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ID PMID Title PublicationDate abstract
7684662 The rheumatoid factor cross-reactive idiotype in juvenile rheumatoid arthritis: role of th 1993 Jun The major rheumatoid factor cross-reactive idiotype (RCRI), which was defined by prototypic monoclonal IgM rheumatoid factors (RF) from Waldenstrom's macroglobulinemia patient Wa, is present on 60% of all monoclonal IgM RF paraproteins. The RCRI is expressed in high frequency by pokeweed mitogen-derived plasma cells (PWM-PCs) and in high concentration in the sera from adults with rheumatoid arthritis (RA) who express RF in their sera. Unlike adults with RA, most children with juvenile rheumatoid arthritis (JRA) are seronegative for RF as detected by classic IgG binding assays. In the experiments summarized herein, we demonstrated that approximately 2/3 of JRA patients who are seronegative for RF, express the RCRI in high concentration in their sera and in high frequency among their PWM-PCs. Expression of this idiotype could not be attributed to expression of hidden IgM RF, or IgA RF, and may be expressed on a parallel set of immunoglobulin molecules, related to RFs, but lacking the ability to bind to IgG. There is an increased number of circulating CD5+ B cells in patients with JRA but there was no significant relationship between CD5+ B cell numbers and serum RCRI concentration, suggesting that in this disease, RCRI bearing immunoglobulins may also be produced by non-CD5+ B cells or by a small subset of CD5+ B cells.
8966136 [Nonconventional therapy in a case of systemic juvenile rheumatoid arthritis]. 1996 May We report a systematic-onset juvenile rheumatoid arthritis in an adolescent girl inadequately controlled by a prolonged course of conventional therapy. After ACTH in combination with elevated dosages of intravenous ascorbic acid therapy she rapidly improved, becoming afebrile. A complete clinical remission one month later was obtained, with no recurrences of the disease in five years followup. The excellent response to ACTH and ascorbic acid in our patient, suggests that a controlled trial of this therapy in juvenile rheumatoid arthritis should be considered.
1285888 The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheum 1992 Oct It has long been established that rheumatoid arthritis improves during pregnancy. The gestational course of other inflammatory arthritides like ankylosing spondylitis (AS), psoriatic arthritis (PsA), and juvenile rheumatoid arthritis (JRA) has been less well studied. The present review summarizes the results of our retrospective and prospective studies on the interaction between these diseases and pregnancy. The results showed clear differences for their gestational course. Patients with PsA improved or even remitted in 80% of the pregnancies, whereas 80% of the AS patients had unaltered or aggravated disease symptoms. The 20% of AS patients who markedly improved while pregnant all had AS with accompanying diseases like psoriasis, ulcerative arthritis, or small joint arthritis. Quiescent JRA was not reactivated by pregnancy, and active disease at conception ameliorated in about 60%. Fetal outcome was not adversely affected by AS, PsA, or JRA nor did there occur serious intercurrent diseases during pregnancy. In AS and PsA patients delivery was mainly uncomplicated. Sequelae of JRA were a frequent cause for cesarean section in JRA patients. A postpartum flare during the first 3 months after delivery occurred in about 90% of the AS pregnancies, 70% of the PsA pregnancies, and about 50% of the JRA pregnancies.
1376077 CD5+ B lymphocytes and T-cell subsets in a case of juvenile rheumatoid arthritis. 1992 May 4 Recent research has demonstrated that CD5+ B lymphocytes have an important role in autoimmune and rheumatic diseases. In a case of juvenile rheumatoid arthritis (JRA), we observed the behavior of these cells and other subpopulations of T lymphocytes of peripheral blood before and after therapy with thymopentin (TP5). All the lymphocyte subpopulations returned to normal range, except the CD5+ B cells, where the percentage remained abnormally high (60%). These data suggest that CD5+ B cells can be a useful monitoring index and confirm their important role in the pathogenesis of juvenile rheumatoid arthritis.
8371218 Decrease in the number of deaths from secondary amyloidosis in patients with juvenile rheu 1993 Jul OBJECTIVE: The analysis of the mortality rate and causes of death of all Finnish patients with juvenile rheumatoid arthritis (JRA) in 1969-1979 and 1980-1990. METHODS: Cases with JRA and deaths at the age of 24 years or younger were identified by using the nationwide register of persons entitled to free medication because of rheumatoid arthritis and allied diseases. Causes of death are based on autopsy in all but 4 of 47 cases. RESULTS: There were 24 deaths during 1969-1979 and 23 during 1980-1990. The expected numbers of deaths were 8.9 and 9.5, giving a standardized mortality rate of 2.7 and 2.4, respectively. Secondary amyloidosis was the direct cause of death in 10 patients during the earlier period and in 4 patients during the later period. CONCLUSIONS: The decrease in amyloidosis as a cause of death may be explained by an increased use of cytotoxic drug treatment for severe JRA in the early 1980s. Deaths from violence have increased.
8694084 Intraocular lens implantation in patients with juvenile rheumatoid arthritis. 1996 Aug PURPOSE: To study intraocular lens implantation in patients with cataracts associated with juvenile rheumatoid arthritis. METHODS: We reviewed the records of seven patients (eight eyes) with juvenile rheumatoid arthritis who had undergone cataract extraction by phacoemulsification with intraocular lens implantation. Initial and final visual acuities, preoperative and postoperative medications, and early and late complications were recorded. RESULTS: Posterior subcapsular cataracts and non-visually disabling peripheral band keratopathy were found in all eyes. The median postoperative follow-up was 17.5 months (mean, 16.6 months; range, nine to 36 months). Five patients were adults, and two patients were less than 10 years old. A best-corrected visual acuity of 20/40 or better was attained in all eyes, and the last recorded visual acuity was 20/40 or better in seven of eight eyes. Early complications included posterior synechiae formation in two eyes, one of which required reoperation. Late complications included visually disabling posterior capsular opacification in one eye and new glaucoma in two eyes. Preoperative corticosteroids were reduced postoperatively in five eyes, were the same in two eyes, and increased in one eye. Persistent postoperative inflammation, posterior synechiae, and a pupillary membrane occurred in one of the children in this study, suggesting that intraocular lens implantation in this age group may have more complications. CONCLUSIONS: Results of this study suggest that, in selected adults, cataracts caused by juvenile rheumatoid arthritis-associated uveitis can be treated by the standard phacoemulsification technique with intraocular lens implantation and can have excellent results. Intraocular lens implantation in children with juvenile rheumatoid arthritis merits further investigation.
8796979 Potential infectious agents in the induction of arthritides. 1996 May In the multifactorial etiology of rheumatic diseases, infectious agents are regarded as the major environmental factors that may cause inflammatory arthritides in genetically susceptible hosts. Two not mutually exclusive pathogenetic pathways are hypothesized to explain the initiation and perpetuation of chronic arthritides by infectious agents: persistent infection and induction of immunopathology. In this review we focus on the role of infections in the etiopathogenesis of rheumatoid arthritis. Retroviruses and enteropathogenic bacteria continue to be the most intensively discussed candidates as possible etiologic factors of rheumatoid arthritis. Although there is ample indirect evidence for the involvement of infections in the pathogenesis of autoimmune disease, direct proof is still missing. There may be no single infectious trigger for rheumatoid arthritis, but multiple infectious agents that share antigenic motifs. The "reverse immunology" approach addresses this issue and is discussed in our outlook on future research directions.
19077973 Rheumatoid-like Arthritis Associated with Hepatitis C. 1995 Jun Rheumatoid arthritis is a clinical entity whose etiology is unknown, although an infectious cause has been suggested. We describe three patients diagnosed to have a rheumatoid arthritis-like disease that was chronic but nonerosive and unresponsive to nonsteroidal anti-inflammatory drugs. The patients were females aged 30, 69 and 70 years who had morning stiffness of more than 30 minutes and symmetric polyarthritis for periods of 4, 6, and 20 months, respectively. A laboratory screening revealed minunal liver enzyme elevations, whereas acute phase reactants were consistent with systemic inflammation, and the presence of rheumatoid factor and cryoglobulins was detected. Serology was positive for hepatitis C virus antigens. Liver biopsies revealed hepatitis and early cirrhosis. Alpha-interferon therapy was associated with clinical improvement of arthritis in two cases. It is suggested that hepatitis C infection may be associated with rheumatoid-like arthritis.
8041686 Juvenile rheumatoid arthritis. Old challenges, new insights. 1994 Aug What are the three main types of disease presentation in juvenile rheumatoid arthritis, and how do they relate to prognosis? Does infection or heredity play a role in causing the illness? Should aggressive therapy with multiple drugs be instituted early? Which therapeutic agents have the best chance of inducing remission? Dr Tibbitts addresses these and other questions in this overview of a disease that is a significant cause of chronic illness and disability in children.
8605265 Arthritis and the family. 1995 Dec OBJECTIVES: This paper reviews the literature on arthritis and the family in two areas, juvenile rheumatic diseases and adult-onset arthritis. METHODS: All published papers related to arthritis and the family were identified through a Medline search and through hand searching of the major rheumatology journals. RESULTS: The literature on the family and juvenile arthritis is somewhat inconsistent, in that some studies demonstrate significant psychosocial impact among children and families, while others find no differences in children who have arthritis compared to normative data or to siblings. Lack of consistency in the literature is largely related to methodologic problems, as most studies are retrospective reports, consisting of relatively small, nonrepresentative samples of children with rheumatic diseases. The influence of adult-onset rheumatoid arthritis and osteoarthritis on family role functioning and the performance of household responsibilities is well documented, and a body of literature on the importance of family functioning to well-being is accumulating. CONCLUSIONS: Future studies should expand sample sizes in order to investigate family impact on juvenile rheumatoid arthritis more thoroughly. More studies on the factors that contribute to improved family functioning and subsequent improvements in well-being, especially in conditions other than rheumatoid arthritis and osteoarthritis, are needed. Intervention studies to reduce perceived pain and functional disability in arthritis by incorporating a family-systems perspective are particularly lacking.
8233575 Nursing management of a child with juvenile rheumatoid arthritis. 1993 Sep Juvenile rheumatoid arthritis is an incurable chronic disease of childhood which involves connective tissue in the joints. Treatment aims are supportive and directed toward pain management, alleviation of inflammation, and optimization of joint function. A multidisciplinary team approach is helpful, with nursing care an essential part of the treatment plan.
7708547 [Pseudorheumatoid nodules in childhood. A case report]. 1994 Nov Subcutaneous nodules of the rheumatic type can occur in patients without other evidence of rheumatic disease. Nodules are characterized by subcutaneous location with predilection for pretibial regions and scalp, occasional large size, spontaneous regression and frequent recurrence. Sometimes lesion biopsy may be usefull for confirmation of the clinical diagnosis; etiology is unknown, therapy is unnecessary. One asymptomatic child with benign rheumatoid nodules is described by the Authors.
8335603 Renal amyloidosis in juvenile rheumatoid arthritis. 1993 Feb We report a child who developed juvenile rheumatoid arthritis at the age of 7 years and nephrotic syndrome due to renal amyloidosis within 2 years of the onset of arthropathy. Literature on the management and prognosis has also been reviewed.
7699669 Cardiac tamponade: an unusual feature of adult onset Still's disease. 1995 Jan Adult onset Still's disease (AOSD) is an uncommon, systemic, inflammatory disorder of unknown etiology characterized by the triad of fever, arthritis and rash. We describe 2 cases of cardiac tamponade in patients with AOSD, review reported cases, and describe the features, and therapy of AOSD.
1548110 Symptomatic cardiac involvement in juvenile rheumatoid arthritis. 1992 Jan In a retrospective study of 172 patients with juvenile rheumatoid arthritis, symptomatic cardiac involvement occurred in 13 (7.6%) patients (11 systemic and 2 polyarticular). There was predominance of the male sex and in most patients the involvement occurred in the initial years of the disease. Pericarditis occurred in seven patients; perimyocarditis in four and myocarditis in two patients. In the follow-up, one of the patients with pericarditis died of an arrhythmia during pericardiocentesis for cardiac tamponade. Among the patients with myocarditis, three died of septicemia during active disease. One of these three patients had myocarditis associated with cardiac tamponade. Among the 172 patients with juvenile rheumatoid arthritis, five children died; four belonged to the symptomatic cardiac involvement group (P less than 0.001). Cardiac involvement, in particular myocarditis and cardiac tamponade, can be regarded as a factor of worse prognosis.
8484133 Autoantibody studies in juvenile rheumatoid arthritis. 1993 Feb Early studies showed few immunologic abnormalities in juvenile rheumatoid arthritis (JRA) patients. There were no specific laboratory markers useful for diagnosis and assessment of the course of disease in JRA. Previous work showed an association of antinuclear antibodies (ANA) with early-onset pauciarticular disease and iridocyclitis. Similarly, the presence of 19S immunoglobulin (Ig) M rheumatoid factors (RF) was associated with late-onset polyarticular disease in girls. More recent studies have detected many unique autoantibodies. Newer assays show 19S IgM RF in up to 35% of JRA patients, although still mainly in girls with late-onset polyarticular disease. Hidden 19S IgM RF can be shown in up to 75% of JRA patients using different procedures, primarily in those with active polyarticular-or pauciarticular-onset disease. Immune complexes have been detected in JRA patients by means of different techniques; their presence usually correlates with active disease. Studies on a specific ANA in JRA have shown no common extractable nuclear antigen, but antihistone antibodies have been found in up to 75% of cases, again mainly in those with pauciarticular onset and iritis. Finally, a variety of unusual immunologic proteins have also been detected, including anti-ocular, anti-cellular, anti-cardiolipin, anti-perinuclear factor, and anti-collagen antibodies. This review evaluates the significance of these antibodies that can now be found in JRA.
8412643 Polyarticular septic arthritis. 1993 Sep Twenty-five cases of polyarticular septic arthritis (PASA) were observed in our department over a 13-year period. They accounted for 16.6% of all septic arthritis (15% on average in the literature). A male predominance was noted in our patients, as well as in the literature. The knee was the most frequent location followed by the elbow, shoulder, and hip, in varying order depending on the series. An average of 4 joints was involved. The causative microorganism was Staphylococcus aureus in 20/25 of our patients and in about 50% of published cases. Other frequently causative organisms were streptococci and gram-negative bacteria. Blood cultures and joint aspirations were positive in 19/22 and 23/25 of our cases, respectively. Other septic lesions were noted in 10/25 of our cases. Fever and severe leukocytosis were absent at admission in 5/25 (literature, 37%) and 10/25 of our 25 patients, respectively. The underlying disease was rheumatoid arthritis in 13/25, while 9 of the other patients had immunodepression caused by drugs or by concurrent illness. Typically, rheumatoid arthritis was long-standing and erosive, patients having ulcerated calluses on the feet. This skin source was also noted in 23/36 published cases of PASA in rheumatoid arthritis. Systemic lupus erythematosus was an uncommon disease in PASA, but its presence promoted gram-negative infection. Despite effective therapy with 2 antibiotics, 8/25 patients died, a prognosis that is equally severe in cases reported in the literature (30%) and one that has remained surprisingly stable over the last 40 years. For comparison, the death rate was only 4% in our patients with MASA. Factors contributing to a poor prognosis were age greater than 50 years, rheumatoid arthritis as an underlying disease, and disease of staphylococcal origin. Septic polyarthritis should be considered even when the clinical picture is not florid--when patients have low fever and normal white blood cell counts. Nor should the simultaneous involvement of distant joints rule out infection. Indeed, the frequency of underlying rheumatic disease and its treatment may further confuse the clinical presentation. Joints suspected of harboring infection should be aspirated, including those previously affected by the concurrent rheumatism.
8519616 Juvenile rheumatoid arthritis and spondyloarthropathies. 1995 Sep Further insight into the etiology and pathogenesis of juvenile rheumatoid arthritis (JRA) is presented in recent immunogenetic studies, particularly the allele associations of the pauciarticular pattern of disease. Evidence suggests that bacterial heat-shock proteins may be significant in the chronic inflammatory response in children with arthritis. Data on the role of complement activation and cytokines and their receptors also are presented. Coagulopathy in JRA may have more than one etiologic factor, including a viral agent, as may the disease itself. In the treatment of growth abnormalities in JRA, the neuroendocrine system, recombinant growth hormone, intravenous iron therapy, and nutritional supplementation are all areas of recent investigation. In outcome studies, ocular involvement and the presence of circulating IgM rheumatoid factor appear to be risk factors for disability. However, disease of less than 2 years' duration and absence of radiographic lesions likely predict good response to methotrexate therapy.
8838185 A search for persistent rubella virus infection in persons with chronic symptoms after rub 1996 Feb Peripheral blood polymorphonuclear leukocytes, mononuclear cells, and plasma and nasopharyngeal specimens were obtained from 6 subjects with persistent symptoms following rubella immunization, 1 subject with persistent symptoms following rubella, 11 children with juvenile rheumatoid arthritis, 17 recently immunized control subjects, and 1 control subject with acute clinical rubella. Rubella virus was isolated from the blood or nasopharynx of four of the 18 control subjects. In contrast, rubella virus was not recovered from any specimens from the seven subjects with persistent symptoms following immunization or natural infection or from the 11 children with juvenile rheumatoid arthritis. A polymerase chain reaction assay detected rubella virus in the blood from three of 14 control subjects but not in the blood from two subjects with persistent symptoms following rubella immunization or in that from three children with juvenile rheumatoid arthritis. We have not been able to confirm the findings of others who have reportedly recovered rubella virus from lymphocytes of persons with persistent symptoms following rubella or rubella immunization.
7691140 Treatment of juvenile rheumatoid arthritis. 1993 Sep New information on the treatment of juvenile rheumatoid arthritis emphasizes more aggressive control of arthritis, particularly the use of methotrexate, both in low- and higher-dose regimens. Information concerning drug toxicity, including that of the nonsteroidal anti-inflammatory drugs, second-line agents, and methotrexate, suggests that these drugs are well tolerated in children. A new corticosteroid, deflazacort, minimizes bone demineralization and growth retardation. Adjunctive measures, including erythropoietin, pain management techniques, conditioning programs, and nutrition, have demonstrated advantages in some children with juvenile rheumatoid arthritis.