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ID PMID Title PublicationDate abstract
7589984 How are class II MHC genes turned on and off? 1995 Nov Fragments of foreign antigen are detected by CD4+ helper T cells via the T cell receptor for antigen in the context of major histocompatibility complex (MHC) class II molecules. Very few cells normally express class II MHC molecules, and these cells play critical roles in antigen presentation and in the thymic selection of T lymphocytes before their exit into the periphery. Because of the central role the class II MHC molecules play in immune system function, it is not surprising that the lack of expression of these molecules results in a severe combined immunodeficiency disorder (called bare lymphocyte syndrome) and that the aberrant expression of the molecules is frequently observed in the target organs of various autoimmune disorders (e.g., multiple sclerosis and rheumatoid arthritis). Because both classes of disease could conceivably be treated by molecular approaches targeted at either restoring or inhibiting expression of class II MHC genes, there has been an intense effort during the past decade to elucidate the regulatory mechanisms of class II MHC genes. An analysis of recent advances in this effort is provided in this review article.
7778960 Physicians as patients. Choices regarding their own resuscitation. 1995 Jun 26 BACKGROUND: Attitudes toward cardiopulmonary resuscitation have changed considerably during the last 30 years. Although physicians are routinely involved in the decision making about cardiopulmonary resuscitation for their patients, little is known about their collective preferences regarding it for themselves. METHODS: A questionnaire was distributed at an internal medicine primary care review course at an urban community hospital. Of the 111 physicians registered at the meeting, 72 (65%) completed the questionnaire and serve as the basis for the results. Physicians were asked if they would want cardiopulmonary resuscitation for themselves in the presence of an acute myocardial infarction, Alzheimer's disease, and nine other advanced chronic diseases at the projected ages of 40, 60, and 80 years. RESULTS: At all projected ages, physicians' desire for cardiopulmonary resuscitation with any advanced chronic disease was significantly less than with an acute myocardial infarction (P < or = .000001 except for rheumatoid arthritis). Fewer physicians wanted cardiopulmonary resuscitation at age 80 years than at 40 years for any disease (P < or = .002). The results did not differ when analyzed by respondents' age, gender, or primary care specialty, or the size of the community in which they practiced. CONCLUSIONS: The results of this initial survey indicate that most physicians would not want cardiopulmonary resuscitation with a variety of underlying chronic diseases and corresponding functional impairments--particularly with advancing age. Conversely, with an acute myocardial infarction, all physicians surveyed would desire cardiopulmonary resuscitation at age 40 years, and many would continue to desire it with advancing age.
7723287 Immunofluorescence quantitation of stromelysin in human synovial fibroblasts by confocal l 1995 Apr BACKGROUND: Elevated levels of stromelysin have been reported in humans with osteoarthritis and rheumatoid arthritis, as well as in animal models of arthritis. However, a considerable amount of heterogeneity is observed in the expression of this enzyme in pathologic tissues as well as in in vitro systems. To analyze this variability, stromelysin expression was quantitated in individual human synovial fibroblasts (HSF) obtained from osteoarthritis patients. EXPERIMENTAL DESIGN: HSF were incubated with interleukin-1 (40 units/ml), an agonist known to induce stromelysin, in the presence or absence of dexamethasone (0.01 to 100 nM), an inhibitor of stromelysin transcription. With a stromelysin-specific antibody and a tetramethyl-rhodamine 5-isothiocyanate-labeled secondary antibody, the enzyme was visualized and the fluorescence in individual cells was quantified with an ACAS 570 laser cytometer in confocal mode. RESULTS: Stromelysin expression varied from one cell to another; however, on the basis of the magnitude of expression of stromelysin by each cell, the "nonresponders" within each treatment were identified. Approximately 34% of the cells showed a higher level of stromelysin expression in IL-1-treated HSF compared with controls. A dose-dependent inhibition in the expression of stromelysin was observed in response to increasing concentrations of dexamethasone. The dose-dependent changes in the accumulation of stromelysin protein correlated well with the stromelysin mRNA expression. CONCLUSIONS: Confocal laser scanning microscopy can be effectively used to analyze cellular heterogeneity in stromelysin expression.
7899167 The porous-coated anatomic (PCA) total hip arthroplasty: a review of 73 uncemented cases w 1995 Jan A total of 73 hips in 62 patients who underwent non-cemented total hip arthroplasties (THA) with porous-coated anatomic (PCA, Howmedica) prostheses have been reviewed. A complete evaluation including preoperative and postoperative Harris hip scores (HHSs), a complete radiographic study, and complication determination has been completed with greater than 2-year follow up. Diagnoses included osteoarthritis (74.0%), rheumatoid arthritis (4.1%), avascular necrosis (15.1%), and posttraumatic arthritis following fracture (6.8%). The complication rate was 10.9% (8 complications/73 arthroplasties); 20 patients (35.6%) received bilateral implants. The mean preoperative HHS for the entire group was 38.7, and the mean postoperative score, irrespective of postoperative time, was 93.6. Key findings regarding the consecutive radiographic review of each arthroplasty included: 9.6% lucencies, 43.8% stress shielding, stable fibrous ingrowth in 74.0%, tip sclerosis in 19.2%, and cortical widening in 4.1%. The finding of loose beads from the pore ingrowth area of the prosthesis was minimal (7 beads in 6 patients). These results demonstrate the efficacy of the PCA prosthesis.
7506999 Structural requirements for recognition of a type II collagen peptide by murine T cell hyb 1994 Jan T lymphocytes play a critical role in the development of murine collagen-induced arthritis (CIA), a syndrome which shares many features with rheumatoid arthritis. In susceptible mouse strains, immunization with type II collagen (cII) results in chronic inflammation with progressive joint destruction. To examine T cell recognition of cII we have isolated T cell hybridomas specific for a cII peptide fragment, cII260-270 (IAGFKGEQGPK). We assessed the importance of particular amino acid residues to formation of the MHC Class II-peptide complex and interaction of this complex with TCRs. Our results indicate that critical residues are concentrated in the N-terminal half of the peptide, with Lys264 and Glu266 having the greatest influence. Replacement of these residues with alanine resulted in loss of detectable activity. Three other residues, Ile260, Gly262, and Phe263, are also important to T cell stimulation because alanine substitution substantially decreased peptide activity. Truncation analyses supported the conclusion drawn from Ala substitutions that C-terminal residues were dispensable. Other alterations in peptide structure resulted in dramatic increases in stimulatory capacity. For example, replacement of either Gly265 or Gly268 with alanine resulted in a 10-fold increase in potency. The addition of 2-5 residues to the N-terminus of the peptide decreased the dose required for maximal T cell stimulation by > 100-fold. The T cell hybridomas exhibited remarkable similarity in their peptide recognition profiles although they express different TCR V beta elements.
8510822 Bilateral changes of substance P-, neurokinin A-, calcitonin gene-related peptide- and neu 1993 Apr 16 It has been hypothesized that the nervous system contributes to the symmetrical response in rheumatoid arthritis. In order to elucidate this, the bilateral concentrations of substance P-like immunoreactivity (SP-LI), neurokinin A-LI (NKA-LI), calcitonin gene-related peptide-LI (CGRP-LI) and neuropeptide Y-LI (NPY-LI) in rat synovial fluid during acute monoarthritis were studied. Equal volumes (0.05 ml) of either Freund adjuvants, carrageenan 2%, substance P 10(-5) M or human recombinant interleukin-1 alpha were injected into the right and saline into the left knee joint. Control rats were given saline bilaterally. Perfusates were obtained from both knees simultaneously at 2, 6 and 24 h after injection and were analysed by specific radioimmunoassays. Increase of SP-, NKA-, CGRP- and NPY-LI in synovial fluid occurred in both knees after injections with the pro-inflammatory substances into the right joints as compared to controls, except for unchanged SP-LI in the right knee joint after 24 h following hrIL-1 alpha injection. There was, however, generally no significant difference in the peptide contents between the right knee (injected with pro-inflammatory substance) as compared to the left knee (given saline) at 2, 6 or 24 h after injection except at three occasions. The results show that experimentally induced monoarthritis induces bilateral changes in synovial fluid peptide content.
1502562 Mechanisms of action of cyclosporine and effects on connective tissues. 1992 Jun Cyclosporine is a potent immunomodulatory agent with an increasing number of clinical applications. Its major mode of action is inhibition of the production of cytokines involved in the regulation of T-cell activation. In particular, cyclosporine inhibits the transcription of interleukin 2. Although cyclosporine's major actions are on T cells, there is some evidence that it produces direct effects on other cell types. Its immunosuppressive action is closely linked to its binding of cyclophilin, a member of a family of high-affinity cyclosporine-binding proteins widely distributed in different cell types and in different species. The cyclophilins have been shown to have peptidyl-prolyl cis-trans isomerase enzyme activity that is blocked by cyclosporine. Although this may be a factor in cyclosporine's selective inhibition of cytokine gene transcription, it is still unclear whether inhibition of this activity is the mechanism through which cyclosporine exerts its effects on target cells. The ubiquitous presence of cyclophilins raises the question of why cyclosporine has major effects on T cells. Perhaps the critical proteins affected are transcriptional regulators restricted in their tissue distribution. The effects of cyclosporine on T cells and, directly or indirectly, on connective tissue cells, all of which can produce a range of cytokines, are of interest in relation to the tissue changes that occur in such inflammatory conditions as rheumatoid arthritis.
1567490 Psychiatric disorder and cognitive impairment in systemic lupus erythematosus. 1992 Apr OBJECTIVES: To determine the point prevalence of psychiatric disorder in patients with systemic lupus erythematosus (SLE). To investigate associations between psychiatric disorder and social stress, cognitive impairment, systemic disease activity, and corticosteroid therapy. METHODS: A cross-sectional study of 73 consecutive patients with SLE assessed using standardized psychiatric and clinical research methods. RESULTS: Current psychiatric disorder was present in 15 patients (20.5%) and was significantly associated with social stress, lack of social support, and impairment on 2 tests of cognitive function (Verbal Fluency Test and Benton Visual Retention Test, Part A, number of errors). There was no association with systemic disease activity or corticosteroid therapy. Cognitive impairment on 2 or more tests was found in 26% and was associated with clinical evidence of central nervous system (CNS) disease, but not systemic disease activity or corticosteroid therapy. CONCLUSIONS: The point prevalence of psychiatric disorder in this cohort of patients with SLE was found to be similar to that observed in patients with rheumatoid arthritis. It was independently associated with social stress and 2 indicators of cognitive impairment, but not with systemic disease activity or corticosteroid therapy. Marked cognitive impairment was present in a significant percentage of patients even when there was no overt evidence of CNS involvement.
19078046 Human immunodeficiency virus infection search for musculoskeletal manifestations and mimic 1996 Jun This study involved 50 human immunodeficiency virus (HIV)-positive patients in various stages of the disease to identify signs and symptoms suggestive of rheumatologic disorders and to determine how frequently such findings mimic rheumatologic pictures. Control subjects were 25 ambulatory HIV-negative patients with similar risk factors, mostly drug abuse. Although arthralgias and myalgias were reported in both groups, arthritis was only detected in the HIV-positive group. Twenty-four HIV cases presented two or more signs or symptoms suggestive of rheumatic disorders versus only six non-HIV cases (p < 0.04). Some features were suggestive of systemic lupus erythematosus, vasculitis-panarteritis nodosa, Sjögren's syndrome, Behcet's syndrome and rheumatoid arthritis, although no patients met criteria for these diseases. Reiter's syndrome was diagnosed in two (4%) HIV-positive patients. On correlating CD4 lymphocyte levels and rheumatic symptomatology, the more severely immunocompromised cases were found to present musculoskeletal manifestations with greater frequency. Potential HIV infection should be considered in differential diagnosis of questionable cases of rheumatic disease to avoid both misdiagnosis and the institution of therapies liable to worsen the immunodeficiency syndrome.
19077997 Rotator cuff dysfunction in patients with rheumatoid arthritis. 1995 Oct Periarticular shoulder problems, particularly those involving the rotator cuff, are commonly found in the general population. Although synovitis of the glenohumeral and acromioclavicular joints may be seen in rheumatiod arthritis (RA), periarticular shoulder problems may also occur. The objective of this study was to define the prevalence of shoulder symptoms and periarticular shoulder abnormalities in a group of RA patients and to correlate findings on physical examination with those obtained with magnetic resonance imaging (MRI).Shoulder function was evaluated by history, physical examination, roentgenogram, and MRI in a group of older, male RA patients; 82% of the 40 patients evaluated had a history of shoulder pain, and 88% had an abnormal physical examination. The most frequent abnormality involved the rotator cuff musculature. Plain roentgenograms were abnormal in only 10 of the 26 (38%) patients. In contrast, abnormalities were noted on MRI in 13 of 14 patients studied (93%). The most frequent MRI abnormalities related to the rotator cuff, with a spectrum of abnormalities ranging from mild inflammatory changes through compete tendon tears. Of note, in all 14 patients undergoing MRI, physical examination findings correlated with abnormalities noted on MRI.Problems referred to the shoulder may be very common in RA patients. Rotator cuff dysfunction was the most common cause of shoulder problems in a population of older, male RA patients. A thorough physical examination often establishes the cause of these problems.
7775806 DNA inoculation as a novel vaccination method against human retroviruses with rheumatic di 1994 There are a number of rheumatologic manifestations of human retroviral infections associated with human immunodeficiency virus type I (HIV-I) and the human T-cell leukemia virus type I (HTLV-I) including arthritis, Sjøgren's syndrome-like symptoms as well as other varied autoimmune phenomena. Infection with HTLV-1 may be directly involved in the etiology and/or pathogenesis of an arthritic condition similar to rheumatoid arthritis. We have been characterizing a new vaccination strategy against human retroviral infections, designated DNA inoculation. This procedure involves the intramuscular injection of DNA plasmids which express specific human retroviral antigens. This technique results in the development of humoral and cellular immune responses against these proteins. Specifically, this method has been successfully used to develop immune responses against HIV-I and HTLV-I. The availability of rat and rabbit infection models for HTLV-I, coupled with the successful development of immune responses in these animals after DNA inoculation with an HTLV-I envelope expressing plasmid, will allow the efficacy of this vaccination technique to be evaluated with protection against in vivo viral challenge as an endpoint.
1300612 Macrophages (phagocytic-histiocytic reticular cells) in reactive-inflammatory lesions of t 1992 Dec An immunohistochemical and morphometric study was performed on trephine biopsies of the bone marrow in 52 patients (28 males/24 females; age 68 years) with various subtypes of myelodysplastic syndromes (MDS) to determine the number of macrophages (phagocytic-histiocytic reticular cells). Quantifications included the haemosiderin-storing subpopulation (Prussian-blue reaction) of this lineage as well as the iron-free compartment. The latter was identified by a new monoclonal antibody (PG-M1) which is specifically directed against histiocytic reticular cells. Bone marrow specimens of individuals without haematological disorders and those showing reactive lesions served as controls. In comparison with the normal bone marrow and inflammatory changes (i.e. rheumatoid arthritis) 23 of the 52 patients with MDS revealed a significant increase in macrophages. This increase encompassed not only the iron-laden subpopulation but also the total number of phagocytic reticular cells. Accumulation of macrophages in MDS was speculated to be due to a premature and enforced degradation of dysplastic cell elements leading to phagocytosis of haemosiderin and debris material. Moreover, cells of the monocyte-macrophage system could be involved in the complex pathomechanism of fibrillogenesis, since in a considerable percentage of patients with MDS, an increase in reticulin (argyrophilic) fibres was noticeable. Our finding of an expansion of the macrophage compartment in about half of the patients with MDS is in keeping with results of cell culture studies on colony formation of granulocyte-macrophage precursors (CFU-GM).
1373911 Expression of collagenase and potential transcriptional factors in the MRL/l mouse arthrop 1992 Feb Typical erosions of articular joint structures in rheumatoid arthritis and in the spontaneous destructive hind-limb arthropathy of autoimmune MRL-lpr/lpr (MRL/l) mice occur predominantly in areas contiguous with proliferating synovial lining cells, suggesting release of proteolytic enzymes from these cells. Synovial lining cells were isolated from arthritic MRL/l mice, and the spontaneous expression of the interstitial procollagenase and its potential transcriptional factors, egr-1 and c-fos, was examined in vitro. The data indicate that basal collagenase RNA expression was stronger in MRL/l cells than in virus-transformed cells. Moreover, elevated RNA levels of the c-fos gene could be detected in the collagenase-expressing synovial lining cells in vitro. In a related immunohistochemical study, collagenase was detected in situ in proliferating synovial lining cells as well as in chondrocytes of the first stage of pathological changes in the MRL/l mouse arthropathy.
8653982 Modern cement technique and the survivorship of total shoulder arthroplasty. 1996 Jul Thirty-eight consecutive Neer II total shoulder arthroplasties were performed in 35 patients by one surgeon using the so called modem cement technique and followed for a mean of 5 years (range, 2-9.5 years). The preoperative diagnosis was osteoarthritis or avascular necrosis in 22 shoulders, rheumatoid arthritis in 10 shoulders, and posttraumatic arthritis in 6 shoulders. The components were implanted using specific improved techniques for cement fixation initially described for total hip arthroplasty. Twenty-six metal-backed and 12 polyethylene glenoid components were used. The humeral component was implanted with cement in 32 shoulders. There were no intraoperative fractures or postoperative neurapraxias. At most recent followup, 36 shoulders had no or slight pain with activity. The mean increase in active forward elevation was 38 degrees and in active external rotation was 29 degrees. There have been no revisions, and all components remain in place. With failure defined as definite radiographic loosening of the components, there was 97% survivorship at 5 years, and 93% at 8 years. Radiolucent lines around more than 50% of the bone cement interface of the humeral component were present in only 3 shoulders. Radiolucent lines around more than 50% of the bone cement interface of the glenoid component were seen in only 2 shoulders. Both components in 1 severely osteopenic shoulder had a complete radiolucent line and a change in position. Meticulous attention to cement technique may improve the long term survival of cemented total shoulder arthroplasty components.
8970272 Coping with osteoarthritis by older adults. 1996 Apr OBJECTIVE: To extend to patients with osteoarthritis (OA) the coping model developed for patients with rheumatoid arthritis. METHODS: Relationship among appraisal, coping, and impact of OA were examined in a prospective study. Older men and women with OA (n = 82) were recruited from the community and were assessed at baseline, 1 month, and 4 months. Appraisal at baseline was measured by an interview addressing patients' beliefs about the intensity of their OA. Active, passive, and behavioral coping were assessed at 1 month, and the impact on OA pain, affective status, and mood was assessed at 4 months. RESULTS: Appraisal of OA as more intense was related to the use of more passive coping at 1 month, and was also related to more negative mood at 4 months. Active coping was predictive of less depressed affective status, whereas passive coping was predictive of subsequent worsening of negative mood. These relationships remained significant after controlling for demographic and medical history variables and functional status measures associated with dependent variables. No relation of either appraisal or coping to pain or positive mood was observed. CONCLUSIONS: The findings suggests that as patients' appraisals of the intensity of their OA decrease, less use of passive coping strategies, which are associated with poorer outcomes, should result. It is recommended that interventions to reduce OA impact should include both modification of appraisals of OA and modification of patients' coping strategies.
7920527 [Prolactin, a link between the neuroendocrine and immune systems. Role in the pathogenesis 1994 Apr Increasing evidence suggest that prolactin (PRL) has important immunoregulatory properties and may play a role in the pathogenesis and disease expression of certain autoimmune diseases. Prolactin is co-mitogenic on murine and human lymphocytes, induces the formation of IL-2 cell surface receptor and modulates the expression of various growth factor related genes. Prolactin also stimulates antibody production both in vivo and in vitro. Specific high affinity prolactin-receptors have been described on T and B lymphocytes as well as on monocytes. They are distributed on heterogeneous lymphocyte subsets and they showed imbalance in autoimmune situations. Lymphocytes may produce PRL-like proteins biologically active that function as autocrine growth factors for lymphoproliferation. Hyperprolactinemia has been found in male patients with systemic lupus erythematosus (SLE) and also during pregnancy in SLE patients. Hyperprolactinemia is correlated with clinical and serological activity in a subset of SLE patients. High levels of PRL aggravates disease activity and accelerates mortality in the B/W mouse model of SLE. In rheumatoid arthritis an excessive and upregulated secretion of PRL has been shown. Hyperprolactinemia has also been shown in a subset of patients with primary Sjögren's syndrome. High PRL levels have been found in Reiter's syndrome patients and bromocriptine treatment has been reported effective in these patients and psoriatic arthritis patients. These data support a potential role of this immunoregulatory hormone in the pathogenesis of some rheumatic diseases.
8129775 The effect of low-dose methotrexate on bone metabolism and histomorphometry in rats. 1994 Feb OBJECTIVE: To ascertain the effects of low-dose methotrexate (MTX) on bone metabolism and histomorphometry in rats. METHODS: Female Sprague-Dawley rats (6 months old, n = 42) were divided into the following 4 groups: intraperitoneal (IP) injections of MTX, with and without ovariectomy, and IP saline (controls), with and without ovariectomy. Injections were given for 16 weeks. The MTX dose was equivalent to a standard dose for rheumatoid arthritis in humans that would yield similar serum MTX levels (0.6 +/- 0.1 mumoles). RESULTS: Bone formation (assessed by serum alkaline phosphatase and osteocalcin levels and histomorphometry) was significantly lower in the MTX groups, and bone resorption (assessed by urinary hydroxyproline levels and histomorphometry) was increased in the MTX groups. Bone mass was significantly diminished in the MTX groups. CONCLUSION: Prolonged administration of low-dose MTX in rats causes significant osteopenia via suppression of osteoblast activity and stimulation of osteoclast recruitment, which results in increased bone resorption.
8254911 [Pure red cell aplasia complicated with polyarthritis, angitis, and acute renal failure]. 1993 Nov A case of pure red cell aplasia (PRCA) with various complications polyarthritis, angitis, acute renal failure and DIC was successfully treated with steroid pulse therapy was described. A 55-year-old woman was hospitalized with a 9-month of intermittent but progressive joint pain, morning stiffness, general fatigue, and fever. Her initial laboratory evaluation revealed a hemoglobin of 4.4 g/dl and absence of reticulocyte. Her bone marrow aspirate showed no erythroblast which was compatible with a diagnosis of PRCA. Marked leukocytosis and thrombocytosis, positive antinuclear antigen, elevation of gammaglobulin and C-reactive protein and the presence of polyarthritis and angitis which was confirmed by renal angiography, indicated an underlying autoimmune disorders. Steroid pulse therapy was administered at 500 mg/day for 3 days, resulting in the complete response in both red cell aplasia and above findings. PRCA is known to be associated with systemic lupus erythematosus and rheumatoid arthritis very rarely, but this case did not fulfill the criteria of known collagen diseases, and there is no previous report representing PRCA with various complications such as polyarthritis, angitis and acute renal failure. This case may help us to understand more about the relationship between PRCA and autoimmune disorders.
1334393 [24 cases of human parvovirus B19 infection in children]. 1992 Nov From January 1, 1987 through December 31, 1990, twenty-four pediatric patients with human parvovirus B19 (HPV B19) infection were seen. In every case the diagnosis was established by a positive capture immunoassay for IgM antibodies against the HPV B19. Four patients had hematologic manifestations, including one case of transient bone marrow aplasia revealing hereditary spherocytosis, one case of autoimmune hemolytic anemia with beta-thalassemia, and two cases of peripheral thrombocytopenia. Eight patients had skin lesions, with a morbilliform rash in six cases, erythema nodosum in one case, and Gianotti-Crosti syndrome in one case. No patients had erythema infectiosum. Seven patients developed joint manifestations: Henoch-Schönlein purpura in two cases, arthralgia in four cases, and polyarticular disease progressing to severe rheumatoid arthritis in a thirteen-year-old girl. Unremarkable symptoms of viral disease were seen in three patients. A five-month-old infant developed severe acute myocarditis. One patient with hepatitis A had acute liver failure. This study confirms the broad spectrum of clinical manifestations of HPV B19 infection. There were a number of unusual findings, including the high rate of joint manifestations (29%) and the severe course of some hematologic and myocardial manifestations. These results raise the question of whether the HPV B19 may be involved in the genesis of chronic juvenile arthritis.
8923377 Pediatric rheumatology clinic populations in the United States: results of a 3 year survey 1996 Nov OBJECTIVE: To describe the patient population referred to pediatric rheumatology centers (PRC) across the US 1992-95; and to compare these results to data on regional PRC populations. METHODS: A Pediatric Rheumatology Disease Registry was established in 1992. Data on new patients seen at 25 PRC across the US were submitted to the registry for a 36 month period from 1992 through 1995. RESULTS: A total of 12,939 patients were submitted to the registry. Of these patients, 5245 (40.5%) had rheumatological diagnoses. Patients with juvenile rheumatoid arthritis were the largest group of the patient population (2071 patients-16% of total diagnoses). There were 1568 patients with other forms of childhood arthritis (12%), 1172 with collagen vascular diseases (9%), and 434 with vasculitis (3.3%). Over 50% of the patients had nonrheumatologic diagnoses, including 1577 with idiopathic pain syndromes (12%). Other diagnoses included infections, orthopedic conditions, and malignancies. Fourteen percent of the patients were not given a diagnosis at the time of the initial visit. CONCLUSION: PRC see a wide variety of patients. Although the majority do have rheumatologic conditions, over 50% of new patients have conditions not autoimmune in origin. Fourteen percent of the patients cannot be diagnosed at the time of their first clinic visit, requiring time to see the evolution of their symptoms before a definitive diagnosis can be assigned.