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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
23961662 [Pharmacological management of rheumatoid arthritis: the state of the art and the future p 2013 Jul Pharmacological management of rheumatoid arthritis (RA) has been rapidly progressed in recent years, which is appeared in the "treat to target" movement and the recommendations developed by some established international/domestic rheumatology associations. The baseline evaluation of poor prognostic factors as well as disease activity with composite measures is necessary for a personalized management. Methotrexate is currently the anchor drug, and other conventional or biological antirheumatic drugs should be added to it for refractory patients. The development of various novel agents including signal transduction inhibitors should promote further advances in the management of RA and other systemic autoimmune and/or inflammatory diseases.
23999372 [Secondary osteoporosis or secondary contributors to bone loss in fracture. Therapeutic in 2013 Sep In rheumatoid arthritis (RA) , the osteoclast pathway is activated by abnormal immune conditions accompanied by chronic inflammation resulting in periarticular osteoporosis and local bone destruction around joints. In addition, multiple factors lead to systemic osteoporosis, including reduced physical activity and pharmacotherapies such as steroids. These conditions cause decreased bone mineral density and bone quality, and expose patients to an increased risk of fracture. When treating patients with RA osteoporosis, it is important to improve systemic osteoporosis using anti-osteoporotic agents, and to suppress fracture risk by controlling inflammation (which is associated with periarticular osteoporosis and bone destruction) with a combination of disease-modifying anti-rheumatic drugs or biological agents.
23445895 [Assessment of joint structure in patients with rheumatoid arthritis]. 2013 Mar Recent progress in the treatment of rheumatoid arthritis (RA) with TNF-inhibitors has brought a paradigm shift, in which clinical and structural remission is now a target to be approached. However, joint damage already develops in a majority of patients before appropriate treatments are provided. Joint damage results from the destruction of bone and cartilage, which can be visualized via radiography as joint erosion (JE) and joint space narrowing (JSN) , respectively. JSN is a surrogate marker for loss of cartilage and it also reflects damage to tissues causing joint dislocation, a phenomenon that is less prevalent among patients with early RA. JE has been perceived to be the most critical indicator of permanent disability in RA. The combination of TNF-inhibitor and MTX reduces the risk of joint damage, measured by radiographic modified total Sharp score (mTSS) . Biologics targeting cytokines and lymphocytes not only expand the array of treatments for RA but also provide important insights into pathogenesis of this disease.
26012104 Treatment to target in rheumatoid arthritis. 2014 Nov 19 Treating to target in rheumatoid arthritis means setting defined treatment goals, regularly measuring disease activity and working with, and informing, the patient of these targets at each step. This article discusses the role of the specialist nurse in developing and delivering treatment to target in RA, its impact on patient care and the development of a nurse-led clinic.
25167330 The disease formerly known as rheumatoid arthritis. 2014 Rheumatoid arthritis is a complex disease where predetermined and stochastic factors conspire to confer disease susceptibility. In light of the diverse responses to targeted therapies, rheumatoid arthritis might represent a final common clinical phenotype that reflects many pathogenic pathways. Therefore, it might be appropriate to begin thinking about rheumatoid arthritis as a syndrome rather than a disease. Use of genetics, epigenetics, microbiomics,and other unbiased technologies will probably permit stratification of patients based on mechanisms of disease rather than by clinical phenotype.
24751105 Rs7574865 polymorphism in signal transducers and activators of transcription 4 gene and rh 2015 Jan OBJECTIVES: The objective of the present meta-analysis was to investigate whether the combined evidence shows an association between the STAT4 rs7574865 polymorphism and RA. METHODS: A systematic search of all relevant studies published through April 2013 was conducted using MEDLINE, EMBASE, OVID, and ScienceDirect. The observational studies that were related to an association between the STAT4 rs7574865 polymorphism and RA were identified. The association between the STAT4 rs7574865 polymorphism and RA susceptibility was assessed using genetic models. RESULTS: Seventeen case-control studies with a total of 28 comparisons (25 300 RA patients and 26 326 controls) met the inclusion criteria. A meta-analysis was conducted for genotype TT versus GT+GG, GT+TT versus GG, TT versus GG and T-allele. The meta-analysis showed an association between RA and the STAT4 rs7574865 TT genotype, GT+TT genotype and T-allele in all subjects. Stratification of RA patients according to ethnic group showed that the TT genotype, GT+TT genotype and T-allele were significantly associated with RA in Europeans, Asians, Africans and Latin Americans. A subgroup analysis according to the absence or presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies revealed that the association between the STAT4 rs7574865 polymorphism and RA may be independent of the presence of RF and anti-CCP antibodies. CONCLUSIONS: This meta-analysis demonstrated that the STAT4 rs7574865 polymorphism confers susceptibility to RA in major ethnic groups. The association may not be dependent on the presence of RF and anti-CCP antibodies.
24859304 The burden of disease in rheumatoid arthritis. 2014 Sep Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5% and 1% of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.
24013270 Physical activity maintenance in patients with rheumatoid arthritis: a qualitative study. 2014 Mar OBJECTIVE: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. DESIGN: A qualitative salutogenic-oriented interview study. SETTING: A rheumatology outpatient clinic. SUBJECTS: A purposive sample of 16 physically active patients (mean age 50, range 37-67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4-46 years). METHODS: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon 'physical activity maintenance' was experienced by patients with rheumatoid arthritis. The interviews were analysed using systematic text condensation, inspired by Giorgi's descriptive phenomenological methodology. RESULTS: The analysis revealed three categories: (1) knowing and enjoying the body; (2) responsibility and challenges; (3) autonomy and social belonging. On the basis of these categories, the essential meaning of the phenomenon of physical activity maintenance for patients with rheumatoid arthritis was summarized into 'striving for a transparent body and participation', pointing to experiences of sensations of wellbeing, liberation from restrictions and social participation on equal terms with non-arthritis populations. CONCLUSION: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.
23961682 [Social security system for patients with rheumatoid arthritis in Japan]. 2013 Jul Support system for patients with rheumatoid arthritis (RA) is a wide variety, such as the health care, the medical economy, the environment, and mental activity. Among these measures, the laws called the social security system are defined. These systems consist of social insurance (medical insurance, long-term care insurance, pension insurance), social welfare (welfare for the disabled) and public health (measures for intractable diseases). As social support under total management of RA, patients can receive mitigation measures and subsidies (physically disabled person's certificate, high-cost medical care, etc.) for high medical expenses at use of biological products, hospitalization and surgery. Furthermore long-term care insurance and disability pension can be used as a further support of home care.
23649300 [Why rheumatoid arthritis needs cardiologists]. 2013 May Rheumatoid arthritis (RA) is associated with a shortened life expectancy. Most premature deaths are caused by cardiovascular (CV) events; therefore it is of importance to consider the increased CV risk when treating RA patients. Traditional CV risk factors cannot fully explain the increased risk but the common understanding is that inflammation significantly contributes to the excess risk observed. Without the use of correction factors commonly used risk calculators underestimate the true CV risk in RA patients. Methotrexate and TNF inhibitors appear to be beneficial with regard to the CV risk. To date there are only few recommendations for interventions in the CV system of RA patients which go beyond those formulated for the general population. The present manuscript summarizes the published evidence concerning the increased CV risk in RA patients.
25416400 The rheumatoid arthritis treat-to-target trial: a cluster randomized trial within the Corr 2014 Nov 21 BACKGROUND: The treat-to-target (T2T) approach to the care of patients with rheumatoid arthritis involves using validated metrics to measure disease activity, frequent follow-up visits for patients with moderate to high disease activity, and escalation of therapy when patients have inadequate therapeutic response as assessed by standard disease activity scores. The study described is a newly launched cluster-randomized behavioral intervention to assess the feasibility and effectiveness of the T2T approach in US rheumatology practices. It is designed to identify patient and provider barriers to implementing T2T management. This initial paper focuses on the novel study design and methods created to provide these insights. METHODS/DESIGN: This trial cluster-randomizes rheumatology practices from the existing Corrona network of private and academic sites rather than patients within sites or individual investigators to provide either T2T or usual care (UC) for qualified patients who meet the 2010 revised American College of Rheumatology criteria for the diagnosis of rheumatoid arthritis and have moderate to high disease activity. Specific medication choices are left to the investigator and patient, rather than being specified in the protocol. Enrollment is expected to be completed by the end of 2013, with 30 practices randomized and enrolling a minimum of 530 patients. During the 12-month follow-up, visits are mandated as frequently as monthly in patients with active disease in the T2T group and every 3 months for the UC group. Safety data are collected at each visit. The coprimary endpoints include a comparison of the proportion of patients achieving low disease activity in the T2T and UC groups and assessment of the feasibility of implementing T2T in rheumatology practices, specifically assessment of the rates of treatment acceleration, frequency of visits, time to next visit conditional on disease activity, and probability of acceleration conditional on disease activity in the 2 groups. DISCUSSION: This cluster-randomized behavioral intervention study will provide valuable insights on the outcomes and feasibility of employing a T2T treatment approach in clinical practice in the United States. TRIAL REGISTRATION: NCT01407419.
22935200 Comparative study of elderly-onset rheumatoid arthritis and young-onset rheumatoid arthrit 2013 Jan OBJECTIVES: Elderly-onset rheumatoid arthritis (EORA) is considered to have different features in relation to young-onset rheumatoid arthritis (YORA). However, results from different evaluated populations worldwide have been inconsistent and in Colombia there are no known descriptions of the differences between these pathologies. The aim of this paper is to compare the clinical, laboratory and immunogenetic features in a Colombian population suffering with EORA and YORA. METHODS: EORA (≥65, n=104) and YORA (<65, n=96) patients were compared regarding clinical, laboratory and HLA-DRB1 alleles features. A control group without rheumatoid arthritis over 65 (n=179) was used to compare the HLA-DRB1 alleles. All patients met the ACR/1987 criteria for rheumatoid arthritis and the clinimetric index was calculated. RESULTS: The gender ratio (female/male) was 1.8:1 in EORA. In both groups, the main onset pattern of disease was an insidious polyarticular onset (p=0.35). EORA was characterised by more distal-proximal joint involvement in comparison to YORA (p=0.0007). In EORA, the rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies frequency was close to 50%, lower than in YORA (63%). In both groups, the DAS28 and HAQ-DI score was higher than 6 and 1, respectively. The HLA-DRB1*0403 and *1402 frequency was significantly higher in EORA than in YORA. Also, the shared epitope (p=0.0392), HLA-DRB1*01 (p=0.0068) and *0101 (p=0.0151) were associated with an anti-CCP positivity and the HLA-DRB1*0403 is protective for the anti-CCP presence in EORA (p=0.0201). CONCLUSIONS: EORA is characterised by a different clinical presentation and HLA-DRB1 alleles with respect to YORA. HLA-DRB1*0403 and *1402 are significantly more frequent in EORA compared to YORA.
23892468 Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options 2013 Sep Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.
23463461 [Rheumatoid arthritis. Systemic inflammation and cardiovascular morbidity]. 2013 Apr In recent years it could be shown that systemic inflammation, which typically occurs in chronic inflammatory rheumatic diseases, significantly contributes to cardiovascular morbidity and mortality. All rheumatic diseases inherit this enhanced risk for cardiovascular complications with rheumatoid arthritis being one of the most prominent. As the underlying pathophysiological mechanisms are very similar with respect to endothelial damage all rheumatic diseases and specifically rheumatoid arthritis should be monitored and treated with disease-modifying drugs and biological agents as consistently as possible to be able to improve the long-term outcome of affected patients as much as possible.
25190289 Classification criteria of early rheumatoid arthritis and validation of its performance in 2014 Sep OBJECTIVES: To develop classification criteria for early rheumatoid arthritis (ERA) based on a large cohort of early inflammatory arthritis patients and to evaluate the performance of these criteria. METHODS: The study population comprised a cohort of early inflammatory arthritis patients with symptom duration less than one year. Classification criteria of ERA were developed by incorporating the most sensitive or specific variables. Performance of the ERA criteria, 1987 ACR and 2010 ACR/EULAR criteria were evaluated. RESULTS: A total of 803 patients were enrolled in this study. By the end of the one year follow-up, 514 patients were diagnosed with RA, 251 with other rheumatic diseases, and 38 patients with undifferentiated arthritis. The ERA criteria are as follows: 1) morning stiffness ≥30 minutes; 2) arthritis of 3 or more joint areas; 3) arthritis of hand joints; 4) positive RF; 5) positive anti-CCP antibody. Rheumatoid arthritis is defined by the presence of 3 or more of the criteria. The sensitivity (84.4%) of the ERA classification criteria was much higher than the 1987 ACR criteria (58.0%). In a validation cohort of early inflammatory arthritis patients, the area under the ROC curves (AUC) showed a better performance for the ERA criteria (0.906, 95%CI 0.866 to 0.945) than the 1987 ACR criteria (0.786, 95%CI 0.725 to 0.848) and the 2010 ACR/EULAR criteria (0.745, 95%CI 0.677 to 0.814). CONCLUSIONS: A set of ERA classification criteria has been developed with good performance for early RA. It is applicable in clinical practice and research.
23961679 [Total joint arthroplasty]. 2013 Jul Control of the disease activity is enabled due to the progress of drug therapy for rheumatoid arthritis. However, surgical treatments are necessary for unresponsive cases to the drug or for achieving higher QOL, and we can attain more tight control or cure by combination of drug therapy and surgical treatments. Total joint arthroplasty provides indolence, mobility, stability and is an useful joint reconstruction method. Shoulder and elbow joint work as a reach function together, and total joint arthroplasty become adaptation when extensive joint destruction or severe pain occurrs. With the usage of biologic agents joint repair is possible in small joints, but if the joint destruction progress in weight-bearing joints, repair is impossible and total joint arthroplasty can be required.
25427394 [The role of diagnostic ultrasound of hands and feet in the patients with rheumatoid arthr 2014 In the past decade diagnostic musculoskeletal ultrasound (US) has revolutionized the approach of treating the pa- tients with inflammatory rheumatic conditions. There is still need for further efforts in establishing the US as a standard tool in everyday rheumatologic practice. Ap- propriate education and training is essential to standard- ize the method. Main limitation of the method is the lack of time for performing US examination because the US is time consuming. Concerns regarding the validity and reproducibility are being addressed. Nowadays in rheu- matology, potential in using US lies in its possibility for early and accurate diagnosis of arthritis, monitoring of the disease and conduction of US-lead interventions in rheumatology.
24315050 To screen or not to screen: how to find and identify very early arthritis. 2013 Aug There is accumulating evidence demonstrating that early treatment leads to better outcomes in rheumatoid arthritis. In order to be treated early, patients thus need to be identified at the earliest possible stage. This means identifying patients with rheumatoid arthritis at their earliest clinical signs but it could also mean screening for healthy individuals at high risk of developing rheumatoid arthritis. The different tools available to screen for these individuals are reviewed here and their relevance is discussed.
24137960 [Pharmacotherapy for rheumatoid arthritis in the early 21st century: Russian and internati 2013 The paper summarizes the data of international and Russian studies concerning current approaches to the pharmacotherapy of rheumatoid arthritis. Particular emphasis is placed on the substantiation of the treat-to-target concept, on the efficacy and safety of genetically engineered biological agents, including the inhibitors of tumor necrosis factor, interleukin-6 receptors, T-lymphocyte co-stimulation, and anti-B-cell therapy.
25005390 Rheumatoid arthritis and fatigue. 2014 Jul 15 Essential facts There are nearly 690,000 people in the UK with rheumatoid arthritis, a chronic autoimmune disease. Many of these people experience pain, inflammation, stiffness, reduced mobility and joint function, and fatigue.