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ID PMID Title PublicationDate abstract
26171649 Literature review of rheumatoid arthritis in India. 2016 May AIM: Rheumatoid arthritis (RA) can lead to severe disability. This literature review assessed the descriptive epidemiology, comorbidities and extra-articular manifestations, functioning abilities and quality of life, and treatment patterns of RA patients in India. METHOD: A literature review of all observational studies published from 1985 to 2012 was conducted using MEDLINE and Embase. Quantitative and qualitative findings were summarized. RESULTS: Twenty-eight studies were identified for data extraction. Seven described the descriptive epidemiology of RA, 14 described comorbidities and extra-articular manifestations, nine described the functioning abilities and quality of life among patients, and 10 provided information on treatments. CONCLUSION: This review is confined to studies with small sample sizes, cross-sectional designs, and/or clinical settings that may not be representative of the entire Indian population. There is a need for more robust studies, as conclusions for the entire Indian RA population cannot be drawn from only the current observational studies.
26648464 Rheumatoid Arthritis: Notable Biomarkers Linking to Chronic Systemic Conditions and Cancer 2016 Adult rheumatoid arthritis (RA) is an autoimmune disorder affecting joints and frequently characterised by initial local and later systemic inflammation. Researchers have, for many years, traced its cause to diverse genetic, environmental and especially immunological responses that work against the body's own cells and tissues. Investigation into several of these biomarkers reveals interconnections that exist between multiple factors, which ultimately lead to specific pathologies. The goal of this paper is to highlight connections present between the major biological players long identified by researchers including more recently uncovered biomarkers in the RA repertoire and some of the pathophysiologies typically affiliated with the disease. Biomarkers reviewed, and becoming more clearly defined for RA include genetic, cytokines like tumor-necrosis factor-α (TNF-α), lymphocytes, nuclear antigens, antibodies to citrullinated peptides (anti-CPs), acute-phase proteins (APPs), microRNA, S100 proteins, platelets and erythrocytes. Some of the disease manifestations that have been connected are bone erosion, diabetes, metabolic syndrome, anemia, synovitis, felty's syndrome, extra-articular manifestations (EAMs) such as atherosclerosis, rheumatoid nodules and cardiovascular (CV) events. Several RA markers associated with malignancy have been identified in literature although there is insufficient evidence of cancer in patients. Due to the complex nature of the disease, the appearance of symptoms and markers vary amongst individuals and the connections may manifest only in part. This manuscript addresses defining factors relevant to rapid identification of pathological influences these biomolecules could exert and to the management of the disease. Each of these biological players may have its place in connecting to symptomatic pathologies and help to highlight potential targets for therapy.
26696331 Rheumatoid Arthritis-Associated Interstitial Lung Disease and Idiopathic Pulmonary Fibrosi 2015 Sep The prevalence of clinically evident interstitial lung disease in patients with rheumatoid arthritis is approximately 10%. An additional 33% of undiagnosed patients have interstitial lung abnormalities that can be detected with high-resolution computed tomography. Rheumatoid arthritis-interstitial lung disease patients have three times the risk of death compared to those with rheumatoid arthritis occurring in the absence of interstitial lung disease, and the mortality related to interstitial lung disease is rising. Rheumatoid arthritis-interstitial lung disease is most commonly classified as the usual interstitial pneumonia pattern, overlapping mechanistically and phenotypically with idiopathic pulmonary fibrosis, but can occur in a non-usual interstitial pneumonia pattern, mainly nonspecific interstitial pneumonia. Based on this, we propose two possible pathways to explain the coexistence of rheumatoid arthritis and interstitial lung disease: (i) Rheumatoid arthritis-interstitial lung disease with a non-usual interstitial pneumonia pattern may come about when an immune response against citrullinated peptides taking place in another site (e.g. the joints) subsequently affects the lungs; (ii) Rheumatoid arthritis-interstitial lung disease with a usual interstitial pneumonia pattern may represent a disease process in which idiopathic pulmonary fibrosis-like pathology triggers an immune response against citrullinated proteins that promotes articular disease indicative of rheumatoid arthritis. More studies focused on elucidating the basic mechanisms leading to different sub-phenotypes of rheumatoid arthritis-interstitial lung disease and the overlap with idiopathic pulmonary fibrosis are necessary to improve our understanding of the disease process and to define new therapeutic targets.
27717942 [Sarcopenia in rheumatoid arthritis]. 2016 The clinical picture of rheumatoid arthritis covers the condition of chronic inflammation connected to the increased concentration of inflammatory mediators, reduced physical activity, immobilization caused by pain, stiffness and joint destruction as well as accompanying hormonal and metabolic disorders. It all may lead to extra-articular complications, also to the loss of muscle mass with the weakness of muscle strength, adding to the disability and significantly lowering the patients' quality of life. Sarcopenia is an advanced form of muscle mass loss which constitutes an independent and vital threat for dexterity. Attempts are made to define and classify sarcopenia basing on the measurements of muscle mass where the examinations are conducted by the method of computed tomography, magnetic resonance imaging, absorptiometry of two X-ray beams of various energies, electric bioimpedance and anthropometric methods. The data gained in few studies conducted in order to estimate the reduction of muscle mass in patients with rheumatoid arthritis confirm the significant increase of sarcopenia occurence in this group. Procedure with rheumatoid arthritis covers primarily treatment of the inflammatory process with traditional and biological medicaments that modify the course of illness. Such treatment seems to diminish the risk of equal sarcopenia occurrence. The effectiveness of using anabolic medicaments and high protein diet has not been proved. Currently, regular physical activity including aerobic exercise and exercises with load is considered a good method of muscle mass loss prevention and a procedure in case of confirmed muscle mass loss.
27824423 [Glucocorticoid therapy in rheumatoid arthritis - pro]. 2016 Oct Glucocorticoids are invaluable in the therapy of chronic-inflammatory diseases, like rheumatoid arthritis (RA). They act fast and efficient to suppress inflammation and serve to bridge the gap until disease modifying drugs (DMARD) show effect. However, the value of glucocorticoids with regard to their cost / benefit ratio in long term RA therapy is still controvers. In this short review, the main aspects favoring glucocorticoids as DMARD in long term RA therapy will be discussed. It becomes apparent, that at low dosage (prednisolone ≤ 5 mg / d), careful selection and monitoring of patients, and osteoporosis prophylaxis according to guidelines, long term therapy with glucocorticoids is an option and, with a favorable cost / benefit ratio, contributes to inflammation control and prevention of structural damage.
26208442 Rheumatoid arthritis in Latin America: the importance of an early diagnosis. 2015 Mar The generalization of the early rheumatoid arthritis (ERA) concept and the existence of a window of therapeutic opportunity-a time span in which the institution of a proper therapeutic method for the disease would determine clinical improvement-have set the notion that early diagnosis and treatment may modify the course of the disease. Although in several regions of the world, especially in North America and Europe, since the year 2000, a significant reduction in diagnostic delay was observed in cohorts of patients with rheumatoid arthritis (RA), probably reflecting a stronger awareness of the importance of early diagnosis, this is not a reality in Latin America (LA). LA is a region of great economic inequality, with disparities in access to the public healthcare system and limited access to private medicine, being widely difficult to obtain a specialized medical evaluation in both scenarios. This paper aims to briefly review the main difficulties in the management of ERA in LA, based on the review of the literature, on the evaluation of a survey conducted among 214 rheumatologists of LA, members of Pan-American League of Associations for Rheumatology (PANLAR) and the experience of the authors. The paper also aims to propose solutions to the difficulties in managing ERA in LA.
25163740 Rheumatoid arthritis: genetic variants as biomarkers of cardiovascular disease. 2015 Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with premature mortality, severe morbidity, and functional impairment leading to considerable financial burden for both patients and society. Since disease progression and complications can differ from one patient to another, genetic markers are of potential relevance for identifying those individuals at a higher risk of more severe disease. RA is a complex polygenic disease. Cardiovascular (CV) disease due to accelerated atherogenesis is the most common cause of premature mortality in patients with RA. Several studies support the implication of genetic factors in the development of CV disease in RA. In addition to the strong association between alleles of the HLA-DRB1*04 shared epitope and both subclinical and clinically evident CV disease, genes implicated in inflammation and metabolism, such as TNFA, MTHFR, and CCR5, seem to be associated with a higher risk of CV disease in patients with RA. We propose the use of these genetic variants as molecular biomarkers that could help to predict disease outcome at diagnosis of RA and, therefore, to optimize the treatment and management of other risk factors from an early stage of the disease.
26850214 [Psychiatric aspects of rheumatoid arthritis: Review of literature]. 2016 Apr BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory degenerative disease whose symptoms are mainly joint with significant functional impact, resulting in a restriction of the activities of the patient and increasing the impact on mental well-being. Several studies have been conducted to explore psychiatric disorders comorbid with RA. OBJECTIVE: The objective of this review is to present the various psychiatric manifestations of RA reported in the medical literature. METHODS: A literature review was conducted using the Pubmed search with the following keywords: psychiatry, psychiatric manifestations, rheumatoid arthritis. Three hundred and sixty-one articles were reviewed for relevance and 47 references were selected. RESULTS: Among the major psychiatric disorders found in RA, the anxiety and depressive disorders are prevalent (13 to 48% of patients), as well as suicide, insomnia and tiredness. The impairment of quality of life is markedly after age 65. The association between RA and schizophrenia seems negative so that factors predisposing one is protective for the other. CONCLUSION: Comorbid psychiatric disorders with RA are prevalent and may increase the impairment of quality of life for patients. The detection and treatment of psychiatric disorders improve the care of patients with RA.
27665289 Medication adherence in patients with rheumatoid arthritis: why do patients not take what 2016 Nov Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which results in extensive articular and extra-articular morbidity and increased mortality from cardiovascular disease. Despite an increasing range of non-biological and biological disease-modifying agents, poor patient adherence with medication is a significant barrier to effective control of the inflammation associated with RA. This review seeks to identify factors that affect patient adherence with medication, examine the effectiveness of interventions to address this issue and offer practical suggestions to improve medication adherence. The impact of health literacy on medication adherence and the novel role of musculoskeletal ultrasound as an educational intervention will also be discussed.
27032786 Is There a Role for Diet in the Therapy of Rheumatoid Arthritis? 2016 May Patients with rheumatoid arthritis (RA) often inquire about dietary interventions to improve RA symptoms. Although the majority of studies of diet and RA were published prior to the start of the twenty-first century, this review discusses the evidence for a relationship between diet, in particular omega-3 fatty acid supplements, vitamin D supplements, alcohol, and the Mediterranean diet and RA disease activity. We review possible mechanisms by which these dietary intakes may affect RA disease activity. Given the complexity of studying the relationship between diet and RA disease activity, we highlight areas deserving further study before specific recommendations can be made to RA patients.
26656659 Cytokines in rheumatoid arthritis - shaping the immunological landscape. 2016 Jan Cytokine-mediated pathways are central to the pathogenesis of rheumatoid arthritis (RA). The purpose of this short Opinion article is to briefly overview the roles of cytokine families in the various phases and tissue compartments of this disease. In particular, we consider the combinatorial role played by cytokines in mediating the overlapping innate and adaptive immune responses associated with disease onset and persistence, and also those cytokine pathways that, in turn, drive the stromal response that is critical for tissue localization and associated articular damage. The success of cytokine inhibition in the clinic is also considerable, not only in offering remarkable therapeutic advances, but also in defining the hierarchical position of distinct cytokines in RA pathogenesis, especially IL-6 and TNF. This hierarchy, in turn, promises to lead to the description of meaningful clinical endotypes and the consequent possibility of therapeutic stratification in future.
26856871 Reliable and cost-effective serodiagnosis of rheumatoid arthritis. 2016 Jun Early diagnosis of patients with rheumatoid arthritis (RA) optimises therapeutic benefit and the probability of achieving disease remission. Notwithstanding clinical acumen, early diagnosis is dependent on access to reliable serodiagnostic procedures, as well as on the discerning application and interpretation of these. In the case of RA, however, no disease-specific serodiagnostic procedure is available due to the multi-factorial and polygenic nature of this autoimmune disorder. This has resulted in the development of an array of serodiagnostic procedures based on the detection of autoantibodies reactive with various putative autoantigens. Other procedures based on measurement of elevations in the concentrations of systemic biomarkers of inflammation, most commonly acute phase reactants and cytokines/chemokines, are used as objective indices of disease activity. Following a brief overview of RA research in African populations, the current review is focused on those autoantibodies/biomarkers, specifically rheumatoid factor, anti-citrullinated peptide antibodies and C-reactive protein, which are currently recognised as being the most reliable and cost-effective with respect to disease prediction and diagnosis, as well as in monitoring activity and outcome.
26497664 Co-morbidity index in rheumatoid arthritis: time to think. 2015 Dec Rheumatoid arthritis patients are clinically complex, and the interplay of their disease activity together with the other associated conditions may lead to increased morbidity and mortality. The recent advances in the disease management attracted the attention to its associated co-morbidities and highlighted the need for a tool to provide clinicians and potential payers with a clinically powerful measure of the disease burden and prognosis. Predicting outcome or co-morbidity probability has been previously implemented successfully for calculating 10-year fracture probability (FRAX) as well as for predicting 1-year patient mortality using co-morbidity data obtained (Charlson index). Developing a specific rheumatoid arthritis-independent tool able to predict morbidity, mortality, cost and hospitalization would be a step forward on the way to achieve full disease remission. The co-morbidity index should be used both at baseline as well as a continuous variable in analyses. It should be implemented regularly in the clinical assessment as a confounder of outcomes. This article will review the redefined health outcomes in rheumatoid arthritis and the concept of co-morbidity index for patients with inflammatory arthritis. It will also present a proposed co-morbidity index for rheumatoid arthritis patients.
26261932 [Ultrasound examination in rheumatoid arthritis]. 2015 Aug Musculoskeletal ultrasound in the clinical routine praxis increases the hit rate for the diagnosis of inflammatory joint diseases. Power Doppler ultrasound is helpful in the detection of subclinical synovitis in the small finger joints in patients with rheumatoid arthritis; subclinical synovitis can lead to severe joint destruction. Rigorous clinical remission criteria result in lower synovitis detected by power Doppler ultrasound.
26460319 Genetic studies of rheumatoid arthritis. 2015 Rheumatoid arthritis (RA) is a common autoimmune disease that results in significant morbidity. As with other complex disorders, genome-wide association studies (GWASs) have greatly contributed to the current understanding of RA etiology. In this review, we describe the genetic configuration of RA as revealed primarily through GWASs and their meta-analyses. In addition, we discuss the pathologic mechanisms of RA as suggested by the findings of genetic and functional studies of individual RA-associated genes, including HLA-DRB1, PADI4, PTPN22, CCR6 and FCRL3, and the potential use of genetic information for RA treatment in clinical practice.
27402108 Preventive Treatments for Rheumatoid Arthritis: Issues Regarding Patient Preferences. 2016 Aug The detection of biomarkers in the preclinical phase of rheumatoid arthritis (RA) and recent therapeutic advances suggest that it may be possible to identify and treat persons at high risk and to prevent the development of RA. Several trials are ongoing to test the efficacy of a therapeutic intervention in primary prevention. This paper reviews potential populations that might be considered for preventative medication. Further, we review the medications that are being explored to treat individuals considered at high risk of developing RA. Finally, in a group of asymptomatic individuals at high risk of developing RA, we assessed which factors mattered most when considering a preventive therapeutic intervention and what type of preventive treatment would be most acceptable to them. Understanding subjects' perceptions of risks and benefits and willingness to undergo preventive therapy will be important in designing and implementing screening and preventive strategies.
26238502 Neuropsychiatric manifestations in rheumatoid arthritis. 2015 Dec Rheumatoid arthritis (RA) is a chronic disease characterized by persistent synovitis, systemic inflammation, and the presence of autoantibodies. Neuropsychiatric manifestations are quite common in RA, including depression, cognitive dysfunction, behavior changes, spinal cord compression and peripheral nerve involvement. Potential causes include systemic inflammatory process, neural compression due to bone and joint destruction, side effects of medications and copying difficulties due to the chronicity of the disease. A high level of suspicious is required for an adequate diagnosis and treatment. In this review, we will discuss topographically the main neuropsychiatric manifestations described in RA patients, in an attempt to help in the management of these complex and multifaceted disease.
26389852 Imaging in rheumatoid arthritis: options, uses and optimization. 2015 Recent advances in imaging technology are dramatically changing the approach to patients with inflammatory arthritis. Conventional radiography is still the major imaging modality used to evaluate patients with rheumatoid arthritis in daily clinical practice. In the last decade, several investigations have shown the diagnostic ability of MRI and ultrasound to rectify the traditional approach to early diagnosis and disease activity monitoring. This review will summarize the options, uses and optimization of these imaging modalities with a special focus on ultrasound, which is currently the most promising tool to change the paradigms in both early diagnosis and therapy monitoring of rheumatoid arthritis.
27717973 [The scaphoid and rheumatoid arthritis : Classification by retrospective X‑ray analysis] 2016 Nov BACKGROUND: Early destruction of the wrist in rheumatoid arthritis is common and often progressive. Even in times of improved and standardized medical treatment this cannot always be prevented. OBJECTIVES: A limited range of motion, pain, reduced grip-force, and aesthetic deficits of the wrist can impair the daily life of patients. There is an additional risk for destruction of the surrounding soft tissue and adjoining joints of the upper extremity. RESULTS: Destruction of wrist in rheumatoid arthritis is multifactorial and is localized in many different structures of the wrist. In this context, scaphoid and periscaphoid structures are of interest. Data were gathered in a retrospective study of the wrist X‑rays of patients with rheumatoid arthritis. The possible consequences for operative options are described.
26739963 The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care. 2016 Jan With the prevalence of obesity increasing dramatically worldwide over the past several decades, an increasing body of literature has examined the impact of obesity in the context of rheumatoid arthritis (RA). Epidemiologic studies suggest that obesity may be associated with a modestly increased risk for the development of RA, although these studies have shown conflicting results. Among patients with established RA, obesity has been observed to be associated with greater subjective measures of disease activity and poor treatment response, but also with a decreased risk of joint damage and lower mortality. A comprehensive evaluation of the influence of obesity on the measurement of disease, response to therapies, and long-term prognosis is critical in order to understand these observations. This review therefore focuses on recent observations, potential explanations for these findings, and implications for clinicians and investigators caring for and studying patients with RA.