Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8940957 | Acute monoarthritis: a practical approach to assessment and treatment. | 1996 Nov 15 | A basic approach to the patient presenting with acute monoarthritis includes a careful history, a physical examination and a selected battery of laboratory tests and radiographs. Because of the possibility of septic joint, rapid assessment and treatment are required. The most common causes of acute monoarthritis are trauma, crystals (gout and pseudogout) and infection. The most important cause of acute monoarthritis is infection, which must be excluded through the use of diagnostic joint aspiration and culture of synovial fluid. | |
| 1734901 | Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis. 84-m | 1992 Feb | OBJECTIVE: To determine the long-term efficacy and safety of low-dose methotrexate (MTX) in rheumatoid arthritis (RA). METHODS: Eighty-four-month open prospective trial at a single academic rheumatology center. RESULTS: Twenty-six patients were enrolled in a prospective study of the long-term efficacy of MTX in RA; a significant improvement had been demonstrated after 36 months of therapy. Twelve patients remained in the study at the 84-month visit; the mean weekly dosage of MTX was 10.2 mg. A significant improvement was still noted at 84 months in the number of painful joints, number of swollen joints, joint pain index, joint swelling index, and physician and patient global assessments. A 50% improvement in the joint pain index and joint swelling index was observed in more than 80% of the 12 patients still enrolled. A significant reduction in prednisone dosage was achieved; of 14 patients taking prednisone at entry, 7 had discontinued prednisone completely. Fourteen patients withdrew from the study: 10 between 0 and 36 months, and 4 between 36 and 84 months. Toxicity in 3 patients and visit noncompliance in 1 patient were the reasons for withdrawal between 36 and 84 months. At 84 months, 46% of the patients remained in the study; 11.5% had discontinued due to MTX toxicity. CONCLUSION: The effectiveness of MTX in the treatment of RA continues to be demonstrated in this prospective study, after 84 months of treatment. | |
| 7825055 | Sacral insufficiency fractures in rheumatoid arthritis. | 1994 Sep 15 | METHODS: All patients with rheumatoid arthritis (RA) attending an outpatient rheumatology clinic at a major military medical center over 6 years were included in follow-up for the development and subsequent course of sacral insufficiency fractures. RESULTS: Sacral insufficiency fractures developed in 4 of 386 patients. Consistent with the literature, patients were female, elderly, and/or postmenopausal, had severe or long-standing disease, and were taking corticosteroids. The correct diagnosis was initially delayed because radiographs were normal but was later established with bone scan and sacral computerized tomography. Each patient improved with calcitonin and/or physical therapy over time. CONCLUSIONS: Patients with RA represent a unique subgroup predisposed to insufficiency fractures because of multiple osteoporotic risk factors. Patients who have RA and acute low back or buttock pain should be evaluated aggressively for sacral insufficiency fractures with bone and/or computed tomography scans regardless of normal plain radiographs. | |
| 8337190 | Depression scales in rheumatoid arthritis: criterion contamination in interpretation of pa | 1993 May | Self-report depression scales include items concerning somatic symptoms, such as fatigue, pain, and inability to work, which may be symptoms of depression in individuals who do not have a chronic disease. However, in patients with somatic diseases such as rheumatoid arthritis, these symptoms may reflect disease rather than depression. Interpretation of responses to these items in patients with chronic disease as indicating depression is known as "criterion contamination". Criterion contamination has been described in responses of patients with rheumatoid arthritis on many widely-used depression scales, including the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Center for Epidemiologic Studies Depression Index (CES-D). Evidence for criterion contamination in responses of patients with rheumatoid arthritis on these depression scales is summarized in this essay. | |
| 8523337 | A preliminary evaluation of hydroxyurea for the treatment of rheumatoid arthritis. | 1995 Sep | OBJECTIVE: To obtain preliminary evidence on the safety and efficacy of low dose hydroxyurea as a treatment for rheumatoid arthritis (RA). METHODS: Five patients with active RA unresponsive to conventional therapy were entered into a 12 week, open label trial of hydroxyurea followed by a one month postdrug evaluation. RESULTS: Three of the 4 patients completing the study had a decrease in morning stiffness and number of swollen and tender joints. All 4 patients had a decrease in pain and an increase in function as measured by a modified health assessment questionnaire. No patient had improvement in sedimentation rate, C-reactive protein, or subjective measures of global well being. However, 3 of the 4 patients had disease flare after the drug was withdrawn, demonstrated by increased number of swollen and tender joints. CONCLUSION: Low dose hydroxyurea may be effective in the treatment of RA, but confirmation will require further testing by a randomized double blind placebo controlled trial of patients with a broader spectrum of disease severity over a longer period of therapeutic intervention. | |
| 8316774 | Pain intensity in patients with fibromyalgia and rheumatoid arthritis. | 1993 | Three times daily continuously during a three-week inpatient rehabilitation course a visual analogue scale (VAS) was used in the assessment of pain intensity in 20 female patients with primary fibromyalgia (PF) and 20 female patients with rheumatoid arthritis (RA). The pain intensity in PF patients was constantly twice as high as in RA patients. The effect of the rehabilitation course on pain intensity, as assessed by linear regression analysis, was significantly higher in RA than in PF (p < 0.001). In comparison of the first and the last two days, the pain intensity decreased significantly (P < 0.01) in RA, but not in PF. The patients with PF were more depressive than the RA patients, but a positive correlation between depression score and pain intensity was found only in RA patients. Depression was not able to explain the high pain intensity in PF patients. Continuous monitoring of pain by VAS seems to be a useful tool for assessing changes in pain intensity in patients with rheumatic disorders. | |
| 7920522 | [The carpus-metacarpus-index distance: a measurement for quantifying radiological lesions | 1994 Apr | The carpus-to-digits distance measured on a posteroanterior roentgenogram of the hands and wrists takes into account 18 different joints. This study demonstrates that the carpus-to-digit distance is a simple, reproducible score which reliably reflects progression of roentgenological rheumatoid arthritis lesions and is correlated with Larsen's lesion score and with Steinbrocker's index, but not with Larsen's erosion score during the first two years after onset of the disease. Larsen's erosion score and similar parameters should be preferred for clinical studies of recent-onset rheumatoid arthritis. The carpus-to-digit distance, which requires neither a reference film not observer training, is appropriate for long-term clinical studies. | |
| 7728394 | Heterogeneity of disease phenotype in monozygotic twins concordant for rheumatoid arthriti | 1995 Mar | The objective of the study was to investigate the genetic contribution to the clinical expression of rheumatoid arthritis (RA) by comparison of disease features in RA-concordant monozygotic (MZ) twin pairs. Fourteen RA-concordant MZ twin pairs recruited from a nation-wide study were examined to determine the degree of similarity in: (a) age of disease onset; (b) pattern of joint involvement; (c) pattern of extra-articular disease; (d) toxic reactions to drugs; (e) disease course; and (f) serology for rheumatoid factor (RF) and antinuclear antibody. There was considerable within-pair diversity in the variables studied. Some similarity within twin pairs was observed for the ages at disease onset (R = 0.63), presence of erosive changes (kappa = 0.61) and the presence of IgM RF (R = 0.87). No important similarity was seen, however, in the pattern of joint involvement, the occurrence of extra-articular disease, adverse drugs reactions, clinical disease course and reported disability level. There is heterogeneity in the genetic contribution to the clinical expression of RA. The overall lack of similarity for the majority of clinical variables indicates the importance of non-genetic factors on the expression of disease. | |
| 8471533 | Uridine diphosphoglucose dehydrogenase activity in normal and rheumatoid synovium: the des | 1993 Feb | Although synovial lining cells (SLC) have been implicated in the production of hyaluronan (HA), which is found at particularly high concentrations in synovial fluid, the degree to which individual cells within the synovium are adapted to this particular function remains to be elucidated. Uridine diphosphoglucose dehydrogenase (UDPGD) activity is the irreversible, rate-limiting step in the production of UDP-glucuronate, an essential monosaccharide in the synthesis of HA. We have assessed the UDPGD activity, microdensitometrically, in individual lining cells of normal and rheumatoid (RA) synovium, using a modified quantitative cytochemical method. In normal synovium, high activity was confined to the cells of the lining with negligible activity in the deeper subintima. The mean UDPGD activity/cell in lining cells of rheumatoid synovium was significantly lower than the activity in normal SLC. In some samples of RA and normal synovium, a bimodal distribution of cells was evident in the lining on the basis of UDPGD activity, a zone of cells in the basal layers with high UDPGD activity and a separate population of cells in more superficial layers with relatively low UDPGD activity. The results suggest that a particular population of cells is present, consistently in normal and more variably in RA synovial lining, which have high UDPGD activity/cell and may be involved in the production of HA. Furthermore, in RA synovium both the UDPGD activity/cell and the relative proportion of these cells within the lining appear to be decreased. | |
| 1412121 | Acute pneumonitis associated with low dose methotrexate treatment for rheumatoid arthritis | 1992 Aug | BACKGROUND: Low dose methotrexate has become established in the treatment of refractory rheumatoid arthritis. Until recently it has been considered that the use of a low dose regimen (< 20 mg/week) would avoid the pulmonary toxicity associated with the higher doses prescribed in malignant disease. Although initial experience with low dose methotrexate was encouraging, an increasing number of cases of an acute, life threatening pneumonitis are being reported in patients with refractory rheumatoid arthritis. PATIENTS: Since 1984 43 patients with refractory rheumatoid arthritis have been established on low dose methotrexate in the Oxford Health District. Five of these patients have subsequently developed acute methotrexate induced pneumonitis. The clinical and radiological features of these cases are described and previous reports reviewed. RESULTS: Five patients having low dose methotrexate treatment developed acute pneumonitis. Presentation was subacute and dominated by constitutional features. Respiratory symptoms developed insidiously but progressed rapidly with increasing dyspnoea associated with severe hypoxia. Chest radiographs were non-specific, showing diffuse interstitial infiltration and alveolar shadowing. Microbiological investigation gave negative results. In all cases methotrexate was discontinued and high dose corticosteroids started, with rapid clinical and radiological improvement. After withdrawal of steroid both clinical and radiological resolution was maintained at follow up. CONCLUSION: Acute pneumonitis is an uncommon but serious adverse effect of low dose methotrexate treatment for refractory rheumatoid arthritis. The initial presentation is non-specific and a high index of suspicion is required as respiratory failure may develop rapidly. Management depends on exclusion of infection, withdrawal of methotrexate, and high dose corticosteroid treatment. Full supportive treatment is indicated as the prognosis in such patients is good. | |
| 7774109 | Microvascular capillaroscopic abnormalities in rheumatoid arthritis patients. | 1995 Jan | Microvascular circulation was investigated by nailfold capillaroscopy in 32 patients affected by rheumatoid arthritis (RA). In all the patients elongated and tiny capillaries as well as tortuousity were the main shape abnormalities of the capillary loops. Higher subpapilar venous plexus (SPVP) visibility was evidentiated in patients presenting antinuclear and anti-RANA antibodies. No differences in the capillaroscopic pattern were found between rheumatoid factor positive and rheumatoid factor negative patients. In conclusion, elongated and tortuous capillaries seem to be the main alterations in RA, although they are not specific to the disease and are not correlated with the presence of rheumatoid factor. Higher SPVP visibility may be an expression of the endothelial damage induced by antinuclear antibodies in vessel walls. | |
| 1285886 | Parity status and the development of rheumatoid arthritis. | 1992 Oct | Rheumatoid arthritis (RA) is one of a number of autoimmune diseases with a marked female excess in incidence, particularly during the reproductive years. It is of interest to investigate whether reproductive factors are important in determining susceptibility to RA. However, difficulties in dating the pathological onset of the disease can make it difficult to distinguish between the reproductive influence history on disease and the influence of (subclinical) disease on reproduction. In women with RA compared to controls, there is no excess of being unmarried. Most but not all studies, show an increase in nulliparity, whereas parity rates in fertile RA women are unchanged. There is an increased rate of onset postpartum, particularly in the first three months after delivery. There is no unifying biological explanation for these epidemiological findings, and it is likely that the apparently obvious link between reproductive experience and pregnancy is complex. | |
| 1290023 | Osteocalcin in patients with rheumatoid arthritis--effect of anatomical stages, inflammato | 1992 | The aim of this study was to investigate whether the degree of inflammatory activity, the anatomical stage and various treatments have an influence on bone turnover in patients with rheumatoid arthritis (RA). Osteocalcin (OC) and other parameters of bone turnover were measured in 131 patients with RA. The mean values of alkaline phosphatase (AP), but not of OC were significantly (P < 0.01) higher in our patients compared to controls. In contrast to AP, OC values increased and correlated significantly (r = +0.33, P < 0.01) with ascending anatomical stage in women not on glucocorticoid treatment. As regards therapy, we found significantly lower OC levels in women receiving steroids compared to controls (P < 0.03) and those being treated with non-steroidal anti-inflammatory drugs (NSAIDs) (P < 0.03), methotrexate (MTX) (P < 0.05), or gold (P < 0.01). Females treated with gold had higher OC levels than patients receiving no antirheumatic drugs (P < 0.03). Furthermore, there was a significantly negative correlation between OC and inflammatory activity [C-reactive protein (CRP)] (r = -0.25, P < 0.003). In conclusion, OC levels were significantly higher (P < 0.032) in patients with advanced (anatomical) stages of RA. In contrast to AP, changes in bone turnover, such as suppression of bone formation by steroids and high inflammatory activity in patients with RA, were easily detected. | |
| 7507805 | High concentrations of immunoreactive gliostatin/platelet-derived endothelial cell growth | 1993 Sep 17 | Since neovascularization plays an important role in the propagation of rheumatoid synovitis, we analyzed the concentration of gliostatin/platelet-derived endothelial cell growth factor (GLS/PD-ECGF), a potent angiogenic and chemotactic factor, in the synovial fluid and serum of rheumatoid arthritis (RA) patients. The immunoreactive GLS/PD-ECGF concentrations (mean value +/- S.D.) in synovial fluid, measured by a sandwich enzyme immunoassay, were significantly higher in RA patients than in osteoarthritis (OA) patients (233.02 +/- 219.40 vs. 9.09 +/- 14.86 ng/g, P < 0.001), and the serum concentrations were also higher in RA patients than in age-matched controls (8.77 +/- 7.60 vs. 3.74 +/- 2.61 ng/ml, P < 0.005). These results suggest that GLS/PD-ECGF may participate in the endothelial proliferation resulting in initiation of the extensive emigration of mononuclear cells and proliferation of the synovial tissues in rheumatoid arthritis, and that the immunoreactive GLS/PD-ECGF in serum as well as synovial fluids may be a useful diagnostic marker of RA. | |
| 1352639 | [An unusual association: panarteritis nodosa and rheumatoid arthritis as an overlapping co | 1992 May | The clinical record of a woman with two connective tissue diseases is presented. It started as a necrotizing arteritis with hepatic involvement and chronic multineuritis consistent with PAN. After a long period of clinical evolution the patient developed a real rheumatoid arthritis with positive RF. This clinical picture overlapped clinically and serologically the former one. A good response to the steroid therapy and a careful follow-up permitted a satisfactory life to this patient for about ten years. | |
| 8012266 | Factors influencing the postoperative range of motion in total knee arthroplasty. | 1993 Summer | This study was undertaken to assess the factors influencing the postoperative range of motion after total knee arthroplasty (TKA). From January 1986 to December 1991, 111 TKA (Miller-Galante I System) surgeries were performed in 71 patients. Of those, 90 joints in 60 patients were kept under observation as the materials of this study. These patients included 37 patients with rheumatoid arthritis and 23 with osteoarthritis. The patients were divided into four groups according to postoperative range of motion (ROM), at the time averaging 51 months. The excellent group, defined as having more than 130 degrees range of motion consisted of 10 knees in 6 patients. The good group of 120 to 129 degrees had 19 knees in 13 patients; the fair group of 91 to 119 degrees consisted of 40 knees in 24 patients. In the poor group of 90 degrees or less there were 21 knees in 17 patients. Each group of patients was examined preoperatively, operatively, and postoperatively for factors relating to range of motion after TKA. The results of this study indicated factors influencing the ROM were: preoperative ROM, the primary indication, heights of postoperative joint line, patellar thickness, postoperative pain, and successive postoperative rehabilitation. | |
| 8761194 | The cost of rheumatoid arthritis. | 1996 Aug | This paper uses the Cost of Illness (COI) framework to estimate the cost of rheumatoid arthritis (RA) to society in the year 1992-93. By doing so, a clear insight is given into the many cost elements of RA treatment and monitoring. This paper estimates point prevalence rates of 2.06 and 6.94 1000 persons at risk for men and women, respectively, showing that prevalence is three times higher amongst women than men. Further to this, prevalence increases with age in both sexes, resulting in very high prevalence rates for RA amongst the elderly. The total economic impact of RA in England was estimated to be pounds 1.256 billion in 1992, of which 52% was a result of production loss caused by RA disability. | |
| 7880121 | Hip involvement in early rheumatoid arthritis. | 1995 Jan | OBJECTIVE: To study early hip involvement in rheumatoid arthritis (RA) and to evaluate the usefulness of ultrasonography in the detection of hip joint synovitis in RA. METHODS: Study I: The number of hip joint replacements was recorded in a cohort of 113 patients with RA of at least five years disease duration followed from an early stage. Study II: Ultrasonography was evaluated as a method to identify hip joint synovitis in 76 patients with RA of shorter disease duration, by relating it to radiograms and clinical findings. RESULTS: Study I: Twenty one hip joint replacements were performed in 15 of the 113 patients. The median disease duration at the time of first arthroplasty was 48 (range 10-76) months; the annual incidence was approximately constant between two and six years. High disease activity at the start of the study was predictive of requirement for hip prosthesis. Study II: Hip ultrasonography was pathological in 13 of the 76 patients studied, bilaterally in nine. Hip joint synovitis could not be confirmed on clinical grounds only as seven of the patients with positive ultrasonographic findings were asymptomatic, and the remaining six patients had only mild symptoms of hip involvement. Also, six of the 63 patients with normal ultrasonography had mild symptoms. There was no difference regarding demographic, clinical, and laboratory findings in patients with and without hip synovitis. CONCLUSIONS: Early hip joint destruction giving symptoms mostly at a very late stage is frequent in RA. Ultrasonography rather than signs or symptoms could identify patients with hip joint involvement and provide a rationale for early treatment. | |
| 8467614 | The influence of fast and vegetarian diet on parameters of nutritional status in patients | 1993 Mar | Nutritional status was studied over a period of 13 months in 34 patients with rheumatoid arthritis (RA). Seventeen patients fasted for 7-10 days, were then transferred to a gluten-free vegan diet for 3.5 months and finally to a lactovegetarian diet for 9 months. The remaining 17 patients followed a "normal" diet. After one month, the values for body mass index (BMI) and triceps skinfold thickness (TSF) were significantly reduced in the diet group compared with the values at inclusion (p < 0.001), whereas upper arm muscle area (UAMA) was not significantly reduced. Evaluation of the whole study course revealed a significantly lower BMI (p = 0.04) and TSF (p < 0.01) in the diet group compared with the control group. The concentration of insulin-like growth factor 1 (IGF1) was significantly reduced in the diet group after one month compared with the value at inclusion (p = 0.01), but the overall difference between the two groups was not significant. There were no overall significant differences with regard to VAMA, concentration of serum albumin, haemoglobin, ferritin, zinc and copper between the two groups. Thus fast, followed by diet manipulations for one year, had a minor impact on nutritional status in patients with RA. | |
| 8419388 | Arthroplasty of the metacarpophalangeal joints with use of silicone-rubber implants in pat | 1993 Jan | The long-term results of 144 arthroplasties of the metacarpophalangeal joints, with use of silicone-rubber implants, were reviewed for twenty-seven patients (thirty-six hands) who had rheumatoid arthritis. The operations were all performed or supervised by the same surgeon. All patients had an arthroplasty of the metacarpophalangeal joint of all four fingers, and all had subjective and objective clinical evaluation and roentgenographic assessment. Relief of pain, the cosmetic appearance of the hand, the range of motion of the metacarpophalangeal and proximal interphalangeal joints, and the presence of residual deformity were evaluated. The average duration of follow-up was eight years and six months (range, five years to sixteen years and three months). Preoperatively, the mean active-extension deficit of the metacarpophalangeal joints ranged from 53 degrees (index finger, right hand) to 70 degrees (little finger, left hand) and the mean flexion ranged from 84 degrees (index finger, right hand) to 94 degrees (little finger, left hand). At the early follow-up evaluation (average, four months postoperatively; range, two to six months), the mean extension deficit had improved to a range of 7 degrees (little finger, right hand) to 19 degrees (index finger, left hand), and mean flexion ranged from 56 degrees (little finger, left hand) to 66 degrees (ring fingers). The range of motion had improved from a non-functional arc of flexion to a more functional arc of extension. At the time of the latest follow-up visit, the motion of the metacarpophalangeal joints had not deteriorated.(ABSTRACT TRUNCATED AT 250 WORDS) |