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ID PMID Title PublicationDate abstract
10752493 Levels of rheumatoid factor isotypes, metalloproteinase-3 and tissue inhibitor of metallop 2000 When synovial effusion is the only symptom, it is often difficult to make an exact diagnosis of the arthritic disease. To distinguish various types of arthritis with synovial effusion, we measured the levels of matrix metalloproteinase-3 (MMP-3, Stromelysin), tissue inhibitor of metalloproteinase-1 (TIMP-1) and rheumatoid factor (RF) isotypes in synovial fluid (SF) from patients with rheumatoid arthritis (RA), osteoarthritis (OA), pyogenic arthritis (PA), pseudogouty arthritis (PG), gouty arthritis (GA) and traumatic arthritis (TA). SF was aspirated from the knee joint or the ankle joint. Levels of IgG-, IgM- and IgA-RF isotypes were measured by ELISA. Levels of MMP-3 and TIMP-1 in SF were simultaneously determined by a one-step EIA system. Levels of IgG-RF, IgM-RF and MMP-3 in SF from RA patients were significantly higher than those in OA, PA, PG, GA and TA. However, IgA-RF in SF from RA patients, when compared with PA and GA, did not show a significantly increased level. In addition, TIMP-1 in SF from RA, when compared with PA and TA, also has not shown a significantly increased level. Therefore, in addition to analysing clinical data, measurements of IgG-RF, IgM-RF and MMP-3 in SF may contribute in distinguishing RA from other arthritic diseases.
9921007 [History of patient education in rheumatic diseases in Croatia]. 1998 The education of rheumatic patients in Croatia has begun in 1975 by introducing the school of back pain. Soon after that has begun the education of children with scoliosis. The education of patients with rheumatoid arthritis and ankylosing spondylitis was establish in 1985. Along with the courses of patient's education, there were printed a publications dedicated to the same problem. At the beginning there was printed a textbook Rheumatic diseases with training for rheumatic patients (1978.) and then textbook Jogging (1982.) and Reta (1984.). During 1994, there were graduated a publications dedicated to the disease having the same name: Rheumatoid arthritis, Ankylosing spondylitis, Uric arthritis and Psoriatic arthritis, which were reprinted in enlarged form (1997). Protection of the joints in rheumatic disease (1998.) is a new textbook for patients about correctly usage of the joints. Textbook Prevention of back pain and neck pain (1998.) is dedicated to healthy people for the prevention of pain syndromes of vertebra. Thus, the education was introduced in almost all parts of rheumatology and in whole Republic of Croatia.
11412691 [Primary Sjögren's syndrome: clinical and immunological characteristics of 114 patients]. 2001 May 26 BACKGROUND: To analyze the clinical and immunological characteristics of a series of 114 patients with primary Sjögren's syndrome (PSS), and to evaluate the different diagnostic criteria and the association to lymphoproliferative disorders. PATIENTS AND METHOD: We included 114 patients (108 female and 6 male) with a diagnosis of PSS. All patients fulfilled the 1993 European Community criteria for the diagnosis of PSS and 76 patients fulfilled the San Diego Criteria. RESULTS: Mean age was 51 years with a mean follow-up of 7.3 years. The commonest clinical manifestation at onset (70%) was xerostomia/xerophtalmia (sicca syndrome). Extra glandular involvement was articular in 42% of cases, neurologic (35%), respiratory (21%) and hepatic (13%). Eleven patients (9%) developed vasculitis, and three (2%) developed a lympho-proliferative disorder. No statistically significant differences regarding symptoms at onset, frequency of glandular or extra glandular manifestations and severity of disease were observed between the two diagnostic criteria groups. HCV infection was associated with vasculitis (p < 0.001; OR: 20.6; CI 95%, 3.2-129) and lymphoproliferative disorders (p < 0.001). CONCLUSIONS: The clinical evolution of PSS does not vary when using different diagnostic criteria (San Diego and European Community criteria). A subset of patients with vasculitis and lymphoproliferative diseases is found to have an associated HCV infection.
10857799 Social, emotional, and behavioral functioning of children with juvenile rheumatoid arthrit 2000 Jun OBJECTIVE: To investigate the hypothesis that children with juvenile rheumatoid arthritis (JRA) would have more social and emotional problems than case-control classmates. METHODS: Using a case-control design, children with JRA (n = 74), ages 8-14, were compared with case-control classmates (n = 74). Peer relationships, emotional well-being, and behavior, based on peer-, teacher-, parent-, and self-report scores on common measures, were compared using analysis of variance. RESULTS: Relative to case-control classmates, children with JRA were similar on all measures of social functioning and behavior. Mothers reported more internalizing symptoms in the child with JRA, but child self reports and father reports showed no differences. Scores on all standardized measures were in the normal range for both the JRA and the case-control groups. CONCLUSION: Children with JRA were remarkably similar to case-control children on measures of social functioning, emotional well-being, and behavior. These findings are not supportive of disability/stress models of chronic illness in childhood and suggest considerable psychological hardiness among children with JRA.
9503315 Screening for uveitis in juvenile rheumatoid arthritis. 1998 Jan BACKGROUND: Uveitis associated with juvenile rheumatoid arthritis (JRA) is an important cause of visual impairment in children. Because uveitis is often asymptomatic in this age group, frequent ophthalmologic screening examinations are recommended. Recent reports have found a decrease in the prevalence and severity of uveitis in JRA when compared to older data. METHODS: The charts of 52 consecutive patients with JRA seen over a 30-month period were retrospectively reviewed. RESULTS: Eye examination identified uveitis in five (12%) patients. All patients with uveitis were female, ANA positive, and had pauciarticular-onset arthritis. Three patients had the onset of uveitis before the age of 2. All patients have maintained good visual acuity and have not developed serious sight-threatening ocular complications over the follow-up period. CONCLUSIONS: Although the prevalence and severity of JRA-associated uveitis may be decreasing, we strongly recommend continued strict adherence to the current screening guidelines.
10493692 Sjögren's syndrome: a critical review of clinical management. 1999 Sep Sjögren's syndrome (SS) is greatly under recognized in clinical practice, primarily for 2 reasons: its presentations are variable and often nonspecific and there are still no clear, uniform diagnostic criteria for this clinical entity. The prevalence, natural history, pathogenesis, and clinical taxonomy of SS are still not well understood. Potential criteria include both subjective symptoms and objective criteria such as measurements of salivary and tear flow, minor salivary gland biopsy, and an increasing variety of serological markers. Physicians often fail to appreciate the profound impact of SS on quality of life. Therefore, screening for SS should include questions exploring symptoms in terms of their effect on the patient's daily life. At present, there is no curative treatment for SS. For symptom relief, local treatments (such as artificial tears or oral topical sprays) are limited in their effects, whereas systemic treatment offers the advantage of addressing a wider range of symptoms. Controlled studies show that oral pilocarpine significantly improves sicca symptoms in the eyes, mouth, and other sites. Clinical experience to date suggests it is safe and well tolerated, with no serious adverse effects, tachyphylaxis, or drug to drug interactions of concern. The most frequent adverse effects are sweating, urinary frequency, diarrhea, and other parasympathomimetic effects, but these do not lead to substantial drug withdrawal rates. Patients should be forewarned that subjective improvement may lag behind improvement in objective measures. Because management often spans several specialties, coordination among them is essential. Dental, gynecological, and ophthalmological perspectives on diagnosis and management are discussed; the primary practitioner has the opportunity to play both a coordinating role and a direct role in early diagnosis and treatment.
9846336 [Neurologic manifestations of primary Gougerot-Sjögren syndrome]. 1998 Oct Primary Sjögren's syndrome is one of the commonest autoimmune connective tissue diseases. Neurological complications occur in about 20 p. 100 of primary Sjögren's syndrome patients. It most frequently involves the peripheral nervous system, predominantly sensorimotor and sensory polyneuropathy. Sensory neuronopathy and trigeminal nerve involvement are less frequent but quite suggestive of primary Sjögren's syndrome. Among central nervous system involvements, focal or multifocal lesions of the brain or the spinal cord are the most frequent. Diffuse encephalic involvement may present either as an aseptic meningoencephalitis or as a cognitive impairment. It is not clear whether psychiatric manifestations (mostly mood and personality disturbances) have an organic substratum or are the psychological consequence of the disability induced by a chronic disease such as Sjögren's syndrome. The response to corticosteroids or immunosuppressive therapy is unpredictable in neurological complications of primary Sjögren's syndrome. The pathophysiology of these complications remains unknown. Different mechanisms could be assumed depending on the neurological manifestations: vasculitis in polyneuropathies and multiple mononeuropathies, humoral and/or cellular mediated immune response against neurones in sensory neuronopathy. In central nervous system involvement, each of these mechanisms could occur.
15775562 [Genetic approaches for rheumatoid arthritis associated osteopenia]. 2001 May Rheumatoid Arthritis (RA) associated osteopenia is a resultant of multifactorial secondary osteoporosis, including disuse-atrophy, glucocorticoid-induced osteopenia, and RA specific activation of osteolysis. In addition, primary osteoporosis, i.e. postmenopausal and senile osteoporosis may overlap with them. Pursuits for the genetic factors for the causes of RA associated osteopenia could be clarified both from the characterization of RA associated factors and the osteoporosis associated factors. Recent progress in systematic genome-wide analysis for the association studies with multiple gene polymorphisms may improve the understandings of genetic contribution of these factors for the pathogenesis of this symptom.
10673580 Recognition and management of Sjögren's syndrome: strategies for the advanced practice nu 2000 Mar Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltration of salivary and lacrimal glands. The systemic production of autoantibodies leads to dry eyes, dry mouth, and other symptoms related to decreased salivary and lacrimal gland function in patients with Sjögren's syndrome. This article discusses origins, epidemiology, contributing factors, symptoms, assessment, diagnostic studies, management, expected outcomes, and research concerning Sjögren's syndrome.
11923921 [Sjögren's syndrome. Consequences for oral health]. 1997 Dec Sjögren's syndrome is an auto-immune disease involving exocrine glands causing amongst others xerostomia and dry eyes. Many other tissues may be affected as well. Early recognition of this disease may help to alleviate signs and symptoms and is, thus, important. The aim of this paper is to provide the dentist with knowledge to enable him to timely diagnose the oral component of Sjögren's syndrome as well as to give guidelines for the treatment.
10333995 CNS Sjögren's syndrome: an underrecognized and underappreciated neuropsychiatric disorder 1999 Spring Sjögren's syndrome is a common medical condition that may produce psychiatric symptoms. Untreated deficits can become permanent, sometimes resulting in death. The hypothesized mechanism involves CNS vasculitis. Psychoactive medications treat psychiatric symptoms but leave the underlying medical process unaffected. Laboratory tests to diagnose Sjögren's syndrome and specific treatments for this condition are improving.
9632087 Juvenile rheumatoid arthritis and common variable hypogammaglobulinemia. 1998 Jun We describe a 9-year-old white boy with systemic juvenile rheumatoid arthritis (JRA) who developed pancytopenia and hypersplenism at the age of 13 years. He underwent splenectomy and 3 years later he developed Coombs' positive hemolytic anemia, alopecia, juvenile warts, and multiple bacterial infections. At that time, investigations were compatible with severe hypogammaglobulinemia associated with common variable immunodeficiency. Concomitantly with this condition he experienced complete remission of his inflammatory arthritis. Immunologic studies of B and T lymphocyte function showed that the number of circulating T and B lymphocytes were normal, while T cell function was depressed, as evidenced by markedly reduced proliferative responses to mitogens and antigens, and ability to mediate B cell help. In addition, his circulating B cells were unable to secrete IgM or IgG. He also exhibited anergy to intradermal challenge with a battery of common antigens. The literature dealing with this clinical association is reviewed, and possible immunologic mechanisms involved are discussed.
11132201 Current concepts on diagnosis, autoantibodies and therapy in Sjögren's syndrome. 2000 Sjögren's syndrome is a chronic autoimmune and rheumatic disorder. Most patients have mild to moderate complaints and this may explain the great discrepancy in prevalence found in population studies compared to studies performed in the clinic. However, there is no straightforward and simple diagnostic test for Sjögren's syndrome, although several classification criteria have been designed. Initiatives have been taken to propose a new set of classification criteria in a joint effort by research groups in Europe and USA. A large number of autoantibodies have been reported in Sjögren's syndrome where, in some cases, the antibodies are correlated with the extent and severity of disease. The finding of serum autoantibodies directed against the muscarinic M3 receptor is an important advance in understanding the pathogenesis of not only the impaired glandular function but also associated features of autonomic dysfunction in some patients. The treatment of primary Sjögren's syndrome is still mainly symptomatic.
10806905 [Heredity and immunology in Sjogren's syndrome]. 2000 Mar 10 BACKGROUND: Over the next 3-5 years, the rapid progress in genomic research will enable the discovery of many genes associated with the more common diseases. An example of such a common disease is the rheumatic disorder Sjögren's syndrome, an autoimmune disease. A more precise genetic explanation of the mechanism leading to Sjögren's syndrome remains to be given. MATERIAL AND METHODS: One way of investigating the disease related genes in such complex polygenic diseases is to perform linkage studies in families with two or more affected. Another possibility is to conduct association studies on trios (parents and affected child), case control studies, or other experimental designs. In association studies one is testing if an allele is significantly elevated among patients compared to controls, while in linkage analyses one finds subchromosomal regions that are significantly more often inherited by patients than by healthy family members. RESULTS: The most well defined genetic association in Sjögren's syndrome is currently related to different HLA alleles and their association with anti-Ro/SSA and anti-La/SSB autoantibodies. Additional genetic studies focusing on non-HLA regions are under way. INTERPRETATION: Increased genetic knowledge would allow optimisation of the diagnostic criteria as well as development of new and more effective treatment for Sjögren's syndrome, which causes substantial suffering for a large group of patients.
11550986 Co-existent sickle cell disease and juvenile rheumatoid arthritis. Two cases with delayed 2001 Sep We describe 2 pediatric patients with sickle cell disease (SCD) who developed seropositive juvenile rheumatoid arthritis (JRA). Both patients have severe joint damage, the compound effect of both disease processes. The bone and cartilage destruction, which poses serious therapeutic challenges, highlights the difficulty of making a diagnosis of chronic inflammatory disease in the setting of SCD. There may be a correlation between increased levels of tumor necrosis factor-alpha in the synovial tissue of joints damaged by arthritis and local sickling. The resultant ischemia and corresponding inflammatory infiltrates could in turn worsen existing synovial proliferation and cartilage destruction as well as trigger further sickling.
15775561 [Osteoprotegerin (OPG/OCIF) inhibits bone destruction in rheumatoid arthritis models]. 2001 May Recent discovery of factors involved in bone destruction in Rheumatoid Arthritis (RA) identified its molecular mechanism. Osteoclast differentiation factor (ODF, also called receptor activator of NF-kappaB ligand (RANKL) ) that controls osteoclast differentiation and function has a major role in the bone destruction among them. Osteoclastogenesis inhibitory factor (OCIF, also called osteoprotegerin (OPG) ) that is a decoy receptor for ODF/RANKL is a specific inhibitor of bone destruction. OPG/OCIF may be useful for and applicable to the treatment of bone destruction in RA.
17984888 MRI evaluation of pathological changes taking place in the hand in patients with rheumatoi 2000 Dec 30 The aim of this study was to use magnetic resonance imaging (MRI) to evaluate the pathological changes taking place in the hands of patients with rheumatoid arthritis (RA), and to attempt to characterize early and persistent changes. 42 patients were examined, including 31 women and 11 men in age from 23 to 75, the duration of illness ranged from 1 month to 27 years (average 7.1 years). The MRI examination was performed using a 1,5 T Magnetom 63 SP whole body system. The SE sequence was used in T1-weighted (TR600, TE15) and fat-suppressed images (A-250, TR1155, TE22), obtained with 3 mm scans, matrix 256 x 512. A knee coil was used. In 30 patients erosion was detected on the joint surfaces of the bones, including 7 patients whose erosion was not visible in plain ordinary x-ray photos. In 31 patients bone marrow edema was detectable, including 6 patients in whom advanced pathological changes were absent. In all patients signs were discovered of thickening of the synovial membrane with (30 of 42) or without (12 of 42) the presence of pannus. Periarticular effusion was observed in all patients, and in 6 patients it occurred together with bone marrow edema. Tendonitis was visible in 25 patients who were in an advanced stage of the disease. For 7 patients, the MR examinations prompted an upgrading of the diagnosed phase of rheumatoid arthritis to a more advanced stage, due to the detection of erosion. In patients with a less advanced stage of the disease, MR examination revealed 11 more joints with pathological changes (periarticular effusion) than were detected by ordinary physical examination. Magnetic Resonance Imaging seems to be the examination of choice in patients with rheumatoid arthritis at an unclear or early stage.
24383731 Menopausal syndrome in female patients with rheumatoid arthritis. 2001 Sep Abstract This study was performed to assess the relationship between joint symptoms in rheumatoid arthritis (RA) and symptoms in menopausal syndrome. Detailed analyses of the clinical course, laboratory data, joint symptoms, and symptoms of menopausal syndrome were performed for five patients with stage I and monocyclic-type RA. The age when joint symptoms first appeared coincided with the age of menopause in all patients, and the mean age was 51.0 years. The mean period from menopause to this study was 5.4 years. All patients showed more than six menopausal syndrome symptoms. Two patients were confirmed gynecologically to have definite menopausal syndrome, and accordingly hormone replacement therapy (HRT) was given. In one patient, the polyarthralgia disappeared after she received HRT. All the American College of Rheumatology (ACR) criteria, with the exception of subcutaneous nodules, can be explained as symptoms related to estrogen deficiency in menopausal syndrome because estrogen regulates the production of inflammatory cytokines such as IL-1, IL-6, and TNFα, and these cytokines are produced in greater abundance in conditions of estrogen deficiency. Estrogen deficiency at the menopause influences joint symptoms and inflammatory parameters in rheumatoid arthritis. Estrogen deficiency in menopausal syndrome may induce joint symptoms resembling RA.
11196526 Isolated tuberculous monoarthritis mimicking oligoarticular juvenile rheumatoid arthritis. 2001 Jan Isolated monoarthritis caused by Mycobacterium tuberculosis in the absence of clinical pulmonary disease is extremely rare in North America. After decades of consistent declines in incidence, a remarkable resurgence of tuberculosis (TB) is occurring in North America. It must always be considered in the differential diagnosis of chronic monoarthritis if devastating sequelae are to be avoided. We describe 2 cases of tuberculous arthritis in young children presenting with monoarthritis of the knee. The presumptive diagnosis in each case was oligoarticular onset juvenile rheumatoid arthritis (JRA). Each had an atypical course for JRA, with lack of response to intraarticular corticosteroid. The diagnosis of TB arthritis was made only with synovial biopsy.
12659695 Does the presence of HLA-DR B1 shared motif affect progression of the disease in rheumatoi 2000 May The present study was undertaken in order to evaluate role of HLA DR Bl shared motif in prognosis of development of erosions in rheumatoid arthritis (RA). HLA genotyping was carried out in a retrospective analysis of 73 RA patients and 87 healthy controls using polymerase chain reaction. The assessment of disease activity was performed according to Mallya-Mace Index, whereas radiographs of hands were assessed according to the Larsen Index. HLA-DR4 and DR10 were significantly increased among RA patients. Relative risk was 7.540 and 4.646, respectively. Interestingly, the presence of DRl and DR14 did not enhance the relative risk in our group of patients. Determination of HLA-DR B1 alleles showed that among RA patients the most frequent was HLA-DR Bl*0401, *0404, and *0408. They gave a rise to a relative risk of 4.010, 7.540, and 3.686 respectively. For the purpose of analysis the patients were divided into three groups. The first group comprised 14 patients with two high-risk alleles (HLA DR B1 *01, *0401, *0404, *0408, *14). The second group gathered 35 patients with one high-risk allele. Twenty-four patients with no high-risk alleles were designated to the third group. We did not notice any differences in damage score and progression of damage score in rheumatoid arthritis patients with different number of high risk motifs. In conclusion, HLA-DR B1 shared motif was found to be significantly more frequent among analyzed erosive rheumatoid arthritis as compared to matched healthy controls. We did not observe any relation between the presence of shared motifs and outcome of the disease. Therefore, it seems that HLA DR B1 determination may very helpful in diagnosing or in establishing groups of risk but it is not likely to have a role in predicting development aggressive forms of RA.