Biomedical subjects

K Kaarela

Publications and source records attributed to K Kaarela.

103 records · Page 6Linked to original sources

PubMedDate not supplied

Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders.

A cohort of 74 patients with rheumatoid arthritis was monitored prospectively for 15 years. At the end of the study 148 shoulders were radiographed with a standard method. The subacromial space was examined from the radiographs with a method where the acromiohumeral interval was measured from the dense cortical bone marking the inferior aspect of the acromion to a point directly above the head of the humerus. The smallest distance was recorded, and negative values were used when the original articular surface of the humerus exceeded the inferior surface of the acromion. Destruction of the glenohumeral (GH) joints was assessed by the Larsen method on a scale of 0 to 5. The relation of subacromial space measurement to the grade of destruction of GH joints was examined. The mean subacromial space was 6.7 (SD 4.4), range from -13 to 12 mm: 6.1 mm (SD 5.6) in men and 6.9 mm (SD 4.0) in women. The mean of nonaffected (Larsen grade 0 or 1) shoulders (n = 77) was 8.6 mm (SD 1.5), and the corresponding mean of the affected (Larsen grade > or =2) shoulders (n = 71) was 4.6 mm (SD 5.5). Previously reported pathologic criterion (<6 mm) indicating rotator cuff involvement was fulfilled in 30 (20%) of 148 shoulders: in 8 (22%) of 36 shoulders in men and in 22 (20%) of 112 shoulders in women. All the shoulders with severe rheumatoid destruction (Larsen grade 4 or 5) fulfilled the pathologic limit. The subacromial space had a significant negative correlation with the GH joint destruction (Larsen grade) in both sides: right r = -.63 (95% CI -.75 to -.47), left r = -.71 (95% CI -.81 to -.58). Progressive upward migration is an inevitable consequence of rheumatoid destruction in the GH joint. A significant step in this process occurred between the Larsen grades of 3 and 4, where the mean distance turned negative, indicating rotator cuff disease. A patient with rheumatoid arthritis and painful shoulder and upward migration of the humerus on the shoulder radiograph should be evaluated by an orthopaedic surgeon. In indistinct cases with subacromial space diminution, imaging techniques like ultrasonography or magnetic resonance imaging may be required to determine the exact pathologic condition of the rotator cuff and to select optimal treatment.

Adolescent↗

PubMedDate not supplied

Prediction of 20-year outcome at onset of seropositive rheumatoid arthritis.

OBJECTIVE: With the advent of new and expensive antirheumatic treatments with potentially serious side effects, it would be essential to identify as early as possible those rheumatoid arthritis (RA) patients who have a poor prognosis. Here study was made of the prognostic value of different markers recorded at the onset of RA. METHODS: At the 20-year follow-up of our prospective study, 66 patients had rheumatoid factor-positive (RF+) RA. At commencement of follow-up (disease duration < 6 months), the prognostic value of 19 demographic, laboratory, clinical and radiographic variables was tested to explain the 20-year Larsen score for peripheral joints and the Health Assessment Questionnaire (HAQ) index using Somers'd for asymmetrical associations. RESULTS: An association was observed between onset blood platelets (0.17), serum IgG (0.18), the onset Larsen score (0.33) and the 20-year Larsen score. Old age (0.30), serum orosomucoid (0.17), the function score (0.28), morning stiffness (0.28), and grip strength (0.24) were associated with the 20-year HAQ. CONCLUSION: The correlation between the investigated entry variables and end-point outcome was poor. In our discussion we conclude that the most important prognostic factor in RF + RA is the treatment.

Aged↗

PubMedDate not supplied

Development rate of mutilans fingers in patients with rheumatic disease.

OBJECTIVE: To describe arthritis mutilans (AM) deformity during the progression of rheumatic disease. METHODS: The development of mutilans-like hand deformities in 2 patients with juvenile chronic arthritis (JCA) and in 2 patients with adult onset rheumatoid arthritis (RA) are presented. The hands of these patients were evaluated at least at two time points during the course of disease using two different scoring methods based on differently summed Larsen grades of the hand joints. RESULTS: Two patients (one with JCA and one with RA) showed AM changes after a disease period of less than 10 years and 2 not until after 30 years. The patients with adult onset disease were young at the onset of joint disease. Early wrist fusions were performed on both patients showing a slow development rate. CONCLUSIONS: The development rate of AM is very variable, even in patients with the same diagnoses. Wrist fusion prevents shortening of the carpus and may decrease the development rate of AM.

Adult↗

PubMedDate not supplied

Radiographic remission in seropositive rheumatoid arthritis. A 20-year follow-up study.

OBJECTIVE: Rheumatoid arthritis (RA) is in most instances a progressive disease. Very little information is available on halting of the radiographic damage, particularly in later phases of the disease. We studied radiographic remission of RA lasting to the end of follow-up, covering the period 1973-96. METHODS: Radiographs of hands and feet were taken at onset and at 1, 3, 8, 15 and 20 years from entry in 102 cases of recent onset (< 6 months) seropositive and erosive RA. A Larsen score of 0-100 was formed for 20 joints of hands and feet. If the score did not worsen by more than one point between one of the above time points and the end of the study, the patient was considered to be in remission. RESULTS: Remission was confirmed in 27 (26%) of the patients. In 3 cases the remission was from the 1-year check-up, in 5 from the 3-year check-up, in 6 from the 8-year check-up and in 13 cases from the 15-year check-up. Some of the remission cases had a mild disease from the outset, but there were cases in which the disease process had led to marked joint destruction before slowing down. CONCLUSION: This data may serve as a basis for comparison with subsequent cohort studies on new treatments-of-choice.

Adolescent↗

PubMedDate not supplied

Differences in understanding and application of 1987 ACR criteria for rheumatoid arthritis and 1991 ESSG criteria for spondylarthropathy. A pilot survey.

OBJECTIVES: To determine areas of agreement and disagreement among experts in the interpretation of the published criteria for RA (ACR) and spondylarthropathies ( ESSG). METHODS: Thirty-two experts (16 from France and 16 from 10 other countries) replied anonymously to a mailed questionnaire. RESULTS: Tenosynovitis and 'sausage-like' painless swelling of the toes were considered as criteria for RA by 18 and 14 experts, respectively. The definition of symmetry differed widely among experts (symmetry of only one group of joints was sufficient for 13). Twenty-five experts considered erosions of other joints than the wrists and fingers as a criterion for RA, 17 thought that fulfilment of criteria could be achieved cumulatively, and 19 would appreciate clarifications of the current criteria. Among possible clarifications for RA, it was frequently recommended that morning stiffness and nodules be eliminated and that new marker antibodies, X-rays of the feet, and exclusion criteria be added. Twenty-three of the 29 experts who gave an opinion (79%) agreed with the notion of SP in the absence of axial signs and sacroiliitis, 26/31 (84%) indicated that a patient can have both RA and SP, and 19/30 (63%) thought that RA and SP could be regarded as syndromes more than diseases. Only 5/32 experts relied more on the criteria than on their clinical judgement in diagnosing RA. CONCLUSIONS: There would seem to be a needfor the optimisation of RA and ESSG criteria, particularly within the context of early arthritis.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Need and sequence of large joint replacements in rheumatoid arthritis. A 25-year follow-up study.

OBJECTIVE: The aim of the present study was to evaluate the number and sequence of large joint replacements (LJR) performed in long-term rheumatoid arthritis (RA) from an inception cohort of 103 patients with rheumatoid factor (RF)-positive RA followed over 25 years. METHODS: A total of 83 patients attended the 15-year and 68 patients the 20-year follow-up. Patient documents and radiographs were evaluated in the beginning of 2001 and a complementary interview was arranged to assess the number and sequence (timing) of LJRs performed. RESULTS: The cumulative number of LJRs performed for 22 patients (19 women) during the 25 years of follow-up was 41. Seventeen total hip joint replacements (THR) (42% of the total number of 41 LURs) were performed on 13 patients, median time from the diagnosis to the operation being 14 years; 14 total knee replacements (TKR) (34%) on 11 patients (after a median time of 17 years); 3 total shoulder replacements (TSR) (7%) on 3 patients (median time of 18 years); and 7 total elbow replacements (TER) (17%) on 4 patients (median time of 21 years), respectively. Six patients had undergone three or more LJRs during the follow-up period. CONCLUSION: During our 25 years of follow-up, in 27% of RA patients LUR was needed, and 41% of them needed more than one replacement.

Adolescent↗

PubMedDate not supplied

Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of peripheral and shoulder joints, and decreased bone mineral density.

OBJECTIVE: To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA. METHODS: An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. RESULTS: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA. CONCLUSIONS: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.

Adult↗

PubMedDate not supplied

Prevalence of Sindbis-related (Pogosta) virus infections in patients with arthritis.

OBJECTIVE: To determine the role of Pogosta virus as a triggering infection in non-specific arthritis. METHODS: Serum samples of 142 patients with acute arthritis were screened for the evidence of Pogosta virus infection. Serological tests for Chlamydia trachomatis, salmonella, parvovirus B19, and Borrelia burgdorferi were also carried out. As verified later, 78 of the patients had rheumatoid arthritis and 63 seronegative poly- or oligoarthritis, while one had systemic lupus erythematosus. RESULTS: In the early stage of the joint symptoms 4 patients with rheumatoid arthritis, 1 with seronegative polyarthritis and 1 with systemic lupus erythematosus had recent Pogosta virus infection. Four of them had probably had Pogosta disease at the time of the onset of arthritis. In 11 patients with a diagnosis of seronegative arthritis, serological evidence of preceding infection due to salmonella or Chlamydia trachomatis was found, strongly suggesting classical reactive arthritis in these cases. CONCLUSIONS: Our study suggests that also a Sindbis virus infection may be associated both to an acute joint inflammation as a part of Pogosta disease or chronic arthritis. At present, this possibility still needs further research.

Adolescent↗

PubMedDate not supplied

The development of bone mineral density and the occurrence of osteoporosis from 15 to 20 years of disease onset in patients with rheumatoid arthritis.

OBJECTIVE: To ascertain the occurrence of osteoporosis and the development of central bone mineral density (BMD) in long-term rheumatoid arthritis (RA) METHODS: BMD of the lumbar spine (L2-L4) and the femoral neck were measured by dual-energy X-ray absorptiometry in a cohort of 59 patients (49 women and 10 men) with rheumatoid factor-positive RA followed up for 20 years. BMD measurements were obtained at the 15- and 20-year follow-up visits. RESULTS: At the 15-year check-up the mean age was 61 (SD 13)for men and 54 (SD 11) years for women. Bone densitometry of these patients revealed decreased BMD at both lumbar spine and femoral neck, the mean T-scores being -1.1 [95%CI: -1.6 to -0.6] and -1.3 [95%CI: -1.6 to -1], respectively). Eighteen (31 %) patients thus had osteoporosis (BMD T -score < or = -2.5) and 32 (54%) patients were osteopenic (BMD T-score -1.0 to -2.5). However, when compared with reference values, the decreases in central bone mineral in this patient group were of low degree; the mean Z-score -0.2 [95%CI: -0.7 to 0.2] at the lumbar spine and -0.5 [95%CI: -0.8 to -0.3] at the femoral neck, respectively. After the subsequent five years the mean Z-score increased 0.45 [95%CI: 0.32 to 0.58] at the lumbar spine and the mean T-score decreased -0.20 [95%CI: -0.32 to -0.08] at the femoral neck. ESR, Larsen score, gender and cumulative dose of prednisolone during the 5 year follow-up and HAQ-index were used as explanatory parameters of BMD change between the 15- and 20-year follow-ups. None of these parameters explained the BMD change. CONCLUSION: We conclude that in long-term RA central bone densities seemed to be only moderately decreased after 15 years from eruption of RA. No essential change in central BMD was found after the consecutive 5 years.

Absorptiometry, Photon↗

PubMedDate not supplied

Synovial fluid acid phosphatase in seropositive and seronegative arthritides.

Synovial fluid acid phosphatase was investigated in 82 arthritic patients with hydropsy in a knee joint. 39 of the patients were seropositive and 43 seronegative. 36 of the seropositive group had erosive rheumatoid arthritis. The mean synovial fluid acid phosphatase in the seropositive group, 11.6 U/l (SD +/- 8.4), was significantly higher (p less than 0.001) than in the seronegative group, 6.5 U/l (SD +/- 4.8).

Acid Phosphatase↗

PubMedDate not supplied

Is seropositive rheumatoid arthritis becoming less severe?

We have followed a community-based cohort of recent-onset arthritis for eight years. In addition to Waaler-Rose and latex agglutination tests we used class-specific enzyme immunoassay for the determination of rheumatoid factors (RFs). Eighty-seven patients had erosions by the end of the follow-up period. The seropositive cases in each RF assay were divided into three groups of equal size according to the mean strength of RF reactivity for three or four available follow-up specimens. The radiological index values in the high-titer groups were no higher than the values for the seropositive cases on average. Thus, no severity gradient according to RF titer could be demonstrated.

Agglutination Tests↗

PubMedDate not supplied

The prediction of radiological destruction during the early stage of rheumatoid arthritis.

A total of 107 patients with definite rheumatoid arthritis of no longer than six months' duration were observed for three years. The radiological destruction of the hand and foot joints after the follow-up time was compared with 65 anamnestic, clinical, laboratory and radiological variables at the onset of the disease. Of the individual variables, early radiological changes in the joints showed the best correlation with the progress of joint destruction. Grip strength, ESR, serum iron, serum C1 esterase inhibitor, rheumatoid factor and old age also had prognostic value. In multiple regression analysis 15 variables explained about 50% of the variance in the progress of joint destruction.

Arthritis, Rheumatoid↗

PubMedDate not supplied

Correlations between clinical facets of outcome in rheumatoid arthritis.

At 8-year follow-up of 103 patients with rheumatoid arthritis, an X-ray index based on Larsen's score for the hands, wrists, ankles and feet showed a high correlation with the joint score (0.75 by Spearman's rank correlation), the function score (0.68), ESR (0.61), and CRP (0.64). These results suggest that Larsen's method of scoring both the hands and feet is a valid single method to assess long-term outcome in rheumatoid arthritis.

Arthritis, Rheumatoid↗