Rheumatoid Arthritis: Finland

Leirisalo-Repo M. · Helsinki University Central Hospital, Department of Medicine, Division of Rheumatology, Helsinki, Finland. · Curr Opin Rheumatol. · Pubmed #15956840 No free full text.

Abstract: PURPOSE OF REVIEW: To summarize the recent literature on the association of infection with early arthritis, and to discuss the possible role of such infections with respect to the development of chronic rheumatic complications. RECENT FINDINGS: Viral infections are frequently associated with arthritis. Alphaviruses belong to mosquito-borne viruses, one form of which (Sindbis virus) can in Scandinavia and Karelia cause acute arthritis with typical rash. The role of this infection leading to chronic erosive arthritis needs further prospective studies. Patients infected with HIV can have various forms of arthritis. The role of HIV virus as an arthritogenic agent is still debated. On the basis of population studies, Campylobacter infections seem to be increasing as causative infections in reactive arthritis. There is no role for prolonged antibiotic therapy to shorten the duration of acute reactive arthritis, but the possibility that such a treatment might reduce the development of chronic sequelae needs to be examined in a larger study. The role of preceding infection initiating the process of rheumatoid arthritis is still an option, the association being observed in about 20% of patients studied in the early phase of arthritis. SUMMARY: Viral and microbial infections play a role in acute arthritis. The role of these infections in the development of chronic arthritis needs further prospective controlled studies.

Laiho K, Kauppi M, Konttinen YT. · Rheumatism Foundation Hospital, Heinola, Finland. · Semin Arthritis Rheum. · Pubmed #15692956 No free full text.

Abstract: Rheumatoid involvement of the 24 joints of the cervical spine leads to prominent changes in the occipito-atlanto-axial area. Eight different subtypes of such changes are recognized, depicted, and defined. The frequencies of these 8 subtypes in rheumatoid arthritis and other arthritides are tabulated. A central role in these disorders is played by a small-size, heavy-duty fitting piece or adapter, atlas, between the occiput and C2. The history of the fate of Atlas, who led the fight of godlike titans against the new gods of Olympos, is recapitulated. In particular, for a short moment Atlas was released from his heavy physical ordeal by another strongman, the heavy-weight wrestler of his times, Heracles. The reasons for the current nomenclature and answer to the question "Why Atlas, why not Heracles" are provided.

Koskinen SK, Niemi P, Kiuru MJ, Mattila KT. · HUS Röntgen, Töölön sairaala. · Duodecim. · Pubmed #15641513 No free full text.

This publication has no abstract.

Löppönen T, Körkkö J, Lundan T, Seppänen U, Ignatius J, Kääriäinen H. · University of Oulu, Oulu, Finland. · Arthritis Rheum. · Pubmed #15593085 links to  free full text

Abstract: OBJECTIVE: To define the clinical, radiologic, and molecular genetic characteristics of a family with early progressive osteoarthritis mimicking childhood rheumatoid arthritis, Scheuermann-like changes of the spine, tall stature, short 3 and 4 metatarsals, and moderate sensorineural hearing loss. METHODS: We describe a 22-year-old woman and her 54-year-old mother with early progressive osteoarthritis mimicking childhood rheumatoid arthritis. The index case, her mother, and 3 other family members underwent a physical examination, anthropometric measurements, and radiologic studies. Their DNA was sequenced for the procollagen type II (COL2A1) gene. RESULTS: Mild scoliosis was noticed in the proband at the age of 6 years, and at the age of 7 years large Schmorl's nodes were found in the vertebrae L1-2. At the age of 11 years, changes resembling Scheuermann's disease were seen, mostly in the thoracic vertebrae. At the same age, she began to have arthralgia in the weight-bearing joints and osteoarthritis progressed fast, necessitating a hip prosthesis at the age of 18 years. The proband and her mother had bilateral sensorineural hearing loss of moderate degree. Both mother and daughter had an Arg75-Cys mutation in the COL2A1 gene. CONCLUSION: This family is the fourth example of the Arg75-Cys mutation in the COL2A1 gene, which appears to lead to a clearly recognizable phenotype. The finding suggests that sensorineural hearing loss may be a part of this syndrome.

Kröger L, Arikoski P. · KYS:n lastenklinikka, Kuopio. · Duodecim. · Pubmed #15560450 No free full text.

This publication has no abstract.

Löfman P, Pelkonen M, Pietilä AM. · South Carelia Polytechnic, Lappeenranta, Finland. · Scand J Caring Sci. · Pubmed #15355529 No free full text.

Abstract: The purpose of this article is to describe the ethical issues arising out of participatory action research (PAR), on the basis of both an empirical study and the research literature, and to discuss how to deal with these issues. The data consist of the experiences and results of three phases of PAR relating to orthopaedic patients with rheumatoid arthritis (RA) and the analysis of 20 articles on the ethics of action research. As a result, the following ethical issues and the ways to treat them were discussed: informed consent, confidentiality and anonymity, protecting an individual from harm, the role of the researcher, the location of 'power' in PAR, and the ownership of the research. The flexibility of PAR in use and its main features are also related to the decisions made and actions taken in response to ethical issues. It is particularly important in PAR to proceed according to the participants, and to involve them from the beginning of the process, in order to insure the equal balance of power between participants and researcher.

Aho K, Heliövaara M. · National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. · Ann Med. · Pubmed #15224650 No free full text.

Abstract: Both genetic and environmental factors contribute to the development of rheumatoid arthritis (RA). A long-term latent process often precedes the onset of arthritis. Hence, the ultimate causes of RA cannot be clarified by studying only the inflamed joints. Longitudinal studies focusing on risk factors are crucial in approaching the true aetiology. At present, most information gained from epidemiological studies is contradictory or vague. For instance, there is no consensus concerning the long-term effects of pregnancy or the putative protective role of oral contraceptives. There is no doubt that diet plays a role, but no specific nutrient has proved to be either protective or deleterious. Smoking is the only environmental risk factor that has been firmly verified epidemiologically for RA. It can be reasonably regarded as a contributory cause of RA. Studying the immunological effects of exposure to cigarette smoke may offer an opportunity to combine information from basic and epidemiological research to clarify the causal chains leading to RA.

Kettunen JA, Kujala UM. · ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland. · Scand J Med Sci Sports. · Pubmed #15144352 No free full text.

Abstract: Exercise therapy would appear to be effective at increasing aerobic capacity and muscle strength in patients with rheumatoid arthritis (RA), and no detrimental effects on disease activity or pain compared with controls has been observed. Exercise therapy--at least in the short-term, improves pain, muscular strength and function in elderly people with mild osteoarthritis (OA) of the hip or knee. For the treatment of both OA and RA the knowledge of the optimal type, frequency, duration and intensity of exercise is still limited, but the exercise should not include high-impact loads or high injury risk. Long-term compliance is important in achieving long-term benefits. Supervised classes appears to be as effective as treatments provided on a one-to-one basis, group-based exercise programme thus providing a cost-effective alternative. Adherence to home programmes seems to be lower. Future research should focus on finding optimal type and dose of exercise, ways of optimally maintaining the beneficial effects of exercise therapy over time as well as on the effects of exercise on the long-term progression of the disease and cost-effectiveness of the therapy.

Kaipiainen-Seppänen O. · KYS:n sisätautien Klinikka PL 1777, 70211 Kuopio. · Duodecim. · Pubmed #15061005 No free full text.

This publication has no abstract.

Häkkinen A. · Department of Physical Medicine and Rehabilitation, Central Hospital, Jyväskylä, Finland. · Curr Opin Rheumatol. · Pubmed #14770099 No free full text.

Abstract: PURPOSE OF REVIEW: As muscle weakness is common in patients with rheumatoid arthritis (RA), strength training is considered to be an important cornerstone of the nonpharmacological treatment. The training methods have varied widely between the studies. Thus, the purpose of this review is to discuss effectiveness and safety but also basic principles and specificity of strength training. RECENT FINDINGS: Moderate or high-intensity strength training has been effective and well-tolerated method to increase or maintain muscle strength in patients with rheumatoid arthritis. No deleterious effects on disease activity and pain were observed. More information is needed regarding long-term effects of strength training on functional capacity, bone mineral density, and radiologic progression. SUMMARY: Moderate or high-intensity strength training programs have better training effects on muscle strength in RA than low-intensity programs. The type of exercises, intensity, and frequency of training are key factors in the effectiveness of training. It is, however, essential to maintain the training routine to obtain long-term benefits from it.

Kotaniemi K, Savolainen A, Karma A, Aho K. · Rheumatism Foundation Hospital, Heinola, Finland. · Surv Ophthalmol. · Pubmed #14499817 No free full text.

Abstract: Chronic scarring-type uveitis is a frequent extra-articular manifestation of juvenile idiopathic arthritis. It occurs in about 20% of children with this disease, commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis, usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition, routine screening of juvenile idiopathic arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics, in severe cases with immunosuppressive agents, and surgical management of complications. Although the prognosis of uveitis is improving, there are cases refractory to standard regimens. Patients in whom uveitis commences prior to the onset of arthritis present a special problem.

Toivanen P. · Department of Medical Microbiology, Turku University, Finland. · Ann Rheum Dis. · Pubmed #12922950 links to  free full text

Abstract: A series of observations have led to the hypothesis that normal intestinal microbiota in patients with rheumatoid arthritis may harbour, for genetic reasons, bacteria with cell walls capable of inducing arthritis. Differences occur between bacterial species, and even between strains of a single species, because some cell walls induce experimental chronic arthritis, whereas some others induce only a transient acute arthritis or no arthritis at all. In susceptible subjects, with continuous seeding of bacterial products from the gut, the synovial inflammation is followed by erosion, exposition of cartilage antigens, and self perpetuating chronic arthritis.

Kotaniemi K. · · Duodecim. · Pubmed #12856436 No free full text.

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Kerkelä E, Saarialho-Kere U. · Department of Dermatology, Helsinki University Central Hospital, Finland. · Exp Dermatol. · Pubmed #12702139 No free full text.

Abstract: Many normal biological processes, such as reproduction, fetal development and wound healing, are critically dependent on controlled degradation of extracellular matrix (ECM) macromolecules. However, excessive degradation of matrix components occurs in pathologic tissue destruction, e.g. in atherosclerosis, rheumatoid arthritis, and cancer. Matrix metalloproteinases (MMPs) are degradative enzymes that play an important role in all aspects of tumor progression by enhancing tumor-induced angiogenesis and destroying local tissue architecture and basement membranes to allow tumor invasion and metastasis. Efficient breakdown of the ECM surrounding invasive cancer islands involves interplay between tumor cells, stromal cells, and inflammatory cells, all of which express a distinct set of MMPs. Besides the classical role of MMPs in degradation of ECM, MMPs may also indirectly influence the tumor microenvironment through the release of growth factors, cryptic sites or angiogenic factors, or through the generation of matrix fragments that inhibit tumor cell proliferation, migration and angiogenesis. This makes the contribution of MMPs to tumorigenesis much more complex than initially thought. Currently, a number of clinical studies have focused on testing MMP inhibitors as potential antineoplastic agents. In this review we discuss the present role of MMPs in the development and progression of cancer, focusing on non-melanoma skin cancers basal (BCC) and squamous (SCC) cell carcinoma, and the possible influence of MMPs in their differences.

Soini I, Kaarela K. · Reumasäätiön sairaala 18120 Heinola. · Duodecim. · Pubmed #12486957 No free full text.

This publication has no abstract.

Kaipiainen-Seppänen O, Leino M. · Department of Medicine, Kuopio University Hospital, PO Box 1777, 70211 Kuopio, Finland. · Ann Rheum Dis. · Pubmed #12480683 links to  free full text

This publication has no abstract.

Soini I, Mikkelsson M, Leppilahti J. · Reumasäätiön sairaala, radiologian osasto 18120 Heinola. · Duodecim. · Pubmed #12239842 No free full text.

This publication has no abstract.

Pertovaara M, Pasternack A. · TAYS:n sisätautien klinikka PL 2000, 33521 Tampere. · Duodecim. · Pubmed #12238167 No free full text.

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Niissalo S, Hukkanen M, Imai S, Törnwall J, Konttinen YT. · Biomedicum Helsinki, Institute of Biomedicine/Anatomy, University of Helsinki, Finland. · Ann N Y Acad Sci. · Pubmed #12114296 No free full text.

Abstract: Classical symptoms of both inflammatory and degenerative arthritides may contribute to neurogenic responses like wheal, flare, edema, and pain. Rheumatoid arthritis (RA) is an autoimmune disease with an immunogenetic background. Neurogenic inflammation has been considered to play an essential role in RA, in part because of the symmetrical involvement (cross-spinal reflexes) and the predominant involvement of the most heavily innervated small joints of the hands and the feet (highly represented in the hominiculus). In contrast, osteoarthritis (OA) is considered to arise as a result of degeneration of the hyaline articular cartilage, which secondarily results in local inflammation and pain. However, it is possible that the age-related and predominant (compared to nociceptive nerves) degeneration of the proprioceptive, kinesthetic and vasoregulatory nerves can represent the primary pathogenic events. This leads to progressive damage of tissue with extremely poor capacity for self-regeneration. Inflammation, be it primary/autoimmune or secondary/degenerative, leads to peripheral sensitization and stimulation, which may further lead to central sensitization, neurogenic amplification of the inflammatory responses and activation of the neuro-endocrine axis. Neuropeptides serve as messengers, which modulate and mediate the actions in these cascades. Accordingly, many neuropeptides have been used successfully as experimental treatments, most recently VIP, which effectively controlled collagen-induced arthritis in mice. Therefore, it can safely be concluded that better treatment/control of disease activity and pain can be achieved by blocking the cascade leading to initiation and/or amplification of inflammatory process combined with effects on central nociceptive and neuroendocrine responses.

Konttinen YT, Käsnä-Ronkainen L. · Department of Medicine/Invärtes medicin, Helsinki University Central Hospital & ORTON Research Institute and the Orthopaedic Hospital of the Invalid Foundation, Finland. · Scand J Rheumatol Suppl. · Pubmed #12109538 No free full text.

Abstract: OBJECTIVE: To critically consider the public opinion/consensus on SS formulated by opinion leaders and textbook chapters. RATIONALE: Although our clinical work is based on evidence-based medicine, it is obvious that we do not have evidence-based solutions to the etiology and pathogenesis of autoimmune rheumatic diseases. In spite of this, consensus if often taken as a truth, which may hamper the production, funding and/or publication of new and original ideas and views. METHODS: Comparison of the classic view with one of the many other possible views. RESULTS: The consensus view states that 1) SS is initiated and/or caused by an exogenous agent, probably some type of retrovirus, and 2) after initiation, a straightforward sequence of events follows: a) salivary gland epithelial cells are disrupted, b) T lymphocytes migrate to and are activated in the glands, c) B cells get the help they need and start to produce SS and RF autoantibodies, which processes lead to structural destruction and loss of acinar cells and, thus, to sicca symptoms (an example of the linear, step-by-step "computer" logic). The problems inherent to this view include: 1) why women? (gender aspect), 2) why at the age of 50? (chronobiologic aspect), 3) is the normal immune system in SS only responding to normal (formely sequestrated) autoantigens? Is the loss of exocrine gland function really caused by "autoimmune" destruction? - or do the SS-autoantibodies and lymphocyte infiltrates only represent markers in an appropriate HLA background? (autoimmune aspect), 4) are the retroviral diseases really similar to SS? (exogenous rs endogenous causes), 5) is our current view compatible with unexpected, future findings? Is the textbook interpretation the final truth (evolutionary aspect of our view on pathogenesis). CONCLUSION: The tubuloalveolar exocrine glands may be seen as 1) locus minoris resistentiae for normal oral microbial flora and immune-inflammatory attacks at the normal environment-host interface. Apoptotic and/or necrotic cells are released into the intraluminal space and pass in normal glands through normal, immunologically competent lymphocyte foci and/or ectopic lymphatic tissue. Acinar cell degeneration/death may increase upon 2) aging and acinar cell renewal and well-being may be hampered by age-dependent deficiencies in the trophic 3) neuro-endocrine support. In a proper immunogenetic setting, a) marker autoantibodies (e.g. RF, SS-A/Ro, SS-B/La), useful in the diagnosis, are produced. However, sicca symptoms/SS develop only if muscarinic receptor or other b) pathogenetic autoantibodies disrupting the normal neuronal-to acinar cell communication are also produced. c) Systemic symptoms could be produced on neuroendocrine, chronobiologic and autoimmune basis. Other professionals are invited to entertain their own views on the pathogenesis of SS - make your own one!

Kaipiainen-Seppänen O. · KYS:n sisätautien klinikka PL 1777, 70211 Kuopio. · Duodecim. · Pubmed #12001459 No free full text.

This publication has no abstract.

Nordström DC, Konttinen YT. · HYKS:n sisätautien laitos Haartmaninkatu 4, 00290 Helsinki. · Duodecim. · Pubmed #11989008 No free full text.

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Konttinen YT, Valleala H, Honkanen V, Törnwall J, Tensing EK, Sorsa T, Nordström D. · · Duodecim. · Pubmed #11941814 No free full text.

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Pelkonen P. · Helsingin yliopiston kliininen laitos, Lasten ja nuorten klinikka PL 281, 00029 HYKS. · Duodecim. · Pubmed #11877828 No free full text.

This publication has no abstract.

Sokka T, Pincus T. · Jyvaskyla Central Hospital, Department of Medicine, Finland. · J Rheumatol. · Pubmed #11469487 No free full text.

Abstract: Work disability is common in rheumatoid arthritis (RA), and accounts for a large fraction of its costs. People with RA who are work disabled have more joint involvement, radiographic damage, and/or laboratory abnormalities than people who are working. However, analysis of predictive and associative markers in 15 studies of work disability indicate that the demographic variables, such as age, occupation, level of education, and duration of disease, as well as functional status in activities of daily living (ADL) identified on a patient questionnaire, appear to identify work status more than physiological variables. Work disability results from complex interactions of a medical disease, demographic variables, social conditions, and government policies. Some patients with RA are work disabled before they see a rheumatologist. Improved work disability outcomes in RA will require attention to social, economic, and political issues, and wider physician and public education concerning RA, in addition to improved medical management of disease.