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Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes

PMID	Title	PublicationDate	abstract
8575143	Baker's cyst in rheumatoid arthritis: an ultrasonographic study with a high resolution tec	1995 Sep	OBJECTIVE: To determine the prevalence of popliteal cyst (Baker's cyst) in rheumatoid arthritis (RA), through the use of a very sensitive and non-invasive method, high resolution ultrasonography. The present is the first such report in the literature. METHODS: Ninety-nine unselected consecutive patients with RA, after undergoing routine clinical and laboratory evaluation, had knee radiographs and ultrasound examinations of both knees, the popliteal fossae and calves, using an Ultramark 9ATL apparatus with a 3 MHz curved array and 10 MHz linear array heads and color doppler ability. RESULTS: A Baker's cyst was detected in 47 patients (47.5%) and in a total of 67 out of the 198 knees (33.8%). Four of the 67 cysts were ruptured. Only 29 of the 67 cysts (43.3%) had been diagnosed clinically. A statistically significant correlation was found between the presence of a Baker's cyst and clinical and radiologic involvement of the knee by rheumatoid arthritis (p < 0.025, and p < 0.05 respectively). There was a highly significant correlation between the presence of a cyst and ultrasonographically demonstrated joint effusion (p < 0.001). CONCLUSION: Baker's cyst is very common in RA but it may escape clinical detection. High resolution ultrasound scanning of the area is a simple, highly sensitive and non-invasive technique able to overcome this problem. Therefore, it should be more widely employed by clinicians in the diagnosis of popliteal cysts, which may sometimes be accompanied by significant morbidity.
7981583	Cell-type specific response of peripheral blood lymphocytes to methotrexate in the treatme	1994 Jul	The mode of action of methotrexate in the treatment of rheumatoid arthritis is still questionable. Although in vitro results suggest an immunosuppressive effect of methotrexate, several clinical studies have failed to confirm these effects in patients treated with oral low-dose methotrexate. With respect to the highly variable bioavailability of methotrexate, we investigated the effects of an intravenous administration of 15 mg methotrexate per week on peripheral blood lymphocyte subsets in eight patients with rheumatoid arthritis. Methotrexate after 12 weeks significantly (P < 0.01) reduced total peripheral blood lymphocytes and led to a pronounced redistribution of lymphocyte subsets with a preferred reductive effect on B-lymphocytes (P < 0.005) and T-lymphocytes (P < 0.05). Natural killer cells and killer cell-like T cells, on the other hand, were unaffected by the treatment. Our results suggest a cell-type specific effect of intravenously administered low-dose methotrexate on peripheral blood lymphocytes. This effect, in our opinion, may contribute to the mode of action of methotrexate as an immunosuppressive drug in the treatment of rheumatoid arthritis.
8771480	Palmar bands in rheumatoid arthritis and other chronic conditions of the upper limb.	1996 Jun	Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.
7840802	Enhancement of leukotriene A4 biosynthesis in neutrophils from patients with rheumatoid ar	1995 Jan 18	Human blood polymorphonuclear cells (PMN) from seven patients with active rheumatoid arthritis (RA) were compared for their capacities to produce leukotrienes ex vivo before (D0) and 24 hr (D1) after glucocorticoid pulse therapy. The present study shows for the first time that endogenous arachidonic acid metabolism via 5-lipoxygenase pathway is significantly increased after glucocorticoid administration, leading to increased generation of the unstable precursor leukotriene A4 (LTA4) followed by predominant non-enzymatic LTA4 opening and leukotriene B4 (LTB4) omega-hydroxylation pathway. These results are unexpected since usually glucocorticoids are usually thought to decrease inflammatory mediator biosynthesis and, moreover, they work to the detriment of the clinical improvement of the patient. The results are discussed in terms of product inactivation and cellular cooperation with monocytes and endothelial cells.
8088068	Comparison of cyclosporin A and azathioprine in the treatment of rheumatoid arthritis--res	1994 Jun	In a prospective randomized double-blind multicentre study cyclosporin A (CyA) and azathioprine (AZA) were compared in 117 patients with rheumatoid arthritis (starting dose CyA 5 mg/kg, AZA 1.5-2 mg/kg). The six-month treatment period was similarly completed in 92 patients with good clinical results in both groups (mean improvement rate CyA vs. AZA: Ritchie-Index 8.2 vs. 7.7, morning stiffness 41.6 vs. 28.4 min., grip strength 10.9 vs. 15.2 mmHg, swollen joint count 28.9 vs. 27.9%). Treatment was discontinued prematurely in 12 patients in each group (CyA: 2 deaths not related to drug, 1 lack of effect, 9 adverse reactions--AZA: 2 drop-outs, 1 lack of effect, 9 adverse reactions). Altogether effectivity and tolerability were equal in both treatment groups with the exception of an increase in blood pressure and serum creatinine which occurred only in the CyA group.
1529286	Measuring the quality of life of women with rheumatoid arthritis or systemic lupus erythem	1992	The Quality of Life Scale (QOLS) was translated into Swedish and reliability and validity was studied. The Swedish version (QOLS-S) was given to 100 women with rheumatoid arthritis or systemic lupus erythematosus along with the Arthritis Impact Measurement Scales and a visual analog pain scale. Disease activity was also measured using the Ritchie Articular Index and a patient version of the Systemic Lupus Activity Measure. Results indicated that the QOLS-S had high test-retest reliability (r = .84 for a 4-week interval) and internal consistency reliability (alpha = .82 at Time 1 and .88 at Time 2). An hypothesis that the QOLS-S would have low to moderate correlations with measures of health status and disease activity was supported. We conclude that the QOLS-S is a reliable and valid measure of quality of life in Swedish women with RA and SLE and that it provides a measure of quality of life that is distinct from health status and disease activity.
7981990	Intestinal flora in early rheumatoid arthritis.	1994 Nov	To study the role of intestinal flora in the pathogenesis of RA, we have applied computerized gas-liquid chromatography (GLC) for bacterial cellular fatty acids (CFAs) present in the stool. The CFA spectra represents the total composition of bacterial CFAs in a faecal sample. Correlation and cluster analysis of CFA spectra gathers samples with quantitatively and qualitatively similar bacterial flora into clusters, which then reveal the relationship of samples to each other. Stool samples were collected at the time of hospital admission from patients with early RA before any specific treatment. The CFA spectra in stool samples of RA patients were significantly different from those of non-RA controls. Patients with erosive RA formed a group most clearly different from the controls. Analyses based on the CFA composition of reference bacteria revealed that anaerobic bacteria are primarily responsible for the differences observed. These results suggest that intestinal bacteria play a role in the development of RA.
7743742	Specificity of IgM antiglobulins produced in rheumatoid arthritis and tropical infections.	1995 Jan	The measurement of rheumatoid factors is of limited value in West Africa due to the low rheumatoid factor seroprevalence among patients with rheumatoid arthritis and the increased seroprevalence among healthy individuals and those with infectious diseases in the region. Using ELISA methods, we have been able to increase the specificity of rheumatoid factor measurement although the sensitivity of this test remains low. Furthermore, among the infectious diseases studied, there was no preferential binding of rheumatoid factors to the Fab gamma portion of immunoglobulin over the Fc gamma portion.
8935189	Acute phase response in rheumatoid arthritis patients treated with immunosuppressive drugs	1995 Apr	We sought to investigate an influence of immunosuppressive drugs on acute phase response (APR) in rheumatoid arthritis (RA). Ninety-six patients (pts) were treated with methotrexate (MTX), or with cyclophosphamide (CTX) (9-intravenously, 19-orally), or with cyclosporin A (CSA). C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and alpha-1 antichymotrypsin (ACT) serum levels were measured by rocket immunoelectrophoresis. AGP and ACT microheterogenities evaluated using immunoelectrophoresis were expressed as reactivity coefficient (RC). Clinical improvement was observed in 71.4% MTX pts, 77.8% CTX intravenously pts, 36.8% CTX orally pts, 60.0% CSA pts. The number of side effects was the highest in CTX oral group (57.9% left the study). CRP, AGP, and ACT serum levels were increased in all groups of RA pts as compared to healthy controls. CRP level decreased only after MTX and CTX intravenous treatment. Moreover, a decrease in ACT was observed in CTX intravenously treated pts. AGP-RC was lower in the initial population of RA pts as compared to healthy control. After 6 months of treatment RC became significantly higher in MTX pts only. In opposite ACT-RC in RA pts was found to be elevated as compared to controls. After the treatment it fell down. The decrease was found to be significant only in pts treated with MTX. From our study we can conclude that MTX is the safest and the most effective agent among immunosuppressive drugs applied in RA. CTX given orally causes a number of adverse reactions, which frequently make continuous and effective treatment impossible. CTX intravenously and CSA are attractive in the treatment of the patients with severe and refractory RA. A lack of clinical benefit is reflected in the absence of acute markers changes.
1583051	The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarso	1992 Apr	Sixty-seven feet in forty-five patients who had rheumatoid arthritis were followed for an average of six years (range, four to ten years) after an operation on the forefoot that included resection of the metatarsophalangeal heads or joints and the insertion of a double-stemmed silicone-rubber implant in the first metatarsophalangeal joint. There were forty-two women and three men, and the average age at the time of the operation was fifty-six years (range, thirty-six to seventy-nine years). The mean duration of known rheumatoid arthritis was fifteen years (range, three to thirty-seven years). Resection of the metatarsophalangeal heads or joints was performed through a plantar approach in forty-one feet and a dorsal approach in twenty-six feet. A double-stemmed silicone-rubber implant was placed in the first metatarsophalangeal joint in all feet. Each patient was evaluated clinically and radiographically with use of a foot-scoring system that was developed for this study. The results were assessed for relief of pain, ability to walk (including the use of shoes), presence of calluses or deformity, and radiographic findings. The average preoperative foot score was 47 points; the score had improved to an average of 81 points at the latest follow-up examination. A good or excellent result was obtained in fifty-eight feet (87 per cent). Complications were infrequent. In three feet, there was delayed healing of the wound; three implants were removed because of dislocation and infection; and four feet had revision to correct deformities of the lesser toes.
8970384	Cellular distribution of bronchus-associated lymphoid tissue in rheumatoid arthritis.	1996 Dec	Bronchus-associated Lymphoid tissue (BALT) has been reported to be present in the lungs of patients with rheumatoid arthritis (RA). However, little is known about the structure and cellular distribution of BALT in this disease, so we investigated these points using immunohistochemical methods. The subjects were eight RA patients with BALT in biopsy specimens and a histologic diagnosis of follicular bronchiolitis. Seven patients had cough and purulent sputum, and four patients had positive sputum cultures. BALT was histologically composed of four distinct regions, which were the lymphoepithelium, the dome area, the follicular area, and the parafollicular area. Surface IgM+ B cells were predominant in the follicular area, whereas IgA+ cells were scattered in the dome and parafollicular areas. T cells were mainly found in the parafollicular area (CD4+ > CD8+), and most of them expressed the T Cell receptor alpha beta (alpha beta TCR). These findings were similar to those described previously for BALT in diffuse panbronchiolitis, which manifests as a chronic respiratory infection. The present study indicated that extrinsic stimulation as well as alterations of the immune response are involved in the development of BALT in RA, although the exact mechanism requires further clarification.
8712872	Occurrence of rheumatoid arthritis is not increased in the first degree relatives of a pop	1996 Feb	OBJECTIVE: To determine the risk of rheumatoid arthritis (RA) in first degree relatives of a true population based sample of probands with inflammatory polyarthritis. METHODS: In a case-control study, a two stage screening procedure was used to ascertain the prevalence of RA in 518 first degree relatives of 207 Norfolk Arthritis Register cases registered in 1990 and 414 first degree relatives of 180 local controls. An initial joint symptom and medical history questionnaire was followed by a physical examination, and serological and radiological evaluation of those with symptoms. RESULTS: The prevalence of RA in the first degree relatives of all the Norfolk Arthritis Register cases was 7.7/1000, compared with 4.8/1000 in the first degree relatives of the controls, with a risk ratio of 1.6 (95% confidence interval 0.3 to 8.7). This very modest increase was also seen when the analysis was restricted to the first degree relatives of Norfolk Arthritis Register cases who satisfied the American Rheumatism Association criteria for RA: prevalence rate 7.2/1000. CONCLUSION: There was no evidence of an important increased familial risk of RA in this community based sample. These data are compatible with others from immunogenetic studies showing only weak HLA associations with community ascertained RA.
8894715	Peripheral blood neutrophil leukotriene B4 release and migration in rheumatoid arthritis.	1996 Oct	The present study was designed to compare peripheral blood neutrophil migration and leukotriene (LT) release between patients with rheumatoid arthritis (RA) and healthy controls and to correlate the neutrophil functions with clinical disease activity. Nineteen patients with moderately active RA and 19 age and sex matched healthy volunteers participated in this study. Isolated peripheral blood neutrophils from RA patients released equal amounts of LTB4 but their random migration was enhanced as compared with neutrophils from healthy controls. LTB4 release in whole blood was significantly lower in samples from RA patients than in those from the healthy volunteers (13.5 +/- 1.4 and 19.1 +/- 1.4 ng/10(6) neutrophils respectively; P < 0.001). LTB4 release from isolated RA neutrophils correlated with the levels of C-reactive protein, duration of morning stiffness and Ritchie articular swelling index. Concentrations of hyaluronate, cyclic AMP and 13, 14-dihydro-15-keto prostaglandin were not different between patients with RA and healthy volunteers. Neither was there any difference in TXB2 production by platelets during blood clotting. In conclusion, peripheral blood neutrophils of RA patients seem to be primed and/or activated as their random migration is enhanced as compared with those of healthy volunteers. In RA, LTB4 release from peripheral blood neutrophils seems to reflect the clinical activity of the disease. However, RA neutrophils released smaller (in whole blood) or equal (isolated cells) amount of LTB4 as compared with the respective controls. These contradictory findings suggest that LTB4 release from peripheral blood neutrophils has no major role in the regulation of disease activity in rheumatoid arthritis.
8597883	Plasma and synovial fluid interleukin-1, interleukin-6 and substance P concentrations in r	1995 Nov	We performed an open, between patients, placebo controlled study in order to evaluate the effect of the treatment with the non steroidal anti inflammatory drugs indomethacin, diclofenac and naproxen on the concentrations of the cytokines IL-1 beta and IL-6 and of the neuropeptide substance P in plasma and synovial fluid of 24 rheumatoid arthritis patients. All patients had high synovial fluid cytokine and substance P levels, and high plasma cytokine levels at the beginning of the study. The treatment with the non steroidal anti inflammatory drugs significantly decreased both plasma and synovial fluid IL-6 and synovial fluid substance P in comparison to placebo, but did not affect IL-1 beta concentrations. This effect can participate in the therapeutic effect of non steroidal anti inflammatory drugs in rheumatoid arthritis.
8608679	Clinical implications of patients' knowledge.	1995 Nov	We evaluated the effectiveness of current strategies for educating patients in routine clinical practice in three related studies. (1) A study of overall knowledge in 100 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) showed knowledge of diagnosis and treatment effects were high (86% and 83% respectively) but only a minority (37%) were well informed about side effects. (2) Patients' detailed knowledge of drug therapy was assessed in 50 RA and OA patients. Between 56%-92% knew why drugs were given, their use and their likely effects. But many patients were unaware of the main adverse reactions and also how to avoid or limit them. (3) The relationship of patient education to overall disease management was evaluated in 89 RA patients with 5-10 years disease duration using validate guidelines for specialist care. Those patients who had been give inadequate education about drug therapy had a reduced level of overall care. Although education is considered important by patients, it is often inadequate, and this is associated with a less effective overall treatment.
7579779	Rheumatoid arthritis in the elderly. Prevalence and optimal management.	1995 Jul	Elderly-onset rheumatoid arthritis (EORA), defined as rheumatoid arthritis (RA) with onset at age 60 years or over, differs slightly from younger-onset RA by a more equal gender distribution, a higher frequency of acute systemic onset with involvement of the shoulder, a higher disease activity, and, in later stages, more radiographic damage and functional decline. Several subsets of EORA are recognised, such as rheumatoid factor-positive RA, polymyalgia rheumatica and 'remitting seronegative symmetrical synovitis with pitting oedema'. These conditions can be difficult to distinguish from crystal-induced arthritis, osteoarthritis and paraneoplastic arthritis. The efficacy and tolerability of second-line drugs is similar in both age groups, but in the elderly caution is needed with the use of nonsteroidal anti-inflammatory drugs and prednisone.
8237318	Periarticular bone mineral content in rheumatoid arthritis and arthrosis of the hip. Dual	1993 Oct	The bone mineral content (BMC) was determined by dual photon X-ray absorptiometry prior to hip replacement in 22 patients with rheumatoid arthritis and 31 with arthrosis. Compared with the arthrosis patients, the rheumatoids had approximately 20 percent lower bone mineral content in the proximal femur, the lumbar spine, and in the innominate bone superior to the acetabulum.
7945496	The large granular lymphocyte syndrome with rheumatoid arthritis. Immunogenetic evidence f	1994 Sep	OBJECTIVE: To assess whether the HLA-DR4 association found in rheumatoid arthritis (RA) is also seen in the large granular lymphocyte (LGL) syndrome. METHODS: HLA-DR genotyping was performed using restriction fragment length polymorphism and polymerase chain reaction analysis. RESULTS: LGL syndrome patients with RA showed the same HLA-DR4 association seen in RA/Felty's syndrome (FS), while LGL syndrome patients without arthritis did not. CONCLUSION: It is proposed that FS and the LGL syndrome represent different variants of a broader syndrome comprising RA, neutropenia, LGL expansions, HLA-DR4 positivity, and splenomegaly.
1488677	Treatment strategies in rheumatoid arthritis.	1992 Dec	Intervention therapies in rheumatoid arthritis (RA) are directed at the immune dysregulation and chronic inflammatory events in the joint. An ideal therapeutic program would rapidly control inflammation, prevent joint damage and preserve function. The various strategies of treatment involve the use of disease-modifying anti-rheumatic agents (DMARDs) either singly or in combination. Gold salts, penicillamine, sulphasalazine, methotrexate and hydroxychloroquine are used when NSAIDs fail to control inflammation. RA not only decreases the functional disability but the life-span of patients. The traditional pyramid strategy which uses single DMARDs consecutively has been found to be inadequate and slow in suppressing joint inflammation. Hence the race to find treatment regimes and strategies that will favourably alter the outcome of RA patients. Both the "step-down bridge" approach and saw-tooth strategy have been advocated in the attempt to break the progression of joint disease. None of the known regimes can be said to be most beneficial and least toxic.
8118571	Approach to initial medical treatment of rheumatoid arthritis.	1993 May	In this article, we review the first line of therapy for rheumatoid arthritis. The components of first-line therapy include patient education, rest, physical therapy, occupational therapy, and nonsteroidal anti-inflammatory agents. We discuss each of these components in detail. Factors that might necessitate the addition of second-line agents (corticosteroids, antimalarials, gold salts, penicillamine, immunosuppressives, and surgery) are also outlined.