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ID PMID Title PublicationDate abstract
1593606 Juvenile rheumatoid arthritis and HLA: report of the Park City III workshop. 1992 Apr The workshop held during the Park City Meeting was directed toward developing a consensus about HLA associations in juvenile rheumatoid arthritis (JRA). Most agreement was achieved in pauciarticular JRA where the strongest associations were with the HLA-DRB1 alleles as is also the case in IgM rheumatoid factor positive polyarticular disease. In addition, HLA-DP associations are being identified although roles for linked genes are still possible. The critical nucleotides among HLA genes are not known; however, disease specific mutations have not been shown.
1588757 [Clinical pictures of juvenile rheumatoid arthritis]. 1992 Mar Juvenile rheumatoid arthritis is a clinical syndrome of primary chronic arthritis in childhood. JRA is subdivided into three subtypes according to the clinical picture within six months of the onset of the disease. The clinical picture of systemic onset type usually starts with a characteristic spiking fever. Children with this onset type, sometimes have pleursy, percarditis, myocarditis, generalyzed lymphnode swelling, hepatosplenomegaly and rheumatoid rash, but arthritis may not appear within the first few months. Children with polyarticular onset type, joint manifestations are similar to that of the rheumatoid arthritis of the adult. In patients with the pauciarticular onset type, the prognosis of arthritis is relatively fair compared with the other two types, but the doctor must always be aware of the complication of chronic and recurrent uveitis which sometimes develop to glaucoma, without subjective signs.
19077936 Is malignancy a major concern in rheumatoid arthritis patients? 1995 Feb There are several major issues related to malignancy that are of importance to the practicing clinician caring for patients with rheumatoid arthritis. Although it has been clearly established that rheumatoid arthritis is associated with an increased risk of hematologic malignancies including non-Hodgkin's lymphoma and multiple myeloma, the absolute risk of developing a hematologic malignancy is less than 1%. In rheumatoid arthritis patients with secondary Sjogren's syndrome, Felty's syndrome, or paraproteinemia, the risks for developing hematologic malignancy are likely to be even higher. These risks are balanced by reduced rates of gastrointestinal cancers. There are no conclusive data that link the FDA-approved second line therapeutic agents with the subsequent development of malignancy. However, the renal transplant experience suggests that immunosuppression alone increases the risk of subsequent malignancy. This should be a guiding principle when obtaining informed consent as well as in planning future therapeutic approaches to rheumatoid arthritis. Alkylating agents markedly increase the risk of leukemia and skin, bladder, and hematologic malignancies when used to treat rheumatoid arthritis.
1643745 Juvenile rheumatoid arthritis patients manifest immune reactivity to the mycobacterial 65- 1992 Aug Immune reactivity to the 65-kDa mycobacterial heat shock protein (hsp65) has been associated with arthritis in rats and humans. In this report we evaluated patients with juvenile rheumatoid arthritis for such immunity. A high proportion of affected children showed both antibody and T lymphocyte responses to hsp65 and to two related peptides: the nonapeptide 180-188 sequence of hsp65 and a partially homologous peptide of the cartilage proteoglycan link protein. The titer of circulating antibodies was generally higher in patients with clinically active disease. In contrast to the juvenile rheumatoid arthritis patients, patients with adult rheumatoid arthritis tended to have lower responses of their peripheral blood T lymphocytes to the whole hsp65 molecule. Moreover, the adult rheumatoid arthritis patients did not respond to the peptides. Thus, there appear to be immunological differences between juvenile and adult forms of rheumatoid arthritis related to hsp65 reactivity.
8936447 Juvenile rheumatoid arthritis. 1996 May Musculoskeletal problems account for the majority of initial complaints attended to by primary care physicians. It is likely that a child who eventually has juvenile rheumatoid arthritis diagnosed will initially be evaluated by a family physician or a pediatrician. Primary care physicians will play an increasingly important role in management of juvenile rheumatoid arthritis, as the availability of specialists in many communities is limited, and access to them may be further limited by managed care initiatives. This article offers a brief review of the definition and classification of juvenile rheumatoid arthritis and introduces a diagnostic algorithm to provide a simplified approach toward evaluating children with arthritis. Treatment and outcomes are summarized in text and graphic formats.
29206601 Rheumatoid arthritis. 1994 Apr Preview The physical effects of rheumatoid arthritis go beyond joint pain and destruction. The disease may take a toll on numerous organ systems and has been shown to increase morbidity and mortality. How does it affect the lungs? The heart? The nervous system? In this article, Dr Bell answers these and other questions about the extra-articular manifestations of rheumatoid arthritis.
29206547 Rheumatoid arthritis. 1993 Dec Preview Once considered relatively benign, rheumatoid arthritis is now recognized as a disabling systemic disease that causes substantial morbidity and mortality. Early, aggressive therapy may be critical for altering the course of disease. Drs Vikings-son and Graziano describe the causes and clinical course of rheumatoid arthritis and discuss diagnostic considerations and prognostic indicators that support optimum management.
1522987 [Molecular genetic, laboratory and clinical study of serum amyloid P]. 1992 Apr 5 Studying the gene polymorphism of serum amyloid P a common constituent of amyloid deposits two restriction fragment length polymorphism patterns were found among Hungarian rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus (SLE) patients and healthy controls. Although no direct connection between DNA polymorphism and the frequency of amyloidosis in three patient groups was found, a marked predominance of the heterozygosity in all studied groups has been described. Authors found close correlation between the serum levels of SAP and CRP in juvenile rheumatoid arthritis, but failed to find the same correlation in SLE and healthy controls. Moreover, the serum level of CRP of heterozygous patients were significantly higher than that of homozygous patients within the juvenile rheumatoid arthritis patient groups.
8108193 A comparison of immunoglobulin G-containing high-molecular-weight complexes isolated from 1993 Dec Circulating immune complexes have been described in both juvenile rheumatoid arthritis and in AIDS. We isolated high-molecular-weight complexes from plasma of children with juvenile rheumatoid arthritis and congenital human immunodeficiency virus infection by sequential gel filtration followed by affinity chromatography on protein A-Sepharose. We demonstrate that 1) mixed IgG-, IgM-, and IgA-bearing immune complexes can be found in both juvenile rheumatoid arthritis and congenital human immunodeficiency virus infection and 2) complexes isolated via affinity chromatography on protein A-Sepharose do not have detectable C4 but activate the classic complement pathway in vitro.
1288405 [Rheumatic wrist]. 1992 The wrist is frequently involved in the course of inflammatory rheumatism. The clinical and radiological features of the arthritis may guide the diagnosis when wrist involvement is isolated. The rheumatoid wrist may associate articular and tendon sheath synovitis, nerve compressions, muscle atrophy and deformities. X-rays reveal increased volume of the soft tissues, followed by cartilaginous destruction. Magnetic resonance imaging may detect the lesions early in their course. RS3PE, rheumatoid arthritis of the elderly, never induces destructive lesions. Still's disease is distinguished from rheumatoid arthritis by the predominant involvement of the radiocarpal and intercarpal joints with relative sparing of the metacarpo-phalangeal and proximal interphalangeal joints. Jaccoud's hand may be observed in the course of lupus with metacarpo-phalangeal dislocation of capsulo-ligamentous origin without cartilaginous destruction. Wrist involvement is often asymmetrical in ankylosing spondylitis. In psoriatic rheumatism, arthritis of the wrist is similar to that observed in rheumatoid arthritis, but demineralization is less common and occurs later and constructive lesions are associated with pinching.
8155258 Utilization of the VH4-21 gene segment by anti-DNA antibodies from patients with systemic 1993 Dec A monoclonal antibody (9G4) which detects an idiotope (Id) rising from heavy chains encoded by the VH4-21 gene segment has been utilized to investigate the role of this gene in encoding anti-DNA antibodies in SLE. Two hybridomas secreting Id-positive anti-DNA antibodies were established from two patients with SLE, with one (RT-79) an IgM kappa and the other (D-5) IgG kappa. Nucleotide sequence analysis of the heavy chain variable regions revealed involvement of the VH4-21 gene; the IgM antibody used the gene in germ line configuration, whereas the IgG antibody had 18 nucleotide changes. The CDR3 sequences for both the antibodies had a predominance of basic amino acids, with RT-79 having five and D-5 two arginine residues respectively. The VH4-21 gene segment, often in germ line configuration, is also used by IgM autoantibodies against red cell Ii antigens. However, IgM from a panel of six hybridomas secreting antibodies of Ii specificity, had no detectable activity against DNA. Conversely, RT-79 had only a weak ability to agglutinate red cells. Comparisons of Ig variable regions indicate that the amino acids in the CDR3 region of the mu chain influence the ability of IgM encoded by the VH4-21 gene segment to discriminate between a carbohydrate Ii antigen and DNA, and strongly support the suggested role of arginine in interaction with DNA. Sera from patients with SLE were found to have significantly raised levels of Id which was expressed by anti-DNA antibodies against both ss and dsDNA.
8185706 Polyarthritis resembling juvenile rheumatoid arthritis in a girl with chronic granulomatou 1994 May Chronic granulomatous disease (CGD) is an uncommon disorder affecting neutrophil function, and is characterized by recurrent and severe pyogenic infections. Associated autoimmune disorders, in particular lupus-like disorders, are found in carriers of X-linked CGD and in patients with both the X-linked and the autosomal recessive (AR) forms of the disease. We describe a girl with the AR form of CGD and with rheumatoid factor-positive polyarthritis resembling juvenile rheumatoid arthritis. This association has been reported previously only in a single case report of a patient with probable CGD. The present report further substantiates the association between autoimmune phenomena and CGD.
8460547 Transient scoliosis in a child with juvenile rheumatoid arthritis. 1993 Feb An 8 year old girl was admitted to hospital complaining of arthralgia in a few large joints. According to the clinical course and serological tests, a diagnosis of a polyarticular type of juvenile rheumatoid arthritis was made. About 6 weeks after the onset, scoliosis was observed. The curvature regressed spontaneously over the following 6 months. Generally, scoliosis associated with juvenile rheumatoid arthritis has been noted a few years after the onset. A transient scoliosis in the early phase of this disease is rare.
1348552 [Early synovectomy in the treatment of juvenile rheumatoid arthritis]. 1992 Authors report on the results of 15 synovectomies of the knee for iligoarticular juvenile rheumatoid arthritis. The operation was performed in every case in the early stage before the development of the radiological destruction. Excellent and good results were obtained in 11 cases; in 4 cases the operation was unsuccessful. It is stated that there is good chance to prevent destruction of the knee with juvenile rheumatic arthritis with an early synocvectomy. The operation is suggested after 6 years of age. The key of the good result is the early intensive mobilization of the joint.
7825454 Preschool sarcoidosis manifesting as juvenile rheumatoid arthritis: a case report and a re 1994 Oct Nine Japanese cases of sarcoidosis in children of 4 years of age or younger have been reported in the literature, including the case presented here. Clinically, preschool sarcoidosis is distinctly different from that of older children; it is characterized by a triad of skin, joint and eye lesions without pulmonary involvement. It is easily confused with juvenile rheumatoid arthritis which also presents the symptoms of arthritis and uveitis. We report on a patient with preschool sarcoidosis who was initially diagnosed as having juvenile rheumatoid arthritis. We recommend prompt skin biopsy to differentiate between these conditions.
8842721 Juvenile rheumatoid arthritis. 1996 Aug Juvenile rheumatoid arthritis occurs quite rarely, but should be suspected in a child presenting with arthralgias and systemic signs of sepsis. Once diagnosed, treatment necessitates a multidisciplinary approach to address the social, medical, and surgical issues. Current research into serologic methods of diagnosis shows great promise for better classifying patients, which ultimately will facilitate treatment. Recent well-designed randomized trials are providing better objective information on pharmacologic treatment alternatives. Surgery is reserved for recalcitrant cases that fail medical and occupational therapy. The goals of surgery in children with JRA are to delay or prevent joint destruction and closure of the epiphysis, to prevent or correct deformity, to decrease pain, and to maintain growth and joint motion.
22827209 Lacrimal defects in adult and senile rheumatoid arthritis. 1993 Rheumatoid arthritis presents with different clinical manifestations according to the age of onset. The authors have studied the involvement of the lacrimal function in two different cohorts of patients, 70 adult-onset (onset of the disease between 15 and 60 years of age) and 30 old-onset (60-79 years), as compared to two groups of normal controls of the same age. Schirmer I, Break-Up Time (BUT), and Bengal rose were tested. Senile rheumatoid arthritis (SRA) not only did not show more severe lacrimal changes when compared to adult rheumatoid arthritis (ARA) of the same duration, but failed to show statistical differences in tear secretion when compared to a healthy population of the same age. ARA patients showed a significant tear deficiency when compared to a healthy population of the same age. Within this cohort of patients, 'long-lasting' ARA showed more severe changes when compared to 'short-lasting' ARA. These results would suggest that the involvement of the lacrimal system is more important when rheumatoid arthritis develops in adult rather than in old age, being a function of the duration rather than of the severity of the disease.
7478815 Pain in children with juvenile rheumatoid arthritis: a descriptive study. 1995 Aug The purpose of this study is to describe the pain experienced by children with juvenile rheumatoid arthritis. A patient sample composed of 33 children, 7-16 y of age, with juvenile rheumatoid arthritis was included in the study. The children, their parents, and the attending rheumatologist assessed the child's pain using the Abu-Saad pediatric pain assessment tool. In addition, a disease activity index was used by the physician. All children reported pain. This was most often described as hurting, stinging, warm, and uncomfortable. Significant correlations were found for present pain between the child, parent, and physician. The worst pain of the child for the previous week, and not the present pain, correlated with the disease activity as rated by the physician. These findings indicate a need for pain assessment in patients with juvenile rheumatoid arthritis and emphasize the importance of longitudinal studies in this area.
7871331 Serum IgM rheumatoid factor by enzyme-linked immunosorbent assay (ELISA) delineates a subs 1994 Using human IgG as an antigen in an enzyme-linked immunosorbent assay (ELISA), we looked for the presence of IgM rheumatoid factor (RF) in the sera of 74 children with juvenile rheumatoid arthritis (JRA). Nine children had RF detectable by both latex agglutination and ELISA. Forty-five percent (26 of 65) of the children who were seronegative by latex agglutination were found to be positive for IgM RF by ELISA. The prevalence of IgM RF was higher in patients with polyarticular onset disease (57.4%) than in those with pauciarticular onset (38.5%) or systemic onset (27.2%) disease. The prevalence of RF was higher in sera from patients with deforming joint disease than those without deformities (P < 0.01).
1283120 Granzyme A-immunoreactive cells in synovial fluid in reactive and rheumatoid arthritis. 1992 Dec Perforin and granzyme A co-localize in the cytotoxic granules of killer cells like cytotoxic T lymphocytes (CTL). Perforin is the cytolytic pore-forming protein, whereas the function of the homodimeric serine protease granzyme A and other members of the granzyme family is still unclear. Granzyme A-immunoreactive cells formed 8 +/- 2% of the resting peripheral blood lymphocytes of healthy individuals. In contrast, granzyme A-positive cells formed 15% of peripheral blood mononuclear cells in patients with reactive or rheumatoid arthritis. However, 29 +/- 4% (p < 0.05 compared to normal peripheral blood) and 25 +/- 4% (p < 0.05) of all lymphocytes in synovial fluid in reactive and rheumatoid arthritis, respectively, were granzyme A-positive. This suggests involvement of cell-mediated cytolytic mechanisms in the articular pathogenic mechanisms. This involvement, however, does not differentiate between reactive and rheumatoid arthritis.