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[Early recognition of rheumatoid arthritis].  


Target to treat within the first 12 weeks. The rheumatoid arthritis (RA) disease process may be modulated best in the very early phase of the disease, therefore the period of the first 12 weeks of the disease is called the "window of opportunity". Patients in whom treatment is started within 12 weeks of onset of symptoms develop less severe joint damage and have a better chance of remission. At present only 31% of Dutch new RA patients are assessed by a rheumatologist within 12 weeks of symptom onset. Arthritis is identified by joint palpation; in order to detect subtle arthritis of minor joints, experience in carrying out this joint examination is required. In order to distinguish patients with early RA from other patients with recent onset arthritis, several prediction models have been developed. Early recognition of arthritis and RA is mandatory for early treatment of RA and improvement of the prospects of RA patients. PMID:22085506

van der Helm-van Mil, Annette H M; Posthumus, Marcel D



Are early arthritis clinics necessary?  


Landmark studies published in the 1980s were the first to reveal the long-term consequences of rheumatoid arthritis (RA). Instead of the benign outcomes previously reported from early population studies, disability, deformity and excess mortality were evident. At this time, the conventional pyramid approach was the standard for therapeutic intervention. Patients were initially treated with non-steroidal anti-inflammatory drug with rest and splinting a approach. Disease-modifying anti-rheumatic drugs and corticosteroids were reserved for patients with joint damage and disability, who had 'earned their treatment' and the perceived risk of toxicity. Thus irreversible damage and disability occurred prior to effective therapy being instituted, with the consequences of poor outcomes. The late 1980s saw the introduction of the concept of early intervention in RA and, shortly after, the introduction of specialist clinics for early assessment of patients with inflammatory arthritis (IA), so-called 'early arthritis clinics' (EACs). Such clinics, initially in large research units, targeted patients with early RA or IA with the potential to evolve to RA, with the aim of early case definition and treatment. After all, the common sense approach to treatment of a chronic inflammatory, destructive condition would be to treat it effectively from its onset, prior to the development of irreversible damage. The detailed documentation undertaken in these clinics subsequently provided much information regarding persistence and prognosis in early IA. Since their initial introduction, EACs have become commonplace, not only in academic units, but also kas part of clinical service provision in many institutions. This review details what an EAC is, who should be referred and when, and the benefits and potential future benefits of their introduction. PMID:15588968

Quinn, Mark A; Emery, Paul



The epidemiology of early inflammatory arthritis.  


Various early arthritis clinics have provided extensive data on presentation, disease course and outcomes of early inflammatory arthritis (EIA). The present Review summarizes the epidemiological data from these early arthritis cohorts (EACs), which provide information about the frequency of, risk factors for, and outcomes of EIA and undifferentiated arthritis (UA). The studies demonstrate the large variation in selection criteria and outcome definitions in EACs, which demands careful interpretation of the results. The annual incidence of EIA ranges from 115 to 271 per 100,000 adults, and the incidence of UA ranges from 41 to 149 per 100,000 adults. Depending on the selection criteria used by the specific EACs, 13-54% of patients with UA will develop rheumatoid arthritis (RA) and in 21-87% UA will persist. Epidemiological data from the various EACs has enabled the development of prediction models for persistent and erosive arthritis. These data formed the basis of new classification criteria developed in 2010, which could enable earlier diagnosis and treatment. Future clinical research should focus on the role of imaging techniques in the early detection of synovitis and on the effect of early treatment on the outcomes of EIA. PMID:21670767

Hazes, Johanna M W; Luime, Jolanda J



Early psoriatic arthritis: facing the challenge.  


Early diagnosis and initiation of therapy has become a primary objective in clinical rheumatology. As psoriatic arthritis causes deformities and joint damage leading to impaired quality of life and function as well as increased mortality risk, there was an urgent call for action aiming at inducing remission of the active inflammatory process. Until the year 2000 there were no treatments that led to a reduction in progression of joint damage. However, with the advent of anti-tumour necrosis factor agents, it is now possible to arrest the progression of damage in these patients. Therefore, the concept of window of opportunity, that is early assessment and management in specialist clinics, has been extended to psoriatic arthritis with successful outcomes among psoriatic arthritis patients similar to those with rheumatoid arthritis. Although all this sounds plausible, early psoriatic arthritis assessment remains limited to research as setting up this type of service in standard clinical practice faces several challenges that would need tackling. The objective of this article is to provide an overview of these challenges and suggest a paradigm for use in standard clinical practice to identify early psoriatic arthritis patients. PMID:24067311

Palmer, Deborah; Miedany, Y El



The diagnosis of early psoriatic arthritis.  


Psoriatic arthritis (PsA) is a chronic inflammatory joint disease with heterogeneous clinical presentation and unpredictable course but often with a tendency to irreversible joint damage. Joint damage can occur early in the disease also in the absence of significant clinical signs of arthritis. These observations and the current availability of effective treatments in controlling skin and joint disease underline the importance of early diagnosis of PsA. The use of specific questionnaires for screening patients at risk of psoriatic arthritis, knowledge of new classification criteria for PsA and especially the proper use of new imaging techniques are all important steps in achieving the goal of early diagnosis of PsA. The dermatologist may play a key role in this regard supported, when necessary, by the collaboration of the rheumatologist and radiologist. PMID:24005143

Altomare, G; Capsoni, F



Sick leave and work disability in patients with early arthritis  

Microsoft Academic Search

We studied the occurrence of sick leave and work disability, the presence of workplace adaptations and the usage of professional\\u000a guidance related to working problems in patients with early arthritis. Inclusion criteria were arthritis symptoms of less\\u000a than 2 years duration and a paid job at the time of diagnosis. Assessments were done in connection with an early arthritis\\u000a clinic (EAC)

Elisabeth J. M. Zirkzee; Arina C. Sneep; Petronella D. M. de Buck; Cornelia F. Allaart; Andreas J. Peeters; H. Karel Ronday; Marie Louise Westedt; Saskia le Cessie; Theodora P. M. Vliet Vlieland



Depressive symptoms in early rheumatoid arthritis: a comparative longitudinal study.  


Our objective was to investigate symptoms of depression in early rheumatoid arthritis (eRA) patients, and follow them longitudinally during a 3-year prospective study of 73 Hungarian and 45 Austrian early rheumatoid arthritis patients. Compared to validated national population data, mild symptoms of depression were detected in Hungarian early rheumatoid arthritis patients, which were independent of corticosteroid use. In the Hungarian subgroup, the Beck Depression Inventory scores were found to be stable during follow-up. Except at the baseline visit, depressive symptoms and functional status, as measured by the Health Assessment Questionnaire, were correlated. Significant differences were detected between Austrian and Hungarian patients despite of their geographical and cultural proximity. The mean depression score was higher in the Hungarian when compared to the Austrian patients. Depression is an important feature of early rheumatoid arthritis. Studies assessing depression in rheumatoid arthritis patients must be based on validated national data of normal population. PMID:17332982

Palkonyai, Eva; Kolarz, Gernot; Kopp, Maria; Bogye, Gabor; Temesvari, Peter; Palkonyay, Laszlo; Ratko, Istvan; Meszaros, Eszter



Treatment of early rheumatoid arthritis with rifampicin.  

PubMed Central

Following a report that seven of 20 patients with rheumatoid arthritis (RA) had come into clinical and laboratory remission after treatment with rifampicin, and that six of the seven responders had a disease duration of less than three years, 21 patients with classical or definite RA of recent onset were treated with 600 mg rifampicin and 300 mg isoniazid daily for six months. Fourteen of 21 patients completed six months' treatment, but there was no significant improvement in the mean values of the clinical and laboratory parameters measured. The improvement suggested by preliminary studies in patients with early RA is not seen in this larger group. In patients with a disease duration of less than 18 months, however, there was a significant decrease in the erythrocyte sedimentation rate and the serum concentrations of C reactive protein after treatment for six months, although there was no significant clinical improvement. Future studies of this drug in patients with RA should concentrate on this group.

Cox, N L; Prowse, M V; Maddison, M C; Maddison, P J



Synovial T Cell Receptor Heterogeneity in Early Arthritis  

Microsoft Academic Search

Rheumatoid arthritis (RA) has been postulated to result from a synovial immune response to an unidentified antigen(s), which should be mirrored by the T cell response. Here we investigate the T cell receptor (TCR) repertoire in the synovial tissue of patients with arthritis of early to moderate duration. We developed a nested polymerase chain reaction (PCR) technique to examine the

Qiong Fang; Yan-Yang Sun; Hani El-Gabalawy; Wei Cai; Linda Ko; Howard Chin; Thurayya Arayssi; H. Ralph Schumacher; William V. Williams



Treating Rheumatoid Arthritis Early May Cut Damaging Effects  


... JavaScript. Treating Rheumatoid Arthritis Early May Cut Damaging Effects Study suggests that delaying treatment leads to more ... non-medicinal approaches, many of which have limited effect," study lead investigator and rheumatologist Dr. Vivian Bykerk ...


Role of ultrasound in assessment of early rheumatoid arthritis.  


This report reviews imaging methods used for diagnosis and monitoring of rheumatoid arthritis, with emphasis on the role of ultrasonography. Traditionally, conventional radiography has been useful in detecting and monitoring the extent of joint destruction in rheumatic disease. However, it is particularly difficult to detect pathological joint changes in the early stages. Magnetic resonance imaging is able to detect inflammation of the synovial membrane and erosions but is limited by cost and availability. Ultrasound has recently emerged as a useful and potentially reliable method for assessing the degree of joint inflammation and erosion in patients with early rheumatoid arthritis. PMID:17533688

Hazy, M D; Slavotinek, J; Smith, M D



Sick leave and work disability in patients with early arthritis  

PubMed Central

We studied the occurrence of sick leave and work disability, the presence of workplace adaptations and the usage of professional guidance related to working problems in patients with early arthritis. Inclusion criteria were arthritis symptoms of less than 2 years duration and a paid job at the time of diagnosis. Assessments were done in connection with an early arthritis clinic (EAC) at entry into the cohort and 12 months thereafter by means of a questionnaire comprising questions on sick leave (absenteeism from work reported to the employer), work disability (receiving a full or partial work disability pension), unemployment, work adaptations and professional guidance related to working problems. Fifty-seven of the 69 participants (83%) had an arthritis symptom duration of <6 months. The number of patients with sick leave due to arthritis in the past 12 months decreased from 28 (41%) at study entry to 18 (26%) after 12 months of follow-up. The number of patients receiving a work disability pension increased from 5 (7%) at study entry to 13 (19%) after 12 months of follow-up (10 partial and 3 full). Sick leave in the 12 months before study entry appeared to be the most important predictor of the institution or increase in a work disability pension (odds ratio, 16.1; 95%CI, 1.8–142.8). Between study entry and follow-up, the number of patients with workplace adaptations increased from 20 (29%) to 28 (42%), whereas the number of patients receiving vocational guidance decreased from 48 (70%) to 36 (52%). In patients with early arthritis and a paid job, arthritis-related sick leave was common and occurred in part before patients entered the EAC and a diagnosis was made. About 20% of the patients became permanently work disabled, with partial work disability being more common than full work disability. Considerable proportions of patients received workplace adaptations and professional guidance with working problems.

Zirkzee, Elisabeth J. M.; Sneep, Arina C.; de Buck, Petronella D. M.; Allaart, Cornelia F.; Peeters, Andreas J.; Ronday, H. Karel; Westedt, Marie Louise; le Cessie, Saskia



The diagnosis and treatment of early psoriatic arthritis  

Microsoft Academic Search

Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder associated with a heterogeneous disease presentation, varied disease expression and an unpredictable but often chronically destructive clinical course. Joint damage can occur early in the disease; indeed, several imaging modalities have demonstrated subclinical joint involvement in psoriasis patients without musculoskeletal signs or symptoms. Efforts are underway to validate questionnaires that will

Christopher T. Ritchlin; Allen P. Anandarajah



Artrite reumatoide all'esordio Early rheumatoid arthritis  

Microsoft Academic Search

SUMMARY Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation of the synovial joints damage and loss of the function. The ultimate goal in managing RA is to prevent joint damage and to maintain functional abil- ity. Consequently, early diagnosis and treatment is important, but predictive markers for RA are still confined to au- to-antibodies and also magnetic

F. Atzeni; P. Sarzi-Puttini


The Stop Arthritis Very Early (SAVE) trial, an international multicentre, randomised, double-blind, placebo-controlled trial on glucocorticoids in very early arthritis  

Microsoft Academic Search

BackgroundGlucocorticoids (GCs) are often used as early arthritis treatment and it has been suggested that they induce remission or at least delay the development of rheumatoid arthritis (RA) and the need to start disease-modifying antirheumatic drugs (DMARDs).ObjectiveTo test the effect of GCs on patients with very early arthritis (symptom duration of <16 weeks) in a randomised controlled trial.MethodsPatients received a

Klaus P Machold; Robert Landewé; Josef S Smolen; Tanja A Stamm; Désirée M van der Heijde; Kirsten N Verpoort; Kerstin Brickmann; Janitzia Vázquez-Mellado; Dimitri E Karateev; Ferdinand C Breedveld; Paul Emery; Thomas W J Huizinga



Identifying Target Areas of Treatment for Depressed Early Inflammatory Arthritis Patients  

Microsoft Academic Search

Background: The goal of this study was to identify target areas for psychosocial intervention for depressed patients with earlyinflammatory arthritis. Methods:One hundred and sixty-five patients with early inflammatory arthritis (?1 joint with synovitis for ?6 weeks and <1 year with a diagnosis of either rheumatoid or undifferentiated inflammatory arthritis) were referred to the McGill Early Arthritis Registry (McEAR) by their

Patricia L. Dobkin; Marta Filipski; Karl Looper; Orit Schieir; Murray Baron



Early glenohumeral arthritis in the competing athlete.  


Early glenohumeral degeneration is, at best, a difficult condition for the competing athlete. This is especially true of athletes who participate in overhead sports of baseball, tennis, swimming, and volleyball. However, competitors in football, basketball, and soccer may also find themselves saddled with severe posttraumatic, post-reconstruction, or primary cartilage loss in their shoulders. Unfortunately, this may lead to impeded performance, and, ultimately, derailed careers. PMID:19064157

Reineck, John R; Krishnan, Sumant G; Burkhead, W Z



Immunohistological analysis of synovial tissue for differential diagnosis in early arthritis  

Microsoft Academic Search

Objective. An early diagnosis in patients presenting with arthritis is important to provide information about prognosis and to initiate treatment. The objective of this study was to determine which markers applied in immunohistological analysis of synovial tissue (ST ) specimens could be used to diVerentiate rheumatoid arthritis (RA) from other forms of arthritis. Methods. Synovial biopsies were obtained by blind

M. C. Kraan; J. J. Haringman; W. J. Post; J. Versendaal; F. C. Breedveld; P. P. Tak





What Is Arthritis? You may have heard about arthritis (say: ar- thry -tis), which is a disease that causes swelling and ... their joints ache less. Back Continue Living With Arthritis Kids with JIA can have a lot of ...


Factor V Leiden and hemophilia  

Microsoft Academic Search

Several inherited prothrombotic risk factors have been identified so far. Among them, the factor V (FV) Leiden mutation causes a reduced ability of activated protein C to inactivate activated FV and is the most frequent genetic predisposing factor for venous thromboembolism. However, the high prevalence of FV Leiden (up to 15%) in the Caucasian population suggests that this mutation might

Massimo Franchini; Giuseppe Lippi



Serum levels of tissue inhibitor of metalloproteinase-1 and periarticular bone loss in early rheumatoid arthritis  

Microsoft Academic Search

We investigated the relationship between disease activity, serum biological mediators of joint damage, and periarticular bone\\u000a loss in inflammatory arthritis. Patients with early inflammatory arthritis were recruited from a dedicated early arthritis\\u000a clinic. At the time of recruitment, all had clinical evidence of synovitis. Patients were assessed at baseline and at 1-year\\u000a follow-up. Periarticular and axial bone mineral density (BMD)

Eithne Murphy; Pascale Roux-Lombard; Terence Rooney; Oliver FitzGerald; Jean-Michel Dayer; Barry Bresnihan



The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence?  

Microsoft Academic Search

Objective. The concepts of early intervention and early arthritis clinics for the management of rheumatoid arthritis (RA) were introduced almost a decade ago. The evidence for these is diverse and the best therapeutic approach remains vehemently debated. This review addresses these issues. Methods. The MEDLINE database was searched to identify relevant papers satisfying inclusion criteria for disease duration and no

M. A. Quinn; P. G. Conaghan; P. Emery



Factor V Leiden and recurrent miscarriage--prospective outcome of untreated pregnancies  

Microsoft Academic Search

BACKGROUND: Some cases of recurrent miscarriage and later pregnancy complications have a thrombotic basis. Factor V Leiden is a common thrombophilic mutation. METHODS: The prospective outcome of untreated pregnancies amongst 25 women heterozygous for the Factor V Leiden allele who had a history of either recurrent early miscarriages only (three or more miscarriages at <12 weeks gestation; n 19) or

R. Rai; M. Backos; S. Elgaddal; A. Shlebak; L. Regan



Bone mineral density in nonsteroid treated early rheumatoid arthritis.  

PubMed Central

OBJECTIVES--To determine whether significant reduction in bone mass is detectable in early disease in patients with rheumatoid arthritis (RA) and to examine the possible influences of disease activity and physical disability on bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN). METHODS--LS and FN BMD values were measured and Z scores determined in a cross-sectional study of 104 patients with RA of less than five years duration. BMD values were also compared between a subgroup of 64 patients and a normal control group matched for age, sex, menopausal status and body mass. BMD values and Z scores were correlated with disease activity, measured by the Stoke Index, disability, measured by HAQ score, and disease duration. RESULTS--Premenopausal female patients with RA had significantly reduced mean FN Z scores (-0.62, 95% CI -0.30 to -0.94) which correlated with HAQ scores (Rs 0.358, p = 0.05) and age (Rs 0.397, p = 0.03). There were no significant changes of BMD in males or postmenopausal females. Disease duration and disease activity did not correlate with BMD changes. CONCLUSION--BMD is reduced in premenopausal female patients with early RA possibly related to the attainment of peak bone mass. No significant reduction of BMD was found in males or postmenopausal females with early disease. Physical disability but not disease activity appears to play a role in the reduction of FN bone mass.

Shenstone, B D; Mahmoud, A; Woodward, R; Elvins, D; Palmer, R; Ring, F; Bhalla, A K



Midcarpal Hemiarthroplasty for Wrist Arthritis: Rationale and Early Results  

PubMed Central

Midcarpal hemiarthroplasty is a novel motion-preserving treatment for radiocarpal arthritis and is an alternative to current procedures that provide pain relief at the expense of wrist biomechanics and natural motion. It is indicated primarily in active patients with a well-preserved distal row and debilitating arthritic symptoms. By resurfacing the proximal carpal row, midcarpal arthroplasty relieves pain while preserving the midcarpal articulation and the anatomic center of wrist rotation. This technique has theoretical advantages when compared with current treatment options (i.e., arthrodesis and total wrist arthroplasty) since it provides coupled wrist motion, preserves radial length, is technically simple, and avoids the inherent risks of nonunion and distal component failure. The KinematX midcarpal hemiarthroplasty has an anatomic design and does not disrupt the integrity of the wrist ligaments. We have implanted this prosthesis in nine patients with promising early results. The indications for surgery were as follows: scapholunate advanced collapse wrist (three), posttraumatic osteoarthritis (three), inflammatory arthritis (two), and Keinböck disease (one). Prospective data has been collected and the results are preliminary given the infancy of the procedure. The mean follow-up was 30.9 weeks (range: 16 to 56 weeks). The mean Mayo wrist score increased from 31.9 preoperatively to 58.8 (p?

Vance, Michael C.; Packer, Greg; Tan, David; Crisco, J.J. Trey; Wolfe, Scott W.



Trial of Early Aggressive Therapy in Polyarticular Juvenile Idiopathic Arthritis  

PubMed Central

OBJECTIVES To determine if aggressive treatment initiated early in the course of rheumatoid factor positive or negative polyarticular juvenile idiopathic arthritis (poly-JIA) can induce clinical inactive disease (CID) within 6 months. METHODS Between May 2007 and October 2010 a multi-center, prospective, double blind, randomized, placebo controlled trial of two aggressive treatments was conducted in 85 children aged 2 to 16 years with polyarticular JIA of less than 12 months duration. Patients received either methotrexate 0.5 mg/kg/wk SQ (40 mg max), etanercept 0.8 mg/kg/wk (50 mg max), prednisolone 0.5 mg/kg/d (60 mg max) tapered to 0 by 17 weeks (Arm 1), or methotrexate (same dose as Arm 1), etanercept placebo, and prednisolone placebo (Arm 2). The primary outcome was CID at 6 months. An exploratory phase determined the rate of clinical remission on medication (6 months of continuous CID) at 12 months. RESULTS By 6 months, 17 of 42 (40%) of patients in Arm 1 and 10 of 43 (23%) in Arm 2 had achieved CID (X2 = 2.91; p = 0.088). After 12 months, 9 patients in Arm 1 and 3 in Arm 2 achieved clinical remission on medication (p = 0.0534). There were no significant inter-arm differences in adverse events. CONCLUSIONS Although this study did not meet its primary endpoint, early aggressive therapy in this cohort of children with recent onset polyarticular JIA resulted in substantial proportions of patients in both arms achieving CID by 6 months and clinical remission on medication within 12 months of treatment.

Wallace, Carol A.; Giannini, Edward H.; Spalding, Steven J.; Hashkes, Philip J.; O'Neil, Kathleen M.; Zeft, Andrew S.; Szer, Ilona S.; Ringold, Sarah; Brunner, Hermine I.; Schanberg, Laura E.; Sundel, Robert P.; Milojevic, Diana; Punaro, Marilynn G.; Chira, Peter; Gottlieb, Beth S.; Higgins, Gloria C.; Ilowite, Norman T.; Kimura, Yukiko; Hamilton, Stephanie; Johnson, Anne; Huang, Bin; Lovell, Daniel J.



Pregnancy and early onset pauciarticular juvenile chronic arthritis  

PubMed Central

OBJECTIVES—To study interaction of early onset pauciarticular juvenile chronic arthritis (EOP-JCA) and pregnancy in the Polish population, in particular to confirm the ameliorating effect of pregnancy on disease activity reported by others and to analyse the factors that govern the occurrence of postpartum flare, with emphasis on the potential role of breast feeding.?METHODS—The reproductive outcome and disease status in 39 adult women with history of EOP- JCA was examined by means of a questionnaire and an interview. In all patients the disease onset occurred before the 6th birthday, 19 had persistent pauciarticular JCA (PeEOP-JCA) and 20 had extended pauciarticular JCA (ExEOP-JCA).?RESULTS—23 women had at least one successful pregnancy, seven had unsuccessful pregnancies but all of them had also one or more successful pregnancies. Among those who have never been pregnant (n=16) there was a higher frequency of eye disease and ExEOP-JCA compared with the rest of the group. In almost all cases pregnancy was associated with remission of disease activity, however a postpartum flare appeared after 22 pregnancies (52%). The flares were more frequent in women who had an active disease before pregnancy, had a flare after a previous pregnancy and/or were breast feeding.?CONCLUSIONS—In EOP-JCA patients pregnancy generally has a good outcome and induces amelioration of disease activity. After delivery, however, a flare of disease often appears, especially in women who were breast feeding, had a postparum flare previously or had an active disease before pregnancy. The pattern of interaction between disease and pregnancy found in EOP-JCA makes EOP-JCA similar in this respect to RA, but different from systemic lupus erythematosus and ankylosing spondylitis.??

Musiej-Nowakowska, E.; Ploski, R.



Contractile, but not endothelial, dysfunction in early inflammatory arthritis: a possible role for matrix metalloproteinase-9  

PubMed Central

BACKGROUND AND PURPOSE Excess morbidity/mortality in rheumatoid arthritis (RA) is associated with increased incidence of cardiovascular disease. In this ‘proof-of-concept’ study, vascular function was characterized in the murine collagen-induced arthritis (mCIA) model, the benchmark choice for evaluation of the pathological processes and assessment of new therapies. EXPERIMENTAL APPROACH Mice in the very early stages of arthritis development [and appropriate naïve (non-immunized) age-matched controls] were used in the study. Blood pressure was measured using tail cuff plethysmography. Vascular function in rings of isolated aorta was studied with isometric tension myography. Levels of NO metabolites (NOx), MMP-9 protein and IL-1? in plasma and MMP-9 protein in aortic homogenates were quantified. KEY RESULTS Impaired vascular contractile responses in arthritis were unaffected by ex vivo inhibition of NOS (endothelial/neuronal and inducible) or COX activities. Endothelium-dependent and -independent relaxation, plasma NOx and blood pressure were unaffected by arthritis. Plasma and aortic homogenate MMP-9 protein levels were increased significantly in arthritis. Incubation of aortic tissues from naïve control animals with exogenous MMP-9 impaired subsequent contractile responses, mirroring that observed in arthritis. A role for IL-1? in perpetuating contractile dysfunction and increasing aortic MMP-9 was excluded. CONCLUSIONS AND IMPLICATIONS These data identify for the first time a relationship between early arthritis and contractile dysfunction and a possible role for MMP-9 therein, in the absence of overt endothelial dysfunction or increased NO production. As such, MMP-9 may constitute a significant target for early intervention in RA patients with a view to decreasing risk of cardiovascular disease.

Reynolds, SL; Williams, AS; Williams, H; Smale, S; Stephenson, HJ; Amos, N; George, SJ; O'Donnell, VB; Lang, D



Airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity?  

PubMed Central

Objective To evaluate the presence of pulmonary abnormalities in subjects with rheumatoid arthritis (RA)-related autoantibody (Ab) positivity without inflammatory arthritis (IA). Methods 42 subjects without IA but with elevations of anti-cyclic citrullinated peptide antibodies and/or 2 or more rheumatoid factor isotypes (a profile that is 96% specific for RA), 15 Ab(?) controls and 12 patients with early established seropositive RA (<1 year duration) underwent spirometry and high-resolution computed tomographic (HRCT) lung imaging. Results The median age of Ab(+) subjects was 54 years-old, 52% were female and 38% were smokers (not significantly different than Ab(?) controls). No Ab(+) subject had IA on joint examination. On HRCT, 76% of Ab(+) subjects had airways abnormalities including bronchial wall thickening, bronchiectasis, centrilobular opacities and air trapping, compared to 33% of Ab(?) controls (p=0.005). The Ab(+) subjects had similar prevalence and type of lung abnormalities compared to patients with early RA. Two Ab(+) subjects with airways disease developed IA classifiable as articular RA ~13 months after lung evaluation. Conclusion Airways abnormalities that are consistent with inflammation are common in Ab(+) subjects without IA, and similar to airways abnormalities seen in early RA. These findings suggest that the lung may be an early site of autoimmune-related injury, and potentially a site of generation of RA-related autoimmunity. Further studies are needed to define the mechanistic role of lung inflammation in the development of RA.

Demoruelle, M. Kristen; Weisman, Michael H.; Simonian, Philip L.; Lynch, David A.; Sachs, Peter B.; Pedraza, Isabel F.; Harrington, Annie R.; Kolfenbach, Jason R.; Striebich, Christopher C.; Pham, Quyen N.; Strickland, Colin D.; Petersen, Brian D.; Parish, Mark C.; Derber, Lezlie A.; Norris, Jill M.; Holers, V. Michael; Deane, Kevin D.



La risonanza magnetica dinamica del polso nella valutazione delle artriti precoci* Dynamic contrast-enhanced magnetic resonance imaging of the wrist in early arthritis  

Microsoft Academic Search

SUMMARY Objectives: MRI has been proposed as the imaging method of choice to evaluate the long-term outcome in patients with early arthritis. The role of dynamic MRI, performed at presentation, in predicting the outcome of patients with early arthritis has been addressed in the present study. Methods: 39 patients with early arthritis, involving at least one wrist, were studied with

G. Zampogna; M. Parodi; B. Bartolini; D. Schettini; G. Minetti; M. D'Auria; E. Silvestri; G. Garlaschi; M. A. Cimmino


Coaching patients with early rheumatoid arthritis to healthy physical activity: A multicenter, randomized, controlled study  

Microsoft Academic Search

Objective. To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. Methods. A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual

Nina Brodin; Eva Eurenius; Irene Jensen; Ralph Nisell; Christina H. Opava



Why are Dutch rheumatologists reluctant to use the COBRA treatment strategy in early rheumatoid arthritis?  

Microsoft Academic Search

Background: The Combinatietherapie Bij Reumatoide Artritis (COBRA) trial has proved that combination therapy with prednisolone, methotrexate and sulphasalazine is superior to sulphasalazine monotherapy in suppressing disease activity and radiological progression of early rheumatoid arthritis (RA). In addition, 5 years of follow-up proved that COBRA therapy results in sustained reduction of the rate of radiological progression. Despite this evidence, Dutch rheumatologists

Lilian H D van Tuyl; Anne Marie C Plass; Willem F Lems; Alexandre E Voskuyl; Ben A C Dijkmans; Maarten Boers



Autoantibodies to cyclic citrullinated peptide 2 (CCP2) are superior to other potential diagnostic biomarkers for predicting rheumatoid arthritis in early undifferentiated arthritis  

Microsoft Academic Search

We evaluated the diagnostic value of anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies and other potential diagnostic\\u000a biomarkers (IgM rheumatoid factor, anti-agalactosyl IgG antibodies, matrix metalloproteinase 3, C-reactive protein) for predicting\\u000a early development of rheumatoid arthritis (RA). Patients were defined as having recent-onset undifferentiated arthritis (UA)\\u000a if they had developed arthritis in two or more joints within the previous 2 years and

Eriko Kudo-Tanaka; Shiro Ohshima; Masaru Ishii; Toru Mima; Masato Matsushita; Naoto Azuma; Yoshinori Harada; Yoshinori Katada; Hitomi Ikeue; Mitsuko Umeshita-Sasai; Kunio Miyatake; Yukihiko Saeki



Diagnosis and treatment of early active rheumatoid arthritis.  


A 59-year-old patient comes to a community pharmacy with unexplained, worsening bilateral foot pain and inflammation. Following evaluation of the situation, the pharmacist suggests that the patient has rheumatoid arthritis (RA). After a visit and consultation with her physician, the patient begins a complicated, rapidly evolving therapeutic regimen for RA. Through extensive counseling and education, the pharmacist is able to help the patient better manage her new medication regimen and understand expected outcomes. Pharmacists can play a very active role in helping patients with RA manage their therapies to optimize health outcomes. PMID:19275464

Cappuzzo, Kimberly A



Current concepts in the pathogenesis of early rheumatoid arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a systemic inflammatory disease with a predilection for symmetrically distributed diarthroidal joints. It is clinically heterogeneous, with particular disease phenotypes defined according to a complex interplay of genes and the environment. In this chapter we first summarize current knowledge of RA genetic susceptibility, a field which has been transformed in recent years by powerful modern genotyping technologies. The importance of a recently described subclassification for the disease based upon the presence or absence of circulating autoantibodies to citrullinated peptides has further informed genetic studies, and we consider the implications for our understanding of RA pathogenesis. We then review the cellular and molecular processes that initiate and perpetuate joint destruction.

Pratt, Arthur G.; Isaacs, John D.; Mattey, Derek L.



Identification of a cytokine network sustaining neutrophil and Th17 activation in untreated early rheumatoid arthritis  

PubMed Central

Introduction Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by sustained synovitis. Recently, several studies have proposed neutrophils and Th17 cells as key players in the onset and perpetuation of this disease. The main goal of this work was to determine whether cytokines driving neutrophil and Th17 activation are dysregulated in very early rheumatoid arthritis patients with less than 6 weeks of disease duration and before treatment (VERA). Methods Cytokines related to neutrophil and Th17 activation were quantified in the serum of VERA and established RA patients and compared with other very early arthritis (VEA) and healthy controls. Synovial fluid (SF) from RA and osteoarthritis (OA) patients was also analyzed. Results VERA patients had increased serum levels of cytokines promoting Th17 polarization (IL-1? and IL-6), as well as IL-8 and Th17-derived cytokines (IL-17A and IL-22) known to induce neutrophil-mediated inflammation. In established RA this pattern is more evident within the SF. Early treatment with methotrexate or corticosteroids led to clinical improvement but without an impact on the cytokine pattern. Conclusions VERA patients already display increased levels of cytokines related with Th17 polarization and neutrophil recruitment and activation, a dysregulation also found in SF of established RA. 0 Thus, our data suggest that a cytokine-milieu favoring Th17 and neutrophil activity is an early event in RA pathogenesis.



Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP)  

Microsoft Academic Search

Objective: To investigate the role of anti-cyclic citrullinated peptide antibody (anti-CCP) for the prediction of radiological outcome in patients with early rheumatoid arthritis.Methods: Anti-CCP was assessed at baseline in 379 patients with early rheumatoid arthritis (disease duration <1 year). Radiological joint damage and progression were assessed by Larsen score after two years of follow up (end point) and used as

K Forslind; M Ahlme?n; K Eberhardt; I Hafstro?m; B Svensson



Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis  

Microsoft Academic Search

Summary Background The value of intensive combination therapy in early rheumatoid arthritis is unproven. In a multicentre, double-blind, randomised trial (COBRA), we compared the combination of sulphasalazine (2 g\\/day), methotrexate (7·5 mg\\/week), and prednisolone (initially 60 mg\\/day, tapered in 6 weekly steps to 7·5 mg\\/day) with sulphasalazine alone. Methods 155 patients with early rheumatoid arthritis (median duration 4 months) were

A. C. Verhoeven; H. M. Markusse; Laar van de M. A. F. J; R. Westhovens; Denderen van J. C. M; Zeben van D; B. A. C. Dijkmans; A. J. G. E. Peeters; P. Jacobs; Brink van de H. R; H. J. A. Schouten; Heijde van der M. F. M; A. Boonen; Linden de S. venr



Detection of multiple viral DNA species in synovial tissue and fluid of patients with early arthritis  

PubMed Central

OBJECTIVE—Viruses have a role in the pathogenesis of various forms of arthritis. This study aimed at determining whether viral DNA can be detected in joint samples in the early stages of idiopathic arthritides.?METHODS—Synovial fluid (SF) and synovial tissue (ST) samples were obtained from 73 patients, with undifferentiated arthritis (n=22), rheumatoid arthritis (n=13), spondyloarthropathy (n=17), crystal arthropathy (n=8), osteoarthritis (n=7), septic arthritis (n=5), and trauma (n=1). The presence of viral DNA was investigated by polymerase chain reaction analysis.?RESULTS—Cytomegalovirus was present in 25 patients, parvovirus B19 in 15 patients, Epstein-Barr virus in 12 patients, and herpes simplex virus in 16 patients (in ST, SF, or both), respectively. The joint samples were negative for viral DNA from adenovirus and varicella-zoster virus. In ST, eight patients were double positive for parvovirus B19 and another viral DNA, with herpes simplex virus being the most prevalent. Seven patients were double positive for other viruses (cytomegalovirus, herpes simplex virus, Epstein-Barr virus). In SF, four patients were double or triple positive for viral DNA. Paired samples were available in 56 patients. In these, viral DNA was detected in 37 patients in ST, as compared with 19 in SF.?CONCLUSION—These data show that one or more viruses can be detected in the synovial specimens of patients with early arthritis, irrespective of the clinical diagnosis. This observation might be explained by migration of inflammatory cells harbouring viral DNA into the inflamed joints.??

Stahl, H.; Hubner, B.; Seidl, B.; Liebert, U.; van der Heijden, I. M; Wilbrink, B.; Kraan, M.; Emmrich, F.; Tak, P.



Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis  

Microsoft Academic Search

Objective. Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is a major contributing factor for poor outcome in rheumatoid arthritis (RA). Although early therapy has been shown to be particularly effective, there is still uncertainty about the optimal time point of DMARD introduction. We wanted to test if a therapeutic window of opportunity may exist within the first few months of

V. P. K. Nell; K. P. Machold; G. Eberl; T. A. Stamm; M. Uffmann; J. S. Smolen



Prevalence of patient-reported comorbidities in early and established psoriatic arthritis cohorts  

Microsoft Academic Search

The aim of this study is to describe the comorbidity profile in patients with early and established psoriatic arthritis (PsA).\\u000a Patients with PsA were selected from a registry of patients with psoriasis in Newfoundland. Patients with a diagnosis of psoriasis\\u000a according to the CASPAR classification criteria are entered in the registry at the time of diagnosis, questioned on their\\u000a medical

Majed Khraishi; Don MacDonald; Emmanouil Rampakakis; Julie Vaillancourt; John S. Sampalis



Biomarkers predict radiographic progression in early rheumatoid arthritis and perform well compared with traditional markers  

Microsoft Academic Search

Objective. To evaluate the performance of bio- chemical and traditional markers in predicting radio- graphic progression in rheumatoid arthritis (RA). Methods. One hundred thirty-two patients with early RA were treated with nonbiologic therapies for 2 years and studied longitudinally. Genomic DNA was analyzed for presence of the shared epitope. Levels of matrix metalloproteinases (matrix metalloproteinase 1 (MMP-1), MMP-13, and MMP-3),

Steven Young-Min; Tim Cawston; Nicola Marshall; David Coady; Stephan Christgau; Tore Saxne; Simon Robins; Ian Griffiths



Clinical, laboratory and radiographic features in early rheumatoid arthritis.  


We evaluated disease status in relation to age, sex and disease duration using some short term indices of disease activity, laboratory tests, and radiological features in 315 patients with rheumatoid arthritis of duration varying from 3 to 36 months (mean 12 months). No differences were observed among various age groups in disease duration, female/male ratio, incidence of radiologic lesions and other indices of disease process. Some clinical markers of the disease process such as involvement of the flexor tendons of the hands and Ritchie's index (score greater than 9) were significantly more frequent in the women (p less than 0.0013 and p less than 0.04, respectively). In the patients with disease of recent onset women were slightly more numerous (56%) than men; however, in those with disease duration of 36 months there were significantly more women (72%) (p less than 0.039), suggesting a greater tendency to chronic disease in this sex. Radiological lesions of the small joints of the hands, feet, and/or wrists were found in 37% of the cases with disease duration of up to 4 months and in 91% at 36 months (p less than 0.0001). The lesions were associated significantly more frequently with Ritchie index (p less than 0.02) and with laboratory indices of inflammatory activity (erythrocyte sedimentation rate greater than or equal to 25 mm/h) (p less than 0.001) and immune response (latex test greater than or equal to 80) (p less than 0.0001). Logistic regression analysis showed that the duration of illness is the most important factor correlating with radiologic lesions. PMID:2254883

Caruso, I; Santandrea, S; Sarzi Puttini, P; Boccassini, L; Montrone, F; Cazzola, M; Azzolini, V; Segre, D



Inflammatory gene profile in early rheumatoid arthritis and modulation by leflunomide and prednisone treatment.  


The effects of low dose prednisone (PD) alone or in combination with leflunomide (LEF) were tested on inflammatory gene expression in early rheumatoid arthritis (RA). Ten RA patients were assigned as group A (untreated)and group B (pretreated with PD 5 mg/day for 3 months -T0). Therefore, both groups were treated with LFN (20mg/day). Expression ratio of 34 inflammatory genes was detected by microarray analysis in early RA patients and CNT (5), before (T0), and after 3 months (T1) of combined therapy (PN+LFN). At T0, 17 genes linked with arthritis were found altered in early RA, (A and B groups), compared to CNT. At T1 in the group A, 41% of genes were found unchanged, 12% upregulated, and 47% downregulated, whereas in the group B, 65% of genes were found unchanged, 6% upregulated, and 29% downregulated. The results suggest that the combination of PN and LEF seems to play a synergistic effect by modulating some inflammatory genes in early RA. PMID:20398002

Cutolo, Maurizio; Villaggio, Barbara; Pizzorni, Carmen; Paolino, Sabrina; Moretti, Stefano; Gallo, Fabio; Bonassi, Stefano; Sulli, Alberto; Seriolo, Bruno; Montagna, Paola; Soldano, Stefano



Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement  

Microsoft Academic Search

OBJECTIVESTo investigate the progression of joint damage in early rheumatoid arthritis (RA) using magnetic resonance imaging (MRI) of the wrist and determine whether this technique can be used to predict prognosis.METHODSAn inception cohort of 42 early patients has been followed up prospectively for one year. Gadolinium enhanced MRI scans of the dominant wrist were obtained at baseline and one year

Fiona M McQueen; Neal Stewart; Jeff Crabbe; Elizabeth Robinson; Sue Yeoman; Paul L J Tan; Lachy McLean



Characterization of histopathology and gene-expression profiles of synovitis in early rheumatoid arthritis using targeted biopsy specimens  

Microsoft Academic Search

The disease category of early rheumatoid arthritis (RA) has been limited with respect to clinical criteria. Pathological manifestations of synovitis in patients whose disease is clinically classified as early RA seem to be heterogeneous, with regular variations. To clarify the relation between the molecular and histopathological features of the synovitis, we analyzed gene-expression profiles in the synovial lining tissues to

Takahito Tsubaki; Norimasa Arita; Takuma Kawakami; Takayuki Shiratsuchi; Haruyasu Yamamoto; Nobuo Takubo; Kazuhito Yamada; Sanpei Nakata; Sumiki Yamamoto; Masato Nose



Early functional improvement after a modified ligament reconstruction tendon interposition arthroplasty for thumb basal joint arthritis.  


Many modifications to trapeziectomy have been proposed for the treatment of thumb basal joint arthritis. Their final outcomes have been discussed intensively, whereas functional changes in the early post-operative period have not been fully documented. The purpose of the present study is to evaluate an early functional change following our modified ligament reconstruction with tendon interposition (LRTI) arthroplasty. Nine patients (ten thumbs) were included in this study. Pain levels, strength, and mobility were assessed before and after surgery at intervals of two months. Pain level significantly improved at two months after surgery. Grip and pinch strengths had increased gradually after a temporal decrease at two-month follow-up, and were significantly stronger at six months after surgery. Palmar abduction improved significantly at six months after surgery, whereas opposition did not change significantly. A modified LRTI is an effective procedure in terms of early functional improvement of pain, strength, and mobility. PMID:19378359

Miura, Toshiki; Osuka, Koji; Itoh, Shozo; Nakagawa, Takumi; Kawano, Hirotaka; Nakamura, Kozo



Positive anti-citrullinated protein antibody status and small joint arthritis are consistent predictors of chronic disease in patients with very early arthritis: results from the NOR-VEAC cohort  

PubMed Central

Introduction The current 1987 American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) have proven less useful in early arthritis. The objective of this study was to identify and compare predictors of three relevant outcomes of chronic arthritis in a cohort of very early arthritis patients. Methods The Norwegian Very Early Arthritis Cohort (NOR-VEAC) includes adult patients with at least one swollen joint of ?16 weeks' duration. Patients are followed for 2 years with comprehensive clinical and laboratory examinations. Logistic regression analyses were performed to determine independent predictors of three outcomes: persistent synovitis, prescription of disease-modifying anti-rheumatic drugs (DMARDs), and established clinical RA diagnosis within one year. Results Of 384 patients eligible for one year follow-up (56.3% females, mean (SD) age 45.8 (14.7) years, median (IQR) duration of arthritis 31 (10-62) days), 14.4% were anti-CCP2 positive, and 11.2% were IgM RF positive. 98 patients (25.5%) had persistent synovitis, 106 (27.6%) had received DMARD treatment during follow-up, while 68 (17.7%) were diagnosed with RA. Consistent independent predictors across all three outcomes were positive anti-citrullinated protein antibody (ACPA) status (odds ratio (OR) 3.2, 5.6 and 19.3), respectively, and small joint arthritis (proximal interphalangeal joint (PIP), metacarpo-phalangeal joint (MCP), and/or metatarso-phalangeal joint (MTP) joint swelling) (OR 1.9, 3.5, and 3.5, respectively). Conclusions Positive ACPA status and small joint arthritis were consistent predictors of three relevant outcomes of chronic arthritis in very early arthritis patients. This consistency supports DMARD prescription as a valid surrogate endpoint for chronic arthritis. Importantly, this surrogate is used in ongoing efforts to develop new diagnostic criteria for early RA.



Association of Morbid Obesity With Disability in Early Inflammatory Polyarthritis: Results From the Norfolk Arthritis Register  

PubMed Central

Objective Obesity has been associated with disease outcomes in inflammatory arthritis. This study aimed to investigate cross-sectionally the relationship between body mass index (BMI) and functional disability in a large inception cohort of patients with early inflammatory polyarthritis (IP). Methods Patients age ?16 years with ?2 swollen joints for ?4 weeks were recruited into the Norfolk Arthritis Register. At the initial assessment, clinical and demographic data were obtained, joints were examined, and height and weight were measured. Blood samples were taken to measure inflammatory markers and autoantibodies, and patients completed the Health Assessment Questionnaire (HAQ) to assess functional disability. Univariate and multivariate ordinal regression were used to examine the cross-sectional association between BMI and the HAQ. Multiple imputation using chained equations allowed inclusion of patients with missing variables. Results A total of 1,246 patients were studied (median age 57 years). Of those patients, 782 patients (63%) were female and 303 (25%) were obese (BMI ?30 kg/m2). Morbid obesity (BMI ?35 kg/m2) was significantly associated with worse functional disability in the univariate and multivariate analysis with missing data imputed, adjusting for age, sex, symptom duration, smoking status, disease activity, autoantibodies, comorbidities, and treatment (multivariate odds ratio 1.87, 95% confidence interval 1.14–3.07). Conclusion Morbid obesity in patients with early IP is associated with worse HAQ scores. This should be taken into account in patient management and when interpreting the HAQ in clinical practice.

Humphreys, J H; Verstappen, S M M; Mirjafari, H; Bunn, D; Lunt, M; Bruce, I N; Symmons, D P M



Prototype system of laser transillumination computed tomography for early diagnosis of rheumatoid arthritis  

NASA Astrophysics Data System (ADS)

So far we have shown, through various preliminary imaging experiments with small-animal ankle"s and human finger"s joints both healthy and joint-diseased, that early diagnosis for joint disease such as rheumatoid arthritis (RA) is feasible using a transillumination laser CT. For a practical purpose, we have recently proposed and developed a transillumination laser CT imaging system using optical fibers based on the optical heterodyne detection method for a clinical use. In the proposed system, motion-artifact free images can be obtained because measurements can be performed with the object fixed. In addition, use of fiber-optics enables portability, and robustness against environmental changes in a room, such as variable temperature, air-flow shifts, and unexpected vibrations. The imaging system has the following sensing properties: spatial resolution of 500 µm, a dynamic range of approximately 120 dB, and a minimum-detectable-optical power of 10-14 W as a result of the excellent properties of the heterodyne detection technique. In the present paper, we describe a prototype laser CT imaging system using optical fibers for early diagnosis of joint disease such as rheumatoid arthritis by demonstrating the first in vivo tomographic image of a volunteer"s index finger joint as well as the fundamental imaging properties.

Sasaki, Yoshiaki; Tanosaki, Shinji; Suzuki, Jota; Emori, Ryota; Inage, Hiroki; Yuasa, Tetsuya; Takagi, Michiaki; Ishikawa, Akira; Taniguchi, Hiroshi; Devaraj, Balasigamani; Akatsuka, Takao



Early intervention in the treatment of rheumatoid arthritis: focus on tocilizumab  

PubMed Central

Tocilizumab is a fully humanized monoclonal antibody against interleukin-6 receptors that was approved for the treatment of patients with rheumatoid arthritis (RA). Several lines of evidence, obtained both from conventional disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors, have supported the concept of “window of opportunity” as showing that these therapies consistently work better in early disease as compared to established RA. This review addresses the question of whether a window of opportunity gained with conventional DMARDs and TNF inhibitors can also be achieved with tocilizumab. To this end, data regarding the use of tocilizumab in early RA patients are summarized. Currently available data suggest that the earlier the treatment with tocilizumab, the better the clinical outcome can be, which may have implications for various aspects of RA treatment strategies.

Yilmaz, Sedat; Simsek, Ismail



A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass  

PubMed Central

Introduction Glucocorticoid (GC)-induced osteoporosis is a frequent complication in patients with rheumatoid arthritis. However, little information exists about the consequences of GC use in patients with early arthritis. Here we describe the variables underlying the use of GC in early arthritis, as well as its effect on bone-mineral density. Methods Data from 116 patients in our early arthritis register were analyzed (90 women; median age, 52.5 years, interquartile range (IQR, 38.5-66); 6-month median disease duration at entry (IQR, 4-9)). In this register, the clinical and treatment information was recorded systematically, including the cumulative GC dose. Lumbar spine, hip, and forearm bone-mineral density (BMD) measurements were performed at entry and after a 2-year follow-up. A multivariate analysis was performed to establish the variables associated with the use of GCs, as well as those associated with variations in BMD. Results Of the patients with early arthritis studied, 67% received GCs during the 2-year follow-up. GCs were more frequently prescribed to elderly patients, those with higher basal disease activity and disability, and patients with positive rheumatoid factor. When adjusted for these variables, GCs were less frequently prescribed to female patients. The use of GCs was associated with an increase of BMD in the ultradistal region of the forearm, although it induced a significant loss of BMD in the medial region of the forearm. No relevant effect of GC was noted on the BMD measured at other locations. Conclusions The frequent use of GCs as a "bridge therapy" in patients with early arthritis does not seem to be associated with relevant loss of bone mass. Moreover, cumulative GC administration might be associated with an increase of juxtaarticular BMD.



The usefulness of magnetic resonance imaging of the hand and wrist in very early rheumatoid arthritis  

PubMed Central

Introduction Magnetic resonance imaging (MRI) was used to study the hand and wrist in very early rheumatoid arthritis (RA), and the results were compared with early and established disease. Methods Fifty-seven patients fulfilling the new American College of Rheumatology criteria for RA, 26 with very early RA (VERA), 18 with early RA (ERA), and 13 with established RA (ESTRA), (disease duration < 3 months, < 12 months, and > 12 months, respectively) were enrolled in the study. MRI of the dominant hand and wrist was performed by using fat-suppressed T2-weighted and plain and contrast-enhanced T1-weighted sequences. Evaluation of bone marrow edema, synovitis, and bone erosions was performed with the OMERACT RA MRI scoring system. Results Edema, erosions, and synovitis were present in VERA, and the prevalence was 100%, 96.15%, and 92.3%, respectively. Significant differences in edema and erosions were found between VERA and ESTRA (P < 0.05). No significant difference was found in synovitis. Conclusions Edema, erosions, and synovitis are findings of very early RA. MRI, by detecting these lesions, may play an important role in the management of these patients.



Preferential reductions of paraarticular trabecular bone component in ultradistal radius and of calcaneus ultrasonography in early-stage rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis (RA) is a major cause of secondary osteoporosis and is frequently associated with both paraarticular and generalized osteoporosis. The present study was designed to investigate the preferential sites of reduction of bone mineral density (BMD), in the early stage of RA, with special emphasis on the differential effect of RA on BMD in trabecular and cortical components. The

Masaaki Inaba; Mayumi Nagata; Hitoshi Goto; Yasuro Kumeda; Keisuke Kobayashi; Kiyoshi Nakatsuka; Takami Miki; Shinsuke Yamada; Eiji Ishimura; Yoshiki Nishizawa



Treatment strategy, disease activity, and outcome in four cohorts of patients with early rheumatoid arthritis  

PubMed Central

OBJECTIVE—To compare four different inception cohorts of patients with early rheumatoid arthritis (RA) with respect to treatment strategies, disease activity, and outcome during a five year follow up period.?METHOD—Data from cohorts of patients with early RA, with a standardised assessment at least every six months for five years from four different centres, were included in one database. Owing to slight differences in the individual study designs, linearly interpolated values were calculated to complete the standard follow up schedule.?RESULTS—Despite similar inclusion criteria, significant differences in demographic factors and baseline disease activity were found between the different cohorts. During the follow up an aggressive treatment strategy was followed in the Dutch and Finnish cohort, an intermediate strategy in the British cohort, and a conservative strategy in the Swedish cohort. A significant improvement in disease activity was seen in all cohorts, though the most rapid and striking improvement was seen in those receiving aggressive treatment. This resulted in less radiographic destruction in the long run.?CONCLUSION—This observational study of cohorts of patients with early RA confirms that early aggressive treatment results not only in a more rapid reduction of disease activity but also in less radiographic progression in the long term.??

Albers, J; Paimela, L; Kurki, P; Eberhardt, K; Emery, P; van `t, Hof M A; Schreuder, F; Leirisalo-Repo, M; van Riel, P L C M



Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study  

Microsoft Academic Search

INTRODUCTION: Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease, and this occurs early in the disease process. The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in RA; however, little information is available regarding MetS in early RA. We aimed to identify the prevalence of MetS and to determine the potential

Hanh-Hung Dao; Quan-Trung Do; Junichi Sakamoto



A randomised controlled trial of occupational therapy for people with early rheumatoid arthritis  

PubMed Central

Background: Occupational therapy (OT) aims at improving performance of daily living tasks, facilitating successful adjustments in lifestyle, and preventing losses of function. Objective: To evaluate the effects of a pragmatic, comprehensive OT programme on self management and health status of people with early rheumatoid arthritis (RA) (<2.5 years). Methods: A randomised, controlled "assessor blinded" trial was conducted with assessments made at entry, 6, 12, and 24 months. Main outcomes were AIMS2: physical function (PF), pain visual analogue scale (VAS), and Arthritis Self-Efficacy Scale (ASES). Results: Groups had similar disease duration (9 months OT (n = 162) v 10 months control (n = 164)). The OT group received 7.57 (SD 3.04) hours of therapy. Self management significantly increased in the OT group. Otherwise, there were no significant differences in any outcome measures, or between groups, by ACR functional class: AIMS2: PF (F = 0.04; p = 0.96); pain VAS (F = 0.29; p = 0.74); total ASES score (F = 0.93; p = 0.39). Conclusions: OT improved self management but not health status in early RA. Functional ability remains reasonably good for many in the first five years, so preventive benefits of self management may not yet be apparent and longer follow up is needed. Although many considered the education and therapy useful, insufficient numbers in the OT group used self management sufficiently to make a difference. Behavioural approaches can improve adherence and, potentially, the long term benefits. Future research should evaluate OT as a complex intervention and develop programmes from a theoretical and evidence base.

Hammond, A; Young, A; Kidao, R



Interleukin 15 Levels in Serum May Predict a Severe Disease Course in Patients with Early Arthritis  

PubMed Central

Background Interleukin-15 (IL-15) is thought to be involved in the physiopathological mechanisms of RA and it can be detected in the serum and the synovial fluid of inflamed joints in patients with RA but not in patients with osteoarthritis or other inflammatory joint diseases. Therefore, the objective of this work is to analyse whether serum IL-15 (sIL-15) levels serve as a biomarker of disease severity in patients with early arthritis (EA). Methodology and Results Data from 190 patients in an EA register were analysed (77.2% female; median age 53 years; 6-month median disease duration at entry). Clinical and treatment information was recorded systematically, especially the prescription of disease modifying anti-rheumatic drugs. Two multivariate longitudinal analyses were performed with different dependent variables: 1) DAS28 and 2) a variable reflecting intensive treatment. Both included sIL-15 as predictive variable and other variables associated with disease severity, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). Of the 171 patients (638 visits analysed) completing the follow-up, 71% suffered rheumatoid arthritis and 29% were considered as undifferentiated arthritis. Elevated sIL-15 was detected in 29% of this population and this biomarker did not overlap extensively with RF or ACPA. High sIL-15 levels (? Coefficient [95% confidence interval]: 0.12 [0.06–0.18]; p<0.001) or ACPA (0.34 [0.01–0.67]; p?=?0.044) were significantly and independently associated with a higher DAS28 during follow-up, after adjusting for confounding variables such as gender, age and treatment. In addition, those patients with elevated sIL-15 had a significantly higher risk of receiving intensive treatment (RR 1.78, 95% confidence interval 1.18–2.7; p?=?0.007). Conclusions Patients with EA displaying high baseline sIL-15 suffered a more severe disease and received more intensive treatment. Thus, sIL-15 may be a biomarker for patients that are candidates for early and more intensive treatment.

Gonzalez-Alvaro, Isidoro; Ortiz, Ana M.; Alvaro-Gracia, Jose Maria; Castaneda, Santos; Diaz-Sanchez, Belen; Carvajal, Inmaculada; Garcia-Vadillo, J. Alberto; Humbria, Alicia; Lopez-Bote, J. Pedro; Patino, Esther; Tomero, Eva G.; Vicente, Esther F.; Sabando, Pedro; Garcia-Vicuna, Rosario



A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis  

PubMed Central

Objective To examine accounts of medication use in participants with early rheumatoid arthritis (RA) from symptom onset to early postdiagnosis. Design Qualitative study with in-depth, personal interviews. Participants 37 women and one man, aged 30–70s, with a diagnosis of RA <12?months. Main outcome measure Participants’ experiences and feelings of medication use in early RA. Setting British Columbia, Canada. Results Medications were central to how people managed symptoms and disease. Two main themes were identified, showing that optimum medication use was hampered, and how this related to delayed diagnosis and effective care. The first theme, ‘paradox of prediagnosis reliance on over the counter (OTC) medications’, describes how people's self-management with OTC medications was ‘effective’. Participants relied extensively on OTC medications for pain relief and to maintain ‘normal life’. However, as this contributed to delayed medical consultation, diagnosis and effective treatment, OTC medication was also potentially detrimental to disease outcome. The second theme, ‘ambivalence around prescription medications post diagnosis’, describes how adherence was hindered by patient beliefs, priorities and ambivalence towards medications. Conclusions This study highlights how people use medications in early RA and contributes to a better understanding of medication use that may transfer to other conditions. Given the drive towards active self-management in healthcare and patients’ ambivalence about using strong medications, an in-depth understanding of how these combined factors impact patient experiences will help healthcare providers to support effective medication practices. The reported extensive reliance on OTC medications may speak to a care gap needing further investigation in the context of health behaviours and outcomes of patient self-management.

Townsend, Anne; Backman, Catherine L; Adam, Paul; Li, Linda C



21 CFR 864.7280 - Factor V Leiden DNA mutation detection systems.  

Code of Federal Regulations, 2010 CFR

...864.7280 Factor V Leiden DNA mutation detection systems...Leiden deoxyribonucleic acid (DNA) mutation detection systems...and instruments which include polymerase chain reaction (PCR) primers...Guidance Document: Factor V Leiden DNA Mutation Detection...



21 CFR 864.7280 - Factor V Leiden DNA mutation detection systems.  

Code of Federal Regulations, 2010 CFR

...864.7280 Factor V Leiden DNA mutation detection systems...Leiden deoxyribonucleic acid (DNA) mutation detection systems...and instruments which include polymerase chain reaction (PCR) primers...Guidance Document: Factor V Leiden DNA Mutation Detection...



21 CFR 864.7280 - Factor V Leiden DNA mutation detection systems.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 false Factor V Leiden DNA mutation detection systems. 864.7280...Packages § 864.7280 Factor V Leiden DNA mutation detection systems. (a) Identification... Factor V Leiden deoxyribonucleic acid (DNA) mutation detection systems are...



Factor V Leiden and G20210A prothrombin mutations in patients with recurrent pregnancy loss: data from the southeast of Turkey  

Microsoft Academic Search

Factor V Leiden (FV-Leiden) and prothrombin gene mutations (FII G20210A) are well-established independent risk factors for\\u000a thrombosis. In the recent years, many studies have suggested that these mutations are associated with an increased risk of\\u000a recurrent pregnancy loss (RPL). We aimed to investigate the prevalence of these molecular defects in subjects with a history\\u000a of early RPL. One hundred and

Abdullah Altintas; Semir Pasa; Nurten Akdeniz; Timucin Cil; Murat Yurt; Orhan Ayyildiz; Sabri Batun; Hilmi Isi



The Features of the Synovium in Early Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria  

PubMed Central

Objectives It has been shown in early arthritis cohorts that the 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) enable an earlier diagnosis, perhaps at the cost of a somewhat more heterogeneous patient population. We describe the features of synovial inflammation in RA patients classified according to these new criteria. Methods At baseline, synovial tissue biopsy samples were obtained from disease-modifying antirheumatic drug (DMARD)-naïve early RA patients (clinical signs and symptoms <1 year). Synovial tissue was analyzed for cell infiltration, vascularity, and expression of adhesion molecules. Stained sections were evaluated by digital image analysis. Patients were classified according to the two different sets of classification criteria, autoantibody status, and outcome. Findings Synovial tissue of 69 RA patients according to 2010 ACR/EULAR criteria was analyzed: 56 patients who fulfilled the criteria for RA at baseline and 13 who were initially diagnosed as undifferentiated arthritis but fulfilled criteria for RA upon follow up. The synovium at baseline was infiltrated by plasma cells, macrophages, and T cells as well as other cells, and findings were comparable to those when patients were selected based on the 1987 ACR criteria for RA. There was no clear cut difference in the characteristics of the synovium between RA patients initially diagnosed as undifferentiated arthritis and those who already fulfilled classification criteria at baseline. Conclusion The features of synovial inflammation are similar when the 2010 ACR/EULAR classification criteria are used compared to the 1987 ACR criteria.

van de Sande, Marleen G. H.; de Hair, Maria J. H.; Schuller, Yvonne; van de Sande, Gijs P. M.; Wijbrandts, Carla A.; Dinant, Huib J.; Gerlag, Danielle M.; Tak, Paul P.



Peer-to-peer mentoring for individuals with early inflammatory arthritis: feasibility pilot  

PubMed Central

Objectives To examine the feasibility and potential benefits of early peer support to improve the health and quality of life of individuals with early inflammatory arthritis (EIA). Design Feasibility study using the 2008 Medical Research Council framework as a theoretical basis. A literature review, environmental scan, and interviews with patients, families and healthcare providers guided the development of peer mentor training sessions and a peer-to-peer mentoring programme. Peer mentors were trained and paired with a mentee to receive (face-to-face or telephone) support over 12?weeks. Setting Two academic teaching hospitals in Toronto, Ontario, Canada. Participants Nine pairs consisting of one peer mentor and one mentee were matched based on factors such as age and work status. Primary outcome measure Mentee outcomes of disease modifying antirheumatic drugs (DMARDs)/biological treatment use, self-efficacy, self-management, health-related quality of life, anxiety, coping efficacy, social support and disease activity were measured using validated tools. Descriptive statistics and effect sizes were calculated to determine clinically important (>0.3) changes. Peer mentor self-efficacy was assessed using a self-efficacy scale. Interviews conducted with participants examined acceptability and feasibility of procedures and outcome measures, as well as perspectives on the value of peer support for individuals with EIA. Themes were identified through constant comparison. Results Mentees experienced improvements in the overall arthritis impact on life, coping efficacy and social support (effect size >0.3). Mentees also perceived emotional, informational, appraisal and instrumental support. Mentors also reported benefits and learnt from mentees’ fortitude and self-management skills. The training was well received by mentors. Their self-efficacy increased significantly after training completion. Participants’ experience of peer support was informed by the unique relationship with their peer. All participants were unequivocal about the need for peer support for individuals with EIA. Conclusions The intervention was well received. Training, peer support programme and outcome measures were demonstrated to be feasible with modifications. Early peer support may augment current rheumatological care. Trial registration number NCT01054963, NCT01054131.

Sandhu, Sharron; Veinot, Paula; Embuldeniya, Gayathri; Brooks, Sydney; Sale, Joanna; Huang, Sicong; Zhao, Alex; Richards, Dawn; Bell, Mary J



Macrophage migration inhibitory factor (MIF): genetic evidence for participation in early onset and early stage rheumatoid arthritis.  


Macrophage migration inhibitory factor (MIF) is an upstream pro-inflammatory cytokine that is associated with the pathogenesis of autoimmune inflammatory diseases including rheumatoid arthritis (RA). Two polymorphisms in the upstream region exist in the MIF gene and are associated with RA susceptibility or severity in different populations. In this case-control study, we investigated whether MIF polymorphisms are associated with RA susceptibility or activity in a western Mexican population .The relationship of MIF levels with clinical features of disease also was assessed. Genotyping of the -794 CATT5-8 (rs5844572) and the -173 G>C (rs755622) polymorphisms was performed by PCR and PCR-RFLP respectively on 226 RA patients and 210 healthy subjects. Serum MIF levels were determined by ELISA. We found a significant association between the -794 CATT5-8 6,7 MIF genotype with RA. Moreover, we detected an association between the -794 CATT7 allele with early onset RA. The -794 CATT7 and -173(*)C alleles, which are in linkage disequilibrium, were associated with high disease activity on RA patients. A positive correlation between circulating MIF levels and C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, anti-citrullinated protein/peptides antibodies and TNF? was detected. MIF levels appear to be associated with disease progression rather than disease activity, which is distinct from the established relationship between disease activity and TNF? levels. In conclusion, the MIF gene and protein are associated with RA in a western Mexican population, with a main contribution onto early onset and early stages of disease. PMID:23402792

Llamas-Covarrubias, M A; Valle, Y; Bucala, R; Navarro-Hernández, R E; Palafox-Sánchez, C A; Padilla-Gutiérrez, J R; Parra-Rojas, I; Bernard-Medina, A G; Reyes-Castillo, Z; Muñoz-Valle, J F



The influence of early life factors on the risk of developing rheumatoid arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a chronic inflammatory disease that develops as a result of the interaction between genetic and environmental risk factors. Although increasing evidence shows the importance of genes in determining the risk of RA, it is clear that environmental factors also have a vital role. Studies to date have tended to concentrate on environmental influences around the time of disease onset. However, a number of pieces of evidence, including the fact that autoantibodies, such as rheumatoid factor (RF), can develop several years before the onset of clinical disease, suggest that environmental factors may influence disease susceptibility during early life. Several recent studies lend weight to this possibility, with an increased risk of RA in the offspring of mothers who smoked during pregnancy and in those with higher birth weight. There has also been a suggestion that the risk of RA is reduced in breast-fed infants. We describe the evidence surrounding the effect of early life factors on the risk of developing RA and possible mechanisms by which they may act.

Colebatch, A N; Edwards, C J



Diagnosis of early-stage rheumatoid arthritis: usefulness of unenhanced and gadolinium-enhanced MR images at 3 T.  


Forty-one consecutive unclassified arthritis patients with polyarthralgia including wrist joint were evaluated with 3-T MRI as possible early-stage rheumatoid arthritis (RA). After prospective follow-up, 21 of 41 patients fulfilled the American College of Rheumatology (ACR) criteria. Synovitis was detected in all 21 RA patients (sensitivity=100%) with postcontrast MRI and in 14 patients (67%) with unenhanced MRI when none of them fulfilled ACR diagnostic criteria. Fat-suppressed intermediate-weighted fast spin-echo (FSE) image showed high detection rate of synovitis and bone erosion, whereas FIESTA image clearly delineated joint fluid and bone trabeculae. MRI at 3 T is a potentially powerful tool for discriminating and managing early-stage RA patients. PMID:23465990

Aoki, Takatoshi; Yamashita, Yoshiko; Saito, Kazuyoshi; Tanaka, Yoshiya; Korogi, Yukunori



A prospective study of renal disease in patients with early rheumatoid arthritis  

PubMed Central

OBJECTIVES—This prospective study was designed to clarify the frequency, causes, and clinical course of renal disease in patients with early rheumatoid arthritis (RA).?METHODS—235 patients (185 women, mean age 49.4 years) with early RA of less than one year's duration were enrolled and assessed monthly. Proteinuria was defined as a positive dipstick result and microscopic haematuria was defined as the presence of ?5 red blood cells per high power field. Urinary abnormalities lasting three months or longer were defined as persistent abnormalities.?RESULTS—At entry, 40 patients exhibited haematuria, two had a raised serum creatinine concentration, and none had proteinuria. During the observation period (average 42 months), persistent haematuria was found in 43, persistent proteinuria in 17, and a raised serum creatinine concentration in 14 patients. Persistent proteinuria was caused by drugs in 14 of 17 patients and disappeared in most cases. Risk factors for drug induced proteinuria included a raised C reactive protein and erythrocyte sedimentation rate and age over 50 at entry. Drugs resulted in a raised serum creatinine concentration in eight of 14 patients. The incidence of haematuria at entry did not differ among patients who had been treated with non-steroidal anti-inflammatory drugs, disease modifying antirheumatic drugs, or no drugs. In some patients with isolated haematuria, the haematuria appeared when the activity of RA was high and resolved when it was low.?CONCLUSIONS—This study suggests that a raised serum creatinine concentration or persistent proteinuria in patients with early RA is predominantly drug related whereas, in contrast, isolated haematuria is more directly associated with the activity of the disease process.??

Koseki, Y; Terai, C; Moriguchi, M; Uesato, M; Kamatani, N



Early menopause and severity of rheumatoid arthritis in women older than 45 years  

PubMed Central

Introduction We aimed to investigate whether recognized hormonal predictors of rheumatoid arthritis (RA) also influence the severity of RA. Methods One hundred thirty-four incident RA cases identified by four different local and national registers, who had participated in a community-based health survey between 1991 and 1996, were included. By a retrospective structured review of the medical records, information on the use of disease-modifying antirheumatic drugs (DMARDs), erosions on radiographs, rheumatoid factor (RF) status, and disability measured by using the health assessment questionnaire (HAQ) were collected. The variables were added to the SPSS TwoStep Cluster Analysis to reveal natural groupings of RA severity. Known hormonal predictors analyzed were breastfeeding history, history of oral contraceptive (OC) use, and menopausal age. Results The mean age at RA diagnosis was 63.4 years; 72% were RF positive, and 28% had received biological treatment. Three clusters were identified, one with severe RA, one with mild/moderate RF-positive RA, and one with mild/moderate RF-negative RA. A significant difference (P = 0.005) was found in the distribution of clusters between patients with a history of early menopause compared with those with menopause after 45 years, with a higher proportion with mild/moderate RF-negative RA in the early-menopause subset. No major difference in severity of the disease was noted depending on OC use or history of breastfeeding. Conclusions Early menopause was associated with a milder form of RA. Hormonal changes may influence pathways that are distinct from those leading to severe, progressive disease.



A parallel group cohort to determine the measurement properties of an early inflammatory arthritis detection tool.  


Objectives. To determine the comprehensibility, internal consistency, test-retest reliability and discriminative properties of an early inflammatory arthritis (IA) detection tool. Methods. Four groups were recruited from outpatient clinics at two tertiary care hospitals: early IA, established IA, non-IA musculoskeletal conditions (MSK) and non-MSK. Participants attended a study visit where they completed the 11-item tool with binary yes/no response options. Comprehensibility was assessed for each tool item on a 5-point Likert scale. For test-retest assessment, the tool was mailed to participants following a 2-week recall washout interval. Two items were randomly selected to test internal consistency. Discriminative properties compared tool item responses with blinded rheumatologist clinical assessments. A previously developed rheumatology triage algorithm was externally validated. Results. A total of 170 participants were enrolled in the study. Comprehensibility approached unity for all tool items. The internal consistency Kuder-Richardson Formula 20 was 0.985 (P < 0.0001). The mean test-retest reliability kappa (s.d.) was 0.81 (0.02). The intraclass correlation coefficient (ICC) (95% CI) for summed yes responses between test and retest phases was 0.94 (0.93, 0.95) and for algorithm scores was 0.97 (0.96, 0.98). Patient responses were significantly associated with the corresponding clinical evaluations (P < 0.0001, respectively). The sum of yes responses and rheumatology triage algorithm scores both differentiated early IA from each of the other three groups (P < 0.004, respectively). The scoring algorithm receiver operating characteristic plot area under the curve (s.e.) was 0.829 (0.003). Conclusion. The tool has favourable measurement and discriminative properties. The discriminative properties of the rheumatology triage scoring algorithm were externally validated. PMID:23962625

Tavares, Ruben; Huang, Selena; Bykerk, Vivian P; Bell, Mary J



Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression  

Microsoft Academic Search

ObjectivesTo identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol.MethodsA total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and\\/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination

Silvia Bosello; Anna Laura Fedele; Giusy Peluso; Elisa Gremese; Barbara Tolusso; Gianfranco Ferraccioli



Serum levels of matrix metalloproteinase-3 in relation to the development of radiological damage in patients with early rheumatoid arthritis  

Microsoft Academic Search

Objective. To evaluate the significance of serum matrix metalloproteinase-3 (MMP-3) levels in relation to the development of radiological damage ( X-ray damage) in early rheumatoid arthritis (RA). Methods. Serum MMP-3 levels were measured in 46 healthy controls (CTRL), 19 osteoarthritis (OA) and 78 RA patients with joint symptoms for <1 yr at presentation (T0): 48 patients without and 30 with

M. D. Posthumus; P. C. Limburg; J. Westra; H. A. Cats; R. E. Stewart; M. A. van Leeuwen; M. H. van Rijswijk



The relationship between the presence of anti-cyclic citrullinated peptide antibodies and clinical phenotype in very early rheumatoid arthritis  

Microsoft Academic Search

BACKGROUND: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA, but are not detectable in all RA patients. The aim of this study was to establish whether the clinical phenotypes of anti-CCP positive and negative disease are distinct at the earliest clinically apparent phase of disease. METHODS: Patients were recruited from the Birmingham early inflammatory arthritis clinic. Participants were

Mohammed Z Cader; Andrew D Filer; Christopher D Buckley; Karim Raza



Why are Dutch rheumatologists reluctant to use the COBRA treatment strategy in early rheumatoid arthritis?  

PubMed Central

Background The Combinatietherapie Bij Reumatoide Artritis (COBRA) trial has proved that combination therapy with prednisolone, methotrexate and sulphasalazine is superior to sulphasalazine monotherapy in suppressing disease activity and radiological progression of early rheumatoid arthritis (RA). In addition, 5?years of follow?up proved that COBRA therapy results in sustained reduction of the rate of radiological progression. Despite this evidence, Dutch rheumatologists seem reluctant to prescribe COBRA therapy. Objective To explore the reasons for the reluctance in Dutch rheumatologists to prescribe COBRA therapy. Methods A short structured questionnaire based on social–psychological theories of behaviour was sent to all Dutch rheumatologists (n?=?230). Results The response rate was 50%. COBRA therapy was perceived as both effective and safe, but complex to administer. Furthermore, rheumatologists expressed their concern about the large number of pills that had to be taken, the side effects of high?dose prednisolone and the low dose of methotrexate. Although the average attitude towards the COBRA therapy was slightly positive (above the neutral point), the majority of responding rheumatologists had a negative intention (below the neutral point) to prescribe COBRA therapy in the near future. Conclusion The reluctance of Dutch rheumatologists to prescribe effective COBRA therapy may be due to perceptions of complexity of the treatment schedule and negative patient?related consequences of the therapy.

van Tuyl, Lilian H D; Plass, Anne Marie C; Lems, Willem F; Voskuyl, Alexandre E; Dijkmans, Ben A C; Boers, Maarten



Collagen-specific T-cell repertoire in blood and synovial fluid varies with disease activity in early rheumatoid arthritis  

PubMed Central

Introduction Type II collagen is a DR4/DR1 restricted target of self-reactive T cells that sustain rheumatoid arthritis. The aim of the present study was to analyze the T-cell receptor repertoire at the onset of and at different phases in rheumatoid arthritis. Methods We used the CDR3 BV-BJ spectratyping to study the response to human collagen peptide 261–273 in 12 patients with DR4+ rheumatoid arthritis (six at the onset of disease and six during the course of disease) and in five healthy DR4+ relatives. Results The collagen-specific T-cell repertoire is quite restricted at the onset of disease, involving approximately 10 rearrangements. Within the studied collagen-specific rearrangements, nearly 75% is shared among patients. Although the size of the repertoire used by control individuals is comparable to that of patients, it is characterized by different T-cell receptors. Part of the antigen-specific T-cell repertoire is spontaneously enriched in synovial fluid. The specific T-cell repertoire in the periphery was modulated by therapy and decreased with the remission of the disease. Failure of immunoscopy to detect this repertoire was not due to suppression of collagen-driven proliferation in vitro by CD4+ CD25+ T cells. Clinical relapse of the disease was associated with the appearance of the original collagen-specific T cells. Conclusions The collagen-specific T-cell receptor repertoire in peripheral blood and synovial fluid is restricted to a limited number of rearrangements in rheumatoid arthritis. The majority of the repertoire is shared between patients with early rheumatoid arthritis and it is modulated by therapy.

Ria, Francesco; Penitente, Romina; De Santis, Maria; Nicolo, Chiara; Di Sante, Gabriele; Orsini, Massimiliano; Arzani, Dario; Fattorossi, Andrea; Battaglia, Alessandra; Ferraccioli, Gian Franco



Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression  

PubMed Central

Objectives To identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol. Methods A total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination with anti-tumour necrosis factor if the patient did not achieve a 44-joint Disease Activity Score (DAS44) ?2.4. At baseline and after 12 months all the patients had hand and foot joint radiographs. Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks. Results In all, 46.3% of the patients reached DAS remission and 24.8% achieved ACR remission. More than 60% of patients reached remission with MTX. Male sex and an erythrocyte sedimentation rate <35 mm/h at onset arose as significant predictors of EULAR remission, while VERA disease was the only predictor of ACR remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis demonstrated that the only independent predictor of erosiveness was ‘not having VERA disease’. After 12 months, VERA was the only factor predicting a lack of new erosions. Conclusions VERA represents the best therapeutic opportunity in clinical practice to achieve a complete remission and to stop the erosive course of rheumatoid arthritis.

Bosello, Silvia; Fedele, Anna Laura; Peluso, Giusy; Gremese, Elisa; Tolusso, Barbara; Ferraccioli, Gianfranco



Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage  

PubMed Central

Objective: To study the value of antibodies to citrullinated proteins/peptides for predicting joint outcomes in patients with recent onset rheumatoid arthritis (RA). Methods: 191 patients with RA onset within the past year were followed up prospectively for five years. Serum samples obtained from 145 patients at baseline before disease modifying antirheumatic drug treatment were examined using three anticitrullinated protein/peptide antibody assays: antiperinuclear factor (APF) by indirect immunofluorescence (IIF), antikeratin antibodies (AKA) by IIF, and anti-cyclic citrullinated peptide (CCP) antibodies by enzyme linked immunosorbent assay (ELISA). Radiographs of the hands and feet taken at baseline and after three and five years were evaluated using Sharp scores modified by van der Heijde. Results:Anti-CCP ELISA was positive in 58.9% of patients. APF/anti-CCP agreement was 77%. The likelihood of a total Sharp score increase after five years was significantly greater among patients with anti-CCP antibodies (67%; odds ratio (OR) 2.5; 95% confidence interval (95% CI) 1.2 to 5.0) or APF (57%; OR 2.4; 95% CI 1.2 to 4.9) but not rheumatoid factor (RF; OR 0.7; 95% CI 0.3 to 1.5). Mean values for radiographic damage, erosion, and joint narrowing scores at the three times were significantly higher in patients with anti-CCP or APF than in those without. AKA did not significantly predict radiographic damage. In separate analyses of patients with and without RF, anti-CCP or APF was better than RF for predicting total joint damage and joint damage progression after five years. Conclusion: Antibodies to citrullinated proteins/peptides determined early in the course of RA by APF IIF or anti-CCP ELISA are good predictors of radiographic joint damage. Further studies of clinical, laboratory, and genetic parameters are needed to improve RA outcome prediction in clinical practice.

Meyer, O; Labarre, C; Dougados, M; Goupille, P.; Cantagrel, A; Dubois, A; Nicaise-Roland, P; Sibilia, J; Combe, B



Do Carotid Artery Diameters Manifest Early Evidence of Atherosclerosis in Women with Rheumatoid Arthritis?  

PubMed Central

Abstract Objective Given the high incidence of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), we examined the associations between RA diagnosis and characteristics and evidence of carotid atherosclerosis. We take a unique approach by evaluating lumen and interadventitial diameters in addition to intima-media thickness and plaque. Methods Ninety-three women with RA were matched with 93 healthy women by age, race, and menopause status. In cross-sectional analyses, we compared common carotid artery measures between groups and examined their relationships with measures of RA severity and activity. Results Mean age was 53.3 years, and median RA duration was 14 years. Lumen diameter in patients was significantly greater than in healthy women (5.50 vs. 5.19?mm, p?early indicator of increased cardiovascular risk.

Kao, Amy H.; Cunningham, Amy; Wildman, Rachel P.; Kuller, Lewis H.; Sutton-Tyrrell, Kim; Wasko, Mary Chester M.



Comparative study of fat-suppressed Gd-enhanced MRI of hands in the early stage of rheumatoid arthritis (RA) and non-RA  

Microsoft Academic Search

The object of this work was to evaluate the usefulness of fat-suppressed gadolinium (Gd)-enhanced magnetic resonance imaging\\u000a (MRI) for the diagnosis of early-stage rheumatoid arthritis. Forty wrists of patients who had suffered from stiff or swollen\\u000a hands for 1–12 months were examined prospectively by MRI. Rheumatoid arthritis (RA) was proven in 21 patients, and the other\\u000a 19 patients were not

Tomoko Matsumoto; Toshiyuki Tsurumoto; Hiroyuki Shindo; Masataka Uetani



Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability  

Microsoft Academic Search

INTRODUCTION: Aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) plays a major role in improving early rheumatoid arthritis (RA) patient outcomes. Persistence and adherence with medication occurs variably (20% to 70%). The objectives of the study were to determine medication persistence (MP) in early RA patients over 13 consecutive visits each 2 months apart, to investigate the relationship between MP and

Virginia Pascual-Ramos; Irazú Contreras-Yáñez; Antonio R Villa; Javier Cabiedes; Marina Rull-Gabayet



Psoriatic Arthritis  


... Diseases and treatments M - P Psoriatic arthritis Psoriatic arthritis Psoriatic arthritis. Having swollen joints in the hands is common. ... people who have psoriasis get a type of arthritis called psoriatic (sore-ee-at-ic) arthritis. This ...


Cystatin C, an early indicator for incipient renal disease in rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis (RA) is a chronic disease requiring potential nephrotoxic therapy with nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs). The rationale of our study was to examine the renal status of patients suffering from prolonged RA by means of plasma cystatin C, a new parameter of renal function. Fifty-six patients affected with RA for more than 5

Harald Mangge; Peter Liebmann; Hinazant Tanil; Josef Herrmann; Carola Wagner; Siegfried Gallistl; Konrad Schauenstein; Wolfgang Erwa



Excretion of pyridinium crosslinks correlates with disease activity and appendicular bone loss in early rheumatoid arthritis  

Microsoft Academic Search

OBJECTIVE--To establish if urinary excretion rates of the collagen crosslinks pyridinoline and deoxypyridinoline, which are known to be elevated in established rheumatoid arthritis (RA), are useful markers of bone loss in this disease. METHODS--Eight hour urine collections on all patients and 52 controls were performed, and the rates of pyridinoline and deoxypyridinoline excretion were measured. Bone mineral density (BMD), by

A K Gough; N F Peel; R Eastell; R L Holder; J Lilley; P Emery



The ratio of circulating osteoprotegerin to RANKL in early rheumatoid arthritis predicts later joint destruction  

Microsoft Academic Search

Objective. Rheumatoid arthritis (RA) is a chronic inflammatory disease that may result in debilitating joint deformities with destruction of bone and cartilage. Inflammation is still considered the pivotal inducer of both components of joint damage. Results of recent animal studies suggested a prominent contribution of osteoclastic bone resorption that could be dissociated from inflammation. RANKL and its natural decoy re-

P. P. Geusens; R. B. M. Landewé; P. Garnero; D. Chen; C. R. Dunstan; W. F. Lems; P. Stinissen; D. M. F. M. van der Heijde; S. van der Linden; M. Boers



Aggressive rheumatoid arthritis registry in Italy. Characteristics of the early rheumatoid arthritis subtype among patients classified according to the ACR criteria.  


The Italian Society of Rheumatology in the year 2000 decided to sponsor the creation of a data base (Registry) of consecutive patients who fulfilled the diagnosis of rheumatoid arthritis (RA) according to the American College of Rheumatology (ACR) criteria. The registry is designed to collect data on the "aggressive" type of RA all over the country in order to determine the percentage of patients who satisfy the established criteria among incident cases of RA and to define the therapeutic approach according to the characteristics of the enrolled patients. Predefined criteria set up by eight recognized opinion leaders on the disease were used by all the centers to create the database. The GIARA registry (Gruppo Italiano Artrite Reumatoide Aggressiva) has now enrolled 706 patients who will be followed up for 24 months. They have been divided into two major subsets--patients with early (< 4 months' disease duration) and late (> 4 months) RA--with the aim of establishing whether differences in clinical, serological, radiographic and therapeutic (DMARDs: disease modifying antirheumatic drugs) parameters may distinguish the two subsets. The major conclusion of this preliminary analysis is that an overall tendency to undertreatment is discernable. PMID:14969064


Rheumatoid arthritis.  


Since the advent of disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis, there has been an increasing emphasis on the early diagnosis and monitoring of this condition. This has led to the greater involvement of advanced imaging techniques such as ultrasound and MRI. Ultrasound appearances of common findings in rheumatoid arthritis are discussed in this review. Comparison of ultrasound in terms of sensitivity and specificity with other imaging modalities and with clinical examination is also made. Quantification is also discussed as a tool to allow assessment of response to drug therapy, an area that is likely to progress further as techniques become increasingly reproducible. Finally, as ultrasound techniques continue to develop, its involvement in the management of patients with rheumatoid arthritis is increasing. New techniques such as fusion imaging and sonoelastography, while at present still largely research-based entities, may offer increasingly improved diagnostic benefits in the field of inflammatory arthropathy. PMID:23487337

Grainger, Andrew J; Rowbotham, Emma L



Antibodies to citrullinated human fibrinogen (ACF) have diagnostic and prognostic value in early arthritis  

Microsoft Academic Search

BACKGROUND: The anti-cyclic citrullinated peptide (CCP) test has a high sensitivity and specificity for rheumatoid arthritis, although CCP is not the physiological target of the autoantibodies. Citrullinated fibrin is abundant in inflamed synovium OBJECTIVE: To assess the diagnostic and prognostic value of antibodies against citrullinated fibrinogen (ACF), a soluble precursor of fibrin, in comparison with IgM-rheumatoid factor (IgM-RF) and the

M M J Nielen; Horst van der A. R; Schaardenburg van D; Horst-Bruinsma van der I. E; Stadt van de RJ; L. A. Aarden; B. A. C. Dijkmans; D. Hamann



A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study.  

PubMed Central

OBJECTIVE: To produce a practical algorithm to predict which patients with early rheumatoid arthritis will develop radiological erosions. DESIGN: Primary care based prospective cohort study. SETTING: All general practices in the Norwich Health Authority, Norfolk. SUBJECTS: 175 patients notified to the Norfolk Arthritis Register were visited by a metrologist soon after they had presented to their general practitioners with inflammatory polyarthritis, and again after a further 12 months. All the patients satisfied the American Rheumatism Association's 1987 criteria for rheumatoid arthritis and were seen by a metrologist within six months of the onset of symptoms. The study population was randomly split into a prediction sample (n = 105) for generating the algorithm and a validation sample (n = 70) for testing it. MAIN OUTCOME MEASURES: Predictor variables measured at baseline included rheumatoid factor status, swelling of specific joint areas, duration of morning stiffness, nodules, disability score, age, sex, and disease duration when the patient first presented. The outcome variable was the presence of radiological erosions in the hands or feet, or both, after 12 months. RESULTS: A simple algorithm based on a combination of three variables--a positive rheumatoid factor test, swelling of at least two large joints, and a disease duration of more than three months--was best able to predict erosions. When the accuracy of this algorithm was tested with the validation sample, the erosion status of 79% of patients was predicted correctly. CONCLUSIONS: A simple algorithm based on three easily measured items of information can predict which patients are at high risk and which are at low risk of developing radiological erosions.

Brennan, P.; Harrison, B.; Barrett, E.; Chakravarty, K.; Scott, D.; Silman, A.; Symmons, D.



Current smoking status is associated to a non-ACR 50 response in early rheumatoid arthritis. A cohort study.  


The purpose of this study is to determine factors associated with a non-ACR 50 response at 6 months of follow-up, in a cohort of patients with early rheumatoid arthritis (RA). Early RA patients (symptom duration <1 year), treated with the same combination treatment (methotrexate and sulfasalazine), were included. Demographic characteristics of the patients including current smoker status (defined as a patient that smokes at least one cigarette per day), years of formal education, a 28-joint count for swelling and tenderness were registered. A basal HAQ questionnaire, visual scales for global assessment, and pain were answered by all patients, and a CDAI basal score was calculated. The ACR 50 response was determined at 6 months follow-up. Multivariable logistic regression analysis was used to calculate adjusted ORs. Two hundred twenty-five patients were evaluated, but only 144 had a complete follow-up, 43% of the latter did not reach an ACR 50 response. The only factor associated with this outcome was current smoking (OR 3.58, P?early rheumatoid arthritis in patients treated with a combination therapy with methotrexate and sulfasalazine. PMID:21607552

Rojas-Serrano, Jorge; Pérez, Leticia Lino; García, Conrado García; Moctezuma, Francisco; Álvarez-Hernández, Everardo; Vázquez-Mellado, Janitzia; Montiel, José Luis; Burgos-Vargas, Rubén



Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF.  


Abstract Purpose: To explore what work-related dilemmas are experienced by patients with early rheumatoid arthritis (RA), according to their own descriptions, and to interpret this in terms of participation categories of the International Classification of Functioning, Disability and Health (ICF). Method: In 48 patients with early RA, qualitative interviews were analyzed, followed by linking of concepts to the activity/participation component of the ICF and interpretation of general themes. Results: Work-related dilemmas represented different societal perspectives on work related to acquiring, keeping and terminating a job, self-employment, part-time, full-time and non-remunerative employment. Dilemmas also represented participation priorities in economic self-sufficiency, self-care such as health care, and avoiding social relationships and recreation in favor of work. Leisure time was influenced because efforts of working took energy and time of day-to-day procedures. Embedded actions in work-related dilemmas were carrying out daily routine, mobility including using transportation, self-care, domestic life and social interaction. Conclusion: The general themes societal perspectives, participation priorities and embedded actions, with the included ICF categories that are described in detail according to the experiences of the patients, can support clinical reasoning and research on quantitative relations to disease activity, body functions, ability and contextual factors. Implications for Rehabilitation In early rheumatoid arthritis, keeping a job is complex; patients and practitioners need to know and handle the perspectives of, e.g. employers and social insurance agents. Participation in work is an issue of prioritizing against, e.g. maintaining one's health and social relationships. Rehabilitation practitioners need to analyze what actions are embedded in a work situation. PMID:23639067

Sverker, Annette; Thyberg, Ingrid; Ostlund, Gunnel; Waltersson, Eva; Thyberg, Mikael



Radiographic progression in early rheumatoid arthritis: a 12-month randomized controlled study comparing the combination of cyclosporin and methotrexate with methotrexate alone  

Microsoft Academic Search

Objective. To determine whether patients with early rheumatoid arthritis (RA) treated with cyclosporin A (CsA) and methotrexate (MTX) in combination for 12 months show a lower rate of radiographic deterioration than those treated with MTX alone. Methods. In this controlled and randomized single-blind trial, 61 consecutive patients with untreated RA of less than 2 yr duration were treated with either

A. Marchesoni; N. Battafarano; M. Arreghini; B. Panni; M. Gallazzi; S. Tosi



Serum Levels of Asymmetric Dimethylarginine and Apelin as Potential Markers of Vascular Endothelial Dysfunction in Early Rheumatoid Arthritis  

PubMed Central

Objectives. Impaired endothelial function represents the early stage of atherosclerosis, which is typically associated with systemic inflammatory diseases like rheumatoid arthritis (RA). As modulators of endothelial nitric oxide synthase expression, asymmetric-dimethylarginine (ADMA) and apelin might be measured in the blood of RA patients to detect early atherosclerotic changes. We conducted a prospective, case-control study to investigate serum ADMA and apelin profiles of patients with early-stage RA (ERA) before and after disease-modifying antirheumatic drug (DMARD) therapy. Methods. We enrolled 20 consecutively diagnosed, treatment-naïve patients with ERA and 20 matched healthy controls. Serum ADMA and apelin levels and the 28-joint disease activity scores (DAS28) were assessed before and after 12 months of DMARDs treatment. All patients underwent ultrasonographic assessment for intima-media tickness (IMT) evaluation. Results. In the ERA group, ADMA serum levels were significantly higher than controls at baseline (P = 0.007) and significantly decreased after treatment (P = 0.012 versus controls). Baseline serum apelin levels were significantly decreased in this group (P = 0.0001 versus controls), but they were not significantly altered by treatment. IMT did not show significant changes. Conclusions. ERA is associated with alterations of serum ADMA and apelin levels, which might be used as biomarkers to detect early endothelial dysfunction in these patients.

Di Franco, Manuela; Spinelli, Francesca Romana; Metere, Alessio; Gerardi, Maria Chiara; Conti, Virginia; Boccalini, Francesca; Iannuccelli, Cristina; Ciciarello, Francesco; Agati, Luciano; Valesini, Guido



Psoriatic Arthritis  


... arthritis that have similar signs and symptoms, including gout, osteoarthritis and rheumatoid arthritis. In patients with psoriatic ... maintain mobility. Psoriatic arthritis is sometimes misdiagnosed as gout, rheumatoid arthritis or osteoarthritis. The rheumatologist's role in ...


MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA)  

Microsoft Academic Search

Objective:To identify predictors of radiographic progression in a 2-year randomised, double-blind, clinical study (CIMESTRA) of patients with early rheumatoid arthritis (RA).Methods:Patients with early RA (n = 130) were treated with methotrexate, intra-articular betamethasone and ciclosporin\\/placebo-ciclosporin. Baseline magnetic resonance imaging (MRI) of the wrist (wrist-only group, n = 130) or MRI of wrist and metacarpophalangeal (MCP) joints (wrist+MCP group, n =

M L Hetland; B Ejbjerg; K Hørslev-Petersen; S Jacobsen; A Vestergaard; A G Jurik; K Stengaard-Pedersen; P Junker; T Lottenburger; I Hansen; L S Andersen; U Tarp; H Skjødt; J K Pedersen; O Majgaard; A J Svendsen; T Ellingsen; H Lindegaard; A F Christensen; J Vallø; T Torfing; E Narvestad; H S Thomsen; M Østergaard



Early effects of tumour necrosis factor ? blockade on skin and synovial tissue in patients with active psoriasis and psoriatic arthritis  

PubMed Central

Background: Tumour necrosis factor ? (TNF?) blockade using infliximab, a chimeric anti-TNF? antibody, is an effective treatment for both psoriasis and psoriatic arthritis (PsA). Objective: To analyse the early effects of infliximab treatment on serial skin and synovial tissue biopsy samples. Methods: Twelve patients with both active psoriasis and PsA received a single infusion of either infliximab (3 mg/kg) (n = 6) or placebo (n = 6) intravenously. Synovial tissue and lesional skin biopsy specimens were obtained at baseline and 48 hours after treatment. Immunohistochemical analysis was performed to analyse the inflammatory infiltrate. In situ detection of apoptotic cells was performed by TUNEL assay and by immunohistochemical staining with anti-caspase-3 antibodies. Stained tissue sections were evaluated by digital image analysis. Results: A significant reduction in mean (SEM) T cell numbers was found in both lesional epidermis (baseline 37 (11) cells/mm, 48 hours 26 (11), p = 0.028) and synovial tissue (67 (56) cells/mm2v 32 (30), p = 0.043) after infliximab treatment, but not after placebo treatment (epidermis 18 (8) v 43 (20), NS; synovium 110 (62) v 46 (21), NS). Similarly, the number of macrophages in the synovial sublining was significantly reduced after anti-TNF? treatment (100 (73) v 10 (8), p = 0.043). The changes in cell numbers could not be explained by induction of apoptosis at the site of inflammation. Conclusions: The effects of anti-TNF? therapy in psoriasis and psoriatic arthritis may be explained by decreased cell infiltration in lesional skin and inflamed synovial tissue early after initiation of treatment.

Goedkoop, A; Kraan, M; Teunissen, M; Picavet, D; de Rie, M A; Bos, J; Tak, P



Anti-Cyclic Citrullinated Peptide Antibody: An Early Diagnostic and Prognostic Biomarker of Rheumatoid Arthritis  

PubMed Central

Objectives To evaluate the role of Anti-Cyclic Citrullinated Peptide (anti-CCP) antibody and Rheumatoid Factor (RF) in Rheumatoid Arthritis (RA) patients. Methods The present study comprised of 60 clinically diagnosed rheumatoid arthritis patients and 30 apparently healthy subjects as controls. Among 60 RA patients, 30 were <2 years duration and 30 were 3 to 15 years duration. Anti-CCP and RF levels were analyed by ELISA and immunoturbidimetric assay respectively. Disease activity was assessed by disease duration, duration of morning stiffness, hand deformity and radiological findings. Anti-CCP and rheumatoid factor were measured. Result A valid comparison showed that autoantibodies directed to citrullinated antigen–anti-CCP are superior to RF for the detection of RA. Anti-CCP antibodies have an independent role in predicting radiological damage and progression in RA patients. Conclusion With their excellent specificity, anti-CCP antibodies can be used as serological marker in establishing the diagnosis of RA. Anti-CCP antibodies discriminated accurately between erosive and nonerosive RA making them a potentially good prognostic marker for the disease.

Manivelavan, D.; C.K., Vijayasamundeeswari



A high serum level of eotaxin (CCL 11) is associated with less radiographic progression in early rheumatoid arthritis patients  

PubMed Central

Introduction Prognosis in rheumatoid arthritis (RA) is difficult to assess. The aim of this study was to examine whether serum levels of a spectrum of cytokines were predictive of radiographic progression in early RA patients. Methods A total of 82 early RA patients (disease duration < 1 year) were followed for 12 months. Clinical assessments, X-rays of hands and magnetic resonance imaging (MRI) of the dominant wrist were assessed at baseline and after 3, 6 and 12 months. The X-rays were scored according to the van der Heijde modified Sharp score (vdHSS). Cytokine analyses were performed with multiplex technology. Associations between cytokines and radiographic progression were examined by logistic regression. Results In all, 49% of the patients developed radiographic progression. The median (interquartile range (IQR)) baseline eotaxin level (pg/ml) was significantly lower in patients with (193 (119 to 247)) than without progression (265 (166 to 360)). In the univariate logistic regression analyses, eotaxin was negatively associated to radiographic progression, and this association was maintained in the multivariate model with an odds ratio (OR) (95% confidence interval (CI)) for progression of 0.58 (0.41 to 0.82) per 50 pg/ml increase in eotaxin level. None of the other measured cytokines showed any association to radiographic progression. Conclusion This study raises the hypothesis that high serum levels of eotaxin predict less radiographic progression in early RA patients.

Syversen, Silje W; Goll, Guro L; Haavardsholm, Espen A; B?yesen, Pernille; Lea, Tor; Kvien, Tore K



Elevated levels of IgM and IgA antibodies to Proteus mirabilis and IgM antibodies to Escherichia coli are associated with early rheumatoid factor (RF)-positive rheumatoid arthritis  

Microsoft Academic Search

Objective. Antibodies to Proteus mirabilis were previously detected in patients with established rheumatoid arthritis (RA). We examined the prevalence of antibodies to P. mirabilis and their associations with RA in early synovitis patients. Methods. Two hundred and forty-six patients with inflammatory arthritis for less than 1 yr were prospectively evaluated for 1 yr. Of these patients, 30% had rheumatoid factor

M. M. Newkirk; R. Goldbach-Mansky; B. W. Senior; J. Klippel; H. R. Schumacher Jr; H. S. El-Gabalawy



The Palomar-Leiden survey of faint minor planets - Conclusion  

Microsoft Academic Search

The results are given of a revision and small extension of the Palomar-Leiden survey of minor planets (van Houten et al., 1970). The majority of the class-4 orbits in the original survey are rederived using positions measured from the second plate of each blink pair, and in some cases the orbits are raised to class-1 quality by the identification of

C. J. van Houten; P. Herget; B. G. Marsden



Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis.  

PubMed Central

The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness. Images

Mottonen, T T; Hannonen, P; Toivanen, J; Rekonen, A; Oka, M



Mannose-binding lectin deficiency is associated with early onset of polyarticular juvenile rheumatoid arthritis: a cohort study  

PubMed Central

Background Mannose-binding lectin (MBL) is an innate immune protein. The aim of our study was to determine whether genetically determined MBL deficiency is associated with susceptibility to juvenile rheumatoid arthritis (JRA) and whether MBL2 genotypes are associated with JRA severity. Methods In a retrospective cohort study of 218 patients with polyarthritis (n = 67) and oligoarthritis (n = 151), clinical and laboratory disease variables were obtained by clinical examination and chart reviews. Healthy Caucasian adults (n = 194) served as control individuals. MBL2 gene mutations were determined by Taqman analysis to identify genotypes with high, medium and low expression of MBL. Functional MBL plasma concentrations were measured using enzyme-linked immunosorbent assay. Associations between clinical and laboratory variables and MBL2 genotypes were determined by Kruskal-Wallis and ?2 tests. Results MBL2 genotype frequencies were similar in polyarthritis and oligoarthritis patients as compared with control individuals. MBL plasma concentrations were associated with the high, medium and low MBL genotype expression groups (P < 0.01). In polyarthritis patients, the presence of low-expressing (deficient) MBL2 genotypes was associated with early age at onset of disease (P = 0.03). In oligoarthritis patients, patients with low-expressing MBL2 genotypes were more often in remission (81%) than patients in the medium (54%) and high (56%) genotype groups (P = 0.02). The remaining clinical and laboratory variables, such as arthritis severity index, presence of radiographic erosions and antinuclear antibody positivity, were not associated with MBL2 genotypes. Conclusion Genetically determined MBL deficiency does not increase susceptibility to JRA, but MBL deficiency is associated with a younger age at onset of juvenile polyarthritis. On the other hand, MBL-deficient children with juvenile oligoarthritis are more often in remission. Therefore, MBL appears to play a dual role in JRA.

Dolman, Koert M; Brouwer, Nannette; Frakking, Florine NJ; Flat?, Berit; Tak, Paul P; Kuijpers, Taco W; F?rre, ?ystein; Smerdel-Ramoya, Anna



Early diagnosis and treatment of rheumatoid arthritis for improved outcomes: focus on etanercept, a new biologic response modifier.  


Early diagnosis and prompt treatment can improve outcomes in rheumatoid arthritis (RA). Significant joint damage occurs early in the course of the disease, when RA is most aggressive. Many rheumatologists now advocate an inverted pyramid approach to therapy, in which treatment with disease-modifying antirheumatic drugs is initiated on diagnosis. The goals of this approach are to preserve patient function and to slow disease progression. Current therapies exhibit varying degrees of efficacy and cumulative toxicity that frequently limit their usefulness, particularly with long-term use. New biologic response modifiers (BRMs) that target specific cells or cytokines involved in the inflammatory response hold great promise for RA therapy because of their improved efficacy and limited toxicity. The first BRM to be approved by the US Food and Drug Administration for use in RA is etanercept, a soluble tumor necrosis factor-receptor fusion protein. Etanercept is highly effective in relieving RA symptoms and has a good safety profile. The availability of well-tolerated therapies may encourage clinicians to diagnose and treat RA more promptly, thereby ensuring patients the best possible outcomes. PMID:10509842

Fleischmann, R M



Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study  

PubMed Central

Introduction Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease, and this occurs early in the disease process. The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in RA; however, little information is available regarding MetS in early RA. We aimed to identify the prevalence of MetS and to determine the potential factors associated with the presence of MetS in Vietnamese women with early RA. Methods A total of 105 consecutive women with early RA (disease duration ?3 years) and 105 age-matched healthy women were checked for MetS according to six MetS definitions (Joint Consensus, International Diabetes Federation, National Cholesterol Education Program 2004 and 2001, European Group for Study of Insulin Resistance, and World Health Organization). Multivariate logistic regression models were constructed to determine independent predictors of MetS in women with RA. Results Prevalence of MetS varied from 16.2% to 40.9% according to the definitions used in women with RA, and was higher (P < 0.001) than in healthy controls (from 10.5% to 22.9%). Among individual components of MetS, differences between women with RA and controls were observed for hypertension (P < 0.001), low high density lipoprotein-cholesterol (HDL-C) levels (P < 0.001), and abdominal obesity (P = 0.019). After adjusting for age and physical activity, higher erythrocyte sedimentation rate (ESR) (odds ratios (OR) = 1.516, 95% confidence interval (CI): 1.073 to 3.195, P = 0.042), disease activity score (DAS28) (OR = 1.736, 95% CI: 1.293 to 2.786, P = 0.019), health assessment questionnaire (HAQ) score (OR = 1.583, 95% CI: 1.195 to 2.367, P = 0.035), and less methotrexate use (OR = 0.736, 95% CI: 0.547 to 0.962, P = 0.024) remained significant independent predictors of the presence of MetS in women with RA. Conclusions Women with early RA already had higher prevalence of MetS compared with healthy controls. Higher systemic inflammatory marker, disease activity and disability scores, and less methotrexate use were independent predictors associated with the presence of MetS in women with early RA. These findings suggest that physicians should screen for MetS in women with early RA to control its components and therefore reduce their risk of cardiovascular diseases.



Association of autoantibodies to filaggrin with an active disease in early rheumatoid arthritis  

PubMed Central

OBJECTIVE—To evaluate the clinical significance of antifilaggrin antibodies (AFA) measured by an enzyme linked immunosorbent assay (ELISA) in serial specimens from patients with recent onset rheumatoid arthritis (RA).?METHODS—Filaggrin was purified from human skin and used as an antigen in ELISA. The AFA test was applied to five serial specimens from 78 patients with recent onset RA followed up for three years. Rheumatoid factor (RF) had been measured earlier from the same samples by quantitative immunoturbidimetry.?RESULTS—The mean AFA level was highest at entry (54% positive), followed by a statistically significant decline at six months and a slight increase at three years. AFA were persistently positive in 23 patients and persistently negative in 28 patients. Eleven of the latter patients were persistently negative for RF. At study entry AFA levels correlated to some degree with RF levels. In general, raised AFA levels at entry were associated with an active and treatment resistant disease, but they did not predict radiological progression.?CONCLUSIONS—The test for AFA has potential for an additional immunological test for RA.??

Paimela, L; Palosuo, T; Aho, K; Lukka, M; Kurki, P; Leirisalo-Repo, M; von Essen, R



The Michael Mason prize: early rheumatoid arthritis--the window narrows.  


RA is a chronic disease in which synovitis drives joint destruction. Immunomodulatory therapy in the established phase of disease limits synovitis, and slows the rate of joint destruction, but is not curative. Increasing evidence suggests that the very early phase of RA, within the first few months after the onset of symptoms, represents a pathologically distinct and temporally transient window during which outcomes can be more effectively modulated by therapy. Furthermore, recent data show that we can accurately predict the development of RA in patients with very early synovitis, using clinical and serological measures. This makes very early targeted treatment a realistic possibility. However, it remains the case that the majority of patients with very early synovitis delay for prolonged periods before seeking medical help. Effective public engagement, to reduce this delay, is the key to translate advances in the fields of pathology, prognostication and therapy into benefit for patients with new onset RA. PMID:19955223

Raza, Karim



Early changes in bone mineral density measured by digital X-ray radiogrammetry predict up to 20 years radiological outcome in rheumatoid arthritis  

Microsoft Academic Search

Introduction  Changes in bone mineral density (BMD) in the hand as evaluated by digital X-ray radiogrammetry (DXR) of the second to fourth\\u000a metacarpal bones has been suggested to predict future joint damage in patients with rheumatoid arthritis (RA). This study's\\u000a objective was to investigate whether DXR-BMD loss early in the course of the disease predicts the development of joint damage\\u000a in

Meliha C Kapetanovic; Elisabet Lindqvist; Jakob Algulin; Kjell Jonsson; Tore Saxne; Kerstin Eberhardt; Pierre Geborek



Methotrexate pneumonia lacking dyspnea and radiographic interstitial patterns during treatment for early rheumatoid arthritis: bronchoalveolar lavage and transbronchial lung biopsy in a differential diagnosis  

Microsoft Academic Search

Methotrexate (MTX) pneumonia is an unpredictable and sometimes life-threatening adverse effect occurring in the treatment\\u000a of rheumatoid arthritis (RA). We present a case of MTX pneumonia lacking severe respiratory symptoms and typical radiographic\\u000a findings. A 66-year-old man with early RA presented with intermittent fever and nonproductive cough during the MTX therapy,\\u000a but neither hypoxemia nor dyspnea was a complaint. His

Isamu Cho; Shunsuke Mori; Fumiya Imamura; Chikage Kiyofuji; Mineharu Sugimoto



The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: results of a pilot randomised 6-month trial with methotrexate  

Microsoft Academic Search

Thirty-five patients with Early Psoriatic Arthritis (EPA) (17 female and 18 male; mean age 25.6 years) entered this randomised\\u000a 6-month study. At the enrolment, all patients were on non-steroidal anti-inflammatory drug (NSAID) therapy on demand and were\\u000a divided in two matched groups (A and B). Group A continued NSAID therapy at full dosage in the following 3 months and then\\u000a added methotrexate

Raffaele Scarpa; Rosario Peluso; Mariangela Atteno; Francesco Manguso; Angelo Spanò; Salvatore Iervolino; Matteo Nicola Dario Di Minno; Luisa Costa; Antonio Del Puente



Clinical significance of low titer anti-nuclear antibodies in early rheumatoid arthritis: implications on the presentation and long-term course of the disease  

Microsoft Academic Search

The objective of this study was to evaluate the clinical significance of anti-nuclear antibodies (ANA) detected in the early\\u000a stages of rheumatoid arthritis (RA), by a retrospective comparison of the clinical, laboratory, and therapeutic characteristics\\u000a of patients with or without ANA. The files of 99 longstanding seropositive RA patients were reviewed. Data relating to demographics,\\u000a medical history, family history, physical

Dan Caspi; Ori Elkayam; Miruna Eisinger; Nurit Vardinon; Michael Yaron; Michael Burke



Circadian Relationships between Interleukin (IL)-6 and Hypothalamic-Pituitary-Adrenal Axis Hormones: Failure of IL6 to Cause Sustained Hypercortisolism in Patients with Early Untreated Rheumatoid Arthritis  

Microsoft Academic Search

Systemic symptoms in rheumatoid arthritis (RA) are mediated, at least in part, by elevated levels of circulating interleukin (IL)-6, and this cytokine is also a potent stimulus of the hypothalamic-pituitary- adrenal axis. To evaluate the 24-h circadian secretory dynamics of ACTH, cortisol, and IL-6 and their interactions in patients with early untreated RA, we recruited and studied five newly diagnosed,



The PTPN22 1858C\\/T polymorphism is associated with anti-cyclic citrullinated peptide antibody-positive early rheumatoid arthritis in northern Sweden  

Microsoft Academic Search

The PTPN22 1858C\\/T polymorphism has been associated with several autoimmune diseases including rheumatoid arthritis (RA). We have shown that carriage of the T variant (CT or TT) of PTPN22 in combination with anti-cyclic citrullinated peptide (anti-CCP) antibodies highly increases the odds ratio for developing RA. In the present study we analysed the association between the PTPN22 1858C\\/T polymorphism and early

Heidi Kokkonen; Martin Johansson; Lena Innala; Erik Jidell; Solbritt Rantapää-Dahlqvist



Does the serum level of IgA-alpha-1-antitrypsin complex correlate with radiological progression in early rheumatoid arthritis? A 3-year follow-up study  

Microsoft Academic Search

We followed the levels of serum IgA-alpha-1-antitrypsin (IgA-AT) complex in 37 patients with early rheumatoid arthritis (RA) during the first 3 years of the disease. The changes in IgA-AT were correlated with a radiological damage score (DS) of the hands assessed according to Larsen. At the onset of the disease, the IgA-AT serum concentration was significantly higher as compared to

J. K. Lacki; T. Schochat; W. Müller; W. Porawska; S. H. Mackiewicz



Randomized phase 2 trial of anti-tumor necrosis factor therapy for cachexia in patients with early rheumatoid arthritis1-3  

Microsoft Academic Search

Background:Tumornecrosisfactor(TNF)isanimportantmediator of cachexia, and its blockade prevents catabolism in animal models. However,littleevidenceshowsthatanti-TNFtherapyiseffectivein treating cachexia in humans. Objective: The main aim of this study was to investigate the effect of etanercept, a synthetic soluble TNF receptor, on body composi- tion in patients with early rheumatoid arthritis (RA). Design: Twenty-six patients were randomly assigned to 24 wk of treatment with etanercept or

Samuele M Marcora; Kathryn R Chester; Gayatri Mittal; Andrew B Lemmey; Peter J Maddison


Reactive Arthritis  


... reactive arthritis. The most common ones include: Chlamydia Salmonella Shigella Yersinia Campylobacter Reactive arthritis isn't contagious. ... borne bacteria that can cause reactive arthritis, including salmonella, shigella, yersinia and campylobacter. In addition, practice safe ...


Nonhealing ulcer secondary to factor V Leiden mutation and cryofibrinogenemia.  


Factor V Leiden is the most common genetic thrombophilia in people of European descent, and is important to recognize as it can have significant implications in dermatology. We report a case of a 30-year-old man who presented for evaluation and treatment of a chronic ulceration on the site of his stump following a below the knee amputation which had been performed for non-healing ulcerations. Despite a variety of treatments, his ulcer persisted. He was referred to a dermatologist who performed a biopsy that was interpreted ass non-specific, and treatment was started for pyoderma gangrenosum. Further investigation revealed a homozygous factor V Leiden mutation and cryofibrinogenemia. He was tapered off of the methylprednisolone and was improving on stanozolol. He healed well after surgery and no new ulcerations have developed. This case highlights the importance of considering this mutation in a non-healing leg ulcer. PMID:15577768

Barrio, Victoria R; Sanfilippo, Angela M; Malone, Janine C; Callen, Jeffrey P



Evolving concepts of rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis is the most common inflammatory arthritis and is a major cause of disability. It existed in early Native American populations several thousand years ago but might not have appeared in Europe until the 17th century. Early theories on the pathogenesis of rheumatoid arthritis focused on autoantibodies and immune complexes. T-cell-mediated antigen-specific responses, T-cell-independent cytokine networks, and aggressive tumour-like

Gary S. Firestein



Prevalence of factor V Leiden in south Tunisian blood donors  

Microsoft Academic Search

Venous thrombosis (VT) is a common disease with multifactorial pathogenesis. Factor V Leiden mutation (G1691A) (FVL) is the\\u000a most common risk factor in venous thrombosis. The prevalence of FVL varies according to geography and ethnicity. Hence, in\\u000a several countries there is a difference in the frequency of this mutation between the southern, central and north. In Tunisia,\\u000a no data is

Lobna Maalej; Basma Hadjkacem; Ikram Ben Amor; Mariem Smaoui; Ali Gargouri; Jalel Gargouri



Pulmonary Mycobacterium abscessus disease in a patient receiving low-dose methotrexate for treatment of early rheumatoid arthritis.  


A 70-year-old woman with methotrexate (MTX)-refractory rheumatoid arthritis (RA) was referred to our hospital for introduction of biological therapy. On high-resolution computed tomography scans, the patient exhibited abnormal findings such as bronchiectasis and centrilobular small nodules, which were highly suggestive of pulmonary nontuberculous mycobacterial (NTM) disease. Although mycobacterial cultures of sputum specimens yielded negative results, cultures of bronchoalveolar lavage fluids grew Mycobacterium abscessus. Frequent follow-up chest radiographs indicated that the patient's pulmonary disease became rapidly worse in 1 month following dose escalation of MTX and administration of low-dose prednisolone. Oral clarithromycin and levofloxacin, chosen on the basis of in vitro susceptibility testing, led to a dramatic recovery from this potentially life-threatening complication. Through our experience with this case, we have learned that (1) pulmonary M. abscessus disease can progress rapidly, even during nonbiological anti-RA therapy; (2) regular follow-up chest radiographs are useful to ensure timely implementation of anti-NTM treatment; (3) bronchoscopic testing should be considered when patients are suspected of pulmonary NTM disease but do not meet the diagnostic criteria; and (4) early isolation, identification, and susceptibility testing of causative NTM species are critical for favorable outcomes. PMID:23430370

Mori, Shunsuke; Imamura, Fumiya; Koga, Yukinori; Uramoto, Hideshi; Ezaki, Toshihiro; Sugimoto, Mineharu



Gene expression patterns in peripheral blood cells associated with radiographic severity in African Americans with early rheumatoid arthritis.  


Gene expression profiling may be used to stratify patients by disease severity to test the hypothesis that variable disease outcome has a genetic component. In order to define unique expression signatures in African American rheumatoid arthritis (RA) patients with severe erosive disease, we undertook a gene expression study using samples of RNA from peripheral blood mononuclear cells (PBMCs). RNA from baseline PBMC samples of 96 African American RA patients with early RA (<2 years disease duration) was hybridized to cDNA probes of the Illumina Human HT-V3 expression array. Expression analyses were performed using the ca. 25,000 cDNA probes, and then expression levels were compared to the total number of erosions in radiographs of the hands and feet at baseline and 36 months. Using a false discovery rate cutoff of Q = 0.30, 1,138 genes at baseline and 680 genes at 36 months significantly correlated with total erosions. No evidence of a signal differentiating disease progression, or change in erosion scores between baseline and 36 months, was found. Further analyses demonstrated that the differential gene expression signature was localized to the patients with the most erosive disease (>10 erosions). Ingenuity Pathway Analysis demonstrated that genes with fold change greater than 1.5 implicated immune pathways such as CTLA signaling in cytotoxic T lymphocytes. These results demonstrate that CLEAR patients with early RA having the most severe erosive disease, as compared to more mild cases (<10 erosions), may be characterized by a set of differentially expressed genes that represent biological pathways with relevance to autoimmune disease. PMID:22238028

Reynolds, Richard J; Cui, Xiangqin; Vaughan, Laura K; Redden, David T; Causey, Zenoria; Perkins, Elizabeth; Shah, Tishi; Hughes, Laura B; Damle, Aarti; Kern, Marlena; Gregersen, Peter K; Johnson, Martin R; Bridges, S Louis



Early treatment with addition of low dose prednisolone to methotrexate improves therapeutic outcome in severe psoriatic arthritis.  


Psoriatic arthritis (PsA) is increasingly being recognized to cause progressive joint damage and disability. PsA unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs), the conventional first-line choice of treatment, is usually managed with disease-modifying antirheumatic drugs (DMARDs) especially methotrexate. An 18-year-old HIV-negative male had progressively severe PsA of 4-month duration that was nearly confining him to a wheel chair. He did not respond to multiple NSAIDs, alone or in combination with methotrexate (15 mg/week), given for 4 weeks. Addition of prednisolone (10 mg on alternate days) controlled his symptoms within a week. The NSAIDs could be withdrawn after 4 weeks as the treatment progressed. The doses were tapered for methotrexate (5 mg/week) and prednisolone (2.5 mg on alternate days) every 8 weekly subsequently during 15 months of follow-up without recurrence/deformities or drug toxicity. For years, the use of corticosteroids in psoriasis has been criticized for their propensity to exacerbate the skin disease on withdrawal. However, monitored use of corticosteroids, even in low doses, combined with DMARDs may be a good therapeutic option in early stage of the PsA rather than 'steroid rescue' later. This will help in early control of joint inflammation, prevent joint damage and maintain long-term good functional capacity and quality of life. This may be useful when the cost or availability of biologics precludes their use. However, we discourage the use of corticosteroids as monotherapy. PMID:23723489

Mahajan, Vikram K; Sharma, Anju Lath; Chauhan, Pushpinder S; Mehta, Karaninder S; Sharma, Nand Lal



Multiparameter Phospho-Flow Analysis of Lymphocytes in Early Rheumatoid Arthritis: Implications for Diagnosis and Monitoring Drug Therapy  

PubMed Central

Background The precise mechanisms involved in the initiation and progression of rheumatoid arthritis (RA) are not known. Early stages of RA often have non-specific symptoms, delaying diagnosis and therapy. Additionally, there are currently no established means to predict clinical responsiveness to therapy. Immune cell activation is a critical component therefore we examined the cellular activation of peripheral blood mononuclear cells (PBMCs) in the early stages of RA, in order to develop a novel diagnostic modality. Methods and Findings PBMCs were isolated from individuals diagnosed with early RA (ERA) (n?=?38), longstanding RA (n?=?10), osteoarthritis (OA) (n?=?19) and from healthy individuals (n?=?10). PBMCs were examined for activation of 15 signaling effectors, using phosphorylation status as a measure of activation in immunophenotyped cells, by flow cytometry (phospho-flow). CD3+CD4+, CD3+CD8+ and CD20+ cells isolated from patients with ERA, RA and OA exhibited activation of multiple phospho-epitopes. ERA patient PBMCs showed a bias towards phosphorylation-activation in the CD4+ and CD20+ compartments compared to OA PBMCs, where phospho-activation was primarily observed in CD8+ cells. The ratio of phospho (p)-AKT/p-p38 was significantly elevated in patients with ERA and may have diagnostic potential. The mean fluorescent intensity (MFI) levels for p-AKT and p-H3 in CD4+, CD8+ and CD20+ T cells correlated directly with physician global assessment scores (MDGA) and DAS (disease activity score). Stratification by medications revealed that patients receiving leflunomide, systemic steroids or anti-TNF therapy had significant reductions in phospho-specific activation compared with patients not receiving these therapies. Correlative trends between medication-associated reductions in the levels of phosphorylation of specific signaling effectors and lower disease activity were observed. Conclusions Phospho-flow analysis identified phosphorylation-activation of specific signaling effectors in the PB from patients with ERA. Notably, phosphorylation of these signaling effectors did not distinguish ERA from late RA, suggesting that the activation status of discrete cell populations is already established early in disease. However, when the ratio of MFI values for p-AKT and p-p38 is >1.5, there is a high likelihood of having a diagnosis of RA. Our results suggest that longitudinal sampling of patients undergoing therapy may result in phospho-signatures that are predictive of drug responsiveness.

Galligan, Carole L.; Siebert, Janet C.; Siminovitch, Katherine A.; Keystone, Edward C.; Bykerk, Vivian; Perez, Omar D.; Fish, Eleanor N.



Development and Early Evaluation of an Inter-professional Post-licensure Education Programme for Extended Practice Roles in Arthritis Care  

PubMed Central

ABSTRACT Purpose: The Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program was developed to train experienced physical and occupational therapists within extended practice roles with the aim of facilitating optimal, timely, and appropriate delivery of health care to patients with arthritis. This paper presents (1) the development of the ACPAC Program and (2) performance across the programme, as well as early quantitative and qualitative changes in clinical practice roles for the 2006 through 2008 cohorts of ACPAC Program graduates (n=19). Methods: Measurement of change in skills and knowledge involved standardized baseline and end-of-programme examinations as well as self-evaluation of a number of areas of clinical competence. Practice-focused surveys issued at baseline, mid-programme, and end of programme, as well as at 6 and 12 months after graduation, evaluated the practitioners' integration of advanced knowledge and skills acquired during the ACPAC Program into their extended practice roles. Results: Participants significantly increased their scores on examinations of clinical knowledge (p<0.001) and skills (p<0.001) from baseline through programme completion. There was an increase in frequency of performance of clinical tasks and assumption of responsibilities related to their extended practice roles from the beginning to the end of the programme. The five areas that changed in relation to these new roles were increased clinical responsibilities, efficiencies in practice settings, roles as educational leaders and mentors in the field of arthritis care, inter-professional collaboration, and improved access to care for patients with arthritis, particularly in remote areas. Conclusion: Graduates of the ACPAC Program have demonstrated knowledge and skills for practising in extended roles that enhance the available human health resource pool for patients with arthritis.

Shupak, Rachel; Schneider, Rayfel; Herold McIlroy, Jodi



How much difference does the age at onset make in early arthritis patients? Comparison between the ACR 1987 and the ACR/EULAR 2010 classification criteria for rheumatoid arthritis at the time of diagnosis.  


The age at onset in early arthritis (EA) may influence the disease activity and its evolution. The aim of the current study is to identify possible differences regarding the "old" and the "new" classification criteria between patients with early-onset and late-onset early arthritis. The study included 64 patients. They were divided in two groups, according to the mean age: early-onset EA-less or equal than 45 years old (group A) and late-onset EA-over 45 years old (group B). The "old" criteria as well as the "new" ones were assessed for all patients, at the time of the first visit to the rheumatologist. The initiation of treatment with Methotrexate was used as "gold standard" to calculate the sensitivity and the specificity of both criteria. "New" criteria were fulfilled in 51 % (A) and 72 % of cases (B), while "old" criteria were fulfilled in 37 % of patients (A) and 62 % (B). Methotrexate was initiated in 82 % of patients (B) and in 51 % (A), p = 0.01. "New" criteria demonstrated a sensitivity of 77.7 % (A) and 83.3 % (B), while "old" criteria had a sensitivity of 50 % (A) and 66.6 % (B). Patients with late onset had significantly higher disease activity scores: 76 % (B) versus 40 % (A), p = 0.04. The sensitivity and the specificity of the "new" criteria for RA are comparable in patients with early-onset and late-onset EA, and the sensitivity of these criteria is increased compared to the "old" criteria. Patients with late onset fulfilling the "old" criteria had poor prognostic factors and higher disease activity at the time of diagnosis, which may have possible implications for the disease course. PMID:22955876

Tamas, Maria-Magdalena; Felea, Ioana; Rednic, Simona



Homozygous factor V Leiden and double heterozygosity for factor V Leiden and prothrombin mutation.  


The most common forms of familial thrombophilia are factor V Leiden (FVL) and prothrombin mutation (PTM). Homozygous FVL and PTM have long been feared conditions thought to cause high rates of morbidity and mortality. To analyse clinical features in patients with homozygous FVL and PTM, as well as patients with double heterozygosity for FVL and PTM. All patients with homozygous FVL, PTM or double heterozygosity in the MATS database of 1465 consecutive unselected patients were analysed regarding age at inclusion venous thromboembolism (VTE), age at first thrombosis, recurrence, clinical course and acquired risk factors. We found 36 patients homozygous for FVL. Patients homozygous for FVL were younger than controls at group level (56 ± 18 vs. 63 ± 17, p < 0.02). Homozygous women were younger than female controls (50 ± 19 vs. 63 ± 18, p < 0.002). No difference was observed when comparing male subjects. Women were younger than men at inclusion thrombosis (50 ± 19 vs. 65 ± 14, p < 0.02) and at first thrombosis (47 ± 19 vs. 64 ± 14, p < 0.01). Deep venous thrombosis (DVT) was seen in 33 patients (92 %), 6 (17 %) had pulmonary embolism (PE) and 3 (8 %) had combined DVT and PE. PE was less frequent in homozygous FVL women compared to female controls (p < 0.03). VTE recurred in 3 subjects during the duration of the study. Odds ratio for VTE in homozygous FVL patients compared to controls was 13.9 (95 % CI 9.9-19.7). We found no subjects with homozygous PTM. Double heterozygosity for FVL and PTM was seen in 12 subjects. There was no difference in age at inclusion VTE between double heterozygotes and controls (59 ± 16 vs. 63 ± 17, ns.). DVT was seen in 92 % at inclusion, 8 % had PE. Mean age at first VTE was 52 ± 17 (27-82). Consecutive homozygous FVL patients had a higher age at first thrombosis than previously described. Homozygous females are affected at an earlier age than homozygous men and female controls. It seems that thrombi in homozygous FVL have a different pattern compared to controls i.e. more prone for thrombosis in the lower extremity. The odds ratio for thrombosis among homozygous FVL seems to be lower than previously described. PMID:23054468

Saemundsson, Ymir; Sveinsdottir, Signý Vala; Svantesson, Henrik; Svensson, Peter J



Validation of a novel multibiomarker test to assess rheumatoid arthritis disease activity  

PubMed Central

Objective Quantitative assessment of disease activity in rheumatoid arthritis (RA) is important for patient management, and additional objective information may aid rheumatologists in clinical decision making. We validated a recently developed multibiomarker disease activity (MBDA) test relative to clinical disease activity in diverse RA cohorts. Methods Serum samples were obtained from the Index for Rheumatoid Arthritis Measurement, Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study, and Leiden Early Arthritis Clinic cohorts. Levels of 12 biomarkers were measured and combined according to a prespecified algorithm to generate the composite MBDA score. The relationship of the MBDA score to clinical disease activity was characterized separately in seropositive and seronegative patients using Pearson's correlations and the area under the receiver operating characteristic curve (AUROC) to discriminate between patients with low and moderate/high disease activity. Associations between changes in MBDA score and clinical responses 6–12 weeks after initiation of anti–tumor necrosis factor or methotrexate treatment were evaluated by the AUROC. Results The MBDA score was significantly associated with the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP) in both seropositive (AUROC 0.77, P < 0.001) and seronegative (AUROC 0.70, P < 0.001) patients. In subgroups based on age, sex, body mass index, and treatment, the MBDA score was associated with the DAS28-CRP (P < 0.05) in all seropositive and most seronegative subgroups. Changes in the MBDA score at 6–12 weeks could discriminate both American College of Rheumatology criteria for 50% improvement responses (P = 0.03) and DAS28-CRP improvement (P = 0.002). Changes in the MBDA score at 2 weeks were also associated with subsequent DAS28-CRP response (P = 0.02). Conclusion Our findings establish the criterion and discriminant validity of a novel multibiomarker test as an objective measure of RA disease activity to aid in the management of RA in patients with this condition.

Curtis, Jeffrey R; van der Helm-van Mil, Annette H; Knevel, Rachel; Huizinga, Tom W; Haney, Douglas J; Shen, Yijing; Ramanujan, Saroja; Cavet, Guy; Centola, Michael; Hesterberg, Lyndal K; Chernoff, David; Ford, Kerri; Shadick, Nancy A; Hamburger, Max; Fleischmann, Roy; Keystone, Edward; Weinblatt, Michael E



Psoriatic arthritis  

SciTech Connect

This book contains 11 chapters. Some of the titles are: The history and epidemiologic definition of psoriatic arthritis as a distinct entity; Psoriatic arthritis: Further epidemiologic and genetic considerations; The radiologic features of psoriatic arthritis; and Laboratory findings and pathology of psoriatic arthritis.

Gerber, L.H.; Espinoza, L.R.



Anti-type II collagen antibodies are associated with early radiographic destruction in rheumatoid arthritis  

PubMed Central

Introduction We have previously reported that high levels of antibodies specific for native human type II collagen (anti-CII) at the time of RA diagnosis were associated with concurrent but not later signs of inflammation. This was associated with CII/anti-CII immune complex (IC)-induced production of pro-inflammatory cytokines in vitro. In contrast, anti-cyclic citrullinated peptide antibodies (anti-CCP) were associated both with late inflammation and late radiological destruction in the same RA cohort. We therefore hypothesized that anti-CII are also associated with early erosions. Methods Two-hundred-and-fifty-six patients from an early RA cohort were included. Baseline levels of anti-CII, anti-CCP and anti-mutated citrullinated vimentin were analyzed with ELISA, and rheumatoid factor levels were determined by nephelometry. Radiographs of hands and feet at baseline, after one and after two years were quantified using the 32-joints Larsen erosion score. Results Levels of anti-CII were bimodally distributed in the RA cohort, with a small (3.1%, 8/256) group of very high outliers with a median level 87 times higher than the median for the healthy control group. Using a cut-off discriminating the outlier group that was associated with anti-CII IC-induced production of proinflammatory cytokines in vitro, baseline anti-CII antibodies were significantly (p = 0.0486) associated with increased radiographic damage at the time of diagnosis. Anti-CII-positive patient had also significantly increased HAQ score (p = 0.0303), CRP (p = 0.0026) and ESR (p = 0.0396) at the time of diagnosis but not during follow-up. The median age among anti-CII-positive subjects was 12 years higher than among the anti-CII-negative patients. Conclusion In contrary to anti-CCP, anti-CII-positive patients with RA have increased joint destruction and HAQ score at baseline. Anti-CII thus characterizes an early inflammatory/destructive phenotype, in contrast to the late appearance of an inflammatory/destructive phenotype in anti-CCP positive RA patients. The anti-CII phenotype might account for part of the elderly acute onset RA phenotype with rather good prognosis.



Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis  

PubMed Central

OBJECTIVES—To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year. Additionally, to compare the results with radiography, bone scintigraphy, and clinical findings.?PATIENTS AND METHODS—Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria for RA at baseline, five fulfilled the criteria only after one year's follow up, whereas eight maintained the original diagnosis of early unclassified polyarthritis. The following MRI variables were assessed at baseline and one year: synovial membrane hypertrophy score, number of erosions, and tenosynovitis score.?RESULTS—MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changed significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (p<0.05).?CONCLUSIONS—MRI detected more erosions than radiography. MR synovial membrane hypertrophy and scintigraphy scores did not parallel the changes seen over time in clinically assessed swollen and tender joint counts. Although joint disease activity may be assessed as quiescent by conventional clinical methods, a more detailed evaluation by MRI may show that a pathological condition is still present within the synovium.??

Klarlund, M; Ostergaard, M; Jensen, K; Madsen, J; Skjodt, H; Lorenzen, I; the, T



Closing the Gap Between Bench and Bedside Research for Early Arthritis Therapies (EARTH)  

PubMed Central

This report summarizes the 2010 AOSSM/NIH (American Orthopaedic Society for Sports Medicine/National Institutes of Health) U13 Post–Joint Injury Osteoarthritis II Conference to include the discussion concerning potential study cohorts, assessment considerations, and research priorities. There was strong consensus and enthusiasm for approaching the development of disease-modifying treatments for osteoarthritis through study of “pre-osteoarthritic” cohorts, particularly human subjects under 30 years of age following acute anterior cruciate ligament injuries. Clinical study of acute treatment strategies initiated within a few days after injury will need development of recruitment pathways and short-term proof-of-concept outcome measures that are specific to the intervention being studied. For example, measures of joint inflammation can be used in short-term prospective randomized controlled trials to determine whether an anti-inflammatory intervention was effective in decreasing early inflammation. These short-term clinical trials will need to be followed by longer-term evaluation of the clinical cohorts for joint and cartilage degeneration to determine if the acute intervention affected later development of osteoarthritis. Research priorities were identified in several disciplines, particularly regarding development and validation of quantitative imaging, biomechanics, and biomarker measures of joint structure, composition, and function that predict the accelerated development of osteoarthritis. Systematic study of posttraumatic osteoarthritis is anticipated to advance understanding and treatment of all forms of osteoarthritis.

Chu, Constance R.; Beynnon, Bruce D.; Buckwalter, Joseph A.; Garrett, William E.; Katz, Jeffrey N.; Rodeo, Scott A.; Spindler, Kurt P.; Stanton, Robert A.



Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort.  


ABSTRACT: INTRODUCTION: Clinical trials have demonstrated that treatment-to-target (T2T) is effective in achieving remission in early rheumatoid arthritis (RA). However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6) in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments. METHODS: A medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations. RESULTS: The 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% (1,092/1,115) of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% (964/1,092). Adherence to the treatment advice was observed in 69.3% (757/1,092) of the visits. In case of non-adherence when remission was present (19.5%, 108/553), most frequently medication was tapered off or discontinued when it should have been continued (7.2%, 40/553) or treatment was continued when it should have been tapered off or discontinued (6.2%, 34/553). In case of non-adherence when remission was absent (42.1%, 227/539), most frequently medication was not intensified when an intensification step should have been taken (34.9%, 188/539). The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28. CONCLUSIONS: The recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practice. PMID:23176083

Vermeer, Marloes; Kuper, Hillechiena H; Bernelot Moens, Hein J; Hoekstra, Monique; Posthumus, Marcel D; van Riel, Piet Lcm; van de Laar, Mart Afj



Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort  

PubMed Central

Introduction Clinical trials have demonstrated that treatment-to-target (T2T) is effective in achieving remission in early rheumatoid arthritis (RA). However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6) in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments. Methods A medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations. Results The 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% (1,092/1,115) of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% (964/1,092). Adherence to the treatment advice was observed in 69.3% (757/1,092) of the visits. In case of non-adherence when remission was present (19.5%, 108/553), most frequently medication was tapered off or discontinued when it should have been continued (7.2%, 40/553) or treatment was continued when it should have been tapered off or discontinued (6.2%, 34/553). In case of non-adherence when remission was absent (42.1%, 227/539), most frequently medication was not intensified when an intensification step should have been taken (34.9%, 188/539). The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28. Conclusions The recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practice.



Trajectories of functional limitation in early rheumatoid arthritis and their association with mortality.  


Objective. This study aimed to identify subgroups with distinct trajectories of functional (HAQ) progression over 10 years following diagnosis of RA and identify baseline characteristics associated with the trajectories and their prognostic value for mortality. Methods. Between 1986 and 1998, 1460 patients with RA symptoms <2 years and prior to disease-modifying treatment (DMARDs) were recruited to an inception cohort (Early RA Study). Standard clinical, functional and laboratory assessments were performed at presentation and annually. Deaths were tracked by the National Health Service Central Register. Growth mixture modelling was used to identify distinct trajectories of HAQ score progression and survival analysis employed to compare all-cause mortality across the trajectory classes. Results. Four HAQ score progression classes were identified: moderate increasing (46%), low stable (6%), moderate stable (28%) and high stable (20%). Only the moderate-increasing class exhibited an accelerated decline in function over normal ageing. Compared with the moderate-increasing class, individuals with high-stable HAQ scores were more likely to be female, have more severe disease and other coexistent conditions. Low-stable class patients were more likely to be male and report less pain. The high-stable class had increased risk of mortality compared with the moderate-increasing class after adjusting for potential confounding factors, whereas low-stable and moderate-stable classes were at reduced mortality risk. Conclusion. The effect of RA on function is set within the first few years and is affected by comorbidity. Identifying distinct groups of patients may help to target those at greater risk of poor functional outcome and mortality. PMID:23934221

Norton, Sam; Sacker, Amanda; Dixey, Josh; Done, John; Williams, Peter; Young, Adam



Factor V Leiden mutation-related chronic skin ulcers.  


Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years' duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur. PMID:23446370

Kayatas, Kadir; Cebeci, Filiz; Karatoprak, Cumali; Benzer, Muhammet; Demirtunç, Refik; Demirkesen, Cuyan



Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort.  


ABSTRACT: INTRODUCTION: Early rheumatoid arthritis (RA) patients may show rapid radiographic progression (RRP) despite rapid initiation of synthetic disease-modifying anti-rheumatic drugs (DMARDs). The present study aimed to develop a matrix to predict risk of RRP despite early DMARD initiation in real life settings. METHODS: The ESPOIR cohort included 813 patients from the community with early arthritis for < 6 months; 370 patients had early RA and had received methotrexate or leflunomide during the first year of follow-up. RRP was defined as an increase in the van der Heijde-modified Sharp score (vSHS) ? 5 points at 1 year. Determinants of RRP were examined first by bivariate analysis, then multivariate stepwise logistic regression analysis. A visual matrix model was then developed to predict RRP in terms of patient baseline characteristics. RESULTS: We analyzed data for 370 patients. The mean Disease Activity Score in 28 joints was 5.4 ± 1.2, 18.1% of patients had typical RA erosion on radiographs and 86.4% satisfied the 2010 criteria of the American College of Rheumatology/European League Against Rheumatism. During the first year, mean change in vSHS was 1.6 ± 5.5, and 41 patients (11.1%) showed RRP. A multivariate logistic regression model enabled the development of a matrix predicting RRP in terms of baseline swollen joint count, C-reactive protein level, anti-citrullinated peptide antibodies status, and erosions seen on radiography for patients with early RA who received DMARDs. CONCLUSIONS: The ESPOIR matrix may be a useful clinical practice tool to identify patients with early RA at high risk of RRP despite early DMARD initiation. PMID:23164197

Fautrel, Bruno; Granger, Benjamin; Combe, Bernard; Saraux, Alain; Guillemin, Francis; Le Loet, Xavier



Recurrent Pregnancy Loss and Its Relation to FV Leiden, FII G20210A and Polymorphisms of Plasminogen Activator and Plasminogen Activator Inhibitor  

Microsoft Academic Search

Thrombophilic disorders and hypofibrinolysis were demonstrated to be risk factors in a majority of women with recurrent pregnancy loss (RPL) and infertility. We investigated the association of FV G1691A mutation, F II G20210A gene polymorphism (PM), 4G\\/5G PAI-1 and Alu I\\/D tPA PM in 32 women with infertility and 49 women with at least 2 unexplained early abortions. FV Leiden

Cornelia E. Wolf; Hannelore Haubelt; Hans Ulrich Pauer; Bernd Hinney; Claudette Krome-Cesar; Tobias J. Legler; Peter Hellstern; Günter Emons; Barbara Zoll; Michael Köhler



The factor V Leiden mutation is not a common cause of recurrent miscarriage  

Microsoft Academic Search

Some investigators suggest that placental thrombosis and infarction can cause recurrent miscarriage. We have shown that the common missense mutation in the factor V gene, the Leiden mutation, which renders factor Va resistant to cleavage inactivation by activated protein C, predisposes to placental thrombosis and spontaneous miscarriage. Our objective was to determine the frequency of the Leiden mutation in a

Donna. S Dizon-Townson; Sonja Kinney; D Ware Branch; Kenneth Ward



Liver transplantation in a patient with Budd-Chiari syndrome secondary to factor V Leiden mutation  

Microsoft Academic Search

A point mutation in the factor V Leiden gene is the most common hereditary thrombophilic state and an important risk factor for Budd-Chiari syndrome. We report on a patient with Budd-Chiari syndrome secondary to factor V Leiden mutation, who underwent successful liver transplantation. Following liver transplantation, his thrombophilic state was corrected and he did not require anticoagulation therapy. There has

Z Karasu; D Nart; E Lebe; T Demirbas; A Memis; M Kilic; M Akyildiz; Y Tokat



Due casi di artrite reumatoide trattati in fase precoce con infliximab con mantenimento dell'effetto dopo la sospensione del farmaco Sustained response to infliximab treatment in two cases of early rheumatoid arthritis that has been maintained after drug withdrawal  

Microsoft Academic Search

SUMMARY The authors report two cases of active seropositive rheumatoid arthritis who were treated in an early phase of the dis- ease with infliximab plus methotrexate obtaining a clinical remission. The benefit was maintained after the discontin- uation of the anti-TNF alpha inhibitor for adverse events, indicating that the early administration of the drug may be followed by a sustained

P. Caramaschi; S. Pieropan; A. Volpe; A. Carletto; L. M. Bambara; D. Biasi


Advanced imaging in rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise\\u000a that conventional radiographic images show changes of rhuematoid arthritis late after irreversible joint damage has occured.\\u000a With the advent of powerful disease-modifying drugs there is a need for early demonstration of rheumatoid arthritis and to\\u000a monitor progress of the disease and response to

J. M. Farrant; A. J. Grainger; P. J. O’Connor



Psoriatic Arthritis  


... your body. Some people with psoriasis have psoriatic arthritis. It causes pain, stiffness, and swelling of the ... physical exam and imaging tests to diagnose psoriatic arthritis. There is no cure, but medicines can help ...


Rheumatoid arthritis  


Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. ... Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) and chloroquine may also be used. ...


Use of amplified Mycobacterium tuberculosis direct test (Gen-probe Inc., San Diego, CA, USA) in the diagnosis of tubercular synovitis and early arthritis of knee joint  

PubMed Central

Background: The diagnosis of knee joint tuberculosis, especially in early stages of synovial disease, has more often been based on clinicoradiological suspicion, with no single test claiming to be a dependable rapid diagnostic test with high sensitivity and specificity. Nuclear amplification tests in vogue like the polymerase chain reaction have shown variable sensitivity and false positivity rates in various studies. We evaluated the role of Amplified Mycobacterium tuberculosis Direct Test (AMTDT) or Genprobe in the diagnosis of knee joint tuberculosis in early, especially, early synovitis and arthritis cases. Patients and Methods: Thirty two patients of suspected knee joint tuberculosis were subjected to diagnostic arthroscopy during the study period. The synovial fluid and tissue were subjected to mycobacterial culture, histopathology, and AMTDT. A comparative analysis of the sensitivity and specificity of this new test with culture and histopathology was done and the time taken for reporting was calculated for each test. Results: Out of 32 tissue samples, 8 were found to be positive with mycobacterial culture [Lowenstein Jensen (LJ)/Bactec], 11 were positive with histopathology, and 5 were found to positive with AMTDT. The sensitivity of AMTDT was found to be 62.5% and specificity was 100% with a P value of 0.083. The results were obtained earliest with AMTDT with a mean reporting time of 1.2 days, while the results of histopathology were obtained in a mean time of 6.8 days, BacT alert in 22.5 days, and conventional LJ medium culture results in 48.6 days. Conclusion: AMTDT or Genprobe is a rapid diagnostic test for early diagnosis of tubercular arthritis, but has low sensitivity in knee joint tuberculosis. Nuclear amplification tests are still far from being a single promising alternative to conventional tests in cases of joint tuberculosis. Routine use of arthroscopic biopsies in all suspected cases is helpful in the early diagnosis of knee joint tuberculosis.

Aggarwal, Vinay Kumar; Nair, Deepthi; Khanna, Geetika; Verma, Jitender; Sharma, Vinod Kumar; Batra, Sumit



Inflammatory arthritis in children with osteochondrodysplasias  

PubMed Central

Osteochondrodysplasias are a heterogeneous group of genetic skeletal dysplasias. Patients with these diseases commonly develop an early degenerative arthritis or osteoarthritis. Occasional observations of inflammatory arthritis have been made in this population but such observations are based on clinical grounds alone without confirmatory imaging studies. Four patients followed up in a paediatric rheumatology clinic with three different skeletal dysplasias, who had both clinical and radiological evidence of an inflammatory arthritis and coexistent degenerative arthritis, are described.??

Scuccimarri, R.; Azouz, E; Duffy, K.; Fassier, F.; Duffy, C.



Prevention of appearance of radiological lesions in early rheumatoid arthritis: a randomized, single-blind study comparing intra-articular rifamycin with auranofin.  


In a prospective, randomized, single-blind study of 116 patients with early rheumatoid arthritis (mean disease duration 7 months), therapeutic activity of intra-articular rifamycin SV (525 mg/week) infiltration into each peripheral joint over 10 weeks was compared with that of 3 mg auranofin given orally twice daily. The incidence of side-effects was lower in rifamycin-treated patients. At the end of follow-up, the clinical variables and erythrocyte sedimentation rate showed a significant and persistent improvement both in 16 patients who continued the auranofin treatment regularly and in 55 treated with rifamycin who had completed the therapeutic cycle 62.5 months before; the latex test decreased only in the rifamycin group. In patients treated with auranofin or who changed to other commonly used antirheumatic agents, 57% of those with an initially negative radiological picture developed new radiological lesions in at least one of the small joints compared with 9% in the rifamycin group. Although the number of patients treated with rifamycin was small and the follow-up relatively short, the results of the study indicated that treatment with intra-articular rifamycin SV may prevent the appearance of radiological lesions in patients with early rheumatoid arthritis and normal radiographs initially. PMID:1568521

Caruso, I; Santandrea, S; Sarzi Puttini, P; Montrone, F; Boccassini, L; Azzolini, V; Cazzola, M; Dell'Acqua, D



EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria.  


The aim of this report was to propose a definition for erosive disease in the context of inflammatory arthritis in light of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria for use in clinical practice and studies. A EULAR task force was formed including 16 rheumatologists and one rheumatology fellow. The process was both evidence based and consensus based, and included, between March 2010 and April 2012, analyses of data from two cohorts, two face-to-face meetings, one online voting and one teleconference. The Leiden Early Arthritis Cohort and the French ESPOIR cohort were used for the evidence-based part. The outcome measures, which were initiation of methotrexate therapy, or any disease-modifying antirheumatic drug therapy within the first year of disease and arthritis persistency over 5 years, were studied with the aim to give the best definition of erosive disease. A decision was made to select a definition with a high specificity and focus on patients who did not otherwise fulfil the 2010 ACR/EULAR RA criteria (<6 points). By a unanimous vote the following definition was selected: erosive disease for use in the 2010 ACR/EULAR RA classification criteria is defined when an erosion (defined as a cortical break) is seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet. A highly specific definition for erosive disease has thus been formulated. PMID:23378540

van der Heijde, Désirée; van der Helm-van Mil, Annette H M; Aletaha, Daniel; Bingham, Clifton O; Burmester, Gerd R; Dougados, Maxime; Emery, Paul; Felson, David; Knevel, Rachel; Kvien, Tore K; Landewé, Robert B M; Lukas, Cédric; McInnes, Iain; Silman, Alan J; Smolen, Josef S; Stanislawska-Biernat, Ewa; Zink, Angela; Combe, Bernard



Central retinal vein occlusion secondary to clomiphene treatment in a male carrier of factor V Leiden.  


We report a case of a 35-year-old previously healthy man treated with clomiphene for infertility, who presented with blurred vision in his left eye due to ocular vein occlusion as documented by fluorescein angiography. The patient was heterozygous for the factor V Leiden (FV Leiden) mutation and for the 1298 A-C polymorphism of the methylene-tetrahydrofolate reductase (MTHFR) gene. He was treated with clopidogrel and is now free of symptoms. Because congenital thrombophilia is a moderate risk factor for central retinal vein occlusion and the administration of clomiphene may trigger this process, we recommend screening of young patients for FV Leiden before clomiphene treatment. PMID:19371211

Politou, Marianna; Gialeraki, Argyri; Merkouri, Efrossyni; Travlou, Anthi; Baltatzis, Stefanos



Differential effects of infliximab on absolute circulating blood leucocyte counts of innate immune cells in early and late rheumatoid arthritis patients  

PubMed Central

Anti-tumour necrosis factor (TNF) biologics have revolutionized therapy of rheumatoid arthritis (RA). We compared the effects of infliximab on numbers of circulating leucocyte subsets in early RA (disease/symptom duration of ?1 year) and late RA patients (>1 year). A control group consisted of early RA patients treated with a combination of methotrexate (MTX) and methylprednisolone. Blood samples were obtained at baseline (pre-therapy) from all RA patients, divided into three groups: (i) late RA receiving infliximab/MTX, (ii) early RA–infliximab/MTX, (iii) early RA–steroid/MTX, and also from follow-up patients at 2 and 14 weeks. Significant differences in absolute counts of monocytes and granulocytes were observed between healthy controls and RA patients. At baseline CD14bright monocytes and CD16+ granulocytes were increased in both early RA and late RA patients. CD4+ T cells, CD8+ T cells and B cells were all increased at baseline in early RA, but not in late RA. At 2 weeks following infliximab treatment decreased granulocytes were observed in both early and late RA and decreased natural killer (NK) cells in late RA. CD16+ granulocytes and NK cells were also decreased at 14 weeks post-infliximab in early RA. Biotinylated infliximab was used to detect membrane-associated TNF (mTNF)-expressing leucocytes in RA patients. CD16+ granulocytes, NK cells and CD14dim monocytes all expressed higher levels of mTNF in RA patients. In summary infliximab is associated with decreased CD16+ granulocyte and NK cell counts, possibly through binding of mTNF. Differential effects of infliximab between early and late RA suggest that pathogenic mechanisms change as disease progresses.

Coulthard, L R; Geiler, J; Mathews, R J; Church, L D; Dickie, L J; Cooper, D L; Wong, C; Savic, S; Bryer, D; Buch, M H; Emery, P; Morgan, A W; McDermott, M F



Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales  

Microsoft Academic Search

BACKGROUND: Depression is common in rheumatoid arthritis (RA), however reported prevalence varies considerably. Two frequently used instruments to identify depression are the Center for Epidemiological Studies Depression (CES-D) scale, and the Hospital Anxiety and Depression Scale (HADS). The objectives of this study were to test if the CES-D and HADS-D (a) satisfy current modern psychometric standards for unidimensional measurement in

Tanya Covic; Julie F Pallant; Alan Tennant; Sally Cox; Paul Emery; Philip G Conaghan



Assessment of the utility of visual feedback in the treatment of early rheumatoid arthritis patients: a pilot study.  


Earlier studies revealed that visual feedback has contributed in the management of neuromuscular as well as psychiatric disorders; however, it has not yet been applied in rheumatology. Visual feedback is a relatively new tool that enables the patient to visualize as well as monitor a real-time change of their disease activity parameters as well as the patient's reported outcome measures. Integrating electronic data recording in the standard rheumatology clinical practice made visual feedback possible. To evaluate the feasibility of using the visual feedback in patients with early inflammatory arthritis (EA) and how ubiquitous computing technology can improve the patients' compliance and adherence to therapy, this was a double-blind randomized controlled study, which included 111 patients diagnosed to have EA according to the new ACR/EULAR criteria. All patients received disease-modifying antirheumatic drugs (DMARDs) therapy and monitored regularly over the period of 1 year. By the 6th month of treatment, the patients were randomly allocated to an active group (55 patients) to whom the visual feedback (visualization of charts showing the progression of disease activity parameters) was added to their management protocol, and a control group (56 patients) who continued their standard management protocols. The patients were monitored for another 6-months period. All the patient's disease activity parameters, patient reported outcome measures (PROMs), medications, scores of falls, and cardiovascular risks were recorded electronically. Primary outcome was the change in the patients' adherence to their medications, disease activity score (DAS-28), and PROMs: pain score, patient global assessment, functional disability, and quality of life. Secondary outcome was the answers to a questionnaire completed by every patient in both the active group and control group (using Visual Analogue Scale) by the end of 1 year of management, to rate from the patient's perspective the impact of the management protocol, whether using the standard or visual feedback approach, on them and their disease. The visual feedback provided a significant greater reduction in disease activity parameters as well as improvement of the patients' adherence to antirheumatic therapy (P < 0.01). Also stopping the DMARDs therapy because of intolerance was significantly less in the active group. Concerns about the future was significantly less in the active group whereas inability to coup with daily life and disease stress were significantly more among the control group. The improvement of disease activity parameters was associated with improvement in functional disability and quality of life scores. Mean changes in disease parameters showed no significant differences at 3-6 months of therapy but differences were statistically significant at 12-months follow-up (P < 0.01). Medication compliance was significantly correlated with changes in all measured disease parameters. By recording and monitoring disease activity parameters electronically and incorporating the visual feedback approach into clinical practice, a new experience can be created. Visual feedback enabled the patients to see how they are doing regarding their disease activity and helps to optimize their adherence to their treatment. Visual feedback had a positive and significant impact on the disease activity control. PMID:21909946

El Miedany, Y; El Gaafary, M; Palmer, D



Capillaroscopic pattern in inflammatory arthritis  

PubMed Central

Background There are limited data about the role of nailfold capillaroscopy in inflammatory arthritis. Objectives To study the role of capillaroscopy in inflammatory arthritis — rheumatoid arthritis (RA), psoriatic arthritis (PsA) and early arthritis. Methods Patients from the following groups were included in the study: 62 patients with RA; 34 patients with PsA with involvement of the joints of the hands; 9 women with early arthritis. Nailfold capillaroscopy was performed with videocapillaroscope. Results Raynaud's phenomenon (RP) was found in 30.6% (19/62) of RA patients, in 32.4% (11/34) of PsA patients and 44.4%, (4/9) of cases with early arthritis. The most frequent found capillaroscopic changes in RA patients were presence of elongated capillaries in 58% of cases (36/62) and prominent subpapillary plexus in 69% (43/62). Dilated capillaries were found in 78.9% (15/19) of patients with secondary RP and in 62.8% (27/43) of those without RP. “Scleroderma-like” capillaroscopic pattern was observed with low frequency in RA patients (14.5%/9/62). “Scleroderma-like” capillaroscopic pattern was also found in 11.1% (1/9) in the group of patients with early arthritis. The low frequency of the last type of capillaroscopic pattern in RA requires patients with such changes to be observed during regular follow-up for the development of systemic rheumatic disease different from inflammatory arthritis. In patients with PsA capillaries with specific morphology (tight terminal convolutions) were found in 58.8% (20/34) of cases. Conclusions Results from the present study confirm the necessity for inclusion of the nailfold capillaroscopy in the diagnostic algorithm in patients with inflammatory arthritis.

Lambova, Sevdalina Nikolova; Muller-Ladner, Ulf



A rare association of early-onset inclusion body myositis, rheumatoid arthritis and autoimmune thyroiditis: a case report and literature review.  


Sporadic inclusion body myositis (sIBM) is a slowly progressive, red-rimmed vacuolar myopathy leading to muscular atrophy and progressive weakness; it predominantly affects males older than fifty years, and is resistant to immunotherapy. It has been described in association with immuno-mediated thrombocytopenic purpura, multiple sclerosis, connective tissue disorders and, occasionally, rheumatoid arthritis. A 37-year-old man with longstanding rheumatoid arthritis and autoimmune thyroiditis with hypothyroidism was referred to us with slowly progressive, diffuse muscle weakness and wasting, which had initially involved the volar finger flexors, and subsequently also the ankle dorsiflexors and knee extensors. Needle electromyography showed typical myopathic motor unit potentials, fibrillation and positive sharp waves with normal nerve conduction studies. Quadriceps muscle biopsy was suggestive of sIBM. Considering data published in the literature, this case may be classified as an early-onset form. The patient was treated with long-term intravenous immunoglobulin and obtained a substantial stabilization of his muscle strength. PMID:24125563

Clerici, A M; Bono, G; Delodovici, M L; Azan, G; Cafasso, G; Micieli, G


Presence and utility of IgA-class antibodies to cyclic citrullinated peptides in early rheumatoid arthritis: the Swedish TIRA project  

PubMed Central

Introduction The present study was carried out to assess whether IgA-class antibodies against cyclic citrullinated peptides (IgA anti-CCP) in recent-onset rheumatoid arthritis add diagnostic and/or prognostic information to IgG anti-CCP analysis. Methods Serum samples were obtained from 228 patients with recent-onset (<12 months) rheumatoid arthritis at the time of inclusion in the Swedish TIRA cohort (Swedish Early Intervention in Rheumatoid Arthritis). Sera from 72 of these patients were also available at the 3-year follow-up. Disease activity and functional ability measures (erythrocyte sedimentation rate, serum C-reactive protein, 28-joint count Disease Activity Score, physician's assessment of disease activity, and the Swedish version of the Health Assessment Questionnaire) were registered at inclusion and at regular follow-ups during 3 years. An IgA anti-CCP assay was developed based on the commercially available IgG-specific enzyme immunoassay from EuroDiagnostica (Arnhem, the Netherlands), replacing the detection antibody by an anti-human-IgA antibody. A positive IgA anti-CCP test was defined by the 99th percentile among healthy blood donors. Results At baseline, a positive IgA anti-CCP test was observed in 29% of the patient sera, all of which also tested positive for IgG anti-CCP at a higher average level than sera containing IgG anti-CCP alone. The IgA anti-CCP-positive patients had significantly higher disease activity over time compared with the IgA anti-CCP-negative patients. After considering the IgG anti-CCP level, the disease activity also tended to be higher in the IgA anti-CCP-positive cases – although this difference did not reach statistical significance. The proportion of IgA anti-CCP-positive patients was significantly larger among smokers than among nonsmokers. Conclusion Anti-CCP antibodies of the IgA class were found in about one-third of patients with recent-onset rheumatoid arthritis, all of whom also had IgG anti-CCP. The occurrence of IgA-class antibodies was associated with smoking, and IgA anti-CCP-positive patients had a more severe disease course over 3 years compared with IgA anti-CCP-negative cases. Although IgA anti-CCP analysis does not seem to offer any diagnostic information in addition to IgG anti-CCP analysis, further efforts are justified to investigate the prognostic implications.

Svard, Anna; Kastbom, Alf; Reckner-Olsson, Asa; Skogh, Thomas



Management of rheumatoid arthritis  

Microsoft Academic Search

The management of rheumatoid arthritis (RA) has changed substantially over recent years. The emphasis is now on making an early diagnosis of RA, which still relies largely on clinical experience. When determining which treatment is most appropriate, clinical and laboratory markers on disease prognosis act as a guide. The choice of single or combination disease modifying drug therapies (DMARDs) has

Asha Srikanth; Chris Deighton



Significantly increased prevalence of factor V Leiden in patients with dural arteriovenous fistulas  

Microsoft Academic Search

Resistance to activated protein C (APCR) is the most common genetic risk factor for venous thrombosis and is generally caused\\u000a by a mutation in the factor V (FV) gene leading to FV Leiden. The recent finding of FV Leiden in three of seven patients with\\u000a dural arteriovenous fistulas (DAVFs) prompted us to evaluate systematically the role of APCR due to

Jürgen A. Kraus; Bettina K. Stüper; Hans-C. Nahser; Thomas Klockgether; Peter Berlit



A comparison of the diagnostic accuracy and prognostic value of the first and second anti-cyclic citrullinated peptides (CCP1 and CCP2) autoantibody tests for rheumatoid arthritis  

PubMed Central

Methods: Anti-CCP1 and anti-CCP2 antibody tests were performed on the same serum samples obtained from 467 patients with early arthritis from the Leiden Arthritis Cohort. The sensitivity, specificity, positive predictive value, and negative predictive value for discriminating between rheumatoid arthritis (RA) and non-RA at 1 year's follow up were calculated for both tests. Results were graphically presented using receiver operating characteristic curves. Progression of radiological joint damage was assessed over 4 years in patients with RA and used to assess the prognostics values of the CCP tests. Results: At a similar specificity the CCP2 test had a higher sensitivity than the CCP1 test. Both tests identified a subgroup of patients with RA with an increased rate of joint damage progression. The anti-CCP2 test identified more patients with an increased rate of joint damage progression than the anti-CCP1 test, and in multiple regression analysis CCP2 was the better predictor of joint damage. Conclusions: The CCP2 test had better diagnostic and prognostic ability than the CCP1 test.

van Gaalen, F A; Visser, H; Huizinga, T



Samuel Goudsmit - Early Influences  

Microsoft Academic Search

Samuel Goudsmit, born in 1902 in The Hague, Netherlands, earned his Ph.D. at the University of Leiden in 1926 with Paul Ehrenfest. The present talk will describe some aspects of his background and early formative years in order to provide context for the broad range of his professional life. Sam belonged to a large tribe of paternal and maternal uncles,

Esther Goudsmit



Unmet needs in rheumatoid arthritis  

Microsoft Academic Search

Until the pathophysiology\\/etiology of rheumatoid arthritis (RA) is better understood, treatment strategies must focus on disease management. Early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) are necessary to reduce early joint damage, functional loss, and mortality. Several clinical trials have now clearly shown that administering appropriate DMARDs early yields better therapeutic outcomes. However, RA is a heterogeneous disease in

Larry Moreland



Levels of anti-citrullinated protein antibodies and IgM rheumatoid factor are not associated with outcome in early arthritis patients: a cohort study  

PubMed Central

Introduction To investigate whether baseline levels of anti-citrullinated protein antibody (ACPA) or IgM rheumatoid factor (IgM-RF) and changes in the year thereafter are associated with disease activity, functional and radiographic outcome in early arthritis patients, and provide additional information over baseline autoantibody status. Methods In 545 early arthritis patients ACPA and IgM-RF levels, disease activity (DAS28), the Health Assessment Questionnaire (HAQ) and Sharp/Van der Heijde Score (SHS) were assessed annually. Baseline status, levels and first-year changes of the autoantibodies were associated with these measures at the two-year follow-up and sub-analysed according to autoantibody status. Results The mean age was 52.7 years, 69% was female, at baseline 56% was ACPA positive, 47% IgM-RF positive. At the two-year follow-up the mean DAS28 was 2.88, and the median HAQ and SHS were 0.38 and 1, respectively. At one year, ACPA and IgM-RF levels had decreased by 31% and 56%, respectively. A switch from negative to positive occurred in 2% for ACPA and 3% for IgM-RF. Positive ACPA and RF status were both associated with SHS at two years (P < 0.001), but baseline levels only showed a minor correlation of ACPA with DAS28 and HAQ at two years. Level changes were not associated with the outcome parameters. Conclusions Baseline levels and first-year changes of ACPA and IgM-RF are hardly associated with outcome after two years. Seroconversion seldom occurs. Therefore, it does not appear useful to repeat ACPA or IgM-RF measurements.



Imaging of rheumatoid arthritis.  


Increased awareness of the need for early diagnosis of rheumatoid arthritis and advances in the ability to effectively treat rheumatoid arthritis have made disease remission and maintenance of function a reality for many patients. However, identification of patients who are at risk for erosive disease remains a challenge. As more is learnt about risk factors for disease severity and the role of imaging techniques such as ultrasound and magnetic resonance imaging, the ability to prevent disease progression in the form of joint damage and its attendant deformity and functional limitation will further improve. PMID:23719075

Vasanth, Lisa C; Pavlov, Helene; Bykerk, Vivian



Apolipoprotein E3Leiden. A new variant of human apolipoprotein E associated with familial type III hyperlipoproteinemia  

Microsoft Academic Search

A variant of apolipoprotein E, denoted apo E3-Leiden, has been identified in a 41-year-old male suffering from type III hyperlipoproteinemia with xanthomatosis. Apo E3-Leiden focus in the E3 position. In contrast with normal apo E3, apo E3-Leiden is defective in binding to the low density lipoprotein (LDL) receptor and does not contain cysteine as evaluated by cysteamine treatment of very

L. Havekes; Elly de Wit; J. Gevers Leuven; E. Klasen; W. Utermann; W. Weber; Ulrike Beisiegel



Psoriatic arthritis  

Microsoft Academic Search

Psoriatic arthritis exhibits specific characteristics that create challenges for physicians attempting to manage the disease. Active research has produced new knowledge in the fields of epidemiology, diagnostic criteria, evaluation tools, outcome prediction, and treatment. Biotherapies have been introduced for psoriatic arthritis, creating a need for a reappraisal of evaluation tools, outcome prediction, and parameters reflecting treatment effects. TNF-? antagonists constitute

Philippe Goupille



Homocysteine and Familial Longevity: The Leiden Longevity Study  

PubMed Central

Homocysteine concentrations are a read-out of methionine metabolism and have been related to changes in lifespan in animal models. In humans, high homocysteine concentrations are an important predictor of age related disease. We aimed to explore the association of homocysteine with familial longevity by testing whether homocysteine is lower in individuals that are genetically enriched for longevity. We measured concentrations of total homocysteine in 1907 subjects from the Leiden Longevity Study consisting of 1309 offspring of nonagenarian siblings, who are enriched with familial factors promoting longevity, and 598 partners thereof as population controls. We found that homocysteine was related to age, creatinine, folate, vitamin B levels and medical history of hypertension and stroke in both groups (all p<0.001). However, levels of homocysteine did not differ between offspring enriched for longevity and their partners, and no differences in the age-related rise in homocysteine levels were found between groups (p for interaction 0.63). The results suggest that homocysteine metabolism is not likely to predict familial longevity.

Wijsman, Carolien A.; van Heemst, Diana; Rozing, Maarten P.; Slagboom, P. Eline; Beekman, Marian; de Craen, Anton J. M.; Maier, Andrea B.; Westendorp, Rudi G. J.; Blom, Henk J.; Mooijaart, Simon P.



Diet-induced hyperlipoproteinemia and atherosclerosis in apolipoprotein E3-Leiden transgenic mice.  

PubMed Central

Apolipoprotein E3-Leiden (APOE*3-Leiden) transgenic mice have been used to study the effect of different cholesterol-containing diets on the remnant lipoprotein levels and composition and on the possible concurrent development of atherosclerotic plaques. On high fat/cholesterol (HFC) diet, the high expressing lines 2 and 181 developed severe hypercholesterolemia (up to 40 and 60 mmol/liter, respectively), whereas triglyceride levels remained almost normal when compared with regular mouse diet. The addition of cholate increased the hypercholesterolemic effect of this diet. In lines 2 and 181, serum levels of apo E3-Leiden also increased dramatically upon cholesterol feeding (up to 107 and 300 mg/dl, respectively). In these high expressing APOE*3-Leiden transgenic mice, the increase in both serum cholesterol and apo E3-Leiden occurred mainly in the VLDL/LDL-sized fractions, whereas a considerable increase in large, apo E-rich HDL particles also occurred. In contrast to the high expressing lines, the low expressing line 195 reacted only mildly upon HFC diet. On HFC diets, the high expresser APOE*3-Leiden mice developed atherosclerotic lesions in the aortic arch, the descending aorta, and the carotid arteries, varying from fatty streaks containing foam cells to severe atherosclerotic plaques containing cholesterol crystals, fibrosis, and necrotic calcified tissue. Quantitative evaluation revealed that the atherogenesis is positively correlated with the serum level of cholesterol-rich VLDL/LDL particles. In conclusion, with APOE*3-Leiden transgenic mice, factors can be studied that influence the metabolism of remnant VLDL and the development of atherosclerosis. Images

van Vlijmen, B J; van den Maagdenberg, A M; Gijbels, M J; van der Boom, H; HogenEsch, H; Frants, R R; Hofker, M H; Havekes, L M



[Early-stage polyarthritis].  


Prodromes, articular signs and the different courses in the early stage of rheumatoid arthritis are explained. Atypical forms and variants of rheumatoid arthritis are especially described. These are the following syndromes: palindromic rheumatism, polymyalgic rheumatoid arthritis, Sjögren-syndrome with rheumatoid arthritis, acute symmetric polyarthritis with pitting edema of elderly people. Furthermore the significance of radiological procedures and the investigation for rheumatoid factors in the early stages are discussed. Early diagnosis and consecutively early therapeutic strategies in patients suffering from rheumatoid arthritis are of paramount importance for prognosis. PMID:8465130

Schlumpf, U



Arthritis gene therapy's first death  

PubMed Central

In July 2007 a subject died while enrolled in an arthritis gene therapy trial. The study was placed on clinical hold while the circumstances surrounding this tragedy were investigated. Early in December 2007 the Food and Drug Administration removed the clinical hold, allowing the study to resume with minor changes to the protocol. In the present article we collate the information we were able to obtain about this clinical trial and discuss it in the wider context of arthritis gene therapy.

Evans, Christopher H; Ghivizzani, Steven C; Robbins, Paul D



Arthritis: Data and Statistics  


... all adults) have arthritis and arthritis-attributable activity limitation. Based on 2003 NHIS data (2) a projected ... those with arthritis will report arthritis-attributable activity limitations by the year 2030. Additional Information The best ...


Arthritis Today.  

National Technical Information Service (NTIS)

Dr. Plotz discusses the symptoms, diagnosis and treatment of arthritis, including osteoarthritis, gout, ankylosing spondylitis and systemic lupus erythematosus. He describes the degenerative processes, immune abnormalities, genetic factors, and infectious...



Gonococcal arthritis  


... a joint (usually just one) due to a gonorrhea infection. See also: Non-gonococcal bacterial arthritis ... a joint. It occurs in people who have gonorrhea caused by the bacteria Neisseria gonorrhoeae . It affects ...


Bacterial arthritis.  


In this review of the 1990 septic arthritis literature, we revisit synovial fluid leukocytosis, examine the utility of synovial fluid glucose and protein measurements, and look at the levels of two cytokines, tumor necrosis factor and interleukin-1, in infected joint fluids. We see the many faces of gonococcal arthritis and the ravages of septic arthritis when the host has rheumatoid arthritis. Should we recommend antibiotic prophylaxis for the rheumatoid patient with a prosthetic joint who is undergoing a procedure that leads to transient bacteremia? What are some of the salient features of septic arthritis when it involves the sternoclavicular or sacroiliac joints? We also look at some unusual microorganisms, eg, group C Streptococcus, Streptococcus viridans, Listeria monocytogenes, Pseudomonas cepacia, Pseudomonas maltophilia, and Neisseria sicca. In patients with acquired immunodeficiency syndrome, we encounter reports of septic arthritis, osteomyelitis, and spinal epidural abscess caused by opportunistic microorganisms. Two unusual sites of infection include the C1-2 lateral facet joint and subacromial bursa without involvement of the glenohumeral joint. Finally, we examine how to drain a septic knee: the orthopedic point of view. PMID:1911055

Ho, G



Pulmonary embolism and deep venous thrombosis during pregnancy or oral contraceptive use: Prevalence of factor V Leiden  

Microsoft Academic Search

Activated protein C resistance caused by factor V Leiden mutation is the most common inherited cause of an underlying predisposition to pulmonary embolism (PE) and deep venous thrombosis (DVT). We studied the frequency of the factor V Leiden mutation in 50 women who had PE and\\/or DVT during or after pregnancy or during oral contraceptive use. Ten (20%; 95% Cl

Denise R. Hirsch; Katriina M. Mikkola; Peter W. Marks; Edward A. Fox; David M. Dorfman; Bruce M. Ewenstein; Samuel Z. Goldhaber



Leiden Mutation, Bed Rest and Infection: Simultaneous Triggers for Maternal Deep-Vein Thrombosis and Neonatal Intracranial Hemorrhage?  

Microsoft Academic Search

The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature baby. Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment

János Sikovanyecz; Hajnalka Orvos; Attila Pál; Márta Katona; Emõke Endreffy; Emese Horváth; János Szabó



Radiographic progression and remission rates in early rheumatoid arthritis – MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial  

Microsoft Academic Search

ObjectiveAt 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained

Merete L Hetland; Kristian Stengaard-Pedersen; Peter Junker; Mikkel Østergaard; Bo J Ejbjerg; Søren Jacobsen; Tine Lottenburger; Ib Hansen; Ulrik Tarp; Lis S Andersen; Anders Svendsen; Jens K Pedersen; Ulrik B Lauridsen; Torkell Ellingsen; Hanne Lindegaard; Jan Pødenphant; Aage Vestergaard; Anne Grethe Jurik; Kim Hørslev-Petersen



Apoptosis in rheumatoid arthritis  

Microsoft Academic Search

\\u000a Rheumatoid arthritis (RA) — a chronic inflammatory disease affecting synovial tissue in multiple joints — is associated with\\u000a long-term morbidity and early mortality despite considerable advances in understanding its pathogenesis. Although the identity\\u000a and role of specific inciting agents is uncertain, immune-mediated mechanisms are likely of crucial importance. The evidence\\u000a to support a role of CD4+T cells in the immune

Paul P. Tak; Gary S. Firestein


Matrix metalloproteinases-3, -8, -9 as markers of disease activity and joint damage progression in early rheumatoid arthritis  

PubMed Central

Objective: To analyse the relation between systemic levels of pro-MMP-3, -8, and -9 matrix metalloproteinase (MMP) activity in ?2 macroglobulin (?2M)/MMP complexes and the progression of joint destruction in patients with recent onset rheumatoid arthritis (RA). Methods: 109 patients with RA of recent onset were entered into this longitudinal study. Patients were followed up for two years; clinical data, blood samples, and radiographs were obtained at baseline and at 1 and 2 years. Serum levels of MMPs were measured by sandwich ELISA and MMP activity assays. Results: During the two years joint damage progressed from 0 to 10 (median Sharp score, p<0.001). Stable levels of pro-MMP-3 and a significant decrease in the levels of pro-MMP-8 and -9 and ?2M/MMP complexes were seen throughout the two years. Regression analysis showed that serum pro-MMP-3 levels at disease onset were independently associated with the progression of joint damage (B=0.7, 95% CI 0.3 to 1.1, p=0.001). Based on the rate of joint destruction, patients were divided into two subgroups: patients with mild and severe joint damage progression. The pro-MMP-3 levels were significantly higher in the group with severe compared with mild disease at all times. Levels of pro-MMP-8 and -9 were decreased in both groups, whereas ?2M/MMP complex levels decreased in the group with mild disease only. Conclusion: Serum levels of the MMPs studied are associated with disease activity, but serum pro-MMP-3 levels at the onset of disease are also predictive of joint damage progression.

Tchetverikov, I; Lard, L; DeGroot, J; Verzijl, N; TeKoppele, J; Breedveld, F; Huizinga, T; Hanemaaijer, R



Mistaken Identity and Mirror Images: Albert and Carl Einstein, Leiden and Berlin, Relativity and Revolution  

NASA Astrophysics Data System (ADS)

Albert Einstein accepted a "special" visiting professorship at the University of Leiden in the Netherlands in February 1920. Although his appointment should have been a mere formality, it took until October of that year before Einstein could occupy his special chair. Why the delay? The explanation involves a case of mistaken identity with Carl Einstein, Dadaist art, and a particular Dutch fear of revolutions. But what revolutions was one afraid of? The story of Einstein's Leiden chair throws new light on the reception of relativity and its creator in the Netherlands and in Germany.

van Dongen, Jeroen



Photoacoustic tomography to identify inflammatory arthritis  

NASA Astrophysics Data System (ADS)

Identifying neovascularity (angiogenesis) as an early feature of inflammatory arthritis can help in early accurate diagnosis and treatment monitoring of this disease. Photoacoustic tomography (PAT) is a hybrid imaging modality which relies on intrinsic differences in the optical absorption among the tissues being imaged. Since blood has highly absorbing chromophores including both oxygenated and deoxygenated hemoglobin, PAT holds potential in identifying early angiogenesis associated with inflammatory joint diseases. PAT is used to identify changes in the development of inflammatory arthritis in a rat model. Imaging at two different wavelengths, 1064 nm and 532 nm, on rats revealed that there is a significant signal enhancement in the ankle joints of the arthritis affected rats when compared to the normal control group. Histology images obtained from both the normal and the arthritis affected rats correlated well with the PAT findings. Results support the fact that the emerging PAT could become a new tool for clinical management of inflammatory arthritis.

Rajian, Justin Rajesh; Girish, Gandikota; Wang, Xueding



Photoacoustic tomography to identify inflammatory arthritis  

PubMed Central

Abstract. Identifying neovascularity (angiogenesis) as an early feature of inflammatory arthritis can help in early accurate diagnosis and treatment monitoring of this disease. Photoacoustic tomography (PAT) is a hybrid imaging modality which relies on intrinsic differences in the optical absorption among the tissues being imaged. Since blood has highly absorbing chromophores including both oxygenated and deoxygenated hemoglobin, PAT holds potential in identifying early angiogenesis associated with inflammatory joint diseases. PAT is used to identify changes in the development of inflammatory arthritis in a rat model. Imaging at two different wavelengths, 1064 nm and 532 nm, on rats revealed that there is a significant signal enhancement in the ankle joints of the arthritis affected rats when compared to the normal control group. Histology images obtained from both the normal and the arthritis affected rats correlated well with the PAT findings. Results support the fact that the emerging PAT could become a new tool for clinical management of inflammatory arthritis.

Rajian, Justin Rajesh; Girish, Gandikota; Wang, Xueding



Differential Diagnosis of Hand Arthritis on MRI  

Microsoft Academic Search

When a patient presents with new-onset arthritis, determining the classification influences treatment. Since an early correct diagnosis can mitigate possible joint destruction, this issue begins a review of the differential diagnosis of arthritis of the hand — a topic we will revisit later in the year. In recent issues, The MRI Mentor profiled the pathogenesis and MRI appearance of the

Stephen J. Pomeranz; Margaret Phillips


Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study  

Microsoft Academic Search

OBJECTIVE: Rheumatoid arthritis (RA) is a common, severe, chronic inflammatory joint disease. Since the disease may initially be indistinguishable from other forms of arthritis, early diagnosis can be difficult. Autoantibodies seen in RA can be detected years before clinical symptoms develop. In an inception cohort of patients with recent-onset arthritis, we undertook this study to assess the predictive value of

F. A. van Gaalen; S. P. Linn-Rasker; W. J. W. van Venrooij; B. A. de Jong; F. C. Breedveld; C. L. Verweij; R. E. M. Toes; T. W. J. Huizinga



Relationship among nitric oxide, leptin, ACTH, corticosterone, and IL-1beta, in the early and late phases of adjuvant arthritis in male Long Evans rats.  


Leptin, a hormone regulating body weight, food intake, and metabolism, is associated with activation of immune cells and inflammation. In this study we analyzed levels of leptin, adrenocorticotropic hormone (ACTH), corticosterone, interleukin 1beta (IL-1beta), and nitric oxide (NO) production on days 10 and 22 of adjuvant arthritis (AA) in male Long Evans rats to ascertain possible relationship of leptin with its modulators during the early and late phases of chronic inflammation. The circulating leptin levels were significantly reduced already on day 10 of AA compared to controls (1.97+/-0.22 ng/ml vs. 3.08+/-0.25 ng/ml, p<0.05); on day 22 no significant further drop was observed (1.06+/-0.21 ng/ml). Leptin mRNA in epididymal fat tissue was reduced in arthritic animals compared to controls on day 22 (0.61+/-0.09 vs. 1.30+/-0.1 arbU/GAPDH (p<0.01). IL-1beta concentration in spleen was enhanced on day 10 of AA (24.55+/-4.67 pg/100 microg protein vs. 14.33+/-1.71 pg/100 microg protein; p<0.05); on day 22 it did not differ from controls. ACTH and corticosterone levels were significantly elevated only on day 22 of AA (ACTH: 306.17+/-42.22 pg/ml vs. 157.61+/-23.94 pg/ml; p<0.05; corticosterone: 5.24+/-1.38 microg/100 ml vs. 1.05+/-0.23 microg/100 ml; p<0.01). Nitrate levels were enhanced similarly on days 10 (49.86+/-1.83 microM) and 22 of AA (43.58+/-2.17 microM), compared to controls (23.42+/-1.39 microM, p<0.001). These results show that corticosterone does not stimulate leptin production during AA. The suppression of leptin may be a consequence of permanent activation of NO, IL-1beta, and of lower weight gain. Circulating leptin does not seem to play a key role in the progression of chronic arthritis. PMID:16962144

Stofkova, Andrea; Skurlova, Martina; Tybitanclova, Katarina; Veselsky, Leopold; Zelezna, Blanka; Jurcovicova, Jana



Patients with early rheumatoid arthritis exhibit elevated autoantibody titers against mildly oxidized low-density lipoprotein and exhibit decreased activity of the lipoprotein-associated phospholipase A2  

PubMed Central

Rheumatoid arthritis is a chronic inflammatory disease, associated with an excess of cardiovascular morbidity and mortality due to accelerated atherosclerosis. Oxidized low-density lipoprotein (oxLDL), the antibodies against oxLDL and the lipoprotein-associated phospholipase A2 (Lp-PLA2) may play important roles in inflammation and atherosclerosis. We investigated the plasma levels of oxLDL and Lp-PLA2 activity as well as the autoantibody titers against mildly oxLDL in patients with early rheumatoid arthritis (ERA). The long-term effects of immunointervention on these parameters in patients with active disease were also determined. Fifty-eight ERA patients who met the American College of Rheumatology criteria were included in the study. Patients were treated with methotrexate and prednisone. Sixty-three apparently healthy volunteers also participated in the study and served as controls. Three different types of mildly oxLDL were prepared at the end of the lag, propagation and decomposition phases of oxidation. The serum autoantibody titers of the IgG type against all types of oxLDL were determined by an ELISA method. The plasma levels of oxLDL and the Lp-PLA2 activity were determined by an ELISA method and by the trichloroacetic acid precipitation procedure, respectively. At baseline, ERA patients exhibited elevated autoantibody titers against all types of mildly oxLDL as well as low activity of the total plasma Lp-PLA2 and the Lp-PLA2 associated with the high-density lipoprotein, compared with controls. Multivariate regression analysis showed that the elevated autoantibody titers towards oxLDL at the end of the decomposition phase of oxidation and the low plasma Lp-PLA2 activity are independently associated with ERA. After immunointervention autoantibody titers against all types of oxLDL were decreased in parallel to the increase in high-density lipoprotein-cholesterol and high-density lipoprotein-Lp-PLA2 activity. We conclude that elevated autoantibody titers against oxLDL at the end of the decomposition phase of oxidation and low plasma Lp-PLA2 activity are feature characteristics of patients with ERA, suggesting an important role of these parameters in the pathophysiology of ERA as well as in the accelerated atherosclerosis observed in these patients.

Lourida, Evangelia S; Georgiadis, Athanasios N; Papavasiliou, Eleni C; Papathanasiou, Athanasios I; Drosos, Alexandros A; Tselepis, Alexandros D



Serial determination of cyclic citrullinated peptide autoantibodies predicted five-year radiological outcomes in a prospective cohort of patients with early rheumatoid arthritis  

PubMed Central

The objective of this study was to evaluate the potential of serially determined anti-cyclic citrullinated peptide (CCP) antibodies for predicting structural joint damage in patients with early rheumatoid arthritis (RA), compared to a single baseline determination. Ninety-nine RA patients with disease durations of less than one year and no history of disease-modifying antirheumatic drug therapy were followed prospectively for at least five years. Anti-CCP2 concentrations were measured using a second-generation ELISA. Sharp scores as modified by van der Heijde were determined on hand and foot radiographs. Anti-CCP2 antibodies were detected in 55.5% of patients at baseline and 63.6% at any time during the first three years. Presence of anti-CCP2 at any time during the first three years was associated with radiographic damage at baseline (odds ratio (OR), 3.66; 95% confidence interval (95% CI) 0.99–13.54) and with five year progression of the total Sharp score (OR, 3.17; 95% CI, 1.3–7.7), erosion score (OR, 5.3; 95% CI, 1.4–19.2) and joint space narrowing score (OR, 2.8; 95% CI, 1.15–6.8). The presence of anti-CCP2 or IgM RF at baseline did not predict these outcomes. Patients with negative anti-CCP2 tests throughout follow-up had less radiographic progression than patients with increasing anti-CCP2 concentrations; they did not differ from patients with decreasing anti-CCP2 antibody levels. HLADRB1* typing showed that progression of the mean modified Sharp score was not correlated with the presence of the shared epitope alleles. In conclusion, serially determined anti-CCP2 antibodies during the first three years of follow-up performs better than baseline determination for predicting radiographic progression in patients with early RA.

Meyer, Olivier; Nicaise-Roland, Pascale; Santos, Marie dos; Labarre, Colette; Dougados, Maxime; Goupille, Philippe; Cantagrel, Alain; Sibilia, Jean; Combe, Bernard



Periarticular and generalised bone loss in patients with early rheumatoid arthritis: influence of alendronate and intra-articular glucocorticoid treatment. Post hoc analyses from the CIMESTRA trial.  


OBJECTIVES: The aims of this study were to investigate the influence of alendronate and intra-articular betamethasone treatment on bone mineral density (BMD) changes in hand, lumbar spine and femoral neck during 1 year of a treat-to-target study (Cyclosporine, Methotrexate, Steroid in RA (CIMESTRA)). PATIENTS AND METHODS: A hundred and sixty patients with early, active rheumatoid arthritis (RA) received methotrexate, intra-articular betamethasone and ciclosporin /placebo-ciclosporin. Patients with Z-score ?0 also started alendronate 10 mg/day. BMD of the hand (digital x-ray radiogrammetry (DXR-BMDhand)), BMD of lumbar spine and femoral neck (dual x-ray absorptiometry (DXA-BMDlumbar spine and DXA-BMDfemoral neck)) and x-rays of hands, wrists and forefeet (modified Sharp-van der Heijde score) were measured at baseline and 1 year, with complete data available in 107 patients. RESULTS: The change in BMD in hand, lumbar spine and femoral neck was negatively associated with the dose of intra-articular betamethasone (p<0.01 for all), but the bone loss in hand was modest and in the axial skeleton comparable with that of healthy individuals. Alendronate did not influence changes in DXR-BMDhand, which averaged -2.8%, whereas significant changes were observed in DXA-BMDlumbar spine and DXA-BMDfemoral neck in alendronate-treated patients (1.8% and 0.8%) compared with untreated patients (-1.8% and -2.2%) (p<0.01 and 0.02). Alendronate did not affect the radiographic progression (alendronate-treated patients: 0 (range 0-19), non-alendronate: 0 (0-18)). CONCLUSIONS: In early active RA, intra-articular betamethasone injections added to disease-modifying antirheumatic drug (DMARD) treatment led to minimal loss of hip and lumbar BMD, and the loss could be prevented by treatment with alendronate. Alendronate treatment did not affect radiographic progression. PMID:23661492

Jensen, T W; Hansen, M S; Hørslev-Petersen, K; Hyldstrup, L; Abrahamsen, B; Langdahl, B; Zerahn, B; Pødenphant, J; Stengaard-Petersen, K; Junker, P; Ostergaard, M; Lottenburger, T; Ellingsen, T; Andersen, L S; Hansen, I; Skjødt, H; Pedersen, J K; Lauridsen, U B; Svendsen, A J; Tarp, U; Lindegaard, H; Jurik, Anne Grethe; Vestergaard, Aage; Hetland, M L



Efficacy of leflunomide addition in relation to prognostic factors for patients with active early rheumatoid arthritis failing to methotrexate in daily practice.  


The recommendations of the European League Against Rheumatism (EULAR) for the management of rheumatoid arthritis (RA) suggest a different therapeutic approach to methotrexate (MTX) resistance according to the presence or absence of poor prognostic factors. Retrospectively, in our patients with active early RA (disease activity score in 28 joints (DAS28)?>?3.2) that failed to respond to initial MTX monotherapy, we investigated whether leflunomide (LEF) addition had a different efficacy when associated with the presence or absence of poor prognostic factors. Of the 20 patients who received LEF, 15 (2 males and 13 females) tolerated the combination. Five patients had no poor prognostic factors, and 4 (80%) of those patients achieved remission or low disease activity (LDA) according to DAS28 and also a good response with the EULAR criteria. Of the 10 patients with at least one poor prognostic factor, remission or LDA occurred in 4 (40%) of the patients, and a good EULAR response was obtained in 3 (30%) of the patients. By Fisher's exact test, no significant difference was found between the two groups of patients in remission or LDA (p?=?0.28) according to DAS28 and a good response (p?=?0.12) with the EULAR criteria. In all patients with an inadequate response to the LEF+MTX combination, the substitution of a TNF inhibitor for LEF or the addition of a TNF inhibitor to the combination led to remission or LDA. Large studies are required to investigate the efficacy of LEF addition in relation to prognostic factors in patients with active early RA that did not respond to the initial therapy with MTX alone. PMID:21904814

Sakellariou, Grigorios T; Sayegh, Fares E; Kapetanos, George A; Berberidis, Charalampos



Frequency of Th17 CD4+ T Cells in Early Rheumatoid Arthritis: A Marker of Anti-CCP Seropositivity  

Microsoft Academic Search

ObjectiveTo examine the frequency and phenotype of Th17 cells in the peripheral blood of early RA (eRA) patients.MethodsCD4+ T cells were isolated from the peripheral blood of 33 eRA patients, 20 established RA patients and 53 healthy controls (HC), and from the synovial fluid of 20 established RA patients (RASF), by ficoll-hypaque gradient and magnetical negative selection. After polyclonal stimulation,

Irene Arroyo-Villa; María-Belén Bautista-Caro; Alejandro Balsa; Pilar Aguado-Acín; Laura Nuño; María-Gema Bonilla-Hernán; Amaya Puig-Kröger; Emilio Martín-Mola; María-Eugenia Miranda-Carús



Orthopterological notes I : On the Lesini of the Leiden Museum (Tettigoniidae, Copiphorinae)  

Microsoft Academic Search

When rearranging a part of the collections of Orthoptera in the Rijksmuseum van Natuurlijke Historie at Leiden I found a number of specimens belonging to this tribus, which by former authors is considered as a separate subfamily with the name Eumegalodontinae (Kirby, 1906, p. 289; Caudell, 1927, p. 30). With Karny I think it justified to let it retain its

Jong de C



Increased risk of second cancers in managing Hodgkin's disease: the 20-year Leiden experience  

Microsoft Academic Search

Summary Between January 1969 and December 1988, 482 patients were treated for Hodgkin's disease at the Leiden University Hospital. All cases were routinely recorded in the Hospital Information System, which has an active annual follow-up. Of all patients, 57% remained relapse free. According to the kinds of treatment they received, the following major categories were established: radiotherapy only (28.2%), chemotherapy

J. K. Sont; W. A. H. J. van Stiphout; E. M. Noordijk; J. Molenaar; J. H. M. Zwetsloot-Schonk; R. Willemze; J. P. Vandenbroucke



Factor V Leiden mutation is associated with ocular involvement in Behçet disease  

Microsoft Academic Search

PURPOSE:Behçet disease is a systemic disease of young adults characterized by venous occlusion in both the deep venous and retinal circulations. In severe ocular disease, blindness may occur despite immunosuppressive treatment. The most common inherited risk factor for the development of idiopathic venous thrombosis is the presence of the Factor V (FV Leiden) mutation, which confers resistance to activated protein

D. H Verity; R. W Vaughan; W Madanat; E Kondeatis; H Zureikat; F Fayyad; C. A Kanawati; I Ayesh; M. R Stanford; G. R Wallace



Fetal carriers of the factor V Leiden mutation are prone to miscarriage and placental infarction  

Microsoft Academic Search

Objectives: The factor V Leiden mutation is the most common genetic predisposition to thrombosis. However, little is known concerning the reproductive outcome of mutation carriers or prenatal expressivity of this thrombogenic mutation. Our purpose was to examine whether this mutation presents phenotypically as miscarriage or idiopathic placental thrombosis. Study design: We performed two studies. First, a case-control comparison to determine

Donna S. Dizon-Townson; Lewis Meline; Lesa M. Nelson; Michael Varner; Kenneth Ward



Factor V Leiden and acquired activated protein C resistance among 1000 women with recurrent miscarriage  

Microsoft Academic Search

Activated protein C (APC) resistance, both in its congenital form, due to the factor V Leiden mutation, and in its acquired form, are important risk factors for systemic venous thrombosis. In view of the suspected thrombotic aetiology of some cases of recurrent miscarriage, the prevalence of APC resistance was determined among 1111 consecutive Caucasian women with a history of either

R. Rai; A. Shlebak; H. Cohen; M. Backos; Z. Holmes; K. Marriott; L. Regan



Livedo (livedoid) vasculitis and the factor V Leiden mutation: additional evidence for abnormal coagulation.  


We report the case of a patient with livedo vasculitis associated with the factor V Leiden mutation. This association provides additional support for abnormalities of coagulation in patients with this disorder. The spectrum of platelet, coagulation, and fibrinolytic disorders reported with livedo vasculitis is reviewed. PMID:11756961

Calamia, Kenneth T; Balabanova, Maria; Perniciaro, Charles; Walsh, John S



Verzeichnis der Echiuridae, Sipunculidae und Priapulidae des Naturhistorichen Reichsmuseums in Leiden  

Microsoft Academic Search

Die vorliegende Mitteilung ist das Ergebnis der Bearbeitung zumeist älteren Materiales an Echiuriden, Sipunculiden und Priapuliden des Naturhistorischen Reichs-Museums in Leiden. Obwohl die Sammlung nach Anzahl der Exemplare nicht umfangreich ist, zeigt sie einen überraschenden Reichtum an Formen ganz verschiedener Provenienz. Es sind nicht weniger als 31 verschiedene Arten vorhanden, die 13 verschiedenen Genera angehoren. Auch die Fundorte sind sehr

G. Stiasny



Resistance to activated protein C and the Leiden mutation: High prevalence in patients with abruptio placentae  

Microsoft Academic Search

Objective: The Leiden mutation, a point mutation in the gene encoding coagulation factor V, is associated with a high frequency of thromboembolic phenomena. It has recently been connected with adverse outcomes of pregnancy. We carried out this study to define its connection with abruptio placentae. Study Design: Twenty-seven women who had abruptio placentae and 29 control subjects matched for age,

Zofnat Wiener-Megnagi; Izhar Ben-Shlomo; Yael Goldberg; Eliezer Shalev



Protein Z influences the prothrombotic phenotype in Factor V Leiden patients  

Microsoft Academic Search

Protein Z enhances the inhibition of factor Xa by protein Z-dependent protease inhibitor (ZPI). Thus, diminution of protein Z should induce prothrombotic tendency due to lowered cofactor activity for ZPI. In Factor V Leiden mice, prothrombotic tendency of severe diminution or lack of protein Z was demonstrated. We here present first studies in humans, indicating that diminution of protein Z

Bettina Kemkes-Matthes; Margareta Nees; Gitta Kühnel; Axel Matzdorff; Karl J Matthes



Posttraumatic Arthritis  

PubMed Central

Posttraumatic arthritis (i.e., degenerative joint disease secondary to injury) is a particular problem in young, active patients. It limits the activities of these vigorous individuals, and the compromised joint must be endured for a long time. The knee is used as an example of a joint commonly involved in this process. Conditions predisposing patients to posttraumatic arthritis are discussed, as are some treatment modalities, including rest, ice therapy, anti-inflammatory medications, physiotherapy, muscle strengthening programs, intra-articular steroid injections, joint arthroplasty, and patient education.

Pickering, Robert D.



Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis  

PubMed Central

Background Currently available biomarkers for the early tissue process leading to joint damage in rheumatoid arthritis are insufficient and lack prognostic accuracy, possibly a result of variable activity of the disease over time. This study represents a novel approach to detect an altered activity of the disease process detected as increasing serum-COMP levels over a short time and whether this would correlate with joint damage progression over the first 5 years of disease. Methods In all, 349 patients from the Swedish BARFOT early RA study were examined. Serum-COMP was analysed by ELISA at diagnosis and after 3 months. Based on changes in serum-COMP levels, three subgroups of patients were defined: those with unchanged levels (change ? 20%) (N=142), decreasing levels (> 20%) (N=173) and increasing levels (> 20%) (N=34). Radiographs of hands and feet were obtained at inclusion, after 1, 2 and 5 years and scored according to Sharp van der Heijde (SHS). Radiographic progression was defined as increase in SHS by ?5.8. Results The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels. Furthermore, the odds ratio of radiographic progression was 2.8 (95% CI 1.26-6.38) for patients with increasing COMP levels vs. patients with unchanged levels. The group of patients with increasing COMP levels had higher ESR at inclusion but there were no baseline differences between the groups for age, gender, disease duration, disease activity (DAS28), function (HAQ), CRP, nor presence of rheumatoid factor or anti-CCP. Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression. Conclusion Increasing serum-COMP levels between diagnosis and the subsequent 3 months in patients with early RA represents a novel indicator of an activated destructive process in the joint and is a promising tool to identify patients with significant joint damage progression during a 5-year period.



Forms of Arthritis  


... stiffness, inflammation, swelling and, sometimes, destruction of joints. Gout — a form of arthritis that occurs when uric ... the joints. Some 2.1 million Americans have gout. Lupus — a form of arthritis, like rheumatoid arthritis, ...


Headache and Arthritis  


... exist. Two of the most common types are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis may begin at any age. It is a ... areas of the neck most commonly afflicted by rheumatoid arthritis are the first and second cervical vertebra. Curiously, ...


Improving healthcare consumer effectiveness: An Animated, Self-serve, Web-based Research Tool (ANSWER) for people with early rheumatoid arthritis  

PubMed Central

Background People with rheumatoid arthritis (RA) should use DMARDs (disease-modifying anti-rheumatic drugs) within the first three months of symptoms in order to prevent irreversible joint damage. However, recent studies report the delay in DMARD use ranges from 6.5 months to 11.5 months in Canada. While most health service delivery interventions are designed to improve the family physician's ability to refer to a rheumatologist and prescribe treatments, relatively little has been done to improve the delivery of credible, relevant, and user-friendly information for individuals to make treatment decisions. To address this care gap, the Animated, Self-serve, Web-based Research Tool (ANSWER) will be developed and evaluated to assist people in making decisions about the use of methotrexate, a type of DMARD. The objectives of this project are: 1) to develop ANSWER for people with early RA; and 2) to assess the extent to which ANSWER reduces people's decisional conflict about the use of methotrexate, improves their knowledge about RA, and improves their skills of being 'effective healthcare consumers'. Methods/design Consistent with the International Patient Decision Aid Standards, the development process of ANSWER will involve: 1.) creating a storyline and scripts based on the best evidence on the use of methotrexate and other management options in RA, and the contextual factors that affect a patient's decision to use a treatment as found in ERAHSE; 2.) using an interactive design methodology to create, test, analyze and refine the ANSWER prototype; 3.) testing the content and user interface with health professionals and patients; and 4.) conducting a pilot study with 51 patients, who are diagnosed with RA in the past 12 months, to assess the extent to which ANSWER improves the quality of their decisions, knowledge and skills in being effective consumers. Discussion We envision that the ANSWER will help accelerate the dissemination of knowledge and skills necessary for people with early RA to make informed choices about treatment and to manage their health. The latest in animation and online technology will ensure ANSWER fills a knowledge translation gap, focusing on the next generation of people living with RA.



Arthritis of the Knee  


... in the article titled "Viscosupplementation Treatment for Arthritis." Gold Salt Injections Special medical treatments for rheumatoid arthritis include gold salt injections and other disease-modifying drugs. Top ...


Population differences in the frequency of the factor V Leiden variant among people with clinically symptomatic protein C deficiency.  

PubMed Central

The factor V Leiden variant, responsible for the phenomenon of activated protein C resistance, was found to be less frequent among British (0.06) and Swedish/Danish (0.15) protein C deficiency patients than previously reported in a Dutch study (0.19). In the Swedish population, a significantly increased frequency of the factor V Leiden allele was apparent in protein C deficiency patients as compared to healthy controls. However, this was not found in the British population. Coinheritance of the factor V Leiden variant is therefore unlikely to be the sole determinant of whether a person with protein C deficiency will come to clinical attention. Nevertheless, when patient data were analysed by type of protein C deficiency, it was noted that the frequency of the factor V Leiden variant was 2.8-fold higher in type II patients compared to type I patients. A possible explanation of this disparity is discussed.

Hallam, P J; Millar, D S; Krawczak, M; Kakkar, V V; Cooper, D N



Rheumatoid arthritis  

Microsoft Academic Search

Neutrophils constitute over 90% of cells found in the synovial fluid of rheumatoid arthritis (RA) patients. Since such fluids also contain immune complexes (IgG-IgG and IgG-IgM rheumatoid factors) and complement split products (C5, C5A, DES, ARG, C3B, etc.), all of the reactants are present for a local Arthus lesion. Moreover, neutrophils from RA patients endocytose these immune complexes and complement

Gerald Weissmann; Helen Korchak



Laboratory diagnosis of rheumatoid arthritis. Prospective study of 85 patients  

Microsoft Academic Search

Because early diagnosis of rheumatoid arthritis is difficult increasingly important, we have assessed the value of laboratory investigation in 85 patients with knee effusions studied from presentation and followed for sufficiently long periods to allow a definite diagnosis. Histopathology on needle biopsy specimens narrowed the differential diagnosis to rheumatoid arthritis and closely related conditions even at an early stage of

C E Bayliss; R L Dawkins; G Cullity; R E Davis; J B Houliston



The explosion of a ship, loaded with black powder, in Leiden in 1807  

Microsoft Academic Search

In 1807 a ship containing 37,000 pounds of black powder exploded in the centre of Leiden. The effects were devastating, resulting in a large number of casualties and an area of 5.5ha (5.5×104m2) completely destroyed. The effects of the explosion were calculated, based on an equivalent amount of 9000kg of TNT, making use of formulas and knowledge derived from detonation

H. J. Reitsma



Determination of the accuracy of truncated Leiden and Berlin virial expansions for pure gases  

Microsoft Academic Search

The accuracy of truncated virial EoS to represent pure gas properties was studied in detail for the residual properties (Z?1), ln? and (HR\\/RT). The Leiden or density expansion was examined with truncation after the second virial coefficient B and also after the third virial coefficient C and compared with the same truncation of the Berlin or pressure expansion. First a

Philip T. Eubank; Harald Kruggel-Emden; Gabriel Santana-Rodriguez; Xiaonian Wang



Septic arthritis in patients with rheumatoid arthritis  

Microsoft Academic Search

There is an increasing number of rheumatoid patients who get septic arthritis. Chronic use of steroids is one of the important predisposing factors. The clinical picture of septic arthritis is different in immunocompromised patients like patients with rheumatoid arthritis. The diagnosis and management are discussed in this review article.

Abdulaziz Al-Ahaideb



Looking through the 'window of opportunity': is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis?  

Microsoft Academic Search

Over the past decade there have been significant advances in the clinical understanding and care of rheumatoid arthritis (RA). Major paradigm changes include earlier disease detection and introduction of therapy, and 'tight control' of follow-up driven by regular measurement of disease activity parameters. The advent of tumour necrosis factor (TNF) inhibitors and other biologic therapies have further revolutionised care. Low

James Woodburn; Kym Hennessy; Martijn PM Steultjens; Iain B McInnes; Deborah E Turner



Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial  

Microsoft Academic Search

OBJECTIVE: Several treatment strategies have proven value in the amelioration of rheumatoid arthritis (RA), but the optimal strategy for preventing long-term joint damage and functional decline is unclear. We undertook this study to compare clinical and radiographic outcomes of 4 different treatment strategies, with intense monitoring in all patients. METHODS: In a multicenter, randomized clinical trial, 508 patients were allocated

Y. P. M. Goekoop-Ruiterman; Vries-Bouwstra de J. K; C. F. Allaart; D. Van Zeben; P. J. S. M. Kerstens; J. M. W. Hazes; A. H. Zwinderman; H. K. Ronday; K. H. Han; M. L. Westedt; A. H. Gerards; Groenendael van J. H. L. M; W. F. Lems; M. V. Van Krugten; F. C. Breedveld; B. A. C. Dijkmans



Local Rheumatoid Arthritis and Radiation Synovectomy  

Microsoft Academic Search

The approach to treatment of rheumatoid arthritis is undergoing fundamental change, and the concept that early and aggressive\\u000a suppression of inflammation and control of disease activity may slow the rate of disease progression is increasingly accepted\\u000a [22]. Nonsteroidal anti-inflammatory and slow-acting antirheumatic drugs are indisputably the primary treatment modalities in\\u000a rheumatoid arthritis (RA). However, persistent synovitis in one or a

Georg M. Kacl; Gerold Stucki


Single-factor scoring validation for the Health Assessment Questionnaire-Disability Index (HAQ-DI) in patients with systemic sclerosis and comparison with early rheumatoid arthritis patients  

Microsoft Academic Search

Objective  Structural validity for the Health Assessment Questionnaire-Disability Index (HAQ-DI) has recently been provided for patients with rheumatoid arthritis (RA). The goal of the current study was to examine the structural validity of the HAQ-DI in patients with systemic sclerosis (SSc, scleroderma) and to compare its performance with that in patients with RA.Methods  The HAQ-DI structural validity was first assessed in a

Jason C. Cole; Dinesh Khanna; Philip J. Clements; James R. Seibold; Donald P. Tashkin; Harold E. Paulus; Michael R. Irwin; Sarosh J. Motivala; Daniel E. Furst



Detection of rheumatoid arthritis using infrared imaging  

Microsoft Academic Search

Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of function in joints; it is difficult to diagnose in early stages. An early diagnosis and treatment can delay the onset of severe disability. Infrared (IR) imaging offers a potential approach to detect changes in degree of inflammation. In 18 normal subjects and 13 patients diagnosed with

Monique Frize; Cynthia Adéa; Pierre Payeur; Gina di Primio; Jacob Karsh; Abiola Ogungbemile



Optical imaging: new tools for arthritis.  


Conventional radiography, ultrasound, CT, MRI, and nuclear imaging are the current imaging modalities used for clinical evaluation of arthritis which is highly prevalent and a leading cause of disability. Some of these types of imaging are also used for monitoring disease progression and treatment response of arthritis. However, their disadvantages limit their utilities, such as ionizing radiation for radiography, CT, and nuclear imaging; suboptimal tissue contrast resolution for radiography, CT, ultrasound, and nuclear imaging; high cost for CT and MRI and nuclear imaging; and long data-acquisition time with ensuing patient discomfort for MRI. Recently, there have been considerable advances in nonionizing noninvasive optical imaging which has demonstrated promise for early diagnosis, monitoring therapeutic interventions and disease progression of arthritis. Optical based molecular imaging modalities such as fluorescence imaging have shown high sensitivity in detection of optical contrast agents and can aid early diagnosis and ongoing evaluation of chronic inflammatory arthritis. Optical transillumination imaging or diffuse optical tomography may differentiate normal joint clear synovial fluid from turbid and pink medium early in the inflammatory process. Fourier transform infrared spectroscopy has been used to evaluate fluid composition from joints affected by arthritis. Hemodynamic changes such as angiogenesis, hypervascularization, and hypoxia in arthritic articular tissue can potentially be observed by diffuse optical tomography and photoacoustic tomography. Optical measurements could also facilitate quantification of hemodynamic properties such as blood volume and oxygenation levels at early stages of inflammatory arthritis. Optical imaging provides methodologies which should contribute to detection of early changes and monitoring of progression in pathological characteristics of arthritis, with relatively simple instrumentation. PMID:20844793

Chamberland, David; Jiang, Yebin; Wang, Xueding



SKG arthritis as a model for evaluating therapies in rheumatoid arthritis with special focus on bone changes.  


The aim was to further characterize the SKG model of rheumatoid arthritis (RA) and its potential for studying intervention treatments, with special focus on bone targeting therapies. Three individual studies were conducted, using a total of 71 SKG mice, comparing arthritis induction with mannan versus zymosan A, female versus male mice, and the effect of dexamethasone intervention treatment initiated at different time points after arthritis induction. Hind paws were embedded undecalcified in methyl methacrylate, and sections were stained with Masson-Goldner trichrome. Areal Bone Mineral Density (aBMD) of the femora was determined with pDXA. RNA was extracted from the hind paws followed by the quantification by reverse transcriptase PCR. SKG mice stimulated with mannan presented a higher arthritis score than mice stimulated with zymosan A. Female SKG mice developed a more severe arthritis than male SKG mice. Dexamethasone inhibited arthritis clinically as well as histologically when the treatment was initiated prophylactically or within the first week of arthritis. Femoral aBMD was lower in animals with arthritis than in control animals. The RANKL RNA expression was elevated in arthritic mice, whereas OPG RNA expression was unchanged. The results suggest mannan as arthritis inductor and female instead of male mice in experiments as well as an optimal time window for the initiation of treatment. Systemic bone loss as well as local up regulation of RANKL was present early in SKG arthritis. These results demonstrate that SKG arthritis is a suitable new model for evaluating therapies in RA. PMID:22948540

Keller, Kresten Krarup; Lindgaard, Lisa Mejlvang; Wogensen, Lise; Dagnæs-Hansen, Frederik; Thomsen, Jesper Skovhus; Sakaguchi, Shimon; Stengaard-Pedersen, Kristian; Hauge, Ellen-Margrethe



Plasma hepcidin levels and anemia in old age. The Leiden 85-Plus Study  

PubMed Central

Hepcidin, an important regulator of iron homeostasis, is suggested to be causally related to anemia of inflammation. The aim of this study was to explore the role of plasma hepcidin in anemia among older persons from the general population. The Leiden 85-Plus Study is a population-based study of 85-year olds in Leiden, the Netherlands. Eighty-five-year old inhabitants of Leiden were enrolled between September 1997 and September 1999. At the age of 86, plasma hepcidin was determined with time of flight mass spectrometry in 490 participants [160 (32.7%) male, 114 (23.3%) with anemia]. Anemia was defined according to criteria of the World Health Organization (hemoglobin level <13 g/dL for men and hemoglobin <12 g/dL for women). The median plasma hepcidin level was 3.0 nM [interquartile range (IQR) 1.8–4.9]. We found strong correlations between plasma hepcidin and body iron status, C-reactive protein and erythropoietin levels. Significantly higher hepcidin levels were found in participants with anemia of inflammation (P<0.01), in participants with anemia of kidney disease (P=0.01), and in participants with unexplained anemia (P=0.01) than in participants without anemia. Participants with iron-deficiency anemia had significantly lower plasma hepcidin levels than participants without anemia (P<0.01). In conclusion, older persons with anemia of inflammation have higher hepcidin levels than their counterparts without anemia. The potential clinical value of hepcidin in future diagnostic algorithms for anemia has to be explored.

den Elzen, Wendy P.J.; de Craen, Anton J.M.; Wiegerinck, Erwin T.; Westendorp, Rudi G.J.; Swinkels, Dorine W.; Gussekloo, Jacobijn



Postoperative pulmonary embolism in a young female accompanying with Factor V Leiden mutation and hereditary sypherocytosis.  


A 20 year-old female, heterozygous for Factor V Leiden mutation (FVLM) is presented. Her personal history was prominent for severe anaemia during her gestation. Aetiology of anaemia was found to be hereditary spherocytosis (HS). Intrauterine foetal death had occurred at 20 weeks of gestational age. Two days after curettage, she developed pulmonary embolism (PE). This is an unusual case of pulmonary embolism and intrauterine foetal death coexisting with FVLM and/or HS. We present the case so that a general practitioner or haematologist can hardly see such cases in daily practice. Hence, a young female with PE should be screened for hypercoagulable states including FVLM or HS. PMID:15353920

Karnak, Demet; Beder, Sumru; Kayacan, Oya; Berk, Ozlem



Thrombophilic mutations among Southern Iranian patients with sickle cell disease: high prevalence of factor V Leiden  

Microsoft Academic Search

Background  A hypercoagulable state in sickle cell disease (SCD) and beta thalassemia has been established and thrombosis is an important\\u000a aspect of the clinical spectrum of sickle cell disease. In a case-control study, the prevalence of factor V Leiden and prothrombin\\u000a G20210A mutations were investigated among SCD patients from Southern Iran.\\u000a \\u000a \\u000a \\u000a Methods  Patients comprised 60 individuals with SCD; of them 35 were

Zohreh Rahimi; Asad Vaisi-Raygani; Ronald L. Nagel; Adriana Muniz



Instrumental pressure observations from the end of the 17th century: Leiden (The Netherlands)  

NASA Astrophysics Data System (ADS)

We present a series of daily pressure readings taken in 1697-98 in Leiden (Netherlands) by W. Senguerd. The readings were reviewed, converted to modern units, and reduced to 0 °C. The 2 year series runs parallel with the Paris 1665-1713 and London 1697-1708 pressure series. Although the series covers a time span of 23 months only, it can be regarded as a useful addition to the very few pressure series that extend back into the 17th century.

Können, G. P.; Brandsma, T.



[Sulfasalazine in rheumatoid arthritis].  


Sulfasalazine (SLZ) is now a second-line treatment in rheumatoid arthritis (RA), as well as in psoriatic arthritis and ankylosing spondylitis. 54 patients with active RA were treated with enteric coated SLZ (2 g daily) in a 24-week open study. Clinical and laboratory parameters of disease activity were monitored initially and thereafter at 2-week intervals for the first 2 months, and then at 4-week intervals until the end of the 24-week study. There was significant clinical improvement at the end, as shown by scores for joint pain (Ritchie), grip strength and morning stiffness (p less than 0.0001, less than 0.0001 and less than 0.01, respectively, by paired t test). Clinical improvement was accompanied by significant decrease in erythrocyte sedimentation rate and increase in hemoglobin (p less than 0.002 and less than 0.016, respectively). There was improvement in some cases as early as 3 weeks after starting therapy. The drop-out rate was significant: 19/54 (35%), most (13) due to side-effects, mainly gastrointestinal; none of the side-effects were serious. Our results, similar to those of other studies, indicate that despite the high rate of side effects, SLZ is an effective, second-line drug for RA. PMID:1682225

Segal, R; Caspi, D; Sukenik, S; Horowitz, I; Rubinov, A; Fluser, D; Scharf, Y; Shapira, D; Weinberger, A; Gedz, D



Temporal Changes in the Activated Protein C Resistance Ratio in a Heterozygote for Factor V Leiden Are Abolished by Dilution in Factor V-Deficient Plasma  

Microsoft Academic Search

Activated protein C resistance (APCR) is the single most common cause of hereditary thrombophilia and is caused by a mutation in the factor V molecule (FV Leiden). Screening for this defect has become a standard part of the laboratory evaluation of thrombophilia. However, the original APTT-based screening test does not discriminate completely between normal individuals and heterozygotes for FV Leiden.

Todd Meyer; Maria Garcia; Elizabeth Helms; Deborah A. Francis; John L. Francis



Arthroscopic washout of the ankle for septic arthritis in a three-month-old boy  

PubMed Central

There is no report of athroscopic treatment for septic arthritis of the ankle in infants. We report a case of successful management of septic arthritis of the ankle in a three-month-old boy by arthroscopic washout. Arthroscopic washout may be a useful treatment for septic arthritis in young infants when performed early after onset.



Sex and Arthritis  


... Pain Pregnancy and Rheumatic Disease Sex and Arthritis Sex and Arthritis PRINT Download PDF Description Sexuality is ... sensation Erectile dysfunction or impotence Begin overcoming barriers Sex is not simply about reaching rapid orgasm with ...


Arthritis in Kansas.  

National Technical Information Service (NTIS)

Arthritis is a word used to describe many different conditions related to chronic joint symptoms, connective tissue disorders, and other rheumatic conditions. As a technical term, arthritis is defined as inflammation of the joint or joints. For the purpos...



Literacy Measure B - Arthritis  

Center for Drug Evaluation (CDER)

... Literacy Measure B - Arthritis. ARTHRITIS. Frequency. Percent. Valid Percent. Cumulative Percent. Valid, Correct, 865, 95.7, 95.7, 95.7. ... More results from


Tofacitinib for Rheumatoid Arthritis  

Center for Biologics Evaluation and Research (CBER)

Text Version... Page 13. Rheumatoid Arthritis: Medical Need Stanley Cohen, MD ... Page 15. Rheumatoid Arthritis (RA) • Chronic, inflammatory, systemic autoimmune ... More results from


Livedoid vasculiltis associated with a double heterozygous Factor V Leiden and prothrombin G20210A gene mutations.  


Livedoid vasculitis (LV) may be an isolated condition or associated with an underlying systemic disease, including coagulation disorders, periarteritis nodosa and systemic autoimmune diseases. The classic histological features of LV (fibrin deposition on dermal vessels and the absence of important perivascular infiltrate or leucocytoclasia) argue against a primary vasculitis and is more in keeping with a thrombotic process. Factor V Leiden mutations have rarely been reported in association with LV. We report a patient with LV, who had doubly inherited thrombophilia, with heterozygous mutations in the Factor V Leiden (G1691A) and prothrombin (G20210A) genes. PMID:19793098

Khenifer, S; Thomas, L; Balme, B; Dalle, S



Aortic incompetence in HLA B27-positive juvenile arthritis.  

PubMed Central

The early onset of isolated aortic incompetence in a male child with HLA B27 and peripheral arthritis is reported. Acute anterior uveitis and lone aortic incompetence occurred at 1 and 9 months respectively after the development of the acute inflammatory arthritis. The uveitis resolved with local therapy and the arthritis remitted 10 months after the onset. There has been no recurrence of the arthritis after 10 years of close follow-up but the aortic incompetence has persisted, though it remains haemodynamically insignificant.

Kean, W F; Anastassiades, T P; Ford, P M



Corynebacterium xerosis septic arthritis.  


A 62-year-old man developed acute septic arthritis due to Corynebacterium xerosis. The patient was treated with ampicillin and rapidly recovered. To the authors' knowledge this is the only reported case of septic arthritis due to C. xerosis. Clinical features of this case and the five previously reported cases of diphtheroid arthritis are discussed. PMID:3354512

Valenstein, P; Klein, A; Ballow, C; Greene, W



Juvenile idiopathic arthritis.  


Juvenile idiopathic arthrithis (JIA) is the most common rheumatic disease of childhood.JIA is a chronic disease that is associated with periods of disease flares and periods of disease inactivity.Early, aggressive treatment with nonsteroidal anti-inflammatory drugs, intra-articular corticosteroid injections, or methotrexate, has significantly improved the outcome of most children who have JIA. Biologics have been shown to be both safe and effective for the treatment of more aggressive forms of arthritis and for uveitis. Long-term safety data of biologics is still uncertain. In the near future, it is hoped that genetic testing will allow earlier diagnosis of JIA as well as help predict the disease course of children who have JIA. Genetic analysis also may allow physicians to target therapies more effectively. It is hoped that development of more specific therapies will decrease overall immunosuppression and other associated toxicities. PMID:22753788

Espinosa, Maria; Gottlieb, Beth S



The Relationship Between Function and Disease Activity as Measured by the HAQ and DAS28 Varies Over Time and by Rheumatoid Factor Status in Early Inflammatory Arthritis (EIA). Results from the CATCH Cohort§  

PubMed Central

Objective: To investigate the relationship between function and disease activity in early inflammatory arthritis (EIA). Methods: Canadian Early Arthritis Cohort (CATCH) (n=1143) is a multi-site EIA cohort. Correlations between the Health Assessment Questionnaire Disability Index (HAQ) and DAS28 were done at every 3 months for the first year and then at 18 and 24 months. We also investigated the relationship between HAQ and DAS28 by age (<65 versus ?65) and RF (positive vs negative). Results: Mean HAQ and DAS28 scores were highest at the initial visit with HAQ decreasing over 24 months from a baseline of 0.94 to 0.40 and DAS28 scores decreasing from 4.54 to 2.29. All correlations between HAQ and DAS28 were significant at all time points (p<0.01). The correlations between HAQ and DAS28 were variable over time. The strongest correlation between HAQ and DAS28 occurred at initial visit (most DMARD naive) (n=1,143) and 18 months (r=0.57, n=321) and 24 months (r=0.59, n=214). The baseline correlation between HAQ and DAS28 was significantly different than correlations obtained at 3, 6, and 12 months (p=0.02, 0.01, and 0.01, respectively). Age did not change the association between HAQ and DAS28 {<65 years old (r=0.50, n=868) versus ?65 (r=0.48, n=254), p=0.49}. The correlation between HAQ and DAS28 was stronger with RF+ patients (r=0.63, n=636) vs RF negative (r=0.47, n=477), p=0.0043 Conclusion: Over 2 years in EIA, HAQ and DAS both improved; correlations at time points were different over 2 years and RF status affected the correlations.

Boyd, Tristan A; Bonner, A; Thorne, C; Boire, G; Hitchon, C; Haraoui, B.P; Keystone, E.C; Bykerk, V.P; Pope, J.E



From reactive arthritis to rheumatoid arthritis  

Microsoft Academic Search

Reactive arthritis was initially described as a sterile synovitis, without microbial components present in the joint tissue. It has, however, become evident that bacterial degradation products, and even bacterial DNA, are present in the synovium of patients with this disease. Since intestinal pathogens are important causes of reactive arthritis, and since cellular homing allows transport of bacterial products from the

Paavo Toivanen



Life-threatening aortic thrombosis in a trauma patient homozygous for factor V Leiden mutation: Case report.  


We report a case of near fatal aortic thrombosis in a trauma patient homozygous for mutation of Factor V Leiden. He responded well to vascular surgery and intensive care unit management and was discharged successfully from the hospital one month later. PMID:21554701

Tsangaris, Iraklis; Tsaknis, Georgios; Tsantes, Argirios; Kopterides, Petros; Armaganidis, Apostolos



Life-threatening aortic thrombosis in a trauma patient homozygous for factor V Leiden mutation: Case report  

PubMed Central

We report a case of near fatal aortic thrombosis in a trauma patient homozygous for mutation of Factor V Leiden. He responded well to vascular surgery and intensive care unit management and was discharged successfully from the hospital one month later.



The factor V Leiden mutation, high factor VIII, and high plasminogen activator inhibitor activity: etiologies for sporadic miscarriage  

Microsoft Academic Search

We hypothesized that the thrombophilic G1691A factor V Leiden gene mutation was a common significant cause of sporadic first trimester miscarriage. We compared thrombophilia and hypofibrinolysis in 92 women (85 white, 5 black, 2 other) with 1 or more pregnancies and 1 miscarriage (143 live births, 92 miscarriages) (cases) and in 380 female controls (355 white, 21 black, 4 other)

Charles J. Glueck; Joel Pranikoff; Dawit Aregawi; Mofiz Haque; Binghua Zhu; Trent Tracy; Ping Wang



Evaluation of Factor V Leiden, Prothrombin and Methylenetetrahydrofolate Reductase Gene Mutations in Patients with Severe Pregnancy Complications in Northern Finland  

Microsoft Academic Search

Background: Thrombosis in placenta may lead to severe pregnancy complications. Most important inherited thrombophilias are factor V Leiden mutation, prothrombin mutation, and methylenetetrahydrofolate reductase mutation. The aim of our research was to evaluate the prevalence of inherited thrombophilias in severe pregnancy complications and in normal pregnancies. Material and Methods: The study subjects with severe preeclampsia, intrauterine growth restriction, placental abruption

J. Jarvenpaa; M. Pakkila; E.-R. Savolainen; A. Perheentupa; I. Jarvela; M. Ryynanen



Current immunotherapy in rheumatoid arthritis.  


Rheumatoid arthritis is a common autoimmune disease primarily manifesting as chronic synovitis, subsequently leading to a change in joint integrity. Progressive disability and systemic complications are strongly associated with a decreased quality of life. To maintain function and health in patients with rheumatoid arthritis, early, aggressive and guided immunosuppressive therapy is required to induce clinical remission. Antirheumatic drugs are capable of controlling synovial inflammation and are therefore named 'disease-modifying antirheumatic drugs' (DMARDs). This article aims to bridge the beginning of DMARD therapy with agents such as methotrexate, leflunomide, sulfasalazine, injectable gold and (hydroxy)chloroquine with biological therapies, and with the new era of kinase inhibitors. Mechanisms of action, as well as advantages and disadvantages of DMARDs, are discussed with respect to the current literature and current recommendations. PMID:23998731

Meier, Florian Mp; Frerix, Marc; Hermann, Walter; Müller-Ladner, Ulf



[Rheumatoid arthritis and recurrent rheumatism associated with sclerosing cholangitis].  


The authors report two cases presenting to a rheumatologist, one with palindromic rheumatism and previously undiagnosed ulcerative colitis, and one with rheumatoid arthritis. Both were subsequently found to have early sclerosing cholangitis with some response treatment. PMID:7833872

Sykes, H R; Deighton, C M; Chuck, A J; Crook, P R



Blind confirmation in Leiden of Geczy factor on the cells of Dutch patients with ankylosing spondylitis  

SciTech Connect

A follow-up blind study, of the ability of cross-reactive antisera to distinguish between the cells of Dutch patients with ankylosing spondylitis (AS) and normal controls, was performed in Leiden. Of the 45 cell samples tested, 29 were fresh peripheral blood mononuclear (PBM) cells while 15 were cryopreserved PBM. No false positives but one false negative was identified among the 45 samples, and the negative was confirmed after the recoded cryopreserved cells from this patient were retested. It is concluded that the cross-reactive antisera raised in Sydney give good discrimination between patients and normals. Factors affecting the success of the /sup 51/Cr-release cytotoxicity assay, and possible reasons for the failure of others to confirm these observations, are briefly discussed.

Geczy, A.F.; van Leeuwen, A.; van Rood, J.J.; Ivanyi, P.; Breur, B.S.; Cats, A.



The purple toe syndrome in female with Factor V Leiden mutation successfully treated with enoxaparin.  


Purple toe syndrome is a rare complication of warfarin therapy. It occurs usually after 3 to 8 weeks of therapy and it is caused by cholesterol emboli from atheromatous plaque. Sudden onset of pain in affected area, typically in toes and feet, is the main characteristic of the syndrome. We describe a case of a 65-year-old female with purple toe syndrome after 6 weeks of warfarin. Indication of warfarin was a proximal deep venous thrombosis, which developed after prolonged immobilization. Factor V (FV) Leiden and persistent high FVIII activity were found as additional eliciting factors for venous thromboembolism. After warfarin withdrawal and enoxaparin treatment, symptoms disappeared promptly but a slight discoloration of the toe persists. PMID:22531482

Dulí?ek, Petr; Bártová, J; Beránek, M; Malý, J; Pecka, M



Psoriatic Arthritis: Signs and Symptoms  


... is often a sign of psoriatic arthritis. Sausage digit Psoriatic arthritis can cause a finger or toe ... swollen finger or toe is called a sausage digit. Heel pain Some people who have psoriatic arthritis ...


Genetics Home Reference: Rheumatoid arthritis  


... Recent literature OMIM Genetic disorder catalog Conditions > Rheumatoid arthritis On this page: Description Genetic changes Inheritance Diagnosis ... Glossary definitions Reviewed September 2013 What is rheumatoid arthritis? Rheumatoid arthritis is a disease that causes chronic ...


A multifrequency angular power spectrum analysis of the Leiden polarization surveys  

NASA Astrophysics Data System (ADS)

The Galactic synchrotron emission is expected to be the most relevant source of astrophysical contamination in cosmic microwave background polarization measurements, at least at frequencies ? ? 70 GHz and at angular scales ?? 30'. We present a multifrequency analysis of the Leiden surveys, linear polarization surveys covering the Northern Celestial Hemisphere at five frequencies between 408 MHz and 1411 MHz. By implementing specific interpolation methods to deal with these irregularly sampled data, we produced maps of the polarized diffuse Galactic radio emission with a pixel size ?0.92°. We derived the angular power spectrum (APS) (PI, E, and B modes) of the synchrotron dominated radio emission as function of the multipole, ?. We considered the whole covered region and some patches at different Galactic latitudes. By fitting the APS in terms of power laws (C_? ˜ ?\\cdot??), we found spectral indices that steepen with increasing frequency: from ? ˜ -(1-1.5) at 408 MHz to ? ˜ -(2-3) at 1411 MHz for 10 ? ? ? 100 and from ? ˜ -0.7 to ? ˜ -1.5 for lower multipoles (the exact values depending on the considered sky region and polarization mode). The bulk of this flattening at lower frequencies can be interpreted in terms of Faraday depolarization effects. We then considered the APS at various fixed multipoles and its frequency dependence. Using the APSs of the Leiden surveys at 820 MHz and 1411 MHz, we determined possible ranges for the rotation measure, RM, in the simple case of an interstellar medium slab model. Also taking into account the polarization degree at 1.4 GHz, it is possible to break the degeneracy between the identified RM intervals. The most reasonable of them turned out to be RM ˜ 9-17 rad/m2 although, given the uncertainty on the measured polarization degree, RM values in the interval 53-59 rad/m2 cannot be excluded.

La Porta, L.; Burigana, C.



Treatment of carrageenan induced arthritis by the platelet activating factor antagonist BN 50730.  

PubMed Central

OBJECTIVE--To evaluate the role of platelet activating factor (PAF) in the early stage of arthritis. METHODS--Arthritis was induced in rabbits by weekly intra-articular injections of carrageenan. A PAF receptor antagonist, BN 50730, was used as a preventive or curative agent. RESULTS--BN 50730 was able partially to prevent the development of arthritis, and was also active on established arthritis. The joint arthritis scores of BN treated animals were significantly lower than those of the non-treated animals. The blood concentrations of PAF, PAF bound to lipoproteins (lipo-PAF), and its precursor, lyso-PAF, were not correlated with clinical variations. CONCLUSIONS--The present data demonstrate a therapeutic action of a PAF antagonist in experimental arthritis and suggest a critical role for PAF during the early stage of arthritis.

Hilliquin, P; Natour, J; Aissa, J; Guinot, P; Laoussadi, S; Benveniste, J; Menkes, C J; Arnoux, B



Treatment of rheumatoid arthritis using photodynamic therapy  

NASA Astrophysics Data System (ADS)

The only early therapy of rheumatoid arthritis in orthopedic surgery is a synovectomy, which is restricted to more or less big joints. A laser-synovectomy of small joints is ineffective yet. An alternative method may be photodynamic therapy. In our study we describe the photodynamic effect of Photosan 3 in a cell culture study.

Hendrich, Christian; Diddens, Heyke C.; Nosir, Hany R.; Siebert, Werner E.



Treatment of rheumatoid arthritis using photodynamic therapy  

NASA Astrophysics Data System (ADS)

The only early therapy of rheumatoid arthritis in orthopedic surgery is a synovectomy, which is restricted to more or less big joints. A laser-synovectomy of small joints is ineffective yet. An alternative method may be photodynamic therapy. In our study we describe the photodynamic effect of Photosan 3 in a cell culture study.

Hendrich, Christian; Diddens, Heyke C.; Nosir, Hany; Siebert, Werner E.



Bacterial and lyme arthritis  

Microsoft Academic Search

Septic arthritis is an infectious disease emergency, requiring aggressive joint drainage and prompt antibiotic therapy. Because\\u000a age and joint damage are major risk factors, septic arthritis may become more common as the baby-boom generation reaches senescence.\\u000a Bacteremic joint infections have a high mortality, and long-term disability from joint damage is common. Lyme arthritis has\\u000a a negligible mortality and low morbidity

John J. Ross; Linden T. Hu




Center for Biologics Evaluation and Research (CBER)

Text VersionPage 1. Tanezumab Arthritis Advisory Committee Briefing Document TANEZUMAB ARTHRITIS ADVISORY COMMITTEE BRIEFING DOCUMENT ... More results from


Atherosclerosis in Juvenile Idiopathic Arthritis  

PubMed Central

Atherosclerosis is a chronic inflammatory disease of the arteries. Clinical consequences of the atherosclerotic process occur in the adult population, however atherosclerotic process begins in childhood. The classic risk factors for atherosclerosis include obesity, dyslipidaemia, age, gender or family history. In recent years, attention has been drawn to the similarity between atherosclerotic inflammatory processes and inflammatory changes in the course of systemic connective tissue disease, in particular systemic lupus etythematosus (SLE) or rheumatoid arthritis (RA). There is also observed the similarity of the pathogenetic background of development of atherosclerosis and juvenile idiopathic arthritis (JIA). Elevated levels of pro-inflammatory cytokines are observed in the course of juvenile idiopathic arthritis. Also homocysteine concentrations, which may play a significant role in the development of atherosclerotic lesions, are observed higher in patients with JIA. Some studies revealed higher carotid intima-media thickness (IMT) index values in children with JIA. In view of the fact that atherosclerotic process begins as early as in childhood, the introduction of appropriate preventive measures in children is a matter of utmost importance.

Jednacz, Ewa; Rutkowska-Sak, Lidia



Atherosclerosis in juvenile idiopathic arthritis.  


Atherosclerosis is a chronic inflammatory disease of the arteries. Clinical consequences of the atherosclerotic process occur in the adult population, however atherosclerotic process begins in childhood. The classic risk factors for atherosclerosis include obesity, dyslipidaemia, age, gender or family history. In recent years, attention has been drawn to the similarity between atherosclerotic inflammatory processes and inflammatory changes in the course of systemic connective tissue disease, in particular systemic lupus etythematosus (SLE) or rheumatoid arthritis (RA). There is also observed the similarity of the pathogenetic background of development of atherosclerosis and juvenile idiopathic arthritis (JIA). Elevated levels of pro-inflammatory cytokines are observed in the course of juvenile idiopathic arthritis. Also homocysteine concentrations, which may play a significant role in the development of atherosclerotic lesions, are observed higher in patients with JIA. Some studies revealed higher carotid intima-media thickness (IMT) index values in children with JIA. In view of the fact that atherosclerotic process begins as early as in childhood, the introduction of appropriate preventive measures in children is a matter of utmost importance. PMID:22933832

Jednacz, Ewa; Rutkowska-Sak, Lidia



IgG rheumatoid factors against the four human Fc-gamma subclasses in early rheumatoid arthritis (the Swedish TIRA project).  


Rheumatoid factor (RF), i.e. a family of autoantibodies against the Fc part of IgG, is an important seromarker of rheumatoid arthritis (RA). Traditional particle agglutination without disclosing the antibody isotype remains the predominating diagnostic method in clinical routine. Although IgG-RF attracts pathogenic interest, its detection remains technically challenging. The present study aimed at developing a set of tests identifying IgG-RFs directed against the four IgG subclasses. IgG-RF against either subclass of human IgG-Fc were analysed with four novel enzyme-linked immunosorbent assays (ELISAs) utilizing four recombinant human Fc-gamma fragments (hIgG1-4) as sources of antigen. Sera from 40 patients with recent onset RA (20 seropositive and 20 seronegative by IgM-RF and IgA-RF-isotype-specific ELISA) were analysed. Sera from 20 healthy blood donors served as reference. Among the IgM-/IgA-RF-positive RA-sera, IgG-RF was found directed against hIgG1 and hIgG2, but not against hIgG3 or hIgG4. Significant correlations were seen between IgG-RF against hIgG2-Fc and IgM-RF (r = 0.666) levels. Further prospective studies are warranted to elucidate any correlation to disease course and outcome. PMID:21916920

Kanmert, D; Kastbom, A; Almroth, G; Skogh, T; Enander, K; Wetterö, J



Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type  

PubMed Central

Background: ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population. Methods: We used data from 2 Danish studies that followed members of the general public from 1977 through 2010. We obtained the genotype of 66 001 white participants for ABO blood type, factor V Leiden R506Q and prothrombin G20210A. We calculated hazard ratios (HRs) and population attributable risk. Our main outcome measures were venous thromboembolism and myocardial infarction. Results: The multivariable adjusted HR for venous thromboembolism was 1.4 (95% confidence interval [CI] 1.3–1.5) for non-O blood type (v. O blood type). For the factor V Leiden R506Q mutation, the adjusted HR was 2.2 (95% CI 2.0–2.5) for heterozygous participants and 7.0 (95%CI 4.8–10) for homozygous participants (v. participants without the mutation). For prothrombin G20210A, the adjusted HR was 1.5 (95%CI 1.2–1.9) for heterozygous participants and 11 (95% CI 2.8–44) for homozygous participants (v. participants without the mutation). When we combined ABO blood type and factor V Leiden R506Q or prothrombin G20210A genotype, there was a stepwise increase in the risk of venous thromboembolism (trend, p < 0.001). The population attributable risk of venous thromboembolism was 20% for ABO blood type, 10% for factor V Leiden R506Q and 1% for prothrombin G20210A. Multivariable adjusted HRs for myocardial infarction by genotypes did not differ from 1.0. Interpretation: ABO blood type had an additive effect on the risk of venous thromboembolism when combined with factor V Leiden R506Q and prothrombin G20210A mutations; blood type was the most important risk factor for venous thromboembolism in the general population.

Sode, Birgitte F.; Allin, Kristine H.; Dahl, Morten; Gyntelberg, Finn; Nordestgaard, B?rge G.



In patients with early inflammatory polyarthritis, ACPA positivity, younger age and inefficacy of the first non-biological DMARD are predictors for receiving biological therapy: results from the Norfolk Arthritis Register  

PubMed Central

Objectives To identify baseline disease-related predictors in patients with early inflammatory polyarthritis (IP) for starting subsequent biological therapy and to determine if patients who failed their first non-biological disease-modifying antirheumatic drug (DMARD) within 6 months were more likely to need biological therapy. Methods Patients with early IP recruited between 1990 and 1994 (cohort 1) and between 2000 and 2004 (cohort 2) in the Norfolk Arthritis Register were included in this study. The association between possible predictors with the start of biological therapy was assessed using Cox proportional hazards regression models. Results 32/407 (7.9%) patients in cohort 1 and 45/416 (10.8%) patients in cohort 2 received biological therapy during follow-up. In both cohorts, anti-citrullinated protein antibody (ACPA) positivity (cohort 1, HR 7.62, 95% CI 2.46 to 23.58; cohort 2, HR 4.68, 95% CI 2.23 to 9.78) was the strongest predictor for starting biological therapy. In cohort 2, younger patients (HR 0.97, 95% CI 0.95 to 0.99) and patients who failed their first non-biological DMARD within 6 months due to inefficacy were also more likely to receive biological therapy (HR 2.35, 95% CI 1.05 to 5.27). Conclusion Patients with early IP who are ACPA positive, are younger or who fail their first non-biological DMARD due to inefficacy within 6 months are more likely to need biological therapy.

Verstappen, Suzanne M M; Lunt, Mark; Bunn, Diane K; Scott, David G I; Symmons, Deborah P M



[Imaging modalities in psoriatic arthritis].  


This review presents an overview of the range of imaging modalities used in the diagnostic evaluation of patients with psoriatic arthritis (PsA). Conventional radiography is used to detect structural changes of the joints and tendon attachments. These changes occur late in the course of PsA hence conventional radiography contributes little to the early detection of PsA; however, the detection of periosteal proliferations on radiographs allows a relatively specific diagnosis of PsA. Skeletal scintigraphy and computed tomography are rarely used in PsA. Arthrosonography (ultrasound of the joints) is gaining increasing importance in the early identification of inflammatory soft tissue signs of PsA in the peripheral joints. Sonography enables early detection of synovitis and tenosynovitis as well as superficial erosions and also inflammatory processes of the tendon attachments. Magnetic resonance imaging (MRI) is indispensable for identifying possible involvement of the axial skeleton. Moreover, it allows good visualization of periostitis and arthritis. High resolution microcomputed tomography is an interesting novel diagnostic tool which allows highly sensitive evaluation of the bone structure and can detect very tiny bone lesions where typical signs of PsA are omega-shaped erosions and small corona-like spikes. Another interesting new diagnostic technique is fluorescence optical imaging (FOI) with the Xiralite system which is highly sensitive for detecting inflammatory processes of the hands. PMID:24085530

Hermann, K-G A; Ohrndorf, S; Werner, S G; Finzel, S; Backhaus, M



Psychological disorders in rheumatoid arthritis: a growing consensus?  

PubMed Central

Previous reviews of psychological factors in arthritis have emphasised the methodological weaknesses of many studies, especially those attempting to measure personality after years of disabling disease. To make sense of the published reports three factors need to be considered separately: previous personality, social stresses, and current mental state. Each can now be measured reliably and independently of symptoms which might be directly attributable to the arthritis. There is a growing consensus that the normal range of personality is represented among patients with early arthritis, that the prevalence of depression is similar to that of patients with other medical conditions, and that social stress is more closely related to depression than activity and the disabling effect of arthritis. Longitudinal studies are now required to examine which social stresses can be attributed to the disabling effect of arthritis. Depression and social stress often manifest themselves to the rheumatologist as excessive complaints of pain and frequent clinic attendances so appropriate psychosocial treatments may reduce this behaviour.

Creed, F



[Dutch midwives: image and occupation. Developments in midwifery in Leiden, Arnhem, 's-Hertogenbosch and Leeuwarden, 1650-1865].  


My study on the social position of Dutch midwives in early modern Europe was induced by the consistently negative image in the literature at the time. Medical doctors and accoucheurs (obstetricians) expressed critical opinions on both the occupation of midwifery and the midwives themselves. They disparaged the behaviour, activities, training, income, additional jobs and social background of midwives. Later, medical doctors and historians reproduced and promulgated this negative image of midwives. At issue is the extent to which the attitudes of medical doctors and accoucheurs corresponded to those of the broader population, and how these attitudes were related to the actual place in society. The question is if midwives took a marginal position in urban society. My work focusses on four Dutch cities: Arnhem, Leeuwarden, Leiden and 's-Hertogenbosch. It deals with the period 1650-1685. The criticism of medical practitioners and of a accoucheurs on midwives are described. The occupation itself is discussed: the activities of midwives and the development of the profession (regulation, training and rivalry). At the end of the seventeenth and the beginning of the eighteenth century, the medical profession began to show an interest in childbirth. Rivalry between accoucheurs and midwives, competition between legal and illegal practitioners of midwifery, and in-fighting within the profession tell us something about the development of the profession. From the eighteenth century on, attending problematic births was claimed as a privilege of accoucheurs. Data from municipal archives were used to find out if and to what extent midwives were marginalised. Their geographical mobility, social background (occupations of parents), occupations of husbands, income and domicile are discussed. Analysis of this material indicates that midwives belonged to the common urban labouring class (consisting of artisans and workers), and were not very different from other members of this class. Certainly they were not marginalised, instead they had a relatively privileged position within the common labouring class. Five motives can be distinguished for the negative image expressed by medical doctors and accoucheurs in their publications: 1) professional rivalry, 2) division of theoretical and practical knowledge, 3) class differences, 4) gender, and 5) 'polluting' activities. Studies on ideas of pollution and 'infamous' occupations might lead one to conclude that midwives in the Dutch Republic were stigmatised. I found no evidence, however, that the opinions of medical doctors and accoucheurs were shared by the broader public. Official recognition of midwives - the regulation of their practice and education - protected tham. This has contributed to their position as independent practitioners in the Netherlands up to today. PMID:11640278

Van der Borg, E



Nitroblue tetrazolium test in psoriatic arthritis, rheumatoid arthritis, and osteoarthrosis  

Microsoft Academic Search

Nitroblue tetrazolium test scores were obtained in 43 patients with psoriatic arthritis, 32 patients with rheumatoid arthritis, and 16 patients with osteoarthrosis. The mean score in all groups was similar and was higher than previously reported in patients awaiting heart surgery or with noninfective dermatoses. The test is not thought to be helpful in differentiating psoriatic arthritis from rheumatoid arthritis,

J R Lambert; M Roberts; V Wright



Predicting low disease activity and remission using early treatment response to anti-TNF therapy in patients with rheumatoid arthritis: Exploratory analyses from the TEMPO trial  

PubMed Central

Objective To derive and validate decision trees to categorize rheumatoid arthritis (RA) patients 12 weeks after starting etanercept with or without methotrexate into three groups: patients predicted to achieve low disease activity (LDA) at 1 year; patients predicted to not achieve LDA at 1 year; and patients who needed additional time on therapy to be categorized. Methods Data from RA patients enrolled in TEMPO were analyzed. Classification and Regression Trees were used to develop and validate decision-tree models with week 12 and earlier assessments that predicted long-term LDA. LDA, defined as DAS28 ? 3.2 or Clinical Disease Activity Index (CDAI) ? 10.0, was measured at 52 or 48 weeks. Demographics, laboratory data, and clinical data at baseline and through week 12 were analyzed as predictors of response. Results Thirty-nine percent (67/172) of patients receiving etanercept and 60% (115/193) of patients receiving etanercept plus methotrexate achieved LDA at week 52. For patients receiving etanercept, 53% were predicted to have LDA, 39% were predicted to not have LDA, and 8% could not be categorized using DAS28 criteria at week 12. For patients receiving etanercept plus methotrexate, 63% were predicted to have LDA, 25% were predicted to not have LDA, and 12% could not be categorized. Conclusion Most (80%–90%) patients in TEMPO initiating etanercept with or without methotrexate could be predicted within 12 weeks of starting therapy as likely to have LDA or not at week 52. However, approximately 10%–20% of patients needed additional time on therapy to decide whether to continue treatment.

Curtis, Jeffrey R.; Yang, Shuo; Chen, Lang; Park, Grace S.; Bitman, Bojena; Wang, Brian; Navarro-Millan, Iris; Kavanaugh, Arthur



Bone status in adults with early-onset juvenile idiopathic arthritis following 1-year anti-TNF? therapy and discontinuation of glucocorticoids.  


Juvenile idiopathic arthritis (JIA) is an inflammatory disease associated with bone loss and low bone mineral density (BMD). The treatment involves disease-modifying antirheumatic drugs, glucocorticoids (GCs) and biological agents. The aim of this study was to evaluate effects of 12-month therapy with the anti-tumor necrosis factor alpha (anti-TNF?) preparations on bone mineral density (BMD) and biochemical turnover markers (BTM) in adult patients with JIA who were previously either treated or not treated with glucocorticoids (GC) and to assess effects of the discontinuation of GCs on their bone status. Nineteen adult patients (12 women, 7 men) aged 18-33 years with active JIA were prospectively enrolled to receive the anti-TNF? therapy (infliximab, etanercept or adalimumab). BMD and BTMs were determined at baseline and 1-year follow-up. The anti-TNF? therapy resulted in a significant reduction in disease activity score 28 (DAS28) and C-reactive protein (CRP) and a significant increase in BMD at the lumbar spine and total body and in serum N-terminal propeptide of type I procollagen (PINP, marker of bone formation). No significant changes in serum beta C-terminal telopeptide of type I collagen (?CTX, marker of osteoclastic bone resorption) and osteocalcin (marker of bone remodeling) were found. A significant negative correlation was observed between the change in the DAS28, CRP and serum PINP. The change in serum PINP concentrations positively correlated with the change in lumbar spine BMD. A significant increase in serum PINP was observed only in patients discontinuing GCs during the anti-TNF? treatment. After the initiation of the anti-TNF? therapy in young adults with JIA, the increase in new bone formation can be explained by discontinuation of GCs administration as the patients with the largest reduction in DAS28 and CRP probably are the ones most likely to stop GC. PMID:23370856

Brabnikova Maresova, Kristyna; Jarosova, Katerina; Pavelka, Karel; Stepan, Jan J



Sporotrichal arthritis in south central Kansas.  


Sporotrichal arthritis is a rare disease, with only 51 cases reported in the English literature. Thirteen patients with sporotrichal arthritis have been treated at Wichita area hospitals since 1979. Most of the patients were middle aged men. Significant alcohol intake was noted in 77% of the patients. There were 17 joints involved in the cases, including 10 knees, three interphalangeal joints, one elbow, one midtarsal, one intercarpal, and one metatarsophalangeal joint. The typical appearance was an afebrile patient with a mildly swollen warm joint without erythema. The leukocyte counts were normal in 85% of patients, and the erythrocyte sedimentation rates were elevated in 100%. The patients had various treatments and responses. Response rates included intravenous amphotericin B (16%), ketoconazole (40%), and arthrodesis (100%). Sporotrichal arthritis may be more common than previously thought. It should be considered early in the differential diagnosis of monoarthritis. PMID:9577429

Howell, S J; Toohey, J S



Livedoid vasculopathy associated with combined prothrombin G20210A and factor V (Leiden) heterozygosity and MTHFR C677T homozygosity.  


Livedoid vasculopathy (LV) is an occlusive thrombotic disease of lower extremities. A 34-year-old woman presented with 4-year history of recurrent necrotic and painful lesions with violaceous and purpuric border on both legs. Initial treatment with hydroxychloroquine, dapsone and prednisone were unsuccessful. Skin biopsy showed inflammatory infiltrate with epidermal necrosis. Prothrombin G20210A and factor V-Leiden heterozygosity, and MTHFR C677T homozygosity with hyperhomocysteinemia were confirmed. LV diagnosis was made; acetylsalicylic acid, folic acid, vitamin B12, and prednisone treatement resulted in complete healing. This is the first report on coexistence of prothrombin G20210A, factor V-Leiden, and homozygous MTHFR C677T with hyperhomocysteinemia in LV. PMID:18360788

Irani-Hakime, Noha A; Stephan, Farid; Kreidy, Raghid; Jureidini, Isabelle; Almawi, Wassim Y



Detection Of New High Velocity Clouds Using The Leiden-Argentina-Bonn Hi All-sky Survey  

NASA Astrophysics Data System (ADS)

We describe a new effort to use the Leiden/Argentina/Bonn (LAB) Galactic HI survey to update the high-velocity clouds catalog of Wakker and van Woerden (1991). The LAB survey (Kalberla et al 2005) combined the Leiden-Dwingeloo survey (Hartmann and Burton 1997) with a complementary southern sky survey (Arnal et al 2000). This survey provides improved angular spacing (0.5 deg vs. 1 deg) and velocity resolution (1 km/s vs. 16 km/s), although it was less sensitive than previous surveys. We describe how we fit the LAB high velocity gas with Gaussian components, providing three levels of review for the quality of fits, and compare the resulting high velocity cloud catalog to previous results for galactic latitudes greater than b=45 degrees. This research was supported by NASA ATP grant NNX10AI70G to the University of Wisconsin-Whitewater.

Engel, Tyler; Wakker, B.; Witt, C.; Gostisha, M. C.; Thomson, E.; Stratman, L.; Benjamin, R. A.



Tuberculous arthritis mimic arthritis of the Sjögren's syndrome: findings from sonography, computed tomography and magnetic resonance images.  


A patient with a history of Sjögren's syndrome developed chronic arthritis of left ankle. It was diagnosed as arthritis of the Sjögren's syndrome initially. However, joint pain persisted despite corticosteroid therapy. Sonography disclosed a multiloculated cystic lesion with peripheral hyperechoic enhancement around left ankle and extended to Achilles tendon and subcutaneous region. Computed tomography (CT) confirmed the findings. Magnetic resonance imaging (MRI) revealed increased signal intensity of the lesion after gadonillium enhancement on T1-weighted images. These abnormalities showed inhomogenous high signal intensities on T2-weighted images. Tuberculous arthritis was diagnosed by positive synovial tuberculous culture. Sonography is a valuable tool that offers significant advantages for the initial evaluation of arthritis of the Sjögren's syndrome and help early suspicious of tuberculous arthritis, because of its cost-effectiveness, superior differentiation between the cyst and solid lesions, convenience for guiding biopsy and drainage. PMID:11731212

Chen, Y C; Hsu, S W



Hypercoagulability in a newborn with concomitant homozygous factor V Leiden and severe homozygous protein C deficiency type 1.  


This is a case report of a female newborn presented with skin necrotic lesions 1 week after delivery. Laboratory investigations revealed severe homozygous protein C deficiency associated with homozygous factor V Leiden, although her pregnancy and perinatal periods were otherwise uneventful, with negative family history of thrombotic or bleeding disorders. Patient stabilization was established by supportive measures and long-term administration of fresh frozen plasma and warfarin. PMID:24056294

Al Antary, Eman T; Haddadin, Isam S; Hamory, Mufeed K; Daauuod, Maram M



A Highly Specific Functional Test for Factor V Leiden: A Modified Tissue Factor Assay for Activated Protein C Resistance  

Microsoft Academic Search

We compared the sensitivity and specificity of a tissue factor-based assay (FVR) with the addition of a phospholipid\\/silica preparation, to the commercially available aPTT-based method, APCR (CoatestTM), and a modified aPTT-based method (APCM) which utilized factor V-depleted plasma, for the detection of the factor V Leiden mutation. A total of 110 patients were included in this study. This included 32

Y. S. Arkel; D.-H. Ku; M. Kamiyama; R. Pajaro; H. Alder; A. Marchand



Angiogenesis Inhibition Suppresses Collagen Arthritis  

Microsoft Academic Search

Summary Neovascularization is observed in a spectrum of diseases such as solid tumors, diabetic retinopathy, and rheumatoid arthritis. It is also evident in rat collagen-induced arthritis (CIA), an animal model with histologic, clinical, and radiographic manifestations resembling rheumatoid arthritis. To evaluate the effects of angioinhibition in CIA, Louvain rats were immunized with type II collagen to induce arthritis and then

Derek J. Peacock; Mona Lisa Banquerigo; Ernest Brahn


Ocular manifestations in children and adolescents with Lyme arthritis  

PubMed Central

BACKGROUND—Lyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.?METHODS—A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospectively for 22-73 (median 44) months in the course of a national study.?RESULTS—Three of 84 patients with Lyme arthritis had ocular inflammation (4%), including keratitis, anterior uveitis, and uveitis intermedia. All three had symptoms of decreased visual acuity. Whereas anterior uveitis disappeared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systematic examination of all patients revealed no further ocular involvement. Of 69 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis.?CONCLUSIONS—Ocular involvement with keratitis, anterior uveitis, and intermediate uveitis may occur in children and adolescents with Lyme arthritis. Visual loss appears to be symptomatic, making regular ocular screening of such patients unnecessary.??

Huppertz, H.; Munchmeier, D.; Lieb, W.



The Relationship between Personality, Supportive Transactions and Support Satisfaction, and Mental Health of Patients with Early Rheumatoid Arthritis. Results from the Dutch Part of the Euridiss Study  

ERIC Educational Resources Information Center

The relationships between two personality characteristics (neuroticism, extraversion), three types of supportive transactions (emotional support, social companionship, instrumental support) and satisfaction with these transactions, and two aspects of mental health (feelings of anxiety and depressive mood) were studied among 280 patients with early

Suurmeijer, Th. P. B. M.; Van Sonderen, F. L. P.; Krol, B.; Doeglas, D. M.; Van Den Heuvel, W. J. A.; Sanderman, R.



Dossier: Rheumatoid arthritis Benign, atypical and malignant lymphoproliferative disorders in rheumatoid arthritis patients  

Microsoft Academic Search

Lymphadenopathy, which may be associated with systemic symptoms, is frequently associated with rheumatoid arthritis (RA). Reactive non- neoplastic tissue comprises the majority of the lymph node lesions. However, several cohort studies have demonstrated that RA has an increased risk of non-Hodgkin's lymphomas (NHLs). Since the early 1990s, an atypical or malignant lymphoproliferative disorders (LPD) in patients immunosupressed with methtorexate (MTX)

M. Kojima; T. Motoori; S. Nakamura



Chlamydia and chronic arthritis.  


Certain bacterial infections have been demonstrated to be causative of reactive arthritis. The most common bacterial trigger of reactive arthritis is Chlamydia trachomatis. Chlamydia pneumoniae is another known cause, albeit far less frequently. Although Chlamydia-induced reactive arthritis will often spontaneously remit, approximately 30% of patients will develop a chronic course. Modern medicine has provided rather remarkable advances in our understanding of the chlamydiae, as these organisms relate to chronic arthritis and the delicate balance between host and pathogen. C. trachomatis and C. pneumoniae both have a remarkable ability to disseminate from the initial site of infection and establish persistently viable organisms in distant organ sites, namely the synovial tissue. How these persistent chlamydiae contribute to disease maintenance remains to be fully established, but recent data demonstrating that long-term combination antimicrobial treatment can not only ameliorate the symptoms but eradicate the persistent infection suggest that these chronically infecting chlamydiae are indeed a driving force behind the chronic inflammation. We are beginning to learn that this all appears possible even after an asymptomatic initial chlamydial infection. Both C. trachomatis and C. pneumoniae are a clear cause of chronic arthritis in the setting of reactive arthritis; the possibility remains that these same organisms are culpable in other forms of chronic arthritis as well. PMID:21864020

Carter, John D; Inman, Robert D; Whittum-Hudson, Judith; Hudson, Alan P



Validity of the 24-hour recall method in infancy: the Leiden Pre-School Children Study.  


In the Leiden Pre-School Children Study the 24-hour recall method was used to determine the energy and nutrient intake of children from four to 28 months. A validation study was carried out in order to get insight into the validity of the collected dietary data. In the first part of the study the validity of the Dutch food table, supplemented with data on commercial babyfoods, was tested. The calculated average energy and nutrient intake of 111 six-month-old non-breastfed infants was compared with the results of chemical analysis of an equivalent composite corresponding with the average food intake of these children. With the exception of calcium and phosphorus the difference between the calculated and analysed values was less than 5%. Secondly the 24-hour recall was validated against the duplicate portion technique among 41 six-month-old non-breastfed infants. With the exception of sodium and iron, energy and nutrient intake data calculated from the 24-hour recall were significantly higher than those obtained after chemical analysis of the duplicate portions. However, on a relative level the results of the 24-hour recall and the duplicate portion technique corresponded very well. These results suggest that for infants a systematic difference exists between both methods. PMID:3384539

Horst, C H; Obermann-De Boer, G L; Kromhout, D



Factor V-Leiden Mutation: A Common Risk Factor for Venous Thrombosis among Lebanese Patients  

PubMed Central

Aim. Lebanon exhibits one of the highest prevalences of factor V-Leiden (FVL) in the world (14.4%). The aim of this study is to evaluate the incidence of FVL mutation among Lebanese patients with lower extremity venous thrombosis. Material and Methods. From January 2003 to January 2011, 283 consecutive Lebanese patients, diagnosed with deep venous thrombosis (DVT) by duplex scan, were retrospectively reviewed. FVL mutation was tested among patients with conditions highly suggestive of hypercoagulation states (65 patients). Results. FVL mutation was detected among 56.9% of patients, 68.6% of patients younger than 50 years, and 43.4% of patients older than 50 years (P = 0.041). FVL mutation was commonly reported in young adults, in patients with pregnancy, estrogen drugs, recurrent DVT, and resistance to anticoagulation. Conclusion. The high rate of FVL mutation observed among Lebanese patients with venous thrombosis is related to the high prevalence of this mutation in the Lebanese population. Thrombophilia screening should be tailored to accommodate a population's risk factor. In countries with high prevalence of FVL, this mutation should be screened among patients younger than 50 years and patients with situations highly suggestive of hypercoagulation states.

Kreidy, Raghid



A Catalog of High-Velocity Clouds in the Leiden/Dwingeloo Survey  

NASA Astrophysics Data System (ADS)

We present a complete, unbiased catalog of high-velocity clouds (HVCs) found in the Leiden/Dwingeloo Survey (LDS) of Galactic HI. We designed an automated routine to search for emission features in each of the >206,000 spectra in the LDS and employed a nonlinear least squares method to fit all detected features with Gaussian profiles. From our compilation of fit parameters, spatial and velocity criteria were used to collect high-velocity features into clouds. The LDS uniformly samples the full sky north of ? =-30o and has twice the spatial and ~ 10 times the velocity resolution of the HI survey used to compile the 1991 all-sky HVC catalog of Wakker and van Woerden. Our catalog is produced with the intent of providing a large sample of HVCs for comparison with observations of other galactic systems. We measure dN(H)/dN and d? /dN, examine the distribution of angular size as a function of vGSR, and determine beam-corrected values of radius and column density for the sample. The catalog will allow us to investigate whether the distribution dN(H)/dN can be directly compared with the same quantity for the Lyman limit systems seen in QSO spectra, and thereby assess whether the HVC properties are consistent with their being extragalactic objects. We also use these data to evaluate the reliability and completeness of previous HVC surveys. This research was partially supported by the National Science Foundation.

Robishaw, T.; Blitz, L.



Hepatocyte-specific IKK-? activation enhances VLDL-triglyceride production in APOE*3-Leiden mice.  


Low-grade inflammation in different tissues, including activation of the nuclear factor ?B pathway in liver, is involved in metabolic disorders such as type 2 diabetes and cardiovascular diseases (CVDs). In this study, we investigated the relation between chronic hepatocyte-specific overexpression of IkB kinase (IKK)-? and hypertriglyceridemia, an important risk factor for CVD, by evaluating whether activation of IKK-? only in the hepatocyte affects VLDL-triglyceride (TG) metabolism directly. Transgenic overexpression of constitutively active human IKK-? specifically in hepatocytes of hyperlipidemic APOE*3-Leiden mice clearly induced hypertriglyceridemia. Mechanistic in vivo studies revealed that the hypertriglyceridemia was caused by increased hepatic VLDL-TG production rather than a change in plasma VLDL-TG clearance. Studies in primary hepatocytes showed that IKK-? overexpression also enhances TG secretion in vitro, indicating a direct relation between IKK-? activation and TG production within the hepatocyte. Hepatic lipid analysis and hepatic gene expression analysis of pathways involved in lipid metabolism suggested that hepatocyte-specific IKK-? overexpression increases VLDL production not by increased steatosis or decreased FA oxidation, but most likely by carbohydrate-responsive element binding protein-mediated upregulation of Fas expression. These findings implicate that specific activation of inflammatory pathways exclusively within hepatocytes induces hypertriglyceridemia. Furthermore, we identify the hepatocytic IKK-? pathway as a possible target to treat hypertriglyceridemia. PMID:21357939

van Diepen, Janna A; Wong, Man C; Guigas, Bruno; Bos, Jasper; Stienstra, Rinke; Hodson, Leanne; Shoelson, Steven E; Berbée, Jimmy F P; Rensen, Patrick C N; Romijn, Johannes A; Havekes, Louis M; Voshol, Peter J



Antiphospholipid antibodies and pregnancy outcomes in women heterozygous for Factor V Leiden  

PubMed Central

Antiphospholipid antibodies are associated with a spectrum of pregnancy complications, including preeclampsia and small for gestational age (SGA) fetuses. We sought to assess anticardiolipin and anti-?2-glycoprotein I (anti-?2-GPI) IgG and IgM antibody prevalence and the relationship of these antibodies to pregnancy complications in women with the Factor V Leiden (FVL) mutation. The study comprised a secondary analysis of a multicenter, prospective observational study of FVL prevalence among 5,188 asymptomatic pregnant women. A subset of 362 women (117 FVL heterozygotes, 245 matched controls) had serum collected at the time of the original study and underwent serum analysis for anticardiolipin and anti-?2-GPI IgG and IgM as a part of this analysis. The primary outcome was preeclampsia and/or SGA (<10%). The overall prevalence of anticardiolipin and anti-?2-GPI IgG and IgM antibodies was low and did not vary with FVL status. Forty-seven women (13.0%) developed preeclampsia and/or SGA. There were no differences in primary outcome rates between women with and without aPL antibodies, regardless of FVL mutation status. Among FVL carriers, the presence of antiphospholipid antibodies does not appear to contribute to adverse pregnancy outcome.

Manuck, Tracy; Branch, D. Ware; Lai, Yinglei; Sibai, Baha; Spong, Catherine Y.; Wendel, George; Wenstrom, Katharine; Samuels, Philip; Caritis, Steve N.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.



The role of the factor v leiden mutation in osteonecrosis of the hip.  


We examined the hypothesis that the factor V Leiden (FVL) and G20101A prothrombin gene mutations are commonly associated with hip osteonecrosis. We prospectively evaluated 244 consecutively referred adults with osteonecrosis (ON), 161 idiopathic and 83 secondary. Cases (n = 244) did not differ from 104 normal controls by race. Of the 244 patients, 23 (9.4%) were FVL heterozygotes versus 2 of 104 controls (1.9%), P = .013, risk ratio (RR) = 4.90, 95% confidence interval (CI) 1.18 to 20.4. Of the 161 patients with idiopathic ON, 15 (9.3%) were FVL heterozygotes versus 2 of 104 normal controls (1.9%), P = .017, RR = 4.84, 95% CI 1.13 to 20.8. Of the 83 patients with secondary ON, 8 (9.6%) FVL heterozygotes versus 2 of 104 normal controls (1.9%), P = .024, RR = 5.01, 95% CI 1.09 to 23.0. Prothrombin gene heterozygosity in normal controls (2.9%) did not differ from ON cases (3.4%), P = 1.0. The thrombophilic FVL mutation is commonly associated with and may be pathoetiologic for hip osteonecrosis. PMID:22696591

Glueck, Charles J; Freiberg, Richard A; Boriel, Gail; Khan, Zia; Brar, Amanpreet; Padda, Jagjit; Wang, Ping



Noninvasive acceleration measurements to characterize knee arthritis and chondromalacia  

Microsoft Academic Search

Devising techniques and instrumentation for early detection of knee arthritis and chondromalacia presents a challenge in the\\u000a domain of biomedical engineering. The purpose of the present investigation was to characterize normal knees and knees affected\\u000a by osteoarthritis, rheumatoid arthritis, and chondromalacia using a set of noninvasive acceleration measurements. Ultraminiature\\u000a accelerometers were placed on the skin over the patella in four

Narender P. Reddy; Bruce M. Rothschild; Mita Mandal; Vineet Gupta; Srikanth Suryanarayanan



DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis  

Microsoft Academic Search

Objectives:To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.Methods:Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to

Y P M Goekoop-Ruiterman; J K de Vries-Bouwstra; P. J. S. M. Kerstens; M. M. J. Nielen; K. Vos; D van Schaardenburg; I. Speyer; P. E. H. Seys; F. C. Breedveld; C. F. Allaart; B. A. C. Dijkmans



Understanding Arthritis: Eradicating Myths  


... Foot, Heel, & Toe View All Exercise Videos From yoga to strength training, get step-by-step instructions ... with arthritis. Physical Activity, Nutrition and Lifestyle From yoga DVDs to walking guides, find a wide variety ...


Juvenile Arthritis: Disease Types  


... Foot, Heel, & Toe View All Exercise Videos From yoga to strength training, get step-by-step instructions ... with arthritis. Physical Activity, Nutrition and Lifestyle From yoga DVDs to walking guides, find a wide variety ...


Arthritis: Metacarpophalangeal (MP) Joint  


... activities. Arthritis is the wearing away of the cartilage at a joint. Cartilage is the coating layer of tissue on the ... that acts as a shock-absorber. Loss of cartilage can lead to joint destruction and a shift ...


What Is Reactive Arthritis?  


... infections get reactive arthritis and others do not? Studying why people with certain genes are more at risk than others. Coming up with ways to find the bacteria in the body that start the reaction. Testing ...


Arthritis and Rheumatic Diseases  


... harmful antibodies in people with severe rheumatoid arthritis. Heat and Cold Therapies Heat and cold can both be used to ... and doctor can determine which one works best. Heat therapy increases blood flow, tolerance for pain, and flexibility. ...


What Is Psoriatic Arthritis?  


About psoriasis Treating psoriasis Psoriatic arthritis Pso what? Bullying Info for parents Childhood psoriasis Treatments Diet Support your child Get involved At school Bullying Resources Parent's forum Find a pediatric derm Further ...


[Rheumatoid arthritis--new perspectives in its diagnosis].  


The early diagnosis of rheumatoid arthritis has ever been a challenge. The need of an early accurate and sensitive diagnostic have grown even more in the last few years since new data showed that an aggressive and early therapy may influence the course of RA and even remission may be achieved. Traditional and new diagnostic tools like ultrasound and MRI are reviewed and analysed in the perspective of early recognition of disease. PMID:15945216

von Mühlenen, M I



Rheumatoid Arthritis: Biologic Treatment Advances and Guideline Interpretation  

Microsoft Academic Search

The practical management of patients with rheumatoid arthritis (RA), including the use of tumor necrosis factor- alpha (TNF-?) inhibitor therapy, is the focus of this issue of PCE Updates in Rheumatology. Early diagnosis is an important factor in selecting and implementing the most effective treatment. Clinical guidelines that identify early symptoms of RA are necessary tools for rheumatologists, nurse practitioners

Martin J. Bergman


Lack of association between polymorphisms of thrombogenic genes and disease susceptibility in rheumatoid arthritis.  


Rheumatoid arthritis (RA) is associated with increased mortality due to cardiovascular disease (CVD). Abnormalities in coagulation have been linked with CVD in general and RA population. The aim of our study is to determine whether particular single nucleotide polymorphisms thought to be involved in the regulation of coagulation are over-represented in patients with RA compared to controls. We compared the frequency of atherothrombotic polymorphisms (Factor V Leiden, fibrinogen G455A, prothrombin G20210A and plasminogen activator inhibitor 4G5G) in 322 RA patients [231 females, mean age 61.5 ± 12, median disease duration 10 years (IQR = 14)] with 441 local controls. No significant differences were observed in genotype or allele frequencies either between RA and controls or between the disease subgroups studied. Whereas these polymorphisms may be of importance at the level of individual patients, they are unlikely to be clinically important on a population basis. PMID:22466403

Dimitroulas, Theodoros; Douglas, Karen M J; Smith, Jacqueline; Panoulas, Vasilis F; Kitas, George D



Functioning in Rheumatoid Arthritis  

Microsoft Academic Search

Objective: There is increasing evidence and awareness that rheumatoid arthritis symptoms, such as joint pain and activity limitations, are strongly influenced by psychosocial variables. We hypothesized that depression is significantly associated with functional capabilities in rheumatoid arthritis (RA) patients. Method: We examined in a cross-sectional, retrospective data-based study the role of depression, pain severity, and self-efficacy in daily functioning in

Claudia A. Orengo; Steven H. Wei; Victor A. Molinari; D. Danielle Hale; Mark E. Kunik



Juvenile Idiopathic Arthritis  

Microsoft Academic Search

\\u000a The term juvenile idiopathic arthritis (JIA) describes a heterogeneous group of several disease subtypes characterized by\\u000a arthritis beginning before the age of 16 years and where symptoms persist for more than 6 weeks. All subtypes of JIA are of\\u000a unknown cause. Although the pathogenesis for each subtype is likely to be different, JIA is generally regarded to be an autoimmune

Günther E. Dannecker; Martin N. Arbogast; Carol B. Lindsley; H. Schacherl; H. J. Girschick; C. Huemer; A. Heiligenhaus; U. Neudorf


Corticosteroids in rheumatoid arthritis.  


This report has presented evidence to support a disease-modifying role for corticosteroids in rheumatoid arthritis. It would appear that the efficacy of these agents in retarding the destructive course of rheumatoid disease has been substantially underestimated. Consideration for more liberal use of corticosteroids in the management of rheumatoid arthritis is warranted. Further study on new approaches to corticosteroid delivery is proposed. PMID:2672343

Weiss, M M



Epigenetics in Rheumatoid Arthritis  

Microsoft Academic Search

Epigenetics is a steadily growing research area. In many human diseases, especially in cancers, but also in autoimmune diseases,\\u000a epigenetic aberrations have been found. Rheumatoid arthritis is an autoimmune disease characterized by chronic inflammation\\u000a and destruction of synovial joints. Even though the etiology is not yet fully understood, rheumatoid arthritis is generally\\u000a considered to be caused by a combination of

Michelle Trenkmann; Matthias Brock; Caroline Ospelt; Steffen Gay



The cellular composition of lymph nodes in the earliest phase of inflammatory arthritis  

PubMed Central

Objectives Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease of unknown aetiology. Recent work has shown that systemic autoimmunity precedes synovial inflammation, and animal models have suggested that changes in the lymph nodes may precede those in the synovial tissue. Therefore, we investigated the cellular composition of the lymph node in the earliest phases of inflammatory arthritis. Methods Thirteen individuals positive for immunoglobulin M (IgM) rheumatoid factor and/or anticitrullinated protein antibodies without arthritis were included. Additionally, we studied 14 early arthritis patients (arthritis duration ?6?months, naïve for disease-modifying antirheumatic drugs), and eight healthy controls. All subjects underwent ultrasound-guided inguinal lymph node biopsy. Different T- and B-lymphocyte subsets were analysed by multicolour flow cytometry. Results There was an increase in activated CD69 CD8 T cells and CD19 B cells in early arthritis patients compared with healthy controls. We also observed a trend towards increased CD19 B cells in autoantibody-positive individuals without arthritis compared with healthy controls. Conclusions This exploratory study suggests that there is increased immune cell activation within lymph nodes of early arthritis patients as well as in autoantibody-positive individuals at risk of developing RA. This method provides a unique tool to investigate immunological changes in the lymph node compartment in the earliest phases of inflammatory arthritis.

van Baarsen, L G M; de Hair, M J H; Ramwadhdoebe, T H; Zijlstra, IJ A J; Maas, M; Gerlag, D M; Tak, P P



A Multiplex Allele Specific Polymerase Chain Reaction (MAS-PCR) for the Detection of Factor V Leiden and Prothrombin G20210A  

PubMed Central

ABSTRACT Introduction: In order to determine the frequencies of factor V Leiden and prothrombin G20210A point mutations in the Iranian population with Azeri Turkish origin. Material and methods: 120 unrelated individuals from general population randomly selected and were examined for factor V Leiden and prothrombin G20210A mutations using a multiplex allele specific polymerase chain reaction (MAS-PCR) assay Outcomes: The frequency of prothrombin G20210A mutation was 2.08%, which means 5 chromosomes out of 240 chromosomes had prothrombin G20210A mutation. The distribution of prothrombin 20210 GG, GA, AA genotypes and prothrombin 20210A allele were 37(92.5%), 3(7.5%), 0(0%) and 3(3.75%) in males and 78(97.5%), 2(2.5%), 0(0%) and 2(1.25%) in females, respectively. Factor V Leiden was not found in our tested group (zero chromosomes out of 240 chromosomes). Analysis of the observed frequencies in the studied groups indicates that there is no statistically significant difference between females and males, regarding prothrombin G20210A mutation (p value>0.05). Conclusions: This is the first study in its own kind in this population and implies that the frequency of Factor V Leiden G1691A (R506Q, FV-Leiden) allele is extremely low but the prothrombin G20210A mutation is more frequent in the tested group.

Bagheri, Morteza; Rad, Isa Abdi



Cartilage Oligomeric Matrix Protein (COMP): A Biomarker of Arthritis  

PubMed Central

Arthritis is a chronic disease with a significant impact on the population. It damages the cartilage, synovium, and bone of the joints causing pain, impairment, and disability in patients. Current methods for diagnosis of and monitoring the disease are only able to detect clinical manifestations of arthritis late in the process. However, with the recent onset of successful treatments for rheumatoid arthritis and osteoarthritis, it becomes important to identify prognostic factors that can predict the evolution of arthritis. This is especially critical in the early phases of disease so that these treatments can be started as soon as possible to slow down progression of the disease. A valuable approach to monitor arthritis would be by measuring biological markers of cartilage degradation and repair to reflect variations in joint remodeling. One such potential biological marker of arthritis is cartilage oligomeric matrix protein (COMP). In various studies, COMP has shown promise as a diagnostic and prognostic indicator and as a marker of the disease severity and the effect of treatment. This review highlights the progress in the utilization of COMP as a biomarker of arthritis.

Tseng, Susan; Reddi, A. Hari; Di Cesare, Paul E.



Increased risk of second cancers in managing Hodgkins disease: the 20-year Leiden experience.  


Between January 1969 and December 1988, 482 patients were treated for Hodgkin's disease at the Leiden University Hospital. All cases were routinely recorded in the Hospital Information System, which has an active annual follow-up. Of all patients, 57% remained relapse free. According to the kinds of treatment they received, the following major categories were established: radiotherapy only (28.2%), chemotherapy only (20.1%), only initial combination of radiotherapy and chemotherapy (34.2%), all other combinations of radio- and chemotherapy (15.4%), or not registered (2.1%). Twenty-seven second cancers were observed; six leukemias, five non-Hodgkin lymphomas, and 16 solid tumors. Of all solid tumors only nine occurred in relapse-free patients. The overall relative risk of second cancers increased with the duration of follow-up. Using general population incidence rates to calculate expected numbers, the risk for developing leukemia, non-Hodgkin lymphoma, and solid tumors was increased 36-fold, 31-fold, and 2.4-fold, respectively. The cumulative risk of developing a second cancer 10 years after diagnosis of Hodgkin's disease was 7% for both the radiotherapy-only and the initial combination of radio- and chemotherapy group. It was 16% and 17% for the chemotherapy-only and the other combinations of radio- and chemotherapy group, respectively. Multivariate analysis (using the Cox regression model) show an increased risk of second cancers (RR = 0.7) when a relapse of Hodgkin's disease resulting in increasing cumulative therapy occurred. Age at diagnosis of Hodgkin's disease was an important determinant for the risk of non-Hodgkin lymphoma and solid tumors. Cumulative chemotherapy intensity was an important factor in increasing leukemic risk in a dose-response fashion. Apart from this, the stage of Hodgkin's disease, although closely related to the kind of therapy, seemed to have an independent effect on leukemic risk. PMID:1457578

Sont, J K; van Stiphout, W A; Noordijk, E M; Molenaar, J; Zwetsloot-Schonk, J H; Willemze, R; Vandenbroucke, J P



Familial Longevity Is Marked by Better Cognitive Performance at Middle Age: The Leiden Longevity Study  

PubMed Central

Background Decline in cognitive performance is a highly prevalent health condition in elderly. We studied whether offspring of nonagenarian siblings with a familial history of longevity, perform better on cognitive tests compared to their partners as controls. This is relevant since it could provide insights into determinants underlying decline in cognitive performance. Methods Cross-sectional analysis within the longitudinal cohort of the Leiden Longevity Study consisting of middle-aged offspring of nonagenarian siblings together with their partners (n?=?500, mean age (SD) 66.3 (6.1) and 65.7 (7.2) years, respectively) as controls. Memory function, attention and processing speed were tested using the 15-Picture Learning Test, Stroop test and Digit Symbol Substitution Test. Data were analyzed with regression adjusted for age, gender, years of education and additionally for diabetes mellitus, cardiovascular diseases, alcohol use, smoking, inflammatory markers and apolipoprotein E genotype. Robust standard errors were used to account for familial relationships among the offspring. Results Cognitive performance was worse at higher calendar age (p<0.001, all except Stroop test part 1). The offspring performed better compared to their partners on trial 3 (p?=?0.005), the immediate (p?=?0.016) and delayed (p?=?0.004) recall of the 15-Picture Learning Test as well as on the interference and combined interference score of the Stroop test (p?=?0.014 and p?=?0.036, respectively) in the fully adjusted model. The difference between offspring and partners was estimated to be more than three years according to the observed difference in calendar age. Conclusions Offspring of nonagenarian siblings with a familial history of longevity have better cognitive performance compared to the group of their partners of comparable age. This effect is independent of age-related diseases and known possible confounders. Possible explanations might be differences in subclinical vascular pathology between both groups.

Stijntjes, Marjon; de Craen, Anton J. M.; van Heemst, Diana; Meskers, Carel G. M.; van Buchem, Mark A.; Westendorp, Rudi G. J.; Slagboom, P. Eline; Maier, Andrea B.



Levels of 25-hydroxyvitamin D in familial longevity: the Leiden Longevity Study  

PubMed Central

Background: Low levels of 25(OH) vitamin D are associated with various age-related diseases and mortality, but causality has not been determined. We investigated vitamin D levels in the offspring of nonagenarians who had at least one nonagenarian sibling; these offspring have a lower prevalence of age-related diseases and a higher propensity to reach old age compared with their partners. Methods: We assessed anthropometric characteristics, 25(OH) vitamin D levels, parathyroid hormone levels, dietary vitamin D intake and single nucleotide polymorphisms (SNPs) associated with vitamin D levels. We included offspring (n = 1038) of nonagenarians who had at least one nonagenarian sibling, and the offsprings’ partners (n = 461; controls) from the Leiden Longevity Study. We included age, sex, body mass index, month during which blood sampling was performed, dietary and supplemental vitamin D intake, and creatinine levels as possible confounding factors. Results: The offspring had significantly lower levels of vitamin D (64.3 nmol/L) compared with controls (68.4 nmol/L; p = 0.002), independent of possible confounding factors. There was no difference in the levels of parathyroid hormone between groups. Compared with controls, the offspring had a lower frequency of a genetic variant in the CYP2R1 gene (rs2060793) (p = 0.04). The difference in vitamin D levels between offspring and controls persisted over the 2 most prevalent genotypes of this SNP. Interpretation: Compared with controls, the offspring of nonagenarians who had at least one nonagenarian sibling had a reduced frequency of a common variant in the CYP2R1 gene, which predisposes people to high vitamin D levels; they also had lower levels of vitamin D that persisted over the 2 most prevalent genotypes. These results cast doubt on the causal nature of previously reported associations between low levels of vitamin D and age-related diseases and mortality.

Noordam, Raymond; de Craen, Anton J.M.; Pedram, Pardis; Maier, Andrea B.; Mooijaart, Simon P.; van Pelt, Johannes; Feskens, Edith J.; Streppel, Martinette T.; Slagboom, P. Eline; Westendorp, Rudi G.J.; Beekman, Marian; van Heemst, Diana



Rheumatoid leptomeningitis: rare complication of rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid leptomeningitis is a rare complication of rheumatoid arthritis (RA). We describe a woman with rheumatoid leptomeningitis\\u000a presenting with acute-onset behavioral changes and consciousness disturbance in the early stage of RA. On fluid-attenuated\\u000a inversion recovery images or diffusion-weighted images, high-signal-intensity lesions in the subarachnoid spaces of the right\\u000a frontal lobe were observed. Biopsies of brain tissues and the dura mater

Reiji Koide; Ayako Isoo; Kazuhiko Ishii; Akinori Uruha; Mitsuaki Bandoh



GUEPARD treat-to-target strategy is significantly more efficacious than ESPOIR routine care in early rheumatoid arthritis according to patient-reported outcomes and physician global estimate  

PubMed Central

Objective. To analyse seven RA Core Data Set measures and three indices for their capacity to distinguish treatment results in early RA in the GUEPARD treat-to-target clinical trial vs ESPOIR routine care. Methods. Post hoc analyses compared 65 GUEPARD and 130 matched control ESPOIR patients over 6 and 12 months for mean changes in measures, relative efficiencies and standardized response means (SRM). Three indices—28-joint disease activity score (DAS28), clinical disease activity index (CDAI) and routine assessment of patient index data (RAPID3)—were compared for mean changes and numbers of patients with high, moderate or low activity or remission using ? values. Results. Greater improvement was seen for GUEPARD vs ESPOIR, statistically significant for physician and patient global estimates and pain and health assessment questionnaire physical function (HAQ-FN), but not joint counts and laboratory tests. Relative efficiencies with tender joint count as the referent measure indicated that pain (2.57) and global estimates by patient (3.13) and physician (2.31) were most efficient in distinguishing GUEPARD from ESPOIR. Mean improvements in GUEPARD vs ESPOIR were ?3.4 vs ?2.6 for DAS28 (0–10) (24%), ?29.8 vs ?23.1 for CDAI (0–76) (23%) and ?13.0 vs ?7.8 for RAPID3 (0–30) (40%) (all P < 0.01); agreement was moderate between CDAI vs DAS28 (? = 0.56) and vs RAPID3 (? = 0.48), and fair between DAS28 vs RAPID3 (? = 0.26). Conclusion. Patient and global measures indicate greater efficacy than joint counts or laboratory measures in detecting difference between GUEPARD treat-to-target and ESPOIR routine care. A RAPID3 of only patient measures may help guide treat-to-target in busy clinical settings.

Castrejon, Isabel; Soubrier, Martin; Lin, Yih Chang; Rat, Anne-Christine; Combe, Bernard; Dougados, Maxime



GUEPARD treat-to-target strategy is significantly more efficacious than ESPOIR routine care in early rheumatoid arthritis according to patient-reported outcomes and physician global estimate.  


Objective. To analyse seven RA Core Data Set measures and three indices for their capacity to distinguish treatment results in early RA in the GUEPARD treat-to-target clinical trial vs ESPOIR routine care. Methods. Post hoc analyses compared 65 GUEPARD and 130 matched control ESPOIR patients over 6 and 12 months for mean changes in measures, relative efficiencies and standardized response means (SRM). Three indices-28-joint disease activity score (DAS28), clinical disease activity index (CDAI) and routine assessment of patient index data (RAPID3)-were compared for mean changes and numbers of patients with high, moderate or low activity or remission using ? values. Results. Greater improvement was seen for GUEPARD vs ESPOIR, statistically significant for physician and patient global estimates and pain and health assessment questionnaire physical function (HAQ-FN), but not joint counts and laboratory tests. Relative efficiencies with tender joint count as the referent measure indicated that pain (2.57) and global estimates by patient (3.13) and physician (2.31) were most efficient in distinguishing GUEPARD from ESPOIR. Mean improvements in GUEPARD vs ESPOIR were -3.4 vs -2.6 for DAS28 (0-10) (24%), -29.8 vs -23.1 for CDAI (0-76) (23%) and -13.0 vs -7.8 for RAPID3 (0-30) (40%) (all P < 0.01); agreement was moderate between CDAI vs DAS28 (? = 0.56) and vs RAPID3 (? = 0.48), and fair between DAS28 vs RAPID3 (? = 0.26). Conclusion. Patient and global measures indicate greater efficacy than joint counts or laboratory measures in detecting difference between GUEPARD treat-to-target and ESPOIR routine care. A RAPID3 of only patient measures may help guide treat-to-target in busy clinical settings. PMID:23864169

Castrejón, Isabel; Pincus, Theodore; Soubrier, Martin; Lin, Yih Chang; Rat, Anne-Christine; Combe, Bernard; Dougados, Maxime



[Chronic arthritis in a child with primary agammaglobulinemia  


OBJECTIVES: To report a case of a child with Bruton's disease and the unusual association with chronic aseptic arthritis resembling juvenile rheumatoid arthritis. METHODS: A 16 month-old boy was seen at the Pediatric Rheumatology unit of HC-UFG and Hospital da Criança (Goiânia- GO). The authors evaluated relevant clinical and laboratorial features, including follow-up and response to therapy. The data were then compared to previous reports published in the world literature based on a Medline search of the subject. RESULTS: Since the age of 6 months, the patient had recurrent episodes of infection that responded poorly to antibiotics. Forty days before admission, he had onset of arthritis in his left knee. The diagnosis of Bruton's disease was based on the seric levels of immunoglobulins and the response to intravenous gammaglobulin infusions. Besides improvement with this therapy, clinical characteristics and other indirect laboratorial tests highly suggested the diagnosis of chronic, aseptic arthritis. CONCLUSION: We present a case of a rare association between Bruton's disease and chronic, aseptic arthritis, very similar to juvenile rheumatoid arthritis. Early recognition of this rare aseptic articular involvement is important for early and efficient therapy with intravenous gammaglobulin infusions, avoiding unnecessary hospital admissions and inappropriate use of antibiotics. PMID:14685503

Pereira, B A; Silva, R R


Cyclosporin A monotherapy versus cyclosporin A and methotrexate combination therapy in patients with early rheumatoid arthritis: a double blind randomised placebo controlled trial  

PubMed Central

Patients and methods: 120 patients with active RA, rheumatoid factor positive and/or erosive, were randomly allocated to receive CsA with MTX (n=60) or CsA with placebo (n=60). Treatment with CsA was started in all patients at 2.5 mg/kg/day and increased to a maximum of 5 mg/kg/day in 16 weeks. MTX was started at 7.5 mg/week and increased to a maximal dose of 15 mg/week at week 16. Primary outcomes were clinical remission (Pinals criteria) and radiological damage (Larsen score), at week 48. Results: Treatment was discontinued prematurely in 27 patients in the monotherapy group (21 because of inefficacy, and six because of toxicity) and in 26 patients in the combination therapy group (14 and 12, respectively). At week 48, clinical remission was achieved in four patients in the monotherapy group and in six patients in the combination therapy group (p=0.5). The median Larsen score increased to 10 (25th, 75th centiles: 3.5; 13.3) points in the monotherapy group and to 4 (1.0; 10.5) points in the combination therapy group (p=0.004). 28/60 (47%) of patients in the monotherapy group v 34/60 (57%) of patients in the combination therapy group had reached an American college of Rheumatology 20% (ACR20) response (p=0.36) at week 48; 15/60 (25%) v 29/60 (48%) of patients had reached an ACR50 response (p=0.013); and 7 (12%) v 12 (20%) of patients had reached an ACR70 response (p=0.11).Their was a tendency towards more toxicity in the combination therapy group. Conclusions: In patients with early RA, neither CsA plus MTX combination therapy nor CsA monotherapy is very effective in inducing clinical remission. Combination therapy is probably better at improving clinical disease activity, and definitely better at slowing radiological progression. Combination therapy should still be compared with methotrexate monotherapy.

Gerards, A; Landewe, R; Prins, A; Bruijn, G; Goei, T; Laan, R; Dijkmans, B



Clinical evaluation of a new functional test for detection of activated protein C resistance (Pefakit® APC-R Factor V Leiden) at two centers in Europe and the USA  

Microsoft Academic Search

A new clotting assay, Pefakit® APC-R Factor V Leiden (Pentapharm Ltd., Switzerland), for the detection of an increased resistance of coagulation factor V against degradation by activated protein C, caused mainly by the factor V Leiden mutation, was evaluated in clinical studies at two University Centers in Europe and the US. The performance was compared with the performance of the

Reto Schöni; Peter Quehenberger; Jogin R. Wu; Marianne Wilmer



Aeromonas hydrophila septic arthritis.  


Septic arthritis is a serious, life and limb threatening infection. If suspected, empiric treatment must begin immediately and account for the most likely pathogens. Eight days following left knee arthroscopic surgery, a 51-year-old active duty male spent approximately 1 hour driving a personal watercraft on Okaloosa Bay near the Gulf of Mexico. Eight days later, he presented to the emergency room with septic arthritis of that knee. Fluid aspirated from the joint yielded Aeromonas hydrophila. The infection resolved with surgical drainage and 21 days of levofloxacin. A. hydrophila is a rare cause of septic arthritis, and reported cases have involved exposure to water after trauma to the affected joint. Many U.S. military bases are located in coastal areas and military members frequently participate in activities which compromise skin integrity and place them at increased risk for contracting waterborne infections. We present the ninth case of A. hydrophila septic arthritis described in the English language literature, highlight the importance of considering this pathogen in at-risk populations, and review the diagnosis and management of septic arthritis. PMID:22338363

Danaher, Patrick J; Mueller, William P



Reactive arthritis (Reiter's syndrome).  


Reactive arthritis, also called Reiter's syndrome, is the most common type of inflammatory polyarthritis in young men. It is sometimes the first manifestation of human immunodeficiency virus infection. An HLA-B27 genotype is a predisposing factor in over two thirds of patients with reactive arthritis. The syndrome most frequently follows genitourinary infection with Chlamydia trachomatis, but other organisms have also been implicated. Treatment with doxycycline or its analogs sometimes shortens the course or aborts the onset of the arthritis. Reactive arthritis may also follow enteric infections with some strains of Salmonella or Shigella, but use of antibiotics in these patients has not been shown to be effective. Reactive arthritis should always be considered in young men who present with polyarthritis. Symptoms may persist for long periods and may, in some cases, cause long-term disability. Initial treatment consists of high doses of potent nonsteroidal anti-inflammatory drugs. Patients with large-joint involvement may also benefit from intra-articular corticosteroid injection. PMID:10465225

Barth, W F; Segal, K



[Rational therapeutic approach in rheumatoid arthritis].  


The natural course of rheumatoid arthritis inevitably leads to joint damage and reduced life expectancy. Therefore, active treatment of rheumatoid arthritis is indispensable. Although the etiology still remains unknown resulting in unsuccessful prophylaxis and incurability of rheumatoid arthritis, learning more about its pathophysiology broadens the spectrum of therapeutic possibilities. The aim of treatment is remission of the disease. Current standards of treatment are based on the idea to start aggressive treatment as early as possible to suppress the activity of the disease. This can be achieved by pharmacotherapy and rehabilitation. Physiotherapy is supplementary but there is no room for spa treatment or alternative therapies. Treatment should be introduced immediately because the "window" for successful change in the natural course of the disease covers the first three months since onset. Diagnostic difficulties during this period support the idea of "early arthritis" and "early rheumatoid arthritis". Glycocorticosteroids at a dose suitable to suppress inflammation represent the first-line treatment. Basic therapy which usually is synonymous for methotrexate 15-25 mg once weekly should be introduced from the 4th month at the latest. In case of methotrexate intolerance, leflunomide is an alternative. Lack of efficacy of monotherapy with these drugs mandates the combination therapy of methotrexate with leflunomide, cyclosporine or sulphasalazine together with hydroxychlorochine. The use of two latter drugs should be limited due to their low efficacy. Patients refractory to combination therapy should be considered as candidates to anticytokine drugs or to lymphocyte B depleting drugs. However, it should be emphasized that their high efficacy is achieved only in combination with full doses of methotrexate. The same rules should be applied to therapeutic decisions in elderly patients and in patients with long history of rheumatoid arthritis. However, lower doses of the drugs should be used at initiation of therapy. Contraindications related to side effects and concomitant diseases should be considered. In these groups, glycocorticosteroids play a more important role and cyclophosphamide is used more frequently. Surgical treatment should be reserved for patients with advanced disease. Total joint replacement is an effective method for large joints. Synovectomy should be done only exceptionally when all options of pharmacotherapy were ineffective. PMID:17471832

T?ustochowicz, Witold



Biomarkers for rheumatoid arthritis: Making it personal  

PubMed Central

Effective treatment of rheumatoid arthritis (RA) has been hampered by the heterogeneity of the disease. Although early intervention can result in disease remission, it requires early diagnosis – and current diagnostic tests are not sufficiently accurate or sensitive in the early stages of RA. As a result, RA is typically diagnosed only once damage to the joints has already begun, a time at which the window for optimal treatment may have been missed. Furthermore, a significant proportion of RA patients do not respond to any given therapeutic. Research efforts are increasingly focused on discovery of biomarkers that enable early diagnosis and stratification of RA, and thus the implementation of timely, targeted therapy. Biomarkers have the potential to transform the management of RA by enabling not only early diagnosis, but also assessment and prediction of disease severity, selection of therapy, and monitoring of response to therapy. In this mini review, we discuss the development of molecular biomarkers for RA.

Lindstrom, Tamsin M.; Robinson, William H.



The Relationship of the Factor V Leiden Mutation and Pregnancy Outcomes for Mother and Fetus  

PubMed Central

Objective We sought to estimate the frequency of pregnancy-related thromboembolic events among carriers of the factor V Leiden (FVL) mutation without a personal history of thromboembolism, and to evaluate the impact of maternal and fetal FVL mutation carriage or other thrombophilias on the risk of adverse outcomes. Methods Women with a singleton pregnancy and no history of thromboembolism were recruited at 13 clinical centers before 14 weeks of gestation from April 2000 to August 2001. Each was tested for the FVL mutation, as was the resultant conceptus after delivery or after miscarriage, when available. The incidence of thromboembolism (primary outcome), and of other adverse outcomes, was compared between FVL mutation carriers and noncarriers. We also compared adverse outcomes in a secondary nested carrier-control analysis of FVL mutation and other coagulation abnormalities. In this secondary analysis, we defined carriers as women having one or more of the following traits: carrier for FVL mutation, protein C deficiency, protein S deficiency, antithrombin III deficiency, activated protein C resistance, or lupus anticoagulant-positive, heterozygous for prothrombin G20210A or homozygous for the 5,10 methylenetetrahydrofolate reductase mutations. Carriers of the FVL mutation alone (with or without activated protein C resistance) were compared with those having one or more other coagulation abnormalities and with controls with no coagulation abnormality. Results One hundred thirty-four FVL mutation carriers were identified among 4,885 gravidas (2.7%), with both FVL mutation status and pregnancy outcomes available. No thromboembolic events occurred among the FVL mutation carriers (0%, 95% confidence interval 0–2.7%). Three pulmonary emboli and one deep venous thrombosis occurred (0.08%, 95% confidence interval 0.02–0.21%), all occurring in FVL mutation noncarriers. In the nested carrier-control analysis (n = 339), no differences in adverse pregnancy outcomes were observed between FVL mutation carriers, carriers of other coagulation disorders, and controls. Maternal FVL mutation carriage was not associated with increased pregnancy loss, preeclampsia, placental abruption, or small for gestational age births. However, fetal FVL mutation carriage was associated with more frequent preeclampsia among African-American (15.0%) and Hispanic (12.5%) women than white women (2.6%, P = .04), adjusted odds ratio 2.4 (95% confidence interval 1.0–5.2, P = .05). Conclusion Among women with no history of thromboembolism, maternal heterozygous carriage of the FVL mutation is associated with a low risk of venous thromboembolism in pregnancy. Neither universal screening for the FVL mutation, nor treatment of low-risk carriers during pregnancy is indicated.

Dizon-Townson, Donna; Miller, Connie; Sibai, Baha; Spong, Catherine Y.; Thom, Elizabeth; Wendel, George; Wenstrom, Katharine; Samuels, Philip; Cotroneo, Margaret A.; Moawad, Atef; Sorokin, Yoram; Meis, Paul; Miodovnik, Menachem; O'Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.; Gabbe, Steven G.



Radiological cervical arthritis in populations.  

PubMed Central

The prevalence of cervical rheumatoid arthritis and its relationship to rheumatoid serum factors and erosive arthritis in peripheral joints has been studied in radiographs of the cervical spine and of the hands and feet drawn from 12 population samples. The changes were graded in accordance with the Atlas of Standard Radiographs of Arthritis. Rheumatoid arthritis of the cervical spine (grades 2-4) was observed in 4.1% of males and 4.7% of females aged 15 and over. Prevalence was greatest in those born before 1900, 15% of whom were affected. There was a significant association with the sheep cell agglutination test but not with the bentonite flocculation test, though the latter correlated well with erosive arthritis in the joints of the hands and feet. Arthritis of the cervical spine showed a significant correlation with both seropositive and seronegative erosive arthritis in the peripheral joints. A significantly higher prevalence of cervical arthritis than expected was noted in two population samples, one in Germany and the other in West Africa, though in neither was there a high prevalence of peripheral arthritis. The German population had relatively high antistreptolysin titres. A low prevalence of cervical arthritis was noted in populations in Czechoslovakia and in Arizona. 'Congenital' block vertebra had a prevalence of 0.9% in persons born before 1935, but none was observed in those born since. The figures suggest that environmental influences predisposing to cervical arthritis and block vertebra have changed in the last 40 years.

Lawrence, J S



[The comparative effectiveness of high-intensity dynamic training with the use of exercise machines and therapeutic gymnastics for the joints in the patients presenting with early rheumatoid arthritis].  


The objective of the present work was to compare the effectiveness of two therapeutic exercise programs for the patients presenting with early rheumatoid arthritis (RA). The study included 51 patients. Fifteen of them (group 1) were given conventional medicamental therapy in combination with high-intensity dynamic physical exercises with the use of the Enraf-Nonius training devices (45-60 min). Eighteen patients of group 2 were offered 10 sessions of remedial gymnastics for the joints (45 min each) under the guidance of an instructor that were continued under the domestic conditions (45 min each session thrice weekly for 3 months). Eighteen patients of group 3 were given medicamental therapy alone (control). The parameters estimated in the study included the mean strength of knee joint extension and ankle joint flexion measured with the use of En-TreeM devices, articular pain (100 mm BAHI), DAS28, HAQ, and RAPID3 indices. It was shown that both programs of therapeutic exercises reduced the severity of the disease, improved the functional and motor activity of the patients and their quality of life. The majority of these characteristics were significantly different from those documented in the control group (p<0.05). The clinical effectiveness of high-intensity training with the use of exercise machines was higher than without them (articular pain was reduced by 57.9% (p<0.01), DAS28 by 24.7% (p<0.05), HAQ by 60.7% (p<0.01). RAPID3 by 47.5% (p<0.01), mean strength of extension of the weak and strong knee joints increased by 87.9% (p<0.01) and 70.5% (p<0.01) respectively, the strength of flexion of the severely and less severely affected ankle joints increased by 84.6 (p<0.01) and 68.8% (p<0.01) respectively. Compliance with regular performance of therapeutic joint exercises during 3 months was higher (83.3%) than with high-intensity dynamic training with the use of exercise machines (60%). It is concluded that the latter modality should be recommended to the younger patients with RA (below 40 years), a short history of the disease, and its low activity. PMID:23718079

Orlova, E V; Karateev, D E; Kochetkov, A V; Mozhar, T E


Pathogenesis of reactive arthritis  

Microsoft Academic Search

There is good evidence that bacteria persist in vivo in patients with reactive arthritis (ReA). While Chlamydia seem to hide inside the joint, other areas such as gut mucosa or lymph nodes seem to be more likely places for Salmonella and Yersinia. T-helper (Th) 1 cells secreting cytokines such as IFNg and TNFa are crucial for an effective elimination of

Joachim Sieper



Metacarpophalangeal joint arthritis.  


Arthritis of the metacarpophalangeal joint can result in considerable disability and pain. Inflammatory, posttraumatic, crystalline, and osteoarthritis are common etiologies of joint disease. A variety of nonsurgical treatment options have been shown to be effective, including activity modification, anti-inflammatory medications, splinting, and cortisone injections. In addition, newer generation disease-modifying antirheumatic drugs geared toward the treatment of rheumatoid arthritis have shown promise in retarding the inflammatory process. Another, relatively newer, conservative treatment option includes topical anti-inflammatories such as diclofenac sodium that are now approved by the Federal Drug Administration. Surgical treatment options most commonly include arthroplasty and arthrodesis. In the treatment of thumb metacarpophalangeal arthritis, arthrodesis is a popular and generally reliable surgical solution. In the fingers, arthroplasty remains the most common treatment option. Traditional constrained silicone joint replacements remain the most commonly used. Newer generation, unconstrained, surface replacement arthroplasties have shown promise in the treatment of osteoarthritis and select cases of inflammatory arthritis in which there is good bone stock, no or minimal deformity, adequate supporting soft tissues, and good disease control. PMID:21276901

Rizzo, Marco



Angiogenesis in rheumatoid arthritis  

Microsoft Academic Search

CHAPTER SUMMARY: The expansion of the synovial lining of joints in rheumatoid arthritis (RA) and the subsequent invasion by the pannus of underlying cartilage and bone necessitate an increase in the vascular supply to the synovium, to cope with the increased requirement for oxygen and nutrients. The formation of new blood vessels – termed 'angiogenesis' – is now recognised as

Ewa M Paleolog



Gene therapy for arthritis  

Microsoft Academic Search

Rheumatoid arthritis is an autoimmune disease with intra-articular inflammation and synovial hyperplasia that results in progressive degradation of cartilage and bone, in severe cases it causes systemic complications. Recently, biological agents that suppress the activities of proinflammatory cytokines have shown efficacy as antiarthritic drugs, but require frequent administration. Thus, gene transfer approaches are being developed as an alternative approach for

P D Robbins; C H Evans; Y Chernajovsky



Arthritis and the Feet  


... protein compounds in foods such as lentils and beans that may play a role. Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of ...



Technology Transfer Automated Retrieval System (TEKTRAN)

Rheumatoid arthritis is a debilitating, chronic, systemic, autoimmune disease of unknown etiology that causes destruction of joint cartilage and bone. It generally occurs between the fourth and sixth decades of life, and affects two to three times more women than men. It is characterized by joint st...


Alabama Arthritis Report, 2005.  

National Technical Information Service (NTIS)

The data summarized in this report indicate that arthritis affects more than a million people in the state of Alabama. The disease is more common in the elderly but it also disproportionately affects women and persons with lower education levels, even aft...



Cachexia in rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis is a debilitating, chronic, systemic, autoimmune disease of unknown etiology that causes destruction of joint cartilage and bone. It generally occurs between the fourth and sixth decades of life, and affects two to three times more women than men. It is characterized by joint stiffness, pain, and swelling, and is accompanied by a loss of body cell mass.

Joseph Walsmith; Ronenn Roubenoff



Activated protein C resistance: a comparison between two clotting assays and their relationship to the presence of the factor V Leiden mutation  

Microsoft Academic Search

Summary. Resistance to the anticoagulant effect of activated protein C (APC resistance), a frequent abnormality in patients with a history of venous thrombosis, is known to ·' be due, in the large majority of cases, to the presence of an abnormal factor V: the factor V Leiden. It is reasonable to surmise that screening for this abnormality should be performed

C. Legnani; G. Palareti; R. Biagi; S. Coccheri; F. Bernardi; F. R. Rosendaal; P. H. Reitsma; H. de Ronde; R. M. Bertina



The Leiden\\/Argentine\\/Bonn (LAB) Survey of Galactic HI. Final data release of the combined LDS and IAR surveys with improved stray-radiation corrections  

Microsoft Academic Search

We present the final data release of observations of lambda21-cm emission from Galactic neutral hydrogen over the entire sky, merging the Leiden\\/Dwingeloo Survey (LDS: Hartmann & Burton 1997, Atlas of Galactic Neutral Hydrogen) of the sky north of delta = -30° with the Instituto Argentino de Radioastronomía Survey (IAR: Arnal et al. 2000, A&AS, 142, 35; and Bajaja et al.

P. M. W. Kalberla; W. B. Burton; Dap Hartmann; E. M. Arnal; E. Bajaja; R. Morras; W. G. L. Pöppel



Questions and Answers about Reactive Arthritis.  

National Technical Information Service (NTIS)

The arthritis associated with reactive arthritis typically involves pain and swelling in the knees, ankles, and feet. wrists, fingers, and other joints are affected less often. People with reactive arthritis commonly develop inflammation of the tendons (t...



Animal models for arthritis: innovative tools for prevention and treatment  

Microsoft Academic Search

The development of novel treatments for rheumatoid arthritis (RA) requires the interplay between clinical observations and studies in animal models. Given the complex molecular pathogenesis and highly heterogeneous clinical picture of RA, there is an urgent need to dissect its multifactorial nature and to propose new strategies for preventive, early and curative treatments. Research on animal models has generated new

George Kollias; Piyi Papadaki; Florence Apparailly; Margriet J Vervoordeldonk; Rikard Holmdahl; Vera Baumans; Christian Desaintes; James Di Santo; Jörg Distler; Paul Garside; Martin Hegen; Tom W J Huizinga; Astrid Jüngel; Lars Klareskog; Iain McInnes; Ioannis Ragoussis; Georg Schett; Bert ‘t Hart; Paul P Tak; Rene Toes; Wim van den Berg; Wolfgang Wurst; Steffen Gay



Patients with rheumatoid arthritis have an altered circulatory aggrecan profile  

Microsoft Academic Search

BACKGROUND: Rheumatoid arthritis (RA) is a chronic auto-immune disease with extensive articular cartilage destruction. Aggrecan depletion, mediated by aggrecanases is one of the first signs of early cartilage erosion. We investigated, whether measurement of aggrecan and fragments thereof in serum, could be used as biomarkers for joint-disease in RA patients and furthermore characterized the fragments found in the circulation. METHODS:

Jean C Rousseau; Eren U Sumer; Gert Hein; Bodil C Sondergaard; Suzi H Madsen; Christian Pedersen; Thomas Neumann; Andreas Mueller; Per Qvist; Pierre Delmas; Morten A Karsdal



Adverse reproductive outcomes in women who subsequently develop rheumatoid arthritis  

Microsoft Academic Search

The rates of adverse reproductive outcomes in 40 women with rheumatoid arthritis (RA) were compared with 67 of their unaffected female relatives. All women were aged between 35 and 65 years at the time of inquiry. Seven of the women with RA reported a perinatal death (six stillbirths, one early neonatal death) compared with one women in the unaffected group:

A J Silman; E Roman; V Beral; A Brown



The relationship between arthritis and human parvovirus B19 infection  

Microsoft Academic Search

In order to evaluate the role of human parvovirus B19 in the etiopathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), synovial fluid and blood specimens were collected at 1-month intervals from 20 patients with early synovitis (ES) and 31 with RA. Blood specimens were also collected from 25 patients with SLE, 25 with osteoarthritis

R. Caliskan; S. Masatlioglu; M. Aslan; S. Altun; S. Saribas; S. Ergin; E. Uckan; V. Koksal; V. Oz; K. Altas; I. Fresko; B. Kocazeybek



Autoantibody systems in rheumatoid arthritis: specificity, sensitivity and diagnostic value  

Microsoft Academic Search

The diagnosis of rheumatoid arthritis (RA) is primarily based on clinical symptoms, so it is often difficult to diagnose RA in very early stages of the disease. A disease-specific autoantibody that could be used as a serological marker would therefore be very useful. Most autoimmune diseases are characterized by a polyclonal B-cell response targeting multiple autoantigens. These immune responses are

Martinus AM van Boekel; Erik R Vossenaar; Frank HJ van den Hoogen; Walther J van Venrooij



Rheumatoid arthritis. Designing and implementing a treatment plan.  


Treating rheumatoid arthritis can be very satisfying when patients participate fully in designing and implementing their therapeutic strategy. However, the strategy's success depends on early intervention and disease modification. Many patients do well when education, rest, diet, exercise, and drug therapy are incorporated into an individualized regimen. PMID:9479310

Gremillion, R B; van Vollenhoven, R F



The Schizophrenia–Rheumatoid Arthritis Connection: Infectious, Immune, or Both?  

Microsoft Academic Search

Schizophrenia and rheumatoid arthritis share an impressive number of similarities. Both are chronic, relapsing diseases of unknown etiology. Both became prominent in the early 19th century and have prevalences of approximately 1% in North America and Europe. Both run in families, have pairwise concordance rates of approximately 30% among monozygotic twins, and are more common among individuals born in urban

E. Fuller Torrey; Robert H. Yolken



The forgotten crystal arthritis: calcium pyrophosphate deposition.  


Calcium pyrophosphate crystals are related to a variety of articular manifestations known as calcium pyrophosphate deposition (CPPD) arthritis. Acute CPPD arthritis is commonly known as pseudogout, but there are many other presentations. Diverse endocrine and metabolic diseases may be related to CPPD arthritis. Septic arthritis is in the differential diagnosis of acute CPPD arthritis. The treatment options for CPPD arthritis include non-steroidal anti-inflammatories and steroids. PMID:22428450

Ivory, Dedri; Velázquez, Celso R


Characterization and treatment monitoring of inflammatory arthritis by photoacoustic imaging: a study on adjuvant-induced arthritis rat model  

PubMed Central

Neovascularity also known as angiogenesis is an early feature of inflammatory arthritis disease. Therefore, identifying the development of neovascularity is one way to potentially detect and characterize arthritis. Laser-based photoacoustic imaging (PAI) is an emerging biomedical imaging modality which may aid in the detection of both early and continued development of neovascularity. In this work, we investigated the feasibility of PAI to measure angiogenesis, for the purpose of evaluating and monitoring inflammatory arthritis and responses to treatment. The imaging results on an arthritis rat model demonstrate that 1) there is noticeable enhancement in image intensities in the arthritic ankle joints when compared to the normal joints, and 2) there is noticeable decrease in image intensities in the arthritic ankle joints after treatment when compared to the untreated arthritic joints. In order to validate the findings from PAI, we performed positron emission tomography (PET) and histology on the same joints. The diameters of the ankle joints, as a clinical score of the arthritis, were also measured at each time point.

Rajian, Justin R.; Shao, Xia; Chamberland, David L.; Wang, Xueding



Progress On A New Catalog Of Intermediate Velocity Clouds Using The Leiden-Argentina-Bonn HI All-sky Survey  

NASA Astrophysics Data System (ADS)

We present progress towards the creation of a new all-sky catalog of intermediate velocity clouds using the Leiden/Argentina/Bonn (LAB) Galactic HI survey. We have developed a Gaussian fitting program to fit individual spectra. Each spectra is initially fit automatically with a set of Gaussians, and then reviewed and adjusted, if necessary, by hand by our undergraduate team. When a satisfactory fit is found, it is submitted for review and adjustment by the senior team member. Intermediate clouds and complexes are formed by grouping Gaussian components by velocity and section of the sky. When complete, this will be the first all-sky catalog of intermediate velocity clouds, which can be compared to dynamical models of the Galactic fountain flows. We present preliminary results for the catalog in the sky with Galactic latitude greater than 45 degrees. This research was supported by NASA ATP grant NNX10AI70G to the University of Wisconsin-Whitewater.

Witt, Christopher M.; Wakker, B.; Engel, T. D.; Gostisha, M. C.; Thomson, E.; Stratman, L.; Benjamin, R. A.



Recent results from the Leiden Observatory Laboratory: (a) band strengths in mixed ices; (b) UV photolysis of solid methanol  

NASA Astrophysics Data System (ADS)

We review, the recent work done in the Leiden Observatory Laboratory on measuring the IR band strengths of CO and CO 2 diluted in various binary ice mixtures. These measurements were performed with a novel technique in Which the component gases are deposited simultaneously through separate tubes; avoiding a number of pitfalls intrinsic in previous methods where the components were pre-mixed in a gas container before deposition. The error in the new method is in general only a few percent. We also review the results on the UV photolysis of solid methanol at t0 K. By starting the IR spectroscopic monitoring after very small UV doses (i.e. 6 s). we clearly distinguish the first order photolysis products. i.e. H 2CO, CH 4, HCO and H 2. from the higher order products. i.e. CO and CO 2.

Schutte, W. A.; Gerakines, P. A.



Recent results from the Leiden Observatory Laboratory: (a) band strengths in mixed ices: (b) UV photolysis of solid methanol.  

NASA Astrophysics Data System (ADS)

The authors review the recent work done in the Leiden Observatory Laboratory on measuring the IR band strengths of CO and CO2 diluted in various binary ice mixtures. These measurements were performed with a novel technique in which the component gases are deposited simultaneously through separate tubes, avoiding a number of pitfalls intrinsic in previous methods where the components were pre-mixed in a gas container before deposition. The error in the new method is in general only a few percent. The authors also review the results on the UV photolysis of solid methanol at 10 K. By starting the IR spectroscopic monitoring after very small UV doses (i.e. 6 s), the authors clearly distinguish the first order photolysis products, i.e. H2CO, CH4, HCO and H2, from the higher order products, i.e. CO and CO2.

Schutte, W. A.; Gerakines, P. A.



[Genetic thrombophilic defects (Factor V Leiden, prothrombin G20210A, MTHFR C677T) in women with recurrent fetal loss].  


Maternal thrombophilia (inherited and acquired) has recently been identified as a major cause of thrombembolism, but it may also contribute to adverse pregnancy outcomes and recurrent pregnancy loss. To determine the association of specific inherited thrombophilias and recurrent fetal loss (RFL), three gene mutations (Factor V Leiden, prothrombin G20210A, MTHFR C677T) were investigated. The prevalence of the thrombophilic markers was compared in 156 women with history of fetal loss in different trimester of pregnancy and 80 matched controls. At least one thrombophilic defect was found in 28.2% of total study group women compared with 16.2% in controls (p=0.06; OR-2.02) and in 50% of women with RFL in third trimester (p=0.008; OR-5.15). Factor V Leiden was more common in the group of women with fetal loss in third trimester (37.5%) compared to the controls (6.2%) (p=0.002; OR-9.0). Presence of FVL was associated with a significant increased risk for RFL in second and third trimester (OR-6.25; P<0.001) and significant protection for RFL in first trimester (OR-0.16; P<0.001). Mutation prothrombin G20210A or MTHFR C677T was more common in group of women with fetal loss in first trimester compared to the controls (28.3% vs. 11.2% respectively; p=0.009; OR-3.11). The presence of either of these mutations was associated with no significant increased risk for RFL in first trimester (OR-2.5). Genetic thrombophilic defects are common in women with RFL and are associated with late fetal loss. This association is manifest by FVL rather than total number of defects involved. PMID:18333414

Kovacheva, K; Ivanov, P; Konova, E; Simeonova, M; Komsa-Penkova, R



The factor V Leiden mutation, high factor VIII, and high plasminogen activator inhibitor activity: etiologies for sporadic miscarriage.  


We hypothesized that the thrombophilic G1691A factor V Leiden gene mutation was a common significant cause of sporadic first trimester miscarriage. We compared thrombophilia and hypofibrinolysis in 92 women (85 white, 5 black, 2 other) with 1 or more pregnancies and 1 miscarriage (143 live births, 92 miscarriages) (cases) and in 380 female controls (355 white, 21 black, 4 other) with 1 or more pregnancies and 0 miscarriages (964 live births). We used polymerase chain reaction techniques to characterize thrombophilic gene mutations (G1691A V Leiden [FV], G20210A prothrombin, C677T/A1298C MTHFR) and hypofibrinolytic gene mutations (plasminogen activator inhibitor [PAI-1] activity 4G4G). We carried out serologic measures of thrombophilia (homocysteine, anticardiolipin antibodies [ACLA] immunoglobulin G and immunoglobulin M, lupus anticoagulant, factor VIII, factor XI, protein C, total and free protein S, antithrombin III) and hypofibrinolysis (plasminogen activator inhibitor activity [PAI-Fx], lipoprotein[a]). Of the 380 controls, 6 (1.6%) had FV heterozygosity vs 12 heterozygous and 2 homozygous FV cases (15.2% [14/92]; P < .0001). Plasminogen activator inhibitor activity was high (> or =21.1 U/mL) in 21 (33%) of 63 cases vs 27 (18%) of 152 controls (P = .013). Factor VIII was high (>150%) in 15 (31%) of 48 cases vs 19 (18%) of 103 controls (P = .079). By logistic regression, with age and factor VIII (categorical [< or =150%, >150%]) as explanatory variables and group (cases, controls) as the dependent variable, after adjusting for age, high factor VIII was a significant predictor for miscarriage (odds ratio, 3.28; 95% confidence interval, 1.34-8.04; P = .01). There were no other group differences (P > .05) in measures of thrombophilia and hypofibrinolysis. After unexplained sporadic first trimester miscarriage, we suggest that measurements be done of the FV mutation, PAI-Fx, and factor VIII, etiologies for sporadic miscarriage. PMID:16154434

Glueck, Charles J; Pranikoff, Joel; Aregawi, Dawit; Haque, Mofiz; Zhu, Binghua; Tracy, Trent; Wang, Ping



Prevalence of factor V Leiden (APCR) and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries  

PubMed Central

Objective—To investigate the role of activated protein C resistance (APCR, factor V Leiden) in coronary artery thrombosis.?Methods—The prevalence of APCR and of congenital deficiencies of antithrombin III, protein C, protein S, plasminogen, and factor XII was investigated in adult patients under 45 years of age with acute myocardial infarction. The results were compared with those of a group of 53 age and sex matched control subjects.?Results—Among 75 patients under the age of 45 years who were admitted from November 1994 to April 1996 for acute myocardial infarction, 22 (29.3%) had normal coronary arteriography (group I) and 53 (70.7%) had significant coronary artery disease (group II). Inherited thrombophilia was more often found in group I (4/22, 18.2%) than in group II (4/53, 7.5%) but the difference was not significant (F test: p = 0.22). The prevalence of APCR was 9.1% (2/22) in group I, 3.8% (2/53) in group 2 (p  = 0.57), and 3.8% (2/53) in the normal control group (p = 0.57).?Conclusions—The prevalence of congenital thrombophilias, including APCR, does not seem to be increased in young patients with myocardial infarction and normal coronary angiograms, compared with young patients with coronary atherosclerosis and with normal control subjects. However, the statistical power of the study is too low to detect a significant difference and these results are published to allow a meta-analysis of this problem in the future.?? Keywords: myocardial infarction;  factor V Leiden;  coagulation factors;  inherited thrombophilia

Dacosta, A; Tardy-Poncet, B; Isaaz, K; Cerisier, A; Mismetti, P; Simitsidis, S; Reynaud, J; Tardy, B; Piot, M; Decousus, H; Guyotat, D



Airways obstruction in rheumatoid arthritis.  

PubMed Central

Owing to the report of an association between rheumatoid arthritis (RA) and obliterative bronchiolitis we have determined the prevalence of airflow obstruction in unselected patients with RA and normal chest radiographs. Spirometry was performed on 100 patients with rheumatoid arthritis and 84 control subjects matched for age, sex, and smoking habits. Patients with rheumatoid arthritis had significantly lower values for FEV1, FVC, FEV1/FVC, and MMEFR when compared with the controls: 39 patients had abnormal spirometry, and at least 32 showed airways obstruction. The prevalence of airflow obstruction is remarkably high, and we suggest that airway disease may be the commonest form of lung involvement in rheumatoid arthritis.

Geddes, D M; Webley, M; Emerson, P A



Reumatoid arthritis in Iraq.  


Altogether 198 patients (149 female and 49 male) with rheumatoid arthritis, 133 classical and 65 definite by A.R.A. diagnostic criteria, have been studied in Baghdad. The disease pattern and the joint distribution are similar to those in Europe but the disease appears to be generally less destructive; hands are involved more often than the feet, and rheumatoid nodules, severe systemic upset and extra-articular manifestations appear to be less common. PMID:866905

Al Rawi, Z S; Al Shackarchi, H A; Marjana, N H; Hart, F D



Elderly Onset Rheumatoid Arthritis  

Microsoft Academic Search

\\u000a As the number of people who are over the age of 60 years is growing in the general population, the prevalence of disability\\u000a from rheumatoid arthritis (RA) is also on the rise. This is an important health concern for patients, their families, and\\u000a society. This review highlights various aspects of elderly onset RA (EORA), including differences from younger onset RA

Venkata Sri Cherukumilli; Arthur Kavanaugh


Amyloidosis mimicking rheumatoid arthritis  

Microsoft Academic Search

A 49-year-old man presented a clinical picture suggesting seronegative rheumatoid arthritis. He developed severe joint contractions, pasty synovial swelling, macroglossia and proteinurie. Subsequent investigations disclosed light-chain multiple myeloma and A1-amyloid deposits in synovial tissue and skin. A1-amyloidosis should be considered in the differential diagnosis of patients with seronegative polyarthritis. Clues to the diagnosis of amyloid arthropathy are a carpal tunnel

E. A. de Ruiter; H. K. Ronday; H. M. Markusse



Nosocomial neonatal septic arthritis  

Microsoft Academic Search

Between August 1993 and August 1994, 17 cases of neonatal septic arthritis occurred at the intensive care baby unit of Princess\\u000a Badia' Teaching Hospital in Northern Jordan.Klebsiella species was the causative pathogen in 10 patients (59%), which indicates a nosocomial acquired infection. The hip was the\\u000a main joint involved in 94% of cases. An epidemiological survey showed that the spread

F. Abuekteish; A. S. Daoud; M. Mesmar; A. Obeidat



Arthritis and angioimmunoblastic lymphadenopathy.  

PubMed Central

We report 2 contrasting cases of a seronegative polyarthritis associated with angioimmunoblastic lymphadenopathy (AILD). Both cases were nonerosive, with symmetrical involvement of the elbows, wrists, knees, and ankles. In one the arthritis appeared concurrently with the main systemic manifestations of AILD. The second presented with polyarthritis 18 months before the onset of AILD. This patient received azathioprine for 11 months before developing AILD, which raises the possibility of this drug being the causative agent. Images

Davies, P G; Fordham, J N



Rheumatoid arthritis in greece  

Microsoft Academic Search

A high frequency of anti-Ro (SSA) circulating antibodies and lack of HLA-DR4 association described recently in Greek rheumatoid arthritis (RA) patients, prompted us to study their clinical and laboratory picture and compare it with that described in the literature. One hundred and ninety seven patients with definite or classical RA were divided into three groups A, B, and C with

A. P. Andonopoulos; V. Galanopoulou; A. A. Drosos; H. M. Moutsopoulos



Management of Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis is a common disease, for which every physician should have a sound approach. This paper details the global management of the disease. Guidelines are given for educating the patient and assessing the level of disease activity. Common questions about the indications and uses of non-steroidal anti-inflammatory drugs, local corticosteroid injections, slow-acting agents, immunosuppressive drugs and steroids are discussed.

Carette, Simon



Gene therapy for arthritis  

Microsoft Academic Search

\\u000a Gene therapy has a potential for effective therapeutic intervention in rheumatoid arthritis (RA). Proof of concept has been\\u000a demonstrated in animal models, either through local gene delivery to the joint space or through systemic gene delivery for\\u000a immune intervention. This chapter reviews how certain clinical applications of gene therapy would be beneficial for RA patients\\u000a and discusses the roadblocks that

Florence Apparailly; Paul Peter Tak; Christian Jorgensen


Etiology of rheumatoid arthritis  

Microsoft Academic Search

Summary Definite genetic associations with immunological cooperative HLA-D(R) antigens have been demonstrated for rheumatoid arthritis (RA). Microbial etiology has not been proven, but some hope for the supporters of this view is still given by small viruses, plasmids of enteric bacteria or perhaps oncogen-like DNA-sequences. Yet, electrophoretical analysis of membrane proteins or surface glycoproteins of RA synovial cells does not

T. Kouri



Adalimumab in psoriatic arthritis.  


Open prospective studies and randomized controlled trials (RCT) have shown the short-term efficacy of adalimumab (ADA) in psoriatic arthritis (PsA) and psoriasis. ADA effectively treated all varied musculoskeletal manifestations characteristic of PsA, including peripheral arthritis, spinal disease, enthesitis, and dactylitis. ADA significantly inhibited structural changes on radiographs, lessened disability, and improved quality of life in patients with active PsA. One study showed the efficacy of 24-week ADA therapy on bone marrow edema and erosions, as measured by magnetic resonance imaging. The clinical and radiographic efficacy of ADA demonstrated during short-term treatment was sustained during longterm treatment. ADA was generally well tolerated and its safety profile was similar to that reported in studies of ADA in rheumatoid arthritis. Overall, ADA has a favorable risk-benefit profile in PsA. The combination of ADA and cyclosporine seems to be more effective than ADA monotherapy in patients with active PsA and inadequate response to methotrexate; however, this observation must be confirmed in RCT. PMID:22751600

Salvarani, Carlo; Pipitone, Nicolò; Catanoso, Mariagrazia; Chiarolanza, Ilaria; Boiardi, Luigi; Caruso, Andrea; Pazzola, Giulia; Macchioni, Pierluigi; Di Lernia, Vito; Albertini, Giuseppe



[Therapy of psoriatic arthritis].  


In psoriatic arthritis (PsA) the heterogeneous spectrum of the disease with arthritis/synovitis, axial manifestation, enthesitis, dactylitis, psoriatic skin disease and nail psoriasis has to be considered. Moreover, PsA activity and severity as well as comorbidities are of importance for making therapeutic decisions. Measurement instruments developed for therapeutic studies of rheumatoid arthritis or ankylosing spondylitis are often not appropriate for application in PsA investigations. In this paper established therapies with nonsteroidal antirheumatic drugs, disease modifying antirheumatic drugs (DMARDs) and TNF-alpha inhibitors and the current EULAR guidelines from 2012 are reviewed. However, there is a need for new therapeutic agents for those patients who do not respond to or do not tolerate the current therapies. Other biologic agents have also been tested for PsA with moderate effects only. New therapeutic options could result from the anti-IL12 and anti-IL23 receptor monoclonal antibody ustekinumab and from small molecules such as the oral PDE-4 inhibitor apremilast. PMID:24043297

Märker-Hermann, E



Does the presence of crystal arthritis rule out septic arthritis?  

Microsoft Academic Search

The objective of this study was to determine the incidence of septic arthritis in the presence of joint crystals. A retrospective study was conducted at a university tertiary care referral center. The study population included all patients with synovial fluid crystals in the joint aspirate sent to the laboratory during the 7-year study period. Septic arthritis was defined as a

Kaushal Shah; Jeffrey Spear; Larry A. Nathanson; Jon McCauley; Jonathan A. Edlow



Deficiencies in provision of integrated multidisciplinary podiatry care for patients with inflammatory arthritis: A UK district general hospital experience  

Microsoft Academic Search

BackgroundFoot problems are highly prevalent in inflammatory arthritis (IA), especially rheumatoid arthritis (RA). Chronic inflammation can lead to permanent structural changes, deformity and disability. Early podiatry intervention in RA improves long term outcomes. National guidelines recommend that patients should be treated by a multidisciplinary team with dedicated podiatry services. In clinical practice funding constraints limit availability of these services.

M. Juarez; E. Price; D. Collins; L. Williamson



AA Amyloidosis Associated With Systemic-Onset Juvenile Idiopathic Arthritis.  


We report a 12-year-old boy with nephrotic syndrome due to renal AA amyloidosis. The AA amyloidosis was associated with a 3-year history of systemic-onset juvenile idiopathic arthritis. The presence of serum amyloid A protein was confirmed by laser microdissection of Congo Red-positive glomeruli and vessels followed by liquid chromatography and tandem mass spectrometry; this analysis excluded hereditary and familial amyloidosis. Aggressive management of the systemic-onset juvenile idiopathic arthritis resulted in improvement in clinical and laboratory parameters. The case represents an unusual cause of nephrotic syndrome in children. Early diagnosis of renal amyloidosis and management of systemic-onset juvenile idiopathic arthritis is paramount to preventing progression of kidney disease. PMID:23664546

Saha, Abhijeet; Chopra, Yogiraj; Theis, Jason D; Vrana, Julie A; Sethi, Sanjeev



Photoacoustic imaging: a potential new tool for arthritis  

NASA Astrophysics Data System (ADS)

The potential application of photoacoustic imaging (PAI) technology to diagnostic imaging and therapeutic monitoring of inflammatory arthritis has been explored. The feasibility of our bench-top joint imaging systems in delineating soft articular tissue structures in a noninvasive manner was validated first on rat models and then on human peripheral joints. Based on the study on commonly used arthritis rat models, the capability of PAI to differentiate arthritic joints from the normal was also examined. With sufficient imaging depth, PAI can realize tomographic imaging of a human peripheral joint or a small-animal joint as a whole organ noninvasively. By presenting additional optical contrast and tissue functional information such as blood volume and blood oxygen saturation, PAI may provide an opportunity for early diagnosis of inflammatory joint disorders, e.g. rheumatoid arthritis, and for monitoring of therapeutic outcomes with improved sensitivity and accuracy.

Wang, Xueding



[Different forms of tuberculous hip arthritis (case study)].  


Tuberculous hip arthritis ranks third in the classification of orthopedic tuberculosis, after tuberculosis of the spine and knee joint. It accounts for about 15 % of all orthopedic tuberculosis. The aim of this paper is to demonstrate the etiology, clinical presentation and forms of disease on the case reports of six patients. The scope of disease is wide - from a mild reversible synovial form, then fibrous or bone ankylosis, to severe destruction of the hip with subluxation or dislocation, pseudoarthrosis or chronic arthritis with a fistula. The wide diversity of clinical findings and difficulties is making diagnosis are often responsible for a late start of therapy. However, only an early and adequate treatment permits the prevention of irreversible damage to the hip joint or further complications. Key words: tuberculous hip arthritis. PMID:17623610

Netval, M; Hudec, T; Hach, J



Gonococcal arthritis in the elderly.  


A 60-year-old women presented with an acute, suppurative, monoarticular arthritis due to N gonorrhoea. Appropriate therapy was delayed because of failure to consider gonococcal infection in the differential diagnosis of pyoarthritis in the elderly. We suggest that this entity should be considered in the managment of acute, suppurative arthritis regardless of the age or physical diability of the patient. PMID:622634

Straus, S E; Vest, J V



Leucapheresis in severe rheumatoid arthritis  

Microsoft Academic Search

Two patients with severe seropositive rheumatoid arthritis previously unresponsive to conventional therapy have been treated with leucapheresis. This technique involves continuous cell separation daily to remove primarily lymphocytes. Clinical improvement was recorded with the use of standard rheumatological measures of inflammation. It is concluded that leucapheresis may help in the management of severely active rheumatoid arthritis when conventional therapy has

J Tenenbaum; M B Urowitz; E C Keystone; I L Dwosh; J E Curtis



Molecular Analysis of Factor V Leiden, Factor V Hong Kong, Factor II G20210A, Methylenetetrahydrofolate Reductase C677T, and A1298C Mutations Related to Turkish Thrombosis Patients  

Microsoft Academic Search

Inherited gene disorders related to the hemostatic system have been documented as risk factors for thrombosis. The roles of factor V Hong Kong (FV Hong Kong), factor V Leiden (FV Leiden), factor II G20210A (FII G20210A), methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations in Turkish patients with thrombosis (270 patients) compared with healthy controls (114 subjects) were evaluated. Polymerase

Bilgen Dölek; Serpil Eraslan; Sevim Ero?lu; Belgin Eroglu Kesim; Turgut Ulutin; Altan Yalç?ner; Yahya R. Laleli; Nermin Gözükirm?z?



Palindromic rheumatism and other relapsing arthritis  

Microsoft Academic Search

Patients with recurrent or relapsing arthritis are frequently seen in rheumatological practice. Besides crystal arthritis, the most frequent cause of recurrent arthritis, there are several diseases that may present clinically as intermittent mono- or polyarthritis. Palindromic rheumatism is the paradigm of this type of condition, but other diseases such as systemic autoinflammatory disorders (periodic fever syndromes), Whipple's disease, arthritis associated

Raimon Sanmarti; Juan D. Cañete; Georgina Salvador



The clinical features of rheumatoid arthritis.  


Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive damage of synovial-lined joints and variable extra-articular manifestations. Tendon and bursal involvement are frequent and often clinically dominant in early disease. RA can affect any joint, but it is usually found in metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints, as well as in the wrists and knee. Articular and periarticular manifestations include joint swelling and tenderness to palpation, with morning stiffness and severe motion impairment in the involved joints. The clinical presentation of RA varies, but an insidious onset of pain with symmetric swelling of small joints is the most frequent finding. RA onset is acute or subacute in about 25% of patients, but its patterns of presentation also include palindromic onset, monoarticular presentation (both slow and acute forms), extra-articular synovitis (tenosynovitis, bursitis), polymyalgic-like onset, and general symptoms (malaise, fatigue, weight loss, fever). The palindromic onset is characterized by recurrent episodes of oligoarthritis with no residual radiologic damage, while the polymyalgic-like onset may be clinically indistinguishable from polymyalgia rheumatica in elderly subjects. RA is characteristically a symmetric erosive disease. Although any joint, including the cricoarytenoid joint, can be affected, the distal interphalangeal, the sacroiliac, and the lumbar spine joints are rarely involved. The clinical features of synovitis are particularly apparent in the morning. Morning stiffness in and around the joints, lasting at least 1 h before maximal improvement is a typical sign of RA. It is a subjective sign and the patient needs to be carefully informed as to the difference between pain and stiffness. Morning stiffness duration is related to disease activity. Hand involvement is the typical early manifestation of rheumatoid arthritis. Synovitis involving the metacarpophalangeal, proximal interphalangeal and wrist joints causes a characteristic tender swelling on palpation with early severe motion impairment and no radiologic evidence of bone damage. Fatigue, feveret, weight loss, and malaise are frequent clinical signs which can be associated with variable manifestations of extra-articular involvement such as rheumatoid nodules, vasculitis, hematologic abnormalities, Felty's syndrome, and visceral involvement. Although there is no laboratory test to exclude or prove the diagnosis of rheumatoid arthritis, several laboratory abnormalities can be detected. Abnormal values of the tests for evaluation of systemic inflammation are the most typical humoral features of RA. These include: erythrocyte sedimentation rate, acute phase proteins and plasma viscosity. Erythrocyte sedimentation rate and C-reactive protein provide the best information about the acute phase response. The C-reactive protein is strictly correlated with clinical assessment and radiographic changes. Plain film radiography is the standard investigation to assess the extent of anatomic changes in rheumatoid arthritis patients. The radiographic features of the hand joints in early disease are characterized by soft tissue swelling and mild juxtaarticular osteoporosis. In the the past 10 years, ultrasonography has gained acceptance for studying joint, tendon and bursal involvement in RA. It may improve the early clinical assessment and the follow-up of these patients, showing such details as synovial thickening even within finger joints. Other imaging techniques, such as magnetic resonance, computed tomography and scintigraphy may provide useful information about both the features and the extent for anatomic damage in selected rheumatoid arthritis patients. The natural history of the disease is poorly defined; its clinical course is fluctuating and the prognosis unpredictable. RA is an epidemiologically relevant cause of disability. An adequate early treatment of RA may alter the diseas PMID:9652497

Grassi, W; De Angelis, R; Lamanna, G; Cervini, C



Classification of degenerative arthritis.  

PubMed Central

It is suggested that the former division of degenerative arthritis into idiopathic types and those secondary to some disease process is no longer valid. Recent studies have indicated that abnormal concentrations of force on cartilage lead to the development of this disease. A classification is presented that is based on the assumption that the process is initiated by abnormal concentrations of force on normal cartilage matrix, normal concentrations of force on abnormal cartilage matrix or normal concentrations of force on normal cartilage matrix that is supported by bone of abnormal consistency.

Mitchell, N. S.; Cruess, R. L.



Lower contribution of factor V Leiden or G202104 mutations to ischemic stroke in patients with clinical risk factors: pair-matched case-control study.  


It was suggested that factor V Leiden and prothrombin G20210A mutations increase the risk of ischemic stroke only in combination with clinical risk factors of arterial ischemic disease. In these studies the controls were derived from the general population, with fewer clinical risk factors, which might have produced biased results. The factor V Leiden and prothrombin G20210A mutations were examined by polymerase chain reaction technique in 120 ischemic stroke patients and 120 controls younger than 65 years of age. Each patient had his own control, tightly matched in clinical risk factors. The prevalences of factor V Leiden and prothrombin G20210A mutations in patients were 8.3% (P = 0.02) and 7.5% (P = 0.04), respectively, and 2.5% for controls for both mutations. All carriers were single heterozygotes. In patients, but not in controls, the carriers of either mutation were mostly women and with fewer clinical risk factors for arterial ischemic events. In particular, considering both mutations as a single coagulation deficit, their presence increased the likelihood of ischemic stroke (odds ratio [OR] = 3.6; 95% confidence interval [CI] 1.4-9.3), especially among women (OR = 4.6; 95% CI: 1.2-17.8), normotensive persons (OR = 9.2; 95% CI: 1.1-17.8) and those having normal cholesterol (OR = 5.9; 95% CI: 1.6-21.2) and triglyceride serum concentrations (OR = 4.3; 95% CI: 1.5-12.8). In the studied sample of adult North Mediterranean population younger than 65 years the prevalences of factor V Leiden and prothrombin G20210A mutations were greater in patients with ischemic stroke than in matched controls. Unlike in studies with unmatched controls, we observed an apparently negative interaction of these mutations with clinical risk factors. PMID:17456629

Eterovi?, Davor; Titli?, Marina; Culi?, Viktor; Zadro, Renata; Primorac, Dragan



Factor V Leiden and prothrombin 20210 GA mutations in controls and in patients with thromboembolic events during pregnancy or the puerperium  

Microsoft Academic Search

.  \\u000a Factor V Leiden and prothrombin 20210 G-A mutations are independent risk factors for venous thrombosis. We studied the frequency\\u000a of these mutations in 35 patients who had thromboembolic events during pregnancy and puerperium, and in 32 women who had a\\u000a history of uncomplicated pregnancy, delivered either vaginally or by cesarean section, and did not have a past history of

Mehmet Yilmazer; Gulay Kurtay; Murat Sonmezer; Nejat Akar



Association between apolipoprotein ?4 allele, factor V Leiden, and plasma lipid and lipoprotein levels with sickle cell disease in southern Iran  

Microsoft Academic Search

To investigate whether there is any association between various APOE alleles and factor V Leiden (FVL) with lipid profiles\\u000a and sickle cell disease (SCD) in Southern Iran. 65 SCD patients consisting of 35 sickle cell anemia homozygous (SS), 15 sickle\\u000a cell heterozygous (AS) and 15 sickle cell\\/?Thalassemia (S\\/?thal) patients and 68 healthy individuals with normal hematological\\u000a indices were studied. APOE

Zohreh Rahimi; Asad Vaisi-Raygani; Tayebeh Pourmotabbed



Prevalence of Factor V 1691 G–A (Leiden) and prothrombin G20210A polymorphisms and the risk of venous thrombosis among cancer patients  

Microsoft Academic Search

Aims  Cancer patients have an increased risk for thromboembolism (TE). Factor V 1691 G–A(Leiden) (FVL) and prothrombin (PT) G20210A\\u000a mutation are common inherited risk factor for TE. The aim of the study is to evaluate the prevalence of FVL and PT G20210A\\u000a polymorphism in cancer patients with and without TE as compared to patients with TE without malignancy and healthy control.

Aydan Eroglu; Arzu Ulu; Ragip Çam; Cengiz Kurtman; Nejat Akar



Detection of the Factor V Leiden Mutation by Direct Allele-specific Hybridization of PCR Amplicons to Photoimmobilized Locked Nucleic Acids  

Microsoft Academic Search

Background: Individuals carrying the factor V Leiden mutation have been shown to have an increased risk of developing venous thromboembolism. Our aim was to develop an ELISA-like assay to detect the mutation in PCR-amplified genomic DNA using novel, high-affinity DNA analogs, termed locked nucleic acids (LNAs). Methods: LNA octamer probes complementary to the factor V wild-type or mutated sequence were

Henrik Ørum; Mogens H. Jakobsen; Troels Koch; Jens Vuust; Martin B. Borre


Improving Life for Hoosiers with Arthritis: The Indiana Arthritis Strategic Action Plan.  

National Technical Information Service (NTIS)

The Indiana Arthritis Initiative mission is to strengthen arthritis management and prevention efforts through the dissemination of information, partnerships with community leaders and organizations, and implementation of our Indiana Arthritis Strategic Ac...



Comparative Effectiveness of Drug Therapy for Rheumatoid Arthritis and Psoriatic Arthritis in Adults.  

National Technical Information Service (NTIS)

Rheumatoid and psoriatic arthritis are among the most disabling forms of arthritis. Rheumatoid arthritis (RA), which affects 1 percent of the U.S. adult population (or upwards of 2 million individuals), is an autoimmune disease that involves inflammation ...

D. E. Jonas G. Gartlehner K. E. Donahue L. J. Lux P. Thieda



Antiperinuclear factors are present in polyarthritis before ACR criteria for rheumatoid arthritis are fulfilled  

PubMed Central

OBJECTIVE—To show that antiperinuclear factor (APF) may be useful for the diagnosis of rheumatoid arthritis at a time when the American College of Rheumatology (ACR) criteria are not yet fulfilled.?METHODS—Testing for APF-IgG (1:100 threshold) and rheumatoid factors (RF) was done in 60 patients with polyarthritis of recent onset during a three year follow up.?RESULTS—At the end of the study, 21/40 rheumatoid arthritis were positive for RF and 31/40 for APF, including 18/40 cases (45%) in which ACR criteria were not yet fulfilled.?CONCLUSIONS—APF are useful in the diagnosis of early rheumatoid arthritis.??

Berthelot, J.; Maugars, Y.; Castagne, A.; Audrain, M.; Prost, A.



What is MRI bone oedema in rheumatoid arthritis and why does it matter?  

PubMed Central

MRI bone oedema occurs in various forms of inflammatory and non-inflammatory arthritis and probably represents a cellular infiltrate within bone. It is common in early rheumatoid arthritis and is associated with erosive progression and poor functional outcome. Histopathological studies suggest that a cellular infiltrate comprising lymphocytes and osteoclasts may be detected in subchondral bone and could mediate the development of erosions from the marrow towards the joint surface. There is emerging evidence from animal models that such an infiltrate corresponds with MRI bone oedema, pointing towards the bone marrow as a site for important pathology driving joint damage in rheumatoid arthritis.

McQueen, Fiona M; Ostendorf, Benedikt



[Constrictive pericarditis and rheumatoid arthritis].  


Pericarditis is the commonest cardiac manifestation of rhumatoid arthritis. It is often clinically latent but it may evolve to constriction or less often to tamponade. The case presented is of a 60 year-old woman with a 5 year history of seropositive nodular rhumatoid arthritis in whom bilateral pleural effusions and constrictive pericarditis were observed after sudden termination of corticotherapy. She was treated successfully by pericardectomy. This complication is far from being exceptional (55 cases already reported). It justifies a systematic search for pericarditis in rhumatoid arthritis, especially by echocardiography. PMID:116613

Baubion, N; Vacheron, A; Heulin, A; Gilles, R; Le Sourd, P; Le Parc, J M; Di Matteo, J



Risks and benefits of low-dosage cyclosporin in rheumatoid arthritis.  


The effects of cyclosporin on the activity of rheumatoid arthritis have mainly been investigated in patients with active, refractory, long-standing disease. The data obtained in these trials suggest that cyclosporin is not only a symptomatic treatment for rheumatoid arthritis but can also be considered a disease-modifying antirheumatic drug (DMARD), since it seems to be capable of slowing the progression of cartilage and bone damage due to rheumatoid arthritis. The trials conducted so far have led to a better understanding of cyclosporin toxicity and, therefore, to better monitoring of patients in order to avoid it. The reasons for studying the role of cyclosporin in patients with early, active and potentially severe rheumatoid arthritis are the poor prognosis of the disease despite the use of the presently available DMARDs, and the hypothesis that the drug is more efficacious and better tolerated in early rheumatoid arthritis. A new classification of antirheumatic drugs proposes that disease-controlling antirheumatic therapies decrease inflammatory synovitis and prevent structural joint damage or significantly reduce its rate of progression. However, few existing drugs meet these criteria. The 12-month results of a disease-controlling antirheumatic therapy clinical trial with a blinded radiological end-point, named GRISAR (Gruppo Reumatologi Italiani Studio Artrite Reumatoide) comparing cyclosporin with conventional DMARDs in patients with early rheumatoid arthritis provide strong evidence that cyclosporin offers better control of ongoing joint damage than do conventional DMARDs. PMID:18031101

Pasero, G; Ferraccioli, G F; Portioli, I



Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum.  


Risk factors for deep-vein thrombosis have been shown not to be always the same as for pulmonary embolism. A well-known example is the factor V Leiden (FVL) paradox: the FVL mutation poses a clearly higher risk for deep-vein thrombosis (DVT) than for pulmonary embolism. We aimed to expand this paradox and therefore present risk estimates for several established risk factors for DVT and pulmonary embolism separately. When such separate risk estimates could not be retrieved from the literature, we calculated these risks in our own data, a large population-based case-control study on venous thrombosis (the MEGA study). Our results showed that the FVL paradox can be broadened (ie, the risk factors oral contraceptive use, pregnancy, puerperium, minor leg injuries, and obesity have an effect comparable with FVL). Furthermore, we found that pulmonary conditions, such as chronic obstructive pulmonary disease, pneumonia, and sickle cell disease, were risk factors with an opposite effect: a higher risk of pulmonary embolism, but little or no effect on DVT. These findings suggest that pulmonary embolism and DVT may not always have the same etiology, and encourage unraveling this phenomenon in further studies. PMID:22496157

van Langevelde, Kirsten; Flinterman, Linda E; van Hylckama Vlieg, Astrid; Rosendaal, Frits R; Cannegieter, Suzanne C



Impact of the factor V Leiden mutation on the outcome of pneumococcal pneumonia: a controlled laboratory study  

PubMed Central

Introduction Streptococcus (S.) pneumoniae is the most common cause of community-acquired pneumonia. The factor V Leiden (FVL) mutation results in resistance of activated FV to inactivation by activated protein C and thereby in a prothrombotic phenotype. Human heterozygous FVL carriers have been reported to be relatively protected against sepsis-related mortality. We here determined the effect of the FVL mutation on coagulation, inflammation, bacterial outgrowth and outcome in murine pneumococcal pneumonia. Methods Wild-type mice and mice heterozygous or homozygous for the FVL mutation were infected intranasally with 2*106 colony forming units of viable S. pneumoniae. Mice were euthanized after 24 or 48 hours or observed in a survival study. In separate experiments mice were treated with ceftriaxone intraperitoneally 24 hours after infection and euthanized after 48 hours or observed in a survival study. Results The FVL mutation had no consistent effect on activation of coagulation in either the presence or absence of ceftriaxone therapy, as reflected by comparable lung and plasma levels of thrombin-antithrombin complexes and fibrin degradation products. Moreover, the FVL mutation had no effect on lung histopathology, neutrophil influx, cytokine and chemokine levels or bacterial outgrowth. Remarkably, homozygous FVL mice were strongly protected against death due to pneumococcal pneumonia when treated with ceftriaxone, which was associated with more pronounced FXIII depletion; this protective effect was not observed in the absence of antibiotic therapy. Conclusions Homozygosity for the FVL mutation protects against lethality due to pneumococcal pneumonia in mice treated with antibiotics.



Factor V Leiden mutation does not affect coagulopathy or outcome in lethal H1N1 influenza.  


Influenza A is a major cause of mortality. Knowledge on coagulation activation in influenza infection is limited. The factor V Leiden (FVL) mutation is possibly subject to positive selection pressure. It is unknown whether this mutation impacts on the outcome of severe influenza. In the present study, the effect of lethal influenza on pulmonary and systemic coagulation activation and whether or not FVL mutation alters coagulation activation in and the course of lethal influenza, was determined. Wild-type mice, and mice heterozygous or homozygous for FVL were infected intranasally with a lethal dose of H1N1 (haemagglutinin 1 and neuraminidase 1) influenza A. Mice were sacrificed after 48 or 96 h for determination of coagulation activation, histopathology, pulmonary inflammatory parameters and viral load, or were observed in a survival study. Extensive local and systemic coagulation activation during lethal influenza was demonstrated by increased lung and plasma levels of thrombin-antithrombin complexes and fibrin degradation products, and by pulmonary fibrin deposition. FVL mutation did not influence the procoagulant response, lung histopathology or survival. FVL mice demonstrated elevated viral loads 48 h after infection. In conclusion, coagulation is activated locally and systemically during lethal murine influenza A infection. The FVL mutation does not influence coagulation activation, lung inflammation or survival in lethal influenza A. PMID:20413539

Schouten, M; van der Sluijs, K F; Roelofs, J J T H; Levi, M; Van't Veer, C; van der Poll, T



Hepatocyte-specific IKK-? activation enhances VLDL-triglyceride production in APOE*3-Leiden mice[S  

PubMed Central

Low-grade inflammation in different tissues, including activation of the nuclear factor ?B pathway in liver, is involved in metabolic disorders such as type 2 diabetes and cardiovascular diseases (CVDs). In this study, we investigated the relation between chronic hepatocyte-specific overexpression of IkB kinase (IKK)-? and hypertriglyceridemia, an important risk factor for CVD, by evaluating whether activation of IKK-? only in the hepatocyte affects VLDL-triglyceride (TG) metabolism directly. Transgenic overexpression of constitutively active human IKK-? specifically in hepatocytes of hyperlipidemic APOE*3-Leiden mice clearly induced hypertriglyceridemia. Mechanistic in vivo studies revealed that the hypertriglyceridemia was caused by increased hepatic VLDL-TG production rather than a change in plasma VLDL-TG clearance. Studies in primary hepatocytes showed that IKK-? overexpression also enhances TG secretion in vitro, indicating a direct relation between IKK-? activation and TG production within the hepatocyte. Hepatic lipid analysis and hepatic gene expression analysis of pathways involved in lipid metabolism suggested that hepatocyte-specific IKK-? overexpression increases VLDL production not by increased steatosis or decreased FA oxidation, but most likely by carbohydrate-responsive element binding protein-mediated upregulation of Fas expression. These findings implicate that specific activation of inflammatory pathways exclusively within hepatocytes induces hypertriglyceridemia. Furthermore, we identify the hepatocytic IKK-? pathway as a possible target to treat hypertriglyceridemia.

van Diepen, Janna A.; Wong, Man C.; Guigas, Bruno; Bos, Jasper; Stienstra, Rinke; Hodson, Leanne; Shoelson, Steven E.; Berbee, Jimmy F. P.; Rensen, Patrick C. N.; Romijn, Johannes A.; Havekes, Louis M.; Voshol, Peter J.



[Lyme arthritis in children: A diagnostic trap].  


Lyme disease incidence is diverse in France. It is rare in many regions but very frequent in Central and Eastern France. Arthritis is a late manifestation of Lyme disease. In children, the clinical and biological picture often resembles that of septic arthritis and juvenile rheumatoid arthritis, which are more frequent. This explains why diagnosis may be delayed, especially when patient lives in a region of low incidence. We report the case of an 8-year old girl with knee arthritis treated as septic arthritis in a region where Lyme disease is rare. Six days later, clinical and biological worsening suggested that the diagnosis had to be reconsidered. Lyme arthritis was confirmed by serology. Treatment was adapted and the progression was positive. This case reminds us that, in children, Lyme arthritis may look alike septic arthritis or juvenile rheumatoid arthritis and must be considered as a possible diagnosis, even in low-incidence areas. PMID:24028811

Leroux, J; Vivier, P-H; Grall, M; Foulongne, E; Ould Slimane, M; Abu Amara, S; Lechevallier, J



[Psoriatic arthritis--diagnostic criteria].  


Arthritis psoriatica has been known for over 160 years, however, not long ago it became a separate nosologic unit. In 1964 American Rheumatological Society introduced the name arthritis psoriatica, which is obligatory nowadays. It was thought in the beginning that the inflammation may coexist with psoriasis accidentally only, whereas epidemiological studies, clinical observations and serologic data excluded such a simple relation. Since the international diagnostic criteria were established and also the rheumatoid factor was discovered it has been clear there's a direct relation between arthritis psoriatica and dermatologic changes of a psoriasis type. Therefore it is a disease where rheumatology and dermatology meet with each other. The aim of our study was to collect the knowledge about the diagnosis of arthritis psoriatica. PMID:10224865

Sobieszek-Kundro, A; Pawlik, H; Roszkiewicz, J; B?onska, E



Psoriatic Arthritis: Tips for Managing  


... may be helpful. Your doctor can write a prescription for physical therapy. During physical therapy, your therapist will evaluate your movement to determine how the arthritis affects you and provide specific ...


Juvenile Arthritis: Access to Care  


... research, news and treatment. [Monthly] sign up Health Care Resources Use this list for everything from general ... help with medication costs – or finding a health care provider. By Arthritis Today Staff Text Size: Bigger ...


L'approccio riabilitativo nell'artrite reumatoide The rehabilitative approach in rheumatoid arthritis  

Microsoft Academic Search

SUMMARY The rehabilitative approach for the patient with rheumatoid arthritis should be early, global and complementary to an early pharmacological therapy, in the context of a multidisciplinary approach, that should include physicians with different specialties and other health professionals. Evaluation scales assessing disability and quality of life are necessary for the rehabilitative approach. These can be classified in 2 groups:

G. Arioli; S. Maddali Bongi; N. Pappone


Osteoarticular tuberculosis mimicking rheumatoid arthritis.  


Tuberculosis (TB) remains a global burden despite extensive efforts to control it. TB arthritis commonly manifest as monoarthritis of weight-bearing joints. We report a rare presentation of osteoarticular TB involving multiple small joints of the hands, which mimicked rheumatoid arthritis (RA). Magnetic resonance imaging showed tenosynovitis. The patient was initially treated for seronegative RA but failed to respond. Subsequently, synovial biopsy led to the diagnosis. Antituberculosis treatment was given for 1 year. PMID:22399018

Seung, Ong Ping; Sulaiman, Wahinuddin



Rheumatoid arthritis and enteric bacteria  

Microsoft Academic Search

Factors in the etiopathogenesis of rheumatoid arthritis (RA) include the genetic back-ground, environmental factors and perpetuation\\u000a of the inflammatory process. This review focuses on enteric bacteria as initiating or perpetuating factors in the etiopathogenesis\\u000a of RA. Based on the hypothesis that entrobacterial antigens that originated from intestinal flora induce rheumatoid inflammation\\u000a in the joints, animal models of arthritis due toEnterobacteriaceae,

Shigehisa Aoki



Rheumatoid arthritis associated with osteopetrosis  

Microsoft Academic Search

Osteopetrosis is an inherited disorder characterized by reduced bone resorption. We here report a rare case of osteopetrosis\\u000a associated with rheumatoid arthritis. The patient was diagnosed as autosomal dominant osteopetrosis type II in his youth and\\u000a developed rheumatoid arthritis at 42 years of age. In spite of the severe inflammation and rapid progression of cartilage\\u000a destruction, the progression of bone erosion

Yuho Kadono; Sakae Tanaka; Jinju Nishino; Keita Nishimura; Ichiro Nakamura; Tsuyoshi Miyazaki; Hiroshi Takayanagi; Kozo Nakamura



Thumb carpal metacarpal arthritis.  


The thumb carpometacarpal (CMC) joint is the most common site of surgical reconstruction for osteoarthritis in the upper extremity. In patients older than age 75 years, thumb CMC osteoarthritis has a radiographic prevalence of 25% in men and 40% in women. The thumb CMC joint obtains its stability primarily through ligamentous support. A diagnosis of thumb CMC arthritis is based on symptoms of localized pain, tenderness and instability on physical examination, and radiographic evaluation. A reproducible radiographic classification for disease severity is based on the four-stage system described by Eaton. Nonsurgical treatment options include hand therapy, splinting, and injection. Surgical treatment is tailored to the extent of arthritic involvement and may include ligament reconstruction, metacarpal extension osteotomy, arthroscopic partial trapeziectomy, implant arthroplasty, and trapeziectomy with or without ligament reconstruction and tendon interposition. PMID:18316712

Van Heest, Ann E; Kallemeier, Patricia



Physiotherapy in Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a chronic and painful clinical condition that leads to progressive joint damage, disability, deterioration in quality of life, and shortened life expectancy. Even mild inflammation may result in irreversible damage and permanent disability. The clinical course according to symptoms may be either intermittent or progressive in patients with RA. In most patients, the clinical course is progressive, and structural damage develops in the first 2 years. The aim of RA management is to achieve pain relief and prevent joint damage and functional loss. Physiotherapy and rehabilitation applications significantly augment medical therapy by improving the management of RA and reducing handicaps in daily living for patients with RA. In this review, the application of physiotherapy modalities is examined, including the use of cold/heat applications, electrical stimulation, and hydrotherapy. Rehabilitation treatment techniques for patients with RA such as joint protection strategies, massage, exercise, and patient education are also presented.

Kavuncu, Vural; Evcik, Deniz



Osteomyelitis and arthritis.  


Infections of bone and the joints can represent major diagnostic and therapeutic challenges to all clinicians. Together with osteomyelitis and septic arthritis, soft-tissue infections like cellulites/fasciitis and abscess formation can occur, which have to be treated appropriately. Bone scintigraphy is a sensitive method that can be used to search for bone and joint infections. Labeled leukocytes often are used as the gold standard to identify infectious foci in the musculoskeletal system, but major drawbacks of this method are the imaging of chronic infections and imaging of the axial skeleton. Like (111)In-labeled leukocyte imaging, (99m)Tc-labeled antigranulocyte antibody scintigraphy has a role in the imaging of osteomyelitis of the peripheral skeleton. Magnetic resonance imaging is widely used to evaluate musculoskeletal infections and is excellent in identifying abscess formation, but the extent and spread of infection is sometimes difficult to delineate because hyperemia and infection are not congruent. PMID:19038598

Stumpe, Katrin D M; Strobel, Klaus



Pathogenesis of rheumatoid arthritis.  


This report gives a review on recent results of investigations of cellular aspects of inflammation. The role of macrophages and T-helper-cells with particular focus to the effects of the various mediators on their target cells will be discussed. Interleukin 1, Tumor Necrosis Factor, Interleukin 2, and Interferon as well as arachidonic acid metabolites contribute to the clinical findings of inflammation. We have to admit that the whole process of inflammation in rheumatic arthritis (RA) is not yet clear. For example we do not know in detail why RA is self perpetuating, why and when rheumatoid pannus occurs or under which circumstances immune complexes may cause the various organ manifestations. Recent findings are discussed. PMID:2464266

Kolarz, G



[Capillaroscopy in rheumatoid arthritis].  


Three capillaroscopic features to be found at the base of nails are recognizable in rheumatoid arthritis. This is in conjunction with the clinical picture, the biological data, and the course of development. In the first, the tissue is transparent, there are many small comma-shaped capillary loops; the second feature is characterized by extreme transparency, pale base and long "hair-pin" loops spread in treillis form over the venular plexus in slow, granular circulation. A third feature recalls from the start a state of collagenosis, because of the inhomogenous opacity of the tissue, the presence of capillary hemorrhage and the irregular appearance of the loops, often of the "megacapillary" variety (I.E. congenital capillary dilatation). This division into three categories determines the character prognosis and treatment. It corresponds histologically to "pulp" biopsy and to the region of glomie arterio-venous anastomosis. There is therefore a real rheumatoid histoangiopathy. PMID:7465641

Merlen, J F; Sarteel, A M


Palindromic rheumatism and other relapsing arthritis.  


Patients with recurrent or relapsing arthritis are frequently seen in rheumatological practice. Besides crystal arthritis, the most frequent cause of recurrent arthritis, there are several diseases that may present clinically as intermittent mono- or polyarthritis. Palindromic rheumatism is the paradigm of this type of condition, but other diseases such as systemic autoinflammatory disorders (periodic fever syndromes), Whipple's disease, arthritis associated with hyperlipidemia, intermittent hydrarthrosis and other diseases should be taken into account in the differential diagnosis of patients with recurrent arthritis. In this chapter, we discuss recent developments in these diseases with special emphasis on palindromic rheumatism, a common condition whose close relationship with rheumatoid arthritis remains intriguing. PMID:15454124

Sanmarti, Raimon; Cañete, Juan D; Salvador, Georgina



Radiological outcome in rheumatoid arthritis is predicted by presence of antibodies against cyclic citrullinated peptide before and at disease onset, and by IgA-RF at disease onset  

Microsoft Academic Search

Objective: To evaluate the significance of antibodies against cyclic citrullinated peptide (anti-CCP) and rheumatoid factors (RFs), before the onset of rheumatoid arthritis and when presenting as early disease (baseline), for disease activity and progression.Methods: 93 of a cohort of 138 patients with early rheumatoid arthritis (<12 months of symptoms) had donated blood before symptoms of rheumatoid arthritis (defined as pre-patients)

E Berglin; T Johansson; U Sundin; E Jidell; G Wadell; G Hallmans; S Rantapa?a?-Dahlqvist



Therapy of rheumatoid arthritis: New developments and trends  

Microsoft Academic Search

The medical therapy of rheumatoid arthritis (RA) has been influenced strongly during the past decade by the recognition that\\u000a many patients develop joint damage within the first year of disease. This observation has motivated rheumatologists to initiate\\u000a disease-modifying antirheumatic drugs (DMARDs) early in the disease course. This trend has been matched by the increased use\\u000a of combinatio DMARD therapy, with

E. William St. Clair



Natural killer cells in viral arthritis.  

PubMed Central

Changes in natural killer (NK) cell activity were studied in patients with polyarthritis associated with rubella or Ross River virus infections. In 30 of 32 Ross River virus patients, peripheral NK cell activity was depressed at some stage of the disease but returned to normal levels as patients recovered from arthritic symptoms. Similar changes did not occur in rubella patients and no difference was found between changes in peripheral NK activity and serum interferon (IFN) levels in rubella patients with arthritis and those without. Neither the peak of NK cell activity in peripheral blood lymphocytes (PBL) recovered early in Ross River virus and rubella infections, nor the depression of NK cell activity late in Ross River virus infections could be correlated with changes in serum IFN levels. The decrease in PBL-NK cell activity in epidemic polyarthritis (EPA) patients could not be attributed solely to loss of NK cells from the peripheral circulation because limiting-cell-dilution (LCD) analyses indicated changes in peripheral NK cell activity were due to changes in both the number and lytic activity of NK cells. Despite the association between HLA-DR7 and EPA no differences were found in levels of peripheral NK cell activity in DR7+ and DR7- EPA patients. The demonstration that peripheral NK cells could kill autologous synovial cells suggested that NK cells in joints of EPA patients may contribute to the arthritis associated with Ross River virus infection.

Aaskov, J G; Dalglish, D A; Harper, J J; Douglas, J F; Donaldson, M D; Hertzog, P J



Expression of TNF? in arthritis caused by caprine arthritis encephalitis virus  

Microsoft Academic Search

Goats infected with caprine arthritis encephalitis virus (CAEV) develop chronic arthritis sharing many features with human rheumatoid arthritis (RA). TNF is thought to be a key mediator contributing to the formation of the arthritic lesion in RA. We studied this cytokine in goats suffering from chronic arthritis. TNF? expressing cells were detected by in situ hybridization in synovial membranes of

Franziska Lechner; Hans-Rudolf Vogt; Heng Fong Seow; Uta von Bodungen; Giuseppe Bertoni; Andreas Zurbriggen; Ernst Peterhans



Rheumatoid nodulosis: is it a different subset of rheumatoid arthritis?  


Rheumatoid nodulosis is an entity that describes a particular variant of polyarthritis associated with early manifestations of palindromic rheumatism, radiologic subchondral bone cysts, and subcutaneous rheumatoid nodules. This study describes the clinical, radiologic, histologic, crystallographic, and laboratory findings, as well as the outcome in a group of 16 patients with rheumatoid nodulosis that were followed for a period of 1-12 years. Six of these patients had an aggressive course and developed classic erosive polyarticular rheumatoid arthritis, while the others continued having episodic arthritis without erosive disease. Seven patients had cholesterol crystals in olecranon bursae containing nodules. Second-line drugs used to control the articular manifestations did not improve the nodulosis, erosive, or cystic subchondral bone changes. Rheumatoid nodulosis mimics several other rheumatic diseases, and in about 40%, classic erosive rheumatoid arthritis develops. The presence of cholesterol crystals in rheumatoid nodules or affected bursae can increase the confusion with other crystal-induced arthritis, in particular, tophaceous monosodium urate gout or xanthomatosis. PMID:17041479

Maldonado, Irama; Eid, Hala; Rodriguez, Graciela R; Rillo, Oscar L; Barcat, Jose A; Reginato, Antonio J



Both Transient and Continuous Corticosterone Excess Inhibit Atherosclerotic Plaque Formation in APOE*3-Leiden.CETP Mice  

PubMed Central

Introduction The role of glucocorticoids in atherosclerosis development is not clearly established. Human studies show a clear association between glucocorticoid excess and cardiovascular disease, whereas most animal models indicate an inhibitory effect of glucocorticoids on atherosclerosis development. These animal models, however, neither reflect long-term glucocorticoid overexposure nor display human-like lipoprotein metabolism. Aim To investigate the effects of transient and continuous glucocorticoid excess on atherosclerosis development in a mouse model with human-like lipoprotein metabolism upon feeding a Western-type diet. Methods Pair-housed female APOE*3-Leiden.CETP (E3L.CETP) mice fed a Western-type containing 0.1% cholesterol for 20 weeks were given corticosterone (50 µg/ml) for either 5 (transient group) or 17 weeks (continuous group), or vehicle (control group) in the drinking water. At the end of the study, atherosclerosis severity, lesion area in the aortic root, the number of monocytes adhering to the endothelial wall and macrophage content of the plaque were measured. Results Corticosterone treatment increased body weight and food intake for the duration of the treatment and increased gonadal and subcutaneous white adipose tissue weight in transient group by +35% and +31%, and in the continuous group by +140% and 110%. Strikingly, both transient and continuous corticosterone treatment decreased total atherosclerotic lesion area by ?39% without lowering plasma cholesterol levels. In addition, there was a decrease of ?56% in macrophage content of the plaque with continuous corticosterone treatment, and a similar trend was present with the transient treatment. Conclusion Increased corticosterone exposure in mice with human-like lipoprotein metabolism has beneficial, long-lasting effects on atherosclerosis, but negatively affects body fat distribution by promoting fat accumulation in the long-term. This indicates that the increased atherosclerosis observed in humans in states of glucocorticoid excess may not be related to cortisol per se, but might be the result of complex indirect effects of cortisol.

Princen, Hans; Romijn, Johannes A.; Havekes, Louis M.; Smit, Johannes W. A.; Meijer, Onno C.; Biermasz, Nienke R.; Rensen, Patrick C. N.; Pereira, Alberto M.



Avascular Villi, Increased Syncytial Knots, and Hypervascular Villi Are Associated with Pregnancies Complicated by Factor V Leiden Mutation  

PubMed Central

There is controversy about whether pathologic abnormalities are associated with pregnancies complicated by factor V Leiden (FVL) mutation. The purpose of this study was to evaluate 105 placentas delivered to mothers heterozygous for FVL mutation to determine if there are pathologic changes suggestive of hypoxia or thrombosis, which correlate with mutation status. We examined placentas obtained as part of a prospective study of 5188 pregnancies analyzed for the presence of FVL mutation in either the mother or the infant. One hundred five placentas from mothers heterozygous for the mutation were compared with 225 controls matched for maternal age, race, and geographic site. Of the 330 pregnancies, 50 infants were FVL mutation heterozygotes. Maternal FVL heterozygote status was associated with more frequent increased numbers of syncytial knots (13% vs 4%); the difference remained significant after controlling for hypertension, preeclampsia, small-for-gestational-age infants, and delivery prior to 35 weeks of gestation (odds ratio 3.6, 95% confidence interval 1.5–8.7, P = 0.004). Maternal FVL heterozygotes had more hypervascular villi (10% vs 3%), with significance retained controlling for delivery route (odds ratio 3.4, 95% confidence ratio 1.2–9.4, P = 0.018). Placentas from infants heterozygous for FVL mutation had more avascular villi than controls (odds ratio 2.9, 95% confidence interval 1.5–5.6, P = 0.001). Fetal or maternal FVL heterozygosity was not associated with infarcts, small-for-gestational-age placentas, or fetal thrombotic vasculopathy. This analysis demonstrates that pathologic findings associated with placental hypoxia, specifically focal avascular villi, increased numbers of syncytial knots, and hypervascular villi, also correlate with FVL heterozygosity in infants or mothers.

Rogers, Beverly Barton; Momirova, Valerija; Dizon-Townson, Donna; Wenstrom, Katharine; Samuels, Philip; Sibai, Baha; Spong, Catherine; Caritis, Steve N.; Sorokin, Yoram; Miodovnik, Menachem; O'Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.



Anti-cyclic citrullinated peptide (CCP) antibodies in patients with long-standing rheumatoid arthritis and their relationship with extra-articular manifestations  

Microsoft Academic Search

ObjectivesTo evaluate frequency of anti-cyclic citrullinated peptide antibodies (anti-CCP) in long-standing rheumatoid arthritis (LsRA) patients and their relationship with extra-articular manifestations of rheumatoid arthritis (RA), in addition to comparing frequency of anti-CCP antibodies in early RA (ERA) and LsRA group.

Cengiz Korkmaz; Tercan Us; Timuçin Ka?ifo?lu; Yurdanur Akgün



Serum cathepsin K levels of patients with longstanding rheumatoid arthritis: correlation with radiological destruction  

PubMed Central

Cathepsin K is a cysteine protease that plays an essential role in osteoclast function and in the degradation of protein components of the bone matrix by cleaving proteins such as collagen type I, collagen type II and osteonectin. Cathepsin K therefore plays a role in bone remodelling and resorption in diseases such as osteoporosis, osteolytic bone metastasis and rheumatoid arthritis. We examined cathepsin K in the serum of 100 patients with active longstanding rheumatoid arthritis. We found increased levels of cathepsin K compared with a healthy control group and found a significant correlation with radiological destruction, measured by the Larsen score. Inhibition of cathepsin K may therefore be a new target for preventing bone erosion and joint destruction in rheumatoid arthritis. However, further studies have to be performed to prove that cathepsin K is a valuable parameter for bone metabolism in patients with early rheumatoid arthritis.

Skoumal, Martin; Haberhauer, Gunther; Kolarz, Gernot; Hawa, Gerhard; Woloszczuk, Wolfgang; Klingler, Anton



Serum cathepsin K levels of patients with longstanding rheumatoid arthritis: correlation with radiological destruction.  


Cathepsin K is a cysteine protease that plays an essential role in osteoclast function and in the degradation of protein components of the bone matrix by cleaving proteins such as collagen type I, collagen type II and osteonectin. Cathepsin K therefore plays a role in bone remodelling and resorption in diseases such as osteoporosis, osteolytic bone metastasis and rheumatoid arthritis. We examined cathepsin K in the serum of 100 patients with active longstanding rheumatoid arthritis. We found increased levels of cathepsin K compared with a healthy control group and found a significant correlation with radiological destruction, measured by the Larsen score. Inhibition of cathepsin K may therefore be a new target for preventing bone erosion and joint destruction in rheumatoid arthritis. However, further studies have to be performed to prove that cathepsin K is a valuable parameter for bone metabolism in patients with early rheumatoid arthritis. PMID:15642144

Skoumal, Martin; Haberhauer, Günther; Kolarz, Gernot; Hawa, Gerhard; Woloszczuk, Wolfgang; Klingler, Anton



Burden of childhood-onset arthritis  

Microsoft Academic Search

Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated

Lakshmi N Moorthy; Margaret GE Peterson; Afton L Hassett; Thomas JA Lehman



Experimental animal models resembling rheumatoid arthritis  

Microsoft Academic Search

Summary The experimental animal models of arthritis which in certain aspects share similarities to human rheumatoid arthritis are reviewed. Various methods have been applied to induce in animals experimental models of arthritis which would provide important insights into the aetiopathogenetic mechanisms of human RA. Immunological methods and infectious agents induced the most interesting models. The histology of the synovial tissue,

Ph. M. Kaklamanis



HDAC Inhibition in Rheumatoid Arthritis and Juvenile Idiopathic Arthritis  

PubMed Central

Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are heterogeneous autoimmune diseases characterized by chronic joint inflammation. Methotrexate is used as the gold standard to treat rheumatoid arthritis, yet there are many patients in whom the disease cannot be controlled or who experience unacceptable intolerance. Most of the biologics currently used are effective, but mostly if combined with methotrexate. Long-term possible side effects, such as impaired host defense mechanisms against infection and lymphoma, are distinct disadvantages and a major concern of anticytokine therapies. Parenteral administration is a problem, particularly in children. Thus, there is a need to explore new treatment options. Here we review the properties of histone deacetylase inhibitors (HDACi) as they apply to rheumatoid arthritis by looking at effects on cytokine production, T-cell differentiation and the function of macrophages, dendritic cells, osteoblasts, osteoclasts and synovial fibroblasts. We also review the safety and efficacy of givinostat (ITF 2357) in the treatment of systemic onset juvenile idiopathic arthritis (SOJIA) and its influence on the cytokine networks in SOJIA. Givinostat is an orally active HDACi which was given to children with SOJIA. After 12 wk of treatment, there were significant benefits, particularly in reducing the pain and arthritic component of the disease and decreasing the neutrophilia. CD40L, IL-1? and IFN? in whole blood lysates decreased at wks 2 and 4 compared with baseline levels. The clinical data are consistent with those from animal models of rheumatoid arthritis and suggest that trials with HDACi are promising as a safe oral alternative to anticytokines and methotrexate.

Vojinovic, Jelena; Damjanov, Nemanja



MicroRNAs in Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a chronic and severe autoimmune disease that affects joint tissues, bone, and cartilage. However, the pathogenesis of RA is still unclear. Autoantibodies such as rheumatoid factor and anti-cyclic citrullinated peptide are useful tools for early diagnosis, monitoring disease activity, and predicting prognosis. Recently, many groups have focused their attention on the role of microRNAs in the pathogenesis of RA, as well as a potential biomarker to monitor RA. In fact, the expression of some microRNAs, such as miR-146a, is upregulated in different cell types and tissues in RA patients. MicroRNAs in RA could also be considered as possible future targets for new therapeutic approaches.

Ceribelli, Angela; Nahid, Md A.; Satoh, Minoru; Chan, Edward K.L.



Ultrasound in rheumatoid arthritis.  


Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation that can lead to structural damage of cartilage, bone and tendons. Assessing the inflammatory activity and the severity is essential in RA to help rheumatologists in adopting proper therapeutic strategies and in evaluating disease outcome and response to treatment. In the last years musculoskeletal (MS) ultrasonography (US) underwent tremendous technological development of equipment with increased sensitivity in detecting a wide set of joint and soft tissues abnormalities. In RA MSUS with the use of Doppler modalities is a useful imaging tool to depict inflammatory abnormalities (i.e. synovitis, tenosynovitis and bursitis) and structural changes (i.e. bone erosions, cartilage damage and tendon lesions). In addition, MSUS has been demonstrated to be able to monitor the response to different therapies in RA to guide local diagnostic and therapeutic procedures such as biopsy, fluid aspirations and injections. Future applications based on the development of new tools may improve the role of MSUS in RA. PMID:23979615

Rizzo, Chiara; Ceccarelli, Fulvia; Gattamelata, Angelica; Vavala, Caterina; Valesini, Guido; Iagnocco, Annamaria



Prostaglandins and Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a chronic, autoimmune, and complex inflammatory disease leading to bone and cartilage destruction, whose cause remains obscure. Accumulation of genetic susceptibility, environmental factors, and dysregulated immune responses are necessary for mounting this self-reacting disease. Inflamed joints are infiltrated by a heterogeneous population of cellular and soluble mediators of the immune system, such as T cells, B cells, macrophages, cytokines, and prostaglandins (PGs). Prostaglandins are lipid inflammatory mediators derived from the arachidonic acid by multienzymatic reactions. They both sustain homeostatic mechanisms and mediate pathogenic processes, including the inflammatory reaction. They play both beneficial and harmful roles during inflammation, according to their site of action and the etiology of the inflammatory response. With respect to the role of PGs in inflammation, they can be effective mediators in the pathophysiology of RA. Thus the use of agonists or antagonists of PG receptors may be considered as a new therapeutic protocol in RA. In this paper, we try to elucidate the role of PGs in the immunopathology of RA.

Fattahi, Mohammad Javad; Mirshafiey, Abbas



Detection of rheumatoid arthritis using infrared imaging  

NASA Astrophysics Data System (ADS)

Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of function in joints; it is difficult to diagnose in early stages. An early diagnosis and treatment can delay the onset of severe disability. Infrared (IR) imaging offers a potential approach to detect changes in degree of inflammation. In 18 normal subjects and 13 patients diagnosed with Rheumatoid Arthritis (RA), thermal images were collected from joints of hands, wrists, palms, and knees. Regions of interest (ROIs) were manually selected from all subjects and all parts imaged. For each subject, values were calculated from the temperature measurements: Mode/Max, Median/Max, Min/Max, Variance, Max-Min, (Mode-Mean), and Mean/Min. The data sets did not have a normal distribution, therefore non parametric tests (Kruskal-Wallis and Ranksum) were applied to assess if the data from the control group and the patient group were significantly different. Results indicate that: (i) thermal images can be detected on patients with the disease; (ii) the best joints to image are the metacarpophalangeal joints of the 2nd and 3rd fingers and the knees; the difference between the two groups was significant at the 0.05 level; (iii) the best calculations to differentiate between normal subjects and patients with RA are the Mode/Max, Variance, and Max-Min. We concluded that it is possible to reliably detect RA in patients using IR imaging. Future work will include a prospective study of normal subjects and patients that will compare IR results with Magnetic Resonance (MR) analysis.

Frize, Monique; Adéa, Cynthia; Payeur, Pierre; di Primio, Gina; Karsh, Jacob; Ogungbemile, Abiola



Comparison of Azathioprine, Cyclophosphamide, and Gold in Treatment of Rheumatoid Arthritis  

PubMed Central

Azathioprine, cyclophosphamide, and gold have been compared under double-blind conditions in the treatment of relatively early rheumatoid arthritis. Over 18 months the two “immunosuppressive” agents produced clinical improvement comparable to that achieved with gold, and they also facilitated a reduction in the dosage of corticosteroids and retarded radiological joint deterioration. Drug management was easiest with azathioprine. Cyclophosphamide was perhaps marginally the most effective drug but it produced azoospermia in males. If the long-term hazards of malignancy and mutagenesis prove to be acceptable then the anti-proliferative agents provide a useful alternative to gold therapy and can with advantage be given relatively early in the course of rheumatoid arthritis.

Currey, H. L. F.; Harris, J.; Mason, R. M.; Woodland, J.; Beveridge, T.; Roberts, C. J.; Vere, D. W.; Dixon, A. St. J.; Davies, J.; Owen-Smith, B.



Kids Get Arthritis Too!  


... it. 5 Jul Read More Super JA Mom Today, on Mother’s Day, I am celebrating the women ... The Basics Early Signs Medical Care Daily Life Kids Teens Research & Resources AF Research Welcome Kit Educational ...


Homing chemokines in rheumatoid arthritis.  


In about 20% of patients with rheumatoid arthritis, B and T lymphocytes recruited into the inflamed synovium are organized into complex microstructures, which resemble secondary lymphoid organs. The development of such lymphoid aggregates with germinal centers appears to contribute to the pathogenesis of the disease. Growing evidence indicates that chemokines and their receptors control the recruitment and positioning of leukocytes as well as their organization into node-like lymphoid structures. Here, we comment on recent studies highlighting the importance of chemokines in rheumatoid arthritis, in particular of B-cell-activating chemokine-1 in lymphoid neogenesis in the inflamed synovium. PMID:12106492

Loetscher, Pius; Moser, Bernhard



[Contact radiotherapy of rheumatoid arthritis].  


The authors have devised a method of contact radiotherapy with open radionuclides (198Au) to be used in the treatment of patients suffering from rheumatoid arthritis. Indications for therapy have been defined. In 360 patients suffering from rheumatoid arthritis, radioactive colloid gold was administered to the affected joints. The therapeutic effect was slow in development. The best clinical results were recorded at month 12. Considerable improvement was noticed in 70% of the patients, improvement in 20%, and in 10% of the patients, no therapeutic effect could be recorded. Good effect was ascertained in patients with X-ray Stage I and II disease (70%). PMID:1284418

Tsyb, A F; Drozdovski?, B Ia; Ikonnikov, A I



Leprosy and rheumatoid arthritis: consequence or association?  


Leprosy or Hansen's disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae with a high prevalence in some developing countries however, it is rarely seen in non-endemic regions. Arthritis has been described in all types of Hansen's disease. Chronic arthritis is known to exist even in paucibacillary forms, resolved or treated disease and in patients without reaction, suggesting a perpetuated inflammatory process. In these cases leprosy can mimic some autoimmune diseases such as rheumatoid arthritis. When a patient with a history of leprosy presents with a symmetric, distal, polyarthritis the diagnosis may not be linear. Possibly it is a rheumatoid-like leprous arthritis with M leprae acting as the trigger element for the chronic process or it is an overlap condition, with a concomitant rheumatoid arthritis? A case report of a patient with a chronic inflammatory arthritis with 10 years of evolution is presented. The differential diagnosis between leprous and rheumatoid arthritis is discussed. PMID:22891014

Henriques, Celia Coelho; Lopéz, Begoña; Mestre, Tiago; Grima, Bruno; Panarra, António; Riso, Nuno



Treatment of arthritis, including rheumatoid arthritis, with radioactive isotopes  

SciTech Connect

A radioactive composition is described for the treatment of arthritis comprising, in combination, a ferric hydroxide or aluminum hydroxide aggregate suspension having a particle size of 3 to 20 microns, wherein a radionuclide is entrapped, the radionuclide being /sup 166/Holmium.

Lieberman, E.; Bordoni, M.E.; Thornton, A.K.



A Multi-Site Study for Detection of the Factor V (Leiden) Mutation from Genomic DNA Using a Homogeneous Invader Microtiter Plate Fluorescence Resonance Energy Transfer (FRET) Assay  

PubMed Central

The goal of this multicenter study was to evaluate the second-generation Invader technology for detecting the factor V (Leiden) mutation directly from genomic DNA of different sample types. Invader assay results were compared with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) or allele-specific PCR (AS-PCR) analysis. The Invader assay is a PCR-independent methodology that uses a microtiter plate format. In the assay, a specific upstream Invader oligonucleotide and a downstream probe hybridize in tandem to a complementary DNA template and form a partially overlapping structure. The Cleavase VIII enzyme recognizes and cuts this structure to release the 5? flap of the probe. This flap then serves as an Invader oligonucleotide to direct cleavage of a fluorescence resonance energy transfer (FRET) probe in a second invasive cleavage reaction. Cleavage of this FRET probe results in the generation of a fluorescent signal. The results of the Invader assay were 99.5% concordant with the PCR-based methods. Of the 372 samples tested once, only two gave discordant results (one from operator error and one from unknown causes), but were concordant on retesting. These results indicate that a simple microtiter plate-based Invader assay can reliably genotype clinical patient samples for the factor V (Leiden) point mutation directly from genomic DNA without prior target amplification.

Ledford, Marlies; Friedman, Kenneth D.; Hessner, Martin J.; Moehlenkamp, Cynthia; Williams, Thomas M.; Larson, Richard S.



Allele-specific genotype detection of factor V Leiden mutation from polymerase chain reaction amplicons based on label-free electrochemical genosensor.  


An electrochemical genosensor for the genotype detection of allele-specific factor V Leiden mutation from PCR amplicons using the intrinsic guanine signal is described. The biosensor relies on the immobilization of the 21-mer inosine-substituted oligonucleotide capture probes related to the wild-type or mutant-type amplicons, and these probes are hybridized with their complementary DNA sequences at a carbon paste electrode (CPE). The extent of hybridization between the probe and target sequences was determined by using the oxidation signal of guanine in connection with differential pulse voltammetry (DPV). The guanine signal was monitored as a result of the specific hybridization between the probe and amplicon at the CPE surface. No label-binding step was necessary, and the appearance of the guanine signal shortened the assay time and simplified the detection of the factor V Leiden mutation from polymerase chain reaction (PCR)-amplified amplicons. The discrimination between the homozygous and heterozygous mutations was also established by comparing the peak currents of the guanine signals. Numerous factors affecting the hybridization and nonspecific binding events were optimized to detect down to 51.14 fmol/mL target DNA. With the help of the appearance of the guanine signal, the yes/no system is established for the electrochemical detection of allele-specific mutation on factor V for the first time. Features of this protocol are discussed and optimized. PMID:12498186

Ozkan, Dilsat; Erdem, Arzum; Kara, Pinar; Kerman, Kagan; Meric, Burcu; Hassmann, Jörg; Ozsoz, Mehmet



Juvenile idiopathic arthritis in the new world of biologics.  


Juvenile idiopathic arthritis results in significant pain and disability in both children and adults. Advances in treatment resulting in improved long-term outcomes have occurred; however, an emphasis on early and aggressive diagnosis and management hopes to improve outcomes further. Juvenile idiopathic arthritis remains a clinical diagnosis of exclusion, but further research may delineate biological markers associated with the disease and its subtypes. Therapy for patients includes intra-articular steroid injections, disease modifying agents such as methotrexate and biological agents. Biological agents have provided exciting new therapeutic options in the last decade; however, long-term side effects of modulating the immune system are not yet fully understood. Systemic steroids may also be required but their long-term use is avoided. Uveitis needs to be screened for in all of those with the diagnosis. Multidisciplinary team care is required in managing these young people. PMID:23647810

Ostring, Genevieve Tyra; Singh-Grewal, Davinder



Follistatin-Like Protein 1 Promotes Arthritis by Up-Regulating IFN-?1  

PubMed Central

Follistatin-like protein-1 (FSTL-1) is a poorly characterized protein that is up-regulated in the early stage of collagen-induced arthritis and that exacerbates arthritis when delivered by gene transfer. The current study was designed to determine the mechanism by which FSTL-1 promotes arthritis. FSTL-1 was injected into mouse paws, resulting in severe paw swelling associated with up-regulation of IFN-? transcript and the IFN-?-induced chemokine, CXCL10. Mice depleted of T cells were protected. A central role for IFN-? was confirmed by the finding that mice deficient in IFN-? failed to exhibit paw swelling in response to injection of FSTL-1. Furthermore, IFN-? secretion from mouse spleen cells exposed to a weak TCR signal was increased 5-fold in the presence of FSTL-1. FSTL-1 could be induced by innate immune signals, including TLR4 agonists and the arthritogenic cytokine, IL-1?, via an NF?B pathway. Finally, FSTL-1 was found to be overexpressed in human arthritis and its neutralization inhibited murine collagen-induced arthritis and suppressed IFN-? and CXCL10 production in arthritic joints. These findings demonstrate that FSTL-1 plays a critical role in arthritis by enhancing IFN-? signaling pathways and suggest a mechanism by which FSTL-1 bridges innate and adaptive immune responses.

Clutter, Suzanne D.; Wilson, David C.; Marinov, Anthony D.; Hirsch, Raphael



Treatment recommendations for psoriatic arthritis  

PubMed Central

Objective: To develop comprehensive recommendations for the treatment of the various clinical manifestations of psoriatic arthritis (PsA) based on evidence obtained from a systematic review of the literature and from consensus opinion. Methods: Formal literature reviews of treatment for the most significant discrete clinical manifestations of PsA (skin and nails, peripheral arthritis, axial disease, dactylitis and enthesitis) were performed and published by members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations were drafted for each of the clinical manifestations by rheumatologists, dermatologists and PsA patients based on the literature reviews and consensus opinion. The level of agreement for the individual treatment recommendations among GRAPPA members was assessed with an online questionnaire. Results: Treatment recommendations were developed for peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis and enthesitis in the setting of PsA. In rotal, 19 recommendations were drafted, and over 80% agreement was obtained on 16 of them. In addition, a grid that factors disease severity into each of the different disease manifestations was developed to help the clinician with treatment decisions for the individual patient from an evidenced-based perspective. Conclusions: Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists and dermatologists. In addition, a grid was established to assist in therapeutic reasoning and decision making for individual patients. It is anticipated that periodic updates will take place using this framework as new data become available.

Ritchlin, C T; Kavanaugh, A; Gladman, D D; Mease, P J; Helliwell, P; Boehncke, W-H; de Vlam, K; Fiorentino, D; FitzGerald, O; Gottlieb, A B; McHugh, N J; Nash, P; Qureshi, A A; Soriano, E R; Taylor, W J



T cells in rheumatoid arthritis  

Microsoft Academic Search

Over the past decade and a half, advances in our understanding of the pathogenesis of immune-mediated diseases such as rheumatoid arthritis (RA) have translated directly into benefit for patients. Much of this benefit has arisen through the introduction of targeted biological therapies. At the same time, technological advances have made it possible to define, at the cellular and molecular levels,

Andrew P Cope



Diagnostic criteria in rheumatoid arthritis.  


For rheumatoid arthritis (RA), criteria have been developed for classification of groups of patients in population surveys, selection for therapeutic trials, inter-institutional comparison of patients, evaluation of diagnostic trials, diagnosis of RA in individual patients, estimation of disease frequency, and assistance in determining prognosis. The American Rheumatism Association (ARA) "Criteria for the Classification of Rheumatoid Arthritis-Diagnostic Criteria for Rheumatoid Arthritis" were published in 1958 and have become a standard. These criteria are empiric and attempt to incorporate reasonable combinations of sensitivity and specificity. Despite the recognition that these criteria should be expected to change with improved knowledge, no further modification has been published. Other criteria such as the ARA "Proposed Criteria for Rheumatoid Arthritis" represent an important effort to encourage uniformity in definitions and use of the term remission. Yet it is well to remember that they have never been tested in prospective studies and are considered preliminary. The Co-operative Systematic Studies in Rheumatic Diseases, when studying slow-acting anti-rheumatic drugs, have chosen to use clinical endpoints such as 50% improvement in joint tenderness and swelling counts (or scores) rather than combined variables which include morning stiffness and changes in laboratory variables. This approach permits the true assessment of drug effects. In summary, current criteria have served us well. Nonetheless, we should not become complacent and should always question their sensitivity, specificity and application. PMID:3317806

Clegg, D O; Ward, J R



Outcome assessments in rheumatoid arthritis.  


Increasing evidence suggests low disease activity or remission is achievable in rheumatoid arthritis (RA). Using a treat to target strategy (T2T) has been shown to achieve these targets of remission or low disease activity in RA. In order to successfully treat to target, rheumatologists need reliable measures of disease activity to switch and/or escalate therapy to achieve or maintain therapeutic targets. Multiple disease-activity measures have been developed for both research and clinical practice. For clinical practice, the American College of Rheumatology (ACR) has recommended the PAS, PAS II, RAPID 3, CDAI, DAS 28, and SDAI for measuring disease activity in rheumatoid arthritis. Each of these measures has strengths and limitations, but they all accurately reflect disease activity, discriminate well between disease states, and are feasible to perform in the clinical setting. Implementation in the clinical setting can be optimized through leveraging technology and systems redesign. Tools such as web-based and smartphone applications have been developed to increase the ease with which these measures can be deployed. Disease-activity measurement in rheumatoid arthritis is included in the rheumatoid arthritis quality measures group in the Centers for Medicare and Medicaid Services' incentive-based Physician Quality Reporting System. PMID:24072601

Gilek-Seibert, Katarzyna; Prescott, Kara; Kazi, Salahuddin



AntiArthritis Therapies 2005.  


This meeting, hosted by Visiongain and B2B conferences, comprised approximately 35 delegates, predominantly from the pharmaceutical industry, and promoted interactive discussion. It covered a broad range of drug discovery and development activities, ranging from preclinical studies with compounds requiring further optimisation, through to launched drugs used in the treatment of arthritis today. PMID:15882127

Braddock, Martin



Alabama Arthritis Control Plan, 2006.  

National Technical Information Service (NTIS)

The data summarized in this report indicate that arthritis affects more than a million people in the state of Alabama.1 The disease is more common in the elderly but it also disproportionately affects women and persons with lower education levels, even af...



Cardiovascular risk in rheumatoid arthritis  

Microsoft Academic Search

The increased mortality in rheumatoid arthritis (RA) is mainly due to (atherosclerotic) cardiovascular disease. The cardiovascular morbidity is also increased in comparison with the general population. This increased cardiovascular burden could be caused by 1) an enhanced prevalence of cardiovascular risk factors 2) under treatment of cardiovascular risk factors or 3) RA itself, particularly due to its chronic inflammatory component.

Michael T. Nurmohamed



The etiology of rheumatoid arthritis  

Microsoft Academic Search

The etiology of rheumatiod arthritis has been elusive, but it finally seems to be explained by a combination of three factors: (i) a relatively mild deficiency of cortisol, the normal adrenocortical hormone that is essential for normal immunity but which has achieved a bad reputation because of the use of excessive dosages of it or its stronger derivatives, (ii) a

W. Mc K. Jefferies



Contrasting diagnosis performance of forced oscillation and spirometry in patients with rheumatoid arthritis and respiratory symptoms  

PubMed Central

OBJECTIVES: Pulmonary involvement in rheumatoid arthritis is directly responsible for 10% to 20% of all mortality. The best way to improve the prognosis is early detection and treatment. The forced oscillation technique is easy to perform and offers a detailed exam, which may be helpful in the early detection of respiratory changes. This study was undertaken to (1) evaluate the clinical potential of the forced oscillation technique in the detection of early respiratory alterations in rheumatoid arthritis patients with respiratory complaints and (2) to compare the sensitivity of forced oscillation technique and spirometric parameters. METHODS: A total of 40 individuals were analyzed: 20 healthy and 20 with rheumatoid arthritis (90% with respiratory complaints). The clinical usefulness of the parameters was evaluated by investigating the sensibility, the specificity and the area under the receiver operating characteristic curve. NCT01641705. RESULTS: The early adverse respiratory effects of rheumatoid arthritis were adequately detected by the forced oscillation technique parameters, and a high accuracy for clinical use was obtained (AUC>0.9, Se?=?80%, Sp?=?95%). The use of spirometric parameters did not obtain an appropriate accuracy for clinical use. The diagnostic performance of the forced oscillation technique parameters was significantly higher than that of spirometry. CONCLUSIONS: The results of the present study provide substantial evidence that the forced oscillation technique can contribute to the easy identification of initial respiratory abnormalities in rheumatoid arthritis patients that are not detectable by spirometric exams. Therefore, we believe that the forced oscillation technique can be used as a complementary exam that may help to improve the treatment of breathing disorders in rheumatoid arthritis patients.

Faria, Alvaro Camilo Dias; Barbosa, Wellington Ribeiro; Lopes, Agnaldo Jose; da Rocha Castelar Pinheiro, Geraldo; de Melo, Pedro Lopes



Effective treatment of rat adjuvant-induced arthritis by celastrol  

PubMed Central

We have previously reported an increase in interleukin (IL)-1? and IL-17 levels, and a continuous activation of caspase-1 in early rheumatoid arthritis (RA) patients. These results suggest that drugs targeting IL-1? regulatory pathways, in addition to tumor necrosis factor (TNF), may constitute promising therapeutic agents in early RA. We have recently used a THP-1 macrophage-like cell line to screen 2320 compounds for those that down-regulate both IL-1? and TNF secretion. Celastrol was one of the most promising therapeutic candidates identified in that study. Our main goal in the present work was to investigate whether administration of celastrol is able to attenuate inflammation in a rat model of adjuvant-induced arthritis (AIA). Moreover, since IL-1? is known to play a role in the polarization of Th17 cells, we also investigate whether administration of digoxin, a specific inhibitor of Th17 cells polarization, is able to attenuate inflammation in the same rat model. We found that celastrol administration significantly suppressed joint inflammation. The histological and immunohistochemical evaluation revealed that celastrol-treated rats had a normal joint structure with complete abrogation of the inflammatory infiltrate and cellular proliferation. In contrast, we observed that digoxin administration significantly ameliorated inflammation but only if administrated in the early phase of disease course (after 4 days of disease induction), and it was not efficient at inhibiting the infiltration of immune cells within the joint and in preventing damage. Thus, our results suggest that celastrol has significant anti-inflammatory and anti-proliferative properties and can constitute a potential anti-inflammatory drug with therapeutic efficacy in the treatment of immune-mediated inflammatory diseases such as RA. Furthermore, we find that early inhibition of Th17 cells polarization ameliorates arthritis but it is not as effective as celastrol.

Cascao, R.; Vidal, B.; Raquel, H.; Neves-Costa, A.; Figueiredo, N.; Gupta, V.; Fonseca, J.E.; Moita, L.F.



Arthritis Services Network: A Partnership in Health Promotion for Older Americans with Arthritis.  

National Technical Information Service (NTIS)

The report discusses the Arthritis Services Network Project, which provided needed services to hundreds of older Americans suffering from arthritis. Four service programs, including a series of self-help education classes, an aquatic and land exercise pro...

F. C. Pennington M. L. Boutaugh



76 FR 29767 - Arthritis Advisory Committee; Notice of Meeting  

Federal Register 2010, 2011, 2012, 2013

...Docket No. FDA-2011-N-0002] Arthritis Advisory Committee; Notice of to the public. Name of Committee: Arthritis Advisory Committee. General Function...indicated for the treatment of gouty arthritis attacks. ILARIS has also been...



Molecular analysis of factor V Leiden, factor V Hong Kong, factor II G20210A, methylenetetrahydrofolate reductase C677T, and A1298C mutations related to Turkish thrombosis patients.  


Inherited gene disorders related to the hemostatic system have been documented as risk factors for thrombosis. The roles of factor V Hong Kong (FV Hong Kong), factor V Leiden (FV Leiden), factor II G20210A (FII G20210A), methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations in Turkish patients with thrombosis (270 patients) compared with healthy controls (114 subjects) were evaluated. Polymerase chain reaction-based restriction enzyme analysis was carried out to screen these mutations, and single-strand conformation analysis was established to identify variations using the primers selected for restriction enzyme analysis studies. As a result, a significant relationship was determined among FV Leiden, FII G20210A, and thrombosis. The FV Hong Kong mutation was observed in only 2 patients with pulmonary vein thrombosis who are FV Leiden/FV Hong Kong compound heterozygous for FV gene. MTHFR C677T and A1298C were equally distributed in the patient group compared with the control group. All named mutations were also identified with single-strand conformation analysis, but a new variant/polymorphism during studies was not found. Because some inherited abnormalities are associated with thromboembolic disorders, determining the mutations and gene-to-gene interactions in patients with thrombosis history has a great impact on diagnosis and treatment of these diseases. PMID:17911197

Dölek, Bilgen; Eraslan, Serpil; Ero?lu, Sevim; Kesim, Belgin Eroglu; Ulutin, Turgut; Yalçiner, Altan; Laleli, Yahya R; Gözükirmizi, Nermin



Attualità e prospettive nella strategia terapeutica dell'artrite reumatoide Reconstructing the pyramid as a therapeutic approach to rheumatoid arthritis  

Microsoft Academic Search

SUMMARY Several recent clinical studies have clearly established that rheumatoid arthritis (RA) is a disease identifiable since its early phases, a disease that can be adequately and efficaciously treated provided the therapeutic program can be started early on. To reach the aim of controlling effectively the disease and of leading the patients to live a normal life, several points must

G. Ferraccioli


Type II collagen-induced arthritis in rats. Passive transfer with serum and evidence that IgG anticollagen antibodies can cause arthritis  

PubMed Central

We have found that serum from rats with type II collagen-induced arthritis, when fractionated with 50% ammonium sulfate and concentrated, would transfer arthritis to nonimmunized recipients. The arthritis in recipients developed within 18-72 h and displayed all of the major histopathologic characteristics of the early lesion in immunized animals but was transient and less severe. Although consideration was given to the possibility that a circulating immune complex was involved, no evidence of such a complex was detected. Further fractionation of the serum yielded an IgG anticollagen antibody that was fully active in transferring disease. The antibody's reaction was inhibited by the native bovine type II collagen used for immunization of donors and the antibody strongly cross-reacted with homologous type II collage but not with denatured collagen. These studies demonstrate that arthritis in rats can be induced with anti- type II collagen antibodies and suggest that an autoimmune process is involved. Because antibodies to collagen have also been detected in human rheumatic diseases, further investigation of the characteristics of collagen antibodies capable of inducing arthritis seems warranted.



Exposure to animals and risk of oligoarticular juvenile idiopathic arthritis: a multicenter case-control study  

Microsoft Academic Search

BACKGROUND: An inverse association between early contact with microbial compounds and respiratory allergies is well established. The protective effect of infant contact with animals was also shown for inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE). We aimed to test the association between animal contact in infancy and oligoarticular juvenile idiopathic arthritis (OA JIA). METHODS: Parents of children with

Katja Radon; Doris Windstetter; David Poluda; Renate Häfner; Silke Thomas; Hartmut Michels; Erika von Mutius



Predominant cervical involvement in patients with psoriatic arthritis: report of two cases  

Microsoft Academic Search

Cervical spine involvement is common but usually delayed in patients with psoriatic arthritis. We report two cases with early and predominant involvement of the upper cervical spine. Synovitis of the atlanto-odontoid joint and fusion of multiple facet joints were noted in one patient. In the other patient, the main finding was atlanto-axial subluxation with erosions of the odontoid process and

Dieu-Donné Ouédraogo; Elisabeth Palazzo; Mireille Nlomé-Nzé; Nathalie Somogyi; Magali Ballard; Gilles Hayem; Olivier Meyer



Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation  

Microsoft Academic Search

Rheumatoid arthritis (RA) patients have increased mortality and morbidity as a result of cardiovascular and cerebrovascular disease. What is not clear, however, is either how early accelerated atherosclerosis begins in RA or how soon risk factors must be rigorously controlled. Furthermore, given the strong relationship of vascular disease to RA mortality and of inflammation to the accelerated atherosclerosis associated with

Suad Hannawi; Brian Haluska; Thomas H Marwick; Ranjeny Thomas



Salmonella Septic Arthritis Complicating Rheumatoid Arthritis in a Patient with Total Knee Replacement  

Microsoft Academic Search

Objective and Importance: Salmonella septic arthritis (SSA) in any age group is a relatively rare disease. The prime objective of this communication is to report a relatively uncommon presentation of SSA in a prosthetic knee joint of a patient with rheumatoid arthritis. Clinical Presentation: We report a 51-year-old lady with rheumatoid arthritis and total knee replacement who, while on methotrexate

Fareeda Boland; Prashant Kaushik; Edet E. Udo; Vincent O. Rotimi; Anand N. Malaviya



Coordinated individual education with an arthritis passport for patients with rheumatoid arthritis  

Microsoft Academic Search

Objective: To evaluate the effects of a program for individual education in combination with the use of an arthritis passport. - \\u000aMethods: We studied 3 groups of patients with rheumatoid arthritis. The first experimental group received educational materials and followed the program under the guidance of their regular providers of health care whose activities were coordinated through arthritis passports. The

Robert P. Riemsma; Erik Taal; Herman L. M. Brus; Johannes J. Rasker; Oene Wiegman



Heat shock proteins and reactive arthritis  

Microsoft Academic Search

\\u000a Reactive arthritis (ReA) is unusual amongst inflammatory joint diseases because the cause of arthritis has been identified,\\u000a namely preceding infection with certain bacteria, whereas the aetiology of rheumatoid arthritis or ankylosing spondylitis,\\u000a or at least the triggering event, remains unknown. Most subjects infected by Chlamydia,Salmonella, Campylobacter,Yersinia or Shigella develop symptoms due to the effects of the infection in the genito-urinary

J. S. Hill Gaston; Richard C. Duggleby; Jane C. Goodall; Roberto Raggiaschi; Mark S. Lillicrap


Can magnetic resonance imaging differentiate undifferentiated arthritis?  

PubMed Central

A high sensitivity for the detection of inflammatory and destructive changes in inflammatory joint diseases makes magnetic resonance imaging potentially useful for assigning specific diagnoses, such as rheumatoid arthritis and psoriatic arthritis in arthritides, that remain undifferentiated after conventional clinical, biochemical and radiographic examinations. With recent data as the starting point, the present paper describes the current knowledge on magnetic resonance imaging in the differential diagnosis of undifferentiated arthritis.

?stergaard, Mikkel; Duer, Anne; H?rslev-Petersen, Kim