Browse

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

ID PMID Title PublicationDate abstract
11265517 [Sjögren syndrome in ORL. Diagnostic considerations]. 2001 A presentation the history of a 51-year-old woman with xerostomia and keratoconjunctivitis sicca (KCS), developed in 10 months, investigations revealed the presence in serum of antibodies against cytoplasmic antigens SS-A (Ac anti-Ro/SS-A), antinuclear antibodies (ANAs) and rheumatoid factor (RF). The Rose Bengal test was positive and in the salivary gammagraphy, made with pertecnate 99 mTc, it was observed a decrease of the captation and excretion of the designer for salivary glands. The histopathology and immunohistochemical study of minor salivary glands showed the presence of a focal lymphocitic sialadenitis (fsa) and a predominance of lymphocites CD4+. It was diagnosed as primary Sjögren's syndrome (PSS) and the patient treated with salivary substitutes, artificial tears and corticoids. We analyse the current diagnostic criteria of the group of study of the European Community for the Sjögren's syndrome (SS) and emphasize the importance of histologic and immunochemical studies, that together with the rest of complementary tests will led us to distinguish not only the different forms of the presentation of the illness but also those of all patients with pathologies which are nowadays very prevalent in our environment, such as the hepatitis C (HCV) an the human immune deficiency (HIV) virus infections.
11297085 Short-term follow-up of the juvenile rheumatoid knee with fat-saturated 3D MRI. 2001 Mar OBJECTIVE: To determine the correlation between clinical status and 3D, fat-saturated contrast-enhanced MRI findings in assessing the response to treatment in patients with knee-joint involvement from juvenile rheumatoid arthritis (JRA). MATERIALS AND METHODS: Synovial hypertrophy, effusion, cartilage and epiphyseal status were scored using spin-echo (SE) T1-weighted, SE T2-weighted and contrast-enhanced, fat-suppressed 3D MRI in 42 knees of 21 patients. MRI findings were evaluated by scoring results and compared with the clinical scoring results. Progression, improvement and equivalence were analysed between 0-3 and 3-6 months, both clinically and by MRI. RESULTS: Fat-suppression imaging generated high contrast between cartilage, synovium, effusion and bone. Correlation coefficients according to progression, improvement and equivalent findings of months 1-3 and months 3-6 comparison of clinical and MRI scores were found to be 0.50 and 0.70, respectively. CONCLUSION: Contrast-enhanced 3D MRI with fat suppression provides good discrimination between synovial hypertrophy and fluid. Fat-suppressed imaging offers better contrast between cartilage and synovium. Long-term MRI follow-up of JRA improves direct follow-up of pathological changes and helps in modifying treatment regimens.
9415657 Induction of invasive and degradative phenotype in normal synovial fibroblasts exposed to 1997 Dec OBJECTIVE: To investigate the effect of synovial fluid (SF) from patients with juvenile rheumatoid arthritis (JRA) on proliferation and induction of degradative and invasive phenotype in normal synovial fibroblasts, and to elucidate the contribution of SF cells to this activity. METHODS: SF and/or conditioned medium (CM) from SF cells were evaluated for their ability to (1) stimulate a proliferative response, (2) induce the "activated phenotype" capable of invading cartilage matrix, and (3) promote the release of key matrix metalloproteinases (MMP) in normal synovial fibroblasts. RESULTS: Proliferation of normal synovial fibroblasts exposed to SF or CM from SF cells of patients with JRA was up to 3 times greater than untreated controls. Concomitant with induction of an activated phenotype in the treated synovial fibroblasts, the activated form exhibited up to 250% invasiveness of cartilage matrix compared to untreated synovial fibroblasts (100%), in addition to releasing increased MMP activity, not normally associated with these quiescent cells. This induction was not solely due to tumor necrosis factor-alpha, transforming growth factor-beta, interleukin 1beta (IL-1beta), and IL-6, as SF and/or CM depleted of these cytokines sustained about 40% of their invasive and inducing ability. We observed that the mononuclear cell (MNC) population that infiltrated into the joint cavity secretes this "inducing activity," which can be maintained in culture up to several weeks. CONCLUSION: Our data suggest that the cellular component of SF releases soluble factor(s) that directly or indirectly contribute to (a) proliferation of synovial fibroblasts, and (b) production and release of extracellular MMP by synovial fibroblasts, thereby inducing a degradative and invasive phenotype culminating in cartilage and bone destruction.
10969505 Efficacy and safety of methotrexate therapy for juvenile rheumatoid arthritis. 2000 Aug BACKGROUND AND PURPOSE: Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study investigated the efficacy and adverse effects of oral methotrexate (MTX) therapy in Taiwanese children with JRA. METHODS: The medical records of 52 Taiwanese children with JRA treated with oral MTX were retrospectively analyzed. The disease onset was polyarticular in 22 children, oligoarticular in 13, and systemic in 17. The indication for MTX therapy was lack of efficacy of previous drugs, including two or more nonsteroidal anti-inflammatory drugs, in all patients. In addition, three patients had received hydroxychloroquine and one had received sulfasalazine, without improvement. Corticosteroid dependency had developed in 27 patients prior to MTX therapy. The mean initial dose of MTX was 9.1 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1), and the mean maximal dose was 10.2 mg.m-2.wk-1 (range, 5-20 mg.m-2.wk-1). The mean duration of treatment was 23 months (range, 6-96 mo), and the mean duration of follow-up was 52 months (range, 10-123 mo) from the start of MTX therapy. RESULTS: Thirty-six children (69%) showed clinical improvement and 25 children (48%) achieved clinical remission. The administration of MTX resulted in more than a 50% reduction in required corticosteroid dosage in six children, and complete discontinuation of corticosteroid in 10 children. MTX was discontinued in 18 patients following a mean of 8 months (range, 2-34 mo) of clinical remission. Relapse occurred in nine (50%) of these patients. Thirteen patients (25%) suffered from adverse effects associated with MTX treatment. All of these adverse effects resolved spontaneously, or subsided within 4 weeks following dosage reduction or discontinuation of MTX. CONCLUSIONS: Oral MTX therapy is effective and well-tolerated in Taiwanese children with JRA. It can serve as the first choice of second-line therapy in JRA.
17984883 Atypical sequelae of knee arthroscopy and reactive arthritis. 2000 Dec 30 Aim. To evaluate the reasons for atypical sequelae of knee arthroscopy.
Material. A group of 11 patients (6 women and 5 men), age 17-56 (mean 33.4), referred for rheumatological consulation because of persistent exudates and/or pain in the operated joint. Infectious arthritis, rheumatoid arthritis, psoriatic arthritis and gout were excluded. Immunological diagnostics were performed on all patients, testing for the presence of anti-Chlamydia trachomatis, anti-Yersinia enterocolitica, anti-Salmonella enteritidis and typhimurium antibodies.
Results. In 10/11 patients various antibodies were detected (most often anti-Chlamydia trachomatis antibodies). Other reasons for atypical sequelae of knee arthroscopy included pigmentous villo-nodular synovitis and chondrocalcinosis. The Discussion presents those clinical symptoms and signs appearing in orthopedic examinations that serve as indications for rheumatological consultation.
Conclusion. The most common reason for atypical sequelae of knee arthroscopy is reactive arthritis caused by Chlamydia trachomatis and G(-) enteric bacteria infections.
9150087 Long-term health outcomes and quality of life in American and Italian inception cohorts of 1997 May OBJECTIVE: To assess the long-term health outcomes and quality of life of patients with juvenile rheumatoid arthritis (JRA) using health and functional assessment questionnaires in 2 populations, one from the USA and one from Italy. METHODS: Patient eligibility criteria: (1) first examined in our units between 1958 and 1990 during the first 6 months after onset of symptoms, (2) diagnosis of JRA by the American College of Rheumatology criteria, (3) disease duration of at least 5 years at the time of assessment of outcome. Instruments used: (1) the Health Assessment Questionnaire (HAQ, short form, or childhood HAQ (CHAQ), and (2) Quality of Life Scales (QOLS, adults only). Eligible patients were identified by computer search and chart review and were then mailed a packet containing a consent/assent form and the assessment instruments. RESULTS: Of 346 patients who met the eligibility criteria were able to locate 301, and 290 verbally agreed to participate and were mailed packets. Signed consent and complete information were received from 227 of the 290 (78%), 178 from the USA and 49 from Italy. Mean duration of disease at the time of outcome assessment was 15 yrs. 127 had pauciarticular, 55 polyarticular, and 45 systemic onset disease. Mean and (median) scores of the outcomes are shown in the table. [table: see text] CONCLUSION: Long-term outcome, as assessed by the instruments used, is very favorable in most patients with JRA 5 years or more after onset of symptoms.
9698030 Septic arthritis with Listeria monocytogenes during low-dose methotrexate. 1998 Jul We describe a 22-year-old female with systemic lupus erythematosus and lymphopenia, who developed septic arthritis of the right knee with Listeria monocytogenes type 1/2 A, whilst on low-dose methotrexate (MTX). So far, septic arthritis due to this microorganism has been reported in two other patients treated with low-dose MTX, one having rheumatoid arthritis and the other psoriatic arthritis. No reports exist on patients treated with other cytotoxic antirheumatic therapies.
10364905 Assessment of mutilans-like hand deformities in chronic inflammatory joint diseases. A rad 1999 Apr OBJECTIVES: To evaluate patients with mutilans-like hand deformities in chronic inflammatory joint diseases and to determine radiographic scoring systems for arthritis mutilans (AM). METHODS: A total of 52 patients with severe hand deformities were collected during 1997. A Larsen hand score of 0-110 was formed to describe destruction of the hand joints. Secondly, each ray of the hand was assessed individually by summing the Larsen grade of the wrist and the grades of the MCP and PIP joints. When the sum of these grades was > or = 13, the finger was considered to be mutilated. A mutilans hand score of 0-10 was formed according to the number of mutilans fingers. Surgical treatment and spontaneous fusions were recorded. RESULTS: The study consisted of 22 patients with juvenile rheumatoid arthritis (JRA), nine with rheumatoid factor (RF) positive and 13 with RF negative arthritis, 27 patients with RF positive RA, and three adult patients with other diagnoses. The mean age of patients with adult rheumatic diseases was 27 years at the onset of arthritis. The mean disease duration in all patients was 30 years. The mean Larsen hand score was 93. Four patients had no mutilans fingers and in 15 patients all 10 fingers were mutilated. The Larsen hand score of 0-110 and the mutilans hand score of 0-10 correlated well (rs = 0.90). Fourteen patients showed spontaneous fusions in the peripheral joints. A total of 457 operations were performed on 48 patients. CONCLUSION: Both the Larsen hand score of 0-110 and the mutilans hand score of 0-10 improve accuracy in evaluating mutilans-like hand deformities, but in unevenly distributed hand deformities the mutilans hand score is better in describing deformation of individual fingers.
27957906 An infected wound in a patient with necrotising fasciitis. 1998 Jun 2 This case study describes the management of a patient with rheumatoid arthritis and diabetes mellitus who presented with necrotising fasciitis.
10418279 Poncet's disease in a north Indian hospital. 1999 Jan Although the entity of tuberculous rheumatism or Poncet's disease has sometimes been the subject of debate, it has been reported infrequently in the English literature. We discuss here seven patients (5 women, 2 men; age 18-48 years) who presented primarily with polyarthritis and fever and developed pulmonary, pleural or nodal tuberculosis later in the course of disease. Rheumatoid arthritis, collagen vascular diseases and other common causes of polyarthritis were ruled out by appropriate investigations. Polyarthritis resolved in all the patients after the institution of antitubercular treatment and did not recur, thus providing a therapeutic confirmation of the clinical diagnosis.
10961249 The current use and interpretation of rheumatologic tests. 1998 Feb The growing emphasis on primary care medicine has led to an increase in the number of physicians ordering and interpreting tests previously used by specialists. In order to prevent unnecessary and inaccurate testing, it is important to determine the necessity and accuracy of a test before it is performed. This chapter reviews several types of autoantibody (ANA) tests sensitive to rheumatologic diseases and explains how such tests may aid diagnosis.
9663477 Intraarticular corticosteroid injection in the management of children with chronic arthrit 1998 Jul OBJECTIVE: Intraarticular (IA) corticosteroid injection is a common therapeutic approach in the management of adult rheumatoid arthritis. This study examined the safety and efficacy of IA corticosteroid injection in 71 patients with juvenile arthritis who were being seen at the Sheba Medical Center during the years 1991-1996. METHODS: Sixty-one patients fulfilled the American College of Rheumatology revised criteria for the diagnosis of juvenile rheumatoid arthritis (JRA), 6 patients had reactive arthritis, and 4 patients had various other arthritic conditions. The mean +/- SD age was 9.4 +/- 5.6 years (range 0.5-18 years); 47 were female (mean age 8.1 +/- 5.5 years) and 24 were male (mean age 10.8 +/- 5.4 years). A total of 300 joints were injected with triamcinolone hexacetonide. The most common sites of injection were the knees (124 injections), ankles (71 injections), wrists (46 injections), shoulders (10 injections), and elbows (7 injections). Children under the age of 6 (n = 17), or older children who received more than 4 joint injections at one time (n = 10) were sedated with either ketamine HCI or propofol. All other children received their joint injections under local anesthesia. RESULTS: Full remission of the joint inflammation lasting >6 months following injection was achieved in 246 of the 300 injections (82.0%). In 54 (18.0%) of the injected joints, the inflammation recurred within 6 months of injection. In patients with pauciarticular arthritis, 115 of 141 injections (81.6%) resulted in full remission. Discontinuation of all oral medications was accomplished in 43 patients (60.6%) of the total group of 71 patients and in 32 of the 43 patients with pauciarticular disease (74.4%). Correction of joint contraction was achieved in 42 children (55 joints). In all 11 patients with Baker's cyst and in 12 patients with tenosynovitis, complete remission was achieved following injection. No infection or other serious complications occurred in any of the patients following the procedure. CONCLUSION: IA corticosteroid joint injection in children with juvenile arthritis is a safe and effective mode of therapy. It may be the only therapy needed in patients with pauciarticular JRA, obviating the need for prolonged oral medications, and is effective in correcting joint contractions and deformities.
11475603 A method to score radiographic change in psoriatic arthritis. 2001 Jun INTRODUCTION: Radiographic features of psoriatic arthritis (PsA) are very characteristic and differ from those observed in rheumatoid arthritis, especially in two aspects: 1) the distribution of affected joints (i.e. DIP joints), 2) the presence of destructive changes and bone proliferation at the same time. A scoring method for PsA, therefore, has to account for these characteristics of PsA. OBJECTIVE: To develop, describe and validate a method for scoring radiographic changes in patients with PsA. DESCRIPTION OF THE METHOD: Forty joints of the hands and feet are scored for destruction and proliferation. In the destruction score (DS) grading on a 0-5 scale is based on the amount of joint surface destruction: 0 = normal, 1 = one or more erosions with an interruption of the cortical plate of > 1 mm with destruction of the total joint surface up to 10%, 2 = 11-25%, 3 = 26-50%, 4 = 51-75%, 5 = > 75% joint surface destruction. The proliferation score (PS) sums up any kind of bony proliferation typical for PsA; graded 0-4: 0 = normal, 1 = bony proliferation of 1-2 mm or bone growth < 25% of the original size (diameter), 2 = bony proliferation 2-3 mm or bone growth 25-50%, 3 = bony proliferation > 3 mm or bone growth > 50%, 4 = bony ankylosis. The DS (0-200) and the PS (0-160) can be summed up to the total score (0-360). VALIDATION OF THE METHOD: To validate the method x-rays of 20 patients with active PsA taken 3 years apart were read twice in pairs, knowing the chronological order but not knowing demographic, clinical or laboratory data of the patients. The data were analyzed with a hierarchical analysis of variance model. RESULTS: There was good agreement between the first and the second reading of the same rater and between the two raters regarding the destruction score. The agreement regarding the proliferation score was lower but still acceptable. The reliability of the method to describe change over time--relation of progression (intra-patient variance) to the measurement error (inter-rater variance)--was 3.9 for the DS, 2.8 for the PS and 4.1 for the total score. The minimal detectable change when the readings of two raters were compared (inter-rater MDC) was 5.8, 5.0 and 4.6%, respectively of the maximum possible score for the destruction, the proliferation and the total score. These data compare very well with the results of standard scoring methods in rheumatoid arthritis. CONCLUSION: We propose a method for scoring radiographic change in psoriatic arthritis which reliably quantifies the progression of the disease seen on radiographs.
10782839 Validation of the proposed ILAR classification criteria for juvenile idiopathic arthritis. 2000 Apr OBJECTIVE: The new International League of Associations for Rheumatology (ILAR) classification criteria were proposed to facilitate communication among pediatric rheumatologists. Before they are applied in daily practice they should be clinically validated. METHODS: We retrospectively applied the proposed criteria on our pediatric rheumatology patient population seen between June 1 and August 31, 1998. RESULTS: We saw 67 patients with oligoarticular (oJRA), 6 with polyarticular/RF negative (pJRA), and 8 with systemic juvenile rheumatoid arthritis (sJRA), all classified according to American College of Rheumatology criteria, 5 with juvenile psoriatic arthritis (PsA) according to the Vancouver criteria, and 11 with juvenile spondyloarthritis (SP) according to the European Spondylarthropathy Study Group preliminary criteria. Of the 97 patients, 85 could be clearly classified according to the ILAR criteria. Twelve patients (12%) were classified as "other." Six patients could not be classified as "oligo" because of a family history of psoriasis, and did not fulfill the criteria for PsA either. All 6 "other" patients fulfilled criteria for 2 different categories. CONCLUSION: With this ILAR proposed classification criteria 88% of patients could be classified. In patients classified as "other," the psoriatic trait caused the most difficulty in classification.
11490538 Spondylarthropathies in children. 1998 Apr Spondylarthropathies in children are still classified among juvenile chronic (rheumatoid arthritides, at least in their undifferentiated forms. However, the ESSG and Armor criteria are very satisfactory for identifying this group of patients. Work conducted by the ILAR Taskforce for Pediatric Rheumatology is in progress for a better identification of these patients.
11724513 Current topics on cryofiltration technologies. 2001 Aug In the last 40 years, therapeutic plasmapheresis techniques have been improving considerably. These include cryofiltration technologies providing novel ways of removing large amounts of cryoproteins from plasma. The concept of cryofiltration involves exposure of plasma to below core (37 degrees C) and room temperatures (25 degrees C) without freezing. It was initially used to treat diseases such as cryoglobulinemia with systemic vasculitis, rheumatoid arthritis, systemic lupus erythematosus, and ABO-incompatible transplants. There are 2 basic types of cryofiltration. The first method removes cryoproteins, namely cryoglobulins that precipitate at 4 degrees C. Several filters have been used for this procedure like the AP06M (Asahi Medical, Tokyo, Japan) with a 0.2 microm pore size, a 0.65 m2 surface area, and a cellulose diacetate (CDA) membrane. It has been used in the United States and Japan for treatment of rheumatoid arthritis and cryoglobulinemia. A major disadvantage was frequent filter plugging, which was cumbersome and it is no longer used in the United States. The G3 cryofilter (Gelman Sciences, Ann Arbor, MI, U.S.A.) with a 3 microm pore size was tried in vitro but proved inadequate by design. Currently in our institution, the cryoglobulin filter (Pall Medical, Ann Arbor, MI, U.S.A.) is used with a 4.3 microm pore size, a 0.135 m2 surface area, and an acrylic co-polymer pleat membrane. We performed over 1,200 procedures in 40 patients in the last 8 years. The second type of cryofiltration removes cryogel, which is an agglutination complex of fibrinogen, fibronectin, fibrin split products, and cold insoluble proteins with a heparin core, at temperatures between 2 and 10 degrees C. The AP06M, the AC1740 (Asahi Medical) with a 0.02 microm pore size, a 1.70 m2 surface area, and a CDA membrane, and the Evaflux-4A (Kuraray Company, Osaka, Japan) with a 0.03 microm pore size, a 2 m2 surface area, and an ethylene vinyl alcohol membrane are used to remove cryogel to treat ABO-incompatible transplants as well as rheumatoid arthritis and other previously mentioned diseases. This article will discuss each cryofiltration treatment modality.
10616003 Identification of a genetic risk factor for systemic juvenile rheumatoid arthritis in the 1999 Dec OBJECTIVE: To study polymorphisms in the 5'-flanking promoter/enhancer region of the tumor necrosis factor alpha (TNFalpha) gene and in the coding regions of HLA class I and class II genes, in order to better understand the genetic background of juvenile rheumatoid arthritis (JRA). METHODS: One hundred eleven Japanese JRA patients (50 with systemic disease, 29 with pauciarticular disease, and 32 with polyarticular disease) and 575 healthy Japanese subjects were examined for the allele frequencies of the TNFalpha, HLA-A, and HLA class II (DRB1, DRB3, DRB4, DRB5, DQA1, DQB1, DPA1, and DPB1) genes, by DNA typing using the polymerase chain reaction-sequence-specific oligonucleotide probe method. RESULTS: The frequencies of the polymorphic allele at positions -1,031 (T to C substitution, termed -1,031C), -863 (C to A, termed -863A), and -857 (C to T, termed -857T) of the TNFalpha gene in patients with systemic JRA, but not in those with polyarticular or pauciarticular JRA, were significantly higher than in the healthy controls. The allele frequencies of DRB1*0405 and DQB1*0401 in systemic JRA, but not in the other JRA types, were significantly higher than in controls. Linkage analysis showed that the presence of both the TNFalpha -857T allele and DRB1*0405 yielded a significantly increased odds ratio (3.84), while the presence of only 1 of them did not yield a high odds ratio (0.87 and 1.58). CONCLUSION: The -1,031C/-863A allele and the -857T allele of the TNFalpha gene, both of which are related to high production of tumor necrosis factor alpha, are associated with systemic JRA. The -857T allele may enhance the effect of the DRB1*0405/DQB1*0401 haplotype in predisposing to development of systemic JRA.
9595837 Case management study: polyarthritis with fever. 1998 May In most cases, a thorough initial evaluation will reveal the cause of fever and polyarthritis. However, in some patients the initial diagnosis may be unclear and, as time passes, the characteristic clinical patterns emerge. Recurrent attacks are suggestive of other conditions such as crystal-induced arthritis, Lyme disease, and Mediterranean fever. In rheumatoid arthritis and Reiter's syndrome, the fever resolves and the articular findings predominate with the passage of time. Similarly, Still's disease is initially diagnosed on the basis of clinical criteria, and later confirmed by the evolution of chronic polyarthritis. Diagnostic approaches for the evaluation of patients presenting with acute arthritis have been published and are readily available (2,8,9). The most reliable way to establish the diagnosis for a rheumatic disease is thoughtful and thorough evaluation by an experienced clinician (3,10). Certain discriminating features and confirmatory tests can aid in the diagnosis of polyarthritis with fever (Tables 2 and 3).
9697989 Bystander suppression of murine collagen-induced arthritis by long-term nasal administrati 1998 Jul Oral and more recently nasal tolerance have attracted attention as potential treatments of autoimmune disease. Arthritis induced by bovine type II collagen (CII) is a widely used animal model of rheumatoid arthritis, which is here used to investigate the efficacy of nasal treatment by a short peptide. The peptide spans residues 707-721 (designated p707), an epitope of mouse CII that is most strongly recognized after immunization of mice with this self-protein. The treatment was partially effective, but almost only when the peptide was administered in large doses over a prolonged period. Mice immunized with bovine CII respond mainly to other peptides, located in the CB11 fragment around amino acid residues 256-270. The tolerance effect therefore results from intramolecular suppression, between epitopes located in different parts of this large protein.
9503700 Joint replacement for arthritis. 1998 Jan BACKGROUND: Joint replacement is most commonly performed at the hip and knee for osteoarthritis. It is also possible to replace joints such as: the shoulder, elbow, metacarpophalangeal joints and ankle, but usually only when the joint has been destroyed by rheumatoid arthritis. While the main benefit of joint replacement is the resolution of arthritic pain, range of movement and function can also be improved and the length of the limb or alignment of the joint may be restored. OBJECTIVE: In this article we address the indications for joint replacement, and how the patient is assessed. The results of joint replacements of varying joints are considered and we discuss some topical current concepts in joint replacement surgery.