Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

The Longitudinal Course of Fatigue in Rheumatoid Arthritis : Results from the Norfolk Arthritis Register

Acknowledgment: The authors would like to thank the University of Manchester for access to the Norfolk Arthritis Register data and Professor Deborah Symmons for comments on an earlier draft of the manuscript. K.L.D. is funded by a studentship from the Institute of Applied Health Sciences, University of Aberdeen.

Predicting functional disability : One year results from the Scottish Early Rheumatoid Arthritis Inception Cohort

Peer reviewed

Determining Pathways to Improvements in Fatigue in Rheumatoid Arthritis : Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Funded by: The Institute of Applied Health Sciences, University of Aberdeen The British Society for Rheumatology Biologics Register for Rheumatoid Arthritis British Society for Rheumatology to the University of Manchester Schering-Plough Wyeth Laboratories Abbott Laboratories Amgen

Viral Delivery of the Fat-1 Gene to Treat Post-Traumatic Arthritis with Diet-Induced Obesity

Post-traumatic arthritis (PTA) is arthritis that develops following joint injury, including meniscus and ligament tears. Current treatments for PTA range from over-the-counter medication to knee replacement; however, in the presence of obesity, the levels of pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-α,) are more elevated than in non-obese individuals. The role of fatty acids, obesity, and PTA has been examined, with omega-3 fatty acids showing promise as an anti-inflammatory after injury due to its ability to suppress IL-1 and TNF-α. Due to the difficulty in switching patients’ diets, an alternative solution to increasing omega-3 levels needs to be developed. The Fat-1 enzyme, an omega-3 desaturase that has the ability to convert omega-6 to omega-3 fatty acids, may be a good target for increasing the omega-3 levels in the body.

In the first study, we examined whether Fat-1 transgenic mice on a high-fat diet would exhibit lower levels of PTA degeneration following the destabilization of the medial meniscus (DMM). Both male and female Fat-1 and wild-type (WT) littermates were put on either a control diet (10% fat) or an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery. Arthritic changes were examined 12 weeks post-surgery. Fat-1 mice on both the control and high-fat diet showed protection from PTA-related degeneration, while WT mice showed severe arthritic changes. These findings suggest that the omega-6/omega-3 ratio plays an important role in reducing PTA following injury, and demonstrates the potential therapeutic benefit of the Fat-1 enzyme in preventing PTA in both normal and obese patients following acute injury.

Following this, we needed to establish a translatable delivery mechanism for getting the Fat-1 enzyme, which is not present in mammalian cells, into patients. In the second study, we examined whether anti-inflammatory gene delivery of the Fat-1 enzyme would prevent PTA following DMM surgery. In vitro testing of both lentivirus (LV) and adeno-associated virus (AAV) was completed to confirm functionality and conformation of the Fat-1 enzyme after transduction. Male WT mice were placed on an omega-6 rich high-fat diet (60% fat) and underwent DMM surgery; either local or systemic AAV injections of the Fat-1 enzyme or Luciferase, a vector control, were given immediately following surgery. 12 weeks post-surgery, arthritic changes were assessed. The systemic administration of the Fat-1 enzyme showed protection from synovial inflammation and osteophyte formation, while administration of Luciferase did not confer protection. These findings suggest the utility of gene therapy to deliver the Fat-1 enzyme, which has potential as a therapeutic for injured obese patients for the prevention of PTA.

Angehörigenratgeber : nehmen sie Bezug auf die eigene Belastung? : am Beispiel der rheumatoiden Arthritis

Die vorliegende Arbeit befasst sich mit der Frage, wie sich chronische Erkrankungen auf die Angehörigen auswirken und auf welchen Ebenen die Beratungsliteratur darauf Bezug nimmt. Im Speziellen geht es dabei um das Krankheitsbild der rheumatoiden Arthritis. Da sich eine Person immer in einem sozialen Geflecht (= System) befindet, wirkt sich eine chronische Erkrankung nicht nur auf die Patienten selbst, sondern auch auf deren Familien, Partner und Freunde aus. Dabei sind alle Lebensbereiche (psychisch, körperlich, sozial, beruflich, finanziell) betroffen, was eine komplexe Vielfalt an Belastungen hervorbringt. Die Untersuchung von 54 Rat gebenden Büchern und Broschüren zeigte, dass das Hauptanliegen überwiegend auf der Wissensvermittlung über das Krankheitsbild und mögliche Behandlungsmaßnahmen liegt. Emotionale, soziale und finanzielle Probleme, sowie Schwierigkeiten im Beziehungsgeschehen werden nur selten aufgegriffen. Teilweise zeigten sich Überschneidungen der tatsächlichen Belastungen/Bedürfnisse der Angehörigen und der in den Ratgebern behandelten Themen. Diese wurden jedoch mehrheitlich nur kurz und oberflächlich behandelt.

Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Simultaneous Occurrence of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Hashimoto’s Thyroiditis and Membranous Glomerulonephritis

Introduction: Membranous glomerulonephritis is commonly described in systemic lupus erythematosus (SLE) and hypothyroidism. Clinical presentation: We report a case of a 40-year-old woman who presented with a membranous glomerulonephritis associated with SLE, rheumatoid arthritis and hypothyroidism due to Hashimoto’s thyroiditis. Conclusions: The simultaneous occurrence of these three diseases as possible causes of membranous glomerulonephritis is extremely exceptional.

Bilateral Panuveitis at Etanercept Initiation for Juvenile Idiopathic Arthritis

Introduction: Uveitis is a well-known extra-rheumatological manifestation of juvenile idiopathic arthritis (JIA). Tumor necrosis factor has been used to treat uveitis associated with inflammatory diseases. A new onset uveitis under anti-TNF therapy is uncommon. Case presentation: A 12-years-old male, affected since the age of six years, by a severe form of polyarticular JIA. When etanercept was started, he presented panuveitis bilaterally, so we switched to infliximab with good response. Conclusions: The TNF soluble receptor could be considered as a possible promoter in inducing endogenous new onset uveitis in JIA.

Sternoclavicular Septic Arthritis Caused by Acupuncture over the Posterior Neck

Acupuncture has been used therapeutically for thousands of years and is considered a relatively safe procedure. Sternoclavicular joint (SCJ) arthritis is a rare joint infection and has never been reported as an adverse event of acupuncture. We report the case of a 50-year-old woman who presented with progressive left neck, shoulder and upper chest pain after acupuncture. A computerized tomography (CT) scan revealed septic arthritis over the left sternoclavicular joint (SCJ) and methicillin-sensitive Staphylococcus aureus bacteraemia was noted. The patient was discharged uneventfully after intravenous antibiotic treatment. SCJ septic arthritis should be considered if unilateral neck and upper chest pain occurs after acupuncture.