Citations
To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents.
Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes.
The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X).
Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.
Citations
To assess the prevalence of peripheral neuropathy in patients with rheumatoid arthritis (RA) having neuropathic symptoms, and to investigate the relationship between electrophysiological findings of peripheral neuropathy and clinical findings of RA.
Patients with a clinical diagnosis of RA and who had tingling or burning sensation in any extremity were electrophysiologically examined for evidence of peripheral neuropathy. Study parameters, including age, gender, laboratory parameters, duration of RA, and medication, were recorded. The symptoms and signs of neuropathy were quantified with the neuropathy symptom score, and the functional statuses of these patients were assessed.
Out of a total of 30 RA patients, 10 (33%) had peripheral neuropathy: 2 had bilateral carpal tunnel syndrome (CTS), 5 had unilateral CTS, 1 had sensory polyneuropathy, and 2 had motor-sensory polyneuropathy. The mean ages of the patients with and without peripheral neuropathy were 69.4 and 56.5 years, respectively (p<0.05). A significant relationship was found between peripheral neuropathy and anti-cyclic citrullinated peptide (anti-CCP) antibody. However, no relationship was found between peripheral neuropathy and the type of medication, RA duration, the patients' functional status, neuropathic symptoms, erythrocyte sedimentation rate, and C-reactive protein values.
Neuropathic symptoms are common in RA patients, and it is difficult to distinguish peripheral neuropathy symptoms from those of arthritis. Patients with RA, particularly elderly patients and anti-CCP antibody positive patients who complain of neuropathic symptoms should undergo electrophysiological examination.
Citations
To evaluate the prevalence and risk factors of peripheral neuropathy in patients with rheumatoid arthritis (RA) treated with leflunomide (LEF) by quantitative sensory testing (QST).
A total of 94 patients were enrolledin this study, out of which 47 patients received LEF. The other 47 patients received alternative disease-modifying antirheumatic drugs and served as the control group. The demographic characteristics, laboratory findings, concomitant diseases, and medication history were evaluated at the time of QST. The cooling (CDT) and vibratory detection threshold (VDT) as the representative components of QST were measured.
Age, gender, RA duration, ESR, and CRP did not show any significant differences between the two groups. VDT did not demonstrate any significant difference in both groups. However, CDT in LEF group was significantly higher than that of the control group (8.6±2.7 in LEF vs. 5.6±3.8 in control). The proportion of RA patients in the LEF group showing abnormally high CDT was over 2 times greater than that of the control group, but these findings were not statistically significant. Age, RA duration (or LEF medication in LEF group), ESR, and CRP did not show significant correlation with CDT in both groups. VDT significantly correlated with age in both groups.
LEF treatment in patients with RA may lead to abnormal CDT in QST. CDT value was not affected by age, RA duration, disease activity, or LEF duration. It remains to be determined whether QST may be a valuable non-invasive instrument to evaluate the early sensory changes in patients with RA taking LEF.
Citations
To assess the efficacy of human placental extract (HPE) in an animal model of rheumatoid arthritis (RA).
We used (i) KRN C57BL/6 TCR transgenic x NOD mice (KBx/N) serum transfer arthritis and (ii) collagen-induced arthritis (CIA) mice to evaluate the effi cacy of HPE (1 ul or 100 ul, intra-peritoneal, three times per week) on RA. Incidence, severity of arthritis, and hind-paw thickness were quantifi ed. Joint destruction was analyzed using modifi ed mammographic imaging. Histopathological analysis for inflammation, cartilage, and osteoclasts was performed using Hematoxylin-eosin (H-E), safranin-O, and tartrate-resistant acidic phosphatase (TRAP). ELISAs were used for detection of various cytokines in serum and joint tissue.
There were no significant differences in incidence of arthritis, clinical scores of arthritis, and hind-paw thickness between HPE-treated and vehicle-treated groups for up to 2 weeks in the KBx/N serum transfer arthritis model. Histopathological analysis also showed no differences 2 weeks after treatment. Levels of TNF-α, IL-1β, IL-6, IL-10, and RANKL in serum and joint tissues were similar in all groups. Furthermore, there were no differences in clinical, radiological, and histological parameters between HPE-treated and vehicle-treated group for 3 weeks in the CIA model.
Systemic treatment with HPE has no beneficial effects on arthritis in animal models of RA. Therefore, indiscreet use of HPE in RA should be forbidden.
Citations
A 64-year-old woman suffering right hemiplegia came in with pain and swelling on her left knee, general weakness and poor oral intake for 2 months. On physical examination we were able to palpate a mass with irregular margin around the left suprapatellar area. From the results of the magnetic resonance imaging (MRI), synovial proliferative disease, infectious arthritis, or gouty arthritis was suspected. We performed a blood laboratory test to detect rheumatologic diseases, knee joint aspiration, and bone scan for differential diagnosis, and were able to diagnose rheumatoid arthritis (RA) from the results of blood laboratory, physical examination, and bone scan. Consequently, we started medications for controlling RA. Herein, we report a case of rheumatoid arthritis with unilateral knee synovial hypertrophy in hemiplegia. If a right hemiplegic patient has recurrent pain on the left knee and synovial hypertrophy, and fails to respond to treatment for osteoarthritis, early detection by evaluation for rheumatic disease is crucial to prevent severe sequelae influencing rehabilitation of hemiplegia.
Citations
Method: The experimental subjects were divided into 3 groups (Group 1: 100 persons; control, Group 2: 100 persons; RA without hand deformity, Group 3: 100 persons; RA with hand deformity). They were assessed with using the Modified Barthel Index (MBI), evaluating the activity of daily living (ADL). A JAMAR Hand DynamometerⰒ, JAMAR Hydraulic Pinch GaugeⰒ (Sammons Preston Rolyan, Ilinois, USA) were used to measure grip and pinch strength. Further assessments included joint deformity counts, and visual analogue scales. Results: The grip and pinch strength significantly decreased in all groups. The total MBI with other groups significantly decreased in RA patients with hand deformity (group 3). The MBI correlated well with visual analogue scales in group 2 and with joint deformity counts in group 3. Conclusion: Hand grip and pinch strength tests would be a useful tool for the evaluation of hand function in rheumatoid arthritis patients. (J Korean Acad Rehab Med 2008; 32: 200-205)
Objective: Ultrasound has been therapeutically applied for pain control in rheumatoid arthritis although little physiologic effects of sonication on rheumatoid tissue were known. This investigation was conducted to determine the effects of sonication on the cell proliferation and matrix metalloproteinase (MMP) production of cultured fibroblast like synoviocytes (FLS) derived from synovial tissues of rheumatoid arthritis.
Method: Pulsed ultrasound (1.0 MHZ, 20 msec on, 80 msec off) with varying intensities (0, 0.1, 0.25, 0.5, 0.75, 1.0 W/cm2) was applied to experimental cell groups growing as monolayers in culture plates for varying durations (0, 30, 90, 180 seconds) in the presence and absence of interleukin-1β (IL-1β).
Results: There were no significant differences in thymidine incorporation between 0, 30, 90 and 180 second sonication groups with 0.5 W/cm2 after 1 day and 2 days. There were no significant differences in thymidine incorporation between 0, 0.1, 0.25, 0.5, 0.75, 1.0 W/cm2 sonication groups 1 day and 2 days after 90 second sonication. There were significant increase in MMP-1 (p=0.025) and MMP-3 production (p=0.000) of FLS after sonication in the absence of IL-1β but there were no significant differences in MMP-1 and MMP-3 production in the presence of IL-1β. And MMP-1 and MMP-3 production were increased significantly in the presence of IL-1β but not than in the absence of IL-1β.
Conclusion: While comparisons made between a limited number of FLS cell lines must be open to question, the overall consistency of the findings suggest sonication with nonthermal effect is not the contraindication in rheumatoid arthritis treatment but further study is needed in vivo in animal and in clinical studies.
Objective: To examine the stiffness of finger joints with StifMeter among the patients with rheumatoid arthritis and to calculate the absolute value of the stiffness with a unit of power and to compare the values of the StifMeter with visual analog scale about stiffness (VASstiff).
Method: Subjects were 53 rheumatoid arthritis patients (male 8, female 45) with disease duration at least 6 months. StifMeter was made up of 10 graded springs of a same spring-constant. Stiffness and pain by VAS and StifMeter, finger circumference and pinch strength were measured at outpatient clinic as well as questionaire, prospectively. Laboratory data were reviewed from medical records to verify the state of disease. We compared StifMeter with VASstiff and VASpain.
Results: Mean score of StifMeter was 5.59 on the right side and 5.53 on the left. The corrected values of the StifMeter with a unit of power were 0.01684 on the right side and 0.01672 on the left side. VASstiff score was positively correlated with that of StifMeter. The older the age, the higher the score of VASstiff that was positively correlated with that of StifMeter. The longer the duration of disease, the higher the score of VASstiff that was positively correlated with that of StifMeter.
Conclusion: StifMeter is a semi-objective method which may be of value in the measurement of finger joint stiffness.
Objective: To determine the usefulness of Jebsen hand function test in rheumatoid arthritis patients
Method: The experimental subjects were divided into 3 groups (Group 1：17 persons; control, Group 2：21 persons; RA without hand deformity, Group 3：16 persons; RA with hand deformity). They were assessed by Jebsen hand function test. Further included assessments were grip and pinch strength, joint deformity counts, and visual analogue scales.
Results: Jebsen hand function test scores were significantly decreased in rheumatoid arthritis patients compared with control. Jebsen hand function test scores were well correlated with visual analogue scales in group 2 and correlated with joint deformity counts in group 3.
Conclusions: Jebsen hand function test would be useful tool for the evaluation of hand function in the rheumatoid arthritis patients with hand deformity.
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