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ID PMID Title PublicationDate abstract
7473486 Frequency of relapse after discontinuation of methotrexate therapy for clinical remission 1995 Aug OBJECTIVE: To investigate the outcome of children with juvenile rheumatoid arthritis (JRA) who discontinued taking methotrexate (MTX) therapy after the achievement of clinical remission. METHODS: We conducted a retrospective review of the clinical course of all consecutive patients with JRA treated with MTX at our department. RESULTS: Seventeen of the 30 patients who responded to treatment entered clinical remission 6 to 30 mo after beginning MTX therapy. All patients were discontinued from MTX within 2 to 5 mo. Five patients relapsed within 9 mo, whereas 12 patients had sustained remission for 12 mo or longer. Four of 5 children with extended pauciarticular JRA relapsed early after MTX discontinuation. These patients were less responsive to a further cycle of MTX, and 3 showed progression of radiographic joint lesions. CONCLUSION: These findings suggest that MTX should be continued in patients with extended pauciarticular JRA even after the achievement of clinical remission.
1379157 Pharmacological management of juvenile rheumatoid arthritis. 1992 Jun The goals of pharmacotherapy in juvenile rheumatoid arthritis (JRA) are to suppress chronic synovitis which causes potential cartilage destruction and deformities, to control the systemic effects of inflammation (including growth retardation and nutritional deficits), relieve pain and limit psychological impact of disease. Currently available methods include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, salicylates, naproxen, tolmetin, ibuprofen and indomethacin; disease modifying antirheumatic drugs (DMARDs) such as oral and injectable gold salts, hydroxychloroquine, penicillamine, oral and injectable methotrexate, and sulfasalazine; oral (daily or on alternate days), intravenous pulse or intra-articular corticosteroids; immunosuppresants, including cyclophosphamide, chlorambucil, cyclosporin, and azathioprine; and gammaglobulin and other experimental therapies. Over the past 10 years, rheumatologists have adopted more aggressive pharmacological treatment of JRA. As time progresses and the safety of certain drugs such as methotrexate and sulfasalazine becomes clearer, wider and earlier use of these agents can be expected. Still the approach to treatment is a 'step by step' one, starting with the classical NSAIDs and ending with the DMARDs as needed.
7741263 Effect of nationwide selenium supplementation in Finland on selenium status in children wi 1995 Mar A study was performed on the effect of increased selenium intake on the serum selenium level of 212 children with juvenile rheumatoid arthritis (JRA) and of 214 controls in a follow-up study during the Finnish nationwide selenium fertilization programme, which was started in 1984. The mean serum level of selenium increased from 0.90 mumol l-1 in 1985 to 1.56 mumol l-1 in 1990 in the children with JRA. The corresponding selenium levels in the controls were 0.87 mumol l-1 in 1985 and 1.33 mumol l-1 in 1990. Boys had slightly higher selenium levels in all the age groups among the patients and the controls. During the entire 10-year observation period, the patients with JRA had slightly higher mean levels of selenium than the controls. The age of the children did not have any significant effect on the selenium level in either group. The present study shows that the main factor affecting the serum level of selenium was the dietary intake of selenium both in patients and in healthy controls.
8463935 Conceptions of illness by children with juvenile rheumatoid arthritis: a cognitive develop 1993 Feb Investigated the conceptions of illness and accuracy of understanding about their disease for children with juvenile rheumatoid arthritis (JRA). 54 children between the ages of 6 and 17 were interviewed individually about various aspects of JRA, with results suggesting that accuracy and illness conceptions could be reliably measured. As predicted, children's understanding about their disease followed a developmental progression, with older children demonstrating a more sophisticated understanding of JRA than younger children (significant differences between age groups on 3 of the 5 questions). Multiple regression analysis indicated that conceptual level (p < .001) was a better predictor of the child's accuracy of knowledge than was age (ns). Despite the developmental progression, there were a significant number of children functioning below the level expected for their age. In fact, the majority (75%) of children exhibited an understanding of JRA at the concrete operational level of cognitive development. The within-subject variability and striking misconceptions argue for ongoing evaluation of each child's understanding as a way to improve educational efforts.
8982123 Functional alpha 1-adrenergic receptors on leukocytes of patients with polyarticular juven 1996 Dec During the last decade it has been shown that the central nervous system can influence the immune system. In healthy individuals, catecholamines can inhibit the production of pro-inflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) via interaction with beta 2-adrenergic receptors. In contrast, we show here that catecholamines can stimulate the production of the interleukin-6 (IL-6) in children with the chronic inflammatory disease polyarticular juvenile rheumatoid arthritis (JRA). The induction of IL-6 is mediated by triggering of alpha 1-adrenergic receptors on peripheral blood leucocytes of the patients with polyarticular JRA. Functional alpha 1-adrenergic receptors are absent on leukocytes of normal donors and on leukocytes of patients with the oligoarticular form of the disease.
1593598 Newer functional outcome measurements in juvenile rheumatoid arthritis: a progress report. 1992 Apr Development of health status questionnaires for pediatric patients with rheumatic disease presents special challenges. At this time, several investigators are actively involved in development of health status instruments which have demonstrated reliability and internal validity. I review these instruments and outline future studies needed for these instruments.
8849344 Levels of soluble Fas/APO-1/CD95 in systemic lupus erythematosus and juvenile rheumatoid a 1995 Dec OBJECTIVE: To quantify soluble Fas/APO-1 (sFas/APO-1) protein in the serum of patients with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA). METHODS: Soluble Fas/APO-1 was quantified using a sandwich enzyme-linked immunosorbent assay. Disease activity in SLE patients was assessed by the SLE Disease Activity Index. RESULTS: Increased serum sFas/APO-1 levels were observed in only 1 of the 27 SLE patients (4%) and 3 of the 10 JRA patients (30%). CONCLUSION: Increased levels of sFas/APO-1 occurred infrequently in SLE, and the levels were lower than 10 ng/ml. Increased levels of sFas/APO-1 are not specific for SLE. Soluble Fas/APO-1 is unlikely to be of major pathogenetic significance in SLE.
8024956 Epidemiology of the rheumatic diseases. 1994 Mar Understanding, description, and classification of musculoskeletal pain syndromes have been further substantiated, but linking them to physical and psychological variables remains problematic. Core tools to measure disability in a population context forms a stable, well validated set of instruments, which increasingly has been translated, tested, and applied in sociocultural settings and in outcome research. Evidence for a declining incidence of rheumatoid arthritis seems established, and paleopathologic evidence indirectly provides some support for a possible causative environmental agent. Within an epidemiologic framework, immunogenetic studies continue to suggest an increasing number of subsets of rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis variants. Studies in which the overuse hypothesis was tested as a cause in the etiology of osteoarthritis have provided conflicting results. Increasing evidence shows a secular trend in loss of bone mineral density, resulting in an increased fracture incidence. However, validated methods to safely prevent osteoporosis and fracture are also being established. Finally, although they are now well recognized and scientifically productive, large long-term epidemiologic studies should be critically examined.
7863282 Psoriatic onycho-periostitis. Report of three cases. 1995 Authors report three cases of psoriatic onycho-periostitis (great toe in two cases, thumb in one case). In a recent study, they demonstrated that osteoperiostitis of the distal phalanx of the great toe was significantly more frequent in patients with psoriatic arthritis than in other groups (cutaneous psoriasis, rheumatoid arthritis, spondylarthropathy, connective tissue diseases, and control subjects), suggesting that the existence of osteoperiostitis of the distal phalanx of the great toe is valuable for the diagnosis of psoriatic arthropathy.
8516556 [HIV-induced clinical conditions: rheumatic conditions]. 1993 Jun Many retroviruses have been shown to be involved in the etiology of rheumatic diseases both in animal models and in humans. In particular, HIV infection has been correlated to a greater incidence of Reiter syndrome, psoriatic arthritis, sicca syndrome and other seronegative polyarthritides. Aim of this paper is to discuss clinical findings, diagnostic strategies and therapy of these diseases. We will describe how the profound abnormalities in the immune system brought about by the HIV infection can induce the development of reactive arthritides, inhibit the clinical expression of rheumatoid arthritis and affect the clinical presentation of SLE.
8803913 The use of chloroquine and hydroxychloroquine for non-infectious conditions other than rhe 1996 Jun Chloroquine and hydrocychloroquine have been evaluated in 30 noninfectious disorders and conditions other than rheumatoid arthritis or lupus erythematosus; 12 of these have been subjected to well-designed controlled trials. It is concluded that chloroquines are safe and effective first line therapies for selected patients with porphyria cutanea tarda, cutaneous sarcoidosis, cutaneous manifestations of dermatomyositis, hyperlipidemias and thromboembolic prophylaxis for patients with antiphospholipid antibodies. Published experience with these and other diseases or syndromes are critically reviewed.
7744099 Cardiac involvement in collagen diseases. 1995 Feb The purpose of this study is to evaluate the early morphological and functional abnormalities of the heart in patients with collagen disease. The study population was free of risk factors for coronary artery disease and without any clinically evident cardiac manifestations. In 62 patients with collagen disease (25 with progressive systemic sclerosis, 19 with systemic lupus erythematosus, 15 with rheumatoid arthritis, three with dermatomyositis) and in 40 healthy subjects an echocardiographic study was performed. Echocardiographic examination from the apical four-chamber view was performed at rest and during the end of a 3 min isometric exercise with handgrip. Global and regional ejection fraction of the left ventricle were calculated. In the group with progressive systemic sclerosis the left ventricular mass index was significantly higher than in the control group (110.78 +/- 48.61 vs 82.18 +/- 28.46 g.m-2) and the ejection fraction (53.61 +/- 7.95%) was the lowest of all groups (control: 61.47 +/- 8.52%, systemic lupus erythematosus: 59.04 +/- 8.58%, rheumatoid arthritis: 62.38 +/- 6.88%). Regional ejection fraction analysis revealed a major dysfunction of the proximal segment of the interventricular septum, in all groups. During isometric exercise, the global and regional ejection fraction did not change significantly, although differences between groups disappeared. In rheumatoid arthritis, mitral and aortic valve leaflet separation appeared to be reduced. In the group with systemic lupus erythematosus, mild abnormalities were noticed, although the mean age and duration of the disease were the smallest compared with the other groups. In conclusion, patients with progressive systemic sclerosis mainly present left ventricular hypertrophy with a reduced ejection fraction while rheumatoid arthritis patients show a predominant valve dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)
7521440 [Autoimmune disorders in interferon therapy]. 1994 Jul Interferons (IFNs) have immunomodulatory properties such as direct increase in the production of pathogen autoantibodies, enhanced cytotoxic T cell and B cell activities, inhibition of T suppressor cell function and induction of HLA class I antigen expression. These actions of IFN induce autoimmune disorders including autoimmune thyroiditis, hemolytic anemia and thrombocytopenia, SLE, rheumatoid arthritis and psoriasis, however, these autoimmune diseases except for autoimmune thyroiditis, are rare among side effects of IFN therapy. Most of the patients showing these autoimmune disorders during IFN treatment have predisposal immunological abnormalities such as positive ANA and antithyroidal autoantibodies. We described here autoimmune disorders during and after IFN treatment among 1023 cases with chronic active type C hepatitis. The cases with SLE, thrombocytopenic purpura, rheumatoid arthritis and psoriasis showed good prognosis after cessation of IFN administration.
8506430 [Arthritis in adolescence]. 1993 Apr 6 Joint problems in adolescence are often monoarticular. In the acute form the differentiation between trauma and infection is of utmost importance, whereas in chronic joint diseases the differentiation will be mainly between mechanical disorders and true rheumatic diseases. In pauci- or polyarticular arthritis of short duration viral infections have to be considered, since true rheumatic diseases tend to run a more chronic course. In girls true sero-positive juvenile rheumatoid arthritis typically appears in this age group. In adolescent boys seronegative Spondylarthropathies involving the lower extremities and not uncommonly with enthesopathies may occur. The typical involvement of the sacro-iliac-joint usually starts after the age of 18 years. Bacterial arthritides are predominantly monoarticular and are caused in more than 50% by staphylococci.
8576590 Immunological parameters in leprosy patients with and without arthritis. 1995 Jul Twelve patients of leprosy with arthritis and 161 patients without arthritis were studied for immunological parameters like immunoglobulins (IgG, IgM, IgA), C-reactive proteins and rheumatoid factor. There was increase in the levels of IgG, IgA value in leprosy patients with and without arthritis compared to healthy control. IgM level was decreased in both the groups compared to control, but significant decrease was observed (p < .01) in patients with arthritis. C-reactive protein was significantly positive in leprosy with arthritis group (p < .01) and positive in 12 cases of leprosy without arthritis group compared to negative control group. Rheumatoid factor was present in leprosy with arthritis (16.6%) compared to both the control group and leprosy without arthritis group. This study concluded the presence of arthritis in leprosy patients as a definite entity which showed changes in immunological parameters.
8838526 Effects of polyarticular and pauciarticular onset juvenile rheumatoid arthritis on facial 1996 Jan OBJECTIVE: To characterize the functional and morphologic effects of polyarticular and pauciarticular onset juvenile rheumatoid arthritis (JRA) on the temporomandibular joint (TMJ). METHODS: Medical and dental histories, intraoral, lateral cephalometric, and panoramic radiographs, facial photographs, and dental study models were obtained for each of 30 patients with JRA (17 pauciarticular and 13 polyarticular onset). Measures of TMJ dysfunction were gathered during the clinical examination, and an index of condylar morphology was inferred from the panoramic radiographs. The lateral cephalograms were traced, and data from 34 linear and angular measures used to compare the facial morphology of the 2 JRA onset types, both to normative standards and to each other (Student's t test). The Kruskal-Wallis test was used to evaluate the significance of between-group differences for the various ordinal indices. RESULTS: As indicated by the higher TMJ dysfunction and condylar index scores, polyarticular onset JRA affects the form and function of the TMJ more frequently and severely than does pauciarticular onset. Moreover, compared to normative cephalometric standards, the patients with polyarticular onset had small, short faces with underdeveloped mandibles. CONCLUSION: Both polyarticular and pauciarticular onset JRA have a negative effect on the form, function, and esthetics of the face and mandible; however, the effects are more pronounced with polyarticular JRA than pauciarticular onset.
8389678 T cell receptor rearrangements in juvenile rheumatoid arthritis: a search for oligoclonali 1993 Mar Southern blot analysis of DNA from paired samples of synovial compartment (membrane and/or fluid) and peripheral blood T cells from nine children with juvenile rheumatoid arthritis (JRA) was carried out. Using a T cell receptor C beta probe, dominant TCR rearrangements were discovered in specimens from three patients: synovial fluid T cells from one, synovial fluid and synovial membrane cells from a second, and synovial membrane and peripheral blood cells from a third. The patient showing dominant bands in peripheral blood as well as in synovium was the only child in the series with systemic disease. Since non-specific T cell recruitment is likely to dilute antigen specific clones to low levels, the finding of dominant rearrangements in three of nine patients may indicate that oligoclonality is indeed a feature of JRA.
7488289 Association of HLA-B39 with HLA-B27-negative ankylosing spondylitis and pauciarticular juv 1995 Nov OBJECTIVE: To investigate the characteristics of HLA-B27 that render susceptibility to seronegative spondylarthropathies. METHODS: Serologic HLA class I typing of Japanese patients with ankylosing spondylitis (AS), juvenile rheumatoid arthritis (JRA), and healthy controls, was performed. HLA-B39 subtypes were determined by polymerase chain reaction-sequence-specific oligohybridization. RESULTS: HLA-B27 was present in 40 of 48 patients with AS (83%), and in only 1 of 210 healthy controls (0.5%). Three of 8 patients (37.5%) who were negative for HLA-B27 were positive for HLA-B39, which was significantly higher compared with the HLA-B27-negative controls (6.2%; P = 0.01). Significant association with HLA-B39 was also noted in the JRA patients (16.7%; P < 0.01), especially in those patients with pauciarticular-onset disease (33.3%; P < 0.01). Ten of 13 HLA-B39-positive patients had subtype B*3901 and 3 had B*3902. CONCLUSION: Because HLA-B27 and HLA-B39 share Glu at position 45 and Cys at position 67, both of which constitute components of the peptide-anchoring B pocket, and because they possess similar peptide-ligand motifs, our results may support either the role of the peptides presented by class I antigens or the importance of Cys at position 67, in the development of spondylarthropathies and pauciarticular-onset JRA.
8812643 Nitric Oxide in Arthritis. 1996 Aug Although arthritis occurs in many different forms, loss of articular cartilage and joint inflammation are the predominant pathophysiological processes consistently present in this group of diseases. Depending upon the particular arthritide, these two pathologies may take place together or separately. Evidence is accumulating to suggest that NO is produced locally within human osteoarthritic and rheumatoid joints. The articular chondrocytes and, perhaps, infiltrating leukocytes appear to be the major intraarticular sources of NO. All published data agree that biosynthesis of NO increases in animal models of rheumatoid arthritis, and inhibitors of NO synthases show strong prophylactic, anti-inflammatory activity. However, one study suggests that therapeutic activity may be weak. Chondrocytes produce large amounts of NO after exposure to interleukin-1 (IL-1). In rabbit, human and rat, but not bovine, articular cartilage endogenously produced NO inhibits the biosynthesis of matrix proteoglycans. However, studies with bovine articular cartilage further indicate that NO partially protects proteoglycans from degradation in response to IL-1. These data encourage the notion that NO is involved in the pathophysiology of arthritis, but caution that this involvement may be complex.
8096698 Second Jenner International Glycoimmunology Meeting. 1993 Mar The importance of oligosaccharides in their own right and their effects on glycoprotein structure and function is being increasingly appreciated. Areas of interest include the importance of oligosaccharides to immune mechanisms, the association of certain changes with diseases such as rheumatoid arthritis, and the potential for the development of novel therapeutic strategies. Here John Axford reports on the recent developments in this area.