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ID PMID Title PublicationDate abstract
21962187 Methotrexate-induced cutaneous ulcers in a nonpsoriatic patient: case report and review of 2011 Sep BACKGROUND: Methotrexate is a mainstay of treatment for autoimmune conditions such as rheumatoid arthritis and psoriasis. Methotrexate has numerous potential side effects and, in rare circumstances, can lead to cutaneous ulceration. Methotrexate can cause skin ulceration, and stopping this medication can lead to complete healing of the ulcerated lesion. OBSERVATIONS: A 67-year-old man with rheumatoid arthritis on long-term methotrexate therapy presented to hospital with ulcers on his hands, elbows, and lower extremities. He had no history of psoriasis. Shortly after admission, the patient was noted to have pancytopenia. A bone marrow biopsy showed a hypocellular marrow. Both the cutaneous ulcers and the hypocellular marrow were thought to be induced by methotrexate. The ulcerated areas were biopsied, and histopathology showed no evidence of vasculitis. After 1 month of rehabilitative skin care, the patient's ulcers healed almost completely and his bone marrow suppression recovered. CONCLUSION: We report the fifth case of methotrexate-induced cutaneous ulceration in a nonpsoriatic patient and review the literature on this unusual drug reaction. Methotrexate can induce cutaneous ulceration in nonpsoriatic patients and should be considered a potential cause of ulceration in patients treated with this antimitotic agent.
22078700 [Meningeal and Guillain-Barrè syndrome in a patient with rheumatoid arthritis receiving a 2011 Nov Adalimumab is a recombinant human monoclonal antibody that blocks the effects of tumor necrosis factor-alpha, and is presently used for treatment of rheumatoid arthritis, with demyelination being a potential adverse effect. A 31 year-old male with seropositive rheumatoid arthritis presented with diarrhea after the second injection of adalimumab. He was treated with ciprofloxacin. In a few days he developed a Guillain-Barrè syndrome confirmed by electromyography, and his cerebrospinal fluid was compatible with meningeal syndrome or partially treated bacterial meningitis. Adalimumab may be associated with the development of demyelination and infectious diseases. Moreover, both the central nervous system and the peripheral nervous system can be affected.
22743847 The +1858C/T PTPN22 gene polymorphism confers genetic susceptibility to rheumatoid arthrit 2012 Sep INTRODUCTION: Rheumatoid arthritis (RA) is a common autoimmune disease with a complex genetic background. The PTPN22 gene encodes lymphoid tyrosine phosphatase LYP, a potent negative regulator of T cell activation. Polymorphic variants of this gene have previously been associated with various autoimmune disorders. The +1858C/T single-nucleotide polymorphism (SNP) (rs2476601), in the exon 14 of the PTPN22 gene has been associated with susceptibility to RA in several population. OBJECTIVE: The aim of this work was to investigate whether the +1858C/T of the PTPN22 gene is associated with susceptibility to RA in Western Mexico population. METHODS: A total of 309 unrelated RA patients, classified according to American College of Rheumatology (ACR) 1987 criteria, as well as 347 controls residents from Western Mexico were recruited for this study. The DNA samples were genotyped for +1858C/T PTPN22 gene SNP using the PCR-RFLP technique. Antibodies to cyclic citrullinated peptides (anti-CCP) were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The frequency of +1858T risk allele was significantly increased in patients with RA compared with controls (p=0.001, OR=2.83, 95%CI=1.50-5.32). To confirm this results we established a comparison between subjects carrying of CT+TT genotypes versus those carrying CC genotype, between both groups (p=0.004, OR=2.65, 95%CI=1.33-5.36). Nevertheless, we not observed association of the +1858C/T PTPN22 gene SNP with clinical activity and functional disability in RA patients. Likewise, the +1858T variant in RA patients seropositive for anti-CCP antibodies, increased the risk for RA (p=0.008, OR=2.5, 95%CI=1.3-5.0) when we compared with controls; however, in the group of seronegative patients, no was found significant difference (p=0.1, OR=2.5, 95%CI=0.9-7.2). CONCLUSIONS: Our results support the association of the +1858T risk allele of the +1858C/T PTPN22 polymorphism with susceptibility to RA and confirm that, in combination with anti-CCP antibodies, this SNP influence the autoimmune processes towards a development of RA in Mexican population.
22730056 Elevated serum osteopontin levels in chronic hepatitis C virus infection: association with 2012 Dec Owing to the suggested role of osteopontin (OPN) in inflammation, autoimmunity and fibrosis, we investigated their serum concentrations in chronic hepatitis C virus (HCV) infected patients with and without autoimmune manifestations and correlated those levels to clinical manifestations and the histological severity of hepatic fibrosis. A total of 70 chronic HCV-infected patients (35 with and 35 without autoimmune rheumatic manifestations‏) were compared with 35 healthy volunteers matched for age and gender. Epidemiological, clinical, immunochemical and virological data were prospectively collected. OPN serum levels were assessed by an Enzyme Linked Immunosorbant Assay. The mean serum OPN levels were higher in HCV patients with autoimmune rheumatologic manifestations and in patients without; than that for the normal controls (p = 0.000). The mean OPN values progressively increased by increasing severity of liver fibrosis (p = 0.009). Multivariate analysis revealed that the presence of rheumatologic manifestations had the highest predictive value (b = 7.141, Beta = 0.414, p = 0.000) followed by liver fibrosis (b = 4.522, Beta = 0.444, p = 0.000) on the variation of OPN levels in our HCV patients. Among the group of patients with HCV and rheumatologic involvement, OPN serum levels were higher in patients with positive cryoglobulin and rheumatoid factor than in those without, and with systemic vasculitis than in those without. Correlation analysis didn't reveal any statistical significance of OPN with age, serum albumin, aminotransferases and viral load. Our data suggests OPN as a promising marker for HCV associated autoimmune rheumatologic involvement, particularly with regard to development of vasculitis and cryoglobinemia. In addition, it could serve as a biomarker to evaluate the severity of liver damages in HCV infected subjects.
23052484 The levels of β-thromboglobulin in female rheumatoid arthritis patients as activation cri 2013 May The activation of the platelets plays a key role in the formation of thrombosis. The variables such as mean platelet volume, platelet factor 4 and β-thromboglobulin have been used in the demonstration of the platelet activation. However, when the literature was reviewed, there was not found any study investigating the level of β-thromboglobulin in patients with rheumatoid arthritis. Our goal is to evaluate the β-thromboglobulin levels together with mean platelet volume in patients with arthritis. This study is a clinical study which has a control group that has been designed prospectively, and in this study, Rheumatology Outpatient Clinic follow-up patients with rheumatoid arthritis and healthy control group were studied. All patients and healthy volunteers were examined β-thromboglobulin and mean platelet volume. Twenty-two patients with rheumatoid arthritis and 21 healthy volunteers participated in the study. β-Thromboglobulin mean was found as 98.00 ± 60.49 ng/mL in rheumatoid arthritis group and it was 62.38 ± 30.41 ng/mL in healthy control group. The differences between these groups were significant in terms of the levels of β-thromboglobulin (p = 0.02). We found significant differences between the groups in terms of mean platelet volume (p = 0.049). In this study, the level of β-thromboglobulin was found significantly higher in patients with rheumatoid arthritis, which is a chronic inflammatory disease. This result could be an indicator, such as platelet activation in patients with rheumatoid arthritis, or it may be a helper marker in the follow-up and treatment of developing cardiovascular risk.
22446868 Evaluation of disease modifying activity of Coriandrum sativum in experimental models. 2012 BACKGROUND & OBJECTIVES: Coriandrum sativum (CS), has been widely used in traditional systems of medicine for treatment of rheumatoid arthritis. However, the mechanism of action for its antiarthritic effects is not clearly known. Therefore, the present study was carried out to evaluate the antiarthritic activity of CS in rats in two experimental models. METHODS: The antiarthritic activity of CS seed hydroalcoholic extract (CSHE) was evaluated in adult Wistar rats by using two experimental models, viz. formaldehyde and Complete Freund's adjuvant (CFA) induced arthritis. The expression of pro-inflammatory cytokines (predominantly contributed by macrophages) was also evaluated. TNF- α level was estimated in serum by ELISA method. TNF-R1, IL-1 β and IL-6 expression in the synovium was analysed by immunohistochemistry. RESULTS: CSHE produced a dose dependent inhibition of joint swelling as compared to control animals in both, formaldehyde and CFA induced arthritis. Although there was a dose dependent increase in serum TNF-α levels in the CSHE treated groups as compared to control, the synovial expression of macrophage derived pro-inflammatory cytokines/cytokine receptor was found to be lower in the CSHE treated groups as compared to control. INTERPRETATION & CONCLUSIONS: Our results demonstrate that the antiarthritic activity of CSHE may be attributed to the modulation of pro-inflammatory cytokines in the synovium. In further studies CSHE could be explored to be developed as a disease modifying agent in the treatment of RA.
21702024 Increased density of sympathetic nerve fibers in metabolically activated fat tissue surrou 2011 Nov OBJECTIVE: To investigate the density of sympathetic nerve fibers in and the metabolic activation of fat tissue surrounding human synovium in rheumatoid arthritis (RA)/osteoarthritis (OA) and in the draining lymph nodes of arthritic and normal mice. METHODS: Using immunofluorescence and immunohistochemistry, the density of sympathetic nerve fibers and the presence of nerve repellent factors were investigated. The metabolic activation of fat tissue was estimated by the occurrence of small-vacuole adipocytes, expression of β3-adrenoceptors, and adipose tissue weight. RESULTS: The density of sympathetic nerve fibers was markedly increased in fat tissue surrounding RA synovium compared with that in fat tissue surrounding OA synovium. In adipose tissue adjacent to draining lymph nodes, the density of sympathetic nerve fibers was higher in arthritic mice compared with normal mice. In human synovium and mouse draining lymph nodes, the 2 sympathetic nerve repellent factors, semaphorin 3C and semaphorin 3F, were highly expressed. In arthritic compared with normal mice, the fat tissue around lymph nodes was markedly lighter, adipocytes had more fragmented lipid droplets, and fat tissue demonstrated high expression of β3-adrenoceptors. CONCLUSION: This study demonstrated an increased density of sympathetic nerve fibers in metabolically activated fat tissue surrounding human RA synovium and the draining lymph nodes of arthritic mice. Because sympathetic neurotransmitters stimulate lipolysis, the repulsion of sympathetic nerve fibers from inflamed regions and their increased occurrence in fat tissue probably represent an adaptive program to support the proinflammatory process by releasing energy-rich substrates.
21648047 Components of sleep quality and sleep fragmentation in rheumatoid arthritis and osteoarthr 2011 Sep OBJECTIVES: Poor sleep is increasingly recognized as contributing to a decreased quality of life, increased morbidity/mortality and heightened pain perception. The purpose of the present study was to assess components of sleep quality and self-identified contributors to sleep fragmentation in rheumatoid arthritis (RA) and osteoarthritis (OA) patient populations. METHODS: Consecutive RA and OA clinic patients were invited to participate in a self-administered questionnaire study which included the validated multi-domain Pittsburgh Sleep Quality Index (PSQI), visual analogue scales for pain, fatigue, global functioning, modified Health Assessment Questionnaire (mHAQ), stress scores, the Centre for Epidemiologic Studies-Depression (CES-D) score, the 36-item short form (SF-36) quality of life measure, the Rheumatoid Arthritis Disease Activity Index (RADAI), the Epworth Sleepiness Scale (ESS), Berlin score for obstructive sleep apnoea (OSA) risk and the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria. RESULTS: The study population included 145 RA and 78 OA patients. PSQI global scores were >5 in 62% of RA and 67% of OA patients. Multivariate analysis identified global functioning and the CES-D to be independent predictors for higher global PSQI scores in RA patients, whereas in OA patients predictors were the mHAQ and SF-36 mental component summary. Abnormalities in subjective sleep assessment, sleep latency, sleep duration, sleep efficiency, daytime dysfunction and increased sleep-aid medication use were observed in both populations. The most common abnormality reported by both RA and OA patients was increased sleep fragmentation. The most frequent self-identified cause for sleep disturbance was 'need to use the washroom' by 51% of RA and 49% of OA patients, and, second most common, 'pain' was identified as a cause for awakening by 33% of RA and 45% of OA patients. CONCLUSIONS: A high prevalence of abnormal sleep quality in both RA and OA patient populations was observed. The most common abnormality was sleep fragmentation, with an increased sleep disturbance score. 'Need to use the washroom' and 'pain' were the most common self-identified reasons for awakening from sleep. A review of sleep hygiene, optimization of urological status, and rheumatological disease symptomatic control may prove beneficial in terms of sleep health.
21068098 Study of the common genetic background for rheumatoid arthritis and systemic lupus erythem 2011 Mar BACKGROUND: Evidence is beginning to emerge that there may be susceptibility loci for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) that are common to both diseases. OBJECTIVE: To investigate single nucleotide polymorphisms that have been reported to be associated with SLE in a UK cohort of patients with RA and controls. METHODS: 3962 patients with RA and 9275 controls were included in the study. Eleven SNPs mapping to confirmed SLE loci were investigated. These mapped to the TNFSF4, BANK1, TNIP1, PTTG1, UHRF1BP1, ATG5, JAZF1, BLK, KIAA1542, ITGAM and UBE2L3 loci. Genotype frequencies were compared between patients with RA and controls using the trend test. RESULTS: The SNPs mapping to the BLK and UBE2L3 loci showed significant evidence for association with RA. Two other SNPs, mapping to ATG5 and KIAA1542, showed nominal evidence for association with RA (p=0.02 and p=0.02, respectively) but these were not significant after applying a Bonferroni correction. Additionally, a significant global enrichment in carriage of SLE alleles in patients with RA compared with controls (p=9.1×10(-7)) was found. Meta-analysis of this and previous studies confirmed the association of the BLK and UBE2L3 gene with RA at genome-wide significance levels (p<5×10(-8)). Together, the authors estimate that the SLE and RA overlapping loci, excluding HLA-DRB1 alleles, identified so far explain ∼5.8% of the genetic susceptibility to RA as a whole. CONCLUSION: The findings confirm the association of the BLK and UBE2L3 loci with RA, thus adding to the list of loci showing overlap between RA and SLE.
22223704 Comparison of radiographic scoring methods in a cohort of RA patients treated with anti-TN 2012 May OBJECTIVE: To compare the ability of the simple erosion narrowing score (SENS) to classify radiographic progression relative to the Sharp/van der Heijde score (SHS) in a prospective cohort of anti-TNF-treated RA patients. METHODS: Radiographs of the hands, wrists and feet of patients enrolled in a pharmacovigilance programme are performed every 2 years. These radiographs were read in chronological order by three rheumatologists and scored using the SHS. SENS scores were derived from the SHS. Additionally, one rheumatologist scored the radiographs using the SENS method only. Patients with radiographic progression in excess of the smallest detectable change were classified as progressors. The probability of agreement and κ-value between the SHS and SENS methods for determining progression was calculated. RESULTS: A sample of 25 patients was selected from the database. The annualized mean (s.d.) change in SHS score was 6.61 U (7.48 U) and in SENS score was 2.27 U (2.17 U). Five patients were classified as progressors using SHS and seven using SENS, with a probability of agreement of 84% (κ = 0.565). CONCLUSION: The SENS method captures radiographic progression reliably compared with the more detailed SHS method. SENS is suitable for application in clinical practice or in observational cohorts.
22975732 Efficacy of adjunct tacrolimus treatment in patients with rheumatoid arthritis with inadeq 2013 Jul OBJECTIVES: We aimed to assess the efficacy of tacrolimus (TAC) as an add-on therapy in patients with rheumatoid arthritis (RA) who were previously treated with methotrexate (MTX) but not with biologics. METHODS: The study group (MTX + TAC group) consisted of 157 patients (selected from among the patients in the Institute of Rheumatology, Rheumatoid Arthritis [IORRA] RA cohort from April 2005 to October 2009) who received add-on therapy with TAC in addition to MTX, but without biologics. A propensity score (PS) for the use of TAC was derived, and 471 PS-matched patients who received MTX alone or MTX with other non-biologic disease-modifying antirheumatic drugs (except for TAC), but not with biologics, were selected and served as the control group. Changes in disease activity in the two groups during three consecutive IORRA phases were analyzed by adjusting for confounding factors. RESULTS: The median 28-joint disease activity score (DAS28) decreased from 4.58 to 3.70 in the MTX + TAC group and from 4.12 to 3.61 in the control group. After adjusting for confounding factors, the decrease in the DAS28 score in the MTX + TAC group was significantly larger (by 0.273 points) than that in the control group (P < 0.05). CONCLUSION: This study demonstrated the efficacy of add-on therapy with TAC to MTX in patients with RA in daily practice.
22760002 Longitudinal model-based meta-analysis in rheumatoid arthritis: an application toward mode 2012 Sep Summary-level longitudinal data on the clinical efficacy of drugs for rheumatoid arthritis (RA) are available in the literature. This information can be used to optimize the clinical development of new drugs for RA. The aim of this study was twofold: first, to quantify the time course of the ACR20 score across approved drugs and patient populations, and second, to apply this knowledge in the decision-making process for a specific compound, canakinumab. The integrated analysis included data from 37 phase II-III studies describing 13,474 patients. It showed that, with the tested doses/regimens of canakinumab, there was only a low probability that this drug would be better than the most effective current treatments. This finding supported the decision not to continue with clinical development of canakinumab in RA. This paper presents the first longitudinal model-based meta-analysis of ACR20. The framework can be applied to any other compound targeting RA, thereby supporting internal and external decision making at all clinical development stages.
22633398 Inclusion of gene-gene and gene-environment interactions unlikely to dramatically improve 2012 Jun 8 Genome-wide association studies have identified hundreds of common genetic variants associated with the risk of multifactorial diseases. However, their impact on discrimination and risk prediction is limited. It has been suggested that the identification of gene-gene (G-G) and gene-environment (G-E) interactions would improve disease prediction and facilitate prevention. We conducted a simulation study to explore the potential improvement in discrimination if G-G and G-E interactions exist and are known. We used three diseases (breast cancer, type 2 diabetes, and rheumatoid arthritis) as motivating examples. We show that the inclusion of G-G and G-E interaction effects in risk-prediction models is unlikely to dramatically improve the discrimination ability of these models.
23006627 Low infliximab serum trough levels and anti-infliximab antibodies are prevalent in rheumat 2012 Sep 24 BACKGROUND: To get insight in the prevalence of high, or low/no serum infliximab trough levels in patients with low disease activity and if serum trough levels are stable and reliable longitudinally we conducted a prospective cohort study METHODS: In a longitudinal, observational cohort of RA patients treated with infliximab for at least 6 months, treatment interval, DAS28, infliximab trough levels and anti-infliximab antibodies were assessed. Prevalence of low (<1 mg/l) and high (>5 mg/l) infliximab serum trough levels and anti-infliximab antibodies was recorded. Relationship of a change in anti-infliximab antibodies and treatment interval was described. Reliability of consecutive infliximab serum trough levels and anti-infliximab antibodies in patients with stable DAS28 and treatment was analysed with Spearman correlation and kappa-analysis. RESULTS: 147 patients with a mean disease duration of 11 years (sd7) and DAS28 of 3.5 (sd1.3) at baseline were followed during 1.5 years. Inter-individual variability in infliximab levels in patients with low DAS28 was high (median 1.4 mg/L, IQR 3.35), with 31% (95%CI: 20-42%) having low (<1 mg/L) and 14% (95%CI 5-22) high trough levels (>5 mg/L). Interestingly also in RA patients with DAS28 ≤ 3.2, anti-infliximab antibodies were found in one-third of the patients, with half of them having antibodies every visit during a median of more than one year. Agreement for consecutive measurements of serum trough levels and anti-infliximab antibodies was high in stable patients: r = 0.97 (p = 0.00001) and kappa = 1.0 (SE 0.14) Anti-infliximab antibody appearance was influenced by interval increases (relative risk (RR) 5.2, 2.6-10.7), but patients still showed low infliximab levels. CONCLUSIONS: Low (and high) infliximab serum trough levels are prevalent, interestingly also in patients with low disease activity. Consecutive measurements of serum trough levels and anti-infliximab antibodies are reliable in stable patients. These test could be used to lower or stop infliximab in selected patients.
22009376 Systemic blockade of TNF-α does not improve insulin resistance in humans. 2011 Oct The purpose of this study was to determine whether long-term modulation of inflammatory activity by tumor necrosis factor (TNF)-α inhibitors has some influence on insulin resistance (IR). 16 active rheumatoid arthritis (RA) patients without CV risk factors treated with anti-TNF-α agents were included in this study. RA activity by disease activity score 28, IR by HOMA2-IR, body composition by impedance analysis, physical activity by accelerometry, abdominal fat distribution by magnetic resonance imaging, and serum level of key adipokines by ELISA were measured at baseline and during a 1-year follow-up period. Patient body mass index increased significantly (26.94 ± 3.88 vs. 28.06 ± 4.57 kg/m2, p=0.02) after 1 year of treatment. Body composition, in terms of fat and fat-free mass, remained unchanged except for a significant elevation in body cell mass (25.50 ± 4.60 vs. 26.60 ± 3.17 kg, p=0.02). Basal levels of IR in the RA patients included in this study were significantly higher than healthy controls (1.6 ± 0.8 vs. 1.11 ± 0.56, p=0.011) but did not change during the follow-up. Nor did basal concentrations of adiponectin, visfatin, leptin, ghrelin, resistin, and apelin in response to anti-TNF-α treatment; only retinol-binding protein 4, showed a significant increase (51.7 ± 32.7 vs. 64.9 ± 28.4 μg/ml, p=0.03) at the end of the study. IR, adiposity distribution, and serum levels of most adipokines are not significantly affected by long-term inhibition of TNF-α in RA patients. Our data suggest that although systemic blockade of TNF-α exerts an anticachectic effect in RA patients, it does not seem to play a major role in IR.
22994085 [Markers of endothelial activation in rheumatoid arthritis]. 2012 AIM: To study relationships between endothelial activation parameters and inflammatory activity markers in patients with rheumatoid arthritis (RA). SUBJECTS AND METHODS: Fifty-three RA patients aged 19 to 62 years were examined. A control group comprised 28 apparently healthy individuals. The markers of endothelial activation, the parameters of RA activity, and their relationship were studied. RESULTS: There was an elevation in the level of interleukin-8 (IL-8) to 413 (295; 547) pg/ml as compared to the control group 208 (207; 212) pg/ml. In the RA group, the concentration of soluble vascular cell adhesion molecule 1 (sVCAM-1) increased up to 1929 (1297.6; 2739.6) ng/ml whereas in the control group it was 750 (734; 762) ng/ml (p < 0.001). In the patients with RA, the concentration of von Willebrand factor antigen (vWFAg) reached 1.4 (0.8; 1.9) IU/ml; in the control group, it was 0.6 (0.3; 0.8) IU/ml. In the RA group, the level of desquamated endotheliocytes (DE) was higher than that in the control group. Positive correlations were found between the markers of vascular endothelial activation and those of inflammation. There was a positive correlation between C-reactive protein (CRP), rheumatoid factor (RF), sVCAM-1, and DE. Significant positive correlations were observed between DAS28 and the inflammatory markers RF and CRP (R = 0.66; p < 0.05 and R = 0.4; p < 0.05) and the endothelial activation markers sVCAM-1 and vWFAg (R = 0.8; p < 0.05 and R = 0.3; p < 0.05, respectively). CONCLUSION: The patients with RA had elevated IL-8, sVCAM-1, and vWFAg levels. Enhanced RA activity resulted in endothelial damage.
22785612 Association analysis of the CCL3L1 copy number locus by paralogue ratio test in Norwegian 2012 Oct Genotyping of multiallelic copy number variants (CNVs) is technically difficult and can lead to inaccurate conclusions. This is reflected by inconsistent results published for the CNV C-C chemokine ligand 3-like 1 (CCL3L1) and its contribution to rheumatoid arthritis (RA) susceptibility. In order to draw robust conclusions about CCL3L1 involvement in RA, we have performed association analysis (CNVtools) using genotyping by the paralogue ratio test of a Norwegian RA case-control material (N=1877). We also analyzed the associations after stratification for anti-citrullinated peptide antibody (ACPA) status. Clear clusters representing specific copy number classes were evident, but significant differential bias was observed resulting in a systematic trend toward slightly higher apparent copy number for cases relative to controls. Controlling for bias revealed no significant differences in copy number distribution either between all patients and controls, or after ACPA stratification. Our results do not support involvement of the CCL3L1 CNV in RA susceptibility.
22658606 Management of the temporomandibular joint in rheumatoid disorders. 2013 Apr This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon.
23251214 Non-MHC risk alleles in rheumatoid arthritis and in the syntenic chromosome regions of cor 2012 Rheumatoid arthritis (RA) is a polygenic autoimmune disease primarily affecting the synovial joints. Numerous animal models show similarities to RA in humans; some of them not only mimic the clinical phenotypes but also demonstrate the involvement of homologous genomic regions in RA. This paper compares corresponding non-MHC genomic regions identified in rodent and human genome-wide association studies (GWAS). To date, over 30 non-MHC RA-associated loci have been identified in humans, and over 100 arthritis-associated loci have been identified in rodent models of RA. The genomic regions associated with the disease are designated by the name(s) of the gene having the most frequent and consistent RA-associated SNPs or a function suggesting their involvement in inflammatory or autoimmune processes. Animal studies on rats and mice preferentially have used single sequence length polymorphism (SSLP) markers to identify disease-associated qualitative and quantitative trait loci (QTLs) in the genome of F2 hybrids of arthritis-susceptible and arthritis-resistant rodent strains. Mouse GWAS appear to be far ahead of rat studies, and significantly more mouse QTLs correspond to human RA risk alleles.
22623367 Screening for signs and symptoms of rheumatoid arthritis by family physicians and nurse pr 2012 Dec OBJECTIVE: To evaluate the sensitivity and specificity of the Gait, Arms, Legs, and Spine (GALS) examination to screen for signs and symptoms of rheumatoid arthritis (RA) when used by family physicians and nurse practitioners. METHODS: Participating health care professionals (2 rheumatologists, 3 family physicians, and 3 nurse practitioners) were trained to perform the GALS examination by viewing an instructional DVD and attending a training workshop. One week after training, the health care professionals performed the GALS examination on 20 individuals with RA and 21 individuals without RA. All participants were recruited through 2 rheumatology practices, and each participant was assessed by 4 health care professionals. The health care professionals were asked to record whether observed signs and symptoms were potentially consistent with a diagnosis of RA. The health care professionals understood the study objective to be their agreement on GALS findings among one another and were unaware that one-half of the participants had RA. Sensitivity and specificity were calculated to determine the ability of the GALS examination to screen for RA using the rheumatologist as the standard for comparison. RESULTS: Sensitivity and specificity values varied from 60-100% and 70-82%, respectively, for the 3 family physicians, and 60-90% and 73-100%, respectively, for the 3 nurse practitioners. CONCLUSION: Following a very short training period, family physicians and nurse practitioners appeared to be able to use the GALS examination as a screening tool for RA signs and symptoms, particularly for identifying an individual with positive results who will benefit from further investigation or rheumatology referral.