Mild Rheumatoid Arthritis Research Articles

The allogeneic umbilical cord mesenchymal stem cells regulate the function of T helper 17 cells from patients with rheumatoid arthritis in an in vitro co-culture system

BackgroundPrevious in vivo studies have shown that mesenchymal stem cell (MSC) transplantation significantly improves the condition of a number of autoimmune diseases including autoimmune cerebrospinal meningitis, multiple sclerosis, glomerulonephritis and systemic lupus erythematosus.MethodsTo investigate the immunoregulatory effect of stem cell transplantation, human umbilical cord MSCs were co-cultured with peripheral blood mononuclear cells (PBMCs) from patients with rheumatoid arthritis (RA). Orphan nuclear receptor gamma (ROR-γ) mRNA and protein expression was detected with real-time PCR and Western blotting. Interleukin (IL)-17, IL-6 and tumor necrosis factor (TNF-α) in the cell culture supernatant were measured using a flow cytometric bead capture method.ResultsAfter 72 hours of co-culture, the mRNA and protein expression levels of ROR-γ in co-cultured PBMCs were decreased compared with that in PBMC of RA patients cultured alone (p < 0.05). Moreover, the decrement was positively related to the disease activity of RA (p < 0.05). Decreased secretion of IL-17, TNF-α and IL-6 were also found in co-culture supernatants of PBMCs from patients with severe and moderate disease activity, but not in supernatant from PBMCs cultured alone. The decreased cytokine expression levels were positively correlated to the concentrations of MSCs. In contrast, PBMCs from healthy controls or patients with mild RA did not show significant differences in ROR-γ expression or cytokine secretion following co-culture with MSCs as compared with those cultured alone.ConclusionsIn vitro co-culture with MSCs down-regulated the inflammatory response of PBMCs from RA patients with severe disease activity, but had no significant effect on PBMCs from healthy controls or patients with mild disease activity, suggesting that the immunoregulatory role of MSCs may associate with the occurrence of inflammatory mediators.

Psoriasis: it's more than just the skin

Journal of Lipid Research Volume 53, 2012 1427 Psoriasis is a skin disease that is accompanied by systemic infl ammation and is one of the most common infl ammatory disorders, estimated to effect between 1 and 3% of the population ( 1 ). It is characterized by epidermal hyperproliferation and dermal infl ammation. The etiology of psoriasis is unknown but genetic factors play a role. Psoriasis may begin at any age but has two peak periods of onset: between 15 and 25 and between 50 to 60 years of age. In many patients, psoriasis affects only a small area of the skin (<2% of body surface area) whereas in other patients, the disease can be quite severe, affecting a large portion of the skin. The cutaneous manifestations lead to considerable morbidity and the emotional burden of severe psoriasis has been shown to be similar to that seen in patients with cancer, diabetes, and heart disease. However, it is important to recognize that psoriasis is associated with systemic metabolic disorders including an increased prevalence of the metabolic syndrome, obesity, diabetes, dyslipidemia, and cardiovascular disease (CVD) ( 2 ‐ 4 ). The increased risk of CVD in patients with psoriasis was fi rst reported by McDonald and Calabresi in 1978 ( 5 ). They observed that patients with psoriasis had a 2.2-fold increase in CVD compared with controls. Since then, a large number of additional epidemiological studies have also shown that the risk of CVD is increased in patients with psoriasis [see Tobin et al. ( 4 ) for an excellent review of the literature] ( 2 ‐ 5 ). Of note psoriasis still conferred an increased risk even when the studies controlled for the usual CVD risk factors such as age, sex, diabetes, hypertension, hyperlipidemia, smoking, and obesity, implying that psoriasis causes abnormalities that increase the risk of CVD that are not dependent on the usual risk factors ( 2 ‐ 4 ). Moreover, studies have suggested that the more severe the psoriasis the greater the risk of CVD. Further, supporting the link of psoriasis with atherosclerosis are studies showing that patients with psoriasis have an increase in coronary artery calcium measured by CT and carotid intima media thickness measured by ultrasound ( 6 ‐ 8 ). A very large number of studies have compared serum lipid levels in patients with psoriasis to control subjects ( 2 ‐ 4 ). Most of these reports included only a small number

Association of Rsa polymorphism of the estrogen receptor-β gene with rheumatoid arthritis

To investigate the possible influence of the single nucleotide polymorphism (SNP) of the estrogen receptor-β gene, rs1256049 (Rsa) in exon 5, on the frequency of rheumatoid arthritis (RA), 263 RA patients and 174 control subjects with osteoarthritis (OA) were recruited. Rsa polymorphism was detected using a PCR-RFLP, Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method. The occurrence of both mutant allele (G) and genotype (GG) were significantly higher in RA than in OA patients (allele P = 0.008, OR: 1.501, 95%CI: 1.12-2.02). In RA patients, GG genotype frequency was higher in severe RA patients than mild RA patients. Moreover, there was significant difference between severe RA patients and OA patients (P = 0.009), also the allele distribution was significant different between severe RA, mild RA, and OA patients (P = 0.025, 95%CI = 0.61-0.93). With respect to gender, GG genotype was statistically more frequent in female RA patients than that of OA, while such an association was not observed in men. Above all, the presence of the GG genotype could be a risk factor for RA and such trend might be different in gender, although additional larger scale study is needed.

Gold Sodium Thiomalate for the Treatment of Rheumatoid Arthritis in a Patient with Hepatitis B

To describe a case of gold sodium thiomalate use for the treatment of rheumatoid arthritis (RA) in a patient with hepatitis B. A 53-year-old Korean American woman with mild RA and chronic hepatitis B infection was treated for worsening RA symptoms with subcutaneous injections of gold sodium thiomalate for 21 months, with the dosage decreased from the initial 40 mg per week to 40 mg every 3 weeks after 51 weeks of successful treatment. She had undergone treatment for hepatitis B in the past with lamivudine; however, she had not received that medication for at least 1 year prior to initiating treatment with gold sodium thiomalate injections. During the treatment period she achieved remission of RA without a significant elevation of her liver enzyme levels or reactivation of hepatitis B. Two main factors influence drug product selection when considering the subset of RA patients with chronic hepatitis B infection: severity of liver function compromise and treatment status of chronic hepatitis B. Our patient did not demonstrate significant liver function compromise, but was not receiving viral suppressive treatment for hepatitis B; therefore, the use of many first-line nonbiologic disease-modifying antirheumatic drugs (DMARDs) was contra-indicated based on current guideline recommendations. Additionally, because the patient had refused viral suppressive therapy, there was great concern with the use of biological DMARDs and potential reactivation of hepatitis B. In the past, gold salts were the standard of care in treating RA until the development of the newer agents and there was some evidence that gold sodium thiomalate could be used with minimal risk of hepatotoxicity. Gold sodium thiomalate proved to be a safe and effective treatment option in a patient with RA and hepatitis B.

Regulation of B cell activating factor (BAFF) receptor expression by NF-κB signaling in rheumatoid arthritis B cells

B cells play an important role in the pathogenesis of rheumatoid arthritis (RA). High levels of B cell activating factor (BAFF) are detected in autoimmune diseases. BAFF and BAFF receptor (BAFF-R) are expressed in B and T cells of RA synovium. The study was undertaken to identify the NF-ΚB signal pathway involved in the induction of BAFF-R in human B cells. Immunohistochemical staining of NF-ΚB p65, NF-ΚB p50, BAFF, and BAFF-R was performed on sections of synovium from severe and mild RA and osteoarthritis (OA) patients. Peripheral blood mononuclear cells (PBMCs) were isolated from control and RA patients and B cells were isolated from controls. BAFF-R was analyzed by flow cytometry, realtime PCR and confocal staining after treatment with NF-ΚB inhibitors. NF-ΚB p65, NF-ΚB p50, BAFF, and BAFF-R were highly expressed in severe RA synovium relative to mild RA synovium or OA synovium. BAFF-R expression was reduced by NF-ΚB inhibitors in PBMCs and B cells from normal controls. We also showed reduction in expression of BAFF-R via inhibition of the NF-ΚB pathway in PBMCs of RA patients. BAFF/BAFF-R signaling is an important mechanism of pathogenesis in RA and that BAFF-R reduction by NF-ΚB blocking therapy is another choice for controlling B cells in autoimmune diseases such as RA.

Psoriasis and Hepatitis C: Improvement with Interferon

Dear Editor: Interferon, an immunomodulator and antiproliferative with antiviral properties, has side effects that include flu-like symptoms, marrow suppression, alopecia and depression. Other side effects of interferon are rare skin reactions1,2, namely erythematous patches at site of injection and eczema. Interferon may also induce or unmask underlying skin diseases such as psoriasis3,4, eczema, sarcoidosis and lupus. The combination of interferon and ribavirin is the current treatment for hepatitis C. We present a patient with extensive psoriasis whose symptoms dramatically improved when she was treated with pegylated interferon and ribavirin for hepatitis C. A 52-year-old white female was referred to us for management of chronic hepatitis C infection in April 2006. She had nonspecific symptoms. She also had hypertension, diabetes mellitus, mild rheumatoid arthritis, depression and obesity. Since age eight, she had had psoriasis involving multiple areas on her body. She expressed low esteem, secondary to the degree of psoriatic involvement and her obesity. She had no allergies. On examination, the patient was alert and had normal vital signs. HEENT (Head, Ears, Eyes, Nose and Throat), cardiopulmonary, abdomen, extremities and neurological examinations were normal. She had no lymphadenopathy. Skin examination was remarkable for extensive bilateral erytherodermic nodular lesions with plaques involving the extensor surfaces of elbows, forearms, thighs and knees. Lesions were more prominent on the left side. She also had scattered involvement over the abdomen, lower back and scalp. Approximately 15~20% of her skin surface was covered with lesions (at this time, no photos were taken) (Table 1). Table 1 Laboratory studies Medications included metformin, hydrochlorathiazide, loratadine and acetaminophen. She was using clobetasol cream topically. In June 2006, the patient was started on hepatitis C treatment with a combination of interferon alfa-2b (1.5 mcg/kg/week subcutaneously) and ribavirin (1,200 mg) orally every day. In the third week following initiation of therapy, she complained of a skin rash and itching over the lower extremities, which subsequently spontaneously improved. An examination at that time showed diffuse, erythematous, maculopapular eruptions which was not psoriatic. She also had flu-like symptoms secondary to interferon. After three months, the patient complained of diarrhea, abdominal cramps and hair loss, but her psoriasis had improved. Examination revealed definite improvement of her skin lesions with less erythema and scaling of the plaques on the elbows, knees and thighs (Fig. 1). There was also significant clearing of the lesions on the scalp, abdomen and back. Serum hepatitis C viral-RNA load decreased to an undetectable level. After the completion of six months interferon/ribavirin therapy, she has had no relapse of hepatitis C infection and only a mild reactivation of the psoriatic lesions (Fig. 2). During this time, she denied use of topical steroids or other psoriasis treatments. Exacerbation of psoriasis following the use of interferon in the treatment of hepatitis has been reported5,6. In fact, interferon is believed to be associated with the pathogenesis of psoriasis5,7,8. Both hepatitis C and psoriasis are diseases in which tumornecrosis factor-α (TNF-alpha) is involved. Fig. 1 Three month follow-ep showing improvement in psoriasis. Fig. 2 After completion of interferon/ribavirin therapy, examination showed only a mild reactivation of the psoriatic lesions. During treatment with interferon/ribavirin, this patient's psoriasis improved and has remained less active for 4+ years following treatment. We have no definite explanation for the significant improvement of psoriasis. The patient has been under no psoriatic treatment program during this time. Precipitating factors such as infection can activate T-cells and cytokine production, resulting in the release of inflammatory mediators that can flare psoriasis. In this patient, perhaps the active hepatitis C infection precipitated more dramatic psoriatic involvement. This hypothesis is supported by the significant decrease and subsequent disappearance of detectable serum load over the time her psoriasis has shown such significant improvement. Further investigation is needed to show a direct causal relationship between the patient's treatment with interferon/ribavirin and improved psoriasis through the decreased activation of T-cells and cytokine production.

Herpes Zoster Risk Factors in a National Cohort of Veterans with Rheumatoid Arthritis

Herpes zoster occurs more commonly in patients taking immunosuppressive medications, although the risk associated with different medications is poorly understood. We conducted a retrospective cohort study involving 20,357 patients who were followed in the Veterans Affairs healthcare system and treated for rheumatoid arthritis from October 1998 through June 2005. Cox proportional hazards regression was used to determine risk factors for herpes zoster and herpes zoster-free survival. Chart review was performed to validate the diagnosis of herpes zoster. The incidence of herpes zoster was 9.96 episodes per 1000 patient-years. In time-to-event analysis, patients receiving medications used to treat mild rheumatoid arthritis were less likely to have an episode of herpes zoster than patients receiving medications used to treat moderate and severe rheumatoid arthritis (P < .001). Independent risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, malignancy, chronic lung disease, renal failure, and liver disease. Among patients receiving tumor necrosis factor-alpha antagonists, etanercept (hazard ratio, 0.62) and adalimumab (hazard ratio, 0.53) were associated with a lower risk of herpes zoster. There was excellent agreement between the International Classification of Diseases, Version 9, Clinical Modification diagnosis of herpes zoster and diagnosis by chart review (kappa = 0.92). Risk factors for herpes zoster included older age, prednisone use, medications used to treat moderate and severe rheumatoid arthritis, and several comorbid medical conditions. These results demonstrate that the Department of Veterans Affairs' national administrative databases can be used to study rare adverse drug events.

Characterization of patients with rheumatoid arthritis according to the health care level

ObjectiveTo characterize rheumatoid arthritis patients seen in rheumatology units at different health care levels. Material and methodsQuestionnaire and clinical examination of rheumatoid arthritis patients seen as outpatients in rheumatology units from primary care, county hospitals and reference hospitals. Demographic, social, labor, and disease data were collected. Statistical study included a description of the variables and a multiple correspondence analysis to define patient profiles. ResultsEight hundred and twelve patients with rheumatoid arthritis were included. There were significant differences in patient profiles at the different care level. In primary care, patients were older, with basic studies, and with short duration and generally mild rheumatoid arthritis. In local hospitals the typical patient was a man, qualified worker, with low income, and an erosive disease with extraarticular manifestations. At reference hospitals prevailing patients were young women with a long duration disease and requiring biological therapy. ConclusionThere are significant differences in rheumatoid arthritis patient profiles at different health care levels.

Serum adiponectin concentrations correlate with severity of rheumatoid arthritis evaluated by extent of joint destruction

Adiponectin is a hormone released by adipose tissue with antidiabetic, antiatherogenic, and anti-inflammatory properties. The present observational study focused on the relation between serum adiponectin level and the disease severity of established rheumatoid arthritis (RA). Ninety patients with more than 5-year diagnosis of RA and 42 age- and BMI-matched control were enrolled. The severity of RA was evaluated according to the number of destructed joints of overall 68 joints on plain radiographs (37 patients had mild RA and 53 had severe RA). Serum adiponectin level was significantly higher in the severe RA group (17.7+/-6.7 microg/ml) than in the control (9.1+/-3.8 microg/ml) and mild RA groups (13.9+/-6.5 microg/ml) (control vs. mild RA group, P<0.001; mild RA vs. severe RA group, P<0.01). These results suggest that increased number of joint destruction is associated with hyperadiponectinemia in established RA patients.

Interpreting studies of cardiovascular mortality in rheumatoid arthritis: The importance of timing

Interpreting studies of cardiovascular mortality in rheumatoid arthritis: The importance of timing

A positive rheumatoid factor and X-ray damage predict focal and generalized bone loss in patients with mild rheumatoid arthritis followed over two years

A positive rheumatoid factor and X-ray damage predict focal and generalized bone loss in patients with mild rheumatoid arthritis followed over two years

Minimal disease activity, remission, and the long‐term outcomes of rheumatoid arthritis

To determine the prevalence of minimal disease activity (MDA) and remission in patients with rheumatoid arthritis (RA), to assess the effect of anti-tumor necrosis factor (anti-TNF) therapy on MDA, and to determine the extent to which MDA status improves long-term outcomes. Using the Patient Activity Scale (PAS) as a surrogate, we assessed the prevalence of MDA and remission in 18,062 patients with RA using the newly developed Outcome Measures in Rheumatology Clinical Trials (OMERACT) criteria for MDA. MDA was noted in 20.2% of 18,062 patients and persistent MDA, operationally defined as having MDA during >or=2 consecutive 6-month observation periods, occurred in 13.5% of 7,433 patients followed longitudinally. Disease activity at remission levels was noted in 7%. Among patients with MDA, 82% received disease-modifying antirheumatic drugs or biologic agents. Following anti-TNF initiation, the cumulative probability of achieving MDA at 2 and 6 years was 4.1% and 7.6%, respectively, and persistent MDA probabilities were 2.7% and 4.5%, respectively. Regardless of RA duration, patients with MDA had substantially better outcomes, including a 10-fold reduction in work disability and an approximately 2-fold reduction in total joint replacement and mortality. Remission remains uncommon in RA, and the prevalence of new remission in community practice is substantially lower than noted in published trials of biologic therapy. On average, persons with MDA appear to have persistently mild RA. This might be the effect of milder RA and/or more effective treatment in early RA. The PAS had satisfactory levels of agreement with the full MDA criteria and appears suitable for use in clinical and epidemiologic research.

Progressive and Concordant Expression of PKC-η and iNOS Phenotypes in Monocytes From Patients With Rheumatoid Arthritis: Association With Disease Severity

Rheumatoid arthritis (RA) is a relatively common autoimmune disease with strong genetic and environmental determinants. The disease manifests itself as inflammation of the synovia and usually progresses to joint erosion and destruction. The disease can also be considered as a systemic disease because extra-articular manifestations are often observed throughout many organs and tissues of the body. Patients with severe RA have altered peripheral blood monocytes (PBM) that express activation markers. Two such markers, PKC-eta and iNOS, were studied using confocal laser scanning microscopy to determine how these markers are expressed during disease progression. Healthy individuals expressed neither of the two markers, but there was an elevated level of PKC-eta observed as the disease progressed (40% in mild RA and 100% in severe RA patients). Concordant expression of the two markers was observed in only 3% of PBM from mild RA patients, reaching 38% in severe RA patients. No cells expressing iNOS alone were observed in any of the patients studied. These data support the hypothesis linking PKC-eta expression with the regulation and predisposition to the development of the iNOS phenotype in severe RA patients. PKC-eta may therefore be a key regulator in the production of elevated plasma nitric oxide (NO) and corresponding circulating reactive nitrogen intermediates in severe RA and may be a possible target to regulate iNOS induction and NO production by monocytic cells in RA patients and possibly other inflammatory diseases.

Unusual cause of painful shoulder in an elderly woman with rheumatoid arthritis

The painful shoulder is a very common condition encountered in the rheumatology clinic with rotator cuff disorders, glenohumeral disorders, acromioclavicular joint disease and referred neck pain being the most common causes. Other rare causes have to be considered in the presence of "red flag" indicators. We describe a case of a patient with mild rheumatoid arthritis and a past medical history of stage 2C epithelial ovarian carcinoma who presented to the rheumatology clinic with a painful shoulder and who was initially diagnosed with rotator cuff tendinopathy. When seen 3 months later she was found to have a 15 x 10-cm firm, non-tender soft tissue mass over the right scapula and X-rays showed a large lytic mass destroying much of the upper border of the scapula, suggestive of metastasis. Bone metastases in patients with ovarian carcinoma are very rare; they occur in about 2% of cases and are invariably predictors of poor prognosis. To our knowledge, this is the first case of ovarian cancer metastasised to the scapula. We suggest that rheumatologists should be aware of the differential diagnosis of painful shoulder and look for "red flag" indicators in patients with known rheumatic conditions.

Use of tumor necrosis factor inhibitors in rheumatoid arthritis: a national survey of practicing United States rheumatologists

ObjectivesTo determine the prescribing practices, laboratory monitoring protocols, and perceived barriers of United States rheumatologists in prescribing tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). MethodsA survey questionnaire was mailed to 1970 rheumatologists who were randomly selected from a national sample of 3008 rheumatologists. A one-page non-response questionnaire was mailed to approximately 200 randomly selected non-responding rheumatologists to assess non-response bias. ResultsTwo mailings yielded a response rate of 22.3% (428 completed, usable surveys out of 1922 deliverable surveys). Rheumatologists reported using all three agents in patients with moderate RA (82–87%), severe RA (94–96%), and in newly diagnosed and mild RA patients (10–18%). In patients with severe RA who inadequately responded to methotrexate, 91% of rheumatologists reported using a TNF inhibitor with one other disease modifying anti-rheumatic drug. Over 94% of rheumatologists reported switching patients from one TNF inhibitor to a different TNF inhibitor due to inadequate response or side effects. Most rheumatologists (96%) ordered the purified protein derivative test for tuberculosis, with almost 82% conducting this test at baseline. Costs to patients and insurance coverage were perceived as major barriers to prescribing these agents although the perception was slightly lower with infliximab than with adalimumab or etanercept. ConclusionsThe use of TNF inhibitors is not restricted to patients with moderate and severe RA. Rheumatologists are fairly similar in their utilization of the three TNF inhibitors although some variation exists in terms of laboratory practices and perceived barriers regarding the use of these agents.

A 71-Year-Old Woman Contemplating a Screening Colonoscopy

DR BURNS: Ms G is a 71-year-old woman with a past medical history of osteoporosis, mitral valve prolapse, mild rheumatoid arthritis, and hypothyroidism. She has Medicare. Ms G is trying to decide whether to undergo a colonoscopy to screen for colon cancer. Ms G is currently feeling well and has no active medical issues. Ms G’s physician has encouraged her to have a colonoscopy, but she remains reluctant to proceed for 3 reasons. First, she has had adverse reactions to anesthetic agents in the past and is concerned about a potential reaction to the agents that would be used for a colonoscopy. Second, she is concerned about needing transportation home after receiving a sedative because her husband has driving restrictions. Third, she is unsure about the importance of colonoscopy given her negative family history of colon cancer. In addition, she expressed a concern about the size of colonoscopes designed for adults. Of note, she has completed home-based fecal occult blood testing (FOBT) on a yearly to every-other-year basis, and test results have always been negative. She has never undergone flexible sigmoidoscopy. She has been screened for breast and cervical cancer. She has had bone densitometry and was found to have osteoporosis for which she currently takes alendronate as well as calcium and vitamin D. Ms G also has had cholesterol screening performed on a yearly basis. She is currently taking alendronate (70 mg weekly), calcium, vitamin D, and levothyroxine (75 μg daily) and reports vomiting as an adverse reaction to diazepam. She has undergone allergy testing, which revealed an allergy to epinephrine and all members of the “caine” family except carbocaine. She is married. She does not smoke and drinks red wine with dinner. She remains physically active around the home and in her garden and practices piano on a daily basis. Travel is restricted by her husband’s limited driving ability. MS G: HER VIEW I’ve had a lot of pressure from my doctor to have a colonoscopy, but I’m reluctant to have one for several reasons. First of all, you have to have some sort of a relaxant and I’m afraid to take one of those tranquilizer type things because I just react badly to that stuff. I talked to my doctor and she thought it might be possible to do it without sedation especially if they used pediatric equipment. Second, I could never have it done here. My husband is truly handicapped and cannot drive other than right around the house, so he could not drive me here and I’d have to have somebody else bring me down. The third thing is that my father is 1 of 9 children, my mother 1 of 5 and nobody has ever had colon cancer on either side of the family that we know. So those are my reasons. However, this summer it really hit me because my doctor said she thinks I should go ahead and have one because my health is so good, that I should, barring trucks hitting me, etc, last a long time, and that I should have the colonoscopy just in case there’s something lurking there. And I had never thought about it that way and I thought that was valid.

How to predict prognosis in early rheumatoid arthritis

In early rheumatoid arthritis (RA), the objectives of therapeutic strategies are to obtain remission and prevent joint destruction as early as possible. These goals may be reached with conventional disease-modifying antirheumatic drugs (DMARDs) or with biological agents. In clinical practice, initial treatments are usually chosen according to the degree of disease activity at baseline, and adapted according to a step-up strategy. A more elegant therapeutic approach would be to choose the most appropriate treatment based on the prognosis of RA. Therefore, prognostic stratification could improve the relative roles and benefits of initial DMARD or biological therapy for early RA. For RA with a severe prognosis, a combination of DMARDs or biologicals could be initiated as the first-line therapy. However, we need to know how to predict outcome in early RA for this type of strategy. This review attempts to answer this question by reporting the most reliable prognostic factors and some predictive models proposed for classification into benign, mild and severe RA.

Magnetic Resonance Imaging Findings in Rheumatoid Arthritis Patients with Temporomandibular Joint Disorder

Objective: To evaluate the ability of magnetic resonance imaging to identify temporomandibular joint involvement in patients with rheumatoid disease.Patients and Methods: Eight patients with temporomandibular joint symptoms of pain and impaired function, who satisfied the 1987 criteria of the American College of Rheumatology for rheumatoid arthritis were enrolled. Clinical findings in the masticatory system were recorded. Open and closed mouth sagittal protondensity and T2-weighted sequences were performed for all patients, and the images were examined for Condylar configuration, presence of erosion, disc position, and disc abnormality.Results: Four of the 8 patients had mild rheumatoid arthritis activity, 2 had moderate activity and rheumatoid arthritis was inactive in the other 2 patients. Six of the 8 patients had Steinbrocker's class II disease and the others had class III disease. Seven of the 8 patients had temporomandibular joint tenderness or jaw opening pain. Coarse crepitus on opening (5 temporomandibular joints) was the commonest joint sound abnormality. Anterior disc displacement without reduction was present in 6 patients and pannus in 2 patients. Condylar deformity was present in all patients. Four patients showed joint effusion.Conclusion: The results of this study clearly demonstrated the ability of magnetic resonance imaging to detect and define abnormalities in the temporomandibular joint of patients with rheumatoid arthritis.

Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis – a pilot study

Objective: To study the effects of Lactobacillus rhamnosus GG (LGG) on rheumatoid arthritis (RA).Methods: Twenty‐one RA patients were randomised to receive 2 capsules of LGG or a placebo twice daily in double‐blind fashion for 12 months. Arthritis activity was evaluated by clinical examination, HAQ index, and laboratory tests (e.g. ESR, CRP, pro‐ and anti‐inflammatory cytokines).Results: There were no statistical differences in the clinical parameters, biochemical variables and HAQ index between the study groups over the intervention period. The mean number of tender and swollen joints decreased from 8.3 to 4.6 in the Lactobacillus group and from 5.5 to 4.8 in the placebo group (p=0.41). According to the global assessment the RA activity was reduced in 71% (LGG group) vs. 30% (controls) (p=0.15). Serum IL‐1β increased slightly in the LGG group (p=0.07), but no differences were seen in IL‐6, TNF‐α, MPO, IL‐10 or 1L‐12.Conclusions: Although there were no statistical significant differences in the activity of RA, more subjects in the LGG group reported subjective well being. More studies on the effects of probiotic bacteria in RA are needed.

Analysis of cartilage-derivedretinoic-acid-sensitive protein (CD-RAP) in synovial fluid from patients with osteoarthritis and rheumatoid arthritis

We have measured the concentration of cartilage-derived retinoic-acid-sensitive protein (CD-RAP) in synovial fluid (SF) from the knees of 49 patients with osteoarthritis (OA) and 79 with rheumatoid arthritis (RA) in order to investigate the correlation between the type of joint disease and level of CD-RAP. The mean concentration of CD-RAP in synovial fluid was significantly higher in OA than in RA. The level of CD-RAP in the group of patients with mild OA was significantly higher than in the moderate or severe groups and that in the group with mild RA was also significantly higher than in the other RA groups and decreased with progression of the disease. Immunohistochemical studies showed expression of CD-RAP in the cytoplasm of chondrocytes in newly-formed fibrocartilage. Since CD-RAP is mainly produced in young and proliferating chondrocytes, our results suggest that the level of CD-RAP in synovial fluid reflects remodelling of articular cartilage and may be used as a marker to estimate objectively the restorative reaction of chondrocytes.