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Very early rheumatoid arthritis

Carla F Gamarra-Hilburn, Grissel Rios, Luis M Vilá
Septic bursitis is usually caused by bacterial organisms. However, infectious bursitis caused by fungi is very rare. Herein, we present a 68-year-old woman with long-standing rheumatoid arthritis who developed pain, erythema, and swelling of the right olecranon bursa. Aspiration of the olecranon bursa showed a white blood cell count of 3.1 × 10(3)/μL (41% neutrophils, 30% lymphocytes, and 29% monocytes). Fluid culture was positive for Candida parapsilosis. She was treated with caspofungin 50 mg intravenously daily for 13 days followed by fluconazole 200 mg orally daily for one week...
2016: Case Reports in Rheumatology
Pascal H P de Jong, Johanna M Hazes, Leander R Buisman, Pieternella J Barendregt, Derkjen van Zeben, Peter A van der Lubbe, Andreas H Gerards, Mike H de Jager, Peter B J de Sonnaville, Bernard A Grillet, Jolanda J Luime, Angelique E A M Weel
OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97)...
August 30, 2016: Rheumatology
Ellen Sauar Norli, Gina H Brinkmann, Tore K Kvien, Olav Bjørneboe, Anne J Haugen, Halvor Nygaard, Cathrine Thunem, Elisabeth Lie, Maria D Mjaavatten
OBJECTIVES: To study occurrence of and factors associated with self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis (RA) (2010 RA criteria) in patients with ≤16 weeks׳ duration of joint swelling. METHODS: We applied the 2010 RA criteria in 1118 patients included in a 2-year longitudinal cohort. In all, 256 patients fulfilled the 2010 RA criteria at baseline; outcome was defined as either "self-limiting arthritis" (no DMARD use during follow-up, no swollen joints at last assessment, and no final clinical diagnosis of RA) or "persistent disease...
July 20, 2016: Seminars in Arthritis and Rheumatism
Makoto Hirao, Kosuke Ebina, Hideki Tsuboi, Takaaki Noguchi, Jun Hashimoto, Hideki Yoshikawa
Control of rheumatoid arthritis (RA) disease activity is an important factor related to the development of hallux valgus (HV) deformity. Furthermore, if valgus hindfoot remains and/or appears after HV surgery, the affected foot is at risk of recurrence of HV deformity. We experienced a case suggesting the possibility that hindfoot valgus deformity appeared after HV surgery because of poor control of RA disease activity, and the HV deformity recurred in the very early period after surgery.
July 18, 2016: Modern Rheumatology
Irina A Udalova, Alberto Mantovani, Marc Feldmann
Macrophages are very important in the pathogenesis of rheumatoid arthritis (RA). The increase in the number of sublining macrophages in the synovium is an early hallmark of active rheumatic disease, and high numbers of macrophages are a prominent feature of inflammatory lesions. The degree of synovial macrophage infiltration correlates with the degree of joint erosion, and depletion of these macrophages from inflamed tissue has a profound therapeutic benefit. Research has now uncovered an unexpectedly high level of heterogeneity in macrophage origin and function, and has emphasized the role of environmental factors in their functional specialization...
August 2016: Nature Reviews. Rheumatology
Valentina Grossi, Maria Infantino, Mariangela Manfredi, Francesca Meacci, Emanuele Bellio, Valerio Bellio, Francesca Li Gobbi, Simone Ugolini, Stefano Catani, Piercarlo Sarzi-Puttini, Fabiola Atzeni, Maurizio Benucci
BACKGROUND: Inflammatory arthritis (IA) is highly prevalent and so the discovery of new early diagnostic biomarkers is of particular interest. Calprotectin is a very sensitive and potentially a predictive biomarker of drug responsiveness. METHODS: Serum calprotectin levels were determined in 88 patients diagnosed as having rheumatoid arthritis (RA), psoriatic arthritis (PsA) or spondyloarthritis (SA), and 73 healthy subjects. RESULTS: Logistic regression and receiver operating characteristic (ROC) analyses showed that serum calprotectin levels were diagnostically accurate in the IA population...
June 28, 2016: Current Rheumatology Reviews
G Gallo, F Brock, U Kerkmann, B Kola, T W J Huizinga
OBJECTIVE: To evaluate the impact of methotrexate (MTX) dosage on clinical, functional and quality of life outcomes in patients with rheumatoid arthritis (RA) from two previous etanercept (ETN) trials after 24 months of treatment. METHODS: Patients with active RA in the ETN+MTX combination treatment arms of the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO) and COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis (COMET) studies were pooled in this post hoc analysis and stratified by MTX dosage at 24 months, having MTX monotherapy groups as control: low dose, <10...
2016: RMD Open
Ilaria Petrucci, Sara Samoni, Mario Meola
Secondary nephropathies can be associated with disreactive immunological disorders or with a non-inflammatory glomerular damage. In systemic lupus erythematosus (SLE), scleroderma and rheumatoid arthritis as in other connective tissue diseases, kidney volume and cortex echogenicity are the parameters that best correlate with clinical severity of the disease, even if the morphological aspect is generally non-specific. Doppler studies in SLE document the correlation between resistance indexes (RIs) values and renal function...
2016: Contributions to Nephrology
S Popelka, A Sosna, P Vavřík, D Jahoda, V Barták, I Landor
UNLABELLED: PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Sara Tengvall, Tove Eneljung, Pernilla Jirholt, Olof Turesson, Kajsa Wing, Rikard Holmdahl, Jan Kihlberg, Anna Stern, Inga-Lill Mårtensson, Louise Henningsson, Kenth Gustafsson, Inger Gjertsson
Here, we investigate induction of immunological tolerance by lentiviral based gene therapy in a mouse model of rheumatoid arthritis, collagen II-induced arthritis (CIA). Targeting the expression of the collagen type II (CII) to antigen presenting cells (APCs) induced antigen-specific tolerance, where only 5% of the mice developed arthritis as compared with 95% of the control mice. In the CII-tolerized mice, the proportion of Tregs as well as mRNA expression of SOCS1 (suppressors of cytokine signaling 1) increased at day 3 after CII immunization...
2016: PloS One
Wietske Kievit, Jake S F Maurits, Elke E Arts, Piet L C M van Riel, Jaap Fransen, Calin D Popa
BACKGROUND: Early detection and pre-emptive treatment of patients at risk is of great importance in reducing the excess risk of cardiovascular disease in Rheumatoid Arthritis (RA). However it is unclear in how far cardiovascular screening in RA is cost-effective. The objective is to assess whether cardiovascular (CV) screening in RA proves to be cost-effective from a medical perspective, using different scenario's based on different guidelines. METHODS: A Markov Chain model was used, with a time horizon of 10 years...
May 9, 2016: Arthritis Care & Research
Agnieszka Matuszewska, Marta Madej, Piotr Wiland
Rheumatoid arthritis (RA) is the most common connective tissue disease of autoimmune origin. The disease is characterized by chronic inflammation leading to bone erosions and organ involvement. RA is a progressive disease. It affects the quality of life, leading to disability and death mainly due to premature cardiovascular disease. Early diagnosis and appropriate treatment are essential for prognosis and quality of life improvement. In 2010 the American College of Rheumatology (ACR) and The European League Against Rheumatism (EULAR) established new RA classification criteria...
2016: Postȩpy Higieny i Medycyny Doświadczalnej
Maria Victoria Hernández, Raimon Sanmartí, Juan D Cañete
INTRODUCTION: Tumor necrosis factor inhibitors (TNFi) were the first biologic therapy authorized for rheumatoid arthritis (RA) treatment and are currently the most used biological drugs in these patients. Although clinical efficacy is proven, adverse events associated with these agents have been described, and further knowledge is essential to facilitate detection at very early stages. AREAS COVERED: We reviewed the safety profile of TNFi, including both articles and congress communications published on this topic, such as clinical trials, meta-analyses, observational studies, data from registries, and spontaneous clinical reports...
May 2016: Expert Opinion on Drug Safety
Maria Mauermann, Kristina Hochauf-Stange, Alexander Kleymann, Karsten Conrad, Martin Aringer
OBJECTIVES: To analyse the subgroup of early arthritis patients with new onset parvovirus infections for details that may help narrow the population tested. METHODS: From their routine patient charts, patient histories and clinical and serological data were obtained for all 130 patients of the Rheumatology division with parvovirus serology performed. 11 patients had acute parvovirus infections, defined by specific IgM antibodies. 95 patients had a previous infection, 16 were never infected, together forming the n=111 control group, and 8 patients had to be excluded...
March 2016: Clinical and Experimental Rheumatology
Charles Peterfy, Gerd R Burmester, Vivian P Bykerk, Bernard G Combe, Julie C DiCarlo, Daniel E Furst, Tom W J Huizinga, Dennis A Wong, Philip G Conaghan, Paul Emery
OBJECTIVES: To assess structural damage progression with subcutaneous abatacept (ABA) in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) trial following abrupt withdrawal of all rheumatoid arthritis (RA) medication in patients achieving Disease Activity Score (DAS)-defined remission or low disease activity. METHODS: Patients with early, active RA were randomised to ABA plus methotrexate (ABA/MTX) 125 mg/week, ABA 125 mg/week or MTX for 12 months...
August 2016: Annals of the Rheumatic Diseases
Tue Wenzel Kragstrup, Babak Jalilian, Kresten Krarup Keller, Xianwei Zhang, Julie Kristine Laustsen, Kristian Stengaard-Pedersen, Merete Lund Hetland, Kim Hørslev-Petersen, Peter Junker, Mikkel Østergaard, Ellen-Margrethe Hauge, Malene Hvid, Thomas Vorup-Jensen, Bent Deleuran
INTRODUCTION: In rheumatoid arthritis (RA) immune activation and presence of autoantibodies may precede clinical onset of disease, and joint destruction can progress despite remission. However, the underlying temporal changes of such immune system abnormalities in the inflammatory response during treat-to-target strategies remain poorly understood. We have previously reported low levels of the soluble form of CD18 (sCD18) in plasma from patients with chronic RA and spondyloarthritis. Here, we study the changes of sCD18 before and during treatment of early RA and following arthritis induction in murine models of rheumatoid arthritis...
2016: PloS One
Raluca B Dumitru, Sarah Horton, Richard Hodgson, Richard J Wakefield, Elizabeth M A Hensor, Paul Emery, Maya H Buch
BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis, with significant impact on quality of life and functional status. Whilst biologic disease modifying anti-rheumatic drugs (bDMARD) such as tumour necrosis factor-inhibitor (TNFi) agents have revolutionised outcomes in RA, early diagnosis with immediate conventional therapy, titrated in a treat to target approach is also associated with high remission rates. The main aim of the VEDERA study (Very Early versus Delayed Etanercept in Rheumatoid Arthritis) is to assess the depth of remission, sustainability of remission and immunological normalisation induced by very early TNFi with etanercept (ETN) or standard of care +/- delayed ETN...
2016: BMC Musculoskeletal Disorders
Maria Juarez, Helen M McGettrick, Dagmar Scheel-Toellner, Lorraine Yeo, Julia Spengler, Banesa de Paz, Rowan Hardy, Mark Cooper, Karim Raza, Christopher D Buckley, Andrew Filer
BACKGROUND: Synovial fibroblasts play a key role in joint destruction and regulation of the inflammatory infiltrate in established rheumatoid arthritis (RA). The mechanisms by which this occurs in the earliest stages of RA are largely unknown. We investigated the role of Dickkopf-related protein 1 (DKK1) produced by synovial fibroblasts of patients with very early rheumatoid arthritis (VeRA). METHODS: Fibroblasts were isolated from the disease-modifying anti-rheumatic drug-naive Birmingham early arthritis cohort of patients with new onset of clinically apparent arthritis and inflammatory symptoms of ≤12 weeks' duration, who at follow-up had either resolving arthritis or RA...
2016: Arthritis Research & Therapy
Thibault Vandhuick, Yannick Allanore, Didier Borderie, Jean-Pierre Louvel, Patrice Fardellone, Philippe Dieudé, Vincent Goëb, Gaëlle Clavel, Marie Christophe Boissier, Fabienne Jouen, Patrick Boumier, Jean-Dominique Allart, Othmane Mejjad, Sophie Pouplin, Mary Jan, Jean François Ménard, Xavier Le Loët, Olivier Vittecoq
OBJECTIVES: Accelerated atherosclerosis has emerged as a critical issue in rheumatoid arthritis (RA). There is a need to better understand the link between RA and atherosclerosis. Our aim was to identify parameters associated with the development of subclinical atheroma in a very early arthritis (VErA) cohort. METHODS: VErA-cohort patients were prospectively recruited from 1998 to 2002. Arthritis treatment was standardised from onset. The clinical, biological and radiological parameters of all patients were collected from inclusion...
January 2016: Clinical and Experimental Rheumatology
Natali W S Gormezano, Clovis A Silva, Nadia E Aikawa, Diego L Barros, Mariana A da Silva, Carini I Otsuzi, Katia Kozu, Luciana Parente Seguro, Rosa M R Pereira, Eloisa Bonfá
The objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet...
January 2016: Clinical Rheumatology
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