Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 3718553 | A multicenter study of hospitalization in rheumatoid arthritis. Frequency, medical-surgica | 1986 May | During 1981, 123 of 816 patients (15.1%) with rheumatoid arthritis were hospitalized 160 times because of the disease. The mean length of hospitalization was 13.1 days, and the cost $7,845. Surgery accounted for 54.4% of admissions, but 69.2% of costs. The average cost for total joint surgery was $12,287. Most medical admissions (46.6%) were for the diagnosis or treatment of articular disease, but 42.5% were for treatment of side effects of therapy, and 11.0% for complications of RA. The most commonly performed surgical procedures included reconstructive surgery of the hand/wrist (n = 35) and foot (n = 22), followed by total knee replacement (n = 18). | |
| 3764520 | Infection versus disease activity in rheumatoid arthritis: eight years' experience. | 1986 Oct | Septic arthritis is a serious and sometimes fatal complication of rheumatoid arthritis. We have examined the clinical characteristics of 16 patients with infectious arthritis seen during an eight-year period. This represented 0.5% of all admissions to our hospital for patients with rheumatoid arthritis. Although rheumatoid arthritis is considered a predisposing factor for joint sepsis, 15 of our patients had other conditions that most likely increased their susceptibility to infection. Many patients lacked distinctive features of joint sepsis (fever, chills) and only one half had leukocytosis. Six had polyarticular complaints despite documented monarthric sepsis. Delay in diagnosis of joint infection and persistent effusions of the infected joints portended a poor prognosis. | |
| 2307867 | Use of a flap of flexor retinaculum to cover bone after osteophyte removal within the carp | 1990 Feb | We describe three instances of ruptured flexor pollicis longus tendons due to bony spurs within the carpal tunnel. In each case, the bony spur was excised and the remaining exposed bone was covered with a flap of flexor retinaculum. | |
| 3602944 | Flattening of the rheumatoid foot in tarsal arthritis on X-ray. | 1987 | 222 consecutive and unselected patients suffering form classical or definite rheumatoid arthritis wee studied. 397 of their feet were examined. Talonavicular arthritis was the commonest finding (31.5% of all patients), followed by sub-talar (23.3%), cuneo-navicular (20.4%) cuneo-metatarsal (14.9%) and tibio-tarsal arthritis (12.6%). Rheumatoid disease of the tarsus becomes commoner as the disease progresses. The incidences of involvement of the talo-navicular and sub-talar joints show a similar pattern, with a leap of 25% between 5 years of duration of the disease and 10 years. The same is seen with involvement of the cuneo-navicular and cuneo-metatarsal joints, between a duration of 10 years of the disease and 15 years. The percentage of flat foot is greater in feet with tarsal arthritis (p less than 0.001). The authors observed a relationship between tarsal arthritis, the length of history of rheumatoid arthritis, and flat foot. The method of investigation is discussed, and theories about evolution of the rheumatoid foot are considered. | |
| 1979349 | Clinical and laboratory effects of prolonged therapy with sulfasalazine, gold or penicilla | 1990 Oct | Serial observations for up to 5 years of clinical score (a subjective global assessment), serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were analyzed in 3 groups of patients with active rheumatoid arthritis (RA) requiring treatment with a second line drug. The groups comprised 315 patients (243 women, 72 men) who had sulfasalazine (SAS); 203 patients (141 women, 62 men) who had sodium aurothiomalate (gold) and 163 patients (131 women, 32 men) who had penicillamine. The groups matched in most respects but the gold group had a smaller proportion of women, a shorter median disease duration and a higher median CRP than the remaining 2 groups. The penicillamine group contained a higher proportion of seropositive patients. In each group there were significant improvements in clinical score, CRP and ESR for all time points from 6 to 30 months; these improvements were maintained for longer (up to 60 months for SAS) in the SAS and gold groups but the differences between the drugs after 30 months were probably a consequence of falling number of patients, not differing drug potencies. The mean ESR and CRP levels fell to about 30 mm/h and 20-30 mg/l, respectively. Response was defined as (1) treatment duration greater than 6 months, (2) clinical score improvement greater than 4 by 6 months, (3) ESR fall to less than 30 mm/h by 6 months. By these criteria 142 of 681 patients (20.9%) responded; the response rates were SAS 20.3%, gold 24.1%, penicillamine 17.8%.(ABSTRACT TRUNCATED AT 250 WORDS) | |
| 2688077 | Critical review of clinical assessment techniques for rheumatoid arthritis trials: new dev | 1989 | Since the early work of Taylor (1937) and Steinbrocker (1949), clinical methods of assessing the response of patients to anti-rheumatic drugs have undergone considerable revision. The evolution of clinical metrology has seen simplicity yield to complexity, and in some instances resulted in controversy. Clinical assessment techniques (indices) for rheumatoid arthritis (RA) trials should fulfil ten fundamental criteria: the index should be designed for a specific purpose (clinical versus radiographic, short versus long-term, unidimensional versus multidimensional outcomes); the index should have been validated on individuals or populations of patients having similar characteristics to future study populations; reliability (test-retest, intra-class correlation, observer agreement) should be adequate for achieving measurement objectives; validity (face, content, criterion, construct) should be adequate for achieving measurement objectives; the index must be sufficiently responsive, i.e. able to detect significant change in the underlying variable; index performance should have been maintained in subsequent applications under similar study conditions; the method of deriving scores, particularly in composite indices, should be both credible and comprehensive; the feasibility of data collection and instrument application should not be constrained by time or cost; the measurement process must be ethical; and finally, utilisation of the index should have been adopted by other clinical investigators. Despite progress in clinical assessment techniques in RA trials, there is still insufficient standardisation. This situation could be improved with further outcome conferences and consensus development exercises. | |
| 2595339 | Course and prognosis of early rheumatoid arthritis. | 1989 | Lessons learned from a 20 year prospective study of 100 Rheumatoid Arthritis (RA) patients are considered. Forty six had died and the causes of death are discussed and correlations with early features; the findings in the survivors and the patterns of the course of arthritis and treatment are described. A loss of life expectancy was observed: the 9 patients whose deaths were due to RA or its systemic complications, died some 15 years prematurely; the 8 in whom RA contributed to death died some 10 years prematurely and in the 29 in whom death was unrelated to RA, death was premature by about 5 years. Already after 1 year of arthritis the functional capacity was reduced in those patients who later died due to RA or in whom RA or its treatment contributed to death. The men died earlier than the women and overall mortality in men was higher despite a younger age at onset. Patients with persistently high ESR and strong seropositivity for rheumatoid factor also did badly. Of the patients, who had died, the functional capacity at last review before their deaths was noted. It appears that already 1-8 years before their deaths 35% of the patients were confined to chair or bed (Steinbröcker grade IV) and 24% markedly restricted (grade III). These figures show that prognosis of RA patients referred to a rheumatologist is probably worse than generally suggested. Rheumatoid arthritis is a severely disabling and potentially lethal disease. | |
| 2012961 | Bone mineral content in patients with rheumatoid arthritis: relationship to low-dose stero | 1991 Apr | Bone mineral content (BMC) of the distal forearm was measured by single photon absorptiometry in 142 patients with rheumatoid arthritis (RA) of whom 27/54 men and 44/88 women received low-dose steroid therapy (less than 10 mg/day). To study the effect of steroid therapy a case-control analysis was undertaken in patients matched for age, sex and disease duration. Steroid therapy was associated with a reduced BMC in men (1.16 +/- 0.29 versus 1.32 +/- 0.23; P less than 0.05) and post-menopausal (0.76 +/- 0.24 versus 0.91 +/- 0.25; P less than 0.02) but not pre-menopausal women (1.1 +/- 0.28 versus 1.1 +/- 0.17). Symptomatic fractures were more common in steroid-treated patients than in those who had not received steroids (10/71 versus 2/71; P less than 0.05). Serum osteocalcin, an index of bone formation, was measured in 106 cases. It tended to be higher in patients with RA than in controls but the values observed in steroid and non-steroid RA groups did not differ significantly. We conclude that low-dose steroid therapy is associated with increased bone loss and numbers of fractures in patients with RA but this does not appear to be the result of a simple defect in bone formation. | |
| 2155456 | [Magnetic resonance tomography (MRT) of the hand in chronic polyarthritis]. | 1990 Feb | Forty hands of 39 patients with rheumatic joint disease were examined by MRT. The method differentiates between inflammatory exudative and proliferative processes in soft tissues and bone. T2-weighted images provided criteria for judging the activity of the disease. MRT provided better demonstration of the soft tissues than just conventional radiography. The methods were of equal value for showing bone lesions. MRT is suitable as a means of diagnosing rheumatoid changes in the hand. | |
| 3740682 | Risk factors for hospitalization and surgery in patients with rheumatoid arthritis: implic | 1986 Sep | Risk factors for hospitalization in patients with rheumatoid arthritis were analyzed to determine if factors proposed for use in adjusting Medicare capitation payments to prepaid health plans are, in fact, associated with use of costly medical care for this illness. Participating physicians from a random sample of half the rheumatologists in northern California provided us with the names of all patients with rheumatoid arthritis presenting during a 1-month period. We surveyed 754 (89%) of these patients in both 1982-83 and 1984 to obtain information about health care use in the previous 12 months. We found that baseline functional status and prior-year admissions (proposed Medicare adjustment factors), as well as disease-specific severity measures, predicted subsequent admissions. The association of prior with subsequent admissions was independent of disease severity and physician characteristics. Adjusting capitation payments for both health status and prior use will increase incentives for prepaid health plans to enroll patients with rheumatoid arthritis who have high expected medical costs. | |
| 2261732 | Methotrexate therapy in rheumatoid arthritis. A two year prospective follow-up. | 1990 Sep | One hundred and thirty seven rheumatoid arthritis (RA) patients refractory to D-penicillamine and some of them (15%) refractory to other slow active drugs were treated with oral methotrexate (MTX) (10-15 mg weekly). After 12-24 months of treatment, 94 and 74 patients respectively showed a significant improvement as judged by duration of morning stiffness (p less than 0.0001), grip strength (p less than 0.0001), degree of joint swelling (p less than 0.01) and tenderness (p less than 0.0001) compared to pre-treatment values. This clinical improvement was also associated with a decrease of erythrocyte sedimentation rate (p less than 0.001), decrease of C-reactive protein (p less than 0.0001) and with improvement of anaemia (p less than 0.05). No changes were seen in rheumatoid factor titres. Seventy-four of the patients were followed for up to 24 months. Thirty-one of them (23%) had complete remission and 43 (31%) had an excellent response. Adverse drug reaction during MTX therapy included: elevated liver enzymes in 34 patients, mucosal ulcers in 21, nausea and vomiting in 8, diarrhoea in 4, leukopenia in 2, interstitial pneumonitis in one, intestinal bleeding in one and finally septic arthritis in another patient. The majority of these side effects were resolved without sequelae. However, 15 patients (11%) with adverse drug reactions had to discontinue the treatment. Forty-one of our patients who received a cumulative mean dose of MTX of 1550.5 +/- 235.5 mg underwent a percutaneous liver biopsy. Ten patients had normal tissue, 12 had minimal changes, 13 nonspecific changes and 6 patients had mild fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS) | |
| 2348429 | Spondyloarthropathy and rheumatoid arthritis in Alaskan Yupik Eskimos. | 1990 Apr | In a Yupik Eskimo population, the prevalence, incidence and clinical features of rheumatoid arthritis (RA) were similar to those described for the United States population in general. More frequent than RA were seronegative spondyloarthropathic disorders, many of which could not be classified by existing disease criteria. Of the adult patients with spondyloarthropathy only half could be classified as having Reiter's syndrome (RS), ankylosing spondylitis (AS) or psoriatic spondylitis. The remaining patients had many signs and symptoms consistent with spondyloarthropathy, but they either did not meet the diagnostic criteria for any specific disease or had features pathognomonic of more than one. The clinical manifestations of the patients who did not meet standard disease definitions are summarized and compared to those of the patients with RS, AS and psoriatic spondylitis. Because of the many shared features, we believe that these as yet unclassified disease states belong with AS and RS in a single spondyloarthropathic disease spectrum and should be defined and recognized as such. | |
| 2073744 | Serum baseline hyaluronate and disease activity in rheumatoid arthritis. | 1990 Dec 13 | The baseline serum hyaluronate (HA) concentration from samples obtained five to seven hours after mobilization of the patient was quantified using a radiometric 125I-HA binding method in 58 patients with rheumatoid arthritis and compared with several clinical and laboratory parameters by means of stepwise multiple linear regression. In the age- and sex-adjusted model, the variables with independent predictive value for serum hyaluronate concentration were the erythrocyte sedimentation rate (ESR) and the joint score index measuring the extent of the synovial inflammation. The estimated synovial mass index and C-reactive protein values did not improve the fit of the model after ESR and joint score were entered, and were left out from the multiple regression equation. When ESR and joint score were studied in univariate regression analysis with serum hyaluronate, the coefficients were r = 0.492 and r = 0.397, and the P values were P less than 0.001 and P less than 0.005, respectively. It was concluded that the baseline hyaluronate level in serum is closely related to the synovitic activity of the rheumatoid inflammation and that measurement of serum hyaluronate is of value when the activity and extent of synovial inflammation is being assessed in patients with rheumatoid arthritis. | |
| 2803785 | Assessment of labial salivary gland changes in patients with rheumatoid arthritis by subje | 1989 | Biopsy of the minor salivary glands is an accepted method in the diagnosis of Sjögren's syndrome, the most characteristic feature being the prominent inflammatory cell infiltration. However, difficulties exist in the early diagnosis of Sjögren's syndrome. The present study was conducted to analyse by subjective and quantitative methods the morphological changes of the salivary glands in patients with rheumatoid arthritis (RA) frequently complicated by Sjögren's syndrome. The subjects of this study were 71 RA patients (mean age 54 +/- 15 years) and their 45 healthy age-matched controls (mean age 60 +/- 14 years). The histologic parameters evaluated were: inflammatory cell infiltration; acinar atrophy; fibrosis, and fatty infiltration. Statistically significant differences between the RA and the control groups were found in all parameters (p less than 0.001) except the fatty infiltration. This indicates that destruction of the salivary glands including fibrosis and acinar atrophy is associated with RA. Only the fatty infiltration seems to be an age-dependent change. All salivary gland biopsies of the RA patients were photographed and evaluated planimetrically, for the same parameters as in the subjective evaluation. An excellent reproducibility between the two methods was found, thus indicating the applicability of the subjective evaluation in the assessment of early salivary gland changes in RA patients. | |
| 1802498 | Relationship of the functional status, duration of the disease and pain intensity and some | 1991 Dec | A sample of 61 patients with rheumatoid arthritis was studied to assess the interrelationship between depression, helplessness, functional abilities, pain intensity and duration of the disease. The following questionnaires were employed: Arthritis Helplessness Index (AHI), Epidemiological Studies Depression Scale (CES-D), and the Modified Health Assessment Questionnaire (MHAQ). The pain intensity level was assessed using the Visual Analogue Scale (VAS). Significant interrelationship of MHAQ with VAS and AHI was found as well as between AHI and CES-D and VAS and CES-D. A slight interrelationship between AHI and CES-D was also found. The results obtained from two groups of patients--one including patients with the disease lasting from 1 to 5, and the other extending over a period of 15 to 24 years--were compared. The second group manifested significantly greater difficulties in performing their everyday activities (MHAQ). | |
| 3624579 | Low-dose methotrexate therapy for cutaneous vasculitis of rheumatoid arthritis. | 1987 Aug | A patient with classic rheumatoid arthritis who developed leukocytoclastic vasculitis is described. Low-dose methotrexate produced prompt healing of the skin lesions. After discontinuation of methotrexate, the lesions recurred, with resolution after a second course of the drug. Methotrexate may be useful in the treatment of cutaneous vasculitis associated with rheumatoid arthritis. | |
| 3137902 | Prediction of erosiveness and rate of development of new erosions in early rheumatoid arth | 1988 Aug | Fifty eight patients suffering from a recent onset of rheumatoid arthritis (RA) were studied. Fifty six patients were followed up for 24 months and two for 18 months. Erosions were detected in 17 patients at the onset and at the end of the follow up period the number of patients with erosions was 44. The erosiveness in the joint groups studied was as follows: metatarsophalangeal (MTP) (36 patients), metacarpophalangeal (MCP) (22), proximal interphalangeal (PIP) (21), interphalangeal (IP) joints of first toes and wrists (13), elbows and knees (two), and shoulders, ankles, and hips (one). Erosiveness in the feet was twice that in the fingers, and the erosions in the feet appeared at an earlier phase of disease. Destructions favoured the dominant hand. Swelling in the PIP joints appeared to be a better predictor of erosiveness than joint tenderness. The number of joints to become eroded was significantly increased in the patients with flexor tenosynovitis in the hands. Erythrocyte sedimentation rate (ESR) was more closely related to progression of joint damage than C reactive protein (CRP) or haemoglobin. The rate of development of new erosions was the same in seronegative and seropositive patients. In addition, HLA-DR4 allele did not correlate either with seropositivity or with erosiveness. Adequate antirheumatic drug treatment (gold in most instances) was not able to restrain the erosive process despite decreased rheumatoid disease activity. | |
| 2787015 | [Possibilities and prospects of multiparameter immunologic examination in the diagnosis an | 1989 Mar | The authors have analysed data from literature and their own results concerning multiparameter examination of the patients with rheumatoid arthritis. An effort has been made to establish a correlative relationship between changes in the following immunologic values: the level of rheumatoid factor, circulating immune complexes, antibodies to streptolysin-0 and immunoglobulin G; the number of T-lymphocytes and the quantity of natural cells of the killers and the hormone regulatory activity of thymus. Positive interdependence between the presence of rheumatoid factor and that of antibodies to streptolysin-0 as well as an increase in the content of circulating hormone complexes has been determined. In view of absence of one value which is strictly specific and compulsory for rheumatoid arthritis, it is only complex investigation that allows to describe the trends in changes of the immunologic state of the patient with rheumatoid arthritis. | |
| 1857811 | [Pleuro-pulmonary manifestations of rheumatoid polyarthritis]. | 1991 | Sensitive investigations such as pulmonary function tests, broncho-alveolar lavage or computered tomography at high resolution enable pleuro-pulmonary disease to be detected in nearly 50% of those patients studied who had rheumatoid arthritis (PR). The prevalence of these manifestations is most usually elevated in male PR sufferers, those who are sero-positive or have associated extra-articular signs such as sub cutaneous nodules. More recently there has been evidence of genetic risk factors linked to HLA grouping or Pi phenotype. Amongst the usual manifestations, the pleurisies and above all necrobiotic nodules, which are most often asymptomatic, sometimes pose difficult problems in differential diagnosis, particularly when they precede the articular disease. The diffuse interstitial fibrosis remains the most worrying specific complication due to the fact of its potential seriousness. The pathophysiology of this form of fibrosis is better understood since the introduction of LBA. In the absence of any specific controlled studies its treatment remains impirical and is similar to that given for diffuse or idiopathic interstitial fibrosis. Pulmonary vascularity, the bronchiolitis obliterans with organising pneumonia and apical fibrosis, very similar to Hamilton's syndrome, are much rarer manifestations. On the other hand non specific respiratory infections are the cause of death in 10-20% of cases. Bronchiolitis obliterans induced by D Penicillamine is the most severe iatrogenic manifestation, since corticosteroid therapy associated with immunosuppressive drugs enables at best a stabilisation of the alveo bronchiolar lesions. More recently there have been twenty observations of hypersensitivity pneumonia to low dose methotrexate. The prevalence of these pulmonary disorders during the treatment of PR is around 5%. However the respiratory contraindications of these drugs which are being used more and more and the methods of pulmonary surveillance under treatment are not yet defined. | |
| 3780144 | Total and peripheral bone mass in patients with psoriatic arthritis and rheumatoid arthrit | 1986 Sep | Psoriatic arthritis is thought to be associated with periarticular osteoporosis while rheumatoid arthritis may be associated with generalised as well as periarticular bone loss. To assess the extent of total and peripheral bone loss in these two diseases, total body calcium was measured by in vivo neutron activation analysis and peripheral bone mass was assessed by metacarpal indices in age-matched patients with psoriatic arthritis and rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs alone. In comparison with age and sex-matched normal controls, total and peripheral bone mass was normal in psoriatic arthritis. There were significant reductions in total (6.2% in men; 7.9% in women) and peripheral (10.9% in men; 12.8% in women) bone mass in patients with rheumatoid arthritis compared with controls. Peripheral bone mass was significantly correlated with the degree of radiographic damage in male and female patients with rheumatoid arthritis. The mean annual loss of total body calcium was insignificant in psoriatic arthritis (0.6% in men; 1.9% in women) but markedly greater in rheumatoid arthritis (4.4% in men; 2.7% in women). The data suggested that total and peripheral bone loss is greater in rheumatoid arthritis than psoriatic arthritis. Substantial reductions in peripheral bone mass in patients with rheumatoid arthritis not receiving corticosteroids may account in part for the small reductions in total bone mass. |