Rheumatoid arthritis 2784 INDEX

Rheumatoid Arthritis. Figure 1 The development of disability overtime in a group of RA patients studied prior to the early 1990s. FDI = functional disease index where 1 = moderate disability, 2 = more marked disability, 3 = severe disability and 4 = very severe disability (from Wolfe, Cathey (1991) J Rheumatol 18 1298). 

Major risk factors include current smoker, low body weight (<127 lb in postmenopausal women), history of osteoporotic fracture in a first-degree relative, and personal history of low-trauma fracture as an adult. Other independent risk factors include age, high bone turnover, low body mass index (<19 kg/m2), rheumatoid arthritis, and glucocorticoid use. Decision tools may help identify individuals who should undergo BMD testing, such as the Osteoporosis Risk Assessment Instrument and the Simple Calculated Osteoporosis Risk Estimation. 

In the study of SLE patients, we and other authors have found that there is a correlation between SLE disease activity index (SLEDAI) and the production of IL-16 (L7) and IL-18 (W19). It was suggested that IL-16 and IL-18 may be a useful indicator of disease activity of SLE. Plasma MCP-1 concentration has also been proposed as a marker for monitoring joint inflammation in rheumatoid arthritis (El). 

The use of cytokine antagonists (monoclonal antibodies to cytokines) used in the management of rheumatoid arthritis and Crohn s disease has some beneficial effect on Graves orbitopathy. A recent stndy of 10 patients with mild to moderately severe Graves orbitopathy showed that the administration of etanercept, an antitrunor necrosis fector drug (25 mg a week for 3 months) was associated with a significant improvement of the clinical activity score and ophthalmopathy index in approximately 60% of patients. 

The maintenance of the normal, anomalous viscosity index of synovial fluid is essential for its proper function as a lubricant between joint surfaces. The concentration and the degree of polymerization of hyaluronic acid in synovial fluids of patients with rheumatoid arthritis and other degenerative joint diseases have been the subjects of widespread investigation. Ragan and Meyer (R1) ascribed the changes in synovial fluid in... 

Penicillamine (dimethylcysteine) is a metabolite of penicillin that contains SH groups it may be used to chelate lead and also copper (see Hepatolenticular degeneration). Its principal use is for rheumatoid arthritis (see Index). 

In addition to its use for rheumatoid arthritis, azathoiprine is employed for its steroid-sparing effect in many autoimmune diseases, as an immxmo-suppressant, e.g. after organ transplant, and to maintain remission in the treatment of vasculitis. Other aspects of azathiopurine are discussed elsewhere in the book (see Index). 

A 43-year-old woman with rheumatoid arthritis developed dizziness having taken celecoxib 200 mg/day for 2 weeks. At the start of treatment she had normal renal function (104). Her serum creatinine was 670 pmol/l (7.4 mg/dl) and blood urea nitrogen 30 mmol/1 (90 mg/dl). Creatinine clearance was 16 ml/minute. Urinalysis was normal and casts were not present. Urinary chemical analysis showed a sodium concentration of 18 mmol/1, a fractional excretion of sodium of 0.3, and a renal failure index of 0.493, consistent with prerenal acute renal insufficiency. Celecoxib was withdrawn. Although her renal function then improved, her serum creatinine was still abnormal (4.7 mg/dl) 1 month later. 

In 1965, the FDA banned investigation in humans of dimethyl sulfoxide owing to the appearance of changes in the refractive index of the lens of the eye in experimental animals. However, in 1966, the FDA allowed the study of dimethyl sulfoxide in serious conditions such as scleroderma, persistent herpes zoster, and severe rheumatoid arthritis, and in 1968 permitted studies using short-term topical application of the solvent. By 1980, the FDA no longer specifically regulated investigations of dimethyl sulfoxide. ... 

Category B medicines of great social and therapeutic value (treatment of heart diseases, rheumatoid arthritis, antibiotics, corticosteroids, antipsychotics). The co-payment (with a maximum amount of 355 Belgian Francs [BF]) is 25 percent for normal insured people and 15 percent for people with a special tariff (pensioners, widows, orphans and invalids). This maximum is adapted each year to the national index figures. 

The method of summated ratings can be shown readily using the index of disease activity (IDA) for rheumatoid arthritis proposed by Mallya and Mace. Six aspects of the patient s condition are assessed (morning stiffness, pain, grip strength, articular index, haemoglobin and the one hour erythrocyte sedimentation rate) and points are assigned to the values of each of these on a scale of 1 (the best situation) to 4 (the worst possibility). 

When oral zinc supplementation is used therapeutically in patients with rheumatoid arthritis, there is a rise in serum alkaline phosphatase values which correlates highly with the increase in serum zinc (S42). This positive correlation between serum zinc and serum alkaline phosphatase levels has also been demonstrated in patients with congenital acrodermatitis enteropathica (W15) and it has been suggested that serum alkaline phosphatase measurements may be employed as a useful index of serum zinc levels in these patients (W15). 

The ratios of TIMP-1 MMP-1 and TIMP-LMMP-3 in blood have been reported to be significantly lower in patients with rheumatoid arthritis versus patients with nonrheumatoid arthritis (CIO). In rheumatoid arthritis patients, serum C-reactive protein correlated with MMP-3 and TIMP-1 levels, but not with MMP-1 levels. The number of erosions noted on X-rays correlated with baseline levels of MMP-3, but not TIMP-1. Cunnane et al. (CIO) postulated that treatment which inhibits the production and activation of MMP-1 may preferentially limit the formation of new joint erosions and improve the clinical outcome of patients with rheumatoid arthritis. In contrast to circulating levels of MMP-1, Keyszer et al. reported that MMPrTIMP complexes in blood correlate with rheumatoid activity scores (modified Lansbury Index and Keitel Function Index) in rheumatoid arthritis nonetheless, this relationship to disease activity was weaker than that of MMP-3 or C-reactive protein (K4). 

A 56-year-old patient with rheumatoid arthritis, who was started on INH chemoprophylaxis for a positive tuberculin skin test, developed interstitial pneumonia 2 weeks after the start of INH. The result of Drug Lymphocyte Stimulation Test (DLST) for INH was positive with the peripheral blood lymphocytes (stimulation index 208%). Trans-Bronchial Lung Biopsy specimens showed cellular no specific interstitial pneumonia pattern... 

Wallny T, Wagner UA, Prange S et al (1999) Evaluation of chronic tears of the rotator cuff by ultrasound a new index. J Bone Joint Surg Br 81 675-678 Wamser G, Bohndorf K, Vollert K et al (2003) Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint differentiation between synovitis and joint effusion. Skeletal Radiol 32 351-359... 

Fig. 11.57a-c. Rheumatoid arthritis, a Longitudinal and transverse (see insert) 12-5 MHz US images over the dorsal aspect of the metacarpophalangeal joint of the index finger reveal bony erosions (arrows) over the surface of the metacarpal head (Met) associated with distension of the dorsal recess of the joint by synovial pannus (asterisks), b Contralateral normal finger. Comparing a and b observe the different appearance of erosions compared with the normal focal notch (arrowhead) located on the dorsal aspect of the metacarpal. PP, proximal phalanx, c Radiographic correlation confirms erosions (arrow) at the level of the metacarpal head... 

---