bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factors in a large cohort of patients with early undifferentiated inflammatory arthritis after application of a structured management protocol
Authors: Quinn Mark A. , Green Michael J. , Marzo‐Ortega Helena , Proudman Susanna , Karim Zunaid , Wakefield Richard J. , Conaghan Philip G. , Emery Paul 
Published: November 2003

AbstractObjectiveInflammatory arthritis of the hands is a frequent clinical presentation with a variable outcome. Patients not satisfying the classification criteria for recognized arthritides are described as having undifferentiated inflammatory arthritis, for which there are no accepted therapeutic algorithms. This study assessed the clinical outcome of patients with undifferentiated arthritis of the hands after use of a treatment algorithm, and evaluated the prognostic features in these patients.MethodsOne hundred consecutive patients with undifferentiated arthritis of the hands were assessed following use of a pragmatic treatment algorithm that was based on clinical presentation and response to treatment. The following standard step‐up treatment protocol was used: 1) nonsteroidal antiinflammatory drugs (NSAIDs), 2) a single dose of corticosteroid administered by either intramuscular or intraarticular injection, and 3) disease‐modifying antirheumatic drugs (DMARDs). Patients with specific rheumatologic diagnoses were excluded. The primary outcome was persistence of synovitis at 12 months.ResultsSeventy‐eight percent of patients received NSAIDs, 72% received corticosteroids, and 30% received DMARD therapy. Among patients who had synovitis at 12 months, the prevalence of rheumatoid factor (RF) seropositivity, swollen joints, and synovitis at baseline was greater than in those without persistent synovitis. Logistic regression analysis showed baseline investigations to be poor predictors of subsequent DMARD use, with the best predictor being persistence of synovitis at 12 weeks. Rheumatoid arthritis (RA) developed in 14 patients. Logistic regression analysis showed that significant predictors of RA were RF seropositivity and the painful joint count at baseline. No patient who experienced resolution of synovitis by 12 weeks had persistent synovitis that subsequently required DMARD therapy. Only 13% of patients entered remission. Early resolution of synovitis was associated with an excellent prognosis.ConclusionUndifferentiated arthritis of the hands is not a benign condition, with 30% of patients receiving DMARD therapy by 12 months and low remission rates. Results of the clinical assessment at 12 weeks is the single best predictor of future therapy. This study provides background data for use in determining future therapeutic interventions.
Use of positron emission tomography with methyl‐11C‐choline and 2‐18F‐fluoro‐2‐deoxy‐D‐glucose in comparison with magnetic resonance imaging for the assessment of inflammatory proliferation of synovium
Authors: Roivainen Anne , Parkkola Riitta , Yli‐Kerttula Timo , Lehikoinen Pertti , Viljanen Tapio , Möttönen Timo , Nuutila Pirjo , Minn Heikki 
Published: November 2003

AbstractObjectiveTo compare positron emission tomography (PET) and magnetic resonance imaging (MRI) in the evaluation of inflammatory proliferation of synovium.MethodsTen patients (mean ± SD age 36 ± 13 years) with inflammatory joint disease and with clinical signs of inflammation of the joint were studied. A new tracer for cellular proliferation, methyl‐11C‐choline (11C‐choline), and a widely used tracer for the detection of inflammation and cancer, 2‐18F‐fluoro‐2‐deoxy‐D‐glucose (18F‐FDG), were applied for PET imaging, and the results were compared with the findings from gadolinium diethylenetriaminepentaacetic acid–enhanced MR images. The uptake of 11C‐choline and 18F‐FDG in the inflamed synovium was measured and expressed as the standardized uptake value (SUV) and the kinetic influx constant (Ki) obtained from graphic analysis, and these values were compared with quantitative values on MRI. Synovial volumes were measured on the coronal contrast‐enhanced T1‐weighted MR images using the standard software of the MR imager.ResultsAll patients showed high accumulation of both 11C‐choline and 18F‐FDG at the site of arthritic changes, where quantification of the tracer uptake was performed. The SUV of 11C‐choline was 1.5 ± 0.9 gm/ml (mean ± SD; n = 10) and the SUV of 18F‐FDG was 1.9 ± 0.9 gm/ml (n = 10) (P = 0.017). The Ki of 11C‐choline (mean ± SD 0.048 ± 0.042 minute−1) was 8‐fold higher than the Ki of 18F‐FDG (0.006 ± 0.003 minute−1) (P = 0.009). Both the uptake of 11C‐choline and the uptake of 18F‐FDG correlated highly with the volume of synovium; the highest correlation was observed with the Ki of 11C‐choline (r = 0.954, P < 0.0001).ConclusionIn the use of PET scans,11C‐choline can be regarded as a promising tracer for quantitative imaging of proliferative arthritis changes. Nevertheless, subsequent prospective studies with larger numbers of patients are necessary to further characterize the relationship between the findings on PET imaging and the clinical and functional measures of inflammation.
Association between etanercept use and employment outcomes among patients with rheumatoid arthritis
Authors: Yelin Edward , Trupin Laura , Katz Patricia , Lubeck Deborah , Rush Stephanie , Wanke Lee 
Published: November 2003

AbstractObjectiveTo assess the association between use of etanercept and employment outcomes among patients with rheumatoid arthritis (RA).MethodsIn 1999, 497 RA patients of working ages (18–64 years) reported their employment status in the year of diagnosis and as of the study year, in structured telephone interviews. Of these, 238 had been in clinical trials of etanercept and were currently taking that medication, while 259 were members of an observational study and were not taking etanercept. We used regression techniques to estimate whether employment outcomes in 1999 (employed versus not and, among the employed, hours of work per week, weeks of work per year, and hours of work per year) among the 379 of the 497 patients who were employed at the time of diagnosis were associated with etanercept use, with and without adjustment for demographic characteristics, RA status, overall health status, and the nature of the job held at the time of diagnosis.ResultsAt the time of diagnosis, 75% of RA patients from the observational study who did not take etanercept and 77% of those who did take the medication were employed. By 1999, among those employed at diagnosis, 55% of the former group and 71% of the latter were employed (difference 16 percentage points). After adjustment for demographics, overall health status, duration of RA, RA status, and occupation and industry, the difference widened to 20 percentage points. Among all who were employed at the time of diagnosis, those from the etanercept clinical trials worked an average of 5.4 more hours per week in 1999; after adjustment, the etanercept group worked 7.4 more hours per week.ConclusionAmong all persons who were employed at the time of RA diagnosis, having been in the etanercept clinical trials was associated with higher employment rates in 1999 and a greater number of hours per week of work in that year, suggesting that a randomized trial to establish the relationship between treatment and employment outcomes is now warranted.
Tumor necrosis factor α, its soluble receptor I, and –308 gene promoter polymorphism in patients with rheumatoid arthritis with or without amyloidosis: Implications for the pathogenesis of nephropathy and anemia of chronic disease in reactive amyloidosis
Authors: Maury C. P. J. , Liljeström M. , Laiho K. , Tiitinen S. , Kaarela K. , Hurme M. 
Published: November 2003

AbstractObjectiveTo study tumor necrosis factor α (TNFα) –308 gene promoter polymorphism and circulating levels of TNFα and soluble TNF receptor type I (sTNFRI) in rheumatoid arthritis (RA) patients with and without reactive amyloidosis.MethodsIn a retrospective study, we examined 55 RA patients with biopsy‐proven reactive amyloidosis and 55 control RA patients without amyloidosis (matched for age, sex, rheumatoid factor titer, and RA duration). Inflammatory activity was assessed by measuring the erythrocyte sedimentation rate and C‐reactive protein level. TNFα gene promoter polymorphism was studied using polymerase chain reaction–restriction fragment length polymorphism assay. Cytokine and receptor levels were measured by enzyme‐linked immunoassays.ResultsPatients with RA and amyloidosis had significantly higher TNFα and sTNFRI levels than did the control RA patients. The increased circulating levels of TNFα correlated with interleukin‐18 levels, but not with the serum amyloid A protein levels or with TNFα –308 gene promoter polymorphism (reported to be associated with high TNFα levels and certain disease susceptibilities). In the patients with RA and amyloidosis, those with anemia had significantly higher TNFα and sTNFRI levels than did those without anemia, and circulating TNFα and sTNFRI levels correlated negatively with hemoglobin concentrations. In the patients with RA and amyloidosis, those with nephropathy had significantly higher TNFα and sTNFRI levels than did those without nephropathy; in patients with isolated proteinuria (but no creatinine elevation) the TNFα level was also significantly increased, indicating that the TNFα elevation was not merely a consequence of impaired renal function.ConclusionThis study shows that circulating levels of TNFα and sTNFRI are significantly increased in RA patients with amyloidosis as compared with control RA patients without amyloidosis and that the increased levels may be implicated in the pathogenesis of certain disease manifestations, including anemia of chronic disease and renal pathology in reactive amyloidosis.
Rheumatoid arthritis synovial fluid macrophages express decreased tumor necrosis factor–related apoptosis‐inducing ligand R2 and increased decoy receptor tumor necrosis factor–related apoptosis‐inducing ligand R3
Authors: Perlman Harris , Nguyen Nadine , Liu Hongtao , Eslick Joy , Esser Sybille , Walsh Kenneth , Moore Terry L. , Pope Richard M. 
Published: November 2003

AbstractObjectiveTo characterize the expression pattern of tumor necrosis factor–related apoptosis‐inducing ligand (TRAIL) and its cognate receptors (TRAIL R1, R2, R3, and R4) on rheumatoid arthritis (RA) synovial fluid (SF) lymphocytes and monocyte/macrophages and on cultured RA synovial fibroblasts.MethodsThe expression of TRAIL and TRAIL receptors on RA SF lymphocytes and monocyte/macrophages, normal macrophages, and RA synovial fibroblasts was examined by flow cytometry with previously characterized monoclonal antibodies. The ability of adenoviral‐mediated delivery of TRAIL to induce macrophage or RA synovial fibroblast apoptosis was examined by flow cytometry.ResultsBy flow cytometry, neither TRAIL nor its cognate receptors was detectable on RA SF lymphocytes or RA synovial fibroblasts. In contrast, RA SF macrophages expressed TRAIL R3, a decoy receptor (P < 0.01 versus isotype control), but not TRAIL, or TRAIL R1, R2, or R4. Normal peripheral blood–derived monocyte‐differentiated macrophages expressed TRAIL R2 (P < 0.01), but not TRAIL or the other TRAIL receptors. Adenoviral‐mediated delivery of TRAIL had no effect on the survival of normal macrophages or RA synovial fibroblasts but readily induced apoptosis in the prostate cancer cell line (PC‐3) that expressed TRAIL R1 and R2.ConclusionTRAIL R1 and R2, which are required for signal transmission by TRAIL, were not detected on RA SF lymphocytes, macrophages, or synovial fibroblasts. These observations do not support a potential therapeutic role for TRAIL in RA.
Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: A study of one hundred thirty‐three cases compared with a control group
Authors: Costedoat‐Chalumeau Nathalie , Amoura Zahir , Duhaut Pierre , Huong Du Le Thi , Sebbough Djamel , Wechsler Bertrand , Vauthier Danièle , Denjoy Isabelle , Lupoglazoff Jean‐Marc , Piette Jean‐Charles 
Published: November 2003

AbstractObjectiveThe use of hydroxychloroquine (HCQ) in pregnancy remains controversial. The recent demonstration that HCQ passes across the placenta, with cord blood concentrations nearly identical to those found in maternal blood, emphasizes the need for careful evaluation of pregnancies in women receiving HCQ. However, only small series of HCQ‐treated pregnant women have been reported, and most of these studies had no control group. We now report our experience with 133 pregnancies in women being treated with HCQ, resulting in 117 live births. Results in the HCQ group are compared with those in a control group.MethodsOne hundred thirty‐three consecutive pregnancies in 90 women treated with 200 mg of HCQ either twice daily (122 pregnancies) or once daily (11 pregnancies) were studied. These pregnancies were compared with 70 consecutive pregnancies in 53 women with similar disorders who did not receive HCQ. Electrocardiography was performed in 47 children of mothers treated with HCQ and in 45 children in the control group.ResultsEighty‐eight percent of pregnancies in the HCQ group and 84% of those in the control group ended successfully with a live birth. The outcomes of pregnancy were not statistically different between groups. One child in each group died of causes related to prematurity. Three malformations were observed in the HCQ group (1 hypospadias, 1 craniostenosis, and 1 cardiac malformation) versus 4 in the control group. On the electrocardiograms, the PR interval and the corrected QT interval were not statistically different between groups. No visual, hearing, growth, or developmental abnormalities were reported in any of the children at the last follow‐up (ages 12–108 months; mean age 26 months).ConclusionOur findings support preliminary evidence for the safety of HCQ therapy during pregnancy. This treatment probably should be maintained throughout pregnancy in patients with systemic lupus erythematosus.
Triplets with systemic lupus erythematosus
Authors: Kamat Sona S. , Pepmueller Peri H. , Moore Terry L. 
Published: November 2003

AbstractWe present herein the first case report of identical triplets who developed systemic lupus erythematosus (SLE). The children were diagnosed as having SLE in reverse birth order at ages 8, 9, and 11 years. Although genetically identical, each sibling manifested different clinical signs and symptoms; however, all 3 children did manifest skin rash, fatigue, and biopsy‐proven glomerulonephritis at different ages. Findings of laboratory studies were similar, including positivity for antinuclear antibodies, anti–native DNA, and anti–double‐stranded DNA, as well as low levels of complement. These findings confirmed SLE in each sibling.
Risk factors for progression of lumbar spine disc degeneration: The Chingford Study
Authors: Hassett G. , Hart D. J. , Manek N. J. , Doyle D. V. , Spector T. D. 
Published: November 2003

AbstractObjectiveFew data exist concerning the natural history of lumbar spine disc degeneration and associated risk factors. We therefore undertook this study to examine the radiographic progression of lumbar spine disc degeneration over the course of 9 years in a population‐based inception cohort of women from the Chingford Study.MethodsSeven hundred ninety‐six paired lumbar spine radiographs were read by a single reader for anterior osteophytes (AO) and disc space narrowing (DSN) using the Lane atlas at each lumbar disc space (L1–5). Disc degeneration was defined using thresholds of AO and DSN grade 1+ in one or more vertebrae (L1–5) within a subject. Progression was defined as an increase in grade in an affected year‐1 vertebra. Potential risk factors were assessed using odds ratios and 95% confidence intervals adjusted for age, body mass index (BMI), and other potential confounders in logistic regression models using the STATA statistical package.ResultsThe mean ± SD age at baseline was 53.8 ± 6.0 years, and mean ± SD BMI was 25.4 ± 4.1 kg/m2. Progression rates for AO and DSN were 4% per annum and 3% per annum, respectively. Progression of DSN was predicted by age, back pain, and radiographic hip and knee osteoarthritis (OA). Progression of AO was predicted by age and radiographic hip OA, with borderline significance for BMI >30 kg/m2. No significant effects were seen for smoking, physical activity, hormone replacement therapy use, multiparity, or hand OA.ConclusionThis is the first population‐based longitudinal study to assess progression of the individual radiographic features of AO and DSN in lumbar spine disc degeneration. We demonstrated progression rates of 3–4% per annum, with important risk factors for progression, including age, back pain, and radiographic OA at the hip and knee.
The influence of fetal loss on the presence of fetal cell microchimerism: A systematic review
Authors: Khosrotehrani Kiarash , Johnson Kirby L. , Lau Joseph , Dupuy Alain , Cha Dong Hyun , Bianchi Diana W. 
Published: November 2003

AbstractObjectiveFetal cells enter the maternal circulation during most pregnancies. Their persistence for years occurs in only some women and has been associated with several autoimmune diseases such as systemic sclerosis. The objective of this study was to determine whether pregnancy history influences the persistence of fetal microchimeric cells.MethodsWe reviewed all reports of studies on fetal cell microchimerism, defined as male DNA in maternal tissue, that describe individual pregnancy histories, disease diagnoses, and microchimerism status. The total numbers of pregnancies, births, and sons, the history of fetal loss (spontaneous abortion and elective termination), and the presence of a maternal autoimmune disease were tested as factors potentially associated with persistent microchimerism.ResultsOne hundred twenty‐four subjects from 11 studies met the inclusion criteria. Only fetal loss was significantly associated with the presence of microchimerism (odds ratio 2.4, 95% confidence interval 1.2–6.0).ConclusionThese results suggest that fetomaternal cell trafficking following fetal loss may be important for the engraftment of microchimeric cells in maternal tissue. This may be due to an increased amount of fetomaternal transfusion or to transfer of a cell type that is more likely to engraft. We recommend that investigators in future studies on microchimerism report detailed pregnancy information, since these data are critical for the understanding of factors that influence the development of fetal cell microchimerism.
Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: A randomized, controlled trial
Authors: Davis John C. , Van Der Heijde Désirée , Braun Jurgen , Dougados Maxime , Cush John , Clegg Daniel O. , Kivitz Alan , Fleischmann Roy , Inman Robert , Tsuji Wayne ,   for the Enbrel Ankylosing Spondylitis Study Group
Published: November 2003

AbstractObjectiveTo determine the safety and efficacy of etanercept in a multicenter, randomized, placebo‐controlled, double‐blind trial of adults with moderate to severe active ankylosing spondylitis (AS).MethodsPatients (n = 277) were treated with either etanercept 25 mg (n = 138) or placebo (n = 139) subcutaneously twice weekly for 24 weeks. The primary outcome measures were the percentages of patients achieving the Assessments in Ankylosing Spondylitis 20% response (ASAS20) at weeks 12 and 24. Other outcome measures included the percentage of patients achieving higher ASAS responses, and the safety of etanercept in patients with AS. All outcome measures were assessed at 2, 4, 8, 12, and 24 weeks.ResultsTreatment with etanercept resulted in dramatic improvement. The ASAS20 was achieved by 59% of patients in the etanercept group and by 28% of patients in the placebo group (P < 0.0001) at week 12, and by 57% and 22% of patients, respectively, at week 24 (P < 0.0001). All individual ASAS components, acute‐phase reactant levels, and spinal mobility measures were also significantly improved. The safety profile of etanercept was similar to that reported in studies of patients with rheumatoid arthritis or psoriatic arthritis. The only adverse events that occurred significantly more often in the etanercept group were injection‐site reactions, accidental injuries, and upper respiratory tract infections.ConclusionEtanercept is a highly effective and well tolerated treatment in patients with active AS.
The release of crosslinked peptides from type II collagen into human synovial fluid is increased soon after joint injury and in osteoarthritis
Authors: Lohmander L. Stefan , Atley Lynne M. , Pietka Terri A. , Eyre David R. 
Published: November 2003

AbstractObjectiveTo determine concentrations of crosslinked C‐telopeptide fragments of type II collagen (CTX‐II) in synovial fluid (SF) from patients with joint injury, osteoarthritis (OA), or other knee arthritides.MethodsTwo study groups were used: a cross‐sectional group, which included healthy‐knee volunteers (reference group [REF]) and patients with pseudogout (PPA), an anterior cruciate ligament tear with or without a meniscus tear (INJ), or primary knee OA (POA); and a longitudinal group, which included patients with arthroscopic cartilage changes or septic arthritis. CTX‐II was quantified by competition enzyme‐linked immunosorbent assay (ELISA) based on a monoclonal antibody that recognized the C‐terminus of the peptide EKGPDP as a proteolytic neoepitope. Aggrecan fragments, matrix metalloproteinases 1 and 3, and tissue inhibitor of metalloproteinases 1 were determined by ELISAs.ResultsConcentrations of CTX‐II in SF were higher in patients with PPA, INJ, and POA than in the REF group (P < 0.001). After joint injury, mean levels of CTX‐II in SF were increased above REF levels at all time intervals (P < 0.001), and were highest within hours after trauma. In those in the longitudinal study group with joint cartilage damage, variation coefficients for CTX‐II were 81% (between patients) and 64% (within patient), monitored over 1 year. In a patient with septic arthritis, SF CTX‐II increased at the onset of symptoms, and peaked 30‐fold higher than the baseline. Concentrations of all biomarkers decreased with successful treatment.ConclusionThis is the first report to describe the release into SF of soluble molecular fragments specific for the degradation of mature, crosslinked, type II collagen (CII) in human OA and joint injury. The results provide strong evidence that the integrity of the CII network of cartilage is compromised soon after joint injury and in arthritis. This early degradation of CII may represent an important treatment target.