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PMID	Title	PublicationDate	abstract
8650991	[Total femur replacement following multiple periprosthetic fractures between ipsilateral h	1996 Jan	Periprosthetic femur fractures are one of the most severe complications in hip surgery. Osteoporosis as seen in patients with rheumatoid arthritis could favour such fractures, which are located mostly between the stems of the hip and knee prostheses. A traumatic event is not even required. The fracture rate increases with predisposing factors, such as preliminary changes of the prosthesis or osteoporosis. This paper reports two patients with rheumatoid arthritis (males, 54 and 71 years old) with femur fractures after total hip and knee replacements. Both had a severe osteoporosis caused by a long-term steroid therapy. Consecutively, both patients showed refractures of the femur with loosening of the osteosynthetic material, so that a total femur replacement was required. However, both patients are able to walk. To reduce the risk of femur fractures between the tips of knee and hip prostheses it is advisable to use knee prostheses without a proximal intramedullary stem. In this way pressure stress is reduced.
8927379	[Silastic arthroplasty of the great toe metatarsal joint].	1996 Aug	This report is based upon experience with 592 implantations of Swanson silastic spacer between 1978 and 1992. The results of 430 cases were followed up in 1995. Complications were observed in 31 cases and required further surgery. In 18 cases, the spacer was resected; in 2 cases a distal amputation was necessary. Due to pain, the spacer was changed in 11 cases, in 5 cases from a single-stem to a double-stem version. Radiological reactions increase over time following the operation without correlation to pain. The results in cases of rheumatoid arthritis and arthrosis disease are compared. Approximately 80% of the patients are free of pain and more than 90% are satisfied with the functional results. The results of the arthrosis group are slightly better.
7670776	Methotrexate action in rheumatoid arthritis: stimulation of cytokine inhibitor and inhibit	1995 Jul	This open label study examines whether methotrexate (MTX) treatment modulates ex vivo synthesis of interleukin-1 receptor antagonist (IL-1ra), soluble tumour necrosis factor receptors (sTNFR p55 and p75), interleukin-1 beta (IL-1 beta), tumour necrosis factor alpha (TNF-alpha), interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) by peripheral blood mononuclear cells (PBMC) and whether changes reflect clinical response. Significant stimulation of IL-1ra and sTNFR p75 as well as inhibition of IL-8 production of PBMC were associated with clinical improvement observed in patients treated with MTX. When defining the characteristics of patients at study entry retrospectively in responders and non-responders, a significantly lower ratio of IL-1ra:IL-1 beta production before and its increase upon treatment was associated with clinical response in 13 patients compared to five patients not responding to MTX. In addition, clinical improvement was associated with decreased synthesis of IL-1 beta, TNF-alpha and IL-8 induced by bacterial lipopolysaccharide, IL-1 alpha and IL-1 beta in PBMC in vitro. These findings suggest that MTX therapy reverses the inflammatory type of rheumatoid arthritis (RA) blood mononuclear cells by stimulating cytokine inhibitor production while inhibiting inflammatory cytokine release at the same time. This may explain the powerful anti-inflammatory properties of low-dose MTX as observed in most RA patients. Pretreatment determination of the IL-1ra:IL-1 beta ratio in PBMC may be predictive with regard to a favourable therapeutic response and therefore may be useful for the selection of RA patients to be treated with MTX.
1731813	Biannual radiographic assessments of hands and feet in a three-year prospective followup o	1992 Jan	In a prospective followup study of 147 patients with rheumatoid arthritis of recent onset, we assessed the progression of radiographic evidence of joint damage on films of the patients' hands and feet obtained biannually. Patients were receiving first-line and second-line treatment. Ninety patients were followed up for 3 years, and 57 were followed up for only 2 years. Radiographic damage was determined by a modification of the method described by Sharp, and to ensure comparability of findings, we determined the percentage of damage per joint group (actual score divided by the maximum possible score). After 3 years, radiographic damage was present in 70% of the patients, all of whom could be identified after 1 year of study. Overall, 18-20% of the joints of the hands and feet were affected after 3 years, with relatively little abnormality per joint (approximately 8% of maximum possible score). During the entire followup, more foot joints than hand joints were affected. The rate of progression in the first year was significantly higher than in the second and third years of study, indicating a flattening of the curve of radiographic progression of joint damage.
1294737	Relationship of changes in helplessness and depression to disease activity in rheumatoid a	1992 Dec	We investigated the relationship between changes in helplessness and depression to disease activity in rheumatoid arthritis (RA). Sixty-three men with RA were examined at baseline, 3 months, and 6 months. Joint counts, immunophenotypic analyses of peripheral blood lymphocytes, and measures of psychological status were obtained at each examination. Zero-order correlations between psychological change and disease activity change from baseline to 6 months were not significant, but hierarchical multiple regression analyses revealed that changes in affective state were significantly related to joint counts at 6 months. Additionally, changes in absolute numbers of HLA-DR+ (human leukocyte antigen DR type) cells were significantly related to joint counts at 6 months. When absolute numbers of HLA-DR+ cells were entered prior to affective state in a hierarchical multiple regression, affective state was only marginally statistically significant. The study shows that longitudinal relationships between affective changes and disease activity are moderated by intervening variables such as immunologic activation.
8445055	Rheumatoid papules: a report on four patients with histopathologic analysis.	1993 Mar	BACKGROUND: The rheumatoid papule is a recently described skin manifestation of rheumatoid arthritis. OBJECTIVE: Rheumatoid papules from four patients with classic rheumatoid arthritis were examined to determine the origin of this palisading granulomatous reaction. METHODS: Immunofluorescence and electron microscopic studies were performed on biopsy specimens of rheumatoid papules. RESULTS: Leukocytoclastic vasculitis with collagen alteration and lymphohistiocytic infiltration were observed. The immunofluorescence study revealed deposits of immunoglobulins and complement in the vessel walls and in the area of collagen alteration. Electron microscopy revealed epithelioid cell-like histiocytes among altered collagen fibers. These cells contained abundant lysosomes and were connected to neighboring cells by well-developed intricate processes. CONCLUSION: Vasculitis is important in the pathogenesis of rheumatoid papules. In patients with rheumatoid papules, systemic evaluation should be performed because these are a manifestation of rheumatoid vasculitis.
7981995	Disease-specific stressors in rheumatoid arthritis: coping and well-being.	1994 Nov	Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping styles directed at the most important chronic stressors of RA i.e. pain, limitations, and dependence. The relation between coping and well-being was analysed while controlling for relevant disease status variables. Comforting cognitions, decreasing activity and diverting attention were styles of coping with pain that were related to well-being, when level of pain was controlled. Optimism, pacing, and seeking creative solutions were styles of coping with limitations. Both optimism and pacing were related to well-being, when functional capacity was being controlled. Acceptance and showing consideration were styles of coping with dependence. Consideration was the only coping style related to well-being, when functional capacity and social network were being controlled.
7703660	Nutrition and the rheumatoid patient.	1995 Feb 9	This review examines the dietary requirements of patients with osteoarthritis and rheumatoid arthritis, evaluates why their requirements are not being met and assesses ways in which the ward environment can affect eating habits.
7783058	Osteoporosis in rheumatoid arthritis: findings in the metacarpal, spine, and hip and a stu	1995 Mar	OBJECTIVE: To determine the relationship between axial and peripheral bone density in patients with rheumatoid arthritis (RA) compared to controls. To study risk factors for axial and peripheral bone loss in RA. METHODS: Twenty women with RA and 20 age matched controls underwent dual energy x-ray absorptiometry (DXA) of the spine and hip and microradioscopy of the hands in order to quantify the combined cortical thickness (CCT) of the 2nd metacarpal. Sharp's method was used to assess the degree of joint space narrowing and erosions. RESULTS: Compared to controls, the RA group had significantly decreased bone density at the hip (0.761 g/cm2 vs 0.852 g/cm2, p < 0.05) and at the 2nd metacarpal (3.77 vs 4.39 mm, p < 0.05), but not at the spine (0.960 vs 0.947 g/cm2, NS). In patients with RA, measurement of the CCT did not predict bone density at the spine or hip (r = 0.07, NS, and r = 0.095, NS, respectively), whereas in controls, the CCT was significantly correlated with bone density at both these axial sites (r = 0.47, p < 0.05, and r = 0.64, p < 0.01, respectively). Grip strength in RA was correlated with the CCT (r = 0.62, p < 0.01), implying a relationship between hand function and local bone density. Sharp's method did not correlate with axial bone density, but it was strongly correlated with the CCT (r = -0.64, p < 0.01). CONCLUSION: In RA, the CCT is not a useful screen for osteoporosis at the spine or hip. This suggests that localized and generalized osteopenia in RA are best viewed as independent processes.
8372740	Combination therapy in rheumatoid arthritis.	1993	Current therapy with slow acting antirheumatic drugs (SAARDs) produce few remissions in rheumatoid arthritis. Significant numbers of patients become severely disabled and their life span is also reduced. Early treatment with SAARDs is now becoming accepted practice in an effort to reduce the rate of progression of erosive disease. Although combinations of SAARDs are now frequently used, few well controlled studies have been conducted and those that have in the main fail to demonstrate a clear benefit of the combination over single drug alone. Combinations of SAARDs with corticosteroids have demonstrated some benefit and a reduction in side effects and further well designed studies of combination therapy are required to ascertain if the theoretical potential benefit of these combinations can be demonstrated in patients.
1628166	Genetic factors influencing the outcome of early arthritis--the role of sulphoxidation sta	1992 Jul	A minority of individuals have an impaired ability to oxidize sulphur. An increased prevalence of this poor S-oxidation capacity has been observed in patients with established rheumatoid arthritis (RA). The role of this enzyme system in the development of disease was studied by testing the S-oxidation capacity of 54 patients with recent onset symmetrical poly-arthritis, who were followed up at 1 and 4 years. Those patients with persistent disease at 1 year had a prevalence of poor S-oxidation of 69%. At 4 years 74% of those with a diagnosis of RA were poor S-oxidizers compared to 31% of those who were asymptomatic (P less than 0.01). A defective ability to oxidize sulphur appears to predispose to persistent clinical disease.
10160078	Economic and quality-of-life impact of NSAIDs in rheumatoid arthritis: A conceptual framew	1995 Dec	In this review, we provide a conceptual framework of the ideal pharmacoeconomic model for nonsteroidal anti-inflammatory drug (NSAID) use in rheumatoid arthritis, together with a review of selected literature focusing on those areas identified in our model. An ideal pharmacoeconomic model fully accounts for the benefits and costs of this therapy. The benefits include: decreased pain and swelling; increased functional status, which may in turn lead to increased earnings potential; and decreased use of adjunctive therapies. The costs include costs for drug acquisition and administration, monitoring and treatment for adverse effects, as well as preventive measures. Noneconomic 'costs' (i.e. losses in quality of life and/or functional status) must also be included in this equation. Our literature review led to the following conclusions. NSAIDs are highly effective agents for the control of musculoskeletal pain and inflammation, and as such are among the most widely used drugs worldwide. It is well recognised that marked improvements in quality of life occur among arthritic patients receiving NSAIDs. Although careful patient selection and monitoring for potential adverse effects is essential, these drugs are well tolerated by most patients. NSAID-induced gastrointestinal events, ranging from dyspepsia to severe complications that can lead to hospitalisation, surgery and death, are reported more commonly than adverse effects from any other class of drugs. These events represent a substantial economic burden to society and have well documented negative effects on quality of life. Although misoprostol (a prostaglandin analogue) prevents the development of clinically defined NSAID-associated ulcers, its effectiveness on clinically important outcomes such as haemorrhage and perforation is somewhat more modest. Furthermore, there is evidence that some patients may experience substantial losses in quality of life because of the adverse effects of medication (particularly diarrhoea). Therefore, the widespread use of misoprostol prophylaxis not only has important economic consequences, but has important consequences for quality of life. More research is needed to address the critical trade-offs between cost and quality of life that are inherent in the use of NSAIDs.
7568051	Anti-C5 monoclonal antibody therapy prevents collagen-induced arthritis and ameliorates es	1995 Sep 12	Activated components of the complement system are potent mediators of inflammation that may play an important role in numerous disease states. For example, they have been implicated in the pathogenesis of inflammatory joint diseases including rheumatoid arthritis (RA). To target complement activation in immune-mediated joint inflammation, we have utilized monoclonal antibodies (mAbs) that inhibit the complement cascade at C5, blocking the generation of the major chemotactic and proinflammatory factors C5a and C5b-9. In this study, we demonstrate the efficacy of a mAb specific for murine C5 in the treatment of collagen-induced arthritis, an animal model for RA. We show that systemic administration of the anti-C5 mAb effectively inhibits terminal complement activation in vivo and prevents the onset of arthritis in immunized animals. Most important, anti-C5 mAb treatment is also highly effective in ameliorating established disease. These results demonstrate a critical role for activated terminal complement components not only in the induction but also in the progression of collagen-induced arthritis and suggest that C5 may be an attractive therapeutic target in RA.
8633829	The effectiveness of early treatment with "second-line" antirheumatic drugs. A randomized,	1996 Apr 15	OBJECTIVE: To compare two therapeutic strategies for patients with recent-onset rheumatoid arthritis. DESIGN: Open, randomized clinical trial. SETTING: Outpatient clinics of six clinical centers. PATIENTS: 238 consecutive patients with recently diagnosed rheumatoid arthritis. INTERVENTIONS: Delayed or immediate introduction of treatment with slow-acting antirheumatic drugs (SAARDs). MEASUREMENTS: Primary end points were functional disability, pain, joint score, and erythrocyte sedimentation rate at 6 and 12 months and progression of radiologic abnormalities at 12 months. RESULTS: Statistically significant advantages at 12 months for patients receiving the SAARD strategy (immediate treatment with SAARDs) with regard to all primary end points that may be clinically important are indicated by the differences in improvements from baseline and their 95% CIs. These differences were 0.3 (95% CI, 0.2 to 0.6) for disability (range, 0 to 3), 10 mm (CI, 1 to 19 mm) for pain (range, 0 to 100 mm), 39 (CI, 4 to 74) for joint score (range, 0 to 534), and 11 mm/h (CI, 3 to 19 mm/h) for erythrocyte sedimentation rate (range, 1 to 140 mm/h), all in favor of SAARD treatment. The SAARD strategy also appears to be advantageous at 6 months. Radiologic abnormalities progressed at an equal rate in the SAARD and the non-SAARD groups; the difference in progression (range, 0 to 448) was 1 (CI, -3 to 5). Analyses were based on the intention-to-treat principle and thus included 29% of patients in the non-SAARD group who discontinued the non-SAARD treatment strategy; treatment was usually discontinued because of insufficient effectiveness. The SAARD strategy including two alternative SAARDs could not be continued by 8% of patients, usually because of adverse reactions. CONCLUSIONS: Early introduction of SAARDs may be more beneficial than delayed introduction for patients with recently diagnosed rheumatoid arthritis.
1362469	[Rheumatoid arthritis. Changes in lymphocyte subsets under the effect of tiopronin].	1992 Sep	Lymphocytes from 12 rheumatoid arthritis patients were phenotyped before and after a 2-month treatment with tiopronin. Originally reduced, CD4 CD45RA-T lymphocytes were shown to augment significantly. Abnormal activation (evaluated on HLA-DR and CD25 expression) of each cell population and sub-population was partially amended.
1570481	HLA system and penicillamine induced pemphigus in nine cases of rheumatoid arthritis.	1992	Nine cases of penicillamine induced pemphigus (PIP) in rheumatoid arthritis patients are reported. Clinical, histological and serological data were compared with previously published cases. No correlation between the occurrence of HLA A, B, DR antigens and PIP was found, even when the data was combined with that from 13 cases described in the literature. The clinical and histological polymorphism of PIP and its unpredictable outcome are emphasized.
8350334	Quality of life of women with systemic lupus erythematosus: a comparison with women with r	1993 Jun	We assessed the quality of life and health status of 50 women with systemic lupus erythematosus (SLE) and compared them with 50 age matched women with rheumatoid arthritis (RA) using open ended questions, the Quality of Life Scale (QOLS-S), Arthritis Impact Measurement Scales (AIMS), Rheumatology Attitudes Index, and 2 measures of disease activity. The patients with SLE expressed more concerns about their disease and potential for managing it than the patients with RA. However, there were no differences between the groups on the QOLS-S. Both were highly satisfied with many aspects of their lives. The best predictor of life quality in both groups was psychological distress followed by social and physical functioning in the group with RA and perception of global impact of the disease in the group with SLE.
8060768	General diseases of the spine in rheumatoid arthritis.	1994 May	The past year has contributed to a better understanding of the management of cervical spine instability in patients with rheumatoid arthritis. Neurologic recovery after surgery is better and the percentage of recurrence is lower in cases of isolated atlantoaxial subluxation (AAS) compared with cases of AAS associated with basilar invagination or with subaxial subluxation. This suggests that the sooner surgery is undertaken in limited AAS, the better the outcome. The atlantoaxial posterior interval seems to be the best predictor of neurologic recovery following posterior fusion for AAS. Osteoporosis is a major problem in patients with rheumatoid arthritis. Recent studies show that corticosteroids, even in a low dosage, contribute to spinal bone loss. This bone loss may be partially reversible after ceasing corticoid therapy. A new corticosteroid, deflazacort, which does not inhibit intestinal absorption of calcium, seems to limit bone loss.
7983640	A comparison of the performance of different methods of disease classification for rheumat	1994 Aug	OBJECTIVE: We have assessed the importance of the distinction between classification criteria for rheumatoid arthritis (RA) that recognize the presence of currently active disease from those that, in addition, incorporate evidence of past disease activity in ascertaining disease occurrence. We applied 7 classification schemes to a population of twins with inflammatory arthritis to determine (a) the number of individuals classified as RA positive by each scheme and hence the effect on the estimate of disease concordance in the twins and (b) their performance in correctly assigning a diagnosis compared with a physician's opinion. METHODS: The schemes assessed were the 1958 ARA (Rome) criteria which detect active disease, the 1966 New York (using both the 2/4 and 3/4 published cutoffs) which detect "ever" disease and 4 variants of the 1987 ARA criteria. These were the 4/7 and decision tree approaches applied on the basis of the relevant features (1) being present at the time of the study and (2) being present ever and allowing current joint deformity to substitute for absent joint swelling. RESULTS: In all, 283 individuals with a history of joint swelling were assessed, 255 of whom were considered to have RA by their physician. Criteria used to recognize "current" RA identified only about 70% of those which recognized RA ever. These differences in ascertainment level produced a marked effect on the monozygotic twin RA concordance estimates with percentages ranging from 10 to 18%. The results from receiver operating curves confirmed that criteria used to assess only current RA were too insensitive to be of value. Of the criteria that recognized RA status ever the 1987 ARA performed best overall. CONCLUSION: The use of classification methods that incorporate past as well as current evidence of disease activity is essential to avoid important misclassification in epidemiological and family studies. The 1987 criteria, applied retrospectively and allowing joint deformity to substitute for swelling, are of enhanced value over other existing schemes.
8428220	Rheumatoid arthritis in a population of persons aged 85 years and over.	1993 Feb	A Dutch urban population of 977 persons aged 85 years and over was examined for the presence of rheumatoid arthritis (RA). Prevalence rates for definite RA, past polyarthritis with joint deformation and past polyarthritis without joint deformation were 0.3%, 0.3% and 0.7%, respectively. The polyarthritis patients did not differ from age-matched controls with respect to crude scores of physical disability, the presence of serum rheumatoid factor or the presence of HLA-DR4. Although these data should be interpreted with caution because of the small patient groups, we conclude that in persons aged 85 years and over the prevalence of RA is low, and the disease is relatively mild.