery from repeated vertebrobasilar thromboembolism that might have been caused by severe upper cervical instability. STUDY DESIGN: Case report. METHODS: A 59-year-old man with a 14-year history of RA experienced nuchal pain because of severe atlantoaxial and vertical subluxations. While awaiting surgery, he developed left Wallenberg syndrome because of occlusion in the left vertebral artery (VA). Five days later, he displayed impaired consciousness and symptoms of right Wallenberg syndrome. Emergency magnetic resonance angiography showed occlusion in the basilar artery. After thrombolytic therapy, he gradually recovered. RESULTS: Because we presumed that the patient's recurrent thrombus formation resulted from kinking of the right VA caused by severe instability of the upper cervical spine, we planned to treat him surgically despite his impaired consciousness and tracheostomy. However, the anesthesiologist would not approve surgery because the patient had high-risk conditions. The cervical spine was thus realigned and immobilized in a halo apparatus for 3 months to achieve stability. Now, more than 5 years after these events, the patient has experienced no more thromboembolic events and his condition has remained stable, without need for surgery. CONCLUSIONS: Repeated vertebrobasilar thromboembolism in patients with RA may sometimes be caused by severe upper cervical instability that can be treated without surgery.
22890178 [Quality of life of osteoporotic patients treated in rheumatology rehabilitation in-patien 2012 Aug 19 There has been no report on demographic, social and quality of life data of osteoporotic patients attending rheumatology rehabilitation in-patient units in Hungary. AIM: The authors analyzed the data of osteoporotic patients treated in rheumatology rehabilitation departments as in-patients in four hospitals in Hungary. METHODS: Demographic and social data were obtained by using a questionnaire developed by the authors, and quality of life was assessed with the use of the SF-36 questionnaire. The quality of life data of osteoporotic patients were compared to that obtained from patients with rheumatoid arthritis, osteoarthrosis and chronic low back pain who were treated in the same department at the same time. RESULTS: Of the 253 patients who were asked to participate in the study, 211 patients filled out the questionnaires. 25.6% of the patients were male. 58% of the patients were younger than 60 years of age, and 40% of them were heavy physical workers earlier. More than 50% of the patients did not complete secondary school education, and only 6.7% of the patients had a per capita monthly income higher than 100 000 HUF. The quality of life of the osteoporotic patients assessed by SF-36 scored 34.7, which was significantly lower than that of the mean of the Hungarian population scoring 70-90. The SF-36 scores of osteoporotic patients were lower in all domains compared to the scores of patients with rheumatoid arthritis, osteoarthritis and low back pain, although the difference was significant only in the domain of physical activity. The affective role of patients with osteoporosis was significantly lower than those with rheumatoid arthritis and osteoarthritis. CONCLUSIONS: Osteoporotic patients attending in-patient rheumatology in-patient rehabilitation units in Hungary have poor quality of life comparable, even worse than that found in patients with rheumatoid arthritis, osteoarthritis and chronic low back pain.
21794765 [Defining remission in Rheumatoid Arthritis. New ACR/EULAR criteria]. 2011 Mar Remission is the ideal treatment objective in the management of rheumatoid arthritis. To define remission, stringent criteria are needed which allow clinicians to assess the presence of active disease and which should be reliable enough to support therapeutic decisions. Currently there are many different remission classifications and none has been validated against important outcome measures such as the absence of progression of joint damage and disability. Recently, a subcommittee of the ACR and EULAR has proposed new criteria for remission based on a categorical classification and a composite score like SDAI allowing their use in clinical practice.
22997721 [Predictors of cardiovascular and cerebral complications in patients with rheumatoid arthr 2012 This 5-year long prospective cohort study of 124 young and middle-aged patients with rheumatoid arthritis (RA) initially without signs of cardiovascular diseases (CVD) aimed at estimating the risk and predictors of cardiovascular and cerebrovascular complications. The patients remained under observation till the following end-points were reached: coronary heart disease, chronic heart failure, disturbed cerebral circulation, cardiovascular death. The following predictors of unfavourable outcome were analysed: CVD risk factors, RA inflammatory activity, and markers of preclinical CVD. Ultrasonic scanning, dopplerography of common and internal carotid arteries, echocardiography, and determination of ankle-brachial index were used. 15 patients reached the end-points; specifically 6 cases of CVD, 4 cerebrovascular complications, and 5 deaths were documented. The total proportion of those survived without CVD was 0.88 (an equivalent to 15 (12%) of the observed events). Survival time till the end-points was 2.41+-1.54 years. CRP level 24 mg/l or higher (odd ratio 3.09, 95% CI 1.03-9.29), smoking (odd ratio 6.6, 95% CI 2.05-21.21), presence of atherosclerotic plaques (odd ratio 6.6, 95% CI 2.05-21.21) and calcinated plaques (odd ratio 8.95, 95% CI 1.36-47.03) in carotid arteries, SCORE risk >5% (odd ratio 19.82, 95% CI 3.25-41.75) were predictors of unfavourable prognosis in RA patients for the nearest 5 years. These data emphasize the necessity of thorough examination of RA patients for asymptotic atherosclerosis taking account of inflammatory activity and CVD risk factors for the optimization of early diagnostics and prediction of CVD.
22260818 Effect of oral clodronate on structural damage and bone turnover in rheumatoid arthritis. 2012 Jan OBJECTIVES: To study the effect of oral clodronate on structural damage and bone metabolism in rheumatoid arthritis (RA). METHODS: In this 2-year proof-of-concept study, sixty patients with at least moderately active RA were randomised to receive anti-rheumatic therapy alone or together with oral clodronate 1600 mg daily. Radiographs of hands and feet and serum samples for bone biomarkers were studied at baseline and at 24 months. RESULTS: At 24 months, progression of radiographic joint damage was similar in the 2 groups. Clodronate suppressed carboxyterminal cross-linked peptide of type I collagen (p=0.03) and aminoterminal propeptide of type I procollagen (p=0.01). Eight patients (27%) withdrew from clodronate therapy due to adverse drug reactions. CONCLUSIONS: Oral clodronate did not retard the focal bone damage in RA despite its beneficial effect on overall bone metabolism, as judged by the decrease in the reference bone biomarkers.
22562975 The impact of endogenous annexin A1 on glucocorticoid control of inflammatory arthritis. 2012 Nov OBJECTIVES: To establish the role and effect of glucocorticoids and the endogenous annexin A1 (AnxA1) pathway in inflammatory arthritis. METHODS: Ankle joint mRNA and protein expression of AnxA1 and its receptors were analysed in naive and arthritic mice by real-time PCR and immunohistochemistry. Inflammatory arthritis was induced with the K/BxN arthritogenic serum in AnxA1(+/+) and AnxA1(-/-) mice; in some experiments, animals were treated with dexamethasone (Dex) or with human recombinant AnxA1 or a protease-resistant mutant (termed SuperAnxA1). Readouts were arthritic score, disease incidence, paw oedema and histopathology, together with pro-inflammatory gene expression. RESULTS: All elements of the AnxA1 pathway could be detected in naive joints, with augmentation during ongoing disease, due to the infiltration of immune cells. No difference in arthritis intensity of profile could be observed between AnxA1(+/+) and AnxA1(-/-) mice. Treatment of mice with Dex (10 µg intraperitoneally daily from day 2) afforded potent antiarthritic effects highly attenuated in the knockouts: macroscopic changes were mirrored by histopathological findings and pro-inflammatory gene (eg, Nos2) expression. Presence of proteinase 3 mRNA in the arthritic joints led the authors to test AnxA1 and the mutant SuperAnxA1 (1 µg intraperitoneally daily in both cases from day 2), with the latter one being able to accelerate the resolving phase of the disease. CONCLUSION: AnxA1 is an endogenous determinant for the therapeutic efficacy of Dex in inflammatory arthritis. Such an effect can be partially mimicked by application of SuperAnxA1 which may represent the starting point for novel antiarthritic therapeutic strategies.
21895339 Raman spectroscopy detects deterioration in biomechanical properties of bone in a glucocor 2011 Aug Although glucocorticoids are frequently prescribed for the symptomatic management of inflammatory disorders such as rheumatoid arthritis, extended glucocorticoid exposure is the leading cause of physician-induced osteoporosis and leaves patients at a high risk of fracture. To study the biochemical effects of glucocorticoid exposure and how they might affect biomechanical properties of the bone, Raman spectra were acquired from ex vivo tibiae of glucocorticoid- and placebo-treated wild-type mice and a transgenic mouse model of rheumatoid arthritis. Statistically significant spectral differences were observed due to both treatment regimen and mouse genotype. These differences are attributed to changes in the overall bone mineral composition, as well as the degree of phosphate mineralization in tibial cortical bone. In addition, partial least squares regression was used to generate a Raman-based prediction of each tibia's biomechanical strength as quantified by a torsion test. The Raman-based predictions were as accurate as those produced by microcomputed tomography derived parameters, and more accurate than the clinically-used parameter of bone mineral density. These results suggest that Raman spectroscopy could be a valuable tool for monitoring bone biochemistry in studies of bone diseases such as osteoporosis, including tests of drugs being developed to combat these diseases.
21607711 A trans-ethnic genetic study of rheumatoid arthritis identified FCGR2A as a candidate comm 2012 Feb Rheumatoid arthritis (RA) is a common systemic autoimmune disease and its onset and prognosis are controlled by genetic, immunological, and environmental factors. The HLA locus, particularly HLA-DRB1, is its strongest genetic risk determinant across ethnicities. Several other genes, including PTPN22 and PADI4, show modest association with RA. However, they cover only a part of its genetic components and their relative contribution is different between populations. To identify novel genetic determinants, we took a candidate gene approach in a trans-ethnic manner. After critical selection of 169 genes based on their immunological function, we performed SNP discovery of these genes by the resequencing of exons and surrounding areas using European and Japanese DNAs. We then generated a panel of 1,509 SNPs for case-control association study in both populations. The DerSimonian-Laird test for meta-analysis, using the combined results of the two populations, identified rs7551957 at the 5'-flanking region of the low-affinity Fc-gamma receptor IIa (FCGR2A) gene as the strongest candidate for the association (p = 8.6 × 10(-5), odds ratio = 1.58 with 95%CI 1.25-1.99). Suggestive signals were also obtained for three SNPs in the dihydropyrimidine dehydrogenase (DPYD) gene (rs6685859; p = 1.3 × 10(-4), rs7550959; p = 1.5 × 10(-4) and rs7531138; p = 1.7 × 10(-4)) and an intronic SNP, rs2269310, of the erythrocytic spectrin beta (SPTB) gene (p = 7.9 × 10(-4)).
21467262 Gold sodium thiomalate for the treatment of rheumatoid arthritis in a patient with hepatit 2011 Apr OBJECTIVE: To describe a case of gold sodium thiomalate use for the treatment of rheumatoid arthritis (RA) in a patient with hepatitis B. CASE SUMMARY: A 53-year-old Korean American woman with mild RA and chronic hepatitis B infection was treated for worsening RA symptoms with subcutaneous injections of gold sodium thiomalate for 21 months, with the dosage decreased from the initial 40 mg per week to 40 mg every 3 weeks after 51 weeks of successful treatment. She had undergone treatment for hepatitis B in the past with lamivudine; however, she had not received that medication for at least 1 year prior to initiating treatment with gold sodium thiomalate injections. During the treatment period she achieved remission of RA without a significant elevation of her liver enzyme levels or reactivation of hepatitis B. DISCUSSION: Two main factors influence drug product selection when considering the subset of RA patients with chronic hepatitis B infection: severity of liver function compromise and treatment status of chronic hepatitis B. Our patient did not demonstrate significant liver function compromise, but was not receiving viral suppressive treatment for hepatitis B; therefore, the use of many first-line nonbiologic disease-modifying antirheumatic drugs (DMARDs) was contra-indicated based on current guideline recommendations. Additionally, because the patient had refused viral suppressive therapy, there was great concern with the use of biological DMARDs and potential reactivation of hepatitis B. In the past, gold salts were the standard of care in treating RA until the development of the newer agents and there was some evidence that gold sodium thiomalate could be used with minimal risk of hepatotoxicity. CONCLUSIONS: Gold sodium thiomalate proved to be a safe and effective treatment option in a patient with RA and hepatitis B.
22740142 Influence of BLK polymorphisms on the risk of rheumatoid arthritis. 2012 Nov B cell lymphocyte kinase (BLK) encodes a member of the Src kinase family and thus may influence the proliferation and differentiation of cells. A single nucleotide polymorphism (SNP) located in the first intron of BLK has shown that the risk C allele of rs2248932 is associated with lower levels of messenger RNA expression of BLK. We hypothesized that this polymorphism may contribute to rheumatoid arthritis (RA) susceptibility. We studied BLK rs2248932 T/C gene polymorphisms in 329 patients with RA and 697 controls in a Chinese population. Genotyping was done using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). When the BLK rs2248932 TT homozygote genotype was used as the reference group, the CC genotype was associated with a significantly increased risk of RA. In the recessive model, when the BLK rs2248932 TT/TC genotypes were used as the reference group, the CC homozygote genotype was associated with a significantly increased susceptibility to RA. In stratification analyses, a significantly increased risk for RA associated with the BLK rs2248932 CC genotype was evident among younger patients, CRP-negative patients and anti-CCP-positive patients compared with the BLK rs2248932 TT/TC genotype. The risk was also significantly evident among RF-positive patients, patients with lower ESR levels, patients with lower or higher DAS28 score and patients with a lower functional class. These findings suggested that the functional SNP BLK rs2248932 T/C variant allele was associated with RA development. However, our results were obtained from a moderate-sized sample, and therefore this is a preliminary conclusion. Validation in a larger study from a more diverse ethnic population is needed to confirm these findings.
21372513 A case of Weber-Christian disease with later development of rheumatoid arthritis. 2011 Weber-Christian disease (WCD) is a syndrome characterized by recurrent subcutaneous nodules, fever, occasional lipoatrophy, fatigue, arthralgia, and myalgia. We report a case of WCD associated with rheumatoid arthritis. A 65-year-old woman consulted our outpatient clinic because of bilateral hand swelling. The patient had presented with fever and subcutaneous nodules in her trunk and upper and lower extremities in 1983. At that time, the dermatology department diagnosed this patient as having WCD after biopsy of the nodules demonstrated lobular panniculitis. She has been treated with corticosteroid (5-15 mg/day) since then. The patient continued to have recurrent episodes of transient inflammatory arthritis in the small joints of the fingers and fever, and was initially assessed at our institution in October 2007. Finally, in November 2007, she was diagnosed as having both WCD and rheumatoid arthritis (RA) and treated with corticosteroid (5 mg/day) and methotrexate (MTX) (7.5 mg/week). Thereafter, her clinical symptoms gradually improved. This is the second case of WCD showing the subsequent development of RA, successfully treated with MTX, in the English literature. This case may provide clinical insight into WCD and RA.
21360490 Tocilizumab inhibits structural joint damage in rheumatoid arthritis patients with inadequ 2011 Mar OBJECTIVE: To assess the efficacy and safety of tocilizumab plus methotrexate (MTX) versus MTX alone in preventing structural joint damage and improving physical function and disease activity in patients with moderate-to-severe rheumatoid arthritis and inadequate responses to MTX. METHODS: A total of 1,196 patients were enrolled in a 2-year, randomized, double-blind, placebo-controlled trial. Patients received tocilizumab (8 mg/kg or 4 mg/kg) or placebo every 4 weeks plus MTX. Rescue treatment was available from week 16. Results from year 1 are presented. RESULTS: Mean change in the total Genant-modified Sharp score was 0.29 and 0.34 with tocilizumab 8 mg/kg plus MTX and 4 mg/kg plus MTX, respectively, versus 1.13 with placebo plus MTX (P < 0.0001 for both comparisons). Analysis of variance of the area under the curve for change from baseline in the disability index of the Health Assessment Questionnaire showed greater decreases with tocilizumab 8 mg/kg and 4 mg/kg (-144.1 and -128.4 units, respectively) than with placebo (-58.1 units; P < 0.0001 for both comparisons). Proportions of patients with American College of Rheumatology 20%, 50%, and 70% improvement and with Disease Activity Score in 28 joints remission were higher in those receiving 8 mg/kg tocilizumab than in those receiving placebo (P < 0.0001 for all comparisons). The safety profile of tocilizumab was consistent with the profiles in previous studies. Infections were the most common adverse and serious adverse events. CONCLUSION: The findings of this study show that tocilizumab plus MTX results in greater inhibition of joint damage and improvement in physical function than does MTX alone. Tocilizumab has a well-characterized safety profile.
22913098 Biomechanical analysis of rheumatoid arthritis of the wrist joint. 2012 Jul The wrist is the most complex joint for virtual three-dimensional simulations, and the complexity is even more pronounced when dealing with skeletal disorders of the joint such, as rheumatoid arthritis (RA). In order to analyse the biomechanical difference between healthy and diseased joints, three-dimensional models of these two wrist conditions were developed from computed tomography images. These images consist of eight carpal bones, five metacarpal bones, the distal radius and ulna. The cartilages were developed based on the shape of the available articulations and ligaments were simulated via mechanical links. The RA model was developed accurately by simulating all ten common criteria of the disease related to the wrist. Results from the finite element (FE) analyses showed that the RA model produced three times higher contact pressure at the articulations compared to the healthy model. Normal physiological load transfer also changed from predominantly through the radial side to an increased load transfer approximately 5% towards the ulnar. Based on an extensive literature search, this is the first ever reported work that simulates the pathological conditions of the rheumatoid arthritis of the wrist joint.