Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 9010967 | Rheumatoid arthritis and bronchiectasis. A retrospective study of fourteen cases. | 1996 Dec | Since 1928, 288 cases of rheumatoid arthritis and bronchiectasis have been reported in the medical literature. The interactions between these two conditions and the etiopathogenic mechanisms they involve remain unclear. During a retrospective study of 100 rheumatoid arthritis patients and 80 bronchiectasis patients, we identified 14 additional patients with both conditions. There were 10 females and four males (ratio 2.5/1). Bronchiectasis was confirmed either by computed tomography of the chest or by bronchography. The respiratory manifestations antedated the joint disease in 12 patients, by a mean interval of 28.5 years. An infectious cause was identified in six cases. Neither the age at onset nor the duration of rheumatoid arthritis were influenced by the presence of bronchiectasis. Seven patients had 15 extraarticular manifestations suggesting potentially severe joint disease. The flares of joint and respiratory symptoms were concomitant in six patients. In six patients, the respiratory manifestations worsened after onset of the joint disease. Tests for rheumatoid factors were positive in 73% of cases. Panhypogammaglobulinemia was found in one case. Ten patients underwent lung function tests, which showed evidence of nonspecific obstructive disease. Overall, our findings are consistent with previous reports in the literature. In patients with predisposing immunogenetic factors, bronchiectasis may be involved in the genesis of rheumatoid arthritis. | |
| 1378718 | Angiogenesis and rheumatoid arthritis: pathogenic and therapeutic implications. | 1992 Jul | Rheumatoid arthritis can be considered as one of the family of 'angiogenesis dependent diseases'. Angiogenesis in rheumatoid arthritis is controlled by a variety of factors found in the synovial fluid and pannus tissue. Modulation of the angiogenic component of the disease may alter the pathogenesis of the condition, and subsequent cartilage and joint destruction, by reducing the area of the endothelium in the pannus and restricting pannus growth. Current therapeutic strategies exert, to varying extents, an inhibitory effect on the angiogenic process. In particular, the mode of action of the slow acting antirheumatic drugs may be due to their effect on the angiogenic response. The development of novel angiostatic treatments for chronic inflammatory joint disease may lead to a new therapeutic approach in controlling disease progression. | |
| 8714794 | The underestimated long term medical and economic consequences of rheumatoid arthritis. | 1995 | Rheumatoid arthritis is generally a progressive disease, with radiographic evidence of joint damage, declines in functional status, and premature mortality. In addition, the disease has severe long term economic consequences, including direct costs of medical care, indirect costs of work disability and interference with social roles, as well as the intangible costs of pain, fatigue, helplessness, loss of self-efficacy, and other psychological difficulties. The consequences of rheumatoid arthritis have often been underestimated by health professionals, reimbursement agencies, the general public, and even rheumatologists. Furthermore, the adverse effects of potential therapies have often been regarded as more severe than the 'adverse effects' of untreated disease. More than 50% of patients with rheumatoid arthritis who are younger than 65 years and who were working at onset of disease receive work disability payments, and 0.8% of the US population eligible to work are individuals who have symmetrical polyarthritis but who, unfortunately, are not working. The total earnings gap between individuals with symmetrical arthritis and those in the general population was $US8.9 billion for women and $US8.7 billion for men, for a total of $US17.6 billion (1986 US dollars). The projected costs of knee replacement in patients with rheumatoid arthritis in the US are between $US600 million and $US900 million annually. New approaches to therapy, which include earlier and more aggressive intervention, new drugs, and combinations of drugs, appear required to provide adequate control of inflammation, so that the long term damage of rheumatoid arthritis might be prevented and the considerable costs ameliorated. The possible adverse effects and costs of treatment must be balanced against the adverse effects and underestimated costs of rheumatoid arthritis. | |
| 8591647 | Innovative treatment approaches for rheumatoid arthritis. T-cell regulation. | 1995 Nov | There is considerable evidence to implicate T cells in the pathogenesis of rheumatoid arthritis (RA). They initiate and sustain inflammation and therefore are attractive targets for immunotherapy. Several strategies targeting T cells have been tried in RA. The use of monoclonal antibodies to deplete T cells have been used extensively but with little success. Studies have shown that T cell depleting antibodies produce profound peripheral blood lymphopenia but they are less effective in depleting lymphocytes in the joint. Since clinical efficacy is likely to depend on depleting almost all synovial lymphocytes, high doses of monoclonal antibodies would have to be given. However, the invariably severe peripheral blood lymphopenia induced by such a regimen is likely to result in profound immunosuppression. Therefore, this strategy has been abandoned and recent attempts have been made to induce tolerance in RA. In animal models of RA, treatment with high dose non-depleting anti-CD4 monoclonal antibody protects them from arthritis induced by injection of streptococcal cell wall. In addition, it leads to a state of anergy which protects the animals from arthritis induction without further treatment with anti-CD4 monoclonal antibody. This is currently being used in clinical trials of RA. Other tolerance inducing treatment strategies include T cell or T cell receptor vaccination and oral tolerance. The former is particularly difficult since the rheumatoid arthritogenic antigen and the pathogenic T cell remain unknown. The latter has shown promise in placebo controlled trials although the ideal dosage remains unknown. The mechanism of action of oral tolerance involves either immunosuppressive T cell cytokines, T cell anergy or depletion. | |
| 8714795 | Prognostic markers in rheumatoid arthritis and classification of antirheumatic therapies. | 1995 | Rheumatoid arthritis is characterised by a generally poor outcome and high morbidity, and has a variable course. Identifying those patients most likely to have a poor prognosis is of key clinical significance. Disease outcome can be predicted from a variety of prognostic markers. Some of these are simple demographic features of the patients, and include age, disease duration, and gender. Others are more specific features of rheumatoid arthritis, including the presence of early erosive changes on plain radiographs, high rheumatoid factor titres, high levels of C-reactive protein, and high scores for disease activity. Although no single marker has adequate specificity or sensitivity to form the basis of clinical decisions, the presence of several is predictive of more severe disease. Thus, patients with early erosive damage who are seropositive for rheumatoid factor and have high levels of C-reactive protein are more likely to have a poor outcome. New markers and imaging techniques are likely to become the prognostic tools for the future. These include genetic markers, and a combination of magnetic resonance imaging and dual energy x-ray absorption scans for localised osteoporosis. | |
| 7858571 | [Rheumatoid arthritis and neoplasms]. | 1994 Dec 15 | The relationships between rheumatoid arthritis and malignant disease have been a focus of controversy for many years. The body of available data supports a relative decrease in the overall rate of occurrence of cancer, in particular of the colon, with no significant impact on mortality. However, increases have been demonstrated in the relative risks of lymphoma and, to a lesser degree, leukemia. The concomitant occurrence of rheumatoid arthritis and multiple myeloma seems fortuitous, with a relative risk of approximately 2. The effect of treatments, including methotrexate, remains unproven to date. | |
| 8467555 | Rheumatoid arthritis: how well do the theories fit the evidence? | 1993 Apr | In this brief review, inspired partly by a symposium at the autumn meeting of the British Society for Immunology, 1992, varying hypotheses concerning the etiopathogenesis of rheumatoid arthritis (RA) are explored and tested against current evidence. Immunogenetic considerations, whilst of interest, have not aided our understanding of the development of this disease. The association with restricted HLA-DR beta chain hypervariable sequences does not hold true with all cases of RA (but may be related to disease severity) and studies of T cell receptor (TCR) beta chain usage fail to show consistent oligoclonality of infiltrating T cells in the synovial compartment. Etiologies based on triggering by bacteria are also considered: homologies between the 'shared epitope' sequences of HLA-DR1 and DR4 beta chains, Escherichia coli dnaJ and Proteus haemolysin do not indicate any feasible mechanisms for the development of RA, and cannot explain the many cases in which such DR sequences do not occur, though new data from man and animals enhance interest in the role of bowel flora. Finally, the striking parallels between slow bacterial infections and RA, in terms of immunogenetics, pathology, IgG glycosylation abnormalities and autoimmune manifestations, are put forward as circumstantial evidence that such bacterial infections may underly, or trigger, this serious disease. | |
| 7612415 | Cell adhesion molecules in rheumatoid arthritis. | 1995 May | The adhesion mechanisms that enable leukocytes to migrate from the blood and function within inflamed synovium continue to occupy an area of intense investigation. Over the past year, advances have been made in understanding the specialized roles that individual adhesion molecules play in the interactions between leukocytes and vascular endothelial cells in inflammation in general. Several articles have described the expression of novel adhesion molecules in rheumatoid synovium, and a number of reports on the measurement of soluble adhesion molecules in blood and in synovial fluid have appeared, although it is too early to know whether this is clinically useful. Finally, inhibiting adhesion molecule function in vivo remains an attractive option for anti-inflammatory therapy. | |
| 8842719 | Extensor tendon problems in rheumatoid arthritis. | 1996 Aug | Extensor tenosynovitis is a common presenting upper extremity problem and, unless it resolves with medical management, preventative tenosynovectomy is indicated to prevent tendon rupture. When a rupture has occurred, tendon reconstruction with either a transfer or a graft has a reasonable chance of restoring function as long as the number of tendons involved is limited. Rupture of a single extensor tendon requires surgical treatment to eliminate the cause and prevent further damage, as well as repairing the injured tendon. It is important to give consideration to associated wrist and MP joint problems before, during, or after treating tendon abnormalities. | |
| 8842716 | Metacarpophalangeal joints in rheumatoid arthritis of the hand. | 1996 Aug | Treatment of the MP joint in the patient with rheumatoid arthritis can lead to very satisfying results. Decision making is based on the degree of compromise in the hand and the knowledge of anticipated outcomes with surgery. In patients in whom pain is an overriding feature, implant surgery is highly successful. The timing for implant surgery in regard to deformity is less clear. Soft tissue correction procedures without implants appear to have value in the treatment of moderate to late disease and further documentation of the long-term outcomes will prove helpful in determining the roles of such procedures. If silicone rubber MCP arthroplasty is performed, one can anticipate an arc of motion in the 50-degree range, with improvement of extensor lag. There also is improvement of ulnar deviation, although recurrence into the 10 to 15 degree range is not unexpected. Complications such as deep infection, recurrent deformity, and implant breakage all play a role in making the decision to undertake surgery. Younger patients obviously have more risk for future prosthetic problems. The development of silicone implant arthroplasty of the MP joint has given the hand surgeon a valuable way of improving hand function in patients with severe rheumatoid involvement. It is a procedure the outcome of which may be anticipated and patients may be reassured with some degree of confidence that the hand surgeon can provide them with improved hand function. | |
| 7600065 | Epidemiology and semiology of rheumatoid arthritis in Third World countries. | 1995 Feb | Studies conducted over the last three decades in Third World countries have confirmed that rheumatoid arthritis occurs throughout the world. When interpreting the results of these studies, however, the potential biases resulting from the socioeconomic, demographic and health care conditions in these countries should be kept in mind. These studies, of which most did not include representative samples, identified geographic variations in the semiology and genetic profile of the disease. In India, the prevalence of rheumatoid arthritis (0.75%) is similar to that in the West. In China, Indonesia, and the Philippines, in contrast, rheumatoid arthritis appears rare (prevalence below 0.4%), in both urban and rural settings. The rarity of rheumatoid arthritis in rural Africa contrasts with the high prevalence of the disease in Jamaica, where over 2% of the adult population are affected. In a study in Latin America, rheumatoid arthritis was the reason for seeking medical advice in 22% of rheumatology clinic patients. These differences probably reflect variations in the interactions between genetic and environmental factors. Rheumatoid arthritis may be less severe in Asia and West Africa than in western countries. No such difference has been found for Jamaica or southern and eastern Africa. In China and India, the genetic profile associated with rheumatoid arthritis is not uniform. Thus, associations with antigens other than HLA DR4 have been demonstrated. This genetic variability may reflect the heterogeneity of the Chinese and Indian populations. It may also support the theory of a shared epitope. In southern Africa, most rheumatoid arthritis patients carry the HLA DR4 antigen.(ABSTRACT TRUNCATED AT 250 WORDS) | |
| 8911650 | The neuroendocrine immunology of rheumatoid arthritis . | 1996 May | Rheumatoid arthritis patients have defective neuroendocrine-immune responses to the stress of inflammation, and currently available data shows that this contributes to the pathophysiology of the disease. The advances in neuroendocrine immunology have improved our understanding of the pathophysiological mechanisms involved in RA. These observations raise important therapeutic questions which are certainly worth further investigation as they may open up novel avenues for the management of the disease. | |
| 8448635 | Immunological actions of cyclosporin A in rheumatoid arthritis. | 1993 Mar | Rheumatoid arthritis is present in a population which is heterogeneous both clinically and immunologically. A variety of cells including lymphocytes, macrophages and fibroblasts play important roles in its pathogenesis, but the T cell appears to be a common thread throughout the disease process. Treatments aimed at reducing these lymphocytes mechanically and specifically result in a good clinical response in many patients. The mechanism of action of cyclosporin A (CyA) in inhibiting T lymphocytes presents a more specific form of therapy. Though limited, studies including immune profiling suggest that certain subgroups of RA patients are more likely to respond to CyA. Further studies are required to test these findings, but targetted therapy with CyA could result in enhanced and longer-lasting efficacy. | |
| 9136394 | The role of psychological stress in rheumatoid arthritis. | 1996 Dec | Psychological stress affects the immune system, and stress is linked to disease onset and exacerbation in the rheumatoid arthritic patient. Stress may precede the onset of disease flare-ups. Adult health and advanced practice nurses should focus on assessing patients for symptoms of stress, identifying methods of coping when faced with stress, and implementing a variety of stress-reduction techniques. | |
| 8535652 | Sulphasalazine: mechanism of action in rheumatoid arthritis. | 1995 Nov | Sulphasalazine a drug used for the treatment of rheumatoid arthritis (RA) shows a wide range of biological activities all of which might contribute to the beneficial clinical effect seen during treatment of RA. This review summarizes some of the biological activities and discusses these in context of possible modes of action of the drug. Sulphasalazine has been described as an antibacterial drug, an anti-inflammatory drug or as an immunomodulator. From the reviewed data it is concluded that the effects of sulphasalazine on various immunological processes, are of outstanding importance for its mode of action. | |
| 8844908 | Management of the foot and ankle in rheumatoid arthritis. | 1996 Aug | Rheumatoid arthritis frequently involves the foot and ankle, resulting in pain, deformity, and difficulty with ambulation. This article outlines clinical, radiographic, and gait evaluation in the management of foot and ankle problems in rheumatoid arthritis. Conservative nonsurgical management of foot deformities is presented including available shoewear and orthotic options. Surgical considerations including indications, biomechanic implications, and specific operative procedures are discussed. | |
| 1588753 | [Amyloidosis in rheumatoid arthritis]. | 1992 Mar | Complication of secondary amyloidosis is becoming an important problem in the management of rheumatoid arthritis in Japan, because patients with rheumatoid arthritis, complicated by amyloidosis, have been increasing recently and the prognosis is poor in most cases. Renal and gastrointestinal symptoms are cardinal features of amyloidosis in rheumatoid arthritis, and most of these patients die of renal failure or cachexia, based on gastrointestinal involvement, within several years. Diagnosis in the early stage is recommended for good management of amyloidosis in rheumatoid arthritis, and gastroscopic biopsy appears to be the most available method for early diagnosis of amyloidosis. | |
| 8842718 | The rheumatoid thumb. | 1996 Aug | The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Fortunately, much can be done to provide pain relief, improve function, enhance appearance, and slow the progression of disease. Specific surgical interventions should be based on the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. Treatment options, in isolation or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Although most thumb deformities can be classified as one of six common types, other patterns of deformity also are seen. It therefore is imperative not to operate on pattern recognition alone, but to examine each patient carefully and individualize treatment. | |
| 8846539 | Humoral immunity and glycosylation abnormalities in rheumatoid arthritis. | 1995 Sep | Humoral abnormalities are a significant feature of rheumatoid arthritis (RA) even if, as seems likely, they do not represent primary phenomena. Thus, autoantibodies including rheumatoid factor, anti-perinuclear factor and anti-RA33 antibodies are important serological features of RA, although none are truly disease-specific. In addition, it has been shown that serum IgGs from RA have an increased number of oligosaccharide structures attached to the Fc region whose outer 'arms' lack galactose [i.e. increased Gal (0)]. Measurement of Gal (0) has been shown to have clinical utility in the assessment and follow-up of patients with RA. | |
| 8688694 | Managing early presentation of rheumatoid arthritis. Systematic overview. | 1996 May | OBJECTIVE: To describe evidence-based management of patients presenting to family physicians with typical signs and symptoms of recent onset of rheumatoid arthritis (RA). STUDY SELECTION: Articles for critical review were included if relevant to primary care management of early RA (less than 1 year duration). Sources included MEDLINE from 1966 to December 1995, the reference library of the Arthritis Community Research and Evaluation Unit, and conference abstracts. FINDINGS: Evidence from randomized, controlled trials supports the short-term benefit of nonsteroidal anti-inflammatory drugs, disease-modifying agents for rheumatic diseases, intravenous pulse corticosteroid therapy, intra-articular therapy, aerobic exercise, patient education, psychologic intervention, home physiotherapy, home occupational therapy, and rehabilitation programs. Some evidence favours acetaminophen for analgesia, low-dose oral corticosteroids for symptom control, and referral to a rheumatologist. Evidence for rest, ice, and heat for symptom control is conflicting and based on low-quality studies. CONCLUSION: Family physicians play an important role in establishing early and accurate diagnosis of RA, coordinating therapy, and providing ongoing support, education, and monitoring to patients and their families. |