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ID PMID Title PublicationDate abstract
9375891 Validation of a Spanish version of the Childhood Health Assessment Questionnaire. 1997 Nov OBJECTIVE: To determine the reliability and validity of a Spanish version of the Childhood Health Assessment Questionnaire (CHAQ). METHODS: Fifty-five patients with juvenile rheumatoid arthritis (JRA) [35 girls, 20 boys; mean age at onset (+/- SD) 11 +/- 3.3 yrs, mean disease duration 3.3 +/- 2.2 yrs] were included in an observational and cross sectional study that evaluated translation validity, cross sectional construct validity, and test-retest reliability of the Spanish version of the CHAQ. The questionnaire was administered to either patients or one of their parents, and results were correlated with the Steinbrocker functional class, the Juvenile Arthritis Functional Assessment Scale (JAFAS), and disease activity. RESULTS: The mean CHAQ score (mean 0.77, range 0.01-2.25) was found to correlate at different levels with Steinbrocker functional class (r = 0.62, p < 0.0001), JAFAS (r = 0.65, p < 0.0001), and disease activity score (r = 0.40, p < 0.0001). Test-retest and interobserver agreement had good correlations. CONCLUSION: The Spanish version of the CHAQ we studied is a reliable and valid tool for assessment of health status in Spanish speaking children with JRA.
9327739 Expression of cytokine mRNA in lentivirus-induced arthritis. 1997 Oct Infection of goats with the lentivirus caprine arthritis encephalitis virus (CAEV) leads to persistent infection and development of chronic arthritis. We analyzed the expression of cytokines and viral RNA in the joints of goats at early time points after experimental infection with CAEV and in those of animals suffering from chronic arthritis as a result of natural infection. In situ hybridization experiments showed that the pattern of cytokine expression in caprine arthritis was similar to that found in rheumatoid arthritis (RA), with a few cells expressing the lymphocyte-derived cytokines interferon (IFN)-gamma and interleukin (IL)-2 and rather more cells expressing monocyte chemoattractant protein (MCP)-1, IL-6, and tumor necrosis factor (TNF)-alpha. IFN-gamma mRNA expression in experimentally infected joints peaked at day 12 and was mostly detected in areas containing viral RNA. At later time points, no IFN-gamma- or virus-expressing cells were found in inflamed joints but both were again detected in goats with severe arthritis. Interestingly, at the clinical stage of arthritis reflecting the chronic stage of infection, the inflammatory lesion was found to be immunologically compartmentalized. Humoral immune responses and cell-mediated immune responses appeared to concurrently occur in distinct areas of the synovial membrane.
9162457 [Toxocara infections in childhood in relation to reactive arthritis]. 1997 Mar Reactive arthritis belongs to a group of rheumatoid diseases known as seronegative spondylarthritis or spondarthropathies. Of many reactive arthritis-evoking agents, the authors focused on larval toxocarosis. The authors describe a child with high anti-Toxocara antibody and circulating antigen titres in combination with acute Chlamydia infection, which may have caused reactive arthritis in this immunologically impaired organism. This is evidence of the coincidence of different pathological factors manifested by reactive affection of the knee joint.
10399791 Agalactosyl IgG is elevated in patients with active spondyloarthropathy. 1999 Patients with rheumatoid arthritis or with Crohn's disease have deficient galactosylation of serum IgG [Gal(0)]. To study whether such deviation occurs in patients with spondyloarthropathy (SPA), we studied the percentage incidence of Gal(0) corrected for age [Gal(0)corr] in 47 SPA patients undergoing ileocolonoscopy and correlated the findings with clinical variables and prognosis of the patients. Gal(0)corr was elevated in 36% of the patients. Such patients had a higher number of inflamed joints (P < 0.02), higher ESR (P < 0.001) and CRP (P < 0.001). Elevated Gal(0)corr was also of prognostic significance: at 6-month follow-up those with elevated levels had a higher number of inflamed joints (P < 0.02) and ESR (P < 0.05). The presence of high Gal(0)corr did not associate with gut inflammation. In conclusion, a proportion of SPA patients has elevated levels of Gal(0), the amount of which correlates with severity of the disease and is a prognostic marker for chronicity of the disease.
9725222 Rheumatoid factor specificity of a VH3-encoded antibody is dependent on the heavy chain CD 1998 Sep 1 Rheumatoid factors (RF) recognize conformational determinants located within the Fc portion of IgG. By analyzing a panel of monoclonal rheumatoid arthritis (RA)-derived RFs, we previously demonstrated that the somatically generated light chain complementarity-determining region 3 (CDR3) contributes to RF specificity. We have now generated a panel of heavy chain mutants of the B'20 Ab, a high affinity RA-derived IgM RF. B'20 also binds avidly to protein A and weakly to ssDNA and tetanus toxoid. B9601, a RF negative Ab that is highly homologous to B'20 but does not bind any of the Ags tested, and RC1, a low affinity polyreactive RF, were used to generate heavy chain mutants with framework (FR) and CDR switches. The mutated heavy chains were cotransfected into a myeloma cell line with the germline counterpart of the B'20 light chain, and the expressed Ig tested for antigenic specificity. We show that both RF specificity and polyreactivity of B'20 is dependent on its unique heavy chain CDR3 region. Replacement with a B9601 CDR3 shortened to the same length as the B'20 CDR3, and with only 5 amino acid differences, did not restore Fc binding. Conversely, absence of protein A binding of B9601 is due to the presence of a serine residue at position 82a in the B9601 heavy chain FR3 region. Together, our data suggest that Ig gene recombination events can generate B cells with autoantibody specificities in the preimmune repertoire. Abnormal release, activation, expansion, or mutation of such cells might all contribute to the generation of a high titer RF response in patients with RA.
11388597 Severe reversible renal failure due to naproxen-associated acute interstitial nephritis. 2001 May Acute interstitial nephritis is uncommon in children and has very rarely been described with naproxen treatment. We report the occurrence of severe acute renal failure in a 10-year-old girl with juvenile rheumatoid arthritis after 1 month of naproxen therapy. Renal biopsy showed severe acute interstitial nephritis. The patient recovered completely after discontinuation of naproxen and administration of methylprednisolone. A review of the literature regarding non-steroidal anti-inflammatory drug-associated acute interstitial nephritis is provided. CONCLUSION: In an era of increasing popularity of non-steroidal anti-inflammatory drugs for use in children, paediatricians should be aware of the potential renal complications of this class of drugs.
9642891 Trajectories of adaptation in pediatric chronic illness: the importance of the individual. 1998 Jun This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.
24383727 Follow-up results of arthroscopic synovectomy for the rheumatoid knee. 2001 Sep Abstract Arthroscopic synovectomy (ASS) of a rheumatoid knee is performed in cases of intractable synovitis. This spares the articular cartilage, and is an effective and simple treatment for chronic knee synovitis. This retrospective study was performed to evaluate the outcome of surgical arthroscopy, and study the clinical results in detail. A total of 160 knees, in 138 patients, were assessed after a mean follow-up of 35 months. There was a statistically significant improvement in pain, synovitis, and walking ability for at least 24 months after surgery. Based on the results of our study, age, duration of rheumatoid arthritis (RA), and erythrocyte sedimentation rate (ESR) and level of C-reactive protein (CRP) at surgery were not predictors of a poor long-term outcome of ASS. However, the clinical results correlated with the Lansbury index, loss of extension of the knee joint, a modified Larsen score, and the Larsen grade of the knee joint. Of the cases studied, total knee arthroplasty (TKA) was performed in 29 knee joints. We concluded that although ASS can reduce local inflammation and delay the need for definitive replacement surgery, patients over 60 years of age who show severe radiographic changes should undergo primary TKA.
24383593 The Senami Wrist Supporter for patients with rheumatoid arthritis. 2000 Sep Abstract One of the wrist orthoses, the Senami Wrist Supporter (SWS), was applied to 203 rheumatoid wrists in 112 patients who had persistent wrist pain and restricted forearm rotation due to synovitis and instability at the distal radioulnar joint (DRUJ). The study was performed by sending out a questionnaire to the patients about the use of the SWS at home, and examining grip strength and forearm rotation with and without the use of the SWS. The average age of the patients was 61 years, and the average follow-up period was 18 months. The rate of compliance of wearing the SWS at home was 73% on average. It was higher in wrists of Larsen-Dale-Eek (LDE) grades 0, I, and II (normal, slight, and definite early abnormality) than in those of grades III, and IV (medium and severe destructive abnormality). Decreased pain was noted in 52% of the wrists at the time of applying the SWS. The SWS was not used in 10% of the wrists because of remission of pain at follow-up. Grip strength increased significantly (P < 0.01) and so did forearm rotation (P < 0.05) by the stabilizing effect of the SWS on the unstable DRUJ. The use of the SWS was confirmed to be an efficient measure to treat painful rheumatoid wrists with early stages of disease at the DRUJ.
9559977 Oral administration of HSP-containing E. coli extract OM-89 has suppressive effects in aut 1998 OM-89 (Subreum) is an E. coli extract used for oral administration in the treatment of rheumatoid arthritis. It contains bacterial heat shock proteins, namely hsp60 and hsp70, which were shown to be major immunogenic constituents of the drug. Immunity to bacterial heat-shock antigens was shown to be a means of immunomodulation of (experimental) autoimmune disease and possibly inflammation in general. This was demonstrated for mycobacterial hsp60 respectively hsp70 in autoimmune disease models for arthritis, diabetes and encephalitis. Parallel to the effects displayed by immunisation with hsp, oral administration of hsp-containing OM-89 was found to modify autoimmune disease in a number of animal models, such as for arthritis, diabetes and SLE. In rats immunisation with OM-89 was found to lead to proliferative T cell responses to hsp60 and hsp70 of both E. coli and mycobacterial origin. Conversely, immunisation with hsp antigens could induce T cell reactivity specific for OM-89. Given this and the autoimmune disease modulating properties of both hsp and OM-89 it is argued that OM-89 acts via the same mechanism as proposed for hsp: that peripheral tolerance is induced at the level of regulatory T cells with specificity for heat-shock proteins. This may constitute one mode of action for OM-89 as an arthritis suppressive oral drug in man.
11102560 Clinical experience with specific COX-2 inhibitors in arthritis. 2000 Nov The common mechanism of action of aspirin and the chemically unrelated non-steroidal anti-inflammatory drugs (NSAIDs) is the inhibition of prostaglandin (PG) production due to interference with the enzymatic activity of cyclooxygenase (COX). These agents have long been used as effective treatments for arthritis. The recognition that the inducible isoform COX-2 was associated with inflammation and arthritis led to the hypothesis that PGs produced by a COX-2-dependent pathway were responsible for the inflammation, pain, and tissue destruction. Since the constitutive COX-1 enzyme was identified as responsible for gastroprotection and inhibition of platelet function, the potential for compounds that were both effective and safer than NSAIDs led to rapid development of agents that specifically inhibit COX-2. These agents have now been tested and approved for use by the US Food and Drug Administration for patients with osteoarthritis and rheumatoid arthritis. They have been shown equally effective to comparitor NSAIDs. More importantly, there is a 3.5-fold reduction in the incidence of endoscopic gastroduodenal ulcerations and early data suggesting a similar reduction in clinically significant perforations, symptomatic ulcers, and bleeds. In patients with arthritis at risk for gastrointestinal complications of NSAIDs, specific inhibitors of COX-2 provide an effective and apparently safer form of anti-inflammatory agent.
11902335 Responses of the rat immune system to arthritogenic adjuvant oil. 2001 Dec T-cell mediated inflammatory joint diseases with similarities to rheumatoid arthritis (RA) can be triggered in arthritis-prone rat strains by intradermal injection of adjuvant oils. The pathogenesis of oil-induced arthritis (OIA) remains elusive, and a largely unresolved question is how the rat immune system responds to arthritogenic oils such as incomplete Freund's adjuvant (IFA). Here we report that IFA already induces increased plasma levels of the acute-phase reactants (APR) fibrinogen and alpha1-acid glycoprotein at day 4 postinjection (p.i). In contrast, no early responses were detected in the joints before infiltration of the T cells, which coincided with arthritis onset at 11-14 days post injection (d.p.i.) The infiltrating cells were possibly derived from draining lymph nodes (LN), which were hyperplastic and contained increased cell numbers from 4 days p.i. and onwards. The magnitude of the early increase in cell numbers and APR was regulated by non-major histocompatibility complex (MHC) genes, as determined by comparison between arthritis-susceptible DA rats and arthritis-resistant but MHC-identical LEW.lAV1 and PVG.1AV1 rats. Arthritisprone DA rats developed a weak acute-phase response, suggesting that this systemic response may be counteracting disease. The DA rats also had the largest early increase in LN-cell numbers, suggesting that the LN hyperplasia is part of a disease pathway. The analysis of hyperplastic LN after in vivo labelling with bromodeoxyuridine (BrdU) revealed increased numbers and proportions of proliferating lymphocytes, including T cells. Furthermore, polymerase chain reaction (PCR)-analysis of LN cytokine mRNA revealed upregulation of interleukin (IL)-1beta at 4 d.p.i. We conclude that adjuvant oil exposure triggers both systemic acute phase reactions and local activation of the peripheral lymphoid system. These responses are genetically regulated and may determine arthritis development and susceptibility.
9776124 Successfully treated sulphasalazine-induced fulminant hepatic failure, thrombocytopenia an 1998 We report the simultaneous development of fulminant hepatic failure, thrombocytopenia and erythroid hypoplasia in a child treated with sulphasalazine. A 12-year-old girl with juvenile rheumatoid arthritis developed fulminant hepatic failure, thrombocytopenia and erythroid hypoplasia, which was confirmed by liver histology and bone marrow examination, 2 weeks after initiation of sulphasalazine therapy. The patient recovered after administration of high doses of intravenous immunoglobulin. This is the first reported case of the concurrent development of these complications associated with sulphasalazine hypersensitivity. The use of intravenous immunoglobulin may have helped in the treatment of this rare adverse effect of sulphasalazine.
11390568 Empirically supported treatments in pediatric psychology: regimen adherence. 2001 Jul OBJECTIVE: To review empirical studies of psychological interventions for nonadherence to medical regimens for three chronic illnesses: asthma, juvenile rheumatoid arthritis (JRA), and type 1 diabetes. METHODS: The Chambless criteria for "promising," "probably efficacious," or "well-established" were applied to 8 intervention studies on asthma, 4 on JRA, and 11 on type 1 diabetes. RESULTS: For asthma, organizational strategies appear probably efficacious in promoting adherence, whereas educational and behavioral strategies appear promising. For JRA, behavioral strategies appear probably efficacious in improving adherence. For type 1 diabetes, multicomponent packages and operant learning procedures appear probably efficacious, whereas cognitive-behavioral strategies appear promising. No interventions were identified as "well-established." CONCLUSIONS: Future studies will need to develop adequate definitions of adherence, accurate methods of assessing adherence, and appropriate designs to evaluate multicomponent treatment programs to advance interventions to the "well-established" category.
11344713 Patterns of intraocular inflammation in children. 2001 AIM: To report on the causes of uveitis in children and young adults and their effects on visual functions. MATERIALS AND METHODS: Two hundred and seventy six patients, 18 years old or younger, with uveitis were included in this study. The intraocular inflammation (uveitis) was classified according to anatomical site of ocular involvement and the most probable etiological factor. The final diagnosis was based on clinical manifestations and the results of specific laboratory investigations. RESULTS: Bilateral intraocular inflammation was observed in 70.3% of the cases and 29.7% had either the left or the right eye involved. The symptomatology was relatively mild in most cases despite the fact that the visual acuity was markedly affected. An associated systemic disease was detected in 40.2% of the cases classified as non-infectious. Of this group, juvenile rheumatoid arthritis was the most common single systemic associated cause detected in 41 children. In 110 children (59.8%), the uveitis was strictly confined to the eyes with 70 of these (25.4% of the total group) classified as idiopathic. Parasites were the most common infectious-associated cause for the uveitis followed by viruses and bacteria. CONCLUSION: Uveitis is highly prevalent among children. In children, symptomatology of the intraocular inflammation may be very mild. However, visual acuity is markedly reduced leading to amblyopia in the young children. Early detection and treatment is therefore of utmost importance.
10752996 Seropositive polyarthritis and skin manifestations in T-prolymphocytic leukemia/Sezary cel 2000 Apr Sezary cell leukemia (SCL) is a rare T cell neoplasia that has been suggested to be a variant of T-prolymphocytic leukemia (T-PLL). Both disorders have an aggressive clinical course, lymphocytosis with characteristic morphology, lymphadenopathy, hepatomegaly, characteristic cytogenetic abnormalities and mature T cell phenotypes. Skin lesions, however, are mainly found in T-PLL. We describe a patient with T-PLL/SCL, who atypically presented with severe seropositive polyarthritis and skin lesions, responding to treatment with human CD52 antibody, CAMPATH-1H and pentostatin. Meningeal leukemia and an assumed myocardial infiltration subsequently developed. Polyarthritis is common in T large granular lymphocyte leukemia and adult T cell lymphoma-leukemia, but both entities could be ruled out in the present case. In rheumatoid arthritis, an expansion of CD4+ and/or CD8+ T lymphocytes is well documented and this phenomenon is believed to be of pathogenetic importance. We speculate that the T cell clone in the present case had special homing properties or cytokine effects resulting in synovitis.
9133961 Systematic detection of mycoplasmas by culture and polymerase chain reaction (PCR) procedu 1997 Mar The objective was to investigate the presence of mycoplasmas in rheumatoid arthritis (RA) and other chronic arthritides. Samples of synovial fluid (SF) were systematically collected from all patients presenting with an articular effusion. Each sample was divided into three parts. The first was kept for cytological count and culture on standard media for pyogens and mycobacteria, the second was cultivated on specific media for mycoplasmas and the third frozen for subsequent study by polymerase chain reaction (PCR). A total of 209 samples were studied. Half of the patients had inflammatory rheumatic diseases: RA (27), spondyloarthropathy (28), connective tissue disease (5), unclassified arthritis (45). The remaining suffered from other conditions, including osteoarthritis (60), gouty arthritis (19), haemarthrosis (5), post-traumatic effusion (2). Eight samples were positive by culture, two for Mycoplasma hominis; three for M. fermentans, one for M. salivarium, one for M. orale and one for Ureaplasma urealyticum. All the patients concerned had an inflammatory rheumatic disease: five had RA, one had psoriatic arthritis and two had unclassified arthritis. These results were confirmed by PCR in two cases (one M. fermentans, one U. urealyticum). The lack of sensitivity of the conventional PCR assay on SF is discussed. Mycoplasmas were mainly detected in SF of RA patients. These results raise the question of the possible role of mycoplasmas in the triggering and maintenance of inflammatory rheumatic diseases, especially RA.
10728745 Total-body bone mineral content in non-corticosteroid-treated postpubertal females with ju 2000 Mar OBJECTIVE: To determine the extent of low total-body bone mineral content (BMC) in non-corticosteroid-treated white postpubertal females with juvenile rheumatoid arthritis (JRA) compared with healthy age- and race-matched female controls, and to identify variables that significantly contribute to total-body BMC. METHODS: Thirty-six females with definite JRA who had never received corticosteroids and 51 healthy female controls were evaluated. All subjects had had their first menstrual period at least 2 years prior to enrollment. Total-body BMC, lumbar spine bone mineral density, and body composition were determined by dual x-ray absorptiometry. Total-body BMC Z-scores were calculated for JRA patients using data from controls. JRA patients were dichotomized into those with "normal" bone mass (total-body BMC at or above the mean or no more than 1 SD below the mean) and those with "low" bone mass (total-body BMC more than 1 SD below the mean). Comparisons of anthropometric measurements, laboratory measurements of bone metabolism, disease activity, dietary intake, and physical activity were performed. Stepwise logistic regression was utilized to determine the presence or absence of low total-body BMC and to identify associated contributing factors. RESULTS: Total-body BMC was 4.5% lower in JRA patients than in controls (mean +/- SD 2,050 +/- 379 gm versus 2,143 +/- 308 gm; P = 0.21). Twenty-five of 36 patients (69.4%) had "normal" and 11 of 36 (30.6%) had "low" total-body BMC. Comparison of JRA patients with "normal" versus those with "low" total-body BMC revealed significant differences in disease characteristics, anthropometric and physical development characteristics, laboratory measures of bone mineralization, and dietary intake. The final regression model contained only lean mass (P = 0.01), which accounted for 76.3% of the variance in total-body BMC. The odds ratio for lean mass was 0.4451 (95% confidence interval 0.2374-0.8348). CONCLUSION: In this study, approximately 30% of the subjects in a sample of postpubertal female patients with mild-to-moderate, non-corticosteroid-treated JRA had low bone mass. The predictor variable that significantly contributed to total-body BMC was lean mass, which demonstrated a protective effect of 0.56 risk reduction for low total-body BMC.
10453030 Acceleration and increased severity of collagen-induced arthritis in P-selectin mutant mic 1999 Sep 1 P-selectin plays an important role in leukocyte adherence to microvascular endothelium and is expressed in synovial tissue from patients with rheumatoid arthritis (RA). However, the contribution of P-selectin to the initiation and chronicity of joint inflammation is not well understood. In these studies, collagen-induced arthritis (CIA) was induced in P-selectin mutant (-/-) mice to explore the role of P-selectin in the development of joint inflammation. Surprisingly, CIA onset was accelerated and severity was increased in P-selectin mutant mice, compared with wild-type mice (+/+). Increased levels of anti-type II collagen IgG were detected in both nonarthritic and arthritic P-selectin mutant mice from days 14-91. In addition, splenocytes isolated from immunized and nonimmunized P-selectin mutant mice produced significantly less IL-2 and IL-4, but significantly higher levels of IL-10 and IL-5 than splenocytes from wild-type mice. These observations show that P-selectin-mediated leukocyte rolling is not required for the development of murine CIA and that P-selectin expression exerts a controlling effect on the development of Ag-driven inflammatory joint disease, possibly by mediating the recruitment and/or trafficking of specific leukocyte subtypes into lymphoid tissue or inflammatory foci.
9795775 Diversification of response to hsp65 during the course of autoimmune arthritis is regulato 1998 Aug Determinant spreading has been implicated in the pathogenesis of certain autoimmune diseases in animal models. We have observed that during the course of adjuvant arthritis (AA) in the Lewis rat, there is 'diversification' of response to the bacterial 65-kDa heat shock protein (Bhsp65) towards its carboxy-terminal determinants (BCTD). Strikingly, pretreatment of naive Lewis rats with BCTD affords significant protection from AA. Our preliminary studies indicate that the diversification of response to BCTD in the Lewis rat is probably triggered in vivo by the induction and enhanced processing of self(rat) hsp65. Thus, the self hsp65-directed T-cell responses appear to be involved in mediating natural remission from acute inflammatory arthritis induced by a foreign antigen, Mycobacterium tuberculosis. This the first report describing that the new T-cell specificities arising during the course of an autoimmune disease are regulatory/protective rather than pathogenic. Moreover, our results suggest that a final common mechanism involving BCTD might be recruited by other rat strains which either are resistant to AA (WKY rats) or whose susceptibility to AA is modulated significantly by microbial flora (Fisher rats). The results of this study would contribute significantly to understanding of the pathogenesis of human rheumatoid arthritis, and in devising new therapeutic strategies for this disease.