OBJECTIVES: Patients with difficult-to-treat rheumatoid arthritis (RA) remain symptomatic despite treatment according to current European League Against Rheumatism (EULAR) management recommendations. These focus on early phases of the disease and pharmacological management. We aimed to identify characteristics of difficult-to-treat RA and issues to be addressed in its workup and management that are not covered by current management recommendations. METHODS: An international survey was conducted among rheumatologists with multiple-choice questions on disease characteristics of difficult-to-treat RA. Using open questions, additional items to be addressed and items missing in current management recommendations were identified. RESULTS: 410 respondents completed the survey: 50% selected disease activity score assessing 28 joints >3.2 OR presence of signs suggestive of active disease as characteristics of difficult-to-treat RA; 42% selected fatigue; 48% selected failure to ≥2 conventional synthetic disease-modifying antirheumatic drugs (DMARDs) AND ≥2 biological/targeted synthetic DMARDs; 89% selected inability to taper glucocorticoids below 5 mg or 10 mg prednisone equivalent daily. Interfering comorbidities, extra-articular manifestations and polypharmacy were identified as important issues missing in current management recommendations. CONCLUSIONS: There is wide variation in concepts of difficult-to-treat RA. Several important issues regarding these patients are not addressed by current EULAR recommendations.

• Klíčová slova
• disease activity, rheumatoid Arthritis, treatment,
• MeSH
• komorbidita MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• revmatoidní artritida * komplikace   farmakoterapie   epidemiologie   MeSH
• revmatologové MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

During gold therapy a patient with rheumatoid arthritis developed nephrotic syndrome, and a patient with juvenile chronic arthritis proteinuria. Electron microscopic examination of bioptic specimens of the kidneys revealed in both instances membranous glomerulonephritis with typical epimembranous deposits and intracellular gold inclusions. Immunofluorescent examination performed only in the second patient revealed that the deposits in the wall of the glomerular capillaries contain IgG which suggests an immunocomplex mechanism of the development of the renal disease, induced very probably by chrysotherapy.

• MeSH
• chronická nemoc MeSH
• glomerulonefritida chemicky indukované   patologie   MeSH
• jehlová biopsie MeSH
• juvenilní artritida farmakoterapie   MeSH
• ledviny patologie   MeSH
• lidé MeSH
• mladiství MeSH
• revmatoidní artritida farmakoterapie   MeSH
• senioři MeSH
• zlato škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• zlato MeSH

Collagen-induced arthritis is the most com-mon in vivo model of rheumatoid arthritis used for investigation of new potential therapies in preclinical research. Rheumatoid arthritis is a systemic inflammatory and autoimmune disease affecting joints, accompanied by significant extra-articular symptoms. The pathogenesis of rheumatoid arthritis and collagen-induced arthritis involves a so far properly unexplored network of immune cells, cytokines, antibodies and other factors. These agents trigger the autoimmune response leading to polyarthritis with cell infiltration, bone and cartilage degeneration and synovial cell proliferation. Our review covers the knowledge about cytokines present in the rat collagen-induced arthritis model and the factors affecting them. In addition, we provide a comparison with rheumatoid arthritis and a description of their important effects on the development of both diseases. We discuss the crucial roles of various immune cells (subtypes of T and B lymphocytes, dendritic cells, monocytes, macrophages), fibroblast-like synoviocy-tes, and their related cytokines (TNF-α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, IL-23, GM-CSF, TGF-β). Finally, we also focus on key antibodies (rheu-matoid factor, anti-citrullinated protein antibodies, anti-collagen II antibodies) and tissue-degrading enzymes (matrix metalloproteinases).

• Klíčová slova
• CIA, animal model, antibodies, collagen-induced arthritis, cytokines, immunopathology, interleukin, rheumatoid arthritis,
• MeSH
• artritida experimentální * farmakoterapie   patologie   MeSH
• cytokiny metabolismus   MeSH
• kolagen škodlivé účinky   MeSH
• krysa rodu Rattus MeSH
• protilátky MeSH
• revmatoidní artritida * metabolismus   terapie   MeSH
• TNF-alfa MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• cytokiny MeSH
• kolagen MeSH
• protilátky MeSH
• TNF-alfa MeSH

Advances in the treatment of rheumatoid arthritis (RA) are attributed to several aspects such as new classification criteria enabling early diagnosis and intensive treatment with the application of treat-to-target principles as well as better understanding of the pathogenesis of RA contributing to the development of targeted therapies. However, reaching remission is still not achieved in most patients with RA, which is one of the driving forces behind the continuous development of novel therapies and the optimization of therapeutic strategies. This review will outline several new therapeutic antibodies modulating anti-inflammatory cytokines interleukin (IL)-2 and IL-10 and pro-inflammatory mediators granulocyte-macrophage colony-stimulating factor, fractalkine, and IL-6 that are in various stages of clinical development as well as the progress in manufacturing biotechnologies contributing to the next generation of antibodies and their potential to expand the therapeutic armamentarium for RA. In addition, the fate of unsuccessful therapies including agents targeting IL-15, the IL-20 family, IL-21, chemokine CXCL10, B-cell activating factor (BAFF), and regulatory T (Treg) cells or a novel concept targeting synovial fibroblasts via cadherin-11 will be discussed.

• Klíčová slova
• biological therapies, monoclonal antibodies, rheumatoid arthritis, therapeutic strategies,
• MeSH
• cytokiny imunologie   MeSH
• fibroblasty účinky léků   MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• revmatoidní artritida terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• cytokiny MeSH
• monoklonální protilátky MeSH

OBJECTIVES: Patients suffering from rheumatoid arthritis (RA) are repeatedly affected by oral diseases or problems, including dental caries and periodontal diseases (PDs). Periodontitis and rheumatoid arthritis are chronic inflammatory destructive diseases that share many similarities. The objective of this study was to assess oral health status including examination of hard dental tissues and periodontium in patients with rheumatoid arthritis and compare the results with healthy controls. We hypothesize some interlink between oral diseases and RA. METHODS: The epidemiological case-control study involved a total of 64 subjects divided into an experimental group (14 rheumatoid arthritis cases) and a control group (50 healthy individuals). Disease activity in the subjects with RA was assessed by the Disease Activity Score (DAS28). The number of Decayed, Missing and Filled Teeth (DMFT) and Community Periodontal Index of Treatment Need (CPITN) as a basic epidemiological oral health indexes were recorded. Finally, the data were analysed statistically. RESULTS: The RA patients (19.21, SD = 6.95) showed a higher caries index level measured by DMFT than the control group (17.72, SD = 6.19); the difference was not statistically significant (U = 387.5, p = 0.547). In terms of a mean number of teeth decayed (p = 0.078), teeth filled due to caries (p = 0.397), and missing teeth (p = 0.126), the two groups were not significantly different. In terms of periodontal health, a significant difference was observed between the two groups concerning the CPI maximum score (p = 0.003). The RA patients showed higher prevalence of periodontitis than the controls. CONCLUSIONS: A complete basic oral examination, along with an oral health instruction including adequate oral and dental hygiene, is crucial to prevent dental caries and periodontal diseases and associated complications in RA patients, since they appear to be more vulnerable than the non-RA population.

• Klíčová slova
• DMFT, oral health, periodontitis, rheumatoid arthritis, tooth decay,
• MeSH
• DMF Index MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci parodontu epidemiologie   MeSH
• orální zdraví * statistika a číselné údaje   MeSH
• revmatoidní artritida * epidemiologie   MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• zubní kaz * epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

In a group of 210 patients with various stages of rheumatoid arthritis divided according to mobility in 3 groups the highest clavicular cortico-diaphyseal indices were found in the group of exercising patients and the lowest results were in the immobilized group. Double measurements repeated after two years allowed us to establish the annlay loss of cortical bone in each group: -2.19% in the exercising group, -6% in the non-exercising group and -8.94% in the immobilized group. Studying the effect of corticosteroids used in the treatment of rheumatoid arthritis in another group of 153 patients we found lower results of cortical thickness only in dependence on daily dose of this drug and not on the whole used dose. The computed annual loss of cortical bone thickness was 7% in patients on doses 5-10 mg of prednisolone, while in patients on doses 12.5-20 mg of prednisolone the annual loss exceeded 10%.

• MeSH
• hormony kůry nadledvin škodlivé účinky   MeSH
• imobilizace MeSH
• kosti a kostní tkáň metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• minerály * MeSH
• revmatoidní artritida etiologie   metabolismus   MeSH
• senioři MeSH
• sexuální faktory MeSH
• tělesná námaha MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• hormony kůry nadledvin MeSH
• minerály * MeSH

Plasma lipid parameters were measured in 99 children with Juvenile Rheumatoid Arthritis and compared with a large age-matched healthy control group. All measurements were made in the same laboratory. Changes in cholesterol levels were found, some levels increased, some decreased. The triglyceride levels were significantly higher. Most marked changes in triglyceride level were observed in patients with changes in the kidneys and amyloidosis.

• MeSH
• cholesterol krev   MeSH
• dítě MeSH
• juvenilní artritida krev   MeSH
• lidé MeSH
• lipidy krev   MeSH
• triglyceridy krev   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cholesterol MeSH
• lipidy MeSH
• triglyceridy MeSH

BACKGROUND: Identification of parameters for early diagnosis and treatment response would be beneficial for patients with early rheumatoid arthritis (ERA) to prevent ongoing joint damage. miRNAs have features of potential biomarkers, and an altered expression of miRNAs was shown in established rheumatoid arthritis (RA). OBJECTIVE: To analyse RA associated miRNAs in the sera of patients with ERA to find markers of early disease, clinical activity or predictors of disease outcome. METHODS: Total RNA was isolated from whole sera in ERA patients (prior to and after 3 and 12 months of therapy with disease modifying antirheumatic drugs), in patients with established RA and in healthy controls (HC) using phenol-chloroform extraction. Expression of miR-146a, miR-155, miR-223, miR-16, miR-203, miR-132 and miR-124a was analysed by TaqMan Real Time PCR. RESULTS: From all analysed miRNAs, levels of miR-146a, miR-155 and miR-16 were decreased in the sera of ERA patients in comparison with established RA. A change in circulating miR-16 in the first 3 months of therapy was associated with a decrease in DAS28 in long term follow-up in ERA (p=0.002). Levels of circulating miR-223 in treatment naïve ERA correlated with C reactive protein (p=0.008), DAS28 (p=0.031) and change in DAS28 after 3 months (p=0.003) and 12 months (p=0.011) of follow-up. However, neither miR-16 nor miR-223 could distinguish ERA from HC. CONCLUSIONS: Differential expression of circulating miR-146a, miR-155 and miR-16 in the sera of ERA patients may characterise an early stage of the disease. We suggest miR-223 as a marker of disease activity and miR-16 and miR-223 as possible predictors for disease outcome in ERA.

• Klíčová slova
• DAS28, Early Rheumatoid Arthritis, Rheumatoid Arthritis,
• MeSH
• antirevmatika terapeutické užití   MeSH
• biologické markery krev   metabolismus   MeSH
• časná diagnóza MeSH
• dospělí MeSH
• exprese genu MeSH
• fibroblasty metabolismus   MeSH
• kultivované buňky MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikro RNA biosyntéza   krev   genetika   MeSH
• následné studie MeSH
• počet leukocytů MeSH
• prognóza MeSH
• revmatoidní artritida diagnóza   farmakoterapie   genetika   MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• stupeň závažnosti nemoci MeSH
• synoviální membrána metabolismus   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antirevmatika MeSH
• biologické markery MeSH
• mikro RNA MeSH
• MIRN16 microRNA, human MeSH Prohlížeč
• MIRN223 microRNA, human MeSH Prohlížeč

• MeSH
• dospělí MeSH
• granulom patologie   MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• revmatoidní artritida metabolismus   patologie   MeSH
• revmatoidní uzlíky patologie   MeSH
• synoviální membrána patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

HLA class II analysis in a group of 153 Czech children with juvenile rheumatoid arthritis by PCR and oligonucleotide hybridization demonstrated associations with several alleles. DRB1*0801 (RR = 5.3, p < 0.005) and DRB1 * 11 (RR = 2.2, p < 0.01) including all subtypes were shown to be increased in the rheumatoid factor-negative group (N = 137). The same results were observed in Italy, England and Norway. In patients with the pauciarticular onset with conversion to polyarticular within 3 years, a statistically significant increase in DR2 (RR = 10.1, p < 0.00005), mostly due to DRB1*1501, was found. In the iridocyclitis and antinuclear factor groups, susceptibility to DRB1*1201 was observed. There was a striking decrease in DRB1*0701 (RR = 0.3, p < 0.00005) in all groups. There was neither an increase in DRB1*1301 or DPB1*0301 nor a decrease in DRB1*04, as reported from other studies in Texas and Norway. The rheumatoid factor-positive group with polyarticular onset (N = 13) was associated with DRB1*04 (RR = 7.1, p < 0.005), as observed in adults. DPB1*0201 was increased in the persistent pauciarticular group (RR = 3.7, p < 0.0005). DPB1*0402 was decreased in all pauciarticular groups with or without conversion (RR = 0.3, p < 0.005). Taken together, there are not only genetic differences and clinical heterogeneity in juvenile rheumatoid arthritis patients but, also, common predisposing factors.

• MeSH
• alely MeSH
• dítě MeSH
• dospělí MeSH
• geny MHC třídy II MeSH
• HLA-D antigeny genetika   MeSH
• HLA-DP antigeny genetika   MeSH
• HLA-DP beta řetězec MeSH
• juvenilní artritida genetika   imunologie   MeSH
• lidé MeSH
• molekulární sekvence - údaje MeSH
• sekvence aminokyselin MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• HLA-D antigeny MeSH
• HLA-DP antigeny MeSH
• HLA-DP beta řetězec MeSH
• HLA-DPB1 antigen MeSH Prohlížeč