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ID PMID Title PublicationDate abstract
21794237 [Vasculitis associated with anti-neutrophil cytoplasmic autoantibodies in rheumatoid arthr 2005 Jun Vasculitis is an uncommon complication of rheumatoid arthritis that is associated with a clear increase in morbidity and mortality, although systemic manifestations such as glomerulonephritis, cerebral vasculitis or pulmonary vasculitis are very rare. Systemic vasculitis with renal involvement is associated with overt polyarthritis in less than 5% and association with rheumatoid arthritis is exceptional. Determination of anti-neutrophil cytoplasmic autoantibodies (ANCA), used in the appropriate clinical context, has become an important diagnostic tool in small-vessel systemic vasculitides. We present two patients with rheumatoid arthritis who subsequently developed systemic vasculitis. ANCA determination was decisive in the early diagnosis of these patients.
15757963 Recurrence risk for psoriasis and psoriatic arthritis within sibships. 2005 Jun OBJECTIVE: To quantify the frequency of siblings of patients with psoriatic arthritis (PsA) having psoriasis and/or inflammatory arthritis. To describe the similarity or otherwise of patterns of arthritis in siblings. METHODS: Available and consenting index cases with PsA and one or more siblings living locally were assessed. Mean sibling concordance rates and Weinberg's segregation analysis were calculated. Heritability was also estimated. To assess whether the same type of arthritis occurred within the same sibship, the dually affected sibships were then classified for type of arthritis according to methods suggested by Moll, Helliwell, Veale and McGonagle. RESULTS: Eighty index cases and 112 siblings were assessed. The median age of index cases was 49 yr (range 24-80 yr) and for siblings 46 yr (range 18-79 yr). The concordance rate for all types of PsA was 14% (9% if enthesitis is excluded) and for psoriasis 21%. There was no difference in the two methods used to calculate concordance rates. Sixteen dually affected sib pairs were found. Four of the 16 sibships (25%) had the same pattern of joint involvement (Moll and Wright classification). The most frequent pattern seen was joint involvement identical to rheumatoid arthritis (3/5). The most common symptom in affected siblings was enthesitis (approximately 5%). When the dually affected sibships were analysed using the other classifications, the simpler the classification the greater the concordance for joint pattern. CONCLUSION: The concordance for psoriasis is greater than for PsA, but the concordance rate for PsA was similar to that in HLA identical siblings with rheumatoid arthritis. There was discordance in pattern of arthritis for most sib pairs. There is no support for the use of more complex classifications of PsA.
15977873 Chorioretinitis as a complication of pauciarticular juvenile rheumatoid arthritis. 2005 May A girl with pauciarticular juvenile rheumatoid arthritis developed bilateral uveitis complicated by cataract and glaucoma. Sequential fundus photography documented development of extensive choroidal scarring and retinal pigment epithelial atrophy in the left macula. Vision was not impaired. This case suggests uveitis in juvenile rheumatoid arthritis can be associated with chorioretinitis.
16821267 Comparative analysis of autoantibodies against a-fodrin in serum, tear fluid, and saliva f 2006 Jul OBJECTIVE: To evaluate levels of IgA and IgG antibodies against a-fodrin in serum, tear fluid, and saliva and compare them with anti-Ro and anti-La antibody levels in the same samples of patients with Sjögren's syndrome (SS). METHODS: Samples from 25 patients with SS (17 primary and 8 secondary), 8 patients with systemic lupus erythematosus (SLE), and 7 patients with rheumatoid arthritis (RA) as well as 20 healthy blood donor controls were collected. Antibodies were measured using ELISA. RESULTS: Although 40% of patients with primary SS had IgG anti-a-fodrin in their sera, it was also found in 36% and 32% of samples of their tear fluid and saliva, respectively. IgA a-fodrin antibodies were detected in 32% of SS sera, 20% of tear fluid samples, and 32% of saliva samples. Although the level of IgG anti-a-fodrin was significantly greater in serum, tear fluid, and saliva of SS patients compared to controls (p < 0.001), a significant difference was observed only in serum and saliva. While anti-Ro was detected in 48%, 56%, and 24% of serum, tear fluid, and saliva samples, respectively, anti-La was found in 40%, 44%, and 28%. Significant association was observed between serum IgG antibodies against a-fodrin and dry eye symptom score and rose bengal staining score. A negative association was also noted between tear IgA antibodies against a-fodrin and Schirmer I test. CONCLUSION: Correlation of IgG and IgA antibodies against a-fodrin with the severity of eye involvement suggests that these autoantibodies may be considered activation markers of SS.
16265694 Enhanced expression of programmed death-1 (PD-1)/PD-L1 in salivary glands of patients with 2005 Nov OBJECTIVE: Programmed death-1 (PD-1) mediates a negative signal and introduces tolerance for lymphocytes. Dysfunction of the PD-1 pathway is thought to result in autoimmune diseases such as rheumatoid arthritis (RA). To investigate the role of the PD-1/PD-L system in the pathology of Sjögren's syndrome (SS), we examined the expression of PD-1 and its ligand PD-L1 in salivary lymphocytes and salivary glands from patients with SS. METHODS: Flow cytometry analysis was used to determine expression of PD-1 in SS salivary lymphocytes. Intracellular staining of interleukin 10 (IL-10) was performed after stimulation with PMA and ionomycin. Indirect immunohistochemistry was used to investigate the expression of PD-1 and PD-L1. RESULTS: The mean fluorescence intensity of PD-1 expression in SS salivary lymphocytes was significantly higher than that from healthy controls and patients with RA or systemic lupus erythematosus. PD-1-positive SS salivary lymphocytes expressed IL-10 intracellularly upon PMA/ionomycin stimulation. Immunohistochemical analysis showed that PD-1 was expressed on infiltrating lymphocytes in salivary gland from 52% of SS patients, and PD-L1 was expressed on ductal and acinar epithelial cells from 68% of SS patients. In vitro analysis using HSG cells revealed that PD-L1 was induced by interferon-gamma but not by tumor necrosis factor-alpha and IL-1beta. CONCLUSION: PD-1 is expressed on T lymphocytes and PD-L1 on epithelial cells from inflamed salivary glands of patients with SS, which suggests that dysfunction of the PD-1/PD-L1 pathway may be related to tolerance for lymphocytes, which causes SS.
15995118 Total knee arthroplasty in juvenile rheumatoid arthritis. 2005 Jul BACKGROUND: There is a paucity of reports regarding the long-term results of total knee arthroplasty in patients with juvenile rheumatoid arthritis. The purpose of this study was to evaluate the outcome of total knee arthroplasty in patients with juvenile rheumatoid arthritis who had been followed for a minimum of twelve years. METHODS: Eight consecutive patients (fifteen knees) with juvenile rheumatoid arthritis underwent total knee arthroplasty at an average age of 16.8 years. Clinical evaluation of pain status, range of motion, and the ability to walk and radiographic evaluation of the alignment of the knees and component loosening were performed preoperatively and at a mean of 15.5 years postoperatively. RESULTS: All patients had substantial pain and functional limitation before the surgery, and seven of the eight patients used a wheelchair. At the time of the latest follow-up, which was after revision surgery in three patients, all of the knees were pain-free and six patients were able to walk about the community. The mean arc of motion had increased from 36 degrees to 79 degrees . The final radiographic evaluation showed that thirteen of the fifteen knees were in neutral alignment and two were in valgus. Failure, defined as revision of any of the components or definite loosening as seen radiographically, occurred in three knees. CONCLUSIONS: Good results, in terms of pain relief and restoration of function, were seen at a minimum of twelve years following total knee arthroplasty in our series of patients with juvenile rheumatoid arthritis. This procedure is a reasonable option when nonoperative therapy has been inadequate for patients with severe disability and pain in this relatively young population.
15730500 Efficacy of rapamycin in patient with juvenile rheumatoid arthritis. 2005 Mar Juvenile rheumatoid arthritis (JRA) is an immune-mediated disease characterized by articular inflammation and subsequent tissue damage that may result in severe disability. Several combinations of drugs, including immunosuppressive agents have been used to control disease progression. Although there is no information available on rapamycin efficacy in JRA, it has demonstrated a potential to inhibit inflammatory processes observed in adult rheumatoid arthritis (RA). We present a 21 years old renal transplant recipient with JRA, primarily treated with tacrolimus and steroids, who achieved a long-term disease remission after introduction of rapamycin. As long as pathogenesis of JRA and RA is similar, we conclude that rapamycin could be promising immunosuppressant for patients after renal transplantation suffering from both JRA and RA.
16758083 [Primary biliary cirrhosis: a thirteen years experience]. 2006 Apr BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic cholestatic disease, which can progress to hepatic failure. AIM: To study the clinical presentation, pathological features, treatment and outcome of a group of patients with PBC. MATERIAL AND METHODS: Retrospective review of medical records of 115 patients (110 females, age range 30-76 years) with PBC. Clinical presentation, pathological stage, treatment, outcome and eventual use of liver transplantation, were recorded. RESULT: Seventy eight percent of patients were symptomatic at presentation (itching in 69% and malaise in 62%). Antimitochondrial antibodies were positive in 56%. No clinical or laboratory differences were observed between symptomatic patients or those with positive antimitochondrial antibodies and the rest of the study group. Sjögren syndrome was present in 38%, hypothyroidism in 13%, scleroderma in 7% and rheumatoid arthritis in 5%. Initially, 61% had fibrosis and/or cirrhosis, and ursodeoxycholic acid was indicated in 94% of the patients. Fifteen patients underwent liver transplantation due to upper digestive bleeding or itching. Survival has been 67% at 36 months after transplantation. In one transplanted liver, PBC recurred. CONCLUSIONS: An early diagnosis and treatment of a progressive disease such as PBC will reduce the incidence of complications and the use of costly treatments.
20476908 Pathogenic role of antibodies to citrullinated proteins in rheumatoid arthritis. 2006 May In the last 10 years, the discovery that antibodies to citrullinated proteins are highly specific for rheumatoid arthritis has led to a model of pathogenesis that ties together the genetic and environmental risk factors for susceptibility and severity of disease. The authors propose that the chronic inflammation is driven by two phases of an immune response. The first phase is the priming of autoimmunity, which may occur many years before the onset of disease and is caused by environmental factors, such as smoking and infectious agents, in the context of disease susceptibility alleles. This may occur in sites outside the joint, such as the respiratory tract. The second phase is the induction of arthritis, which is associated with the generation of citrullinated proteins within the joint, which is then perpetuated as the erosive disease by a local chronic immune response. The identity of candidate synovial citrullinated antigen(s), whether fibrin, vimentin, alpha-enolase, collagen type II or others yet to be described, may be the key to the pathogenesis of the destructive disease characteristic of rheumatoid arthritis. There is emerging evidence that citrullination may already be modified by established therapy in rheumatoid arthritis, but more specific inhibitors of deimination may provide new agents for future treatments.
20528552 New models of care for patients with rheumatoid arthritis. 2006 Apr Traditional comprehensive care, involving a team of health professionals from various disciplines, has been widely used in patients with rheumatoid arthritis. However, in many countries, its access and use are hindered by limitations in human and financial resources. Moreover, due to developments in the medical treatment of rheumatoid arthritis and in healthcare and society in general, the patients' needs and demands regarding the contents and organization of comprehensive care are changing. To guarantee the provision of care meeting the varying requirements of rheumatoid arthritis patients throughout the disease trajectory, several new care models are being developed. Some of these models include nurses or other health professionals and general practitioners in care pathways and processes. In other models, organizational aspects play a major role, such as new ways of running early arthritis and direct-access clinics. In addition, an optimal use of information technology may prove to be an important step forward. With all of these developments, aspects such as the patients', as well as healthcare providers', educational needs, continuity, access and funding have to be taken into account. Moreover, evaluations of effectiveness and costs in various healthcare systems and local organizations are needed.
16362444 Juvenile rheumatoid arthritis and bronchiolitis obliterans organized pneumonia. 2007 Feb Diverse pleuropulmonary manifestations, including pleural effusion, rheumatoid nodulosis, fibrosis, obliterans brochiolitis, bronchiectasias, vasculitis, drug-induced lung disease, and obliterans bronchiolitis with organized pneumonia, have been described in patients with rheumatoid arthritis (RA). Bronchiolitis obliterans organized pneumonia (BOOP) is an uncommon condition described in patients with RA but not in juvenile RA (JRA). We described a patient with JRA who developed a BOOP.
17009016 Is measurement of IgM and IgA rheumatoid factors (RF) in juvenile rheumatoid arthritis cli 2007 Feb The prevalence and clinical relevance of IgM and IgA RF detected by ELISA were studied in 91 patients with juvenile rheumatoid arthritis (JRA) and 45 healthy children. IgM and IgA RF were detected, respectively, in 33 and 44% of the patients, compared to 6.7 and 15.6% of the healthy children (p = 0.001 and 0.0006, respectively). The frequency of IgM RF was significantly higher in patients with polyarticular (52%) as compared to systemic onset JRA (21%; p = 0.04). Five out of ninety-one patients and none of the control group were IgM RF positive by the latex test. High levels of IgM RF were detected more frequently in patients with active disease (p = 0.01) and positive latex agglutination test (p < 0.001) and had a marginally significant association with severe radiological deformities (p = 0.05). The presence of IgA RF was associated with active disease in polyarticular onset JRA children (p = 0.04). In conclusion, high levels of IgM RF and the detection of IgA RF can be useful in assessing clinical activity in a subset of patients with JRA.
29793290 Pharmacogenomics in the treatment of rheumatoid arthritis: clinical implication and perspe 2006 May Rheumatoid arthritis (RA) is a chronic inflammatory disease. The inflammatory process of the joint destroys articular architecture and causes a significant disability. The efficacy of disease modifying antirheumatic drugs such as methotrexate, sulfasalazine and biological response modifiers, is widely accepted. However, the outcome of the treatment with these agents is known to vary among patients. The application of the pharmacogenomics is expected to reduce toxicities and enhance the desirable effects of therapeutic agents for RA. Recently, pharmacogenomic studies on methotrexate, sulfasalazine and tumor necrosis factor-α inhibitors have been reported. These investigations suggest that the pharmacogenomic approach is useful for the treatment of RA, although there are points to be considered before the translation of the pharmacogenomic data into clinical practice. This review focuses on the latest information on the pharmacogenomics of antirheumatic drugs and its clinical implication in the treatment of RA.
16384777 Etanercept and demyelinating disease in a patient with psoriasis. 2006 Jan The tumor necrosis factor-alpha antagonist (TNF-alpha) etanercept has been approved for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis. Earlier reports on the use of etanercept or infliximab in patients with rheumatoid arthritis, psoriatic arthritis, or juvenile rheumatoid arthritis suggested an increased risk of demyelinating disease. It is imperative that dermatologists have a keen awareness of this possible adverse event given the increased use of this class of drugs. We report a case of demyelinating disease occurring in a patient treated for psoriasis. The relation of TNF-alpha antagonist therapy to demyelinating disease/multiple sclerosis is explored. It is recommended that patients be diligently screened before starting TNF-alpha antagonist therapy and that vigilance for symptoms of demyelinating disease/multiple sclerosis be included in follow-up examinations during treatment with these drugs.
17603463 The value of synovectomy of the knee in the treatment of rheumatoid arthritis. 2006 Feb 28 The goal of the present study is to evaluate the usefulness of synovectomy of the knee joint in patients with rheumatoid arthritis. Synovectomy of the knee is the most common lower limb operation performed in patients with rheumatoid arthritis. Depending on the stage of the disease, the symptoms, and the degree of intra-articular changes in the radiological image, there are indications for performing both early and late synovectomy. The progress of the disease is not dependent on its duration, but on the aggressiveness and dynamics of the rheumatoid process. The authors present the advantages of early synovectomy, which halts the progress of the disease and protects the joint from destruction. After early synovectomy one obtains an average of 75% good outcomes, while after late synovectomy the percentage of positive outcomes is about 70%. The authors point out the effectiveness and low level of invasiveness of arthroscopic synovectomy, thanks to which the progress of the disease can be checked and monitored. Another possible therapy is chemical synovectomy, with the specific action of radioisotopes: synoviorthosis with laser irradiation. The authors emphasize that an important factor in obtaining good outcome after every synovectomy is rehabilitation, during which the range, frequency of exercise, and physicotherapeutic procedures are established, depending on the stage of advancement of the rheumatoid process.
17179701 Macrophage activation syndrome in juvenile rheumatoid arthritis successfully treated with 2006 Dec Macrophage activation syndrome (MAS) is one of the serious complications of juvenile rheumatoid arthritis (JRA) and recently, cyclosporine A has been found to be effective in patients with corticosteroid-resistant MAS. A 29-yr-old male was admitted with high fever and jaundice for one month. He was diagnosed as juvenile arthritis 16 yr ago. Physical and laboratory results showed hepatosplenomegaly, high fever, pancytopenia and impaired liver and renal function tests, elevated triglyceride and serum ferritin levels. Bone marrow biopsy showed hyperplasia of histiocytes with active hemophagocytosis. He was diagnosed as MAS associated with juvenile rheumatoid arthritis and managed with high-dose corticosteroids initially, but clinical symptoms and laboratory findings did not improve immediately. Finally, he completely recovered after treatment with cyclosporine A (3 mg/kg/day).
16909773 [Ultrasonography in diagnosing Lyme arthritis of the knee joints in correlation with anti- 2006 Lyme disease, a multi-system disorder may be associated with arthritis. Lyme arthritis most commonly affects the knee joints. Ultrasonography can show the inflammation changes of the knee joint and can be a usefull method in diagnosis of Lyme arthritis. The most freguent ultrasonographic finding was knee joint effusion. Because of Lyme arthritis similarities to rheumatoid arthritis, a serologic test antibodies against cyclic cytrulinated peptid (anty CCP) can be helpfull in distinguishing of these two diseases.
29539040 Periodontitis and Rheumatoid Arthritis: A Review. 2005 Nov Periodontitis and rheumatoid arthritis (RA) appear to share many pathologic features. In this review, the common pathologic mechanisms of these two common chronic conditions are explored. Emerging evidence now suggests a strong relationship between the extent and severity of periodontal disease and RA. While this relationship is unlikely to be causal, it is clear that individuals with advanced RA are more likely to experience more significant periodontal problems compared to their non-RA counterparts, and vice versa. A case is made that these two diseases could be very closely related through common underlying dysfunction of fundamental inflammatory mechanisms. The nature of such dysfunction is still unknown. Nonetheless, there is accruing evidence to support the notion that both conditions manifest as a result of an imbalance between proinflammatory and anti-inflammatory cytokines. As a result, new treatment strategies are expected to emerge for both diseases that may target the inhibition of proinflammatory cytokines and destructive proteases. The clinical implications of the current data dictate that patients with RA should be carefully screened for their periodontal status.
15708901 Radiographic progression in children with polyarticular juvenile rheumatoid arthritis: a p 2005 Mar OBJECTIVE: To assess disease progression on hand/wrist x rays from children with polyarticular juvenile rheumatoid arthritis. METHODS: Initial and subsequent films of 13 white children (10 girls) were read blind by a paediatric radiologist for the presence of joint space narrowing (JSN), erosions, and relative carpal length (RCL). RESULTS: One child had subcutaneous nodules; one (of 11) was rheumatoid factor positive; six were ANA positive. Median age at diagnosis was 10.7 years (2.5 to 15.9). Median number of involved joints (swelling, pain, or decreased range of motion) at diagnosis was 16 (6 to 33). Four initial x rays had either erosions or JSN. Subsequent x rays were done at (median) 13.3 (8.3 to 24.9) months after initial x rays. One of 10 subsequent x rays had shortened RCL, and six of 13 were worse than the initial ones. Four of these developed new erosions, one had increased number of erosions, and one developed new JSN. CONCLUSIONS: About half the children with polyarticular juvenile rheumatoid arthritis will have evidence of radiographic progression within two years after diagnosis. Thus newly diagnosed children are at high risk of substantial joint destruction and potential disability, emphasising the need for prompt treatment.
17668696 Total hip and knee arthroplasty for juvenile rheumatoid arthritis. 2006 We performed 23 total hip and knee arthroplasties (15 total hip and 8 total knee arthroplasties) in 18 children with juvenile rheumatoid arthritis between 1984 and 2001. The mean age at surgery was 17.8 years (range 13 to 24 years). The age of presentation of the disease was from 4 to 10 years with average 7.3 years. The average length of follow-up was 9.7 years (range 7 to 16 years). All patients conformed with the American Rheumatism Association criteria for juvenile rheumatoid arthritis. All patients had complete loss of joint space and various combination of subchondral sclerosis, flattening of the femoral head, anterior inclination of the neck. Three knees were diagnosed with bony ankylosis. Follow-up was based on the Merle d'Aubigne et Postel scale modified by Charnley. One acetabular component has been revised to date. No femoral or tibial components have been revised. No patient had pain post-operatively and function was very satisfactory. Total hip and knee arthroplasties are technically difficult to execute in this age and should be performed in specialized centers. With appropriate indications pain relief,decrease of deformity and improvement of quality of life can be achieved in most patients.