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ID PMID Title PublicationDate abstract
18203307 Alendronate-induced synovitis. 2008 Mar We describe 7 cases of synovitis or arthritis occurring after commencement of alendronate for treatment of osteoporosis. These were cases from our practice or notified to the New Zealand Pharmacovigilance Centre, Dunedin, New Zealand. There was no evidence of rheumatoid arthritis, pyrophosphate arthropathy, or seronegative arthritis in any patient. Symptoms recurred on rechallenge in 5 of the cases. We conclude alendronate should be considered as a possible cause of synovitis or polyarthritis in patients treated with it in the absence of any other pathology.
18564448 Recommendations for the diagnosis and treatment of latent and active tuberculosis in infla 2008 Mar The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFalpha) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFalpha therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFalpha therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFalpha therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the duration is < 5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again < 5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test, after risk/benefit assessment.
18299856 [Burden of illness. First routine report on socio-medical consequences of inflammatory rhe 2008 Mar A synopsis of different socio-medical consequences of inflammatory rheumatic diseases is not yet available for Germany. Therefore, the data reported during the past decade for rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematodes, and Wegener's granulomatosis are summarized in this article. Apart from clinical studies, relevant data sources were the national data base of the German collaborative arthritis centres, statistical figures from the compulsory health insurance and the national pension insurance scheme. Data were mainly available for sick leave and work disability showing limitations, which frequently occurred during the early course of diseases and increased with disease duration. Furthermore, different risk factors were identified. Measures to maintain continued participation in the labour force, such as part-time employment, partial work disability instead of full work disability, were not being adequately utilized. Only few data regarding the need of help and care were available. The proportion of patients in need of help and care increased with the duration of rheumatoid arthritis to more than 50% after more than 2 decades. This review presents detailed information concerning aspects of the burden of rheumatic diseases, which are frequently not adequately taken into account. They may be useful for the advice and care of individual patients as well as for decision processes concerning the health care system.
17027524 The role of IL-1 and IL-1Ra in joint inflammation and cartilage degradation. 2006 Interleukin (IL)-1 is a cytokine that plays a major role in inflammatory responses in the context of infections and immune-mediated diseases. IL-1 refers to two different cytokines, termed IL-1alpha and IL-1beta, produced from two genes. IL-1alpha and IL-1beta are produced by different cell types following stimulation by bacterial products, cytokines, and immune complexes. Monocytes/macrophages are the primary source of IL-1beta. Both cytokines do not possess leader peptide sequences and do not follow a classical secretory pathway. IL-1alpha is mainly cell associated, whereas IL-1beta can be released from activated cells after cleavage of its amino-terminal region by caspase-1. IL-1 is present in the synovial tissue and fluids of patients with rheumatoid arthritis. Several in vitro studies have shown that IL-1 stimulates the production of mediators such as prostaglandin E(2), nitric oxide, cytokines, chemokines, and adhesion molecules that are involved in articular inflammation. Furthermore, IL-1 stimulates the synthesis and activity of matrix metalloproteinases and other enzymes involved in cartilage destruction in rheumatoid arthritis and osteoarthritis. The effects of IL-1 are inhibited in vitro and in vivo by natural inhibitors such as IL-1 receptor antagonist and soluble receptors. IL-1 receptor antagonist belongs to the IL-1 family of cytokines and binds to IL-1 receptors but does not induce any intracellular response. IL-1 receptor antagonist inhibits the effect of IL-1 by blocking its interaction with cell surface receptors. The use of IL-1 inhibitors in experimental models of inflammatory arthritis and osteoarthritis has provided a strong support for the role of IL-1 in the pathogeny of these diseases. Most importantly, these findings have been confirmed in clinical trials in patients with rheumatic diseases. Additional strategies aimed to block the effect of IL-1 are tested in clinical trials.
17559725 The effect of infliximab on oxidative stress in chronic inflammatory joint disease. 2007 Jun OBJECTIVE: To evaluate infliximab effect on oxidative stress in active chronic inflammatory joint disease. PATIENTS AND METHODS: The study population comprised 12 patients: five with ankylosing spondylitis, five with rheumatoid arthritis and two with psoriatic arthritis. At the time of the study all patients were divided into two groups: (i) seven active patients and (ii) five inactive patients according to the accepted criteria that define activity of disease for each of the diseases. C-reactive protein and erythrocyte sedimentation rate were measured. Patient's Global Assessment of the Disease (PGA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for ankylosing spondylitis patients and Disease Activity Score (DAS 28) for rheumatoid arthritis patients) were used for assessment of disease activity. Patients with active chronic inflammatory joint disease were introduced into the infliximab therapy programme. RESULTS: Infliximab effects were evaluated after 6 weeks of treatment as changes in the quantity of lipid peroxidation products, protein carbonyl groups, reduced glutathione content, glutathione peroxidase, catalase and superoxide dismutase. CONCLUSIONS: Our results revealed that: (i) infliximab has antioxidative properties, (ii) chronic inflammatory joint patients show high levels of oxidative injury, and (iii) oxidative stress is more intense in active disease group than in the inactive disease group.
16652430 Bone mineral density and turnover in non-corticosteroid treated African American children 2006 May OBJECTIVE: To determine bone mineral content (BMC), bone mineral density (BMD), Z scores, and markers of bone turnover in African American children with juvenile rheumatoid arthritis (JRA). METHODS: Eight children with JRA with no prior exposure to corticosteroids were evaluated. Lumbar spine (L1-L4) and total body and total hip BMC and BMD were determined using dual x-ray absorptiometry (DXA), and Z scores (BMD) were calculated. Serum samples of markers of bone turnover including pyridinoline (PYR), N-terminal propeptide of type I procollagen (P1NP), osteocalcin (OC), and bone-specific alkaline phosphatase (BSAP) were measured. RESULTS: The mean Z score (BMD) at the lumbar spine (L1-L4) in patients with JRA was -1.2+/-0.8. Z scores for total body and total hip were within 1 standard deviation of normal compared with healthy historical controls matched for age, sex, and race. CONCLUSION: BMD was normal for chronological age (defined as Z score >or= 2.0) in African American children with JRA who had not previously been treated with corticosteroids. Further studies are needed on the effects of JRA on skeletal health in African American children.
16501924 [Outcome parameters for use in psoriatic arthritis]. 2006 Mar The most important and most commonly occurring form of psoriasis is psoriasis vulgaris. In the specialism of rheumatology palmoplantar pustulosis is also important. The outcome is influenced mainly by how severe and how widespread the manifestations affecting the skin and nails are. All manifestations affecting the joints and occurring in association with psoriasis are subsumed under the term 'psoriatic arthritis' (PsA). Asymmetric oligoarthritis, enthesitis and inflammatory spinal manifestations are especially frequent. PsA is a rheumatic illness with widely varying clinical pictures, most patients having signs and symptoms resembling those of spondyloarthritides (SpA) and other features of rheumatoid arthritis (RA) and/or of arthrosis/osteoarthritis (OA). Clinical features that are particularly typical of PsA are ray-wise joint involvement, dactylitis and osteodestructive and osteoproliferative joint destruction. Dactylitis, asymmetric joint involvement and enthesitis also occur in other SpA. It is becoming increasingly important to define outcome parameters for use in PsA against the backdrop of new forms of treatment. In the case of clinical outcome basic distinctions must be made between clinical signs and symptoms, function and structure. In PsA the sometimes significant manifestations affecting skin and nails must also be considered. The outcome parameters used thus far have varied very widely. The extent and intensity of involvement of the peripheral joints and insertions of tendons and of spinal involvement are particularly important in PsA. In addition, functional impairments, quality of life and parameters concerned with work must be considered. There are hardly any measuring instruments specific to PsA; many have been developed and used primarily for SpA or RA.
18450638 Conversion of bilateral hip and knee ankylosis to total joint replacements. 2008 May We present a 25-year-old patient with juvenile rheumatoid arthritis and ankylosis of both hips and both knees treated by staged bilateral hip and knee arthroplasty. She was followed up for 18 months. We discuss the pre-operative planning, surgical details and post-operative rehabilitation.
16237529 The protective effects of incadronate on inflammation and joint destruction in established 2006 Jun The effects of a new generation bisphosphonate, incadronate, in established adjuvant arthritis rats were evaluated according to the arthritis index, hind paw volume, and radiological and histopathological examinations. Incadronate suppressed the radiological and histopathological changes of hind paws, as well as the joint swelling in a dose-dependent manner. In contrast, the arthritis control rats showed drastic joint inflammation, marked destruction of bone and articular cartilage. The remains of articular cartilage lost Safranin O staining, and were attached with numerous TRAP-positive multinuclear cells. Some of resorption lacunas could be seen at the cartilage matrix nearby the TRAP-positive multinuclear cells. As regards the chondroprotective effects of bisphosphonates, we speculate that it is probably concerned with the inhibition of the chondroclasts. These data indicate that bisphosphonates may be a class of effective agent that can be considered for treatment of various arthritic conditions, including human rheumatoid arthritis.
16413614 Dissection of the genetic complexity of arthritis using animal models. 2006 Mar 15 Rheumatoid arthritis (RA) is a chronic inflammatory disease directed towards peripheral joints. As all common diseases it is associated with several genes and a multitude of environmental factors. In addition, in similarity with most other complex diseases, it is defined only on the basis of clinical signs and symptoms, it is therefore more properly classified as a syndrome rather than a distinct disease entity. This complexity of RA has led to difficulties in finding the underlying genes. In spite of large efforts it is still only the MHC class II region that reaches genome wide significance in confirmed studies. However, this has been known for decades and we are still unable to conclusively identify the underlying gene/s. We hypothesize that an MHC class II gene is involved and although we have detailed knowledge on both structure and function we do not know its possible pathogenic role in RA. In this review I will argue for the usefulness of animal models as a tool to identify genes and pathways associated with disease. The examples to be discussed are genes controlling the oxidative burst pathways and MHC class II genes.
18388943 Protocol for the induction of arthritis in C57BL/6 mice. 2008 Collagen-induced arthritis is a well-validated, but strain-dependent mouse model of rheumatoid arthritis, with H-2(q) and H-2(r) strains showing the greatest degree of susceptibility. This protocol describes the induction of arthritis in the C57BL/6 strain (H-2(b)), which forms the genetic background of the majority of genetically modified strains. This protocol involves purification of type II collagen from chicken sternums, immunization of mice, clinical assessment of arthritis and analysis of T- and B-cell responses to type II collagen. Key aspects of the protocol are the need to use chicken collagen for immunization and the importance of avoiding aggressive behavior in males. The incidence of arthritis varies from 50 to 80% and is milder than the classical collagen-induced arthritis model. This procedure takes approximately 3 months to complete.
17996759 Arthritis and sexuality. 2007 Dec More than 120 kinds of arthritis exist. This article focuses on the more common types of musculoskeletal disorders, which are osteoarthritis, rheumatoid arthritis, and osteoporosis. Because of the pain, fatigue, and joint stiffness associated with arthritis, physical intimacy may be difficult. These symptoms can be ameliorated during sexual activity by good communication between the partners, timing medication, and experimenting with different positions. Clients may need to be taught to be creative and to be willing to experiment. Learning the relaxation response, in addition to fantasizing and guided imagery, can enhance the sexual experience for people who have arthritis.
17056293 Rheumatologic manifestations of chronic hepatitis C infection. 2006 Dec The many rheumatologic manifestations associated with chronic hepatitis C virus (HCV) infection include arthralgia, myalgia, arthritis, vasculitis, and sicca syndrome. Arthralgia is the most common extrahepatic manifestation and may indicate mixed cryoglobulinemia or an adverse reaction to interferon therapy. HCV arthritis unrelated to cryoglobulinemia is far less common but constitutes an independent entity. The picture may mimic rheumatoid arthritis (RA), particularly as rheumatoid factor is present in 50-80% of cases. Tests are usually negative for antibodies to cyclic citrullinated peptides (anti-CCP), which may help to differentiate the two conditions. The management of HCV arthritis is empirical and poorly standardized. Although low-dose glucocorticoid therapy, hydroxychloroquine, and methotrexate have been used successfully in several patients, little is known about their hepatic safety profile. Arthritis associated with cryoglobulinemia usually responds to antiviral treatment. Sicca syndrome is common in patients with chronic HCV infection and shares similarities with primary Sjögren syndrome, suggesting that HCV infection may deserve to be included among the causes of secondary Sjögren syndrome. HCV-associated vasculitis is usually related to cryoglobulinemia, although a few cases of polyarteritis nodosa-like disease affecting the medium-sized vessels have been reported. Other conditions reported in patients with chronic HCV infection include fibromyalgia, systemic lupus erythematosus (SLE), antiphospholipid syndrome, and osteosclerosis.
16681863 Lack of association between mannose-binding lectin gene polymorphisms and juvenile idiopat 2006 Many studies have reported that polymorphisms of the mannose-binding lectin (MBL) gene are associated with autoimmune disease. Here, we investigate the relationship between MBL gene polymorphisms and susceptibility to juvenile idiopathic arthritis (JIA) in a Han-nationality population from the Hubei province of China. PCR-restriction fragment length polymorphism was used to investigate polymorphisms of codons 54 and 57 in exon 1 of the MBL gene in 93 patients with JIA and 48 control children. Neither group showed codon 57 polymorphisms. There was no significant difference in the genotypic frequencies of codon 54 between patients with JIA and healthy controls (wild type, 71.0% versus 75.0%, respectively; heterozygous type, 25.8% versus 25.0%, respectively; and homozygous type, 3.2% versus 0.0%, respectively). In addition, no association was found between the subgroups of patients with JIA and control individuals. Our results provide no evidence for a relationship between MBL gene mutation and susceptibility to JIA.
17305538 Psoriatic arthritis-new insights give new options for treatment. 2007 Psoriatic arthritis (PsA), an inflammatory joint disease associated with psoriasis of the skin, has a heterogeneous pattern expressed by different manifestations, such as mild mono-oligoarthritis, a very severe, erosive and destructive polyarthritis indistinguishable from rheumatoid arthritis, and spondylarthropathy with axial involvement or enthesitis. The disease pattern often differs between patients as well as within the same patient over time. Measurable inflammatory activity is not always evident. Early detection of inflamed joints or axial involvement in patients with PsA is important in order to reduce the inflammation and prevent destruction, deformity and functional disability in the joints involved. Several factors, e.g., genetic, immunological, environmental and vascular, have been proposed to be of importance for the aetiology, the expression and prognosis of PsA. The basic treatment for PsA has been administration of non-steroid anti-inflammatory drugs (NSAIDs). Few disease modifying anti-rheumatic drugs (DMARDs) have been available due to a lack of efficacy of most of the DMARDs used for other rheumatic diseases. New insights into genetic, immunological and vascular factors in PsA are of interest as possible targets for future therapy and will be discussed in this review.
17387612 Musculoskeletal complaints and serum autoantibodies associated with chronic hepatitis C an 2007 May We sought to compare the musculoskeletal symptoms and immune markers found in chronic hepatitis C (HCV) and nonalcoholic fatty liver disease (NAFLD). Patients with HCV or NAFLD answered a questionnaire and donated serum for autoantibody testing. Univariate analysis between the HCV and NAFLD groups revealed joint pain in 67% of the HCV group and 65% of the NAFLD group. Those with joint pain reported inflammatory characteristics that were similar between the groups. The presence of a positive rheumatoid factor and cryoglobulins was higher in the HCV group, however both groups had a similar prevalence of a low positive antinuclear antibody (ANA). We conclude that the NAFLD group reported a higher amount of joint pain and inflammatory joint symptoms than anticipated. We were unable to determine a variable that predicted the presence of joint pain. Therefore, more investigation is needed to determine whether these findings are due to liver disease alone.
19058694 Uncemented total hip arthroplasty in patients less than twenty-years. 2008 Oct A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, total hip arthroplasty may occasionally be necessary for treatment of end-stage disabling arthritis of the hip in the young. There is paucity of information documenting the outcome of uncemented total hip arthroplasty in adolescents. We report our experience with total hip arthroplasty in patients under the age of twenty years. The results of 35 consecutive total hip arthroplasties performed at our institution in 25 patients between 1993 and 2003 were reviewed. There were 17 females and 8 males with a mean age of 17.6 years (range: 13.5 to 20). All patients received a Hydroxyapatite (HA) plasma sprayed Titanium acetabular component and a tapered femoral stem proximally coated with HA. Follow-up averaged 6.6 years (range: 4.2 to 10). The underlying diagnosis was avascular necrosis (16 hips), juvenile rheumatoid arthritis (9 hips), sequelae of DDH (2 hips), spondyloepiphyseal dysplasia (2 hips), sequelae of Perthes (2 hips), osteoarthritis (2 hips), post-traumatic arthritis (1 hip), and pseudo rheumatoid chondrodysplasia (1 hip). There was a significant improvement in function and relief of pain as measured by the Harris Hip score and SF-36. All uncemented components were found to be stable and osseo-integrated at the latest followup. There were no complications, or reoperations. There was one revision secondary to severe polyethylene wear. This patient was revised 10 years after the index surgery. Uncemented total hip arthroplasty was found to confer a significant improvement in function and to have an acceptable short-term outcome in very young patients with end-stage arthritis of the hip. Longer-term follow-up is needed to assess the durability of this procedure in adolescents.
17951670 Angiogenesis in arthritis: methodological and analytical details. 2007 Angiogenesis is the formation of new blood vessels from existing vessels. The formation of new vessels appears to be an early and fundamental process for the evolution of the inflammatory response in synovial joints affected by arthritis. The propagation of new vessels in the synovial membrane allows the invasion of this tissue over the intraarticular cartilage in an adherent fashion. This process appears to support the active infiltration of synovial membrane into cartilage and results in erosion and destruction of the cartilage. This process results in joint damage and ultimately in deformity, as the normal joint architecture and balance of tendons becomes disrupted. Angiogenesis may be assessed in vivo by direct visualization through the introduction of a needle arthroscope using local anesthesia, differential patterns of vascular morphology have been described in seropositive rheumatoid arthritis and seronegative arthritides such as psoriatic and reactive arthritis. At a microscopic level, angiogenesis may be examined in the tissue sections using immunohistochemistry or immunofluorescence. Endothelial cells may also be studied in vitro in culture to examine production of angiogenic growth factors, cell activation, migration, and tubule formation. Finally, synovial biopsy explants may be cultured ex vivo to provide a model simulating the intra-articular milieu.
19037135 Delayed diagnosis of pyoderma gangrenosum: a case study. 2008 Nov Pyoderma gangrenosum (PD) is a rare, chronic, relapsing, ulcerative, neutrophilic cutaneous disease and may be difficult to recognize. It is not uncommon for PD to be mistakenly diagnosed as vascular occlusive or venous disease, vasculitis, cancer, infection, exogenous tissue injury, or other inflammatory disorders. A 55-year-old woman with a 5-year history of a very painful and enlarging ulcer presented at the authors' clinic. Previously, based on an original diagnosis of venous ulcer, the wound had been surgically debrided and managed with saline-soaked gauze and compression therapy. After the authors secured a complete history (which included rheumatoid arthritis) and assessment, PD was suspected. A biopsy was performed for histological confirmation. Pyoderma gangrenosum treatment, including oral corticosteroids and topical 0.01% tacrolimus twice daily covered with nonadhesive gauze and compression wrapping, was started. After 4 weeks, the wound had improved noticeably and pain medications to manage wound pain were discontinued. The wound was completely healed after 4 months. The presence or absence of PD must be ascertained in all patients who present with a history of painful lower leg ulcers and PD risk factors, such as rheumatoid arthritis.
18782270 Identification of new loci controlling collagen-induced arthritis in mouse using a partial 2008 Oct Collagen-induced arthritis (CIA) is a well studied mouse model of the human disease rheumatoid arthritis (RA). Both CIA and RA are complex diseases affected by multiple genes as well as environmental factors. Identifying the genes that determine susceptibility to arthritis would give invaluable clues to the largely unknown aetiology of RA. In this study, we dissected a known locus, Cia6, as well as a genomic region on chromosome 14 with no previously known arthritis loci, using a partial advanced intercross and a collection of congenic strains. The chromosome 14 congenic fragment, containing the T-cell receptor alpha (Tcra) locus, was included based on the hypothesis that the Cia6 locus is caused by a polymorphism in the Tcr beta (Tcrb) locus and that the two loci interact. Splitting up the congenic fragments revealed multiple loci affecting arthritis traits as well as production of collagen-specific autoantibodies. In total seven new loci were identified of which four were in the previously unlinked chromosome 14 region. Both Tcr loci were within CIA loci making them candidate susceptibility genes. The results demonstrate the importance of breaking up genetic regions in smaller fragments to identify the underlying complex set of loci.