Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 2200144 | Rheumatoid pleuritis. | 1990 Aug | My case is one in which the principal manifestation of rheumatoid arthritis is pleurisy. It is a case that underscores the clinical nuances of rheumatoid pleuritis. The major articles that have shaped our view of rheumatoid pleuritis are discussed in light of my case, a perspective that raises the possibility that some of the established biases about rheumatoid pleuritis may be misleading. It is necessary to consider rheumatoid pleuritis in any patient with an unexplained pleural effusion. | |
| 2661583 | Management of the patient with rheumatoid arthritis. The role of the hand therapist. | 1989 May | The treatment of patients with rheumatoid arthritis requires a team approach, with the patient as the key player. These patients have a chronic disease that necessitates monitoring by physicians, nurses, social workers, therapists, and vocational counselors. The hand therapist provides individual exercise and activities programs, hand splinting, and instruction in joint protection and energy conservation techniques. When a patient requires surgery, the hand therapist works in conjunction with the surgeon in both the preoperative phase of patient evaluation and education, and in the postoperative management. The team working together helps the patient receive maximum benefits from treatment and to live more comfortably with his disease. | |
| 3277682 | Clinical and laboratory assessment of outcome in rheumatoid arthritis. | 1988 | The management of rheumatoid arthritis would be assisted by an ability to assess prognosis in the individual patient. A number of studies have investigated the role of various clinical and laboratory measurements as predictors of prognosis, but all are hindered by the lack of adequate measures of outcome. Age, sex, initial radiograph and functional grades, the presence of rheumatoid factor or nodules may all be useful indicators. Mode of onset may have a bearing on outcome. The relationship between these variables and the clinical and biochemical assessment of disease activity is discussed in relation to prognosis. | |
| 1877428 | Diagnosing rheumatoid arthritis: current criteria. | 1991 Sep | Rheumatoid arthritis is a chronic, systemic inflammatory connective tissue disorder with major effects on the articular system. Causative mechanisms remain unknown, and no specific diagnostic tests are available. Descriptive criteria form the basis of disease classification and diagnosis. Either the 1987 American College of Rheumatology criteria for classification of rheumatoid arthritis or the new rheumatoid arthritis classification tree may be used to diagnose and classify this disease. | |
| 2009678 | The role of the neutrophil in rheumatoid arthritis. | 1991 Apr | Neutrophils acquire lysosomal granules and assembly systems for producing soluble mediators of inflammation during the process of maturation in the bone marrow. Subsequently, they emigrate from the circulation when they become attracted to joint spaces of rheumatoid arthritis patients by chemoattractants such as the complement split product, C5a, and leukotriene B4. Exposure to immune complexes, rheumatoid factor, and cytokines in the synovial fluid results in neutrophil activation with release of granule contents, toxic oxygen metabolites, and proinflammatory products of the arachidonic acid cascade. This process is analogous to a local Arthus reaction in which activation of the complement system is a central event. Some of the inflammatory materials released by this reaction contribute to the cartilage destruction seen in rheumatoid arthritis. Because others are chemoattractants themselves, they perpetuate intraarticular inflammation and permit the predominance of acute inflammatory cells in lesions maintained by chronic inflammation. | |
| 3486592 | Pathogenesis of rheumatoid arthritis. | 1986 Apr 28 | Many types of cells are activated and transformed in rheumatoid synovium, thereby contributing to amplification of the disease process. The immune response in rheumatoid arthritis is probably initiated by an antigen, although there is some evidence that anticollagen antibodies develop in response to tissue destruction, after rheumatoid arthritis has evolved clinically. Early inflammation in the synovium is characterized by a striking vascular proliferation, occurring in response to angiogenesis factors released by activated macrophages. Generalized activation of macrophages and lymphocytes typical of the immune reaction in the synovium generates antibody production, including production of rheumatoid factor. Data suggest that immune complexes deposited within cartilage attract polymorphonuclear leukocytes, which then release enzymes onto the cartilage surface. Many products of inflammation act as mediators, driving proliferation of synovial cells. Stellate cells, macrophages, and fibroblasts have been found along the pannus/cartilage junction; by various interactions, these contribute to destruction of cartilage and bone. | |
| 10302583 | The effect of patient-practitioner interaction on compliance: a review of the literature a | 1988 Jun | Persons with rheumatoid arthritis, like those with other chronic illnesses, often demonstrate poor compliance with their treatment regimens. Numerous factors have been identified as influencing compliances, including various features of diseases and therapeutic regimens, and demographic and sociobehavioral features of patients. Perhaps the most significant factor is the physician-patient relationship. Because of the relatively high prevalence of rheumatoid arthritis and the numerous characteristics of the disease and its treatment which adversely affect compliance, this literature review deals with the effects of the patient-practitioner interaction on compliance with treatment programs for rheumatoid arthritis. Specifically, this review examined the reported effects of four components of the patient-practitioner interaction--pedagogical techniques, sharing of expectations, the patient's assumption of responsibility and affective tone. Based on this literature review, several suggestions are provided for the health professional regarding ways to enhance compliance through the interaction with the patient, and specific areas for further research are identified. | |
| 1880170 | The distal radioulnar joint complex in rheumatoid arthritis: an overview. | 1991 May | Rheumatoid arthritis frequently involves the distal radioulnar joint region and is progressive. Early recognition of involvement is paramount to offering patients appropriate and timely treatment. Early operative intervention should be considered preventative. Synovectomy, hemiresection interposition technique, matched distal ulna resection and distal radioulnar fusion with creation of a pseudarthrosis through the distal ulnar shaft have been advocated for patients with early involvement. Distal ulnar resection remains the most commonly used procedure for advanced disease. No soft tissue reconstructive procedure to stabilize the ulnar stump offers distinct advantages. They should be considered modifiers and augmentations to distal ulna resection. Judicious resection of the ulnar head minimizes instability of the ulnar stump. The use of an ulnar cap is not recommended for routine use. | |
| 2680311 | Review of dose-response studies of NSAIDs in rheumatoid arthritis. | 1989 Sep | Double-blind dose-response studies of aspirin, phenylbutazone, indomethacin, ibuprofen, naproxen, piroxicam, diclofenac, diflunisal, and tolfenamic acid were reviewed, using pain and a combined effect measure as outcome variables. The increase in effect obtained with the highest doses of the drugs was small, and as a general rule, NSAIDs should be used at the lower end of the recommended dose ranges. | |
| 2251508 | Resolve: methotrexate is the drug of choice after NSAIDs in rheumatoid arthritis. | 1990 Oct | This article, in favor of the resolution that methotrexate (MTX) is the drug of choice after nonsteroidal antiinflammatory treatment, develops the following four points. MTX is an effective treatment of rheumatoid arthritis. MTX is easy to administer and to monitor for effectiveness and safety. MTX has demonstrated a therapeutic to toxic ratio that exceeds that of other second-line antirheumatic drugs. MTX has the potential to impair disease progression. | |
| 2487708 | Natural history and treatment decisions in rheumatoid arthritis revisited. | 1989 Sep | Compliance with RA therapeutic intervention must be viewed within the context of the natural history of the disease with or without drug treatment. Published studies from the 30s to the 80s provide a grim picture: both premature death and marked functional morbidity occur even in population-based analyses. Intervention with drugs appears to have short-term gains with little impact beyond 2 years. The reasons for this apparent paradox are two-fold. (1) our drugs are not as successful as we would like; and (2) clinical trials and long-term outcome studies exaggerate their differences from each other by selection criteria and other methodologic issues. Nevertheless, the picture that is emerging for the 90s is revolutionary. Patients with the worst prognosis are being treated more aggressively earlier in their course, and those that have a favorable prognosis do well without aggressive management and are treated differently. Traditional outcome measures are giving way to others that are more realistic and patient-oriented. The assumption that more (not less) treatment will remedy the situation is being tested. The impact of the success of Methotrexate on this change in philosophy should not be underestimated. | |
| 1883695 | Assessment of rheumatoid arthritis. | 1991 Jun | Accurate assessment of disease activity and progression is essential in diseases with marked chronicity such as rheumatoid arthritis. It is not surprising that rheumatologists continue to seek improvement in old indices and to develop new ones. In the field of clinical indices, selection of data that contribute independently to the overall value of a compound assessment index will simplify trial methodology considerably. The trend is to reduce the number of tests done, but there is still a need to include functional indices and perhaps psychologic ones, because disability and self-image clearly affect prognosis. In the laboratory area, the trend is to develop methods to specifically assess different aspects of inflammation rather than to rely on overall nonspecific measures such as acute-phase proteins. Radiographs remain the simplest method for detecting scars of previous disease and the potential exists to improve and perhaps mechanize the reading of such films. Magnetic resonance imaging has the potential for assessment of the current state of inflammation if newer methodologies are used. Radionuclides may also have much to offer in joint assessment in the 1990s. | |
| 3053308 | Collagen autoimmunity and arthritis. | 1988 Nov | Collagen-induced arthritis in animals is an example of polyarthritis that sufficiently resembles human rheumatoid arthritis to be used as a model. It is caused by immunizing susceptible animals with type II collagen isolated from articular cartilage. Susceptibility is genetically determined and linked to the major histocompatibility locus. It is important because some human arthritis is also associated with major histocompatibility genes and may be caused or aggravated by the presence of autoimmunity to normal cartilage components. Collagen-induced arthritis is also important because it is an example of immunologically mediated joint destruction, which may share some of the mechanisms present in human disease. Although it is caused by autoimmunity to collagen, susceptibility and responsiveness to type II collagen are not completely correlated, and there are examples of animals with high levels of collagen immunity who do not develop arthritis. The initial lesion appears to be the deposition of an antibody on the surface of articular cartilage, which precedes development of overt arthritis by several days. Disease can be readily transferred with specific antibody. Arthritogenic antibodies appear to have restricted epitope specificity, which may partially explain the disparities between responsiveness to immunization with collagen and susceptibility to arthritis, but precise delineation of the epitopes involved has not yet been accomplished. Complement activation also appears to be intimately involved since the disease correlates with the presence of high levels of complement-binding IgG isotypes, and passive transfer is possible only into complement-sufficient recipients. Inflammation progresses rapidly so that cartilage destruction and marginal erosion develop over a period of a few days. Collagen-induced arthritis offers a unique opportunity to study autoimmune-mediated arthritis in which the inducing antigen is well characterized and readily available. Analysis of the disease has permitted the proposal of a schema for its pathogenesis. | |
| 2487702 | Adherence with treatment regimens among adult rheumatoid arthritis patients: current statu | 1989 Sep | This paper reviews the literature concerning adult rheumatoid arthritis (RA) patients' adherence with medication regimens, home exercise, splint usage, and self-management of pain. There are few reliable data regarding the prevalence of adherence problems or the attributes of patients, health-care providers, and environments that may influence adherence. In addition, little effort has been devoted to the development of interventions that may enhance adherence. Future investigators should attend to (1) the development of reliable and valid measures of adherence; (2) longitudinal studies of changes in adherence as a function of disease activity, treatment methods, and third-party reimbursements for services; (3) observational studies of patient-provider interactions and their influence on adherence; and (4) interventions to enhance adherence that are based on a self-regulation model. | |
| 3547654 | The role of stress and trauma in rheumatoid arthritis and systemic lupus erythematosus. | 1987 Feb | Only one study, albeit inconclusive, has specifically addressed the etiologic role of physical trauma in RA. The weight of evidence from a variety of studies strongly suggests a role for psychologic stress in inducing, exacerbating, and effecting the ultimate outcome in RA. Well designed controlled trials aimed specifically at deciding these issues are urgently needed. This also applies to SLE, where the role of physical trauma has never been investigated, and disease exacerbation induced by emotional stress has been strongly suggested, but not yet verified in a scientifically acceptable fashion. Stress can depress immune responsiveness, but the end result of this (eg, increased susceptibility to infection, increased disease activity) is not known. It is uncertain how much or what kind of stress is required to depress responsiveness, or even how differing degrees of stress can be quantitated or reproduced. Even though eight million Americans have RA and SLE, we still know very little about the influences of stress and trauma on these disorders. | |
| 2688075 | Reassessment of twelve traditional paradigms concerning the diagnosis, prevalence, morbidi | 1989 | Twelve traditional paradigms concerning the diagnosis, prevalence, morbidity and mortality of rheumatoid arthritis have provided much of the conventional wisdom in textbooks and clinical practice. Reassessment of these paradigms may lead to new insights and improved outcomes in rheumatoid arthritis. | |
| 2101237 | [The foot in rheumatoid arthritis]. | 1990 | Because of its high incidence of rheumatoid arthritis, the foot is probably the best place to study this pathology. Timely diagnosis is very important considering the high risk of disability. On the basis of both other studies and first-hand observations, the particular clinical and radiographic characteristics of rheumatoid arthritis of the foot are analyzed, differentiating it from the same disease in other joints. The research and comparison of these particular aspects helped with the overall clinical evaluation of early-diagnosed rheumatoid arthritis, that is before the development of reabsorption phenomena, bone damage, deformities, and ankylosis of the joints of the foot. | |
| 1836280 | Worldwide trends in the socioeconomic impact and long-term prognosis of rheumatoid arthrit | 1991 Oct | Rheumatoid arthritis (RA), once considered a benign and nonprogressive disease, is a debilitating condition with serious physical, emotional, and economic consequences. It afflicts approximately 1% of the adult population worldwide; prevalence increases with age, with twice as many women as men affected. In the United States, age, lack of formal education, and lower socioeconomic class correlate with both the incidence and poor prognosis of RA. The patient with RA faces increasing functional disability, the likelihood of work disability within 10 years after the onset of the disease, and a drastic reduction in earnings. Compared with individuals without the disease, patients with RA incur higher medical care costs, increased hospitalization, and a greater number of physician visits. As in the general population, the leading cause of death among patients with RA is cardiovascular disease, and deaths due to malignancy occur at a comparable incidence; however, patients with RA are at greater risk of mortality due to infection, renal disease, respiratory conditions, and gastrointestinal disease. Life expectancy is shorter among patients with RA than in the general population, and survival rates are comparable to those for Hodgkin's disease, diabetes mellitus, stroke, and three-vessel coronary artery disease. Efforts must be made to develop improved therapeutic strategies and rehabilitative programs to improve the quality of life of patients with RA. | |
| 3024188 | Rheumatoid arthritis of the shoulder. | 1986 Dec | The shoulder frequently is affected by rheumatoid arthritis (RA), often resulting in musculoskeletal dysfunction. The primary purpose of this article is to provide the clinician with an in-depth look at the pathological factors and treatment of RA as it affects the shoulder. The review includes sections on pathological factors, radiology, morbidity, clinical manifestations, and both conservative and surgical management. The secondary purpose of this article is to acquaint the clinician with some of the other rheumatic diseases in which shoulder dysfunction may occur. I hope that the presentation of management principles will stimulate discussion and interest regarding the scientific rationale for the treatment of musculoskeletal manifestations of RA. | |
| 3074285 | Premises for immune interventional therapy in rheumatoid arthritis. | 1988 Jul | Consideration of rheumatoid arthritis (RA) as an autoimmune disease includes initiating event(s), genetic predisposition, immune regulatory derangements, and effector cycles of articular damage. The initiating event is still unknown. Collagen type 2 has good claims as a rheumatogenic autoantigen which perpetuates disease. The association of HLA DR4 with rheumatoid arthritis is in part explainable by the affinity of binding of the rheumatogenic antigen to a hypervariable portion of MHC Class II molecules with selective presentation of this complex to T cell receptors. Immune regulatory derangements include lymphokine-induced aberrant expression of MHC Class II molecules on synovial tissues, the presence of a 'resistant' subset of B cells (CD5 + ve), failure of anti-idiotypic control of autoantibodies (not well established as yet in rheumatoid arthritis), and defective immune suppression, revealed by low counts in synovial fluids of a suppressor-inducer subset of CD4 + ve T cells. The many possibilities for therapeutic immune intervention would include polyclonal or monoclonal antibody to block (a) receptors for antigen on B or T lymphocytes (but this would require knowledge of the rheumatoid arthritis-inducing antigen), (b) the CD4 complex on helper T lymphocytes, (c) MHC Class II (Ia) molecules, for which there are excellent prototypes in experimental immunopathology, or (d) lymphokines or their receptors. Induction of suppression by 'tolerogenic vaccines' is experimentally validated, but only for diseases for which an autoantigen can be identified. |