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ID PMID Title PublicationDate abstract
7693940 Antikeratin antibody and antiperinuclear factor as markers for subclinical rheumatoid dise 1993 Aug OBJECTIVE: Antikeratin antibody (AKA) and antiperinuclear factor (APF) are antibodies characteristic for rheumatoid arthritis (RA). Our purpose was to obtain information on the occurrence of APF before the onset of clinical disease and on the occurrence of AKA and APF in cases with false-positive rheumatoid factor (RF) reactions. METHODS: AKA and APF were measured with indirect immunofluorescence technique using rat esophagus and buccal mucosa cells, respectively, as antigen source. RESULTS: Five of 30 preillness specimens from subjects who later developed seropositive RA were positive for AKA and APF, 3 sera were positive for only AKA and 3 for only APF. All the eleven sera positive for AKA or APF were RF positive. Both AKA and APF were detected in 6 of 70 sera from RF positive subjects who did not develop RA within a 10-year followup, 3 sera were positive for only AKA and 3 for only APF. CONCLUSION: AKA and APF appear to be linked markers of an immunological process which, in RF positive subjects, predicts the development of clinical arthritis. However, disease manifestations develop in only a proportion of cases.
8356407 Amyloidosis--incidence and early risk factors in patients with rheumatoid arthritis. 1993 In a 15-year follow-up examination, reactive secondary amyloidosis (RSA) was found by subcutaneous fat biopsy in six out of 74 still living patients (8.1%) of an original population of 102 with erosive and seropositive rheumatoid arthritis (RA). Five of the 24 deceased patients had had RSA. Thus the 15-year incidence of RSA in RA was at least 10.9% (11/102). To study early prognostic aspects of RSA, comparison was made of 14 entry variables and the initial treatment in the RSA group (n = 11) and the control group (n = 81) respectively. At onset (< or = 6 months) of RA only serum orosomucoid, but after three years morning stiffness, ESR, serum CRP and orosomucoid were significantly worse in patients whom later developed RSA. Three out of 48 patients treated with gold sodium thiomalate and seven out of 30 treated with chloroquine developed RSA (p = 0.04). It is concluded that continuously active disease was the risk factor underlying RSA. The role of early chloroquine therapy is discussed.
7932413 Are patient self-report measures of arthritis activity confounded by mood? A longitudinal 1994 Jun OBJECTIVE: To determine the extent to which mood in general, and depression in particular, may confound self-report measures of functional disability, pain, and global arthritis status among patients with rheumatoid arthritis (RA). METHODS: Twenty-four patients with RA were prospectively examined every 2 weeks for up to 60 weeks. At each examination, self-report measures of functional disability, pain, and global arthritis status were assessed using the Health Assessment Questionnaire, and the clinical measures of swollen and tender joint counts, duration of morning stiffness, grip strength, 50' walk time, and Westergren sedimentation rate were recorded. In addition, patients completed a questionnaire derived from the Profile of Mood States-B (POMS-B), which assessed positive and negative moods, and the Center for Epidemiologic Studies Depression Scale (CES-D) at each examination. The degree to which mood or depression confounded the self-report measures of functional disability, pain, and global arthritis status was estimated using pooled time series regression models that examined the relationship between changes in either mood or depression and changes in each self-report measure over the course of the study, while controlling for the effects of the clinical measures of arthritis activity. RESULTS: Mood, as measured by the POMS-B scale, explained 2.0% or less of the variation in longitudinal changes in each of the self-report measures, after controlling for the effects of the clinical measures of arthritis activity. Depression, as measured by the CES-D, explained less than 2.0% of the variation in changes in functional disability, but explained 6.0 and 8.0% of the variation in changes in pain and global arthritis status, respectively. CONCLUSION: Depression may confound self-reports of pain and global arthritis status somewhat, but appears to have minimal influence on self-reported functional disability.
8308769 Adverse effects of low dose methotrexate therapy in rheumatoid arthritis. 1993 Nov OBJECTIVE: To determine (1) the risk of treatment termination for low dose, weekly methotrexate (MTX) therapy in patients with rheumatoid arthritis (RA), and (2) the prevalence, nature and predictors of adverse effects due to longterm low dose MTX therapy. METHODS: A 13-year, retrospective survey of all patients with RA receiving low dose MTX therapy was conducted using life table, logistic regression and case control methods of analyses. Major and minor adverse effects were defined. RESULTS: Consecutive patients with RA (144) starting MTX (mean dose 8.2 mg/week) were observed to have a 75% risk of treatment termination at 60 months. Reasons for 81 patients stopping MTX were adverse effects (43), loss/lack of effect (18), other medical and nonmedical reasons (13), and lost to followup (7). Sixty-two patients experienced 83 major adverse events, including gastrointestinal symptoms (29), hepatic enzyme test abnormalities (23), pneumonitis (5) and severe leukopenia (8). Aging was the only predictor of treatment discontinuation associated with a major toxicity. Five patients developed a malignancy during the observation period. CONCLUSIONS: In our survey the risk of treatment termination was 75% in patients with RA taking MTX after 60 months. An adverse drug effect is a more common reason for treatment termination (53%), compared to loss/lack of beneficial effect (22%) or other reasons (16%) or lost to followup (9%). Increasing age is associated with an increased risk of treatment termination associated with a major toxicity.
7911664 Treatment of refractory rheumatoid arthritis with a chimeric anti-CD4 monoclonal antibody. 1994 Jun OBJECTIVE: To evaluate CD4+ T cell counts of rheumatoid arthritis (RA) patients at 18 and 30 months after treatment with a chimeric anti-CD4 monoclonal antibody (MAb), cM-T412, in a phase I trial. METHODS: Of the 25 RA patients who received the MAb, 23 were available for followup at 18 and 30 months. Levels of circulating CD4+ T cells were measured by flow cytometry. RESULTS: Circulating CD4+ T cell levels in these 23 RA patients remained below normal at 18 and 30 months posttreatment. More profound CD4+ T cell depletion was noted in the higher-dose groups (300 and 700 mg). CONCLUSION: Prolonged suppression of circulating CD4+ T cells was noted both in single-infusion and multiple-infusion groups 18 and 30 months after cM-T412 treatment. The depression was more pronounced in patients who received multiple infusions of cM-T412. The prolonged decrease in CD4+ T cell numbers suggests that the capacity to reconstitute CD4+ T cells in this patient population (treated with methotrexate) is limited. One patient, who was also receiving methotrexate and prednisone, died 18 months after receiving 100 mg of cM-T412. No other significant adverse effects, in particular, no opportunistic infections, were reported in these 23 RA patients at 18 and 30 months of followup.
1426901 [Blood protein-volume indicators in massive plasmapheresis]. 1992 Feb Hyperproteinemia values were studied before and after plasmapheresis in 32 rheumatoid arthritis patients with no manifest circulatory disorders. Mathematical patterns enabling prediction of changes in protein concentration depending on the volume of removed plasma and the type of substitution have been proposed for 3 alternative regimens of the procedure (removal of 0.5 or 1.0 volume of the circulating plasma, and substitution for rheopolyglucin or albumin). The data of independent "examining" sampling (15 patients) have proved adequacy of the linear regression patterns.
8670314 Decrease in cellularity and expression of adhesion molecules by anti-tumor necrosis factor 1996 Jul OBJECTIVE: The effect of chimeric anti-tumor necrosis factor alpha (TNF alpha) monoclonal antibody (MAb) therapy on synovial inflammation was studied in order to address the hypothesis that anti-TNF alpha therapy leads to down-regulation of adhesion molecules and a decrease in inflammatory cell influx in synovial tissue (ST). METHODS: The immunohistologic features of synovial biopsy specimens, both before and 4 weeks after anti-TNF alpha MAb (cA2) therapy, were studied in 14 patients with rheumatoid arthritis (RA). The patients either received a placebo (n = 2), or were given intravenous doses of cA2 at 10 mg/kg (n = 5) or 20 mg/kg (n = 7). RESULTS: A significant (P < 0.03) reduction in the mean scores for T cells and for the adhesion molecules, vascular cell adhesion molecule 1 and E-selectin, was observed after therapy with 10 mg/kg or 20 mg/kg of cA2 in RA patients. CONCLUSION: The reduced expression of adhesion molecules, and the decrease in cellularity of rheumatoid ST after cA2 administration support the hypothesis that the antiinflammatory effect of anti-TNF alpha therapy might be partly explained by down-regulation of cytokine-inducible vascular adhesion molecules in ST, with a consequent reduction of cell traffic into joints.
7575711 Treatment of active refractory rheumatoid arthritis with humanized monoclonal antibody CAM 1995 Sep OBJECTIVE: To investigate the dose tolerance and potential clinical activity of a humanized antilymphocyte monoclonal antibody, CAMPATH-1H (C1H), in patients with active, refractory rheumatoid arthritis (RA). METHODS: Thirty adult patients with active, refractory RA were treated in an open-label, 3-center, dose-escalation study of subcutaneously injected C1H. Six patients were assigned to each of 5 dosage groups (0.3, 1.0, 3.0, 10.0 or 30.0 mg/day), and received 10 daily injections of C1H over a 12-day period. RESULTS: Side effects occurred primarily during the first 1-2 days of dosing, and included mild fever, chills, nausea, vomiting, headache, and, in a minority of patients, hypotension. All patients developed some discomfort at the injection site. Self-limited infections occurred in 5 patients during the 6-month study period. Peripheral blood lymphocyte counts fell promptly after initial dosing and recovered slowly, usually over 2-3 months. Serum antibodies to C1H developed in 54% of patients following treatment. Clinical improvement was observed in 56% of patients, based on the composite Paulus criteria, with a median time-to-response of 22 days and a median response duration of 32 days. CONCLUSION: C1H is a lymphocyte-depleting antibody that exhibits biologic potency when administered subcutaneously to patients with refractory RA. Its use is associated with mild to moderate toxicity and short-term amelioration of disease activity.
1622055 Should the glenoid be replaced in shoulder arthroplasty with an unconstrained Dana or St. 1992 Twenty-six patients, 11 with rheumatoid arthritis and 15 with osteoarthritis, have been operated on with an unconstrained total shoulder arthroplasty. Mean follow-up was 47 months. Three prostheses have been extracted. All patients stated that they had pain relief after surgery. At three year follow-up all except one had developed radiolucent zones around the glenoid component. No zones were observed around the humeral component. In shoulders with preserved glenoid surface replacement of only the humeral head might provide better long-term results than a total shoulder arthroplasty.
8014928 Microheterogeneity of alpha 1-acid glycoprotein in early and established rheumatoid arthri 1993 Dec OBJECTIVE: To determine whether factors related to disease activity determine changes in the glycosylation of alpha 1-acid glycoprotein (AGP) observed at the early stage of rheumatoid arthritis (RA). METHODS: Using affinoimmunoelectrophoresis with the lectin concanavalin A (Con-A), the microheterogeneity of serum AGP was studied in patients with early (n = 54) and established (n = 46) RA and the results were expressed as reactivity coefficients (AGP-RC). RESULTS: When compared with controls (n = 44), AGP-RC values were increased in the patients with very recent RA of no more than 3 months duration (p < 0.05), whereas normal or low AGP-Con-A reactivity was found in the patients with early RA with disease duration exceeding 3 months. In the entire group with early RA, the multiplicative model of regression described the relationship between AGP-Con-A reactivity and disease duration (p < 0.005). AGP variant with low binding affinity to Con-A predominated in the sera of patients with established RA and no relationship between the glycosylation profile of AGP and disease duration was observed in this group. When AGP-RC values were compared in the subgroups of patients with early and established RA with similar disease activity as measured by the Mallya-Mace score or erythrocyte sedimentation rate, there was a significant decrease in AGP-RC with increasing disease activity (p < 0.05). CONCLUSION: In view of our findings, early RA begins as an acute inflammation with increase of AGP-Con-A reactivity and becomes chronic during the first year of the disease. Factors related to disease activity appear important in determining the rate at which RA enters a chronic phase.
8976642 Glutathione reductase activity, riboflavin status, and disease activity in rheumatoid arth 1996 Nov OBJECTIVE: To measure erythrocyte glutathione reductase (EGR) activity and riboflavin status, and their relations to disease activity, in rheumatoid arthritis patients compared to healthy controls. METHODS: Patients with rheumatoid arthritis were classified as active if there were features of articular inflammation which required initiation or change of disease modifying therapy, and as inactive if they had little evidence of articular inflammation. EGR was measured in patients and healthy controls by a functional assay with or without the addition of flavin adenine dinucleotide (FAD). The ratio of stimulated EGR (with FAD added) to basal EGR (no added FAD), which measures riboflavin status, is known as the EGR activation coefficient (EGRAC). An EGRAC > or = 1.3 represents biochemical riboflavin deficiency. RESULTS: 91 patients with rheumatoid arthritis, including 57 with active disease, and 220 healthy controls were studied. Both basal and stimulated EGR were significantly higher in patients with rheumatoid arthritis (P = 0.0001) than in controls. Biochemical riboflavin deficiency was identified in 41% controls and 33% patients with active rheumatoid arthritis but was significantly less frequent (9%) in patients with inactive compared to active disease (P = 0.02) or healthy controls (P = 0.0006). Pain score, articular index, C reactive protein, and erythrocyte sedimentation rate were increased in patients with riboflavin deficiency (all P < 0.02). CONCLUSIONS: Higher basal and stimulated EGR might be expected in patients with rheumatoid arthritis in response to chronic oxidative stress due to synovial inflammation. The association of riboflavin deficiency with increased disease activity suggests that impaired EGR activity could facilitate continuing inflammation in these patients.
8053952 Dynamic magnetic resonance imaging for the evaluation of synovitis in patients with rheuma 1994 Aug OBJECTIVE: To investigate whether the findings of magnetic resonance imaging (MRI) reflect rheumatoid synovitis. METHODS: Dynamic imaging enhanced with gadolinium-diethylenetriamine pentaacetic acid was performed on 10 affected knees of 9 patients with rheumatoid arthritis. Changes in signal intensity were correlated with pathologic findings in synovial biopsy specimens obtained during total knee arthroplasty. RESULTS: Enhancement was greater in regions with a higher degree of fibrin exudation, cellular infiltration, villous hypertrophy, vascular proliferation, and granulation formation. CONCLUSION: Dynamic MRI can be used for assessing local disease activity in rheumatoid synovium.
8239224 Hydroxychloroquine compared with placebo in rheumatoid arthritis. A randomized controlled 1993 Dec 1 OBJECTIVE: To assess the efficacy of hydroxychloroquine, 400 mg daily, for rheumatoid arthritis. DESIGN: Six-month, double-blind, randomized trial. SETTING: Ambulatory referral clinic in a Mexico City, Mexico, teaching hospital. PATIENTS: A total of 126 patients with early rheumatoid arthritis were randomly assigned to receive hydroxychloroquine, 400 mg/d, or placebo; 121 patients completed the study. RESULTS: Hydroxychloroquine showed a clinically and statistically significant improvement over placebo in joint score (20% greater mean improvement; 10% more patients improved by > 50%); pain (40% greater mean improvement; 19% more patients improved by > 50%); grip strength (22% greater mean improvement; 21% more patients improved by > 50%); patient global assessment (16% more patients stated they had improved); and physician global assessment (12% more patients were judged to have improved). Side effects were mild, and no patients in the hydroxychloroquine group required discontinuation of therapy. Patient compliance with the study medication was high. CONCLUSION: Hydroxychloroquine is moderately effective in early rheumatoid arthritis.
8122121 Corticosteroid pulse therapy in active rheumatoid arthritis. 1993 Dec The infusion of high doses of corticosteroids (corticosteroid pulse therapy, CPT) is used to treat refractory rheumatoid arthritis (RA). In the first part of this article, literature on the efficacy of CPT is reviewed, and different CPT regimens (high-dose, low-dose, oral CPT) are compared. Several CPT regimens are beneficial in RA, the clinical effect lasting 4 to 10 weeks. Only high-dose CPT (1,000 mg methylprednisolone intravenously) has been shown to bridge the gap between the start and the effect (lag time) of a disease-modifying antirheumatic drug initiated at the same time. A retrospective study on the incidence of short-term and long-term side effects of CPT in 50 patients with RA who received a total of 78 pulse regimens is described in the second part. Side effects occurred frequently, but in most cases they were mild. The possible relationship between CPT and osteonecrosis of the femoral head is discussed. It is concluded that CPT is beneficial in RA. A substantial number of patients suffer side effects of varying severity.
1512910 A controlled evaluation of continuous passive motion in patients undergoing total knee art 1992 Sep 16 OBJECTIVE: To evaluate the efficacy of continuous passive motion (CPM) in the postoperative management of patients undergoing total knee arthroplasty. DESIGN: A randomized controlled single-blind trial of CPM plus standardized rehabilitation vs standard rehabilitation alone. SETTING: A referral hospital for arthritis and musculoskeletal care. PATIENTS: Consecutive patients with end-stage osteoarthritis or rheumatoid arthritis undergoing primary total knee arthroplasty who had at least 90 degrees of passive knee flexion. One hundred fifty-four patients were eligible and 102 patients agreed to participate and were randomized. Ninety-three patients completed the study protocol. INTERVENTION: Continuous passive motion machines programmed for rate and specified arc of motion within 24 hours of surgery with range increased daily as tolerated with standardized rehabilitation program compared with standardized rehabilitation program alone. MAIN OUTCOME MEASURES: Primary outcomes were pain, active and passive knee range of motion, swelling (or circumference), quadriceps strength at postoperative day 7, as well as complications, length of stay, and active and passive range of motion and function at 6 weeks. RESULTS: Use of CPM increased active flexion and decreased swelling and the need for manipulations but did not significantly affect pain, active and passive extension, quadriceps strength, or length of hospital stay. At 6 weeks there were no differences between the two groups in either range of motion or function. In this series, use of CPM resulted in a net savings of $6764 over conventional rehabilitation in achieving these results. CONCLUSION: For the average patient undergoing total knee arthroplasty, CPM is more effective in improving range of motion, decreasing swelling, and reducing the need for manipulation than is conventional therapy and lowers cost.
7670780 Parity and risk of rheumatoid arthritis in Finnish women. 1995 Jul Several recent case-control studies have suggested that nulliparity is a risk factor for rheumatoid arthritis (RA). We studied parity for its association with the incidence of RA in a cohort of adult Finnish women examined by the Mobile Clinic of the Social Insurance Institution in 1966-72. The 15,441 women were > or = 30 yr of age and had neither arthritis nor a history of it at the time of the baseline examination. They were followed up by examining records kept at the population register of the institution, to identify patients entitled to free anti-rheumatic medication. Up to late 1989, 269 women had developed RA. Of the incident cases, 176 were rheumatoid factor (RF)-positive. Compared with nulliparous women, the age-adjusted relative risks (95% confidence intervals) of parous women developing RF-positive RA, RF-negative RA or either type were 1.26 (0.82-1.92), 0.80 (0.48-1.32) and 1.06 (0.77-1.46), respectively. The number of childbirths presented an n-shaped relationship with the risk of RF-positive RA, but there were distinct differences between subpopulations. In female farmers the association was inverse, but in housewives and in other occupational groups (mainly employees) it was clearly positive. The results challenge the view that there is a causal relation between parity status and the development of RA.
1582117 Experimental animal models resembling rheumatoid arthritis. 1992 Mar The experimental animal models of arthritis which in certain aspects share similarities to human rheumatoid arthritis are reviewed. Various methods have been applied to induce in animals experimental models of arthritis which would provide important insights into the aetiopathogenetic mechanisms of human RA. Immunological methods and infectious agents induced the most interesting models. The histology of the synovial tissue, regardless of the inducing mechanisms, is similar to the lesions of RA. Yet, none of these experimental models of arthritis reflects all the articular and systemic features, the immunological profile and the genetic factors which characterize the human disease. The animal models of arthritis reported here and the development of new ones may ultimately offer the information necessary for the understanding of the mechanisms involved in the aetiopathogenesis of human rheumatoid disease.
7631437 [Synovectomy in rheumatoid arthritis]. 1995 Jun 5 Surgical synovectomy in the treatment of rheumatoid arthritis has been performed for more than a 100 years, and yet the definite indication has not been made clear. Synovectomy has a convincing, but mostly time-limited effect on pain and articular hydrops, but the radiological progression continues almost undisturbed. Histological evaluation of the regenerating synovial membrane has now shown a tendency towards reversing to baseline within about a year. The difficulties in evaluating the operation are caused by the lack of comparable randomized studies performed on large populations, treated in a double-blind fashion and examined in cooperation between surgeon and rheumatologist.
7603711 Rheumatoid nodules of the larynx. 1995 Jul Two unique cases of rheumatoid nodules affecting the larynx are reported. These subcutaneous nodules represent localized laryngeal involvement from autoimmune disorders. The otolaryngologist should be aware of these possibilities as part of the differential diagnosis in the workup of dysphonia.
8578888 [Coping with stress and rheumatoid factor--a comparative study]. 1995 Sep Forty-six seropositive female RA patients were compared to 28 seronegative female RA patients and 51 healthy women using the stress-coping questionnaire of Janke et al. (9). In comparison to healthy controls, patients with RA exhibit a stress-coping behavior characterized by more cognitive coping mechanisms, less self-accusation, less aggression, and less use of alcohol or pharmaca. They too use more substitutive gratification, a strategy which is used by seropositive patients even more than by seronegative patients. Further, compared to healthy controls and seronegative patients, seropositive patients describe more attempts to control their reactions in stress situations.
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