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PMID	Title	PublicationDate	abstract
7847432	A randomized trial of hydroxychloroquine in early rheumatoid arthritis: the HERA Study.	1995 Feb	PURPOSE: Studies of the efficacy of hydroxychloroquine in rheumatoid arthritis have had methodological flaws and have failed to produce definitive results. The benefits and toxicity of hydroxychloroquine sulfate in 120 patients with rheumatoid arthritis of less than 2 years duration are assessed. PATIENTS AND METHODS: A 36-week randomized double-blind, placebo-controlled trial was conducted at two university centers and four community rheumatology private practices. Patients had to have had their disease for less than 2 years and to have never received a second-line drug. Patients were randomly assigned to receive hydroxychloroquine or an equivalent number of placebo tablets in a dose of up to 7 mg/kg per day (maximum 400 mg/day). The initial dose was half the maximum dose and, if after 2 weeks of treatment there had been no side effects, the full dose was prescribed. There were four a priori primary outcomes: (1) a joint index composed of the tender joint count, the swollen joint count, the grip strength, and the duration of morning stiffness; (2) a pain index composed of the pain dimension of the Arthritis Impact Measurement Scales (AIMS) and the visual analog pain scale of the Health Assessment Questionnaire (HAQ); (3) a physical function index composed of the HAQ, the physical disability dimension of the AIMS, and the McMaster-Toronto Arthritis Patient Performance Disability Questionnaire; (4) the psychological function subscale of the AIMS. Secondary outcomes included adverse events, patient and physician global assessments, hematocrit, erythrocyte sedimentation rate (ESR) and corticosteroid usage. An intent-to-treat analysis assessed improvement at 36 weeks by Student's t-test and average improvement over the course of the study by analysis of variance for repeated measures. RESULTS: Of 148 eligible patients, 120 were randomized. The characteristics of those randomized to hydroxychloroquine compared to placebo were similar at the study onset. At 36 weeks and over the course of the study there was statistically significant improvement in the joint index (P = 0.004, P = 0.034, respectively), the pain index (P = 0.007, P = 0.001, respectively), and the physical function index (P = 0.020, P = 0.011, respectively) in the group receiving hydroxychloroquine compared to the placebo group. There was no improvement in psychological function for hydroxychloroquine compared to placebo (P = 0.837 at 36 weeks, P = 0.89 over the course of the study). Among the secondary outcomes there was significant improvement only in the patient's (P = 0.01) and the outcome assessor's (P = 0.03) assessment of change and a trend towards a fewer number of intra-articular corticosteroid injections (P = 0.05) in the hydroxychloroquine-treated group. There were no important differences in the side effects between hydroxychloroquine or placebo. CONCLUSION: Over 36 weeks, hydroxychloroquine had a significant benefit on synovitis, pain, and physical disability of recent-onset rheumatoid arthritis, but did not benefit psychological function.
8833061	Recruitment of patients with early rheumatoid arthritis -- the Netherlands experience.	1996 Mar	We wished to evaluate whether early arthritis clinics (EAC) contribute to the shortening of time between the onset of complaints and the moment that adequate therapy is started in patients with arthritis. We evaluated 212 patients with arthritis referred in 1993 to an EAC. A definite diagnosis could be made in 68% of the patients 2 weeks after referral. Arthritis persisted in a large majority of patients with rheumatoid arthritis and the time between disease onset and initiation of therapy could be reduced to +/-3 months. EAC are therefore helpful in achieving early effective treatment of arthritis.
8105504	Toleration, side-effects and efficacy of sulphasalazine in rheumatoid arthritis patients o	1993 Aug	Sulphasalazine is an effective second-line agent in the management of rheumatoid arthritis. The risk:benefit ratio in the elderly is less well established. We studied the risk:benefit ratio in relation to age, retrospectively combining five prospective studies of enteric coated sulphasalazine therapy in 352 patients with rheumatoid arthritis. Clinical and laboratory assessments of efficacy and toxicity were made by an independent assessor at 0, 12, 24 and 48 weeks. The only significant differences between young, middle aged and elderly patients at the initial assessment were in pain perception, ESR and C-reactive protein. Sulphasalazine was equally effective in all age groups. The toxicity profile was similar in all age groups. We conclude that sulphasalazine is equally effective in rheumatoid arthritis in the elderly as in the young. There was no significant change in the frequency or nature of side-effects with increasing age.
1324125	Cytomegalovirus genomes demonstrated by polymerase chain reaction in synovial fluid from r	1992 Mar	Synovial fluid from 20 patients with rheumatoid arthritis was analyzed to detect human cytomegalovirus (CMV) genomic material using polymerase chain reaction. Of 20 samples tested, 9 were positive for CMV by either ethidium bromide staining or Southern blotting. In contrast, CMV was detected in only 2 of 18 control patients with osteoarthritis. These results suggest an etiologic relationship between CMV and rheumatoid arthritis.
7633797	Breast feeding, other reproductive factors and rheumatoid arthritis. A prospective study.	1995 Jun	The evidence regarding reproductive events as risk factors for rheumatoid arthritis (RA) is not conclusive. In the present study a population-based cohort consisting of 63,090 women were followed from 1961 to 1989. Detailed data on reproductive factors were collected through personal interviews in the period 1956-9. The endpoint used was mention of RA on the death certificate. Mortality rate ratios were estimated by Poisson regression, controlling for various demographic variables. During 1,485,400 person-yr of observation, a total of 355 cases with RA mentioned on the death certificate were identified. Total time of lactation was associated with a decreased mortality of RA, with an approximate dose-response relationship. The results did not support a role of parity, age at first and last birth, or age at menarche and menopause in the development of RA. This protective effect of lactation on the development of RA has not previously been described, and since a definite biological explanation is lacking, the association should be confirmed in other populations.
1286594	[A study on origin of the hyperplastic synovial lining cells in rheumatoid arthritis].	1992 Jun	The one of striking microscopic feature is synovium hyperplasia in rheumatoid arthritis. The origin of the hyperplastic synovial lining cells in RA remains unsettled. Two marked monoclonal antibodies and two marked antisera are used to run the immunohistochemical study. Our finding revealed that synovial lining cells bear marks for blood monocytes. It is suggested that the increased synovial lining cells population appear to derive from bone marrow. Besides, the results of immunoelectron microscopy showed that synovial lining cells of type A and type C express HLA-DR antigen. HLA positive dendritic cells are distinctly more frequently seen in RA synovium than in that of osteoarthritis.
8884367	Lymphocytes from site of disease indicate probable microbiological etiology of "infective-	1996 Oct	Synovial lymphocytes, from the site of disease, by their response to microbiological antigen stimulation as measured by the [3H]thymidine uptake method, indicate the microbiological causes of reactive arthritis and also oligoarthritis unassociated with enteric or genital symptoms. In the study of the etiology and pathogenesis of rheumatoid arthritis, the application of the same procedures gives an indication that the disease is an immune response to a variety of common infective agents, both viral and bacterial. The demonstration of antigens or nucleic acid of an infective agent at the site of disease, in association with a specific local immune response suggests the pathogenetic importance of the agent. Recent studies of relationships between epitopes of infective agents and MHC gene products suggest several ways in which infective agents can directly cause a disease such as rheumatoid arthritis without any requirement for autoimmune contributions. Because the infective agent may be the primary determining factor and the one most amenable to correction or eradication, the term "infective-immune" is suggested in preference to "autoimmune" for these immune-mediated diseases.
7582725	In-patient treatment for active rheumatoid arthritis: clinical course and predictors of im	1995 Sep	The objective was to determine the clinical course and predictors of clinical response in patients with rheumatoid arthritis (RA) who are hospitalized for active disease and functional deterioration. Sixty-three patients who were admitted to a rheumatology clinic for multidisciplinary treatment were prospectively evaluated at 2-weekly intervals. During the admission period, which lasted for a mean of 47 +/- 24 days, patients improved significantly according to variables of disease activity, functional status and emotional status. The change in the variables appeared to be linear with time. Twenty-seven patients (43%) fulfilled the Paulus 20% criteria for clinical response during treatment. A long disease duration, a high Larsen erosion score, a high level of disease activity at admission and the institution of a disease-modifying anti-rheumatic drug within 3 months before admission were associated with a clinical response. In patients hospitalized for active disease, improvement appeared to be linear with time during admission. Patients with long-standing, destructive disease and a high level of disease activity improved most during hospitalization.
8724293	Pathogenetic mechanism and prevalence of the stable atlantoaxial subluxation in rheumatoid	1996 May	OBJECTIVE: To study the pathogenetic mechanisms responsible for and prevalence of stable atlantoaxial subluxation (AAS). METHODS: Lateral view cervical spine radiographs during flexion and extension were studied in 262 patients with rheumatoid arthritis (RA). RESULTS: AAS was found in 130 patients, 42 (32%) of whom had a stable deformity; in a population based subseries, stable AAS was seen in 16% of the patients with ASS. Atlantoaxial impaction (AAI) was diagnosed in 98 cases and in 37 (88%) of the 42 patients with stable AAS. CONCLUSION: The main cause of the spontaneous stabilization and occasional ankylosis of the atlantoaxial area is the development of erosions and collapse in the lateral facet joints leading to AAI.
7837142	Measurement and prediction of radiological progression in early rheumatoid arthritis.	1994 Oct	OBJECTIVE: To compare radiological scoring systems in early RA, and then to determine if the rate of radiological progression in the first year of disease (RRP01) predicts the subsequent rate of progression up to 8 years (RRP1-8). METHODS: Hand and feet radiographs were performed at 0, 1, 2 and 8 years in 65 patients presenting with nonerosive RA and symptoms for less than 3 years. All films were scored by Sharp's method; Sharp, Larsen and carpometacarpal (CMC) ratio methods were compared in 23 patients. RESULTS: Significant change in score was detected over the first year using Sharp (median of 15.5 vs 7.5, p < 0.00002) and Larsen (30.5 vs 22.5, p < 0.0002), but not CMC ratio (1.13 vs 1.14, p = 0.07). Sharp had greater range and sensitivity of change, and had better inter and intraobserver reproducibility. RRP01 showed a skewed distribution (median 0.7 units/month; range -0.3 to +6.1). Spearman correlation between RRP01 and RRP1-8 was r = 0.57, p < 0.001. CONCLUSION: Both Sharp and Larsen indices are sensitive to change in the first year of RA, but Sharp has advantages of greater sensitivity and reproducibility: CMC ratio is not useful. Radiological progression rate in the first year correlates only moderately with subsequent rate of progression up to 8 years. This suggests that radiological progression is nonuniform and that different patterns of progression over time may exist.
7932410	Phenotype/genotype relationships for the cytochrome P450 enzyme CYP2D6 in rheumatoid arthr	1994 Jun	OBJECTIVE: To determine whether particular genotypes for the cytochrome P450 enzyme CYP2D6, a polymorphic enzyme, are associated with susceptibility to rheumatoid arthritis (RA) and whether CYP2D6 enzyme activity is altered as a result of the disease or its treatment. METHODS: CYP2D6 genotypes and metabolic phenotypes were determined for 53 patients with RA and 73 healthy controls. Genotyping was carried out by restriction fragment length polymorphism analysis with the restriction enzyme XbaI and by 2 separate polymerase chain reaction assays; phenotyping was by analysis of in vivo metabolism of the probe drug debrisoquin. RESULTS: No significant difference in the distribution of overall genotypes between the 2 groups was observed. When the frequency of individual alleles was investigated, a significant difference in allele frequency for the CYP2D6D allele (p < 0.005) was observed with fewer patients with RA showing this mutation. Metabolic phenotypes were broadly similar between the patients and controls. However, a number of the patients with RA showed higher than expected metabolic ratios for their particular genotype due to interference by the analgesic dextropropoxyphene in the phenotyping procedure. CONCLUSION: Our findings demonstrate that CYP2D6 activity is not impaired in RA.
7540528	Flare of arthritis with successful treatment of Felty's syndrome with granulocyte colony s	1995 Mar	A 58-year-old white male with Felty's syndrome was successfully treated with granulocyte colony stimulating factor (GCSF). GCSF can correct the granulocytopenia of Felty's syndrome and may be a beneficial therapeutic adjunct in patients who have serious infections associated with neutropenia. The patient developed a flare of arthritis concomitant with increased circulating neutrophils following GCSF therapy.
7863284	Angioimmunoblastic lymphadenopathy with disproteinemia arising in a patient with rheumatoi	1995	Angioimmunoblastic lymphadenopathy with disproteinemia (AILD) is a systemic lymphoproliferative disorder characterized by constitutional symptoms such as generalized lymphadenopathy, hepatosplenomegaly and skin rash. In this article, we report on a patient with seronegative Rheumatoid Arthritis of 18 years duration who recently developed AILD.
7716627	Subaxial lesions in rheumatoid arthritis. Radiographic factors suggestive of lower cervica	1995 Jan 15	STUDY DESIGN: The present study focused on the radiographic and clinical parameters that suggest lower cervical lesions directly or indirectly related to lower cervical myelopathy in rheumatoid arthritis. OBJECTIVES: The results provided the risk factor for predicting compressive myelopathy due to lower cervical spine lesions in patients with rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: The clinical pathology and radiographic risk factor for upper cervical myelopathy in rheumatoid arthritis has been well documented, but the compressive factors for lower cervical myelopathy due to subaxial lesions remain unclear. METHODS: Radiographic analysis on the lateral radiographs (neutral, flexion, and extension) of the cervical spine and neurologic evaluation were carried out in 100 patients with rheumatoid arthritis. Fifty-eight of these patients were followed-up for 5 to 10 years (mean, 5.4 years) radiographically and clinically. A comparative study on the incidence of radiographic abnormalities also was performed in 100 patients with rheumatoid arthritis and in age- and sex-matched patients with cervical spondylosis. CONCLUSIONS: Among the radiographic parameters of the lesions related to lower cervical myelopathy, marked destruction of spinous processes, axial shortening, and narrow spinal canal may be important factors that suggest myelopathy. Time-related deterioration of lower cervical myelopathy can be predicted by progressions of anterior slip, axial shortening, spinous process erosion, apophysial joint erosion, and intervertebral disc collapse. Younger patient age, longer duration of disease, higher dose of corticosteroid administration, and higher stage or class of rheumatoid arthritis also are thought to be significant general factors for myelopathy.
8831866	Experience of pain in rheumatoid arthritis--an empirical evaluation of the contribution of	1996 Jun	Using a structured biographical history we evaluated the relationship between aspects of development and reports of pain experience (i.e. intensity of pain, affective and affective-evaluative dimensions of pain according to the McGill pain questionnaire, and effectiveness of medication) in 66 patients with rheumatoid arthritis. It was postulated that higher loading with regard to developmental stress would have a negative influence on reports of pain experience. Multiple regression analysis showed that (i) the intensity of pain was significantly correlated with the functional stage of the illness, (ii) affective and affective-evaluative dimensions of pain experience correlated with the interviewer's scoring of nurture and the patient's relationship with his or her partner, and (iii) the effectiveness of medication was significantly associated with the partner's understanding of the patient's pain and duration of illness. However, independent variables could explain only part of the variance (i.e. 12% for pain intensity, 17% for affective and affective-evaluative dimensions of pain experience and 26% for the effectiveness of medication). These results suggest that the previously assumed importance of developmental psychosocial stress as a factor in chronic intractable pain may require careful reassessment.
8921921	Nerve conduction studies in rheumatoid arthritis.	1996	We performed a controlled study in search of possible differences in nerve conduction parameters in 52 patients with rheumatoid arthritis (RA) and 77 healthy controls. Nerve conduction studies (NCS) including recordings of motor and sensory amplitudes, the nerve conduction velocities and the distal latencies were investigated in both groups. The mean summed amplitude of compound muscle action potentials was 30.3 mV (SD = 7.9) in the patients compared with 35.9 mV (SD = 6.8) in the controls (p = 0.0001). Contrary to this, the mean values for motor distal latency was 14.3 msec (SD = 2.0) in the patients and 15.9 msec (SD = 1.8) in the controls (p = 0.0001). Decreased values for nerve conduction studies found in the patients may indicate impaired nerve functions in RA. However, the summed motor and sensory distal conduction were in fact better in the patient group.
8508558	Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis.	1993 Mar	The aim of this study was to evaluate magnetic resonance images (MRI) of soft tissue abnormalities in the wrist of RA patients in the early stage of the disease. We performed magnetic resonance imaging of the wrist in 15 patients with early rheumatoid arthritis according to ACR criteria, of less than 10 months duration (mean duration 4.8 months). None of the patients had carpal bone erosions on standard radiography. MRI demonstrated abnormality of the soft tissue in 13 of the 15 cases. On coronal MRI, the sites of involvement of the synovitis were the recess of the distal ulnar (9 pts.), the distal radioulnar joint (4 pts.) and the radiocarpal joint (7 pts.). On axial MRI, tendon sheath effusion of the digital flexor was present in 3 patients. Carpal bone lacunae were present in only 4 patients. Disease activity was not associated with the extent of the synovitis on wrist MRI. Our study suggests that MRI is a sensitive method for the detection of synovitis in early RA.
8480143	Cyclosporin treatment in rheumatoid arthritis is associated with an increased serum activi	1993	The serum activity of beta-glucuronidase (beta-gluc) has been presumed to indicate the disease activity in rheumatoid arthritis (RA). In 10 patients with RA the serum beta-gluc was repeatedly determined after the initiation of a treatment with cyclosporin for one year. A significant increase of beta-gluc was found after 8, 12 and 16 weeks compared to the values before treatment, while the concentration of the soluble interleukin 2-receptor decreased. The data reveal, that beta-gluc is not a useful indicator of the disease activity during cyclosporin treatment.
8281539	Cardiac involvement in rheumatoid arthritis: an echocardiographic study.	1993	Thirty-nine consecutive patients with rheumatoid arthritis (RA) and 40 control subjects were studied by echocardiography in order to assess the incidence of cardiac involvement in this disease. The occurrence of anatomic lesions in our series was lower than that observed in other studies. No differences in mean values of left and right ventricular diastolic function indexes obtained by Doppler echocardiography were found between patients and controls. However, in 26% of patients with RA, left ventricular abnormalities probably secondary to myocardial fibrosis were observed.
7631035	Radiographic assessment of rheumatoid arthritis.	1995 May	In this article, the rationale for the use of radiographs in the assessment of patients with rheumatoid arthritis is presented, along with a discussion of the choice of radiographs to be used. The author's choices for the scoring methods best used for minimal, intermediate, and more comprehensive databases for use in clinical research, other available scoring methods, factors influencing the type of database to be employed, and prior applications of scoring methods are also discussed.