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Sample records for arthritis patients treated

  1. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab

    OpenAIRE

    Aira, Lazaro E.; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A.; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2015-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical ...

  2. Efficacy of abatacept and tocilizumab in patients with rheumatoid arthritis treated in clinical practice

    DEFF Research Database (Denmark)

    Leffers, Henrik Christian; Ostergaard, Mikkel; Glintborg, Bente;

    2011-01-01

    To describe drug survival, disease activity and clinical response in patients with rheumatoid arthritis (RA) treated with abatacept or tocilizumab in routine care, based on prospectively registered observational data from the nationwide Danish DANBIO registry.......To describe drug survival, disease activity and clinical response in patients with rheumatoid arthritis (RA) treated with abatacept or tocilizumab in routine care, based on prospectively registered observational data from the nationwide Danish DANBIO registry....

  3. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab

    NARCIS (Netherlands)

    Van Assen, Sander; Holvast, Albert; Benne, Cornelis A.; Posthumus, Marcel D.; Van Leeuwen, Miek A.; Voskuyl, Alexandre E.; Blom, Marlies; Risselada, Anke P.; De Haan, Aalzen; Westra, Johanna; Kallenberg, Cornelis; Bijl, Marc

    2010-01-01

    Objective. For patients with rheumatoid arthritis (RA), yearly influenza vaccination is recommended. However, its efficacy in patients treated with rituximab is unknown. The objectives of this study were to investigate the efficacy of influenza vaccination in RA patients treated with rituximab and t

  4. Treating approaches of neurotic disorders in patients with rheumatoid arthritis

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    Erkin Toirov

    2010-09-01

    Full Text Available During investigation of neurotic conditions in 168 patients with rheumatoid arthritis in 65.6% patients it was determined neurotic disorders (ND of different severity. Astheno-vegetative disorders were diagnosed in most cases (61.3%. Treatment of ND was carried out depending on the type and degree of its significance. In case of mild ND degree the complex treatment included sing general stimulating medications, physiotherapy and treatable physical training. Treatment for moderate ND degree used sedative medication (novopassit, sedavit, glisin, pion tincture, and the one for severe disease degree used antidepressants and tranquilizers. The treatment duration depended on the type of therapy (10-21 days.The treatment course provided significant reduction of ND symptoms in 66 patients (54.1% and full reduction of symptoms - in 44 patients (36.1%. In 12 patients (9.8% we did not determine any reductions of clinical symptoms of ND. Psychotherapy course provided positive outcomes in 62.3% of patients, satisfactory - in 26.2% of patients, and unsatisfactory - in 11.5% of patients. In the control group (46 patients without ND these results were taken accordingly in 52.2%, 37.0% and 10.8% of patients.

  5. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab.

    Science.gov (United States)

    Aira, Lazaro E; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease.

  6. Immunological evaluation of rheumatoid arthritis patients treated with itolizumab

    Science.gov (United States)

    Aira, Lazaro E.; Hernández, Patricia; Prada, Dinorah; Chico, Araceli; Gómez, Jorge A.; González, Zuyén; Fuentes, Karla; Viada, Carmen; Mazorra, Zaima

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation that affects approximately 1% of the general population. Itolizumab, a monoclonal antibody specific for the human CD6 molecule mainly expressed on T lymphocytes, has been shown to inhibit proliferation of T cells and proinflammatory cytokine production in psoriasis patients. We have now assessed the immunological effect of itolizumab in combination with methotrexate in rheumatoid arthritis by analyzing clinical samples taken from 30 patients enrolled in a clinical trial. T and B cell subpopulations were measured at different time points of the study. Plasma cytokine levels and anti-idiotypic antibody response to itolizumab were also evaluated. The combined treatment of itolizumab and methotrexate led to a reduction in the frequency of T cell subpopulations, and plasma levels of proinflammatory cytokines showed a significant decrease up to at least 12 weeks after treatment ended. No anti-idiotypic antibody response was detected. These results support the relevance of the CD6 molecule as a therapeutic target for the treatment of this disease. PMID:26466969

  7. Risk of virus-associated cancer in female arthritis patients treated with biologigal DMARDs

    DEFF Research Database (Denmark)

    Cordtz, René; Mellemkjær, Lene; Glintborg, Bente;

    2016-01-01

    .0) cancer only occurred among bDMARD-treated patients. SIR was not increased for cervical cancer, either in ever or never bDMARD-treated patients. SIRs for Hodgkin's and non-Hodgkin's lymphomas were increased in never bDMARD-treated patients (SIR = 2.5, 95% CI: 1.5, 4.0). CONCLUSION: bDMARD therapy...... was not associated with an overall excess of virus-associated cancers in female arthritis patients. The observed increased occurrence of oropharyngeal cancer needs further investigation. Lymphoma incidence was increased in patients unexposed to bDMARD treatment.......OBJECTIVE: To investigate the risk of virus-associated cancer in female arthritis patients ever treated with biological DMARDs (bDMARDs) compared with never bDMARD-treated patients and ever and never treated with bDMARD compared with the general population. METHODS: This was a cohort study...

  8. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics

    DEFF Research Database (Denmark)

    Mercer, Louise K; Askling, Johan; Raaschou, Pauline;

    2017-01-01

    OBJECTIVES: Some studies have reported a possible association between exposure to tumour necrosis factor (TNF) inhibitors and an increased risk of melanoma. The aim of this study was to investigate the incidence of invasive cutaneous melanomas in patients with rheumatoid arthritis (RA) treated wi...

  9. Incidences of overall and site specific cancers in TNFα inhibitor treated patients with rheumatoid arthritis and other arthritides - a follow-up study from the DANBIO Registry

    DEFF Research Database (Denmark)

    Dreyer, Lene; Mellemkjær, Lene; Andersen, Anne Rødgaard;

    2013-01-01

    To investigate the incidence of cancer in arthritis patients treated with or without TNFα inhibitors (TNF-I).......To investigate the incidence of cancer in arthritis patients treated with or without TNFα inhibitors (TNF-I)....

  10. Scabies in a Patient with Rheumatoid Arthritis Treated with Adalimumab - A Case Report.

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    Marković, Ivan; Pukšić, Silva; Gudelj Gračanin, Ana; Čulo, Melanie Ivana; Mitrović, Joško; Morović-Vergles, Jadranka

    2015-01-01

    Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by synovitis, erosions, and destruction of affected joints. If untreated, it leads to severe disability and premature mortality. Tumor necrosis factor alpha (TNF-α) inhibitors are biological drugs used in treatment of rheumatoid arthritis. Possible side effects include skin allergic reactions, which, if generalized, are the reason for discontinuation of the drug. We report the case of a 46-year-old female patient with rheumatoid arthritis who presented with pruritus and erythematous papular exanthema after administration of the second dose of adalimumab. At first, we suspected a drug hypersensitivity reaction. As the signs and symptoms persisted for 2 months after discontinuation of adalimumab and despite continuous administration of antihistamines and glucocorticoids, further work-up was performed, and scabies was diagnosed. The patient was treated with topical 10% crotamiton. The symptoms were persistent and additional applications of the preparation were needed. After clinical remission of scabies, treatment of active rheumatoid arthritis with adalimumab was restarted without any complications.

  11. Treating rheumatoid arthritis to target

    DEFF Research Database (Denmark)

    Smolen, Josef S; Breedveld, Ferdinand C; Burmester, Gerd R

    2016-01-01

    BACKGROUND: Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards...

  12. Neprhrotic syndrome in a patient with rheumatoid arthritis treated with adalimumab: a case report

    Directory of Open Access Journals (Sweden)

    M.G. Portuesi

    2011-09-01

    Full Text Available The pathogenetic role of TNFα in inflammatory diseases has been known for a long time and has modified the therapeutic approach towards this pathology. All over the word, about 400.000 patients have been treated with biological anti-TNFα drugs. Particular attention has been taken for the safety of their use. Let us describe a case of 60 year old man affected by rheumatoid arthritis who has developed nephrotic syndrome with histological pattern typical of systemic lupus erythematosus-like syndrome, without autoantibodies.

  13. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint

    NARCIS (Netherlands)

    Cutolo, M.; Kitas, G.D.; Riel, P.L.C.M. van

    2014-01-01

    OBJECTIVE: The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations. METHODS: MEDLINE searches identified papers published in English from

  14. Delayed clinical response in patients with juvenile idiopathic arthritis treated with etanercept

    NARCIS (Netherlands)

    Otten, Marieke H; Prince, Femke H M; Twilt, Marinka; van Rossum, Marion A J; Armbrust, Wineke; Hoppenreijs, Esther P A H; Kamphuis, Sylvia; Koopman-Keemink, Yvonne; Wulffraat, Nico M; Gorter, Simone L; Ten Cate, Rebecca; van Suijlekom-Smit, Lisette W A

    2010-01-01

    OBJECTIVE: To evaluate response in patients with juvenile idiopathic arthritis (JIA) who failed to meet response criteria after 3 months of etanercept treatment. METHODS: This was a prospective ongoing multicenter observational study of all Dutch patients with JIA using etanercept. Response accordin

  15. Primary Hepatic Lymphoma in a Patient with Rheumatoid Arthritis Treated with Methotrexate

    Directory of Open Access Journals (Sweden)

    Goichi Tatsumi

    2014-01-01

    Full Text Available Primary hepatic lymphoma (PHL has rarely been reported in patients with immunosuppression. We herein describe a case of Epstein-Barr virus- (EBV- positive PHL in a 67-year-old Japanese woman receiving methotrexate (MTX treatment for rheumatoid arthritis (RA. The patient, who had been receiving MTX therapy for more than 6 years, presented with low-grade fever and abdominal pain. Initial laboratory tests showed mildly elevated liver enzymes with normal levels of alpha-fetoprotein and carcinoembryonic antigen, and computed tomography scans revealed multiple hepatic tumors with no lymph-node swelling. Examination of liver specimens obtained via ultrasonography-guided needle biopsy indicated EBV-positive diffuse large B cell lymphoma; therefore, she was diagnosed with PHL. MTX was discontinued, and she was carefully monitored thereafter owing to the prolonged history of MTX administration for RA. Rapid progression of PHL was observed; therefore 10 days after the PHL diagnosis, she received 6 cycles of R-THP-COP (rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone therapy and achieved complete remission for more than 1 year. Although MTX-associated lymphoproliferative disorders often show remission after withdrawal of MTX, early diagnosis and treatment are essential for PHL in patients with RA treated with MTX, because of the aggressive nature of the disease.

  16. Long-term followup of rheumatoid arthritis patients treated with total lymphoid irradiation

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    Tanay, A.; Field, E.H.; Hoppe, R.T.; Strober, S.

    1987-01-01

    Total lymphoid irradiation was administered to 32 patients with intractable rheumatoid arthritis. Twenty-four patients showed at least a 25% improvement in 3 of 4 disease activity parameters, which persisted during the followup period of up to 48 months. Eight of the 32 patients required adjunctive immunosuppressive drug therapy to maintain improvement. Four patients died after total lymphoid irradiation; the causes of death were acute myocardial infarction (1 patient), pulmonary embolism (1 patient), and rheumatoid lung disease complicated by respiratory infection (2 patients). After therapy, patients exhibited a prolonged reduction in the number and function of circulating T helper cells.

  17. Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

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    Popelka Stanislav

    2012-08-01

    Full Text Available Abstract Background Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability. Methods The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Results Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3% in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%. Conclusion The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

  18. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate

    OpenAIRE

    Štuhec, Matej

    2015-01-01

    The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were noadverse effects in concurrent administration of yellow fever vaccine and methotrexate. This patient did not show severe adverse reactions and did not contract yellow fever despite potential exposure. ...

  19. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report:

    OpenAIRE

    Štuhec, Matej

    2014-01-01

    The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were noadverse effects in concurrent administration of yellow fever vaccine and methotrexate. This patient did not show severe adverse reactions and did not contract yellow fever despite potential exposure. ...

  20. Rehabilitation of patients with rheumatoid arthritis treated in stationary spa treatment

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    Amila Jaganjac

    2015-04-01

    Full Text Available Introduction: Rheumatic diseases are nonsurgical diseases of the locomotor system and connective tissue. Rheumatoid arthritis (RA is a systemic inflammatory disease of connective tissue of unknown cause, with progressive chronic or subacute course. The aim of the research is to determine whether stationary spa treatment leads to improvement of the functional status in patients with rheumatoid arthritis. Methods: We included 35 patients with diagnosis of rheumatoid arthritis, referred for treatment at the spa " Ilidža " Gradačac from February to April 2014. Patients not adhering to treatment protocols were excluded. We used Visual analogue pain scale (VAS, HAQ questionnaire and assessment of the clinical condition before and after the treatment based on the scores 1-5.Results: There were 32 female and 3 male patients. The average age was 62.28±8.31 years. Based on the HAQ, 12 patients had no difficulties, 9 of them perform activities with little difficulties, 10 with many difficulties, and 4 patients cannot perform certain activities. Before treatment VAS was 6.63±2.36, and after treatment the 2.51±2.27. Ratings of clinical condition before treatment was 2.38±0.74, and after the treatment 3.64±0.98. The most frequently used therapies were kinesitherapy, magnetotherapy and interferential electricity. Conclusions: Stationary treatment at the spa „Ilidža“ Gradačac leads to an improvement of the functional status in patients with rheumatoid arthritis.

  1. Septic arthritis in patients with rheumatoid arthritis

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    Al-Ahaideb Abdulaziz

    2008-07-01

    Full Text Available Abstract 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.

  2. Septic arthritis in patients with rheumatoid arthritis

    OpenAIRE

    Al-Ahaideb Abdulaziz

    2008-01-01

    Abstract 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.

  3. Clinical Observation on Methotrexate Combined with Chinese Preparations in Treating Rheumatoid Arthritis Patients

    Institute of Scientific and Technical Information of China (English)

    陈洪滔; 张晓

    2002-01-01

    @@ Rheumatoid arthritis (RA) is an auto-immune disease, the cause of which is not clear. It manifested joint change as chief lesion, is a frequently encountered, common disease. In recent years the disease modifying antirheumatic drugs (DMARDs) combined application in treating RA has conducted many studies in domestic study and abroad, indicating that it can effectively retard the progressing of the disease. Meanwhile the domestic reports on the Chinese medicine (CM) in treating RA has obtained some efficacy, but the long-term efficacy was not sure. From May 1999 to August, 2001, the authors have applied and observed methotrexate (MTX) combined with CM preparation and MTX combined with western medicine (WM) in treating 43 cases of RA, the report is as follows.

  4. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report.

    Science.gov (United States)

    Stuhec, Matej

    2014-01-01

    The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were no adverse effects in concurrent administration of yellow fever vaccine and methotrexate. This patient did not show severe adverse reactions and did not contract yellow fever despite potential exposure. More research is needed on possible adverse effects of concurrent administration of yellow fever vaccine and methotrexate to determine the potential of this method for more frequent use.

  5. Canakinumab for the Patient With Difficult-to-Treat Gouty Arthritis: Review of the Clinical Evidence.

    Science.gov (United States)

    Bardin, Thomas

    2015-10-01

    Many patients with gouty arthritis experience frequent flares and have comorbidities that may limit their anti-inflammatory treatment options for acute flare management. For patients with contraindications to both NSAIDs and/or colchicine, treatment options are particularly limited, and there is an unmet medical need in this subgroup of patients. Two phase 3 studies and their extensions have demonstrated that a single dose of canakinumab during an acute flare provided rapid and effective pain relief and prolonged suppression of flares and inflammation in patients with a history of frequent flares and contraindicated for, intolerant of, or unresponsive to NSAIDs and/or colchicine. Canakinumab was consistently superior to the active comparator triamcinolone acetonide and was generally well tolerated in this patient population with a high prevalence of multiple medical comorbidities. Canakinumab should therefore be considered as a treatment option in a target population of patients with frequent gouty arthritis attacks who are unable to use NSAIDs and colchicine and in whom frequent use of corticosteroids is not considered appropriate.

  6. Candida infections in psoriasis and psoriatic arthritis patients treated with IL-17 inhibitors and their practical management

    DEFF Research Database (Denmark)

    Saunte, D M; Mrowietz, U; Puig, L

    2017-01-01

    infections, especially those due to Candida sp., as evidenced by findings in patients with genetic defects in IL-17 related immune responses. To assess the potential of anti-Il-17 treatment to promote Candida infections, here we have systematically reviewed published clinical trials of patients...... with psoriasis or psoriatic arthritis. Candida infections were reported in 4.0% of patients treated with brodalumab, 2.1% with secukinumab, and 3.3% with ixekizumab, compared with 0.3%, 2.3% and 0.8% of those assigned to placebo, ustekinumab or etanercept, respectively. Although the incidence of Candida...... infection was found to be increased by a only small degree during anti-IL-17 therapy, patients undergoing such treatment should be monitored for fungal infection and treated as necessary. We propose to adopt the recently updated recommendations for the practical management of Candida infection in patients...

  7. Radiographic outcome in Hispanic early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs

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    Contreras-Yanez, Irazu, E-mail: uzari02@hotmail.com.mx [Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, C.P. 14000, Tlalpan, Mexico, D.F. (Mexico); Rull-Gabayet, Marina, E-mail: rull.marina@gmail.com [Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, C.P. 14000, Tlalpan, Mexico, D.F. (Mexico); Vazquez-LaMadrid, Jorge, E-mail: docjvlradiologo@yahoo.com [Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, C.P. 14000, Tlalpan, Mexico, D.F. (Mexico); Pascual-Ramos, Virginia, E-mail: virtichu@gmail.com.mx [Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, C.P. 14000, Tlalpan, Mexico, D.F. (Mexico)

    2011-08-15

    Objectives: To determine rates of incident erosive disease in early rheumatoid arthritis patients, to identify baseline predictors and to evaluate erosion's impact on patient-reported outcomes. Methods: 82 patients with {<=}12 months of disease duration, {>=}3 years of follow-up and conventional treatment were included. Consecutive evaluations assessed swollen and tender joint counts, treatment and comorbidity, acute reactant-phase determinations and patient-reported outcomes. Digitized radiographs of the hands and feet were obtained at baseline and yearly thereafter. RA was defined as erosive when at least one unequivocal cortical bone defect was detected. Descriptive statistics and Cox regression analysis were performed. Results: At baseline, 71 of the patients were Female Sign , population median (range) age was of 38.7 (16-78.2) years, 58 patients had antibodies and all the patients had active disease and substantial disability. Follow-up cohort was of 299.3 person-years. At last follow-up (49 {+-} 13.8 months), 28 patients developed erosions. Erosion's location was the feet, in 12 patients. Incident rates of erosive disease at one, two, three and four years were of 8.1, 12.8, 13.8 and 5.6 per 100 person-years, respectively. Higher C-reactive protein (HR: 1.20, 95%CI: 1.04-1.4, p = 0.01) and positive antibodies (HR: 5.09, 95%CI: 1.08-23.86, p = 0.04) were baseline predictors of incident erosive disease. Erosions had minor impact on patient-reported outcomes. Conclusion: Rheumatoid arthritis patients with antibodies and higher C reactive protein at baseline are at risk for incident erosions which appear most frequently at the feet. Up to 1/3 patients conventionally treated develop incident erosions, which minimally impact function.

  8. Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute.

    Science.gov (United States)

    Momohara, Shigeki; Inoue, Eisuke; Ikari, Katsunori; Yano, Koichiro; Tokita, Asami; Honjo, Yurino; Sakuma, Yu; Hiroshima, Ryo; Iwamoto, Takuji; Seto, Yohei; Tanaka, Eiichi; Taniguchi, Atsuo; Yamanaka, Hisashi

    2012-04-01

    The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.

  9. Distinct Trajectories of Disease Activity Over the First Year in Early Rheumatoid Arthritis Patients Following a Treat-to-Target Strategy

    NARCIS (Netherlands)

    Siemons, Liseth; Klooster, ten Peter M.; Vonkeman, Harald E.; Glas, Cees A.W.; Laar, van de Mart A.F.J.

    2014-01-01

    Objective Although treat-to-target (T2T) strategies are effective in early rheumatoid arthritis (RA) patients, important individual variations exist in the course toward remission. Growth mixture modeling provides more insight into this heterogeneity by identifying subgroups of patients with similar

  10. The Way Forward: Practical Clinical Considerations for the Use of Canakinumab in Patients With Difficult-to-Treat Gouty Arthritis.

    Science.gov (United States)

    Bardin, Thomas; van de Laar, Martinus A F J

    2015-10-01

    Canakinumab is indicated for patients with frequent gouty arthritis attacks who cannot be managed with standard-of-care medication, and should be used according to the labeled indication. Given its mechanism of action, physicians need to be aware of the potential contraindications and precautions with its use. When deciding as to whether a patient with gouty arthritis is an appropriate candidate for canakinumab treatment, several key clinical considerations should be kept in mind, which are discussed herein.

  11. Measurement of quality of life among patient undergoing arthroplasty of the thumb to treat CMC arthritis

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    Marcio Aurélio Aita

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: To present the clinical and functional results, including measurement of quality of life, of patients undergoing trapeziometacarpal arthroplasty. METHOD: This was a prospective evaluation on 45 patients (53 thumbs with a diagnosis of idiopathic rhizarthrosis who underwent resection arthroplasty and interposition of an uncemented Ascension(r implant, made of pyrocarbon. The clinical and functional results were analyzed through radiography, range of motion (ROM in degrees (°, visual analog scale (VAS for pain and the disability of arm, shoulder and hand (DASH questionnaire for quality of life. In the group analyzed, 38 were women and seven were men, and their mean age was 63.17 years (range: 50-78. Eight patients were treated bilaterally. RESULTS: After 42.08 months of follow-up (range: 8-73, the subjective pain evaluation (VAS score was 1.37 (range: 1-4. The complete ROM of the thumb increased to 95.75% (range: 75-100% in relation to the contralateral side. The mean DASH questionnaire score was 9.98 (range: 1-18. The complication rate (negative events was 11.32%. Five patients presented dislocation of the thumb prosthesis. All of them were reoperated by means of dorsal capsuloplasty using a portion of the retinaculum of the extensors as a graft, and good clinical evolution was achieved in these cases. One patient presented fracturing of the metacarpal and was treated by means of osteosynthesis using Kirschner wires. CONCLUSION: This method is effective for treating rhizarthrosis, according to the measurements made on the clinical and functional results, even after taking the complication rate into consideration. Moreover, it provides an improvement of quality of life for these patients.

  12. Sexual dysfunction in a patient with rheumatoid arthritis treated with adalimumab

    OpenAIRE

    Levent Yazmalar; Mustafa Akif Sarıyıldız; İbrahim Batmaz

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic, systemic and inflammatory disease characterized by symmetric polyarthritis and arthralgia, morning stiffness, fatigue and rheumatoid nodules. Multifactorial etiology such as genetic, infectious, hormonal or environmental factors contribute to disease susceptibility. However, clear etiology is not still defined. Both women and men with RA suffer from decreased sexual function. Also, many factors include disease activity, medications or psychological diso...

  13. No overall damage progression despite persistent inflammation in adalimumab-treated psoriatic arthritis patients

    DEFF Research Database (Denmark)

    Poggenborg, René Panduro; Wiell, Charlotte; Bøyesen, Pernille;

    2014-01-01

    OBJECTIVE: In a comparative conventional MRI, dynamic contrast-enhanced (DCE)-MRI, CT and radiography study, the authors aimed to monitor whether inflammation is reduced or even eliminated and damage halted in PsA patients receiving anti-TNF therapy. METHODS: A 48-week prospective open......-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the Ps......A Response Criteria (PsARC). RESULTS: In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P MRI signs...

  14. Clinical audit of foot problems in patients with rheumatoid arthritis treated at Counties Manukau District Health Board, Auckland, New Zealand

    Directory of Open Access Journals (Sweden)

    Dalbeth Nicola

    2009-05-01

    Full Text Available Abstract Background At diagnosis, 16% of rheumatoid arthritis (RA patients may have foot joint involvement, increasing to 90% as disease duration increases. This can lead to joint instability, difficulties in walking and limitation in functional ability that restricts activities of daily living. The podiatrist plays an important role in the multidisciplinary team approach to the management of foot problems. The aim of this study was to undertake a clinical audit of foot problems in patients with RA treated at Counties Manukau District Health Board. Methods Patients with RA were identified through rheumatological clinics run within CMDHB. 100 patients were eligible for inclusion. Specific foot outcome tools were used to evaluate pain, disability and function. Observation on foot lesions were noted and previous history of foot assessment, footwear/insoles and foot surgery were evaluated. Results The median age of the cohort was 60 (IQR: 51–64 years old with median disease duration of 15 (IQR: 7.3–25 years. Over 85% presented with foot lesions that included corns and callus over the forefoot region and lesser toe deformities. Moderate to high disability was noted. High levels of forefoot structural damage were observed. 76% had not seen a podiatrist and 77% reported no previous formal foot assessment. 40% had been seen at the orthotic centre for specialised footwear and insoles. 27% of RA patients reported previous foot surgery. A large proportion of patients wore inappropriate footwear. Conclusion This clinical audit suggests that the majority of RA patients suffer from foot problems. Future recommendations include the provision of a podiatrist within the current CMDHB multidisciplinary rheumatology team to ensure better services for RA patients with foot problems.

  15. Correlations between immunogenicity, drug levels, and disease activity in an Italian cohort of rheumatoid arthritis patients treated with tocilizumab

    Science.gov (United States)

    Benucci, Maurizio; Meacci, Francesca; Grossi, Valentina; Infantino, Maria; Manfredi, Mariangela; Bellio, Emanuele; Bellio, Valerio; Li Gobbi, Francesca; Bazzichi, Laura; Moscato, Paolo; Caputo, Dario; Saviola, Gianantonio; Talotta, Rossella; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola

    2016-01-01

    The aim of this study was to evaluate the real-life immunogenicity of anti-drug antibodies, drug levels, and disease activity in an Italian cohort of rheumatoid arthritis patients treated with tocilizumab (TCZ). We evaluated 126 TCZ-treated patients with rheumatoid arthritis (16 males and 110 females; mean age 59±12 years, range 26–83; mean disease duration 11±5 years) with inadequate 12-week response to any synthetic and biological disease-modifying anti-rheumatic drugs, in a retrospective analysis. One-hundred and seven patients were treated with methotrexate mean dose 12.6±1.3 mg/week in combination with TCZ, 13 received TCZ monotherapy, and six received leflunomide 20 mg/day plus TCZ; all patients were treated with prednisone mean dose 6.4±1.2 mg/day. They had a 28-joint Disease Activity Score (DAS28) of >3.2, an erythrocyte sedimentation rate (ESR) of >30 mm/hour, and CRP levels of >1.0 mg/dL. We evaluated at baseline and after 6 months of treatment: DAS28; rheumatoid factor (RF) IgM, IgA, and IgG; anti-citrullinated peptide antibody; ESR; CRP; TNF-α; and IL-6. TCZ and anti-TCZ antibodies were detected using LISA-TRACKER Duo TCZ. TCZ levels of 10 µg/mL high. After 6 months of treatment only one patient was positive for anti-TCZ antibodies. There were correlations between DAS28, ESR, and CRP and IL-6 levels in all patients. Comparison of the 84 patients with TCZ levels of 10 µg/mL showed the following differences: DAS28: 3.09±1.32 vs 2.78±1.32, P=0.0005; ESR: 27±14.8 vs 14±12 mm/hour, P=0.0001; CRP: 1.47±1.05 vs 0.65±0.80 mg/dL, P=0.0086; TNF-α: 10.2±1.2 vs 9.9±1.1 pg/mL, P=0.999; IL-6: 3.65±4.75 vs 3.62±4.41 pg/mL, P=0.97; anti-citrullinated peptide antibody: 85.2±93.7 vs 86.7±90.3 IU/mL, P=0.94; RF IgM: 72.4±62.7 vs 68.3±61.6 IU/mL, P=0.754; RF IgA: 41.7±36.4 vs 47.8±42.1 U/mL, P=0.449; and RF IgG: 46.4±46.1 vs 59.3±58.2 U/mL, P=0.212. These findings show that the occurrence of anti-drug antibodies against TCZ is very rare and that

  16. No erosive progression revealed by MRI in rheumatoid arthritis patients treated with etanercept, even in patients with persistent MRI and clinical signs of joint inflammation

    DEFF Research Database (Denmark)

    Døhn, Uffe Møller; Skjødt, Henrik; Hetland, Merete;

    2007-01-01

    The aim of this study is to investigate the course of magnetic resonance imaging (MRI) signs of inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints during etanercept treatment. MRI of the non-dominant wrist and second to fifth MCP joints...... was performed in five clinical active RA patients before and 4 and 16 weeks after initiation of etanercept treatment. MRI was evaluated according to the EULAR-OMERACT RA MRI reference image atlas. The median 28-joint count disease activity score (DAS28; erythrocyte sedimentation rate based) was 5.6 (range 5...... patient showed erosive regression, while no patient showed erosive progression on MRI during 16 weeks of etanercept therapy; even though clinical and MRI signs of joint inflammation remained. This small study supports that erosive progression judged by MRI is minimal in RA patients treated with etanercept...

  17. Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis.

    Directory of Open Access Journals (Sweden)

    Ingunn Fride Tvete

    Full Text Available Rheumatoid arthritis patients have been treated with disease modifying anti-rheumatic drugs (DMARDs and the newer biologic drugs. We sought to compare and rank the biologics with respect to efficacy. We performed a literature search identifying 54 publications encompassing 9 biologics. We conducted a multiple treatment comparison regression analysis letting the number experiencing a 50% improvement on the ACR score be dependent upon dose level and disease duration for assessing the comparable relative effect between biologics and placebo or DMARD. The analysis embraced all treatment and comparator arms over all publications. Hence, all measured effects of any biologic agent contributed to the comparison of all biologic agents relative to each other either given alone or combined with DMARD. We found the drug effect to be dependent on dose level, but not on disease duration, and the impact of a high versus low dose level was the same for all drugs (higher doses indicated a higher frequency of ACR50 scores. The ranking of the drugs when given without DMARD was certolizumab (ranked highest, etanercept, tocilizumab/ abatacept and adalimumab. The ranking of the drugs when given with DMARD was certolizumab (ranked highest, tocilizumab, anakinra/rituximab, golimumab/ infliximab/ abatacept, adalimumab/ etanercept [corrected]. Still, all drugs were effective. All biologic agents were effective compared to placebo, with certolizumab the most effective and adalimumab (without DMARD treatment and adalimumab/ etanercept (combined with DMARD treatment the least effective. The drugs were in general more effective, except for etanercept, when given together with DMARDs.

  18. Polyarticular septic arthritis in an immunocompetent patient.

    Science.gov (United States)

    Clements, J; Dinneen, A; Heilpern, G

    2013-03-01

    Septic arthritis is an uncommon condition with an incidence of 2-3/100,000. It is clinically notable, however, as it is a rapidly destructive joint disease with significant associated morbidity and mortality. Polyarticular septic arthritis has an estimated incidence of 15% of all cases of infectious arthritis. We report a case of polyarticular septic arthritis with involvement of bilateral shoulders and wrist to highlight the importance of early diagnosis and treatment as well as the high mortality rates associated with this condition. Bilateral septic shoulder arthritis poses a challenge to treat, and its significance should not be underestimated as even with early surgical intervention and aggressive antibiotic and fluid resuscitation death is a sad but perhaps not uncommon outcome. It is therefore imperative that the diagnosis of polyarticular septic arthritis is kept prominent in the physician's mind when confronted with a patient with symptomatic polyarthralgia.

  19. The number needed to treat for second-generation biologics when treating established rheumatoid arthritis

    DEFF Research Database (Denmark)

    Kristensen, L. E.; Jakobsen, A. K.; Bartels, E. M.

    2011-01-01

    To evaluate the number needed to treat (NNT) and the number needed to harm (NNH) of the second-generation biologics abatacept, certolizumab, golimumab, rituximab, and tocilizumab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX)....

  20. The number needed to treat for second-generation biologics when treating established rheumatoid arthritis

    DEFF Research Database (Denmark)

    Kristensen, L E; Jakobsen, A K; Bartels, E M;

    2011-01-01

    To evaluate the number needed to treat (NNT) and the number needed to harm (NNH) of the second-generation biologics abatacept, certolizumab, golimumab, rituximab, and tocilizumab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX).......To evaluate the number needed to treat (NNT) and the number needed to harm (NNH) of the second-generation biologics abatacept, certolizumab, golimumab, rituximab, and tocilizumab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX)....

  1. Treating rheumatoid arthritis to target

    DEFF Research Database (Denmark)

    Smolen, Josef S; Aletaha, Daniel; Bijlsma, Johannes W J;

    2010-01-01

    BACKGROUND: Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA). OBJECTIVE: /st> To develop recommendations for achieving optimal therapeutic outcomes in RA. METHODS...

  2. MRI findings of treated bacterial septic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Bierry, Guillaume; Huang, Ambrose J.; Chang, Connie Y.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2012-12-15

    The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis. The study included 12 patients (8 male and 4 female; mean age 38 years, range 9-85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n = 3), knee (n = 3), shoulder (n = 2), sacroiliac (n = 2), ankle (n = 1), wrist (n = 1), and elbow (n = 1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings. Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p = 0.001). Abscesses were present in 5 cases (38 %), and their sizes decreased significantly at follow-up (p = 0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77 %) at baseline and in 8 cases (62 %) at follow-up MRI. Bone marrow edema was present in 10 joints (77 %) at baseline and persisted in 8 joints (62 %). Bone erosions were found in 8 joints (62 %) and persisted at follow-up MRI in all cases. The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection. (orig.)

  3. Do changes in prescription practice in patients with rheumatoid arthritis treated with biological agents affect treatment response and adherence to therapy? Results from the nationwide Danish DANBIO Registry

    DEFF Research Database (Denmark)

    Hetland, M L; Lindegaard, H M; Hansen, A;

    2008-01-01

    BACKGROUND: Prescription practice for tumour necrosis factor alpha (TNFalpha) inhibitors has changed towards treating patients with lower disease activity. OBJECTIVE: To determine the trend in treatment response in cohorts of patients with rheumatoid arthritis who started TNFalpha inhibitor...... treatment between 2000 and 2005. METHODS: 1813 patients with RA starting treatment with biological agents in 2000-5 were registered prospectively in the nationwide DANBIO Registry. Baseline disease activity and 12 months' treatment responses were determined in cohorts based on start year (2000/1; 2002; 2003...

  4. Correlations between immunogenicity, drug levels, and disease activity in an Italian cohort of rheumatoid arthritis patients treated with tocilizumab

    Directory of Open Access Journals (Sweden)

    Benucci M

    2016-03-01

    Full Text Available Maurizio Benucci,1 Francesca Meacci,2 Valentina Grossi,2 Maria Infantino,2 Mariangela Manfredi,2 Emanuele Bellio,2 Valerio Bellio,2 Francesca Li Gobbi,1 Laura Bazzichi,3 Paolo Moscato,4 Dario Caputo,4 Gianantonio Saviola,5 Rossella Talotta,6 Piercarlo Sarzi-Puttini,6 Fabiola Atzeni71Rheumatology Unit, Ospedale San Giovanni di Dio, Florence, Italy; 2Allergology and Immunology Laboratory, Ospedale San Giovanni di Dio, Florence, Italy; 3Rheumatology Unit, University of Pisa, Pisa, Italy; 4Internal Medicine and Rheumatology Unit, University of Salerno, Salerno, Italy; 5Rheumatology Unit, Salvatore Maugeri Foundation, Mantua, Italy; 6Rheumatology Unit, Ospedale Luigi Sacco, Milan, Italy; 7IRCCS Galeazzi Orthopedic Institute, Milan, ItalyAbstract: The aim of this study was to evaluate the real-life immunogenicity of anti-drug antibodies, drug levels, and disease activity in an Italian cohort of rheumatoid arthritis patients treated with tocilizumab (TCZ. We evaluated 126 TCZ-treated patients with rheumatoid arthritis (16 males and 110 females; mean age 59±12 years, range 26–83; mean disease duration 11±5 years with inadequate 12-week response to any synthetic and biological disease-modifying anti-rheumatic drugs, in a retrospective analysis. One-hundred and seven patients were treated with methotrexate mean dose 12.6±1.3 mg/week in combination with TCZ, 13 received TCZ monotherapy, and six received leflunomide 20 mg/day plus TCZ; all patients were treated with prednisone mean dose 6.4±1.2 mg/day. They had a 28-joint Disease Activity Score (DAS28 of >3.2, an erythrocyte sedimentation rate (ESR of >30 mm/hour, and CRP levels of >1.0 mg/dL. We evaluated at baseline and after 6 months of treatment: DAS28; rheumatoid factor (RF IgM, IgA, and IgG; anti-citrullinated peptide antibody; ESR; CRP; TNF-α; and IL-6. TCZ and anti-TCZ antibodies were detected using LISA-TRACKER Duo TCZ. TCZ levels of <10 µg/mL were considered low and >10 µg/mL high. After

  5. Evaluation of Clinical and Ultrasonographic Parameters in Psoriatic Arthritis Patients Treated with Adalimumab: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    M. Teoli

    2012-01-01

    Full Text Available Objectives. The aim of this study was to evaluate clinical and US-PD parameters in PsA during adalimumab treatment. Methods. A retrospective study has been conducted in forty patients affected by moderate-to-severe peripheral PsA. Clinical, laboratory, and US-PD evaluations were performed at baseline, after 4, 12, and 24 weeks of treatment. They included erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, visual analogue scale (VAS, Health Assessment Questionnaire (HAQ modified for Spondyloarthritis, Psoriasis Area Severity Index (PASI score, the 28-joint Disease Activity Score (DAS 28, and US-PD assessment. US-PD findings were scored according to a semiquantitative scale (ranging 0–3 for synovial proliferation (SP, joint effusion (SE, bone erosions (BE, and PD. Results. Data obtained for clinical, laboratory findings and US-PD evaluation showed statistical significant improvement in all the measures performed except for BE. A significant parallel decrease in SE, SP, and PD values were demonstrated. Conclusion. This study demonstrated that US-PD is a valid technique in monitoring the response to adalimumab in moderate-to-severe PsA.

  6. Reduced risk of all-cancer and solid cancer in Taiwanese patients with rheumatoid arthritis treated with etanercept, a TNF-α inhibitor

    Science.gov (United States)

    Lan, Joung-Liang; Tseng, Chun-Hung; Chen, Jiunn-Horng; Cheng, Chi-Fung; Liang, Wen-Miin; Tsay, Gregory J.

    2017-01-01

    Abstract Biologics has been widely used in the treatment of rheumatoid arthritis. We aimed to determine whether etanercept, a TNF-α inhibitor (TNFi) that is used to treat patients with rheumatoid arthritis (RA), affects cancer risk. This retrospective matched cohort study used data in the Registry of Catastrophic Illness Database in Taiwan from January 1, 1996 to December 31, 2010. RA, all-cancer, and solid cancer were defined using International Classification of Disease codes (ICD-9-CM 714.X, 140–208, and 140–199, respectively). Cox proportional hazard modeling was used to estimate the hazard ratio (HR) of cancer in all TNFi-treated RA patients, with a focus on the risk in the etanercept-treated patients, after adjusting for comorbidities and concomitant medication. In this Taiwanese dataset, there were 1111 TNFi-treated RA patients and 16,812 RA patients who were naive to all biologics identified. Among the 1002 pairs of etanercept-treated and biologic-naive patients who were matched 1-to-1 for age, gender, RA duration, methotrexate-use, and index date of TNFi prescription, the mean age was 48.9 ± 15.0 years. The highest proportion of patients was in the age subgroup of 30 to 60 years (63.8%). Most patients (77.2%) were women. The mean RA duration before etanercept treatment was 2.0 ± 1.5 years. During a mean 2.1 years of observation, etanercept was associated with significant risk reduction for all-cancer (HR 0.59, 0.36–0.98) and solid cancer (HR 0.46, 0.27–0.79) relative to the matched biologic-naive patients. The current study explored the safety profile of TNFi and identified a potential benefit of etanercept on the incidence of all-cancer and solid cancer in RA patients. PMID:28207513

  7. Plasma leptin and neuropeptide Y concentrations in patients with rheumatoid arthritis treated with infliximab, a TNF-α antagonist

    OpenAIRE

    Kopec-Medrek, Magdalena; Kotulska, Anna; Widuchowska, Malgorzata; Adamczak, Marcin; Więcek, Andrzej; Kucharz, Eugene J.

    2011-01-01

    TNF-α is one of the key proinflammatory cytokines in pathogenesis of rheumatoid arthritis (RA). TNF-α was also found to enhance synthesis of leptin. Leptin is mainly adipocyte-derived hormone controlling appetite and energy expenditure. It acts through inhibition of neuropeptide Y secretion. It is possible that TNF-α-induced leptin secretion contributes to body mass reduction in patients with RA. The study was designed to determine the influence of inactivation of the TNF-α with infliximab on...

  8. Impact of a magnetic resonance imaging-guided treat-to-target strategy on disease activity and progression in patients with rheumatoid arthritis (the IMAGINE-RA trial)

    DEFF Research Database (Denmark)

    Møller-Bisgaard, Signe; Hørslev-Petersen, Kim; Ejbjerg, Bo Jannik;

    2015-01-01

    BACKGROUND: Rheumatoid arthritis (RA) is a chronic, progressive joint disease, which frequently leads to irreversible joint deformity and severe functional impairment. Although patients are treated according to existing guidelines and reach clinical remission, erosive progression still occurs...... and increase the remission rate in patients with low disease activity or clinical remission. METHODS/DESIGN: The study is a non-blinded, multicenter, 2-year RCT with a parallel group design. Two hundred anti-CCP-positive, erosive RA patients characterized by low disease activity or remission, no clinically...... and clinical examinations as well as MRI (intervention group). Treatment is intensified according to a predefined treatment algorithm in case of inflammation defined as a disease activity score (DAS28) >3.2 and at least one clinically swollen joint (control and intervention groups) and/or MRI-detected BME...

  9. Rapidly progressing polyarticular septic arthritis in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Dhaliwal, Sandeep; LeBel, Marie-Eve

    2012-07-01

    Septic arthritis is an orthopedic emergency that can lead to significant morbidity and mortality. Polyarticular involvement is a relatively rare phenomenon occurring primarily in high-risk patients. In this article, we report the rare case of a patient with rheumatoid arthritis presenting with an acute episode of septic arthritis involving most of the joints of the body. Surprisingly, his bilateral total hip arthroplasties were completely unaffected. Unusual polyarticular presentations of septic arthritis, though rare, must still be considered within the differential diagnosis by all healthcare providers when treating certain high-risk groups.

  10. Epicardial Fat Thickness as Cardiovascular Risk Factor and Therapeutic Target in Patients with Rheumatoid Arthritis Treated with Biological and Nonbiological Therapies

    Directory of Open Access Journals (Sweden)

    Marcos M. Lima-Martínez

    2014-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease associated with high cardiovascular morbidity and mortality. Epicardial adipose tissue (EAT thickness may act as a therapeutic target during treatments with drugs modulating the adipose tissue. We evaluate EAT thickness in RA patients treated with biological and nonbiological disease-modifying antirheumatic drugs (DMARDs. A cross-sectional study was conducted with a cohort of 34 female RA patients and 16 controls matched for age and body mass index (BMI. Plasma glucose, basal insulin, plasma lipids, and high-sensitivity C-reactive protein (hs-CRP were assessed. EAT thickness and left ventricular mass (LVM were measured by echocardiography. No significant differences in waist circumference (WC, blood pressure, fasting blood glucose, basal insulin, and lipid parameters were found between the groups. The control group showed lower concentrations (P=0.033 of hs-CRP and LVM (P=0.0001 than those of the two RA groups. Patients treated with TNF-α inhibitors showed significantly lower EAT thickness than those treated with nonbiological DMARDs (8.56 ± 1.90 mm versus 9.71 ± 1.45 mm; P=0.04. Women with no RA revealed reduced EAT thickness (5.39 ± 1.52 mm as compared to all RA patients (P=0.001. Results suggest that RA patients have greater EAT thickness than controls regardless of BMI and WC.

  11. Improvement in symptoms and signs in the forefoot of patients with rheumatoid arthritis treated with anti-TNF therapy

    Directory of Open Access Journals (Sweden)

    Dewbury Keith

    2010-06-01

    Full Text Available Abstract Background Inhibition of tumour necrosis factor (TNF is an effective way of reducing synovitis and preventing joint damage in rheumatoid arthritis (RA, yet very little is known about its specific effect on foot pain and disability. The aim of this study was to evaluate whether anti-TNF therapy alters the presence of forefoot pathology and/or reduces foot pain and disability. Methods Consecutive RA patients starting anti-TNF therapy (infliximab, etanercept, adalimumab were assessed for presence of synovial hypertrophy and synovitis in the 2nd and 5th metatarso-phalangeal (MTP joints and plantar forefoot bursal hypertrophy before and 12 weeks after therapy. Tender MTP joints and swollen bursae were established clinically by an experienced podiatrist and ultrasound (US images were acquired and interpreted by a radiologist. Assessment of patient reported disease impact on the foot was performed using the Manchester Foot Pain and Disability Index (MFPDI. Results 31 patients (24 female, 7 male with RA (12 seronegative, 19 seropositive completed the study: mean age 59.6 (SD 10.1 years, disease duration 11.1 (SD 10.5 years, and previous number of Disease Modifying Anti Rheumatic Drugs 3.0 (1.6. Significant differences after therapy were found for Erythrocyte Sedimentation Rate (t = 4.014, p Presence of MTP joint synovial hypertrophy on US was noted in 67.5% of joints at baseline and 54.8% of joints at twelve weeks. Presence of plantar forefoot bursal hypertrophy on US was noted in 83.3% of feet at baseline and 75% at twelve weeks. Although there was a trend for reduction in observed presence of person specific forefoot pathology, when the frequencies were analysed (McNemar this was not significant. Conclusions Significant improvements were seen in patient reported foot pain and disability 12 weeks after commencing TNF inhibition in RA, but this may not be enough time to detect changes in forefoot pathology.

  12. [Dry eye syndrome in rheumatoid arthritis patients].

    Science.gov (United States)

    Polanská, V; Hlinomazová, Z; Fojtík, Z; Nemec, P

    2007-11-01

    The aim of this cross-sectional study was to review the incidence of the dry eye syndrome in rheumatoid arthritis (RA) patients, evaluate the association among the incidence of the dry eye syndrome, presence of positive rheumatoid factor (RF), the RA stage, and the duration of the disease. The group consisted of altogether 100 patients, 16 men and 84 women; the average age was 58.9 years (SD 14.6). The average duration of RA was 12.3 years, SD 11.0. In each patient, the Schirmer test I was performed, the presence of the LIPCOF (Lid Parallel Conjunctival Folds) on the slit lamp was assessed, the BUT (Tear Break-Up Time) was measured and vital fluorescein staining was performed. In each patient the data of the presence or absence of the RF in the serum, RA severity according to the X-ray examination, and the disease duration were recorded. The Pearson's association test for nominal variables was used for statistical evaluation of the association between the rheumatoid arthritis presence and the dry eye syndrome. In our group of 100 patients, the Schirmer test I was positive in 67% of patients. Positive BUT was marked in 84 % of patients. The conjunctival folds were present in 45 % of patients only. The pathological findings after cornea fluorescein staining appeared in 18 % of patients. The dry eye syndrome incidence was marked in 74% of patients with RA. Subjective difficulties were declared by 38.3% of patients only. The local treatment was already established in 23.0% of patients only. We did not find statistically significant correlation between the RF positive rheumatoid arthritis appearance and dry eye syndrome, nor between the stage of the rheumatoid arthritis and presence of the dry eye syndrome. We proved statistical connection between the presence of dry eye syndrome and the duration of rheumatoid arthritis longer than 10 years. Keratoconjunctivitis sicca is the most common ocular complication in rheumatoid arthritis patients. We proved the connection

  13. Immunogenicity and Lupus-Like Autoantibody Production Can Be Linked to Each Other along With Type I Interferon Production in Patients with Rheumatoid Arthritis Treated With Infliximab: A Retrospective Study of a Single Center Cohort

    Science.gov (United States)

    Ishikawa, Yuki; Fujii, Takao; Ishikawa, Seiko Kondo; Yukawa, Naoichiro; Hashimoto, Motomu; Furu, Moritoshi; Ito, Hiromu; Ohmura, Koichiro; Mimori, Tsuneyo

    2016-01-01

    Besides anti-drug antibodies, anti-nuclear antibodies and anti-DNA antibodies are often induced in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors. We examined the association between immunogenicity, autoantibody production, and serum cytokine profiles in patients with rheumatoid arthritis treated with infliximab. Japanese patients with rheumatoid arthritis (n = 57) were retrospectively examined. Serum trough levels of infliximab, anti-drug antibody, anti-nuclear antibody, and anti-DNA (Farr), anti-single-stranded DNA and anti-double-stranded DNA antibodies were measured. Interleukin-6, interferon-γ, interferon-α, and B-cell activating factor levels were also measured in the same sera. Then, we validated the association between anti-drug antibody and these serum markers along with clinical response to infliximab. Anti-drug antibodies developed in twenty-one patients (36.8%), whose serum trough levels of infliximab were significantly lower than those in anti-drug antibody-negative patients (0.09 ± 0.03 vs. 2.48 ± 0.326 μg/mL, p lupus-like autoantibody production in patients with rheumatoid arthritis treated with infliximab can be linked each other along with increased lupus-associated cytokine levels including type I interferons. PMID:27643491

  14. Improvement of reduced serum cartilage oligomeric matrix protein levels in systemic juvenile idiopathic arthritis patients treated with the anti-interleukin-6 receptor monoclonal antibody tocilizumab.

    Science.gov (United States)

    Nakajima, Shoko; Naruto, Takuya; Miyamae, Takako; Imagawa, Tomoyuki; Mori, Masaaki; Nishimaki, Shigeru; Yokota, Shumpei

    2009-01-01

    In this study, we determined serum cartilage oligomeric matrix protein (COMP) levels in systemic juvenile idiopathic arthritis (sJIA) patients during both the active and the remission phases to investigate how the growth cartilage turnover changed under tocilizumab treatment. Specimens were collected from 201 healthy children under 16 years of age with no growth impairment, and paired sera were collected from 11 sJIA patients treated with tocilizumab. Disease activity was assessed from white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and ferritin, and the COMP concentration was determined by sandwich enzyme-linked immunosorbent assay. Serum COMP concentrations were found independent of age, and the mean value in healthy children was 17.74+/-5.6 U/L. The mean serum COMP in sJIA patients during the active phase was 10.75+/-3.9 U/L, lower than that of healthy children. The mean serum COMP in the remission phase (14.89+/-3.9 U/L) was significantly higher than that in the active period (P<0.05). These results suggested that in sJIA patients, a reduced serum COMP concentration is a useful marker of active disease and growth impairment, and that the growth cartilage turnover suppressed during the active phase is improved in the remission phase under tocilizumab treatment.

  15. Dynamic contrast-enhanced, extremity-dedicated MRI identifies synovitis changes in the follow-up of rheumatoid arthritis patients treated with rituximab

    DEFF Research Database (Denmark)

    Cimmino, Marco A; Parodi, Massimiliano; Zampogna, Giuseppe

    2014-01-01

    OBJECTIVES: The aim of this study is to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by rheumatoid arthritis (RA). METHODS: Ten patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti-CCP positive, RA ...

  16. Agreement between the DAS28-CRP assessed with 3 and 4 variables in patients with rheumatoid arthritis treated with biological agents in the daily clinic

    DEFF Research Database (Denmark)

    Madsen, Ole Rintek

    2013-01-01

    The Disease Activity Score-28-C-reactive Protein 4 [DAS28-CRP(4)] composite measure for rheumatoid arthritis (RA) is based on 4 variables: tender and swollen joint counts, CRP, and patient global assessment. DAS28-CRP(3) includes only 3 variables, because patient global assessment has been omitted...

  17. Erosions in the foot at baseline are predictive of orthopaedic shoe use after 10 years of treat to target therapy in patients with recent onset rheumatoid arthritis

    NARCIS (Netherlands)

    S.A. Bergstra (Sytske Anne); I.M. Markusse (Iris M.); G. Akdemir (Gülşah); H.K. Ronday; K.H. Han (K. Huub); W.F. Lems (Willem); P.J.S.M. Kerstens; R. van Den Berg (Rosaline); R. Landewé (Robert); C.F. Allaart (Cornelia)

    2016-01-01

    textabstractThe objective of this study is to investigate if foot joint damage due to rheumatoid arthritis (RA) can predict whether patients will start wearing orthopaedic shoes (OS) within 10 years after treatment start. Data from recent onset RA patients with 10 years follow-up from the BeSt (Dutc

  18. Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice

    DEFF Research Database (Denmark)

    Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine

    2016-01-01

    start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. RESULTS: Estimated HBL/year varied strongly with age and sex. Compared to the reference...... remission (0.0032 vs. 0.0058 g/cm(2)/year; p sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only......BACKGROUND: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking...

  19. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers

    Science.gov (United States)

    Mercer, Louise K; Askling, Johan; Raaschou, Pauline; Dreyer, Lene; Hetland, Merete Lund; Strangfeld, Anja; Zink, Angela; Mariette, Xavier; Finckh, Axel; Canhao, Helena; Iannone, Florenzo; Zavada, Jakub; Morel, Jacques; Gottenberg, Jacques-Eric; Listing, Joachim

    2017-01-01

    Objectives Some studies have reported a possible association between exposure to tumour necrosis factor (TNF) inhibitors and an increased risk of melanoma. The aim of this study was to investigate the incidence of invasive cutaneous melanomas in patients with rheumatoid arthritis (RA) treated with TNF inhibitors (TNFi), other biologic disease modifying drugs and non-biologic therapy. Methods Eleven biologic registers from nine European countries participated in this collaborative project. According to predefined exposure definitions, cohorts of patients with RA were selected. Using the country-specific general population of each register as reference, age, sex and calendar year standardised incidence ratios (SIRs) of invasive histology-confirmed cutaneous melanoma were calculated within each register. Pooled SIR and incidence rate ratios (IRRs) comparing biologic cohorts to biologic-naïve were calculated across countries by taking the size of the register into account. Results Overall 130 315 RA patients with a mean age of 58 years contributing 579 983 person-years were available for the analysis and 287 developed a first melanoma. Pooled SIRs for biologic-naïve, TNFi and rituximab-exposed patients were 1.1 (95% CI 0.9 to 1.4), 1.2 (0.99 to 1.6) and 1.3 (0.6 to 2.6), respectively. Incidence rates in tocilizumab and abatacept-exposed patients were also not significantly increased. IRR versus biologic-naïve patients were: TNFi 1.1 (95% CI 0.8 to 1.6); rituximab 1.2 (0.5 to 2.9). Conclusions This large European collaborative project did not confirm an overall increased risk of melanoma following exposure to TNFi. PMID:27307502

  20. Changes in serum lipids in patients with rheumatoid arthritis treated with a combination of tocilizumab and methotrexate compared with methotrexate alone for 24 weeks of observation

    Directory of Open Access Journals (Sweden)

    E. V. Udachkina

    2015-11-01

    Full Text Available Background. According to the some studies tocilizumab therapy (TCZ in patients with rheumatoid arthritis (RA is accompanied by deterioration of blood lipid profile. Aim. To study changes in serum lipid parameters in patients with RA treated with a combination of tocilizumab and methotrexate compared with methotrexate alone for 24 weeks of observation. Material and methods. Patients (n=72 with RA were included into the pilot non-randomized 24-week study and divided in two groups: 1 TCZ+MTX group (n=39; women 30; median age 51 [43-55] years; 6 i.v. infusions of TCZ 8 mg/kg + МТX 10-20 mg/week; 2 MTX group (n=33; women 23; mеdian age 56 [48-63] years; MTX 7.5-20 mg/week. Results. At the baseline, similar proatherogenic blood profile was observed in both groups. The patients of MTX group more frequently took statins (n=19; 57.6% compared with the group TCZ+MTX (n=7; 18%, (p<0.05. The lipid levels correlated positively with traditional risk factors (p<0.05. RA activity and duration correlated negatively with high density lipoprotein cholesterol (HDL-C, (p<0.05. Good/satisfactory anti-inflammatory effect was achieved in both groups after 24 weeks of treatment. Patients of TCZ+MTX group showed an increase in total cholesterol and HDL-C levels by 11% and 110%, respectively and decrease in plasma atherogenic index (PAI by 47%, (p<0.05. HDL-C level increased by 22% and PAI decreased by 16% in patients of MTX group (p<0.05. Among patients of MTX group without statin therapy HDL-C as well as non-HDL-C levels were increased by 24% and 27%, respectively (p<0.05; PAI did not change significantly in this subgroup. Among patients of MTX group treated with statins isolated increase in HDL-C level by 22% and decrease in PAI by 37.3% (p<0.05 were observed. A number of patients with achieved target levels of all studied lipid parameters did not change significantly in both groups. Conclusions. TCZ+MTX combined therapy as well as MTX monotherapy are associated

  1. Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis

    NARCIS (Netherlands)

    Oosterveld, Frederikus G.J.; Rasker, Johannes J.; Floors, Mark; Landkroon, Robert; Rennes, van Bob; Zwijnenberg, Jan; Laar, van de Mart A.F.J.; Koel, Gerard J.

    2009-01-01

    To study the effects of infrared (IR) Sauna, a form of total-body hyperthermia in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients were treated for a 4-week period with a series of eight IR treatments. Seventeen RA patients and 17 AS patients were studied. IR was well

  2. Drug-specific risk and characteristics of lupus and vasculitis-like events in patients with rheumatoid arthritis treated with TNFi: results from BSRBR-RA

    Science.gov (United States)

    Dixon, William G; Kersley-Fleet, Lianne; Bruce, Ian N; Chinoy, Hector; Barton, Anne; Lunt, Mark; Watson, Kath; Hyrich, Kimme L

    2017-01-01

    Objective To compare the risk of lupus-like events (LLEs) and vasculitis-like events (VLEs) in tumour necrosis factor-α inhibitor (TNFi)-treated patients with rheumatoid arthritis (RA) to those receiving non-biological disease-modifying antirheumatic drugs (nbDMARDs). Methods Patients were recruited to the British Society for Rheumatology Biologics Register—RA, a national prospective cohort study. Two cohorts recruited between 2001 and 2015: (1) patients starting first TNFi (adalimumab, etanercept, infliximab and certolizumab) (n=12 937) and (2) biological-naïve comparison cohort receiving nbDMARDs (n=3673). The risk of an event was compared between the two cohorts using Cox proportional-hazard models, adjusted using propensity scores. Rates of LLE/VLE were compared between TNFi and nbDMARD patients. Results The crude incidence rates for LLEs were: TNFi 10/10 000 patient-years (pyrs) (95% CI 8 to 13) and nbDMARD 2/10 000 pyrs (95% CI 1 to 6); for VLEs: TNFi 15/10 000 pyrs (95% CI 12 to 19) and nbDMARD 7/10 000 pyrs (95% CI 4 to 12). The risk of both events was highest in the first year of TNFi treatment. After adjusting for differences in baseline characteristics, there was no difference in risk of LLEs (adjHR 1.86; 95% CI 0.52 to 6.58) or VLEs (adjHR 1.27; 95% CI 0.40 to 4.04) for TNFi compared to nbDMARD-treated patients. Infliximab conferred the highest overall risk, followed by etanercept, although 95% CIs overlapped following adjustment. Conclusions In one of the largest biological registers, the absolute risk of both events is low. The addition of TNFi to nbDMARD does not alter the risk of either event in patients with RA selected for TNFi. This is the first study to assess the risk of these outcomes in a prospective, observational cohort. PMID:28123776

  3. Patient education for adults with rheumatoid arthritis

    NARCIS (Netherlands)

    Riemsma, R.P.; Kirwan, J.R.; Taal, E.; Rasker, H.J.J.

    2009-01-01

    Patient education shows short-term benefits for adults with rheumatoid arthritis. The purpose was to examine the effectiveness of patient education interventions on health status (pain, functional disability, psychological well-being and disease activity) in patients with rheumatoid arthritis (RA).

  4. Individualized monitoring of drug bioavailability and immunogenicity in rheumatoid arthritis patients treated with the tumor necrosis factor alpha inhibitor infliximab

    DEFF Research Database (Denmark)

    Bendtzen, Klaus; Geborek, Pierre; Svenson, Morten

    2006-01-01

    Infliximab, an anti-tumor necrosis factor alpha (anti-TNFalpha) antibody, is effective in the treatment of several immunoinflammatory diseases. However, many patients experience primary or secondary response failure, suggesting that individualization of treatment regimens may be beneficial...

  5. Pulmonary involvement in early rheumatoid arthritis patients.

    Science.gov (United States)

    Habib, Hisham M; Eisa, Ashraf A; Arafat, Waleed R; Marie, Mohamed A

    2011-02-01

    Pulmonary involvement in rheumatoid arthritis (RA) is common and can be due to the disease itself as well as to the therapies used to treat it. The purpose of this study was to disclose the pulmonary involvement in early RA patients not more than 2 years disease duration using the computed tomography (CT) as well as the pulmonary function tests as ways of pulmonary involvement assessment. Forty patients aged 37.6 ± 10.3 with early rheumatoid arthritis not more than 2 years of disease duration were recruited for the study. All patients were assessed clinically for their RA with DAS28, which was utilized for disease activity determination. Ten percent of our patients were found to be clinically involved by interstitial lung disease (ILD), where 27% have abnormal HRCT finding and 32.5% with abnormal PFT. Predilection for clinically manifest ILD was evident in active RA patients with high DAS28 score, seropositive RA patients, and in patients receiving steroids and anti-TNFα therapy. ILD occurs early in the course of RA, with more predilection for clinically active RA disease.

  6. Patient-Reported Outcomes and the Association With Clinical Response in Patients With Active Psoriatic Arthritis Treated With Golimumab: Findings Through 2 Years of a Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

    Science.gov (United States)

    Kavanaugh, Arthur; McInnes, Iain B; Krueger, Gerald G; Gladman, Dafna; Beutler, Anna; Gathany, Tim; Mack, Michael; Tandon, Neeta; Han, Chenglong; Mease, Philip

    2013-01-01

    Objective To evaluate the effect of golimumab on physical function, health-related quality of life (HRQOL), and productivity in psoriatic arthritis (PsA). Methods GO-REVEAL was a multicenter, randomized, placebo-controlled study. Adult patients with active PsA (n = 405) received golimumab (50 or 100 mg) or placebo every 4 weeks, with early escape at week 16 (placebo → 50 mg, 50 → 100 mg) or placebo crossover to golimumab 50 mg at week 24. Patient-reported outcomes included physical function (Health Assessment Questionnaire [HAQ] disability index [DI] score), HRQOL (36-item Short Form health survey [SF-36] mental component summary [MCS] and physical component summary [PCS] scores), and productivity (home/school/work). Clinical response was assessed using the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP) and the Psoriasis Area and Severity Index (PASI) score for arthritis and skin symptoms, respectively. Results At week 24, golimumab-treated patients had significant mean improvements in HAQ DI (0.36), SF-36 (PCS 7.83, MCS 3.84), and productivity (2.24) scores compared with placebo (−0.01, 0.67, −0.60, and 0.08, respectively; P <0.001 for all). Also, greater proportions of golimumab- than placebo-treated patients had clinically meaningful improvements in HAQ DI (≥0.30) and SF-36 PCS and MCS (≥5) scores at week 24 (P <0.05). Also at week 24, improvements in DAS28-CRP scores were significantly but moderately correlated with improvements in HAQ DI, SF-36 PCS, and productivity scores. Correlations between these patient-reported outcomes and improvements in PASI, enthesitis, and dactylitis scores were very weak. Improvements in HAQ DI, SF-36, and productivity scores were similar among all groups by week 52 and week 104 when including placebo → golimumab crossover patients. Conclusion Golimumab-treated patients had significant improvements in physical function, HRQOL, and productivity through week 24; these improvements

  7. Preserved skeletal muscle protein anabolic response to acute exercise and protein intake in well-treated rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Mikkelsen, Ulla Ramer; Dideriksen, Kasper; Andersen, Mads Bisgaard

    2015-01-01

    of genes related to inflammatory signaling, myogenesis and muscle growth/atrophy were analyzed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: CRP was significantly higher in the RA patients (2.25 (0.50) mg/l) than in controls (1.07 (0.25) mg/l; p = 0.038) and so was TNF...... similar in RA vs. CON, however, expression of the genes coding for TNF-α, myogenin and HGF1 were more responsive to exercise in RA patients than in CON. CONCLUSIONS: The study demonstrates that muscle protein synthesis rate and muscle gene expression can be stimulated by protein intake alone...... and anabolic signaling response in patients with RA compared to healthy controls. METHODS: Thirteen RA patients (age range 34-84 years; diagnosed for 1-32 years, median 8 years) were individually matched with 13 healthy controls for gender, age, BMI and activity level (CON). Plasma levels of C-reactive protein...

  8. Monitoring patients with rheumatoid arthritis in routine care

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Jensen, Dorte Vendelbo; Krogh, Niels Steen

    2014-01-01

    , little is known about the feasibility of a T2T strategy in patients with rheumatoid arthritis (RA) treated in routine care. The aim of the present study was to (i) present the annual number of patients included in DANBIO between 2006 and 2013 and their disease characteristics and (ii) estimate coverage...

  9. The ratio Neutrophil/Lymphocyte and Platelet/Lymphocyte in patient with Rheumatoid Arthritis that are Treating with Anti-TNF

    Directory of Open Access Journals (Sweden)

    İsmail Boyraz

    2014-06-01

    Full Text Available OBJECTIVES: Rheumatoid arthritis (RA is a chronic inflammatory disorder with unknown etiology. RA is characterized by a variable course of remissions and relapses, and subclinical inflammation persists between the disease exacerbations. Anti-TNF therapies have become more often preferred in recent years in the treatment of RA. The aim of the present study was to determine the relationship between N/L and P/L ratios and subclinical inflammation in patients with RA who achieved remission with anti-TNF therapy. METHODS: The present study was a retrospective, controlled and multicenter study. The present study reviewed the medical records of the patients who were on follow-up in the outpatient clinics of the Department of Physical Therapy in Abant İzzet Baysal University and Harran University due to rheumatoid arthritis (RA and who achieved remission with anti-TNF therapy.A total of 80 patients in the inactive phase of RA and 45 healthy subjects in the control group were included in the study. Hemogram results of the people were examined retrospectively. RESULTS: There was significant difference between the patient and the control group in terms of platelet ratio and lymphocyte and neutrophil ratio. There was no significant difference between the group in terms of N/L and P/L ratios.CONCLUSIONS:  In the current study, we found significant differences between the patient and the control group in terms of neutrophil, lymphocyte, and platelet counts; however, there was no significant difference between the two groups in terms of N/L and P/L ratios. These findings suggest that therapies with anti-TNF agents in patients with RA achieved complete control of inflammation. 

  10. Difficult-to-treat gouty arthritis: a disease warranting better management.

    Science.gov (United States)

    Schlesinger, Naomi

    2011-07-30

    Gouty arthritis is the most common inflammatory arthritis in adults and is characterized by very painful flares. Gouty arthritis results from an elevated body uric acid pool, which leads to deposition of monosodium urate crystals, mainly in the joints. These crystals trigger the release of proinflammatory cytokines, in particular interleukin (IL)-1β, which stimulates inflammation. Gouty arthritis can progress to a chronic, deforming and physically disabling disease through the development of disfiguring tophi, joint destruction and persistent pain. Standard treatments are effective in most patients. Acutely, anti-inflammatory therapies provide rapid pain relief and resolution of flares. Chronically, urate-lowering therapies reduce serum urate levels and, in combination with anti-inflammatory prophylaxis, reduce the risk of flares. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of co-morbidities. Indeed, metabolic syndrome, hypertension, dyslipidaemia, cardiovascular disease, diabetes mellitus and renal impairment are all highly prevalent in individuals with gouty arthritis, and may lead to standard treatments being ineffective or inappropriate. Such patients with difficult-to-treat disease require alternative therapies. Gouty arthritis can have a major impact on health-related quality of life (HR-QOL), especially in patients with difficult-to-treat disease, as revealed by recent studies comparing HR-QOL for patients with gouty arthritis with that of the general population. All studies revealed clinically significant reductions in physical functioning for individuals with gouty arthritis compared with the general population. The difference was particularly marked for patients with difficult-to-treat disease. Gouty arthritis also constitutes an important economic burden through absence from work and medical costs. Again, the burden is greater in patients with difficult-to-treat

  11. The Human and Economic Burden of Difficult-to-Treat Gouty Arthritis.

    Science.gov (United States)

    Bardin, Thomas; Voshaar, Martijn A H Oude; van de Laar, Martinus A F J

    2015-10-01

    Gouty arthritis, one of the most painful and common forms of adult arthritis, is caused by monosodium urate crystal deposits in joints, most often in the lower extremities. Crystals trigger an inflammatory response leading to acute flares characterized by a rapid onset of pain, warmth, swelling, and redness in involved joints. Over time, continued monosodium urate crystal deposits and inflammation can lead to chronic tophaceous gout that result in bone erosion, progressing to joint destruction and significant disability. The goal of therapy in an acute gout flare is prompt and safe termination of pain and inflammation. Acute gouty arthritis is usually treated with nonsteroidal anti-inflammatory drugs, colchicine, or corticosteroids. However, for a growing number of patients, current standard treatments are ineffective or are contraindicated, largely due to the presence of comorbidities. Gouty arthritis can have a major negative impact of health-related quality of life, especially in patients with difficult-to-treat disease, as revealed by recent studies comparing health-related quality of life with that of the general population. Additionally, gouty arthritis also constitutes an important economic burden through absence from work and medical costs. This burden is even greater in patients with difficult-to-treat disease.

  12. Safety and efficacy of intra-articular anti-tumor necrosis factor α agents compared to corticosteroids in a treat-to-target strategy in patients with inflammatory arthritis and monoarthritis flare.

    Science.gov (United States)

    Carubbi, Francesco; Zugaro, Luigi; Cipriani, Paola; Conchiglia, Armando; Gregori, Lorenzo; Danniballe, Cristino; Letizia Pistoia, Maria; Liakouli, Vasiliki; Ruscitti, Piero; Ciccia, Francesco; Triolo, Giovanni; Masciocchi, Carlo; Giacomelli, Roberto

    2016-06-01

    The aim of this study was to assess safety and efficacy of ultrasonography (US)-guided intra-articular injections using tumor necrosis factor (TNF) blockers compared to corticosteroids in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients, experiencing refractory monoarthritis despite the current systemic therapy. Eighty-two patients were randomized to receive three intra-articular injections monthly of either corticosteroid or TNF blockers. Primary endpoints were the safety and an improvement greater than 20% for visual analogic scales of involved joint pain in patients injected with anti-TNFα. Further clinical, US, and magnetic resonance imaging (MRI) evaluations were considered secondary endpoints. Intra-articular TNF blockers are a safe strategy, determining a significant reduction of patient and physician reported clinical outcomes and US/MRI scores, in RA and PsA patients, when compared to intra-articular injections of corticosteroids. US guidance excluded the possibility to inject the drug in the wrong site, maximizing local effects, reducing systemic effects, and increasing the safety of the procedure. Patients with inflammatory monoarthritis could be successfully treated with US-guided intra-articular TNF blockers that are a safe and well tolerated procedure, to achieve a longstanding clinical and radiological good clinical response and/or disease remission.

  13. Arthritis

    Science.gov (United States)

    ... injected into painful joints or given by mouth. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. ...

  14. Group Education for patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Taal, Erik; Riemsma, Rob P.; Brus, Herman L.M.; Seydel, Erwin R.; Rasker, Johannes J.; Wiegman, Oene

    1993-01-01

    Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining ¿self-management¿ behaviors. We develope

  15. Sedentary behaviour in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Thomsen, Tanja; Beyer, Nina; Aadahl, Mette

    2015-01-01

    BACKGROUND: Despite increasing interest in investigating sedentary behaviour (SB) in the general population and in patients with rheumatoid arthritis (RA), there is little documentation of the subjective experiences of SB in patients with RA. This study aimed to examine how patients with RA...

  16. Long‐Term Safety, Efficacy, and Quality of Life in Patients With Juvenile Idiopathic Arthritis Treated With Intravenous Abatacept for Up to Seven Years

    Science.gov (United States)

    Ruperto, Nicolino; Mouy, Richard; Paz, Eliana; Rubio‐Pérez, Nadina; Silva, Clovis A.; Abud‐Mendoza, Carlos; Burgos‐Vargas, Ruben; Gerloni, Valeria; Melo‐Gomes, Jose A.; Saad‐Magalhaes, Claudia; Chavez‐Corrales, J.; Huemer, Christian; Kivitz, Alan; Blanco, Francisco J.; Foeldvari, Ivan; Hofer, Michael; Huppertz, Hans‐Iko; Job Deslandre, Chantal; Minden, Kirsten; Punaro, Marilynn; Block, Alan J.; Giannini, Edward H.; Martini, Alberto

    2015-01-01

    Objective The efficacy and safety of abatacept in patients with juvenile idiopathic arthritis (JIA) who experienced an inadequate response to disease‐modifying antirheumatic drugs were previously established in a phase III study that included a 4‐month open‐label lead‐in period, a 6‐month double‐blind withdrawal period, and a long‐term extension (LTE) phase. The aim of this study was to present the safety, efficacy, and patient‐reported outcomes of abatacept treatment (10 mg/kg every 4 weeks) during the LTE phase, for up to 7 years of followup. Methods Patients enrolled in the phase III trial could enter the open‐label LTE phase if they had not achieved a response to treatment at month 4 or if they had received abatacept or placebo during the double‐blind period. Results One hundred fifty‐three (80.5%) of 190 patients entered the LTE phase, and 69 patients (36.3%) completed it. The overall incidence rate (events per 100 patient‐years) of adverse events decreased during the LTE phase (433.61 events during the short‐term phase [combined lead‐in and double‐blind periods] versus 132.39 events during the LTE phase). Similar results were observed for serious adverse events (6.82 versus 5.60), serious infections (1.13 versus 1.72), malignancies (1.12 versus 0), and autoimmune events (2.26 versus 1.18). American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) responses, Pedi 70 responses, and clinically inactive disease status were maintained throughout the LTE phase in patients who continued to receive therapy. Improvements in the Child Health Questionnaire physical and psychosocial summary scores were maintained over time. Conclusion Long‐term abatacept treatment for up to 7 years was associated with consistent safety, sustained efficacy, and quality‐of‐life benefits in patients with JIA. PMID:26097215

  17. Psoriatic arthritis: A retrospective study of 162 patients

    Directory of Open Access Journals (Sweden)

    Pavlica Ljiljana

    2005-01-01

    Full Text Available Aim. The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. Methods. The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 ± 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. Results. Psoriatic arthritis developed in 183 (9.3% out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (χ2=3.2; p<0.05. Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13,B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti

  18. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny

    2012-01-01

    OBJECTIVES: To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide.METHODS: 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab.RESULTS: 1195 patients...... were treated with rituximab plus methotrexate, 177 with rituximab plus leflunomide and 505 with rituximab alone. Significantly more patients achieved a European League Against Rheumatism good response at 6 months when treated with rituximab plus leflunomide (29.1%) compared with rituximab plus...... methotrexate (21.1%) and rituximab alone (19.3%; p=0.02 and p=0.01, respectively). Similar results were observed at 12 months. Adverse events occurred in 10.2%, 13.2% and 13.9% of patients on rituximab plus leflunomide, rituximab plus methotrexate and rituximab alone, respectively.CONCLUSIONS: Leflunomide...

  19. Physical function improvements and relief from fatigue and pain are associated with increased productivity at work and at home in rheumatoid arthritis patients treated with certolizumab pegol

    NARCIS (Netherlands)

    J.M.W. Hazes (Mieke); P. Taylor (Peter); V. Strand (Vibeke); O. Purcaru (Oana); G. Coteur (Geoffroy); P. Mease (Philip)

    2010-01-01

    textabstractObjectives: To evaluate the association between improvements in physical function, fatigue and pain and improvements in productivity at work and at home in patients treated with certolizumab pegol (CZP) in combination with MTX. Methods: Physical function, fatigue and pain were assessed i

  20. Septic arthritis due to Roseomonas mucosa in a rheumatoid arthritis patient receiving infliximab therapy.

    Science.gov (United States)

    Sipsas, Nikolaos V; Papaparaskevas, Joseph; Stefanou, Ioanna; Kalatzis, Konstantinos; Vlachoyiannopoulos, Panayiotis; Avlamis, Athina

    2006-08-01

    We report a case of septic arthritis due to Roseomonas mucosa in a rheumatoid arthritis patient receiving infliximab therapy. This is the first report of septic arthritis due to R. mucosa, and infliximab therapy might be a predisposing factor because this infection was never reported in the pre-anti-tumor necrosis factor alpha therapy period.

  1. Ureaplasma septic arthritis in an immunosuppressed patient with juvenile idiopathic arthritis.

    Science.gov (United States)

    George, Michael David; Cardenas, Ana Maria; Birnbaum, Belinda K; Gluckman, Stephen J

    2015-06-01

    Mycoplasmas, including Ureaplasma and Mycoplasma species, are uncommon but important causes of septic arthritis, especially affecting immunosuppressed patients. Many of the reported cases have been associated with congenital immunodeficiency disorders, especially hypogammaglobulinemia. Mycoplasmas are difficult to grow in the laboratory, and these infections may be underdiagnosed using culture techniques. We report a case of a 21-year-old woman with juvenile idiopathic arthritis and hip arthroplasties treated with rituximab and adalimumab who developed urogenital infections and soft tissue abscesses followed by knee arthritis with negative routine cultures. Ureaplasma species was identified from synovial fluid on 2 separate occasions using a broad-range 16S ribosomal RNA gene polymerase chain reaction. Azithromycin led to rapid improvement in symptoms, but after completion of therapy, involvement of the hip prosthesis became apparent, and again, 16S rRNA gene polymerase chain reaction was positive for Ureaplasma species. The literature is reviewed with a discussion of risk factors for Mycoplasma septic arthritis, clinical presentation, methods of diagnosis, and treatment.

  2. Monitoring patients with rheumatoid arthritis in routine care

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Jensen, Dorte Vendelbo; Krogh, Niels Steen

    2014-01-01

    , little is known about the feasibility of a T2T strategy in patients with rheumatoid arthritis (RA) treated in routine care. The aim of the present study was to (i) present the annual number of patients included in DANBIO between 2006 and 2013 and their disease characteristics and (ii) estimate coverage......OBJECTIVES: Advances in aggressive use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) as well as biological DMARDs (bDMARDs) have improved the treatment armamentarium for rheumatologists, and modern treatment principles include a treat-to-target (T2T) strategy. However...

  3. Comorbidities in Patients with Psoriatic Arthritis

    Science.gov (United States)

    Haddad, Amir; Zisman, Devy

    2017-01-01

    Epidemiological studies have shown that patients with psoriatic arthritis (PsA) are often affected by numerous comorbidities that carry significant morbidity and mortality. Reported comorbidities include diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, inflammatory bowel disease, autoimmune eye disease, non-alcoholic fatty liver disease, depression, and fibromyalgia. All health care providers for patients with PsA should recognize and monitor those comorbidities, as well as understand their effect on patient management to ensure an optimal clinical outcome. PMID:28178440

  4. Optimizing Exercise Programs for Arthritis Patients.

    Science.gov (United States)

    Boulware, Dennis W.; Byrd, Shannon L.

    1993-01-01

    Exercise can help decrease pain and improve function in people with rheumatoid arthritis or osteoarthritis. Physicians must provide individualized, realistic, enjoyable exercise programs that help affected joints, build fitness, and maximize patient compliance. Physicians must also provide appropriate follow-up care, adjusting the exercise program…

  5. 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

    OpenAIRE

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

    2013-01-01

    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...

  6. Arthritis and the Feet

    Science.gov (United States)

    ... some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis. Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by ...

  7. Osteoporosis diagnostics in patients with rheumatoid arthritis.

    Science.gov (United States)

    Węgierska, Małgorzata; Dura, Marta; Blumfield, Einat; Żuchowski, Paweł; Waszczak, Marzena; Jeka, Sławomir

    2016-01-01

    Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease. The development of comorbidities often occurs in the course of RA. One of them is osteoporosis, which has serious social and economic effects and may contribute to the increase in the degree of disability and premature death of the patient. Due to the young age in which RA disease occurs, densitometry (DXA) of the lumbar spine is the basic examination in osteoporosis diagnostics. In the course of RA, much more frequently than in healthy persons of the same age, osteoporotic fractures of vertebral bodies occur, which hinder a correct assessment in the DXA test. Rheumatoid arthritis patients often undergo computed tomography (CT) examination of the abdominal cavity for other medical indications than suspected spinal injury. Then, CT examination may also serve for the assessment of bone density, especially in patients with osteoporotic fractures.

  8. Allied health team management of rheumatoid arthritis patients.

    Science.gov (United States)

    Feinberg, J R; Brandt, K D

    1984-09-01

    The use of a coordinated team of allied health professionals (AHPs) to treat patients with rheumatoid arthritis assigned to experimental groups (EG) and comparison groups (CG) was assessed. The EG patients were evaluated regularly by each AHP team member, whereas CG patients were seen by AHPs only upon referral. Of the 10 EG and 13 CG patients who remained in the study for 2 years, the EG patients initially exhibited somewhat greater disease activity than CG (as reflected by erythrocyte sedimentation rate and duration of morning stiffness). After 2 years, EG patients demonstrated less disease activity than at the outset, whereas CG patients either showed little change in these parameters or deteriorated during the study. Grip strength, which was initially similar in the two groups, improved in EG patients but decreased in CG patients, so that after 2 years a significant difference was noted between the two groups (p less than .05). Tendency to lose hand range of motion was also greater in CG than in EG patients. Some EG patients showed improvement in finger flexion deformities during the study. Furthermore, EG patients showed a greater tendency to acquire positive attitudes regarding themselves and family relationships. These results suggest that ongoing "team care" may be more efficacious than episodic use of AHPs in management of patients with mild rheumatoid arthritis.

  9. Fungal arthritis of the hip in patient with aplastic anaemia.

    Science.gov (United States)

    Le Calloch, Ronan; Ianotto, Jean-Christophe; Guillerm, Gaëlle; Tonnelier, Jean Marie

    2013-08-13

    Aplastic anaemia is a rare and serious disease characterised by severe immunosuppression due to prolonged neutropenia and the use of immunosuppressants such as corticosteroids, cyclosporine and antithymocyte globulin. Candida species are pathogens of low virulence colonising the skin and the digestive tract of many healthy individuals. Nonetheless, the incidence of invasive candidal infection is increasing. The widespread use of central intravascular catheters, invasive procedures, broad-spectrum antibiotics and immunosuppresion predisposes patients to these infections. Eye, skin, cardiac, liver, spleen and brain infection are the most common sites of invasive candidiasis. Bone and joint infections are less frequent and Candida hip septic arthritis is extremely rare. We present here a patient treated for aplastic anaemia, who developed fungal arthritis of the hip and systemic candidaemia.

  10. Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Murphy, C L

    2015-01-01

    The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.

  11. Oral bacterial DNAs in synovial fluids of arthritis patients

    OpenAIRE

    Moen, Ketil; Johan G. Brun; Eribe, Emenike R.K.; Olsen, Ingar; Jonsson, Roland

    2011-01-01

    Arthritis may be triggered by microbial constituents, more specifically, bacterial cell wall fragments, or bacterial DNA. The aim of this study was to analyze the amount of oral bacterial DNA in synovial fluids (SF) of arthritis patients. SF from 15 rheumatoid arthritis (RA) patients, 15 arthritides (non-RA) patients and 9 osteoarthritis (control) patients were extracted for oral bacterial DNA. DNA was used in a checkerboard DNA/DNA hybridization set-up, in order to identify 40 different spec...

  12. Prevalence of acute and chronic viral seropositivity and characteristics of disease in patients with psoriatic arthritis treated with cyclosporine: a post hoc analysis from a sex point of view on the observational study of infectious events in psoriasis complicated by active psoriatic arthritis

    Science.gov (United States)

    Colombo, Delia; Chimenti, Sergio; Grossi, Paolo Antonio; Marchesoni, Antonio; Bardazzi, Federico; Ayala, Fabio; Simoni, Lucia; Vassellatti, Donatella; Bellia, Gilberto

    2016-01-01

    Background Sex medicine studies have shown that there are sex differences with regard to disease characteristics in immune-mediated inflammatory diseases, including psoriasis, in immune response and susceptibility to viral infections. We performed a post hoc analysis of the Observational Study of infectious events in psoriasis complicated by active psoriatic arthritis (SYNERGY) study in patients with psoriatic arthritis (PsA) treated with immunosuppressive regimens including cyclosporine, in order to evaluate potential between-sex differences in severity of disease and prevalence of viral infections. Methods SYNERGY was an observational study conducted in 24 Italian dermatology clinics, which included 238 consecutively enrolled patients with PsA, under treatment with immunosuppressant regimens including cyclosporin A. In this post hoc analysis, patients’ demographical data and clinical characteristics of psoriasis, severity and activity of PsA, prevalence of seropositivity for at least one viral infection, and treatments administered for PsA and infections were compared between sexes. Results A total of 225 patients were evaluated in this post hoc analysis, and 121 (54%) were males. Demographic characteristics and concomitant diseases were comparable between sexes. Statistically significant sex differences were observed at baseline in Psoriasis Area and Severity Index score (higher in males), mean number of painful joints, Bath Ankylosing Spondylitis Disease Activity Index, and the global activity of disease assessed by patients (all higher in females). The percentage of patients with at least one seropositivity detected at baseline, indicative of concomitant or former viral infection, was significantly higher among women than among men. No between-sex differences were detected in other measures, at other time points, and in treatments. Patients developed no hepatitis B virus or hepatitis C virus reactivation during cyclosporine treatment. Conclusion Our post hoc

  13. Erosive progression is minimal, but erosion healing rare, in rheumatoid arthritis patients treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure

    DEFF Research Database (Denmark)

    Møller Døhn, Uffe; Boonen, Annelies; Hetland, Merete Lund;

    2008-01-01

    OBJECTIVE: With computed tomography (CT) and radiography to investigate if repair of bone erosions, defined as regression of erosion scores, occurs during adalimumab-treatment of rheumatoid arthritis (RA) patients. METHODS: Fifty-two RA patients, naïve to biologics, with at least two low...

  14. Prevalence of acute and chronic viral seropositivity and characteristics of disease in patients with psoriatic arthritis treated with cyclosporine: a post hoc analysis from a sex point of view on the observational study of infectious events in psoriasis complicated by active psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Colombo D

    2015-12-01

    Full Text Available Delia Colombo,1 Sergio Chimenti,2 Paolo Antonio Grossi,3 Antonio Marchesoni,4 Federico Bardazzi,5 Fabio Ayala,6 Lucia Simoni,7 Donatella Vassellatti,1 Gilberto Bellia1 On behalf of SYNERGY Study Group 1Novartis Farma Italia, Origgio (VA, 2Tor Vergata Polyclinic Rome, 3Macchi Hospital and Foundation, Varese, 4Orthopaedic Institute Pini, Milan, 5S Orsola-Malpighi Polyclinic, Bologna, 6University Federico II Naples, 7MediData srl, Modena, Italy Background: Sex medicine studies have shown that there are sex differences with regard to disease characteristics in immune-mediated inflammatory diseases, including psoriasis, in immune response and susceptibility to viral infections. We performed a post hoc analysis of the Observational Study of infectious events in psoriasis complicated by active psoriatic arthritis (SYNERGY study in patients with psoriatic arthritis (PsA treated with immunosuppressive regimens including cyclosporine, in order to evaluate potential between-sex differences in severity of disease and prevalence of viral infections.Methods: SYNERGY was an observational study conducted in 24 Italian dermatology clinics, which included 238 consecutively enrolled patients with PsA, under treatment with immunosuppressant regimens including cyclosporin A. In this post hoc analysis, patients' demographical data and clinical characteristics of psoriasis, severity and activity of PsA, prevalence of seropositivity for at least one viral infection, and treatments administered for PsA and infections were compared between sexes.Results: A total of 225 patients were evaluated in this post hoc analysis, and 121 (54% were males. Demographic characteristics and concomitant diseases were comparable between sexes. Statistically significant sex differences were observed at baseline in Psoriasis Area and Severity Index score (higher in males, mean number of painful joints, Bath Ankylosing Spondylitis Disease Activity Index, and the global activity of disease

  15. Pneumococcal polyarticular septic arthritis after a single infusion of infliximab in a rheumatoid arthritis patient: a case report

    Directory of Open Access Journals (Sweden)

    Hayashi Masatoshi

    2012-03-01

    Full Text Available Abstract Introduction We present a case of Streptococcus pneumoniae polyarticular septic arthritis in a patient with rheumatoid arthritis receiving a single infusion of infliximab. Case presentation A 38-year-old Japanese man with a 5-year history of seronegative rheumatoid arthritis had previously received sulphasalazine and methotrexate therapies and was on regular low-dose prednisolone therapy. Despite these treatments, his disease activity remained high and infliximab was introduced in addition to methotrexate, prednisolone, and folic acid. However, he was admitted to hospital with a fever of 40.6°C, chills, and polyarthralgia eight days after the first infusion of infliximab. His joints were swollen, painful, and warm. Laboratory data showed marked acute inflammation. He was diagnosed with bacterial septic polyarthritis, and emergency surgical joint lavage and drainage was performed at the knees along with needle aspiration and lavage of the ankles and right wrist. He was then given intravenous antibiotic therapy for 31 days. He made a good recovery and was discharged on day 37. Conclusions We believe this is the first reported case of severe pneumococcal septic arthritis requiring hospitalization in a patient treated with infliximab. S. pneumonia is now a well-recognized but uncommon cause of polyarticular septic arthritis that can lead to cessation of therapy, as in our patient's case.

  16. Sulfasalazine-induced extrinsic allergic alveolitis in a patient with psoriatic arthritis.

    Science.gov (United States)

    Woltsche, M; Woltsche-Kahr, I; Roeger, G M; Aberer, W; Popper, H

    2001-11-20

    We report the first case of a well defined extrinsic allergic alveolitis as a complication of sulfasalazine therapy in a patient treated for psoriatic arthritis. CT of the chest showed small nodular densities over both lungs, BAL demonstrated a highly active lymphocytic alveolitis and transbronchial biopsies revealed lymphoplasmocytic interstitial infiltration. Sulfasalazine as causative agent was proven by an inadvertent rechallenge three years later and a positive lymphocyte transformation test. sulfasalazine; psoriatic arthritis; extrinsic allergic alveolitis

  17. [Optic neuritis in juvenile idiopathic arthritis patient].

    Science.gov (United States)

    Lourenço, Daniela M R; Buscatti, Izabel M; Lourenço, Benito; Monti, Fernanda C; Paz, José Albino; Silva, Clovis A

    2014-01-01

    Optic neuritis (ON) was rarely reported in juvenile idiopathic arthritis (JIA) patients, particularly in those under anti-tumor necrosis factor alpha blockage. However, to our knowledge, the prevalence of ON in JIA population has not been studied. Therefore, 5,793 patients were followed up at our University Hospital and 630 (11%) had JIA. One patient (0.15%) had ON and was reported herein. A 6-year-old male was diagnosed with extended oligoarticular JIA, and received naproxen and methotrexate subsequently replaced by leflunomide. At 11 years old, he was diagnosed with aseptic meningitis, followed by a partial motor seizure with secondary generalization. Brain magnetic resonance imaging (MRI) and electroencephalogram showed diffuse disorganization of the brain electric activity and leflunomide was suspended. Seven days later, the patient presented acute ocular pain, loss of acuity for color, blurred vision, photophobia, redness and short progressive visual loss in the right eye. A fundoscopic exam detected unilateral papilledema without retinal exudates. Orbital MRI suggested right ON. The anti-aquaporin 4 (anti-AQP4) antibody was negative. Pulse therapy with methylprednisolone was administered for five days, and subsequently with prednisone, he had clinical and laboratory improvement. In conclusion, a low prevalence of ON was observed in our JIA population. The absence of anti-AQP4 antibody and the normal brain MRI do not exclude the possibility of demyelinating disease associated with chronic arthritis. Therefore, rigorous follow up is required.

  18. Which patients improve the most from arthritis rehabilitation?

    DEFF Research Database (Denmark)

    Hagel, Sofia; Lindqvist, Elisabet; Petersson, Ingemar F

    2014-01-01

    Objective: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investi...

  19. MICROBIOLOGICAL ASPECTS OF BIFIFORM USE IN PATIENT WITH RHEUMATOID ARTHRITIS AND COLON DISBIOSIS

    Directory of Open Access Journals (Sweden)

    Malyarchuk AR

    2012-12-01

    Full Text Available The article presents the results of research clinical features of patients with rheumatoid arthritis, a determined degree of dysbiosis colon analyzed corrective action Bifiform probiotics on the microflora of the colon treated with different types of pathogenetic treatment of the underlying disease. In the process we used the following methods: a list of complaints of patients with rheumatoid arthritis of the gastrointestinal tract, conducted bacteriological research content oral microbiota of the colon by conventional methods. The classic method of a determined degree of dysbiosis large intestine in patients with rheumatoid arthritis treated with different types of pathogenetic treatment of the underlying disease before and after probiotic therapy by Bifiform. The studies established the presence of various complaints of the gastrointestinal tract in patients with rheumatoid arthritis. All of the surveyed patients had microbiological characteristics of different degrees of dysbiosis colon. Confirmed the positive effect of probiotics on the composition of microbiota Bifiform in colon of patients with rheumatoid arthritis treated with different schemes of pathogenetic treatment.

  20. Flare up of rheumatoid arthritis associated with VogtKoyanagi-Harada syndrome treated with leflunomide

    Institute of Scientific and Technical Information of China (English)

    Jia; Wang; Qi-Bing; Xie; Yi; Zhao; Yi; Liu

    2014-01-01

    Dear Editor,We present a case of"Flare up of rheumatoid arthritis associated with Vogt-Koyanagi-Harada(VKH)syndrome treated with leflunomide".To our knowledge,this is the first case of uveitis and arthritis inflammation active at the same time and no treatment for this condition has been described in the literature.

  1. Periodontal condition in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Eduardo de Paula Ishi

    2008-03-01

    Full Text Available The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA are associated. The study included 39 RA patients (test group and 22 age- and gender-matched healthy individuals (control group. Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006, the percentage of sites showing gingival bleeding was not different (Fisher’s exact test, p > 0.05. Based on our results, we suggest that there is an association between periodontal disease and RA.

  2. Attenuation of gouty arthritis by emodinol in monosodium urate crystal-treated mice.

    Science.gov (United States)

    Chen, Lvyi; Lan, Zhou; Ma, Shuwei; Zhao, Ling; Yang, Xinzhou

    2013-05-01

    A series of studies have recently demonstrated that the release of interleukin 1β induced by monosodium urate crystals is central to the experimental gouty arthritis. Elaeagnus pungens has been traditionally used for the treatment of gouty arthritis in China for more than thousands years. However, there is still little known about the active ingredients and mechanisms of E. pungens against gouty arthritis. Emodinol, as a major triterpene compound in E. pungens, has been seldom reported to have an effect on gouty arthritis. Therefore, the potential beneficial effects and mechanisms of emodinol on gouty arthritis were investigated in this study. Results showed that it significantly ameliorated the hyperalgesia, inflammation, and levels of multiple proinflammatory cytokines in monosodium urate crystals-treated mice. These findings elucidate that emodinol exhibits a prominent effect on improving symptoms of acute gouty arthritis induced by monosodium urate crystals through inhibiting the generation of proinflammatory cytokines.

  3. Improving inflammatory arthritis management through tighter monitoring of patients and the use of innovative electronic tools.

    Science.gov (United States)

    van Riel, Piet; Alten, Rieke; Combe, Bernard; Abdulganieva, Diana; Bousquet, Paola; Courtenay, Molly; Curiale, Cinzia; Gómez-Centeno, Antonio; Haugeberg, Glenn; Leeb, Burkhard; Puolakka, Kari; Ravelli, Angelo; Rintelen, Bernhard; Sarzi-Puttini, Piercarlo

    2016-01-01

    Treating to target by monitoring disease activity and adjusting therapy to attain remission or low disease activity has been shown to lead to improved outcomes in chronic rheumatic diseases such as rheumatoid arthritis and spondyloarthritis. Patient-reported outcomes, used in conjunction with clinical measures, add an important perspective of disease activity as perceived by the patient. Several validated PROs are available for inflammatory arthritis, and advances in electronic patient monitoring tools are helping patients with chronic diseases to self-monitor and assess their symptoms and health. Frequent patient monitoring could potentially lead to the early identification of disease flares or adverse events, early intervention for patients who may require treatment adaptation, and possibly reduced appointment frequency for those with stable disease. A literature search was conducted to evaluate the potential role of patient self-monitoring and innovative monitoring of tools in optimising disease control in inflammatory arthritis. Experience from the treatment of congestive heart failure, diabetes and hypertension shows improved outcomes with remote electronic self-monitoring by patients. In inflammatory arthritis, electronic self-monitoring has been shown to be feasible in patients despite manual disability and to be acceptable to older patients. Patients' self-assessment of disease activity using such methods correlates well with disease activity assessed by rheumatologists. This review also describes several remote monitoring tools that are being developed and used in inflammatory arthritis, offering the potential to improve disease management and reduce pressure on specialists.

  4. Antibodies to Infliximab and Adalimumab in Patients with Rheumatoid Arthritis in Clinical Remission

    DEFF Research Database (Denmark)

    Eng, Grith P; Bendtzen, Klaus; Bliddal, Henning;

    2015-01-01

    Objective. To investigate if antibodies towards biological TNF-α inhibitors (anti-TNFi Abs) are present in patients with rheumatoid arthritis (RA) in clinical remission and to relate any anti-TNFi Abs to circulating level of TNF-α inhibitor (TNFi). Methods. Patients with RA, treated with infliximab....... These data suggest that continued infliximab treatment may be redundant in a proportion of RA patients treated with infliximab and in clinical remission....

  5. Candida arthritis in a patient diagnosed with spondyloarthritis

    Directory of Open Access Journals (Sweden)

    Remzi Çevik

    Full Text Available Abstract Candida arthritis is an unusual manifestation that usually affects the knees. A 35-year-old man presented with a 2-month history of pain and swelling in the right knee. Swelling persisted after anti-inflammatory treatment. Peripheric spondyloarthritis was considered, but methotrexate, sulfasalazine, and methylprednisolone did not reduce the swelling. Direct examination of synovial fluid and a culture were positive for Candida albicans. Intravenous and intra-articular amphotericin-B were administered. The arthritis regressed and a culture and direct staining showed negative results. Candida arthritis should be considered in patients with arthritis that is resistant to treatment and prolonged, even if risk factors are absent.

  6. EFFECT OF «TREAT-TO-TARGET» ANTIRHEUMATIC THERAPY ON DIASTOLIC DYSFUNCTION OF THE LEFT AND RIGHT VENTRICLES IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING 18 MONTHS OF OBSERVATION

    Directory of Open Access Journals (Sweden)

    I. G. Kirillova

    2015-01-01

    Full Text Available Aim. To study the effect of «treat-to-target» antirheumatic therapy on diastolic dysfunction of the left (DDLV and right (DDLV ventricles in patients with early rheumatoid arthritis (RA during 18 months of observation.Material and methods. The study included patients with early RA (n=66; 71% women; age - 56 [46; 61] years with moderate/high activity (DAS28 5.3 [5.0; 6.2], seropositive on rheumatoid factor (77% and/or cyclic citrullinated peptide antibodies (100%, disease modifying anti-rheumatic drugs (DMARD and glucocorticoids naive. Treatment with methotrexate (MTX with the escalation of the dose up to 25-30 mg/week subcutaneously was initiated in all the patients. After 3 months in 47 (71% patients biologics were added to MTX due to its inefficiency. In 18 months remission of RA was achieved in 44% of the patients. 51 (77% patients had a cardioprotective therapy. The target blood pressure (BP level was achieved in 38 (58% patients. Evaluation of traditional cardiovascular risk factors, 24-hour BP monitoring and echocardiography were performed in all patients initially and in 18 months of MTX/MTX + biologics use.Results. After 18 months DDLV incidence decreased by 7% (from 49% to 42%; p>0.05 and DDRV incidence decreased by 5% (from 24% to 17%; p>0.05. A more significant decrease in DDLV incidence [from 23 (62% to 18 (49%] and of DDRV incidence (from 12 (32% to 6 (16%] (р=0.05, was found in MTX + biologics group than in MTX only group [DDLV incidence remained unchanged - 7 (28%, and DDRV incidence increased from 3(12% to 4 (16%; p>0.05]. The normalization of left ventricle (LV diastolic function in early RA patients depended primarily on the efficacy of antihypertensive treatment, and of right ventricle (RV diastolic function - on the achievement of target BP level and RA remission. Reduced erythrocyte sedimentation rate (ESR and C-reactive protein (CRP plasma levels were associated with the improved LV diastolic function [E/A LV and

  7. EFFECT OF «TREAT-TO-TARGET» ANTIRHEUMATIC THERAPY ON DIASTOLIC DYSFUNCTION OF THE LEFT AND RIGHT VENTRICLES IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING 18 MONTHS OF OBSERVATION

    Directory of Open Access Journals (Sweden)

    I. G. Kirillova

    2015-09-01

    Full Text Available Aim. To study the effect of «treat-to-target» antirheumatic therapy on diastolic dysfunction of the left (DDLV and right (DDLV ventricles in patients with early rheumatoid arthritis (RA during 18 months of observation.Material and methods. The study included patients with early RA (n=66; 71% women; age - 56 [46; 61] years with moderate/high activity (DAS28 5.3 [5.0; 6.2], seropositive on rheumatoid factor (77% and/or cyclic citrullinated peptide antibodies (100%, disease modifying anti-rheumatic drugs (DMARD and glucocorticoids naive. Treatment with methotrexate (MTX with the escalation of the dose up to 25-30 mg/week subcutaneously was initiated in all the patients. After 3 months in 47 (71% patients biologics were added to MTX due to its inefficiency. In 18 months remission of RA was achieved in 44% of the patients. 51 (77% patients had a cardioprotective therapy. The target blood pressure (BP level was achieved in 38 (58% patients. Evaluation of traditional cardiovascular risk factors, 24-hour BP monitoring and echocardiography were performed in all patients initially and in 18 months of MTX/MTX + biologics use.Results. After 18 months DDLV incidence decreased by 7% (from 49% to 42%; p>0.05 and DDRV incidence decreased by 5% (from 24% to 17%; p>0.05. A more significant decrease in DDLV incidence [from 23 (62% to 18 (49%] and of DDRV incidence (from 12 (32% to 6 (16%] (р=0.05, was found in MTX + biologics group than in MTX only group [DDLV incidence remained unchanged - 7 (28%, and DDRV incidence increased from 3(12% to 4 (16%; p>0.05]. The normalization of left ventricle (LV diastolic function in early RA patients depended primarily on the efficacy of antihypertensive treatment, and of right ventricle (RV diastolic function - on the achievement of target BP level and RA remission. Reduced erythrocyte sedimentation rate (ESR and C-reactive protein (CRP plasma levels were associated with the improved LV diastolic function [E/A LV and

  8. TIME COURSE OF CHANGES IN BLOOD LIPID PARAMETERS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS DURING TREAT-TO-TARGET ANTIRHEUMATIC THERAPY: ACCORDING TO 18-MONTH FOLLOW-UP FINDINGS

    Directory of Open Access Journals (Sweden)

    E. V. Udachkina

    2016-01-01

    Full Text Available The mechanisms for lowering a cardiovascular risk (CVR in patients with early rheumatoid arthritis (RA when implementing the treat-to-target strategy remain inadequately investigated.Objective: to estimate the time course of changes in blood lipid parameters in patients with early RA during Treat-totarget antirheumatic therapy at an 18-month follow-up.Subjects and methods. Seventy-four patients (73% women; median age, 56 years with early RA meeting the respective 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR classification criteria and moderate or high activity (median DAS28-ESR score of 5.4 were examined within the framework of the REMARCA trial. After 6-month treatment, RA activity significantly reduced (p < 0.05. At months 6 to 18, no significant change in RA activity was recorded. After 18 months, remission was observed in 31 (42% patients: in 17 (55% on methotrexate (MTX monotherapy and in 14 (45% on combined therapy with MTX and a biological agent. Blood lipid levels were determined at inclusion in the investigation, 6 and 18 months later. The values of lipid parameters were estimated in terms of the total CVR. 67.6% of the patients were classified as at very high CVR. At 18 months of treatment, 34 (46% patients were treated with statins (median atorvastatin and rosuvastatin doses were 10 mg/day each.Results and discussion. Only 12% of the patients had optimal baseline values of just all lipid parameters. The concentration of total cholesterol (TC, low-density lipoprotein cholesterol (LDL-C, and high-density lipoprotein cholesterol (HDL-C correlated negatively with C-reactive protein (CRP levels, DAS28-ESR, DAS28-CRP, and HAQ (p < 0.05. After 6-month treatment, there were increases in TC by 7%, LDL-C by 12.5%, and HDL-C by 19.7%, and a decrease in the atherogenic index by 16% (p < 0.05. ΔCRP negatively correlated with ΔTC, ΔLDL-C, and ΔHDL-C (r = -0.3; p < 0.05. A correlation of TC and LDL-C with

  9. Prediction of remission and low disease activity in disease-modifying anti-rheumatic drug-refractory patients with rheumatoid arthritis treated with golimumab

    Science.gov (United States)

    Kutzbach, Abraham Garcia; Amital, Howard; Pavelka, Karel; Lazaro, María Alicia; Moots, Robert J.; Wollenhaupt, Jürgen; Zerbini, Cristiano A. F.; Louw, Ingrid; Combe, Bernard; Beaulieu, Andre; Schulze-Koops, Hendrik; Dasgupta, Bhaskar; Fu, Bo; Huyck, Susan; Weng, Haoling H.; Govoni, Marinella; Durez, Patrick

    2016-01-01

    Objective. To create a tool to predict probability of remission and low disease activity (LDA) in patients with RA being considered for anti-TNF treatment in clinical practice. Methods. We analysed data from GO-MORE, an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ⩾3.2) despite DMARD therapy. Patients received 50 mg s.c. golimumab (GLM) once monthly for 6 months. In secondary analyses, regression models were used to determine the best set of baseline factors to predict remission (DAS28-ESR <2.6) at month 6 and LDA (DAS28-ESR ⩽3.2) at month 1. Results. In 3280 efficacy-evaluable patients, of 12 factors included in initial regression models predicting remission or LDA, six were retained in final multivariable models. Greater likelihood of LDA and remission was associated with being male; younger age; lower HAQ, ESR (or CRP) and tender joint count (or swollen joint count) scores; and absence of comorbidities. In models predicting 1-, 3- and 6-month LDA or remission, area under the receiver operating curve was 0.648–0.809 (R2 = 0.0397–0.1078). The models also predicted 6-month HAQ and EuroQoL-5-dimension scores. A series of matrices were developed to easily show predicted rates of remission and LDA. Conclusion. A matrix tool was developed to show predicted GLM treatment outcomes in patients with RA, based on a combination of six baseline characteristics. The tool could help provide practical guidance in selection of candidates for anti-TNF therapy. PMID:27114562

  10. Patients with rheumatoid arthritis treated with methotrexate (MTX): concentrations of steady-state erythrocyte MTX correlate to plasma concentrations and clinical efficacy

    DEFF Research Database (Denmark)

    Hornung, N.; Ellingsen, T.; Attermann, J.;

    2008-01-01

    -six patients with RA were included in this open prospective study: 40 were included before initiation of MTX therapy. Laboratory analyses, intracellular MTX concentrations in erythrocytes (Ery-MTX), and clinical examinations including toxicity data were performed prospectively for 52 weeks. Plasma...... concentrations of MTX were measured and area under the plasma concentration versus time curve (AUC) was estimated along with other pharmacokinetic variables in a population based software model.RESULTS: Ery-MTX rose after initiation of therapy and reached a steady state after 6-8 weeks. The correlation between...... steady-state Ery-MTX and dose was poor (r(2) = 0.16), whereas steady-state Ery-MTX levels correlated strongly with the estimated AUC (r(2) = 0.51, log-transformed variables). Both steady-state Ery-MTX levels and estimated AUC were significantly higher in patients responding to MTX therapy than...

  11. Monitoring Drug and Antidrug Levels: A Rational Approach in Rheumatoid Arthritis Patients Treated with Biologic Agents Who Experience Inadequate Response While Being on a Stable Biologic Treatment

    Directory of Open Access Journals (Sweden)

    Diana Mazilu

    2014-01-01

    and ETN regarding EULAR response (P=0.002 and P=0.023, DAS28 score (P=0.002 and P=0.003, and SDAI score (P=0.001 and P=0.026. Detectable biologic drug levels correlated with a better clinical response in patients experiencing their first RA inadequate response while being on a stable biologic treatment with RTX, IFX, and ETN.

  12. Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Christensen, Ib Jarle; Tarp, Ulrik;

    2010-01-01

    OBJECTIVE: To compare tumor necrosis factor alpha inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response. METHODS: The nationwide DANBIO registry...... collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n = 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment...

  13. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

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    V. N. Amirdzhanova

    2014-01-01

    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  14. Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vugt, R.M. van; Sijbrandij, E.S.; Bijlsma, J.W.J. [Univ. Hospital Utrecht (Netherlands)

    1996-03-01

    Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with methylprednisolone pulse therapy. MRI and conventional radiography were performed before MP-pulse therapy and 6 and 12 months thereafter. Two patients showed unilateral changes compatible with AVN. One patient became symptomatic and revealed characteristic radiographic abnormalities. The other patient remained asymptomatic and the MRI appearance returned to normal after 6 months. 18 refs., 2 figs., 1 tab.

  15. Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis.

    Science.gov (United States)

    Rubino, M; Civani, A; Pagani, D; Sansone, V

    2013-10-01

    We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

  16. Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis.

    Science.gov (United States)

    Alghadir, Ahmad H; Gabr, Sami A; Al-Eisa, Einas S

    2016-10-01

    This study aimed to evaluate the effects of green tea and supervised exercise training interventions on improvement of disease activity and bone metabolism markers in rheumatoid arthritis patients. [Subjects and Methods] One-hundred and twenty subjects who had a mean age of (60.7 ± 2.53 years) and had been diagnosed with rheumatoid arthritis at least ten years previously were randomly included in this study. Patients were treated with infliximab, green tea, or a supervised exercise program for six months. Disease activity markers as well as antioxidant activity of green tea extracts were estimated before supplementation using in vitro assays. [Results] Rheumatoid arthritis patients treated with green tea for 6 months alone or in combination with infliximab or an exercise program showed significant improvement in disease activity parameters, including C-reactive protein, and erythrocyte sedimentation rate, swollen and tender joints counts, and modified Stanford Health Assessment Questionnaire score, along with an increase in serum levels of bone resorption markers, i.e., deoxypyridinoline, amino-terminal telopeptide of type 1 collagen, and bone alkaline phosphatase, at 6 months of after initial treatment. The European League Against Rheumatism and American College of Rheumatology scores revealed more clinical improvement in the disease activity of rheumatoid arthritis patients treated with green tea along with exercise compared with rheumatoid arthritis patients treated with infliximab or exercise combinations. This may have been due to the higher potential antioxidant activity of green tea (89.6% to 96.5%). [Conclusion] Both exercise and green tea interventions appeared to be beneficial as nondrug modulates for rheumatoid arthritis disorders.

  17. Fragility Fractures in Patients with Psoriatic Arthritis.

    Science.gov (United States)

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele

    2015-11-01

    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile.

  18. CLINICAL EXPERIENCE WITH USTEKINUMAB IN THE TREATMENT OF EARLY PSORIATIC ARTHRITIS USING TREAT-TO-TARGET STRATEGY

    Directory of Open Access Journals (Sweden)

    E. Yu. Loginova

    2015-01-01

    Full Text Available The new Treat-to-Target (T2T strategy in the treatment of early psoriatic arthritis (PsA is aimed at achieving remission or low disease activity. As of now, the new biological agent ustekinumb (UST, anti-interleukin (IL 12/23 monoclonal antibodies, was used to treat psoriasis and PsA. The paper presents clinical observations of the efficacy of UST in early PsA treated according T2T strategy. The described clinical cases demonstrate that use of UST 45 mg both alone and in combination with methotrexate for early PsA with moderate and high activity reduced manifestations of peripheral arthritis and psoriasis, promoting rapid achievement of remission or minimal disease activity. Overall, UST is well tolerated by the patients.

  19. Risk factors for asymptomatic ventricular dysfunction in rheumatoid arthritis patients.

    Science.gov (United States)

    Garza-García, Carlos; Rocío, Sánchez-Santillán; Orea-Tejeda, Arturo; Castillo-Martínez, Lilia; Eduardo, Canseco; López-Campos, José Luis; Keirns-Davis, Candace

    2013-01-01

    Objective. The aim of the study was to describe echocardiographic abnormalities in patients with rheumatoid arthritis, concurrent systemic comorbidities, rheumatologic clinical activity, serologic markers of rheumatoid arthritis, and inflammatory activity. Methods. In an observational, cross-sectional study, rheumatoid arthritis outpatients were included (n = 105). Conventional transthoracic echocardiographic variables were compared between patients with arthritis and non-RA controls (n = 41). For rheumatoid arthritis patients, articular activity and rheumatologic and inflammatory markers were obtained. Results. Ventricular dysfunction was found in 54.3% of the population: systolic (18.1%), diastolic (32.4%), and/or right (24.8%), with lower ejection fraction (P Pulmonary hypertension was found in 46.9%. Other echocardiographic findings included increased left atrial diameter (P = 0.01), aortic diameter (P = 0.01), ventricular septum (P = 0.01), left ventricular posterior wall (P = 0.013), and right ventricular (P = 0.01) and atrial diameters compared to control subjects. Rheumatoid factor and anti-CCP antibodies levels were significantly elevated in cases with ventricular dysfunction. Angina and myocardial infarction, diabetes, and dyslipidemia were the main risk factors for ventricular dysfunction. Conclusions. Ventricular dysfunction is common in rheumatoid arthritis and associated with longer disease duration and increased serologic markers of rheumatoid arthritis. Screening for cardiac abnormalities should be considered in this kind of patients.

  20. Eikenella corrodens septic hip arthritis in a healthy adult treated with arthroscopic irrigation and debridement.

    Science.gov (United States)

    Gowda, Ashok L; Mease, Samuel J; Dhar, Yasmin

    2014-09-01

    We present the case of a seemingly spontaneous septic hip arthritis in a patient with no pertinent medical history. Our patient presented with persistent and worsening sharp lower back pain and underwent arthrocentesis of the hip joint, yielding purulent fluid positive for Eikenella corrodens. Our patient's treatment consisted of arthroscopic irrigation with debridement and limited synovectomy that used a supine 2-incision technique. To our knowledge, this is the first reported case of an E corrodens septic hip arthritis.

  1. The electroneurophysiological findings in rheumatoid arthritis patients.

    Science.gov (United States)

    Sivri, A; Güler-Uysal, F

    1999-01-01

    In rheumatoid arthritis (RA), vasculitis is a serious complication usually found in patients with long-standing erosive nodular seropositive disease. One clinical hallmark of this systemic arteritis is the appearance of neurological findings. However, it is often difficult to diagnose these slight or early neuropathies and the study of the peripheral neuromuscular system is often made difficult by symptoms resulting from pain in the joints and limitations of movement. It is nevertheless often possible by means of electroneuromyography to show objectively the existence and distribution of even subclinical neuropathies. In order to evaluate the neurophysiological functions of RA patients by means of the peripheral nerve conduction and somatosensorial evoked potential studies, 33 RA patients and 20 healthy controls were included in this study. Two (6%) patients were found to have carpal tunnel syndrome, while 6 (18%) patients had mononeuritis multiplex. Delayed N12, N13, N1 and P1 latencies were detected in 6 (18%) of 33 RA patients suggesting central nervous system involvement with intact peripheral nervous system. Our results confirm earlier observations that symptoms of neuropathy are fairly common in cases of RA without there being any clear correlation with any clinical variable. By means of electroneurophysiological studies, it is to evaluate the integrity of the peripheral nerve, the spine and the central pathways. Besides enabling to detect early subclinical involvement of the peripheral nervous system in RA, SEPs should also be used for the evaluation of subclinical myelopathy due to atlantoaxial subluxation or vasculitis. The inclusion of an electroneurophysiologic examination of the RA patients is recommended in routine diagnostic procedure.

  2. [Anemia in patients with rheumatoid arthritis].

    Science.gov (United States)

    Wahle, M

    2012-12-01

    One of the most frequent extra-articular organ manifestations in rheumatoid arthritis (RA) is anemia. As anemia in RA patients may result in severe symptoms and aggravation of other disease manifestations (e.g. arteriosclerosis), the influence on the course of RA is profound. However, the importance of anemia in RA patients is frequently underestimated. The etiology of anemia in RA is complex. Anemia of inflammation (AI) and iron deficiency anemia, alone or in combination are the most frequent forms of anemia in RA. Changes in iron metabolism are the leading causes of anemia in RA patients and mainly induced by the altered synthesis and function of hepcidin and ferroportin. Hepcidin, a peptide produced in the liver and immunocompetent cells, impairs the expression of ferroportin on iron-secreting cells, thus reducing iron bioavailability. The typical changes of iron metabolism and hepcidin synthesis in RA are induced by proinflammatory cytokines, primarily interleukin-6. Hence, the treatment of RA with cytokine antagonists has significant therapeutic implications on anemia in the context of inflammation and impaired iron metabolism.

  3. Use of tofacitinib in real clinical practice to treat patients with rheumatoid arthritis resistant to synthetic and biological disease-modifying antirheumatic drugs: Results of a multicenter observational study

    Directory of Open Access Journals (Sweden)

    D. E. Karateev

    2016-01-01

    Full Text Available Tofacitinib (TOFA, a member of a new class of targeted synthetic disease-modifying antirheumatic drugs (DMARDs, is a promising medication for the treatment of rheumatoid arthritis (RA and other immunoinflammatory diseases. The paper describes the Russian experi-ence with TOFA used to treat severe RA.Patients and methods. 101 RA patients (18 men and 83 women; mean age, 51.03±11.28 years; mean disease duration, 105.4±81.43 months who were positive for rheumatoid factor (89.1% and anti-cyclic citrullinated peptide antibodies (74.7% and resistant to therapy with synthetic DMARDs (sDMARDs (80.2% and biological agents (19.8% were given TOFA at a dose of 5 mg twice daily, which could be doubled if necessary. TOFA was used alone (n=9 or in combination with methotrexate (MT (n=75 or other sDMARDs (n=17. The achievement of low disease activity (LDA and clinical remission at 3 and 6 months of treatment by DAS28-ESR SDAI, and CDAI scores, and the indices of safety and tolerability were assessed.Results. A total of 93 (92.1% of the 101 patients completed a 24-week period of the investigation. 8 (7.9% patients prematurely discontinued TOFA after an average of 2.75±0.71 months. At the end of the study, the patients achieved the primary endpoint (LDA including remission in terms of DAS28-ESR ≤3.2 (34.7%, SDAI ≤11 (47.5%, and CDAI ≤10 (48.5% and the secondary endpoints (clinical remission in terms of DAS28-ESR ≤2.6 (17.8%, SDAI ≤3.3 (8.9%, and CDAI ≤2.8 (6.9%. When TOFA was combined with MT, the discontinuation rate for the former was significantly lower (2.7% than when TOFA was used in combination with other sDMARDs (29.4% or alone (11.1%; p<0.01. At 3 and 6 months of follow-up, LDA was achieved more frequently when TOFA was combined with MT than when other treatment regimens were used. Fatal outcomes and serious adverse events (AEs, as AEs previously undescribed in the literature, were not seen during a follow-up within

  4. Prevalence of eye disease in Brazilian patients with psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Fernanda B. F. de Lima

    2012-01-01

    Full Text Available OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal. Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%, and the majority had polyarticular disease (57.5%. Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

  5. Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis

    OpenAIRE

    2016-01-01

    This study aimed to evaluate the effects of green tea and supervised exercise training interventions on improvement of disease activity and bone metabolism markers in rheumatoid arthritis patients. [Subjects and Methods] One-hundred and twenty subjects who had a mean age of (60.7 ± 2.53 years) and had been diagnosed with rheumatoid arthritis at least ten years previously were randomly included in this study. Patients were treated with infliximab, green tea, or a supervised exercise program fo...

  6. Thyroid Gland in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    B T Turumhambetova

    2009-09-01

    Full Text Available The purpose of our study was to investigate the main parameters of thyroid status in patients with rheumatoid arthritis (RA, as well as particularities of course of this disease depending on of thyroid gland function disorder. Materials and methods. 52 women with RA were examined. The first group consisted of 11 women with subclinical and manifestive hypothyroidism the second one 41 women without thyroid gland function disorder. The group comparison was conducted on main indexes of thyroid gland condition the hormon level, AT-TPO, ultrasonic data, as well as clinical and laboratory RA data. Results. In women with hypothyroidism the systemic manifestations of RA were more often truely diagnosed; DAS28 indexes, ESR, the number ot swollen joints were higher. The high level ot AT-TPO was diagnosed in 54,55% – I group and in 31,7% – II group TTG level was really less in patients receiving synthetic glycocorticoids. Small thyroid gland volume was diagnosed in 23,07% of examined patients. The thyroid gland status indexes in them did not differ from patients with normal thyroid gland volume. Reliable increasing of the peripheral resistance index was revealed in lower thyroid artery according to the ultrasonic study data under the reduced thyroid gland size. Conclusions. High incidence of hypothyroidism and AT-TPO carriage in RA was revealed. Hypothyroidism development is accompanied by high clinic-laboratory RA activity. The reduction of the thyroid gland volumes in RA is possibly stipulated not only by autoimmunal pathology, but also chronic ischemia of the organ in the conditions of immune-complex vasculitis and early atherosclerosis. The TTG level in patients with RA is defined not only by pathology of the thyroid gland, but glycocorticoid therapy as well.

  7. Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor α therapy: results from the nationwide Danish DANBIO registry

    DEFF Research Database (Denmark)

    Glintborg, Bente; Østergaard, Mikkel; Krogh, Niels Steen;

    2011-01-01

    Objective To investigate disease activity, treatment response, and drug survival, and predictors thereof, among Danish patients with psoriatic arthritis (PsA) receiving their first treatment series with a tumor necrosis factor a (TNFa) inhibitor. Methods Patients with PsA were identified from...... a prospective nationwide rheumatologic database, the Danish biologics registry DANBIO, using data registered from 2000–2009. Information was obtained on the patients' clinical response to anti-TNFa treatment (defined as achievement of the American College of Rheumatology 20% [ACR20], ACR50, and ACR70...... improvement criteria or a European League Against Rheumatism [EULAR] good response at least once during the first 6 months of treatment) and duration and rate of drug adherence (referred to as drug survival), as well as predictors thereof. Results Of 764 patients with PsA, 320 received adalimumab, 260...

  8. Clinical experiences of treating septic arthritis in the equine by repeated joint lavage: a series of 39 cases.

    Science.gov (United States)

    Meijer, M C; van Weeren, P R; Rijkenhuizen, A B

    2000-08-01

    The condition of septic arthritis was treated in 12 foals with 21 affected joints (Group I) and in 27 adult horses. The adult horses were divided into three groups, based on aetiology of the condition: haematogenous (Group II, n = 6), iatrogenic (Group III, n = 6), and perforating trauma (Group IV, n = 15). The treatment consisted of an initial systemic antibiotic that anticipated the microbial agents that were considered most likely per group, repeated through-and-through joint lavages every other day and non-steroidal anti-inflammatory drugs. The antibiotics were adjusted to the results of bacteriological culture and susceptibility tests. Joint lavages were continued until the white blood cell count dropped below 15 G/l and bacteriological culture was negative, after which a single dose of a short-acting corticosteroid was administered intra-articularly. Joint recovery rate in group I was 71%. Patient recovery rate of the foals, however, was lower (42%). Three foals were killed for reasons other than arthritis; one foal because of an arthritis-related problem and three foals because of persistent arthritis. Overall joint recovery rate, equalling patient recovery rate, in the adult horses was 81%. The expected predominance of Streptococcus spp. in haematogenous arthritis in adult horses was not confirmed, indicating that in these cases also, an initial antibiotic treatment with a broad-spectrum combination is preferable. It is concluded that with intensive treatment, the prognosis of septic arthritis in the adult horse can be classified as fair to even good. Results in the foals are not as good, but this seems to be more due to the specific problems surrounding the equine neonate than to unresponsiveness to the treatment.

  9. Incidence of herpes zoster infections in juvenile idiopathic arthritis patients.

    Science.gov (United States)

    Nimmrich, S; Horneff, G

    2015-03-01

    The risk of herpes zoster among patients with juvenile idiopathic arthritis (JIA) exposed to biologics has not been evaluated. We determined incidence rates of herpes zoster among children with JIA in correlation with medication at time of occurrence and total drug exposure. The German biologics register database was used to identify patients with herpes zoster. Crude infection rates and incidence ratios (IRR) were compared to published rates. Demographics and overall exposure and particular exposure time to corticosteroids, immunosuppressive drugs and biologics were analyzed. The JIA cohort included 3,042 patients with 5,557.9 person-years of follow-up; 1,628 have used corticosteroids, 2,930 methotrexate and 1,685 etanercept. In total, 17 herpes zoster events have been documented [6/1,000 patients (3.5-9.0); 3.1/1,000 patient-years (1.9-4.9)]. Thus, the incidence rate in JIA patients was higher than expected [IRR 2.9 (1.8-4.5), p herpes zoster. Compared to the healthy population, a significant higher IRR is observed in JIA patients who received a monotherapy with etanercept or in combination with steroids and methotrexate, but not in JIA patients exposed to methotrexate without biologics. In comparison with our control group of patients treated with methotrexate, the IRR was higher for exposure to etanercept monotherapy and combination of etanercept and corticosteroids irrespective of methotrexate use. A generally higher incidence rate in JIA patients treated with etanercept was observed. No serious or refractory manifestations occurred.

  10. 来氟米特治疗中医不同证型类风湿关节炎疗效观察%Effects of Leflunomide in Treating Patients with Rheumatoid Arthritis of Different Chinese Medical Syndrome Patterns

    Institute of Scientific and Technical Information of China (English)

    王智明; 吴燕; 李伟青

    2013-01-01

    目的 观察来氟米特(leflunomide,LEF)治疗中医不同证型类风湿关节炎(rheumatoid arthritis,RA)的疗效有无差异.方法 选取150例类风湿关节炎患者,按照中医辨证标准分为湿热痹阻证、寒湿痹阻证、肾气虚寒证、肝肾阴虚证、瘀血痹阻证5个证型组,应用LEF口服治疗,疗程3个月,观察LEF治疗前后压痛关节数、肿胀关节数、晨僵时间、患者疼痛评分(visual analog scale,VAS)、类风湿因子(rheumatoid factor,RF)、血沉(erthrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、美国风湿病协会标准20%改善 (American College of Rheumatology 20% improvement,ACR20)、美国风湿病协会标准50%改善(American College of Rheumatology 50% improvement,ACR50)等指标的变化,进行统计分析.结果 与本组治疗前比较,各组治疗后压痛关节数、肿胀关节数均减少,VAS、ESR、CRP、RF均降低,差异有统计学意义(P <0.05);除肾气虚寒证、肝肾阴虚证外,其余各组关节晨僵时间均缩短,差异有统计学意义(P <0.05).其中湿热痹阻、寒湿痹阻、瘀血痹阻证型治疗后压痛关节数、肿胀关节数、晨僵时间、VAS、RF改变及总有效率改善明显优于肾气虚寒证和肝肾阴虚证,差异有统计学意义(P <0.05).结论 LEF治疗RA疗效显著,其中湿热痹阻证、寒湿痹阻证、瘀血痹阻证效果明显优于肝肾阴虚证和肾气虚寒证.%Objective To study whether the effects of Leflunomide were different in treating patients with rheumatoid arthritis (RA)of different Chinese medical syndrome patterns. Methods Totally 150 RA patients were recruited and assigned to 5 Chinese medical syndrome types, i.e., the heat-dampness blocking collateral type, cold-dampness blocking collateral type, Shen-qi deficiency cold type, Gan-Shen yin deficiency type, and stagnant blood blocking collateral type according to Chinese medical syndrome typing standards. They were treated with Leflunomide

  11. Management of gouty arthritis in patients with chronic kidney disease.

    Science.gov (United States)

    Abdellatif, Abdul A; Elkhalili, Naser

    2014-01-01

    Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with gouty arthritis. However, data from randomized controlled trials in patients with gouty arthritis and CKD are limited, and current gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and colchicine are recommended first-line treatments for acute gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury. Also, colchicine toxicity is increased in patients with CKD, and dosage reduction is required based on level of kidney function. Allopurinol, febuxostat, and pegloticase are all effective treatments for controlling elevated uric acid levels after the treatment of an acute attack. However, in patients with CKD, required allopurinol dosage reductions may limit efficacy; pegloticase requires further investigation in this population, and febuxostat has not been studied in patients with creatinine clearancegouty arthritis including urate-lowering therapy in patients with CKD. Challenges specific to primary care providers are addressed, including guidance to help them decide when to collaborate with, or refer patients to, rheumatology and nephrology specialists based on the severity of gout and CKD.

  12. The Role of Different Therapeutic Courses in Treating 47 Cases of Rheumatoid Arthritis with Acupuncture

    Institute of Scientific and Technical Information of China (English)

    Wang Ruihui; Jiang Chanjuan; Lei Zhengquan; Yin Kejing

    2007-01-01

    Objective: To observe the effect of acupuncture therapeutic courses on rheumatoid arthritis. Method:Forty-seven patients were treated with acupuncture for 6 courses and at the end of the third and sixth course of treatment, the therapeutic effects of acupuncture on morning rigidity, swelling and pain of joints as well as rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)were observed. Result: At the end of the third course, the markedly effective rate was 34.0% for morning rigidity, 9.5% for swelling and 23.4% for pain, the RF negative-turning rate was 2.2%, and there was no significant difference (P>0.05) in the reduction of ESR and CRP as compared to that before treatment.However, at the end of the sixth course, the markedly effective rate was 80.9% for morning rigidity, 64.3%for swelling and 87.2% for pain, the RF negative-turning rate was 26.7%, and there was a very significant difference (P<0.01) in the reduction of ESR and CRP as compared to that before treatment. Conclusion:More acupuncture therapeutic courses can bring about better therapeutic results on rheumatoid arthritis.

  13. Physical activity maintenance in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Loeppenthin, K; Esbensen, Bente Appel; Østergaard, Mikkel

    2014-01-01

    were analysed using systematic text condensation, inspired by Giorgi's descriptive phenomenological methodology. RESULTS: The analysis revealed three categories: (1) knowing and enjoying the body; (2) responsibility and challenges; (3) autonomy and social belonging. On the basis of these categories...... with non-arthritis populations. CONCLUSION: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life....

  14. Fever of unknown origin in a patient of systemic onset juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Vinod Kolar Vishwanath

    2010-01-01

    Full Text Available Hemophagocytic lymphohistiocytosis is a potentially fatal condition characterized by pathologic immune activation, which can complicate infections, childhood systemic rheumatologic diseases and malignancies. Here we report a case of reactive hemophagocytic lymphohistiocytosis [macrophage activation syndrome] complicating systemic onset juvenile idiopathic arthritis, which was treated successfully with dexamethasone and cyclosporine. Reactive hemophagocytic lymphohistiocytosis or macrophage activation syndrome should be considered in patients of juvenile idiopathic arthritis with prolonged fever of unknown origin and cytopenias. Early diagnosis with high index of suspicion and prompt, aggressive treatment are needed for successful outcomes.

  15. Gouty arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Barthelemy, C.R.; Nakayama, D.A.; Lightfoot, R.W. Jr.; Wortmann, R.L.; Carrera, G.F.

    1984-01-01

    A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.

  16. Fatigue in rheumatoid arthritis: from patient experience to measurement

    NARCIS (Netherlands)

    Nikolaus, Stephanie

    2012-01-01

    Many patients with rheumatoid arthritis (RA) complain about fatigue. In-depths interviews with patients showed that fatigue is experienced as an annoying symptom that can have far-reaching consequences for daily life. However, not each patient has the same experience of fatigue: emotions, consequenc

  17. Treating rheumatoid arthritis to target: Revision of the 2014 International Expert Group Recommendations

    Directory of Open Access Journals (Sweden)

    N. T. Vatutin

    2016-01-01

    Full Text Available The paper presents a new edition (2014 of basic approaches to therapy of rheumatoid arthritis (RA based on the principle of «Treat to target », which has been elaborated by the experts of the European League Against Rheumatism (EULAR and the American College of Rheumatology (ACR. The revised recommendations consider the results of numerous randomized controlled and cohort studies, as well as the data of an extensive systematic review of the literature. The new 2014 version contains 4 basic principles and 10 recommendations for the management of patients with RA. When making the updated recommendations, the experts took into account particularly issues, such as criteria for defining a remission, the need to minimize comorbidities in patients with RA and to individualize its therapy, as well as their working ability. The basic principles in the management of patients with RA, by using a treat-to-target strategy, are discussed in detail and the rewording of the main points of the 2010 recommendations and their new edition are substantiated.

  18. Post-traumatic arthritis in patient with Jadassohn’s anetoderma

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    R. Rondinone

    2011-09-01

    Full Text Available We describe the emergence of arthritis following a physical trauma, in a young man with clinical and histopathologic features of primary anetoderma (Jadassohn type of 13 years’ duration. Diagnosis of post-traumatic arthritis in a young patient with genetic predisposition was assumed. Indeed septic arthritis and other possible cause of arthritis were ruled out.

  19. Validation of a Prediction Rule for the Diagnosis of Rheumatoid Arthritis in Patients with Recent Onset Undifferentiated Arthritis

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    Zaida Bedran

    2013-01-01

    Full Text Available Objectives. To validate van der Helm-van Mil score (vHvM and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA in patients with undifferentiated arthritis (UA. Patients and Methods. Adult patients with UA (swelling ≥2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs. Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4, 74% females. Median symptoms duration was 2 months (IR: 1–4 months. Mean van der Helm-van Mil score was 6.9 (SD: 2. After a mean followup of 6.2 months (SD: 6, 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's area under the curve (AUC for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity. Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA.

  20. INVESTIGATION OF CYTOKINE PROFILE IN PATIENTS WITH REACTIVE ARTHRITIS

    Directory of Open Access Journals (Sweden)

    T. V. Gaponova

    2008-01-01

    Full Text Available Abstract. Pathogenesis of reactive arthritis (ReA is not clear yet. Several trials suggest that increased production of proinflammatory cytokines is responsible for development of arthritis in ReA, while other studies report that Th1 cytokine response in ReA is impaired in favor of Th2 response. The aim of our study was to investigate serum levels of cytokines IL-1β, IL-4, IL-6, TNFα, IFNγ and IL-1Ra in the patients with ReA of different etiology, as compared with infection-related arthritis. The results of our study had demonstrated that serum levels of IL-1β and TNFα in the patients with ReA were significantly higher, whereas IL-1Ra, IL-4, IL-6 proved to be significantly lower than in healthy controls. Serum levels of IL-6 were significantly higher in patients with chronic ReA, as compared to the cases of acute and recurrent ReA. No significant differences in cytokine profiles were found between the patients with ReA, and the persons with infection-related arthritis. The data obtained are, generally, suggestive for proinflammatory Th1 cytokine profile in ReA patients studied, this confirming the mostly assumed pathogenetic hypothesis for reactive arthritis where an underlying cytokine imbalance is suggested. (Med. Immunol., 2008, vol. 10, N 2-3, pp 167-172.

  1. Using an electronic platform interactively to improve treatment outcome in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete L; Krogh, Niels Steen; Hørslev-Petersen, Kim;

    2016-01-01

    OBJECTIVES: Electronic platforms have been developed to help the clinician monitor disease activity in rheumatoid arthritis (RA) to support at treat-to-target strategy. We present an initiative to interactively improve disease control in patients with rheumatoid arthritis. METHODS: In patients who......>3.2. Which action do you as a physician take today: □ Intensify treatment, □ Treatment intensification is not possible currently/awaiting results of additional investigations, □ No further treatment intensification is possible, □ The patient does not want to intensify treatment, □ Other decisions...... taken" RESULTS: Of 21,056 patients with RA, 40% fulfilled the criteria for getting the alert message. The pop-up was activated and completed by the physician in 65% of those (5,428 patients). Treatment was intensified in 67%. In 2% of patients, no additional treatment intensification was possible, and 8...

  2. Subclinical atherosclerosis in gouty arthritis patients: a comparative study.

    Science.gov (United States)

    Çukurova, Selçuk; Pamuk, Ömer Nuri; Ünlü, Ercüment; Pamuk, Gülsüm Emel; Çakir, Necati

    2012-06-01

    We evaluated the incidence of subclinical atherosclerosis and associated factors in our gouty arthritis patients. We included 55 gouty arthritis patients diagnosed at our center within the last 4 years. The control group included 41 patients with rheumatoid arthritis (RA) and 34 patients with asymptomatic hyperuricemia (AHU). Atherosclerotic risk factors were determined in all subjects. Carotid intima-media thickness (IMT) and the presence of plaques were evaluated by B-mode ultrasonography. The carotid IMT in gouty arthritis patients (0.730 ± 0.19) was significantly higher than in AHU subjects (0.616 ± 0.12) (P = 0.004) and tended to be higher than the RA group (0.669 ± 0.17) (P = 0.1). Atheromatous plaques were significantly more frequent in gouty arthritis patients (16 cases, 29.1%) than in RA patients (5 cases, 12.2%) and AHU subjects (3 cases, 8.8%) (P values, 0.05 and 0.023). Gout patients with plaques were older (P = 0.006) and tended to have tophi more frequently (P = 0.06). Logistic regression analysis showed that age (OR: 1.3, 95% CI: 1.02-1.54) and the presence of tophi (OR: 12.5, 95% CI: 1.2-140) were independent risk factors for the presence of plaques. Gouty arthritis bears a higher risk of atherosclerosis than both RA and AHU.

  3. Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

    NARCIS (Netherlands)

    P. Krijnen (Pieta); C.J. Kaandorp; E.W. Steyerberg (Ewout); D. van Schaardenburg (Dirkjan); H.J. Moens; J.D.F. Habbema (Dik)

    2001-01-01

    textabstractOBJECTIVE: To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. METHODS: In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint dise

  4. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    Directory of Open Access Journals (Sweden)

    Tuite Helen

    2010-11-01

    Full Text Available Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  5. Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

    LENUS (Irish Health Repository)

    Smyth, Andrew

    2010-11-17

    Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

  6. [RETROSPECTIVE DATA ANALYSIS OF THE PATIENTS WITH INFLAMMATORY JOINT DISEASES TREATED WITH GOLIMUMAB IN CROATIA].

    Science.gov (United States)

    Anić, Branimir; Babić-Naglić, Ðurđica; Grazio, Simeon; Kehler, Tatjana; Kaliterna, Dusanka Martinović; Radoncić, Ksenija Mastrović; Morović-Vergles, Jadranka; Novak, Srđan; Prus, Visnja; Vlak, Tonko; Baresić, Marko

    2015-01-01

    Golimumab is a human monoclonal antibody which inhibits tumor necrosis factor-alpha (TNF-α) and is approved for the treatment of inflammatory arthritides (rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis) when the conventional non-pharmacological and pharmacological therapies fail to cause remission or low disease activity. In this retrospective study there were included patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who were treated in Croatia with golimumab, from June 2011 to June 2013. included and these retrospective data are compared with similar data from clinical trials and other available databases. Standard variables of disease activity and functional ability were observed. Results demonstrated significant efficacy of golimumab regarding lowring the disease activity and imrpving functional ability in pateints with these inflammatory rherumatic disease. In conclusion, in this retrospective study during two years treatment golimumab showed efficacy in decreasing disease activity and imrpove functional ability in patiemts with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

  7. The assessment of diastolic function in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Obradović-Tomašević Biljana

    2009-01-01

    Full Text Available Introduction. Rheumatoid arthritis (RA is a systemic inflammatory autoimmune chronic disease. In comparison with the overall population, mortality and morbidity of RA patients are increased due to cardiovascular diseases. There is increasing evidence that autoimmunity mechanisms are included in pathogenesis of cardiovascular diseases. Isolated disorder of diastolic function can, even with normal heart contractility, lead to heart failure. The aim of this study was to assess diastolic function in RA patients and determine factors causing diastolic dysfunction. Material and methods. The study included 88 patients with RA treated at Rheumatology Department, Clinical Hospital Centre, Zemun. All the patients were thoroughly examined (clinical findings, laboratory and echocardiographic examination. All parameters of diastolic function (mitral and pulmonary flow were measured. Results. In RA patients 98,9% had diastolic function disorder. This parameter had been changed prior to clinical signs of heart failure and decrease of ejection fraction. Indicators of diastolic function, velocities E, A and their ratio VE/VA, as well as velocities S, D and their ratio VS/VD were lower in patients with positive rheumatoid factor. The patients' age (p<0.01, duration of the disease (p<0.05, high level of cholesterol (p<0.05, triglycerides (p<0.05 and arterial hypertension (p<0.05 were significant factors considerably affecting diastolic function. Conclusion. These findings suggest subclinical myocardial disorder in a great number of RA patients. Apart from early and aggressive treatment of the chronic inflammatory process, it is also necessary to prevent further heart complications by timely recognition and treatment of 'standard' risk factors for cardiovascular diseases.

  8. End-stage rheumatoid arthritis: specific features of patient management

    Directory of Open Access Journals (Sweden)

    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available The paper provides data on the treatment of patients with end-stage rheumatoid arthritis (RA and a rationale for the long-term treatment with disease-modifying antirheumatic drugs, including leflunomide as a first-line agent. It describes a clinical case of a patient with end-stage RA during arava treatment.

  9. A pure polysaccharide from Ephedra sinica treating on arthritis and inhibiting cytokines expression.

    Science.gov (United States)

    Wang, Qiuhong; Shu, Zunpeng; Xing, Na; Xu, Bingqing; Wang, Changfu; Sun, Guibo; Sun, Xiaobo; Kuang, Haixue

    2016-05-01

    In our previous study, we found that the acidic polysaccharides of Ephedra sinica had immunosuppressive effect to treat rheumatoid arthritis and the pure polysaccharide ESP-B4 was the main composition of the acidic polysaccharides. At present, the exact molecular mechanism of ESP-B4 on treating arthritis is unclear. We are thus evaluating the properties of ESP-B4 on LPS-induced THP-1 pro-monocytic cells and adjuvant-induced arthritis in Wistar rats via TLR4. In vitro, ESP-B4 decreased the production of cytokines induced by LPS. In addition, ESP-B4 reduced the LPS-stimulated nuclear translocation of p65 subunit of NF-κB. Pretreatment with ESP-B4 significantly down-regulated the phosphorylation of MAPKs induced by LPS. Furthermore, in vivo, after 12 days of disease induced by adjuvant, rats were treated with ESP-B4 for 16 days. ESP-B4 significantly improved all parameters of inflammation. ESP-B4 reduced the release of inflammatory factors and cytokines by inhibiting the TLR4 signaling pathway to treat rheumatoid arthritis.

  10. In rheumatoid arthritis patients treated with tocilizumab, the rate of clinical disease activity index (CDAI) remission at 24 weeks is superior in those with higher titers of IgM-rheumatoid factor at baseline.

    Science.gov (United States)

    Kawashiri, Shin-Ya; Kawakami, Atsushi; Iwamoto, Naoki; Fujikawa, Keita; Aramaki, Toshiyuki; Tamai, Mami; Yamasaki, Satoshi; Nakamura, Hideki; Origuchi, Tomoki; Ueki, Yukitaka; Migita, Kiyoshi; Mizokami, Akinari; Aoyagi, Kiyoshi; Eguchi, Katsumi

    2011-08-01

    We aimed to evaluate the efficacy of tocilizumab in patients with rheumatoid arthritis (RA), using the clinical disease activity index (CDAI), and to determine the baseline variables associated with CDAI remission. Fifty-eight patients with active RA were enrolled. We tried to evaluate whether baseline variables were associated with CDAI remission at 24 weeks. Twenty-two of the 58 patients (37.9%) had received tumor necrosis factor (TNF) inhibitors. The continuation rate of tocilizumab at 24 weeks was 87.9%. The seropositivity rates of IgM-rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies at baseline were both 91.4%. The rate of CDAI remission at 24 weeks was 20.7%. We selected baseline variables including age, gender, duration of disease, concomitant use of glucocorticoids, concomitant use of methotrexate (MTX), previous anti-TNF therapy, titer of anti-CCP antibodies (high or low toward median), titer of IgM-RF (high or low toward median), and CDAI, and found that a high titer of IgM-RF was the only variable to be associated with CDAI remission, according to univariate and logistic regression analyses. This is a new finding, and may be specific to tocilizumab as compared with previous observations in anti-TNF therapy.

  11. The Impact of Imagery Therapy on Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Wadee Alhalabi

    2012-09-01

    Full Text Available This paper concerns computer applications in medicine that exploit the potentially powerful interconnection between psychology and physiology. An important class of applications involve patients who suffer chronic pain caused by rheumatoid arthritis; these patients look for any kind of therapeutic technique to use in addition to traditional medicine in order to alleviate pain, reduce physical disabilities caused by the disease or delay disease progress and improve their lifestyle. This paper focuses on a particular class of therapeutic techniques that provide imagery therapy using virtual reality in the treatment of rheumatoid arthritis. We describe imagery therapy involving guided imagery and illustrate its effects. We particularly describe the application of VR and IT in the treatment of rheumatoid arthritis. A brief introduction to our system and the research we have done in this field is presented, showing some preliminary results that support our hypothesis.

  12. The radiographic features of rheumatoid arthritis in HLA-B27-positive patients

    Energy Technology Data Exchange (ETDEWEB)

    Rundback, J.H. (Dept. of Radiology, Beth Israel Medical Center, New York, NY (United States)); Rosenberg, Z.S. (Dept. of Radiology, Hospital for Joint Diseases, Orthopaedic Inst., New York, NY (United States)); Solomon, G. (Dept. of Rheumatology, Hospital for Joint Diseases, Orthopaedic Institute, New York, NY (United States))

    1993-05-01

    Radiographs were reviewed in a group of nine patients with classical seropositive rheumatoid arthritis who on tissue typing were found to express the class I HLA-B27 allele. Radiographs were analyzed with regard to whether or not they demonstrated radiographic features of (1) classical rheumatoid arthritis, (2) seronegative arthritis, or (3) mixed features of rheumatoid and seronegative arthritis. Five patients (55%) displayed radiographic features consistent with a diagnosis of rheumatoid arthritis, two patients (22%) showed radiographic features of seronegative disorder (periostitis and sacroiliitis), and two patients (22%) showed a mixed picture with evidence of both rheumatoid arthritis and a seronegative disorder. Thus, the HLA-B27 allele contributed to the radiographic features in 44% of patients with rheumatoid arthritis and associated HLA-B27. Thus, the wide range of findings in our population indicates that the radiographic attributes are not specific enough to constitute a unique subpopulation of patients with rheumatoid arthritis. (orig.)

  13. Rheumatoid Arthritis Educational Video Series

    Science.gov (United States)

    ... Corner / Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life ...

  14. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ...

  15. How to optimize treatment in patients with gout and chronic arthritis Urisan is in focus

    Directory of Open Access Journals (Sweden)

    A E Ilyina

    2009-01-01

    Full Text Available The paper outlines the specific features of the clinical picture and diagnosis of chronic gouty arthritis. It describes difficulties in treating chronic gout when one has to face the so-called vicious circle, to which is contributed by comorbidity that is present in most patients. A way out of this clinical difficulty is proposed to use the herbal complex Urisan that has antihyperuricemic and inflammatory properties.

  16. How to optimize treatment in patients with gout and chronic arthritis Urisan is in focus

    Directory of Open Access Journals (Sweden)

    A E Ilyina

    2009-03-01

    Full Text Available The paper outlines the specific features of the clinical picture and diagnosis of chronic gouty arthritis. It describes difficulties in treating chronic gout when one has to face the so-called vicious circle, to which is contributed by comorbidity that is present in most patients. A way out of this clinical difficulty is proposed to use the herbal complex Urisan that has antihyperuricemic and inflammatory properties.

  17. Pancytopenia, including macrocytic anemia, associated with leflunomide in a rheumatoid arthritis patient.

    Science.gov (United States)

    Toyokawa, Yasuhiko; Kingetsu, Isamu; Yasuda, Chiho; Yasuda, Jun; Yoshida, Ken; Kurosaka, Daitaro; Yamada, Akio

    2007-01-01

    A female rheumatoid arthritis patient was admitted for productive cough and general fatigue that had gradually developed after leflunomide therapy. Side effects including severe hypoxia, thrombocytopenia, lymphocytopenia, and macrocytic anemia with schistocytes (probably drug-induced megaloblastic anemia) were noted. Leflunomide-eliminating cholestyramine therapy successfully treated all conditions excluding severe hypoxia, which occurred owing to deteriorating interstitial pneumonia and complicated bacterial pneumonia following antibiotic treatment. This is a rare case of leflunomide-associated multiple hematopoietic impairments.

  18. Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis.

    LENUS (Irish Health Repository)

    Lahiff, C

    2007-12-01

    Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells\\/mm(3). We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.

  19. Factors secreted from dental pulp stem cells show multifaceted benefits for treating experimental rheumatoid arthritis.

    Science.gov (United States)

    Ishikawa, Jun; Takahashi, Nobunori; Matsumoto, Takuya; Yoshioka, Yutaka; Yamamoto, Noriyuki; Nishikawa, Masaya; Hibi, Hideharu; Ishigro, Naoki; Ueda, Minoru; Furukawa, Koichi; Yamamoto, Akihito

    2016-02-01

    Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial hyperplasia and chronic inflammation, which lead to the progressive destruction of cartilage and bone in the joints. Numerous studies have reported that administrations of various types of MSCs improve arthritis symptoms in animal models, by paracrine mechanisms. However, the therapeutic effects of the secreted factors alone, without the cell graft, have been uncertain. Here, we show that a single intravenous administration of serum-free conditioned medium (CM) from human deciduous dental pulp stem cells (SHED-CM) into anti-collagen type II antibody-induced arthritis (CAIA), a mouse model of rheumatoid arthritis (RA), markedly improved the arthritis symptoms and joint destruction. The therapeutic efficacy of SHED-CM was associated with an induction of anti-inflammatory M2 macrophages in the CAIA joints and the abrogation of RANKL expression. SHED-CM specifically depleted of an M2 macrophage inducer, the secreted ectodomain of sialic acid-binding Ig-like lectin-9 (ED-Siglec-9), exhibited a reduced ability to induce M2-related gene expression and attenuate CAIA. SHED-CM also inhibited the RANKL-induced osteoclastogenesis in vitro. Collectively, our findings suggest that SHED-CM provides multifaceted therapeutic effects for treating CAIA, including the ED-Siglec-9-dependent induction of M2 macrophage polarization and inhibition of osteoclastogenesis. Thus, SHED-CM may represent a novel anti-inflammatory and reparative therapy for RA.

  20. Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases.

    Science.gov (United States)

    Mekinian, Arsène; Braun, Thorsten; Decaux, Olivier; Falgarone, Géraldine; Toussirot, Eric; Raffray, Loic; Omouri, Mohamed; Gombert, Bruno; De Wazieres, Benoit; Buchdaul, Anne-Laure; Ziza, Jean-Marc; Launay, David; Denis, Guillaume; Madaule, Serge; Rose, Christian; Grignano, Eric; Fenaux, Pierre; Fain, Olivier

    2014-01-01

    We describe the characteristics and outcome of inflammatory arthritis in patients with myelodysplastic syndrome (MDS) in a French multicenter retrospective study. Twenty-two patients with MDS (median age, 77.5 yr [interquartile range, 69-81]; 10 women) were included. Inflammatory arthritis presented as polyarthritis in 17 cases (77%) and with symmetric involvement in 15 cases (68%). At diagnosis, the median disease activity score 28 based on C-reactive protein (DAS28-CRP) was 4.5 [2-6.5]. Two patients had anti-citrullinated protein antibodies (ACPAs), and 1 had radiologic erosions. The median time between the diagnoses of arthritis and MDS was 10 months [6-42], with a median articular symptom duration of 3 months [2-8]. The diagnosis of both diseases was concomitant in 6 cases (27%); arthritis preceded MDS in 12 cases (55%), and occurred after MDS in 4 (18%). While the number of swollen and tender joints significantly decreased during follow-up, as did the median DAS28-CRP (from 4.3 [3.8-4.6] at baseline to 2.9 [1.75-3.3]; p 20 mg/L) in 8 patients (42%). Nevertheless, radiographic progression and new ACPA positivity were not observed during a median follow-up of 29 months [9-76]. While most of the patients were treated with steroids (n = 16) for arthritis, additional treatment was administered in only 4 patients (hydroxychloroquine, n = 2; sulfasalazine [Salazopyrin] and etanercept, n = 1, respectively). Eleven patients died during follow-up from acute myeloid leukemia (n = 5); infections (n = 3); or cerebral bleeding, cardiorespiratory failure, or undetermined cause (n = 1, respectively). Inflammatory arthritis associated with MDS can have various presentations and is often seronegative and nonerosive. Steroids alone are the most common treatment in MDS-associated arthritis, but that treatment is insufficient to control arthritis. Steroid-sparing strategies need to be identified.

  1. Targeting the humoral immune system of patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Teng, Yoe Kie Onno

    2008-01-01

    The aim of this thesis was to unravel the role of the humoral immune system in rheumatoid arthritis patients by employing new immunosuppressive strategies, i.e. specific B-cell depletion with Rituximab and non-specific lymfoablative treatment with high dose chemotherapy and hematopoeietic stem cell

  2. EULAR recommendations for patient education for people with inflammatory arthritis

    DEFF Research Database (Denmark)

    Zangi, Heidi A; Ndosi, Mwidimi; Adams, Jo;

    2015-01-01

    OBJECTIVES: The task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals' educational needs in order to provide evidence-based PE.......4-9.8). The task force proposed a research agenda and an educational agenda. CONCLUSIONS: The eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals...

  3. Subtalar joint septic arthritis in a patient with hypogammaglobulinemia.

    Science.gov (United States)

    Wynes, Jacob; Harris, William; Hadfield, Robert A; Malay, D Scot

    2013-01-01

    The clinical presentation of a monoarticular, red, hot, and swollen joint has many possible diagnoses, including septic arthritis, which is 1 of the most devastating. The morbidity associated with this pathologic process involves permanent joint damage and the potential for progression to systemic illness and, even, mortality. The common risk factors for joint sepsis include a history of rheumatoid arthritis, previous joint surgery, joint prosthesis, intravenous drug abuse, alcoholism, diabetes, previous intra-articular steroid use, and cutaneous ulceration. The diagnosis is primarily determined from the culture results after arthrocentesis and correlation with direct visualization, imaging, and various serologies, including synovial analysis. In the present report, a case of an insidious presentation of subtalar joint septic arthritis and its association with a unique patient presentation concomitant with primary immunodeficiency and culture-proven Myocplasma hominis infection is discussed. Septic arthritis has a predilection for the lower extremities and typically is isolated to the hip or knee, with less common involvement of the ankle or metatarsophalangeal joints. Owing to the uncommon nature of primary immunodeficiency disorders and the paucity of studies discussing their association with septic arthridites, we aimed to raise awareness of subtalar joint septic arthritis and to provide a brief overview of the pathogenesis as it presented in a 33-year-old male with X-linked hypogammaglobulinemia/agammaglobulinema.

  4. Clinical and Epidemiological Characterization of Patients with Rheumatoid Arthritis

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    Zoe Alina González Otero

    2015-12-01

    Full Text Available Background: rheumatoid arthritis is a chronic systemic inflammatory disease, it has varied clinical manifestations and cause different degrees of discomfort and disability. Objective: to conduct a clinical and epidemiological characterization of all rheumatoid arthritis patients admitted to the clinical services of the Arnaldo Milián Castro Provincial University Hospital. Methods: a cross-sectional study was conducted in the clinical services of the Arnaldo Milián Castro University Hospital from 2009 through 2013. The universe consisted of 280 patients hospitalized due to rheumatoid arthritis. The following variables were studied: age, sex, skin color, past medical history, clinical manifestations, complications, affected organs, time of diagnosis and treatment. Chi square and prevalence ratio with a 95% confidence interval were calculated. Results: arthritis was found in 2 men every 5 women. White middle-aged patients predominated. Hypertension was the major illness described in the past medical history. Arthralgia and movement limitations prevailed. No family history of rheumatic disease was found. The time of diagnosis was less than six months and infection was among the most frequent complications. The most common treatment was the combination of non-steroidal anti-inflammatory drugs and steroids, especially in seropositive patients. Conclusions: rheumatoid arthritis was more common in females and white middle-aged patients. Hypertension was the major illness found in the past medical history. Patients with two target organs affected predominated. Arthralgia and movement limitations prevailed in the clinical picture. The most common treatment was the combination of non-steroidal anti-inflammatory drugs and steroids.

  5. PSYCHOPHYSIOLOGICAL AND IMMUNE STATUS IN THE PATIENTS WITH RHEUMATOID ARTHRITIS

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    T. Y. Abramova

    2008-01-01

    Full Text Available Abstract. The aim of this study was to elucidate a role of brain hemispheres in formation of rheumatoid arthritis (RA. The parameters of higher nervous activity, autonomous and immune systems in these patients that were characterized by domination of the left or right hemispheres of a brain, were defined in present work. The results of this work allow of justifying the following items: a relative increase in functional activity of right brain hemisphere in woman may represent a factor that either contributes to triggering of rheumatoid arthritis, or predisposes for its development; b formation of rheumatoid arthritis in females is accompanied by complex changes in psychophysiological and immune parameters, that exhibit significant features depending on functional asymmetry of the hemispheres; c a pronounced dependence is revealed between clinical course of disease and functional asymmetry of hemispheres.

  6. Dispositional Affect in Unique Subgroups of Patients with Rheumatoid Arthritis

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    Danielle B. Rice

    2016-01-01

    Full Text Available Background. Patients with rheumatoid arthritis may experience increased negative outcomes if they exhibit specific patterns of dispositional affect. Objective. To identify subgroups of patients with rheumatoid arthritis based on dispositional affect. The secondary objective was to compare mood, pain catastrophizing, fear of pain, disability, and quality of life between subgroups. Methods. Outpatients from a rheumatology clinic were categorized into subgroups by a cluster analysis based on dispositional affect. Differences in outcomes were compared between clusters through multivariate analysis of covariance. Results. 227 patients were divided into two subgroups. Cluster 1 (n=85 included patients reporting significantly higher scores on all dispositional variables (experiential avoidance, anxiety sensitivity, worry, fear of pain, and perfectionism; all p<0.001 compared to patients in Cluster 2 (n=142. Patients in Cluster 1 also reported significantly greater mood impairment, pain anxiety sensitivity, and pain catastrophizing (all p<0.001. Clusters did not differ on quality of life or disability. Conclusions. The present study identifies a subgroup of rheumatoid arthritis patients who score significantly higher on dispositional affect and report increased mood impairment, pain anxiety sensitivity, and pain catastrophizing. Considering dispositional affect within subgroups of patients with RA may help health professionals tailor interventions for the specific stressors that these patients experience.

  7. Associations Between Patient Characteristics and the Amount of Arthritis Medication Information Patients Receive.

    Science.gov (United States)

    Geryk, Lorie Love; Blalock, Susan; DeVellis, Robert F; Morella, Kristen; Carpenter, Delesha Miller

    2016-10-01

    Little is known about factors associated with the receipt of medication information among arthritis patients. This study explores information source receipt and associations between demographic and clinical/patient characteristics and the amount of arthritis medication information patients receive. Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA; n = 328) completed an online cross-sectional survey. Patients reported demographic and clinical/patient characteristics and the amount of arthritis medication information received from 15 information sources. Bivariate and multivariate linear regression analyses were used to investigate whether those characteristics were associated with the amount of medication information patients received. Arthritis patients received the most information from health professionals, followed by printed materials, media sources, and interpersonal sources. Greater receipt of information was associated with greater medication adherence, taking more medications, greater medication-taking concerns, more satisfaction with doctor medication-related support, and Black compared to White race. RA patients reported receiving more information compared to OA patients, and differences were found between RA patients and OA patients in characteristics associated with more information receipt. In conclusion, arthritis patients received the most medication information from professional sources, and both positive (e.g., greater satisfaction with doctor support) and negative (e.g., more medication-taking concerns) characteristics were associated with receiving more medication information.

  8. [Four corner fusion in patients with wrist arthritis].

    Science.gov (United States)

    Vázquez-Alonso, María Francisca; Viñas-Silva, Alberto

    2016-01-01

    Scapholunate advance collapse (SLAC) and Scaphoid nonunion advance collapse (SNAC), are the two most common patterns of postraumatic wrist arthritis. SLAC wrist develops after attenuation, either traumatically or atraumatically, of the scapholunate ligament. Atraumatic causes of SLAC wrist include calcium pyrophosphate dehydrate deposition disease, reumathoid arthritis, neuropathic diseases, and b2-microglobulin asociated amyloid deposition diseases. On the other hand, SNAC wrist develops following a scahpoid fracture that has progressed to a nonunion. Both of these processes lead to abnormal joint kinematics, since the lunate is unrestrained by the distal scaphoid and, therefore, assumes an extended posture. Over time, this may result in Dorsal intercalated segment instability (DISI) deformity, which invariably progresses to degenerative arthritis of the radioescaphoid articulation, followed by carpal collapse and midcarpal arthritis. The purpose of this retrospective study is to evaluate the functional outcome and pain relief in SLAC/SNAC wrist, after four corner fusion. This study was made in 52 patients of the Hospital de Traumatología y Ortopedia Lomas Verdes, these patients undergone four corner fusion surgery, in a period january 2007 to december 2014. We used Quick Dash Questionary to evaluate functional outcome and pain relief in these patients.

  9. Treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis

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    Marina Amaral de Ávila Machado

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To evaluate treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis who started therapies with disease-modifying antirheumatic drugs (DMARD and tumor necrosis factor blockers (anti-TNF drugs. METHODS This retrospective cohort study from July 2008 to September 2013 evaluated therapy persistence, which is defined as the period between the start of treatment until it is discontinued, allowing for an interval of up to 30 days between the prescription end and the start of the next prescription. Odds ratio (OR with 95% confidence intervals (95%CI were calculated by logistic regression models to estimate the patients’ chances of persisting in their therapies after the first and after the two first years of follow-up. RESULTS The study included 11,642 patients with rheumatoid arthritis – 2,241 of these started on anti-TNF drugs (+/-DMARD and 9,401 patients started on DMARD – and 1,251 patients with ankylosing spondylitis – 976 of them were started on anti-TNF drugs (+/-DMARD and 275 were started on DMARD. In the first year of follow-up, 63.5% of the patients persisted in their therapies with anti-TNF drugs (+/-DMARD and 54.1% remained using DMARD in the group with rheumatoid arthritis. In regards to ankylosing spondylitis, 79.0% of the subjects in anti-TNF (+/-DMARD group and 41.1% of the subjects in the DMARD group persisted with their treatments. The OR (95%CI for therapy persistence was 1.50 (1.34-1.67 for the anti-TNF (+/-DMARD group as compared with the DMARD group in the first year for the patients with rheumatoid arthritis, and 2.33 (1.74-3.11 for the patients with ankylosing spondylitis. A similar trend was observed at the end of the second year. CONCLUSIONS A general trend of higher rates of therapy persistence with anti-TNF drugs (+/-DMARD was observed as compared to DMARD in the study period. We observed higher persistence rates for anti-TNF drugs (+/-DMARD in patients with ankylosing

  10. Depression in patients with rheumatoid arthritis: description, causes and mechanisms

    OpenAIRE

    MARGARETTEN, MARY; JULIAN, LAURA; KATZ, PATRICIA; Yelin, Edward

    2011-01-01

    Two sets of contributory factors to depression among patients with rheumatoid arthritis (RA) are generally examined – the social context of the individual and the biologic disease state of that person’s RA. This article will review the evidence for both. RA affects patients both physically and psychologically. Comorbid depression is common with RA and leads to worse health outcomes. Low socioeconomic status, gender, age, race/ethnicity, functional limitation, pain and poor clinical status hav...

  11. Periarticular and generalised bone loss in patients with early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Jensen, T W; Hansen, M S; Hørslev-Petersen, Kim;

    2014-01-01

    )). 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......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...

  12. PSORIASIS AND PSORIATIC ARTHRITIS: CHARACTERISTICS AND RISK FACTORS AMONG ADULT PATIENTS IN EGYPT

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    Essam A. El-Moselhy, Ibrahim Saad Nada, Hamed O. Khalifa,

    2012-04-01

    Full Text Available Background: Psoriasis and psoriatic arthritis are common, chronic, immune mediated disease of the skin and joints. Interaction between genes and environment are important in disease causation. Objectives: The aim of the present study was to determine the socioemographic and clinical characters of adult patients with psoriasis and those with psoriatic arthritis, to define psoriasis and psoriatic arthritis etiological risk factors, and to define the relationship between psoriasis severity and these items. Subjects and methods: This study was conducted at Dermatology Clinic, Al-Hussein University Hospital. A case-control study design was chosen to perform this research. The study was conducted on 100 adult patients with psoriasis and an equal number of free adults as controls. Criteria for diagnosis of psoriasis and psoriatic arthritis were used. A comprehensive questionnaire was used to survey the studied groups. Body surface area of the affected patients was used as a marker of disease severity.Results: The study showed that 44.0% of the cases had psoriasis age of onset; 22-45 years. Stress was the most common etiological risk factor, 67.0%. While, the most important risk factors were family history of psoriasis, recurrent pharyngitis, smoking ≥20 cigarettes/ day and higher level of education, odds ratio (OR=7.58, 5.94, 2.78 and 2.69, respectively. Also, 32.0% of the patients had psoriatic arthritis. Psoriatic arthritis comes after psoriasis and had mild severity in 65.6% and 68.7% of the cases, respectively. The most important etiological risk factors were severe psoriasis, smoking ≥20 cigarettes/day and early onset of psoriasis, OR=9.64, 3.06 and 2.72, respectively.Conclusions and recommendations: The epidemiology of psoriasis is not well defined in Egypt. The heredity and environmental factors are the most important risk factors. Also, psoriatic arthritis is an important associated disease. The fact that it has no cure has important

  13. No impact of concomitant methotrexate use on serious adverse event and serious infection risk in patients with rheumatoid arthritis treated with bDMARDs: a systematic literature review and meta-analysis

    Science.gov (United States)

    Baradat, Claire; Degboé, Yannick; Constantin, Arnaud; Cantagrel, Alain; Ruyssen-Witrand, Adeline

    2017-01-01

    Objectives To compare the risk of serious adverse events, serious infections and death caused by methotrexate and biological disease-modifying antirheumatic drug (bDMARD) combination therapy versus a bDMARD prescribed as monotherapy in rheumatoid arthritis (RA). Methods A systematic literature review was conducted until February 2016 in PubMed, Embase and Cochrane Library databases by selecting randomised controlled trials comparing methotrexate and bDMARD combination therapy to bDMARD monotherapy in RA. The meta-analysis compared the occurrence of (1) serious adverse events, (2) serious infections and (3) death among these groups by the Mantel-Haenszel method. Results The literature review selected 16 controlled trials comparing methotrexate and bDMARD combination therapy to bDMARD monotherapy. After meta-analysis comparing patients under monotherapy to those under combination therapy: (1) the risk of occurrence of serious adverse events was comparable in 12 trials: RR (95% CI) 0.92 (0.78 to 1.08). (2) No significant difference was observed in the risk of occurrence of serious infections in 13 trials: RR (95% CI) 1.15 (0.84 to 1.58). We noted a trend, although insignificant, towards a high risk of the occurrence of tuberculosis in 10 studies: RR (95% CI) 1.78 (0.63 to 4.99). (3) The risk of death was comparable in 12 trials: RR (95% CI) 0.73 (0.40 to 1.35). Conclusions The results showed no significant difference between the two groups, confirming that the use of methotrexate and bDMARD combination therapy in RA does not cause an increased risk of serious adverse events or serious infections or death compared with bDMARD monotherapy. PMID:28270933

  14. Medical ozone increases methotrexate clinical response and improves cellular redox balance in patients with rheumatoid arthritis.

    Science.gov (United States)

    León Fernández, Olga Sonia; Viebahn-Haensler, Renate; Cabreja, Gilberto López; Espinosa, Irainis Serrano; Matos, Yanet Hernández; Roche, Liván Delgado; Santos, Beatriz Tamargo; Oru, Gabriel Takon; Polo Vega, Juan Carlos

    2016-10-15

    Medical ozone reduced inflammation, IL-1β, TNF-α mRNA levels and oxidative stress in PG/PS-induced arthritis in rats. The aim of this study was to investigate the medical ozone effects in patients with rheumatoid arthritis treated with methotrexate and methotrexate+ozone, and to compare between them. A randomized clinical study with 60 patients was performed, who were divided into two groups: one (n=30) treated with methotrexate (MTX), folic acid and Ibuprophen (MTX group) and the second group (n=30) received the same as the MTX group+medical ozone by rectal insufflation of the gas (MTX+ozone group). The clinical response of the patients was evaluated by comparing Disease Activity Score 28 (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), Anti-Cyclic Citrullinated (Anti-CCP) levels, reactants of acute phase and biochemical markers of oxidative stress before and after 20 days of treatment. MTX+ozone reduced the activity of the disease while MTX merely showed a tendency to decrease the variables. Reactants of acute phase displayed a similar picture. MTX+ozone reduced Anti-CCP levels as well as increased antioxidant system, and decreased oxidative damage whereas MTX did not change. Glutathione correlated with all clinical variables just after MTX+ozone. MTX+ozone increased the MTX clinical response in patients with rheumatoid arthritis. No side effects were observed. These results suggest that ozone can increase the efficacy of MTX probably because both share common therapeutic targets. Medical ozone treatment is capable of being a complementary therapy in the treatment of rheumatoid arthritis.

  15. Comparison of packages for suppositories by patients with rheumatoid arthritis.

    Science.gov (United States)

    Verheggen-Laming, B N; Phiferons, H; Mulder, E F; van der Meij, N T; van Harten, R P; Dijkmans, B A

    1988-01-01

    Ninety-four patients with rheumatoid arthritis were asked via a questionnaire about the convenience of packages containing tablets, capsules, or suppositories for home use. Almost half of the patients stated that they had difficulty in opening packages containing capsules or tablets, and two-thirds had difficulty with the packages used for suppositories. The characteristics of six packages used for suppositories were also compared. Patients were given the packages in random order and were asked to open them and remove a suppository. Many of them were unable to open three of the packages with their hands. The evaluation of the six packages by the patients differed widely.

  16. Functional state of knee arthritis patients and related factors

    Science.gov (United States)

    Lee, Jiyeon; Kim, Jung-Hee; Chung, EunJung; Lee, Byoung-Hee

    2017-01-01

    [Purpose] The objective of this study is to provide a direction for efficient management of arthritis through the analysis of multiple factors related to the functional state of patients. [Subjects and Methods] The Visual Analog Scale, Knee Society Knee Score & Function Score, Hospital for Special Surgery, Short Form-36 Health Survey and Western Ontario McMaster Universities Osteoarthritis Index for a total of 135 patients with knee arthritis were determined with a survey. [Results] There is a significant correlation between age, pain, Knee Society Knee Score, Hospital for Special Surgery, Knee Society Function Score, and Western Ontario McMaster Universities Osteoarthritis Index score. [Conclusion] It is necessary to improve the factors that affect knee function and quality of life, and a study on knee joint muscle strength is suggested as a follow-up study. PMID:28265166

  17. Morganella morganii-associated arthritis in a diabetic patient.

    Science.gov (United States)

    Cetin, Meryem; Ocak, Sabahattin; Kuvandik, Guven; Aslan, Bahadir; Temiz, Muhyittin; Aslan, Ahmet

    2008-03-01

    This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

  18. A commentary on TREAT: The trial of early aggressive drug therapy in juvenile idiopathic arthritis

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    Baildam Eileen

    2012-06-01

    Full Text Available Abstract Polyarticular juvenile idiopathic arthritis (JIA is a category of JIA where multiple joints are affected by chronic inflammation, and where serious and lasting damage to joints is the expected natural history in untreated disease. There is evidence of response to disease-modifying antirheumatic and biologic drugs, but little evidence of permanent remission from any of the existing therapeutic trials. The TREAT trial by Wallace et al., recently published in Arthritis and Rheumatism, used a collaborative multicenter approach to studying early aggressive treatment of polyarticular JIA in an attempt to achieve full clinical inactive disease after 6 months of treatment. The study's main finding that the earlier in the disease course that treatment is started, the better the chance of disease control, has provided evidence that there is a 'window of opportunity' for treating JIA as there is in adult rheumatoid arthritis (RA. The study provides both a platform and an impetus for concentrating future treatment trials on early rather than established disease and investigating a standard of starting treatment within 10 to 12 weeks.

  19. Data Of Daily Blood Pressure Monitoring In Patients With Rheumatoid Arthritis

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    A.P. Rebrov

    2009-06-01

    Full Text Available The aim of present work is to study the frequency of hypertension and the peculiarity of 24-hour blood pressure monitoring in patients with rheumatoid arthritis. We studied 584 patients with rheumatoid arthritis. Daily blood pressure monitoring was carried out in 46 patients with arthritis and 18 patients with essential hypertension. Frequency of hypertension was higher in patients with arthritis then in general population. Elevation of systolic blood pressure, heart rate and arterial blood pressure adequate decrease at night were developed to associate with advance of the disease.

  20. The beneficial effects of rehabilitation on hand function in patients with rheumatoid arthritis

    Science.gov (United States)

    Księżopolska-Orłowska, Krystyna; Kasprzak, Katarzyna; Gaszewska, Ewa; Rodkiewicz-Bogusławska, Agnieszka; Sokołowska, Beata

    2016-01-01

    Objectives The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA) due to deformities, which occur in approximately 90% of patients. It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb. The study aimed to assess the effect of rehabilitation on the function of the hand in rheumatoid arthritis. Material and methods The study group consisted of 40 women with RA. The patients had been previously treated at the Rehabilitation Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The study group underwent 3 weeks of rehabilitation involving individual therapy, exercises with equipment, patient education and physical therapy. The control group included women without a diagnosis of RA, hands pain-free and fully mobile. In both groups the hand was assessed for grip value, grip quality and manipulative ability. In the study group the basis of pain intensity was noted. The measurements were performed twice – prior to the rehabilitation and after 3 weeks of rehabilitation in women with RA and once in women without hand problems. Results The results obtained revealed marked limitation of hand function in patients with rheumatoid arthritis. The treatment resulted in an improvement of all assessed parameters except cylindrical grip, in which only a part of the findings was statistically significant. Conclusions The analysis of the study material showed that appropriately adjusted and conducted hand physiotherapy in women with rheumatoid arthritis contributed to the improvement of its function by pain reduction, improved value and quality of grip, and also increased manipulative ability. PMID:28115778

  1. Modified-release prednisone: in patients with rheumatoid arthritis.

    Science.gov (United States)

    Henness, Sheridan; Yang, Lily P H

    2013-12-01

    Prednisone is a well-established treatment option in rheumatoid arthritis. Low-dose glucocorticoid therapy alleviates disease signs and symptoms, is better tolerated than high-dose therapy, and its addition to disease-modifying anti-rheumatic drugs (DMARDs) inhibits radiographic disease progression. A low-dose, modified-release (MR) formulation of prednisone, administered in the evening, was developed to counter the circadian rise in pro-inflammatory cytokine levels that contributes to disease activity. In a 12-week, randomized trial (CAPRA-2) in adult patients with rheumatoid arthritis who were receiving stable DMARD therapy, the addition of MR prednisone reduced disease signs and symptoms by ≥20 % according to the American College of Rheumatology criteria (in 48 % of patients vs. 29 % with placebo; p prednisone to stable DMARD therapy reduced the mean duration of morning stiffness to a greater extent than addition of morning immediate-release (IR) prednisone (22.7 vs. 0.4 %; p = 0.045 [primary endpoint]). The improvement in morning stiffness with MR prednisone was maintained for 9-12 months during the open-label extension of CAPRA-1. These findings were supported by data from observational studies in various adult populations with rheumatoid arthritis. Treatment with evening MR prednisone for up to 12 months was generally well tolerated, with an overall similar tolerability profile compared with evening placebo or morning IR prednisone, and no new safety concerns. MR prednisone was estimated to be cost effective relative to IR prednisone in patients with rheumatoid arthritis in a UK pharmacoeconomic model.

  2. Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis and bronchial asthma: a case report

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    Yildiz Levent

    2010-09-01

    Full Text Available Abstract Objective Strongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions. Strongyloides infection has been described in immunosupressed patients with lymphoma, rheumatoid arthritis, diabetes mellitus etc. Our case who has rheumatoid arthritis (RA and bronchial asthma was treated with low dose steroids and methotrexate. Methods A 68 year old woman has bronchial asthma for 55 years and also diagnosed RA 7 years ago. She received immunusupressive agents including methotrexate and steroids. On admission at hospital, she was on deflazacort 5 mg/day and methotrexate 15 mg/week. On her physical examination, she was afebrile, had rhonchi and mild epigastric tenderness. She had joint deformities at metacarpophalengeal joints and phalanges but no active arthritis finding. Results Oesophagogastroduodenoscopy was performed and it showed hemorrhagic focus at bulbus. Gastric biopsy obtained and showed evidence of S.Stercoralis infection. Stool and sputum parasitological examinations were also all positive for S.stercoralis larvae. Chest radiography result had no pathologic finding. Albendazole 400 mg/day was started for 23 days. After the ivermectin was retrieved, patient was treated with oral ivermectin 200 μg once a day for 3 days. On her outpatient control at 15th day, stool and sputum samples were all negative for parasites. Conclusion S.stercoralis may cause mortal diseases in patients. Immunosupression frequently causes disseminated infections. Many infected patients are completely asymptomatic. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. In immunosupressed patients, to detect S.stercoralis might help to have the patient survived and constitute the exact therapy.

  3. Blood antioxidant enzyme levels in patients with Rheumatoid Arthritis

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    M. Jalali

    2006-08-01

    Full Text Available Background: Rheumatoid arthritis (RA is an autoimmune disorder with unknown etiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis. The aim of this study was to analyze the level of activities of catalase, glutathione peroxidas (GSH-Px, Super oxide dismotase (SOD in patients with RA compared with the healthy subjects. Methods: In a case-control study sixty rheumatoid arthritis patients 18-75 years old and 60 healthy sex and age-matched controls were selected, Catalase activity was measured by determining the constant rate (k of hydrogen peroxide decomposition. GSH-Px activity of plasma was measured with spectrophotometer by Glutathione oxide generation due to GSH-Px. SOD activity is measured by degree of inhibition effect of SOD in generating super oxide radicals by xanthine and xanthine oxidase. C-reactive protein and rheumatoid factor values were determined by agglutination and latex tests. Results: The plasma activity of catalase (p0.05. There was a negative significant relation between C reactive protein and Rheumatoid factor values with the erythrocyte activity of catalase and GSH-Px (p<0.01. Conclusion: These results suggested that oxidative stress plays a very important role in the inflammation and pathogenesis of RA.

  4. Experience with conservative rehabilitation in patients with juvenile chronic arthritis

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    T. A. Shelepina

    2016-01-01

    Full Text Available Objective: to estimate a need for conservative rehabilitation treatment in patients with juvenile chronic arthritis (JCA.Material and methods. Data on the principles and procedures of rehabilitation treatment were analyzed in patients with JCA on the basis of 25- year experience. The need for these packages of measures in 1999, 2008, and 2014 was compared. Standard procedures for joints at different sites were described. According to the degree of joint functions, there were rehabilitation treatment packages: corrective, mobilization, and general health-improving.Results and discussion. All patients with juvenile arthritis need rehabilitation (physical, psychological, and social. Comparison of the total number of patients who had received rehabilitation treatment in 1999, 2008, and 2014 showed a small trend towards its reduction. This is due to the smaller number of patients with dysfunctions and to the larger number of those without movement disorders who had received adequate treatment in early periods of the disease. The high percentage of patients having limited joint functions needs a mobilization package. Analysis of the data available in the literature and the authors' experience may lead to the conclusion that all patients with JCA need exercise therapy. The latter is a major procedure for physical rehabilitation and should be included in the standards for adjuvant treatment during basic medical therapy. Emphasis is laid on the importance of the early initiation of treatment to prevent incapacitating deformity at early stages of the disease.

  5. Use of Complementary Therapies Among Primary Care Clinic Patients With Arthritis

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    Carla J. Herman

    2004-10-01

    Full Text Available Introduction Use of complementary and alternative medicine (CAM for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. Methods To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18–84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. Results Nearly half (44.6% of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than $25,000. Most (90.2% had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin (34.1%, mind-body therapies (29.0%, and herbal topical ointments (25.1%. Fewer participants made current use of vitamins and minerals (16.6%, herbs taken orally (13.6%, a CAM therapist (12.7%, CAM movement therapies (10.6%, special diets (10.1%, or copper jewelry or magnets (9.2%. Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. Conclusion Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning.

  6. Sedentary behaviour in patients with rheumatoid arthritis: A qualitative study

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    Tanja Thomsen

    2015-10-01

    Full Text Available Background: Despite increasing interest in investigating sedentary behaviour (SB in the general population and in patients with rheumatoid arthritis (RA, there is little documentation of the subjective experiences of SB in patients with RA. This study aimed to examine how patients with RA describe their daily SB. Methods: Fifteen patients with RA (10 women and 5 men from 23 to 73 years of age and with a disease duration ranging from 4 to 27 years were interviewed following a semi-structured interview guide. Data were analysed using the content analysis method described by Graneheim. Results: SB appeared in three categories covering: 1 A constant battle between good and bad days; SB could be a consequence of RA in terms of days with pronounced pain and fatigue resulting in many hours of SB. 2 Adaptation to everyday life; living with the unpredictability of RA included constant modification of physical activity level causing increase in SB, especially during periods of disease flare. Prioritizing and planning of SB also functioned as part of self-management strategies. 3 It has nothing to do with my arthritis; for some patients, SB was not related to RA, but simply reflected a way of living independent of the disease. Conclusions: SB is perceived, motivated, and performed differently in patients with RA. An individually tailored approach may be essential in understanding and encouraging patients’ motivation towards sustainable change in SB and activity patterns.

  7. Staphylococcal Superantigens in Synovial Fluid of 62 Patients With Arthritis

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    A Tabatabaei

    2012-04-01

    Full Text Available Background: Determining the etiologic causes of septic arthritis is of the most importance. Goal of this study was to investigate presence of staphylococcal enterotoxins A, B, C and Toxic Shock Staphylococcal toxin-1 in the synovial fluid of patients with arthritis. Methods: This cross-sectional study was performed in the Pediatric and Orthopedic Wards of Hazrat Rasoul Hospital in Tehran, Iran during 2008- 2010. Gram stains, conventional cultures, direct detection of soluble bacterial antigens were used to detect H. influenza, S. pneumonia, group B streptococci, and N. meningitidis while Latex particle agglutination test was used for staphylococcal supper antigens (by enzyme immunoassays upon synovial fluid tapping of 62 individuals (5 mo to 16 yrs, mean=113.8 yrs. P<0.05 was considered statistically significant. Results: Positive SF cultures (n=11: 5 positive cases of S. aureus; 5 S. pneumonia; 1 H. influenza, and 1 Klebsiella. Positive gram stains: 10%; and positive LPA: 4%. Staphylococcal arthritis was diagnosed in 7 (39% cases upon positive culture or positive gram stain. The most common type was TSST-1 (47% and the least common was enterotoxin B (18%. Isolation of S. aureus (positive culture was correlated to presence of enterotoxin A in synovial fluid but not to enterotoxins B, C or TSST-1. Conclusion: Staph. aureus had a prominent role in arthritis. 47% of cases with negative culture for S. aureus had at least one type of staphylococcal super antigens in the synovial fluid. Searching for antigens of usual organisms or staphylococcal supper antigens could be helpful for diagnosis and subsequent treatment.

  8. Cytomegalovirus ileocolitis in a rheumatoid arthritis patient: case report and literature review

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    M. S. Dag

    2015-06-01

    Full Text Available Rheumatoid arthritis (RA is an autoimmune, systemic, chronic, inflammatory disease generally treated with various immunosuppressive drugs. Cytomegalovirus (CMV is an opportunistic, viral infection that is commonly seen in immunosuppressed patients. A sixty-four-year old female diagnosed with RA and treated with immunosuppressive agents was admitted to our rheumatology outpatient service with complaints of diarrhea and abdominal pain, which had lasted longer than four weeks. The patient’s colonoscopy revealed inflamed and ulcerated areas in the colon and in the terminal ileum. A biopsy showed intra-nuclear inclusion particles consistent with CMV. We started an oral valganciclovir therapy in this serum-CMV-polymerase chain reactionpositive patient. The concomitant use of immunosuppressive agents and anti-viral drugs eased the patient’s complaints, and the endoscopic picture improved. Consequently, cytomegalovirus ileocolitis in immunosuppressed patients admitted with severe diarrhea must be considered in the differential diagnosis.

  9. Adverse drug reactions associated with the use of disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis.

    Science.gov (United States)

    Machado-Alba, Jorge Enrique; Ruiz, Andrés Felipe; Machado-Duque, Manuel Enrique

    2014-12-01

    This study describes the adverse drug reactions (ADRs) and their incidence in patients with rheumatoid arthritis who were treated in the Colombian health system. A retrospective cohort study was conducted using information from all patients who were diagnosed with rheumatoid arthritis and attended specialized health care centers in the cities of Bogotá, Cali, Manizales, Medellin, and Pereira between 1 December 2009 and 30 August 2013. The ADRs were obtained from medical records and the pharmacovigilance system registry and sorted by frequency and affected tissue according to World Health Organization Adverse Reaction Terminology (WHO-ART). A total of 949 reports of ADRs were obtained from 419 patients (32.8 ADRs per 100 patient-years); these patients were from a cohort of 1,364 patients being treated for rheumatoid arthritis and followed up for an average of 23.8 months (± 12.9). The cohort was mostly female (366, 87.4%) and had a mean age of 52.7 years (± 13.1). The highest numbers of ADRs were reported following the use of tocilizumab, rituximab, and infliximab (28.8, 23.1, and 13.3 reports per 100 patient-years respectively). The most frequently reported ADRs were elevated transaminase levels and dyspepsia. Overall, 87.7% of ADRs were classified as type A, 36.6% as mild, 40.7% as moderate, and 22.7% as severe. As a result, 73.2% of patients who experienced an ADR stopped taking their drugs. The occurrence of ADRs in patients treated for rheumatoid arthritis is common, especially in those associated with the use of biotechnologically produced anti-rheumatic drugs. This outcome should be studied in future research and monitoring is needed to reduce the risks in these patients.

  10. Treating statin-intolerant patients

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    Pigna G

    2011-04-01

    Full Text Available Marcello Arca, Giovanni PignaAtherosclerosis Unit, Department of Internal Medicine and Allied Medical Specialities, Sapienza University of Rome, Rome, ItalyAbstract: Statins are effective in reducing cardiovascular events and are safe for almost all patients. Nevertheless, intolerance to statins is frequently faced in clinical practice. This is mostly due to muscular symptoms (myalgia with or without increase of plasma creatinine kinase and/or elevation of hepatic aminotransferases, which overall constitutes approximately two-thirds of reported adverse events during statin therapy. These side effects raise concerns in patients as well as in doctors and are likely to reduce patients' adherence and, as a consequence, the cardiovascular benefit. Therefore, it is mandatory that clinicians improve their knowledge on the clinical aspects of muscular and hepatic side effects of statin therapy as well as their ability to manage patients with statin intolerance. Besides briefly examining the clinical aspects and the mechanisms that are proposed to be responsible for the most common statin-associated side effects, the main purpose of this article is to review the available approaches to manage statin-intolerant patients. The first step is to determine whether the adverse events are indeed related to statin therapy. If so, lowering the dosage or changing statin, alternate dosing options, or the use of nonstatin compounds may be practical strategies. The cholesterol-lowering potency as well as the usefulness of these different approaches in treating statin-intolerant patients will be examined based on currently available data. However, the cardiovascular benefit of these strategies has not been well established, so their use has to be guided by a careful clinical assessment of each patient.Keywords: statin therapy, atorvastatin, rosuvastatin, aminotransferase levels, myopathy

  11. Raman spectroscopy detects deterioration in biomechanical properties of bone in a glucocorticoid-treated mouse model of rheumatoid arthritis

    Science.gov (United States)

    Maher, Jason R.; Takahata, Masahiko; Awad, Hani A.; Berger, Andrew J.

    2011-08-01

    Although glucocorticoids are frequently prescribed for the symptomatic management of inflammatory disorders such as rheumatoid arthritis, extended glucocorticoid exposure is the leading cause of physician-induced osteoporosis and leaves patients at a high risk of fracture. To study the biochemical effects of glucocorticoid exposure and how they might affect biomechanical properties of the bone, Raman spectra were acquired from ex vivo tibiae of glucocorticoid- and placebo-treated wild-type mice and a transgenic mouse model of rheumatoid arthritis. Statistically significant spectral differences were observed due to both treatment regimen and mouse genotype. These differences are attributed to changes in the overall bone mineral composition, as well as the degree of phosphate mineralization in tibial cortical bone. In addition, partial least squares regression was used to generate a Raman-based prediction of each tibia's biomechanical strength as quantified by a torsion test. The Raman-based predictions were as accurate as those produced by microcomputed tomography derived parameters, and more accurate than the clinically-used parameter of bone mineral density. These results suggest that Raman spectroscopy could be a valuable tool for monitoring bone biochemistry in studies of bone diseases such as osteoporosis, including tests of drugs being developed to combat these diseases.

  12. Clinical features of psoriatic arthritis in Korean patients with psoriasis: a cross-sectional observational study of 196 patients with psoriasis using psoriatic arthritis screening questionnaires.

    Science.gov (United States)

    Shin, Dongyun; Kim, Hee Joo; Kim, Dae Suk; Kim, Soo Min; Park, Jin Su; Park, Yong-Beom; Lee, Min-Geol

    2016-02-01

    The prevalence and clinical features of psoriatic arthritis (PsA) in psoriasis patients vary widely in different countries, and studies on Korean population are rarely reported. The aim of this study was to investigate the clinical features of PsA in a Korean population of patients with psoriasis by using psoriatic arthritis screening questionnaires. A cross-sectional observational study was conducted, and consecutive psoriatic patients were evaluated for PsA by using two kinds of psoriatic arthritis screening questionnaires: Psoriatic Arthritis Screening and Evaluation tool (PASE) and Psoriasis Epidemiology Screening Tool (PEST). Psoriatic patients with higher score in screening questionnaires were referred to rheumatologist for confirmative diagnosis of PsA. Among 196 psoriasis patients screened by PASE and PEST, total prevalence of PsA was 11.2 % (n = 22/196) with 59.1 % of the cases being newly diagnosed. Compared with patients without PsA, patients with PsA had more extensive psoriasis, higher frequency of pustular and inverse type of psoriasis, and lower frequency of plaque type of psoriasis. Spondylitis was the most common manifestation pattern, followed by polyarthritis, oligoarthritis, predominant distal interphalangeal arthritis, and arthritis mutilans. Our findings are consistent with a low prevalence of PsA among patients with psoriasis in Asia. We also confirm a spondylitis as the most common pattern of PsA in Korea. PsA screening questionnaires can be a simple and useful tool to screen PsA in patients with psoriasis.

  13. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach

    DEFF Research Database (Denmark)

    Rezaei, Hamed; Torp-Pedersen, Søren; af Klint, Erik;

    2014-01-01

    INTRODUCTION: This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. METHODS: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis...... by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints...... for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P

  14. Two-dimensional electrophoretic analysis of human leukocyte proteins from patients with rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Willard, K.E. (Argonne National Lab., IL); Thorsrud, A.K.; Munthe, E.; Jellum, E.

    1982-04-01

    Human leukocyte proteins from more than 150 patients with rheumatoid arthritis, together with age- and sex-matched controls, were analyzed by use of the ISO-DALT technique of two-dimensional polyacrylamide gel electrophoresis. Patients with ankylosing spondylitis, polymyalgia rheumatica, psoriatic arthritis, calcium tendinitis, post-infectious arthritis, and asymmetrical seronegative arthritis were also included as positive controls. Synthesis of several proteins, referred to by number as members of the Rheuma set, is shown to increase in the leukocyte preparations from patients with classical rheumatoid arthritis. Several of these proteins are specific to monocytes or granulocytes; others are of unknown cellular origin, but appear to be unique to rheumatoid arthritis. The Rheuma proteins appear to be indicators of disease activity, because their increased synthesis can be correlated with sedimentation rate and other clinical indices of rheumatoid disease activity.

  15. Expression of public idiotypes in patients with Lyme arthritis.

    Science.gov (United States)

    Axford, J S; Watts, R A; Long, A A; Isenberg, D A; Steere, A C

    1993-01-01

    OBJECTIVE: Joints are often affected in Lyme disease and in some instances this may be due to immune autoreactivity. To characterise further the immune response in this disease investigations were carried out to determine the expression of three public idiotypes on serum immunoglobulins in patients with Lyme disease during the development of varying degrees of arthritis. METHODS: The expression of idiotypes (Ids) 16/6, BEG2, and PR4, first identified on monoclonal antibodies to DNA, was determined by an enzyme linked immunosorbent assay (ELISA) in serial blood samples from 12 patients with Lyme disease over a mean period of six years during the development of a variety of arthritic symptoms, and in serum samples from healthy control subjects and control subjects with systemic lupus erythematosus. RESULTS: Expression of serum IgM or IgG public Ids 16/6 and BEG2 was significantly increased in patients with Lyme disease. IgA Id 16/6 expression, in contrast, was significantly increased only during episodes of arthritis and was also related to its severity. IgM and IgG Id 16/6 expression was related to their respective total immunoglobulin concentration and, in the case of IgM, to the level of IgM antibodies to Borrelia burgdorferi, whereas similar findings were not apparent with IgA antibodies. This may indicate that the IgA response is related to the pathogenesis of arthritis, especially as total IgA and IgA Id 16/6 levels were found to increase over the duration of disease. Sequential analysis of antibodies also showed restriction in the expression of Id 16/6 as it was never found on all immunoglobulin isotypes at the same time, and Id PR4 was never expressed. Ids 16/6 and BEG2 expression, however, may be associated as seven patients expressed these idiotypes simultaneously. CONCLUSIONS: These data indicate the use of public idiotypes in the immune response against B burgdorferi, which may be restricted in terms of idiotype class and isotype expression, and a

  16. Psychological variables and physical exercise in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Amabile Borges Dario

    2010-09-01

    Full Text Available The purpose of this study was to provide a literature review aiming to clarify the most prevalent psychological changes present in individuals suffering from rheumatoid arthritis (RA, the impact of exercise on such changes, and the exercise protocols commonly adopted to improve these individuals' mental health. The few studies available report anxiety disorders and depression as most prevalent and physical exercise as a significant therapeutic strategy for this population. There is some evidence of the beneficial effects of exercise on those psychological variables providing RA patients with more effective treatments.

  17. Psychological variables and physical exercise in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    A.B. Dario

    2010-01-01

    Full Text Available ABSTRACTThe purpose of this study was to provide a literature review aiming to clarify the most prevalent psychological changes present in individuals suffering from rheumatoid arthritis (RA, the impact of exercise on such changes, and the exercise protocols commonly adopted to improve these individuals' mental health. The few studies available report anxiety disorders and depression as most prevalent and physical exercise as a significant therapeutic strategy for this population. There is some evidence of the beneficial effects of exercise on those psychological variables providing RA patients with more effective treatments.

  18. Leflunomide, a new disease-modifying drug for treating active rheumatoid arthritis in methotrexate-controlled phase Ⅱ clinical trial

    Institute of Scientific and Technical Information of China (English)

    鲍春德; 陈顺乐; 顾越英; 劳志英; 倪立青; 於强; 徐建华; 李向培; 刘嘉玲; 孙凌云; 何培根; 马骥良; 徐淑云; 丁长海

    2003-01-01

    Objective To evaluate the efficacy and safety of leflunomide in comparison with methotrexate (MTX) on patients with rheumatoid arthritis (RA) in China.Methods Five hundred and sixty-six patients with active rheumatoid arthritis were randomly assigned to receive leflunomide at 20 mg once daily or MTX at 15 mg once weekly in a controlled trial. Five hundred and four patients completed the 12-week treatment and some patients continued the treatment for 24 weeks.Results Both leflunomide and MTX could improve the symptoms, signs, and joint function, but there were no changes in X-ray observations of patients with rheumatoid arthritis. In the leflunomide group, the overall rates of effectiveness at 12 weeks and 24 weeks were 86.94% and 92.31% respectively; the rates of remarkable improvement were 64.95% and 79.81% respectively. In the MTX group, the overall rates of effectiveness at 12 weeks and 24 weeks were 84.04% and 83.15% respectively; the rates of remarkable improvement were 56.81% and 75.28% respectively. According to intent-to-treat analysis, the ACR 20% response rates at 12 weeks and 24 weeks in the leflunomide group were 62.54% and 67.18% respectively, compared with 60.08% and 61.32% respectively in MTX group. No statistical differences were shown in the efficacy between the two groups (P>0.05). The adverse events in the leflunomide group were gastrointestinal symptoms, skin rash, alopecia, nervous system symptoms, decreased leukocyte count, and elevation of alanine aminotransferase (ALT). Most of these side effects were mild and transient. The incidence of adverse events in the leflunomide group was 16.84%, significantly lower than that in MTX group (28.17%, P=0.002).Conclusions Leflunomide is effective in the treatment of RA with less adverse events than MTX. Its efficacy is similar to MTX, but the incidence of adverse events and the rate of withdrawal due to adverse events were lower in the leflunomide group than in MTX group.

  19. Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients

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    Mahmoud A. Alomari

    2012-01-01

    Full Text Available Objective. To examine the relationship of handgrip strength with forearm blood flow (BF and vascular resistance (VR in rheumatoid arthritis (RA patients. Methods. Forearm BF at rest (RBF and after upper arm occlusion (RHBF, and handgrip strength were examined in 78 individuals (RA=42 and controls (CT=36. Subsequently, VR at rest (RVR and after occlusion (RHVR were calculated. Results. The patients’ RBF (P=0.02 and RHBF (P=0.0001 were less, whereas RVR (P=0.002 and RHVR (P=0.0001 were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P=0.0001. Finally, handgrip strength was directly associated with RBF (r=0.43; P=0.0001, and RHBF (r=0.5; P=0.0001, and inversely related to RVR (r=-0.3; P=0.009 and RHVR (r=-0.3; P=0.007. Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.

  20. Dietary recommendations for patients with rheumatoid arthritis: a review

    Directory of Open Access Journals (Sweden)

    Vitetta L

    2012-06-01

    Full Text Available Luis Vitetta,1 Samantha Coulson,1 Janet Schloss,1 Shoshannah L Beck,1 Robert Allen,2 Avni Sali21Centre for Integrative Clinical and Molecular Medicine, The University of Queensland School of Medicine, Brisbane, 2National Institute of Integrative Medicine, Melbourne, AustraliaAbstract: Dietary interventions can assist with the management of disease symptoms that accompany rheumatoid arthritis (RA, such as pain, tender swollen joints, stiffness, and associated disability and disease progression. Dietary interventions have gained widespread appeal for both clinicians and RA patients. Interventions that promote self-help through education can have significant benefits for patients as they negotiate pain and musculoskeletal disability. There is substantial scientific evidence that demonstrates patients diagnosed with RA may benefit from dietary interventions; however, recent systematic reviews remain uncertain about the therapeutic efficacy of dietary manipulation for RA due to clinical trials with a high risk of bias. However, dietary interventions with plausible therapeutic activity may be indicated for reducing RA-associated symptoms, including elimination of foods that may trigger an allergic or intolerant response, introduction of known anti-inflammatory dietary compounds and correction of food, or drug-induced gastrointestinal tract microbiota abnormalities and permeability.Keywords: diet, rheumatoid arthritis, vegetarian, vegan, Mediterranean, fish oils, probiotics

  1. Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    D'Agostino, Maria Antonietta; Terslev, Lene; Wakefield, Richard

    2016-01-01

    The absence of specific guidance on how to use ultrasound (US) to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of US in clinical practice, potentially limiting its benefits for patient outcomes. In view of...

  2. Heart failure in patients treated with bisphosphonates

    DEFF Research Database (Denmark)

    Grove, Erik; Abrahamsen, B; Vestergaard, P

    2013-01-01

    The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates.......The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates....

  3. AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2014-07-01

    Full Text Available Aim – to identify disorders of autonomic regulation of cardiac activity in patients with psoriatic arthritis (PsA by determining the heart rate variability (HRV, and also establish the relationship of HRV with systemic inflammation and traditional cardiovascular risk factors.Materials and methods. The study included 53 patients with PsA (mean age 43.64 ± 12.1 years, including 48.2 % men, mean disease durationwas 10.32 ± 10.2 years. The control group included 25 healthy volunteers (average age 46.7 ± 12.45 years, 49.1 % – men. Time andfrequency measures of HRV were analyzed. Active PsA was determined by an index DAS4, rate erythrocyte sedimentation rate (ESR, levels of C-reactive protein (CRP and fibrinogen. Patients with clinical manifestations of cardiovascular disease, and patients with symptomsof carotid atherosclerosis, detected by duplex study were excluded.Results. Deterioration of HRV in patients with PsA compared with those in patients of the control group, the availability of statistically significant reverse relationship of temporal and spectral parameters of HRV with PsA activity (ESR, CRP, entezit score, DAS4, duration of arthritis, the classical factors of cardiovascular risk were established.Conclusion. Patients with PsA had noted a violation of autonomic regulation of cardiac activity in the form of reduced HRV and activation of the sympathetic part of it. Identified changes were associated with activity of systemic inflammation and classical factors of cardiovascular risk.

  4. Influence of patient personality in the treatment of rheumatoid arthritis.

    Science.gov (United States)

    Leon, Leticia; Redondo, Marta; Garcia-Vadillo, Alberto; Perez-Nieto, Miguel A; Rodriguez-Rodriguez, Luis; Jover, Juan A; Gonzalez-Alvaro, Isidoro; Abasolo, Lydia

    2016-11-01

    Individualized treatment of rheumatoid arthritis (RA) based on genetic/serologic factors is increasingly accepted. Moreover, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Our objective was to evaluate whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. One hundred seventy-six RA patients were included (80 % women, disease begin median age 55 years). Treatment was considered aggressive in 57.9 % of the sample. Scores were high in extraversion in 50.8 % of patients, neuroticism in 29.5 % and psychoticism in 14.7 %. Neuroticism was the only factor associated with aggressive treatment, which was less probable (p = 0.04, OR = 0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p = 0.04, OR = 0.28). Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important to educate about their disease so that they will accept more aggressive approaches in clear cases of poor outcome.

  5. AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2011-01-01

    Full Text Available Aim – to identify disorders of autonomic regulation of cardiac activity in patients with psoriatic arthritis (PsA by determining the heart rate variability (HRV, and also establish the relationship of HRV with systemic inflammation and traditional cardiovascular risk factors.Materials and methods. The study included 53 patients with PsA (mean age 43.64 ± 12.1 years, including 48.2 % men, mean disease durationwas 10.32 ± 10.2 years. The control group included 25 healthy volunteers (average age 46.7 ± 12.45 years, 49.1 % – men. Time andfrequency measures of HRV were analyzed. Active PsA was determined by an index DAS4, rate erythrocyte sedimentation rate (ESR, levels of C-reactive protein (CRP and fibrinogen. Patients with clinical manifestations of cardiovascular disease, and patients with symptomsof carotid atherosclerosis, detected by duplex study were excluded.Results. Deterioration of HRV in patients with PsA compared with those in patients of the control group, the availability of statistically significant reverse relationship of temporal and spectral parameters of HRV with PsA activity (ESR, CRP, entezit score, DAS4, duration of arthritis, the classical factors of cardiovascular risk were established.Conclusion. Patients with PsA had noted a violation of autonomic regulation of cardiac activity in the form of reduced HRV and activation of the sympathetic part of it. Identified changes were associated with activity of systemic inflammation and classical factors of cardiovascular risk.

  6. Anti-collagen antibodies in sera from rheumatoid arthritis patients.

    Science.gov (United States)

    Beard, H K; Ryvar, R; Skingle, J; Greenbury, C L

    1980-11-01

    Anti-cartilage antibodies, demonstrable by immunofluorescence, were found in 3.3% of rheumatoid arthritis patients. In most of these patients antibodies to type II collagen were detected. In specificity studies on these anti-collagen antibodies, they appeared to be type specific, showing no reaction with collagen types I and III. Denatured type II collagen reacted much less well than native type II, but isolated peptides from different regions of the collagen molecule were differentiated by individual sera. Removal of the glycoside side chains from native type II collagen had no effect on its antigenicity. The findings suggest that these patients produce highly specific antibodies which react with the triple helix of type II collagen.

  7. Secondary Osteoporosis in Patients with Juvenile Idiopathic Arthritis

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    Kristyna Brabnikova Maresova

    2011-01-01

    Full Text Available Bone disease in patients with juvenile idiopathic arthritis (JIA is associated with focal (joint erosion and juxtaarticular osteopenia and systemic bone loss (generalized osteopenia or reduction of bone mass density. Pathophysiology of bone loss is multifactorial and involves particularly proinflammatory cytokines and deleterious effects of glucocorticoid therapy. Clinical studies in patients with JIA indicate excessive activation of osteoclastogenesis and reduction of bone formation. Reduction of physical activity, muscle atrophy caused by high disease activity, and compulsory restriction in movements are also associated with bone loss. In patients with JIA, the disease can be complicated by growth cartilage involvement and systemic or local growth retardation. In the absence of preventive measures, fragility fractures can occur even at an early age.

  8. EFFICACY OF UNDERWATER INTERFERENTIAL CURRENT ON HAND FUNCTION IN PSORIATIC ARTHRITIS PATIENTS

    OpenAIRE

    Ahmed Fathy Samhan. PhD PT

    2014-01-01

    Background: Psoriatic arthritis is an entity of inflammatory joint disease associated with psoriasis. Purpose: The purpose of this study was to evaluate the efficacy of underwater interferential current therapy on hand function in psoriatic arthritis of both hands. Method: Thirty patients (18 females and 12 males) had psoriatic arthritis of hands, aged 42 to 50 years with 45.77 ± 3.52 mean, were assigned randomly into two groups of equal number: study group received 20 minutes ...

  9. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2013-05-01

    The objectives of this study were to: (1) assess the prevalence of psoriatic arthritis (PsA) among Psoriasis (Ps) patients attending dermatology clinics; (2) identify clinical predictors of the development of PsA; and (3) compare the performance of three PsA screening questionnaires: Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST) and Toronto Psoriatic Arthritis Screening (ToPAS).

  10. Anti-infliximab antibodies are already detectable in most patients with rheumatoid arthritis halfway through an infusioncycle: an open-label pharmacokinetic cohort study

    NARCIS (Netherlands)

    Bemt, B.J.F van den; Broeder, A. den; Wolbink, G.J.; Hekster, Y.A.; Riel, P.L. van; Benraad, B.; Hoogen, F.H. Van den

    2011-01-01

    BACKGROUND: This study in patients with rheumatoid arthritis (RA) treated with infliximab describes prospectively the course of (anti)infliximab levels within an infusioncycle to assess at what moment patients develop low/no infliximab trough levels and/or detectable anti-infliximab levels. METHODS:

  11. Salmonella septicemia in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: association with decreased interferon-gamma production and Toll-like receptor 4 expression.

    NARCIS (Netherlands)

    Netea, M.G.; Radstake, T.R.D.J.; Joosten, L.A.B.; Meer, J.W.M. van der; Barrera Rico, P.; Kullberg, B.J.

    2003-01-01

    OBJECTIVE: Patients treated with antibodies to tumor necrosis factor alpha (TNFalpha) have an increased susceptibility to intracellular infections. We describe 2 patients with rheumatoid arthritis (RA) who developed Salmonella septicemia during anti-TNF treatment. The aim of this study was to identi

  12. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis

    DEFF Research Database (Denmark)

    Huynh, Tuan Khai; Ostergaard, Ann; Egsmose, Charlotte;

    2014-01-01

    OBJECTIVES: To examine the preferences of rheumatoid arthritis (RA) patients and health professionals (HPs) for the route and frequency of administration of biologic drugs. METHODS: One hundred and seven RA patients treated with biological agents for intravenous or subcutaneous use, 35 biologic-n...

  13. Effects of the live attenuated measles-mumps-rubella booster vaccination on disease activity in patients with juvenile idiopathic arthritis : a randomized trial

    NARCIS (Netherlands)

    Heijstek, Marloes W; Kamphuis, Sylvia; Armbrust, Wineke; Swart, Joost; Gorter, Simone; de Vries, Lara D; Smits, Gaby P; van Gageldonk, Pieter G; Berbers, Guy A M; Wulffraat, Nico M

    2013-01-01

    IMPORTANCE: The immunogenicity and the effects of live attenuated measles-mumps-rubella (MMR) vaccination on disease activity in patients with juvenile idiopathic arthritis (JIA) are matters of concern, especially in patients treated with immunocompromising therapies. OBJECTIVES: To assess whether M

  14. Cost of tumor necrosis factor blockers per patient with rheumatoid arthritis in a multistate Medicaid population

    Directory of Open Access Journals (Sweden)

    Bonafede M

    2014-09-01

    Full Text Available Machaon Bonafede,1 George J Joseph,2 Neel Shah,2 Nicole Princic,1 David J Harrison2 1Truven Health Analytics, Cambridge, MA, 2Amgen Inc., Thousand Oaks, CA, USA Background: The purpose of this study was to estimate the annual cost per treated patient for the tumor necrosis factor (TNF blockers, etanercept, adalimumab, and infliximab in rheumatoid arthritis (RA patients covered by Medicaid. Methods: The MarketScan Medicaid Multistate Database was used to identify adult RA patients who used etanercept, adalimumab, or infliximab (index agents from 2007 to 2011. The index date was the first claim preceded by 180 days and followed by 360 days of continuous enrollment. Patients with other conditions for which these agents are approved by the US Food and Drug Administration were excluded. “Continuing” patients had one or more pre-index claim for their index biologic, and "new" patients did not. Cost per treated patient was calculated in the 360 day post-index period for each index agent as the total index drug and administration cost to the payer and the costs of switched-to agents divided by the number of patients who received the index agent. Results: A total of 1,085 patients met the study criteria. Forty-eight percent received etanercept (n=521; 37% received adalimumab (n=405; and 15% received infliximab (n=159. Patient characteristics were similar across groups (mean age 47.4 years, 83% female. The annual cost per treated patient was lowest for etanercept ($18,466, followed by adalimumab ($20,983 and infliximab ($26,516. For all agents, annual costs were lower for new patients ($17,996 for etanercept, $18,992 for adalimumab, and $24,756 for infliximab than for continuing patients ($19,004 for etanercept, $24,438 for adalimumab, and $28,127 for infliximab. Conclusion: Etanercept had lower costs per treated patient than adalimumab or infliximab in both new and continuing Medicaid enrollees with RA. Keywords: cost, tumor necrosis factor

  15. An Insight into Methods and Practices in Hip Arthroplasty in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Mohammad Saeed Mosleh-shirazi

    2015-01-01

    Full Text Available Total hip arthroplasty (THA has improved the quality of life of patients with hip arthritis. Orthopedic community is striving for excellence to improve surgical techniques and postoperative care. Despite these efforts, patients continue facing postoperative complications. In particular, patients with rheumatoid arthritis display a higher risk of certain complications such as dislocation, periprosthetic infection, and shorter prosthesis durability. In this review we present the current knowledge of hip arthroplasty in patients with rheumatoid arthritis with more insight into common practices and interventions directed at enhancing recovery of these patients and current shortfalls.

  16. Histoplasmosis infection in patients with rheumatoid arthritis, 1998-2009

    Directory of Open Access Journals (Sweden)

    Matteson Eric L

    2011-05-01

    Full Text Available Abstract Background Patients with rheumatic diseases including rheumatoid arthritis (RA are at increased risk for infections related to both the disease and its treatments. These include uncommonly reported infections due to histoplasmosis. Methods Medical record review of all patients with a diagnosis of RA who developed new histoplasmosis infection in an endemic region between Jan 1, 1998 and Jan 30, 2009 and who were seen at Mayo Clinic in Rochester, Minnesota was performed. Results Histoplasmosis was diagnosed in 26 patients. Most patients were on combination therapies; 15 were on anti-tumor necrosis factor (anti-TNF agents, 15 on corticosteroids and 16 on methotrexate. Most received more than 6 months of itraconazole and/or amphotericin treatment. Two patients died of causes unrelated to histoplasmosis. Anti-TNF treatment was restarted in 4/15 patients, with recurrence of histoplasmosis in one. Conclusions In this largest single center series of patients with RA and histoplasmosis in the era of immunomodulatory therapy, we found that most patients had longstanding disease and were on multiple immunomodulatory agents. Most cases were pulmonary; typical signs and symptoms of disease were frequently lacking.

  17. Plasma Homocysteine Concentrations In Patients With Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Vasiljevic Dragan

    2015-09-01

    Full Text Available In this study, we investigated the concentration of serum homocysteine (Hcy in patients with rheumatoid arthritis (RA compared with the control group and the connection between homocysteine and parameters of inflammation and disease activity. Sixty RA patients and 20 healthy controls were included in the study, and clinical examination and investigation were performed during which disease activity was assessed. Peripheral blood samples were used for all of the assays. Levels of Hcy were 33% higher in the RA patients than in the control subjects (mean +/− SD 11.79±3.72 μmol/L versus 8.90±1.38 μmol/L; p< 0.01. A significant correlation was found between parameters of inflammation (C-reactive protein and homocysteine in patients (r=0.322, p=0.012. Patients with high disease activity had a significantly greater increase in homocysteine (p<0.05. An increase in plasma homocysteine in RA patients is related to the parameters of inflammation and disease activity. Elevated Hcy levels occur commonly in patients with RA and may explain some of the increased cardiovascular mortality seen in RA patients.

  18. Maintenance of physical activity in patients with rheumaoid arthritis

    DEFF Research Database (Denmark)

    Løppenthin, Katrine; Esbensen, Bente Appel; Østergaard, Mikkel

    2012-01-01

    Background: Several exercise trials indicate that physical activity (PA) may improve physical function and quality of life, and reduce pain in patients with rheumatoid arthritis (RA) 1, 2. Few of these studies have included physical activity maintenance. Thus, it is still unknown how and why some....... The analysis was discussed within a multidisciplinary team of qualitative researchers. Results: The analysis revealed tree dimensions of PA maintenance: (1) A bodily dimension: physical sensations of vitality, sparkling energy and liberation in movement; (2) a mental component: referring to experiences of self......, described experiences of bodily well-being and liberation from illness provided and secured through PA maintenance. The understanding of regular PA as a resistance resource is essential to development future health promoting interventions aimed to encourage PA maintenance in patients with RA....

  19. EuroQol-5 dimensions utility gain according to British and Swedish preference sets in rheumatoid arthritis treated with abatacept, rituximab, tocilizumab, or tumour necrosis factor inhibitors

    DEFF Research Database (Denmark)

    Gülfe, Anders; Wallman, Johan K; Kristensen, Lars Erik

    2016-01-01

    BACKGROUND: The development of EuroQol-5 dimensions (EQ-5D) utility over time in rheumatoid arthritis (RA) patients, treated with biologics other than tumour necrosis factor inhibitors (TNFi), based on the standard British (UK) and the new Swedish (SE) EQ-5D preference sets, has not been previously...... described. METHODS: Demographics, core set data, EQ-5D utility, and treatment characteristics for patients with established RA, receiving biologics in southern Sweden from January 2006 to March 2014, were retrieved from observational databases. Theoretical, UK, and experience-based, SE, EQ-5D mean utilities...

  20. Polymorphisms of RAD51B are associated with rheumatoid arthritis and erosion in rheumatoid arthritis patients

    Science.gov (United States)

    Zhi, Liqiang; Yao, Shuxin; Ma, Wenlong; Zhang, Weijie; Chen, Honggan; Li, Meng; Ma, Jianbing

    2017-01-01

    Rheumatoid arthritis (RA) is a common, chronic autoimmune disease affecting 0.5–1.0% of adults worldwide, including approximately 4.5–5.0 million patients in China. The genetic etiology and pathogenesis of RA have not yet been fully elucidated. Recently, one new RA susceptibility gene (RAD51B) has been identified in Korean and European populations. In this study, we designed a two-stage case-control study to further assess the relationship of common variants in the RAD51B gene with increased risk of RA in a total of 965 RA patients and 2,511 unrelated healthy controls of Han Chinese ancestry. We successfully identified a common variant, rs911263, as being significantly associated with the disease status of RA (P = 4.8 × 10−5, OR = 0.64). In addition, this SNP was shown to be related to erosion, a clinical assessment of disease severity in RA (P = 2.89 × 10−5, OR = 0.52). These findings shed light on the role of RAD51B in the onset and severity of RA. More research in the future is needed to clarify the underlying functional link between rs911263 and the disease. PMID:28361912

  1. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K

    2015-08-01

    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

  2. Iodine-131 uptake in a patient with thyroid cancer and rheumatoid arthritis during acupuncture treatment

    Energy Technology Data Exchange (ETDEWEB)

    Otsuka, N.; Fukunaga, M.; Morita, K.; Ono, S.; Nagai, K.; Katagiri, M.; Harada, T.; Morita, R. (Kawasaki Medical School, Okayama (Japan))

    1990-01-01

    A patient with thyroid carcinoma had abnormal accumulation of I-131 in the areas of both feet and hands on whole body scan. The sites of abnormal accumulation of I-131 were similar to those on bone scintigraphy. The radiographic examination of the lesions showed characteristic findings of rheumatoid arthritis, and the presence of small gold needles for acupuncture treatment was demonstrated. There were no findings of bone metastases. Although the mechanism of accumulation of I-131 in this patient is unknown, interpreters of I-131 whole body scintigraphs should keep this case in mind when acupuncture treatment has been done. The authors can only speculate on a common blood flow mechanism for enhanced HMDP and I-131 uptake in this arthritic patient who had been treated by acupuncture.

  3. Dosing celecoxib in pediatric patients with juvenile rheumatoid arthritis.

    Science.gov (United States)

    Krishnaswami, Sriram; Hutmacher, Matt M; Robbins, Jeffery L; Bello, Akintunde; West, Christine; Bloom, Bradley J

    2012-08-01

    The objective was to derive dosing recommendations for the use of celecoxib in patients with juvenile rheumatoid arthritis (JRA) using pharmacokinetic (PK) and exposure-response data. PK and efficacy data from a randomized, double-blind, 12-week study of celecoxib dosed at 3 and 6 mg/kg twice a day (bid) as an investigational suspension formulation in 152 JRA patients aged 2 to 17 years, PK data from 36 adult RA patients, and relative bioavailability data in healthy adults comparing suspension or capsule sprinkles with the commercial capsule were analyzed. Typical oral clearance (L/h) values were 40% and 24% lower in patients weighing 10 and 25 kg, respectively, compared with a 70-kg patient. Longitudinal, logistic pharmacodynamic models incorporating linear effects of dose/area under the plasma concentration-time curve (AUC) over 0 to 12 hours (AUC(0-12)) suggested that the percentage of responders increased with celecoxib exposure. Systemic exposures (AUC) were similar for the suspension, capsule sprinkles, and intact capsule. Administration of a 50-mg bid capsule (or sprinkles) for patients weighing 10 to 25 kg and 100 mg bid for patients >25 kg was predicted to yield similar exposures and response rates as those observed in the JRA trial. Doses and dosage forms not studied in the JRA trial were approved based on the results of this analysis.

  4. The impact of patient heterogeneity and socioeconomic factors on abatacept retention in rheumatoid arthritis across nine European countries

    DEFF Research Database (Denmark)

    Finckh, A; Neto, D; Iannone, F

    2015-01-01

    BACKGROUND: There are substantial differences in accessibility to biological disease modifying antirheumatic drugs (bDMARDs) across countries. The objective of this study was to analyse the impact of patient demographics, disease characteristics and gross domestic product (GDP) on abatacept (ABA......) retention in patients with rheumatoid arthritis (RA) treated in clinical practice. METHODS: Data from nine European observational RA cohorts of patients treated with ABA were pooled. Kaplan-Meier analysis was used to compare drug retention across registries. Specific causes of drug retention were...... investigated using competing risks multivariate Cox regression. RESULTS: A total of 3961 patients treated with ABA, with 6188 patient-years of follow-up, were included. Patients in the different national registries had similar demographic features, but varied in baseline disease characteristics. ABA drug...

  5. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    DEFF Research Database (Denmark)

    Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard;

    2015-01-01

    Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year...

  6. Risk factors for septic arthritis in patients with joint disease: A prospective study

    NARCIS (Netherlands)

    C.J. Kaandorp; D. van Schaardenburg (Dirkjan); P. Krijnen (Pieta); J.D.F. Habbema (Dik); M.A.F.J. van de Laar (Mart)

    1995-01-01

    markdownabstractObjective. To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention. Methods. The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored

  7. Systems biology guided by Chinese medicine reveals new markers for sub-typing rheumatoid arthritis patients

    NARCIS (Netherlands)

    Wietmarschen, H. van; Yuan, K.; Lu, C.; Gao, P.; Wang, J.; Xiao, C.; Yan, X.; Wang, M.; Schroën, J.; Lu, A.; Xu, G.; Greef, J. van der

    2009-01-01

    BACKGROUND: Complex chronic diseases such as rheumatoid arthritis have become a major challenge in medicine and for the pharmaceutical industry. New impulses for drug development are needed. OBJECTIVE: A systems biology approach is explored to find subtypes of rheumatoid arthritis patients enabling

  8. BIOLOGICAL THERAPY AND INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS: RELEVANCE AND PROSPECTS

    Directory of Open Access Journals (Sweden)

    B. S. Belov

    2014-01-01

    Full Text Available The past decades are marked by the obvious progress in rheumatology, which is related to the practical introduction of biological agents. At the same time the use of these drugs is associated with the increasing risk of infections of different nature and locations, including opportunistic ones (invasive mycoses, Pneumocystis pneumonia, etc., and with the greater risk of reactivation of latent infection, primary with that of tuberculosis. Beyond that point, there are cases of severe infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissue lesions, etc., including those with a fatal outcome. This review analyzes mainly the past 3-year literature data on the rate and location of infections treated with biologics, which have been obtained in the placebo-controlled and direct comparative studies of patients with rheuma- toid arthritis. It characterizes the importance of different infections (tuberculosis, pneumonia, chronic viral hepati- tides, herpesvirus infections, etc. for treatment policy in the above patients. This underlines the need for wider immu- nization with different vaccines (chiefly against pneumococcus and influenza in patients with autoimmune inflam- matory rheumatic diseases. 

  9. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    J.A. Mendonça

    2011-01-01

    Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

  10. Cardiovascular parasympathetic nervous system dysfunction in female rheumatoid arthritis patients.

    Science.gov (United States)

    Saraswathi, P V; Neelambikai, N; Mahesh, Arjun; Govindarajan, K

    2013-01-01

    The autonomic dysfunction has been reported in patients with (rheumatoid arthritis) RA and systemic lupus erythematosus (SLE) like connective tissue disorders and it may be due to the vasculitis of vasa nervorum and secondary amyloidosis. The pathogenesis may also have an immune component that affects autonomic functions. In the present study, three standard cardiovascular parasympathetic function tests were performed in 207 RA patients and in 106 healthy controls. 14.45% patients were presented with symptoms related to cardiovascular autonomic dysfunction. Heart rate variation to deep breathing (DBD), standing (30:15 ratio), Valsalva ratio (VR) were found to be significantly reduced in RA patients and was weakly associated with female RA patients (r = 0.165, p = 0.018) and was not correlated to disease duration, RF positivity & severity of the disease. In conclusion, this study has confirmed the presence of significant subclinical cardiovascular parasympathetic nervous dysfunction in RA patients and its positive association with female gender. Hence, inclusion of cardiovascular autonomic function tests in the routine clinical examination may be helpful in the early detection of autonomic dysfunction in RA.

  11. Circulating IL-27 Is Elevated in Rheumatoid Arthritis Patients

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    Xiaofei Lai

    2016-11-01

    Full Text Available Cytokines are key immunoregulatory molecules that regulate T lymphocyte-mediated immune responses and inflammatory reactions. We determined whether there is aberrant expression of interleukin-27 (IL-27 in rheumatoid arthritis (RA patients and investigated the clinical significance of these changes. IL-27 is a key cellular factor that regulates the differentiation of CD4+ T cells, which can secrete interleukin-10 (IL-10 and interleukin-17 (IL-17 in vivo. Concentrations of serum IL-27 in 67 RA patients, and 36 sex- and age-matched control subjects were measured by enzyme-linked immunosorbent assay (ELISA. Results showed that concentrations of serum IL-27 in all RA patients were significantly higher than in healthy control subjects, and there was a significant and positive correlation between serum IL-27 levels and disease activity in all RA patients. Levels of serum IL-27 in RA patients were significantly correlated with disease activity score in 28 joints (DAS28. Moreover, immunosuppressive treatment with leflunomide downregulated the levels of IL-27 in active RA patients. Therefore, the elevated production of circulating T cell inflammatory factors contributes to the pathogenesis of RA, and serum IL-27 could potentially serve as a new biomarker of RA disease activity.

  12. How early should psoriatic arthritis be treated with a TNF-blocker?

    LENUS (Irish Health Repository)

    Harty, Leonard

    2012-02-01

    PURPOSE OF REVIEW: Psoriatic arthritis (PsA) is the second most commonly identified inflammatory arthropathy in early arthritis clinics. It is a complex multisystem disease involving the skin and joints, but may also present with inflammation of the spine - spondylitis, digits - dactylitis, eyes - uveitis and ligamentous insertions - enthesitis. The skin manifestations may be mild or patchy and often precede the joint inflammation. Joint erosions, however, may occur within the first 2 years in up to half of PsA patients and an erosion rate of 11% per annum has been reported suggesting it is not a benign disease as it was once regarded. RECENT FINDINGS: Therapy with mild anti-inflammatories is only beneficial in very mild or localized disease. In cases of more widespread joint involvement systemic therapy with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may be required and in the case of extra-articular or spinal disease, in which DMARDs have failed to show efficacy, biologic therapy may be highly effective. SUMMARY: The question of how early treatment should be instituted should be decided in a specialist rheumatology referral centre following appropriate assessment. Optimal therapy with combination DMARD and biologics may result in remission rates of up to 60%.

  13. Rituximab therapy in Greek patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Haralampos M Moutsopoulos

    2008-10-01

    Full Text Available Aristotelis P Tsiakalos*, Nestor K Avgoustidis*, Haralampos M MoutsopoulosDepartment of Pathophysiology, Medical School, National Univercity of Athens, Athens, Greece. *These authors contributed equally to this workObjective: An open-label, prospective, uncontrolled study created to investigate clinical response, serological changes and side effects in Greek patients with rheumatoid arthritis (RA, after B-cell depletion with rituximab.Methods: Patients with high disease activity (disease activity score [DAS]-28 > 5.1 were selected for treatment with rituximab and received two infusions, 1 gr each, 2 weeks apart. Different disease parameters (visual analog scale, DAS-28, C-reactive protein [CRP], erythrocyte sedimentation rate, health assessment questionnaire, complement (C3, C4, rheumatoid factor [RF], anti-cyclic citrullinated peptide antibody [anti-CCP], swollen joint count, tender joint count, immunoglobulin M [IgM], IgG, IgA were performed at base line, 2, 4, and 6 months post-treatment. Response was defined according to the American College of Rheumatology (ACR criteria.Results: Seventeen patients received therapy. Treatment led to a reduction in various disease parameters. ACR20 was achieved in 41.11% of patients by week 8, 52.94% by week 16, and 82.35% by week 24. ACR50 was achieved in 5.88% by week 8, 41.17% by week 16, and 64.7% by week 24. ACR70 was achieved only by week 24 in 23.52% of patients. Statistical analysis has shown no differences in clinical response, between RF positive/negative patients, and anti-CCP-positive/negative patients, while decline of RF was better correlated with reduction of DAS-28 than with anti-CCP.Conclusions: Rituximab is a well tolerated and effective treatment in RA. Response was not correlated to RF or anti-CCP positivity. Decline of RF was associated with clinical response and reduction of DAS-28 and CRP.Keywords: rituximab, Greek patients, rheumatoid arthritis

  14. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-03-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients' function.

  15. Do Surgeons Treat Their Patients Like They Would Treat Themselves?

    NARCIS (Netherlands)

    Janssen, S.J.; Teunis, T.; Guitton, T.G.; Ring, D.; Biert, J.

    2015-01-01

    BACKGROUND: There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. QUESTIONS/PURPOSES: (1) Are surgeons more likely to reco

  16. Cardiovascular risk factors in patients with rheumatoid arthritis in combination with hypertension depending on body weight

    Directory of Open Access Journals (Sweden)

    Sіrenko O.Yu.

    2014-11-01

    Full Text Available The objective was to evaluate the frequency of cardiovascular risk factors and hypertension in patients with rheumatoid arthritis depending on body weight. The study involved 100 patients with rheumatoid arthritis and stably selected therapy for more than 6 months at the age from 45 to 65 years (mean age 53,19 ± 5,40 years. Traditional cardiovascular risk was assessed, taking into account risk factors by SCORE scale and amended for patients with RA. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Arterial hypertension was diagnosed in 41 (41% patients with rheuma¬toid arthritis and was associated with traditional risk factors (age, obesity, rheumatoid factor, hyperuricemia and the duration of glucocorticoid therapy. Obesity and excess body mass occurred in the majority of patients with rheumatoid arthritis, herewith the highest level of inflammation indicators and risk of cardiovascular events was in overweight patients. Obesity was associated with duration of rheumatoid arthritis, the activity of the inflammatory process, the duration of glucocorticoids taking. It is found that the traditional SCORE scale does not fully reflect the risk of cardiovascular events in rheumatoid arthritis. Identification of hypertension and obesity increases the information content of the risk assessment of cardiovascular events in rheumatoid arthritis.

  17. Efficacy of Anakinra for Various Types of Crystal-Induced Arthritis in Complex Hospitalized Patients: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    A. Aouba

    2015-01-01

    Full Text Available Background. There are few data on anakinra use after failure of conventional medications for crystal-induced peripheral arthritis and/or crowned dens syndrome among complex hospitalized patients. Methods. We retrospectively analyzed the outcome of six patients affected with subacute crystal-induced arthritis who had received anakinra in second or third line therapy, including three patients with crowned dens syndrome and three others with gouty arthritis. Patients’ comorbidities, reasons for anakinra use and associated drugs, and outcomes were recorded. Results. All patients presented with elevated inflammatory syndrome, systemic symptoms with poly/oligoarthritis. Except for absolute contraindications, all patients were previously treated with full or decreased dose of NSAID, colchicine, and/or glucocorticoids, with unsatisfactory response. All three gouty patients exhibited complete responses in all acute involvements under anakinra within 3 to 5 days, including one of them who needed the reintroduction of colchicine treatment that was previously unsuccessful. Crowned dens syndrome patients, including two with pseudogout and one with subacute hydroxyapatite deposition disease, needed 9 to 11 days to achieve complete response. Tolerance to anakinra was good. Conclusion. In case series of complex hospitalized patients, anakinra showed good activity in crowned dens syndrome and associated crystal-induced peripheral arthritis, with longer treatment duration than in gouty arthritis.

  18. Interleukin-6 promoter haplotypes are associated with etanercept response in patients with rheumatoid arthritis.

    Science.gov (United States)

    Schotte, Heiko; Schmidt, Hartmut; Gaubitz, Markus; Drynda, Susanne; Kekow, Jörn; Willeke, Peter; Schlüter, Bernhard

    2015-12-01

    Indices prognosticating anti-tumor necrosis factor (TNF) response in patients with rheumatoid arthritis are a matter of interest. Differential outcome under anti-TNF and anti-interleukin-6 (IL-6) therapy raises the question whether genetic polymorphisms that have previously been linked to IL-6 production are associated with response to anti-TNF therapy. Fifty (50) rheumatoid arthritis (RA) patients were treated with etanercept (median 36 weeks, range 4-52). In terms of the EULAR response criteria, 25 patients responded well, 17 patients moderately and 8 patients not. By direct sequencing, the patients and 91 matched healthy controls were genotyped for the IL-6 promoter SNPs -597G > A (rs1800797), -572G > C (rs1800796) and -174G > C (rs1800795) and for an AnTn microsatellite tract at -373. Alleles and haplotypes were tested for association with disease susceptibility and therapy response. No significant difference was seen in the genotype distribution between patients and healthy controls. Confirming the results of previous studies, we observed a trend of -174G being more frequent in patients with a good or moderate therapy response. Beyond that, carriage of the A9T11 microsatellite allele within the -174G haplotype was associated most closely with a favourable response (relative risk 1.31; 95 % confidence interval 1.02-1.68). A subtle analysis of the IL-6 promoter giving respect to its complex haplotypic structure results in more precise information as to the association of genotypes with the long-term etanercept response. Despite a conclusive hypothesis that a genetically determined IL-6-dominated RA responds less well to anti-TNF, more work has to be done to provide us with reliable information regarding the functional aspects of these genetic polymorphisms.

  19. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients: results of a 1-year follow-up study from the CERERRA collaboration.

    NARCIS (Netherlands)

    Chatzidionysiou, K.; Lie, E.; Nasonov, E.; Lukina, G.; Hetland, M.L.; Tarp, U.; Riel, P.L.C.M. van; Nordstrom, D.C.; Gomez-Reino, J.; Pavelka, K.; Tomsic, M.; Kvien, T.K.; Vollenhoven, R.F. van; Gabay, C.

    2012-01-01

    OBJECTIVES: To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. METHODS: 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. RESULTS: 1195 patient

  20. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients : results of a 1-year follow-up study from the CERERRA collaboration

    NARCIS (Netherlands)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny; Lukina, Galina; Hetland, Merete Lund; Tarp, Ulrik; van Riel, Piet L. C. M.; Nordstrom, Dan C.; Gomez-Reino, Juan; Pavelka, Karel; Tomsic, Matija; Kvien, Tore K.; van Vollenhoven, Ronald F.; Gabay, Cem

    2012-01-01

    Objectives To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. Methods 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. Results 1195 patients w

  1. Severe Osteomyelitis and Septic Arthritis due to Serratia marcescens in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Hiba Hadid

    2015-01-01

    Full Text Available Septic arthritis and osteomyelitis due to Serratia marcescens in immunocompetent patients without risk factors are extremely rare. Here, we report a case of septic arthritis and severe adjacent osteomyelitis of the tibia due to Serratia marcescens in a diabetic community-dweller patient. The patient had no contact with healthcare workers or facilities and had no chronic disease except for poorly controlled diabetes. Without predisposing risk factors, this type of infection is extremely rare, even in diabetics.

  2. Paradoxical psoriasis after the use of anti-TNF in a patient with rheumatoid arthritis*

    Science.gov (United States)

    de Vasconcellos, Jaqueline Barbeito; Pereira, Daniele do Nascimento; Vargas, Thiago Jeunon de Sousa; Levy, Roger Abramino; Pinheiro, Geraldo da Rocha Castelar; Cursi, Ígor Brum

    2016-01-01

    The use of tumor necrosis factor antagonists (anti-TNF) has become a usual practice to treat various inflammatory diseases. Although indicated for the treatment of psoriasis, anti-TNF may paradoxically trigger a psoriasiform condition. We present a case of a female patient who, during the use of infliximab for rheumatoid arthritis, developed psoriasis. In an attempt to switch anti-TNF class, we observed a cumulative worsening of the lesions requiring suspension of the immunobiological agent and the introduction of other drugs for clinical control. The therapeutic challenge of this paradoxical form of psoriasis is the focus of our discussion. The use of another anti-TNF in these patients is a matter of debate among experts.

  3. Rheumatoid arthritis and sexuality: A patient survey in France

    Directory of Open Access Journals (Sweden)

    Kobelt Gisela

    2012-09-01

    Full Text Available Abstract Background The objective of this study was to evaluate the impact of rheumatoid arthritis (RA on patients’ sexuality and identify disease and other factors such as fatigue that most influence sexual relationships. Methods A specific pretested questionnaire was sent to all members of a French patient association (ANDAR. Questions related to demographics, disease status, quality of life (utility, EQ-5D, pain, psychological status (mood, fatigue and emotional and sexual relationships. To isolate the impact of RA, an attempt was made to include a matched sample from the general population. Results The analysis included 1271 patients, but only 70 controls agreed to participate and comparisons should therefore be considered with caution. The two groups were similar in terms of age, gender distribution, living conditions and diseases other than RA. However, patients scored worse for global health, mood, fatigue, had a lower utility (0.55 versus 0.65. Controls were more active sexually (69% versus 63%, in particular women (71% versus 60%. Age, gender, living alone, physical function and mood were significant predictors for being sexually active for patients; for controls, age and overall quality of life (utility were significant predictors. Conclusions While it is known that RA has a negative impact on patients’ sexuality, there have been few attempts to quantify the problem. Our study highlights the negative impact of RA on patients’ sexuality, and triggers the question how to include this aspect into care.

  4. Bone mineral density in patients with juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Sušić Gordana

    2009-01-01

    Full Text Available Introduction. It is well known that juvenile idiopathic arthritis (JIA as a chronic inflammatory disease with onset during the childhood, beside other complication, can lead to bone metabolism disturbance and osteoporosis. Objective. To assess bone mineral density (BMD in children with JIA and to identify factors playing role in bone mineral disturbance. Methods. Seventy-five patients (26 male and 49 female average disease duration 7.2 (2.4-16.8 years, and 73 age matched healthy control subjects (29 male and 44 female participated in the study. Mean age of the groups was about 14.5 years. BMD was determined by dual x-ray absorptiometry (DEXA of the lumbar spine (L2-L4. For further analysis we used the absolute value of BMD, expressed as g/cm2, Z score expressed as SD (relative value as standard deviation decline of normal BMD values of referent Italian population with identical age and gender, bone mineral content (BMC as g/cm, and corrected BMD - BMDv as g/cm3. Results. Z score in the group of patients was significantly lower (-1.02±1.6 in comparison to the control group (-0.09±1.4; p<0.001. BMD, BMDv and BMC were also statistically lower in patients with JIA. The lowest Z score was found in patients with systemic onset (-2.63 SD. Z score showed a statistically significant positive correlation with arthritis course (polyarticular course had lower Z score, body mass index and standard deviation score for height and weight. Statistically significant negative correlation was detected in regard to Z score and glucocorticoid (GC treatment duration, GC cumulative dose, number of joints with limited range of motion, radiological stage and functional class. Conclusion. The results showed a decreased BMD in patients with JIA in comparison to the control group. Systemic onset, polyarthritis, longer treatment with GC and higher cumulative dosage, as well as higher damage level (functional status and radiological stage are factors playing negative role

  5. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-01-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients’ function. PMID:28356649

  6. Erosive progression is minimal, but erosion healing rare, in patients with rheumatoid arthritis treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure

    DEFF Research Database (Denmark)

    Møller Døhn, U; Boonen, A; Hetland, M L;

    2009-01-01

    : Disease activity score, C-reactive protein, tender and swollen joints count and Health Assessment Questionnaire score had all decreased at 6 and 12 months (wilcoxon signed-ranks test pchange in any imaging parameters of joint destruction was observed at 6 and 12 months. High...... two low-grade radiographic erosions in the wrist or metacarpophalangeal (MCP) joints in the same (index) hand, initiated adalimumab 40 mg subcutaneously every other week. Thirty-five patients completed the study (median age 61 years (interquartile range 46-68), disease duration 8 years (3-15)). CT...... intrareader agreements were reached (mean intraobserver intraclass coefficients: 0.96 (CT) and 0.97 (radiography)). The number of patients with change scores exceeding the smallest detectable change (SDC) was comparable on CT and radiography, as were the proportions of patients progressing...

  7. Initial experience with oral gold salts in the treatment of rheumatoid arthritis in patients followed up for one year.

    Science.gov (United States)

    Lignère, G C; Giavarini, S; Longatti, S

    1984-01-01

    Fifteen patients, eight males and seven females, suffering from classic or definite rheumatoid arthritis were treated for 1 year with Auranofin, a new gold salt active by the oral route, different from parenteral gold as far as dosage, mechanism of action and toxicity are concerned. Patients received a dosage of 3 mg twice daily, equivalent to 0.85 mg of elemental gold, in order to evaluate the therapeutic efficacy and tolerability of this new compound. Subjective and objective parameters were monitored during the trial and serum gold levels were assayed every 2 months by atomic absorption spectrophotometry. Our study, which is on-going, shows the therapeutic efficacy of Auranofin which seems better tolerated than parenteral gold salts and will probably become a widely used drug in the long-term treatment of rheumatoid arthritis.

  8. Down-titration and discontinuation strategies of tumor necrosis factor-blocking agents for rheumatoid arthritis in patients with low disease activity

    NARCIS (Netherlands)

    Herwaarden, N. van; Broeder, A.A. den; Jacobs, W.; Maas, A. van der; Bijlsma, J.W.J.; Vollenhoven, R.F. van; Bemt, B.J.F van den

    2014-01-01

    BACKGROUND: Anti-tumor necrosis factor (TNF) agents are effective in treating patients with rheumatoid arthritis (RA), but they are associated with (dose-dependent) adverse effects and high costs. To prevent overtreatment, several trials have assessed the effectiveness of down-titration compared wit

  9. Low infliximab serum trough levels and anti-infliximab antibodies are prevalent in rheumatoid arthritis patients treated with infliximab in daily clinical practice: results of an observational cohort study

    NARCIS (Netherlands)

    Maas, A. van der; Bemt, B.J. van den; Wolbink, G.; Hoogen, F.H.J. van den; Riel, P.L. van; Broeder, A.A. den

    2012-01-01

    ABSTRACT: BACKGROUND: To get insight in the prevalence of high, or low/no serum infliximab trough levels in patients with low disease activity and if serum trough levels are stable and reliable longitudinally we conducted a prospective cohort study METHODS: In a longitudinal, observational cohort of

  10. The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis.

    NARCIS (Netherlands)

    Welsing, P.M.J.; Landewe, R.B.; Riel, P.L.C.M. van; Boers, M.; Gestel, A.M. van; Linden, S.G. van der; Swinkels, H.L.; Heijde, D.M.F.M. van der

    2004-01-01

    OBJECTIVE: Radiologic progression in rheumatoid arthritis (RA) is considered the consequence of persistent inflammatory activity. To determine whether a change in disease activity is related to a change in radiologic progression in individual patients, we investigated the longitudinal relationship b

  11. Decreased prolactin response to hypoglycaemia in patients with rheumatoid arthritis: correlation with disease activity.

    NARCIS (Netherlands)

    Eijsbouts, A.M.M.; Hoogen, F.H.J. van den; Laan, R.F.J.M.; Sweep, C.G.J.; Hermus, A.R.M.M.; Putte, L.B.A. van de

    2005-01-01

    OBJECTIVE: To compare basal and stimulated prolactin levels between patients with rheumatoid arthritis and healthy controls, and to assess the effects of antirheumatic treatment on prolactin concentrations. METHODS: Serum prolactin was assessed under basal conditions and during an insulin tolerance

  12. Early detection of patients at risk for rheumatoid arthritis : A challenge for primary and secondary care

    NARCIS (Netherlands)

    C. Alves (Celina)

    2015-01-01

    markdownabstract__Abstract__ Rheumatoid arthritis (RA) is a systemic auto-immune disease mainly characterized by articular manifestations [1]. Patients present initially with synovitis and joint damage, while extra-articular manifestations such as vasculitis, pleuritis and pericarditis are manifest

  13. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Bruyn, G A W

    2009-03-01

    To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the overall agreement between US and MRI.

  14. Progressive subretinal fibrosis in patients with rheumatoid arthritis and renal dysfunction.

    Science.gov (United States)

    Matsuo, T; Matsuo, N

    1998-01-01

    We present two patients (56-year-old and 71-year-old women) who developed subretinal fibrosis in parallel with exacerbation of rheumatoid arthritis and deteriorated renal function. The first patient developed subretinal fibrosis in the right eye, coupled with multifocal choroiditis and serous retinal detachment in both eyes, in the course of rapidly progressive glomerulonephritis complicated with rheumatoid arthritis. Antineutrophil cytoplasmic antibody was positive in a perinuclear pattern (pANCA) and the increased dose of prednisolone to 40 mg/day resulted in subsidence of the subretinal inflammation. The second patient developed subretinal fibrosis in the left eye with mottled retinal pigment epithelium of both eyes, in the course of rheumatoid arthritis and stable chronic renal failure. Although the manifestations of subretinal fibrosis and concurrent renal dysfunction were different between these two patients, subretinal fibrosis might be noted as a complication of rheumatoid arthritis and renal dysfunction.

  15. Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Løppenthin, Katrine; Esbensen, Bente Appel; Jennum, Poul

    2014-01-01

    disturbances, fatigue, pain, depressive symptoms, physical function, health-related quality of life and cardiorespiratory fitness. DISCUSSION: This trial will provide evidence of the effect of intermittent aerobic exercise on the improvement of sleep in patients with rheumatoid arthritis, which is considered......BACKGROUND: Poor sleep is prevalent in patients with systemic inflammatory disorders, including rheumatoid arthritis, and, in addition to fatigue, pain, depression and inflammation, is associated with an increased risk of co-morbidity and all-cause mortality. Whereas non...... of an intermittent aerobic exercise intervention on sleep, assessed both objectively and subjectively in patients with rheumatoid arthritis. METHODS/DESIGN: A randomized controlled trial including 44 patients with rheumatoid arthritis randomly assigned to an exercise training intervention or to a control group...

  16. The humoral immune response to Chlamydia trachomatis in patients with acute reactive arthritis

    DEFF Research Database (Denmark)

    Larsen, B; Birkelund, Svend; Mordhorst, CH;

    1994-01-01

    Sera from 25 patients with clinical signs of reactive arthritis were analysed for antibodies against Chlamydia trachomatis by immunoblotting. Purified elementary bodies, purified Chlamydia outer membrane complexes, and purified recombinant subcomponents were used as antigens. Antibodies against C...

  17. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Bruyn, G. A. W.; Naredo, E.; Moeller, I.; Moragues, C.; Garrido, J.; de Bock, G. H.; d'Agostino, M-A; Filippucci, E.; Iagnocco, A.; Backhaus, M.; Swen, W. A. A.; Balint, P.; Pineda, C.; Milutinovic, S.; Kane, D.; Kaeley, G.; Narvaez, F. J.; Wakefield, R. J.; Narvaez, J. A.; de Augustin, J.; Schmidt, W. A.; Moller, I.; Swen, N.; de Agustin, J.

    2009-01-01

    Objective: To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography ( US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis ( RA) and to determine the overall agreement between US and MRI. Meth

  18. Risk of serious infection in biological treatment of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Singh, Jasvinder A; Cameron, Chris; Noorbaloochi, Shahrzad

    2015-01-01

    BACKGROUND: Serious infections are a major concern for patients considering treatments for rheumatoid arthritis. Evidence is inconsistent as to whether biological drugs are associated with an increased risk of serious infection compared with traditional disease-modifying antirheumatic drugs (DMAR...

  19. Arterial stiffness is not increased in patients with short duration rheumatoid arthritis and ankylosing spondylitis.

    Science.gov (United States)

    Dzieża-Grudnik, Anna; Sulicka, Joanna; Strach, Magdalena; Siga, Olga; Klimek, Ewa; Korkosz, Mariusz; Grodzicki, Tomasz

    2017-04-01

    Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is an independent predictor of CV events. The aim of the study was to assess arterial stiffness and inflammatory markers in patients with short duration chronic arthritis. We assessed carotid-femoral pulse wave velocity (PWV), augmentation index (AIx), traditional CV risk factors and inflammatory and endothelial markers in 71 chronic arthritis patients (RA and AS) and in 29 healthy controls. We did not find differences in PWV (for RA, AS and controls, respectively: 10 [8.8-10.9] versus 10.7 [9.1-11.8] versus 9.2 [8.3-11.4] m/s; p = .14) and AIx (for RA, AS and controls, respectively: 24.3 ± 11.5 versus 5.7 ± 12.4 versus 10 ± 12.8%; p = .22). Both groups of arthritis patients had active disease with significantly elevated inflammatory markers compared to controls. There were no correlations between endothelial and inflammatory markers and parameters of arterial stiffness in arthritis patients. When analyzing arthritis patients according to median of PVW, there were no significant differences in inflammatory and endothelial markers. We found that in patients with short duration active RA and AS arterial stiffness was not increased and furthermore, there was no association between markers of systemic inflammation and arterial stiffness.

  20. Small airway obstruction in patients with rheumatoid arthritis.

    Science.gov (United States)

    Mori, Shunsuke; Koga, Yukinori; Sugimoto, Mineharu

    2011-04-01

    This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF(25-75)) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DL(CO)) and ratio of DL(CO) to alveolar ventilation (DLco/VA) were within the normal range, but median FEF(25-75), forced expiratory flow at 25% of vital capacity (V(25)), and V(25)/height were dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70-15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10-6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27-6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF(25-75), although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF(25-75) are respiratory symptoms, smoking history, and RA duration.

  1. Total knee reconstruction without posterior stabilization in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Radu Prejbeanu

    2010-12-01

    Full Text Available Objectives: to present the results with posterior cruciate ligament-retaining total knee arthroplasty in rheumatoid arthritis (RA patients. Background: Total knee replacement in RA patients has many particularities. One of them is the difficulty of obtaining a proper ligamentous balance.Methods: 24 RA patients were followed for a 5-year period after posterior cruciate ligament-retaining total knee arthroplasty. Clinical assessments analyzed general health status by using Hospital for Special Surgery Knee Evaluation Form (HSSKEF and mediolateral and anteroposterior ligament stability by using varus-valgus and posterior drawer tests. Radiological assessments evaluated axial alignment, size and position of components, radiolucent lines in anteroposterior and lateral standard views, integrity of the posterior cruciate ligament on lateral view X-ray at 45 degrees of flexion.Results: the mean HSSKEF score increased from 32 to 84 points at the end of follow-up. Preoperative mean range of motion was 60 degrees; postoperative mean range of motion was of 105 degrees, with significant statistical difference (p<0.05. The mean femoral component axial deviation was 6 degrees. The tibial component had a mean axial deviation of 1 degree of varus. There were no radioluscency lines of more than 1mm. 21 patients had excellent results. None of the knees was unstable. Conclusion: posterior cruciate ligament-retaining total knee arthroplasty can be used in RA patients without excessive valgus deformity (over 15 degrees, providing thus sufficient stabilization. The outcomes re similar to those patients who followed a posterior stabilized endoprosthesis.

  2. Candida Parapsilosis Arthritis Involving the Ankle in a Diabetes Patient: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Jin Kyeong; Chun, Kyung Ah [Dept. of Radiology, The Catholic University of Korea Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

    2011-06-15

    Candida parapsilosis is a rare opportunistic fungal pathogen of the musculoskeletal region. Immune function of almost all patients is severely disturbed. Most reported cases of septic arthritis of joints by Candida involve the knee, especially Candida parapsilosis. To our knowledge, there has been only one case report of Candida parapsilosis involving the ankle presented on only plain radiography. We report a case of Candida parapsilosis arthritis involving the ankle in a diabetes patient which was shown on MR imaging.

  3. "Wegener’s granulomatosis in a patient with Rheumatoid arthritis "

    Directory of Open Access Journals (Sweden)

    "Ahmadi Nejad Z

    2001-06-01

    Full Text Available Wegener’s Granulomatosis is a necrotizing granulomatous vasculitis involving small and medium sized vessels. The syndrome is classically defined as having involvement of kidney, lungs and upper respiratory tract (i.e. sinuses. Wegener’s Granulomatosis may be present in other autoimmune or inflammatory diseases, particulary systemic lupus erythematosis (SLE, but most frequently has been associated with polyarteritis and glumerulonephritis.We present a case of wegener’s Granulomatosis (WG in a middle age lady with Rheumatiod Arthritis (RA; and discuss the implications of these two conditions co-existing in one patient. As for as we are aware, through medline and interent research, this is probably the fourth case with such as association of WG and RA and the fist one in Iran.Presentation of new uncontrollable sing and symptoms, in a previously well controlled RA patient, might suggest a new overlapping syndrome like Wegener’s Granulomatosis besides to flare up of previous disease as differential diagnosis

  4. Expression of Prostaglandin E2 Enzymes in the Synovium of Arthralgia Patients at Risk of Developing Rheumatoid Arthritis and in Early Arthritis Patients.

    Directory of Open Access Journals (Sweden)

    Maria J H de Hair

    Full Text Available Arthralgia may precede the development of synovial inflammation in autoantibody-positive individuals at risk of developing rheumatoid arthritis (RA. A major pathway involved in pain is the prostaglandin (PG E2 pathway. We investigated this pathway in the synovium of individuals with RA-specific autoantibodies and in early arthritis patients.Nineteen autoantibody-positive individuals (IgM-rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies with arthralgia (n=15 and/or a positive family history of RA (n=8, who had been prospectively followed for at least 2 years, were included. In addition, we included early arthritis patients (disease-modifying antirheumatic drug naïve who after 2 years follow up fulfilled classification criteria for RA (n=63, spondyloarthritis (SpA; n=14, or had unclassified arthritis (UA; n=27. In all subjects we assessed pain and performed synovial biopsy sampling by mini-arthroscopy at baseline. Tissue sections were examined by immunohistochemistry to detect and quantify PGE2 pathway enzymes expression levels (mPGES-1; COX-1 and -2; 15-PGDH.In both study groups synovial expression of PGE2 enzymes was not clearly related to pain sensation. Expression levels at baseline were not associated with the development of arthritis after follow up (6 out of 19 autoantibody-positive individuals. However, in early SpA patients the expression levels of mPGES-1 and COX-1 were significantly increased compared to RA and UA patients.Pain in autoantibody-positive individuals without synovial inflammation who are at risk of developing RA and in early arthritis patients may be regulated by pathways other than the PGE2 pathway or originate at sites other than the synovium. In contrast, in SpA, the PGE2 pathway may be inherently linked to the pathophysiology/etiology of the disease.

  5. Long-Term Safety of Anti-TNF Adalimumab in HBc Antibody-Positive Psoriatic Arthritis Patients: A Retrospective Case Series of 8 Patients

    Directory of Open Access Journals (Sweden)

    R. Laurenti

    2013-01-01

    Full Text Available Immunosuppressive drugs commonly used in the treatment of psoriatic arthritis make patients more susceptible to viral, bacterial, and fungal infections because of their mechanism of action. They not only increase the risk of new infections but also act altering the natural course of preexisting infections. While numerous data regarding the reactivation of tuberculosis infection are available in the literature, poor information about the risk of reactivation or exacerbation of hepatitis viruses B and C infections during treatment with biologics has been reported. Furthermore, reported series with biological therapy included short periods of followup, and therefore, they are not adequate to verify the risk of reactivation in the long-term treatment. Our study evaluated patients with a history of hepatitis B and psoriatic arthritis treated with adalimumab and monitored up to six years. During the observation period, treatment was effective and well tolerated in all patients, and liver function tests and viral load levels remained unchanged.

  6. The Human and Economic Burden of Difficult-to-Treat Gouty Arthritis

    NARCIS (Netherlands)

    Oude Voshaar, Martijn A.H.; Bardin, Thomas; Laar, van de Martinus A.F.J.

    2015-01-01

    Gouty arthritis, one of the most painful and common forms of adult arthritis, is caused by monosodium urate crystal deposits in joints, most often in the lower extremities. Crystals trigger an inflammatory response leading to acute flares characterized by a rapid onset of pain, warmth, swelling, and

  7. [A case of pseudomembranous colitis in a juvenile rheumatoid arthritis patient taking methotrexate].

    Science.gov (United States)

    Yu, Ji Han; Kim, Na Young; Lee, Hae Min; Lee, Ha Ni; Ahn, Hyo Jun; Kim, Sang Woo; Choi, Kyu Yong

    2010-12-01

    Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.

  8. Temporomandibular joint alterations and their orofacial complications in patients with juvenile idiopathic arthritis.

    Science.gov (United States)

    Carvalho, Renata Teixeira de; Braga, Flávia Silva Farah Ferreira; Brito, Fernanda; Capelli Junior, Jonas; Figueredo, Carlos Marcelo; Sztajnbok, Flávio Roberto

    2012-12-01

    Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications.

  9. Intravenous Laser Blood Irradiation and Tocilizumab in a Patient with Juvenile Arthritis

    Directory of Open Access Journals (Sweden)

    Dragos Andrei Chiran

    2014-01-01

    Full Text Available This study presents effects of intravenous laser blood irradiation (ILBI in a transient immunodeficiency patient with juvenile idiopathic arthritis (JIA treated with an interleukin-6 receptor inhibitor (Tocilizumab. Biological agents induce JIA remission, but some patients do not respond favorably to this final therapeutic line of defense. ILBI was performed in a 16-year-old male patient, with JIA and transient immunodeficiency. When ILBI was introduced, the patient was receiving disease-modifying drugs, steroids, tocilizumab, and physical therapy. Because the disease was not well controlled, ILBI was applied in addition to other ongoing therapies. The patient underwent 1 session daily, and 10 successive sessions per month, repeated every 3 months, for 7 months. Patient evaluation was performed before ILBI was started and at 3, 6, 9, and 12 months after ILBI initiation, using the ACR Pediatric response. The outcome was evaluated using Pediatric 50, 70, and 90 responses and compared to initial status, after 3, 6, 9, and 12 months. At the end of study, the titre of IgA and IgG levels returned to normal. Synergistic anti-inflammatory effect of ILBI was evident, if applied additionally in combination with tocilizumab, in a patient with a therapy-resistant severe form of JIA and related subacute transient immunodeficiency.

  10. Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis.

    LENUS (Irish Health Repository)

    Tobin, Anne-Marie

    2012-02-01

    OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) have an increased incidence of cardiovascular disease (CVD) and cardiovascular risk factors such as smoking, hypertension, and metabolic syndrome compared to the normal population. Patients with psoriasis and PsA may also have increased risk from nonconventional risk factors such as raised levels of homocysteine and excessive alcohol consumption. We conducted a comprehensive review of the literature on CVD and all cardiovascular risk factors in patients with psoriasis and PsA. METHODS: Data sources: All studies identified from a Medline (www.ncbi.nlm.nih.gov) search pertaining to CVD, individual risk factors in psoriasis, and PsA were included. Study selection: Studies included a healthy reference population, were published between 1975 and 2009, and were written in English. RESULTS: Our search yielded 14 studies that documented rates of CVD in patients with psoriasis and PsA compared to controls. Substantial evidence points to elevated risk of CVD in patients with psoriasis and PsA. CONCLUSION: It remains difficult to conclude if risk factors are caused by psoriasis or share a common pathogenesis. Physicians treating patients with psoriasis and PsA must be aware of all potential cardiovascular risk factors in their patients.

  11. Effect of methotrexate and anti-TNF on Epstein-Barr virus T-cell response and viral load in patients with rheumatoid arthritis or spondylarthropathies

    OpenAIRE

    Miceli-Richard, Corinne; Gestermann, Nicolas; Amiel, Corinne; Sellam, Jérémie; Ittah, Marc; Pavy, Stephan; Urrutia, Alejandra; Girauld, Isabelle; Carcelain, Guislaine; Venet, Alain; Mariette, Xavier

    2009-01-01

    Introduction There is a suspicion of increased risk of Epstein-Barr virus (EBV)-associated lymphoproliferations in patients with inflammatory arthritides receiving immunosuppressive drugs. We investigated the EBV load and EBV-specific T-cell response in patients treated with methotrexate (MTX) or anti-TNF therapy. Methods Data for patients with rheumatoid arthritis (RA) (n = 58) or spondylarthropathy (SpA) (n = 28) were analyzed at baseline in comparison with controls (n = 22) and after 3 mon...

  12. Efficacy of prednisone 1–4 mg/day in patients with rheumatoid arthritis: a randomised, double-blind, placebo controlled withdrawal clinical trial

    OpenAIRE

    2008-01-01

    Objective: A randomised double-blind placebo controlled withdrawal clinical trial of prednisone versus placebo in patients with rheumatoid arthritis (RA), treated in usual clinical care with 1–4 mg/day prednisone, withdrawn to the same dose of 1 mg prednisone or identical placebo tablets. Methods: All patients were from one academic setting and all trial visits were conducted in usual clinical care. Patients were taking stable doses of 1–4 mg prednisone with stable clinical status, documented...

  13. PADI4 Polymorphisms in Iranian Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Elmira Shamsian

    2016-10-01

    Full Text Available Aim: Rheumatoid arthritis (RA is a chronic autoimmune disease which affects many tissues and organs, but majorly attacks synovial joints. Beyond the major histocompatibility complex (MHC genes, Peptidyl arginine deiminase type IV (PADI4 has been suggested to be associated with RA susceptibility. Evidence regarding the association of PADI4 single nucleotide polymorphisms (SNP and RA is controversial, thus we conducted this large-scale case-control study to assess the association of rs874881 and rs11203367 PADI4 SNPs with susceptibility to RA. Materials and Methods: Study population (including 665 RA patients and 392 sex-, age-, and ethnicity-matched healthy controls were enrolled from Rheumatology Research Center of Tehran University of Medical Sciences, Shariati hospital. Results: Allele or genotype frequencies of the investigated PADI4 SNPs were not different between RA patients and healthy subjects; genotypes (expressed as odds ratios of rs11203367 [TT 0.98 (0.68-1.4, CT 0.93 (0.71-1.24, P value > 0.05] and rs874881 [CC 1.02 (0.71-1.46, CG (0.70-1.39, p value > 0.05] did not affect RA risk. Disease severity score DAS28, RF and anti-CCP antibodies of RA patients were not different between various genotypes of PADI4 SNPs. Conclusions: These findings were similar for haplotypes and diplotypes of rs11203367 and rs874881 PADI4 SNPs. In conclusion, in this case-control study with sufficient sample size to detect associations, we observed that PADI4 SNPS rs11203367 and rs874881 do not significantly determine RA susceptibility; which is in line with studies of some European populations. It seems RA pathogenesis might be different among various ethnicities, which encourage us to consider these differences in developing therapeutic interventions for management of patients.

  14. Non-pharmacological and pharmacological interventions in patients with early arthritis: a systematic literature review informing the 2016 update of EULAR recommendations for the management of early arthritis

    Science.gov (United States)

    DAIEN, Claire Immediato; HUA, Charlotte; COMBE, Bernard; LANDEWE, Robert

    2017-01-01

    Objective To perform a systematic literature review (SLR) on pharmacological and non-pharmacological treatments, in order to inform the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis (EA). Methods The expert committee defined research questions concerning non-pharmacological interventions, patient information and education, non-steroidal anti-inflammatory drug, glucocorticoid (GC) and disease-modifying antirheumatic drugs (DMARDs) use, as well as on disease monitoring. The SLR included articles published after the last EULAR SLR until November 2015 found in the MEDLINE, EMBASE and Cochrane databases and abstracts from the 2014 and 2015 American College of Rheumatology and EULAR conferences. Results Exercise programmes may improve pain and physical function in patients with EA. Patients with EA treated within the first 3 months of symptoms have better clinical and radiological outcomes than those treated beyond 3 months. The clinical and radiological efficacy of GCs is confirmed, with similar efficacy of oral and parenteral administrations. Long-term data raise concerns regarding cardiovascular safety when using GCs. Step-up DMARD therapy is as effective as intensive DMARD therapy ‘ab initio’ for the long-term outcome of EA. Short-term superiority of intensive therapy with bDMARDs is not maintained on withdrawal of bDMARD. Patients with early psoriatic arthritis have better skin and joint outcomes when tight control is used compared to standard care. Conclusions The findings confirm the beneficial effect of exercise programmes and the importance of early drug therapy and tight control. They support the use of methotrexate and GCs as first-line drugs, although the long-term use of GCs raises safety concerns.

  15. The effect of infliximab on antiviral antibody profiles in patients with rheumatoid arthritis.

    Science.gov (United States)

    Kaufman, Ilana; Moscovici, Yolanda Braun; Abudi, Yair; Sofer, Denit; Mendelson, Ella; Balbir-Gurman, Alexandra; Caspi, Dan; Elkayam, Ori

    2010-01-01

    The duration of humoral immunity in patients treated with immunosuppressive drugs is poorly defined. The objective of the study was to investigate the effect of infliximab on the levels of antiviral antibodies against poliomyelitis, rubella and measles in rheumatoid arthritis (RA) patients. Fifty-two consecutive RA patients being treated with 3 mg/kg infliximab were prospectively studied. The antiviral antibody profiles for measles, rubella and three serotypes of poliomyelitis were tested on the day of the first infusion of infliximab and 6 months later. The study group comprised 36 women and 16 men (mean age 54 years, range 33-81) with a mean disease duration of 15 +/- 9 years. Forty-two (81%) patients were being treated with methotrexate and 22 (42%) were receiving prednisone. All patients had baseline protective levels of antibodies against measles and the three strains of polio, while 48 (92%) patients had protective antibodies against rubella. No significant change in the levels of antiviral antibodies was observed after 6 months of treatment with infliximab: from 3.67 at baseline to 3.87 IU/ml for measles, 169.50-197.0 IU/ml for rubella. No change was noticed for the geometric mean concentrations of antibodies against strains of poliomyelitis: 366-478 IU/ml for the Mahoney polio strain, 906-845 IU/ml for the MEF strain and 175-196 IU/ml for the Sauket strain. Patients with longstanding RA conserve long-term immunity to common viruses despite the use of immunosuppressive drugs. Levels of antiviral antibodies against measles, rubella and polio remain stable under treatment with infliximab.

  16. An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors\\' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.

  17. Influence of physical treatment on disease activity and health status of patients with chronic arthritis

    Directory of Open Access Journals (Sweden)

    Mustur Dušan

    2008-01-01

    Full Text Available Introduction This is an open uncontrolled study about effects of physical treatment on disease activity parameters of patients with rheumatoid arthritis and psoriatic arthritis. Objective The aim of the study was to establish if there was any improvement of disease activity parameters after four weeks of physical and spa treatment. METHOD We compared morning stiffness, tender and swollen joint count, body pain level and Disease Activity Score 28 (DAS-28 in patients with rheumatoid and psoriatic arthritis, and assessed the effect of physical and spa treatment on those parameters. The research encompassed 109 patients: 69 with rheumatoid arthritis (RA group and 40 with psoriatic arthritis (PA group. They were from Norway, staying for four weeks in June-September 2003. The groups served as their own controls - "one group pre-test post test" study. Disease activity measurement was made twice: at the beginning and at the end of treatment. The therapeutic set consisted of mud applications, kinesitherapy, mineral water pool and electrotherapy. Results At the beginning there was no significant difference in observed disease activity parameters between patients with rheumatoid and psoriatic arthritis (p>0.05. After four weeks of physical and spa treatment disease activity was significantly reduced in all observed parameters in both groups: morning stiffness (p<0.001 RA+PA, tender joint count (p<0.01 RA+PA, swollen joint count (p<0.01 RA; p<0.05 PA, body pain (p<0.01 RA+PA and DAS-28 score (p<0.01 RA+PA. Conclusion Physical and spa treatment, together with climatic factors in Igalo, lead to a significant reduction of disease activity parameters of patients suffering from rheumatoid arthritis and psoriatic arthritis. .

  18. 针刀治疗痛风性关节炎疗效观察%Efficacy observation on treating gouty arthritis by acupuncture

    Institute of Scientific and Technical Information of China (English)

    杨戈

    2012-01-01

      Objective: To investigate the clinical efficacy of acupuncture on treating gout arthritis. Methods: Retrospective analysis of the medical records that patients with gout were treated by acupuncture plus TCM and medicinal liquor oral topicalnearly a decade. Results: The clinical cure rate was more than 90%, the recurrence rate is very low. Conclusion: The acupuncture have a breakthrough in principle and the cure rate, that explains the effect of acupuncture is simple and convenient on treating gouty arthritis, and worthy of clinical promoted application.%  目的:探讨针刀治疗痛风的临床疗效。方法:回顾分析近十年间所有痛风患者给予小针刀配合中药、药酒内服外用之病案。结果:临床治愈率达90%以上,复发率极低。结论:小针刀治疗痛风在原理上和治愈率方面均有突破,说明小针刀治疗痛风性关节炎具有简便验廉的效果,值得临床大力推广运用。

  19. Septic manubriosternal arthritis in a patient with Reiter's disease.

    Science.gov (United States)

    Van Linthoudt, D; De Torrente, A; Humair, L; Ott, H

    1987-06-01

    A man with a quiescent Reiter's disease presented with abrupt upper chest pain. This symptom resulted from a septic arthritis of the manubriosternal joint due to staphylococcus aureus cultured from the synovial fluid.

  20. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    Science.gov (United States)

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p notch step-off, diastasis or DRUJ

  1. Infliximab Induces Increase in Triglyceride Levels in Psoriatic Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Karla R. Castro

    2011-01-01

    Full Text Available Objectives. To evaluate lipid profile changes after anti-TNF therapy in patients with psoriatic arthritis (PsA. Methods. Fifteen PsA patients (eight polyarticular, four oligoarticular, two axial, and one mutilating under infliximab were included. None had dyslipoproteinemia or previous statin use. Total cholesterol (TC and its fractions, inflammatory markers, and prednisone use were evaluated. Results. The comparisons of lipid levels between baseline and after three months (3M of anti-TNF therapy showed that there was a significant increase in mean triglycerides (117.8±49.7 versus 140.1±64.1 mg/dL, P=0.028 and VLDL-c (23.6±10.5 versus 28.4±13.7 mg/dL, P=0.019 levels. In contrast, there were no differences in the mean TC (P=0.28, LDL-c (P=0.42, and HDL-c (P=0.26 levels. Analysis of the frequencies of each lipid alteration at baseline and at 3M were alike (P>0.05. Positive correlations were found between VLDL-c and CRP (r=0.647, P=0.009 and between triglycerides and CRP (r=0.604, P=0.017 levels at 3M. ESR reduction was observed after 3M (P=0.04. Mean prednisone dose remained stable at beginning and at 3M (P=0.37. Conclusion. This study demonstrated that anti-TNF may increase TG and VLDL-c levels in PsA patients after three months.

  2. TNF and LT binding capacities in the plasma of arthritis patients: effect of etanercept treatment in juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Gudbrandsdottir, S; Larsen, R; Sørensen, L K;

    2004-01-01

    Etanercept (Enbrel) induces a rapid and sustained decline in disease activity in the majority of patients with refractory juvenile idiopathic arthritis (JIA). For unknown reasons, however, a number of JIA patients fail to respond to this therapy. During this treatment neutralisation of tumour...... necrosis factor (TNF, previously termed TNF alpha) and lymphotoxin (LT, previously termed TNF beta) may be mediated by etanercept itself as well as by naturally occurring soluble TNF receptors. In light of this, it was of interest to study the total TNF neutralizing capacity in plasma before and during...... treatment with etanercept....

  3. Septic arthritis as the first sign of Candida tropicalis fungaemia in an acute lymphoid leukemia patient

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    Vicari Perla

    2003-01-01

    Full Text Available Fungal infections caused by Candida species have increased in incidence during the past two decades in England, North America and Europe. Candidal arthritis is rare in patients who are not intravenous drug users or are who not using a prostheses. We report the case of a 24-year-old man with acute lymphoid leukemia, who developed Candida tropicalis arthritis during an aplastic period after chemotherapy. This is the eighth case described in the literature of C. tropicalis causing arthritis without intra-articular inoculation. We call attention to an unusual first sign of fungal infection: septic arthritis without intra-articular inoculation. However, this case differs from the other seven, since despite therapy a fast and lethal evolution was observed. We reviewed reported cases, incidence, risk factors, mortality and treatment of neutropenic patients with fungal infections.

  4. Cancer risk of anti-TNF-α at recommended doses in adult rheumatoid arthritis: a meta-analysis with intention to treat and per protocol analyses.

    Directory of Open Access Journals (Sweden)

    Guillaume Moulis

    Full Text Available BACKGROUND: The risk of malignancies on TNF-α antagonists is controversial. The aim of this survey was to assess cancer risk on TNF-α antagonists in adult rheumatoid arthritis patients, including the five marketed drugs (infliximab, etanercept, adalimumab, golimumab and certolizumab used in line with the New Drug Application. Furthermore, the relative interest of modified intention to treat or per protocol analyses to assess such sparse events remains unknown. METHODOLOGY/PRINCIPAL FINDINGS: Data sources were MEDLINE, CENTRAL, ISI Web of Science, ACR and EULAR meeting abstracts, scientific evaluation of the drugs leading to their marketing approval, and clinicaltrials.gov, until 31 December 2012.We selected double-blind randomized controlled trials in adult rheumatoid arthritis patients, including at least one treatment arm in line with New Drug Application. We performed random effect meta-analysis, with modified intention to treat and per protocol analyses. Thirty-three trials were included. There was no excess risk of malignancies on anti-TNF-α administered in line with New Drug Application in the per protocol model (OR, 0.93 95%CI[0.59-1.44], as well as in the modified intention to treat model (OR, 1.27 95%CI[0.82-1.98]. There was a non-significant tendency for an excess non-melanoma skin cancer risk in both models (respectively, 1.37 [0.71-2.66] and 1.90 [0.98-3.67]. With fixed effect Peto model restricting to trials during at least 52 weeks, the overall cancer risk was respectively 1.60 [0.97-2.64] and 1.22 [0.72-2.08]. Whatever the model, modified intention to treat analysis led to higher estimations than per protocol analysis. The later may underestimate the treatment effect when assessing very sparse events and when many patients dropped out in placebo arms. In metaregression, there was no differential risk among the five drugs. CONCLUSIONS/SIGNIFICANCE: This study did not find any evidence for an excess cancer risk on TNF

  5. Ayurveda-modern medicine interface: A critical appraisal of studies of Ayurvedic medicines to treat osteoarthritis and rheumatoid arthritis.

    Science.gov (United States)

    Chopra, Arvind; Saluja, Manjit; Tillu, Girish

    2010-07-01

    The potential of Ayurvedic philosophy and medicines needs to be recognized and converted into real life treatment paradigm. This article describes a comprehensive therapeutic approach used in Ayurveda and modern medicine to treat arthritis. We present concise summary of various controlled drug trials carried out by us to validate standardized Ayurvedic drugs using modern medicine protocol to treat Rheumatoid Arthritis and Osteoarthritis knees. Several of the latter are published. The trials consistently demonstrate excellent safety of Ayurvedic medicines but often fail to unequivocally show superior efficacy. Some key findings of a recently unpublished trial in OA knees are also presented to show equivalence between Ayurvedic medicine and celecoxib and glucosamine, and we speculate that equivalence trials may be a way forward. The data from the trials also supports the Ayurvedic 'Rasayana' concept of immune-modulation and healing. We need to interpret logic of Ayurveda when, adopting modern science tools in drug development and validation and much research is required. Validation of Ayurvedic medicines using the latter approach may lead to an evidence based Ayurveda - Modern Medicine interface. Also, in pursuit of finding better treatment solutions, we ought to step beyond the realm of only drugs and attempt validation of comprehensive specific treatment package as per classical Ayurveda. Finally, validation of a combined (Ayurveda and modern medicine) therapeutic approach with superior efficacy and safety is likely to be a major leap in overcoming some of the current frustrations to treat difficult disorders like arthritis using only modern medicines.

  6. Efficiency of teaching patients with early-stage rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Evgenia Vladislavovna Orlova

    2014-01-01

    Full Text Available Education programs are an important part of the management of patients with rheumatoid arthritis (RA.Objective: to develop a unified model of an education program for RA patients and to evaluate its efficiency at the early stage of the disease.Material and methods. A group education program was worked out with the support of the All-Russian public organization of the disabled “The Russian rheumatology organization “Nadezhda” (Hope” and encompassed 4 daily classes lasting 90 min. All information was presented by a multidisciplinary team of specialists (rheumatologists, a cardiologist, a psychologist, a physiotherapist, and a physical trainer. The study included 55 patients with early RA (89.1% of women aged 18 to 62 years; the duration of the disease was 2 to 22 months; of them 25 were taught using the education program (a study group; 30 received drug therapy only (a control group. Following 3 and 6 months, the number of tender and swollen joints, erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, and pain were determined applying a 100-ml VAS, DAS28, HAQ, and RAPID3. Adherence to non-drug treatments was assessed employing a special patient questionnaire.Results. Three and six months after being taught, two patient groups showed increases in adherence to joint protection methods by 13 and 10 times (p<0.01, regular physical training by 4 and 3.25 times (p<0.01, uses of orthoses for the wrist joint by 2 times and 75% (p<0.01 and knee orthoses by 33.3 and 50.0% (p<0.01, and orthopedic insoles by 71.4 and 57.1% (p<0.01, respectively. Following 6 months, there were statistically significant differences between the two groups in most parameters (p<0.05, except for ESR, CRP, and DAS28 (p>0.05. Further more, a good response to treatment was significantly more common in these periods, as shown by the EULAR response criteria (DAS28: 56.3% versus 40% in the control group (p<0.05.Conclusion. The education program decreases the intensity

  7. Prevalence and significance of MEFV gene mutations in patients with gouty arthritis.

    Science.gov (United States)

    Karaarslan, Ahmet; Kobak, Senol; Kaya, Işın; Intepe, Nazım; Orman, Mehmet; Berdelı, Afig

    2016-11-01

    Gouty arthritis is a chronic erosive autoinflammatory disease. Pyrin has anti-inflammatory effects in the regulation of inflammasome and is encoded by the MEFV gene. The relationship between different rheumatic diseases and the MEFV gene mutations was demonstrated. The aim of this study was to determine the frequency of MEFV gene mutations in patients with gouty arthritis and identify a possible correlation with disease phenotype. Ninety-three patients with gouty arthritis and 102 healthy controls, compatible with age, gender and ethnicity, were included in the study. MEFV gene mutations were investigated by PCR method. Out of 93 patients with gouty arthritis, 36 (38.7 %) showed MEFV gene mutations carriage, whereas 20.6 % in healthy control group. Distribution of mutations identified in patients with gouty arthritis was as; R202Q in 18 (19.3 %), E148Q in 5 (5.4 %), K695R in 4 (4.3 %), M680I in 2 (2.1 %), V726A in 2 (2.1 %), P369S in 2 (2.1 %), R408Q in 2 (2.1 %), M694 V in 1 (1.1 %), respectively. Three patients were identified with compound heterozygosity. Distribution of MEFV gene mutations carriage in healthy controls was; E148Q in 11 (10.7 %), M694 V in 2 (1.9 %), M694I in 1 (0.9 %), M680I in 2 (1.9 %), V726A in 1 (0.9 %), A744S in 1 (0.9 %), K695R in 2 (1.9 %), and P369S in 1 (0.9 %) patients, respectively. Higher MEFV gene mutations carrier frequency was observed in patients with gouty arthritis, compared with the control group (p = 0.009). Heterozygous R202Q was the most common mutation detected in patients with gouty arthritis, while heterozygous E148Q in healthy control group. Statistically significant difference was not detected between clinical findings of gouty arthritis and the MEFV gene mutations (p > 0.05). We determined higher prevalence of MEFV gene mutations in patients with gouty arthritis compared with the healthy control group. The most frequently detected mutation was heterozygous R202Q, whereas E148Q in healthy

  8. An Evaluation of Non-Surgical Periodontal Therapy in Patients with Rheumatoid Arthritis

    OpenAIRE

    Roman-Torres, Caio V.G; Neto, José S; Souza, Marcio A; Schwartz-Filho, Humberto O; Brandt, William C; Diniz, Ricardo E.A.S

    2015-01-01

    aim of this study was to evaluate the efficacy of periodontal scaling and oral hygiene instruction for patients with mild chronic periodontitis and rheumatoid arthritis through clinical periodontal parameters and laboratory tests for CRP (C- reactive protein) and ESR (erythrocyte sedimentation rate). Twelve individuals with rheumatoid arthritis and 12 healthy individuals were evaluated, with a mean age of 45.38 and 46.75 respectively, all female and with mild, chronic periodontitis. The parti...

  9. Treatment of knee flexion contracture in patients with chronic juvenile arthritis: A case report

    OpenAIRE

    Matijević Radmila; Stanković Milan; Ninković Srđan; Savić Dragan; Milankov Miroslav

    2006-01-01

    Introduction. Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. Case report. A 23-year-old female patient with chronic juvenile arthriti...

  10. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany

    Directory of Open Access Journals (Sweden)

    Waller J

    2017-03-01

    Full Text Available John Waller,1 Emma Sullivan,1 James Piercy,1 Christopher M Black,2 Sumesh Kachroo2 1Adelphi Real World, Manchester, UK; 2Center for Observational and Real-World Evidence (CORE, Merck & Co., Inc., Kenilworth, NJ, USA Objectives: We examined rheumatologists’ motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. Methods: Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015–2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into “investigative”, “conservative” and “other” groups. Results: Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for <10% of all biologic therapy prescriptions, and >95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%–41%, potential side effects (26%–32% and potential long-term problems (19%–30%. Conclusion: Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and

  11. Anti-TNFa treatment in patients with rheumatoid arthritis and anti-Ro/SSA antibodies

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    P. Airò

    2011-09-01

    Full Text Available Objective: To analyse clinical efficacy, onset of new autoantibodies or symptoms of autoimmune disease in patients affected by rheumatoid arthritis with anti-Ro/SSA treated with anti-TNFa agents. Methods: Six anti-Ro/SSA positive subjects with RA were studied every six months until 24th month of treatment in order to detect ANA titer (IFI, anti-dsDNA (Farr, anti-cardiolipin and anti-beta2glycoprotein I (ELISA, anti-ENA (CIE. The titre of anti-Ro/SSA were analysed by ELISA. Four patients were diagnosed as overlap RA/SS. Results: Six female patients (mean age 58ys, SD 9.8ys, with long-standing RA (mean 7ys, range 5-22 ys were treated with anti-TNFa agents for a mean of 31 months (SD: 20.4 m: 4 with Infliximab and 2 with Etanercept. All the patients showed a significant reduction of DAS until 24th month (p<0.006 with stability of sicca symptoms. The titer of ANA and anti-Ro/SSA was stable, while 4 subjects developed anti-dsDNA at low titer within 6-12 months. One patient withdrawn the treatment, because of lupus-like features; another one, with HCV hepatitis, interrupted Etanercept because of elevation of liver enzymes. No anticardiolipin or antibeta2GPI antibodies were detected. One subject with RA-SS also presented a primary biliary cirrhosis: clinical and histological features of cholangitis remained stable during Etanercept treatment. Conclusions: Anti-TNFa treatment showed good efficacy and safety in anti-Ro/SSA positive patients with RA. Anti-ds- DNA antibodies at low titer appeared in most patients while the onset of lupus-like disease could be considered a rare event also in RA patients with a rich autoimmune repertoire.

  12. ULTRASONOGRAPHIC ASSESSMENT OF COMMON CAROTID ARTERY ATHEROSCLEROSIS IN PATIENTS OF RHEUMATOID ARTHRITIS

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    Jayakumar

    2015-02-01

    Full Text Available BACKGROUND & OBJECTIVES: Patients with Rheumatoid Arthritis (R.A. have a marked increase in Carotid Atherosclerosis independent of traditional risk factors like family history of myocardial infarction in first degree male relatives younger than 55 years of age or first degree female relatives younger than 65 years of age, smoking, hypertension (D efined as blood pressure of 140/90 mm hg or higher, diabetes mellitus and fasting serum cholesterol levels including age. Chronic inflammation and possibly disease severity and duration are atherogenic in Rheumatoid Arthritis patients. Preclinical disease may also be identified by using ultrasonography to determine carotid intimal - media thickness, an indirect measure of atherosclerosis. The common carotid artery Intima media thickness in Rheumatoid Arthritis patients is positively associated with disease duration, Early Rheumatoid Arthritis (D uration less or = 1 year is associated with lesser Intima media thickness than was Rheumatoid Arthritis of longer duration. Increased carotid artery Intima media thickness and the presence of carotid plaque are associated with markers of systemic inflammation in patients with Rheumatoid Arthritis and in healthy subjects. OBJECTIVE OF THE STUDY: To determine preclinical atherosclerosis occurring prematurely in patients of Rheumatoid Arthritis by ultrasonograhic measurement Common Carotid Artery Intima media thickness and to evaluate the risk factors associated with arterial intima media thickness in patient of Rheumatoid Arthritis. RESULTS: In RA patients, common carotid artery IMT was significantly higher when compared to healthy controls (0.65 ± 0.06 v/s 0.57 ± 0.049 and was significantly associated with the duration of RA, swollen joint count and erosive changes on hand x - ray independently of other confounding variables. CONCLUSION: Patients with rheumatoid arthritis have a marked increase in carotid atherosclerosis independent of traditional risk factors

  13. Secondary Sjogren's Syndrome in 83 Patients With Rheumatoid Arthritis

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    Asghar Hajiabbasi

    2016-07-01

    Full Text Available Sjogren syndrome (SS can occur alone, primary Sjogren syndrome, or in association with other rheumatic diseases, secondary Sjogren syndrome (sSS, such as Rheumatoid arthritis (RA. The occurrence of Sjogren syndrome with RA makes it course worse and increases high morbidity and mortality of RA. In this exploratory study we aim to determine the prevalence of sSS (diagnosed based on the revised version of American–European consensus Group Classification Criteria: AUCG-criteria, sicca symptoms (dry eye, dry mouth, positive autoantibody tests (Anti RO or Anti-LA antibodies, UWSFR (Unstimulated Whole Salivary Flow Rate, Schirmer and Lissamine test. In this cross-sectional study, eighty three consecutive RA patients (according to American College of Rheumatology criteria 1987 who were visited at rheumatology clinic of Razi General Hospital located in the north of Iran entered into our study. Our exclusion criteria was a positive history of past head and neck radiation treatment, Hepatitis C infection, acquired immunodeficiency disease (AIDS, pre-existing lymphoma, sarcoidosis, graft versus host disease, use of anticholinergic drugs (including neuroleptics, antidepressants, antihypertensive and parasympatholytics. They examined with UWSFR by a rheumatologist and with Schirmer test and Lissamine test by an ophthalmologist. Participants were 90.4% female with the mean age 48.3±13 years. Duration of RA was in 36.1% less than 5 years, in 22.9% 5-10 years, in 12.1% 11-15 years and in 28.9% more than 15 years. Our results demonstrated that the prevalence of sSS was 5.9% (CI:0.6%-10.5%. Number of 27.7% of RA patients positively responded to at least one question about sicca symptoms. Among objective tests, only Positive UWSFR and Lissamine test were significantly more common in RA patients with sSS in comparison to ones without sSS (P<0.001, P=0.01 respectively. In RA patients, we found a linear trend between sicca symptoms and aging (P=0.02. In patients

  14. Fungal arthritis of the wrist caused by Candida parapsilosis during infliximab therapy for rheumatoid arthritis.

    Science.gov (United States)

    Miyamoto, Hideaki; Miura, Toshiki; Morita, Euan; Morizaki, Yutaka; Uehara, Kosuke; Ohe, Takashi; Tanaka, Sakae

    2012-11-01

    A 60-year-old woman with rheumatoid arthritis, who had been treated with infliximab, presented with uncontrollable wrist arthritis. Fungal arthritis caused by Candida parapsilosis was confirmed by examining her aspirated joint fluid. Her infliximab therapy was interrupted, and antifungal therapy with fluconazole was started. After the fungal infection had been ameliorated, surgical debridement and arthrodesis of the wrist joint were conducted, and her symptoms completely resolved. Although fungal arthritis is rare, it should be considered as a differential diagnosis of exacerbated monoarthritis in patients treated with biological agents.

  15. PREDICTION OF CLINICAL EFFICIENCY OF SIMVASTATIN TREATMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    I. V. Shirinsky

    2009-01-01

    Full Text Available Abstract. Treatment with statins results in reduction of disease activity in one-third of patients with rheumatoid arthritis (RA. The aim of this study was to assess some factors that may predict clinical response to simvastatin therapy before starting the treatment. We evaluated an association of treatment efficacy with baseline clinical and laboratory parameters including disease activity measures, cytokine profiles in sera and culture supernatants of peripheral blood mononuclear cells. Thirty-three patients with active RA were enrolled in the study. The patients were treated with simvastatin at 40 mg/day for three months. Eleven patients (33% developed a moderate response according to EULAR criteria. It was shown that serum IL-10 concentrations was higher in responders, and positively correlated with clinical response to simvastatin. We carried out a receiver operating characteristic curve (ROC analysis in order to assess the accuracy of serum IL-10 for the predicting of EULAR response development. The cut-off threshold corresponding to the highest sensitivity (89% and specificity (62% was a value of 6.5 pg/ml. In conclusion, the performance characteristics of serum IL-10 measurement proved to be good enough to predict EULAR response to simvastatin therapy in RA patients.

  16. Effects of Bee Venom Acupuncture on the Rehabilitation and Quality of Life in Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Lee Sang-Hoon

    2002-12-01

    Full Text Available Objective: To evaluate the effects of bee venom acupuncture(BVA on the rehabilitation and quality of life in rheumatoid arthritis(RA patients Methods: Patients with RA were treated with the BVA therapy twice a week for 3 months. Tender joint counts, swollen joint counts, morning stiffness, Erythrocyte Sedimentation Rate(ESR, C-reactive protein(CRP, patient global assessment, physician global assessment, Korean health assessment questionnaire(KHAQ were estimated and analyzed before and after BVA therapy. Results: Tender joint counts, swollen joint counts, morning stiffness showed significant decrease after BVA therapy. But, as acute inflammatory reactants, ESR showed no significant difference and CRP showed significant increase after BVA therapy. Patient global assessment, physician global assessment, and KHAQ index showed significant improvement after BVA therapy. Conclusions: BVA therapy can improve rehabilitation and health-related quality of life in RA patients as well as clinical symptoms and signs. Further study is required in more population with large scale including acute inflammatory reaction of BVA therapy.

  17. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany

    Science.gov (United States)

    Waller, John; Sullivan, Emma; Piercy, James; Black, Christopher M; Kachroo, Sumesh

    2017-01-01

    Objectives We examined rheumatologists’ motivation for prescribing biosimilars, assessed their treatment preferences in relation to prescribing behavior and explored patient attitudes to biosimilars. Methods Data were taken from the Adelphi Real World Biosimilars Programme, a real-world, cross-sectional study undertaken with German rheumatologists and patients with rheumatoid arthritis, ankylosing spondyloarthritis or psoriatic arthritis in 2015–2016. Rheumatologists provided data on their prescribing behavior and attitudes toward biosimilars and invited the next eight eligible consecutive consulting patients to complete a questionnaire. Rheumatologists were split into “investigative”, “conservative” and “other” groups. Results Overall, 50 rheumatologists and 261 patients participated. Biosimilars accounted for 95% of rheumatologists would prescribe a biooriginator rather than biosimilar as the first- or second-line therapy if unrestricted. Patients showed some reluctance to accept biosimilars, and a small proportion of patients were unhappy when switched from a biooriginator to a biosimilar. Satisfaction with treatment was highest in patients who started treatment with a biooriginator prior to biosimilar availability. Patient concerns when starting treatment with a biooriginator or a biosimilar included not knowing enough about the drug (25%–41%), potential side effects (26%–32%) and potential long-term problems (19%–30%). Conclusion Study results demonstrate that there is some reluctance from patients to accept biosimilars and the need to educate patients who are unsure to allow them to be involved in decision making, highlighting the importance of patient and physician communication. There remains a need for further research into nonclinical switching and the long-term impact of prescribing biosimilars. PMID:28331299

  18. Patients with rheumatoid arthritis have an altered circulatory aggrecan profile

    Directory of Open Access Journals (Sweden)

    Mueller Andreas

    2008-05-01

    Full Text Available Abstract 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 The study consisted of 38 patients, 12 males (62.2 ± 16.0 years and 26 females (59.8 ± 20.7 years diagnosed with RA: 41.5 ± 27.5 mm/h erythrocyte sedimentation rate (ESR, 38.4 ± 34.7 mg/ml C-reactive protein (CRP and 4.8 ± 1.7 disease activity score (DAS and 108 healthy age-matched controls. Aggrecan levels were measured using two immunoassays, i.e. the 374ARGSVI-G2 sandwich ELISA measuring aggrecanase-mediated aggrecan degradation and the G1/G2 sandwich assay, detecting aggrecan molecules containing G1 and/or G2 (total aggrecan We further characterized serum samples by western blots, by using monoclonal antibodies F-78, binding to G1 and G2, or by BC-3, detecting the aggrecanase-generated N-terminal 374ARGSVI neo-epitope. Results Total aggrecan levels in RA patients were significantly decreased from 824.8 ± 31 ng/ml in healthy controls to 570.5 ± 30 ng/ml (31% decrease, P Conclusion This is the first study, which characterizes different aggrecan fragments in human serum. The data strongly suggests that total aggrecan levels, i.e. aggrecan molecules containing G1 and/or G2 are lower in RA patients, and that RA patients have at least one specific subpopulation of aggrecan fragments, namely aggrecanse generated 374ARGSVI fragments. Further clinical studies are needed to investigate the potential of G1/G2 as a structure-related biochemical marker in destructive joint-diseases.

  19. The effects of dietary supplementation with n-3 polyunsaturated fatty acids in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Nielsen, G L; Faarvang, K L; Thomsen, B S

    1992-01-01

    STUDY OBJECTIVE: To determine the effect of dietary supplementation with n-3 polyunsaturated fatty acids (n-3 PUFA) on disease variables in patients with rheumatoid arthritis. DESIGN: Multicenter, randomized, placebo controlled, double blind. SETTING: Three Danish hospital Departments...... of Rheumatology. PATIENTS: Fifty-one patients with active rheumatoid arthritis. INTERVENTION: Random allocation to 12 weeks of treatment with either six n-3 PUFA capsules (3.6 g) or six capsules with fat composition as the average Danish diet. MAIN RESULTS: Significant improvement of morning stiffness and joint...... tenderness. No significant effect on the four other assessed clinical parameters. No serious side effects. CONCLUSIONS: Dietary supplementation with n-3 PUFA in patients with rheumatoid arthritis improved two out of six patient reported disease parameters. Further studies are needed to clarify the more...

  20. Compliance to drug treatment of patients with rheumatoid arthritis : A 3 year longitudinal study

    NARCIS (Netherlands)

    Viller, F.; Guillemin, F.; Briancon, S.; Moum, T.; Suurmeijer, T.; van den Heuvel, W.

    1999-01-01

    Objective. Patient compliance is considered necessary for the success of drug treatment in chronic diseases. We document compliance with drug treatment and the factors affecting it in a cohort of patients with rheumatoid arthritis (RA). Methods. A prospective cohort study of 556 patients with RA fol

  1. Motivation, self-regulation and physical activity among patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Knittle, Keegan

    2013-01-01

    Regular participation in moderate-intensity physical activity (PA) is beneficial for patients with rheumatoid arthritis (RA); however, a large proportion of patients with RA are not physically active. In this dissertation, we describe the pilot-testing of an intervention to promote PA among patients

  2. Exercise therapy in patients with rheumatoid arthritis and osteoarthritis: a review.

    NARCIS (Netherlands)

    Dekker, J.; Mulder, P.H.; Bijlsma, W.J.; Oostendorp, A.B.

    1993-01-01

    Exercise therapy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) is controversial, because both improvement and deterioration of the patients' condition can be expected to occur. The literature was searched for studies on the outcome of exercise therapy in RA- and OA-patients. Twen

  3. A case of fungal arthritis caused by Hansenula anomala.

    Science.gov (United States)

    Choi, Sung-Wook; Lee, Tong-Joo; Kim, Myung-Ku; Lee, Moon; Jung, Jae-Ho

    2010-03-01

    Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.

  4. Pulse Wave Velocity and Electroneurophysiological Evaluation in patients of Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Geetanjali Sharma

    2011-07-01

    Full Text Available Rheumatoid arthritis is a chronic systemic inflammatory disease of undetermined etiology involving the synovial membranes and articular structures of multiple joints and is also associated with carditis, pleuritis, hepatitis, peripheral neuropathy and vasculitis. The present study was undertaken to investigate arterial stiffness using carotid-radial and femoral-dorsalis pedis pulse wave velocity measurements and electrophysiological tests for peripheral nervous system involvement. 25 patients (aged between 20-60 years with rheumatoid arthritis according to the criteria of the American College of Rheumatology and 25 control subjects of the same age and sex were recruited. In the motor conduction studies, out of 25 patients of Rheumatoid arthritis, 6 had clinical evidence of peripheral neuropathy. 11 patients showed pure sensory neuropathy (44%, 10 showed mixed sensory motor neuropathy (40% while 4 showed normal motor and sensory conduction velocity. Two patients (8% showed features of entrapment neuropathy of median nerve i.e. feature of Carpal tunnel syndrome. In the pulse wave velocity evaluation statistically significant increase in pulse wave velocity between femoral-dorsalis pedis and carotid-radial artery segments was observed in Rheumatoid arthritis patients as compared to the control group. Measurement of carotid-radial and femoral-dorsalis pedis PWV may provide a simple and non-invasive technique for identifying patients at increased risk of vascular disease in Rheumatoid arthritis.

  5. A case-control study of determinants for the occurrence of gouty arthritis in heart failure patients

    NARCIS (Netherlands)

    Hueskes, B.A.; Willems, F.F.; Leen, A.C.; Ninaber, P.A.; Westra, R.; Mantel-Teeuwisse, A.K.; Janssens, H.; Lisdonk, E.H. van de; Roovers, E.A.; Janssen, M.

    2012-01-01

    AIMS: Gouty arthritis is a frequent and disabling complication in heart failure patients. This study aimed to investigate which factors are associated with the occurrence of gouty arthritis in these patients. METHODS AND RESULTS: A case-control study was performed in heart failure patients (February

  6. Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis*

    Science.gov (United States)

    Fonseca, Gabriela Poglia; Werner, Betina; Seidel, Gabriela; Staub, Henrique Luiz

    2017-01-01

    BACKGROUND The nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease. OBJECTIVES To analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis. METHODS This is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi. RESULTS There were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis. STUDY LIMITATIONS Small sample size and use of medications. CONCLUSIONS Nail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis. PMID:28225951

  7. The effect of alkylating agents on the reproductive and hormonal testicular function in patients with rheumatoid arthritis.

    Science.gov (United States)

    Lazowski, Z; Janczewski, Z; Polowiec, Z

    1982-01-01

    An evaluation of testicular function was undertaken in 11 boys and young men aged 14-26 years suffering from rheumatoid arthritis complicated by amyloidosis and treated with cyclophosphamide and chlorambucil. 7 cases were studied during life and 4 at autopsy. Semen analysis showed azoospermia in 4 cases; in one, cryptozoospermia; in one, oligoasthenotheratozoospermia; and in one, asthenoteratozoospermia. In 4 patients with azoospermia and in one with cryptozoospermia, testicular biopsy was done for histo-pathological examination. In patients with azoospermia, only Sertoli cells were present in the seminiferous tubules. In one patient with cryptozoospermia, normal spermato- and spermiogenesis was found only in occasional seminiferous tubules. Microscopic examination of the testis failed to show any changes in the structure of the interstitial gland in any of the patients. Amyloid deposits were found in the vascular walls of the interstitial gland in one patient only. The serum testosterone level was depressed in 3 patients of the 9 examined. The LH level was elevated in 2 patients. The mean value of testosterone-LH ratio was significantly lower in patients treated with alkylating agents as compared with patients not so treated. Serum FSH level was elevated in 6 patients. Post-mortem examination of the testis in 4 patients showed complete absence of the germinal epithelium and only the presence of Sertoli cells. In 2 cases, amyloid deposits were found in the vascular walls in the rete testis. It was concluded that alkylating agents, besides damaging the testicular germinal epithelium, also affect the function of Leydig cells.

  8. Spontaneous septic arthritis of the pubic symphysis in an afebrile patient.

    Science.gov (United States)

    Simon, Erin L; Kovacs, Mitch; Gair, Leslie

    2016-05-01

    Septic arthritis is a rare infection usually involving the knee or hip but can infrequently affect less obvious joints such as the pubic symphysis.Risk factors for septic arthritis include joint repair or replacement surgery, systemic infection, intravenous recreational drug use, and alcoholism.We present the case of a 48-year-old man with a final diagnosis of septic arthritis of the pubic symphysis who had no risk factors besides alcoholism. The presentation was unusual in that the patient was afebrile,and the infection seemed to be spontaneous. The infecting pathogen was identified as Streptococcus anginosus or S constellatus, both being normal intestinal flora. Infection by either bacterium is rare in septic arthritis.

  9. Monitoring patients treated with anti-TNF-alpha biopharmaceuticals: assessing serum infliximab and anti-infliximab antibodies

    DEFF Research Database (Denmark)

    Svenson, M; Geborek, P; Saxne, T;

    2007-01-01

    Infliximab is an anti-tumour necrosis factor-alpha (TNF-alpha) mouse-human IgG1/kappa antibody used to treat patients with rheumatoid arthritis (RA) and other inflammatory diseases. Unfortunately, response failure and side-effects due to immunogenicity of the drug are not rare. In this study, we ...

  10. Monitoring patients treated with anti-TNF-alpha biopharmaceuticals: assessing serum infliximab and anti-infliximab antibodies

    DEFF Research Database (Denmark)

    Svenson, M; Geborek, P; Saxne, T

    2007-01-01

    Infliximab is an anti-tumour necrosis factor-alpha (TNF-alpha) mouse-human IgG1/kappa antibody used to treat patients with rheumatoid arthritis (RA) and other inflammatory diseases. Unfortunately, response failure and side-effects due to immunogenicity of the drug are not rare. In this study, we...

  11. Non-healing tongue ulcer in a rheumatoid arthritis patient medicated with leflunomide. An adverse drug event?

    OpenAIRE

    Eleni-Marina KALOGIROU; Katsoulas, Nikolaos; Tosios, Konstantinos I.; Lazaris, Andreas C; Alexandra SKLAVOUNOU

    2017-01-01

    Leflunomide is a member of the disease modifying anti-rheumatic drugs group used as a treatment modality in active rheumatoid and psoriatic arthritis. “Oral ulcers” are reported in 3-5% of leflunomide medicated rheumatoid arthritis patients with adverse events, but they are not described in detail in the literature. We present a case of an ulcer in the tongue of a rheumatoid arthritis patient managed with leflunomide and contemplate on its pathogenesis. Key words:Leflunomide, oral ulcer, DHOD...

  12. Non-healing tongue ulcer in a rheumatoid arthritis patient medicated with leflunomide. An adverse drug event?

    Science.gov (United States)

    Kalogirou, Eleni-Marina; Katsoulas, Nikolaos; Tosios, Konstantinos I; Lazaris, Andreas C; Sklavounou, Alexandra

    2017-02-01

    Leflunomide is a member of the disease modifying anti-rheumatic drugs group used as a treatment modality in active rheumatoid and psoriatic arthritis. "Oral ulcers" are reported in 3-5% of leflunomide medicated rheumatoid arthritis patients with adverse events, but they are not described in detail in the literature. We present a case of an ulcer in the tongue of a rheumatoid arthritis patient managed with leflunomide and contemplate on its pathogenesis. Key words:Leflunomide, oral ulcer, DHODH.

  13. Treating gouty arthritis inTCM%痛风性关节炎的中药治疗

    Institute of Scientific and Technical Information of China (English)

    何静; 朱电波

    2015-01-01

    中医各家对于痛风性关节炎均有不同程度的认识,且都通过临床取得了良好的疗效。现将治疗痛风性关节炎的药方以及其他治疗方法进行阐述,以期为今后治疗痛风性关节炎提供更多的借鉴思路。%Pathogeny of gouty arthritis was understood of varying degrees by different parties of TCM doctors. In clinical, according to theory of different parties of TCM doctors, signiifcant efifcacy was received. In the paper, prescription and other treatment methods for treating gouty arthritis were described, in order to provide ideas for the future.

  14. Clenched fist injury complicated by septic arthritis and osteomyelitis treated with negative pressure wound therapy: One case report

    Institute of Scientific and Technical Information of China (English)

    Miroslav Kilian

    2016-01-01

    We reported a 30 years old man who suffered a bite wound of the right hand in a fight.Two days after the injury,he was admitted in emergency because of stab wound above the head of the third metacarpal bone.He presented the swelling,redness,pain and fever.Primary revision confirmed only partial lesion of the extensor apparatus.During the following days,we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the third metacarpophalangeal joint.The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics.After resolution of clinical and laboratory findings,the wound was finally closed by delayed primary suture.Clenched fist injury is a medical emergency that requires immediate surgical revision.We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.

  15. Acute anterior uveitis after discontinuation of tocilizumab in a patient with rheumatoid arthritis

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    Sato T

    2014-01-01

    Full Text Available Tomohito Sato,1 Shinya Minakuchi,1 Manabu Mochizuki,2 Masaru Takeuchi11Department of Ophthalmology, National Defense Medical College, Saitama, Japan; 2Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, JapanBackground: Tocilizumab is a humanized monoclonal anti-interleukin-6 (IL-6 receptor antibody and has been approved in Japan for the treatment of Castleman's disease, rheumatoid arthritis (RA, and systemic juvenile idiopathic arthritis. Conjunctivitis and dry eye are known ocular adverse effects, but uveitis has not been reported.Case report: A 72-year-old woman had undergone bilateral cataract surgery without complications. Six months after the surgery, she was diagnosed with RA and treated with tocilizumab infusion every 4 weeks. However, severe malaise and dizziness occurred after the third tocilizumab infusion, and the treatment was suspended. Since the symptoms associated with RA had resolved, she was followed without any medication thereafter. At 5 weeks after the third tocilizumab infusion, she developed severe anterior inflammation with hypopyon in her left eye, and her visual acuity dropped to less than 2/200. Considering her age and history of cataract surgery, endophthalmitis was suspected and a vitrectomy was performed, but no pathogens were detected from the intraocular fluid samples collected during surgery. The ocular inflammation was gradually resolved with systemic antibiotics and corticosteroids. However, severe anterior uveitis recurred in the same eye during the tapering of the systemic corticosteroids, when the aqueous humor IL-6 level was 46,100 pg/mL. The recurrent ocular inflammation was resolved with increased doses of topical and systemic corticosteroids, and the patient has since remained relapse-free. No symptom of inflammation was observed in the right eye during the follow-up period.Conclusion: This case indicates a possibility that acute

  16. 口服中药治疗痛风性关节炎疗效观察%Efficacy Observation on Treating Gouty Arthritis by Orally Taking Chinese Herbs

    Institute of Scientific and Technical Information of China (English)

    于长志; 罗懿明; 林玉洁

    2014-01-01

    Objective:To investigate the efficacy of treating gouty arthritis by orally taking Chinese herbs. Methods:83 cases of patients with gouty arthritis were randomly divided into treatment group (43 cases) and control group (40 cases), the treatment group treated by orally taking self-made Chinese herbas, while control group by orally taking etoricoxib and benzbromarone, and observed the efficacy of two groups. Results:There was no significant difference on total effecitve rate between two groups (P>0.05). Conclusion:Orally taking Chinese herbs has significant curative effect on gouty arthritis, which also can avoid adverse reactions that brings by chemical drugs, deserves clinical promotion and application.%目的:探讨口服中药治疗痛风性关节炎的疗效。方法:将83例痛风性关节炎患者随机分为治疗组(43例)和对照组(40例),治疗组给予自拟中药内服,对照组则服用依托考昔及苯溴马隆治疗,观察两组临床疗效。结果:两组总有效率差异无统计学意义(P>0.05)。结论:口服中药治疗痛风性关节炎疗效显著,且可避免化学药物带来的不良反应,值得临床推广应用。

  17. Intake of antioxidants in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Bruna Nolasco Siqueira Silva

    2014-12-01

    Full Text Available Objective: to investigate dietary intake of antioxidants in patients with rheumatoid arthritis. Methods: this is a cross-sectional case series study with 53 women accompanied at the Rheumatology Outpatient Clinic, Hospital das Clínicas/UFPE, from January to October 2012. Demographic and anthropometric parameters (weight, height, body mass index, weight change were collected by means of a form. The assessment of food consumption was conducted using a semi-quantitative food frequency survey, analyzed according to a food composition table. Database construction and statistical analysis were performed using Excel and SPSS version 18.0, using chi-squared test, Anova, and Student’s t-test, at a confidence level of 5%. Results: the sample was composed of 53 women with a mean age of 54.51 ± 4.24 years and BMI of 25.97 ± 5.94 kg/m². In the sociodemographic variables, statistically significant differences in origin, occupation, and income were observed. Daily consumption showed significance for vitamins A, C, and zinc. In adults, vitamins A and C were in accordance with recommendations, while in the elderly a low intake of vitamin E and selenium was observed. The relation between vitamin E and origin was significant. Conclusion: the sample was composed of 53 women with a mean age of 54.51 ± 4.24 years and BMI of 25.97 ± 5.94 kg/m². In the sociodemographic variables, statistically significant differences in origin, occupation, and income were observed. Daily consumption showed significance for vitamins A, C, and zinc. In adults, vitamins A and C were in accordance with recommendations, while in the elderly a low intake of vitamin E and selenium was observed. The relation between vitamin E and origin was significant.

  18. 中医适宜技术治疗类风湿性关节炎的临床探讨%Clinical study on treating rheumatoid arthritis with the suitable technology of TCM

    Institute of Scientific and Technical Information of China (English)

    屈秀明

    2013-01-01

    目的:探讨适宜技术治疗类风湿性关节炎的体会。方法:对37例类风湿性关节炎患者从心理、饮食、用药、理疗等方面进行中西医治疗及护理。结果:中医适宜技术治疗类风湿性关节炎,取得了满意的治疗效果。结论:中医适宜技术治疗及护理类风湿性关节炎能有效的促进患者康复。%Objective:To investigate the experience for treating rheumatoid arthritis with the suitable technology of TCM. Methods:37 cases of rheumatoid arthritis patients from psychology, diet, medication, physical therapy and other aspects of the integrative medicine treatment and nursing. Results: The suitable technology of TCM had a satisfactory therapeutic effect on treating rheumatoid arthritis. Conclusion:The suitable technology of TCM and nursing of rheumatoid arthritis can effectively promote the rehabilitation of patients.

  19. An intra-articular ganglion cyst in a patient with juvenile idiopathic arthritis.

    Science.gov (United States)

    Deng, Donna Y; Yee, Keolamau; Burkhalter, William; Okimoto, Kelley Chinen; Kon, Kevin; Kurahara, David K

    2014-01-01

    We report an intra-articular ganglion cyst (IAGC) presenting as knee pain and a mass in a patient with longstanding Juvenile Idiopathic Arthritis (JIA). We could not find a similar case of an IAGC occurring in the knee of JIA patients in the literature. IAGC may need to be included as a possibility in patients with inflammatory arthritis with new-onset knee pain, especially in those with a palpable mass. MRI was useful in distinguishing IAGC from more worrisome causes of a knee mass. Orthopedic input was helpful in diagnosis and treatment. In addition, methotrexate therapy was effective in bringing about a long-lasting remission.

  20. Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis.

    Science.gov (United States)

    Atzeni, Fabiola; Boiardi, Luigi; Sallì, Salvatore; Benucci, Maurizio; Sarzi-Puttini, Piercarlo

    2013-07-01

    Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. Usual interstitial pneumonia and nonspecific interstitial pneumonia seem to be the most frequent patterns in RA patients with ILD, although the proportion of patients with usual interstitial pneumonia is higher than among patients with other systemic rheumatic autoimmune diseases. RA patients with ILD most frequently present with chronic symptoms of cough and dyspnea when climbing stairs or walking uphill. A physical examination may reveal inhalatory crackles and a pulmonary function test demonstrates restrictive physiology, often with reduced diffusing capacity. High-resolution computed tomography is generally sufficient to confirm a diagnosis of ILD, although a minority of cases may require a surgical lung biopsy. Conventional disease-modifying antirheumatic drugs such as methotrexate (MTX) or leflunomide (LEF) and biological agents such as TNF-blocking agents or rituximab may trigger or aggravate ILD in RA patients, and infections may contribute to increased mortality in such patients. LEF should not be used in patients with a history of MTX pneumonitis. The prevalence of interstitial pneumonia among RA patients treated with anti-TNF agents ranges from 0.5 to 3%; however, as the evidence that anti-TNF increases or decreases the risk of ILD is controversial, it is not clear whether this indicates more severe RA requiring biological therapy or the effect of exposure to potentially toxic drugs such as MTX or LEF. The development of treatment-related ILD is a paradoxical adverse event, and patients should be warned about this rare but serious complication of biological or disease-modifying antirheumatic drug therapy.

  1. Influenza and pneumococcal vaccination and varicella status in inflammatory arthritis patients.

    LENUS (Irish Health Repository)

    McCarthy, E M

    2011-11-15

    Patients with inflammatory arthritis are at increased risk of vaccine preventable infections. This risk is increased by immunomodulatory therapies. Vaccination for influenza and pneumococcal disease reduces the risk. Severe cases of varicella infection have occurred in patients on biologic therapies. We sought to identify vaccination rates for commonly acquired infections and to ascertain varicella immune status in patients with inflammatory arthritis. 100 patients with inflammatory arthritis were administered a standardised questionnaire. Data collected included age, diagnosis, vaccination history, history of varicella, treatment and the presence of other indications for vaccination. 58 patients (58%) had not received the influenza vaccine in the past year. Only 19 patients (19%) had ever received pneumococcal vaccine. Anti TNF use did not predict vaccination (p = .46). An increasing number of co morbid conditions predicted both pneumococcal (p < 0.003) and influenza vaccine (p < 0.03) administration. Nineteen patients (19%) gave no history of varicella infection, none having had varicella titres checked pre treatment. Immunisation rates in patients with inflammatory arthritis on immunosuppressive therapies are low. Immunisation schedules should be available for each patient during rheumatology and general practice consultations.

  2. Psoriatic Arthritis and Burden of Disease: Patient Perspectives from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

    OpenAIRE

    Kavanaugh, Arthur; Helliwell, Philip; Christopher T. Ritchlin

    2016-01-01

    Introduction Psoriatic arthritis (PsA) is underdiagnosed and has a substantial impact on quality of life, disability, and work productivity. The population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey examined the impact of PsA on patients’ activities of daily living and unmet treatment needs. Methods This large-scale, random digit dialing, telephone survey of patients self-reporting a diagnosis of psoriasis and/or PsA was conducted in North America and Eu...

  3. CD6 and syntaxin binding protein 6 variants and response to tumor necrosis factor alpha inhibitors in Danish patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Krintel, Sophine B; Essioux, Laurent; Wool, Assaf;

    2012-01-01

    TNFα inhibitor therapy has greatly improved the treatment of patients with rheumatoid arthritis, however at least 30% do not respond. We aimed to investigate insertions and deletions (INDELS) associated with response to TNFα inhibitors in patients with rheumatoid arthritis (RA)....

  4. Correlation between subtalar varus angle and disability in patients with patellofemoral arthritis

    Directory of Open Access Journals (Sweden)

    Patel Birenkumar Jagdishbhai

    2009-11-01

    Full Text Available Aim: To find the correlation between subtalar varus angle & disability in patients with patellofemoral arthritis. Methods: A total of 30 subjects aged (48.86±5.74 referred to the department of physiotherapy, with patellofemoral arthritis and fulfilling the criteria of inclusion were recruited for the study, sampling method being convenient sampling. Disability score was measured of each patient by WOMAC index (Western Ontario and McMaster Universities Index of Osteoarthritis disability questionnaire and subtalar varus angle was measured in non weight bearing position in prone lying. Results: Pearson’s correlation coefficient test showed a highly significant (p=0.000 positive correlation (r=0.821 between disability scores and subtalar varus angle. Conclusion: There is a highly significant relation between disabilities due to patellofemoral pain in patellofemoral arthritis patients and sub talar varus angle

  5. Multidisciplinary vocational rehabilitation for patients with chronic arthritis

    NARCIS (Netherlands)

    Buck, de Petronella D.M.

    2006-01-01

    Working gainfully is a major activity of adult life, providing income, structure, social interaction and an opportunity to learn and practice skills, and a source of self-esteem. In people with chronic arthritis work disability is common, having a major impact upon individuals as well as society. In

  6. Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent

    DEFF Research Database (Denmark)

    Courvoisier, D S; Alpizar-Rodriguez, D; Gottenberg, J E;

    2016-01-01

    BACKGROUND: Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). METHODS: Pooled analysis of nine national registries...

  7. Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Ammitzbøll-Danielsen, Mads; Østergaard, Mikkel; Fana, Viktoria;

    2017-01-01

    OBJECTIVE: The aim of this study was to compare the efficacy of intramuscular versus ultrasound (US)-guided intratenosynovial glucocorticoid injection in providing disease control after 2, 4 and 12 weeks in patients with rheumatoid arthritis(RA) with tenosynovitis. METHODS: Fifty patients with RA...

  8. Adrenaline-induced immunological changes are altered in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Kittner, JM; Jacobs, R; Pawlak, CR; Heijnen, CJ; Schedlowski, M; Schmidt, RE

    2002-01-01

    Objective. To investigate whether in rheumatoid arthritis (RA) patients the immunological changes induced by adrenaline are different from healthy controls (HC). Methods. Fifteen female RA patients and 14 HC were infused with 1 mug/kg adrenaline over 20 min. Blood was drawn before, immediately after

  9. An online tailored self-management program for patients with rheumatoid arthritis: a developmental study.

    NARCIS (Netherlands)

    Zuidema, R.M.; Gaal, B.G.I.; Dulmen, S. van; Repping-Wuts, H.; Schoonhoven, L.

    2015-01-01

    Background: Every day rheumatoid arthritis (RA) patients make many decisions about managing their disease. An online, computer-tailored, self-management program can support this decision making, but development of such a program requires the active participation of patients. Objective: To develop an

  10. Engagement and satisfaction with an Internet-based physical activity intervention in patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Berg, M.H. van den; Ronday, H.K.; Peeters, A.J.M.; Voogt-van der Harst, E.M.; Munneke, M.; Breedveld, F.C.; Vliet Vlieland, T.P.M.

    2007-01-01

    OBJECTIVE: To assess the engagement in and satisfaction with an Internet-mediated physical activity intervention with individual supervision in patients with rheumatoid arthritis (RA). METHODS: The intervention studied was one of the two strategies aimed at enhancing physical activity in RA patients

  11. Calibration of the PROMIS Physical Function Item Bank in Dutch Patients with Rheumatoid Arthritis

    NARCIS (Netherlands)

    Voshaar, M.A.; Klooster, P.M. ten; Glas, C.A.; Vonkeman, H.E.; Taal, E.; Krishnan, E.; Moens, H.J.; Boers, M.; Terwee, C.B.; Riel, P.L.C.M. van; Laar, M.A. van der

    2014-01-01

    OBJECTIVE: To calibrate the Dutch-Flemish version of the PROMIS physical function (PF) item bank in patients with rheumatoid arthritis (RA) and to evaluate cross-cultural measurement equivalence with US general population and RA data. METHODS: Data were collected from RA patients enrolled in the Dut

  12. Calibration of the PROMIS Physical Function Item Bank in Dutch Patients with Rheumatoid Arthritis

    NARCIS (Netherlands)

    Oude Voshaar, M.A.; Klooster, ten P.M.; Glas, C.A.W.; Vonkeman, H.E.; Taal, E.; Krishnan, E.; Moens, H.J.; Boers, M.; Terwee, C.; Riel, van P.L.C.M.; Laar, van de M.A.F.J.

    2014-01-01

    OBJECTIVE: To calibrate the Dutch-Flemish version of the PROMIS physical function (PF) item bank in patients with rheumatoid arthritis (RA) and to evaluate cross-cultural measurement equivalence with US general population and RA data. METHODS: Data were collected from RA patients enrolled in th

  13. Reliability of in-Shoe Plantar Pressure Measurements in Rheumatoid Arthritis Patients

    Science.gov (United States)

    Vidmar, Gaj; Novak, Primoz

    2009-01-01

    Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar…

  14. Physical and mental functioning in patients with established rheumatoid arthritis over an 11-year followup period

    NARCIS (Netherlands)

    Hoek, Van Den Joëlle; Roorda, Leo D.; Boshuizen, Hendriek C.; Tijhuis, Gerard J.; Bos, Van Den Geertrudis A.; Dekker, Joost

    2016-01-01

    Objective. To investigate the longterm association of a wide range of comorbidities with physical and mental functioning in patients with rheumatoid arthritis (RA). Methods. Longitudinal data over a period of 11 years were collected from 882 patients with RA. Somatic comorbidity and comorbid depr

  15. Chronic comorbidity in patients with early rheumatoid arthritis: a descriptive study.

    NARCIS (Netherlands)

    Kroot, E.J.A.; Gestel, A.M. van; Swinkels, H.L.; Albers, M.; Putte, L.B.A. van de; Riel, P.L.C.M. van

    2001-01-01

    OBJECTIVE: To study the presence of chronic coexisting diseases in patients with rheumatoid arthritis (RA) and its effect on RA treatment, disease course, and outcome during the first years of the disease. METHODS: From January 1985 to December 1990, 186 patients with recent onset RA were enrolled i

  16. HLA-DRB1 alleles genotyping in patients with rheumatoid arthritis in Chinese.

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    Objective: To explore the role of HLA-DRB1 genes in the development of rheumatoid arthritis (RA) and the correlations between HLA-DR alleles and clinical manifestations of patients with RA. Methods: 86 patients and 106 race matched controls in whom HLADR typing was performed by the method of DNA amplification with sequence-specific primers (PCR-SSP)

  17. Cardiovascular diseases-related hospital admissions of patients with inflammatory arthritis.

    NARCIS (Netherlands)

    Ursum, J.; Nielen, M.M.J.; Twisk, J.W.R.; Peters, M.J.L.; Schellevis, F.G.; Nurmohamed, M.T.; Korevaar, J.C.

    2015-01-01

    Objective: Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care-based population of patients wit

  18. Fatigue as experienced by patients with rheumatoid arthritis (RA): a qualitative study.

    NARCIS (Netherlands)

    Repping-Wuts, H.; Uitterhoeve, R.; Riel, P.L.C.M. van; Achterberg, T. van

    2008-01-01

    OBJECTIVE: Interest in fatigue research has grown since the finding that fatigue is, besides pain, the symptom most frequently reported by patients with rheumatoid arthritis (RA). The aim of this study was to explore the experience of fatigue from the patients' perspective. METHODS: Twenty-nine pati

  19. Increased muscle activity to stabilise mobile bearing knees in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Garling, E.H.; Eck, M; Wedding, T.; Veeger, H.E.J.; Valstar, E.R.; Nelissen, R.G.H.H.

    2005-01-01

    The aim of this study was to assess the differences in muscle activity (surface EMG) between a posterior stabilised (PS) total knee design and a mobile bearing (MB) posterior cruciate ligament retaining design in rheumatoid arthritis (RA) patients during a step-up task. Four patients with a PS total

  20. Emotion regulation predicts change of perceived health in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    van Middendorp, H; Geenen, R; Sorbi, MJ; van Doornen, LJP; Bijlsma, JWJ

    2005-01-01

    Objectives: To examine whether emotion regulation predicts change of perceived health in patients with rheumatoid arthritis ( RA). Methods: Sixty six patients ( 44 female, 22 male; mean (SD) age 57.7 (11.6) years) participated in a prospective study. Hierarchical regression analysis was used to pred

  1. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P;

    2014-01-01

    OBJECTIVE: To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. METHODS: Patients were randomised to receive...

  2. 1H NMR spectroscopy-based interventional metabolic phenotyping: a cohort study of rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Lauridsen, Michael Brændgaard; Bliddal, Henning; Christensen, Robin Daniel Kjersgaard;

    2010-01-01

    1H NMR spectroscopy-based metabolic phenotyping was used to identify biomarkers in the plasma of patients with rheumatoid arthritis (RA). Forty-seven patients with RA (23 with active disease at baseline and 24 in remission) and 51 healthy subjects were evaluated during a one-year follow-up with a...

  3. Hypoacusia in a Patient Treated by Isotretinoin

    Directory of Open Access Journals (Sweden)

    L. Rosende

    2011-01-01

    Full Text Available Isotretinoin is the most effective treatment for severe acne, but there are several adverse effects associated with its use, some of them very exceptional (<1/10000. We report one case of hypoacusia and tinnitus in a 15-year-old boy treated with isotretinoin during 6 weeks, who quickly improved after isotretinoin withdrawal. Also, we comment other publications about hearing alterations in patients treated with isotretinoin and other retinoids.

  4. A Case of Fungal Arthritis Caused by Hansenula Anomala

    OpenAIRE

    Choi, Sung-Wook; Lee, Tong-Joo; Kim, Myung-Ku; Lee, Moon; Jung, Jae-Ho

    2010-01-01

    Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic the...

  5. Reactive Arthritis

    Directory of Open Access Journals (Sweden)

    Eren Erken

    2013-06-01

    Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

  6. Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report

    Directory of Open Access Journals (Sweden)

    Probst Corina

    2010-08-01

    Full Text Available Abstract Background Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis. Case Presentation An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA. Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed. Conclusions Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients.

  7. CONVENTIONAL THERAPY OF PSORIATIC ARTHRITIS: EVIDENCE-BASED REVIEW

    Directory of Open Access Journals (Sweden)

    E.R. Soriano

    2011-09-01

    Full Text Available Psoriatic arthritis is a heterogeneous condition, the pattern of which is determined by any combination of pathology affecting peripheral joints, the enthesis and the spine. There is a paucity of evidence for most of the conventional agents used to treat psoriatic arthritis, with many of them being used on the basis of experience in rheumatoid arthritis. Herein, we summarise the evidence compiled relating to effectiveness of treatment for various manifestation of PsA. For those patients with progressive forms of arthritis who may benefit from intervention of newer biological therapies, the continued use of conventional therapy needs ever increasing scrutiny. Key words: Psoriatic arthritis, psoriasis, therapy

  8. The effect of marine n-3 polyunsaturated fatty acids on cardiac autonomic and hemodynamic function in patients with psoriatic arthritis

    DEFF Research Database (Denmark)

    Kristensen, Salome; Schmidt, Erik Berg; Schlemmer, Annette;

    2016-01-01

    The aim of this study was to investigate the effect of marine n-3 polyunsaturated fatty acids (PUFA) on cardiac autonomic function and vascular function in patients with psoriatic arthritis.......The aim of this study was to investigate the effect of marine n-3 polyunsaturated fatty acids (PUFA) on cardiac autonomic function and vascular function in patients with psoriatic arthritis....

  9. Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab

    DEFF Research Database (Denmark)

    Nguyen, Mai; Pødenphant, Jan; Ravn, Pernille

    2013-01-01

    We report three cases of severe disseminated Staphylococcus aureus infection in patients with rheumatoid arthritis (RA) treated with tocilizumab. Tocilizumab is a new drug, unknown to most internists, and injections given weeks before admission may not be considered by the patient as part......-intensive diagnostic work-up and early treatment should be performed. Systematic postmarketing studies are needed to clarify if there is a true increased risk of disseminated S aureus infections. We suggest caution when prescribing tocilizumab to patients with prosthetic joints and/or prior invasive S aureus...

  10. The effectiveness of occupational therapy in restoring the functional state of hands in rheumatoid arthritis patients.

    Science.gov (United States)

    Rapoliene, Jolita; Krisciūnas, Aleksandras

    2006-01-01

    The aim of the study was to evaluate the effectiveness of occupational therapy in rheumatoid arthritis patients with impaired hand function. Standardized Functional Independence Measure was employed in order to evaluate the functional status of the patients and impaired activities. A dynamometer was used for the measurements of muscular strength of hands and a goniometer, for the range of motion of the wrist. Totally, we have examined 120 rheumatoid arthritis patients. They were divided into two groups: 60 patients in each. Occupational therapy was applied only to the patients of the first group. The mean age of Group 1 patients was 53.4+/-1.8 years, the mean age of Group 2 patients was 52.0+/-1.9 years. The mean duration of the disease was 11.5+/-2.6 years and 12.1+/-2.4 years, respectively. The effectiveness of therapy was considered ineffective if, after the completion of the course of occupational therapy, no increase in Functional Independence Measure score for patients with rheumatoid arthritis was observed. When the score increased from 1 to 3, we considered this as moderate effectiveness; when the score increased to 4-6, we evaluated the effectiveness of occupational therapy as good, and when the score of 7 was attained, effectiveness of occupational therapy was considered as very good. In Group 1, the moderate effectiveness of occupational therapy was determined in 31.7% of patients; good effectiveness, in 61.7%; and very good effectiveness, in 3.3% of rheumatoid arthritis patients. In Group 2, the moderate effectiveness of treatment was determined in 48.3% of patients and good effectiveness, in 5% of rheumatoid arthritis patients. CONCLUSIONS. Hand function (the strength of fingers and hands, the range of motion of the wrist) significantly improved in patients with rheumatoid arthritis after completion of a course of occupational therapy (p<0.05). The improvement of hand functions in patients with rheumatoid arthritis led to increased ability to take food

  11. Neonatal Candida arthritis

    Directory of Open Access Journals (Sweden)

    Saurabh Sharma

    2014-01-01

    Full Text Available Fungal arthritis is an uncommon yet serious disorder in the newborn. Delay in diagnosis and management can lead to significant morbidity. We report our experience with management of two such cases. Two preterm neonates with multifocal arthritis caused by Candida were studied. Diagnosis was made by clinical examination, laboratory investigations, radiological investigations and culture. Both were treated by aspiration, arthrotomy and antifungal therapy. One patient recovered fully from the infection while the other had growth disturbances resulting in limb length inequality at recent followup. Prompt and expeditious evacuation of pus from joints and antifungal therapy is imperative for treatment. Associated osteomyelitis leads to further difficulty in treatment.

  12. The role of health literacy and social networks in arthritis patients' health information-seeking behavior: a qualitative study.

    Science.gov (United States)

    Ellis, Janette; Mullan, Judy; Worsley, Anthony; Pai, Nagesh

    2012-01-01

    Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources. Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through their informal social network. Methods. An exploratory, qualitative study consisting of one-on-one semi-structured interviews. Twenty participants with arthritis were recruited from community organizations. The interviews were designed to elicit participants' understanding about their arthritis and arthritis medication and to determine how the participants' health literacy informed selection of where they found information about their arthritis and pain medication. Results. Participants with low health literacy were less likely to be engaged with health information-seeking behaviour. Participants with intermediate health literacy were more likely to source arthritis-focused health information from newspapers, television, and within their informal social network. Those with high health literacy sourced information from the internet and specialist health sources and were providers of information within their informal social network. Conclusion. Health professionals need to be aware that levels of engagement in health information-seeking behaviour and sources of arthritis-focused health information may be related to their patients' health literacy.

  13. The Role of Health Literacy and Social Networks in Arthritis Patients' Health Information-Seeking Behavior: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Janette Ellis

    2012-01-01

    Full Text Available Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources. Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through their informal social network. Methods. An exploratory, qualitative study consisting of one-on-one semi-structured interviews. Twenty participants with arthritis were recruited from community organizations. The interviews were designed to elicit participants' understanding about their arthritis and arthritis medication and to determine how the participants' health literacy informed selection of where they found information about their arthritis and pain medication. Results. Participants with low health literacy were less likely to be engaged with health information-seeking behaviour. Participants with intermediate health literacy were more likely to source arthritis-focused health information from newspapers, television, and within their informal social network. Those with high health literacy sourced information from the internet and specialist health sources and were providers of information within their informal social network. Conclusion. Health professionals need to be aware that levels of engagement in health information-seeking behaviour and sources of arthritis-focused health information may be related to their patients' health literacy.

  14. Effect of methotrexate on the temporomandibular joint and facial morphology in juvenile rheumatoid arthritis patients.

    Science.gov (United States)

    Ince, D O; Ince, A; Moore, T L

    2000-07-01

    Juvenile rheumatoid arthritis is a disease characterized by chronic inflammation in one or more joints; it affects children and adolescents up to 18 years of age. This disease may cause significant skeletal joint destruction, and the temporomandibular joint, like other joints, may become severely affected resulting in aberrant mandibular growth, abnormal dentofacial development, and/or altered orofacial muscle function. Methotrexate is the most common remittive agent used in juvenile rheumatoid arthritis to modify the course of inflammatory destruction of peripheral joints. The purpose of this study was: (1) to evaluate the effect of methotrexate therapy on the prevalence of temporomandibular joint lesions and aberration in craniofacial development in children afflicted with juvenile rheumatoid arthritis; (2) to further examine the relationship between the temporomandibular joint/cephalometric findings and rheumatologic data (ie, age at onset, duration of disease); and (3) to evaluate further pauciarticular- and polyarticular-onset disease in juvenile rheumatoid arthritis and the prevalence of temporomandibular joint lesions and facial dysmorphology. The following information was obtained from 45 patients with juvenile rheumatoid arthritis: (1) routine rheumatologic clinical examination data; (2) anamnestic temporomandibular joint evaluation data; (3) clinical temporomandibular joint examination data; (4) lateral cephalometric measurement data; (5) posteroanterior cephalometric measurement data; and (6) individually corrected axial tomographic data. The results demonstrated the following: (1) radiographic evidence of condylar degeneration was apparent in 63% of all patients with juvenile rheumatoid arthritis with pauciarticular patients showing less temporomandibular involvement than polyarticular patients; (2) polyarticular juvenile rheumatoid arthritis patients receiving methotrexate showed less severe temporomandibular joint involvement than the polyarticular

  15. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement.

    Science.gov (United States)

    Abdel, Matthew P; Figgie, Mark P

    2014-10-01

    Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.

  16. Osteopoikilosis in a patient with rheumatoid arthritis complicated with dry eyes.

    Science.gov (United States)

    Ureten, Kemal

    2007-09-01

    Osteopoikilosis is an uncommon sclerosing bone dysplasia of unknown etiology. It is usually detected as a coincidental finding at radiographic examination. Mild joint pain and swelling may be seen in 15-20% of cases. Osteopoikilosis is rarely associated with rheumatoid arthritis. In this case report a young man with osteopoikilosis who was diagnosed as having rheumatoid arthritis complicated with dry eyes is presented. Although patients with osteopoikilosis may have articular symptoms, those patients should be carefully examined for a possible association with a rheumatic condition.

  17. First diagnosis of rheumatoid arthritis in a patient with temporomandibular disorder: a case report.

    Science.gov (United States)

    Malliari, Maria; Bakopoulou, Athina; Koidis, Petros

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic disease of unknown etiology, characterized by synovitis of the diarthroidal joints, gradual bone erosion, and cartilage destruction. Temporomandibular joint (TMJ) arthritis is frequent in patients with RA, but it is seldom the first joint to be affected. This report presents a case of a female patient with undiagnosed RA who first presented with signs and symptoms of the disease in the TMJs. It highlights the importance of professional awareness and provides a roadmap for clinical and radiologic examination followed by biochemical and genetic monitoring for early diagnosis of RA.

  18. X-ray diagnosis of mutilating arthritis in patients with psoriatic arthritis Smirnov A.V.

    Directory of Open Access Journals (Sweden)

    A.V. Smirnov

    2014-01-01

    Full Text Available The typical X-ray symptoms of psoriatic arthritis (PsA in joints of hands and distal sections of feet (asymmetric lesions; isolated lesion of distal interphalangeal joints (DIJ of hands with no changes in other small joints of hands; axial lesion of three joints in a single finger; transverse lesion of joints of the hand at the same level; destruction of distal phalanges; narrowing of the distal epiphysis of hand finger phalanges and metacarpal bones; cup-shaped deformity of the proximal portion of hand finger phalanges and narrowing of distal epiphysis; osseous ankyloses; multiple osteolytic lesions and destruction of bone epiphysis and joint deformities; inflammatory changes in the sacroiliac joints; and typical degenerative changes in the spine are described. It is especially important to know X-ray manifestations of PsA when there are no typical cutaneous manifestations of psoriasis. 

  19. DISEASE COPING STYLES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE OR RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Y. K. Galetskayte

    2013-01-01

    Full Text Available Objective: to study the types of response to illness in patients with chronic obstructive pulmonary disease (COPD or rheumatoid arthritis (RA.Subjects and methods. The sample consisted of 100 patients (mean age 59.2 ± 14.4 years from University Clinical Hospital One, I.M. Seche nov First Moscow State Medical University, 57 of whom were treated for RA and 43 were for COPD. All the patients were examined by a psychiatrist, a psychologist, and a therapist. The Beck Depression Inventory, SF-36 quality of life questionnaire, and projective psychological tests were also used.Results. Three main types of response to illness were identified. The features of aberrant hypochondria were most common in the patientswith COPD (53.3 % (23/43. In RA, hypochondriacal development as a confrontation with illness was intrinsic to a considerable proportion of patients (42.1 % (24/57. The common response was hypochondriacal neurosis (health anxiety, organ neurotic and omatoautonomic disorders that was encountered in 27 % (27/100 in the patients with COPD or RA and more common in those with RA (29.8 % (17/57. The examination revealed nosogenic depressive reactions in 19.2 % (11/57 of the patients with RA and in 9.3 % (4/43 of those with COPD.Conclusion. The main types of response to somatic illness in the two chronic diseases similar in their impact on quality of life have been investigated, which may be further used to manage this category of patients.

  20. DISEASE COPING STYLES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE OR RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Y. K. Galetskayte

    2014-07-01

    Full Text Available Objective: to study the types of response to illness in patients with chronic obstructive pulmonary disease (COPD or rheumatoid arthritis (RA.Subjects and methods. The sample consisted of 100 patients (mean age 59.2 ± 14.4 years from University Clinical Hospital One, I.M. Seche nov First Moscow State Medical University, 57 of whom were treated for RA and 43 were for COPD. All the patients were examined by a psychiatrist, a psychologist, and a therapist. The Beck Depression Inventory, SF-36 quality of life questionnaire, and projective psychological tests were also used.Results. Three main types of response to illness were identified. The features of aberrant hypochondria were most common in the patientswith COPD (53.3 % (23/43. In RA, hypochondriacal development as a confrontation with illness was intrinsic to a considerable proportion of patients (42.1 % (24/57. The common response was hypochondriacal neurosis (health anxiety, organ neurotic and omatoautonomic disorders that was encountered in 27 % (27/100 in the patients with COPD or RA and more common in those with RA (29.8 % (17/57. The examination revealed nosogenic depressive reactions in 19.2 % (11/57 of the patients with RA and in 9.3 % (4/43 of those with COPD.Conclusion. The main types of response to somatic illness in the two chronic diseases similar in their impact on quality of life have been investigated, which may be further used to manage this category of patients.

  1. Influence of balneophysical therapy on activity, functional capacity, and quality of life in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Stojanović Sonja

    2009-01-01

    Full Text Available Introduction It has been well known that balneophysical therapy has a therapeutic effect on clinical and biological parameters of disease activity in the patients with rheumatoid arthritis (RA. Objective. To determine the influence of balneophysical therapy on functional capacity, activity and quality of life of the patients with RA primarily treated with some of disease modifying antirheumatic drugs. Methods. The study enrolled 73 patients with RA treated with some of disease modifying antirheumatic drugs (Methotrexate in 85% of patients. During hospitalization at the Clinical Rheumatologic Department of the Institute 'Niska Banja', the patients were treated, beside the medicamentous therapy, by hydrotherapy (oligomineral, homeothermic, low radioactive water, mineral peloid therapy, electrotherapy and kinesiotherapy. Before and after balneotherapy, the patients filled in the Health Assessment Questionnaire (HAQ and the Quality of Life Rheumatoid Arthritis (QOL-RA scale. The Disease Activity Score (DAS 28 was used to measure the disease activity before and after balneotherapy. A possible value of HAQ was from 0 to 3, and QOL-RA from 0 to 10. Results. The mean value of the duration of balneophysical therapy was 14.7±4.8 days. We found significant improvement of functional capacity in the patients with RA. The average HAQ score before balneotherapy was 1.07±0.61, and 0.86±0.55 after balneotherapy, which was statistically significantly lower (p<0.05. DAS 28 after balneotherapy was also statistically significantly lower than DAS 28 before balneotherapy: the mean value of DAS 28 before therapy was 6.30±0.81 and after therapy 5.48±0.75 (p<0.001. The quality of life significantly improved after balneophysical therapy: the mean value of QOL-RA scale before therapy was 5.38±1.62 and after therapy 7.35±1.81 (p<0.05. Conclusion. Balneophysical therapy, when properly dosed, is an effective, adjuvant therapy in the patients with RA of mild disease

  2. Anakinra, a recombinant human IL-1 receptor antagonist, in clinical practice. Outcome in 60 patients with severe rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    S. Todesco

    2011-09-01

    Full Text Available Objective: We evaluated both the efficacy and safety of anakinra in daily routine rheumatoid arthritis clinical practice. Methods:We studied 60 cases, including patients with previous anti-TNFα exposure, treated with anakinra (100 mg/daily s.c. in combination with methotrexate (7.5-10 mg/week i.m. or leflunomide (20 mg/die in a two year observational study. Efficacy measures were assessed using the American College of Rheumatology (ACR response criteria. Safety was evaluated according to a modified World Health Organization adverse reaction term dictionary. Results: At week 14, ACR 20% response criteria have been fulfilled by 53 (91.3% out of 58 patients, 51 (87.9% of them achieving also an ACR 50%and 15 (25.8% an ACR 70%response. Thirteen patients touched 102 weeks of treatment: ACR 20% response was achieved in 92.3%, while ACR 50% and ACR 70% were respectively found in 84.6% and 38.4% of the cases. The mean decrease in HAQ score was 0.38, p<0.001. Of the 16 patients who were previously treated with anti-TNFα blockers, 81.2% responded to anakinra. There was no significant difference in the ACR response between groups with and without previous anti-TNFα exposure. Seventeen patients (28.3% stopped anakinra because of side-effects (5% or failure to respond (23.3%. Only 4 cases of pulmonitis, of which 2 have been hospitalised, and 1 case with tuberculosis (previously treated with infliximab were observed. Conclusions: Our clinical experience confirms that anakinra is effective and safe in the treatment of rheumatoid arthritis. Anakinra seems also useful in patients with previous anti-TNFα blockers failures. Even though major adverse events were rare, clinicians should be aware of such a possibility

  3. Chronic arthritis in systemic lupus erythematosus: distinct features in 336 paediatric and 1830 adult patients.

    Science.gov (United States)

    Gormezano, Natali W S; Silva, Clovis A; Aikawa, Nadia E; Barros, Diego L; da Silva, Mariana A; Otsuzi, Carini I; Kozu, Katia; Seguro, Luciana Parente; Pereira, Rosa M R; Bonfá, Eloisa

    2016-01-01

    The objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet. Data were compared using Student's t test or the Mann-Whitney test for continuous variables. For categorical variables, differences were assessed by Fisher's exact test and Pearson chi-square. Frequencies of chronic arthritis were similar in cSLE and aSLE (2.4 vs. 3.8%, p = 0.261). The median time from disease onset to appearance of chronic arthritis was shorter in cSLE (0 vs. 10 years, p lupus anticoagulant (40 vs. 1.6%, p = 0.012), anticardiolipin IgM (40 vs. 1.5%, p = 0.012) and median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [10.5(1-20) vs. 6(4-16), p = 0.029] were higher in cSLE. Frequency of rhupus, (12 vs. 17%, p = 1.0), Jaccoud's arthropathy (0 vs. 17%, p = 0.343) and treatments were similar in cSLE and aSLE. We determined that chronic arthritis in SLE has distinct features in children, with very early onset, polyarticular involvement and association with active disease. We further demonstrated in this series that a proportion of chronic arthritis involvement in SLE is manifested as rhupus and Jaccoud's arthropathy.

  4. Erythrocyte-methotrexate and disease activity in children treated with oral methotrexate for juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Kristensen, K; Nielsen, S; Karup Pedersen, F;

    2000-01-01

    The concentration of methotrexate (MTX) in erythrocytes (E-MTX) was measured twice with three months interval in 21 children suffering from juvenile chronic arthritis (JCA). At the same time joint score, visual analogue scale (VAS), and laboratory parameters (CRP, WBC, PMNs, and ALAT) were obtained...

  5. Relationship of patient-reported outcomes with MRI measures in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Baker, Joshua F; Conaghan, Philip G; Emery, Paul;

    2017-01-01

    PURPOSE: We assessed whether MRI measures of synovitis, osteitis and bone erosion were associated with patient-reported outcomes (PROs) in a longitudinal clinical trial setting among patients with rheumatoid arthritis (RA). METHODS: This longitudinal cohort of 291 patients with RA was derived from...... across treatment groups. CONCLUSIONS: MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments. These observations support the validity of MRI biomarkers. TRIAL REGISTRATION NUMBER: NCT00264537; Post-results....

  6. Clinical and Serological Findings in Juvenile Patients with Idiopathic Arthritis in Southwestern of Iran

    Directory of Open Access Journals (Sweden)

    Soheila Alyasin

    2014-10-01

    Full Text Available Introduction: The purpose of this study was to describe clinical features and serological findings of children with idiopathic arthritis in south-western Iran.Methods: This descriptive study included 60 patients with juvenile idiopathic arthritis who were referred to a pediatric rheumatology clinic at a university hospital during 6-month period. Initial manifestations, first laboratory tests and clinical course of patients were reviewed.Results: Sixty children (32 boys and 28 girls with idiopathic arthritis ranged in age from 1.5 to 16 years. The mean age at the first presentation was 4.92 years (SD= 3.68. Oligoarthritis was the most common subtype in 27 (45%, followed by systemic- onset in 17 (28.3% and polyarthritis in 16 (26.7% of patients. The most commonly involved joints were knee 53(88.3%, ankle 28(46.6% and wrist 27(45%. Uveitis was detected in two patients, and positivity for ANA titer was revealed in one patient. Conclusions: In this study, the pattern of most clinical features in different subtypes of juvenile idiopathic arthritis resembles to other studies. Positive ANA was less; however, the low numbers of Iranian patients with uveitis was noteworthy.

  7. Infection and immune-mediated meningococcal-associated arthritis: combination features in the same patient

    Directory of Open Access Journals (Sweden)

    Karim Yaqub Ibrahim

    2012-04-01

    Full Text Available We present a case of a 16-year-old male patient with sudden-onset, rash, arthritis and meningitis by Neisseria meningitidis one week after an acute upper respiratory infection. On the 10th day of treatment followed by neurological and arthritis clinical improvement, he presented once again a tender and swollen left knee with a moderate effusion, and active and passive range of motion was severely limited secondary to pain, and when he was submitted to surgical drainage and synovial fluid analysis he showed inflammatory characteristics. A non-steroidal anti-inflammatory drug was taken for five days with complete improvement of symptoms. The case is notable for its combination of features of septic and immune-mediated arthritis, which has rarely been reported in the same patient.

  8. Cartilage oligomeric matrix protein in patients with juvenile idiopathic arthritis: relation to growth and disease activity

    DEFF Research Database (Denmark)

    Bjørnhart, Birgitte; Juul, Anders; Nielsen, Susan;

    2009-01-01

    : 87 patients with JIA entered the study, including oligoarticular JIA (n = 34), enthesitis-related arthritis (n = 8), polyarticular rheumatoid factor (RF)-positive JIA (n = 2), polyarticular RF-negative JIA (n = 27), systemic JIA (n = 6), and undifferentiated JIA (n = 10). Plasma levels of COMP were......OBJECTIVE: Cartilage oligomeric matrix protein (COMP) has been identified as a prognostic marker of progressive joint destruction in rheumatoid arthritis. In this population based study we evaluated associations between plasma concentrations of COMP, disease activity, and growth velocity...... in patients with recent-onset juvenile idiopathic arthritis (JIA). COMP levels in JIA and healthy children were compared with those in healthy adults. Plasma levels of insulin-like growth factor I (IGF-1), which has been associated with COMP expression and growth velocity, were studied in parallel. METHODS...

  9. Reduced mandibular growth in experimental arthritis in the temporomandibular joint treated with intra-articular corticosteroid.

    Science.gov (United States)

    Stoustrup, Peter; Kristensen, Kasper D; Küseler, Annelise; Gelineck, John; Cattaneo, Paolo M; Pedersen, Thomas K; Herlin, Troels

    2008-04-01

    The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.

  10. 孙维峰治疗痛风性关节炎经验%Sun Wei-feng's Experience of Treating Gouty Arthritis

    Institute of Scientific and Technical Information of China (English)

    劳贝妮

    2016-01-01

    Professor Sun Wei-feng thinks that gouty arthritis during the intermittent period and chronic phase are mainly due to yin deficiency of the liver and kidney leading to the spleen failing to activate,internal phlegmatic dampness,intermingled phlegm and blood stasis blocking in meridians,joints and the viscera.He emphasizes that "deficiency of the liver,spleen and kidney,intermingled phlegm and blood stasis" are the root of gouty arthritis during the intermittent period and chronic phase,so the treatment should focus on "purging turbidity and removing pathogenesis,dissolving the dampness and clearing away heat,activating blood circulation to remove blood stasis." He uses self-made (XZCBD) to treat it.He especially pays attention to prevention and regulation of patients with gouty arthritis.%孙维峰教授认为痛风性关节炎间歇期及慢性期的病因多为肝肾阴虚,脾失健运,痰湿内生,久则痰瘀互结,留滞经脉、关节、脏腑,强调“肝脾肾虚、痰瘀互结”为痛风的发病根源.孙教授认为痛风性关节炎间歇期及慢性期的治疗原则为“泄浊祛邪、化湿清热、活血化瘀”,自拟“泄浊除痹汤”治疗痛风间歇期及慢性期.孙维峰教授特别注重对痛风性关节炎患者生活上的预防调摄.

  11. Clinical significance in detection of inflammatory cytokines in rheumatoid arthritis patients

    Institute of Scientific and Technical Information of China (English)

    Liang-Qian Wang; Yang Tang; Xiu-Yang Li; Da-Jun Liu

    2016-01-01

    Objective:To investigate the relationship between inflammatory cytokines and rheumatoid arthritis, and explore the clinical application value of cytokines in the diagnosis, treatment and prognosis of rheumatoid arthritis.Methods:A total of 136 cases of patients with rheumatoid arthritis were regarded as the RA group. Among them, 62 patients were in remission and 74 patients were in the active phase of the disease. Besides, 53 cases of healthy volunteers were considered as the control group. The changes of the IL-1β, IL-6, IL-8, IL-10 and IFN-γ of the three groups were compared and the correlation of the inflammatory cytokines in patients with rheumatoid arthritis, DSA28 score and C-reactive protein would be explored. Results:The IL-1β and IFN-γ of patients in remission in the RA group showed no statistical differences as compared with those of the control group; the IL-1β and IFN-γ of patients in the active phase of the disease in the RA group presented statistical differences as compared with those of patients in the control group and patients in remission in the RA group; The IL-6, IL-8 and IL-10 were compared in pairs and all showed statistical differences; CRP and DSA28 score and IL-6, IL-8 and IL-10 were positively correlated, while IL-1β, IFN-γ and CRP and DSA 28 score had no correlations.Conclusions:It is of important significance in the clinic to detect inflammatory cytokines in the early diagnosis, disease evaluation and prognostic prediction of rheumatoid arthritis.

  12. Effects of Antitumor Necrosis Factor Therapy on Osteoprotegerin, Neopterin, and sRANKL Concentrations in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Katharina Kurz

    2015-01-01

    Full Text Available Background. Rheumatoid arthritis is a systemic autoimmune disease characterized by joint erosions, progressive focal bone loss, and chronic inflammation. Methods. 20 female patients with moderate-to-severe rheumatoid arthritis were treated with anti-TNF-antibody adalimumab in addition to concomitant antirheumatic therapies. Patients were assessed for overall disease activity using the DAS28 score, and neopterin, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP concentrations as well as osteoprotegerin (OPG and soluble receptor activator of NF-κB ligand (sRANKL concentrations were determined before therapy and at week 12. Neopterin as well as OPG and sRANKL were determined by commercial ELISAs. Results. Before anti-TNF therapy patients presented with high disease activity and elevated concentrations of circulating inflammatory markers. OPG concentrations correlated with neopterin (rs=0.494, p=0.027, but not with DAS28. OPG concentrations and disease activity scores declined during anti-TNF-treatment (both p<0.02. Patients who achieved remission (n=7 or showed a good response according to EULAR criteria (n=13 presented with initially higher baseline OPG levels, which subsequently decreased significantly during treatment (p=0.018 for remission, p=0.011 for good response. Conclusions. Adalimumab therapy was effective in modifying disease activity and reducing proinflammatory and bone remodelling cascades.

  13. Treating axial and peripheral spondyloarthritis, including psoriatic arthritis, to target: results of a systematic literature search to support an international treat-to-target recommendation in spondyloarthritis

    Science.gov (United States)

    Schoels, M M; Braun, J; Dougados, M; Emery, P; Fitzgerald, O; Kavanaugh, A; Kvien, T K; Landewé, R; Luger, T; Mease, P; Olivieri, I; Reveille, J; Ritchlin, C; Rudwaleit, M; Sieper, J; Smolen, J S; de Wit, M; van der Heijde, D

    2014-01-01

    Background Current recommendations for the management of axial spondyloarthritis (SpA) and psoriatic arthritis are to monitor disease activity and adjust therapy accordingly. However, treatment targets and timeframes of change have not been defined. An international expert panel has been convened to develop ‘treat-to-target’ recommendations, based on published evidence and expert opinion. Objective To review evidence on targeted treatment for axial and peripheral SpA, as well as for psoriatic skin disease. Methods We performed a systematic literature search covering Medline, Embase and Cochrane, conference abstracts and studies in http://www.clinicaltrials.gov. Results Randomised comparisons of targeted versus routine treatment are lacking. Some studies implemented treatment targets before escalating therapy: in ankylosing spondylitis, most trials used a decrease in Bath Ankylosing Spondylitis Disease Activity Index; in psoriatic arthritis, protocols primarily considered a reduction in swollen and tender joints; in psoriasis, the Modified Psoriasis Severity Score and the Psoriasis Area and Severity Index were used. Complementary evidence correlating these factors with function and radiographic damage at follow-up is sparse and equivocal. Conclusions There is a need for randomised trials that investigate the value of treat-to-target recommendations in SpA and psoriasis. Several trials have used thresholds of disease activity measures to guide treatment decisions. However, evidence on the effect of these data on long-term outcome is scarce. The search data informed the expert committee regarding the formulation of recommendations and a research agenda. PMID:23740234

  14. Compliance with methotrexate treatment in patients with rheumatoid arthritis: influence of patients' beliefs about the medicine. A prospective cohort study

    DEFF Research Database (Denmark)

    de Thurah, Annette; Nørgaard, Mette; Harder, Ingegerd;

    2010-01-01

    Objective of the study is to investigate how compliance during the first year of methotrexate (MTX) treatment in rheumatoid arthritis (RA) is influenced by the patients' perception of the necessity for and concern about MTX, the patients' functional disability, and the dose of MTX. A total of 126...

  15. Safety and Efficacy of Vaccination Against Influenza in Patients With Rheumatoid Arthritis

    OpenAIRE

    Ori Elkayam

    2006-01-01

    Vaccination against influenza is currently recommended for patients with rheumatoid arthritis (RA). The safety and efficacy of vaccination in patients suffering from rheumatic diseases is still a matter of debate. This review summarizes the studies performed on the safety and immunogenicity of influenza vaccination in patients with RA as well as the rheumatic complications of the vaccine in otherwise healthy persons. Several trials have shown that the vaccine induces an adequate humoral respo...

  16. Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity

    OpenAIRE

    Ebru Karaca Umay; Eda Gurcay; Pinar Bora Karsli; Aytul Cakci

    2016-01-01

    Abstract Introduction Our aim in this study was to present the results of sensory evaluation tests and electrophysiological evaluations in rheumatoid arthritis (RA) patients with foot deformity and to determine their relation with general health status and lower extremity functionality. Materials and methods Fifty-one patients with RA diagnosis and foot deformity were included in the study. Demographic and disease characteristics of the patients were recorded, and a detailed neurological ex...

  17. Interleukin 6 blockage-induced neutropenia in a patient with rheumatoid arthritis and resolved hepatitis B.

    Science.gov (United States)

    Chmielińska, Magdalena; Olesińska, Marzena; Felis-Giemza, Anna

    2015-01-01

    The authors present a case report of a 59-year-old woman with rheumatoid arthritis after documented recovery from hepatitis C (HCV) infection and with resolved HBV infection who has been undergoing successful tocilizumab treatment. The patient experienced moderate to severe neutropenia after consecutive tocilizumab administrations. However, no serious infections or HBV reactivation was recorded during that period.

  18. [The patient with arthritis: care by both general practitioners and rheumatologists].

    NARCIS (Netherlands)

    Janssens, H.; Lisdonk, E.H. van de; Janssen, M.

    2011-01-01

    Early aggressive treatment of rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs such as TNF inhibitors prevents joint damage and improves the quality of life. There is increasing insight regarding the cardiovascular risks of patients suffering from RA or gout. These aspects and ot

  19. Compliance in rheumatoid arthritis and the role of formal patient education

    NARCIS (Netherlands)

    Brus, Herman; Laar, van de Martin; Taal, Erik; Rasker, Johannes; Wiegman, Oene

    1997-01-01

    Objective: This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient edu

  20. Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia

    NARCIS (Netherlands)

    Näring, G.W.B.; Lankveld, W.G.J.M. van; Geenen, R.

    2007-01-01

    OBJECTIVE: Trauma and dissociation tend to be interrelated. The objective of this study was to examine the frequency of traumatic experiences and somatoform dissociation in patients with fibromyalgia syndrome (FMS) or rheumatoid arthritis (RA), two conditions that are both characterized by pain and

  1. Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia

    NARCIS (Netherlands)

    Näring, G.W.B.; Lankveld, W.G.J.M. van; Geenen, M.J.M.

    2007-01-01

    Objective: Trauma and dissociation tend to be interrelated. The objective of this study was to examine the frequency of traumatic experiences and somatoform dissociation in patients with Fibromyalgia syndrome (FMS) or rheumatoid arthritis (RA), two conditions that are both characterized by pain and

  2. Incorporating the patient perspective into outcome assessment in rheumatoid arthritis - progress at OMERACT 7

    NARCIS (Netherlands)

    Kirwan, John R.; Hewlett, Sarah E.; Heiberg, Turid; Hughes, Rod A.; Carr, Maggie; Hehir, Maggie; Kvien, Tore K.; Minnock, Patricia; Newman, Stanton P.; Quest, Enid M.; Taal, Erik; Wale, Janney

    2005-01-01

    The Patient Perspective Workshop at OMERACT 7 addressed the question of assessing the outcomes of intervention in rheumatoid arthritis (RA) from the perspective of those who experience the disease. A particular emphasis at this workshop was placed on fatigue, but other areas included well-being, rea

  3. Gene therapy in animal models of rheumatoid arthritis: are we ready for the patients?

    NARCIS (Netherlands)

    Loo, F.A.J. van de; Smeets, R.L.L.; Berg, W.B. van den

    2004-01-01

    Rheumatoid arthritis (RA) is a chronic inflammatory disease of the synovial joints, with progressive destruction of cartilage and bone. Anti-tumour necrosis factor-alpha therapies (e.g. soluble tumour necrosis factor receptors) ameliorate disease in 60-70% of patients with RA. However, the need for

  4. Productivity at work and quality of life in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Vilsteren, M. van; Boot, C.R.; Knol, D.L.; Schaardenburg, D. van; Voskuyl, A.E.; Steenbeek, R.; Anema, J.R.

    2015-01-01

    Background The aim of this study was to determine which combination of personal, disease-related and environmental factors is best associated with at-work productivity loss in patients with rheumatoid arthritis (RA), and to determine whether at-work productivity loss is associated with the quality o

  5. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis

    OpenAIRE

    GUPTA, M.; Sturrock, R; Field, M

    2003-01-01

    Objective: To investigate whether patients with acute septic arthritis (SA) diagnosed by positive synovial fluid (SF) culture (Newman grade A) have different clinical and serological features from those with sterile SF in whom there is nonetheless a high suspicion of SA (Newman grades B and C).

  6. Septic Arthritis Caused by Legionella dumoffii in a Patient with Systemic Lupus Erythematosus-Like Disease

    NARCIS (Netherlands)

    Flendrie, M.; Jeurissen, S.M.F.; Franssen, M.; Kwa, D.; Klaassen, C.; Vos, F.

    2011-01-01

    We describe a patient with systemic lupus erythematosus (SLE)-like disease on immunosuppressive treatment who developed septic arthritis of the knee involving Legionella dumoffii. Cultures initially remained negative. A broad-range 16S PCR using synovial fluid revealed L. dumoffii rRNA genes, a find

  7. Scintigraphic detection of tumour necrosis factor in patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Barrera Rico, P.; Oyen, W.J.G.; Boerman, O.C.; Riel, P.L.C.M. van

    2003-01-01

    OBJECTIVES: To investigate the biodistribution and specific targeting for tumour necrosis factor (TNF) of a fully human, radiolabelled anti-TNF monoclonal antibody (anti-TNF mAb) in patients with active rheumatoid arthritis (RA). To assess whether this agent is suitable for visualisation of synoviti

  8. Is Coping Self-Efficacy Related to Psychological Distress in Early and Established Rheumatoid Arthritis Patients?

    NARCIS (Netherlands)

    Benka, Jozef; Nagyova, Iveta; Rosenberger, Jaroslav; Macejova, Zelmira; Lazurova, Ivica; Van der Klink, Jac; Groothoff, Johan; Van Dijk, Jitse

    2014-01-01

    The study aimed to explore associations between coping self-efficacy and psychological distress in early and established rheumatoid arthritis (RA) patients. Two samples differing in disease duration were collected at outpatient rheumatology clinics in Eastern Slovakia. The first sample consisted of

  9. Inhibition of cytokine production by methotrexate. Studies in healthy volunteers and patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Gerards, A.H.; Lathouder, de S; Groot, E.R.; Dijkmans, B.A.C.; Aarden, L.A.

    2003-01-01

    OBJECTIVES: To analyse whether the beneficial effects of methotrexate in rheumatoid arthritis (RA) could be due to inhibition of inflammatory cytokine production. METHODS: Cytokine production was studied using whole blood (WB) and mononuclear cells (MNC) of healthy volunteers and RA patients. Cultur

  10. Periodontitis in established rheumatoid arthritis patients : A cross-sectional clinical, microbiological and serological study

    NARCIS (Netherlands)

    Smit, Menke de; Westra, Johanna; Vissink, Arjan; Doornbos-van der Meer, Berber; Brouwer, Elisabeth; van Winkelhoff, Arie Jan

    2012-01-01

    INTRODUCTION: The association between rheumatoid arthritis (RA) and periodontitis is suggested to be linked to the periodontal pathogen Porphyromonas gingivalis. Colonization of P. gingivalis in the oral cavity of RA patients has been scarcely considered. To further explore whether the association b

  11. Keitel Functional Test for patients with rheumatoid arthritis: translation, reliability, validity, and responsiveness

    DEFF Research Database (Denmark)

    Jacobsen, S.; Skjodt, H.; Klarlund, M.;

    2008-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to translate the German Keitel Functional Test (KFT) into Danish and test it for reliability, concurrent and predictive validity, and responsiveness in patients with rheumatoid arthritis (RA). METHODS: Translation of the KFT was performed acco...

  12. Effects of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial.

    NARCIS (Netherlands)

    Ende, C.H.M. van den; Breedveld, F.C.; Cessie, S. le; Dijkmans, B.A.C.; Mug, A.W. de

    2000-01-01

    Objectives: To investigate the effects of a dynamic, intensive exercise regimen on pain, disease activity, and physical functioning in active rheumatoid arthritis (RA). Methods: 64 patients with RA with a mean age of 60 (13) years and mean disease duration of 8 (8) years, admitted to hospital becaus

  13. Pulmonary tuberculosis in a patient with rheumatoid arthritis undergoig immunosuppressive treatment: case report

    Directory of Open Access Journals (Sweden)

    Sandro Ceratti

    2014-02-01

    Full Text Available Rheumatoid arthritis is a disease which characteristically affects the joints. Because it is an autoimmune disease, immunosuppressive drugs are widely used in its treatment. The present case report illustrates the association of immunosuppressive treatment with the development of opportunistic infections in a 64-year-old patient.

  14. Osteoprotegerin CGA haplotype protection against cerebrovascular complications in anti-CCP negative patients with rheumatoid arthritis.

    Directory of Open Access Journals (Sweden)

    Fernanda Genre

    Full Text Available Rheumatoid arthritis is an inflammatory disease with high incidence of cardiovascular disease due to accelerated atherosclerosis. Osteoprotegerin (OPG has been associated with increased risk of atherosclerotic disease in the general population. Several polymorphisms in the OPG gene with functional effects on cardiovascular disease in non-rheumatic individuals have been described. Therefore, we aimed to analyze the effect of three of these functional OPG polymorphisms on the risk of cardiovascular disease in a large and well-characterized cohort of Spanish patients with rheumatoid arthritis.Three OPG gene variants (rs3134063, rs2073618 and rs3134069 were genotyped by TaqMan assays in 2027 Spanish patients with rheumatoid arthritis. Anti-cyclic citrullinated peptide (anti-CCP antibody testing was positive in 997 of 1714 tested. Also, 18.3% of the whole series had experienced cardiovascular events, including 5.4% with cerebrovascular accidents. The relationship between OPG variants and cardiovascular events was assessed using Cox regression.No association between OPG gene variants and cardiovascular disease was observed in the whole group of rheumatoid arthritis patients or in anti-CCP positive patients. Nevertheless, a protective effect of CGA haplotype on the risk of cardiovascular disease in general, and specifically in the risk of cerebrovascular complications after adjusting for sex, age at disease diagnosis and traditional cardiovascular risk factors was disclosed in anti-CCP negative patients (HR = 0.54; 95%CI: 0.31-0.95; p = 0.032 and HR = 0.17; 95%CI: 0.04-0.78; p = 0.022, respectively.Our results indicate a protective effect of the OPG CGA haplotype on cardiovascular risk, mainly due to a protective effect against cerebrovascular events in anti-CCP negative rheumatoid arthritis patients.

  15. Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients

    Energy Technology Data Exchange (ETDEWEB)

    Nusman, Charlotte M.; Hemke, Robert [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Benninga, Marc A.; Kindermann, Angelika [University of Amsterdam, Department of Pediatric Gastroenterology, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Schonenberg-Meinema, Dieneke; Berg, J.M. van den; Kuijpers, Taco W. [University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Rossum, Marion A.J. van [University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Reade, Department of Pediatric Rheumatology, Amsterdam (Netherlands); Maas, Mario [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands)

    2016-04-15

    To evaluate enhancing synovial thickness upon contrast-enhanced magnetic resonance imaging (MRI) of the knee in children unaffected by clinical arthritis compared with clinically active juvenile idiopathic arthritis (JIA) patients. A secondary objective was optimization of the scoring method based on maximizing differences on MRI between these groups. Twenty-five children without history of joint complaints nor any clinical signs of joint inflammation were age/sex-matched with 25 clinically active JIA patients with arthritis of at least one knee. Two trained radiologists, blinded for clinical status, independently evaluated location and extent of enhancing synovial thickness with the validated Juvenile Arthritis MRI Scoring system (JAMRIS) on contrast-enhanced axial fat-saturated T1-weighted MRI of the knee. Enhancing synovium (≥2 mm) was present in 13 (52 %) unaffected children. Using the total JAMRIS score for synovial thickening, no significant difference was found between unaffected children and active JIA patients (p = 0.091). Additional weighting of synovial thickening at the JIA-specific locations enabled more sensitive discrimination (p = 0.011). Mild synovial thickening is commonly present in the knee of children unaffected by clinical arthritis. The infrapatellar and cruciate ligament synovial involvement were specific for JIA, which - in a revised JAMRIS - increases the ability to discriminate between JIA and unaffected children. (orig.)

  16. Increased demand for steroid therapy in hyperprolactinemic patients with rheumatoid arthritis.

    Science.gov (United States)

    Rovenský, J; Bakosová, J; Payer, J; Lukác, J; Raffayová, H; Vigas, M

    2001-01-01

    The role of increased plasma prolactin (PRL) in rheumatoid arthritis (RA) is not fully explained. The aim of this study was to compare the clinical features and the treatment administered in RA patients with normal and elevated plasma PRL concentrations. Forty-nine patients with rheumatoid arthritis and 16 healthy subjects were included in this study In healthy controls, PRL concentrations were 7.6 micro/l (median), in 34 patients plasma PRL was less than 20 micro/l (9.9 micro/l) and in 15 patients it was elevated, with a median of 26.7 micro/l. No differences in clinical features were found compared with normal or increased plasma PRL. The introduction of corticoid therapy produced a significant difference. Steroid therapy was administered to 93% of the patients with hyperprolactinemia, compared with 59% of those with normal PRL concentrations. Daily prednisone doses higher than 5 mg were administered to 43% of the patients with elevated PRL, compared with 25% of patients with normal prolactin concentrations. In conclusion, the clinical feature of patients with rheumatoid arthritis did not differ in subjects with elevated PRL concentrations and in those with normal concentrations. The difference between these two groups was in the higher demand for steroid therapy in patients with hyperprolactinemia.

  17. Late results of total shoulder replacement in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Søjbjerg, J.O.; Frich, Lars Henrik; Johannsen, H.V.;

    1999-01-01

    at the authors' institution. Total shoulder replacement yields satisfactory short and long term results even in patients with severely destructed joints. Pain relief is reliable and significant as reported in short and long term studies. In most patients the functional result is good or acceptable. Although......Rheumatoid arthritis of the shoulder is a progressive and destructive joint disease, and similar to arthritis in other joints, progression of the disease is unpredictable and may stop at any stage of involvement. Between 1983 and 1996, more than 500 shoulder prostheses were implanted in patients...... range of motion is only slightly increased, a satisfactory overall range of motion is achieved by most patients because of the unaffected scapulothoracic motion. However, deteriorating results, emphasizing the complexity of shoulder arthroplasty, were seen with increasing observation time in patients...

  18. Impact of tofacitinib on patient outcomes in rheumatoid arthritis – review of clinical studies

    Directory of Open Access Journals (Sweden)

    Boyce EG

    2016-01-01

    Full Text Available Eric G Boyce, Deepti Vyas, Edward L Rogan, Cynthia S Valle-Oseguera, Kate M O'Dell Department of Pharmacy Practice, Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, USAAbstract: Rheumatoid arthritis is a chronic, progressive autoimmune disease associated with inflammation and destruction of joints and systemic effects, which result in significant impact on patient's quality of life and function. Tofacitinib was approved for the treatment of rheumatoid arthritis in the USA in 2012 and subsequently in other countries, but not by the European Medicines Agency. The goal of this review was to evaluate the impact of tofacitinib on patient-reported and patient-specific outcomes from prior clinical studies, focusing on quality of life, functionality, pain, global disease assessment, major adverse consequences, and withdrawals. A total of 13 reports representing 11 clinical studies on tofacitinib in rheumatoid arthritis were identified through PubMed and reference lists in meta-analyses and other reviews. Data on improvements in patient-driven composite tools to measure disease activity in rheumatoid arthritis, such as the Health Assessment Questionnaire, served as a major outcome evaluated in this review and were extracted from each study. Additional data extracted from those clinical studies included patient assessment of pain (using a 0–100 mm visual analog scale, patient global assessment of disease (using a 0–100 mm visual analog scale, patient withdrawals, withdrawals due to adverse effects or lack of effect, and risk of serious adverse effects, serious infections, and deaths. Tofacitinib 5 mg bid appears to have a favorable impact on patient outcomes related to efficacy and safety when compared with baseline values and with comparator disease-modifying antirheumatic drugs and placebo. Improvements were seen in the composite and individual measures of disease activity. Serious adverse effects, other

  19. Management of patients using unproven regimens for arthritis.

    Science.gov (United States)

    Wolman, P G

    1987-09-01

    Such treatments as vegetarian diets, fresh or raw diets, allergy diets, no-dairy-products diets, fasting, vitamin and mineral supplementation, apple cider vinegar, and honey drinks are touted in the popular press as effective for the treatment of arthritis. In contrast to conventional therapies, the unproven treatments promise not only relief from symptoms but freedom from the disease as long as the diet regimen is followed. Several of the remedies appear to be harmless, but others are dangerous, especially if followed for prolonged periods. Nutrition professionals should be aware of the nature of these treatments and be prepared to offer sound, scientifically based but nonjudgmental care and information.

  20. Life Expectancy in Patients Treated for Osteoporosis

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Osmond, Clive; Cooper, Cyrus

    2015-01-01

    Osteoporosis is a chronic disease, carrying an elevated risk of fractures, morbidity, and death. Long-term treatment may be required, but the long-term risks with osteoporosis drugs remain incompletely understood. The competing risk of death may be a barrier to treating the oldest, yet this may...... not be rational if the risk of death is reduced by treatment. It is difficult to devise goal-directed long-term strategies for managing osteoporosis without firm information about residual life expectancy in treated patients. We conducted an observational study in Danish national registries tracking prescriptions...... for osteoporosis drugs, comorbid conditions, and deaths. We included 58,637 patients and 225,084 age- and sex-matched control subjects. Information on deaths until the end of 2013 was retrieved, providing a follow-up period of 10 to 17 years. In men younger than 80 years and women younger than 60 years...

  1. Relationship between patient-reported and objective measurements of hand function in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    S.M. Günay

    2016-12-01

    Full Text Available Rheumatoid arthritis (RA often results in impairments in upper extremities, especially in the small joints of hand. Involvement of hand brings limitations in activities of daily living. However, it is commonly observed that patient-reported functional status of hand does not always corresponds to their actual physical performance in the clinical setting. The aim of this pilot study is to investigate the relationship between patient self-reported and objectively measured hand functions in patients with RA. Twenty-six patients (51±13 years with RA diagnosis participated in the study. Hand grip and pinch (lateral, bipod, tripod strengths were measured and Jebsen Hand Function Test (JHFT was performed for objective functional performance. Duruöz Hand Index and Beck Depression Inventory - Turkish version were completed by patients. Grip and all three-pinch strength results significantly correlated with Duruöz Hand Index scores (p<0.05. JHFT results except the sentence writing also correlated with the Duruöz scores (p<0.05. Our results showed that self-reported outcome scales might be used for determining functional level of hand in patients with RA in rheumatology practice. Objective quantitative functional tests are the best methods in evaluating functional level of hand, but require valid and reliable equipment with accurate calibration. Therefore, in case of unavailability of objective assessment tools, patient-reported scales may also reflect the real status of hand functions.

  2. A comprehensive analysis of treatment outcomes in patients with pemphigus vulgaris treated with rituximab.

    Science.gov (United States)

    Ahmed, A Razzaque; Shetty, Shawn

    2015-04-01

    Approximately 500 treatment recalcitrant pemphigus vulgaris patients have been treated with rituximab. They were treated according to the lymphoma protocol (N=224) or rheumatoid arthritis protocol (RAP) (N=209) patients. Others were treated with modifications or combinations of the two. The mean duration of follow-up with the lymphoma protocol was 28.9months and 21.9 in the rheumatoid arthritis protocol. The majority of the patients received corticosteroids and immunosuppressive therapy before, during, and after rituximab therapy. A clinical remission on therapy was observed in 90%-95% of patients within less than six weeks. A complete resolution occurred within three to four months. A small percentage of patients were able to stay in clinical remission without the need for additional systemic therapy. The incidence of relapse was at least 50%. The number of patients who required additional rituximab was 60% to 90%. A majority of patients in clinical remission post-rituximab therapy, were still on CS and ISA, albeit at lower doses. Serious adverse events were reported in a mean of five patients (range 2-9), the most important was infection and frequently resulting in septicemia. The mortality rate related to rituximab was a mean of 2 patients (range 1-3). Hence, the preliminary conclusions that can be drawn are that rituximab is an excellent agent to induce early remission. The protocols that were used were not ideal for producing a prolonged and sustained remission without additional therapy. The advantages and specificity of targeting B-cells demonstrate that rituximab is one of the best biological agents, currently available for treating recalcitrant pemphigus. Its further use is encouraged. Future research needs to focus on modifying, improving and possibly adding additional agents, so that prolonged and sustained remissions can be obtained by its use.

  3. EFFICACY OF UNDERWATER INTERFERENTIAL CURRENT ON HAND FUNCTION IN PSORIATIC ARTHRITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Ahmed Fathy Samhan. PhD PT

    2014-04-01

    Full Text Available Background: Psoriatic arthritis is an entity of inflammatory joint disease associated with psoriasis. Purpose: The purpose of this study was to evaluate the efficacy of underwater interferential current therapy on hand function in psoriatic arthritis of both hands. Method: Thirty patients (18 females and 12 males had psoriatic arthritis of hands, aged 42 to 50 years with 45.77 ± 3.52 mean, were assigned randomly into two groups of equal number: study group received 20 minutes underwater interferential current for one month, 3 times per week (12 sessions and control group received placebo interferential current. Visual analogue scale for patient-reported pain, the Disability of Arm, Shoulder and Hand questionnaire score, and hand function (grip force in Pound of dominant hand were assessed pretreatment and post-treatment. Results: showed significant improvement in the 3 outcomes in study group (p 0.005. Visual analogue scale had a strong positive correlation (p < 0.001 with the disability score and a strong negative correlation (p < 0.001 with the grip force. Conclusion: Using underwater interferential current therapy in patient with psoriatic arthritis of hands was effective in improvement of hand function and quality of life.

  4. Patient safety risks and patients treated by multiple specialties.

    NARCIS (Netherlands)

    Baines, R.; Bruijne, M. de; Langelaan, M.; Wagner, C.

    2013-01-01

    Objectives: To determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission. Methods: We performed structured retrospective patient record review study by trained nurses and physicians. We included 20 hospitals in the N

  5. Risk factors for venous thromboembolic events in patients with rheumatoid arthritis

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    M. A. Satybaldyeva

    2016-01-01

    Full Text Available Objective: to determine the incidence and risk factors of venous thromboembolic events (VTEE in patients with rheumatoid arthritis (RA.Subjects and methods. The investigation enrolled 362 patients (302 women and 60 men with RA fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria. The patients' mean age was 53.7±13.3 years; the disease duration was 12.4±10.9 years. All the patients were treated at the V.A. Nasonova Research Institute of Rheumatology in the period 2014 to 2015. Each patient underwent standard clinical examination of peripheral joints. RA activity was assessed with DAS28. There was a questionnaire survey that included traditional risk factors for VTEE and risk factors that might be due to RA and its therapy.Results and discussion. 34 (9.9% patients were found to have VTEE during their hospitalization or in their history. In 32 of them thromboses were located in the veins of the lower extremities, namely 18 and 14 patients had thromboses in the distal and proximal segments, respectively. One patient was recorded to have upper extremity vein thrombosis and another had central retinal vein thrombosis. Lower extremity deep vein thrombosis was complicated by pulmonary thromboembolism in one case. Multivariate analysis has shown that the risk factors of VTEE in RA patients are bed care, heart failure, varicose vein disease, and oral administration of glucocorticoids (GC and intraarticular GC administration (>5 injections; the weighted coefficients of the risk factors are 1.0, 0.92, 3.13, 0.02, and 0.52, respectively. According to the model obtained (p < 0.0001, the risk of VTEE can be predicted using the following formula: Z = 1.0 × bed care (yes, 1 / no, 0 + 0.92 × heart failure (yes, 1 / no, 0 + 3.13 × varicose vein disease (yes, 1 / no, 0 + 0.02 × oral GC use (yes, 1 / no, 0 + 0.52 × intraarticular GC administration (>5 injections; yes, 1 / none, 0.Conclusion. The risk of VTEE should

  6. Prioritizing the patient: optimizing therapy in rheumatoid arthritis. Results of a patient questionnaire in northern Germany

    Directory of Open Access Journals (Sweden)

    Wollenhaupt J

    2013-05-01

    Full Text Available Jürgen Wollenhaupt,1 Inge Ehlebracht-Koenig,2 André Groenewegen,3 Dieter Fricke41Rheumatologikum Hamburg, Schön Klinik Hamburg Eilbek, Hamburg, Germany; 2Center of Rehabilitation, Bad Eilsen, Germany; 3UCB Pharma SA, Brussels, Belgium; 4UCB Pharma GmbH, Monheim, GermanyPurpose: A 40-question postal survey was developed to gain insight into the nature of difficulties experienced by patients due to rheumatoid arthritis (RA, as well as patient perceptions and priorities regarding their RA treatmentPatients and methods: A total of 3000 Lower Saxony, Germany members of Rheuma-Liga (RL, a patient support group for people with RA, were invited to participate between July 1, and August 20, 2009. The questionnaire was divided into four sections: (1 patient demographics, (2 quality of life (QOL, (3 treatment expectations and, (4 patient perceptions of RL. The questionnaire could be completed in writing or via the internet.Results: Of 959 respondents (response rate = 32.0%, 318 had diagnosed RA and were included in the analysis. The respondents were mostly retired (71.2%, female (83.3%, and >60 years of age (63.5%. Members’ responses indicated that most were generally satisfied with their current treatment (67.3%, considered it efficacious (84.0%, and reported minimal (none or little side-effects (61.2%. Patient involvement in treatment decisions, however, was reportedly low (49.6% felt insufficiently involved. Patients’ primary impairments were reflected in their treatment priorities: mobility (97.0%, ability to run errands/do shopping (97.1%, do the housework (95.6%, and be independent of others (94.2%. The primary service provided by RL and used by respondents was physiotherapy (70.6%, which was reported to benefit physical function and mood by over 90.0% of respondents.Conclusion: RA had a detrimental effect upon respondents' quality of life, specifically impairing their ability to perform daily tasks and causing pain/emotional distress

  7. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique

    Science.gov (United States)

    van Onna, M; Ten Cate, D F; Tsoi, K L; Meier, A J L; Jacobs, J W G; Westgeest, A A A; Meijer, P B L; van Beek, M C; Rensen, W H J; Bijlsma, J W J

    2016-01-01

    Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA. PMID:26452538

  8. Posttraumatic Arthritis

    OpenAIRE

    Pickering, Robert D.

    1984-01-01

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

  9. Long-term safety of abatacept in patients with rheumatoid arthritis.

    Science.gov (United States)

    Atzeni, Fabiola; Sarzi-Puttini, Piercarlo; Mutti, Alessandra; Bugatti, Serena; Cavagna, Lorenzo; Caporali, Roberto

    2013-10-01

    Abatacept is a selective T cell co-stimulation modulator that was first approved by the Italian Medicines Agency and reimbursed by the Italian National Health Service when used to treat active rheumatoid arthritis "not sufficiently responsive to other disease-modifying anti-rheumatic drugs (DMARDs) including at least one TNF inhibitor", and is now also approved as a first line biological agent. The aim of this review is to summarise the safety data collected in clinical trials and observational studies.

  10. Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Majid Purabdollah

    2015-09-01

    Full Text Available Introduction: Rheumatoid arthritis as one of the most common autoimmune diseases is known to be one of the leading causes of disability. Sleep disorders have direct influence on patient’s life. According to studies, sleep problems are known to have negative impact on well-being and functioning, but the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood. This study aimed to investigate the relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis patients. Methods: In a descriptive -correlative study, 210 patients with rheumatoid arthritis referred to Tabriz medical university clinics selected by convenience sampling and were assessed by Sleep Disorders Questionnaire (SDQ, Epworth Sleepiness Scale (ESS, SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS. Data were analyzed using SPSS-13 by descriptive statistics such as frequency, mean (SD and inferential statistics including Spearman correlation analysis, linear regression, x2, t- test and ANOVA. Results: The mean age of participants was 48.41(12.92 years in which most of them (74% were female. The mean (SD quality of life was 40.51(22.94, sleepiness 13.14 (5.6 and pain 6.09 (2.14. There was significant negative relationship between some sleep disorders such as (naps, apnea, asphyxia, ... and pain with quality of life but pain severity had more effect on QOL compared to sleep problems. Furthermore, participants had low quality of life with more restriction in physical (mean=34.71 and general health (mean=34.42.Conclusion: Sleep problems and pain were associated with poor quality of life in Rheumatoid Arthritis patients.

  11. Depression and Insomnia in Patients With Psoriasis and Psoriatic Arthritis Taking Tumor Necrosis Factor Antagonists.

    Science.gov (United States)

    Wu, Chun-Ying; Chang, Yun-Ting; Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Yu-Pu; Shieh, Jeng-Jer; Liu, Han-Nan; Chen, Yi-Ju

    2016-05-01

    Psoriasis patients with moderate to severe disease often present with depression and insomnia. Treatment targeting both psoriasis and psychological comorbidities is needed to improve the quality of life of these patients.In this nationwide cohort study, a total of 980 patients with psoriatic arthritis or psoriasis who had received nonbiological disease-modifying antirheumatic drugs and biologics therapy between 2009 and 2012 were identified. The prevalence rates of patients taking medications for depression and insomnia were compared before and after biologics therapy. Logistic regression method was used to investigate the risk factors for depression and insomnia. Further stratified analyses were performed to examine the prevalence of use of medications for depression and insomnia among different patient subgroups.The prevalence of patients taking regular antidepressants before starting biologics therapy was about 20%. There was a more than 40% reduction in this prevalence after biologics therapy for 2 years. Age higher than 45 years, female sex, presence of comorbidities, and psoriatic arthritis were independently associated with depression and insomnia. Further stratified analyses revealed a more rapid and significant reduction in depression/insomnia in those undergoing continuous biologics therapy, younger than 45 years, without psoriatic arthritis and not taking concomitant methotrexate, when compared with their counterparts.The results suggest that biologics therapy may be associated with reduced rates of depression and insomnia, and a reduced rate of regular antidepressants use in psoriasis patients.

  12. Diagnostics of septic arthritis in the sternoclavicular region - 10 consecutive patients and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Bodker, Tina; Jurik, Anne Grethe [Dept. of Radiology, Aarhus Univ. Hospital, Aarhus (Denmark)], e-mail: tina.b.madsen@gmail.com; Toettrup, Mikkel; Kjaer Petersen, Klaus [Dept. of Orthopedic Surgery, The Infection Team, Aarhus Univ. Hospital, Aarhus (Denmark)

    2013-02-15

    Background: Septic arthritis in the sternoclavicular (SC) region is rare and may be difficult to diagnose clinically and radiologically. It mainly affects immunocompromised persons, and can clinically be misinterpreted as tumor and rheumatic disorders. Lacking radiological reference standard, a multimodality approach may contribute to a prolonged diagnostic process. Purpose: To describe the diagnostics of septic arthritis in the SC region. Material and Methods: Between 2001 and 2011, 10 patients with Staphylococcus infection in the SC region were investigated in our institution. Clinical, biochemical, radiological, and microbiological findings were studied retrospectively; all CT and MR examinations were re-evaluated. Results: Initial radiography in nine patients and ultrasonography in six patients were inconclusive resulting in supplementary MRI and/or CT. Five patients examined by MRI were immediately diagnosed with septic arthritis whereas CT in five patients led to the diagnosis in only one. Three were subsequently diagnosed by MRI, but delayed more than 2.5 weeks, and one was diagnosed by surgery. The median time to diagnosis was 1.5 weeks. The delay caused by imaging was 0 days to 11.5 weeks (median 0 days). By re-evaluation overlooked complications included mediastinitis in seven patients (three diffuse, four localized), and abscesses and pleuritis each in four patients. Conclusion: Awareness of infection in the SC region is important to avoid diagnostic delay. MRI is proposed as the initial imaging procedure.

  13. Physiotherapeutic procedures in patients with rheumatoid arthritis with maximum difficulties in the joints of the hand area

    OpenAIRE

    LEDVINOVÁ, Eva

    2014-01-01

    This bachelor thesis is focused on physiotherapeutic methods used in patients with rheumatoid arthritis whose difficulties are mainly in the joints of their hand. Rheumatoid arthritis is a chronic inflammatory joint disease in most cases with a protracted course and it may cause joint deformations. These lead to handling issues which complicate normal daily activities of the patients. Thus this disease causes both physical disability of the patient and as well significantly disrupts their soc...

  14. The impact of physical therapy on the quality of life of patients with rheumatoid and psoriatic arthritis

    OpenAIRE

    Mustur Dušan; Vujasinović-Stupar Nada

    2007-01-01

    Introduction: This open, uncontrolled study examined the effects of physical therapy and rehabilitation on the quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Material and methods: The study included a total of 109 patients (69 with RA and 40 with PsA). Patients came from Norway for a four-week rehabilitation period at the Institute of Physical Medicine, Rehabilitation & Rheumatology - Igalo from June till October, 2003. This was a self-controlled...

  15. A clinical exploratory study with itolizumab, an anti-CD6 monoclonal antibody, in patients with rheumatoid arthritis

    OpenAIRE

    Rodriguez, Pedro C; Torres-Moya, Roberto; Reyes, Gil; Molinero, Claudino; Prada, Dinorah; Lopez, Ana M.; Hernandez, Isabel M.; Hernandez, Maria V.; Martinez, Jose P.; Hernandez, Xochel; Casaco, Angel; Ramos, Mayra; Avila, Yisel; Barrese, Yinet; Montero, Enrique

    2012-01-01

    T cells are involved in the pathogenesis of rheumatoid arthritis (RA). CD6 is a co-stimulatory molecule, predominantly expressed on lymphocytes, that has been linked to autoreactive responses. The purpose of this study was to evaluate the safety, immunogenicity and preliminary efficacy of itolizumab, a humanized anti-CD6 monoclonal antibody, in patients with active rheumatoid arthritis. Fifteen patients were enrolled in a phase I, open-label, dose-finding study. Five cohorts of patients recei...

  16. ASSOCIATION BETWEEN ULTRASOUND SIGNS OF JOINT INFLAMMATION AND RADIOGRAPHIC PROGRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    O. G. Alekseeva

    2016-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease causing joint destructive changes and disability.Objective: to investigate the association between the ultrasound signs of active inflammation and destruction of the joints, as evidenced by radiography, in RA patients treated with a treat-to-target strategy and to study whether ultrasound study (USS of the joints can be used to predict the occurrence of their destructive changes.Subjects and methods. The investigation included 81 patients (medium age 56 [46; 62] years with RA, who had been followed up at the V.A. Nasonova Research Institute of Rheumatology within the first Russian strategic study of pharmacotherapy for RA – REMARCA (Russian invEstigation of MethotrexAte and biologicals for eaRly aCtive Arthritis. In all the patients, methotrexate (Metoject, MEDAS, Germany as the first disease-modifying anti-rheumatic drug was subcutaneously injected at an initial dose of 10 mg/week with its rapid escalation up to 20–25 mg/week. Then the therapy was added by biologicals as the need arose. Clinical and laboratory parameters were analyzed immediately before and then after 12, 24, 36, and 48 weeks. Efficacy was assessed using the European League Against Rheumatism (EULAR criteria, CDAI, and SDAI. USS of eight articular areas (the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal, second and fifth metatarsophalangeal joints in the hand and foot of the clinically dominant side was carried out in all the patients before treatment and then after 12, 24, 36, and 48 weeks. Semiquantitative gray-scale (GS assessment and power Doppler (PD were performed. Radiographic examination was done before and after 48 weeks of therapy. The Sharp method modified by van der Heijde was employed to estimate X-ray changes.Results and discussion. In the group of patients with radiographic progression, the activity of inflammation, as evidenced by PD USS, was significantly

  17. Evaluating and mitigating fracture risk in established rheumatoid arthritis.

    Science.gov (United States)

    Mullen, Matthew B; Saag, Kenneth G

    2015-01-01

    Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.

  18. Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept

    DEFF Research Database (Denmark)

    Carlsen, K M; Riis, L; Madsen, O R

    2009-01-01

    We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA). The patient had previously been treated with different disease-modifying drugs (DMARDs) alone or in combination but had never revealed signs of liver dysfunction. Due to high...... disease activity, treatment with infliximab (3 mg/kg i.v.) was initiated in combination with methotrexate (MTX) (25 mg/week) and folic acid (5 mg/week). The patient stopped MTX and folic acid on her own initiative after 3 weeks due to improvement of joint symptoms. After seven infusions, progressive...... elevations of the transaminases up to five times the upper normal limit were noted and treatment with infliximab was terminated. Serological tests for viral and autoimmune hepatitis and for ANA and anti-dsDNA were all negative. Specific infliximab antibodies could not be detected. Ultrasound of the liver...

  19. Genetic Variation in the TLR5 Locus Is Associated with Anti-TNF Response Among Rheumatoid Arthritis Patients

    DEFF Research Database (Denmark)

    Sode, Jacob

    2014-01-01

    linkage data exists) previously found to be associated with RA anti-TNF response in a Dutch cohort (1) and it has been associated with higher PBMC IFN-γ secretion and altered CCL20 production. TLR1 rs4833095 has been associated with high PBMC TLR1 expression. Subgroup associations were found......Background/Purpose: In a recent study (paper in press) of Danish rheumatoid arthritis (RA) patients we found single nucleotide polymorphisms (SNPs) in the NLRP3 and interferon-γ genes to be associated with response to tumor necrosis factor a inhibitors (anti-TNF). The aim of this study...... was to extend and corroborate these associations by analyzing a new set of functional polymorphisms in the NLRP3-inflammasome and interferon-γ pathways in RA patients treated with anti-TNF. Methods: Twenty-three functional single nucleotide polymorphisms (SNPs) in 14 genes involved in the inflammasome...

  20. Pneumothorax necessitans in a patient with trapped lung and rheumatoid arthritis

    OpenAIRE

    Ahmed, Rumman; Ahmed, Usama; Syed, Imran

    2013-01-01

    The authors report the case of a patient with a background of trapped lung following thoracocentesis who developed an anterolateral intercostal pneumothoracocele resulting in a pneumothorax necessitans (PN). Our purpose is to highlight the pathophysiology and interesting radiological features associated with PN in trapped lung. Our case is particularly unique due to the subacute nature of its presentation in a patient with rheumatoid arthritis and unusual pre-existing lung pathology.

  1. Development of exclusively cutaneous sarcoidosis in patient with rheumatoid arthritis during treatment with etanercept

    Directory of Open Access Journals (Sweden)

    Marcella Amaral Horta Barbosa Vieira

    Full Text Available Summary We report the case of a patient with rheumatoid arthritis who, after 2 months of treatment with etanercept, showed disseminated asymptomatic violaceous papules. Biopsy of the skin lesion showed chronic granulomatous dermatitis with negative staining for fungi and acid-fast bacilli (AFB. After discontinuation of etanercept, the patient's condition improved. Although apparently paradoxical, cases of cutaneous and systemic sarcoidosis after anti-TNF medications have been reported in the literature, with very few cases presenting exclusive cutaneous involvement.

  2. Development of exclusively cutaneous sarcoidosis in patient with rheumatoid arthritis during treatment with etanercept.

    Science.gov (United States)

    Vieira, Marcella Amaral Horta Barbosa; Saraiva, Maria Isabel Ramos; Silva, Larissa Karine Leite da; Fraga, Rafael Cavanellas; Kakizaki, Priscila; Valente, Neusa Yuriko Sakai

    2016-11-01

    We report the case of a patient with rheumatoid arthritis who, after 2 months of treatment with etanercept, showed disseminated asymptomatic violaceous papules. Biopsy of the skin lesion showed chronic granulomatous dermatitis with negative staining for fungi and acid-fast bacilli (AFB). After discontinuation of etanercept, the patient's condition improved. Although apparently paradoxical, cases of cutaneous and systemic sarcoidosis after anti-TNF medications have been reported in the literature, with very few cases presenting exclusive cutaneous involvement.

  3. Aerobic exercise improves oxidant-antioxidant balance in patients with rheumatoid arthritis

    OpenAIRE

    2015-01-01

    [Purpose] Although oxidative stress is known to be present in rheumatoid arthritis (RA), the effects of exercise on oxidative parameters are unknown. The aim of this study was to investigate the effects of acute aerobic exercise on serum oxidant and antioxidant levels in patients with RA. [Subjects and Methods] Sixteen patients with RA and 10 age-matched healthy volunteers participated in this study. All participants wore polar telemeters and walked on a treadmill for 30 minutes at a speed el...

  4. Relationship between depression and physical activity, disability, burden, and health-related quality of life among patients with arthritis.

    Science.gov (United States)

    Joshi, Namita; Khanna, Rahul; Shah, Ruchit M

    2015-04-01

    This study purports to examine the relationship of depression with physical activity, disability, arthritis-attributable burden (joint limitation, work limitation, social activity limitation, and joint pain), and health-related quality of life (HRQOL) among arthritis patients. Data from the 2011 Behavioral Risk Factor Surveillance System, a nationally representative sample of noninstitutionalized adults in the United States, was used for the purpose of this study. Multivariable logistic regression was employed to address the study objectives. The final study sample included 167,068 arthritis patients, 45,459 of whom had comorbid depression. Arthritis patients with depression had lower odds of engaging in physical activity (odds ratio [OR]=1.070, confidence interval [CI] 1.006-1.139) and higher odds of being disabled (OR=1.411, CI 1.306-1.524). Arthritis patients with depression also had greater odds of arthritis-attributable joint limitations (OR=1.551, CI 1.460-1.648), work limitations (OR=1.506, CI 1.414-1.604), social activity limitations (OR=1.647, CI 1.557-1.742), and pain (OR=1.438, CI 1.364-1.517) as compared to those without depression. Arthritis patients with versus without depression had greater odds of poor general health status (OR=1.698, CI 1.586-1.819), physical HRQOL (OR=1.592, CI 1.486-1.704), mental HRQOL (OR=6.225, CI 5.768-6.718), and activity limitations (OR=2.345, CI 2.168-2.537). Study results indicate toward a negative functional impact of depression among arthritis patients. Policy makers should consider incorporating screening and management of depression into routine clinical care of arthritis patients.

  5. [Recurrent new-onset uveitis in a patient with rheumatoid arthritis during anti-TNFalpha treatment].

    Science.gov (United States)

    Di Gangi, M; Foti, R; Leonardi, R; Leonetti, C; Castellino, P

    2007-01-01

    Inflammation involving the uveal tract of the eye, termed uveitis, is frequently associated with various rheumatic disease, including seronegative spondylarthropathies, juvenile rheumatoid arthritis, Crohn's disease and Behçet's disease. Scleritis and keratitis may be associated with rheumatoid arthritis and systemic vasculitides such as Wegener's granulomatosis. Immune-mediated uveitis can have a chronic relapsing course and produce numerous possible complications, many of which can result in permanent vision loss. Treatment typically includes topical or systemic corticosteroids with cycloplegic-mydriatic drugs and/or noncorticosteroid immunosuppressants, but often there is an insufficient clinical effectiveness. Anti-TNFalpha therapy is promising in the treatment of sight threatening uveitis, particularly in patients with Behçet's disease. However, there have been also reports of new-onset uveitis during treatment of joint disease with TNFalpha inhibitors. We describe a case of new-onset uveitis in a patient with rheumatoid arthritis during therapy with etanercept at first and infliximab at last. Although we cannot exclude uveitis as linked to rheumatoid arthritis, it is unlike that the uveitis arises when the joint disease is well controlled. The hypothetical paradoxical effect of anti-TNF is here discussed.

  6. Recurrent new-onset uveitis in a patient with rheumatoid arthritis during anti-TNFα treatment

    Directory of Open Access Journals (Sweden)

    C. Leonetti

    2011-09-01

    Full Text Available Inflammation involving the uveal tract of the eye, termed uveitis, is frequently associated with various rheumatic disease, including seronegative spondylarthropathies, juvenile rheumatoid arthritis, Crohn’s disease and Behçet’s disease. Scleritis and keratitis may be associated with rheumatoid arthritis and systemic vasculitides such as Wegener’s granulomatosis. Immune-mediated uveitis can have a chronic relapsing course and produce numerous possible complications, many of which can result in permanent vision loss. Treatment typically includes topical or systemic corticosteroids with cycloplegic-mydriatic drugs and/or noncorticosteroid immunosuppressants, but often there is an insufficient clinical effectiveness. Anti-TNFα therapy is promising in the treatment of sight threatening uveitis, particularly in patients with Behçet’s disease. However, there have been also reports of new-onset uveitis during treatment of joint disease with TNFα inhibitors. We describe a case of new-onset uveitis in a patient with rheumatoid arthritis during therapy with etanercept at first and infliximab at last. Although we cannot exclude uveitis as linked to rheumatoid arthritis, it is unlike that the uveitis arises when the joint disease is well controlled. The hypothetical paradoxical effect of anti-TNF is here discussed.

  7. [Phaeomycotic cyst caused by Exophiala xenobiotica in a patient with rheumatoid arthritis and lung cancer].

    Science.gov (United States)

    Urano, Shoko; Suzuki, Yoko; Anzawa, Kazushi; Ohishi, Tsuyoshi; Kuroishi, Shigeki; Itoh, Naomi; Okada, Takathika; Mochizuki, Takashi

    2014-01-01

    In black fungal infections, Exophiala species are frequently encountered as causative agents of human mycosis, particularly in immunocompromised patients. Among them, Exophiala jenselmei was previously reported as the most common etiological agent. Advances in molecular taxonomy proved this taxon to be heterogeneous, and led to newly introduced or redefined species. Exophiala xenobiotica is one of the novel species differentiated from E. jenselmei on the basis of molecular phylogeny.Here, we report a case of pheomycotic cyst caused by E. xenobiotica, which was well controlled via drainage and local thermotherapy. A 70-year-old man developed a cystic nodular lesion on the dorsum of his right thumb over the previous 3 months. He had been treated with prednisolone and methotrexate for 4 years for rheumatoid arthritis. The patient also had lung cancer with vertebral bone metastasis. Direct microscopic examination of the greenish pus aspirated from the cyst revealed mycelial elements. Culture of the pus on blood and Sabouraud dextrose agar yielded numerous black colonies multiple times. Histopathological examination of a biopsy specimen showed subcutaneous abscess formation surrounded by granulomatous tissues. Faintly pigmented pseudohyphae were seen within the abscess. The presence of melanin in the fungal cells was determined by Fontana-Masson staining. Initial microscopic examination of the isolate revealed annellidic conidiogenous cells, suggestive of E. jenselmei. This strain was further identified as E. xenobiotica by sequence analysis of the internal transcribed spacer (ITS) region of ribosomal RNA, showing a 100% sequence homology with the strain type.Pheomycotic cysts should be considered on identifying a slowly developing chronic subcutaneous abscess in immunocompromised patients. Sequencing is recommended for accurate species identification of causative pathogens.

  8. People Getting a Grip on Arthritis: A Knowledge Transfer Strategy to Empower Patients with Rheumatoid Arthritis and Osteoarthritis

    Science.gov (United States)

    Brosseau, Lucie; Lineker, Sydney; Bell, Mary; Wells, George; Casimiro, Lynn; Egan, Mary; Cranney, Ann; Tugwell, Peter; Wilson, Keith G.; De Angelis, Gino; Loew, Laurianne

    2012-01-01

    Objective: The purpose of this study was twofold. First, to help people with arthritis become aware of and utilize Rheumatoid Arthritis (RA) and Osteoarthritis (OA) Clinical Practice Guidelines (CPGs) as they relate to self-management strategies. Second, to evaluate the impact of specific Knowledge Translation (KT) activities on CPG uptake. More…

  9. Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis - A prospective cohort study

    NARCIS (Netherlands)

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

    2004-01-01

    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

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

    NARCIS (Netherlands)

    Gaalen, van FA; Linn-Rasker, SP; Venrooij, W.J.; Jong, B.A.; Breedveld, F.C.; Verweij, C.L.; Toes, RE; Huizinga, T.W.

    2004-01-01

    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

  11. Rheumatoid arthritis-associated autoantibodies in non-rheumatoid arthritis patients with mucosal inflammation : a case-control study

    NARCIS (Netherlands)

    Janssen, Koen M. J.; de Smit, Menke J.; Brouwer, Elisabeth; de Kok, Fenne A. C.; Kraan, Jan; Altenburg, Josje; Verheul, Marije K.; Trouw, Leendert A.; van Winkelhoff, Arie Jan; Vissink, Arjan; Westra, Johanna

    2015-01-01

    Introduction: Rheumatoid arthritis-associated autoantibodies (RA-AAB) can be present in serum years before clinical onset of rheumatoid arthritis (RA). It has been hypothesized that initiation of RA-AAB generation occurs at inflamed mucosal surfaces, such as in the oral cavity or lungs. The aim of t

  12. Patient-self assessment of flare in rheumatoid arthritis: translation and reliability of the Flare instrument.

    Science.gov (United States)

    Maribo, Thomas; de Thurah, Annette; Stengaard-Pedersen, Kristian

    2016-04-01

    The Flare instrument (FI) is a French self-administrated questionnaire used to identify flares in disease activity in patients with rheumatoid arthritis. In addition to a total score, the FI has two subscales: one relating to joint symptoms and one relating to general symptoms. The objective of this study was to translate and adapt the French FI into Danish and to determine the reliability of the FI in a consecutive cohort of patients with RA. The FI was translated according to international guidelines, tested among 10 patients and 5 health professionals, and adapted. Test-retest reliability was determined by the standard error of the measurement (SEM) and the intra class correlation coefficients (ICC). The FI was administered to 50 patients with rheumatoid arthritis from an outpatient clinic of a university hospital and re-administered after 10 days. The patients had a mean age of 65.3 years (SD 12.0) and mean disease duration of 18.1 years (range 2-47 years). We found an excellent reliability with ICC higher than 0.95 and SEM between 0.44 and 0.63. Best reliability was found in the total FI score. Thus, the results of the present study show that the FI is a feasible and reliable tool for evaluation of flares in patients with rheumatoid arthritis.

  13. Part I. Respiratory system involvement in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ruzana Ramilovna Samigullina

    2013-01-01

    Full Text Available On 23–25 May 2013, the Karolinska Institute (Stockholm, Sweden with the support of MSD company held a meeting on a Clinical Observational Program for rheumatologists, which was attended by the well-known rheumatologists and leading specialists of the Institute Prof. R. van Vollenhoven, Prof. L. Klareskog, Dr. E. af Klint, and Dr. C. Carlens. The reports and interactive sessions discussed the problems of rheumatoid arthritis (RA, including early RA (pathology, pathogenesis, and treatment, registers of with rheumatic diseases; ultrasound diagnosis of inflammatory locomotor diseases; biological therapy for rheumatic diseases; organization of work in the research immunological laboratory, outpatient/day hospital units of a rheumatology clinic. The Program was also attended by physicians from different European countries (Sweden, Germany, Russia, Spain, Greece, etc.. Below is given an overview of the proceedings of the Clinical Observational Program.

  14. Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Møller-Bisgaard, S; Ejbjerg, B J; Eshed, I;

    2017-01-01

    OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to i......OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients......, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. METHOD: In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (... no consistent statistically significant differences between treatment groups. CONCLUSIONS: In this eRA treat-to-target trial, MTX and intra-articular glucocorticoids markedly reduced, but did not eliminate, MRI osteitis, synovitis, and tenosynovitis. Accordingly, minimal but statistically significant increases...

  15. SHOULD DISEASE-MODIFYING THERAPY BE STOPPED IN PATIENTS WITH RHEUMATOID ARTHRITIS BEFORE ENDOPROSTHETIC JOINT REPLACEMENT?

    Directory of Open Access Journals (Sweden)

    N. A. Savenkova

    2011-01-01

    Full Text Available Objective: to analyze disease activity, functional state, quality of life (QL, and the frequency of infectious complications in methotrexate (MT – or leflunomide (LF-treated patients with rheumatoid arthritis (RA who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1 36 patients who continuously received MT or LF in the perioperative period; 2 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%. In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01; in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005; in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67. The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05. There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005. Conclusion. Continuous use of MT

  16. Rheumatic patients at work : a study of labour force participations and its determinants in rheumatoid arthritis, ankylosing spondylitis, and juvenile chronic arthritis

    NARCIS (Netherlands)

    Chorus, A.M.J.

    2004-01-01

    This thesis at the University of Maastricht, defended at May 7, 2004, yields several important and new findings with regard to work related quality of life, participation in the labour force and its determinants of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and juvenile chr

  17. TWEAK and its receptor Fn14 in the synovium of patients with rheumatoid arthritis compared to psoriatic arthritis and its response to tumour necrosis factor blockade

    NARCIS (Netherlands)

    A.W.R. van Kuijk; C.A. Wijbrandts; M. Vinkenoog; T.S. Zheng; K.A. Reedquist; P.P. Tak

    2010-01-01

    Objective: To investigate the expression of tumour necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) and its receptor fibroblast growth factor inducible 14 (Fn14) in the inflamed synovium of patients with arthritis, as TWEAK blockade has been observed to have a beneficial effect in an ani

  18. People Getting a Grip on Arthritis II: An Innovative Strategy to Implement Clinical Practice Guidelines for Rheumatoid Arthritis and Osteoarthritis Patients through Facebook

    Science.gov (United States)

    Brosseau, Lucie; Wells, George A.; Brooks, Sydney; De Angelis, G.; Bell, Mary; Egan, Mary; Poitras, Stephane; King, Judy; Casimiro, Lynn; Loew, Laurianne; Novikov, Michael

    2014-01-01

    Objective: The purpose of the study is to determine if an updated online evidence-based educational programme delivered through Facebook is effective in improving the knowledge, skills, and self-efficacy of patients with arthritis in relation to evidence-based self-management rehabilitation interventions for osteoarthritis (OA) and rheumatoid…

  19. 40 Cases of Acute Gouty Arthritis Treated by Warming Needle Moxibustion%温针灸治疗急性痛风性关节炎20例

    Institute of Scientific and Technical Information of China (English)

    宗静杰; 高宇; 王淑颖; 荷花女

    2011-01-01

    目的:观察温针灸治疗急性痛风性关节炎的临床疗效及对血尿酸的影响,寻求治疗急性痛风性关节炎的有效方法.方法:将40例急性痛风性关节炎患者随机分为温针灸组(治疗组)和西药组(对照组),每组20例,分别采用温针灸及口服西药2种方法治疗,并于治疗前、后分别测定两组患者血尿酸的变化,然后进行两组临床疗效的对比研究.结果:两组疗效比较差异有显著性意义(P<0.01),治疗组、西药组的有效率分别为95.0%、75.0%;治疗组能显著降低血尿酸值、症状积分指标(各项指标其自身前后对比及与西药组的组间比较有显著性差异,P<0.01).结论:温针灸是治疗急性痛风性关节炎的有效方法,且对血尿酸有调节作用.%Objective: To study the clinical curative effect on acute gouty arthritis and the influence of blood serum uric acid treated by warming needle moxibustion, to follow up the effective method of treating acute gouty arthritis. Methods: 40 cases of acute gouty arthritis patients were randomly divided into warming needle moxibustion group (treatment group) and western group (control group), and 20 cases in each group, acupuncture and oral medicine treatment of two methods by used respectively, and the changes of their blood uric acid levels before and after treatment were detected and their therapeutic effects were compared.Results: There was a significant difference between the two groups in clinical therapeutic effect (P<0. 01 ), and the effective rate was respectively 95.0%, 75.0% in the treatment group and oral medicine group. Uric acid of acupuncture group significantly decreased, symptom score index ( there is significantly difference not only in the patients of their own but also between the two groups, P<0.01 ). Conclusion: The warming needle moxibustion is effective on treating of acute gouty arthritis, and has regulatory effects on the blood uric acid.

  20. The importance of an ophthalmologic examination in patients with juvenile idiopathic arthritis.

    Science.gov (United States)

    Rodríguez-García, Alejandro

    2015-01-01

    Uveitis occurs within the first year of arthritis onset in 73% of patients with juvenile idiopathic arthritis (JIA) considered at risk. The intraocular inflammation is characterized by an insidious onset and a silent and chronic clinical course capable of producing significant visual loss due to complications such as: cataract formation, secondary glaucoma, maculopathy and optic neuropathy. The absence of initial signs and symptoms, along with a deficient ophthalmic monitoring produce a delay in diagnosis with serious consequences. It has been estimated that 47% of JIA patients at risk for developing uveitis are legally blind (20/200 or worse) at least in one eye at the time of their first visit to the ophthalmologist. To reduce ocular complications and improve their visual outcome, it is necessary that rheumatologists refer all patients recently diagnosed (within the first month) with JIA for an ophthalmic evaluation, and maintain periodical follow-up visits based on classification and risk category of the disease.

  1. Single- versus dual-energy quantitative computed tomography for spinal densitometry in patients with rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Laan, R.F.J.M.; Erning, L.J.Th.O. van; Lemmens, J.A.M.; Putte, L.B.A. van de; Ruijs, S.H.J.; Riel, P.L.C.M. van (University Hospital, Nijmegen (Netherlands))

    1992-10-01

    Lumbar bone mineral density was measured by both single- and dual-energy quantitative computed tomography in 109 patients with rheumatoid arthritis. The results were corrected for the age-related increase in vertebral fat content by converting them to percentages of expected densities, using sex and energy-level specific regression equations obtained in a normal reference population. The percentages of expected density are approximately 10% lower in the single- than in the dual-energy mode, both in the patients with and without prednisone therapy. This difference is statistically highly significant, and is positively correlated with the duration of the disease and with the degree of radiological joint destruction. The data suggest that the vertebral fat content may be increased in patients with rheumatoid arthritis, as a consequence of disease-dependent mechanisms. (Author).

  2. Non-pharmacological treatment effects on psychosomatic and immune regulatory mechanisms in patients with rheumatic arthritis

    Directory of Open Access Journals (Sweden)

    Zharikova I.P.

    2014-12-01

    Full Text Available Objective: comparative analysis of the influence of the methods of the lateral ophthalmotilapia and low-intensity magnetic therapy on the Central and peripheral nervous system and the immune status in patients with rheumatoid arthritis. Material and methods: a comparative analysis of the impact of the 44 patients with rheumatoid arthritis aged 18 to 65 years, of which 19 patients (43.2 percent — 1 group received low-frequency low-intensity magnetic therapy and 25 patients (56.8 per cent — group 2, the lateral ophthalmotilapia. Results. In group 1 significantly improved memory both short-term (from 69.2±9.0 to 81,7±12,7, p=0.003, and the reminiscence relating to medium-term characteristics of memory (57,3±22 to 79,0±14,5; p=0.004. In patients of the 2nd group in the course of treatment was observed more pronounced dynamics of improvement of parameters of higher nervous activity, namely short-term memory (79,4±17 to 88,2±12, p=0.003and reminiscences of memory (from 69.4±27 to 82.4±19,5, p=0,0016. Conclusion. Lateral ophthalmotilapia and low-frequency magnetotherapy for help expand the list of rehabilitation programs in rheumatoid arthritis, the disease having dual autoimmune and psychosomatic genesis.

  3. Synovial fluid sedimentation in the immobile patient: a commentary on modern septic arthritis and the addition of a new variable confounding diagnosis

    Directory of Open Access Journals (Sweden)

    Cunningham G

    2013-01-01

    Full Text Available Gregory Cunningham,1 Brendan Ricciardo21Royal Perth Hospital, Perth, Western Australia, Australia; 2Bunbury Regional Hospital, Bunbury, Western Australia, AustraliaAbstract: Septic arthritis is a serious cause of morbidity and mortality. Despite recent advances, monoarticular and polyarticular septic arthritis (SA have a mortality rate of approximately 11% and 30%, respectively. SA has a 40% risk of permanent loss of joint function. Diagnosis of SA is difficult, given that no rapidly available individual test proves 100% sensitive or 100% specific. There are no previous reports on the phenomenon of synovial fluid sedimentation in an immobile patient, although the occurrence has been identified in vitro. This commentary also presents an extended report of a patient who had been immobile and supine for 24 hours before her right knee was aspirated and treated for septic arthritis. Due to her immobilization, the synovial fluid had settled. The color and opacity of the sequential aliquots from one arthrocentesis was noted to change from light straw-colored, to thick opaque purulent material. Laboratory reports showed increasing white cell counts (WCCs, from 2.6 × 109 to 78 × 109 between the sequential samples. This demonstrates a newly identified phenomenon of sedimentation. This might have led to a diagnostic difficulty, had the knee not been fully aspirated. Aspiration serves as a diagnostic tool, because it collects a sample, but it also serves as a treatment measure, because it removes purulent material. Complete aspiration of the joint should be performed for full therapeutic benefit and to avoid the potential diagnostic confusion of a falsely low WCC due to this newly identified phenomenon of synovial fluid sedimentation in the immobile patient.Keywords: septic arthritis, inflammatory arthritis, joint, sedimentation, orthopedic

  4. NOD2/CARD15 gene mutations in patients with gouty arthritis

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    Ahmet Karaarslan

    2016-11-01

    Full Text Available Nucleotide binding and oligomerization domains/caspase recruitment domain-containing protein 15 (NOD2/CARD15 is a cytoplasmic molecule controlling apoptosis and inflammatory processes by recognizing some microbial components. We aimed to identify the frequencies of NOD2/CARD15 gene mutations in patients with gouty arthritis and to determine their possible correlation with the disease phenotype. The study included 93 patients with gouty arthritis and 51 healthy controls matched for age, gender, and ethnicity. The NOD2/CARD15 R702W and G908R gene mutations were explored by the polymerase chain reaction restriction fragment length polymorphism method while the 3020insC mutation was analyzed by DNA sequencing. The mean patient age was 54.2 ± 14.2 years and mean duration of the disease was 3.1 ± 2.9 years. The first metatarsophalangeal and finger joint involvements were detected in 72 (77.4% and 18 (19.5% patients, respectively. Ankle arthritis and knee arthritis were detected in 43 (46.2% and 20 (21.5% patients, respectively. In total, 4 (9% heterozygous mutations were detected in the G908R and R702W genes, while no mutation was detected in the 3020insC gene. Compared to the control group, there were no significant differences in all three DNA regions (G908R, R702W, and 3020insC; p = 0.452, p = 0.583, and p = 0.350, respectively. No correlation between the NOD2/CARD15 variants and clinical or laboratory findings (p > 0.05 was found. The frequencies of the NOD2/CARD15 gene mutations in the patients were similar to healthy control group. No association between clinical or laboratory findings and the NOD2/CARD15 gene mutations was observed.

  5. NOD2/CARD15 gene mutations in patients with gouty arthritis.

    Science.gov (United States)

    Karaarslan, Ahmet; Kobak, Senol; Berdeli, Afig

    2016-11-10

    Nucleotide binding and oligomerization domains/caspase recruitment domain-containing protein 15 (NOD2/CARD15) is a cytoplasmic molecule controlling apoptosis and inflammatory processes by recognizing some microbial components. We aimed to identify the frequencies of NOD2/CARD15 gene mutations in patients with gouty arthritis and to determine their possible correlation with the disease phenotype. The study included 93 patients with gouty arthritis and 51 healthy controls matched for age, gender, and ethnicity. The NOD2/CARD15 R702W and G908R gene mutations were explored by the polymerase chain reaction restriction fragment length polymorphism method while the 3020insC mutation was analyzed by DNA sequencing. The mean patient age was 54.2 ± 14.2 years and mean duration of the disease was 3.1 ± 2.9 years. The first metatarsophalangeal and finger joint involvements were detected in 72 (77.4%) and 18 (19.5%) patients, respectively. Ankle arthritis and knee arthritis were detected in 43 (46.2%) and 20 (21.5%) patients, respectively. In total, 4 (9%) heterozygous mutations were detected in the G908R and R702W genes, while no mutation was detected in the 3020insC gene. Compared to the control group, there were no significant differences in all three DNA regions (G908R, R702W, and 3020insC; p = 0.452, p = 0.583, and p = 0.350, respectively). No correlation between the NOD2/CARD15 variants and clinical or laboratory findings (p > 0.05) was found. The frequencies of the NOD2/CARD15 gene mutations in the patients were similar to healthy control group. No association between clinical or laboratory findings and the NOD2/CARD15 gene mutations was observed.

  6. Anti-TNFα agents in elderly patients with rheumatoid arthritis: a study of a group of 105 over sixty five years old patients

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    C. Biasini Rebaioli

    2011-09-01

    Full Text Available Objective: To evaluate the efficacy and the safety of anti-TNF-alfa treatment in elderly patients (≥65 years old with active rheumatoid arthritis (RA, in comparison with younger (17-65 years old. Methods: We considered retrospectively 295 patients, affected by RA and treated with anti-TNF-alfa drugs. They were divided in two groups, according to their age, and followed up for two years: over-65-years old patients (190 and under-65-years old patients (105. Effectiveness of drugs was assessed analyzing RA disease activity (DAS28, DAS44, SDAI, functional status (HAQ and serological parameters (CRP before and after anti-TNF-alfa therapy. Safety was studied considering discontinuation rate of biological disease-modifying antirheumatic drugs, and collateral events rate. Results: At baseline, elderly patients showed higher disease activity’s score (DAS 28, DAS44, SDAI, HAQ with important loss of articular function (worse quality of life, HAQ than younger patients (p0.05. Conclusions: Anti-TNF-alfa treatment was efficacious and safe in both groups of patients. These drugs induced improvement in disease activity, apart from the age. No functional improvement was observed in HAQ, showing the irreversible loss of articular function and the incomplete recovery in elderly patients. Age doesn’t interfere with the possibility to treat elderly patients with anti-TNF-alfa drugs.

  7. Lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a diabetic patient.

    Science.gov (United States)

    Vallianou, N; Gounari, P; Skourtis, A; Kougias, M; Sioula, E

    2013-10-01

    Pyomyositis is a rarely encountered infection among diabetics, which usually affects lower extremities. Herein, we present a case of lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a patient with poorly controlled diabetes mellitus.

  8. The Relationship between Emotional Deficit and Pain in Patients with Rheumatoid Arthritis in Isfahan City

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    F rezaei

    2013-10-01

    Full Text Available Introduction: A link between emotional deficit and somatic factors has been widely established، yet little is known about different factors that may predict this relationship.The idea of psychopathology as a mediator has been supported by some pieces of evidencebut in fact, it has not been exactly scrutinized.Therefore, the present study examined the relationship between emotional deficit and pain severity in patients with rheumatoid arthritis. Methods: In this descriptive-correlational study، the target population included all patients with rheumatoid arthritis who referred to medical centers of Isfahan during spring 2012. A total number of 100 men and women with rheumatoid arthritis were selected via convenience sampling. A sociodemographic data form، Toronto Alexithymia Scale (TAS-20, Hospital Anxiety and Depression Scale (HADS and rheumatoid arthritis pain scale (RAPS were administered to each subject andrequired information was obtained. The study data was analyzed by SPSS-18، AMOS-18 software, Pearson Correlation, and Structural Equation Modeling methods. Results: Results indicated that the structural model fit clinical sample extremely well (chi2= 3.04; p= 0.218. Alexithymia، depression and anxiety were correlated with pain severity. In this model a latency variable (emotional deficit was explored that predicted painseverity sowell(CFI, T,I، AGFI and GFI > 0.9. Conclusion: The study findings revealed thatemotional deficit hasan important role in the rheumatoid arthritis and the pain severity. The model can confirm those pieces of evidence indicating the psychological treatments included in multidisciplinary programs for this disorder.

  9. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis

    DEFF Research Database (Denmark)

    Sørensen, Jan; Hetland, Merete Lund

    2014-01-01

    ) and ankylosing spondylitis (AS) changed from year 2000 to 2011. METHODS: Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset...

  10. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis

    DEFF Research Database (Denmark)

    Sørensen, Jan; Hetland, Merete Lund

    2015-01-01

    ) and ankylosing spondylitis (AS) changed from year 2000 to 2011. METHODS: Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13,721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset...

  11. Macrophage activation syndrome in a patient with systemic onset of the juvenile idiopathic arthritis.

    Science.gov (United States)

    Jain, Deepak; Aggarwal, Hari K; Rao, Avinash; Mittal, Anshul; Jain, Promil

    2016-01-01

    Systemic onset juvenile idiopathic arthritis (sJIA) is defined as arthritis affecting one or more joint usually in the juvenile age group (< 16 years of age) with or preceded by fever of at least 2 weeks duration that is documented to be daily ("quotidian") for at least 3 days which may be associated with evanescent (non-fixed) erythematous rash or generalized lymph node enlargement or hepatomegaly/splenomegaly/both or serositis. Macrophage activation syndrome (MAS) is a life-threatening complication of sJIA marked by sudden onset of non-remitting high fever, profound depression in all three blood cell lines (i.e. leukopenia, anemia, and thrombocytopenia), hepatosplenomegaly, lymphadenopathy, and elevated serum liver enzyme levels. In children with systemic juvenile idiopathic arthritis, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. We report a case of a 16-year-old female patient presenting with high grade fever with joint pains and generalized weakness which proved to be systemic onset juvenile idiopathic arthritis with macrophage activation syndrome after ruling out all other differential diagnoses and responded well to intravenous steroids.

  12. Arthritis: Frequently Asked Questions

    Science.gov (United States)

    ... of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and ankylosing spondylitis. Modifiable risk ... involve the following: Medications. Nonpharmacologic therapies. Physical or occupational therapy. Splints or joint assistive aids. Patient education and ...

  13. Imaging in Psoriatic Arthritis

    DEFF Research Database (Denmark)

    Poggenborg, René Panduro; Østergaard, Mikkel; Terslev, Lene

    2015-01-01

    Psoriatic arthritis (PsA) is an inflammatory joint disease characterized by arthritis and often enthesitis in patients with psoriasis, presenting a wide range of manifestations in various patterns. Imaging procedures are primarily conventional radiography, ultrasonography (US), and magnetic...

  14. Patients' Perceptions of Navigating “The System” for Arthritis Management: Are They Able to Follow Our Recommendations?

    OpenAIRE

    Winter Di Cola, Jennifer; Juma, Shahiroz; Kennedy, Deborah; Dickson, Patricia; Denis, Suzanne; Robarts, Susan; Gollish, Jeffrey; Webster, Fiona

    2014-01-01

    Purpose: To understand whether a visit to a Hip/Knee Arthritis Assessment Centre (AC), where non-surgical candidates with arthritis are directed toward community resources and provided with a conservative treatment “prescription,” contributes to patients' self-management and ability to access community resources. Methods: A purposive sample of non-surgical patients was contacted 3–10 months after their AC visit. Three focus groups (n=20) and 20 semi-structured telephone interviews were conduc...

  15. Impact of tumour necrosis factor inhibitor treatment on radiographic progression in rheumatoid arthritis patients in clinical practice

    DEFF Research Database (Denmark)

    Ornbjerg, Lykke Midtbøll; Østergaard, Mikkel; Bøyesen, Pernille;

    2013-01-01

    To compare radiographic progression during treatment with disease-modifying antirheumatic drugs (DMARD) and subsequent treatment with tumour necrosis factor α inhibitors (TNF-I) in rheumatoid arthritis (RA) patients in clinical practice.......To compare radiographic progression during treatment with disease-modifying antirheumatic drugs (DMARD) and subsequent treatment with tumour necrosis factor α inhibitors (TNF-I) in rheumatoid arthritis (RA) patients in clinical practice....

  16. Can the application of control theory assist patient management in rheumatoid arthritis?

    Science.gov (United States)

    Mann, Cindy

    2010-09-01

    Supporting patient self-management is an important part of the care of patients with rheumatoid arthritis (RA) but patients vary in their capacity and willingness to manage their illness and may feel overwhelmed by the challenge of controlling the impact on their life. This paper discusses the value and importance of control theory and how it might be applied to enhance patients' self-management. Not only does it offer a means of identifying those who might have greatest difficulty in managing their illness, but it also points the way to effective interventions.

  17. Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Redlund-Johnell, I.; Sjoeblom, K.G.

    Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.

  18. HLA types in patients with rheumatoid arthritis developing leucopenia after both gold and sulphasalazine treatment.

    OpenAIRE

    Bliddal, H; Eiberg, B; Helin, P; Svejgaard, A.

    1989-01-01

    HLA types, especially HLA-DR3, are associated with the development of toxic reactions in patients with rheumatoid arthritis after treatment with gold or D-penicillamine. In this study, after treatment with sulphasalazine, leucopenia was observed in three patients, who all had a history of leucopenia after previous gold treatment. The HLA types of these patients did not include HLA-DR3; the two patients developing mild leucopenia had HLA-DR2 and the one developing agranulocytosis had HLA-DR4.

  19. Management of melioidosis osteomyelitis and septic arthritis.

    Science.gov (United States)

    Shetty, R P; Mathew, M; Smith, J; Morse, L P; Mehta, J A; Currie, B J

    2015-02-01

    Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse. We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048). More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

  20. Treatment of knee flexion contracture in patients with chronic juvenile arthritis: A case report

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    Matijević Radmila

    2006-01-01

    Full Text Available Introduction. Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. Case report. A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion con­tractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The pre operative range of motion in the rigth knee was 30°-70° and in the left 40°-80°. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0°-100° and in the left 0°-105°. The strength of tested muscles was increased and gait was improved. Conclusion. Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff, and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee. .

  1. Prevalence and clinical patterns of psoriatic arthritis in Indian patients with psoriasis

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    Ramesh Kumar

    2014-01-01

    Full Text Available Background: The prevalence and clinical patterns of psoriatic arthritis (PsA varies in different parts of the world and there is little clinical and epidemiological data from the Indian subcontinent. Aims: Our study was designed to evaluate the prevalence and clinical patterns of PsA in Indian patients. Methods: This was a non-interventional, cross-sectional study, in which 1149 consecutive psoriasis patients seen over 1 year were screened for PsA according to classification of psoriatic arthritis (CASPAR criteria. Demographic and disease parameters were recorded including Psoriasis Area and Severity Index (PASI, Nail Psoriasis Severity Index (NAPSI, and number of swollen and tender joints. Results: Among 1149 patients with psoriasis, 100 (8.7% patients had PsA, of which 83% were newly diagnosed. The most common pattern was symmetrical polyarthritis (58%, followed by spondyloarthropathy 49%, asymmetric oligoarthritis (21%, isolated spondyloarthropathy (5%, predominant distal interphalangeal arthritis (3%, and arthritis mutilans (1%. Enthesitis and dactylitis were present in 67% and 26% of cases, respectively. The mean number of swollen and tender joints were 3.63 ± 3.59 (range, 0-22 and 7.76 ± 6.03 (range, 1-26, respectively. Nail changes were present in 87% of the cases. The median PASI and NAPSI of the subjects with PsA was 3.6 and 20, respectively. There was no significant correlation of number of swollen/tender joints with PASI or NAPSI. Conclusion: There is a relatively low prevalence of PsA among Indian psoriasis patients presenting to dermatologists. No correlation was found between the severity of skin and nail involvement and articular disease.

  2. Application of (1)H NMR-based serum metabolomic studies for monitoring female patients with rheumatoid arthritis.

    Science.gov (United States)

    Zabek, Adam; Swierkot, Jerzy; Malak, Anna; Zawadzka, Iga; Deja, Stanisław; Bogunia-Kubik, Katarzyna; Mlynarz, Piotr

    2016-01-05

    Rheumatoid arthritis is a chronic autoimmune-based inflammatory disease that leads to progressive joint degeneration, disability, and an increased risk of cardiovascular complications, which is the main cause of mortality in this population of patients. Although several biomarkers are routinely used in the management of rheumatoid arthritis, there is a high demand for novel biomarkers to further improve the early diagnosis of rheumatoid arthritis, stratification of patients, and the prediction of a better response to a specific therapy. In this study, the metabolomics approach was used to provide relevant biomarkers to improve diagnostic accuracy, define prognosis and predict and monitor treatment efficacy. The results indicated that twelve metabolites were important for the discrimination of healthy control and rheumatoid arthritis. Notably, valine, isoleucine, lactate, alanine, creatinine, GPC  APC and histidine relative levels were lower in rheumatoid arthritis, whereas 3-hydroxyisobutyrate, acetate, NAC, acetoacetate and acetone relative levels were higher. Simultaneously, the analysis of the concentration of metabolites in rheumatoid arthritis and 3 months after induction treatment revealed that L1, 3-hydroxyisobutyrate, lysine, L5, acetoacetate, creatine, GPC+APC, histidine and phenylalanine were elevated in RA, whereas leucine, acetate, betaine and formate were lower. Additionally, metabolomics tools were employed to discriminate between patients with different IL-17A genotypes. Metabolomics may provide relevant biomarkers to improve diagnostic accuracy, define prognosis and predict and monitor treatment efficacy in rheumatoid arthritis.

  3. FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

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    M. A. Gromova

    2016-01-01

    Full Text Available Objective: to establish features of a chronic pain syndrome disorders in patients with rheumatoid arthritis, to reveal correlation with psychoemotional disorders and to develop the differential approach to maintaining patients. Materials and methods. 101 patients at the age of 60.6 ± 11.8 years, 92 % of women, with reliable rheumatoid arthritis (American College of Rheumatology – ACR, 1987, were examined. The visual analog scale was used for an assessment of pain strength at the moment; the Van Korff’s questionnaire – for determination of pain strength at the moment and retrospectively for the last half a year with an assessment of disadaptation level and disability, ranging of a chronic pain syndrome on classes; the McGill Pain Questionnaire – for the characteristic of touchsensitive and emotional components of pain. Neuropathic pain was revealed by DN4 questionnaire. Anxiety and depression were determined by the Hospital Anxiety and Depression Scale (HADS. Fibromyalgia diagnosed by criteria of ACR, (1990. Results. Pain estimated by various scales and questionnaires varied from moderated to intensive. According to Van Korff’s questionnaire it was characterized by average level of disadaptation and easy disability that corresponded to the second class of chronic pain. The Rank pain index of the McGill Pain Questionnaire touch scale testified that pain was described by a smaller number of definitions on a touch scale than on emotional. This indicates a moderate impact of pain syndrome on a state of mind. Neuropathic pain is diagnosed for 37.3 % of patients with tunnel syndrome, mononeuritis and touch polyneuropathy. The secondary fibromyalgia is revealed for 2 % of patients with early rheumatoid arthritis of high activity. According to HADS anxiety and depression was revealed for 58 and 59 % of patients correspondingly. This demanded psychotherapeutic consultation and additional correction. We proposed the algorithm of diagnostic and

  4. Targeting interleukin-15 in patients with rheumatoid arthritis: a proof-of-concept study

    DEFF Research Database (Denmark)

    Baslund, Bo; Tvede, Niels; Danneskiold-Samsoe, Bente;

    2005-01-01

    Interleukin-15 (IL-15) is a proinflammatory, innate response cytokine that mediates pleiotropic effector function in rheumatoid arthritis (RA) inflammatory synovitis. Our objective was to study the ability of HuMax-IL15, a human IgG1 anti-IL-15 monoclonal antibody, to neutralize exogenous and end...... and endogenous IL-15 activity in vitro and to perform a phase I-II dose-escalation trial with HuMax-IL15 in patients with active RA....

  5. Distal radius fracture after Sauvé-Kapandji procedure in a rheumatoid arthritis patient.

    Science.gov (United States)

    Ochi, Kensuke; Horiuchi, Yukio; Matsumura, Takashi; Nakamura, Mitsukazu; Takei, Terue; Yabe, Hiroki

    2012-04-01

    We report a case of distal radius fracture after a Sauvé-Kapandji procedure combined with synovectomy and tendon transfer in a rheumatoid arthritis patient. This case shared several unusual features that were also seen in a previously reported case. Based on these features, we discuss favorable surgical treatment for the rheumatoid wrist with extensor tendon rupture, and also the optimal treatment for distal radius fracture after such procedures.

  6. Effect of nonsurgical periodontal treatment in patients with periodontitis and rheumatoid arthritis: A systematic review

    Science.gov (United States)

    Silvestre-Rangil, Javier; Bagan, Leticia; Bagan, Jose V.

    2016-01-01

    Background Periodontitis has been regarded as a potential risk factor for rheumatoid arthritis (RA). A systematic review is made to determine whether nonsurgical periodontal treatment in patients with RA offers benefits in terms of the clinical activity and inflammatory markers of the disease. Material and Methods A search was made of the Medline-PubMed, Cochrane, Embase and Scopus databases to identify studies on the relationship between the two disease processes, and especially on the effects of nonsurgical treatment in patients of this kind. The search was based on the following keywords: rheumatoid arthritis AND periodontitis (MeSH), rheumatoid arthritis AND periodontal treatment. Results Eight articles on the nonsurgical treatment of patients with periodontitis and RA were finally included in the study. All of them evaluated clinical (DAS28) and laboratory test activity (ESR, CRP, IL-6, TNFα) before and after treatment. A clear decrease in DAS28 score and ESR was recorded, while other parameters such as CRP, IL-6 and TNFα showed a non significant tendency to decrease as a result of treatment. Conclusions Nonsurgical treatment improved the periodontal condition of patients with periodontitis and RA, with beneficial effects upon the clinical and laboratory test parameters (DAS28 and ESR), while other inflammatory markers showed a marked tendency to decrease. However, all the studies included in the review involved small samples sizes and follow-up periods of no more than 6 months. Larger and particularly longitudinal studies are therefore needed to more firmly establish possible significant relations between the two disease processes. Key words:Periodontitis, rheumatoid arthritis, periodontal treatment. PMID:26946202

  7. The use of magnetic fields in treatment of patients with rheumatoid arthritis. Review of the literature

    OpenAIRE

    Zwolińska, Jolanta; Gąsior, Monika; Śnieżek, Elżbieta; Kwolek, Andrzej

    2016-01-01

    Magnetic fields are commonly used in therapies designed for subjects with rheumatic diseases, yet the effects of magnetotherapy are not entirely clear in these disorders. This study is designed to examine the literature investigating applications of magnetotherapy in the treatment of rheumatoid arthritis (RA). The review focused on publications related to administering magnetotherapy in patients with RA. The databases Science Direct, SpringerLink, Medline, PubMed, and Polska Bibliografia Leka...

  8. Prevalence of psoriatic arthritis and costs generated by treatment of psoriatic arthritis patients in the public health system – the case of Poland

    Science.gov (United States)

    Raciborski, Filip; Śliwczyński, Andrzej; Kwiatkowska, Brygida; Brzozowska, Melania; Tłustochowicz, Małgorzata

    2016-01-01

    Objective The objective of the study was to analyse the prevalence of psoriatic arthritis (PsA) in Poland and to assess the costs generated by treatment of PsA patients in the system of public healthcare. Material and methods The analysis was based on the database of the public payer, the National Health Fund (NFZ). PsA was defined by the diagnostic ICD-10 codes M07 (Enteropathic arthropathies) and L40.5 (Psoriatic arthropathies). The estimate of the costs was based on the reports submitted to the NFZ by health service providers. The prevalence rates were calculated using the NFZ data and the population estimates from the Central Statistical Office of Poland (GUS). Results In 2015, the prevalence of PsA (ICD-10: L40.5 and M07) in Poland was 3.2 per 10 000 population (3.7 in women and 2.6 in men). In 2015, nearly 7.3 thousand patients with the diagnosis of M07 and 6.3 thousand patients with the diagnosis of L40.5 received healthcare benefits. Women accounted for 60.6% of those patients. Nearly three fourths of PsA patients were aged 40 to 69 years with the median age of 54 years (56 years in women and 50 years in men). Between 2008 and 2015 the NFZ expenditure on the treatment of PsA increased from 6.6 million Polish zloty (PLN) (1.9 million EUR) to PLN 50.8 million (12.1 million EUR). In the same period, the number of PsA patients increased from 3.4 thousand to 11.9 thousand. In 2015, the mean cost of treatment per PsA patient was PLN 3.8 thousand. Conclusions The PsA prevalence rates estimated by the authors from the NFZ database are clearly lower than those derived from studies in other European countries, which may suggest that the actual number of PsA patients in Poland may be underestimated. Still the number of patients treated for PsA increased nearly 3.5-fold during 2008–2015, when the cost of PsA treatment rose more than 7 times. PMID:28115777

  9. TCM Sequential Enema Treat Acute Gouty Arthritis%中药序贯灌肠治疗急性痛风性关节炎临床观察

    Institute of Scientific and Technical Information of China (English)

    李晓霞; 赵威

    2013-01-01

    [Objective] To observe the clinical effect of sequential enema treatment on acute gouty arthritis. [Method]60 patients were divided randomly in two groups named traditional Chinese medicine enema in the treatment of group sequential and the control group of Western Medicine. Observation of the two groups before and after treatment syndrome of traditional Chinese Medicine, the clinical curative effect is related to the changes of parameters. [Result] The treatment group in syndrome of traditional Chinese Medicine, the overall clinical efficacy, blood uric acid ( BUA ) ,erythrocyte sedimentation rate(ESR),Creaction protein(CRP),white blood cell(WBC),liver and kidney function are superior to that of control group. [Conclusion] Chinese medicine sequential enema in the treatment of acute gouty arthritis is an effective method in treating this disease.%[目的]观察序贯灌肠治疗急性痛风性关节炎的临床疗效.[方法]采用随机对照的方法,将60例患者分为中药序贯灌肠治疗组与西药对照组,观察两组治疗前后中医证候、临床疗效及各项相关指标的变化.[结果]治疗组在中医证候、临床总体疗效、血尿酸(Blood uric acid,BUA)、血沉(Erythrocyte sedimentation rate,ESR)、C反应蛋白(C reaction protein,CRP)、血白细胞(White blood cell,WBC)、肝肾功能等方面优于对照组.[结论]中药序贯灌肠治疗急性痛风性关节炎疗效满意,是治疗本病的有效方法之一.

  10. Psoriatic Arthritis in Psoriasis Patients: Evaluation of Clinical and Radiological Features

    Directory of Open Access Journals (Sweden)

    Hatice Reşorlu

    2016-08-01

    Full Text Available Objective: The purpose of this study was to perform radiological and clinical determination of the presence of psoriatic arthritis (PsA in patients with psoriasis and to evaluate associations with clinical findings. Materials and Methods: The medical files of 72 patients with psoriasis presenting to our clinic between years 2009-2014 with a pre-diagnosis of PsA were reviewed retrospectively. Hand, foot and sacroiliac joint radiograms were evaluated by a radiologist who was blinded to the patient’s clinical status and who is experienced on musculoskeletal radiology. Patients with psoriasis were divided into two groups according to the presence of arthritis which was determined based on radiographic findings or on Classification Criteria for Psoriatic Arthritis (CASPAR criteria. All patients’ demographic characteristics, length of disease, nail involvement, smoking-alcohol consumption were recorded. Results: The mean age of all patients was 47.24±14.61 years, and the mean duration of disease was 14.13±11.92 years. Smoking and alcohol consumptions were determined in 54.2% (n=39 and 23.6% (n=17 of the cases, respectively. Nail involvement was determined in 56.9% (n=41 of the cases. PsA was determined based on radiological findings in 58.3% (n=42 of the patients. The mean age and age at onset of disease were higher in PsA (+ patients than in radiologically non-PsA subjects. Based on clinical findings, PsA based on CASPAR criteria was determined in only 18.1% (n=13 of all patients. Conclusion: A higher level of PsA was determined using radiological evaluation in this study. The main cause of this condition is the existence of asymptomatic-subclinical patients. A detailed medical history should therefore be taken from patients, and good clinical evaluation is very important. Radiological and clinical evaluation should be performed together in the diagnosis.

  11. Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD

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    Wais Afzal

    2016-01-01

    Full Text Available Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD. Septic arthritis due to Mycobacterium avium-intracellulare (MAI is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC count in the synovial fluid analysis, she was empirically started on intravenous (IV vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI, and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.

  12. Treating gouty arthritis inTCM%中医综合治疗痛风性关节炎的治疗效果观察

    Institute of Scientific and Technical Information of China (English)

    刘广荣

    2015-01-01

    Objective: To treat gouty arthritis patients in TCM. Methods: 86 cases of gouty arthritis were divided into the observed group and the control group. Observed group recieved oral comprehensive treatment of TCM plus colchicine treatment. Results: In observation efficacy and adverse reactions rates were 93.02% (40/43), 4.65% (2/43), better than control group 86.05% (37/43), 13.95% (6/43) (P < 0.05). Conclusion: The TCM treatment for gouty arthritis can effectively improve the clinical symptoms and fewer adverse reactions, and should be promoted.%目的:对痛风性关节炎患者采用中医综合治疗,观察分析其临床治疗效果.方法:将我院于 2012 年 1 月-2014年3月期间收治的86例痛风性关节炎患者按照随机数字表法分为观察组和对照组.对照组采用秋水仙碱治疗;观察组采用中医内服综合治疗联合秋水仙碱治疗.观察两组患者治疗期间的临床疗效及所发生的不良反应情况.结果:观察组治疗有效率与不良反应率分别为 93.02%(40/43)、4.65%(2/43);与对照组的86.05%(37/43)、13.95%(6/43)比较,P<0.05.结论:临床采用中医综合治疗痛风性关节炎,可有效改善患者的临床症状,提高治疗效果,且不良反应少,值得推广与应用.

  13. Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity

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    Ebru Karaca Umay

    2016-06-01

    Full Text Available Abstract Introduction Our aim in this study was to present the results of sensory evaluation tests and electrophysiological evaluations in rheumatoid arthritis (RA patients with foot deformity and to determine their relation with general health status and lower extremity functionality. Materials and methods Fifty-one patients with RA diagnosis and foot deformity were included in the study. Demographic and disease characteristics of the patients were recorded, and a detailed neurological examination was performed. Superficial sensation, pain, heat, vibration, and two-point discrimination sensation were evaluated in each foot, and their sum was used to determine the sensory deficits index (SDI of 0–10. The presence of polyneuropathy was evaluated with electrophysiological methods. The Health Assessment Questionnaire and mobility and walking subscales of the Arthritis Impact Measurement Scales-2 were used to assess general health status and lower extremity functionality, respectively. According to the sensory examination and electromyography results, patients were compared in terms of their general health status and lower extremity functional status. Results Sensory disturbance was detected in 39 patients (74% during the examination; however, 27 patients (52.9% had polyneuropathy determined electrophysiologically. In patients with sensory deficits, statistically significant deterioration was detected in general health and foot functionality, including mobility and walking, when compared to patients with a normal sensory evaluation. Conclusions Even in the presence of normal electrophysiological tests, sensory dysfunction alone seems to be associated with severe disability in general health status and foot functionality when compared to patients with a normal sensory examination.

  14. Safety and Efficacy of Vaccination Against Influenza in Patients With Rheumatoid Arthritis

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    Ori Elkayam

    2006-01-01

    Full Text Available Vaccination against influenza is currently recommended for patients with rheumatoid arthritis (RA. The safety and efficacy of vaccination in patients suffering from rheumatic diseases is still a matter of debate. This review summarizes the studies performed on the safety and immunogenicity of influenza vaccination in patients with RA as well as the rheumatic complications of the vaccine in otherwise healthy persons. Several trials have shown that the vaccine induces an adequate humoral response and does not induce clinical exacerbation of RA. Rheumatic complications (mainly vasculitis following influenza vaccination in the general population are scarce.

  15. Prolactin and growth hormone responses to hypoglycemia in patients with systemic sclerosis and psoriatic arthritis.

    Science.gov (United States)

    Rovensky, Jozef; Raffayova, Helena; Imrich, Richard; Radikova, Zofia; Penesova, Adela; Macho, Ladislav; Lukac, Jozef; Matucci-Cerinic, Marco; Vigas, Milan

    2006-06-01

    This study compared prolactin (PRL) and growth hormone (GH) responses to hypoglycemia in premenopausal females with systemic sclerosis (SSc) and psoriatic arthritis (PsA) with those in matched healthy controls. No differences were found in glucose and GH responses to hypoglycemia in both groups of patients compared to controls. SSc patients had lower PRL response (P < 0.05) to hypoglycemia compared to controls. PRL response tended to be lower also in PsA patients, however the difference did not reach level of statistical significance (P = 0.11). The present study showed decreased PRL response to hypoglycemia in premenopausal females with SSc.

  16. Analysis of Borrelia burgdorferi Genotypes in Patients with Lyme Arthritis: High Frequency of RST 1 Strains in Antibiotic-Refractory Arthritis

    Science.gov (United States)

    Jones, Kathryn L.; McHugh, Gail A.; Glickstein, Lisa J.; Steere, Allen C.

    2009-01-01

    Objective Most of the B. burgdorferi genotypes have been isolated from erythema migrans (EM) skin lesions in patients with Lyme disease; outer-surface protein C (OspC) type K strains, which are 16S-23S rRNA intergenic spacer type 2 (RST 2), are most commonly recovered, but a higher percentage of OspC type A strains (RST 1), the next most common type, are detectable in blood. Our goals were to determine the B. burgdorferi genotypes in the joints of patients with Lyme arthritis. Methods Joint fluid samples from 124 patients seen over a 30-year period were analyzed for OspC types by semi-nested PCR and sequencing, and for RST by nested PCR and RFLP techniques. This information was correlated with clinical outcome. Results OspC and RST genotypes could be determined in 49 of the 124 joint fluid samples (40%). Of the 49 samples, 21 (43%) were OspC type K (RST 2), 11 (22%) were type A (RST 1), and 17 (35%) were distributed among 8 other OspC types and all 3 RSTs. However, among 17 patients who received current antibiotic regimens, all 7 infected with RST 1 strains had antibiotic-refractory arthritis compared with 4 of 6 patients infected with RST 2 strains and only 1 of 4 infected with RST 3 strains (P=0.03). Conclusions Most of the B. burgdorferi genotypes infected the joints of patients with Lyme arthritis, particularly OspC type K (RST 2); and genotype frequencies reflected those in EM skin lesions. However, RST 1 strains were most frequent in patients with antibiotic-refractory arthritis. PMID:19565522

  17. Features of lipid metabolism disturbances in patients with rheumatoid arthritis

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    A E Sizikov

    2009-01-01

    Full Text Available Objective. To characterize specters of common and modified lipoproteins (LP in serum of pts with rheumatoid arthritis (RA according to age and sex and compare with healthy donors (with normal lipid level. Material and methods. 103 pts with RA (88 female and 15 male aged 21 to 69 years were included. Specters of common and modified LP in serum and plasma were evaluated with small-angle x-ray scattering. Results. Low level of intermediate density lipoproteins (IDLP subfractions and very low density lipoproteins (VLDLP as well as high level of low density lipoproteins (LDLP30 was revealed in pts with RA. Mean level of LP modification was about 60%. High density lipoproteins (HDLP subfraction was least and IDLP subfraction – most susceptible to modification. LP modification level increased due to LDLP and VLDLP fractions. This level had a tendency to increase with age because of elevation of atherogenic LP part. Mean values of common LP did not differ between sex and age groups of pts with RA. Unexpectedly low (in comparison with normal lipid content level of LP modification of the whole fraction of HDLP was the feature of modified LP specter in pts with RA. Conclusion. Level of common and modified LP in blood plasma and serum of RA pts is connected with general state of lipid metabolism and immune defense factors balance. Low level of VLDLP cholesterol and high level of LDLP cholesterol as well as high degree of LP of these fractions modification may be probably considered as markers of RA activity.

  18. Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

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    Eman M Khedr

    2015-01-01

    Conclusion Cognitive impairment, depression, anxiety and peripheral neuropathy are common in RA patients. Early diagnosis and management of neuropsychiatric disorders in RA patients may greatly improve the patients′ health-related quality of life.

  19. SUBTYPE CHARACTERICS OF DENDRITIC CELLS FROM PERIPHERAL BLOOD OF PATIENTS WITH RHEUMATOID ARTHRITIS

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    S. A. Falaleeva

    2013-01-01

    Full Text Available Abstract. Characteristics of myeloid and plasmacytoid dendritic cells from peripheral blood were studied in healthy donors and patients with rheumatoid arthritis (RA. We evaluated relative amounts of dendritic cell by their subtypes, degree of their maturity, and ability to respond to the maturation factors (toll-like receptor 4, 7 and 8 agonists. The results of in vitro experiments have shown that the patients with rheumatoid arthritis exhibited a significant reduction in numbers of plasmacytoid dendritic cells from peripheral blood. A sufficient decrease in CD83, CD80 expression on dendritic cell subtypes in RA patients was significantly less, than in healthy donors. In patients with RA, a significant increase in the number of CCR7-expressing plasmacytoid dendritic cells was shown in peripheral blood. In stimulated cultures, maturation of dendritic cells expressing maturation markers (CD83, CD80, CCR7 proved to be increased up to normal values. It should be noted that the counts of plasmacytoid dendritic cells in peripheral blood of RA patients expressing CCR7 was significantly higher than among healthy donors. Meanwhile, expression of CD83 and CD80 increased tovalues of healthy donors.Hence, we have found a significant reduction in relative counts of blood-derived myeloid and plasmacytoid dendritic cells expressing markers of mature dendritic cells (CD83, CD80 in patients with rheumatoid arthritis. Upon stimulated in vitro maturation, the counts of myeloid and plasmacytoid dendritic cells expressing CD83 and CD80 increased to the values corresponding to those of control group. RA patients showed significantly higher numbers of plasmacytoid dendritic cells expressing CCR7. This could indicate some changes in functional activity of dendritic cells in peripheral blood of patients with RA.

  20. Arthritis - resources

    Science.gov (United States)

    Resources - arthritis ... The following organizations provide more information on arthritis : American Academy of Orthopaedic Surgeons -- orthoinfo.aaos.org/menus/arthritis.cfm Arthritis Foundation -- www.arthritis.org Centers for Disease Control and Prevention -- www. ...

  1. High Frequency of Fibromyalgia in Patients with Psoriatic Arthritis: A Pilot Study

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    Marina N. Magrey

    2013-01-01

    Full Text Available Background. Widespread pain from fibromyalgia syndrome (FMS is observed in patients with psoriatic arthritis (PsA. We hypothesized that there is increased frequency of FMS in patients with PsA that contributes to fatigue and pain. Method. We prospectively enrolled patients with PsA based on the Classification criteria for Psoriatic Arthritis and healthy subjects were used as controls. The frequency of FMS was determined using London Fibromyalgia Epidemiologic Study Screening Questionnaire (LFESSQ and Symptoms Intensity scale (SIs. Results. 34 PsA patients and 44 controls fulfilled the inclusion criteria. Median age of PsA patients was 52 years with 53.33% females. Median age of controls was 50.5 years with 59% females. FMS was present in 53.33% of PsA patients compared to 4.54% of the controls (, based on LFESSQ. 37.50% of PsA had FMS compared to 6.66% of controls ( based on SIs. There was a significant correlation between LFESSQ and SIs in the psoriatic group (. 76.66% of PsA patients complained of fatigue compared to 40.90% of controls, but the mean fatigue score between the two groups was comparable (5.03 versus 5.18. Conclusion. FMS-associated pain and fatigue are significantly more frequent in patients with PsA compared to controls.

  2. Trace element analysis in rheumatoid arthritis under chrysotheraphy

    Science.gov (United States)

    Lecomte, R.; Paradis, P.; Monaro, S.; Barrette, M.; Lamoureux, G.; Menard, H.-A.

    1981-03-01

    Proton induced X-ray emission (PIXE) analysis is used to measure trace element concentrations in blood serum from patients with rheumatoid arthritis. Initially trace element contaminations in blood-collecting and storing devices are determined. Then mean values and nyctemeral cycles are measured both in normal subjects and patients with rheumatoid arthritis and other similar pathologies. Abnormal concentrations of Cu and Zn and anomalies in the nyctemeral cycle are found in the patients. In the second phase of the project, the special case of chrysotherapeutically treated (gold salt treatment) rheumatoid arthritis patients is studied for extended periods of time (up to 53 weeks).

  3. Challenges faced in Latin America for the implementation of an ideal health-care model for rheumatoid arthritis patients: are we ready?

    Science.gov (United States)

    Rodríguez Jaillier, Juan Carlos; Posada Arango, Ana María; Martínez Pérez, David Antonio

    2015-03-01

    Rheumatoid arthritis (RA) is a chronic, inflammatory, progressive disease characterized by inflammation of the synovial tissue. It results in the severe functional deterioration of the joints involved and the incapacity to work. Our main aim is to determine the characteristics of the current health-care models used in treating rheumatoid arthritis patients in Latin America. We want to analyze the details, using them as the foundation to create an ideal health-care model that is focused on the patient. We have revised documents, including guides to clinical practice, monitoring models and health-care models according to the current policies and resources available in various Latin American countries. Based on this information, the qualities and deficiencies of the current models will be analyzed, in order to use this as a basis on which to construct a proposed health-care model that covers the specific needs of rheumatoid arthritis patients, considering the resources of each population. Despite the collapse seen in many health systems throughout history, we can learn from them and should develop a new model starting from the path pursued, capitalizing on our experiences, teachings, and errors committed. However, in most cases, the obstacles to the success of the systems do not lie in the fundamental structure or the "spirit of the legislator" but rather in the day-to-day development within the community and the special interest of each agent in a system.

  4. MHC2TA and FCRL3 genes are not associated with rheumatoid arthritis in Mexican patients.

    Science.gov (United States)

    Mendoza Rincón, J F; Rodríguez Elias, A K; Fragoso, J M; Vargas Alarcón, G; Maldonado Murillo, K; Rivas Jiménez, M L; Barbosa Cobos, R E; Jimenez Morales, S; Lugo Zamudio, G; Tovilla Zárate, C; Ramírez Bello, J

    2016-02-01

    Rheumatoid arthritis (RA) is a multifactorial disease. A combination of genetic and environmental risk factors contributes to its etiology. Several genes have been reported to be associated with susceptibility to the development of RA. The MHC2TA and FCRL3 genes have been associated previously with RA in Swedish and Japanese populations, respectively. In two recent reports, we show an association between FCRL3 and juvenile rheumatoid arthritis (JRA), and MHC2TA and acute coronary syndrome (ACS) in Mexican population. We assessed the association between three single nucleotide polymorphisms (SNPs) of the MHC2TA (-168G/A; rs3087456, and +16G/C; rs4774) and FCRL3 (-169T/C; rs7528684) genes and rheumatoid arthritis in Mexican population through a genotyping method using allelic discrimination assays with TaqMan probes. Our case-control study included 249 patients with RA and 314 controls. We found no evidence of an association between the MHC2TA -168G/A and +1614G/C or FCRL3 -169T/C polymorphisms and RA in this Mexican population. In this cohort of Mexican patients with RA, we observed no association between the MHC2TA or FCRL3 genes and this autoimmune disease.

  5. Employment is maintained and sick days decreased in psoriasis/psoriatic arthritis patients with etanercept treatment

    DEFF Research Database (Denmark)

    Boggs, Robert L; Kárpáti, Sarolta; Li, Wenzhi;

    2014-01-01

    BACKGROUND: Psoriasis and psoriatic arthritis (PsA) impair quality of life, including reduction in employment or job duties. The PRESTA (Psoriasis Randomized Etanercept STudy in Patients with Psoriatic Arthritis) study, a randomized, double-blind, two-dose trial, examined the efficacy of etanercept...... to receive etanercept 50 mg twice weekly (BIW; n=379) or 50 mg once weekly (QW; n=373) for 12 weeks by subcutaneous injection. All participants then received open-label etanercept 50 mg QW for 12 additional weeks, while remaining blinded to the randomization. A pharmacoeconomic questionnaire was administered...... to disease and in reducing sick time. Effective treatment of psoriasis and PsA may reduce missed work days....

  6. Adalimumab-induced acute interstitial lung disease in a patient with rheumatoid arthritis

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    Olivia Meira Dias

    2014-01-01

    Full Text Available The use of immunobiological agents for the treatment of autoimmune diseases is increasing in medical practice. Anti-TNF therapies have been increasingly used in refractory autoimmune diseases, especially rheumatoid arthritis, with promising results. However, the use of such therapies has been associated with an increased risk of developing other autoimmune diseases. In addition, the use of anti-TNF agents can cause pulmonary complications, such as reactivation of mycobacterial and fungal infections, as well as sarcoidosis and other interstitial lung diseases (ILDs. There is evidence of an association between ILD and the use of anti-TNF agents, etanercept and infliximab in particular. Adalimumab is the newest drug in this class, and some authors have suggested that its use might induce or exacerbate preexisting ILDs. In this study, we report the first case of acute ILD secondary to the use of adalimumab in Brazil, in a patient with rheumatoid arthritis and without a history of ILD.

  7. Incidence and Prognosis of Psoriasis and Psoriatic Arthritis in Patients Undergoing Bariatric Surgery

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Sørensen, Jens Ahm; Gislason, Gunnar Hilmar;

    2016-01-01

    Importance: Psoriasis and obesity are strongly linked, and weight loss appears to improve psoriasis symptoms and severity. Bariatric surgery may induce remission of psoriasis, but data are limited to small studies and case series. Objective: To examine the incidence and prognosis of psoriasis...... and psoriatic arthritis in patients undergoing bariatric surgery (gastric bypass and gastric banding). Design, Setting, and Participants: This population-based cohort study used individual-level linkage of administrative and public health registers in Denmark. All Danish citizens who received gastric bypass...... or gastric banding between January 1, 1997, and December 31, 2012, were included in the study. Data analysis was performed from February 4 to April 14, 2016. Main Outcomes and Measures: The outcomes were incident (new-onset) psoriasis or psoriatic arthritis, or progression to severe psoriasis. Incidence...

  8. Large Vessel Vasculitis Occurring in Rheumatoid Arthritis Patient under Anti-TNF Therapy

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    Valentina Cestelli

    2014-01-01

    Full Text Available Vasculitis is a heterogeneous group of disorders characterized by the presence of necrotic inflammatory phenomena and destruction of blood vessels. Vasculitis is classified as primary (idiopathic or secondary to infections, connective tissue diseases and drugs but can also be considered as a paraneoplastic phenomenon. Evidence shows that the increasing use of biological agents results in a growing number of reports of autoimmune diseases induced by these therapies. An inflammatory articular chronic disease such as rheumatoid arthritis may be complicated by extra-articular manifestations, such as cutaneous or systemic vasculitis. Herewith, we describe the case of a great vessels arteritis in a patient affected by rheumatoid arthritis in therapy with an anti-TNF agent (etanercept.

  9. CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS WITHIN THE REMARCA STUDY: PRELIMINARY DATA

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    D. S. Novikova

    2015-01-01

    Full Text Available Most patients with early rheumatoid arthritis (RA have a high or very high cardiovascular risk (CVR before therapy with disease-modifying antirheumatic drugs (DMARDs. Objective: to evaluate the impact of antirheumatic therapy performed in accordance with the Treat-to-Target strategy on the progression of atherosclerosis and CVR in patients with early RA. Subjects and methods. This investigation enrolled 74 patients (72% women; median age, 56 years with early RA having moderate to high activity (median DAS28, 5.6 who had not previously received DMARDs and glucocorticoids (GCs. All patients were anticyclic citrullinated peptide antibody-positive and 87% of the patients were rheumatoid factor-positive. All patients received methotrexate (MT subcutaneously with dose escalation up to 25–30 mg/week, in case of its inefficiency at 3 months a biological agent (BA was added. After 6 months, 39% of the patients achieved remission; 19% had low; 35 and 7% had moderate and high disease activity, respectively. The majority (n = 20 (69% who achieved remission received MT monotherapy; 9 (31% – MT + BA whereas among the patients who did not achieve remission 15 (33% and 30 (67% respectively. At baseline and after 6 months of treatment, traditional CVR factors were assessed in all patients, by determining the total coronary risk by the SCORE scale, including that modified by EULAR (mSCORE, carotid artery atherosclerosis (CAA by duplex scanning data, coronary calcification (CC by multislice spiral computed tomography and by estimating the degree of CVR.Results and discussion. The rates of hypertension, overweight, abdominal obesity, low activity, smoking, and type 2 diabetes mellitus did not change significantly after 6 months. There were increases in the levels of total cholesterol by 7% (p < 0.05, low-density lipoprotein cholesterol by 9% (p<0.01, high-density lipoprotein cholesterol by 26% (p < 0.005, and body mass index (BMI by 1% (p < 0.01 and a decrease

  10. Simultaneous bilateral septic arthritis of the knee after intraarticular steroid injection: A clinical report.

    Science.gov (United States)

    Munigangaiah, Sudarshan; O'Sullivan, Theresa A; Lenehan, Brian

    2014-07-01

    Osteoarthritis of knee is one of the common problems in elderly population. Intraarticular corticosteroid injection is a conservative management modality in osteoarthritis of knee. Septic arthritis is an infective complication of intraarticular corticosteroid injection. Septic arthritis in rheumatoid arthritis patients have worse prognosis because of delay in diagnosis. A higher rate of infectious complications following intraarticular injection is expected in immunocompromised and rheumatoid patients. We would like to report an extremely rare case of simultaneous bilateral knee septic arthritis after bilateral knee intraarticular steroid injection in a rheumatoid arthritis patient. Patient was treated successfully with multiple bilateral knee arthroscopic washouts and long-term intravenous antibiotics. This case report emphasizes the increased risk of infection in rheumatoid arthritis patients and a risk benefit assessment on individual basis before carrying out intraarticular steroid injection. Patient should be aware of this increased risk of infection.

  11. Effects of Rebixiao Granules(热痹消颗粒剂) on Blood Uric Acid in Patients with Repeatedly Attacking Acute Gouty Arthritis

    Institute of Scientific and Technical Information of China (English)

    JI Wei; ZHU Xuan-xuan; TAN Wen-feng; LU Yan

    2005-01-01

    Objective:To observe the clinical effect of Rebixiao granule (热痹消颗粒剂, RBXG) in treating repeatedly attacking acute gouty arthritis and through experimental study on blood uric acid to explore RBXG's therapeutic mechanism. Methods: Ninety repeatedly attacking acute gouty arthritis patients were divided into the treated group (n= 60) and control group (n = 30). The treated group was treated with RBXG, and the control group was treated with Futalin tablets (diclofenac sodium). The baseline treatment including good rest, Iow purine diet, sufficient water drinking and urine alkalization, etc. was then given to both groups. Hypoxanthine 600 mg/kg and niacin 100 mg/kg was applied to hyperuricemic mice by gastrogavage to establish the animal models. Results: The clinical effective rate of the treated group was 95.0% and that of the control 90.0 %. Good therapeutic effects were won, insignificant difference (P>0.05)was shown between the two groups. However, the cure rate of the treated group was 26.7% while that of the control group was 10.0%, with significant difference (P<0.01) shown between them. The treated group had its blood uric acid lowered, which was significantly different (P<0.05) from that of the control group. The animal experiment indicated that all the three groups treated with different dosages of RBXG, as well as the Ash bark and Smilax glabra rhizome groups had their blood uric acid content reduced in the hyperuricemic mice. Conclusion: RBXG has a quicker initiation and better treatment effects than sole anti-inflammatory and analgesic agents on the treatment of repeatedly attacking acute gouty arthritis, showing no obvious toxic or adverse reactions and therefore good for long-term administration and likely to be a safe TCM preparation to control the symptoms and reduce the onsets of repeatedly attacking of acute gouty arthritis. The animal experiment shows that both the compound preparation and part of the single ingredients in the

  12. Unusual case of an elbow mass caused by Candida arthritis in a patient with systemic lupus erythematosus.

    Science.gov (United States)

    Imamura, Hitoshi; Iwamoto, Takuji; Momohara, Shigeki

    2014-01-01

    A 45-year-old woman with systemic lupus erythematosus presented with a painless bulky mass on her elbow. Joint fluid analysis showed the presence of a yeast-like organism. Surgical debridement was performed and specimens obtained at surgery showed growth of Candida albicans. Although Candida species are an uncommon cause of infectious arthritis, fungal arthritis should be considered in the patient with predisposing factors.

  13. Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient

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    Shailee Y. Shah

    2015-01-01

    Full Text Available Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be C. burnetii by PCR (polymerase chain reaction sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.

  14. Identification of novel autoantigen in the synovial fluid of rheumatoid arthritis patients using an immunoproteomics approach.

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    Sagarika Biswas

    Full Text Available Rheumatoid arthritis (RA is a chronic, autoimmune and inflammatory joint disease with a poorly understood etiology. Despite widespread diagnostic use of anti-citrullinated protein antibodies and rheumatoid factor proteins there is a strong demand for novel serological biomarkers to improve the diagnosis this disease. The present study was aimed to identify novel autoantigens involved in rheumatoid arthritis (RA pathogenesis through immune-proteomic strategy. Synovial fluid samples from clinically diagnosed RA patients were separated on two-dimensional gel electrophoresis (2-DE. Samples from patients with non-RA rheumatisms (osteoarthritis and trauma were used as controls. Immunoreactive proteins were spotted by Western blotting followed by identification through Q-TOF mass spectrometer analysis. Forty Western blots were generated using plasma from ten individual RA patients and 33 reactive spots were identified, 20 from the high molecular weight (HMW gel and 13 from the low molecular weight (LMW gel. Among the 33 common immunogenic spots, 18 distinct autoantigens were identified, out of which 14 are novel proteins in this context. Expression analysis of five important proteins, vimentin, gelsolin, alpha 2 HS glycoprotein (AHSG, glial fibrillary acidic protein (GFAP, and α1B-glycoprotein (A1BG by Western blot analysis using their specific antibodies revealed their higher expression in RA synovial fluid as compared to non-RA samples. Recombinantly expressed GFAP and A1BG protein were used to develop an in-house ELISA to quantify the amount of autoantibodies in the RA patients. RA patients revealed an increase in the expression of GFAP and A1BG in the plasma as compared to osteoarthritis patients. Therefore, GFAP and A1BG can be proposed as potential new autoantigens of diagnostic importance for RA subjects. Further characterization of these proteins in rheumatoid arthritis will be helpful in understanding the role of these proteins in the disease

  15. The Danish nationwide clinical register for patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Ibfelt, Else Helene; Jensen, Dorte Vendelbo; Hetland, Merete Lund

    2016-01-01

    done electronically, including patient-reported outcome measures registered electronically by the patients with the use of touch screens. MAIN VARIABLES: Core variables such as diagnosis, year of diagnosis, age, and sex are registered at the beginning. Data entered at later visits included...

  16. Adherence and resource use among patients treated with biologic drugs: findings from BEETLE study

    Directory of Open Access Journals (Sweden)

    Degli Esposti L

    2014-09-01

    Full Text Available Luca Degli Esposti,1 Diego Sangiorgi,1 Valentina Perrone,2 Sonia Radice,2 Emilio Clementi,3,4 Francesco Perone,4,5 Stefano Buda1 1CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy; 2Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L Sacco University Hospital, Università di Milano, Milan, Italy; 3Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, CNR Institute of Neuroscience, L Sacco University Hospital, Università di Milano, Milan, Italy; 4Scientific Institute, IRCCS E Medea, Lecco, Italy; 5Local Health Unit, Caserta, Italy Objectives: Systemic administration of anti-tumor necrosis factor alpha (anti-TNF alpha leads to an anti-inflammatory and joint protective effect in pathologies such as rheumatoid arthritis, psoriasis, and Crohn's disease. The aim of this study was to assess adherence to therapy, persistence in treatment (no switches or interruptions, and consumption of care resources (drugs, outpatient services, hospitalizations. Methods: We conducted an observational retrospective cohort analysis using the administrative databases of five local health units. Patients filling at least one prescription for anti-TNF alpha between January 1, 2009 and December 31, 2011 were included and followed up for 1 year. Patients were defined as adherent if >80% of the follow-up period was covered by drugs dispensation. Results: A total of 1,219 patients were analyzed (mean age 49.6±14.6, male 47%. Among enrolled patients, 36% were affected by rheumatoid arthritis, and 31% and 10% were affected by psoriasis and Crohn's disease, respectively; other indications remained below these percentages. Thirty-four percent of patients (420 were treated with adalimumab, 51% (615 with etanercept, and 15% (184 with infliximab. Among the 94% of patients who did not switch, those treated with infliximab had a higher rate of adherence across all indications (51% overall when compared to that

  17. Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study

    NARCIS (Netherlands)

    Vermeer, M.; Kuper, H.H.; Hoekstra, M.; Haagsma, C.J.; Posthumus, M.D.; Brus, H.L.; Riel, P.L. van; Laar, M.A. van der

    2011-01-01

    OBJECTIVE: Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a tre

  18. Health-related quality of life of patients with rheumatoid arthritis. Which factors are of significance?

    DEFF Research Database (Denmark)

    Linde, L.; Sørensen, J.; Ostergaard, M.;

    2008-01-01

    . Modern medical therapy has improved HRQoL in RA patients, while demographic factors (female sex and older age), low socioeconomic status (in terms of education and position in the work force) and the presence of comorbid conditions appear to be associated with poorer HRQoL Udgivelsesdato: 2008/3/3......Rheumatoid arthritis (RA) is a chronic inflammatory disease causing joint pain, loss of function and decreased health-related quality of life (HRQoL). HRQoL in RA patients is associated with several risk factors; in this paper the evidence relating to the most important risk factors is reviewed...

  19. Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report

    Science.gov (United States)

    Kim, Sang Hoon; Seo, Young Ho; Kim, Ji Hyoung; Jeong, Il Woo; Sohn, Sung Birm

    2014-01-01

    The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization. PMID:25568848

  20. Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi;

    2008-01-01

    OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5...... exercise were statistically significantly associated with remission. CONCLUSION: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials...