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ID PMID Title PublicationDate abstract
22087092 Interstitial granulomatous dermatitis: another clinical variant. 2011 Sep A 70-year-old female patient presented with an eruption consisting of symmetrically distributed erythematous papules around the umbilicus 1 month after the cessation of adalimumab for the treatment of rheumatoid arthritis. Biopsy of a papule showed an interstitial granulomatous infiltrate in the dermis, without deposition of mucin. The lesions cleared only after re-initiation of treatment 2 months later. Interstitial granulomatous dermatitis is thought to be a distinct histopathological pattern, either drug induced or associated with rheumatoid arthritis or autoimmune collagen diseases. In our case, there was a distinct clinical presentation of interstitial granulomatous dermatitis, composed of symmetrically distributed indurated papules around the umbilicus as well as a mild granulomatous reaction pattern.
23559798 Clinical efficacy of Shiva Guggulu and Simhanada Guggulu in Amavata (Rheumatoid Arthritis) 2012 Apr Amavata is the second most common joint disorders. Nowadays erroneous dietary habits, lifestyle and environment have led to various autoimmune disorders i.e. Amavisajanya Vikaara and Amavata is one among them. Rheumatoid arthritis can be correlated with Amavata in view of its clinical features. Many research studies have been done to solve this clinical enigma, but an effective, safe, less complicated treatment is still required for the management of Amavata. In the present study, 24 patients of Amavata were registered and randomly grouped into two. In group A, Shiva Guggulu 6 g/day in divided doses and in group B, Simhanada Guggulu 6 g/day in divided doses were given for 8 weeks. On analysis of the results, it was found that Simhanada Guggulu provided better results as compared to Shiva Guggulu in the management of Amavata.
24294153 Impairment and disability: Renoir's adaptive coping strategies against rheumatoid arthriti 2012 Dec Pierre-Auguste Renoir was one of the most influential painters in art history, but few people know that he suffered from debilitating rheumatoid arthritis. Despite his arthritis, he was able to maintain an incredible level of precision and efficiency with his painting. More importantly, he remained positive and did not let his condition affect his passion for painting or take away from the beauty that he saw in the world around him. Renoir applied a wide variety of coping mechanisms and used his ingenuity to come up with different ways to continue painting even as his arthritis weakened him. Renoir's long battle with rheumatoid arthritis serves as an inspiration to patients who experience the pain and limited mobility associated with this disease, encouraging them to persevere and to develop coping mechanisms that prevent the effects of their impairment from disabling them.
23049184 Effect of kshara basti and nirgundi ghana vati on amavata (rheumatoid arthritis). 2012 Jan Ayurveda has taken the foremost place in the management of crippling disease, one of them is Amavata which can be compared with Rheumatoid Arthritis due to its clinical appearance. Due to wide spectrum of disease, much prevalence in the society and lack of effective medicament, the disease is being chosen for the study. The line of treatment described for the disease in Chakradatta can be summarized under following captions. i.e to bring Agni to normal state to digest Ama, and eliminate vitiated Vata and Ama. Thus, here Kshara Basti is selected for the present study as Samshodhana process which corrects all of above captions. It is mentioned in Chikitsa Sutra described by Chakradatta. Nirgundi has Amavatahara property which is stated by Bhavaprakasha, considering which Nirgundi Patra Ghanavati is selected as Shamana drug. Total 50 randomly selected patients of Amavata were registered among them 45 were completed the treatment. Kshara Basti in the format of Kala Basti was given to these patients and Nirgundi Ghana Vati was given for one month. Statistically significant improvement was found in ESR, RA factor (quantitative) and also highly significant results were found in symptoms of Amavata. Moderate improvement was seen in 40% of patients, 35.56% patients got marked improvement, while mild improvement was found in 24.44% of patients.
31643529 Antirheumatic Agents. 2012 The term "antirheumatic drugs" refers to agents used in the therapy of inflammatory arthritis, predominantly rheumatoid arthritis, but also idiopathic juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and others. Aspirin, the nonsteroidal antiinflammatory agents and corticosteroids are used commonly in these conditions, but have little effect in altering the natural history and outcomes of inflammatory arthritis, which can lead to cartilage and joint destruction and severe disability. More important and diverse are the "Disease-Modifying Anti-Rheumatic Drugs" (DMARDs) which are the mainstay of therapy in rheumatoid arthritis and have dramatically altered the outcome of these conditions, and improved the quality of life of patients with rheumatoid arthritis. The initial DMARDs were the gold preparations which were first used in the 1930s. More potent and better tolerated agents followed in the 1950s and 1960s, including methotrexate, hydroxychloroquine, sulfasalazine, penicillamine, azathioprine and the thiopurines. More modern DMARDs have included potent, small molecule immunosuppressive agents such as leflunomide, cyclosporine, tacrolimus and mycophenolate. More recently, monoclonal antibodies and biologics have been developed that act on the primary cytokines and inflammatory pathways that are active and play a major role in rheumatoid arthritis. These important agents include the tumor necrosis factor antagonists, anticytokines (such as anakinra) and other major immunosuppressive agents (rituximab, abatacept, and tocilizumab). Agents used predominantly as antirheumatic drugs are listed below with specific links to the individual drugs. Medications for gout are given under "Antigout Agents" and nonsteroid antiinflammatory agents under "NSAIDs".
23251815 Wound healing with medications for rheumatoid arthritis in hand surgery. 2012 Introduction. Medications used to treat rheumatoid arthritis, such as corticosteroids, disease-modifying agents (DMARDs), and injectable biological agents (anti-TNFα), may have widespread effects on wound healing. In hand surgery, it is important to balance the risks of poor wound healing from continuing a medication against the risks of a flare of rheumatoid arthritis if a drug is temporarily discontinued. Materials and Methods. A United Kingdom (UK) group of 28 patients had metacarpophalangeal joint replacement surgery in 35 hands (140 wounds). All medication for rheumatoid arthritis was continued perioperatively, except for the injectable biological agents. Results. There were no instances of wound dehiscence or deep infection and only one episode of minor superficial infection. Conclusions. We conclude that provided care is taken to identify and treat any problems promptly, it is appropriate to continue most antirheumatoid medications in the perioperative period during hand surgery to reduce the risk of destabilising the patients' overall rheumatoid disease control.
21966629 Imaging features of the pleuropulmonary manifestations of rheumatoid arthritis: pearls and 2011 Rheumatoid arthritis (RA) is a common disorder that affects the joints. RA is a systemic disease associated with relatively frequent and variable pleuropulmonary manifestations. This article reviews the common and potentially serious thoracic sequelae in terms of pleural disease, pulmonary nodules, airways disorders, and interstitial disease, as well as pulmonary side effects of antirheumatic medication. An imaging-guided approach to classification of RA-associated lung disease is outlined and the comparative values of different imaging modalities are discussed. An appreciation of current knowledge of epidemiology, pathological correlation, and prognostic implications of different RA-associated lung disease is provided. We highlight importance of considering pertinent differential diagnoses to avoid misdiagnosis, and outline common pitfalls in dealing with pleuropulmonary rheumatoid disease.
26673409 The pathogenesis of rheumatoid arthritis in radiological studies. Part II: Imaging studies 2012 Sep Early diagnosis of rheumatoid arthritis followed by early initiation of treatment, prevent the destruction of joints and progression to disability in the majority of patients. A traditional X-ray fails to capture early inflammatory changes, while late changes (e.g. erosions) appear after a significant delay, once 20-30% of bone mass has been lost. Sonography and magnetic resonance imaging studies have shown that erosions are seen in the first 3 months from the appearance of symptoms in 10-26% of patients, while in 75% they are seen in the first 2 years of the disease. Power Doppler ultrasound and dynamic magnetic resonance studies allow for qualitative, semiquantitative and quantitative monitoring of the vascularization of the synovium. In addition, magnetic resonance enables assessment of the bone marrow. The ultrasonographic examination using a state-of-the-art apparatus with a high-frequency probe allows for images with great spatial resolution and for the visualization of soft tissues and bone surfaces. However, the changes seen in ultrasonography (synovial pathologies, the presence of exudate, tendons changes, cartilage and bone lesions, pathologies of tendon attachments and ligaments - enthesopathies) are not only specific for rheumatoid arthritis and occur in other rheumatic diseases. Qualitative methods are sufficient for diagnosing the disease through ultrasound or magnetic resonance imaging. Whereas semiquantitative and quantitative scales serve to monitor the disease course - efficacy of conservative treatment and qualification for radioisotope synovectomy or surgical synovectomy - and to assess treatment efficacy.
23264838 Pain treatment in arthritis-related pain: beyond NSAIDs. 2012 Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.
22465972 Autoimmune hepatitis/primary biliary cirrhosis overlap syndrome and associated extrahepati 2012 May AIM: To assess the prevalence of concurrent extrahepatic autoimmune diseases in patients with autoimmune hepatitis (AIH)/primary biliary cirrhosis (PBC) overlap syndrome and applicability of the 'mosaic of autoimmunity' in these patients. METHODS: The medical data of 71 AIH/PBC overlap patients were evaluated for associated autoimmune diseases. RESULTS: In the study population, 31 (43.6%) patients had extrahepatic autoimmune diseases, including autoimmune thyroid diseases (13 patients, 18.3%), Sjögren syndrome (six patients, 8.4%), celiac disease (three patients, 4.2%), psoriasis (three patients, 4.2%), rheumatoid arthritis (three patients, 4.2%), vitiligo (two patients, 2.8%), and systemic lupus erythematosus (two patients, 2.8%). Autoimmune hemolytic anemia, antiphospholipid syndrome, multiple sclerosis, membranous glomerulonephritis, sarcoidosis, systemic sclerosis, and temporal arteritis were identified in one patient each (1.4%). A total of 181 autoimmune disease diagnoses were found in our patients. Among them, 40 patients (56.4%) had two, 23 (32.3%) had three, and eight (11.3%) had four diagnosed autoimmune diseases. CONCLUSION: A large number of autoimmune diseases were associated with AIH/PBC overlap patients. Therefore, extended screening for existing autoimmune diseases during the routine assessment of these patients is recommended. Our study suggests that the concept of 'mosaic of autoimmunity' is a valid clinical entity that is applicable to patients with AIH/PBC overlap syndrome.
22291641 Simultaneous Breast Cancer and Kaposi's Sarcoma Complicating Rheumatoid Arthritis. 2011 Sep For a number of years we have been following the medical literature to find a relationship between chronic treatment with methotrexate and breast cancer occurrence, because we had had in our clinic a female patient who had had two consecutive cancers following methotrexate treatment for rheumatoid arthritis (RA). We were much surprised to find in some papers that breast cancer incidence is low in women with RA. Since then, we have found several papers explaining the low incidence of breast cancer among women being under NSAIDs, but those papers are not univocal. Methotrexate is a known antifolate agent and it has been demonstrated that dietary shortage of folate is a risk factor for breast cancer development.
22870493 Treatment of rheumatoid arthritis in patients with concomitant chronic hepatitis C infecti 2012 Feb Hepatitis C virus (HCV) infection is present in 1.8% of the general US population and its prevalence worldwide is estimated at 2-3%. HCV infected patients with concomitant rheumatoid arthritis (RA) pose a particular challenge to the rheumatologist because of the risks of treatment with disease-modifying medications in patients with chronic liver infection. In this paper the difficulties of diagnosing RA in HCV patients and the safety of RA treatment in patients with both conditions are discussed.
22408298 Clinical evaluation of Vardhamana Pippali Rasayana in the management of Amavata (Rheumatoi 2011 Apr Amavata is described as a difficult to cure (Krichhrasadhya) disease in Ayurveda. Pain in joints with swelling is a cardinal feature of this disease. It can be correlated with rheumatoid arthritis described in modern medical science. In conventional medical science, steroids and some nonsteroidal anti-inflammatory drugs are used for its management, but they cause certain dangerous side effects in the patients. Ayurveda promises an excellent therapy for it. The present clinical trial was conducted with the same objective to provide a safe, economical and effective therapy to the patients of Amavata. The present study was conducted in 73 patients having classical symptoms of Amavata. The patients were given Vardhamana Pippali Rasayana for 15 days. Patients with any other acute or chronic systemic illness or infection were excluded from the study. The observations and results obtained were analyzed statistically applying the "t" test. All the patients experienced up to 50% relief from the signs and symptoms of Amavata after the therapy. The drug might have produced its beneficial effects in the patients of Amavata due to its Agnideepana, Amapachana, Vatashamaka and Rasayana effects in the body. A significant decrease in the erythrocyte sedimentation rate in all the patients was also noticed. All the results obtained were highly significant statistically. Thus, it can be implicated that the Vardhamana Pippali Rasayana has a lot of beneficial effects in the patients of Amavata.
21836772 Longitudinal MRI follow-up of rheumatoid arthritis in the temporomandibular joint: importa 2011 Jun This article describes longitudinal magnetic resonance imaging (MRI) observations in a patient with rheumatoid arthritis of the temporomandibular joint. The characteristic findings included marked synovial proliferation, which was observed before the onset of severe bone destruction. MRI is considered to provide valuable information for the early detection of rheumatoid arthritis of the temporomandibular joint.
23814559 A radiographic evaluation of temporomandibular and hand (Metacarpophalangeal) / wrist join 2012 Dec BACKGROUND: A review of literature revealed that, although the involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is not uncommon, variation in presentation persist. Comparative studies of bony changes in the right and left TMJ with the right and left peripheral hand (Metacarpophalangeal-MCP)/wrist joints have not been done, to the best of our knowledge. MATERIALS AND METHODS: In this cross-sectional study, the temporomandibular and hand (MCP) and wrist joints of fifteen rheumatoid arthritis patients were evaluated with questionnaires, clinical and lab assessment and radiographically using conventional radiographs and computed tomography. Students t-test was applied for the statistical analysis of the data obtained and a P value of 0.05 was considered as statistically significant. RESULTS: Comparisons between the right TMJ with right MCP/wrist joint and left TMJ with left MCP/wrist joint did not reveal statistically significant results. Radiographically, flattening and erosions were the common manifestations. MCP joints were more affected than the wrist, but whenever the wrist was involved, it was more likely to be bilaterally affected. CONCLUSIONS: Although the TMJ showed osseous changes of a higher grade than the hand (MCP) and wrist joints radiographically, it was observed that patients were more aware of the peripheral joint discomfort. There were no significant differences between TMJ and peripheral joints on both right and left sides.
27790008 Critical appraisal of efficacy and safety of abatacept in the treatment of refractory rheu 2012 Rheumatoid arthritis is a chronic, progressive, autoimmune disease that leads to significant disability and premature mortality. Various treatment options are available, but the foundation of treatment includes nonbiologic and biologic disease-modifying antirheumatic drugs. The incidence of patients with rheumatoid arthritis refractory to first-line agents is estimated to be at least 20%. Abatacept, a T cell costimulation modulator, is the first agent to interfere with full T cell activation by competing with CD28 for binding of CD80 and CD86, which results in decreased secretion of proinflammatory cytokines and autoantibody production. Current American College of Rheumatology treatment guidelines recommend abatacept for patients with at least moderate disease activity and a poor prognosis demonstrating an inadequate response to other agents. Several key Phase III trials have been conducted to evaluate the efficacy and safety of abatacept in patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy. Response rates in all trials showed statistically significant improvements compared with placebo according to American College of Rheumatology criteria for disease improvement. The most common adverse event report in patients receiving abatacept was infection; however, the frequency of adverse events was similar to placebo. Abatacept is a safe and effective rheumatoid arthritis treatment for patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy.
21912729 Toll-like receptors are potential therapeutic targets in rheumatoid arthritis. 2011 Jul 26 Toll-like receptors (TLRs) are found on the membranes of pattern recognition receptors and not only play important roles in activating immune responses but are also involved in the pathogenesis of inflammatory disease, injury and cancer. Furthermore, TLRs are also able to recognize endogenous alarmins released by damaged tissue and necrosis and/or apoptotic cells and are present in numerous autoimmune diseases. Therefore, the release of endogenous TLR ligands plays an important role in initiating and driving inflammatory diseases. Increasing data suggest a role for TLR signaling in rheumatoid arthritis, which is an autoimmune disease. Although their involvement is not comprehensively understood, the TLRs signaling transducers may provide potential therapeutic targets.
22850902 Efficacy, safety and mechanism of action of modified-release prednisone in rheumatoid arth 2012 Jun Glucocorticoids (GCs) provide a powerful and widely used anti-inflammatory and disease-modifying therapy for rheumatoid arthritis (RA). However, concerns about adverse effects are driving efforts to find 'safer' GC or GC analogues. One novel approach has been to change the timing of GC delivery, targeting the early hours of the morning to suppress the observed circadian peak in interleukin-6 (IL-6). The CAPRA-1 study has shown that this produces a clinically useful beneficial improvement in morning stiffness and mechanistic studies have shown that this correlates with a strong suppression of the IL-6 early morning peak. With no obvious additional adverse reactions, this improvement in the therapeutic ratio offers additional treatment options in RA, and perhaps in other inflammatory diseases that show circadian variation in symptoms.
22870486 The efficacy and safety of tacrolimus in rheumatoid arthritis. 2011 Dec The crucial role of T cells in the pathogenesis of rheumatoid arthritis (RA) is well recognized. Tacrolimus is an immunomodulator that acts by the inhibition of T-cell activation. There have been numerous studies examining the use of tacrolimus in RA, including four randomized controlled trials. This article reviews these data with respect to the efficacy of the use of tacrolimus in RA as monotherapy and as part of combination therapy. The safety of tacrolimus use in RA is then evaluated. Tacrolimus is shown to be an effective and safe therapeutic option for RA patients intolerant of or resistant to previous disease-modifying antirheumatic drugs (DMARDs). In addition to monotherapy, tacrolimus has been successfully used as part of combination RA therapy, in particular in conjunction with methotrexate. Further assessment of combination approaches involving tacrolimus use alongside other DMARDs or biologics would be helpful. More studies are required to examine the effects of tacrolimus on the radiographic progression of RA.
27790016 The impact of tocilizumab on physical function and quality of life in patients with rheuma 2012 OBJECTIVE: To determine the impact of tocilizumab on physical function and quality of life in patients diagnosed with rheumatoid arthritis. METHODS: A systematic literature review was performed to select for trials that could be used to examine the impact of tocilizumab on patients in terms of health-related physical function, quality of life, and quality of sleep. By examining background therapy, disease duration, and remission rates, we were able to determine the impact that a dose of tocilizumab has on various patients. RESULTS: A total of 2617 tocilizumab-treated patients and 1271 controls were available for this study. Tocilizumab improved the Health Assessment Questionnaire Disability Index score statistically in comparison to the controls, with odds ratios from 1.4 to 7.0. Tocilizumab improved the physical function measure substantially more than the minimal clinically important difference (MCID) (5 units) - 8.9 and 9.7 - compared to 4.1 and 5.0 for controls. Seven and nine units of improvement were observed when measuring fatigue in rheumatoid arthritis patients. Using the Epworth Sleepiness Scale, we found that sleep improved (from 7.7 [3.1] to 3.4 [2.2]). CONCLUSION: Tocilizumab improves function and quality of life and decreases fatigue in patients with rheumatoid arthritis.