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ID PMID Title PublicationDate abstract
24203688 Positive and negative affect in rheumatoid arthritis: Increased specificity in the assessm 1996 Jun Because most patients with chronic medical illness do not suffer from diagnosable depressive conditions, models of normal emotional functioning might be useful in assessing the emotional consequences of physical illness. In this study of 72 male and female patients with rheumatoid arthritis, we examined the Watson and Tellegen (1985) two-dimensional model in this regard. Depression scores were associated, independently, with both positive and negative affect. Pain, daily hassles, and cognitive distortion were associated with depression and negative affect but not with positive affect. Positive daily events were associated with positive affect but not negative affect. This suggests that the routine use of measures of depression in studies of emotional adjustment in chronic medical illness can lead to a loss of more specific information, especially as it concerns positive emotionality.
1316553 AAEM minimonograph #38: neuropathies in connective tissue disease. 1992 May Neuropathies are common in patients with known or suspected connective tissue disease. A vasculitic mononeuropathy multiplex is often seen in patients initially presenting with polyarteritis nodosa or developing arteritis as a complication of rheumatoid arthritis. However, vasculitic neuropathy may become confluent and present as as distal symmetrical polyneuropathy or occur without systemic necrotizing vasculitis. Distal symmetrical polyneuropathies without associated vasculitis are also common in many connective tissue diseases. Compression neuropathies, especially carpal tunnel syndrome, occur with increased frequency in rheumatoid arthritis. Finally, certain neuropathies may be the major presenting feature of particular connective tissue diseases. For example, trigeminal neuropathy often heralds the onset of systemic sclerosis or mixed connective tissue disease, and sensory neuronopathy may be the initial presenting feature of Sjögren's syndrome.
7768059 Autoimmune epitheliitis: Sjögren's syndrome. 1994 Nov Sjögren's syndrome (SS), an autoimmune exocrinopathy, is a common, chronic disease of females. Clinical studies of kidney involvement in SS patients have shown that the predominant lesion is interstitial nephritis which produces tubular dysfunction. Studies on lung involvement have previously indicated that one fourth of SS patients suffer from subclinical interstitial lung disease. Re-evaluation, however, of the pulmonary disease using functional, radiologic and histopathologic studies showed that the lesion starts peribronchially. Finally, evaluation of liver disease in SS patients revealed that this consists of a pericholangeal round-cell infiltrate resembling the early lesion of primary biliary cirrhosis. These clinical studies suggest that the systemic manifestations of SS are probably due to the attraction of lymphocytes by different epithelial tissues. Studies of the epithelial cells of minor salivary glands from SS patients have shown that these inappropriately and selectively express HLA class II molecules and the proto-oncogene c-myc. Evaluation of cytokines in the minor salivary glands from these patients by in situ hybridization revealed that the proinflammatory cytokines IL-1 and IL-6 are also produced by the epithelial cells. Finally, proviral DNA has been shown to be incorporated in the DNA of epithelial cells. On the basis of these clinical and laboratory observations, we would like to suggest that the target tissue involved in the autoimmune histopathologic lesions of SS is the epithelium, and therefore we propose the term "Autoimmune Epitheliitis" instead of "Sjögren's syndrome" for this disease.
7801957 The gastrointestinal manifestations of Sjögren's syndrome. 1995 Jan Sjögren's syndrome (SS) is an autoimmune exocrinopathy that primarily affects the salivary glands but can also involve almost any other part of the gut. The most distressing manifestation of SS is xerostomia secondary to destruction of the salivary glands. The lack of saliva also leads to difficulty with chewing and initial swallowing and an increased frequency of dental caries. Another major problem is dysphagia due to the lack of saliva as well as esophageal dysmotility and/or esophageal webs. Chronic atrophic gastritis probably accounts for the epigastric pain, nausea, and other dyspeptic symptoms seen in SS. Sjögren's syndrome is also one of the most frequent extrahepatic diseases associated with primary biliary cirrhosis, suggesting that this entity may be a secondary form of SS. The degree to which SS affects the small and large bowel is unclear, whereas pancreatic involvement appears to lead to only subclinical exocrine insufficiency.
8492412 [Cyclosporine therapy of adult onset Still's disease with disseminated intravascular coagu 1993 Feb In April, 1991, a 61-year-old man was admitted to our hospital because of pancytopenia and disseminated intravascular coagulation (DIC). Five years prior to admission he had developed high fever, skin eruption and arthralgia which had been improved by antibiotics, but recurred. Steroid therapy was ineffective for pancytopenia and DIC. Laboratory findings were as follows: RBC count, 274 x 10(4)/microliters; WBC count, 470/microliters; Platelets, 6.4 x 10(4)/microliters; fibrinogen, 153mg/dl; FDP, 67.0 micrograms/ml; FDP-D.Dimer, 13040ng/ml; thrombin-antithrombin complex, > 60.0ng/ml; and plasmin alpha 2-plasmin inhibitor complex, 10.3 micrograms/ml. As we suspected adult onset Still's disease on the basis of clinical course, we treated him with methylprednisolone pulse therapy, which was, however, ineffective. leukocytopenia, thrombocytopenia and DIC improved after cyclosporine treatment. Since cyclosporine is known to be very effective to autoimmune diseases, we speculate that in this patient immunological mechanism may be involve in the pathogenesis of DIC.
8636829 Macrophage activation syndrome in systemic juvenile rheumatoid arthritis successfully trea 1996 Feb A macrophage activation syndrome, possibly related to methotrexate toxicity, developed in a boy with systemic juvenile rheumatoid arthritis. Corticosteroid administration was ineffective, whereas a prompt response to cyclosporine was observed. Two months later, Pneumocystis carinii pneumonia developed.
7982732 Migratory activity of blood polymorphonuclear leukocytes during juvenile rheumatoid arthri 1994 Aug Polymorphonuclear leukocyte (PMN) migration is measured in whole blood in a migration chamber consisting of a membrane filter (3-microns pores, 140 microns thick) with an integrated chemoattractant depot (FMLP in solid form) attached to a plastic container. Control chambers lack FMLP (blanks). One test unit requires 300 microliters blood. Numbers and distribution of the PMN immigrants into the filters are determined microscopically. Altogether 26 measurements of PMN migration in five juvenile rheumatoid arthritis (JRA) patients with varying disease activity were compared with the reactions of a healthy control group (N = 32). Correlations were calculated with conventional laboratory parameters (WBC, PLT, BSR, CRP, Hgb, serum Fe) and disease activity. In comparison with healthy controls, PMNs of JRA patients generally show a markedly increased penetration depth into the filters irrespective the presence of the chemoattractant or the disease activity. Increased migratory reactions to FMLP in comparison to blanks were found during high disease activity only. The PMN penetration depth correlates positively with the CRP, and reciprocally with the Hgb blood levels. The migration assay combines fast and simple processing with good preservation of the genuine PMN activation state.
1463040 Causes of reduced visual acuity on long-term follow-up after cataract extraction in patien 1992 Dec 15 We reviewed the long-term follow-up on a consecutive series of 16 eyes from ten patients with juvenile rheumatoid arthritis-associated cataracts that were removed by using pars plana lensectomy and vitrectomy. All patients had prominent cataracts, chronic uveitis, posterior synechiae, and vitreitis preoperatively, and had at least 12 months of follow-up postoperatively. The median length of follow-up was 51 months (range, 12 months to ten years). In the early postoperative period, a visual acuity of 20/70 or better was obtained in 13 of 16 eyes (81%). With longer follow-up, the final visual acuity was 20/70 or better in only nine of 16 eyes (56%). The primary categories of delayed visual loss in these cases were glaucoma and macular disease (chronic cystoid macular edema, macular hole, hypotony maculopathy, and recurrent macular pucker). Despite these limitations in maintaining good visual acuity, a pars plana lensectomy and vitrectomy approach is effective for cataracts in these patients with uveitis.
1634451 Passive smoking among children with chronic respiratory disease. 1992 The purpose of this study was to determine the prevalence and source of passive smoke exposure among children with chronic respiratory diseases and compare these to both a well child and nonrespiratory chronic illness child population. Rates and source of passive smoke exposure were compared among four child groups: asthma, cystic fibrosis, rheumatoid arthritis, and well children using a questionnaire mailed to the parents of the selected children. Twenty percent of respondents reported current smoking with a significantly higher rate among the cystic fibrosis and rheumatoid arthritis groups. One-third of all children surveyed were exposed to passive smoke at home and/or day care on a daily basis. Over 80% of the asthma and cystic fibrosis respondents reported a change in smoking behavior (i.e., smoking outside the home or smoking fewer cigarettes) after the diagnosis of their child's illness as compared with only 40% of the nonrespiratory groups. Health care providers need to inquire about potential sources of passive smoke exposure in their patients, particularly children with chronic respiratory disease.
7692031 Serum antiocular antibodies in patients with juvenile rheumatoid arthritis. 1993 Jul Although the uveitis associated with juvenile rheumatoid arthritis (JRA) is presumed to have an autoimmune etiology, its pathogenesis is unknown. We utilized immunohistochemical techniques to detect the presence of serum antibodies directed against ocular tissues in these patients. The staining patterns of serum from patients with JRA, with and without uveitis, were compared with normal controls. Antibodies directed against epitopes in iris and ciliary body basement membranes, lens epithelium and fibers, Bruch's membrane, and iris and retinal blood vessels were observed in the sera of several individuals. These staining patterns were statistically more frequent among the pauciarticular and polyarticular JRA patients, with and without uveitis, than either the systemic JRA or normal populations. These results demonstrate the presence of antiocular antibodies in the sera of JRA patients, with and without uveitis. Whether those nonuveitic JRA patients with antiocular antibodies will develop uveitis is unknown at this time.
7685125 [Monarthritis of unknown etiology: course and prognosis]. 1993 Apr 6 The diagnosis of monarthritis of unknown etiology is made by exclusion. Monarthropathies, periarthropathies, monarthritis of known etiology and systemic disease of which monarthritis is the first manifestation have to be excluded initially. Furthermore, during the course of the disease one has to look for initially undiagnosed causes of systemic diseases which are manifesting themselves during the course, such as rheumatoid arthritis, ankylosing spondylitis, sarcoidosis by repeated examination. After remission the diagnosis of monarthritis of unknown etiology can be made. There is, after a period of remission, rarely a relapse of the disease and transition into rheumatoid arthritis. There are four forms of monoarthritis of unknown aetiology, namely the acute form, the recurrent acute form, the persistent chronic form and the recurrent chronic form. According to the literature, monarthritis of unknown etiology resolves in about 70% of the cases after one year, in about 80% after two years and in about 90% after three years, in the great majority without leaving any signs of destruction. Non steroidal anti-inflammatory drugs, intra-articular corticosteroids, synovectomy or synoviorthesis can temporarily relieve symptoms and signs of inflammation. They have never proved to alter the course of the disease regardless of the length or the extent of the final clinical or radiological destruction. There are no prognostic markers for length and severity of the disease. As monarthritis of unknown aetiology is a self-limiting disease without destruction, it is also called benign monarthritis.
7955628 Juvenile psoriatic arthritis, or juvenile arthritis with psoriasis? 1994 Sep Juvenile psoriatic arthritis (JPsA) has traditionally been considered to be one of the spondyloarthropathies. Clinical and laboratory evidence had shed doubt on the appropriateness of its inclusion in this classification, however. It is suggested that included under the rubric of JPsA there are two or more conditions: one in which arthritis and psoriasis occur coincidentally, and a second in which psoriasis occurs with a characteristic pattern of joint involvement: asymmetric oligoarthritis affecting large and small joints, with or without dactylitis, chronic uveitis, and antinuclear antibodies. Whether it is appropriate to consider JPsA as a variant of juvenile rheumatoid arthritis, or as an entirely separate disorder is uncertain.
8112482 Rifamycin SV administered by intra-articular infiltrations shows disease modifying activit 1993 Sep The therapeutic activity of rifamycin SV administered by the intra-articular route was evaluated in 52 children with juvenile rheumatoid arthritis (oligopolyarthritis). Each active joint was injected once a week for 10 weeks; thereafter patients were followed for 3-48 months. The number of active joints and joints with limitation of motion, the erythrocyte sedimentation rate (ESR) and C-reactive protein improved significantly at the end of the treatment cycle, with progressive improvement during the subsequent period of observation. At 48-month of follow-up, 78% of joints did not present signs of inflammation; and 66% of joints showed no functional limitations. Joints without radiological lesions at baseline and large joints responded best to the rifamycin treatment. Persistent knee effusions were reabsorbed completely in most cases during the treatment and within the first 6 months of follow-up. Recurrences of synovitis were observed in 7% of joints. De novo radiological lesions in initially undamaged joints occurred during the second year of follow-up in only 10% of patients. At 24 months, 62% of patients with oligoarthritis and 24% with polyarthritis showed complete remission in all affected joints and recovered movement in all those joints which had shown limitations at baseline. There was also a normalization of inflammatory indexes (ESR, C-reactive protein) and regression of general features of disease. Further long term studies are now required to confirm these promising preliminary results.
10832470 Juvenile rheumatoid arthritis--Madras experience. 1996 Jul In a prospective study of 1,053 consecutive children who attended the Rheumatic Care Centre, Government General Hospital, Madras from 1991 to 1995, 331 children fulfilled the criteria proposed by the American Rheumatism Association as modified by Cassidy et al for the diagnosis of Juvenile Rheumatoid Arthritis. These children were thoroughly examined and investigated and classified into 3 onset types which was then sub-classified into early entry and late entry groups based on the duration of illness. Other arthritic conditions were excluded. There were 44 cases belonging to Systemic onset, 171 belonging to polyarticular onset and 116 belonging to oligoarticular onset type. In the systemic onset type 44/44 patients had fever, 40/44 had lymphadenopathy and 19/44 had skin rash; wrists and knees 31/44 were the most commonly involved joints; neck involvement was present in 13/44 of the cases; ANA was positive in 5/44 cases and anaemia was seen in 24/44 cases. In polyarticular onset type wrists 119/171, knees 143/171, hip joints 105/171 and ankles 113/171 were commonly involved; in the RF +ve subtype 3/23 had subcutaneous nodules and 7/23 were positive for ANA; in the Rf -ve subtype 59/148 were positive for ANA. In the oligoarticular subtype-1 ANA was positive in all cases but iridocyclitis was not seen in any case. In oligoarticular subtype-2 HLA B27 was positive in 13/26 cases while Sacroilitis was seen in 16/26 cases. In oligoarticular type-3 HLA B27 was negative.
8857660 The temporomandibular joint in juvenile rheumatoid arthritis: Part II. Relationship betwee 1996 Jul A study was undertaken to examine the relationship between the clinical signs and symptoms of temporomandibular joint (TMJ) disorder and computed tomographic (CT) evidence of destruction of these joints in children afflicted with juvenile rheumatoid arthritis (JRA). A thorough clinical examination including determination of the craniomandibular index (CMI) was performed on each of 37 consecutive JRA patients (6-17 years old), who had also received comprehensive evaluations of TMJ morphology by axial CT (see Part I, Pediatr Dent, 17:46-53, 1995). Measures of facial asymmetry (photographic) and mandibular size (cephalometric) also were collected. Published norms for mandibular dimensions and for prevalences of symptoms and signs of TMJ disorders served as control data. Various ANOVA and nonparametric statistical models were used for analysis. Average maximal opening was significantly less in the JRA subjects compared with the controls, and more than 50% of the JRA children manifested chin deviations or vertical disparities between mandibular angle regions, indicating compromised mandibular function and form. With the exception of facial asymmetry, however, none of the clinical signs or symptoms of TMJ dysfunction were remarkable predictors of bony destruction of the TMJ. Subjects with definitive evidence (CT) of TMJ destruction (62%) could not be identified reliably by any of the clinical measures used here. These findings indicate that clinical examination alone is inadequate for detecting condylar degeneration in the TMJ of children with JRA.
8777845 Sjögren's in adult Still's disease? 1996 Mar The objective of the study was to search for clinical, ophthalmological and serological manifestations of Sjögren's syndrome in patients with adult onset Still's Disease (AOSD). Eight consecutive patients with AOSD were evaluated. In all cases a standardized questionnaire to disclose sicca symptoms as well as extraglandular manifestations commonly associated with Sjögren's syndrome(SS) was conducted. Ophthalmological and serological evaluation was undertaken in all patients. Oral involvement was investigated by minor salivary gland biopsy in 7 patients. One case presented symptomatic keratoconjunctivitis sicca and grade III Chisholm labial biopsy. A further 2 patients had grade IV (4 foci per 4 mm2) salivary gland biopsy, in the absence of xerostomia or xerophthalmia. The search for autoantibodies proved negative throughout. It was concluded that focal sialoadenitis was not uncommon in our patients with AOSD. Whether this finding corresponds to a true SS is not yet clearly determined.
8039292 HLA associations in juvenile arthritis. 1994 Mar This review of the current status of HLA associations in juvenile arthritis begins with a discussion of the terms used to identify these patients and an approach for their clinical classification. The authors suggest that seven different types should be identified on the basis of clinical features and associated immunogenetic factors and that each of them should be recognized and called by a separate name. Different combinations of patients have been included in the studies performed in different cities and this fact may explain some of the observed differences in HLA associations in various reports. Results from an on-going study in Dallas are compared with published reports from Prague, Cincinnati, and Houston. HLA alleles associated with susceptibility in pauciarticular patients include certain DR and DQ alleles, one DP allele (DPB1*0201) and one HLA class I allele (HLA-A*0201). Susceptibility for polyarticular onset disease was found by the authors to be uniquely associated with DPB1*0301. Important interactions were observed between alleles at the different loci, with markedly increased odds ratios when combinations of susceptibility alleles were analyzed. The possibility that interaction between class I and class II susceptibility factors might be due to the effect of an allele at one of the TAP loci was examined by probing for polymorphic variants of the TAP1 and TAP2 genes. In addition, class I alleles associated with resistance for the development of juvenile arthritis were discussed. The main allele associated with rheumatoid arthritis (DRB1*0401) appears to be protective for the development of several forms of arthritis prevalent in children.
8179828 Distribution of Borrelia burgdorferi specific antibody among patients with juvenile rheuma 1993 Dec Lyme disease, a multi-systemic infection occurring worldwide, has yet to be reported in Korea, although the spirochete B. burgdorferi, known as the causative organism of the disease, has recently been isolated from the vector tick Ixodes persulcatus in the region. To contribute to revealing whether Lyme disease exists in Korea or not, B. burgdorferi specific antibodies (IgG, IgM, and/or IgA) were measured by three individual enzyme-linked immunosorbent assays (ELISA) utilizing different antigens in 38 patients with juvenile rheumatoid arthritis (JRA) which shares a number of clinical features with Lyme arthritis. The antibody prevalence rates in patients with JRA were various depending on the antigens (21% of IgG and IgM antibodies to purified organisms, 0% for IgG antibody to purified native flagella, and 5% for IgG, IgM, and IgA antibodies to recombinant p39) and were not different compared to 39 controls (21%, 0%, and 0% respectively). The antibody prevalence rates compared in various subgroups of patients with JRA according to types of JRA, length of illness, age, and sex were not different. Comparing the three different antigens, the greatest number of positive responders were yielded by purified organisms followed by p39 and purified flagellin, however the possibility of nonspecificity with purified organisms remained. The data indicate that serologic tests using ELISA fail to illustrate Lyme disease among 38 patients with JRA in Korea.
1556702 Interleukin 6 levels in synovial fluids of patients with different arthritides: correlatio 1992 Jan Interleukin 6 (IL-6), a multifunctional cytokine particularly active in regulation of the acute phase response, governs the terminal maturation of B lymphocytes and participates in early activation of T cells. IL-6 levels of synovial fluids of 153 patients with different arthritides were measured by a simple sandwich enzyme immunoassay. Highest IL-6 concentrations were detected in patients with rheumatoid arthritis (RA), particularly in those characterized by very active general symptoms and severe joint pain. High IL-6 levels were detected in patients with juvenile RA with polyarticular onset of disease and in gout. Corresponding to the suggested in vivo relevance of IL-6, dose correlation of IL-6 levels with the synovial IgM rheumatoid factor accumulation was demonstrated. The rate of the correlation between synovial IL-6 level and concentration of serum C-reactive protein in RA was inversely proportional to the dose of steroid treatment in patients with RA.
7510485 Local proliferation of fibroblast-like synoviocytes contributes to synovial hyperplasia. R 1994 Feb OBJECTIVE: To test the hypothesis that local proliferation contributes significantly to the hyperplasia of rheumatoid synovium. METHODS: Immunohistologic and chemical staining was used to identify 3 markers of cell proliferation: proliferating cell nuclear antigen, c-myc proto-oncogene, and nucleolar organizer regions. Synovium from 21 patients with rheumatoid arthritis, 34 with degenerative joint disease, and 7 with joint trauma was examined. RESULTS: All 3 markers indicated substantial, active proliferation of synovial lining cells in synovium with hyperplasia. Proliferating cells showed type I procollagen immunoreactivity but were negative for CD68, a monocyte/macrophage marker. Proliferation was greater in rheumatoid arthritis than in the other conditions evaluated. CONCLUSION: In situ proliferation of fibroblast-like synoviocytes in the synovium lining contributes considerably to the increase in cell numbers in rheumatoid synovium.