Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 7788338 | Bone tissue in rheumatoid arthritis (2). Pathophysiologic data, pathologic findings, and t | 1995 Mar | The occurrence of bone decalcification during rheumatoid arthritis is well documented, despite discrepancies among published data. The most recent studies support a decrease in bone mass, especially at the proximal femur, although estimations of the extent of bone loss ascribable to rheumatoid arthritis vary. The fracture risk is increased by approximately 100% in rheumatoid arthritis patients. Bone mass is negatively correlated with functional impairment, joint motion restriction and disease activity as assessed by laboratory tests for inflammation. Increased physical activity can reduce bone loss. Markers for bone formation (osteocalcin, procollagen type I carboxy-terminal propeptide) are normal or decreased, whereas markers for bone resorption (hydroxyproline, pyridinoline, and deoxypyridinoline) are elevated. This decoupling of bone formation and resorption may be responsible for bone loss. Although estrogen therapy can keep in check menopause-related bone loss, earlier findings suggesting that estrogens may have beneficial effects on the joint disease itself have been disproven. The value of preventive bisphosphonate therapy is currently under debate. | |
| 7554570 | Treatment of early rheumatoid arthritis: a review of current and future concepts and thera | 1995 May | This review contrasts the difficulty of differentiating early rheumatoid arthritis (RA) from the many other causes of inflammatory polyarthritis and emphasizes the need for early treatment of RA with drugs that are present considered inappropriate for a mild, self-limiting disease. Pointers to help establish a definitive diagnosis of RA include the use of the American College of Rheumatology (ACR; formerly the American Rheumatism Association) diagnostic criteria, the presence of rheumatoid factor (RF), a raised erythrocyte sedimentation rate (ESR), raised serum levels of C-reactive protein (CRP) and low concentrations of serum sulphydryl (SH) groups. More sophisticated tests that are helpful and indicative of erosive-type disease are genetic markers such as the human leukocyte antigen HLA DR4 (especially the third allelic variable of DR beta 1) as well as an impaired sulphoxidation status. Similarly, the presence of the shared epitope alleles 0401 and 0404 quantitatively increases disease susceptibility and severity as their penetration increases. Experience with treatment indicates that control of the inflammatory process of RA reduces the progression of radiological damage. It is concluded that antimalarials are effective in mild disease, as is auranofin, whilst sulphasalazine is more effective than hydroxychloroquine in patients with disease diagnosed as definitive or classical RA. Intramuscular gold also lessens the development of erosions. The role of corticosteroids has not been defined. A number of combinations of drugs have been used, although they are probably not indicated as the first choice treatment for very early disease. Attitudes towards early treatment are changing; these are briefly reviewed and the authors' opinions on the management of early disease are outlined. Finally some new ideas, both theoretical and practical, on future development are summarized. | |
| 7552074 | Immunology of systemic rheumatoid disease. | 1995 Apr | Extra-articular or systemic features occur commonly in seropositive erosive rheumatoid arthritis (RA). Clinical, pathological and immunogenetic evidence suggests that nodule formation, vasculitis and Felty's syndrome can be considered as manifestations of the same fundamental disease process as rheumatoid synovitis. However, while synovitis seems likely to be driven by macrophage activation induced by Th1 cells, systemic involvement in RA is characterised by B cell overactivity, immune complex formation and complement consumption, suggesting that Th2 cells are involved in the pathogenesis of extra-articular rheumatoid disease. | |
| 8102215 | [Drug therapy of rheumatoid arthritis]. | 1993 Jul 26 | Continuous, computer-aided registration of large numbers of patients with rheumatoid arthritis (RA) had lead to a revised concept of the prognosis. More patients than previously throught develop severe progressive, erosive, deforming, and crippling disease. Most of the permanent damage develops within the first 10 years of the course of the disease. The patients die 10-15 years before the background population, even though the cause of death is rarely a direct consequence of the disease. Because of these observations, the treatment strategy is now becoming more aggressive than previously. Treatment with slow acting anti-rheumatic drugs (SAARDs) is started within the first year. Synovitis activity is monitored continuously, and in case of primary or secondary resistance to one SAARD the drug is replaced by another one for as long as the disease is active. This procedure makes it necessary that all patients with suspected RA be evaluated early and repeatedly by rheumatologists during the whole course of the disease. The drug treatment should be conducted with close cooperation between the general practitioners and the rheumatologists. | |
| 8846541 | Rheumatoid arthritis: new trends in therapy. | 1995 Sep | Recently, definite progress has been made in the pharmacotherapy of rheumatoid arthritis (RA). Since progression of joint damage is greatest during the first years of the disease, aggressive treatment nowadays is usually started early. RA has been considered to be a T cell driven disease, but therapies directed at eliminating T cells have not been consistently successful. Recent data indicate that macrophages may play an important role in the pathogenesis, and disease suppression has been demonstrated by antibodies against macrophage-derived cytokines. An important development in the treatment of RA has been the introduction of sulphasalazine and methotrexate, which are probably more effective than gold, D-penicillamine or hydroxychloroquine. The drug survival curve of the former drugs is better than that of the latter and their faster mode of action means that titration of these drugs towards optimal efficacy is easier. Due to these developments, the establishment of relevant measures for monitoring joint destruction and inflammatory mass are mandatory. | |
| 1563036 | The effects of gender and sex hormones on outcome in rheumatoid arthritis. | 1992 Feb | Disease patterns in RA vary between the sexes; the condition is more commonly seen in women, who exhibit a more aggressive disease and a poorer long-term outcome. Men, however, are more likely than women to die from extra-articular complications of rheumatoid disease. This chapter discusses the outcome and mortality studies that substantiate these conclusions and then examines the possible mechanisms that may account for them, including the HLA system, seropositivity, compliance, response to therapy and pain threshold. In particular, sex and sex hormones emerge as independent risk factors in rheumatoid disease. The epidemiological evidence points towards a peak age of onset of RA at the time of the menopause in women and towards later in life in men. Premenopausal women may fare better than postmenopausal women with RA. The possible protective effects of the oral contraceptive pill and the dramatic amelioration with pregnancy are well documented. In vivo and in vitro studies have demonstrated that sex hormones interfere with a number of the putative processes involved in the pathogenesis of RA, including immunoregulation, interaction with inflammatory mediators and the cytokine system, and direct effects on cartilage itself. All these observations point towards the importance of gonadal hormones. However, trials on the potential therapeutic use of sex hormones in RA are limited and, as yet, disappointing. Further work is necessary to determine whether the roles of sex hormones are as central protagonists or just supporting cast in the complex arena of rheumatoid disease. | |
| 8778987 | Rheumatoid arthritis: are pets implicated in its etiology? | 1996 Apr | Rheumatoid arthritis (RA) is thought to be triggered by an environmental agent or agents in immunogenetically predisposed persons. To investigate if animals or animal products might be the disease reservoir for a putative environmental trigger for RA that acts in childhood, a case-control study was undertaken. Included were 122 cases of RA and 114 control subjects of similar age. A specifically trained assistant, blinded to the diagnosis, used a standard interview proforma to gather information on ages of exposure to agents before onset of symptoms. Univariate analysis showed that cases were significantly more likely to have had a close association with a cat in the prepubertal period (65%) than were controls (27%); odds ratio (OR), 4.9 (confidence interval [CI] 2.7 to 9.0). In addition, there was a dose-response relationship between extent of prior exposure to cats and RA. There was a weaker association between recalled prior exposure to birds, budgerigars (parakeets) in particular, and RA. These data suggest that certain pets may be the reservoirs for environmental agents that trigger RA after a period of latency. | |
| 7673550 | Skin manifestations associated with rheumatoid arthritis. | 1995 May | We examined cutaneous manifestations of rheumatoid arthritis (RA) of 142 Japanese patients who visited both the Departments of Dermatology and Rheumatology of our hospital. We classified cutaneous lesions into specific and/or characteristic or nonspecific ones. Nonspecific lesions predominated in our series. Among the specific skin manifestations, which comprised 10% of the total, rheumatoid nodules, rheumatoid papules, rheumatoid neutrophilic dermatitis, and severe vasculitic ulcers correlated with high titers of rheumatoid factors and progression of RA, while purpura and livedo did not. Nonspecific skin manifestations failed to correspond with the level of rheumatoid factors. Among the nonspecific lesions, asteatotic eczema, candida interdigitalis, and tinea unguium were commonly detected. | |
| 1599817 | New horizons in the medical treatment of rheumatoid arthritis. | 1992 Jun | To date, the medical management of rheumatoid arthritis has been less than optimal for a significant number of patients. This has been manifested by progressive deformity, functional disability, and increased mortality in these patients. Alternative treatment schedules of currently available drugs, as recently advocated by some investigators and the results of both the preclinical and the applied clinical evaluations of a number of novel pharmacologic therapies are reviewed. Several effective nonpharmacologic treatments have been reported in the last year, and their significance in the treatment of rheumatoid arthritis are also discussed. | |
| 9010081 | Clinical and laboratory assessments in rheumatoid arthritis and osteoarthritis. | 1996 Dec | Clinical and laboratory assessments in rheumatoid arthritis and osteoarthritis precede imaging methods in both defining diagnosis and determining response to therapy. Some assessments are similar in both diseases, e.g. measuring joint pain, the number of involved joints and functional impairment. There are also areas of difference; for example, rheumatoid arthritis is a systemic disease with immune disturbance and positive tests for rheumatoid factor and elevated acute phase markers while osteoarthritis is a more local disease with little systemic upset. In both diseases pain and progressive joint damage result in increasing disability. There is agreement on a core data set in rheumatoid arthritis which comprises: swollen joint counts, tender joint counts, pain assessment, patient's global assessment, an acute phase marker such as the ESR and a self-administered functional questionnaire. There is less agreement on the core data set in osteoarthritis, though pain and functional impairment are both important. Combined or overall indices have been used in both rheumatoid arthritis (e.g. the disease activity score) and in osteoarthritis (e.g. the Lequesne functional index), but there is no general agreement on their value. In both diseases plain radiology is useful to define diagnostic groups and follow progression in long-term studies. Mortality is increased in rheumatoid arthritis and is useful for defining the long term effects of the disease; little is known about mortality in osteoarthritis. Standardizing clinical methods is important and much work is needed in this area. | |
| 8247993 | Rheumatoid arthritis. Importance of early diagnosis in long-term outcome. | 1993 Dec | Rheumatoid arthritis is a common disorder that does not have the favorable outcome it was once thought to have. A detailed clinical history, thorough physical examination, and judicious use of serologic tests and radiologic studies should allow accurate diagnosis, even at an early stage. Traditional therapy can successfully improve short-term functional status but may not alter long-term outcome. Early, aggressive therapy may improve prognosis, but this approach must be further studied and, if attempted, should be done in consultation with a rheumatologist. | |
| 8842715 | The distal radioulnar joint in rheumatoid arthritis. | 1996 Aug | This article outlines the relevant pathoanatomy and kinematics, clinical and radiographic findings, and treatment alternatives for the rheumatoid distal radioulnar joint. A summary of the authors preferred techniques is presented. | |
| 8523363 | The validity of radiography as outcome measure in rheumatoid arthritis. | 1995 Sep | Radiographic imaging of hand (and foot) joints is regarded as one of the gold standards of outcome for rheumatoid arthritis. Outcome can be defined as suffering or loss of health caused by the disease process, and process as the abnormal physiological consequences that follow from the cause of the disease. By these definitions and through a review of validity components, I propose that radiographic damage may be best viewed as a unique and important measure of past process, and possibly as a proxy for outcome. | |
| 8942945 | [Criteria of response to treatment of rheumatoid arthritis]. | 1996 Oct 5 | Rheumatoid arthritis is a chronic inflammatory rheumatic disease with clinical and biological signs of inflammation, responsible for bone and cartilage defects. These latter are responsible for irreversible functional impairment. Because of the lack of effective therapy of the disease, there is a need for clinical, biological and radiological outcome variables to assess the symptomatic and structural severity of the disease. Different consensual meetings of the international rheumatological community dramatically facilitated uniformization of the medical language in this field by providing simple accurate tools to be used in daily practice. | |
| 1599814 | The immunogenetic component of susceptibility to rheumatoid arthritis. | 1992 Jun | The precise nature of the HLA element associated with rheumatoid arthritis has been identified as a short sequence of amino acids on the alpha helix of a range of DR beta alleles. Recently the range of alleles known to bear this sequence and to be associated with rheumatoid arthritis has increased considerably. Although these findings lend further weight to the validity of the original hypothesis, they have also made it very difficult to propose a mechanism for the association. It has also become clear that the simple model of dominant susceptibility is unsatisfactory. Patients with early disease show little or no association with any HLA alleles, whereas patients with severe forms of rheumatoid arthritis are frequently homozygous for DR4, showing a disproportionate tendency toward compound heterozygocity--expressing two different molecules sharing the conserved sequence. | |
| 8619092 | Assessment of long-term outcomes of rheumatoid arthritis. How choices of measures and stud | 1995 Aug | In this article, previous review articles concerning long-term outcomes of rheumatoid arthritis are extended. A summary is provided of evidence that impressions concerning the long-term natural history and results of therapy in rheumatoid arthritis are strongly influenced by the types of measures and study designs used to assess patient status and outcomes. | |
| 1563035 | Quantitative measures to assess, monitor and predict morbidity and mortality in rheumatoid | 1992 Feb | The use of quantitative measures to analyse the long-term course of RA appears to have provided new insights into the severe morbidity and increased mortality rates of this disease. Quantitative assessment of RA may be viewed as an expression of clinical rheumatology as a quantitative science designed to assess accurately the long-term course of disease. The description of the joint count, radiographic scores, laboratory tests, questionnaire measures and physical measures of functional status, as well as the importance of socio-economic status, may provide new insights into the pathogenesis, prevalence, morbidity and mortality of RA. | |
| 8632966 | Perioperative management of rheumatoid arthritis. Areas of concern for primary care physic | 1996 Feb | The presence of rheumatoid arthritis can impose increased risks on patients undergoing surgical procedures. Affected patients often have peripheral joint inflammation, temporomandibular joint disease, laryngeal involvement, or cervical spine disease. Preoperative evaluation should also include assessment of cardiovascular disease, pulmonary disorders, and Sjögren's syndrome. Perioperative control of infection and prophylactic use of antibiotics are particularly important. To avoid wound-healing problems, preoperative discontinuation of therapy with aspirin, nonsteroidal anti-inflammatory drugs, and some slow-acting antirheumatic agents may be necessary. Effective management requires a team approach involving the primary care physician, the surgeon, other subspecialists, and allied healthcare personnel. To prevent unnecessary delays once the patient is hospitalized, preoperative assessment should be done primarily on an outpatient basis. | |
| 8086845 | Rheumatoid hand. Practical approach to assessment and management. | 1994 Jul | Rheumatoid arthritis is a systemic inflammatory disease with a predilection for the synovial tissues. Its diverse involvement can be demonstrated in the hand, where several anatomical structures can be affected simultaneously. Proper management requires attention to this principle, and a complete diagnostic evaluation will help to identify correctly the cause of the patient's functional limitation and pain. We present a practical approach to managing rheumatoid arthritis in the hand. | |
| 8539481 | [Usefulness of the determination of C reactive protein and other acute phase proteins in r | 1995 Nov | The acute phase response is defined as a large number of diverse reactions which attempt to adjust the organism to the effects of stress/injury. It is now clear that there is a complex interaction between the cytokines with interleukin-6 predominant, but also involving interleukin-1, tumor necrosis factor and a group of recently described cytokines including as well interleukin-11, leukaemia inhibitory factor and oncostatin M all of which influence the levels of acute phase proteins. In clinical practice, C reactive protein (CRP) is frequently used as marker of the acute-phase response. It has a short half-life and consequently it is a sensitive measure of cytokine-induced protein synthesis. In rheumatoid arthritis (RA) the rate appearance of bony erosions in the early phase of the disease correlated with the mean serum concentration of CRP in some studies. A recent study examining the rate of spinal trabecular bone loss in the first year of rheumatoid disease found a strong correlation between bone loss and serum CRP concentrations. It appears that CRP concentrations reflect the level of "systemic osteoclast-activating factor" and are, therefore, a good measure of the general catabolic state of the patient. Many would now consider that persistently elevated serum CRP in patients with RA is in itself an indication for immunosuppressive therapy. |