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ID PMID Title PublicationDate abstract
21736857 Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed b 2011 Jul OBJECTIVES: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden. METHODS: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction. RESULTS: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective. CONCLUSIONS AND POLICY IMPLICATIONS: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment.
21605158 Increased concentrations of antibody against heat shock protein in patients with myelopero 2011 Aug To determine serum antibody against human and bacterial heat shock protein (HSP) 60/70 in myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic autoantibody (ANCA) positive microscopic polyangiitis (MPA), 58 patients with MPO-ANCA positive MPA, 48 with RA (rheumatoid arthritis) and 40 with SLE (systemic lupus erythematosus) were studied. Serum antibodies against HSP (human HSP 70, human HSP 60, Mycobacterium HSP 70, and Escherichia coli HSP 60) were measured by sandwich ELISA. The frequency of anti-human HSP 60/70 antibody positive patients was significantly greater in MPO-ANCA positive MPA than SLE and healthy controls. Anti-human HSP 60/70 antibody titers in patients with MPO-ANCA positive MPA were significantly higher than those of healthy controls; anti-bacterial HSP 60/70 antibody titers were also higher. There was a significant correlation between titers of anti-human HSP 70 antibody and anti-Mycobacterium HSP 70 antibody. A correlation was also found between titers of anti-human HSP 70 antibody and anti-human HSP 60 antibody. Anti-human and bacterial HSP 60/70 antibody titers changed in parallel with disease activity in patients with antibody positive MPA. The anti-HSP antibody titer was also increased in patients with RA and SLE. These results suggest that an immunological background via anti-HSP 60/70 antibodies might be associated with pathogenesis in MPO-ANCA positive MPA.
21208558 [Analysis of frequency of peripheral blood CD4+; CD25(high);Tregs and CD4+; CD25(low);T ce 2011 Jan AIM: To explore the frequencies of peripheral blood CD4(+);CD25(high);Treg and CD4(+);CD25(low);T cells and the expression of the co-stimulatory molecule PD-1 on these two group cells surface in SLE and RA patients, and to explore their roles in cell immunity disorder of SLE and RA. METHODS: Flow cytometry (FCM) was used to determine the frequencies of peripheral blood CD4(+);CD25(high);Treg and CD4(+);CD25(low);T cells, and the expression percentage of PD-1. RESULTS: Compared with healthy control, the frequencies of peripheral blood CD4(+);CD25(high);Treg from both SLE and RA patients groups decreased significantly(P<0.05). Compared between two disease groups, the frequency of peripheral blood CD4(+);CD25(high);Treg in SLE patients was significantly lower(P<0.05). The expression percentage of PD-1 on CD4(+);CD25(high);Treg surface in RA group was obviously lower than that in both healthy control and SLE patients groups(P<0.05), while the percentage had no significant difference between SLE patients and healthy control(P>0.05). There was no significant difference in both the frequency of CD4(+);CD25(low);T cells and the expression percentage of PD-1 on this subset cells among three groups. CONCLUSION: The weakened ability of peripheral blood CD4(+);CD25(high);Treg to suppress effector T cells resulted from their production deficiency is the common characteristic of SLE and RA patients. Decreased expression of PD-1 is the primary cause leading to the suppressive function of peripheral blood CD4(+);CD25(high);Treg weakened in RA patients. However, PD-1 does not play major role in weakening the suppression activity of CD4(+);CD25(high);Treg from SLE patients.
22177794 Simultaneous bilateral total hip arthroplasty with hydroxyapatite-coated implants: a 20-ye 2012 Aug Bilateral hip arthroplasty has been reported to be a safe and effective way to treat bilateral hip arthritis in a selective group of patients. We report a follow-up of 30 patients who underwent simultaneous bilateral total hip arthroplasty with hydroxyapatite implants and were followed for an average of 19.4 years. Patients had an average Harris Hip Score of 90 at the latest follow-up (range, 78-99). The average Western Ontario and McMaster Universities Arthritis Index questionnaire index score was 12 (range, 0-41), with high functional results on the 12-Item Short Form Health Survey (SF-12) and Oxford 12 questioners. Using the Kaplan-Meier survivorship analysis, with revision for any reason as an end point, survivorship was 94% at 12 years, 88% at 15 years, 74% at 18 years, and 61% at 23 years. All revisions were for the acetabular component, and the survivorship for the femoral component was 100% throughout the 23-year period. We conclude that bilateral uncemented total hip arthroplasty can provide satisfactory long-term clinical, radiological, and functional outcomes in patients even with older-generation polyethylene liners and stem designs.
22516985 [Sulphasalazine in patients with rheumatoid arthritis in China: a cross-sectional study]. 2012 Apr 18 OBJECTIVE: To investigate the medication status of rheumatoid arthritis (RA) patients and to analyze the clinical use of sulphasalazine (SSZ) and the adverse effect. METHODS: A total of 1 096 outpatients and inpatients diagnosed with RA were investigated in 21 hospitals all over China from July 2009 to December 2010, including gender, age of onset, clinical manifestations, as well as the clinical characteristics and medication status of 160 RA patients who received SSZ therapy. RESULTS: In the group of 160 patients who received SSZ, the male-to-female ratio was 1:7, The average age at onset was (46.1±15.0) years, while the average course was (9.9±7.8) years. The average dose of sulphasalazine was (1.87±0.52) g/d for a mean duration of (26.3± 14.6) months. Only 17% (27/160) of the patients received SSZ monotherapy. Methotrexate (63.1%), leflunomide (36.2%) and hydroxychloroquine (18.1%) were most commonly used combination drugs. And 36.2% (58/160) of the patients used the two-drug combination of methotrexate plus sulphasalazine .In this group, 41.9% (67/160) once used SSZ but withdrew for adverse events and other reasons, while 17.5% (28/160) withdrew for adverse events, of which the most common were gastrointestinal (8.8%), skin (3.8%) and liver toxicity (3.1%). CONCLUSION: Sulphaszlazine is not a common choice in the RA therapeutics in China, and the average dose of SSZ is lower than the standard dose of 2 to 3 g/d . The adverse events of SSZ are common; however, there are few severe adverse events or threat to life,SSZ is relatively safe in clinical practice.
22013980 Vitamin D status in patients with chronic plaque psoriasis. 2012 Mar BACKGROUND: Vitamin D could have important immunomodulatory effects in psoriasis. OBJECTIVES: To measure 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and calcium serum levels in patients with psoriasis and the associations with some relevant clinical features. METHODS: A cross-sectional study was conducted over 1 year including 145 patients with chronic plaque psoriasis, 112 patients with rheumatoid arthritis (RA) and 141 healthy controls. 25(OH)D, PTH and calcium serum levels were measured in a centralized laboratory. Demography, comorbidities, disease severity and exposure time to sunlight (which was derived by questionnaire) were collected. RESULTS: The prevalence of vitamin D deficiency [25(OH)D levels <20ngmL(-1) ] in patients with psoriasis was 57·8% vs. 37·5% in patients with RA and 29·7% in healthy controls (P<0·001). In winter, the prevalence of vitamin D deficiency rose to 80·9% in patients with psoriasis, to 41·3% in those with RA and to 30·3% in healthy controls (P<0·001). Patients with psoriasis or psoriatic arthritis did not differ in 25(OH)D serum levels nor in the prevalence of vitamin D deficiency. In the logistic regression analysis, vitamin D deficiency was associated with psoriasis independently of age, sex, body mass index, calcium, PTH levels and season of blood sampling. A limitation is that the study design does not allow a causal or temporal relationship between vitamin D deficiency and psoriasis to be established. CONCLUSIONS: Vitamin D deficiency may be common in patients with psoriasis, especially in winter.
22236882 Screening serum biomarker of knee osteoarthritis using a phage display technique. 2012 Mar OBJECTIVES: To screen serum biomarker of knee osteoarthritis (OA) using a phage random peptide library. DESIGN AND METHODS: A phage random peptide library of random peptide 12-mers was screened with purified immunoglobulin G (IgG) from sera of knee OA patients. Patients with knee rheumatoid arthritis (RA), hip OA, non-erosive hand OA or erosive hand OA, and healthy volunteers were used as controls. RESULTS: A phage clone with inserted peptide TGLESGHGPGDS (named KOA1) showed 90% positive reaction rate with the knee OA patients, significantly higher than that with the knee RA patients (27.8%), the non-erosive hand OA patients (34.3%), the erosive hand OA patients (31.3%) and the healthy controls (12.0%), but not the hip OA patients (82.5%). CONCLUSIONS: The novel knee OA mimic peptide KOA1 identified with a random phage display peptide library and sera from knee OA patients could be a potential serum biomarker for knee OA.
22540283 Local versus systemic anti-tumour necrosis factor-α effects of adalimumab in rheumatoid a 2012 Jul 1 BACKGROUND AND OBJECTIVE: The pharmacokinetic models that are applied to describe the disposition of therapeutic antibodies assume that the interaction between an antibody and its target takes place in the central compartment. However, an increasing number of therapeutic antibodies are directed towards soluble/mobile targets. A flawed conclusion can be reached if the pharmacokinetic and pharmacodynamic analysis assumes that the interaction between the therapeutic antibody and its target takes place in the central compartment. The objective of this study was to assess the relative importance of local versus systemic interactions between adalimumab and tumour necrosis factor (TNF)-α in rheumatoid arthritis (RA), identify localization of the site of adalimumab action and assess the efficacy of local (intra-articular) versus systemic adalimumab administration for treatment of RA. METHODS: The clinical and preclinical data on adalimumab and TNFα disposition were analysed using a pharmacokinetic modelling and simulation approach. The disposition of adalimumab and TNFα and the interaction between them at the individual compartments (the synovial fluid of the affected joints, central and peripheral compartments) following different routes of adalimumab administration were studied. RESULTS: Outcomes of modelling and simulation using the pharmacokinetic model developed indicate that adalimumab can efficiently permeate from the diseased joints to the central circulation in RA patients. Permeability of TNFα, which is excessively secreted in the joints, is even higher than that of adalimumab. As a result, subcutaneous, intravenous and intra-articular administration of the clinically used dose of adalimumab (40 mg) exert similar effects on the time course of TNFα concentrations at different locations in the body and efficiently deplete the TNFα in all of the compartments for a prolonged period of time (8-10 weeks). At this dose, adalimumab exhibits predominantly systemic anti-TNFα effects at the central and peripheral compartments (∼93% of the overall effect) and the contribution of the local effects in the rheumatic joints is ∼7% for all of the studied routes, including the local intra-articular injections. The major pathway of TNFα elimination from the synovial fluid (∼77% for subcutaneous administration, and ∼72% for intravenous and intra-articular administration of adalimumab 40 mg) is interaction with adalimumab, which reaches the joints following local or systemic administration. CONCLUSIONS: The kinetics of adalimumab permeation to the synovial fluid (0.00422 L/h clearance of permeation) versus the rate of TNFα turnover in the affected joints (1.84 pmol/h synthesis rate and 0.877 h(-1) degradation rate constant) are apparently the major parameters that determine the time course of TNFα concentrations in the synovial fluid and the TNFα-neutralizing effects of adalimumab in RA patients. Outcomes of this study suggest that intra-articular administration of adalimumab is not preferable to subcutaneous or intravenous treatment. Local and systemic permeability, turnover and interactions between the drug and the target should be taken into account for optimization of the use of drugs acting on soluble targets (growth factors, interferons, interleukins, immunoglobulins, etc.).
21885487 Effectiveness of a third tumor necrosis factor-α-blocking agent compared with rituximab a 2011 Nov OBJECTIVE: To compare the effectiveness of a third tumor necrosis factor-α (TNF-α)-blocking agent with rituximab after failure of 2 TNF-blocking agents in patients with rheumatoid arthritis (RA) in daily clinical practice. METHODS: Patients receiving a third TNF-blocking agent or rituximab after failure of 2 TNF-blocking agents were selected from a Dutch biologic registry. The primary outcome was the results from the Disease Activity Score of 28 joints (DAS28) over the first 12 months after start of the third biologic using mixed-model analyses. Secondary outcomes included the course of the Health Assessment Questionnaire (HAQ) and the separate components of the DAS28 over the first 12 months and the change from baseline in DAS28 and HAQ at 3 and 6 months. RESULTS: The overall course of the DAS28 over the first 12 months was significantly better for rituximab (p = 0.0044), as also observed for the HAQ, although the latter results were not statistically significant (p = 0.0537). The erythrocyte sedimentation rates, C-reactive protein, and swollen joint counts showed a better course for rituximab (p = 0.0008, p = 0.0287, p = 0.0547, respectively), but not the tender joint counts or visual analog scale for general health. DAS28 decreased significantly in both groups at 3 and 6 months (p ≤ 0.024), but the change in HAQ was significant for rituximab only at 3 months (p = 0.009). CONCLUSION: During the first 12 months of therapy, a larger improvement in disease activity and a trend toward a larger decrease in functional disability was observed in patients receiving rituximab. Switching to a biologic with another mechanism of action might be more effective after failure of 2 TNF-blocking agents in RA.
22923753 Efficacy and safety of certolizumab pegol in a broad population of patients with active rh 2012 Dec OBJECTIVE: To investigate the efficacy and safety of certolizumab pegol (CZP) in a broad population of patients with active RA. METHODS: In this 12-week, double-blind period of the phase IIIb trial, RA patients with inadequate response to at least one DMARD were randomized 4:1 to CZP (400 mg at weeks 0, 2 and 4, followed by 200 mg every 2 weeks) or placebo (every 2 weeks) plus current therapy stratified by previous TNF inhibitor use, concomitant methotrexate use and disease duration (<2 vs ≥2 years). The primary outcome was ACR20 response rate at week 12. RESULTS: Of 1063 patients (CZP = 851; placebo = 212), 37.6% had previous TNF inhibitor use. Baseline mean HAQ Disability Index (HAQ-DI) and DAS 28-joint assessment-ESR [DAS28(ESR)] values were 1.5 and 6.4 in the CZP group, and 1.6 and 6.4 in the placebo group, respectively. The primary endpoint was significant (week 12 ACR20, CZP vs placebo: 51.1 vs 25.9%; P < 0.001); differences were noted at week 2 (31.8 vs 8.5%; P < 0.001). HAQ-DI and DAS28(ESR) change from baseline and ACR50 were significant from week 2. Week 12 ACR20 responses were similar across CZP patient subgroups regardless of concomitant DMARD use at baseline. Adverse and serious adverse events were comparable between CZP and placebo, with no new safety signals. CONCLUSION: CZP was associated with rapid and consistent clinical responses and improved physical function in a diverse group of RA patients, irrespective of concomitant or previous therapy. TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov/, NCT00717236.
22876713 [Liver diseases in rheumatoid and psoriatic arthritis]. 2012 Jun OBJECTIVE: The aim of this study was to evaluate the prevalence, risk factors and features of liver diseases (LD) in rheumatoid and psoriatic arthritis. PATIENTS AND METHODS: From July 2007 to January 2010, 118 non-selected patients were consecutively examined. The assessment consisted of a medical record, biochemical studies and abdominal ultrasounds. The diagnosis of fatty liver disease was based on the ultrasound drug induced liver injury (DILI) was evaluated by the Maria-Victorino system criteria. Liver biopsy associated with chronic administration of methotrexate was performed using the histological classification of Kleiner et al. For the statistical analysis chi square test with Yates correction, Student's t test or Mann-Whitney test were applied when appropriate. In the multivariate analysis a binary logistic regression was used. The threshold of significance was P < 0.05. RESULTS: LD was diagnosed in 47 patients (39.8%). The most frequent LD was fatty liver disease in 35 patients (29.7%), followed by DILI in 15 (12.7%), associated with non-steroidal anti-inflammatory drugs (NSAID). In the multivariate analysis, obesity was the only independent risk factor associated with fatty liver disease [Odds ratio (OR) 6.4 (confidence interval (CI) 95%: 2.5-16.1; P = 0.000)] and fatty liver disease was the only risk factor associated with DILI [OR 7.7 (CI 95%: 2.0-30.0; P = 0.003)]. CONCLUSIONS: In our series, there was a high prevalence of LD, being fatty liver disease associated with obesity the most frequent finding. The second frequent disease was DILI, being fatty liver disease its main risk factor. The presence of obesity and the use of NSAIDs, especially in patients with steatosis, arise from our results as two conditions that require special care in handling this particular population.
22325961 Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. 2012 Jun Cementless femoral fixation has become widely accepted in modern total hip arthroplasty. Treating patients who have a stovepipe-shaped femur (Dorr type C) with cementless implants has traditionally been challenging. We treated 53 consecutive patients (60 hips) who had type C bone with identical tapered, proximally coated implants and postoperative weight bearing as tolerated. At 6 weeks, all 60 hips had radiographically documented bony integration, and at 1 year, there was no evidence of fracture, subsidence, thigh pain, stress shielding, loose stems, or risk of failure. Of those patients, 40 (43 hips) had midterm follow-up (average, 6 years; range, 4-9 years); the findings were the same. We conclude that modern proximally tapered stems can be used with early weight bearing in patients with type C bone.
22985924 [Hypokalemic paralysis: the first presentation of primary Sjögren's syndrome]. 2012 Mar The Sjögren's syndrome is a systemic autoimmune disorder characterized by chronic inflammation of the exocrine glands with extraglandular manifestations in up to 25% patients. Renal involvement occurs in 18.4-67% of cases, with tubulointerstitial nephritis being the most frequent pathology. We present the case of a 37 year-old woman admitted because of generalized grade 2 muscle weakness which developed over a week. We detected: hypokalemia, rhabdomyolysis, urinary pH 6.5, proteinuria and metabolic acidemia. The laboratory tests suggestive of distal renal tubular acidosis with hypokalaemia led to the diagnosis of lymphoplasmocytic tubulointerstitial nephritis, which was confirmed by renal biopsy, and to a clinical suspicion of Sjögren's syndrome. Primary Sjögren's syndrome was diagnosed in this patient based on the following criteria: xerophthalmia, xerostomia, sialadenitis, positive anti-SSA and anti-SSB antibodies, and absence of criteria for lupus and rheumatoid arthritis. During hospitalization, the patient developed deep vein thrombosis. Tests showed positive antiphospholipid antibodies and the diagnosis of secondary antiphospholipid syndrome was made. She was treated with potassium, bicarbonate, steroids, ramipril and warfarin. The authors wish to highlight the extraglandular manifestations and in particular the rarity of hypokalemic paralysis as the presenting manifestation of primary Sjögren's syndrome.
22278935 6-Mer hyaluronan oligosaccharides increase IL-18 and IL-33 production in mouse synovial fi 2012 Oct Hyaluronan (HA) oligosaccharides stimulate pro-inflammatory responses in different cell types by modulating both cluster determinant 44 (CD44) and TLR4. The activation of these receptors is also mediated by collagen-induced arthritis (CIA) that, via two different pathways, culminates in the liberation of NF-κB. This then stimulates the production of pro-inflammatory cytokines, including IL-18 and IL-33, that are greatly involved in rheumatoid arthritis. The aim of this study was to investigate the effects of 6-mer HA oligosaccharides on mouse synovial fibroblasts obtained from normal DBA/J1 mice or mice subjected to CIA. Compared with normal synovial fibroblasts (NSF), rheumatoid arthritis synovial fibroblasts (RASF) showed no up-regulation of CD44 and TLR4 mRNA expression and the related proteins, as well as no activation of NF-κB. Very low levels of both mRNA and related proteins were also detected for IL-18 and IL-33. Treatment of NSF and RASF with 6-mer HA oligosaccharides significantly increased all the parameters in both fibroblast groups, although to a greater extent in RASF. The addition of hyaluronan binding protein to both NSF and RASF inhibited HA activity and was able to reduce the effects of 6-mer HA oligosaccharides and the consequent inflammatory response.
22242954 Bone and joint protection ability of ceramic material with biological effects. 2012 Feb 29 Ceramic materials with biological effects (bioceramic) have been found to modulate various biological effects, especially those effects involved in antioxidant activity and hydrogen peroxide scavenging. As arthropathy and osteopathy are the major chronic diseases of geriatric medicine, we explored the possible activity of bioceramic on these conditions using animal and cell models. Rabbits received intra-articular injections of lipopolysaccharides (LPS) to induce inflammation that mimic rheumatic arthritis. FDG isotopes were then IV injected for PET scan examinations at 16 hours and 7 days after the LPS injection. We examined and compared the bioceramic and control groups to see if bioceramic was capable of relieving inflammation in the joints by subtracting the final and initial uptake amount of FDG (max SUV). We studied the effects in prostaglandin E2 (PGE2) inhibition on the human chondrosarcoma (SW1353) cell line, and the effects on the murine osteoblast (MC3T3-E1) cell line under oxidative stress. All the subtractions between final and initial uptakes of FDG in the left knee joints of the rabbits after LPS injection indicated larger decreases in the bioceramic group than in the control group. This anti-arthritic or inflammatory effect was also demonstrated by the PGE2 inhibition of the SW1353 cells. We further proved that bioceramic treatment of the MC3T3-E1 cells resulted in increased viability of osteoblast cells challenged with hydrogen peroxide toxicity, and increased alkaline phosphatase activity and the total protein production of MC3T3-E1 cells under oxidative stress. Since LPS-induced arthritis is an experimental model that mimics RA, the potential therapeutic effects of bioceramic on arthropathy merit discussion. Bioceramic may contribute to relieving inflammatory arthritis and maintaining bone health.
22782529 No differences in cancer screening rates in patients with rheumatoid arthritis compared to 2012 Oct OBJECTIVE: Previous study findings have suggested that patients with chronic diseases such as rheumatoid arthritis (RA) do not receive optimal preventive medical services, including cancer screening tests. This study was undertaken to evaluate cancer screening rates in RA patients compared to non-RA control populations. METHODS: Using data from a large US commercial insurance plan, we examined rates of screening tests for cervical, breast, and colon cancer in patients with RA compared to control subjects without RA (non-RA controls) or control subjects with hypertension. Individuals were included in the RA cohort if they had at least 2 visits coded for a diagnosis of RA and had received at least 1 prescription for a disease-modifying antirheumatic drug during the study period. Multivariable Cox proportional hazards models were used to compare the rates of different cancer screening tests between RA patients and non-RA controls. RESULTS: RA patients (n = 13,314) and control subjects (non-RA and hypertension controls) (n = 212,324) were screened, on average, once every 3 years for cervical cancer and once every 2 years for breast cancer during the followup period (mean 2.3 years of followup). In the age-adjusted Cox regression model, women with RA were more likely to receive ≥ 1 Papanicolaou smear (hazard ratio [HR] 1.21, 95% confidence interval [95% CI] 1.17-1.24), ≥ 1 mammogram (HR 1.49, 95% CI 1.45-1.53), and ≥ 1 colonoscopy (HR 1.69, 95% CI 1.61-1.77) compared to female non-RA control subjects. Men with RA were also more likely to receive at least 1 colonoscopy (HR 1.52, 95% CI 1.40-1.64) than were male non-RA control subjects. These results were robust in multivariable analyses adjusted for age, number of physician visits, percentage of visits made to primary care physicians, and the Charlson Comorbidity Index. CONCLUSION: Patients with RA did not appear to be at risk for receiving fewer cancer screening tests when compared to individuals without RA. The majority of both RA patients and non-RA control subjects were screened regularly for cervical, breast, and colon cancer, in accordance with current recommendations.
21752582 Midterm results of Optetrak posterior-stabilized total knee system after 7 to 12 years in 2011 Dec A clinical study has been carried out on 434 posterior-stabilized knee prostheses (Optetrak; Exactech, Gainesville, Fla) implanted between 1995 and 2000 in a university general hospital by 23 surgeons. At a mean follow-up of 8.8 years, 297 knees in 249 patients were available for review. Average patient age at surgery was 71.8 years. Average body mass index was 28.8 kg/m(2). Mean flexion range was 108° .The average knee score (Hospital for Special Surgery) increased from 48 points preoperatively to 86 points (60-97 points) at the final review. Of the patients, 81% had an excellent or good result, 14.9% had a fair result, and 4.1% had a poor result. Using the Kaplan-Meier method, we obtained a 91.3% predicted implant survival at 12 years including septic and aseptic revision in the best-case scenario.
20980284 Elevated number of recently activated T cells in bone marrow of patients with rheumatoid a 2011 Jan OBJECTIVES: (1) To compare the absolute T-cell numbers in bone marrow (BM) isolated from patients with rheumatoid arthritis (RA) and osteoarthritis (OA); (2) to measure the levels of soluble interleukin 15 (IL-15) and IL-7; (3) to analyse the expression of activation markers on T cells; (4) to analyse influence of IL-15 stimulation on T-cell proliferation. METHODS: BM samples were obtained from patients undergoing joint replacement surgery. Concentrations of IL-15 and IL-7 were measured using specific ELISAs. The absolute number of T lymphocytes, their activation status and proliferation were evaluated by flow cytometry. RESULTS: BM from patients with RA contained double the number of CD3 T cells in comparison with OA (6.1 vs 2.7 × 10(6) cells/ml, p<0.008). Ratio CD3CD4:CD3CD8 was increased in RA BM, clearly indicating accumulation of CD3CD4 cells. T cells obtained from patients with RA expressed higher level of early activation markers than from OA. Elevated levels of IL-15 were found in BM plasma from patients with RA in comparison with patients with OA (1304.5±956.3 pg/ml and 760±238.7 pg/ml respectively, p<0.01). These data were confirmed by immunohistochemistry of RA BM from regions proximal and distal to the joint. Although both CD3CD4 and CD3CD8 cells proliferated after IL-15 stimulation in vitro, CD3CD4 cells from patients with RA proliferated more vigorously than those from patients with OA, reflecting the composition of T-cell subsets in BM. CONCLUSION: These results suggest that locally overproduced IL-15 may be responsible for the activation and proliferation of T cells in situ, reflected by significantly increased number of activated T cells in RA BM, possibly contributing to the pathogenesis of RA.
20838203 Disseminated tuberculosis secondary to adalimumab. 2012 Jul A 62-year-old woman with rheumatoid arthritis presented with fever (T-103.9°F). Vital signs and physical examination were normal. She was taking adalimumab, methotrexate, and prednisone for the past 9 months. Blood and urine cultures, human immunodeficiency virus, rapid plasma reagin, purified protein derivative, and cerebrospinal fluid test findings were negative. Computed tomography showed scattered 0.2-cm nodules in the lungs and innumerable subcentimeter lesions in the liver and spleen. Broad-spectrum antibiotics were started empirically. Liver biopsy findings revealed necrotizing granulomas and were negative for acid fast bacilli and fungi on staining. As the patient was persistently febrile despite antibiotics, the antibiotics were discontinued, and an antituberculous regimen including INH, ethambutol, and pyrazinamide was initiated empirically on day 40 of hospitalization. Fourteen days after liver biopsy, acid-fast bacilli grew in the tissue culture. Disseminated tuberculosis (TB) was diagnosed. Fever subsided after 1 week of anti-TB treatment. Antitumor necrosis factor alpha therapy in rheumatoid arthritis increases the risk of TB 5-fold. This is mostly as a result of reactivation of latent TB and commonly presents as disseminated TB. It usually occurs in the early stage of treatment. In our patient, the screening test results for TB before initiation of Adalimumab could have been falsely negative due to immunosuppression secondary to steroids. Our case emphasizes that current screening tests can miss latent TB especially in immunosuppressed patients. As it is difficult to diagnose TB with polymerase chain reaction and culture, histopathology should be sought early. Patients on antitumor necrosis factor alpha therapy presenting with fever of unknown origin should be considered for empirical anti-TB treatment regardless of microbiological and tissue diagnosis.
22257812 [Giant coronary artery aneurysm in a patient with rheumatoid arthritis]. 2011 Dec A 52-year-old men with rheumatoid arthritis of 12-year history presented with severe chest pain. The electrocardiogram was consistent with acute inferior myocardial infarction. Transthoracic echocardiography showed increased left ventricular dimensions and hypokinesia in the inferolateral wall. Coronary angiography performed for percutaneous coronary intervention showed aneurysmatic dilatation (15-16 mm) and total occlusion of the right coronary artery by a large thrombus. As there was no stent available for dilated right coronary artery and due to the large thrombus burden, medical therapy was decided and tissue plasminogen activator infusion was started. The patient's chest pain progressively decreased. Coronary angiography performed on the fifth day of admission showed TIMI 3 flow in the right coronary artery. Warfarin was added to standard anti-ischemic treatment with a target INR of 2.5-3.0. Our literature search yielded no reported case of such aneurysmatic dilatation associated with rheumatoid arthritis.