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ID PMID Title PublicationDate abstract
11434220 [Comparison of ultrasonography and sialography vs. magnetic resonance in the diagnosis of 2001 Feb To date there is no agreement as to which imaging technique is best for the evaluation of the oral component of primary Sjögren's Syndrome (SS). The purpose of the present study has, therefore, been to determine the reliability of Magnetic Resonance (MR) in the evaluation of salivary alterations in patients with SS. The study involved 23 patients suffering from SS according to the European criteria. All the patients underwent ultrasonography and MR of the major salivary glands, parotid sialography and biopsy of the minor salivary glands. The first control group was made up of 50 healthy subjects who underwent parotid ultrasonography. The second control group comprised 23 subjects who underwent MR of the head and neck for other non parotid pathology. The ultrasonography, MR and sialography images were evaluated by a single observer during a single session and scored from 0 to 4. In the SS patients ultrasonography was abnormal in all 23 cases (100%): 3 patients showed grade 1 alterations (13%); 5 grade 2 (21.7%); 9 grade 3 (39.1%); 6 grade 4 (26.1%). In the healthy controls, grade 0 was found in 36 subjects (72%) while the remaining 14 subjects revealed grade 1 alterations (28%). Using MR imaging only one of the SS patients showed grade 0 alterations (4.3%), 7 showed grade 1 alterations (30.4%), 9 grade 2 (39.1%), 5 grade 3 (21.7%) and only 1 grade 4 (4.3%). MR imaging sensitivity was 95.8% while specificity was 100%. For ultrasonography, considering grade 1 as non pathological, we found a sensitivity of 88.4% and specificity of 100%. The MR score for SS patients was compared to that obtained with sialography and ultrasonography. There was a good correlation between MR and sialography (r = 0.528, p = 0.010) while the correlation between MR and ultrasonography was not statistically significant. This study confirms that, of the diagnostic procedures available for evaluation of salivary gland involvement in SS, the most useful initial examination is ultrasonography. When there is some doubt or there are subtleties, MR is a valid alternative to classical sialography.
10944035 Sonography of lacrimal glands in Sjögren syndrome. 2000 Aug This study evaluates the potential role of high resolution sonography and color Doppler sonography in the evaluation of the lacrimal glands in Sjögren syndrome. We examined 15 women (age range, 52-73 years) affected by Sjogren syndrome and 15 women with no history and signs of lacrimal disease (age range, 47-75 years). The lacrimal glands were visualized bilaterally in 6 of 15 patients. The lacrimal artery was detectable in all patients; the resistive index was higher than normal (0.72+/-0.04). An abnormal Schirmer test was present in six of six patients with visible glands and in two of nine patients with invisible glands; xerophthalmia was present in six of six patients with visible glands and in four of nine patients with invisible glands; high levels of serum immunoglobulins were present in six of six patients with visible glands and in three of nine patients with invisible glands. Sonography is able to provide noninvasively much of the information needed by the clinician.
10771573 [Sjögren's syndrome with MALT (mucosa-associated lymphoid tissue) lymphoma in a 13-year-o 2000 Feb We report A case of Sjögren's syndrome complicated with MALT (mucosa-associated lymphoid tissue lymphoma) in childhood. Additionally, Helicobacter pylori infection into the gastric mucosa was highly suspected in this case. A 13-year-old girl suffering from multiple joint pain had received treatment as Juvenile Rheumatic Arthritis with no clinical improvement until introduction to our hospital. On admission to our hospital, high levels of serum anti-SSA and anti-SSB (80.2 and 16.1 holds, respectively) were detected. Minor salivary gland biopsy showed a typical histological finding for Sjögren's syndrome as infiltrating lymphocytes around the excretory ducts. Computed tomography and 67Gallium scintigraphy showed a gastric tumor, and it was diagnosed as primary gastric B-cell MALT lymphoma by the histopathological findings. Additionally, Helicobacter pylori infection into the gastric mucosa was highly suspected. Recently it is emphasized that infection of Helicobacter pylori is related with gastric MALT lymphoma. There has been no reports of children who have Sjögren's syndrome associated with malignant lymphoma. Taken together, Helicobacter pylori infection superimposed with Sjögren's syndrome might accelerate clinical course in our particular case.
10348514 Primary sialoangiectasia--a diagnostic pitfall in Sjögren's syndrome: case report. 1999 May A case of primary sialoangiectasia, which in this case was initially misdiagnosed as Sjögren's syndrome, is described. Other diseases, including HIV infection, psoriatic arthritis, and acute parotitis, may cause glandular changes similar to the changes found in the syndrome. Therefore, sialography must be combined with other methods of assessment of the oral cavity when suspicion is high for Sjögren's syndrome. Properly applied, sialography provides essential information regarding the severity of glandular damage and the progression of the disease.
9610303 A preliminary assessment of intra-oral lubricating systems for dry mouth patients. 1997 Jul OBJECTIVE: To provide extended intra-oral delivery of a saliva substitute. INTERVENTION: Three different types of prostheses containing saliva substitute were designed and assessed: a two-part device resembling a mandibular complete denture sealed by cobalt-samerium magnets, a one-part clear resin device for the edentate patients and a flexible mouth guard type of appliance containing a lubricant releasing bubble for the dentate patients. SETTING: A teaching hospital Oral Medicine and Rheumatology Clinic. SUBJECTS: 8 edentate and 3 dentate Sjogren Syndrome sufferers. OUTCOME MEASURES: Subjective dryness after a week of wearing the lubricating appliance. RESULTS: The majority of the subjects wore the appliances for 6-12 hours during each 24 hours. The initial dryness severity diminished after wearing the lubricating prosthesis. The patients preferred to wear the appliance at night. CONCLUSION: All criteria were fulfilled on designing a saliva substitute lubricating appliance and some of the subjects have worn this prosthesis successfully for up to 3 years. Particular benefit was obtained by night-time wear.
10854877 Interphalangeal joint and tendon forces: normal model and biomechanical consequences of su 2000 Sep Soft tissue reconstructive surgery for rheumatoid-related proximal interphalangeal joint deformities frequently fails to produce the long-term predicted results. Detailed information on the biomechanics of this joint, under both normal and pathological conditions, is required to assess the efficacy of such surgical intervention. A biomechanical model of the proximal interphalangeal joint has been developed to investigate tendon and joint loading during real life three-dimensional activities. Based on a rigid body mechanics approach, the model uses high resolution MRI scans to obtain anatomical tendon and bone geometries in conjunction with three-dimensional kinematic and loading data. The model incorporates an optimisation routine which minimises overall maximum tendon stress in the eight individual elements considered. Radial and ulnar joint force components are included at the proximal interphalangeal joint level. Two simulated pathological versions of the mathematical model are developed to accommodate the altered anatomic relationships after tendon reconstructive surgery. Joint forces of up to 450N and common usage of the extensor mechanism during normal pinching and grasping activities are predicted. The ulnar lateral bands of the extensor tendon are generally loaded to a greater extent than the radial bands. Extensor tendon and joint forces in the simulated pathological models are significantly higher than those in the normal model. Combined with the poor tendon quality of rheumatoid arthritis patients generally, these amplified internal forces may lead to further joint deformation.
11407702 Etanercept therapy in children with treatment-resistant uveitis. 2001 Jun OBJECTIVE: To evaluate the safety and efficacy of the tumor necrosis factor fusion protein etanercept in children with treatment-resistant uveitis. METHODS: Ten children with chronic active uveitis (7 girls and 3 boys, mean age 7.5 years [range 3-12 years]) were enrolled in this prospective study. In 7 children, uveitis was associated with pauciarticular juvenile rheumatoid arthritis. Five children were antinuclear antibody positive. All patients had failed previous therapy with topical steroids and methotrexate and/or cyclosporine. All were treated with etanercept at a dosage of 0.4 mg/kg twice weekly for the first 3 months, and then, if eyes did not improve, with 25 mg twice weekly (mean 1.1 mg/kg) for at least 3 additional months. RESULTS: At the beginning of the trial, uveitis affected 18 eyes in the 10 children. Within 3 months, 10 of 16 affected eyes (63%; P = 0.017) showed a rapid decrease in anterior chamber cell density, including remission of uveitis in 4 eyes. In children with visual acuity of less than 20/25, 4 of 10 eyes (40%) improved. An exacerbation of uveitis during etanercept therapy occurred in only 1 child (1 of 14 eyes [7%]). Other ocular outcome parameters, such as intraocular pressure, synechia formation, and lens clarity, remained unchanged. Following a dosage increase to an average of 1.1 mg/kg after 3 months in 7 children, no further improvement was noted. CONCLUSION: Our data suggest that etanercept injected subcutaneously twice a week has a beneficial effect on treatment-resistant chronic uveitis in children. Further controlled studies with etanercept in systemic or topical form are necessary to confirm its efficacy and optimal mode of administration.
10990221 Secondary health service care and second line drug costs of early inflammatory polyarthrit 2000 Sep OBJECTIVE: To estimate the secondary health service care and second line drug costs (including drug monitoring costs) for a cohort of people with early inflammatory polyarthritis (IP) and the subgroup classified as having rheumatoid arthritis (RA) recruited to a population based register. METHODS: The study population consisted of 344 people with IP who had enrolled on the Norfolk Arthritis Register (NOAR) in 1990-91, an average of 24 weeks after onset of their symptoms. Utilizing resource use data from NOAR, augmented by unit cost data from other sources, the average (per person) and cumulative secondary care and second line drug costs were estimated for Years 1, 2, 3, 4, and 5 following registration with NOAR. RESULTS: The total secondary health service care and second line drug costs were 472,125 (338,704 for RA subgroup) (1990-91 prices) over the 5 year study period, with inpatient stays, outpatient visits, and second line drugs accounting for 58, 9, and 33%, respectively. Nineteen percent of the study population neither visited hospital nor were prescribed second line drugs. CONCLUSION: Overall, inpatient stay costs represented the largest proportion of secondary health service care and second line drug costs, making 21% of the total study cohort responsible for 80% of the total 5 year costs incurred.
9249647 Pain management in osteoarthritis: the role of COX-2 inhibitors. 1997 Jul Pain is the major symptom that leads patients to consult their physicians for the treatment of arthritis; therefore, effective pain control is an important goal in the management of this disorder. Pharmacologic therapy begins with simple analgesics and education. In many patients, simple analgesics do not adequately control moderate arthritis pain, and nonsteroidal antiinflammatory drugs (NSAID) are substituted for or added to the analgesic therapy. While NSAID are effective in controlling pain in mild to moderate osteoarthritis (OA), they are associated with significant toxicity (most frequently gastrointestinal) and may even cause complications that result in death. Patients who experience the pain associated with arthritis would therefore benefit from the antiinflammatory and analgesic actions of agents that are devoid of significant toxicities. Cyclooxygenase-2 (COX-2) inhibitors are being evaluated in clinical trials or are in development. These agents appear to inhibit only the COX-2 isoenzyme, which is produced largely during inflammation and is responsible for the biosynthesis of prostaglandins and other mediators of inflammation as well as sensitizers to pain. Because COX-2 inhibitors do not inhibit COX-1 isoenzyme activity at pharmacologic concentrations, they are devoid of many of the toxicities that are typical side effects of NSAID. Short term studies in dental pain, OA, and rheumatoid arthritis found that the COX-2 inhibitor celecoxib was an effective analgesic but did not cause gastroduodenal erosions. It has the potential to provide analgesia and antiinflammatory action in patients with arthritis without the side effects of NSAID. Further studies are required to substantiate these findings.
10544838 Effects of PEGylated soluble tumor necrosis factor receptor type I (PEG sTNF-RI) alone and 1999 Sep OBJECTIVE: To determine the potential combination benefit of treatment with PEG sTNF-RI and methotrexate in adjuvant arthritic rats. METHODS: Lewis rats with adjuvant arthritis were treated by sc injections of either 3.0 or 0.3 mg/kg PEG sTNF-RI on days 9, 11, and 13 of adjuvant arthritis. The effects of PEG sTNF-RI treatment alone were compared to treatment with daily oral methotrexate (0.075, 0.06 or 0.045 mg/kg) or methotrexate in combination with PEG sTNF-RI. Efficacy was monitored by volume measurement of ankle joints, final paw weights and histologic evaluation with particular emphasis on bone lesions. RESULTS: Treatment with 3.0 or 0.3 mg/kg PEG sTNF-RI alone resulted in 52% or 28% inhibition, respectively, of paw swelling as assessed by final paw weight. Treatment with methotrexate at either 0.075, 0.06, or 0.045 mg/kg gave 84%, 51% or 18% inhibition and combination treatment resulted in additive inhibitory effects. Histologic evaluation of ankle joints demonstrated 68% or 25% inhibition of bone resorption with PEG sTNF-RI alone at 3.0 or 0.3 mg/kg. Treatment with 0.075, 0.06 or 0.045 mg/kg methotrexate resulted in 98%, 76% or 40% inhibition of bone resorption. Additive benefit was best seen with the lower doses of methotrexate. CONCLUSION: Combination therapy with PEG sTNF-RI and methotrexate results in additive benefit, with the final result being excellent inhibition of all arthritis parameters. Data from these studies supports the clinical investigation of the use of combination therapy of PEG sTNF-RI and methotrexate in rheumatoid arthritis patients.
10599323 Autoimmune thyroid disorders in juvenile chronic arthritis and systemic lupus erythematosu 1999 The appearance of autoimmune thyroiditis in the course of other autoimmune diseases, which do not affect specific organs (systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis and others), is more frequent than is usually believed. Nevertheless, it is scarcely studied, especially in children. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE). Twenty seven children having JCA and twelve children with SLE, aged 5 to 18 years, were enrolled into study. In all of them the disease was in an active phase. The serum levels of total thyroid hormones (T3, T4) and TSH, thyroid antibodies (TAB and MAB) and antinuclear antibodies (ANAB) were analyzed using respectively fluoroimmunologic, microhemagglutination and indirect immunofluorescention tests. According to our results, autoimmune thyroiditis was found in 12 out of 27 children with JCA (44.4%); 85.2% of them were euthyroid, 11.1% had a compensated hypothyroidism, and 3.7% had Hashi-toxicosis. From a clinical point of view, very interesting was the combination of JCA, autoimmune thyroiditis and pseudoxanthoma elasticum in a 13-year old girl. Positive thyroglobulin antibodies (1:80-1:5120) were found in 17 out of 27 cases of JCA (63%). The microsomal antibodies were elevated (1:100-1:1600) in 7 out of 27 (25.9%); antinuclear antibodies (1:80-1:640) were detected in 15 out of 27 cases of JCA (55.5%). A simultaneous elevation of all three kinds of antibodies was found in 14.8% of children with JCA, and of TAB and MAB--in 18.5%. Thyroid gland disorders were detected also in children suffering from SLE. Thyroglobulin antibodies were positive (1:80-1:5120) in 7 out of 12 cases. Antinuclear antibodies (1:320-1:2560) were detected in 8 out of 12 cases (66.7%). The serum levels of T3, T4 and TSH were in the reference limits in all children with SLE. The present study suggests that involvement of the thyroid gland is not uncommon in autoimmune disease in Autoimmune thyroiditis can occur in association with other autoimmune diseases, affecting some organs or systems, such as the insulin-dependent diabetes mellitus, pernicious anaemia, thrombocytopenia, vitiligo, as well as some chromosomal aberrations--Turner's syndrome, Noonan's syndrome and Down's disease [1]. The appearance of autoimmune thyroiditis together with other autoimmune diseases which do not affect specific organs (such as systemic lupus erythematosus, Sjögren syndrome) is the reason to classify them in a common subgroup of the autoimmune polyendocrine syndromes--type IIID [2]. The rheumatic diseases are--more frequently than suspected--associated with autoimmune thyroiditis, but this connection is not well studied. The literature offers very scarce information on the problem, especially for the childhood. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE).
10415595 Neuroendocrine immune features of pediatric inflammatory rheumatic diseases. 1999 Jun 22 Juvenile rheumatoid arthritis (JRA) and juvenile systemic lupus erythematosus (JSLE) are the most common autoimmune rheumatic diseases in children associated with high levels of autoantibodies and immune reactivity. JRA and JSLE are more common in girls. Disease activity is worse in the morning, improves during the daytime and worsens at night suggesting that neuroendocrine immune mechanisms are involved in disease pathophysiology. Adult patients with RA and SLE have excessive levels of prolactin (PL) while cortisol (CS) production is down-regulated for the degree of ongoing inflammation. PL has potent proinflammatory properties. Normal to low levels of cortisol have been observed in children with active JRA despite the high serum levels of IL-6, IL-1 beta, and TNF-alpha, which activate the hypothalamic-pituitary-adrenal axis (HPA). The CS levels are in fact subnormal because inflammatory stress activates the HPA. Normal serum PL levels were seen in children with JRA, most of whom were not active with higher levels in those with active ANA +ve JRA complicated by uveitis. A trend toward high PL levels was seen in 33 children with JSLE. High serum PL levels are seen in patients with active juvenile ankylosing spondylitis (JAS) only. Growth retardation is a feature of JRA. Patients with JRA have low to normal levels of growth hormone (GH) and low levels of insulin-like growth factor 1 (IGF-1). IGF-1 mediates the effects of GH. The observation of low IGF-1 in JRA raises the therapeutic possibility with IGF-1. Overall, high levels of follicle stimulating hormone and luteinizing hormone are found in children with JSLE while the levels in JRA tend to be normal. Testosterone levels are low in patients with JRA. No significant differences in estrogen levels have been found between patients with JRA and those with JSLE and matched controls. There is evidence that the autonomic nervous function is defective in patients with JRA.
11771864 Association of non-urological diseases with lower urinary tract symptoms. 2001 Oct OBJECTIVE: Clinical observations indicate that many non-urological diseases seem to be associated with lower urinary tract symptoms (LUTS). This has also been shown in studies usually concerning single diseases. This study investigated the impact of non-urological diseases on LUTS in the general population. MATERIAL AND METHODS: A questionnaire on LUTS and medical history was mailed to all 50-, 60- and 70 year-old men in Tampere and in 11 municipalities in the same county, in total 3143 subjects. Day-time frequency, nocturia, urge, urge incontinence, hesitancy and incomplete emptying were used to form an index for LUTS. The men were asked to report any disease that they had. The number of the following diseases reported by the participants was large enough for statistical analysis: lower back pain, hypertension, arthritis, heart disease, pulmonary disease, diabetes, constipation. stroke, transient ischaemic attack, cancer (other than prostate or bladder), neurological disease, inguinal hernia, rheumatoid arthritis and faecal incontinence. The association between LUTS and non-urological diseases was estimated by logistic regression as a prevalence odds ratio (OR) with 95% confidence intervals (CI). RESULTS: In the multivariate analysis a significant association was found between LUTS and the following diseases: faecal incontinence (OR 4.5, CI 2 .3-9.1), neurological disease (OR 2.4, CI 1.3-4.4), constipation (OR 2.3, CI 1.5-3.3) and arthritis (OR 1.5, CI 1.2-2.0). CONCLUSIONS: According to this population-based study LUTS is an important part of the symptomatology of faecal incontinence, neurological disease, constipation and arthritis. Thus, the patients with these diseases and presenting with LUTS require careful investigation, at least in the cases in which the primary therapy of LUTS has failed.
10569738 Effect of MALP-2, a lipopeptide from Mycoplasma fermentans, on bone resorption in vitro. 1999 Dec Mycoplasmas may be associated with rheumatoid arthritis in various animal hosts. In humans, mycoplasma arthritis has been recorded in association with hypogammaglobulinemia. Mycoplasma fermentans is one mycoplasma species considered to be involved in causing arthritis. To clarify which mycoplasmal compounds contribute to the inflammatory, bone-destructive processes in arthritis, we used a well-defined lipopeptide, 2-kDa macrophage-activating lipopeptide (MALP-2) from M. fermentans, as an example of a class of macrophage-activating compounds ubiquitous in mycoplasmas, to study its effects on bone resorption. MALP-2 stimulated osteoclast-mediated bone resorption in murine calvaria cultures, with a maximal effect at around 2 nM. Anti-inflammatory drugs inhibited MALP-2-mediated bone resorption by about 30%. This finding suggests that MALP-2 stimulates bone resorption partially by stimulating the formation of prostaglandins. Since interleukin-6 (IL-6) stimulates bone resorption, we investigated IL-6 production in cultured calvaria. MALP-2 stimulated the liberation of IL-6, while no tumor necrosis factor was detectable. Additionally, MALP-2 stimulated low levels of NO in calvaria cultures, an effect which was strongly increased in the presence of gamma interferon, causing an inhibition of bone resorption. MALP-2 stimulated the bone-resorbing activity of osteoclasts isolated from long bones of newborn rats and cultured on dentine slices without affecting their number. In bone marrow cultures, MALP-2 inhibited the formation of osteoclasts. It appears that MALP-2 has two opposing effects: it increases the bone resorption in bone tissue by stimulation of mature osteoclasts but inhibits the formation of new ones.
11550983 Resorption of the temporomandibular condylar bone according to subtypes of juvenile chroni 2001 Sep OBJECTIVE: To evaluate the relative impact of sex, type of onset, course of disease, age at onset, duration of disease and status of HLA-B27, antinuclear antibodies (ANA), and rheumatoid factor on the risk of developing a condylar erosion. METHODS: Condylar changes of the temporomandibular joint (TMJ) were diagnosed on orthopantomograms from 169 consecutive patients with juvenile chronic arthritis (JCA). A multiple regression analysis was applied to establish the relative weight of the independent variables affecting the severity of the condylar erosion. RESULTS: It was found that 62.1% of the patients exhibited condylar resorption. The highest prevalence was seen in children with a polyarticular onset or course of disease and early age at onset and severe resorption was also frequent in these groups. Patients with positive ANA also had a high prevalence but with a mild degree of resorption. In contrast, HLA-B27 positive patients had a lower risk of TMJ involvement and resorptive changes of the condyle. CONCLUSION: Polyarticular and early onset arthritis are associated with a high risk for TMJ involvement and a severe condylar bone loss can be expected. ANA positive patients have a high prevalence, and B27 positive patients have a low prevalence of TMJ arthritis but in both subgroups, the outcome of the bone resorptive process is mild.
9541589 Chronic parvovirus B19 infection induces the production of anti-virus antibodies with auto 1998 Mar Human parvovirus B19 infection in adults shows some clinical features similar to those found in autoimmune connective tissue diseases. To better clarify the relationship between viral infection and autoimmunity, we have evaluated the ability of anti-parvovirus antibodies to specifically recognize autoantigens in ten patients with chronic symmetric arthritis resembling rheumatoid arthritis or with recurrent episodes of arthritis and cutaneous manifestations and persistence of specific IgM antibodies against B19 parvovirus. We synthetized a 24-amino acid immunodominant peptide corresponding to a part of the virus protein 1 and virus protein 2 overlapping region. The peptide has been used to test patients' sera at different time points with an enzyme-linked immunosorbent assay (ELISA) and to purify anti-virus antibodies by affinity chromatography on a peptide-Sepharose column. Eluted immunoglobulins recognized the B19 peptide in both direct and competitive ELISA. Affinity-purified anti-parvovirus antibodies were then tested on a panel of autoantigens including human keratin, collagen type II, thyreoglobulin, single-strand (ss)DNA, cardiolipin and ribonucleoprotein antigen Sm. Eluted antibodies specifically recognized keratin, collagen type II, ssDNA and cardiolipin. Autoantibody activity was not detected in the immunoglobulin fraction after complete removal of anti-peptide antibodies and in antibodies eluted from normal donors. Epstein-Barr virus-transformed cell clones obtained from two subjects produced antibodies which simultaneously recognize the viral peptide and several autoantigens. To further confirm the role of the virus in inducing an autoantibody response, eight BALB/c mice were immunized with the viral peptide coupled to a carrier protein. Autoantibody activity against keratin, collagen II, cardiolipin and ssDNA was detected in six of the eight mice which developed a strong anti-virus response. Together, these data indicate that B19 parvovirus may be linked to the induction of an autoimmune response.
11310194 The effect of nonsteroidal anti-inflammatory drugs on the use of gastroprotective medicati 2001 Apr OBJECTIVE: To estimate the incidence of gastroprotective medication use among users and nonusers of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) who have arthritis. STUDY DESIGN: A retrospective cohort study. PATIENTS AND METHODS: We used the Protocare Sciences proprietary Managed Care Organization database, which contains data on more than 3 million lives, to identify 57,136 patients given an initial diagnosis of osteoarthritis (OA; International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] codes: 715, 721.0, 721.3, or 721.9) or rheumatoid arthritis (RA; ICD-9-CM codes: 714.0, 714.1, 714.2, or 714.9); the diagnoses were made during inpatient or outpatient medical encounters occurring between October 1, 1993, and September 30, 1997. The duration of therapy was calculated as the sum of the total number of days of receipt of all prescriptions during the year. The prescribed daily dose was determined by multiplying the drug dose by the number of pills dispensed and the dividing the product by the number of days supplied, as noted in the pharmacy records. RESULTS: During the year after NSAID initiation, 27% of people with RA and 12% of those with OA were chronic NSAID users. NSAID users with RA were 4 times as likely as NSAID nonusers with RA to begin using a gastroprotective agent within the first year; NSAID users with OA were twice as likely as nonusers with OA to do so. CONCLUSION: The use of gastroprotective agents during the first year after NSAID initiation for the treatment of arthritis was greater than their use by those who did not take NSAIDs.
10870654 Antinuclear antibody (ANA) and ANA profile tests in children with autoimmune disorders: a 2000 The study objective was to determine the clinical value of positive antinuclear antibody (ANA) and ANA profile tests in children with autoimmune disorders. A retrospective chart review was carried out of all patients under 18 years of age with a positive ANA test (HEp-2 cell substrate, titre > or =1:40) and ANA profile (ELISA) referred to the paediatric rheumatology service at the authors' institution between 1992 and 1996. Of 245 children with a positive ANA test, 134 (55%) had an autoimmune disease, including juvenile rheumatoid arthritis (n = 49), systemic lupus erythematosus (SLE) (n = 40) and others (n = 45). The remaining 111 patients did not have identifiable autoimmune diseases. Patients with autoimmune disorders had significantly higher ANA titres of > or = 1:160 (chi2 = 16, P<0.0001). In addition, of the 245 patients with a positive ANA test, 86 had an ANA profile performed; this was positive in 32 and negative in 54. All 32 patients with a positive ANA profile (100%) had an autoimmune disorder, compared to 22 (41%) of 54 with a negative ANA profile who had autoimmune disorders. Of 22 SLE patients with a positive ANA profile, 16 (73%) had positive anti-dsDNA and 15 (68%) had positive anti-Sm and positive anti-RNP. A positive ANA profile correlated strongly with an ANA titre > or = 1:640 (chi2 = 5.7 , P<0.02). The study demonstrated that only 55% of children with a positive ANA test had a definitive diagnosis of autoimmune disorder. These children tend to have higher ANA titres of > or =1:160. However, a positive ANA profile was strongly correlated with an ANA titre > or =1:640 and highly indicative of an autoimmune disorder (100%). We suggest that in order to reduce cost, an ANA profile should not be performed on all patients with positive ANA, but reserved for those with an ANA titre of > or =1:640 and/or those with a high clinical index of suspicion for autoimmune disorder, especially SLE.
17039122 Exocrine dysfunction of the pancreas in patients with chronic polyarthritis. 2001 Jun We studied the extent to which exocrine dysfunction of the pancreas is seen among patients with severe chronic polyarthritis and whether it might account for some gastrointestinal symptoms. Our series consisted of 50 such chronic polyarthritis cases; most had rheumatoid arthritis but had neither diagnosed or suspected pancreatitis nor primary Sjögren's syndrome. They were asked about gastrointestinal (GI) and sicca symptoms. The exocrine function of each pancreas was evaluated by the fecal elastase-1-enzyme test. Thirty-two patients had GI symptoms at least weekly. Forty had sicca eye syndrome and 26 had dry mouth. There were two cases (4%; 95% confidence interval, 1-14%) with abnormally low fecal elastase-1-enzyme test level. Chronic GI and sicca symptoms are frequent among patients with severe chronic polyarthritis. Secondary Sjögren's syndrome may cause exocrine insufficiency in the pancreas. That circumstance was not common here, but it is worth remembering because it can be diagnosed by a noninvasive method, and enzyme preparation treatment is available for the symptoms, especially for postprandial pain and distention of the stomach.
11595964 Information that orthopedists still need to know and what is missing from the MR images of 2001 Sep Magnetic resonance imaging (MRI) has a very established role in imaging many pathologic conditions in the wrist. MRI provides useful clinical information regarding neoplastic processes. It also provides valuable information in the evaluation of tendons and synovium in rheumatoid arthritis. However, it has been and is less useful when early ligamentous injuries, including grade I and grade II scapholunate and lunotriquetral ligament lesions, are suspected. Also, information regarding cartilage injuries and degeneration, especially in wrist instabilities, would be more than desirable for treating orthopedists and hand surgeons. However, at the current stage, this information is missing, and only the more advanced changes are seen in MRI. This article describes and explains clinical entities in which that information would help patient care and management.