Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
11081000 Family-level coping in juvenile rheumatoid arthritis: assessing the utility of a quantitat 1999 Oct OBJECTIVE: To explore the viability of a quantitative family interview to describe family-level coping strategies used to deal with juvenile rheumatoid arthritis (JRA)-related stressors for early and late adolescents. METHOD: A structured interview protocol with 30 adolescents with JRA and family members assessed ways JRA disrupts or changes family functioning. Emotional reactions, sequential phases of family response, and treatment adherence were discussed. Interviews were coded for family-level coping. To assess adjustment, family members completed the Youth Self Report and the Family Environment Scale. The pediatric rheumatologist provided medical information. RESULTS: The family interview produced both quantitative and qualitative data. Families reported multiple JRA-related stressors (mean 6.6). For many adolescents, treatment adherence was problematic. Families used all 3 types of coping strategies (appraisal-, problem-, and emotion-focused) to varying degrees. Problem-focused approaches were most commonly used and included seeking support (used by 73% of families), self-reliance (70%), and family coordination (70%) for dealing with specific problems, and seeking information about JRA (67%). Emotion-focused approaches, such as impulsive outbursts and diminished awareness of others' feelings, were associated with problematic adjustment. Few differences were found between the families of early and late adolescents. CONCLUSION: The quantitative family interview has the potential to be a useful tool in documenting JRA-related stressors, family-level coping processes, and how family-level coping is associated with treatment adherence and psychosocial adjustment.
9489836 Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthr 1998 Feb OBJECTIVE: To describe outcome and determine predictive factors in juvenile rheumatoid arthritis (JRA) and juvenile spondyloarthopathy (JSpA). METHODS: Seventy-two children with chronic arthritis were studied on first admission to the pediatric rheumatology clinic and after a mean of 9.7 +/- 1.8 yrs of disease duration. RESULTS: At followup, 53 patients had JRA and 19 had JSpA. Eleven (21%) of the patients with JRA did not meet the criteria for JRA on first admission, and 12 (22%) of 54 children diagnosed as having JRA on first admission were later reclassified as having another disease. Remission occurred in 43 (60%) of the 72 patients with JRA and JSpA. Forty-four patients (60%) reported no disability by the childhood or adult Health Assessment Questionnaire and 18 patients (25%) had developed joint erosions. Disease modifying antirheumatic drugs (DMARD) were given to 49 patients (68%) after a median of 0.8 yrs (range 0.2-10.8) disease duration. The patients who developed erosions and disability tended to have started treatment later than those who did not (NS). Active disease 5 years after onset was a predictor of disability in JRA and JSpA (OR 4.5, 95% CI 1.6-12.5). Predictors of joint erosions were long duration of elevated erythrocyte sedimentation rate (ESR) (OR 3.7/yr of elevated ESR, 95% CI 1.9-7.2), long disease duration before first admission (OR 1.5/yr of duration, 95% CI 1.1-2.1), long disease duration before treatment with DMARD (OR 1.8, 95% CI 1.0-3.3), and IgM rheumatoid factor (OR 12 x 10(4), 95% CI 0-1.2 x 10[52]). CONCLUSION: The longterm outcome in JRA and JSpA was more favorable than previously reported. This may be explained by less selection in favor of severely diseased patients and by the use of early aggressive treatment regimes.
10599346 Incidence of antiperinuclear factor in patients with psoriatic arthritis. 1999 Antiperinuclear factor (APF) is considered a disease marker of rheumatoid arthritis (RA) and its diagnostic value is obvious in patients who are seronegative for rheumatoid factor (RF) activity. We have evaluated APF positivites in 76 patients with psoriatic arthritis, 38 uncomplicated psoriatic patients, 119 patients with non-inflammatory rheumatic diseases (NIRD), 36 RF- and 123 RF + RA patients and 204 healthy controls. APFs were investigated with an indirect immunofluorescence (IIF) test using epithelial cells from human buccal mucosa as a substrate. 6/76 (7.9%) PA patients were APF+. The incidence was greater than in healthy controls (2/204; p < 0.01) and similar to the incidences in patients with uncomplicated psoriasis (1/38; p = NS) and patients with non-inflammatory rheumatic disease NIRD (5/119; p = NS). However, the incidence was much lower than in RF- (19/36; p < 0.001) as well as RF+ (111/123; p < 0.001) RA patients. Finally, we emphasise that 3 out of 6 APF positivities shown by PA patients were found in our 3 patients with pustolotic arthroosteitis, a new specific entity in the spectrum of PA.
9890094 Juvenile arthritis: genetic update. 1998 May Juvenile arthritis (JA) is a term that covers a number of different disease entities, of which only three present with significant Human Leukocyte Antigen (HLA) associations. (1) Pauciarticular JA with late onset and a strong male proponderance is associated with HLA-B27 and represents the group of juvenile spondyloarthropathies related to adult ankylosing spondylitis. (2) Early onset pauciarticular JA with a preponderance of females and a frequent occurance of chronic iridocyclitis and the frequent presence of anti-nuclear antibodies is associated with alleles from three different regions of the HLA system: HLA-A2, which shows a very strong correlation with early age of onset; DR8, DR11 and DR12 as well as DQA1*0401, *0501, *0601 and finally DPB1*0201. These alleles show no linkage disequilibrium in the control population. (3) Rheumatoid factor positive polyarticular JA is associated, as is adult rheumatoid arthritis, with DR4. Concerning the possible mechanisms of the immunopathogenesis, it is speculated that the normal function of HLA molecules, namely the presentation of antigenic peptides, plays a major role. Data collected on HLA associations in early onset pauciarticular JA have been interpreted as indicating that alleles of the DQA1 locus (*0401, *0501, *0601) are probably responsible for presenting the hypothetical arthritogenic peptides. It is speculated that the pathogenic process includes the presentation of HLA-A2 or HLA-DPB1*0201 derived peptides presented by DQ molecules. It is clearly stated that typing for HLA alleles has very little or no importance for clinical diagnosis and prognosis.
24383689 Long-term use of mizoribine in rheumatoid arthritis patients on hemodialysis. 2001 Jun Abstract Small doses of mizoribine (MZR) were administered to five rheumatoid arthritis (RA) patients on hemodialysis (HD). A maintenance dose of 25 mg or less was administered either once per day or once following HD. The Lansbury activity index improved in all patients. The blood concentrations of MZR before and after HD were 0.33-1.79 μg/ml and 0-0.93 μg/ml, respectively. Hence, the rate of elimination by HD ranged from 50.3% to 83.4%. As far as side effects were concerned, alopecia was seen in two patients, and one patient developed shingles. However, the severity of these symptoms was mild and, after discontinuing or reducing the dose of MZR for a certain period of time, we were able to continue its administration. These findings suggest that the long-term administration of MZR is a useful treatment for RA patients on HD.
18031088 [Not Available]. 1997 Feb Rimexolone is a locally active nonfluorinated glucocorticoid which has minimal systemic effects and is virtually devoid of any atrophogenic effects on the skin.It has high corticosteroid receptor affinity and remains localised at the injection site for a prolonged period after intra-articular injection. Thus, serum rimexolone concentrations remain low.Rimexolone had the longest mean intra-articular residence time of several intra-articular steroid preparations (25 days, vs 6 days for triamcinolone hexacetonide and 1 to 4 days for the other drugs, which included methylprednisolone acetate).Single intra-articular injections of rimexolone provided long-lasting improvement of clinical efficacy parameters in patients with rheumatoid arthritis or osteoarthritis.In patients with rheumatoid arthritis, rimexolone was superior to placebo for treating knee joints and superior to placebo and similar to methylprednisolone acetate for treating small joints of the hand.In patients with osteoarthritis of the knee joint, rimexolone was superior to placebo, tended to be slightly more effective than methylprednisolone acetate and was similar to triamcinolone acetonide or a depot preparation of betamethasone dipropionate.
19078424 The foot pad in rheumatoid arthritis measurement and possible effects on foot disability. 1999 Dec The human foot pad is essential in buffering stress and strain during ambulation. Foot pad atrophy has been associated with foot pain, limping gait, callous formation, and foot ulcers. We report a method to measure foot pad thickness and have investigated its measurement reliability. Two podiatrists independently and bilaterally measured fore and rear foot pads on lateral view radiographs of weight bearing for 78 patients with rheumatoid arthritis. The intrarater coefficient on the fore and rear foot pads was 0.90 or higher, whereas the interrater reliability ranged from 0.73 to 0.92. These results suggest foot pad measurement is simple, practical, and reproducible for measuring foot pad atrophy. This measurement will help identify patients at risk for foot pain and/or ulceration so that appropriate orthotics and soft tissue supplements may be recommended.
11862767 [Peripheral septic arthritis in adults. Epidemiologic study in a Galician health area]. 2001 Nov BACKGROUND: Both, clinical and biologic manifestations of septic arthritis are long been know, but few studies of its epidemiological aspects are well-documented. Literature concerning epidemiological aspects of septic arthritis remains exceptional in Galician Autonomic Community. OBJECTIVE: The aim of this investigation was to study the etiopathogenesis and epidemiological characteristic of septic arthritis in the adult population from hospital county of Servicio Galego de Saúde (SERGAS). MATERIAL AND METHODS: We conducted a retrospective study of all peripheral septic arthritis registered between 1 January 1995 and 31 December 2000 on adult population of our health district of SERGAS (127.000 inhabitants). The location, etiology, pathogenesis and epidemiological characteristics were obtained from medical records. RESULTS: The case records of 45 patients with 46 septic arthritis (37 native joints and 9 prosthetic joints) were registered. The mean age was 57 years and 24 patients were male. During the study period, the incidence of bacterial arthritis suffered a progressive reduction to 10.2/105 inhabitants (1995) up to 3.1/10(5) (2000) with a median of 7.2/10(5). Ten patients (22%), eight male and two women, had a post-traumatic septic arthritis. Major risk factors were diabetes mellitus (5 patients), rheumatoid arthritis (5 patients) and intravenous drug abuse (3 patients). Staphylococcus aureus was the principal causative agent (28 patients, 62%) and the knee was the most commonly affected joint (41%), followed by the hip (15%) and ankle (15%). CONCLUSIONS: During the past six years, the incidence of adult peripheral septic arthritis in our SERGAS health district has been gradually reduced. Trauma was a important factor in the development of septic arthritis through direct inoculation or through spread from adjacent infectious focus. The major systemic factors predisposing to joint infection were rheumatoid arthritis and diabetes mellitus. In both, native and prosthetic joints, Staphylococcus aureus was the most common isolated pathogen.
18031112 Techniques for health status measurement in the management of rheumatoid arthritis. 1999 Jan Measuring health status in rheumatoid arthritis is complex, and there are a number of methods available. These range from observed measures of function to broader measures of general health status or quality of life which can be assessed by questionnaires which are completed by the patient or administered by a trained interviewer. The choice of measure depends on the purpose of measurement and the context in which the measurement is being made. Many of the measures available (for example, the SF-36) were developed for use in research and have not been adopted for widespread clinical use. There are, however, some measures, such as the disease repercussion profile, which were developed specifically as clinical tools, or which lend themselves to clinical use by virtue of their ease of completion and their clinical meaningfulness. The choice of method will depend on the purpose of measurement, the question being asked and the instrument the investigator feels most comfortable with.
24383782 Total knee arthroplasty in a patient with rheumatoid arthritis and spontaneous fusion of t 2001 Dec Abstract Bilateral total knee arthroplasty for a painful stiff knee was performed in a 50-year-old woman with rheumatoid arthritis who had spontaneous fusion of the right hip. Despite several manipulations, the range of motion of the right knee worsened. After total hip arthroplasty and ipsilateral knee revision, the right knee had a stable range motion of -15° to 75°. This case suggests that even if the ankylosed hip is in a good position, ipsilateral knee arthroplasty with a fused hip may result in a poorer range of motion than that after total hip arthroplasty.
11564378 Inflammatory conditions of the eye associated with rheumatic diseases. 2001 Oct Ocular inflammation occurs in many patients with systemic rheumatic disease. The best examples are rheumatoid arthritis, juvenile rheumatoid arthritis, temporal arteritis, systemic lupus erythematosus, Wegener's granulomatosis, polyarteritis nodosa, relapsing polychondritis, and Adamantiades-Behçet's disease. Ocular inflammation may precede the symptoms of the systemic disease and can be helpful in systemic diagnosis. After diagnosis, ocular inflammation can mark the severity of the systemic condition. Thus, prompt diagnosis and treatment of inflammatory conditions of the eye are warranted and may be sight- and life-saving.
24383694 Guillain-Barré syndrome accompanied by central nervous system lupus in a patient with juv 2001 Jun Abstract We describe a 17-year-old female with juvenile rheumatoid arthritis accompanied by Guillain-Barré syndrome (GBS) during the course of central nervous system (CNS) lupus. She initially developed CNS lupus, including headache and convulsion. A high-signal area in a magnetic resonance scan of her brain with T2-weighted images was noted, and her cerebrospinal fluid exhibited increased levels of IgG and interleukin-6. Eighteen days after the onset of CNS lupus, polyneuropathy in the lower extremities developed, and a diagnosis of GBS was made. No obvious preceding infections in the upper respiratory or gastrointestinal systems were noted before the onset of GBS, indicating that GBS might be part of the symptoms of CNS lupus.
10725071 Evidence for activation of the alternate complement pathway in patients with juvenile rheu 2000 Feb OBJECTIVE: Complement activation has been shown to occur in patients with juvenile rheumatoid arthritis (JRA). Since the two pathways of complement are activated by different stimuli (the alternate pathway by microbial products and IgA, and the classical pathway by immune complexes), we decided to study the relative contribution of the two pathways of complement activation in patients with JRA. METHODS: In 56 patients with JRA, plasma levels of C3 and C4 were measured by turbidimetric assays, and those of C4d, factor Bb and sC5-9 complex by solid-phase enzyme immunoassays. Levels beyond the mean +/- 2 S.D. of normal were considered abnormal. RESULTS: Plasma C3 and C4 levels were decreased in one patient each. The C4d values were increased in 17 patients, whereas levels of factor Bb were elevated in 42 patients and levels of sC5-9 complex were elevated in 51 patients. The values of factor Bb and sC5-9 had a linear correlation (r = 0.75), but there was no significant correlation between C4d and sC5-9 levels (r = 0.36). CONCLUSION: Complement activation in JRA is initiated predominantly by the alternate pathway and culminates in the formation of terminal membrane attack complex.
9832043 Juvenile rheumatoid arthritis and del(22q11) syndrome: a non-random association. 1998 Nov Del(22q11) is a common microdeletion syndrome with an extremely variable phenotype. Besides classical manifestations, such as velocardiofacial (Shprintzen) or DiGeorge syndromes, del(22q11) syndrome may be associated with unusual but probably causally related anomalies that expand its phenotype and complicate its recognition. We report here three children with the deletion and a chronic, erosive polyarthritis resembling idiopathic cases of juvenile rheumatoid arthritis (JRA). Patient 1, born in 1983, initially presented with developmental delay, facial dysmorphism, velopharyngeal insufficiency, and severe gastro-oesophageal reflux requiring G tube feeding. From the age of 3 years, he developed JRA, which resulted in severe restrictive joint disease, osteopenia, and platyspondyly. Patient 2, born in 1976, had tetralogy of Fallot and peripheral pulmonary artery stenosis. She developed slowly, had mild dysmorphic facial features, an abnormal voice, and borderline intelligence. JRA was diagnosed at the age of 5 years. The disorder followed a subacute course, with relatively mild inflammatory phenomena, but an extremely severe skeletal involvement with major osteopenia, restrictive joint disease (bilateral hip replacement), and almost complete osteolysis of the carpal and tarsal bones with phalangeal synostoses, leading to major motor impairment and confinement to a wheelchair. Patient 3, born in 1990, has VSD, right embryo-toxon, bifid uvula, and facial dysmorphism. She developed JRA at the age of 1 year. She is not mentally retarded but has major speech delay secondary to congenital deafness inherited from her mother. In the three patients, a del(22q11) was shown by FISH analysis. These observations, and five other recently published cases, indicate that a JRA-like syndrome is a component of the del(22q11) spectrum. The deletion may be overlooked in those children with severe, chronic inflammatory disorder.
9150089 Immunity to cartilage link protein in patients with juvenile rheumatoid arthritis. 1997 May OBJECTIVE: To determine whether children with juvenile rheumatoid arthritis (JRA) express cellular immunity to cartilage link protein. METHODS: Link protein was purified from human fetal epiphyseal and bovine adult nasal cartilage. It was used in proliferation assays with the peripheral blood lymphocytes isolated from 54 children with JRA and 22 nonarthritic controls. RESULTS: Patients with JRA expressed a significantly higher prevalence of cellular proliferation to human link protein compared with the control group, independent of whether they had pauciarticular, polyarticular, or systemic disease. In the case of bovine link protein, significant differences were only noted for the polyarticular group. There was significant correlation between the immunity to bovine and to human link proteins. Furthermore, immune responses to both molecules correlated with measures of joint disease activity. CONCLUSION: These results suggest that immunity to link protein may play a role in the pathogenesis of JRA.
19078490 Odontoid erosions in rheumatoid arthritis: utility of the open mouth view. 2000 Dec To determine if odontoid erosions are a marker for more severe cervical spine disease in rheumatoid arthritis (RA), 25 patients with RA were enrolled and had radiographs of the cervical spine including lateral and open mouth odontoid (OMO) views. The presence of odontoid erosions and of anterior atlantoaxial subluxation (AAS) was noted. Lateral cervical spine views were available for 19 patients, 11 of whom demonstrated odontoid erosions. Seven of 22 patients who had OMO views available demonstrated odontoid erosions. In only 3 of the 15 patients could odontoid erosions be seen on both views. Anterior AAS was present in 6 of 25 patients, 5 of whom had odontoid erosions. Anterior AAS was seen more commonly in patients with odontoid erosions. We propose that if erosions are present, patients should be more closely monitored for AAS and neurologic signs. OMO views are not as sensitive but are complementary to lateral cervical spine views in the detection of odontoid erosions.
9751476 Arteriovenous malformation of knee masquerading as juvenile arthritis. 1998 This is a rare case of involvement of knee joint by an arteriovenous malformation. A nine year old girl had recurrent monoarticular pain and swelling of long duration and had been treated as juvenile rheumatoid arthritis. Angiographic and histological features suggested an arteriovenous malformation of lower thigh with knee joint involvement.
22013008 Predicting pain and adjustment in rheumatoid arthritis: the role of life stress and emotio 1997 Apr The role of disclosure and emotional processing of stressful life events has not been studied in chronically ill populations. We attempted to predict the pain, physical dysfunction, and affective disturbance of 82 patients with rheumatoid arthritis (RA) from their life stress and from various measures of emotional processing: disclosure to others and thought frequency about stressful events, positive and negative emotional expression, ambivalence about emotional expression and secrecy. After controlling for demographics (gender, race, education, disability status), disease measures (duration of diagnosis, objective disease activity), and life stress, we found that pain was related to an increased expression of negative emotion; physical dysfunction was related to an increased frequency of thinking about stressful events; and affective disturbance was related to both increased ambivalence about emotional expression and increased thought frequency. We conclude that RA pain and adjustment are better predicted by emotional processing of stressful life events-including disclosure to others and emotional expression-than by the experience of stressful events, per se.
10891835 Neonatal onset of rash in Still's disease. 2000 Jul We report a neonate with a rash that appeared on the second day of life in association with elevated body temperatures and increased C-reactive protein levels. The rash was evanescent and recurred on a daily basis during the first year of life. At 15 months, the infant developed swelling of the right knee joint. Early-onset systemic juvenile rheumatoid arthritis can mimic congenital infections and should be considered in the differential diagnosis of neonatal exanthemas.
9588729 Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the Uni 1998 May OBJECTIVE: To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain). METHODS: The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020. RESULTS: Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form of arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected. CONCLUSION: Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.