Rheumatoid arthritis

Angiogenesis is essential for the growth of solid tumors. Antiangiogenic therapy has therefore attracted considerable interest as a novel therapy for various tumors including colorectal carcinoma. We experimentally investigated the therapeutic effect of TNP-470, a nonspecific inhibitor of angiogenic factors, and vascular endothelial growth factor (VEGF)-neutralizing antibody (VEGFAb), was a VEGF-specific inhibitor, on liver metastases of colon carcinoma using a murine orthotopic transplantation model. TK-4 and TK-13 are moderately differentiated adenocarcinoma strains established in our department which express VEGF mRNA and protein. Administration of TNP-470 30 mg/kg significantly inhibited the liver metastases of both strains, as did administration of VEGFAb 100 micrograms/mouse. The therapeutic effect on liver metastases was more dominant with antiangiogenic therapy than with chemotherapy (mitomycin C). Furthermore, the sustained effect of TNP-470 induced tumor dormancy and consequently improved the survival of the animals. These results suggest that antiangiogenic treatment will be a potent therapy for liver metastases of human colorectal carcinoma in the future.     

Rheumatoid arthritis. Designing and implementing a treatment plan

Treating rheumatoid arthritis can be very satisfying when patients participate fully in designing and implementing their therapeutic strategy. However, the strategy's success depends on early intervention and disease modification. Many patients do well when education, rest, diet, exercise, and drug therapy are incorporated into an individualized regimen.     

Rheumatoid arthritis and ankylosing spondylitis

Povidone-iodine is the cleansing agent most commonly used before accessing implanted venous devices. This agent has peak bacteriocidal action when allowed to air-dry for 20 min postscrub. However, the drying time increases the length of the procedure and the risk for accidental contamination of the site. In this study, the effectiveness of air drying versus blot drying povidone-iodine-prepared skin sites was compared by examining the number of bacterial colonies present on skin cultures obtained after each drying method. No significant differences in the number of bacterial colonies between the two drying methods were found.     

Rheumatoid arthritis in a patient with osteopoikilosis

57-years old woman with spotted bones was reported, with concomitant rheumatoid arthritis. It was great concern because of low incidence of osteopoikilia and diagnosis obstacles concerning coexistence of this two pathologies.     

Rheumatoid arthritis and risk of cancer

In the current study we linked data from the Danish Hospital Discharge Register and the Danish Cancer Registry to estimate cancer occurrence among more than 20,000 patients hospitalized at least once with rheumatoid arthritis during 1977-1987. During a follow-up interval of up to 15 years, we found increased risks of non-Hodgkin's lymphoma, Hodgkin's disease and lung cancer, while the risk of colorectal cancer was decreased. These findings were all in agreement with the results of previous studies from two other Nordic countries, which were based on a similar type of data. We also found an excess of non-melanoma skin cancer and a deficit of female breast cancer, of which only the breast cancer observation had been seen in an earlier study.     

Rheumatoid arthritis and the risk of malignancy

OBJECTIVE: To determine the relative risks of malignancy and of site-specific malignancies in patients with rheumatoid arthritis (RA). METHODS: In a prospective cohort study, 862 patients with RA (96% white) were enrolled from 1966 to 1974 and were followed up for up to 35 years (mean 17.4 years) at the University of Saskatchewan Rheumatic Disease Unit. All diagnoses of cancer were cross-referenced with the Provincial Cancer Registry. Expected cancer incidence rates were determined based on province of Saskatchewan population statistics matched to each study patient for age, sex, and calendar year. Standardized incidence ratios (SIRs) of the observed-to-expected cancer incidence and 95% confidence intervals (95% CI) were then calculated. RESULTS: A total of 136 cases of cancer were observed compared with 168 expected (SIR 0.80, P = 0.011 [95% CI 0.67-0.95]). The relative risk of colorectal malignancy was significantly reduced in the RA study population (SIR 0.52, P = 0.037 [95% CI 0.25-0.96]). A significant excess of leukemia was found (SIR 2.47, P = 0.026 [95% CI 1.12-4.69]), whereas the incidence rates for Hodgkin's disease and non-Hodgkin's lymphoma and all other site-specific malignancies were not found to be significantly different from general population rates. CONCLUSION: In our cohort of RA patients, colorectal cancer was detected in only half the expected number of patients. This risk reduction may be related to long-term nonsteroidal antiinflammatory drug (NSAID) use in RA, as has been suggested in several other studies of long-term NSAID use. An increased risk of leukemia was confirmed. This may be due to the persistent immune stimulation associated with RA itself, since other potential explanatory factors for increased leukemia were not apparent. Despite the excess of hemopoietic malignancy and despite treatment of RA with potentially oncogenic agents, the overall risk of malignancy was reduced in this RA cohort.     

Rheumatoid arthritis treated with chlorambucil: a five-year follow-up

Tympanotomy and a transvestibular approach to the fundus of the internal auditory meatus is described. The surgical technique is modified from that proposed by Alvarez de Cozar and Antoli-Candela in 1970. The surgical anatomy of the operative sites is detailed. The surgical procedure is found indicated in patients in whom preservation of hearing is not considered and vestibular neurectomy required. The described technique provides a simple but efficient and safe alternative to the translabyrinthine approach to the internal auditory meatus for division of the vestibular and cochlear nerves.     

Rheumatoid arthritis: current clinical and research directions

Conventional PCR-SSP, which is based on an agarose gel-based read-out, has the disadvantages of time-consuming post-PCR steps and low potential for automation. The aim of our study was to sort out these drawbacks by establishing a fluorescence-based PCR-SSP system for HLA-C. The assay relies on the sequence-specific identification of amplicons with individually labeled probes that are cleaved during successful PCR by the 5'-3' exonuclease activity of the Taq-DNA Polymerase. The oligonucleotides are labeled with a unique and spectrally resolvable fluorescent reporter dye at the 5' terminus (FAM or TET) and a common quencher dye at the 3' terminus (TAMRA). In case of amplification, the reporter escapes from the quenching control caused by the physical separation of the dyes, resulting in a significant increase of the reporter fluorescence. This allows simultaneous and differential detection of the specific HLA (FAM) and internal control (TET) product. The HLA-C fluorotyping information is based on the individual reporter fluorescence released by 18 PCR primer mixes. Using this method, we analyzed 145 samples previously typed with conventional PCR-SSP and found a concordance rate of 100%. Furthermore, fluorotyping revealed quantitative results that may indicate the presence of homozygosity by high signal intensities. This provided extra protection not to miss new alleles which are not amplified by the current primer mixes. These features as well as the capability of high sample throughput and the possibility of automation makes fluorotyping an attractive tool for PCR-based HLA typing.     

Rheumatoid arthritis: Review of psychological factors related to etiology, effects, and treatment.

Provides a comprehensive review of the psychological literature related to the etiology, effects, and treatment of rheumatoid arthritis (RA), which is a chronic disease with no known cause or cure that typically follows an unpredictable course. A brief summary of the relevant medical aspects of RA is also included. The possible role of psychological variables in the onset of RA is discussed, with emphasis on the potential etiological role of stress. An examination of the multiple consequences of RA suggests that psychologists can play an important role in the development of standardized assessment techniques to measure the effects of RA. The increasing use of psychological treatment strategies to reduce the pain and disability associated with RA also reflects the growing collaboration between rheumatologists and psychologists. It is concluded that methodological problems apparent in the literature must be overcome for psychologists to contribute further to clinical research and practice in the rheumatic disease area. (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebral demyelination with 5-fluorouracil and levamisole

We report a patient who developed multifocal cerebral demyelination with the use of 5-fluorouracil, levamisole, and leucovorin as adjuvant treatment for intestinal adenocarcinoma. The clinical features were acute confusion, restlessness, ataxia, and slurred speech. Magnetic resonance imaging revealed multifocal enhancing white matter lesions. Brain biopsy showed a well-demarcated area of demyelination in cerebral white matter. The patient improved clinically and radiologically after cessation of chemotherapy and a short course of steroids. There have been only 4 previously reported cases of multifocal leukoencephalopathy related to the use of combination 5-fluorouracil and levamisole. The extensive use of these agents as adjuvant treatment for colorectal carcinoma may result in more frequent recognition of this form of neurological toxicity.     

Rheumatoid arthritis and vertebral artery occlusion: a case report with angiographic and magnetic resonance demonstration

A 40-year-old woman with rheumatoid arthritis (RA) who presented with vertigo and nausea, was found to have left vertebral artery occlusion on angiography. There was minimal atlantoaxial subluxation and no odontoid herniation. Magnetic resonance imaging (MRI) was suggestive of a left vertebral artery dissection. This is the first report of MRI of vertebral artery occlusion in RA. It will be important to accumulate MR images of this complication in future cases.