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ID PMID Title PublicationDate abstract
8014944 Level of agreement between parents and children in rating dysfunction in juvenile rheumato 1993 Dec OBJECTIVE: To determine the level of agreement between parents and children in rating dysfunction in juvenile rheumatoid arthritis (JRA) and juvenile spondyloarthritides. METHODS: We conducted separate interviews (parents and patients) of children > or = 9 years of age with JRA and spondyloarthritis attending our clinic. A questionnaire consisting of 100 probes (57 physical activities, 26 psychosocial issues and 17 general symptoms) was used. Probes were scored by respondents on a 6-point scale for their frequency of occurrence (all probes) and importance to the patient (physical activities, only), giving a total of 157 scores. Forty patients were included. Level of agreement between patients and parents was determined by weighted kappa (kappa). RESULTS: Mean kappa for all scores was 0.60; gross motor 0.51, fine motor 0.64, psychosocial 0.56 and general symptoms 0.64. One hundred and forty scores (89%) showed at least moderate agreement. CONCLUSIONS: Our data confirm that there is good parent-child agreement on the level of dysfunction of children > or = 9 years of age with JRA and spondyloarthritis. This level of agreement extends over a wide range of general symptoms and includes physical and psychosocial function. Thus both the parent and the child are reliable informants on the impact of chronic arthritis on the quality of life of affected children and either can be used for this type of assessment.
7639812 Development of an observation method for assessing pain behaviors in children with juvenil 1995 Aug OBJECTIVE: To develop an observation method for assessing pain behaviors in children with juvenile rheumatoid arthritis (JRA). METHODS: Thirty children with JRA performed a standardized sequence of activities for video recording, and correlations between the pain behaviors observed on the videotapes and established measures of pain, depression, and functional disability were determined. RESULTS: Pain behaviors were reliably observed (kappa coefficients 0.53-0.79). Total pain behaviors were significantly correlated with subjective reports of pain (r = 0.50) and disability levels (r = 0.64). These behaviors were not significantly associated with children's depression ratings (r = 23). CONCLUSION: The results indicate that the behavioral observation method provides a reliable and valid measure of pain associated with JRA. Measurement of pain behaviors may be especially useful in treatment outcome studies because these behaviors are relatively independent of depression.
7801204 [Clinical features of infantile patient with juvenile rheumatoid arthritis]. 1994 Oct Little is known about clinical features of infantile juvenile rheumatoid arthritis (JRA) because it is very rare for the patients to develop JRA within one year of age. In the past 20 years, we experienced three JRA patients whose onset was under 1 year of age. The incidence of infantile JRA was 3.2% of all JRA patients in our facility. They are 9 month-old male with systemic onset, 6-month-old female with polyarticular onset and 8 month-old female with systemic onset. It was difficult to evaluate subjective symptoms such as arthralgia or morning stiffness since the patients could not complain precisely. Therefore, careful observation on their behaviors, such as the delayed development of their motor function and bad humor and/or loss of activity in the morning, was important for evaluating joint symptoms. In case 1, measuring the serum level of hyaluronic acid was specifically useful to evaluate the arthritis. Drug therapy was not successful especially in infantile JRA. One of the reason for this ineffectiveness of drug therapy might be explained by poor adsorption of drugs in infants; the serum acetyl salicylic acid level was lower in infantile patients than the other patients with JRA even though they received enough dose of aspirin. Infantile JRA was revealed to have specific difficulties in early diagnosis and adequate treatment. Therefore, accumulated case studies about clinical features of infantile JRA is essential for their better prognosis.
7788171 Adult onset Still's disease in northern India: comparison with juvenile onset Still's dise 1995 May The present study compared the clinical and laboratory picture, the disease course and outcome in 31 patients having adult onset Still's disease (AOSD) with 23 patients having juvenile onset Still's disease (JOSD). The median age at disease onset was 20 and 7 yr for AOSD and JOSD patients, respectively. On analysing and comparing our data on these two groups, no significant differences emerged except that adults had a significantly lower time interval from disease onset to remission as compared to juveniles. Upon comparison of data on our AOSD patients with that published from abroad, rash, adenopathy and sore throat were less frequent. No clinical or laboratory variables were found to predict the subsequent disease course and outcome in either group. The functional outcome was good in about 70% of both groups and mortality was low. It is concluded that the clinical picture and outcome in AOSD is similar to that of JOSD.
8016418 Criteria for diagnosis of Sjögren's syndrome. 1994 May The criteria for diagnosis of SS remain controversial, and several sets of diagnostic criteria have been proposed. On one hand, we have used a stringent set of criteria (termed the San Diego criteria) that requires evidence for an autoimmune process associated with destruction of salivary and lacrimal gland tissues. At the other extreme, several groups (including the Copenhagen and EEC Study group) have based their diagnostic criteria on clinical findings of dry eyes and mouth with no absolute requirement for gland biopsy or presence of autoantibodies. The EEC study group believe that the San Diego criteria identify only the tip of the iceberg--namely, those patients with full-blown disease--and ignore those patients with milder forms of SS. Until the underlying pathogenesis of SS is known, we suggest the continued use of the San Diego criteria for classification of SS, because it identifies a group of patients with serologic and histologic evidence for a systemic autoimmune process in association with their sicca symptoms. In patients lacking such evidence for an autoimmune process, we suggest the classification "sicca syndrome" or "dry mouth syndrome." This will allow the clinicians and clinical trials to focus on a more homogeneous group of SS patients who may share a common pathogenesis, treatment response, and prognosis. Also, patients lacking evidence of an autoimmune role in pathogenesis can be reassured, and other causes for their sicca symptoms can be investigated. Further, in the United States the particular diagnosis codes may have implications in obtaining insurance and other medical benefits. Thus, classification criteria involve not only future epidemiologic studies but also economic considerations for the individuals who are given a particular diagnostic code.
8281354 Pulmonary function abnormalities in patients with primary Sjögren's syndrome. 1993 Jul Thirty-two patients with primary Sjögren's syndrome (SS) were studied in order to determine the frequency of pulmonary disease using respiratory function tests. Eleven of the 32 patients revealed positive symptoms compatible with lung disease, including dyspnea, dry or productive cough and pleuritic pain. Seven of these 11 patients also showed a positive physical examination, and 5 showed abnormal chest roentgenograms. Restrictive lung disease was detected in 28.1% of the patients, obstructive disease in 21.8%, and 25% showed a combination of these features (mixed disease). Only 8 patients had completely normal function. There was no significant relationship between respiratory changes and age, smoking habits or glandular and extraglandular manifestations. Positive antinuclear antibodies (p < 0.03) detected by the indirect immunofluorescence test, and anti-SS-A(Ro) and anti-SS-B(La) antibodies (p < 0.009) detected by Ouchterlony occurred more frequently in those patients with primary SS and restrictive pulmonary disease. The patients with anti-SS-A(Ro) and anti-SS-B(La) antibodies also showed significantly lower values for total lung capacity (TLC) (p < 0.0001) and forced vital capacity (FVC) (p < 0.0005) than patients without these serum abnormalities. The study of primary SS may help to elucidate the prevalence of lung abnormalities and their relationship with serum autoantibodies.
7768045 Secondary Sjögren's syndrome--the sausage factory revisited. 1994 Nov Many different factors combined cause an autoimmune disease like Sjögren's syndrome. In this review a new analogy is described to represent the relationship between Sjögren's when it occurs on its own, compared to its existence against the background of another autoimmune condition. The issue of whether Sjögren's should really be thought of as a syndrome or a disease is also highlighted.
1300170 A 72-year-old female with adult Still's disease. 1992 Dec We treated a 72-year-old woman with adult Still's disease. The diagnosis was made on the basis of a prolonged, high grade, quotidian fever, polyarthritis, maculopapular skin rashes and exclusion of other possible diseases. A high serum ferritin value was a key factor both in making the diagnosis and in the follow-up. The patient responded to the administration of oral prednisolone at 30 mg/day, which was tapered to 10 mg/day, with no recurrence of symptoms. This disorder can be an important cause of prolonged fever in the elderly as well as in the younger population.
1604256 The concomitant occurrence of Sjögren's syndrome and polymyositis. 1992 A patient with both Sjögren's syndrome and polymyositis is described. The literature on the concomitant occurrence of these disorders is reviewed.
8567161 Fine structure and distribution of lymphatics in the synovial membrane of monkey and human 1995 The fine structure and distribution of lymphatics in the synovial membrane of monkey knee joints, and human knees with osteoarthritis and rheumatoid arthritis, were studied by light and electron microscopy using an enzyme-histochemical method. Whole mount preparations and tissue sections were doubly stained for 5'-nucleotidase and alkaline phosphatase. The 5'-nucleotidase positive lymphatics could be distinguished from the alkaline phosphatase positive blood vessels. In monkey specimens the 5'-nucleotidase lymphatics were densely distributed in the medial and lateral parts of the suprapatellar pouch and infrapatellar fat pad, in both the superficial and deep of the sublining cell layers. Collecting lymphatics were well developed in the deep fibrous layer and in the merging epimysium. In the knees with both types of arthritis, the patterns of distribution were the same as in the monkey. No lymphatics were found in well developed villi in rheumatoid arthritis, but many blood vessels were present.
8835571 Reliability of the articular examination in children with juvenile rheumatoid arthritis: i 1995 Dec OBJECTIVE: To assess the interobserver agreement of articular examination in children with juvenile rheumatoid arthritis (JRA) and identify sources of disagreement. METHODS: Four rheumatologists graded tenderness/pain on motion, swelling, and limitation of motion in the joints of 10 children with JRA, as recommended by the Pediatric Rheumatology Collaborative Study Group, and 17 different joint indices were computed. Agreement was measured by kappa (kappa) and intraclass correlation coefficients (Ri). RESULTS: All 4 observers detected tenderness in 15.7% of the joints, but they disagreed (2 vs 2) on 4.2% (kappa = 0.71). They detected swelling in 5.2% but disagreed on 6.2% (kappa = 0.47). They found limitation in 4.9%, but disagreed on 8.1% (kappa = 0.54). The tender joint count, and the American Rheumatism Association cooperating clinics and Hart modified Ritchie indices were the most reliable (Ri > 0.93); the swelling severity index fared the worst (Ri = 0.40). There were differences in examination maneuvers and judgment among examiners. Discrepancies were larger in metacarpophalangeal joints and in patients with many involved joints. CONCLUSION: There was low agreement in the assessment of joint swelling and limitation of motion. Differences in examiners' techniques, patients with severe disease, and the small hand joints were important sources of disagreement.
7890317 Lymphocytes from the site of disease are functionally different from peripheral blood lymp 1994 Oct Over a 12-year period, in vitro synovial lymphocyte responses to microbiological antigen stimulation were measured by the [3H]thymidine uptake method in referred patients with all types of non-crystal, non-septic, inflammatory arthritis. From this large study group comparisons of synovial with peripheral blood lymphocyte (PBL) responses were available in 9 patients with enteric reactive arthritis (ERA), 12 patients with sexually acquired reactive arthritis (SARA) and 18 patients with recurrent or persistent oligoarthritis or with polyarticular 'rheumatoid' arthritis. Employing 2-tailed t tests, analysis of variance (ANOVA) or meta-analysis, as appropriate to the obtained data, significant differences were found between synovial and peripheral blood responses. In only 2 of 9 patients with bacteriologically defined ERA, in only 4 of 12 patients with SARA and in only 2 of 18 patients with oligoarthritis or 'rheumatoid' arthritis did the PBLs show statistically significant responses to the antigen that elicited a significant response from synovial lymphocytes. It is concluded that lymphocytes from the site of disease are often functionally different from PBLs and may demonstrate etiologically related antigen specificity; thus they may be a preferred source of lymphocytes for the investigation of immunologically mediated disease, the etiology of which is not understood. This viewpoint is supported by a recent paper on the specificity of hepatic lymphocytes for a protein of hepatitis C in patients with chronic hepatitis C, and also by the use of tumour-infiltrating lymphocytes for anti-melanoma therapy.
8371217 Calcium absorption and metabolism in children with juvenile rheumatoid arthritis assessed 1993 Jul OBJECTIVE: To assess calcium intake, absorption, urinary excretion and the fraction of urinary calcium originating from bone and diet in patients with juvenile rheumatoid arthritis (JRA). METHODS: A dual tracer stable isotope technique was used to study 6 girls and 3 boys with JRA. RESULTS: Fractional absorption in the 6 girls, ages 4-9, with JRA was significantly lower than that in 10 similar, healthy girls (22.6 +/- 4.7% vs 30.4 +/- 8.4%, p = 0.033). Urinary calcium excretion tended to be higher in the girls with JRA than in controls, (2.9 +/- 1.5 vs 1.6 +/- 1.7, p = 0.15). The urinary calcium in patients with JRA was derived principally from bone, and there was no increase in diet derived urinary calcium. One of the boys with new onset JRA was markedly hypercalciuric and in negative calcium balance (-222 mg/day). CONCLUSION: Our data show that hypercalciuria in patients with JRA results from bone resorption, not hyperabsorption of dietary calcium and suggest that increases in calcium intake may benefit children with JRA.
8407245 Autoimmune diseases in humans, e.g. autoimmune rheumatic diseases. 1993 In spite of increasing evidence that viruses and especially retroviruses could act as etiologic factors in autoimmune and especially autoimmune rheumatic diseases, clear-cut evidence for an involvement of these agents is still missing. Findings, which, for example, indirectly support the hypothesis that retroviruses might play a part, are the demonstration of antibodies to the gp24 in SLE and Sjögren's patients as well as the description of retroviral antigens in the inflamed synovium of rheumatoid arthritis patients. Furthermore, evidence comes from animal models that viruses, such as the Visna or Caprine arthritis encephalitis virus, induced chronic inflammatory diseases in sheep and goats. More recently, a mouse model for rheumatoid arthritis and Sjögren's syndrome was reported in mice transgenic for HTLV-1tax. It is hoped that, especially from the experimental animal models, the possible role of retroviruses as etiological factors in autoimmune rheumatic diseases can be clarified.
8756156 Multicentric reticulohistiocytosis. A report of 3 cases and review of literature. 1996 Jun Multicentric reticulohistiocytosis (MR) is a rare systemic disease of unknown cause. The disease is characterized by tissue infiltration of lipid-laden histiocytes and multinucleated giant cells. Destructive polyarthritis and skin lesions are the most common findings. The disease becomes apparent in adult life. We report on 3 patients and discuss the specific radiographic characteristics of bone and joint involvement. The radiologic feature is a bilateral, symmetric joint involvement with predilection for the interphalangeal and metacarpophalangeal joints. In all of our cases we found an early involvement of shoulder joints. Erosive arthritis begins at the margins of the joints, progressing to osseous defects and to severe joint destruction. In contrast to rheumatoid arthritis, periarticular osteoporosis and early joint space loss are absent in MR. In addition, significant erosions of distal interphalangeal joints are not common in rheumatoid arthritis.
1727317 Juvenile rheumatoid arthritis of the knee: MR evaluation with Gd-DOTA. 1992 Jan Synovial hypertrophy, effusion, and articular cartilage status were evaluated with gadolinium tetraazacyclododecanetetraacetic acid (DOTA)-enhanced magnetic resonance (MR) imaging in 24 knees in 24 pediatric patients (17 female, seven male; mean age, 10 years; range, 3-18 years) with juvenile rheumatoid arthritis (JRA). T1-weighted spin-echo sequences were performed with a 0.5-T unit before and immediately after injection of Gd-DOTA (0.1 mmol/kg). Substantial enhancement of synovial proliferation was seen in 23 of 24 knees, allowing precise assessment of pannus extension (n = 23), joint effusion (n = 21), cartilage loss (n = 21), and meniscal hypotrophy (n = 23). On T1-weighted images without contrast enhancement, cartilage thickness, loculation of joint effusion, and pannus extension were underestimated. Thus, Gd-DOTA-enhanced MR imaging is mandatory in the assessment of knee involvement in children with JRA and may prove to be useful in the evaluation of response to therapy.
7674248 Breast feeding and the development of juvenile rheumatoid arthritis. 1995 Jun OBJECTIVE: To determine if children with juvenile rheumatoid arthritis (JRA) are less likely to have been breast fed than controls. METHODS: Case-control study of data obtained from a survey of mothers 54 children with JRA and 79 playmates regarding breast feeding. Duration of breast feeding was tabulated and odds ratios (OR) with 95% confidence intervals (CI) were determined. RESULTS: OR for breast feeding in children with JRA was 0.40 (0.20-0.81, 95% CI) compared to playmates. For pauciarticular JRA (N = 28) OR was 0.31 (0.10-0.93); in polyarticular JRA (N = 24) OR was 0.60 (0.21-1.70). Lower OR for increased durations of breast feeding were noted in children with JRA. CONCLUSION: Children who have had JRA, especially pauciarticular JRA, are less likely to have been breast fed than controls, suggesting that breast feeding may have a protective effect on the development of JRA.
8304248 Copper and zinc body levels in inflammation: an overview of the data obtained from animal 1993 Jul The development of acute and chronic inflammatory processes induces, in the laboratory animal, a net accumulation of both copper and zinc in many body compartments, the inflamed area included. In rheumatoid arthritis, as well as in animal models, only plasma zinc concentration seems to be significantly correlated with disease severity, while the increase in total plasma copper could be described as an "all or nothing" phenomenon. Moreover, in rheumatoid arthritis, it appears that the disease develops and progresses without being linked to either copper or zinc deficiency conditions. Thus, it seems reasonable to suggest that a rationale for the use of copper and/or zinc in the treatment of inflammatory disorders can only be drawn from the intrinsic pharmacological properties of such trace elements, rather than from the need for their repletion.
1307135 Isolated vertebral blocks in the cervical spine. 1992 Jan The author presents a review of seven cases with isolated vertebral block of the cervical spine, studied in 1980 in order to verify if the etiology was congenital or acquired. This kind of bony alteration of the spine confused in the literature with Klippel-Feil's syndrome, which is a congenital constellation of bone alterations. The author concludes that, even in two cases with a diagnosis of rheumatoid arthritis, the vertebral block probably was not related to the inflammatory pathology. For one case of severe rheumatoid arthritis, it is proposed that the congenital block may have been present before the onset of the inflammatory disease. The cervical vertebral block can be considered to be an asymptomatic radiological finding.
1428451 Pyoderma gangrenosum: associations revisited. 1992 Aug Fourteen cases of pyoderma gangrenosum were seen over a period of 24 years at the Hull Royal Infirmary Dermatology Department. Several associated conditions were found. Seven cases were associated with rheumatoid arthritis of which five were sero-positive, including one with Felty's syndrome. One case was associated with both ulcerative colitis and psoriasis; one with polycythemia rubra vera; two patients had diverticular disease including one who also had rheumatoid arthritis; one had positive syphilis serology. In three cases there was no significant associated disease identified. Ten out of the fourteen cases were women, indicating a female preponderance by a ratio of about 2F:1M; a figure similar to that stated by Seitzinger. The age of presentation ranged from 30 to 80 years.