Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8546725 | The antiinflammatory and antiviral effects of hydroxychloroquine in two patients with acqu | 1996 Jan | OBJECTIVE: To report the antiinflammatory and antiviral effects of hydroxychloroquine (HCQ) treatment in 2 patients with AIDS and inflammatory arthritis. METHODS: Two patients with AIDS and inflammatory arthritis were treated with HCQ, which was given in a loading dose of 600 mg/day. The maintenance dosage was calculated to remain below 6.5 mg/kg/day. Both patients had initial T cell subset studies; 1 patient, had serum and plasma collected before and after 1 year of HCQ treatment. Assays were performed for T cell subsets, recoverable human immunodeficiency virus type 1 (HIV-1) RNA, mitogen- and antigen-specific proliferation, and interleukin-6 (IL-6) levels. New studies on the use of HCQ as an anti-HIV-1 agent are reviewed. RESULTS: Both patients had a dramatic decrease in their arthritis activity. Neither patient required immunosuppressive therapy or developed an opportunistic infection. In the patient who was studied after 1 year of therapy, there was a 1-log decrease in recoverable HIV-1 RNA, improved mitogen- and antigen-specific immune responses, and a large decrease in the IL-6 level while taking HCQ. Recent in vitro and in vivo assays in patients with HIV infection have shown similar antiviral and antiinflammatory effects from HCQ. CONCLUSION: HCQ may exert simultaneous anti-inflammatory and antiviral effects in patients with HIV infection and inflammatory arthritis. If larger studies confirm this observation, it may be the drug of choice in this population of patients. | |
| 8856625 | Synovial cyst as differential diagnosis of supraclavicular mass in rheumatoid arthritis. | 1996 Aug | We describe a mass located at the supraclavicular space in a patient with a 5 year history of erosive rheumatoid arthritis. The mass was initially diagnosed as a suspected metastasis, but direct puncture and magnetic resonance imaging revealed a cyst. Clinical and radiological characteristics are described and pathogenesis and treatment are discussed. | |
| 1295411 | Rheumatoid arthritis in Singapore: carpal predominance and lower incidence of erosive chan | 1992 Nov | Radiographs of the hand and wrists in 33 patients with a diagnosis of classic or definite rheumatoid arthritis were reviewed. The mean duration of disease was about five years. A scoring system for quantitative analysis was used to assess the presence and severity of erosions, joint space narrowing and deviation of joint alignment. No radiological abnormality was seen in 30% of patients while in another 30%, only minor radiological changes were seen. Moderate to severe radiological abnormality was seen in only 40% and in this group of patients all showed more severe disease in the wrists than in the finger joints. Erosions in the fingers were only seen in 21% of patients and erosions in the wrists were present in 57%. Previous reports have indicated that disease in the wrists can be more severe than the hands in up to 60% while the incidence of erosions can be expected to range from 40% at 3 months to 95% at 10 years. Although the sample size in this study is small, the findings suggest that the radiological pattern of rheumatoid in the hands in Singapore is quite different from that classically described in temperate countries as the incidence of erosions appears lower while disease in the wrists can be expected to be more severe than in the fingers in almost all cases. The usual radiological criteria used to aid diagnosis of the disease may not be applicable. | |
| 7682757 | Expression of integrin family of cell adhesion receptors in rheumatoid synovium. Alpha 6 i | 1993 Apr | Integrins are heterodimeric cell adhesion receptors. The beta 1 integrin subunit can be in a complex with multiple a subunits and form receptors for collagen, laminin, fibronectin, and vitronectin. We have characterized the distribution of eight integrin subunits in rheumatoid synovium, with special interest in the lining cell layer. The beta 1 integrin subunit was found in abundance in synovial stroma and in lining cells. The only alpha subunit seen constantly in lining cells was alpha 6. In complex with alpha beta subunit, alpha 6 forms a laminin receptor usually seen in epithelial or endothelial cells or in macrophages. The fact that laminin was found in the extracellular matrix around synovial cells suggests the importance of alpha 6 integrin in the adhesion of synovial lining cells. Furthermore, alpha 6 expression was noticeably weaker in strongly proliferative lining cell layers, indicating that the inflammatory process may regulate integrin expression. A potential connection between altered expression of cell adhesion receptors and the pathological behavior of rheumatoid lining cells is suggested. | |
| 8867548 | Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. | 1996 Mar | The effect of low dose methotrexate (MTX) on postoperative complications in rheumatoid arthritis patients undergoing elective total joint arthroplasty was observed prospectively in 32 patients. Patients were assigned to discontinue MTX the week prior to and during the week of surgery (Group 1, n = 19) or to continue MTX throughout the perioperative period (Group 2, n = 13). Nineteen patients in Group 1 had 26 procedures, with no postoperative infections. Thirteen patients in Group 2 had 16 procedures, with 4 postoperative infections: 2 infected prostheses, 1 infected joint fusion, and 1 deep wound infection (P = .03). No patient had a postoperative flare of rheumatoid arthritis. Temporary discontinuation of MTX prior to joint arthroplasty appears to decrease the risk of postoperative infection. | |
| 7983124 | Anterior ankle arthrodesis with cross-screw fixation. A dowel graft method used in 20 case | 1994 Nov | We report a new method of ankle arthrodesis which combines an anterior approach with a dowel technique of bone grafting and screw fixation. In 20 ankles of 20 patients, ten with osteoarthritis, eight with rheumatoid arthritis and two others, we achieved 19 solid bony fusions and one painless fibrous ankylosis. The average time to union was 12.5 weeks. Patient satisfaction was high and the functional results were as good as for other reported methods, with fewer complications. | |
| 8308783 | Association of methotrexate treatment with a decrease of double negative (CD4-CD8-) and ga | 1993 Nov | OBJECTIVE: It has been suggested that double negative (CD4-CD8-) (DN) and gamma/delta T cells may be involved in some autoimmune diseases. We investigated peripheral blood DN and gamma/delta T cell levels in patients with active juvenile rheumatoid arthritis (JRA). METHODS: DN and gamma/delta T cell levels were measured in 42 patients with active JRA and in 10 healthy controls comparable for age by an immunofluorescence double staining procedure. RESULTS: All 3 JRA onset types had DN and gamma/delta T cell levels not significantly different from those of controls, although a wide scattering of data was present. No correlation was found between DN or gamma/delta T cell levels and erythrocyte sedimentation rate values or the number of active joints. When patients were divided according to treatment, we found that DN and gamma/delta T cell levels were significantly lower (p = 0.001, p = 0.02, respectively) in patients receiving methotrexate (MTX) than in patients not receiving MTX. The association of MTX treatment with a decrease in DN and gamma/delta T cell levels was also confirmed in a followup study of individual patients. Among patients not receiving MTX, patients with systemic JRA presented DN T cell levels significantly higher than those of controls. In 5 patients with pauciarticular JRA DN and gamma/delta T cell levels were higher in synovial fluid than in the peripheral blood. CONCLUSIONS: We found an increase in peripheral blood DN T cell levels in systemic JRA; treatment with MTX appears to be associated with a decrease in DN and gamma/delta T cell levels. | |
| 8877921 | Increase of bone mineral density and anabolic variables in patients with rheumatoid arthri | 1996 Sep | OBJECTIVE: To determine the bone mineral density (BMD) and anabolic variables in a cohort of patients with severe, early rheumatoid arthritis (RA) resistant to weekly doses of methotrexate (MTX), after addition of cyclosporin A (CyA) therapy. METHODS: We studied 10 rheumatoid factor positive patients of 58 with early erosive, aggressive RA with poor response to a 6 month course of MTX (< 20% improvement in the American College of Rheumatology core set of criteria). BMD was assessed at entry, after 6 months of MTX, and after a further 6 months of combination therapy of MTX plus CyA. Bone Gla protein (BGP) dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1, somatomedin C) levels were determined along with clinical variables and acute phase reactants (C-reactive protein, erythrocyte sedimentation rate). RESULTS: An average BMD decline of 4.05 +/- 0.8% (mean, SD) occurred in the first 6 months of MTX treatment, along with a statistically significant decline of IGF-1 (-24.8%), DHEAS (-21.6%), and BGP (-19.7%) levels. After adding CyA 3 mg/kg daily for 6 months, BMD had increased by 3.9 +/- 0.97%, IGF-1 by 42.4%, DHEAS by 34.2%, BGP by +34.3%. These changes mirrored the clinical variables (Health Assessment Questionnaire, morning stiffness, joint count) and acute phase reactants, which improved in a statistically significant manner. CONCLUSION: Patients with active RA, even in the early phases, lose bone very rapidly. Effective control of systemic inflammation allowed a rapid rescue of BMD, at least in the short term. This happened with a simultaneous increase in some anabolic variables such as IGF-1, BGP, and DHEAS. | |
| 8702374 | Personality and stress: an exploratory comparison of rheumatoid arthritis and osteoarthrit | 1996 Aug | OBJECTIVE: To characterize and investigate the relationship between stress and personality in people with rheumatoid arthritis (RA) compared to those with osteoarthritis (OA). DESIGN: Survey of personality characteristics determined by using Cattell's 16 Personality Factor (16PF) questionnaire and stressful life events at disease onset determined by using the Social Readjustment Rating Scale of Holmes and Rahe. SETTING: Inpatients of an arthritis hospital and outpatients of a clinic, both of which specialize in rheumatic diseases and musculoskeletal problems. PARTICIPANTS: Diagnosed as "definite" or "classical" RA (N = 128) according to the ARA Diagnostic Criteria for Rheumatoid Arthritis (1958 Revision) or as OA (N = 79) according to radiological and clinical evidence; randomly selected, resulting in a close match for gender, age at disease onset, duration of disease, functional classification, and pattern of disease progress. All individuals approached participated. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Twenty personality characteristics, as well as amount of stressful life events at disease onset (Life Change Units). RESULTS: The RA subjects had significantly (p < .001) more stress at disease onset compared to the OA subjects. A subgroup of high-stress-at-onset RA subjects experienced a higher degree of disease severity (p < .01) than did the RA subjects with no stress at onset. Although the mean personality scores for those with RA were not significantly different from those with OA, the RA personality frequency distributions were different. Some of these differences could be explained by the stress-at-onset subgroup personality characteristics. CONCLUSIONS: As a group, subjects with RA exhibited more stress at disease onset than those with OA. Although mean personality scores were not different between RA and OA subjects, they did exhibit different frequency distributions. There appeared to be a high-stress-at-onset subgroup of RA patients who had a worse disease prognosis and who corresponded to a personality frequency subgroup. The interaction between these variables is more complex than implied by the "RA personality" concept. | |
| 7526289 | The effect of gold salts on substance P levels in rheumatoid arthritis. | 1994 Jun 20 | The effect of gold salt therapy on substance P immunoreactivity levels in plasma and synovial fluid was studied in 42 patients with rheumatoid arthritis. Decreased levels of synovial fluid substance P, although not statistically significant, were found in rheumatoid patients who were currently receiving gold therapy when compared to either those patients previously treated or to those who never received this therapy. In addition, we found that patients who received more than 1000 mg of gold salts had significantly lower levels of substance P in synovial fluid than those treated with lower doses. Our results, therefore, seem to support the hypothesis that gold salts appear to be slow-acting neurotoxic drugs that significantly decrease the intrasynovial concentrations of substance P, a well-known inflammatory neuropeptide, in arthritis patients. | |
| 7668906 | A tumour necrosis factor alpha polymorphism is not associated with rheumatoid arthritis. | 1995 Jul | OBJECTIVE: To determine whether a polymorphism within the tumour necrosis factor alpha (TNF alpha) gene is associated with susceptibility to, or severity of, rheumatoid arthritis (RA). METHODS: Consecutive patients with recent onset RA were enrolled in a prospective trial. DNA was collected, disease activity was measured at presentation, and radiographic progression at three years was assessed. Typing of TNF alpha was by polymerase chain reaction and single stranded conformation polymorphism analysis. RESULTS: No association of TNF alpha alleles and susceptibility to, or severity of, RA was demonstrated. CONCLUSIONS: These results indicate that this TNF alpha polymorphism does not play a part in the genetic background of RA. | |
| 8961901 | Effects of pulse methylprednisolone on cell adhesion molecules in the synovial membrane in | 1996 Dec | OBJECTIVE: To investigate the effects of a 1,000-mg intravenous pulse of methylprednisolone succinate (MP) on cell adhesion molecule expression on the synovial vascular endothelium in patients with rheumatoid arthritis (RA). METHODS: Sequential arthroscopic biopsy samples were taken before and 24 hours after MP administration (10 patients) and at the time of RA flare (2 patients) and after retreatment with MP (1 patient). Immunoperoxidase staining for E-selectin (CD62E), P-selectin (CD62P), intercellular adhesion molecule 1 (ICAM-1; CD54) and platelet-endothelial cell adhesion molecule (PECAM; CD31) was performed, and the staining was quantified by color video image analysis. RESULTS: MP caused a rapid (within 24 hours) and substantial decrease in the expression of E-selectin on the synovial vascular endothelium, with a smaller reduction in ICAM-1 expression on synovial vascular endothelium and the synovial lining. There were no similar effects on synovial membrane P-selectin or PECAM expression. CONCLUSION: A potential mechanism by which MP impairs neutrophil trafficking into inflamed RA joints might be by reducing E-selectin, and possibly, ICAM-1, expression in the synovial membrane. | |
| 7983111 | Sacral insufficiency fractures in the elderly. | 1994 Nov | Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms. | |
| 8065206 | [Esophageal amyloidosis secondary to rheumatoid arthritis simulating achalasia]. | 1994 May 7 | The involvement of the esophagus in amyloidosis secondary to rheumatoid arthritis is rare. The case of a female patient with rheumatoid arthritis and secondary esophageal amyloidosis (type AA) with a radiologic and endoscopic clinical picture compatible with achalasia is presented. In the manometry carried out after two cardiomyotomies, abundant non propulsant tertiary waves were seen, as were two primary waves, intraesophageal pressure higher than that of the gastric fundus and lower hypertensive esophageal sphincter which was completely relaxed on one occasion, resulting in a manometric pattern which was different to that of the other two cases published with the same disease. Endoscopic cardiomyotomies and dilatations were performed. The patient died after 2 years due to post dilatation esophageal perforation. The manometric findings are compared with those of the two previous similar cases with emphasis being made in that the anarchic arrangement of the amyloid in the esophagus produces different unforeseen and uncharacteristic motility patterns. The authors only found in the literature two cases of esophageal amyloidosis secondary to rheumatoid arthritis simulating achalasia. | |
| 8363814 | Sympathetic skin response and R-R interval variation in rheumatoid arthritis. Two simple t | 1993 Aug | Autonomic nervous system involvement with peripheral neuropathy is a well known complication of rheumatoid arthritis (RA). In the assessment of autonomic function of patients with rheumatoid arthritis, we performed sympathetic skin response (SSR) and R-R interval variation (RRIV) tests in 30 patients and in 30 normal controls. Of 30 patients, 5 had complaints of clinical dysautonomic symptoms. SSRs were abnormal in 6 of 30 patients, whereas 8 showed abnormal RRIVs during deep breathing. Nine of 30 patients also showed electrophysiologic evidence of peripheral neuropathy. All 5 of the patients with clinical dysautonomic symptoms showed abnormal SSR and RRIV test results. No patients with normal results on both tests had clinical dysautonomia. This study showed that there are frequent abnormalities in SSR and RRIV tests in patients with rheumatoid arthritis whether there is a clinical symptom of autonomic dysfunction or not. | |
| 7543346 | A dominant human leucocyte antigen DR4-Dw15 restricted mycobacterial 65 kDa antigen-specif | 1995 Jun | The human leucocyte antigen DR4-associated immune responses to Mycobacterium tuberculosis 65 kDa heat shock protein were considered to be relevant to the pathogenesis of rheumatoid arthritis (RA). In the Chinese population, DR4-Dw15 was found to be the predominant DR4 subtype in RA. To further define the immune responses associated with DR4-Dw15 molecules, the proliferative responses of peripheral (PBMC) and synovial mononuclear cells (SFMC) to mycobacterial 65 kDa antigen were evaluated. The SFMC of all of our RA patients responded significantly to 65 kDa mycobacterial antigen. The responses of PBMC to this antigen in RA were much lower than those of SFMC. Our results further indicated that relatively low numbers of peripheral antigen-specific T-cells, but not incompetence of peripheral antigen presenting cells, might be related to the observed low responsiveness to 65 kDa antigen in PBMC of RA patients. Of utmost importance, DR4-Dw15 was proved to be one of the major restrictive molecules in mycobacterial 65 kDa antigen-specific immune responses in Chinese RA patients. | |
| 8823685 | Changes in synovial membrane and joint effusion volumes after intraarticular methylprednis | 1996 Jul | OBJECTIVE: To evaluate synovial membrane volumes, effusion volumes, and cartilage and bone erosion scores determined by magnetic resonance imaging (MRI) as markers of disease activity and severity in arthritis. METHODS: Gadolinium-DTPA enhanced MRI of 18 arthritic knees was performed before and 1, 7, 30 and 180 days after intraarticular methylprednisolone injection until clinical relapse. Intraobserver, interobserver, and inter-MRI variations were determined from 2 successive MRI of another 6 knees. RESULTS: In all knees synovial membrane and effusion volumes decreased within the first posttreatment week (median decrease 49 and 65%, respectively), and remained low during remission. Synovial volumes, but not effusion volumes, increased to pretreatment levels in case of clinical relapse, indicating that synovial volumes were most important to the clinical appearance. The intraobserver + interobserver + inter-MRI variation was maximally 26%. Total volumes and volumes in a selected sagittal slice were highly statistically correlated. The duration of clinical remission in patients with rheumatoid arthritis (RA) was significantly inversely correlated to the pretreatment synovial volume (both total and "one slice" volumes), but not to the effusion volume, MRI or radiography scores of erosions or any clinical/laboratory variables. Cartilage and bone erosions, invisible by radiography, were visualized by MRI. No progressive erosive changes were observed. CONCLUSION: MRI-determined synovial and effusion volumes and MRI scores of cartilage and bone erosions are reproducible and may be sensitive measures of disease activity and severity in RA. The synovial volume may rather than the effusion volume determine clinical appearance. Both are influenced by the present inflammatory activity. The pretreatment synovial volume may have predictive value to treatment outcome in RA. | |
| 8242109 | [A short-term randomized controlled study with methotrexate in rheumatoid arthritis]. | 1993 Apr | Randomized, controlled and double-blind study of 36 patients aimed at the evaluation of the efficacy and toxicity of MTX in the treatment of rheumatoid arthritis. Twenty-eight patients completed the study period: 14 in the MTX group and 14 in the placebo group. The patients treated with MTX presented a statistically significant improvement (p < 0.05) in pain, grip strength and functional ability when compared to placebo treated patients. Mild adverse effects were observed in 4 patients treated with MTX and in 2 patients treated with placebo. These findings support other studies and give to methotrexate a relevant position in the treatment of rheumatoid arthritis, owing to its convenient posology, beneficial effectivity and favourable toxicity. | |
| 7570216 | [Rehabilitation in rheumatoid arthritis (RA) patients--assessment of effects of rehabilita | 1995 Jun | The 37 hospitalized RA patients undergoing rehabilitation (for 4 weeks) were evaluated on effects of rehabilitation by comparing scores of ADL at the time of admission and discharge. Items of ADL were composed of 32. Items of ADL which were likely to be disabled were related to those of ADL which were influenced by rehabilitation (r = 0.7412, p < 0.01). From this result, 11 items of ADL which were likely to be disabled and influenced by rehabilitation could be selected in order. Usefulness of these selected items of ADL on evaluation of rehabilitation was admitted. | |
| 8452584 | Assessment of clinical competence of medical students by using standardized patients with | 1993 Mar | OBJECTIVE: To assess medical students' clinical competence in addressing musculoskeletal problems. METHODS: Nineteen junior medical students completed 2 standardized patient-based tests structured to capture their clinical decisions from undiagnosed chief complaint to management. RESULTS: No student approached the highest possible score on either test, and the students as a group received less than half the possible points on 5 important aspects of diagnostic reasoning. CONCLUSION: Standardized patient-based tests can be structured to provide enlightening information about medical students' clinical competence with regard to musculoskeletal problems. |