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ID PMID Title PublicationDate abstract
8506431 [Laboratory diagnosis of monarthritis: how much, what for, when?]. 1993 Apr 6 Analysis of the synovial fluid is the major investigation of monoarthritis. Appearance, viscosity (low if inflamed), cell number and differential, presence of crystals or organisms are all relevant. If septic arthritis is suspected, culture of other sites such as blood, urine, sputum etc. is essential, and may alone yield the organism. If mycobacterium is possible, synovial membrane staining and culture is usually necessary. Gonococcal may be lost in culture if the specimen is not immediately processed. Partially treated sepsis may produce sterile culture, and early work suggests that P.C.R. may diagnose these cases. Other investigations such as erythrocyte sedimentation rate, C-reactive protein indicate inflammatory activity, though they are not specific. Antibodies such as antinuclear antibodies, rheumatoid factors lead towards an "autoimmune" disease diagnosis, that do not alone measure activity. Specific antibodies to virus e.g. parvovirus may be diagnostic. The monoarthritis must be seen in the total patient context, where often clues e.g., asymptomatic uveitis (in juvenile chronic arthritis) and psoriasis may give the diagnosis.
8029628 [Histopathologic lesions of the accessory salivary glands in Gougerot-Sjögren syndrome: r 1994 In a retrospective study, we used a series of 29 patients with Sjögren's Syndrome diagnosed according to the new European criteria (Cl. Vitali, S. Bombardieri, H. M. Moutsopoulos et al.) (8). (Arthritis Rheum 1993; 36:340-7). A labial biopsy technique allowed to classify these patients into the anatomical "scores" formerly related by Chisholm and Mason and Chomette et al. Referring to these criteria, only 45% of patients presented a characteristic histopathological pattern. If another complementary criterium, i.e. ductal tropism of lymphoid infiltrates, was added, that percentage remained low (50% only). Thus, these results would suggest the following considerations: the classical histopathological criteria do not seem sufficiently specific; other histological criteria such as ductal lesions previously noted by Leroy et al. must in addition be looked for; thus it would seem to be of considerable value to use in the future complementary quantitative studies by means of morphometric methods.
1616324 Sjögren's syndrome: a stepwise approach to the use of diagnostic tests. 1992 May One hundred and forty two patients (62 with definite Sjögren's syndrome, 24 with probable Sjögren's syndrome, and 56 in whom Sjögren's syndrome was finally ruled out) were studied. Schirmer's test and rose bengal staining for the diagnosis of keratoconjunctivitis sicca and salivary scintigraphy and a labial biopsy sample for the diagnosis of xerostomaia were studied in all patients. Rose bengal staining showed high specificity (98%) but low sensitivity (55%). All patients with positive rose bengal staining results had associated xerostomia. In the rose bengal staining positive patients, scintigraphy had 100% specificity. A labial biopsy sample showed high sensitivity in the rose bengal staining, salivary scintigraphy positive group, and high specificity in the rose bengal staining positive, salivary scintigraphy negative group. In patients with negative rose bengal staining, salivary scintigraphy showed 96% specificity and 36% sensitivity. A labial biopsy sample had a sensitivity and specificity greater than 90% in rose bengal staining negative patients. Only 29 biopsy samples were needed to achieve a diagnosis of Sjögren's syndrome in 142 patients (20%). Hence the suggested approach may make it unnecessary to take biopsy samples in approximately 80% of patients with suspected Sjögren's syndrome. Using the stepwise approach of first rose bengal staining, then salivary scintigraphy, and eventually a labial biopsy sample in patients with suspected Sjögren's syndrome, the diagnosis is relatively simple.
1333310 Active oxygen species, articular inflammation and cartilage damage. 1992 Rheumatoid arthritis and osteoarthritis are age-related diseases, in which degenerative changes (arthrosis) and superimposed inflammatory reactions (arthritis) lead to progressive destruction of the joints. Active oxygen species derived from various sources play a role in this process, which may be influenced by appropriate treatment with antioxidants and free radical scavengers.
7820033 Abdominal visceral calcification in secondary amyloidosis: CT findings. 1994 Nov Amyloid fibrils have an affinity for calcium, and radiographically detectable calcified amyloid deposits may occur in both primary and secondary amyloidosis. However, abdominal visceral calcification is rare. A patient with secondary amyloidosis due to juvenile rheumatoid arthritis is described who developed extensive liver, adrenal, and renal calcification shown by computed tomography. Adrenal calcification in amyloidosis has not been previously described.
8072500 Arthritis of the cervical spine. 1994 May Neck pain often occurs in the absence of neurologic findings, and the diagnostic dilemma of the clinician is to determine if there is a definable lesion. Radiographically, the cervical spine is commonly involved, especially in persons older than 50 years. Excluding soft-tissue inflammation and spasm, osteoarthritis is the most common rheumatic disease of the cervical spine. Radiculopathy and myelopathic involvement from disk, foraminal, or spinal canal impingement are all sequelae of this disease. Other diseases, such as DISH, rheumatoid arthritis, and ankylosing spondylitis, can affect the spine as well. Assessment of the integrity of the atlantoaxial joint is important in avoiding neurologic compromise.
7847184 Antirheumatic drug profiles evaluated in the adjuvant arthritis of rats by multiparameter 1994 Aug Freund's adjuvant arthritis (FAA) in susceptible rats (male, Lewis strain) is a well-established experimental model of rheumatoid arthritis to evaluate inherent drug properties, i.e. anti-inflammatory and/or immunosuppressive/immunomodulatory properties which are only ascertained by combining multiple parameter analysis. We employed a synoptic multiparametric evaluation system for the multifaceted FAA, a so-called "spider scheme", to facilitate a more rapid and easier comparison of qualitative and quantitative drug properties by visual display than that achieved by mere tabulation of the data. The spider scheme comprised six well-established parameters to evaluate the FAA disease (primary and secondary hind paw swelling, arthritic index which included macroscopic alterations of non-injected paws, nose, ears and tail, body weight changes and relative organ weights of thymus and spleen). By calculation of an index as a percent change in comparison to control and untreated diseased animals, the degree of improvement or impairment of the FAA by a tested compound could easily be entered into the spider scheme. The FAA parameter spider scheme clearly differentiated the most beneficial immunomodulatory properties of cyclosporin A from those of the immunosuppressive agents dexamethasone and cyclophosphamide as well as from the mere anti-inflammatory cyclooxygenase inhibitors. Among this latter class of non-steroidal anti-inflammatory compounds, a similar profile was demonstrated for indometacin and diclofenac, as well as for tenidap, which is claimed to have cytokine-modulating properties, as reflected by the reduction of acute-phase proteins in patients with rheumatoid arthritis. Yet, in this FAA model, with tenidap, no additional qualitative drug properties could be discerned.(ABSTRACT TRUNCATED AT 250 WORDS)
8743282 The primary role of steroids on the osteoporosis in juvenile rheumatoid patients evaluated 1996 Mar Osteoporosis, a common clinical feature in children affected with Juvenile Rheumatoid Arthritis (JRA), is generally divided into two forms, a localized juxta-articular osteoporosis of the single joints and a generalized reduction of bone mass due to the disease itself, joint involvement and steroid treatment. Recently Dual Energy X-ray Absorptiometry (DEXA) has been suggested for Bone Mineral Density (BMD) measurement. In the present study DEXA has been used to investigate the lumbar spine BMD in JRA patients as compared to healthy children. Our results showed that BMD is reduced in JRA patients (BMD 0.685 g/cm2) when compared to healthy children (BMD 0.722 g/cm2), and it is significantly lower in the group of patients treated with steroids (BMD 0.623 g/cm2) when compared to those treated with nonsteroidal antiinflammatory drugs (BMD 0.710 g/cm2). The analysis of all risk factors of bone loss indicated that steroids represent the only parameter of significant negative correlation with BMD.
8463919 Identification of nonsteroidal antiinflammatory drug-induced gastroduodenal injury in chil 1993 Apr In a cohort of children with juvenile rheumatoid arthritis treated with nonsteroidal antiinflammatory drugs and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers. Epigastric pain strongly correlated with documented gastroduodenal injury. Therapy with ranitidine or misoprostol led to clinical improvement. Nonsteroidal antiinflammatory drugs are associated with significant gastrointestinal abnormalities in children.
7492219 Rheumatoid factor, chronic arthritis and mortality. 1995 Oct OBJECTIVE: To investigate chronic arthritis and rheumatoid factor (RF) for their prediction of premature total and cardiovascular mortality. METHODS: In 1978-80, a representative population sample of 8000 Finns aged 30 or more was invited to participate in a comprehensive health examination; 90% complied. Arthritis was diagnosed on the basis of medical history, symptoms, and physical examination. Serum RF was determined by the sensitised sheep cell agglutination test. RESULTS: By the end of 1992 1597 of the subjects had died from all causes, including 876 deaths from cardiovascular diseases. When adjusted for age, gender and smoking, the relative risk of persons with RF positive arthritis dying from any cause was 1.61 (95% confidence interval (CI) 1.03 to 2.51); RF negative non-erosive arthritis was not associated with mortality (relative risk 1.03; 95% CI 0.72 to 1.49). In the absence of arthritis, 'false positive' RF titres > or = 128 predicted cardiovascular deaths with a relative risk of 1.74 (95% CI 1.06 to 2.86). CONCLUSION: Both RF positive arthritis and false positive RF reactions predict mortality, but through different disease patterns.
1593584 Repetitive use of pulse therapy with methylprednisolone and cyclophosphamide in addition t 1992 Apr Patients with systemic juvenile rheumatoid arthritis (JRA) are often poorly responsive to existing therapeutic modalities. We evaluated the effectiveness of pulse therapy consisting of methylprednisolone 30 mg/kg/day for 3 consecutive days combined with cyclophosphamide 0.4 g/m2 body surface area on the 3rd day, for 18 patients with definite systemic JRA, who were enrolled in an open trial of 12 months' duration. The children received pulse therapy every 3 months; oral methotrexate 10 mg/m2 was started after the first pulse. A rapid and clinically significant suppression of systemic and articular manifestations was seen in all patients. Significant decreases in laboratory indices of disease activity were also observed. Side effects were minor and reversible. The results of our preliminary trial support the development of a controlled study to evaluate the efficacy of pulse therapy in systemic JRA.
8782143 Evaluation of associations between breast feeding and subsequent development of juvenile r 1996 Jun OBJECTIVE: To determine if previously breast fed children are more or less likely to have developed juvenile rheumatoid arthritis (JRA). Reports suggest that non-breast fed children are more likely to develop certain diseases for which an autoimmune pathogenesis is suspected. METHODS: Data from a longitudinal, case controlled population survey of childhood rheumatic diseases in Saskatchewan, Canada, included information pertaining to breast feeding history. These data were analyzed in the context of a retrospective, case controlled study to confirm results of an earlier report in which JRA was found to occur less frequently in previously breast fed children. For this analysis a child who had been breast fed for any length of time was categorized as having been a breast fed subject. RESULTS: A population of 88 children with pauciarticular JRA were more likely than an unmatched control population of 331 healthy children (p = 0.01) or those with polyarticular JRA (p = 0.006) to have been breast fed. However, when corrected for the number of comparisons made, statistical significance was not achieved 49 children with polyarticular JRA did not have a breast feeding history significantly different from the unmatched control population. In a retrospective, case control analysis of 54 children with pauciarticular JRA and 23 children with polyarticular JRA, no significant differences were noted when the JRA populations were compared to the parent selected, matched control populations (odds ratio for pauciarticular JRA 2.17: confidence interval 0.87-5.44; p = 0.06 and for polyarticular JRA 1.17: CI 0.33-4.20: p = 0.78). CONCLUSION: These results do not indicate a strong relationship between antecedent breast feeding and the subsequent onset of JRA and fail to confirm the results of earlier analyses in which JRA was found to occur more frequently in children who had not been breast fed.
8600412 Changing patterns in uveitis of childhood. 1996 Mar BACKGROUND: Although uveitis is relatively uncommon in children, its diagnosis and management present a distinct clinical challenge for the physician. An improved knowledge of disease patterns and associated morbidity will help in the care of children with uveitis. METHODS: The authors reviewed the records of 130 patients with onset of uveitis at 16 years of age or younger. The etiology of uveitis, complications encountered, treatment administered, and visual results were analyzed. RESULTS: Uveitis associated with juvenile rheumatoid arthritis (JRA) was the largest group (41.5%) followed by idiopathic uveitis (21.5%) and pars planitis (15.3%). Twenty-six percent of the eyes had less than 20/200 visual acuity at the time of first referral. Patients with JRA had the highest rate of complications: cataract (71%), glaucoma (30%), band keratopathy (66%), and hypotony (19%). The most frequent complication of pars planitis was maculopathy (55%). Final visual acuity was less than 20/200 in 26% of eyes with JRA, 10.5% with pars planitis, and 14% with idiopathic uveitis. CONCLUSION: Uveitis beginning in childhood is a serious disease associated with sight-threatening complications. Juvenile rheumatoid arthritis-associated uveitis remains a leading cause of ocular morbidity in patients with childhood uveitis. Increased awareness by pediatricians, rheumatologists, and ophthalmologists of the seriousness of ocular complications of uveitis in childhood may lead to earlier diagnosis and more effective treatment regimens in the future.
8838525 Effects of systemic onset juvenile rheumatoid arthritis on facial morphology and temporoma 1996 Jan OBJECTIVE: Twenty-four patients with systemic onset juvenile rheumatoid arthritis (JRA) were evaluated to determine its effects on facial morphology and temporomandibular joint (TMJ) form and function. METHODS: Patients were evaluated with medical and dental histories, facial photographs, intraoral examination, TMJ examination, lateral tomograms or panoramic radiographs, cephalograms, and impressions for study models. The craniomandibular index (CMI) was used to quantitate mandibular movement, tenderness, and TMJ noise. Symptoms were measured by symptom severity index (SSI). CMI data from the patients with JRA were compared to a group of 24 children without JRA with similar mean age and sex distribution. RESULTS: Our study indicates the facial morphology of patients with systemic onset JRA is similar to that of healthy children except for a mild convex facial profile and backward rotation of the mandible. Changes in facial form were associated with radiographic condylar abnormalities. CMI scores and SSI scores of systemic onset patients were significantly greater than controls, and radiographic condylar changes were noted in 29.2% of the patients with systemic onset JRA. CONCLUSION: Our study suggests that systemic onset JRA significantly affects TMJ form and function. Facial form was only affected in the few patients with significant radiographic condylar changes.
7777831 The variable clinical picture of arthritis induced by human parvovirus B19. Report of seve 1995 Seven patients with arthritis due to infection with human parvovirus B19 are reported, and the literature association reviewed. B19 virus arthritis most frequently affects young to middle aged women and occurs predominantly during the first six months of the year. The majority of cases have oligoarthritis or polyarthritis, and the joints most often involved are the proximal interphalangeal joints and knees. Of the seven patients reported, one case developed systemic lupus erythematosus, one case evolved into erosive, seropositive rheumatoid arthritis while one case was subsequently diagnosed as undifferentiated connective tissue disease.
7779128 The early clinical recognition of juvenile-onset ankylosing spondylitis and its differenti 1995 Jun OBJECTIVE: To determine which early clinical data differentiate juvenile-onset ankylosing spondylitis (AS) from juvenile rheumatoid arthritis (JRA). METHODS: Medical records of 35 patients with juvenile-onset AS and 75 with JRA (excluding type II pauciarticular JRA), all of whom had disease onset at age < or = 16 years, disease duration of < or = 2 1/2 years at the initial visit to the rheumatology clinic, and followup of > or = 10 years, were analyzed retrospectively with regard to features of disease found 6 months, 12 months, and 10 years after onset. RESULTS: At 6 months, various features appeared more frequently in the juvenile-onset AS group than in the JRA group, i.e., pauciarthritis (54.3% versus 30.7%; P = 0.03, odds ratio [OR] = 2.7), enthesopathy (82.9% versus 0%; P < 0.0001, OR = 321.4), tarsal disease (71.4% versus 1.3%; P < 0.0001, OR = 185.0), and lumbar/sacroiliac symptoms (11.4% versus 0%; P = 0.02, OR = 11.9). At 12 months, the features found more frequently among juvenile-onset AS patients than JRA patients were enthesopathy (88.6% versus 4.0%; P < 0.0001, OR = 186.0), tarsal disease (85.7% versus 10.7%; P < 0.0001, OR = 50.3), and knee disease (100.0% versus 82.7%; P = 0.04, OR = 8.0). Involvement of the upper extremities (especially the hands) was found in significantly fewer juvenile-onset AS patients compared with the JRA group. Definite involvement of the spine and sacroiliitis in juvenile-onset AS occurred after a mean +/- SD of 7.3 +/- 2.0 years. CONCLUSION: Regardless of axial disease, enthesopathy and tarsal disease in children who have arthritis of the lower, but not of the upper extremities differentiate juvenile-onset AS from JRA within 1 year of symptoms. The discriminative value of these parameters approaches that of axial disease (the gold standard) throughout the followup period.
8829384 [Rupture of extensor tendons due to an isolated lesion in the distal ulnar extremity]. 1996 Rupture of the extensor tendons is a well known complication of rheumatoid arthritis involving the wrist or any form of diffuse arthrosis. It is much less common in the context of isolated arthrosis of the distal radioulnar joint. The authors report ten cases of this disease in patients without rheumatoid arthritis. All patients in this series were over sixty years of age and reported insidious development of an extension deficit of the little finger, followed by the ring finger. The typical radiographic image of erosion into the sigmoid notch of the radius should be noted and should lead to arthrography in order to determine the status of the joint capsule. Surgical intervention should be performed before major tendon rupture occurs. The results presented here were adversely affected by the delay in surgical treatment. Once rupture of the extensor digiti minimi has occurred, the articular and tendinous pathology must be both be treated, including tendon repair and plasty of the dorsal retinaculum.
1287416 Monoclonal antibodies against human fibroblast collagenase and the design of an enzyme-lin 1992 Dec Monoclonal antibodies have been raised against purified human fibroblast collagenase and characterised. One of these antibodies has been used in combination with a polyclonal anticollagenase antibody in a double antibody sandwich ELISA to measure collagenase. The assay range was 2-50 ng/ml collagenase. The assay measures total collagenase, i.e. pro- and active enzyme as well as collagenase in complex with TIMP. The level of collagenase has been measured in sera samples from patients with rheumatoid arthritis and compared with age- and sex-matched controls. The levels measured were: rheumatoid arthritis, 69 +/- 29 ng/ml; normal, 49 +/- 14 ng/ml.
1529281 Paf-acether acetylhydrolase activity is increased in patients with rheumatic diseases. 1992 Paf-acether (platelet-activating factor) is a phospholipid described as a potent mediator of inflammatory response. We have recently shown that the level of paf bound to lipoproteins was significantly higher in the serum from patients with rheumatic diseases, compared to that of control subjects. In serum, paf is inactivated in part by a paf acetylhydrolase that catalyses the hydrolysis of the acetate residue. Acetylhydrolase activity was measured in the serum and synovial fluid of patients with rheumatoid arthritis and other arthritides, i.e. osteoarthritis and chondrocalcinosis. In serum, the activity of acetylhydrolase was significantly increased in patients with rheumatic diseases when compared with that in the control group. However, it was enhanced to a lesser degree in rheumatoid arthritis than in non inflammatory rheumatic diseases. These results suggest a role for acetylhydrolase in controlling paf levels in rheumatic diseases.
19077955 Synovial Biopsy of the Knee Joint under Direct Visualization by Needle Arthroscopy. 1995 Apr During a 30-month period, 51 needle-arthroscopic procedures using a small diameter (1.9 mm) flexible fiberoptic arthroscope were performed to obtain synovial tissue from knee joints. This procedure was performed in an outpatient setting using only a local anesthetic. Twenty-eight procedures were conducted involving 23 rheumatoid arthritis patients and 1 osteoarthritis patient as part of research protocols. In addition, arthroscopy and synovial biopsy were performed on 23 patients to obtain tissue for diagnostic purposes. Large samples of synovial tissue (over 10 g) were easily obtained in most patients. No complications were observed.The easy accessibility to large quantities of synovial tissue provided by needle arthroscopy should enable investigators to better define the pathogenic mechanisms operative in early rheumatoid arthritis. In addition, this technique will afford opportunities for determining the influence of current treatments as well as experimental treatments on molecular events in the synovium of patients. We conclude that outpatient needle arthroscopy using a small fiberoptic arthroscope can be used safely by rheumatologists trained in arthroscopy to obtain synovial biopsies for research and diagnostic purposes.