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PMID	Title	PublicationDate	abstract
3162870	Reduction of prostaglandin E2 concentrations in synovial fluid of patients suffering from	1988	Prostaglandin E2 (PGE2) is a potent stimulator of inflammation, and the inhibition of its synthesis is one possible mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs). We have investigated patients suffering from rheumatoid arthritis to determine how synovial fluid levels of PGE2 are affected by tiaprofenic acid or indomethacin medication. Ten patients suffering from rheumatoid arthritis were studied, with 5 patients receiving tiaprofenic acid and 5 indomethacin for a 1-week period. Synovial fluid and serum samples were collected over an 8-hour period on days 1 and 8; these were then assayed for PGE2 and active drug concentrations. The concentration of PGE2 in the synovial fluid fell consistently as the concentration of each drug rose, and low levels of PGE2 persisted on continuation of the medication. Tiaprofenic acid appeared to cause a faster onset of inhibition of PGE2 synthesis than indomethacin.
2979825	The pathogenesis of rheumatoid arthritis.	1988 Jan	The results of recent immunohistological studies and ex vivo and in vitro experiments in rheumatoid arthritis (RA) are presented. These findings are used as the basis for a unifying concept of the pathogenesis of RA which serves to explain many clinical and laboratory features of this disease. This hypothesis, which may be regarded for experimental purposes as being analogous to the in vitro AMLR, provides a rational basis for the further analysis of the cellular immune mechanisms operating in RA and the development of effective therapeutic regimens. The ultimate goal is the early diagnosis and cure of RA before the development of irreversible joint damage.
1835800	Social support, disability and depression: a longitudinal study of rheumatoid arthritis.	1991	The objectives of this study were (i) to assess aspects of the reliability and validity of an instrument measuring social support and social relationships, in the field of physical disability; (ii) to assess the impact of disability on social relationships and (iii) to examine effects of social support upon psychological well-being over time. One hundred and forty nine individuals with rheumatoid arthritis (RA) were assessed on two occasions separated by 15 months. Social support was assessed by means of the Interview Schedule for Social Interaction. The instrument was found to have satisfactory reliability and validity. It revealed that more diffuse social relationships were more affected by RA. Scores for social relationships were as strongly related to depressed mood over time as were disease and disability variables.
2783021	Bilateral total hip and knee replacement in rheumatoid arthritis patients.	1989	Between 1978 and 1983, 14 patients suffering from rheumatoid arthritis were treated by bilateral total hip and knee replacement. At the time of this follow-up study (32-92 months postoperatively) one patient had died of concomitant disease and was excluded. The postoperative results regarding pain relief, improvement in performing daily activities, and function were studied in the remaining 13 patients. A 200-point rating scale was used, which compared the pre- and postoperative findings at follow-up. All patients showed marked relief from pain, good function and a good functional score. Although walking ability did not always improve, all patients were enthusiastic.
3184068	HLA: linkage with rheumatoid arthritis or seropositivity.	1988 Aug	HLA haplotype sharing was compared in sibships from multicase families with rheumatoid arthritis (RA), subdivided by rheumatoid factor status, to investigate the claim that HLA is linked more to RA severity than susceptibility. Considerable deviation from expected (Mendelian) inheritance towards greater sharing of inherited parental haplotypes was observed in the sibships as a whole and when subdivided according to the serological status of the sibship's members. Further, there was no evidence that linkage was stronger in the seropositive concordant than in the other sibships. Linkage was also demonstrated between HLA and seropositivity even in sibships where not all members expressed clinical RA. These results, therefore, do not support the existence of genetic heterogeneity between seropositive and seronegative RA, a possibility previously suggested from population studies of antigen associations.
1802496	Rheumatoid metatarsus. The original evolution of the first metatarsal.	1991 Dec	Three hundred and eight unselected rheumatoid feet underwent a weight-bearing X-ray examination. If the malformations of the forefoot studied here present a statistical association, the primus metatarsus adductus is closely connected with tarsal arthritis and flattened foot but does not depend on the duration of the disease. The spread forefoot is indeed related to the duration of the disease and the presence of a metatarsal erosion at the foot level, but is not affected by the lesions of the midfoot. It appears then that an early orthopaedic treatment should be prescribed, once the first signs of involvement of the first ray or pronounced pronation of the hindfoot are noticed; it must affect the hindfoot, the midfoot and the first ray which progress together.
1991217	The development and use of Patient Knowledge Questionnaire in rheumatoid arthritis.	1991 Feb	A multi-choice Patient Knowledge Questionnaire (PKQ) was developed for use with patients with rheumatoid arthritis (RA). Test/re-test was used to test its stability (r = 0.81), and Kuder Richardson formula 20 (r = 0.72) for internal consistency. Seventy randomly selected RA patients then completed the PKQ in a rheumatology out-patient clinic of a large teaching hospital. There was a wide variation in total scores ranging from 3 to 28 out of 30. Total scores correlated with years of general education (P less than 0.05) but not with disease duration or age. Sixty-two per cent of patients knew that the cause of RA is, as yet, unknown but 27% thought it could be caused by injury and 11% by cold damp weather. Fifty-two per cent had no idea why they had blood tests. All but four patients were taking some form of medication but there was widespread confusion about disease-modifying drugs and non-steroidal anti-inflammatory drugs (NSAIDs). Exercise was reasonably well understood but many patients were unable to differentiate between methods of energy conservation and joint protection. This study highlights the need for careful individual knowledge assessment by use of tools such as the PKQ and effective patient education programmes.
2650798	Combination therapy with gold and hydroxychloroquine in rheumatoid arthritis: a prospectiv	1989 Apr	We studied combination therapy with two slow-acting antirheumatic drugs given concurrently in active rheumatoid arthritis (RA). A 12-month prospective randomized controlled trial compared gold and hydroxychloroquine in 52 patients to gold and placebo in 49. The patients continued to receive non-steroidal anti-inflammatory drugs and analgesics. They were selected from three rheumatology centres in the West Midlands. Combination therapy led to a greater number of withdrawals due to adverse reactions (18 cases compared to 10 receiving gold/placebo). Patients completing 12 months' therapy (27 taking gold/hydroxychloroquine and 32 on gold/placebo) were compared using five clinical, seven laboratory, and one radiological measure. All 13 variables favoured gold/hydroxychloroquine with an overall advantage of 20-25% for the combination. This only reached statistical significance (at the 1% level) for C-reactive protein. An overall disease activity index was better at 12 months (at the 5% level) and showed a more rapid response with gold/hydroxychloroquine. This is the first randomized prospective placebo-controlled trial to show a significant advantage from a combination of two slow-acting drugs. There are many different ways of giving such combinations and we consider these should be explored to maximize the effectiveness of treatment for RA.
1784889	Histology of joint inflammation induced in rats by cell wall fragments of the anaerobic in	1991	To study the arthropathic properties of human intestinal bacteria, cell wall fragments (CWF) of the anaerobic bowel bacterium Eubacterium aerofaciens were injected intraperitoneally (i.p.) in arthritis-susceptible Lewis rats. Rat paw joints were subsequently studied for histopathological changes. A persisting synovitis accompanied by marginal erosions of cartilage and bone and a marked periosteal apposition of new bone tissue were the main features of the polyarthritis induced. These results are discussed in relation to streptococcal cell wall induced arthritis and compared with histopathological findings in rheumatoid arthritis (RA) in man.
3418622	Selective destruction of the calcified zone in a patient with seronegative rheumatoid arth	1988 Jun	A 41-year-old woman with seronegative rheumatoid arthritis is presented. Three metatarsal heads showed a nearly selective destruction of the calcified zone of cartilage while other zones remained intact. The mechanisms underlying joint destruction are discussed.
2388997	Chronic pericardial disease in patients with rheumatoid arthritis: a longitudinal study.	1990 May	We have reviewed the clinical and investigative findings in 13 patients with chronic pericardial disease and seropositive rheumatoid arthritis. In eleven cases the diagnosis was made on clinical grounds, while the diagnosis was confirmed only at post-mortem in two patients. Pleural effusions were present in seven patients, while pulsus paradoxus was found in only one case. Echocardiograms were undertaken in ten patients and all showed evidence of pericardial effusions, which were usually small and sited posteriorly. A delayed ventricular filling pattern indicating abnormal ventricular relaxation was seen in two patients with cardiac tamponade. The surviving 11 patients were reviewed a median of three years after diagnosis of their pericardial disease. Pericardectomy had been performed in six, all of whom were asymptomatic and had a normal chest radiograph. Steroids alone had been given to the other five, and three of these remained dyspnoeic with cardiomegaly. The clinical features distinguishing chronic pericardial disease from other causes of right heart failure in rheumatoid arthritis patients are subtle. As management is fundamentally different, serious consideration should be given to the diagnosis of chronic pericardial disease in any patient with rheumatoid arthritis who presents with right-sided heart failure.
2303092	[Histopathological study of arthritic lesions induced by immunization with type II collage	1990 Jan	Eight male DBA/1J mice immunized twice by intradermal injection of type II collagen were autopsied 12 weeks after the first immunization and analyzed for anti-type II collagen antibody level, and the limb joints were examined radiologically and histopathologically. Clinical onset of swelling and erythema in the limb joints occurred about 5 weeks after the first immunization and deformity of the limbs was observed in a few animals about 5 weeks later. Although there were marked individual differences, serum anti-type II collagen antibody levels were elevated in all animals. Histopathologically, the changes were similar to those seen in human rheumatoid arthritis and were characterized by proliferation of synovial lining cells, formation of granulation tissue with destruction of cartilage and subchondral bone, and ankylosis. Systematic examination of various joints of the fore- and hind-limbs revealed definitely that the sequence of arthritic lesions was not uniform. The knee joint was involved most frequently, but smaller joints such as the phalangeal joints were involved less frequently but exhibited severe changes. The significance of histopathological examinations in the evaluation of effects of anti-rheumatic drugs was discussed with reference to this model.
2487707	Compliance and quality of life: confessions of a difficult patient.	1989 Sep	Noncompliance has been treated as a deviant behavior. This paper argues that nonadherence is more complex and is the expression of independence and a judgment about the utility of any medical, surgical, or rehabilitation intervention. The quality of one's life is a personally defined concept and so too are the reasons why a patient refuses to do what is recommended. Appropriate health behavior should be thought of as a behavior that meets the person's goals and achieves some mutually definable outcome.
3707221	Small joint involvement: a systematic roentgenographic study in rheumatoid arthritis.	1986 Apr	Standard hand and foot roentgenograms from 200 consecutively hospitalised patients with definite or classical rheumatoid arthritis (RA) were read for marginal erosions by three independent observers. For each joint or group of joints analysed the degree of symmetry (S = absolute symmetry, U = unilateral, PS = partial symmetry) was determined. The total number of joints affected significantly correlated only with disease duration; symmetry of erosions and number of affected patients were not influenced by seropositivity. Metatarsophalangeal erosions (in 70%) were the most common and were classified as S in 16%, U in 21%, and PS in 63%. Metacarpophalangeal erosions (in 68%) were also common, with a symmetry pattern of S in 19%, U in 21%, and PS in 60%. Proximal finger interphalangeal erosions (in 42%) were unilateral in 42% (S in 8% and PS in 50%). The only site where symmetry was usual (90%) was the wrist, but radiocarpal and intercarpal joints were considered together. Erosions also occurred in about 16% of the finger distal interphalangeal and 28% of the great toe interphalangeal joints. In RA roentgenographic asymmetry is usual and unilateral involvement common.
2058315	[The cricoarytenoid joint in chronic polyarthritis].	1991 Jan	The cricoarytenoid joints are frequently asymptomatically involved in rheumatoid arthritis with a severe course. At least the symptoms recede into the background compared with the other complaints. Signs of obstructive laryngeal changes are often falsely interpreted. Dangerous respiratory tract obstructions may be initiated by bacterial infections of the larynx and mechanical laryngeal changes or by the acute exacerbation of the arthritis. The clinical diagnosis of CA-arthritis is supplemented by laryngoscopic, radiologic and computertomographic techniques. Simple clinical examination methods only are relevant for routine or screening tests. The differential diagnosis requires consideration of neurogenic, traumatic, infectious or neoplastic and psychosomatic diseases. Corticosteroids and non-steroidal antiinflammatory drugs are of doubtful value in treatment. Physical conservative methods are usually sufficiently effective for prophylaxis and control of symptoms. In an emergency tracheotomy can be life-saving. Arytenoidectomy or mobilisation and lateral fixation of the vocal chord are considered definitive treatment.
2765010	Sleep fragmentation in rheumatoid arthritis.	1989 Aug	Fatigue is commonly reported by patients with rheumatoid arthritis (RA), and it is frequently used to evaluate disease activity and response to therapy. We theorized that the feeling of fatigue in patients with RA may be a manifestation of disturbance of sleep. Sixteen patients with chronic, active RA, who were selected for early onset of fatigue (less than 6 hours after morning awakening), were extensively evaluated by formal all-night polysomnographic recording and multiple sleep latency testing (MSLT). Although no sleep deprivation was found, all patients had some type of marked disturbances of sleep, including unanticipated sleep apnea (2 patients), frequent movement of extremities (all 16 patients), and frequent arousal (all 16 patients). The alpha-delta sleep pattern was present in 13 patients, and 7 were found by MSLT to be hypersomnolent. None of the patients accurately recognized the degree of their sleep disruption. Our findings from the MSLT indicate that fatigue in patients with RA may be a manifestation of sleep fragmentation, rather than a nonspecific constitutional symptom.
2619359	Immune complexes and rheumatoid factors in canine arthritides.	1989 Dec	Thirty two domestic dogs with naturally occurring polyarthritis were investigated to determine the contribution of autoimmunity in the pathological mechanisms. Comparisons were made with canine infective arthritis (12 dogs), osteoarthritis (32), and osteoarthritis secondary to rupture of the cranial cruciate ligament (19). Rheumatoid factors, immune complexes, and complement fixation (C1q binding) were measured in sera and synovial fluids. Compared with normal dogs (32), dogs with rheumatoid arthritis (RA) had increased serum and synovial fluid immune complexes and rheumatoid factors. Increases were generally also seen in dogs with other arthropathies, however. Rheumatoid factors were higher in sera than in synovial fluids. Rheumatoid factors correlated with immune complex levels and complexed rheumatoid factor only in the group of dogs with RA. Both rheumatoid factors and immune complexes may contribute to the pathogenesis of canine RA but are considered to arise as a result of non-specific inflammatory mechanisms in the non-rheumatoid groups.
1994916	Clinical correlations with serum C1q levels in patients with rheumatoid arthritis.	1991 Feb	Previous studies have suggested that serum C1q levels measured during the first 5 years of rheumatoid arthritis (RA) may be predictive of the extent of subsequent joint damage. To further evaluate the clinical significance of this marker in RA, levels of C1q were measured by radial immunodiffusion in serum samples from 107 well-characterized patients with RA. Mean levels of C1q were higher in patients with a disease duration less than or equal to 5 years (173 micrograms/ml) than in patients with a disease duration greater than 5 years (148 micrograms/ml) (P = 0.032). Serum C1q levels were correlated with total joint counts and activities of daily living scores, but no correlation was observed with erythrocyte sedimentation rates or with radiographic scores. The results suggest that C1q may be a useful early marker of disease activity in patients with RA.
2241304	Surgery of the rheumatoid elbow.	1990 Oct	I suggest that for too long the problem of the rheumatoid elbow, particularly the need for surgical intervention, has been underestimated. Where the latter has been advocated the philosophy has been adopted that synovectomy and debridement with excision of the head of the radius is probably all that is required, or that in the late case excision arthroplasty may yield an adequate result. I suggest that these approaches are no longer tenable. Synovectomy and debridement with or without excision of the head of the radius does indeed retain an extremely valuable place in the management of stage 1, 2, and early stage 3 disease. In the later stages of the disease, however, serious consideration must now be given to total joint replacement, the results of which can be remarkably successful and durable, and the complications from which can now be contained within acceptable limits provided that the operating team is fully experienced. It must also be stressed how necessary it is in the medical or combined clinic to pursue careful clinical and radiological monitoring of the rheumatoid elbow so that signs of dangerous deterioration can be recognised early, and surgery applied at a time when optimal conditions for the particular surgical weapons to be used still exist.
3689462	Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography	1987 Nov	In a prospective study of 6 patients with classic rheumatoid arthritis, we evaluated 3 measures of disease activity: comprehensive joint swelling and joint tenderness counts, and ultrasonography of joints. After baseline data were obtained on these 6 patients, therapy with fenbufen, a new nonsteroidal antiinflammatory drug, was begun. Followup examinations were performed at 4 weeks and 24 weeks after baseline. There were statistically significant differences between joint tenderness and joint swelling findings and between joint tenderness and joint ultrasonography findings (P less than 0.05 by kappa test statistic). In comparisons of joint swelling and ultrasonography, no difference was found (P greater than 0.05). When measures of changes over 6 months were compared, there was a high concordance between improvement in joint swelling and improvement in joint ultrasonography (P less than 0.01). Our results demonstrate that clinical assessment of joint swelling provides an accurate measure of synovial effusion, as confirmed by the more objective ultrasound measurements.