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ID PMID Title PublicationDate abstract
15887508 Periodontal status and sulcular Candida albicans colonization in patients with primary Sjà 2005 Mar OBJECTIVE: The purpose of this study was to compare the periodontal status and prevalence of sulcular Candida albicans between subjects with primary Sjögren's Syndrome (SS-1) and healthy control subjects. MATERIAL AND METHODS: Ten SS-1 subjects and 10 age- and sex-matched control subjects were recruited. All subjects met the comprehensive European Community Criteria for primary Sjögren's Syndrome. Periodontal probing depth (PD), clinical attachment loss (CAL), plaque and gingivitis were scored on index teeth in each subject. Gingival crevicular fluid (GCF) volume was measured from the same teeth using Periopaper strips. Candida albicans presence was determined by plating paper strips directly into culture media tubes (Oricult kit). RESULTS: Despite having similar mean PD measures and gingivitis and plaque scores, SS-1 subjects who had Sjögren's Syndrome for a mean of 8.8 years had significantly more CAL (5.4 mm vs 2.7 mm; P < .01) and GCF (101.3 +/- 4.25 microL vs 33.0 +/- 1.91 microL; P < .001) than healthy control subjects. Candida albicans was detected in the sulci of only one SS-1 subject and in none of the control subjects. CONCLUSION: These data indicate that the cohort of the SS-1 patients in this particular study have significantly more gingival recession and GCF than do control subjects. The increased attachment loss in SS-1 patients is not attributed to an increase in colonization of the gingival sulci by Candida albicans organisms.
16568213 Double-filtration plasmapheresis for resolution of corticosteroid resistant adult onset St 2006 Jul A 45-year-old Japanese male was diagnosed with adult onset Still's disease (AOSD). High-dose corticosteroid initially resolved the illness; however, high fever, maculopalpular rashes, arthralgia, and acute pericarditis rapidly recurred, and were followed by a somnolent state without focal signs. A diagnosis of corticosteroid resistant, severe, recurrent AOSD was made, and double-filtration plasmapheresis (DFPP) was performed immediately. The somnolent state began to resolve during the first plasmapheresis procedure, and the other symptoms resolved shortly thereafter. DFPP theoretically removes monocyte-activating cytokines, such as monocyte colony-stimulating factor (M-CSF) from the circulation, and therefore may prove to be an effective treatment for corticosteroid resistant, rapidly developing cases of AOSD.
17087339 [Case of rapid progressive interstitial pneumonia associated with primary Sjogren syndrome 2006 Oct A 72-year-old woman with a dry cough and dyspnea on exertion was admitted to our hospital. A chest radiograph showed reticular opacities and volume loss in both lower lung fields. She was troubled with xerostomia and her laboratory test showed positive reaction for anti SS-A and SS-B antibody. Labial biopsy led to a diagnosis of primary Sjogren's syndrome (pSjS). Lung biopsy specimens obtained by video-assisted thoracoscopic surgery (VATS) revealed interstitial pneumonia. On the sixth postoperative day, hypoxemia acutely worsened and her chest radiograph showed widespread diffuse ground-glass attenuation. A diagnosis of acute exacerbation was made, and steroid and immunosuppressive therapy was started. In spite of intensive therapy, she died due to respiratory failure. We report a rare case of interstitial pneumonia with pSjS resulting in acute exacerbation.
16453296 Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome. 2006 May Peripheral neuropathy is common in patients with Sjögren's syndrome (SS), but its precise prevalence is unknown. Most prior studies were conducted at neurology or rheumatology specialty clinics and likely selected for a more severely affected population. We evaluated 22 SS patients and 10 controls for evidence of neuropathy in an outpatient setting at a regional meeting of the Sjögren's Syndrome Foundation. We performed neurological examinations and nerve conduction studies (NCSs) and measured serum antinuclear antibody (ANA) and SS-A and SS-B antibody levels. Participants filled out a questionnaire pertaining to symptoms, diagnosis, and treatment. We found that signs and symptoms related to small axons were more common in patients with SS than in controls. Complaints of painful distal paresthesias in the feet were noted in 59% of patients but in only 10% of controls, and of abnormal sweating in 41% and 0%, respectively. Examination revealed decreased pinprick sensation in 64% of patients with SS, but in only 30% of controls. Overall, 45% of the patients but none of the controls were thought to have an isolated small-fiber neuropathy. Large-fiber dysfunction (as measured by testing vibration, deep tendon reflexes, and NCSs) was similar between the two groups. We conclude that small-fiber neuropathy is common in patients with SS.
16396696 Nailfold capillaroscopic findings in primary Sjögren's syndrome: clinical and serological 2005 Nov OBJECTIVE: To describe the capillaroscopic abnormalities observed in patients with primary Sjögren's Syndrome (pSS), associating them with clinical and serologic features, and comparing these findings to those observed in normal controls. METHODS: Sixty-one consecutive patients with pSS were studied by clinical evaluation, serology, and nailfold capillary microscopy (NCM). Twenty-one normal controls were also examined. Capillaroscopic findings were recorded in a standardized way by a blinded observer Capillary loss on NCM was evaluated using a deletion score. RESULTS: NCM was normal in 59.0% of pSS patients; 29.5% had non-specific abnormalities, and 11.5% presented a SD-like pattern. Patients presented a higher deletion score than controls (p < 0.001). Other capillaroscopic parameters (number of dilated, bizarre, and meandering capillaries; capillary hemorrhages; venous plexus visibility) did not differ significantly between patients and controls. Among patients, the deletion score was higher in those with systemic manifestations (p = 0.022) and Raynaud's phenomenon (p = 0.050). No association between the presence of antinuclear antibodies, rheumatoid factor, anti-SSA/Ro and anti-SSB/La with qualitative or quantitative NCM findings was found. Among the 7 patients with SD-like pattern on NCM, 6 had Raynaud's phenomenon, but only 2 presented autoantibodies related to systemic sclerosis (1 with anticentromere and 1 with low titer antitopoisomerase I). None of these patients met the ACR criteria for SSc. CONCLUSIONS: SD-like pattern on NCM is observed in a small but significant proportion of pSS patients. The association of systemic involvement with a higher deletion score may be related to the hypothesis that these manifestations represent clinical expressions of systemic vasculitis.
15801022 Perinatal characteristics and risk of developing primary Sjögren's syndrome: a case-contr 2005 Apr OBJECTIVE: To study perinatal characteristics as risk factors for developing primary Sjogren's syndrome (SS). METHODS: This was a case control study with extraction of information from birth records comprising 32 cases with SS (fulfilling the unified American-European classification criteria) and 159 controls. Cases were selected from a patient register of SS cases in Malmö, Sweden. For each case, 5 controls (living in the same catchment area, matched by date of birth, sex, and delivery unit) from the general population were identified. The relative risks of developing SS were assessed as odds ratios (OR). The primary predictor searched for was birth weight. Secondary predictors were breastfeeding during postpartum hospital stay, paternal occupation, placenta weight, gestational length, diseases during pregnancy, maternal age, parity, and history of miscarriage. RESULTS: Significantly increased OR were observed for high birth weight (>/= 4000 vs 3000-3999 g, OR = 3.8 95% confidence interval, CI: 1.3-11.7) and low maternal age (p < 0.05). Low paternal socioeconomic status (OR = 3.2, 95% CI: 1.0-10.5) and being first-born (OR = 2.5 95% CI: 1.0-5.0) tended to be associated with SS. CONCLUSIONS: Our findings suggest that characteristics of the perinatal period may be of etiologic importance in the pathogenesis of SS. Possible mechanisms include modulation of the immune system early in life. It is conceivable that birth weight may be a marker for qualitative and/or quantitative differences in the immune system.
15693602 [Research methods in dentistry 7. Diagnostic tests in oral diseases]. 2005 Jan A variety of tests are available to arrive at the proper diagnosis of oral and perioral diseases, which may be extremely important if further treatment is indicated. When oral cancer is suspected the main diagnostic tool remains the histopathologic examination of a biopsy specimen. The value of cytologic examination, whether obtained by exfoliation of cells or by a brush technique, is somewhat questionable. A positive result of such examination needs to be confirmed by a biopsy. The same applies to the use of toluidine blue stain. The presence or absence and, if present, the degree of epithelial dysplasia as observed in a biopsy is still the most reliable predictor of possible future malignant transformation of oral leukoplakie in spite of recently reported, promising results with DNA-ploidy measurements. A salivary gland biopsy, whether taken from the parotid gland or from the accessory gland of the lower lip, plays a valuable role in establishing a diagnosis of Sjögren's syndrome. Computertomography (CT) and Magnetic Resonance Imaging (MRI) have become important imaging tools in disease processes in the bones and the soft tissues.
16267408 Adult-onset Still disease as the cause of fever of unknown origin. 2005 Nov We conducted the current study to evaluate the cases of fever of unknown origin (FUO) admitted in our institution during the 10 years between 1991 and 2001 and to compare the patients diagnosed as having adult-onset Still disease (AOSD) with the patients with FUO due to other diagnoses. We performed a case-control study and analyzed 26 patients with AOSD and 135 patients with FUO due to other diseases. Controls were classified into 1 of 4 groups: 1. Infectious diseases; 2. Malignant conditions; 3. Autoimmune diseases; 4. No diagnosis. Differences between groups were evaluated by analysis of variance (ANOVA). Odds ratios (OR) were calculated by multiple logistic regression analyses. Patients with AOSD were younger than controls. Arthritis (OR, 8.6; 95% confidence interval [CI], 1.5-49.1; p = 0.014), pharyngitis (OR, 6.9; 95% CI, 1.5-30.2; p = 0.010), splenomegaly (OR, 5.4; 95% CI, 1.1-26.7; p = 0.039), and neutrophilic leukocytosis (OR, 18.1; 95% CI, 3.5-93.6; p = 0.001) were significantly more common in patients with AOSD than in the control groups. A clinical scale that identifies patients with AOSD was designed. It proved to be highly specific ( approximately 98%), with predictive values greater than 90%.AOSD is a defined clinical entity. In most cases, it is clinically distinguishable from other causes of FUO. We propose a clinical scale as a tool to identify patients whose disease can be diagnosed based on clinical grounds without the need of long, costly diagnostic procedures.
16126964 Antifodrin antibodies in Sjogren's syndrome: a review. 2005 Jun Establishing the diagnosis of Sjögren's syndrome has been difficult in light of its nonspecific symptoms (dry eyes and mouth) and lack of both sensitive and specific laboratory markers. Recently, antibodies against alpha-fodrin have been characterized: first in animal models of Sjögren's syndrome, and later in humans. Antibodies against alpha-fodrin have been shown to be present in up to 98% of untreated patients. These antibodies are directed against an apoptotic cleavage product of alpha-fodrin. Anti-alpha-fodrin is clearly involved in the pathogenesis of murine models of Sjögren's syndrome. However, in humans, conflicting data have recently been generated with regard to the prevalence of antibodies against alpha-fodrin in the disease. These differences may be caused by interference of treatment with antibody concentrations, but may also reflect varying methods of patient selection. Further studies on untreated patients are needed to establish the diagnostic efficiency of antibodies against alpha-fodrin in Sjögren's syndrome, which may be a potential diagnostic marker in addition to antibodies against Ro. In this review, the potential of antifodrin antibodies as laboratory markers of Sjögren's syndrome is discussed.
15899048 Increased serum HO-1 in hemophagocytic syndrome and adult-onset Still's disease: use in th 2005 Heme oxygenase-1 (HO-1), an inducible heme-degrading enzyme, is expressed by macrophages and endothelial cells in response to various stresses. Because ferritin synthesis is stimulated by Fe2+, which is a product of heme degradation, we examined the relation between HO-1 and ferritin levels in the serum of patients with hemophagocytic syndrome (HPS), adult-onset Still's disease (ASD), and other diseases that may cause hyperferritinemia. Seven patients with HPS, 10 with ASD, 73 with other rheumatic diseases, 20 with liver diseases, 10 recipients of repeated blood transfusion because of hematological disorders, and 22 healthy volunteers were enrolled. Serum HO-1 and ferritin levels were determined by ELISA. Expression of HO-1 mRNA and protein by peripheral blood mononuclear cells (PBMCs) was determined by real-time PCR and immunocytochemical techniques, respectively. Serum levels of HO-1 were significantly higher in patients with active HPS and ASD than in the other groups (P < 0.01). HO-1 levels were not elevated in patients with other causes of hyperferritinemia but were moderately elevated in patients with dermatomyositis/polymyositis. Among patients with HPS and ASD, serum HO-1 levels correlated closely with serum ferritin levels, and the levels of both returned to normal after therapy had induced remission. Increased expression of HO-1 mRNA was confirmed in PBMCs from some patients with HPS and ASD. Hyperferritinemia correlated closely with increased serum HO-1 in patients with HPS and ASD but not other conditions, indicating that measurement of serum HO-1 and ferritin levels would be useful in the differential diagnosis of hyperferritinemia and perhaps also in monitoring disease activity in HPS and ASD.
15703951 Sjögren's syndrome in the community: can serology replace salivary gland biopsy? 2006 Feb BACKGROUND: It is relatively difficult in a community setting to perform salivary gland biopsy or reliable diagnostic tests for salivary gland involvement in a patient suspected to suffer from Sjögren's syndrome (SS). OBJECTIVE: To investigate whether anti-Ro/La antibodies are a good substitute for salivary gland biopsy in community patients suspected to suffer from SS. METHODS: Forty-one patients suspected as having SS due to dry eyes and mouth, articular complaints, and/or serological findings were examined for the presence of anti-Ro/La, and underwent minor salivary gland biopsy. RESULTS: Sixteen patients (39%) were classified as primary SS by the American-European Consensus Group criteria. Twelve subjects had anti-Ro/La antibodies and 11 subjects in this group had positive biopsy findings. Of 29 patients without anti-Ro/La antibodies, only four manifested positive biopsy findings. A significant association was found between the presence of anti-Ro/La antibodies and positive salivary gland findings characteristic for SS (p<0.0001, Fisher's exact test). CONCLUSION: These findings tend to support the suggestion that a patient suspected to suffer from SS in a community setting may be first tested for the presence of anti-Ro/La antibodies to confirm the diagnosis. Only those with a negative result for the presence of anti-Ro/La antibodies need to be referred for salivary gland biopsy.
16876917 [Cystic lung disease associated with Sjögren's syndrome: 2 cases]. 2006 Aug INTRODUCTION: Cystic lung disease is characterised on chest iconography by foci of decreased lung density with definable and thinned walls (wall thickness<4 mm) and with length's diameter superior at 1 cm. Cystic lung disease is exceptionally associated with the Sjögren's syndrome; very few cases have been described. EXEGESIS: We report two cases of cystic lung disease associated with Sjögren's syndrome, one occurring in a Lupus-Sjögren's overlapping syndrome, and another revealing primary Sjögren's syndrome. CONCLUSION: The Sjögren's syndrome should be recognised as could be associated with Cystic lung disease; and latent Sjögren's syndrome should be researched in presence of cystic lung lesions.
21794267 [Psoriatic synovitis: pathogenic and therapeutic implications]. 2005 Dec Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune disease characterized by arthritis and psoriasis of the skin. It is classified within the spondyloarthropathies (SpA) group. The wide clinical heterogeneity of PsA has hampered research into its pathogenesis and the performance of large randomized clinical trials with disease-modifying anti-rheumatic drugs. The success of biologic agents in PsA has stimulated wide interest in this disease as well as in its clinical classification and underlying pathogenic mechanisms. Several recent articles on the pathogenesis of PsA are reviewed, focussing on the potential of synovial angiogenesis as a therapeutic target and on synovial expression of macrophages and p53 protein related to joint damage in rheumatoid arthritis (RA) and PsA. Finally, the question of whether the polyarticular variant of PsA shares immunohistochemical features with RA or SpA is also discussed. Although the success of tumor necrosis factor-alpha antagonists in both RA and PsA supports a similar pathogenesis in both disorders, these and other studies suggest that there are differences in the synovial expression and pathogenic significance of certain cells and molecules. If confirmed, this phenomenon could open new avenues in specific therapy for PsA.
16194464 [Bone scintigraphy with 99mTc-MDP in a patient with acute lymphoblastic leukemia initially 2005 Sep We present a 43-year-old male, who was admitted with the diagnosis of Adult-onset Still's disease, after several months of arthralgias, febricula and loss of weight. Chest x-ray, abdominal ultrasonography, chest, abdomen and pelvic CT scan and bone scintigraphy were performed. Scintigraphic findings oriented to the performance of a bone marrow biopsy with diagnosis of acute lymphoblastic leukemia.
17611434 Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis. 2005 Dec 30 In RA patients with a very aggressive disease, pathological changes in the knee occur in 90% of cases in the end-stage period. These changes are often accompanied by severe deformities, such as flexion contracture, valgus deformity, and more rarely varus deformity. In order to provide soft tissue balance, these deformities require additional surgery before implantation of the prosthesis. In this article the authors describe different methods, depending on the nature of the deformities, such as posterior release and lateral soft-tissue release, which should be done in successive stages. The problem of the patella and loss of bone stock for reconstruction is briefly discussed.
16353072 [Cardiovascular involvement in rheumatic diseases]. 2005 Cardiovascular system involvement with early development of atherosclerosis is characteristic for rheumatic diseases. Among causes of death in various rheumatic diseases cardiovascular pathology also prevails. This paper contains a review of most important studies of impairment of the heart, arterial and venous parts of cardiovascular system in patients with diffuse diseases of connective tissue, rheumatoid arthritis and systemic vasculitides. The role of immune mechanisms, endothelial dysfunction, dyslipidemia in pathogenesis of cardiovascular disturbances with development of myocardial and vascular remodeling in rheumatic diseases is also discussed. Major risk factors of cardiovascular pathology in rheumatic patients are presented. Treatment of a cardiovascular pathology in these patients presumes the use of angiotensin converting enzyme inhibitors, aldosterone antagonists and statins.
20144051 Inhibitors targeting hepatocyte growth factor receptor and vascular endothelial growth fac 2006 May Amgen disclosed a series of 4-heteroaryloxy quinoline/quinazoline compounds as multiple kinase inhibitors, including hepatocyte growth factor (HGF) receptor tyrosine kinase c-Met and vascular endothelial growth factor (VEGF) receptor tyrosine kinase. These compounds are stated to have wide therapeutic applications for the treatment of a variety of cancers, hypertension, arteriosclerosis, myocardial infarction and rheumatoid arthritis.
17042001 The updated BSR guidelines for anti-TNF in adults with RA: what has changed and why? 2005 In 2001 the British Society for Rheumatology (BSR) published guidelines for prescribing TNF-alphablockers in adults with rheumatoid arthritis (RA). In an unusual move, the National Institute of Clinical Excellence (NICE) accepted the BSR guidelines and published them unchanged and included them in their own Technology Appraisal (National Institute of Clinical Excellence, 2002). The field of anti-TNF in RA is rapidly changing, and the BSR Standards, Guidelines and Audit Working Group decided in 2004 to update the guidelines. These were published in February 2005 (Ledingham and Deighton, 2005). This article summarizes the key changes, and attempts to justify them, using further data that has emerged since the updated guidelines were produced, and audit data from the Derby Rheumatology department.
17603446 Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis. 2006 Apr 28 In RA patients with a high activity disease, pathological changes in the knee occur in 90% of cases in the end-stage period. These changes are often accompanied by severe deformities, such as flexion contracture, valgus deformity, and more rarely varus deformity. In order to provide soft tissue balance, these deformities require additional surgery before implantation of the prosthesis. In this article the authors describe different methods, depending on the nature of the deformities, such as posterior release and lateral soft-tissue release, which should be done in successive stages. The problem of the patella and loss of bone stock for reconstruction is briefly discussed.
16684006 Pathogenesis of haemophilic arthropathy. 2006 Jul The pathogenetic mechanism of haemophilic arthropathy is multifactorial and includes degenerative cartilage-mediated and inflammatory synovium-mediated components. Intra-articular blood first has a direct effect on cartilage, as a result of the iron-catalysed formation of destructive oxygen metabolites (resulting in chondrocyte apoptosis), and subsequently affects the synovium, in addition to haemosiderin-induced synovial triggering. Both processes occur in parallel, and while they influence each other they probably do not depend on each other. This concept resembles degenerative joint damage as found in osteoarthritis as well as inflammatory processes in rheumatoid arthritis. These processes finally result in a fibrotic and destroyed joint.