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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
23316401 Complete Remission of Methotrexate-Related Epstein-Barr-Virus-Associated Hodgkin-Like Lymp 2012 Patients with rheumatoid arthritis (RA) are known to develop lymphoproliferative disorders (LPDs) during the course of illness, particularly in cases treated with methotrexate (MTX) for long periods. We describe a case of MTX-related Epstein-Barr-virus-(EBV-) associated LPD resembling Hodgkin's lymphoma (HL), in which a dramatic complete remission was achieved after withdrawal of MTX coupled with clarithromycin (CAM) administration. Withdrawal of MTX coupled with CAM administration seemed to be effective for treating MTX-related EBV-associated LPDs. In particular, an immunomodulative effect of CAM might have been involved in achieving complete remission.
22833992 Transdermal delivery of methotrexate: past, present and future prospects. 2012 Mar Mehotrexate has been reported as an immunosuppressant and an antimetabolite widely used in the treatment of rheumatoid arthritis and psoriasis. However, it causes various toxicities and has low bioavailability when taken orally, thus, it is desirable that the drug be delivered transdermally. The water solubility and charged structure of methotrexate, however, limits its use via the transdermal route mainly due to the highly organized microstructure of the stratum corneum. Hence, various technologies, such as chemical enhancers, iontophoresis, electroporation, ultrasound and microneedles, either alone or in combination, are being explored to enhance its permeability by disrupting the barrier property of the skin. The present article discusses the past, present and future of transdermal delivery of methotrexate.
22662645 Effusion under the microscope. 2012 Mar Pseudochylothorax is a very rare form of pleural effusion. It is also called chyliform or cholesterol pleural effusion. It is usually a unilateral process and approximately one-third of patients are asymptomatic at presentation. We report a case of a 60 year old man with a background of rheumatoid arthritis who presented with progressive dyspnea. Chest X-ray revealed a new left pleural effusion and a small persistent right pleural effusion. He presented 5 years prior due to recurrent pleural effusion and no diagnosis was made. Repeat thoracentesis yielded 350 milliliters of thick, milky, tan-colored fluid.
22868421 [Aortic valve surgery for autoimmune disease]. 2012 Jul Aortic valve disease of autoimmune disease is complicated in pre-, peri- and post-operative care. Recommended care in aortitis, ankylosing spondylitis, systemic lupus erythematosus and rheumatoid arthritis were described. Surgical strategy should be determined depending on basic disease, degree of inflammation and region of disease. Because of the fragile tissue of autoimmune disease patient, modified Bentall procedure is recommended to prevent a prosthetic valve dropping off for aortitis. Perioperatively, it is important to control the inflammation of basic disease, thus a steroid cover is necessary perioperatively. Some complications such as infection, out-of-control of anti-coaguration or gastro-intestinal bleeding should be avoided. Post operation, a strict follow up of prosthetic valve and aorta around suture line and control of autoimmune disease should be achieved.
22522860 [Glucocorticoids: examples of translational medicine; from molecular aspects to bedside]. 2012 Glucocorticoids are anti-inflammatory, immunosuppressant and anti-allergic drugs derived from hydrocortisone. Their widespread use was originated from Hench's observations in patients with rheumatoid arthritis. These drugs are examples of translational medicine and they can be envisaged as one of the most prescribed and feared drugs. The objective of this review is to highlight their pharmacological properties and thus, allow a more suitable prescription.
21636022 Stenosing synovitis of the extensor pollicis longus tendon. 2011 Jun There are only a few published cases of extensor pollicis longus (EPL) tenosynovitis in patients without rheumatoid arthritis. Even less common are cases of stenosing tenosynovitis of the EPL associated with triggering. This article presents 2 cases of EPL stenosing tenosynovitis with triggering of the thumb in the area of Lister's tubercle and addresses how to treat them.
22389819 Penicillamine neurotoxicity: an hypothesis. 2011 Penicillamine, dimethyl cysteine, thiovaline, remains the drug of choice for the treatment of patience with Wilson disease. It is also of value in the treatment of cysteinuria and rheumatoid arthritis, it has also been suggested that it has value in the management of other rare diseases. It also has multiple toxicities. The majority of these can be explained as chemical toxicity, for instance its weak antipyridoxine action and its ability to interfere with lysyloxidea resulting in skin lesions. More important are its ability to induce immune reactions such as SLE, immune complex nephritis, the Ehlers Danlos syndrome and Goodpasture's syndrome. However the sudden increase in neurological signs which may occur in a small number of patients remains unexplained. The theory is proposed that this is due to lethal synthesis. In susceptible patients the-SH radical is liberated from penicillamine and will inhibit-SH dependent enzymes in the Krebs cycle leading to death in neurones. Other toxic metabolites may also be produced such as methyl mercaptan and ethyl mercaptan either of which could produce a similar metabolic block.
22475905 Polymyalgia rheumatica and interspinous FDG uptake on PET/CT. 2012 May Polymyalgia rheumatica (PMR) is an inflammatory disease with macrophage infiltration and CD4+ T-lymphocytes-related mild synovitis commonly causing neck, shoulder, and hip stiffness in patients older than 50 years. Closely related to giant cell arthritis (GCA), PMR symptoms can be similar to rheumatoid arthritis. Erythrocyte sedimentation rate and C-reactive protein levels are elevated in >90% of cases. In 4 patients with PMR, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) demonstrates uptake in the shoulder and hip joints and also interspinous and supraspinous focal and diffuse uptake. We propose diffuse uptake may reflect ligament inflammation with focal uptake in adjacent interspinous bursitis.
21941595 Advancements in adeno-associated viral gene therapy approaches: exploring a new horizon. 2011 Gene therapy is a promising new therapeutic strategy that has been explored in a wide variety of diseases, ranging from cancer to hemophilia, and ocular disorders to autoimmune diseases, among others. Proof of concept of gene transfer approaches has been shown in over 100 studies of animal models of disease, although only a few are under development for clinical application. The US Food and Drug Administration and the European Medicines Agency have not approved any viral human gene therapy products for sale so far, but the amount of gene-related research and development occurring in the United States and Europe continues to grow at a fast rate. This review summarizes the current status of developments in the field of viral gene therapy using adeno-associated virus as a vector, with a special focus on arthritis. For rheumatoid arthritis, and to a lesser extent for other immune-related inflammatory disorders, several cell and gene transfer approaches have been investigated at the preclinical level and a few have been implemented in clinical trials. Finally, both the potential and the hurdles that are faced during development of a viral gene therapy through to its clinical application are discussed.
22583895 Total shoulder arthroplasty - arthroplasty for glenohumeral arthropathies: results and com 2012 Jun INTRODUCTION: Arthroplasty for glenohumeral arthropathies have specific complications and the final results are sometimes more dependent upon the type of shoulder arthroplasty than the initial etiology. The aim of our study was to evaluate the rate of complications and the functional improvement with different types of shoulder arthroplasties after a minimum follow-up of 8 years. MATERIALS AND METHODS: This was a multicenter retrospective study of 198 shoulders including 85 primary osteoarthritis of the shoulder, 76 cuff tear arthropathies, 19 avascular necrosis and 18 rheumatoid arthritis. Arthroplasties included 104 anatomic total shoulder arthroplasties (TSA), 77 reverse arthroplasties and 17 hemiarthroplasties. Ten patients had their arthroplasty revised, and 134 patients with TSA were able to be present at the final follow-up or provide information on their case. Function was evaluated by the Constant-Murley score and loosening by standard radiographs. RESULTS: In the group with primary osteoarthritis of the shoulder, there were eight complications (11%) including six (8.3%) requiring implant revision. In the group of rotator cuff arthropathies, there were nine (14.7%) complications including four (6.5%) requiring implant revision. In the group with rheumatoid arthritis, there was one complication, and no surgical revision was necessary. There were no complications in the group with avascular necrosis. Glenoid migration occurred in 28.5% of anatomic TSA, and 3.4% of reverse arthroplasties. This difference was significant (P<0.001). The Constant-Murley score was significantly improved in all etiologies. CONCLUSIONS: Glenohumeral arthropathies can be successfully treated by arthroplasty. Anatomic TSA was shown to be associated with a high risk of glenoid loosening at radiographic follow-up, which makes us hesitate to use the cemented polyethylene implant, especially in young patients. LEVEL OF EVIDENCE: IV - Retrospective study.
22460511 [Locomotive syndrome and frailty. Locomotive syndrome due to the underlying disease of deg 2012 Apr Japan became a superaging society. We have been putting a new focus on locomotive syndrome and frailty. The prevention and treatment of locomotive syndromes, such as osteoarthritis, degenerative spondylosis, lumbar canal stenosis, osteoporosis, upper extremity diseases, rheumatoid arthritis, and many other disorders of the locomotive organs are important. Because, the locomotive syndrome results in deterioration of the exercise function and loss of mental and physical health. The aim of locomotive syndrome exercises are: to reduce pain, to restore and improve joint function. We need to take a comprehensive approach to locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise.
23412245 Classifications of glenoid dysplasia, glenoid bone loss and glenoid loosening: a review of 2013 Apr So far, glenoid implantation still remains a challenge and is technically demanding even for an experienced shoulder surgeon. Each shoulder pathology has its own evolution. In primary glenohumeral osteoarthritis, glenoid involvement and proper morphology vary considerably. Erosion is more posterior and inferior. In rheumatoid arthritis, glenoid erosion is more medial with a very weak and soft bone. In eccentric arthritis, glenoid erosion is most of the time superior. Glenoid component loosening has been recognized as one of the common indications for revision surgery after total shoulder arthroplasty. Scapular notching is specific to the reverse shoulder arthroplasty. Moreover, there is concern about the high frequency of glenoid components that demonstrate radiographic periprosthetic lucencies. There is little information available to guide clinical decision making regarding glenoid surgery. Placement or replacement with a standard glenoid component is usually possible. In some instances, bone graft reconstruction or the use of augmented or custom components can be an option. The purpose of this study is to evaluate the main glenoid erosion classifications.
23365885 PAGAS: Portable and Accurate Gait Analysis System. 2012 Gait analysis systems are powerful tools in the monitoring and rehabilitation of many health conditions which result in an altered gait (such as Parkinson's disease and rheumatoid arthritis), along with the injury of lower limbs. However, current systems that provide accurate gait monitoring and analysis are large and expensive, and therefore are available only in professional settings. The goal of this research is to develop and test a Portable and Accurate Gait Analysis System, denoted PAGAS, which enables patients to monitor their own gait and track their progress and improvement over time. Moreover, PAGAS will enable therapists to follow the progress of their patients over time without the need for multiple visits required at a rehabilitation facility, thus saving significant healthcare costs. PAGAS includes footswitches and a micro-controller, which connects to an Android Smart-phone using Bluetooth communication. An application on the Smartphone analyzes the raw data to produce temporal gait parameters that are displayed to the user on a graphical user interface.
23201918 The role of Fc receptors and complement in autoimmunity. 2013 Apr Autoantibodies interact with the innate immune system, including the complement network and Fc receptors (FcRs) bearing effector cells, resulting in the induction of tissue injury. It was suggested that these two pro-inflammatory pathways might mediate distinct effector responses, and that only one or the other effector arm may usually dominate an inflammatory response. Recent studies, however, support the notion that autoantibody-induced tissue injury may depend on both, FcRs and selected pathways of the complement network. This review summarizes our current knowledge on the interactions between autoantibodies, FcRs and complement components as essential triggers of tissue injury in autoimmune diseases like rheumatoid arthritis, anti-glomerular basement membrane glomerulonephritis and subepidermal blistering diseases. Manipulation of these connective pathways might be of therapeutic use to control antibody-mediated autoimmune diseases.
22284131 Emerging patterns of genetic overlap across autoimmune disorders. 2012 Jan 27 Most of the recently identified autoimmunity loci are shared among multiple autoimmune diseases. The pattern of genetic association with autoimmune phenotypes varies, suggesting that certain subgroups of autoimmune diseases are likely to share etiological similarities and underlying mechanisms of disease. In this review, we summarize the major findings from recent studies that have sought to refine genotype-phenotype associations in autoimmune disease by identifying both shared and distinct autoimmunity loci. More specifically, we focus on information from recent genome-wide association studies of rheumatoid arthritis, ankylosing spondylitis, celiac disease, multiple sclerosis, systemic lupus erythematosus, type 1 diabetes and inflammatory bowel disease. Additional work in this area is warranted given both the opportunity it provides to elucidate pathogenic mechanisms in autoimmunity and its potential to inform the development of improved diagnostic and therapeutic tools for this group on complex human disorders.
21824589 Neck pain from a rheumatologic perspective. 2011 Aug This article provides a comprehensive review of rheumatologic considerations for a clinician when evaluating a patient with neck pain. Clearly, anatomic derangements of the cervical spine should be considered when a patient complains of cervicalgia. However, one must also entertain the possibility of a systemic illness as the cause of the pain. Examples of diseases that may present with a prominent feature of neck pain are discussed, including rheumatoid arthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, myositis, and fibromyalgia. Evidence of an underlying rheumatic illness may guide the clinician in a different therapeutic direction.
21459266 Chronic inflammatory diseases and cardiovascular risk: a systematic review. 2011 Mar Despite recent advancements in the treatment of coronary artery disease (CAD), it remains the number one cause of death in the world. While traditional risk factors partially account for the development of CAD, other novel risk factors have recently been implicated. Specifically, chronic inflammation has been postulated to play a role in the development and propagation of this disease. The purpose of this systematic review is to examine the available evidence to determine if patients with chronic inflammatory diseases have higher rates of cardiovascular disease. A MEDLINE search was conducted for articles published between 1980-2009. We focused on studies that assessed hard cardiovascular endpoints in subjects with chronic inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polymyositis/dermatomyositis, and inflammatory bowel disease. Although largely based on small studies, our review indicates that patients with chronic inflammatory conditions are likely at elevated risk for the development of CAD. Further research consisting of prospective cohort studies is needed to better quantify this risk.
21322517 Adhesive capsulitis: a review. 2011 Feb 15 Adhesive capsulitis is a common, yet poorly understood, condition causing pain and loss of range of motion in the shoulder. It can occur in isolation or concomitantly with other shoulder conditions (e.g., rotator cuff tendinopathy, bursitis) or diabetes mellitus. It is often self-limited, but can persist for years and may never fully resolve. The diagnosis is usually clinical, although imaging can help rule out other conditions. The differential diagnosis includes acromioclavicular arthropathy, autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis), biceps tendinopathy, glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear (with or without impingement), and subacromial and subdeltoid bursitis. Several treatment options are commonly used, but few have high-level evidence to support them. Because the condition is often self-limited, observation and reassurance may be considered; however, this may not be acceptable to many patients because of the painful and debilitating nature of the condition. Nonsurgical treatments include analgesics (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs), oral prednisone, and intra-articular corticosteroid injections. Home exercise regimens and physical therapy are often prescribed. Surgical treatments include manipulation of the joint under anesthesia and capsular release.
21291537 Evidence for somatic gene conversion and deletion in bipolar disorder, Crohn's disease, co 2011 Feb 3 BACKGROUND: During gene conversion, genetic information is transferred unidirectionally between highly homologous but non-allelic regions of DNA. While germ-line gene conversion has been implicated in the pathogenesis of some diseases, somatic gene conversion has remained technically difficult to investigate on a large scale. METHODS: A novel analysis technique is proposed for detecting the signature of somatic gene conversion from SNP microarray data. The Wellcome Trust Case Control Consortium has gathered SNP microarray data for two control populations and cohorts for bipolar disorder (BD), cardiovascular disease (CAD), Crohn's disease (CD), hypertension (HT), rheumatoid arthritis (RA), type-1 diabetes (T1D) and type-2 diabetes (T2D). Using the new analysis technique, the seven disease cohorts are analyzed to identify cohort-specific SNPs at which conversion is predicted. The quality of the predictions is assessed by identifying known disease associations for genes in the homologous duplicons, and comparing the frequency of such associations with background rates. RESULTS: Of 28 disease/locus pairs meeting stringent conditions, 22 show various degrees of disease association, compared with only 8 of 70 in a mock study designed to measure the background association rate (P < 10-9). Additional candidate genes are identified using less stringent filtering conditions. In some cases, somatic deletions appear likely. RA has a distinctive pattern of events relative to other diseases. Similarities in patterns are apparent between BD and HT. CONCLUSIONS: The associations derived represent the first evidence that somatic gene conversion could be a significant causative factor in each of the seven diseases. The specific genes provide potential insights about disease mechanisms, and are strong candidates for further study.
23069957 Golimumab-exacerbated subacute cutaneous lupus erythematosus. 2012 Oct BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE) is characterized by annular, nonscarring, photodistributed, or papulosquamous lesions. The disease may be idiopathic, drug induced, or drug exacerbated. OBSERVATIONS: A 66-year-old woman with a history of hypertension, parkinsonism, rheumatoid arthritis, anxiety and depression, and symptoms of Sjögren syndrome was seen with a 1-month history of an eruption on her upper extremities and upper trunk. The eruption had begun 2 to 3 weeks after subcutaneous injection of golimumab for rheumatoid arthritis. She had developed SCLE 2 years previously due to furosemide use and 10 years previously due to hydrochlorothiazide use. Physical examination revealed scaly, annular, erythematous plaques photodistributed on the arms, legs, and upper trunk. A punch biopsy specimen demonstrated vacuolar interface dermatitis and lymphohistiocytic perivascular inflammation. Serological abnormalities included a positive antinuclear antibody, an elevated anti-La/SS-B antibody level, and an elevated anti-Ro/SS-A antibody level. She was diagnosed as having SCLE and was initially treated with desonide lotion, photoprotection, prednisone (40 mg/d) tapered over 6 weeks, and hydroxychloroquine sulfate (200 mg twice daily). Because of persistent disease, methotrexate sodium (12.5 mg/wk) was subsequently added to the regimen, and her eruption cleared completely. CONCLUSIONS: Golimumab should be added to the list of medications capable of inducing or exacerbating SCLE. Our patient demonstrated variable times to the resolution of SCLE, possibly attributable in part to the different half-lives of the agents administered.