Treatment of Periodontoid Pannus With Infliximab in a Patient With Rheumatoid Arthritis

Sallı, Ali; Şahin, Nilay; Paksoy, Yahya; Küçüksaraç, Seher; Uğurlu, Hatice

doi:10.1097/rhu.0b013e3181b18797

Cited by 9 publications

(10 citation statements)

References 6 publications

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“…As 3 T MRI instruments have only recently become available, we wished to try this technique to assess cervical spine pathology in RA. Moreover, there have been only very few reports with respect to cervical spine involvement in biologic-treated RA patients [15][16][17]. Our cohort included 49 RA patients with no cervical spine and neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…As there have been few reports on the association of biologic therapy with cervical spine involvement in RA [15][16][17], we also tried to compare MTX-versus biologic-treated, as well as, within the biologic-treated subset, also IFX-versus TCZ-treated RA patient subsets. In our cross-sectional study, MTX-and biologic-treated patients had similar clinical features.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in early RA patients managed according to the treat-to-target strategy, AAS is relatively rare compared to our patients with 10-11 years of disease duration. Salli et al [16] reported successful IFX treatment of periodontoid pannus in one RA patient. We have not found any other reports on the possible effects of biologics on cervical spine pathologies in RA.…”

Section: Discussionmentioning

confidence: 99%

“…However, it still remains an issue to select patients with an increased risk of cervical spine involvement to initiate therapeutic intervention before neurologic deterioration occurs [6,15]. We found only very few reports on the association of biological therapy and cervical spine pathology in RA [15][16][17]. Thus, in the present crosssectional study we wished to assess cervical spine involvement in Hungarian RA patients undergoing biologic versus methotrexate (MTX) therapy.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Oláh¹,

Kardos²,

Kostyál

et al. 2020

Rheumatol Int

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Cervical spine involvement may lead to severe complications in rheumatoid arthritis (RA). In the era of modern therapies, atlantoaxial subluxation (AAS) may be rare; however, it may still be detected in asymptomatic patients. The onset of myelopathy can occur at any time. Altogether 49 female RA patients were included. Among them, 15 were methotrexate treated, biologic free, while 34 patients received biologics. The patients had no cervical pain or any neurological symptoms. We assessed the first (C1) and second (C2) cervical vertebrae by 3 T magnetic resonance imaging (MRI). In addition to AAS, we also determined odontoid erosion or periodontal soft tissue thickening. We associated our MRI findings with clinical, laboratory parameters, and hand radiography. We detected anterior AAS and soft tissue thickening in one-quarter, while odontoid erosions in eight (16%) of RA patients. There were no significant differences among the therapeutic subgroups. No posterior or vertical AAS was seen. Anterior AAS was associated with higher degree of inflammation, soft tissue thickening was seen at younger age, while odontoid erosions were associated with van der Heijde–Sharp scores of the hand. None of the patients had any lesions requiring surgery. The presence of cervical involvement in RA patients with 10–11 years of disease duration is still an important and frequent phenomenon. Higher disease activity and erosive disease are associated with atlantoaxial involvement. 3 T MRI is a sensitive method to assess AAS, as well as soft tissue lesions and odontoid erosions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Oláh¹,

Kardos²,

Kostyál

et al. 2020

Rheumatol Int

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“…Pathophysiology The cause of RA remains unknown, but several hypotheses, involving autoimmune mechanism, super antigen-driven disease (7), and infectious stimulus have been postulated. The etiology and pathogenesis of RA remain a mystery, despite efforts of a number of investigators over the past 40 years (8). Although the pathogenesis of RA remains poorly understood, much E J M R attention has been paid for cellular and molecular mechanisms of the disease.…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid Arthritis: A Chronic Inflammatory Disease and Its Pathophysiology

Rathore¹,

Rathore²,

Singh³

2019

EJMR

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Rheumatoid arthritis is a systemic inflammatory disorder which mainly affects the diarthrodial joint. It has societal effect in terms of cost, disability, and lost productivity. However the pathogenesis of disease is not well understood. Efforts are being made to understand the cellular and molecular mechanism for the pathogenesis of RA. It has been reported that proinflammatory cytokines such as TNF-a, IL-1b, and IL-6 are important mediators of the disease perpetuation. Moreover, there are also reports that free radical generation worsens the disease and contribute towards damage to bone and cartilage. Immune cells such as T cells also impart their role in the progress of the disease. Apart from the conventional treatment strategies using NSAIDs, DMARDs and glucocorticoids newer and safer drugs are continuously being searched, as long term usage of these drugs have resulted in the hepatic and gastrointestinal disorders. Alternative medicine is another therapeutic approach for treatment of the disease, which include herbal and folklore medicines. Many plants and plant products are under scientific exploration to develop a novel therapeutic agent. Here we have tried to review traditional medicine for their potential to treat RA.

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Predictors factors of atlanto‐axial subluxation in Tunisian patients with rheumatoid arthritis

Bettaieb

Ferjani

Nessib

et al. 2023

Musculoskeletal Care

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BackgroundThe aim of this study was to describe clinical and imaging features of atlantoaxial subluxation (AAS) and the associated risk factors in patients with rheumatoid arthritis (RA).MethodsWe conducted a retrospective and comparative study including 51 RA patients with AAS and 51 RA patients without AAS. Atlantoaxial subluxation was defined by the presence of an anterior C1C2 diastasis on the cervical spine radiograph in hyperflexion and/or an anterior, posterior, lateral or rotatory C1C2 dislocation on MRI with/without inflammatory signal.ResultsIn G1, clinical presentations revealing AAS were mainly neck pain (68.7%) and neck stiffness (29.8%). MRI revealed: diastasis C1C2 (92.5%), periodontoid pannus (92.5%), odontoid erosion (23.5%), vertical subluxation (9.8%) and spinal cord involvement (7.8%). A collar immobilisation and corticosteroid boluses were indicated in 86.3% and 47.1% of cases. C1‐C2arthrodesis was performed in 15.4% of cases. Atlantoaxial subluxation was significantly associated with: age at disease onset (p = 0.009), history of joint surgery (p = 0.012), disease duration (p = 0.001), rheumatoid factor (p = 0.01), anti‐cyclic citrullinated peptide (p = 0.02), erosive radiographic status (p < 0.005), coxitis (p < 0.001), osteoporosis (p = 0.012), extra‐articular manifestations (p < 0.001), and high disease activity (p = 0.001). Multivariate analysis identified RA duration (p < 0.001, OR = 1.022 CI[1.01–1.034]) and erosive radiographic status (p = 0.01, OR = 21.236 CI[2.05–219.44]) as predictive factors of AAS.ConclusionOur study showed that longer disease duration and joint destruction are the major predictive factors of AAS. Early treatment initiation, tight‐control and regular monitoring of cervical spine involvement are required in these patients.

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Treatment of Periodontoid Pannus With Infliximab in a Patient With Rheumatoid Arthritis

Cited by 9 publications

References 6 publications

Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Rheumatoid Arthritis: A Chronic Inflammatory Disease and Its Pathophysiology

Predictors factors of atlanto‐axial subluxation in Tunisian patients with rheumatoid arthritis

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