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ID PMID Title PublicationDate abstract
11687174 Methotrexate for treating juvenile idiopathic arthritis. 2001 BACKGROUND: In both adult rheumatoid arthritis (RA) and juvenile arthritis, the focus has shifted from 'inflammation parameters' to more patient centered disability outcomes. In RA this resulted in the development of the Outcome Measures in Arthritis Clinical Trials (OMERACT), and in juvenile arthritis the Pediatric Rheumatology International Trials Organization (PRINTO) core set. This PRINTO-core set was established using a combination of statistical and consensus formation techniques. This core set contains a number of patient centered disability measures. This review systematically searched the available literature and reports the available evidence of efficacy of MTX, with special focus on patient centered disability measures in Juvenile Idiopathic Arthritis (JIA). OBJECTIVES: To perform a systematic review on the effects of MTX on functional ability, range of motion, quality of life, overall well-being and pain for patients with JIA. SEARCH STRATEGY: The Cochrane Controlled Trials Register (CCTR) and MEDLINE were searched up to March 2001, using the search strategy sensitive for randomised controlled trials, used by the Cochrane Collaboration. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials comparing MTX against placebo or standard care in patients with Juvenile Idiopathic Arthritis (JIA) were selected. DATA COLLECTION AND ANALYSIS: Two reviewers (TT, JN) determined the studies to be included in this review and extracted the data of patient centered disability measures. The data were pooled using standardized mean differences (SMD) for limited joint range score, number of joints with swelling. The number of joints with pain on motion were evaluated using weighted mean differences (WMD). Physicians global assessment, parents global assessment and withdrawals due to efficacy and side effects were evaluated with pooled odds ratios (OR). MAIN RESULTS: Only two studies with a total 165 JIA patients under 18 years of age were included in this review. For JIA patients, MTX therapy had small to moderate effects on patient centered disability outcomes. The effect on joint range of motion, number of joints with pain and swelling and physician's and parent's assessment of disease activity showed a relative percentage improvement from 3 to 23% greater with MTX than with placebo. REVIEWER'S CONCLUSIONS: Current evidence suggests that MTX does have minimal clinically significant effects (>20%) on patient centered disability measures in JIA patients.
11319579 Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-infl 2000 Mar More than 30 million people worldwide consume prescription nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis. Gastrointestinal (GI) toxicity owing to the use of NSAIDs is a well-recognized clinical problem, with approximately 25% of all reported adverse drug reactions being attributed to prescription NSAID use. In addition to prescription NSAIDs, the use of over-the-counter (OTC) formulations of these products is common. Although it has been suggested that OTC doses of NSAIDs may not lead to significant GI toxicity, the data confirming this have been lacking. Data on the GI risks of OTC doses of aspirin, ibuprofen, naproxen, paracetamol, and no drug from 4164 consecutively diagnosed patients with rheumatoid arthritis from eight ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) centers in North America are presented. Serious GI events were defined as GI bleeds and other clinically significant GI events requiring hospitalization. Relative risks were standardized for potential demographic confounders using Cox proportional hazard models. Although the relative risk of OTC doses of NSAIDs (3 to 4) is less than the previously published risk of prescription doses (6 to 7), it remains clinically significant and a matter of serious concern because of the widespread use of these medications and an underappreciation of the true risk. Paracetamol was not associated with increased risk of GI complications and should be considered first-line therapy.
11145024 Amelioration of collagen-induced arthritis in DBA/1J mice by recombinant TSG-6, a tumor ne 2000 Dec OBJECTIVE: To examine the effect of recombinant TSG-6 on collagen-induced arthritis (CIA) in DBA/1J mice. TSG-6 is a tumor necrosis factor (TNF)/ interleukin-1 (IL-1)-inducible hyaluronan-binding protein produced by synovial cells and chondrocytes that is present in synovial fluids of patients with rheumatoid arthritis. METHODS: To determine the effect of TSG-6 on chronic inflammatory joint disease, we induced CIA in DBA/1J mice by immunization with bovine type II collagen. Animals were treated with 12 intraperitoneal doses of 200 microg of recombinant TSG-6, beginning 3 days before the expected onset of disease symptoms. Progression of arthritis was monitored by determining the disease incidence, arthritis index, and footpad swelling. Levels of IgG1, IgG2a, and IgG2b antibodies against bovine and murine type II collagen and serum concentrations of IL-6 were determined at various time points. Histologic examination of affected joints was performed approximately 20 days after the onset of arthritis. RESULTS: Treatment with recombinant TSG-6 protein had a potent ameliorative effect, manifested by decreases in the disease incidence, arthritis index, and footpad swelling. Histologic examination of affected joints in TSG-6-treated animals revealed little pannus formation and cartilage erosion, features which were conspicuous in control mice. Animals treated with recombinant TSG-6 developed significantly reduced levels of IgG1, IgG2a, and IgG2b antibodies against bovine and murine type II collagen. CONCLUSION: The antiinflammatory effect of the TNF/IL-1-inducible TSG-6 protein in murine CIA suggests a role for this protein as an endogenous regulator of the inflammatory process.
10486239 PECAM-1 and leukosialin (CD43) expression correlate with heightened inflammation in rat ad 1999 Aug A hallmark of both adjuvant-induced arthritis (AIA) and rheumatoid arthritis is chronic joint inflammation characterized by ingress of leukocytes into the inflamed synovial tissue. The timing of expression of adhesion molecules, which govern the ingress of leukocytes, is important in the orchestration of an inflammatory response. We examined the expression of vascular cell adhesion molecule-1 (VCAM-1), sialo adhesin, platelet and endothelial cell adhesion molecule-1 (PECAM-1), and leukosialin (CD43) in AIA, starting at adjuvant injection (day 0), through the peak of inflammation (day 18 postadjuvant injection), until day 54. VCAM-1 is constitutively expressed on the lining layer and ECs and its expression levels do not change throughout the progression of AIA. Sialoadhesin synovial tissue lining cell expression is decreased after adjuvant injection. In contrast, PECAM-1 expression is increased on synovial tissue lining cells on day 7 and is elevated through day 54 (peaking on day 54 with six-fold more cells expressing PECAM-1). PECAM-1 expression on endothelial cells peaks on day 7 with three-fold more cells expressing it, while on macrophages expression maximizes on day 25 with six-fold more cells expressing PECAM-1. CD43 expression is increased on synovial tissue lining cells, macrophages, neutrophils, and lymphocytes on days 18 and 25, before going back to basal levels. The increased expression of PECAM-1 and CD43 on leukocytes at the height of inflammation in AIA suggests important roles for these adhesion molecules in potentially binding their EC ligands resulting in leukocyte ingress into the synovial tissue.
9178393 Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee. 1997 Apr The place of arthroscopy-assisted synovectomy in the treatment of inflammatory synovitis of the knee was evaluated by studying 26 patients who underwent this procedure between November 1992 and September 1995. Half the patients had rheumatoid arthritis. Twenty-three patients (28 knees) were reevaluated after a mean follow-up of 32 months (range, 4-50 months). The arthroscopic synovectomy was done either as the first-line synovectomy procedure, after failure of triamcinolone hexacetonide injection into the joint, or as the second-line synovectomy procedure, after failure of osmic acid or yttrium-90 synovectomy. Except in one patient with severe arthritis, arthroscopic synovectomy produced statistically significant improvements regarding pain (visual scale), function (Lequesne's index), range of flexion, amount of joint fluid and knee circumference. The range of extension of the knee was normal at baseline and remained so after the procedure. Overall efficacy was similar for first-line and second-line procedures. Results were rated good to very good by 71% of the patients and 61% of the physicians overall and the overall improvement in knee arthritis as perceived by the patients was 60%. The procedure was well tolerated in 93% of cases. The mean time needed to achieve a stable improvement was 3.2 weeks for pain, 4.7 weeks for swelling and 3.6 weeks for range of motion. One case each of hemarthrosis and stiffness of the knee were recorded, with a full recovery in both cases. Arthroscopic synovectomy is effective and safe but more burdensome and expensive than osmic acid or radiation synovectomy, and consequently deserves a place of choice in patients who have failed to respond to either of the last two methods.
11012598 Rupioid psoriasis with arthropathy. 2000 Jul A 31-year-old male presented with limpet-like, cone-shaped skin lesions on the scalp, the extremities, and the trunk of 4 months' duration, and had had severe joint pain in his right fingers, wrist, and knee for 1 month. Radiological examination revealed arthritis of the above mentioned multiple joints. Rheumatoid factor was serologically negative. Histopathological findings showed dense inflammatory cell infiltration and remarkable Munro's microabscesses in the horny layer in addition to psoriasiform epidermal hyperplasia, and predominant dermal oedema. Based on clinicopathological findings, a diagnosis of rupioid psoriasis with arthropathy was made. Following treatment for arthralgia using low doses of systemic steroid, the effects of cyclosporin combined with topical steroids was seen to alleviate dramatically the skin lesions and arthritis within 2 weeks. There was no recurrence of such skin and joint lesions during a follow-up period of 1 year.
11808982 Antibodies and vascular involvement in inflammatory joint disease: clinical relevance. 2001 Dec The vascular endothelium is a common target of inflammatory joint disease. Autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome can be responsible for a spectrum of vascular disorders that encompasses vasculitis, thrombosis and/or atheroma associated with the antiphospholipid syndrome, and vascular damage caused by cryoglobulin deposition. These mechanisms can coexist, particularly in lupus patients. Joint disease is sometimes the presenting manifestation in primary vasculitis. Autoantibodies are detectable in most patients with vascular involvement and inflammatory joint disease. They are not merely markers for vascular involvement: in vitro and in vivo data suggest that some autoantibodies may contribute to the genesis of endothelial lesions, together with other factors. For instance, evidence of pathogenic effects has been found for antineutrophil cytoplasmic antibody (ANCA), most notably with antimyeloperoxidase or antiproteinase-3 specificity, in small-vessel vasculitides (Wegener's granulomatosis, Churg-Strauss syndrome, and microscopic polyangiitis); for immune complexes, particularly those containing cryoglobulins, in vasculitides secondary to CTDs; and for circulating anticoagulant and anticardiolipin antibodies, above all anti-beta2-glycoprotein I, in antiphospholipid syndrome. Antibodies to annexin V, modified lipoproteins, and endothelial cells may be of interest; their clinical relevance is unclear, however, and no standardized assays are available, so thatthese antibodies are not looked for in everyday practice. When deciding which antibody tests should be performed in a given patient, the circumstances surrounding the onset of the vasculopathy should be borne in mind. In patients with previous CTD, the tests are selected based on the diagnosis. In contrast, in a patient with no previous diagnosis, a vasculopathy can be either primary or secondary to undiagnosed CTD or to antiphospholipid syndrome: consequently, a broader array of tests is needed in this situation.
24383638 Validity and reliability of a revised Japanese version of the Arthritis Impact Measurement 2000 Dec Abstract This study aims to evaluate the validity and reliability of a Japanese version of the Arthritis Impact Measurement Scales, version 2 (AIMS2) for patients with rheumatoid arthritis (RA). The Japanese version of the AIMS2 questionnaire was administered to 1643 patients with classical or definite RA at 11 hospitals nationwide in Japan. Reliability was assessed by a test-retest procedure, 4 weeks apart, using 75 randomly selected patients. Internal consistency was measured by Cronbach's α, and factor analysis was used to obtain the proportion of variance explained by the first factor in principal component analysis. The validity of the AIMS2 scales was assessed by internal standards. Internal consistency (α coefficients, 0.84-0.94), test-retest reliability (intraclass correlation coefficients, 0.75-0.93), and factor analysis (0.62-0.85) of the AIMS2 health status scales proved that they are highly reliable in the Japanese version. Validity, as measured by the relationships among the scores on the questionnaire items, was also sufficiently secured. The validity and reliability of the Japanese version of the AIMS2 are sufficient for all practical purposes when compared with the original and with other translated versions of the questionnaire.
9349435 Direct retrovirus-mediated gene transfer to the synovium of the rabbit knee: implications 1997 Sep We have investigated the feasibility of using high-titer murine leukemia virus-based retroviral vectors to deliver exogenous genes to naive and chronically inflamed knee joints of rabbits in vivo. Intraarticular injection of retrovirus encoding beta-galactosidase (beta-gal or lacZ) was found to transduce synoviocytes in both naive and inflamed joints, but a significantly higher number of lacZ+ cells were found in inflamed knees. Using a retrovirus encoding a secretable marker, human growth hormone (hGH), quantitative comparison of ex vivo and in vivo gene delivery methods demonstrated that transgene expression following in vivo gene transfer was at least equivalent to that of the ex vivo method in inflamed knees. In addition, hGH transgene expression was maintained for at least 4 weeks. These experiments suggest that high-titer retroviral vector could be used for efficient in vivo gene transfer to inflamed joints in patients with rheumatoid arthritis (RA).
9150127 Hematopoietic stem cell transplantation in rheumatic diseases other than systemic sclerosi 1997 May Hematopoietic stem cells (HSC) are increasingly available as an alternative to whole marrow aspirate for bone marrow transplantation (BMT). They may be derived from an HLA matched individual (allogeneic) or from the patient (autologous). Allogeneic BMT is associated with a 15 to 35% mortality, largely due to graft versus host disease. Autologous HSC are used to rescue the patient after severe immunosuppression, and the transplant related mortality is 3 to 5%. The opportunity to ablate severe autoimmune disease with increased safety is particularly attractive for necrotizing vasculitides, polymyositis/dermatomyositis, primary Sjögren's syndrome, systemic juvenile arthritis, relapsing polychondritis, and Behçet's disease, where correct selection of cases would ensure an acceptable benefit/risk ratio. Rheumatoid arthritis (RA), psoriasis associated arthritis (PsA) and some non-rheumatic diseases such as inflammatory bowel disease (IBD), multiple sclerosis, and type 1 diabetes mellitus may also be candidates, but careful selection of patients with a poor prognosis is necessary. There are allogeneic BMT data from patients with aplastic anemia or leukemia and concurrent RA, PsA, and IBD and also autologous HSC BMT data from animal models to support the concept of cure. Patient studies should proceed using recently published protocol guidelines and centralized data collection.
9779854 Utilization and predictive value of laboratory tests in patients referred to rheumatologis 1998 Oct OBJECTIVE: Antinuclear antibodies (ANA), rheumatoid factors (RF), and erythrocyte sedimentation rate (ESR) are among the most frequently requested tests in the diagnosis and investigation of connective tissue diseases (CTD). We evaluate the utilization patterns and predictive value of these tests in patients referred to rheumatologists by primary care physicians. METHODS: We reviewed the records of all new patients referred by primary care physicians in 1994 to 2 rheumatologists practicing at the University of Alberta. Data extracted from the records included diagnostic tests requested by referring primary care physicians, signs and symptoms at the initial rheumatology consult, and followup diagnoses. RESULTS: Seven hundred eleven new patients had been referred by over 300 primary care physicians: RF had been requested in 25%, ANA in 21%, and ESR in 29%. One hundred nine (15%) of the 711 patients had a CTD, 45 (6%) had rheumatoid arthritis (RA), and 8 (1%) systemic lupus erythematosus (SLE). The predictive values of positive tests for the diagnosis of CTD were low: 49% for RF, 29% for ANA, and 35% for ESR. For RA, the positive predictive values were 44% for RF, 8% for ANA, 17% for ESR; for SLE, 2, 12, and 3%, respectively. Diffuse musculoskeletal pain and fatigue were significantly associated with test utilization, although most patients with these symptoms had fibromyalgia or localized soft tissue rheumatism. CONCLUSION: Primary care physicians frequently requested autoantibodies in patients referred to rheumatologists. Most tests were negative, and were often requested in patients without CTD, resulting in low positive predictive values and questionable clinical utility. These findings suggest inappropriate overuse and lack of understanding of the use of autoantibody tests in diagnosing rheumatic diseases. A decrease in inappropriate use could be achieved by emphasizing that fatigue and diffuse musculoskeletal pain are not indicative of CTD in the absence of other features such as joint swelling, typical rash, or organ involvement.
10082597 Pseudoporphyria induced by propionic acid derivatives. 1999 Jan BACKGROUND: Pseudoporphyria is a photosensitive bullous skin disease that is distinguished from porphyria cutanea tarda (PCT) by its normal porphyrin profile. Drugs are a major cause of this disease, and the list of culprits is continually expanding. Nonsteroidal antiinflammatory agents (NSAIDs), especially naproxen and other propionic acid derivatives, appear to be the most common offenders. OBJECTIVE: The study was carried out to increase awareness about the etiology and characteristic features of pseudoporphyria. METHODS: We report two cases of pseudoporphyria caused by naproxen and oxaprozin. We review the current English language literature on this entity and discuss its clinical features, histology, ultrastructure, etiology, and pathophysiology. RESULTS: A 44-year-old man taking naproxen for chronic low back pain and a 20-year-old woman on oxaprozin for rheumatoid arthritis presented with tense bullae and cutaneous fragility on the face and the back of the hands. In both, skin biopsy showed a cell-poor subepidermal vesicle with festooning of the dermal papillae. Direct immunofluorescence revealed staining at the dermal-epidermal junction and around blood vessels with IgG in the first case and with IgG, IgA, and fibrin in the second case. Urine collections and serum samples yielded normal levels of uro- and coproporphyrins. CONCLUSIONS: Most cases of pseudoporphyria are drug-induced. Naproxen, the most common offender, has been associated with a dimorphic clinical pattern: a PCT-like presentation and one simulating erythropoietic protoporphyria in the pediatric population. Other NSAIDs of the propionic acid family can also cause pseudoporphyria.
12743631 The role of telomerase in joint deterioration in rheumatoid arthritis. 2001 Sep The rate of bone formation is largely determined by the number of osteoblasts, which in turn is determined by the rate of replication of progenitors and the life span of mature cells, reflecting the timing of death by apoptosis. To date, however, the exact age-dependent changes of the cellular activity, replicative potential and life span of osteoblasts have not been investigated. Here we review evidence that the cellular activity, telomere lengths and replicative life span of osteoblastic cells obtained from juxtaarticular bone marrow gradually decrease with the advance of donor age in arthritides. Also, we show that the ability to extend the cellular life span of osteoblasts may have important implications for biological research and the development of new technologies for bone and joint diseases. (c) 2001 Prous Science. All rights reserved.
12472464 Management of patients undergoing hydroxychloroquine (Plaquenil) therapy. 2000 Jan The quinolines, hydroxychloroquine (Plaquenil) and chloroquine are used primarily for their anti-inflammatory effects in the treatment of auto-immune conditions such as rheumatoid arthritis. Another common use of these drugs is the prophylaxis and suppression of malaria. The use of quinolines may cause several ocular side-effects. The most significant complication is irreversible macular damage resulting in both visual acuity and visual field loss. However, the Royal College of Ophthalmologists, UK (RCO) recently recommended against the monitoring of patients receiving quinoline therapy as it was deemed to be too costly, given the low incidence of retinal complications. In this article, we present a case of hydroxychloroquine retinopathy, describe the ocular changes associated with quinoline therapy and recommend an optometric review schedule for patients who are currently taking these drugs. Furthermore, we recommend a proactive approach toward medical practitioners prescribing these drugs for optometric-based monitoring of these patients.
11762295 [Cholesterol crystals pericarditis]. 2001 Sep Cholesterol pericarditis is an uncommon, specific form of pericardial disease that is characterized by the presence of cholesterol crystals in pericardial fluid. The etiology may be either idiopathic or in association with systemic disorders such as tuberculosis, rheumatoid arthritis, myxedema or hypercholesterolemia. We report a case of cholesterol pericarditis in a 51-year-old male who was diagnosed with chronic renal failure due to polycystic kidney disease. To our knowledge no similar cases have been reported to date in the literature.
11734240 Infliximab-induced aseptic meningitis. 2001 Nov 24 We report an episode of aseptic meningitis in a 53-year-old man, who was treated with infliximab for active rheumatoid arthritis. He had acute, severe muscle pain after initial infusion of the drug, and similar symptoms with a transient lymphocytic meningitis after a subsequent infusion. We measured no change in antibodies to nuclei, DNA, or to neurones. Functional antibodies to infliximab were not induced and concentrations of tumour necrosis factor a in spinal fluid were not raised. This adverse reaction to infliximab might have been caused by inability of the drug to enter the central nervous system.
11387119 Anesthetic and Corticosteroid Joint Injections: A Primer. 1998 Complex joint anatomy may render the clinical diagnosis of a patient with joint pain difficult. Pain may be referred to a joint from an adjacent area (e.g., from the back to the hip) making the diagnosis difficult. The radiologist with the use of fluoroscopy is the ideal person to perform diagnostic and therapeutic joint injections. Long-acting anesthetic alone or combined with a corticosteroid may help the clinician localize the cause of the joint pain and subsequently institute the proper therapy. This article includes a discussion of the commonly used injectable corticosteroids that are available. The choice of corticosteroid is based on personal preference. Depomedrol (Upjohn, Kalamazoo, MI) is the least expensive corticosteroid available; however, a relatively insoluble drug such as Aristospan (Lederle, Deerfield, IL) or a combination drug such as Celestone Soluspan (Schering, Kenilworth, NJ) may be a better choice in rheumatoid arthritis. The technique used to inject the hip and the shoulder is discussed.
10386113 Gout: beyond the stereotype. 1999 Jun 15 Not all gout presents with involvement of the big toe, and not all gout patients are middle-aged men. Chronic gout may mimic rheumatoid arthritis; hyperuricemia may develop in postmenopausal women and in organ transplant recipients who are being treated with immunosuppressive agents. Both classic and nonclassic cases may benefit from new therapeutic agents.
10352912 Pseudo-Gaucher cells in peritoneal fluid: an uncommon manifestation of extramedullary hema 1999 Jun Pseudo-Gaucher cells have been observed in the bone marrow of patients suffering from a variety of hematologic disorders, including chronic myeloid leukemia, multiple myeloma, and immune thrombocytopenic purpura, as well as other conditions, such as rheumatoid arthritis. While the presence and potential clinical significance of pseudo-Gaucher cells have been documented in the hematology literature, references in standard cytology texts and journals are lacking. We report a case of ascites developing in the context of myelofibrosis, in which abdominal paracentesis yielded numerous pseudo-Gaucher cells as part of a mixed cellular population containing immature hematopoietic elements, consistent with extramedullary hematopoiesis.
10078007 [Polymyalgia rheumatica]. 1999 Feb Polymyalgia rheumatica (PMR) is a disease of unknown etiology characterized by severe myalgia and stiffness at shoulder girdle and pelvic girdle muscles and by normal serum creatine kinase levels. Marked elevation of erythrocyte sedimentation rate, acute onset within two weeks, and appearance in the aged are also additional characteristics of PMR. Ten to 50% of PMR patients have a concomitant temporal arteritis (TA)(giant cell arteritis). For the differential diagnoses of PMR, rheumatoid arthritis, polymyositis, fibromyalgia, malignancies, infections and depression should be considered. PMR without TA is treatable successfully with small amount of steroids (15-20 mg/day of prednisolone). For the PMR patients with TA should be treated with large amount of steroids (40-60 mg/day of prednisolone) or steroid pulse therapy.