Physician diagnosed arthritis, reported arthritis and radiological non-axial osteoarthritis

OBJECTIVE: To determine the question that best predicts radiographic evidence of non-axial osteoarthritis (OA). DESIGN: The Melbourne Women's Mid-life Health Project (MWMHP), commenced in 1991, is a population-based prospective study of 438 Australian-born. Two hundred and fifty-seven (57%) women remained in longitudinal assessment in 2002 and 224 (87%) women agreed to undergo X-rays of their hands and knees between 2002 and 2003. METHODS: Annually participants were asked about aches and stiff joints and arthritis or rheumatism. In the eleventh year of follow-up X-rays were scored for evidence of OA using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, mood, smoking, body mass index (BMI) and age were obtained by both self-administered and face-to-face questionnaires. RESULTS: Patient reported physician diagnosed arthritis was the best predictor of radiological OA (ROA). The question had a specificity of 64%, a positive predictive value of 57% and a negative predictive value of 71%. Even the most reliable question about arthritis still had a relatively low specificity for radiologically diagnosed OA. Reporting symptoms were significantly more common in participants who were depressed, those who had a higher negative affect and those with a higher BMI. CONCLUSION: In large epidemiological studies where questionnaire assessment of OA is required, the greatest accuracy is achieved by asking about physician diagnosed arthritis. Concurrent application of a validated scale for mood is important.     

Spontaneous septic arthritis complicating rheumatoid arthritis

Thirteen cases (in twelve patients) of septic arthritis complicating rheumatoid arthritis are reported. One ankle, one metacarpopophalangeal joint, one shoulder, and ten knees were involved. Staphylococcus aureus was cultured from twelve joints and Escherichia coli, from one. Treatment consisted of repeated needle aspirations in two patients, arthrotomy with Penrose drainage in six, and arthrotomy with through-and-through irrigation in four. Needle aspiration was the least effective therapy. The authors recommend as the treatment of choice: systemic antibiotic therapy and immediate arthrotomy followed by through-and-through irrigation with fluid containing the appropriate antibiotics.     

Rheumatoid arthritis and anaesthesia

There has been a great deal of progress in our understanding and management of rheumatoid arthritis in recent years. The peri-operative management of rheumatoid arthritis patients can be challenging and anaesthetists need to be familiar with recent developments and potential risks of this multi system disease.     

Rheumatoid arthritis and pregnancy

During pregnancy, oestrogen and progesterone levels are increased. Consequently the initial predominant immune cellular response (Th1 type) is decreased, whereas humoral response (Th2 type) is increased. Due to this switch, a lot of Th2 anti-inflammatory cytokines IL-4 and IL-10 are synthesized. During the last months of pregnancy Treg lymphocytes level is elevated leading to overexpression of IL-4 and IL-10. Due to these mechanisms, reduce disease activity of rheumatoid arthritis (RA) occurred. Impaired fertility has not been demonstrated in women with RA. However, some studies suggest that polyarthritis could induced a reduced weight at birth and more frequent pregnancy and delivery complications. Methotrexate and biotherapies have demonstrated no effect on fertility; however these drugs must be stopped before conception for a period equal to seven fold of the half live of the molecule. No teratogenic effect are known for sulfazalasine and hydroxychloroquine; these drugs could be used during pregnancy. It is also the same for ciclosporine, which used is quite unfrequent in RA. Methotrexate is teratogenic in animal models and is forbidden during pregnancy. For leflunomide which is metabolised in A771726, highly teratogenic, a washout period of 3,5 months is necessary. All commercially available TNFalpha inhibitors are classified by the food and Drug Administration as pregnancy risk category B: no adverse pregnancy adverse effects have been observed in animal studies, but there have been insufficient controlled human studies. The published experiences with TNFalpha inhibition in pregnancy is limited to some case reports and ongoing registry. More recently some cases of Vater syndromes (polymalformations) were possibly related to TNFalpha blocking agents. Such treatment must be avoided during pregnancy. Only few case reports are published concerning rituximab use during pregnancy. No data have been found for abatacept.     

Osteoarthritis and inflammatory arthritis

The term ‘arthritis’ encompasses most of the pathology that causes joint symptoms or dysfunction. Arthritis can be broadly categorized into osteoarthritis, which is a degenerative disease, and inflammatory arthropathies, in which there is true inflammation of the affected joints and their associated structures. Osteoarthritis is the most common form of arthritis. It is, to an extent, part of the ageing process, but it can arise as a consequence of joint damage resulting from other diseases or injury and some individuals have an increased risk of osteoarthritis owing to hereditary factors. The management of osteoarthritis is symptomatic up to the point of serious joint dysfunction, when surgical approaches are used. Inflammatory arthropathies can be due to infection, crystal deposition within joints and their associated structures (gout, pyrophosphate arthropathy and hydroxyapatite arthropathy) or autoimmune disease. All of the autoimmune inflammatory arthropathies also have extra-articular manifestations. Rheumatoid arthritis is the most common of the inflammatory arthropathies, and is characterized by progressive, deforming inflammation of joints owing to a destructive synovitis. Another group of diseases (ankylosing spondylitis, reactive arthritis/Reiter’s syndrome, psoriatic arthritis) are characterized by enthesitis and are associated with HLA-B27. Treatment of these diseases is becoming more effective with the development of targeted biological treatments.     

环氧化酶-2与关节炎

许多非细菌性关节炎如骨性关节炎 (OA)、类风湿性关节炎 (RA)、强直性脊柱炎 (AS)、痛风性关节炎等 ,尽管病因和发病机制不同 ,但在病理过程中都会出现炎症因子大量释放 ,造成滑膜和关节周围组织炎症、软骨破坏及增生等病变。前列腺素 (PG)尤其前列腺素E2 (PGE2 )是参与上述病理变化的主要介质 ,故作为PG合成和起始步骤关键酶的环氧化酶(COX)对于关节炎的发病和发展具有重要作用和影响。近来随着对COX研究的深入 ,特别是其同工酶的发现 ,给关节炎的认识和治疗也带来了新的变化。1　COX的结构和功能COX属膜结合蛋白 ,主要存在于细…     

Septic arthritis and osteomyelitis

The pathophysiology, bacteriology, diagnosis, and treatment of septic arthritis and osteomyelitis are presented. Possible complications are reviewed and illustrated.     

Rheumatoid arthritis and pregnancy

The problems of pregnancy in rheumatoid arthritis are presented in this paper.     

生物矿化与类风湿性关节炎

生物矿化是新近发现的纳米细菌的特性之一,机体感染后产生的炎症反应是其主要的致病原因.纳米细菌的生物矿化特性受到感染机体体内多种因素的影响,故生物矿化过程表现为时急时缓,感染的病症也相应地表现为反复迁延.临床类风湿性关节炎部分病例的发病或许即由纳米细菌感染所致,然而对这一认识的缺乏使得很多病因研究误入歧途.该文就纳米细菌生物矿化的特性进行综述,为类风湿性关节炎病因学研究提供一种新思路.     

骨质疏松与类风湿关节炎

类风湿关节炎和骨质疏松在我国都属于常见病和多发病,而二者之间又有着非常重要的联系。但是目前临床上还没有一个广泛应用的药物可以同时对两者都产生很好的治疗效果。为了进一步了解骨质疏松和类风湿关节炎的关系,将来能够找到更好的治疗药物,笔者从流行病学、发病机制以及治疗方法等方面分别进行了论述。     

Rheumatoid arthritis and depression

Depression constitutes the most frequent comorbid condition associated with rheumatoid arthritis (RA), with prevalence rates ranging from 14% to 48%. This wide range can be explained by several factors including subtypes of depression considered, instrument of measure (i.e. self-questionnaires versus clinical interview), threshold applied but also the overlap of symptoms between the two conditions. Despite being a frequent comorbid condition in RA, depressive states are repeatedly underdiagnosed and thus, often remain untreated. Consequences are dramatic as conclusive evidence show that depression deleteriously impacts just about all outcomes of RA, including disease activity, arthritis-related complications, level of pain, chance of remission, quality of life and mortality. Importantly, links between depression and RA appear to be bidirectional as if RA patients show increased prevalence of depression. Conversely, patients with depression compared to the general population have higher risk to develop RA. Among the factors explaining this strong association between depression and RA, recent advances have underlined the putative role of models based on the inflammatory hypothesis. Pro-inflammatory cytokines such as tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-18 are involved in RA pathogenesis, but also in depression. Furthermore, the connections between the central nervous system, the peripheral system and the immune system are now better understood. As a consequence of the strong comorbidity and the aggravate prognostic, the management of patient showing this dual diagnosis should be carefully monitor. The common physiopathology also opens the path to utilization of RA treatment in severe depression or treatment-resistant depression.     

Septic arthritis in patients with rheumatoid arthritis

There is an increasing number of rheumatoid patients who get septic arthritis. Chronic use of steroids is one of the important predisposing factors. The clinical picture of septic arthritis is different in immunocompromised patients like patients with rheumatoid arthritis. The diagnosis and management are discussed in this review article.