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ID PMID Title PublicationDate abstract
12955195 [Endoprosthetic surgery of the elbow]. 2003 Aug Artificial joint replacement has found a firm place in orthopaedic surgery since its first introduction in the late 1960s. While the initial fixed bearing implants tended to progress to early loosening, the development of so-called "sloppy joints" has seen a major advance in the survival and success rate of this arthroplasty. The surgical approach and technique have also been modified in such a way as to allow a complete ventral release of a flexion contracture, while at the same time preserving the integrity of the extensor mechanism. In this way, the improvement of the biomechanics of the implant combined with diligent surgical technique have enhanced this procedure dramatically. Between 1978 and 1999, 305 GSB 3-type prosthesis were implanted, with the underlying pathologies being rheumatoid arthritis (77%), posttraumatic arthritis (21%) and degenerative arthritis (2%). The range of motion could be significantly improved from the pre-operative state for extension as well as flexion. This was even more obvious in the rheumatoid than in the posttraumatic situation. The survival rate for this type of implant was 90% at 10 years, with the implants after rheumatoid surgery faring somewhat better than those of the posttraumatics. Alternative treatment options, such as resection arthroplasty, distraction arthroplasty, or arthrodesis, are nowadays employed only in rare cases where a previous infection, personal preference or an inability by the patient to co-operate in a rehabilitation program have to be considered. The overall functional results of these types of treatments seem to be inferior to that of elbow arthroplasty. Therefore, this procedure is recommended not only for advanced degenerative and rheumatoid pathologies, but also in cases of posttraumatic arthrosis.
15168985 Spondylo-arthropathies. 2003 Sep Spondylo-arthropathies are a broad group of inflammatory diseases that primarily involve the axial skeleton and the sacro-iliac joints. The pattern of peripheral joint involvement in spondylo-arthropathies differs from rheumatoid arthritis. Spondylo-arthropathies are known to include several conditions like ankylosing spondylitis, reactive arthritis (including Reiter's syndrome), arthritis associated with psoriasis and inflammatory bowel disease, juvenile and also undifferentiated spondylo-arthropathies. The characteristic features of spondylo-arthropathies are absence of rheumatoid factor, inflammatory low backache, sacro-iliitis, peripheral arthritis, enthesopathy, tendency to familial aggregation and association with HLA-B27. ESR may be elevated and patients may exhibit anaemia of chronic inflammation. HLA-B27 is a useful adjunctive test. The radiologic interpretation is very important. Non-steroidal anti-inflammatory drugs and spinal exercises are the cornerstone of therapy. Intra-articular corticosteroids are helpful. Patients may be benefited from, sulfasalazine, methotrexate or azathioprine.
14711598 Hepatitis B-assocciated adult-onset Still's disease presenting with neutrophilic urticaria 2003 Dec 9 Adult-onset Still's disease (AOSD) is an uncommon systemic inflammatory disorder that is characterized by quotidian fever, articular manifestations, neutrophilic leukocytosis, and maculopapular rash. The aetiology of the disease is unknown, however, an infectious cause has been suggested. Here we describe a patient in whom neutrophilic urticaria was the cutaneous manifestation of AOSD. In addition, the patient suffered from chronic hepatitis B infection that may be a potential trigger factor of AOSD. In patients with AOSD, serological investigations for detection of infection should include hepatitis serology. Further, we suggest that urticarial lesions may be a more common cutaneous manifestation of AOSD than has been recognized previously. Thus it is important to include AOSD in the differential diagnosis of urticaria.
15589426 Should patients with recent-onset polyarthritis receive aggressive treatment? 2004 Nov The diagnostic and therapeutic management of rheumatoid arthritis has benefited considerably in recent years not only from the introduction of new treatments (including new disease-modifying antirheumatic drugs, new combinations of these drugs, and TNF inhibitors), but also from the development of new concepts. Important new concepts include the use of novel diagnostic approaches, very early management within the first 3-6 months of symptom onset, periodic assessments of clinical disease activity based on objective clinical criteria and radiographic progression, and earlier use of aggressive treatments. The goal is to induce a clinical remission, thereby preventing radiographic deterioration. These concepts are firmly supported by sound scientific data. At present, patients at risk for progression to severe rheumatoid arthritis must be identified early on, and disease activity and progression must be monitored closely. This should enable patients with highly progressive disease to receive aggressive treatment (e.g., a combination of disease-modifying antirheumatic drugs or biological therapy) very early on with the goal of minimizing joint destruction and subsequent functional impairments.
12079901 Prevalence and clinical significance of anti-cyclic citrullinated peptide antibodies in ju 2002 Jul BACKGROUND: Antibodies against cyclic citrullinated peptide (anti-CCP) are considered to be specific for rheumatoid arthritis (RA). OBJECTIVE: To assess the clinical significance of anti-CCP in a cohort of patients with juvenile idiopathic arthritis (JIA). METHODS: Anti-CCP were tested by an enzyme linked immunosorbent assay (ELISA) in serum samples from 109 patients with JIA (30 boys, 79 girls), with a mean age of 8.7 years (range 0.6-20.3) and mean disease duration of 3.6 years (range 3 months to 15.6 years). As control groups, anti-CCP were also tested in sera of 30 healthy children, 25 patients with juvenile onset systemic lupus erythematosus (SLE), and 50 adult patients (30 with RA, 20 with SLE). RESULTS: Positive anti-CCP values were found in sera of two patients with JIA (2%), one with polyarthritis, and one with oligoarthritis. Statistical analysis showed that anti-CCP were not associated with the presence of antinuclear antibodies, raised erythrocyte sedimentation rate, or erosions. In the control groups, none of the patients with juvenile onset SLE and only one of 20 adults with SLE were positive for anti-CCP, but 19/30 (63%) adults with RA showed anti-CCP positivity. CONCLUSIONS: Anti-CCP can be detected in children with JIA, but are less frequently present than in adults with RA.
12960485 Macrophage activation syndrome and reactive hemophagocytic lymphohistiocytosis: the same e 2003 Sep PURPOSE OF THE REVIEW: One of the most perplexing features of systemic-onset juvenile rheumatoid arthritis is the association with macrophage activation syndrome, a life-threatening complication caused by excessive activation and proliferation of T cells and macrophages. The main purpose of the review is to summarize current understanding of the relation between macrophage activation syndrome and other clinically similar hemophagocytic disorders. RECENT FINDINGS: Clinically, macrophage activation syndrome has strong similarities with familial and virus-associated reactive hemophagocytic lymphohistiocytosis. The better understood familial hemophagocytic lymphohistiocytosis is a constellation of rare, autosomal recessive immune disorders. The most consistent immunologic abnormalities in patients with familial hemophagocytic lymphohistiocytosis are decreased natural killer and cytotoxic cell functions. In approximately one third of familial hemophagocytic lymphohistiocytosis patients, these immunologic abnormalities are secondary to mutations in the gene encoding perforin, a protein that mediates cytotoxic activity of natural killer and cytotoxic CD8+ T cells. Several recent studies have suggested that profoundly depressed natural killer cell activity and abnormal levels of perforin expression may be a feature of macrophage activation syndrome in systemic-onset juvenile rheumatoid arthritis as well. Although it has been proposed that in both hemophagocytic lymphohistiocytosis and macrophage activation syndrome, natural killer and cytotoxic cell dysfunction may lead to inadequate control of cellular immune responses, the exact nature of such dysregulation and the relation between macrophage activation syndrome and hemophagocytic lymphohistiocytosis still remain to be determined.
15513679 Factors affecting clinical and therapeutic outcomes of patients with juvenile rheumatoid a 2004 OBJECTIVE: To investigate clinical features, medications, and therapeutic responses of juvenile rheumatoid arthritis (JRA) among Taiwanese children. METHODS: A retrospective chart review was conducted among all children newly diagnosed with JRA at the National Taiwan University Hospital between 1996 and 2001. RESULTS: Forty boys and 30 girls were enrolled in the study. The mean follow-up was 45 months. Oligoarticular onset was the most common type. A bimodal distribution of age at onset was observed, with peaks at 4 and 10 years. All patients received non-steroidal anti-inflammatory drugs (NSAIDs); 27 (39%) received corticosteroids, and 44 (63%) had second-line drugs during the first course of treatment. Forty-three patients (69%) achieved clinical remission after a mean of 14.8 months of medication, and 19 (31%) were drug-dependent. The major factors related to the failure of first remission were human leukocyte antigen B27 (HLA-B27), high C-reactive protein (CRP) level, and thrombocytosis at diagnosis. CONCLUSION: There are different phenotypic features among Taiwanese children with JRA. Factors related to the failure of first remission were HLA-B27, high CRP level, and thrombocytosis at diagnosis.
17143657 Genetic epidemiology of psoriatic arthritis. 2004 Psoriatic arthritis (PsA) is defined as an inflammatory arthritis (IA) associated with psoriasis and is usually negative for rheumatoid factor. This ambiguous definition has impeded research into this subject, but as yet no agreed definition or classification criteria exist for PsA. Furthermore, there are those who question whether PsA exists as a distinct disease, or is a mere coincidence of inflammatory arthritides such as rheumatoid arthritis or ankylosing spondylitis with psoriasis. The pathogenesis of both IA and psoriasis is complex, involving interactions between many different genes and environmental etiological factors. It is likely that PsA is also a complex disease. The identification of genetic susceptibility factors unique to PsA over and above those that contribute to IA or psoriasis alone would put an end to speculation as to whether PsA exists as a distinct disease. In addition, it may aid in the development of novel therapies which target PsA specifically. This review summarizes the approaches taken to identify PsA susceptibility genes, and outlines some interesting regions which may harbor PsA susceptibility genes.
12133169 Correlation of the score for subjective pain with physical disability, clinical and radiog 2002 Jul 19 BACKGROUND: To analyse the relationship between subjective pain score and other measures of clinical, radiographic and functional status; in particular Larsen radiographic scores and Health Assessment Questionnaire (HAQ); in patients with severe rheumatoid arthritis (RA) with a disease duration of less than 3 years. METHODS: In this cross sectional study of 105 patients with RA (76 women, 29 men: mean age 50.93; mean disease duration 15.86 months; 71% rheumatoid factor positive) subjective pain was assessed according to the Visual Analog Scale (VAS). Correlation coefficients between pain score and disease activity measures (patients' global assessment of disease by VAS, number of tender and swollen joints, morning stiffness, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and titre of rheumatoid factor, radiographic evaluations (Larsen-Dale scores for radiographic damage of the small joints of the hands, wrist and feet), disability measures (health assessment questionnaire [HAQ]), and demographic variables were calculated; hierarchical regression analysis was done with subjective pain score as the dependent variable. RESULTS: The Spearman's correlation coefficient comparing subjective pain and HAQ was 0.421 (p < 0.001), between subjective pain and global assessment of disease and morning stiffness was 0.573 (p < 0.001) and 0.427 (p < 0.001) respectively, and between pain and number of tender and swollen joints 0.037 and 0.050 respectively (p > 0.05). In regression analysis, global assessment of disease by patients explained 32.8% of the variation in pain intensity score, morning stiffness 10.7%, CRP 4.0%, HAQ 3.8% and Larsen-Dale scores explained 2.1%; other variables were not significant in the model. CONCLUSIONS: Pain scores of patients with early severe rheumatoid arthritis are correlated at higher levels with patients' global assessment of disease and with morning stiffness rather than with radiographic or other clinical variables such as number of tender and swollen joints.
15501188 Magnetic resonance imaging of the axial skeleton in rheumatoid disease. 2004 Dec The axial skeleton is a target for both spondyloarthritis and rheumatoid arthritis. While conventional radiography allows the clear documentation of the late stages of inflammatory changes, magnetic resonance imaging (MRI) is sensitive enough to depict early inflammatory lesions. It is, therefore, of particular importance for radiologists and clinicians to know the MRI appearances of inflammatory changes of the axial skeleton in rheumatoid diseases. Typical lesions in ankylosing spondylitis and related conditions comprise spondylitis (Romanus lesion), spondylodiscitis (Andersson lesion), arthritis of the apophyseal joints, the costovertebral and costotransverse joints, and insufficiency fractures of the ankylosed vertebral spine (non-inflammatory type of Andersson lesion). Sacroiliitis is associated with chronic changes such as sclerosis, erosions, transarticular bone bridges, periarticular accumulation of fatty tissue and ankylosis. In addition, acute findings include capsulitis, juxta-articular osteitis and the enhancement of the joint space after contrast medium administration. Another important sign of spondyloarthritis is enthesitis, which affects the interspinal and supraspinal ligaments of the vertebral spine and the interosseous ligaments in the retroarticular space of the sacroiliac joints. The main site of manifestation of spinal involvement in rheumatoid arthritis is the cervical spine. Typical changes are the destruction of the atlantoaxial complex by pannus tissue with subsequent atlantoaxial subluxation, basilar impression and erosion of the dens axis. Changes in the lower segments of the cervical spine are destruction of the apophyseal joints resulting in the so-called stepladder phenomenon. Because of the uniform response of the discovertebral complex to different noxae, a number of different conditions must be distinguished on the basis of the patient's clinical findings and history in combination with their imaging appearance. These conditions comprise degenerative disc disease, septic spondylodiscitis, Scheuermann's disease, Paget's disease and diffuse idiopathic skeletal hyperostosis (DISH).
14711024 Juvenile idiopathic arthritis: an update. 2003 Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy of childhood. Previous terminology identified this entity as juvenile rheumatoid arthritis. The 7 subsets of JIA identified under the new classification system are discussed, as are current treatments. A differential diagnosis of JIA is included as this condition continues to be diagnosed by exclusion. Recent studies, which discuss the outcome of adults with previous childhood arthritis, are reviewed.
12139564 Diagnostic significance of increased serum hyaluronic acid in juvenile rheumatoid arthriti 2002 Aug BACKGROUND: We have previously reported that serum levels of hyaluronic acid (HA) objectively reflect the severity of arthritis in juvenile rheumatoid arthritis (JRA). However, clear diagnostic standards do not exist for JRA; it is difficult to evaluate arthritis in children, particularly in small children and the diagnostic criteria for JRA requires an exclusion of several diseases. Therefore, if a specific test finding associated with JRA could be established, it would enable general pediatricians to make an objective diagnosis. METHODS: We measured the serum HA levels in children with joint symptoms as a chief complaint. The total number of subjects were 197 children; of these 89 had JRA, 39 had rheumatic diseases other than JRA, and 69 had non-rheumatic diseases (including systemic 31, polyarticular 40 and pauci-articular in 17), rheumatic diseases other than JRA in 39 subjects, and non-rheumatic diseases in 69 subjects. Sandwich enzyme-linked immunosorbent assay measured HA by using the HA binding protein. RESULTS: The serum level of HA was significantly higher in systemic and polyarticular JRA patients than in patients with pauci-articular JRA, with rheumatic diseases other than JRA, and non-rheumatic patients. With a cut-off value of 100 ng/mL, a diagnostic value of HA in all JRA patients was 48.3% sensitivity and 98.1% specificity. CONCLUSIONS: In children presenting with joint symptoms, serum HA measurement is useful for diagnosing systemic and polyarticular JRA.
11990861 Clinical features of psoriatic arthritis. 2002 Apr The past 5 years have seen major advances in understanding the immunology and molecular biology of psoriatic arthritis (PsA), especially the impact of cytokines such as tumor necrosis factor (TNF), which has produced striking, long-term benefits in patients with rheumatoid arthritis (RA). Because PsA is not the same disease as RA, the ability to distinguish between them is important to physicians in managing patients who have clinical features consistent with an arthropathy. The development of TNF inhibitors directed specifically at the mechanisms of skin and joint inflammation offers hope to patients who suffer from the debilitating effects of PsA.
12613728 Diagnostic and therapeutic injection of the wrist and hand region. 2003 Feb 15 Joint injection of the wrist and hand region is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for carpal tunnel syndrome, de Quervain's tenosynovitis, osteoarthritis of the first carpometacarpal joint, wrist ganglion cysts, and digital flexor tenosynovitis (trigger finger) are reviewed. Indications for carpal tunnel syndrome injection include median nerve compression resulting from osteoarthritis, rheumatoid arthritis, diabetes mellitus, hypothyroidism, repetitive use injury, and other traumatic injuries to the area. For the first carpometacarpal joint, injection may be used to treat pain secondary to osteoarthritis and rheumatoid arthritis. Pain associated with de Quervain's tenosynovitis is treated effectively by therapeutic injection. If complicated by pain or paresthesias, wrist ganglion cysts respond to aspiration and injection. Painful limitation of motion occurring in trigger fingers of patients with diabetes or rheumatoid arthritis also improves with injection. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.
12892254 Mandibular osteotomies in patients with juvenile rheumatoid arthritic disease. 2003 OBJECTIVE: This retrospective study evaluates the results after orthognathic surgery in a group of patients with juvenile rheumatoid arthritis. METHODS: The material comprised sixteen patients where genioplasty with or without bilateral sagittal split (BSSO) had been performed during a 10-year period between 1991 and 2000. The patients were recalled for follow-up examination and the clinical records and radiographs of the patients were analysed. RESULTS: All patients reported an improved facial esthetics. Sixty-two% reported altered neurosensory dysfunction in the inferior alveolar nerve, but no patients reported altered feelings to interfere with function. Two patients reported reduction in pain in the TMJ from a score 10 and 7 in the VAS-scale preoperatively, to 0 after the orthognathic surgery. Eight of the patients reported this to be less uncomfortable compared to other surgical procedures because of their JRA. Ninety-four% noted a positive social change after the operation. CONCLUSION: Orthognathic surgical treatment of the JRA patient improves the facial profile. The described procedures are safe and serious complications were not seen in our study.
15272812 Anti-lactoferrin antibodies in patients with connective tissue diseases. 2003 AIM: To study the prevalence of antineutrophil cytoplasmic antibodies against lactoferrin in patients with connective tissue diseases and to characterize the antibody response to lactoferrin in these patients. METHODS: Sera from 60 patients with systemic lupus erythematosus, 98 with rheumatoid arthritis, 11 with systemic sclerosis, and 6 with mixed connective tissue disease were studied. The presence of anti-lactoferrin antibodies was detected by enzyme-linked immunosorbent assay. The IgG subclass reactivity of antibodies to lactoferrin was analyzed by biotin-extravidin amplified enzyme-linked immunosorbent assay and monoclonal antibodies to human IgG subclasses. RESULTS: Anti-lactoferrin antibodies were found in 15 patients (5 patients with rheumatoid arthritis and 10 with systemic lupus erythematosus). IgG1 was the predominant subclass for antibodies to lactoferrin. CONCLUSION: Patients with connective tissue diseases are known to develop multiple auto-antibodies; anti-lactoferrin antibodies mainly of IgG1 isotype can also be found in patients with rheumatoid arthritis and more often in patients with systemic lupus erythematosus.
15380210 Inhibition of lysosomal cysteine proteases by chrysotherapeutic compounds: a possible mech 2004 Oct 18 Although Au(I) complexes have been used to treat rheumatoid arthritis for over 75 years, their mechanism of action is still poorly understood. A family of enzymes responsible for joint destruction in rheumatoid arthritis, the cathepsins, has been discussed as a possible biological target of Au(I). In this study, inhibition of the cathepsins by known Au(I) drugs and related compounds was investigated. The compounds tested inhibited cathepsin activity with IC50 values as low as 600 nM. More typical IC50 values were in the 50-200 microM range. Although the gold complexes are not extremely potent cathepsin inhibitors, it is likely that this inhibition is biologically relevant given the high concentrations of Au(I) in the serum and joints of patients undergoing chrysotherapy. While it is likely that there are multiple targets of Au(I) in vivo, inhibition of the cathepsins would provide protection against the joint destruction that is a hallmark of rheumatoid arthritis and is one possible mechanism for Au(I) antiarthritic activity.
12778344 The safety and efficacy of chicken type II collagen on uveitis associated with juvenile rh 2002 Jun PURPOSE: To investigate the safety and efficacy of chicken type II collagen in treating uveitis associated with juvenile rheumatoid arthritis (JRA). METHODS: A prospective dose-ranging (60 and 540 microg) pilot study of orally administered chicken type II collagen in 13 participants, aged 2-18 years, with JRA and uveitis and without prior exposure to collagens. Anterior chamber cells, flare, vitreous haze, visual acuity, and concomitant anti-inflammatory medications were the ophthalmic outcomes. Arthritis outcomes included the American College of Rheumatology (ACR) core set. RESULTS: No serious or related adverse events were reported. Four participants (2 low dose, 2 high dose) experienced improvement in ophthalmic outcome, while two participants (1 in each group) worsened (p > 0.5). According to ACR criteria, six participants showed improvement in JRA. CONCLUSIONS: Although appearing safe, clearly demonstrating the efficacy of this treatment for JRA or uveitis remains a challenge. Based on the results from this pilot study, a large positive treatment effect on uveitis is unlikely.
15111590 A new noninvasive tear stability analysis system for the assessment of dry eyes. 2004 May PURPOSE: This was a prospective case-control study conducted to evaluate the effectiveness of the Tear Stability Analysis System (TSAS) for the assessment of patients with dry eye. METHODS: The TSAS can take 10 consecutive corneal topograms at one per second for 10 seconds. Examinations using the TSAS were conducted in 26 eyes of 26 healthy control subjects and in 27 eyes of 27 patients with dry eye. Examinations were also conducted in 14 eyes of 14 patients before and after the insertion of punctum plugs. Surface regularity and asymmetry indices (SRI, SAI), as well as new tear stability regularity and asymmetry indices (TSRI, TSAI), derived from SRI and SAI, were analyzed. RESULTS: The mean SRI and SAI in dry eyes were significantly greater than in control eyes (P < 0.05). The time-wise change of SRI and SAI was significantly different between dry eyes and control eyes (P < 0.05). TSRI and TSAI in dry eyes were also significantly greater than in control eyes. Punctum plug insertion was associated with a significant decrease in SRI and SAI (P < 0.05). CONCLUSIONS: TSAS was effective in objectively assessing the tear stability in patients with dry eye. This system may be useful in noninvasive diagnosis of dry eye and evaluation of treatment effects.
11886706 The oral side of Sjögren syndrome. Diagnosis and treatment. A review. 2002 Mar Sjögren syndrome (SS) is an inflammatory disease of the exocrine glands. Although not always present, signs and symptoms of dry eyes and xerostomia are characteristic features of SS. Oral dryness is one of the most important data of patients with SS. Several sets of criteria have been published; however, there is no definitive agreement concerning which is the most useful. In addition to its various clinical manifestations, lack of understanding of the causes of SS delays prompt diagnosis. Histologically, the salivary gland shows a characteristic lymphocytic infiltrate, which is implicated in the destruction of gland cells. Saliva performs an important role in maintaining and protecting oral health. Deficient quality and quantity of saliva have a detrimental consequence for dental and oral health. In some patients, appropriate information regarding dry mouth care is not offered because most professionals either neglect or ignore adequate attention to oral health. Therefore, lack of treatment is frequent. Medical and dental studies that focus on the oral aspects of diagnosis, consequences, and treatment of SS are commented on. Diagnostic methods used for the oral component are also reviewed. The role of the oral tests developed to diagnose SS is assessed, especially tests used by the majority of criteria. Impairment of salivary secretion increases the risk of developing oral diseases; the therapeutic modalities designed to ameliorate these damages by increasing salivary output or by substitution of saliva are reviewed. We discuss published prevention techniques to diminish dental, periodontal, and soft tissue infections.