Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8685732 | Quality of care: a comparison of preferences between medical specialists and patients with | 1996 Mar | In this study, we have looked for differences between medical specialists and patients with chronic diseases (COPD, rheumatoid arthritis and diabetes mellitus) in preferences of aspects of care in relation to the quality of care. Firstly, to enumerate relevant aspects for chronic diseases, open interviews and a concept mapping were conducted among patients with chronic disease, and medical specialists treating them. Here, the respondents have been asked to evaluate statements in relation to the quality of care. Secondly, a final questionnaire, including statements of nine relevant aspects of care, was presented to patients and medical specialists. The response rate among patients was 96% (N = 260) and among medical specialists 67% (N = 340). Both study populations ranked 'effectiveness of care' the highest. However, the difference in opinion between the two populations was significant, mainly due to the patient's giving a higher ranking to 'continuity of care' and a lower ranking to 'efficiency'. Significant differences were also found between the three patient groups on the aspects 'knowledge' and 'waiting time for treatment'. Patients with rheumatoid arthritis ranked 'knowledge' higher and 'waiting time for treatment' lower than did the other two patient groups. A lower level of education, having state-regulated health insurance and being older were associated with a higher preference for 'continuity'. Between the three groups of the medical specialists, no significant differences were found regarding to the profession, age, and sex. IN CONCLUSION: the patients and medical specialists researched did not show wide differences of opinion on preferences of care in relation to quality. The only exception to this concerned 'continuity of care' which was ranked higher by patients. | |
| 8461925 | Pelvic insufficiency fractures in rheumatoid arthritis. | 1993 Apr | The occurrence of pelvic insufficiency fractures in patients with rheumatoid arthritis has not previously been well emphasized. These fractures are difficult to detect clinically and appropriate radiological investigation is necessary for diagnosis. We describe five patients with a spectrum of radiological features and discuss the approach to diagnosis and treatment of these lesions. | |
| 8379135 | [Ultrasonic arthrotomography in the complex diagnosis of rheumatoid arthritis]. | 1993 Jan | Ultrasound tomography (UT) was used for visualization of the elbow and knee joints in 52 patients with rheumatoid arthritis and 28 healthy persons. The technique is described. Results were compared with data of roentgenological and scintigraphic examinations. It is shown that UT permits to visualize directly the substrate of inflammation and its severity. UT has advantages over roentgenography and scintigraphy in detecting patients with rheumatoid arthritis with emphasis of the inflammatory changes of the periarticular soft tissues, periarticular cysts, exudation in the articular cavity, destructions of intraarticular cartilage. | |
| 8537906 | Henoch-Schönlein purpura. Case report and review of the literature. | 1995 Nov | The similarity in the skin manifestations in Henoch-Schönlein purpura as compared with systemic lupus erythematosus and rheumatoid arthritis complicates diagnosis. Therefore, analysis of hematologic studies, tissue histology, and immunofluorescence should be thoroughly reviewed. | |
| 8833066 | Efficacy assessment in trials of combination therapy for rheumatoid arthritis. | 1996 Mar | The comparison of a combination disease modifying antirheumatic drug (DMARD) regimen with a single DMARD, or one combination with another, raises the same issues encountered when studying rheumatoid arthritis: how to design, conduct, and analyze randomized controlled trials. However, these claims of comparison are unique in that the setting to show primary efficacy is the same as that showing the primary therapeutic placement relative to standard therapy. Ordinarily standard therapy is not determined prior to approval. Accordingly, any combination DMARD trial presupposes agreement on what constitutes standard therapy and, if the intent is to show equivalence, on what (small) difference can be condoned to grant the claim. I address some important considerations regarding the rigor and credibility of designs for these claims, problems far less significant with simple drug vs placebo strategies. These can be grouped into 3 categories: (1) choice of controls/designs/patients to ensure a fair comparison; (2) sufficiently broad design formulations to yield controlled assessments of safety that are as thorough as those for efficacy in the past, and (3) maintaining blinding despite new design features that threaten it. | |
| 7670788 | Shared care between hospital and general practice: an audit of disease-modifying drug moni | 1995 Jul | To assess the correspondence between ideal and actual monitoring for disease-modifying anti-rheumatic drugs and the reasons for protocol failure, and the sharing of this task between primary and secondary care, we studied 249 patients with rheumatoid arthritis in a single district general hospital. Ideal monitoring protocols were derived from data sheets and from the rheumatological literature. Overall the ideal protocol was followed in 65% of cases: this ranged from 93% for methotrexate to 26% for sodium aurothiromalate. Most of the monitoring was done in general practice (e.g. 67% of all blood tests) and, with some exceptions, general practitioners (GPs) were willing to perform this task. However, many GPs reported logistic differences with specimen transfer and expressed the need for more information and support. Poor communication between hospital, patient and GP was also found to be a cause of protocol failure. | |
| 8923370 | Arthroscopic lavage treatment in rheumatoid arthritis of the knee. | 1996 Nov | OBJECTIVE: To assess the efficacy of outpatient arthroscopic lavage in rheumatoid arthritis (RA) of the knee. METHODS: 9 patients with RA and active synovitis of at least one knee were selected. All patients were taking disease modifying antirheumatic drugs and nonsteroidal antiinflammatory drugs and had failed intraarticular corticosteroid injection of the knee. Using the 1.9 mm office arthroscope and strict sterile technique the affected knee was lavaged with at least 750 cc of normal saline. At the end of the procedure 40 mg triamcinolone acetonide was injected through the arthroscope. Assessment was done at baseline and 4, 8, and 12 weeks after the lavage using a visual analog scale for pain and 50 foot walk time. RESULTS: 8 of the 9 patients showed marked improvement in their pain and walk time. This effect was maintained at least 12 weeks after the procedure. CONCLUSION: Office arthroscopic lavage treatment is beneficial in a selected group of patients. This procedure is simple and well tolerated without major complications, and may be an option when more conservative therapies have failed. | |
| 1350233 | Pharmacology of antiarthritic drugs. | 1992 Apr | The clinical use of corticosteroids and second-line antirheumatic drugs provides relief in many patients but is associated with short-term and long-term toxicity. The beneficial effects are evident but are not well understood, particularly for the second-line agents. Rheumatoid arthritis is associated with abnormalities in macrophage, lymphocyte, and fibroblast functions. Corticosteroids and second-line agents appear to alter many of these responses (Table 2). Effects on macrophage and other antigen processing and phagocytic cells are common, but T- and B-lymphocytes also may be affected. Some of these agents have direct anti-inflammatory properties by inhibiting prostaglandin or leukotriene synthesis. A few are able to inhibit fibroblast proliferation and secretion of inflammatory mediators. Many other activities are possible. Understanding pharmacokinetics also should assist in determining dosing, possible consequences of other disorders, and predicting duration of acute effects. A better understanding of the disease process in rheumatoid arthritis and other disorders treated with these agents will lead to the better therapeutic approaches and, it is hoped, the discovery of more specific and less toxic agents. | |
| 1290019 | Double blind controlled phase III multicenter clinical trial with interferon gamma in rheu | 1992 | The controlled clinical trial reported here is part of a multicenter clinical and basic research project, sponsored by the German Federal Minister of Science and Technology, directed by a standing commission of the president of the Max-Planck-Gesellschaft, and coordinated by the Max-Planck-Institut für Biochemie, München. Overall, 249 patients with rheumatoid arthritis (RA) were enrolled by 16 participating hospitals. In addition to NSAID treatment, patients were randomly given either interferon gamma (IFN-gamma) or placebo. In the IFN-gamma group, 107 patients were evaluated and in the control group, 116 patients were evaluated. The response rate after 3 months of treatment, according to joint pain indexes, was significantly higher in the IFN-gamma group with an error probability of 1%. IFN-gamma was able to reduce the quantity of corticosteroids administered. Compared with the control group, the IFN-gamma group benefited considering all parameters measured. Most important side effects were transient fever and transient influenza-like symptoms; all other adverse events were comparable in both groups. | |
| 20058452 | Surgical management of the subaxial cervical spine (C3-T1) in rheumatoid arthritis. | 1993 Aug | In the process of skeletal changes in rheumatoid arthritis (RA) the lower cervical spine may characteristically be affected by subluxation, discoligamentous insufficiency and bone resorption. These may cause severe pain and important neurological deficit and necessitate surgical intervention. Out of a series of 122 RA patients who underwent surgery of the cervical spine, in 23 the subaxial cervical spine was operated on. Pain was the leading symptom in all patients. In only six were there no pathological neurological findings, and all showed marked kyphotic deformity of the cervical spine. Fourteen patients were operated by a posterior approach, one by a ventral approach, and in eight patients the surgical procedure consisted of anterior decompression and dorsal stabilization. A mean of 21.3 months after surgery, clinical and radiological evaluation was performed. In two patients the sensomotor deficit improved, and out of 16 patients with cervical myelopathy, nine improved. No pseudoarthrosis was noted, and moderate loss of correction was seen in only three patients. In a subjective evaluation, 14 patients rated their result as good, six as fair and none as poor. In conclusion, following decompression, we noted good recovery from myelopathic symptoms. Sufficient stability in patients with RA is achieved by a combined anterior and posterior approach, the main goal of the anterior approach being decompression by vertebrectomy and that of the posterior approach stabilization by plate and screw fixation. | |
| 7586812 | Arthroscopic ankle arthrodesis in rheumatoid arthritis. | 1995 Nov | Several techniques for ankle arthrodesis have been described. Many of them are not suitable in patients with severe rheumatoid arthritis because of multiple joint involvement, osteoporosis, and increased risk of infection caused by poor skin conditions. The arthroscopic technique described in this article has been used in 7 patients with seropositive rheumatoid arthritis and 1 patient with seronegative rheumatoid arthritis (10 ankle joints; 2 patients surgically treated bilaterally). All patients successfully obtained ankle joint arthrodesis. The mean time to fusion was 10 weeks (range, 6-12 weeks). There was a 100% fusion rate without any complication. | |
| 8705690 | Interaction of indometacin farnesil, a new nonsteroidal antiinflammatory drug with periphe | 1996 Apr | Indometacin farnesil (Indo-F) is a prodrug of indomethacin designed to reduce the occurrence of side-effects by esterification of the carboxyl group on indomethacin with farnesol. We have examined the pharmacological kinetics and action of Indo-F in peripheral blood mononuclear cells (PBMNC) and polymorphonuclear leukocytes (PBPNL) from patients with rheumatoid arthritis (RA). PBMNC and PBPNL were obtained from 31 RA patients. Indo-F was incubated with PBMNC or PBPNL in the presence or absence of granulocyte-macrophage colony stimulating factor (GM-CSF) (100 pg/ml) for 3 approximately 7 days, after which the concentrations of Indo-F and indomethacin in the culture supernatants or in the cytoplasm extracts were measured with HPLC. The levels of Indo-F in the culture supernatants were significantly decreased in the presence of PBMNC or PBPNL from either normal individuals or RA patients. Indo-F was found to be taken up by PBMNC as well as by PBPNL from RA patients. Conversion of Indo-F into indomethacin was significantly enhanced by GMCSF in the presence of PBMNC, but not PBPNL. The results indicate that Indo-F is taken up by peripheral blood leukocytes from RA patients. Moreover, the data suggest that monocyte-lineage cells might play an important role in the conversion of Indo-F into indomethacin since GM-CSF markedly facilitated the conversion in the presence of PBMNC, but not PBPNL. | |
| 10148583 | Primary resection total knee arthroplasty for complicated fracture of the distal femur wit | 1993 May | Treatment of fractures of the distal end of the femur in an elderly patient is difficult. If the knee joint is arthritic, the problem is even greater. The reports of two patients with rheumatoid arthritis who sustained fractures of the distal end of the femur and underwent unconventional treatment with a resection total knee arthroplasty are presented. | |
| 8275590 | Serum levels of secretory IgA and in vitro production of IgA in rheumatoid arthritis. | 1993 Sep | Twenty-three per cent of rheumatoid arthritis (RA) patients show an increase of serum IgA concentrations. To determine the role of mucous-associated lymphoid tissue (MALT) in the elevation of serum IgA in RA, we studied the serum secretory-IgA (s-IgA) in 63 RA patients and in 30 healthy controls. We also analysed the secretion of circulating B cells producing IgA, which is known to reflect mucous tissue activity, in a subgroup of 15 patients with increased serum IgA concentrations, and in control patients. The mean s-IgA in the RA patients was 0.046 mg/ml +/- 0.064, versus 0.002 +/- 0.004 mg/ml in controls (not significant). Active disease defined by clinical criteria was associated with an increase in serum s-IgA (p < 0.001). Furthermore, in a subgroup of RA patients with high serum IgA levels, we found an increase in in vitro IgA production by circulating blood lymphocytes (17.39 +/- 15.2 micrograms/ml), versus RA patients with normal serum IgA levels or controls (p < 0.001). These results were not modified by LPS or PWM. Our results further support the hypothesis of primary MALT activation following environmental antigenic stimulation in RA patients. | |
| 1595004 | [Evaluation of immunosuppressive acid protein (IAP) in patients with rheumatoid arthritis] | 1992 Apr | Immunosuppressive acidic protein (IAP) is evaluated to be a useful parameter for the observation of the clinical course of patients with cancer, who are frequently associated with an increment of serum IAP levels. And also, immune complex diseases such as rheumatoid arthritis (RA), SLE and so on, have been described to produce immune-complex and, consequently, to generate IAP in vivo. Our study focuses on correlations of the IAP values with acute phase reactants, chronic phase reactants and grading of bone stages in patients with RA. Serum IAP showed the positive relationships with grading of bone stages, erythrocyte sedimentation rate (ESR), CRP, RF, RAHA, beta 2-microglobulin (BMG) and IgA in RA. Serum IAP was influenced by deterioration of bone pathological change. The more progressed pathological change of bone, the more increased serum IAP levels. It seems likely that there exist the similar mechanisms with production of IAP and parts of acute and chronic phase reactants and also, serum IAP level may be a useful parameter to predict bone pathological change in patients with RA. | |
| 1595003 | [Analysis of blood coagulation and fibrinolysis in rheumatoid arthritis using the urokinas | 1992 Apr | The urokinase activated thromboelastography is useful for the analysis of blood coagulation and fibrinolysis in rheumatoid arthritis (RA). In 43 RA patients without extraarticular symptoms (mean year old +/- SD = 50.3 +/- 10.9) and 20 healthy control subjects (mean year old +/- SD = 49.5 +/- 13.8, which is not significant), we have examined reaction time (r), coagulation time (k), r+k, maximal amplitude (ma), lysis time (LT) of the urokinase (final density = 85U/ml) activated platelet rich plasma thromboelastography. In RA patients r, k, r+k are shorter, ma is larger, LT is longer than in control subjects. Especially, k, ma and LT are remarkably statistically significant. these findings suggest that most of RA patients have hypercoagulability and/or prolongation of lysis time simultaneously, k, ma and LT are pathophysiologically important. | |
| 8012331 | [Macrophages in rheumatoid synovial membrane: an update]. | 1993 Oct | The immunophenotype of lining and subintimal synovial mononuclear phagocytes (MP) of rheumatoid arthritis (RA) were sought by immunohistology and compared with osteoarthritis (OA) tissue in order to determine the significance of MPs in the pathobiology of RA. Almost all the lining cells (SLCs) in RA consisted of MPs (80 to 90% expressing CD45/CD14/CD68). A major proportion of the interaggregate areas of the rheumatoid subintima was also made of MP cells (50 to 70% expressing CD14/CD68). A marked variation in the immunohistological reaction of antibodies reacting within intimal MPs and between intimal and subintimal MPs was found. Intimal MPs expressed a wide range of macrophage-associated antigens, including receptors for Fc (CD16, CD32, CD64) and complement (CD35, CD11b, CD11c) as well as several integrin and non-integrin cell adhesion molecules (CD29/CD49b, CD49d, CD49f, CD51/CD61, CD11a, CD31, CD54, CD44, CD9, CD63). The monocyte marker, CD14, was down-regulated on SLCs in both RA and OA. When compared to intimal expression of leucocyte common antigen (CD45), CD68, a pan-macrophage maturation antigen, was found to be an unreliable macrophage antigen in OA intima. There was no difference in antigenic phenotype of SLCs in inflammatory and non-inflammatory OA with early activation markers (CD25, CD71) mainly present on MPs. In RA, synovial MPs showed increased expression of activation, maturation and functional antigens suggesting that they are rapidly and fully activated. The fact that their recruitment was independent of the degree of lymphocyte infiltration further emphasises the central importance of synovial MPs in RA. | |
| 8102405 | Bronchoalveolar lavage and lung biopsy in rheumatoid arthritis. In vivo effects of disease | 1993 Jun | Bronchoalveolar lavage (BAL) and histology of transbronchial forceps biopsy was performed in 59 patients with rheumatoid arthritis (RA) to evaluate the in vivo effects of disease modifying drugs (DMARD). All patients had no clinical pulmonary symptoms and there was no evidence of drug induced alveolitis. Patients were divided into 5 subgroups according to drug treatment: 9 patients taking chloroquine, 15 patients gold, 8 patients penicillamine, 8 patients methotrexate (MTX) and 19 patients not taking DMARD. Duration of DMARD regimen was more than 3 months. No patient was treated with corticosteroids. BAL results revealed an increased percentage of lymphocytes and a diminished proportion of alveolar macrophages in patients treated with gold, penicillamine, MTX and no DMARD. In contrast, patients receiving chloroquine had a normal distribution of lymphocytes and macrophages as seen in a control group of 15 persons. Patients taking MTX showed a normal distribution of T and B lymphocytes and DR positive cells, whereas patients receiving chloroquine, gold, or penicillamine had an elevated proportion of T lymphocytes and DR positive cells and a diminished percentage of B lymphocytes. The latter was also observed in patients not taking DMARD. The percentage of natural killer cells was significantly elevated only in the penicillamine group. Patients receiving gold had higher absolute values of CD3, CD4 and DR positive cells. Abnormal lung histology was associated with an increased percentage of lymphocytes and with higher DR positive cells in BAL. Patients not receiving DMARD had a significantly higher percentage (42.1%) of abnormal histologic features of lung tissue than patients receiving DMARD (17.5%).(ABSTRACT TRUNCATED AT 250 WORDS) | |
| 7981992 | Combination of methotrexate and sulphasalazine vs methotrexate alone: a randomized open cl | 1994 Nov | To compare efficacy, toxicity, and the pharmacokinetics of the combination of sulphasalazine (SASP) and methotrexate (MTX) vs MTX alone in the treatment of SASP-resistant RA we conducted a controlled open clinical trial. Forty RA patients with active arthritis despite adequate SASP therapy, were allocated randomly to regimes of either SASP+MTX or MTX alone. The patients were evaluated openly by a single observer for 24 weeks. In the first 15 patients using the combination, pharmacokinetics of MTX without and with SASP were studied. Thirty-eight patients completed the trial. The mean decrease in the disease activity score in the group of patients receiving the combination was significantly greater than in the MTX group (-2.6 vs -1.3 respectively). The same pattern was seen concerning the other efficacy variables. There was no difference in the occurrence of toxicity. SASP had no influence on the pharmacokinetics of MTX. In conclusion in this open study the efficacy of the combination of MTX and SASP seems to be superior to MTX alone, the toxicity of both therapies was similar. This effect was not explained by the pharmacokinetics of MTX which were not altered by concomitant SASP administration. | |
| 7650397 | Unexpected presence of polyreactive catalytic antibodies in IgG from unimmunized donors an | 1995 Sep 1 | Polyclonal IgG from healthy humans and unimmunized mice was screened for peptide-methylcoumarinamide (peptide-MCA) hydrolyzing activity. The activity was detected in every IgG sample examined. Contaminant enzymes were precluded as an explanation, as the activity tracked exactly with the 150-kDa IgG peak separated by gel filtration in denaturing solvent (6 M guanidine hydrochloride) and with the 50-kDa Fab fragment peak produced by papain-digestion of the IgG. Patients with rheumatoid arthritis displayed a 3.2-fold reduced peptide-MCA hydrolyzing activity (mean) compared to healthy subjects. Control osteoarthritis patients showed no diminution in activity. A progressive decrease in the activity by 7.4-fold of the pre-immune levels was observed in mice over the course of hyperimmunization with SRBC, indicating that exogenous Ag challenge, like rheumatoid arthritis, is associated with decreased catalytic activity. Apparent Km values of the IgG for Pro-Phe-Arg-MCA were 0.39 to 0.53 mM, values approximately 3-orders of magnitude greater than observed previously for Ag-specific catalysis by Abs. The only common structural feature in peptide-MCA conjugates utilized by the Abs as substrates was the presence of Arg-MCA and Lys-MCA bonds. The IgG hydrolyzed Pro-Phe-Arg-Phe at the Arg-Phe peptide bond, showing that the activity is relevant to cleavage of peptide bonds in natural Ags. The universal occurrence of this polyreactive catalytic activity in unimmunized donors and its diminution in an autoimmune disease and nonspecific Ag challenge suggest that it may possess an important, but as yet unidentified, biologic role. |