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ID PMID Title PublicationDate abstract
1455791 [A low-frequency alternating magnetic field and its combination with radon baths in juveni 1992 Jul Children suffering from juvenile rheumatoid arthritis (JRA) (n-132) were exposed to low-frequency variable magnetic field. Therapeutic response registered consisted of analgetic and anti-inflammatory effects most pronounced in 14-19 mT regimen. The addition of radon baths to the above exposure resulted in higher effectiveness of the treatment due to involvement of pathogenetic JRA mechanisms.
1570490 Expression of the rheumatoid factor cross-reactive idiotype in JRA: association with disea 1992 We previously reported that approximately one-third of patients with juvenile rheumatoid arthritis (JRA) express high concentrations of antibodies marked by the rheumatoid factor cross reactive idiotype (RCRI) in their sera (6). In order to determine if an expression of RCRI is associated with certain clinical features of the disease, we prospectively studied 49 patients with JRA over a six month period, and determined serum RCRI concentrations by inhibition ELISA. RCRI concentrations correlated significantly with the duration of morning stiffness (r = .3866, p less than .01), and the functional class (p less than .001), but not with the number of active joints. Expression of RCRI was higher in patients with systemic onset disease (p less than .03), compared to patients with pauciarticular or polyarticular disease. In patients studied on more than one occasion, the RCRI expression was relatively constant despite changes in disease activity. A subset of JRA patients with systemic onset disease, higher serum concentrations of the RCRI.
8711538 [Three cases with juvenile rheumatoid arthritis who showed hypocomplementemia related to d 1996 Feb We encountered three cases of juvenile rheumatoid arthritis which showed a depressed serum complement level during the clinical course. Circulating immune complex and increased secondary fibrinolysis were detected in all cases. The laboratory data suggested the presence of vesculitis. Cutaneous vasculitis was observed by biopsy in 2 cases and abnormal respiratory function in one cases. These 3 cases were in contrast to other 95 JRA cases treated in our department who showed normal serum complement levels. Estimation of serum complement may, therefore be useful to predict the vascular complication and refractoriness to therapy in JRA.
8807219 An unusual presentation of Sjögren's syndrome. 1996 Jul A 44-year-old woman presented with a long history of nausea and vomiting and was found to have hypokalemic metabolic acidosis with elevation of the urine bicarbonate level consistent with the new onset of renal tubular acidosis, type I. Her laboratory findings and histologic picture of a buccal biopsy sample of two minor salivary glands were consistent with Sjögren's syndrome. Treatment with steroids markedly improved her symptoms.
8551408 Liver biopsy findings in patients with juvenile rheumatoid arthritis receiving long-term, 1996 Jan We performed percutaneous liver biopsy in nine children who had received a weekly dose of methotrexate, 10 mg/m2 per week, for at least 3 years to address the concern about subclinical liver toxicity from single, weekly, low-dose methotrexate therapy for juvenile rheumatoid arthritis. No patient had clinical or biochemical evidence of liver injury. All biopsy results were interpreted as normal. These results suggest that the recommendations of the American College of Rheumatology for adults receiving single weekly methotrexate therapy for rheumatoid arthritis can be extended to children.
7534965 [Concentration of acute phase proteins in serum of children with rheumatoid arthritis]. 1993 Dec An attempts was made at evaluation of the changes of acute phase proteins-seromucoid (BRS), alpha 1-acid glycoprotein (alpha 1-AGP), alpha 1-antitrypsin (alpha 1-AT), haptoglobin (Hp), C3 protein of complement system (C3), C1 esterase inhibitor (C1-INH), and transferrin (Tf) in the serum of children with rheumatoid arthritis. The patients were divided into clinical and age groups. The studies carried out have shown in ill children increase of BRS, alpha 1-AGP, alpha 1-AT, Hp, and C1-INH levels, During remission increased levels of alpha 1-AGP and Hp persisted. In the studied clinical groups a positive correlation was found between the intensity of changes of the studied indices and the degree of disease activity. In the age groups greater increase of the levels of the studied acute phase proteins was found in the group of preschool children and the group of puberty spurt. The obtained results suggest that the determination of acute phase proteins may be useful in laboratory investigation of children with rheumatoid arthritis.
8148849 [Value of the self-evaluation of functional and painful disorders for the differentiation 1993 Jul The authors sought to determine whether the self-report questionnaire developed by L.F. Callahan and T. Pincus is of use for the diagnosis of fibromyalgia when severe and/or chronic pain raises doubts as to an inflammatory rheumatic disease. This questionnaire evaluates the ratio between pain severity assessed on a visual analog scale and impairment of activities of daily living. High values suggest fibromyalgia, whereas low values occur in rheumatoid arthritis patients. The French translation of the questionnaire was completed by 15 fibromyalgia patients and 22 patients with inflammatory arthritic syndrome of whom 15 had rheumatoid arthritis. Mean pain/impairment ratio was 5.85 +/- 0.68 (SEM) in the fibromyalgia group versus 3.01 +/- 0.38 in the inflammatory rheumatism group. This difference was highly significant (p = 0.001 by Student's t test). The rheumatoid arthritis subgroup was also significantly different from the fibromyalgia group (p = 0.003). These findings are very similar to those reported by Callahan and Pincus. Our data confirm the value of this simple self-evaluation tool. In practice, ratios greater than 5 suggest fibromyalgia whereas ratios under 3 support the diagnosis of rheumatoid arthritis.
8877942 Treatment of juvenile rheumatoid arthritis: approach to patients who fail standard therapy 1996 Sep Approaches to the initial management of juvenile rheumatoid arthritis and comprehensive therapeutic strategies for the management of children who fail to respond to first line treatment are reviewed. Guidelines for introducing advanced antirheumatic drugs, combination therapy, experimental agents, and alternative forms of therapy are considered.
8035404 An unusual pattern of growth disturbance of the hip in juvenile rheumatoid arthritis. 1994 Apr OBJECTIVE: An unusual deformity in the hip in juvenile rheumatoid arthritis (JRA) consisting of a small femoral head in a capacious acetabulum has been described as an isolated finding, but no explanation as to the cause of the deformity has been proposed. We have also observed this deformity and the objective of this investigation was to determine the cause. METHODS: In 1987, a review of hip disease in JRA was carried out at the Wellesley Hospital. Nine hips in 5 patients were identified as having a mismatch in size between the femoral head and acetabulum. Six of these hips came to surgery during the growth phase. RESULTS: The 6 hips undergoing surgery between the ages of 16-19 showed an identical picture at the time of surgery. The pattern of pathology consisted of a femoral head devoid of articular cartilage and an acetabulum that showed an intact triradiate cartilage. Each of the 6 hips was treated with a resurfacing arthroplasty. CONCLUSION: The femoral head grows in circumference by endochondral ossification of the articular cartilage. If the rheumatoid process destroys that articular cartilage, growth of the femoral head ceases. The intact triradiate cartilage permits continuing acetabular growth and the deformity of a small femoral head in a large capacious acetabulum results.
7795616 False positive seroreactivity to Borrelia burgdorferi in systemic lupus erythematosus: the 1995 Apr The object of this study was to determine the incidence of seropositivity to B. burgdorferi by the commonly available enzyme-linked immunosorbent assay (ELISA) in patients with SLE and other rheumatic diseases and to evaluate immunoblot analysis as a tool to differentiate true from false positive ELISA. Sera were obtained from patients with SLE (n = 35), rheumatoid arthritis (n = 26), seronegative arthritis (n = 28) and Lyme disease (n = 18). Reactivity to B. burgdorferi antigens was analysed by two available diagnostic techniques: ELISA and immunoblot. Correlations were made between seroreactivity to B. burgdorferi and standard serological tests of autoimmunity: antibodies to nuclear antigens, dsDNA, cardiolipin, SSA and SSB. Seroreactivity to B. burgdorferi antigens by the ELISA system was detected in 40% of patients with SLE, 8% of patients with rheumatoid arthritis and 4% with seronegative arthritis. Among patients seropositive by ELISA, immunoblots were negative in all cases. However, eight of 14 patients with rheumatoid arthritis (57%) showed cross-reactivity to multiple borreli antigens. No significant correlations were found between Lyme seropositivity by ELISA and other autoantibodies except IgM rheumatoid factor (r = 0.61, P < 0.01) in patients with rheumatoid arthritis. IN CONCLUSION: a positive ELISA for Lyme disease was found in up to 40% of patients with established SLE and also in other rheumatic diseases. However, specific serum antibodies to Borrelia were not confirmed by the more specific immunoblot technique.(ABSTRACT TRUNCATED AT 250 WORDS)
19077983 More Aggressive Drug Treatment of Rheumatoid Arthritis in a University-based Practice. 1995 Aug We sought to assess the impact of recent observations and recommendations on the treatment of rheumatoid arthritis in a university-based rheumatology practice over a recent 6-year period. Data was collected from information recorded in a database by physicians treating patients in outpatient rheumatology clinics. The treatment regimens of all patients with rheumatoid arthritis seen during the first half of 1987 and 1993 were compared. The populations were similar in age, race, and sex distribution, disease duration, and seropositivity. Nonsteroidal anti-inflammatory drug use decreased from 85% to 74%, while corticosteroid use increased from 31% to 44% of patients. Second-line agent use increased from 46% to 65% of patients, all of which could be accounted for by the increase in methotrexate use from 11% to 32%. The use of other second-line agents remained stable (hydroxychloroquine, auranofin, azathioprine), declined (intramuscular gold, penicillamine), or increased slightly (sulfasalazine). An increase in combination second-line drug therapy from 2% to 6% was noted. This study shows that between 1987 and 1993, our drug therapy for rheumatoid arthritis has become more aggressive: we have increased steroid use, decreased nonsteroidal use, and more frequently used second-line agents, particularly methotrexate.
8934930 Animal models for autoimmune disease-associated xerostomia and xerophthalmia. 1996 Apr Numerous models of exocrine tissue pathology related to autoimmune initiation of disease have been described, primarily by either immunohistology or histopathology. These model systems include inbred mouse strains that develop systemic lupus erythematosus, rheumatoid arthritis, graft vs. host disease, and diabetes. Commonly observed features of these mice include organized lymphocytic foci, composed of CD4+ and CD8+ T-cells, in both the salivary and the lacrimal glands. However, only the diabetic mouse model (NOD) undergoes a corresponding loss in exocrine gland function related to the presence of lymphocytic infiltrates. As we define the underlying pathophysiology of Sjögren's syndrome, the future of animal models for this disease will involve genetic exploration of candidate genes for development of autoimmune exocrinopathy.
8463908 Differentiation of systemic juvenile rheumatoid arthritis from acute leukemia near the ons 1993 Apr Many children with acute leukemia have musculoskeletal complaints and non-specific hematologic abnormalities. A total of 10 children with acute leukemia and 10 with systemic juvenile rheumatoid arthritis were compared to delineate which early features could differentiate these diagnoses. Attention to evolving hematologic abnormalities and musculoskeletal findings may expedite diagnosis of these diseases.
1372645 Angiogenesis inhibition suppresses collagen arthritis. 1992 Apr 1 Neovascularization is observed in a spectrum of diseases such as solid tumors, diabetic retinopathy, and rheumatoid arthritis. It is also evident in rat collage-induced arthritis (CIA), an animal model with histologic, clinical, and radiographic manifestations resembling rheumatoid arthritis. To evaluate the effects of angioinhibition in CIA, Louvain rats were immunized with type II collagen to induce arthritis and then administered an angiogenesis inhibitor, AGM-1470, in an attempt to either prevent arthritis or suppress established disease. Using clinical and radiographic criteria, AGM-1470 prevented CIA and significantly suppressed established disease without evidence of immunosuppression. Histologic sections from control ankle joints manifested pannus and neovascularization, which were absent in experimental animals. This is the first study to investigate this novel agent in an autoimmune disease, and additional evaluation of this promising compound in other diseases that are potentially angiogenesis dependent, such as rheumatoid arthritis, might be warranted.
19078008 Can foot orthoses prevent hallux valgus deformity in rheumatoid arthritis? A randomized cl 1995 Dec Hallux valgus deformity is the most commonly observed forefoot deformity in patients with rheumatoid arthritis. This 5-year, double-blind, randomized clinical trial compared treatment orthoses with placebo orthoses for the prevention of hallux valgus deformity in the rheumatoid arthritic foot.One hundred and two subjects with active rheumatoid arthritis and with foot pain and minimal radiographic changes of the feet participated in the study. They were recruited from five arthritis clinics in the Chicago metropolitan area that are affiliated with or are teaching clinics of area medical schools. Patients were followed for 3 years.Eighty-one subjects completed the study. In a logistic regression analysis, the treatment group was 73% less likely to develop hallux valgus deformity compared with the control group (adjusted odds ratio 0.27, 95% confidence interval 0.078, 0.916 p = .04). These findings suggest that foot orthoses can prevent or slow the progression of hallux valgus deformity.
8869217 Adult Still's disease. Part II. Management, outcome, and prognostic factors. 1995 Dec DESIGN: a multicenter study conducted in France identified 65 cases of adult Still's disease. Follow-up exceeded one year in 52 cases. OBJECTIVES: were as follows: 1) to describe treatments used; 2) to analyze disease course patterns; 3) to study joint alterations; 4) to determine whether any characteristics present within the first six months of onset were of prognostic significance. RESULTS: aspirin was ineffective. Indomethacin ensured satisfactory control in eight patients. Corticosteroid therapy was required in 88% of cases. Among patients followed up for more than one year, half developed radiologic joint alterations; 23% had monocyclic systemic disease, 38.5% had polycyclic systemic disease and 38.5% had chronic articular disease. More than half of the patients (58%) had more than one systemic flare. Polyarthritis at onset and involvement of the proximal limb joints were significantly predictive of chronic articular disease, whereas isolated arthralgia was predictive of monocyclic or polycyclic systemic disease. Oligoarthritis was not predictive of the outcome. CONCLUSION: the knowledge that polyarthritis or proximal limb joint involvement within six months of onset is predictive of chronic joint disease may have important therapeutic implications.
7553038 [Clinical studies on 14 cases of adult-onset Still's disease]. 1995 Feb We here report fourteen patients diagnosed as adult-onset Still's disease (AOSD) in our hospital. Seven patients were males (mean age at onset was 26.6 years), and seven were females (30.6 years). All of the cases had spiking fever ( > 39 degrees C) and joint symptoms. Hepatomegaly, splenomegaly, and lymphadenopathy were noted in 50% of the patients, respectively. Skin eruption was seen in twelve patients (85.7%). Among them, nine patients (64.3%) exhibited typical rash. Pleuritis or pericarditis was seen in one case each. Only one patient revealed neurological disorder. Abdominal pain was present in 50% of the cases. The ratio of occurrence of secondary amyloidosis was 14.3%. Four patients (28.6%) were diagnosed to have the apophyseal narrowing at the cervical spine (C2-C3). Two patients (14.3%) accompanied by Sjögren's syndrome were women over 40 years of age. The levels of soluble interleukin-2 receptor were significantly elevated in the sera obtained from seven patients with AOSD and four patients with juvenile-onset Still's disease, compared with normal controls. It seems to support the notion that immunopathologic processes via T cell activation play an important role in the pathogenesis of AOSD.
22959644 Extra-glenohumeral joint shoulder surgery in rheumatoid arthritis: The role of bursectomy, 1994 Mar Twenty-four painful shoulders in patients with rheumatoid arthritis have been studied before and after extra-glenohumeral joint surgery. Preoperative local anesthetic injections were used to localize sites of pain and served as a basis for the surgical procedure performed. Radiographs were graded with the Larsen classification; 17 shoulders had radiographic evidence of advanced glenohumeral disease. Surgery included subacromial bursectomy, anterior acromioplasty, and excision of the outer end of the clavicle. At an average follow-up of 30 months (range 18 to 50 months) for 22 of the shoulders, 19 had minimal pain. Average motions improved in flexion from 68° to 121° and in external rotation from 23° to 52°. Two experienced infections, one superficial and one deep. One further operation has been necessary to treat the shoulder arthritis. Extra-glenohumeral joint surgery, planned according to the results of preoperative injection testing, has a useful role in management of the shoulder in rheumatoid arthritis, even when the glenohumeral joint is involved radiographically.
8047499 Mitral and aortic insufficiency in polyarticular juvenile rheumatoid arthritis. 1994 May Valvar heart disease is a rare complication of juvenile rheumatoid arthritis (JRA), the aortic valve being most commonly affected. Reported cases with symptomatic mitral involvement are rare. We describe a 13-year-old boy with seronegative, polyarticular onset of JRA in whom mitral and aortic valve insufficiency was diagnosed by clinical and laboratory investigations. Two-dimensional and continuous-wave Doppler echocardiography confirmed mild pericardial effusion with moderate mitral and mild aortic insufficiency. Cardiac assessment and echocardiographic follow-up are recommended in all patients with JRA.
1731679 Homograft root replacement for juvenile rheumatoid aortic valve incompetence. 1992 Feb We report a case of severe, crippling juvenile rheumatoid arthritis and aortic insufficiency in a young woman. Homograft replacement of the aortic root offered both long-term durability and the freedom from thromboembolism that her systemic illness required.