Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8312674 | Rheumatoid arthritis in the aged. Incidence and optimal management. | 1993 Nov | Rheumatoid arthritis (RA) is estimated to occur in 0.3 to 3% of the general population. Up to one-third of RA patients first present for treatment after the age of 60 years (elderly-onset RA). The overall frequency in individuals older than 65 is increased, so that 30 to 40% of RA patients treated in rheumatology centres are > 60 years of age. Optimal management of all RA patients includes physical therapy, medications, both nonsteroidal anti- inflammatory drugs (NSAIDs) and remittive agents, and, in some cases, surgery. In the elderly, these treatment modalities at times need to be altered to accommodate age-related changes in body mechanics and organ function. Thus, the approach to physical therapy in older patients is different than in the young. There are fewer rest periods and more passive exercises. Drug treatment must also be modified, since NSAIDs and several remittive agents are more hazardous in elderly patients. Indications for orthopaedic procedures may also be different. The long term management of RA requires a delicate balance of benefit and risk. It is wise to begin with the least toxic medications. However, if necessary, potentially toxic medications can be given cautiously, with close monitoring for adverse effects. | |
| 8842714 | The wrist in rheumatoid arthritis. | 1996 Aug | In the rheumatoid wrist, cartilage loss, synovial expansion with erosive disease and ligamentous laxity, result in loss of carpal height and stability and development in varying amounts of ulnar/palmar translocation and supination of the carpus on the distal forearm. This results in a painful wrist which influences deformity development distally. The aims of surgery are relief of pain and adequate stability while retaining as much motion as possible consistent with the degree of destruction present. A variety of procedures from soft-tissue reconstruction to total arthrodesis are available to achieve these aims. | |
| 7673848 | Immunopathogenesis and immunotherapy in rheumatoid arthritis: an area in transition. | 1995 Sep | In years to come, new therapeutic modalities for the treatment of chronic arthritis will be launched for general clinical use. These therapies, until today only used in clinical studies, are based on knowledge obtained from animal models of chronic arthritis. This knowledge not only ushers therapeutic use in humans: in many settings, the animal studies have proven to be irreplacable tools to get insights into the pathogenesis of chronic arthritis. Rheumatoid arthritis (RA) shows a strong linkage of susceptibility to a certain epitope common to some HLA-DR beta chains; this immunogenetic linkage is the strongest evidence for specific, T-cell dependent immunity in the pathogenesis of the disease. Despite intense efforts, no unequivocal proofs of T-cell specificity or oligoclonality have been found in RA. Therapeutic efforts directed against T-cells or T-cell functions have also at the best showed partial effects. As compared to the local production of T-cell cytokines in the joint, monokine production is abundant. Therapies aimed at neutralizing the effects of the cartilage-devastating monokine TNF-a have showed remarkable results in small clinical trials. The possibility of increasing the presence of the regulatory cytokines IL-4, IL-10 and TGF-beta has also been explored, but only in animal studies. Immunology has also shed light on the mode of action of the commonly used 'disease modifying' drugs, and combinations of such drugs have shown increased potentials in recent clinical studies. The possibility of combining traditional anti-arthritic drugs with recent immunological tools seem promising for the future. This review discusses recent advances in the understanding of pathogenesis and delineate new therapeutic approaches for chronic arthritis from the point of view of the immunologically oriented clinician. | |
| 7728887 | Rheumatoid arthritis and connective tissue disorders: India and South-East Asia. | 1995 Feb | With a few exceptions, there remains a paucity of good epidemiological studies from India and South-East Asia. The overall impression is that the prevalence of rheumatoid arthritis (RA) is slightly less compared with the West and follows a milder course. There may be differences in the articular expression of the disease with the wrist and forefoot less commonly affected than in Caucasian studies. Extra-articular manifestations and erosive change are less frequent and severe. HLA DR4 does not correlate with seropositivity and severity of RA. The prevalence of SLE may be less in the Indian subcontinent than in the West. However, recent indications are that in South-East Asia and the Pacific region the prevalence morbidity and mortality are higher than in developed countries. An improvement in socio-economic conditions may be accompanied by an improvement in the survival of patients with SLE. | |
| 8820794 | Cell adhesion molecules in rheumatoid arthritis. | 1996 Aug | Rheumatoid arthritis is a systemic inflammatory disease of the joints and major internal organs that has an unknown aetiology. Cell adhesion molecules (CAMs) are expressed on the surface of cells, enabling homotypic and heterotypic cell-cell interactions that are fundamental in the process of the inflammatory reaction. Three major families of CAMs are now recognised, with numerous subtypes. Many of these molecules play an important role in the mechanism of disease in rheumatoid arthritis. E-Selectin and intercellular adhesion molecule (ICAM)-1 are upregulated on the synovial endothelium, while vascular cell adhesion molecule (VCAM)-1 plays an important role in the synovial lining layer cells and within the synovial stroma. The expression of CAMs may be blocked by monoclonal antibodies and modified by nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs. This has very important implications in the therapy of rheumatoid arthritis. | |
| 10155281 | The costs of rheumatoid arthritis. | 1994 Dec | The economic costs associated with rheumatoid arthritis (RA), a chronic, systemic, inflammatory disorder that affects many joints, are high, approximating those of coronary heart disease. The estimated prevalence of RA in the US is 0.9%. Incidence increases with age, and is highest among women in the fourth to sixth decades of life. The primary impact of RA is due to the significant morbidity associated with this disease. Mortality is increased among a poorly defined subgroup of RA patients. The average level of disability among RA patients is moderate, but 6.5 to 12% of patients are severely disabled. Between one- and two-thirds of previously employed patients have a reduced work capacity. Treatment primarily involves the use of nonsteroidal anti-inflammatory drugs and disease modifying antirheumatic drugs. Rehabilitation measures and orthopaedic surgery are also used. Total annual direct costs of RA (total charges) have been calculated to be $US5275 and $US6099 (1991 dollars) per patient. Lifetime medical care charges were estimated at $US12,578 per patient (1991 dollars). The direct costs of RA are substantial, but indirect costs have been calculated to be much higher because of extensive morbidity. The difference between the direct and indirect costs of RA is decreasing because salary increases have not kept pace with rising healthcare costs. The latter are increasing rapidly in RA because of the use of new technology, surgical procedures, and the greater use of drugs with frequent monitoring requirements and significant toxicity. Because intangible costs such as pain form a substantial part of the overall costs of RA but are difficult to evaluate, cost estimates inevitably underestimate the impact of the disease on individuals and society. | |
| 1502566 | Cyclosporine in rheumatoid arthritis: beyond experimentation. | 1992 Jun | The potential for combined therapy in rheumatoid arthritis is rapidly increasing considering the recent development of various new treatment modalities. However, an aggressive effort must be made to stage patients according to various clinical and immunological parameters. Only then can appropriate combined therapy be used effectively in this disease process. The development of such combined therapy could expand into other diseases such as scleroderma, systemic lupus erythematosus, and multiple sclerosis. | |
| 8348112 | Quality of life 3. Rheumatoid arthritis. | 1993 Jun 18 | It has increasingly been recognized that for the evaluation of interventions in patients with rheumatoid arthritis not only physician-oriented variables, like laboratory or radiographic assessments but also patient-oriented variables such as quality of life are of importance. Many different arthritis-specific quality of life instruments have been developed in recent years using different or no definition at all about the concept 'quality of life'. In this review a generally accepted definition of quality of life, existing of three components, is presented. The interrelationship between quality of life and all the different variables used in assessing disease activity in rheumatoid arthritis is discussed. | |
| 8833048 | Prognostic factors in rheumatoid arthritis. | 1996 Mar | To determine prognostic factors that predict the course of rheumatoid arthritis (RA) from an early phase of the disease, we reviewed publications on possible prognostic factors. We excluded studies with patients with long standing disease, studies with a followup less than one year, studies providing insufficient methodological information, and studies using noninformative outcome measures. We identified individual factors associated with worse outcome: presence of serum rheumatoid factor (RF), HLA-DR4, signs of high disease activity [number of swollen or tender joints, elevated C-reactive protein (CRP)], rheumatoid nodules, radiological abnormalities, poor grip strength, and poor functional status. The accuracy of prediction of these individual factors is low. Therefore, in several studies, combinations of entry variables were investigated for accuracy in predicting the severity of radiological abnormalities. IgM RF in combination with radiographic damage at onset of RA and either clinical measures of disease activity and/or laboratory measures such as erythrocyte sedimentation rate (ESR) or CRP and/or a functional ability score, and/or HLA-DR4 could predict radiological abnormalities with an accuracy of 70-80%. Further research should be directed to find more specific disease markers and to validate an internationally accepted combination of prognostic criteria. | |
| 7939727 | Biological markers in rheumatoid arthritis. | 1994 Jun | Rheumatoid arthritis is characterized by chronic inflammation associated with considerable damage to the musculoskeletal system, particularly in and around diarthrodial joints. By using newly developed immunoassays and chemically based assays for cartilage-, bone-, and synovium-derived molecules, which are products of synthesis and/or degradation, it is now possible to detect the release of these molecules and their degradation products into body fluids such as serum, synovial fluid, and urine. This release is influenced significantly by the inflammatory process and reflects the damage caused to these tissues by chronic inflammation. Some new markers for skeletal metabolism are reviewed and examples are given of how they determine the damaging effects of this chronic inflammatory disease on these tissues before changes are observed radiologically. Some of these markers have both prognostic value and potential for rapidly interpreting the effects of therapy. | |
| 8907068 | Biologic agents for the treatment of rheumatoid arthritis. | 1996 Feb | Substantial progress has been made in our understanding of the immune system and immunopathogenesis of rheumatoid arthritis. This knowledge, combined with advances in biotechnology, has resulted in the development of biologic agents to selectively target elements of the immune system participating in the inflammatory response. This article reviews the available data from clinical trials of biologic agents for the treatment of rheumatoid arthritis. Randomized controlled trials comparing administration of a biologic agent to placebo are emphasized. Despite concerns raised by initial trials with these agents, they still offer the most promise as treatments for autoimmune diseases ++such as rheumatoid arthritis. | |
| 1298223 | Current management of rheumatoid arthritis. | 1992 Jul 1 | Rheumatoid arthritis (RA) is usually a relentlessly progressive disease leading to joint damage and disability. While the long-term value of disease-modifying drugs is still questioned, the quality of life of RA patients has improved, possibly reflecting the earlier more aggressive and multifaceted approach to management and/or the innate attenuation in the disease over recent years. | |
| 8842717 | Finger deformities in rheumatoid arthritis. | 1996 Aug | Swan neck and boutonniere deformities describe the two most common afflictions of the interphalangeal joints attributable to rheumatoid arthritis. Two separate classifications have been described, with an emphasis on practical treatment. The complications that can occur are very significant and the decision to perform reconstructive surgery in these patients must be made with full consideration of the patient's disease process, careful functional evaluation of the patient, specific adjacent joint involvement, and the overall treatment plan for improving the patient's function. The timing of hand, foot, and large joint surgery is complex and requires excellent communication among the patient and all the treating specialists, including the primary internist, rheumatologist, orthopaedic surgeon, and hand surgeon. The care for these patients is served best by a coordinated team approach. | |
| 8833046 | The natural history of rheumatoid arthritis. | 1996 Mar | The natural history of rheumatoid arthritis (RA) is best defined by a combination of disease specific measures such as radiographs and remission rates, and patient specific measures such as functional and work disability, total joint replacement, adverse drug reactions, social disruption and premature mortality. Prognosis depends largely on how RA is defined, since clinical RA has a worse and epidemiologic RA a better prognosis. Seronegative polyarthritis confounds the assessment of RA since it has a better prognosis for remission and longterm outcome. RA is a progressive disease in the clinic, particularly in patients with longterm followup. Ongoing cohort studies of recent onset RA may aid in our understanding of RA prognosis, but may still beg the question, what is RA? | |
| 1475632 | Long-term outcome of rheumatoid arthritis. | 1992 | Although developments in surgical and medical treatment methods have improved the average long-term outcome of rheumatoid arthritis (RA), it still is a severe disease. An 8-year follow-up study of patients with seropositive RA showed a large variation in the outcome. Only 24 percent of patients had no progression in the radiological destruction of the joints of hands and feet. Premature mortality seems to accumulate in patients with a poor outcome. Study of prognostic markers for RA would be of great importance. | |
| 8535651 | Long-term outcomes in rheumatoid arthritis. | 1995 Nov | Long-term outcomes in the majority of patients with established rheumatoid arthritis (RA) include radiographic progression, severe functional declines, work disability and premature mortality. These outcomes have been recognized primarily in long-term clinical observational studies, which also indicate that most courses of traditional therapies are discontinued within 2 yr. Severe long-term outcomes in RA are predicted more effectively by sustained inflammatory activity than by any measure of baseline activity at a single point in time. Aggressive efforts to control inflammatory activity prior to irreversible damage would appear to be a reasonable strategy for treatment of RA. | |
| 7846571 | Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors o | 1994 Oct 15 | OBJECTIVE: This article reviews the current knowledge of predictors of paralysis and the potential for neurologic recovery in patients with rheumatoid arthritis involving the cervical spine. The primary goal is to prevent the onset of an irreversible neurologic deficit. SUMMARY OF BACKGROUND DATA: Use of the posterior atlantodental interval of less than 14 mm as measured from lateral cervical radiographs is a reliable screening tool for identifying high risk patients who require further evaluation with magnetic resonance or computed tomography/myelography. The primary technical objective of surgery in patients with impending neurologic deficit is stabilization of the diseased spine segments and relief of spinal cord compression via reduction of subluxation or direct decompression. Complications are not uncommon, but tend to occur less frequently in patients who have surgical intervention before the onset of severe myelopathy. Pain relief is good when a solid arthrodesis is achieved, and neurologic recovery is most favorable when severe cord compression is not present preoperatively. CONCLUSION: An improved understanding of the natural history, physical findings, and radiographic parameters will allow the construction of a management strategy for timely intervention in rheumatoid patients with progressive cervical disease. | |
| 8810685 | Joint assessment in rheumatoid arthritis. | 1996 Sep | Determining the number of swollen joints and tender joints is a key component in the clinical assessment of rheumatoid arthritis (RA). There have been a series of investigations carried out in the last decade, which have defined the best ways to measure joint inflammation and have identified which joints should be evaluated. There is not complete agreement on the optimal joint count, but two approaches are widely used. These comprise counting either 66/68 or 28 joints. The main difference is that the 28-joint count excludes the joints in the feet. Both methods give similar information and are reproducible and valid. Tenderness and swelling should be measured separately. There are advantages and disadvantages associated with using the 28-joint count. It has the benefit of simplicity and takes less time, although some potentially relevant clinical information about the feet may be lost. There is general agreement that grading the severity of individual joint involvement is of limited advantage. Using weighted joint counts is also not widely accepted. Finally there is growing recognition of the need for training in the methods of assessing joints and the importance of international standardization. Joint counts are a component of the core clinical data set for RA and will continue to play a key role in the foreseeable future. | |
| 8604724 | Rheumatoid arthritis: pathogenesis and early recognition. | 1996 Feb 26 | Rheumatoid arthritis (RA) is a chronic, destructive disease characterized by joint pain and swelling, which progresses in a substantial percentage of patients to invasion of bone and cartilage. If not successfully treated, progressive joint destruction results in loss of function, disability, and increased mortality. The time from onset of symptoms to joint destruction is frequently measured in months rather than years. Unfortunately, the time from disease onset to diagnosis and initiation of effective therapy is often prolonged, allowing development of irreversible joint destruction. In order to apply current knowledge to reduce the disability and death associated with progressive RA, the clinician must understand the pathophysiologic stages of the disease as reflected in symptoms, radiography, and biochemical markers. Prognostic factors relevant to RA severity, including factors relevant to RA severity, including serum markers and genetic traits, must also be known so that appropriate therapeutic strategies can be planned. Although current therapy cannot reliably alter the long-term outcome of RA, new approaches are promising. Patients at high risk or who fail to respond to conservative therapy are candidates for earlier, more aggressive strategies using single or possibly combination antirheumatic therapy. | |
| 8523364 | Assessment of radiographic abnormalities in rheumatoid arthritis: what have we accomplishe | 1995 Sep | Assessment of radiographic damage in rheumatoid arthritis (RA) by scoring methods is useful to describe the progression of disease, and is an objective method of determining the effects of treatment. The history of the development of radiographic scoring methods is reviewed. None is ideal or truly quantitative and better methods are needed. Features of an ideal method are presented and the results of assessing treatment of RA by current methods of radiographic scoring are reviewed. Suggestions are made regarding the design of future therapeutic trials to take advantage of study features most likely to yield conclusive results by radiographic outcome assessment. |