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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
26608852 [Imaging assessment of bone and cartilage destruction in rheumatoid arthritis]. 2015 Dec Rheumatoid arthritis (RA) is characterized by synovitis and subsequent joint destruction involving bone and cartilage. Recent therapeutic development have improved outcomes including disease activity and structural progression in RA, and standardized procedures of imaging assessment including modified total Sharp score (mTSS) have contributed largely for the development of therapeutic strategy. In addition, ultrasonography and MRI of joints have been recently emerging as novel imaging methods for RA. Here, we review current imaging assessments of bone and cartilage destruction in RA.
25876429 [The analysis of dynamics of oxidative modification of proteinsin the blood sera of the pa 2015 Jan OBJECTIVE: To evaluate the indicators of oxidative modification of proteins (OMP) in the patients presenting with secondary osteoarthrosis associated with rheumatoid arthritis (RA) and to determine their dynamics under the influence of the combined treatment with the use of low-intensity laser irradiation (LILI). MATERIAL AND METHODS: A total of 50 patients with RA associated with secondary osteoarthritis and 25 healthy subjects were enrolled in this study. The patients of one study sub-group (n = 25) were given combined therapy with the use of LLLI, those in the second sub-group (n = 25) received only drug therapy. We made use of the VAS and DAS 28 scales to estimate dynamics of pain and compared serum OMP in the patients and healthy subjects. RESULTS: The analyses of the data obtained demonstrated the increased OMP in the patients with RA in comparison with the healthy subjects. The patients of sub-group 1 experienced a significant decrease in the clinical parameters of pain based on the VAS and DAS 28 scales accompanied by the marked reduction of OMP. In sub-group 2, the patients also exhibited the statistically significant dynamics of these indicators, but it was less pronounced than in sub-group 2. CONCLUSION: The patients presenting with rheumatoid arthritis are characterized by the elevated level of protein oxidative modification, a marker of oxidative stress. LlLI introduced in the combined treatment of the patients with RA not only increases the anti-inflammatory and analgesic effects but also has the antioxidant properties.
26096922 Comparison of Care Provided in Practices With Nurse Practitioners and Physician Assistants 2015 Dec OBJECTIVE: The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for patients with rheumatoid arthritis (RA) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only. METHODS: We enrolled 7 rheumatology practices in the US (4 with NPs or PAs and 3 without). RA disease activity (categorized as in remission, low, moderate, or high, using standardized measures) was abstracted from medical records from the most recent 2 years. We performed a repeated-measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist-only practices, adjusting for disease duration, serologic status, RA treatments, and disease activity measures. RESULTS: Records from 301 patients, representing 1,982 visits, were reviewed. The patients' mean age was 61 years and 77% were female. In the primary adjusted analysis, patients seen in practices with NPs or PAs were less likely to have higher disease activity (odds ratio 0.32, 95% confidence interval 0.17-0.60; P = 0.004) than those seen in rheumatologist-only practices. However, there were no differences in the change in disease activity. CONCLUSION: Patients seen in practices with NPs or PAs had lower RA disease activity over 2 years compared to those seen in rheumatologist-only practices; no differences were observed in the change in disease activity between visits either within or between the different types of provider practice.
24880140 A challenging case of diffuse diabetic musculoskeletal system involvement: diagnostic conf 2015 Jan A diabetic patient who was misdiagnosed as rheumatoid arthritis because of complicated musculoskeletal manifestations of diabetes is reported here. A 57 year old woman had been on sulphasalazine treatment with a diagnosis of rheumatoid arthritis for 3 years but failed to respond. Her past medical history disclosed that she had been using metformin due to diabetes mellitus for 8 years. On physical examination there was no evidence of arthritis. Her clinical picture was compatible with diffuse idiopathic skeletal hyperostosis (DISH), shoulder periarthritis, carpal tunnel syndrome, limited joint mobility of diabetes and furthermore myalgia due to metformin induced by hypovitaminosis D. Finally rheumatoid arthritis was excluded and a diagnosis of diabetes mellitus originated diffuse musculoskeletal system involvement was made. Diabetic musculoskeletal complications are common and sometimes cause clinical dilemmas. This case is also important for highlighting the contribution of low vitamin D status to the clinical status.
26908249 Rheumatic diseases of the spine: imaging diagnosis. 2016 Apr Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.
25619810 Distraction arthroplasty with arthroscopic microfracture in a patient with rheumatoid arth 2015 Mar We treated a 39-year-old female who had experienced destruction of her ankle joint owing to rheumatoid arthritis. This relatively young patient wished to avoid ankle fusion and joint replacement. Therefore, distraction arthroplasty with arthroscopic microfracture was performed to improve her symptoms and preserve motion. A microfracture procedure specifically for cartilage defects of the tibial plafond and talar dome was performed with the arthroscope, after which a hinged external fixator was applied to distract the ankle joint. The ankle joint space was enlarged by the external device and joint movement allowed. After 3 months, removal of the external device and repeat arthroscopy revealed newly formed fibrocartilage on the surfaces of both the tibia and the talus. At 2 years after the surgery, a radiograph showed that the joint space enlargement of the ankle had been maintained. The American Orthopaedic Foot and Ankle Society score improved from 37 points preoperatively to 82 points at 2 years postoperatively. Our findings suggest that good clinical results can be achieved with distraction arthroplasty and arthroscopic microfracture in a relatively young patient with rheumatoid arthritis.
26406204 Ultrasound guided injection of resistant extra-articular shoulder and elbow cysts in rheum 2016 Apr 27 A 26-year-old female who had been diagnosed with rheumatoid arthritis (RA) 5 years previously, developed multiple extra-articular cysts on shoulder and elbow. She referred to Physical Medicine and Rehabilitation department for musculoskeletal ultrasound guided intervention. RA cysts were resistance to previous blind injections and surgical resection. She had anterior shoulder and elbow pain and hand paresthesia. The average diameters of the cysts in sonography were 3 cm. The patient was keen to treat the cysts on her right shoulder and elbow as it hampered her activity of daily livings. However, it resisted previous interventions, when symptoms grew further we performed ultrasound guided injection of cysts with Triamcinolone. The symptoms were relieved, and the cysts were resolved completely in 12 month follow up sonographic investigations.
27916724 Use of a C1-C2 Facet Spacer to Treat Atlantoaxial Instability and Basilar Invagination Ass 2017 Feb BACKGROUND: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that often affects the craniovertebral junction. RA is associated with atlantoaxial instability and basilar invagination; the detailed presentations vary. Surgical treatment of atlantoaxial instability and basilar invagination caused by RA is challenging due to anatomic complexity and poor bone quality. The prevailing procedure is posterior occipitocervical fixation after transoral decompression or posterior decompression followed by occipitocervical fixation. However, these surgical modalities inevitably severely limit neck motion and cause dysesthesia of the C2 dermatome. CASE DESCRIPTION: We report our surgical experience with a C1-C2 facet spacer, specifically the usual cervical cage containing an autologous bone chip combined with a C1 lateral mass screw and a C2 pedicle without resection of C2 roots. The facet space was maintained on the 3-year follow-up radiograph. CONCLUSIONS: This method effectively reduces BI and allows AAI fixation without significantly compromising neck motion or causing C2 dermatome dysesthesia.
26753213 [The heart and anticytokine therapy]. 2015 Treatment targeting TNF revolutionized management for rheumatoid arthritis patients offering attainment of clinical remission, preventing patients from disability and improving their quality of life. Anti-cytokine therapy, however may in some circumstance contribute to development of serious adverse effects, including congestive heart failure. The heart failure in patients treated with anti-TNF agents seems to be paradoxical as TNF plays an important pathogenetic role in both conditions. In congestive heart failure, TNF may act as a regulatory factor and may stabilize the heart function, so TNF blockade may result in progression of the heart failure. In this paper, the pathogenetic role of TNF has been discussed with the special emphasis to the role of cytokine in conditions of heart failure and systemic inflammation.
29782739 [EFFECT OF MELATONIN ON THE GLUTATHIONE ANTIOXIDANT SYSTEM ACTIVITY IN RAT TISSUES UNDER C 2016 The influence of melatonin on the reduced glutathione content, activity of glutathione peroxidase, glutathione reductase, and glutathione transferase in blood serum, heart, liver, and skeletal muscle of rats under conditions of experimental rheumatoid arthritis development has been estimated. A change in these parameters toward normal control values under the action of hormone has been revealed. The results can be related to realization of the melatonin antioxidant and protective properties under conditions of oxidative stress accompanying the development of rheumatoid arthritis.
25689091 Near infrared fluorescence imaging for early detection, monitoring and improved interventi 2015 Apr Joints consist of different tissues, such as bone, cartilage and synovium, which are at risk for multiple diseases. The current imaging modalities, such as magnetic resonance imaging, Doppler ultrasound, X-ray, computed tomography and arthroscopy, lack the ability to detect disease activity before the onset of anatomical and significant irreversible damage. Optical in vivo imaging has recently been introduced as a novel imaging tool to study the joint and has the potential to image all kinds of biological processes. This tool is already exploited in (pre)clinical studies of rheumatoid arthritis, osteoarthritis and cancer. The technique uses fluorescent dyes conjugated to targeting moieties that recognize biomarkers of the disease. This review will focus on these new imaging techniques and especially where Near Infrared (NIR) fluorescence imaging has been used to visualize diseases of the joint. NIR fluorescent imaging is a promising technique which will soon complement established radiological, ultrasound and MRI imaging in the clinical management of patients with respect to early disease detection, monitoring and improved intervention.
27770044 Methotrexate impact on radiographic progression in biologic-treated rheumatoid arthritis u 2016 Dec We describe Caucasian monozygotic twin brothers with rheumatoid arthritis (RA) and discuss influence of predictors to methotrexate (MTX) outcome treatment. Single nucleotide polymorphisms (SNPs) of the MTX metabolic pathways were genotyped. Twins have multiple mutations: a CC mutation of SNP 1298A>C in methylenetetrahydrofolate reductase (MTHFR) gene, CC mutations of three SNPs in the adenosine receptor gene ADORA2A (rs3761422_4217241T>C, rs2267076_4221164T>C, rs2236624_4226593T>C), and a heterozygous genotype in SNPs ATIC_rs2372536_347C>G, MTHFD1_rs2236225_1958G>A. These mutations are known to predict a worse outcome of MTX treatment. The twins had different lifestyles (alcohol drinking and smoking in Twin 1, regular coffee consumption in Twin 2), but a very similar clinical presentation of the outset of RA, radiographic scoring according to the Sharp/van der Heijde method with an almost identical antibodies presentation. The period of the patients before anti-TNFα treatment was characterized by unsuccessful per oral MTX pharmacotherapy in both cases (a low effect of MTX in Twin 1; an early discontinuation of MTX due to an adverse event in Twin 2). In both twins, the outcome of well-controlled anti-TNFα treatment (co-medication with MTX in Twin 1) for 10 years was expressed as low disease activity measured using composite index DAS28. It is interesting that Twin 2 had an unfavorable radiographic scoring after a 10-year follow-up than Twin 1 in spite of the comparable DAS28 in Twin 2 and smoking in Twin 1. In conclusion, co-medication of MTX with biologics may impact on RA radiographic progression despite predicted bad MTX outcome based on pharmacogenetic analysis.
24386983 CD8-positive T-cell lymphoproliferative disorder associated with Epstein-Barr virus-infect 2016 We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.
27180448 EFFECT OF THERAPY WITH ANTI-TNF α DRUGS AND DMARD ON DISEASE ACTIVITY AND HEALTH RELATED 2016 Mar The aim of this pilot study was to evaluate the response to 16 and 52 weeks of treatment with adalimumab and etanercept and its effect on disease activity and quality of life in patients with rheumatoid arthritis (RA). Patients were selected from 2155 medical cards of patients of Connective Tissue Health Centre (Poznań, Poland) who were refractory to conventional treatment with disease modifying anti-rheumatic drugs. To assess the disease activity, Disease Activity Score (DAS28) was used and the measurement of quality of life was evaluated with the Polish version of the WHOQoL-Bref questionnaire. To assess the disability, we have used Health Assessment Questionnaire Disability Index (HAQ-DI) and to assess the patients' pain caused by RA, Visual Analogue Scale (VAS) was used. The results of the study show a significant decrease in inflammatory activity of the disease and, consequently, an improvement in quality of life after anti-TNF α treatment. Results obtained with TNF-blockers after 52 weeks of treatment in RA objectively show the efficacy of these drugs and also the patients' perception of the effect on their quality of life. Study results also indicate changes in disability caused by RA and patients' pain due to disease between 16 and 52 weeks of treatment.
24382334 The association between TNFα gene polymorphisms and susceptibility to rheumatoid arthriti 2016 Apr AIM: The aim of our study was to determine the genetic associations between polymorphisms of the TNFα gene (-308G/A and -238G/A) with disease susceptibility and severity in patients with rheumatoid arthritis (RA) in an ethnic Kashmiri population. METHODS: Allele and genotype frequencies of TNFα-308G/A and TNFα-238G/A polymorphisms were compared between 150 RA patients and 200 healthy controls by using polymerase chain reaction - restriction fragment length polymorphism method. Demographic, clinical and serological data were prospectively evaluated. Disease activity score (DAS28) was also assessed. RESULTS: We did not find any significant association between TNFα-308G/A and TNFα-238G/A polymorphism and RA risk (P > 0.05), but TNFα-308GG genotype was associated significantly with rheumatoid factor seropositivity (P < 0.01) and TNFα-238GA genotype was associated with swollen joint count < 5 (P = 0.04) as well as with less severe disease activity as measured by DAS28 score (P = 0.02). CONCLUSION: Our findings suggest the possible roles of TNFα-308GG and TNFα-238GA as important determinants for the development of certain manifestations and disease severity in RA in ethnic Kashmiri population.
24517518 Successful leukocytapheresis therapy in a patient with rheumatoid arthritis on maintenance 2015 Jan We report the case of a 44-year-old female undergoing maintenance hemodialysis in whom early-phase rheumatoid arthritis (RA) was successfully treated by leukocytapheresis (LCAP). The effects of prednisone, tacrolimus, and etanercept were limited, but LCAP was highly effective and its efficacy continued even after cessation of LCAP. Moreover, remission was maintained for 2 years after discontinuation of medication. LCAP may be an important treatment option for RA patients with end-stage renal failure who are on hemodialysis.
25693218 [Nonspecific ulcerative colitis in combination with rheumatoid arthritis (case report)]. 2015 Jan The rheumatoid arthritis in the structure of rheumatological diseases occupies about 10% and is one of the most widespread inflammatory diseases of joints. The joint damage often meeting by the nonspecific ulcerative colitis, but combination of rheumatoid arthritis with nonspecific ulcerative colitis is rare. In this article described a case of the nonspecific ulcerative colitis associated with rheumatoid arthritis, in which arthritis occurred 8 years before the onset of nonspecific ulcerative colitis.
26044288 Acute exacerbation of rheumatoid interstitial lung disease during the maintenance therapy 2017 Nov We report a case involving a 68-year-old woman with rheumatoid arthritis (RA) with acute exacerbated interstitial lung disease (ILD) during certolizumab pegol maintenance therapy. She recovered quickly with steroid pulse therapy and was discharged without deterioration of basal pulmonary function. Immunoblot analysis demonstrated the circulating cleaved interleukin-1β at the phase of acute exacerbation of RA-associated ILD (RA-ILD) in this patient. The findings from this case suggested that the Nod-like receptor pyrin domain-containing protein 3 inflammasome is implicated in acute RA-ILD exacerbation.
26608857 [The regulation of CTLA4-Ig in bone and cartilage destruction of rheumatoid arthritis]. 2015 Dec CTLA4-Ig is a regulator of co-stimulation and inhibits the activation of T cells through interfering with the interaction of CD80/86 on antigen-presenting cells with CD28. Recently CTLA4-Ig has shown additional effect beyond T cell inhibition, such as direct inhibition of differentiation of osteoclast, enhancement of osteogenesis. These effects may contribute to prevention of bone destruction in rheumatoid arthritis.
27231868 Connective Tissue Disease-Associated Interstitial Lung Diseases: Unresolved Issues. 2016 Jun Interstitial lung disease (ILD) complicating connective tissue disorders, such as scleroderma and rheumatoid arthritis, is associated with significant morbidity and mortality. Progress has been made in our understanding of these collective diseases; however, there are still many unanswered questions. In this review, we describe the current views on epidemiology, clinical presentation, treatment, and prognosis in patients with connective tissue disease (CTD)-associated ILD. We also highlight several areas that remain unresolved and in need of further investigation, including interstitial pneumonia with autoimmune features, histopathologic phenotype, and pharmacologic management. A multidisciplinary and multidimensional approach to diagnosis, management, and investigation of CTD-associated ILD patients is essential to advance our understanding of the epidemiology and pathobiology of this challenging group of diseases.