Effects Of Rheumatoid Arthritis Research Articles

Analysis on rheumatoid arthritis of clinical nursing by total glucosides of paeony and leflunomide combined with minimally invasive steel knife Chinese dialectic

Objective To investigate effect for rheumatoid arthritis by total glucosides of paeony and leflunomide combined with minimally invasive steel knife Chinese dialectic.Methods 72 cases of rheumatoid arthritis in our hospital from January 2010 to December 2013,according to the odd and even number of beds group,odd as study group,even for the control group (n=36),then comparative analysis was carried out for the therapeutic effects of two groups.Results The study group of joint pain,joint swelling,tender joint count,time of morning stiffness and its curative effects was obviously better than that of the control group,with statistical significant differences (P ＜ 0.05).Conclusion Total glucosides of radix paeoniae alba,leflunomide combined with minimally invasive steel knife Chinese dialectic nursing of rheumatoid arthritis has obvious curative effect,which is worthy of clinical nursing promotion. Key words: Minimally invasive steel knife; Traditional Chinese medicine dialectical nursing; Rheumatoid arthritis; Total glucosides of paeony; Leflunomide

Impact of Rheumatoid Arthritis on Health Related Quality of Life in Elderly Patients

The study was a cross-sectional study conducted to assess the relationship and effect of rheumatoid arthritis on quality of life of elderly subjects.

A1.38 Mesenchymal stem cells induce non-classical IL-10-producing regulatory TH17 cells in arthritis: role of gilz

Background and ObjectivesRegulatory T (Treg) cells have a critical inhibitory effect in rheumatoid arthritis (RA) and are a potential target for therapies that suppress inflammation. Induction of Treg cells by...

Muscle wasting in collagen-induced arthritis and disuse atrophy

The mechanisms of muscle wasting and decreased mobility have a major functional effect in rheumatoid arthritis, but they have been poorly studied. The objective of our study is to describe muscular involvement and the pathways in an experimental model of arthritis compared to the pathways in disuse atrophy. Female Wistar rats were separated into three groups: control (CO), collagen-induced arthritis (CIA), and immobilized (IM). Spontaneous locomotion and weight were evaluated weekly. The gastrocnemius muscle was evaluated by histology and immunoblotting to measure the expression of myostatin (a negative regulator), LC3 (autophagy), MuRF-1 (proteasome-mediated proteolysis), MyoD, and myogenin (satellite-cell activation). The significance level was set at P < 0.05, and histological analysis of joints confirmed the severity of the arthropathy. There was a significant difference in spontaneous locomotion in the CIA group. Animal body weight, gastrocnemius muscle weight, and relative muscle weight decreased 20%, 30%, and 20%, respectively, in the CIA rats. Inflammatory infiltration and swelling were present in the gastrocnemius muscles of the CIA rats. The mean cross-sectional area was reduced by 30% in the CIA group and by 60% in the IM group. The expressions of myostatin and LC3 between the groups were similar. There was increased expression of MuRF-1 in the IM (1.9-fold) and CIA (3.1-fold) groups and of myogenin in the muscles of the CIA animals (1.7-fold), while MyoD expression was decreased in the IM (20%) rats. This study demonstrated that the development of experimental arthritis is associated with decreased mobility, body weight, and muscle loss. Both IM and CIA animal models presented muscle atrophy, but while proteolysis and the regeneration pathways were activated in the CIA model, there was no activation of regeneration in the IM model. We can assume that muscle atrophy in experimental arthritis is associated with the disease itself and not simply with decreased mobility.

Plasma osteopontin is correlated with bone resorption markers in rheumatoid arthritis patients

To assess whether any form of osteopontin (OPN) is correlated with bone resorption markers or treatment effects in rheumatoid arthritis (RA). Subjects comprised 119 patients with RA. RA disease activity was evaluated by Disease Activity Score (DAS) 28, erythrocyte sedimentation rate (ESR), and levels of C-reactive protein (CRP), rheumatoid factor (RF) and matrix metalloproteinase (MMP)-3. OPN levels in plasma and urine were measured by enzyme-linked immunosorbent assay (ELISA). Levels of tartrate-resistant acid phosphatase (TRACP) 5b in serum and C-terminal telopeptide of type 1 collagen (CTX)-1 in urine were measured by ELISA. Patients were divided into responder and nonresponder groups, and OPN levels were compared at baseline and after treatment. Levels of full-length OPN in plasma (P-fOPN) were significantly correlated with levels of TRACP 5b (r=0.44, P<0.001), urine CTX-1 (r=0.26, P=0.004) and MMP-3 (r=0.34, P<0.001). Levels of TRACP 5b were significantly correlated with age (r=0.25, P=0.007), but levels of P-fOPN were not. After treatment, plasma OPN levels were significantly decreased in responders (P=0.003). Levels of full-length or thrombin-cleaved forms of OPN in urine were not correlated with TRACP 5b or CTX-1. Our results suggest that plasma OPN may reflect inflammatory bone destruction in RA patients.

SAT0111 Description of Glucocorticoid Sparing Effect in Rheumatoid Arthritis (RA) Patients Treated by Tocilizumab (TCZ) in Real Life: An Interim Analysis of the Spare-1 Study

BackgroundAlthough glucocorticoid treatment may be appropriate in RA patients, there is general agreement that glucocorticoid therapy sparing is desirable when possible (1, 2). The safety of corticosteroids is duration and...

AB0289 MMP-3 as biomarlker for evaluation of disease activity and treatment effectiveness in rheumatoid arthritis

BackgroundSince usage of biologic agents, treatment strategy of Rheumatoid Arthritis (RA) is now being a new target. In T2T principle, our first goal to achieve is clinical remission. Biologic agents...

THU0485-HPR Current practice and barriers to the management of sexual issues in rheumatology: Results of a survey of 647 health professionals

BackgroundSexual concerns are prevalent among patients with rheumatic diseases, and there is evidence that patients want disease-related sexual aspects to be addressed in the health care setting (2). However, some...

New methods for determining comparative effectiveness in rheumatoid arthritis

To provide an overview of recently published articles describing or applying newer methods for evaluating comparative effectiveness research (CER) in rheumatoid arthritis (RA). Historically, clinical trials in RA have compared newer therapies against placebo. Newer trials designed to increase the relevance of trial results to real-world settings include head-to-head comparisons, some that incorporate noninferiority, factorial and crossover designs. Extensions of traditional meta-analysis through network meta-analysis can combine direct and indirect evidence together and can compare multiple treatments with each other.Observational data used to support CER include disease registries, administrative claims data and electronic medical records. Pooling and linking across these data sources and applying newer epidemiologic methods to analyse such data can provide more valid inferences regarding optimal treatment regimens for RA. CER methods in RA include head-to-head clinical trials, advanced techniques to summarize and aggregate data across studies, enrich the data available in observational settings and enhance the methods used for analysis. Efforts to continue to apply and improve these methodologies will address key needs of clinicians, patients and health policy decision-makers to generate evidence regarding real-world risks and benefits.

Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice

BackgroundIn the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice.MethodFollowing ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data.Results245 questionnaires were completed (128–non-specialist working in the private sector, 101 non–specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines.ConclusionsThis study has revealed some crucial information about podiatrists’ level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners, the guidelines helped them to identify their professional development needs and for the few non-specialists that did use them, they enabled appropriate referral to the rheumatology team for foot health management. The barriers to their use included a lack of understanding of the risk associated with managing people with RA and that guidelines can be too long and detailed for use in clinical practice. Suggestions are made for improving the implementation of foot health guidelines.

Use of complementary and alternative therapy among patients with rheumatoid arthritis and osteoarthritis

We wanted to assess the prevalence of complementary and alternative therapy use among patients suffering from rheumatoid arthritis or osteoarthritis in the Lebanese population and to determine the perceived efficacy and side effects of complementary and alternative therapy in the treatment of these diseases. Complementary and alternative therapy has become popular among patients with chronic illnesses because of its widespread use. Rheumatoid arthritis and osteoarthritis are two diseases associated with severe pain, inflammation and limited activity. Although both are quite common in Lebanon, no studies were conducted in our country to portray complementary and alternative therapy use in their treatment. Descriptive cross-sectional study. Conducted individualised questionnaire-based interviews among 250 adult patients, ranging between the ages of 20-90 years and diagnosed with either rheumatoid arthritis or osteoarthritis. The questionnaire included demographic information, clinical information, use of conventional therapies and complementary and alternative therapy, and the disease status before and after complementary and alternative therapy use. Fifty-eight (23·2%) patients used complementary and alternative therapy in addition to their conventional medications in the treatment of either rheumatoid arthritis or osteoarthritis. Most herbal medicine users (63·8%) believed that complementary and alternative therapy was beneficial. The disease status measured by the intensity of pain, sleeping pattern and level of activities was significantly improved after using complementary and alternative therapy (p =0·01). Forty-eight (82·75%) patients were using herbals as complementary and alternative therapy, 14 (24·1%) of whom have sought medical care because of potential concomitant drug-complementary and alternative therapy side effects. However, these side effects were not serious and reversible. Although complementary and alternative therapy might have beneficial effects in rheumatoid arthritis and osteoarthritis, patients should be cautious about their use and should necessarily inform their health care providers about the consumption of any products other than their conventional medicines. It is quite essential for health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing medical care to patients with arthritis.

Effect of Rheumatoid Arthritis (RA) Susceptibility Genes on the Immune Response to Viral Citrullinated Peptides in RA

To the Editor: Anticitrullinated peptide/protein antibodies (ACPA) are a family of rheumatoid arthritis (RA)-specific antibodies that recognize various protein sequences containing citrulline, the deiminated form of arginine produced posttranslationally by peptidylarginine deiminase (PAD) enzymes. Recently, viral citrullinated peptides (VCP) derived from Epstein-Barr virus nuclear proteins EBNA-1 and EBNA-2 have been described as a target of ACPA in RA sera1,2. Genetic factors predisposing to RA, namely HLA-DRB1 shared epitope (SE) alleles and PTPN22 gene variants, as well as the TRAF1/C5 locus and PADI4 susceptible haplotype, have been found to be predominantly associated with ACPA-positive RA, even if the association with ACPA-negative RA cannot be excluded. We evaluated the influence of genes conferring susceptibility to RA on the production of anti-VCP antibodies and tested the interaction of VCP with HLA in vitro . We analyzed 172 patients with RA of French white origin3. All provided informed consent and the Ethics Committee of Hopital Bicetre (AP-HP, Paris, France) approved the study. HLA-DRB1 typing and subtyping were performed by a polymerase chain reaction (PCR)-based method, using a panel of sequence-specific oligonucleotide probes. PADI4 haplotypes were obtained by typing 3 single-nucleotide polymorphisms (SNP: rs1886303, PADI4\_92, PADI4\_96 – CGC haplotype) by PCR-restriction fragment-length polymorphism (RFLP)4. PTPN22 (R620W; rs24766601 – T variant) and C5/TRAF1 region polymorphisms (rs10818488 – A variant) were genotyped by PCR-RFLP5,6. … Address correspondence to Dr. P. Migliorini; E-mail: paola.migliorini{at}med.unipi.it

Treatment-specific changes in circulating adipocytokines: a comparison between tumour necrosis factor blockade and glucocorticoid treatment for rheumatoid arthritis

ObjectiveThere is increasing evidence that adipocytokines may exert proinflammatory and destructive effects in rheumatoid arthritis (RA). Hence, the authors investigated the relationship between adipocytokines and several features associated with RA...

Metastasis-inducing S100A4 protein is associated with treatment response in patients with recent-onset rheumatoid arthritis

Background/objectivesThere is increasing evidence that metastasis-inducing S100A4 protein may exert pro-inflammatory and destructive effects in rheumatoid arthritis (RA). The authors have previously demonstrated that S100A4 is significantly up-regulated in RA...

Noninvasive atherosclerosis imaging modalities and their application to investigating cardiovascular drug effects in rheumatoid arthritis

AbstractRheumatoid arthritis (RA) is a systemic inflammatory disorder that affects not only joints but also the cardiovascular (CV) system. Premature endothelial dysfunction and accelerated atherosclerosis are pertinent findings in patients with RA, resulting in increased CV morbidity and mortality. Thus, detection of subclinical atherosclerosis is important in RA management. A range of promising imaging modalities is currently available to visualize early vascular disease and monitor changes in atherosclerotic plaque burden, serving as important tools in CV risk stratifications and as surrogate markers for CV endpoints in intervention trials. This review summarizes various noninvasive imaging modalities, implemented in widespread clinical use, such as vascular ultrasonography and cardiac computer tomography, as well as novel emerging technologies, such as magnetic resonance imaging and positron emission tomography. These novel technologies make a step forward in the evaluation and quantification of atherosclerotic plaque features, permitting the detection of vulnerable plaque as well as functional assessment of vessel wall metabolic activity that was previously not achievable. Application of the imaging modalities to monitor CV drug effects in therapeutic clinical trials in both the general and RA population is further presented and discussed. Drug Dev Res 72:739–749, 2011. © 2011 Wiley Periodicals, Inc.

Optimization of the immunologic diagnostic criteria for rheumatoid arthritis

Objective To optimize the immunologic diagnostic criteria of rheumatoid arthritis commonly used in clinical,to find methods to diagnose rheumatoid arthritis quickly,accurately and economically.Methods The levels of RF,CRP,ESR,anti-CCP,AKA,CP I,anti-MCV in blood of the patients with rheumatoid arthritis were simultaneously measured, and their sensitivity and specificity was compared.Results The sensitivity and specificity of antiMCV was 76.8% and 90.6% ,anti-CCP 67.2% and 90.3% ,AKA 75.2% and 84.7% ,RF 72.8% and 79.1%.The sensitivity and specificity of them were higher.The specificity of GPI(92.1% ) was high,but the sensitivity of it (46.4% )was low.The sensitivity and specificity of other criteria were low.Conclusion anti-MCV,anti-CCP,AKA and RF could be preferentially used in the diagnosis,therapy and monitor of curative effect of rheumatoid arthritis. Key words: Rheumatoid arthritis; Diagnostic criteria; Optimizing

A randomised, controlled study of outcome and cost effectiveness for RA patients attending nurse-led rheumatology clinics: Study protocol of an ongoing nationwide multi-centre study

BackgroundThe rise in the number of patients with arthritis coupled with understaffing of medical services has seen the deployment of Clinical Nurse Specialists in running nurse-led clinics alongside the rheumatologist clinics. There are no systematic reviews of nurse-led care effectiveness in rheumatoid arthritis. Few published RCTs exist and they have shown positive results for nurse-led care but they have several limitations and there has been no economic assessment of rheumatology nurse-led care in the UK. ObjectiveThis paper outlines the study protocol and methodology currently being used to evaluate the outcomes and cost effectiveness for patients attending rheumatology nurse-led clinics. Design and methodsA multi-centred, pragmatic randomised controlled trial with a non-inferiority design; the null hypothesis being that of ‘inferiority’ of nurse-led clinics compared to physician-led clinics. The primary outcome is rheumatoid arthritis disease activity (measured by DAS28 score) and secondary outcomes are quality of life, self-efficacy, disability, psychological well-being, satisfaction, pain, fatigue and stiffness. Cost effectiveness will be measured using the EQ-5D, DAS28 and cost profile for each centre. Power calculationsIn this trial, a DAS28 change of 0.6 is considered to be the threshold for clinical distinction of ‘inferiority’. A sample size of 180 participants (90 per treatment arm) is needed to reject the null hypothesis of ‘inferiority’, given 90% power. Primary analysis will focus on 2-sided 95% confidence interval evaluation of between-group differences in DAS28 change scores averaged over 4 equidistant follow up time points (13, 26, 39 and 52 weeks). Cost effectiveness will be evaluated assessing the joint parameterisation of costs and effects. ResultsThe study started in July 2007 and the results are expected after July 2011. Trial registrationThe International Standard Randomised Controlled Trial Number ISRCTN29803766.

Body mass index and clinical response to infliximab in rheumatoid arthritis

Adipose tissue has immunomodulating effects in rheumatoid arthritis (RA), although the exact role is, at present, unclear. The purpose of this study was to determine whether body mass index (BMI) affects response to infliximab in RA patients investigated prospectively. In 89 patients with active RA, the BMI was calculated before initiation of infliximab treatment (3 mg/kg intravenously). After 16 weeks of treatment, changes in disease activity were assessed with the Disease Activity Score in 28 joints (DAS28). The mean ± SD BMI was 26 ± 5 kg/m(2) (range 17-42). The BMI correlated positively with the DAS28 at baseline (r = 0.34, P = 0.001). Since selection of study patients according to DAS28 values could influence the clinical response to tumor necrosis factor (TNF) blockade due to regression to the mean because the clinical response is itself based on the change in the DAS28 values, analysis of covariance was used to correct for the baseline DAS28. A highly significant, negative association between the BMI and the absolute decrease in the DAS28 after 16 weeks (P = 0.001) was found also when adjusted for anti-citrullinated protein antibodies. Although the infliximab dosage is based on body weight, RA patients with a high BMI responded less well to infliximab, a finding that held true when adjusted for the baseline DAS28 or anti-citrullinated protein antibody status. These results support the notion that adipose tissue may be involved in the pathophysiology of RA and could have implications for other immune-mediated inflammatory conditions treated with TNF antagonists.

CD40: Novel Association with Crohn's Disease and Replication in Multiple Sclerosis Susceptibility

BackgroundA functional polymorphism located at −1 from the start codon of the CD40 gene, rs1883832, was previously reported to disrupt a Kozak sequence essential for translation. It has been consistently associated with Graves' disease risk in populations of different ethnicity and genetic proxies of this variant evaluated in genome-wide association studies have shown evidence of an effect in rheumatoid arthritis and multiple sclerosis (MS) susceptibility. However, the protective allele associated with Graves' disease or rheumatoid arthritis has shown a risk role in MS, an effect that we aimed to replicate in the present work. We hypothesized that this functional polymorphism might also show an association with other complex autoimmune condition such as inflammatory bowel disease, given the CD40 overexpression previously observed in Crohn's disease (CD) lesions.MethodologyGenotyping of rs1883832C>T was performed in 1564 MS, 1102 CD and 969 ulcerative colitis (UC) Spanish patients and in 2948 ethnically matched controls by TaqMan chemistry.Principal FindingsThe observed effect of the minor allele rs1883832T was replicated in our independent Spanish MS cohort [p = 0.025; OR (95% CI) = 1.12 (1.01–1.23)]. The frequency of the minor allele was also significantly higher in CD patients than in controls [p = 0.002; OR (95% CI) = 1.19 (1.06–1.33)]. This increased predisposition was not detected in UC patients [p = 0.5; OR (95% CI) = 1.04 (0.93–1.17)].ConclusionThe impact of CD40 rs1883832 on MS and CD risk points to a common signaling shared by these autoimmune conditions.

Interleukin‐10 gene promoter polymorphism in Polish rheumatoid arthritis patients

Interleukin (IL)-10 is an important multifunctional cytokine with both anti-inflammatory and immunoregulatory effects in rheumatoid arthritis (RA). In the present study, we evaluated the frequency and potential impact of IL-10 promoter polymorphisms on susceptibility to and severity of RA in Polish in - patients with a high disease activity (mean DAS 28 C-reactive protein 5.25). DNA was obtained from 244 RA patients and 106 healthy controls. The -592C/A and -1082G/A IL-10 gene polymorphisms were amplified by polymerase chain reaction with restriction endonuclease mapping. The frequency of the IL-10-592CA, -592AA genotypes (respectively: 30% vs 5% and 7% vs 0%) and allele -592A (37% vs 5%) were significantly higher in RA patients as compared with a control group. We did not find any association of the IL-10-592C/A genotype distribution with disease parameters, except for an increased ESR (erythrocyte sedimentation rate) in patients with the -592CC genotype as compared with those with -592CA or -592AA genotypes (P = 0.01). The frequency of the IL-10-1082GG genotype was lower (P = 0.0001), and that of the IL-10-1082GA genotype was higher (P = 0.009) in RA patients comparing with the control group. In RA patients with -1082GA or -1082AA genotypes the time duration of the disease (P = 0.03), Health Assessment Questionnaire (HAQ) Score (P = 0.04) and PLT count (P = 0.001) were significantly increased as compared with subjects with -1082GG genotype. Presented findings indicate that IL-10-592C/A and IL-10-1082G/A polymorphisms may be considered genetic risk factors for RA susceptibility and severity.