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ID PMID Title PublicationDate abstract
23562291 Outcome of Copeland shoulder resurfacing arthroplasty with a 4-year mean follow-up. 2013 Oct BACKGROUND: Published data on the outcome of Copeland shoulder resurfacing arthroplasty (CSRA) are limited. This observational case series study reports the functional and radiological outcome of CSRA during a mean follow-up of 4 years and highlights the correlation between key outcome measures. METHODS: One-hundred two consecutive patients with osteoarthritis (OA-47.1%), rheumatoid arthritis (RA-40.2%), rotator cuff arthropathy (RCA-8.8%), and avascular necrosis (AVN-3.9%) underwent CSRA. The outcome assessment included pain and satisfaction, physical limitation, Oxford Shoulder score (OSS), Constant score (CS), and SF-12. Imaging was reviewed for glenoid morphology (Walch classification) and humeral head (HH) migration. RESULTS: Highest patient satisfaction and lowest pain levels were related to the primary pathology with AVN best followed by OA, RA, and with RCA having the poorest outcome. Comparing the two largest groups the CS was significantly higher in OA (61 ± 21.3) than RA (44 ± 20.5). OSS showed a significant correlation with CS and physical subscale of SF-12. Walch type A (67.6%) and HH migration (47%) were the commonest radiographic observations. OSS, CS, pain, and satisfaction were significantly different between migration and nonmigration groups. CONCLUSION: The CSRA resulted in satisfactory outcome in many patients. AVN and OA were associated with the best and RCA with the poorest results. The CSRA was associated with glenoid erosion and HH migration particularly in RCA. CSRA remains an option in the treatment of arthritic conditions of the shoulder but its future use may be limited to younger patients where implanting a glenoid may be regarded as problematic.
24032580 The rise of the metal elbow. 2013 Painful arthritis of the elbow joint has long been a challenging problem. Elbow arthroplasty has emerged as viable treatment method for many patients. Implant design and surgical technique have evolved to provide more predict-able symptom relief without compromising function. Elbow arthroplasty can now be used to treat a wide variety of conditions, including osteoarthritis, rheumatoid arthritis, and fractures. This review article presents historical and contemporary perspectives on elbow arthroplasty. A thorough discussion of implant design, surgical technique, and clinical outcomes is presented.
24627625 Results of a human factors experiment of the usability and patient acceptance of a new aut 2014 PURPOSE: This study evaluated the human factors affecting the ease of use of a disposable autoinjector developed for subcutaneous self-injections performed by patients with chronic diseases. MATERIALS AND METHODS: This was a randomized, single-center study conducted with 65 patients with rheumatoid arthritis. Patients performed six simulated injections. Assessments of patient device acceptance and device usability were made by patient reports and independent observations of compliance with the device instruction for use (IFU) following single injections and repeated injections. RESULTS: A total of 390 simulated injections were performed. Patient device acceptance was high; more than 90% of patients found each of the tested criteria to be acceptable (>80% was required for statistical significance; P<0.016). Perceived ease of use and simplicity of the three-step process resulted in high acceptance scores: mean scores (± standard deviation) were 8.71 (±1.18) and 8.05 (±0.37), respectively, on a 0-10-point scale. Patients also expressed their acceptance with the ease and usefulness of the detection of the remaining drug in the autoinjector. In addition, 80% of patients declared that they would recommend the device to someone else. Globally, the human factors tested (age, sex, hand disability [Cochin score], extent of previous experience with self-injection [ie, expert or naïve]) had no impact on IFU device compliance. In particular, the lack of a Cochin score interaction indicated that the degree of hand disability is not a predictive factor of poor self-injection capability with this autoinjector. CONCLUSION: This study demonstrated a high level of patient acceptance for self-injection with this autoinjector among patients with rheumatoid arthritis. In particular, patients with severe hand disability were able to successfully comply with device IFU.
23497510 Severity index for rheumatoid arthritis and its association with health care costs and bio 2013 Mar 12 OBJECTIVE: This study aimed to apply the previously validated severity index for rheumatoid arthritis (SIFRA) to prevalent rheumatoid arthritis (RA) groups in Turkey and determine the effect of RA severity on health care costs and biologic use. METHODS: This retrospective study used the Turkish national health insurance database MEDULA (June 1, 2009-December 31, 2011). Prevalent RA patients were required to be age 18 to 99, have two RA diagnoses at least 60 days apart and be continuously enrolled 1 year prior to (baseline period) and post (follow-up period) index date, which was the first RA claim during the identification period (June 1, 2010-December 31, 2010). SIFRA was calculated for the baseline period. Total health care costs and biologic use were examined for the follow-up period. The chi-square test was used to determine the association between SIFRA score terciles and outcomes. Generalized linear models were applied to determine health care costs while multivariate logistic regression determined the effect of SIFRA on outcome measures for biologic use. RESULTS: A total of 1,920 patients were identified. The mean SIFRA score was 14.21, and 7.05 (49.57%) of the mean composed of clinical and functional status variables, followed by 6.32 (44.47%) for medications, 0.48 (3.40%) for radiology and laboratory findings, and 0.32 (2.25%) for extra-articular manifestation. There was a significant variation in scores across cities. After controlling for age, gender, region, and comorbidity index, patients in the high SIFRA tercile were 5.16 times more likely to be prescribed biologics (p<0.001, confidence interval [CI]: 3.46-7.69), and incurred annual health care costs that were €2,091 higher (p<0.001, CI: €1,557 - €2,625) than those in the low SIFRA score tercile. CONCLUSION: RA severity varies throughout Turkey and is a significant determinant of health care costs and biologic therapy use. Therefore, future comparative effectiveness studies should include the severity measure in their analysis.
25096587 [Immune diagnostics in rheumatology]. 2014 Aug Laboratory diagnostics play a fundamental role in rheumatology but must always be interpreted in the context of symptoms and clinical signs. Laboratory tests have a variety of purposes, such as confirmation or negation of a diagnosis, differential diagnosis, evaluation of activity and prognosis, involvement of organs and drug side effects. Markers of inflammation and specific autoantibodies are the most important laboratory parameters in rheumatology. Thus, with the suspicion of rheumatoid arthritis the analysis of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), the rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP or ACPA) should be performed as the first line tests. Only a few antibody titers are suitable for monitoring of disease activity. Some autoantibodies exhibit such a high diagnostic value that the antibodies are included in the classification criteria or in the definition of a disease entity.
25584620 [Psoriatic Arthritis concomitant with Paget's Disease - a case report]. 2014 Oct Paget disease of bone is a focal disorder of bone metabolism; it is characterized by an accelerated rate of bone remodeling, with profound changes in the bone structure, making it fragile. This condition affects approximately 2% to 5% of the population older than 40. The main clinical manifestations of Paget's disease are pain and bone deformity, although the majority of patients are asymptomatic. Psoriatic Arthritis is a spondyloarthritis with a prevalence of about 0,1%. It is characterized by the presence of arthritis, enthesitis and/or dactylitis associated with a familiar or personal history of psoriasis. Several clinical patterns of joint involvement in psoriatic arthritis have been identified, namely, the polyarticular pattern, similar to rheumatoid arthritis. Arthritis precedes skin disease in approximately 13 to 17 % of the cases. The authors report a clinical case of a 60 years old patient with polyarthritis and dactylitis who was diagnosed with psoriatic arthritis and Paget's disease of bone. The concomitance of the two entities, in the same individual, with so different pathogenesis and clinical features, have never been described on literature. Because of the complexity on the clinical and imaging evaluation as the result of the coexistence of both pathologies, the authors consider relevant to publish this singular case.
24219040 Methotrexate in psoriatic arthritis. 2013 Psoriatic arthritis (PsA) is a form of inflammatory arthritis that occurs in patients with psoriasis and is distinct from rheumatoid arthritis (RA). Methotrexate (MTX) is one of the most commonly used drugs for the treatment of PsA, yet there is scant controlled trial data to document its efficacy. Controlled trials have not demonstrated significant separation from placebo, but the studies have significant limitations which inhibit our ability to draw firm conclusions about the efficacy of MTX. A number of observational studies have described benefit for joint and skin disease. As yet unstudied, are the effects on enthesitis, dactylitis, and spondylitis of PsA. Psoriasis studies have shown modest benefit for psoriatic skin lesions. It is not yet known if MTX contributes an additive or synergistic benefit when used in combination with TNF inhibitors in PsA. The potential value of low dose MTX to suppress antibody formation against biologic therapies should be considered in a patient fail- ing benefit from such therapy. Although adverse effects are similar to those seen in RA treatment with MTX, awareness of the tendency for PsA and psoriasis patients to be obese and have non-alcoholic steatohepatosis, which may amplify transaminitis potential, should be borne in mind.
23811580 Autophagy: a key pathway of TNF-induced inflammatory bone loss. 2013 Aug Autophagy describes the degradation of unnecessary or dysfunctional cellular components through the lysosomal machinery. Autophagy is essentially required to prevent accumulation of cellular damage and to ensure cellular homeostasis. Indeed, impaired autophagy has been implicated in a variety of different diseases. We examined the role of autophagy in inflammatory bone loss. We demonstrated that autophagy is activated by the pro-inflammatory cytokine tumor necrosis factor (TNF/TNFα) in osteoclasts of patients with rheumatoid arthritis (RA). Autophagy induces osteoclast differentiation and stimulates osteoclast-mediated bone resorption in vitro and in vivo, thereby highlighting autophagy as a novel mediator of TNF-induced bone resorption.
24026194 MORPHOMETRY FOR EARLY MONITORING OF TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS. 2013 New aggressive therapeutic options have recently become available to treat inflammatory arthritis (IA) and rheumatoid arthritis in particular. These treatments not only control joint destruction, they may also aid in new bone formation at sites of eroded bone. Separation of non-responders from responders to these treatments, is critical, and is known to lead to reduced disease burden, toxicity, side-effects and overall cost. The bones of the wrist are early targets of IA and are known to show response to therapy early. In this paper, we develop a method to quantify point-wise erosive changes of wrist bones in IA patients undergoing treatment. The method employs 3D registration-based morphometric analysis. Our results indicate that the proposed method has potential to improve sensitivity to small, early changes in bone erosion status. This study has potential to provide new imaging biomarkers to be used in clinical trials evaluating the efficacy of new arthritis drugs.
24533356 Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Manageme 2014 Jan Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of non- specific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.
24312865 Rhizomes of Eremostachys laciniata: Isolation and Structure Elucidation of Chemical Consti 2013 PURPOSE: The purpose of this study was the isolation and structure elucidation of chemical compounds from the rhizomes of Eremostachys laciniata (L) Bunge (EL), an Iranian traditional medicinal herb with a thick root and pale purple or white flowers as well as the clinical studies on the therapeutic efficacy and safety of topical application of the EL extract in the management of some inflammatory conditions, e.g., arthritis, rheumatoid arthritis and septic arthritis (Riter's syndrome). METHODS: The structures of the isolated compounds were elucidated unequivocally on the basis of one and two dimensional NMR, UV and HR-FABMS spectroscopic data analyses. A single-blinded randomized clinical trial was carried out with the extract of the rhizomes of E. laciniata (EL) to determine the efficacy and safety of the traditional uses of EL compared to that of piroxicam in treatment of inflammatory diseases, e.g., osteoarthritis, rheumatoid arthritis and Reiter's syndrome. RESULTS: Eleven iridoid glycosides, two phenylethanoids and two phytosterols were isolated and identified for the first time from the rhizomes of EL. After 14 days of treatment with the EL and piroxicam ointments, all groups showed significant improvements compared to the control groups. EL (5%) ointment induced better initial therapeutic response than piroxicam (5%) onitment. CONCLUSION: This clinical trial established that EL was suitable for topical applications as a safe and effective complementary therapy for inflammatory diseases.
25582994 Assessment of fatigue and dryness in primary Sjögren's syndrome: Brazilian version of "Pr 2015 Mar OBJECTIVE: To perform a cross-cultural adaptation and validation of the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (short form) (PROFAD-SSI-SF) questionnaire assessing the subjective aspects of the symptoms of primary Sjögren syndrome (pSS), for the Brazilian Portuguese language. METHOD: Conceptual, of the item, semantic and operational equivalences were evaluated. The Brazilian version of PROFAD-SSI-SF was administered to 62 women with pSS according to the European-American consensus 2002 to assess measurement equivalence. α-Cronbach was used for internal consistency; intraclass correlation coefficient (ICC) for intraobserver reproducibility; and Spearman correlation coefficient for validity by comparing with Patient Global Assessment (PaGA), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F) and EuroQOL (EQ-5D). RESULTS: The internal consistency of PROFAD, SSI and total score was 0.80; 0.78; and 0.87, respectively. The intraobserver reproducibility of total PROFAD was 0.89; of total SSI of 0.86; and total score of 0.89. In terms of validity, PROFAD correlated significantly with PaGA (r = 0.50), FACIT-F (r = 0.59), ESSPRI (r = 0.58) and all domains of EQ-5D, with the exception of Mobility. On the other hand, SSI correlated significantly with PaGA (r = 0.43), FACIT-F (r = 0.57), ESSPRI (r = 0.55) and most areas of EQ-5D. The total score of PROFAD-SSI-SF had a non-statistically significant correlation only with Mobility domain and with 1-100 range of EQ-5D. CONCLUSION: The Portuguese version of PROFAD-SSI-SF proved to be an adaptable, reproducible and valid tool for the Brazilian Portuguese language.
25480887 Defining disease activity states and clinically meaningful improvement in primary Sjögren 2016 Feb OBJECTIVES: To define disease activity levels, minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) with the primary Sjögren's syndrome (SS) disease activity indexes: European League Against Rheumatism (EULAR) SS disease activity index (ESSDAI) and EULAR SS patient-reported index (ESSPRI). METHODS: For 790 patients from two large prospective cohorts, ESSDAI, physician evaluation of disease activity, ESSPRI and patients' satisfaction with their current health status were recorded. Receiver operating characteristic curve analyses and anchoring methods were used to estimate disease activity levels of ESSDAI and the PASS of ESSPRI. At follow-up visit, patients and physicians assessed, respectively, whether symptoms and disease activity have improved or not. An anchoring method based on this evaluation was used to estimate MCII of ESSDAI and ESSPRI. RESULTS: Low-activity (ESSDAI<5), moderate-activity (5≤ESSDAI≤13) and high-activity (ESSDAI≥14) levels were defined. MCII of ESSDAI was defined as an improvement of at least three points. The PASS estimate was defined as an ESSPRI<5 points and MCII as a decrease of at least one point or 15%. CONCLUSIONS: This study determined disease activity levels, PASS and MCII of ESSDAI and ESSPRI. These results will help designing future clinical trials in SS. For evaluating systemic complications, the proposal is to include patients with moderate activity (ESSDAI≥5) and define response to treatment as an improvement of ESSDAI at least three points. For addressing patient-reported outcomes, inclusion of patients with unsatisfactory symptom state (ESSPRI≥5) and defining response as an improvement of ESSPRI at least one point or 15% seems reasonable.
25005026 Diagnostic accuracies of sialography and salivary ultrasonography in Sjögren's syndrome p 2014 Jul OBJECTIVES: The purpose of this study was to compare the diagnostic performance of sialography and salivary ultrasonography (US) for Sjögren's syndrome (SS) patients. METHODS: We searched Medline, Embase, and the Cochran library, and performed two meta-analyses on the diagnostic accuracy of sialography and salivary US in SS patients. RESULTS: A total of six studies including 488 patients and 447 controls from two European and four Asian studies were available for the meta-analysis. The pooled sensitivity and specificity of sialography were 80.0% (95% confidence interval [CI] 76.4-83.2) and 89.0% (85.8-91.8), respectively, and 77.4 (73.7-80.9) and 81.5 (77.6-85.0) for US, respectively. For sialography, the PLR, NLR, and DOR were 9.296 (4.200-20.57), 0.228 (0.170-0.305), and 46.51 (16.14-134.0), respectively, and for US were 4.631 (2.707-7.864), 0.302 (0.226-0.403), and 17.48 (10.03-30.45), respectively. The area under the curve (AUC) of sialography was 0.824, and the Q* index was 0.757, while the AUC of US was 0.864, and its Q* index was 0.794, indicating that the diagnostic accuracy of US is comparable with sialography in SS patients. A subgroup meta-analysis according to the diagnostic criteria did not change the overall diagnostic accuracy. CONCLUSIONS: Our meta-analysis of published studies demonstrates that the diagnostic accuracy of salivary US is comparable with sialography in SS patients.
24844268 Increased utilisation of eye disorder-related ambulatory medical services prior to the dia 2014 May 20 OBJECTIVES: To investigate the utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of primary Sjögren's syndrome in female Taiwanese patients. DESIGN: A nationwide, population-based case-control study. SETTING: Taiwan's National Health Insurance Research Database. PARTICIPANTS: A total of 347 patients with a diagnosis of primary Sjögren's syndrome from 2005 to 2010 and 1735 controls frequency matched on 10-year age interval and index year were identified from Taiwan's National Health Insurance Research Database. Diagnoses of eye disorder (International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes from 360 to 370) were retrospectively screened to 1997. MAIN OUTCOME MEASURE: The utilisation of eye disorder-related medical service over different intervals prior to diagnosis of Sjögren's syndrome between cases and controls were compared using generalised estimating equations with negative binomial distribution and log link function. RESULTS: A significantly higher proportion of patients with Sjögren's syndrome (7.5%) utilised eye disorder-related ambulatory medical services over an 8-year interval prior to the diagnosis of the disease compared with controls (4.8%). The annual frequency of utilisation of eye disorder-related ambulatory medical services increased significantly faster when closer to the index date in patients with Sjögren's syndrome compared with controls (interaction effect, p=0.010). Subgroup analyses indicated that the changes over time in the utilisation of services related to disorders of lacrimal system (interaction effect, p=0.019) and conjunctiva (interaction effect, p=0.066) were significantly greater in patients with Sjögren's syndrome compared with controls. CONCLUSIONS: An increase in the utilisation of eye disorder-related ambulatory medical services was observed in patients with Sjögren's syndrome several years prior to the diagnosis of the disease. General practitioners and ophthalmologists can play an important role by including Sjögren's syndrome in the diagnostic evaluation of their patients afflicted with relevant symptoms.
25799786 [Enhanced ocular staining score in patients with primary Sjögren's syndrome]. 2014 The authors focus on the assessment of ocular manifestation in patients with primary Sjögren's syndrome using the Ocular Staining Score. The method offers the possibility to stain different ocular structures separately: cornea with fluorescein and conjunctiva with lissamine green dye and provides for separate evaluation of abnormalities, unlike the current system assessing ocular damage where ocular tissues are stained either with bengal rose or lissamine green dye. The paper presents new criteria for the diagnosis of dry eye secondary to the autoimmune Sjögren's syndrome and their high specificity (94.7% and 93.3%)ö based on the results of clinical trials in 1618 patients, conducted by an international research team.
24126399 Hypokalemic paralysis as a presenting manifestation of primary Sjögren's syndrome accompa 2013 Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by progressive lymphocyte infiltration of the exocrine glands. Overt or latent renal tubular acidosis (RTA) is a common extraglandular manifestation of pSS.Vitamin D deficiency is associated with autoimmune disorders; however, the potential correlation between pSS and vitamin D deficiency is rarely discussed. The current patient presented with distal RTA, hypocalcemia, and hypophosphatemia that were found to be secondary to both vitamin D deficiency and pSS. In patients diagnosed with both distal RTA and vitamin D deficiency, clinicians should consider autoimmune diseases such as pSS, as a possible underlying etiology.
24053103 [Clinical case of the month. A rare case of arthritis and fever]. 2013 Jul We present the case report ofa 28 year old male presenting with recurrent fever episodes and arthralgia. Based on the presence of an inflammatory syndrome, a hyperferritinemia, a salmon-pink rash and recurrent fever episodes, the diagnosis of an adult onset Still's disease (AOSD) was made. A treatment with corticosteroids was started. During the following years, the corticosteroids could not be tapered. Eventually, a treatment with anakinra, an interleukin 1 (IL-1) receptor antagonist was started, allowing tapering of the corticosteroids. This case report supports the possible role of IL-1 in the pathogenesis ofAOSD, possibly through the inflammasome.
24907148 Ultrasonography as an additional item in the American College of Rheumatology classificati 2014 Nov OBJECTIVE: In this study we evaluated US as an additional classification item in the ACR classification of SS. METHODS: Of 581 patients classified as either SS (n = 364) or non-SS (n = 217) based on the minimum requirements of the American-European Consensus Group (AECG) classification, 184 patients (102 SS and 82 non-SS) who had scored two or more positive or two or more negative results according to the ACR criteria were selected. The AECG classification was used as the gold standard. A parotid and/or submandibular gland that was assigned a score ≥G1 was designated as SS positive. We evaluated US alone or with varying combinations of the ACR classification items in the diagnosis of SS. RESULTS: The ACR criteria diagnosed the 184 patients with 91% sensitivity, 90% specificity and 91% accuracy. US alone diagnosed the 184 ACR patients with 79% sensitivity, 90% specificity and 83% accuracy, which was comparable to the results of US diagnosis in the AECG cohort (81%, 86% and 83%, respectively). Incorporating the US criteria as an alternative to one of the three ACR classification items achieved 89-91% sensitivity, 87-96% specificity and 89% or 92% accuracy, which was comparable to that of the original ACR classification. Furthermore, kappa analysis indicated that the results of the original ACR and US-replaced ACR classifications matched completely (κ = 0.960-0.974). CONCLUSION: These results suggest that US can be used as an alternative to any of the three ACR classification items.
24339344 Primary Sjögren's syndrome: fatigue is an ever-present, fluctuating, and uncontrollable l 2014 Aug OBJECTIVE: To examine how fatigue may differ from ordinary tiredness in patients with primary Sjögren's syndrome (SS). METHODS: A purposive, heterogeneous sample of individuals with primary SS who had participated in a study that examined the effects of medication on fatigue was asked to participate in individual interviews. Patients were asked about their fatigue before and after the onset of illness, changes due to medications, and how fatigue was experienced in daily life. An inductive thematic analysis founded on a social constructionist perspective was performed. RESULTS: Five women and 4 men ages 27-76 years participated. Two themes were identified. "A heavy, resistant body and ever-present lack of vitality" represented a profound, ever-present lack of energy along with an unfamiliar bodily heaviness quite different from the experience after alleviation by the drug and being healthy. The patients had scaled down their everyday life in different ways to manage this lack of energy. "Unpredictable and uncontrollable fluctuations in fatigue" expressed how the level of fatigue fluctuated from day to day and even within a particular day. The informants tried to portion out their energy without knowing exactly how much energy they would have at any time. On bad days, patients felt that their "batteries were flat," and they had to put their life on hold. CONCLUSION: Fatigue in primary SS clearly differs from ordinary tiredness. Patients describe it as an ever-present, fluctuating, and nonrelievable lack of vitality being beyond one's own control.