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1

[Early recognition of rheumatoid arthritis].  

PubMed

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

2011-01-01

2

Radiographic changes in early rheumatoid disease  

Microsoft Academic Search

We have studied the radiological features in 94 patients with early rheumatoid disease followed prospectively for 5 years. The changes appeared very early and occurred in up to 71-3% of patients. Erosive changes occurred in the feet much more commonly than in the hands and considerably earlier. Erosive changes were present before there was joint-space loss. Frequent x-ray examination of

A Brook; M Corbett

1977-01-01

3

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

PubMed

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

2007-02-28

4

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

1992-01-01

5

Treating Rheumatoid Arthritis Early May Cut Damaging Effects  

MedlinePLUS

... 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 ...

6

Extra-articular features in early rheumatoid disease  

Microsoft Academic Search

One hundred and two patients who presented with rheumatoid disease within the first year of onset were studied prospectively every four months for a mean 4.5 years to assess the incidence of extra-articular features. The features that seemed to be common in the early stages included hand-muscle wasting, carpal tunnel syndrome, lymphadenopathy, non-specific ankle swelling, and rheumatoid nodules, and to

A Fleming; S Dodman; J M Crown; M Corbett

1976-01-01

7

Role of ultrasound in assessment of early rheumatoid arthritis.  

PubMed

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

2007-04-01

8

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

9

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

1994-01-01

10

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

2001-01-01

11

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

2008-01-01

12

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

2007-01-01

13

Diagnosis and treatment of early active rheumatoid arthritis.  

PubMed

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

2008-12-01

14

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.

2009-01-01

15

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

2004-01-01

16

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

1997-01-01

17

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

2007-01-01

18

How accurately does a simulation glove reflect function compared to rheumatoid arthritis sufferers?  

PubMed Central

INTRODUCTION This study assessed the ability of gloves to simulate rheumatoid arthritis of the hand. SUBJECTS AND METHODS Assessments were made in the dominant hand of 24 healthy volunteers with no glove, glove A (simulating stiffness only) and glove B (simulating stiffness and pain). Results were compared to data held on 23 rheumatoid arthritis patients. Sollerman score was used as a standardised measure of hand function and time taken to complete testing was recorded. Grip strength was also measured in volunteers. RESULTS Both gloves simulate a reduction in power and prolong time taken to complete Sollerman hand-function testing. The gloves are less able to simulate a matched reduction in function when compared to rheumatoid arthritis sufferers. Sollerman score is 9.7% less in rheumatoid arthritis hands than a healthy volunteer using the glove. CONCLUSIONS The glove could, therefore, be used to guide future design of tools and aides that accommodate for hand disorders. More work on the usefulness of such disease simulation in the design of tools for such patients is needed.

Hall, TC; Nixon, MF; Dias, JJ; Graham, T; Cook, S

2010-01-01

19

Clinical, laboratory and radiographic features in early rheumatoid arthritis.  

PubMed

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

1990-10-01

20

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

2004-01-01

21

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.

2010-01-01

22

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

1999-01-01

23

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

2005-01-01

24

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

2005-01-01

25

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

2011-01-01

26

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

2003-07-01

27

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

2013-01-01

28

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

PubMed

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

2013-02-09

29

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

2003-01-01

30

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.

2011-01-01

31

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.

2012-01-01

32

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

PubMed

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

2010-04-01

33

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

2001-01-01

34

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

2010-01-01

35

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

2003-01-01

36

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

2013-01-01

37

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

2011-01-01

38

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

1999-01-01

39

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

2001-01-01

40

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

2007-01-01

41

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

2008-01-01

42

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

2009-01-01

43

Lytic lesions of the femoral neck in rheumatoid arthritis simulating pigmented villonodular synovitis or malignancy  

Microsoft Academic Search

Summary  Large lytic lesions, relatively asymptomatic, involving the femoral neck and the base of the head are described in two patients suffering from a classical seropositive rheumatoid arthritis. Histological examination failed to reveal signs of malignancy, infection or pigmented villonodular synovitis. There were no rheumatoid nodules but a chronic hypertrophic villous synovitis was found. Rheumatoid synovium may invade the superior extremity

J. C. Gerster; P. Anani; P. de Goumoens; M. Pellation

1982-01-01

44

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

2004-01-01

45

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

2011-01-01

46

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

2001-01-01

47

Early use of simulation in medical education.  

PubMed

An oft-cited belief that, until recently, simulators used in education of health care professionals were simple models is wrong. Hundreds of years ago and, in one instance, thousands of years ago, intricate models were used to help teach anatomy and physiology and in training in obstetrics and many surgical disciplines. Simulators were used to learn skills before performing them on patients and in high-stakes assessment.The newest technologies were often used in simulators to improve fidelity. In the 18th century, obstetric simulators could leak amniotic fluid, and blood were used to train midwives and obstetricians to recognize and manage complications of childbirth. Italy was the major source of simulators early in the 18th century, but in the 19th century, dominance in clinical simulation moved to France, Britain, and then Germany. In comparison, much of the 20th century was a "dark age" for simulation. PMID:22374231

Owen, Harry

2012-04-01

48

Rheumatoid arthritis.  

PubMed

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

2013-03-13

49

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.

2012-01-01

50

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.

2009-01-01

51

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.

2011-01-01

52

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.

1996-01-01

53

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

2009-01-01

54

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

2000-01-01

55

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

1994-01-01

56

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

2006-01-01

57

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

2012-01-01

58

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

PubMed

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

59

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

PubMed

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

2012-08-20

60

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

2003-01-01

61

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

PubMed

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

2011-05-24

62

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

PubMed

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

2013-05-01

63

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

2007-01-01

64

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

2012-01-01

65

Causal Modeling Using Network Ensemble Simulations of Genetic and Gene Expression Data Predicts Genes Involved in Rheumatoid Arthritis  

PubMed Central

Tumor necrosis factor ? (TNF-?) is a key regulator of inflammation and rheumatoid arthritis (RA). TNF-? blocker therapies can be very effective for a substantial number of patients, but fail to work in one third of patients who show no or minimal response. It is therefore necessary to discover new molecular intervention points involved in TNF-? blocker treatment of rheumatoid arthritis patients. We describe a data analysis strategy for predicting gene expression measures that are critical for rheumatoid arthritis using a combination of comprehensive genotyping, whole blood gene expression profiles and the component clinical measures of the arthritis Disease Activity Score 28 (DAS28) score. Two separate network ensembles, each comprised of 1024 networks, were built from molecular measures from subjects before and 14 weeks after treatment with TNF-? blocker. The network ensemble built from pre-treated data captures TNF-? dependent mechanistic information, while the ensemble built from data collected under TNF-? blocker treatment captures TNF-? independent mechanisms. In silico simulations of targeted, personalized perturbations of gene expression measures from both network ensembles identify transcripts in three broad categories. Firstly, 22 transcripts are identified to have new roles in modulating the DAS28 score; secondly, there are 6 transcripts that could be alternative targets to TNF-? blocker therapies, including CD86 - a component of the signaling axis targeted by Abatacept (CTLA4-Ig), and finally, 59 transcripts that are predicted to modulate the count of tender or swollen joints but not sufficiently enough to have a significant impact on DAS28.

Xing, Heming; McDonagh, Paul D.; Bienkowska, Jadwiga; Cashorali, Tanya; Runge, Karl; Miller, Robert E.; DeCaprio, Dave; Church, Bruce; Roubenoff, Ronenn; Khalil, Iya G.; Carulli, John

2011-01-01

66

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

2009-01-01

67

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

2001-01-01

68

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

2008-01-01

69

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

1988-01-01

70

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

PubMed

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

1999-09-01

71

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.

2012-01-01

72

Rheumatoid nodules without rheumatoid arthritis  

Microsoft Academic Search

Four female patients with rheumatoid nodules are described who had no other clinical manifestations of rheumatoid disease. Only one of the patients was seropositive for the rheumatoid factor and HLA-DR4. Nosologic aspects of such isolated rheumatoid nodules are discussed.

P. Herzer; S. Scholz; H. S. Füeßl; M. Schattenkirchner

1982-01-01

73

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

2011-01-01

74

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

2007-01-01

75

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

2001-01-01

76

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,

LESLIE J. CROFFORD; KONSTANTINE T. KALOGERAS; GEORGE MASTORAKOS; MARIA-ALEXANDRA MAGIAKOU; JANA WELLS; KEITH S. KANIK; PHILIP W. GOLD; GEORGE P. CHROUSOS; RONALD L. WILDER

77

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

2007-01-01

78

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

1995-01-01

79

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

80

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.

2010-01-01

81

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

PubMed

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

2009-12-02

82

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

PubMed

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

2013-02-21

83

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

2009-01-01

84

Rheumatoid arthritis  

MedlinePLUS

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. ...

85

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

PubMed

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

2012-01-12

86

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

PubMed

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

2012-01-01

87

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.

2009-01-01

88

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

2008-01-01

89

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

90

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

PubMed

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

2012-11-23

91

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.

2012-01-01

92

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

PubMed

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

2013-08-08

93

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

2003-01-01

94

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

2006-01-01

95

Quasars, the early universe, and plasma simulations  

SciTech Connect

Quasars are among the most luminous objects in the universe, and the most distant for which we can obtain good spectroscopy. These spectra carry with them information about the formation of the first large structures in the universe and the first generations of star formation in newly born galaxies. The spectrum of a quasar has strong broad emission lines, formed by a non-equilibrium low-density photoionized gas. This spectrum can best be interpreted by reference to large-scale simulations of the full environment. This in turn is strongly coupled to many basic plasma physics questions. Here we discuss the current status of quasar research, numerical plasma simulations, and the atomic database.

Ferland, Gary J.; Verner, Dmitri A. [Physics Department, University of Kentucky, Lexington, Kentucky 40506 (United States)

1998-09-28

96

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

PubMed

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

1992-02-01

97

Imaging of rheumatoid arthritis.  

PubMed

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

2013-08-01

98

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

2005-01-01

99

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

2009-01-01

100

[Early-stage polyarthritis].  

PubMed

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

1993-03-23

101

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

2008-01-01

102

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

2012-01-01

103

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

PubMed

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

104

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

2007-01-01

105

Rheumatoid nodulosis: is it a different subset of rheumatoid arthritis?  

PubMed

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

2003-10-01

106

Rheumatoid Meningitis  

PubMed Central

An 80-year-old woman with rheumatoid arthritis had gait difficulties and frequent falls. MRI of the brain showed an extra-axial enhancing lesion overlying the right frontal–parietal cortex, that progressively extended to the contralateral side. This was accompanied by further decline in her functional status. We discuss the diagnostic and therapeutic approach of a pachy–leptomeningeal process in a rheumatoid patient.

Servioli, Maria J.; Chugh, Chandril; Lee, John M.; Biller, Jose

2011-01-01

107

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

1984-01-01

108

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

PubMed

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

2012-11-19

109

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

110

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.

2013-01-01

111

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

2010-01-01

112

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

2003-01-01

113

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

2007-01-01

114

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

2006-01-01

115

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.  

PubMed

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

2013-05-01

116

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.

2010-01-01

117

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

PubMed

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

2011-09-09

118

Cerebral rheumatoid vasculitis: a case report  

PubMed Central

Introduction Central nervous system involvement in rheumatoid arthritis is infrequent. The most frequent neurological manifestations of rheumatoid arthritis are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae. Cerebral rheumatoid vasculitis is an uncommon and serious complication which can be life-threatening. Case presentation A 52-year-old North African Tunisian Caucasian woman presented with a six-week history of headache. She had suffered seropositive and destructive rheumatoid arthritis for nine years without any extra-articular complications. Magnetic resonance imaging of the brain with the T2 sequence showed high-intensity signal images at the frontal and parietal cortico-subcortical junction suggesting hemispheric vasculitis. Conclusions Cerebral vasculitis is an infrequent complication in rheumatoid arthritis which is associated with high morbidity and in some cases can be life-threatening. Early assessment and a high index of suspicion to recognize such complications are essential in managing these patients.

2012-01-01

119

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

1975-01-01

120

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

2012-01-01

121

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

2010-01-01

122

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

123

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.

2009-01-01

124

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

PubMed

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

2011-09-11

125

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 www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

126

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

2011-01-01

127

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

2010-01-01

128

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

2005-01-01

129

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

2003-01-01

130

Simulation Experiments on Dust Aggregation in the Early Solar Nebula  

NASA Astrophysics Data System (ADS)

The evolution of dust particles in the early solar nebula is most probably determined by aggregation of micron-sized grains. With respect to different scenarios as Brownian motion, differential sedimentation, orbital decay and turbulence, relative velocities between different particles are generated which lead to subsequent collisions, sticking and growth. The aggregates evolve to certain structures which might be characterized by a fractal dimension d, relating the mass m of the clusters to its size s, m ~ s(d) . Computer simulations show that d is supposed to be close to 2. The value of d is important for the timescales of the formation of planetesimals. Parameters for the model calculations, such as sticking probabilities for different velocities and the ability of the particles for sliding and rolling on the surfaces during impacts are needed. We carried out collision experiments with aggregates consisting of up to a few hundred single micron-sized amorphous SiO_2 particles. The device generating these aggregates, an aggregation experiment of its own, produces clusters of the fractal dimension 1.9. In 'levitation tube' experiments, we observed collisions between single clusters due to differential sedimentation. The collision velocities ranged from 1 mm/s to 1 cm/s. All collisions resulted in sticking as predicted by theory. We found no significant restructuring within the limits of our optical system, a long distance microscope and flash lamp illumination. Images were taken by a digital CCD camera (256 * 256 pixels) with 150 frames per second. In another series of experiments under the microgravity conditions of the drop tower in Bremen as well as in the laboratory, we directed a beam of the above-mentioned clusters to a thin target and observed sticking and restructuring due to the impact and gravitational torques. We will present new results of these investigations.

Wurm, G.; Blum, J.

1996-09-01

131

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

2006-01-01

132

The Effects of Infant Simulators on Early Adolescents.  

ERIC Educational Resources Information Center

Examined the effects of infant simulators (computerized dolls designed to simulate normal infants) on 236 8th-grade students. Findings indicated that the doll experience had a significant impact on the students, especially females. It helped them to learn about the challenges of infant care, and to think of the implications before engaging in…

Divine, James H.; Cobbs, Gene

2001-01-01

133

From early virtual garment simulation to interactive fashion design  

Microsoft Academic Search

Virtual garment design and simulation involves a combination of a large range of techniques, involving mechanical simulation, collision detection, and user interface techniques for creating garments. Here, we perform an extensive review of the evolution of these techniques made in the last decade to bring virtual garments to the reach of computer applications not only aimed at graphics, but also

Pascal Volino; Frederic Cordier; Nadia Magnenat-thalmann

2005-01-01

134

Current immunotherapy in rheumatoid arthritis.  

PubMed

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

2013-09-01

135

Genetics Home Reference: Rheumatoid arthritis  

MedlinePLUS

... 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 ...

136

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

PubMed

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

1994-06-01

137

Computational Simulations of the Early Steps of Protein Aggregation  

Microsoft Academic Search

There is strong evidence that the oligomers of key proteins, formed during the early steps of aggregation, could be the primary toxic species associated with human neuro- degenerative diseases, such as Alzheimer's and prion diseases. Here, we review recent progress in the development of computational approaches in order to understand the structures, dynamics and free energy surfaces of oligomers. We

Guanghong Wei; Normand Mousseau; Philippe Derreumaux

2007-01-01

138

Corticosteroids in rheumatoid arthritis.  

PubMed

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

1989-08-01

139

Just Running Around: Some Reminiscences of Early Simulation/Gaming in the United Kingdom  

ERIC Educational Resources Information Center

|The article begins with an abbreviated CV of the author and then recounts the formation of Society for the Advancement of Games and Simulation in Education and Training (SAGSET) and the early days of simulation and gaming in the United Kingdom. Four strands of elements of development are described together with the key events of the 1970s and…

van Ments, Morry

2011-01-01

140

The effects of infant simulators on early adolescents.  

PubMed

The researchers examined the effects of infant simulators (computerized dolls designed to simulate normal infants) on 236 eighth-grade students. As part of their health and sex education curriculum, students had to provide care--24 hours a day, over several days--to dolls that cried when they "were hungry," "needed a diaper change," or "needed attention." The dolls enabled teachers to evaluate the care given by students. Students kept daily charts and journals, and wrote essays about their experiences. One to two years later, the students were surveyed, along with 461 comparison students who did not have the infant simulator experience. The findings indicated that the doll experience had a significant impact on the students, especially the females. It helped them to learn about the challenges of infant care, and to think of the implications before engaging in sexual intercourse. The comparison group felt less knowledgeable about what it takes to care for an infant, and judged infant care as less time consuming, difficult, and expensive than did those who had the infant simulator experience. PMID:11817639

Divine, J H; Cobbs, G

2001-01-01

141

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.

1994-10-01

142

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.

1995-03-01

143

Computational Simulations of the Early Steps of Protein Aggregation  

PubMed Central

There is strong evidence that the oligomers of key proteins, formed during the early steps of aggregation, could be the primary toxic species associated with human neurodegenerative diseases, such as Alzheimer's and prion diseases. Here, we review recent progress in the development of computational approaches in order to understand the structures, dynamics and free energy surfaces of oligomers. We also discuss possible research directions for the coming years.

Wei, Guanghong; Mousseau, Normand

2007-01-01

144

[Sulfasalazine in rheumatoid arthritis].  

PubMed

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

1991-05-15

145

Early genetic responses in rat vascular tissue after simulated diving.  

PubMed

Diving causes a transient reduction of vascular function, but the mechanisms behind this are largely unknown. The aim of this study was therefore to analyze genetic reactions that may be involved in acute changes of vascular function in divers. Rats were exposed to 709 kPa of hyperbaric air (149 kPa Po(2)) for 50 min followed by postdive monitoring of vascular bubble formation and full genome microarray analysis of the aorta from diving rats (n = 8) and unexposed controls (n = 9). Upregulation of 23 genes was observed 1 h after simulated diving. The differential gene expression was characteristic of cellular responses to oxidative stress, with functions of upregulated genes including activation and fine-tuning of stress-responsive transcription, cytokine/cytokine receptor signaling, molecular chaperoning, and coagulation. By qRT-PCR, we verified increased transcription of neuron-derived orphan receptor-1 (Nr4a3), plasminogen activator inhibitor 1 (Serpine1), cytokine TWEAK receptor FN14 (Tnfrsf12a), transcription factor class E basic helix-loop-helix protein 40 (Bhlhe40), and adrenomedullin (Adm). Hypoxia-inducible transcription factor HIF1 subunit HIF1-? was stabilized in the aorta 1 h after diving, and after 4 h there was a fivefold increase in total protein levels of the procoagulant plasminogen activator inhibitor 1 (PAI1) in blood plasma from diving rats. The study did not have sufficient power for individual assessment of effects of hyperoxia and decompression-induced bubbles on postdive gene expression. However, differential gene expression in rats without venous bubbles was similar to that of all the diving rats, indicating that elevated Po(2) instigated the observed genetic reactions. PMID:23132759

Eftedal, Ingrid; Jørgensen, Arve; Røsbjørgen, Ragnhild; Flatberg, Arnar; Brubakk, Alf O

2012-11-06

146

Surgery of the rheumatoid elbow.  

PubMed Central

I suggest that for too long the problem of the rheumatoid elbow, particularly the need for surgical intervention, has been underestimated. Where the latter has been advocated the philosophy has been adopted that synovectomy and debridement with excision of the head of the radius is probably all that is required, or that in the late case excision arthroplasty may yield an adequate result. I suggest that these approaches are no longer tenable. Synovectomy and debridement with or without excision of the head of the radius does indeed retain an extremely valuable place in the management of stage 1, 2, and early stage 3 disease. In the later stages of the disease, however, serious consideration must now be given to total joint replacement, the results of which can be remarkably successful and durable, and the complications from which can now be contained within acceptable limits provided that the operating team is fully experienced. It must also be stressed how necessary it is in the medical or combined clinic to pursue careful clinical and radiological monitoring of the rheumatoid elbow so that signs of dangerous deterioration can be recognised early, and surgery applied at a time when optimal conditions for the particular surgical weapons to be used still exist. Images

Souter, W A

1990-01-01

147

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

2006-01-01

148

Using the hybrid simulation for early user evaluations of pervasive interactions  

Microsoft Academic Search

To reach a good user-friendliness, knowledge about user requirements is crucial in the development process of a product. The sooner the knowledge is achieved via user evaluations, the more money and time can be saved. In this paper we investigate an approach called hybrid simulation for the early stages evaluation of mobile applications where real mobile phones are used as

Karin Leichtenstern; Elisabeth André; Matthias Rehm

2010-01-01

149

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

2001-01-01

150

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

2010-01-01

151

Clinicopathologic Characteristics and Prognosis of Advanced Gastric Cancer Simulating Early Gastric Cancer  

PubMed Central

Background Although the clinicopathologic features and prognosis of Borrmann type advanced gastric cancer has been well characterized, those of advanced gastric cancer simulating early gastric cancer (AGC simulating EGC) still remains unclear. Methods We reviewed 1985 gastric cancer patients who had undergone gastrectomy at our hospital to determine the clinicopathologic characteristics, susceptible sites for lymph node metastasis, and prognosis of AGC simulating EGC in comparison with Borrmann type advanced gastric cancer. Results Among 102 patients with AGC simulating EGC, 100 patients (98%) had tumors with depressed type appearance. The frequencies of serosal invasion, lymph node metastasis, lymphatic vessel invasion, blood vessel invasion, and liver metastasis were significantly lower in AGC simulating EGC than in Borrmann type tumors. The prognosis of AGC simulating EGC was significantly better than that of the Borrmann type tumors. Multivariate analysis indicated that the gross appearance was an independent prognostic factor. In patients with AGC simulating EGC which invaded to the the muscularis propria (MP), most lymph node metastasis was restricted with the perigastric lymph nodes (1st-titer lymph nodes) and lymph node metastasis to 2nd-titer lymph nodes was only observed at station 8a. Conclusion AGC simulating EGC is less advanced in comparison with Borrmann type advanced gastric cancer. Based on the results of susceptible sites for lymph node metastasis in the current study, limited lymph node dissection could be indicated for AGC simulating EGC whose depth of invasion is MP.

Saito, Hiroaki; Miyatani, Kozo; Takaya, Seigo; Matsunaga, Tomoyuki; Fukumoto, Yoji; Osaki, Tomohiro; Wakatsuki, Toshiro; Ikeguchi, Masahide

2013-01-01

152

CELLULAR ORIGIN OF RHEUMATOID FACTOR  

PubMed Central

Fluorescein-labelled aggregated human ?-globulin was found to react in precipitin-type tests with serums of individuals with rheumatoid arthritis. This reagent was also highly reactive and specific for the localization of rheumatoid factor in frozen sections of synovial membranes, lymph nodes, and subcutaneous nodules. In synovial membranes from patients with active rheumatoid arthritis, rheumatoid factor was present in the cytoplasm of plasma cells at various stages of development and maturity. The appearance of the cytoplasm and the occasional presence nearby of extracellular particles suggested the possibility of a secretory process. All other cells were devoid of rheumatoid factor. Some plasma cells contained 7S and/or 19S ?-globulin and many lacked detectable ?-globulin. In lymph nodes from a patient with active rheumatoid arthritis, rheumatoid factor was present in approximately one in ten germinal centers as well as in internodular plasma cells. The rheumatoid factor was localized in the cytoplasm and the characteristic protoplasmic processes of the germinal-center cells. All other cells were devoid of rheumatoid factor. 7S and/or 19S ?-globulin was demonstrated in approximately eight in ten germinal centers in these lymph nodes. Plasma cells with rheumatoid factor were also seen on occasion in rheumatoid subcutaneous nodules. Tissue sections of comparable structure prepared from normal and pathological control material did not contain rheumatoid factor. Staining for rheumatoid factor was blocked by pretreatment of sections either with unlabelled aggregated human ?-globulin or with rabbit antiserum against 19S human ?-globulin.

Mellors, Robert C.; Heimer, Ralph; Corcos, Josue; Korngold, Leonhard

1959-01-01

153

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

2013-01-01

154

Rheumatoid nodulosis: A puzzling variant of rheumatoid arthritis  

Microsoft Academic Search

Summary Four patients with rheumatoid nodulosis are here described, together with a review of cases reported to date in the literature. This particular variant of rheumatoid arthritis (RA) is characterized by the presence of subcutaneous rheumatoid nodules, scanty or absent systemic manifestations and a clinically benign course. Joint involvement appears more commonly as palindromic rheumatism, although patients with arthralgia episodes

M. A. Goñi; E. J. Scheines; S. O. Paira; H. A. Barceló; J. A. Maldonado Cocco

1992-01-01

155

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

156

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

PubMed

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

2005-05-01

157

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.

1997-01-01

158

Growth and infectious exposure during infancy and the risk of rheumatoid factor in adult life  

Microsoft Academic Search

Background: The contribution of the environment to rheumatoid arthritis (RA) remains uncertain. Intrauterine and early postnatal life may be important. Rheumatoid factor (RF) found in around 10% of the normal population confers a risk of developing RA and may be present years before onset of clinical disease. The immune pathology leading to RA and RF may have similar genetic and

C J Edwards; R Goswami; P Goswami; H Syddall; E M Dennison; N K Arden; C Cooper

2006-01-01

159

Rheumatoid forefoot reconstruction.  

PubMed

Management of the patient with rheumatoid forefoot deformity requires a multidisciplinary integrated approach for a successful outcome. Despite recent advances in the pharmacological management of rheumatoid arthritis and its impact upon disease progression, forefoot deformity and pain remain common manifestations requiring input from orthopaedic surgeons. The typical deformities encountered include hallux valgus, with subluxation or frank dislocation at the lesser metatarsophalangeal (MTP) joints. Surgical intervention is directed at correcting and decompressing these deformities, with the ultimate goal of a stable, painless, functional plantigrade foot. Although a variety of surgical options exist, fusion of the 1st MTP joint with lesser MTP joint excision arthroplasty remains the gold standard, upon which newer procedures should be judged. This article reviews the pathophysiology of forefoot deformity in rheumatoid arthritis with special emphasis on recent advances in surgical management. PMID:20698446

Amin, Amit; Cullen, Nicholas; Singh, Dishan

2010-06-01

160

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.

2005-01-01

161

Reactive molecular dynamic simulations of early stage of wet oxidation of Si (001) surface  

NASA Astrophysics Data System (ADS)

We have investigated the initial stage of oxidation of Si (001) surface by water (H2O) molecules using reactive molecular dynamics (MD) simulation at 300 K and 1200 K without any external constraint on the water molecules. Previously, reported water reaction behaviors on silicon surface by ab initio calculations or experimental observations were reproduced by the present MD simulation. The present simulation further revealed that the hydrogen atom in H2O is more attractive than oxygen atom in O2 to bond with Si, such that it accelerates the dissociation process of H2O. It was also observed that the oxidation reaction was enhanced with increased number of the supplied water molecules. It was suggested that the repulsion between water molecules and their fragments facilitates the dissociation of both water molecules and hydroxyl decomposition on the Si surface. Therefore, the wet oxidation behavior appeared to have more temperature dependence even in the early stage of oxidation.

Pamungkas, Mauludi Ariesto; Kim, Byung-Hyun; Lee, Kwang-Ryeol

2013-08-01

162

Direct Monte Carlo Simulations of the Intermediate eXperimental Vehicle at Early Stages of Reentry  

NASA Astrophysics Data System (ADS)

Within the European Space Agency (ESA) framework program FLPP Next Generation Launcher (NGL) preparatory activities on System, In-Flight Experimentation and Aerothermodynamics Period 1, Step 2, von Karman Institute (VKI) has to perform ground testing and numerical simulations to contribute to the aerothermodynamic database of the Intermediate eXperimental Vehicle (IXV) along its trajectory during re-entry. The present article summarizes the part of these activities in relation with the evaluation of the aerodynamic properties in the early stages of re-entry. Due to the rarefied nature of the higher atmosphere, the computations were carried out by means of Direct Simulation of Monte Carlo (DSMC) method. The aim of this work was to a., validate the methodology used at VKI, b., perform computations at several points along the trajectory and c., assess the feasibility of joint simulation of rarefied flow and thrusters.

Bányai, T.; Torres, E.; Kashkovsky, A. V.; Vashchenkov, P. V.; Ivanov, M. S.; Rambaud, P.

2011-08-01

163

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

2006-01-01

164

Simulation of The Early Mars Climate With A General Circulation Model  

NASA Astrophysics Data System (ADS)

In spite of a solar luminosity significantly lower than it is today, geological evidence shows that, early in its history during the Noachian erra, Mars was warm enough to support flowing water. The atmospheric conditions required to produce and sustain a warm, wet climate on early Mars remains uncertain. Several models have been used in the past to study this enigma, but all of them were simple 1D model. To improve our understanding of the early Mars Climate, we have developped a 3D general circula- tion model similar to the one used on current Earth or Mars to study the details of the climate today. To simulate what could have been the early Mars conditions, we have coupled the Martian General Circulation model developped at LMD with a sophis- ticated correlated k distribution model developped at NASA Ames Research Center. As a first step, we assumed that the early Mars atmosphere was composed of 2 bars of pure CO2, with CO2 ice clouds possibly condensing in the atmosphere. Using the correlated k distribution model allowed us to take into account the complex radiative transfer processes which occur in such an atmosphere (gaseous and scaterring green- house effect). Preliminary results suggest that temperature near or above the freezing point of water could have easily been obtained seasonally in the summer hemisphere even if the scaterring greenhouse effect of the clouds is negelected, whereas warming CO2 ice clouds would have especially formed in the winter hemisphere.

Forget, F.; Haberle, R. M.; Marcq, E.; Colaprete, A.; Schaeffer, J.; Wanherdrick, Y.

165

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

2002-01-01

166

CACHEXIA IN RHEUMATOID ARTHRITIS  

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...

167

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

2002-01-01

168

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.

2011-01-01

169

Pangaean climate during the Early Jurassic: GCM simulations and the sedimentary record of paleoclimate  

SciTech Connect

Results from new simulations of the Early Jurassic climate show that increased ocean heat transport may have been the primary force generating warmer climates during the past 180 m.y. The simulations, conducted using the general circulation model (GCM) at the Goddard Institute for Space Studies, include realistic representations of paleocontinental distribution, topography, epeiric seas, and vegetation, in order to facilitate comparisons between model results and paleoclimate data. three major features of the simulated Early Jurassic climate include the following. (1) A global warming, compared to the present, of 5 {degrees}C to 10 {degrees}C, with temperature increases at high latitudes five times this global average. Average summer temperatures exceed 35 {degrees}C in low-latitude regions of western Pangaea where eolian sandstones testify to the presence of vast deserts. (2) Simulated precipitation and evaporation patterns agree closely with the moisture distribution interpreted from evaporites, and coal deposits. High rainfall rates are associated primarily with monsoons that originate over the warm Tethys Ocean. Unlike the {open_quotes}megamonsoons{close_quotes} proposed in previous studies, these systems are found to be associated with localized pressure cells whose positions are controlled by topography and coastal geography. (3) Decreases in planetary albedo, occurring because of reductions in sea ice, snow cover, and low clouds, and increases in atmospheric water vapor are the positive climate feedbacks that amplify the global warming. Similar to other Mesozoic climate simulations, our model finds that large seasonal temperature fluctuations occurred over mid- and high-latitude continental interiors, refuting paleoclimate evidence that suggests more equable conditions. 101 refs., 9 figs., 3 tabs.

Chandler, M.A. [Columbia Univ., Palisades, NY (United States); Rind, D.; Ruedy, R. [Goddard Institute for Space Studies, New York, NY (United States)

1992-05-01

170

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.

2012-01-01

171

A new multi-sensor approach to simulation assisted tsunami early warning  

NASA Astrophysics Data System (ADS)

A new tsunami forecasting method for near-field tsunami warning is presented. This method is applied in the German-Indonesian Tsunami Early Warning System, as part of the Indonesian Tsunami Warning Center in Jakarta, Indonesia. The method employs a rigorous approach to minimize uncertainty in the assessment of tsunami hazard in the near-field. Multiple independent sensors are evaluated simultaneously in order to achieve an accurate estimation of coastal arrival times and wave heights within very short time after a submarine earthquake event. The method is validated employing a synthetic (simulated) tsunami event, and in hindcasting the minor tsunami following the Padang 30 September 2009 earthquake.

Behrens, J.; Androsov, A.; Babeyko, A. Y.; Harig, S.; Klaschka, F.; Mentrup, L.

2010-06-01

172

Rheumatoid factor in Nigerian sera  

PubMed Central

A high prevalence of rheumatoid factor has been found in the sera of apparently healthy inhabitants of two Western Nigerian villages. The prevalence of rheumatoid factor at high titre increased markedly with age. The rheumatoid factor found in the sera of these apparently healthy subjects showed a selective affinity for human ?-globulin rather than rabbit ?-globulin. Rheumatoid factor activity was shown to be restricted to the serum IgM fraction. In one of the two villages a significant correlation was found between the presence of rheumatoid factor at high titre and the presence of IgM malaria antibodies at high titre and the possible role of malaria in the induction of rheumatoid factor formation in these two communities is discussed.

Greenwood, B. M.; Muller, A. S.; Valkenburg, H. A.

1971-01-01

173

[Rational therapeutic approach in rheumatoid arthritis].  

PubMed

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

2006-01-01

174

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

1979-01-01

175

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

2013-01-01

176

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

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

2013-07-17

177

[Capillaroscopy in rheumatoid arthritis].  

PubMed

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

178

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

2008-01-01

179

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

1988-01-01

180

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

2002-01-01

181

Rheumatoid arthritis. Designing and implementing a treatment plan.  

PubMed

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

1998-02-01

182

Artrite Reumatóide e Doenças Cardiovasculares Rheumatoid Arthritis and Cardiovascular Disease  

Microsoft Academic Search

The increased prevalence of cardiovascular disease (CVD) in rheumatoid arthrtis (RA) patients is by now largely recognized. The purpose of this extensive literature review is to analyze the epidemiological evidences of CVD, particularly coronary heart disease (CHD), as the leading cause of early death in RA, the presence of coronary risk factors, the relationship between RA and atherosclerosis, the shared

Dawton Yukito Torigoe; Iêda Maria Magalhães Laurindo

2006-01-01

183

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

2001-01-01

184

Lower limb joint replacement in rheumatoid arthritis  

PubMed Central

Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov). We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.

2012-01-01

185

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

186

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

1998-01-01

187

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

1987-01-01

188

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

1984-01-01

189

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

1985-01-01

190

Testing early life connectivity using particle tracking simulations and otolith chemistry  

NASA Astrophysics Data System (ADS)

Large-scale circulation may structure populations of oceanic fish, and hence distributions of chemistry in their otoliths. We applied a combination of Lagrangian modelling and otolith chemistry of Scotia Sea icefish (Chaenocephalus aceratus), a species with a long pelagic larval phase found along the Antarctic Circumpolar Current, to test connectivity previously predicted between the Antarctic Peninsula and South Georgia. Material laid down in the otolith nucleus during early life showed evidence of heterogeneity between sampling areas on the northern Antarctic Peninsula, whereas similar nucleus chemistry at sampling areas off South Georgia suggested a discrete, locally-recruiting population, consistent with observed larval assemblages. Strong evidence of a population boundary discounted hypotheses of early life connectivity between the two regions. This was consistent with particle simulations of the large-scale circulation, which predicted that particles released deep on the Antarctic Peninsula shelf during late winter, corresponding to hatching of icefish larvae from benthic nests, are transported close to the ACC southern boundary, missing South Georgia but following trajectories along the south Scotia Ridge. Used together, the two techniques promise an innovative approach to generate and test predictions, and resolve early dispersal and connectivity related to the physical circulation of oceanic systems.

Ashford, Julian; Fach, Bettina A.; La Mesa, Mario; Jones, Christopher; Everson, Inigo

2010-05-01

191

Albedo and heat transport in 3-D model simulations of the early Archean climate  

NASA Astrophysics Data System (ADS)

At the beginning of the Archean eon (ca. 3.8 billion years ago), the Earth's climate state was significantly different from today due to the lower solar luminosity, smaller continental fraction, higher rotation rate and, presumably, significantly larger greenhouse gas concentrations. All these aspects play a role in solutions to the "faint young Sun paradox" which must explain why the ocean surface was not fully frozen at that time. Here, we present 3-D model simulations of climate states that are consistent with early Archean boundary conditions and have different CO2 concentrations, aiming at an understanding of the fundamental characteristics of the early Archean climate system. In order to do so, we have appropriately modified an intermediate complexity climate model that couples a statistical-dynamical atmosphere model (involving parameterizations of the dynamics) to an ocean general circulation model and a thermodynamic-dynamic sea-ice model. We focus on three states: one of them is ice-free, one has the same mean surface air temperature of 288 K as today's Earth and the third one is the coldest stable state in which there is still an area with liquid surface water (i.e. the critical state at the transition to a "snowball Earth"). We find a reduction in meridional heat transport compared to today, which leads to a steeper latitudinal temperature profile and has atmospheric as well as oceanic contributions. Ocean surface velocities are largely zonal, and the strength of the atmospheric meridional circulation is significantly reduced in all three states. These aspects contribute to the observed relation between global mean temperature and albedo, which we suggest as a parameterization of the ice-albedo feedback for 1-D model simulations of the early Archean and thus the faint young Sun problem.

Kienert, H.; Feulner, G.; Petoukhov, V.

2013-08-01

192

Non-thermal water loss of the early Mars: 3D multi-ion hybrid simulations  

NASA Astrophysics Data System (ADS)

In this study we analyze the non-thermal loss rates of O +, O 2+ and CO 2+ ions over the last 4.5 billion years (Gyr) in the Martian history by using a 3D hybrid model. For this reason we derived the past solar wind conditions in detail. We take into account the intensified particle flux of the early Sun as well as an Martian atmosphere, which was exposed to a sun's extreme ultraviolet (EUV) radiation flux 4.5 Gyr ago that was 100 times stronger than today. Furthermore, we model the evolution of the interplanetary magnetic field by a Weber & Davis solar wind model. The 'external' influences of the Sun's radiation flux and solar wind flux lead to the formation of an ionospheric obstacle by photoionization, charge exchange and electron impact. For the early Martian conditions we could show that charge exchange was the dominant ionization mechanism. Several hybrid simulations for different stages in the evolution of the Martian atmosphere, at 1, 2, 5, 10, 30 and 100 EUV, were performed to analyze the non-thermal escape processes by ion pick-up, momentum transfer from the solar wind to the ionosphere and detached ionospheric plasma clouds. Our results show a non-linear evolution of the loss rates. Using mean solar wind parameters the simulations result in an oxygen loss equivalent to the depth of a global Martian ocean of about 2.6 m over the last 4.5 Gyr. The induced magnetic field strength could be increased up to about 2000 nT. A simulation run with high solar wind density results in an oxygen loss of a Martian ocean up to 205 m depth during 150 million years after the sun reached the zero age mean sequence (ZAMS).

Boesswetter, A.; Lammer, H.; Kulikov, Y.; Motschmann, U.; Simon, S.

2010-12-01

193

Additional diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis  

Microsoft Academic Search

In the past decade significant advantages have been made in the treatment of rheumatoid arthritis (RA) and therapeutic strategies have changed a lot. These days, highly effective disease modifying anti-rheumatic drugs enable intervention early in the disease process, in order to prevent major joint damage.For years, serological support in the diagnosis of RA has been limited to the presence of

Inka Vallbracht; Klaus Helmke

2005-01-01

194

The clinical features of rheumatoid arthritis.  

PubMed

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

1998-05-01

195

[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].  

PubMed

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

196

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

1979-01-01

197

FORMING EARLY-TYPE GALAXIES IN {Lambda}CDM SIMULATIONS. I. ASSEMBLY HISTORIES  

SciTech Connect

We present a sample of nine high-resolution cosmological simulations in the mass range of M{sub vir} = 7 Multiplication-Sign 10{sup 11}-4 Multiplication-Sign 10{sup 12} M{sub Sun} starting from {Lambda}CDM initial conditions. Our simulations include primordial radiative cooling, photoionization, star formation, supernova II feedback, but exclude supernova-driven winds and active galactic nucleus feedback. The simulated galaxies assemble in two phases, with the initial growth dominated by compact (r < r{sub eff}) in situ star formation fueled by cold, low-entropy gas streams resulting in a very similar mean assembly redshift of z{sub f,ins} {approx} 2.5 for the in situ stellar component in all galaxies. The late growth is dominated by accretion of old stars formed in subunits outside the main galaxy (r > r{sub eff}) resulting in an assembly redshift of z{sub f,acc} {approx} 0.5-1.5 with much larger scatter. We find a positive correlation between the fraction of accreted stars and the final mass of our galaxies. We show that gravitational feedback strongly suppresses late star formation in massive galaxies contributing to the observed galaxy color bimodality. The accretion of stellar material is also responsible for the observed size growth of early-type galaxies. In addition, we find that the dark matter fractions within the stellar half-mass radii continuously increase toward lower redshift from about f{sub DM} {approx} 0.05 at z {approx} 3 to f{sub DM} {approx} 0.1-0.3 at z = 0. Furthermore, the logarithmic slope of the total density profile is nearly isothermal at the present day ({gamma}' {approx} 1.9-2.2). Finally, the input of gravitational heating lowers the central dark matter densities in the galaxies, with the effect being smaller compared to simulations without supernova feedback.

Johansson, Peter H. [Department of Physics, University of Helsinki, Gustaf Haellstroemin katu 2a, FI-00014 Helsinki (Finland); Naab, Thorsten [Max-Planck-Insitut fuer Astrophysik, Karl-Schwarzschild-Str. 1, D-85741 Garching bei Muenchen (Germany); Ostriker, Jeremiah P., E-mail: Peter.Johansson@helsinki.fi [Department of Astrophysics, Peyton Hall, Princeton, NJ 08544 (United States)

2012-08-01

198

Forming Early-type Galaxies in ?CDM Simulations. I. Assembly Histories  

NASA Astrophysics Data System (ADS)

We present a sample of nine high-resolution cosmological simulations in the mass range of M vir = 7 × 1011-4 × 1012 M ? starting from ?CDM initial conditions. Our simulations include primordial radiative cooling, photoionization, star formation, supernova II feedback, but exclude supernova-driven winds and active galactic nucleus feedback. The simulated galaxies assemble in two phases, with the initial growth dominated by compact (r < r eff) in situ star formation fueled by cold, low-entropy gas streams resulting in a very similar mean assembly redshift of z f, ins ~ 2.5 for the in situ stellar component in all galaxies. The late growth is dominated by accretion of old stars formed in subunits outside the main galaxy (r > r eff) resulting in an assembly redshift of z f, acc ~ 0.5-1.5 with much larger scatter. We find a positive correlation between the fraction of accreted stars and the final mass of our galaxies. We show that gravitational feedback strongly suppresses late star formation in massive galaxies contributing to the observed galaxy color bimodality. The accretion of stellar material is also responsible for the observed size growth of early-type galaxies. In addition, we find that the dark matter fractions within the stellar half-mass radii continuously increase toward lower redshift from about f DM ~ 0.05 at z ~ 3 to f DM ~ 0.1-0.3 at z = 0. Furthermore, the logarithmic slope of the total density profile is nearly isothermal at the present day (?' ~ 1.9-2.2). Finally, the input of gravitational heating lowers the central dark matter densities in the galaxies, with the effect being smaller compared to simulations without supernova feedback.

Johansson, Peter H.; Naab, Thorsten; Ostriker, Jeremiah P.

2012-08-01

199

Recondensation of chondritic material in the early solar system: Results of thermodynamic simulation  

NASA Astrophysics Data System (ADS)

We have performed a thermodynamic simulation of the recondensation of evaporated meteoritic material. We suggest that evaporation and recondensation occurred in impact events during the intercollision of planetesimals during the early evolution of the solar system. The source materials adopted for our model are the chondrites CI Orgueil and H5 Richardton. These chondrites are representative examples of the two extremes regarding volatile content and oxidation state. We calculated equilibrium mineral compositions of the closed systems of the Orgueil's and Richardton's elemental composition at the P-T conditions characteristic of the explosion cloud formed at a planetesimal collision. The P-T conditions are as follows: 10-4 bar, and 1500 and 2000 K. The results are presented.

Dorofeyeva, V. A.; Makalkin, A. B.; Mironenko, M. V.; Vityazev, A. V.

1993-03-01

200

Microgravity simulation as a probe for understanding early Xenopus pattern specification.  

PubMed

Pattern specification in early amphibians (Xenopus) was monitored in embryos subjected to gravity compensation (microgravity simulation) by constant low-speed rotation on a horizontal axis (clinostat). The useful range of clinostat speeds was determined empirically. The results were interpreted in terms of a set of models which account for the reorganization of the egg cytoplasm that follows fertilization and that correlates with the establishment of dorsal/ventral polarity. Large percentages of clinostated eggs displayed a positive result (normal axial structure morphogenesis). Consequently, normal development of amphibian eggs in the microgravity environment of space should be possible. Models which depend upon gravity-driven rearrangements for cytoplasmic organization (e.g. dorsal/ventral polarization) of the early embryo should, therefore, not be favoured. At several clinostat speeds symmetrization of the egg in accordance with the site of sperm penetration, a natural phenomenon, was altered. The results at those clinostat speeds indicate that models which employ sperm entrance as an obligatory feature of the cytoplasmic rearrangements that generate egg polarity are not applicable. PMID:4093749

Neff, A W; Malacinski, G M; Chung, H M

1985-10-01

201

Early MIMD experience with a plasma physics simulation program on the CRAY X-MP  

SciTech Connect

This paper describes some early experience with converting a plasma physics simulation program to the CRAY X-MP, a current multiple instruction, multiple data (MIMD) computer consisting of two processors with architecture similar to that of the CRAY-1. The computer program used in this study is an all Fortran version of SELF, a two species, one space, two velocity, electromagnetic, Newtonian, particle in cell, plasma simulation code. The approach to converting SELF to use both processors of the CRAY X-MP is described in some detail. The resulting multiprocessor version of SELF is nearly a factor of two faster in real time than the single processor version. The multiprocessor version obtains 58.2+-.1 seconds of central processor time in 30+-.5 seconds of real time. For comparison, the CRAY-1 execution time if 74.5 seconds. For SELF, which is mostly scalar coding, the CRAY X-MP is about 2.5 times faster overall than the CRAY-1.

Rhoades, C.E. Jr.

1986-02-01

202

SIMULATIONS OF EARLY BARYONIC STRUCTURE FORMATION WITH STREAM VELOCITY. I. HALO ABUNDANCE  

SciTech Connect

It has been recently shown that the relative velocity between the dark matter and the baryons (v{sub bc}) at the time of recombination can affect the structure formation in the early universe. We statistically quantify this effect using large cosmological simulations. We use three different high-resolution sets of simulations (with separate transfer functions for baryons and dark matter) that vary in box size, particle number, and the value of the relative velocity between dark matter and baryons. We show that the total number density of halos is suppressed by {approx}20% at z = 25 for v{sub bc} = 1{sigma}{sub vbc}, where {sigma}{sub vbc} is the variance of the relative velocity, while for v{sub bc} = 3.4{sigma}{sub vbc} the relative suppression at the same redshift reaches 50%, remaining at or above the 30% level all the way to z = 11. We also find a high abundance of 'empty halos', i.e., halos that have gas fraction below half of the cosmic mean baryonic fraction f-bar{sub b}. Specifically, we find that for v{sub bc} = 1{sigma}{sub vbc} all halos below 10{sup 5} M{sub Sun} are empty at z {>=} 19. The high abundance of empty halos results in significant delay in the formation of gas-rich minihalos and the first galaxies.

Naoz, Smadar [CIERA, Northwestern University, Evanston, IL 60208 (United States); Yoshida, Naoki [IPMU, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8583 (Japan); Gnedin, Nickolay Y., E-mail: snaoz@northwestern.edu [Particle Astrophysics Center, Fermi National Accelerator Laboratory, Batavia, IL 60510 (United States)

2012-03-10

203

Rheumatoid nodulosis: a puzzling variant of rheumatoid arthritis.  

PubMed

Four patients with rheumatoid nodulosis are here described, together with a review of cases reported to date in the literature. This particular variant of rheumatoid arthritis (RA) is characterized by the presence of subcutaneous rheumatoid nodules, scanty or absent systemic manifestations and a clinically benign course. Joint involvement appears more commonly as palindromic rheumatism, although patients with arthralgia episodes alone and others with chronic polyarthritis have been described. Seldom reported up to now, a consideration of this entity may help to avoid diagnostic pitfalls and the use of aggressive therapy. PMID:1458790

Goñi, M A; Scheines, E J; Paira, S O; Barceló, H A; Maldonado Cocco, J A

1992-09-01

204

Towards a flash flood early warning system through hydrological simulation of probabilistic ensemble forecasts  

NASA Astrophysics Data System (ADS)

In this work we test a flash flood early warning system based on state-of-the-art probabilistic weather forecasting input data. We make use of the Limited area Ensemble Prediction System (LEPS) provided by the Consortium for Small scale Modeling (COSMO). COSMO-LEPS ensembles are fed into a distributed hydrological model, to obtain discharge estimates. Likewise, discharge climatology is created from a continuous meteorological dataset based on 30-year COSMO-LEPS hindcasts, and used as reference to detect threshold exceedance in the operational ensemble hydrographs. Coherent reference climatology is particularly useful for flash flood events, as they often take place in small watersheds, where no gauge measurements are available. The concept of persistence of meteorological forecasts is also tested as a method to improve the detection of severe events. Starting from the operational 5-km simulation at the European scale, when a signal for possible flash flooding is detected a regional catchment-scale simulation is activated on a finer spatial scale (1 km grid). Two targeted analyses are carried out to investigate: a) an automatic rule to activate the fine-scale analysis, and b) the influence of initial conditions on the estimated hydrographs, and in turn on threshold exceedances. The Gardon d'Anduze catchment, in the south of France, is chosen as a case study. A number of simulations are performed and results are analyzed and discussed. Our findings show that flash floods can sometimes be detected with a considerable lead time, especially if compared to the response time of the catchments where these phenomena take place. However, the amount of uncertainty related to the forecast is considerable, therefore the choice of appropriate thresholds for flash flood detection is of crucial importance and should account for the maximum acceptable number of either false alarms and undetected events.

Alfieri, Lorenzo; Thielen Del Pozo, Jutta

2010-05-01

205

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

2010-01-01

206

3D simulations of the early Mars climate with a General Circulation Model  

NASA Astrophysics Data System (ADS)

The environmental conditions that existed on early Mars during the Noachian period are subject to debate in the community. While some authors suggest that the difference resulted from a stronger geothermalism during that period, and that a warm climate was not necessary to explain the valley network, others claim that a warm, wet early climate capable of supporting rainfall and surface runoff is the most plausible scenario for explaining the entire suite of geologic and mineralogical features in the Martian cratered highlands. The recent observations from the Mars Exploration Rovers, Mars Express and Mars Odyssey are more than ever raising the issue. To help understand this key issue in Mars science, we have developped a 3D general circulation model similar to the one used on current Earth or Mars to study the details of the climate today. Our first objective is to answer the following questions : how is the Martian climate modified if 1) the surface pressure is increased up to several bars (our baseline: 1 or 2 bars) and 2) if the sun luminosity is decreased by 25% like 3.8 Billion years ago. We did not take into account the heat possibly released by impacts during short periods, although it may have played a role. Preliminary results obtained assuming a 2 bars atmosphere suggest that, even without taking into account the radiative effect of CO2 clouds, temperature near or above the freezing point of water may be obtained. In particular, the CO2 gas greenhouse effect may be stronger than usually expected because pressure induced absoprtion may have been underestimated in studies Moreover CO2 ice clouds are found to form almost everywhere on the planet in the upper atmosphere above 40 km. Their radiative effect on the climate is very model dependent but, in our baseline simulation, correspond to a15 K warming of the surface. We found that above freezing temperatures are especially likely in the lower plains, due to the atmospheric adiabating warming. This would support a scenario were the lower northern plains would be filled by liquid water and the higher regions more or less covered by snow and glaciers. To better investigate the kind of water cycle one can expect in such conditions, we plan to apply parameterisations currently used in Earth models to simulate the water cycle on our planet.

Forget, F.; Haberle, R. M.; Montmessin, F.; Marck, E.; Colaprete, A.

2004-12-01

207

Simulating the early Holocene eastern Mediterranean sapropel formation using an ocean biogeochemical model  

NASA Astrophysics Data System (ADS)

The early Holocene sapropel S1 is an organic-rich sediment layer deposited under oxygen depleted conditions below 1800 m between 10 to 6.5 kyr BP in the eastern Mediterranean Sea. Whereas this silled ocean basin is well-ventilated and has a low biological productivity today, the S1 formation indicates drastic changes in the deep water circulation and/or productivity. Commonly, both of these processes are attributed to an enhanced humidity over the broader Mediterranean area. In particular, an increase in the strength of the African monsoon during the African humid period (AHP) is thought to have provided enhanced Nile runoff and nutrient load. However, the exact mechanisms leading to S1 formation are still being debated. Here we apply a regional ocean general circulation model coupled to a marine biogeochemical model covering the entire Mediterranean Sea to explore some of the many published hypotheses on sapropel formation. With a set of simulations we show that S1 formation cannot be explained by either enhanced biological productivity fueled by increased riverine nutrient input, or by an AHP climatic induced stagnating deep water circulation combined with enhanced biological productivity. The main reasons are: (i) Enhanced biological productivity cannot overcome the effect of a continuous deep ventilation, so that a stagnating deep water circulation is a prerequisite for S1 formation. (ii) The pre-sapropel period is characterized by low particulate organic carbon (POC) sediment burial fluxes, implying that river induced eutrophication is not a viable scenario. (iii) The time span required for complete oxygen depletion within the stagnating deep water circulation exceeds the time span between the beginning of the AHP and the onset of the S1 oxygen deficiency, so that the enhanced Nile runoff fueled by the AHP climate is an unlikely trigger for deep water isolation that caused S1 formation. Available data suggest substantial freshening and warming of the Mediterranean upper ocean during the last glacial-interglacial transition that stabilized stratification and prevented deep water ventilation. Imposing the climatic signals of the last glacial-interglacial transition triggers a persistent (> 4 kyr) deep water stagnation in this simulation. The productivity regime in this simulation was assumed similar to the present-day oligotrophic regime, and the simulated POC burial fluxes agree with observed pre-sapropel burial fluxes in sediments. No deep water anoxia evolves in the short time frame of this simulation (4 kyr) relative to the temporal extent of the deglaciation period, which started at ~17.5 kyr BP. The trend of the modeled oxygen consumption suggests that it takes at least 6.5 kyr until deep water anoxia is established. The simulation also suggests that addition of freshwater is required to maintain the stratification in order to meet the reconstructed spatial extent and duration of the S1 deposition. An examination of records of epibenthic deep-sea foraminifera ?18O supports our findings, and indicates that the stagnation of the deep circulation started ~6 kyr before the onset of the S1 deposition.

Grimm, Rosina; Maier-Reimer, Ernst; Mikolajewicz, Uwe; Schmiedl, Gerhard; Adloff, Fanny; Emeis, Kay

2013-04-01

208

Risks and benefits of low-dosage cyclosporin in rheumatoid arthritis.  

PubMed

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

1997-05-01

209

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

1999-01-01

210

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

2009-01-01

211

Ensemble hydro-meteorological simulation for flash flood early detection in southern Switzerland  

NASA Astrophysics Data System (ADS)

Ongoing changing climate has raised the attention towards weather driven natural hazards. Local floodings and debris flows following exceptional downpours often come without any adequate warning and cause heavy tolls to the human society. This work proposes a novel flood alert system for small catchments prone to flash flooding, capable of monitoring a large portion of the European domain. Operational streamflow simulations are produced through distributed hydrological modeling of ensemble weather forecasts. A long-term reforecast dataset is run through the same hydrological model to derive coherent warning thresholds. These are compared with operational discharge ensembles in a threshold exceedance analysis to produce early warnings.A case study in the southern Switzerland is tested over a 17-month period and system skills are evaluated by means of different quantitative and qualitative analyses. Results from three different predictors derived from the streamflow ensemble are shown and compared, also by accounting for the persistence of lagged forecasts. Significant improvements in predicting discharge thresholds exceedance are achieved by fitting gamma probability distributions to the raw ensemble. Further discussion underlines the limits of predictability of extreme events in small catchments due to the comparatively coarse space-time resolution of current weather forecasts.

Alfieri, Lorenzo; Thielen, Jutta; Pappenberger, Florian

2012-03-01

212

Splinting the rheumatoid hand.  

PubMed

Splinting of the rheumatoid hand is a complex topic. Understanding is assisted by the use of precise terminology and so is accurate prescription. Dynamic and static orthoses can be prescribed for any part of the upper limb to assist function or provide resistance exercise. Orthoses can be valuable in planning surgery and assisting return of function postoperatively. The importance of training in prescription, manufacture, fitting and wearing of orthoses is stressed and careful discussion with the patient is vital. Thermoplastic materials have provided a new spectrum of designs. Spring wire attachments developed at Chessington (Wynn Parry et al, 1970), Odstock (Glanville, 1962) and The London Hospital (Ellis, 1981) have introduced further possibilities. Designs should be functional and must be acceptable to the patient. PMID:6398183

Ellis, M

1984-12-01

213

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

2004-01-01

214

Pathogenesis of rheumatoid arthritis.  

PubMed

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

1988-01-01

215

Amyloid arthropathy mimicking seronegative rheumatoid arthritis in multiple myeloma: case reports and review of the literature.  

PubMed

We report two patients who suffered from symmetrical polyarthritis simulating rheumatoid arthritis. Acute phase response was almost within normal limits, and autoantibodies including rheumatoid factor were negative. Both of them were diagnosed as having amyloid arthropathy (AmyA) secondary to kappa multiple myeloma based on deposition of kappa-light chain-immunoreactive amyloid in biopsied tissue and Bence Jones protein in urine. Systemic AL amyloidosis may be important in the differential diagnosis of chronic polyarthralgia. PMID:19922335

Alpay, Nilüfer; Artim-Esen, Bahar; Kamali, Sevil; Gül, Ahmet; Kalayo?lu-Be?i?ik, Sevgi

2009-12-01

216

MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid arthritis is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. Rheumatoid nodules have been reported in as many as 20–30% of patients with rheumatoid arthritis; however, they are not commonly seen in the feet. We present magnetic resonance (MR) findings of a rarely seen case of rheumatoid bursitis in the retrocalcaneal bursa

Hakan Mutlu; Huseyin Sildiroglu; Zekai Pekkafali; Esref Kizilkaya; Hakan Cermik

2006-01-01

217

Rheumatoid nodule presenting as Morton's neuroma.  

PubMed

Among 101 feet that presented with symptoms and signs similar to Morton's neuroma, intermetatarsal rheumatoid nodules were found in five feet (three patients). Two patients had bilateral involvement. Histology of the excised tissue showed the presence of a rheumatoid nodule and Morton's neuroma in four feet and a rheumatoid nodule with unremarkable nerve bundles in one. A rheumatoid nodule can coexist with Morton's neuroma, as seen in our patients, and the presentation is often similar to that of a Morton's neuroma. Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis. Rheumatoid nodule should be considered in the differential diagnosis of Morton's neuroma in not only rheumatoid arthritis patients but also asymptomatic patients who have never been tested for rheumatoid antibodies. PMID:23135058

Chaganti, S; Joshy, S; Hariharan, K; Rashid, M

2012-11-08

218

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

219

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

1999-01-01

220

Microarray analysis of the primate luteal transcriptome during chorionic gonadotrophin administration simulating early pregnancy  

PubMed Central

To explore chorionic gonadotrophin (CG)-regulated gene expression in the primate corpus luteum (CL), adult female rhesus macaques were treated in a model of simulated early pregnancy (SEP). Total RNA was isolated from individual CL after specific intervals of exposure (1, 3, 6 and 9 days) to recombinant hCG in vivo and hybridized to Affymetrix™ GeneChip Rhesus Macaque Genome Arrays. The mRNA levels of 1192 transcripts changed ?2-fold [one-way ANOVA, false discovery rate (FDR) correction; P< 0.05] during SEP when compared with Day 10 untreated controls. Real-time PCR validation indicated that 15 of 17 genes matched in expression pattern between PCR and microarray. Protein levels of three genes identified as CG-sensitive, CYP19A1 (aromatase), PGRMC1 (progestin-binding protein) and STAR (steroidogenic acute regulatory protein) were quantified by western blot analysis. To further analyze global changes in gene expression induced by CG exposure, luteal gene expression was compared between SEP (rescued) and regressing CL, utilizing previously banked GeneChip data from the luteal phase of the menstrual cycle. Expression patterns and mRNA levels were analyzed between time-matched intervals. Transcripts for 7677 mRNAs differed in expression patterns ?2-fold (one-way ANOVA, FDR correction; P< 0.05) between the hCG-exposed (SEP) CL and regressing CL. Regressed CL (at menses) were most unlike all other CL. Pathway analysis of significantly affected transcripts was performed; the pathway most impacted by CG exposure was steroid biosynthesis. Further comparisons of the genome-wide changes in luteal gene expression during CG rescue and luteolysis in the natural menstrual cycle should identify additional key regulatory pathways promoting primate fertility.

Bishop, C.V.; Satterwhite, S.; Xu, L.; Hennebold, J.D.; Stouffer, R.L.

2012-01-01

221

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

2005-01-01

222

Serum cathepsin K levels of patients with longstanding rheumatoid arthritis: correlation with radiological destruction.  

PubMed

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

2004-11-10

223

Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents  

Microsoft Academic Search

Background  In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends\\u000a on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze\\u000a whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance.\\u000a \\u000a \\u000a \\u000a Methods  A randomized

P. Ström; L. Hedman; L. Särnå; A. Kjellin; T. Wredmark; L. Felländer-Tsai

2006-01-01

224

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

2006-01-01

225

Numerical simulation of aeolian dusty sand transport in a marginal desert region at the early entrainment stage  

Microsoft Academic Search

Aeolian dusty sand transport in the marginal region of a desert is described numerically from first suspension motion at the early entrainment stage to the unsteady state within a moderate range (1000 m long×500 m high). A two-dimensional model is built for wind-blown dust flow, and the calculations are carried out using Fluent software. The simulation results describe an integrated picture of

Yintang Li; Yi Guo

2008-01-01

226

Ultrasound in rheumatoid arthritis.  

PubMed

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

2013-09-01

227

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

2012-01-01

228

Tubercular synovitis mimicking rheumatoid nodules.  

PubMed

Tubercular tenosynovitis is an uncommon condition and usually affects the upper limb. We report a case of a patient with Systemic Lupus Erythematosus who presented with wrist swelling. The clinical findings were suggestive of rheumatoid nodules, but the radiographic finding of calcification associated with the nodules and marked erosive changes primarily of the radio-carpal joint with sparing of the metacarpal joints led the radiologist to believe that the nodules may not be rheumatoid nodules. The presence of solid and fluid nature of the nodule and hyperechoic small echogenic foci (matted rice bodies within thickened synovium) on ultrasound suggested the presence of chronic synovitis of tuberculous infection rather than rheumatoid nodule as in our case. We recommend the use of ultrasound to determine the nature of nodular swellings seen clinically in patients with arthropathy. PMID:18942309

Teo, S C; George, J; Kamarul, T

2008-06-01

229

[Rehabilitation of the rheumatoid hand].  

PubMed

Treatment of patients suffering from rheumatoid arthritis is complicated and it consists mainly of applying general measures, medical therapy, physical therapy and rehabilitation, and, if necessary, surgical - orthopedic measures. The treatment is conducted as team work and it lasts for years. The chronic and evolutionary character of the disease requires a rather dynamic effort against the onset of joint deformation as well as the constant follow up of the evolution of the disease, and the local condition of the joints. Within the examined group of a hundred patients with classical and definitive rheumatoid arthritis, formed deformations of hand joints were registered in 72% of patients by means of clinical examination. Preventive measures against joint deformation make an integral part of rheumatoid arthritis patient treatment. Their application starts from the moment when the diagnosis is made and lasts as long as the disease does. PMID:2233556

Buza, M

1990-01-01

230

Acute periostitis in early acquired syphilis simulating shin splints in a jogger.  

PubMed

Acute periostitis affecting the long bones is a characteristic but uncommon manifestation of syphilis in the adult with an early acquired infection. This report describes the history of a jogger who developed acute localized periostitis of the shaft of both tibiae during the early stage of acquired syphilis. Symptomatology was initially attributed to the medial tibial stress syndrome. PMID:3728786

Meier, J L; Mollet, E

231

Homing chemokines in rheumatoid arthritis.  

PubMed

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

2002-01-31

232

Complete reversal of rheumatoid nodulosis.  

PubMed

A woman first seen in 1978 had a history of seropositive rheumatoid arthritis (RA) of 12 years' duration with attacks of palindromic rheumatism for 3 years. She was treated with D-penicillamine, pyridoxine and hydroxychloroquine and serial measurements of her grip strength and proximal interphalangeal joint circumference were taken. By 1987 all her nodules had resorbed completely. Hydroxychloroquine effects probably helped her improvement. Although spontaneous resorption of a rheumatoid nodule is not a rare event, to the best of our knowledge, this is the first instance of complete resolution of all nodules in a patient with RA with the nodulosis variant. PMID:1865421

McCarty, D J

1991-05-01

233

[Contact radiotherapy of rheumatoid arthritis].  

PubMed

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

1992-01-01

234

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

2011-03-01

235

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.

1974-01-01

236

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

2008-01-01

237

Diagnostic criteria in rheumatoid arthritis.  

PubMed

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

1987-01-01

238

Outcome assessments in rheumatoid arthritis.  

PubMed

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

2013-11-01

239

Epigenetic modifications in rheumatoid arthritis  

Microsoft Academic Search

Over the last decades, genetic factors for rheumatoid diseases like the HLA haplotypes have been studied extensively. However, during the past years of research, it has become more and more evident that the influence of epigenetic processes on the development of rheumatic diseases is probably as strong as the genetic background of a patient. Epigenetic processes are heritable changes in

Simon Strietholt; Britta Maurer; Marvin A Peters; Thomas Pap; Steffen Gay

2008-01-01

240

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

2009-01-01

241

Management of the temporomandibular joint in rheumatoid disorders.  

PubMed

This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon. PMID:22658606

Sidebottom, A J; Salha, R

2012-06-01

242

Reactive molecular dynamics simulation of early stage of dry oxidation of Si (100) surface  

NASA Astrophysics Data System (ADS)

Initial stage of oxidation of Si (100) surface by O2 molecules was investigated in atomic scale by molecular dynamics (MD) simulation at 300 K and 1200 K without external constraint on the oxygen molecules. A reactive force field was used for the simulation to handle charge variation as well as breaking and forming of the chemical bonds associated with the oxidation reaction. Results of the present simulation are in good agreement with previous first principle calculations and experimental observations: the oxygen molecules spontaneously dissociated on the Si (100) surface and reacted with Si first layer without energy barrier. The simulation also exhibited that the reacted oxygen preferentially located in the back bonds of the surface dimer. Consecutive oxidation simulation with 300 O2 molecules showed that the diffusion of oxygen atom into the subsurface of clean Si surface can occur during very short time of the present oxidation simulation. The present MD simulation also revealed that the oxidation at 300 K results in more stoichiometric oxide layer than that at 1200 K.

Pamungkas, Mauludi Ariesto; Joe, Minwoong; Kim, Byung-Hyun; Lee, Kwang-Ryeol

2011-09-01

243

Rheumatoid Factor in Liver Shown by Immunofluorescence Method.  

National Technical Information Service (NTIS)

In liver diseases and in chronic bronchitis the appearance of sera testing positive for rheumatoid factor is quite frequently noted. The presence of rheumatoid factor was demonstrated in the livers of patients with rheumatoid arthritis and in patients wit...

L. Bonomo

1966-01-01

244

Early warnings of the potential for malaria transmission in rural Africa using the hydrology, entomology and malaria transmission simulator (HYDREMATS)  

PubMed Central

Background Early warnings of malaria transmission allow health officials to better prepare for future epidemics. Monitoring rainfall is recognized as an important part of malaria early warning systems. The Hydrology, Entomology and Malaria Simulator (HYDREMATS) is a mechanistic model that relates rainfall to malaria transmission, and could be used to provide early warnings of malaria epidemics. Methods HYDREMATS is used to make predictions of mosquito populations and vectorial capacity for 2005, 2006, and 2007 in Banizoumbou village in western Niger. HYDREMATS is forced by observed rainfall, followed by a rainfall prediction based on the seasonal mean rainfall for a period two or four weeks into the future. Results Predictions made using this method provided reasonable estimates of mosquito populations and vectorial capacity, two to four weeks in advance. The predictions were significantly improved compared to those made when HYDREMATS was forced with seasonal mean rainfall alone. Conclusions HYDREMATS can be used to make reasonable predictions of mosquito populations and vectorial capacity, and provide early warnings of the potential for malaria epidemics in Africa.

2010-01-01

245

Bayesian inference analyses of the polygenic architecture of rheumatoid arthritis.  

PubMed

The genetic architectures of common, complex diseases are largely uncharacterized. We modeled the genetic architecture underlying genome-wide association study (GWAS) data for rheumatoid arthritis and developed a new method using polygenic risk-score analyses to infer the total liability-scale variance explained by associated GWAS SNPs. Using this method, we estimated that, together, thousands of SNPs from rheumatoid arthritis GWAS explain an additional 20% of disease risk (excluding known associated loci). We further tested this method on datasets for three additional diseases and obtained comparable estimates for celiac disease (43% excluding the major histocompatibility complex), myocardial infarction and coronary artery disease (48%) and type 2 diabetes (49%). Our results are consistent with simulated genetic models in which hundreds of associated loci harbor common causal variants and a smaller number of loci harbor multiple rare causal variants. These analyses suggest that GWAS will continue to be highly productive for the discovery of additional susceptibility loci for common diseases. PMID:22446960

Stahl, Eli A; Wegmann, Daniel; Trynka, Gosia; Gutierrez-Achury, Javier; Do, Ron; Voight, Benjamin F; Kraft, Peter; Chen, Robert; Kallberg, Henrik J; Kurreeman, Fina A S; Kathiresan, Sekar; Wijmenga, Cisca; Gregersen, Peter K; Alfredsson, Lars; Siminovitch, Katherine A; Worthington, Jane; de Bakker, Paul I W; Raychaudhuri, Soumya; Plenge, Robert M

2012-03-25

246

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. ClinicalTrials.gov: 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

2012-01-01

247

Rheumatoid nodulosis: report of two cases.  

PubMed

We present two patients with subcutaneous nodular lesions of several years' duration. These lesions were well defined and painless and were located next to bony surfaces or in the pulps of fingers and elbows. No other symptoms were observed except for frequent attacks of palindromic rheumatism with no evidence of arthritis or systemic manifestations suggestive of rheumatoid arthritis. Other studies performed were normal with negative results for rheumatoid factor and antinuclear antibodies. Radiographs of affected sites showed no signs of arthritis while the histopathologic study revealed some findings compatible with rheumatoid nodule. One of the patients also presented desquamate papular lesions at the level of elbows while histologically a process of transepidermal elimination of fibrinoid could be observed. Our patients fulfil all the diagnostic criteria for rheumatoid nodulosis as they present multiple rheumatoid nodules confirmed on biopsy, symptoms of palindromic rheumatism, no evidence of arthritis or radiological alterations and negative rheumatoid factor. PMID:14761141

Gómez, M T Bordel; Polo, A Mariscal; Romero, A Miranda; Gutiérrez, J Vega; García, G Martínez

2003-11-01

248

Extra-articular Manifestations in Rheumatoid Arthritis  

PubMed Central

ABSTRACT Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main characteristic is persistent joint inflammation that results in joint damage and loss of function. Although RA is more common in females, extra-articular manifestations of the disease are more common in males. The extra-articular manifestations of RA can occur at any age after onset. It is characterised by destructive polyarthritis and extra-articular organ involvement, including the skin, eye, heart, lung, renal, nervous and gastrointestinal systems. The frequence of extra-articular manifestations in RA differs from one country to another. Extra-articular organ involvement in RA is more frequently seen in patients with severe, active disease and is associated with increased mortality. Incidence and frequence figures for extra-articular RA vary according to study design. Extra-articular involvement is more likely in those who have RF and/or are HLA-DR4 positive. Occasionally, there are also systemic manifestations such as vasculitis, visceral nodules, Sjögren's syndrome, or pulmonary fibrosis present. Nodules are the most common extra-articular feature, and are present in up to 30%; many of the other classic features occur in 1% or less in normal clinic settings. Sjögren's syndrome, anaemia of chronic disease and pulmonary manifestations are relatively common – in 6-10%, are frequently present in early disease and are all related to worse outcomes measures of rheumatoid disease in particular functional impairment and mortality. The occurrence of these systemic manifestations is a major predictor of mortality in patients with RA. This paper focuses on extra-articular manifestations, defined as diseases and symptoms not directly related to the locomotor system.

Cojocaru, Manole; Cojocaru, Inimioara Mihaela; Silosi, Isabela; Vrabie, Camelia Doina; Tanasescu, R

2010-01-01

249

Autoantibodies in rheumatoid arthritis: rheumatoid factors and anticitrullinated protein antibodies  

PubMed Central

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease, characterized by chronic, erosive polyarthritis and by the presence of various autoantibodies in serum and synovial fluid. Since rheumatoid factor (RF) was first described, a number of other autoantibodies have been discovered in RA patients. The autoantigens recognized by these autoantibodies include cartilage components, chaperones, enzymes, nuclear proteins and citrullinated proteins. However, the clinical significances and pathogenic roles of these antibodies are largely unknown except for RF and anticitrullinated protein antibodies (ACPAs), whose clinical usefulness has been acknowledged due to their acceptable sensitivities and specificities, and prognostic values. This review presents and discusses the current state of the art regarding RF and ACPA in RA.

Kang, E.H.

2010-01-01

250

Simulation of planetary UV radiation climate on the example of the early Earth  

Microsoft Academic Search

Solar UV radiation is a dynamic driving force of organic chemical evolution. However, it may have severe constraints in biological evolution, for instance in the early history of life on Earth, before atmospheric evolution of a protective ozone layer. Today, the full spectrum of solar UV radiation is experienced only in space. In the experiment RD-UVRAD on D-2 the biological

P. Rettberg; G. Horneck; W. Strauch; R. Facius; G. Seckmeyer

1998-01-01

251

New paradigm of predictive MOSFET and interconnect modeling for early circuit simulation  

Microsoft Academic Search

A new paradigm of predictive MOSFET and interconnect modeling is introduced. This approach is developed to specifically address SPICE compatible parameters for future technology generations. For a given technology node, designers can use default values or directly input L eff, Tok, Vt, Rdsw and interconnect dimensions to instantly obtain a BSIM3v3 customized model for early stages of circuit design and

Yu Cao; Takashi Sato; Michael Orshansky; Dennis Sylvester; Chenming Hu

2000-01-01

252

Early stages of the recovery stroke in myosin II studied by molecular dynamics simulations  

PubMed Central

The recovery stroke is a key step in the functional cycle of muscle motor protein myosin, during which pre-recovery conformation of the protein is changed into the active post-recovery conformation, ready to exersice force. We study the microscopic details of this transition using molecular dynamics simulations of atomistic models in implicit and explicit solvent. In more than 2 ?s of aggregate simulation time, we uncover evidence that the recovery stroke is a two-step process consisting of two stages separated by a time delay. In our simulations, we directly observe the first stage at which switch II loop closes in the presence of adenosine triphosphate at the nucleotide binding site. The resulting configuration of the nucleotide binding site is identical to that detected experimentally. Distribution of inter-residue distances measured in the force generating region of myosin is in good agreement with the experimental data. The second stage of the recovery stroke structural transition, rotation of the converter domain, was not observed in our simulations. Apparently it occurs on a longer time scale. We suggest that the two parts of the recovery stroke need to be studied using separate computational models.

Baumketner, Andrij; Nesmelov, Yuri

2011-01-01

253

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

2007-01-01

254

Epigenetics in rheumatoid arthritis: a primer for rheumatologists.  

PubMed

Epigenetic anomalies are emerging as key pathogenic features of rheumatoid arthritis (RA). The effect of epigenetics in RA ranges from contributing to complex disease mechanisms to identifying biomarkers for early diagnosis and response to therapy. This review focuses on three key epigenetic areas in RA, namely DNA methylation, histone modification, and expression and/or function of microRNAs. Epigenomics studies of DNA methylation have identified alterations of genome-wide DNA methylation in cells from patients with rheumatoid arthritis. Histone modification studies have focused on histone acetylation, which tends to be increased in RA. Preclinical studies show that inhibitors of histone deacetylases are effective in cellular and animal models of RA. Genome-wide and candidate microRNA surveys identified increased or reduced expression of selected microRNAs in rheumatoid arthritis. These microRNA are either pro or anti-inflammatory in multiple cell types or affect osteoclast physiology and the pathogenesis of bone erosion. Defining epigenetic contributions to the pathogenesis of RA, especially in combination with understanding genetic associations, could lead to novel therapy and a clearer understanding of disease risk. PMID:24072602

Bottini, Nunzio; Firestein, Gary S

2013-11-01

255

[Bone structure in rheumatoid arthritis].  

PubMed

In rheumatoid arthritis (RA) , the osteoclast pathway is activated by abnormal immune conditions accompanied by chronic inflammation, resulting in periarticular osteoporosis and local bone destruction around joints. In addition, multiple factors, including reduced physical activity and pharmacotherapies such as steroids, lead to systemic osteoporosis. These conditions cause decreasing bone mineral density and deterioration of bone quality, and expose patients to increased risk of fracture. Understanding the bone structures of RA and evaluating fracture risk are central to the treatment of RA. PMID:23811586

Ono, Kumiko; Ohashi, Satoru; Tanaka, Sakae; Matsumoto, Takuya

2013-07-01

256

Osteoarticular tuberculosis mimicking rheumatoid arthritis.  

PubMed

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

2012-03-08

257

Rheumatoid arthritis and cardiovascular disease  

Microsoft Academic Search

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting approximately 1% of the adult general population.\\u000a Cardiovascular disease is recognized as the leading cause of death in RA patients, accounting for nearly 40% of their mortality.\\u000a Patients with RA are at a twofold increased risk for myocardial infarction and stroke, with risk increasing to nearly threefold\\u000a in patients who

Saurabh S. Dhawan; Arshed A. Quyyumi

2008-01-01

258

Biologic therapies in rheumatoid arthritis  

Microsoft Academic Search

Our growing understanding of the immune response mechanism has created a wave of novel biologic agents for the treatment of\\u000a rheumatoid arthritis. The domain of biologic agents includes: 1) Recombinant regulatory cytokines; 2) engineered molecules\\u000a and monoclonal antibodies that target proinflammatory cytokines; 3) monoclonal antibodies against lymphocyte cell-surface\\u000a proteins; 4) fusion proteins and monoclonal antibodies that block the second signal

Ken J. Bulpitt

1999-01-01

259

Glucocorticoid use in rheumatoid arthritis  

Microsoft Academic Search

More than 50 years after their discovery, glucocorticoids continue to be a mainstay of treatment for many patients with rheumatoid\\u000a arthritis (RA). Although the short- and moderate-term efficacy of glucocorticoids in RA is seldom debated, increasing evidence\\u000a favors a disease-modifying role of glucocorticoids. Despite renewed enthusiasm based on this newer long-term data, glucocorticoid\\u000a use is marred substantially by the potential

Kenneth G. Saag

2002-01-01

260

Association of IL4R single-nucleotide polymorphisms with rheumatoid nodules in African Americans with rheumatoid arthritis  

PubMed Central

Introduction To determine whether IL4R single-nucleotide polymorphisms (SNPs) rs1805010 (I50V) and rs1801275 (Q551R), which have been associated with disease severity in rheumatoid arthritis (RA) patients of European ancestry, relate to the presence of rheumatoid nodules and radiographic erosions in African Americans. Methods Two IL4R SNPs, rs1805010 and rs1801275, were genotyped in 749 patients from the Consortium for Longitudinal Evaluation of African-Americans with Early Rheumatoid Arthritis (CLEAR) registries. End points were rheumatoid nodules defined as present either by physical examination or by chest radiography and radiographic erosions (radiographs of hands/wrists and feet were scored using the modified Sharp/van der Heijde system). Statistical analyses were performed by using logistic regression modeling adjusted for confounding factors. Results Of the 749 patients with RA, 156 (20.8%) had rheumatoid nodules, with a mean age of 47.0 years, 84.6% female gender, and median disease duration of 1.9 years. Of the 461 patients with available radiographic data, 185 (40.1%) had erosions (score >0); their mean age was 46.7 years; 83.3% were women; and median disease duration was 1.5 years. Patients positive for HLA-DRB1 shared epitope (SE) and autoantibodies (rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP)) had a higher risk of developing rheumatoid nodules in the presence of the AA and AG alleles of rs1801275 (odds ratio (OR)adj = 8.08 (95% confidence interval (CI): 1.60-40.89), P = 0.01 and ORadj = 2.97 (95% CI, 1.08 to 8.17), P = 0.04, respectively). Likewise, patients positive for the HLA-DRB1 SE and RF alone had a higher risk of developing rheumatoid nodules in presence of the AA and AG alleles of rs1801275 (ORadj = 8.45 (95% CI, 1.57 to 45.44), P = 0.01, and ORadj = 3.57 (95% CI, 1.18 to 10.76), P = 0.02, respectively) and in the presence of AA allele of rs1805010 (ORadj = 4.52 (95% CI, 1.20 to 17.03), P = 0.03). No significant association was found between IL4R and radiographic erosions or disease susceptibility, although our statistical power was limited by relatively small numbers of cases and controls. Conclusions We found that IL4R SNPs, rs1801275 and rs1805010, are associated with rheumatoid nodules in autoantibody-positive African-American RA patients with at least one HLA-DRB1 allele encoding the SE. These findings highlight the need for analysis of genetic factors associated with clinical RA phenotypes in different racial/ethnic populations.

2010-01-01

261

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

262

Magnetohydrodynamic simulations of the collapsar model for early and late evolution of gamma-ray bursts.  

PubMed

I present results from magnetohydrodynamic (MHD) simulations of a gaseous envelope collapsing onto a black hole (BH). These results support the notion that the collapsar model is one of the most promising scenarios to explain the huge release of energy in a matter of seconds associated with gamma-ray bursts (GRBs). Additionally, the MHD simulations show that at late times, when the mass supply rate is expected to decrease, the region in the vicinity of the BH can play an important role in determining the rate of accretion, its time behaviour and ultimately the energy output. In particular, the magnetic flux accumulated around the BH can repeatedly stop and then restart the energy release. As proposed by Proga & Zhang, the episode or episodes of reoccurrence of accretion processes can correspond to X-ray flares discovered recently in a number of GRBs. PMID:17293321

Proga, Daniel

2007-05-15

263

Direct numerical simulation of vortex ring evolution from the laminar to the early turbulent regime  

NASA Astrophysics Data System (ADS)

Direct numerical simulation is used to study the temporal development of single vortex rings at various Reynolds numbers and core thicknesses. Qualitative differences between the evolution of thin- and thick-core rings are observed leading to a correction factor to the classical equation for the ring translational velocity. We compare the obtained linear modal growth rates with previous work, highlighting the role of the wake in triply periodic numerical simulations. The transition from a laminar to a turbulent ring is marked by the rearrangement of the outer core vorticity into a clearly defined secondary structure. The onset of the fully turbulent state is associated with shedding of the structure in a series of hairpin vortices. A Lagrangian particle analysis was performed to determine the ring entrainment and detrainment properties and to investigate the possibility of an axial flow being generated around the circumference of the core region prior to the onset of turbulence.

Archer, P. J.; Thomas, T. G.; Coleman, G. N.

264

A Systematic Review of Serum Biomarkers Anti-Cyclic Citrullinated Peptide and Rheumatoid Factor as Tests for Rheumatoid Arthritis  

PubMed Central

This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) tests in the diagnosis and prognosis of rheumatoid arthritis (RA). We reviewed publications on tests and biomarkers for early diagnosis of RA from English-language MEDLINE-indexed journals and non-MEDLINE-indexed sources. 85 publications were identified and reviewed, including 68 studies from MEDLINE and 17 non-MEDLINE sources. Anti-CCP2 assays provide improved sensitivity over anti-CCP assays and RF, but anti-CCP2 and RF assays in combination demonstrate a positive predictive value (PPV) nearing 100%, greater than the PPV of either of the tests alone. The combination also appears to be able to distinguish between patients whose disease course is expected to be more severe and both tests are incorporated in the 2010 ACR Rheumatoid Arthritis Classification Criteria. While the clinical value of anti-CCP tests has been established, differences in cut-off values, sensitivities and specificities exist between first-, second- and third-generation tests and harmonization efforts are under way. Anti-CCP and RF are clinically valuable biomarkers for the diagnosis and prognosis of RA patients. The combination of the two biomarkers in conjunction with other clinical measures is an important tool for the diagnosis and management of RA patients.

Taylor, Peter; Gartemann, Juliane; Hsieh, Jeanie; Creeden, James

2011-01-01

265

The non-linear evolution of baryonic overdensities in the early universe: initial conditions of numerical simulations  

NASA Astrophysics Data System (ADS)

We run very large cosmological N-body hydrodynamical simulations in order to study statistically the baryon fractions in early dark matter haloes. We critically examine how differences in the initial conditions affect the gas fraction in the redshift range z= 11-21. We test three different linear power spectra for the initial conditions. (1) A complete heating model, which is our fiducial model; this model follows the evolution of overdensities correctly, according to Naoz & Barkana (2005), in particular including the spatial variation of the speed of sound of the gas due to Compton heating from the CMB. (2) An equal-? model, which assumes that the initial baryon fluctuations are equal to those of the dark matter, while conserving ?8 of the total matter. (3) A mean cs model, which assumes a uniform speed of sound of the gas. The latter two models are often used in the literature. We calculate the baryon fractions for a large sample of haloes in our simulations. Our fiducial model implies that before reionization and significant stellar heating took place, the minimum mass needed for a minihalo to keep most of its baryons throughout its formation was ˜3 × 104 M?. However, the alternative models yield a wrong (higher by about 50 per cent) minimum mass, since the system retains a memory of the initial conditions. We also demonstrate this using the 'filtering mass' from linear theory, which accurately describes the evolution of the baryon fraction throughout the simulated redshift range.

Naoz, Smadar; Yoshida, Naoki; Barkana, Rennan

2011-09-01

266

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

2006-01-01

267

Fluorescence imaging of experimental rheumatoid arthritis in vivo using a fast flying-spot scanner  

NASA Astrophysics Data System (ADS)

We have developed a flying-spot scanner for fluorescence imaging of rheumatoid arthritis in the near infrared (NIR) spectral range following intravenous administration of contrast agents. The new imaging system has been characterized with respect to linearity, dynamic range and spatial resolution with the help of fluorescent phantoms. In vivo experiments were performed on an animal model of rheumatoid arthritis. Finally, NIR-fluorescence images of early stages of joint inflammation have been compared with findings from contrast enhanced MR imaging and histology.

Berger, J.; Voigt, J.; Seifert, F.; Ebert, B.; Macdonald, R.; Gemeinhardt, I.; Gemeinhardt, O.; Schnorr, J.; Taupitz, M.; Vater, A.; Vollmer, S.; Licha, K.; Schirner, M.

2007-07-01

268

Early stage formation of iron oxyhydroxides during neutralization of simulated acid mine drainage solutions.  

PubMed

The phases and stability of ferric iron products formed early during neutralization of acid mine drainage waters remain largely unknown. In this work, we used in situ and time-resolved quick-scanning X-ray absorption spectroscopy and X-ray diffraction to study products formed between 4 min and 1 h after ferric iron sulfate solutions were partially neutralized by addition of NaHCO(3) ([HCO(3)(-)]/[Fe(3+)] < 3). When [HCO(3)(-)]/[Fe(3+)] = 0.5 and 0.6 (initial pH ? 2.1 and 2.2, respectively), the only large species formed were sulfate-complexed ferrihydrite-like molecular clusters that were stable throughout the duration of the experiment. When [HCO(3)(-)]/[Fe(3+)] = 1 (initial pH ? 2.5), ferrihydrite-like molecular clusters formed initially, but most later converted to schwertmannite. In contrast, when [HCO(3)(-)]/[Fe(3+)] = 2 (initial pH ? 2.7), schwertmannite and larger ferrihydrite particles formed immediately upon neutralization. However, the ferrihydrite particles subsequently converted to schwertmannite. The schwertmannite particles formed under both conditions aggregated extensively with increasing time. This work provides new insight into the formation, stability and reactivity of some early products that may form during the neutralization of natural acid mine drainage. PMID:22765054

Zhu, Mengqiang; Legg, Benjamin; Zhang, Hengzhong; Gilbert, Benjamin; Ren, Yang; Banfield, Jillian F; Waychunas, Glenn A

2012-07-18

269

Purine enzyme activities in recent onset rheumatoid arthritis: are there differences between patients and healthy controls?  

PubMed Central

OBJECTIVE: Purine enzyme activities may predict the effectiveness of azathioprine treatment and be associated with increased deaths from infectious diseases. In rheumatoid arthritis, patients show variable responses to azathioprine and a higher percentage of death is caused by infections. The aim of the study was to investigate possible rheumatoid arthritis associated abnormalities of purine enzyme activities by measuring several of these enzymes in patients with recent onset rheumatoid arthritis before treatment with disease modifying antirheumatic drugs or prednisone. METHODS: 23 patients with recent onset rheumatoid arthritis and 28 healthy controls were studied. Activities of the enzymes 5'-nucleotidase, purine nucleoside phosphorylase (PNP), hypoxanthine guanine phosphoribosyltransferase (HGPRT), and thiopurine methyltransferase (TPMT) were measured. Assessment of disease activity and blood sampling for routine measurements and HLA typing were done simultaneously. RESULTS: Purine enzyme activities did not differ between patients and healthy controls. Enzyme activities had no significant relations with indices of disease activity or rheumatoid factor titre or with the rheumatoid arthritis associated HLA types. Activity of 5'nucleotidase decreased with age (P < or = 0.05) and was lower by about 27% (P = 0.007) in males than in females. CONCLUSIONS: In rheumatoid arthritis patients, neither the variability in azathioprine effectiveness nor the increased death rate from infections can be explained by pre-existing abnormalities in the activities of the purine enzymes 5'-nucleotidase, PNP, HGPRT, or TPMT at an early stage of the disease, before disease modifying antirheumatic drugs or prednisone treatment. Besides adjustment for age, results of studies involving purine 5' nucleotidase activity should also be adjusted for sex.

Stolk, J N; Boerbooms, A M; De Abreu, R A; Kerstens, P J; de Koning, D G; de Graaf, R; Mulder, J; van de Putte, L B

1996-01-01

270

Cytokines in the pathogenesis of rheumatoid arthritis  

Microsoft Academic Search

Cytokines regulate a broad range of inflammatory processes that are implicated in the pathogenesis of rheumatoid arthritis. In rheumatoid joints, it is well known that an imbalance between pro- and anti-inflammatory cytokine activities favours the induction of autoimmunity, chronic inflammation and thereby joint damage. However, it remains less clear how cytokines are organized within a hierarchical regulatory network, and therefore

Georg Schett; Iain B. McInnes

2007-01-01

271

Multiple peripheral pulmonary nodules preceding rheumatoid arthritis  

Microsoft Academic Search

The case of a young woman is reported, presenting multiple peripheral lung nodules, preceding the onset of classical rheumatoid arthritis 3 months later. The nodules observed seemed to be of pleural origin because they all had contact with the pleura which was partly thickened as demonstrated by computer-assisted tomography. The histopathology of material obtained by an open-lung biopsy revealed rheumatoid

H. G. Niisslein; W. Rödl; J. Giedel; M. Missmahl; J. R. Kalden

1987-01-01

272

Roles of B cells in rheumatoid arthritis  

Microsoft Academic Search

B lymphocytes play several critical roles in the pathogenesis of rheumatoid arthritis. They are the source of the rheumatoid factors and anticitrullinated protein antibodies, which contribute to immune complex formation and complement activation in the joints. B cells are also very efficient antigen-presenting cells, and can contribute to T cell activation through expression of costimulatory molecules. B cells both respond

Gregg J Silverman; Dennis A Carson

2003-01-01

273

Rheumatoid Factors: Good or Bad for You?  

Microsoft Academic Search

Background: Rheumatoid factors (RFs) are autoantibodies associated with rheumatoid arthritis. They can be detected in normal individuals, although transiently. This dichotomy has led to questions about the origins and types of RFs. Recently it has been shown that B cells that produce RFs only do so when activated by two signals, one from engagement of the B-cell receptor and the

Urszula M. Nowak; Marianna M. Newkirk

2005-01-01

274

Perichondrial wrist arthroplasty in rheumatoid patients.  

PubMed

A new method is proposed for reconstruction of the wrist joint in rheumatoid arthritis. Perichondrial arthroplasty done in four patients with severe deformity of the wrist from rheumatoid arthritis gave functionally improved results. In one case biopsy of the reconstructed joint showed newly formed cartilaginous tissue four months after initial surgery. PMID:488794

Pastacaldi, P; Engkvist, O

1979-06-01

275

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

2008-01-01

276

History of enteric coated sulfasalazine in rheumatoid arthritis.  

PubMed

Sulfasalazine was synthesized almost 50 years ago specifically to treat rheumatoid arthritis. At that time bacterial infection was believed to be an important factor in pathogenesis. The linkage of sulfapyridine and salicylate with an azobond was viewed as a method of combining antibacterial and antiinflammatory actions while minimizing gastric irritation. Early therapeutic results were encouraging, but the drug was discarded as an antirheumatic agent for 30 years, until its serendipitous rediscovery. Subsequent controlled trials have confirmed its efficacy, which may be related to sulfasalazine itself or to the sulfapyridine moiety. PMID:2903922

Pinals, R S

1988-09-01

277

Automated radiographic absorptiometry system for quantitative rheumatoid arthritis assessment  

NASA Astrophysics Data System (ADS)

Quantifying disease progression of patients with early stage Rheumatoid Arthritis (RA) presents special challenges. Establishing a robust and reliable method that combines the ACR criteria with bone and soft-tissue measurement techniques, would make possible the diagnosis of early RA and/or the monitoring of the progress of the disease. In this paper an automated, reliable and robust system that combines the ACR criteria with radiographic absorptiometry based bone and soft-tissue density measurement techniques is presented. The system is comprised of an image digitization component and an automated image analysis component. Radiographs of the hands and the calibration wedges are acquired and digitized following a standardized procedure. The image analysis system segments the relevant joints into soft-tissue and bone regions and computes density values of each of these regions relative to the density of the reference wedges. Each of the joints are also scored by trained radiologists using the well established ACR criteria. The results of this work indicate that use of standardized imaging procedures and robust image analysis techniques can significantly improve the reliability of quantitative measurements for rheumatoid arthritis assessment. Furthermore, the methodology has the potential to be clinically used in assessing disease condition of early stage RA subjects.

Swarnakar, Vivek; Fan, Bo; Genant, Harry K.

2001-07-01

278

Idiopathic membranous nephropathy preceding the onset of rheumatoid arthritis: a case report.  

PubMed

Introduction: Membranous nephropathy (MN) in the context of rheumatoid arthritis (RA), is often an iatrogenic complication due to the nephrotoxic effects of antirheumatic drugs. Rare cases of non-iatrogenic association between these two diseases were reported in the literature. Case report: A 30-year-old female patient presented in September 2005 with nephrotic syndrome. Renal biopsy showed features consistent with MN. Search for etiology was negative, particularly lupus serology which remained negative throughout the course of her illness. Accordingly, she was diagnosed as a case of idiopathic MN. Initially, she was treated with angiotensin converting enzyme inhibitors and angiotensin receptor blockers which maintained her protein excretion below nephrotic range for two years. Her nephrotic syndrome then relapsed and was treated with steroids and chlorambucil, according to the Ponticelli protocol. A few months later, she presented with early morning joint stiffness, polyarthritis involving the small joints of the hands, and strongly positive rheumatoid factor, fulfilling the diagnostic criteria of rheumatoid arthritis (RA). Her serum creatinine remained normal and a second renal biopsy revealed the same features of MN. Her RA was treated with pulsed methylprednisolone followed by oral steroids and methotrexate resulting in remission of the joints disease and the nephrotic syndrome. Remission was maintained for the last two years up to the time of this report. Conclusion: We hereby report a case of secondary membranous nephropathy that preceded the onset of rheumatoid arthritis by three years. Keywords: Auto-immunity; Membranous nephropathy; Rheumatoid arthritis. PMID:24053746

Haddiya, Intissar; Rhou, Hakima; Benamar, Loubna; Ezzaitouni, Fatima; Bayahia, Rabia; Ouzeddoun, Naima

2013-09-01

279

Computer aided graphics simulation modelling using seismogeologic approach in sequence stratigraphy of Early Cretaceous Punjab platform, Central Indus Basin, Pakistan  

SciTech Connect

Modelling stratigraphic sequence by using seismo-geologic approach, integrated with cyclic transgressive-regressive deposits, helps to identify a number of non-structural subtle traps. Most of the hydrocarbons found in Early Cretaceous of Central Indus Basin pertain to structural entrapments of upper transgressive sands. A few wells are producing from middle and basal regressive sands, but the massive regressive sands have not been tested so far. The possibility of stratigraphic traps like wedging or pinch-out, a lateral gradation, an uplift, truncation and overlapping of reservoir rocks is quite promising. The natural basin physiography at times has been modified by extensional episodic events into tectono-morphic terrain. Thus, seismo scanning of tectonically controlled sedimentation might delineate some subtle stratigraphic traps. Amplitude maps representing stratigraphic sequences are generated to identify the traps. Seismic expressions indicate the reservoir quality in terms of amplitude increase or decrease. The data is modelled on computer using graphics simulation techniques.

Qureshi, T.M.; Khan, K.A. [Oil and Gas Development Corporation, Islamabad (Pakistan)

1996-08-01

280

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.  

PubMed

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

2012-09-07

281

Metabolic Syndrome in Rheumatoid Arthritis  

PubMed Central

Insulin resistance is an essential feature of the metabolic syndrome that has been linked to rheumatoid arthritis (RA). Understanding how inflammation arising in one tissue affects the physiology and pathology of other organs remains an unanswered question with therapeutic implications for chronic conditions including obesity, diabetes mellitus, atherosclerosis, and RA. Adipokines may play a role in the development of atherogenesis in patients with RA. Biologic therapies, such as TNF-? antagonists, that block proinflammatory cytokines have beneficial effects on the insulin resistance that is often observed in patients with RA.

Ferraz-Amaro, Ivan; Gonzalez-Juanatey, Carlos; Lopez-Mejias, Raquel; Riancho-Zarrabeitia, Leyre; Gonzalez-Gay, Miguel A.

2013-01-01

282

Marine methane cycle simulations for the period of early global warming  

NASA Astrophysics Data System (ADS)

Geochemical environments, fates, and effects are modeled for methane released into seawater by the decomposition of climate-sensitive clathrates. A contemporary global background cycle is first constructed, within the framework of the Parallel Ocean Program. Input from organics in the upper thermocline is related to oxygen levels, and microbial consumption is parameterized from available rate measurements. Seepage into bottom layers is then superimposed, representing typical seabed fluid flow. The resulting CH4 distribution is validated against surface saturation ratios, vertical sections, and slope plume studies. Injections of clathrate-derived methane are explored by distributing a small number of point sources around the Arctic continental shelf, where stocks are extensive and susceptible to instability during the first few decades of global warming. Isolated bottom cells are assigned dissolved gas fluxes from porous-media simulation. Given the present bulk removal pattern, methane does not penetrate far from emission sites. Accumulated effects, however, spread to the regional scale following the modeled current system. Both hypoxification and acidification are documented. Sensitivity studies illustrate a potential for material restrictions to broaden the perturbations, since methanotrophic consumers require nutrients and trace metals. When such factors are considered, methane buildup within the Arctic basin is enhanced. However, freshened polar surface waters act as a barrier to atmospheric transfer, diverting products into the deep return flow. Uncertainties in the logic and calculations are enumerated including those inherent in high-latitude clathrate abundance, buoyant effluent rise through the column, representation of the general circulation, and bacterial growth kinetics.

Elliott, Scott; Maltrud, Mathew; Reagan, Matthew; Moridis, George; Cameron-Smith, Philip

2011-03-01

283

Color matrix display simulation based upon luminance and chromatic contrast sensitivity of early vision  

NASA Astrophysics Data System (ADS)

This paper describes the design and operation of a new simulation model for color matrix display development. It models the physical structure, the signal processing, and the visual perception of static displays, to allow optimization of display design parameters through image quality measures. The model is simple, implemented in the Mathematica computer language, and highly modular. Signal processing modules operate on the original image. The hardware modules describe backlights and filters, the pixel shape, and the tiling of the pixels over the display. Small regions of the displayed image can be visualized on a CRT. Visual perception modules assume static foveal images. The image is converted into cone catches and then into luminance, red-green, and blue-yellow images. A Haar transform pyramid separates the three images into spatial frequency and direction-specific channels. The channels are scaled by weights taken from human contrast sensitivity measurements of chromatic and luminance mechanisms at similar frequencies and orientations. Each channel provides a detectability measure. These measures allow the comparison of images displayed on prospective devices and, by that, the optimization of display designs.

Martin, Russel A.; Ahumada, Albert J., Jr.; Larimer, James O.

284

Marine methane cycle simulations for the period of early global warming  

SciTech Connect

Geochemical environments, fates, and effects are modeled for methane released into seawater by the decomposition of climate-sensitive clathrates. A contemporary global background cycle is first constructed, within the framework of the Parallel Ocean Program. Input from organics in the upper thermocline is related to oxygen levels, and microbial consumption is parameterized from available rate measurements. Seepage into bottom layers is then superimposed, representing typical seabed fluid flow. The resulting CH{sub 4} distribution is validated against surface saturation ratios, vertical sections, and slope plume studies. Injections of clathrate-derived methane are explored by distributing a small number of point sources around the Arctic continental shelf, where stocks are extensive and susceptible to instability during the first few decades of global warming. Isolated bottom cells are assigned dissolved gas fluxes from porous-media simulation. Given the present bulk removal pattern, methane does not penetrate far from emission sites. Accumulated effects, however, spread to the regional scale following the modeled current system. Both hypoxification and acidification are documented. Sensitivity studies illustrate a potential for material restrictions to broaden the perturbations, since methanotrophic consumers require nutrients and trace metals. When such factors are considered, methane buildup within the Arctic basin is enhanced. However, freshened polar surface waters act as a barrier to atmospheric transfer, diverting products into the deep return flow. Uncertainties in the logic and calculations are enumerated including those inherent in high-latitude clathrate abundance, buoyant effluent rise through the column, representation of the general circulation, and bacterial growth kinetics.

Elliott, S.; Maltrud, M.; Reagan, M.T.; Moridis, G.J.; Cameron-Smith, P.J.

2011-01-02

285

Postcollapse hydrodynamics of SN 1987A - Two-dimensional simulations of the early evolution  

SciTech Connect

The first few seconds of the explosion of SN 1987A are modeled here using a 2D cylindrical geometry smooth particle hydrodynamics code. The success of the explosion is determined to be sensitive to the duration of the infall, the timing of the bounce, and the subsequent neutrino heating. A semianalytical model for the initial structure of the collapsed object is used to present two simulations that differ by the mass that has been allowed to collapse into a neutron star prior to the bounce. In the case of a short initial infall, the explosion fails due to excessive cooling. For a longer initial infall, the cooling is less and the explosion is successful although relatively weak. It is shown that in this case, a successful explosion is brought about by the presence of an entropy gradient which, combined with the gravitational pull of the neutron star, leads to extremely strong instabilities. The critical importance of the global circulation for the success of the explosion is demonstrated. 43 refs.

Herant, M.; Benz, W.; Colgate, S. (Harvard-Smithsonian Center for Astrophysics, Cambridge, MA (United States) Steward Observatory, Tucson, AZ (United States) Los Alamos National Laboratory, NM (United States))

1992-08-01

286

Spotlight on infliximab in Crohn disease and rheumatoid arthritis.  

PubMed

Infliximab (Remicade) is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha that has shown efficacy in Crohn disease and rheumatoid arthritis with a disease-modifying activity and rapid onset of action. It is administered intravenously, generally in a schedule with initial infusions at 0, 2, and 6 weeks, followed by administration once every 8 weeks. Infliximab is effective in the treatment of patients with moderately to severely active Crohn disease with an inadequate response to other treatment options or those with fistulizing disease. In combination with methotrexate, infliximab reduced signs and symptoms and delayed disease progression in patients with active, methotrexate-refractory rheumatoid arthritis and in those with early disease. The drug was generally well tolerated. Recrudescence of tuberculosis infection and worsening of heart failure and demyelinating disease are among some of the concerns with anti-TNFalpha therapy, requiring cautious use of these agents in high-risk patients. Current data suggest that infliximab may be cost effective, especially when long-term clinical outcomes and burden of the diseases are taken into account. More robust, prospective pharmacoeconomic studies are required to better ascertain the cost effectiveness of infliximab. Direct head-to-head comparative trials of infliximab with other biological agents are not yet available and would be helpful in determining with greater certainty the place of infliximab in the management of these diseases. Nonetheless, infliximab, like other biological agents, is a valuable treatment option in patients with moderately to severely active Crohn disease (including fistulizing disease) or rheumatoid arthritis (including early disease). PMID:16573354

Siddiqui, M Asif A; Scott, Lesley J

2006-01-01

287

Rejuvenating the immune system in rheumatoid arthritis.  

PubMed

In rheumatoid arthritis (RA), the aging process of the immune system is accelerated. Formerly, this phenomenon was suspected to be a consequence of chronic inflammatory activity. However, newer data strongly suggest that deficiencies in maintaining telomeres and overall DNA stability cause excessive apoptosis of RA T cells, imposing proliferative pressure and premature aging on the system. Already during the early stages of their life cycle, and long before they participate in the inflammatory process, RA T cells are lost owing to increased apoptotic susceptibility. A search for underlying mechanisms has led to the discovery of defective pathways of repairing broken DNA and elongating and protecting telomeric sequences at the chromosomal ends. Two enzymatic machineries devoted to DNA repair and maintenance have been implicated. RA T cells fail to induce sufficient amounts of the telomeric repair enzyme telomerase, leaving telomeric ends uncapped and thus susceptible to damage. Of equal importance, RA T cells produce low levels of the DNA repair enzyme ataxia telangiectasia mutated and the complex of nucleoproteins that sense and fix DNA double-strand breaks. The inability to repair damaged DNA renders naive T cells vulnerable to apoptosis, exhausts T-cell regeneration and reshapes the T cell repertoire. Therapeutic attempts to reset the immune systems of patients with RA and prevent premature immunosenescence should include restoration of DNA repair capability. PMID:19798035

Weyand, Cornelia M; Fujii, Hiroshi; Shao, Lan; Goronzy, Jörg J

2009-10-01

288

Predicting factors for severity of rheumatoid arthritis: a prospective multicenter cohort study of 172 patients over 3 years.  

PubMed

Rheumatoid arthritis may take an unfavourable course leading to rapid functional decline in a certain percentage of patients. Early identification of these patients is desirable. The aim of this study was to evaluate clinical and laboratory parameters for their value in the prediction of bad outcome. A total of 172 patients with early arthritis were followed for 3 years. Higher initial values for erythrocyte sedimentation rate, IgG and IgM rheumatoid factor, serum concentration of cartilage oligomeric matrix protein, Health Assessment Questionnaire score, Larsen score of feet, disease activity score, and swollen and tender joint count predicted worse outcome. An association with the presence of IgA rheumatoid factor or anti-cyclic-citrullinated peptide could not be established. We conclude that prognosis in an individual with rheumatoid arthritis depends on many factors. The determination of independent prognostic factors for progression of rheumatoid arthritis is a valuable tool in early arthritis to select patients for more aggressive therapy. PMID:17429638

Wagner, E; Ammer, K; Kolarz, G; Krajnc, I; Palkonyai, E; Scherak, O; Schödl, C; Singer, F; Temesvari, P; Wottawa, A

2007-04-11

289

Epigenetic modifications in rheumatoid arthritis  

PubMed Central

Over the last decades, genetic factors for rheumatoid diseases like the HLA haplotypes have been studied extensively. However, during the past years of research, it has become more and more evident that the influence of epigenetic processes on the development of rheumatic diseases is probably as strong as the genetic background of a patient. Epigenetic processes are heritable changes in gene expression without alteration of the nucleotide sequence. Such modifications include chromatin methylation and post-translational modification of histones or other chromatin-associated proteins. The latter comprise the addition of methyl, acetyl, and phosphoryl groups or even larger moieties such as binding of ubiquitin or small ubiquitin-like modifier. The combinatory nature of these processes forms a complex network of epigenetic modifications that regulate gene expression through activation or silencing of genes. This review provides insight into the role of epigenetic alterations in the pathogenesis of rheumatoid arthritis and points out how a better understanding of such mechanisms may lead to novel therapeutic strategies.

Strietholt, Simon; Maurer, Britta; Peters, Marvin A; Pap, Thomas; Gay, Steffen

2008-01-01

290

The Synovium in Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis (RA) is a chronic autoimmune disease targeting multiple joints. The synovium is the primary site of the inflammatory process, which if untreated leads to irreversible damage to the adjacent cartilage and bone. It is now well established that autoantibodies that are characteristic of RA, including rheumatoid factor (RF) and anti-citrulluninated protein antibodies (ACPA), are present before clinical disease onset. Studies in both humans and animal models are beginning to provide new insights into how this asymptomatic autoimmunity evolves into an inflammatory process that is localized in the synovium. Once RA synovitis established, a number of amplification mechanisms serve to sustain the process leading to the persistence of the disease. These mechanisms include engagement of the resident mesenchymal cells and the establishment of ectopic lymphoid structures in the synovium, although the relationship between these lymphoid structures and the presence of RA autoantibodies remains unclear. An enhanced understanding of the mechanisms that initiate and sustain RA synovitis offers unprecedented opportunities for therapeutics, and ultimately prevention strategies.

Hitchon, Carol A; El-Gabalawy, Hani S

2011-01-01

291

Classification criteria for rheumatoid arthritis and ankylosing spondylitis.  

PubMed

The history of classification and diagnostic criteria for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is similar and different. Important criteria sets have been published for both disease in the mid eighties, for AS in 1984 and for RA in 1987. The leading clinical symptoms, inflammatory back pain (IBP) in AS and the predominant polyarticular symmetric involvement of the hands in RA were, of course, central, and so was morning stiffness as a major clinical sign of an inflammatory disease state. In RA, there was more focus on laboratory parameters (rheumatoid factor), while this could have been the case also in AS (HLA B27) but this was not recognized at this point in time. In contrast, imaging has played a more important role in AS - especially because the sacroiliac joints are involved in the vast majority of AS patients, while in RA radiographic changes of the joints of hands and feet may contribute to the diagnosis. However, in both diseases, early structural changes visualized by conventional radiography rather have prognostic impact since these patients are much more likely to progress in comparison to others who do not have cartilage and joint damage early in the course of the disease. Further developments of criteria for AS have broadened the spectrum of AS to spondyloarthritis (SpA) and axial SpA which covers most early forms. The leading clinical symptom is chronic back pain in young adults and IBP. New criteria for RA which include more patients with early disease and anti-CCP antibodies as new markers are being developed. This is important since early treatment strategies are increasingly and successfully used to treat inflammatory diseases more efficiently. PMID:19822049

Braun, J; Sieper, J

292

Differential Reactivity of Rheumatoid Synovial Cells and Serum Rheumatoid Factors to Human Immunoglobulin G Subclasses 1 and 3 and Their CH3 Domains in Rheumatoid Arthritis.  

National Technical Information Service (NTIS)

Nineteen S Immunoglobulin M rheumatoid factors (RF) are polyclonal autoantibodies that may play an important pathogenic role in sustaining inflammatory synovitis in rheumatoid arthritis (RA). RF in RA have reactivity for as-yet-uncharacterized antigenic d...

D. L. Robbins W. F. Benisek E. Benjamini R. Wistar

1987-01-01

293

The role of the circadian clock in rheumatoid arthritis  

PubMed Central

Rheumatoid arthritis exhibits diurnal variation in symptoms, with patients suffering with increased painful joint stiffness in the early morning. This correlates with an early morning rise in circulating levels of pro-inflammatory cytokines, such as interleukin-6. This temporal variation in disease pathology is directed by the circadian clock, both at a systemic level, through signalling pathways derived in the central clock, and at a local level by autonomous clocks found within inflammatory organs and cells. Indeed, many cellular components of the immune system, which are involved in the pathogenesis of rheumatoid arthritis, possess independent clocks that facilitate temporal gating of their functions. Furthermore, the circadian clock regulates the expression and activity of several genes and proteins that have demonstrated roles in progression of this autoimmune disease. These include a number of nuclear receptors and also fat-derived adipokines. Employing the knowledge we have about how the inflammatory response is regulated by the clock will facilitate the development of chronotherapy regimens to improve the efficacy of current treatment strategies. Furthermore, a full understanding of the mechanisms by which the clock couples to the immune system may provide novel therapeutic targets for the treatment of this debilitating disease.

2013-01-01

294

Comparison of simulated changes of climate in Asia for two scenarios: Early Miocene to present, and present to future enhanced greenhouse  

Microsoft Academic Search

We use a climate model (GENESIS) to simulate the changes in climate associated with two scenarios, one from the past and one from the future, with a focus on the Asian continent. The two scenarios are: (1) Early Miocene to Present—a period of uplift of the Himalayan–Tibetan plateau and of decreasing concentration of atmospheric carbon dioxide, and (2) Present to

John E. Kutzbach; P. Behling

2004-01-01

295

Modeling and simulation of blast-induced, early-time intracranial wave physics leading to traumatic brain injury.  

SciTech Connect

The objective of this modeling and simulation study was to establish the role of stress wave interactions in the genesis of traumatic brain injury (TBI) from exposure to explosive blast. A high resolution (1 mm{sup 3} voxels), 5 material model of the human head was created by segmentation of color cryosections from the Visible Human Female dataset. Tissue material properties were assigned from literature values. The model was inserted into the shock physics wave code, CTH, and subjected to a simulated blast wave of 1.3 MPa (13 bars) peak pressure from anterior, posterior and lateral directions. Three dimensional plots of maximum pressure, volumetric tension, and deviatoric (shear) stress demonstrated significant differences related to the incident blast geometry. In particular, the calculations revealed focal brain regions of elevated pressure and deviatoric (shear) stress within the first 2 milliseconds of blast exposure. Calculated maximum levels of 15 KPa deviatoric, 3.3 MPa pressure, and 0.8 MPa volumetric tension were observed before the onset of significant head accelerations. Over a 2 msec time course, the head model moved only 1 mm in response to the blast loading. Doubling the blast strength changed the resulting intracranial stress magnitudes but not their distribution. We conclude that stress localization, due to early time wave interactions, may contribute to the development of multifocal axonal injury underlying TBI. We propose that a contribution to traumatic brain injury from blast exposure, and most likely blunt impact, can occur on a time scale shorter than previous model predictions and before the onset of linear or rotational accelerations traditionally associated with the development of TBI.

Ford, Corey C. (University of New Mexico, Albuquerque, NM); Taylor, Paul Allen

2008-02-01

296

Rheumatoid Factors in Salmonelia and Schistosoma Infections.  

National Technical Information Service (NTIS)

Rheumatodi serum factors (anti-globulin antibodies) were studied in chronic salmonella bacteriaemia associated with schistosomiasis, in acute typhoid and paratyphoid fevers, and in schistosomiasis. Rheumatoid factor existed in high frequency and high titr...

J. S. Lehman G. I. Higashi S. Bassily Z. Farid

1972-01-01

297

Vocational Rehabilitation for Persons with Rheumatoid Arthritis.  

ERIC Educational Resources Information Center

Useful vocational rehabilitation strategies for persons with rheumatoid arthritis include (1) management of symptoms and reduction of energy demand; (2) reasonable job accommodations; (3) identification of suitable jobs and necessary training; and (4) enhancement of self-advocacy skills. (SK)

Allaire, Saralynn H.

1998-01-01

298

Leprosy and rheumatoid arthritis: consequence or association?  

PubMed

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

2012-08-13

299

Rheumatoid lymphadenopathy: a morphological and immunohistochemical study.  

PubMed Central

Sixteen lymph nodes from 14 patients with rheumatoid arthritis were examined immunohistochemically and morphometrically and compared with 10 control nodes showing follicular hyperplasia from patients without rheumatoid disease. Frozen material was available from nine patients and all controls. The nodes from patients with rheumatoid arthritis seemed to share characteristic features. The most striking of these was follicular hyperplasia in which the germinal centres, in spite of being quite large, showed relatively sparse proliferative activity. The nodes often showed infiltration of germinal centres by CD8 positive T lymphocytes and contained fewer IL2R positive cells in the paracortex than controls. These and other features may have some correlation with disease activity. Lymphadenopathy in rheumatoid arthritis may not just be a manifestation of joint inflammation but an active component of this multisystem disease and may reflect a widespread immunological abnormality. Images

Kondratowicz, G M; Symmons, D P; Bacon, P A; Mageed, R A; Jones, E L

1990-01-01

300

Vocational Rehabilitation for Persons with Rheumatoid Arthritis.  

ERIC Educational Resources Information Center

|Useful vocational rehabilitation strategies for persons with rheumatoid arthritis include (1) management of symptoms and reduction of energy demand; (2) reasonable job accommodations; (3) identification of suitable jobs and necessary training; and (4) enhancement of self-advocacy skills. (SK)|

Allaire, Saralynn H.

1998-01-01

301

Tight control applied to the biological therapy of rheumatoid arthritis.  

PubMed

In the last decade, treatment strategies for rheumatoid arthritis (RA) have included the early use of disease-modifying anti-rheumatic drugs, since prompt suppression of disease activity is associated with a reduction in radiological damage. This strategy has now been incorporated into the broader concept of "tight control", defined as a treatment strategy tailored to each patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time. To pursue this goal, tight control should include careful and continuous monitoring of disease activity, and early therapeutic adjustments or switches should be considered as necessary. It is noteworthy that the key role of tight control of RA has been stressed by the recent EULAR Guidelines. This review discusses the most recent evidence concerning the role of a tight control strategy in the treatment of RA, and on how this strategy should be pursued. PMID:23219770

Epis, Oscar Massimiliano; Giacomelli, Luca; Deidda, Silvia; Bruschi, Eleonora

2012-12-03

302

Cardiovascular risk in rheumatoid arthritis: pathogenesis, diagnosis, and management.  

PubMed

Rheumatoid arthritis is characterized by early and accelerated atherosclerosis leading to increased cardiovascular morbidity and mortality. Beyond traditional cardiovascular risk factors, several pathogenetic mechanisms have been proposed, including emerging inflammatory and autoimmune mechanisms. Inflammatory stimuli are now believed to cause vascular damage, which can be estimated by well-established noninvasive techniques. Carotid intima-media thickness, pulse-wave velocity and flow-mediated dilatation, markers of subclinical atherosclerosis, arterial stiffness, and endothelial function, respectively, have been recently used to detect vascular dysfunction in the wide spectrum of autoimmune diseases. The role of anti-tumor necrosis factor ? and novel biologic agents remains unclear, although early control of the inflammatory process seems crucial for reducing cardiovascular risk. Considering the importance of cardiovascular risk management, further well-designed studies are warranted to clarify the potential benefits and harms of anti-inflammatory treatment. PMID:23188207

Gkaliagkousi, Eugenia; Gavriilaki, Eleni; Doumas, Michael; Petidis, Konstantinos; Aslanidis, Spyros; Stella, Douma

2012-12-01

303

Rheumatoid arthritis mimicking metastatic squamous cell carcinoma  

Microsoft Academic Search

We report a case of a cervical rheumatoid nodule in close relation to the hyoid bone mimicking a metastatic carcinoma. A 74-year-old\\u000a female with a 15-year history of rheumatoid arthritis (RA) on treatment with methotrexate presented with tenderness of the\\u000a right base of tongue. Imaging demonstrated a 1.4 cm cystic lesion at the hyoid bone. Biopsies were unsuccessful and the

Fernando Gomez-Rivera; Adel K El-Naggar; Nandita Guha-Thakurta; Michael E Kupferman

2011-01-01

304

Pathogenesis and Therapy of Rheumatoid Arthritis  

Microsoft Academic Search

Rheumatoid arthritis is a chronic disabling disease affecting at least 1% of the population on a worldwide basis. Research\\u000a aimed at understanding the pathogenesis of this disease led to the identification of TNF? as a major pro-inflammatory cytokine\\u000a expressed in the inflamed joints of patients with rheumatoid arthritis. Subsequently, in vitro studies provided evidence to\\u000a suggest that TNF? played an important role in

R. O. Williams

305

Gastrointestinal and Hepatic Manifestations of Rheumatoid Arthritis  

Microsoft Academic Search

Rheumatoid arthritis (RA), characterized by inflammation of the synovium and surrounding structures, has a prevalence of 0.5–1%.\\u000a Rheumatoid vasculitis (RV) is an inflammatory condition of the small- and medium-sized vessels that affects up to 5% of patients\\u000a with RA with intestinal involvement in 10–38% of these cases. Clinically apparent RV of the gastrointestinal (GI) tract, while\\u000a rare, is often catastrophic,

Ellen C. Ebert; Klaus D. Hagspiel

2011-01-01

306

Macrophagic myofascitis associated with rheumatoid arthritis  

Microsoft Academic Search

Macrophagic myofascitis (MMF) is an unusual inflammatory myopathy characterized by muscle infiltration by macrophages and\\u000a lymphocytes. Here, we describe a case of MMF which is associated with rheumatoid arthritis. A 53-year-old Japanese rheumatoid\\u000a arthritis (RA) patient presented with focal tenderness of lower extremities. Magnetic resonance imaging showed evidence of\\u000a myofascitis involving fascias of anterior tibialis muscle. Muscle biopsy showed a

Kiyoshi Migita; Ruka Ueda-Nakata; Tomoko Masuda; Taichiro Miyashita; Tomohiro Koga; Yasumori Izumi; Katsuhiro Ichinose; Hironori Ezaki; Masahiro Ito; Masakatsu Motomura; Katsumi Eguchi

2010-01-01

307

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

2013-01-01

308

Early-season effects of solar UV-B enhancement on plant canopy structure, simulated photosynthesis and competition  

SciTech Connect

Mixed-species stands of wheat (Triticum aestivum) and wild oat (Avena fatua) were exposed to enhanced solar UV-B radiation simulating a 20% reduction in column ozone to assess the timing and seasonal development of the UV-B-induced alterations in competitive balance between these species. Results from two years of field studies revealed that UV-B enhancement did not significantly affect the magnitude or timing of seeding emergence of the combined-species LAI of 4-week old mixtures (near 2 for both years). The UV-B did, however, significantly increase (5-9%) the relative proportion of the mixture LAI contributed by wheat which then resulted in a 6-8% increase in its calculated relative light interception and canopy carbon gain. These findings, and others indicate that the effects of enhanced UV-B on competitive balance are realized very early during canopy development and suggest that UV-B-induced alterations in seedling growth may have peristent and significant consequences for light competition later in the growing season.

Barnes, P.W.; Flint, S.D.; Caldwell, M.M. (Southwest Texas State Univ., San Marcos, TX (United States))

1994-06-01

309

Molecular dynamical simulation of the behavior of early precipitated stage in aging process in dilute Cu-Cr alloy  

SciTech Connect

The aging behaviors of Cu-Cr alloys in the early stage at different temperatures are investigated by molecular dynamics simulations. First principles potentials are used for the interactions between Cu and Cr atoms. The initial behavior of precipitation is characterized by transmission electron microscope and electron energy disperse spectroscopy. The results showed that Cu-Cr supersaturated solid solution is thermodynamically unstable. The mean-square displacements of the atoms are used to describe the diffusivity. At room temperature, the atoms only show harmonic vibrations near the equilibrium positions. The mutual diffusion at 873 K is different from the unidirectional diffusion in low temperatures. The calculation shows that aging process is accelerated with increasing temperature, which is not only due to the lower diffusion activation energy of Cr at higher temperature, but also because Cu atoms are also participated in the aging process. When ''aging'' at 1073 K, the precipitation of Cr element is dissolved again into Cu matrix, which is an ''over-aging'' state of Cu-Cr alloy at high temperature.

Feng, J.; Liu, L.; Chen, J.; Du, Y.; Zhou, R. [Key Laboratory of Advanced Materials of Precious-Nonferrous Metals, Education Ministry of China, and Key Lab of Advanced Materials of Yunnan Province, Kunming University of Science and Technology, Kunming 650093 (China); Xiao, B. [Department of Physics, School of Science and Engineering, Tulane University, New Orleans 70118 (United States)

2010-06-15

310

Pharmacotherapy Options in Rheumatoid Arthritis  

PubMed Central

Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-modifying antirheumatic drugs. Current clinical practice guidelines recommend that clinicians start biologic agents if patients have suboptimal response or intolerant to one or two traditional disease modifying agents (DMARDs). Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine are the commonly used DMARDs. Currently, anti-TNF is the commonly used first line biologic worldwide followed by abatacept and it is usually combined with MTX. There is some evidence that tocilizumab is the most effective biologic as a monotherapy agent. Rituximab is generally not used as a first line biologic therapy due to safety issues but still as effective as anti-TNF. The long term data for the newer oral small molecule biologics such as tofacitinib is not available and hence used only as a last resort.

Kumar, Pradeep; Banik, Snehashish

2013-01-01

311

Rheumatoid arthritis: GWAS or TMI?  

PubMed

Genome-wide association studies are the most comprehensive and straightforward approach to teasing out the identity of genetic polymorphisms associated with any given disease or characteristic. With the availability of DNA banks from large cohorts of ethnically matched patients and healthy individuals it is now possible to define even marginal genetic associations between genetic polymorphisms and diseases. As increasing numbers of these studies are carried out and as associations with smaller and smaller risks are identified, there is the growing concern that the findings will be of increasingly marginal value. Thus, the glut of new genetic associations is rapidly overwhelming our interest in the results, a situation that could be described as TMI (too much information). Recent genetic association studies in rheumatoid arthritis suggest that we may be approaching the TMI stage of genome-wide association studies. PMID:19863773

Cronstein, Bruce N

2009-10-27

312

[Team management of rheumatoid arthritis].  

PubMed

The main objectives of team management of rheumatoid arthritis are to stop structural damage of joints and to reduce functional, psychological, socioprofessional and economic consequences. Team management requires the collaboration, around the patient, of a rheumatologist, a nurse, a psychologist, a physiotherapist, an occupational therapist, an orthopaedic surgeon at the same time, in the same place. More and more patients wish to manage their disease by themselves. Team care should not be proposed to every patient; it must be reserved to patients whose condition required such an approach because of the severity of the disease, comorbidity, psychological or socioprofessionnal difficulties. Team management should be personalized. Utility of team management is now accepted; out-patient administration is as effective as in-patient one. A good educational program is very important. However, search is still needed to define optimal modalities of team management and tools to measure the efficiency of this approach. PMID:11937986

Le Loët, X; Vittecoq, O

2001-12-01

313

Psychosocial Concepts in Rheumatoid Arthritis  

PubMed Central

This article reviews and tabulates some of the current concepts of the role of psychosocial factors in rheumatoid arthritis (RA). Concepts prevalent during the 1950's are listed followed by discussion of some of the variable factors that complicate studies in this field. Studies are then cited which lead to the following conclusions: 1. Patients with RA tend to have certain personality characteristics, such as depression, rigidity, dependency, neurotic response patterns, emotional instability, feelings of guilt and low ego strength. 2. These are not specific to RA. 3. They may well be sequelae of the disease rather than pre-morbid features. 4. There is no clear evidence as to the role of psychological stress in causing or activating RA. 5. Personality factors have an influence on the course of the disease.

McGillivray, Donald C.

1973-01-01

314

[Why rheumatoid arthritis needs cardiologists].  

PubMed

Rheumatoid arthritis (RA) is associated with a shortened life expectancy. Most premature deaths are caused by cardiovascular (CV) events; therefore it is of importance to consider the increased CV risk when treating RA patients. Traditional CV risk factors cannot fully explain the increased risk but the common understanding is that inflammation significantly contributes to the excess risk observed. Without the use of correction factors commonly used risk calculators underestimate the true CV risk in RA patients. Methotrexate and TNF inhibitors appear to be beneficial with regard to the CV risk. To date there are only few recommendations for interventions in the CV system of RA patients which go beyond those formulated for the general population. The present manuscript summarizes the published evidence concerning the increased CV risk in RA patients. PMID:23649300

Pieringer, H; Hoppe, U C

2013-05-01

315

Pharmacotherapy options in rheumatoid arthritis.  

PubMed

Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-modifying antirheumatic drugs. Current clinical practice guidelines recommend that clinicians start biologic agents if patients have suboptimal response or intolerant to one or two traditional disease modifying agents (DMARDs). Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine are the commonly used DMARDs. Currently, anti-TNF is the commonly used first line biologic worldwide followed by abatacept and it is usually combined with MTX. There is some evidence that tocilizumab is the most effective biologic as a monotherapy agent. Rituximab is generally not used as a first line biologic therapy due to safety issues but still as effective as anti-TNF. The long term data for the newer oral small molecule biologics such as tofacitinib is not available and hence used only as a last resort. PMID:23997576

Kumar, Pradeep; Banik, Snehashish

2013-08-08

316

[Genetic analyses of rheumatoid arthritis].  

PubMed

The etiology of rheumatoid arthritis (RA) is unknown and genetic information is important for understanding the mechanisms of the disorder. In order to identify diseases-associated genes, genome wide association study (GWAS) has been performed. Through GWAS, many RA associated genes have been reported. Several genes are related to T cell differentiation, signaling in the immune cells, innate immunity and TNF signaling. Some of these polymorphisms are shared by several autoimmune diseases. On the other hands, it is important to know that there are ethnic differences in these autoimmune related genes. We reported functional haplotypes of PADI4, encoding citrullinating enzyme peptidylarginine deiminase 4, are associated with RA. We also identified an RA associated polymorphism in the promoter region of FCRL3, a member of the Fc receptor-like family. Through these studies, we believe that we could obtain further insights into the disease mechanisms, develop novel therapies and make personalized medicine possible based on the individual's genetics. PMID:23961660

Yamamoto, Kazuhiko

2013-07-01

317

[Kidney involvement in rheumatoid arthritis].  

PubMed

Rheumatoid Arthritis (RA) is a widespread disease and its renal involvement, relatively common, is clinically significant because worsens course and mortality of the primary disease. There is still no agreement on the prevalence of renal disorders in RA: data analysis originates from different sources, as death certificates, autopsies, clinical and laboratory findings and kidney biopsies, each with its limitations. Histoimmunological studies on bioptical specimens of patients with RA and kidney damage, led to clarify prevalent pathologies. In order of frequency: glomerulonephritis and amyloidosis (60-65% and 20-30% respectively), followed by acute or chronic interstitial nephritis. Kidney injury during RA includes secondary renal amyloidosis, nephrotoxic effects of antirheumatic drugs and nephropathies as extra-articular manifestations (rheumatoid nephropathy). Amyloidosis affects survival, increases morbidity and is the main cause of end stage renal disease in patients with RA and nephropathy. Strong association between RA activity and amyloidosis needs the use of immunosuppressive and combined therapies, to prevent this complication and reduce risk of dialysis. Long-lasting and combined RA pharmacotherapy involves various renal side effects. In this review we describe NSAIDs and DMARDs (Disease-Modifying Antirheumatic Drugs) nephrotoxicity, particularly by gold compounds, D-penicillamine, cyclosporine A and methotrexate. Rare cases of IgA glomerulonephritis during immunomodulating therapy with leflunomide and TNF blocking receptor (etanercept) are reported; real clinical significance of this drug-related nephropathy will be established by development of RA treatment. In RA nephropathies, mesangial glomerulonephritis is the most frequent histological lesion (35-60 % out of biopsies from patients with urinary abnormalities and/or kidney impairment), followed by minimal change glomerulopathy (3-14%) and p-ANCA positive necrotizing crescentic glomerulonephritis. PMID:12874640

Icardi, A; Araghi, P; Ciabattoni, M; Romano, U; Lazzarini, P; Bianchi, G

2003-01-01

318

Complement fixation by rheumatoid factor.  

PubMed Central

The capacity for fixation and activation of hemolytic complement by polyclonal IgM rheumatoid factors (RF) isolated from sera of patients with rheumatoid arthritis and monoclonal IgM-RF isolated from the cryoprecipitates of patients with IgM-IgG mixed cryoglobulinemia was examined. RF mixed with aggregated, reduced, and alkylated human IgG (Agg-R/A-IgG) in the fluid phase failed to significantly reduce the level of total hemolytic complement, CH50, or of individual complement components, C1, C2, C3, and C5. However, sheep erythrocytes (SRC) coated with Agg-R/A-IgG or with reduced and alkylated rabbit IgG anti-SRC antibody were hemolyzed by complement in the presence of polyclonal IgM-RF. Human and guinea pig complement worked equally well. The degree of hemolysis was in direct proportion to the hemagglutination titer of the RF against the same coated cells. Monoclonal IgM-RF, normal human IgM, and purified Waldenström macroglobulins without antiglobulin activity were all inert. Hemolysis of coated SRC by RF and complement was inhibited by prior treatment of the complement source with chelating agents, hydrazine, cobra venom factor, specific antisera to C1q, CR, C5, C6, or C8, or by heating at 56 degrees C for 30 min. Purified radiolabeled C4, C3, and C8 included in the complement source were bound to hemolysed SRC in direct proportion to the degree of hemolysis. These data indicate that polyclonal IgM-RF fix and activate complement via the classic pathway. The system described for assessing complement fixation by isolated RF is readily adaptable to use with whole human serum.

Tanimoto, K; Cooper, N R; Johnson, J S; Vaughan, J H

1975-01-01

319

Significance of bone marrow edema in pathogenesis of rheumatoid arthritis  

PubMed Central

Summary Assessing the pathology of the synovium, its thickening and increased vascularity through ultrasound and magnetic resonance examinations (more often an ultrasound study alone) is still considered a sensitive parameter in the diagnosis of rheumatoid arthritis and in monitoring of treatment efficacy. Magnetic resonance studies showed that, aside from the joint pannus, the subchondral bone tissue constitutes an essential element in the development of rheumatoid arthritis. Bone marrow edema correlates with inflammation severity, joint destruction, clinical signs and symptoms of rheumatoid arthritis, and thus is considered a predictor of rapid radiological progression of the disease. The newest studies reveal that bone marrow edema may be a more sensitive indicator of the response to therapy than appearance of the synovium. Bone marrow edema presents with increased signal in T2-weighted images, being most visible in fat saturation or IR sequences (STIR, TIRM). On the other hand, it is hypointense and less evident in T1-weighted images. It becomes enhanced (hyperintense) after contrast administration. Histopathological studies confirmed that it is a result of bone inflammation (osteitis/osteomyelitis), i.e. replacememt of bone marrow fat by inflammatory infiltrates containing macrophages, T lymphocytes, B lymphocytes, plasma cells and osteoclasts. Bone marrow edema appears after a few weeks from occurrence of symptoms and therefore is considered an early marker of inflammation. It correlates with clinical assessment of disease activity and elevated markers of acute inflammatory phase, i.e. ESR and CRP. It is a reversible phenomenon and may become attenuated due to biological treatment. It is considered a “herald” of erosions, as the risk of their formation is 6-fold higher in sites where BME was previously noted

Sudol-Szopinska, Iwona; Kontny, Ewa; Maslinski, Wlodzimierz; Prochorec-Sobieszek, Monika; Warczynska, Agnieszka; Kwiatkowska, Brygida

2013-01-01

320

Significance of bone marrow edema in pathogenesis of rheumatoid arthritis.  

PubMed

Assessing the pathology of the synovium, its thickening and increased vascularity through ultrasound and magnetic resonance examinations (more often an ultrasound study alone) is still considered a sensitive parameter in the diagnosis of rheumatoid arthritis and in monitoring of treatment efficacy. Magnetic resonance studies showed that, aside from the joint pannus, the subchondral bone tissue constitutes an essential element in the development of rheumatoid arthritis. Bone marrow edema correlates with inflammation severity, joint destruction, clinical signs and symptoms of rheumatoid arthritis, and thus is considered a predictor of rapid radiological progression of the disease. The newest studies reveal that bone marrow edema may be a more sensitive indicator of the response to therapy than appearance of the synovium. Bone marrow edema presents with increased signal in T2-weighted images, being most visible in fat saturation or IR sequences (STIR, TIRM). On the other hand, it is hypointense and less evident in T1-weighted images. It becomes enhanced (hyperintense) after contrast administration. Histopathological studies confirmed that it is a result of bone inflammation (osteitis/osteomyelitis), i.e. replacememt of bone marrow fat by inflammatory infiltrates containing macrophages, T lymphocytes, B lymphocytes, plasma cells and osteoclasts. Bone marrow edema appears after a few weeks from occurrence of symptoms and therefore is considered an early marker of inflammation. It correlates with clinical assessment of disease activity and elevated markers of acute inflammatory phase, i.e. ESR and CRP. It is a reversible phenomenon and may become attenuated due to biological treatment. It is considered a "herald" of erosions, as the risk of their formation is 6-fold higher in sites where BME was previously noted. PMID:23493495

Sudo?-Szopi?ska, Iwona; Kontny, Ewa; Ma?li?ski, W?odzimierz; Prochorec-Sobieszek, Monika; Warczy?ska, Agnieszka; Kwiatkowska, Brygida

2013-01-01

321

Simulators  

SciTech Connect

This book discusses the following topics: oil industry, gas industry, chemical process control, electricity supply generation, food industry, simulator applications, operator maintenance training, online process control, determination of safety limits and margins, the design implementation of the simulators, hardware aspects, space and power requirements, sensors, miniaturisation, low-cost mass storage, computer-generated imaging, optimisation of trainer design.

Not Available

1983-01-01

322

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

2004-01-01

323

Quality of Life Profiles in the First Years of Rheumatoid Arthritis: Results From the EURIDISS Longitudinal Study  

Microsoft Academic Search

Objective. The aim of this study was to examine the quality of life (QoL) profiles of patients with early rheumatoid arthritis (RA) and to relate these to disease and impairment variables as indicated, respectively, by erythrocyte sedimentation rate (ESR) and by tender joint count (Ritchie Articular Index), fatigue, and pain. Methods. The present study uses part of the European Research

Th. P. B. M. Suurmeijer; M. Waltz; T. Moum; F. Guillemin; F. L. P. van Sonderen; S. Briancon; R. Sanderman

2001-01-01

324

Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score  

Microsoft Academic Search

An investigation of clinical and laboratory variables which might form the basis for judging disease activity in clinical practice was made by six rheumatologists in a prospective study of up to three years' duration of 113 patients with early rheumatoid arthritis. Decisions to start treatment with slow acting antirheumatic drugs were equated with moments of high disease activity. If treatment

D M van der Heijde; M A van't Hof; P L van Riel; L A Theunisse; E W Lubberts; M A van Leeuwen; M H van Rijswijk; L B van de Putte

1990-01-01

325

Common Therapy for Rheumatoid Arthritis Reduces Risk of Death  

MedlinePLUS

... Common Therapy for Rheumatoid Arthritis Reduces Risk of Death Taking methotrexate—a commonly prescribed anti-inflammatory medication—may reduce the risk of death among patients with rheumatoid arthritis (RA), according to ...

326

Rheumatoid Arthritis Diet: Do Certain Foods Reduce Symptoms?  

MedlinePLUS

... rheumatoid-arthritis /AN00198 ">Rheumatoid arthritis diet: Do certain foods reduce symptoms? Guidelines for sites linking to MayoClinic.com Advertisement Mayo Clinic Store Check out these best-sellers ...

327

Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis  

PubMed Central

BACKGROUND—Recent epidemiological studies have suggested that smoking is a risk factor for rheumatoid factor (RF) positive rheumatoid arthritis (RA). Being overweight, high serum cholesterol, and dietary factors have in some studies been found to be associated with the risk of RA. No attention, however, has been paid to coffee consumption as a risk determinant, though it is a shared covariate of the alleged risk factors.?OBJECTIVES—This study aimed at examining coffee consumption for its associations with RF positivity and with the risk of RA.?METHODS—Coffee consumption was studied, firstly, for its association with RF (sensitised sheep cell agglutination titre ?128) in a cross sectional survey of 6809 subjects with no clinical arthritis, and secondly, for its prediction of RA in a cohort of 18 981 men and women who had neither arthritis nor a history of it at the baseline examination in 1973-76. Up to late 1989, 126 subjects of the cohort study had developed RA, of whom, 89 were positive for RF by the time of diagnosis.?RESULTS—In the cross sectional survey the number of cups of coffee drunk daily was directly proportional to the prevalence of RF positivity. Adjusted for age and sex this association was significant (p value for linear trend, 0.008), but after further adjustment for smoking the linear trend declined below significance (p=0.06). In the cohort study there was an association between coffee consumption and the risk of RF positive RA that was not due to age, sex, level of education, smoking, alcohol intake, body mass index, or serum cholesterol. After adjustment for these potential confounders the users of four or more cups a day still had a relative risk of 2.20 (95% confidence interval 1.13 to 4.27) for developing RF positive RA compared with those drinking less. Coffee consumption did not predict the development of RF negative RA.?CONCLUSION—Coffee consumption may be a risk factor for RA, possibly through mechanisms contributing to the production of RF. This hypothesis remains to be tested in further studies.??

Heliovaara, M; Aho, K; Knekt, P; Impivaara, O; Reunanen, A; Aromaa, A

2000-01-01

328

Effects of fish oil supplementation in rheumatoid arthritis.  

PubMed Central

Sixteen patients with rheumatoid arthritis entered a trial to determine the clinical and biochemical effects of dietary supplementation with fractionated fish oil fatty acids. A randomised, double blind, placebo controlled crossover design with 12 week treatment periods was used. Treatment with non-steroidal anti-inflammatory drugs and with disease modifying drugs was continued throughout the study. Placebo consisted of fractionated coconut oil. The following results favoured fish oil rather than placebo: joint swelling index and duration of early morning stiffness. Other clinical indices improved but did not reach statistical significance. During fish oil supplementation relative amounts of eicosapentaenoic acid and docosahexaenoic acid in the plasma cholesterol ester and neutrophil membrane phospholipid fractions increased, mainly at the expense of the omega-6 fatty acids. The mean neutrophil leucotriene B4 production in vitro showed a reduction after 12 weeks of fish oil supplementation. Leucotriene B5 production, which could not be detected either in the control or in the placebo period, rose to substantial quantities during fish oil treatment. This study shows that dietary fish oil supplementation is effective in suppressing clinical symptoms of rheumatoid arthritis.

van der Tempel, H; Tulleken, J E; Limburg, P C; Muskiet, F A; van Rijswijk, M H

1990-01-01

329

Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis.  

PubMed

Molecular and multimodal imaging procedures that complement the use of existing anatomical modalities for the diagnosis and monitoring of rheumatoid arthritis (RA) have undergone substantial developmental advances. These techniques have the potential to greatly improve the management of patients with RA through early diagnosis and maximization of the newly available opportunities for early therapeutic intervention. Quantitative, noninvasive monitoring of biomarkers of the molecular events induced during the onset of RA could be used to guide the initial selection of therapy and for assessment of early therapeutic responses. Biomolecular imaging techniques that can reveal the pathophysiological features of RA--including infrared thermography, near-infrared molecular imaging, and PET--are being used to investigate the earliest cellular and biochemical inflammatory events in the development of the disease. Noninvasive imaging of abnormal specific molecular events in early RA could enable early targeted intervention that could be tailored to optimize patient responses before destructive anatomical changes occur. In this Review, we summarize new advances in biomolecular imaging techniques, with an emphasis on their current state of development in terms of the management of RA. PMID:23007740

Mountz, James M; Alavi, Abass; Mountz, John D

2012-09-25

330

Good long-term outcome of synovectomy in advanced stages of the rheumatoid elbow  

PubMed Central

Background and purpose Synovectomy is an effective procedure for management of the rheumatoid elbow at radiographically early stages (Larsen grades 1 and 2). However, its efficacy for advanced stages (Larsen grades 3–5) is controversial. We investigated the outcome of synovectomy for advanced stages of the rheumatoid elbow. Methods Between May 1985 and September 1994, synovectomy was performed for 67 rheumatoid elbows in 59 patients (mean age 52 (26–72) years, 54 women). 3 elbows (3 patients) were lost to follow-up after mean 15 (10–23) years. Thus, 64 elbows were evaluated clinically and radiographically. Results The mean Mayo elbow performance score (MEPS) improved from 42 (15–75) points preoperatively to 78 (45–100) points at the final follow-up examination. In cases of Larsen grade 5, the mean MEPS at final follow-up examination (69 points) was lower than those of Larsen grade 3 and 4 cases (80 and 79 points, respectively) (p < 0.01). Recurrence of synovitis was obvious in 20/67 elbows. 12 cases had a total elbow arthroplasty mean 13 years after the synovectomy. The 10-year, 15-year, and 20-year survival rates were 97%, 75%, and 70%, respectively. Interpretation Our findings suggest that synovectomy for the rheumatoid elbow gives a good long-term outcome for radiographically judged destroyed joints of Larsen grades 3–4.

2012-01-01

331

The effect of methotrexate on bone metabolism markers in patients with rheumatoid arthritis  

Microsoft Academic Search

The aim of the present study was to evaluate the influence on urinary excretion levels of N-telopeptide of type I collagen\\u000a (NTX) and deoxypyridinoline (DPD) as a useful marker for bone resorption, and on serum-bone alkaline phosphate (BAP) levels\\u000a as a useful marker for bone formation and an early marker of osteoblast differentiation in patients with rheumatoid arthritis\\u000a (RA) treated

Eiji Torikai; Yasunori Kageyama; Masaaki Takahashi; Akira Nagano

2006-01-01

332

Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients: An Open Problem  

Microsoft Academic Search

Rheumatoid arthritis is a chronic systemic auto-immune inflammatory disease which may affect all parts of the body but predominantly\\u000a afflicts the limb joints. Despite progress in medical therapy, a high number of patients still face the destructive and deforming\\u000a sequelae of the disease, in part because of a late, inadequate, or refused early pharmacological treatment. Flexible prostheses,\\u000a like the Swanson,

F. Catalano

333

Acute Generalized Exanthematous Pustulosis due to Tocilizumab in a Rheumatoid Arthritis Patient  

PubMed Central

We report a female patient with rheumatoid arthritis which was refractory to methotrexate, leflunomide, and anti-TNF therapy. She was treated with anti-IL-6 tocilizumab (TCZ), with an early appearance of sterile pustules on erythematous swollen skin of trunk, back, and abdominal area. The lesions were consistent with the diagnosis of acute drug-related generalized exanthematous pustulosis (AGEP). This adverse event was controlled with medical treatment without requiring removal of TCZ.

Izquierdo, J. H.; Bonilla-Abadia, F.; Ochoa, C. D.; Agualimpia, A.; Tobon, G. J.; Canas, C. A.

2012-01-01

334

Diagnostic value of synovial fluid anti-cyclic citrullinated peptide antibody for rheumatoid arthritis  

Microsoft Academic Search

Early and accurate diagnosis and treatment of rheumatoid arthritis (RA) improves disease outcome. Anti-cyclic citrullinated\\u000a peptide antibody (anti-CCP) which is highly specific for RA is produced locally from inflamed synovium. The present study\\u000a was designed to assess the diagnostic performance of synovial fluid anti-CCP (sf-CCP) for RA. A total of 128 patients consisted\\u000a of 37 RA confirmed by the American

Behzad Heidari; Hassan Abedi; Alireza Firouzjahi; Parnaz Heidari

2010-01-01

335

Current view of glucocorticoid co-therapy with DMARDs in rheumatoid arthritis  

Microsoft Academic Search

Glucocorticoids are widely used anti-inflammatory and immunosuppressive drugs for rheumatoid arthritis (RA). The disease-modifying potential of low to medium doses of glucocorticoids has been reconfirmed in the past decade, and co-administration of DMARDs and glucocorticoids has become standard in many treatment protocols, especially those for early disease stages but also for long-standing RA. The glucocorticoid regimens used range from continuous

Johannes W. G. Jacobs; Frank Buttgereit; Johannes W. J. Bijlsma; Jos N. Hoes

2010-01-01

336

Insufficiency fractures of the distal tibia misdiagnosed as cellulitis in three patients with rheumatoid arthritis  

SciTech Connect

We describe 3 patients with rheumatoid arthritis who presented with diffuse pain, swelling, and erythema of the distal aspect of the lower extremity, suggestive of either cellulitis or thrombophlebitis, but were found to have insufficiency fractures of the distal tibia. The value of technetium-99m diphosphonate bone scintigraphy in the early recognition of these fractures and a possible explanation for the associated inflammatory symptoms are discussed.

Straaton, K.V.; Lopez-Mendez, A.; Alarcon, G.S. (Univ. of Alabama, Birmingham (USA))

1991-07-01

337

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) therapy

M. Kojima; T. Motoori; S. Nakamura

2006-01-01

338

Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs  

Microsoft Academic Search

Modern therapy for rheumatoid arthritis (RA) is based on knowledge of the severity of the natural history of the disease.\\u000a RA patients are approached with early and aggressive treatment strategies, methotrexate as an anchor drug, biological targeted\\u000a therapies in those with inadequate response to methotrexate, and “tight control,” aiming for remission and low disease activity\\u000a according to quantitative monitoring. This

Tuulikki Sokka; Minja Envalds; Theodore Pincus

2008-01-01

339

Complete heart block and bowel infarction secondary to rheumatoid disease.  

PubMed Central

A case of complete heart block secondary to rheumatoid involvement of the conduction system is presented. The same patient died after infarction of the colon as a consequence of arterial spasm superimposed upon pre-existing rheumatoid changes in the mesenteric arteries. The coexistence of rheumatoid involvement of the heart and of the bowel vasculature has not previously been reported. Images

Wilsher, M; Smeeton, W M; Koelmeyer, T D; Roche, A H

1985-01-01

340

Autoantibodies in rheumatoid arthritis and their clinical significance  

Microsoft Academic Search

Autoantibodies are proven useful diagnostic tools for a variety of rheumatic and non-rheumatic autoimmune disorders. However, a highly specific marker autoantibody for rheumatoid arthritis (RA) has not yet been determined. The presence of rheumatoid factors is currently used as a marker for RA. However, rheumatoid factors have modest specificity (~70%) for the disease. In recent years, several newly characterized autoantibodies

Günter Steiner; Josef Smolen

2002-01-01

341

Smoking–gender interaction and risk for rheumatoid arthritis  

Microsoft Academic Search

The present case–control study was conducted to investigate the relationship between smoking and rheumatoid arthritis, and to investigate formally the interaction between sex, smoking, and risk for developing rheumatoid arthritis. The study was performed in the Central District of Finland. Cases were patients with rheumatoid arthritis and the control group was a random sample of the general population. Logistic regression

Eswar Krishnan; Tuulikki Sokka; Pekka Hannonen

2003-01-01

342

Serum ADA and C-reactive Protein in Rheumatoid Arthritis  

Microsoft Academic Search

Immunological and inflammatory reactions play a pivotal role in the initiation and perpetuation of rheumatoid arthritis. The present study is an attempt to estimate the levels of adenosine deaminase (ADA) activity, a marker for cell mediated immunity and C-reactive protein a marker for inflammation in patients with rheumatoid arthritis.75 cases presenting rheumatoid arthritis and same number of age and sex

H. Surekha Rani; G. Madhavi; B. M. V. Srikanth; P. Jharna; U. R. K. Rao; A. Jyothy

2006-01-01

343

Simulations  

Microsoft Academic Search

\\u000a In this chapter, we use R to generate, examine, detect, and illuminate simulated yield tables, projections, or sets of possible\\u000a future forest conditions. Our objectives are to 1) cover the major topics and tasks required to generate forest forecasts;\\u000a 2) compare some common metrics from the resulting simulations; and 3) examine and present potential shortcomings and remedies\\u000a for the methods

Andrew P. Robinson; Jeff D. Hamann

344

Case Report: Safety and Efficacy of Tocilizumab in a Patient with Rheumatoid Arthritis and Chronic Hepatitis C  

PubMed Central

Tocilizumab is a monoclonal humanized anti-IL-6-receptor antibody used for the treatment of rheumatoid arthritis. The safety of tocilizumab in HCV patients is an open question. We report on safety and efficacy of tocilizumab in a 71-year-old female with rheumatoid arthritis and chronic hepatitis C. Monotherapy with tocilizumab (8?mg/kg every 4 weeks, i.v.) was prescribed after the discontinuation, determined by clinical inefficacy, of anti-TNF-alfa agents (adalimumab and, subsequently, etanercept). We have registered an optimal and rapid clinical response to tocilizumab with early remission (SDAI <3.3 since 4 weeks). The safety was good with no adverse events and maintenance, during a six-month followup, of normal liver enzymes. These data suggest a good safety profile of tocilizumab in patients with rheumatoid arthritis and chronic hepatitis C virus pathology.

Iebba, Filippo; Di Sora, Fiorella; Tarasi, Agapito; Leti, Wilma; Montella, Tatiana; Montella, Francesco

2012-01-01

345

The microbiome and rheumatoid arthritis  

PubMed Central

Humans are not (and have never been) alone. From the moment we are born, millions of micro-organisms populate our bodies and coexist with us rather peacefully for the rest of our lives. This microbiome represents the totality of micro-organisms (and their genomes) that we necessarily acquire from the environment. Micro-organisms living in or on us have evolved to extract the energy they require to survive, and in exchange they support the physiological, metabolic and immune capacities that have contributed to our evolutionary success. Although currently categorized as an autoimmune disorder and regarded as a complex genetic disease, the ultimate cause of rheumatoid arthritis (RA) remains elusive. It seems that interplay between predisposing genetic factors and environmental triggers is required for disease manifestation. New insights from DNA sequence-based analyses of gut microbial communities and a renewed interest in mucosal immunology suggest that the microbiome represents an important environmental factor that can influence autoimmune disease manifestation. This Review summarizes the historical clues that suggest a possible role for the microbiota in the pathogenesis of RA, and will focus on new technologies that might provide scientific evidence to support this hypothesis.

Scher, Jose U.; Abramson, Steven B.

2012-01-01

346

The microbiome and rheumatoid arthritis.  

PubMed

Humans are not (and have never been) alone. From the moment we are born, millions of micro-organisms populate our bodies and coexist with us rather peacefully for the rest of our lives. This microbiome represents the totality of micro-organisms (and their genomes) that we necessarily acquire from the environment. Micro-organisms living in or on us have evolved to extract the energy they require to survive, and in exchange they support the physiological, metabolic and immune capacities that have contributed to our evolutionary success. Although currently categorized as an autoimmune disorder and regarded as a complex genetic disease, the ultimate cause of rheumatoid arthritis (RA) remains elusive. It seems that interplay between predisposing genetic factors and environmental triggers is required for disease manifestation. New insights from DNA sequence-based analyses of gut microbial communities and a renewed interest in mucosal immunology suggest that the microbiome represents an important environmental factor that can influence autoimmune disease manifestation. This Review summarizes the historical clues that suggest a possible role for the microbiota in the pathogenesis of RA, and will focus on new technologies that might provide scientific evidence to support this hypothesis. PMID:21862983

Scher, Jose U; Abramson, Steven B

2011-08-23

347

Bronchoalveolar lavage in rheumatoid arthritis.  

PubMed

Bronchoalveolar lavage (BAL) was performed on 70 RA patients, 28 without extra-articular manifestations, nine with pulmonary involvement, 13 with sicca-syndrome, 20 with other extra-articular manifestations such as renal involvement, cutaneous vasculitis and rheumatoid nodules. Fifteen patients without rheumatic or pulmonary disease served as the control group. Compared with the control group RA patients showed a statistically significant increase of lymphocytes, especially of activated (DR+)T(CD3+)-helper (CD4+) cells, resulting in a significantly diminished percentage of alveolar macrophages, B(CD21+)-lymphocytes, T-suppressor (CD8+) cells and an increased CD4/CD8 ratio. This cell distribution pattern was more pronounced in RA patients with lung involvement with significant differences to the other RA patients with regard to lymphocytes, DR positive cells and CD4 positive/DR positive cells. It is concluded that these results indicate an altered balance of immunocompetent cells not only in the joints but also in the lung. The changes are more distinct if local manifestations can be diagnosed clinically. PMID:8339125

Kolarz, G; Scherak, O; Popp, W; Ritschka, L; Thumb, N; Wottawa, A; Zwick, H

1993-07-01

348

HLA-linked rheumatoid arthritis  

SciTech Connect

Twenty-eight pedigrees were ascertained through pairs of first-degree relatives diagnosed with rheumatoid arthritis (RA). RA was confirmed in 77 pedigree members including probands; the absence of disease was verified in an additional 261 pedigree members. Pedigree members were serologically typed for HLA. We used likelihood analysis to statistically characterize the HLA-linked RA susceptibility locus. The genetic model assumed tight linkage to HLA. The analysis supported the existence of an HLA-linked RA susceptibility locus, estimated the lifetime penetrance as 41% in male homozygotes and as 48% in female homozygotes. Inheritance was recessive in males and was nearly recessive in females. In addition, the analysis attributed 78% of the variance within genotypes to genetic or environmental effects shared by siblings. The genetic model inferred in this analysis is consistent with previous association, linkage, and familial aggregation studies of RA. The inferred HLA-linked RA susceptibility locus accounts for approximately one-fifth of the RA in the population. Although other genes may account for the remaining familial RA, a large portion of RA cases may occur sporadically. 79 refs., 9 tabs.

Hasstedt, S.J.; Clegg, D.O.; Ingles, L.; Ward, R.H. [Univ. of Utah, Salt Lake City, UT (United States)

1994-10-01

349

International Reference Preparation of Rheumatoid Arthritis Serum  

PubMed Central

The National Institute for Medical Research, London, England, was requested by the WHO Expert Committee on Biological Standardization to arrange a collaborative study of the serum pool they had obtained, to determine its suitability to serve as an international reference preparation of rheumatoid arthritis serum. A batch of this serum was assayed by 11 laboratories in 7 countries against 30 test preparations. On the basis of the results obtained, the serum has been established as the International Reference Preparation of Rheumatoid Arthritis Serum and the International Unit of Rheumatoid Arthritis Serum has been defined as the activity contained in 0.171 mg of the international reference preparation. A description is also given of the British reference preparation of rabbit antibody to sheep red blood cells (amboceptor) and this material was also tested in the collaborative study.

Anderson, S. G.; Bentzon, M. W.; Houba, V.; Krag, P.

1970-01-01

350

A rheumatoid arthritis study by Fourier transform infrared spectroscopy  

NASA Astrophysics Data System (ADS)

Rheumatoid arthritis is a systemic inflammatory disease of unknown causes and a new methods to identify it in early stages are needed. The main purpose of this work is the biochemical differentiation of sera between normal and RA patients, through the establishment of a statistical method that can be appropriately used for serological analysis. The human sera from 39 healthy donors and 39 rheumatics donors were collected and analyzed by Fourier Transform Infrared Spectroscopy. The results show significant spectral variations with p<0.05 in regions corresponding to protein, lipids and immunoglobulins. The technique of latex particles, coated with human IgG and monoclonal anti-CRP by indirect agglutination known as FR and CRP, was performed to confirm possible false-negative results within the groups, facilitating the statistical interpretation and validation of the technique.

Carvalho, Carolina S.; Silva, Ana Carla A.; Santos, Tatiano J. P. S.; Martin, Airton A.; Dos Santos Fernandes, Ana Célia; Andrade, Luís E.; Raniero, Leandro

2012-02-01

351

[Occupational therapy after rheumatoid hand surgery].  

PubMed

Occupational therapists face a number of challenges in the after-treatment of rheumatoid hand surgery. They have to take into account the specialties of the surgery and the remaining deformities of the rheumatoid hand. Edema prophylaxis and scar treatment are similar for all patients, while splinting and functional training depend greatly on the different kinds of surgery. Both splinting and mobilization have to be adjusted to patient and process of the therapy. The protracted treatment requires a high compliance of the patient. Instruction and information about operation and postoperative therapy support comprehension and cooperation of the patient. PMID:15744658

Holzer, K

2005-02-01

352

[Rheumatoid arthritis. Systemic inflammation and cardiovascular morbidity].  

PubMed

In recent years it could be shown that systemic inflammation, which typically occurs in chronic inflammatory rheumatic diseases, significantly contributes to cardiovascular morbidity and mortality. All rheumatic diseases inherit this enhanced risk for cardiovascular complications with rheumatoid arthritis being one of the most prominent. As the underlying pathophysiological mechanisms are very similar with respect to endothelial damage all rheumatic diseases and specifically rheumatoid arthritis should be monitored and treated with disease-modifying drugs and biological agents as consistently as possible to be able to improve the long-term outcome of affected patients as much as possible. PMID:23463461

Decker, E; Müller-Ladner, U

2013-04-01

353

Production of Human Monoclonal Rheumatoid Factor Secreting Hybridomas Derived from Rheumatoid Synovial Cells.  

National Technical Information Service (NTIS)

Although the cellular arm of the immune system is undoubtedly important in the pathogenesis of rheumatoid arthritis (RA), RA is an autoimmune extravascular immune complex disease involving synovium and interstitial tissues. The major autoantibody present ...

D. L. Robbins J. W. Larrick R. Wistar T. P. Kenny

1989-01-01

354

A simulation model for compensatory plasticity in the prefrontal cortex inducing a cortico-cortical dysconnection in early brain development  

Microsoft Academic Search

Summary.  In the present work, an abstract prefrontal cortex simulation model is used to predict compensatory structural alterations\\u000a of the cortico-cortical connectivity pattern in the normal and pathologic forebrain maturation. The simulation network shows\\u000a different representative courses of morphogenesis when developing undisturbed or when suffering from disturbing excitatory\\u000a afferences. The simulative results could be affirmed by an immuno-histochemical study, revealing a

M. Butz; G. Teuchert-Noodt

2006-01-01

355

Rheumatoid arthritis-associated gene-gene interaction network for rheumatoid arthritis candidate genes  

Microsoft Academic Search

Rheumatoid arthritis (RA, MIM 180300) is a chronic and complex autoimmune disease. Using the North American Rheumatoid Arthritis Consortium (NARAC) data set provided in Genetic Analysis Workshop 16 (GAW16), we used the genotype-trait distortion (GTD) scores and proposed analysis procedures to capture the gene-gene interaction effects of multiple susceptibility gene regions on RA. In this paper, we focused on 27

2009-01-01

356

Optical monitoring of rheumatoid arthritis: Monte Carlo generated reconstruction kernels  

NASA Astrophysics Data System (ADS)

Optical imaging in biomedicine is governed by the light absorption and scattering interaction on microscopic and macroscopic constituents in the medium. Therefore, light scattering characteristics of human tissue correlate with the stage of some diseases. In the near infrared range the scattering event with the coefficient approximately two orders of magnitude greater than absorption plays a dominant role. When measuring the optical parameters variations were discovered that correlate with the rheumatoid arthritis of a small joint. The potential of an experimental setup for transillumination the finger joint with a laser diode and the pattern of the stray light detection are demonstrated. The scattering caused by skin contains no useful information and it can be removed by a deconvolution technique to enhance the diagnostic value of this non-invasive optical method. Monte Carlo simulations ensure both the construction of the corresponding point spread function and both the theoretical verification of the stray light picture in rather complex geometry.

Minet, O.; Beuthan, J.; Hielscher, A. H.; Zabarylo, U.

2008-06-01

357

Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer  

Microsoft Academic Search

BACKGROUND: Mathematical modelling and analysis is now accepted in the engineering design on par with experimental approaches. Computer simulations enable one to perform several 'what-if' analyses cost effectively. High speed computers and low cost of memory has helped in simulating large-scale models in a relatively shorter time frame. The possibility of extending numerical modelling in the area of breast cancer

Eddie Y-K Ng; NM Sudharsan

2004-01-01

358

Aerobic Exercise Prescription for Rheumatoid Arthritics.  

ERIC Educational Resources Information Center

The use of exercise as a general treatment for rheumatoid arthritics (RA) has included range of motion, muscular strength, water exercise and rest therapy while virtually ignoring possible benefits of aerobic exercise. The purposes of this project were to examine the guidelines for exercise prescription in relation to this special population and…

Evans, Blanche W.; Williams, Hilda L.

359

Complement activation induced by rabbit rheumatoid factor.  

PubMed Central

Rabbit rheumatoid factor produced in animals by hyperimmunized with group C streptococcal vaccine activated guinea pig complement. Anti-streptococcal serum was fractionated by Sephacryl S-200 chromatography into excluded (19S) and included (7S) material and examined for hemolytic activity in a sensitive homologous hemolytic assay system. In the presence of complement, both 19S and 7S antistreptococcal serum fractions induced lysis of bovine (ox) erythrocytes coated with mildly reduced and carboxymethylated rabbit anti-erythrocyte immunoglobulin G. That rabbit rheumatoid factor was responsible for the observed hemolytic activity was substantiated by hemolytic inhibition assays. Significant inhibition of hemolysis was effected when antistreptococcal serum fractions were incubated in the presence of human immunoglobulin G, rabbit immunoglobulin G, and Fc, whereas, no inhibition was detected when the same fractions were tested in the presence of rabbit Fab or F(ab')2 fragments. Deaggregation of inhibitor preparations revealed a preferential reactivity of rheumatoid factor for rabbit immunoglobulin G. In addition to the rheumatoid factor-dependent hemolytic activity observed in humoral preparations, immunoglobulin G-specific antibody-forming cells in spleen and peripheral blood lymphocyte isolates were enumerated by plaque-forming cell assay.

Meyer, R R; Brown, J C

1980-01-01

360

Group education for rheumatoid arthritis patients  

Microsoft Academic Search

This article reviews the effectiveness of group education programs in improving the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied.

Erik Taal; Johannes J. Rasker; Oene Wiegman

1997-01-01

361

Healing of erosions in rheumatoid arthritis  

PubMed Central

Reports on healing of erosions in rheumatoid arthritis are rare. However, it is expected that repair of erosions should be seen more often during the period of extensive use of disease modifying antirheumatic drugs, especially in patients who experience sustained remission. Two such cases are described.??

Sokka, T.; Hannonen, P.

2000-01-01

362

Idiopathic Hypoparathyroidism Associated with Adult Rheumatoid Arthritis  

Microsoft Academic Search

A 48-year-old female patient with adult onset idiopathic hypoparathyroidism diagnosed at the age of 28 years developed a typical seropositive rheumatoid arthritis (RA) at 46 years of age after several years of evolution of a palindromic rheumatism. Only one case of an association between idiopathic hypoparathyroidism and RA has been described in the medical literature. Autoimmunity seems to play a

G. Salvador; R. Sanmartí; I. Ros; I. Halperin; J. D. Cañete; C. Orellana

1999-01-01

363

Healing of erosions in rheumatoid arthritis  

Microsoft Academic Search

Reports on healing of erosions in rheumatoid arthritis are rare. However, it is expected that repair of erosions should be seen more often during the period of extensive use of disease modifying antirheumatic drugs, especially in patients who experience sustained remission. Two such cases are described.

Tuulikki Sokka; Pekka Hannonen

2000-01-01

364

How does infliximab work in rheumatoid arthritis?  

Microsoft Academic Search

Since the initial characterization of tumor necrosis factor alpha (TNF?), it has become clear that TNF? has diverse biologic activity. The realization that TNF? plays a role in rheumatoid arthritis (RA) has led to the development of anti-TNF agents for the treatment of RA. Infliximab, a chimeric monoclonal antibody that specifically, and with high affinity, binds to TNF? and neutralizes

Ravinder N Maini; Marc Feldmann

2002-01-01

365

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

1992-01-01

366

Hard Metal Alveolitis Accompanied by Rheumatoid Arthritis  

Microsoft Academic Search

Hard metal lung diseases (HML) are rare, and complex to diagnose. We describe the case of a patient with allergic alveolitis accompanied by rheumatoid arthritis. A sharpener of hard metal by trade, our patient was a 45-year-old, nonsmoking Caucasian female who experienced symptoms of cough and phlegm, and dyspnea on exertion. Preliminary lung findings were inspiratory rales in both basal

Paula A. Hahtola; Ritva E. Järvenpää; Kari Lounatmaa; Jorma J. Mattila; Immo Rantala; Jukka A. Uitti; Seppo Sutinen

2000-01-01

367

[Musculoskeletal symptoms in systemic lupus erythematosus and their differential diagnosis with rheumatoid arthritis].  

PubMed

The musculoskeletal system is involved in nearly all patients with systemic lupus erythematosus (SLE). Transient arthralgias and arthritis are commonly observed. Some patients develop chronic synovitis, which can result in deformities of the joints known as Jaccoud's arthropathy and seen in 10-35% of patients with SLE. Many patients with SLE are initially misdiagnosed with rheumatoid arthritis (RA). Differentiation of SLE from RA can be done with diagnostic imaging, tests for anticitrullinated peptide antibodies (anti-CCP) and rheumatoid factor, and analysis of the clinical picture. It is important to undertake the differential diagnosis not only in early arthritis but also at later stages of the disease when new clinical symptoms have cast doubt on the diagnosis. PMID:21365939

Wiland, Piotr

2010-01-01

368

Role of anti-citrullinated protein antibodies in diagnosis and prognosis of rheumatoid arthritis  

PubMed Central

Antibodies to citrullinated proteins/peptides (ACPAs) are the second serological marker to have recently been included in the 2010 ACR/EULAR Rheumatoid Arthritis (RA) Classification Criteria, which are focused on early diagnosis and therapy. This review discusses their history and some clinical aspects of ACPAs, focusing on the diagnostic utility of anti-cyclic citrullinated peptide (anti-CCP) antibodies as a marker of RA as compared to the widely used rheumatoid factor (RF). Simultaneously, this review aims to raise physician awareness and interest in anti-citrullinated vimentin antibody (anti-Sa/anti-MCV), another member of the ACPA family, which appears to have a better predictive value as a marker of RA than anti-CCP or RF and correlates closely with disease activity and therapeutic response among patients with RA.

Puszczewicz, Mariusz; Iwaszkiewicz, Cezary

2011-01-01

369

Hepatotoxicity due to tocilizumab and anakinra in rheumatoid arthritis: two case reports  

PubMed Central

Elevation of liver enzymes in patients with rheumatoid arthritis treated with the biological agents, tocilizumab and anakinra, is now well documented. However, histological characterization of these effects and outcomes has not been defined. Here we report toxic liver effects in two women with rheumatoid arthritis, refractory to all nonbiological therapies, following treatment with anakinra and tocilizumab. Liver biopsy in both cases showed focal necrosis of hepatocytes as a hallmark of drug toxicity, along with steatosis and early fibrosis. In addition, the patient treated with anakinra demonstrated inflammatory changes. Tocilizumab was continued with no further deterioration in liver function. Withdrawal of anakinra led to rapid normalization of liver function. The biological agents, tocilizumab and anakinra, may result in significant histological hepatic changes, including necrosis, but despite this, the outcome appears to be good.

Mahamid, Mahmud; Paz, Kalman; Reuven, Mader; Safadi, Rifaat

2011-01-01

370

[Reconstructing the pyramid as a therapeutic approach to rheumatoid arthritis].  

PubMed

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 be fulfilled. The first is an early diagnosis obtained through a careful clinical examination along with an appropriate laboratory immunological work-up, followed by an adequate monotherapy within the first 4 months from symptoms onset. The second is the therapeutic re-assessment that needs to be done every three months, to start a possible combination therapy (COMBO), in order to rescue monotherapy failures. The third is the initiation of biological response modifiers (BRMs) within 6 months from monotherapy onset, within 3 months from COMBO in the most resistant cases. Having at hand several molecules with BRMs characteristics, we believe that the future appears much more favourable in most cases even in those with the severe disease. PMID:15201940

Ferraccioli, G

371

21 CFR 866.5775 - Rheumatoid factor immuno-logical test system.  

Code of Federal Regulations, 2010 CFR

...measure by immunochemical techniques the rheumatoid factor (antibodies to immunoglobulins...body fluids, and tissues. Measurement of rheumatoid factor may aid in the diagnosis of rheumatoid arthritis. (b) Classification. Class...

2009-04-01

372

21 CFR 866.5775 - Rheumatoid factor immuno-logical test system.  

Code of Federal Regulations, 2010 CFR

...measure by immunochemical techniques the rheumatoid factor (antibodies to immunoglobulins...body fluids, and tissues. Measurement of rheumatoid factor may aid in the diagnosis of rheumatoid arthritis. (b) Classification. Class...

2010-04-01

373

Rheumatoid nodulosis: report of two new cases and discussion of diagnostic criteria.  

PubMed

Two patients with typical rheumatoid nodulosis are described and compared with 24 reported cases. Rheumatoid nodulosis is a particular variant of rheumatoid arthritis associated with palindromic rheumatism, subcutaneous rheumatoid nodules, mild or no systemic manifestation and a benign clinical course. Positive rheumatoid factor and radiologic subchondral bone cysts are usual, but their absence should not eliminate the diagnosis of rheumatoid nodulosis, particularly at the onset of the disease. PMID:3058975

Couret, M; Combe, B; Chuong, V T; Leroux, J L; Blotman, F; Sany, J

1988-09-01

374

Amyloid arthropathy resembling seronegative rheumatoid arthritis in a patient with IgD-kappa multiple myeloma.  

PubMed

A 67-year-old woman suffered from symmetrical polyarthralgia and multiple joint swelling simulating rheumatoid arthritis (RA). Laboratory examination showed negative results for rheumatoid factor, decreased levels of IgG, IgA, and IgM, and an increased level of IgD. Immunoelectrophoresis in her serum and urine revealed an IgD-kappa monoclonal component and Bence Jones protein (kappa), respectively. A bone marrow biopsy showed an excess of atypical plasma cells. A synovial biopsy revealed amyloid deposition composed of IgD-kappa. She was diagnosed with amyloid arthropathy (AmyA) secondary to IgD-kappa multiple myeloma. It is important to pay attention to AmyA due to multiple myeloma in patients with seronegative RA. PMID:12583633

Fujishima, Masumi; Komatsuda, Atsushi; Imai, Hirokazu; Wakui, Hideki; Watanabe, Wataru; Sawada, Ken-ichi

2003-01-01

375

Rheumatoid arthritis in Kenya. II.Serological observations.  

PubMed Central

Sera from 48 Kenyan Africans with rheumatoid arthritis, 43 patients with other diseases, and 98 blood donors were tested for the presence of rheumatoid factor by latex fixation tests using human European, human African, and rabbit immunoglobulin, and a sheep cell haemagglutination test. In the patients with rheumatoid arthritis the frequency of rheumatoid factor was comparable to that reported in series from Europe and the USA, thus differing from the findings in West Africa. In the control patients and blood donors a high frequency of positive tests for rheumatoid factor was found; a similar result has been obtained from population studies in other African countries. Broadly similar results were obtained with each of the latex tests, and these were found to be less specific for rheumatoid arthritis than the sheep cell haemagglutination test.

Houba, V; Bagg, L R; Hansen, D P; Bowry, T

1979-01-01

376

Current Concepts in the Management of the Rheumatoid Hand  

PubMed Central

Hand surgeons are an integral part of the management team for patients with rheumatoid arthritis. There is now a greater understanding of the national utilization of rheumatoid hand surgery, which highlights the differences between hand surgeons and rheumatologists regarding the treatment of the rheumatoid hand. Advances in medical treatments have also decreased the prevalence of hand deformities caused by this disease. Hand surgeons today have less exposure to treating rheumatoid hand, but despite more effective medical options, surgery may still offer patients hope for improvement of hand function and appearance. This article will summarize the current state of rheumatoid hand surgery and discuss the surgical treatment strategies for optimizing outcomes for patients suffering from rheumatoid arthritis.

Chung, Kevin C; Pushman, Allison G

2011-01-01

377

Hepatotoxicity of tocilizumab and anakinra in rheumatoid arthritis: management decisions  

PubMed Central

Background Elevation of liver enzymes in rheumatoid arthritis patients treated with tocilizumab (Actemra®) or anakinra (Kineret®) is a well-documented phenomenon. However, characterization of liver histology has not been defined in most cases. Similarly, the factors involved in decisions regarding discontinuation of treatment and outcome have not been discussed in the literature to any significant extent. Cases Two women with rheumatoid arthritis refractory to standard therapies are reported here. One was treated with tocilizumab and the other with anakinra, and both developed toxic liver effects. Liver biopsy in both cases showed focal necrosis of hepatocytes – a hallmark of drug toxicity – with steatosis and early fibrosis. Inflammatory infiltrates were prominent in the patient treated with anakinra but not in the tocilizumab-treated patient. However, FibroTest (Assistance publique – Hôpitaux de Paris, Paris, France) in the latter patient showed an inflammatory activity of A2 and was staged as F2, and the histology also showed hemorrhagic areas. Although both patients were overweight and both had been exposed to steroids, the steatosis and steatohepatitis were considered to be related to drug hepatotoxicity. Other possible etiologies for liver injury were excluded. Discontinuation of anakinra led to rapid normalization of liver enzymes. The patient receiving tocilizumab developed hepatosplenomegaly but had normal liver enzymes. In spite of the hepatosplenomegaly, the tocilizumab treatment was continued since the patient had not responded to other drugs. There was a good response to the tocilizumab treatment and the liver biopsy showed only insignificant, reversible liver injury. At follow-up at 6-months the patient remains stable. Conclusion As cases showing tocilizumab or anakinra liver toxicity are appearing more frequently to the authors, a full assessment for liver injury is recommended in patients given those drugs, with careful consideration of the decision to continue or discontinue treatment. Further studies with long-term follow-up analysis are mandatory to guide appropriate management strategies.

Mahamid, Mahmud; Mader, Reuven; Safadi, Rifaat

2011-01-01

378

Transpiration and Assimilation of Early Devonian Land Plants with Axially Symmetric Telomes—Simulations on the Tissue Level  

Microsoft Academic Search

Early terrestrial ancestors of the land flora are characterized by a simple, axially symmetric habit and evolved in an atmosphere with much higher CO2concentrations than today. In order to gain information about the ecophysiological interrelationships of these plants, a model dealing with their gaseous exchange, which is basic to transpiration and photosynthesis, is introduced. The model is based on gas

W. KONRAD; A. R OTH-NEBELSICK; H KERP; H. HASS

2000-01-01

379

Rheumatoid nodulosis. Two cases with destructive polyarthritis after 20 years  

Microsoft Academic Search

The term “rheumatoid nodulosis” was coined by Ginsberg in 1975 to designate a rare and distinctive form of rheumatoid disease. Anecdotal case reports suggest a benign nondestructive course, although prolonged follow-up data are usually unavailable. We describe two cases of typical rheumatoid nodulosis with follow-ups exceeding 25 years. Onset occurred at 14 and 22 years of age, respectively. Both patients presented with

Fabienne Roux; Marie-José Wattiaux; Gilles Hayem; Elisabeth Palazzo; Marcel-Francis Kahn; Olivier Meyer

2006-01-01

380

Oral contraception, parity, breast feeding, and severity of rheumatoid arthritis.  

PubMed

In France, researchers compared data on 176 women 25-84 years old who had been diagnosed with rheumatoid arthritis at Gui de Chauliac Hospital in Montpellier and who had had at least 1 birth with data on 145 healthy female controls to examine the influence of oral contraceptives (OCs), breast feeding, and parity on rheumatoid arthritis. Women who used OCs for fewer than 5 years were less likely to develop rheumatoid arthritis than nonusers (adjusted odds ratio [AOR] = 0.713), but the difference was not significant. OC use before onset of rheumatoid arthritis was less common in women with severe rheumatoid arthritis than in those with mild rheumatoid arthritis (21.7% vs. 44%; p 0.0001). OC use of more than 5 years had a protective effect against severe rheumatoid arthritis. When adjusted for age at birth, OC use, and breast feeding, parities 2 and 3 increased the risk of developing severe rheumatoid arthritis 2.9 and 4.8 fold, respectively (p 0.0001). 46% of cases with severe disease had totally breastfed for more than 6 months compared to 26% of those with mild rheumatoid arthritis (p 0.02). After adjusting for age, parity, and OC use, breast feeding duration of more than 6 months did not increase the risk of severe rheumatoid arthritis. Women with severe rheumatoid arthritis were more likely to have breastfed more children than those with mild disease (29% vs. 9%; p 0.008). After adjustment for age at birth, OC use, and parity, having breastfed at least 3 children increased the risk of severe disease (AOR = 1.4). These findings show that parity and, to a lesser extent, breast feeding worsened the prognosis of rheumatoid arthritis, while OC use has a protective effect against severe disease. The underlying mechanisms for these effects may involve prolactin and estrogen but further research in the field of immunoendocrinology is needed to determine the mechanisms. PMID:8712873

Jorgensen, C; Picot, M C; Bologna, C; Sany, J

1996-02-01

381

Which component of sulphasalazine is active in rheumatoid arthritis?  

PubMed Central

Sulphasalazine is known to be effective as a second line agent in the treatment of rheumatoid arthritis. The two chemical constituents of sulphasalazine (sulphapyridine and 5-aminosalicylic acid) were assessed separately in the treatment of rheumatoid arthritis. Over 24 weeks sulphapyridine showed a pronounced second line effect comparable with sulphasalazine and with a similar toxicity profile, whereas 5-aminosalicylic acid showed only a weak first line effect. Thus sulphapyridine appears to be the active moiety responsible for the second line effect of sulphasalazine in rheumatoid arthritis. The efficacy of the antibacterial component of sulphasalazine yet again permits speculation about the role of a bacterial pathogen in the aetiopathogenesis of rheumatoid disease.

Pullar, T; Hunter, J A; Capell, H A

1985-01-01

382

The effect of etanercept on anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis  

Microsoft Academic Search

Objective: To evaluate the changes in anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) following etanercept treatment in patients with rheumatoid arthritis.Methods: The study included 90 patients with rheumatoid arthritis who failed treatment with disease modifying antirheumatic drugs (DMARDs). All patients were allowed to continue treatment with DMARDs; 52 of them received etanercept as a twice weekly 25 mg

H A Chen; K C Lin; C H Chen; H T Liao; H P Wang; H N Chang; C Y Tsai; C T Chou

2006-01-01

383

On some additional recollections, and the absence thereof, about the early history of computer simulations in statistical mechanics  

SciTech Connect

This lecture is an extension and correction of a previous lecture given by the author ten years ago at ``Corso 97`` in Varenna. Here again he emphasizes that his early work was exclusively with applications of the Metropolis Monte Carlo method. His only connection with the early work on the molecular dynamics method was in collaboration with Alder and Wainwright in their joint effort to reconcile the results of the Monte Carlo and molecular dynamics methods for hard spheres. Here he amplifies a point suggested by a question asked by Professor Ciccotti: Namely, when was it discovered that the Metropolis method consists in the generation of a realization of a Markov chain, for which there was a large body of mathematical theory that made the justification of the method quite a simple matter?

Wood, W.W. [Los Alamos National Lab., NM (United States). Theoretical Div.

1995-09-01

384

Benefits of Exercise in Rheumatoid Arthritis  

PubMed Central

This paper aims to highlight the importance of exercise in patients with rheumatoid arthritis (RA) and to demonstrate the multitude of beneficial effects that properly designed exercise training has in this population. RA is a chronic, systemic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence and progression of cardiovascular disease, and accelerated loss of muscle mass, that is, “rheumatoid cachexia”. These factors contribute to functional limitation, disability, comorbidities, and reduced quality of life. Exercise training for RA patients has been shown to be efficacious in reversing cachexia and substantially improving function without exacerbating disease activity and is likely to reduce cardiovascular risk. Thus, all RA patients should be encouraged to include aerobic and resistance exercise training as part of routine care. Understanding the perceptions of RA patients and health professionals to exercise is key to patients initiating and adhering to effective exercise training.

Cooney, Jennifer K.; Law, Rebecca-Jane; Matschke, Verena; Lemmey, Andrew B.; Moore, Jonathan P.; Ahmad, Yasmeen; Jones, Jeremy G.; Maddison, Peter; Thom, Jeanette M.

2011-01-01

385

One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis  

Microsoft Academic Search

Objective. Joint protection aims to reduce pain and local inflammation, preserve the integrity of joint structures and improve function. There is evidence that it can improve pain and function in the short term, but the long-term effects are uncertain. This study evaluated the effects of joint protection in early rheumatoid arthritis (RA). Methods. A randomized, controlled, assessor-blinded trial of duration

A. Hammond; K. Freeman

2001-01-01

386

Neurophysiology study of early visual processing of face and non-face recognition under simulated prosthetic vision  

Microsoft Academic Search

Behavioral researches have shown that the visual function can be partly restored by phosphene-based prosthetic vision for the non-congenital blinds. However, the early visual processing mechanisms of phosphene object recognition is still unclear. This paper aimed to investigate the electro-neurophysiology underlying the phosphene face and non-face recognition. The modulations of latency and amplitude of N170 component in the event-related potential

Yuan Yang; Hong Guo; Shanbao Tong; Yisheng Zhu; Yihong Qiu

2009-01-01

387

Computer aided graphics simulation modelling using seismogeologic approach in sequence stratigraphy of Early Cretaceous Punjab platform, Central Indus Basin, Pakistan  

Microsoft Academic Search

Modelling stratigraphic sequence by using seismo-geologic approach, integrated with cyclic transgressive-regressive deposits, helps to identify a number of non-structural subtle traps. Most of the hydrocarbons found in Early Cretaceous of Central Indus Basin pertain to structural entrapments of upper transgressive sands. A few wells are producing from middle and basal regressive sands, but the massive regressive sands have not been

T. M. Qureshi; K. A. Khan

1996-01-01

388

NETs are a source of citrullinated autoantigens and stimulate inflammatory responses in rheumatoid arthritis.  

PubMed

The early events leading to the development of rheumatoid arthritis (RA) remain unclear, but formation of autoantibodies to citrullinated protein antigens (ACPAs) is considered a key pathogenic event. Neutrophils isolated from patients with various autoimmune diseases display enhanced neutrophil extracellular trap (NET) formation, a phenomenon that exposes autoantigens in the context of immunostimulatory molecules. We investigated whether aberrant NETosis occurs in RA, determined its triggers, and examined its deleterious inflammatory consequences. Enhanced NETosis was observed in circulating and RA synovial fluid neutrophils compared to neutrophils from healthy controls and from patients with osteoarthritis (OA). Further, netting neutrophils infiltrated RA synovial tissue, rheumatoid nodules, and skin. NETosis correlated with ACPA presence and levels and with systemic inflammatory markers. RA sera and immunoglobulin fractions from RA patients with high levels of ACPA and/or rheumatoid factor significantly enhanced NETosis, and the NETs induced by these autoantibodies displayed distinct protein content. Indeed, during NETosis, neutrophils externalized the citrullinated autoantigens implicated in RA pathogenesis, and anti-citrullinated vimentin antibodies potently induced NET formation. Moreover, the inflammatory cytokines interleukin-17A (IL-17A) and tumor necrosis factor-? (TNF-?) induced NETosis in RA neutrophils. In turn, NETs significantly augmented inflammatory responses in RA and OA synovial fibroblasts, including induction of IL-6, IL-8, chemokines, and adhesion molecules. These observations implicate accelerated NETosis in RA pathogenesis, through externalization of citrullinated autoantigens and immunostimulatory molecules that may promote aberrant adaptive and innate immune responses in the joint and in the periphery, and perpetuate pathogenic mechanisms in this disease. PMID:23536012

Khandpur, Ritika; Carmona-Rivera, Carmelo; Vivekanandan-Giri, Anuradha; Gizinski, Alison; Yalavarthi, Srilakshmi; Knight, Jason S; Friday, Sean; Li, Sam; Patel, Rajiv M; Subramanian, Venkataraman; Thompson, Paul; Chen, Pojen; Fox, David A; Pennathur, Subramaniam; Kaplan, Mariana J

2013-03-27

389

Raised circulating tenascin-C in rheumatoid arthritis  

PubMed Central

Introduction The aim of this study was to examine whether circulating levels of the pro-inflammatory glycoprotein tenascin-C (TNC) are elevated in musculoskeletal disorders including rheumatoid arthritis (RA) and to assess in RA whether levels are related to clinical disease status and/or patient response to treatment. Methods TNC in serum or plasma was quantified by ELISA. Samples from 4 cohorts of RA patients were examined and compared to normal human subjects and to patients with other inflammatory diseases. Results Circulating TNC levels were significantly raised in patients with RA, as well as patients with systemic lupus erythematosus, idiopathic inflammatory myositis, psoriatic arthritis and ankylosing spondylitis, whilst patients with Sjogren's syndrome displayed levels similar to healthy controls. The highest levels of TNC were observed in RA patients with late stage disease. In early disease TNC levels correlated positively with ultrasound determined erosion scores. Treatment of early RA patients with infliximab plus methotrexate (MTX) resulted in a transient decrease in circulating TNC over the first year of therapy. In contrast, TNC levels increased over time in RA patients receiving MTX alone. In patients treated with infliximab plus MTX, baseline TNC levels significantly correlated with tender joint counts (TJC) at 18 and 54 weeks after initiation of infliximab therapy. Conclusions Raised circulating TNC levels are detected in specific inflammatory diseases. Levels are especially high in RA where they may act as a biomarker of bone erosion and a predictor of the effect of infliximab on RA patient joint pain.

2012-01-01

390

Clinical measures in rheumatoid arthritis and ankylosing spondylitis.  

PubMed

Except for morning stiffness, the clinical symptoms and the history of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) usually differ: the location in RA is mostly the hands and feet, and in AS rather the back. Patients with RA tend to be older (>50 years) and female, while in AS there are somewhat more often male and younger (<30 years) at onset of inflammatory back pain, the leading clinical symptom. The clinical examination of patients in the early phase of the disease is usually easier in RA, although arthralgia and arthritis may be difficult to differentiate. Joint counts are useful in states of high disease activity with polyarticular flares and more established disease. In comparison, in AS, young patients with back pain frequently show normal physical examens, a reduction of lateral spinal flexion and chest expansion are often the earliest signs which are also sensitive to change on therapy with biologics. The cervical spine may be affected in RA and AS - more frequently in advanced disease stages but rather early cases have been reported. PMID:19822051

Fendler, C; Braun, J

391

Immunologic mechanisms in the pathogenesis of rheumatoid arthritis.  

PubMed

Although much is known about the etiology and pathogenesis of rheumatoid arthritis (RA), our understanding of the immune pathways remains incomplete. The observed clinical and pathologic manifestations result from activation of several interrelated immune pathways. Current concepts of RA pathogenesis, supported by animal models, laboratory studies, and clinical observation, have reestablished and revised some of the original views. Early proposals emphasized the importance of autoantibodies and immune complexes in the initiation of RA, suggested a role for T cells in the inflammatory response characteristic of RA, and based disease perpetuation on an imbalance in the cytokine networks. We now recognize that each of these interrelated mechanisms significantly contributes to RA pathogenesis, including T cells that can help initiate and perpetuate the disease. This article reviews the major components and immune pathways involved in RA and briefly discusses the animal models that contribute to our understanding. Although a unified theory of RA pathogenesis may not be possible at this time, a paradigm is presented that considers the immune pathways that contribute to disease progression and joint destruction. These pathways may have important implications for treatment, because their modulation by biologic response modifiers (BRMs) directed toward specific targets provides benefits to patients with RA. BRMs are a new class of therapeutic agents derived from biologically active molecules and designed to modulate specific immune or inflammatory pathways. Although currently approved BRMs still have limitations, choosing an appropriate target, possibly early rather than late in the immune response, might result in new and improved therapies for RA. PMID:16357749

Firestein, Gary S

2005-06-01

392

Current therapies in rheumatoid arthritis: a Latin American perspective.  

PubMed

Rheumatoid arthritis (RA) is a systemic inflammatory disease affecting the synovium of joints, tendons, and some extra-articular sites. RA prevalence in Latin America ranges from 0.4 to 1.6%. Early treatment of RA translates into a substantial reduction in the cost to society. In light of this, early disease clinics are being established in some countries. Barriers to RA management, such as delay in referral to rheumatologists and limited access to therapy, have been identified. Evidence-based treatment guidelines have been adapted by countries according to their own situations. The need for keeping accurate records of biologics prescribed has been addressed by biologic registries, thereby contributing toward a better understanding of rheumatic diseases and their treatment. Current biologics include the tumor necrosis factor (TNF)-? inhibitors (etanercept, infliximab, and adalimumab), B-cell depletion agent (rituximab), interleukin-6 receptor blocker (tocilizumab), and T-cell co-stimulatory blocker (abatacept). Future therapies include kinase inhibitors (tofacitinib and fostamatinib), alternative TNF-? inhibitors (golimumab and certolizumab), and biosimilars. PMID:23337169

Burgos-Vargas, Rubén; Catoggio, Luis Jose; Galarza-Maldonado, Claudio; Ostojich, Kasmir; Cardiel, Mario H

2013-01-20

393

New therapeutic targets for rheumatoid arthritis  

Microsoft Academic Search

New insights into the pathogenesis of rheumatoid arthritis (RA) and consequently new targets of therapy are covered in a broad overview fashion. Short-term significant beneficial effect on RA disease activity has been established in a small but rapidly growing number of double-blind placebo-controlled trials now including recombinant human IL-1 receptor antagonist, chimeric (mouse\\/human) monoclonal antibodies (mAb) against TNFa (cA2), humanised

H. J. Dinant; B. A. C. Dijkmans

1999-01-01

394

Epidemiology and genetics of rheumatoid arthritis  

Microsoft Academic Search

CHAPTER SUMMARY: The prevalence of rheumatoid arthritis (RA) is relatively constant in many populations, at 0.5–1.0%. However, a high prevalence of RA has been reported in the Pima Indians (5.3%) and in the Chippewa Indians (6.8%). In contrast, low occurrences have been reported in populations from China and Japan. These data support a genetic role in disease risk. Studies have

Alan J Silman; Jacqueline E Pearson

2002-01-01

395

Rheumatoid arthritis: direct and indirect costs  

Microsoft Academic Search

Rheumatoid arthritis (RA) causes disability, deformities, progressive radiological joint damage often with a need for joint replacement surgery, premature death, and alterations in quality of life. The economic burden created by RA is enormous. Direct costs per patient have been estimated at 1812–11 792 € annually and indirect costs at 1260–37 994 € annually. These mean values are approximations, as variations occur across countries,

Anne-Christine Rat; Marie-Christophe Boissier

2004-01-01

396

Rheumatoid arthritis in blacks in South Africa  

Microsoft Academic Search

The spectrum of rheumatoid arthritis (RA) was studied in a group of 52 blacks who attended a rheumatology unit in Cape Town, South Africa. The mean age of the patients was 44.6 years, and the female to male ratio was 3.7:1. Significant radiographic changes were frequently noted, and the mean Larsen scores were 34.9 for the hands, 19.6 for the

G M Mody; O L Meyers

1989-01-01

397

Understanding emerging treatment paradigms in rheumatoid arthritis  

Microsoft Academic Search

Treatment strategies for rheumatoid arthritis (RA) will continue to evolve as new drugs are developed, as new data become\\u000a available, and as our potential to achieve greater and more consistent outcomes becomes more routine. Many patients will find\\u000a both symptom relief and modest control of their disease with disease-modifying antirheumatic drugs (DMARDs), yet this course\\u000a of therapy is clearly not

Ferdinand C Breedveld; Bernard Combe

2011-01-01

398

Advances in Rheumatoid Arthritis Animal Models  

Microsoft Academic Search

Experimental models of rheumatoid arthritis have contributed immensely to our understanding of the pathogenesis as well as\\u000a the treatment of this debilitating autoimmune disease. Significant progress has been made in the past few years in defining\\u000a the role of newer cytokines and regulatory T cells, of inflammation-mediated bone and cartilage damage, and of the cholinergic\\u000a anti-inflammatory pathway in modulating the

Kamal D. Moudgil; Peter Kim; Ernest Brahn

399

TH-17 cells in rheumatoid arthritis  

Microsoft Academic Search

INTRODUCTION: The aim of this study was to quantify the number of T-helper (TH)-17 cells present in rheumatoid arthritis (RA) synovial fluid (SF) and to determine the level of interleukin (IL)-17 cytokine in RA, osteoarthritis (OA) and normal synovial tissue, as well as to examine SF macrophages for the presence of IL-23, IL-27 and interferon (IFN)-?. METHODS: Peripheral blood (PB)

Shiva Shahrara; QiQuan Huang; Arthur M Mandelin II; Richard M Pope

2008-01-01

400

B cell targets in rheumatoid arthritis  

Microsoft Academic Search

B cells are critical to the pathogenesis of rheumatoid arthritis (RA). There is substantial evidence of the efficacy of depletion\\u000a of B cells in many patients with RA using the first licensed agent, rituximab. Recent research has focused on enhancing efficacy\\u000a using other targets to inhibit B cell function, including other B cell-depleting antibodies and cytokines critical to B cell

Edward M. Vital; Shouvik Dass; Paul Emery

401

Current drug therapy for rheumatoid arthritis  

Microsoft Academic Search

.  ?The etiology of rheumatoid arthritis (RA) remains unclear at present, but advances have been made in the drug therapy for\\u000a RA. Recent attention has been focused on selective cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal antiinflammatory drugs\\u000a (NSAIDs) that inhibit a subtype of cyclooxygenase. Various clinical studies have confirmed that the selective COX-2 inhibitors\\u000a cause fewer severe gastrointestinal complications, although an increased incidence

Shinichi Kawai

2003-01-01

402

Pathophysiology of Rheumatoid Arthritis and Other Disorders  

Microsoft Academic Search

Rheumatoid arthritis (RA) is a chronic systemic disorder of unknown cause. There are many manifestations, but the typical\\u000a feature of RA is chronic inflammatory synovitis, usually involving peripheral joints in a symmetric pattern. Although family\\u000a studies indicate a clear genetic predisposition, it must be considered that this genetic risk does not fully account for the\\u000a incidence of the disease, suggesting

Heinrich Resch

403

Gene therapy approaches for treating rheumatoid arthritis.  

PubMed

Current gene therapy approaches for treating rheumatoid arthritis have made use of gene transfer technology as an improved delivery system for emerging proteins and other biologicals whose activities may have therapeutic value. Preclinical research has focused on two primary directions, evaluation of methods of gene delivery and identification of gene products with antiarthritic potential. Although there are reports involving systemic gene delivery, the bulk of effort has focused on local, intraarticular administration using ex vivo and in vivo methods. Viral-based vectors, including adenovirus, adeno-associated virus and herpes simplex virus have the greatest efficiency of gene delivery after intraarticular injection and are capable of generating relevant levels of gene products in several animal models of disease. However, there are limitations to existing generations of these systems that currently preclude their clinical application. Those gene products found to be efficacious in animal models of rheumatoid arthritis include proteins that specifically block the activity of the primary inflammatory cytokines, and include interleukin-1 receptor antagonist and soluble receptors for tumor necrosis factor and interleukin-1. Delivery and expression of genes encoding certain cytokines such as interleukins -4, -10, and -13 and viral interleukin-10, that block synthesis of inflammatory mediators and downregulate aspects of cellular and humoral immune pathways have been found beneficial. Although significant progress has been made, leading to Phase I clinical trials, there remain several hurdles to the routine practice of gene therapy for treatment of rheumatoid arthritis. PMID:11039782

Ghivizzani, S C; Oligino, T J; Glorioso, J C; Robbins, P D; Evans, C H

2000-10-01

404

[Clinical quality management in rheumatoid arthritis].  

PubMed

Clinical quality management in rheumatoid arthritis (RA) aims at reducing inflammatory activity and pain in the short term and damage and disability in the long term. In the "Swiss Clinical Quality Management in rheumatoid arthritis" (SCQM) project, which started in 1997, a measurement-improvement system with feedback reports allows the rheumatologists to follow their RA patients with the aim of improving the quality of outcome. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Activity Index questionnaire (RADAI), damage with an X-ray score and disability with the Stanford Health Assessment Questionnaire (HAQ). The feedback is used by the individual rheumatologist to optimize the therapy of his/her RA patients. Beside the aim of improving the quality of treatment, the SCQM projects wants to build a Swiss cohort of RA patients, to improve the collaboration of rheumatologists in the clinic and in practice and to establish standards of treatment in RA. In this paper we describe the SCQM project in detail, we show two cases illustrating the usefulness of the SCQM in the management of individual RA patients, and we present the cross sectional analysis of the first 1223 RA patients included in the project. PMID:11759233

Langenegger, T; Fransen, J; Forster, A; Seitz, M; Michel, B A

2001-10-01

405

Lower limb arterial incompressibility and obstruction in rheumatoid arthritis  

PubMed Central

Background: Despite increased cardiovascular morbidity and mortality in rheumatoid arthritis, the peripheral arteries remain understudied. Objective: To examine the lower limb arteries in age and sex matched, non-smoking subjects with and without rheumatoid arthritis. Methods: The ankle-brachial index (ABI) was measured at the posterior tibial and dorsal pedal arteries. Arteries were classified as obstructed with ABI ?0.9, normal with ABI >0.9 but ?1.3, and incompressible with ABI >1.3. Multinomial logistic regression was used to estimate differences in ABI between patients and controls, adjusting for cardiovascular risk factors, rheumatoid arthritis manifestations, inflammation markers, and glucocorticoid dose. Results: 234 patients with rheumatoid arthritis and 102 controls were studied. Among the rheumatoid patients, 66 of 931 arteries (7%) were incompressible and 30 (3%) were obstructed. Among the controls, three of 408 arteries (0.7%) were incompressible (p = 0.002) and four (1%) were obstructed (p = 0.06). At the person level, one or more abnormal arteries occurred among 45 rheumatoid patients (19%), v five controls (5%, p = 0.001). The greater frequency of arterial incompressibility and obstruction in rheumatoid arthritis was independent of age, sex, and cardiovascular risk factors. Adjustment for inflammation markers, joint damage, rheumatoid factor, and glucocorticoid use reduced rheumatoid arthritis v control differences. Most arterial impairments occurred in rheumatoid patients with 20 or more deformed joints. This subgroup had more incompressible (15%, p?0.001) and obstructed arteries (6%, p = 0.005) than the controls, independent of covariates. Conclusions: Peripheral arterial incompressibility and obstruction are increased in rheumatoid arthritis. Their propensity for patients with advanced joint damage suggests shared pathogenic mechanisms.

del Rincon, I; Haas, R; Pogosian, S; Escalante, A

2005-01-01

406

Bone marrow edema and osteitis in rheumatoid arthritis: the imaging perspective.  

PubMed

ABSTRACT: Magnetic resonance imaging bone marrow edema is an imaging feature that has been described in many conditions, including osteomyelitis, overuse syndromes, avascular necrosis, trauma, and inflammatory arthritides. In rheumatoid arthritis (RA), bone edema has special significance as it has been shown to be a common and widespread lesion that is often apparent at the hands and wrists but has also been described elsewhere, including the feet. It may occur in early or late disease and has been shown in several large cohort studies to have major negative implications for prognosis. It is the strongest predictor of erosive progression yet to be identified and characteristically occurs in those patients with the most aggressive and potentially disabling disease. In patients with undifferentiated arthritis, bone edema also predicts progression to criteria-positive RA, both independently and to a greater extent when combined with anti-cyclic citrullinated peptide status or rheumatoid factor positivity. Its histological correlate in the late stages of RA has been shown to be osteitis, in which the bone marrow beneath the joint is invaded by an inflammatory and vascular lymphoplasmacytic infiltrate. This lies adjacent to trabecular bone, where increased numbers of osteoclasts have been observed within resorption lacunae, suggesting a mechanistic link between inflammation and erosive bone damage. This could lead to erosion both of the overlying cortex, leading to classic radiographic rheumatoid erosions, and of local trabecular bone, possibly contributing to periarticular osteopenia and cyst formation. In addition to synovitis, osteitis is now regarded as a major rheumatoid lesion that is responsive to therapeutic intervention. PMID:23043770

McQueen, Fiona M

2012-09-28

407

Dewetting of thin polymer films adsorbed on solid substrates: A Monte Carlo simulation of the early stages  

Microsoft Academic Search

Using an off-lattice bead–spring model of flexible polymer chains containing N=32 beads under bad solvent conditions, thin films of polymer melts are simulated. The films are confined between two parallel plates, the upper plate being purely repulsive while the lower plate exerts a short range attraction on the polymer layer so that a dense thin film is adsorbed on this

Andrey Milchev; Kurt Binder

1997-01-01

408

Differences in early contrail evolution of two-engine versus four-engine aircraft: Lidar measurements and numerical simulations  

Microsoft Academic Search

Jet- and vortex-regime evolution of contrails behind cruising aircraft is investigated by focusing on the role of aircraft type. Cross-section measurements by ground-based lidar and observational analysis are combined with numerical simulations of fluid dynamics and microphysics in the wake of a two-engine aircraft. Depending on ambient humidity levels, contrail evolution behind short-\\/medium-range twin-turbofan airliners is classified into two scenarios,

Ralf Sussmann; Klaus M. Gierens

2001-01-01

409

Health-related quality of life in rheumatoid arthritis: therapeutic education plus pharmacological treatment versus pharmacological treatment only  

Microsoft Academic Search

Objective: To determine whether therapeutic education added to conventional drug therapy reduced disability and pain in patients with early rheumatoid arthritis (RA). Methods: Fourty-three patients with RA, 29F\\/14 M, were included in a randomized, controlled trial and assigned to a control group receiving conventional pharmacological treatment only (n=21), or an intervention group receiving therapeutic education added to conventional pharmacological treatment (n=22).

Montserrat Núñez; Esther Núñez; Carmen Yoldi; Llorenç Quintó; José Muñoz-Gómez

2006-01-01

410

Clinical associations of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis  

Microsoft Academic Search

SUMMARY Hand bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) has potential as a marker of progression in early rheumatoid arthritis (RA). We examined a DXA methodology and studied in a cross-sectional manner 202 patients with RA. Hand BMD correlated inversely with age and was higher in males. Hand BMD correlated with lumbar and femoral sites. In females,

J. DEVLIN; J. LHJLEY; A. HUISSOON; R. HOLDER; R. REECE; P. PERKINS; P. EMERY

1996-01-01

411

2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology\\/European League Against Rheumatism collaborative initiative  

Microsoft Academic Search

ObjectiveThe 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA.MethodsA joint working group from the ACR and the European League Against Rheumatism developed, in three phases, a new approach to

Daniel Aletaha; Tuhina Neogi; Alan J. Silman; Julia Funovits; David T. Felson; Clifton O Bingham III; Neal S. Birnbaum; Gerd R. Burmester; Vivian P. Bykerk; Marc D. Cohen; Bernard Combe; Karen H. Costenbader; Maxime Dougados; Paul Emery; Gianfranco Ferraccioli; Johanna M. W. Hazes; Kathryn Hobbs; Tom W. J. Huizinga; Arthur Kavanaugh; Jonathan Kay; Tore K Kvien; Timothy Laing; Philip Mease; Henri A Ménard; Larry W. Moreland; Raymond L. Naden; Theodore Pincus; Josef S Smolen; Ewa Stanislawska-Biernat; Deborah Symmons; Paul P. Tak; Katherine S. Upchurch; Ji?í Vencovský; Frederick Wolfe; Gillian Hawker

2010-01-01

412

The role of side-chain interactions in the early steps of aggregation: Molecular dynamics simulations of an amyloid-forming peptide from the yeast prion Sup35  

NASA Astrophysics Data System (ADS)

Understanding the early steps of aggregation at atomic detail might be crucial for the rational design of therapeutics preventing diseases associated with amyloid deposits. In this paper, aggregation of the heptapeptide GNNQQNY, from the N-terminal prion-determining domain of the yeast protein Sup35, was studied by 20 molecular dynamics runs for a total simulation time of 20 ?s. The simulations generate in-register parallel packing of GNNQQNY -strands that is consistent with x-ray diffraction and Fourier transform infrared data. The statistically preferred aggregation pathway does not correspond to a purely downhill profile of the energy surface because of the presence of enthalpic barriers that originate from out-of-register interactions. The parallel -sheet arrangement is favored over the antiparallel because of side-chain contacts; in particular, stacking interactions of the tyrosine rings and hydrogen bonds between amide groups. No ordered aggregation was found in control simulations with the mutant sequence SQNGNQQRG in accord with experimental data and the strong sequence dependence of aggregation.

Gsponer, Jörg; Haberthür, Urs; Caflisch, Amedeo

2003-04-01

413

Fibrocyte activation in rheumatoid arthritis  

PubMed Central

Objectives. RA is a common, relapsing autoimmune disease primarily affecting the joints. Fibroblast-like synovial (FLS) cells are thought to be responsible for pannus formation and secretion of factors that recruit leucocytes to affected joints, thereby promoting bone and cartilage destruction. Fibrocytes are multipotent circulating stem cells that may have a role in RA pathogenesis, perhaps as the precursors of the FLS cells, or by regulating FLS cell function. Methods. We utilized multidimensional phospho-specific flow cytometry to characterize the activation status of peripheral blood (PB) fibrocytes derived from human RA patients at different stages of disease and from mice with CIA. Results. Human PB fibrocytes from RA patients exhibited phosporylation activation of the p44/42 and p38 MAP kinases (MAPKs), and STAT3 (signal transducer and activator of transcription) and STAT-5 early in disease, within the first year of diagnosis. Similarly, in murine CIA, an increase in the total number of PB phosphoSTAT5-positive fibrocytes was observed at early time points in disease. Notably, in the affected paws of mice with CIA, we identified an increased number of fibrocytes, in contrast to the paws of control mice. Conclusions. These data suggest that activated fibrocytes may influence the disease process in RA and may serve as surrogate markers for disease in the PB of affected patients.

Galligan, Carole L.; Siminovitch, Katherine A.; Keystone, Edward C.; Bykerk, Vivian; Perez, Omar D.

2010-01-01

414

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

1978-01-01

415

Rheumatoid nodulosis. Two cases with destructive polyarthritis after 20 years.  

PubMed

The term "rheumatoid nodulosis" was coined by Ginsberg in 1975 to designate a rare and distinctive form of rheumatoid disease. Anecdotal case reports suggest a benign nondestructive course, although prolonged follow-up data are usually unavailable. We describe two cases of typical rheumatoid nodulosis with follow-ups exceeding 25 years. Onset occurred at 14 and 22 years of age, respectively. Both patients presented with palindromic rheumatism, positive tests for rheumatoid factors, negative tests for other biological markers, and normal radiographs. Multiple subcutaneous nodules developed after 4 and 6 years with palindromic flares, respectively. Functional impairments and disfigurement required several surgical procedures to remove nodules. Histology was typical for rheumatoid nodules. Neither patient responded to disease-modifying anti-rheumatic drugs (gold, antimalarials, and D-penicillamine). Treatment consisted of nonsteroidal anti-inflammatory drugs combined with prednisone as needed. After 20 and 22 years of follow-up, respectively, both patients had typical rheumatoid arthritis with deformities and radiological joint destruction. In conclusion, these two cases establish that rheumatoid nodulosis can occur as a presentation of rheumatoid arthritis with a potential for severe joint damage after many years. PMID:16377229

Roux, Fabienne; Wattiaux, Marie-José; Hayem, Gilles; Palazzo, Elisabeth; Kahn, Marcel-Francis; Meyer, Olivier

2005-11-15

416

Cells of the synovium in rheumatoid arthritis. Macrophages  

Microsoft Academic Search

The multitude and abundance of macrophage-derived mediators in rheumatoid arthritis and their paracrine\\/autocrine effects identify macrophages as local and systemic amplifiers of disease. Although uncovering the etiology of rheumatoid arthritis remains the ultimate means to silence the pathogenetic process, efforts in understanding how activated macrophages influence disease have led to optimization strategies to selectively target macrophages by agents tailored to

Raimund W Kinne; Bruno Stuhlmüller; Gerd-R Burmester

2007-01-01

417

Artrite reumatóide no idoso Rheumatoid arthritis in the elderly  

Microsoft Academic Search

Rheumatoid arthritis is a chronic, complex disease of yet unknown pathogenesis with genetic and environmental infl uences. This article deals with the disease characteristics specifi cally related to old age including its clinical picture, diagnosis and treatment. In old age, differently from the young, the main objective is rapid pain relieve. Current treatment for rheumatoid arthritis involves the use of

Ieda Maria Magalhães Laurindo

418

B lymphocytes and humoral immune responses in rheumatoid arthritis  

Microsoft Academic Search

Summary Although the etiology of rheumatoid arthritis (RA) remains unknown at present, major evidence implicates humoral immune mechanisms in the pathophysiology of this disease. The primary lesions occur in the synovium and are characterized by immunological activation and chronic inflammation. Activated B cells and plasma cells secrete antibodies including rheumatoid factors and anticollagen antibodies. These antibodies give rise to immune

L. S. DE CLERCK

1995-01-01

419

Functional haplotypes of PADI4, encoding citrullinating enzyme peptidylarginine deiminase 4, are associated with rheumatoid arthritis  

Microsoft Academic Search

Individuals with rheumatoid arthritis frequently have autoantibodies to citrullinated peptides, suggesting the involvement of the peptidylarginine deiminases citrullinating enzymes (encoded by PADI genes) in rheumatoid arthritis. Previous linkage studies have shown that a susceptibility locus for rheumatoid arthritis includes four PADI genes but did not establish which PADI gene confers susceptibility to rheumatoid arthritis. We used a case-control linkage disequilibrium

Akari Suzuki; Xiaotian Chang; Shinya Tokuhiro; Tetsuji Sawada; Masakatsu Suzuki; Miyuki Nagasaki; Makiko Nakayama-Hamada; Reimi Kawaida; Mitsuru Ono; Masahiko Ohtsuki; Hidehiko Furukawa; Shinichi Yoshino; Masao Yukioka; Shigeto Tohma; Tsukasa Matsubara; Shigeyuki Wakitani; Ryota Teshima; Yuichi Nishioka; Akihiro Sekine; Aritoshi Iida; Atsushi Takahashi; Tatsuhiko Tsunoda; Yusuke Nakamura; Kazuhiko Yamamoto; Ryo Yamada

2003-01-01

420

Atlanto-axial dislocation in rheumatoid arthritis--diagnostic and therapeutic aspects.  

PubMed

Symptoms, signs and neuroradiological findings of 15 cases with atlanto-axial dislocation (AAD) due to rheumatoid arthritis are presented. CT of the craniocervical region revealed the exact anatomical relationships between the dens, the subarachnoid space and the brain stem, especially after intrathecal contrast medium injection and different positions of the head. From the results of operative procedures to reduce AAD it was concluded that early diagnosis and treatment of AAD leads to prompt relief of painful symptoms within 3 months and protects from neurological deterioration. PMID:3577854

Hildebrandt, G; Agnoli, A L; Zierski, J

1987-01-01

421

Isolated rheumatoid arthritis-associated cerebral vasculitis: a diagnostic challenge.  

PubMed

Central nervous system involvement in rheumatoid arthritis is uncommon. In order of frequency, published cases have reported rheumatoid nodules, meningeal vasculitis, and cerebral vasculitis (CV). The frequency of vasculitic cerebral involvement in rheumatoid arthritis is unknown. However, it is known that it is more common in patients with seropositive, long-standing rheumatoid arthritis, and in those with concomitant systemic vasculitis. We report the case of a 47-year-old woman with an 11-year history of seropositive rheumatoid arthritis without any extra-articular manifestations, with the exception of secondary Sjogren's syndrome, presenting with mental status changes and tonic-clonic seizures as symptoms of isolated CV. Magnetic resonance imaging (T2) showed hyperintense white-matter lesions in the frontal and temporal lobes, as well as in the hippocampus and cerebellum. Transcranial Doppler ultrasound findings were consistent with CV. Other differential diagnoses were ruled out. The patient responded favorably to methylprednisolone and intravenous gammaglobulin therapy. PMID:22858148

Guadalupe Loya-de la Cerda, Denisse; Avilés-Solís, Juan Carlos; Delgado-Montemayor, María José; Camara-Lemarroy, Carlos Rodrigo; Galarza-Delgado, Dionicio Ángel

2012-07-31

422

Correlation of Anti-Cyclic Citrullinated Antibody with Hand Joint Erosion Score in Rheumatoid Arthritis Patients  

PubMed Central

Background/Aims To examine the correlation between radiological joint damage and serological parameters in early rheumatoid arthritis (RA). Methods This retrospective study reviewed the records of 216 patients diagnosed with RA and classified them according to disease duration: group 1, ? 24 months; group 2, > 24 months; and group 3, all patients combined. The extent of joint damage was assessed from plain radiographs using a modified version of the Larsen method and compared among groups. Results The mean radiographic joint damage score was significantly higher in patients who had established RA (10.1 points) compared with those who had early RA. In group 1, the inflammatory parameters, erythrocyte sedimentation rate, and C-reactive protein were positively correlated with the joint damage score, but rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody were not. A subgroup analysis revealed that the anti-CCP positive patients in groups 1 and 2 had greater joint damage scores than did the anti-CCP negative patients, but no difference in RF was observed between subgroups. Anti-CCP positivity was not significantly correlated with joint damage sores in group 3. Conclusions Anti-CCP positivity was significantly correlated with more severe joint damage at diagnosis. A correlation was observed between the radiological joint damage score and inflammatory parameters in early and established RA, indicating that anti-CCP can serve as a diagnostic tool and predict structural joint damage. These findings suggest anti-CCP positive patients should receive aggressive therapeutic intervention.

Kim, Hyun Hee; Kim, JiHun; Kim, Seong-Kyu; Kim, Ok-Dong; Choe, Jung-Yoon

2010-01-01

423

Anti-citrullinated protein antibodies and their clinical utility in rheumatoid arthritis.  

PubMed

One of the most important serological discoveries in rheumatology in recent years has been the characterization of autoantigens in rheumatoid arthritis (RA) containing the amino acid citrulline. There are many citrullinated proteins in the inflamed RA synovium. Rheumatoid factor (RF), which is the immunologic hallmark of RA, is not specific for RA, as it is found in 5% of healthy individuals and in 10-20% of those over the age of 65 years. RFs are of low titer in early disease stages when a clear diagnosis is often not yet possible; But anti-citrullinated protein antibodies (ACPAs) can be found early in the disease course of RA, even years before the onset of clinical symptoms. The identification of citrullinated epitopes led to the development of the first and later second generation anti-cyclic citrullinated peptide (anti-CCP) antibody assays. Anti-CCP2 antibody has shown a specificity of 98% in sera from patients with established RA and 96% in sera from subjects with early RA. Anti-CCP can predict erosive disease, therefore could be a good serological marker for RA diagnosis. PMID:23992255

Farid, Sima Sh; Azizi, Gholamreza; Mirshafiey, Abbas

2013-07-15

424

Disseminated Herpes Zoster Mimicking Rheumatoid Vasculitis in a Rheumatoid Arthritis Patient on Etanercept  

Microsoft Academic Search

Tumor necrosis factor-? (TNF?)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster

S. Tresch; R. M. Trüeb; J. Kamarachev; L. E. French; G. F. L. Hofbauer

2009-01-01

425

The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis  

Microsoft Academic Search

BACKGROUND: Alterations in the feet of patients with rheumatoid arthritis (RA) are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL) based on validated scales and its relationship to disease activity. METHODS: This was a cross-sectional study in which 95

Adriana Rojas-Villarraga; Javier Bayona; Natalia Zuluaga; Santiago Mejia; Maria-Eugenia Hincapie; Juan-Manuel Anaya

2009-01-01

426

Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature.  

PubMed

Two cases of rheumatoid nodules evaluated by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and video-assisted thoracic surgery (VATS) biopsy are reported. The first case was that of a 44-year-old woman who presented with a cavitated nodule with intense standardized uptake values (SUVs) both in the early (max 3.4) and delayed (max 4.4) phases, suggesting malignancy. However, after VATS biopsy, she was diagnosed as having a rheumatoid nodule with vasculitis. The second case was that of a 74-year-old woman admitted with bilateral lung nodules, two of which showed intense early (max 2.2) and delayed (max 6.0) phase SUVs, and mild early (max 0.6) and delayed (max 0.9) phase SUVs. These two nodules were finally proven to be a lung cancer and rheumatoid nodule without vasculitis, respectively. These cases show that rheumatoid nodules with an enhanced inflammatory process, such as vasculitis, can appear false-positive for malignancy on FDG-PET/CT scan images. PMID:22669597

Saraya, Takeshi; Tanaka, Ryota; Fujiwara, Masachika; Koji, Hitoshi; Oda, Miku; Ogawa, Yukari; Nagatomo, Tomoko; Watanabe, Masato; Yokoyama, Takuma; Ishii, Haruyuki; Takei, Hidefumi; Goya, Tomoyuki; Takizawa, Hajime; Goto, Hajime

2012-06-06

427

Comparative Specificities of Serum and Synovial Cell 19S IgM Rheumatoid Factors in Rheumatoid Arthritis.  

National Technical Information Service (NTIS)

Rheumatoid factor (RF) may play a key role in sustaining the inflammatory events and tissue damage in rheumatoid arthritis (RA). However, many serum RF have greater specificity for rabbit IgG than for human IgG, thus raising questions about RF pathogenici...

D. L. Robbins R. Wistar

1985-01-01

428

A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal  

Microsoft Academic Search

Introduction. Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to treat rheumatoid arthritis (RA). Early trials showed their toxicity while recent trials suggest superior efficacy. Trials of DMARD combinations have enrolled different types of patient (early or established RA), used different designs (step-up, parallel or step-down) and utilized a range of outcome measures. We undertook a systematic review of

E. H. S. Choy; C. Smith; C. J. Dore; D. L. Scott

2005-01-01

429

Cerebral complications in juvenile rheumatoid arthritis  

PubMed Central

A study of 170 patients with juvenile rheumatoid arthritis and a review of the literature indicate that this disease can significantly affect the central nervous system. Signs of CNS dysfunction were observed in 13 children. During the acute toxic stages the EEG is abnormal in many cases. Other manifestations of toxic encephalopathy such as irritability, drowsiness, stupor, convulsions and marked meningismus may be evident in severe cases. Meningitis is often suspected but ruled out by the finding of normal CSF. Steroids can rapidly improve the condition of these children. If `unexplained' seizures occur during the chronic stage, the diagnosis of cerebral vasculitis should be entertained.

Jan, James E.; Hill, Robert H.; Low, Morton D.

1972-01-01

430

Antiglobulins in Nigerians with rheumatoid disease.  

PubMed Central

The levels of IgG and IgM antiglobulins in the sera of Nigerian patients with seropositive rheumatoid arthritis, seronegative arthritis, and Reiter's syndrome have been studied using an immunosorbent of glutaraldehyde insolubilized human IgG. No conclusion could be reached in the case of IgM antiglobulins because of the relatively high threshold of detectability in the quantitation procedure, but all groups of patients had significantly higher levels of IgG antiglobulins than did a group of healthy Nigerians.

Okafor, G O; Turner, M W; Greenwood, B M

1975-01-01

431

RHEUMATOID FACTOR PROPERTIES OF HYPERIMMUNE RABBIT SERA  

PubMed Central

The rheumatoid factor-like substance (RFLS) induced by hyperimmunization of rabbits with bacteria was consistently and exclusively associated with the macroglobulin fraction of the sera studied. The RFLS is separable from the bulk of serum proteins by zone centrifugation, DEAE cellulose chromatography, and gel filtration. Partially purified preparations of the RFLS were studied by immunoelectrophoretic analysis and analytical ultracentrifugation. Certain RFLS sera demonstrated selective reactivity with one or more rabbit isohemagglutinin antibodies. Pepsin treatment of rabbit ?-globulin removed or greatly diminishes its capacity to react with the RFLS.

Christian, Charles L.

1963-01-01

432

Progress toward personalized treatment of rheumatoid arthritis.  

PubMed

Treatment of rheumatoid arthritis (RA) has advanced significantly over the past decade, in part because of the identification of key elements in the immunopathogenesis of the disease, leading to the development of targeted immune-based therapies. Despite the availability of many highly specific therapies, the process of selecting a treatment regimen for an individual patient remains empirical. Personalized treatment, focused on predicting efficacy, non-response, and toxicity to better guide medication selection, moves closer to realization as genomic methods continue to be extended and refined. PMID:22910444

Keith, M P; Edison, J D; Gilliland, W R

2012-08-22

433

Idiopathic hypoparathyroidism associated with adult rheumatoid arthritis.  

PubMed

A 48-year-old female patient with adult onset idiopathic hypoparathyroidism diagnosed at the age of 28 years developed a typical seropositive rheumatoid arthritis (RA) at 46 years of age after several years of evolution of a palindromic rheumatism. Only one case of an association between idiopathic hypoparathyroidism and RA has been described in the medical literature. Autoimmunity seems to play a pivotal role in the aetiopathogenesis of both diseases, and could explain the nature of this association; nevertheless, a chance association could not be excluded. PMID:10468176

Salvador, G; Sanmartí, R; Ros, I; Halperin, I; Cañete, J D; Orellana, C; Muñoz-Gomez, J

1999-01-01

434

Cardiovascular Disease and Rheumatoid Arthritis: An Update  

PubMed Central

Patients with rheumatoid arthritis (RA) suffer significantly increased cardiovascular (CV) morbidity and mortality when compared to the general population. Both traditional CV risk factors and high levels of systemic inflammation have been linked to the increased CV risk in RA patients, but significant uncertainty remains regarding the mechanisms through which these factors contribute to CVD. In addition, ongoing questions remain regarding how best to identify RA patients at high risk for CVD, and what primary and secondary prevention strategies are effective at influencing CV outcome. The current review summarizes recent research in this field.

Charles-Schoeman, Christina

2012-01-01

435

[Perioperative use of biologicals in rheumatoid arthritis].  

PubMed

The high prevalence of patients with rheumatoid arthritis (RA) treated with biologics and the high proportion of RA patients requiring elective orthopaedic surgery indicates that the question of whether to continue or to interrupt biologic therapy in the context of a surgical procedure is a clinically relevant problem. Few data are available and the quality of the studies performed is somewhat limited. Thus, a straightforward recommendation on how this problem should be handled cannot be given on this basis. Therefore, individualized management based on risk stratification for postoperative complications seems currently to be the best solution. PMID:21267736

Heldmann, F; Dybowski, F; Baraliakos, X; Braun, J

2011-01-01