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ID PMID Title PublicationDate abstract
15775558 [Osteoporosis and fracture in rheumatoid arthritis]. 2001 May Patients with rheumatoid arthritis often have periarticular and generalized osteoporosis. Bone resorption develops through increased productions of cytokines and prostaglandines by synovium and bone. Important risk factors of osteoporosis are functional impairment, postmenopausal state, and corticosteroids usage. Osteoporotic fracture occurs at the spinal body, femoral neck, distal radius, and periprosthetic bone.
9632076 Chronic arthritis in patients with aspartylglucosaminuria. 1998 Jun OBJECTIVE: To study the frequency and clinical features of chronic inflammatory arthritis in aspartylglucosaminuria (AGU), a rare disorder of glycoprotein degradation inherited as an autosomal recessive trait and significantly more frequent in Finland than in other parts of the world. METHODS: Of the 164 patients with AGU identified in Finland, 121 were examined by one of the authors, and 43 by their own physicians. For this study, we clinically reexamined all patients with AGU who had arthritis, and relevant laboratory and radiographic studies were performed. RESULTS: Nine of 164 patients (5.5%) were found to have chronic inflammatory arthritis. In 5 patients, the symptoms had started in childhood. Five were seropositive for rheumatoid factor. Symmetric polyarthritis of both small and large joints was seen in 5 patients and erosions in 5. Seropositive rheumatoid arthritis was found in 3 first-degree relatives as well. CONCLUSION: Chronic inflammatory arthritis is a feature of AGU and is characterized by onset in childhood, seropositivity for rheumatoid factor, and a deforming course.
9375864 Connective tissue activation. XXXVII. Effects of cytokine combinations, implications for a 1997 Nov OBJECTIVE: Since many cytokines have been identified in chronically inflamed human synovium, it is possible that particular cytokines or combinations of cytokines play dominant roles in driving or inhibiting metabolic processes important to inflammation. To assess these possibilities, we compared selected effects of individual cytokines and their binary, ternary, and higher combinations in human synovial cell cultures. METHODS: Cytokines studied known to occur in human synovial tissue included: interleukin 1beta (IL-1beta), IL-6, tumor necrosis factor-alpha, granulocyte macrophage colony stimulating factor, interferon-gamma, acidic fibroblast growth factor (aFGF), basic FGF (bFGF), platelet derived growth factor, transforming growth factor-beta1, connecting tissue activating peptide-III, and epidermal growth factor. The growth related effects of these agents singly and in combinations were assessed by measuring newly synthesized [3H]DNA and [14C]GAG (glycosaminoglycan) in human synovial cell cultures. Cytokine induced synthesis of prostaglandin E2 (PGE2) was measured by ELISA. RESULTS: Most cytokine combinations resulted in additive/synergistic anabolic effects, except when IL-1beta was present; IL-1beta was markedly antagonistic to the mitogenic effects of other cytokines tested. Combinations of platelet derived cytokines were the most potent stimulators of DNA synthesis, while combinations of synovial derived cytokines were more active in stimulating GAG synthesis. Synovial cells exposed simultaneously to both platelet and synovial derived cytokines produced large quantities of [14C]GAG and showed a modest increase in [3H]DNA synthesis. IL-1beta, alone or in combinations, was dominant with respect to stimulation of PGE2 synthesis. Acetylsalicylic acid substantially interfered with all the effects of cytokine combinations measured. CONCLUSION: Quantitative alterations in synovial cell synthesis of GAG and DNA varied greatly depending on the ambient mixture of cytokines. Virtually all combinations of cytokines tested gave rise to large increases in synovial cell synthesis of GAG. Four platelet derived cytokines, a "physiologic combination," appeared to be dominant agents in stimulating DNA synthesis. This effect was profoundly reduced by the antagonistic effect of IL-1beta, mediated in part by PGE2. The patterns of cytokine combination induced metabolic effects suggest that the "cytokine network" has a significant measure of redundancy with respect to control of synovial cell metabolism.
10599324 Prevalence of IgM-, IgA- and IgG-rheumatoid factors in seronegative polyarticular disease 1999 OBJECTIVE: To determine the prevalence of the rheumatoid factor isotypes measured by enzyme-linked immunosorbent assay (ELISA) in polyarticular and pauciarticular juvenile chronic arthritis (JCA), and evaluate the diagnostic test qualities. PATIENTS AND METHODS: 53 patients with JCA (20 with seronegative polyarticular disease at onset, 21 with pauciarticular onset and course of disease and 12 with extended pauciarticular disease), as well as 125 control children (58 healthy controls and 67 patients with other diseases) were tested. ELISA for the detection of IgM-, IgA- and IgG-isotypes of RFs was used. The diagnostic characteristics of the tests were evaluated by means of clinical epidemiology methods. RESULTS: The prevalence of the ELISA for IgG-, IgA-, and IgM-RF for JCA patients vs all controls at optimal cut-off titres was 13%, 29%, and 32%, respectively. The test for IgG-RF was established to be of no significance. IgA-RF had higher prevalence in the polyarticular and extended pauciarticular form, 40% and 33%, respectively. IgM-RF showed a prevalence of 55% for the polyarticular and 42% for the extended pauciarticular form. No significant prevalence has been found in the pauciarticular form. CONCLUSION: Our results indicate that ELISA for IgG-RF is of no diagnostic value for JCA. The ELISAs for IgM- and IgA-RFs demonstrated a diagnostic significance for the polyarticular and extended pauciarticular form. Juvenile chronic arthritis (JCA) is a heterogeneous disease which encompasses different forms defined by the type of onset. There is evidence, supported by immunogenetic studies that the various subgroups may represent distinct disease entities [1, 2]. Numerous immunological abnormalities have been detected in JCA, but the most characteristic serological findings are ANA and IgM-rheumatoid factor, thought to be useful in the classification of patients and their management. Antinuclear antibodies are universal in JCA, most commonly found in children with early onset pauciarthritis and late onset seropositive polyarthritis [1, 2, 3]. In contrast, the IgM-rheumatoid factor, measured by conventional agglutination techniques, is a hallmark only of polyarthritis with late onset resembling adult rheumatoid arthritis. This group of patients with "seropositive" disease represents less than 20% of all JCA children. Of those patients with "seronegative" disease 20-30% have a systemic onset and the remainder have either a pauciarticular or polyarticular form [2, 3]. Following the introduction of more sensitive techniques, it has already been established that rheumatoid arthritis (RA) patients' sera contain not only the "classical" 19S IgM-RF, but also other isotypes of the rheumatoid factor (RF). A number of studies have emphasized the presence of IgG-, IgA-, IgM- and even IgE- RF in patients with "seronegative" RA [4, 5, 6]. The aim of this study is to determine the prevalence of IgG, IgM and IgA RFs and to attempt at evaluating the diagnostic and prognostic qualities of the ELISA-tests for rheumatoid factor isotypes in polyarticular and pauciarticular forms at onset of JCA.
20944289 Neurofibroma occurring in patients with rheumatoid arthritis. 1997 Mar Two female patients suffering from rheumatoid arthritis presented with the complaint of papular skin lesions over the dorsal aspect of hands. Histopathological examination of papules showed the features of neurofibroma.
9880448 The relationship of hepatotoxic risk factors and liver histology in methotrexate therapy f 1999 Jan OBJECTIVE: To examine the relationship between hepatotoxic risk factors and liver histopathology in patients with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX). STUDY DESIGN: We graded the histology of 33 percutaneous liver biopsy specimens from 25 patients with JRA treated at Children's Hospital Medical Center, Cincinnati, Ohio, using the Roenigk Classification Scale. Stepwise linear and logistic regression analyses were performed to examine the relationship of the Roenigk grade and presence of liver fibrosis of biopsy specimens with potential risk factors. RESULTS: Twenty-seven biopsy specimens (82%) were classified as grade I, 4 (12%) as grade II, and 2 (6%) as grade IIIA; none demonstrated significant fibrosis. The frequency of biochemical abnormalities (P <.001) and body mass index (P =.05) were the only risk factors found to significantly relate to the Roenigk grade. The following factors were not significantly associated with the Roenigk grade: age, gender, disease duration, JRA subtype and course, duration of MTX administration, weekly MTX dose, cumulative dose of MTX, route of MTX administration, use of folic acid supplementation, concurrent use of other medications, and potential hepatotoxic comorbidities. CONCLUSIONS: Serial biochemical abnormalities are significantly associated with Roenigk grade and the presence of liver fibrosis. These findings concur with studies of patients with rheumatoid arthritis, suggesting that guidelines for monitoring MTX hepatotoxicity in rheumatoid arthritis may be applicable to patients with JRA.
11559995 [Effect of tocopherol acetate, indomethacin and dexamethasone on some indices of local lun 2001 May Marked disorders in the system of local lung defence are noted in experimental rheumatoid arthritis. In such a setting non-unidirectional shifts occur in the quantitative and qualitative indicators of cellular factors for the local pulmonary defensive system, characterized by discordant changes in the indicators of alveolar macrophages and segmented neutrophiles. There occur apparent disturbances in the functional activity of alveolar macrophages manifested by changes both in their phagocytary and metabolic activity and by depression of humoral mechanisms in the local pulmonary defensive system. The use of indomethacin, dexamethasone and vitamin E in an experimental rheumatoid arthritis setting favors positive shifts in indices for humoral and cellular links of the local pulmonary defensive system. Effects of vitamin E on indices for cellular and humoral links of the local pulmonary defensive system are more manifest as compared to those of indomethacin and dexamethasone.
11182663 The prevalence of uveitis in juvenile rheumatoid arthritis. 2001 Feb BACKGROUND: Because asymptomatic uveitis has been an important cause of visual loss in children with juvenile rheumatoid arthritis, periodic ophthalmologic screenings of such patients have been recommended. Recently, some authors have found a decreased prevalence of uveitis in children with juvenile rheumatoid arthritis. METHODS: We studied a total of 76 patients (63 girls and 13 boys, aged 1 to 16 years), referred to 3 pediatric ophthalmology practices between March 1976 and October 1999. Follow-up examinations were performed at intervals of 3 to 6 months according to current guidelines, during the following 6 months to 23 years (mean, 55 months). RESULTS: Uveitis developed in 10 children (13%). Of these 10 children, 2 were symptomatic (blurred vision, discomfort) and 7 were diagnosed with uveitis at the initial visit. Only 1 patient had asymptomatic uveitis after initial negative findings on screening examination. Final visual acuity for all the compliant children in the uveitis group was better than 20/30. DISCUSSION: The prevalence of uveitis in our study is similar to rates found by other recent authors. This decrease may reflect a tendency for systemic medications to prevent the development of ocular inflammation. We believe that screening guidelines should be reevaluated, especially for asymptomatic children with negative findings on initial examinations.
18020507 Methotrexate in rheumatoid arthritis: folate supplementation should always be given. 1997 Sep Methotrexate is now the disease-modifying antirheumatic drug prescribed most frequently for the treatment of rheumatoid arthritis. Methotrexate is an antifolate that inhibits methylation reactions and reactions of amino acid, purine and pyrimidine metabolism. Toxic manifestations of methotrexate administration for rheumatoid arthritis (at relatively low doses compared with those used in cancer chemotherapy) include cytopenias, gastrointestinal intolerance, liver disease, pulmonary injury, central nervous system dysfunction, skin rashes and nodulosis. Delayed wound healing and increased risk for infections with opportunistic organisms also occur. Some of these toxic manifestations respond to supplementation with folates [folic acid or folinic acid (calcium folinate)]. The folate status of patients has been shown to be impaired after prolonged treatment with methotrexate, and poor baseline folate status is an independent risk factor for subsequent toxicity. Numerous studies have now documented that folic acid, even in high doses, and moderate doses of folinic acid are beneficial in preventing methotrexate toxicity without affecting efficacy. In this article we present guidelines and rationale for monitoring methotrexate therapy, and guidelines for folate supplementation during methotrexate therapy for rheumatoid arthritis. It is our recommendation that folic acid should be empirically supplemented in all patients at the initiation of methotrexate therapy. This regimen is associated with a high benefit : risk ratio and is likely to be cost effective.
10655991 Routine immunofluorescence detection of Ro/SS-A autoantibody using HEp-2 cells transfected 1999 Sep BACKGROUND: Ro/SS-A autoantibodies associated with systemic lupus erythematosus (SLE) and Sjögren syndrome may be missed during routine screening for antinuclear autoantibodies (ANA) by immunofluorescence using HEp-2 cells. AIMS: To investigate the use of HEp-2 cells transfected with human 60 kDa Ro/SS-A for routine detection of these antibodies. METHODS: 10,500 sera were screened at a dilution of 1:200 for Ro/SS-A antibodies, identified by intense immunofluorescence staining in 10-15% of hyperexpressing cells of either the nucleus and nucleolus combined or the nucleus alone. RESULTS: Ro/SS-A antibodies were identified in 160/2100 ANA positive sera (8%), of which seven were ANA negative (titre < 200) and 33 had weak ANA titres (200) in 85-90% of non-hyperexpressing "background" cells. Enzyme linked immunosorbent assay (ELISA) confirmed the presence of Ro/SS-A antibodies in 110 newly diagnosed Ro/SS-A positive sera. Of these, 50 reacted with Ro/SS-A, 51 with Ro/SS-A and La/SS-B, and nine with Ro/SS-A and other extractable nuclear antigen (ENA) specificities. Fifteen sera which did not show Ro/SS-A antibodies by immunofluorescence tested positive for Ro/SS-A by immunodiffusion, counter-immunoelectrophesis, or ELISA; of these, 14 had ANA titres > 200. Clinical data from 95 Ro/SS-A positive patients showed that 52% had SLE, 24% Sjögren syndrome, 8% rheumatoid arthritis, and 16% other diseases. CONCLUSIONS: (1) HEp-2 cells transfected with human 60 kDa Ro/SSA are useful for routine immunofluorescence detection for Ro/SS-A antibodies with a positive predictive value of 100%; (2) sera positive for Ro/SS-A antibodies by immunofluorescence should be tested for ENA by other methods because > 50% of these sera will have another ENA reactivity in addition to Ro/SS-A; (3) detection of Ro/SS-A by immunofluorescence may be missed in the presence of high titre ANAs; (4) with a detection sensitivity of 91%, a negative immunofluorescence results for Ro/SS-A does not exclude the presence of this autoantibody.
17984878 Surgical treatment of the elbow joint in rheumaid arthritis, with particular attention to 2000 Dec 30 Elbow involvement in rheumatoid arthritis begins at a later stage in the development of the disease and proceeds slowly. Depending upon the degree of intensity and the involvement of neighboring joints (shoulder, wrist, hand), pathological changes in the elbow may be the cause of serious limitations in the performance of basic daily life activities. This article presents methods of surgical treatment of the elbow joint in rheumatoid arthritis. Synovectomy and debridement, which given the proper indications are performed with simultaneous resection of the radial head, can significantly reduce pain and improve joint function. In cases where considerably reduced range of motion or ankylosis is preventing the performance of daily life activities, one of the surgical treatment methods in use is resection arthroplasty using the Hass-Vainio technique. The author presents his whom (42 elbows) were followed up post-operatively over a period of 3-30 years (mean 18 years). The favourable outcome obtained in a large majority of these cases indicates that resection arthroplasty is still a valuable method for the surgical treatment of rheumatoid arthritis, despite progress in prosthesis replacement.
9209130 [A girl with systemic onset juvenile rheumatoid arthritis suspected to be due to human par 1997 May We encountered a case of a girl where Human Parvovirus B19 infection was considered to have been concerned with the development of systemic type juvenile rheumatoid arthritis (JRA). While the affected child did not show any evident infectious erythema-like findings, changes in the serum antibody titer by the EIA method presented the pattern of first infection. During the clinical course the condition of the disease as JRA was serious and hemophagocytic syndrome developed concurrently. Furthermore, the resistance to the treatment was also noted. So the patient was treated with prednisolone combined with low dose weekly MTX therapy. The possibility of Human parvovirus B19 being concerned with the development of rheumatoid arthritis in one form or another has been suggested in recent years. In the disease type with systemic angititis as main pathophysiology, which is called systemic JRA we encountered this time, it is not clear how Human Parvovirus B19 was concerned with the development of this disease, but it appeared to hold a key position in studying pathophysiology of the development.
11327261 Sulfasalazine for the management of juvenile rheumatoid arthritis. 2001 Apr OBJECTIVE: Sulfasalazine (SSZ) has regulatory approval for treatment of inflammatory bowel disease in children and adults, and for use as a slow acting agent in adult rheumatoid arthritis (RA). This report surveys the literature for experience with SSZ in juvenile RA. METHODS: Medline, Excerpta Medica, and Derwent were searched under the terms juvenile, rheumatoid, arthritis, and sulfasalazine. RESULTS: The search found reports of experience in 550 patients, of whom about half had pauciarticular and nearly one-third polyarticular disease. The studies generally reported at least some drug associated benefit in all subtypes. Some identified late onset pauciarticular disease as most responsive, but others reported poly- and pauciarticular response rates about the same. Systemic onset disease responded poorly and showed a substantial incidence of intolerance in the form of serum sickness. Most studies showed useful disease control in spondylitis. Overall, the patterns of toxicity and intolerance were close to those seen in adult SSZ recipients, with the possible exception of the serum sickness-like response. CONCLUSION: SSZ has demonstrated useful antirheumatic activity and can contribute to the care of selected patients.
9728315 Synovial biopsy. A comparative study from Saudi Arabia and Malaysia. 1998 A comparative study of synovitis in Saudi Arabia and Malaysia was made with a view to determining any geographic variation in the incidence and pattern of the arthritides. The diagnostic spectrum in both series included pyogenic arthritis, rheumatoid arthritis, brucellar and tubercular arthritis, gout, pigmented villonodular synovitis, synovial chondromatosis and acute rheumatic fever. Date-palm thorn synovitis was observed only in the Saudi Arabian series. While brucellar and tuberculous arthritis were predominantly seen in Saudi Arabia, the incidence of rheumatoid arthritis, pigmented villonodular synovitis and acute suppurative arthritis was almost equal in both countries.
10761540 Enzyme and combination therapy with cyclosporin A in the rat developing adjuvant arthritis 1999 Recent knowledge of the pathophysiology of rheumatoid arthritis and the mechanism of drug effects have enabled the use of new drugs and drug combinations in rheumatoid arthritis therapy. This study investigates the efficacy of both enzyme therapy and combined therapy with cyclosporin in rats with adjuvant arthritis. Rats with adjuvant-induced arthritis were administered either cyclosporin A (2.5 or 5.0 mg/kg/day per os), a mixture of enzymes (Phlogenzym (PHL); 45 mg/kg twice daily intrarectally), or a combination of 2.5 mg cyclosporin A and 90 mg PHL for a period of 40 days from the adjuvant application. Levels of serum albumin, changes in hind paw swelling and bone erosions were measured in rats as variables of inflammation and arthritis-associated destructive changes. Treatment with 5 mg of cyclosporin A, as well as with the combination therapy with cyclosporin A plus PHL, significantly inhibited both the inflammation and destructive arthritis-associated changes. However, 2.5 mg of cyclosporin A and PHL alone inhibited these disease markers, although to a lesser extent and at a later stage of arthritis development. The results show the inhibitory effect of enzyme therapy on rat adjuvant arthritis, as well as the efficacy of a low dose of cyclosporin A given in combination with enzyme therapy, which may be useful in the treatment of rheumatoid arthritis.
11585021 Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical f 2001 Sep Primary Sjögren's syndrome (pSS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine glands and predominantly the salivary and lacrimal glands. The impaired gland function is assumed to be a result of progressive lymphocyte-mediated destruction of the exocrine gland tissue leading to the cardinal manifestations, hyposalivation and keratoconjunctivitis sicca (KCS), as well as devastating symptoms of oral and ocular dryness. Although primarily characterised as an exocrine dysfunction, non-exocrine organs may also be affected. The onset and course of pSS is usually insidious but may develop into a disabling disease, which profoundly affects the patient's general well being and quality of life. Moreover, pSS may even evolve into a lymphoid malignancy. The aetiology of pSS remains unknown but the pathogenesis of exocrine cell damage is apparently multi-factorial, including immunological, genetic, hormonal and viral components. Recent research also includes neurogenic aspects of exocrine gland dysfunction, including the interference of immune mediators with glandular response to neurotransmitters released from nerve fibres. pSS usually affects middle-aged women and the female:male ratio is 9:1. The prevalence varies from 0.29-4.8%, depending on the population sampled and the diagnostic criteria used. At present, there are no specific diagnostic tests for pSS and no universally accepted diagnostic criteria. The current therapy is primarily symptomatic. This review focuses on the current oral clinical, diagnostic, pathogenic and therapeutic aspects of pSS.
11419080 [Effectiveness of systemic immunoglobulins in the treatment of the systemic variants of ju 2001 Preparations of intravenous immunoglobulin (sandoglobulin, pentaglobin, intraglobin F, octagam) were given daily or each other day in a course dose 0.3-1 g/kg to 43 patients aged 4 to 15 years. Eight of them had allergosepsis, 22--allergoseptic variant of juvenile rheumatoid arthritis (JRA) and 13--systemic JRA and generalized joint syndrome. The treatment induced remission in patients with allergosepsis, prednisolone was discontinued. JRA patients coped with fever, eruption, polyserositis, infection symptoms. Leukocyte count normalized. Preparations of intravenous immunoglobulin in low doses can be therapy of choice in patients with rheumatic-like diseases. In JRA patients it can be effectively used against fever, eruption, polyserositis, carditis, leukocytosis, intercurrent infection before or in the course of immunosuppressive therapy.
10961251 Juvenile rheumatoid arthritis and the spondyloarthropathies. 1998 Feb Juvenile rheumatoid arthritis (JRA) and the spondyloarthropathies affect approximately one in a thousand children under the age of 17 years and are more common than diabetes, cystic fibrosis, and many other chronic conditions. The author explores differential diagnoses for musculoskeletal pain, classifies types of JRA and the spondyloarthropathies, and describes how such conditions may be effectively managed with drug and physical rehabilitation therapy. The article also discusses behavioral, school, and vocational issues.
11083287 Development of diabetes mellitus during etanercept therapy in a child with systemic-onset 2000 Nov Although clinical trials of etanercept in adult and juvenile rheumatoid arthritis have generally revealed few adverse events, significant concern has arisen over the potential evolution of secondary autoimmune disease due to modulation of tumor necrosis factor. There have been few reports of such diseases developing, and none in children receiving this therapy. Reported herein is the case of a 7-year-old girl with a 3-year history of systemic-onset juvenile rheumatoid arthritis with a polyarticular course, in whom type 1 diabetes mellitus developed 5 months after the initiation of etanercept therapy.
9830883 Substance use among adolescents with juvenile rheumatoid arthritis. 1998 Oct OBJECTIVE: To determine the prevalence of substance use among adolescents with juvenile rheumatoid arthritis and to assess available opportunities for rheumatologists to identify high risk teens. METHODS: Fifty-two teens (mean age 13.9 years, 86% female) completed questionnaires regarding substance use (alcohol, tobacco, marijuana, and other illicit substances), functional disability, and frequency of health care contacts. RESULTS: Alcohol use was reported by 30.7% of teens, including 23.5% of those for whom methotrexate was prescribed; 15.4% reported tobacco use in the last year, and 13.4% reported other illicit substance use in their lifetime, although most use was experimental. No teen reported marijuana use. The majority reported regular contact with their rheumatologist but only 26.9% were ever interviewed alone. CONCLUSION: Many teens with juvenile rheumatoid arthritis, including those prescribed methotrexate, used substances, especially alcohol. When rheumatologists see adolescents, particularly in situations where methotrexate may be prescribed, a clinical setting conductive to confidentially, physician comfort in asking about sensitive topics such as substance abuse, and referral relationships with skilled adolescent health and substance abuse counseling providers are essential.