Home About us Contact | |||
Rheumatoid Arthritis (rheumatoid + arthritis)
Kinds of Rheumatoid Arthritis Terms modified by Rheumatoid Arthritis Selected AbstractsRHEUMATOID ARTHRITIS , CLINICAL ASPECTSINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2006Article first published online: 6 JUL 200 First page of article [source] RHEUMATOID ARTHRITIS , TREATMENTINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2006Article first published online: 6 JUL 200 First page of article [source] RHEUMATOID ARTHRITIS , AETIOLOGY AND PATHOGENESIS/ANIMAL MODELINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2006Article first published online: 6 JUL 200 First page of article [source] Assessing functional health status in adults with haemophilia: towards a preliminary core set of clinimetric instruments based on a literature search in Rheumatoid Arthritis and OsteoarthritisHAEMOPHILIA, Issue 4 2005P. De Kleijn Summary., People with haemophilia experience a progressive deterioration of their functional health status. Regular clinical assessment of functional health status provides insight into their process of disablement. As such, the development of a core-set of measurement tools is warranted. The aim of this study was to gather data to prepare a (preliminary) core set of clinically relevant and feasible instruments to assess the functional health status of adults with haemophilia, and to indicate their psychometric qualities. Therefore, clinimetric instruments frequently used in two haemophilia-resembling diseases (Rheumatoid Arthritis and Osteoarthritis) were reviewed from the literature. An extensive search in Medline yielded 13 relevant review articles, incorporating a total of 182 instruments, of which 40 were appropriate for haemophilia. Of these 40 instruments 3 measure body structures, 13 body functions, 19 activities (of which 5 are performance based and 14 self-report based), and 3 measure participation. This classification is based on the International Classification of Functioning, Disability and Health. Detailed information regarding the psychometrics (reliability, validity and responsiveness) of four instruments is described fully in the literature, whereas the psychometrics of the majority of the other instruments are only partly described. The results of this literature study may contribute to the formation of a (preliminary) core set of clinimetric instruments to assess the functional health status of adults with haemophilia. Decisions on the final core set should be held within the Musculoskeletal Committee of the World Federation of Haemophilia. [source] Certain Aspects of ACTH and Cortisone Therapy in Older Patients with Rheumatoid ArthritisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2002Max M. Montgomery MD First page of article [source] Early Prosthetic Valve Failure in a Patient with Rheumatoid ArthritisJOURNAL OF CARDIAC SURGERY, Issue 1 2009Sanjay Asopa M.R.C.S. Most patients do not require cardiac surgical intervention unless they develop complications such as significant valvular regurgitation. Patients with RA often require orthopedic operations and therefore a bioprosthetic valve replacement is normally advocated to avoid problems related to anticoagulation. We report a case of a 64-year-old woman with seropositive RA who had undergone bioprosthetic aortic valve replacement three years previously. She re-presented with early prosthetic valve failure due to accelerated degeneration and calcification. This was treated successfully with redo replacement with a mechanical prosthesis. Here, we discuss our experience and debate the various valve choices available that should be considered in patients with rheumatoid disease. [source] Unmitigated Communion, Social Constraints, and Psychological Distress Among Women With Rheumatoid ArthritisJOURNAL OF PERSONALITY, Issue 1 2004Sharon Danoff-Burg This longitudinal study is the first to examine the influence of unmitigated communion on adaptation to a chronic illness that affects a much greater proportion of women to men. Women with rheumatoid arthritis completed measures of unmitigated communion, social constraints, and psychological distress at study entry and repeated the distress measure one year later. As expected, unmitigated communion was associated with psychological distress. Cross-sectional moderation analyses indicated that low social constraints buffered the negative effects of unmitigated communion. [source] Guidelines for the Management of Rheumatoid Arthritis 2002 UpdateJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2002APRN-C, Mary Jo Goolsby EdD Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month's column describes the recommended care of patients who have been previously diagnosed with RA. [source] Patients' conceptions of the cause of their rheumatoid arthritis: A qualitative studyMUSCULOSKELETAL CARE, Issue 4 2009MScN, Ulrika Bergsten RN Abstract Background:,Patients' perspective of the causes and consequences of rheumatoid arthritis (RA) can conflict with that of healthcare professionals and lead to misunderstanding, difficulties in management and a poorer outcome. Objectives:,The aim of this study was to describe the variation in how patients' conceive the cause of their RA. Methods:,An open written question from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, aimed at patients recently diagnosed with RA, was answered by 38 strategically selected patients during 2003 and analysed using the phenomenographic approach. Results:,Two descriptive categories and six concepts emerged: the category ,consequences beyond personal control' comprised not having a clue, being exposed to climatic change, being genetically exposed and unexpected effects of events; the category ,overloaded circumstances' involved work and family-related strain. Consequences beyond personal control implied that the patients could not prevent the disease and expressed their lack of understanding as to why they contracted it. Overloaded circumstances were described as strained situations that were both work and family related and could be influenced by the patient. Conclusions:,The patient's perspective of the cause of their RA includes aspects that complement the current pathogenetic models and should therefore be considered in the management of the disease. When dealing with rheumatic diseases, it is necessary to be aware of the patient's perspectives in order to new management strategies. In addition to epidemiological studies, further studies of patients' own experience are needed in order to achieve a more tailored care model. Copyright © 2009 John Wiley & Sons, Ltd [source] Harlequin Ichthyosis in Association with Hypothyroidism and Juvenile Rheumatoid ArthritisPEDIATRIC DERMATOLOGY, Issue 5 2003Yuin-Chew Chan M.D. Two Chinese children, a 2-year-old boy and an 11-year-old girl, presented with these classic features as well as alopecia and loss of eyebrows and eyelashes. The boy was small for his age and was found to have hypothyroidism at the age of 18 months; he is currently on thyroxine replacement therapy. At 6 years of age, the girl developed symmetrical polyarthritis associated with positive rheumatoid factor and radiologic evidence of erosive arthritis, suggestive of juvenile rheumatoid arthritis. She received prednisolone, nonsteroidal anti-inflammatory drugs (NSAIDs), and subsequently methotrexate for her arthritis, with clinical and radiologic improvement. Early therapy with oral retinoids in both children accelerated shedding of the hyperkeratotic plates as well as improved ectropion and eclabium. There was no major adverse reaction to oral retinoids. The development of juvenile rheumatoid arthritis in survivors with harlequin ichthyosis has not been previously described. The use of prednisolone and NSAIDs in the girl did not affect the skin condition, but the addition of methotrexate led to a decrease in erythema. The association with autoimmune disease is probably coincidental. The psychosocial impact of this severe lifelong disease on the two families was enormous. Early retinoid therapy may improve the disorder and help increase survival rates. A multidisciplinary approach, including psychosocial support of the affected families, is vital in the management of this lifelong disease. [source] The Observational Evaluation of Subjective Well-Being in Patients with Rheumatoid ArthritisAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 1 2009Afton L. Hassett An important aspect of general health is subjective well-being (SWB), which is defined as happiness and overall satisfaction with life. Herein we examined the reliability and validity of observation-based ratings of SWB in patients with rheumatoid arthritis (RA). Ten RA patients experiencing a disease flare (period of increased symptoms) completed two semi-structured interviews (baseline and 4 weeks later) that were digitally recorded. Twelve healthcare professionals watched the 20 brief videos in random order and scored them using the Well-Being Coding System (WBCS) for observer-reported SWB. Patient-reported SWB scores and scores from the Medical Outcomes Study: 36-Item Short Form Survey (SF-36) were compared to observer-reported scores for SWB. We found inter-rater reliability to be extremely high and a significant relationship between observer SWB composite scores and patient SWB composite scores. Observer SWB composite scores and other scores associated with SWB from the SF-36 were also related significantly. There was also some evidence supporting the ability of observers to detect change in SWB. Taken together, we found preliminary evidence suggesting that when using information gleaned from brief patient interviews clinicians can make reliable and valid evaluations of patients' SWB. [source] Gene,environment interaction between the DRB1 shared epitope and smoking in the risk of anti,citrullinated protein antibody,positive rheumatoid arthritis: All alleles are importantARTHRITIS & RHEUMATISM, Issue 6 2009Emeli Lundström Objective An interaction effect for developing rheumatoid arthritis (RA) was previously observed between HLA,DRB1 shared epitope (SE) alleles and smoking. We aimed to further investigate this interaction between distinct SE alleles and smoking regarding the risk of developing RA with and without anti,citrullinated protein antibodies (ACPAs). Methods We used data regarding smoking habits and HLA,DRB1 genotypes from 1,319 patients and 943 controls from the Epidemiological Investigation of Rheumatoid Arthritis, in which 972 patients and 488 controls were SE positive. Subsequently, 759 patients and 328 controls were subtyped for specific alleles within the DRB1*04 group. Odds ratios with 95% confidence intervals (95% CIs) were calculated by means of logistic regression. Interaction was evaluated by calculating attributable proportion due to interaction, with 95% CIs. Results A strong interaction between smoking and SE alleles in the development of ACPA-positive RA was observed for all DRB1*04 SE alleles taken as a group (relative risk [RR] 8.7 [95% CI 5.7,13.1]) and for the *0401 and *0404 alleles (RR 8.9 [95% CI 5.8,13.5]) and the *01 and *10 alleles (RR 4.9 [95% CI 3.0,7.8]) as specific, separate groups, with similar strength of interaction for the different groups (attributable proportion due to interaction 0.4 [95% CI 0.2,0.6], 0.5 [95% CI 0.3,0.7], and 0.6 [95% CI 0.4,0.8], respectively). Conclusion There is a statistically significant interaction between distinct DRB1 SE alleles and smoking in the development of ACPA-positive RA. Interaction occurs with the *04 group as well as the *01/*10 group, demonstrating that regardless of fine specificity, all SE alleles strongly interact with smoking in conferring an increased risk of ACPA-positive RA. [source] Different patterns of associations with anti,citrullinated protein antibody,positive and anti,citrullinated protein antibody,negative rheumatoid arthritis in the extended major histocompatibility complex regionARTHRITIS & RHEUMATISM, Issue 1 2009Bo Ding Objective To identify additional variants in the major histocompatibility complex (MHC) region that independently contribute to risk in 2 disease subsets of rheumatoid arthritis (RA) defined according to the presence or absence of antibodies to citrullinated protein antigens (ACPAs). Methods In a multistep analytical strategy using unmatched as well as matched analyses to adjust for HLA,DRB1 genotype, we analyzed 2,221 single-nucleotide polymorphisms (SNPs) spanning 10.7 Mb, from 6p22.2 to 6p21.31, across the MHC. For ACPA-positive RA, we analyzed samples from the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) and the North American Rheumatoid Arthritis Consortium (NARAC) studies (totaling 1,255 cases and 1,719 controls). For ACPA-negative RA, we used samples from the EIRA study (640 cases and 670 controls). Plink and SAS statistical packages were used to conduct all statistical analyses. Results A total of 299 SNPs reached locus-wide significance (P < 2.3 × 10,5) for ACPA-positive RA, whereas surprisingly, no SNPs reached this significance for ACPA-negative RA. For ACPA-positive RA, we adjusted for known DRB1 risk alleles and identified additional independent associations with SNPs near HLA,DPB1 (rs3117213; odds ratio 1.42 [95% confidence interval 1.17,1.73], Pcombined = 0.0003 for the strongest association). Conclusion There are distinct genetic patterns of MHC associations in the 2 disease subsets of RA defined according to ACPA status. HLA,DPB1 is an independent risk locus for ACPA-positive RA. We did not identify any associations with SNPs within the MHC for ACPA-negative RA. [source] Aspirin antiplatelet therapy and nonsteroidal antiinflammatory drugs: Comment on the 2002 update of the American College of Rheumatology Guidelines for the Management of Rheumatoid ArthritisARTHRITIS & RHEUMATISM, Issue 11 2002José L. Pablos MD No abstract is available for this article. [source] Effect of Filtration Leukocytapheresis Therapy: Modulation of White Blood Cell Enzyme Activities in Patients with Rheumatoid ArthritisARTIFICIAL ORGANS, Issue 4 2002Satoshi Yamasaki Abstract: We treated 12 patients with rheumatoid arthritis by filtration leukocytapheresis (FLCP) and evaluated its effect on leukocyte enzyme activities. We calculated the number of leukocytes removed and assessed the clinical response. We also evaluated the cellular enzyme activities of elastase and dipeptidylpeptidase IV (DPP IV). Out of 12 patients, 7 patients achieved 20% improvement for 4 weeks following FLCP. The FLCP treatment resulted in removal of 96% of granulocytes, 98% of monocytes, and 61% of lymphocytes. Granulocytes and monocytes with high elastase activity were effectively removed by FLCP. The elastase activity of granulocytes was increased 4 weeks after the last FLCP only in responders. On the other hand, the DPP IV activity of lymphocytes was low at 4 weeks after the last FLCP in responders. Modulation of leukocyte enzyme activities is one of the main effects of FLCP therapy and alteration of granulocytes, monocytes, and lymphocytes. [source] Angio-oedema in a Patient Treated with Etanercept for Rheumatoid ArthritisBASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 6 2009Omer Faruk Sendur One of these drugs, etanercept, is a recombinant soluble fusion protein of tumour necrosis factor-, type 2 receptor. Although it has many well-established side effects, up to date there has not been any report of angio-oedema in the literature. Hence, we aimed to present clinical findings of a 59-year-old female patient who received etanercept for rheumatoid arthritis and developed angio-oedema during treatment, and to the discuss side effects of the drug within the context of current literature. [source] Physical illness and schizophrenia: a review of the literatureACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2007S. Leucht Objective:, The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method:, We searched MEDLINE (1966 , May 2006) combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results:, A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion:, The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. [source] Certolizumab pegol: a new option for rheumatoid arthritisFUTURE PRESCRIBER, Issue 4 2009MSc Rheumatology SpR, Margaret HY Ma MBBS Rheumatoid arthritis (RA) presents a significant burden to healthcare in the UK. New biological therapies have advanced treatment but at a high cost to the NHS. Certolizumab pegol is a new TNF inhibitor, providing an additional treatment option for RA. In this article Dr Ma and Dr Choy consider the efficacy of certolizumab pegol, and where it may fit into the RA armoury. Copyright © 2009 John Wiley & Sons, Ltd. [source] Rituximab in advanced rheumatoid arthritisFUTURE PRESCRIBER, Issue 2 2006Michael Guida BSc Rheumatoid arthritis (RA) continues to have a major impact on public health. Costs to the individual and to the NHS are high, and treatment options for RA are by no means perfect. This article reviews rituximab, an agent that interrupts inflammatory events via a novel mode of action, and shows promise as a new intervention in cases of moderate to severe RA. Copyright © 2006 John Wiley & Sons, Ltd. [source] Managing comorbidity in patients with rheumatoid arthritisINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2008Vicky LU Abstract Rheumatoid arthritis (RA) is a chronic inflammatory disease that decreases physical function and imposes substantial medical costs. Comorbid conditions are common in patients with RA and they adversely affect quality of life and RA-related outcomes such as work disability and mortality. Rheumatologists have the important responsibility to consider comorbidities and their risks when treating patients and to adapt therapies to the specific situation of individual patients. This paper discusses the common comorbidities in patients with RA and management approaches. [source] The spectrum of cutaneous lesions in rheumatoid arthritis: a clinical and pathological study of 43 patientsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2003C. M. Magro Introduction:, Rheumatoid arthritis (RA) is an idiopathic arthropathy syndrome that has a propensity to affect the small joints of the hands and feet with extra-articular manifestations comprising skin lesions, neuropathy, pericarditis, pleuritis, interstitial pulmonary fibrosis and a systemic polyarteritis nodosa (PAN)-like vasculitic syndrome. The most widely recognized skin lesion is the rheumatoid nodule. Other skin manifestations are poorly defined. Materials and methods:, Using a natural language search of the authors' outpatient dermatopathology databases, skin biopsies from 43 patients with RA were selected for retrospective analysis in an attempt to define the dermatopathological spectrum of RA and its clinical correlates. Results:, The biopsies were categorized by the dominant histologic pattern, recognizing that in most cases there were additional minor reaction patterns. Palisading and/or diffuse interstitial granulomatous inflammation was the dominant pattern seen in 21 patients; the lesions included nodules, plaques and papules with a predilection to involve skin over joints. Besides interstitial histiocytic infiltrates and variable collagen necrobiosis, these cases also showed interstitial neutrophilia, vasculitis and pauci-inflammatory vascular thrombosis. The dominant morphology in 11 other patients was vasculopathic in nature: pauci-inflammatory vascular thrombosis, glomeruloid neovascularization, a neutrophilic vasculitis of pustular, folliculocentric, leukocytoclastic or benign cutaneous PAN types, granulomatous vasculitis, and lymphocytic vasculitis and finally occlusive intravascular histiocytic foci for which the designation of ,RA-associated intravascular histiocytopathy' is proposed. Rheumatoid factor (RF) positivity and active arthritis were common in this group, with anti-Ro and anticardiolipin antibodies being co-factors contributing to vascular injury in some cases. Immunofluorescent testing in three patients revealed dominant vascular IgA deposition. In nine patients, the main pattern was one of neutrophilic dermal and/or subcuticular infiltrates manifested clinically as urticarial plaques, pyoderma gangrenosum and panniculitis. Conclusions:, The cutaneous manifestations of RA are varied and encompass a number of entities, some of which define the dominant clinical features, such as the rheumatoid papule or subcutaneous cords, while others allude to the histopathology, i.e. rheumatoid neutrophilic dermatosis. We propose a more simplified classification scheme using the adjectival modifiers of ,rheumatoid-associated' and then further categorizing the lesion according to the dominant reaction pattern. Three principal reaction patterns are recognized, namely extravascular palisading granulomatous inflammation, interstitial and/or subcuticular neutrophilia and active vasculopathy encompassing lymphocyte-dominant, neutrophil-rich and granulomatous vasculitis. In most cases, an overlap of the three reaction patterns is seen. Co-factors for the vascular injury that we believe are integral to the skin lesions of RA include RF, anti-endothelial antibodies of IgA class, anti-Ro and anticardiolipin antibodies. [source] Rheumatoid Leptomeningitis: Magnetic Resonance Imaging and Pathologic Findings,A Case ReportJOURNAL OF NEUROIMAGING, Issue 2 2010Alessandro Cianfoni MD ABSTRACT BACKGROUND AND PURPOSE Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease with articular and extra-articular manifestations. Intracranial manifestations of RA are rare. Purpose of this article is to report on a rarely described leptomeningeal involvement in RA, and on its neuroimaging features, including diffusion-weighted imaging (DWI). METHODS The authors describe the case of a 74-year-old woman with a 5-year history of RA presenting with progressive left-side weakness and hypoesthesia. The patient underwent laboratory investigation and brain contrast-enhanced MRI, also with DWI, before undergoing brain biopsy. RESULTS Neuroimaging revealed abnormal high T2-signal in right frontal and parietal lobes, restricted diffusion in the subarachnoid space, and diffuse thick linear leptomeningeal contrast-enhancement. These findings were interpreted as rheumatoid leptomeningitis, and brain biopsy confirmed this diagnosis. CONCLUSIONS In summary, rheumatoid meningitis is a rare neurological complication of RA, but it should be considered in the proper clinical setting when patient presentation and laboratory results fail to support the other differential diagnostic possibilities proposed by the MR imaging findings. [source] Guidelines for the Management of Rheumatoid Arthritis 2002 UpdateJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2002APRN-C, Mary Jo Goolsby EdD Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month's column describes the recommended care of patients who have been previously diagnosed with RA. [source] Spectrum of Fibrosing Diffuse Parenchymal Lung DiseaseMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 1 2009Adam S. Morgenthau MD Abstract The interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the pulmonary interstitium. In 2002, the American Thoracic Society and the European Respiratory Society revised the classification of interstitial lung diseases and introduced the term diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are a subtype of diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are subdivided into usual interstitial pneumonia (with its clinical counterpart idiopathic interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and lymphocytic pneumonia. Sarcoidosis and hypersensitivity pneumonitis are the 2 most common granulomatous diffuse parenchymal lung diseases. Rheumatoid arthritis, systemic sclerosis, and dermatomyositis/polymyositis (causing antisynthetase syndrome) are diffuse parenchymal lung diseases of known association because these conditions are associated with connective tissue disease. Hermansky-Pudlak syndrome is a rare genetic diffuse parenchymal lung disease characterized by the clinical triad of pulmonary disease, oculocutaneous albinism, and bleeding diathesis. This review provides an overview of the chronic fibrosing diffuse parenchymal lung diseases. Its primary objective is to illuminate the clinical challenges encountered by clinicians who manage the diffuse parenchymal lung diseases regularly and to offer potential solutions to those challenges. Treatment for the diffuse parenchymal lung diseases is limited, and for many patients with end-stage disease, lung transplantation remains the best option. Although much has been learned about the diffuse parenchymal lung diseases during the past decade, research in these diseases is urgently needed. Mt Sinai J Med 76:2,23, © 2009 Mount Sinai School of Medicine [source] ,All singing from the same hymn sheet': Healthcare professionals' perceptions of developing patient education material about the cardiovascular aspects of rheumatoid arthritisMUSCULOSKELETAL CARE, Issue 4 2009Holly John BM BS, MRCP Abstract Objective:,Cardiovascular disease (CVD) is the leading cause of death in Britain, and its prevention is a priority. Rheumatoid arthritis (RA) patients have an increased risk of CVD, and management of modifiable classical risk factors requires a programme with patient education at its heart. Before a programme for RA patients is implemented, it is important to explore the perceptions of patients and relevant healthcare professionals and consider how these could influence the subsequent content, timing and delivery of such education. Here, we assess healthcare professionals' perceptions. Methods:,Qualitative focus group methodology was adopted. Four group meetings of healthcare professionals were held using a semi-structured interview schedule. The focus group transcripts were analysed using interpretative phenomenological analysis. Results:,Three superordinate themes emerged: professional determinations about people with RA, including their perceptions about patients' priorities and motivations; communication about CVD risk, including what should be communicated, how, to whom and when; and responsibility for CVD management, referring to patients and the healthcare community. Conclusions:,Although healthcare professionals agree that it is important to convey the increased CVD risk to patients with RA, there is concern they may be less proactive in promoting risk management strategies. There was uncertainty about the best time to discuss CVD with RA patients. Maintaining a close relationship between primary and secondary care was thought to be important, with all healthcare professionals ,singing from the same hymn sheet'. These findings can inform the development of novel education material to fulfil a currently unmet clinical need. Copyright © 2009 John Wiley & Sons, Ltd. [source] Rheumatoid arthritis, alcohol, leflunomide and methotrexate.MUSCULOSKELETAL CARE, Issue 4 2008Can changes to the BSR guidelines for leflunomide, methotrexate on alcohol consumption be justified? Introduction:,The summary of product characteristics for leflunomide and methotrexate recommend avoiding alcohol. By contrast, the latest British Society for Rheumatology (BSR) guidelines suggest that alcohol should be ,well within national limits'. A postal survey was performed of rheumatoid arthritis (RA) patients to address their alcohol consumption, and assess whether this influenced any rise in alanine transaminase (ALT) levels while on leflunomide or methotrexate. Methods:,RA patients commenced on methotrexate or leflunomide within the preceding two years were identified using the departmental database. A total of 200 patients on methotrexate or leflunomide were sent questionnaires covering demographics, disease details, duration of disease-modifying anti-rheumatic drug (DMARD) use, previous medical and drug history, alcohol advice recalled, and alcohol consumption while on the drug. ALT levels at drug commencement and the highest level on the drug were recorded. Results:,Replies were received from 69.5% of methotrexate and 57.5% of leflunomide patients. 68.6% of patients recalled receiving alcohol advice. 55.8% of leflunomide patients did not drink alcohol prior to taking the DMARD, compared with 39.4% of methotrexate patients. 27.7% of leflunomide patients continued to drink alcohol compared with 64.3% on methotrexate. For both drugs, no patterns emerged to suggest that baseline or highest ALT levels were influenced by higher levels of alcohol consumption. Discussion:,No differences were found with either methotrexate or leflunomide for self-reported alcohol consumption influencing ALT levels. It is appropriate to give similar alcohol advice to patients beginning therapy with either methotrexate or leflunomide. This research has not found any evidence to contradict the relaxation of advice on alcohol consumption with methotrexate and leflunomide in the updated BSR guidelines. Copyright © 2008 John Wiley & Sons, Ltd. [source] Occupational balance of women with rheumatoid arthritis: a qualitative studyMUSCULOSKELETAL CARE, Issue 2 2004Tanja Stamm MSc MBA MagPhil OTR Abstract Objective: Occupational balance has been shown to be an important factor in maintaining health. Rheumatoid arthritis (RA) reduces functional ability and quality of life and may thus reduce occupational balance. The aim of this qualitative pilot study was to explore occupational balance in women who have RA. Methods: Nine women with RA with past, but not current, paid work experience, no other confounding neuro-motor disease and with disease duration of 0.75,31 years were selected from an Austrian rheumatology outpatient clinic. Age range of the participants was 28,68 years. A semi-structured interview was conducted with each participant and transcribed verbatim. Data were analysed by the constant comparative method from an occupational perspective. Results: Three main categories emerged: (1) The participants experienced a process of change that affected their occupational balance. (2) This new state of occupational balance was characterized by changed levels of involvement in physical, mental, social and rest occupations and by a certain level of unpredictability of symptoms. (3) Overall, the new state of occupational balance was valued differently: positively, indifferently or negatively. Conclusion: RA was found to have a considerable impact on occupational balance. The experience is not invariably seen as negative as previous literature would suggest. Further research should explore the longitudinal dimension of occupational balance in people with RA. Copyright © 2004 Whurr Publishers Ltd. [source] A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative studyNURSING & HEALTH SCIENCES, Issue 3 2006S. Barbro Arvidsson rnt Abstract, The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities. [source] Gene therapy for rheumatoid arthritisTHE JOURNAL OF GENE MEDICINE, Issue 6 2002Natacha Bessis Abstract Rheumatoid arthritis (RA) is a severe autoimmune systemic disease. Chronic synovial inflammation results in destruction of the joints. No conventional treatment is efficient in RA. Gene therapy of RA targets mainly the players of inflammation or articular destruction: TNF-, or IL-1 blocking agents (such as anti-TNF-, monoclonal antibodies, soluble TNF-, receptor, type II soluble receptor of IL-1, IL-1 receptor antagonist), antiinflammatory cytokines (such as IL-4, IL-10, IL-1), and growth factors. In this polyarticular disease, the vector expressing the therapeutic protein can be administered as a local (intra-articular injection) or a systemic treatment (extra-articular injection). All the main vectors have been used in experimental models, including the more recent lentivirus and adeno-associated virus. Ex vivo gene transfer was performed with synovial cells, fibroblasts, T cells, dendritic cells, and different cells from xenogeneic origin. In vivo gene therapy is simpler, although a less controlled method. Clinical trials in human RA have started with ex vivo retrovirus-expressing IL-1 receptor antagonists and have demonstrated the feasibility of the strategy of gene therapy. The best target remains to be determined and extensive research has to be conducted in preclinical studies. Copyright © 2002 John Wiley & Sons, Ltd. [source] Adiponectin-mediated changes in effector cells involved in the pathophysiology of rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 10 2010Klaus W. Frommer Objective Rheumatoid arthritis (RA) is associated with increased production of adipokines, which are cytokine-like mediators that are produced mainly in adipose tissue but also in synovial cells. Since RA synovial fibroblasts (RASFs), lymphocytes, endothelial cells, and chondrocytes are key players in the pathophysiology of RA, this study was undertaken to analyze the effects of the key adipokine adiponectin on proinflammatory and prodestructive synovial effector cells. Methods Lymphocytes were activated in part prior to stimulation. All cells were stimulated with adiponectin, and changes in gene and protein expression were determined by Affymetrix and protein arrays. Messenger RNA and protein levels were confirmed using semiquantitative reverse transcription,polymerase chain reaction (PCR), real-time PCR, and immunoassays. Intracellular signal transduction was evaluated using chemical signaling inhibitors. Results Adiponectin stimulation of human RASFs predominantly induced the secretion of chemokines, as well as proinflammatory cytokines, prostaglandin synthases, growth factors, and factors of bone metabolism and matrix remodeling. Lymphocytes, endothelial cells, and chondrocytes responded to adiponectin stimulation with enhanced synthesis of cytokines and various chemokines. Additionally, chondrocytes released increased amounts of matrix metalloproteinases. In RASFs, adiponectin-mediated effects were p38 MAPK and protein kinase C dependent. Conclusion Our previous findings indicated that adiponectin was present in inflamed synovium, at sites of cartilage invasion, in lymphocyte infiltrates, and in perivascular areas. The findings of the present study indicate that adiponectin induces gene expression and protein synthesis in human RASFs, lymphocytes, endothelial cells, and chondrocytes, supporting the concept of adiponectin being involved in the pathophysiologic modulation of RA effector cells. Adiponectin promotes inflammation through cytokine synthesis, attraction of inflammatory cells to the synovium, and recruitment of prodestructive cells via chemokines, thus promoting matrix destruction at sites of cartilage invasion. [source] |