Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8619090 | Epidemiology of rheumatoid arthritis. | 1995 Aug | Rheumatoid arthritis is a relatively common disorder that affects men and women at the prime of their lives. Only 30% of the causes of rheumatoid arthritis can be attributed to genetic factors; the rest remain unexplained. Descriptive and analytic epidemiologic methods may lead to a better understanding of the causative, precipitating, and modulatory factors in rheumatoid arthritis. | |
| 7846569 | Rheumatoid arthritis. Neuroanatomy, compression, and grading of deficits. | 1994 Oct 15 | STUDY DESIGN: The authors summarize published data regarding cervical spine involvement in rheumatoid arthritis, define the neurologic manifestations, and provide recommendations for management of these complex and difficult problems. OBJECTIVES: The authors attempted to accurately define the neurologic lesions resulting from rheumatoid involvement of the cervical spine despite the complexity of the neuroanatomy of the cervicomedullary region and the diversity of pathology. SUMMARY OF BACKGROUND DATA: Despite the long-standing recognition of cervical spine involvement in rheumatoid arthritis, appreciation of the different neurologic manifestations of this disease has been lacking or misunderstood. METHODS: The authors reviewed the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions that interact to create these complex and often confusing clinical situations. RESULTS: Rheumatoid arthritis produces encroachment on the brainstem and cervical spinal cord. The minimum space available at the craniocervical junction for the neural structures is 13 to 14 mm, which is fairly constant. Below C2, the available space is only 12 mm. When the amount of space reduced below this amount, there is, by definition, neural compression. The site of compression and/or repeated microcontusions will determine subsequent neurologic deficits. At the craniovertebral junction, neural compression and traumatic injury typically occur anteriorly at the pyramidal decussation producing cruciate paralysis with considerable weakness in both arms and minimal leg involvement. Cranial settling can result in lower medulla and cranial nerve dysfunction. Subaxial stenosis typically results in a more typical myelopathy. CONCLUSIONS: Accurate diagnostic studies are mandated to determine the location of compression and to fully appreciate the resultant neurologic deficits. To improve more complete comprehension of the neurologic manifestations of rheumatoid arthritis, the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions must be understood. | |
| 7975042 | Rheumatoid arthritis. | 1994 Jul | Much has been learned about the interactions of immunologic events and the development of musculoskeletal disease. Much more needs to be learned. The partnership of astute clinicians and investigators will enhance this learning process and eventually benefit the health and well being of our patients, and perhaps, humankind. | |
| 8650589 | Mortality in rheumatoid arthritis. | 1995 Dec | Patients with rheumatoid arthritis (RA) have a substantially reduced life expectancy. The standardized mortality ratio in different studies has ranged from 1.13 to 2.98. This mainly applies to rheumatoid factor (RF)-positive cases, although there is a subgroup of RF-negative cases with an adverse long-term prognosis. Clinically based studies probably overestimate the true shortening of life span and population-based studies may underestimate it. Excess mortality from infection and from renal disease likely reflects the presence of severe disease, whereas most of the added mortality from gastrointestinal causes is treatment related. The reasons for the surplus of mortality from cardiovascular causes are not fully known. RF may have a direct role, and preillness factors such as smoking may predipose patients to RA and also render them susceptible to cardiovascular diseases. The excess mortality associated with RA is appreciably higher than is apparent from the cases in which RA is regarded as an underlying cause of death. The effect of treatment on mortality remains largely unknown. | |
| 1285887 | Estrogens and rheumatoid arthritis. | 1992 Oct | Epidemiological and immunological evidence has suggested that female sex hormones may play a role in the etiology and course of autoimmune diseases such as rheumatoid arthritis (RA). In this review the present clinical data with regard to estrogens and RA are discussed, with emphasis on the possible preventive effect of oral contraceptives on the incidence of RA and on the possibility of using estrogens as adjuvant therapy in RA. It is concluded that oral contraceptives may mitigate or postpone the onset of RA slightly, but that estrogens are not able to alleviate the symptoms of RA. Presently there is no evidence to promote the use of estrogens in preventing or treating RA in females. | |
| 7863269 | Rheumatoid arthritis: a medical emergency? | 1994 | Rheumatoid arthritis (RA), previously considered to be a benign controllable disease with a good prognosis in the majority of patients, is now known to be a severe, progressive disease in terms of radiographic damage, severe functional deterioration, progressive work disability and premature mortality. The traditional approach to RA therapy (from less toxic to more toxic drugs) is inadequate and the risk of drug toxicity is generally overestimated while that of severe disease is underestimated. Consequently, aggressive treatment could be considered in an attempt to reverse the inflammation prior to long-term end-organ damage, rather than in response to such damage. As patients with RA may progress to an anticipated 5-year survival similar to that in patients with cardiovascular or neoplastic disease, RA should be viewed as an urgent medical problem--a "medical emergency"--in order to control the long-term consequences of the disease process. | |
| 7848078 | Rheumatoid arthritis: new approaches for its evaluation and management. | 1995 Feb | Rheumatoid arthritis is a chronic, progressive disease with a long-term outcome characterized by significant morbidity, loss of functional capacity, and increased mortality. The cornerstone of therapy includes the appropriate melding of pharmacological, rehabilitative, and surgical treatments. New developments in the care of patients with rheumatoid arthritis have focused on aggressive pharmacological therapy early in the course of the illness, ongoing assessment of disease activity and patient function, and a better understanding of the role of rehabilitative techniques such as therapeutic exercise and behavioral approaches to education. This article synthesizes information from studies on recent advances in the management of rheumatoid arthritis outlining diagnosis and assessment, disability issues, outcome studies, current status of traditional and experimental pharmacological therapies, and new strategies of nonpharmacological treatments aimed at the clinician challenged by this fascinating disorder. | |
| 8250199 | Anaesthesia and rheumatoid arthritis. | 1993 Nov | A review of the implications of rheumatoid arthritis on peri-operative anaesthetic management is presented. Pre-operative assessment should include a careful search for articular and systemic manifestations of the disease that may complicate intraoperative care. Drug disposition may vary from the normal patient as a result of changes in serum protein binding, together with possible exaggeration of pharmacodynamic responses. Airway management presents one of the greatest challenges to the anaesthetist, and care in manipulation of the cervical spine is paramount. | |
| 8846647 | Cytokines in rheumatoid arthritis. | 1995 Sep | An ever-growing number of cytokines that play a critical role as soluble mediators of immune and inflammatory responses are being described. Not surprisingly, most of them have been detected in SF or serum of patients with RA. However, given the numerous interactions within the cytokine network--e.g., agonistic and antagonistic properties and natural inhibitors--one should beware of over-simplistic views, the most so as extrapolation from in vitro and animal models is always a challenge. From a clinical viewpoint, more work is required before measurements of cytokines in RA be used as activity indices and--more importantly--as prognostic marker. | |
| 8717520 | Role of cytokines in rheumatoid arthritis. | 1996 | Analysis of cytokine mRNA and protein in rheumatoid arthritis tissue revealed that many proinflammatory cytokines such as TNF alpha, IL-1, IL-6, GM-CSF, and chemokines such as IL-8 are abundant in all patients regardless of therapy. This is compensated to some degree by the increased production of anti-inflammatory cytokines such as IL-10 and TGF beta and cytokine inhibitors such as IL-1ra and soluble TNF-R. However, this upregulation in homeostatic regulatory mechanisms is not sufficient as these are unable to neutralize all the TNF alpha and IL-1 produced. In rheumatoid joint cell cultures that spontaneously produce IL-1, TNF alpha was the major dominant regulator of IL-1. Subsequently, other proinflammatory cytokines were also inhibited if TNF alpha was neutralized, leading to the new concept that the proinflammatory cytokines were linked in a network with TNF alpha at its apex. This led to the hypothesis that TNF alpha was of major importance in rheumatoid arthritis and was a therapeutic target. This hypothesis has been successfully tested in animal models, of, for example, collagen-induced arthritis, and these studies have provided the rationale for clinical trials of anti-TNF alpha therapy in patients with long-standing rheumatoid arthritis. Several clinical trials using a chimeric anti-TNF alpha antibody have shown marked clinical benefit, verifying the hypothesis that TNF alpha is of major importance in rheumatoid arthritis. Retreatment studies have also shown benefit in repeated relapses, indicating that the disease remains TNF alpha dependent. Overall these studies demonstrate that analysis of cytokine expression and regulation may yield effective therapeutic targets in inflammatory disease. | |
| 7572560 | The radiology of rheumatoid arthritis. | 1995 Oct | Rheumatoid arthritis is a connective tissue disorder of unknown etiology that can involve any synovial-lined joint in the body. The most frequently involved joints are the small joints of the hands and feet, the wrists, knees and elbows, and the glenohumeral and acromioclavicular joints. The radiographic hallmarks of rheumatoid arthritis are swelling of the soft tissue, osteoporosis, narrowing of the joint spaces and marginal erosions. The unique combination of osteoporosis, marginal erosions and relatively minimal reactive bone formation help distinguish rheumatoid arthritis from other inflammatory arthritides. | |
| 8234096 | Does rheumatoid factor always mean arthritis? | 1993 Nov 1 | Rheumatoid arthritis is a clinical syndrome, and the diagnosis requires the presence of pain, swelling, and tenderness in the joints. In the absence of these features, identification of rheumatoid factor in the serum is of little use. Because rheumatoid factor is an immune complex, it is a marker of immune activation and, therefore, may be present in the circulation of persons with a variety of inflammatory conditions that stimulate the immune system. Also, 5% of the healthy population have significant titers of rheumatoid factor in their serum. | |
| 7933593 | [Malignant rheumatoid arthritis]. | 1994 Aug | Malignant rheumatoid arthritis (MRA) is designated as rheumatoid arthritis with vasculitis, but MRA is commonly called rheumatoid vasculitis in western countries. Patients with MRA show a variety of symptoms and signs based on vasculitis. The clinical features include subcutaneous nodule, skin ulcer, pericarditis, myocarditis, pleuritis, pneumonitis, intestinal infarction, mononeuritis multiplex and other involvements. The cause of the various vascular lesions in MRA has not been clearly defined, but a number of observations suggest that they result from injury induced by immune complexes, especially, those containing rheumatoid factor (RF). The theory of self-associated IgG RF has been proposed. MRA is usually treated with steroid, and steroid pulse therapy and immunosuppressants are highly useful for severe MRA. | |
| 1571312 | Schizophrenia and rheumatoid arthritis: a review. | 1992 Mar | Fourteen epidemiologic studies of the relationship of rheumatoid arthritis to schizophrenia have been conducted between 1934 and 1985. Twelve of the studies report a lower-than-expected rate of rheumatoid arthritis in populations of schizophrenics. Methodologic weaknesses in the studies are assessed. Nutritional, hormonal, psychosocial, genetic, and immunologic data and theories are briefly reviewed which might explain the epidemiologic results. There is sufficient evidence for the negative association between the two disorders to justify further research. | |
| 1599816 | Assessment and prognosis of rheumatoid arthritis. | 1992 Jun | Efforts continue to identify and consistently utilize those clinical, laboratory, imaging, and other features of rheumatoid arthritis that best reflect the disease process and its impact on individual patients. We seek descriptions that are accurate, reproducible, simple, sensitive, and predictive. Such assessments will lead to development of prognoses for individual patients and to more rational patient management. The past year has witnessed reemphasis of health status indexes (instruments) and other simple approaches to clinical assessment of patients, eg, use of standardized grip strength, button test, walk time, and modified articular indexes. Computed tomography and magnetic resonance imaging provided clinically important and otherwise unappreciated (but expensive) information about joint integrity and inflammatory disease with sensitivity and resolution considerably beyond conventional techniques. Laboratory assessment of patients included consideration or reconsideration of the utility of measurements of C-reactive protein, rheumatoid factors, immune complexes, complement receptors and complement activation products, antiperinuclear factors, trace elements, interleukins and interleukin receptors, soluble cell surface receptors, lymphoid cell phenotypes, and synovial immunohistology; all are important in the pathogenesis of rheumatoid arthritis and all have contributed variably to predicting patient outcomes. None were shown to be more clinically informative than erythrocyte sedimentation rate or C-reactive protein. The variables that have been associated with unfavorable prognosis for rheumatoid arthritis are also discussed. We hope that continued study will lead to identification and adoption of simple assessments that will prove to be powerful predictors of good or poor patient outcomes and stratification of patient risk. This uniform measure of disease assessment will improve judgments of potential benefits of therapeutic interventions. | |
| 8391952 | TNF-alpha in rheumatoid arthritis and prospects of anti-TNF therapy. | 1993 Mar | Our work has shown that TNF alpha is produced by cultured mononuclear cells from rheumatoid arthritis joints and appears to regulate the production of IL-1. Immunohistochemical examination has shown the presence of TNF alpha in the synovium, e.g. in the lining layer, some endothelial cells and most importantly, in the cells in the cartilage pannus junction. TNF receptors (both p55 and p75) have a similar distribution, thereby suggesting that TNF has the potential for autocrine and paracrine activity in the joint. The concept that TNF alpha is pathogenic in inflammatory arthritis has been validated by showing that neutralizing monoclonal anti-TNF antibodies significantly attenuate collagen-induced arthritis in mice. In preliminary trials in rheumatoid patients anti-TNF appears to have an impressive effect on indices of disease activity including C-reactive production and serum amyloid-A production. TNF alpha appears to be a relevant therapeutic target in rheumatoid disease. | |
| 8597773 | Prospects of immunotherapy for rheumatoid arthritis. | 1995 Nov 24 | The main challenge in the development of new modalities for the treatment of rheumatoid arthritis is to enhance the specificity while reducing the adverse side-effects of therapeutics. Biotechnology provides a variety of reagents, such as monoclonal antibodies, recombinant cytokines, cytokine antagonists, and small peptides, with the potential to interfere with selected stages of the disease process in a highly specific manner. In addition, several new therapeutic approaches have emerged as a result of extensive research with animal models of disease, including T-cell vaccination and bone marrow transplantation. This article discusses current insights into the pathogenesis of rheumatic diseases, focusing on rheumatoid arthritis. A number of new therapeutic modalities for rheumatoid arthritis, in particular those acting on the immune system, are discussed. Because it is not possible to provide a complete overview of all the developments in the field in limited space, a selection of strategies and modalities which are representative of the broad variety of immunotherapeutic approaches currently used are highlighted. | |
| 7728886 | Rheumatoid arthritis and connective tissue disorders: sub-Saharan Africa. | 1995 Feb | Rheumatoid arthritis (RA) once a rarity in Africa, is now reported in large numbers from many parts of Africa. Although epidemiological surveys have shown that the prevalence in urban populations is similar to Western communities, it is less common in rural areas. Further epidemiological studies are needed to confirm these findings in other parts of Africa and identify factors contributing to this difference to provide a better understanding for the emergence of RA in Africa. Earlier reports suggested that in African blacks RA was a mild disease, severe radiographic changes were uncommon, deformities were rare and extra-articular features were unusual and only symptomatic therapy was necessary to control symptoms in most patients. Recent experience shows that severe disease with deformities and radiographic changes are seen and a wide spectrum of extra-articular features are noted although they may be less common than in Caucasians. African blacks with RA may have a younger age of onset and the genetic association with HLA DR4 has been confirmed. Systemic lupus erythematosus (SLE) is also recognized more often in African blacks who have a younger age of onset. SLE is also recognized less often in males. Features such as photosensitivity and serositis are less common while renal disease is more common. A reported short-term mortality of about 30% emphasizes the need for urgent efforts to improve the prognosis in SLE. The infrequent occurrence of localized systemic sclerosis and the absence of anti-centromere antibodies in blacks was noted in a recent large series of patients with systemic sclerosis. The other connective tissue diseases and systemic vasculitides are reported much less frequently and will probably be detected more often in future. Anti-cardiolipin antibodies are detected frequently in association with infections, including HIV infection. The spectrum of diseases associated with ANCA includes a variety of connective tissue diseases and infections such as HIV infection and invasive amoebiasis must be added. | |
| 8452769 | Clinical features, diagnosis, and prognosis in rheumatoid arthritis. | 1993 Mar | The past year has witnessed a modest expansion in our understanding of the clinical, diagnostic, and prognostic features of rheumatoid arthritis. Almost every continent has reported prevalence, phenotype, and clinical features of rheumatoid arthritis subpopulations. Reviews of the natural history and therapy of cervical spine disease, Felty's disease, and lung involvement dominate the clinical literature. Rheumatoid arthritis-like syndromes have been reported to occur after immunotherapy with interferon alfa and interleukin-2. There have been case studies on human immunodeficiency virus, cachexia, pregnancy, "pseudosepsis," bone loss, and malignancy in rheumatoid arthritis. Diagnostic criteria and new classifications for functional and global impairment have been published, and new health impairment questionnaires have been evaluated. Novel isotopes and the role of magnetic resonance imaging in damaged joints were discussed. Rheumatoid factor was reaffirmed as a significant prognostic variable, and the roles of immunogenetic loci, sulfur oxidation, and serum matrix proteins were evaluated in early rheumatoid arthritis. Functional status was again verified as a strong prognostic marker. | |
| 7768054 | The pathophysiology of rheumatoid arthritis. | 1994 Nov | The main focus of the chronic inflammatory response in rheumatoid arthritis (RA) is the synovium. Even though we do not know what causes this debilitating disease, characterisation of the infiltrating inflammatory cells and their products is of major importance in understanding the pathogenesis. In this short review we will highlight the main cell populations and their products (cytokines) in RA synovium which may be candidate targets for therapy. |