Browse

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

ID PMID Title PublicationDate abstract
27298866 Retrospective Analysis of Varied Clinical Presentations and Delayed Diagnosis in Tuberculo 2012 Jul INTRODUCTION: Tuberculous involvement of extremities is not rare (50% of osseous disease which is 1-8% of extrapulmonary tuberculosis. These are commonly seen in larger joints followed by foot joints. These are termed milder form of tuberculosis as they are paucibacilary and have low chance of spread of infection. Also due to this nature they are often mis-diagnosed and mistreated. Invasive procedures to yield biological sample may be required to diagnose it. CASE REPORT: We report a series of 7 cases with involvement of extremities. Anatomical sites involved were lateral humeral condyle, flexor tenosynovium, distal femur, knee joint, calcaneum, ankle skin. They were initially treated as tennis elbow (arthritis elbow), carpel tunnel syndrome (flexor tenosynovitis, Rheumatoid arthritis), plantar fasciitis (calcaneum osteomyelitis), pyogenic osteomyelitis and non-healing ulcer (osteomyelitis distal femur and ankle ulcer respectively). Average age was 46.3 years and all patients were males. Average duration of detection from the onset of symptoms to diagnosis was mean16 months, much longer in upper limb (mean29.3 months) and shorter in lower limb (6 months). ESR was elevated in all cases with mean value of 63.4. Chest radiograph was negative (71.4%) in all except two. AFB culture and Mantoux test were positive in 2 cases. Histopathology showed granulomatous inflammation in all specimens and all patients were started on AKT on basis of this. All cases responded well to anti-tuberculous regimen with no recurrence at last follow up. CONCLUSIONS: Monoarthritis, recurrent compression neuropathies due to synovitis, non-healing osteomyelitis, sinuses and ulcers must be viewed with caution. The usual hematological investigations are not very reliable, but a moderately raised ESR is useful findings to suspect and intervene. Appropriate specimens from the suspected site of involvement should be obtained for microscopy, culture and histopathological examination to increase the detection rate. Anti tuberculous drugs can be started if there is evidence of granulomatous synovitis in histopathological examination and if there is no other obvious causes.
21234398 Immunomodulation of Autoimmune Arthritis by Herbal CAM. 2011 Rheumatoid arthritis (RA) is a debilitating autoimmune disease of global prevalence. The disease is characterized by synovial inflammation leading to cartilage and bone damage. Most of the conventional drugs used for the treatment of RA have severe adverse reactions and are quite expensive. Over the years, increasing proportion of patients with RA and other immune disorders are resorting to complementary and alternative medicine (CAM) for their health needs. Natural plant products comprise one of the most popular CAM for inflammatory and immune disorders. These herbal CAM belong to diverse traditional systems of medicine, including traditional Chinese medicine, Kampo, and Ayurvedic medicine. In this paper, we have outlined the major immunological pathways involved in the induction and regulation of autoimmune arthritis and described various herbal CAM that can effectively modulate these immune pathways. Most of the information about the mechanisms of action of herbal products in the experimental models of RA is relevant to arthritis patients as well. The study of immunological pathways coupled with the emerging application of genomics and proteomics in CAM research is likely to provide novel insights into the mechanisms of action of different CAM modalities.
22975756 Autophagy regulates TNFα-mediated joint destruction in experimental arthritis. 2013 May OBJECTIVES: Autophagy is a homeostatic process to recycle dispensable and damaged cell organelles. Dysregulation of autophagic pathways has recently been implicated in the pathogenesis of various diseases. Here, we investigated the role of autophagy during joint destruction in arthritis. METHODS: Autophagy in osteoclasts was analysed in vitro and ex vivo by transmission electron microscopy, Western blotting and immunohistochemistry for Beclin1 and Atg7. Small molecule inhibitors, LysMCre-mediated knockout of Atg7 and lentiviral overexpression of Beclin1 were used to modulate autophagy in vitro and in vivo. Osteoclast differentiation markers were quantified by real-time PCR. The extent of bone and cartilage destruction was analysed in human tumour necrosis factor α transgenic (hTNFα tg) mice after adoptive transfer with myeloid specific Atg7-deficient bone marrow. RESULTS: Autophagy was activated in osteoclasts of human rheumatoid arthritis (RA) showing increased expression of Beclin1 and Atg7. TNFα potently induced the expression of autophagy-related genes and activated autophagy in vitro and in vivo. Activation of autophagy by overexpression of Beclin1-induced osteoclastogenesis and enhanced the resorptive capacity of cultured osteoclasts, whereas pharmacologic or genetic inactivation of autophagy prevented osteoclast differentiation. Arthritic hTNFα tg mice transplanted with Atg7(fl/fl)×LysMCre(+) bone marrow cells (BMC) showed reduced numbers of osteoclasts and were protected from TNFα-induced bone erosion, proteoglycan loss and chondrocyte death. CONCLUSIONS: These findings demonstrate that autophagy is activated in RA in a TNFα-dependent manner and regulates osteoclast differentiation and bone resorption. We thus provide evidence for a central role of autophagy in joint destruction in RA.
22001857 Therapeutic effects of total coumarins from Urtica dentata Hand on collagen-induced arthri 2011 Nov 18 ETHNOPHARMACOLOGICAL RELEVANCE: Urtica dentata Hand (UDH), the root of Laportea bulbifera (Sieb. et. Zucc.) Wedd, has long been utilized in traditional Chinese medicine for the treatment of rheumatoid arthritis and some other autoimmune diseases. Coumarins are the main active principles contributing to UDH's efficacy, but the mechanisms have not been fully clarified. AIM OF STUDY: To explore effects of total coumarins (TC) isolated from UDH on the development of type II collagen (CII)-induced arthritis (CIA) in Balb/c mice. MATERIALS AND METHODS: Arthritis was induced in Balb/c mice by immunization with an emulsion of 200mg CII and complete Freund's adjuvant (CFA). The CIA mice were then given with a suspension of TC or saline by intragastric (i.g.) administration every other day. The incidence and severity of disease and histopathology of inflammation were assessed. Inflammatory response was determined by measuring the levels of different inflammation mediators in serum. The effect of TC on differentiation of CD4(+)CD25(+) Foxp3(+)Treg cells was examined by flow cytometry. The phenotype of bone marrow-derived dendritic cells (DCs), T-bet mRNA level and IL-12p70 secretion by DCs were also detected. RESULTS: Pharmacologically, treatment with TC for type II collagen induced arthritis in mice through oral administration displayed significant and dose-dependent drop of clinical arthritis score and paw swelling, compared with the untreated CIA mice. Pathologic changes showed that TC protected tissues against bone destruction, whereas an almost complete destruction occurred in the CIA model group. The protective status was associated with a substantial decrease in the production of IFN-γ and IL-2, an increase of IL-10 and TGF-β and suppressive expression of T-bet in DCs. TC also induced the generation of CD4(+)CD25(+) Treg cells with a Treg phenotype Foxp3. TC-treated DCs were characterized as low expression of MHC class II and CD86 molecules, as well as a reduction of IL-12p70. CONCLUSIONS: Our data suggest that TC provides substantial therapeutic protection against CIA by eliciting immune tolerance and it would be a valuable candidate for further investigation as a new anti-arthritic agent.
20954188 In vivo fluorescence imaging of E-selectin: quantitative detection of endothelial activati 2011 Jan OBJECTIVE: In vivo optical imaging can delineate at the macroscopic level processes that are occurring at the cellular and molecular levels. E-selectin, a leukocyte adhesion molecule expressed on endothelium, is induced by tumor necrosis factor α (TNFα) and other cytokines involved in the pathogenesis of rheumatoid arthritis (RA). Collagen-induced arthritis (CIA) in mice is widely used to study the disease mechanisms and identify new treatments for RA. The purpose of this study was to demonstrate E-selectin-targeted fluorescence imaging in vivo in a mouse model of paw edema generated by local injection of TNFα as well as in mice with CIA. METHODS: Animals with either CIA or TNFα-induced paw edema were injected with anti-E-selectin or control antibodies labeled with a DyLight 750-nm near-infrared (NIR) probe. In vivo imaging studies were undertaken using an NIR optical imaging system, and images were coregistered with plain radiographic images. RESULTS: The mean fluorescence intensity measured over the time-course of TNFα-induced edema demonstrated a 1.97-fold increase (P<0.001) in signal in inflamed paws at 8 hours following injection of anti-E-selectin antibody, as compared to that in the isotype control. In the CIA model, a 2.34-fold increase in E-selectin-targeted signal was demonstrated (P<0.01). Furthermore, significant E-selectin-targeted signal was observed in the paws of animals immunized with collagen that did not display overt signs of arthritis. CONCLUSION: E-selectin-targeted fluorescence in vivo imaging is a quantifiable method of detecting endothelial activation in arthritis and can potentially be applied to the quantification of disease and the investigation of the effects of new therapies. Importantly, this approach may also be useful for the detection of subclinical disease in RA.
31643761 Abatacept. 2012 Abatacept is a recombinant fusion protein of the cell surface marker CTLA-4 and a fragment of immunoglobulin G that acts by interfering with T cell activation and is used to treat rheumatoid and psoriatic arthritis and juvenile idiopathic arthritis. Abatacept has been linked to a low rate of serum enzyme elevations during therapy, and to rare cases of idiosyncratic, clinically apparent liver injury with jaundice. Because abatacept is a potent inhibitor of lymphocyte function, it can cause reactivation of hepatitis B in susceptible patients.
23131442 Outcome of transfibular ankle arthrodesis with Ilizarov apparatus. 2012 Nov BACKGROUND: Both transfibular ankle arthrodesis with fibular onlay grafting and ankle arthrodesis using the Ilizarov apparatus have resulted in acceptable fusion rates. This study analyzed outcomes in the authors' practice for all patients who underwent transfibular ankle arthrodesis with fibular onlay grafting using the Ilizarov apparatus. MATERIALS AND METHODS: A retrospective review was conducted of all patients who experienced severe ankle pain associated with osteoarthritis, rheumatoid arthritis, talar osteonecrosis, or septic arthritis and underwent transfibular ankle arthrodesis with an Ilizarov apparatus between 1995 and 2010. Postoperative clinical outcomes were evaluated for 42 consecutive patients (43 feet) who received primary or revision ankle arthrodesis using the Ilizarov technique at two centers. Mean duration of follow-up was 4.1 (range, 1.5 to 13) years. Outcomes were assessed using the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society. RESULTS: All ankles fused successfully. Mean clinical outcome improved significantly from 36.2 (range, 8 to 64) preoperatively to 77.4 (range, 0 to 86; p < .05) postoperatively. CONCLUSION: Transfibular ankle arthrodesis using the Ilizarov external fixation system and fibular onlay strut grafting can achieve a very high rate of bony union and lead to general improvements in clinical outcome. Forefoot stabilization with a forefoot ring achieved rigid stabilization resulting in a shorter duration of external fixation.
22922033 Mutation of membrane type-1 metalloproteinase, MT1-MMP, causes the multicentric osteolysis 2012 Sep 7 The "vanishing bone" syndromes represent a group of rare skeletal disorders characterized by osteolysis and joint destruction, which can mimic severe rheumatoid arthritis. Winchester syndrome was one of the first recognized autosomal-recessive, multicentric forms of the disorder. It was originally described nearly 50 years ago in two sisters with a severe crippling osteolysis. Using cultured fibroblasts from the proband, we have now identified homozygous mutations in membrane type-1 metalloproteinase (MT1-MMP or MMP14). We demonstrate that the resulting hydrophobic-region signal-peptide substitution (p.Thr17Arg) decreases MT1-MMP membrane localization with consequent impairment of pro-MMP2 activation, and we propose a structure-based mechanism for this effect.
22244102 Evidence-based indications for elbow arthroscopy. 2012 Feb PURPOSE: The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions. METHODS: A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence. RESULTS: There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade C(f) recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation). CONCLUSIONS: The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor. LEVEL OF EVIDENCE: Level IV, systematic review of Level II-IV studies.
20702682 Factors associated with increased pain communication by older adults. 2011 Mar The purpose of this secondary analysis study was to identify factors associated with increased pain communication by older adults. Data were obtained from 312 older adults with osteoarthritis pain. Content analysis was conducted using criteria from the American Pain Society's "Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis" to identify important pain management information described by the older adults in response to general questions about their pain. Gender was the only factor associated with increased pain communication from the predictor variables of age, education, gender, ethnicity, race, marital status, pain intensity, functional pain interference, treatment from a practitioner for arthritis and for pain, and pain relief. The lack of association between pain communication and factors such as pain intensity suggests that practitioners should routinely elicit specific pain information from older adults who have a history of chronic painful conditions such as osteoarthritis.
23069303 Treatment of thalidomide resistant pyoderma gangrenosum with etenercept. 2012 Tumor necrosis factor alfa (TNF-α) is a cytokine with a central role in inflammation. Its blockade can be achieved by using specific inhibitors like etanercept. At present, etanercept is approved for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and psoriasis treatment. However, it has been used with promising results in other inflammatory dermatoses. A case is presented of a 54-year-old man diagnosed with pyoderma gangrenosum. He completed treatment with oral prednisolone with favorable outcome, but with recurrence after glucocorticoid therapy withdrawal. Thalidomide was introduced, but after complaints of glove and sock paresthesia and hypoesthesia, the drug was discontinued. Taking into account the favorable outcome with thalidomide and the necessity of drug withdrawal, it was decided to introduce therapy acting on the same step in the inflammation cascade. In this regard, etanercept was initiated. The aim of this article is to present an alternative therapy for refractory pyoderma gangrenosum, along with a literature review.
22879627 The changing spectrum of rheumatic disease in HIV infection. 2012 Sep BACKGROUND: Rheumatic manifestations were described soon after human immunodeficiency virus (HIV) was discovered. Since however, combination anti-retroviral therapy (cART) has revolutionized the course of the infection. Less clear is what effect cART has had on rheumatic manifestations. SOURCES OF DATA: References were retrieved from the PubMed database using keywords including: 'HIV' and 'arthritis'; 'myalgia'; 'arthralgia' and other disease-specific terms, e.g. 'rheumatoid arthritis'. AREAS OF AGREEMENT: Musculoskeletal pain was common in HIV and increased with AIDS. Immune restoration inflammatory syndrome on initiation of cART causes de novo autoimmune inflammatory rheumatic disorders. Seronegative inflammatory arthritis with/without axial involvement has been reported widely with HIV. AREAS OF CONTROVERSY: It is unclear if HIV causes these conditions, creates an environmental milieu supportive of these conditions or acts as a marker of other risk factors. It is unclear what effect cART has had on these conditions. GROWING POINTS: Variable diagnostic classification criteria have caused this literature to be poorly comparable. AREAS TIMELY FOR DEVELOPING RESEARCH: High-quality controlled epidemiological studies using standardized criteria are needed among cART users. Treatment of active autoimmune disease in HIV patients needs to be evaluated formally.
22057410 Chinese medicine pattern differentiation and its implications for clinical practice. 2011 Nov Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field: general pattern differentiation; genitourinary (recurrent cystitis); cardiovascular (coronary heart disease; arterial hypertension; angina pectoris); neurology (stroke); surgery; metabolic (diabetes mellitus); hepatic (cirrhosis); gastrointestinal (chronic superficial gastritis); orthopedic (low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis); oncology (gastric mucosal dysplasia; lung cancer); gynecologic and obstetric manifestations (nausea and vomiting). The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.
21435697 The emerging role of Dickkopf-1 in bone biology: is it the main switch controlling bone an 2011 Oct BACKGROUND: Dickkopf-1 (DKK-1), an inhibitor of the Wnt pathway, has recently emerged as an important player in several critical aspects of bone biology. METHODS: We performed an extensive internet search (MEDLINE) using the key words Dickkopf-1 and the abbreviation DKK-1. RESULTS: DKK-1 is a regulator of bone mass with increased expression linked to osteopenia and decreased expression to high bone mass. Moreover, it appears to actively participate in joint remodeling in animal models of arthritis, with increased levels related to bone resorption and decreased levels to new bone formation. Recent studies indicate its possible involvement in the remodeling process of human systemic rheumatic diseases such as rheumatoid arthritis and ankylosing spondylitis. DKK-1 may also play a role in osteoarthritis, metabolic bone disease (osteoporosis and Paget's disease), as well as multiple myeloma-associated bone disease and prostate cancer bone metastases. CONCLUSIONS: DKK-1 is a regulator of bone mass and joint remodeling. It may be a promising therapeutic target in osteoporosis; monoclonal antibody-based inhibition of Dkk-1 is already under development for osteoporosis treatment. Its role as a regulator of joint remodeling in animal models requires further exploration in humans.
22275266 Regulation of inflammatory responses and fibroblast-like synoviocyte apoptosis by calcineu 2012 Jul OBJECTIVE: Calcineurin-binding protein 1 (CABIN-1) regulates calcineurin phosphatase activity as well as the activation, apoptosis, and inflammatory responses of fibroblast-like synoviocytes (FLS), which actively participate in the chronic inflammatory responses in rheumatoid arthritis (RA). However, the mechanism of action of CABIN-1 in FLS apoptosis is not clear. This study was undertaken to define the regulatory role of CABIN-1 in FLS from mice with collagen-induced arthritis (CIA). METHODS: Transgenic mice overexpressing human CABIN-1 in joint tissue under the control of a type II collagen promoter were generated. Expression of human CABIN-1 (hCABIN-1) in joints and FLS was determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. The expression of cytokines, matrix metalloproteinases (MMPs), and apoptosis-related genes in FLS was determined by enzyme-linked immunosorbent assay, gelatin zymography, and RT-PCR, respectively. Joints were stained with hematoxylin and eosin and with tartrate-resistant acid phosphatase for histologic analysis. RESULTS: Human CABIN-1-transgenic mice with CIA had less severe arthritis than wild-type mice with CIA, as assessed according to hind paw thickness and histologic features. The milder arthritis was accompanied by significantly enhanced apoptosis in transgenic mice, evidenced by a significantly greater number of TUNEL-positive cells in synovial tissue. Expression of inflammatory cytokines and MMPs in the transgenic mice with CIA was reduced, and they exhibited decreased Akt activation and increased expression of p53, caspase 3, caspase 9, and Bax. CONCLUSION: Our findings demonstrate that hCABIN-1 plays a critical role in promoting apoptosis of FLS and in attenuating inflammation and cartilage and bone destruction in RA. These results help elucidate the pathogenic mechanisms of RA and suggest that CABIN-1 is a potential target for treatment of this disease.
20554144 US-guided interventional joint procedures in patients with rheumatic diseases--when and ho 2011 Sep OBJECTIVE: To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness. MATERIALS AND METHODS: 27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n=11) had rheumatoid arthritis, 11% (n=3) spondyloarthropathies, 18% (n=5) psoriatic arthritis, 15% (n=4) undifferentiated arthritis, 3% (n=1) Sjögren syndrome and 11% (n=3) had gout. Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists. Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy. RESULTS: In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period. CONCLUSIONS: US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.
22085508 [The multidisciplinary practice guideline "The responsible use of biologicals"]. 2011 A multidisciplinary working group has developed a practice guideline containing various recommendations on the responsible and efficient use of biologicals. These biologicals include both soluble immune-receptor proteins and monoclonal antibodies that are aimed at immune mediators, receptors or cells. They are produced by biotechnology. Biologicals are used to treat patients with immune-mediated inflammatory disorders (IMIDs) such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis, juvenile idiopathic arthritis (JIA), psoriasis, ulcerative colitis, Crohn's disease, uveitis and sarcoidosis. This article summarises the most important recommendations contained in the practice guideline. The practice guideline is intended for members of the medical profession in addition to patients, who are considering, or are already, using biologicals.
22074366 Etanercept: efficacy and safety for approved indications. 2012 Jan INTRODUCTION: Etanercept is a tumor necrosis factor alpha (TNF-α) inhibitor, which is approved for the treatment of immune-mediated inflammatory conditions including rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and psoriasis (PsO). AREAS COVERED: Clinical efficacy and safety data of etanercept for the approved indications are reviewed in this paper. Data were obtained from published clinical trials, registries, post-marketing data as well as information provided by Amgen. EXPERT OPINION: Etanercept is a generally well-tolerated treatment for the approved inflammatory diseases. The most common adverse effect of etanercept treatment is injection site reaction, which is generally self-limiting and often does not require treatment. Etanercept may be associated with an increased risk for infection, the development of malignancy, demyelinating disease and congestive heart failure. Fewer patients withdraw from etanercept due to adverse events than with other biologics. For pediatric patients, there are more data for etanercept than other biologics, and etanercept may have lower rates for the development of malignancy.
22945500 Incidences of overall and site specific cancers in TNFα inhibitor treated patients with r 2013 Jan OBJECTIVES: To investigate the incidence of cancer in arthritis patients treated with or without TNFα inhibitors (TNF-I). METHODS: Arthritis patients from the DANBIO database were followed-up for cancer in the Danish Cancer Registry during 2000-2008. RESULTS: Hazard ratio for cancer overall was 1.02 (95% confidence interval (CI) 0.80-1.30) in 3347 TNF-I-treated RA patients compared to non-treated. Excess among TNF-I-treated was found for colon cancer (HR 3.52 (95%CI 1.11-11.15), whereas 6 and 0 ovarian cancer cases were observed in treated and non-treated patients, respectively. Compared to the general population, TNF-I-treated RA patients had increased risk for cancer overall, cancer in lymphatic-haematopoietic tissue and non-melanoma skin cancer, while non-RA patients had no increase in overall cancer risk. CONCLUSIONS: Our results suggest that TNF-I therapy in routine care is not associated with an overall excess of cancer in arthritis patients, but observed increased risks of colon and ovarian cancer need further investigation.
22763052 Clinical outcomes of total wrist arthroplasty. 2012 Aug PURPOSE: Current indications for total wrist arthroplasty include patients with symptomatic end stage posttraumatic wrist arthritis, rheumatoid arthritis, and Kienböck disease, as an alternative to wrist arthrodesis. Arthroplasty may have advantage over arthrodesis because of the ability to retain motion. The purpose of this study was to evaluate the short-term clinical outcomes and complications of the Maestro Total Wrist System. METHODS: We report the results of a retrospective review of 23 total wrist prostheses implanted in 22 patients. We administered the visual analog pain scale and Mayo wrist and Disabilities of the Arm, Shoulder, and Hand questionnaires. We reviewed wrist motion, grip strength, radiographs, and complications. RESULTS: At a mean follow-up of 28 months (range, 4-55 mo), the Disabilities of the Arm, Shoulder, and Hand score and Mayo wrist score were 31 and 54, respectively. Mean pain scores improved from 8.0 to 2.2. The mean wrist flexion-extension arc was 90°. Radiographs revealed no evidence of prosthetic loosening. Grip strength averaged 60% of the strength of the opposite hand. Complications occurred in 7 of 23 patients. One failure occurred as a result of deep infection in a patient with prior intercarpal fusion, and was successfully converted to a wrist fusion. CONCLUSIONS: Total wrist arthroplasty performed for pancarpal arthritis as an alternative to wrist arthrodesis can yield successful outcomes with low short-term failure rates. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.