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ID PMID Title PublicationDate abstract
24839423 MCP arthrodesis using an intramedullary interlocking device. 2014 Jun BACKGROUND: A variety of metacarpophalangeal joint (MCPJ) arthrodesis techniques have been described for the treatment of symptomatic arthritis and instability of the thumb MCPJ including K wire fixation, tension-band arthrodesis, plate fixation, intramedullary screw, and other intramedullary devices. This study presents a retrospective review of one surgeon's initial series of patients undergoing thumb MCP arthrodesis using an intramedullary compression device with a fixed angle of 25°. METHODS: A retrospective chart and radiographic review of patients treated for thumb MCP arthrodesis using the intramedullary device was performed. Final radiographs were evaluated for arthrodesis angle, bony fusion, and implant fixation. Any complication found during surgery or the follow-up period was noted. RESULTS: In this study, 17 patients were reviewed. Indications for surgery were osteoarthritis (five patients), rheumatoid arthritis (three patients), MCP instability alone (seven patients), and post-traumatic conditions (two patients). Of these, 12 patients had a simultaneous trapeziometacarpal (TMC) soft tissue arthroplasty. Mean follow-up was 4.9 months. All 17 patients had clinical and radiographic evidence of fusion at an average of 7.9 weeks, with an average fusion angle of 24.4°. There were no hardware complications, no infections, no revisions, and no indications for hardware removal. DISCUSSION: Our study results indicate the technique promotes rapid union at a precise angle, provides strong fixation that does not require prolonged immobilization, does not cause hardware irritation, and can be used in conjunction with other procedures including TMC arthroplasty when MCP arthrodesis is indicated for joint instability.
19669855 Pulmonary arterial hypertension complicating adult-onset Still's disease. 2013 Mar Adult-onset Still's disease (AOSD) is a rare condition diagnosed by a combination of clinical and laboratory features and after ruling out other conditions. Pulmonary manifestations, apart from pleuritis, are uncommon and pulmonary arterial hypertension (PAH) in extremely uncommon. We have described a case of AOSD with severe PAH. There have been rare reports of PAH occurring in AOSD in the literature. Probably, this manifestation may have been understudied, being confined to cases which are symptomatic. A larger study to look at the asymptomatic occurrences of PAH in AOSD may help in unraveling the mystery of this disease.
23968620 Comparison of the American-European Consensus Group Sjogren's syndrome classification crit 2014 Jan OBJECTIVE: To compare the performance of the American-European Consensus Group (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's Syndrome (SS) in a well-characterised sicca cohort, given ongoing efforts to resolve discrepancies and weaknesses in the systems. METHODS: In a multidisciplinary clinic for the evaluation of sicca, we assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR criteria in 646 participants. Global gene expression profiles were compared in a subset of 180 participants. RESULTS: Application of the AECG and ACR criteria resulted in classification of 279 and 268 participants with SS, respectively. Both criteria were met by 244 participants (81%). In 26 of the 35 AECG+/ACR participants, the minor salivary gland biopsy focal score was ≥1 (74%), while nine had positive anti-Ro/La (26%). There were 24 AECG-/ACR+ who met ACR criteria mainly due to differences in the scoring of corneal staining. All patients with SS, regardless of classification, had similar gene expression profiles, which were distinct from the healthy controls. CONCLUSIONS: The two sets of classification criteria yield concordant results in the majority of cases and gene expression profiling suggests that patients meeting either set of criteria are more similar to other SS participants than to healthy controls. Thus, there is no clear evidence for increased value of the new ACR criteria over the old AECG criteria from the clinical or biological perspective. It is our contention, supported by this report, that improvements in diagnostic acumen will require a more fundamental understanding of the pathogenic mechanisms than is at present available.
24391401 American college of rheumatology and transcatheter cardiovascular therapeutics. 2013 Dec Rheumatology topics included therapies for rheumatoid arthritis, psoriatic arthritis, and Behçet's syndrome. At the TCT meeting, researchers examined the effects of pharmacological strategies for myocardial infarction, along with platelet function testing as a guide to antiplatelet therapy.
23894061 Exacerbated inflammatory arthritis in response to hyperactive gp130 signalling is independ 2013 Oct OBJECTIVE: Interleukin (IL)-17A producing CD4 T-cells (TH-17 cells) are implicated in rheumatoid arthritis (RA). IL-6/STAT3 signalling drives TH-17 cell differentiation, and hyperactive gp130/STAT3 signalling in the gp130F/F mouse promotes exacerbated pathology. Conversely, STAT1-activating cytokines (eg, IL-27, IFN-γ) inhibit TH-17 commitment. Here, we evaluate the impact of STAT1 ablation on TH-17 cells during experimental arthritis and relate this to IL-17A-associated pathology. METHODS: Antigen-induced arthritis (AIA) was established in wild type (WT), gp130F/F mice displaying hyperactive gp130-mediated STAT signalling and the compound mutants gp130F/F:Stat1-/- and gp130F/F:Il17a-/- mice. Joint pathology and associated peripheral TH-17 responses were compared. RESULTS: Augmented gp130/STAT3 signalling enhanced TH-17 commitment in vitro and exacerbated joint pathology. Ablation of STAT1 in gp130F/F mice (gp130F/F:Stat1-/-) promoted the hyperexpansion of TH-17 cells in vitro and in vivo during AIA. Despite this heightened peripheral TH-17 cell response, disease severity and the number of joint-infiltrating T-cells were comparable with that of WT mice. Thus, gp130-mediated STAT1 activity within the inflamed synovium controls T-cell trafficking and retention. To determine the contribution of IL-17A, we generated gp130F/F:IL-17a-/- mice. Here, loss of IL-17A had no impact on arthritis severity. CONCLUSIONS: Exacerbated gp130/STAT-driven disease in AIA is associated with an increase in joint infiltrating T-cells but synovial pathology is IL-17A independent.
25306627 [Synovial lipoma arborescens]. 2014 Jul The paper describes a case of synovial lipoma arborescens (tree-forming lipoma) of the knee joint. This tumor is a variety of lipomas--a benign tumor composed of mature adipose tissue without signs of atypia. Most investigators regard lipoma as a reactive rather than neoplastic process. X-ray and histological studies should be performed for its differential diagnosis with pigmented villonodular synovitis, synovial chondromatosis, synovial hemangioma, xanthoma, a group of chronic synovitis in rheumatic diseases (rheumatoid arthritis, amyloid arthropathy, psoriatic arthritis). Its final diagnosis is possible only after morphological study.
25098416 Co-occurrence of Kikuchi-Fujimoto's disease and Still's disease: case report and review of 2015 Dec Kikuchi-Fujimoto's disease (KFD) and adult-onset Still's disease (AOSD) are rare inflammatory conditions with some overlapping features. We encountered a 22-year-old male patient who presented with daily fevers, neck discomfort, and sore throat and subsequently developed rash, arthritis, and cervical lymphadenopathy. Biopsy of the skin rash was consistent with KFD skin involvement. Given that the patient also met criteria for AOSD, a final diagnosis of KFD/AOSD co-occurrence was made. Anti-IL-1β therapy with anakinra resulted in rapid resolution of all symptoms. A literature search identified eight more cases of KFD/AOSD. Fever, rash, arthritis, and lymphadenopathy were present in all patients. No case report demonstrated an association of rash eruption clearly associated with fever spikes. Duration of symptoms ranged from 3 weeks to 10 years. Seven patients had leukocytosis, six had anemia, and five demonstrated elevated ferritin and/or decreased glycosylated ferritin. Seven patients had elevated erythrocyte sedimentation rate (ESR), and seven had transaminitis. Eight of nine patients had no evidence of infectious disease. Autoantibodies were absent from all patients. KFD and AOSD are very rare diseases, yet they may overlap. The two conditions not only share several clinical and laboratory characteristics but also differ in characteristic ways. Given the rapid response observed with anakinra in the index patient, IL-1β likely plays a role in both diseases.
25133066 Microbial Infection and Rheumatoid Arthritis. 2013 Dec Rheumatoid arthritis (RA) is a complex autoimmune disease affecting 1-2% of general worldwide population. The etiopathogenesis of RA involves the interplay of multiple genetic risk factors and environmental triggers. Microbial infections are believed to play an important role in the initiation and perpetuation of RA. Recent clinical studies have shown the association of microbial infections with RA. Accumulated studies using animal models have also found that microbial infections can induce and/or exaggerate the symptoms of experimental arthritis. In this review, we have identified the most common microbial infections associated with RA in the literature and summarized the current evidence supporting their pathogenic role in RA. We also discussed the potential mechanisms whereby infection may promote the development of RA, such as generation of neo-autoantigens, induction of loss of tolerance by molecular mimicry, and bystander activation of the immune system.
25349859 The effect of conditioning exercise on the health status and pain in patients with rheumat 2014 Jul BACKGROUND: Rheumatoid Arthritis (RA) is a systemic and inflammatory disease of unknown etiology which is mostly characterized by inflammation of the synovial joints. Studies have proved that most people with RA avoid doing physical activities due to fear that it may worsen the pain or cause pressure on joints, resulting in decreased muscle strength and ultimately leading to disability of patients. We aimed to investigate the effects of conditioning exercises on the health status and pain in patients suffering from RA. METHODS: In this randomized controlled clinical trial, we enrolled 66 women with confirmed RA referred to the rheumatology clinic of Hafez hospital, Shiraz, southwest Iran during May-July 2013. Balanced block randomization method was used to randomize the participants into case and control groups (two groups of 33 each).Data were collected using visual analog scale (VAS), Arthritis Impact Measurement Scales 2 short form (AIMS2-SF), and demographic questionnaire. After obtaining written informed consent, the participants in the case group were asked to participate in conditioning exercise programs including aerobic, isometric, and isotonic exercises and received a training booklet explaining the exercises that they could do at home after the intervention. RESULTS: There was a statistically significant difference between the health status scores of the patients in the case groups before and after the intervention (P=0.001). The pain score also decreased significantly in the case group compared with the control group after the intervention (P=0.003). CONCLUSION: We concluded that physical training programs, especially conditioning exercises, could improve the health status and reduce pain in patients with RA. TRIAL REGISTRATION NUMBER: IRCT201308187531N3.
23946756 Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient T 2013 Jul Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.
24480517 The expression of P2X7 receptors on peripheral blood mononuclear cells in patients with pr 2014 May OBJECTIVES: To study surface expression of P2X7 receptors (P2X7R) on peripheral blood mononuclear cells (PBMC) in patients with primary Sjögren's syndrome (pSS), and its correlation with anxiety and/or depression. METHODS: The Hamilton Anxiety Scale (HAMA) and Hamilton Rating Scale for Depression (HRSD) were used to assess 31 patients with pSS. P2X7R expression on the surface of CD14+ and CD14- PBMC, with or without ATP stimulation, was measured by flow cytometry. IL-1β and IL-6 levels in blood plasma and supernatant after ATP stimulation were measured by ELISA. Nineteen patients with rheumatoid arthritis (RA), 18 patients with anxiety and/or depression, and 20 healthy cases were used as controls. RESULTS: P2X7R expression was detected in all subjects. Compared with no ATP stimulation, significant up-regulation of P2X7R expression on CD14+ PBMC was observed after ATP stimulation in the pSS group only (p=0.001), while on CD14- PBMC there was significant up-regulation in both the pSS (p<0.001) and anxiety/depression (p=0.003) groups. After ATP stimulation, P2X7R expression on CD14+ PBMC in the pSS group was significantly higher than the RA group (p=0.044), anxiety/depression group (p=0.004) and healthy controls (p=0.002). Moreover, in the pSS group, P2X7R expression on CD14+ PBMC was significantly positively correlated to IL-1β supernatant levels (r=0.447, p=0.025). Overall, there were 45.2% (14/31) patients with anxiety and 32.3% (10/31) with depression, in the pSS group. P2X7R expression on CD14- PBMC was significantly positively correlated to scores of anxiety (r=0.344, p=0.030) and depression (r=0.319, p=0.045). CONCLUSIONS: Surface expression of P2X7R on PBMC in patients with pSS was significantly higher than controls, suggesting P2X7R may contribute to the complex pathogenesis of pSS and also anxiety and/or depression.
23864939 Laryngeal manifestations of rheumatoid arthritis. 2013 Rheumatoid arthritis is a destructive autoimmune disease that affects 3% of the adult population. It is characterized by the formation of both articular and extra-articular lesions with predilection for small joints. There are ubiquitous reports on the head and neck manifestations of RA with emphasis on the larynx. The laryngeal presenting features of this systemic disease may mimic a plethora of medical conditions, inflammatory and neoplastic. The main phonatory and respiratory symptoms are often subtle and misleading. This paper represents a literature review of the laryngeal manifestations of RA with emphasis on the clinical symptoms, laryngeal findings, diagnosis, and treatment. An early diagnosis of laryngeal involvement may prevent drastic complications.
25409667 Rheumatoid arthritis and cardiovascular risk: between lights and shadows. 2013 The increased mortality rate for cardiovascular (CV) diseases in rheumatoid arthritis RA) patients has been mainly attributed to an increased prevalence of some classical CV risk factors in these patients. Nonetheless, the potential role of chronic inflammation itself as an independent CV risk factor has been recently emphasized. Indeed, different basic alterations present in RA may anticipate and/or accelerate the atherosclerotic process in these patients. However, results of clinical studies are conflicting. We therefore considered data of the more recently published meta-analyses aiming to perform a critical reappraisal in such a topic. Unfortunately, there is a significant heterogeneity among the trials, and the role of classical CV risk factors was not taken into account in several studies. Therefore, whether RA is an independent risk for CV diseases still remains unclear.
23840943 Restless legs syndrome as a comorbidity in rheumatoid arthritis. 2013 Rheumatoid arthritis (RA) is a multisystem disease with a complex immunologic pathophysiology. Likewise, sleep disorders can involve a complicated interplay between the neurologic pathways, immune system, and respiratory system. Recent studies have shown an elevated prevalence of sleep abnormalities in connective tissue disorders compared to the general population. Restless legs syndrome (RLS) may be present in up to 30% of RA patients. These findings may be related to cytokine release and other immunomodulatory responses. TNF- α levels relate to sleep physiology and anti-TNF- α therapy may improve sleep patterns. Most of the patients with this disorder can distinguish their RLS sensations from their arthritic symptoms. RLS is a common comorbidity seen with RA, and prompt recognition and treatment can improve patient quality of life.
25544845 Large Vessel Vasculitis Occurring in Rheumatoid Arthritis Patient under Anti-TNF Therapy. 2014 Vasculitis is a heterogeneous group of disorders characterized by the presence of necrotic inflammatory phenomena and destruction of blood vessels. Vasculitis is classified as primary (idiopathic) or secondary to infections, connective tissue diseases and drugs but can also be considered as a paraneoplastic phenomenon. Evidence shows that the increasing use of biological agents results in a growing number of reports of autoimmune diseases induced by these therapies. An inflammatory articular chronic disease such as rheumatoid arthritis may be complicated by extra-articular manifestations, such as cutaneous or systemic vasculitis. Herewith, we describe the case of a great vessels arteritis in a patient affected by rheumatoid arthritis in therapy with an anti-TNF agent (etanercept).
25462579 Prolactin: a versatile regulator of inflammation and autoimmune pathology. 2015 Mar Prolactin (PRL) has long been proposed as an immune-stimulating and detrimental factor in autoimmune disorders. However, recent findings have challenged this common view, showing that PRL does not play a crucial role in the development of experimental autoimmune encephalomyelitis, animal model for multiple sclerosis (MS), and even protects against adjuvant-induced model of rheumatoid arthritis (RA). In this review we provide a critical overview of data supporting a role for PRL in the regulation of immune responses. In addition, we focus on studies exploring the involvement of PRL in autoimmune diseases, such as systemic lupus erythematosus, MS and RA, in light of the recently-outlined regenerative properties of this hormone.
24368922 Amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis. 2013 Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented.
25046647 Markers of inflammation and oxidative stress studied in adjuvant-induced arthritis in the 2015 Feb Oxidative stress (OS) is important in the pathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and its experimental model--adjuvant arthritis (AA). Antioxidants are scarcely studied in autoimmunity, and future analyses are needed to assess its effects in ameliorating these diseases. Although there are studies about antioxidants effects on the course of RA, their role in combination therapy has not yet been studied in detail, especially on extra-articular manifestations of AA. During the 28-d administration of pinosylvin (PIN) in monotherapy and in combination with methotrexate (MTX) to AA rats, we evaluated the impact of the treatment on selected parameters. The experiment included: healthy controls, untreated AA, AA administered 50 mg/kg b.w. of PIN daily p.o., AA administered 0.4 mg/kg b.w. of MTX twice weekly p.o. and AA treated with a combination of PIN+MTX. AA was monitored using: hind paw volume, C-reactive protein, monocyte chemotactic protein-1 (MCP-1), thiobarbituric acid reactive substances (TBARS) and F2-isoprostanes in plasma, γ-glutamyltransferase activity in spleen, activity of lipoxygenase (LOX) in lung, heme oxygenase-1 (HO-1) and nuclear factor kappa B (NF-κB) in liver and lung. PIN monotherapy significantly improved the activation of NF-κB in liver and lung, HO-1 expression and activity of LOX in the lung, MCP-1 levels in plasma (on 14th d) and plasmatic levels of F2-isoprostanes. An important contribution of PIN to MTX effect was the reduction of OS (an increase of HO-1 expression in lung and reduction of plasmatic TBARS) and decrease of LOX activity in the lung.
24603927 Oral health status in outpatients with rheumatoid arthritis: the OSARA study. 2014 Mar BACKGROUND: Observational studies and clinical trials are increasingly highlighting significant associations between periodontitis (chronic, infectious, inflammatory disease affecting tooth supporting tissues) and rheumatoid arthritis (chronic systemic autoimmune disease). OBJECTIVE: The aim of the study was to describe the dental, periodontal and oral prosthetic status of outpatients with Rheumatoid Arthritis (RA). MATERIAL AND METHODS: The study was conducted from June 2010 to March 2011 in the Rheumatology Day Care Department of the University Teaching Hospital, Toulouse. Activity of the RA was defined according to disease activity score 28 (DAS28). 74 subjects with RA were included. Periodontal status was determined using measurements of pocket depth, bleeding on probing and attachment loss. Periodontal Epithelial Surface Area (PESA) and Periodontal Inflamed Surface Area (PISA) were calculated. RESULTS: The study population was 60.3 ± 11.9 years old with 75.7% women. 48.6% of the subjects had moderate RA (3.2 < DAS28 ≤ 5.1) and 22.2% high RA activity (DAS28 > 5.1); 93.2% were treated by biotherapy. The mean number of natural teeth was 18.9 ± 9.7. The mean number of teeth replaced by removable prostheses was 7.1 ± 10.5. The mean PISA was 291.9 mm(2) ± 348.7 and the PISA:PESA ratio was 33.2% ± 24.2. 94% of patients had periodontitis, which was moderate in 48% and severe in 46%. CONCLUSION: This study highlights the need for prevention and for adequate dental care to improve global and oral quality of life of subjects with rheumatoid arthritis. Given the frequency of periodontitis and some physiopathological hypotheses, clinical trials are needed to assess if periodontal treatment could improve RA biological and clinical parameters.
24400286 The Importance of General Self-Efficacy for the Quality of Life of Adolescents with Diabet 2013 PURPOSE: To (i) investigate the influence of general self-efficacy on quality of life outcomes over time among adolescents with type I diabetes or juvenile rheumatoid arthritis (JRA), (ii) investigate parents' perceptions of general self-efficacy and quality of life of adolescents with diabetes or JRA over time, and (iii) identify possible differences in the evaluations of adolescents and parents. METHODS: This study included adolescents aged 12-25 years with type I diabetes or JRA and their parents. At T1, 171/573 (30% response rate) adolescents with diabetes or JRA and 229/563 (41% response rate) parents completed the questionnaire. At T2, 230/551 (42% response rate) adolescents and 220/559 (39% response rate) parents still participating in the study completed the questionnaire. A total of 112 adolescents and 143 parents filled in the questionnaires at both T1 and T2. RESULTS: Adolescents perceived significant improvement in their general self-efficacy and reduced quality of life over time, whereas parents' perceptions did not change. According to adolescents and parents, physical functioning was better among adolescents with diabetes than among those with JRA. Regression analyses of adolescents' data showed that general self-efficacy at T1 (β = 0.13; p ≤ 0.10) and changes in general self-efficacy (β = 0.22; p ≤ 0.01) predicted quality of life at T2. Parents' responses revealed that adolescents' general self-efficacy at T1 (β = 0.16; p ≤ 0.05) and changes in adolescents' general self-efficacy (β = 0.18; p ≤ 0.05) predicted adolescents' quality of life at T2. CONCLUSION: General self-efficacy and changes therein positively affected quality of life in adolescents with diabetes or JRA over time, as perceived by adolescents and parents. These findings emphasize the need for the implementation of interventions aiming to improve general self-efficacy in these populations.