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ID PMID Title PublicationDate abstract
1578458 Preliminary criteria for classification of adult Still's disease. 1992 Mar We have attempted to design classification criteria for adult Still's disease by analyzing the data obtained through a multicenter survey of 90 Japanese patients with this disease and of 267 control patients. The proposed criteria consisted of fever, arthralgia, typical rash, and leukocytosis as major, and sore throat, lymphadenopathy and/or splenomegaly, liver dysfunction, and the absence of rheumatoid factor and antinuclear antibody as minor criteria. Requiring 5 or more criteria including 2 or more major criteria yielded 96.2% sensitivity and 92.1% specificity. However, an exclusion process will be needed for an accurate classification, since this disease is relatively rare.
8484098 Nodules of the shoulder girdle in two Indonesian villages. 1993 During a community survey of rheumatic complaints in a Javanese rural population, fibrous shoulder girdle nodules having a consistent form and position were observed in seven men. This was 2.3% of 303 men with complaints examined from a total population of 2184 men surveyed by house-to-house interviews (response rate 95.2%). Nodules were not seen in any of the 640 women examined with complaints from a total population of 2499, nor were they seen in 130 men and 159 women with complaints from an urban population of 481 men and 590 women over the age of 15 years. It was considered most likely that these shoulder nodules were the result of longstanding repetitive mechanical irritation due to carrying heavy loads by a resilient wooden pole balanced across the shoulder.
1586255 Adult onset Still's disease: clinical experience with 18 patients over 15 years in norther 1992 Apr Over a 15 year period 18 patients (eight men, 10 women), 16-50 years old, were diagnosed as having adult onset Still's disease. Fever and arthralgia were always present but prominent lymphadenopathy was uncommon and the serosa were rarely affected. The typical rash of this disease was observed in nine patients. Several complications, including deforming arthritis, amyloidosis, granulomatous hepatitis, uveitis, scleritis, cutaneous vasculitis, and cardiomyopathy, were observed during follow up. Two patients were affected by a nosocomial infection during immunosuppressive treatment for uncontrolled disease. There were no characteristic features at necropsy. Ten patients had a monocyclic course that responded well to aspirin and indomethacin, whereas eight had a polycyclic pattern which invariably required treatment with corticosteroids. Serious complications developed exclusively in the latter group. This group of patients requires early, intensive disease modifying treatment.
7768253 Methotrexate in juvenile rheumatoid arthritis. Evidence of age dependent pharmacokinetics. 1995 Children with juvenile rheumatoid arthritis (JRA) have been reported to require higher doses (per kg body weight) of methotrexate (MTX) than adults with rheumatoid arthritis to control their disease. The purpose of the present study was to characterise the plasma pharmacokinetics of MTX and its major metabolite, 7-hydroxymethotrexate (7-OHMTX) in children, and to compare the results with those previously obtained in adults. Thirteen patients (age 5-16 y) with JRA (median disease duration 5.5 y) were studied after once weekly oral administration of MTX (median 0.21 mg.kg-1). The analytical method was sufficiently sensitive to permit determination of plasma and urinary concentrations of MTX and 7-OHMTX during the entire dose interval in most of the patients. The dose normalized area under the plasma concentration versus time-curve (AUC) of MTX increased with the age of the children and was lower than previously found in adults. The dose normalized AUC of 7-OHMTX was not dependent on age. No correlation was found between the AUCs of MTX and 7-OHMTX. The results suggest that the age-dependence of the pharmacokinetics of MTX might explain the observation that at least some children require higher doses of MTX than adults to obtain a sufficient therapeutic effect.
9102237 [A case of recurrent bilateral shoulder dislocation in a patient with Felty's syndrome]. 1996 A case of recurrent bilateral shoulder dislocation in patient with Felty disease is presented. Good clinical result has been achieved after surgical treatment inclusive of synovectomy and bone bar implantation into the anterior edge of the scapula followed by appropriate rehabilitation.
1496158 Sjögren's syndrome: historical overview and clinical spectrum of disease. 1992 Aug Sjögren's syndrome is a chronic autoimmune and inflammatory disease characterized by lymphocyte proliferation that progressively destroys exocrine glands. The lymphocytes can infiltrate other and more vital organs and may at times become malignant. Another name for this disease is autoimmune exocrinopathy. It was first described over 100 years ago both as a benign syndrome of oral and ocular dryness and also as a lymphoid malignancy. Thus, Sjögren's syndrome is related to the autoimmune rheumatic diseases, as well as to lymphoid B-cell malignancies.
8814238 Abnormality of Oct-1 DNA binding in T cells from Sjögren's syndrome patients. 1996 Sep Primary Sjögren's syndrome (SS) is an autoimmune rheumatic disease characterized by T cell hypoactivity. To understand the diminished T cell response to activation signals, we measured nucleoprotein DNA-binding activities regulating gene expression during T cell activation using the electrophoretic mobility shift assay. Peripheral blood lymphocytes from 9/19 SS patients were found to be defective in their ability to bind an october sequence (Oct-1). This Oct-1-binding phenotype remained stable in culture for up to 3 days prior to activation. This abnormality was not seen in resting T cells nor T cells from patients with systemic lupus erythematosus, rheumatoid arthritis (RA), or SS accompanied by RA. The SS Oct-1 DNA-binding abnormality correlated significantly with an inability of cells to exit the Gzero/G1 cell cycle phase when stimulated in vitro. Importantly, nucleoprotein extracts showing decreased DNA-binding activity had normal amounts of Oct-1 proteins as determined by immunoprecipitation, implying a functional defect in the Oct-1 protein. Moreover, defective DNA binding was corrected by treatment with acid phosphatase.
7497534 Sjögren's syndrome. 1995 Aug The review describes the historical development and nomenclature of Sjögren's syndrome--primary and secondary. The strengths and weaknesses as well as similarities and dissimilarities for establishing the diagnosis of keratoconjunctivitis sicca and xerostomia used among the five most commonly classification criteria sets are focused upon in text and table. Validation of the different sets of criteria are performed. Primary and secondary disease activity markers and outcome measures as well as future research plans for improving diagnosis are dealt with.
8457222 HLA class II alleles and heterogeneity of juvenile rheumatoid arthritis. DRB1*0101 may def 1993 Apr OBJECTIVE: To examine the distribution of HLA class II alleles in clinically distinct juvenile rheumatoid arthritis (JRA) subsets. METHODS: We typed 298 patients and 181 controls for HLA-DRB1, DQA1, DQB1, and DPB1 alleles using polymerase chain reaction and oligonucleotide probe techniques. RESULTS: Each JRA subset was characterized by a distinct distribution of HLA class II alleles. For the persistently pauciarticular and rheumatoid factor-negative polyarticular JRA subsets, certain combinations of DRB1 and DPB1 alleles were characteristic. In patients without antinuclear antibodies and chronic iridocyclitis, there was an increase of DRB1*0101/02 and DQA1*0101. CONCLUSION: Findings of HLA typing support clinical subdivisions of the disease and suggest the existence of a novel DRB1*0101/02 and DQA1*0101 associated disease subset.
8513595 Elevated soluble CD8 antigen and soluble interleukin-2 receptors in the sera of patients w 1993 Jul Activated T lymphocytes release various molecules including soluble CD8 (sCD8) antigen and soluble interleukin-2 receptor (sIL-2R). Elevated serum sCD8 antigen levels have been found in patients with viral infections, certain hematologic malignancies, and rheumatoid arthritis. On the other hand, elevated serum levels of sIL-2R have been found in various diseases including juvenile rheumatoid arthritis (JRA). We measured sCD8 antigen and sIL-2R levels using enzyme-linked immunosorbent assays in the sera of 49 afebrile patients with JRA (systemic 15, polyarticular 16, and pauciarticular 18) and 16 normal children. Disease activity was classified as mild, moderate, and severe. Sera from patients with severe JRA expressed statistically significant higher levels of both sCD8 and sIL-2R, whereas patients with mild disease had the lowest levels. There were no differences in the serum sCD8 and sIL-2R levels between the groups of patients with pauciarticular-, systemic-, and polyarticular-onset disease. Patients who were treated with prednisone had statistically nonsignificant higher serum levels of sCD8 and sIL-2R. A statistically significant positive correlation was found between sCD8 and sIL-2R levels, sCD8 levels and erythrocyte sedimentation rate (ESR), and sIL-2R levels and ESR. Our findings further suggest the presence of activated lymphocytes in patients with JRA and show that sCD8 antigen serum levels correlate with both serum levels of sIL-2R and ESR and thus may represent alternative indicators of disease activity.
8237716 Cefadroxil reduces the production of IgE in a 3 year old asthmatic with juvenile rheumatoi 1993 Jul Cefadroxil, a cephalosporin, had been prescribed to children with superinfected atopic dermatitis, and was shown to improve both the infection, the clinical status and induced a dramatic lowering of the serum total IgE levels. Further studies have confirmed the IgE immunomodulating properties of cefadroxil. We report the case of a 3 year old asthmatic child who was hospitalized for superimposed pneumonia and was included in a study evaluating cefadroxil. The child was also suffering of juvenile rheumatoid arthritis. After treatment with cefadroxil and oral salbutamol, the child fully recovered. The initially elevated serum IgE (day 1:556 IU/ml) dropped to normal values (day 21: 52 IU/ml), while the production of IgE in vitro by peripheral blood B cells was normalized. We suggest that one mechanism of action of cefadroxil is the stimulation of production of gamma interferon in patients with atopic disorders; this mechanism interferes with the IL-4 primary signal, as well as with other second signals recognized for the synthesis of IgE. Gamma interferon may also prove beneficial for the control of juvenile rheumatoid arthritis.
7837165 Phospholipase A2 in juvenile rheumatoid arthritis: correlation to disease type and activit 1994 Oct OBJECTIVE: Secretory nonpancreatic phospholipase A2 (snpPLA2) is a proinflammatory enzyme and its activity in serum correlates with disease activity in adults with rheumatoid arthritis. Juvenile rheumatoid arthritis (JRA) may be stratified into 3 clinical types with differing degrees of disease activity. Since in JRA there are no reliable indices of disease activity, our objective was to find whether the level of circulating snpPLA2 correlates with the severity of inflammation and with JRA activity. METHODS: PLA2 enzymatic activity was assayed using E. coli membranes labelled with (14C)-oleic acid. SnpPLA2 immunoreactivity was tested by ELISA technique using monoclonal antibodies against recombinant human (rh) snpPLA2. SnpPLA2 activity was determined in sera of 127 children including 25 with systemic (S-JRA), 50 with polyarticular (Po-JRA) and 52 with pauciarticular (Pa-JRA) types of JRA. Twenty-five patients with active disease, were subsequently restudied in an inactive phase. RESULTS: Markedly increased snpPLA2 (> mean + 2 SD of normal mean, i.e., > 575 U/ml) was found during the active disease in 100% S-JRA, 57% Po-JRA and 25% Pa-JRA patients. The differences in the mean and median PLA2 activity among these 3 subtypes of JRA were highly significant (p < 0.001) with the highest levels found in S-JRA and the lowest in Pa-JRA. Presence of rheumatoid factor and/or of antinuclear antibody had no relation to the level of snpPLA2. SnpPLA2 activity became markedly lower when active inflammation became quiescent. In the whole group, snpPLA2 activity correlated highly with the Lansbury index, number of involved joints and number of effusions. A significant positive correlation was also found between snpPLA2 and erythrocyte sedimentation rate (ESR) and neutrophil count, while a significant negative correlation was noted with the level of albumin and hemoglobin. With the exception of snpPLA2, other laboratory variables did not correlate with the number of effusions or the number of active joints. However a negative correlation was noted between both hemoglobin and albumin, and Lansbury index. CONCLUSION: Circulating snpPLA2 significantly correlates with JRA activity and may serve as an index of activity in JRA especially in patients with systemic type of disease.
1575579 Disseminated intravascular coagulation with renal and liver damage as the predominant mani 1992 Mar Relapses of systemic juvenile rheumatoid arthritis associated with intravascular coagulation are rare. This paper describes a patient who, over a two year period, had two relapses, each accompanied by evidence of liver and renal damage and disseminated intravascular coagulation. The patient was not receiving non-steroidal anti-inflammatory drugs, and all laboratory and clinical manifestations of her disease rapidly resolved after treatment with prednisone. It is therefore believed that the hepatocellular damage, in addition to the disseminated intravascular coagulation, was a direct manifestation of disease activity. A possible pathogenic role for tumour necrosis factor is suggested.
8923375 Serum levels of hyaluronic acid indicate the severity of joint symptoms in patients with s 1996 Nov OBJECTIVE: Elevated serum levels of hyaluronic acid (HA) correlate with joint inflammation in adult rheumatoid arthritis (RA). There are no laboratory indices for specifically assessing joint inflammation. Therefore, serial measurements of HA were assessed as a possible tool for measuring the severity of arthritic symptoms in children with juvenile rheumatoid arthritis (JRA). METHODS: Serum levels of HA, measured by a sandwich assay method using HA binding protein, were correlated with the severity of joint symptoms and with laboratory test values in 71 patients with JRA, 30 children with other rheumatic diseases, and 138 children without rheumatic disease. RESULTS: Serum levels of HA showed significant correlation with the severity of joint symptoms, but not with systemic symptoms, in patients with systemic and polyarticular JRA. No other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, reflected the severity of joint symptoms. This correlation of serum levels of HA with joint symptoms was observed in patients with systemic and polyarticular JRA, but not in pauciarticular JRA, other rheumatic diseases, or nonrheumatic diseases, even when signs of arthritis were present in the latter 3 groups. CONCLUSION: Serum levels of HA are useful in objectively evaluating arthritic symptoms in patients with systemic and polyarticular JRA, and may have diagnostic value in this disease.
8248736 Mandibular condyle lesions related to age at onset and subtypes of juvenile rheumatoid art 1993 Oct The severity of lesions in the temporomandibular joint (TMJ) area and their association with age at onset, the various forms of juvenile rheumatoid arthritis (JRA), and certain serologic tests for rheumatoid factor (RF), antinuclear antibodies (ANA), and human leukocyte antigen (HLA)-B27 were determined in 15-yr-old children. The series comprised 121 JRA children, 78 girls and 43 boys, in whom an analysis had recently been made of the relation of TMJ lesions to jaw movement and occlusal status. The mean age at onset was 7.3 yr, the girls contracting JRA earlier than the boys. Also, the girls with lesions in the TMJ area were significantly younger than those with no lesions. TMJ abnormalities were found in 50% of cases with a pauciarticular or systemic onset, but in 72% of those representing the polyarticular subtype. Flattened condyles and grave lesions were equally represented in all subgroups and in both sexes. A crossover from onset type to present diagnosis was found in 30% of the cases, mostly from pauciarticular to polyarthritis, which also increased the risk of TMJ lesions from 50 to 60%. RF, ANA, or HLA-B27 alone did not seem to be associated with a risk of TMJ abnormalities. Maximal opening capacity is more restricted in patients with early onset or a polyarticular mode of JRA. Since the TMJ is affected in more than half of JRA children, regular measurements of maximal movements of the mandible or roentgenologic examinations of the TMJ are essential for their optimal treatment.
1553868 [A case of juvenile rheumatoid arthritis with panuveitis]. 1992 Jan An association of bilateral panuveitis and juvenile rheumatoid arthritis (JRA) was recognized in a case which had an acute onset of systemic JRA without ocular manifestations 3 years previously. On the present occasion she had no active systemic inflammation at the onset of panuveitis. Fluorescein angiography demonstrated bilateral hypo-fluorescent patches at the posterior pole in the early stage and corresponding window defects in the late stage. Topical corticosteroid treatment and oral non-steroid therapy resulted in clinical improvement of the uveitis. It is concluded that ophthalmologic examinations, including fundus ophthalmoscopy, are important in patients with JRA, since there is a possibility of ocular symptoms, even in the systemic type in which ocular complications are rare, as well as in cases with a long interval since the onset of arthritis.
7567188 Drug treatment in children with juvenile rheumatoid arthritis. Past, present, and future. 1995 Oct Rheumatology made its debut as a legitimate subspecialty of pediatrics sometime in the 1940s in Europe, and in the 1970s in North America. Therapy of juvenile rheumatoid arthritis has evolved from salicylates and gold injections to newer, less toxic nonsteroidal anti-inflammatory drugs and methotrexate. Corticosteroids remain as important drugs when life-threatening complications or blinding iridocyclitis develop. Immune response modifiers and gene therapies offer considerable potential for eventually halting or curing the disease but have yet to make a substantial impact on therapy. Methods for the correct conduct and interpretation of data from clinical trials are discussed.
8358994 Chronic destructive monoarthritis of the wrist in patients with anti-SSA/Ro antibodies: re 1993 Jun Among 340 patients with rheumatic diseases, two cases of chronic destructive monoarthritis of the wrist with anti-SSA/Ro antibodies and rheumatoid factor, were observed for over three years. It is not clear whether these cases represent a specific subset of rheumatoid arthritis (RA) or whether they may progress to diffuse symmetrical destructive polyarthritis typical of RA. Long-term follow-up studies including analysis of autoantibodies will be needed to clarify the characteristics and course of chronic monoarthritis.
8377573 [Alternative methods of therapy in rheumatic diseases]. 1993 Jan Four hundred and forty patients with various rheumatic diseases were tested. We asked their opinion regarding an eventual attempt to treat their disease by alternative methods of treatment, about the success of treatment, their relationship to these methods before and after treatment. Among the investigated persons there were 218 women and 222 men. Thirty per cent (134) tried out one or more methods of alternative treatment. As regards the number, among our patients those with lumbar syndrome hold first place (N = 151), followed by those with rheumatoid arthritis (N = 123). Thirty per cent of patients with lumbar syndrome and 51% of those with rheumatoid arthritis tried out one or more methods of alternative treatment. In both groups of patients, a significantly longer duration of treatment was established (p < 0.005). In the patients with rheumatoid arthritis the most frequently chosen method was acupuncture (62%), in patients with lumbar syndrome it was chiropraxis (76%). From among the total number of patients trying out alternative methods of treatment (N = 134), before treatment 79% had a positive and only 3% negative relationship to it. Eighteen per cent, evaluated this kind of treatment merely as an experiment or were indifferent to it. After the treatment, only 37% of the previous 79% still had a positive opinion, while the share of negative opinions increased from 3% to 32%, 31% of the patients were indifferent. After the treatment, 36% of our patients with rheumatoid arthritis who had tried out alternative methods of treatment still had a positive relationship, while 41% had a negative and 23% an indifferent relationship to this kind of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
8656139 Primary Sjögren's syndrome: the challenge for classification of disease manifestations. 1996 Jun A new model for classifying the clinical disease manifestations of primary Sjögren's syndrome is introduced. Three "exocrine' and four "nonexocrine' subgroups of disease manifestations are defined. Accordingly, "surface exocrine disease' includes the diagnostic features from eyes, mouth, and the manifestations from the upper airways, skin and genital tract. Involvement of the excretory parenchyma of the lungs, hepatobiliary system, pancreas, gastrointestinal tract and kidneys is designated "internal organ exocrine disease'. We suggest "monoclonal B lymphocyte disease' to be an exocrine disease manifestation because it originates mostly from the immunoinflammatory foci of the autoimmune exocrinopathy. The nonexocrine manifestations are subgrouped into "inflammatory vascular disease'. "noninflammatory vascular disease', "mediator-induced disease' and "autoimmune endocrine disease'.