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ID PMID Title PublicationDate abstract
17143696 Treatment of infected total knee arthroplasty in patients with rheumatoid arthritis. 2004 The primary aim of treating infected knee joints after total knee arthroplasty is to eradicate the infection, but this is difficult to achieve. We reviewed the treatment of infections that occurred after total knee arthroplasty in patients with rheumatoid arthritis. The subjects were 14 patients with rheumatoid arthritis (3 men, 11 women; ages 38-81 years) who had 14 infected knee joints. The outcome was preservation of the implant in two cases, revision arthroplasty in six cases, arthrodesis in three cases, resection arthroplasty in one case, amputation in one case, and death in one case. If there is no loosening, preservation of the implant should be attempted. If preservation is impossible, revision arthroplasty is the next best option considering the effect on daily activities in patients with the disease affecting multiple joints.
17041467 Panniculitis: a presenting manifestation of disseminated histoplasmosis in a patient with 2003 Aug We report a case of histoplasma panniculitis in a patient with rheumatoid arthritis treated with multiple immunosuppressive agents including infliximab. The patient presented with erythematous plaques involving the right upper anterior abdominal wall, the right flank and later extension to involve the left flank and the left axilla. The histopathologic examination of these lesions was consistent with lobular panniculitis and the cultures of these lesions and blood grew Histoplasma capsulatum. The clinical and histopathologic picture of histoplasma panniculitis and rheumatoid arthritis-associated panniculitis can be very similar, but the treatment is clearly different. Our case emphasizes the importance of considering rare manifestations of opportunistic infections in an era of widespread use of immunosuppressive medications in the field of rheumatology.
17039199 Disseminated Histoplasmosis Mimicking Felty's Syndrome. 2002 Feb The successful treatment of rheumatoid arthritis often requires the use of immunosuppressive medications. Although these agents have different potential toxicities, they share in common the potential for permitting the development of opportunistic infections. We describe 2 patients with chronic rheumatoid arthritis treated with immunosuppressive agents who developed progressive neutropenia with documented splenomegaly. The differential diagnosis included Felty's syndrome versus bone marrow suppression from their immunosuppressive medication. Although both patients had the triad of Felty's syndrome, high titer seropositive rheumatoid arthritis with splenomegaly and neutropenia, the diagnosis of this syndrome relies on excluding other potential causative factors. Further investigation revealed that both patients had disseminated histoplasmosis with bone marrow involvement, which most likely represented reactivation from prior exposure to Histoplasma capsulatum. Opportunistic infections such as disseminated histoplasmosis can mimic other disease processes, including Felty's syndrome, and are important to consider when there is a change in the clinical status of patients with rheumatic disease who are immunocompromised.
11773549 Current treatment of juvenile rheumatoid arthritis. 2002 Jan Prognostic factors in juvenile rheumatoid arthritis (JRA) include polyarticular onset, polyarticular disease course, and rheumatoid factor positivity; in the systemic onset subtype, persistence of systemic features at 6 months after onset confers a worse prognosis. Timely diagnosis and appropriate aggressive treatment of patients with poor prognostic features improve quality of life and outcome. After nonsteroidal anti-inflammatory drugs, methotrexate is the most commonly used second-line agent. However, approximately one third of patients do not respond to methotrexate adequately. Randomized, placebo-controlled, clinical trials in patients with JRA are few, but one such trial with the tumor necrosis factor inhibitor etanercept shows that this drug is effective and well-tolerated. Other recently approved agents for rheumatoid arthritis, including infliximab, leflunomide, celecoxib, and rofecoxib, have not been adequately studied in pediatric patients, and the role of these agents in children with JRA remains to be determined.
24383900 Development of large pseudocysts adjacent to the knee joint in rheumatoid arthritis. Asses 2002 Jun Abstract  This study examined the pathogenesis of large pseudocysts adjacent to knee joints in rheumatoid arthritis (RA). The radiological and histopathological features of 17 large subarticular pseudocysts in 12 knee joints of 10 patients were analyzed. Nine of the 10 patients were classified as class 2 according to Steinbrocker's functional class. Eight large pseudocysts were located at the lateral femoral condyle, seven were at the proximal part of the tibia, one was at the medial femoral condyle, and one was at the patella. The large pseudocysts were divided into two groups according to whether they did or did not connect with the joint cavity. Serial radiographs revealed that all large pseudocysts in communication with the joint cavity had enlarged gradually over the past several months. They extended from the subarticular area toward the bone marrow. Histopathological findings confirmed that holes allowing communication were located at a transitional zone between the ligament and the hyaline cartilage, and that rheumatoid granulation tissue invaded the large pseudocyst through these holes. The results of this study indicate that large pseudocysts are formed by the extension of articular inflammation. Moreover, repeated extrinsic mechanical stress due to walking and the aggressive inflammatory nature of rheumatoid arthritis play important roles in the formation of large pseudocysts.
24383829 Relationship between psychological factors and arthralgia in patients with rheumatoid arth 2002 Mar Abstract Various factors were assessed in terms of their contribution to arthralgia in a rheumatoid arthritis patient. Eighty-two outpatients (62 women and 20 men) with rheumatoid arthritis (RA) were examined with respect to the subjective degree of arthralgia, age, disease duration, dysfunction, steroid dose, steroid period, depression, anxiety, extroversion, neurotic disorder, and number of caretakers. The results were explained on the basis of stepwise regression analysis and psychological and clinical data. We analyzed results of a correlation coefficient test on the mutual relationship between variables. Stepwise regression analysis was performed to assess factors of arthralgia in terms of "depression," "mean activity," "morning stiffness," and "steroid dose." Depression is a factor of arthralgia as shown in this study, but it is clear that other factors are also involved. Anxiety was a factor distinct from the activity of RA. The factor contributing most to arthralgia was found to be depression, whereas anxiety had no effect.
12013305 Changing patterns of hospital admissions for patients with rheumatic diseases. 2002 Mar 22 AIMS: To audit trends in hospital admission of patients with rheumatic diseases to a rheumatology unit. METHODS: Numbers of admissions for 1990-1999 were reviewed. Notes of patients admitted in 1993, 5, 7 and 9 were reviewed for principal diagnosis and other data. RESULTS: There was a 75% decline in admissions during the study period. There was a significant fall in admissions for control of active rheumatoid arthritis which declined from 53% to 21% of total admissions (p=0.004). CONCLUSIONS: In the last decade in Otago there has been a substantial decrease in patient admissions for treatment. This was mainly due to decreased admissions for treatment of flares of rheumatoid arthritis and its complications. Determining if this was due merely to more rigorous admission criteria or improved effectiveness of treatment of rheumatoid arthritis will be important for guiding decisions on healthcare services for patients with rheumatic diseases.
15068578 Fathers' experience of parenting a child with juvenile rheumatoid arthritis. 2004 Apr The author examined the experience of fathers who have a child with juvenile rheumatoid arthritis (JRA). He used grounded theory methodology, in which 22 fathers participated in semistructured interviews, and developed a substantive theory of fathers' experience that addresses the impact of their child's JRA, their adaptational responses, and the meanings they associated with their experiences. Fathers were profoundly affected, perceived their child's condition as a catalyst for meaningful involvement, experienced many emotions, and sought to adopt a positive approach to making sense of their child's condition. Fathers' efforts to be strong for others resulted in an overreliance on self-support strategies, particularly during periods of high stress. Given the nature of fathers' experience and the extent of their involvement, greater attention by health care practitioners to fathers' adaptation is indicated.
17656946 Dermatitis herpetiformis and rheumatoid arthritis. 2002 Jul A 35- year-old deaf and dumb woman with clinical and histopathological diagnosis of dermatitis herpetiforrnis (DH) is reported for its rare association with rheumatoid arthritis (PA).
11980843 Expression of a wide range of extracellular matrix molecules in the tendon and trochlea of 2002 May PURPOSE: To show that the molecular composition of the extracellular matrix of the trochlea and its associated tendon may explain the link between some cases of acquired Brown syndrome and rheumatoid arthritis. METHODS: One trochlea and its tendon from 11 dissecting-room cadavers were fixed in methanol, cryosectioned, and immunolabeled with a panel of monoclonal antibodies against types I, II, III, V, and VI collagens, chondroitin-4 and -6, keratan and dermatan sulfates, aggrecan, link protein, versican, and tenascin. Labeling was detected with an avidin-biotin-peroxidase detection kit. RESULTS: The trochlea had a central core of hyaline cartilage surrounded by a band of fibrocartilage, but the tendon had no cartilage cells. Significantly, however, both structures immunolabeled for aggrecan, link protein, and type II collagen-molecules typical of articular cartilage. CONCLUSIONS: The presence of aggrecan, link protein, and type II collagen may account for the coincidence between transient attacks of acquired Brown syndrome in patients with juvenile and adult forms of chronic rheumatoid arthritis. Cleavage of aggrecan by aggrecanase in articular cartilage characterizes cartilage degeneration in rheumatoid arthritis. Thus, it is possible that aggrecan cleavage also occurs in the trochlea and tendon and contributes to their degeneration or to a local inflammatory reaction that may swell and thicken the tendon. In this context, it is also significant that link protein and type II collagen are now regarded as relevant antigenic targets for autoimmune responses in rheumatoid arthritis.
15547097 Diagnostic accuracy of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic 2004 Dec OBJECTIVE: To correlate serum anti-cyclic citrullinated peptide antibodies (anti-CCP) levels with juvenile idiopathic arthritis (JIA) subtypes and with an erosive disease course. METHODS: The study group comprised 122 children with JIA; 16 were evaluated during both active disease and remission. Nineteen children with systemic lupus erythematosus (SLE), 27 with rheumatoid arthritis (RA), and 15 healthy children were also included in the study. Twelve children with JIA were rheumatoid factor (RF) positive, and 34 patients had persistent erosive joint disease. Anti-CCP antibody levels were determined by ELISA; values above 5 relative units were regarded as positive. RESULTS: Three girls with seropositive polyarticular JIA and erosive joint disease had positive anti-CCP values. Children evaluated during active disease and remission, patients with SLE, and healthy children all had negative anti-CCP antibody levels. However, 19/27 (70%) adult patients with RA had positive anti-CCP antibody values. CONCLUSIONS: In contrast with RA, anti-CCP positivity is only rarely found in patients with JIA. In patients with RF positivity and/or in patients with erosive joint disease, anti-CCP can be detected.
12848952 The epidemiology of autoimmune diseases. 2003 May Autoimmune diseases are among the leading causes of death among young and middle-aged women in the United States. Incidence rates vary among the autoimmune diseases, with estimates ranging from less than one newly-diagnosed case of systemic sclerosis to more than 20 cases of adult-onset rheumatoid arthritis per 100,000 person-years. Prevalence rates range from less than 5 per 100,000 (e.g. chronic active hepatitis, uveitis) to more than 500 per 100,000 (Grave disease, rheumatoid arthritis, thyroiditis). At least 85% of thyroiditis, systemic sclerosis, systemic lupus erythematosus, and Sjögren disease patients are female. Although most diseases can occur at any age, some diseases primarily occur in childhood and adolescence (e.g. type 1 diabetes), in the mid-adult years (e.g. myasthenia gravis, multiple sclerosis), or among older adults (e.g. rheumatoid arthritis, primary systemic vasculitis). Ethnic and geographic differences in incidence of specific autoimmune diseases have been documented, but specific groups may be at higher risk for some diseases and lower risk for other diseases. The incidence of type 1 diabetes increased but the rates of rheumatoid arthritis declined over the past 40 years. Thus although there are commonalities, there are also important demographic differences between diseases. Disease-specific research, as well as studies that focus on potentially related diseases, needs to be conducted.
17041968 Biologic agents used to treat rheumatoid arthritis and their relevance to podiatrists: a p 2004 This review considers the pharmacological management of rheumatoid arthritis including the role of anti-tumour necrosis factor alpha (TNFalpha) agents, as a precursor to highlighting some of the issues for podiatrists involved in the care of patients on this particular medication.
14567062 Sjögren's disease. 2003 Aug In summary, Sjögren's syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands. The sicca complex of xerophthalmia and xerostomia are the hallmark features of Sjögren's symptomatology. In addition to these hallmark symptoms of oral and ocular dryness, one third of patients with Sjögren's syndrome present with extraglandular manifestations. Many osf these extraglandular manifestations, as well as the sicca symptoms, have otolaryngologic relevance. Because patients with Sjögren's syndrome may present with vague or nonspecific head and neck complaints, ranging from oral dryness to hoarseness to hearing loss, an otolaryngologist's high index of suspicion for this disorder may prevent delay in diagnosis, allow appropriate diagnostic evaluation, and optimize therapeutic intervention.
12546252 A 41-year-old active duty U.S. Air Force enlisted man with a 3-week history of fevers, art 2003 Jan A 41-year-old active duty male was transferred to Walter Reed Army Medical Center in Washington, DC, for further evaluation of fever, rash, myalgias, arthralgias, and respiratory failure. An extensive evaluation with input from numerous subspecialties of medicine was performed. The patient was eventually diagnosed with adult Still's disease, which is a diagnosis of exclusion. This case illustrates the importance of having a broad differential diagnosis when evaluating a patient with fever of unknown origin, with emphasis on the approach to young, active duty military personnel.
12691251 Sjögren's syndrome--implications for perioperative practice. 2003 Mar Sjögren's syndrome (SS) is a chronic autoimmune rheumatic disorder in which lymphocytes invade the exocrine glands, leading to destruction of the glandular tissue. Systemic inflammation also may occur and involve multiple organs. Ninety percent of patients with SS are female, Caucasian, and middle-aged. The characteristic symptoms of xerostomia and xerophthalmia often are trivialized, and the disorder is significantly underdiagnosed. Early diagnosis and management can prevent devastating oral and ocular complications and internal organ damage. Treatment modalities are aimed at providing comfort and preventing complications and progression of the disease. In the perioperative practice setting, nurses play an important role in the health care team involved in providing surgical care to patients with SS.
15241154 Ankle arthroplasty using three generations of metal and ceramic prostheses. 2004 Jul Ankle arthroplasties using metal and polyethylene prostheses were done on 28 patients (30 ankles) with painful osteoarthritis or rheumatoid arthritis between 1975 and 1980. Significant loosening and subsidence of the metal prostheses occurred in most patients, and ceramic prostheses were introduced in 1980. Ceramic prostheses with or without cement were used to replace 60 ankles in 56 patients with painful arthritis between 1980 and 1991. Revision surgery was required for five patients (five ankles) during the followup period (mean, 12 years 6 months). Loosening and subsidence of the prostheses were seen in 50% of patients within 5 years after the index procedure. As a result, a new design of bead-formed alumina coated with hydroxyapatite was used. A tibial prosthesis fixed to the posterior cortex of the tibia with a screw was used from 1991. These new ceramic prostheses were used to replace 70 ankles in 62 patients between 1991 and 2000. Thirty-six patients (36 ankles) with a mean age of 71 years (range, 50-87 years) had osteoarthritis, and 26 patients (31 ankles) with a mean age of 60 years (range, 41-76 years) had rheumatoid arthritis. During followup, with an average of 5 years 2 months, three patients (three ankles) required revision surgery (one for infection, two for talar necrosis). Overall results for patients with osteoarthritis were excellent in 21 ankles, good in 10 ankles, fair in two, ankles and poor in zero ankles. Results in patients with rheumatoid arthritis were excellent in five ankles, good in 16 ankles, fair in three ankles, and poor in two. In the intermediate study, 29 patients (31 ankles; 91.2%) with osteoarthritis and 19 patients (21 ankles; 76.9%) with rheumatoid arthritis were satisfied with the short-time results of arthroplasty.
12107998 [Pneumonitis caused by gold salts in psoriatic arthritis: report of 2 cases]. 2002 May The gold-salts compounds have been used for the treatment of rheumatoid arthritis and of psoriatic arthritis, they are generally tolerates and when have adverse effects they are minor. The gold-induced lung toxicity is a infrequent adverse effect of patients with rheumatoid arthritis characterized by three types: interstitial penumonitis, bronchiolitis obliterans with organizing pneumonia and bronchiolitis obliterans, usually the first is the more frequent. The diagnostic is supported by the clinical manifestations, chest roentgenogram, bronchoalveolar lavage fluid and chest computed tomography scan. Biopsy study of the lung, is only needed for exclusion of other pulmonary disease. The gold-induced lung toxicity in the psoriatic arthritis is rarelly described, we report two cases with gold-induced pneumonitis with benign clinical course after cessation of therapy and treatment with corticosteroids.
12838054 Elbow synovectomy on patients with juvenile rheumatoid arthritis. 2003 Jul Twenty-four primary elbow synovectomies were done between 1991 and 1998 at the authors' institution on 19 patients (15 females, four males) with juvenile rheumatoid arthritis. Five bilateral and 14 unilateral procedures were done. The mean age of the patients was 29 years (range, 11-64 years) at the time of surgery and the mean disease duration was 19 years (range, 2-51 years). Preoperatively radiographic destruction of Larsen Grade 1 was detected in 21% of elbows, Grade 2 in 54%, and Grade 3 in 4%. In 21% of elbows no radiographic destruction was present (Grade 0). The cumulative survival rate of elbow synovectomy was 84% (95% confidence interval, 68-98) at 5 years. Four resynovectomies and two elbow replacement arthroplasties were done during the followup period. Complete pain relief was documented in 44% of patients and subjective outcome was excellent or good in 72% of patients. No significant improvement was observed in functional ability or range of motion in extension and flexion or pronation and supination. The results of the current study (mean followup, 5 years; range, 2-9 years) are slightly worse compared with the short-term results of elbow synovectomy in patients with adult-onset rheumatoid arthritis.
24383899 Usefulness of actarit in elderly rheumatoid arthritis. 2002 Jun Abstract  Many elderly patients with rheumatoid arthritis (RA) who have decreased physiological functions due to aging may also have symptoms of other complications. Therefore, attention must be paid not only to the efficacy, but also to any possible adverse reactions, when selecting disease-modifying antirheumatic drugs (DMARDs). In this study, we examined the efficacy and safety of actarit for elderly patients with mildly to moderately active rheumatism. Twenty patients with elderly rheumatoid arthritis were enrolled on a 48-week course of actarit (300 mg/day). In the overall evaluation, 14 out of 20 patients (70%) met the criteria for a 20% improvement in the American College of Rheumatology (ACR) core set, and seven out of 20 patients (35%) met the criteria for a 50% improvement. In the evaluation parameters, a significant improvement was shown in the number of swollen joints, the patient's evaluation of pain, the patient's evaluation of chronic arthritis activity, the doctor's evaluation of chronic arthritis activity, erythrocyte sedimentation rate, C-reactive protein (CRP), and Lansbury's activity index after 48 weeks. A particularly remarkable improvement was shown in tender and swollen joints in the small joint category in elderly onset RA. No adverse reactions and no aggravation of complications were observed in this study. From these results, it was concluded that actarit was a safe and highly effective drug for use with elderly patients.