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

ID PMID Title PublicationDate abstract
12173996 Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis. 2002 Aug OBJECTIVE: To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort. METHOD: In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified. RESULTS: Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (chi(2) = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 x 10(-7)) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up. CONCLUSION: These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.
12525388 The level of BLyS (BAFF) correlates with the titre of autoantibodies in human Sjögren's s 2003 Feb BACKGROUND: Increased levels of B lymphocyte stimulator (BLyS) have been detected in serum from patients with systemic lupus erythematosus and rheumatoid arthritis. OBJECTIVE: To determine the level of BLyS in serum from patients with primary's Sjögren's syndrome (SS), another autoimmune disease in which B cell activation is high. METHODS: Serum samples from 49 patients with primary SS according to the revised European criteria were assayed for BLyS, quantitative immunoglobulins, and autoantibody levels and compared with samples from 47 healthy control subjects. RESULTS: The median level of BLyS was 5.99 ng/ml (25th-75th centile range 3.20-8.93 ng/ml) in SS v 2.49 ng/ml (25th-75th centile range 1.96-2.96 ng/ml) in healthy controls (p<0.001). More importantly, among patients with SS, the presence of anti-SSA antibodies was associated with significantly higher levels of BLyS (medians 7.90 ng/ml v 3.70 ng/ml; p=0.008) as was the presence of anti-SSB antibodies (medians 7.14 ng/ml v 3.70 ng/ml; p=0.02) and of rheumatoid factor (medians 7.70 ng/ml v 3.80 ng/ml; p=0.016). The level of BLyS in three patients with a monoclonal gammopathy was higher than in the other patients (medians 26.53 ng/ml v 5.92 ng/ml; p=0.13). Higher levels of BLyS were associated with higher levels of gammaglobulins and IgG. There was a strong correlation between BLyS and rheumatoid factor level (r=0.71, p<0.0001), anti-SSA IgG level (r=0.32, p=0.02) and anti-SSA IgM level (r=0.39, p=0.006). CONCLUSION: In human SS the level of BLyS correlates with the level of autoantibodies. Thus, BLyS may play a part in activating specific autoreactive B cells and modulating the level of production of autoantibodies which are the hallmark of the disease. These findings raise the possibility of a novel therapeutic approach in human SS.
17043451 Color Doppler ultrasound of the hand: observations on clinical utility in rheumatoid arthr 2004 Feb The use of ultrasound with color Doppler in the evaluation of rheumatoid arthritis was followed in 25 patients with joint complaints. Small joint ultrasound of the metacarpophalangeal joints (MCPs) as well as the wrists was performed with supplementation by color Doppler. In addition, 6 patients were followed for at least 3 months after start of treatment of rheumatoid arthritis using the same technique. In patients with what appeared to be definite rheumatoid arthritis, ultrasound supported this diagnosis as evidenced by the finding of cortical defects, extensor tendon sheath thickening, and synovial proliferation. Increased activity by color Doppler ultrasonography was the most common finding. Significant decrease in color Doppler activity was noted in the 6 patients who were followed up after 3 months of therapy with disease-modifying agents. Therefore, the use of ultrasound with color Doppler could aid in the diagnosis and follow up of patients with rheumatoid arthritis.
24387729 A total wrist arthroplasty in rheumatoid arthritis: a case followed for 24 years. 2004 Dec Abstract We report a case of rheumatoid arthritis treated with a total wrist arthroplasty. A Meuli-type total wrist arthroplasty was performed on the left wrist in 1979. We have treated the patient's rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) (Actarit 100 mg and Mijoribine 50 mg) and nonsteroidal anti-inflammatory drugs (NSAIDs) for a total of 26 years before and after the total wrist arthroplasty. The activity of the rheumatoid arthritis has been kept at a low level. The operated wrist was followed up for 24 years postoperatively. It is thought that the antirheumatic treatments over a long period have been very successful in preventing the destruction of the operated wrist.
15001555 Interactions between bradykinin (BK) and cell adhesion molecule (CAM) expression in peptid 2004 May Bradykinin (BK), a vasoactive, proinflammatory nonapeptide, promotes cell adhesion molecule (CAM) expression, leukocyte sequestration, inter-endothelial gap formation, and protein extravasation in postcapillary venules. These effects are mediated by bradykinin-1 (B1R) and-2 (B2R) receptors. We delineated some of the mechanisms by which BK could influence chronic inflammation by altering CAM expression on leukocytes, endothelium, and synovium in joint sections of peptidoglycan-polysaccharide-injected Lewis rats. Blocking B1R results in significantly increased joint inflammation. Immunohistochemistry of the B1R antagonist group revealed increased leukocyte and synovial CD11b and CD54 expression and increased CD11b and CD44 endothelial expression. B2R antagonism decreased leukocyte and synovial CD44 and CD54 and endothelial CD11b expression. Although these findings implicate B2R involvement in the acute phase of inflammation by facilitating leukocyte activation (CD11b), homing (CD44), and transmigration (CD54). Treatment with a B2R antagonist did not affect the disease evolution in this model. In contrast, when both BK receptors are blocked, the aggravation of inflammation by B1R blockade is neutralized and there is no difference from the disease-untreated model. Our findings suggest that B1R and B2R signaling show physiologic antagonism. B1R signaling suggests involvement in down-regulation of leukocyte activation, transmigration, and homing. Further studies are needed to evaluate the B1 receptor agonist's role in this model.
12428187 Inhibition of the TNF-pathway: use of infliximab and etanercept as remission-inducing agen 2002 Jul 27 OBJECTIVE: To examine the potential of the two tumour necrosis factor (TNF) inhibitors infliximab and etanercept as remission-inducing agents in chronic therapy-resistant inflammatory disorders of immune or non-immune pathogenesis. METHODS: 14 patients with adult Still's disease/macrophage activation syndrome (4), Wegener's disease (3), Behçet's disease (3), keratoscleritis (1), lymphomatous tracheo-bronchitis (1) Cogan's syndrome (1), and rapidly destructive crystal arthropathy (1) were treated with infliximab (n = 10) and etanercept (n = 4). All patients showed organ-threatening progression of their diseases with resistance to conventional immunosuppressive medication. Therapeutic benefit was assessed clinically and by documenting organ-specific functional and morphological alterations. Side effects were compared with the data of our clinic's rheumatoid arthritis (RA) patients treated by TNF inhibitors. RESULTS: A rapid and dramatic beneficial effect was documented in 9 patients and a moderate one in 5. Best responses (clinical and laboratory parameters) were seen in patients with macrophage activation syndrome/adult Still's disease and Behçet's disease, while the results were less impressive in those with Wegener's disease, Cogan's syndrome, idiopathic cerato-scleritis and lymphomatous tracheobronchitis. In all cases immunosuppressive agents and systemic glucocorticoids could be reduced or discontinued. CONCLUSIONS: TNF inhibition may be highly effective in patients with severe, therapy-resistant chronic inflammatory disorders.
11844973 Bronchiolitis obliterans in a case of juvenile rheumatoid arthritis presented with pneumom 2002 We present a case of bronchiolitis obliterans associated with juvenile rheumatoid arthritis in whom pneumomediastinum was the presenting manifestation. Diagnosis of bronchiolitis obliterans was made on the basis of the clinical history, pulmonary function tests and high-resolution computerized tomography scan findings. Pneumomediastinum resolved in a few days following high-dose nasal oxygen. This case shows that bronchiolitis obliterans can occur in patients with juvenile rheumatoid arthritis. Complicating pneumomediastinum in such cases should be considered as an indication of underlying bronchiolitis obliterans.
28086595 Rheumatoid arthritis reduces women's lifespans. 2002 Dec 11 Rheumatoid arthritis (RA) is associated with a significantly increased risk of mortality, researchers from the United States say.
12784008 Total knee arthroplasty in young patients with juvenile rheumatoid arthritis. 2003 Jun BACKGROUND: Juvenile rheumatoid arthritis is a disabling and destructive condition that commonly affects the knee during childhood. Total knee arthroplasty occasionally may be necessary for the treatment of end-stage disabling arthritis of the knee in young patients. There is a paucity of available data on the results of total knee arthroplasty in adolescents. We report our experience with total knee arthroplasty in patients under the age of twenty years who had juvenile rheumatoid arthritis. MATERIALS AND METHODS: We reviewed the results of twenty-five consecutive total knee arthroplasties that had been performed at our institution between 1982 to 1997 in thirteen patients (mean age, seventeen years) with juvenile rheumatoid arthritis. The average duration of clinical follow-up was 10.7 years, and the average duration of radiographic follow-up was 6.5 years. RESULTS: The mean Knee Society pain score improved markedly from 27.6 to 88.3 points, and the mean Knee Society function score improved modestly from 14.8 to 39.2 points. There was a slight improvement in the range of motion. Symptomatic and progressive radiolucent lines were noted in two knees, one of which was revised. Two knees (one patient) required exchange of the polyethylene liner at thirteen years. There were four additional reoperations, including manipulation under general anesthesia (two knees in one patient), lysis of adhesions (one knee), and extensor mechanism realignment (one knee). CONCLUSIONS: Despite a substantial number of postoperative complications, total knee arthroplasty provided excellent relief of pain and improvement in function in this group of adolescent patients with juvenile rheumatoid arthritis.
11815776 Thalidomide therapy for recalcitrant systemic onset juvenile rheumatoid arthritis. 2002 Jan Systemic onset juvenile rheumatoid arthritis unresponsive to nonsteroidal anti-inflammatory drugs may be controlled with corticosteroids, but these drugs have significant side effects. We report 2 steroid-dependent children with systemic onset juvenile rheumatoid arthritis who did not respond to multiple nonsteroidal anti-inflammatory drugs, methotrexate, azathioprine, cyclosporine, and etanercept. Both children had significant improvement with thalidomide therapy.
15314222 Aromatase-deficient mice spontaneously develop a lymphoproliferative autoimmune disease re 2004 Aug 24 Sjögren's syndrome (SS) is an incurable, autoimmune exocrinopathy that predominantly affects females and whose pathogenesis remains unknown. Like rheumatoid arthritis, its severity increases after menopause, and estrogen deficiency has been implicated. We have reported that estrogen receptor-alpha and -beta-knockout mice develop autoimmune nephritis and myeloid leukemia, respectively, but neither develops SS. One model of estrogen deficiency in rodents is the aromatase-knockout (ArKO) mouse. In these animals, there is elevated B lymphopoiesis in bone marrow. We now report that ArKO mice develop severe autoimmune exocrinopathy resembling SS. By 1 year of age, there is B cell hyperplasia in the bone marrow, spleen, and blood of ArKO mice and spontaneous autoimmune manifestations such as proteinuria and severe leukocyte infiltration in the salivary glands and kidney. Also, as is typically found in human SS, there were proteolytic fragments of alpha-fodrin in the salivary glands and anti-alpha-fodrin antibodies in the serum of both female and male ArKO mice. When mice were raised on a phytoestrogen-free diet, there was a mild but significant incidence of infiltration of B lymphocytes in WT mice and severe destructive autoimmune lesions in ArKO mice. In age-matched WT mice fed a diet containing normal levels of phytoestrogen, there were no autoimmune lesions. These results reveal that estrogen deficiency results in a lymphoproliferative autoimmune disease resembling SS and suggest that estrogen might have clinical value in the prevention or treatment of this disease.
12192251 Hip disease in juvenile rheumatoid arthritis. 2002 Sep In contrast to adult rheumatoid arthritis, hips are commonly affected joints in severe, destructive, juvenile rheumatoid arthritis (JRA). Hip disease develops in 30 to 50% of children with JRA. Because of the importance of the hip joint in weight bearing the advent of hip disease in a child with JRA warns of future disability [1, 2]. The challenges for the clinician are to prevent significant hip involvement, to halt further damage when hip disease is noted, and in the event that conservative treatment fails, to guide the child and family through hip arthroplasty and rehabilitation. Recent trends suggest that today's more aggressive treatment approach and more effective drugs are resulting in fewer children with JRA developing into severe hip disease requiring hip surgery. Similarly, with improvements in orthopedic surgery, the results of hip arthroplasty have improved.
17041383 Mycobacterium marinum tenosynovitis in a patient on etanercept therapy for rheumatoid arth 2002 Oct Opportunistic infections are a theoretical concern with the use of tumor necrosis factor antagonists, as these agents can impair host immunity. A 61-year-old man with rheumatoid arthritis being treated with only etanercept (soluble tumor necrosis factor receptor) and in remission from the rheumatoid arthritis presented with dorsal tenosynovitis of his right wrist. The synovitis was not improved by a local corticosteroid injection. Surgical exploration showed granulomatous inflammation, and cultures were positive for Mycobacterium marinum infection. Etanercept was discontinued 4 months after the hand infection started. The infection resolved completely with surgery and antibiotic therapy with clarithromycin 500 mg twice daily orally for 3 months. Although M. marinum infection was locally invasive, there was no systemic dissemination of the infection despite ongoing etanercept therapy for 4 months before it was discontinued. With more frequent use of this class of agents for rheumatoid arthritis and Crohn's disease, we caution physicians to be alert for the possibility of this kind of local opportunistic infection.
15303043 Tortuous vertebral artery injury complicating anterior cervical spinal fusion in a symptom 2004 Aug 15 STUDY DESIGN: A case report of a 60-year-old patient with rheumatoid arthritis who sustained injury of a tortuous vertebral artery after anterior cervical spinal fusion is reported. The literature relevant to this topic is reviewed. OBJECTIVE: To report the surgical injury of a tortuous vertebral artery resulting from rheumatoid arthritis and to stress the value of cross-sectional imaging in identifying this anomaly before surgery in these patients. BACKGROUND DATA: Rheumatoid arthritis causes well-known bony complications such as atlantoaxial and subaxial subluxation and spinal stenosis with spinal cord compression. Less emphasized is vertebral artery loop formation and vascular compression. Anomalous vertebral artery position could jeopardize otherwise successful anterior diskectomy and corpectomy in these patients. METHODS: A 60-year-old man with rheumatoid arthritis sustained a vertebral artery injury during anterior corpectomy, which resulted in cerebral and cerebellar infarction. RESULTS: Computed tomography and magnetic resonance imaging and angiography confirmed the medially deviated vertebral artery. A computed tomography scan confirmed the cerebral infarction that resulted from dissection and injury of the artery at the time of surgery. CONCLUSION: The patient with rheumatoid arthritis of the cervical spine could have associated tortuosity of the vertebral artery, mandating a thorough awareness of vascular anatomy before surgical decompression. Cross-sectional imaging effectively locates the position of the vertebral arteries and should be carefully studied before anterior cervical spinal fusion in these patients.
15454125 Adult-onset Still's disease. 2004 Oct Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology and pathogenesis. AOSD is a rare condition, usually presenting with high fever accompanied by systemic manifestations. The disease is a heterogeneous pathological entity with a range of etiologies, manifestations and prognosis. There is no single diagnostic test for AOSD; rather, the diagnosis is based upon clinical criteria such as arthralgia, fever, skin rash, lymphadenopathy, and hepatosplenomegaly. Determination of the procalcitonin level and the biological response to empirical corticosteroid therapy generally helps the diagnosis, while immune-serology, as a 'screening' test, will not add meaningful information in most cases. Treatment consists of anti-inflammatory medications. Non-steroid anti-inflammatory drugs have limited efficacy, corticosteroid therapy and disease-modifying antirheumatic drugs are usually required. Novel therapeutic approaches, such as anti-tumor necrosis factor blockade and stem cell transplantation, are promising. In this chapter we present clinical and laboratory parameters of 18 patients diagnosed with AOSD at our institution between 1997 and 2003, and review the literature.
15158743 Sjögren's syndrome. 2004 Jun Sjögren's syndrome is an autoimmune disease characterized by inflammation of the exocrine glands, leading to impaired function. Here, I review the relatively short history of the syndrome and explain why it is frequently underdiagnosed, undertreated and under-researched. Attempts to provide classification criteria have culminated in the revised American-European Consensus Criteria, which provide a sound basis for both clinical management and research. The recognition that Sjögren's syndrome is a disease of considerable morbidity has led to a more aggressive approach to therapy ranging from topical therapies to systemic treatment with secretagogues such as pilocarpine and cemiveline, and immunomodulatory drugs such as hydroxychloroquine and interferon-alpha. The central role of the glandular epithelial cell is identified as the key to understanding the pathogenesis of the disease. Hypofunction rather than destruction of these cells is now regarded as the main mechanism of secretory failure in Sjögren's syndrome.
11898381 [Combined ultrasound and sinusoidal modulated currents in treating children with juvenile 2002 Jan The exposure of the joints to ultrasound and sinusoidal modulated currents in combination with radon baths proved highly effective in slowly progressive juvenile rheumatoid arthritis of the first degree of activity.
14752936 Detection of anti-SS-A/Ro and anti-SS-B/La antibodies of IgA and IgG isotypes in saliva an 2003 Dec To assess the frequency and the possibility of local production of autoantibodies against SS-A/Ro and SS-B/La in patients with primary Sjögren's syndrome (SS), serum and saliva samples were obtained from 42 patients with SS, 10 with rheumatoid arthritis without sicca syndrome, and 12 healthy volunteers. Autoantibodies were detected using enzyme-linked immunosorbent assay and immunoblotting. The frequencies of IgA anti-SS-A antibody, IgA anti-SS-B antibody, IgG anti-SS-A antibody and IgG anti-SS-B antibody in serum from SS patients were 45%, 50%, 43% and 21%, respectively. The frequencies of IgA anti-SS-A antibody, IgA anti-SS-B antibody, IgG anti-SS-A antibody and IgG anti-SS-B antibody in saliva from SS patients were 31%, 33%, 40%, and 19%, respectively. We also found secretory IgA anti-SS-A and anti-SS-B antibodies accompanying secretory components in saliva and sera in representative SS patients. Significant correlations were found between serum and salivary levels of IgA anti-SS-A antibodies, and between serum and salivary levels of IgA anti-SS-B antibodies in SS patients. Significant correlations were also found between serum and salivary levels of IgG anti-SS-A antibodies, and between serum and salivary levels of IgG anti-SS-B antibodies in SS patients. Immunoblot analysis confirmed the presence of IgA-class autoantibodies against SS-A and SS-B in saliva and serum from representative patients. The presence of IgA- and IgG-class autoantibodies against SS-A and SS-B and those accompanying secretory components in saliva from SS patients suggests the local production of these antibodies and the relationship between local and systemic antibody responses.
15775138 [Mechanism of bone destruction in rheumatoid arthritis]. 2003 Jun Osteoclasts play a critical role in bone destruction in rheumatoid arthritis. Activation of osteoclastogenesis is mediated by the enhanced expression of RANKL (receptor activator of NF-kappaB ligand), accompanied by reduced expression of its inhibitor, IFN-gamma. Accumulating evidence indicates that the osteoclast-targeted therapy is effective in arthritis models, suggesting a promising new strategy for rheumatoid bone destruction.
12920226 Detection of parvovirus B19 capsid proteins in lymphocytic cells in synovial tissue of aut 2003 Aug The pathogenic influence of viral agents in chronic inflammatory joint diseases like rheumatoid arthritis has been discussed for many years. More recently, DNA of several viruses, among them parvovirus B19 (B19), was traceable by PCR analysis in synovial fluid and synovial tissue. To investigate the potential role of parvovirus B19 in rheumatoid arthritis, we analyzed the expression of B19 VP1/VP2 proteins by immunohistochemistry in paraffin sections of 63 synovial specimens in rheumatoid arthritis (RA; n = 29), psoriatic arthritis (PSA; n = 6), nonspecific arthritis or synovitis (n = 26), and normal synovia (n = 2). Thereby we could demonstrate replicative virus infection in a variable number of cells in about 90% of rheumatoid specimens and in four of six (66%) cases of psoriatic arthritis, but only in 38% of cases with chronic reactive inflammation and one case of normal synovia. In virus-positive rheumatoid specimens, moreover, the average number of affected cells was significantly higher than in virus-expressing synovia of nonspecific reactive inflammation. These findings support the importance of B19-viral infection in the pathogenesis of chronic arthritis. B19-positive cells in the synovia could be ascribed to CD20- or CD3-positive B- or T-lymphocytes by double immunostaining. Based on these results, B19 infection of lymphocytic cells also seems possible.