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ID PMID Title PublicationDate abstract
15523252 [Diagnosis, progression and prognosis, aetiology and treatment of adult-onset Still's dise 2004 Sep 11 DIAGNOSTIC DOUBTS: Despite an increased awareness of the clinical features of the disease, adult onset Still's disease (AOSD) remains a diagnosis of exclusion. Many diagnostic criteria have been published, and the most popular are those proposed by Yamaguchi, even though they do not consider the presence of hyperferritinemia or the decrease of it glycosylated fraction, and they include exclusion criteria that are difficult to satisfy. UNPREDICTABLE PROGRESSION: Three evolutive forms have been described: monocyclic, intermittent with articular and/or systemic flares, chronic, usually in the form of chronic polyarthritis. Vital prognosis is sometimes compromised by severe systemic manifestations or the occurrence of amyloidosis, whilst destructive polyarthritis, particularly common in the chronic form, may compromise the function. The aetiology of AOSD remains unknown. THERAPEUTIC UNCERTAINTIES: Treatment is largely empirical in the absence of randomized clinical trials because of the rarity of the disease. Nonsteroidal anti-inflammatory drugs could be used in moderately severe forms of the disease, but they rare rarely sufficient. Around 80% of the patients require corticosteroids. Among the disease modifying drugs, methotrexate still remains the most effective. The role of the new anti-TNF molecules remains to be specified.
14710969 Primary Sjogren's syndrome: rarity in India. 2003 Sep OBJECTIVE: Primary Sjogren's syndrome (SS) is rarely reported from India. We have studied the clinical spectrum and immunological profile of patients with primary SS. METHODS: A prospective analysis of patients with primary Sjogren's syndrome fulfilling San Francisco criteria, seen at our clinic in the last 10 years was carried out. RESULTS: The study included 26 patients, 21 being women. The presenting symptoms included dry eyes, dry mouth, and arthritis/arthralgia. Extra-glandular manifestations were glomerulonephritis, vasculitis, renal tubular acidosis and peripheral neuropathy. The important laboratory abnormalities were hypergammaglobulinaemia (16/20), antinuclear antibodies (18/26), anti-La (11/19) and anti-Ro (10/19). Minor salivary gland provided a definitive diagnosis in 16/26 (60%). CONCLUSION: The prevalence of primary Sjogren's syndrome is rare even in tertiary care rheumatology clinics. The clinical and immunological profile as seen here is similar to that reported in Western countries.
12375339 Rheumatoid arthritis after 9 years of human immunodeficiency virus infection: possible con 2002 Oct Infection by human immunodeficiency virus (HIV) may affect joints in different ways. It usually increases the severity of reactive arthritis. Conversely, when rheumatoid arthritis (RA) is seen in association with HIV infection, remission of RA has been observed in some cases. We describe a patient who developed 3 successive forms of joint manifestations: early HIV related arthralgias followed by drug related arthritis, and more recently by typical RA. The first signs of joint manifestations started one year after HIV seroconversion and resolved when antiviral treatment with AZT was started. The second episode ended when lamivudine dosage was reduced. Finally, after 9 years of infection, the diagnosis of seropositive RA was made in this HLA-DR1 positive patient. The symptoms started when the immune status reached normal CD4 T cell levels, in response to antiviral tritherapy. This observation indicates the complex effect of HIV on joint inflammation.
17143691 A case of femoral nerve palsy caused by iliopectineal bursitis associated with rheumatoid 2004 We report the case of a 46-year-old woman with rheumatoid arthritis who developed femoral nerve palsy caused by an enlarged iliopectineal bursa. Surgical excision revealed that the iliopectineal bursa was connected with the hip joint. The patient showed good recovery from the femoral nerve palsy after surgery. It was considered that iliopectineal bursitis had developed following the synovial inflammation of the hip joint.
12819466 Biologic therapies in the spondyloarthritis: new opportunities, new challenges. 2003 Jul Therapeutic options for patients suffering from the more severe forms of spondyloarthritis have been rather limited in the last decades. There is now accumulating evidence that antitumor necrosis factor therapy is highly effective in spondyloarthritis, especially in ankylosing spondylitis and psoriatic arthritis. Based on the data recently published on more than 500 patients with ankylosing spondylitis and psoriatic arthritis, this treatment seems to be even more effective than in rheumatoid arthritis. The antitumor necrosis factor-alpha agents currently available, infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira), are approved for the treatment of rheumatoid arthritis in the United States and partly in Europe. The situation in spondyloarthritis is different from that of rheumatoid arthritis because there is an unmet medical need, especially in ankylosing spondylitis: no therapies with disease-modifying antirheumatic drugs are available for severely affected patients, especially with spinal disease. Thus, tumor necrosis factor blockers may even be considered a first-line treatment in a patient with active ankylosing spondylitis and psoriatic arthritis whose condition is not sufficiently controlled with nonsteroidal antiinflammatory drugs in the case of axial disease, and sulfasalazine or methotrexate in the case of peripheral arthritis. For infliximab, a dose of 5 mg/kg was required, and intervals between 6 and 12 weeks were necessary to suppress disease activity constantly-also a major aim for long-term treatment. The standard dosage of etanercept is 2 x 25 mg subcutaneously per week. There are no studies yet on adalimumab (standard rheumatoid arthritis dose, 20-40 mg subcutaneously every 1-2 weeks) in spondyloarthritis. Infliximab was very recently approved for AS in Europe. The efficacy of etanercept was first demonstrated in psoriatic arthritis, and it is now approved for this indication. A double-blind study has also been performed in ankylosing spondylitis, with similarly clear efficacy. There is preliminary evidence that both agents do also work in other spondyloarthritis, such as undifferentiated spondyloarthritis. Ideally, both agents will be approved soon for the short-term treatment of severe, uncontrolled spondyloarthritis. In parallel, studies should be performed to document the long-term efficacy of this treatment. There is hope that ankylosis may be preventable, but it remains to be shown whether patients benefit from long-term antitumor necrosis factor therapy and whether radiologic progression and ankylosis can be stopped. Severe adverse events have remained rare. Complicated infections including tuberculosis have been reported. These can be largely prevented by appropriate screening. At it stands now, the benefits of antitumor necrosis factor therapy in ankylosing spondylitis seem to outweigh these shortcomings.
15552514 Healing of erosive changes in rheumatoid arthritis. 2004 Sep This is an overview over the history and present state of knowledge of radiographic signs of erosion healing. The existence of healing or repair has been confirmed; different observers agree in the identification of healing; it may be identified without knowing the sequence of the films. As healing indicates that inflammation has discontinued for several months in an individual joint, it might represent a good additional outcome measure in RA clinical trials.
12433016 Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnos 2002 Nov Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.
15124264 Another patient with chromosome 18 deletion syndrome and juvenile rheumatoid arthritis. 2004 May Previously, 4 children with deletion of the long arm of chromosome 18 and chronic arthritis were reported. We present an 8-year-old girl with arthritis, atrial septal defect, external auditory canal atresia, and developmental delay. She is the fifth child reported with 18q- syndrome and juvenile rheumatoid arthritis. Evidence is mounting that genetic loci on chromosome 18 may play a role in the expression of complex autoimmune diseases. Idiopathic arthritis should be considered as a potential additional feature in 18q- syndrome.
15177482 Novel p38 inhibitors with potent oral efficacy in several models of rheumatoid arthritis. 2004 Jul 5 A library of trisubstituted oxazoles, thiazoles, imidazoles (1,2,4- and 2,4,5-substituted) and imidazo[1,2-b]pyridines was prepared and evaluated in vitro as p38alpha inhibitors and in vivo in several models of rheumatoid arthritis. Four structures--32, 37, 45 and 59--were identified as potent inhibitors of p38alpha with high efficacy in the LPS induced TNFalpha release model in the mouse, the adjuvant induced arthritis and the collagen induced arthritis in the rat with ED50s between 1.0 and 9.5 mg/kg p.o.
12215860 Synovial fluid levels of E-selectin and intercellular adhesion molecule-1: relationship to 2002 Sep E-selectin and intercellular adhesion molecule (ICAM)-1 are crucial to the inflammatory response in chronic inflammatory arthritis. Soluble (s) levels of these molecules in sera and synovial fluid (SF) correlate with some clinical parameters and synovial tissue expression of the same molecules in rheumatoid arthritis. Studies of sera from children with chronic inflammatory arthritis corroborate this information; corresponding SF data are relatively lacking. We thus studied SF sE-selectin and sICAM-1 in 28 children with active juvenile rheumatoid arthritis or a spondyloarthropathy. Levels were correlated with erythrocyte sedimentation rate (ESR), SF leukocyte counts, duration of disease, and duration of response to concomitant intra-articular corticosteroid injection. Levels were compared according to use of methotrexate and/or sulfasalazine. Synovial fluid sE-selectin correlated with ESR and SF leukocyte counts. There was a trend toward lower sICAM-1 in patients treated with sulfasalazine and/or methotrexate. We conclude that SF levels of sE-selectin accurately reflect intra-synovial inflammation. Soluble ICAM-1 levels may reflect the effects of disease-modifying agents.
12490627 A controlled longitudinal study of the social functioning of children with juvenile rheuma 2003 Jan OBJECTIVE: To complete an assessment of social functioning of children with juvenile rheumatoid arthritis (JRA) and nonchronically ill controls who had been evaluated 2 years earlier (Noll et al., 2000) and to examine the impact of disease severity or disease activity over time on the social functioning of children with JRA. METHODS: Peer-, teacher-, and self-reports of social functioning were obtained from 57 children with JRA and 63 controls. Social reputation and social acceptance were examined cross-sectionally and longitudinally. RESULTS: Cross-sectional analyses indicated no significant differences between children with JRA and controls on measures of social functioning. For children with more severe disease, like ratings declined over the 2-year period relative to children with mild disease. Children with active disease were chosen fewer times over the 2-year period as a best friend than children in remission. CONCLUSIONS: Because children with severe or active JRA may be at risk for difficulties with social acceptance over time, they are appropriate targets for interventions that ameliorate or prevent these difficulties.
15549152 Clinical manifestations, disease course, and complications of adult-onset Still's disease 2004 Nov BACKGROUND AND PURPOSE: Data on the disease course and ultimate outcome of adult-onset Still's disease (AOSD) are limited. We analyzed the clinical manifestations, disease course, and complications of patients with AOSD in Taiwan. METHODS: A retrospective cohort design with prospective follow-up was used. Eighty two patients with AOSD diagnosed between 1983 and 2003 were evaluated. Their clinical features and laboratory findings at presentation, disease course, and complications were analyzed. RESULTS: Fifty nine patients (72%) were female and 55 (67.1%) were aged between 16-35 years at onset. The most common clinical manifestations were fever (100%), articular symptoms (100%), evanescent rash (87%), and sore throat (84%). Dermatographism was noted in 59% of patients. Elevation of erythrocyte sedimentation rate and C-reactive protein, which were significantly correlated with disease activity score (both p < 0.01) occurred in more than 90% of AOSD patients. Elevation of serum ferritin, which was significantly correlated with disease activity score and hepatic enzyme levels, was present in 91% of patients. Polycyclic systemic course was the most common (45%), followed by monocyclic systemic course (34%); only 20% of patients progressed to chronic arthropathy. CONCLUSIONS: The multisystemic involvement and various patterns of disease course in this series illustrate the heterogenic nature of AOSD. Serum ferritin levels can be used as a marker for monitoring disease activity in AOSD.
14522445 Anti-inflammatory effects of an herbal medicine (Xuan-Ju agent) on carrageenan- and adjuva 2003 Nov Xuan-Ju agent is an herbal formula containing aqueous extract of Formica fusca, Herba epimedii, Fructus cnidii, and Fructus lycii, all of which are reputed for their beneficial effects in the treatment of the immunodeficient diseases such as rheumatoid arthritis. We performed a study on the anti-inflammatory effects of this agent using carrageenan- and adjuvant-induced paw edema in rats. Xuan-Ju agent showed a marked inhibitory effect on edema in two models of inflammation in rats, at the dose of 0.20, 0.40 and 0.80g/kg. Based on this study, Xuan-Ju agent is considered to be a potentially useful drug suitable for further evaluation for rheumatoid arthritis.
24387181 A case of rheumatoid arthritis that developed autoimmune hepatitis associated with anti-Go 2003 Jun Abstract A 50-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) 7 months earlier, was admitted to our hospital because of liver dysfunction. Her laboratory data and histological findings satisfied the criteria for autoimmune hepatitis (AIH) as revised by the International AIH Group. Laboratory examinations (indirect immunofluorescence and immunoblotting analyses) revealed that anti-Golgi complex antibodies (AGA) were positive in her serum. AGA are thought to be closely associated with AIH and/or liver dysfunction according to several reports.
15059264 Multiple functions for CD28 and cytotoxic T lymphocyte antigen-4 during different phases o 2004 Chronic T cell responses, as they occur in rheumatoid arthritis, are complex and are likely to involve many mechanisms. There is a growing body of evidence that, in concert with the T cell antigen receptor signal, CD28 and cytotoxic T-lymphocyte antigen-4 (CTLA-4; CD152) are the primary regulators of T cell responses. Whereas CD28 primarily activates T cell processes, CTLA-4 inhibits them. The mechanism for this dichotomy is not fully understood, especially as CD28 and CTLA-4 recruit similar signalling molecules. In addition, recent studies demonstrate that CD28 and CTLA-4 have multiple functions during T cell responses. In particular, CTLA-4 exerts independent distinct effects during different phases of T cell responses that could be exploited for the treatment of rheumatoid arthritis.
24387653 A case of acquired hemophilia caused by factor VIII inhibitor with rheumatoid arthritis, s 2004 Sep Abstract We report the case of a patient who presented with acquired hemophilia associated with rheumatoid arthritis. The patient's factor VIII activity was less than 1% and factor VIII inhibitor was detected. Based on the blood analysis, the patient was diagnosed as having the factor VIII inhibitor. She was successfully treated with prednisolone, cyclophosphamide, and gammaglobulin to suppress the factor VIII inhibitor, and the administration of recombinant activated factor VII was effective in controlling severe bleeding episodes.
12057023 Experimental arthritis induced by a clinical Mycoplasma fermentans isolate. 2002 Jun 3 BACKGROUND: Mycoplasma fermentans has been associated with rheumatoid arthritis. Recently, it was detected in the joints and blood of patients with rheumatoid arthritis, but it is not clear yet how the bacteria enter the body and reach the joints. The purpose of this study was to determine the ability of M. fermentans to induce experimental arthritis in rabbits following inoculation of the bacteria in the trachea and knee joints. METHODS: P-140 and PG-18 strains were each injected in the knee joints of 14 rabbits in order to evaluate and compare their arthritogenicity. P-140 was also injected in the trachea of 14 rabbits in order to test the ability of the bacteria to reach the joints and induce arthritis. RESULTS: M. fermentans produced an acute arthritis in rabbits. Joint swelling appeared first in rabbits injected with P-140, which caused a more severe arthritis than PG-18. Both strains were able to migrate to the uninoculated knee joints and they were detected viable in the joints all along the duration of the experiment. Changes in the synovial tissue were more severe by the end of the experiment and characterized by the infiltration of neutrophils and substitution of adipose tissue by connective tissue. Rabbits intracheally injected with P-140 showed induced arthritis and the bacteria could be isolated from lungs, blood, heart, kidney, spleen, brain and joints. CONCLUSION: M. fermentans induced arthritis regardless of the inoculation route. These findings may help explain why mycoplasmas are commonly isolated from the joints of rheumatic patients.
11930008 Osteopontin deficiency protects joints against destruction in anti-type II collagen antibo 2002 Apr 2 Rheumatoid arthritis is one of the most critical diseases that impair the quality of life of patients, but its pathogenesis has not yet been fully understood. Osteopontin (OPN) is an extracellular matrix protein containing Arg-Gly-Asp (RGD) sequence, which interacts with alpha(v)beta3 integrins, promotes cell attachment, and cell migration and is expressed in both synovial cells and chondrocytes in rheumatoid arthritis; however, its functional relationship to arthritis has not been known. Therefore, we investigated the roles of OPN in the pathogenesis of inflammatory process in a rheumatoid arthritis model induced by a mixture of anti-type II collagen mAbs and lipopolysaccharide (mAbs/LPS). mAbs/LPS injection induced OPN expression in synovia as well as cartilage, and this expression was associated with joint swelling, destruction of the surface structures of the joint based on scanning electron microscopy, and loss of toluidine blue-positive proteoglycan content in the articular cartilage in wild-type mice. In contrast, OPN deficiency prevented the mice from such surface destruction, loss of proteoglycan in the articular joint cartilage, and swelling of the joints even when the mice were subjected to mAbs/LPS injection. Furthermore, mAbs/LPS injection in wild-type mice enhanced the levels of CD31-positive vessels in synovia and terminal deoxynucleotidyltransferase-mediated UTP end labeling-positive chondrocytes in the articular cartilage, whereas such angiogenesis as well as chondrocyte apoptosis was suppressed significantly in OPN-deficient mice. These results indicated that OPN plays a critical role in the destruction of joint cartilage in the rheumatoid arthritis model in mice via promotion of angiogenesis and induction of chondrocyte apoptosis.
12814334 Prevalence of joint disease in patients with psoriasis: implications for therapy. 2003 Joint diseases are common among patients with psoriasis. Psoriatic arthritis, the most important of these, can be defined as a rheumatoid factor-negative inflammatory arthritis associated with psoriasis and has emerged as a specific disease independent from rheumatoid arthritis. Psoriatic arthritis is divided into several clinical subsets, which is helpful in differentiating it from other types of inflammatory arthritis. The prevalence of arthritis in patients with psoriasis may be far higher than the previously accepted average of 7%. In a recent study of 5,795 members of the Nordic Psoriasis Associations, the prevalence was found to be 30%. Arthritis has a significant impact on quality of life in patients with psoriasis. These factors should be recognised as they have implications for therapy, since a number of drugs can delay or stop joint damage when given in time. This also applies to the new biologic agents, although at present these therapies are generally restricted to patients non-responsive to other available drugs. Alone or in combination, the new drugs may achieve higher response rates and have better safety profiles than older therapies. However, long-term experience is still lacking and, unfortunately, the new drugs will be far from affordable by all for some time to come.
12480677 Cell death by apoptosis is a feature of the rheumatoid nodule. 2003 Jan OBJECTIVE: To examine the site and extent of apoptosis in the rheumatoid nodule and to determine whether this process make a significant contribution to the control of inflammation in the rheumatoid nodule as in other granulomas. METHODS: Nine nodules and seven synovial membranes were examined by terminal deoxynucleotidyl transferase-mediated nick end labelling (TUNEL) in situ and a subset was further examined by DNA electrophoresis. The phenotype of apoptotic cells was identified using monoclonal antibodies and immunohistology. RESULTS: Apoptosis occurred in all zones of the nodule and, except in one case, was not focused adjacent to the necrotic centre. Apoptosis occurred in 3.5 (4.5)% (mean (SD)) of cells in the nodule and 3.6 (3.1)% of cells in synovial membranes. Apoptosis was more common in nodule T cells (4.1 (2.9)%) than fibroblasts (1.0 (1.4)%), p = 0.01. Among macrophages 3.2 (4.7)% were apoptotic. Banding of DNA consistent with apoptosis was seen in two of three nodules examined. CONCLUSION: Apoptosis occurs at a low level in the nodule, similar to the synovial membrane. The results suggest that two modes of cell death occur in the nodule: apoptosis, which occurs throughout the nodule; and necrosis, which is concentrated near the necrotic centre. Apoptosis was more common in infiltrating inflammatory cells than in resident fibroblasts. These results are consistent with the proposal that apoptosis of infiltrating inflammatory cells is important in controlling accumulation of cells in the rheumatoid nodule as has been established in experimental granulomas.