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ID PMID Title PublicationDate abstract
24060405 Different amounts of protein-bound citrulline and homocitrulline in foot joint tissues of 2013 Sep 23 BACKGROUND: Antibodies binding to citrullinated proteins are a frequent finding in rheumatoid arthritis patients and may precede the onset of clinical symptoms several years. The antibodies are a predisposing factor for bone erosions but their origin is unknown. In this study we analyze in detail the levels of protein bound citrulline and homocitrulline in several tissue samples of a single erosive arthritic surgery patient. METHODS: Serum antibodies binding to CCP, MCV and citrulline- or homocitrulline-containing type I and II collagen carboxytelopeptides were measured. Tissue samples of a single RA patient, taken in two separate operations performed with two-year time span were hydrolyzed and analyzed for citrulline and homocitrulline content by HPLC. RESULTS: Protein-bound citrulline and homocitrulline were found in several joint tissues of a RA patient with ACPA-positive erosive disease. The amount of homocitrulline stayed relatively constant between the different tissues. The amount of citrulline in erosive tissue was 3-times higher than in non-erosive tissue in the first operation. In the samples of the second operation 3-4-times higher mean amounts of citrulline were found in two out of the six tissues investigated. CONCLUSIONS: Homocitrulline is present in rheumatoid nodule together with citrulline. There is more variation in the amount of citrulline than in the amount of homocitrulline between the tissues. The tissue sample containing the most citrulline was the most erosive.
23584366 A simple model that suggests possible cost savings when modified-release prednisone 5 mg/d 2013 Aug OBJECTIVE: The effects of a 12-week treatment with modified-release prednisone (MR-pred) on the costs of drug treatment of RA were modelled. METHODS: With the results of a recent randomized trial as source data, we expressed the effect of treatment (MR-pred vs placebo) on the decrease in the proportion of RA patients meeting disease activity thresholds for reimbursement of biologic treatment. RESULTS: The results showed 11-13% more patients on MR-pred than on placebo dropped below reimbursement thresholds for The Netherlands, Belgium and the UK. Assuming 1 year of biologics cost €15,000 and MR-pred costs €1/day, €396 are saved in each patient delaying biologic treatment by 12 weeks. CONCLUSION: Despite a considerably higher cost than conventional prednisone, MR-pred is a cost-effective option for RA patients not on glucocorticoids who are eligible for therapy with biologic agents.
25365107 ESPOIR and the French database management: what have we learned from the first years of fo 2014 Sep ESPOIR (Etude et Suivi des POlyarthrites Indifférenciées Récentes) is a multicentre national cohort sponsored by the French Society for Rheumatology. The patients had early arthritis (<6-month disease duration), had a certain/probable clinical diagnosis of RA or undifferentiated arthritis potentially becoming RA and were DMARDs or glucocorticoids naïve. ESPOIR is a cohort of early arthritis, highly enriched for rheumatoid arthritis (RA) patients, since in patients followed for 5 years more than 90% met ACR/EULAR criteria for RA. A total of 813 patients were enrolled between December 2002 and March 2005 in 14 academic regional centres with the participation of a network of private rheumatologists. Today, 104 clinical research projects have been selected by the scientific committee of the cohort. The projects focus on data from the first 5 years of follow-up. Many studies are in progress, and 54 original articles have been published. The research projects cover a wide range of topics, including environmental factors, diagnosis, evolution, and prognosis, evaluation of disease, imaging, genetics, biomarkers, medical economics and therapeutic strategies.
24702489 Decrease in serum interleukin-21 levels is associated with disease activity improvement in 2014 Interleukin-21 (IL-21) plays an important role in the pathogenesis of rheumatoid arthritis (RA). The aim of our study was to assess serum levels of IL-21 in patients with recent-onset RA in relation to disease activity and response to treatment. We analyzed serum levels of IL-21 in 51 RA patients, both before and 12 weeks after the initiation of treatment and in 36 healthy individuals. Disease activity was assessed at baseline and at weeks 12 and 24 using the Disease Activity Score for 28 joints, serum levels of C-reactive protein, and the total swollen joint count. We found that IL-21 levels were not increased in patients with recent-onset RA compared with healthy controls, but they had significantly decreased from baseline to week 12 during treatment. Baseline levels of IL-21 significantly correlated with measures of disease activity (p<0.02 for all). Although IL-21 levels did not predict achievement of remission, decrease in IL-21 levels correlated with improvement in disease activity after 12 weeks (p<0.02) and also after 24 weeks (p<0.04) of treatment. Our data suggest that circulating IL-21 levels may serve as a biomarker of disease activity and better outcome in early phase of RA.
24273975 [Distribution features of Chinese medical syndrome types of rheumatoid arthritis patients 2013 Sep OBJECTIVE: To explore features of Chinese medical syndrome types in rheumatoid arthritis (RA) patients accompanied depressive symptoms. METHODS: The degree of depressive symptoms was assessed in 263 RA patients using self-rating depression scale (SDS). The correlation between depressive symptoms and modified Disease Activity Score (DAS28) were analyzed. The features of Chinese medical syndrome types of RA patients accompanied with depressive symptoms were also assessed. RESULTS: The percentage of these patients of sputum-stasis obstruction syndrome (SSOS) was 47.2% and that of qi-blood deficiency syndrome (QBDS) was 45.8%, obvious higher than that of other groups (P < 0.05). DAS28 score was higher and their course of the disease was longer in RA patients accompanied with depressive symptoms. But there was no obvious difference in age. There were more RA patients with depressive symptoms holding higher levels of certificate than those holding lower levels of certificate. CONCLUSIONS: There was certain correlation between Chinese medical syndrome types and depressive symptoms in RA patients. RA patients of SSOS and QBDS were easier to suffer from depressive symptoms. Higher DAS28, longer course of the disease, and holding higher levels of certificate might be three risk factors for RA patients accompanied with depressive symptoms.
23345597 MRI comes of age in RA clinical trials. 2013 Jun The success of modern rheumatoid arthritis (RA) therapies and treatment strategies has led to extended placebo phases being unethical in RA randomised controlled trials (RCTs). Modern trials therefore increasingly involve active comparator designs, and this together with some technical issues has meant difficulties in differentiating structural progression using traditional radiographic outcome measures. Magnetic resonance imaging (MRI) has been demonstrated to assess damage more sensitively than radiographs, but importantly it can measure the upstream drivers of erosions and cartilage loss, synovitis and osteitis. An increasing number of recent RCTs using the RA MRI scoring system (RAMRIS) have demonstrated the ability of MRI to discriminate progression and treatment effect. Consistency of erosion progression determination was seen across the majority of these studies. In most studies, MRI demonstrated reduction in synovitis and osteitis at early (12 week) timepoints, and MRI predicted subsequent radiographic findings. Often small numbers of patients were required to demonstrate such changes. The time is right for regulatory authorities to include MRI as an alternative to radiographic data in support of claims of inhibition of progression of structural damage in RA trials.
23961680 [Surgical reconstruction of joint function]. 2013 Jul In recent years a concept of "treat to target" is introduced into a medical treatment of RA, and tight control is recommended from the early stage of the disease. However, it is difficult to relieve all patients in a true remission. Nowadays, disease activity is controlled well and a reconstructive surgery is performed at a limited number of the damaged joints in a state of good remaining of bone and soft tissue structures. The patients are highly motivated, and a newly developed disorder at the non-surgically treated joints is uncommon. Therefore, an aggressive rehabilitation is possible. Combined with a medical treatment of RA, a surgical intervention enables to acquire a higher level of ADL and an improved QOL (Japanese T2T).
24641754 Extensor tendon dislocation after end-to-side transfer in a rheumatoid patient. 2014 We report a case of extensor tendon dislocation at the metacarpophalangeal joint of the middle finger in which it appeared that an ulnar translation force created by an end-to-side transfer contributed to the dislocation. We recommend alterations in technique or alternative method of extensor tendon reconstruction to avoid this complication if unfavorable factors for end-to-side transfer exist.
22956597 Reasons for medical help-seeking behaviour of patients with recent-onset arthralgia. 2013 Aug OBJECTIVE: Patient delay in seeking medical help may cause suboptimal use of the therapeutic window in rheumatoid arthritis. We aimed to assess the motivations and the urgency with which patients with arthralgia seek medical help. METHODS: 612 patients with arthralgia-visiting two Dutch Early Arthritis Recognition Clinics-were studied. Patients filled out a questionnaire with questions on their symptoms and their reasons for seeking medical help. Comparisons were made for patients with short or prolonged patient delay, patients with and without arthritis, age and gender. RESULTS: The median symptom duration was 4 weeks. A prolonged delay in seeking help was associated with a gradual onset of symptoms (78%) and the perception that symptoms would not be serious or would go away (16% and 48%, respectively). Arthralgia patients who promptly sought medical help more often had an acute onset of symptoms and more frequently reported impairments at work or in daily functioning than patients who postponed seeking help (all p<0.005). Patients with and without arthritis generally had similar reasons for seeking help. The proportion of patients who had a prolonged patient delay was comparable between male and female subjects and between age categories. Particularly younger patients postponed seeking help because they thought their symptoms would disappear spontaneously. CONCLUSIONS: This large-scale study observed several reasons and symptom characteristics influencing the help-seeking behaviour of persons with arthralgia. These data can be helpful to define strategies aiming at early identification of arthritis.
25265654 [Clinical and pathogenetic relationships between immuno-inflammatory rheumatic diseases an 2014 Literature data and original observations have been used to develop the rationale for the necessity of studying psychic disorders (PD) in patients with immuno-inflammatory rheumatic diseases (RD), such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Special attention is given to the high frequency of disturbances of the anxiety and depression profile (DADP) in patients having RA and SLE with reference to the common provoking stress and pathogenic factors, clinical manifestations, and RD. Great importance is attributed to the degree of depression associated with inflammatory activity, pain intensity, fatigue, sleep disorders, severe functional insufficiency and low quality of life in the patients with RA and SLE. Special emphasis is laid on the influence of depression and stress factors on the survival and morality of patients with these pathologies, the necessity of their combined treatment with the participation of rheumatologists, psychiatrists and medical psychologists for the improvement of clinical course and prognosis of RD.
23861163 First-year radiographic progression as a predictor of further progression in early arthrit 2013 Dec OBJECTIVE: A major goal in the treatment of recent arthritis is the prevention of joint destruction. The value of radiographic progression in the first year for predicting further radiographic progression has not been evaluated comparatively with conventional predictive factors. METHODS: Patients with arthritis of <6 months' duration were included in the prospective French ESPOIR cohort. Radiographs were obtained and modified Sharp scores were determined by a blinded reader. The rate of progression was determined over the first year, then over the second and third years. Rapid progression was defined as a >5-point annual increase in the total Sharp score. RESULTS: In total, 500 patients had complete data available after 3 years and were included. The total Sharp score indicated rapid progression in 123 patients (25%) in year 1 and 92 patients (18%) in years 2/3. By logistic regression, the variables independently associated with rapid progression in years 2/3 were year 1 rapid progression of the erosion and total Sharp scores, baseline erosion Sharp score, the serologic American College of Rheumatology/European League Against Rheumatism criterion, and interleukin-6 level. When these variables were combined, year 1 rapid progression made the largest contribution to predicting years 2/3 rapid progression. CONCLUSION: First-year radiologic progression is the best independent predictor of further rapid progression in early arthritis.
24974502 Complete heart block in a case of rheumatoid arthritis. 2013 Nov We report a case of complete heart block in a patient with rheumatoid arthritis because of its rarity and unusual features like younger age, short duration and negative rheumatoid factor.
24841727 The impact of social support on the acceptance process among RA patients: a qualitative st 2014 Acceptance is an important component of pain management, being associated with improved quality of life and lower levels of pain and depression. In enabling patients with chronic diseases to accept unpleasant consequences and to establish a new way of living, the support they receive from their social environment may play a decisive role. In this article, we identify the key sources and types of social support that are relevant for rheumatoid arthritis (RA) patients, and explore when and how those sources are important across the different stages of the acceptance process. We conducted a qualitative study involving 20 semi-structured interviews with RA patients in Switzerland. Analysis of the data followed the precepts of grounded theory. We found that, amid the complexity and variety of patients' struggles for acceptance, there were some common experiences or 'key moments' in which social support played an important role. While three sources of support - family, physicians and the external social context - are fundamental for RA patients, all three may inhibit as well as encourage acceptance, due to the invisible and unpredictable character of the disease. There is a pervasive risk either of underestimating patients' suffering or of over-supporting, both of which prevent patients accepting the disease and developing a new 'normal' life. We conclude that sources of social support need to find a middle way between scepticism and solicitousness.
24046282 Analyses of synovial tissues from arthritic and protected congenic rat strains reveal a ne 2013 Nov 15 Little is known about the genes regulating disease severity and joint damage in rheumatoid arthritis (RA). In the present study we analyzed the gene expression characteristics of synovial tissues from four different strains congenic for non-MHC loci that develop mild and nonerosive arthritis compared with severe and erosive DA rats. DA.F344(Cia3d), DA.F344(Cia5a), DA.ACI(Cia10), and DA.ACI(Cia25) rats developed mild arthritis compared with DA. We found 685 genes with significantly different expression between congenics and DA, independent of the specific congenic interval, suggesting that these genes represent a new nongenetic core group of mediators of arthritis severity. This core group includes genes not previously implicated or with unclear role in arthritis severity, such as Tnn, Clec4m, and Spond1 among others, increased in DA. The core genes also included Scd1, Selenbp1, and Slc7a10, increased in congenics. Genes implicated in nuclear receptor activity, xenobiotic and lipid metabolism were also increased in the congenics, correlating with protection. Several disease mediators were among the core genes reduced in congenics, including IL-6, IL-17, and Ccl2. Analyses of upstream regulators (genes, pathways, or chemicals) suggested reduced activation of Stat3 and TLR-related genes and chemicals in congenics. Additionally, cigarette smoking was among the upstream regulators activated in DA, while p53 was an upstream regulator activated in congenics. We observed congenic-specific differential expression and detection in each individual strain. In conclusion, this new nongenetically regulated core genes of disease severity or protection in arthritis should provide new insight into critical pathways and potential new environmental risk factor for arthritis.
24339154 Roles of nurse practitioners and physician assistants in rheumatology practices in the US. 2014 Jul OBJECTIVE: A recent workforce study of rheumatology in the US suggests that during the next several decades, the demand for rheumatology services will outstrip the supply of rheumatologists. Midlevel providers such as nurse practitioners and physician assistants may be able to alleviate projected shortages. METHODS: We administered a nationwide survey of midlevel providers during 2012. Invitations with the survey were sent with one followup reminder. The survey contained questions regarding demographics, training, level of practice independence, responsibilities, drug prescribing, use of objective outcome measures, and knowledge and use of treat-to-target (TTT) strategies. RESULTS: The invitation was sent to 482 eligible midlevel providers via e-mail and 90 via US mail. We received a total of 174 responses (30%). The mean age was 46 years and 83% were women. Nearly 75% had ≤10 years of experience and 53% had received formal training in rheumatology. Almost two-thirds reported having their own panel of patients. The top 3 practice responsibilities described were performing patient education (99%), adjusting medication doses (98%), and conducting physical examinations (97%). More than 90% felt very or somewhat comfortable diagnosing rheumatoid arthritis (RA) and a similar percentage prescribed disease-modifying antirheumatic drugs. Three-quarters reported using disease activity measures for RA and 56% reported that their practices used TTT strategies. CONCLUSION: Most respondents reported that they had substantial patient care responsibilities, used disease activity measures for RA, and incorporated TTT in their practice. These data suggest midlevel providers may help to reduce shortages in the rheumatology workforce and conform with recommendations to employ TTT strategies in RA treatment.
23734791 Swedish version of the multi dimensional health assessment questionnaire -- translation an 2013 Jun 4 BACKGROUND: Health assessment measurements for patients with Rheumatoid arthritis (RA) have to be meaningful, valid and relevant. A commonly used questionnaire for patients with RA is the Stanford Health Assessment Questionnaire Disability Index (HAQ), which has been available in Swedish since 1988. The HAQ has been revised and improved several times and the latest version is the Multi Dimensional Health Assessment Questionnaire (MDHAQ). The aim of this study was to translate the MDHAQ to Swedish conditions and to test the validity and reliability of this version for persons with RA. METHODS: Translation and adaption of the MDHAQ were performed according to guidelines by Guillemin et al. The translated version was tested for face validity and test-retest in a group of 30 patients with RA. Content validity, criterion validity and internal consistency were tested in a larger study group of 83 patients with RA. Reliability was tested with test-retest and Cronbach´s alpha for internal consistency. Two aspects of validity were explored: content and criterion validity. Content validity was tested with a content validity index.Criterion validity was tested with concurrent validity by exploring the correlation between the MDHAQ-S and the AIMS2-SF. Floor and ceiling effects were explored. RESULTS: Test-retest with intra-class correlation coefficient (ICC) gave a coefficient of 0.85 for physical function and 0.79 for psychological properties. Reliability test with Cronbach´s alpha gave an alpha of 0.65 for the psychological dimension and an alpha of 0.88 for the physical dimension of the MDHAQ-S.The average sum of the content validity index for each item was of the MDHAQ-S was 0.94. The MDHAQ-S had mainly a moderate correlation with the AIMS2-SF, except for the social dimension of the AIMS2-SF, which had a very low correlation with the MDHAQ-S. CONCLUSIONS: The MDHAQ-S was considered to be reliable and valid, but further research is needed concerning sensitivity to change.
23063507 Rhupus syndrome: assessment of its prevalence and its clinical and instrumental characteri 2013 Feb The term "rhupus" is traditionally used to describe patients with coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The aim of the present work was to investigate prevalence, clinical and radiological picture as well as the serological profile of a series of rhupus patients; SLE patients and RA patients from our Unit were used as disease control groups. A total of 103 consecutive SLE patients were screened; among the entire cohort, 10 patients (9.7%) were classified as "rhupus". In our rhupus patients SLE features preceded the onset of arthritis in 5 patients (50%) while in the remaining patients arthritis appeared before or simultaneously (3 and 2 patients respectively). As compared with SLE patients, rhupus patients have significantly less kidney involvement (p=0.01) while no differences were observed between neuropsychiatric, cutaneous, hematological involvement or serositis. At our physical examination, 9 (90%) rhupus patients were presenting active joint involvement; CRP positivity and ESR levels resulted significantly higher than in SLE (p=0.006) patients while no differences were observed with respect to RA patients. In all rhupus patients, at least one pathological finding was revealed by ultrasound (US) examination at wrist and/or hand joints; overall, rhupus patients presented higher scores in all the US parameters with respect to SLE patients, especially at hands; no statistically significant differences have been observed with respect to RA patients. Magnetic resonance (MR) revealed erosions in all rhupus patients with a concomitant bone edema in five patients. The cumulative erosive burden in rhupus patients was significantly higher than in SLE patients and similar to RA patients (SLE vs rhupus p=0.005); bone pathology distribution was also similar between rhupus patients and RA patients. These data suggest the importance of assessing joint involvement in SLE with advanced imaging techniques and of evaluating the presence of prognostic factors for joint disease severity in order to establish adequate disease monitoring and to institute early appropriate therapies to avoid late consequences of unrecognized concomitant rheumatoid arthritis (Amezcua-Guerra et al., 2006 [25]; Zhao et al., 2009 [26]).
24567061 Genetics: a new interpretation of genetic studies in RA. 2014 Apr Understanding the genetics of rheumatoid arthritis (RA) is complex, multiple genes and environmental factors are involved. A new multicentre genetic study summarizes the fundamental gene polymorphisms, pathways and cell types that are related to RA and, based on this analysis, proposes new targets for RA drug treatments.
23819332 [Rheumatology in Russia in the early 21st century]. 2013 Rheumatoid arthritis (RA) is the most common immune inflammatory rheumatic disease. The paper gives the current data of Russian investigations into the early diagnosis of RA and into innovative approaches to its therapy.
25509802 [Rheumatic joint diseases in the elderly]. 2014 Oct The most frequent rheumatic joint disease in the elderly is rheumatoid arthritis (RA). Recent advances in the treatment of RA improve prognosis, and gradually increase the elderly patients with RA. There are some differences in clinical features between the patients with elderly onset RA and young onset RA, such as systemic symptoms and distribution of affected joints. In addition, it is occasionally difficult to differentiate elderly onset RA from the other rheumatic diseases like polymyalgia rheumatica and RS3PE syndrome, pseudogout, and osteoarthritis. Since elderly patients tend to have more co-morbidity and co-existing diseases requiring treatment with other drugs, a risk/benefit profile must always be taken into consideration when choosing the treatment in elderly patients with rheumatic joint diseases.