OBJECTIVE: To study the prognostic value of the antiperinuclear factor (APF), determined by an indirect immunofluorescence test (IIF) and a recently developed anti-citrullinated cyclic peptide (CCP) ELISA, in combination with rheumatoid factor (RF) status, in early RA (< 1 year). METHODS: A total of 249 participants in a randomized trial of treatment strategies were divided into 4 groups according to their APF (or CCP) and RF status at baseline. Differences in disability, joint involvement and radiological damage over a 3-year period were analysed. RESULTS: APF-IIF results differed from CCP-ELISA in 42 cases (17%); 38 of the 42 had a positive IIF and negative ELISA value. Disability after 3 years did not differ significantly between the RF and APF groups. APF- patients had significantly lower Thompson joint scores compared to APF+ patients (6 vs 24 for CCP-ELISA; 2 vs 24 for IIF). RF+APF+ patients exhibited more radiological damage compared to RF-APF- patients. RF+APF- and RF-APF+ patients had intermediate scores. Within the RF+ and RF- groups, APF+ was associated with more radiological damage and thus yielded prognostic information in addition to RF. In this respect, the results of ELISA and IIF were comparable. Thirty percent of the RF+APF+ patients had a radiological score higher than 45, compared to 13% of the RF+APF-, none of the RF-APF+, and 2% of RF-APF- patients (p < 0.001). In addition, more large joints were affected in APF+ than in APF- patients, while no difference was observed between RF+ and RF- patients. CONCLUSION: APF has prognostic value in addition to RF for joint involvement and radiological damage in early RA. The CCP-ELISA technique for APF assessment may facilitate its use in clinical practice. However, the prognostic value of the two tests lies in their ability to predict mild disease. Reliable identification at baseline of individual patients with progressive disease is still not possible.

Adolescent↗

PubMedDate not supplied

Alternative medicine in rheumatology: threat or challenge?

Explore the source record for details and available documents.

Complementary Therapies↗

PubMedDate not supplied

The effect of radiation synovectomy in patients with persistent arthritis: a prospective study.

OBJECTIVE: To investigate and compare the effects of radiation synovectomy of various joints in a rheumatological practice. METHODS: Consecutive patients referredfor radiation synovectomy to Medical Center Alkmaarfrom 1993 till 1996 were analyzed (n = 138). Patients had to have persistent arthritis despite at least two intra-articular glucocorticoid injections with 20 mg triamcinolone hexacetonide. The knees were treated with 185 MBq Yttrium-90; shoulders, elbows, wrists, hips and talocrural joints received 185 MBq Rhenium-186 and meta-carpophalangeal joints and proximal interphalangeal joints 37 MBq Erbium-169. The radionuclide injection was followed by injection of 20 mg triamcinolone in order to prevent flare-up of synovitis (due to chemical irritation) and needle-track burn. The clinical effect was assessed by evaluating VAS pain (0-10 point scale), functional disability, tenderness and swelling of the treated joint and patient's and physician's global assessments of the effect of therapy (each on a 4-point scale). RESULTS: The overall success rate for radiation synovectomy one year after treatment was 70% with a significant improvement in the variables VAS pain, functional disability and joint tenderness and swelling, when compared to baseline values (p < 0.000001). Moderate to considerable satisfaction of patients and physicians one year after treatment was found for > 50% of cases. Wrists and shoulders were the joints with highest success rate of treatment, followed by the elbows. Lowest success rates were found for hips and ankles. In RA treatment was effective in 76% of cases whereas patients with OA exhibited a success rate of 50%. In RA all treated joints, except the ankles, exhibited a success rate of > or = 75%. No short-term clinical adverse side effects were noted. CONCLUSION: Radiation synovectomy seems to be a successful treatment for persistent arthritis when other therapeutic modalities have failed.

Adult↗

PubMedDate not supplied

The Utrecht experience with different treatment strategies in early rheumatoid arthritis.

Since 1990 the Utrecht Rheumatoid Arthritis Cohort study group has performed several clinical trials on different treatment strategies in early rheumatoid arthritis (RA) patients. From 1990 till 1994, patients were randomly assigned to the pyramid strategy group or the early DMARD group. Patients in the early DMARD group were allocated to one of the three following treatment strategies: strategy I, starting with hydroxychloroquine (HCQ); strategy II, starting with intramuscular gold (iAU); or strategy III, starting with oral methotrexate (MTX). After one year, statistically significant advantages for the early DMARD group compared with the pyramid group were found for disability, pain, joint score, and ESR. The increase in radiological damage did not differ significantly between the two strategy groups. These first year results proved that early introduction of DMARDs is more beneficial than a delayed introduction. After 5 years, however, no prolongation of the clinical advantages in favor of the early DMARD group, as observed after one year, was found. It was found that patients assigned to the pyramid group received more intra-articular injections during the first two years; at the end of this period 75% of them used DMARDs, especially the more aggressive DMARDs. Based on the first year results, all patients were randomly assigned to one of the three treatment strategies in the early DMARD group between 1994 and 1998. Patients who started with MTX or iAU as the first DMARD demonstrated better results regarding clinical efficacy and radiological damage after 2 years. However, more patients who received iAU therapy had to discontinue their therapy compared with patients who took MTX. We therefore conclude that MTX is the DMARD of first choice and that treatment should be tailored to the individual patient.

Adult↗

PubMedDate not supplied

[Venous thrombosis after production of a lympho-venous anastomosis by the "pull through" method].

A histological study of 83 artificial lymphatico-venous communications established in the rabbit by applying the pull through method, revealed that venous thrombosis is a relatively rare feature which only occurs during the first weeks after the operation. Intramuscular administration of heparin does not exert any inhibitory influence on the development of thrombosis.

Animals↗

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Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids.

OBJECTIVES: To examine the relationship between roentgenological deformities of the vertebral column and clinical manifestations of vertebral fractures in patients with RA, treated with glucocorticosteroids (Cs). METHODS: In all outpatients of Utrecht University Hospital with RA, who were currently using Cs (n = 52), roentgenograms of the thoracic and lumbar vertebral column were taken. Roentgenological deformities were scored à vue using the Kleerekoper score, and quantitatively using the Heidelberg and Utrecht scoring methods. Clinical manifestation of a vertebral fracture was defined as a vertebral deformity leading to prescription of therapy: bedrest and/or analgesics. Clinical manifestations of fractures were also recorded in a control group of 55 RA patients not on Cs, matched for age and gender. RESULTS: The prevalence of vertebral deformities in the Cs-treated RA patients, assessed with the Kleerekoper score, was 58% (30 of 52 patients). In 7 of the Cs-treated patients clinical manifestations of a vertebral fracture were present, versus 1 in the control group (p = 0.03). No significant correlation between the 3 deformity scores and the cumulative dose of Cs was found. No (inverse) correlation between serum osteocalcin and the daily dosage of prednisone was found. CONCLUSION: Corticosteroids in active RA are associated with fractures, even when low doses are used: the prevalence of vertebral deformities (58%) in the Cs-treated RA patients was much higher than the frequency in postmenopausal women of the same age reported in the literature, and the reported incidence of clinically manifestations of vertebral fractures was higher in the Cs-treated RA patients than in the control group of RA-patients not treated with Cs.

Aged↗

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Is there an indication for HLA-DR typing for individual patients with rheumatoid arthritis?

The clinical expression of rheumatoid arthritis (RA) varies considerably among individual patients. Genetic variations in human leucocyte antigen (HLA) may influence susceptibility to RA and the severity of the disease. The literature concerning the association of HLA-DR with the susceptibility to and the clinical expression of RA is reviewed here, taking into account the different populations studied and different typing techniques. An association between the 'shared epitope' and RA susceptibility is present on a group level and may be of some pathophysiological interest. However HLA-DR typing is not useful as a diagnostic test for individuals. The reported associations between HLA-DR and RA severity are various, which might be due to the different typing techniques used. Results from most studies using genomic techniques for HLA-DR typing show an association between HLA-DR4+, DR1+ and a more severe disease course in patient groups. However, this association is too weak to be relevant for individual patients. Therefore, with our current typing techniques, HLA-DR typing is not a useful prognostic test for individual RA patients.

Arthritis, Rheumatoid↗