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ID PMID Title PublicationDate abstract
18949678 [Interdisciplinary and evidence-based treatment guideline for juvenile idiopathic arthriti 2008 Nov Treatment of Juvenile Idiopathic Arthritis (JIA) has improved quality of life in children and adolescents suffering from JIA. However, it varies considerably from caregiver to caregiver. Therefore a standardisation of care on the basis of consensus treatment recommendations offers the chance to further improve the quality of care for children and adolescents with JIA. We aimed to establish an interdisciplinary, evidence-based treatment guideline for JIA based on the existing guideline from 2005. METHODS: We did a systematic literature analysis in PUBMED with the key words "juvenile idiopathic (rheumatoid) arthritis" and "therapy". As limits in PUBMED we used: humans, published in the last 3 years, all child 0-18 years, clinical trial. Studies relating to diagnosis of JIA, Uveitis, vaccination, transition and rofexocibe were excluded. Authors of the 2005 guideline and representatives nominated by different societies were invited to attend the consensus conferences which were hosted by a professional moderator. Following societies were invited: Berufsverband der Kinder- und Jugendärzte (BVKJ), Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Deutsche Gesellschaft für Rheumatologie (DGRh), Deutsche Ophthalmologische Gesellschaft (DOG), Deutsche Rheuma-Liga Bundesverband, Verein zur Förderung und Unterstützung rheumatologisch erkrankter Kinder und deren Eltern, Vereinigung für Kinderorthopädie, Zentraler Verband der Physiotherapeuten und Krankengymnasten (ZVK). Consensus conferences took place in Düsseldorf on May 9th and August 1st 2007 and were each attended by more than 95% of the nominated representatives Finally, statements were confirmed in a Delphi method. RESULTS AND CONCLUSION: Consensus statements regarding drug therapy, symptomatic and surgical management of JIA were compiled and judged strictly by the criteria of Evidence-Based Medicine (EBM).
23285486 Drug Therapy for Rheumatoid Arthritis: Comparative Effectiveness. 2007 In response to a request from the public to the Agency for Healthcare Research and Quality (AHRQ) concerning the expanding use of disease-modifying anti-rheumatic drugs (DMARDs) to treat rheumatoid arthritis (RA), a systematic review was undertaken to review the effectiveness and safety of the oral and biologic DMARDs. This summary is based on a systematic review prepared as an update to a review published in 2007. In addition to the material reported in 2007, this update includes articles published after the 2007 report and before January 2011 (a total of 211 studies). The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/dmardsra.cfm. This summary, based on the full report of research evidence, is provided to clinicians to inform discussions of options with patients and to assist in decisionmaking along with consideration of a patient’s values and preferences. Reviews of evidence should not be construed to represent clinical recommendations or guidelines.
16220288 Association of macrophage migration inhibitory factor gene -173 G/C polymorphism with prog 2006 Jun The objectives of this study were to determine genotypic and allelic frequencies of macrophage migration inhibitory factor (MIF) gene -173 G/C polymorphism in patients with juvenile rheumatoid arthritis (JRA) and to evaluate the association of the MIF -173 C allele with the outcome of JRA. Genomic DNA was collected from 67 JRA patients and 153 healthy individuals. To evaluate the association of the MIF -173 polymorphism with the outcome, we analyzed the data concerning the treatment regimen, duration of glucocorticoid treatment, score on the childhood health assessment questionnaire (C-HAQ) and the number of joints with active arthritis. Nonsignificant differences were observed between the study and control groups in the distribution of genotype and allele frequencies of the MIF gene -173 G/C polymorphism. In JRA patients, carrying a MIF -173 C allele, the number of disease modifying antirheumatic drugs required for the treatment was more, the duration of glucocorticoid treatment was significantly longer, and at the last visits the C-HAQ scores and the number of joints with active arthritis were significantly higher. MIF gene -173 C allele frequency did not differ between the controls and JRA patients. MIF -173 C allele did not confer increased susceptibility to JRA in our study group. Carriage of the MIF -173 C allele was found to be a strong predictor of poor outcome in all types of JRA.
18466533 An integrated genome-wide association analysis on rheumatoid arthritis data. 2007 We propose a nonparametric association analysis combining both family and unrelated case-control genotype data. Under the assumption of Hardy-Weinberg equilibrium, we formed an affected group to compare with a group of unaffecteds.Comparison with traditional case-control chi-square test and transmission-disequilibrium test shows that this new approach has noticeably improved power. All analysis was based on the simulated rheumatoid arthritis data provided by Genetic Analysis Workshop 15. In the situation of population stratification, we also suggest an approach to update the genotype data using principal components. However, the Genetic Analysis Workshop 15 simulation data does not simulate population stratification. All analysis was done without knowledge of the answers.
19092833 Is there a role for everolimus in the treatment of RA? 2009 Feb The past decade has seen remarkable advances in the treatment of rheumatoid arthritis. Although this is good news for the majority of patients, one consequence is that the environment for the development of new drugs has become difficult as a result of high expectations for efficacy. Nevertheless, there remains a subgroup of patients with rheumatoid arthritis who are not candidates for treatment with the newer biologic agents and in whom oral DMARDs have certain advantages. A recent report by Bruyn et al. suggests that the proliferation-signal inhibitor everolimus could have unique properties, in addition to a convenient once-daily oral dosing schedule, that might fit this niche in the therapeutic armamentarium. Further studies are required, however, to confirm the disease-modifying effects and adverse event profile of this drug.
20528323 Critical appraisal of pharmacoeconomic studies comparing TNF-alpha antagonists for rheumat 2007 Dec Clinical trials and economic models have showed that anti-TNF agents are effective and cost effective compared with standard therapies (mainly disease-modifying antirheumatic drugs) in patients with rheumatoid arthritis. However, no head-to-head clinical trials between these agents are available and the relative effectiveness and cost-effectiveness is uncertain. We have conducted a literature review in order to identify full economic evaluations that compared two or more TNF antagonists. A description of each study was given and key methodological issues identified. These included methods for evidence synthesis, model characteristics and methods to address uncertainty in model parameters. Important differences in methodological features and results have been found between studies. More attention in future studies should be given to methods for indirect comparisons between the biological agents.
17083768 Defining remission in psoriatic arthritis. 2006 Nov Driven in part by the introduction of highly effective agents, there has been growing interest in the overall therapeutic approach to patients with psoriatic arthritis (PsA). As with any form of arthritis, the goal of treatment for PsA would be to improve the outcome to the greatest extent possible. In other conditions, such as rheumatoid arthritis, recent discussions have centered on how best to define "remission." For patients with PsA, the heterogeneity among disease manifestations as well as the need to validate outcome measures make definition of remission challenging. In this paper we present a number of key principles and considerations critical to laying the groundwork for defining remission in PsA.
18322784 Anti-annexin II antibodies in systemic autoimmune diseases and antiphospholipid syndrome. 2008 Jul OBJECTIVES: The objective of this study were (1) to evaluate the prevalence of anti-annexin II antibodies in patients with various autoimmune diseases and antiphospholipid syndrome and (2) to correlate anti-annexin II antibodies with anti-phospholipid antibodies. MATERIALS AND METHODS: Anti-annexin II antibodies and anti-phospholipid were detected, using an enzyme-linked immunosorbent assay, in the serum of patients with primary antiphospholipid syndrome (n = 16), systemic lupus erythematosus (n = 53), primary Sjögren syndrome (n = 71), systemic sclerosis (n = 17), systemic vasculitis (n = 18), and rheumatoid arthritis (n = 119). Healthy blood donors (n = 99) were used as controls. RESULTS: Anti-annexin II antibodies were significantly more prevalent in patients with connective tissue diseases (8.5%), especially antiphospholipid syndrome (14.8%) and rheumatoid arthritis (10%), than in controls (2%). An inverse correlation was observed between anti-annexin II antibodies and antiphospholipid antibodies. CONCLUSION: Annexin II can be recognized by antibodies in serum from patients with systemic autoimmune disorders. Further studies are required to determine the clinical significance of anti-annexin II antibodies in rheumatoid arthritis and to determine their diagnostic value in discriminating clinical subgroups of patients with antiphospholipid syndrome.
17960689 Social and economic impact of inflammatory arthritis. 2006 May The inflammatory arthritides place a substantial burden on society with direct healthcare costs and indirect costs due to reduced productivity and social function. These progressive conditions cause significant pain, joint destruction, and reduced function, and therefore also place a substantial disease burden on affected patients and their families. This article reviews the epidemiology, social impact, and disease costs associated with 3 common inflammatory arthritides--rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.
18189192 Estimation of the prevalence of primary Sjögren's syndrome in two age-different community 2008 Jan OBJECTIVE: To estimate the point prevalence of primary Sjögren's syndrome (pSS) in two populations, aged 40-44 and 71-74 years, using two sets of classification criteria. METHODS: The participating individuals were recruited from the Hordaland Health Study (HUSK) conducted during 1997-99. A total of 18 592 individuals born 1953-57 and 3346 individuals born 1925-27 were sent a questionnaire covering various health-related questions, including four questions about sicca symptoms. Among those answering positive to at least one of the four questions, 99 and 90 individuals born 1953-57 and 1925-27, respectively, were examined further. For diagnosis of pSS two classifications were used, the preliminary European criteria from 1993, and the revised European criteria from 1996. RESULTS: By using the two classification criteria from 1993 and 1996, the point prevalences were 0.44% [95% confidence interval (CI) 0.34-0.57] and 0.22% (95% CI 0.15-0.32), respectively, for the population group born 1953-57. The corresponding estimates were 3.39% (95% CI 2.77-4.14) and 1.40% (95% CI 1.02-1.92) for the population born 1925-27. CONCLUSION: The point prevalence of pSS was approximately seven times higher in the elderly population aged 71-74 years compared to individuals aged 40-44 years, regardless of the classification criteria used.
16678940 [Adult-onset Still's disease revealed by a pericardial tamponade: report of two cases]. 2006 Jul INTRODUCTION: Adult onset Still's disease is a systemic inflammatory disorder of unknown etiology characterized by the association of a high spiking fever, an evanescent skin rash, arthritis, and hyperleukocytosis. Pericarditis is amongst the most common systemic manifestations of adult onset Still's disease. EXEGESIS: We report on two patients with a pericardial tamponade revealing an adult onset Still's disease in a 52-year-old female and a 31-year-old male. Pericardial fluid was bloody in the two cases, and histopathology only disclosed non specific inflammatory changes. Both patients received corticosteroids and outcome was uneventful with a follow-up of 8 years and 12 months, respectively. CONCLUSION: Pericardial tamponade is an uncommon clinical feature of adult-onset Still's disease and usually occurs at disease onset. It makes the diagnosis of adult-onset Still's disease difficult as the other disease manifestations are commonly neglected. Adult onset Still's disease should be added to the differential of acute pericarditis and tamponade.
19043259 Primary Sjögren's syndrome complicated by sarcoidosis. 2008 A 51-year-old woman suffered from xerophthalmia and xerostomia for 3 years without being medically examined. In July 2006, she was referred to our hospital for the evaluation of chest roentgenogram showing slight pleural effusion in the right lung. A chest CT scan revealed multiple nodules, enlarged mediastinal and hilar lymph nodes, and bilateral slight pleural effusions. A diagnosis of Sjögren's syndrome was made on the basis of the results of sialography, lip biopsy, Schirmer's test, and elevated titer of antibody to SS-A antigen. Histological examination of the specimen from the nodular lesion by video-assisted thoracoscopic biopsy revealed noncaseating epithelioid cell granuloma containing giant cells, which confirmed the diagnosis of sarcoidosis. Although the coexistence of Sjögren's syndrome and sarcoidosis has been reported occasionally, cases with histological evidence of sarcoidosis have been rare. Pulmonary sarcoidosis should be considered in the differential diagnosis of pulmonary multiple nodules in patients with Sjögren's syndrome.
19074185 Patient-reported outcomes in primary Sjogren's syndrome: comparison of the long and short 2009 Feb OBJECTIVES: The long-form 64-item Profile of Fatigue and Discomfort--Sicca Symptoms Inventory (PROFAD-SSI) questionnaire was developed as a patient-reported assessment tool for use in primary SS (PSS) and other rheumatic disorders. In this study, we assess whether the (shorter and more practical) 19-item PROFAD-SSI-SF (short form) gives similar results and whether a still briefer version using visual analogue scales (VASs) is feasible. METHODS: Questionnaire surveys comprising the long and short versions of the PROFAD-SSI were mailed to 43 patients with PSS and 50 patients with RA, who were asked to complete these contemporaneously as well as repeating the process 1 month later. PSS patients also completed a series of VASs comprising fatigue and sicca domains of the SSI. RESULTS: Surveys were returned from 35 PSS patients and 35 RA patients. All domains of the long- and short-form PROFAD-SSI showed strong correlations (Spearman rho between 0.779 and 0.996, P < 0.01). Factor analysis generally confirmed the previously validated domain structure with Cronbach's alpha = 0.99. The PROFAD-SF somatic fatigue domain correlated more strongly with a fatigue VAS than did the mental fatigue domain. The SSI-SF domain scores correlated with equivalent VAS scores. CONCLUSION: The long- and short-form PROFAD-SSI questionnaires correlate closely suggesting that the PROFAD-SF is valid as an outcome tool. Preliminary data also suggest that an even briefer form with compression of the domains into single VAS is also feasible.
18443796 A case of adult onset Still's disease showing marked accumulation in the liver and spleen, 2008 Aug A 35-year-old woman was admitted to our hospital because of high fever and skin rash, and subsequently diagnosed as having adult onset Still's disease (AOSD). Because of resistance to the steroid hormones, high levels of the serum-soluble form of the interleukin-2 receptor and splenomegaly, we suspected a possible diagnosis of malignant lymphoma and performed positron emission tomography (PET), which disclosed an intense accumulation of 2-deoxy-2 [F18] fluoro-D-glucose (FDG) in the liver and spleen. However, bone marrow aspiration and liver biopsy did not reveal any malignant cells. After the treatment of high-dose adrenocorticosteroids and plasma exchange, her symptoms and laboratory data, including PET findings, gradually improved. This is a rare case of severe AOSD in which an intense accumulation of FDG was detected by PET, and a differential diagnosis from malignant lymphoma may be difficult by FDG-PET alone, so that careful evaluation by techniques including histopathological examination may be necessary.
18328102 Mild autonomic dysfunction in primary Sjögren's syndrome: a controlled study. 2008 INTRODUCTION: The aim of this study was to compare cardiovascular autonomic nervous system function in patients with primary Sjögren's syndrome (pSS) with that in control individuals, and to correlate the findings with autonomic symptoms and the presence of exocrine secretory dysfunction. METHODS: Twenty-seven female patients with pSS and 25 control individuals completed the COMPASS (Composite Autonomic Symptom Scale) self-reported autonomic symptom questionnaire. Beat-to-beat heart rate and blood pressure data in response to five standard cardiovascular reflex tests were digitally recorded using a noninvasive finger pressure cuff and heart rate variability was analyzed by Fourier spectral analysis. Analysis was performed by analysis of variance (ANOVA), multivariate ANOVA and repeated measures ANOVA, as indicated. Factor analysis was utilized to detect relationships between positive autonomic symptoms in pSS patients. RESULTS: Multiple, mild autonomic disturbances were observed in pSS patients relating to decreased heart rate variability, decreased blood pressure variability and increased heart rate, which were most evident in response to postural change. There was a strong trend toward an association between decreased heart rate variability and increased severity of the secretomotor, orthostatic, bladder, gastroparesis and constipation self-reported autonomic symptom cluster identified in pSS patients. This symptom cluster was also associated with fatigue and reduced unstimulated salivary flow, and therefore may be an important component of the clinical spectrum of this disease. CONCLUSION: There was evidence of mild autonomic dysfunction in pSS as measured with both cardiovascular reflex testing and self-reported symptoms. Pathogenic autoantibodies targeting M3 muscarinic receptors remain a strong candidate for the underlying pathophysiology, but practical assays for the detection of this autoantibody remain elusive.
18095015 Acute hepatitis in adult Still's disease during corticosteroid treatment successfully trea 2008 May Adult onset Still's disease (AOSD) is a well-recognized clinical disorder characterized by involvement of various organs, including liver. However, acute hepatitis or hepatic failure is extremely rare, and most of the reported cases occurred during treatment with hepatotoxic drugs. Anakinra is an interleukin-1 receptor antagonist (IL-1Ra). Experimental and clinical data support a central role for IL-1Ra in fulminant hepatic failure. We report the case of a patient with AOSD complicated with acute hepatitis during treatment with corticosteroids, which was dramatically improved with anakinra.
16880196 Experience with experimental biological treatment and local gene therapy in Sjogren's synd 2006 Nov Sjögren's syndrome is an autoimmune exocrinopathy, mainly affecting the lacrimal and salivary glands, and resulting in ocular and oral dryness (keratoconjunctivitis sicca and xerostomia). The aetiology and pathogenesis are largely unknown, and only palliative treatment is currently available. Data obtained from experimental animal and human studies using biological agents or gene therapeutics can offer insight into the disease process of Sjögren's syndrome. This article reviews the current literature on these approaches and assesses the lessons learnt about the pathogenesis of Sjögren's syndrome.
16465479 Kikuchi-Fujimoto disease coexisted with Sjogren's syndrome. 2007 Apr Here we described a case of primary Sjogren's syndrome that coexisted with Kikuchi-Fujimoto disease.
16332955 Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982-2003. 2006 Feb OBJECTIVES: To investigate the incidence and prevalence, as well as the mortality and survival rates, of primary Sjögren's syndrome (pSS) in a defined area of north-west Greece with a population of about 500 000 inhabitants. METHODS: Cases were recorded from the following sources: (i) in- and out-patients referred to the rheumatology clinics of the Ioannina University Hospital and the Ioannina General Hospital; and (ii) patients referred to private rheumatologists practising in the study area. All patients diagnosed between 1 January 1982 and 31 December 2003 who were resident in the study area were included as incident cases. Diagnosis was based on the American-European consensus criteria for SS. Incidence and prevalence rates were calculated as numbers of cases per 10(5) inhabitants. Population data were based on the National Censuses of 1981, 1991 and 2001. RESULTS: A total of 422 incident cases were identified for the study period 1982-2003. Age-adjusted mean annual incidence rate for this period was 5.3 (95% confidence interval [CI] 4.5-6.1) cases per 10(5) adult inhabitants. The female/male ratio of incident cases was about 20/1. The age-adjusted prevalence rate for the adult population was 92.8 (95% CI 83.7-101.9) cases per 10(5) inhabitants on 31 December 2003. The 5-yr survival rate in the incidence cohort was 96.6% and the 10-yr survival rate 92.8%. The standardized mortality ratio in comparison with the general population of the study area was 1.02 (95% CI 0.4-2.0). The main causes of death were cardiovascular diseases and cancer. The occurrence of the disease shows a slightly decreasing, but not statistically significant, trend with time. CONCLUSIONS: The estimated incidence and prevalence of pSS in this study were slightly higher in comparison with data from other studies based on physician-diagnosed cases. The prevalence was significantly lower when compared with the findings of studies based on the examination of a sample of the general population. Mortality rates did not differ significantly between pSS patients and the general population.
19097398 [Pulmonary hypertension revealing systemic diseases: two Senegalese case reports]. 2007 INTRODUCTION: Pulmonary hypertension (PH) is a complication of autoimmune diseases which worsen the prognosis. In Senegal, a few cases of PH have been previously reported in patients with systemic sclerosis. CASE REPORTS: We report two cases of patients with PH that revealed autoimmune diseases (Sharp' syndrome and Sjögren syndrome). Epidemiological, clinical, evolutive and laboratory data were analyzed. Evolution of disease was favourable for one patient and fatal for the other. CONCLUSION: These two cases show necessity of early diagnosis of systemic diseases in our countries. PH should be screened in each patient with autoimmune disease before installation of irreversible pulmonary arterial lesions that respond to treatment. New therapy used in idiopathic PH are not yet accessible for our patients.