Adult-onset Rheumatoid Arthritis Research Articles

Porous-coated total hip arthroplasty in rheumatoid arthritis

Thirty-five porous-coated total hip arthroplasties were implanted in 25 patients with juvenile-onset or adult-onset rheumatoid arthritis and prospectively followed for a mean of 4.5 years (range, 3–6.5 years). Using the Harris hip rating, the mean hip score at the final follow-up evaluation was 91, and 86% of the hips had a good or excellent result. Thirty-one hips had no hip or thigh pain, while four had occasional slight pain. After surgery, 10 patients were employed and the remainder were ambulatory. There were no early or late deep infections. There was one reoperation for recurrent dislocation of the hip, but the components were not removed. Radiographic evaluation of the acetabular component showed that only one component had a complete radiolucent line in all three zones. Three femoral components had nonprogressive subsidence. At this intermediate-term follow-up period, porous-coated total hip arthroplasty is a promising technique that is likely to be successful in young patients with rheumatoid arthritis.

Improved radiographic survival of the Charnley prosthesis in rheumatoid arthritis and osteoarthritis: Results of new versus old operative techniques in 402 hips

Two hundred one consecutive, primary, noninfected Charnley (Thackray, Leeds) hip arthroplasties, implanted from 1968 to 1985 due to adult-onset rheumatoid arthritis, were matched in pairs with respect to year of operation, age, and sex with 201 Charnley prostheses implanted due to osteoarthritis. The 10-year survival estimate for nonrevisions was 95% in the rheumatoid group and 89% in the osteoarthritic group. Using definite radiographic loosening as a determinant, the 7-year survival rate for stems increased from 80% to 96% for both groups after the introduction of new cementing techniques, and the relative risk for stem loosening was decreased to one fifth. In the rheumatoid arthritis group, the 7-year radiographic socket survival increased from 87% to 96%, an increase ascribed to the overall effect of the introduction of flanged sockets, bone-grafts in acetabular protrusion, the rejection of the pilot hole technique, and improvements in the cement handling technique. In the osteoarthritis group the radiographic socket survival rate at 7 years was 97% and at 10 years was 95%.

Inflammatory Diseases of the Vertebral Column

The purpose of this lesson is in review the variety of inflammatory disorders that may involve the vertebral column. These inflammatory disorders include the seronegative spondyloarthopathies, adult-onset rheumatoid arthritis, juvenile chronic arthritis, crystal deposition diseases, and inflections. Although some radiographic findings are found in more than one of these disorders, characteristic involvement of specific “target areas” will help in establishing an accurate diagnosis. Any or all of several different types of vertebral acidulations including synovial, calaginous, and fibrous joints or enthuses (sits of tendon or ligament attachment to bone) may be involved in these inflammatory diseases.

Reduction in IgG galactose in juvenile and adult onset rheumatoid arthritis measured by a lectin binding method and its relation to rheumatoid factor.

Glycosylation changes in patients with juvenile chronic and adult onset rheumatoid arthritis have been studied using a novel binding method. Both these major types of arthritis showed decreased galactosylation of serum IgG, which confirms earlier studies using a different, more complex chemical method. No significant correlation between serum IgG, IgM, and IgA rheumatoid factors and age corrected G(o) (percentage of oligosaccharide chains lacking galactose) was found. The possibility that the less glycosylated IgG is preferentially confined to circulating IgM/IgG immune complexes cannot be excluded, however.

Low‐dose methotrexate compared with auranofin in adult rheumatoid arthritis

Weekly treatment with low-dose oral methotrexate (MTX) was compared with daily auranofin (AUR) treatment in a 36-week double-blind, randomized, multicenter study of 281 patients with active, adult-onset rheumatoid arthritis. Both treatment groups showed significant improvement by the usual measures of clinical efficacy. The response with MTX occurred earlier and was consistently greater than that with AUR. An intent-to-treat analysis showed significantly greater improvement (P less than 0.01) with MTX for painful and swollen joint counts and physician and patient global assessments of disease activity. Adverse reactions were reported more frequently in the AUR group, and more AUR-treated patients were withdrawn from the study because of toxicity. MTX was thus more effective and better tolerated than AUR in this study.

Inflammatory disorders of the vertebral column: Seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis

A variety of inflammatory disorders may involve the spine and sacroiliac joint. Of these, the seronegative spondyloarthropathies (consisting principally of ankylosing spondylitis, psoriasis, Reiter's syndrome, and certain intestinal diseases), adult-onset rheumatoid arthritis, and juvenile chronic arthritis are particularly important. The imaging abnormalities accompanying these disorders, supplemented with some clinical and pathologic data, are the subject of this review.

GALACTOSYLATION OF IgG ASSOCIATED OLIGOSACCHARIDES: REDUCTION IN PATIENTS WITH ADULT AND JUVENILE ONSET RHEUMATOID ARTHRITIS AND RELATION TO DISEASE ACTIVITY

The prevalence of agalactosyl N-linked oligosaccharides on serum IgG was determined for patients with juvenile onset and with adult rheumatoid arthritis. A. significant difference in the prevalence of these structures from age matched controls was found in both types of arthritis. In patients with adult onset rheumatoid arthritis, the results showed a strong correlation between the prevalence of IgG-associated agalactosyl oligosaccharides and disease activity. A correlation between disease activity and agalactosyl structures was also seen in a retrospective analysis of serial IgG samples from patients with juvenile onset disease. The finding that childhood onset arthritis and adult rheumatoid arthritis share a defect of glycosylation of serum IgG suggests that there may be a greater similarity between these two varieties of rheumatoid arthritis than has been hitherto considered. The observation that the incidence of agalactosyl oligosaccharides on IgG fluctuates with disease activity provides indirect evidence for a seminal role for this change of glycosylation in the inflammatory process which, in rheumatoid arthritis, is focused on the synovial tissues and results in bone erosions and joint destruction.

The familial aggregation of rheumatoid arthritis and its relationship to the HLA-DR4 association.

This investigation of the familial aggregation of rheumatoid arthritis in Rochester, Minnesota, was prompted by the considerable variability in previous reports and the need to interpret findings in light of the recently established human lymphocyte antigen (HLA)-DR4 association. The historical cohort methodology was applied to determine the incidence of adult-onset rheumatoid arthritis in 1631 biologic relatives of 78 probands compared with the Rochester population incidence. The ratio of the age- and sex-adjusted rates in first-degree relatives compared with the general population was 1.7 (95% confidence interval 1.0-2.9). The increase was concentrated in the 16- to 40-year-old age group, suggesting some disease heterogeneity. However, the level of familial risk was not significantly affected by the proband's sex, seropositivity, age, or parental disease status. Integrating these findings with prior research in which case ascertainment was complete led to the conclusion that familial aggregation of rheumatoid arthritis is weak. The apparent discrepancy between weak familial aggregation and the known strong HLA-DR4 association with rheumatoid arthritis was resolved by examining the mathematical relationship between the measures of association in the two different types of studies. Results show that to be consistent with weak familial clustering, any putative susceptibility gene must have very low penetrance, and/or there must be a large residual of sporadic cases.

Auranofin versus placebo in the treatment of rheumatoid arthritis

In a six-month, multicenter, double-blind study Involving 340 patients, auranofin, 3 mg twice daily, was compared with placebo in the treatment of adult-onset rheumatoid arthritis. All patients were continued on a therapeutic regimen of salicylates and/or a newer nonsteroidal anti-inflammatory drug. Patients in both treatment groups who completed six months of therapy with coded medications showed significant improvement in the clinical features of rheumatoid arthritis (that is, number of tender and swollen joints, severity of pain, grip strength and duration of morning stiffness); however, the mean improvement was greater in the auranofin-treated group. Fifty-two percent of the auranofin-treated patients compared with 24 percent of the placebo-treated patients (p < 0.05) were judged by their physician to have shown marked or moderate improvement. Only in the auranofin-treated patients was there significant improvement from baseline in the laboratory parameters of disease activity: erythrocyte sedimentation rate, IgA, IgG, and IgM. After at least three months of therapy, 30 percent (46 of 152) of the placebo-treated patients but only 9 percent (13 of 152) of the auranofin-treated patients (p < 0.05) withdrew from coded medication due to insufficient therapeutic effect. Study medication was discontinued by 5 percent (eight of 152) of the auranofin-treated patients and 3 percent (four of 152) of the placebo-treated patients because of adverse therapy events (p = 0.24). This study demonstrates the efficacy of auranofin when added to salicylates and/or nonsteroidal anti-inflammatory drugs in the treatment of rheumatoid arthritis.

Rheumatoid and other diseases of the cervical interspinous bursae, and changes in the spinous processes.

Bursal spaces between the cervical interspinous processes were found at necropsy in 14 out of 27 "normal' adult necks, especially when the spines were close together. In this random series they were the seat of crystallopathic disease in 2 instances out of 14 cases. In spines from 9 cases of adult-onset rheumatoid arthritis, rheumatoid bursitis was seen in 2 and banal bursitis in 2. In juvenile-onset chronic arthritis inflammatory bursal changes of rheumatoid nature were found in 2 out of 5 cases, and are compared with the "normal'. A third case showed crystallopathic destruction. In one instance of adult RA very severe changes were seen, with destruction of the spinous processes, and this was associated with hypermobile segments dependent on discal destruction starting in the oncovertebral joints. An association is described between discal lesions, spinous erosion, enthesopathy, and interspinous bursitis.

Familial rheumatoid arthritis: A kindred identified through a proband with seronegative juvenile arthritis includes members with seropositive, adult-onset disease

Segregation of chromosome #6 markers has been studied in a large family, identified by a proband with seronegative, juvenile-onset rheumatoid arthritis, which contains four individuals with adult-onset rheumatoid arthritis (RA). Two of the adult-onset patients bare classical seropositive RA. Sera from two healthy members of this family also contain rheumatoid factors (RF). Six family members had crossovers in the short arm of chromosome #6. There individuals with recombinants between HLA-B and HLA-D were identified: three others had identifiable crossovers between HLA-D and GLO (Glyoxylase 1). Linkage analysis suggested that susceptibility to RA in this family was influenced by a dominant gene located centromeric to HLA-B. The highest lod score (1.64) was obtained for linkage to GLO at a recombination rate of zero. Inheritance of specific chromosome #6 or Gm immunoglobulin allotype markers did not appear to influence serum RF. These results agree with previous family studies which suggest that acquisition of childhood- and adult-onset RA is influenced by a common disease susceptibility gene, linked to the major histocompatibility gene complex.

Circulating autoantibodies to IgD in rheumatic diseases.

Most mature B lymphocytes possess IgD on their cell surface. Antibodies to IgD produce an adjuvant-like effect in many experimental systems. Employing sensitive class-specific radioimmunoassays, elevated concentrations of autoantibodies to IgD of the IgA, IgM, and IgG classes were detected in the sera of 55% of patients with adult onset rheumatoid arthritis (RA), of 45% with systemic lupus erythematosus (SLE), of 67% with mixed connective tissue disease syndrome (MCTD), and of only 8% of juvenile RA. Marked differences in the class of anti-IgD were noted. An elevated IgA anti-IgD was detected in 45% (p less than 0.01) of RA sera, 27% of SLE sera, and 58% (p less than 0.01) of MCTD sera. IgG anti-IgD was increased in only 26% of RA, 32% of SLE, and 8% of MCTD sera. IgM anti-IgD was elevated in only one patient. IgA anti-IgD was inhibited greater than 90% by IgD but not at all by IgG. Correlations between the concentration of immunoglobulin G and IgA anti-IgD were noted in RA (rs = 0.37, p = 0.02), SLE (rs = 0.46, p = 0.015), and MCTD (rs = 0.4). These data suggest a potential role for autoantibodies to cell surface IgD as modulators of the immune system in some patients with autoimmune disorders.

Book Review: Non-Operative Hand Management of Adult Onset Rheumatoid Arthritis

Book Review: Non-Operative Hand Management of Adult Onset Rheumatoid Arthritis

Rheumatoid arthritis and cataract surgery

The prevalence of patients with adult onset rheumatoid arthritis among populations undergoing cataract surgery is low. Only 0.7% of 982 cataract surgery patients in the 45–79 age group, had rheumatoid arthritis. From the prevalence of rheumatoid arthritis in the U.S.A., 12.5% of women and 5.6% of men in the 45–79 age group should have undergone cataract surgery. The lower prevalence of cataracts among rheumatoid arthritis patients may be due to a slower progression of cataracts or to medications (such as acetyl salicylic acid) received for therapy Acetyl salicylic acid which lowers blood tryptophan may delay or prevent the formation of senile cataracts.

Benign Rheumatoid Nodules

Fifteen asymptomatic children with benign rheumatoid nodules, followed up to 12 years, are described. Nodules are characterized by subcutaneous location with predilection for pretibial regions and scalp, occasional large size, spontaneous regression, and frequent recurrence. Granuloma annulare was present in two patients. All 15 children were healthy and free from rheumatoid arthritis, rheumatic fever, or any other recognizable systemic disease at followup and none had positive tests for antinuclear antibodies or rheumatoid factors. Histologically the nodules closely resembled those seen in adult-onset rheumatoid arthritis. Though biopsy may be useful for confirmation of the clinical diagnosis of benign rheumatoid nodules, wide surgical excision, skin grafting, and treatment with medication are unnecessary in this self-limited syndrome.

Chemotaxis of polymorphonuclear leukocytes from patients with rheumatoid arthritis.

Using a new in vitro method of measuring the chemotaxis of polymorphonuclear leukocytes from peripheral blood, a chemotactic index has been calculated. The mean chemotactic index of 320 in 24 patients with definite rheumatoid arthritis, was significantly less (P < 0.0005) than the mean of 555 in 24 normal controls matched for age and sex. The mean chemotactic index of 435 in eight patients with juvenile rheumatoid arthritis was also significantly less (P < 0.01) than that of 553 in similarly matched controls. The chemotactic index could not be correlated with age, sex, disease activity, drugs used in treatment, latex titer, immunoglobulin levels, or protein coating on the cells. However, there was a correlation between the chemotactic index and the serum complement B(1e)/B(1a) value (P < 0.01) in 17 patients with adult onset rheumatoid arthritis. Although the serum complement B(1e)/B(1a) values were within the normal range, the lowest chemotactic indices were associated with the lowest complement values. The chemotactic indices in three patients with severe connective tissue disease (seropositive rheumatoid arthritis, systemic lupus erythematosus, and polymyositis) returned to normal after 5 days' treatment with 60 mg of prednisolone per day. Incubation of the cells from patients with rheumatoid arthritis with hydrocortisone in vitro failed to alter the chemotactic indices. Prior incubation of normal cells with purified rheumatoid factor complexes, rheumatoid serum, or macromolecules of iron dextran impaired their chemotaxis. It is suggested that phagocytosis of complexes in vivo is a possible mechanism by which the chemotaxis of the polymorphonuclear leukocytes of patients with rheumatoid arthritis is impaired. This impairment in chemotaxis may explain the increased incidence of bacterial infection, both during life and as a cause of death in these patients.

Heat stress in non-ferrous foundries.

<h3>Objective.</h3> To describe current trends in arthritis-related joint surgery among a population-based cohort of patients with rheumatoid arthritis (RA) and to examine the influence of joint surgery on mortality. <h3>Methods.</h3> A retrospective medical record review was performed of all orthopedic surgeries following diagnosis in cases of adult-onset RA in Olmsted County, Minnesota, USA, in 1980–2007. Surgeries included primary total joint arthroplasty, joint reconstructive procedures (JRP), soft tissue procedures (STP), and revision arthroplasty. Cumulative incidence of surgery was estimated using Kaplan-Meier methods. Time trends, sex differences, and mortality were examined using Cox models with time-dependent covariates for surgery. <h3>Results.</h3> A total of 189 of 813 patients underwent at least 1 surgical procedure involving joints during followup. The cumulative incidence of any joint surgery at 10 years after RA incidence for the 1980–94 cohort was 27.3% compared to 19.5% for the 1995–2007 cohort (p = 0.08). The greatest reduction was in STP, which decreased from 12.1% in 1980–94 to 6.0% in 1995–2007 at 10 years after RA incidence (p = 0.012). Women had more surgery (cumulative incidence 26.6% at 10 years for women; 20.4% for men; p = 0.049), as did obese patients. JRP were significantly associated with mortality (hazard ratio 2.6; 95% CI 1.8, 3.9; p &lt; 0.001) compared to patients not requiring JRP. <h3>Conclusion.</h3> The rates of joint surgery continue to decrease for patients more recently diagnosed with RA. JRP is associated with increased mortality. These findings may reflect improved treatments for RA as well as continued higher disease burden among some patients.