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ID PMID Title PublicationDate abstract
10368574 [Diagnostic criteria of Sjögren syndrome]. 1999 Mar The present knowledge about Sjögren classification, diagnosis, therapy and its prognosis is reviewed. Some researchers about immunological and histological factors are also underlined. Finally, a complete picture of this syndrome is given.
10084046 A population-based study on uveitis in juvenile rheumatoid arthritis. 1999 Jan OBJECTIVE: To obtain information on the occurrence and characteristics of uveitis in a population-based survey of patients with juvenile rheumatoid arthritis (JRA). METHODS: The subjects in this study were entitled, under the nationwide sickness insurance scheme, to receive specially reimbursed medication for JRA in 5 of the 21 central hospital districts in Finland (population base about 270,000 children < 16 years of age) in 1980, 1985 and 1990. RESULTS: A total of 114 incident cases (34 boys and 80 girls) satisfied the criteria for JRA. Uveitis was diagnosed in 18 of these patients (16%). The mean age of uveitis patients at the diagnosis of JRA was 6.8 years (median 5.4 years) and the mean interval from the diagnosis of JRA to the detection of uveitis was 2.9 years. Silent (asymptomatic) anterior uveitis was found in 4 boys and 11 girls and acute anterior uveitis in 2 boys. One girl had marginal corneal ulceration with mild anterior uveitis. Uveitis was chronic (> 6 months) in 9 cases. Uveal inflammation was most severe in the 3 children whose uveitis was detected at the time of the diagnosis of JRA. CONCLUSION: The study provides population-based information on the occurrence and characteristics of uveitis associated with JRA.
10608732 Changes of plasma fibronectin in patients treated with cryofiltration for an extended peri 1999 Nov The purpose of this study was to evaluate correlations between extra domain A fibronectin (EDA[+]FN) in plasma and the clinical course in cryofiltration for an extended period. Two patients with systemic lupus erythematosus (SLE), 1 with aortitis syndrome, 1 with ankylosis spondylitis, 1 with polymyositis, 1 with rheumatoid arthritis, and 1 with chronic rejection of a kidney graft, were regularly treated with cryofiltration for more than 3 years. The average level of EDA(+)FN in each year did not show significant change in clinically stable patients with aortitis syndrome, polymyositis, and SLE. In the patient with ankylosis spondylitis, the average level of EDA(+)FN in each year elevated, so cryofiltration was performed frequently. On the other hand, cryofiltration could not attenuate the progression in the juvenile rheumatoid arthritis patient. In the patient with chronic rejection of a kidney graft, kidney function without hemodialysis could be prolonged for 33 months by cryofiltration. The average level of EDA(+)FN elevated as the graft function got worse. Changes of average level of EDA(+)FN in plasma corresponded with changes in the clinical courses of patients with autoimmune disease and chronic rejection of a kidney graft. The EDA(+)FN level might give prognostic information and determine the interval of cryofiltration.
9330950 Hodgkin's lymphoma in systemic onset juvenile rheumatoid arthritis after treatment with lo 1997 Oct We describe the occurrence of malignant lymphoma as a possible complication of immunosuppression associated with low dose methotrexate (MTX) therapy for juvenile rheumatoid arthritis (JRA). A 6-year-old girl with systemic onset JRA who had received low dose MTX therapy for 16 months developed diffuse peripheral lymphadenopathy and enlargement of the lymph nodes in the mediastinum, hilum of the lungs, and liver. Lymph node histology disclosed mixed cellularity Hodgkin's lymphoma; the neoplastic cells were positive for CD30 and CD15, but negative for Epstein-Barr virus RNA or EBV latent membrane protein. After chemotherapy, the girl had complete remission of her disease lasting for 18 months; however, the disease relapsed and autologous peripheral stem cell transplantation was performed. Although the occurrence of lymphoma may be associated with autoimmune diseases, our observations suggest that in pediatric patients, the increasing use of low dose MTX therapy for JRA may be an additional factor for the development of lymphoproliferative disease.
11200497 Large granular lymphocyte leukemia: case report of chronic neutropenia and rheumatoid arth 2001 Jan Lymphoproliferative disorders of large granular lymphocytes (LGL) are heterogeneous, with a clinical/pathologic spectrum ranging from a benign polyclonal expansion to an aggressive clonal disease. Often these lymphoproliferative disorders are associated with autoimmune disease. The clonal form of the disorder, LGL leukemia, typically occurs in older adults with a median age of 55 years at diagnosis. Pediatric cases are referred to in review articles; however, no detailed reports of T-cell LGL leukemia in children exist. This report illustrates a case of a child who presented initially at age 2 and 1/2 years with psoriasis, juvenile rheumatoid arthritis-like symptoms, and neutropenia. Bone marrow examinations obtained throughout his course have demonstrated progressive hypercellularity with increased reticulin fibers and replacement of the normal marrow elements by lymphocytes, which were later identified as large granular lymphocytes. Further testing with immunophenotyping by flow cytometry and T-cell receptor gene rearrangement studies revealed a monoclonal proliferation of large granular lymphocytes and confirmed a diagnosis of LGL leukemia. Although rare, large granular lymphocyte leukemia should be included in the differential diagnosis of chronic neutropenia in children.
9870893 Activation of the haemostatic system in children with juvenile rheumatoid arthritis correl 1998 Dec 15 Twenty-four children with juvenile rheumatoid arthritis (JRA) and 10 children with postinfectious arthropathies were investigated for markers of blood coagulation and fibrinolytic activity: Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and D-Dimer were measured using solid phase enzyme linked immunosorbent assays (ELISA). Results were compared with clinical and conventional laboratory signs of disease activity. F1+2, TAT, D-Dimer, and fibrinogen were significantly elevated in children with JRA as compared with healthy children and children with postinfectious arthropathies. F1+2, TAT, and D-Dimer correlated significantly with disease activity, assessed by determination of the joint index score and C-reactive protein (CRP). The study demonstrates a subclinical activation of the haemostatic system in children with JRA correlating with disease activity, which might be caused by the action of several immunomediators on cells (monocytes, endothelial cells) playing a role in the regulation of blood coagulation activity.
10529148 Increased circulating vascular endothelial growth factor is correlated with disease activi 1999 Oct OBJECTIVE: To investigate the relevance of vascular endothelial growth factor (VEGF) in the pathogenesis of juvenile rheumatoid arthritis (JRA). METHODS: Serum VEGF levels in 58 patients with JRA (systemic in 17, polyarticular in 29, pauciarticular in 12) were measured by ELISA and compared with those of 21 patients with infectious diseases and 50 healthy children. Correlations of VEGF levels with number of joints with active arthritis, erythrocyte sedimentation rate (ESR), and hyaluronic acid (HA) were examined. RESULTS: Serum levels of VEGF in patients with JRA were significantly higher than in healthy controls. Patients with systemic and polyarticular JRA showed statistically higher levels of VEGF than those with infectious diseases. VEGF levels correlated statistically with C-reactive protein (CRP) in patients with both infectious diseases and polyarticular JRA, but the regression slope (VEGF/CRP) was much steeper in polyarticular JRA than in infectious diseases. Serum VEGF levels correlated with disease activity variables such as the number of joints with active arthritis, ESR, and serum HA levels in polyarticular JRA. CONCLUSION: The correlation of serum VEGF levels and disease activity in polyarticular JRA suggests that VEGF may take an active part in joint inflammation.
16015467 Cytokines as drug targets. 2001 Apr Cytokines (interleukins, chemokines, and some growth factors) play an important role in cancer, metabolic disorders, autoimmune disorders and inflammatory diseases, such as rheumatoid arthritis, asthma, Crohn's disease, psoriasis, multiple sclerosis and asthma. Cytokine-based drugs and anticytokine therapies are an increasingly important class of drugs in the treatment and management of many diseases. Interferons are being used to treat viral diseases and cancers. Anti-tissue necrosis factor therapies, such as Enbrel (etanercept; Immunex Corp) and Remicade (infliximab; Centocor) have demonstrated clinical efficacy in rheumatoid arthritis and Crohn's disease. In addition, thalidomide (Celgene) is being used to treat erythema nodosum in leprosy, cancers (multiple myeloma and colon cancer) and autoimmune diseases. This conference focused on new developments in basic research, drug discovery and clinical development of cytokine-based drugs.
9567208 Update in the epidemiology of the rheumatic diseases. 1998 Mar The epidemiology of early synovitis syndromes in the community remains of interest. Attempts to identify those cases likely to progress to erosive rheumatoid arthritis have yielded some prognostic features that may be clinically applicable. The incidence of juvenile rheumatoid arthritis appears to fluctuate in a cyclic pattern, suggesting microbial or other environmental factors contributing to its occurrence. In the United States, the frequency of scleroderma varies among racial groups with rising rates noted especially among African-American women. A very high prevalence of scleroderma among Oklahoma Choctaws is providing an opportunity to study interactions of environmental and genetic risk factors. Excess weight in middle-aged women and possibly low intake of antioxidants contribute to the progression of established osteoarthritis of the knee.
14647685 [Role of oxidative stress in the maintenance of inflamation in patients with juvenile rheu 2000 Mar OBJECTIVE: To determine the level of cellular oxidative stress blood markers and the enzymatic system of antioxidant defense establishing the oxidative profile in patients with Juvenile Rheumatoid Arthritis. METHODS: Case-control study that included 64 patients (46 of female sex) with Juvenile Rheumatoid Arthritis (JRA) following clinical control in the Pediatric Rheumatology Service of the Vall dacute;Hebron Hospital, Barcelona, Spain. The patients were separated in three subtypes based on the pattern of onset within the first six months of disease: polyarticular, pauciarticular and systemic. The control group included 60 patients (38 of female sex) following clinical control to diseases of non inflammatory nature, in the same hospital. The plasmatic levels of malondialdehyde (MDA), lipoperoxide (LPO), hydroperoxide (HPX), carbonile groups (CG) of proteins and gluthathione and the enzymatic activities of Superoxide dismutase (SOD), gluthathione peroxidase (GSH-Px) and gluthathione reductase were determined. RESULTS: The group of patients with JRA presented high concentrations of lipid peroxidation products, evaluated by determining the plasmatic levels of MDA, LPO, and HPX; oxidative damage of the circulate protein, determined by CG contents of plasma proteins; elevation of enzymatic activity of SOD and GSH-Red; decrease of GSH-Px activity and GSH levels. CONCLUSIONS: Our results show the presence of molecular damage determined by oxygen free radicals in the JRA patients. The SOD activity and the changes of gluthathione redox enzymatic cycle confirm the decrease of capacity of cellular defense system against the induced toxicity of oxidative stress in these patients.
24387022 Comparative study of fat-suppressed Gd-enhanced MRI of hands in the early stage of rheumat 2001 Mar Abstract The object of this work was to evaluate the usefulness of fat-suppressed gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early-stage rheumatoid arthritis. Forty wrists of patients who had suffered from stiff or swollen hands for 1-12 months were examined prospectively by MRI. Rheumatoid arthritis (RA) was proven in 21 patients, and the other 19 patients were not classified as having RA. Hypertrophy of the synovial membrane and tendon sheaths were evaluated by fat-suppressed Gd-enhanced MRI, and bone erosions were also evaluated by T1-enhanced MRI. These results were compared between two groups. Seventeen of 19 patients (89.5%) in the non-RA group showed little or no synovial hypertrophy, while 17 of 21 patients (81%) in the RA group showed moderate to severe hypertrophy of the synovial membrane. Little or no tenosynovitis was found in 14 of 19 patients (73.7%) in the non-RA group, while 14 of 21 patients (66.7%) in the RA group had moderate to severe tenosynovitis. No bone erosion was found in the non-RA group, while a few bone erosions were found in 10 of 21 patients (47.6%) of the RA group. Fat-suppressed, Gd-enhanced MRI was useful in differentiating early-stage RA from non-RA when all patients had some symptoms in their hands.
24383771 Diagnosis and therapy of rheumatoid arthritis in the future. 2001 Dec Abstract Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic disease characterized by joint pain and destruction. We describe the importance of early diagnosis, recording magnetic resonance images images at an early stage, monitoring disease progression using gliostatin purified in our laboratory, and sugar-chain analysis of RA serum IgG. For treatment of RA, cyclooxygenase-2-selective inhibitors, disease-modifying antirheumatic drugs, biological products, and the possibility of gene therapy are discussed. The development of therapeutic methods based on the elucidation of the pathology of RA has progressed markedly in the past decade, and further progress and the development of an early diagnostic method are expected.
17984876 Problems involved in total knee arthroplasty for rheumatoid arthritis patients. 2000 Dec 30 In view of the systemic nature of rheumatoid arthritis, total knee arthroplasty in these patients should be preceded by a careful evaluation of general and local clinical status in terms of systemic changes and pathological changes in the adjacent hip and foot joints. In the event of destructive changes in these joints, a change in the sequence of operations should be considered. All the components of joint deformity should be corrected during surgery. The surgical outcome depends not only on the operative technique, the proper selection of prosthesis, and postoperative rehabilitation, but also on the progression of the disease and the state of advancement of pathological changes in other joints. After surgery, the parameters of general physical capacity (such as walking distance, stair climbing and descending, standing up and sitting down) are difficult to evaluate. The outcome of arthroplasty should be evaluated primarily in terms of pain relief and function in the operated joint.
19078454 Neck mass in a rheumatoid arthritis patient taking etanercept. 2000 Apr A 60-year-old Caucasian woman with a history of rheumatoid arthritis and a remote history of a post-traumatic splenectomy developed a serious head and neck infection 11 weeks after beginning therapy with etanercept. The patient required incision and drainage of a neck abscess and 2 weeks of i.v. antibiotics to achieve complete recovery. Her etanercept was also discontinued. The causative organism was Streptococcus constellatus, which is a member of the group of encapsulated organisms known as S. intermedius. A normal functioning spleen as well as tumor necrosis factor are both necessary to ward off encapsulated bacteria. Patients who have had a splenectomy and are then started with etanercept may be especially prone to infections with encapsulated organisms, such as streptococcus.
10503661 Genetic susceptibility to the connective tissue diseases. 1999 Sep Genes important in the connective tissue diseases are being recognized in two basic ways: association studies and linkage analysis. Traditionally, association studies have confirmed a genetic influence in disease pathogenesis, especially in systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis, and the spondyloarthropathies. One of the strongest associations is with the HLA region. As techniques improve, genome scan studies suggest that multiple genes are involved in each of the connective tissue diseases, with some genes in common that confer an autoimmune susceptibility. Linkage analysis is identifying new candidate genes that will help to explain the etiology of connective tissue diseases.
24383737 Huge tumor-like subacromial bursitis associated with rheumatoid arthritis. 2001 Sep Abstract We report a rare case of a huge subacromial bursitis in rheumatoid arthritis. A solid tumor was initially suspected because it was very large with no apparent local sign of inflammation, and because no fluid retention was observed. We performed radiograms, a plain computed tomogram, a (99)mTc-MDP bone scintigram, a (67)Ga-citrate scintigram, and a digital subtraction arteriogram, which all indicated no evidence of tumor. Finally, a bursogram proved the mass to be a huge enlarged subacromial bursa. Surgical exploration revealed that the bursa contained 450 g of a yellowish, jelly-like substance, which was considered to be a thick collection of fibrin. No recurrence was noted at a follow-up 16 years after surgery.
24383643 Histopathological characteristics of early rheumatoid arthritis: a case one month after cl 2000 Dec Abstract A 68-year-old woman with early rheumatoid arthritis (RA) was admitted to the hospital because of tender and swollen knee joints. We performed a targeted synovial biopsy under arthroscopy to examine the histopathological characteristics 1 month after clinical onset. The synovia showed the typical histopathology of RA. Although the inflammatory changes were predominantly limited to the surface area of the synovia, associated with neovascularization and cell infiltrates composed mainly of T cells, plasma cells, and macrophages, lesions with fibrin deposition, mesenchymoid transformation and/or immature lymphoid follicles were also observed in part, indicating that this case was in the progression phase of RA. What we regularly call "early" might be "too late" even if it is within 1 month of clinical onset.
22049012 Problematic and positive support in relation to depression in people with rheumatoid arthr 2000 Mar This study focuses on the associations of both positive and problematic aspects of social support with depression in patients with rheumatoid arthritis. In a hierarchical multiple regression analysis we found that stressors such as functional limitations and pain are strongly related to depression. Positive and problematic support each explain an additional significant portion of the variance in depression. More positive support is associated with fewer feelings of depression and more problematic support is associated with more feelings of depression. An interaction effect between positive and problematic social support indicates that the negative aspects of problematic support may be partly diminished by positive support (buffering effect). Patients receiving more problematic support and less positive support experience the most feelings of depression.
9631612 Sjögren's syndrome: a model for dental care in the 21st century. 1998 Jun The diagnosis and treatment of Sjögren's syndrome, which poses many severe complications, should be of critical interest to dentists, who are often the first practitioners to detect symptoms. Dentistry is an integral part of health care delivery for patients with this condition. Management of Sjögren's syndrome can be seen as a model for the expanded scope of dental care in the future.
11288854 Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predic 2001 The aim of this study was to evaluate if subjective symptoms, radiographic and especially MR parameters of cervical spine involvement, can predict neurologic dysfunction in patients with severe rheumatoid arthritis (RA). Sequential radiographs, MR imaging, and neurologic examination were performed yearly in 46 consecutive RA patients with symptoms indicative of cervical spine involvement. Radiographic parameters were erosions of the dens or intervertebral joints, disc-space narrowing, horizontal and vertical atlantoaxial subluxation, subluxations below C2, and the diameter of the spinal canal. The MR features evaluated were presence of dens and atlas erosion, brainstem compression, subarachnoid space encroachment, pannus around the dens, abnormal fat body caudal to the clivus, cervicomedullary angle, and distance of the dens to the line of McRae. Muscle weakness was associated with a tenfold increased risk of neurologic dysfunction. Radiographic parameters were not associated. On MR images atlas erosion and a decreased distance of the dens to the line of McRae showed a fivefold increased risk of neurologic dysfunction. Subarachnoid space encroachment was associated with a 12-fold increased risk. Rheumatoid arthritis patients with muscle weakness and subarachnoid space encroachment of the entire cervical spine have a highly increased risk of developing neurologic dysfunction.