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ID PMID Title PublicationDate abstract
9522834 Arthropathy in hemochromatosis. 1998 Mar 15 Arthritis may be the presenting manifestation of iron overload. The metacarpophalangeal joints are often involved, producing a condition that resembles osteoarthritis but at a site typically affected by rheumatoid arthritis. Treatment of the arthritis is often disappointing, but identification of the underlying disease permits institution of life-saving phlebotomy therapy.
9083955 Prevalence of uveitis in an outpatient juvenile arthritis clinic: onset of uveitis more th 1997 Mar PURPOSE: To determine the prevalence and severity of uveitis in an outpatient pediatric arthritis clinic in the midwestern United States during the 1990s. METHODS: The prevalence and clinical characteristics of uveitis were studied retrospectively for all children diagnosed with arthritis at Shriner's Hospital for Crippled Children and followed by the pediatric rheumatology and ophthalmology units of the St Louis Children's Hospital between 1992 and 1995. RESULTS: Seven children (9%) developed uveitis in a population of 78 patients with juvenile arthritis. Six of the seven children were female, and all six females had anti-nuclear antibody (ANA)-positive, juvenile rheumatoid arthritis (JRA). The prevalence of anterior uveitis in females with ANA-positive, pauciarticular JRA was 20%, and in polyarticular JRA, 17%. One of the girls with uveitis had combined JRA and sarcoidosis; the boy with uveitis had juvenile spondylitis. Arthritis preceded the onset of uveitis in each child by 1 to 13 years (average, 6.4 years). Progression of the uveitis in three of the children resulted in band keratopathy and cataract, causing significant visual loss in two (i.e., in 29% of the children who developed uveitis). CONCLUSION: The prevalence and ocular morbidity of uveitis in juvenile arthritis appears to have remained relatively stable over the last 2 decades. Onset of the uveitis in several of the children in our study population occurred more than a decade after the diagnosis of arthritis. Girls with ANA-positive JRA and boys with juvenile spondylitis may need to be followed by periodic slit-lamp examination for longer periods than recommended previously.
19078385 Improved gastrointestinal tolerance and patient preference of enteric-coated sulfasalazine 1999 Aug Off-label use of uncoated sulfasalazine tablets (TAB) by rheumatoid arthritis (RA) patients in the United States has resulted in poor gastrointestinal (GI) tolerance and compliance. Two studies have shown that treatment of inflammatory bowel disease with enteric-coated sulfasalazine ([EN] Azulfidine ENtabs) resulted in significantly less frequent and severe GI symptoms, compared with treatment with TAB. The current study was conducted to compare GI tolerance of EN and TAB in rheumatoid arthritis (RA) patients. Fifty adult sulfasalazine-naive patients, who displayed stable RA and no significant GI toxicity with nonsteroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs at baseline, were randomized to receive 2 g EN or TAB, in a prospective, 10-week, investigator-blinded, crossover study. After an initial 3-week dosing period with either EN or TAB and a 2-week washout, patients were crossed over to the alternative sulfasalazine formulation for a 2nd 3-week dosing period and 2-week follow-up. GI tolerance of EN and TAB in patients who completed both arms of the crossover was assessed bv frequency and intensity of reported adverse events (primary endpoints) and responses to health questionnaires (secondary endpoints).Twelve patients dropped out early because of adverse events and the discontinuation rate was similar in E and TAB-treated patients. Patients taking EN who completed the study reported significantly fewer (p < 0.001) GI adverse events (abdominal pain, anorexia, flatulence, diarrhea, heartburn, nausea, and vomiting), compared with those patients taking TAB. The intensity of adverse events was predominantly mild in patients treated with either EN or TAB. Responses to questionnaires were similar in patients taking either formulation of sulfasalazine. However, when asked which treatment period was preferred at the end of the study, 849 of patients completing the study (p < 0.001) chose EN. This study suggests that enteric-coating of sulfasalazine improved GI tolerance and RA patient preference.
11739338 Variation in diagnosis and management of common foot problems by GPs. 2001 Dec BACKGROUND: There are indications that the diagnosis and management of common foot problems vary widely in general practice. OBJECTIVES: Our aim was to explore the variation of GPs' diagnosis and management of common foot problems and the possible correlation between GPs' characteristics and their competence to diagnose correctly. METHODS: In a cross-sectional design, 90 GPs in The Netherlands were invited to complete a questionnaire regarding seven vignettes with common foot problems (hallux valgus, hallux rigidus, fasciitis plantaris, tarsal tunnel syndrome, metatarsalgia, corns and calluses, and rheumatoid arthritis), combined with questions covering diagnoses, management options and some GP characteristics. RESULTS: A total of 72 GPs responded (80%). They most often diagnosed hallux valgus (79%) and rheumatoid arthritis (86%) correctly, and most often hallux rigidus (37%) and tarsal tunnel syndrome (74%) incorrectly. GP characteristics did not correlate with their competence in diagnosing. The most frequently suggested management was referral to a podiatrist. The referral rate to medical specialists was low, except in the case of rheumatoid arthritis (79%). CONCLUSIONS: More than half of the GPs were competent in diagnosing vignettes of common foot problems. This diagnostic competence showed great variation and was not associated independently with GP characteristics. Educational programmes are recommended. Management showed less variation and often included referral to podiatrists. Further research into the effectiveness of specific treatments for different foot problems is recommended.
17638097 The role of COX-2 inhibitors in rheumatoid and osteoarthritis. 1999 Are NSAIDs doomed to fade away, to be replaced by more targeted treatments? Or, as I have long maintained, will they survive the other current approaches to the therapy of osteoarthritis and rheumatoid arthritis, despite the recent disdain for them in some academic circles? To answer these questions, one must look at the rationale behind the development of NSAIDs.
9229179 Reactive arthritis. 1997 Jul The complex interactions between the triggering microbe and the defense mechanisms of the host in reactive arthritis have been studied in several laboratories around the world, and interesting observations have been made. Research has also focused on the mediators in the inflammatory process in joints, and these results are helping to slowly build a comprehensive picture about the pathogenetic process in reactive arthritis. For the practicing clinician, some important new findings have emerged. It is known that asymptomatic urogenital infections are quite common as a trigger of reactive arthritis. More aggressive treatment, including disease-modifying drugs as used in the therapy of rheumatoid arthritis, is becoming accepted. The value of antibiotic treatment is being studied, but final conclusions will not be made for perhaps a few years.
11791634 Treatment of collagen induced arthritis in DBA/1 mice with L-asparaginase. 2001 Nov OBJECTIVE: To evaluate the safety and efficacy of L-asparaginase as an immunosuppressive agent in a mouse model of rheumatoid arthritis. METHODS: Male DBA/1 mice with collagen-induced arthritis (CIA) were treated at different intervals with various doses of native and pegylated L-asparaginase from E. coli. The mice were observed for 4 weeks during which time arthritis was scored. Outcome parameters included effect on severity and progression of established arthritis as well as prevention of disease. In addition, X-rays from the affected joints were obtained for comparison. RESULTS: Both native L-asparaginase at a dose of 50 IU/injection intraperitoneally three days a week and pegylated asparaginase (PEG-L-asparaginase) at a dose of 25 IU/injection twice a week, significantly reduced the mean arthritic score (MAS) in mice with established arthritis (p < 0.001 for PEG-L-asparaginase). When native L-asparaginase was administered before the onset of arthritis (days 14-post immunization) the number of mice developing arthritis as well as the number of arthritic paws and the severity of arthritis in the treatment group were significantly decreased (p < 0.0001). Significant differences were found in the X-ray evaluation between treated and control mice. None of the animals died due to drug related events or showed signs of asparaginase induced toxicity. CONCLUSION: Our data provide the first direct evidence that L-asparaginase is a potent antiarthritic agent and may represent an effective second line agent for future treatment studies in juvenile and adult rheumatoid arthritis.
21959761 Models of inflammation: adjuvant-induced arthritis in the rat. 2001 Aug Injection of adjuvant (Mycobacterium butyricum suspended in mineral oil) into rats produces an immune reaction that characteristically involves inflammatory destruction of cartilage and bone of the distal joints with concomitant swelling of surrounding tissues. Adjuvant-induced arthritis in rats is commonly used to evaluate compounds that might be of potential use as drugs for treatment of rheumatoid arthritis and other chronic inflammatory conditions. This unit describes a method for inducing arthritis by injecting adjuvant into the tail and evaluating a test compound for the ability to inhibit the inflammatory response.
9171480 Dental professional's role in diagnosing Sjögren's syndrome. 1997 Jan In this investigation, a written questionnaire was used to assess patient's perceptions of health care professionals' knowledge about Sjögren's syndrome. Results show that dental and other health care professionals need to be better informed about the nature of Sjögren's and its symptoms so they can diagnose patients. Early diagnosis may help mollify symptoms and reduce anxiety or other perceived harmful consequences.
9891713 Psoriatic arthritis. 1998 Nov Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. It is classified with the human leukocyte antigen B27 seronegative spondyloarthropathies because it shares certain features with other conditions included in that group. Specific features of PsA, however, distinguish it from both rheumatoid arthritis and other spondyloarthropathies. Although the cause and pathogenesis of PsA are not known, genetic, immunologic, and environmental factors are thought to play a role, and provide a rationale from therapeutic modalities.
10852163 Reevaluation of laboratory parameters in relation to histological findings in primary and 2000 Jun OBJECTIVE: We reevaluated the diagnostic value of laboratory parameters in relation to histopathological findings in Sjögren's syndrome (SS) to clarify whether autoantibodies are useful diagnostic criteria for SS, and whether any laboratory data are useful in estimating the degree of salivary gland change. PATIENTS AND METHODS: Laboratory parameters and histopathological findings were analyzed in 96 patients examined by labial biopsy. RESULTS: The percentage of cases with positive assays of rheumatoid factor and anti-SS-A/Ro antibodies was significantly higher in Definite SS. Patients with dense mononuclear cell infiltration of salivary tissues also had higher titers of rheumatoid factor. No useful laboratory parameters were found for the diagnosis of secondary SS. CONCLUSION: Rheumatoid factor and anti-SS-A/Ro antibodies are useful for the diagnosis of primary SS, and rheumatoid factor is also an indicator of the severity of salivary glandular damage.
9499997 [Are the anatomopathological classifications of primary Gougerot-Sjögren syndrome correla 1997 Seventy-two cases of primary Sjögren's syndrome, according to the European classification criteria, were studied looking for a correlation between anatomic criteria and clinico-biological signs in this disease. Labial salivary gland biopsy was performed in all patients and anatomic criteria were evaluated according to both Chisholm and Chomette scales. Work-up included recording of functional and clinical signs. Our study shows no clinico-histological correlation in Sjögren's syndrome. Moreover, we did not find any correlation between the two histological scales. We think, therefore, that labial salivary gland biopsy appears to be an important step in Sjögren's syndrome diagnosis according to European criteria. However, it does not present any benefit in patient treatment.
9852707 Primary Sjögren's syndrome presenting as autonomic neuropathy. Case report. 1998 Nov Abnormalities of the autonomic nervous system have been described in several connective tissue diseases, but the relation with primary Sjögren's syndrome is unclear. This report describes a patient with primary Sjögren's syndrome who presented with severe autonomic failure. The present knowledge on dysfunction of the autonomic nervous system in primary Sjögren's syndrome and other connective tissue diseases is shortly reviewed.
9681921 Possible feedback control of white blood cells: effect of splenectomy in Felty's syndrome. 1998 May Feedback control of the white blood cell (WBC) count was analyzed in 20 cases reported by Coon, before and after splenectomy in Felty's syndrome. In only one case did the total white cell count fail to rise postsplenectomy, while in a second case the polymorphonuclear (poly) count did not exceed the preoperative value. Both of these patients had initial poly counts above 1000/mm3. If the preoperative poly count was 35% or greater of total WBC, the postoperative percentage was lower in five out of six cases. A comparison was made between pre- and postoperative poly counts, and three cases were noted to be underresponsive. However, two had a later rise in polys ('late responders'). A non-poly was defined as total WBC minus polys; a relationship was noted between pre- and post-operative non-polys, described by the difference between initial and postoperative counts. Thus, there is evidence for feedback control of the white cell count in Felty's syndrome after splenectomy.
11764213 Widespread pain and Sjögren's syndrome. 2001 Dec OBJECTIVE: Reports exist of an association between fibromyalgia (FM) and Sjogren's syndrome (SS). Widespread pain is a necessary component of FM. We explored the association of widespread pain and SS. METHODS: Data were abstracted from the records of the most recent 100 patients evaluated in the SS clinic. The subjects included individuals with or without SS who had screened for features of the disorder. Patients with confounding disorders or missing data were excluded. The presence of widespread pain was established by questionnaire in 92 subjects. Widespread pain followed the definition in the 1990 American College of Rheumatology classification criteria for FM. By objective criteria used in the clinic, patients were initially classified into SS (requiring keratoconjunctivitis sicca. positive labial salivary gland biopsy, and serological evidence of autoimmunity), incomplete SS (at least one of the latter objective findings), or non-SS (if all 3 objective findings were negative). For subsequent analyses, the study population was also classified into cases by applying the European criteria for SS, and the subjective or objective components of European criteria. Descriptive statistics and Cochran-Mantel chi-square tests were performed. RESULTS: Only 2/27 (7%) of those diagnosed with SS reported symptoms of widespread pain. The incomplete SS group consisted of 8/56 (14%), while the non-SS were 1/9 (11%). There was a trend toward greater widespread pain in those 9 of 52 (17%) subjects meeting the European criteria for SS who had widespread pain compared with 2 of 50 (5%) who did not. However, this was not significant (p = 0.0728). The greater the subjectivity of the criteria applied to classify cases of SS, the higher was the prevalence of widespread pain. No significant association was found between widespread pain and SS for any of the criteria applied. CONCLUSION: No significant association between widespread pain and SS was found in our study population. Further study is indicated to explore a possible lack of association between SS and FM.
8995954 Sjögren's syndrome with chronic pancreatitis, sclerosing cholangitis, and pulmonary infil 1997 Jan We report a patient with Sjögren's syndrome and multiple gastrointestinal manifestations who successfully responded to therapy with ursodeoxycholic acid. Our patient had sialoadenitis with dry mouth, dry eyes, arthralgia, chronic pancreatitis, sclerosing cholangitis, and pulmonary infiltrations. The first signs of disease were the symptoms of chronic pancreatitis followed by icterus, caused by extrahepatic bile duct obstruction. Sclerosing cholangitis was diagnosed by liver biopsy and endoscopic retrograde cholangiography. Sialoadenitis, causing dry mouth, was verified by buccal biopsy. Pulmonary infiltrations were seen on standard chest x-ray, and also shown by high-resolution computed tomography examination. Obstructive icterus and even pulmonary infiltration responded successfully to treatment with ursodeoxycholic acid.
12973433 Rationale and risks of novel immunomodulatory therapies in rheumatoid arthritis. 1999 Apr The need for new therapies for the treatment of rheumatoid arthritis (RA) has arisen during an era where clinicians have realized that RA is a far more ominous condition than was thought previously. The last decade has revealed numerous studies depicting the limited long-term efficacy and tolerability of conventional disease-modifying antirheumatic drug (DMARD) therapies. Moreover, DMARDs have not been shown to be truly capable of modifying articular, functional and radiographic outcomes in patients with RA. These issues have been raised amidst significant advances in our understanding of the immunopathogenesis of RA and advances in biotechnology. Such advances have led to a revised approach to using conventional DMARDs, while new pharmacologic and biospecific interventions are being developed. This chapter will discuss the clinical and biologic rationale for novel therapies for patients with RA and the hazards imposed by the therapeutic manipulation of various immune effector mechanisms in patients with RA.
11890658 Matrix metalloproteinase inhibitors in rheumatic diseases. 2001 Nov The rheumatic diseases continue to represent a significant healthcare burden in the 21st century. However, despite the best standard of care and recent therapeutic advances it is still not possible to consistently prevent the progressive joint destruction that leads to chronic disability. In rheumatoid arthritis and osteoarthritis this progressive cartilage and bone destruction is considered to be driven by an excess of the matrix metalloproteinase (MMP) enzymes. Consequently, a great number of potent small molecule MMP inhibitors have been examined. Several MMP inhibitors have entered clinical trials as a result of impressive data in animal models, although only one MMP inhibitor, Ro32-3555 (Trocade), a collagenase selective inhibitor, has been fully tested in the clinic, but it did not prevent progression of joint damage in patients with rheumatoid arthritis. The key stages and challenges associated with the development of an MMP inhibitor in the rheumatic diseases are presented below with particular reference to Trocade. It is concluded that the future success of MMP inhibitors necessitates a greater understanding of the joint destructive process and it is hoped that their development may be accompanied with clearer, more practical, outcome measures to test these drugs for, what remains, an unmet medical need.
10910610 A follow-up study of systemic-onset juvenile rheumatoid arthritis in children. 1999 May We analyzed the clinical and laboratory features, treatment, and course of twenty-one children with systemic-onset juvenile rheumatoid arthritis (S-JRA) encountered at our institution over the past ten years. There were eleven boys and ten girls. The mean age at onset was 11.6 +/- 4.2 years. The mean duration of symptoms prior to diagnosis was 5.5 +/- 1.7 months, and the mean follow-up period was 45.7 +/- 9.5 months. The clinical and laboratory features at presentation were similar to previous reports, except that peripheral blood smear revealed toxic granulation of neutrophils in 60% of our patients. Although systemic manifestation could be readily controlled by non-steroidal anti-inflammatory drugs (NSAIDs) with or without additional steroids, nine patients suffered from chronic arthritis (duration > 6 months) requiring disease-modifying anti-rheumatic drugs (DMARDs). Of the nine children with chronic arthritis, six (67%) had a monocylic systemic course, and seven (78%) had polyarticular disease (five or more joints affected) at the disease onset. Five patients developed severe destructive polyarthritis, with persistent anemia, thrombocytosis, elevated serum C-reactive protein (CRP) levels, and marked functional limitation during follow-up. One of the five patients with severe arthritis developed systemic lupus erythromatosis after 8-year follow-up, and died of sepsis. Our study indicated significant morbidity in children with S-JRA in Taiwan.
9330949 Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoi 1997 Oct OBJECTIVE: To determine the prevalence and outcome of chronic uveitis in patients with juvenile rheumatoid arthritis (JRA). METHODS: A retrospective analysis of 760 patients with JRA followed in 4 pediatric rheumatology centers. Patients with chronic uveitis were identified and their medical and ophthalmologic records were reviewed. RESULTS: Seventy-four patients with uveitis were identified. The prevalence of uveitis was 9.3%. The mean interval from the onset of JRA to the onset of uveitis was 21 months, and 90% of the patients who developed uveitis did so within the first 4 years of their disease. Visual complications (synechiae, band keratopathy, cataract, or glaucoma) developed in 31% of the patients with uveitis. Complications were more common in patients who presented with uveitis early in the course of their JRA. Complications were also more common in antinuclear antibody (ANA) negative than in ANA positive patients. Visual loss to 20/50 or worse occurred in only 11% of patients with uveitis, and no patient became blind. CONCLUSION: In a very large cohort of patients with JRA, uveitis was uncommon and poor visual outcome was rare. Visual complications did not necessarily result in a poor outcome.