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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
24883138 Practical US of the forefoot. 2014 Jun Disorders affecting the forefoot are common in the clinical practice. Accurate history and physical examination are the mainstays of diagnosis but imaging modalities are frequently obtained to confirm the clinical suspicion and plan appropriate treatment. In this article we will present the ultrasound (US) technique of examination of the forefoot followed by a brief description of the normal US anatomy and of US appearance of the most frequent forefoot disorders; rheumatoid arthritis, osteoarthritis, overuse arthropathy, Morton neuromas, bursitis, mucoid cysts, foreign bodies, bone disorders.
29539475 Severe erosive polyarthritis in a human skeleton dated to the early modern period of Japan 2015 Mar A human skeleton apparently afflicted with severe polyarthritis was unearthed from an early modern grave at the Tamukai site in the northernmost part of Honshu in Japan. The bones, likely from a late middle-aged male, showed severe resorptive lesions and ankylosis in many of the peripheral joints. Lesions were found in both bilateral and symmetrical distributions, sometimes accompanied by juxta-articular osteoporosis. Differential diagnoses included either rheumatoid arthritis, psoriatic arthritis, or leprosy, with psoriatic arthritis being the most likely. Whatever the final diagnosis, the identification of arthritis mutilans is clear. Because some bones were missing and a mixture of characteristics of both types of arthritis was evident, it was impossible to make a definitive diagnosis. However, this case is valuable for the severity of the lesions and the rarity of erosive polyarthritis found in archaeological skeletons from an Asian site.
25077842 Chronic arthritis and cardiovascular disease: altered blood parameters give rise to a prot 2014 Dec OBJECTIVE: Rheumatoid arthritis, and to a lesser extent ankylosing spondylitis and psoriatic arthritis, associates with increased morbidity and mortality due to cardiovascular complications. We hypothesized that the increased risk of cardiovascular disease is reflected by changes in blood parameters that are compatible with a prothrombotic propensity. To substantiate this notion, we performed an extensive literature search identifying such parameters. METHODS: A search through PubMed (1970-2013) was done to find primary articles with the following search terms: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or synovial fluid. These were combined with keywords reflecting processes of atherothrombosis: atherosclerosis, cardiovascular disease, coagulation, endothelial, fibrinolysis, mean platelet volume, microparticle, platelet, platelet count and mass, thrombosis, and thrombus. RESULTS: The published studies point to a multitude of blood-related processes that can contribute to a prothrombotic propensity in chronic inflammatory diseases. These include an increase in platelet mass; low-level platelet activation, enforced by interaction with leukocytes and the formation of proinflammatory cytokines; a locally activated endothelium; and an increased coagulant activity. Patient treatment with methotrexate or TNF-α blockers appears to result in normalization of several of these prothrombotic parameters. CONCLUSION: This analysis provides a first identification of the mechanisms by which inflammatory arthritis can aggravate cardiovascular disease.
25405085 Power Doppler ultrasonographic assessment of the ankle in patients with inflammatory rheum 2014 Nov 18 Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound (US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler (PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.
25381481 New treatments for inflammatory rheumatic disease. 2014 Dec As our understanding of the pathogenesis of autoimmune diseases is growing, new therapies are being developed to target disease-specific pathways. Since the introduction of etanercept in 1998, several biotechnological agents have been developed, most of them indicated in the treatment of rheumatoid arthritis, but also psoriatic arthritis. Most currently available molecules target TNF-alfa with different strategies (i.e., etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol), IL-6 (tocilizumab), CTLA-4 (abatacept), and B cells (rituximab, belimumab) as they are key mediators in the cascade of inflammation. Further, small molecules have been recently developed to target intracellular signaling, such as Janus Kinases for tofacitinib, the first FDA-approved small molecule for rheumatoid arthritis. Most novel treatments are being developed for arthritis with specific differences between rheumatoid and psoriatic arthritis, as well as for systemic lupus erythematosus, following the approval of belimumab. Finally, biologic therapies are effective also in gout, mainly targeting interleukin-1 to block the inflammasome. This review article describes the new and upcoming treatment options for rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and gout to dissect what we should be aware of when discussing these new and promising molecules.
25232528 Interleukins and interleukin receptors in rheumatoid arthritis: Research, diagnostics and 2014 Sep 18 Rheumatoid arthritis (RA) is an autoimmune disease, resulting in a chronic, systemic inflammatory disorder. It may affect many tissues and organs, but it primarily affects the flexible joints. In clinical practice patient care generates many questions about diagnosis, prognosis, and treatment. It is challenging for health care specialists to keep up to date with the medical literature. This review summarizes the pathogenesis, the polymorphisms of interleukin and interleukin genes and the standard available and possible future immunologic targets for RA treatment. The identification of disease-associated interleukin and interleukin receptor genes can provide precious insight into the genetic variations prior to disease onset in order to identify the pathways important for RA pathogenesis. The knowledge of the complex genetic background may prove useful for developing novel therapies and making personalized medicine based on the individual's genetics.
24350212 The effects of a pilot intervention for community-dwelling adults with rheumatoid arthriti 2013 This study examined the effects of a pilot educational intervention program on knowledge, perceived self-efficacy, and health-related quality of life (HRQoL) of community-dwelling adults with rheumatoid arthritis (RA). A convenience sample of 16 participants with RA completed the program in Wuhan, China. Data were collected in face-to-face interviews using questionnaires at baseline, post-test, and 1 month follow-up. Knowledge scores were significantly increased over time. Significant differences were found in pain self-efficacy, symptoms self-efficacy, bodily pain, social functioning, and role emotional functions. Community health providers should provide educational programs to improve HRQoL for adults with RA.
25849672 Bucillamine-induced membranous nephropathy with crescent formation in a patient with rheum 2015 Jan Bucillamine is a disease-modifying antirheumatic drug that is structurally similar to D-penicillamine. The major renal side effect of bucillamine and D-penicillamine is proteinuria caused by membranous nephropathy (MN). In addition to MN, combined crescent formation has been occasionally reported in D-penicillamine-induced MN, while crescent formation has been rarely reported in bucillamine-treated cases. Here, we describe a 76-year-old female who presented with nephrotic syndrome and rapidly progressive glomerulonephritis. She was receiving bucillamine as initial treatment for recently diagnosed rheumatoid arthritis, and renal biopsy showed MN with crescent formation. To the best of our knowledge, this is the first report of bucillamine-induced MN with crescent formation in the English literature.
25972704 Shortening femoral osteotomy with stemmed resurfacing total knee arthroplasty for severe f 2015 Jun Juvenile Rheumatoid Arthritis (JRA) is a progressive disease characterized by pain, swelling, and loss of motion in the joints of adolescents. Total knee arthroplasty (TKA) can be indicated, during the adolescent years, in patients with advanced JRA to alleviate pain and improve function. Because of the relative infrequency of TKA in patients with JRA, evaluation of the type of TKA performed and the results merit review. This case report present two distinct operations performed to obtain full extension. 1. Distal femoral resection with conversion to hinged arthroplasty. 2. Femoral shortening osteotomy with resurfacing TKA.
25266144 The risk of ischemic stroke in major rheumatic disorders. 2014 Dec 15 Rheumatic disorders (RD) are a range of conditions associated with inflammation of joints and connective tissue. They can manifest beyond the musculoskeletal system. Recent focus has been placed on the association of ischemic stroke with these conditions. Traditional vascular risk factors seem to be more prevalent in patients with certain types of RD than in the general population, but these factors do not fully explain the enhanced vascular risk in this population. Four major RD will be discussed in terms of their relationship with ischemic stroke: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis.
25273131 Prophylactic effect of the oral administration of transgenic rice seeds containing altered 2014 Rheumatoid arthritis is an autoimmune disease associated with the recognition of self proteins secluded in arthritic joints. We generated transgenic rice seeds expressing three types of altered peptide ligands (APL) and the T cell epitope of type II collagen (CII256-271). When these transgenic rice and non-transgenic rice seeds were orally administrated to DBA/1 J mice once a day for 14 days, followed by immunization with CII, the clinical score of collagen-induced arthritis (CIA) was reduced and inflammation and erosion in the joints were prevented in mice fed APL7 transgenic rice only. IL-10 production against the CII antigen significantly increased in the splenocytes and iLN of CIA mice immunized with the CII antigen, whereas IFN-γ, IL-17, and IL-2 levels were not altered. These results suggest that IL-10-mediated immune suppression is involved in the prophylactic effects caused by transgenic rice expressing APL7.
23858337 Targeting interleukin-17 in patients with active rheumatoid arthritis: rationale and clini 2013 Jun Clinical and experimental evidence suggest that interleukin-17A (IL-17A; also known as IL-17) is an attractive therapeutic target in rheumatoid arthritis (RA). Rheumatoid synovial tissue produces IL-17A, which causes cartilage and bone degradation in synovial and bone explants. Overexpression of IL-17A induces synovial inflammation and joint destruction in animal RA models. These effects are attenuated in IL-17A-deficient animals and by agents that block IL-17A. Serum IL-17A levels and, to a greater extent, synovial fluid IL-17A levels are elevated in many patients with RA. In some RA cohorts, higher IL-17A levels have been associated with a more severe clinical course. Several IL-17A blockers, including the anti-IL-17A monoclonal antibodies secukinumab and ixekizumab, and the anti-IL-17 receptor subunit A monoclonal antibody brodalumab have been evaluated in phase II clinical trials. Of these, secukinumab is the most advanced with respect to clinical evaluation in RA, with phase III trials ongoing in patients on background methotrexate who had inadequate responses to previous tumor necrosis factor blocker therapy.
24757465 Hemorrhagic synovial cyst associated with rheumatoid atlantoaxial subluxation. 2013 Jun Synovial cyst on prevertebral space of C1-2 joint is rare but may be associated hemorrhagic event. We describe a case of a 72-year-old woman who presented with sudden severe headache in her left occipital area with dyspnea. She had rheumatoid arthritis for 14-years. Large hemorrhagic cystic mass was seen around prevertebral space of the atlantoaxial joint on the left side on cervical MRI (magnetic resonance image) and it obstructed the nasopharyngeal cavity. Aspiration of the cystic lesion was performed via transoral approach, followed by posterior occipito-cervical fusion. The specimen was xanthochromic, suggesting old hemorrhage. The patient was tolerable on her postoperative course and showed good respiration and relieved headache. We suggest that repeated microtrauma due to atalantoaxial subluxation associated with rheumatoid arthritis as a main cause of hemorrhagic event on the cyst.
24648832 Mavrilimumab: an evidence based review of its potential in the treatment of rheumatoid art 2014 Rheumatoid arthritis (RA) management has greatly improved with the development of biologic disease modifying antirheumatic drugs, but a proportion of patients do not improve despite the biologic drugs currently available. We need new biologic agents with novel mechanisms of action for the treatment of refractory patients. Recent evidence has shown that granulocyte-macrophage colony-stimulating factor (GM-CSF) is involved in the pathogenesis of RA. GM-CSF can exacerbate RA and elevated levels of this cytokine have been observed in synovial fluid from RA patients. Antagonism of GM-CSF can strikingly reduce established disease in mouse models of arthritis. Mavrilimumab, a human monoclonal antibody to GM-CSF receptor α, is a competitive antagonist of GM-CSF signaling. Phase I and II studies have shown good clinical response with a good safety profile in patients with mild to moderate RA, suggesting encouraging effects of mavrilimumab for the treatment of RA. This paper reviews the preclinical and clinical data evaluating the safety, tolerability, and efficacy of mavrilimumab in the treatment of RA.
25225510 Predictors of frequent oral analgesic use in rheumatoid arthritis. 2014 Sep OBJECTIVE: The main objective of this study was to determine the predictors of frequent oral analgesic use among Rheumatoid Arthritis (RA) patients who were prescribed with the above medication on an 'as-needed' basis. METHODS: Patients with RA were recruited consecutively from the Rheumatology outpatient clinics in this cross-sectional study. The sociodemographic data, frequency of oral analgesic intake, Patient Global Assessment (PGA) scores and HAQ (Health Assessment Questionnaire) scores were determined by interviewing the subjects. Subjects were divided into 2 groups; frequent users (3 days and above in a week) and less frequent users (less than 3 days in a week). RESULTS: In a total of 112 subjects, 39 (34.8%) were frequent analgesic users. Both the HAQ and PGA scores were significantly higher among the frequent users (p<0.05). Using multivariate analysis, the HAQ scores (p=0.015, odds ratio 3.161 [95% confidence interval of 1.246-8.015]) and PGA scores (p=0.039 odds ratio 1.291 [95% confidence interval of 1.012-1.646]) were found to be independent predictors of frequent analgesic use. CONCLUSIONS: Our study confirms that the frequency of analgesic intake in Rheumatoid Arthritis has a significant relationship with patient-reported functional capacity and well being.
25755869 Neonatal Lupus erythematosus Following Rheumatoid Arthritis: Case Report and Literature Re 2014 Aug BACKGROUND: Neonatal lupus erythematosus (NLE) is a transient autoimmune disease of developing fetus and neonate in mothers with systemic lupus erythematosus (SLE). In this report we introduce an infant with NLE whose mother had rheumatoid arthritis. CASE PRESENTATION: Our case was a 40 day old male infant with discoid-like and annular skin lesions over forehead and neck, irritability and low grade fever. There was a history of prematurity due to preeclampsia. There was no cytopenia or cardiac involvement but liver enzymes were more than 5-fold increased. FANA, Anti Ro and La were negative. The mother had a history of un-controlled rheumatoid arthritis for 12 years with deformity in metacarpal and PIP and ulnar deviation in hands. FANA=1/640 and anti-SSB/La was positive in the mother but there was no other clinical and paraclinical sign of SLE. Without any treatment and during months, the skin and mucosal lesions gradually disappeared without any scar and liver enzymes reached the normal level. After 6 months follow up, he was symptom free with normal growth and development. CONCLUSION: We recommend to check anti SSA/Ro and anti SSB/La antibodies in all pregnant women with connective tissue diseases to prevent life-threatening involvement of the infant.
25232527 Arthrodesis of the wrist in rheumatoid arthritis. 2014 Sep 18 In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease (two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.
24995169 HLA-DR/DQ Genotypes in Kurd Patients with Rheumatoid Arthritis: Relation to Disease Activi 2014 May BACKGROUND: Specific alleles present at the HLA-DR/DQ loci seem to be associated with disease activity of rheumatoid arthritis. AIM: In the present study, our aim was to investigate the distribution of HLA-DR/DQ alleles among Kurd patients with rheumatoid arthritis and to ascertain their relationship with disease activity. MATERIALS AND METHODS: Sixty five patients with rheumatoid arthritis (RA) and 65 apparently healthy subjects participated in the study. Diagnosis and disease activity were confirmed. Blood analyses, including those of laboratory markers of disease activity, were done. The 28 joint disease activity score (DAS-28) was calculated. HLA-DR/DQ typing was performed by polymerase chain reaction (PCR).The association between HLA-DR/DQ genotypes and disease activity was determined. RESULTS: The most frequent alleles which were identified in RA patients were HLA-DRBI*01(23.1%) and HLA-DQBI*6(34.6%), whereas in healthy subjects, they were HLA-DRBI*11(17.7%) and HLA-DQBI*03(35.4%). Patients with active disease had high frequencies of HLA-DQBI*6 (40.0%) as compared to those with moderate disease activity (16.7%); OR=3.33. Patients with severe RA had increased frequencies of HLA-DQBI*6 (56.3%) as compared to those with mild RA (10.0%); OR = 11.57. Patients with positive rheumatoid factor (RF) and positive Anti-citrullinated peptide antibody (Anti-CCP), also had high frequencies of HLA-DQBI*06 (38.4% and 39.4%) as compared to frequencies of 11.1% and 15.4% which were seen in patients with negative rheumatoid factor and negative anti-CCP (OR= 4.98 and3.10) respectively. CONCLUSION: HLA-DQBI*06 was found to be more common in Kurd patients and it was significantly associated with disease activity; this may indicate a high risk for developing a more progressive type of the disease.
25210275 A rare case of temporal arteritis with rheumatoid arthritis and interstitial lung disease 2014 Jul A 75-year-old male patient was planned for dental treatment due to pain of suspected pulpo-periodontal origin in relation to right maxillary first molar. Careful evaluation revealed the pain to be non-odontogenic in nature and led to the diagnosis of temporal arteritis with rheumatoid arthritis along with interstitial lung disease (ILD). Characteristic findings of temporal arteritis include headache, jaw claudication, visual loss, and constitutional symptoms (malaise, fever, weight loss, loss of appetite). Temporal artery biopsy (TAB) remains the gold standard for diagnosis. Additional diagnostic tests include blood tests (ESR, CRP). This article reports and discusses how the orofacial manifestations can lead to misdiagnosis of temporal arteritis. Hence, temporal arteritis should be included in the differential diagnosis of orofacial pain in the elderly especially to prevent complications like vision loss.
26155108 CD4(+)CD25(+) regulatory T cells as a therapeutic target in rheumatoid arthritis. 2014 CD4(+)CD25(+) T cells are regulatory T cells (CD4(+)CD25(+) Tregs), which can strengthen immune tolerance. They play a critical role in controlling the development of autoimmune diseases in animals and humans. Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the peripheral joints and eventually leads to joint destruction. Although the pathogenesis of RA remains unknown, it is supposed to be affected by autoreactive T cells and antibodies. At the same time, to make the CD4(+)CD25(+) T cells active and to increase the number of the cells are responsible in the therapy of RA in recent studies. Now, many techniques about expansion of Tregs in vitro have been established to overcome the problem of their limited numbers in vivo. It is important to carry out a study of induction or amplification of Tregs in vitro. Here, we review our current understanding of CD4(+)CD25(+) T cells in RA and the targeting of these cells in RA therapy.