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ID PMID Title PublicationDate abstract
8451058 Methotrexate use in juvenile rheumatoid arthritis. 1993 Jan Juvenile Rheumatoid Arthritis (JRA) is a chronic, inflammatory, autoimmune disease of childhood. Methotrexate is an emerging antirheumatic drug in the pediatric population for disease refractory to conventional medications. While observations are encouraging, the toxic side effects can be potentially serious. Toxicity includes gastrointestinal intolerance, ulcerative stomatitis, chemical hepatitis, minor liver fibrosis, infection, hematologic suppression, acute pneumonitis, reversible oligospermia, and cirrhosis. The liver toxicities are of the greatest concern. If proper dosage and monitoring are followed, serious toxic effects can be prevented from occurring.
7856465 [Sjögren's syndrome]. 1994 Oct This paper consists the theorical review and the current concepts of the subject and the second includes the casuistry of the Stomatology Department of the Pulido Valente Hospital. From April 1989 to 1991 (2 years), a study was made on Sjögren Syndrome (Primary and Secondary) of multiple character with the particular co-operation of the Portuguese Institute of Rheumatology. With this paper we wish to point out the importance of the oral evaluation of the study of the plurisystemic diseases as well as to establish criterions of diagnosis for the Portuguese population. Eighty cases of suspected Sjögren's Syndrome have been assessed, 66 of which have been fully. The reason for the consultation was dry mouth, dry eyes and enlargement of parotid glands. The symptoms were isolated or in association with other pathologies after other causes had been excluded. We had to establish the salivary reference values for the Portuguese population in 22 healthy volunteers. The xerostomia was evaluated by the Sialochemistry, Sialography, Cintigraphy and biopsies of the lower lip and of the sublingual gland. The ophthalmologic examination took place in the Ophthalmology Department of Santo António dos Capuchos Hospital by means of Shirmer test, Rosa Bengala and B.U.T. In spite of Sjögren's Syndrome being, up to now, so remotely determined in connection with the treatment, these patients need medical care and Stomatology plays a fundamental role as far as the diagnosis and the therapeutic points of view are concerned. We maintain the notion that the Syndrome is not as infrequent as one would believe and the evaluation of the oral field is important to establish the degree of the disease and its treatment.
9103020 [The EHF therapy of children with juvenile rheumatoid arthritis]. 1996 Nov 138 children with juvenile rheumatoid arthritis were exposed to EHF treatment. Three regimens of the microwave therapy were tested. The best results were achieved at the exposure of the thymic acupuncture points and most affected joint. Combination of microwave therapy with radon or effervescent sulfurated hydrogen baths is also recommended.
8714114 [The ocular manifestations in Felty's syndrome]. 1996 Jan The Felty syndromme is a rare clinical form of the rheumatoid poliarthritis, which involves, besides the articular manifestations specific to the latter, other manifestations such as: splenomegalia with hypersplenism, poliadenopathy, ulcerations at the low leg level and skin pigmentation. In some cases, the Felty syndromme may be associated with ocular modifications: episcleritis, nodular scleritis, corneal ulcer, Sicca syndromme, iridocyclitis, retineal vasculite. A clinical observation of Felty syndromme associated with ocular modifications is presented. Some aspects regarding the nosologic classification of Felty syndromme, its clinical and ethiopathogenical particularities are discussed; the accent is put on the immunopathological component. The ocular modifications particularities, their diagnosis and the therapeutical aspects are presented.
8467610 Protrusio acetabuli in juvenile rheumatoid arthritis. 1993 Mar Acetabular protrusion (PA) as measured by a line crossing method was studied in 73 patients with juvenile rheumatoid arthritis (JRA) and its frequency found to be 12% (9/73), presenting bilaterally in 5 cases and unilaterally in 4. All patients had some other forms of radiological damage and the presence of PA was predominantly observed in the JRA group with greater age at onset (8 vs 4.2 years; p < 0.001) and lower frequency of extraarticular manifestations (22% vs 72%; p < 0.01). There was no correlation with type of JRA onset, course of disease, sex, disease duration, seropositivity for rheumatoid factor, and prior steroid intake.
7511075 Epitope mapping with synthetic peptides of 52-kD SSA/Ro protein reveals heterogeneous anti 1994 Mar The reactivity of autoantibodies present in the sera of 489 patients with Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and other autoimmune diseases was investigated by ELISA using recombinant 52-kD SSA/Ro protein (rRo52) and 39 overlapping synthetic peptides representing the entire sequence of Ro52. We report that IgG antibodies reacting with rRo52 were present in the sera of a large number of patients with SS (67% of patients with primary SS and 46% of patients with SS associated with SLE), whereas they were less frequent (10-25%) in SLE, rheumatoid arthritis (RA), juvenile chronic arthritis (JCA) and mixed connective tissue disease (MCTD), and absent in scleroderma. Among the 39 peptides tested, five were recognized by sera from 30-65% of patients with SS, namely peptides representing residues 2-11, 107-122, 107-126, 277-292 and 365-382. Patients with JCA had raised levels of IgG antibodies reacting with peptides 2-11 and 365-382, and 51% of patients with MCTD had raised levels of IgG antibodies reacting with peptide 365-382. None of the five peptides was recognized by more than 20% of sera from patients with SLE and RA. Interestingly, and of importance in the field of diagnostic tests based on peptides, the reactivity of antibodies to the Ro52 synthetic peptides varied greatly according to the origin of sera. Inhibition experiments using either patients' sera or antibodies induced in rabbits against Ro52 peptides showed that the four domains 2-11, 107-122, 277-292 and 365-382 are accessible on the surface of the Ro52 protein. These regions may thus be involved in the induction of specific antibodies in autoimmune patients.
8441141 Predicting remission in juvenile rheumatoid arthritis with methotrexate treatment. 1993 Jan Forty-nine children with a polyarticular course of juvenile rheumatoid arthritis treated with methotrexate (MTX) for at least one year were analyzed to identify clinical characteristics that would predict remission of arthritis after MTX treatment. Twenty-two children (45%) had remission of arthritis after a mean of 13.6 months of treatment and did not differ from the 27 with persistently active arthritis regarding years of disease before starting MTX, age starting MTX, maximum MTX dose, disease onset type, presence of radiographic joint destruction, concomitant treatment with hydroxychloroquine, sulfasalazine or prednisone, or presence of rheumatoid factor or antinuclear antibodies. Higher dose MTX, earlier treatment, genetic markers, and a standardized route of therapy may yield important information in future studies.
9355676 HLA and juvenile rheumatoid arthritis. 1994 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.
1486300 Genetically determined factors as predictors of radiological change in patients with early 1992 Dec 5 OBJECTIVE: To determine whether genetic factors associated with established rheumatoid arthritis could, in combination with rheumatoid factor, predict the development of radiological erosions in patients with early symmetrical (rheumatoid-like) arthritis. DESIGN: Prospective study. SETTING: Teaching hospital, early arthritis clinic. SUBJECTS: Forty nine patients with symmetrical polyarthritis attending the early arthritis clinic. MAIN OUTCOME MEASURES: Conserved sequence of DR beta third allelic hypervariable region, sulphoxidation capacity, rheumatoid factor, and development of radiologically determined bone erosions. RESULTS: None of the 49 patients had radiological erosions at presentation but 25 developed these by four years. Patients with the conserved class II major histocompatibility complex (third allelic hypervariable of DR beta 1) genes associated with rheumatoid arthritis had a relative risk for the development of erosions of 1.9 (95% confidence interval 0.8 to 4.5). For poor sulphoxidation the risk was 2.5 (1.1 to 5.6) and for the presence of rheumatoid factor 1.8 (0.9 to 3.7). Of the 33 patients who had two or three of these risk factors, 24 developed erosions, with a relative risk of 11.6 (1.7 to 78.5) compared with only one of the 16 individuals with no or one risk factor. CONCLUSIONS: This preliminary study shows that by using these stable markers it is possible to make clinically useful predictions of outcome in patients with early symmetrical inflammatory arthritis.
10830002 Juvenile rheumatoid arthritis--clinical manifestations. 1996 May Chronic inflammatory arthritis in childhood could be due to an obvious cause (e.g. sepsis, rheumatic fever, systemic lupus erythematosus etc.), or it could be idiopathic. After excluding those with obvious cause there still remains a large group of chronic inflammatory arthritis in childhood. This category has been variously called 'juvenile rheumatoid arthritis', 'juvenile arthritis', 'juvenile chronic arthritis', and more recently, 'idiopathic arthritis of childhood', The present article reviews the various classification criteria used for defining this group of disorders with emphasis on the common features as well as the major differences between these criteria. The major classes within this group with their characteristic clinical and laboratory features are also discussed.
8009011 [Felty's syndrome: retrospective study of 12 cases]. 1993 A retrospective study of twelve cases of Felty's syndrome was performed. The main points of this syndrome (clinical presentation, physiopathology, complications, treatment) are described.
1462119 Studies of antibody to herpes simplex virus Fc gamma-binding protein gE in patients with r 1992 Dec IgG antibody to gE, the Fc gamma-binding herpes simplex 1 (HSV-1) viral glycoprotein, was studied in 49 rheumatoid arthritis (RA) patients and 43 normal controls. Antibody to gD, another important HSV-1 antigen, was assayed in parallel. No difference between RA patients and normal controls was found in levels of anti-gE antibody measured by reactivity of IgG F(ab')2 fragments reacting with gE coated to ELISA plates. No difference in anti-gD antibody was recorded between normals and patients with RA. Levels of IgG anti-IgE antibody did not correlate with quantitative elevations of serum rheumatoid factor (RF) in RA patients. When IgG anti-gE and anti-gD were assayed in 20 patients with juvenile rheumatoid arthritis and 22 children controls, no significant differences were noted. However, when individual RFs from patients with RA were tested for reactivity against a panel of affinity-isolated F(ab')2 antibodies to gE, some evidence for individual autospecificity was obtained. Four of 20 monoclonal IgM RFs produced from RA patients' B cells showed marked elevations of reactivity with some RA patients' F(ab')2 antibodies to gE. All four of the monoclonal RFs showing this specificity were derived from RA synovial tissue B cells. These findings may provide support for the concept that some RFs in patients with RA show individual specificity for internal image determinants of IgG antibodies to viral Fc gamma-binding proteins.
8006901 Fatal bronchiolitis obliterans in a patient with juvenile rheumatoid arthritis receiving c 1994 Mar Bronchiolitis obliterans has been described in adults with rheumatoid arthritis, particularly in association with D-penicillamine treatment, but to our knowledge has not been reported in juvenile rheumatoid arthritis (JRA). We describe a 12-year-old girl with JRA who developed bronchiolitis obliterans after a 6-month course of intramuscular gold. She presented with severe obstructive airway disease (FEV1, 17% predicted) unresponsive to bronchodilators, without obvious pathology on chest radiograph. Despite aggressive immunosuppressive therapy and eventual lung transplantation, she died 3 1/2 years after her initial diagnosis of JRA. Although rare, bronchiolitis obliterans must be considered in the differential diagnosis of respiratory distress in children with JRA.
1375649 Evaluation and management of pain in children with juvenile rheumatoid arthritis. 1992 Apr The systematic evaluation and management of chronic and recurrent pain in children with juvenile rheumatoid arthritis (JRA) is only in the beginning stages of empirical development. While recent advances have been made in the assessment of pain secondary to JRA, very little clinical research has been targeted toward pain management. Development of reliable and valid pediatric pain measures is the first step in advocating controlled clinical trials with pain as an essential outcome variable.
1594908 [Mono-arthritis of uncertain etiology--a follow-up study]. 1992 May 9 78 patients in whom the cause of a monoarticular arthritis remained unclear after an initial workup were contacted for a follow-up interview (and an additional clinical examination in 64 cases) after 6 to 11 years (mean 8 years). The mean age at the onset of symptoms was 39 years, with 51% of the patients presenting in the range between 20 and 40 years. There was a slight male preponderance (56%). Large joints, mainly the knee, and less often the wrist, ankle or hip, were affected in 79%. Finger, toe and other small joints were involved in only 21%. During the course of the disease 14% of the cases developed arthritis in other joints. At the time of follow-up an etiologic or nosologic diagnosis was possible only in 5%: 1 infectious Pneumococcus pneumoniae arthritis, 1 Lyme arthritis (Borrelia burgdorferi), 1 gouty arthritis and 1 erosive seronegative rheumatoid arthritis. 95% of all cases remained unclear. However, 91% of all patients became free of symptoms after 6 years. The remaining patients (9%) suffered from arthralgia of undetermined origin (n = 5), from nonclassified destructive coxitis with consecutive development of unclear gonarthritis (n = 1), or from erosive seronegative rheumatoid arthritis (n = 1). 10 patients (13%) underwent a total of 16 invasive procedures related to their arthritis, such as synoviorthesis, synovectomy or arthrodesis. The result of the erythrocyte sedimentation rate had no influence on the outcome. The following conclusions are offered: monoarticular arthritis initially should prompt a thorough investigation in order to exclude infectious or metabolic etiologies for their destructive potential.(ABSTRACT TRUNCATED AT 250 WORDS)
8279445 Plasma thrombomodulin as a marker of vascular injuries in collagen vascular diseases. 1994 Jan Thrombomodulin, a thrombin receptor on the vascular endothelial cell surface, is released into circulating blood. The plasma concentrations in patients with collagen vascular diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis, juvenile rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, polymyositis and/or dermatomyositis (PM/DM), Behçet's disease, and Wegener's granulomatosis, were measured and compared with those of healthy persons. The mean plasma thrombomodulin concentrations in patients with juvenile rheumatoid arthritis, systemic sclerosis, PM/DM, Wegener's granulomatosis, and active states of SLE, rheumatoid arthritis, and Beçhet's disease were significantly higher than those in the control group. Patients with Wegener's granulomatosis showed the highest mean value. The mean values in patients with inactive states of the diseases and Sjögren's syndrome were not significantly different from the values in the control group. In cases of juvenile rheumatoid arthritis, systemic sclerosis, PM/DM, and Wegener's granulomatosis, patients with active interstitial pneumonitis or extensive pulmonary lesions frequently showed higher values of plasma thrombomodulin than those without overt pulmonary involvement. Elevated plasma thrombomodulin values were decreased along with amelioration of the diseases by treatment. These results may indicate that plasma thrombomodulin measurement may be helpful for evaluating vascular injury in patients with collagen diseases.
8000398 [Etiologies of chronic polyarthritis in Lomé (Togo)]. 1994 Jan Medical records were reviewed retrospectively to determine the causes of chronic polyarthritis in patients attending a hospital outpatient clinic in Lomé (Togo). Among 2812 patients seen over 44 months, 70 (2.5%; 28 female, 42 male) had polyarthritis of at least three months' duration. Twenty-six patients (17 female, 9 male), with a mean age of 30 years at disease onset, had isolated, nondestructive polyarthritis mainly involving the distal appendicular joints and responsible for short-lived flares usually adequately controlled by nonsteroidal antiinflammatory agents alone; antinuclear antibodies were looked for in 16 of these patients with positive results in eight. The favorable outcome and negative tests for rheumatoid factors differentiated this condition from rheumatoid arthritis. None of the 26 patients had systemic manifestations possibly suggestive of connective tissue disease. Diagnoses in the 44 remaining patients included gout (n = 15), spondyloarthropathy (n = 12), rheumatoid arthritis (n = 12), juvenile chronic arthritis (n = 2) and human immunodeficiency virus infection (n = 3). These data confirm that rheumatoid arthritis is infrequent in West Africa. The leading cause of chronic polyarthritis in Lomé may be mild isolated nondestructive polyarthritis reminiscent of adult-onset oligoarthritis with antinuclear antibodies. Long-term follow-up and immunological evaluation of patients with this condition can be expected to provide valuable pathogenic and nosologic information.
7794979 Predicting pain among children with juvenile rheumatoid arthritis. 1995 Mar OBJECTIVE: Children and adolescents with juvenile rheumatoid arthritis (JRA) often report pain as a major symptom that affects their daily activities. Little is known about the factors that contribute to pain, however. Demographic, disease status, and social-psychologic variables were used to predict pain of JRA. METHODS: Participants were 37 girls and 23 boys who were 7 to 17 years old. Measures included the Hopelessness Scale for Children, the Sadness Scale from the Differential Emotions Scale--IV, and the Social Support Questionnaire--Revised. A pain visual analogue scale served as the criterion measure. RESULTS: Reported pain was modestly correlated with disease duration and age. A hierarchical regression indicated that the predictor variables accounted for a modest amount of variance in pain scores. CONCLUSIONS: The results suggest that the factors contributing to pain in children with JRA are different from those in adults with rheumatoid arthritis (RA). Research is needed to identify the psychologic and socioenvironmental variables that influence pain among children with JRA.
1643451 Cystic fibrosis arthritis. A report of five cases. 1992 Aug In a retrospective study of 206 patients with cystic fibrosis (CF), five cases of CF arthritis were recorded. This is a frequency of 2.5% and of 4.5% in patients aged over 10. Four patients had episodic arthritis, which was related to the course of pulmonary disease in two cases. In three patients, synovial fluid examination revealed minimal evidence of inflammation. In one of these three cases, synovial biopsy revealed a mild and non-specific synovitis. The fifth patient had chronic arthropathy and was positive for rheumatoid factor, but did not fulfil the criteria for rheumatoid arthritis. There were no radiographic abnormalities in any of these cases. CF arthritis is a rare syndrome of unknown pathogenesis.
7567190 Clinical and genetic evidence that juvenile arthritis is not a single disease. 1995 Oct Ample evidence shows that what was formerly called "juvenile rheumatoid arthritis" is not a single disease. At least six separate diseases were included as subgroups or subtypes of juvenile rheumatoid arthritis in other classifications. The clinical and laboratory features that differentiate these diseases are discussed. Genetic differences, primarily within the HLA system but also for T-cell receptor genes are described and correlated with the new clinical classification of arthritis.