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ID PMID Title PublicationDate abstract
1629820 Genetic studies of anti-Ro (SSA) antibodies in families with rheumatoid arthritis. 1992 Feb Forty-nine members of 4 families with multiple cases of rheumatoid arthritis (RA) were investigated. Nine patients with RA, one patient with primary Sjögren's syndrome (SS) and one patient with systemic lupus erythematosus (SLE) were detected among them. Anti-Ro (SSA) antibodies were found in 11 members (22%) of the investigated group; 6 suffered from RA, SLE or primary SS, and 5 were healthy first degree relatives. Anti-La (SSB) antibodies were detected in only one family member with primary SS. Secondary SS was evident in 5 patients with RA, 3 of whom had anti-Ro antibodies; HLA-DR4 was present in 7 of 9 patients with RA (78%) but in only 7 of 26 asymptomatic relatives (27%) (p less than 0.05). All patients with RA and their relatives who had anti-Ro antibodies were found to have HLA-DR4. Our results demonstrate that anti-Ro antibodies are present in relatives of patients with RA and are strongly associated with HLA-DR4.
7708395 [Orthopedic surgery in patients with rheumatoid arthritis]. 1995 Mar 26 Studying their subject the authors have been found that among the orthopedic surgical interventions the most frequently applied procedure were the alloarthroplasty and the synovectomy. Half of the operations are performed on the hand and the knee. Because of the polyarticular and multilocular characteristic of the disease very often more than one operations are necessary in case of rheumatoid patients. In case of sequence operations attention is called constant communication with rheumatologist and individual assessment of each case.
8890538 Elbow synovectomy in rheumatoid arthritis. 1996 Sep We present the results of a clinical and radiographic follow-up study of patients undergoing elbow synovectomies. Twenty-five elbows in 24 patients with rheumatoid arthritis were followed for a median period of 52 months (range 10-108) after operation. Nineteen (74%) stated they had improvement of pain and function. Two patients reported increased pain. Improvement of motion was noted, but this was not statistically significant. Radiographic classification showed statistically significant progressive changes. Three complications were noted, all without permanent sequels. Moderate elbow destruction can provide a good indication for elbow synovectomy in the treatment of patients suffering from rheumatoid arthritis.
8324667 Total hip arthroplasty in rheumatoid arthritis: comparison of cemented and uncemented impl 1993 Jun In a group of patients who underwent total hip arthroplasty because of rheumatoid arthritis, the outcome in 42 hips was assessed. There were 17 cemented and 25 uncemented prostheses. The average follow-up was 5 years for cemented prostheses and 3 years for uncemented prostheses. The average Harris hip scores were similar in the two groups (84 and 86 respectively). Radiologically, the incidence of migration of femoral and acetabular components was similar in the two groups. Component migration was not affected by component fixation. Uncemented implants may have a role in hip arthroplasty in patients with rheumatoid arthritis.
8311539 Clinical and laboratory parameters which affect soluble interleukin-2 receptor levels in t 1993 Dec OBJECTIVE: To investigate whether soluble interleukin-2 receptor (sIL-2R) could be a useful marker of disease activity in rheumatoid arthritis (RA); sIL-2R levels in serum and in synovial fluid were determined by enzyme-linked immunosorbent assay. METHODS: Sixty five serum and 27 synovial fluid samples were obtained from patients with RA. Twenty five serum and 28 synovial fluid samples from patients with osteoarthritis (OA) were used as controls. Furthermore, 10 synovial fluid samples from healthy volunteers were also examined. Variable laboratory and clinical data were compared with serum sIL-2R levels, in 26 patients with RA and serial samples from some patients were examined. RESULTS: Concentrations of sIL-2R in serum (median 81, range 40-350 pM) and synovial fluid (median 125, range 52-460 pM) from patients with RA were significantly higher than in serum (median 45, range 13-100 pM) and synovial fluid (median 37, range 15-140 pM) from patients with OA, and healthy control synovial fluid (median 2.5, range 0-10 pM). Serum sIL-2R levels correlated strongly with serum levels of C-reactive protein (p = 0.0001), and a significant correlation with erythrocyte sedimentation rate (ESR) (p = 0.048), IgG levels (p = 0.028), IgA levels (p = 0.044) and Lansbury Index (p = 0.037) was observed. However, serum sIL-2R levels showed no significant correlation with rheumatic factor, IgM or T cell subsets. CONCLUSION: These findings indicate that sIL-2R levels in patients with RA reflect disease activity.
8485020 The pharmacokinetics of methotrexate and its 7-hydroxy metabolite in patients with rheumat 1993 Apr 1. The pharmacokinetics of MTX and its 7-hydroxy metabolite (7-OHMTX) were investigated in nine patients with rheumatoid arthritis (RA). Each patient received 15 mg MTX i.v., i.m. and p.o. after an overnight fast in a randomized cross-over design. The plasma concentrations of MTX and 7-OHMTX were measured over 7 days and their urinary excretion over 24 h. 2. Plasma concentrations of MTX were described by a triexponential function after i.v. administration, a triexponential function with zero or first order absorption after oral administration, and a biexponential function with zero of first order absorption after i.m. injection. Plasma concentrations of 7-OHMTX were described by a biexponential function after all three routes of administration. The median terminal elimination half-lives of MTX and 7-OHMTX were 55 h and 116 h, respectively. The area under the plasma concentration-time curve (AUC (0,170 h)) of MTX did not differ between i.m. and oral administration indicating similar bioavailability after these routes of administration. The AUC (0,170 h) values of 7-OHMTX after i.v., oral and i.m. administration were similar. Over 80% of MTX was excreted in urine as intact drug and about 3% was excreted as 7-OHMTX during 24 h after drug administration. 3. Plasma concentrations of MTX and 7-OHMTX were measurable at the end of the dose interval in most of the patients and may help to identify non-responders or patients with increased risk of side-effects.
8129763 Objective and subjective sleep disturbances in patients with rheumatoid arthritis. A reapp 1994 Jan OBJECTIVE: To assess objective and subjective evidence of sleep disturbances in patients with rheumatoid arthritis (RA) and to examine correlations between parameters of inflammatory activity and sleep pathology. METHODS: Nineteen RA patients and 19 age-matched healthy control subjects underwent all-night polysomnography on 2 consecutive nights. RA patients were also evaluated for daytime sleepiness by mean sleep latency test and responded to a self-report questionnaire on their first night. RESULTS: Whereas normal sleep architecture is conserved in RA, we confirmed former findings of severe sleep fragmentation and an enhanced presence of primary sleep disorders. No correlation exists between RA activity and the sleep disorders. Subjective assessment was not consistent with the objective evidence of sleep disruption, unlike the findings in patients with fibrositis. CONCLUSION: Sleep is severely disturbed in patients with RA, regardless of the inflammatory disease activity. The specificity of the sleep disorders assessed needs confirmation, as does specific sleep therapy for these patients.
7810238 [The significance of inflammatory changes in the tarsometatarsal joints for development of 1994 Sep The involvement of foot joints is a common finding in more than 90% of the patients with rheumatoid arthritis. The typical deformity of the forefoot is the splayfoot with hallux valgus or hallux rigidus and deformities of the lesser toes. 70 feet of 36 patients with rheumatoid arthritis were observed radiologically over a period between 5 years/1 month and 6 years/1 month. The x-rays were analyzed for arthritic changes of the various joints and changes of the foot statics. The question was whether the splay of the forefoot is caused by an arthritis of the metatarsophalangeal or tarsometatarsal joints with a consequent weakening of joint capsules and ligaments, or statistically by a flattening of the longitudinal arch owing to arthritic changes of the hindfoot. The statistic analysis showed that the splay of the forefoot appears between the first and second metatarsal bones. The arthritis of the tarsometatarsal joints II-IV could be identified as a statistically significant factor for the development of a splayfoot in rheumatoid arthritis. The influence of arthritic changes of the tarsometatarsal joints I and V was striking, but not statistically significant. The arthritis of the tarsometatarsal joints caused a flattening of the transverse arch already at an early stage. An arthritis of the metatarsophalangeal joints and the flattening of the longitudinal arch with arthritides of the rear foot had no statistically significant influence on the forefoot. From the results, we must draw the conclusions that orthopedic aids like shoe supports with retrocapital metatarsal bars should be recommended already at an early stage of the disease and that the support of the longitudinal arch is not sufficient to prevent a splayfoot.
8501459 Differences in illness intrusiveness across rheumatoid arthritis, end-stage renal disease, 1993 Jun Illness intrusiveness derives from illness-induced lifestyle disruptions that interfere with continued involvements in valued activities and interests and is hypothesized to represent a fundamental determinant of the psychosocial impact of chronic conditions. The present investigation compared reported levels of illness intrusiveness across 305 individuals from three chronically ill populations: rheumatoid arthritis (N = 110), end-stage renal disease (N = 101), and multiple sclerosis (N = 94). Although multiple sclerosis was significantly more intrusive, overall, into lifestyles, activities, and interests as compared with rheumatoid arthritis and end-stage renal disease (which did not differ), a significant illness group x life domain interaction indicated that intrusiveness into eight individual life domains differed significantly across the groups and that the pattern of differences varied as a function of the particular life domain involved. Differences in the constellations of signs, symptoms, and treatment regimens associated with a given condition were hypothesized to account for observed differences in illness intrusiveness.
8024639 Long-term therapy with the new glucocorticosteroid deflazacort in rheumatoid arthritis. Do 1994 May The long-term anti-inflammatory and immunosuppressive properties and the safety of deflazacort (Calcort, CAS 14484-47-0) were assessed investigating the effect on clinical symptoms and safety parameters in patients with rheumatoid arthritis compared to prednisone as standard therapy in a randomized double-blind controlled clinical trial. Monitoring was performed according to GCP-guidelines closely in order to have a maximum of the patients entered completed at the end of the 12-month therapy with high data quality. 76 patients, meeting the criteria for classical or definite rheumatoid arthritis and requiring corticosteroid therapy, were randomly allocated to a 12-months treatment with either deflazacort (6 mg/tablet) or the corticoid standard prednisone (5 mg/tablet). Steady state dosage between 1/2 and 3 tablets per day was individually adjusted according to the severity of the clinical symptoms. Due to the close monitoring of the trial in the 6 study centres, 25 patients completed 12 months of deflazacort and 28 patients 12 months of prednisone treatment, being controlled 7 times during the trial. Five efficacy parameters were assessed at each visit: Ritchie Index, duration of morning stiffness, grip strength, effective dosage of study medication and global assessment of disease status. Following safety and tolerance parameters were controlled during the trial: vital signs, weight, Cushing's symptoms and adverse events at each visit; 32 laboratory parameters at 6 visits; ECG at 3 visits; and the global tolerance was assessed at the end of the study.(ABSTRACT TRUNCATED AT 250 WORDS)
9139278 [An unusual case of Kartagener's syndrome associated with rheumatoid arthritis]. 1996 Dec We observed a 56-year-old woman with Kartagener's syndrome and severe seropositive rheumatoid arthritis. This is the third case of such association in the world literature and a second one being diagnosed in our Department. The patient was also as the previous one a carrier of HLA DR1 and B27 antigens. An electromicroscopic study showed normal bronchial cilia in contrast to classical course of the disease. A number of immunological disturbances were observed, especially defective granulocyte function. We suggest that the severe course of rheumatoid arthritis may be related to the chronic stimulation of immune system by microbes continuously present in the patients airways.
8111198 [Immune function of rheumatoid arthritis treated by medicated-bath therapy in Tibetan medi 1993 Aug The changes of the immune function of rheumatoid arthritis before and after the Tibetan medicated-bath was observed. It showed a higher level of the rheumatoid factor (RF) titre, immunoglobulin (Ig) G, M, A and CD4 cells, but the CD8 cells was obviously lower before the treatment. Clinical data indicated that the medicated-bath had significant effective rate. In order to elucidate the mechanism of the medicated-bath upon rheumatoid arthritis the RF titre, Ig level, complement C3, 3H-TdR incorporated with lymphocytes transformation and CD3, CD4, CD8 cell level were assayed. Results showed that RF titre decreased after the bath and the negative transforming rate reached 70.6%, Ig level obviously dropped as well as the number of CD4 cells while CD8 cell level increased. The transforming stimulation index of lymphocyte cells obviously decreased. All of the above mentioned showed that there was a higher concentration of the enhancing factor of interleukin-2 (IL2-EF) involved in lymphocyte culture of rheumatoid arthritis patients. They suggested that the Tibetan medicated-bath had an immunomodulating effect on rheumatoid arthritis patients through increasing the level of CD8 cells and reducing CD4 cells.
8478876 The validity of pooled outcome measures (indices) in rheumatoid arthritis clinical trials. 1993 Mar No consensus exists on the appropriate (set of) endpoints to be reported in rheumatoid arthritis clinical trials. The traditional endpoints are not comprehensive, show overlap, and are insensitive to change. A single, pooled outcome measure or index may be an alternative. However, such an index must be valid and acceptable. An overview of the existing indices suggests several options are available. To date, practical experience with these indices in trials is limited.
8630111 Reduction in long-term disability in patients with rheumatoid arthritis by disease-modifyi 1996 Apr OBJECTIVE: Therapeutic strategies for rheumatoid arthritis (RA) have been evolving from the traditional "pyramid" approach toward one based upon early and sustained use of disease-modifying antirheumatic drugs (DMARDs), in the hope of improving long-term health outcomes. However, few data to have been presented to document the effects of this approach. We sought to directly assess associations between consistent DMARD use and long-term functional outcomes. METHODS: We studied 2,888 RA patients who were followed up prospectively for up to 20 years (average 9 years) at 8 databank centers. The independent variable was the proportion of patient encounters that resulted in treatment with > or = 1 DMARD (hydroxychloroquine, sulfasalazine, auranofin, intramuscular gold, D-penicillamine, methotrexate, and/or azathioprine). The dependent variable was each patient's last recorded Disability Index value from the Health Assessment Questionnaire (HAQ). RESULTS: Increased DMARD use was strongly associated with better long-term Disability Index values (P < 0.0001). The association was strengthened when restricted to more seriously affected (rheumatoid factor (RF)-positive) patients. The magnitude of the effect, unadjusted, was a difference of 0.53 HAQ Disability units (scale 0-3) between 100% DMARD use and 0%. Correlation coefficients ranged up to 0.26. Effects were similar for all disease duration periods (0-4, 5-9, 10-14, 15-19, and 20+ years). "Control" correlations, with variables computed to represent the proportion of time in which patients were taking either nonsteroidal anti-inflammatory drugs or prednisone, failed to show positive associations. A multiple linear regression model, which controlled for age, disease duration, sex, RF positivity, proportion of visits under a prednisone regimen, and initial disability level, included the proportion of time in which patients were taking DMARDs (P < 0.0001), with a model R2 of 0.54. These results were obtained despite an adverse selection bias in which more severely affected individuals were given DMARDS more frequently, and despite absence of data on drug use early in the disease course of many patients. Thus, these results, which suggest up to a 30 percent reduction in long term disability with consistent DMARD use, are most likely conservative. CONCLUSION: An association between consistent DMARD use and improvement in long-term functional outcomes in RA is supported by these data.
7526870 A new model for rheumatoid arthritis generated by engraftment of rheumatoid synovial tissu 1994 Nov OBJECTIVE: A new animal model was used to study the interaction between rheumatoid synovial cells and cartilage and to explore the cellular basis of rheumatoid joint destruction. METHODS: Fresh synovial tissue derived from patients with rheumatoid arthritis was implanted with normal human cartilage into SCID mice, either subcutaneously or under the renal capsule, for up to 304 days. The implants were analyzed by light and electron microscopy, as well as by immunohistochemistry and in situ hybridization. RESULTS: Human synovial tissue and cartilage implanted in SCID mice are maintained by the animals for up to 304 days. After 35 days, focal erosions occur at the site of attachment of synovial lining cells to the cartilage. After 105 days, a pannus-like formation, consisting of proliferating synovial fibroblast-like cells invading the cartilage, is observed. The fibroblast nature of these cells was supported by observation of only focal expression of the macrophage markers CD14 and CD68. Cells at the immediate site of cartilage destruction express messenger RNA for cathepsin L, whereas cathepsin D messenger RNA was detected in subsynovial regions away from the site of destruction. The human origin of the tissue involved in cartilage destruction was demonstrated using monoclonal antibodies to HLA-ABC and human type IV collagen. CONCLUSION: The present approach introduces a novel in vivo model of rheumatoid arthritis for the study of the molecular and cellular mechanisms of rheumatoid joint destruction at sites of synovial attachment to cartilage. In this model, the SCID mouse acts as a useful host for studying the properties of rheumatoid synovium in the absence of circulating human blood components.
7900739 D-penicillamine-induced myasthenia gravis: diagnosis obscured by coexisting chronic obstru 1995 Apr D-penicillamine, a drug used to treat rheumatoid arthritis, Wilson's disease, and cystinuria, can cause myasthenia gravis. Fortunately, the myasthenia typically resolves after discontinuation of the drug. The diagnosis may be missed if weakness is blamed on a patient's underlying disease(s), in particular, rheumatoid arthritis. Reported here are the cases of two patients with chronic obstructive lung disease who were taking D-penicillamine for rheumatoid arthritis, then experienced increasing respiratory failure. At first, their problem seemed to stem from chronic lung disease, but further evaluation revealed the cause of the hypoventilation to be D-penicillamine-induced myasthenia gravis.
7894520 Changes in fat free mass in overweight patients with rheumatoid arthritis on a weight redu 1994 Dec The aim of this work was to compare and validate seven different methods for estimating changes in fat free mass, in patients suffering from rheumatoid arthritis. Measurements were made of fat and fat free mass before and after 12 weeks on an energy restricted, protein rich diet and physical training. The subjects were sixteen female and three male overweight out-patients (mean body mass index at baseline: 30 kg/m2) suffering from rheumatoid arthritis, according to the criteria of the American Rheumatism Association. Fat free mass was estimated by eight different body composition methods (a four-compartment model, total body water, total body potassium, impedance, near infrared interactance, creatinine excretion, body mass index and skinfold measurements). Mean weight loss was 2.7 kg fat and 1.7 kg fat free mass. There was no difference between measurements of mean change in fat free mass by the four-compartment model and the other methods, except for the creatinine method (P = 0.03). Compared to the four-compartment method, the total body water method gave the most accurate estimate of individual fat free mass changes (residual Mean Square: 0.4 kg), second to this method, the impedance method, seemed most valid (residual Mean Square: 0.8 kg). Accuracies of the other methods were lower (residual Mean Square between 4.2 and 8.2 kg [corrected]). Of eight methods for estimating changes in FFM, the TBW method gave the most accurate estimate of individual FFM changes, compared to a four-compartment model used as reference.(ABSTRACT TRUNCATED AT 250 WORDS)
7554519 An ultrastructural study of glomerular basement membrane in rheumatoid arthritis patients 1995 Jun We measured the thickness of the glomerular basement membrane (GBM) in 48 rheumatoid arthritis (RA) patients with proteinuria and/or hematuria and studied its relationship to clinical features of RA. Ten cases with minor glomerular abnormalities, renal cancer, donor of renal transplantation, were studied as controls. Secondary glomerular diseases and hereditary thin basement membrane disease (TBMD) were excluded. Mean GBM thickness was 289 +/- 74 nm (mean +/- SD) in RA patients, which was significantly thinner than that of control group (342 +/- 38 nm) (p < 0.01). Mean GBM thickness were 276 +/- 72 nm and 336 +/- 68 nm in RA patients with and without gold sodium thiomalate (GST) treatment, respectively (p < 0.05). Mean GBM thickness of RA patients without GST and controls were not different statistically, but RA patients with GST had significantly thinner GBM, compared with controls (p < 0.01). The mean thickness of GBM were also 274 +/- 69 nm and 344 +/- 72 nm in RA patients with and without hematuria, respectively (p < 0.01). According to these results, we suspect that the thinning of GBM in RA patients may be related to GST treatment.
7694626 Spontaneous ruptures of flexor tendons secondary to extreme DISI deformity of the lunate i 1993 Spontaneous flexor tendon ruptures in rheumatoid arthritis are associated with flexor tenosynovitis and/or with attrition due to bony prominences in the carpal tunnel. The commonest bony prominence observed is the distal pole of a rotated scaphoid. We are reporting the case of an eighty-year-old woman with long-standing rheumatoid arthritis who presented with the inability to actively flex both the interphalangeal and the metacarpophalangeal joints of the right index finger, with preservation of passive motion. There was also loss of active flexion of the interphalangeal joint of the right thumb. Roentgenograms revealed a marked dorsal intercalated segment instability (DISI) pattern in both wrists associated with advanced joint destruction and collapse. Surgical exploration revealed total rupture of the FDS and FDP of the index finger and of the FPL, as well as partial rupture of the flexor tendons of the long finger. Rupture of the FPL was found to be due to attrition on the relatively common finding of a prominent and malrotated scaphoid. Ruptures of the flexor tendons of the index and long fingers appeared to be caused by a markedly prominent palmar protrusion of the lunate. Surgical repair was undertaken, including correction of the DISI deformity and reconstruction of carpal height by radiolunate fusion from a palmar approach. In addition the tubercle of the scaphoid was resected, and the FDS tendon of the ring finger was transferred to the distal stump of the FDP of the index finger; the FPL tendon was not reconstructed as arthrodesis of the interphalangeal joint of the thumb was planned at a later date.(ABSTRACT TRUNCATED AT 250 WORDS)
7492239 Mast cells, cytokines, and metalloproteinases at the rheumatoid lesion: dual immunolocalis 1995 Nov OBJECTIVES: To examine the distribution and activation of mast cells (MCs) in the rheumatoid lesion (cartilage-pannus junctions demonstrating cartilage erosion), and to determine whether or not their tissue distribution is related to that for tumour necrosis factor alpha (TNF alpha), interleukin-1 (IL-1), stromelysin-1, and collagenase. METHODS: Immunolocalisation of MC-tryptase was used to identify MCs and their states of degranulation in 35 specimens of cartilage-pannus junctions. Dual immunolocalisation techniques using alkaline phosphatase and peroxidase conjugated antibodies were used to compare the distributions of MCs with the proinflammatory cytokines TNF alpha and IL-1, and the cartilage or matrix degrading enzymes stromelysin-1 and collagenase. RESULTS: Stromelysin-1, TNF alpha, and IL-1 beta were especially prominent at the cartilage-pannus junctions, albeit with patchy distributions. Extracellular MC tryptase, indicative of MC activation/degranulation, was commonly observed at sites of cartilage erosion, and was often associated with the microenvironmental expression of TNF alpha, IL-1 beta, stromelysin-1, and collagenase. Such observations were often associated with localised sites of tissue oedema and stromal disruption. CONCLUSION: MC activation was frequently associated with proinflammatory cytokine and metalloproteinase expression by neighbouring cells, thereby suggesting an important contributory role for the MC in mediating matrix degradation and oedematous changes within microfoci of the rheumatoid lesion.
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