Bakgrund Reumatoid artrit (RA) och artros är komplexa tillstånd som kan vara svåra att diagnostisera och leda till långvarig smärta. Effektiv smärtlindring och hantering är avgörande för att förbättra livskvaliteten för personer med dessa sjukdomar. Primärvården spelar en central roll i hanteringen av kronisk smärta genom att erbjuda personcentrerad vård och integrera interdisciplinära metoder. Personers upplevelser av vården, inklusive kommunikation och tillgänglighet, är viktiga för att säkerställa effektiv smärtbehandling och välbefinnande. Personcentrerad vård, baserad på sjuksköterskans kärnkompetenser, är en grundläggande princip för att möta individuella behov och förbättra utfall för personer med reumatisk smärta. Syfte Syftet med litteraturöversikten var att belysa personer med reumatoid artrit och artros upplevelse av smärthantering inom primärvården. Metod En icke-systematisk litteraturöversikt där 11 vetenskapliga artiklar granskades. Artiklarna hämtades ur databaserna PubMed och CINAHL. Sökningarna baserades på noggrant utvalda sökord som lades ihop till sökblock. Vidare analyserades och kategoriserades artiklarna genom en integrerad analys baserad på Kristensson (2014). Resultat Dagliga utmaningar till följd av RA och artros identifierades, inklusive fysiska begränsningar, social isolering och psykologiska påfrestningar. Självhanteringsprogram och digitala verktyg visade sig kunna förbättra smärtbehandling och livskvalitet. Interaktionen med vårdpersonal betonade vikten av kommunikation, förståelse och patienttillfredsställelse. Tillgång till vård och socialt stöd ansågs avgörande för smärthantering. Slutligen, en personcentrerad vårdmodell och egenmaktstrategier visade positiva resultat för delaktighet och självhantering. Slutsats Personer med RA och artros får inte tillräckligt stöd och smärthantering i primärvården. Brist på information och personcentrerad vård leder till försämrad livskvalitet. Strukturerade interventioner, inklusive utbildning och fysisk aktivitet, visar sig vara viktiga för att förbättra hanteringen av smärtan och livskvaliteten för personerna. Ett holistiskt synsätt och personcentrerad behandling är avgörande för att uppnå god smärthantering och välbefinnande. / Background Rheumatoid arthritis (RA) and arthritis are complex conditions that can be difficult to diagnose and lead to long-term pain. Effective pain management is critical to improving quality of life for people with these diseases. Primary care plays a central role by offering person-centered care and integrating interdisciplinary methods. People's experiences of care are important to ensure effective pain management and well-being. Person-centred care is a fundamental principle for meeting individual needs and improving outcomes for people with rheumatic pain. Aim The aim of the literature review was to shed light on the experiences of individuals with RA and arthritis regarding pain management in primary care. Method A non-systematic literature review in which 11 scientific articles were reviewed. The articles were retrieved from the databases PubMed and CINAHL. The searches were based on carefully selected keywords that were combined into search blocks. Furthermore, the articles were analyzed and categorized through an integrated analysis based on Kristensson (2014). Results Daily challenges resulting from RA and arthritis were identified, including physical limitations, social isolation and psychological stress. Self-management programs and digital tools were shown to improve pain management and quality of life. Interaction with healthcare professionals emphasized the importance of communication, understanding and patient satisfaction. Access to care and social support was considered crucial for pain management. Finally, a person-centered care model and empowerment strategies showed positive results for participation and self-management. Conclusion People with RA and arthritis do not receive sufficient support and pain management in primary care. Lack of information and person-centred care leads to a reduced quality of life. Structured interventions, including education and physical activity, are shown to be important in improving pain management and quality of life for individuals. A holistic approach and person-centered treatment are essential to achieve good pain management and well-being.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 5 uppsatser.

Multimedia - Wort des Jahres 1995 - taucht als populärer Begriff in allen Bereichen unserer Gesellschaft auf. Auch an Universitäten erhofft man sich durch die Einführung von computerunterstützten Lernformen eine höhere Qualität der Lehre sowie Kosteneinsparungen. Nach ersten Versuchen in den 60er Jahren war das Neue in den 90ern die realitätsnahe, multimediale Simulation von Entscheidungssituationen. Auf dem Gebiet der Rheumatologie ist derzeit jedoch noch ein Mangel an deutschsprachigen Softwaretiteln zu erkennen. Ziel war die Erstellung eines multimedialen Kompendiums über die rheumatoide Arthritis für den Einsatz in der universitären und postgraduierten Lehre. Das System soll als elektronisches Nachschlagewerk und als Basis für interaktive Diashows geeignet sein. Mit Hilfe eines Apple Macintosh und der Autorensoftware Macromedia Director wurde eine CD-ROM entwickelt, die sowohl für Macintosh- als auch für Windows-Computer geeignet ist. Die Beschreibung der Symptome der rheumatoiden Arthritis und der erforderlichen Untersuchungstechniken nimmt mit 31% der Bildschirmseiten den größten Teil des vorliegenden Multimedia-Kompendiums ein. Weitere Schwerpunkte wurden auf Pathogenese (19%), bildgebende Verfahren (14%), Differentialdiagnosen (11%), Therapie (10%) und Laboruntersuchungen (7%) gelegt. Videos und Animationen dienen der Illustration zellulärer Vorgänge und der Zusammenfassung klinischer Untersuchungstechniken. Etablierte Kriterienkataloge für elektronische Medien dienten der Qualitätssicherung im Entwicklungsprozeß. Eine parallel durchgeführte formative Evaluation lieferte erste Erkenntnisse über Praxistauglichkeit und Stabilität des Programmes, ohne jedoch eine fundierte summative Evaluation ersetzen zu können. Multimedia-Lehrbücher wie das vorliegende Kompendium stellen für den konventionellen Unterricht eine ideale Ergänzung zum klassischen Lehrbuch dar und dienen für die problemorientierte Ausbildung als schnell zur Verfügung stehende Wissensbasis. Jedoch blieben bei der fakultativen Nutzung von computerbasierten Lernmöglichkeiten in Lernzentren die Ergebnisse bisher hinter den Erwartungen zurück. Es ist zu diskutieren, inwieweit die Vorteile der Multimedia-Technologie durch gezielte Integration in das Curriculum an deutschen Hochschulen zu Kosten- und Zeitersparnissen führen können. / Multimedia - word of the year 1995 in Germany - is a popular term cropping up in all areas of society. Universities, too, hope to improve the quality of teaching and to cut costs by introducing computer-based forms of learning. Following initial attempts in the sixties, a new aspect introduced in the nineties was the life-like multimedia simulation of decision-making situations. In medicine, there still is a lack of German-language software packages in rheumatology. The aim of the present project was to develop a multimedia compendium on rheumatoid arthritis for teaching at the university and postgraduate level. The system was intended to serve both as an electronic work of reference and as a basis for interactive slide presentations. Using the authoring tool Macromedia Director on an Apple Macintosh computer, a CD-ROM was developed that can be run on Macintosh and Windows computers alike. The largest part of the multimedia compendium now available (31% of the screen pages) is dedicated to the description of the symptoms of rheumatoid arthritis and examination techniques. Other main areas are pathogenesis (19%), imaging modalities (14%), differential diagnoses (11%), therapy (10%), and laboratory tests (7%). Videos and animations serve to illustrate cellular processes and to summarize the clinical examination techniques. Catalogues of established criteria for electronic media were adhered to during development to assure quality. A simultaneously performed formative evaluation yielded initial results about the practicability and stability of the program but cannot replace a thorough summative evaluation. Multimedia textbooks such as the compendium presented here are ideal supplements to classical textbooks in conventional teaching, providing a rapidly accessible knowledge base for problem-oriented training. However, the results achieved with computer-based learning tools available for optional use at teaching centers have so far lagged behind expectations. It remains to be discussed to what extent the advantages of multimedia technology can save both cost and time by being selectively integrated into the curriculum at German universities.

Besides the molecular mechanisms regulating activation of FLS mentioned above, we also investigated anti-inflammatory activities of Chinese herbal medicine sinomenine and Liang Miao San on activated human FLS in RA. Sinomenine, an alkaloid isolated from the root of Sinomenium acutum, has been used to alleviate the symptoms of rheumatic diseases. Liang Miao San (LMS), composed of the herbs Rhizoma Atractylodis (Cangzhu) and Cotex Phellodendri (Huangbai), is another traditional Chinese medicine formula for RA treatment. Since the potential anti-inflammatory activities of sinomenine and LMS have been demonstrated, we investigated the in vitro anti-inflammatory effects of sinomenine and LMS on inflammatory cytokine TNF-alpha activation of human normal and RA-FLS and the underlying intracellular mechanisms. In the present study, sinomenine was found to significantly inhibit TNF-alpha induced cell surface expression of VCAM-1 and release of inflammatory cytokine and chemokine IL-6, CCL2 and CXCL8 from both normal and RA-FLS (all p < 0.05). Our results provide a new insight into the differential anti-inflammatory activities of sinomenine and LMS through the suppression of TNF-alpha activated FLS by modulating distinct intracellular signaling pathways in RA, and help to provide a biochemical basis for the development of a cost-effective human synoviocyte model for the future screening of traditional Chinese medicine (TCM) possessing potential anti-rheumatic activities. (Abstract shortened by UMI.) / IL-27, a novel member of the IL-12 family that is produced early by antigen-presenting cells (APCs), can promote T cell proliferation as well as the production of interferon-gamma by naive T lymphocytes. Recent studies have found that elevated expression of IL-27 has been detected in the synovial membranes and fluid of RA. Herein we investigated the in vitro effects of IL-27, alone or in combination with inflammatory cytokine TNF-alpha or IL-Ibeta on the pro-inflammatory activation of human primary FLS isolated from RA patients and normal control subjects, and the underlying intracellular signaling molecules were also studied. We found that the plasma concentration of IL-27 in RA patients (n=112) was significantly higher than that in control subjects (n=46). Both normal and RA-FLS constitutively express functional IL-27 receptor heterodimer, gp130 and WSX-1, with more potent IL-27-mediated activation of signal transducers and activators of transcription (STAT)1 in RA-FLS. IL-27 was found to induce significantly higher cell surface expression of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 and release of inflammatory cytokine IL-6, chemokine CCL2, CXCL9, CXCL10 and matrix metalloproteinase (MMP)-1 of RA-FLS than that of normal FLS (all p < 0.05). The above findings therefore provide a new insight into the IL-27-activated immunopathological mechanisms mediated by distinct intracellular signal transductions in joint inflammation of RA and may have important therapeutic implications. / In the present study, we have investigated the mechanisms of the activation of human fibroblast-like synoviocytes (FLS) induced by various stimuli including interleukin (IL)-27, tumor necrosis factor (TNF)-alpha and IL-beta. The activation of human FLS was studied in terms of the release of cytokines and chemokines and the expression of adhesion molecules. / We investigated the in vitro effects of uric acid crystals, alone or in combination with inflammatory cytokine TNF-alpha or IL-beta on the pro-inflammatory activation of human FLS from RA patients and normal control subjects, and the underlying intracellular signaling molecules were also determined. In the present study, uric acid crystals were found to result in a significant increase of inflammatory cytokine IL-6, chemokine CXCL8 and MMP-1 from both normal and RA-FLS (all p < 0.05). Moreover, additive or synergistic effect was observed in the combined treatment of uric acid crystals and TNF-alpha or IL-1beta on the release of IL-6, CXCL8 and MMP-1 from both normal and RA-FLS. Further investigations showed that the release of inflammatory cytokine, chemokine and matrix metalloproteinase stimulated by uric acid crystals was differentially regulated by intracellular activation of extracellular signal-regulated kinase (ERK) and JNK pathways. Our results therefore provide a new insight into the endogenous danger signal uric acid crystals-activated immunopathological mechanisms mediated by distinct intracellular signal transductions in joint inflammation, and also provide biochemical basis for the development of new modality for inflammatory rheumatic diseases. / Chen, Dapeng. / Adviser: Wong Chun Kwok. / Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 203-240). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Base teórica: Artrite reumatoide (AR) é uma doença autoimune que afeta as articulações e progride de maneira simétrica e erosiva. Além dos achados articulares, pode ocorrer de perda muscular e síndrome da caquexia. Atualmente, não existe um marcador que sirva de preditor da síndrome de caquexia reumatoide. Estudos metabolômicos em pacientes com AR demonstram uma complexidade em encontrar um biomarcador para caquexia. Ademais, não há modelo experimental de caquexia descrito na literatura, mas o modelo de artrite induzida por colágeno (CIA) possui potencial de ser modelo de caquexia reumatoide. A partir deste modelo, pode-se fazer a busca por biomarcadores de caquexia reumatoide via metabolômica. Objetivo: Avaliar o modelo de CIA como modelo experimental de caquexia reumatoide. Avaliar o perfil metabólico da urina no modelo de CIA e correlacionar com parâmetros clínicos de caquexia reumatoide em busca de possíveis biomarcadores. Métodos: Camundongos machos DBA/1J foram induzidos (CIA; n=13) no dia zero e receberam reforço 18 dias após, e grupo mantidos saudáveis sem indução (CO; n=11). Nos dias 0, 18, 25, 35, 45, 55 e 65 após a indução, foram realizados: coleta de urinas; teste de desempenho físico; teste de locomoção espontânea; teste de força; medida do volume do edema da pata traseira; avaliação do escore clínico; pesagem; e avaliação da ingestão alimentar. Após os 65 dias, os animais foram eutanasiados e tecidos musculares (gastrocnêmio – GA; e tibial anterior – TA) foram dissecados para pesagem e realização da razão sarcoplasmática. Os dados foram analisados por ANOVA de duas vias, seguido de Bonferroni, ou teste t de Pearson, com significância a partir de um p<0,05. A urina coletada foi submetida à ressonância nuclear magnética (1D e 2D J-res). Os metabolitos foram identificados via Chenomx (1D) e pelo Birmingham Metabolite Library (BML; 2D J-res). Utilizou-se a o modelo estatístico de PCA, PLSDA e PLSR para criar ranqueamento de metabolitos (significância a partir de um p<0,05). Analizou-se as rotas metabólicas via Metaboanalyst a partir do ranqueamento de metabólitos obtidos. Os metabólitos obtidos foram filtrados para rotas metabólicas que ocorrem no músculo para identificação de potenciais biomarcadores de perda muscular. Resultados: O grupo CIA apresentou redução de até 24% na locomoção espontânea, de até 66% na força e de até 24% no teste de desempenho físico após 35 dias da indução, bem como redução no peso do GA (24%) e TA (25%), e relação sarcoplasmática (22 e 23%, respectivamente) em relação ao grupo CO. Os modelos estatísticos de PCA, PLSDA e PLSR, e o filtro pelas rotas metabólicas relacionadas com o músculo geraram uma lista de 28 metabólitos e relacionados com o desenvolvimento da doença, sendo eles: 3-metilhistidina, 4-aminobutirato, acetilcolina, arginina, aspartato, carnosina, creatina, creatinina, glutamina, histamina, histidina, isoleucina, leucina, metionina, lisina, mio-inositol, dimetilglicina, acetilalanina, acetilmetionina, pantotenato, fenilalanina, fosfocolina, fosfocreatina, piridoxina, sarcosina, succinilacetona, tiamina, e urocanato. Conclusão: Em concordância com os resultados de redução nos parâmetros de: massa muscular, locomoção espontânea, força e desempenho físico, somando-se a ausência de anorexia bem como mudança no peso, o modelo animal de CIA representa um modelo experimental próprio para caquexia reumatoide. A análise do perfil metabólico deste modelo permite sugerir 28 metabólitos relacionados ao processo de perda muscular, que podem vir a ser biomarcadores de caquexia reumatoide, objetivando prognóstico, diagnóstico e acompanhamento da síndrome. Destes metabólitos, os principais são pertencentes ao metabolismo de: histidina; arginina e prolina; glicina, serina e treonina; fosfocreatina, bem como outros aminoácidos e vitaminas do complexo B. / Background: Rheumatoid Arthritis (RA) is an autoimmune disease that affects the joints and has a symmetric development and it is erosive. Besides joint damage, it can develop muscle loss progress into cachexia syndrome. Currently, there is no marker that can predict it development in rheumatoid patients. Metabolomics in RA have shown to be complex to find out a biomarker for this syndrome. Also, there is no experimental model of cachexia described in literature yet; however the collageninduced arthritis (CIA) animal model seems to be a feasible model for rheumatoid cachexia. With this model, the research for a biomarker of rheumatoid cachexia can be done by metabolomics. Objectives: It will be evaluated if the CIA animal model can be also an animal model of rheumatoid cachexia. Afterwards, it will be evaluated a metabolic profile from urine of this animal model and correlate with clinical signs of rheumatoid cachexia to find out plausible biomarkers of it. Methods: Male DBA/1J mice were submitted to CIA (n=13), immunization occurred at day zero and a booster was performed 18 days after, and a healthy group with no induction (CO; n=11). At the 0,18, 25, 35, 45, 55 and 65 days after the first injection, it was done: urine collection; physical performance test; free exploratory locomotion test; strength test; hindpaw edema volume measurement; follow up disease development; weighted; and food intake. After the 65 days, animals were euthanized and muscle (gastrocnemious – GA; and tibial anterior – TA) were dissected, and weighted for sarcoplasmic ratio. Data were analyzed by two-way ANOVA followed by Bonferroni post hoc, and t-test of Pearson, and statistical critical limit was set for p<0.05. The collected urine was used for nuclear magnetic resonance (1D and 2D J-res). Metabolites were identified by Chenomx (1D) and by the Birmingham Metabolite Library (BML; 2D J-res). Statistical model were performed using PCA, PLSDA and PLSR to create a ranking list of the metabolites (statistical critical limit was set for p<0.05). It was analyzed the metabolic pathway by Metaboanalyst from the data of metabolite ranking list. Then, the metabolite list was filtered by the metabolic pathways that take place in muscle tissue, in order to identify plausible biomarkers of muscle loss. Results: CIA group has shown reduction in up to 24% of free locomotion fatigue, up to 66% of strength and up to 24% of endurance physical performance after 35 days of the induction, as well as a decrease in GA (24%) and TA (25%) weight, and sarcoplasmic ratio also reduced (22 and 23%, respectivamente) related to CO group. The PCA, PLSDA and PLSR statistical models, and the filter by metabolic pathways related to muscle provided a list of 28 metabolites related to disease development, as can be listed: 3-methylhistidine, 4-aminobutyrate, acetylcholine, arginine, aspartate, carnosine, creatine, creatinine, glutamine, histamine, histidine, isoleucine, leucine, methionine, lysine, myo-inositol, dimethylglycine, acetylalanine, acetylmethionine, pantothenate, phenylalanine, phosphocholine, phosphocreatine, pyridoxine, sarcosine, succinylacetone, thiamine, and urocanate. Conclusions: Accordingly with the data with reduction of: muscle mass, spontaneous locomotion, strength and physical performance, added with absence of anorexia as well as weight change, CIA animal model is a feasible experimental model for rheumatoid cachexia. Concerning the metabolic profile from this model, it can be suggested 28 metabolites related to muscle loss in which can be tested for biomarker of rheumatoid cachexia, targeting prognosis, diagnosis, and syndrome follow up. From those metabolites, the main ones are engaged to metabolism of: histidine; arginine and proline; glycine, serine and threionine; phosphorcreatine, as well as other amino acids and vitamins from B complex.

Abstract not available

The host response toward biomaterial component of tissue-engineered devices has been extensively investigated. The objective of this research was to understand the response of dendritic cells (DCs) to different biomaterials upon contact and identify biomaterials suitable for use in tissue engineering constructs for rheumatoid arthritis (RA) applications. Differential levels of functional DC maturation were observed depending on the type of biomaterial in 2-dimensional films or 3-dimensional scaffolds used to treat immature DCs; Poly(lactic-co-glycolic acid) (PLGA) or chitosan supported higher levels of DC maturation, as compared to immature DCs. Alginate supported moderate levels of DC maturation. Agarose did not support DC maturation whereas hyaluronic acid inhibited DC maturation. Further, these DCs treated with different biomaterials induced differential phenotype and polarization of autologous T cells upon co-culture of DCs and T cells; DCs treated with PLGA induced T helper type I with immunogenic response while DCs treated with agarose did T helper type II with tolerogenic response. Effect of different biomaterials (PLGA and agarose) was assessed in vivo upon implantation of them into the knee joint of RA-induced rabbit. Total leukocyte concentrations in the peripheral blood or in the joint lavage of the left knees (untreated control) were observed in differential levels depending on the biomaterial implant, possibly due to the systemic circulation of the peripheral blood. Furthermore, cartilage and bone healing progression was differentially observed in the osteochondral defect of the knee joint of RA-induced rabbit, depending on type of biomaterial scaffold implanted into the defect. Collectively, these results demonstrate the multifunctional impacts of inherently different biomaterials on in vitro immunomodulation of phenotype and polarization of DCs and autologous T cells. Furthermore, taken together with these immunomodulatory impacts of biomaterials, in vivo effects of different biomaterial scaffolds on RA environment shown in this study can suggest the criteria of selection and design of biomaterials for orthopedic tissue engineering, which may ultimately be best integrated into the diseased cartilage and bone.

No description available.

B cells have a central role in the pathogenesis of collagen-induced arthritis (CIA), an animal model of the autoimmune disease rheumatoid arthritis. In this report, a specific subset of an innate type of B cells, B-1 B cells, have been studied for the involvement in CIA. The B-1 B cells were shown to produce small amounts of collagen-specific antibodies upon stimulation in vitro, suggesting that they play a minor role in the development of CIA. This report also includes how marginal zone B cells, another innate type of B cells with natural collagen-reactivity, can be identified in the medullary sinuses of lymph nodes of collagen-immunized mice, implying involvement in auto antigen trapping.