Maria Majdan
Research interests
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InterestsVasculitis, Antiphospholipid Syndrome, Systemic Lupus Erythematosus, Autoimmune Diseases, Rheumatic Diseases, Autoimmunity, Autoantibodies, Arthritis
Publications
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8.11Impact points
Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent?
Annals of the rheumatic diseases. 04/2012;
OBJECTIVES: To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchange... [more] OBJECTIVES: To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices.METHODS: Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics.RESULTS: Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices.CONCLUSIONS: PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.
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Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity.
Arthritis care & research. 11/2011; 64(2):206-14.
To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL asse... [more] To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0-10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance. The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels. Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the "disease experience" of patients, particularly pain and fatigue, is warranted for effective care of RA.
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1.49Impact points
Antibodies against cyclic citrullinated peptide don't decrease after 6 months of infliximab treatment in refractory rheumatoid arthritis.
Rheumatology international. 11/2011; 31(11):1439-43.
Anti-citrullinated peptide antibodies (ACPA) and the rheumatoid factor (RF) are well-established serological markers for rheumatoid arthritis (RA). ACPA are very useful in the diagnosis of RA, especially at the early stages of the disease when ACPA have a greater diagnostic value than RF. The aim of... [more] Anti-citrullinated peptide antibodies (ACPA) and the rheumatoid factor (RF) are well-established serological markers for rheumatoid arthritis (RA). ACPA are very useful in the diagnosis of RA, especially at the early stages of the disease when ACPA have a greater diagnostic value than RF. The aim of the study was to assess the influence of infliximab treatment on RF IgM and ACPA serum levels and RA activity during 6 months of treatment. Thirty-two patients with refractory RA were treated with infliximab during a 6-month period. At baseline, 3 and 6 months of treatment the patients were examined for the number swollen and tender joints out of 28 (SJC, TJC) and the visual analogue scale of arthritis activity according to the patient (VAS). Serum samples were tested for erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP), ACPA and RF IgM. The disease activity score (DAS-28) parameter was also calculated at the same time. During the course of our study, we observed statistically significant improvement in ESR, CRP, TJC, SJC, VAS DAS-28, and RF IgM after 3 and 6 months of infliximab treatment when compared to the baseline, whereas the ACPA level remained unchanged after 3 and 6 months of treatment (P = 0.96 and P = 0.85). The changes in the ACPA level are not a factor for evaluation of successful infliximab treatment but the changes in RF IgM are. According to different behavior of these antibodies during infliximab treatment, we suggest that the roles of ACPA and RF in the pathogenesis of RA are different.
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1.19Impact points
The relationship between carotid intima-media thickness and the activity of rheumatoid arthritis.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 08/2011; 17(5):249-55.
Cardiovascular (CV) disease, the most common cause of mortality in patients with rheumatoid arthritis (RA), is largely attributable to accelerated atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis. The aim of the study was to asse... [more] Cardiovascular (CV) disease, the most common cause of mortality in patients with rheumatoid arthritis (RA), is largely attributable to accelerated atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis. The aim of the study was to assess cIMT in RA patients lacking concomitant comorbidities potentially influencing cIMT value. The study group consisted of 74 RA patients, without diagnosed heart or kidney disease, hypertension, diabetes, obesity, or current smoking (mean age, 46.4 [SD, 10.6] years; range, 19-70 years). Assessment of cIMT was determined by high-resolution B-mode ultrasonography in RA patients and 31 control subjects (mean age, 42.6 [SD, 8.0] years; range, 27-59 years). The mean maximum cIMT value was significantly greater in RA patients than in control subjects (0.73 [SD, 0.14] vs 0.59 [SD, 0.12] mm; P < 0.0001). In RA patients, cIMT correlated positively with a number of immunological and inflammatory parameters and also with amino-terminal pro-brain natriuretic peptide (NT-proBNP), age, metabolic variables (serum cholesterol, creatinine, cystatin C). In multiple linear regression analysis, significant association was found between cIMT and NT-proBNP and age. Patients without atherosclerosis (cIMT <0.6 mm) were younger and had significantly lower concentrations of NT-proBNP and total cholesterol, as well as higher estimated glomerular filtration rate. The course of RA in patients without atherosclerosis was characterized by shorter disease duration, lower tender joint count, and C-reactive protein. Values of cIMT were significantly greater in RA compared with control subjects. Features of RA, such as extra-articular manifestations, erosions, high inflammatory parameters, and long disease duration, even in the absence of traditional clinical CV risk factors, were associated with greater cIMT, suggesting an unfavorable CV risk profile.
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1.49Impact points
Efficacy of radiosynoviorthesis and its impact on chosen inflammatory markers.
Rheumatology international. 06/2011;
Radiosynoviorthesis is used for the local treatment of recurrent joint effusions and leads to synovium necrosis after radionuclide administration. This procedure provides opportunity to full recovery of normal synovium function after local corticosteroids and systemic modifying drugs failure.... [more] Radiosynoviorthesis is used for the local treatment of recurrent joint effusions and leads to synovium necrosis after radionuclide administration. This procedure provides opportunity to full recovery of normal synovium function after local corticosteroids and systemic modifying drugs failure.
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Associations between parameters of nutritional status and disease activity in patients with rheumatoid arthritis.
Polskie Archiwum Medycyny Wewnętrznej. 04/2011; 121(4):122-8.
In patients with rheumatoid arthritis (RA), the loss of body cell mass is observed, known as rheumatoid cachexia. Cachexia is associated with increased morbidity and premature mortality of RA patients. The aim of the study was to assess the effect of chronic inflammation and disease activity on nutr... [more] In patients with rheumatoid arthritis (RA), the loss of body cell mass is observed, known as rheumatoid cachexia. Cachexia is associated with increased morbidity and premature mortality of RA patients. The aim of the study was to assess the effect of chronic inflammation and disease activity on nutritional status in RA patients. In 140 patients with RA (111 women, 29 men), RA activity was measured using the Disease Activity Score in 28 joints (DAS28) and using the Modified Health Assessment Questionnaire (M-HAQ). The nutritional status was assessed with the following parameters: serum albumin and total cholesterol (TC), body mass index (BMI), hand-grip strength (HGS), and tricipital skinfold thickness. There was a significant association between the parameters of nutritional status and the markers of inflammatory disease activity (number of swollen and tender joints, C-reactive protein, hemoglobin) and physical disability (M-HAQ). Swollen joint count and M-HAQ were inversely correlated with several nutritional parameters. In patients with high disease activity, significantly lower HGS and serum albumin levels were observed. Advanced stages of the disease (erosive and/or long-standing RA) were associated with lower HGS and higher TC levels. The nutritional status of RA patients is determined by the intensity of chronic inflammatory process observed in the course of the disease and by disease duration.
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1.67Impact points
Amino-terminal pro-brain natriuretic peptide as a prognostic marker in patients with rheumatoid arthritis.
Clinical rheumatology. 01/2011; 30(1):61-9.
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, of which amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. The objective of the study was to investigate associations between NT-proBNP and age, gender, markers of inflammation,... [more] Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, of which amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. The objective of the study was to investigate associations between NT-proBNP and age, gender, markers of inflammation, disease activity, and kidney function in RA patients, without co-morbidities potentially influencing NT-proBNP concentration. The study group consisted of 90 patients with RA, without clinically relevant coronary heart disease, hypertension, diabetes, advanced chronic kidney disease. The comprehensive assessment of clinical and laboratory parameters of inflammation, disease activity, and kidney function was performed. Plasma samples were frozen for NT-proBNP analysis. Carotid intima media thickness (cIMT) was determined by high-resolution B-mode ultrasonography. The mean NT-proBNP concentrations were significantly higher in a group of RA patients with high disease activity (DAS28 > 5.1) and in a group of patients with subclinical atherosclerosis diagnosed by cIMT ≥ 0.6 mm. In all RA patients, NT-proBNP correlated positively with the age, C-reactive protein, erythrocyte sedimentation rate, cIMT, tricipital skin fold and negatively with hand-grip strength, hemoglobin, red blood cell count, albumin. In the group of women with RA, we found significant positive correlation between NT-proBNP and cystatin-C. Also, patients with NT-proBNP level ≥ 100 pg/ml had significantly higher cystatin-C than those with lower NT-proBNP. NT-proBNP level, in RA patients without co-morbidities potentially influencing this level, is correlated with age, disease activity markers of inflammation, and subclinical renal impairment. It means that risk of CV disorders is higher in older patients with more active RA.
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[Antiphospholipid syndrome and the kidney diseases].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 05/2010; 28(167):341-4.
Antiphospholipid syndrome (APS) is the most common connective tissue disease (CTD) in man. Renal involvement in APS is poorly recognized. The renal manifestations of APS may result from thrombosis occurring at any location within the renal vasculature. The clinical syndromes of renal involvement in ... [more] Antiphospholipid syndrome (APS) is the most common connective tissue disease (CTD) in man. Renal involvement in APS is poorly recognized. The renal manifestations of APS may result from thrombosis occurring at any location within the renal vasculature. The clinical syndromes of renal involvement in APS includes renal artery stenosis, arterial hypertension, APS nephropathy--with variable degrees of severity, extension and chronic microangiopathy, renal vein thrombosis, renalfailure, allograft vascular thrombosis. Clinical symptoms of APS includes hypertension, nephritic or nephrotic syndrome, acute renal insufficiency, chronic kidney disease and reduced survival of renal allografts. Recently a new subset of the APS is proposed--microangiopathic antiphospholipid syndrome (MAPS) comprising those patients presenting with thrombotic microangiopathy and antiphospholipid antibodies. Effective, full anticoagulation is a treatment of choice in any patients with APS and renal involvement.
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Gastrointestinal involvement in patients with systemic sclerosis.
Polskie Archiwum Medycyny Wewnętrznej. 04/2010; 120(4):132-6.
Gastrointestinal (GI) involvement is a serious complication of systemic sclerosis (SSc). The aim of the study was to determine the incidence of GI manifestations in SSc. We studied 73 patients with SSc (60 women and 13 men). Diffuse cutaneous SSc (dcSSc) was diagnosed in 30 patients and limited cuta... [more] Gastrointestinal (GI) involvement is a serious complication of systemic sclerosis (SSc). The aim of the study was to determine the incidence of GI manifestations in SSc. We studied 73 patients with SSc (60 women and 13 men). Diffuse cutaneous SSc (dcSSc) was diagnosed in 30 patients and limited cutaneous SSc (lcSSc) in 43 patients. Upper GI involvement was assessed based on clinical symptoms such as dysphagia and gastroesophageal reflux-related complications. The majority of patients underwent radiographic examination including a barium swallow. Lower GI involvement was evaluated on the basis of such clinical symptoms as constipation and diarrhea. GI symptoms were observed in 54 (74%) SSc patients. Upper GI symptoms were observed in 54 (74%) patients and lower GI symptoms in 22 (30%) patients. The presence of anticentromere antibodies is associated with a lower risk of GI involvement. There are no significant differences in the incidence of pulmonary involvement between SSc patients with and without GI symptoms. GI involvement is observed in the majority of SSc patients. Clinical symptoms of GI involvement are significantly more common in patients with dcSSc. The incidence of upper GI symptoms is significantly higher than that of lower GI symptoms.
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[Wegener's granulomatosis with subglottic stenosis: options for local and systemic treatment. Review of the literature].
Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:58-61.
Wegener's granulomatosis (WG) is a primary systemic vasculitis with characteristic clinical manifestations from upper airways, lungs, and kidneys. Subglottic stenosis is one of the local symptoms which may occur independently or in association with involvement of other organs. We present a patie... [more] Wegener's granulomatosis (WG) is a primary systemic vasculitis with characteristic clinical manifestations from upper airways, lungs, and kidneys. Subglottic stenosis is one of the local symptoms which may occur independently or in association with involvement of other organs. We present a patient with systemic WG positive for C-ANCA. Regression of pulmonary changes was achieved with induction therapy but the patient developed subglottic stenosis. Endotracheal dilation was partly successful, so systemic treatment had to be reintroduced to inhibit the activity of the disease. The problem of localized organ lesions in the course of a systemic disease is discussed. It is important to distinguish between signs of active disease requiring systemic therapy and organ lesions which demand a localized approach.
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[Mycophenolate mofetil for the treatment of lupus nephritis. The case of lupus nephritis--class IV according to WHO--treated with mycophenolate mofetil].
Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:91-4.
Lupus nephritis (LN) develops in almost 60% of patients with systemic lupus erythematosus. In its most severe proliferative forms, LN often leads to end-stage renal failure. Therapeutic regimens in severe lupus nephropathies, especially class IV according to WHO, are based on glucocorticosteroids (G... [more] Lupus nephritis (LN) develops in almost 60% of patients with systemic lupus erythematosus. In its most severe proliferative forms, LN often leads to end-stage renal failure. Therapeutic regimens in severe lupus nephropathies, especially class IV according to WHO, are based on glucocorticosteroids (GCSs) administered together with cyclophosphamide (CPA) as the first-line drugs. New therapeutic options appeared once immunosuppressive properties of mycophenolic acid derivatives (mycophenolate mofetil) were documented. We describe a patient with LN class IV treated according to various immunosuppressive protocols adjusted to the degree of LN activity. The remission-inducing protocol based on intravenous pulses of GCSs and CPA resulted in regression of renal lesions but was associated with the risk of complications. Mycophenolate mofetil was found effective for maintenance therapy. The choice of therapy for patients with LN should be based on the severity of renal disease at the time of diagnosis and on the histopathology of the renal bioptate. Discrepancies obtain as to first-line drugs for severe forms of LN and duration of remission-inducing therapy.
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[Gout and comorbidities associated with hyperuricemia].
Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:34-9.
Gout is a condition presenting with inflammatory arthritis caused by crystallization and phagocytosis of monosodium urate in synovial fluid. It is the most common form of arthritis in men above the age of 40 years. Four clinical stages of gout have been distinguished: asymptomatic hyperuricemia, acu... [more] Gout is a condition presenting with inflammatory arthritis caused by crystallization and phagocytosis of monosodium urate in synovial fluid. It is the most common form of arthritis in men above the age of 40 years. Four clinical stages of gout have been distinguished: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic gout. Experimental and epidemiologic studies provide growing evidence that hyperuricemia is not only the driving force behind symptoms attributed to the deposition of monosodium urate in the musculoskeletal system but also the important etiological factor in common morbidities of modern societies such as arterial hypertension, cardiovascular disease, chronic kidney disease, and type 2 diabetes mellitus. Today, the majority of gout cases demonstrate clinical features of the metabolic syndrome. Recommendations of the European League Against Rheumatism (EULAR) published in 2006 address key issues in the diagnosis of gout, as well as in the nonpharmacologic and pharmacologic management with regard to the clinical condition and comorbidities of the individual patient. Routinely used antihyperuricemic drugs include allopurinol, colchicine, and uricosuric agents. New agents have recently been introduced into clinical practice, like pegylated uricase and febuxostat, a nonpurine inhibitor analog of xanthine oxidase. Thus, novel therapeutic options are now available to combat this chronic illness which often leads to significant disability.
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Development of Churg-Strauss syndrome with severe multiple mononeuropathy after leukotriene receptor antagonist treatment in one of the monozygotic twins with asthma: case report.
Polskie archiwum medycyny wewnetrznej. 11/2009; 119(11):761-764.
Several cases of Churg-Strauss syndrome (CSS) have been reported in asthmatic patients treated with leukotriene receptor antagonists (LTRAs). It is not clear whether LTRA is a causative factor in the development of vasculitis. We present the case of a 26-year-old patient, who developed severe centra... [more] Several cases of Churg-Strauss syndrome (CSS) have been reported in asthmatic patients treated with leukotriene receptor antagonists (LTRAs). It is not clear whether LTRA is a causative factor in the development of vasculitis. We present the case of a 26-year-old patient, who developed severe central and peripheral neuropathy after a short-term treatment with LTRA, followed by gastrointestinal perforation and bleeding. The patient was successfully treated with high-dose glucocorticoids, immunoglobulins, and cyclophosphamide. His monozygotic twin brother treated for asthma does not meet classification criteria for Churg-Strauss syndrome at the moment, but his condition is being monitored. Both asthma and rheumatology specialists should consider the possibility of CSS development in patients treated with LTRAs.
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Adiponectin and leptin serum concentrations in patients with rheumatoid arthritis.
Rheumatology international. 08/2009;
Adipose tissue is regarded as an active metabolic and endocrine organ producing adipokines. The purpose of the study was to evaluate adiponectin and leptin concentrations in rheumatoid arthritis (RA) patients (pts) in relation to disease duration and activity. The study group consisted of 80 RA pts.... [more] Adipose tissue is regarded as an active metabolic and endocrine organ producing adipokines. The purpose of the study was to evaluate adiponectin and leptin concentrations in rheumatoid arthritis (RA) patients (pts) in relation to disease duration and activity. The study group consisted of 80 RA pts. Serum adiponectin and leptin concentrations remained within normal ranges. Adiponectin concentration correlated positively both with the age and disease duration. Both adipokines levels correlated negatively with glomerular filtration rate. There were significant positive correlations between adipokines' concentrations and lipid profile components (between adiponectin and HDL-cholesterol, leptin and total cholesterol and LDL-cholesterol). In pts with long-standing RA, there was a negative correlation between adiponectin and numbers of tender, swollen joints and a positive relationship between leptin level and DAS28. The results confirm adipokines' involvement in the process of inflammation and atherosclerosis: protective and antiinflammatory adiponectin effect and proatherogenic and proinflammatory leptin function.
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1.67Impact points
Antiphospholipid antibodies and kidney involvement in patients with systemic sclerosis.
Clinical rheumatology. 06/2009;
Antiphospholipid (aPL) antibodies are often detected in systemic autoimmune diseases. The aim of the study was to examine the correlation between the presence of aPL and certain markers of renal function in systemic sclerosis (SSc). Fifty patients (pts) with SSc were examined for the presence of ant... [more] Antiphospholipid (aPL) antibodies are often detected in systemic autoimmune diseases. The aim of the study was to examine the correlation between the presence of aPL and certain markers of renal function in systemic sclerosis (SSc). Fifty patients (pts) with SSc were examined for the presence of antibodies to cardiolipin (aCL) and to anti-beta 2 glycoprotein I (a-B2GPI) in immunoglobulin M (IgM) and IgG class. Moreover, serum levels of creatinine, cystatin C, and glomerular filtration rate (GFR) were determined in all patients. In all studied pts together, three multiple-regression analyses were performed with one set cystatin C as a dependent variable, in the second GFR according to the Cockcroft-Gault formula and in the third creatinine clearance by Modification of Diet in Renal Disease (MDRD) formula. As independent variables, aPL of either type were inserted in addition to disease duration and age. IgG aCL was significantly positively associated with serum cystatin C (p = 0.002), significantly negatively associated with creatinine clearance according to the Cockcroft-Gault and MDRD formula (p = 0.01 and 0.02, respectively). IgG a-B2GPI was significantly negatively associated with creatinine clearance according to the Cockcroft-Gault (p = 0.03) and MDRD (p = 0.01) formula. IgM aCL and IgM a-B2GPI were not associated with any markers of the renal function. Our study suggests the relationship between kidney involvement and the positivity for some aPL in patients with SSc. Positivity for IgG aCL and IgG a-B2GPI in patients with SSc without secondary antiphospholipid syndrome seems to be connected with decrease of glomerular filtration.
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4.15Impact points
Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries.
Arthritis and rheumatism. 10/2008; 58(9):2642-51.
OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5,84... [more] OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR) definition, Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI), clinical remission assessed using 42 and 28 joints (Clin42 and Clin28), patient self-report Routine Assessment of Patient Index Data 3 (RAPID3), and physician report of no disease activity (MD remission). RESULTS: The overall remission rate was lowest using the ACR definition of remission (8.6%), followed by the Clin42 (10.6%), Clin28 (12.6%), CDAI (13.8%), MD remission (14.2%), and RAPID3 (14.3%); the rate of remission was highest when remission was defined using the DAS28 (19.6%). The difference between the highest and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and <5% in 7 countries (the latter of which had generally low remission rates [<5.5%]). Regardless of the definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular exercise were statistically significantly associated with remission. CONCLUSION: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials and clinical studies have to be interpreted in light of the definition of remission that has been used.
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1.64Impact points
Parthenolide inhibits proliferation of fibroblast-like synoviocytes in vitro.
Inflammation. 09/2008; 31(4):281-5.
Parthenolide is a bioactive constituent of an aromatic herb Feverfew (Tanacetum parthenium). It has been found that both parthenolide and extract of feverfew have anti-inflammatory and antinociceptive properties. Moreover, they demonstrate antiproliferative activities on different human tumour cells... [more] Parthenolide is a bioactive constituent of an aromatic herb Feverfew (Tanacetum parthenium). It has been found that both parthenolide and extract of feverfew have anti-inflammatory and antinociceptive properties. Moreover, they demonstrate antiproliferative activities on different human tumour cells. The massive hyperplasia of synovial fibroblasts is the one of the most striking features of rheumatoid arthritis. It is not known whether this is due to the proliferation of synovial fibroblasts or to defective apoptosis. We investigated the effect of parthenolide on the proliferation of rabbit synoviocytes cell line HIG-82, rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) and human skin fibroblasts (HSF) in vitro. Cell proliferation was assessed by means of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and 5'-bromo-2'-deoxy-uridine methods. Parthenolide inhibited proliferation of HIG-82 and human RA-FLS. The proliferation of HSF was inhibited less effectively. The antiproliferative potential of parthenolide was demonstrated.
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1.49Impact points
Coexistence of five autoimmune diseases: diagnostic and therapeutic difficulties.
Rheumatology international. 08/2008; 28(9):919-23.
We report the case of coexistence of five autoimmune diseases in a 36-year-old woman, who initially developed psoriasis. Several years later, the patient was diagnosed with a mixed connective tissue disease and primary biliary cirrhosis (PBC). On admission to the Department of Rheumatology and Conne... [more] We report the case of coexistence of five autoimmune diseases in a 36-year-old woman, who initially developed psoriasis. Several years later, the patient was diagnosed with a mixed connective tissue disease and primary biliary cirrhosis (PBC). On admission to the Department of Rheumatology and Connective Tissue Diseases, the patient fulfilled classification criteria of an overlap syndrome systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome/systemic sclerosis (SSc)/Sjogren's syndrome (SS) with coexisting PBC and psoriasis. The SLE symptoms included discoid lupus erythematosus, arthritis, pancytopenia, antinuclear antibodies and anticardiolipin antibodies. Moreover, the patient met the criteria of antiphospholipid syndrome diagnosed based on preterm delivery before week 34, and high values of anticardiolipin antibodies were found at repeated determinations. The SSc symptoms included sclerodactyly, pulmonary fibrosis with pulmonary hypertension and esophageal dysfunction. The SS syndrome involved xerostomia, xerophthalmia, the positive Schirmer's test and presence of anti-SS antibodies. The literature reports overlap syndromes in various combinations; however, the coexistence of five autoimmune diseases is extremely rare.
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1.49Impact points
Leptin serum levels in rheumatoid arthritis patients: relation to disease duration and activity.
Rheumatology international. 04/2008; 28(6):585-91.
Leptin is a peptide hormone with the tertiary structure of a cytokine, which not only regulates body weight by inhibiting food intake, but also modulates inflammatory and immune responses. The aim of the study was to investigate if there are connections between leptin concentrations and parameters o... [more] Leptin is a peptide hormone with the tertiary structure of a cytokine, which not only regulates body weight by inhibiting food intake, but also modulates inflammatory and immune responses. The aim of the study was to investigate if there are connections between leptin concentrations and parameters of nutritional status and disease activity in a group of rheumatoid arthritis (RA) patients. The study group consisted of 37 patients. The mean leptin serum concentration was significantly higher in women than in men. The leptin concentrations correlated positively with BMI only in women with RA. The leptin concentrations were significantly higher in patients with erosive RA. Assessing the group of patients with long-standing RA (duration > 10 years), we found that leptin levels were significantly higher in patients with higher disease activity than in those with DAS28 < or = 5,1; there was also a positive correlation between serum leptin concentration and the value of DAS28, ESR and the number of tender joints. The results suggest that some important dependence exists between the risk of aggressive course of RA and increased leptin levels.
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4.27Impact points
Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study.
Arthritis research & therapy. 01/2008; 10(2):R30.
INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of... [more] INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care. METHODS: The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models. RESULTS: Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries. CONCLUSION: In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.
Following (9)
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Andrzej Breborowicz
Poznan University of Medical Sciences -
Rieke Alten
SCHLOSSPARK-KLINIK, Charité Universitätsmedizin Berlin -
Alexandros A Drosos
University of Ioannina -
Jacqueline Detert
Charité Universitätsmedizin Berlin -
Robert Zwolak
Medical University of Lublin
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