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Query: UMLS:C0003873 (rheumatoid arthritis)
 53,068 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sensitive investigations such as pulmonary function tests, broncho-alveolar lavage or computered tomography at high resolution enable pleuro-pulmonary disease to be detected in nearly 50% of those patients studied who had rheumatoid arthritis (PR). The prevalence of these manifestations is most usually elevated in male PR sufferers, those who are sero-positive or have associated extra-articular signs such as sub cutaneous nodules. More recently there has been evidence of genetic risk factors linked to HLA grouping or Pi phenotype. Amongst the usual manifestations, the pleurisies and above all necrobiotic nodules, which are most often asymptomatic, sometimes pose difficult problems in differential diagnosis, particularly when they precede the articular disease. The diffuse interstitial fibrosis remains the most worrying specific complication due to the fact of its potential seriousness. The pathophysiology of this form of fibrosis is better understood since the introduction of LBA. In the absence of any specific controlled studies its treatment remains impirical and is similar to that given for diffuse or idiopathic interstitial fibrosis. Pulmonary vascularity, the bronchiolitis obliterans with organising pneumonia and apical fibrosis, very similar to Hamilton's syndrome, are much rarer manifestations. On the other hand non specific respiratory infections are the cause of death in 10-20% of cases. Bronchiolitis obliterans induced by D Penicillamine is the most severe iatrogenic manifestation, since corticosteroid therapy associated with immunosuppressive drugs enables at best a stabilisation of the alveo bronchiolar lesions. More recently there have been twenty observations of hypersensitivity pneumonia to low dose methotrexate. The prevalence of these pulmonary disorders during the treatment of PR is around 5%. However the respiratory contraindications of these drugs which are being used more and more and the methods of pulmonary surveillance under treatment are not yet defined.
Rev Mal Respir 1991
PMID:[Pleuro-pulmonary manifestations of rheumatoid polyarthritis]. 185 11

Ten patients (6 women and 4 men), with a group mean age of 65 years, defined as severe and with a mean follow-up period of 9 years and refractory to conventional treatments, were treated with monoclonal anti-CD4 antibodies in an open study. The monoclonal antibodies, of murine origin, were administered by intravenous route for ten consecutive days at a dose of 10 mg (1 patient), 15 mg (2 patients) or 20 mg (7 patients). Local and systemic tolerability were excellent. Clinical improvement was rapid (pain, morning stiffness, Ritchie index, p = 0.005 between D0 and D15), as was the paraclinical improvement (C-reacting protein, p = 0.008), although without achieving complete remission. The outcome revealed that the effect was more prolonged in patients treated with 20 mg per day than in the others, suggesting a dose-effect relationship. The improvement obtained may persist for more than 9 months in some patients. No significant change in immunological parameters was found at the end of the treatment (lymphocyte populations, immunoglobulins, complement). Only 2 out of 10 patients developed anti-mouse antibodies. As a result of its excellent tolerability and rapid effectiveness, this antibody appears to offer fresh therapeutic prospects in rheumatoid arthritis.
Rev Rhum Mal Osteoartic 1991 Jan
PMID:[Therapeutic use of a monoclonal, anti-CD4 antibody in refractory rheumatoid polyarthritis. Preliminary results]. 187 15

Type II anticollagen (CII) autoimmunity is a frequently reported, but non-specific, phenomenon in rheumatoid arthritis (RA). The authors show that in 88 sera samples from patients suffering from RA, the incidence of antibodies targeted against endogenous human CII was the same as that found for 149 control blood donors (14.8% versus 11.4%). However, a significant difference was found for the incidence of antibodies targeted against the alpha-chains of CII (26.1% versus 6.0%, p less than 0.001). As a result of investigating the specificity of the anti-CII antibodies in greater detail by means of an immunoprinting of the CII peptide fragments obtained after splitting the molecule by cyanogen bromide, the authors have demonstrated that the largest CII peptides (CB10 and CB11) were better recognized than the smaller peptides (CB8, CB9.7), with no significant difference between PR and control plasmas. Using competitive methods, evidence was obtained in support of heterogeneous recognition by the anti-CII antibodies: some recognize conformational determinants only, whereas others are targeted against the primary sequences of the alpha-1 (II) chain.
Rev Rhum Mal Osteoartic 1991 Jan
PMID:[Role of collagen conformation in type II anticollagen immunity in rheumatoid polyarthritis]. 187 16

This retrospective study involved 60 patients (7 men, 53 women) with rheumatoid arthritis (RA) and given methotrexate between 1985 and 1990. The mean time that RA had been present was 12 years and more than half of the patients had received more than 3 types of general treatment in the past. The mean total duration of MTX was 17.3 months, with a total dose of 790 mg. The efficacy of MTX was confirmed by a significant improvement in clinical and laboratory parameters. Treatment was withdrawn permanently in 21 cases (35% of patients). Adverse reactions, responsible for two thirds of treatment withdrawals (14/21) occurred in most instances during the first year of treatment. Hepatic toxicity was commonest. Two cases of aplasia were reported as well as 3 cases of pneumonitis, one fatal. These involved two cases of secondary infection and one of pneumonitis directly imputable to MTX. Withdrawals for inefficacy were rare, occurring in less than 10 p. cent of patients. Treatment continuation rates were 77 p. cent at 1 year, 66 p. cent at 18 months, 55 p. cent at 2 years, 42 p. cent at 3 years and 32 p. cent at 4 years. MTX is effective treatment for RA but is not free of adverse reactions, sometimes potentially fatal. Prolonged monitoring is necessary because of the sometimes delayed onset of adverse reactions.
Rev Rhum Mal Osteoartic 1991 Jun
PMID:[Treatment of rheumatoid polyarthritis with methotrexate]. 189 82

The ability in performing daily life activities, as assessed with self-administered questionnaire, measures the functional severity of rheumatoid arthritis (RA). The HAQ Disability Index, designed to explore RA, was translated by 3 francophone teams. Three anglophones gave a back-translation. The latters were compared with the original HAQ under the control of 2 bilingual individuals, allowing to the adjustment of the French version. The validity of this measurement tool was studied in a group of recent RA (n = 40, mean disease duration: 2.4 years), longstanding RA (n = 32, mean disease duration: 8.4 years) and controls (n = 59). The construct validity was assessed in a principal component analysis, which showed the contribution of each item of the questionnaire. The intra-subject reproducibility was satisfactory. The HAQ score correlated well with usual clinical and radiological parameters. It differed significantly in the groups, showing a high discriminant ability. A validated instrument for measuring functional ability in French RA patients is now available for the follow-up and therapeutic assessment.
Rev Rhum Mal Osteoartic 1991 Jun
PMID:[Measurement of the functional capacity in rheumatoid polyarthritis: a French adaptation of the Health Assessment Questionnaire (HAQ)]. 189 87

The authors report the development of thrombocytopenia purpura in one patient with seropositive and erosive rheumatoid arthritis treated successfully for 11 months with D-penicillamine. Anti-platelet-bound antibodies were present, but also: anti-erythrocyte antibodies with hemolytic anemia (then defining Evans's syndrome): higher level of antinuclear antibodies; intermittent neutropenia. The responsibility of D-penicillamine is discussed, but thrombocytopenia purpura evolved for itself. Glucocorticoids alone, intravenous immunoglobulin, vincristine did not induced remission, which at least occurred under the association danazol-glucocorticoids, without toxicity, especially on the liver function.
Rev Rhum Mal Osteoartic
PMID:[Evans' syndrome caused by D-penicillamine in rheumatoid arthritis. Value of the corticoids-danazol combination]. 192 97

Rheumatoid factors of the IgA isotype directed to human IgG Fc fragment were assayed, using an Elisa test, in the serum of 30 patients with seropositive rheumatoid arthritis and in the synovial fluid of 9 of them. A high incidence was found in the serum (90%) and synovial fluids (77%). Clinical, radiological and biological parameters of each patients were recorded at the time of the assay, and two years later. There was no statistically significant association between IgA rheumatoid factors levels and other parameters, nor with a pejorative evolution. However, a significant negative correlation was observed between IgA rheumatoid factors levels and the duration of the disease, suggesting that IgA rheumatoid factors are predominantly produced at the earliest stages of rheumatoid arthritis.
Rev Rhum Mal Osteoartic
PMID:[Levels of IgA rheumatoid factors in seropositive rheumatoid polyarthritis. Absence of correlation with disease activity or pejorative course]. 192 96

Fifteen patients with rheumatoid arthritis were treated with tiopronine, and an immunological check-up carried out before the onset and after a two-month treatment. The latex test titres decreased, and there was a significant fall in the levels of IgA-containing circulating immune complexes, in parallel with a depletion of plasma complement breakdown products. Patients displayed a decrease in CD8+T cells and in CD4+Leu 8-T cells and a high proportion of activated T lymphocytes. This returned to normal after treatment. Treatment with TP led also to a reduction of adherence and chemotaxis of polymorphonuclear cells.
Rev Rhum Mal Osteoartic 1990 Apr 10
PMID:[Tiopronin, an example of hydrosulphonated derivatives used in the treatment of rheumatoid polyarthritis. Study of immunologic effects]. 197 55

At the start of the nineties, the therapeutic strategy for rheumatoid arthritis (RA) is still disappointing, and the natural history of this affection remains only slightly influenced by the treatments; a general re-assessment of the treatment seems therefore justified. Some new slow acting drugs are effective, but they cannot be considered as being therapeutic revolutions: gold salts per os, sulphasalazine, tiopronine whose efficacy is comparable to D-penicillamine without systematic cross interaction, methotrexate, cyclosporin which is difficult to manipulate. These observations encourage the search for new strategies, namely for the early treatment of the synovitis before the pannus and radiological signs appear. For this, the early and irrefutable diagnosis of RA must be made possible; and no completely reliable, early detection test is available yet. Though promising, the new therapeutic approaches, immunomanipulation or cell manipulation, do not revolutionize the evolution of this pathology. Other fields of research need to be developed, namely on the remission-inducing agents observed during pregnancy. It is still impossible to know which approach will provide the absolute weapon against RA.
Rev Rhum Mal Osteoartic 1990 Apr 10
PMID:[Does the general strategy for the treatment of rheumatoid polyarthritis need to be reviewed?]. 197 56

Rheumatic disorders are relatively rare among internal medicine out-patients in Kinshasa. Diseases encountered most often are osteoarthrosis, gout and rheumatoid arthritis. The authors report the relative incidence of these diseases and note that sites of osteoarthrosis are predominantly axial, that the clinical pattern of rheumatoid arthritis is less severe with the absence of abarticular manifestations and that gout, in contrast, does not differ from the classical features described in the literature. These findings encourage the authors to continue their study in order to better define the clinical features of rheumatic disorders in Kinshasa and in Zaire in general.
Rev Rhum Mal Osteoartic 1991 Feb
PMID:[Osteoarthrosis, gout and arthritis rheumatoid in internal medicine in Kinshasa]. 204 5


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