Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 7880122 | Rheumatoid arthritis, corticosteroid therapy and hip fracture. | 1995 Jan | OBJECTIVE: To identify the risk of hip fracture in patients with rheumatoid arthritis and those taking corticosteroids. METHODS: In a population based case-control study, we compared 300 consecutive patients with hip fracture aged 50 years and over from a defined district and 600 age and sex matched community controls. RESULTS: The risk of hip fracture was increased in patients with rheumatoid arthritis (odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0 to 4.7) and those receiving corticosteroids (OR 2.7; 95% CI 1.2 to 5.8). The risk attributable to rheumatoid arthritis was markedly reduced by adjusting for functional impairment, while that for steroid use remained after adjusting for body mass index, smoking, alcohol, and functional status. CONCLUSIONS: Hip fracture risk is approximately doubled amongst patients with rheumatoid arthritis and among those taking steroids. These risk increases are, to some extent, independent of each other. In rheumatoid arthritis, the risk was most closely associated with functional impairment, whereas steroid use did not appear to be confounded by this variable. | |
| 8465133 | [Local joint treatment in chronic polyarthritis: intra-articular corticosteroids and radio | 1993 Mar 23 | Intrasynovial injection of corticosteroids is currently one of the routine measures in the treatment of patients with rheumatoid arthritis. Crystalline corticosteroid suspensions have proved their value and are effective for approximately one to three weeks. One or two injections can control synovitis for prolonged periods of time. Special attention has to be given to impeccable technique of instillation. However, it must be kept in mind that, within the overall management of rheumatoid arthritis, the intra-articular injection of corticosteroids is a local, palliative and temporary measure. The intrasynovial instillation of radionuclides is used only in selected cases. Therapy of the knee joint is mainly performed with Yttrium-90, less frequently, the interphalangeal joints are treated with Erbium-169. Costs and radiation exposure are low, but a favourable result is only achieved in slightly more than 50 per cent of cases. This review provides a synopsis of the basic concepts and practical applications of intrasynovial corticosteroid and radioisotope injection therapy. | |
| 1433006 | Light microscopy of dried saliva in the evaluation of xerostomia of the sicca syndrome. A | 1992 Sep | Dried, freshly produced saliva from 21 patients with xerostomia related to the sicca syndrome [15 with primary Sjögren's syndrome (pSS), 3 with rheumatoid arthritis (RA) and secondary Sjögren's syndrome (sSS), and 3 with Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE)] and 21 age and sex matched controls, was examined by light microscopy. A typical fern-like pattern was demonstrated by the crystallized mucus of the healthy individuals. In contrast, much thicker, shorter, irregular and densely arranged branches of crystallized mucus, sometimes giving a reindeer horn appearance, were observed in the patients' saliva. Given the lack of a reliable clinical measure for the objective evaluation of xerostomia, light salivary microscopy, simple and easy as it is, may fill this deficit, if its sensitivity and specificity are documented. | |
| 1502423 | [The articular sequelae of rheumatic fever: Jaccoud's dislocation arthritis. A case report | 1992 Feb | A case of rheumatic fever with severe heart involvement, in which articular rheumatoid-like features involving both hands appeared many years after clinical onset, is described. After reviewing the articular sequelae of rheumatic fever and describing the clinical features of each form, the authors point out the main differences between rheumatic fever and rheumatoid arthritis, and diagnose Jaccoud's arthritis. | |
| 8919442 | Total shoulder replacement in rheumatoid arthritis: proximal migration and loosening. | 1996 Jan | A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal migration of the humerus before surgery was performed. The mean follow-up time was 92 months (range 52 to 139 months). The results revealed proximal migration in 55% of the patients (34 shoulders), and 40% (25 shoulders) showed progressive radiographic loosening of the glenoid component. Five of 12 press-fit humeral components demonstrated progressive radiographic loosening, whereas no signs of loosening were found in 50 cemented humeral components. In spite of progressive component loosening and progressive migration, this study demonstrated good pain relief in 89% of the patients (55 shoulders) and also a significant improvement in range of movement and function. The presence of proximal humeral migration did not significantly influence the average results-neither pain relief, range of movement, abduction force, nor function. Also, component loosening did not significantly influence the average pain relief, range of movement, abduction force, or function. The risk of clinical asymptomatic loosening is a relatively late complication that is eventually followed by pronounced bone destruction related to the loose component. Long-term radiographic control of total shoulders with rheumatoid arthritis is recommended. Hemiarthroplasty with a cemented humeral prosthesis may be a better treatment in the end stage of rheumatoid arthritis of the shoulder. | |
| 8266113 | Cholesterol crystals in synovial and bursal fluid. | 1993 Oct | Cholesterol crystals were found in two patients with classic rheumatoid arthritis (RA). In one patient, cholesterol crystals were found in synovial fluid from both shoulder joints, and in the second they were in an olecranon bursa. To examine the possible systemic etiology of cholesterol crystals in synovial and bursal fluid, lipid concentrations and the presence of serum antilipoprotein antibodies were measured. Antilipoprotein antibodies were not found. The concentration of lipid and lipoproteins, as well as the normal pattern of lipoprotein on agarose gel, eliminates the possibility of hyperlipoproteinemia. Results seemed to exclude a systemic etiology for the formation of cholesterol crystals in synovial and bursal fluid in the RA patients. It appears that several local factors such as defective drainage, local destruction, increased permeability of synovial membrane, and intraarticular (bursal) bleeding are possible etiologies. | |
| 7603736 | Evaluation of certain immunity parameters in rheumatoid arthritis, treated with cortisone. | 1994 Dec | The authors present their study on interleukin-2 receptors (IL-2R), transferrin receptors (R-Tr), CD-4/CD-8 ratio, T-lymphocytes after therapy with a corticosteroid (125 mg/die), in 7 female geriatric patients suffering from rheumatoid arthritis. The study was performed with conjugated monoclonal antibody marking the lymphocytes with fluorescein (FITC) and phycoerythrin (PE). Using the considered parameters a depressant effect was presumed on T-lymphocytes and on the immune defences in the first 6 hours after starting therapeutic cortisone infusion. The proliferative effect on T-lymphocytes, CD4 and on the receptor state of the membrane, for IL-2R and Tr-R, was already evident in the 11-12th hour with a peak at 24 hours. It is therefore useful to follow the evolution of the immune state, even using the above parameters, in order to evaluate the correct therapeutic course. | |
| 7826134 | Relationship between weakness and muscle wasting in rheumatoid arthritis. | 1994 Nov | OBJECTIVE: To relate weakness of grip to loss of forearm muscle bulk, hand joint deformity, and hand joint tenderness in patients with rheumatoid arthritis (RA). METHODS: Using anthropometric data we have estimated the anatomical cross-sectional area (CSA) of forearm muscles in 100 subjects with RA compared with 100 aged and sex-matched normal subjects. We also recorded hand joint tenderness using a modification of the Ritchie articular index, and a simple index of hand joint deformity. RESULTS: We found a significant reduction in anatomical CSA in RA (forearm CSA in normal subjects 29.7 cm2 and in RA 25.9 cm2; p = 0.002). In simple linear regression we found that 46.3% of the variation in grip strength in normal subjects was explained by variation in muscle CSA; in RA this figure decreased to 33.4%. Adding terms for joint deformity and pain in a multiple regression model improved the amount of variation explained to 37.9%. CONCLUSIONS: Although there is significant muscle wasting in RA, it is likely that reduction in strength is also attributable to joint deformity and pain leading to inhibition of grip directly and, indirectly, by arthrogenous muscle inhibition. Doubts remain about the quality of muscle in RA. | |
| 8508553 | How to measure health status in rheumatoid arthritis in non-English speaking patients: val | 1993 Mar | The HAQ-Disability Index (HAQ-DI) is a useful instrument to measure health status in rheumatoid arthritis (RA) patients. Translation into another language requires a validation process, however. We have translated the HAQ-DI to be used on Spanish-speaking populations. We administered the questionnaire to 97 RA patients during the course of routine medical care. Reliability, measured by a test-retest with a one-month interval, was high (Spearman's rho = 0.89). Convergent and construct validity was obtained for all comparisons (Pearson's r > 0.4). The instrument was sensitive in detecting clinical improvement. We conclude that the Spanish HAQ-DI retains the characteristics of the original index and can be used to assess outcome in Spanish-speaking patients with RA. The procedure described may be used to translate the instrument into other languages either directly from English or from the Spanish version presented here. | |
| 8702449 | Health outcomes of two telephone interventions for patients with rheumatoid arthritis or o | 1996 Aug | OBJECTIVE: The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis (RA) or osteoarthritis (OA), compared with usual care, were assessed. METHODS: A 3-group, randomized, controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales (AIMS2) as the outcome measure. RESULTS: Analyses of covariance showed that the AIMS2 total health status of the treatment counseling group (effect size = 33, P < 0.01), but not the symptom monitoring group (effect size = 0.21, P = 0.10), was significantly improved, compared with usual care, for both RA and OA patients. The specific types of benefits differed significantly between RA and OA patients. The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced (P < 0.01). CONCLUSION: Telephone contact using the treatment counseling strategy produced significant, but different, health status benefits for RA and OA patients. The symptom monitoring strategy produced modest benefits. | |
| 7986223 | Methotrexate concentrations in synovial membrane and trabecular and cortical bone in rheum | 1994 Dec | OBJECTIVE: To determine methotrexate (MTX) concentrations in the synovial membrane (SM) and cortical and trabecular bone of rheumatoid arthritis (RA) patients. METHODS: Ten RA patients (9 women, 1 man; mean +/- SD age 49.2 +/- 10.6, mean disease duration 13.2 +/- 9.9 years) undergoing surgical procedures for rheumatoid articular lesions participated in this study. Mean +/- SD MTX treatment duration was 26.4 +/- 21.3 months. The day preceding surgery, 10 mg of MTX was administered intramuscularly. During surgery, a mean +/- SD of 19.7 +/- 2.6 hours after MTX administration, SM, bone fragments, and blood were collected simultaneously. MTX was assayed by fluorescence polarization immunoassay in plasma and tissues. RESULTS: The mean +/- SD plasma concentration was 0.0252 +/- 0.01 nmoles/ml at the time of tissue sampling. The mean MTX concentration in SM was 0.285 +/- 0.159 nmoles/gm. The mean MTX concentrations in trabecular and cortical bone were 0.292 +/- 0.164 and 0.286 +/- 0.126 nmoles/gm, respectively. CONCLUSION: After intramuscular administration, high MTX concentrations are found in SM and cortical and trabecular bone of RA patients. | |
| 7848513 | New perspectives on rheumatoid arthritis. | 1994 Dec | Rheumatoid arthritis (RA) remains one of the most common, puzzling and poorly treated diseases of humans. However, a surge of interest in the biology of chronic inflammation and in the design of more-potent and specific inhibitors of pro-inflammatory pathways heralds an optimistic era for the treatment of RA. A recent symposium provided a multidisciplinary perspective on the current status of such studies. | |
| 7776904 | Neutrophil-macrophage interaction: a paradigm for chronic inflammation. | 1995 Jan | Autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease are characterized by chronic inflammatory responses resulting in tissue damage. These diseases have a number of common denominators including: abnormal cytokine expression, aberrant antigen-antibody complexes, T cell anomalies, and increased numbers of neutrophils and macrophages. We propose that the interaction between neutrophils and macrophages induces a state of chronic inflammation which contributes to the disease state. One of the central players in this scenario is myeloperoxidase (MyPo). This enzyme functions in the 'cytotoxic triad' and is involved in cell killing. Studies done by the present investigators have known that MyPo, which is released from neutrophils, induces macrophages to secrete interleukin-1, interferon alpha beta and tumor necrosis factor alpha. Furthermore, our studies have suggested a major immunoregulatory role of this enzyme. We propose that the release of MyPo from neutrophils and subsequent binding to macrophages initiates a cascade of events which enhance the production of reactive oxygen intermediates and cytokine expression resulting in the chronic inflammatory state associated with autoimmune diseases. | |
| 7510620 | Methotrexate in rheumatoid arthritis. An update. | 1994 Jan | Methotrexate has been approved for the treatment of refractory rheumatoid arthritis by several regulatory agencies, including the Food and Drug Administration. The tendency is now to prescribe it at earlier stages of the disease. Methotrexate is a well known antifolate. Its exact mechanism of action in rheumatoid arthritis remains uncertain. The polyglutamated derivatives of methotrexate are potent inhibitors of various enzymes, including dihydrofolate reductase and 5-aminoimidazole-4-carboxamide ribonucleotide transformylase. Inhibitory effects on cytokines, particularly interleukin-1, and on arachidonic acid metabolism, as well as effects on proteolytic enzymes, have been reported. Some of them may be linked to the antifolate properties of methotrexate. Overall, the drug appears to act in rheumatoid arthritis as an anti-inflammatory agent with subtle immunomodulating properties. Direct inhibitory effects on rapidly proliferating cells in the synovium have also been suggested. Methotrexate is usually given orally. Marked interindividual variation in its bioavailability has been found. Food intake has no significant effect on the pharmacokinetics of oral methotrexate. Methotrexate undergoes significant metabolism. The functionally important metabolites are the polyglutamated derivatives of methotrexate, which are selectively retained in the cells. Less than 10% of a dose of methotrexate is oxidised to 7-hydroxy-methotrexate, irrespective of the route of administration. This metabolite is extensively (91 to 93%) bound to plasma proteins, in contrast to the parent drug (35 to 50% bound). Methotrexate is mainly excreted by the kidneys. It undergoes tubular secretion and may thereby compete with various organic acid compounds. Early placebo-controlled trials demonstrated that weekly low dosage methotrexate produced early symptomatic improvement in most rheumatoid arthritis patients. Two meta-analyses showed that methotrexate is among the most efficacious of slow-acting antirheumatic agents, together with parenteral gold (sodium aurothiomalate), penicillamine and sulfasalazine. Furthermore, in the short term context of clinical trials, methotrexate has one of the best efficacy/toxicity ratios. There is little evidence that methotrexate, or any available slow-acting antirheumatic agent, is a true disease-modifying drug. However, the probability that a patient will continue methotrexate therapy over time appears quite favourable compared with any other slow-acting antirheumatic drug. Combination therapy with slow-acting drugs has been advised for the management of rheumatoid arthritis, but the evidence currently available does not support general use of combination therapy including methotrexate. Almost all investigations indicated that toxic effects, rather than lack of response, were the major reason for discontinuing methotrexate therapy.(ABSTRACT TRUNCATED AT 400 WORDS) | |
| 8171357 | Three-dimensional motion of the upper cervical spine in rheumatoid arthritis. | 1994 Feb 1 | Rheumatoid arthritis frequently contributes to instability of the upper cervical spine. Rotational instability of the upper cervical spine was evaluated in rheumatoid arthritis patients using biplanar x-ray photogrammetry. Three-dimensional cervical motion and the instantaneous axis of rotation of the atlas relative to the axis were evaluated in normal and rheumatoid arthritis patients during axial rotation in the horizontal plane. Anterior atlantoaxial subluxation did not increase during axial head rotation in either the atlantoaxial subluxation or the vertical subluxation groups, while the instantaneous axes of rotation were distributed posteriorly in the dens in the RA-normal group, but were widely scattered in the atlantoaxial subluxation group. | |
| 8156466 | Heterotopic ossification after primary cemented and noncemented total hip arthroplasty in | 1994 Apr | OBJECTIVE: To compare the frequency and severity of heterotopic ossification (HO) in patients with osteoarthritis or rheumatoid arthritis who undergo cemented or noncemented total hip arthroplasty. DESIGN: A prospective case study. SETTING: A university referral centre. PATIENTS: One hundred and sixty one patients underwent 184 total hip arthroplasties. The 184 hips were categorized as follows: cemented total hip arthroplasty--60 osteoarthritis hips, 26 hips affected by rheumatoid arthritis; noncemented total hip arthroplasty--67 osteoarthritic hips, 31 hips affected by rheumatoid arthritis. INTERVENTIONS: Total hip arthroplasty. A standard approach was used to implant either a cemented or noncemented prosthesis. Radiographs were obtained of each hip preoperatively, immediately postoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. MAIN OUTCOME MEASURES: Radiographs were graded in blind fashion for HO, according to the criteria of Brooker. Modified Harris hip scores were calculated at 1 and 2 years postoperatively. RESULTS: HO (incidence of Brooker grades 2, 3 and 4) was greater after cemented (22%) than noncemented (9%) total hip arthroplasty in osteoarthritic hips (p < 0.05), but there was no significant difference between the two types of prosthesis in hips affected by rheumatoid arthritis. When both types of prosthesis were considered together there was no significant difference in the incidence of HO between osteoarthritic hips (15%) and hips affected by rheumatoid arthritis (12%). With respect to Harris hip score, the presence of grade 4 HO was associated with a significantly (p < 0.05) lower score (50.6) than grade 3 (89.4) and grade 2 (91) HO. CONCLUSIONS: Cemented total hip arthroplasty increases the frequency of HO only in osteoarthritic hips. Compared with Brooker's grades 2 and 3 HO, grade 4 HO significantly lowers the Harris hip score after total hip arthroplasty. | |
| 8356251 | Aggressive therapy does not substantially alter the long-term course of rheumatoid arthrit | 1993 Feb | A consensus has evolved that there is little evidence supporting the view that the second line agents significantly alter long-term outcomes in rheumatoid arthritis. Consequently, changes in approaches to treatment currently being employed include earlier use of existing second line agents, their use in combinations, and greater use of corticosteroids. Our awareness that our current drugs, at best, fall considerably short of attaining the therapeutic results we would like to achieve causes us to look forward to the development of rationally derived biologic agents with considerable anticipation. | |
| 8245090 | Factors affecting the range of movement of total knee arthroplasty. | 1993 Nov | We have investigated those factors which influence the range of movement after total knee arthroplasty, including sex, age, preoperative diagnosis and preoperative flexion deformity and flexion range. We also compared cemented and cementless tibial fixation, the influence of collateral ligament and lateral parapatellar releases and of replacement of the patella, and of the period of postoperative immobilisation. We reviewed 516 Johnson-Elloy (Accord) knee arthroplasties performed between 1982 and 1989, with a minimum follow-up of 12 months. The most important factors in the range of flexion achieved after arthroplasty are the diagnosis and the preoperative range of flexion. In patients with osteoarthritis there was a mean loss of flexion; in rheumatoid arthritis there was a mean gain. In both groups, the stiffer knees gained motion and the more mobile knees lost it. Post-operative range of motion was not influenced significantly by cement fixation, collateral ligament or patellar retinacular releases, prolonged immobilisation or patellar replacement. | |
| 7799342 | Ultrasound evaluation of painful rheumatoid shoulders. | 1994 Sep | OBJECTIVE: To provide more information about various types of rheumatoid involvement of the painful shoulder by ultrasonography (US). METHODS: US examinations were performed in 44 patients (88 shoulders) with rheumatoid arthritis (RA). The technique of shoulder ultrasonography was standardized in studies of 30 healthy volunteers (60 shoulders) without shoulder complaints. US findings were compared with clinical, laboratory and radiographic data to find any relationship. RESULTS: Sonography could reveal inflammatory conditions at early stages of RA when no radiographic changes were seen. The most common US finding was subacromial-subdeltoid bursitis in 61 shoulders (69%) of 35 patients. Synovitis in the glenohumeral joint was seen in 51 shoulders (58%) of 32 patients, biceps tendinitis in 50 shoulders (57%) of 29 patients and changes in the supraspinatus tendon in 29 shoulders (33%) of 20 patients. There were multiple rheumatoid symptoms in 61 shoulders (69%), one condition resulted in changes in 17 shoulders (19%) and no visible US findings in 10 shoulders (11%). Clinical findings were rather unspecific. Flexion, abduction and outward rotation were often restricted in shoulder symptoms, whereas inward rotation was rarely limited. Shoulder swelling indicated subacromial-subdeltoid bursitis. CONCLUSION: Ultrasonography is a very useful method for rheumatologists and orthopedists to see inside joints. It can provide remarkable help for local injection therapy and for planning surgery because of its suitability for evaluation of the extent of rheumatoid disease. | |
| 8422292 | Rheumatoid arthritis as a risk factor for multiple myeloma: a case-control study. | 1993 | This population-based case-control investigation was designed to study the importance of rheumatoid arthritis, other diseases and different types of treatment for the risk of developing multiple myeloma. In total, 275 cases with verified myeloma in northern Sweden were matched to as many control subjects. Information about different diseases, drug use, diagnostic X-ray investigations and radiotherapy was obtained through an extensive questionnaire mailed to all living subjects, i.e. cases and controls, and to the next of kin regarding deceased subjects. The study confirmed a suspected association with both rheumatic diseases in general and rheumatoid arthritis specifically. No other disease gave an increased risk for myeloma, but on the contrary, other diseases were in general more common among the controls. In accordance with this finding, use of medications and diagnostic X-ray investigations were also less common in cases than in controls. The study did, however, give some support to a recent finding that the number of X-ray investigations might be a risk factor for myeloma. Earlier radiotherapy on benign indications was more common in cases, whereas radiotherapy for malignant disease was more common among controls in this study. |