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ID PMID Title PublicationDate abstract
23721060 Quantification of "end products" of tissue destruction in inflammation may reflect converg 2013 Aug The degree of inflammation in auto-immune diseases such as rheumatoid arthritis is often assessed in serum and used for diagnostic and prognostic purposes. The serum levels of acute inflammatory signaling molecules (C-reactive protein and serum amyloid A) in conjunction with the important pro-inflammatory cytokines themselves may have limited utility due to several limitations. (1) These traditional biomarkers are associated with substantial variation due to biological not technical issues. (2) The combined burden of cytokines rather than one single player may be responsible for the progression of disease. (3) The cellular and tissue origins of cytokines that are detected systemically are difficult to determine as the cytokines lack tissue specificity. (4) There is substantial redundancy in the signaling potential of cytokines. Despite these major limitations, the total burden of inflammatory signaling molecules and pro-inflammatory cytokines are important in assessing the degree of inflammation in conjunction with a diagnosis of disease. The total burden of signaling ultimately results in protease expression, tissue destruction and disease progression. One of the pivotal events in the downstream inflammatory signaling is the generation of pathological enzymes, which results in the release of small but tissue-specific protein fragments into the serum that may be used as molecular biochemical markers. We discuss the potential of this new class of biochemical markers, which may be viewed as "end products of tissue destruction". These so-called protein fingerprints may also be considered end-products of the convergence cytokine signaling pathways, as they are the final end-result of tissue destruction.
25028384 Effect of human immunodeficiency virus infection on disease activity in rheumatoid arthrit 2014 Aug OBJECTIVE: To determine the effect of human immunodeficiency virus (HIV) infection on disease activity in rheumatoid arthritis (RA). METHODS: A retrospective records review of patients who contracted HIV infection subsequent to RA diagnosis (HIV group), compared to an HIV-negative group of patients with RA (control group), for 28-joint Disease Activity Score (DAS28) scores at initial presentation (T0) and last clinic visit (TL), and at diagnosis of HIV infection (TH) in the HIV group. RESULTS: Of 1712 patients with RA, 85 were HIV-positive (4.9%), 43 of them contracting HIV subsequent to RA diagnosis. The mean (SD) age, RA disease duration, and duration following diagnosis of HIV were 47.1 (10.1), 10.5 (8.4), and 2.9 (2.0) years, respectively, for the HIV group. Both the HIV and control groups showed similar improvement in joint counts and C-reactive protein (CRP) at visit TL, in spite of methotrexate (MTX) being withdrawn in most patients in the HIV group by visit TL (11.6% in the HIV group were still taking MTX vs 83.7% in the control group, p = 0.0002), but a minority (13.9%) had ongoing moderate to high disease activity at visit TL. In the HIV group, the mean DAS28-erythrocyte sedimentation rate (ESR) and DAS28-CRP scores were similar at baseline, but at visits TH and TL the mean DAS28-ESR scores were significantly higher than the mean DAS28-CRP scores (31% and 31.8%, p < 0.0005 and p < 0.004, respectively), mainly resulting from ESR increase following HIV seroconversion. CONCLUSION: Disease activity improved in most patients in the HIV group in spite of stopping the MTX as the "anchor drug." The DAS28-ESR overestimates disease activity compared to the DAS28-CRP in the setting of HIV infection.
23352423 Vertebral artery dissection in rheumatoid arthritis with cervical spine disease. 2013 Oct A 59-year-old woman with long-standing active rheumatoid arthritis presented with posterior circulation ischemic stroke after vertebral dissection. She had severe multilevel degenerative changes of her cervical spine. She did not have classic stroke risk factors nor evidence of atherosclerotic disease or other systemic diseases. The most likely mechanism appears to be injury of the artery wall by an osteophyte, causing dissection that resulted in thrombosis and subsequent embolic strokes.
25539828 Gene, environment, microbiome and mucosal immune tolerance in rheumatoid arthritis. 2016 Mar RA is a complex multifactorial chronic disease that transitions through several stages. Multiple studies now support that there is a prolonged phase in early RA development during which there is serum elevation of RA-related autoantibodies including RF and ACPAs in the absence of clinically evident synovitis. This suggests that RA pathogenesis might originate in an extra-articular location, which we hypothesize is a mucosal site. In discussing this hypothesis, we will present herein the current understanding of mucosal immunology, including a discussion about the generation of autoimmune responses at these surfaces. We will also examine how other factors such as genes, microbes and other environmental toxins (including tobacco smoke) could influence the triggering of autoimmunity at mucosal sites and eventually systemic organ disease. We will also propose a research agenda to improve our understanding of the role of mucosal inflammation in the development of RA.
25180623 Managed care implications in managing rheumatoid arthritis. 2014 May Rheumatoid arthritis (RA) is a systemic inflammatory form of arthritis characterized by joint inflammation, pain, swelling, and stiffness. While contemporary treatment strategies based on early diagnosis, aggressive treatment, and regular monitoring have helped a significant number of patients achieve evidence-based treatment goals, RA still presents substantial management challenges to both clinicians and patients, and has the potential to lead to severe disability over time. In addition to its significant clinical consequences, RA has important economic implications. Both direct and indirect medical costs associated with RA are significant, including costs of medications, ambulatory and office-based care, and quality-of-life and productivity costs. In addition, a significant proportion of patients with prevalent RA have associated cardiovascular disease and other comorbidities, further compounding healthcare costs and complicating management of this disorder. Clinically favorable and cost-effective management must focus on prevention of disease progression and the improved patient health status and productivity than can result from optimal disease control. With the myriad of treatment options both available and emerging, managed care organizations are faced with difficult decisions surrounding the most clinically and cost-effective allocation of treatments designed to improve disease outcomes for patients with RA. It is vital that managed care clinicians and providers analyze both the overall burden and the specific costs of RA. This will allow a better understanding of how costs and issues relating to healthcare utilization affect the treatment of patients with RA and impact individualized therapy, care coordination, and outcomes.
24564960 Association between PADI4 gene polymorphisms and anti-cyclic citrullinated peptide antibod 2014 May OBJECTIVES: The present study was undertaken to investigate the association of peptidyl-arginine-deiminase type IV gene (PADI4) single nucleotide polymorphisms (SNPs) with rheumatoid arthritis (RA) susceptibility, and to determine whether there is any impact of PADI4 polymorphisms on RA subsets or phenotypes in a large Chinese Han cohort. METHODS: Two PADI4 SNPs (rs2240340 and rs1748033) were genotyped in 1216 Chinese Han RA patients and 1040 unaffected controls by TaqMan SNP Assays. Serum anti-CCP antibody and anti-PAD4 antibody levels were measured by ELISA. Bone destruction was scored by Sharp-van der Heijde scores (SHSs) of hands in 463 patients. RESULTS: The two SNPs rs2240340 and rs1748033 of PADI4 showed strong association with RA susceptibility (OR=1.23, 95% CI 1.09-1.38, p=6.66×10⁻⁴; and OR=1.24, 95% CI 1.10-1.41, p=6.98×10⁻⁴, respectively). RA risk genotypes of PADI4 were specifically associated with anti-CCP positive RA (rs2240340: p=5.13×10⁻⁶; rs1748033: p=2.97×10⁻³, respectively). Furthermore, there was a trend association between PADI4 rs2240340 and radiographic severity, though it did not reach the statistic significance (p=0.088). CONCLUSIONS: Our data provide strong evidence that PADI4 polymorphisms are risk factors contributed to RA susceptibility, especially for anti-CCP positive RA, and may confer higher risk of RA radiographic severity in Chinese Han population.
23111117 Low-field MRI versus ultrasound: which is more sensitive in detecting inflammation and bon 2013 Jan OBJECTIVES: The aim of the present paper is to determine if the ultrasound of hands and feet is comparable to the MRI of the dominant hand to detect erosive disease and inflammation in mild or moderate rheumatoid arthritis (RA). METHODS: Twenty-six patients (14 females; mean age, 48 years) with active mild or moderate RA (mean DAS28, 3.9; mean disease duration, 19 months) were examined clinically, by ultrasound and by gadolinium-enhanced low-field MRI at baseline, after 6 and 12 months (78 examinations). Radiographs from hands and forefeet were taken at baseline and after 12 months. MRI was performed at the clinically most active (dominant) hand or forefoot evaluating the MCP 1-5 or MTP 1-5 joints. Ultrasound examination additionally included all other 2nd, 5th MCP and 5th MTP joints. RESULTS: MRI and ultrasound detected erosive disease in 67 and 56 of 78 examinations, respectively (p<0.01); radiography only in 8 of 52 examinations (p<0.001). MRI and ultrasound were equally sensitive to detect synovitis (in 64 and 66 examinations). Synovial power Doppler signals were present in 38 ultrasound examinations. Bone marrow oedema was present in 37 MRI examinations. Ultrasound was more sensitive than MRI to detect tenosynovitis (in 30 vs. 15 examinations; p=0.001). CONCLUSIONS: MRI of the dominant hand and bilateral ultrasound of MCP and MTP joints are superior to x-ray to detect erosive disease in mild and moderate RA. MRI is slightly, but significantly more sensitive than ultrasound for erosive disease, while ultrasound is more sensitive to detect tenosynovitis. Ultrasound and MRI are comparably sensitive to detect synovitis.
24237847 Perioperative outcomes in patients with rheumatoid versus osteoarthritis for total hip art 2013 Nov OBJECTIVES: Little is known about perioperative outcomes among the subset of patients undergoing total hip arthroplasty (THA) for a diagnosis of rheumatoid arthritis (RA) rather than osteoarthritis (OA). We sought to 1) identify the prevalence of RA in patients undergoing THA, 2) compare their demographics to those being operated on for OA, 3) determine differences in perioperative outcomes and 4) analyse if RA represents an independent risk factor for complications, mortality, utilisation of resources, increased length of stay and cost. METHODS: Entries of patients who underwent elective THA between 2006 and 2010 were identified in a national database and subgrouped according to presence of a concurrent diagnosis of RA. Differences in demographics and perioperative outcomes were analysed. RESULTS: We identified 157,775 entries for patients who underwent THA between 2006 and 2010. RA was present in 3.42% (n=5,400). Patients in the group RA were on average younger [RA: 63.94 years vs. OA: 65.64 years; p<0.0001] and more likely female [RA: 75.47% vs. OA: 56.09%; p<0.0001]. While mortality was not statistically different, perioperative pulmonary and infectious complications occurred more frequently in RA patients. Compared with OA, multivariate logistic regression revealed higher overall odds for complications [OR=1.15 (CI 1.05;1.25), p=0.0037], need for mechanical ventilation [OR=1.42 (CI 1.01;2.00), p=0.0414], transfusion [OR=1.35 (CI 1.26;1.44), p<0.0001], prolonged hospitalisation [OR=1.16 (CI 1.08;1.23), p<0.0001] and increased hospital charges [OR=1.17 (CI 1.09;1.26), p<0.0001]. CONCLUSIONS: In THA patients suffering from RA, perioperative risk for complications and utilization of health care resources continues to be increased compared to OA patients.
23957541 Primary nasal tuberculosis during anti-tumour necrosis factor alpha treatment of a patient 2013 Dec Anti-tumour necrosis factor alpha (anti-TNFα) therapy is increasingly used in several inflammatory disease processes, including rheumatoid arthritis. However it has a significant potential for adverse events, such as reactivation of latent tuberculosis, which is frequently found in disseminated or extrapulmonary forms. We present a rare case of primary nasal tuberculosis within the context of anti-TNFα therapy for rheumatoid arthritis. To our knowledge, this is the first reported case of primary nasal tuberculosis in a patient with rheumatoid arthritis receiving anti-TNFα therapy.
24685295 Adjuvant induced autoimmune/inflammatory syndrome presenting as joint and lung manifestati 2014 Nov A 59 year-old female with a history of injection of an oily material in the buttocks 11 years ago. She developed symmetric aditive polyarthritis as well as superior and inferior airways involvement. There was no evidence of granulomatosis with polyangiitis (Wegener). She had several serum autoantibodies and a skin biopsy showed a foreign body granuloma. The diagnosis of adjuvant induced autoimmune/inflammatory syndrome was made. The pulmonary involvement was an atypical manifestation at the onset of disease.
24960526 Comparison of discrimination and prognostic value of two US Doppler scoring systems in rhe 2014 Jul OBJECTIVES: The aim of this paper is to investigate sensitivity to change (SRM), predictive validity and discriminative ability of a quantitative (QS) and a semi-quantitative (SQS) Doppler ultrasound scoring systems in patients with rheumatoid arthritis (RA) treated with anti-TNF-α therapy. METHODS: RA patients with wrist joint affection treated with TNF-α inhibitor were followed for one year. The wrist was examined with Doppler before initiating therapy and after one year. DAS28 was determined at both visits. One person trained in the SQS system and one in the QS system evaluated the anonymised images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS: Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0.6). A decrease in Doppler activity was seen for both systems after anti-TNF-α therapy. Sensitivity to change was seen, SRM=-0.52 (95%CI; -0.83 to -0.21; QS) and -0.24 (-0.53 to -0.05; SQS). Predictive value was poor (QS rs=-0.24; SQS rs=-0.05). Construct validity was; QS: rs=0.29, SQS: rs=0.23. CONCLUSIONS: Both systems were to some extent sensitive to change. Predictive validity and discriminate capacity of both systems showed only a weak association to DAS 28 in the study population. The QS was a little superior to the SQS. The results do not necessarily reflect Doppler evaluation as being ineffective, but may be caused by DAS28 not being a perfect marker of inflammation.
23263550 Tc-99 m diethylenetriamine-pentaacetic acid (DTPA): is it reliable for assessment of metho 2013 Dec Methotrexate (MTX) is commonly employed as the initial DMARD used for the treatment of rheumatoid arthritis (RA). We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. A total of 52 RA adult female patients with normal baseline serum creatinine and GFR at the initial diagnosis of the disease were included. Group 1 (G1) included 30 patients (mean age 40.4 ± 4.4 years) on MTX and NSAIDS, while 22 RA patients (mean age 38.5 ± 8.2 years) who received NSAIDs only served as control group (G2). Renal function was assessed by GFR measurement using technetium diethylenetriamine-pentaacetic acid (Tc-99 m DTPA) at a point of the study time corresponding to disease duration. Twenty-one out of thirty (70 %) in G1 showed reduced GFR compared to 6/22 (27.3 %) in G2 (P = 0.007), with 3.3 ± 0.5 % annual reduction in GFR. Reduced GFR in G1 showed significant negative correlation with age (r = -0.396, P = 0.005), MTX cumulative dose (r = -0.263, P = 0.049), MTX-intake duration (r = -0.293, P = 0.031) and NSAIDs-intake duration (r = -0.344, P = 0.014). Low-dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction overtime that could be monitored by Tc-99 m DTPA.
24972953 Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace 2014 Oct PURPOSE: To determine whether T1 post-gadolinium chelate images (T1Gd) can replace T2-weighted images (T2) for evaluating bone marrow oedema (BME), thereby allowing a shorter magnetic resonance imaging (MRI) protocol in rheumatoid arthritis (RA). MATERIAL AND METHODS: In 179 early arthritis patients and 43 advanced RA patients, wrist and metacarpophalangeal joints were examined on a 1.5-T extremity MRI system with a standard protocol (coronal T1, T2 fat-saturated and coronal and axial T1 fat-saturated after Gd). BME was scored according to OMERACT RAMRIS by two observers with and without T2 images available. Agreement was assessed using intraclass correlation coefficients (ICCs) for semi-quantitative scores and test characteristics with T2 images as reference. RESULTS: Agreement between scores based on T2 and T1Gd images was excellent ICC (0.80-0.99). At bone level, sensitivity and specificity of BME on T1Gd compared to T2 were high for both patient groups and both readers (all ≥80 %). CONCLUSION: T1Gd and T2 images are equally suitable for evaluating BME. Because contrast is usually administered to assess (teno)synovitis, a short MRI protocol of T1 and T1Gd is sufficient in RA. KEY POINTS: • Bone marrow oedema scores are equal on T2 and T1-Gd-chelate enhanced sequences. • Agreement between scores based on T2 and T1-Gd-chelate images was excellent. • Sensitivity and specificity for presence of bone marrow oedema were high. • A short protocol without T2 images suffices in rheumatoid arthritis patients.
24197059 A 5-22-year follow-up study of stemmed alumina ceramic total elbow arthroplasties with cem 2014 Jan BACKGROUND: We determined mid to long-term results of total elbow arthroplasty (TEA) by use of unlinked elbow prostheses with solid alumina ceramic trochleae, and ceramic ulnar stems (stemmed Kyocera type I; SKC-I) for patients with rheumatoid arthritis. PATIENTS AND METHODS: Fifty-four elbows of 39 patients were available for detailed clinical and radiographic review after a follow-up period of at least 5 years. The mean follow-up period was 12.6 years (range 5-22 years). Clinical condition before and after surgery was assessed by use of a modified version of the Mayo Elbow Performance Score (MEPS; 0-100 points) and a Japan Orthopaedic Association Elbow score (JOA score; 0-100 points). The radiographs were reviewed and loosening was defined as a progressive radiolucent line >1 mm wide that was completely circumferential around the prosthesis. Clinical records of post-operative events affecting the elbows were used for survival analysis of the prostheses using the Kaplan-Meier method. RESULTS: The average modified MEPS and JOA scores improved significantly from 39.7 ± 14.3 to 44.7 ± 9.4, respectively, pre-operatively, to 89.7 ± 15.4 and 83.1 ± 12.8, respectively, post-operatively (P < 0.0001). The functional assessment score also improved from 4.9 ± 2.8 to 8.5 ± 3.3 points (P < 0.0001). With loosening or implant revision defined as end points, the likelihood of survival of the prosthesis for up to 20 years was 92.6% (95% confidence interval (CI), 85.6-100.0) or 86.3 % (95 % CI 75.0-97.6), respectively. CONCLUSION: Satisfactory clinical results were obtained after TEA using SKC-I prostheses, which provided excellent pain relief and functional range of motion. The results of our study reveal the high reliability over a long period of the cemented SKC-I prosthesis with an alumina ceramic component.
23934052 [Urological comorbidities in patients with rheumatoid arthritis : literature review]. 2013 Nov Patients with rheumatoid arthritis (RA) have an increased risk of urolithiasis which is further negatively impacted by a reduced bone density. Interstitial cystitis also tends to occur more often in patients with rheumatic diseases. The high incidence of bacterial urogenital infections is influenced by the use of immunomodulating drugs. Many RA patients have to undergo numerous tests until a diagnosis is reached and are then treated as outpatients on a tightly controlled schedule. Despite a closely controlled rheumatological follow-up, urological screening and determination of a baseline prostate-specific antigen (PSA) value (in men over 45 years old) should not be neglected. In patients with an increased risk of renal and bladder neoplasms or when such a diagnosis is known, the benefit of long-term use of high doses of non-steroidal anti-inflammatory drugs (NSAID, aspirin type) should be carefully weighed up with a risk profile and after specialist urological assessment. Patients who suffer from sexual dysfunction due to physical limitations and prolonged medical therapy should undergo urological and gynecological assessment to exclude contributing causes. The use of aphrodisiacs and erection-enhancing drugs (e.g. PDE5 inhibitors, local injection with prostaglandins and vacuum therapy) require prior approval by a medical specialist and also cardiovascular stability. Acute urinary retention is more common in chronic inflammatory musculoskeletal diseases.
25168478 The cyclooxygenase-2/thromboxane A2 pathway: a bridge from rheumatoid arthritis to lung ca 2014 Nov 1 Patients with rheumatoid arthritis (RA) appear to be at a higher risk of lung cancer (LC). Although the connection between RA and LC has been an active area of research for many years, the molecular pathogenesis of the disease process remains unclear. The cyclooxygenase (COX)-2/thromboxane A2 (TxA2) pathway has been shown to play a potential role in LC development through an auto-regulatory feedback loop. An increased level of TxA2 has been found in RA patients, and intriguingly, the positive feedback loop for the COX-2/TxA2 pathway was shown to have a potential function in RA fibroblast-like synoviocytes (RA-FLS). Thus, the molecular basis of LC development in patients with RA has been at least in partly described. It is possible that COX-2-derived TxA2 could be monitored for the early detection of LC in RA patients, and targeting this molecular pathway may decrease the risk of LC in patients with RA.
24832839 Subjective health expectations at biological therapy initiation: a survey of rheumatoid ar 2014 May Subjective health expectations of patients with rheumatoid arthritis (RA) and rheumatologists remain understudied. We measured subjective expectations regarding treatment effects of biologicals as well as future length and quality of life. Moreover, we compared expectations regarding treatment effects to actual treatment effects. We recruited a sample of Hungarian RA patients initiating treatment with biologicals. Expectations regarding treatment effects and future health were obtained through a written questionnaire from patients and physicians, including functional impairment (HAQ-DI), health status (EQ-5D) and disease activity (DAS28). After three months, actual treatment effects were obtained. Ninety-two RA patients (females N = 81, 88%) with mean age of 51 (SD 12) and disease duration of 9 (SD 8) years with high average disease activity (DAS28: 6.1) were included. Patients expected significant and large health improvement within three months with mean changes on the HAQ-DI of -0.8 and on the EQ-5D of +0.4. Rheumatologists' estimates were similar, and they expected significant decrease of 2.3 on the DAS28. Actual scores after three months were obtained for 77 patients. The measured scores were significantly lower than expected scores for the HAQ-DI and EQ-5D. Rheumatologists' expectations for the DAS28 score were not significantly different from measured scores. Patients' average expectations regarding quality of life scores for ages 60, 70, 80 and 90 were 0.44, 0.24, 0.06 and -0.02, respectively. Our results suggest that both RA patients and rheumatologists expect quick and significant health improvements from biological drugs and tend to overestimate actual short term treatment effects. Nonetheless, RA patients expect a sharp deterioration of future health.
24023001 Societal costs of rheumatoid arthritis in China: a hospital-based cross-sectional study. 2014 Apr OBJECTIVE: To estimate the annual direct and indirect costs of rheumatoid arthritis (RA) in China and identify the predictors for cost of illness. METHODS: A cross-sectional study of cost of illness from the societal perspective was conducted on 829 patients with RA in 21 tertiary care hospitals in China between July 2009 and December 2010. Data on demographics, clinical variables, and components of costs were collected by physician interview. Costs were represented in 2009 US dollars using purchasing power parity estimates. Univariate and multivariate linear regression analyses were performed to identify the predictors for cost of illness. RESULTS: The mean ± SD total cost of RA in China was $3,826 ± $5,659 per patient-year, given a gross domestic product per capita of $6,798 in China in 2009. Direct costs and indirect costs comprised 90.0% and 10.0% of the total costs, respectively. Drug expense represented approximately half of the total costs, dominated by biologic agents (48.2%) and disease-modifying antirheumatic drugs (23.5%). Additionally, the cost of extracted herbal drugs and traditional Chinese medicine comprised ∼17.6% of the drug expense. Higher education level, noninsured status, longer disease duration, more extraarticular manifestations, and higher Health Assessment Questionnaire score independently predicted higher total costs. CONCLUSION: Our results provide the first study of costs of RA in China. This study not only demonstrates the economic burden of RA, but also identifies the predictors that could be interventional factors to reduce the societal costs of RA in China.
24063209 [Differential serum proteomic analysis of rheumatoid arthritis patients of cold-dampness a 2013 Jul OBJECTIVE: To preliminarily study the essence of rheumatoid arthritis (RA) patients of cold-dampness arthralgia spasm syndrome (CDASS) at the protein expression level. METHODS: Totally 24 RA patients were recruited from Department of Rheumatology, Affiliated Hospital of Nanjing University of Chinese Medicine from July 2009 to September 2010. They were assigned to the CDASS group and the dampness-heat arthralgia spasm syndrome (DHASS) group according to Chinese medicine syndrome typing, 12 in each group. The normal control group consisted of 12 healthy volunteers from the Health Examination Center, Affiliated Hospital of Nanjing University of Chinese Medicine. The serum proteins were compared between the CDASS group and the normal control group/the DHASS group respectively using two-dimensional gel electrophoresis. The common differential protein spots of CDASS were analyzed by mass spectrometry. The SwissProt database was inquired using Mascot Software to identify differential proteins. RESULTS: There were 81 differential protein spots between the CDASS group and the normal control group. There were 45 differential protein spots between the CDASS group and the DHASS group. Thirteen protein spots were found to be higher or lower in protein expression quantity of the CDASS group when compared with those of the other two groups. Nine differential protein spots were identified by mass spectrometry and database retrieval. It's suggested that these proteins were most likely to be related with inhibition of cellular events, such as cell proliferation, cell differentiation, and so on. CONCLUSION: 4.1 protein and DLC-1 protein were of potential significance in the diagnosis, prognostic markers, or treatment targets of RA patients of CDASS, which also provided evidence for further studies on the essence of CDASS.
24151269 The long-term outcome of uncemented Low Contact Stress total knee replacement in patients 2013 Nov We reviewed the long-term clinical and radiological results of 63 uncemented Low Contact Stress (LCS) total knee replacements (TKRs) in 47 patients with rheumatoid arthritis. The mean age of the patients at the time of surgery was 69 years (53 to 81). At a mean follow-up of 22 years (20 to 25), 12 patients were alive (17 TKRs), 27 had died (36 TKRs), and eight (ten TKRs) were lost to follow-up. Revision was necessary in seven patients (seven TKRs, 11.1%) at a mean of 12.1 years (0 to 19) after surgery. In the surviving ten patients who had not undergone revision (15 TKRs), the mean Oxford knee score was 30.2 (16 to 41) at a mean follow-up of 19.5 years (15 to 24.7) and mean active flexion was 105° (90° to 150°). The survival rate was 88.9% at 20 years (56 of 63) and the Kaplan-Meier survival estimate, without revision, was 80.2% (95% confidence interval 37 to 100) at 25 years.