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ID PMID Title PublicationDate abstract
8399431 Comparison of peak isometric knee extensor torque in children with and without juvenile rh 1993 Jun This study compared peak isometric knee extensor torque in children with juvenile rheumatoid arthritis (JRA) and healthy children. A secondary purpose was to determine the relationship between measures of articular disease severity and peak isometric knee extensor torque. Peak torque was measured with a computerized dynamometer. Twenty-eight children with JRA and 28 children without JRA were matched for age, sex, and body surface area. Peak isometric knee extensor torque was significantly lower among the children with JRA than their respective control (P < 0.05, paired Student's t-test, one-tailed). There was no relationship between peak torque and measures of articular disease severity among the children with JRA. Subjects complained of quadriceps muscle discomfort as a result of the isometric muscle test. One child with JRA complained of increased knee pain and swelling. Peak isometric knee extensor torque appears to be a useful variable for characterizing muscle function deficits in children with JRA. Isometric muscle performance did not correlate with articular disease severity. The results suggest that isometric strengthening programs are indicated for this patient population. We recommend that clinicians monitor patients for joint and muscle symptoms during exercise training sessions.
7899103 The temporomandibular joint in juvenile rheumatoid arthritis: I. Computed tomographic find 1995 Jan The temporomandibular joints (TMJ) of children afflicted with juvenile rheumatoid arthritis (JRA) were evaluated with clinical examinations and computed tomography (CT). Thirty-seven consecutive patients (6-17 years old) from the Texas Scottish Rite Hospital arthritis clinic were studied to investigate morphological abnormalities in the TMJ by CT. Both qualitative and quantitative measures of TMJ morphology were made from axial CT scans. Ten children without JRA served as a control group. Various ANOVA and nonparametric statistical models were used for analysis. Evidence of TMJ abnormalities from the CTs was found in 62% of these JRA children. The TMJ pathosis indices for left and right joints were significantly higher in the JRA subjects than those in the control children (P < 0.03) and joint spaces were narrower (P < 0.02). These features are indicative of TMJ destruction. Thus, there is considerable risk for TMJ involvement and its debilitating and deforming sequelae in children afflicted with JRA.
1586253 Predictive value of synovial fluid analysis in juvenile chronic arthritis. 1992 Apr To investigate the value of synovial fluid analysis in predicting the articular evolution of juvenile chronic arthritis, synovial fluid from 29 patients with oligoarticular onset juvenile chronic arthritis were examined prospectively. The patients were subsequently classified after a three year period of observation as having polyarticular (10 patients) or pauciarticular (19 patients) disease. The synovial fluid samples were analysed for total and differential white blood cell count, total protein, beta 2 microglobulin, and total complement activity. For comparison, synovial fluid samples from 95 patients with adult onset rheumatoid arthritis were also analysed. In patients with polyarticular disease polymorphonuclear cells and beta 2 microglobulin concentrations were higher than in the patients with pauciarticular disease (80 (29.2) v 58.1 (25.3), and 3.6 (1.2) v 2.2 (0.5) mg/l, respectively), but there was no significant difference from the patients with rheumatoid arthritis. Synovial fluid analysis may be useful in predicting the evolution of juvenile chronic arthritis and improve definition of its subtypes.
10830003 Juvenile rheumatoid arthritis--assessment. 1996 May The assessment of overall health status of a child with juvenile rheumatoid arthritis (JRA) is complex and multi-dimensional. The general physical examination is complemented by a rheumatological evaluation that includes determination of articular indices of inflammation and duration of inactivity stiffness. Laboratory assessment plays a critical role in monitoring side effects of pharmacologic management, but is limited in its ability to portray accurately the degree of active inflammation. Newly measureable indicators of inflammatory activity, such as serum cytokine and soluble cytokine receptors will likely become part of routine laboratory assessment in the future. Radiographs remain a useful tool for assessing disease progression, but may be replaced in the future by magnetic resonance imaging. In recent years, rheumatologists have realized that measurement of overall physical and psycho-social functional ability, quality of life, and pain are major descriptors to consider during routine follow-up. They are also critical in the assessment of long-term clinical effectiveness. The importance of nutritional assessment has also been realized. This section seeks to describe some of the methodologic approaches currently used to assess the variables mentioned above, and includes a brief discussion of the evolving instrumentation which attempts to measure variables of a more cognitive or subjective aspect.
7656474 Erosive polyarthritis and Crohn's disease. A case with HLA DRB1 determination. 1995 Mar The authors report the case of a 49-year-old woman with an asymmetrical, seronegative and peripheral polyarthritis with erosions, who subsequently developed Crohn's disease. She was diagnosed as having an erosive Crohn polyarthritis as no evidence of rheumatoid arthritis was found. However, the patient was homozygote for DR4 and the HLA DRB1 oligotyping was 0401/0404. This corresponds to two susceptibility alleles for rheumatoid arthritis responsible for the severity of this disease. Erosive polyarthritis is rarely encountered in inflammatory bowel diseases. The underlying mechanism of the erosions in these conditions is unknown but granulomatous synovitis with contiguous erosive bone changes has been reported. HLA DR has not been previously reported in erosive Crohn polyarthritis. The homozygosity for DR4 with DRB1*0401/0404 subtypes suggests that DR4 could contribute to the erosive course in this patient. This question is of interest, and HLA DR must be further studied in inflammatory bowel diseases with erosive arthritic manifestations.
7761362 [Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relations 1995 Apr 1 Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.
8142680 Adult Still's disease with Sjögren's syndrome successfully treated with intravenous pulse 1993 Sep A patient with adult Still's disease and Sjögren's syndrome failed to respond to conventional doses of corticosteroids. Therefore intravenous pulse methylprednisolone combined with oral cyclophosphamide was given which subsequently resolved the flare of rashes, fevers, and arthritis. This combination therapy may be a useful therapy to consider in patients with adult Still's disease who are resistant to conventional treatment and may allow a reduction in daily corticosteroid requirement.
1603201 Management of the oral features of Sjögren's syndrome. 1992 Apr In this paper the basis of the oral features of Sjögren's syndrome is described and guidelines for proper management of these features are given. The most pronounced oral symptoms are a dry sensation in the mouth and difficulties with swallowing and speech. Furthermore, these patients do not sleep well and may complain about burning mucous membranes, rampant caries and candidosis. Rampant caries can be prevented by optimal oral hygiene and frequent applications of a fluoride gel. Prophylaxis of candidosis can be achieved by meticulous oral hygiene and removal of predisposing factors (e.g. poorly fitting dentures). It is only possible to treat the other oral signs of Sjögren's syndrome symptomatically, because damage of salivary-gland parenchyma is progressive and irreversible. In the early stages of Sjögren's syndrome, good results can be obtained by gustatory or pharmacological stimulation of the salivary secretion. In the more advanced stages, the patient has to resort to oral rinses and saliva substitutes, the majority of which are not satisfactory. Promising results have been obtained with mucin-containing lozenges.
8991998 Temporomandibular joint and mandibular growth alterations in patients with juvenile rheuma 1995 Oct OBJECTIVE: To determine the frequency and type of lesions of the temporomandibular joints (TMJ) as well as orthodontic alterations present in patients with juvenile rheumatoid arthritis (JRA). METHODS: Twenty-six patients had their TMJ evaluated clinically and by high resolution computer tomography. The patients were also submitted to orthodontic evaluation. Children with isolated malocclusion were used as a control group. RESULTS: Computer tomography detected TMJ alterations in 13 (50%) patients with JRA. Bilateral mild lesions were the most frequent. TMJ alterations were especially observed in young patients with JRA with the systemic and polyarticular type of onset. Worse functional class and corticosteroid therapy were also related to TMJ involvement. We observed orthodontic alterations in 18 patients with JRA (69%): midline deviation, convex facial profile. Class II molar relation, crowded lower anterior teeth, anterior open bite, and reduction in the maximum opening of the mouth. Severe TMJ lesions were correlated to cephalometric alterations, suggesting decreased mandibular growth.
8295192 Pilot investigation of naproxen/methotrexate interaction in patients with juvenile rheumat 1993 Oct OBJECTIVE: To investigate the potential interaction of naproxen and methotrexate (MTX) in children with juvenile rheumatoid arthritis (JRA). METHODS: Nine children with JRA served as their own control taking their usual doses of MTX (0.22-1.02 mg/kg/week) and naproxen (14.6-18.8 mg/kg/day) separately and in combination. RESULTS: MTX affected a > or = 30% change in naproxen kinetics in 6/8 patients, while naproxen altered MTX kinetics by > or = 30% in 4/9 patients. CONCLUSION: MTX can alter nonsteroidal antiinflammatory drug (NSAID) kinetics in children with JRA and NSAID can alter MTX kinetics. NSAID toxicity should be considered when assessing adverse reactions in patients receiving the combination treatment of MTX and NSAID:
1496166 Central nervous system disease in Sjögren's syndrome. New insights into immunopathogenesi 1992 Aug Although peripheral nervous system disease is a well-established complication of primary Sjögren's syndrome (SS), until relatively recently little attention has been focused on the central nervous system (CNS) complications of this disorder. The observations discussed in this article pertain to patients with primary SS in whom the presence of a second connective tissue disorder and other etiologies for neurologic disease have been rigorously excluded. In this article, the growing clinical spectrum of CNS manifestations, neurodiagnostic techniques, serologic analyses, and immunogenetic markers associated with this disorder are reviewed.
8859257 Seasonal onset of systemic-onset juvenile rheumatoid arthritis. 1996 Oct OBJECTIVE: This study was undertaken to investigate the recent finding of a seasonal difference in the onset of systemic-onset juvenile rheumatoid arthritis (SoJRA). We hypothesized that a seasonal onset pattern might implicate on infectious agent as a cause of SoJRA. METHODS: The date of onset was collected from the records of all patients with SoJRA from 1980 to 1992 at presentation to pediatric rheumatology clinics across Canada. The onset pattern of SoJRA was then compared with incidence data on viral infections obtained for the same period. RESULTS: Across Canada the onset of SoJRA was constant across the seasons. However, in the Prairie region there was a statistically significant seasonal pattern, with peaks in autumn and early spring. We could find no evidence that viral incidence correlated with disease incidence either throughout Canada or in the Prairie region. CONCLUSIONS: If a seasonal infectious agent causes SoJRA, then it is likely only one of several causes and may act only in certain regions. Future studies should be carried out in those areas where SoJRA does have a seasonal onset pattern.
1362072 The activity of dipeptidyl peptidase II and dipeptidyl peptidase IV in mice immunized with 1992 Dec We investigated the activity of peptidases in the serum of mice with experimental polyarthritis that was induced by the injection of type II collagen, an experimental model of human rheumatoid arthritis. The activity of dipeptidyl peptidase II (DPP II) was increased and that of dipeptidyl peptidase IV (DPP IV) was decreased resulting in the significant increase of the serum DPP II/DPP IV ratio in the polyarthritic mice compared with that of controls. These results indicate that the DPP II/DPP IV ratio is a novel index of disease activity in mice with collagen-induced polyarthritis and may be useful in assessing the activity of rheumatoid arthritis in humans.
7473488 Elevated circulating interleukin-7 levels in patients with systemic juvenile rheumatoid ar 1995 Aug OBJECTIVE: Since interleukin-7 (IL-7) has been shown to induce monocyte production of IL-1, IL-6, IL-8, and tumor necrosis factor-alpha, we investigated plasma and synovial fluid levels of IL-7 in patients with juvenile rheumatoid arthritis (JRA). METHODS: IL-7 levels were measured using an ELISA in 60 patients with JRA and in 25 patients with other rheumatic disorders (ORD). RESULTS: In patients with systemic JRA, but not in patients with polyarticular or pauciarticular JRA or with ORD, plasma IL-7 levels were significantly higher (p < 0.0001) than those of healthy controls. IL-7 was undetected in all synovial fluid tested. Among patients with systemic JRA, those with persistent systemic symptoms had IL-7 levels significantly higher (p < 0.01) than those of patients in which systemic symptoms subsided. CONCLUSION: Plasma IL-7 levels are elevated in patients with systemic JRA and are associated with the presence and severity of systemic symptoms.
7473487 Elevated serum prolactin levels in children with juvenile rheumatoid arthritis and antinuc 1995 Aug OBJECTIVE: To determine if antinuclear antibody seropositivity in girls with juvenile rheumatoid arthritis (JRA) is associated with elevated serum levels of the anterior pituitary hormone prolactin. METHODS: Nineteen premenarchal girls meeting ACR classification criteria for JRA were evaluated for disease activity, antinuclear antibodies (ANA) seropositivity, and serum concentrations of prolactin, estrogen, and thyroid stimulating hormone. RESULTS: The mean serum prolactin concentration of ANA seropositive patients with JRA (10.9 +/- 1.9 micrograms/l) was significantly higher than that for ANA negative patients (5.7 +/- 1.0 micrograms/l; p = 0.043) and an age matched control group (5.8 +/- 1.3 micrograms/l; p = 0.048). CONCLUSION: Children with ANA seropositive JRA have elevated serum levels of the immunostimulatory hormone prolactin.
24440886 An activity analysis of hand grips used in housework by female rheumatoid arthritics. 1994 In this nonexperimental study, videofilmed, self-selected housework activities of rheumatic women were analyzed. The women gripped and manipulated objects in their homes. The activities were analyzed under the headings Activity, Actions, Objects, and Grip. The films were viewed frame by frame, and the data was computerized for statistical analysis. The women performed five self-selected housework activities and eight groups of actions (n = 340). During the actions the women handled 12 groups of objects using the eight grip classes of Sollerman's grip classification. The diagonal volar grip was the most common grip (20%), and the tripoid pinch was the least common (0.29%); 34% of the actions were right-handed, 19% left-handed, and 47% bimanual. No clear grip pattern was revealed by the activity analysis.
8936899 Mental health of mothers of children with juvenile rheumatoid arthritis: appraisal as a me 1996 Oct Examined direct and mediated relations between condition parameters and maternal mental health for 53 mothers of 2- to 11-year-old children with juvenile rheumatoid arthritis (JRA). Multivariate analyses revealed that when considered simultaneously, indices of both biological severity and functional severity were associated significantly with maternal mental health. Further, mother's appraisals of the impact of the child's illness on the family partially mediated the effects of medication type and child's functional status on mother's mental health. Results provide support for conceptual models that emphasize the cognitive mechanisms by which condition parameters such as biological and functional severity might affect maternal mental health. Explicating the processes by which a child's JRA might lead to psychological adjustment problems in the parent has implications for developing preventive and treatment interventions.
7674245 Clinically significant gastropathy associated with nonsteroidal antiinflammatory drug use 1995 Jun OBJECTIVE: To estimate the frequency of documented clinically significant gastrointestinal (GI) side effects secondary to nonsteroidal antiinflammatory drugs (NSAID) therapy and to describe the adverse events. METHODS: Computerized medical records of 702 patients with juvenile rheumatoid arthritis (JRA) administered NSAID were searched for the occurrence of clinically significant gastropathy (esophagitis, gastritis, peptic ulcer disease). RESULTS: Five children were identified who had a total of 10 events of gastropathy documented by either barium swallow or endoscopy, and thought to be attributable to NSAID therapy. Each child had at least 2 separate events of clinically significant gastropathy. CONCLUSION: Although mild GI disturbances are frequent side effects associated with NSAID therapy, the number of children with JRA who experience clinically significant gastropathy appears to be low.
7699666 Radiologic features of systemic onset juvenile rheumatoid arthritis. 1995 Jan OBJECTIVE: To document the radiologic abnormalities in patients with systemic onset juvenile rheumatoid arthritis (SOJRA) including abnormalities occurring early in the course of disease. METHODS: A retrospective review of the charts and radiographs of 42 consecutive children with SOJRA was carried out. Radiographs were reviewed by a single experienced radiologist with no knowledge of the clinical course of the patients. RESULTS: Soft tissue swelling and osteoporosis were the most common radiologic abnormalities (34/42; 81%). Cartilage loss and/or bone erosions were also common, occurring in 50% of patients. Erosions occurred within 2 years of disease onset in 11/36 (31%). Subchondral irregularity and sclerosis within 2 years of disease onset preceded erosions in 11 patients with serial radiographs. Severe radiologic abnormalities included joint ankylosis (8/42; 19%), subluxation (9/42; 21%), and protrusio acetabuli (4/42; 10%). Joint ankylosis occurred most commonly between 3 and 5 years after disease onset and subluxation between 2 and 6 years. CONCLUSION: A subgroup of children with SOJRA develops early destructive radiologic changes whose severity is comparable to those of children with rheumatoid factor positive polyarticular JRA. Early subchondral changes may be predictive of subsequent erosive disease in SOJRA and require prospective study using newer imaging techniques.
7993708 Epidemiology, pathogenesis, animal models, and treatment of Sjögren's syndrome. 1994 Sep Sjögren's syndrome is characterized by dry eyes (xerophthalmia) and dry mouth (xerostomia). Although general agreement exists about the ocular features of Sjögren's syndrome, significant controversy surrounds the classification criteria for defining the oral component. This has resulted in confusion in both the clinical and the research literature. The recent litigation involving silicone breast implants has forced clinicians to evaluate critically whether the condition of a particular patient fulfills specific diagnostic criteria for Sjögren's syndrome. Research studies have focused on potential genetic and environmental factors in the pathogenesis of Sjögren's syndrome. Studies of various ethnic populations have demonstrated an association with particular HLA-DR and -DQ alleles. However, the associated alleles are different for each ethnic group. No single environmental agent has been identified as a critical cofactor. Studies have concentrated on herpesviruses (Epstein-Barr virus and human herpesvirus type 6), hepatitis C virus, and retroviruses. Epstein-Barr virus isolated from patients has altered the ability to transform and lytically infect particular types of lymphocytes. Hepatitis C can lead to sicca symptoms, even in patients with relatively normal salivary gland biopsy findings. One report of Japanese patients indicated the presence of human T cell lymphotropic virus type I-like tax genes in the salivary biopsy specimens of a subset of patients and no gag, pol, or env sequences; this finding suggested a potential infection by a defective retrovirus. Studies on the pathogenesis have indicated that cytokines produced in the salivary gland are similar to T helper type 1 lymphocytes (interferon gamma).(ABSTRACT TRUNCATED AT 250 WORDS)