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ID PMID Title PublicationDate abstract
15498797 Primary Sjögren's syndrome: new clinical and therapeutic concepts. 2005 Mar Sicca features are the central clinical manifestations of Sjögren's syndrome (SS), but recent studies have confirmed that primary SS has a systemic expression, including extraglandular manifestations. Patients with a predominantly extraepithelial expression should be managed differently from patients with predominantly periepithelial or sicca limited disease. In coming years treatment will be based on muscarinic agonists for sicca features and immunosuppressive/biological agents for extraglandular features.
11934967 Sjögren's syndrome in an out-patient clinic: classification of patients according to the 2002 Mar OBJECTIVES: To investigate whether out-patients with a clinical diagnosis of Sjögren's syndrome (SS) satisfied current preliminary European criteria for SS, and to determine the proportion of patients who satisfied the proposed modified European criteria for SS and thus had indication of an autoimmune process. METHODS: Out-patients with a clinical diagnosis of SS registered between 1 January 1999 and 1 November 2000 were included in the study. RESULTS: Of 203 patients with a clinical diagnosis of SS, 116 (57.1%) satisfied the current European criteria and 83 (40.9%) satisfied the proposed modified criteria. CONCLUSIONS: Sicca symptoms and signs may have a variety of causes. In our study only 40.9% of the patients with a clinical diagnosis of SS satisfied the proposed modified European criteria and had evidence of SS as an autoimmune condition. Our findings indicate that for patient populations with an established diagnosis of SS according to the preliminary European criteria, approximately one-third will lose the diagnosis according to the modified criteria.
15370745 Identifying the concepts contained in outcome measures of clinical trials on musculoskelet 2004 Jul OBJECTIVES: To systematically identify and compare the concepts contained in outcome measures of clinical trials on low back pain, chronic widespread pain, osteoarthritis, osteoporosis and rheumatoid arthritis using the International Classification of Functioning, Disability and Health (ICF) as a reference. METHODS: Randomized controlled trials carried out between 1991 and 2000 were identified using MEDLINE and selected according predefined criteria. The outcome measures were extracted and the concepts contained in the outcome measures were linked to the ICF. RESULTS: One hundred and twenty-nine trials on low back pain, 42 trials on chronic widespread pain, 176 trials on osteoarthritis, 107 trials on osteoporosis and 382 trials on rheumatoid arthritis were included. Fifty-nine different health status questionnaires were extracted in low back pain, 29 in chronic widespread pain, 29 in osteoarthritis, 3 in osteoporosis and 48 in rheumatoid arthritis. Across conditions at least 77% (range 77-88%) of the extracted concepts could be linked to the ICF. In low back pain, chronic widespread pain and osteoarthritis the most used ICF-categories were sensation of pain (b280), in osteoporosis structure of trunk (s760) and in rheumatoid arthritis additional musculoskeletal structures related to movement (s770). The most used category across conditions was sensation of pain (b280) except for osteoporosis. CONCLUSION: The ICF provides a useful reference to identify and quantify the concepts contained in outcome assessment used in clinical trials.
12017857 [Diseases of the hip joint in childhood and adolescence--ultrasonic differential diagnoses 2002 Mar A total of 329 children with hip pain were examined by ultrasound, which indicated transient synovitis (n = 161), rheumatoid arthritis (n = 16), tuberculoid arthritis (n = 3), septic arthritis (n = 16), Legg-Calvé-Perthes disease (n = 102), and slipped capital femoral epiphysis (n = 31). Using the standard planes described by DEGUM and DGOOC, it is possible to analyze the joint capsule, the surface of the femoral head, and the periarticular structures. In cases of synovitis or joint effusion, a capsular distension can be diagnosed by ultrasound. This distension is typical in transient synovitis, septic and tuberculoid arthritis, juvenile rheumatoid arthritis, and the onset phase of Perthes disease. Because capsular distension exhibits no significant differences in the various diseases, differentiation is not possible with ultrasound in the absence of osseous abnormalities. In cases with both capsular distension and osseous abnormalities, ultrasound usually allows a differentiation between slipped capital femoral epiphysis and Perthes disease as well as septic and unspecific arthritis.
12808011 Brief report: adjustment to juvenile rheumatoid arthritis: a family systems perspective. 2003 Jul OBJECTIVE: To examine the relations of the family environment to adjustment to juvenile rheumatoid arthritis (JRA), and to examine how those relations are influenced by child sex and age. METHOD: Ninety-four children with JRA completed a questionnaire on family environment and adjustment. RESULTS: Family cohesion was related to good adjustment, whereas family conflict was related to poor adjustment. Some relations of family cohesion to adjustment were stronger for younger than for older children. The relations of child autonomy to adjustment depended on child sex and age. CONCLUSION: The relations of the family environment to adjustment to JRA are dependent on child sex and age.
24387731 Gustatory sweating due to autonomic neuropathy in a patient with amyloidosis secondary to 2004 Dec Abstract Autonomic neuropathy, although often reported to occur in patients with AL (amyloid of light chain of immunoglobulin) amyloidosis, is extremely rare in AA (amyloid A) amyloidosis. We describe a patient with AA amyloidosis secondary to rheumatoid arthritis (RA) in whom autonomic neuropathy resulted in gustatory sweating during the end stage of RA. We discuss the importance of gustatory sweating as a characteristic sign of autonomic nervous system dysfunction in AA amyloidosis secondary to RA, and stress the availability of cardiovascular autonomic tests as an indicator of autonomic neuropathy in not only AL amyloidosis but also AA amyloidosis.
24728115 [Not Available]. 2002 Sep Rheumatoid Arthritis is a progressive and systemic inflammatory disorder of unknown etiology that frequently leads to joint destruction accompanied by multi-system extra-articular manifestations. No curative therapy is available today. Compared to usual Disease Modifying Antirheumatic Drugs (DMARDs), biologicals such as tumor necrosis factor (TNF) α- and interleukin (IL) 1-inhibitors appear to offer greater efficacy and safety, especially in refractory cases. This article deals with the new agents infliximab, etanercept, and anakinra as well as with additional newly developed cytokine-inhibitors. In order to control their use and possible unknown long-term effects, a network of international and national committees has been installed. The actual recommendations for the treatment of rheumatoid arthritis with biologicals are presented, and the cost-benefit relation is discussed.
12027105 Placement of a collagen glaucoma drainage device to control intraocular pressure and chron 2002 May A patient with juvenile rheumatoid arthritis and chronic iritis is reported with intraocular pressure near 30 mm Hg and previous episodes of intraocular pressure as high as 50 mm Hg despite maximally tolerated medical therapy. Because of the potential risk involved with a full-thickness filtration procedure, it was decided that a nonpenetrating deep sclerectomy would be appropriate, followed by placement of a collagen glaucoma drainage device to maintain aqueous outflow. Immediately postoperatively, intraocular pressure was stabilized. At 24 months postoperatively, intraocular pressure was well controlled at 15 mm Hg with patient receiving only Lotemax. No significant complications were noted at any point in the postoperative course. Because of the patient's predisposition for serious complications frequently associated with trabeculectomy, nonpenetrating deep sclerectomy with the collagen glaucoma drainage device was an effective alternative for this patient.
12353838 Quality of life outcomes in congenital chronic intestinal pseudo-obstruction. 2002 Sep The goal of this study was to assess the quality of life for children with chronic intestinal pseudoobstruction. We used a retrospective chart review to identify children with congenital chronic intestinal pseudoobstruction, then a structured telephone interview with parents that included the Child Health Questionnaire to gather information about the current status and quality of life for each patient and family. Children with chronic intestinal pseudo-obstruction had less freedom from pain, depression, and anxiety than healthy children or children with juvenile rheumatoid arthritis (P < 0.05 for all three parameters). Parents of children with chronic intestinal pseudo-obstruction had poorer emotional status than parents of healthy children or children with juvenile rheumatoid arthritis. The time required for parents to care for children with chronic intestinal pseudo-obstruction was greater than the time required to care for healthy children or children with juvenile rheumatoid arthritis (P < 0.01). In conclusion, the quality of life for children with chronic intestinal pseudo-obstruction lags behind that of healthy children and children with another chronic illness. Appropriate treatment of chronic pain may improve the quality of life for children with chronic intestinal pseudo-obstruction and their families. Moreover, attention to reducing each family's burden of time and emotional distress may help them cope better with their chronically ill child.
15314695 Distinct contribution of IL-6, TNF-alpha, IL-1, and IL-10 to T cell-mediated spontaneous a 2004 Aug Cytokines play key roles in spontaneous CD4(+) T cell-mediated chronic autoimmune arthritis in SKG mice, a new model of rheumatoid arthritis. Genetic deficiency in IL-6 completely suppressed the development of arthritis in SKG mice, irrespective of the persistence of circulating rheumatoid factor. Either IL-1 or TNF-alpha deficiency retarded the onset of arthritis and substantially reduced its incidence and severity. IL-10 deficiency, on the other hand, exacerbated disease, whereas IL-4 or IFN-gamma deficiency did not alter the disease course. Synovial fluid of arthritic SKG mice contained high amounts of IL-6, TNF-alpha, and IL-1, in accord with active transcription of these cytokine genes in the afflicted joints. Notably, immunohistochemistry revealed that distinct subsets of synovial cells produced different cytokines in the inflamed synovium: the superficial synovial lining cells mainly produced IL-1 and TNF-alpha, whereas scattered subsynovial cells produced IL-6. Thus, IL-6, IL-1, TNF-alpha, and IL-10 play distinct roles in the development of SKG arthritis; arthritogenic CD4(+) T cells are not required to skew to either Th1 or Th2; and the appearance of rheumatoid factor is independent of joint inflammation. The results also indicate that targeting not only each cytokine but also each cell population secreting distinct cytokines could be an effective treatment of rheumatoid arthritis.
17043543 Accelerated cutaneous nodulosis during infliximab therapy in a patient with rheumatoid art 2004 Dec Up to one fourth of patients with rheumatoid arthritis (RA) may have extraarticular findings such as subcutaneous nodules. These are discrete subcutaneous granulomatous nodules located on extensor surfaces, especially of the elbows. Over the past 10 to 15 years, there have been reports of accelerated cutaneous nodulosis in patients receiving methotrexate therapy. Recently, antitumor necrosis factor alpha (anti-TNFalpha) biologic therapy has become commonplace in the management of RA, especially in methotrexate-resistant or toxic patients. There have been recent reports of accelerated nodulosis in patients with RA on etanercept. We describe what we believe is the first case of accelerated cutaneous nodulosis resulting from infliximab anti-TNFalpha therapy in a patient with RA. One year after the initiation of infliximab, with RA in remission, our patient noted the rapid development of rheumatoid nodules of both hands. A biopsy was characteristic of a rheumatoid nodule, revealing palisading granulomas and fibrinoid necrosis.
12478506 Bipolar hemiarthroplasty in juvenile rheumatoid arthritis: long-term survivorship and outc 2002 Dec Because controversy surrounds the management of end-stage hip disease in juvenile rheumatoid arthritis (JRA), this study evaluated the long-term outcome of bipolar hemiarthroplasty as an alternative to conventional joint arthroplasty. A total of 24 JRA patients underwent 39 hemiarthroplasties; follow-up averaged 12 years (range, 3 to 15 years). There were 14 hips (36%) revised, and 25 hips (64%) maintained the original components. Mean Harris hip scores in surviving hips improved from 29 to 69 points (P<.001). Radiographs showed progressive bipolar superomedial migration (P<.01) despite attempted augmentation. Failure defined as revision to total hip arthroplasty or definite radiographic loosening occurred in 15 hips (38%). Ten-year Kaplan-Meier survivorship for all prostheses was 78%. Independent multivariate risk factors for failure included acetabular grafting (P =.006), prosthesis type (P<.001), and unilateral replacement (P<.001).
15135922 A role for substance P in arthritis? 2004 May 6 Substance P is a neuropeptide that is released from sensory nerves and which has a number of pro-inflammatory effects. In this article, we review the evidence for a role of substance P in arthritis, both in experimental animal models and rheumatoid arthritis patients. Substance P expression is altered in the joint and dorsal horn of arthritic animals, exogenous substance P and neurokinin 1 (NK(1)) receptor antagonists modulate responses in the joint, and there is some evidence for a role of substance P in human joint disease. However, the therapeutic potential of NK(1) receptor antagonists in the treatment of rheumatoid arthritis remains controversial.
12219321 Th1/Th2 cytokine imbalance in patients with Sjögren syndrome secondary to hepatitis C vir 2002 Aug OBJECTIVE: To investigate if the serum immunologic profile, as delineated by serum circulating levels of Th1/Th2 cytokines and autoantibodies, is different in patients with Sjögren syndrome (SS) with and without hepatitis C virus (HCV) infection. METHODS: This study included 20 patients with HCV-related SS and 47 consecutive patients with primary SS. All fulfilled 4 or more of the modified 1996 European criteria for SS. Serum levels of interleukin (IL)-2 (pg/mL), srIL-2 (pM), tumor necrosis factor (TNF)-alpha (pg/mL), IL-6 (pg/mL), and IL-10 (pg/mL) were determined using enzyme immunoassay. We also analyzed the following immunologic tests: anti-nuclear antibodies (ANA), anti-mitochondrial antibodies (AMA), anti-parietal cell antibodies (PCA), anti-smooth muscle antibodies (SMA), anti-liver-kidney microsome antibodies type-1 (LKM-1), anti-Ro/SS-A, anti-La/SS-B, rheumatoid factor (RF), complement factors (C3 and C4), and cryoglobulins. RESULTS: Of the 20 patients with HCV-related SS, 18 were women and 2 men (mean age, 66 years). Patients with HCV-related SS had a different cytokine profile compared with patients with primary SS, with higher circulating levels of IL-6 (73.6 v 33.0 pg/mL, P =.045), IL-10 (6.7 v 3.1 pg/mL, P =.01), srIL-2 (124.6 v 72.7 pM, P =.001), and TNF-alpha (59.8 v 31.7 pg/mL, P =.003). The main immunologic features were ANA, detected in 75% of patients, RF in 63%, cryoglobulinemia in 50%, hypocomplementemia in 40%, SMA in 30%, PCA in 25%, anti-Ro/SS-A in 25%, AMA in 20% and anti-La/SS-B in 16%. When compared with primary SS patients, those with HCV-related SS had a higher prevalence of AMA (20% v 2%, P =.025), hypocomplementemia (40% v 11%, P =.015), and cryoglobulinemia (50% v 12%, P =.003). CONCLUSION: Although chronic HCV infection may mimic the main clinical, histologic and immunologic features of primary SS, patients with HCV-related SS showed some differentiated characteristics, including a predominant Th2 pattern and a higher frequency of cryoglobulinemia and hypocomplementemia (features closely related to HCV). This suggests that the SS observed in some HCV patients should be interpreted as one of the extrahepatic manifestations of chronic HCV infection.
12672208 Radiologic outcome and its relationship to functional disability in juvenile rheumatoid ar 2003 Apr OBJECTIVE: To determine the radiologic outcome in juvenile rheumatoid arthritis (JRA) and the relationship of radiologically detected joint damage to functional disability using multivariate analyses. METHODS: Selection criteria included a diagnosis of JRA made by 1977 American College of Rheumatology criteria, onset of arthritis > or = 5 years prior to study, current age > or = 8 years, a minimum grade 3 reading ability, and the availability of radiographs. Disability was measured by the Childhood Health Assessment Questionnaire (CHAQ) and Steinbrocker classifications. Radiographs taken within 2 years after onset (early) and the most recent radiographs (late) were examined by a single pediatric radiologist blinded to patients' identities, diagnoses, and outcomes. Multiple regression analyses were performed. RESULTS: On late radiographs the frequencies of joint space narrowing were 38, 14, 43, and 79%, respectively, among patients with systemic, pauciarticular, rheumatoid factor (RF) negative polyarticular, and RF positive polyarticular onset; erosions occurred in 63, 25, 39, and 75%, respectively. Early erosions were most frequent in patients with RF+ polyarticular onset, while both joint space narrowing and erosions occurred early in systemic onset. Radiologic signs of joint damage were most frequent at hips and wrists, while knees and ankles were relatively spared. Based on patients who had radiographs performed within one year of clinical study, 17.7% of the variation in CHAQ score was explained by joint space narrowing, 32.4% by pain, and 5% by a severe rating on physician's global estimate of disease activity. The odds of a Steinbrocker class > I were increased by joint space narrowing, pain, systemic onset, and active joint count. CONCLUSION: Differences in the frequencies and patterns of joint damage occur both among JRA onset subtypes and among individual joints. Radiographic damage, especially joint space narrowing, correlates with functional disability. However, pain is the major contributor to variation in CHAQ scores.
17041966 A review of the history of hand exercises in rheumatoid arthritis. 2004 The management of the hand in the patient with rheumatoid arthritis (RA) is a challenge to all therapists and evidence for optimum management historically scarce. Given that it is estimated that hands and wrists are affected in 80-90% of RA patients (Maini and Feldmann, 1998), it is apparent that this is an important area for both the patient and practitioner. While acknowledging the importance of hand function to the patient with RA (Jones et al., 1991), it should also be admitted that there is little research evidence relating to the conservative management of hand function in this patient population. This paper reviews the research that has been carried out in this area and explores possible areas for further research.
17143679 Two localization patterns of vascularity demonstrated by power Doppler sonography at the s 2004 Intraarticular vascularization in 54 knee joints of 27 patients with rheumatoid arthritis was examined by power Doppler sonography. Localization of the vascularity at the suprapatellar recess was classified into two patterns: intracapsular and supra-cortical. The patients with supra-cortical vascularization showed a tendency to higher grades of synovitis and higher levels of inflammatory laboratory indices than those with intracapsular vascularization.
24387219 Case report: rheumatoid arthritis occurring during observation after surgery for localized 2003 Sep Abstract In the rare case presented here, arthroscopic resection was performed after a diagnosis of localized pigmented villonodular synovitis (LPVS) of the knee, but the disorder recurred after about 1 year as the diffuse form, and synovectomy was performed through a medial parapatella incision. Subsequently, rheumatoid arthritis (RA) occurred during the postoperative observation period. The course of this case is interesting because of the combination of the two diseases. In cases of PVS, the possibility of RA should always be considered.
24387215 A case of amyloidosis secondary to rheumatoid arthritis complicated with Graves' ophthalmo 2003 Sep Abstract We report the case of a 73-year-old woman who suffered from amyloidosis secondary to rheumatoid arthritis (RA) complicated with Graves' ophthalmopathy. She had goiter, diplopia, and exophthalmos with polyarthralgia. We diagnosed Graves' ophthalmopathy with thyroid-stimulating hormone (TSH)-receptor antibodies (TBII and TSAb). The amyloid deposit was detected in her stomach. The complication of Graves' ophthalmopathy in amyloidosis secondary to RA has rarely been reported.
15077263 Predictors of pain in children with established juvenile rheumatoid arthritis. 2004 Apr 15 OBJECTIVE: To examine demographic and disease-related variables that affect pain in a large cohort of patients with juvenile rheumatoid arthritis (JRA). METHODS: Selection criteria were an onset of JRA >/=5 years prior to study and age >/=8 years at the time of the study. Pain was measured by a self-administered 10-cm visual analog scale. Possible explanatory variables studied included age at study, sex, race, onset subtype, active disease duration, active joint count, and physician's global assessment (PGA). RESULTS: In a multiple regression model, active disease duration, PGA, and age at study were independent predictors explaining 22% of the variation in pain scores. Stratified analyses showed an effect of age in the 8-15-year group, but not in older patients. CONCLUSION: Disease-related factors explain only a small proportion of the variation in pain scores. Age has an effect on pain scores only in younger patients. The role of other factors, including psychosocial factors, needs further study.