Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 7674227 | Functional impairment and disability in early rheumatoid arthritis--development over 5 yea | 1995 Jun | OBJECTIVE: To evaluate the development of functional impairment and disability in early rheumatoid arthritis (RA). METHODS: Sixty-three patients with definite RA with mean disease duration of about 1 year were followed for 5 years. Joint inflammation was evaluated with an active joint count, and radiographic changes in hands and feet with the Larsen method. Functional impairment of particular joint systems was assessed with a performance index, Signals of Functional Impairment Index, and disability with the Health Assessment Questionnaire (HAQ). RESULTS: During the observation time the disease activity decreased, and the radiographic changes of hands and feet increased significantly. Joint replacement in 10 hips, 1 knee, and 1 shoulder were performed in 9 patients after median 43 months. At study start almost half the patients had impaired hand function, mostly affecting finger flexion and pincer grip. The most marked deterioration of joint function had occurred already after 2 years in metatarsophalangeal joints (55%), elbow joints (35%), ankle joints (30%), shoulder joints (28%), and hip joints (25%). The median HAQ level at study start was 0.8, and the median change of HAQ over 5 years was 0.1. (not significant). The progression of dysfunction was not linear but followed a highly variable course over the years. Patients with higher HAQ scores at study end could be correctly classified in 75% of the cases by the 3 factors, baseline HAQ score, female sex, and a low educational level. Presence of a replaced joint did not contribute significantly, but patients with joint replacement tended to be more disabled. CONCLUSION: Functional outcome of RA after about 6 years of disease was fairly good. Functional impairment of different joints had progressed, but most patients were still mildly disabled. A subgroup of 9 patients had a worse disease course with rapidly progressing large joint destruction. | |
| 8768144 | [Generalized osteoporosis in chronic polyarthritis--pathomechanisms and treatment approach | 1996 May | Juxtaarticular osteoporosis is a typical x-ray symptom of rheumatoid arthritis and is an early radiological criterion of the disease before destructive changes of joints can be seen. A systemic osteoporosis, independent from corticoid treatment, will develop significantly later. Nevertheless both conditions have some pathogenetic mechanisms in common. The risk of generalized osteoporosis in rheumatoid arthritis correlates with the degree of inflammatory activity. Different cytokines originating from the affected joints can be measured in plasma at increased levels and augment osteoclastic activity in bone tissue. During the early phase of disease the best prevention of osteoporosis is therefore adequate suppression of inflammation. Taking into account these mechanisms, corticoid treatment may be osteoprotective. Clinical manifestation of systemic osteoporosis in rheumatic patients depends on bone mass at onset of disease, on the activity of inflammation, and on additional negative effects on bone mass due to corticoids and immobility. | |
| 8824717 | In situ hybridization study of vascular cell adhesion molecule-1 messenger RNA expression | 1995 Dec | Upregulation of vascular cell adhesion molecule-1 (VCAM-1) has been implicated in various pathological conditions. In this study, we used in situ hybridization to determine the cell types expressing VCAM-1 mRNA in rheumatoid synovium. Synovial tissues from seven rheumatoid arthritis (RA) and four osteoarthritis (OA) patients were examined for VCAM-1 mRNA expression. In situ hybridization as well as immunohistochemical analysis showed that VCAM-1 expression was mainly localized to the hyperplastic synovial lining cells and to a lesser extent endothelial cells and synovial fibroblasts in rheumatoid synovium. VCAM-1 expression in OA is less prominent. Hyperplastic synovial lining cells expressing VCAM-1 were mainly CD13+, CD14+, CD33+ and HLA-DR+. Together with morphological features, this suggests that they are type A macrophage-like synovial cells. Our findings indicate that overexpression of VCAM-1 may contribute to the formation of hyperplastic lining layers in the synovium seen in this disorder. | |
| 8826679 | Surgical principles and planning for the rheumatoid hand and wrist. | 1996 Jul | Each surgical procedure available for the rheumatoid hand has a score card. The most indicated and necessary procedures include: extensor tenosynovectomy and Darrach for the impending or already ruptured extensor tendons; flexor tenosynovectomy and carpal tunnel release for the patient with impaired median nerve function; stabilization of the deformed unstable thumb with MP or IP arthrodesis; and flexor tenosynovectomy in the palm and finger of a motivated patient with significant disparity between active and passive motion. Relative indications for surgery include arthrodesis for the unstable wrist; MP arthroplasty for the fixed MP volar and ulnar subluxation with inability to open the hand; synovectomy for the occasional patient with painful boggy synovitis of the MP or PIP joint; and reconstruction of the fixed swan neck deformity with relatively good PIP joints. Both MP and PIP joints can and should be operated on at the same time. Extensive wrist surgery, that is, tenosynovectomy and Darrach or arthrodesis, should not be performed at the same time as MP arthroplasty. Try to do the "winner operations" first. | |
| 8973871 | Thyroid function and immune profile in rheumatoid arthritis. A controlled study. | 1996 Nov | The aim of our study was to determine the prevalence of thyroid dysfunction and autoimmune abnormalities in rheumatoid arthritis (RA) and to further investigate the possible association between D-penicillamine and autoimmune thyroiditis. For this purpose, one hundred and one unselected consecutive patients with RA and 70 age and sex matched controls were studied prospectively. Evaluation included a complete history and physical examination with special attention to symptoms suggestive of thyroid pathology, routine laboratory and serologic immune profile, plus determination of serum levels of thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), antibodies to thyroid peroxidase (AbTPO) and TSH receptor antibodies (TRAB). Serum thyroxine binding globulin (TBG) was measured in all subjects with high thyroid hormone levels, whereas free T3 and T4 concentrations were determined in all individuals with abnormal T3, T4, TSH or TBG. Six patients with hyperhyroidism, 3 with hypothyroidism and 1 with the euthyroid hyperthyroxinemia (EH) syndrome were found, whereas four of the controls had hyperthyroidism. Thirteen patients and 6 controls had high AbTPO levels whereas no one had high TRAB. No association was detected between thyroid abnormalities and any serologic RA finding. Furthermore, no correlation between thyroid dysfunction and elevated AbTPO's was found. A relatively high prevalence of thyroid dysfunction (9,9%) and subclinical autoimmune thyroiditis (12,9%), the latter indicated by elevated AbTPO's, was found in our RA patients. These figures were higher than those in the control group (5,7% and 8,6% respectively), but the difference did not reach statistical significance. Of further interest may be our finding that, despite anecdotal reports blaming D-penicillamine for cases of autoimmune thyroiditis, the incidence of the latter was similar among recipients and nonrecipients of the drug. Similarly, TRAB were not detected in any patient treated with D-penicillamine. | |
| 7709304 | Corticosteroid therapy and bone mass--comparison of rheumatoid arthritis and systemic lupu | 1994 Jul | This study was designed to evaluate the effects of low-dose corticosteroid (CS) therapy for rheumatoid arthritis (RA) and of high-dose CS therapy for systemic lupus erythematosus (SLE) on metacarpal bone mass in young (premenopausal) subjects. Ninety-eight patients with RA, 63 patients with SLE and 85 healthy controls of comparable age, race, sex and nutritional status were studied. Metacarpal bone mass was measured by radiogrammetry using a digitiser. In the RA patients, mean bone mass of CS-treated subjects (27%) was 52.31 g/cm2, while that of untreated subjects was 56.69 g/cm2 (P < 0.02). In the SLE group, mean bone mass of CS-treated subjects (76%) was 61.47 g/cm2 and that of untreated subjects 62.36 g/cm2 (P > 0.1). Although patients with SLE required larger cumulative doses of CS for longer periods, their bone mass was higher than that of the RA subjects (P < 0.01). None of the patients had femoral neck or vertebral crush fractures. In RA, bone loss was probably a feature of severe disease rather than of CS therapy. | |
| 8373715 | Disposition of the enantiomers of hydroxychloroquine in patients with rheumatoid arthritis | 1993 Jul | In eight patients with rheumatoid arthritis receiving racemic hydroxychloroquine, blood and urine concentrations of the enantiomers of hydroxychloroquine and its major metabolites were measured each month over the first 6 months of therapy. Plasma concentrations of hydroxychloroquine enantiomers were measured in five of these patients. In all patients, the blood concentration of (R)-hydroxychloroquine exceeded that of the (S)-enantiomer, the mean (R)/(S) ratio being 2.2 (range 1.6-2.9). A similar excess of (R)-hydroxychloroquine was found in the plasma, the mean (R)/(S) ratio being 1.6 (range 1.2-1.9). The mean enantiomer blood concentration ratio (R)/(S) for the metabolite desethylhydroxychloroquine was 0.45 (range 0.34-0.58) and for desethylchloroquine it was 0.56 (range 0.35-0.86) suggesting stereoselective metabolism of hydroxychloroquine. (S)-hydroxychloroquine had a mean (+/- s.d.) renal clearance from blood of 41 +/- 11 ml min-1, approximately twice that of (R)-hydroxychloroquine. The predicted unbound renal clearance was also higher for (S)-hydroxychloroquine. The clinical implications of enantioselective disposition of hydroxychloroquine are currently not known. | |
| 1342640 | Correlation of tumor necrosis factor alpha levels with disease activity of rheumatoid arth | 1992 Nov | In this study, positive correlations were found between tumor necrosis factor alpha (TNF alpha) levels in the sera of rheumatoid arthritis (RA) patients and the duration of morning stiffness, joint tenderness count, the Ritchie articular index and erythrocyte sedimentation rate. Further, higher mean grades of disease activity of RA were accompanied by correspondingly higher levels of serum and synovial TNF alpha. In the longitudinal study, when the disease activity of RA decreased after treatment, serum TNF alpha levels also decreased. This suggests that the levels of serum and synovial TNF alpha correlate positively with RA disease activity. The levels of TNF alpha in synovial fluid were significantly higher in RA and acute gouty arthritis (GA) patients than in osteoarthritis (OA) patients. This suggests that joint inflammation in inflammatory arthritis related to local production of TNF alpha in the joint cavities. Serum TNF alpha levels in RA patients were significantly higher than those in the OA patients; no statistical difference was found between acute GA and OA patients. | |
| 7924458 | Selenium and the selenium-dependent glutathione peroxidase in rheumatoid arthritis. | 1994 Jun | Selenium is an essential component in the two antioxidant enzymes glutathione peroxidase (GSH-Px) and phospholipid hydroperoxide glutathione peroxidase (PLGSH-Px). Free oxygen radicals are involved in the inflammatory process seen in rheumatoid arthritis (RA) and are generated mainly through the phagocytic activity of the polymorphonuclear leucocytes. Several experimental studies indicate that selenium is important to the functioning of the immune system and to the inflammatory process. A low selenium status among patients with RA has been reported from areas with both high and low natural selenium intake. The reduction in the serum level is approx. 10%. This reduction is related to the clinical disease activity in arthritis patients in both cross-sectional and longitudinal studies, and selenium concentrations have been found to fluctuate during the disease. Reduced selenium concentrations have been reported in red blood cells, too, and concentrations have been found to be slightly reduced in the polymorphonuclear leucocytes. Studies do not agree on the activity of GSH-Px among RA patients. Thus activity levels have been reported to range from low to high. Those studies that have focused on the subgroup of patients with high persistent disease activity have reported reduced GSH-Px activities in both serum, red blood cells and polymorphonuclear leucocytes. Selenium supplementation using organic selenium compounds in doses of around 250 microgram/day increases the selenium concentration in serum and red blood cells considerably. However, supplementation is not reflected in the selenium level in polymorphonuclear leucocytes from RA patients as opposed to healthy subjects, in whom the level of selenium in polymorphonuclear leucocytes increases. Selenium supplementation increased GSH-Px activity in serum, red blood cells and platelets from RA patients, but in the polymorphonuclear leucocytes the increase was not sufficient to reach the levels of the controls. This apparent lack of de novo synthesis of GSH-Px in polymorphonuclear leucocytes from RA patients may be explained by their inability to increase their selenium content in spite of high levels of available extracellular selenium. this may be in accordance with the lack of anti-arthritic effect of selenium supplementation in controlled clinical studies among RA patients. Several experimental studies have reported inhibition of GSH-Px by antirheumatic drugs, in particular gold. In addition, gold has been found to reduce selenium in rat plasma. These interactions can, however, be modified by increasing the amount of selenium in the feed. Among RA patients there is no clear evidence of an interaction between gold, selenium and GSH-Px.(ABSTRACT TRUNCATED AT 400 WORDS) | |
| 7699677 | Antimalarial drug induced decrease in creatinine clearance. | 1995 Jan | OBJECTIVE: To confirm the antimalarial drug induced increase of creatinine to determine the factors contributing to this effect. METHODS: Patients with rheumatoid arthritis (RA) (n = 118) who have used or still use antimalarials (chloroquine or hydroxychloroquine). Serum creatinines prior to antimalarials and serum creatinines during antimalarials were recorded and the creatinine clearance was estimated. RESULTS: The mean creatinine clearance decreased from 99 ml/min to 92 ml/min (p < 0.001) after the start of antimalarial drugs. Fifty-five percent of the patients with chloroquine compared to 15% of the patients with hydroxychloroquine (chi 2 = 17.8; p < 0.001) had more than 10% decrease of the creatinine clearance. Age (beta = 0.004; p = 0.0002) and the kind of antimalarial (beta = 0.095; p = 0.0002) were strong independent predictors of the decrease of the creatinine clearance in the multiple regression analysis. For patients using chloroquine the mean age adjusted decrease of creatinine clearance was 11.2%. CONCLUSION: Antimalarials cause a significant reduction of the creatinine clearance. The use of chloroquine and older age were associated with decreased creatinine clearance. Whether antimalarials affect glomerular filtration or tubular excretion of creatinine remains to be investigated. | |
| 8846545 | Rheumatoid arthritis in Greece: clinical, serological and genetic considerations. | 1995 Sep | In the present study we summarize the clinical, serological and genetic peculiarities of Greek rheumatoid patients. Initially we demonstrated that Greek RA patients have a high frequency of Ro(SSA) antibodies in their sera and that these patients present a high incidence of D-penicillamine (DP) side effects. In addition, we showed that these patients were predominantly female and had an increased incidence of positive salivary gland biopsy, compatible with Sjögren's syndrome (SS). Subsequently, longitudinal studies showed that this subgroup of Ro(SSA) positive RA patients present erosive arthritis in a similar frequency compared to Ro(SSA) negative patients. In addition, we evaluated the prevalence of secondary SS in RA patients. We found that secondary SS was common (31%), benign, subclinical and required specific tests for its diagnosis. To answer the question regarding the existence of additional markers of DP toxicity (other than Ro(SSA) antibodies) in RA patients, we found that in addition to Ro(SSA) antibodies, circulating cryoglobulins were associated with DP side effects. All of these observations prompted us to compare the clinical, serological and radiological expression of RA in Greek and British patients. We found that Greek patients had less inflammatory articular disease, fewer extra-articular manifestations, less radiological joint destruction, and a high frequency of Ro(SSA) antibodies linked to a higher prevalence of secondary SS. Furthermore, a study from our group showed a lack of association of RA with HLA antigens, and only a weak association with HLA-DR1 and DR4 antigens. To clarify the clinical, serological and genetic differences between RA in Greece and that in other European countries, we examined HLA class II DNA polymorphisms in 92 adult Greek RA patients and compared them with those of 84 healthy ethically matched controlled individuals. We showed that RA in Greece is associated with the same HLA-DR beta alleles which confer susceptibility in northern European caucasoids. However, whereas 83% of northern European patients carry the HLA-DR beta motif, this was found in 43.5% of Greek patients. In addition, we investigated whether HLA-DR4 is a marker of disease severity in Greek RA patients. There was no difference between the DR4+ and DR4- patients with respect to disease duration, severity of arthritis, and the functional and anatomical joint scores. There was no statistical difference in the clinical manifestations among patients with different HLA-DR4 subtypes. The same was also true when the clinical picture was correlated with the "shared RA epitope". Finally, we investigated the prevalence of antikeratin antibodies (AKA) in our RA population. 16% of the patients had positive AKA antibodies. These antibodies were correlated with the presence of RF and HLA-DR1 antigen. We conclude that RA in Greece differs on clinical, serological and genetic grounds compared to RA in northern European countries. Multicenter European studies may provide valuable information regarding the differences observed among Greek and northern European RA. | |
| 8436995 | Fixation of cemented acetabular prostheses. The influence of preoperative diagnosis. | 1993 Feb | The authors evaluated the fixation of cemented acetabular prostheses in patients with osteoarthritis (20 hips), rheumatoid arthritis (15 hips), and sequelae after fracture of the femoral neck (13 hips) using roentgen stereophotogrammetric analysis. The three-dimensional displacements of the cups were measured during the first 2 postoperative years, and radiographs were examined to assess bone quality, containment, inclination, and area of cement surrounding the cups. There was a greater proportion of migrating cups in patients with rheumatoid arthritis and fracture of the femoral neck compared with osteoarthritis. Patients with poor bone quality according to the modified Engh index, small cement area surrounding the cups, and cups with small inclination displayed increased frequency of migration. | |
| 7932412 | Upper limb lymphedema associated with polyarthritis of rheumatoid type. | 1994 Jun | OBJECTIVE: To determine the cause of upper limb edema in 8 patients with peripheral polyarthritis of rheumatoid-type. METHODS: Objective assessment of lymph function using quantitative lymphoscintigraphy. RESULTS: Seven cases with either rheumatoid or psoriatic arthritis were found to have impaired lymph drainage associated with edema. All cases shared a distal rheumatoid pattern of arthritis but showed no relation between severity of lymphatic impairment and either duration or severity of arthritis. CONCLUSION: Polyarthritis of rheumatoid-type may be associated with lymphedema due to impaired lymphatic function. | |
| 8174492 | Immunopharmacological evaluation of bucillamine in rheumatoid arthritis. | 1993 | Seventy six patients with rheumatoid arthritis (RA) treated with bucillamine, a novel immunomodulating drug with no antiinflammatory effects, were evaluated in terms of the immunomodulating effects. Clinical symptoms and laboratory data, including lymphocyte subset changes, were followed for 12 or more months. Long-term administration of bucillamine markedly improved arthritis and suppressed the titre of rheumatoid arthritis haemagglutination. Flow cytometric analysis of peripheral blood T cell subsets showed that bucillamine induced a characteristic increase in the cell constituent ratio of CD4+CD45RA+ T cells. Decreases in CD4+CD45RO+ T cells, CD8+HLA-DR+ T cells and CD5+ B cells were considered characteristic features induced by bucillamine administration. | |
| 1345138 | Radiographic evidence of disease progression in methotrexate treated and nonmethotrexate d | 1992 Dec | Methotrexate (MTX) has proven to be efficacious in the treatment of rheumatoid (RA), but it remains to be proven whether it can slow disease progression, as determined radiographically, in comparison with other disease modifying antirheumatic drugs (DMARD). We performed a meta-analysis of the available data to answer this question. A literature search, including abstracts, was conducted and inclusion criteria developed (description of patients, accountability of patients, inclusion of a control group of patients, specified radiographic endpoint, and appropriate reading of the radiographs). Publications were scored on a scale of 0 to 5 with a score > or = 3 required for inclusion in the study. For abstracts selected, additional data were obtained directly from the investigators. Data for 353 MTX treated and 205 non-MTX-DMARD treated patients with RA were gathered. Not all publications used the same scoring system, so some assumptions were required to analyze the combined data. Only the erosion score was included since not all publications included a reading of the joint space. All scores were transformed into Sharp scores (Arthritis Rheum 1985;28:1449), including the important contributions of 3 Larsen scored publications. Finally a monthly rate of disease progression was computed. Several comparisons were made. Overall, the rates of disease progression were similar for MTX and non-MTX-DMARD treated patients with RA. The non-MTX-DMARD treated patients with RA were separated into a group treated with gold salts (oral or parenteral) and a group treated with azathioprine with each group compared to the MTX treated patients. MTX had slower rates of disease progression than azathioprine, (rates 0.004 vs 0.012) but not slower rates than gold salts (0.008 vs 0.008). Despite its efficacy, the possible role of MTX in slowing disease progression more than other DMARD, as determined radiographically, appears to be evident only when compared to azathioprine. | |
| 1619384 | Suppression of autoantibodies to factor VIII and correction of factor VIII deficiency with | 1992 Jun | The presence of autoantibodies against factor VIII is an unusual but serious complication in rheumatoid arthritis. We describe the case of a patient who developed this kind of complication, with spontaneous bleeding and marked changes in the haematological parameters, that was unsuccessfully treated with a high dose of intravenous gammaglobulin. Subsequently, combined therapy with porcine factor VIII concentrate, cyclophosphamide and steroids led to the disappearance of the anti-factor VIII autoantibodies. | |
| 1439633 | Sensitivity to UV light during treatment with chloroquine in rheumatoid arthritis. | 1992 | Chloroquine and hydroxychloroquine have long been suspected of causing light sensitivity in patients with rheumatoid arthritis (RA). To gain insight into the effect of chloroquines and ultraviolet (UV) light in RA we have phototested 25 RA patients with and without chloroquine. The thresholds for UVA and UVB did not change upon treatment with chloroquine or hydroxychloroquine. Provocation with high dose UVA and UVB was similar with and without treatment with chloroquine or hydroxychloroquine. Our results have shown that photosensitivity during medication with chloroquine and hydroxychloroquine is uncommon and that there is no need to stop this treatment due to sun exposure. | |
| 8342045 | Antilipoprotein antibodies in rheumatoid arthritis. | 1993 Jun | Antibodies against very low-density lipoproteins and low-density lipoproteins (aLA) were found in 26 of 69 (38%) patients with active rheumatoid arthritis (RA) but not in any control subjects (ie, 40 patients with psoriatic arthritis, 21 patients with osteoarthritis, and 65 healthy blood donors). In 21 RA patients (30%), lipoproteins were found in the dissociated components of circulating immune complexes. RA patients with aLA had significantly decreased cholesterol levels in all lipoprotein fractions and total serum lipids, while serum triglycerides were significantly increased compared with RA patients without aLA. Anticardiolipin antibodies as measured by the Venereal Disease Research Laboratory test were not found in any subject in this study. These findings suggest a possible autoimmune origin of dyslipoproteinemia in some patients with active RA. | |
| 8260643 | Perceived needs and patient satisfaction in relation to care provided in individuals with | 1993 Sep | A cross-sectional study was performed upon a group of patients (N = 222) with rheumatoid arthritis (RA), from a Swedish health care district. The aim was to elucidate expectations and satisfaction with health care workers. The participants indicated that a good reception is more important than professional knowledge followed by the ability to inform about RA and the ability to show empathy. There was a trend towards increasing satisfaction with information about medical problems with severity of RA. This stands in contrast to the lack of such a systematic relation with regard to increasing functional disability as measured by the Stanford Health Assessment Questionnaire. Reasons for this could be that the physicians tend to respond more to clinical signs than to daily living restrictions. A relatively high percentage (around 80%) of the patients were satisfied with the surgical procedures offered to them. Only one third of the individuals felt that they had been involved in planning of treatment and discharge although a majority expressed this as very important. The importance of a continuous dialogue between patient and physician with regard to fulfillment of patient expectations is emphasized. | |
| 7699379 | Clinical and roentgenographic results of cementless total hip arthroplasty. | 1994 Dec | A retrospective clinical and roentgenographic review was performed on 69 consecutive cementless total hip arthroplasties that had been in situ for an average of 64.4 months (range, 57-91 months). Four patients had bilateral operations. There were 23 men and 42 women. The Lord Madreporic prosthesis (Bacneux, France) was used in 49 cases, and the Link prosthesis (Waldemar Link, Hamburg, Germany) was used in 20 cases. Preoperative diagnoses were osteoarthritis (76.8%), rheumatoid arthritis (17.4%), and miscellaneous (5.8%). At the final follow-up examination, the median hip score, assessed according to a modification of the Mayo scoring system, was 86.7 points. Seventy-eight percent of the cases had a good result, 11% were fair, and 4.7% were poor. The overall revision rate was 6.3%. No significant correlation existed between the roentgenographic and clinical findings. Subsidence of the femoral component is not a definitive hallmark of loosening in the midrange interval, that is, between 2 and 5 years. The cementless hip arthroplasty is suitable for patients with rheumatoid arthritis. |