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ID PMID Title PublicationDate abstract
9435404 [Hepatitis C virus infection and Sjögren's syndrome]. 1997 Mar Various immunologic and clinical abnormalities have been described in patients with chronic hepatitis C: mixed cryoglobulins, autoimmune thyroiditis, pulmonary fibrosis, polymyositis, and vasculitis. Moreover, laboratory immunologic changes have been reported in this type of infection, such as rheumatoid factor and antinuclear antibodies. The association of primary Sjögren's syndrome with hepatitis C virus infection has been suggested. We will discuss different clinical and laboratory aspects of this association.
9584362 Hallux metatarsophalangeal arthritis. 1998 Apr Arthritis of the hallux metatarsophalangeal joint is a common disorder that affects shoewear, ambulation, and other activities of daily living. Etiologies include degenerative arthritis (hallux rigidus), crystal induced arthropathy (gout, pseudogout), rheumatoid arthritis, the seronegative spondyloathropathies, posttraumatic degeneration, and advanced hallux valgus. Accurate diagnosis and selection of the appropriate intervention depends on recognition of pertinent clinical and radiographic features. This study presents a synopsis of the senior author's (LCS) experience with 439 surgically treated patients with hallux metatarsophalangeal arthritis, focusing on origin and treatment.
11327263 Anti-alpha-fodrin antibodies in Sjögren's syndrome in children. 2001 Apr OBJECTIVE: To investigate the prevalence of anti-alpha-fodrin antibody specific for adult Sjögren's syndrome (SS) in patients with juvenile onset SS. METHODS: Serum anti-alpha-fodrin antibody was examined in 15 patients with juvenile SS (11 cases of primary SS and 4 secondary SS) and in 16 children with systemic lupus erythematosus (SLE) by Western blot analysis using a recombinant 120 kDa alpha-fodrin fusion protein. RESULTS: All the 15 serum samples from patients with SS reacted with a recombinant alpha-fodrin fusion protein in Western blot analysis. In contrast, reactivity was found in only 2 of the 16 patients with SLE. The clinical features of the 15 patients with juvenile onset SS were very specific; only 4 patients complained of dryness, while 6 had abnormal excretion ability. Salivary gland enlargement was the most common clinical manifestation. Characteristic laboratory findings in juvenile onset SS included a higher prevalence of antinuclear antibodies, anti-SSA/Ro antibodies, and rheumatoid factor, as well as increased erythrocyte sedimentation rate and hypergammaglobulinemia. CONCLUSION: The pathogenesis of juvenile SS seems to be the same as that of adult SS, although subjective symptoms of dryness are less frequent in juvenile cases. This discrepancy may indicate that SS is a slowly progressive disease with a long time span. The anti-alpha-fodrin antibody is likely to be a reliable diagnostic marker for juvenile SS.
9852745 [Diagnosis for human parvovirus B19-polyarthritis: usefulness of empty particle B19.ELISA 1998 Oct OBJECTIVE: To evaluate the usefulness of new ELISA for human parvovirus B19 (B19) antibodies and PCR for the diagnosis of acute onset of B19 polyarthritis. METHODS: We evaluated the reproducibility and sensitivity on the detection of anti-B19 antibody by ELISA using recombinant VP-1 and VP-2 (empty particle), and then studied for the prevalence of IgM and IgG B19 antibody in 125 samples for anti-B19 tests. The random study on anti-B19 antibody assay as well as PCR for B19-DNA was also performed in 130 cases with acute onset of arthritis excluding those with known origins, 224 with rheumatoid arthritis and 149 with other categories. RESULTS: The results by using B19-empty particle ELISA were reproducible and showed the assay was a sensitive way for clinical use. IgM anti-B19 antibodies were positive not only in all samples from erythema infectiosum, but also often in those from hemolytic anemia, pure red cell aplasia, fetal hydrops, hepatic injury, fever of unknown origin. Among 130 with acute onset of arthritis, 21 showed positive tests for IgM anti-B19 antibody and/or B19 DNA. On the other hand, 4 among 224 patients with rheumatoid arthritis were positive for IgM anti-B19 antibody, but all of 149 in control group were negative for IgM anti-B19 antibodies and for B19 DNA. CONCLUSION AND DISCUSSION: Anti-B19 ELISA using B19-empty particle which has been introduced as a routine test system, is a useful tool for the diagnosis of acute onset of B19 arthritis. An additional examination using PCR for B19 DNA may contribute for understanding persistent B19 polyarthritis or reactivation of B19 infection.
9239145 [Systemic manifestations of primary Gougerot-Sjögren syndrome. Nature and incidence aprop 1997 Jun 21 OBJECTIVES: Assess the systemic manifestations observed in patients with primary Sjörgen's syndrome and the correlation between clinical findings and paraclinical data. METHODS: This retrospective study included patients who met the preliminary European criteria established in 1993. RESULTS: Among the 34 patients with primary Sjögren's syndrome (32 women, 2 men, mean age 54.9 years), systemic manifestations were observed as the inaugural sign in 25 (73.5%) and 31 cases (91%) during a mean 43-month follow-up. Clinical signs in 23 patients were: neuropsychiatric disorders including depressive syndromes (n = 17) and peripheral neuropathies (n = 13), joint and muscle disorders (n = 16), Raynaud's phenomenon (n = 8), pulmonary disorders (n = 8), digestive disorders (n = 8) including two cases of chronic autoimmune hepatitis, skin disease (n = 7), and renal (n = 3) and thyroid (n = 8) disorders. Antinuclear antibodies were found in 20 cases and anti-SSA antibodies in 5 associated with anti-SSB in 4. Eight patients had hematologic disorders. There was a correlation between the number of systemic signs (at least 2) and positive Rose-Bengal test (p = 0.045). DISCUSSION: Different systemic manifestations were found at percentages comparable with data in the literature except for Raynaud's syndrome which was less frequent and neurological disorders which were more frequent.
11317926 [Stevens-Johnson syndrome followed by Gougerot-Sjögren syndrome]. 2001 Mar 24 BACKGROUND: Sicca syndrome after Stevens-Johnson syndrome is classically described. However, to our knowledge, authentic Sjögren's syndrome following epidermal necrolysis has not been described previously. CASE REPORT: A 36-year-old woman with Steven-Johnson syndrome developed transient hepatitis and a persistent sicca syndrome. Fourteen years later an authentic Sjögren's syndrome was identified with presence of antinuclear and anti-SSA antibodies and lymphocytes infiltration of the accessory salivary glands, i.e. grade IV disease in the Chisholm classification. DISCUSSION: The initial mucosal destruction observed in our patients may have laid the ground for Sjögren's syndrome via abnormal antigen presentation in a predisposed dysimmune context.
10841426 Neural network based algorithm to quantify joint space width in joints of the hand for art 2000 May Arthritis diseases are widespread with enormous societal costs. The two most common forms, rheumatoid arthritis and osteoarthritis, affect joints of the hand and cause narrowing of the joint spaces as the disease destroys the articular cartilage. Radiographic assessment is one of the most promising tools to detect subtle changes in joint space width (JSW), and therefore disease progression. Currently radiographic assessment of arthritis in joints of the hand is accomplished though semiquantitative subjective scoring systems which do not provide a quantitative measurement of the JSW. We describe here an automated method which calculates the average JSW of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joint spaces for fingers 2 to 5 (index, middle, ring, and little) on digitized hand radiographs. The method was tested with a set of 54 hand radiographs on joints with mild to moderate rheumatoid arthritis. Performance was evaluated by comparing algorithm measured JSW to a gold standard determined from expertly hand-drawn joint margins. The agreement was quantified by a measurement of root mean square deviation, 0.148 mm, 0.089 mm, and 0.114 mm for the MCP, PIP, and DIP joints, respectively. In addition, the algorithm measured JSW strongly correlated with the gold standard: R2=0.80 (MCP), R2= 0.82 (PIP), and R2= 0.84 (DIP). This is an accurate and robust algorithm and should provide a more quantitative measure of disease progression than current methods.
9676775 The relationship between strength and function in females with juvenile rheumatoid arthrit 1998 Jul OBJECTIVE: To describe the relationship between isokinetic concentric and eccentric quadriceps strength and function in females with juvenile rheumatoid arthritis (JRA). METHODS: Twenty girls with JRA aged 6 to 16 years participated in the study. Function and strength were measured on one occasion. Isokinetic concentric and eccentric quadriceps torque was measured on the Kin-Com dynamometer. Function was measured with the Childhood Health Assessment Questionnaire (CHAQ) and the Canada Fitness Award 50 m run. Pain and joint count were taken as measures of disease activity. Pain was assessed on a visual analog scale through parent- and self-report. Correlations between function, standardized torque values, pain, and joint count were determined. Stepwise multiple regression analyses with function as the predicted variable were performed. RESULTS: Correlations between standardized torque and CHAQ scores were moderate (r = -0.48, p = 0.03 for concentric torque and r = -0.43, p = 0.06 for eccentric). Correlations between torque and run scores were also moderate (r = -0.48, p = 0.03 for concentric, r = -0.31, p = 0.19 for eccentric). Pain and total joint count were the best predictors of CHAQ score (r2 = 0.80), while concentric torque was the best predictor of running ability (r2 = 0.23). CONCLUSION: Quadriceps torque was moderately correlated to function in girls with JRA. Function as determined on the CHAQ was best predicted from measures of disease activity, while function as determined on the 50 m run was best predicted from concentric quadriceps torque. Further research is required to determine a cause-effect relationship between strength and function in girls with JRA.
9229174 Clinical and therapeutic aspects of juvenile-onset spondyloarthropathies. 1997 Jul Relatively little is written about the juvenile spondyloarthropathies. The literature of the past year has included data on the frequency of juvenile spondyloarthropathies, which indicate that these are almost certainly a more common form of childhood arthropathy than formerly believed. Although clinical differences exist between juvenile spondyloarthropathies and juvenile rheumatoid arthritis, there is only limited information about differences in the pathophysiology of these diseases. One study suggests some differences in the expression of tumor necrosis factor and its receptors. Evidence also presented this year suggests that juvenile psoriatic arthritis is probably a separate condition from the spondyloarthropathies. It is hoped that better understanding of the epidemiology and pathophysiology of the juvenile spondyloarthropathies will lead to better treatment strategies.
11247732 Adult Still's disease associated with Mycoplasma pneumoniae infection. 2001 Mar 15 Adult Still's disease (ASD) is a systemic inflammatory disorder of unknown origin. Several reports have suggested a triggering infection in ASD. We describe a case of ASD associated with acute Mycoplasma pneumoniae infection. The close temporal relationship between ASD and acute infection strongly suggests that M. pneumoniae triggered ASD. We suggest that M. pneumoniae should be added to the list of infectious agents that may play a role in its etiology.
11530896 A comparison of individual and family psychology of adolescents with chronic fatigue syndr 2001 Aug Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1l) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction.
11490413 [Effectiveness and side-effects of long-term treatment with glucocorticoids in patients wi 2001 The authors studied the response to and side effects of long-term glucocorticoid (GC) therapy of systemic juvenile rheumatoid arthritis (SJRA). GC were given to 24 girls and 9 boys at the age of 4 to 15 years with classic SJRA in a mean dose 1.6 +/- 0.13 mg/kg (24.0 +/- 0.55 mg/day) for 6.3 +/- 0.55 years, on the average. Mean duration of the disease was 7.1 +/- 0.55 years. 94% of the patients had lymphaticohypolastic constitution. Long-term GC monotherapy in a dose 0.2-0.5 mg/kg/day failed to control a SJRA course and to produce an immunosuppressive effect while side effects were severe: inhibition of activity of the hypothalamohypophysioadrenal system and resultant hormone dependence (100%), Cushing's syndrome (97%), nanism (85%), osteoporosis (64%), secondary infections (58%), aseptic necrosis of heads of the femur (52%). Oral GC treatment is not effective as first-line therapy of SJRA. It should be used as adjuvant to immunodepressants. Intraarticular and/or intravenous administration is preferable.
10968478 Efficacy of recombinant human growth hormone in children with juvenile rheumatoid arthriti 2000 Jul Ten patients with juvenile rheumatoid arthritis (JRA) and growth failure were treated with recombinant human growth hormone (GH) for 1 to 3 years at a dosage of 0.57 IU/kg/wk. All the patients had been on prednisone at a mean dosage of 4.12 mg p.o. daily. GH was low in one patient, two patients had a borderline level and seven patients had adequate response to provocative tests or post-sleep measurement. Serum IGF-I was found to be low in five of six patients. Mean growth velocity increased from 2.45 cm/yr to 4.79 cm/yr after 1 year's treatment with GH (P<0.004). Six patients continued on GH treatment for a second year and continued to have a better growth velocity, with a mean of 5.43 cm/yr (P<0.014). Two patients entered puberty during the second year of GH treatment. This study demonstrates the potential beneficial effect of GH treatment in patients with JRA with growth failure of systemic onset or polyarticular onset who are on prednisone. Further study is needed to determine the long-term effect of GH treatment on ultimate height.
10332988 Seasonal variation in systemic onset juvenile rheumatoid arthritis in Israel. 1999 May OBJECTIVE: To determine whether there is a seasonal peak onset of systemic juvenile rheumatoid arthritis (SOJRA) suggestive of an infectious etiology. We examined the seasonal variability of SOJRA in Israel. METHODS: A multicenter retrospective chart review of 59 patients with SOJRA, enrolled from 10 rheumatology units or pediatric departments in Israel. All patients met defined criteria of SOJRA. RESULTS: Fifty-nine patients (31 female, 28 male) were followed from 1982 to 1997. Their mean age was 7.1 +/- 4.3 years (range 0.9-16). Forty-six were Jewish and 13 were Arabs or of Bedouin origin. Eighteen patients (31%) had disease onset in the winter, 16 (27%) in the spring, 12 (20%) in the summer, and 13 (22%) in the fall. Twenty-eight patients had a monophasic disease subtype, while 31 had a chronic or cyclic subtype. The seasonal onset in the patients with the monophasic type versus the chronic or the cyclic type shows 7 versus 11 in the winter, 7 versus 9 in spring, 8 versus 4 in summer, and 6 versus 7 in fall, respectively. CONCLUSION: There is no seasonal pattern to SOJRA disease onset in Israel. However, the disease onset of patients having the chronic or the polycyclic subtype tends to be more common in winter and spring. Since patients with this type have more severe disease, it is possible that another specific infectious agent is one of the factors involved in the pathogenesis of the disease. Larger sampling and multicenter studies are required to clarify this point.
11493848 Fibrocartilage in the transverse ligament of the human atlas. 2001 Aug 15 STUDY DESIGN: Immunohistochemical investigation. OBJECTIVE: To determine whether molecules typical of articular cartilage are present in the transverse ligament and whether the ligament may be a target for an autoimmune response in rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: In chronic rheumatoid arthritis there is often a marked instability of the atlantoaxial complex, and the transverse ligament can show degenerative changes that compromise its mechanical function. In some rheumatoid patients there can be an autoimmune response to cartilage link protein, aggrecan, and Type II collagen. METHODS: Transverse ligaments were removed from 13 cadavers and fixed in 90% methanol. Cryosections were immunolabeled with antibodies against proteoglycans (aggrecan, link protein, and versican), glycosaminoglycans (chondroitin-4-sulfate, chondroitin-6-sulfate, dermatan sulfate, and keratan sulfate), and collagens (Types I, II, III, and VI). RESULTS: Labeling for aggrecan and link protein was characteristic of the fibrocartilages, but versican was only detected in the fibrous regions. Equally, Types I, III, and VI collagens and keratan, dermatan, and chondroitin-4-sulfates were found throughout the ligament, but labeling for Type II collagen and chondroitin-6-sulfate was restricted to the fibrocartilages. CONCLUSION: The presence of molecules typical of articular cartilage (aggrecan, link protein, and Type II collagen) in the transverse ligament explains why it can be a target for destruction in rheumatoid arthritis and also suggests that it is subject to constant compression against the dens rather than only at the extremes of movement.
9613355 Mannan binding lectin deficiency and concomitant immunodefects. 1998 Mar OBJECTIVE: To determine the prevalence of a mannan binding lectin (MBL) deficiency in children with increased susceptibility to infections and to investigate whether other coexisting immunodeficiencies affecting opsonisation are needed to render MBL deficiency clinically significant. PATIENTS AND METHODS: 343 serum samples were collected from 266 children with repeated infections, a single episode of severe infection, or prolonged symptoms relating to infection. The concentrations of MBL, immunoglobulin G (IgG), M (IgM), A (IgA), and IgG subclasses (IgG1-4) were analysed. RESULTS: MBL deficiency was found in nine children (3.2%), seven of whom had repeated infections or a single episode of severe infection. In two, initial symptoms and signs suggestive of infection eventually led to the diagnosis of an autoimmune disease--Still's disease in one and pauciarticular juvenile rheumatoid arthritis in the other. Among the children with MBL deficiency and infections, concomitant IgG subclass deficiency was detected in five and a transient low level of one or two IgG subclasses in two. Prevalence of an IgG subclass deficiency in children with MBL deficiency was higher than in those without (56% and 22%, respectively). CONCLUSIONS: MBL deficiency alone is not an independent risk factor for infection but may be manifested in association with another humoral immunodeficiency affecting opsonisation. Among children with MBL deficiency, those with juvenile rheumatoid arthritis were overrepresented. This calls for further study.
9292810 Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid art 1997 Sep OBJECTIVE: To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA). METHODS: Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated. RESULTS: Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiography, after a period ranging from 21 to 39 months. CONCLUSION: Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA.
8989369 Delayed repair of DNA damage by ionizing radiation in cells from patients with juvenile sy 1997 Jan We used a single-cell alkaline gel electrophoresis (SCAGE) assay to study repair of primarily single-stranded DNA breaks after in vitro exposure to ionizing radiation in cells from children with systemic lupus erythematosus (SLE), juvenile rheumatoid arthritis (JRA), systemic sclerosis (SSc) and dermatomyositis. Peripheral blood lymphocytes from patients with SLE, JRA and SSc had significantly greater DNA damage after irradiation with 1.5 Gy and 30 min incubation (i.e. repair time) than did those from controls, as assessed by the length of the migrating DNA comet. The mean comet tail lengths were: SLE, 42 microns; JRA, 40 microns; and SSc, 36 microns. Each of these was significantly different from controls, which had a mean comet tail length of 18 microns (P < 0.001, < 0.001 and < 0.05, respectively). Cells from patients with dermatomyositis had an average comet tail length of 22 microns and were not significantly different from controls. Understanding the etiology of the delay in DNA repair in these diseases may provide insight into disease pathogenesis.
11555734 Bacterial arthritis. 2001 Jul The septic arthritis literature of 2000 revisited several topics previously examined in some detail. These include septic arthritis in rheumatoid arthritis, rheumatic manifestations of bacterial endocarditis, and infectious complications of prosthetic joints. The trend in antibiotic prophylaxis to prevent late infections in total joint replacement is to narrow the targeted hosts to those most at risk, to define the procedures associated with the greatest risk of bacteremia, and to simplify the antibiotic regimen. The diagnoses of septic arthritis of the lumbar facet joint and septic arthritis caused by direct inoculation of bacteria by a foreign object penetrating the joint are facilitated by noninvasive imaging technologies. Septic arthritis caused by uncommon microorganisms and septic arthritis in immunocompromised hosts are other noteworthy topics in this year's literature.
12861359 Leflunomide: efficacy and safety in clinical trials for the treatment of rheumatoid arthri 2000 Jun Leflunomide is a new disease modifying antirheumatic drug (DMARD) that inhibits lymphocyte proliferation by blocking dihydroorotate dehydrogenase (DHODH), the enzyme critical for the production of pyrimidine necessary for DNA synthesis. Through this mode of action, leflunomide inhibits the lymphocyte proliferation associated with the clonal expansion of T cells in rheumatoid arthritis (RA). In clinical trials, leflunomide was superior to placebo and comparable to sulfasalazine and methotrexate for improving both the signs and symptoms of RA. Leflunomide was also superior to placebo and sulfasalazine and comparable to methotrexate in overall improvement of physical function. Leflunomide was equivalent to methotrexate and sulfasalazine in retarding disease progression measured radiographically. Due to its unique mode of action in the treatment of RA, leflunomide shows value in combination therapy with methotrexate for patients refractory to methotrexate alone. The most common adverse reactions associated with leflunomide therapy include gastrointestinal symptoms, allergic reactions, reversible alopecia and elevated liver enzymes. Adverse events were generally mild to moderate, and resolved without complication. The results of phase II and phase III clinical trials indicate that leflunomide is a safe and efficacious drug for the treatment of RA.