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ID PMID Title PublicationDate abstract
17162381 Subpopulations within juvenile psoriatic arthritis: a review of the literature. 2006 Jun The presentation of juvenile psoriatic arthritis (JPsA) has long been recognized to be clinically heterogeneous. As the definition of JPsA expanded to accommodate atypical manifestations of psoriasis in young children, studies began to reflect an increasingly clear biphasic distribution of age of onset, with peaks in the first few years of life and again in early adolescence. These two subpopulations differ in gender ratio, pattern of joint involvement, laboratory findings and potentially response to therapy. Intriguingly, a similar distribution of age of onset has been observed in juvenile rheumatoid arthritis (JRA), and correlates with patterns of HLA association. While a secure classification of subpopulations within JPsA awaits improved pathophysiologic understanding, future research must consider the possibility that different disease mechanisms may be operative in distinct subsets of patients with this disorder.
16485224 [Discrepancy between objective measurement and subjective recognition of sicca syndrome be 2006 Feb BACKGROUND: This study was designed to examine if patients undergoing the same operative procedure (blepharochalasis operation) have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons. PATIENTS AND METHOD: The study included 32 patients (25 women, 7 men, mean age 57.8 +/- 12.1 years), who underwent blepharochalasis operation between 1/2005 and 5/2005. In 17 patients (group 1) the operation was done for cosmetic reasons, in 15 patients we found a medical indication (group 2). We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre- or postoperative recognition of dry eye problems (all done by scales). Additionally we measured tear secretion by Schirmer's test and break-up time before and after operation. RESULTS: The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation (p < 0.005), but objective data were nearly identically (BUT, Schirmer's test). CONCLUSION: When operated due to cosmetic reasons the stronger recognition of sicca problems (while objectively lacking) is may be caused by a stronger fixation on the lid disease itself. It seems necessary to document objective data for that reason.
16739213 Quality of life and psychological status in patients with primary Sjögren's syndrome and 2006 Jun 15 OBJECTIVE: To compare pain, fatigue, and sicca symptoms; quality of life; and psychological status between patients with primary Sjögren's syndrome (SS) and those with sicca symptoms but no autoimmune features (sicca asthenia polyalgia syndrome [SAPS]), and to determine whether a psychological pattern can be detected in patients with SAPS, which could suggest psychological distress as the cause. METHODS: This cross-sectional, prospective study included 111 patients with primary SS according to the American-European Consensus Group criteria and 65 SAPS patients with no focus on lip biopsy and no anti-SSA/SSB antibodies. Pain, fatigue, and sicca symptoms were assessed using visual analog scales; quality of life was assessed using the Short Form 36 (SF-36); and psychological distress by the Symptom Checklist-90-Revised (SCL-90-R) questionnaire. RESULTS: No difference was observed between primary SS and SAPS patients for pain, fatigue, sicca symptoms, quality of life, and psychological status. Fatigue and pain, but not dryness, were correlated with both quality of life and psychological distress in both groups. For primary SS patients, physical and mental composite scores on the SF-36 correlated well with global severity index (GSI) scores of the SCL-90-R (r = -0.29, P = 0.006 and r = -0.61, P < 0.0001, respectively). CONCLUSION: Patients with primary SS and SAPS do not differ in quality of life or psychological status. Although both diseases probably have a different origin, they may require the same psychological support or psychiatric care. The strong correlation between the composite physical and mental scores of the SF-36 and the GSI scores of the SCL-90-R in primary SS patients emphasizes the importance of the psychological dimension in results of the SF-36.
16261891 Evaluation of international classification criteria (2002) for primary Sjögren's syndrome 2005 Sep OBJECTIVE: To evaluate the sensitivity and specificity of international classification criteria (2002) for primary Sjögren's syndrome (pSS) and the role of lower lip biopsy in diagnosis of pSS in Chinese patients. METHODS: Patients who were diagnosed by the experts/rheumatologists as pSS during 1990-2002 from the Department of Rheumatology, Peking Union Medical College Hospital were retrospectively collected as experimental group. Patients who were diagnosed as non-pSS connective tissue diseases or non-connective tissue diseases served as control group. Those with a history of head-neck radiation, hepatitis C virus infection, AIDS, lymphoma, sarcoidosis, graft versus host disease (GVHD), and anti-acetylcholine drug use were exempted. Both groups were required to complete questionnaires about symptoms such as dry eyes and dry mouth, and complete the objective tests of keratoconjunctivitis and xerostomia including Schirmer test, corneal staining, unstimulated salivary flow, sialography, lower lip biopsy, and antinuclear antibodies (including anti-SSA/SSB antibodies) test. RESULTS: A total of 330 pSS patients were included in experimental group and 185 non-pSS patients in control group. The mean age of both groups matched (47.8 +/- 10.9 years vs. 46.2 +/- 13.6 years, P > 0.05). The sensitivities of the criteria in pSS patients with lower lip biopsy and in pSS patients without lower lip biopsy were 89.2% and 87.2%, respectively; the overall sensitivity was 88.5%. The specificity was 97.3%. A total of 11.3% pSS patients with negative anti-SSA/SSB anti- bodies were diagnosed as pSS by lower lip biopsy. CONCLUSION: The international classification criteria (2002) for pSS is feasible in Chinese patients. It has high sensitivity and specificity, and may serve as diagnosis criteria in routine clinical practice.
15689728 Family health and characteristics in chronic fatigue syndrome, juvenile rheumatoid arthrit 2005 Feb OBJECTIVE: To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. METHOD: Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. RESULTS: Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the child's illness in comparison with families of children with JRA. CONCLUSIONS: CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness.
16979538 Management of patients presenting with Sjogren's syndrome. 2006 Aug Sjogren's syndrome is an autoimmune exocrinopathy that predominantly affects salivary and lachrymal glands, leading to dry eyes and mouth. The most common clinical problems faced by the rheumatologist are those of dry eyes and mouth, parotid swelling, fatigue and extraglandular manifestations. The first stage in management is to make an accurate diagnosis based on the American/European consensus criteria. The most frequent differential diagnoses are dry eyes and mouth symptoms, a variant of chronic fatigue syndrome and fibromyalgia, and sialosis, which causes a non-inflammatory enlargement of the parotid glands. The mainstay of treatment for the sicca symptoms is local therapy, and that for the milder systemic symptoms is hydroxychloroquine. Steroids and immunosuppressive drugs are reserved for more severe extraglandular disease. In spite of intensive research in other systemic treatments including biologic therapies, there is limited evidence to support their use in routine clinical practice.
16907920 In the rat, citrullinated autologous fibrinogen is immunogenic but the induced autoimmune 2006 Sep Conversion of arginyl to citrullyl residues (citrullination) is essential for the formation of the epitopes recognized by rheumatoid arthritis (RA)-associated autoantibodies to citrullinated proteins (ACPA). ACPA are secreted by plasma cells of the rheumatoid synovial tissue where their major target, citrullinated fibrin, is abundant. Although numerous arguments suggest that ACPA play an important role in RA, their pathological relevance remains to be established. In the present study, we assessed the immunogenicity and arthritogenicity of complete Freund's adjuvant-emulsified autologous citrullinated (C-rFBG) or non-citrullinated (NC-rFBG) fibrinogen in Lewis (LEW) and Brown-Norway rats, which exhibit drastic differences in their susceptibility to induced autoimmune diseases. NC-rFBG induced no antibody response. In contrast, a single injection of C-rFBG induced an IgG response directed mainly to citrullinated determinants of rFBG. However, all rat strains remained devoid of clinical and histological signs of arthritis up to 3 months after C-rFBG inoculation. Next, in LEW rats, we tested whether autoimmunity to C-rFBG could aggravate acute ankle arthritis triggered by intra-articular injection of incomplete Freund's adjuvant (IFA). However, such arthritis evolved identically in the presence or absence of anti-C-rFBG autoantibodies. However, IFA-injected joints were devoid of citrullinated fibrin deposits. Therefore, citrullination allows breakdown of immunological tolerance but the autoimmune response developed is not spontaneously arthritogenic. Whether or not it can aggravate arthritis with citrullinated fibrin deposits remains to be evaluated.
15965819 [Jaccoud arthritis in systemic lupus erythematosus]. 2005 Jun Jaccoud arthritis is a manifestation of systemic lupus erythematosus and other rheumatic diseases. It is characterized by non-erosive subluxation and synovialitis ultimately leading to severe deformity of the hands. The clinical aspect may be misleading and suggestive of rheumatoid arthritis manifestations.
16274869 Hemiresection arthroplasty of the distal radioulnar joint. 2005 Nov One of the critical requirements for this procedure to succeed is a functional TFCC structure. In rheumatoid arthritis or traumatic disruption of the DRUJ, the TFCC is unstable. If the TFCC can be reconstructed and DRUJ arthritis exists, this is the situation in which the hemiresection procedure excels. In the face of a normal DRUJ without arthritis, an ulnar shortening with a repair of the TFCC, if necessary, is the more appropriate procedure. The other caveat for this procedure to succeed is a careful preoperative plan to make sure stylocarpal impingement does not occur. The procedure does not restore stability in the unstable painful radioulnar joint; it simply substitutes a less painful instability. When correctly planned and performed the hemiresection interposition technique can be a good procedure in the arsenal of treatment for the DRUJ.
16085961 [Superoxide dismutase in children with juvenile idiopathic arthritis]. 2005 Apr The use or antioxidants as drugs that may control the inflammatory process recently has become widely studied in adults. One of the most important components or antioxidant barrier in humans is enzyme superoxide dismutase. Experimental treatment with superoxide dismutase proved to be effective in animals. THE AIM of the present study was to estimate the activity of superoxide dismutase (SOD) in patients with rheumatoid disease of childhood -- juvenile idiopathic arthritis and to analyse it in different clinical aspects of the disease including its activity, course and time of duration. MATERIAL AND METHODS: A group of 70 children with juvenile idiopathic arthritis, age from 3 to 18 years, patients of Rheumatologic Hospital in Sopot was examined in years 1996-2001. Juvenile idiopathic arthritis was diagnosed according to the International League Against Rheumatism classification (Durban 1997). The control group consisted of 29 healthy children age from 3 to 18 years. Superoxide dismutase activity was determined in full, heparinised blood with the use of spectrophotometric method or Randox. The study was accepted by the Local Committee of Ethics. RESULTS: A statistically significant increase in superoxide dismutase activity was found in group of children with juvenile idiopathic arthritis compared to the control group. In the polyarticular form of disease the activity of superoxide dismutase was also significantly higher than in the control group. CONCLUSIONS: In course of juvenile idiopathic arthritis, differently from rheumatoid arthritis of adults, superoxide dismutase activity seems to be stimulated in the majority of cases, so the treatment with exogenous superoxide dismutase may not be effective.
17957858 The complexity of the differential diagnosis for the inflammatory arthritides. 2006 May Increasing evidence reveals that patients who have inflammatory arthritis experience structural damage early in the course of the disease. To effectively minimize the destruction caused by chronic inflammation, it is necessary to identify these patients soon after the onset of symptoms. However, differential diagnosis is not always straightforward. This article reviews selected underlying issues that complicate the differential diagnosis of the inflammatory arthritides and describes key features of the typical presentations for 3 of the commonly seen forms of inflammatory arthritis--rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.
16122880 Elimination of arthritis pain and inflammation for over 2 years with a single 90 min, topi 2005 Arthritis is inflammation in a joint often with joint damage, usually accompanied by pain, swelling and stiffness, resulting from infection, trauma, degenerative changes, metabolic disturbances, autoimmune or other causes. It occurs in various forms, including rheumatoid arthritis, osteoarthritis, bacterial arthritis and gout. Gallium III can inhibit the production of inflammatory cytokines, such as IL-1beta, produced by macrophage-like cells in vitro. A dose-dependent inhibition of IL-1beta and TPA stimulated MMP activity by gallium nitrate at increasing concentrations occurs, demonstrating that gallium nitrate can be a useful modulator of inflammation in arthritis. Gallium III is an inhibitor of bone resorption and is an effective treatment for hypercalcemia. Gallium III has been reported to be effective in the treatment of mycobacterium butycicum-induced arthritis in rats by antagonism of iron III. Long-term elimination of pain from arthritis by gallium III was first observed in horses primarily being treated for navicular disease. Several people treating their horses with gallium nitrate coincidentally found that arthritis pain in their fingers ended and did not return after soaking their hands in 14% gallium nitrate solution. Therefore, the severely arthritic hands of a 60-year-old woman were topically treated with a 14% aqueous solution of gallium nitrate for 90 min. Pain and inflammation from rheumatoid arthritis diminished rapidly, and neither pain nor inflammation returned during the following 2 years from that single treatment. A 61-year-old woman who had osteoarthritis in her left knee, shoulders and wrists was treated orally with 50 ml of a 1% gallium nitrate solution (120 mg elemental gallium) daily using a two week on and two week off protocol, resulting in almost total elimination of pain while on gallium nitrate, while pain partially returned during the two week off periods. Treatment of frozen shoulder with topical 40% gallium nitrate for 120 min resulted in greatly reduced pain and crepitus almost immediately with complete restoration of range of motion, with pain remaining essentially absent for over 1 year. Mechanisms of action are hypothesized to include anti-inflammatory, bone density improvements, antibacterial, anti-iron III and anti-aluminum III effects. Proper use of gallium III may be effective in terminating pain and inflammation of arthritis for years, often with a single treatment.
16331762 Psychological and somatic predictors of perceived and measured ocular dryness of patients 2005 Dec OBJECTIVE: To test if age, disease activity, pain, fatigue, and depression are associated with subjective and objective ocular dryness of patients with primary Sjögren's syndrome (pSS). METHODS: Sixty female patients with pSS and 60 age matched healthy controls filled out visual analog scale (VAS) scores of ocular dryness and pain, and questionnaires regarding fatigue (Multidimensional Fatigue Inventory) and depression (Zung). Lacrimal tear production was measured by Schirmer I test. As surrogate indicators of disease activity the erythrocyte sedimentation rate, hemoglobin concentration, and total serum immunoglobulin G were determined. RESULTS: Perceived ocular sicca symptoms were not related to Schirmer I test scores. The rate of tear production was related to age (r = -0.47, p < 0.001), disease activity (r = -0.27, p < 0.05), and pain (r = 0.42, p < 0.001). Age and pain together explained 42% of the variance of the Schirmer I test results. CONCLUSION: Not unexpectedly, age and disease activity were associated with ocular dryness, but contrary to expectation, pain was associated with more instead of less tear production. We did not find evidence that pain, fatigue, or depression are associated with reduced tear production or perceived ocular dryness.
16000970 Family functioning and hope in children with juvenile rheumatoid arthritis. 2005 Jul PURPOSE: To examine the relationships among family functioning, hope, and quality of life in children with juvenile rheumatoid arthritis (JRA). STUDY DESIGN AND METHOD: Sixty-eight children (8 to 12 years of age) with a diagnosis of JRA and one of their parents/guardians participated in this descriptive correlational study. Parents completed the Feetham Family Functioning Survey (FFFS), the Parent Report for Children Pediatric Quality of Life Inventory (PedsQL), and the Parent Report for Children PedsQL Rheumatology Module. The children completed the Children's Hope Scale (CHS), the Child Report for PedsQL, and the Child Report PedsQL Rheumatology Module. Data were analyzed using chi-square, t-tests, and correlation analyses. RESULTS: Family functioning and children's hope showed a negative correlation, indicating that a child's hope was lower when the parent reported greater dissatisfaction with family functioning. Hope was not related to parent or child ratings of the child's quality of life. CLINICAL IMPLICATIONS: In caring for children with JRA, nurses can assess the family's satisfaction with relationships to the broader community, subsystems, and individual members and seek ways to promote healthy family functioning. Nurses also can assess the level of hope in children with JRA and facilitate the development of hopefulness by helping children establish goals and develop strategies to meet them.
15967077 Ocular involvement in connective tissue disorders. 2005 Jul Connective tissue disorders have well-known ocular associations that may be presenting features of the disease or occur as complications during the course of the disorder. Keratoconjunctivitis sicca, keratitis, scleritis, uveitis, retinal vasculitis, choroidopathy, and their associations with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, psoriatic arthritis, juvenile idiopathic arthritis, and polymyositis are reviewed.
17592401 Instability of the rheumatoid wrist: patterns and treatment. 2006 Jun 30 Pathology of the wrist is frequent in rheumatoid arthritis. The proper treatment leading to improvement in function and symptoms relief is of a big importance. The classification based on natural pattern of the disease is presented including three types: ankylotic, arthritic changes with artrodesis and instability leading to wrist collapse. It the third type it is important to add partial or total arthrodesis to the common synovectomy and ulnar head resection.
16344933 Lymphocytic alveolitis: A surprising index of poor prognosis in patients with primary Sjog 2006 Jul Twelve years ago we reported that lymphocytic alveolitis [or bronchoalveolar lavage (BAL) lymphocytosis] correlates with clinical pulmonary involvement in primary Sjogren's syndrome (pSS). Our thesis was based on subtle clinical and functional evidence of interstitial lung disease (ILD) in pSS patients with "high lymphocytic alveolitis" (>15% lymphocytes in BAL). This report is a follow-up study of these patients. Basic clinical and functional re-evaluation of the 22 patients with pSS, studied in 1991, emphasized the differences between those with alveolitis and those without alveolitis. There was no significant functional decline. There were, however, two statistically significant differences between the two groups: (1) only patients with BAL lymphocytosis had to be treated with steroids (5/12 vs. 0/10, P < 0.05) and (2) only patients with BAL lymphocytosis had died in the mean time (6/12 vs. 0/10, P < 0.01). The causes of death were various. On only two occasions were they related to respiratory infections while there were no deaths from respiratory failure secondary to ILD. BAL lymphocytosis appears to be a surprisingly serious index of dismal prognosis in patients with pSS. We offer no unifying pathophysiologic mechanism for it and, therefore, all we propose is that BAL is performed early, in as many patients with pSS as possible. These patients should then be followed up systematically, in order to evaluate if BAL lymphocytosis has any pathophysiologic importance in the development of clinically serious pSS, which is serious enough to lead to death.
16014536 Prevalence of IgG anti-{alpha}-fodrin antibodies in Sjogren's syndrome. 2005 Jun The objective of this study was to determine the prevalence of antibodies against alpha-fodrin (alpha-fodrin) of the immunoglobulin G (IgG) isotype in Sjögren's syndrome (SS), as defined by European Community Study Group (ESG) and ESG-modified criteria. We arrived at the prevalence and mean concentrations of IgG anti-alpha-fodrin antibodies using enzyme-linked immunosorbent assay (ELISA) in 507 patients with SS, primary SS (pSS), and secondary SS (sSS), classified according to either the ESG or the ESG-modified criteria. IgG anti-alpha-fodrin antibodies were detected in 6/507 (1.2%) and 4/228 (1.7%) of the SS group, according to the ESG or ESG-modified criteria, respectively. Similar prevalence was found for patients with pSS or sSS. Anti-Ro/SSA antibodies were present in 151/409 (36.9%) vs. 149/213 (70.0%) of the SS group, 85/195 (43.6%) vs. 83/101 (82.2%) of the pSS group, and 66/214 (30.8%) vs. 66/112 (58.9%) of the sSS group. Anti-La/SSB antibodies were detected in 77/403 (19.1%) vs. 73/212 (34.4%) of the SS group, 47/194 (24.2%) vs. 45/101 (44.5%) of the pSS group, and 30/209 (14.3%) vs. 28/111 (25.2%) of the sSS group. No clinical associations were found. Only two IgG anti-alpha-fodrin-positive sera were anti-Ro/SSA-negative. We conclude that IgG antibodies against alpha-fodrin are present in a small percentage of people with SS, pSS, and sSS. The lower prevalence in patients classified according to the ESG criteria reflects the lower specificity of these criteria. IgG anti-alpha-fodrin antibodies can be detected in some SS patients whose sera do not contain anti-Ro/SSA antibodies.
16045835 Treatment advances in psoriatic arthritis. 2005 Aug Treatment of psoriatic arthritis, like the treatment of rheumatoid arthritis, now commonly includes the use of inhibitors of tumor necrosis factor in addition to traditional synthetic disease-modifying antirheumatic drugs. This paper examines the most recent data from therapeutic trials in psoriatic arthritis, with particular emphasis on the effectiveness of the tumor necrosis factor inhibitors. Recent data on potential future therapies is discussed as well, along with data on the mechanisms of current therapies that may have relevance for future treatment approaches.
17957859 New directions in the standard of care for inflammatory arthritis. 2006 May Inflammatory arthritides are associated with progressive joint destruction early in the course of disease; therefore, early diagnosis and treatment with drugs that offer the potential to slow disease progression or induce remission is crucial. This article discusses the most recent approaches to treatment for 3 common inflammatory arthritic conditions: rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.