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ID PMID Title PublicationDate abstract
30756048 Seropositive Rheumatoid Arthritis with Very Unusual X-ray Findings. 2018 We described the case of a 23-year-old Nepalese man with seropositive rheumatoid arthritis and abnormal x-ray findings, found to be due to a very rare bone disease: Camurati Engelmann disease or progressive diaphyseal dysplasia (PDD). This is the first case reported in the Gulf area, although approximately 300 cases have been described worldwide. These patients usually present with limb pain and easy fatigability. Our patient first presented with bilateral, symmetrical inflammatory polyarthritis involving the knees, ankles and wrists but sparing the hands and feet. The diagnosis of PDD in our case was based on the classic radiological findings and a bone scan. LEARNING POINTS: Rheumatoid arthritis is a common condition with typical radiological findings.Any unusual radiological finding should be carefully assessed and explained.In our case the unusual findings were due to progressive diaphyseal dysplasia.
30487996 Comparative analyses of responsiveness between the Rheumatoid Arthritis Impact of Disease 2018 OBJECTIVE: To evaluate the responsiveness of the Rheumatoid Arthritis Impact of Disease (RAID) score compared with other patient-reported outcome measures (PROMs), inflammatory markers and clinical disease activity measures in patients with early rheumatoid arthritis (RA). METHODS: Disease-modifying antirheumatic drug-naïve patients with RA with short disease duration were included in the treat-to-target ARCTIC trial and followed for 24 months. The responsiveness of the RAID score was evaluated using standardised response mean (SRM) and relative efficiency (RE) with respect to tender joints by Ritchie Articular Index (RAI). SRMs and REs were also calculated for other PROMs, inflammatory markers and clinical outcome measures. An SRM with value above 0.80 was considered high. RESULTS: 230 patients with RA were included. The mean±SD symptom duration was 7.1±5.4 months and the baseline mean±SD  RAID score was 4.49±2.14. At 3 months of follow-up, the mean±SD change score for RAID was -2.25±1.98  and the SRM (95%  CI) -1.13 (-1.33 to -0.96). The RAID score showed high responsiveness both at 3 and 6 months (SRM≥0.80) and was more sensitive in detecting change than the reference, tender joints assessed by RAI. CONCLUSIONS: The RAID score proved to be highly responsive to change in patients with RA with short disease duration who followed a treat-to-target strategy. The RAID score was more efficient in detecting change than the reference (RAI) as well as most other PROMs.
29911143 Simultaneous Quadruple Joint Replacement (QJR) in Disabling Juvenile Rheumatoid Arthritis 2018 May We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and both knees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in single sitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followed up for four years and has been performing his activities of daily living independently. We discuss the preoperative planning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.
30034655 Use of the Orem self-care model on pain relief in women with rheumatoid arthritis: a rando 2018 Jun BACKGROUND AND AIM: Self-care is an important tool in controlling pain in patients with rheumatoid arthritis. The aim of this study was to determine the use of the Orem self-care model on pain relief in patients with rheumatoid arthritis. METHODS: This was a clinical trial performed on 60 patients with rheumatoid arthritis who referred to a rheumatology clinic in Karaj during 2013-2015 (30 patients in the control group and 30 patients in the intervention group), convenience sampling was done and subjects were divided into two groups randomly. Data collecting tools were a demographic questionnaire which consisted of 19 questions and the Numeric Pain Rating Scale. The data result was analyzed by SPSS version 19, using independent-samples t-test and Chi square test. P-value of less than 0.05 was considered significant. RESULTS: The mean age was 44.63±10.65 years, 90% were married and 35% had a high school diploma. The results showed a significant difference in three measures of pain in the intervention group (p=0.001), while in the control group, this difference was not significant (p=0.59). CONCLUSION: According to the results, the Orem self-care model is effective in reducing pain in patients with rheumatoid arthritis Therefore, applying the Orem self-care model is recommended to promote and maintain self-care behavior in patients with rheumatoid arthritis. TRIAL REGISTRATION: The trial was registered at the Iran Registry of Clinical Trials (http://en.irct.ir) with code IRCT2014052517840N1. FUNDING: The authors received no financial support for the research, authorship, and/or publication of this article.
30072986 Autophagy and Rheumatoid Arthritis: Current Knowledges and Future Perspectives. 2018 Autophagy is a degradation mechanism by which cells recycle cytoplasmic components to generate energy. By influencing lymphocyte development, survival, and proliferation, autophagy regulates the immune responses against self and non-self antigens. Deregulation of autophagic pathway has recently been implicated in the pathogenesis of several autoimmune diseases, including rheumatoid arthritis (RA). Indeed, autophagy seems to be involved in the generation of citrullinated peptides, and also in apoptosis resistance in RA. In this review, we summarize the current knowledge on the role of autophagy in RA and discuss the possibility of a clinical application of autophagy modulation in this disease.
30430055 Non-insidious Large Joint Manifestation of Severe Cachectic Rheumatoid Arthritis. 2018 Sep 7 Rheumatoid arthritis (RA) is an autoimmune disorder in which constitutional symptoms typically occur before joint swelling becomes a true clinical phenomenon. Weight loss, although common, is generally mild in nature and occurs after long standing inflammation. While large joints do become inflamed, RA has a much stronger predilection for the small joints. Our case is a rarity in the fact that there was initial large joint swelling without long standing inflammation. Additionally, the weight loss was cachectic in nature and extreme. Furthermore, while extra-articular manifestations do commonly occur, spontaneous pneumothorax is certainly atypical. The content of this manuscript serves to enlighten hospitalist physicians and residents, as to the odd way in which a case like this may present.
29404271 Nivolumab-induced new-onset seronegative rheumatoid arthritis in a patient with advanced m 2018 Jan Immune-related adverse events have been reported in patients treated with anti-programmed death-1 receptor drugs such as nivolumab. We present a case of a new-onset seronegative rheumatoid arthritis in a patient with metastatic melanoma treated with nivolumab.
35129925 2018 Jul Current consensus amongst the rheumatology community is that a treat-to-target strategy should be used when treating people with rheumatoid arthritis (RA) with DMARDs. A treat-to-target strategy is a strategy that defines a treatment target (such as remission or low disease activity) and applies tight control (for example, monthly visits and respective treatment adjustment) to reach this target. The treatment strategy often follows a protocol for treatment adaptions depending on the disease activity level and degree of response to treatment. The 2009 NICE guideline: Rheumatoid arthritis in adults: management suggested a treat-to-target approach in the recommendations that said to measure inflammatory markers and disease activity monthly “until treatment has controlled the disease to a level previously agreed with the person with RA”. However, the committee agreed that the evidence for a treat-to-target strategy should be reviewed, to make this recommendation clearer and more direct if supported by the evidence. The committee also agreed that greater clarity was needed on how frequently people with rheumatoid arthritis should be monitored, as there was currently variation in practice and some uncertainty about how frequent monitoring should be in different groups of people with rheumatoid arthritis with varying degrees of disease activity. However, the frequency of monitoring review excluded an update of the annual review recommended in the previous guideline, as it is an essential and well-established practice and therefore was not included within the scope of this update. Three interrelated evidence reviews were conducted to answer the following key questions in this area: 1. Is treat-to-target more effective than usual care? 2. If so, should the treatment target be low disease activity or remission? 3. How often should people be monitored, outside of the annual review?
30052100 Characteristic patterns of HLA presentation and T cell differentiation in adult-onset Stil 2018 Jan We examined the expression of human leukocyte antigen (HLA) and composition of differentiated T cells in the peripheral blood to understand the characteristics of the immune changes in patients with adult-onset Still's disease (AOSD). This study enrolled patients with AOSD (n = 14), patients with rheumatoid arthritis (RA, n = 20), and healthy controls (HC, n = 20). The percentage of surface-stained cells with HLA-DP, DQ, and DR alleles and the composition of differentiated T cells in peripheral blood leukocytes (PBLs) were evaluated by flow cytometry. AOSD patients exhibited significantly higher percentages of lymphocytes presenting HLA-DP and HLA-DR, and lower percentages of cells presenting HLA-DQ, than RA patients or HC. The proportions of CD4+, CD4+CCR7+, CD4+CD62L-, and CD8+CD62L- cells from PBLs were decreased in AOSD patients relative to RA patients or HCs. By contrast, AOSD patients had higher proportions of CD8+naïve T cells in whole blood relative to RA patients or HC. The proportions of CD4+ effector memory T cells, CD8+ naïve T cells, and CD8+ effector memory T cells in whole blood cells and CD4+ effector memory T cell in lymphocytes were significantly associated with the systemic score. While the proportions of CD4+, CD8+, CCR7+, CD4+CCR7+, CD4+CD62L-, and CD8+CD62L- cells were significantly decreased in AOSD patients, and the proportion of CD8+naïve T cells was elevated in AOSD and correlated with the systemic score. Further studies of a large cohort of AOSD patients will be necessary to evaluate these markers in the pathogenesis of AOSD.
35129929 2018 Jul Current consensus amongst the rheumatology community is that a treat-to-target strategy should be used when treating people with rheumatoid arthritis (RA) with DMARDs. A treat-to-target strategy is a strategy that defines a treatment target (such as remission or low disease activity) and applies tight control (for example, monthly visits and respective treatment adjustment) to reach this target. The treatment strategy often follows a protocol for treatment adaptions depending on the disease activity level and degree of response to treatment. The 2009 NICE guideline: Rheumatoid arthritis in adults: management suggested a treat-to-target approach in the recommendations that said to measure inflammatory markers and disease activity monthly “until treatment has controlled the disease to a level previously agreed with the person with RA”. However, the committee agreed that the evidence for a treat-to-target strategy should be reviewed, to make this recommendation clearer and more direct if supported by the evidence. The committee also agreed that greater clarity was needed on how frequently people with rheumatoid arthritis should be monitored, as there was currently variation in practice and some uncertainty about how frequent monitoring should be in different groups of people with rheumatoid arthritis with varying degrees of disease activity. However, the frequency of monitoring review excluded an update of the annual review recommended in the previous guideline as it is an essential and well-established practice, and therefore was not included within the scope of this update. Three interrelated evidence reviews were conducted to answer the following key questions in this area: 1. Is treat-to-target more effective than usual care? 2. If so, should the treatment target be low disease activity or remission? 3. How often should people be monitored, outside of the annual review?
35129932 2018 Jul Current consensus amongst the rheumatology community is that a treat-to-target strategy should be used when treating people with rheumatoid arthritis with DMARDs. A treat-to-target strategy is a strategy that defines a treatment target (such as remission or low disease activity) and applies tight control (for example, monthly visits and respective treatment adjustment) to reach this target. The treatment strategy often follows a protocol for treatment adaptions depending on the disease activity level and degree of response to treatment. The 2009 NICE guideline: Rheumatoid arthritis in adults: management suggested a treatto-target approach in the recommendations that said to measure inflammatory markers and disease activity monthly “until treatment has controlled the disease to a level previously agreed with the person with RA”. However, the committee agreed that the evidence for a treat-to-target strategy should be reviewed, to make this recommendation clearer and more direct if supported by the evidence. The committee also agreed that greater clarity was needed on how frequently people with rheumatoid arthritis should be monitored, as there was currently variation in practice and some uncertainty about how frequent monitoring should be in different groups of people with rheumatoid arthritis with varying degrees of disease activity. However, the frequency of monitoring review excluded an update of the annual review recommended in the previous guideline, as it is an essential and well-established practice and therefore was not included within the scope of this update. Three interrelated evidence reviews were conducted to answer the following key questions in this area: 1. Is treat-to-target more effective than usual care? 2. If so, should the treatment target be low disease activity or remission? 3. How often should people be monitored, outside of the annual review?
31007859 Full-Blown Rheumatoid Heart and Vessels Associated with Rheumatoid Arthritis. 2018 Jul We report the case of a 54-year-old female patient with a history of rheumatoid arthritis (RA) who presented with dyspnea on exertion. Her pulsation on both arms was weak. Magnetic resonance (MR) angiography revealed Takayasu's arteritis (TA) characterized by multiple stenosis involving innominate, left common carotid, and left subclavian arteries. With regard to cardiac imaging, coronary computed tomography angiography revealed calcified stenosis of the left anterior descending and diagonal branch arteries, with an abdominal aorta narrowed concomitantly. Restrictive diastolic dysfunction with concentric hypertrophic myocardium was observed on echocardiography, and cardiac MR imaging revealed diffuse, subendocardial late gadolinium enhancement compatible with cardiac amyloidosis (CA). Herein, we describe a case of RA with "full-blown" complications of TA, CA, and coronary artery disease.
30326593 Evidence for Transient Receptor Potential (TRP) Channel Contribution to Arthritis Pain and 2018 Oct 15 Based on clinical and preclinical evidence, Transient Receptor Potential (TRP) channels have emerged as potential drug targets for the treatment of osteoarthritis, rheumatoid arthritis, and gout. This review summarizes the relevant data supporting a role for various TRP channels in arthritis pain and pathogenesis, as well as the current state of pharmacological efforts to ameliorate arthritis symptoms in patient populations.
30319285 Comparing the effect of eye movement desensitization and reprocessing (EMDR) with guided i 2018 OBJECTIVE: Previous studies reported the reduction of pain following eye movement desensitization and reprocessing (EMDR) and guided imagery; however, the effectiveness of these modalities was not compared. The current study aimed to compare the effects of EMDR and guided imagery on pain severity in patients with rheumatoid arthritis. MATERIAL AND METHODS: In this randomized controlled trial, 75 patients were selected using non-random method, and then allocated into two intervention groups and one control group. Interventions were conducted individually in six consecutive sessions for the intervention groups. The Rheumatoid Arthritis Pain Scale was used for data collection before and after the interventions. Collected data were analyzed with descriptive and inferential statistics in SPSS. Significance level was considered at P<0.05. RESULTS: The post-intervention mean scores of physiological, affective, sensory-discriminative, and cognitive pain sub-scales for patients in guided imagery group were 16.3±2.2, 13.9±2.2, 30.6±3.4, and 23.2±3, respectively. The post-intervention mean scores of these sub-scales in the EMDR group were 22±1.5, 18.1±1.8, 39.6±2.8, and 29±1.8, respectively. A significant difference was observed in the mean pain score between EMDR and guided imagery groups, and also between each intervention group and the control group (P=0.001). CONCLUSION: Guided imagery and EMDR could reduce pain in rheumatoid arthritis, but pain reduction was more following the EMDR than guided imagery.
29686436 Methotrexate treatment for rheumatoid arthritis in Poland: Retrospective analysis of patie 2018 OBJECTIVES: The aim of this study was to evaluate methotrexate (MTX) treatment administered by Polish rheumatologists in everyday practice. MATERIAL AND METHODS: The study was based on a retrospective analysis of a cohort of 1957 patients with rheumatoid arthritis (RA). It was conducted among 100 rheumatologists, each of whom received 20 questionnaires and completed them based on the data from their rheumatoid arthritis patients. RESULTS: Methotrexate was taken by 91% of patients, and 80% of them continued the treatment either as a monotherapy (65%) or concomitantly with other disease-modifying anti-rheumatic drugs. In 60% of the cases, therapy was initiated within six months of diagnosis. Dose modifications were observed in 76% of cases and were contingent on different factors, e.g. lack of efficacy, presence of adverse events. The most prevalent adverse events were nausea and vomiting, weakness, and elevated liver enzyme activity. The most common initial dose of MTX was 10 or 15 mg/week. An increase in dose to the maximum of 25 mg/week was observed in 36% of cases, with continuation for 27% of patients. Treatment interruption was noted in 21% of patients, predominantly due to MTX intolerance; however, in 13% of cases, it was due to patient choice. CONCLUSIONS: Methotrexate is the most common agent used to treat rheumatoid arthritis. Dose modifications are often applied to maximise efficacy and reduce adverse reactions, which could lead to withdrawal. Methotrexate is an effective drug for treatment of RA when used according to current recommendations. To optimise MTX therapy, regular medical visits are required.
29531881 Association of Hypertrophic Obstructive Cardiomyopathy with Rheumatoid Arthritis. 2018 Jan 5 Our article refers to a 50-year-old woman with previously diagnosed rheumatoid arthritis (RA) who presented with symptoms of dyspnea on exertion and dizziness. An echocardiogram revealed a 17-mm asymmetric interventricular septum hypertrophy and systolic anterior motion of the anterior mitral valve leaflet. Association of hypertrophic obstructive cardiomyopathy (HCM) with connective tissue diseases has been well documented. For RA the human leukocyte antigen (HLA) system, particularly HLA-DR4, may possibly be a link between the two entities, as it is associated with both RA and HCM. Therefore, a patient with RA and suggestive history should be investigated for cardiac involvement. Further studies are needed to elucidate a more accurate association between the above diseases.
30002787 Insufficiency fractures: A rare cause of foot and ankle pain in three patients with rheuma 2018 Aug Insufficiency fractures are recognized but rare complications in patients with longstanding rheumatoid arthritis. Such fractures are typically solitary and are rarely seen to affect the foot and ankle. We describe 3 women with longstanding rheumatoid arthritis, treated with one, or a combination of, corticosteroids, DMARDs and anti-TNF, presenting with foot and ankle pain with no prior history of trauma. MRIs showed rare multiple florid insufficiency fractures of the foot and ankle, in 2 cases bilaterally, which were managed conservatively. These cases highlight the importance of considering insufficiency fractures in similar patients presenting with foot and ankle pain. Radiographs may fail to demonstrate these lesions, delaying diagnosis, and worsening patient outcome, therefore in such cases MRI is a valuable modality.
29930884 Abatacept as a Therapeutic Option for Rheumatoid Vasculitis. 2018 Apr 19 Abatacept is a fusion protein composed of the fragment crystallizable region (Fc region) of the immunoglobulin IgG1 fused to the extracellular domain of cytotoxic T-lymphocyte-associated protein 4. Our patient presented with lower extremity purpura in the setting of rheumatoid arthritis and common variable immunodeficiency disease. A biopsy of cutaneous lesions confirmed the etiology of rheumatoid vasculitis. Although rituximab is the recommended treatment, it has the potential to exacerbate immunodeficiency. The cutaneous lesions responded well to abatacept after failure to respond to other treatment modalities. This case is the first, to our knowledge, to be reported in North America. Our case may encourage extensive clinical trials on abatacept as a treatment option.
30005857 Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloart 2018 Sep Spondyloarthritides (SpA) include inflammatory joint diseases with various clinical phenotypes that may also include the axial skeleton and/or entheses. SpA include psoriatic arthritis, reactive arthritis, enteropathic arthritis and ankylosing spondylitis; the latter is frequently associated with extra-articular manifestations, such as uveitis, psoriasis, and inflammatory bowel disease. SpA are associated with the HLA-B27 allele and recognize T cells as key pathogenetic players. In contrast to other rheumatic diseases, SpA affect women and men equally and are not associated with detectable serum autoantibodies. In addition, but opposite to rheumatoid arthritis, SpA are responsive to treatment regimens including IL-23 or IL-17-targeting biologics, yet are virtually unresponsive to steroid treatment. Based on these differences with prototypical autoimmune diseases, such as rheumatoid arthritis or connective tissue diseases, SpA may be better classified among autoinflammatory diseases, with a predominant innate immunity involvement. This would rank SpA closer to gouty arthritis and periodic fevers in the spectrum of rheumatic diseases, as opposed to autoimmune-predominant diseases. We herein provide available literature on risk factors associated with SpA in support of this hypothesis with a specific focus on genetic and environmental factors.
30023036 A case of Caplan syndrome in a recently diagnosed patient with silicosis: A case report. 2018 Jun Rheumatoid pneumoconiosis, also known as Caplan's syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplan's syndrome.