Haara et al. recently published a study assessing epidemiological
aspects of osteoarthritis (OA) in Finland.[1] A finding of interest was
their identification of OA (in any finger joint) as a predictor of
cardiovascular death among men, with the authors suggesting an
undetermined metabolic factor as a mechanism. It may be that the
disability conferred by OA in the lower limbs delays presenta...
Haara et al. recently published a study assessing epidemiological
aspects of osteoarthritis (OA) in Finland.[1] A finding of interest was
their identification of OA (in any finger joint) as a predictor of
cardiovascular death among men, with the authors suggesting an
undetermined metabolic factor as a mechanism. It may be that the
disability conferred by OA in the lower limbs delays presentation of
patients with ischaemic heart disease due to lack of exertional symptoms.
Thus treatment to reduce risk is delayed. Additionally, some patients who
also have generalised OA and are less physically active may be at higher
risk of cardiac events.[2]
Occupation and levels of education have been used as surrogates of
social class.[3] Certain jobs that require repetitive movements or
heavier work intensity increase the risk of developing OA ,[4] although
occupation is not always linked to the development of hand OA.[5]
Generally, manual workers, whose jobs demand higher physical input, are
poorly paid compared to professionals.
Haara et al. found no link between duration of education and
osteoarthritis of the fingers but the association between OA and earlier
death may, nevertheless, be mediated by an effect of social class. Death
due to coronary disease is known to be associated with lower socioeconomic
groups. Another Finnish study noted higher incidence of myocardial
infarction in those of lower income, with higher pre-hospital, 28 day and
12 month mortality rates.[6] These higher rates may reflect differences in
prevalence and awareness of cardiac risk factors among the different
socioeconomic groups, which may also contribute to higher cardiovascular
death in men with OA.
References
(1) Haara MM, Manninen P et al. Osteoarthritis of finger joints in
Finns aged 30 or over: prevalence, determinants, and association with
mortality. Ann Rheum Dis 2003;62:151-8.
(2) Wagner A, Simon C et al. Physical activity and coronary event
incidence in N. Ireland and France. Circulation 2002;105:2247-52.
(3) Davey Smith G, Hart C et al. Education and occupational social
class: which is the more important indicator of mortality risk? J Clin
Epidemiol Community Health 1998;52:153-60.
(4) National Institutes of Health Conference. Osteoarthritis: new
insights. Ann Intern Med 2000;133:635-46.
(5) Jones G, Cooley HM, Stankovich JM. A cross sectional study of the
association between sex, smoking and other lifestyle factors and
osteoarthritis of the hand. J Rheumatology 2002;29:1719-24.
(6) Salomaa V, Niemela M et al. Relationship of Socioeconomic Status to
the Incidence and Prehospital, 28-Day, and 1-Year Mortality Rates of Acute
Coronary Events in the FINMONICA Myocardial Infarction Register Study.
Circulation 2000;101:1913-8.
Maillefert and colleagues have reported an interesting study
concerning the possible relationship between hepatitis C virus
(HCV)infection and rheumatoid arthritis (RA).[1] They found a 0.65 %
prevalence of HCV infection in 309 patients with RA, which is similar to
that reported in the general French population.[2] They concluded that
HCV infection can not be implicated in the pathogenesis of RA. HCV
in...
Maillefert and colleagues have reported an interesting study
concerning the possible relationship between hepatitis C virus
(HCV)infection and rheumatoid arthritis (RA).[1] They found a 0.65 %
prevalence of HCV infection in 309 patients with RA, which is similar to
that reported in the general French population.[2] They concluded that
HCV infection can not be implicated in the pathogenesis of RA. HCV
infection is a major public health concern.[3]
Since its discovery it has
been associated with some autoimmune diseases such as mixed
cryoglobulinemia[4] and sicca syndrome.[5] It as also been reported a
significant association between HCV infection and psoriatic arthritis in
an Italian study.[6]
In the last two years we evaluated the presence of HCV infection in 72
consecutive patients with RA. All the patients fulfilled the ACR criteria
for RA. All of them were screened for the presence of anti-HCV antibodies
even in the absence of any data suggestive of liver disease as a standard
procedure before the initiation of treatment with methotrexate or other
immunosuppressive agents. Cases with positive serology were further
evaluated for HCV-RNA with a RT-PCR method. Our patients were 70.8%
females, had a mean age of 57.9 years (range 21-77 y), and 56.9% were
positive for the rheumatoid factor. We found evidence of HCV infection
(anti-HCV plus HCV-RNA positivity) in 5 patients (6.9%). As control
patients we used a group of 47 patients with other rheumatological
diseases observed in the same period that were screened for HCV infection
on the same basis and with the same methods. These patients were 59.6%
females and had a mean age of 53 years (range 21-82 y). We found evidence
of HCV infection in 4 of them (8.5%).
We found a rather high prevalence of HCV infection in our RA patients.
However, we observed the same prevalence in our control goup.
Epidemiological studies have shown high prevalence of HCV infection even
in the general population from some Italian areas.[7,8] Therefore, our
data seem to confirm the absence of correlation between HCV infection and
RA. The great variability in the prevalence of HCV infection in different
geographical areas and patient subpopulations[9] must be taken into
account when evaluating the possible role of HCV in systemic diseases in
order to avoid wrong conclusions.
References
(1) Maillefert JF, Muller G, Falgarone G, Bour JB, Ratovohery D, Dougados
M, et al. Prevalence of hepatitis C virus infection in patients with
rheumatoid arhritis. Ann Rheum Dis 2002; 61: 635-7.
(2) Dubois F, Desenclos JC, Mariotte N, Goudeau A. Hepatitis C in a French
population-based survey, 1994: seroprevalence, frequency of viremia,
genotype distribution, and risk factors. Hepatology 1997; 25: 1490-6.
(3) Sharara AI, Hunt CM, Hamilton JD. Hepatitis C. Ann Intern Med 1996;
125: 658-68.
(4) Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection
in type II cryoglobulinemia. N Engl J Med 1992; 327: 1490-5.
(5) Jorgensen C, Legouffe MC, Perney P, Coste J, Tissot B, Segarra C, et
al. Sicca syndrome associated with hepatitis C virus infection. Arthritis
Rheum 1996; 39: 1166-71.
(6) Taglione V, Vatteroni ML, Martini P, Galluzzo E, Lombardini F, Delle
Sedie A, et al. Hepatitis C virus infection: prevalence in in psoriasis
and psoriatic arthritis. J Rheumatol 1999; 26: 370-2.
(7) Guadagnino V, Stroffolini T, Rapicetta M, Costantino A, Kondili LA,
Menniti-Ippolito F, et al. Prevalence, risk factors, and genotype
distribution of hepatitis C virus infection in the general population: a
community-based survey in southern Italy. Hepatology 1997; 26: 1006-11.
(8) Coppola RC, Masia G, Pradat P, Trepo C, Carboni G, Argiolas F, Rizzetto
M. Impact of hepatitis C virus infection on healthy subjects on an Italian
island. J Viral Hepat 2000; 7: 130-7.
(9) Wasley A, Alter MJ. Epidemiology of hepatitis C: geographic differences
and temporal trends. Sem Liver Dis 2000; 20: 1-16.
Hepatitis B vaccination has been reported to trigger autoimmune conditions on the appropriate genetic background. Macrophagic myofasciitis
(MMF) is a recently described muscle disease that seems to be triggered by
aluminic vaccines (hepatitis B and tetanus toxoid). We
recently observed an interesting case of identical twins who both developed MMF after hepatitis B
vaccination. This observation suggested the...
Hepatitis B vaccination has been reported to trigger autoimmune conditions on the appropriate genetic background. Macrophagic myofasciitis
(MMF) is a recently described muscle disease that seems to be triggered by
aluminic vaccines (hepatitis B and tetanus toxoid). We
recently observed an interesting case of identical twins who both developed MMF after hepatitis B
vaccination. This observation suggested the role of a genetic background
to MMF (Guis et al[1]). We
recently found that this is, indeed, the case as most MMF patients express
HLA-DRB1*01 (Guis et al.[2]).
Thus, at least in the case of MMF, hepatitis B vaccination may trigger
disease on the HLA-DRB1*01 background. Should people who express HLA-DR1
be advised against hepatitis B (and tetanus toxoid) vaccination?
References
(1) Guis S, Mattei JP, Nicoli F, Pellissier JF, Kaplanski G, Figarela D, Manez G, Antipoff G, Roudier J. Identical twins with macrophagic myofasciitis: genetic susceptibility and triggering by aluminic vaccine adjuvants.
Arthritis and Rheumatism 2002;47:543-545
(2) Guis S, Pelissier JF, Nicoli F, Reviron D, Mattei JP, Gherardi R,
Pelletier J, Kaplanski G, Figarella D, Roudier J.
HlA-DRB1*01 and macrophagic myofasciitis.
Arthritis and Rheumatism 2002;46:2535-2537.
We read with interest the article by Dr Kvien and colleagues
concerning cyclosporine–A (CsA) versus parenteral gold salts (PGS) in
early rheumatoid arthritis (RA).[1] The authors concluded that both drugs
had similar results on radiological progression of the disease, while CsA
was associated with severe side effects especially hypertension and renal
function impairment. We would like to make some comme...
We read with interest the article by Dr Kvien and colleagues
concerning cyclosporine–A (CsA) versus parenteral gold salts (PGS) in
early rheumatoid arthritis (RA).[1] The authors concluded that both drugs
had similar results on radiological progression of the disease, while CsA
was associated with severe side effects especially hypertension and renal
function impairment. We would like to make some comments concerning the
CsA efficacy and side effects.
It is known that CsA man cause hypertension and may increase serum
creatinine levels. On the other hand, renal disease in RA patients may be
influenced by many factors, such as: long disease duration, previous
disease modifying antirheumatic drugs (DMARDs) usage, the intake of non
steroidal anti–inflammatory drugs (NSAIDs), the dose of CsA given and even
the usage of other drugs which interfere with CsA renal function.[2,3]
Considering the above parameters, 42% of CsA patients in Dr Kvien study
received other DMARDs and were also allowed to receive NSAIDs during the
study. In addition, in some patients the dose of CsA was 5 mg/kg body
weight. We believe that the above parameters may influence blood pressure
and renal function in CsA treated patients. To avoid this inconvenience,
it is better to treat early RA patients with CsA and small doses of
steroids. Indeed, we have reported a prospective two year randomised trial
in early RA patients using small doses of CsA (3 mg/day) and 7.5 mg of
prednisone per day, versus methotrexate (MTX). We found that the efficacy,
tolerability and safety were similar between the two drugs.[4] In
addition, in a long term follow up study for 42 months, we found similar
results and no radiological deterioration in both groups.[5] In the above
long term trial, 27% of CsA treated patients developed side effects. Eight
of them (15%) had hypertension, which was managed very well with
nifedipine 10 mg/day. A total of 7 patients (14%) discontinued the study
due to side effects, one because of uncontrolled hypertension, three because
of gingival hyperplasia, and three because of severe hyperthrichosis.[5]
Furthermore, none of our patients increased the serum creatinine more than
30% from the baseline levels and none of them discontinued the study due
to renal function deterioration. In addition to that, in a recent study
from our group, we investigated the effectiveness, toxicity, and drug
survival in a long term observational trial in early RA patients. After 12
years of follow up, the longest drug survival time was seen in MTX treated
patients, followed by CsA without significant differences between these
two drugs. Finally, PGS and D–penicillamine had the most serious adverse
drug reaction and the lowest drug survival time.[6]
Thus, considering the pathophysiology of RA and the role of CD4+
T–cells in its pathogenesis,[7] we believe that CsA has a place in the
treatment of early RA patients, but it will be given as monotherapy or in
combination therapy with small doses of steroids or/and MTX but without
the use of NSAIDs.
References
(1) Kvien TK, Zeidler HK, Hannonen P, Wollheim FA, Førre Ø, Hafström I, et
al. Long term efficacy and safety of cyclosporin versus parenteral gold in
early rheumatoid arthritis: a three year study of radiographic
progression, renal function, and arterial hypertension. Ann Rheum Dis
2002;61:511–6.
(2) Boers M. Renal disorders in rheumatoid arthritis. Semin Arthritis Rheum
1990;20:57–68.
(3) Altman RD, Perez GO, Sfakianakis GN. Interaction of cyclosporine A and
non steroidal anti–inflammatory drugs on renal function in patients with
rheumatoid arthritis. Am J Med 1992;93:396–402.
(4) Drosos AA, Voulgari PV, Papadopoulos IA, Politi EN, Georgiou PE, Zikou
AK. Cyclosporine A in the treatment of early rheumatoid arthritis. A
prospective, randomized 24–month study. Clin Exp Rheumatol
1998;16:695–701.
(5) Drosos AA, Voulgari PV, Katsaraki A, Zikou AK. Influence of cyclosporin
A on radiological progression in early rheumatoid arthritis patients: a
42–month prospective study. Rheumatol Int 2000;19:113–8.
(6) Papadopoulos NG, Alamanos Y, Papadopoulos IA, Tsifetaki N, Voulgari PV,
Drosos AA. Disease modifying antirheumatic drugs in early rheumatoid
arthritis: a longterm observational study. J Rheumatol 2002;29:261–6.
(7) Choy EH, Panayi GS. Cytokine pathways and joint inflammation in
rheumatoid arthritis. N Engl J Med 2001;344:907–16.
We read with great interest the letter of Triolo et al[1]. In the discussion section of the article the authors mentioned
that this is the first report of the treatment of ocular BD with
anticytokine specific treatment.
In July 2001, Sfikakis et al.[2] reported on a series of five patients with relapsing
Behçet's panuveitis, treated with a single infusion of infliximab at the
immed...
We read with great interest the letter of Triolo et al[1]. In the discussion section of the article the authors mentioned
that this is the first report of the treatment of ocular BD with
anticytokine specific treatment.
In July 2001, Sfikakis et al.[2] reported on a series of five patients with relapsing
Behçet's panuveitis, treated with a single infusion of infliximab at the
immediate onset of their last relapse. Remission of ocular inflammation
was evident within the first 24 hours, and complete suppression was seen 7
days after treatment in all patients. The authors suggested that
infliximab is a rapid and effective new therapy for sight-threatening
ocular inflammation in Behçet's disease.
References
(1) Triolo G, Vadalà M, Accardo-Palumbo A, A Ferrante , Ciccia F, Giardina E, Citarrella P, Lodato G, and Licata G. Anti-tumour necrosis factor monoclonal antibody treatment for ocular Behçet's disease. Ann Rheum Dis 2002;61:560-561.
(2) Sfikakis PP, Theodossiadis PG, Katsiari
CG, Kaklamanis P, Markomichelakis NN: Effect of infliximab on sight-threatening panuveitis in Behçet's disease. Lancet 2001 Jul 28;358(9278):295-6
I read with immense interest the e-letter on the analgesic effect of
pamidronate.In fact I have been observing this effect with alendronate for
past couple of years. When I prescribe weeky alendronate for my patients
who also have rheumatoid arthritis, they come back requesting for the
weekly dose to be prescribed daily. The symptom relief however lasts only
for the day the dose is administered. In...
I read with immense interest the e-letter on the analgesic effect of
pamidronate.In fact I have been observing this effect with alendronate for
past couple of years. When I prescribe weeky alendronate for my patients
who also have rheumatoid arthritis, they come back requesting for the
weekly dose to be prescribed daily. The symptom relief however lasts only
for the day the dose is administered. In other words even though the effect
of weekly alendronate on osteoporosis may last a whole week, the pain
relief as well as a feeling of well being and improvement in appetite
lasts only for the day it is given.
I am wondering why, in this day and age, researchers into the long
term effects/links of infections and the possible connection with
potentially devastating conditions do not use PCR testing for the
identification of these infecting or trigger organisms?
My understanding is that PCR testing is far more sensitive than indirect
methods of detecting the body's response to the bug concerned.
I am wondering why, in this day and age, researchers into the long
term effects/links of infections and the possible connection with
potentially devastating conditions do not use PCR testing for the
identification of these infecting or trigger organisms?
My understanding is that PCR testing is far more sensitive than indirect
methods of detecting the body's response to the bug concerned.
Dear Editor
Haara et al. recently published a study assessing epidemiological aspects of osteoarthritis (OA) in Finland.[1] A finding of interest was their identification of OA (in any finger joint) as a predictor of cardiovascular death among men, with the authors suggesting an undetermined metabolic factor as a mechanism. It may be that the disability conferred by OA in the lower limbs delays presenta...
Dear Editor
Maillefert and colleagues have reported an interesting study concerning the possible relationship between hepatitis C virus (HCV)infection and rheumatoid arthritis (RA).[1] They found a 0.65 % prevalence of HCV infection in 309 patients with RA, which is similar to that reported in the general French population.[2] They concluded that HCV infection can not be implicated in the pathogenesis of RA. HCV in...
Dear Editor
Hepatitis B vaccination has been reported to trigger autoimmune conditions on the appropriate genetic background. Macrophagic myofasciitis (MMF) is a recently described muscle disease that seems to be triggered by aluminic vaccines (hepatitis B and tetanus toxoid). We recently observed an interesting case of identical twins who both developed MMF after hepatitis B vaccination. This observation suggested the...
Dear Editor
We read with interest the article by Dr Kvien and colleagues concerning cyclosporine–A (CsA) versus parenteral gold salts (PGS) in early rheumatoid arthritis (RA).[1] The authors concluded that both drugs had similar results on radiological progression of the disease, while CsA was associated with severe side effects especially hypertension and renal function impairment. We would like to make some comme...
Dear Editor
We read with great interest the letter of Triolo et al[1]. In the discussion section of the article the authors mentioned that this is the first report of the treatment of ocular BD with anticytokine specific treatment.
In July 2001, Sfikakis et al.[2] reported on a series of five patients with relapsing Behçet's panuveitis, treated with a single infusion of infliximab at the immed...
Dear Editor,
I read with immense interest the e-letter on the analgesic effect of pamidronate.In fact I have been observing this effect with alendronate for past couple of years. When I prescribe weeky alendronate for my patients who also have rheumatoid arthritis, they come back requesting for the weekly dose to be prescribed daily. The symptom relief however lasts only for the day the dose is administered. In...
I am wondering why, in this day and age, researchers into the long term effects/links of infections and the possible connection with potentially devastating conditions do not use PCR testing for the identification of these infecting or trigger organisms? My understanding is that PCR testing is far more sensitive than indirect methods of detecting the body's response to the bug concerned.
I would be inte...
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