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ID PMID Title PublicationDate abstract
25530733 Male Veterans Coping With the Pendulum Swing of Rheumatiod Arthritis Pain: A Qualitative S 2012 Jul This study describes the physical, psychological and social context of rheumatoid arthritis (RA) pain from the male veterans. A qualitative, descriptive design was employed using a purposive sampling to ensure representation of male veterans. Interviews were conducted with 12 male veterans of the VA Greater Los Angeles Healthcare System. Socio-demographic characteristics, clinical profiles and descriptors of rheumatoid pain experienced by male veterans' since their diagnoses were gathered. Interviews were audio recorded and transcribed verbatim. Grounded Theory analysis techniques were used to identify concepts related to living with RA Pain. Six concepts related to RA pain adaptation emerged. Three concepts were associated with movement (keep moving, consequences of not moving, staying physically active) and three were related to emotion (thinking positive thoughts, doing jobs, focusing on male identity). The "keep moving" concept explained coping with chronic RA pain through three activity types: physical, cognitive and socio-economic activities. These activities fluctuated in intensity depending upon the disease stage and RA symptoms. The forward and backward pendulum swing described the unpredictable course and pain coping strategy of the veterans. Further studies are recommended to determine the transferability of our findings to other populations and to confirm the impact of continuous motion as an effective pain management strategy for RA.
22727543 Clinical features of children with juvenile idiopathic arthritis using the ILAR classifica 2013 Aug BACKGROUND/PURPOSE: The aim of the study was to describe the clinical features of children affected by juvenile idiopathic arthritis (JIA) under the International League of Associations for Rheumatology-derived classification criteria in a community-based setting. METHODS: Consecutive cases of JIA from defined geographic areas of Taiwan were diagnosed and followed in an observational cohort from 1995 to 2010. In addition to the clinical and laboratory data required for the International League of Associations for Rheumatology system, information about the medication and disease activity during the study period was also recorded. RESULTS: Out of 292 children with chronic joint pain, 195 were diagnosed as JIA: systemic arthritis (19%), oligoarthritis (persistent 16.4%; extended 6.7%), polyarthritis rheumatoid factor-negative (11.8%), polyarthritis rheumatoid factor-positive (4.6%), psoriatic arthritis (1.5%), enthesitis-related arthritis (ERA; 37.4%), and undifferentiated arthritis (2.6%). Human leukocyte antigen-B27 was positive in 82.2% of patients with ERA. Uveitis was observed in 6.7% of patients. Disease-modifying anti-rheumatic drugs, including biologic medications, were used in 73.3% of children during the observational period. At the last follow-up, 40% of patients experienced a continuously active or relapsing course. CONCLUSION: Compared with previous reports on Western populations, a remarkably high prevalence was found in the ERA of the Chinese cohort, but a relatively low rate of uveitis. Ongoing disease activity was evident in a substantial number of children. These results provided a good starting point in understanding the epidemiology of this serious disease in the Chinese population.
24155540 Reduction of interleukin-6 expression in human synoviocytes and rheumatoid arthritis rat j 2011 BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disorder that involves inflammation and pain of joints. Low-level laser irradiation is being evaluated for treating RA, however, the effectiveness of linear polarized near infrared light (SuperLizer; SL) irradiation is unclear. AIM: It has been reported that interleukin 6 (IL-6) plays a key role in the progression of RA. In our previous study, using DNA microarray analysis, we examined the gene expression profiling of human rheumatoid fibroblast-like synoviocyte MH7A in response to IL-1ß administration and SL irradiation. As a result, IL-6 was listed in altered gene as increased by IL-1ß and decreased by SL irradiation. MATERIAL AND METHODS: The reduction of IL-6 gene expression in MH7A by SL irradiation was confirmed by reverse transcription polymerase chain reaction (RT-PCR) and real-time PCR. Effect of SL irradiation on the RA inflammation in the collagen induced arthritis (CIA) rats was also studied by measuring temperature. IL-6 production in knee joint of rats was analyzed by immunohisto-chemistry. RESULTS: Scatter plot analysis demonstrated that an increase in IL-6 gene expression by IL-1ß was reduced by SL irradiation. The reduction of IL-6 mRNA level by SL irradiation was successfully confirmed by RT-PCR and real-time PCR. SL irradiation treated CIA rat decreased the temperature of knee joints. The immunohistochemical analysis demonstrated a strong IL-6 staining in synovial membrane tissue of CIA rat joint, and SL irradiation significantly reduced the staining. DISCUSSION: Since IL-6 has been identified to be an important proinflarnmatory cytokine in the pathogenesis of RA, the reduction of IL-6 expression is one of mechanisms in reduction of inflammation in RA joints by SL irradiation suggesting that SL irradiation may be useful for RA therapy. CONCLUSION: SL irradiation reduced IL-6 gene expression in MH7A, and reduced inflammation and IL-6 protein expression in knee joint of CIA rats.
21928273 Relation of dry eye to disease activity in juvenile rheumatoid arthritis. 2012 May PURPOSE: To study the frequency and severity of dry eye in patients with juvenile rheumatoid arthritis (JRA) and its relation to disease activity. PATIENTS AND METHODS: Evaluation for dry eye was done in 40 patients with juvenile rheumatoid arthritis referred for ocular assessment in the Ophthalmology Clinics, Faculty of Medicine, Ain Shams University. They were 28 girls and 12 boys with age range of 7-12 years. Medical history, clinical examination, and full ophthalmologic evaluation were performed for each patient. The dry eye tests included tear film break-up time, Schirmer-1 test, and corneal fluorescein staining. Dry eye severity grading was used. Twenty healthy, age- and sex-matched children were assessed for dry eye as a control group. RESULTS: Thirty patients (75%) showed findings consistent with the diagnosis of dry eye. Twenty patients (50%) showed first-degree dryness, 8 (20%) showed second-degree, and 2 (5%) showed third-degree. The score of dry eye severity was significantly lower in remission compared to disease activity. Multiregression analysis showed the only factor affecting dry eye parameters was the duration of illness. CONCLUSIONS: Dry eye is a common incident in children with JRA and should be screened for in all patients with this disease. Severity of eye dryness is highly correlated with the disease activity.
21806480 Rituximab after methotrexate failure in rheumatoid arthritis: evaluation of the SERENE tri 2011 Nov B cell targeted therapy using rituximab, a genetically engineered chimeric mouse/human monoclonal antibody, is recommended for patients with active rheumatoid arthritis who have failed to respond to both conventional disease-modifying drugs and TNF inhibitors. The value of ritixumab in patients with earlier disease, who have only failed methotrexate, was evaluated in a large multicentre randomised, placebo-controlled trial. The Study Evaluating Rituximab's Efficacy in MTX iNadequate rEsponders (SERENE) trial enrolled 511 patients with active rheumatoid arthritis. They received one of two doses of rituximab (500 mg × 2 or 1000 mg × 2) or placebo in addition to methotrexate therapy. By 6 months significantly more patients receiving active treatment with rituximab achieved American College of Rheumatology 20 and 50% responses and had low disease activity or remission. These benefits extended to 12 months. There was not an excess of adverse reactions with rituximab. There was some evidence, albeit incomplete, that patients who were seronegative for rheumatoid factor were less likely to respond to rituximab. There is some evidence rituximab might be suitable as first choice biologic treatment, although head-to-head trials are needed against TNF inhibitors before such an approach can be justified. Its value is likely to be restricted to seropositive patients.
24991593 Serum adenosine deaminase in patients with rheumatoid arthritis treated with methotrexate. 2012 Oct OBJECTIVE: Recently, adenosine deaminase (ADA) is introduced as helpful marker in diagnosis, prognosis, and monitoring of treatment in rheumatoid arthritis (RA). The aim of this study was to determine the efficacy of the serum ADA in diagnosis, prognosis, and monitoring of treatment with methotrexate (MTX) in RA. METHODS: This was a self-controlled clinical trial conducted in university hospitals of Isfahan, Iran. The serum level of ADA, erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were measured for 70 patients with active RA (Disease Activity Score-28 [DAS28] > 3/2). After three months of MTX treatment and disease remission (DAS28 < 2.6) these markers were measured again. ANCOVA multiregression and paired t-test were used to compare and evaluate the mean level and correlation of ADA, ESR, IgM-RF, and DAS before and after RA remission. FINDINGS: The mean value for ADA activity was significantly higher than the normal one compared with other studies. Significant decreases were seen in values of ADA, ESR, RF, visual analogue scale (VAS), and DAS after remission. Also, the correlation coefficient between the values of ADA with ESR and DAS were statistically significant in baseline. Moreover, the statistically significant correlation between ADA and ESR, VAS, and DAS were seen after remission. No correlation was found in the case of the dosage of MTX with the value of ADA. CONCLUSION: It was concluded that ADA may be considered useful as a marker in diagnosis, prognosis, and monitoring of treatment with Methotrexate in RA.
23227598 [The main directions in case of polyarthritis]. 2012 Oct The polyarthritis is a relatively frequent situation which can translate a whole set of diverse and varied etiologies. A careful history and physica examination are key to accurate diagnosis of polyarthritis: the context, the topography of the articular involvement, the existence of general signs and extra-articular signs are crucial. It is advisable first of all to eliminate the infectious disease especially in case of fever (endocarditis). It is also necessary to look for a microcrystalline arthritis (gout, chondrocalcinosis) which the treatment justifies specific measures. Once these spread diagnoses, we can envisage an inflammatory rheumatism chronic and first of all, a rheumatoid arthritis (symmetric bilateral polyarthritis affecting hands and respecting distal interphalangeal joints). The rheumatoid arthritis is an urgency diagnosis: it requires an early, specialized, individualized and multidisciplinary care. The rapid institution of a disease-modifying antirheumatic drug can allow obtain a remission, mproves clinical outcomes and reduces the accrual of joint damage and disability.
22197001 Effect of atorvastatin with or without prednisolone on Freund's adjuvant induced-arthritis 2012 Feb 15 Rheumatoid arthritis is a chronic systemic inflammatory disease where cardiovascular diseases have been recognized as major determinants of early morbidity and mortality. Recently, there has been renewed interest in medication with glucocorticoids to decrease joint damage, but in long-term they incur substantial increase in the risk of cardiovascular diseases and their overall risk/benefit ratio is deemed unfavorable. So, the proposed role of statins in treatment of rheumatoid arthritis when corticosteroids indicated as traditional therapy needs to be investigated. Fifty albino rats were divided into 5 equal groups; normal control group, Freund's adjuvant induced arthritis group, group of induced arthritis treated with atorvastatin, group of induced arthritis treated with prednisolone, and group of induced arthritis treated with atorvastatin and prednisolone. The change in paw volume, serum levels of malondialdehyde (MDA), paraoxonase1 (PON1) activity, nitrites, C-reactive protein (CRP) and lipid profile was determined. The results revealed that treatment by atorvastatin in combination with prednisolone produced better satisfactory results than in either remedy alone evidenced by significant decrease in volume of hind paw, levels of MDA, nitrites, CRP, significant increase in PON1 activity and HDL and amelioration of other lipid profile parameters that were impaired by prednisolone. The present work demonstrated that statins exert beneficial anti-inflammatory and antioxidant effects beyond their basic cholesterol-lowering activity. Thus, we suggest that if corticosteroid therapy is indicated in rheumatoid arthritis, atorvastatin could be added to get benefit from its pleiotropic effects. However, further studies are needed to verify to what extent statin therapy contribute to clinical benefits in human.
22408871 [Evolutive forms of primary Sjögren's syndrome]. 2012 Feb Primary Sjogrën's syndrome (pSS) could be restricted in 50% of the cases to glandular involvement with a chronic sicca syndrome, with a considerable alteration of quality of life. It could be complicated by systemic involvements, which are responsible of the visceral severity. Thus systemic complications could appear many years after initial pSS diagnosis and justify long-term surveillance. Initial parotid gland enlargement, Raynaud phenomenon, cutaneous vasculitis and immunological abnormalities (anti-SSA and/or SSB positivity, hypergammaglobulinemia, and cryoglobulinemia) are also implicated in systemic complications.
21231797 The point prevalence of clinically relevant primary Sjögren's syndrome in two Norwegian c 2011 May OBJECTIVE: Primary Sjögren's syndrome (PSS) is a chronic autoimmune inflammatory disease characterized by exocrine gland inflammation producing clinical symptoms such as dryness of the mouth and eyes. The reported prevalence of PSS is variable, probably because of different classification criteria used and selection bias. The aim of this study was to determine the prevalence of PSS in a well-defined Norwegian Caucasian population using the revised American-European Consensus Group (AECG) criteria. METHODS: Three hospitals and three private rheumatology practices provide all of the rheumatology services to the local population in Hordaland and Rogaland counties, which included 852 342 Caucasian inhabitants as of 1 January 2009. Patients on file fulfilling the new revised AECG criteria for PSS were included, and patients with incomplete data were invited to a screening visit. RESULTS: A total of 424 PSS patients were identified. Their mean age was 61.6 ± 13.2 years; 28 (7%) were men and 396 (93%) were women. The point estimate for the proportion of PSS was 0.050% [95% confidence interval (CI) 0.048-0.052]. CONCLUSION: The prevalence of PSS in this Norwegian population of Caucasians is lower than previously reported when less stringent criteria for identifying PSS were used, but is in line with more recent studies using the same criteria and methods as in this study.
22424197 Sjögren's syndrome, the old and the new. 2012 Feb Sjögren's syndrome is a chronic autoimmune disease characterised by progressive injury to exocrine glands accompanied by diverse extra-glandular manifestations. The spectrum of Sjögren's manifestations expanded in recent years to include new symptoms and signs such as small fibre neuropathy, and also well-defined activity and prognostic indexes. Similar to other non-organ-specific autoimmune diseases, a mosaic of factors have been linked with the development and appearances of Sjögren's syndrome. Progress has been made unravelling those factors, including susceptibility genes, immunological parameters and various environmental factors in the last decade, some of which may enable targeted therapies, biological and non-biological ones, for patients suffering from this disease. Thus, herein we review the postulated aetiologies, pathogenesis and new insights related to Sjögren's syndrome.
22570799 Epstein-barr virus reactivation after infliximab in rheumatoid arthritis: a case report. 2011 TNF-alpha blockers represent one of the most important therapeutic strategies for rheumatoid arthritis, but their use has raised the question about their safety profile, particularly in respect to viral infections/reactivations. We describe the case of a patient who developed a symptomatic EBV reactivation 11 days after the first infusion of infliximab.
23193470 Prostaglandins and rheumatoid arthritis. 2012 Rheumatoid arthritis (RA) is a chronic, autoimmune, and complex inflammatory disease leading to bone and cartilage destruction, whose cause remains obscure. Accumulation of genetic susceptibility, environmental factors, and dysregulated immune responses are necessary for mounting this self-reacting disease. Inflamed joints are infiltrated by a heterogeneous population of cellular and soluble mediators of the immune system, such as T cells, B cells, macrophages, cytokines, and prostaglandins (PGs). Prostaglandins are lipid inflammatory mediators derived from the arachidonic acid by multienzymatic reactions. They both sustain homeostatic mechanisms and mediate pathogenic processes, including the inflammatory reaction. They play both beneficial and harmful roles during inflammation, according to their site of action and the etiology of the inflammatory response. With respect to the role of PGs in inflammation, they can be effective mediators in the pathophysiology of RA. Thus the use of agonists or antagonists of PG receptors may be considered as a new therapeutic protocol in RA. In this paper, we try to elucidate the role of PGs in the immunopathology of RA.
22046525 The roles of interleukin-6 in the pathogenesis of rheumatoid arthritis. 2011 Several clinical studies have demonstrated that the humanized anti-interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) improves clinical symptoms and prevents progression of joint destruction in rheumatoid arthritis (RA). However, the precise mechanism by which IL-6 blockade leads to the improvement of RA is not well understood. IL-6 promotes synovitis by inducing neovascularization, infiltration of inflammatory cells, and synovial hyperplasia. IL-6 causes bone resorption by inducing osteoclast formation via the induction of RANKL in synovial cells, and cartilage degeneration by producing matrix metalloproteinases (MMPs) in synovial cells and chondrocytes. Moreover, IL-6 is involved in autoimmunity by altering the balance between T(h)17 cells and T(reg). IL-6 also acts on changing lipid concentrations in blood and on inducing the production of hepcidin which causes iron-deficient anemia. In conclusion, IL-6 is a major player in the pathogenesis of RA, and current evidence indicates that the blockade of IL-6 is a beneficial therapy for RA patients.
21603876 A series of 22 patients with adult-onset Still's disease presenting with fever of unknown 2012 Jan Adult-onset Still's disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece. The aims of the study were: (1) to study the incidence of AOSD and (2) to retrospectively apply different classifications to the data of these patients in search of a more efficient way of diagnosing these patients in the future. The annual incidence of AOSD was estimated at two new cases per 10(5). The clinical manifestations of the patients are discussed, with an emphasis on specific manifestations being considered as criteria by Yamaguchi and Fautrel classifications. Four patients exhibited markedly increased serum D: -dimers, a finding of which the potential pathophysiologic implications are discussed. Serum ferritin levels have additive values, both for diagnostic and cost-reduction purposes in cases presenting as FUO; serum ferritin values are not included in any diagnostic set of criteria at present. The finding of high levels of D-dimers in AOSD needs further studies.
22833735 Glutamate signaling in healthy and diseased bone. 2012 Bone relies on multiple extracellular signaling systems to maintain homeostasis of its normal structure and functions. The amino acid glutamate is a fundamental extracellular messenger molecule in many tissues, and is used in bone for both neural and non-neural signaling. This review focuses on the non-neural interactions, and examines the evolutionarily ancient glutamate signaling system in the context of its application to normal bone functioning and discusses recent findings on the role of glutamate signaling as they pertain to maintaining healthy bone structure. The underlying mechanisms of glutamate signaling and the many roles glutamate plays in modulating bone physiology are featured, including those involved in osteoclast and osteoblast differentiation and mature cell functions. Moreover, the relevance of glutamate signaling systems in diseases that affect bone, such as cancer and rheumatoid arthritis, is discussed, and will highlight how the glutamate system may be exploited as a viable therapeutic target. We will identify novel areas of research where knowledge of glutamate communication mechanisms may aid in our understanding of the complex nature of bone homeostasis. By uncovering the contributions of glutamate in maintaining healthy bone, the reader will discover how this complex molecular signaling system may advance our capacity to treat bone pathologies.
22315615 Tocilizumab for the treatment of rheumatoid arthritis and other systemic autoimmune diseas 2012 Interleukin (IL)-6 is a cytokine featuring redundancy and pleiotropic activity. While IL-6, when transiently produced, contributes to host defense against acute environmental stress, continuous dysregulated IL-6 production plays a significant pathological role in several systemic autoimmune diseases. In response to the expectation that IL-6 blockade would constitute a novel therapeutic strategy for the treatment of these diseases, tocilizumab, a humanized anti-IL-6 receptor antibody, was developed. Clinical trials have verified the efficacy and the safety of tocilizumab for patients with rheumatoid arthritis, resulting in approval of this innovative biologic for the treatment of rheumatoid arthritis in more than 90 countries worldwide. Pathological analyses of the effect of IL-6 on the development of autoimmune diseases and a considerable number of case reports and pilot studies have also indicated the beneficial effects of this antibody on other systemic autoimmune diseases, including systemic lupus erythematosus, systemic sclerosis, polymyositis, and large-vessel vasculitis.
22315865 Is this acute lymphoblastic leukaemia or juvenile rheumatoid arthritis. 2011 Aug Arthritis could be a presenting feature of acute lymphoblastic leukaemia (ALL) and could be wrongly diagnosed as juvenile rheumatoid arthritis (JRA). Clinical and laboratory parameters might differentiate ALL and JRA in children who present with arthritis. Out of a total of 250 children of ALL, 10 were referred to the department of child health and paediatric haemato-oncology of Christian Medical College, Vellore during 1990-2002. They were compared with 10 age-matched children who had systematic onset of JRA. The age groups in ALL and JRA were 6.05 +/- 2.45 years and 5.47 +/- 4.4 years respectively. Severe pain as evidenced by inability to walk was found in children but one child with JRA was unable to walk (p < 0.05). Lymphocytosis was noticed in 7 children (70%) with ALL whereas none had in JRA group. ESR was elevated in all cases in both the groups. One case in each group had antinuclear antibody positivity. It can be concluded that ALL can masquerade as systematic onset of JRA. So paediatricians should be careful enough while diagnosing the disease process.
23155993 Sjögren's syndrome: a case report and review of the literature. 2012 Jun The manifestations and complications of Sjögren's syndrome are important to know, and dentists can play an important role in the detection of this disease. This report highlights such a case.
23729962 Management of early- and late-stage rheumatoid arthritis: are physiotherapy students' inte 2012 Summer PURPOSE: This study examined whether physiotherapy students in a problem-based learning (PBL) curriculum intend to implement best practices for management of clients with rheumatoid arthritis (RA). METHOD: Physiotherapy students (n=49) completed a subsection of the ACREU Primary Care Survey to evaluate the concordance between intended behaviours and Canadian best practices for early- and late-stage RA, before and after completing the relevant PBL content. Changes in scores were assessed using McNemar's test for dependent proportions. RESULTS: Most students indicated that they would recommend treatments or referrals for physiotherapy/exercise, education, and occupational therapy or joint protection pre- and post-PBL (>83% and >95%, respectively). Post-PBL, more students recommended referral to a rheumatologist and disease-modifying anti-rheumatic drugs (DMARDs) for both early and late RA; however, the increase was significant only for early RA (p=0.013 and 0.031 for referral to rheumatologist and DMARDs, respectively). More students recommended psychosocial support at both stages of RA post-PBL (early RA: p<0.001; late RA: p=0.031). Although more students recommended DMARDs post-PBL, only 8 students in total made this recommendation (16%), and fewer students considered use of non-steroidal anti-inflammatory drugs. Most students (94%) did not recommend referral to a surgeon for early or late RA. CONCLUSION: Intended behaviour of physiotherapy students was more consistent with Canadian best practice guidelines for managing clients with early- and late-stage RA following the PBL curriculum. Further study is required to determine whether the students were less aware of best practices related to pharmacologic interventions and timely referral to appropriate specialists, or whether they considered these issues to be outside their scope of practice.