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ID PMID Title PublicationDate abstract
23027334 [Proximal interphalangeal (PIP) finger prosthesis - what have we learnt? Experiences over 2012 Oct PURPOSE: In the following article we evaluate the clinical and radiological results after PIP joint replacement to answer the question if the outcome improved over the last years. PATIENTS AND METHODS: In a retrospective clinical study 53 patients with 66 PIP joint implants (SBI-Avanta, Small Bone Innovations, Inc.) were assessed on the basis of clinical and radiological parameters. We examined the patients' range of motion, their grip strength, the rate of radiological loosening, the development of pain and the patients' satisfaction. 2 groups were included in the study. Patients operated from 2001 to 2007 (group A) were compared with patients operated from 2008 to 2011 (group B). To facilitate a standardized examination, we developed a score providing a comprehensive representation of the outcome after PIP joint replacement. RESULTS: Group B showed significant improvement in the rate of loosening of the prosthesis (44-4%) in the last follow-up examination. Further improvement was demonstrated in pain reduction, range of motion (77°/67°), the patients' satisfaction and development of swan neck deformity (11%/18%). There was no significant improvement in the patients' grip strength and the rate of revision surgery. CONCLUSION: Overall, the results after PIP joint replacement are very good. All patients reported a marked improvement in pain reduction. In group B a significant reduction in the rate of loosening of the prosthesis was shown. Moreover, the rate of swan neck deformity, the range of motion, the reduction of pain and the patient's satisfaction improved over the last years. The application of a new PIP-joint-score for a standardized evaluation of the outcome indicated a good correlation with patient satisfaction over time. The experience of the past years enabled improvements in PIP joint replacement. We consider cementing the prosthesis, a large contact area between the prosthesis and the bone and an emphasis on easy intraoperative flexion/extension as factors which can improve the results after PIP joint replacement. However, some problems could not been solved to date. In this respect, prospective clinical and biomechanical studies are necessary.
21091853 A systematic approach for uptake of evidence on sex-specific issues in guidelines--a pilot 2012 Apr RATIONALE, AIMS AND OBJECTIVES: Increasing evidence indicates that sex-specific issues may have impact on prevention, diagnosis, or treatment. These issues are not systematically considered during the development of Dutch clinical practice guidelines. The aim of this study is to identify how members of guideline development groups discuss sex-specific evidence, and whether and how the outcomes of these discussions are reflected in the guideline. METHODS: Six guideline development committees (GDCs) were studied. Each committee was supported by a staff member from the guideline organization who was trained and received feedback to facilitate uptake of evidence on sex differences in the process of guideline development. Non-participant observation and transcription of audio recordings from 22 GDC meetings were performed. Content analysis of meeting transcripts and guidelines were studied to analyse characteristics of discussion episodes on sex-specific research data-based issues (subject matter, initiator and group approach towards the topic and themes) and whether or not conclusions on evidence were reflected in the final guideline text. RESULTS: Of the 87 identified discussion episodes, 68 dealt with sex-specific research evidence potentially relevant to guidelines. Respectively 51%, 28% and 21% of the latter episodes were initiated by committee members, staff members and chairpersons. Group approaches towards the subject matter were generally positive. Data from 60% of those episodes were reflected in the final guideline text. Sex-specific data on reproductive issues were more often discussed and reflected in guideline texts than data on other health issues. Discussion episodes on sex-specific evidence initiated by chairpersons were most often reflected in the guidelines. CONCLUSIONS: This pilot study indicates that GDCs regularly focused on sex-specific issues. The participation of a trained staff member contributed to this.
20541357 Five- to eight-year results of a prospective study in 118 arthroplasties using posterior-s 2011 Jun We prospectively enrolled 118 patients (133 knees) whose arthroplasties were performed using posterior-stabilized rotating-platform knee implants. Introduced in year 2000, this implant's performance beyond 5 years is not reported on, to date. We present 5- to 8-year (average, 6.5 years) results of 118 posterior-stabilized rotating-platform knee arthroplasties. Kaplan-Meier survival rate was 100%, considering revision or the need for it as the end point. Mean Knee Society Score improved from 27 (range, 1-54) to 96 (range, 54-100). Mean function score improved from 51 (range, 5-81) to 83 (range, 0-100). No patient had spin-out of rotating bearing or osteolysis. Postoperatively, knee flexion averaged 120° (range, 80°-155°), 34% patients achieved more than 130° flexion, and 67% patients could sit cross legged. Only 5% patients presented with patellofemoral symptoms.
21725875 Effect of electro-acupuncture on tumor necrosis factor-α and vascular endothelial growth 2011 Jul OBJECTIVE: To observe the effect of electro-acupuncture (EA) on tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in peripheral blood and joint synovia in patients with rheumatoid arthritis (RA) to verify the clinical efficacy of EA. METHODS: Adopting randomized controlled principle, the 63 RA patients enrolled were assigned to two groups, the 32 patients in the EA group were treated with EA, and the 31 patients in the simple needling (SN) group treated with simple needling. According to the integral-local combining method, the acupoints were selected mainly from yang-meridian and local Ashi points (pain-point). EA or SN was applied every other day, 10 times as a course, and each patient received a total of 3 courses of treatment. RESULTS: Blood and synovial levels of TNF-α and VEGF were reduced significantly after treatment in both groups. The lowering (absolute value and difference value) of TNF-α as well as the absolute value of VEGF, either in blood or in synovia, were similar in the two groups (P>0.05); but the lowering of VEGF after treatment was more significant in the EA group than that in the SN group (P<0.05). CONCLUSION: EA could effectively lower the contents of TNF-α and VEGF in peripheral blood and joint synovia to improve the internal environment for genesis and development of RA, so as to enhance the clinical therapeutic effectiveness.
21261760 When to initiate and discontinue biologic treatments for rheumatoid arthritis? 2011 Jun The introduction of biologic therapies heralded a new era in the treatment for chronic inflammatory autoimmune diseases of which rheumatoid arthritis is one of the most prevalent. From a scientific point of view, these therapies demonstrated that the targeting of individual cytokines or cell-surface markers is a very effective approach. For the physician, the appropriate selection of patients in whom these therapies should be initiated is critical, as is the even more contentious issue of whether these therapies can or should be discontinued in selected patients with excellent clinical responses. Whereas the former issue has been addressed in a large number of clinical trials and observational studies, the latter remains poorly investigated and is currently the subject of further study.
21267755 Impact of natural disasters on the functional and health status of patients with rheumatoi 2011 Aug To examine the effects of natural disasters on rheumatoid arthritis (RA) patients we conducted a questionnaire survey targeted to 1,477 members of a nationwide RA patient group in Japan who lived in the municipalities affected by natural disasters between 2004 and 2006. Functional statuses measured by the modified Health Assessment Questionnaire and self-rated health statuses before and after the events were retrospectively examined. The associations between the changes in functional and health status and socio-demographics, direct damage, and preparedness status were statistically analyzed. Of the 665 individuals who responded, the data on 192 women RA patients were analyzed. The values at 1 and 6 months post-event were the same, with 14% experiencing deteriorations of functional status, while 22% experienced a worsening of self-rated health status. Those in poorer functional status before the events were more likely to experience deteriorations of functional [odds ratio (OR) 4.4, 95% confidence interval (CI) 1.5-13.6] and health (OR 2.8, 95% CI 1.2-6.7) status at both 1 month and 6 months (OR 3.9, 95% CI 1.3-12.0, and OR 2.8, 95% CI 1.2-6.7, respectively) after the events. Based on these results, we conclude that the functional and health status of women RA patients could worsen due to the consequences of a natural disaster, with a disproportionately large impact upon those with a poorer functional status.
23726309 [Corneal chrysiasis. Gold salt deposits in the cornea in a patient with rheumatoid arthrit 2013 Jun CASE REPORT: A 60-year-old woman with rheumatoid arthritis of 20 years onset, on treatment with monthly intramuscular gold salts (GS) for the last 7 years. She complained of suffering from halo vision, and the examination showed a visual acuity of 0.6 in both eyes (BE). The slit lamp showed some deposits in the stroma with scattered golden granulated, without any further inflammatory reaction. DISCUSSION: GS deposits are dose-dependent and reversible, although very slowly. In this article, we introduce, for the first time, evidence of deposits of GS in all layers of the cornea, predominantly in the corneal stroma and in the endothelium.
22647501 Evaluating joint-space narrowing and cartilage loss in rheumatoid arthritis by using MRI. 2012 May 30 INTRODUCTION: Magnetic resonance imaging (MRI) has been shown to be superior to radiography (XR) for assessing synovitis, osteitis, and bone erosion in rheumatoid arthritis (RA), particularly in clinical trials. However, relatively little has been reported on the ability of MRI to evaluate articular cartilage loss, or joint-space narrowing (JSN), in the hands and wrists. In a previous study, we adapted the nine-point Genant-modified Sharp XR-JSN score for use with MRI (MRI-JSN). In this study, we compare MRI-JSN with XR-JSN by using images from two multicenter clinical trials. METHODS: Baseline XR and 1.5-Tesla MR images of one hand and wrist from each of 47 subjects with RA enrolled in one of two multicenter clinical trials were evaluated by using the XR-JSN and MRI-JSN methods by a single radiologist experienced in the two methods. Radiographs and MR images were read independently on different occasions. RESULTS: In total, 575 of 611 joints were compared (one metacarpophalangeal joint of the thumb and 35 proximal interphalangeal joints were outside the MRI field of view and could not be assessed). The 22 (47%) subjects showed JSN with both XR and MRI, and 25 (53%) subjects showed no JSN with either method. No subject showed JSN with only one or the other method. MRI showed high agreement with XR (intraclass correlation coefficient = 0.83). Sensitivity of MRI for JSN, by using XR as the gold standard, was 0.94; specificity was 0.91; accuracy was 0.91; positive predictive value was 0.64; and negative predictive value was 0.99. CONCLUSIONS: This validation exercise suggests that MRI JSN scoring may offer a viable alternative to XR JSN scoring in multicenter clinical trials of RA. However, the relative longitudinal sensitivity of MRI to change and the ability to discriminate therapeutic effect on JSN were not evaluated in this study.
22130974 Avidity maturation of anti-citrullinated protein antibodies in rheumatoid arthritis. 2012 May OBJECTIVE: Anti-citrullinated protein antibodies (ACPAs) are highly specific for rheumatoid arthritis (RA) and are present years before the onset of symptoms. The avidity of autoantibodies can have a strong impact on their effector potency. This study was undertaken to analyze the avidity of ACPAs in serum samples obtained from ACPA-positive healthy individuals (predisease), patients with early disease, and patients with established RA as well as the avidity maturation over time in samples from healthy subjects who later developed RA. METHODS: We measured ACPA avidity in serum samples from ACPA-positive healthy individuals, symptomatic individuals, and patients with established RA in 5 collections from The Netherlands, Canada, and Austria. We determined the dynamics of avidity maturation of ACPAs from the predisease stage to established disease in 1 case from the native North American population and in 10 cases from a Dutch blood donor cohort. RESULTS: The overall ACPA response was characterized by low-avidity antibodies. Higher-avidity ACPAs were observed in symptomatic patients only, while low-avidity ACPAs were observed in both healthy subjects and patients. In longitudinal samples obtained from subjects prior to disease onset, ACPA avidity increased over time until disease onset. No further avidity maturation was observed after disease onset. CONCLUSION: Our findings indicate that avidity maturation of the ACPA response takes place prior to disease onset.
21328257 Herbal therapy for treating rheumatoid arthritis. 2011 Feb 16 BACKGROUND: Herbal medicine interventions have been identified as having potential benefit in the treatment of rheumatoid arthritis (RA). OBJECTIVES: To update an existing systematic (Cochrane) review of herbal therapies in RA. SEARCH STRATEGY: We searched electronic databases Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, AMED, CINAHL, Web of Science, Dissertation Abstracts (1996 to 2009), unrestricted by language, and the WHO International Clinical Trials Registry Platform in October 2010. SELECTION CRITERIA: Randomised controlled trials of herbal interventions compared with placebo or active controls in RA. DATA COLLECTION AND ANALYSIS: Two authors selected trials for inclusion, assessed risk of bias and extracted data.  MAIN RESULTS: Twelve new studies were added to the update, a total of 22 studies were included.Evidence from seven studies indicate potential benefits of gamma linolenic acid (GLA) from evening primrose oil, borage seed oil, or blackcurrent seed oil, in terms of reduced pain intensity (mean difference (MD) -32.83 points, 95% confidence interval (CI) -56.25 to -9.42,100 point pain scale); improved disability (MD -15.75% 95% CI -27.06 to -4.44%); and an increase in adverse events (GLA 20% versus placebo 3%), that was not statistically different (relative risk 4.24, 95% CI 0.78 to 22.99).Three studies compared Tripterygium wilfordii (thunder god vine) to placebo and one to sulfasalazine and indicated improvements in some outcomes, but data could not be pooled due to differing interventions, comparisons and outcomes. One study reported serious side effects with oral Tripterygium wilfordii Hook F. In the follow-up studies, all side effects were mild to moderate and resolved after the intervention ceased. Two studies compared Phytodolor(®) N to placebo but poor reporting limited data extraction. The remaining studies each considered differing herbal interventions. AUTHORS' CONCLUSIONS: Several herbal interventions are inadequately justified by single studies or non-comparable studies in the treatment of rheumatoid arthritis. There is moderate evidence that oils containing GLA (evening primrose, borage, or blackcurrant seed oil) afford some benefit in relieving symptoms for RA, while evidence for Phytodolor® N is less convincing.Tripterygium wilfordii products may reduce some RA symptoms, however, oral use may be associated with several side effects. Many trials of herbal therapies are hampered by research design flaws and inadequate reporting. Further investigation of each herbal therapy is warranted, particularly via well designed, fully powered, confirmatory clinical trials that use American College of Rheumatology improvement criteria to measure outcomes and report results according to CONSORT guidelines.
20824799 Responsiveness of the ABILHAND questionnaire in measuring changes in rheumatoid arthritis 2011 Jan OBJECTIVE: ABILHAND is a Rasch-built questionnaire that measures manual ability in rheumatoid arthritis (RA) patients. This study aimed to examine the test-retest reliability and the responsiveness of ABILHAND in RA patients. METHODS: Eighty-eight patients underwent 3 evaluations: the first evaluation was at baseline (time 1), the second was 2 weeks later (time 2), and the third was 1 year later (time 3). Disease activity was assessed using the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP). Patients rated the intensity of their RA-related pain using a 100-mm visual analog scale for pain and completed questionnaires based on their activity limitations (ABILHAND and the Health Assessment Questionnaire) and quality of life. RESULTS: The responsiveness analyses were conducted by using global, group, and individual approaches. The global approach showed significant differences between the time 1 and time 3 scores of the DAS28-CRP (P = 0.04) and ABILHAND (P = 0.04). Based on the changes in disease activity scores and the European League Against Rheumatism response criteria, the sample was divided into 3 groups: deteriorated, stable, and improved. The mean ± SD changes in manual ability were higher in the deteriorated (-1.23 ± 1.53 logit) and in the improved (1.22 ± 2.06 logits) groups than in the stable group (0.48 ± 1.09 logit). The effect size and standardized response mean confirmed that observation. The minimal clinically important difference was assessed in each group of patients. CONCLUSION: The ABILHAND questionnaire exhibited responsiveness in detecting slight changes in RA patients. Therefore, the ABILHAND tool can be used to evaluate the functional status of RA patients in clinical trials and settings.
22032557 Early effects of IL-6 receptor inhibition on bone homeostasis: a pilot study in women with 2011 Nov OBJECTIVES: A critical role of interleukin-6 (IL-6) in bone homeostasis has been suggested in experimental studies. We examined whether inhibition of IL-6 receptor in patients with rheumatoid arthritis (RA) results in early alterations of circulating markers of bone remodelling. METHODS: Circulating levels of osteoprotegerin, receptor activator of nuclear factor-kappaB ligand (RANKL), Wnt signalling pathway inhibitors Dickkopf-1 (Dkk-1) and sclerostin, markers of bone resorption (C-terminal cross-linking telopeptide of collagen type-I (CTX), tartrate-resistant acid phosphatase isoform-5b) and bone formation (bone-specific alkaline-phosphatase, osteocalcin) were examined in 22 women with active RA before and after two monthly infusions of tocilizumab (8mg/kg each); 'healthy', non-osteopenic, 1:1 age-matched women served as controls. RESULTS: At baseline, osteoprotegerin/RANKL ratio in patients was lower than controls by 5-fold; circulating osteoprotegerin correlated negatively with corresponding 28-joint-count disease activity scores and circulating RANKL correlated positively with C-reactive protein. Also, Dkk-1, sclerostin, CTX and osteocalcin levels were higher in RA than controls. After two months, osteoprotegerin/RANKL ratio increased, Dkk-1 decreased and sclerostin increased comparing to baseline; other markers did not change significantly. Increases of osteoprotegerin/RANKL ratio were more prominent in 10 patients who achieved remission or low disease activity after tocilizumab than in 12 patients who did not. In contrast, the significant alterations of both Wnt inhibitors were comparable between these patient subgroups. CONCLUSIONS: Anti-IL-6 therapy induced suppression of the inflammatory response affects rapidly the disrupted bone homeostasis in active RA. An additional, possibly specific, effect of IL-6 receptor inhibition on bone remodelling in humans should be further examined.
22829412 The frequency of antibodies against cyclic citrullinated peptides and rheumatoid factor in 2013 Apr Rheumatoid arthritis (RA) is a chronic, systemic and an autoimmune disease characterized by inflammation of the synovial membrane that affects approximately 1 % of the total world population. Rheumatoid factor (RF) is a widely used auto antibody in diagnosis of the RA and found positive in 50-80 % of the patients but with a lower specificity. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) is the latest serological marker with a specificity around 98 %. This field survey was conducted in different regions to investigate the frequency of RF and anti-CCP and also frequency of RA in a northern province of Turkey. This study was conducted in 70 local areas (12 urban and 58 rural) in the province of Tokat, which is located in northern Turkey. The population of Tokat was reported to be 828,000 at the last census and about 530,000 individuals aged > 18 years old. The study population of 941 subjects (462 male and 479 female; urban 501 and rural 440) was selected by random sampling method among 530,000 individuals. Of the 941 healthy controls assigned to the study, 479 of them were female (51 %) and 462 of them were males (49 %), and median age of all participants was 41 ± 17. Twenty-six subjects were RF positive (2.8 %), and 9 patients were anti-CCP positive (1 %). The presence of both RF and anti-CCP antibodies has also been shown in two patients (0.2 %). In conclusion, we demonstrated that the frequency of RA was 0.53 %, RF presence was 2.8 %, and anti-CCP presence was 1 % in total 941 healthy subjects enrolled into study.
21080021 Can simple ultrasonography predict the clinical effect of intra-articular injection therap 2011 Jun To investigate whether ultrasonographic joint assessment can predict the clinical response to intra-articular injection therapy of the knee. Patients with persistent gonarthritis intra-articularly received in a randomized double-blinded crossover fashion radiation synovectomy or a glucocorticoid injection, both followed by clinical bed rest. Prior to treatment and 3 months afterwards, grey-scale ultrasonography (US) of the knee was performed, measuring synovial thickness and extent of effusion. The final clinical effect of these two treatments was assessed at 3 months and finally at 6 months using a composite index. Ninety-seven patients, mainly suffering from undifferentiated arthritis (40%) or rheumatoid arthritis (31%), received 165 injections (including crossovers). Clinical effect at 6 months was not related to the baseline ultrasonographic extent of effusion or synovial thickness, nor with ultrasonographic decrease of effusion after the first 3 months. Nevertheless, it was associated with ultrasonographic decrease of synovial thickness within the first 3 months. Simple baseline US measurements fail to predict the final clinical effect of intra-articular treatment of the knee at 6 months, in contrast to early US changes of synovial thickness 3 months after therapy.
21551509 Impact of IL-6 receptor inhibition on human memory B cells in vivo: impaired somatic hyper 2011 Aug OBJECTIVE: Interleukin 6 (IL-6) receptor (IL-6R) inhibition by tocilizumab is a novel anti-inflammatory therapy for rheumatoid arthritis (RA) patients. As IL-6 is a late differentiation factor of B cells the authors asked if IL-6R inhibition impacts on the mutational differentiation of human memory B-cell antigen receptors in vivo. METHODS: 1733 immunoglobulin receptors (IgR) of single cell sorted preswitch and postswitch memory B cells were prospectively analysed from 11 RA patients under IL-6R inhibition (7 patients) or tumour necrosis factor (TNF) inhibition (4 patients). RESULTS: The results show a reduced mutational frequency in IgR of preswitch memory B cells (p=0.0001) during week 12, week 24 and 1 year of tocilizumab therapy. Mutational hotspot RGYW/WRCY motifs indicated significantly decreased targeting (p<0.05) in preswitch and postswitch memory B cells. Anti-TNFα therapy had no effect on mutational frequency and mutational hotspot targeting motifs in memory B-cell subsets. CONCLUSIONS: These data suggest that preswitch and postswitch memory B cells are susceptible to IL-6R inhibition in vivo. Acquisition of mutations was substantially altered in preswitch memory B cells, while targeting of mutational hotspots affected preswitch and postswitch memory B cells. The results indicate that preswitch and postswitch memory B cells have a differential dependence on the IL-6/IL-6R system for differentiation, which can be influenced by tocilizumab in vivo.
21358439 TNF-α antagonist use and risk of hospitalization for infection in a national cohort of ve 2011 Mar Medications used to treat rheumatoid arthritis (RA) may confer an increased risk of infection. We conducted a retrospective cohort study of veterans with RA followed in the United States Department of Veterans Affairs health care system from October 1998 through September 2005. Risk of hospitalization for infection associated with tumor necrosis factor (TNF)-α antagonists therapy was measured using an extension of Cox proportional hazards regression, adjusting for demographic characteristics, comorbid illnesses, and other medications used to treat RA. A total of 20,814 patients met inclusion criteria, including 3796 patients who received infliximab, etanercept, or adalimumab. Among the study cohort, 1465 patients (7.0%) were hospitalized at least once for infection. There were 1889 hospitalizations for infection. The most common hospitalized infections were pneumonia, bronchitis, and cellulitis. Age and several comorbid medical conditions were associated with hospitalization for infection. Prednisone (hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.88-2.43) and TNF-α antagonist use (HR, 1.24; 95% CI, 1.02-1.50) were associated with hospitalization for infection, while the use of disease-modifying antirheumatic drugs (DMARDs) other than TNF-α antagonists was not. Compared to etanercept, infliximab was associated with risk for hospitalization for infection (HR, 1.51; 95% CI, 1.14-2.00), while adalimumab use was not (HR, 0.95; 95% CI, 0.68-1.33). In all treatment groups, rate of hospitalization for infection was highest in the first 8 months of therapy. We conclude that patients with RA who are treated with TNF-α antagonists are at higher risk for hospitalization for infection than those treated with other DMARDs. Prednisone use is also a risk factor for hospitalization for infection.
22035435 Promising new treatments for rheumatoid arthritis - the kinase inhibitors. 2011 Three major advances over the last decade have impacted the way we treat rheumatoid arthritis; early and aggressive treatment, use of disease activity measures leading to treat to target, and availability of biologic agents. No oral biologic agents are available at this time but promising data is emerging for two drugs, tofacitinib and fostamatinib, inhibitors of JAK and Syk kinases, respectively. This paper will review some of the relevant published data for these agents and discuss where they may be placed in our treatment options for RA.
21823421 [Multi-center clinical study on therapeutic effect of kunxian capsule on rheumatoid arthri 2011 Jun OBJECTIVE: To assess the therapeutic efficacy and safety of Kunxian Capsule (KXC) in treatment of rheumatoid arthritis (RA). METHODS: Randomized positive parallel controlled and multi-center open test method was adopted. 240 RA patients of mild/moderate degree were randomly assigned to three groups equally, i.e., KXC group (who took KXC), the methotrexate (MTX) group (who took MTX), and the KXC + MTX group (who took KXC and MTX simultaneously), respectively. The therapeutic course for them all was 12 weeks. The effect of the treatment was assessed in items of DAS28, ACR20, and ACR50; number of joints with pain and swelling; VAS score of pain, tiredness, and general condition; time of morning stiffness; bilateral grip strength; HAQ score, as well as blood levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP antibody, and platelet count. RESULTS: By the end of the 4th week, the improvement of ACR20, ACR50, DAS28 efficacy judgment, and DAS28 score in the KXC + MTX group were much better than those in the other two groups, with statistical difference (P<0.05). The total effective rate was 88. 6% and the markedly effective rate was 51.8% in the KXC + MTX group at the 12 th week. The Improvement was more obviously shown in all groups after treatment (all P<0.05). Better effects in reducing VAS scores of pain and tiredness were shown in the KXC group and the KXC + MTX group. The effects of KXC + MTX were superior to the other two groups in terms of swollen joint numbers, pain joints, grip strength (assessed by researcher), as well as VAS score of general condition and HAQ score (assessed by both patients and researcher, P<0.05). But the differences among groups in improving morning stiffness and the incidence rate of adverse events were in- significant. CONCLUSIONS: KXC could relieve symptoms, improve joint functions, physical signs, and laboratory indices of RA patients with less adverse reaction. It was synergistic with MTX.
22511570 Randomized prospective study of a work place ergonomic intervention for individuals with r 2012 Oct OBJECTIVE: To conduct a longitudinal randomized controlled trial comparing a work place ergonomic intervention versus a control (i.e., provision of written educational materials) for persons with rheumatoid arthritis (RA) or osteoarthritis (OA) regarding employment, physical, and symptom outcomes. METHODS: Eighty-nine participants (mean age 50.54 years, 87% women, 38% with RA, 62% with OA) were randomized into the intervention or control group. Seventy-five participants completed baseline, 12-month, and 24-month evaluations. Outcome measures included Arthritis Impact Measurement Scales 2 (AIMS2) physical, symptom (i.e., pain), and role scores (i.e., impact of arthritis on employment); Job Satisfaction Survey (JSS); and Brief Symptom Inventory Global Severity Index. The study design was a 2-factor (treatment and time) with repeated measures on 1 factor (time) design used with baseline as a covariate for 12- and 24-month data. RESULTS: Between-group analyses indicated differences at 24 months for the AIMS2 role score (P < 0.03), with the intervention group reporting less arthritis-related impact on their work. Within-group analyses indicated significant improvements for the intervention group in AIMS2 change scores for physical functioning and symptom variables at 12 months (P < 0.04 and P < 0.01, respectively) and 24 months (P < 0.01 and P < 0.01, respectively). Job satisfaction (JSS) decreased at 12 months for both the intervention (P < 0.01) and control groups (P < 0.01), and at 24 months for the control group (P < 0.01). CONCLUSION: An ergonomic work place intervention (versus a control) is associated with decreased arthritis-related work difficulties over 2 years for individuals with OA and RA, as well as improvements in physical functioning and pain.
22127701 Overexpression of SPACIA1/SAAL1, a newly identified gene that is involved in synoviocyte p 2011 Dec OBJECTIVE: To identify novel genes associated with dysregulated proliferation of activated synovial fibroblasts, which are involved in arthritic joint destruction. METHODS: We performed transcriptome analysis to identify genes that were up-regulated in the foot joints of mice with collagen-induced arthritis (CIA). The effect of candidate genes on proliferation of synovial fibroblasts was screened using antisense oligodeoxynucleotides and small interfering RNAs (siRNAs). We characterized the expression and function of a novel gene, synoviocyte proliferation-associated in collagen-induced arthritis 1 (SPACIA1)/serum amyloid A-like 1 (SAAL1) using antibodies and siRNA and established transgenic mice to examine the effect of SPACIA1/SAAL1 overexpression in CIA. RESULTS: Human and mouse SPACIA1/SAAL1 encoded 474 amino acid proteins that shared 80% homology. SPACIA1/SAAL1 was primarily expressed in the nucleus of rheumatoid arthritis (RA) synovial fibroblasts and was highly expressed in the hyperplastic lining of inflamed synovium. In addition, its expression level in RA- or osteoarthritis (OA)-affected synovial tissue was positively correlated with the thickness of the synovial lining. Furthermore, SPACIA1/SAAL1 siRNA inhibited the proliferation of synovial fibroblasts, especially tumor necrosis factor α-induced synovial fibroblasts, by blocking entry into the S phase without inducing apoptosis. Finally, transgenic mice overexpressing SPACIA1/SAAL1 exhibited early onset and rapid progression of CIA. CONCLUSION: These results suggest that SPACIA1/SAAL1 is necessary for abnormal proliferation of synovial fibroblasts and its overexpression is associated with the progression of synovitis in mice and humans. Thus, therapy targeting SPACIA1/SAAL1 might have potential as an inhibitor of synovial proliferation in RA and/or OA.