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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
11765658 [Popliteal (Baker's) cyst in a patient with tubercular arthritis. Report of a case and rev 2001 Nov The Baker's cyst is a distension of the bursa subtendinea and is caused by noninfectious knee effusion secondary to arthrosis, meniscal tears, trauma, rheumatoid arthritis, gout, or any other form of sinovitis, like rheumatoid arthritis. An infected popliteal cyst is much less common; tuberculous arthritis is exceptional, in fact only four cases are described in literature. Herein we describe an additional tbc case of a 51 years old men, who has been initially treated with cytostatic and corticosteroid agents, for a suspected rheumatoid arthritis. The review of the literature suggests the importance of a correct approach to the diagnosis, based on the analysis and culture of the synovial fluid, because delays latency of effective antibiotic therapy can result in permanent joint damage that invalidate the patients.
10652650 Bone marrow transplantation. 1999 Dec Some severe auto-immune diseases, including rheumatoid arthritis, require immunosuppression to save life or vital organ function. One major limiting factor in such immunosuppression is the unwanted and dangerous haematoablation occurring at the same time. It is now possible to give supralethal doses of haematoimmunoablative drugs, and to 'rescue' the patient with haematopoietic stem cell transplantation. There are case reports of patients with rheumatoid arthritis who have received bone marrow transplantation, now called haematopoietic stem cell transplantation (HSCT), for a conventional indication such as aplastic anaemia or malignancy, in whom a long lasting improvement of the arthritis was observed. However, not all cases have responded, and there are still many open questions concerning optimal treatment regimens. In addition, some animal model research has supported the concept of HSCT as a permanent treatment of auto-immune disease including arthritis. In the past three years, HSCT has been applied to treat auto-immune disease alone in around 180 patients, 20 of whom having had rheumatoid arthritis and 13 juvenile arthritis. Early results are encouraging, but many issues require further clarification through co-ordinated clinical trials. The evolution of this project, details of the early results, the remaining open questions and possible strategies to resolve these are the subject of this chapter.
17039145 Acute synovitis, fever and rash possibly caused by metallic debris from a loosened knee pr 2001 Aug A 39-year-old woman with long-standing seropositive rheumatoid arthritis who had a total replacement of her left knee with a modular prosthesis in 1994 presented with fever, pruritic rash, and acute synovitis of that joint following local trauma. Synovial fluid showed a charcoal-like color, and contained abundant phagocytes laden with metal particles. In patients with rheumatoid arthritis who have undergone total joint replacement, metal particle reactions and possible hyper-sensitivity should be added to the list of potential causes of superimposed acute synovitis and systemic manifestations.
24383734 A case of malignant fibrous histiocytoma on the knee joint in a patient with rheumatoid ar 2001 Sep Abstract An elderly woman with rheumatoid arthritis and receiving nonsteroidal anti-inflammatory drugs (NSAIDs) treatment was diagnosed with a malignant fibrous histiocytoma in her left knee joint. However, no metastatic lesion caused by the malignant fibrous histiocytoma was found, probably owing to the NSAIDs therapy. Her general condition worsened, and eventually led to renal failure and death from progressive respiratory failure caused by pulmonary effusion. This is the first known report of a malignant fibrous histiocytoma originating in the left knee joint that was complicated by rheumatoid arthritis.
9052627 Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. 1997 Feb PURPOSE: The purpose of the study is to delineate the visual prognosticators in juvenile rheumatoid arthritis-associated uveitis. METHODS: The records of 43 patients with juvenile rheumatoid arthritis-associated uveitis who were observed for at least 6 months were studied retrospectively. Bivariate and multivariate statistical models were applied to more than 40 parameters to determine the relative odds of visual rehabilitation among patients with each characteristic. RESULTS: Thirty-seven (86%) patients were females and 6 (14%) males. The mean known age of uveitis onset was 13 years, with females having, on average, 4 years earlier onset of disease compared to males (P = 0.04). Ninety-three percent had chronic, 5% had recurrent, and 2% had an acute monophasic disease course. Of the 76 affected eyes, 93% were nongranulomatous and 97% had iridocyclitis. The mean overall duration of uveitis was 146 months, with females suffering from a significantly longer duration of active disease than did males (P < 0.001). Nineteen (44%) patients underwent cataract extraction, and 16 (37%) underwent vitrectomy. Thirty (70%) of the patients experienced visual improvement with their therapy. When controlling for potential confounders, male sex (P = 0.006), shorter duration of uveitis (P = 0.007), older age at disease onset (P = 0.02), and a shorter delay in presentation to a subspecialist (P = 0.02) were associated significantly with visual acuity improvement. Visual acuity at presentation (P = 0.001), use of systemic nonsteroidal anti-inflammatory drugs (P = 0.01), older age at disease onset (P = 0.02), absence of glaucomatous neuropathy (P = 0.02), and male sex (P = 0.03) were correlated strongly with a final visual acuity outcome of 20/40 or better. CONCLUSION: Juvenile rheumatoid arthritis-associated uveitis is a serious disease with a guarded visual prognosis. It is hoped that increased awareness of its prognosticators will lead to treatment and referral patterns that have the best chance of minimizing the likelihood of visual impairment in patients with juvenile rheumatoid arthritis.
10773964 Pyogenic arthritis in adults. 2000 Jan Septic arthritis has shown no change in incidence, and despite advances in antimicrobial therapy is often responsible for residual functional impairment and for a high mortality rate among debilitated patients. Risk factors include older age, diabetes mellitus, rheumatoid arthritis, immunodeficiency, and a preexisting joint disease (e.g., rheumatoid arthritis) to which the symptoms of septic arthritis are sometimes ascribed. Staphylococcus aureus contributes over two-thirds of identified organisms; a range of streptococci and gram-negative bacilli are next in frequency. The most common site is the knee, followed by the hip and shoulder. Over 10% of patients have polyarticular involvement reflecting bacteremia and diminished resistance to infection; (over 50% of polyarticular forms occur in rheumatoid arthritis patients). Prosthetic joint infection is becoming increasingly common; chronic forms due to intraoperative contamination and resulting in septic loosening should be distinguished from acute hematogenous infection in which emergency treatment can allow to salvage the prosthesis. Demonstration of the organism in the joint is the key to the diagnosis. Joint aspiration should be performed on an emergency basis, if needed after identification of radiographic landmarks or under ultrasonographic guidance. Seeding the fluid on blood culture flasks immediately after aspiration increases the yield. Antibiotics should be started as soon as the microbiological specimens have been collected. When aspiration is difficult (hip) or inadequate, arthroscopic drainage usually makes arthrotomy unnecessary. Early antiinflammatory therapy (nonsteroidal antiinflammatory drugs, systemic or local glucocorticoids, anticytokines, and antiinflammatory cytokines) are being considered as tools for limiting joint damage; their efficacy and safety will first have to be established in animal studies.
9709718 Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. 1998 Aug We used low-dose methotrexate to treat seven children with juvenile rheumatoid arthritis-associated uveitis complicated by cataract and glaucoma or resistant to topical corticosteroid. The use of methotrexate decreased the severity of uveitis in six of seven patients and allowed for the discontinuation or reduction of corticosteroid drops.
9632088 Severe aortic regurgitation with mechanical prosthetic valve replacement in pauciarticular 1998 Jun We describe a patient with pauciarticular juvenile rheumatoid arthritis with aortic insufficiency who underwent successful aortic valve replacement with a mechanical prosthetic valve.
10782858 Gene therapy for juvenile rheumatoid arthritis? 2000 Apr Gene therapy shows promise as a means of improving the treatment of a number of rheumatic diseases, including adult rheumatoid arthritis (RA). We summarize these developments and discuss the merits of extending such approaches to the treatment of juvenile RA. The special issues that arise when treating children by experimental new procedures predicate a cautious approach using strategies first shown to be safe in adults. Patients with severe, erosive, nonremitting pauciarticular juvenile RA might be suitable first candidates for gene therapy.
10223060 Sjogren's syndrome? 1999 Apr Dry eyes and mouth are just two of the many symptoms that can develop as a result of this common but little-known autoimmune disease that gradually destroys the exocrine glands. Because the effects are so far-reaching, it's important to familiarize yourself with diagnostic and treatment options as well as the special care needs of these patients.
9746861 Evolving concepts of diagnosis, pathogenesis, and therapy of Sjögren's syndrome. 1998 Sep Differences in diagnostic criteria for Sjögren's Syndrome (SS) have led to confusion in the research literature and in clinical practice. A particular challenge is the clinical diagnosis of the patients with sicca symptoms, fibromyalgia, chronic fatigue, vague cognitive defects, and a low titer antinuclear antibody. Until recently, many of these patients would have been classified as primary SS using the European criteria. A suggested revision of the European criteria will require inclusion of anti SS-A antibody or characteristic minor salivary gland biopsy, leading to greater agreement between European and San Diego criteria. Recent studies have emphasized that lacrimal and salivary gland flow involves an entire "functional" unit that includes the mucosal surface (the site of inflammation), efferent nerve signals sent to the midbrain (lacrimatory and salvatory nucleus), efferent neural signals from the brain, and acinal/ductal structures in the gland. Thus, symptoms of dryness or pain can result from interferences with any part of this functional unit. The initiating antigens in SS remain unknown, but immune reactivity against SS-A, SS-B, fodrin, alpha- amylase, and carbonic anhydrase have been demonstrated in patients with established disease. The inflammatory process in the gland releases metalloproteinases that alter the relationship of epithelial cells to their matrix, an interaction that is necessary for glandular function and survival. Therapies for SS remain inadequate. In SS patients with immune-mediated extraglandular manifestation (ie, lung, kidney, skin, nerve), the therapeutic approach is similar to systemic lupus erythematosus, although these therapies have relatively little effect on tear or saliva flow.
11521410 Sjögren's syndrome: pathogenesis, diagnosis, and treatment. 2001 Aug Sjögren's syndrome (SS) is the most common autoimmune disorder among women. Symptoms occur when the infiltration of immune cells into the salivary and lacrimal glands causes a progressive decline in sight, smell, and taste. Although symptoms seriously disrupt quality of life, the disease's vague manifestations usually prevent individuals from seeking immediate help. By the time a diagnosis is rendered, significant systemic organ involvement may have occurred. Although there is no cure, clinician understanding of the epidemiology, etiology, and pathophysiology of SS enhances its symptomatic management in primary care settings.
9316767 Sjögren's syndrome. Controversies and progress. 1997 Sep Diagnostic criteria for Sjögren's syndrome (SS) are required by both physicians and patients to (1) provide a rational basis for their symptoms, assess their prognosis, and guide therapy; (2) identify a group of patients who are most likely to share a common etiopathogenesis, in order to identify those genetic and environmental factors that are crucial in pathogenesis; (3) fill out the myriad medical insurance forms that require a diagnosis code; and (4) serve as a "shorthand" code that alerts specialists in different fields (oral medicine, ophthalmology, and a variety of specialists in internal medicine) to search for particular clinical problems found in the SS patient. The key question in this article is whether the term "Sjögren's syndrome" should apply to a rather restricted group of individuals (those with an autoimmune basis for exocrinopathy) or to a rather large group of individuals who share a similar symptom complex of dry eyes and mouth. Primary SS, as defined by San Diego criteria, is a systemic autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia resulting from lymphocytic infiltrates of the lacrimal and salivary glands. The criteria for the diagnosis of SS continues to be controversial, leading to confusion in the clinical and research literature. It is important to distinguish SS (an idiopathic autoimmune process) from other processes including hepatitis C infection, retroviral infection, lymphoma, autonomic neuropathy, depression, primary fibromyalgia, and drug side effects that can result in sicca symptoms. Recent studies on pathogenesis of SS in human and animal models have examined the clonality of the T-cell infiltrates, the production of cytokines by lymphocytes and glandular epithelial cells, neuroendocrine and hormonal factors that affect glandular secretion, and the fine structure of antigens recognized by T cells and B cells. Studies in SS have allowed comparison of lymphocytes in blood and in the glandular tissue lesions; important differences in the gland microenvironment play an important role in the initiation and perpetuation of the autoimmune process. For example, apoptotic death depends on the balance of Fas, Fas ligand, nuclear factors (such as bcl-2, bax, and myc), cytokines, neuropeptides, and cell membrane interactions with extracellular matrix. Although increased rates of apoptosis may be present in the blood T cells of SS patients, some glandular T cells are resistant to apoptosis. Recent advances have led to improved understanding of signal transduction in response to cytokines and hormones that play a role in the local and systemic manifestations of SS.
10651082 Clinical relevance of IgA rheumatoid factor (RF) in children with juvenile rheumatoid arth 1999 This study proposed to investigate the prevalence and clinical relevance of serum immunoglobulin A (IgA) rheumatoid factor (RF) in juvenile rheumatoid arthritis (JRA) as published reports vary in their conclusion. Sera of 82 children with JRA and 25-age and sex-matched healthy children were measured for IgA RF by an enzyme linked immunoassay using human IgG as the antigen. Forty-three percent of the disease population were positive and the prevalence in pauciarticular, polyarticular and systemic onset was 9/18 (50%), 21/47 (44.7%) and 5/17 (27.7%) respectively when mean + 2SD of normal was taken as the cut-off value. By defining the upper limit of normal as mean + 6SD, 16/47 (34%) were positive in the polyarticular as compared to 2/18 (11.1%) in pauciarticular and 1/17 (5.8%) of systemic onset disease groups. The prevalence in the polyarticular subset with the upper cut-off limit was significantly higher than the pauciarticular and the systemic onset group (P < 0.05). Furthermore, the mean level of IgA RF was significantly higher in the polyarticular group compared to the mean level in the systemic onset group (P < 0.05). The mean level of IgA RF was also significantly higher (P < 0.05) in 61 children with active diseases.
9746863 Juvenile rheumatoid arthritis and spondyloarthropathies. 1998 Sep This paper reviews the current literature on the clinical aspects of juvenile rheumatoid arthritis (JRA) and the juvenile spondyloarthropathies. The classification of the juvenile arthritides remains controversial. A sibling pair registry established a role for genetic influences on the onset and course types of JRA. Even in the absence of steroid treatment, children with JRA demonstrated decreased bone mineral density and an impairment of linear growth. Magnetic resonance imaging was found to be helpful in detecting subtalar or sacroiliac involvement. Studies were published on the use of azathioprine, cyclosporine, and cyclopyhosphamide in the treatment of severe JRA. The lack of severe liver toxicity was shown in patients having received high total doses of methotrexate. An international agreement was reached on defining improvement in JRA. Several studies found an improved long-term outcome in patients with JRA or the juvenile spondyloarthropathies.
9492378 Long-term outcome among patients with juvenile rheumatoid arthritis. 1998 Mar 21 Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory disease primarily affecting the joints but also extra articular tissue. The long-term outcome of JRA has different aspects, which include disease outcome, mortality, iridocyclitis and stature. Several studies, which have addressed these issues, are reviewed in this article. In addition, functional, educational and employment status of patients with JRA are also reviewed. To facilitate better understanding of these various studies, a description of the terminology used in defining disease is provided. Several of the instruments that are available for assessing outcome among patients are described. The role of laboratory and radiological evaluation in predicting outcome is also addressed.
15992017 New prospects for the treatment of rheumatoid arthritis. 1998 Jul Rheumatoid arthritis (RA) is a common inflammatory and destructive arthropathy. Current therapies fail to stop joint damage and reduce long-term disability. Greater understanding of disease pathogenesis has identified many inflammatory mediators as possible therapeutic targets. Novel therapeutic agents, such as monoclonal antibodies (mAbs), cytokine receptor-human immunoglobulin constructs, recombinant human proteins and antisense oligodeoxynucleotides targeting these inflammatory mediators have been tested in rheumatoid arthritis with some success. In particular, inflammation can be effectively suppressed using anticytokine therapies. However, the ideal treatment for RA, one that is immunomodulatory and induces prolonged disease remission after a single course of therapy, still eludes us. Strategies aiming to achieve this include TCR peptide vaccination and anti-CD4 mAbs, currently in clinical trials in RA.
9124059 Preschool sarcoidosis mimicking juvenile rheumatoid arthritis: the significance of gallium 1997 Feb Preschool sarcoidosis occurring in children less than 6 years old is rare and characterized by the triad of skin, joint and eye manifestations without any pulmonary lesion. Because of similar clinical manifestations, the diagnosis of preschool sarcoidosis and juvenile rheumatoid arthritis (JRA) is confusing. A girl with preschool sarcoidosis, initially diagnosed and treated as having JRA, is reported here. Ophthalmologic examinations revealed posterior involvement of the eye. A gallium scintigram of the head showed panda appearance. Biopsy of the cutaneous lesion demonstrated non-caseating granuloma. Gallium scanning may be an important clue to correct diagnosis.
9431587 Magnetic resonance imaging in juvenile rheumatoid arthritis. 1997 Dec OBJECTIVES: This study was undertaken to examine the role of magnetic resonance imaging (MRI) in the management of patients with juvenile rheumatoid arthritis (JRA). METHODS: A Medline search was performed to identify all publications pertaining to MRI in JRA. Further searches and identification of articles from bibliographies identified articles pertaining to plain radiograph imaging in JRA and MRI in adult rheumatoid arthritis. RESULTS: Studies in both children and adults have shown superiority of MRI to plain radiography in detecting synovial hypertrophy and articular cartilage abnormalities. Several studies in adults have shown a good correlation of MR images with gross anatomic as well as histological findings at arthroscopy. Biochemical changes that occur before structural changes within the joint may even be detectable with magnetic resonance spectroscopy. CONCLUSIONS: MRI holds promise for the assessment of disease progression in JRA and may be useful in serial evaluation, as in clinical trials.
11044836 Early onset sarcoidosis masquerading as juvenile rheumatoid arthritis. 2000 Nov Symptoms of early onset sarcoidosis characterized by skin eruptions, arthritis, and uveitis mimic those of systemic type juvenile rheumatoid arthritis (JRA). We report 2 Japanese patients with early onset sarcoidosis, both of whom were initially diagnosed and treated as having JRA. Intermittent fever and synovial swelling may mask sarcoidosis in children less than 4 years old.