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ID PMID Title PublicationDate abstract
10953752 Antioxidant status in children with juvenile rheumatoid arthritis (JRA) living in Cairo, E 2000 Mar The aim of this study was to examine both enzymatic and non-enzymatic antioxidant status in a select group of children with juvenile rheumatoid arthritis (JRA), living in Cairo, Egypt. The plasma concentrations of albumin, ceruloplasmin, vitamin C, vitamin E as well as erythrocyte superoxide dismutase and whole blood glutathione peroxidase activities were all significantly decreased in the presence of JRA compared to those without JRA. Unlike these antioxidant factors, vitamin A and its carrier (e.g. retinol binding protein), which have very little or no antioxidant property, remained unaffected by JRA. These results suggest that the children with JRA are subject to oxidative stress.
28246819 Ankle prostheses. Mid-term results after Thompson-Richards and STAR prostheses. 1998 Mar Thirty-seven patients with 20 cemented Thompson-Richards prostheses and 19 cementless S. T. A. R. prostheses (2 bilateral cases) were followed up after 1-12 years. Rheumatoid arthritis was the main diagnosis in both populations, with females dominating. The investigation was based on the Kofoed ankle score. At follow-up the total scoring improved to 86.9 pts. in S. T. A. R. and to 77.7 pts. in T. R. P. replacement. The radiological examination showed a high rate of radiolucency for the tibial component (53.3 %) in cemented T. R. P.; subsidence of talar component was seen in 3 cases with T. R. P. In cementless S. T. A. R. prosthesis only 3 cases showed small radiolucent lines of the flat tibial component. Talar subsidence was not seen at all. In T. R. P. we had two revisions due to prosthesis loosening and one maleollar fracture, giving a cumulative estimated survival rate of 87 % at 12 years. In the S. T. A. R. prosthesis group two revisions had to be performed because of one meniscal breakage and correction of meniscal height. The estimated survival rate at 6 years was 94.3 %.
11329483 Risk and resistance factors in the adaptation in mothers of children with juvenile rheumat 2001 Jun OBJECTIVE: To examine the importance of illness severity, child functional status, psychosocial stress, intrapersonal factors, stress processing, and social-ecological factors in predicting psychological symptoms among mothers of children with juvenile rheumatoid arthritis (JRA). METHODS: Mothers of 92 children with JRA completed surveys while waiting with their children for physician appointments or during JRA meeting breaks. RESULTS: Mothers reported higher mean levels of psychological symptoms than a normative group. Higher levels of psychosocial stress predicted increased psychological symptoms after accounting for disease severity and functional status. Maternal appraisal of the illness tended to moderate the relationship between illness stress and psychological symptoms, and maternal education moderated the relationship between daily hassles stress and psychological symptoms. CONCLUSIONS: These data indicate that mothers of children with JRA are at risk for psychological distress. Inteventions that take into account the buffering effects of maternal education and appraisal may serve to decrease the effects of maternal stress.
9000483 Altered (oxidized) C1q induces a rheumatoid arthritis-like destructive and chronic inflamm 1997 Feb Previous studies have identified an altered C1q molecule in synovial fluids from the joints of rheumatoid arthritis patients. We therefore immunized arthritis-susceptible Lewis 1A.AVN rats with either native C1q (C1q nat), altered (oxidized) C1q (C1q ox), or type II collagen (CII, induces arthritis in these animals), in order to induce arthritis. Unlike C1q nat, both CII and C1q ox were able to induce swelling and erythema of joints consistent with an arthritis-like inflammatory reaction. Histopathological evaluation of individual joint sections revealed synovitis, bursitis and tendovaginitis, massive joint destruction, and severe pannus formation. In a time-course study, no differences in onset of arthritis or pathology were observed between C1q ox-induced arthritis and that induced by CII. High titers of antibodies recognizing CII, but not C1q (native or oxidized), were detected in rats immunized with CII. In contrast C1q ox, but not C1q nat, induced antibodies reactive with both C1q and CII. Antibodies from C1q ox-immunized animals contained an antibody subset that reacted with C1q but not CII and a subset that reacted with CII but not C1q, implying that induction of an immune response to CII does not require CII. These data support the hypothesis that C1q may provide one of the early antigens involved in induction of arthritis, before CII becomes available as antigen.
10721762 Rehabilitation of orthopedic and rheumatologic disorders. 2. Connective tissue diseases. 2000 Mar This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with connective tissue diseases. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include the management of patients who have polymyalgia rheumatica, juvenile rheumatoid arthritis, ankylosing spondylitis, rheumatoid cervical spine, and rheumatoid hand.
9002031 Systemic juvenile rheumatoid arthritis and associated Isaacs' syndrome. 1997 Jan We describe a patient with systemic onset juvenile chronic arthritis who developed clinical and electromyographic features of acquired Isaacs' syndrome. This association has not been reported before and possible links between the 2 diseases are discussed.
18031099 Felty's Syndrome. 1997 May Felty's syndrome is a complication of rheumatoid arthritis whereby patients develop neutropenia of varying severity. Although the main clinical concern is the development of serious infections, often patients remain asymptomatic or continue with clinical problems related to the rheumatoid arthritis and not to the neutropenia. There is now considerable clinical experience with the use of the recombinant human haemopoietic growth factors granulocyte and granulocyte-macrophage colony-stimulating factors (G-CSF and GM-CSF) in the treatment of patients with Felty's syndrome. The only indication for the use of either growth factor for Felty's syndrome is the onset of infectious complications, which may be recurrent and serious. In general, when this occurs, the neutropenia is severe (<10(8) cells/L). The mechanism(s) underlying development of the neutropenia in Felty's syndrome is similar to that in other forms of immune-mediated neutropenia, and in general is associated with a terminal defect in neutrophil maturation. It is likely that the maturational defect is a consequence of ;immune based' inhibition, although we lack detailed understanding of this inhibitory process. Growth factor therapy does not relieve the defect in terminal maturation, but in general may induce a significant improvement in the peripheral white cell count. Instances where growth factor therapy does not work appear to be due to an inability to overcome the maturational defect. Thus, the level of granulopoietic inhibition mediated by the rheumatoid process varies in severity among patients. To date, treatment options for Felty's syndrome have included disease-modifying antirheumatic drugs, corticosteroids and splenectomy. The addition of growth factor therapy is a welcome addition to these less than optimal treatment options. However, all of the above therapies fail on occasion. Moreover, the dosage and frequency of growth factors must be titrated to keep the white blood cell count <5 x 10(9) cells/L, since overshoot may result in complications, the most common being exacerbation of the rheumatoid arthritis. Another mechanism by which these drugs may exacerbate rheumatoid arthritis is through activation of neutrophils. The addition of disease-modifying drugs may relieve the maturational defect, improve the peripheral white cell count and minimise disease exacerbation by limiting neutrophil exposure to the administered haemopoietic growth factor. However, long term monotherapy with G-CSF has been successfully employed without requiring disease-modifying therapy.
11280465 Erythematous swelling of the lip associated with Sjögren's syndrome and mimicking cheilit 2001 Jan A 64-year-old Japanese woman developed therapy-resistant erythematous swelling of her upper lip. Our tentative clinical diagnosis of cheilitis granulomatosa was ruled out later by the laboratory findings including increased levels of anti-nuclear-antibody (ANA), anti-SSA/Ro antibody, and positive Schirmer test as well as by a histopathological picture showing a dense perivascular infiltration of plasma cells and mononuclear cells in the dermis instead of granulomatous changes. To the best of our knowledge, this is the first patient in whom annular erythema associated with S ogren's syndrome involved only the upper lip and produced clinical features simulating cheilitis granulomatosa.
9598905 Hypercalciuria and hematuria in juvenile rheumatoid arthritis. 1998 May OBJECTIVE: To investigate the frequency of hypercalciuria and the relationship between hypercalciuria and hematuria in patients with juvenile rheumatoid arthritis (JRA). METHODS: Twenty-eight children with JRA were studied, as well as 10 patients with acute arthritis unrelated to JRA and 14 healthy children as control groups. Cases with urinary calcium excretion (UCE) >4 mg/kg/day were considered hypercalciuric. Urinalysis was performed for detecting hematuria in all cases. RESULTS: UCE was 4.19 +/- 2.9 mg/kg/day in patients with JRA, 1.94 +/- 1.57 mg/kg/day in children with acute arthritis, and 2.0 +/- 1.45 mg/kg/day in healthy children. UCE was significantly higher in JRA compared with the other study groups. Of the 28 patients with JRA, 13 (46.4%) had hypercalciuria and 6 (21.4%) had hematuria. UCE was significantly higher in hematuric patients with JRA than in those with no hematuria (p<0.05). UCE in patients with JRA without hematuria was also higher than the UCE values detected in the disease and healthy control groups (p<0.05). CONCLUSION: Hypercalciuria is a frequent finding in patients with JRA [13/28 (46.4%)] and should be considered during the investigation of hematuria in patients with JRA.
9229181 Viral arthritis. 1997 Jul Viral infections are important in rheumatic disease not only because of the acute and subacute syndromes they cause but also because of their potential importance as etiologic factors in common chronic diseases such as rheumatoid arthritis. During 1996, the clinical spectrum of the acute polyarthritis caused by parvovirus B19 was further delineated and was shown to include carpal tunnel syndrome, hepatic dysfunction, and possibly angioedema. B19 infection can be studied using the salivary antibody response. No convincing additional data were reported regarding B19 in chronic syndromes such as rheumatoid arthritis or Behçet's syndrome. Regarding rubella as a possible cause of chronic arthropathy, more negative evidence accumulated with two additional studies in vaccinees and chronic arthritis using epidemiologic and virologic methods including the polymerase chain reaction. To define a possible link between rubella and autoimmunity in vitro, interactions of rubella RNA, ribonucleoprotein complexes including Ro and La, and calreticulin were explored. There was an avalanche of new information about hepatitis C virus infection, particularly its relationship to mixed cryoglobulinemia and related clinical syndromes. These syndromes have become much more commonly recognized, particularly in areas of high prevalence of hepatitis C virus infection such as Italy. The lymphotrophic nature of the virus is probably ultimately responsible for the rheumatic disease manifestations. Treatment is still problematic, but immunosuppressive drugs should be avoided. Epstein-Barr virus appears to have an etiologic role in the lymphomas occurring in immunosuppressed patients, including those who have had methotrexate therapy. Significant new studies regarding other viruses did not appear during the past year.
10923151 [Fever of unknown origin caused by the adult form of Still's disease]. 2000 Jul 15 In three patients, two women aged 70 and 19 years and a man aged 33 years with long-lasting fever no diagnosis was made after extensive diagnostic work-up. After exclusion of infectious, malignant and rheumatic diseases, adult-onset Still's disease was diagnosed in all three patients on the basis of clinical and laboratory criteria. Adult-onset Still's disease is an important but less well known cause of fever. Clinically, adult-onset Still's disease is characterized by the triad of fever, skin rash and arthritis/arthralgia. A greatly elevated serum ferritin level proved to be an additional valuable diagnostic clue. Treatment consists of non-steroidal anti-inflammatory drugs, corticosteroids or immunosuppressive agents. The long-term prognosis is usually good, but severe joint destruction may occur. All three patients recovered.
9694066 Successful methotrexate therapy for adult Still's disease with marked thrombocytopenia. 1998 A 34-year-old Japanese woman developed spiking fever, splenomegaly, arthritis, neutrophilia, hyperferritinaemia (22517 ng/ml), elevated C-reactive protein (9.1 mg/ml) and severe thrombocytopenia (1.7 x 10(4)/microl). The patient had depressed antithrombin III activity and abnormally high concentrations of both fibrin degradation products and thrombin-antithrombin complexes. This condition was resistant to high-dose prednisolone therapy (120 mg/day) and non-steroidal anti-inflammatory drugs. We initiated oral methotrexate therapy (7.5 mg/week, orally) with a favourable outcome. The patient's spiking fever subsided on the first day of methotrexate administration. Elevated levels of ferritin and C-reactive protein in the sera rapidly normalised. Methotrexate rapidly improved the disease state which suggested that methotrexate act via modulation of cytokine production or secretion.
9309194 Pathogenesis and treatment of Sjögren's syndrome. 1997 Sep The criteria for diagnosis of primary Sjögren's syndrome continue to be controversial, leading to confusion in clinical practice and in the research literature. Among Sjögren's syndrome patients who fulfill the European criteria, only 15% of those would fulfill the San Diego criteria. This difference in disease classification leads to difficulty in evaluating clinical trials and in elucidating pathogenetic mechanisms, because different patient populations are evaluated. As a result of the ease and safety of minor salivary gland biopsy, Sjögren's syndrome serves as a prototype model to study the immunopathogenic features of a human organ-specific autoimmune disease. Critical features of pathogenesis include: 1) failure to "delete" autoimmune T cells at the level of thymic selection; 2) "homing" of autoimmune lymphocytes to salivary and lacrimal glands via high endothelial venules; 3) clonal expansion of autoimmune T cells in the glands; 4) upregulation of major histocompatibility antigens and adhesive molecules by epithelial cells in the glands; 5) secretion of proinflammatory cytokines by both lymphocytes and epithelial cells; 6) decreased neural innervation of the glands; 7) failure of residual glandular tissue express secretory functions; and 8) failure to remove autoimmune T cells by normal mechanisms of apoptosis. Each of these steps is regulated by cell-matrix interactions, cytokine and growth factor secretion, cell membrane receptor stimulation, "second" signals in the cytoplasm, and nuclear transcription factors. Recent studies on each of these steps in Sjögren's syndrome have suggested their role in pathogenesis and, consequently, their potential as sites for therapeutic intervention.
10051620 Localization of non-Mhc collagen-induced arthritis susceptibility loci in DBA/1j mice. 1999 Mar 2 One approach to understanding common human diseases is to determine the genetic defects responsible for similar diseases in animal models and place those defective genes in their corresponding biochemical pathways. Our laboratory is working with an animal model for human rheumatoid arthritis called collagen-induced arthritis (CIA). We are particularly interested in determining the location of disease-predisposing loci. To that end, we performed experiments to localize susceptibility loci for CIA in an F2 cross between the highly susceptible mouse strain DBA/1j and the highly resistant mouse strain SWR/j. Specifically, a quantitative trait locus analysis was performed to localize regions of the mouse genome responsible for susceptibility/severity to CIA. One susceptibility locus, Cia1 in the major histocompatibility locus, had been identified previously. Two additional loci were detected in our analysis that contribute to CIA severity (Cia2, Cia3) on chromosomes 2 and 6. A third locus was detected that contributes to the age of onset of the disease. This locus (Cia4) was located on chromosome 2 and was linked to the same region as Cia2. Determining the identity of these loci may provide insights into the etiology of human rheumatoid arthritis.
24387026 Crescentic glomerulonephritis with antimyeloperoxidase antibodies developing during the co 2001 Mar Abstract Glomerulonephritis, such as membranous nephropathy, IgA nephropathy, and p-antineutrophil cytoplasmic autoantibody (ANCA)-related crescentic glomerulonephritis, has been shown to occur in rheumatoid arthritis (RA). However, the occurrence of two types of glomerulonephritis in a patient with RA is rarely observed. Here, we describe a patient with RA who developed crescentic glomerulonephritis with antimyeloperoxidase (MPO) antibodies during the course of IgA nephropathy. This case indicates that crescentic glomerulonephritis and IgA nephropathy may occur together in association with p-ANCA in RA.
11996432 Arthritis in sarcoidosis. 2001 Dec AIMS AND METHODS: Sarcoidosis is systemic granulomatous disorder. Articular manifestations have received little attention in the literature. Case records of patients with sarcoidosis, presenting with articular symptoms between 1990-1999, were retrospectively analysed. RESULTS: Twenty nine patients, 15 males and 14 females, median age 44 years (range 15-67 years) and median duration of articular symptoms of eight months diagnosed clinically (n=9) and on biopsy (n=20) were studied. Twenty five patients had arthritis as the presenting manifestation. Fifteen patients had chronic arthritis (> six months). Lofgren's syndrome was seen in 7% of the patients. Acute arthritis was episodic (n=4), more common in males (M:F = 9:5), predominantly affected lower limb joints and mimicked reactive arthritis. Chronic arthritis was more frequently observed in females (M:F = 1:2) and presented with involvement of bilateral symmetric hand joints, mimicking rheumatoid arthritis. Extra-articular manifestations like neuropathy and constitutional symptoms were observed in acute arthritis. Skin plaque, splenomegaly and interstitial lung disease were seen with chronic arthritis. At a median follow up of 12 months, 10/14 and 5/15 achieved complete remission whereas 2/14 and 9/15 achieved partial remission of the articular symptoms in the acute and chronic groups, respectively. CONCLUSION: Arthritis in sarcoidosis is an early manifestation of disease and may mimic reactive or rheumatoid arthritis. Unsatisfactory response in chronic arthritis highlights the need for immunosuppressive drugs in addition to steroids.
28246857 Differential diagnosis of septic hip arthritis in childhood by ultrasound examination. 1997 Oct The efficiency of ultrasound was tested in septic arthritis. A total of 259 children with hip pain, septic arthritis (n = 14), transient synovitis (n = 120), juvenile rheumatoid arthritis (n = 12), Legg-Calvé-Perthes disease (n = 92) and slipped capital femoral epiphysis (n = 21) were examined by ultrasound. By using the standard planes described by the DEGUM, it is possible to analyze the joint capsule, the surface of the femoral head and the periarticular structures. In cases with synovitis or joint effusion, capsular distention can be diagnosed by ultrasound. This distention is typical in septic arthritis, transient synovitis, juvenile rheumatoid arthritis, and in the onset phase of Perthes disease. Because capsular distention and osseous abnormalities in the various diseases are similar differentiation is not possible. Therefore, ultrasound cannot distinguish between septic and non-specific arthritis; capsular distention is a non-specific ultrasound sign. Immediate diagnostic puncture is necessary if septic arthritis is suspected (possible by ultrasound control). In cases with both capsular distention and osseous abnormalities, ultrasound usually allows differentiation between slipped capital femoral epiphysis/Perthes disease and septic/non-specific arthritis.
28246734 The unstable radiocarpal joint in rheumatoid arthritis. 1999 Oct The inflammation of the wrist occurs very early in Rheumatoid arthritis. In cases of wrist deviation the biomechanics of the hole hand are affected. Carpal collaps will severly influence the range of motion (ROM) of the fingers. Operative techniques of how to maintain hand function are discussed. There are different procedures available - partial arthrodesis, arthrodesis and arthroplasty.
17341939 Serum B2-microglobulin concentration correlates with urinary concentrations of type 1 coll 1998 Mar BACKGROUND: Determination of serum ss2-microglobulin concentration, an invasive procedure, has been advocated for monitoring patientsA centAA response to treatment in rheumatoid arthritis. The object of this study was to find out if serum ss2-microglobulin concentration correlated with urinary excretions of type 1 collagen crosslinked N-telopeptides (NTx) and deoxypyridinoline (Pyrilinks-D) in rheumatoid arthritis (RA). SUBJECTS AND METHODS: Using chemiluminiscent assay, serum ss2-microglobulin concentrations were estimated in 25 female patients with active RA, 25 female with inactive disease, and 25 age-matched healthy female controls. Concentrations of NTx and Pyrilinks-D were also determined by immunoabsorbent assays in spot urine samples from these subject groups. RESULTS: The serum concentration of ss2-microglobulin in patients with RA (7.45+/-2.10 mg/L) was significantly higher (P<0.001) than the concentrations in patients with inactive disease (3.33+/-0.76 mg/L), or than in normal healthy controls (2.747plusmn;0.52 mg/L). Similarly, in patients with active RA, the spot urinary concentrations of NTx (123.08+/-25.53 nmol BCE/mmol creatinine) and Pyrilinks-D (15.087plusmn;3.29 nmol/mmol creatinine) were significantly higher (P<0.01) than those in patients with inactive disease (58.42AA+/-12.65 nmol BCE/mmol creatinine and 10.10+/-2.43 nmol/mmol creatinine, respectively). In patients with active RA, serum concentration of ss2-microglobulin correlated positively with spot urinary NTx concentrations (r=0.9910, P=0.0001), and Pyrilinks-D concentration (r=0.6177, P=0.001). CONCLUSION: In patients with active RA, the spot urinary concentrations of NTx and Pyrilinks-D correlated positively with serum AA2-microglobulin. Therefore, the estimations of these urinary markers may take the place of serum ss2-microglobulin estimation in monitoring the patientA centAAs response to treatment in rheumatoid arthritis.
24387025 Recurrent ischemic colitis in a patient with malignant rheumatoid arthritis (MRA). 2001 Mar Abstract A 63-year-old male with a 5-year history of malignant rheumatoid arthritis (MRA) developed recurrent massive melena and abdominal pain. Methylprednisolone pulse therapy and high doses of oral prednisolone markedly improved the clinical symptoms and normalized immunological disorders. However, he died of disseminated intra-vascular coagulation secondary to pneumonia caused by methicillin-resistant Staphylococcus aureus. Although a high dose of glucocorticoid therapy is effective for ischemic colitis complicated with MRA, intensive care to avoid any opportunistic infection is required.