Rheumatoid Arthritis: Christensen R

Bliddal H, Boesen M, Christensen R, Kubassova O, Torp-Pedersen S. · The Parker Institute, Frederiksberg Hospital, 2000 Frederiksberg, Denmark. · Best Pract Res Clin Rheumatol. · Pubmed #19041080 No free full text.

Abstract: Imaging is key to the objective analysis of status in joint diseases. X-ray is the mainstay of imaging in both osteoarthritis (OA) and rheumatoid arthritis (RA) due to its accessibility, low cost and very good reproducibility. Also, considerable experience has been gathered in the evaluation of X-rays with the Sharp score in RA and the Kellgren-Lawrence score in OA. X-rays only show structural changes and, in comparison with magnetic resonance imaging (MRI), the detection of erosions on X-ray is delayed for more than 1 year. More advanced imaging by both MRI and ultrasound (US) may add to clinical examinations by showing signs of RA activity. US is by far the easiest modality to apply in a rheumatology outpatient setting, and is becoming an everyday diagnostic tool in many clinics. The definitions and standards for US are still being tested and need further work before application in longitudinal settings is possible. Reproducibility is better with MRI, but this examination is time-consuming, both in the acquisition phase with the patient and also for interpretation and scoring by the examiner. The latter issue seems to be overcome by computer-assisted diagnostics using algorithms for automatic evaluation. With technical developments and increasing knowledge regarding both MRI and US, both of these modalities may be of value in the evaluation of rheumatology patients.

Kristensen LE, Christensen R, Bliddal H, Geborek P, Danneskiold-Samsøe B, Saxne T. · Department of Rheumatology, Lund University Hospital, Lund, Sweden. · Scand J Rheumatol. · Pubmed #18092260 No free full text.

Abstract: OBJECTIVE: To compare the efficacy of adalimumab, etanercept, and infliximab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX) by calculating the number needed to treat (NNT) using three different methods. METHODS: A systematic literature search of the Cochrane Library, MEDLINE, and EMBASE was conducted from inception to 30 June 2006. Two pairs of investigators, a Danish and a Swedish pair, independently conducted a structured literature review. The reviewers selected any published randomized, double-blind, MTX controlled study of adalimumab, etanercept, and infliximab, presenting the American College of Rheumatology 50% response (ACR50) after 12 months in RA patients with a mean disease duration of at least 5 years. The two review groups independently extracted the estimates necessary to calculate the NNT. RESULTS: The reviewers consistently selected the same three randomized, controlled trials (RCTs), one for each of the drugs, and extracted equal data for the number of patients completing the 12-month intervention, and the corresponding number of ACR50 responding patients after therapy. Some baseline differences were noted: patients in the etanercept trial had a shorter disease duration and did not receive MTX prior to inclusion; patients in the adalimumab study had lower Health Assessment Questionnaire (HAQ) scores. The calculated NNTs varied slightly depending on the method used. The fully adjusted NNTs (95% confidence intervals) for adalimumab, etanercept, infliximab standard dosage and infliximab double dosage were 4 (3-6), 4 (3-6), 8 (4-66), and 4 (3-11) patients, respectively. CONCLUSION: This study indicates equal efficacy of the three anti-tumour necrosis factor (TNF) therapies.

Prolo P, Chiappelli F, Cajulis E, Bauer J, Spackman S, Romeo H, Carrozzo M, Gandolfo S, Christensen R. · UCLA School of Dentistry, and Dental Research Institute, Los Angeles, California 90095, USA. · Ann N Y Acad Sci. · Pubmed #12114301 No free full text.

Abstract: Rheumatoid arthritis involves psychoneuroendocrine-immunopathological comorbidities. In the stoma, patients with rheumatoid arthritis frequently show signs of periondontal disease consequent to elevated levels of crevicular proinflammatory cytokines. It is not clear whether rheumatoid arthritis may manifest in association with immunopathological manifestations of the oral soft mucosa. Oral lichen planus (OLP), first described by E. Wilson in 1859, is a T-cell-mediated inflammatory disease whose lesions characteristically lack B cells, plasma cells, immunoglobulin. or complement. It is increasingly well characterized and recognized as a model for psychoneuroimmunology research in oral biology and medicine. To date, we have shown an association between changes in hypothalamic-pituitary-adrenal (HPA) regulation, systemic markers of cellular immunity and mood states, with clinical stages of OLP (i.e., atrophic vs. erosive vs. bullous lesions). We report significant associations (p < 0.05) between the stage of OLP, HPA deregulation, and altered distribution and functional responses of naïve CD4(+) cells. We emphasize the need to study in greater details the psychoneuroendocrine-immune inter-relationships in OLP, and we propose a novel neuroimmune hypothesis for OLP.