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ID PMID Title PublicationDate abstract
11157138 A prospective 2-year study of 75 patients with adult-onset septic arthritis. 2001 Jan AIMS AND METHODS: To assess the clinical features of septic arthritis and characterize therapeutic strategies and outcome in a prospective study of 75 patients selected by positive synovial fluid culture. RESULTS: Underlying joint disease was present in 46 patients, 25 of whom had rheumatoid arthritis and 15 osteoarthritis. Eleven patients were i.v. drug abusers. Fifty-six per cent of cases involved the knee, 15% involved two or more joints, and staphylococci and streptococci were cultured in >90%. Seventy-eight per cent of patients lived in areas of high social deprivation. Fever was present in 64% and the white cell count (WCC) was normal in 38%. The C-reactive protein was elevated in 98%. Leg ulcers were present in 11% of all patients but in 38% of patients who died (P<0.006). Median duration of antibiotic therapy was 15 days i.v. with subsequent oral treatment for 21 days. Thirty-seven per cent of cases required surgical intervention. Mortality was 11%. A raised WCC at presentation (P<0.02) and the development of abnormal renal function (P<0.015) were predictors of poor prognosis.
11064960 Family reinforcement of illness behavior: a comparison of adolescents with chronic fatigue 2000 Oct Parental encouragement of illness behavior is hypothesized to correlate with psychosocial dysfunction in adolescents with chronic illness. To explore this hypothesis, adolescents aged 11 to 17 years with chronic fatigue syndrome (CFS) (n = 10), juvenile rheumatoid arthritis (JRA) (n = 16), and healthy adolescents (n = 14) were recruited for the study. Measures included the Achenbach parent and youth self report forms, the Family Adaptability and Cohesion Evaluation Scale-II (FACES II), the Children's Depression Rating Scale, and number of days absent from school. The Illness Behavior Encouragement Scale (IBES) generated measures of parental reinforcement of illness behavior. As predicted, the teens with CFS scored statistically higher on measures of depression, total competence, and number of days of school missed in the previous 6 months (mean = 40). Children with JRA scored significantly lower than the CFS group on the measure of parental reinforcement of illness behavior. The healthy group produced intermediate scores. Results and implications for future clinical and research activity are discussed.
9446416 [Radiologic findings in gout]. 1997 Radiological gout manifestations are detectable in the early stage, but also especially in the chronic stage of gout. Whereas in the early stage only soft tissue mutations (bursitis inflammation) and light calcium deposits are usually discernible, chronic gout leads to asymmetrical, diverse forms of osseous destruction, favouring smaller joints, but also affecting larger ones, which are caused by the intra-articular and extra-articular deposit of tophus material, corresponding to the progression and degree of severity of the illness. Radiologically-detectable changes in other organs, such as the kidneys, will be addressed. The high number of, and to some extent very characteristic, osseous mutations are compared with those mutations which are very similar to the diagnoses of other syndromes affecting the joints. Specifically, problems in differentiating diagnosis of rheumatoid arthritis, arthritis psoriatica, chondrocalcinosis, and other diseases of the joints will receive special mention. Reference is also made to the extreme diagnostic difficulties resulting from the rare but nevertheless conceivable influence of gout on the spine or sacroiliac joints. The method of magnetic resonance imaging for gout shows a characteristic signal behaviour of the tophus material. It has been determined that, through magnetic resonance tomography, interosseous tophi can be detected earlier and in a more widespread manner than with the aid of native X-ray images, such that an increase in the use of this method is to be expected.
9092017 [Pseudo-Still disease and deep neoplasm]. 1997 Some rare observations with the diagnosis of Still's disease in adults reveal a different diagnosis: a paraneoplasic syndrome related to a non differentiated bronchitic carcinoma. The term "paraneoplasic pseudo Still's disease" can be considered. However we have to add a syndrome of intestinal dysfunction with characteristics of pseudoblockage with an imprecise mechanism.
12973415 Cytokines and cell adhesion molecules in musculoskeletal disorders. 1999 Feb This paper reviews the cytokine profiles and various cell adhesion molecules expressed in the more common inflammatory joint conditions such as rheumatoid arthritis, psoriatic arthritis, the spondyloarthropathies (Reiter's syndrome, ankylosing spondylitis), as well as systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, giant cell arteritis and polymyositis. Knowledge of the broad range of cytokines produced in these conditions and the expression of cell adhesion molecules that result from cytokine production will assist in the understanding of the pathogenesis of these conditions and may lead to new therapeutic interventions.
11402412 Rehabilitation after total shoulder arthroplasty. 2001 Jun Physical therapy constitutes an essential determinant of clinical outcome after total shoulder arthroplasty. We reviewed our results in 81 shoulders at a minimum of 2 years' follow-up, with specific focus on the maintenance of motion and the development of soft tissue healing problems. Our findings show that our graduated rehabilitation program allows most patients to obtain motion comparable to that possible intraoperatively with few complications. Of patients, 70% maintained their elevation, and 90% maintained external rotation. Patients with a diagnosis of rheumatoid arthritis, traumatic arthritis, and osteonecrosis were identified as being at risk for failure to regain motion and for tendon healing complications.
17039146 Polymyalgia rheumatica and temporal arteritis with sacroiliitis and osteitis pubis. 2001 Aug Polymyalgia rheumatica (PMR) and temporal arteritis (TA) have been associated with a seronegative polyarthritis that can mimic rheumatoid arthritis. Sacroiliitis and osteitis pubis are most often encountered in the different types of spondyloarthropathy. However, sacroiliitis and osteitis pubis have rarely been described in patients with polymyalgia rheumatica and temporal arteritis. We present two patients, one with temporal arteritis and the other with polymyalgia rheumatica, who also had many features of a spondyloarthropathy, including sacroiliitis and osteitis pubis. In reviewing the literature, we found 30 other patients with a diagnosis of PMR who also had sacroiliitis and/or osteitis pubis. We propose that the inflammatory arthritis associated with polymyalgia rheumatica and temporal arteritis can involve the axial joints, resembling a spondyloarthropathy. It is important for the clinician to recognize that sacroiliitis and osteitis pubis have been associated with PMR and TA so that their radiographic presence does not dissuade the clinician from making the correct diagnosis.
11828677 The clinical entity of remitting seronegative synovitis with pitting edema (RS3PE syndrome 2001 Nov Remitting seronegative symmetrical synovitis with pitting edema is a clinical entity distinct from polymyalgia rheumatica arthritis appearing in elderly patients. Distal pitting edema and tenosynovitis of the digitorum tendons are characteristically seen in this disorder. In contrast to polymyalgia rheumatica and rheumatoid arthritis, treatment with low-dose glucocorticoids usually produces a prompt and enduring remission after several months. Follow-up evaluations are necessary not only to assure this diagnosis is posterior, but also to observe for the possible occurrence of associated neoplasms.
11094458 Bone loss. Factors that regulate osteoclast differentiation: an update. 2000 Osteoclast activation is a critical cellular process for pathological bone resorption, such as erosions in rheumatoid arthritis (RA) or generalized bone loss. Among many factors triggering excessive osteoclast activity, cytokines such as IL-1 or tumour necrosis factor (TNF)-alpha play a central role. New members of the TNF receptor ligand family (namely receptor activator of nuclear factor-kappa B [RANK] and RANK ligand [RANKL]) have been discovered whose cross-interaction is mandatory for the differentiation of osteoclasts from hemopoietic precursors, in both physiological and pathological situations. Osteoprotegerin, a decoy receptor which blocks this interaction, decreases osteoclast activity and could have a fascinating therapeutic potential in conditions associated with upregulated bone resorption.
9637749 Gold, the noble metal and the paradoxes of its toxicology. 1998 Mar Gold is possibly the most ancient and, in its recent incarnation as a delivery vehicle for gene therapy, one of the most modern agents in all of medicine's pharmacopoeia. Its administration to humans is both deliberate and inadvertent. It is universally recognized as the most inert of metals, yet it can be sensitizing. Gold's broadest clinical application (in rheumatoid arthritis) derives from a premise that was totally flawed. It is employed clinically to effect immune suppression yet it can engender toxicities that stem from immunostimulation. To complete this series of paradoxes, the toxicity of gold, unlike that of most pharmaceuticals, is, in general, not predictably related to the levels it attains within bodily tissues. Accordingly, the pharmacology and toxicology of gold is remarkably complex. Recent laboratory discoveries concerning gold's metabolism, have emphasized the important metabolic differences between its three oxidation states (0, I and III). When placed in the context of a wealth of clinical experience, these discoveries provide useful insights into its toxicology and shine a revealing light on the mechanisms which account for its seemingly paradoxical behaviour.
16113966 BMS-188667 (Bristol-Myers Squibb). 1999 Dec Bristol-Myers Squibb is developing CTLA4-Ig, an immunosuppressant immunoglobulin, for the potential treatment of various immunological disorders, including graft versus host disease, lupus erythematosus and psoriasis. A phase II trial has commenced for psoriasis. The compound is also in development for inflammation, rheumatoid arthritis and allergy. A collaboration with Genzyme Transgenics covers the following indications: psoriasis; organ transplant rejection; and several autoimmune disorders.
9884360 Different therapeutic and bystander effects by intranasal administration of homologous typ 1999 Jan To assess the efficiency of nasally administered cartilage-specific collagens as vaccination against development of arthritis and to ameliorate already established chronic arthritis, experimental models which develop chronic arthritis, pristane-induced arthritis (PIA), and homologous collagen-induced arthritis (CIA) in the rat were selected. Cartilage-specific collagens type IX (CIX) and type II (CII) were used for vaccination intranasally. A single dose of 250 microg CII instilled intranasally in rats with established PIA ameliorated the disease. For the prevention of disease, the same dose given before immunization was found to be most effective. Most importantly, the disease was more severe if this dose was given three times. For treatment of PIA, CIX was found to be more effective than CII, whereas for treatment of CIA only CII was effective. The amelioration of CIA was associated with a marked suppression of delayed type hypersensitivity and the flare reaction to CII and lower levels of IgG2b anti-CII antibodies in serum, i.e., with suppression of the TH1 rather than the TH2 response to CII. These findings, that cartilage proteins, if given intranasally, can both prevent and ameliorate established chronic arthritis in rats, are of significant importance for possible use in rheumatoid arthritis. The identification of two different cartilage-specific proteins (CII and CIX) effective against a disease induced with a well-defined nonimmunogenic adjuvant such as pristane will be of value for enhancing the effectiveness of the treatment.
10422216 The Olerud Cervical Fixation System; a study of safety and efficacy. 1999 To evaluate safety and efficacy of the Olerud Cervical Fixation System a one-year follow up study was done by an independent observer. There were 30 patients (14 women) with a mean age of 68 (37-85) years. Indications were rheumatoid arthritis in 10, spinal stenosis in 6, trauma in 6, metastases in 4, revisions in 3, and painful spondylotic deformity in one patient. Short fusions were performed in 8 patients and long fusions in 22. Four patients were fused to occiput. C1-C2 fusion was performed in 3 patients. Nineteen of the 20 still alive were evaluated at follow up. One patient was deliberately fused in hyperlordosis, in the rest the alignment was acceptable. Primary stabilization was achieved in all but one. 107 pedicle screws were used; one screw in Th2 was placed lateral to the pedicle. 42 subaxial transarticular screws were used. There were no complications related to these screws. One patient experienced a non-instrument related neurological deterioration. Two infections and one hematoma drainage healed on conservative treatment. Loss of fixation and non-union developed in 2 patients. Patients with metastasis or myelopathy due to rheumatoid arthritis carried a high mortality risk. The Olerud Cervical Spine Fixation System is versatile in posterior fixation of the cervical spine and has proven to be both safe and efficient.
17638130 A methodological appraisal of the impact of different classification procedures used in th 1998 AIMS: To compare methodological aspects of the impact of different classification procedures used in three phases of a twin study examining genetic factors in the aetiopathogenesis of rheumatoid arthritis (RA). METHODS: We have previously reported the results of a study of the aetiopathogenesis of RA based on the Australian Twin Registry (ATR). In the original 258 pairs self-reporting a diagnosis of RA in twin, co-twin or both, a very high false positive self-reporting rate for RA was noted (Phase 1). Subsequent diagnostic information obtained by a disease-specific questionnaire, followed by telephone interviews with subjects and review of information obtained by mail and telephone interview from the patient's general practitioner or musculoskeletal specialist, identified 23 'true' RA pairs (Phase 2). Pairwise concordance percentages for RA based on those 20 discordant and 3 concordant pairs were as follows: monozygotic (MZ) 21% (95% confidence interval (CI)=6-44%), dizygotic (DZ) 0% (95% CI=0-25%) (probandwise concordance MZ 35% (8.9-67.3), DZ 0% (0-50.3)). Given the potential effects of misclassification on data interpretation, we have further pursued the accuracy of diagnosis by a systematic clinical, serological and radiographical evaluation of the 23 RA pairs (Phase 3). RESULTS: In only one instance did more intense diagnostic investigation of the 23 pairs result in recategorization. The probandwise concordance percentages were recalculated: MZ=37.5%, DZ=0%. CONCLUSIONS: Our original contention that genetic factors play some part in the aetiopathogenesis of RA, but do not account entirely for its determination, has been substantiated at a higher level of confidence and at almost identical levels of concordance.
11603694 Cartilage damage by matrix degradation products: fibronectin fragments. 2001 Oct Catabolic cytokines play a major role in cartilage degradation not only in rheumatoid arthritis but also in osteoarthritis. Although the major source in rheumatoid arthritis may be mononuclear cells and synovial tissue and the cause of release may be multifactorial, the source of cytokines in osteoarthritis would be mostly from chondrocytes. However, there are few explanations of how upregulation of the cytokines might occur in osteoarthritis. One possibility is that degradation products of the extracellular matrix arising from elevated protease levels, substrate, or both, might regulate cytokine activities. Fragments of the extracellular matrix protein, fibronectin, upregulate cytokine expression and induce the events of suppressed matrix synthesis and upregulation of matrix metalloproteinases, characteristic of osteoarthritis. The catabolic aspects of this system are short term, subsequently serve to enhance anabolic processes above untreated levels, and condition the tissue against additional insult. It will be necessary to determine whether in vivo these degradation products precede cytokine expression and act early and are targets for intervention or instead are a consequence of cytokine damage. Whether they regulate anabolism and catabolism, blocking of their activities may not be ideal.
10463513 Selective cyclooxygenase-2 inhibitors for the treatment of arthritis. 1999 Jul The purpose of this paper is to review the rationale for a new class of nonsteroidal anti-inflammatory drugs (NSAIDs) known as selective cyclooxygenase (COX)-2 inhibitors and to present preliminary clinical data on 2 COX-2 inhibitors that are approved for use in the United States. The primary mechanism of NSAIDs in the treatment of inflammation is the inhibition of COX, which exists in 2 forms. COX-I appears to regulate many normal physiologic functions, and COX-2 mediates the inflammatory response. Theoretically, an NSAID that inhibits COX-2 selectively should decrease inflammation but not influence normal physiologic functions and thus should cause fewer gastrointestinal side effects. Preliminary data suggest that celecoxib, a highly selective COX-2 inhibitor, is superior to placebo and similar to traditional NSAIDs in the short-term treatment of pain due to osteoarthritis, although it has been associated with adverse effects such as headache, change in bowel habits, abdominal discomfort, and dizziness. Celecoxib also has been shown to be as effective as traditional NSAIDs in the treatment of rheumatoid arthritis, but it may cause fewer adverse effects, including endoscopically documented ulcers. Celecoxib is metabolized in the liver by the cytochrome P-450 isozyme CYP2C9, and thus serious drug interactions are possible. In the treatment of osteoarthritis, rofecoxib has been shown to be as effective as traditional NSAIDs and may cause fewer endoscopically documented ulcers, but its complete adverse-effect profile is not known. Until the selective COX-2 inhibitors are widely used and more clinical as well as pharmacoeconomic studies are published, the exact role of COX-2 therapy cannot be determined. words: cyclooxygenase, celecoxib, rofecoxib, rheumatoid arthritis, osteoarthritis.
11303307 Sonographically guided procedures in rheumatology. 2001 Apr OBJECTIVE: To provide some representative examples of sonographically guided arthrocentesis and intralesional injection therapy. METHODS: Sonographic evaluation was performed with high-frequency linear (13 MHz) and mechanical sector (20 MHz) transducers. The images were obtained in representative patients with rheumatoid arthritis and posttraumatic subacromial bursitis. RESULTS: Sonographically guided intralesional injection is a rapid and reliable procedure, especially in patients with arthritis, tenosynovitis, and bursitis. After target localization, needle placement can be performed under continuous sonographic monitoring. Sonographic guidance is particularly useful when fluid collections are small (less than 5 mm) and deep or when the inflammatory process is adjacent to anatomic structures that could be seriously damaged by the injection. CONCLUSIONS: Over the last few years, the rapid technologic advancements in ultrasonography have dramatically increased the potential applications of sonographically guided procedures. The simplicity and reliability of the technique might warrant rheumatologists to undergo sonographic training.
10573768 Diets, dietary supplements, and nutritional therapies in rheumatic diseases. 1999 Nov Rheumatoid arthritis and many other systemic rheumatic diseases remain illnesses of unknown cause for which current therapy is often inadequate. This leads patients to seek questionable remedies, prominent among which are dietary manipulations. Is there a role for dietary modifications in the routine therapy for patients with rheumatic diseases? This article discusses the relationships between diets, fasting, elemental nutrition, vitamins, minerals, and foods for rheumatic diseases. Known scientific-based evidence for the use, safety, and efficacy of diets and dietary-related practices subscribed by patients with rheumatic diseases are presented. Studies that link diet with arthritis offer the possibility of identifying new therapeutic approaches for selected patients and of developing new insights to disease pathogenesis. Dietary therapy for arthritis, however, is still being investigated.
17039086 Is Listeria monocytogenes an important pathogen for prosthetic joints? 2001 Feb Listeria monocytogenes usually causes meningitis or bacteremia, often in immunocompromised adults, pregnant women, or infants. We report a case of septic arthritis caused by L. monocytogenes in a patient with seronegative rheumatoid arthritis (RA) whose hip replacement was infected. She subsequently died, probably secondary to an adult respiratory distress syndrome, a rare complication of listerial infection. We also reviewed all 18 previously reported cases of septic arthritis caused by L. monocytogenes. The frequency of underlying RA, diabetes, neoplastic disease, and immunosuppressive therapy is prominent, as is the concurrent presence of a previous knee or hip replacement. Thus, the simultaneous presence of immune suppression and certain medical disorders or their treatment and a prosthetic joint should alert the clinician to the possibility that L. monocytogenes is the offending microbial agent. In contrast, in immunocompetent persons the usual Gram-positive cocci such as staphylococci, streptococci, or even pneumococci predominate. Although the outcome of appropriate treatment with penicillin or ampicillin alone (or with an aminoglycoside or trimethoprim/sulfamethoxazole in penicillin-allergic individuals) is usually favorable, complicating medical disorders can lead to death. Cephalosporins are rarely effective antimicrobial agents in patients with listeriosis.
11327239 Arthritis and rheumatism are neglected health priorities: a bibliometric study. 2001 Apr OBJECTIVE: To investigate the frequency of publications about arthritis and rheumatic diseases relative to other diseases and to examine which topics received most attention. METHODS: Available health statistics were used to quantify the burden of illness due to musculoskeletal (MSK) conditions. Next, a bibliographic analysis of MEDLINE was performed comparing disease categories using the MeSH tree structure for 1991 and 1996. Diseases were ranked according to the frequency of citations attributable to them and further analyses were performed for journal categories, MeSH subheadings, and the frequency of citations for specific types of arthritis and rheumatic diseases. RESULTS: Compared with 9 other causes, MSK diseases are leading contributors to health professional consultations, total health costs, chronic ill health, and disability. In contrast, MSK diseases ranked ninth among twelve major MEDLINE disease categories in 1996 and 1991. These rankings were similarly low across journal categories reflecting basic science research and clinical application. Radiography, rehabilitation, history and embryology were the most frequently used subheadings for MSK diseases. In 1996, there were 16,603 citations for MSK diseases, led by bone diseases (7,304 citations), joint diseases (4,987), muscular diseases (4,236), arthritis (3,555), and rheumatic diseases (3195). Among arthritic and rheumatic diseases, rheumatoid arthritis had the largest number of citations (2,004), followed by systemic lupus erythematosus (927) and osteoarthritis (793). CONCLUSION: Arthritis and rheumatic diseases receive far less attention in the scientific literature than is warranted by their enormous and growing disease burden. Both research and dissemination are lacking and more adequate resources for these activities are indicated.