Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
8657466 Hypertrophic bursopathy of the subacromial-subdeltoid bursa in juvenile rheumatoid arthrit 1996 Hypertrophic bursopathy is a term used to describe the massive synovial proliferation occasionally seen in the bursae of patients with arthritis. Involvement of the subacromial-subdeltoid (SA-SD) bursa in adults in uncommon, and it is still rarer in children. It may simulate synovial proliferation or fluid within the adjacent shoulder joint. Sonography clearly shows the location and nature of the soft-tissue swelling. Two cases of this entity in children with juvenile rheumatoid arthritis are described, one with a uniquely severe sonographic picture.
8507226 Autoantibodies to chromatin components in juvenile rheumatoid arthritis. 1993 Jun OBJECTIVE: To characterize autoantibodies to chromatin components in patients with juvenile rheumatoid arthritis (JRA). METHODS: The sera of 50 children with JRA were analyzed for antinuclear antibodies (ANA) by immunofluorescence and enzyme-linked immunosorbent assay (ELISA) techniques. RESULTS: By immunofluorescence, ANA and antibodies to high-mobility group proteins or to DNA-free histones were common in patients with pauciarticular JRA and rheumatoid factor-positive polyarticular JRA. However, reactivity with histone-DNA complexes was rare. CONCLUSION: Because antihistone antibodies detected by ELISA failed to bind chromatin or other histone-DNA complexes, they are not likely to represent the immunofluorescent ANA activity in serum.
8703715 Retroperitoneal fibrosis and juvenile rheumatoid arthritis. 1996 Apr We describe a 13-year-old girl with juvenile rheumatoid arthritis who developed obstructive uropathy and renal failure. Retroperitoneal fibrosis (RPF) was confirmed by surgery. Although the renal failure and hydronephrosis resolved after surgery, the symptoms of vascular occlusion persisted. We consider that early diagnosis and treatment are essential. In cases of autoimmune disease, RPF should be considered when there is acquired obstructive uropathy accompanied by vascular occlusion syndrome.
7591586 Juvenile rheumatoid arthritis and renal amyloidosis (case report). 1995 Clinical renal abnormalities, including haematuria, proteinuria, abnormal urinary sediment, decreased renal functions and hypertension are relatively common in children with juvenile rheumatoid arthritis (JRA). These findings may be due to renal amyloidosis or administration of drugs that are potentially nephrotoxic. The case of an 11 years old boy diagnosed as JRA at 4.5 months of age and treated with steroids for 10 years is presented. In his history he had hypertension for 5 years and cataract for one year. Renal biopsy was done to evaluate the aetiology for proteinuria, which was overlooked before his admission to our Department. Secondary renal amyloidosis due to JRA was found at biopsy. The importance of investigation for amyloidosis during the long-term follow-up of JRA is reemphasized.
8256629 A study of prognosis in 52 cases with juvenile rheumatoid arthritis. 1993 Oct The prognosis in 52 patients with juvenile rheumatoid arthritis (JRA) was studied. There were 35 cases of systemic onset, 12 of polyarticular onset and 5 of pauciarticular onset. Thirteen systemic cases developed a polycyclic course with chronic polyarthritis. Many monocyclic JRA in systemic cases subsided within 1 year. There were no instances of polyarticular cases or pauciarticular cases that shifted to other type. However, there were many cases with a long active polyarticular JRA and with remission at an early stage in the pauciarticular type. The stage and class were I or II in 90% of cases with a good prognosis for the joints, but there were some serious cases. Transient carditis or iritis which developed at an early stage subsided later. The intractable systemic cases had drug-induced complications. The cases with steroid-induced complications tended to be chronic. One death in a systemic case was caused by hepatic failure.
8941447 Clinical features, pathogenesis, and treatment of Sjögren's syndrome. 1996 Sep Primary Sjögren's syndrome (SS) is a systemic autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia resulting from lymphocytic infiltrates of the lacrimal and salivary glands. The criteria for the diagnosis of SS continue to be controversial, leading to confusion in the clinical and research literature. It is important to distinguish SS (an idiopathic autoimmune process) from other processes, including hepatitis C infection, autonomic neuropathy, and drug side effects, that can result in sicca symptoms. Recent studies on the pathogenesis of SS in humans and in animal models examine the clonality of the T cell infiltrates, cytokine production by lymphocytes and glandular epithelial cells, neuroendocrine and hormonal factors that affect glandular secretion, and the fine structure of antigens recognized by T and B cells. Studies of SS have allowed comparison of lymphocytes in blood and in the glandular tissue lesions; important differences in the gland microenvironment play an important role in the initiation and perpetuation of the autoimmune process. For example, apoptotic death depends on the balance of Fas, Fas ligand, nuclear factors (eg, bcl-2, bax, and myc), cytokines, neuropeptides, and cell membrane interactions with extracellular matrix. Although increased rates of apoptosis may be present in the blood T cells of SS patients, some glandular T cells are resistant to apoptosis. Recent advances have led to improved understanding of signal transduction in response to cytokines and hormones that play a role in the local and systemic manifestations of SS. New approaches to therapy are designed to improve the qualitative properties of corneal epithelial surface, as well as increase tear volume.
8542010 The discriminating value of serum lactate dehydrogenase levels in children with malignant 1996 Jan OBJECTIVES: To determine if serum lactate dehydrogenase levels distinguish patients with malignant neoplasm presenting with musculoskeletal complaints from patients with juvenile rheumatoid arthritis who reported similar symptoms. DESIGN: Retrospective case-comparison study. SETTING: Tertiary care, outpatient clinics. PATIENTS: Twelve patients with malignant neoplasms who presented with arthritis or arthralgias and normal complete blood cell counts and blood smears in whom rheumatologic diagnosis was initially made were compared with 24 children with a final diagnosis of juvenile rheumatoid arthritis. The patients with malignant neoplasms all had normal blood counts and elevated sedimentation rates at symptom onset. INTERVENTIONS: None. RESULTS: Serum lactate dehydrogenase levels were significantly higher in the cancer patients at 2.2 times the normal values vs 0.8 times high normal for patients with juvenile rheumatoid arthritis (P =.004, Mann-Whitney U test) No significant differences were observed in white blood cell counts, hemoglobin levels, platelet counts, erythrocyte sedimentation rate, or uric acid or aspartate aminotransferase levels at initial evaluation. CONCLUSIONS: Serum lactate dehydrogenase values may distinguish patients with malignant neoplasms from those with rheumatic disease early in the course of illness when symptoms and other laboratory values are not helpful.
1625093 Human leukocyte antigen-DRB1*1104 in the chronic iridocyclitis of pauciarticular juvenile 1992 Jul To determine whether genetic markers for chronic iridocyclitis could be identified, we used both serologic and oligonucleotide dot blot techniques to characterize immunogenetically 164 children with early-onset pauciarticular juvenile rheumatoid arthritis. Seventy-eight children (47.6%) had chronic iridocyclitis and 86 (52.4%) had not had evidence of eye disease during a mean follow-up period after the onset of arthritis of 15.8 years (minimum of 5.5 years). Control subjects were 218 healthy, unrelated individuals. The analysis was limited to alleles known to be associated with an increased or decreased risk of early-onset pauciarticular juvenile rheumatoid arthritis or of chronic iridocyclitis in this form of juvenile rheumatoid arthritis. Only one split of human leukocyte antigen (HLA)-DR5, HLA-DRB1* 1104, showed a statistically significant association with a risk of chronic iridocyclitis (chi-square value = 7.52; p = 0.036 adjusted; odds ratio 3.45); HLA-DQA1* 0501 and HLA-DQB1* 0301, both in linkage disequilibrium with HLA-DRB1* 1104, also were significantly associated with eye disease. Patients with both the DRB1* 1104 and DPB1* 0201 genes had a 7.7-fold increased risk for chronic iridocyclitis compared with that for other patients. The presence of HLA-DRB1* 1104 was about four times as specific, but only about one third as sensitive, as antinuclear antibodies in identifying patients at risk for eye disease. Although all children with early-onset pauciarticular juvenile rheumatoid arthritis should undergo periodic slit-lamp examinations, those with the HLA class II gene DRB1* 1104 are at particularly high risk for eye disease, and we recommend that they be monitored carefully for its evolution.
8750313 Antiperinuclear factor in the diagnosis of juvenile rheumatoid arthritis. 1995 Aug The antiperinuclear factor (APF) was estimated by immunofluorescent microscopy in the sera of 32 children and adolescents with juvenile rheumatoid arthritis (JRA) in comparison to a group of 16 children and adolescents with other rheumatologic disorders and a group of 20 age-matched healthy subjects. The APF was detected in 17 children with JRA (53%), in only one patient in the group of other rheumatologic disorders (6%), and in 2 healthy children (10%). Accordingly, APF had a sensitivity of 53%, a specificity of 92%, and a diagnostic efficiency of 74% in our series. APF was found to have a higher diagnostic gain in rheumatoid factor (RF) seronegative cases than did the RF in APF negative cases, meaning a higher sensitivity of APF as compared to the RF. The APF seropositivity was neither altered by the use of corticosteroids nor influenced by the age, gender, duration of illness, or number of joints affected. Three out of 5 patients with JRA had the APF detected in their synovial fluid; they were running rather a severe course of illness. The use of the APF could be an aid in the diagnosis of JRA.
29219665 Juvenile rheumatoid arthritis. 1994 Aug Preview 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.
8353991 Normal levels of soluble CD4 in sera from patients with juvenile chronic arthritis. 1993 May Sera from a group of patients with juvenile chronic arthritis (JCA) were tested for soluble CD4 (sCD4). In most cases normal levels of the molecule were detected independent of disease activity. Similar results were obtained when sera from a population of adult rheumatoid arthritis (RA) patients were analyzed. Immunophenotypic studies of circulating mononuclear cells from seven JCA patients with active disease showed that T cells did not express activation markers. Finally, preliminary experiments showed that sCD4 levels were high in the synovial fluids from 3 RA patients as compared with paired serum determinations.
8091143 Serum concentration of hyaluronan, IgM and IgA rheumatoid factors in a population based st 1994 Increased serum levels of hyaluronan (HA) have been found in patients with liver diseases, psoriasis, malignancies as well as in rheumatoid arthritis and osteoarthritis. In the two latter groups serum HA levels may reflect the extent of synovial involvement and inflammation, rather than only unspecific information. This study was performed to elucidate the value of measuring HA in children with juvenile chronic arthritis (JCA) and to study its relation to class specific rheumatoid factors (IgM Rf and IgA Rf). HA was analysed in sera from 271 patients with JCA and 130 controls using a radiometric assay and IgM Rf and IgA Rf were analysed using an enzyme immunoassay. The results were analysed in relation to JCA subgroup, disease activity and functional outcome. In patients and controls higher levels of HA were found in young children than in older. Raised levels of HA and IgM Rf were mainly found in children with polyarticular disease. Impaired functional outcome was related to raised HA levels. No correlation was found between HA levels and IgM Rf or IgA Rf. Measurement of HA levels in JCA is of no diagnostic value because of low sensitivity. Quantification of HA may, however, have prognostic value in a subgroup of patients belonging to the polyarticular subgroup.
7774064 Composition and biological behaviour of immune complexes isolated from synovial fluid of p 1995 Jun Data published from in vitro studies have shown that IgM-rheumatoid factor (RF)-bearing immune complexes possess several biological features that may contribute to their pathogenicity. However, no studies have demonstrated that such complexes exist at sites of inflammation in children with rheumatoid disease. We used two methods of sequential column chromatography to purify immune complexes from synovial fluids of children with JRA. We demonstrate that high molecular weight complexes contain IgM-RF, have not bound C4 in vivo, but activate the classical pathway in vitro. In contrast, complexes which have bound C3 in vivo do not contain IgM-RF and are weak complement activators in vitro.
7612409 Corticosteroids in the treatment of rheumatologic diseases. 1995 May Over the past year, a number of important advances have been made in understanding the pathobiology and clinical utility of corticosteroid agents for rheumatic disease patients. Unfortunately, the new information did not always confirm our preconceived notions. Pulse or intermittent high-dose steroid administration for rheumatoid arthritis as yet does not have a clear role. Observational analyses of populations of rheumatoid arthritis subjects, although based on data from the most severely ill patients, turn us away from using prednisone as background therapy in rheumatoid arthritis. Bone loss may be rapid and profound in rheumatoid arthritis patients in spite of clinical improvement from what are believed to be "acceptable" low doses of prednisone, and high-dose corticosteroid treatment of giant cell arteritis may be worse than the disease itself. Several reviews point to thoughtful strategies for the prevention of corticosteroid side effects. It is clear that new dosing arrangements need to be created and studied.
10709025 Rheumatoid Arthritis of the Foot and Ankle. 1994 Nov Rheumatoid arthritis of the foot and ankle can be a debilitating problem, particularly for patients who have undergone successful hip or knee arthroplasty. Optimal medical management, use of orthotic devices, and surgical intervention are essential components of patient care. Forefoot involvement with hallux valgus and lesser metatarsophalangeal joint subluxation and dislocation are the most common findings. Reconstruction usually requires lesser metatarsophalangeal joint excisional arthroplasty and first metatarsophalangeal joint arthrodesis. Midfoot tarsometatarsal and intertarsal involvement is treated with orthotic devices and intertarsal fusion for advanced arthropathy. Hindfoot involvement frequently leads to pes planovalgus deformity, which may require isolated talonavicular arthrodesis if treated early or triple arthrodesis for advanced destruction. Ankle involvement is less frequent; when it is unresponsive to conservative measures, ankle symptoms may be improved by arthrodesis. Although great advances have been made in medical and surgical management of rheumatoid arthritis, the disease remains a serious problem. Through prudent use of medical management, orthotic devices, and other conservative measures as well as surgical intervention, long-term function can be enhanced greatly.
1570125 Multiple sclerosis in pregnancy: a review. 1992 May This case history discussed multiple sclerosis that began during pregnancy, in a patient with a history of juvenile rheumatoid arthritis. The etiology, epidemiology, pathophysiology, diagnosis, clinical course, and management of MS are reviewed from the point of view of an obstetrician, with emphasis on the interaction between MS and pregnancy. The similarities and differences between MS and rheumatoid arthritis, with respect to the effect of pregnancy on these diseases, is discussed. Because of the generally beneficial effect of pregnancy on MS and rheumatoid arthritis, and the frequent exacerbations of both diseases seen in the postpartum period, further studies of the relationship between pregnancy and these diseases may provide clues to the immunology and treatment of multiple sclerosis and other autoimmune diseases.
7728888 Rheumatoid arthritis and connective tissue disorders: juvenile chronic arthritis. 1995 Feb That juvenile chronic arthritis (JCA) occurs in tropical countries there is no doubt. The spectrum of differential diagnoses is wider than in temperate regions. The disease tends to be more severe irrespective of the type of onset, and there is a high incidence of positive rheumatoid factor. Many cases present with advanced disease. There is a need for the establishment of clinics devoted specifically to the detection, documentation, and treatment of JCA.
8323239 Arthroscopic and radiographic examination of patients with juvenile rheumatoid arthritis b 1993 In a 5-year follow-up after open knee joint synovectomy in 18 patients with juvenile rheumatoid arthritis (JRA) there was no radiographic progression of the juvenile rheumatoid arthritic changes. Radiographic evidence indicative of osteoarthrosis and of the soft tissue swelling were scored separately. Radiographic changes consistent with osteoarthrosis increased significantly during the observation period (P < 0.001). Arthroscopic evaluation of cartilage changes and radiographic evaluation of osteoarthrosis correlated significantly (P = 0.004). These were the only parameters found predicting the development of further cartilage destruction (P = 0.001). Clinically, the patients had significant improvement five years following synovectomy (P = 0.018), even though three patients required resynovectomy (one successfully after four years, and two patients are waiting for resynovectomy). At the 5-year follow-up both radiographic and clinical data indicate that juvenile rheumatoid arthritic activity of the knee joint was reduced following open synovectomy while osteoarthrosis developed. A new system of scoring radiographic JRA changes of the knee joint was found useful.
1732294 Hip involvement in juvenile rheumatoid arthritis. 1992 Jan We followed 386 children who met the criteria for juvenile rheumatoid arthritis (JRA) an average of 89 months. Hip involvement in JRA results in poor functional capacity. The prognosis for the pauciarticular group is good, but patients with onset at age greater than 6 years appear to do worse than those aged less than 6 years. In the polyarticular group, age of onset did not change the prognosis, whereas the systemic-onset group aged less than 6 years had a worse prognosis and more frequent radiographic changes than the older group.
1631205 Exercise response in children with and without juvenile rheumatoid arthritis: a case-compa 1992 May The primary purpose of the study was to compare the response to bicycle ergometer exercise in children with and without juvenile rheumatoid arthritis (JRA). Heart rate, exercise duration, highest work load completed, and peak oxygen consumption (peak VO2) were compared. A secondary purpose of the study was to determine the relationship between peak VO2 and articular disease severity. Thirty children with JRA and 30 controls matched for age, sex, and body surface area (BSA) were the subjects. Peak VO2 was determined by an open-circuit computerized gas analysis system. Peak VO2, highest work load completed, exercise duration, and peak heart rate were significantly lower among the children with JRA than their respective controls. Submaximal heart rate was significantly higher for the children with JRA. There was no difference in resting heart rate between the two groups. There was no relationship between peak VO2 and articular disease severity among the children with JRA. The results suggest that aerobic conditioning programs may be indicated soon after diagnosis for patients with JRA, regardless of the severity of their articular disease. One subject with JRA and 2 control subjects reported light-headedness and dizziness, and 1 subject with JRA complained of increased knee swelling. We recommend that physical therapists monitor patients for signs of exercise intolerance and joint symptoms during exercise training sessions. [Jasso Giannini M, Protas EJ. Exercise response in children with and without juvenile rheumatoid arthritis: a case-comparison study.