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ID PMID Title PublicationDate abstract
24701712 [Disease modifying antirheumatic drugs]. 2014 Mar 12 The natural history of rheumatoid arthritis, previously burdened with high morbidity, has been strongly modified by appropriate treatment. Early diagnosis and treatment, and follow-up by a specialist, with the aim to achieve remission or low disease activity, are essential for the functional outcome of patients. Disease-modifying anti-rheumatic drugs include "conventional" treatments like methotrexate, biologic therapies such as TNF-inhibitors, abatacept, tocilizumab and rituximab, and targeted synthetic therapies such as tofacitinib (a JAK kinase inhibitor). New treatments currently under study should allow rheumatologists to successfully treat even more patients than nowadays.
25509803 [Metabolic bone and joint diseases]. 2014 Oct Metabolic bone and joint diseases in adults include osteomalacia, rheumatoid arthritis, gouty arthritis. Recently, the newest molecular biology procedures and the clinical observation studies can produce good results for understanding of these diseases. From this perspective, the author introduced updated information of the pathophysiology, the latest diagnostic criteria and the therapy of these diseases.
22890965 Users' experience of physical activity monitoring technology in rheumatoid arthritis. 2013 Jun OBJECTIVES: The aim of the present study was to qualitatively explore users' experiences of home monitoring of health with specific regard to physical activity monitors. METHODS: Fourteen participants were randomly selected from a larger sample of individuals with rheumatoid arthritis (RA) who had taken part in a physical activity monitoring study and had worn two physical activity monitors for seven days in their homes. These individuals were assigned to one of two focus groups. Each focus group lasted for between 40 minutes and an hour and was audio-recorded. A semi-structured questioning route was used, followed by subsequent theoretical thematic analysis. RESULTS: No statistically significant differences were noted in the demographic factors between those who took part in the focus groups and the entire RA sample. Three distinct themes were identified: i) Experiences of having health monitored in the home, which was found to be largely positive; ii) Experiences of use of specific technology to monitor physical activity, which was generally reported as unobtrusive and not to impact significantly negatively on their daily life; iii) Perceptions and experiences of physical activity and exercise, which monitoring was reported to facilitate focusing on physical activity choices. CONCLUSIONS: These focus groups were the first to highlight the perceptions held by individuals with RA regarding home monitoring and, in particular, physical activity monitoring. This has implications for those planning interventions for this group which involve home monitoring. Interesting findings were also highlighted regarding the perceptions and understanding of physical activity and exercise among people with RA.
24999142 Determination of specificity and sensitivity of anti-RA 33 in diagnosis of early rheumatoi 2014 May 28 BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease with uncertain etiology characterized by symmetric polyarthritis in peripheral joints. Its diagnosis is based on clinical findings and serologic tests. They are rarely conclusive in early course of the disease. So, its early diagnosis could be difficult. The present study was designed to evaluate the role of Anti -RA33; an Auto-Antibody against RA33 in early diagnosis of the disease. MATERIALS & METHODS: forty three patients who had been visited in a Rheumatology Clinic were randomly selected. Their disease has been diagnosed by a Rheumatologist. 55 persons were chosen from healthy individuals who had attended in other clinic. Their age and sex were matched with the case group. Anti-RA33 and RF titers were measured in their blood sample using standard methods. FINDINGS: RF and Anti-RA33 titers had significant correlation in case group (p=0.015). Anti -RA33 test had 98% sensitivity, 20% specificity, 55% positive predictive value, and 90% negative predictive. CONCLUSION: Anti -RA33 could have diagnostic and prognostic value in diagnosis and evaluation of patients with RA, and its differentiation from other small joint disorders, particularly when the other serologic tests are negative.
24956986 Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the D 2014 Oct OBJECTIVE: The primary aim of the study was to evaluate whether rheumatoid arthritis (RA) patients considered to be in remission according to clinical criteria sets still had persisting ultrasound (US) synovitis. We further intended to evaluate the capacity of our US score to discriminate between the patients with a clinically active disease versus those in remission. METHODS: This is an observational study nested within the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) rheumatoid arthritis cohort. A validated US score (SONAR score) based on a semi-quantitative B-mode and Doppler (PwD) score as part of the regular clinical workup by rheumatologists in different clinical settings was used. To define clinically relevant synovitis, the same score was applied to 38 healthy controls and the 90st percentile was used as cut-off for 'relevant' synovitis. RESULTS: Three hundred and seven patients had at least one US examination and concomitant clinical information on disease activity. More than a third of patients in both DAS28 and ACR/EULAR remission showed significant gray scale synovitis (P=0.01 and 0.0002, respectively) and PwD activity (P=0.005 and 0.0005, respectively) when compared to controls. The capacity of US to discriminate between the two clinical remission groups and patients with active disease was only moderate. CONCLUSION: This observational study confirms that many patients considered to be in clinical remission according the DAS and the ACR/EULAR definitions still have residual synovitis on US. The prognostic significance of US synovitis and the exact place of US in patients reaching clinical remission need to be further evaluated.
24824381 Association of two polymorphisms rs2910164 in miRNA-146a and rs3746444 in miRNA-499 with r 2014 Jul BACKGROUND: It has been reported that two single nucleotide polymorphisms (SNPs) rs2910164 in miRNA-146a and rs3746444 in miRNA-499 might be associated with the susceptibility to rheumatoid arthritis (RA). Owing to mixed and inconclusive results, we conducted a meta-analysis to systematically summarize and clarify the association between the two SNPs and RA risk. METHODOLOGY/MAIN RESULTS: A systematic search of studies on the association of two SNPs with susceptibility to RA was conducted in PubMed and Embase. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to pool the effect size. A total of 6 case-control studies on rs2910164 and 3 studies on rs3746444 were included. Though no evidence of association was found between rs2910164 polymorphism and RA risk in all the genetic models, a trend of reduced risk could be drawn. (C versus G: OR=0.93, 95% CI 0.82-1.05; GC versus GG: OR=0.89, 95% CI 0.73-1.10; CC versus GG: OR=0.84, 95% CI 0.64-1.10; GC/CC versus GG: OR=0.89, 95% CI 0.73-1.08; CC versus GC/GG: OR=0.94, 95% CI 0.77-1.14). A significant increased risk of RA was observed in the rs3746444 polymorphism in homozygote comparison, recessive comparison, and allele comparison, but there was insufficient data to fully confirm the association of RA and rs3746444 in miRNA-499. CONCLUSIONS: MiRNA-146a rs2910164 polymorphism is not associated with RA risk, while miRNA-499 rs3746444 polymorphism is correlated with RA risk. However, the results of miRNA-499 rs3746444 should be interpreted with caution due to limited sample and heterogeneity. Large-scale and well-designed studies are needed to validate our findings.
25288064 [Rheumatoid neutrophilic dermatitis]. 2014 Oct BACKGROUND: Rhumatoid arthritis (RA) is a chronic inflammatory joint disease. It appears to be caused by a combination of genetic and environmental factors. It may be accompanied by well-known extra-articular damage (e.g. lung, kidney, heart), while cutaneous involvement such as rheumatoid neutrophilic dermatitis (RND) is much less frequent. PATIENTS AND METHODS: A 64-year-old woman was referred by rheumatologists after she developed a cutaneous eruption on the forearms, elbows and scalp in a setting of progressive RA. A skin biopsy showed a dermal neutrophilic infiltrate throughout its entire thickness as well as leukocytoclasia, with fibrinoid material visible in certain areas. No vasculitis was observed. This histological examination led to a diagnosis of RND. The eruption was successfully treated with topical corticosteroids. COMMENTS: RND is a rare sign in RA that presents clinically as plaques, erythematous nodules or urticarial lesions. The lesions tend to disappear naturally or on treatment of RA. Topical corticosteroids or systemic therapy, in particular dapsone, may be suggested to treat cutaneous damage.
24624921 Pharmacogenetics and pharmacogenomics for rheumatoid arthritis responsiveness to methotrex 2014 Mar Rheumatoid arthritis (RA) is a complex, systemic autoimmune disease characterized by chronic inflammation of multiple peripheral joints, which leads to serious destruction of cartilage and bone, progressive deformity and severe disability. Methotrexate (MTX) is one of the first-line drugs commonly used in RA therapy owing to its excellent long-term efficacy and cheapness. However, the efficacy and toxicity of MTX treatment have significant interpatient variability. Genetic factors contribute to this variability. In this review, we have summarized and updated the progress of RA response to MTX treatment since 2009 by focusing on the fields of pharmacogenetics and pharmacogenomics. Identification of genetic factors involved in MTX treatment response will increase the understanding of RA pathology and the development of new personalized treatments.
22729869 Synovial cyst of the hip in a patient with rheumatoid arthritis. 2013 May A 67-year-old woman with rheumatoid arthritis (RA; Steinblocker stage IV, class 4) who had RA onset at 34 years of age had anterior thigh pain, femoral neuropathy and lower abdominal pain. Physical examination showed multidirectional limit of motion, and radiographic examination showed destruction of the hip joint. MRI and arthrography indicated a cystic lesion that communicated with the hip joint. The rheumatoid synovial cyst was removed during total hip arthroplasty. The symptoms were relieved, and the mass was reduced in size.
24769916 Illness perceptions and psychological distress associated with physical health-related qua 2014 Dec Notwithstanding that psychological distress and illness perceptions are important in determining outcomes in rheumatic diseases, few studies investigated these variables in primary Sjögren's syndrome (pSS). We aimed to compare illness perceptions and psychological distress in patients with pSS, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and to test whether their associations with health-related quality of life (HRQoL) are similar in these groups of patients. In 57 patients with pSS, 75 with SLE and 199 with RA, we administered the Patient Health Questionnaire (PHQ-9), the Symptom Check-List and the Brief-Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short-Form to assess HRQoL. Hierarchical regression models determined the associations of psychological variables with HRQoL after adjusting for demographic variables and clinical parameters. The prevalence of clinically significant depressive symptoms (PHQ-9 ≥ 10) was 24.6 % in pSS, 29.3 % in SLE and 25.1 % in RA. Patients with pSS showed little understanding of their disease (comprehensibility) and attributed more symptoms to their illness (identity) compared with the other groups of patients. Illness perceptions and depressive symptoms were independently associated with physical HRQoL in a similar pattern in all three groups. In pSS, however, the patients' worries about the consequences of their illness was a stronger correlate of physical HRQoL than pain. These findings indicate that psychological factors are important correlates of HRQoL in these disease groups and encourage the design of psycho-educational therapies targeting disease-related cognitions in pSS in an attempt to improve patient's physical HRQoL.
23378146 Different wording of the Patient Global Visual Analogue Scale (PG-VAS) affects rheumatoid 2013 Dec OBJECTIVE: The Disease Activity Score in 28 joints (DAS28) is a key measure in clinical practice and clinical trials. There are at least five different versions of the 'Patient Global' Visual Analogue Scale (PG-VAS) being used in the DAS28. The developers suggested that the PG-VAS can be an assessment of global health or disease activity, but did not specify the wording of the question. There is no consensus on what the PG-VAS is intended to capture, and the different words and phrases have not been evaluated. The aim of this study was to test if phrasing affects PG-VAS scores and hence yields different results for the DAS28. METHODS: Fifty patients with rheumatoid arthritis taking biologic agents in a rheumatology outpatient department completed a self-administered questionnaire containing five versions of the 100 mm PG-VAS. RESULTS: All PG-VAS versions correlated strongly with each other (rho = 0.67-0.87, p < 0.0001). However, individual scores for each PG-VAS, when compared with the comparator on a Bland-Altman chart had wide limits of agreement--the largest being -42 mm to +45 mm. The five overall DAS28 scores were calculated for each patient using the five different PG-VAS. The largest difference in DAS28 scores was 0.63. CONCLUSION: Different phrasing of the PG-VAS gives different DAS28 results. As the DAS28 is a key outcome measure, such differences have the potential to influence clinical decisions relating to eligibility for biologic agents and evaluation of new therapies. We urgently need to decide on the concept to be measured and the phrasing required to capture this. The PG-VAS phrasing should then be standardized and validated.
22984169 Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthriti 2013 Aug OBJECTIVE: To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA). METHODS: We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS: Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (κ value 0.72 for B-mode; κ value 0.78 for PD mode). Interobserver reliability assessment showed good κ values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate κ values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45). CONCLUSIONS: US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.
23886014 New autoantibodies in early rheumatoid arthritis. 2013 Jul 25 INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease causing articular cartilage and bone destruction. Since irreversible joint destruction can be prevented by intervention at the early stages of disease, early diagnosis of RA is important. In this study, we identified new autoantibodies in the sera of patients with early (less than one year) RA. METHODS: We screened the sera of 20 RA patients with disease duration less than one year, 19 RA patients with disease duration more than five years and 23 controls on 8,268 human protein arrays. We confirmed the validity of protein array detection by ELISA assays. We then performed epitope mapping with overlapping 15-mers to analyze RA sera reactivity. RESULTS: WIBG (within BGCN homolog (Drosophila)), GABARAPL2 (GABA(A) receptor associated protein like 2) and ZNF706 (zinc finger protein 706) proteins are preferentially recognized by autoantibodies from early RA patients. Of interest, autoantibodies to WIBG are very specific for early RA. Indeed, 33% of early RA patients' sera recognize WIBG versus 5% of RA patients with disease duration more than 5 years and 2% of controls. We identified three linear peptides on WIBG GABARAPL2 and ZNF706 that are preferentially recognized by sera of early RA patients. CONCLUSIONS: We identified new autoantibodies associated with RA with disease duration less than one year. These autoantibodies could be used as diagnosis markers in RA patients.
24288765 Lipid imbalance in individuals predisposed to rheumatoid arthritis: possible relationship 2013 Oct Lipid balance was studied in female patients with late rheumatoid arthritis, their healthy female relatives liable to autoimmune diseases, and healthy women without family history of autoimmune diseases. Previous studies showed that the relatives of patients with rheumatoid arthritis suffered from frequent stubborn common infections, which prompted us to analyze the relationship between lipid metabolism and the infectious syndrome parameters. Blood serum and cells were collected for analysis when females had no clinical symptoms of infections (in all groups) or laboratory signs of inflammatory process (in the relatives and controls). Proatherogenic shifts in serum lipid composition presumably associated with frequent lasting infections were detected in individuals liable to rheumatoid arthritis development. Elevated cholesterol content in mononuclear leukocytes in this group could lead, in turn, to dysfunctions of these cells and augment the defects of anti-infection defense. The parameters of lipid balance in patients with late rheumatoid arthritis were close to the age-specific norm.
24754417 [Oral infection and rheumatic diseases]. 2014 Feb Periodontitis (PD) is one of the most common infectious diseases of dental attachment. From epidemiological studies there is known association of periodontitis with chronic diseases as for example diabetes mellitus, cardiovacular diseases, atherosclerosis or Crohn disease. In last decade there is an increasing evidence for association of rheumatoid arthritis (RA) and periodontitis also. RA and PD have some common genetic, environmental and immunopathological characters. Important aspect of reciprocal relationship is also ability to citrullination, which is innate to one of most important oral patogen - Porphyromonas gingivalis. Citrullination and production of autoantibodies against this modified proteins is one the important pathophysiological actions in course of RA. Recently, there has been published papers drawing attention to potential influence of periodontitis therapy to course and activity of RA. Furthermore there appear some information pointing to possible association between PD and other rheumatic diseases as for exam-ple spondyloarthritis. Interrelationship between PD and rheumatic diseases thus stay important and still open question in research of pathophysiology, course and therapeutic possibilities of rheumatic diseases.
23711386 MDR-ABC transporters: biomarkers in rheumatoid arthritis. 2013 Sep MDR-ABC transporters are widely expressed in cell types relevant to pathogenesis of rheumatoid arthritis. Many reports demonstrate the interaction of small molecule drugs with MDR-ABC transporters. Cell-based assays for disease relevant cell types can be easily gated and could reveal specific drug targets and may increase significance and utilisation of data in clinical practice. Many commonly used DMARDs (e.g. methotrexate, sulfasalazine, leflunomide/teriflunomide, hydroxychloroquine) are ABCG2 substrates. Consequently, the activity of this transporter in patients should be determined to understand the disposition and pharmacokinetics of the therapy. In addition, MDR-ABC transporters transport a variety of endobiotics that play important roles in cell proliferation, cell migration, angiogenesis and inflammation. Therefore, MDR-ABC transporters are important biomarkers in rheumatoid arthritis.
23374997 Tools for monitoring remission in rheumatoid arthritis: any will do, let's just pick one a 2013 Jan 28 Rheumatoid arthritis treatment has seen major changes in the last decade, one of which is the concept of treating to target. Various composite outcome measures have been developed, and the latest is the new American College of Rheumatology/European League Against Rheumatism remission criteria. Zhang and colleagues test the predictive validity of the new criteria in an observational cohort and show that they work as well as other definitions of remission. Our main challenge remains getting rheumatologists to use one of the outcome measures rather than developing new measures that are basically no different from already available measures in predicting functional and radiographic changes, the two most important long-term outcomes of rheumatoid arthritis.
23087181 Serological changes in the course of traditional and biological disease modifying therapy 2013 Feb OBJECTIVE: To investigate changes of rheumatoid factor (RF) and antibodies against citrullinated peptides (ACPA) during therapy with disease modifying antirheumatic drugs. METHODS: We obtained clinical and serological data of patients from the treatment start and after 6 months of therapy. With non-parametric tests, we analysed changes of ACPA and RF levels between the two visits and the influence of treatment response. Furthermore, we analysed potential influential factors as disease chronicity, different therapeutics and the trend over 18 months. RESULTS: 143 ACPA and RF positive patients were included. The median (25th/75th percentile) relative changes after 6 months were -35.6% (-63.3; -8.3) for RF and -15.2% (-40.0; 10.0) for ACPA (p<0.001 for both). Changes of RF levels were significantly greater than those seen for ACPA (p<0.001). The decrease of ACPA and RF was significantly higher in treatment responders (p=0.034 and p=0.01, respectively). Aside from changes in disease activity, only a short disease duration showed an independent effect on changes of RF levels (p=0.087). CONCLUSIONS: ACPA and RF levels decreased significantly after 6 months of therapy. Reductions of both autoantibodies were closely linked to a reduction of disease activity. RF declined faster, to a larger extent and in greater numbers of patients than ACPA.
24972003 Autoantibodies in pre-clinical autoimmune disease. 2014 Nov 1 The presence of autoantibodies is characteristic of autoimmune diseases. It is widely accepted that autoantibodies provide crucial diagnostic and prognostic information for autoimmune diseases. Indeed, numerous studies have demonstrated that the appearance of autoantibodies precedes the clinical onset of autoimmune diseases. We performed a literature review regarding the appearance of autoantibodies that preceded the clinical onset of autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, primary biliary cirrhosis, inflammatory bowel disease, and multiple sclerosis. Herein we review and comment on the major findings of these studies.
23287359 An evaluation of molecular and clinical remission in rheumatoid arthritis by assessing rad 2013 May OBJECTIVES: To determine whether molecular remission defined by a multi-biomarker disease activity (MBDA) score predicts a reduced risk of joint damage progression, and whether the MBDA score can augment existing classifications of remission. METHODS: The study examined 271 visits for 163 RA patients in the Leiden Early Arthritis Cohort. The MBDA score and other variables from each visit were evaluated for prediction of progression [change in Sharp-van der Heijde Score (ΔSHS) >3] over the ensuing 12 months. Positive likelihood ratios (PLRs) for non-progression were calculated for remission based upon DAS based on 28-joint counts and CRP (DAS28-CRP <2.32), EULAR/ACR Boolean criteria and MBDA score (≤25). RESULTS: Ninety-three per cent of patients in MBDA-defined remission did not experience progression, compared with 70% of patients not in MBDA remission (P = 0.001). There were no significant differences in the fraction of non-progressers between patients in remission and those not in remission using either DAS28-CRP or EULAR/ACR criteria. The PLR for non-progression over 12 months for MBDA remission was 4.73 (95% CI 1.67, 15.0). Among patients in DAS28-CRP remission, those with a high MBDA score were 2.3 times as likely (95% CI 1.1, 3.7) to have joint damage progression during the next year. CONCLUSION: MBDA-defined remission was an indicator of limited radiographic progression over the following 12 months. For patients in DAS28-CRP remission, high MBDA scores were a significant indicator of elevated risk of progression. MBDA results may provide a useful adjunct to clinical assessment to identify progression-free remission and assess subclinical disease.