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ID PMID Title PublicationDate abstract
12750765 The role of chemokines and adhesion molecules in the pathogenesis of rheumatoid arthritis. 2001 Jul Rheumatoid arthritis (RA) is characterized by marked infiltration of the synovium by T-cells. The mediator of joint inflammation has been shown to be both cellular and soluble and the concept of cross-talk between adhesion molecules and cytokines, and its relevance to inflammation, is emerging. The expression and function of adhesion molecules are tightly regulated via intracellular signaling induced by cytokine or chemokine stimulation, a process which is designated "inside-to-out signaling". Such regulation is particularly important in inflammatory processes in which T-cells migrate from the circulation into the tissue. Adhesion molecules not only function as glue, but also transduce extracellular information into cytoplasmic organelles via the "outside-to-in signal", resulting in cell activation and cytokine production. For instance, the abundant intracellular adhesion molecule ICAM-1 and CD44 on RA synoviocytes not only potentially facilitate the interaction with T-cells or extracellular matrix, but also induce cytokine gene transcription in synovial cells. Thus, the two-directional cross-talk among adhesion molecules and cytokines appears to be significant for the initiation and prolongation of inflammatory processes through T-cell migration into RA synovial tissues and activation of both T-cells and synovial cells in this region. The concept proposed would greatly help in clarifying the pathological processes in rheumatoid synovitis, as well as in discovering new pharmacological approaches to more specifically control synovial inflammation. (c) 2001 Prous Science. All rights reserved.
9506577 Comparative sequence analysis of the human T cell receptor beta chain in juvenile rheumato 1998 Mar OBJECTIVE: To identify features of the T cell receptors (TCRs) present on clonally expanded T cells in the joints of patients with similar types of childhood rheumatic disease. Vbeta8 and Vbeta20 TCRs were selected as prototypic for polyarticular juvenile rheumatoid arthritis (JRA) and pauciarticular/juvenile spondylarthropathy (SpA), respectively. METHODS: The portion of the TCR beta chain involved in antigen recognition in the synovial tissue, synovial fluid, and peripheral blood from patients with JRA and juvenile SpA was cloned and sequenced. The frequency of expanded clonotypes, size of expansions, the Jbeta region, and sequence motifs were determined for >2,000 sequences. RESULTS: The majority of Vbeta20 and Vbeta8 clonal expansions were found in the joint rather than the peripheral blood. While instances of both Vbeta8 and Vbeta20 clonal expansion were detected in all disease types, the features of these expanded clonotypes were specific for disease type and Vbeta family. For example, Vbeta20 clonal expansion was characterized by many small expanded clonotypes in samples from patients with pauciarticular JRA and juvenile SpA while single large Vbeta8-specific expansions were found only in patients with polyarticular disease. Motifs specific to individual patients were identified, and for Vbeta20 clonotypes, a motif was found in synovial tissue samples. CONCLUSION: Identification of common TCR features in oligoclonal expansions within individual patients and between patients with the same type of JRA suggests the recognition of a common or limited group of antigens in these diseases.
12973434 The role of T-cells in rheumatoid arthritis and the use of immunomodulating drugs. 1999 Apr Rheumatoid arthritis (RA) is a chronic inflammatory process of unknown etiology affecting 1% of the population worldwide. It results in excess morbidity in a majority of cases and early mortality in patients with aggressive disease. Early immunohistologic studies of the rheumatoid synovium demonstrate that T-cells, especially cluster of differentiation (CD)4(+) cells, are a major component of the infiltrating inflammatory cells. It has also been demonstrated that RA patients share a common major histocompatibility complex (MHC) class II molecule, HLA-DR4. Immune activation by T-cells requires the formation of the antigen recognition complex composed of the T-cell receptor, the MHC II molecule, and antigen. Many treatment modalities for RA have targeted the T-cell and/or the antigen recognition complex. These have varied from relatively crude methods such as leukopheresis to very specific monoclonal antibodies directed toward specific T-cell antigens such as the CD4 molecule itself. Not only have these therapies been effective, but also they have provided some interesting data on the pathogenesis of RA. Unfortunately, some have been associated with harmful side effects. To date, the safest and most effective modality has been immunomodulatory drugs such as cyclosporin and FK506, either alone or in combination with other agents. It appears that the earlier these treatments are started in the course of RA, the more effective they are, not only in controlling disease but also in achieving a potential remission.
10943644 Vegan diet in physiological health promotion. 1999 We have performed a number of studies including dietary interventions and cross-sectional studies on subjects consuming uncooked vegan food called living food (LF) and clarified the changes in several parameters related to health risk factors. LF consists of germinated seeds, cereals, sprouts, vegetables, fruits, berries and nuts. Some items are fermented and contain a lot of lactobacilli. The diet is rich in fiber. It has very little sodium, and it contains no cholesterol. Food items like berries and wheat grass juice are rich in antioxidants such as carotenoids and flavonoids. The subjects eating living food show increased levels of carotenoids and vitamins C and E and lowered cholesterol concentration in their sera. Urinary excretion of sodium is only a fraction of the omnivorous controls. Also urinary output of phenol and p-cresol is lowered as are several fecal enzyme levels which are considered harmful. The rheumatoid arthritis patients eating the LF diet reported amelioration of their pain, swelling of joints and morning stiffness which all got worse after finishing LF diet. The composite indices of objective measures showed also improvement of the rheumatoid arthritis patients during the intervention. The fibromyalgic subjects eating LF lost weight compared to their omnivorous controls. The results on their joint stiffness and pain (visual analogue scale), on their quality of sleep, on health assessment questionnaire and on general health questionnaire all improved. It appears that the adoption of vegan diet exemplified by the living food leads to a lessening of several health risk factors to cardiovascular diseases and cancer. Rheumatoid patients subjectively benefited from the vegan diet which was also seen in serum parameters and fecal analyses.
9987798 Loteprednol etabonate, a new soft steroid is effective in a rabbit acute experimental mode 1999 Jan Loteprednol etabonate, a new soft steroid designed for use as a local therapeutic, was compared to dexamethasone in rabbit experimental model for arthritis. METHODS: Joint inflammation was induced by local injection of antigen into the patellofemoral articulation in sensitized rabbits. Co-administration of either dexamethasone or loteprednol etabonate directly into the joint effectively blocked the inflammatory response. Both the synovial fluid cellular content and synovium histology were examined. The steroid treatments prevented the adverse inflammatory effects of antigen action. These results, together with previous studies showing decreased systemic activity of the soft steroid, indicate that the loteprednol etabonate could provide a therapeutic advantage over currently used intra-articular steroids for alleviating rheumatoid arthritis.
9569558 Use of bioelectric impedance analysis (BIA) in children with alterations of body water dis 1998 May Validation studies of bioelectric impedance analysis (BIA) were performed in children with obesity, Duchenne muscle dystrophy and juvenile rheumatoid arthritis. BIA allowed an accurate assessment of total body water in all groups (CV from 4.1 to 5.1%). However, the prediction of extracellular water by BIA was not always satisfactory (CV from 8.5 to 12.5%), being better in the groups of children with the lowest variability in body water distribution.
9712110 Fibrin D-dimer as a marker of disease activity in systemic onset juvenile rheumatoid arthr 1998 Aug OBJECTIVE: To study the prevalence of coagulation abnormalities in children with systemic juvenile rheumatoid arthritis (JRA) using a sensitive marker of fibrin degradation, and to determine whether serial levels of this variable parallel disease activity or predict response to medications in this disease. METHODS: Levels of d-dimer were determined in 24 consecutive patients with systemic JRA in conjunction with complete blood counts, erythrocyte sedimentation rate, maximum fever, duration of morning stiffness, and swollen joint count. Serial levels were then obtained in 11 patients. Linear regression analyses were done to determine any correlations between d-dimer and the other variables; and paired t test was used to compare levels before and after treatment interventions. Levels of d-dimer were also compared against concurrent clinical events such as pericarditis. RESULTS: Elevated levels of d-dimer were found in 23/24 of the patients (96%). When serial levels were analyzed, there were correlations between levels of d-dimer and fever (p = 0.03) and total leukocyte count (p = 0.04), but not with other variables. There was a significant reduction in levels before and after treatment in patients deemed to be clinical responders to immunomodulatory agents (p = 0.02). Elevated levels were also indicative of severe disease over the remainder of followup; lack of d-dimer indicated a benign disease course. CONCLUSION: With the use of a sensitive and specific marker of fibrinolysis known as d-dimer, coagulation abnormalities were more prevalent in children with systemic JRA than previously reported, and are frequently found during periods of active disease. Furthermore, serial levels of d-dimer appear to parallel response to disease modifying agents, and may predict outcome over a short followup period. Fibrin d-dimer may represent a novel marker that, when used in combination with known variables, could enhance that assessment of disease activity and response to medications in children with systemic onset JRA.
11246677 Clinical response to etanercept in polyarticular course juvenile rheumatoid arthritis. 2001 Feb OBJECTIVE: To evaluate safety and clinical response to treatment with etanercept in the polyarticular course of patients with juvenile rheumatoid arthritis (JRA). METHODS: Ten patients were studied (8 female, 2 male; 6 polyarticular JRA, 4 systemic onset; mean age 13.3 yrs; mean duration of disease 6.6 yrs). Patients received 0.4 mg/kg etanercept subcutaneously twice weekly in addition to their existing therapeutic regimen. Observed duration of treatment ranged between 4 and 12 months. RESULTS: Patients tolerated treatment with etanercept well. No serious adverse events were noted. Treatment response showed considerable improvement of morning stiffness (mean reduction of 96 min approximately equal to -93%) and joint counts including swollen joints (delta -8.2 approximately equal to -40%), tender joints (delta -9.2 approximately equal to -88%), and total joints (delta -9.8 approximately equal to -37%). Laboratory results included decreases in ESR (delta -46 mm/h approximately equal to -53%) and improvement of anemia. CONCLUSION: Our results confirm etanercept is a powerful adjunct in the therapy of polyarticular JRA resistant to conventional treatment regimens.
10510406 C1q-containing immune complexes purified from sera of juvenile rheumatoid arthritis patien 1999 Oct 15 Immune complexes that vary in size and composition are present in the sera and synovial fluid of juvenile rheumatoid arthritis (JRA) patients. They are believed to be potent inducers of the ongoing inflammatory process in JRA. However, the precise composition and role of these complexes in the pathophysiology of JRA remain unclear. We hypothesized that circulating ICs have the potential to interact with resident joint synovial fibroblasts (synoviocytes) and induce the expression of inflammatory cytokines. To test this hypothesis, cultures of synoviocytes from healthy individuals were treated with ICs isolated from the sera of JRA patients. Studies reported in this work demonstrate that IgM affinity-purified ICs from the sera of JRA patients contain IgM, C1q, IgG, and C3 to a variable extent. These ICs induce IL-8 mRNA and protein production in normal synoviocytes. Our data indicate that C1q in these ICs mediates, in part, IL-8 induction in synoviocytes. This is based on our findings of C1q-binding proteins for collagen stalks (cC1qR) and globular heads (gC1q-binding protein) of C1q in synoviocytes. In addition, collagen stalk and to some extent globular head fragments of C1q inhibit IC-mediated IL-8 induction in synoviocytes. Together, these findings provide evidence for a novel mechanism of IL-8 production by synoviocytes, which could play a key role in inflammation by recruiting leukocytes to synovial tissue and fluid-and subsequently contributing to joint disease.
9586680 Methotrexate therapy in systemic-onset juvenile rheumatoid arthritis in Saudi Arabia: a re 1998 Eighteen patients (nine girls, nine boys) with systemic onset juvenile rheumatoid arthritis (SO-JRA) treated with methotrexate (MTX) for a mean period of 18 months (range 6-41 months) were analysed to evaluate the safety and efficacy of MTX in this disease subtype. The MTX dose ranged from 2.5 to 15 mg/week with a mean cumulative dose of 684.9 mg/patient at the last follow-up visit. Systemic features were severe in 10 patients before MTX was started. None of these patients showed systemic features at the last follow-up visit. Sixteen patients (89%) showed improvement in both the active joint count (from a mean of 12.0 to 1.3 joints/patient) and function class (from a mean of 3.0 to 1.3) while receiving MTX. Eleven patients (61%) showed a significant decrease in the erythrocyte sedimentation rate (>50% of the initial value), an improvement in anaemia (haemoglobin >2 g) and reduced thrombocytosis (platelets 2 x 10[5]). Of the patients receiving corticosteroids, three patients (20%) were able to discontinue prednisone and the dose was reduced to less than 50% of the initial dose in seven patients (47%). At these doses of MTX, no gastrointestinal, hepatic or haematological toxicity was encountered and none of the patients withdrew because of toxicity or lack of efficacy. This report suggests that MTX is an effective and safe treatment in controlling systemic and articular features in this subtype of JRA.
9137323 Growth retardation in non-steroid treated juvenile rheumatoid arthritis. 1997 Growth in height was studied in 58 patients with juvenile rheumatoid arthritis (JRA) followed for 4.9 +/- (SD) 2.8 years, who had never received steroids. Height measurements were converted to Height Z Scores. Height Z scores at first and at last visit were respectively 0.7 +/- 1 and 0.7 +/- 0.9 (NS) in pauciarticular, 0 +/- 1.6 and -0.55 +/- 1.6 (p = 0.045) in systemic, 0.29 +/- 0.8 and -0.4 +/- 1 (p = 0.0001) in polyarticular JRA patients. In systemic and polyarticular patients a significant negative relation was found between the duration of disease and the delta Height Z score (p = 0.0008) as well as between the sum of the periods of active disease and the delta Height Z score (p = 0.0001). The patients with functional class = 1 lost 0.01 +/- 0.19 Height Z score per year while those with functional class > or = 2 lost 0.16 +/- 0.13 Height Z score per year (p = 0.005). The loss of Height Z score in systemic and polyarticular subjects observed during pubertal age (-0.71 +/- 0.67 Height Z score) was significantly (p = 0.02) greater than in those observed before puberty (-0.1 +/- 0.72). The longer duration of disease, the higher degree of functional joint involvement, and the age of puberty appear to be risk factors for height growth impairment in systemic and polyarticular JRA.
10493690 Soluble adhesion molecules in juvenile rheumatoid arthritis. 1999 Sep OBJECTIVE: To determine serum levels of soluble (s) adhesion molecules in patients with juvenile rheumatoid arthritis (JRA), and to determine whether differences exist in these levels among the 3 subtypes of JRA, and whether levels of these molecules correlate with other measures of disease activity. METHODS: Serum levels of soluble forms of intercellular adhesion molecule-1 (ICAM-1), ICAM-3, vascular (V) CAM-1, L-selectin, and E-selectin were determined by sandwich ELISA in 16 patients with JRA (6 systemic, 6 polyarticular, 4 pauciarticular). Differences in levels among JRA subtypes were determined by ANOVA, and correlations between levels and the following clinical variables were assessed by linear regression analysis: erythrocyte sedimentation rate (ESR), total white blood cell count (WBC), hematocrit (HCT), platelet count (PLT), and total swollen joint count (JC). RESULTS: sE-selectin levels were significantly higher in patients with systemic disease compared to other subtypes (p<0.04). Furthermore, there was a trend toward higher levels of sICAM-1 in systemic disease, which did not reach statistical significance. Significant correlations were found between sE-selectin and ESR (r = 0.68, p<0.006), WBC (r = 0.70, p<0.003), and PLT (r = 0.54, p<0.05) and between sL-selectin and WBC (r = 0.55, p<0.03). CONCLUSION: Because of the small number of patients studied, and the lack of age matched control data, our results must be interpreted with caution. Nonetheless, levels of sE-selectin, and possibly ICAM-1 appear to be relatively elevated in systemic JRA, and may indicate cytokine induction and endothelial cell activation in that subtype. Several molecules, especially sE-selectin, correlate with hematologic variables in JRA. These results suggest that serum levels of these molecules may provide a useful additional marker for disease activity in certain patients.
10758474 Awake fibreoptic intubation following failed regional anaesthesia for caesarean section in 2000 Mar The anaesthetic management of a 25-year-old parturient with juvenile rheumatoid arthritis (Still's disease) and a difficult airway presenting for elective Caesarean section is described. Inadequate block after epidural anaesthesia necessitated general anaesthesia. This was safely accomplished by securing the airway with awake oral fibreoptic intubation before general anaesthesia was induced. The problems of performing an awake fibreoptic intubation in a pregnant patient are discussed and a simple method for performing the technique is described.
10950110 Treatment with soluble VEGF receptor reduces disease severity in murine collagen-induced a 2000 Aug Maintenance of the invasive pannus in rheumatoid arthritis is an integral part of disease progression. The synovial vasculature plays an important role in the delivery of nutrients, oxygen, and inflammatory cells to the synovium. Vascular endothelial growth factor (VEGF), an endothelial mitogen expressed by cells within the synovial membrane, is thought to contribute to the formation of synovial blood vessels. Our objective in this study was to measure the kinetics of VEGF production in a murine model of collagen-induced arthritis and to determine whether VEGF blockade reduces disease progression. Synovial cells isolated from the knee joints of naive or sham-immunized mice, or from mice immunized with collagen but without arthritis, released little or no detectable VEGF. Onset of arthritis was associated with expression of VEGF mRNA and protein. The levels of VEGF secreted by synovial cells isolated from the joints of mice with severe arthritis were significantly higher than from mice with mild disease. To block VEGF activity, animals were treated after arthritis onset with a soluble form of the Flt-1 VEGF receptor (sFlt), which was polyethylene glycol (PEG)-linked to increase its in vivo half-life. Treatment of arthritic mice with sFlt-PEG significantly reduced both clinical score and paw swelling, compared with untreated or control-treated (heat-denatured sFlt-PEG) animals. There was also significantly less joint inflammation and reduced bone and cartilage destruction in sFlt-PEG-treated animals, as assessed by histology. Our data demonstrate that, in collagen-induced arthritis, expression of the potent angiogenic cytokine VEGF correlates with disease severity. Furthermore, specific blockade of VEGF activity results in attenuation of arthritis in both macroscopic and microscopic parameters. These observations indicate that blood vessel formation is integral to the development of arthritis and that blockade of VEGF activity might be of therapeutic benefit in rheumatoid arthritis.
10451083 Use of ELISA to measure antinuclear antibodies in children with juvenile rheumatoid arthri 1999 Aug OBJECTIVE: To compare a series of commercial ELISA tests with an indirect immunofluorescent antibody (IFA) test for the detection of antinuclear antibodies (ANA) in children with juvenile rheumatoid arthritis (JRA). METHODS: Sera from 178 patients with JRA (88 pauciarticular, 68 polyarticular, 22 systemic) were compared with 26 healthy pediatric subjects. Twenty-one samples from patients with systemic lupus erythematosus (SLE) were also tested. All samples were analyzed by IFA and by 3 commercial ELISA methods. Concordance of ELISA results with IFA results (selected standard) were used as a measure of performance. Sensitivity and specificity were calculated for each test and likelihood ratios (LR) were established for IFA and ELISA in pauciarticular and polyarticular JRA sera. The increment in pretest probability was then obtained for each test as an additional measure of test performance. RESULTS: IFA rendered positive results on 18-77% of the JRA sera depending upon the subset, 100% of SLE sera, and 15% of normal patient sera. Using IFA as the standard, correspondence with positive results among patients with JRA ranged from 0 to 74% for the 3 ELISA tests, while it ranged from 5 to 73% in IFA negative sera. IFA tests showed intermediate range likelihood ratios (0.3, 0.5, 3.5, and 5) and increments in pretest probability ranging from 25 to 45%. While one of the ELISA tests attained 50% of increment in pretest probability for the positive test, it showed 0% increment as a negative test. The other 2 ELISA tests incremented the pretest probability from 0 to 25%. CONCLUSION: Our findings indicate that in JRA, the lack of correspondence with the historic standard IFA precludes the use of ELISA tests for detection of ANA. In addition, IFA out-performs ELISA by a substantial degree when "clinical utility" analysis of test performance is utilized. Detection of ANA in children with JRA should either continue to rely on IFA or be based on a different set of antigens if an ELISA format is chosen.
9672993 Effect on lung function of methotrexate and non-steroid anti-inflammatory drugs in childre 1998 We evaluated lung function in a group of patients affected by juvenile rheumatoid arthritis (JRA), without clinical and/or radiological signs of respiratory involvement. We compared the effects on pulmonary function of methotrexate (MTX) therapy combined with non-steroid anti-inflammatory drugs (NSAIDs) to those of NSAIDs alone and correlated lung function to subtype onset, disease duration and disease activity. Our patients were 27 JRA children, subdivided into two groups according to the therapy (group A = 14 patients, treated with a low dose of MTX and NSAIDs; group B = 13 patients, treated with NSAIDs alone). Clinical evaluation, haematological data and pulmonary function tests (PFTs) were obtained in each group at baseline (time 0) and at 1 year (time 1). At time 0 and time 1 PFTs were altered in 51.8% of JRA patients. The restrictive pattern (reduced forced vital capacity, FVC) was the most frequent feature, observed in 22.2% of patients. In group A the mean values of FVC, FEV1 (forced expiratory flow in 1 s), FRC (functional residual capacity), TLC (total lung capacity) and DLCO (diffusing lung capacity of carbon monoxide) were significantly lower compared to those of group B, at time 0 and at time 1. No functional parameter was correlated to subtype, duration or activity of the disease. Our study confirms that abnormalities in PFTs may be detected in JRA patients, even in the absence of clinical and/or radiological signs of lung disease; MTX in combination with NSAIDs does not seem to affect lung function at 1 year more than NSAIDs alone.
19078198 The importance of identifying depression in patients with rheumatoid arthritis: evaluation 1997 Oct Depression is common in patients with chronic illness including rheumatoid arthritis (RA). Identifying depression accurately and treating it appropriately are important for helping to maintain function in patients with RA. Several self-administered screening tools are available that are sensitive for the detection of depression in medical outpatients and are easy to use in a clinic setting. There has been debate regarding the validity of some of these tools for detecting depression in RA patients because of "arthritis-biased" questions. In this study, we evaluated 77 patients with RA and measured their responses to one of these screening tools, the Beck Depression Inventory (BDI). We compared disease activity and severity measures and measures of functional status between patients who were designated as depressed by BDI score and patients without depressive symptoms.We were unable to demonstrate differences in specific objective measures of disease activity, severity, or objective functional measures between nondepressed and depressed RA patients. However, depressed patients reported greater disease activity and poorer physical function, and observer global assessment of depressed patients was poorer. We conclude that the "arthritis-biased" questions in the BDI did not interfere with the detection of depression in patients with RA and should not be a deterrent for its use. We found that the BDI can be used effectively in a clinic setting as a screening tool for depression in patients with RA.
19078443 Amiprilose hydrochloride for the treatment of rheumatoid arthritis. 2000 Feb The intent of this study was to compare, in a monotherapy framework, an optimal dose of the synthetic hexose sugar, amiprilose hydrochloride (HCl), to a placebo in the treatment of rheumatoid arthritis. In this double-blind, randomized, multi-center study, patients first underwent a washout period from disease-modifying antirheumatic drugs. Those who subsequently met flare criteria within 14 days of discontinuing previously stable doses of nonsteroidal anti-inflammatory drugs were randomized to amiprilose HCl (103 patients) or a placebo (115 patients) for the subsequent 20 weeks. Glucocorticoid or nonsteroidal anti-inflammatory drugs use was not permitted. At the baseline, demographic and disease characteristics were similar in both groups. Of patients completing the course of therapy, 73% were in the amiprilose HCl group and 66% were in the placebo group. Using an intent-to-treat analysis, numeric trends favoring amiprilose HCl treatment were found for clinical and laboratory parameters of disease activity. Compared with the placebo group, statistically significant degrees of improvement were achieved for the number of swollen joints (p /= 50% reduction in swollen joints (p
9507608 Nontuberculous mycobacterial bursitis and arthritis of the shoulder. 1998 Jan A 56-year-old woman with systemic lupus erythematosus developed septic arthritis and bursitis of the left shoulder due to an atypical mycobacterium, M. xenopi. Plain radiography, ultrasound (US), and MRI were performed. Articular disease by tuberculous and nontuberculous mycobacteria have similar presentations, clinically as well as radiologically, and have to be differentiated from other chronic bacterial or fungal infections, pigmented villonodular synovitis, rheumatoid arthritis, gout, hemophilia, and synovial chondromatosis. Although atypical mycobacterial involvement of the skeleton and soft tissues is relatively uncommon, its incidence is increasing, as is the incidence of extrapulmonary tuberculosis in western countries. The triad of Phemister is reemphasized, and the US and MRI findings are demonstrated. The definitive diagnosis has to be made by culturing biopsied synovium or synovial fluid.
11221451 [Use of outcome measures in physical medicine/rheumatological rehabilitation. Results of a 2001 Jan 29 BACKGROUND: As part of the EU-project ProESOR (Project for the European Standardisation of Outcome Measurement in Rehabilitation), a survey was undertaken to investigate the use of Outcome Measures (OM) within rehabilitation across Europe. This paper presents some of the Danish results of this survey. AIM: Evaluate the extent of use of OMs in rehabilitation. MATERIAL: All 37 Rheumatology/Physical Medicine and Rehabilitation departments and institutions in Denmark. METHOD: A questionnaire was mailed to the institutions. This included questions about the institution and its personnel, and nine diagnostic groups: Low back pain, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke, traumatic brain injury, hip and knee replacement, and lower limb amputees, with estimation of the number of patients treated and the extent of use of OMs. RESULTS: The majority of the departments treated more than 200 in- and out-patients per year. Patients with low back pain and rheumatoid arthritis were the largest patient groups, followed by patients with hip and knee replacement and stroke. OMs were most frequently used with rheumatoid arthritis and, to a lesser extent, patients with low back pain. Although many departments used one or more OM, several did not use any at all. For each diagnostic group more OMs were used if the patient was treated in a department specialised for patients with the particular diagnosis. More OMs were used with patients who tended to have longer inpatient stays. CONCLUSION: There is little consensus regarding which OMs should be used. We recommend that this challenge be taken up.