Rheumatoid Arthritis: Graninger W

Schett G, Herak P, Graninger W, Smolen JS, Aringer M. · Division of Rheumatology, Department of Internal Medicine III, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. · J Clin Microbiol. · Pubmed #15872306 links to  free full text

Abstract: Listeriosis can be a cause of infectious arthritis. Here, we present a case of articular listeriosis in a patient with rheumatoid arthritis receiving treatment with etanercept, a tumor necrosis factor antagonist. We review the literature of articular listeriosis and discuss the role of tumor necrosis factor blockade in precipitating listeriosis.

Peloschek P, Bögl K, Sailer J, Wick M, Graninger W, Robinson S, Lomoschitz F, Böhm P, Kainberger F, Imhof H. · Section Osteoradiology, Department of Diagnostic Radiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, A-1090 Vienna. · Acta Orthop Scand Suppl. · Pubmed #12545667 No free full text.

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Graninger W, Smolen J. · Division of Rheumatology, Internal Medicine III, University of Vienna, General Hospital, Vienna, Austria. · Int Arch Allergy Immunol. · Pubmed #11893849 No free full text.

Abstract: Chimeric, humanized and fully human monoclonal antibodies directed against tumor necrosis factor-alpha as well as TNF receptor constructs can be administered relatively safely during long-term use for the treatment of rheumatoid arthritis (RA). Their therapeutic efficacy in patients refractory to treatment with conventional disease-modifying drugs was proven in large clinical trials and their ability to slow the progression of disease was demonstrated radiographically. The insights into the pathophysiology of RA provided by the beneficial effects of blocking proinflammatory cytokines will lead to further drug development for this destructive autoimmune disease.

Graninger M, Handl-Zeller L, Hohenberg G, Staudenherz A, Kainberger F, Graninger W. · Department of Rheumatology, Vienna University Medical School, Vienna, Austria. · Ann Rheum Dis. · Pubmed #15608312 links to  free full text

Abstract: BACKGROUND: Low dose radiotherapy is commonly used for painful rheumatic conditions in clinical practice. Teleradiotherapy may be a cheap, painless procedure which is applicable to many joints at a time. OBJECTIVE: To determine if the local application of x rays to inflamed joints in rheumatoid arthritis (RA) affects the signs and symptoms of inflammation. METHODS: In a randomised, controlled, double blind study, roentgen irradiation was administered in a total dose of 20 Gy during 2 weeks to single joints in six patients with RA who were receiving constant and stable pharmacological treatment with DMARDs and NSAIDs. Single inflamed joints on the contralateral side of the body were used as controls and received sham irradiation. Swelling and tenderness was assessed by blinded investigators before and until 3 months after the irradiation; general disease activity and pain scales were included in the assessment. RESULTS: No change in the scores for tenderness, swelling, pain, or disease activity was seen. The trial was stopped for ethical reasons. CONCLUSION: Local roentgen treatment of RA at a substantial dose of 20 Gy was ineffective in this pilot trial.

Scholten C, Brodowicz T, Graninger W, Gardavsky I, Pils K, Pesau B, Eggl-Tyl E, Wanivenhaus A, Zielinski CC. · Department of Internal Medicine II, University of Vienna Medical School, Austria. · Arch Phys Med Rehabil. · Pubmed #10527088 No free full text.

Abstract: OBJECTIVE: To assess the sustainable benefits of a professional, multidisciplinary training program for patients with rheumatoid arthritis. DESIGN: Two studies with different observation periods. Study I was a prospective, randomized trial for 1 year. Study II was a noncontrolled observation over 5 years. SETTING: The 9-day program for eight patient groups encompassed a multidisciplinary cooperation between rheumatologists, orthopedists, physicotherapists, psychologists and social workers. PATIENTS: Sixty-eight consecutive patients with rheumatoid arthritis participated in an arthritis training program either immediately after enrollment in the program or after 1 year. INTERVENTIONS: The program covered the following fields: pathogenesis of rheumatoid arthritis, drug therapy, physicotherapy, practical exercise in remedial gymnastics, use of joint protection devices, orthopedic perspectives, psychological counseling, dietetics, information about unproven cures and social assistance. MAIN OUTCOME MEASURES: Clinical outcome was assessed by self-report questionnaires: (1) Stanford Health Assessment Questionnaire, (2) Freiburg Questionnaire of Coping with Illness, (3) Beck Depression Inventory, and (4) a 21-point scale to evaluate cognitive-behavioral and environmental impact. RESULTS: A significant and persistent improvement of all investigated parameters was demonstrated in the 1-year controlled trial. Between the end-point of the 1-year study and the 5-year evaluation, this improvement increased even more for functional status and coping with illness, whereas depression returned to baseline values. These effects were seen even without reinforcement of the training. CONCLUSION: A professional, multidisciplinary approach to educate patients with rheumatoid arthritis leads to a significant and sustained improvement of the clinical outcome and is an approach that should be established as a part of conventional therapy.

Emery P, Van Vollenhoven R, Ostergaard M, Choy E, Combe B, Graninger W, Krueger K, Matucci-Cerinic M, Navarro F, van Riel P, Settas L, Steinfeld S. · University of Leeds, Leeds, UK. · Ann Rheum Dis. · Pubmed #19286904 No free full text.

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Yazdani-Biuki B, Brickmann K, Wohlfahrt K, Mueller T, März W, Renner W, Gutjahr M, Langsenlehner U, Krippl P, Wascher TC, Paulweber B, Graninger W, Brezinschek HP. · Department of Internal Medicine, Division of Rheumatology, Medical University Graz, Austria. · Arthritis Res Ther. · Pubmed #16776848 links to  free full text

Abstract: An association between susceptibility to rheumatoid arthritis (RA) and a common -168A>G polymorphism in the MHC2TA gene with differential major histocompatibility complex (MHC) II molecule expression was recently reported in a Swedish population. The objective of the present study was to replicate this finding by examining the -168A>G polymorphism in an Austrian case-control study. Three hundred and sixty-two unrelated RA cases and 351 sex-matched and age-matched controls as well as 1,709 Austrian healthy individuals were genotyped. All participants were from the same ethnic background. Genotyping was performed using 5' allelic discrimination assays. The association between susceptibility to RA and the -168A>G single nucleotide polymorphism was examined by chi-square test. Comparison was made assuming a dominant effect (AG + GG genotypes versus AA genotype). In contrast to the primary report, the frequency of MHC2TA -168G allele carriers was not significantly different between patients and controls in the Austrian cohort. The homozygous MHC2TA -168 GG genotype was more frequent in matched controls than in Austrian RA patients. There was no association between the presence of RA-specific autoantibodies and the MHC2TA -168 GG genotype. In this cohort of Austrian patients, no association between the MHC2TA polymorphism and RA was found.

Wick M, Peloschek P, Bögl K, Graninger W, Smolen JS, Kainberger F. · Division of Rheumatology, Department of Internal Medicine III, University of Vienna, Austria. · Ann Rheum Dis. · Pubmed #12759300 links to  free full text

Abstract: BACKGROUND: Precise diagnosis and follow up treatment of rheumatoid arthritis (RA) requires objective quantification, which is still lacking. For this purpose, radiological analyses are considered to be the most appropriate method. OBJECTIVE: To develop computer assisted quantification software that is particularly applicable to joint scoring in rheumatic disorders. METHODS: 3914 radiographs from hands and feet of 190 patients with RA were collected, expertly examined, analysed, and statistically evaluated. Radiographs were quantified using the conventional Larsen score and the "X-Ray RheumaCoach" (XRRC) software. The XRRC is a Java stand alone application which can support and accelerate, but not fully automate, the scoring procedure in RA. The scorer can apply both the Larsen and the Ratingen-Rau scores. RESULTS: Compared with conventional scoring procedures, the XRRC software accelerated quantification time by approximately 25%. The program, which is now available on the internet free of charge, ran stably and proved to be a consistently valuable tool. CONCLUSIONS: Compared with conventional scoring methods, the XRRC software offers several advantages: (a) structured data analysis and input that minimises variance by standardisation; (b) faster and more precise calculation of sum scores and indices; (c) permanent data storing and fast access to the software's database; (d) the possibility of cross calculation to other scores; (e) "user friendly" technology and a dedicated help program; (f) fast access and data transfer through the internet if desired; and (g) reliable documentation of results in a specially designed printout.

Peloschek P, Bögl K, Robinson S, Böhm P, Lomoschitz F, Graninger W, Kainberger F. · Universitätsklinik für Radiodiagnostik, Währinger Gürtel 18-20, A-1090 Wien. · Wien Med Wochenschr Suppl. · Pubmed #12621836 No free full text.

Abstract: Driven by the increasing implementation of electronical picture archiving and communications system (PACS) into every days practice a fully operative Java application software was developed to support the efficacy of the scoring process in rheumatoid arthritis. This software, namely the "Rheuma-Coach" offers the possibility to use the Larsen- or the Ratingen-Score. We measured time savings of approximately 20% per case if this computer assistance was used. The lack of a standard for the positioning of limbs was confirmed.

Macheiner W, Jantschitsch C, Graninger W, Pálóczy K, Bálint G, Marschalkó M, Kainberger F, Breier F, Knobler RM. · Department of Dermatology, Division of Special and Environmental Dermatology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria. · J Am Acad Dermatol. · Pubmed #12582392 No free full text.

Abstract: We describe a patient with therapy-resistant cutaneous T-cell lymphoma, Sézary syndrome variant, in association with concurrent polyarthritis and vitiligo, who was successfully treated with extracorporeal photochemotherapy (ECP). The combination of Sézary syndrome with seronegative rheumatoid arthritis is rare. In our patient the T-cell lymphoma was refractory to standard treatments that included psoralen-UVA, lymph node irradiation, and polychemotherapy. ECP has been shown to be effective in the treatment of selected cases of Sézary syndrome. There is a strong suggestion that ECP as a monotherapy can provide a significant benefit for other T-cell-mediated diseases including rheumatoid arthritis. In spite of a disease duration of 10 years, a very low CD8 cell count (2% of lymphocytes), a very high CD4 cell count (94%), and multiple unsuccessful chemotherapeutic trials before initiation of ECP, our patient achieved a long-lasting complete remission of both diseases with normalization of the CD4+ and CD8+ T-lymphocyte subsets. Concurrent developing vitiligo was unaffected by ECP.

Köller M, Aringer M, Kiener H, Erlacher L, Machold K, Eberl G, Studnicka-Benke A, Graninger W, Smolen J. · Division of Rheumatology, Department of Internal Medicine III, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. · Ann Rheum Dis. · Pubmed #10531076 links to  free full text

Abstract: OBJECTIVE: To determine the presence of adhesion molecules on monocytes/macrophages (Mphi) from peripheral blood (PB) and synovial fluid (SF) in patients with osteoarthritis (OA) and inflammatory joint diseases (rheumatoid (RA) and reactive arthritis (ReA)) in order to improve our understanding of the possible mechanisms underlying the inflammatory process. METHODS: Whole blood and SF cells were stained with monoclonal antibodies against CD11a (LFA-1), CD15 s (sialyl-Lewis X), CD44, CD54, VLA-4, and HLA-DR counterstained with anti-CD14 antibodies as a Mphi marker for dual fluorescence analysis by flowcytometry. RESULTS: On PB-Mphi, CD15s was markedly increased in both RA as well as ReA compared with OA. Furthermore, in the PB LFA-1, CD44, and HLA-DR showed a higher surface density on Mphi in ReA than in OA. Comparison between SF and PB showed significantly higher CD44 and CD54 expression on SF-Mphi. These molecules play an important part in lymphocyte-Mphi interaction. CONCLUSION: In PB from patients with inflammatory joint diseases, Mphi are activated, allowing recruitment into the synovial compartment. These disorders, in contrast with OA seem to be "systemic" in nature. Within the SF, different adhesion molecules are expressed on CD14(+) Mphi as compared with PB.