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Sample records for arthritis patients treated

  1. Treating Psoriatic Arthritis

    Science.gov (United States)

    ... to find out more! Email * Zipcode Treating Psoriatic Arthritis Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints ... recommend treatments based on the type of psoriatic arthritis, its severity and your reaction to treatment. Download ...

  2. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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.

  5. 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)....

  6. 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 this t...

  7. Difference in the risk of serious infections in patients with rheumatoid arthritis treated with adalimumab, infliximab and etanercept: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry

    NARCIS (Netherlands)

    Dartel, van Sanne A.A.; Fransen, Jaap; Kievit, Wietske; Flendrie, Marcel; Broeder, den Alfons A.; Visser, H.; Hartkamp, A.; Laar, van de Mart A.F.J.; Riel, van Piet L.C.M.

    2013-01-01

    Background Tumour necrosis factor (TNF)-inhibiting therapy increases the risk of serious infections in rheumatoid arthritis (RA). However, it is not clear whether this risk differs between TNF inhibitors. Objective To analyse whether the risk of serious infections in patients with RA treated with

  8. Difference in the risk of serious infections in patients with rheumatoid arthritis treated with adalimumab, infliximab and etanercept: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry

    NARCIS (Netherlands)

    Dartel, S.A.A. van; Fransen, J.; Kievit, W.; Flendrie, M.; Broeder, A. den; Visser, H.; Hartkamp, A.; Laar, M.A. van der; Riel, P.L.C.M. van

    2013-01-01

    BACKGROUND: Tumour necrosis factor (TNF)-inhibiting therapy increases the risk of serious infections in rheumatoid arthritis (RA). However, it is not clear whether this risk differs between TNF inhibitors. OBJECTIVE: To analyse whether the risk of serious infections in patients with RA treated with

  9. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Septic arthritis in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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.

  15. 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.

  16. A case of surgically treated peristomal pyoderma gangrenosum in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Khajehnoori, Masoomeh; O'Brien, Tim

    2016-01-01

    Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that is difficult to diagnose and treat. It is characterized by the rapid progression of painful necrotic ulcer surrounding an area of abdominal stoma. It is almost exclusively associated with inflammatory bowel disease even after bowel surgery and is associated with significant morbidity. Diagnosis of pyoderma gangrenosum is based on exclusion of other disorders replicating some of its clinical features and histopathological evidence.This is a case report of a 56-year-old lady with rheumatoid arthritis who presented with rapidly progressing abdominal ulcer 8 months after a Hartmanns procedure for perforated diverticulitis. The ulcer had formed a large cavity causing faecal filling in the dependent defect. The other causes of ulcer were excluded with negative histopathology, negative polymerase chain reaction for Mycobacterium ulcerans and negative acid fast bacillus (AFB) test. She was diagnosed with PPG which is routinely treated medically due to risk of setting off a second focus of pyoderma if surgically intervened. However due to increased risk of faecal peritonitis, it was decided to proceed with surgical debridement. This article will discuss the case in more detail and briefly discuss diagnosis and treatment options for PPG. PMID:27302499

  17. 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

  18. 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...

  19. 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.

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

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    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

  1. 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 Lund;

    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...

  2. 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.

  3. 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)....

  4. 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...... for Southern Denmark, S-20110109. Dissemination will occur through presentations and publication in international peer-reviewed journals. TRIAL REGISTRATION: The study is registered in http://www.ClinicalTrials.gov identifier: NCT01656278 (5 July 2012)....

  5. 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)....

  6. Treating Rheumatoid Arthritis: Are Biologic Drugs Right for You?

    Science.gov (United States)

    Treating Rheumatoid Arthritis: Are Biologic Drugs Right for You? What is rheumatoid arthritis (RA)? Rheumatoid arthritis (RA) is a serious condition. The body’s immune system attacks the lining of ...

  7. 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...

  8. MRI findings of treated bacterial septic arthritis

    International Nuclear Information System (INIS)

    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.)

  9. MRI findings of treated bacterial septic arthritis

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    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.)

  10. 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...

  11. 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

  12. 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.

  13. Melanoma risk in patients with rheumatoid arthritis treated with tumour necrosis factor alpha inhibitors: a systematic review and meta-analysis.

    Science.gov (United States)

    Olsen, Catherine M; Hyrich, Kimme L; Knight, Lani L; Green, Adèle C

    2016-10-01

    Clinicians are concerned that treatment of rheumatoid arthritis (RA) with tumour necrosis factor alpha antagonists (TNFα biologics) may increase patients' risk of melanoma compared with treatment with nonbiologic disease-modifying antirheumatic drugs (nbDMARDS). We aimed to assess the risk of melanoma in RA patients treated with TNFα biologics compared with RA patients treated with nbDMARDS. A secondary aim was to quantify the risk of melanoma in RA patients treated with TNFα biologics compared with the general population. We carried out a systematic review and meta-analysis searching Medline, Embase and the ISI Science Citation Index databases to January 2016. Cohort studies that enabled a quantitative assessment of the risk of melanoma in RA patients treated with TNFα biologics compared with either RA patients treated with nbDMARDS or the general population or both were included. Data were pooled using a random-effects model. From 812 articles, we identified six that fulfilled the inclusion criteria. Four studies reported on the risk of melanoma in RA patients treated with TNFα biologics compared with those treated with nbDMARDS, with a pooled effect estimate of 1.60 (95% confidence interval 1.16-2.19). Five reported on the risk of melanoma in RA patients treated with TNFα biologics compared with the general population, and the pooled effect estimate was 1.87 (95% confidence interval 1.53-2.30). There was no significant heterogeneity in either analysis. This systematic review and meta-analysis does not allay clinician's fears and, while awaiting further evidence from large collaborative studies, this patient population may benefit from regular skin checks and counselling to avoid excessive sun exposure. PMID:27391143

  14. Medicines to Treat Rheumatoid Arthritis

    Science.gov (United States)

    ... it costs. Ask if they have a drug discount program that can help you pay less for your medicine. Buy your medicine from the pharmacy that gives you the cheapest price.  Sign up for patient assistance programs: Most companies that make medicines have programs that help people ...

  15. 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.

  16. 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.

  17. 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

    OBJECTIVE: To investigate the accumulation of methotrexate (MTX) in circulating erythrocytes and the association with pharmacokinetic variables, weekly dose, and clinical efficacy in 2 cohorts of patients with chronic active rheumatoid arthritis (RA) undergoing MTX monotherapy. METHODS: Seventy...

  18. [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

  19. 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

  20. 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

  1. 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 rheumatoid arthritis treated with infliximab can be linked each other along with increased lupus-associated cytokine levels including type I interferons. PMID:27643491

  2. 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 ...

  3. 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...

  4. Pre-treatment whole blood gene expression is associated with 14-week response assessed by dynamic contrast enhanced magnetic resonance imaging in infliximab-treated rheumatoid arthritis patients.

    Directory of Open Access Journals (Sweden)

    Kenzie D MacIsaac

    Full Text Available Approximately 30% of rheumatoid arthritis patients achieve inadequate response to anti-TNF biologics. Attempts to identify molecular biomarkers predicting response have met with mixed success. This may be attributable, in part, to the variable and subjective disease assessment endpoints with large placebo effects typically used to classify patient response. Sixty-one patients with active RA despite methotrexate treatment, and with MRI-documented synovitis, were randomized to receive infliximab or placebo. Blood was collected at baseline and genome-wide transcription in whole blood was measured using microarrays. The primary endpoint in this study was determined by measuring the transfer rate constant (Ktrans of a gadolinium-based contrast agent from plasma to synovium using MRI. Secondary endpoints included repeated clinical assessments with DAS28(CRP, and assessments of osteitis and synovitis by the RAMRIS method. Infliximab showed greater decrease from baseline in DCE-MRI Ktrans of wrist and MCP at all visits compared with placebo (P<0.001. Statistical analysis was performed to identify genes associated with treatment-specific 14-week change in Ktrans. The 256 genes identified were used to derive a gene signature score by averaging their log expression within each patient. The resulting score correlated with improvement of Ktrans in infliximab-treated patients and with deterioration of Ktrans in placebo-treated subjects. Poor responders showed high expression of activated B-cell genes whereas good responders exhibited a gene expression pattern consistent with mobilization of neutrophils and monocytes and high levels of reticulated platelets. This gene signature was significantly associated with clinical response in two previously published whole blood gene expression studies using anti-TNF therapies. These data provide support for the hypothesis that anti-TNF inadequate responders comprise a distinct molecular subtype of RA characterized by

  5. 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

    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......: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI...... increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p 

  6. 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

  7. 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

  8. 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).

  9. 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.......0-6.8) at baseline and 3.5 (1.5-4.1) at week 16 (decreased in all patients compared to baseline, Wilcoxon-Pratt, p < 0.05). The median MRI synovitis score was 18 (14-21), 18 (10-20) and 16 (10-20) at baseline, week 4 and 16, respectively (decreased in all patients compared to baseline, Wilcoxon-Pratt, p < 0...

  10. 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.

  11. Treating psoriatic arthritis: how effective are TNF antagonists?

    OpenAIRE

    Gottlieb, Alice B.; Antoni, Christian E

    2004-01-01

    Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy that commonly appears after the onset of the characteristic cutaneous lesions. This complication affects about 40% of patients with moderate to severe cutaneous disease. Analysis of synovial fluid and tissue in patients with PsA demonstrates a profile of high levels of tumor necrosis factor (TNF) plus other cytokines similar to those seen in patients with rheumatoid arthritis (RA). In the past, medical management of patients with...

  12. 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. This ...

  13. Hepatitis B reactivation in a patient with rheumatoid arthritis with antibodies to hepatitis B surface antigen treated with rituximab

    OpenAIRE

    Gigi, E; GEORGIOU T; Mougiou, D; Boura, P; Raptopoulou-Gigi, M

    2013-01-01

    Hepatitis B virus (HBV) can still be found within the hepatocytes after its clearance and the control of viral replication depends on the immune response. However during immunosuppression, seroconversion of HBsAg has been described followed by disease reactivation. Hepatitis B virus reactivation represents an emerging cause of liver disease in patients undergoing treatment with biologic agents and in particular, by the use of rituximab (anti-CD20) and alemtuzumab (anti-CD52) that cause profou...

  14. [Serum soluble CD44 isoform variant 5 level in patients with seropositive rheumatoid arthritis treated with cyclosporin A].

    Science.gov (United States)

    Feyertag, J; Haberhauer, G; Skoumal, M; Kittl, E M; Bauer, K; Dunky, A

    2000-01-01

    CD44 is a widely expressed cell surface glycoprotein which is involved in many cell-cell and cell-matrix interactions. Expression of soluble CD44 splice variants is strictly regulated and is linked to a high rate of cell division. Serum levels of soluble CD44 variant 5 (sCD44v5) were determined in 14 patients with erosive RA. Patients were divided into two groups. In group 1 cyclosporin A treatment (CYA) was initiated after the first visit. In group 2 preliminary CYA was continued. Controls were performed after 6 months. We found a significant decrease of swollen joint count (SJC) and sCD44v5 in group 1. No effect of CYA was found on c-reactive protein, erythrocyte sedimentation rate and IgM-rheumatoid factor (IgM-RF). In group 2 a significant decrease of CRP was found. Therefore we conclude that measurement of sCD44v5 might be useful in monitoring RA+ patients with CYA. PMID:11261266

  15. 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...

  16. 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......-time feedback to the physician is feasible, although the goal of treat-to-target is not achieved in a substantial proportion of patients in routine care....

  17. Radiographic manifestations of arthritis in AIDS patients

    International Nuclear Information System (INIS)

    The purpose of this study is to familiarize the radiologist with a newly discovered association between arthritis and acquired immunodeficiency syndrome (AIDS). The authors retrospectively reviewed the clinical and radiographic findings in 31 patients with human immunodeficiency virus (HIV) infection referred to their rheumatology clinic with musculoskeletal complaints. The patients carried a wide range of clinical diagnosis including Reiter syndrome, psoriatic arthritis, undifferentiated seronegative arthritis, isolated enthesopathies, rheumatoid arthritis and osteonecrosis. Radiographs were available in 24 of the 31 patients, and in 20 they showed radiographic features of arthritis, which included soft-tissue swelling periarticular osteoporosis, synovial effusions, sacroiliitis, periosteal reaction, joint space narrowing, marginal erosions, and osteonecrosis. Although the radiographic abnormalities were frequently mild, they were significant, given the short duration of disease in many of their patients (weeks to months) at the time radiographs were obtained. The range of radiographic findings in their series was varied and paralleled the wide range of clinical diagnoses. No findings were pathognomonic for HIV-associated arthritis. Nevertheless, HIV infection needs to be considered in any patient belonging to a recognized risk group who presents with musculoskeletal disease. This is particularly important since immunosupressive drugs used for the treatment of arthritis can be detrimental to patients with HIV infection

  18. Surgical options for the young patient with glenohumeral arthritis.

    Science.gov (United States)

    Barlow, Jonathan D; Abboud, Joseph

    2016-01-01

    Young patients with glenohumeral arthritis are an ongoing treatment challenge. They typically have high demands of their shoulders, require long-term durability due to their young age, and often have altered local anatomy, through their disease process (instability arthropathy, juvenile rheumatoid arthritis, etc.) or from previous surgery (capsulorraphy arthropathy, chondrolysis, etc.). Workup to evaluate underlying causes of early arthritis, and to exclude infectious causes are necessary. When nonoperative management fails, arthroscopic debridement, hemiarthroplasty (isolated, with glenoid reaming, or with biological interposition), and total shoulder arthroplasty are treatment options available to the treating surgeon. Debridement or hemiarthroplasty can provide pain relief for a subset of patients, but results have not been reproducible across the literature and have not been durable over time. Total shoulder arthroplasty provides the most reliable pain relief, but long-term glenoid loosening and wear continue to lead to high revision rates in this patient population. PMID:26980987

  19. Surgical options for the young patient with glenohumeral arthritis

    Directory of Open Access Journals (Sweden)

    Jonathan D Barlow

    2016-01-01

    Full Text Available Young patients with glenohumeral arthritis are an ongoing treatment challenge. They typically have high demands of their shoulders, require long-term durability due to their young age, and often have altered local anatomy, through their disease process (instability arthropathy, juvenile rheumatoid arthritis, etc. or from previous surgery (capsulorraphy arthropathy, chondrolysis, etc.. Workup to evaluate underlying causes of early arthritis, and to exclude infectious causes are necessary. When nonoperative management fails, arthroscopic debridement, hemiarthroplasty (isolated, with glenoid reaming, or with biological interposition, and total shoulder arthroplasty are treatment options available to the treating surgeon. Debridement or hemiarthroplasty can provide pain relief for a subset of patients, but results have not been reproducible across the literature and have not been durable over time. Total shoulder arthroplasty provides the most reliable pain relief, but long-term glenoid loosening and wear continue to lead to high revision rates in this patient population.

  20. Treating Rheumatoid Arthritis to Target : multinational recommendations assessment questionnaire

    NARCIS (Netherlands)

    Haraoui, Boulos; Smolen, Josef S.; Aletaha, Daniel; Breedveld, Ferdinand C.; Burmester, Gerd; Codreanu, Catalin; Da Silva, Jose Pereira; de Wit, Maarten; Dougados, Maxime; Durez, Patrick; Emery, Paul; Fonseca, Joao Eurico; Gibofsky, Allan; Gomez-Reino, Juan; Graninger, Winfried; Hamuryudan, Vedat; Jannaut Pena, Maria Jose; Kalden, Joachim; Kvien, Tore K.; Laurindo, Ieda; Martin-Mola, Emilio; Montecucco, Carlomaurizio; Santos Moreno, Pedro; Pavelka, Karel; Poor, Gyula; Cardiel, Mario H.; Stanislawska-Biernat, Ewa; Takeuchi, Tsutomu; van der Heijde, Desiree

    2011-01-01

    Aim To measure the level of agreement and application of 10 international recommendations for treating rheumatoid arthritis (RA) to a target of remission/low disease activity. Methods A 10-point Likert scale (1=fully disagree, 10=fully agree) measured the level of agreement with each of 10 recommend

  1. 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

    /regressing. Decreased erosion scores at 12 months were registered in 1.6% and 1.8% of sites assessed on CT and radiography, respectively. CONCLUSION: Repair of erosions in adalimumab-treated patients with RA is rare, but erosive regression, exceeding the SDC, on CT and radiography occurred. The very limited overall......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 patients with rheumatoid arthritis (RA). METHODS: Fifty-two patients with RA, naïve to biological agents, with at least...... 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...

  2. The incidence of malignant disease in patients receiving cytotoxic therapy for rheumatoid arthritis.

    OpenAIRE

    Kirsner, A B; Farber, S. J.; Sheon, R P; Finkel, R I

    1982-01-01

    One hundred and twenty-six patients with definite or classical rheumatoid arthritis admitted to hospital between 1965 and 1974 for cytotoxic therapy were studied for the presence and type of malignant disease. Each of the cytotoxic treated patients was age and sex matched to a rheumatoid arthritis patient admitted to hospital during the same years but who did not receive cytotoxic therapy. There was no increase in malignancy in the cytotoxic treated group over the control group.

  3. A New Approach to Rheumatoid Arthritis: Treating Inflammation with Computerized Nerve Stimulation

    OpenAIRE

    Andersson, Ulf; Kevin J Tracey

    2012-01-01

    Editor’s note: Doctors currently treat rheumatoid arthritis, a crippling autoimmune disease, with an arsenal of drugs that, while often effective, can have serious side effects. Authors Ulf Andersson and Kevin J. Tracey describe a circuit between the immune system and the nervous system that enabled development of an implanted nerve stimulator to treat the disorder, now being tested by a patient in Bosnia. If further clinical trials show as much promise as this initial case, similar devices m...

  4. Prevention and nursing measures of adverse drug reaction in patients with rheumatoid arthritis treated with Tolicizumab%托珠单抗治疗类风湿关节炎不良反应的预防护理

    Institute of Scientific and Technical Information of China (English)

    吴丹纯; 方蘅英; 谢园园; 姚咏梅; 周小香

    2014-01-01

    Objective To analyze the prevention and nursing measures of adverse drug reaction in patients with rheumatoid arthritis treated with Tolicizumab.Method The clinical data and nursing measures in 30 patients with rheumatoid arthritis treated with Tolicizumab were reviewed and analyzed.Result All the patients completed the treatment and no infusion reaction was observed in the first 24 hours.Conclusions Comprehensive and intensive assessment is necessary before application of Tocilizumab. Executing standard drug dispensing and injection process,mastering the infusion reaction emergency processing measures and establishing injection related systems are of great significance to observe and treat various adverse reactions in time,ensuring drug effects and safety of the patients.%目的:探讨预防托珠单抗治疗类风湿关节炎(rheumatoid arthritis,RA)不良反应的护理经验。方法回顾性分析和总结30例RA患者接受托珠单抗治疗及护理经过。结果30例RA患者全部完成治疗,24 h内无出现不良反应。结论在使用托珠单抗前进行全面、深入、细致的评估;使用过程中执行规范的配置流程和注射流程,掌握发生不良反应的应急处理措施,建立输液相关制度,及时发现和有效处理各种不良反应,对保证药物疗效和患者安全具有重要意义。

  5. 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

  6. 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

  7. A multicentre, double blind, randomised, placebo controlled trial of anakinra (Kineret), a recombinant interleukin 1 receptor antagonist, in patients with rheumatoid arthritis treated with background methotrexate

    OpenAIRE

    Cohen, S.; Moreland, L; Cush, J; Greenwald, M.; Block, S; Shergy, W.; Hanrahan, P; Kraishi, M; Patel, A; Sun, G; Bear, M

    2004-01-01

    Objective: To assess the efficacy and safety of 100 mg daily anakinra (Kineret), a recombinant form of the naturally occurring interleukin 1 receptor antagonist, plus methotrexate (MTX) in reducing the signs and symptoms of rheumatoid arthritis (RA).

  8. 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.

  9. 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...... 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....

  10. 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…

  11. 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.

  12. 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.

  13. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis

    DEFF Research Database (Denmark)

    Duer-Jensen, Anne; Hørslev-Petersen, Kim; Hetland, Merete Lund;

    2011-01-01

    To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA).......To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA)....

  14. 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.

  15. Cardiovascular Risk in Patients with Psoriatic Arthritis

    Directory of Open Access Journals (Sweden)

    Tracy Y. Zhu

    2012-01-01

    Full Text Available Psoriatic arthritis (PsA is an inflammatory arthritis associated with psoriasis. In addition to skin and joint involvement, there is increasing evidence suggesting that patients with PsA also have an increase in risk of clinical and subclinical cardiovascular diseases, mostly due to accelerating atherosclerosis. Both conventional and nonconventional cardiovascular risk factors contribute to the increased cardiovascular risk in PsA. Chronic inflammation plays a pivotal role in the pathogenesis of atherosclerosis in PsA, acting independently and/or synergistically with the conventional risk factors. In this paper, we discuss the current literature indicating that patients with PsA are at risk of cardiovascular diseases.

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

    OpenAIRE

    Malyarchuk AR; Klymnyuk SI; Kuchmak OB

    2012-01-01

    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 o...

  17. 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

  18. 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

  19. The number needed to treat for adalimumab, etanercept, and infliximab based on ACR50 response in three randomized controlled trials on established rheumatoid arthritis

    DEFF Research Database (Denmark)

    Kristensen, L E; Christensen, R; Bliddal, H;

    2007-01-01

    To compare the efficacy of adalimumab, etanercept, and infliximab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX) by calculating the number needed to treat (NNT) using three different methods.......To compare the efficacy of adalimumab, etanercept, and infliximab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX) by calculating the number needed to treat (NNT) using three different methods....

  20. The number needed to treat for adalimumab, etanercept, and infliximab based on ACR50 response in three randomized controlled trials on established rheumatoid arthritis

    DEFF Research Database (Denmark)

    Kristensen, L E; Christensen, R; Bliddal, H;

    2011-01-01

    To compare the efficacy of adalimumab, etanercept, and infliximab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX) by calculating the number needed to treat (NNT) using three different methods.......To compare the efficacy of adalimumab, etanercept, and infliximab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX) by calculating the number needed to treat (NNT) using three different methods....

  1. [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.

  2. THERAPEUTIC ACTIVITY OF BEE-STINGS THERAPY IN RHEUMATOID ARTHRITIS CAUSES INFLAMMATION AND OXIDATIVE STRESS IN FEMALE PATIENTS

    Directory of Open Access Journals (Sweden)

    Abdel-Rahman M.

    2013-06-01

    Full Text Available Here the present study aimed to evaluate the therapeutic activity of bee venom acupuncture in rheumatoid arthritis (RA which causes inflammation and oxidative stress in female patients. 75 female patients were divided into 5 groups as control, bee venom acupuncture, rheumatoid arthritis, treated rheumatoid arthritis and rheumatoid arthritis stung with bee venom groups. Serum rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, prostaglandins E2 and F2α, lipid peroxidation, nitric oxide, glutathione and total antioxidant capacity levels were determined in all groups. Rheumatoid arthritis in female patients was resulted in a significant elevation in serum rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, prostaglandins E2 and F2α, lipid peroxidation and nitric oxide levels (p < 0.05 compared to control group. In addition, rheumatoid arthritis caused a significant reduction in serum glutathione and total antioxidant capacity levels. On the other hand, bee venom stings alleviated rheumatoid arthritis inflammation and oxidative stress effects, where all investigated parameters were statistically significant compared to rheumatoid arthritis group. Moreover, bee venom therapy was more potent than the routine treatment of rheumatoid arthritis in patients treated group. Bee venom acupuncture in RA patient may have therapeutic, anti-inflammatory and antioxidant activities.

  3. 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.

  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...

  5. 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.

  6. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    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.

  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. 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...

  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. Personalized Unicompartmental Knee Implant Treats Early Stage Arthritis While Preserving Bone

    Medline Plus

    Full Text Available Personalized Unicompartmental Knee Implant Treats Early Stage Arthritis while Preserving Bone (6:00pm CST) You must have Javascript enabled in your web browser. View Program Transcript Click Here to view the ...

  13. Interplay between environmental factors, articular involvement, and HLA-B27 in patients with psoriatic arthritis.

    OpenAIRE

    Scarpa, R.; DEL PUENTE A; di Girolamo, C; Della Valle, G.; E. Lubrano; Oriente, P

    1992-01-01

    Medical records of 138 patients with psoriatic arthritis and 138 with rheumatoid arthritis were reviewed for the occurrence of an environmental factor triggering arthritis. Twelve (9%) of the patients with psoriatic arthritis had had an acute disorder immediately preceding onset of arthritis (an operation in four cases, articular trauma in three, abortion in two, myocardial infarction, thrombophlebitis, and phosphoric ester intoxication in one case each). Peripheral arthritis occurred in all ...

  14. 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.

  15. Rheumatoid arthritis patients' experience of climate care.

    Science.gov (United States)

    Vaks, Katrin; Sjöström, Rita

    2015-12-01

    The purpose of this qualitative study was to understand and examine how patients with rheumatoid arthritis (RA) experience climate care and its effects. A qualitative approach was chosen for the study. Two men and six women were interviewed according to a semistructured interview guide. The text was analyzed using a manifest content analysis. The analysis resulted in four categories and 10 subcategories. The interviewees experienced climate care positively. The training was perceived increasing gradually. The patients felt that they performed to a maximum capacity during training and were impressed by the staff's enthusiasm and encouragement. The patients felt that they were involved in the goal setting and the choice of treatment, and the staff noticed individual needs. There was a feeling among the patients of being acknowledged by the staff. Information about the disease was perceived as individualized. The climate and beautiful surroundings were viewed as encouraging physical activity and a feeling of well-being. Patients made new friends, had fun together and also shared experiences about their disease. Furthermore, the patients described a sense of belonging to a group as well as a feeling of not being the only one that was sick among the healthy. Not having to do everyday tasks and having time to themselves were perceived positively. Several factors contributed to the positive experiences of climate care; climate, environment, physical activity, social context, staff involvement, and information about the disease were described as interacting together and resulting in a sense of well-being. A proposal for future research would be to examine if/how the various factors might interact and affect the RA patients' illness and quality of life. PMID:26730385

  16. Effect of Methotrexate In Treating Patients with Rheumatoid Arthritis of Different Chinese Medical Syndrome Patterns%甲氨蝶呤治疗中医不同证型类风湿关节炎疗效观察

    Institute of Scientific and Technical Information of China (English)

    赵霞; 方勇飞

    2011-01-01

    目的 观察甲氨蝶呤治疗中医不同证型类风湿关节炎疗效有无差异.方法 回顾312例患者病史,按照中医辨证标准分寒湿阻络、湿热阻络、痰瘀互结、寒热错杂4型(组),观察甲氨蝶呤结合其他对症疗法治疗前后关节压痛数、关节肿胀数、晨僵时间、患者疼痛评分(visual analog scale scores,VAS)、患者生活质量评分(health assessment questionnarie,HAQ);实验室检查:类风湿因子(rheumatoid factor,RF)、血沉(erythrocyte sedimentation rate,ESR)等指标,进行统计分析.结果 4组治疗后肿胀关节数、压痛关节数、晨僵时间、疼痛评分、血沉与本组治疗前比较,差异均有统计学意义(P<0.05),4组间比较,以湿热阻络型疗效最佳,差异有统计学意义(x2=45.3,P<0.05).结论 结合中医辨证分型,甲氨喋呤治疗类风湿关节炎,湿热阻络组疗效优于其他各组.%Objective To study whether the effects of methotrexate were different in treating patients with rheumatoid arthritis (RA) of different Chinese medical syndrome patterns. Methods Retrospective analysis was conducted in 312 RA patients treated with methotrexate, the Chinese medical syndrome patterns in them were differentiated into the cold-dampness blocking collateral type (SA), the heat-dampness blocking collateral type (SB), the phlegm blood-stasis intermingling type (SC), and the heat-cold complex type (SD). Parameters including numbers of joint with tendemess(Njt) and that with arthroncus (Nja); patient's moming stiffness duration ( MSD), scores estimated by visual analog scale ( VAS ) and health assessment questionnaire (HAQ); as well as laboratory indices involving rheumatoid factor ( RF), erythrocyte sedimentation rate (ESR), etc. were recorded before and after treatment and statistically analyzed. Results After treatment, improvements were shown in all patients in terms of Njt, Nja, MSD, VAS scores and ESR, showing significant difference as compared with those

  17. Cartilage oligomeric matrix protein in patients with juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Bjørnhart, Birgitte; Juul, Anders; Nielsen, Susan;

    2009-01-01

    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...

  18. Physical activity maintenance in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVE: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. DESIGN: A qualitative salutogenic-oriented interview study. SETTING: A rheumatology outpatient clinic. SUBJECTS: A purposive sample of 16 physically active patients (mean age 50, range 37......-67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4-46 years). METHODS: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon 'physical activity maintenance' was experienced by patients with rheumatoid arthritis. The interviews......, the essential meaning of the phenomenon of physical activity maintenance for patients with rheumatoid arthritis was summarized into 'striving for a transparent body and participation', pointing to experiences of sensations of wellbeing, liberation from restrictions and social participation on equal terms...

  19. 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-grade ra...... regression, exceeding the SDC, on CT and radiography occurred. The very limited overall erosive progression supports that joint destruction is minimal during adalimumab treatment of RA patients.......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......-grade radiographic erosions in the wrist or metacarpophalangeal (MCP) joints in the same (index) hand, initiated adalimumab 40 mg sc. eow. Thirty-five patients completed the study (median age 61 years (range 19-86), disease duration 8 years (0-36)). CT of index wrist and MCP2-5 and radiographs of hands and forefeet...

  20. 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.

  1. 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.

  2. 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...

  3. 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.

  4. Education for arthritis patients: a community pharmacy based pilot project

    OpenAIRE

    Petkova VB

    2009-01-01

    There are different kinds of arthritis, widely spread among the population, that make them a clinical problem with social, psychological and economic burden. Different education programs have been developed in order to improve patients’ disease management, medication compliance and from there patients’ quality of life. Objective: To develop and implement a community pharmacy-based educational program for patients with arthritis. Improvements in pain, medication compliance, decrease in general...

  5. Characterisation of uveitis in patients with psoriatic arthritis

    OpenAIRE

    Paiva, E.; Macaluso, D.; Edwards, A.; ROSENBAUM, J.

    2000-01-01

    OBJECTIVE—The purpose of this study is to describe the clinical characteristics of uveitis related to psoriatic arthritis (PsA), and also to compare the uveitis in PsA to the uveitis in spondyloarthropathy (SA).
METHODS—Sixteen patients with uveitis and PsA were evaluated in a tertiary care uveitis clinic. These patients were compared retrospectively to a series of 89 patients with uveitis and SA.
RESULTS—Eight (50%) of the 16 patients with uveitis had strictly peripheral arthritis, while two...

  6. 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.

  7. 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.

  8. Rheumatoid Arthritis Educational Video Series

    Medline Plus

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

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. Impact of Managed Care Health Insurance System for Indigent Patients with Rheumatoid Arthritis in Puerto Rico

    OpenAIRE

    Santiago-Casas, Yesenia; González-Rivera, Tania; Castro-Santana, Lesliane; Ríos, Grissel; Martínez, David; Rodríguez, Vanessa; González-Alcover, Rafael; Mayor, Ángel M.; Vilá, Luis M.

    2013-01-01

    The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared to non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease...

  12. 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

  13. 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.

  14. Progress of Mechanism Study on Rheumatoid Arthritis Treated by Moxibustion

    Institute of Scientific and Technical Information of China (English)

    张传英; 唐照亮; 黄国琪

    2009-01-01

    Objective:There is a better therapeutic effect in the treatment of rheumatoid arthritis by moxibustion,doing a literature review to explore the mechanism in the treatment of rheumatoid arthritis by moxibustion.Methods:The literature on the treatment of rheumatoid arthritis in the recent ten years were categorized and analyzed.Results and Conclusion:Mainly by its anti-inflammatory and immune effects,moxibustion therapy can be supposed to improve immune functions,inhibit the secretion of the synovial cells factors in the joints,control the proliferation of the synovial cells,and induce apoptosis of the synovial cells in the synovitis,and promote the apoptosis of the fibroblast,so as to play a therapeutic role in the treatment of rheumatoid arthritis.The therapeutic effect ia obtained by the comprehensive effect created from integration between the physical factors and herbal factors in burning moxa wool and the special functions of the acupoints and meridians.%目的:艾灸治疗类风湿性关节炎有较好的疗效.进行文献综述以探讨艾灸治疗类风湿性关节炎的机理.方法:采用文献综述法,整理分析近10多年的艾灸治疗类风湿性关节炎的文献.结果与结论:艾灸主要通过抗炎免疫作用达到改善机体免疫功能,抑制关节滑膜细胞因子分泌,控制滑膜细胞过度增生,诱导滑膜炎症细胞凋亡及促进戍纤维细胞凋亡等多种途径,对类风湿性关节炎起到治疗作用,疗效的获得是艾燃烧时的物理因子、药物因子与腧穴、经络的特殊作用相结合产生的一种综合效应.

  15. [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.

  16. New risk factors for cardiovascular diseases in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Obradović-Tomašević Biljana

    2008-01-01

    Full Text Available Introduction In the last three decades numerous epidemiologic studies have shown the correlation between risk factors and cardiovascular diseases. Clinical research has proven that rheumatoid arthritis patients (RA have higher prevalence of classical risk factors in relation to general population, and over the last few years there has been an emphasis on some new risk factors which can contribute to cardiovascular diseases (CVD. Material and methods This study examined risk factor values for CVD in 88 patients with RA treated at Rheumatology Department, Clinical Hospital Center, Zemun. All patients have been thoroughly examined (clinical findings, laboratory and echocardiographic examination. Apart from classical factors, 'new' risk factors have been examined in all patients: C-reactive proteine (CRP, high-sensitive C-reactive proteine (hs-CRP and homocystein. Results It has been determined that RA patients have more frequent higher new risk factors in comparison to classical ones. 84.1% of patients had higher CRP values, 97.1% had hsCRP and 39.5% had homocystein. The mean CRP values, especially hsCRP have been higher in patients with positive rheumatoid factor finding. Discussion Rheumatoid arthritis patients may have worse 'background atherosclerosis' than even subjects matched for classical cardiovascular risk factors. Continuous exposure to high grade systemic inflammation may be linked to accelerated atherosclerosis. Conclusions Timely identification of patients with risk factors, particularly with new risk factors, enables adequate approach in prevention of and treatment for CVD in rheumatoid arthritis patients.

  17. 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.

  18. 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.

  19. 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.)

  20. Which patients improve the most from arthritis rehabilitation?

    DEFF Research Database (Denmark)

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

    2014-01-01

    functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during......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...... = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46...

  1. Heart Rate Variability in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Kawser Jahan, Noorzahan Begum, Sultana Ferdousi

    2012-12-01

    Full Text Available Background: Altered cardiovascular autonomic nerve function with impaired sympathovagal balance is found in rheumatoid arthritis (RA. Heart Rate Variability (HRV analysis is an important tool for assessment of autonomic nerve activity.Objective: To assess cardiac autonomic nerve function status in patients with Rheumatoid arthritis (RA by time domain measures of HRV.Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU, Dhaka from January to December 2010. Sixty female RA patients, age range 18-50 years were constituted study group enrolled from the Out- patient Rheumatology Wing, Department of Medicine, BSMMU. Age matched thirty apparently healthy females were studied as control. Time domain measures of Heart Rate Variability (HRV such as Mean RR intervals, Mean HR, SDNN, RMSSD, NN50% and PNN 50% were recorded for 5 minutes by a Polygraph machine to observe cardiac autonomic nerve function activity. Data were analyzed by independent sample t test.Results: Mean R-R interval, SDNN, RMSSD, PNN50%, NN50% were significantly lower (p<0.001 but heart rate was significantly (P<0.001 higher in rheumatoid arthritis patients.Conclusion: Cardiac autonomic nerve function is impaired and characterized by reduced resting parasympathetic activity in female Rheumatoid Arthritis patients.

  2. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... is Happening to the Joints? Rheumatoid Arthritis: Gaining Control – Working with your Rheumatologist Rheumatoid Arthritis: Additional Conditions ... Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients ...

  3. 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 ...

  4. Rheumatoid Arthritis Educational Video Series

    Medline Plus

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

  5. 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 ...

  6. 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.

  7. Arthritis

    Science.gov (United States)

    ... training for muscle tone. Your provider may suggest physical therapy. This might include: Heat or ice Splints or ... American College of Rheumatology guidelines for management of gout. Part 2: therapy and anti-inflammatory prophylaxis of acute gouty arthritis. ...

  8. 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...

  9. Clinical and Epidemiological Characterization of Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. 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.

  12. 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. PMID:27668523

  13. 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.

  14. 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. PMID:26603475

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

    Directory of Open Access Journals (Sweden)

    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

  16. Labour force participation among patients with rheumatoid arthritis

    OpenAIRE

    Chorus, A; Miedema, H.; Wevers, C; Linden, S.

    2000-01-01

    OBJECTIVES—To assess work history and labour force participation among patients with rheumatoid arthritis (RA) in the Netherlands.
METHODS—A random sample of 1056 patients with RA aged 16-59 years from 17 rheumatology practices in the Netherlands was examined. Data on disease status and outcome were obtained by a questionnaire including standardised instruments, such as the Rapid Assessment of Disease Activity in Rheumatology (RADAR) and RAND-36 questionnaires. Labour force participation was ...

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

    OpenAIRE

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

    1980-01-01

    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 i...

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

    Directory of Open Access Journals (Sweden)

    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

  19. Education for arthritis patients: a community pharmacy based pilot project.

    Directory of Open Access Journals (Sweden)

    Petkova VB

    2009-06-01

    Full Text Available There are different kinds of arthritis, widely spread among the population, that make them a clinical problem with social, psychological and economic burden. Different education programs have been developed in order to improve patients’ disease management, medication compliance and from there patients’ quality of life.Objective: To develop and implement a community pharmacy-based educational program for patients with arthritis. Improvements in pain, medication compliance, decrease in general practitioner’s visits and hospitalizations are expected.Methods: Prospective, randomized, controlled trial. The sample consisted of 43 individuals, with different stages of arthritis (aged 15 - 71, attending pharmacies – intervention group; and 43 individuals – control group. A 4-month education was conducted on the following topics: what causes arthritis and what are the factors that can intensify it; pain management and physical activities; self-management and prevention; pharmacotherapy and possible adverse drug reactions. Patient's health-related quality of life was assessed in the beginning and at the end of the survey. Results: Parameters assessed during the four stages of the program were: frequency of severe pain, frequency of general practitioner’s visits, frequency of urgent medical aid calls, compliance with therapy, satisfaction with pharmacy services. Improvement in patients’ health-related quality of life was observed and also: decrease in the severity of patients’ pain, decrease in the physician’s visits, and increase in satisfaction overall care.Conclusions: Positive results from the educational approach in pharmacy conditions were demonstrated. These consequences have a potential to increase arthritis patient’s quality of life.

  20. 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.

  1. 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.

  2. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

    Science.gov (United States)

    Smolen, Josef S; Breedveld, Ferdinand C; Burmester, Gerd R; Bykerk, Vivian; Dougados, Maxime; Emery, Paul; Kvien, Tore K; Navarro-Compán, M Victoria; Oliver, Susan; Schoels, Monika; Scholte-Voshaar, Marieke; Stamm, Tanja; Stoffer, Michaela; Takeuchi, Tsutomu; Aletaha, Daniel; Andreu, Jose Louis; Aringer, Martin; Bergman, Martin; Betteridge, Neil; Bijlsma, Hans; Burkhardt, Harald; Combe, Bernard; Durez, Patrick; Fonseca, Joao Eurico; Gibofsky, Alan; Gomez-Reino, Juan J; Graninger, Winfried; Hannonen, Pekka; Haraoui, Boulos; Kouloumas, Marios; Landewe, Robert; Martin-Mola, Emilio; Nash, Peter; Ostergaard, Mikkel; Östör, Andrew; Richards, Pam; Sokka-Isler, Tuulikki; Thorne, Carter; Tzioufas, Athanasios G; van Vollenhoven, Ronald; de Wit, Martinus

    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 this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the

  3. Plasma TNF binding capacity in patients with juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Bjørnhart, Birgitte; Svenningsen, Pernille; Gudbrandsdottir, Sif;

    2005-01-01

    Tumour necrosis factor (TNF)-alpha and TNF-beta, also called lymphotoxin (LT), are bound by soluble truncated TNF receptors (sTNFRI and II) that are released from cell surfaces and act as natural inhibitors of TNF-induced inflammation. We investigated the plasma levels of sTNFRI and II in paralle...... with LT binding capacity (LTBC) in 44 patients with juvenile chronic arthritis (JIA)....

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

    OpenAIRE

    Airò, P; R. Gorla; M. Vianelli; M. Frassi; Danieli, E; F. Franceschini; I. Cavazzana; Cattaneo, R

    2011-01-01

    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 w...

  5. Higher prevalence of peripheral arthritis among ankylosing spondylitis patients.

    OpenAIRE

    Lee, Ji-Hyun; Jun, Jae-Bum; Jung, Sungsoo; Bae, Sang-Cheol; Yoo, Dae-Hyun; Kim, Think-You; Kim, Seong Yoon; Kim, Tae-Hwan

    2002-01-01

    This study was performed to define the clinical spectrum and disease manifestations of ankylosing spondylitis (AS) in a referral hospital setting. We identified the differences in clinical manifestations according to the sex, the age at onset, the presence of peripheral arthritis and the presence of HLA B27. A total 412 patients (357 males, 55 females) were recruited. Eighty-seven percent were men and 155 out of 412 patients (35%) were juvenile-onset. HLA B27 was detected in 385 patients (93%...

  6. THE PROBLEM OF OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

    OpenAIRE

    Irina Mikhailovna Marusenko; O. Yu. Barysheva; N N Vezikova

    2009-01-01

    Objective. To estimate the frequency and degree of osteopenia and osteoporosis (OP) in patients with rheumatoid arthritis (RA) versus those in patients with osteoarthrosis (OA). Subjects and methods. The study included 150 patients aged above 18 years with the valid diagnosis of RA or OA, in whom the risk factors of OP were assessed. Bone mineral density (BMD) (the relative units were T test) of the lumbar spine in the frontal projection (LII-LIV) and the proximal femur (head, neck, WardXs...

  7. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis

    OpenAIRE

    Peters, M.J.L.; Symmons, D P M; McCarey, D; Dijkmans, B.A.C.; de Nicola, P.; Kvien, T K; McInnes, I B; Haentzschel, H.; Gonzalez-Gay, Miguel A; Provan, S.; Semb, A.; Sidiropoulos, P.; Kitas, G; Smulders, Y.M.; Soubrier, M.

    2010-01-01

    Additional tables are published online only at http:// ard.bmj.com/content/vol69/ issue2 Objectives: To develop evidence-based EULAR recommendations for cardiovascular (CV) risk management in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Methods: A multidisciplinary expert committee was convened as a task force of the EULAR Standing Committee for Clinical Affairs (ESCCA), comprising 18 members including rhe...

  8. Anti-inflammatory Effect of Isaria sinclairii Glycosaminoglycan in an Adjuvant-treated Arthritis Rat Model

    OpenAIRE

    Ahn, Mi Young; Jee, Sang Duck; Hwang, Jae Sam; Yun, Eun Young; Ahn, Kwang Seok; Kim, Yeong Shik

    2013-01-01

    The anti-inflammatory effects of glycosaminoglycan (GAG) derived from Isaria sinclairii (IS) and of IS extracts were investigated in a complete Freund’s adjuvant (CFA)-treated chronic arthritis rat model. Groups of rats were treated orally with 30 mg/kg one of the following: [1] saline control, extracts of [2] water-IS, [3] methanol-IS, [4] butanol-IS, [5] ethyl acetate-IS, or [6] Indomethacin® as the positive control for a period of two weeks. The anti-paw edema effects of the individual ext...

  9. Altered composition of gut microbiota in rheumatoid arthritis patients.

    Science.gov (United States)

    Maeda, Yuichi; Kumanogoh, Atsushi; Takeda, Kiyoshi

    2016-01-01

      Manifestation of rheumatoid arthritis (RA) can be attributed to both genetic and environmental factors. Some researchers have been focusing on intestinal microbiota which is thought to be one of the environmental factors that may enhance the development of RA. The advancement of culture-independent, high throughput microbial DNA sequencing had enabled us to understand the interplay between intestinal microbiota and host immune systems. In this study, we have reviewed the previous findings in animal and human studies with respect to the role of intestinal microbiota in RA. Mouse models of arthritis have demonstrated that gut microbiota plays a critical role in the disease development. K/BxN and IL-1 receptor-antagonist knock-out mice did not develop disease in germ free condition, however, colonization of particular intestinal bacteria was sufficient to induce arthritis. Moreover, the dysbiosis was observed in the human RA patients from United States, China and Finland. Thus, we believe that endeavors to improve the dysbiosis would serve as a novel therapeutic or preventive strategy in RA patients. PMID:27181236

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity in patients with psoriatic arthritis

    OpenAIRE

    Osterhaus, Jane T; Purcaru, Oana

    2014-01-01

    Introduction The novel arthritis-specific Work Productivity Survey (WPS) was developed to estimate patient productivity limitations associated with arthritis within and outside the home, which is an unmet need in psoriatic arthritis (PsA). The WPS has been validated in rheumatoid arthritis. This report assesses the discriminant validity, responsiveness and reliability of the WPS in adult-onset PsA. Methods Psychometric properties were assessed using data from the RAPID-PsA trial (NCT01087788)...

  13. 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.

  14. 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.

  15. Anti-Interleukin-6 Receptor Antibody Therapy-Induced Retinopathy in a Patient with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Asumi Tada

    2012-01-01

    Full Text Available Tocilizumab, a humanized anti-human interleukin-6 (IL-6 receptor monoclonal antibody, is beneficial for treating autoimmune conditions such as rheumatoid arthritis (RA. The most common adverse event is upper respiratory tract infection; ocular side effects are rare. We describe a case of skin ulceration and bilateral retinopathy with multifocal cotton-wool spots and retinal hemorrhages in a patient with RA treated with tocilizumab. Tocilizumab administration increased the serum level of IL-6 without affecting the IL-8 levels. We could not exclude the possibility of blood coagulation or retinal vascular changes caused by tocilizumab. The current case highlights the need to consider that ocular adverse effects can develop in patients treated with tocilizumab.

  16. 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.

  17. HLA-B27 frequency in a group of patients with psoriatic arthritis *

    OpenAIRE

    Danilo Garcia Ruiz; Mário Newton Leitão de Azevedo; Omar Lupi

    2012-01-01

    BACKGROUND: HLA-B27 is associated with spondyloarthritis, a group of diseases that includes psoriatic arthritis. OBJECTIVES: To describe the HLA-B27 frequency in a group of Brazilian patients with psoriatic arthritis and correlate its presence or absence with their clinical manifestations. METHODS: Cross-sectional study with 44 psoriatic arthritis patients of a Rheumatology clinic. Demographic and social data were recorded, as were skin and joints clinical examination. HLA-B27 was tested. All...

  18. 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.

  19. Comparison of discrimination and prognostic value of two US Doppler scoring systems in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Terslev, Lene; Christensen, Robin;

    2014-01-01

    OBJECTIVES: The aim of this paper is to investigate sensitivity to change (SRM), predictive validity and discriminative ability of a quantitative (QS) and a semi-quantitative (SQS) Doppler ultrasound scoring systems in patients with rheumatoid arthritis (RA) treated with anti-TNF-α therapy. METHODS......: RA patients with wrist joint affection treated with TNF-α inhibitor were followed for one year. The wrist was examined with Doppler before initiating therapy and after one year. DAS28 was determined at both visits. One person trained in the SQS system and one in the QS system evaluated the anonymised...... images. The SRM, predictive validity and discriminative ability for both systems were calculated using DAS28 as the measure of disease improvement. RESULTS: Fourty-six patients with RA (80% females) were included. The mean Doppler activity at baseline was QS:24.4% (SD=17.7%) and SQS:2.0 (SD=0...

  20. 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.

  1. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries

    DEFF Research Database (Denmark)

    Sokka, Tuulikki; Kautiainen, Hannu; Toloza, Sergio;

    2007-01-01

    OBJECTIVE: To conduct a cross-sectional review of non-selected consecutive outpatients with rheumatoid arthritis (RA) as part of standard clinical care in 15 countries for an overview of the characteristics of patients with RA. METHODS: The review included current disease activity using data from......) within and between countries was graphically analysed. A median regression model was applied to analyse differences in disease activity between countries. RESULTS: Between January 2005 and October 2006, the QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid...... Arthritis) project included 4363 patients from 48 sites in 15 countries; 78% were female, >90% Caucasian, mean age was 57 years and mean disease duration was 11.5 years. More than 80% of patients had been treated with methotrexate in all but three countries. Overall, patients had an active disease...

  2. Preventive Treatments for Rheumatoid Arthritis: Issues Regarding Patient Preferences.

    Science.gov (United States)

    Finckh, Axel; Escher, Monica; Liang, Matthew H; Bansback, Nick

    2016-08-01

    The detection of biomarkers in the preclinical phase of rheumatoid arthritis (RA) and recent therapeutic advances suggest that it may be possible to identify and treat persons at high risk and to prevent the development of RA. Several trials are ongoing to test the efficacy of a therapeutic intervention in primary prevention. This paper reviews potential populations that might be considered for preventative medication. Further, we review the medications that are being explored to treat individuals considered at high risk of developing RA. Finally, in a group of asymptomatic individuals at high risk of developing RA, we assessed which factors mattered most when considering a preventive therapeutic intervention and what type of preventive treatment would be most acceptable to them. Understanding subjects' perceptions of risks and benefits and willingness to undergo preventive therapy will be important in designing and implementing screening and preventive strategies. PMID:27402108

  3. 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

  4. 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.

  5. 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.

  6. Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    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.

  7. 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

  8. Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Bøyesen, Pernille; Haavardsholm, Espen A; van der Heijde, Désirée;

    2011-01-01

    To examine the associations between modern imaging modalities and joint damage measured as 1-year MRI erosive progression, in early rheumatoid arthritis (RA) patients.......To examine the associations between modern imaging modalities and joint damage measured as 1-year MRI erosive progression, in early rheumatoid arthritis (RA) patients....

  9. 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.

  10. 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.

  11. 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.

  12. Identification of Patients With Early Rheumatoid Arthritis: Challenges and Future Directions

    Science.gov (United States)

    Orozco, Catalina; Olsen, Nancy J.

    2006-01-01

    Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis that affects the adult population. Early diagnosis and treatment are the cornerstones to prevent joint damage and avoid long-term costs and disability. This article reviews the limitations of the currently available tools for the evaluation of patients with early arthritis, including clinical assessment, serologic markers and imaging modalities. It also discusses gene expression analysis, a newer and potentially promising approach to the early diagnosis of RA. PMID:17162371

  13. Identification of patients with early rheumatoid arthritis: challenges and future directions.

    Science.gov (United States)

    Orozco, Catalina; Olsen, Nancy J

    2006-01-01

    Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis that affects the adult population. Early diagnosis and treatment are the cornerstones to prevent joint damage and avoid long-term costs and disability. This article reviews the limitations of the currently available tools for the evaluation of patients with early arthritis, including clinical assessment, serologic markers and imaging modalities. It also discusses gene expression analysis, a newer and potentially promising approach to the early diagnosis of RA. PMID:17162371

  14. 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).

  15. Predictors of infusion reactions during infliximab treatment in patients with arthritis.

    Science.gov (United States)

    Kapetanovic, Meliha C; Larsson, Lotta; Truedsson, Lennart; Sturfelt, Gunnar; Saxne, Tore; Geborek, Pierre

    2006-01-01

    In the present study we evaluated the impact of baseline antinuclear antibody (ANA) status and use of methotrexate on development of infliximab-related infusion reactions in patients with rheumatoid arthritis (RA) or spondylarthropathies (SpAs), including psoriatic arthritis. All patients with RA (n = 213) or SpA (n = 76) treated with infliximab during the period 1999-2005 at the Department of Rheumatology in Lund, Sweden were included. ANAs were present in 28% and 25% of RA and SpA patients, respectively. Because of differences in baseline characteristics, we used a binary logistic regression model to calculate odds ratios (ORs), adjusting for age, sex and prednisolone dosage. Altogether 21% of patients with RA and 13% of patients with SpA developed infusion reactions (P = 0.126). The OR for development of infusion reactions in RA patients with baseline ANA positivity alone was 2.1. Infliximab without methotrexate and infliximab as monotherapy were associated with ORs of 3.1 and 3.6, respectively. Combining infliximab without methotrexate and ANA positivity yielded an OR for infusion reaction of 4.6. Lower age at disease onset and longer disease duration were associated with infusion reactions (P = 0.012 and P = 0.036, respectively), but age, sex, C-reactive protein, erythrocyte sedimentation rate, Health Assessment Questionnaire and Disease Activity Score-28 at baseline were not. No predictors of infusions reactions were identified in SpA patients. RA patients treated with infliximab without methotrexate, and who are positive at baseline for ANAs are at increased risk for developing infliximab-related infusion reactions.

  16. 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

  17. 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

  18. 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.

  19. Association Between Ischemic Stroke and Tumor Necrosis Factor Inhibitor Therapy in Patients With Rheumatoid Arthritis

    Science.gov (United States)

    Low, Audrey S. L.; Lunt, Mark; Mercer, Louise K.; Watson, Kath D.; Dixon, William G.; Symmons, Deborah P. M.

    2016-01-01

    Objective Patients with rheumatoid arthritis (RA) are at an increased risk of ischemic stroke. Tumor necrosis factor inhibitors (TNFi) may influence risk and mortality after ischemic stroke by reducing inflammation. This study was undertaken to examine the association of TNFi with the risk of incident ischemic stroke and with 30‐day and 1‐year mortality after ischemic stroke. Methods Patients with RA starting therapy with TNFi and a biologics‐naive comparator group treated with synthetic disease‐modifying antirheumatic drugs (DMARDs) only were recruited to the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis from 2001 to 2009. Patients were followed up via clinical and patient questionnaires as well as the national death register. Incident strokes were classified as ischemic if brain imaging reports suggested ischemia or if ischemic stroke was reported as the underlying cause of death on a death certificate. Patients with a previous stroke were excluded. Risk of ischemic stroke was compared between patients receiving synthetic DMARDs only and those ever‐exposed to TNFi using a Cox proportional hazards regression model adjusted for potential confounders. Mortality after ischemic stroke was compared between synthetic DMARD–treated patients and TNFi‐treated patients using logistic regression, adjusted for age and sex. Results To April 2010, 127 verified incident ischemic strokes (21 in 3,271 synthetic DMARD–treated patients and 106 in 11,642 TNFi‐treated patients) occurred during 11,973 and 61,226 person‐years of observation, respectively (incidence rate 175 versus 173 per 100,000 person‐years). After adjustment for confounders, there was no association between ever‐exposure to TNFi and ischemic stroke (hazard ratio 0.99 [95% confidence interval (95% CI) 0.54–1.81]). Mortality 30 days or 1 year after ischemic stroke was not associated with concurrent TNFi exposure (odds ratio 0.18 [95% CI 0.03–1.21] and 0.60 [95

  20. 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.

  1. 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.

  2. TELOMERE SHORTENING IN MONOCYTES OF THE PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    V. I. Borisov

    2006-01-01

    Full Text Available Abstract. Present study deals with size measurements of telomeric DNA from the human peripheral mononuclear immune cells in rheumatoid arthritis (RA. A method for measuring the relative telomere length by in situ hybridization followed by flow cytometric analysis (flow-FISH was used. Relative telomere length (RTL in monocytes was estimated as mean fluorescence intensity (MFI of test cells divided by MFI values of internal control cells. Hybridization conditions for analysis of telomere length in monocytes have been optimized in advance. It has been shown that RTL of monocytes was significantly lower in RA patients compared to donors. Significant differences in telomere length of monocytes between RA patients and donors were revealed for the young persons under 30 years old. The findings obtained may be considered as an additional argument confirming the hypothesis on genetic defects of hematopoietic stem cells determining RA development.

  3. 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....

  4. Successful reintroduction of methotrexate after pneumonitis in two patients with rheumatoid arthritis.

    OpenAIRE

    Cook, N J; Carroll, G J

    1992-01-01

    Two patients are described with severe and progressive rheumatoid arthritis in whom methotrexate was reintroduced despite previous methotrexate related pneumonitis. In both patients a marked improvement in disease control occurred without a recurrence of the pneumonitis.

  5. Tumor Necrosis Factor-Blocker Dose Escalation in Rheumatoid Arthritis Patients in a Pharmacy Benefit Management Setting

    OpenAIRE

    Blume, Steven W; Fox, Kathleen M.; Joseph, George; Chuang, Chien-Chia; Thomas, Jessy; Gandra, Shravanthi R

    2013-01-01

    Introduction Dose escalation with tumor necrosis factor (TNF)-blockers is poorly characterized in pharmacy benefit management (PBM) settings. Methods This retrospective study used integrated pharmacy and medical claims from the PBM Medco to characterize dose escalation among rheumatoid arthritis (RA) patients treated with etanercept and adalimumab. Data from adults with RA with pharmacy claims for etanercept or adalimumab between 1/1/2007 and 12/31/2009 and continuous enrollment for ≥6 months...

  6. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... member of our patient care team. Managing Your Arthritis Managing Your Arthritis Managing Chronic Pain and Depression ...

  7. 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.

  8. 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.

  9. 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

  10. An increased risk of non-melanoma skin cancer during TNF-inhibitor treatment in psoriasis patients compared to rheumatoid arthritis patients probably relates to disease-related factors

    NARCIS (Netherlands)

    Lümig, P.P.M. van; Menting, S.P.; Reek, J.M.P.A. van den; Spuls, P.I.; Riel, P.L.C.M. van; Kerkhof, P.C.M. van de; Fransen, J.; Kievit, W.; Jong, E.M.G.J. de

    2015-01-01

    BACKGROUND: Concerns exist about a risk of non-melanoma skin cancer (NMSC) in psoriasis patients and rheumatoid arthritis (RA) patients treated with TNF-inhibitors. However, current data also show that in some psoriasis patients, NMSC is diagnosed relatively short after the start of TNF-inhibitors,

  11. 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.

  12. Is it Crohn's disease? A severe systemic granulomatous reaction to sulfasalazine in patient with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Haftel Hilary M

    2001-08-01

    Full Text Available Abstract Background Sulfasalazine is a widely used anti-inflammatory agent in the treatment of inflammatory bowel disease and several rheumatological disorders. Although as many as 20% of treated patients may experience reversible, dose-dependent side effects, less frequent but potentially severe, systemic reactions have also been reported. Case Presentation A severe systemic reaction to sulfasalazine developed in a 21-year old female with rheumatoid arthritis characterized by eosinophilia, granulomatous enteritis and myelotoxicity, cholestatic hepatitis, and seizures. The clinical course and management of this patient are presented as well as a review of the incidence and outcome of severe systemic reactions to sulfasalazine. Conclusions Granulomatous myelotoxicity and enteritis developed in a 21 year old female within 3 weeks of initiating sulfasalazine for rheumatoid arthritis. Following a short course of corticosteroids, the patient had resolution of her cholestatic hepatitis, rash, eosinophilia, and gastrointestinal symptoms with no residual manifestations at 7 months follow-up. Although severe reactions to sulfasalazine are rare and unpredictable, practicing physicians should be aware of unusual clinical presentations of toxicity when prescribing sulfasalazine.

  13. 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. 

  14. Stress response system and personality in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    M. Marcenaro

    2011-09-01

    Full Text Available Various factors such as immunogenetic determinants, sex, age and stress paly an important role in the pathogenesis of rheumatoid arthritis (RA. The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Twenty-three patients underwent a clinical inteview and other specific psychometric tests. Macro and microstressful life-events preceded RA in 83% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. An obsessive-compulsive personality was found in 26% of the patients. Anxia was detected in 40% of the patients. Among the group of patients with borderline disorder’s was also detected alexithymia. The high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an importunat pathogenetic factor in the disease.

  15. 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.

  16. 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....... METHODS: A multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda...... and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement). RESULTS: Based on the SLR and expert opinions...

  17. Detection of gene expression signatures related to underlying disease and treatment in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Serikawa, Kyle A; Jacobsen, Søren; Lundsgaard, Dorthe;

    2013-01-01

    OBJECTIVES: Gene expression signatures can provide an unbiased view into the molecular changes underlying biologically and medically interesting phenotypes. We therefore initiated this study to identify signatures that would be of utility in studying rheumatoid arthritis (RA). METHODS: We used...... microarray profiling of peripheral blood mononuclear cells (PBMCs) in 30 RA patients to assess the effect of different biologic agent (biologics) treatments and to quantify the degree of a type-I interferon (IFN) signature in these patients. A numeric score was derived for the quantification step and applied...... to be heterogeneous for an IFN component. A comparison of individuals currently untreated with a biologic with those treated with infliximab, tocilizumab, or abatacept suggested that each biologic induces a specific gene signature in PBMCs. CONCLUSIONS: It is possible to observe signs of type-I IFN pathway activation...

  18. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult Patients with Arthritis Complementary and Alternative Medicine for ... Patient Update Transitioning the JRA Patient to an Adult Rheumatologist Drug Information for Patients Arthritis Drug Information ...

  19. 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%.

  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, 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

  1. 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

  2. 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.

  3. 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

  4. 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...

  5. 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

  6. 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.

  7. 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

    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...... 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...

  8. 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.

  9. 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

  10. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... for Arthritis Yoga Poses for Arthritis Patients from Johns Hopkins Stategies to Increase your Level of Physical ... Arthritis Management How to Give a Subcutaneous Injection Johns Hopkins Rheumatology Arthritis Center Lupus Center Lyme Disease ...

  11. 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.

  12. 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

  13. 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.

  14. "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

  15. 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.

  16. Tapering and discontinuation of methotrexate in patients with RA treated with TNF inhibitors: data from the DREAM registry

    NARCIS (Netherlands)

    Manders, S.H.M.; Laar, M.A. van der; Dartel, S.A.A. van; Bos, R. van den; Visser, H.; Brus, H.L.; Jansen, T.; Vonkeman, H.E.; Riel, P.L.C.M. van; Kievit, W.

    2015-01-01

    OBJECTIVES: To study the number of patients that taper or discontinue concomitant methotrexate (MTX) in daily practice in patients with rheumatoid arthritis (RA) treated with tumour necrosis factor inhibitor (TNFi) and to analyse the effects of that adaption on disease activity and drug survival. ME

  17. 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.

  18. 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.

  19. 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.

  20. Disentangling Rheumatoid Arthritis Patients' Implicit and Explicit Attitudes toward Methotrexate.

    Science.gov (United States)

    Linn, Annemiek J; Vandeberg, Lisa; Wennekers, Annemarie M; Vervloet, Marcia; van Dijk, Liset; van den Bemt, Bart J F

    2016-01-01

    Medication non-adherence is a major public health problem that has been termed an 'invisible epidemic.' Non-adherence is not only associated with negative clinical consequences but can also result in substantial healthcare costs. Up to now, effective adherence interventions are scarce and a more comprehensive model of adherence determinants is required to target the determinants for not taking the medication as prescribed. Current approaches only included explicit attitudes such as self-reported evaluations of medication as determinants, neglecting the role of associative processes that shape implicit attitudes. Implicit processes can predict daily behavior more accurately than explicit attitudes. Our aim is to assess explicit and implicit attitudes toward medication and explore the relation with beliefs, adherence and clinical (laboratory) outcomes in chronically ill patients. Fifty two Rheumatic Arthritis (RA) patients' attitudes toward Methotrexate (MTX) were explicitly (self-reported) and implicitly (Single-Category Implicit Association Test) assessed and related to the Beliefs about Medicine Questionnaire, the Compliance Questionnaire on Rheumatology and laboratory parameters [Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP)]. Results show that explicit attitudes were positive and health-related. Implicit attitudes were, however, negative and sickness-related. Half of the patients displayed explicitly positive but implicitly negative attitudes. Explicit attitudes were positively related to ESR. A positive relationship between implicit attitudes and disease duration was observed. In this study, we have obtained evidence suggesting that the measurement of implicit attitudes and associations provides different information than explicit, self-reported attitudes toward medication. Since patients' implicit attitudes deviated from explicit attitudes, we can conclude that the relationship between implicit attitudes and medication adherence is worthwhile

  1. 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.

  2. Gap between short- and long-term effects of patient education in rheumatoid arthritis patients: a systematic review.

    NARCIS (Netherlands)

    Niedermann, K.; Fransen, J.; Knols, R.H.; Uebelhart, D.

    2004-01-01

    OBJECTIVE: To systematically review educational or psychoeducational interventions for patients with rheumatoid arthritis focusing on long-term effects, especially health status. METHODS: Two independent reviewers appraised the methodologic quality of the included randomized controlled trials, publi

  3. 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. .

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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

  6. Expression of Adhesion Molecules in Synovia of Patients with Treatment-Resistant Lyme Arthritis

    OpenAIRE

    Akin, Evren; Aversa, John; Steere, Allen C.

    2001-01-01

    The expression of adhesion molecules in synovium in patients with Lyme arthritis is surely critical in the control of Borrelia burgdorferi infection but may also have pathologic consequences. For example, molecular mimicry between a dominant T-cell epitope of B. burgdorferi outer surface protein A and an adhesion molecule, human lymphocyte function-associated antigen 1 (LFA-1), has been implicated in the pathogenesis of treatment-resistant Lyme arthritis. Using immunohistochemical methods, we...

  7. Mycobacterium Avium Arthritis with Extra-articular Abscess in a Patient with Mixed Connective Tissue Disease

    OpenAIRE

    Lee, Choong Won; Sung, Han Dong; Choi, Byong Moon; Kim, Chun Wook; Jun, Su Jin; Min, Sang Jo

    2003-01-01

    A case of Mycobacterium avium arthritis in a 39-year-old female patient with mixed connective tissue disease (MCTD) was reported. An extra-articular abscess had formed outside the knee joint and extended down the calf. A culture was taken of the abscess and synovial fluid disclosed Mycobacteriun avium. This was resistant to most anti-tuberculosis agents. A combination of anti-tuberculosis drugs followed a total resection of the abscess. We concluded that M avium septic arthritis could insidio...

  8. Features of diagnosis and treatment of anemic syndrome in patients with rheumatoid arthritis

    OpenAIRE

    N V Koryakova; N N Vesikova; I M Marusenko

    2009-01-01

    Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA) pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\\l for men and less than 120g\\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV),...

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

    Directory of Open Access Journals (Sweden)

    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

  11. 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...... two infusions of placebo (n=63), rituximab 500 mg (n=62), or rituximab 1000 mg (n=60) intravenously on days 1 and 15. MRI scans and radiographs of the most inflamed hand and wrist were acquired at baseline, weeks 12 (MRI only), 24 and 52. The primary end point was the change in MRI erosion score from...... baseline at week 24. RESULTS: Patients treated with rituximab demonstrated significantly less progression in the mean MRI erosion score compared with those treated with placebo at weeks 24 (0.47, 0.18 and 1.60, respectively, p=0.003 and p=0.001 for the two rituximab doses vs placebo) and 52 (-0.30, 0...

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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

  19. The Effect of Omega-3 Fatty Acids in Patients With Active Rheumatoid Arthritis Receiving DMARDs Therapy: Double-Blind Randomized Controlled Trial

    Science.gov (United States)

    Rajaei, Elham; Mowla, Karim; Ghorbani, Ali; Bahadoram, Sara; Bahadoram, Mohammad; Dargahi-Malamir, Mehrdad

    2016-01-01

    Background: Rheumatoid arthritis is a symmetric peripheral polyarthritis of unknown etiology that, untreated or if unresponsive the therapy, typically leads to deformity and destruction of joints due to erosion of cartilage and bone. Omega-3 fatty acids have been shown to reduce morning stiffness, the number of tender joints and swollen joints in patients with rheumatoid arthritis. This study is designed for evaluation of omega-3 effects on disease activity and remission of rheumatoid arthritis in DMARDs treated patients and on weight changes and reduction of analgesic drugs consumption versus placebo. Methods: Sixty patients with active rheumatoid arthritis (49 female and 11 male) underwent rheumatologist examination and disease activity score were calculated. Then patients were enrolled in this 12 week, double blind, randomized, placebo- controlled study. The patients in both groups continued their pre study standard treatment. The patients were visited every 4 weeks, 4 times and data were recorded. Results: Significant improvement in the patient’s global evaluation and in the physician’s assessment of disease was observed in those taking omega-3. The proportions of patients who improved and of those who were able to reduce their concomitant analgesic medication were significantly greater with omega-3 consumption. There were no weight changes. Conclusion: Daily supplementation with omega-3 results has significant clinical benefit and may reduce the need for concomitant analgesic consumption without weight changes. PMID:26925896

  20. 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.

  1. Prescribing pattern and adverse drug reactions monitoring in patients with rheumatoid arthritis in a tertiary care hospital

    OpenAIRE

    Lakshmi Prabha M; Geetha Rani A; Meenakshi Balasubramanian; Ezhil Ramya J

    2016-01-01

    Background: Rheumatoid arthritis is a chronic inflammatory arthritis which requires lifelong treatment to prevent the damage to joints and to maintain day to day functioning of patients. All the drugs used in the treatment of rheumatoid arthritis show significant toxicity and hence it is very important that their use require regular monitoring for adverse reactions. The present study is designed to estimate the prescribing pattern and the occurrence of adverse drug reactions in patients with ...

  2. Measurement of the Common Carotid Arteries Intima-Media Thickness by Ultrasonography in Patients with Rheumatoid Arthritis.

    OpenAIRE

    Raouf Rahim Merza; Salah Muhammed Fateh; Hawar Ali Ehsan

    2014-01-01

    Purpose: Rheumatoid arthritis is a chronic inflammatory disabling disease affecting articular and extra articular organs and one of these important organs is cardiovascular system which its involvement is a leading cause of morbidity and mortality of Rheumatoid arthritis patients ; it is important to look for the relation of Rheumatoid arthritis and the extent of cardiovascular involvement among those patients by Ultrasound (US ) which is feasible, simple and low cost investigation and so...

  3. Medication Adherence in Patients with Rheumatoid Arthritis: The Effect of Patient Education, Health Literacy, and Musculoskeletal Ultrasound

    Directory of Open Access Journals (Sweden)

    Samantha Joplin

    2015-01-01

    Full Text Available Background. Rheumatoid arthritis (RA is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. Objective. The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. Methods. Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. Results. Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. Conclusion. Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.

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

    Directory of Open Access Journals (Sweden)

    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

  5. 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.

  6. Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health

    Science.gov (United States)

    Martire, Lynn M.; Keefe, Francis J.; Stephens, Mary Ann Parris; Schulz, Richard

    2015-01-01

    Background In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention. Purpose The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health. Methods Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N = 152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models. Results Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year. Conclusions Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health. PMID:24604529

  7. 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.

  8. 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.

  9. 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.

  10. Prevalence of psoriatic arthritis in psoriasis patients according to newer classification criteria.

    Science.gov (United States)

    Maldonado Ficco, Hernán; Citera, Gustavo; Maldonado Cocco, José Antonio

    2014-02-01

    The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to CASPAR criteria, ASAS peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs. 10 years, p = 0.02), and a higher frequency of nail involvement (88.2 vs. 49.4 %, p = 0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs. 1.2 %, p = 0.0006 and 80 vs. 16.7 %, p = 0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding

  11. 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 ...

  12. The predictors of foot ulceration in patients with rheumatoid arthritis.

    Science.gov (United States)

    Firth, Jill; Waxman, Robin; Law, Graham; Nelson, E Andrea; Helliwell, Philip; Siddle, Heidi; Otter, Simon; Butters, Violet; Baker, Lesley; Hryniw, Rosemary; Bradley, Sarah; Loughrey, Lorraine; Alcacer-Pitarch, Begonya; Davies, Samantha; Tranter, Jennifer

    2014-05-01

    This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration

  13. 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

  14. Potentiated antibodies to tumor necrosis factor-alpha in the therapy of patients with rheumatoid arthritis.

    Science.gov (United States)

    Kozlovskaya, L V; Mukhin, N A; Rameev, V V; Sarkisova, I A; Epstein, O I

    2003-01-01

    We studied the efficiency and safety of a new homeopathic preparation Artrofoon containing affinely purified antibodies to tumor necrosis factor-alpha in the therapy of patients with rheumatoid arthritis. Artrofoon produced a positive antiinflammatory effect on the course of rheumatoid arthritis. This preparation reduced the severity of arthralgia (indexes of Li and Ritchie) and morning stiffness and decreased the erythrocyte sedimentation rate and contents of rheumatoid factor and C-reactive protein. One-month therapy improved the state of patients. Artrofoon was well tolerable. The preparation did not cause the ulcerogenic and nephrotoxic effects. Artrofoon holds much promise for combination therapy of patients with rheumatoid arthritis (including severe articular-and-visceral forms) and complications after treatment with nonsteroid antiinflammatory preparations.

  15. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature

    NARCIS (Netherlands)

    Bemt, B.J.F. van den; Zwikker, H.E.; Ende, C.H.M. van den

    2012-01-01

    Adherence to medication in patients with rheumatoid arthritis is low, varying from 30 to 80%. Improving adherence to therapy could therefore dramatically improve the efficacy of drug therapy. Although indicators for suboptimal adherence can be useful to identify nonadherent patients, and could funct

  16. An Online Tailored Self-Management Program for Patients With Rheumatoid Arthritis: A Developmental Study

    NARCIS (Netherlands)

    Zuidema, R.M.; Gaal, B.G. van; 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

  17. 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)

  18. Experience with abatacept used in the treatment of patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    V I Mazurov

    2011-01-01

    Full Text Available The efficiency and safety of therapy with abatacept in combination with methotrexate were studied in patients with rheumatoid arthritis. The performed therapy was shown to reduce the activity of an immune inflammatory process and the magnitude of articular syndrome and to improve the patients' functional status.

  19. 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

  20. 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

  1. 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

  2. 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…

  3. Partner participation in cognitive-behavioral self-management group treatment for patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Lankveld, W.G.J.M. van; Helmond, T. van; Näring, G.W.B.; Rooij, D.J.R.A.M. de; Hoogen, F.H.J. van den

    2004-01-01

    OBJECTIVE: To determine if participation of the spouse of patients with rheumatoid arthritis in cognitive-behavioral oriented self-management training aimed at improving disease related cognitions and coping with pain has additional benefits for the patients. METHODS: A total of 59 couples were rand

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. Lyme arthritis in a 12-year-old patient after a latency period of 5 years.

    Science.gov (United States)

    Albert, S; Schulze, J; Riegel, H; Brade, V

    1999-01-01

    Lyme arthritis (LA) may be confused with other rheumatic diseases, particularly in the absence of a history of erythema migrans (EM). We report the case of a 12-year-old patient who developed a large effusion of the right knee joint. The titer for antinuclear antibodies was 1:80 and the test for rheumatoid factor was negative. Investigations for antibody response to Borrelia burgdorferi demonstrated remarkable elevation of IgG antibody and no specific IgM response. These results were confirmed by immunoblotting reactivity with the bands p83/100, p58, p43, p41, p39, OspA, p30, OspC, p21, and p17. We subsequently learned that the child had suffered a tick bite followed by an EM 5 years earlier and had been treated with trimethoprim/sulfamethoxazole at that time. The patient now was given intravenous ceftriaxone, 2 g daily for 14 days. In the absence of clinical improvement 3 weeks later a knee joint aspiration was performed which resulted in a positive polymerase chain reaction (PCR) test for B. burgdorferi DNA (OspA) in the synovial fluid. The patient fully recovered 2 months later without further treatment. The case indicates that the latency period between EM and onset of LA may last up to 5 years. In addition to serologic test methods, analysis of synovial fluid using PCR may be decisive for making the final diagnosis of LA.

  10. Predictive factors of radiological progression after 2 years of remission-steered treatment in early arthritis patients: a post hoc analysis of the IMPROVED study

    Science.gov (United States)

    Akdemir, Gülşah; Verheul, Marije K; Heimans, Lotte; Wevers-de Boer, Kirsten V C; Goekoop-Ruiterman, Yvonne P M; van Oosterhout, Maikel; Harbers, Joop B; Bijkerk, Casper; Steup-Beekman, Gerda M; Lard, Leroy R; Huizinga, Tom W J; Trouw, Leendert A; Allaart, Cornelia F

    2016-01-01

    Objectives To identify predictive factors of radiological progression in early arthritis patients treated by remission-steered treatment. Methods In the IMPROVED study, 610 patients with early rheumatoid arthritis (RA) or undifferentiated arthritis (UA) were treated with methotrexate (MTX) and a tapered high dose of prednisone. Patients in early remission (disease activity score (DAS) <1.6 after 4 months) tapered prednisone to zero. Patients not in early remission were randomised to arm 1: MTX plus hydroxychloroquine, sulfasalazine and prednisone, or to arm 2: MTX plus adalimumab. Predictors of radiological progression (≥0.5 Sharp/van der Heijde score; SHS) after 2 years were assessed using logistic regression analysis. Results Median (IQR) SHS progression in 488 patients was 0 (0–0) point, without differences between RA or UA patients or between treatment arms. In only 50/488 patients, the SHS progression was ≥0.5: 33 (66%) were in the early DAS remission group, 9 (18%) in arm 1, 5 (10%) in arm 2, 3 (6%) in the outside of protocol group. Age (OR (95% CI): 1.03 (1.00 to 1.06)) and the combined presence of anticarbamylated protein antibodies (anti-CarP) and anticitrullinated protein antibodies (ACPA) (2.54 (1.16 to 5.58)) were independent predictors for SHS progression. Symptom duration <12 weeks showed a trend. Conclusions After 2 years of remission steered treatment in early arthritis patients, there was limited SHS progression in only a small group of patients. Numerically, patients who had achieved early DAS remission had more SHS progression than other patients. Positivity for both anti-CarP and ACPA and age were independently associated with SHS progression. Trial registration numbers ISRCTN Register number 11916566 and EudraCT number 2006 06186-16. PMID:26925251

  11. Power Spectral Analysis of Heart Rate Variability in Female Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Kawser Jahan

    2012-06-01

    Full Text Available Background: Association of increased cardiovascular morbidity and higher sympathetic activity in patients with Rheumatoid arthritis (RA has been recognized. Heart rate variability (HRV is a useful measure to assess sympatho-vagal balance.Objective: To assess autonomic nerve function status in patients with Rheumatoid Arthritis (RA by HRV analysis.Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU, Shahbag, Dhaka from January to December 2010. Sixty female RA patients aged 18-50 years were included in the study group. They were enrolled from the Out Patient Department of Rheumatology Wing of the Department of Medicine, BSMMU, Dhaka. For comparison age matched thirty apparently healthy females were also studied as control. The HRV parameters were recorded by a Polyrite machine. For statistical analysis independent sample t test was used.Results: Mean resting pulse rate, diastolic blood pressure and mean systolic blood pressure were higher in rheumatoid arthritis patients in comparison to those of healthy control. Mean values of LF power, LF norm and LF/ HF were significantly higher (p<0.001 & TP and HF power, HF norm were significantly lower (p<0.001 in RA patients in comparison to those of healthy control.Conclusion: This study may conclude that sympathetic activity was higher with lower parasympathetic activity along with shifting of sympathovagal balance towards sympathetic predominance in patients with rheumatoid arthritis.

  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. 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.

  14. 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.

  15. 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

  16. 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

    . The compression of the experience-based SE preference set towards higher utilities may compromise its ability to detect between-group differences in quality-adjusted life-years, thus making cost-effectiveness harder to demonstrate in cost-utility analyses applying this preference set, rather than the standard UK.......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...

  17. 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. PMID:23223701

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. Left ventricular deformation by speckle tracking echocardiography at 2-year follow-up in treatment naive rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Logstrup, B. B.; Masic, D.; Laurberg, T. B.;

    2015-01-01

    Background: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) including heart failure. The role of autoimmunity and especially citrullination in the pathogenesis of the increased risk of CVD and the time-course of left ventricular (LV) dysfunction is...... unknown. Objectives: To assess the LV function according to the amount of inflammation during a 2-year follow-up period in a cohort of treatment naive RA patients without known CVD. Methods: Thirty-nine patients (21 women) with mean age 59+/-10.7 years and steroid- and disease-modifying antirheumatic drug...... (DMARD)-naive early RA were included and followed for 2 years. All patients were treated with methotrexate and followed the National treatment algoritm. Disease activity was assessed at baseline and at 2-year follow-up by the use of the Danish national DANBIO registry. IgM rheumafactor (IgM-RF) and anti...

  3. Adalimumab added to a treat-to-target strategy with methotrexate and intra-articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study

    DEFF Research Database (Denmark)

    Hørslev-Petersen, Kim; Hetland, Merete Lund; Junker, Peter;

    2014-01-01

    OBJECTIVES: An investigator-initiated, double-blinded, placebo-controlled, treat-to-target protocol (Clinical Trials:NCT00660647) studied whether adalimumab added to methotrexate and intra-articular triamcinolone as first-line treatment in early rheumatoid arthritis (ERA) increased the frequency......-label biologics after 6-9 months. Efficacy was assessed primarily on the proportion of patients who reached treatment target (DAS28CRP

  4. Depression and Insomnia in Patients With Psoriasis and Psoriatic Arthritis Taking Tumor Necrosis Factor Antagonists

    OpenAIRE

    Wu, Chun-Ying; Chang, Yun-Ting; Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Yu-Pu; Shieh, Jeng-Jer; Liu, Han-Nan; Chen, Yi-Ju

    2016-01-01

    Abstract 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 m...

  5. Contact Frequency, Travel Time, and Travel Costs for Patients with Rheumatoid Arthritis

    OpenAIRE

    Jan Sørensen; Louise Linde; Merete Lund Hetland

    2014-01-01

    Objectives. To investigate travel time, and travel cost related to contacts with health care providers for patients with rheumatoid arthritis (RA) during a three-month period. Methods. Patient-reported travel time and travel cost were obtained from 2847 patients with RA. Eleven outpatient clinics across Denmark recruited patients to the study. Data collected included frequency, travel time and travel costs for contacts at rheumatology outpatient clinics, other outpatient clinics, general prac...

  6. Sexual Self-Concept and General Health in Rheumatoid Arthritis Patients

    OpenAIRE

    Saadat, Seyed Hassan; Ramezani, Arash; Ahmadi, Khodabakhsh

    2015-01-01

    Background: There are several studies regarding sexual dysfunction in chronic diseases such as diabetes and renal failure; however, no significant study has been done on Iranian rheumatoid arthritis (RA) patients. Objectives: In this study, we aimed to identify and compare sexual dysfunction between RA patients and the normal population. Patients and Methods: In this case-control study, two groups of females (87 RA patients and 89 controls) were randomly selected from the rheumatology clinic ...

  7. 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.

  8. Hydroxychloroquine decreases Th17-related cytokines in systemic lupus erythematosus and rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Juliana Cruz da Silva

    2013-06-01

    Full Text Available OBJECTIVES: Hydroxychloroquine is an antimalarial agent that has been used in systemic lupus erythematosus and rheumatoid arthritis treatment for many years. Recently, novel mechanisms of action have been proposed, thereby broadening the therapeutic perspective of this medication. The purpose of this study was to evaluate the immunomodulatory activity of hydroxychloroquine in T helper 17 (Th17 cytokines in healthy individuals and patients. METHODS: Eighteen female patients with systemic lupus erythematosus (mean age 39.0±12.9 years and 13 female patients with rheumatoid arthritis (mean age 51.5±7.7 years were recruited from Universidade Federal de Pernambuco-Brazil. The patients were included after fulfilling four classification criteria for systemic lupus erythematosus or rheumatoid arthritis from the American College of Rheumatology. After being stimulated with phorbol 12-myristate 13-acetate and ionomycin in the absence or presence of different concentrations of hydroxychloroquine, the interleukin 6, 17 and 22 levels were quantified with an enzyme-linked immunosorbent assay in culture supernatants of peripheral blood mononuclear cells from healthy individuals and patients. RESULTS: We demonstrated that in peripheral blood mononuclear cells from healthy volunteers and in systemic lupus erythematosus and rheumatoid arthritis patients, there was a significant reduction in the IL-6, IL-17 and IL-22 supernatant levels after adding hydroxychloroquine. CONCLUSIONS Our in vitro results demonstrated that hydroxychloroquine inhibits IL-6, IL-17 and IL-22 production and contributes to a better understanding of the mechanism of action of this medication.

  9. 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.

  10. 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

    infection was the primary measure of treatment effect and calculated 95% credible intervals using Markov Chain Monte Carlo methods. FINDINGS: The systematic review identified 106 trials that reported serious infections and included patients with rheumatoid arthritis who received biological drugs. Compared......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 (DMARDs......Trials.gov from their inception to Feb 11, 2014. Search terms included "biologics", "rheumatoid arthritis" and their synonyms. Trials were eligible for inclusion if they included any of the approved biological drugs and reported serious infections. We assessed the risk of bias with the Cochrane Risk of Bias Tool...

  11. Arthritis in cystic fibrosis.

    OpenAIRE

    Schidlow, D V; Goldsmith, D P; Palmer, J; Huang, N N

    1984-01-01

    We have confirmed previous observations of a transient, non-disabling recurrent arthritis in patients with cystic fibrosis. This arthritis differs from classic rheumatoid arthritis, is frequently associated with skin arthritis lesions, and its occurrence is unrelated to the severity of lung disease.

  12. 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.

  13. Multidisciplinary vocational rehabilitation for patients with chronic arthritis

    OpenAIRE

    Buck, de, A.J.

    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 the Netherlands, rheumatic diseases account for about 15% of the costs due to work disability payments. Given this significance, work retention issues have been identified as one of the aims of th...

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

    OpenAIRE

    Vitetta L; Coulson S; Schloss J; Beck SL; Allen R; Sali A

    2012-01-01

    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 progressio...

  15. 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.

  16. Apoptotic cell infusion treats ongoing collagen-induced arthritis, even in the presence of methotrexate, and is synergic with anti-TNF therapy

    OpenAIRE

    Bonnefoy, Francis; Daoui, Anna; Valmary-Degano, Séverine; Toussirot, Eric; Saas, Philippe; Perruche, Sylvain

    2016-01-01

    Background Apoptotic cell-based therapies have been proposed to treat chronic inflammatory diseases. The aim of this study was to investigate the effect of intravenous (i.v.) apoptotic cell infusion in ongoing collagen-induced arthritis (CIA) and the interaction of this therapy with other treatments used in rheumatoid arthritis (RA), including methotrexate (MTX) or anti-TNF therapy. Methods The effects of i.v. apoptotic cell infusion were evaluated in a CIA mouse model in DBA/1 mice immunized...

  17. 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...

  18. 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...

  19. 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.

  20. Silibinin Improves the Effects of Methotrexate in Patients with Active Rheumatoid Arthritis: Pilot Clinical Study

    Science.gov (United States)

    Hussain, Saad Abdulrahman; Mortada, Ahmed Hashem; Jasim, Nazar Abdulateef; Gorial, Faiq Isho

    2016-01-01

    Objectives Our study sought to evaluate the effects of silibinin in patients with active rheumatoid arthritis (RA) treated with methotrexate (MTX). Methods We conducted a randomized multi-center, double-blind, placebo-controlled clinical trial over a 16-week treatment period at the Al-Sader and Baghdad Teaching Hospitals in Najaf and Baghdad, respectively. A total of 60 patients (30 of each sex) with active RA, already maintained on 12 mg MTX weekly for at least three consecutive months, were included in the study. Patients were randomly allocated to receive either 120 mg silibinin twice daily or a placebo, combined with their regular MTX regimen. The patients were evaluated by measuring disease activity score using the 28-joint Disease Activity Score, Simple Disease Activity Index, and Health Assessment Questionnaire–Disability Index scores at the start and end of the study. Blood samples were evaluated for the erythrocyte sedimentation rate (ESR), hemoglobin (Hb), high-sensitivity C-reactive protein (hs-CRP), creatine kinase (CK), anti-cyclic citrullinated peptide (CCP), and the serum cytokine levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-10, and IL-2. Results Silibinin significantly decreases the already elevated clinical scores compared to placebo treatment. ESR, IL-8, IL-6, TNF-α, anti-CCP, hs-CRP levels were significantly reduced. Additionally, the use of silibinin significantly increases Hb, IL-10, and IL-2 levels. Conclusion Silibinin may improve the effects of MTX on certain biochemical and clinical markers of patients with active RA. PMID:27403238

  1. Adherence and resource use among patients treated with biologic drugs: findings from BEETLE study

    Science.gov (United States)

    Degli Esposti, Luca; Sangiorgi, Diego; Perrone, Valentina; Radice, Sonia; Clementi, Emilio; Perone, Francesco; Buda, Stefano

    2014-01-01

    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 observed in patients treated with etanercept (27%) or adalimumab (23%). The mean annual nonpharmacological expenditure for each patient in analysis was €988 for adherent and €1,255 for nonadherent patients. Infliximab was associated with the lowest cost for all indications as determined by the multivariate generalized linear model. Conclusions Patients treated with infliximab were associated with higher adherence and persistence in treatment and lower costs, as compared to those treated with adalimumab or etanercept. PMID:25258545

  2. CCR5Δ32 variant and cardiovascular disease in patients with rheumatoid arthritis: a cohort study

    OpenAIRE

    Rodríguez Rodríguez, Luis; González Juanatey, Carlos; García Bermúdez, Mercedes; Vázquez Rodríguez, Tomás R.; Miranda Filloy, José Alberto; Fernández Gutiérrez, Benjamín; Llorca Díaz, Javier; Martín Ibáñez, Javier; González-Gay Mantecón, Miguel Ángel

    2011-01-01

    Introduction The aim of our study was to analyze the influence of the CCR5Δ32 polymorphism in the risk of cardiovascular (CV) events and subclinical atherosclerosis among patients with rheumatoid arthritis (RA). Methods A total of 645 patients fulfilling the American Rheumatism Association 1987 revised classification criteria for RA were studied. Patients were genotyped for the CCR5 rs333 polymorphism using predesigned TaqMan assays. Also, HLA DRB1 genotyping was performed using mo...

  3. Immune responses to stress after stress management training in patients with rheumatoid arthritis

    OpenAIRE

    de Brouwer, Sabine JM; van Middendorp, Henriët; Kraaimaat, Floris W.; Radstake, Timothy RDJ; Joosten, Irma; Donders, A Rogier T; Eijsbouts, Agnes; Koulil, Saskia Spillekom-van; van Riel, Piet LCM; Evers, Andrea WM

    2013-01-01

    Introduction Psychological stress may alter immune function by activating physiological stress pathways. Building on our previous study, in which we report that stress management training led to an altered self-reported and cortisol response to psychological stress in patients with rheumatoid arthritis (RA), we explored the effects of this stress management intervention on the immune response to a psychological stress task in patients with RA. Methods In this study, 74 patients with RA, who w...

  4. 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...

  5. Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis

    OpenAIRE

    McEntegart, A; Morrison, E; Capell, H; M. Duncan; Porter, D.; Madhok, R; Thomson, E.

    1997-01-01

    OBJECTIVE—Social deprivation is now recognised to have an important impact on morbidity and mortality. This study sought to ascertain the effect of deprivation, if any, on disease severity, functional disability, and outcome in rheumatoid patients in Glasgow.
METHODS—814 patients with rheumatoid arthritis (RA) were assessed for clinical, functional, and laboratory indices of disease activity. Deprivation categories for individual patients were determined using the Carstairs index. Five year f...

  6. Vasoprotective Effects of Genetically Engineered Biologic Drugs in Patients with Rheumatoid Arthritis

    OpenAIRE

    N.S. Meshcherina; L.А. Knyazeva; I I Goryainov; L I Knyazeva

    2015-01-01

    The aim of the investigation was to evaluate the impact of genetically engineered biologic drugs (GEBD) — infliximab and rituximab — on endothelium functional state in patients with rheumatoid arthritis (RA) without any concomitant cardiovascular diseases. Materials and Мethods. The study involved 77 patients with RA aged from 18 to 50. The patients matched ACR (1987) or ACR/EULAR (2010) classification criteria, had no concomitant cardiovascular diseases, and had at least a two-year RA hi...

  7. Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Riemsma, R.P.; Taal, E.; Rasker, J.J.; Houtman, P.M.; Paassen, van H.C.; Wiegman, O.

    1996-01-01

    DUTCH-AIMS2, a Dutch version of AIMS2 and successor to DUTCH-AIMS, is an instrument to assess health status among patients with rheumatic diseases. It provides measurements of 12 areas of health status on scales for health status proper, satisfaction, attribution and arthritis impact. We assessed th

  8. 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).

  9. 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

  10. 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

  11. 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

  12. [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

  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. Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Svensson, Annemarie Lyng; Christensen, Robin; Persson, Frederik;

    2016-01-01

    INTRODUCTION: Cardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD) in pati...

  15. 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

  16. Advanced glycation endproducts are increased in rheumatoid arthritis patients with controlled disease

    NARCIS (Netherlands)

    de Groot, Lodewijk; Hinkema, Helmy; Westra, Johanna; Smit, Andries J.; Kallenberg, Cees G. M.; Bijl, Marc; Posthumus, Marcel D.

    2011-01-01

    Introduction: Advanced glycation end products (AGEs) are produced and can accumulate during chronic inflammation, as might be present in patients with rheumatoid arthritis (RA). AGEs are involved in the development of cardiovascular disease. The aim of this study is to evaluate whether AGEs are incr

  17. 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

  18. 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

  19. Prevalence and Severity of Periodontitis in Indonesian Patients With Rheumatoid Arthritis

    NARCIS (Netherlands)

    Susanto, Hendri; Nesse, Willem; Kertia, Nyoman; Soeroso, Juwono; van Reenen, Yvonne Huijser; Hoedemaker, Eveliene; Agustina, Dewi; Vissink, Arjan; Abbas, Frank; Dijkstra, Pieter U.; Soeroso§, Juwono

    2013-01-01

    Background: Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic

  20. 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

  1. 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

  2. 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

  3. Development of Acute Promyelocytic Leukemia in a Patient With Gouty Arthritis on Long Term Colchicine.

    Science.gov (United States)

    Buyukkurt, Nurhilal; Korur, Asli; Boga, Can

    2016-06-01

    Colchicine is a frequently used drug in rheumatological diseases. Acute promyelocytic leukemia developed in a patient who used colchicine for gouty arthritis since 10 years is presented and the possible relation between the long term use of colchicine and hematological malignancies is discussed. PMID:27408362

  4. 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.

  5. 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.)

  6. Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients

    International Nuclear Information System (INIS)

    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.)

  7. Pyridoxine supplementation corrects vitamin B6 deficiency but does not improve inflammation in patients with rheumatoid arthritis

    Science.gov (United States)

    Patients with rheumatoid arthritis have subnormal vitamin B6 status, both quantitatively and functionally. Abnormal vitamin B6 status in rheumatoid arthritis has been associated with spontaneous tumor necrosis factor (TNF)-alpha production and markers of inflammation, including C-reactive protein an...

  8. Systematic review of patient-reported outcome measures (PROMs) for assessing disease activity in rheumatoid arthritis.

    Science.gov (United States)

    Hendrikx, Jos; de Jonge, Marieke J; Fransen, Jaap; Kievit, Wietske; van Riel, Piet Lcm

    2016-01-01

    Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and to evaluate the measurement properties of these measures. Systematic literature searches were performed in the PubMed and EMBASE databases to identify articles reporting on clinimetric development or evaluation of PROM-based instruments to monitor disease activity in patients with RA. 2 reviewers independently selected articles for review and assessed their methodological quality based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. A total of 424 abstracts were retrieved for review. Of these abstracts, 56 were selected for reviewing the full article and 34 articles, presenting 17 different PROMs, were finally included. Identified were: Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, Patient-based Disease Activity Score (PDAS) I & II, Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28), Patient-derived Simplified Disease Activity Index (Pt-SDAI), Global Arthritis Score (GAS), Patient Activity Score (PAS) I & II, Routine Assessment of Patient Index Data (RAPID) 2-5, Patient Reported Outcome-index (PRO-index) continuous (C) & majority (M), Patient Reported Outcome CLinical ARthritis Activity (PRO-CLARA). The quality of reports varied from poor to good. Typically 5 out of 10 clinimetric domains were covered in the validations of the different instruments. The quality and extent of clinimetric validation varied among PROMs of RA disease activity. The Pt-DAS28, RADAI, RADAI-5 and RAPID 3 had the strongest and most extensive validation. The measurement properties least reported and in need of more evidence were: reliability

  9. 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...

  10. 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

  11. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos was designed ... Activity Role of Body Weight in Osteoarthritis Educational Videos for Patients Rheumatoid Arthritis Educational Video Series Psoriatic ...

  12. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Arthritis Center since 2000, currently serving as the Nurse Manager. She is a critical member of our patient care team. Managing Your Arthritis Managing Your Arthritis Managing ...

  13. Rheumatoid Arthritis Educational Video Series

    Medline Plus

    Full Text Available ... Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ... Sheets Benefits and Risks of Opioids in Arthritis Management How to Give a Subcutaneous Injection Johns Hopkins ...

  14. Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression

    DEFF Research Database (Denmark)

    Haavardsholm, Espen A; Bøyesen, Pernille; Ostergaard, Mikkel;

    2008-01-01

    consecutive patients with RA with disease duration <1 year were enrolled. Patients were treated according to standard clinical practice, and evaluated at baseline, 3, 6 and 12 months by core measures of disease activity, conventional radiographs of both hands and wrists and MRI of the dominant wrist. MR......Objectives: To examine the spectrum and severity of magnetic resonance imaging (MRI) findings in patients with early rheumatoid arthritis (RA), and to investigate the predictive value of MRI findings for subsequent development of conventional radiographic (CR) damage and MRI erosions. Methods: 84...... images were scored according to the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS), and conventional radiographs according to the van der Heijde modified Sharp score. Results: MRI findings reflecting inflammation (synovitis, bone marrow oedema and tenosynovitis) decreased during...

  15. 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.

  16. 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

  17. Multiple pulmonary cavitary nodules with pyoderma gangrenosum in patient with rheumatoid arthritis.

    Science.gov (United States)

    Be, Miae; Cha, Hee Jeong; Park, Chanho; Park, Yongtae; Jung, Hwasik; Lee, Yoeunim; Jegal, Yangjin

    2016-01-01

    Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of skin. Its pulmonary manifestations are uncommon and only less than forty cases have been reported in the literature previously. PG is associated with variable systemic diseases, most commonly inflammatory bowel disease and hematologic malignancies. It reported rarely in rheumatoid arthritis (RA). We report a case of PG lung involvement in patient with RA associated interstitial lung disease. A 66-year-old woman presented with productive cough and recurrent ulcerative lesion on her left ankle. She had a 15-year history of RA associated interstitial lung disease and treated with methotrexate, sulfasalazine, hydroxychloroquine and methylprednisolone. On physical examination, there were a few tender, erythematous subcutaneous nodules ranging from 1 to 3 cm in diameter on her left thigh and left elbow. Anti-neutrophil cytoplasmic antibodies (ANCAs) are negative. Her chest CT scan demonstrated multifocal cavitary consolidations on the background of reticular opacity and honeycombing. Punch biopsy of erythematous nodule on thigh showed neutrophilic abscess with necrotic debris. The skin and lung lesions were rapidly improved with 0.5 mg/kg/day of prednisolone. PMID:26889492

  18. Sustained improvements in MRI outcomes with abatacept following the withdrawal of all treatments in patients with early, progressive rheumatoid arthritis

    Science.gov (United States)

    Peterfy, Charles; Burmester, Gerd R; Bykerk, Vivian P; Combe, Bernard G; DiCarlo, Julie C; Furst, Daniel E; Huizinga, Tom W J; Wong, Dennis A; Conaghan, Philip G; Emery, Paul

    2016-01-01

    Objectives To assess structural damage progression with subcutaneous abatacept (ABA) in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) trial following abrupt withdrawal of all rheumatoid arthritis (RA) medication in patients achieving Disease Activity Score (DAS)-defined remission or low disease activity. Methods Patients with early, active RA were randomised to ABA plus methotrexate (ABA/MTX) 125 mg/week, ABA 125 mg/week or MTX for 12 months. All RA treatments were withdrawn after 12 months in patients with DAS28 (C reactive protein (CRP)) <3.2. Adjusted mean changes from baseline in MRI-based synovitis, osteitis and erosion were calculated for the intention-to-treat population. Results 351 patients were randomised and treated: ABA/MTX (n=119), ABA (n=116) or MTX (n=116). Synovitis and osteitis improved, and progression of erosion was statistically less with ABA/MTX versus MTX at month 12 (−2.35 vs −0.68, −2.58 vs −0.68, 0.19 vs 1.53, respectively; p<0.01 for each) and month 18 (−1.34 vs −0.49 −2.03 vs 0.34, 0.13 vs 2.0, respectively; p<0.01 for erosion); ABA benefits were numerically intermediate to those for ABA/MTX and MTX. Conclusions Structural benefits with ABA/MTX or ABA may be maintained 6 months after withdrawal of all treatments in patients who have achieved remission or low disease activity. Trial registration number NCT01142726; Results. PMID:26865601

  19. 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.

  20. 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.

  1. Diagnostics of septic arthritis in the sternoclavicular region - 10 consecutive patients and literature review

    International Nuclear Information System (INIS)

    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

  2. Lymphoma in a patient with rheumatoid arthritis receiving methotrexate treatment: successful treatment with rituximab

    OpenAIRE

    Stewart, M; Malkovska, V; Krishnan, J.; Lessin, L; Barth, W.

    2001-01-01

    A 55 year old man with chronic lymphocytic leukaemia (CLL) and rheumatoid arthritis (RA), treated for four years with methotrexate (MTX), who developed a B cell non-Hodgkin's lymphoma (B-NHL), is described. The tumour was localised to the shoulder and axillary lymph nodes, and positive for Epstein-Barr viral antigens. After failure of radiation and chemotherapy, a complete remission was achieved with a combination of antibody treatment (rituximab) and EPOCH. The development of a second malign...

  3. 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.

  4. HLA B27 allele types in homogeneous groups of juvenile idiopathic arthritis patients in Latvia

    OpenAIRE

    Guseinova Dinara; Lazareva Arina; Sochnevs Arturs; Zavadska Dace; Eglite Jelena; Stanevicha Valda; Shantere Ruta; Gardovska Dace

    2010-01-01

    Abstract Juvenile idiopathic arthritis (JIA) is a heterogeneous condition and therapeutic strategies vary in different JIA types. The routinely accepted practice to start with Sulphasalazine (SS) as the first line treatment in patients with HLA B27 positive JIA proves to be ineffective in a large proportion of children. Objective to investigate HLA B27 positive JIA patients clinical characteristics, determined HLA B27 allele types and their connection with antirheumatic treatment in homogenou...

  5. 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.

  6. In-vitro T cell mediated function in patients with active rheumatoid arthritis.

    OpenAIRE

    Slavin, S; Strober, S

    1981-01-01

    In-vitro synthesis of peripheral blood lymphocytes from patients with rheumatoid arthritis was measured after stimulation with phytohaemagglutinin (PHA) in a short-term, serum-free culture system. Diminished responses were found in 16 out of 17 consecutive patients with active disease. Normal PHA responsiveness was recovered by assaying Ficoll-Hypaque isolated E rosette forming cells in serum-free medium, indicating basically normal T cell function in RA. Preincubation of normal peripheral bl...

  7. Psychophysiological responses to stress after stress management training in patients with rheumatoid arthritis.

    OpenAIRE

    de Brouwer, Sabine J. M.; Kraaimaat, Floris W.; Sweep, Fred C. G. J.; Donders, Rogier T.; Agnes Eijsbouts; Saskia van Koulil; van Riel, Piet L C M; Evers, Andrea W. M.

    2011-01-01

    BACKGROUND: Stress management interventions may prove useful in preventing the detrimental effects of stress on health. This study assessed the effects of a stress management intervention on the psychophysiological response to stress in patients with rheumatoid arthritis (RA). METHODS: Seventy-four patients with RA, who were randomly assigned to either a control group or a group that received short-term stress management training, performed a standardized psychosocial stress task (Trier Socia...

  8. Self Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013

    OpenAIRE

    Kordasiabi, Mosharafeh Chaleshgar; Akhlaghi, Maassoumeh; Baghianimoghadam, Mohammad Hossein; Morowatisharifabad, Mohammad Ali; Askarishahi, Mohsen; Enjezab, Behnaz; Pajouhi, Zeinab

    2015-01-01

    Introduction: Rheumatoid Arthritis (RA) is a systemic, autoimmune and inflammatory disease with an unknown etiology that is associated with progressive joint degeneration, limitation of physical activity and disability. The aim of the study was to evaluate self-management behaviors and their associated factors in RA patients. Material and Method: This cross-sectional study was performed in 2013 on 185 patients in Iran. Data were selected through convenient sampling. The collected data include...

  9. Prevalence and Severity of Periodontitis in Indonesian Patients With Rheumatoid Arthritis

    OpenAIRE

    Susanto, Hendri; Nesse, Willem; Kertia, Nyoman; Soeroso, Juwono; van Reenen, Yvonne Huijser; Hoedemaker, Eveliene; Agustina, Dewi; Vissink, Arjan; Abbas, Frank; Dijkstra, Pieter U.; Soeroso§, Juwono

    2013-01-01

    Background: Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA. Methods: A full-mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 In...

  10. Periodontitis in established rheumatoid arthritis patients: a cross-sectional clinical, microbiological and serological study

    OpenAIRE

    de Smit, Menke; 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 between periodontitis and RA is dependent on P. gingivalis, we compared host immune responses in RA patients with and without periodontitis in relation to presence of cultivable P. gingivalis in sub...

  11. Anterior Ischaemic Optic Neuropathy in Patient with Rheumatoid Arthritis – Case Report

    OpenAIRE

    Perić, S; Cerovski, B.; Perić, P.

    2001-01-01

    This case report presents a patient with long-lasting rheumatoid arthritis (RA) of fourth clinical grade, having ocular complications. RA was diagnosed according to current modified ARA criteria from 1987. Upon admission to the Department of Ophthalmology clinical examination revealed anterior ischaemic optic neuropathy (AION), which is not characteristic manifestation of RA in the eye. The occurrence of AION in patients with RA has been explained in literature as a secondary m...

  12. Ultrasonographic Findings of the Shoulder in Patients with Rheumatoid Arthritis and Comparison with Physical Examination

    OpenAIRE

    Kim, Hyun Ah; Kim, Su Ho; Seo, Young-Il

    2007-01-01

    The objectives of this study were: 1) to identify the ultrasonographic (US) abnormalities and 2) to compare the findings of physical examination with US findings in rheumatoid arthritis (RA) patients with shoulder pain. We studied 30 RA patients. Physical examination was performed systemically as follows: 1) area of tenderness; 2) range of passive and active shoulder motion; 3) impingement tests; 4) maneuvers for determining the location of the tendon lesions. US investigations included the b...

  13. 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.

  14. 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...... was normal. Liver biopsy showed late signs of acute toxic hepatitis without MTX-related fibrosis. This is one the first cases that convincingly demonstrates that infliximab treatment may cause toxic hepatitis. Moreover, the case suggests a lack of hepatic cross-toxicity between infliximab and etanercept...

  15. [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.

  16. 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.

  17. [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. PMID:25742995

  18. 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

  19. 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…

  20. 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

  1. 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

  2. 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…

  3. 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

  4. 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...

  5. 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.

  6. Goal-setting in multidisciplinary team care for patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Meesters, Jorit; Hagel, Sofia; Klokkerud, Mari;

    2013-01-01

    Objective: To make a cross-cultural comparison of the contents of rehabilitation goals of patients admitted for rehabilitation and to compare the contents with the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis, by linking...... their contents to the ICF. Patients: A random sample of 80 patients with rheumatoid arthritis was retrieved from rehabilitation clinics in 4 countries. Methods: Rehabilitation goals were extracted from the medical records and linked to the ICF using standardized linking rules. Results: A total of 495...... rehabilitation goals were identified and linked to 952 ICF codes, resulting in 151 unique ICF codes. Two-hundred and seventy-five (29%) of the 952 ICF codes were related to "Body Functions" (b-codes), 80 (8%) to "Body Structures" (s-codes), 419 (44%) to "Activities and Participation" (d-codes) and 178 (19...

  7. 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...... treatment in patients with moderate-to-severe plaque psoriasis and PsA and the main results have been presented previously. This analysis examined employment status, job duties and sick days, pre-defined endpoints in PRESTA, among this patient population. METHODS: Participants (N=752) were randomized...... at baseline, week 12 and week 24 of treatment. The questionnaire included employment status and changing job responsibilities and sick time taken due to psoriasis or PsA. The statistical methods included analysis of covariance, t-test, Fisher's exact test and McNemar's test. Last...

  8. Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment.

    Science.gov (United States)

    Janta, Iustina; Martínez-Estupiñán, Lina; Valor, Lara; Montoro, María; Baniandres Rodriguez, Ofelia; Hernández Aragüés, Ignacio; Bello, Natalia; Hernández-Flórez, Diana; Hinojosa, Michelle; Martínez-Barrio, Julia; Nieto-González, Juan Carlos; Ovalles-Bonilla, Juan Gabriel; González, Carlos Manuel; López-Longo, Francisco Javier; Monteagudo, Indalecio; Naredo, Esperanza; Carreño, Luis

    2015-05-01

    The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs. PMID:25636779

  9. HLA B27 allele types in homogeneous groups of juvenile idiopathic arthritis patients in Latvia

    Directory of Open Access Journals (Sweden)

    Guseinova Dinara

    2010-10-01

    Full Text Available Abstract Juvenile idiopathic arthritis (JIA is a heterogeneous condition and therapeutic strategies vary in different JIA types. The routinely accepted practice to start with Sulphasalazine (SS as the first line treatment in patients with HLA B27 positive JIA proves to be ineffective in a large proportion of children. Objective to investigate HLA B27 positive JIA patients clinical characteristics, determined HLA B27 allele types and their connection with antirheumatic treatment in homogenous patient groups. Materials and methods 56 patients diagnosed with JIA and observed over the period 2006 to 2009 included in the study. HLAB27 allele types were determined using PCR method. Results In HLA B27 positive JIA patients mean disease onset was 12.34 ± 3.3 years. Most common (44% JIA type was enthesitis related arthritis. Positive response to the treatment with SS was found in 32% of patients, Methotrexate (MTX - in 43%, combined treatment - SS with MTX was effective in 12.5%. 12.5% of patients required combination MTX with Enbrel. Eight HLA B27 allele types were found in JIA patients in Latvia: *2702, *2703, *2704, *2705, *2710, *2715, *2717, *2728. The most common was *2705 - in 55% of cases. Among all the patients enthesitis related arthritis most commonly occurred in patients with HLAB*2705 allele (OR = 2.01, p Conclusions There are 8 different HLA B27 alleles in JIA patients in Latvia and the most common is *2705, but in order to assert them to be disease associated alleles, more extensive studies are needed, including control group of HLA B27 positive healthy individuals. Standard treatment approach with SS proves to be unsatisfactory in the majority of JIA patients. To improve children's quality of life achieving rapid disease control, the first line treatment in HLA B27 positive patients should be MTX. In order to start with the most appropriate drug it is necessary to determine HLAB 27 type at the onset of disease.

  10. 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.

  11. 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

  12. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders

    DEFF Research Database (Denmark)

    Agca, R; Heslinga, S C; Rollefstad, S;

    2016-01-01

    Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors a...

  13. 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...

  14. 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...

  15. How I treat glioblastoma in older patients.

    Science.gov (United States)

    Mohile, Nimish A

    2016-01-01

    Glioblastoma, a WHO grade IV astrocytoma, is the most common primary malignant brain tumor in adults. It is characterized by molecular heterogeneity and aggressive behavior. Glioblastoma is almost always incurable and most older patients survive less than 6 months. Supportive care with steroids and anti-epileptic drugs is critical to improving and maintain quality of life. Young age, good performance status and methylation of the methyl guanyl methyl transferase promoter are important positive prognostic factors. Several recent clinical trials suggest that there is a subset of the elderly with prolonged survival that is comparable to younger patients. Treatment of glioblastoma in older patients includes maximal safe resection followed by either radiation, chemotherapy or combined modality therapy. Recent advances suggest that some patients can avoid radiation entirely and be treated with chemotherapy alone. Decisions about therapy are individual and based on a patient's performance status, family support and molecular features. Future work needs to better determine the role for comprehensive geriatric assessments in this patient population to better identify patients who may most benefit from aggressive therapies. PMID:26725536

  16. 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.

  17. 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...

  18. Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis.

    OpenAIRE

    Ursum, J.; Horsten, N.C.; Hoeksma, A.F.; Dijkmans, B A; Knol, D L; van Schaardenburg, D.; Dekker, J.; Roorda, L D

    2011-01-01

    Objectives: To identify early predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis (RA). Design: A longitudinal study of an inception cohort. Setting: A large outpatient clinic. Participants: Consecutive patients who attended the Early Arthritis Clinic for at least 2 years and fulfilled the American College of Rheumatology criteria for RA at baseline and/or at the 1-year follow-up were invited to participate until 200 pa...

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

    Directory of Open Access Journals (Sweden)

    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. .

  20. Prevalence and clinical patterns of psoriatic arthritis in Indian patients with psoriasis

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

    2016-01-01

    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.

  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

    2016-01-01

    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. PMID:26476882

  3. 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.

  4. Developing the Thai Siriraj Psoriatic Arthritis Screening Tool and validating the Thai Psoriasis Epidemiology Screening Tool and the Early Arthritis for Psoriatic Patients questionnaire.

    Science.gov (United States)

    Chiowchanwisawakit, Praveena; Wattanamongkolsil, Luksame; Srinonprasert, Varalak; Petcharat, Chonachan; Siriwanarangsun, Palanan; Katchamart, Wanruchada

    2016-10-01

    To validate the Thai language version of the Psoriasis Epidemiology Screening Tool (PEST) and the Early Arthritis for Psoriatic Patients Questionnaire (EARP), as well as also to develop a new tool for screening psoriatic arthritis (PsA) among psoriasis (Ps) patients. This was a cross-sectional study. Ps patients visiting the psoriasis clinic at Siriraj Hospital were recruited. They completed the EARP and PEST. Full musculoskeletal history, examination, and radiography were evaluated. PsA was diagnosed by a rheumatologist's evaluation and fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to evaluate the performances of the tools. The Siriraj Psoriatic Arthritis Screening Tool (SiPAT) contained questions most relevant to peripheral arthritis, axial inflammation, and enthesitis, selected from multivariate analysis. Of a total of 159 patients, the prevalence of PsA was 78.6 %. The ROC curve analyses of Thai EARP, PEST, and SiPAT were 0.90 (95 % CI 0.84, 0.96), 0.85 (0.78, 0.92), and 0.89 (0.83, 0.95), respectively. The sensitivities of SiPAT, Thai EARP, and PEST were 91.0, 83.0, and 72.0 %, respectively, while the specificities were 69.0, 79.3, and 89.7 %, respectively. All screening questionnaires showed good diagnostic performances. SiPAT could be considered as a screening tool with its desirable properties: higher sensitivity and taking less time. Thai PEST and EARP could possibly be sequentially administered for people with a positive test from SiPAT to reduce the number of false positives. PMID:27333800

  5. FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

    Directory of Open Access Journals (Sweden)

    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

  6. Magnetic resonance imaging of the shoulder in patients with rheumatoid arthritis.

    OpenAIRE

    Kieft, G. J.; Dijkmans, B A; Bloem, J. L.; Kroon, H.M.

    1990-01-01

    To evaluate the ability of magnetic resonance imaging (MRI) to detect shoulder abnormalities 18 patients (36 shoulders) with rheumatoid arthritis (RA) and shoulder complaints were studied. Osseous abnormalities of the glenoid and humeral head were readily detected with MRI. The imaging planes used were not suitable for the evaluation of acromioclavicular joint involvement. Magnetic resonance imaging depicted soft tissue abnormalities that were not clearly visualised by plain film radiography,...

  7. The kinase inhibitor tofacitinib in patients with rheumatoid arthritis: latest findings and clinical potential

    OpenAIRE

    Cutolo, Maurizio

    2013-01-01

    Macrophages, T and B cells, and neutrophils concentrate mainly into the synovial tissue of rheumatoid arthritis (RA) patients and produce several inflammatory mediators including cytokines. More recently, small molecule inhibitors of signalling mediators which have intracellular targets (mainly in T and B cells) such as the Janus kinase (JAK) family of tyrosine kinases have been introduced in RA treatment. The JAK family consist of four types: JAK1, JAK2, JAK3 and TyK2. In particular, JAK3 is...

  8. Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction

    OpenAIRE

    Pokorný David; Štursa Pavel; Vavřík Pavel; Hromádka Rastislav; Popelka Stanislav; Jahoda David; Sosna Antonín

    2010-01-01

    Abstract Background The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. Methods Between 2002 and 2005 we performed isolated talonavicular arthrodesis...

  9. Disseminated cutaneous Kaposi sarcoma in a patient receiving triptolide/tripdiolide for rheumatoid arthritis

    OpenAIRE

    Grzegorzewska, Alicja E.; Frankiewicz, Dorota; Bręborowicz, Danuta; Matławska, Irena; Bylka, Wiesława

    2012-01-01

    Summary Background To date, Kaposi sarcoma has not been mentioned among the adverse effects of triptolide/tripdiolide, ethyl acetate extracts or polyglycosides of the Chinese herbal remedy Tripterygium wilfordii Hook F. Case Report A patient was diagnosed with rheumatoid arthritis at the age of 29 years. She underwent treatment with corticosteroids, methotrexate and gold sodium thiosulfate, and was chronically taking ketoprofen. At the age of 59 years she started to take a powder (≈2 g/day) f...

  10. Effects of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial.

    OpenAIRE

    Ende, C.H.M. van den; Breedveld, F C; Cessie, S Le; Dijkmans, B.A.C.; de Mug, A W

    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 because of active disease, were randomly assigned to an intensive exercise programme or to a conservative exercise programme during their period in hospital with a mean length of 30 (14) days. The intens...

  11. Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations

    OpenAIRE

    Shunsuke Mori; Mineharu Sugimoto

    2015-01-01

    Pneumocystis jirovecii infection causes fulminant interstitial pneumonia (Pneumocystis pneumonia, PCP) in patients with rheumatoid arthritis (RA) who are receiving biological and/or nonbiological antirheumatic drugs. Recently, we encountered a PCP outbreak among RA outpatients at our institution. Hospital-acquired, person-to-person transmission appears to be the most likely mode of this cluster of P. jirovecii infection. Carriage of P. jirovecii seems a time-limited phenomenon in immunocompet...

  12. SECONDARY AMYLOIDOSIS WITH LUNG INVOLVEMENT INA FEMALE PATIENT WITH RHEUMATOID ARTHRITIS

    OpenAIRE

    Irina Mikhailovna Marusenko; Ya A Avdeyeva; I I Polskaya

    2009-01-01

    The paper considers the problem of secondary amyloidosis that more frequently occurs in patients with various arthritides, both seropositive and seronegative. According to the data available in the literature, the most common manifestations of secondary amyloidosis are involvements of the kidney, liver, nervous system, and, less frequently, the lung. The authors describe their own observation of secondary amyloidosis in rheumatoid arthritis, which is accompanied by the involvement of the lung...

  13. 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...... of a biologic corresponding to current available options, given that effects, adverse effects, and financial costs were identical for the different choices. The subjects were also asked to justify their preferences. The chi-square goodness-of-fit test was used to examine the distributions over different......% of patients currently treated with SCH (Pbiologic-naïve patients (Pbiologic-naïve RA patients than for those currently on IVC (P

  14. 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.

  15. Clinical subgroups and HLA antigens in Italian patients with psoriatic arthritis.

    Science.gov (United States)

    Salvarani, C; Macchioni, P L; Zizzi, F; Mantovani, W; Rossi, F; Baricchi, R; Ghirelli, L; Frizziero, L; Portioli, I

    1989-01-01

    The frequencies of HLA antigens were studied in 101 Italian patients with psoriatic arthritis. The total group showed a significant increase in frequency of A1 and B38, and a reduction of B5 when compared to healthy controls. No association between DR and/or DQw antigens and PA were demonstrated. The comparisons between the clinical subgroups and normal controls revealed a significant association of B38 with asymmetric peripheral arthritis, B27 and B39 with spondylitis (with or without peripheral involvement). When intergroup comparison were made, the patients with spondylitis had an increase in frequency of B27 and DQw3 as compared to those with symmetric and asymmetric peripheral disease. DR4 and DRw53 were associated with earlier age of onset of arthritis. There were also significant associations between DQw3 and severe disease, and between A9, B5 and presence of erosions and joint space narrowing. No association with DR4 was showed in a subgroup of patients with symmetric polyarthritis without DIP involvement. PMID:2591112

  16. Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. Features of lipid metabolism disturbances in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    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.

  19. Distal bronchial tubes damage in patients with rheumatoid arthritis

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    M V Sheyanov

    2009-12-01

    Full Text Available Objective. To study prevalence and clinical picture of distal parts of bronchial tree(bronchiolitis in pts with rheumatoid arthritis (RA. Material and methods. 104 nonsmoking pts with RA and 100 pts without RA and chronic diseases of respiratory apparatus were included. General clinical examination, spirometry, bodyplethysmography, examination of lung diffusion capacity (LDC and multispiralcomputed tomography (MSCT of lungs were performed. Results. Direct and indirect bronchiolitis signs were revealed with MSCT in 36 (35% ptswith RA and 1 pt of control group (p<0,01. Pts with signs of bronchiolitis complained of shortness of breath (69% of pts, cough (56%, phlegm discharge (56%, heavy breathing (25%. Obstructive lung ventilation disturbances were revealed in 19 (53% RA pts with bronchiolitis. Restrictive disturbances and LDC decrease were present in 3 (8% pts. High frequency of oligosymptomatic bronchiolitis course was found in RA pts. Bronchiolitis symptoms in RA pts coincided with signs of proximal bronchial tubes damage forming picture of diffuse damage of bronchial tree. Conclusion. Bronchiolitis is a prevalent variant of respiratory apparatus damage in pts with RA. Pts with MSCT signs of bronchiolitis often have cough, phlegm discharge, shortness of breath, heavy breathing. Lung ventilation disturbances of obstructive type are common but part of pts has normal lung functional measures or restriction. Oligosymptomatic forms of distal bronchial tubes damage are prevalent in RA pts. Lung MSCT is the main method of bronchiolitis diagnostics because bronchiolitis induces nonspecific clinical signs and RA pts have multilevel respiratory apparatus damage. MSCT reveals signs of distal bronchial tubes damage in 35% of RA pts.

  20. Clinical and subclinical neuropsychiatric abnormalities in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    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.

  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. Clinical Risk Factors for the Development of Psoriatic Arthritis Among Patients with Psoriasis: A Review of Available Evidence.

    Science.gov (United States)

    Ogdie, Alexis; Gelfand, J M

    2015-10-01

    Psoriatic arthritis (PsA), a chronic inflammatory arthritis, affects about 10% of patients with psoriasis with higher prevalence seen in patients with more extensive skin disease. Early identification of PsA may result in improved outcomes. While it remains unclear which patients with psoriasis will develop PsA, several studies have identified potential risk factors for PsA among patients with psoriasis. This review examines the basic epidemiologic principles of identifying risk factors and reviews the evidence to date about risk factors for PsA among patients with psoriasis.

  3. 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. ...

  4. Anti-tumor necrosis factor-α therapy and changes of flow-mediated vasodilatation in psoriatic and rheumatoid arthritis patients.

    Science.gov (United States)

    Mazzoccoli, Gianluigi; Notarsanto, Incoronata; de Pinto, Gennaro Davide; Dagostino, Mariangela Pia; De Cata, Angelo; D'Alessandro, Giuseppe; Tarquini, Roberto; Vendemiale, Gianluigi

    2010-12-01

    For a long time, the endothelial covering of the vessels has been considered an inert surface. On the contrary, the endothelial cells are active and dynamic elements in the interaction between blood and tissues. The control of the vessel basal tone is obtained by the complex balance between the relaxing and contracting endothelial factors. Previous clinical studies show that patients suffering from rheumatoid arthritis and other autoimmune rheumatologic pathologies are at high risk of death being prematurely affected by atherosclerosis and cardiovascular diseases. Blocking tumor necrosis factor (TNF)-α by biological drugs improves the endothelial function. The aim of our study was to evaluate the effects of two anti-TNF-α drugs (infliximab and etanercept) on the endothelial function by evaluating the flow-mediated dilatation (FMD), which was measured in the brachial artery before and after treatment and after 8-12 weeks. We enrolled 36 patients (average age 52 ± 9.8 years, 12 men and 24 women), 25 of them were affected by rheumatoid arthritis (RA) and 11 were affected by psoriatic arthritis (PsA) and they were divided into three groups: 10 patients were treated with etanercept, 13 patients were treated with infliximab, 13 patients were treated with DMARDs. We measured the common carotid intimal-medial thickness (ccIMT) and the endothelial function was evaluated by FMD measurement in the brachial artery, before treatment, 1 h after the beginning of treatment and after 8-12 weeks. No statistically significant difference between the three groups was found for the ultrasonographic evaluation of the carotid IMT. On the contrary, the differences between FMD values before and after the treatment in the patients treated with etanercept (13.1 ± 0.01 vs. 18.8 ± 0.01%, p biological drugs in patients affected by autoimmune arthritis can modify the endothelial function, as indicated by the induced FMD changes, but the long-term effect tends to be considerably

  5. Treating 38 cases of rheumatoid arthritis in the integrative medicine%中西医结合治疗类风湿性关节炎38例

    Institute of Scientific and Technical Information of China (English)

    王亚敏; 施兆明; 蔡建盛; 林玉萍; 苏惠红

    2012-01-01

      目的:为提高类风湿性关节炎的临床疗效,减少该病致残致死率。方法:按美国风湿病学会、欧洲风湿病防治联合会2009年诊断标准,治疗类风湿性关节炎38例,西药予甲氨蝶呤、关节疼痛剧烈予小剂量激素口服。中医治疗予独活寄生汤加减,急性活动期予祛风寒除湿热通痹止痛;慢性稳定期予补肝肾益气血强筋壮骨。结果:治疗2个月全部患者临床缓解。结论:中西医结合治疗,抗炎调整免疫功能对解除关节疼痛,缓解病情疗效显著。%  Objective:To improve the clinical efficacy of rheumatoid arthritis, and to reduce the rate of maiming and killing of the disease. Methods:According to 2009 diagnostic criteria of American College of Rheumatology, the European Federation of rheumatism prevention, treating 38 cases of rheumatoid arthritis, had given methotrexate of modern medicine, severe joint pain given low dose hormone oral. TCM treatment given to Duhuo Jisheng decoction, the acute activity period given the Qufenghan Chishire Tongbi Zhitong pills;the chronic stable period given to Buganshen Yiqixue Qingjin Zhuanggu. Results:The treatments for two months, all patients with clinical symptoms had been alleviated. Conclusion:The effects of anti-inflammatory adjust immune function of the integrative medicine was significantly in relieving joint pain and alleviating the disease.

  6. 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.

  7. Large Vessel Vasculitis Occurring in Rheumatoid Arthritis Patient under Anti-TNF Therapy

    Directory of Open Access Journals (Sweden)

    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.

  8. Adalimumab-induced acute interstitial lung disease in a patient with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    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.

  9. CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS WITHIN THE REMARCA STUDY: PRELIMINARY DATA

    Directory of Open Access Journals (Sweden)

    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. Small Airways Involvement in Patients with Rheumatoid Arthritis

    OpenAIRE

    2012-01-01

    Objectives: One of the common causes of morbidity in patients with RA is pulmonary involvement. Some studies have shown that the possible abnormal results of pulmonary function tests in rheumatoid disease are higher than usual. We aimed to evaluate the prevalence of spirometric abnormalities in patients with RA. Materials & Methods: This case-control study was conducted on 99 patients with RA who referred to a rheumatology clinic in Qazvin, northwest Iran. Sixty five age- and sex-matched heal...

  11. 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.

  12. Identification of novel autoantigen in the synovial fluid of rheumatoid arthritis patients using an immunoproteomics approach.

    Directory of Open Access Journals (Sweden)

    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

  13. 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

  14. 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. PMID:23800448

  15. Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient

    Directory of Open Access Journals (Sweden)

    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.

  16. Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry

    DEFF Research Database (Denmark)

    Pedersen, Line Merete Blak; Klarlund, Mette; Jacobsen, Søren;

    2004-01-01

    of rheumatoid arthritis (RA) diagnoses recorded in the NPR. We identified medical records for 217 patients recorded as having RA in the NPR between 1977 and 2001. Using two definitions of RA (clinically confirmed RA and fulfilment of the American College of Rheumatology (ACR) 1987 diagnostic criteria for RA...... to RA satisfying the ACR 1987 classification criteria was estimated to 26%. Our conclusion is that with careful attention to the limitations in the data, discharge diagnoses for patients with records of RA in the Danish NPR can be used for epidemiological research purposes; however, our findings prompt...

  17. The use of TNF-α blockers in psoriatic arthritis patients with latent tuberculosis infection

    OpenAIRE

    Atteno, Mariangela; Costa, Luisa; Matarese, Alessandro; Caso, Francesco; Del Puente, Antonio; Cantarini, Luca; Bocchino, Maria Luisa; Sanduzzi, Alessandro; Scarpa, Raffaele

    2014-01-01

    Psoriatic arthritis (PsA) is an inflammatory arthropathy associated with skin and/or nail psoriasis. TNF-α is an essential cytokine for the host defense, and its depletion by treatment may facilitate the risk of infections or their reactivation. The aim of this study was to evaluate the efficacy and safety of TNF-α blockers in patients with PsA and concomitant latent tuberculosis infection (LTBI) comparing their outcome with non-infected PsA patients. This is a retrospective study in 321 pati...

  18. Trends of inflammatory markers and cytokines after one month of phototherapy in patients with rheumatoid arthritis

    OpenAIRE

    José Meneses Calderón; Irma González Sánchez; Guillermo Aburto Huacuz; Arely Sarai Alonso Barreto; María del Carmen Colín Ferreyra; Hugo Mendieta Zerón

    2015-01-01

    Objective. to evaluate changes in the expression of tumor necrosis factor-α in patients with rheumatoid arthritis submitted to phototherapy. Materials and methods. This was an open label study, enrolling ten patients. The phototherapy scheme within a range of 425 to 650 nm, 11.33 Joules/cm2, 30 cm above the chest was as follows: a) 45-min daily sessions from Monday to Friday for 2 to 3 months; b) three, 45min weekly sessions for 1 to 2 months; c) twice weekly 45-min sessions for 1 to 2 months...

  19. 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...

  20. 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

    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....... 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...

  1. Association between Periodontal Disease and serum levels of IL-17 in Patients with Rheumatoid Arthritis

    OpenAIRE

    Kiani F; Setoudeh Maram Sh.; Masoumi S.; Kamali sarvestani E.; Aflaki E.

    2012-01-01

    Statement of Problem: Several lines of evidence have indicated that IL-17 might be important in the pathogenesis of RA and chronic periodontitis. IL-17 could be secreted primarily by T-helper cells.Purpose: The purpose of this study was to evaluate periodontal status of rheumatoid arthritis patients and its correlation with serum level of IL-17 in comparison to chronic periodontitis patients. Materials and Method: In the present case-control study, serum level of I1-17 was determined by Eliza...

  2. [The effect of Na-aurothiomalate on circulating immune complex dynamics in patients with rheumatoid arthritis].

    Science.gov (United States)

    Vlak, T; Jajić, I

    1992-01-01

    The objective of this research has been to determine the efficacy of Na-aurothiomalate, under the trade name Tauredon, on the development of circulating immune complexes (CIC) in patients with rheumatoid arthritis. During a continuous six month administering of Tauredon to a group of patients with the diagnosis of rheumatoid arthritis various parameters have been observed. The group comprised 43 patients, 8 men and 35 women, their average age being 50. By continuous observations of both the patients and their laboratory reports in regular intervals during six-month administering of Tauredon, a positive effect of Tauredon on the development of the CIC IgM values (P = 0.006) has been proved, i.e. reducing their level in the patients' serum. Owing to great individual differences in the decrease of the CIC IgG values, it has been difficult to prove the consequences of this fall (P = 0.086). The impossibility of testing the significant decrease of the CIC IgA values is due to a small number of patients with the positive CIC IgA values. PMID:1366145

  3. Openness to and preference for attributes of biologic therapy prior to initiation among patients with rheumatoid arthritis: patient and rheumatologist perspectives and implications for decision making

    Science.gov (United States)

    Bolge, Susan C; Goren, Amir; Brown, Duncan; Ginsberg, Seth; Allen, Isabel

    2016-01-01

    Purpose Despite American College of Rheumatology recommendations, appropriate and timely initiation of biologic therapies does not always occur. This study examined openness to and preference for attributes of biologic therapies among patients with rheumatoid arthritis (RA), differences in patients’ and rheumatologists’ perceptions, and discussions around biologic therapy initiation. Patients and methods A self-administered online survey was completed by 243 adult patients with RA in the US who were taking disease-modifying antirheumatic drugs (DMARDs) and had never taken, but had discussed biologic therapy with a rheumatologist. Patients were recruited from a consumer panel (n=142) and patient advocacy organization (n=101). A separate survey was completed by 103 rheumatologists who treated at least 25 patients with RA per month with biologic therapy. Descriptive and bivariate analyses were conducted separately for patients and rheumatologists. Attributes of biologic therapy included route of administration (intravenous infusion or subcutaneous injection), frequency of injections/infusions, and duration of infusion. Results Over half of patients (53.1%) were open to both intravenous infusion and subcutaneous injection, whereas rheumatologists reported 40.7% of patients would be open to both. Only 26.3% of patients strongly preferred subcutaneous injection, whereas rheumatologists reported 35.2%. Discrepancies were even more pronounced among specific patient types (eg, older vs younger patients and Medicare recipients). Among patients, 23% reported initiating discussion about biologics and 54% reported their rheumatologist initiated the discussion. A majority of rheumatologists reported discussing in detail several key aspects of biologics, whereas a minority of patients reported the same. Conclusion Preferences differed among patients with RA from rheumatologists’ perceptions of these preferences for biologic therapy, including greater openness to intravenous

  4. Viral arthritis.

    Science.gov (United States)

    Marks, Michael; Marks, Jonathan L

    2016-04-01

    Acute-onset arthritis is a common clinical problem facing both the general clinician and the rheumatologist. A viral aetiology is though to be responsible for approximately 1% of all cases of acute arthritis with a wide range of causal agents recognised. The epidemiology of acute viral arthritis continues to evolve, with some aetiologies, such as rubella, becoming less common due to vaccination, while some vector-borne viruses have become more widespread. A travel history therefore forms an important part of the assessment of patients presenting with an acute arthritis. Worldwide, parvovirus B19, hepatitis B and C, HIV and the alphaviruses are among the most important causes of virally mediated arthritis. Targeted serological testing may be of value in establishing a diagnosis, and clinicians must also be aware that low-titre autoantibodies, such as rheumatoid factor and antinuclear antibody, can occur in the context of acute viral arthritis. A careful consideration of epidemiological, clinical and serological features is therefore required to guide clinicians in making diagnostic and treatment decisions. While most virally mediated arthritides are self-limiting some warrant the initiation of specific antiviral therapy. PMID:27037381

  5. Monitoring multiple myeloma patients treated with daratumumab

    DEFF Research Database (Denmark)

    McCudden, Christopher; Axel, Amy E; Slaets, Dominique;

    2016-01-01

    and IFE can confound the use of these tests for response assessment in clinical trials and disease monitoring. METHODS: To discriminate between endogenous myeloma protein and daratumumab, a daratumumab-specific immunofixation electrophoresis reflex assay (DIRA) was developed using a mouse anti......-daratumumab antibody. To evaluate whether anti-daratumumab bound to and shifted the migration pattern of daratumumab, it was spiked into daratumumab-containing serum and resolved by IFE/SPE. The presence (DIRA positive) or absence (DIRA negative) of residual M-protein in daratumumab-treated patient samples...... was evaluated using predetermined assessment criteria. DIRA was evaluated for specificity, limit of sensitivity, and reproducibility. RESULTS: In all of the tested samples, DIRA distinguished between daratumumab and residual M-protein in commercial serum samples spiked with daratumumab and in daratumumab...

  6. Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol

    Directory of Open Access Journals (Sweden)

    Paudyal Priyamvada

    2012-07-01

    Full Text Available Abstract Background Rheumatoid arthritis is a chronic inflammatory condition that affects the joints causing unpredictable episodes of pain, stiffness and disability. People with rheumatoid arthritis usually require lifelong specialist follow-up but frequently have periods when their disease can be managed through self-care or that provided by their general practitioner. Compared to the traditional clinician-driven care in rheumatoid arthritis, patient-initiated care has proven to be more beneficial in terms of reducing unnecessary medical reviews, providing greater satisfaction to patients and staffs and maintaining the patient’s physical and psychological status. We aim to evaluate the implementation of a patient-initiated review system in a routine secondary care rheumatology service in a public hospital in England, where patients get the opportunity to self-manage their disease by requesting specialist reviews at times of need instead of clinician-scheduled appointments. Methods/design Three hundred and eighty patients attending routine review at Plymouth Hospitals NHS Trust will be randomised to either enrol immediately into a patient-initiated review system (direct access group, or to be seen regularly by a clinician at the hospital (regular clinician-initiated group. Patients (or their general practitioner in the direct access group can arrange a review by calling a rheumatology nurse-led advice line that enables telephone delivered clinical advice, or where appropriate, an appointment with a rheumatologist within 10 working days. Patients in the regular clinician-initiated group will attend their planned appointments at regular intervals during the intervening period of 12 months. The primary outcome of interest is patient satisfaction; secondary outcomes include service use, waiting times and clinical measures. Semi-structured, in-depth interviews will be conducted with a subset of patients and staff with the aim of identifying

  7. Blood flow in the forearm in patients with Rheumatoid arthritis and healthy subjects under local thermotherapy

    Directory of Open Access Journals (Sweden)

    C. Mucha

    2002-02-01

    Full Text Available Objectives: Muscle blood flow in the forearm of patients with rheuma-toid arthritis and healthy volunteers following treatment with temperature increasingarm baths, mudpacks and short- or decimeter-wave diathermy was studied in thisinvestigation. The aim of the study was to find out the difference of reactive hyperemia between the different temperature methods as well as the influence on theconsensual reaction. Subjects: Eighty patients with rheumatoid arthritis, stage 3 according toSteinbrocker, as well as 80 healthy human subjects had been assigned numerically in the four therapy- and controlgroups. Patients with diseases influencing the peripheral blood flow were excluded. Design: Blood flow was measured by venous occlusion plethysmography in both forearms with the subjects lyingsupine. The application of the local heat therapies had been excluded on the left forearm. The forearm blood flow wasmonitored before heat therapy, directly after as well as in two further 10 minutes intervals. An analysis of variancewas used to determine the influence on blood flow of the response to the heat therapies in patients with rheumatoidarthritis and healthy subjects.Results: Under homogeneous starting conditions and a statistically uniformed high blood flow in rest the reactive values of blood flow on the left-hand side of application and the right consensual side showed high significant differencesbetween all methods of therapy. Differences between the patients and the healthy subjects only showed tendencies withpartially lower reactions, concerning the patients with rheumatoid arthritis. All methods of heat therapy caused a statistically provable consensual reaction that turned out smaller after diathermic methods. Here the post therapeuticreaction of the blood flow on the side of application was also lower or rather shorter. Conclusion: Greater differences of the blood flow in rest between the patients with rheumatoid arthritis and healthysubjects

  8. Serum levels of parathyroid hormone and markers of bone metabolism in patients with rheumatoid arthritis. Relationship to disease activity and glucocorticoid treatment

    DEFF Research Database (Denmark)

    Jensen, Tonny Joran; Hansen, M; Madsen, J C;

    2001-01-01

    OBJECTIVE: To evaluate the influence of inflammatory activity and glucocorticoid (GC) treatment on serum parathyroid hormone (s-PTH) and bone metabolism in patients with rheumatoid arthritis (RA). Furthermore, in patients with active RA, to examine the PTH secretion and Ca2+ set point before...... and after treatment with GC. METHODS: A range of biochemical markers of bone metabolism and calcium homeostasis were measured in 95 patients with definite RA stratified into groups according to disease activity and GC treatment. In a subgroup of 12 patients with active disease, initiating slow...... groups. The levels of urine pyridinoline (Pyr) and s-albumin-corrected calcium (s-AlbCorrCa2+) were elevated in patients with active disease and patients treated with GC. S-PTH and s-phosphate were within normal ranges. S-TAP, s-ICTP, Pyr and s-AlbCorrCa2+ correlated positively with indices of disease...

  9. Features of diagnosis and treatment of anemic syndrome in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    N V Koryakova

    2009-01-01

    Full Text Available Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\\l for men and less than 120g\\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV, mean concentration of hemoglobin (MCH, serum iron and ferritin was carried out. In a part of pts serum transferrin receptor and erythropoietin concentrations was defined. 30 pts were examined after 6 month of disease modifying therapy. Results. In 49(79 % of the pts the anemia was an easy degree of weight, MCH decreased in 33(53 % of the pts and 15(24 % pts had decreased values for MCV. Deficiency of iron in 16(26% of pts has been established at research of concentration a ferritin, sTfR and an index sTfR \\log ferritin. At the dynamic research after 6 month of disease modifying therapy the authentic gain levels of hemoglobin, red cells count and serum iron significantly increased in the pts with good and satisfactory effect of therapy. Сonclusion. Definition of MCH, MCV and ferrokinetic data for assessment of iron defi- ciency in the RА pts is necessary. sTfR and sTfR\\log ferritin may be study for pts with normal and increased ferritin levels. The major factor influencing on the course of anemia of chronic disease in the rheumatoid arthritis pts is the course rheumatoid arthritis, that efficacy disease modifying treatment to control.

  10. Candida tropicalis arthritis of the elbow in a patient with Ewing’s sarcoma that successfully responded to itraconazole

    Directory of Open Access Journals (Sweden)

    Seung Youn Kim

    2011-09-01

    Full Text Available Fungal infections are rarely responsible for arthritis. Few cases of fungal arthritis have been reported, even in immunocompromised hosts susceptible to low-virulence organisms. Herein, the authors report the first case of Candida tropicalis arthritis in a child with a solid tumor. A 13-year-old boy with Ewing’s sarcoma developed arthritis in his elbow during the neutropenic period after chemotherapy. Despite treatment with broad-spectrum antibiotics, his condition did not improve and serial blood cultures failed to reveal any causative organisms. After surgical drainage, culture of the joint fluid revealed the presence of C. tropicalis . Itraconazole treatment was started and after 3 months of therapy, the patient completely recovered full elbow function.

  11. Lipid Extract from Hard-Shelled Mussel (Mytilus coruscus Improves Clinical Conditions of Patients with Rheumatoid Arthritis: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Yuanqing Fu

    2015-01-01

    Full Text Available Studies have suggested a lipid extract from hard-shelled mussel (Mytilus coruscus (HMLE possessed strong anti-inflammatory activity in arthritis model of rats. This study investigated whether HMLE could improve clinical conditions of rheumatoid arthritis patients. Fifty rheumatoid arthritis patients (28–75 years were randomly assigned to receive HMLE capsules or receive placebo capsules for 6 months. Forty-two subjects and 50 subjects were included in per-protocol and intention-to-treat analysis, respectively. Significant differences in changes on disease activity score (DAS28 and clinical disease activity index (CDAI after 6-month intervention (p < 0.01 were observed in both analyses with more evident efficacy shown in per-protocol population (∆DAS28 = 0.47; ∆CDAI = 4.17, which favored the benefits of the HMLE group. TNF-α (tumor necrosis factor α, interleukin (IL-1β and PGE2 (prostaglandin E2 but not IL-6, were significantly decreased in both groups, and the decrements were much larger in the HMLE group for TNF-α and PGE2 after 6 months from baseline (p < 0.05. IL-10 was significantly increased in both groups and the change was much more evident in the HMLE group (p < 0.05. In conclusion, HMLE exhibited benefits for the clinical conditions of rheumatoid patients in relation to improvement in the balance between pro- and anti-inflammatory factors, which indicated its potential to serve as adjunctive treatment for rheumatoid arthritis. (ClinicalTrials.gov NCT02173587.

  12. HLA-DRB1 ALLELES GENOTYPING IN PATIENTS WITH RHEUMATOID ARTHRITIS IN CHINESE

    Institute of Scientific and Technical Information of China (English)

    赵岩; 董怡; 朱席林; 邱长春

    1996-01-01

    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 with rheumatoid arthritis and 106 race matched controls were studied in whom HLA-DR typing was perfomed by the method of DNA amplification with sequence-specific primers(PCR-SSP). The subtypes of HLA-DR4 were determined by the method of hybridization of PCR products with sequence-specific oligonucletides(PCR SSO). The absence or presence of the patients.Results.Compared with controls,an increased gene frequency of HLA-DR4(48.8% vs 17.9%,P<0.001) and a decreased frequency of HLA-DR7(16.3% vs 27.4%,P=0.06) were found.The DRB1 0405 account for 61.9% of DR4+RA patients with respect to age,sex,duration of disease,rheumatoid factor(RF),extra-articular manifestations including secondary Sjogren's syndrome.According to the wrisr X-ray stage,the patlents of DR4+were more severe than that of DR4-P(P<0.05).Conclusion.HLA-DR4 and DR4 subtype of DRB1 0405 are related to the development of RA in Chinese.HLA-DR4 can be a useful prognosric marker in the patients with RA.

  13. Association between Periodontal Disease and serum levels of IL-17 in Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Kiani F.

    2012-02-01

    Full Text Available Statement of Problem: Several lines of evidence have indicated that IL-17 might be important in the pathogenesis of RA and chronic periodontitis. IL-17 could be secreted primarily by T-helper cells.Purpose: The purpose of this study was to evaluate periodontal status of rheumatoid arthritis patients and its correlation with serum level of IL-17 in comparison to chronic periodontitis patients. Materials and Method: In the present case-control study, serum level of I1-17 was determined by Eliza technique using PCR-RFLP method in 142 RA patients and 106 control subjects. Specific measures for periodontitis included probing pocket depth (PDD, clinical attachment level (CAL. Bleeding score (BI and plaque score (PI were also assessed and compared in the two groups.Results: No significant association was found between different paraclinical findings (including CRP, RF, ESR and age of the onset of RA. The highest level of IL-17 was found in RA patients with moderate to severe periodontitis ( p =0.013. The prevalence and severity of periodontitis were higher in the test group. In the present study, Kruskal-Wallis test was used for evaluation of serum level of IL-17.Conclusion: The findings of the present study suggest that rheumatoid arthritis patients are prone to severe periodontitis and the level of IL-17 in the serum is positively associated with severity of periodontitis.

  14. REHABILITATIVE TACTICS OF TREATMENT OF PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    T A Shelepina

    2001-01-01

    Full Text Available Summary The aim of the study is the substantiation of movement regimen for children with JCA and damage of hip joints. 20 patients with prevalent hip joints damages in clinical picture were examined. Clinical, laboratory, anthropometric methods and U-sound diagnostics were used. Basing on the analysis of anamnestic, clinical data and U-sound examination the regimen of loads for patients with hip joints damage was substantiated. Method of Junctional treatment was suggested including the treatment by position, exercise therapy in combination with gradually increasing regimen of locomotive loads, its efficacy was assessed.

  15. Responsiveness of health status measures and utility-based methods in patients with rheumatoid arthritis.

    Science.gov (United States)

    Salaffi, F; Stancati, A; Carotti, M

    2002-11-01

    The aim of the study was to compare the responsiveness of disease-specific (Arthritis Impact Measurement Scale 2, AIMS2), generic (Medical Outcome Study Short Form Health Survey, SF-36) and preference-based instruments (rating scale, RS and time tradeoff, TTO) to changes in articular status and perceived health in patients with rheumatoid arthritis (RA). Seventy-eight consecutive patients with RA, attending the care facilities of the Department of Rheumatology of Ancona, were recruited in this longitudinal study. In order to assess the responsiveness three strategies were used: effect size (ES), standardised response mean (SRM) and receiver operating characteristic (ROC). There were 55 women and 23 men with a mean age of 56 years (range 19-78) and arthritis duration of 7.1 years (range 6 months to 24 years). Using three-category EULAR criteria as external indicators of improvement/response, 21 patients (27%) reported a significant improvement, 23 (29.5%) moderate improvement, and 34 (43.5%) no change over the 12-month period. The mean change scores in generic and specific health status instruments and utility measures were significantly related to response category. The AIMS2 subscales (physical function, pain, psychological function and social interaction) were slightly more responsive than those of SF-36. The physical and pain dimensions were most sensitive for measuring change over a 12-month period, followed by psychological and social dimensions. For the utility measurement, RS scores were found to be significantly more responsive in detecting changes in preferences than TTO scores. These results may have implications for the application of the health status and utility measures in clinical trials in patients with RA. PMID:12447631

  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. Satisfaction with Access to Health Services: The Perspective of Estonian Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Kaja Põlluste

    2012-01-01

    Full Text Available In this cross-sectional study we explained the possible determinants of satisfaction with access to health services in patients with rheumatoid arthritis (RA. Of the 2000 randomly selected Estonian adult patients with RA, a total 1259 completed the survey. Regression analysis was used to analyse the predictors of patients' satisfaction with access to health services. Half of the respondents were satisfied with their access to health services. Factors that had a negative impact on satisfaction included pain intensity, longer waiting times to see the doctors, as well as low satisfaction with the doctors. Transportation costs to visit a rheumatologist and higher rehabilitation expenses also affected the degree of satisfaction. Patients who could choose the date and time at which they could visit the rheumatologist or who could visit their “own” doctor were more likely to be satisfied than patients whose appointment times were appointed by a healthcare provider.

  18. Contact frequency, travel time, and travel costs for patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Sørensen, Jan; Linde, Louise; Hetland, Merete Lund

    2014-01-01

    Objectives. To investigate travel time, and travel cost related to contacts with health care providers for patients with rheumatoid arthritis (RA) during a three-month period. Methods. Patient-reported travel time and travel cost were obtained from 2847 patients with RA. Eleven outpatient clinics...... across Denmark recruited patients to the study. Data collected included frequency, travel time and travel costs for contacts at rheumatology outpatient clinics, other outpatient clinics, general practitioners, privately practicing medical specialists, inpatient hospitals and accident and emergency...... and 13 € on travelling per contact, corresponding to a total of 4.6 hours and 56 € during the 3-month period. There was great variation in patient travel time and costs, but no statistically significant associations were found with clinical and sociodemographic characteristics. Conclusion. The results...

  19. An Unexpected Cause of Knee Pain in a Patient with Juvenile Idiopathic Arthritis: Osteoid Osteoma

    Directory of Open Access Journals (Sweden)

    Mehmet Eroğlu

    2014-06-01

    Full Text Available Patients with chronic diseases may sometimes be underestimated because of the relapsing nature of the disease and thus some newly developing phenomena may be overlooked. In this case we present a 12- year old female patient who was followed up for juvenile idiopathic arthritis and applied to us as an exacerbation of the disease. After initiation of therapy all her complaints but the right knee improved. In the examination of knee, limitation in hip movements was detected. X- ray of the hip revealed a mass neighboring the minor trochanter. On magnetic resonance imaging the mass was detected to be an osteoid osteoma. The patient is free of pain with conservative treatment for tumor after twelve months. It is important to evaluate the patient thoroughly without focusing on a single point and keep in mind that in especially skeletally immature patients hip pain can be felt in the knee.

  20. Septic arthritis caused by Aspergillus fumigatus in an immunosuppressive patient: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Tuba Dal

    2012-03-01

    Full Text Available Septic arthritis is a serious medical problem that causes rapidly chronic and irreversible joint damage when diagnosisand treatment are delayed. Although, the bacteria are the most frequent cause of septic arthritis, rarely fungi may beresponsible for this disease. We presented here a case of septic arthritis caused by Aspergillus fumigatus, developed ina 65 years-old-male patient with diabetes mellitus. The patient admitted to our hospital with complaints of pain, swelling,redness in the right knee and high fever, which are not exceeding despite using vancomycin and ceftriaxone for 18days. Imipenem was started to the patient in our hospital. At the end of 7 days because of no regression of patient’scomplaints, arthroscopic synovectomy and lavage were performed for the patient’s right knee. Aspergillus fumigatuswas isolated from the aspiration biopsy specimen that received during the surgical operation and patient was treatedwith voriconazole, successfully. J Microbiol Infect Dis 2012; 2(1: 29-32

  1. AN INTERESTING CASE OF PNEUMOTHORAX IN RHEUMATOID ARTHRITIS

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    Shruthi

    2014-11-01

    Full Text Available : Rheumatoid Arthritis is a multisystem disease with pulmonary manifestations including idiopathic pulmonary fibrosis, obliterative bronchiolitis, pneumonitis, bronchiectasis as well as pneumothorax. Cases of rheumatoid arthritis with active tuberculosis disease have been documented as well as reactivation of latent tuberculosis as a result of methotrexate therapy with or without systemic steroids has led to a renewed interest in the association of the two diseases. We report the case of rheumatoid arthritis in a young female patient who presented with cough and fever of fortnight duration and rapidly developed spontaneous pneumothorax that eventually required surgical pneumonectomy. CONCLUSION: Even though patients with rheumatoid arthritis can present with spontaneous pneumothorax due to rupture of rheumatic nodules, Common diseases like tuberculosis should be kept in mind while treating pulmonary complaints in patients with rheumatoid arthritis, especially those who are on methotrexate therapy

  2. Promoting physical activity in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Berg, Machteld Heleen van den

    2007-01-01

    The aim of the thesis was to study: 1. The engagement of patients with RA in various forms of physical activity and their preferences regarding the delivery of physical activity interventions; 2. The evidence regarding the effectiveness of physical activity interventions delivered by means of the I

  3. The effect of TNFalpha blockade on the antinuclear antibody profile in patients with chronic arthritis: biological and clinical implications.

    Science.gov (United States)

    De Rycke, L; Baeten, D; Kruithof, E; Van den Bosch, F; Veys, E M; De Keyser, F

    2005-01-01

    Since the first proof of efficacy of TNFalpha blockade, both the number of patients treated worldwide and the number of indications for treatment with TNFalpha blockers have grown steadily. Surprisingly, the profound immunomodulation induced by anti-TNFalpha therapy is associated with a relatively low incidence of immune-related complications such as lupus-like syndromes and demyelinating disease. This contrasts sharply with the prominent induction of autoantibodies such as antinuclear antibodies (ANA) and anti-dsDNA antibodies during TNFalpha blockade. Although this phenomenon has been recognized for several years, the clinical and biological implications are not yet fully understood. In this review, recent studies analysing the effect of TNFalpha blockade (infliximab and etanercept) on the ANA profile in autoimmune arthritis will be discussed. Taken together, these reports indicate that the prominent ANA and anti-dsDNA autoantibody response is 1) not a pure class effect of TNFalpha blockers, 2) independent of the disease background, 3) largely restricted to the induction of short-term IgM anti-dsDNA antibodies, and 4) not associated with other serological or clinically relevant signs of lupus. Nevertheless, a careful follow-up of patients treated with TNFalpha blockers remains mandatory, including monitoring for lupus-like characteristics.

  4. Most Trial Eligibility Criteria and Patient Baseline Characteristics Do Not Modify Treatment Effect in Trials Using Targeted Therapies for Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Christensen, Anton Wulf; Tarp, Simon; Furst, Daniel E;

    2015-01-01

    )) for rheumatoid arthritis (RA). METHODS: We conducted a meta-epidemiological study of all trials evaluating a targeted therapy approved by regulatory authorities for treating RA. The database search was completed on December 11th 2013. Eligible trials reported ACR20 data at months 3-6 and used an add-on design......OBJECTIVE: To determine if variations in trial eligibility criteria and patient baseline characteristics could be considered effect modifiers of the treatment response when testing targeted therapies (biological agents and targeted synthetic disease modifying antirheumatic drugs (DMARDs...

  5. Leflunomide in treating rheumatoid arthritis: a double-blind study%来氟米特治疗类风湿关节炎双盲试验

    Institute of Scientific and Technical Information of China (English)

    劳志英; 倪立青; 张之澧; 周嘉陵; 陈丽华; 张芳; 刘大栋; 杨晓凌; 朱琦; 张湛明; 沈杰

    2001-01-01

    目的:比较来氟米特和甲氨蝶呤治疗类风湿关节炎的疗效及安全性。方法:80例类风湿关节炎病人、随机分配入2组,各组40例。2组病人于试验前1 wk停用原有非甾体抗炎药,服用奥沙普秦(oxaprozin)每晚2片。第1组服抗炎1号,每日2片;抗炎3号,每周1次,每次6片。第2组服抗炎2号,每日2片;抗炎4号每周1次,每次6片。4~6 wk后2组停用奥沙普秦,其余服药至24 wk后揭盲。结果:来氟米特组总有效率93 %,显效85 %,甲氨蝶呤组分别为93 %和83 %,P>0.05。不良反应:来氟米特组9例占23%,甲氨蝶呤组17例占43 %。结论:来氟米特疗效与甲氨蝶呤相似,不良反应则较低。%treating rheumatoid arthritis. METHODS: Eighty patients with rheumatoid arthritis were randomly divided into two groups with each group having 40 patients. Group one (M 8, F 32; age 46 a± s 11 a; disease history 63 mo±48 mo) was treated with anti-inflammation sub-group No.1 and No.3. Group two (M 6, F 34; 44 a±9 a; disease history 45 mo±45 mo) was treated with sub-group No.2 and No.4. One week before the initiate of the study, the originally used non-steroid anti-inflammation drugs were stopped for all two-groups patients and each patient took 2 tablets of oxaprozin po qn. At the beginning of the study the patients received 2 tablets of anti-inflammation drugs No.1 daily and 6 tables of No.3 weekly in 1st group, and 2 tablets of anti-inflammation drugs No.2 daily and 6 tablets of No.4 weekly in 2nd group respectively. RESULTS: In the leflunomide group, the total effect rate was 93 % and the remarkable improvement rate was 85 %. In the methotrexate group, the total effect rate was also 93 % and the remarkable effect rate was 83 %, P>0.05. Nine patients (23 %) in leflunomide group had adverse reaction as mainly skin itch, nettle-like rash, decrease of leukocytes, liver malfunction and others. Seventeen parients (43 %) in methotrexate

  6. Trends of inflammatory markers and cytokines after one month of phototherapy in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    José Meneses Calderón

    2015-11-01

    Full Text Available Objective. to evaluate changes in the expression of tumor necrosis factor-α in patients with rheumatoid arthritis submitted to phototherapy. Materials and methods. This was an open label study, enrolling ten patients. The phototherapy scheme within a range of 425 to 650 nm, 11.33 Joules/cm2, 30 cm above the chest was as follows: a 45-min daily sessions from Monday to Friday for 2 to 3 months; b three, 45min weekly sessions for 1 to 2 months; c twice weekly 45-min sessions for 1 to 2 months, and d one weekly session for 1 to 2 months until completion. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were measured in peripheral blood and tumor necrosis factor-α, interleukin-1β, and interleukin-10 in leukocytes by quantitative real-time Reverse transcriptase-Polymerase chain reaction. In all the patients the next indexes: Karnofsky scale, Rheumatoid Arthritis-specific quality of life instrument, Steinbrocker Functional Capacity Rating and the Visual Analog Scale were evaluated. Results. Erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor declined notoriously after the indicated sessions. In gene expression, there was a tendency in tumor necrosis factor-α to decrease after 1 month, from 24.5±11.4 to 18±9.2 relative units, without reaching a significant statistical difference. The four tested indexes showed improvement. Conclusion. Phototherapy appears to be a plausible complementary option to reduce the inflammatory component in rheumatoid arthritis.

  7. Mannose-binding lectin gene polymorphisms are associated with disease activity and physical disability in untreated, anti-cyclic citrullinated peptide-positive patients with early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Garred, Peter; Madsen, Hans Ole;

    2009-01-01

    high producers (YA/YA). Anti-CCP was present in 93 patients (59%). High scores of disease activity, C-reactive protein-based DAS28 (p=0.02), and physical disability by HAQ (p=0.01) were associated with high MBL2 expression genotypes in a gene-dose dependent way, but only in anti-CCP-positive patients......OBJECTIVE: To study the association between polymorphisms in the mannose-binding lectin gene (MBL2) and disease activity, physical disability, and joint erosions in patients with newly diagnosed rheumatoid arthritis (RA). METHODS: Patients with early RA (n=158) not previously treated with disease...... activity by Disease Activity Score-28 (DAS28 score), physical disability by Health Assessment Questionnaire (HAQ) score, and erosive changes in hands and feet (Sharp-van der Heijde score). RESULTS: Eight patients were homozygous MBL2 defective (O/O), 101 belonged to an intermediate group, and 49 were MBL2...

  8. Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction

    Directory of Open Access Journals (Sweden)

    Pokorný David

    2010-02-01

    Full Text Available Abstract Background The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. Methods Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery. Results The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years. The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain, six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case. Conclusions Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.

  9. Bioboosters in the treatment of rheumatic diseases: a comprehensive review of currently available biologics in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Fabrizio Cantini

    2009-12-01

    Full Text Available Fabrizio Cantini, Carlotta Nannini, Laura NiccoliSecond Division of Medicine, Rheumatology Unit, Hospital of Prato, ItalyAbstract: Immunologic research has clarified many aspects of the pathogenesis of inflammatory rheumatic disorders. Biologic drugs acting on different steps of the immune response, including cytokines, B- and T-cell lymphocytes, have been marketed over the past 10 years for the treatment of rheumatoid arthritis (RA, ankylosing spondylitis (AS, and psoriatic arthritis (PsA. Randomized controlled trials (RCTs of anti-cytokine agents in RA (including the anti-tumor necrosis factor alpha (TNFα drugs infliximab, etanercept, adalimumab, golimumab, certolizumab, anti-interleukin (IL-1 anakinra, and anti-IL-6 tocilizumab demonstrated a significant efficacy compared to traditional therapies, if combined with methotrexate (MTX, as measured by ACR 20, 50 and 70 response criteria. The new therapies have also been demonstrated to be superior to MTX in slowing or halting articular damage. RCTs have shown the efficacy of anti-TNFα in AS patients through significant improvement of symptoms and function. Trials of anti-TNFα in PsA patients showed marked improvement of articular symptoms for psoriasis and radiological disease progression. More recent studies have demonstrated the efficacy of B-cell depletion with rituximab, and T-cell inactivation with abatacept. All these drugs have a satisfactory safety profile. This paper reviews the different aspects of efficacy and tolerability of biologics in the therapy of RA, AS, and PsA.Keywords: anti-TNF, anti-cytokine agents, rituximab, abatacept, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis

  10. Self-reported adherence to a home-based exercise program among patients affected by psoriatic arthritis with minimal disease activity.

    Science.gov (United States)

    Chimenti, Maria Sole; Triggianese, Paola; Conigliaro, Paola; Santoro, Matteo; Lucchetti, Ramona; Perricone, Roberto

    2014-11-01

    More than half of all patients with psoriatic arthritis (PsA) exhibit progressive erosive arthritis, associated with severe functional impairment and psychosocial disability. Biologics have been suggested to be more effective in inducing minimal disease activity" (MDA) than disease-modifying antirheumatic drugs (DMARDs). Behavioral patient education appears to be more effective in encouraging patients to increase their physical activity (PA) levels. The aim of the study was to evaluate the benefits of home-based exercises program on disease activity and quality of life in MDA-PsA patients treated with an anti-tumor necrosis factor (TNF) and DMARD therapy. We observed a self-reported adherence rate to home-based exercise of 76.6% and data showed the impact of the exercise program on self-reported health and mental assessment. A positive relationship between patient and therapist is crucial, influencing the quality of the performance, the emotional support, and increasing motivation in PsA patients. PMID:25381979

  11. Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies

    Directory of Open Access Journals (Sweden)

    Receveur Marie-Catherine

    2009-12-01

    Full Text Available Abstract Background Chikungunya fever is an emerging arboviral disease characterized by an algo-eruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years. Up to now, the pathophysiology of the chronic stage is poorly understood. Case presentation We report the first case of CHIKV infection with chronic associated rheumatism in a patient who developed progressive erosive arthritis with expression of inflammatory mediators and persistence of specific IgM antibodies over 24 months following infection. Conclusions Understanding the specific features of chikungunya virus as well as how the virus interacts with its host are essential for the prevention, treatment or cure of chikungunya disease.

  12. Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial

    OpenAIRE

    Van den Ende, C H M; Breedveld, F.; Le Cessie, S; Dijkmans, B; de Mug, A W; Hazes, J

    2000-01-01

    OBJECTIVE—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 because of active disease, were randomly assigned to an intensive exercise programme or to a conservative exercise programme during their period in hospital with a mean length of 30 (14) days. The intensive...

  13. SECONDARY AMYLOIDOSIS WITH LUNG INVOLVEMENT INA FEMALE PATIENT WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Irina Mikhailovna Marusenko

    2009-01-01

    Full Text Available The paper considers the problem of secondary amyloidosis that more frequently occurs in patients with various arthritides, both seropositive and seronegative. According to the data available in the literature, the most common manifestations of secondary amyloidosis are involvements of the kidney, liver, nervous system, and, less frequently, the lung. The authors describe their own observation of secondary amyloidosis in rheumatoid arthritis, which is accompanied by the involvement of the lung, kidney, and intestine, resulting in fatal outcome. The lifetime diagnosis of amyloidosis was histologically verified.

  14. Patients' Experiences of Nurse-Led Screening for Cardiovascular Risk in Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Frølund, Jannie Christina; Primdahl, Jette

    2015-01-01

    are screened for CVD. Such information is important in order to organize and further develop screening programmes for CVD in patients with RA. The aim of the present study was to explore RA patients' experiences of participation in nurse-led screening for CVD and to identify key issues for the future......BACKGROUND: Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular disease (CVD). Screening for cardiovascular risk is recommended by the European League Against Rheumatism (EULAR). There is a lack of evidence of the experiences of RA patients who...... organization of screening programmes. METHODS: Three qualitative focus group interviews were carried out with 14 outpatients diagnosed with RA. The participants were stratified into groups, depending on whether they had a low-to-moderate or high ten-year risk of cardiovascular death according to the European...

  15. Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

    Science.gov (United States)

    Stundner, Ottokar; Danninger, Thomas; Chiu, Ya-Lin; Sun, Xuming; Goodman, Susan M; Russell, Linda A; Figgie, Mark; Mazumdar, Madhu; Memtsoudis, Stavros G

    2013-01-01

    There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events. PMID:23764034

  16. Serum YKL-40 concentrations in patients with rheumatoid arthritis: relation to disease activity

    DEFF Research Database (Denmark)

    Johansen, J S; Stoltenberg, M; Hansen, M;

    1999-01-01

    according to disease activity in RA, but provides in some respect information different from conventional markers. Our previous studies are consistent with a local release of YKL-40 in the arthritic joint followed by a secondary increase in serum YKL-40. YKL-40 may prove to be a new tool for the study of......OBJECTIVE: YKL-40, also called human cartilage glycoprotein-39, is secreted by chondrocytes, synovial cells, macrophages and neutrophils. Studies have shown that YKL-40 is an autoantigen in rheumatoid arthritis (RA). We evaluated whether serum YKL-40 was related to disease activity in patients with...... RA. METHODS: Serum YKL-40 was determined by radioimmunoassay in 156 patients with RA during a 1 yr longitudinal study. RESULTS: Serum YKL-40 was increased in 54% of the patients with clinically active disease. Patients with clinically active disease initially who became inactive after 12 months had a...

  17. Blood levels of CD11b+ memory T lymphocytes are selectively upregulated in patients with active rheumatoid arthritis

    DEFF Research Database (Denmark)

    Nielsen, H; Petersen, A A; Skjødt, H;

    1999-01-01

    The adhesion molecules CD11b (a beta2-integrin component) and CD54 (ICAM-1) on blood leukocytes were studied by flow cytometry in patients with rheumatoid arthritis (RA). The fractions of CD4+ cells co-expressing CD11b were elevated in 16 patients with active RA compared with those in 16 RA...

  18. Adherence and satisfaction of rheumatoid arthritis patients with a long-term intensive dynamic exercise program (RAPIT program).

    NARCIS (Netherlands)

    Munneke, M.; Jong, Z. de; Zwinderman, A.H.; Jansen, A.; Ronday, H.K.; Peter, W.F.; Boonman, D.C.; Ende, C.H.M. van den; Vliet Vlieland, T.P.M.; Hazes, J.M.W.

    2003-01-01

    OBJECTIVE: To evaluate adherence and satisfaction of patients with rheumatoid arthritis (RA) in a long-term intensive dynamic exercise program. METHODS: A total of 146 RA patients started an intensive (strength and endurance training for 75 minutes, twice a week, for 2 years) exercise program (Rheum

  19. Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Ursum, J.; Horsten, N.C.; Hoeksma, A.F.; Dijkmans, B.A.; Knol, D.L.; Schaardenburg, D. van; Dekker, J.; Roorda, L.D.

    2011-01-01

    Objectives: To identify early predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis (RA). Design: A longitudinal study of an inception cohort. Setting: A large outpatient clinic. Participants: Consecutive patients who attended t

  20. Correlates of functional disability in early rheumatoid arthritis : A cross-sectional study of 706 patients in four European countries

    NARCIS (Netherlands)

    Smedstad, LM; Moum, T; Guillemin, F; Kvien, TK; Finch, MB; Suurmeijer, TPBM; vandenHeuvel, WJA

    1996-01-01

    In this cross-sectional study of 706 European patients with rheumatoid arthritis (RA) of less than or equal to 4 yr duration, we examined possible correlates of functional disability assessed by the Health Assessment Questionnaire. First, we examined a subsample of 237 Norwegian patients. The Ritchi

  1. Monitoring rheumatoid arthritis using an algorithm based on patient-reported outcome measures: a first step towards personalised healthcare

    NARCIS (Netherlands)

    Hendrikx, J.; Fransen, J.; Riel, P.L.C.M. van

    2015-01-01

    OBJECTIVES: The objective of this proof of concept study was to evaluate alerts generated by a patient-reported outcome measure (PROM)-based algorithm for monitoring patients with rheumatoid arthritis (RA). METHODS: The algorithm was constructed using an example PROM score of an equally weighted mea

  2. Infliximab has no apparent effect in the inner ear hearing function of patients with rheumatoid arthritis and ankylosing spondylitis.

    Science.gov (United States)

    Toktas, H; Okur, E; Dundar, U; Dikici, A; Kahveci, O K

    2014-01-01

    Animal studies suggest that tumor necrosis factor (TNF) alpha blockers may pass to the inner ear in adequate concentration. In this prospective study, we aimed to evaluate the effect of infliximab on the inner ear hearing function in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). The patients with high disease activity, who were planned to begin infliximab for therapy by physical medicine and rehabilitation department, were referred to ear-nose-throat clinic for consultation. After physical and otoscopic examination, audiological tests were performed. Air conduction thresholds between 250 and 8,000 Hz, bone conduction thresholds between 500 and 4,000 Hz, pure tone average, speech discrimination scores, distortion product otoacoustic emission (DPOAE) were used to evaluate the hearing function. The tests were repeated 2 and 6 months after the initiation of the drug "infliximab." A total of 44 ears of 22 patients (17 males and 5 females) were evaluated. Fifteen patients had a diagnosis of AS, and seven patients had RA. After initiation of infliximab therapy, statistically significant improvement was observed in disease activity scores [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS, Disease Activity Score 28 (DAS-28) for RA] after 2 and 6 months (p  0.05). Any problem about the balance, vertigo, or dizziness was not reported from the patients during the treatment period. As a result, our study showed that there was no notable change or deterioration in the hearing function of the patients with AS and RA who were treated with infliximab. Further studies with higher number of patients with AS and RA and also with different TNF alpha inhibitors are needed to make more valid conclusion.

  3. Silent myocardial infarction secondary to cardiac autonomic neuropathy in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Unnikrishnan, Dileep; Jacob, Aasems; Anthony Diaz, Mark; Lederman, Jeffrey

    2016-01-01

    An 83-year-old female patient with rheumatoid arthritis and hypertension presented to the emergency department with fever and chills of 1 day duration. On examination, temperature was 100.9 F, heart rate 111/min and she had orthostatic hypotension. Laboratory tests showed elevated blood urea nitrogen and white cell count. The patient underwent treatment for symptomatic urinary tract infection and while her fever and leucocytosis resolved, tachycardia persisted. An EKG done showed T inversions in leads II, III, arteriovenous fistula, V2 and V3. Troponin-I was elevated. Nuclear stress test revealed apical wall motion abnormality confirming myocardial infarction. Ewing's tests were carried out at bedside and these diagnosed severe autonomic neuropathy. Rheumatoid arthritis can cause cardiac autonomic neuropathy from chronic inflammation. This case entails the importance of assessing and detecting cardiac autonomic neuropathy in chronic inflammatory conditions, and the need to be cautious of acute coronary events in these patients, even for minimal or no symptoms. PMID:27489064

  4. Circadian rhythm of C-reactive protein in patients with rheumatoid arthritis.

    Science.gov (United States)

    Herold, M; Günther, R

    1987-01-01

    Ten men with classic rheumatoid arthritis were studied for 23 days in Badgastein, Austria, in August, 1980. One man (patient 07) showed a marked increase of disease activity after a few days. C-reactive protein (CRP) concentrations increased from 8.7 mg/dl on day 2 to 13.0 mg/dl on day 16. CRP values expressed as percent mean of a day showed a significant circadian rhythm with the acrophase at -30 degrees. For the same patient we also found significant circadian rhythms in grip strength and pearl stringing with acrophases in the evening and a circadian rhythm in walking time with the acrophase in the early morning. Seven of the ten men in the study had elevated CRP concentrations during the 3 weeks of observation. Population-mean cosinor results of CRP, grip strength, pearl stringing, and walking time revealed acrophases similar to the single cosinor results of patient 07. Our results suggest that inflammation in rheumatoid arthritis is a circadian rhythmic process with lowest disease activity in the evening.

  5. Efficacy of educational programm for patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    E V Bolshakova

    2003-01-01

    Full Text Available Objective. To estimate influence of educational programm on the level of knowledge of patients with RA about the disease, readiness for compliance, quality of life, efficiency of therapy and attitude to the disease. Methods. 103 women with RA were included in the study. They were divided into four groups: a control group, "passive" school and "active" school groups and a group with individual training (33, 21, 29 and 20 pts respectively. At the discharge from hospital and 12 months later medical estimation of patient knowledge and 10 test tasks were performed including "Index of biotic satisfaction" (N.Panin, quality of life estimation on visual analogous scale, a self-rating "of health and happiness" (Dembo- Rubinstein, "Level of social frustration" and "type of attitude to illness" (SPb Bechterev’s institute, readiness for complianse (original questionnaire. Results. At the time of discharge and in after 12 months test tasks and medical estimation of pts knowledge indices in "active" school and individual training groups were significantly higher, than in of control group and group of "passive" school (p < 0,001. The collective medical assessment demonstrated a correlation between treatment efficacy and the method of information transfer (p=0.29: p < 0,05. The quality of life correlates with the method of training according to all assessment techniques. Estimation of training method influencing on compliance provided similar results (p: = 0.45; p < 0,05. In groups of "active" school and individual training the number of pts who strictly followed the regimens of physical rehabilitation increased. Conclusion. Our data confirm the necessity of purposeful and systematic educational training in RA. The active methods and individual training promote the achievement of best results

  6. Polymorphisms within the IL-1 gene cluster: effects on cytokine profiles in peripheral blood and whole blood cell cultures of patients with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis

    DEFF Research Database (Denmark)

    Poulsen, Anne Havemose; Sørensen, Lars Korsbaek; Bendtzen, Klaus;

    2007-01-01

    Genetic polymorphisms of cytokines have been associated with the susceptibility, severity, and clinical outcome of inflammatory diseases, such as periodontitis and chronic arthritis. An important question to address is how interleukin (IL)-1 polymorphisms affect the cytokine profiles of patients ...

  7. Assessment by MRI of inflammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: results of the GO-FORWARD trial

    DEFF Research Database (Denmark)

    Conaghan, Philip G; Emery, Paul; Østergaard, Mikkel;

    2011-01-01

    To evaluate golimumab's effect on MRI-detected inflammation and structural damage in patients with active rheumatoid arthritis (RA) despite methotrexate (MTX).......To evaluate golimumab's effect on MRI-detected inflammation and structural damage in patients with active rheumatoid arthritis (RA) despite methotrexate (MTX)....

  8. Quality-Adjusted Life Expectancies in Patients with Rheumatoid Arthritis-Comparison of Index Scores from EQ-5D, 15D, and SF-6D

    DEFF Research Database (Denmark)

    Sørensen, Jan; Linde, Louise; Østergaard, Mikkel;

    2012-01-01

    The aim of this study was to compare quality-adjusted life expectancy (QALE) for patients with rheumatoid arthritis generated from three generic health-related quality-of-life instruments.......The aim of this study was to compare quality-adjusted life expectancy (QALE) for patients with rheumatoid arthritis generated from three generic health-related quality-of-life instruments....

  9. Clinical Response, Drug Survival, and Predictors Thereof Among 548 Patients With Psoriatic Arthritis Who Switched Tumor Necrosis Factor α Inhibitor Therapy

    DEFF Research Database (Denmark)

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

    2013-01-01

    To describe the frequency of treatment switching and outcomes among patients with psoriatic arthritis (PsA) who switched tumor necrosis factor α inhibitor (TNFi) agents in routine care.......To describe the frequency of treatment switching and outcomes among patients with psoriatic arthritis (PsA) who switched tumor necrosis factor α inhibitor (TNFi) agents in routine care....

  10. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial.

    NARCIS (Netherlands)

    Jong, Z. de; Munneke, M.; Zwinderman, A.H.; Kroon, H.M.; Jansen, A.; Ronday, H.K.; Schaardenburg, D. van; Dijkmans, B.A.C.; Ende, C.H.M. van den; Breedveld, F.C.; Vliet Vlieland, T.P.M.; Hazes, J.M.W.

    2003-01-01

    OBJECTIVE: There are insufficient data on the effects of long-term intensive exercise in patients with rheumatoid arthritis (RA). We undertook this randomized, controlled, multicenter trial to compare the effectiveness and safety of a 2-year intensive exercise program (Rheumatoid Arthritis Patients

  11. Adipokines in psoriatic arthritis patients: the correlations with osteoclast precursors and bone erosions.

    Directory of Open Access Journals (Sweden)

    Yu Xue

    Full Text Available Significant bone remodeling with disordered osteoclastogenesis has been implicated in the pathogenesis of psoriatic arthritis (PsA. And there is a high prevalence of the metabolic syndrome (MS in PsA patients. Adipokines, especially leptin and adiponectin, have recently been reported to be involved in the development and regulation of some autoimmune diseases. In this study, we examined the alternation of circulating osteoclastogenesis related cytokines [tumor necrosis factor-α (TNF-α, osteoprotegerin (OPG and receptor activator of nuclear factor-κB ligand (RANKL] and adipokines (leptin, adiponectin, resistin, chemerin, omentin in PsA patients, and analysed the correlations between these factors and osteoclast precursors numbers, radiographic damage scores, and disease activity index. 41 PsA patients, 20 psoriasis patients, and 24 healthy controls were recruited. Blood samples were obtained for detecting the levels of TNF-α, OPG, RANKL and the adipokines. The numbers of osteoclast precursors (OCs in peripheral blood were assessed. Radiographs of affected joints in PsA patients were scored for erosion, joint-space narrowing, osteolysis, and new bone formation. Compared with healthy controls, patients with PsA had higher TNF-α, RANKL, OCs, leptin and omentin but lower adiponectin and chemerin. Increased serum levels of TNF-α, RANKL, leptin, and omentin were positively correlated with OCs numbers. In contrast, serum adiponectin levels were decreased in PsA patients and negatively correlated with OCs numbers. TNF-α, RANKL and leptin were positively correlated with Psoriatic Arthritis Joint Activity Index (PsAJAI. Only TNF-α was positively correlated with radiographic damage scores. Our data demonstrated that systemic expression of soluble mediators of osteoclastogenesis and adipokines were disordered in PsA. Certain adipokines were elevated in the circulation of patients with PsA and might contribute to pathogenesis of arthritis. Prospective

  12. The assessment of knowledge level about their disease in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ali Yavuz Karahan

    2014-09-01

    Full Text Available Objective: This study aims to evaluate, the level of knowledge about the disease of patients with rheumatoid arthritis (RA and its relationship with the disease activity. Methods: A total of 50 patients with RA, diagnosed according to 2010 ACR/EULAR Rheumatoid Arthritis classification criteria, included in this study. Demographic features of patients were recorded. Turkish version of Patient Knowledge Questionnaire (PKQ used to evaluate the level of knowledge about the disease of patients with RA. Daily activity score (DAS-28, Health Assessment Questionnaire (HAQ and visual analog scale (VAS were used to evaluate the activity of the disease. Results: The mean age of patients was 57.2±12.2 (36 females and 14 males. The mean of disease duration was 6.2±5.8 years. The mean was 3.2 (maximum value 9 for etiology, symptom and laboratory components, the mean of medication component: 2.9 (maximum value 7, the mean of exercise component: 2.4 (maximum value 7, the mean of protection of joints and energy component: 2.4 (maximum value 7 of PKQ. The total mean point was 10.9 (maximum value 30. There was no correlation between PKQ points and HAQ, DAS-28 and VAS parameters but there was a positive correlation between disease duration and PKQ points. Conclusion: The results of the study show no relationship between level of knowledge about the disease and disease activity and also functional status. On the other hand the level of knowledge about disease of patients with RA is very low. The results show the need for education programs and informative activities about RA. J Clin Exp Invest 2014; 5 (3: 429-434

  13. Soluble P-selectin levels in synovial fluid and serum from patients with psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    G. Valesini

    2011-09-01

    Full Text Available Objective: P-selectin is an adhesion molecule expressed by activated endothelial cells and platelets favouring the leukocyte adherence to microvascular endothelium. A soluble form of this molecule has been described, whose serum levels were found to be elevated and correlate with disease activity in rheumatoid arthritis (RA patients. Aim of this study was to determine soluble P-selectin levels in synovial fluid (SF and serum from patients with psoriatic arthritis (PsA, where it has never been investigated, to define its involvement in PsA synovial damage. Methods: we analysed, by ELISA, soluble P-selectin serum and SF levels in 100 patients presenting a knee joint effusion: 38 of them presented PsA, 40 RA and 22 osteoarthritis (OA. We examined the main clinical and laboratory parameters of these patients. Soluble P-selectin serum levels were also detected in 15 healthy subjects. Results: soluble P-selectin SF levels were significantly higher in PsA and RA patients respect to OA subjects. Soluble P-selectin SF levels were lower than those found in serum and the SF/serum ratio was higher in PsA and RA patients respect to OA. Soluble P-selectin serum levels were not significantly different among patients and controls. No correlation was found between SF and serum levels of soluble P-selectin and the main clinical parameters. Conclusions: our study of soluble P-selectin in PsA reveals a prominent local role of this molecule, with no differences respect to RA. Histological findings may be of help in understanding the role of this adhesion molecule in PsA.

  14. Enteropathic Arthritis

    Science.gov (United States)

    ... Info For Teens Message Boards & Forums Donate Enteropathic Arthritis Learn About Spondylitis / Enteropathic Arthritis Overview For The ... Work and Spondylitis Spondylitis Awareness Month Overview: Enteropathic Arthritis Enteropathic (en-ter-o-path-ic) arthritis is ...

  15. [The presence of dry eye syndrome and corneal complications in patients with rheumatoid arthritis and its association with -174 gene polymorphism for interleukin 6].

    Science.gov (United States)

    Polanská, V; Serý, O; Fojtík, Z; Hlinomazová, Z

    2008-03-01

    The aim of this study was to evaluate the presence of the dry eye syndrome and corneal complications in patients with rheumatoid arthritis and to assess its association with the -174 gene polymorphism for interleukin 6. The group consisted of 123 patients treated for rheumatoid arthritis (20 men, 103 women); the mean age was 53 years (+/- 13.6). Every patient had completely ophthalmologic examination and special attention was paid to the amount of tears. The presence of corneal complications was detected in the medical history and evaluated during the slit lamp examination. In all patients the polymorphism-174 IL-6 examinations were performed. For the statistical data processing, the chi square (chi2) test for nominal variable was used. The dry eye syndrome (DES) was found in 98 eyes (79.7%), severe dry eye syndrome was detected in 53 patients (43.1%). Corneal complications appeared in 9 patients (7.3%). DES was present in 32 patients with the GG genotype (91.4%, n1 = 35), in 49 patients with the CG genotype (71.0%, n2 = 69), and in 8 patients with the CC genotype (42.1%, n3 = 19). After the statistical evaluation we have found the association between the dry eye syndrome and the GG genotype (chi2 = 8.9) and the association between less common dry eye syndrome appearance and the presence of the CC genotype (chi2 = 10.3). Severe dry eye syndrome we proved in 18 patients with GG genotype (51.4%, n1 = 35), in 31 patients with CG genotype (44.9%, n2 = 69), and in 4 patients with CC genotype CC (21.1%, n3 = 19). We proved statistically significant association between CC genotype and less often appearance of the severe dry eye syndrome (chi2 = 4.45). Corneal complications we noticed in one patient with GG genotype (2.8%, n1 = 35), in 5 patients with CG genotype (7.2%, n2 = 69), and in 3 patients with CC genotype (15.8%, n3 = 19). We did not prove statistically significant association between the 174 IL-6 polymorphism and corneal complications appearance. The 174 IL-6

  16. The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis

    OpenAIRE

    Harrison, M. J.; Davies, L M; Bansback, N. J.; McCoy, M J; Verstappen, S.M.M.; Watson, K.; Symmons, D P M; ,

    2009-01-01

    Purpose Comparative evidence regarding the responsiveness of the EQ-5D and SF-6D in arthritis patients is conflicting and insufficient across the range of disease severity. We examined the comparative responsiveness of the EQ-5D and SF-6D in cohorts of patients with early inflammatory disease through to severe rheumatoid arthritis (RA). Methods Responsiveness was tested using the effect size (ES) and standardised response mean (SRM). Correlation of change in EQ-5D and SF-6D with disease speci...

  17. Etoricoxib versus indometacin in the treatment of Chinese patients with acute gouty arthritis: a randomized double-blind trial

    Institute of Scientific and Technical Information of China (English)

    LI Ting; CHEN Shun-le; DAI Qing; HAN Xing-hai; LI Zhan-guo; WU Dong-hai; ZHANG Xiao

    2013-01-01

    Background Acute gout is an intensely painful,inflammatory arthritis.Although the non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for this condition,the efficacy is based on only a few studies,particularly in China.We tried to assess the safety and efficacy of etoricoxib in the treatment of acute gouty arthritis in China.Methods A randomized,double-blind,active comparator study was conducted at 10 sites in China.Patients (n=178; ≥18 years of age) with acute gouty attack (<48 hours) were treated for 5 days with etoricoxib (120 mg/d; n=89) or indometacin (75 mg twice daily; n=89).The primary efficacy end point was self-assessed pain in the affected joint (0-4 point Likert scale) from days 2-5.Secondary end points included investigator assessments of tenderness and swelling,patient/ investigator global assessments of response to therapy,and patients discontinuing treatment.Safety was assessed by adverse events (AEs).Results Etoricoxib and indometacin had comparable primary and secondary end points.Mean change difference from baseline from days 2-5 was 0.03 (95% confidence interval (Cl)-0.19 to 0.25; P=0.6364),which fell within the prespecified comparative bounds of-0.5 to 0.5.No severe AEs were associated with etoricoxib use.Non-severe AEs were mainly digestive and general,and most (73.7%) were mild,although they caused withdrawal of two subjects in the etoricoxib group,due to bilateral renal calculi and uronephrosis of the left kidney (unrelated to etoricoxib) and fever and chills (potentially etoricoxib-related).Overall,AEs were similar,although the absolute number of AEs in the etoricoxib group (n=31) was less than the indometacin group (n=34).Conclusions Etoricoxib (120 mg once daily) is effective in treating acute gout,is generally safe and well-tolerated,and is comparable in efficacy to indometacin (75 mg twice daily).

  18. Successful Treatment of Focal Segmental Glomerulosclerosis after Kidney Transplantation with Plasma Exchange and Abatacept in a Patient with Juvenile Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Hannelore Sprenger-Mähr

    2016-01-01

    Full Text Available Recurrent focal segmental glomerulosclerosis (FSGS after renal transplantation is difficult to treat. Recently a series of four patients unresponsive to plasma exchange (PE and rituximab, who were successfully treated with abatacept, has been reported. We present a 26-year-old Caucasian patient who suffered from juvenile rheumatoid arthritis and developed severe proteinuria eleven days after transplantation. An allograft biopsy was suggestive of recurrent focal segmental glomerulosclerosis. He did not respond to PE therapy. A first dose of abatacept produced partial remission. Four weeks later proteinuria again increased and a second biopsy showed progression of disease. After another ineffective course of PE he was given a second dose of abatacept, which was followed by rapid, complete, and sustained resolution of proteinuria. This treatment caused a significant increase in BK and JC viremia. Whether abatacept ameliorated proteinuria via an effect on podocytes or on the patient’s primary disease remains speculative.

  19. Physical activity and the association with fatigue and sleep in Danish patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Loppenthin, K.; Esbensen, B. A.; Østergaard, M.;

    2015-01-01

    . An inverse univariate association was found between moderate to vigorous physical activity, and fatigue (MFI mental, MFI activity, MFI physical and MFI general), sleep, diabetes, depression, pain, patient global assessment, HAQ and disease activity. The multivariate prediction model demonstrated that fatigue......The aim of this study was to examine physical activity behavior in patients with rheumatoid arthritis and to identify potential correlates of regular physical activity including fatigue, sleep, pain, physical function and disease activity. A total of 443 patients were recruited from a rheumatology...... outpatient clinic and included in this cross-sectional study. Physical activity was assessed by a four-class questionnaire, in addition to the Physical Activity Scale. Other instruments included the Multidimensional Fatigue Inventory (MFI), the Pittsburgh Sleep Quality Index and the Health Assessment...

  20. Anterior ischaemic optic neuropathy in patient with rheumatoid arthritis--case report.

    Science.gov (United States)

    Perić, S; Cerovski, B; Perić, P

    2001-01-01

    This case report presents a patient with long-lasting rheumatoid arthritis (RA) of fourth clinical grade, having ocular complications. RA was diagnosed according to current modified ARA criteria from 1987. Upon admission to the Department of Ophthalmology clinical examination revealed anterior ischaemic optic neuropathy (AION), which is not characteristic manifestation of RA in the eye. The occurrence of AION in patients with RA has been explained in literature as a secondary manifestation of hypertension in these patients or, by the presence of other connective tissue disease apart from RA (for example, MCTD--mixed connective tissue disease). Both mentioned causes were excluded in our case, as well as any other condition that could lead to AION. Therefore, we had concluded that AION presented a late complication of RA.

  1. Population Pharmacokinetics of Ofatumumab in Patients With Chronic Lymphocytic Leukemia, Follicular Lymphoma, and Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Struemper, Herbert; Sale, Mark; Patel, Bela R;

    2014-01-01

    Ofatumumab is a human monoclonal antibody directed at CD20 approved for treatment of chronic lymphocytic leukemia. The population pharmacokinetics of intravenous ofatumumab were characterized in patients with relapsed/refractory chronic lymphocytic leukemia, relapsed/refractory follicular lymphoma......, and rheumatoid arthritis, diseases with widely varying CD20(+) B-cell counts in blood. Serum concentration data from a total of 477 patients who received ofatumumab doses ranging from 100 mg to 2000 mg in different dosing regimens were analyzed to determine the pharmacokinetic characteristics of ofatumumab...... across different patient groups and to identify factors contributing to the pharmacokinetic variability. Ofatumumab pharmacokinetics were well described by a linear two-compartment model component to represent non-specific monoclonal antibody clearance from the central compartment interacting...

  2. Sleep quality and correlates of poor sleep in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

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

    2015-01-01

    The objective of this study is to examine sleep quality and correlates of poor sleep in patients with rheumatoid arthritis (RA). Five hundred patients with RA were recruited from a rheumatology outpatient clinic and included in this cross-sectional study. Sleep quality and disturbances were...... assessed using the Pittsburgh Sleep Quality Index (PSQI). Other instruments included the Multidimensional Fatigue Inventory, the Epworth Sleepiness Scale, and the Health Assessment Questionnaire. Disease activity was assessed according to disease activity score DAS28-CRP-based. Complete scores on PSQI were...... obtained from 384 patients (77 %). In those, the prevalence of poor sleep (PSQI >5) was 61 %, and the mean global PSQI score was 7.54 (SD 4.17). A linear association was found between poor sleep and mental fatigue, reduced activity related to fatigue, physical fatigue, and general fatigue. Mental fatigue...

  3. Pain behavior, spouse responsiveness, and marital satisfaction in patients with rheumatoid arthritis.

    Science.gov (United States)

    Williamson, D; Robinson, M E; Melamed, B

    1997-01-01

    Although the pain behavior of some diagnostic groups has been shown to be reactive to social influences, the reactivity of pain behavior in a rheumatoid arthritis (RA) population remains an open question. The authors in this article combined laboratory and self-report assessment techniques to examine the extent to which the pain report and behavior of 52 RA patients was susceptible to influence of social factors within the marital unit. The authors' findings suggest that (a) different types of spouse responsiveness (e.g., solicitous, punishing) may be viewed differently by the RA population than more general chronic pain populations; (b) the patient's perception of spouse responsiveness is a significant predictor of the pain behavior, whereas the spouse's perception of these same behaviors is not; and (c) the patient's perception of the spouse's responsive behavior adds significantly to the prediction of pain behavior over a model based on "disease impact" variables alone. PMID:8995045

  4. Anserina Bursitis—A Treatable Cause of Knee Pain in Patients with Degenerative Arthritis

    Science.gov (United States)

    Brookler, Morton I.; Mongan, Edward S.

    1973-01-01

    The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient. PMID:4731586

  5. Anserina bursitis. A treatable cause of knee pain in patients with degenerative arthritis.

    Science.gov (United States)

    Brookler, M I; Mongan, E S

    1973-07-01

    The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient.

  6. Overexpression of P-glycoprotein on fibroblast-like synoviocytes in refractory rheumatoid arthritis patients: a potential mechanism for multidrug resistance in rheumatoid arthritis treatment.

    Science.gov (United States)

    Liu, Y M; Chen, J W; Chen, L X; Xie, X; Mao, N

    2016-01-01

    This study aims to investigate the role of P-glycoprotein (P-gp) expression level in drug resistance to disease-modifying anti-rheumatic drugs in refractory rheumatoid arthritis (RRA). We evaluated and compared the expression levels of P-gp in fibroblast-like synoviocyte (FLS) cells in patients with rheumatoid arthritis (RA) and osteoarthritis (OA), and investigated the potential mechanism of P-gp-induced multidrug resistance in RRA. Ten patients were enrolled and divided into two groups: six in the RA group and four in the OA group. The expression level of P-gp in FLS cells was detected by western blotting following cell culture. A linear correlation algorithm was used to assess the association between the level of P-gp and disease activity  (using DAS28 scoring), as well as the duration of methotrexate (MTX) treatment in the RRA patients. The level of P-gp in the RRA patients was markedly higher than that in the OA patients (P P-gp level in FLS cells and the duration of MTX treatment in the RRA group (Г = 0.733, P P-gp level and DAS28 scoring (Г = 0.206, P > 0.05). P-gp might be upregulated during the progression of RRA, which possibly correlates with the development of resistance to MTX. PMID:27323187

  7. Usefulness of Patients-Reported Outcomes in Rheumatoid Arthritis Focus Group

    Science.gov (United States)

    Amaya-Amaya, Jenny; Botello-Corzo, Diana; Calixto, Omar-Javier; Calderón-Rojas, Rolando; Domínguez, Aura-Maria; Cruz-Tapias, Paola; Montoya-Ortiz, Gladis; Mantilla, Ruben-Dario; Anaya, Juan-Manuel; Rojas-Villarraga, Adriana

    2012-01-01

    Objective. Patient-reported outcomes (PROs) have become an essential part of the assessment of patients with rheumatoid arthritis (RA). We aimed to evaluate the agreement and correlation between PROs and the physician's measurements. Methods. This was a cross-sectional analytical study in which 135 patients with RA were clinically evaluated during two different sessions of focus group interviews. Rheumatologist recorded 28 swollen (SJCs) and tender joint counts (TJCs). The patients filled out the PROs instruments (MDHAQ, RADAI, RAPID3, 4, and 5 and self-report articular index (SAI) diagram for pain and joint swelling). DAS28 was calculated (C-reactive protein). An adjusted multiple lineal regression model was done (DAS28 as dependent variable). Results. Highly significant agreements were found between SJC and TJC registered by the physician and patient. There was moderate correlation between DAS28 with patient SJC (r = 0.52), patient TJC (r = 0.55), RADAI (r = 0.56), RAPID3 (r = 0.52), RAPID4 (r = 0.56), RAPID5 (r = 0.66), and VAS-Global (r = 0.51). Likewise, we found moderate to high correlations between CDAI and SDAI with all variable measurements done by the patients. The resulting predictive equation was DAS28(CRP) = 2.02 + 0.037 × RAPID4 + 0.042× patient SJC. Conclusion. PROs applied in focus groups interview are a useful tool for managing patients with RA regardless of gender, educational level, and duration of disease. PMID:23097701

  8. Usefulness of Patients-Reported Outcomes in Rheumatoid Arthritis Focus Group

    Directory of Open Access Journals (Sweden)

    Jenny Amaya-Amaya

    2012-01-01

    Full Text Available Objective. Patient-reported outcomes (PROs have become an essential part of the assessment of patients with rheumatoid arthritis (RA. We aimed to evaluate the agreement and correlation between PROs and the physician's measurements. Methods. This was a cross-sectional analytical study in which 135 patients with RA were clinically evaluated during two different sessions of focus group interviews. Rheumatologist recorded 28 swollen (SJCs and tender joint counts (TJCs. The patients filled out the PROs instruments (MDHAQ, RADAI, RAPID3, 4, and 5 and self-report articular index (SAI diagram for pain and joint swelling. DAS28 was calculated (C-reactive protein. An adjusted multiple lineal regression model was done (DAS28 as dependent variable. Results. Highly significant agreements were found between SJC and TJC registered by the physician and patient. There was moderate correlation between DAS28 with patient SJC (r=0.52, patient TJC (r=0.55, RADAI (r=0.56, RAPID3 (r=0.52, RAPID4 (r=0.56, RAPID5 (r=0.66, and VAS-Global (r=0.51. Likewise, we found moderate to high correlations between CDAI and SDAI with all variable measurements done by the patients. The resulting predictive equation was DAS28(CRP=2.02+0.037×RAPID4+0.042× patient SJC. Conclusion. PROs applied in focus groups interview are a useful tool for managing patients with RA regardless of gender, educational level, and duration of disease.

  9. Effectiveness and drug adherence of biologic monotherapy in routine care of patients with rheumatoid arthritis: a cohort study of patients registered in the Danish biologics registry

    DEFF Research Database (Denmark)

    Jørgensen, Steen Hylgaard; Rasmussen, Claus; Espesen, Jakob

    2014-01-01

    We report two cases of cholesterol crystals (CC) in synovial fluid (SF) in patients with rheumatoid arthritis (RA). Injection of triamcinolone had satisfactory effect on the bursitis in one patient which is in contrast to previous reports. Both patients died short after presentation. There is evi...

  10. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Eshed, Iris; Hørslev-Petersen, Kim;

    2015-01-01

    effect. METHODS: In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed...... at months 0, 6 and 12. Synovitis, osteitis, tenosynovitis, MRI bone erosion and joint space narrowing (JSN) were scored with validated methods. Dynamic contrast-enhanced MRI (DCE-MRI) was carried out in 14 patients. RESULTS: Synovitis, osteitis and tenosynovitis scores decreased highly significantly (p...OBJECTIVES: To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional...

  11. THE FIRST RUSSIAN STRATEGIC STUDY OF PHARMACOTHERAPY FOR RHEUMATOID ARTHRITIS (REMARCA TRIAL: RESULTS OF 12-MONTH TREATMENT IN 130 PATIENTS

    Directory of Open Access Journals (Sweden)

    D. E. Karateev

    2014-01-01

    Full Text Available To introduce treat-to-target recommendations is an important task of modern rheumatology; however, there is still a diversity of serious problems relating to a scientific rationale and a clinical one for this strategy and to the possibilities of its implementation in real clinical practice, in the rheumatology service of the Russian Federation in particular, by taking into account the specific features of funding for high-tech medical care.Objective: to determine the efficiency and safety of combined therapy with subcutaneous methotrexate (MT and biological agents (BA when using the treat-to-target strategy in patients with active early and extended-stage rheumatoid arthritis (RA who have risk factors for a poor prognosis.Subjects and methods.The results of the REMARCA (Russian InvEstigation of MethotrexAte and biologicals in eaRly aCtive inflammatory Arthritis trial of 130 patients followed up for 12 months or more were given. There was a female preponderance; mean age 48.9±13.9 years, rheumatoid factor positivity (86.9%; anti-cyclic citrullinated peptide antibody positivity (89.2%. Seventy patients formed a subgroup of early RA (disease duration ≤6 months (mean 4.17±1.39 months; 60 patients were a subgroup of advanced-stage RA (disease duration >6 months (mean 30.8±32.7 months. In all the patients, therapy was initiated by using subcutaneous MT with its rapid dose escalation up to 20–30 mg/week and the achievement of the treatment goal (low disease activity or remission was checked every 3 months and depending on the result a decision had been taken to add or not to add a biological agent (BA (a tumor necrosis factor inhibitor or abatacept. If the former was insufficiently effective, it was substituted for a BA from another class.Results. Subcutaneous MT monotherapy provided remission or low disease activity in 49 (37.7% patients; a BA was given to 81 (62.3% patients. Following 6 and 12 months, low activity or remission

  12. THE FIRST RUSSIAN STRATEGIC STUDY OF PHARMACOTHERAPY FOR RHEUMATOID ARTHRITIS (REMARCA TRIAL: RESULTS OF 12-MONTH TREATMENT IN 130 PATIENTS

    Directory of Open Access Journals (Sweden)

    D. E. Karateev

    2015-01-01

    Full Text Available To introduce treat-to-target recommendations is an important task of modern rheumatology; however, there is still a diversity of serious problems relating to a scientific rationale and a clinical one for this strategy and to the possibilities of its implementation in real clinical practice, in the rheumatology service of the Russian Federation in particular, by taking into account the specific features of funding for high-tech medical care. Objective: to determine the efficiency and safety of combined therapy with subcutaneous methotrexate (MT and biological agents (BA when using the treat-to-target strategy in patients with active early and extended-stage rheumatoid arthritis (RA who have risk factors for a poor prognosis. Subjects and methods. The results of the REMARCA (Russian InvEstigation of MethotrexAte and biologicals in eaRly aCtive inflammatory Arthritis trial of 130 patients followed up for 12 months or more were given. There was a female preponderance; mean age 48.9±13.9 years, rheumatoid factor positivity (86.9%; anti-cyclic citrullinated peptide antibody positivity (89.2%. Seventy patients formed a subgroup of early RA (disease duration ≤6 months (mean 4.17±1.39 months; 60 patients were a subgroup of advanced-stage RA (disease duration >6 months (mean 30.8±32.7 months. In all the patients, therapy was initiated by using subcutaneous MT with its rapid dose escalation up to 20–30 mg/week and the achievement of the treatment goal (low disease activity or remission was checked every 3 months and depending on the result a decision had been taken to add or not to add a biological agent (BA (a tumor necrosis factor inhibitor or abatacept. If the former was insufficiently effective, it was substituted for a BA from another class. Results. Subcutaneous MT monotherapy provided remission or low disease activity in 49 (37.7% patients; a BA was given to 81 (62.3% patients. Following 6 and 12 months, low activity or remission according

  13. Sexual health in patients with rheumatoid arthritis: experiences, needs and communication with health care professionals.

    Science.gov (United States)

    Josefsson, Kristina Areskoug; Gard, Gunvor

    2012-06-01

    Pain, fatigue and decreased joint mobility caused by rheumatoid arthritis (RA) often decrease sexual health in RA patients. Regular physiotherapy interventions in patients with RA are often aimed at improving those factors. The aim of the present study was to explore the experiences and views of patients concerning the impact of RA on their sexual health, the possible impact of physiotherapy interventions, and communication in clinical situations. A self-administered questionnaire was sent to patients with RA at two rehabilitation clinics in Sweden. The questionnaire included questions concerning the impact of RA on intimate relationships and sexual function, as well as experiences of physiotherapy and sexual health communication with health professionals. The questionnaire was answered by 63 patients. The majority of the patients thought that pain, stiffness, fatigue and physical capacity were related to sexual health. Communication between health professionals and patients about sexual health was less common, even if the desire for communication about sexual health was higher in this study than in other studies. The authors concluded that physiotherapists need to be aware that pain, fatigue, decreased joint mobility and physical capacity can affect sexual health and that physiotherapy can make a difference in sexual health in patients with RA. The impact of RA on sexual health is rarely discussed by health professionals and RA patients, and needs greater attention.

  14. HLA class II genes in Latvian patients with juvenile rheumatoid arthritis.

    Science.gov (United States)

    Rumba, I; Denisova, A; Sochnev, A; Nilsson, B; Sanjeevi, C B

    1997-01-01

    PCR-based HLA genotyping was used to analyze the association of HLA-DR and -DQ genes in 127 juvenile rheumatoid arthritis patients and 111 population-based controls from Latvia. The results show DQA1*03 to be positively associated in overall patients and DRB1*01-DQA1*0101-DQB1*0501 to be negatively associated with JRA in overall patients and in polyarthritis patients compared to controls. These data indicate the immunogenetic heterogeneity in the JRA patients, in the disease subgroups and in different ethnic groups. Rheumatoid factor (RF) was assayed in patients (n = 119) and controls (n = 98). RF was present in patients (7/119, 6%) compared to controls (5/98, 5%). None of the DQA1, DQB1 alleles, DQ and DR-DQ haplotypes was associated in seropositive patients compared to seropositive controls. DR1-DQ5 (DQA1*0101-B*0501) was decreased in seronegative patients (11/111, 10%) compared to seronegative controls (24/105, 23%), but the difference was not significant after correction of the p value.

  15. Acromioclavicular septic arthritis and sternoclavicular septic arthritis with contiguous pyomyositis.

    Science.gov (United States)

    Corey, Sally A; Agger, William A; Saterbak, Andrew T

    2015-03-01

    Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.

  16. Diffuse alveolar damage in a patient with rheumatoid arthritis under prolonged leflunomide treatment: A Case Report and Literature Review.

    Science.gov (United States)

    Keng, Li-Ta; Lin, Mong-Wei; Huang, Hsien-Neng; Chung, Kuei-Pin

    2016-06-01

    Patients with rheumatoid arthritis (RA) often have pulmonary involvement, and interstitial lung disease (ILD) is the primary manifestation, in which diffuse alveolar damage (DAD) is a rare histopathologic pattern. Leflunomide (LEF) is a frequently prescribed disease-modifying antirheumatic drug for treating RA. LEF-related ILD in the form of DAD has been reported in patients with RA, with the duration of LEF treatment before symptom onset ranging from 6 to 1204 days.We present a case of elderly woman with RA under prolonged LEF treatment for >9 years (3291 days), who had acute respiratory failure with the initial presentation of exertional dyspnea, fever, chills, and productive cough for 2 days. The histopathologic result of surgical lung biopsy was compatible with DAD. She was diagnosed as having LEF-related ILD, based on correlated clinical history, compatible histopathologic examination and excluding possible infection after extensive survey.Although the causative role of LEF cannot be confirmed, this case still hints that LEF-related DAD may occur even if LEF has been prescribed for a prolonged period. PMID:27368035

  17. Pharmacokinetics of CTLA4Ig fusion protein in healthy volunteers and patients with rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    Ying MA; Bi-rong LIN; Bei LIN; Sheng HOU; Wei-zhu QIAN; Jing LI; Min TAN; Jian MA; Bo-hua LI; Hao WANG; Ai-dong WEN; Ya-jun GUO

    2009-01-01

    Aim: To evaluate single-dose and multiple-dose pharmacokinetics of cytotoxic T-lymphocyte-associated antigen 4 fusion protein (CTLA4Ig) in healthy volunteers and patients with rheumatoid arthritis (RA). Methods: The clinical trials included two phase I open studies: study 1 was an open-label dose-escalation study in 27 healthy volunteers and study 2 was a single-group, open-label study in patients with rheumatoid arthritis. In study 2, 9 patients were arranged to receive 10 mg/kg of CTLA4Ig at 0, 2, 4, 8, 12, and 16 weeks. The concentration-time data obtained by a validated ELISA method were subjected to non-compartmental pharmacokinetic analysis by DAS 2.1 software. Results: In study 1, serum CTLA4Ig concentrations climbed rapidly to the peak and declined slowly with a t1/2 of 15.1±2.6 d, 14.2±2.3 d, and 11.8±1.2 d after a single infusion of 1, 10, and 20 mg/kg, respectively. Cmax and AUC0-∞increased propor-tionally with the dose. In study 2, the steady-state condition for CTLA41g following multiple doses of 10 mg/kg appeared to be attained at the fourth dose (d 56), with peak and trough concentrations of 239.8±45.3 mg/L and 20.5±7.9 mg/L, respec-tively. After multiple infusions, serum concentrations dropped slowly and the terminal half-life was 12.6±4.7 d. Conclusion: Intravenous infusion of CTLA4Ig was well tolerated in healthy volunteers and patients with rheumatoid arthritis. CTLA4Ig exhibited linear pharmacokinetics over the dose range of 1 to 20 mg/kg in healthy volunteers. The pharmacokinetics in RA patients appeared to be similar to that in healthy volunteers. No system accumulation appeared upon repeated infusions of 10 mg/kg every 4 weeks.

  18. Human Lyme arthritis and the immunoglobulin G antibody response to the 37-kilodalton arthritis-related protein of Borrelia burgdorferi.

    Science.gov (United States)

    Salazar, Carlos A; Rothemich, Monika; Drouin, Elise E; Glickstein, Lisa; Steere, Allen C

    2005-05-01

    In Borrelia burgdorferi-infected C3H-scid mice, antiserum to a differentially expressed, 37-kDa spirochetal outer-surface protein, termed arthritis-related protein (Arp), has been shown to prevent or reduce the severity of arthritis. In this study, we determined the immunoglobulin G (IgG) antibody responses to this spirochetal protein in single serum samples from 124 antibiotic-treated human patients with early or late manifestations of Lyme disease and in serial serum samples from 20 historic, untreated patients who were followed longitudinally from early infection through the period of arthritis. These 20 patients were representative of the spectrum of the severity and duration of Lyme arthritis. Among the 124 antibiotic-treated patients, 53% with culture-proven erythema migrans (EM) had IgG responses to recombinant glutathione S-transferase (GST)-Arp, as did 59% of the patients with facial palsy and 68% of those with Lyme arthritis. In addition, 75 to 80% of the 20 past, untreated patients had reactivity with this protein when EM was present, during initial episodes of joint pain, or during the maximal period of arthritis. There was no association at any of these three time points between GST-Arp antibody levels and the severity of the maximal attack of arthritis or the total duration of arthritis. Thus, after the first several weeks of infection, 60 to 80% of patients had IgG antibody responses to GST-Arp, but this response did not correlate with the severity or duration of Lyme arthritis.

  19. Olecranon Bursitis Caused by Candida parapsilosis in a Patient with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Carla F. Gamarra-Hilburn

    2016-01-01

    Full Text Available Septic bursitis is usually caused by bacterial organisms. However, infectious bursitis caused by fungi is very rare. Herein, we present a 68-year-old woman with long-standing rheumatoid arthritis who developed pain, erythema, and swelling of the right olecranon bursa. Aspiration of the olecranon bursa showed a white blood cell count of 3.1×103/μL (41% neutrophils, 30% lymphocytes, and 29% monocytes. Fluid culture was positive for Candida parapsilosis. She was treated with caspofungin 50 mg intravenously daily for 13 days followed by fluconazole 200 mg orally daily for one week. She responded well to this treatment but had recurrent swelling of the bursa. Bursectomy was recommended but she declined this option. This case, together with other reports, suggests that the awareness of uncommon pathogens, their presentation, and predisposing risk factors are important to establish an early diagnosis and prevent long-term complications.

  20. Neurological Recovery after Amantadine Treatment in a Patient with Septic Arthritis: A Case Report

    Directory of Open Access Journals (Sweden)

    Esra Özayar

    2016-04-01

    Full Text Available SUMMARY In this case report a patient with septic arthritis who developed impaired consciousness that responded to amantadine sulfate treatment was presented. A 67 years old male patient who had high fever, leukocytosis, hypotension, and generalized organ failure findings after knee prosthesis revision surgery was accepted to intensive care unit. Patient was intubated and connected to mechanical ventilation as he lost consciousness during non-invasive mechanical ventilation. In the follow-up he was diagnosed with bone abscess and was started penicillin according to culture results. Despite of clinical and laboratory resolving of sepsis finding, patient had tonic-clonic seizures especially on the right upper extremity with normal cranial computerized tomography findings. Septic course of the patient improved with antibiotic treatment, while impaired consciousness and seizures continued. Radiological evaluation of the patient was within normal ranges; however he was diagnosed as organic neurological dysfunction that developed secondary to sepsis. Amantadine sulfate 200 mg/day was initiated after neurology department consultation. Neurological suppression and seizures started to improve after the 6th day and completely resolved after the 10th day of the treatment. Patient was discharged from intensive care unit after resolution of septic clinic after 57 days. As a result we believe that amantadine is an efficient agent in treatment of neurological patients with coma and significantly decrease rehabilitation duration