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ID PMID Title PublicationDate abstract
22427231 The association between interleukin-6 polymorphisms and rheumatoid arthritis: a meta-analy 2012 Jul OBJECTIVE: The aim of this study was to determine whether the functional interleukin-6 (IL-6) promoter -174 G/C and -572 G/C polymorphisms confer susceptibility to rheumatoid arthritis (RA) in ethnically different populations. METHODS: Meta-analysis was conducted on the associations between these IL-6 polymorphisms and RA. RESULTS: A total of nine studies involving 3,851 subjects (RA 2,053 and controls 1,798) were considered in this study and ethnicity-specific meta-analysis was performed on European subjects. In all study subjects, meta-analysis revealed a trend toward to an association between RA and the IL-6 -174 G allele (odds ratio [OR] = 0.699, 95 % confidence interval [CI] = 0.463-1.054, p = 0.088). Stratification by ethnicity indicated a significant association between RA and the IL-6 -174 G/C polymorphism in Europeans using the dominant (OR = 0.329, 95 % CI = 0.155-0.699, p = 0.004) and recessive (OR = 0.823, 95 % CI = 0.679-0.997, p = 0.047) models. Meta-analysis of the IL-6 -572 G/C polymorphism showed no association between RA and the IL-6 -572 G allele in all study subjects (OR = 1.641, 95 % CI = 0.613-4.397, p = 0.324). CONCLUSIONS: This meta-analysis shows that the IL-6 -174 G/C polymorphism may confer susceptibility to RA in Europeans.
22829691 Comparison of joint destruction between standard- and low-dose etanercept in rheumatoid ar 2012 Dec OBJECTIVE: To evaluate the prevention of joint destruction and clinical efficacy of low-dose etanercept (ETN) (25 mg/week) compared with standard-dose ETN (50 mg/week) in RA. METHODS: In this prospective, randomized, open-label study, 70 patients were assigned to receive ETN at either 50 or 25 mg/week for 52 weeks. The primary endpoint was the variation in modified total Sharp score (mTSS), and secondary endpoints were variations in disease activity score in 28 joints (DAS-28), modified HAQ and adverse event rate. Values of mTSS were calculated at baseline and after 52 weeks. Non-progression was estimated as ΔmTSS ≤0.5, and the non-progression rate was compared between groups. RESULTS: Mean values at baseline were as follows: disease duration 9.2 years; DAS-28 5.45; and annual progression of mTSS 26.1. No significant differences in background were seen between groups. At 52 weeks, the non-progression rate was significantly less in the 25 mg/week group (36.7%) than in the 50 mg/week group (67.7%) (P = 0.041). Mean ΔmTSS was higher at 25 mg/week (1.03) than at 50 mg/week (-0.13). DAS-28 was significantly improved at 4 weeks, and the effect of treatment lasted for 52 weeks in both groups. No differences in adverse event rates were seen between groups. CONCLUSION: Low-dose ETN is not inferior to standard-dose ETN in terms of effects on clinical manifestations. However, in terms of the radiographic non-progression rate, the effects of low-dose ETN may be inferior to the effects of standard-dose ETN. TRIAL REGISTRATION: UMIN Clinical Trials Registry, http://www.umin.ac.jp/ctr/, UMIN000001798.
22039226 Biologic agents for rheumatoid arthritis--negotiating the NICE technology appraisals. 2012 Jan In England and Wales, the National Institute for Health and Clinical Excellence (NICE) has provided guidance [technology appraisals (TAs) 130, 186, 195, 198 and 225] on the use of biologic drugs for the treatment of RA. This is based on an analysis of efficacy, safety and cost-effectiveness, and has resulted in a complex management pathway that restricts freedom to prescribe biologics according to their licensed indications. Specifically, TNF antagonists are the only class of biologics that can be used first line in DMARD-inadequate responders, and only in patients with a persistent 28-joint DAS score of ≥5.1. Alternative biologic agents are denied to those with contraindications to anti-TNF drugs and are also not supported following intolerance to TNF antagonists. Rituximab is the only class of biologic permitted after TNF antagonist inefficacy, in the absence of a contraindication to its use, whereas abatacept and tocilizumab are licensed and may be a more efficacious choice at this stage in some patient groups. Furthermore, for patients who demonstrate sequential inadequate responses, treatment is restricted to one TNF antagonist, rituximab and tocilizumab, whereas abatacept is only a permitted choice when rituximab is contraindicated or has been withdrawn because of an adverse event. In this review, we discuss the treatment algorithm published by NICE, and suggest alternatives where perceived deficiencies exist.
23073350 Long-term results of the FIN-RACo trial; treatment with a combination of traditional disea 2012 Jul The Finnish Rheumatoid Arthritis Combination Therapy Trial (FIN-RACo) started in 1993, in an era of disappointing results in the treatment of rheumatoid arthritis (RA). The FIN-RACo was the first trial aiming at remission and comparing two different treatment strategies: initially triple therapy with compulsory prednisolone (FIN-RACo strategy), or monotherapy with optional prednisolone (SINGLE strategy). The results at 2, 5 and at 11 years are in favour of the initial FIN-RACo strategy without an increase in adversities. Nevertheless, with targeted treatment, even the SINGLE strategy group patients show low disease activity and moderate radiographic progression. Most leading Finnish rheumatologists participated in the FIN-RACo trial and have become convinced of the excellent results, good safety, and feasible administration of the FIN-RACo strategy. They have thus adopted it in real life and tutored the next generation to do the same. This has undoubtedly affected the Finnish approach to treating early RA; the Finnish Current Care Guideline recommends the FIN-RACo combination as the first treatment choice in early, active RA. As a consequence, the use of biologics in early RA is less frequent in Finland compared to many countries. Simultaneously, however, at least one hard outcome of RA, work disability, has decreased.
21819170 Impact of Celecoxib restrictions in medicare beneficiaries with arthritis. 2011 OBJECTIVE: To compare the incidence of serious gastrointestinal (GI) complications and associated medical costs in a population with either osteoarthritis (OA) or rheumatoid arthritis (RA) enrolled in Medicare plans with celecoxib formulary restrictions versus plans without such restrictions. METHODS: This study was a retrospective cohort analysis of Medicare members in plans with and without celecoxib restrictions. Members diagnosed with OA or RA were identified and followed for 1 year. RESULTS: The restricted group had higher levels of nonselective nonsteroidal anti-inflammatory drug use (51% vs 40%, p <.001), and celecoxib use was double in the unrestricted group (16% vs 8%, p <.001). The incidence of a serious GI complication was slightly higher in the restricted group (5.4% vs 4.6%, P <.001). The adjusted mean serious GI complication-related cost for the restricted group was more than 15 times higher than that for the nonrestricted group ($1559 [95% confidence interval (CI) $1341-$1811] vs $101 [95% CI $87-$117]), adjusted mean arthritis-related medical costs were $5733 per year (95% CI $5097-$6448) for the restricted group and $3170 (95% CI $2816-$3569) for the unrestricted group. CONCLUSIONS: The restricted group had significantly less use of celecoxib, indicating that restriction was effective at reducing celecoxib utilization. Although limitations exist when comparing populations from different health plans, and the underlying causes of serious GI complications are multifactorial, the restricted group had a higher incidence of serious GI complications and higher costs related to serious GI complications and arthritis.
23149388 Comparison of the clinical expression of patients with ankylosing spondylitis from Europe 2012 Dec OBJECTIVE: To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA). METHODS: We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out. RESULTS: There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations. CONCLUSION: The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.
23152085 Triple DMARD combination for rheumatoid arthritis resistant to methotrexate and steroid co 2013 Jun The mainstay of RA treatment is the disease-modifying antirheumatic drugs, and triple DMARD combination is now known to be better than monotherapies. Our aim in this trial was to report our clinical experience with triple DMARD therapy for resistant rheumatoid arthritis. Data of 140 patients with RA resistant to methotrexate and steroid combination were evaluated retrospectively. One hundred and nineteen (85 %) were female, and the median age at diagnosis was 56 (29-82) years. The median time between the diagnosis and beginning of triple therapy was 45.5 (6-564) months. Fifty-two (37.1 %) patients (group 1) on triple therapy protocol achieved remission, but the others (88; 62.9 %) (group 2) did not. The mean DAS28 scores for the study group before triple DMARD therapy and after 12 months under triple DMARD therapy were 4.93 and 3.24, respectively. The DAS28 scores after 12 months for groups 1 and 2 were 2.57 and 3.64. The median follow-up period for patients in group 1 was 60 months (23-118), and the mean DAS28 score at the time of the analysis for group 1 was 2.36. Triple DMARD combination may save one-third of the MTX-resistant RA patients from the serious side effects and the cost of anti-TNF.
21806780 Association of tumour necrosis factor-alpha -308 G/A promoter polymorphism with susceptibi 2011 Oct The objective was to analyze the possible involvement of tumour necrosis factor-alpha (TNF-α) -308 G/A promoter polymorphism in the susceptibility and/or the disease profile of rheumatoid arthritis (RA) in Egyptian patients. TNF-α-308 G/promoter polymorphism detection by amplification refractory mutation system (ARMS) technique was carried out for 122 RA patients and 120 healthy controls. TNF-α-308 G allele/GG homozygous genotype were higher in patients with rheumatoid arthritis than those in control group (P < 0.001, respectively). A statistically significant association was found between the frequency of the A allele and presence of erosion (OR = 3.42, P = 0.015). No associations were found between the distribution of TNF-α-308 G/A alleles/genotypes and age of patients, disease duration, absence of remission, presence of deformity, clinical manifestations of the disease and presence or absence of rheumatoid factor. The positivity of rheumatoid factor was associated with occurrence of erosion (OR = 25.0, P < 0.001). The results of this study demonstrate the association of the TNF-α-308 G allele and GG homozygous genotype with susceptibility to RA and the A allele with the presence of erosion in the Egyptian patients.
22037665 Effects of intravenous iron saccharate on improving severe anemia in rheumatoid arthritis 2012 Mar Anemia in rheumatoid arthritis (RA) is multifactorial. Iron deficiency, either definite or relative (defect in iron utilization), exists in RA patients with anemia. Intravenous iron therapy is indicated in severe and symptomatic cases or those with conditions precluding use of oral iron, but its safety and long-term efficacy have not been well-established. Forty severe anemic (hemoglobin < 9 g/dL) RA patients with or without demonstrable bone marrow iron stain were enrolled in this study. Fractionated administration of intravenous iron saccharate was undertaken and the median follow-up time was 1 year. All patients exhibited significant elevations of hemoglobin 3 months after treatment, which were more pronounced in the nonstainable iron marrow subjects {median (interquartile range): 3.8 (2.9-4.8) g/dL versus 2.9 (2.0-3.0) g/dL, p < 0.01}. Thereafter, hemoglobin remained at a plateau level that lasted during the observation period. Throughout the whole course, none of the cases exhibited side effects or flare up of disease activities. The use of intravenous iron saccharate, preferably administrated in a fractionated way, is effective in the correction of severe anemia in RA patients, especially those with nonstainable iron marrow.
21986577 Hypomethylation of proximal CpG motif of interleukin-10 promoter regulates its expression 2011 Nov AIM: The promoter of human interleukin-10 (IL10), a cytokine crucial for suppressing inflammation and regulating immune responses, contains an interspecies-conserved sequence with CpG motifs. The aim of this study was to investigate whether methylation of CpG motifs could regulate the expression of IL10 in rheumatoid arthritis (RA). METHODS: Bioinformatic analysis was conducted to identify the interspecies-conserved sequence in human, macaque and mouse IL10 genes. Peripheral blood mononuclear cells (PBMCs) from 20 RA patients and 20 health controls were collected. The PBMCs from 6 patients were cultured in the presence or absence of 5-azacytidine (5 μmol/L). The mRNA and protein levels of IL10 were examined using RT-PCR and ELISA, respectively. The methylation of CpGs in the IL10 promoter was determined by pyrosequencing. Chromatin immunoprecipitation (ChIP) assays were performed to detect the cyclic AMP response element-binding protein (CREB)-DNA interactions. RESULTS: One interspecies-conserved sequence was found within the IL10 promoter. The upstream CpGs at -408, -387, -385, and -355 bp were hypermethylated in PBMCs from both the RA patients and healthy controls. In contrast, the proximal CpG at -145 was hypomethylated to much more extent in the RA patients than in the healthy controls (P=0.016), which was correlated with higher IL10 mRNA and serum levels. In the 5-azacytidine-treated PBMCs, the CpG motifs were demethylated, and the expression levels of IL10 mRNA and protein was significantly increased. CHIP assays revealed increased phospho-CREB binding to the IL10 promoter. CONCLUSION: The methylation of the proximal CpGs in the IL10 promoter may regulate gene transcription in RA.
22992856 Impact of total shoulder arthroplasty on generic and shoulder-specific health-related qual 2012 Sep 5 BACKGROUND: Total shoulder arthroplasty is increasingly used in the treatment of arthritis. However, the effect of total shoulder arthroplasty on health-related quality of life has not been fully established. The goal of this systematic review and meta-analysis was to characterize the change in generic and shoulder-specific health-related quality-of-life measures resulting from total shoulder arthroplasty. METHODS: We identified published studies reporting preoperative and postoperative health-related quality-of-life outcomes for patients receiving total shoulder arthroplasty. Health-related quality-of-life measures were identified, and meta-analysis was used to calculate standardized mean differences (SMDs, reflective of the effect size) and 95% confidence intervals for each scale. RESULTS: Twenty studies (1576 total shoulder replacements) met the inclusion criteria. Outcome measures were analyzed after an average postoperative follow-up duration of 3.7 ± 2.2 years. The Short Form-36 demonstrated significant improvement in physical component summary scores (SMD = 0.7, p < 0.001) but not in mental component summary scores (SMD = 0.2, p = 0.37). Significant improvements were observed in the visual analog scale score for pain (SMD = -2.5, p < 0.001) and scores on three shoulder-specific measures: the Constant score (SMD = 2.7, p < 0.001), American Shoulder and Elbow Surgeons score (SMD = 2.9, p < 0.001), and Simple Shoulder Test (SMD = 2.3, p < 0.001). CONCLUSIONS: Total shoulder arthroplasty leads to significant improvements in scores for function and pain. Shoulder-specific measures of function consistently showed the greatest degree of improvement, with large effect sizes. Total shoulder arthroplasty also leads to significant improvements in overall physical well-being, with a moderate-to-large effect size.
21459677 Role of 2-methoxyestradiol as inhibitor of arthritis and osteoporosis in a model of postme 2011 Jul In postmenopausal rheumatoid arthritis, both the inflammatory disease and estrogen deficiency contribute to the development of osteoporosis. As hormone replacement therapy is no longer an option, we hypothesized that 2-methoxyestradiol (2me2) could be beneficial, and asked if such therapy was associated with effects on reproductive organs. Mice were ovariectomized and arthritis was induced, whereafter mice were administered 2me2, estradiol, or placebo. Clinical and histological scores of arthritis, together with bone mineral density were evaluated. Uteri weight, reactive oxygen species (ROS) from spleen cells, and characterization of cells from joints and lymph nodes were analyzed. In addition, in vivo activation of estrogen response elements (ERE) by 2me2 was evaluated. Treatment with 2me2 and estradiol decreased the frequency and severity of arthritis and preserved bone. Joint destruction was reduced, neutrophils diminished and ROS production decreased. The uterine weight increased upon long-term 2me2 exposure, however short-term exposure did not activate ERE in vivo.
21347803 Efficacy and safety of additional use of tacrolimus in patients with early rheumatoid arth 2011 Oct In this trial, we investigated the safety and efficacy of tacrolimus used in addition to standard antirheumatic drugs in patients with rheumatoid arthritis. Tacrolimus 3 mg or placebo was orally administered once daily for 52 weeks in a double-blind manner to patients with early active rheumatoid arthritis receiving other disease-modifying antirheumatic drugs (DMARDs). A total of 123 patients were randomized to the tacrolimus group (61 patients) and to the placebo group (62 patients). In the tacrolimus group, 70.5% achieved a clinical response according to American College of Rheumatology (ACR) 20 criteria, whereas 45.2% in the placebo group did so (P = 0.005). The tacrolimus group also showed significant improvement in terms of the European League Against Rheumatism (EULAR) response criteria of "good or moderate" versus the placebo group (86.9 vs. 56.5%, respectively). Likewise, significantly more patients in the tacrolimus group versus the placebo group achieved remission of the Disease Activity Score in 28 joints (DAS28) (45 vs. 21%). The mean changes in the Total Sharp Score and erosion score were lower in the tacrolimus group, but the differences between the two groups were not significant. There was no significant difference between the two groups in the incidence of adverse events. Based on these results, we can conclude that the additional use of tacrolimus in patients with early rheumatoid arthritis with inadequate response to other DMARD treatments is useful, and this could become one of the treatment options for these rheumatoid arthritis patients.
21996547 Comparative study of indices of activity evaluation in rheumatoid arthritis. 2011 Oct INTRODUCTION: Choosing between the different indices of activity evaluation in RA is often difficult considering the very heterogeneous clinical expression of the disease. The objective of our study was to evaluate the level of similarity between SDAI, CDAI, DAS28-(ESR) and DAS28-(CRP) indices in the evaluation of RA activity. PATIENTS AND METHODS: In this transversal study, a total of 100 patients with RA responding to the ACR 87 criteria were followed up for a period of 20 months. The correlations between the four indices were studied through the Pearson's correlation coefficient (r). The similarity between these tools was evaluated through Kendall's (K) "tau" similarity coefficient. RESULTS: The 87 female and 13 male patients (sex ratio: 6.7F/1M) were of a mean age of 52.9±11.6 years (17-77) and have been living with RA for a mean of 8.3±9 years (2 months-41 years). The DAS28-(ESR) mean score was 5.53±1.46 [1.25-8.05]. The DAS28-(CRP) mean score was 5.01±1.44 [1.68-7.81]. The CDAI mean score was 30.72±15.04 [2-62] and that of SDAI was 28.86±15.86 [2.3-71.3]. A positive, statistically significant correlation was noted between the four indices of RA activity. The level of similarity between the different indices was good (K variation between 0.758 and 0.943). DAS28-(ESR) allowed classifying the patients in the same category of disease activity than DAS28-(CRP) in a proportion of 85%. This proportion was 88% when comparing DAS28-(ESR) to CDAI and SDAI, respectively. Regarding DAS28-(CRP) and CDAI, these two indices classified the patients in the same category in a proportion of 80%, compared to 87% regarding DAS28-(CRP) and SDAI. Finally, CDAI and SDAI classified the patients in the same category in a proportion of 92% with an excellent level of similarity. CONCLUSION: Different evaluation indices of RA activity are currently available. DAS28 is the most used. CDAI and especially SDAI have a good level of similarity with DAS28. Their advantage is to be simple and quick, and seem therefore well adapted to the follow-up of outpatients.
20455995 Expression of CD147 (EMMPRIN) on neutrophils in rheumatoid arthritis enhances chemotaxis, 2011 Apr The occurrence of neutrophils at the pannus-cartilage border is an important phenomenon for understanding the pathogenesis of rheumatoid arthritis (RA). Matrix metalloproteinases (MMPs) are predominant enzymes responsible for the cartilage degradation. The present article studied the expression of CD147 on neutrophils and its potential role in neutrophil chemotaxis, MMPs production and the invasiveness of fibroblast-like synoviocytes (FLS). The results of flow cytometry revealed that the mean fluorescence intensity of CD147 expression on neutrophils of peripheral blood from RA patients was higher than that in healthy individual. The potential role of CD147 in cyclophilin A (CyPA)-mediated cell migration was studied using chemotaxis assay and it was found that the addition of anti-CD147 antibody significantly decreased the chemotactic index of the neutrophils. Significantly elevated release and activation of MMPs were seen in the co-culture of neutrophil and FLS compared with cultures of the cells alone. An increased number of cells invading through the filters in the invasion assays were also observed in the co-cultured cells. The addition of anti-CD147 antibody had some inhibitory effect, not only on MMP production but also on cell invasion in the co-culture model. Our study demonstrates that the increased expression of CD147 on neutrophils in RA may be responsible for CyPA-mediated neutrophil migration into the joints, elevated MMPs secretion and cell invasion of synoviocytes, all of which may contribute to the cartilage invasion and bone destruction of RA. Better knowledge of these findings will hopefully provide a new insight into the pathogenesis of RA.
22294296 Effects of the pro-inflammatory milieu on the dedifferentiation of cultured fibroblast-lik 2012 Apr The aim of this study was to determine whether the inflammatory milieu and/or hypoxia induces the dedifferentiation of synovial cells into mesenchymal stem-like cells, which may contribute to the tumor-like growth of synovial cells. Expression of mesenchymal stem cell markers (CD24, CD44, CD90, CD106, CD146 and Stro-1) was compared among cultured fibroblast-like synoviocytes (FLSs) from patients with rheumatoid arthritis (RA) or osteoarthritis (OA), bone marrow mesenchymal stem cells (BM MSCs) and normal dermal fibroblasts. After the cells were stimulated with pro-inflammatory cytokines for 3 days under hypoxia or normoxia, the stem cell markers were analyzed by FACS. CD44 and CD90 were expressed constitutively in all four cell types. Only the BM MSCs strongly expressed CD146. The expression of stem cell markers was similar between FLSs from RA and those from OA patients. In addition, the expression levels in FLSs were similar to those in normal dermal fibroblasts. The stimulation of FLSs and dermal fibroblasts with IL-1β or a mixture of cytokines under hypoxia did not induce a marked change in the expression of stem cell markers. These results indirectly suggest that the pro-inflammatory milieu may be not sufficient to induce the dedifferentiation of FLSs in arthritic joints.
23006887 Acquired Chiari malformation secondary to atlantoaxial vertical subluxation in a patient w 2012 A 65-year-old woman with a history of rheumatoid arthritis presented with a rare case of acquired Chiari malformation secondary to atlantoaxial vertical subluxation, associated with congenital atlanto-occipital assimilation. Syringomyelia and tetraparesis improved immediately after posterior fossa decompression and simultaneous occipito-cervical junction fusion. The progression of acquired Chiari malformation is not well known. We concluded that coexisting assimilation accelerated crowded foramen magnum following atlantoaxial vertical subluxation and induced acquired Chiari malformation over the course of a few years.
21742604 Calciphylaxis in a morbidly obese woman with rheumatoid arthritis presenting with severe w 2011 Jul OBJECTIVE: To present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritis and normal renal function. METHODS: We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year. RESULTS: The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritis were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight. CONCLUSION: This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy.
21635863 [Sarcoïdosis and anti-TNF: a paradoxical class effect? Analysis of the French Pharmacovig 2011 Mar OBJECTIVES: To identify and characterize the observations of sarcoidosis occurring during anti-TNF blockade collected in the French Pharmacovigilance system database and reported in the literature. RESULTS: Seven cases were reported in the French Pharmacovigilance system database and 39 cases (37 original) have been reported internationally. Monoclonal antibodies (infliximab and adalimumab) and fusion protein (etanercept) are equally involved. Sarcoidosis have been confirmed histologically and occurred predominantly in the rheumatoid arthritis (22) and spondylarthropathy (16). CONCLUSION: The lack of protopathic bias suggests that these paradoxical sarcoidosis occurring during treatment with anti-TNF are a class-effect, as with psoriasis, uveitis, and IBD reported under similar conditions. Their pathogenesis remains unclear.
21641178 Anterior dislocation after a posterior stabilized total knee arthroplasty. 2012 Feb Dislocation of a total knee arthroplasty is a rare but serious complication. In previous literature, when dislocation does occur, it is usually in the posterior direction in cases with a posterior stabilized total knee arthroplasty due to cam jump. We report an unusual case of anterior dislocation of an 11-year-old posterior stabilized total knee arthroplasty in a 55-year-old woman with rheumatoid arthritis occurred after a slip.