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ID PMID Title PublicationDate abstract
20190504 [Sjögren's syndrome (SS) in childhood: is it essentially different from adult SS?]. 2010 Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by a progressive lymphocytic infiltration of the exocrine glands with varying degrees of systemic involvement. Chronic inflammation compromised the glands' function and leads to dry symptoms in the mouth/eyes. SS has been thought to be rare in children. Recent epidemiological study revealed, however, that the incident of childhood SS (cSS) per 100,000 children was more than 0.5. This indicate cSS is common disease after SLE in children with rheumatic diseases. Sicca symptoms are rare in cSS even though oral and ocular involvement are present. This may be from the slowly progression feature of the disease course. Two follow-up studies indicate that there were almost no changes in clinical symptoms and autoantibody profiles during the 10 years of follow-up. However, auto-antibody profiles of cSS including alpha-fodrin-antibody, specifically found in adult SS, are the same as that of adult SS. These data indicate that no essential difference exist in SS between adult and childhood patients, and also indicate the specific features seen in cCSS just reflect early stage of SS. In order to establish the diagnostic criteria for cSS in the feature, early pathophysiologic features should be included in the criteria.
19229790 Sjögren's syndrome of the parotid gland: value of diffusion-weighted echo-planar MRI for 2009 Mar PURPOSE: To investigate the value of diffusion-weighted echo-planar imaging (DW-EPI) for quantifying functional changes of the parotid gland in Sjögren's disease and to evaluate whether ADC mapping allows for early diagnosis based on MR sialography grading. MATERIALS AND METHODS: Using a DW-EPI sequence at 1.5 T (b-factors: 0, 500 and 1000 sec/mm (2)), the parotid glands of 52 healthy volunteers and 13 patients with histologically verified affection of Sjögren's disease were examined. All scans were performed prior to and following gustatory stimulation with 5 ml of lemon juice. ADC maps were evaluated by placing an inordinate region-of-interest (ROI) enclosing the entire parotid gland. Sjögren's disease was graded based on MR sialography findings using a 4-point grading-scale. Statistics included student t-test and kappa-analysis. RESULTS: In healthy volunteers mean ADCs of 1.14 x 10 (-3 )mm (2) /sec before and 1.2 x 10 (-3) mm (2) /sec after stimulation were observed. Higher ADCs were determined for early-stage Sjögren's disease, averaging 1.22 x 10 (-3) mm (2) /sec before and 1.29 x 10 (-3) mm (2) /sec after stimulation. Advanced disease revealed significantly lower ADCs (0.97 x 10 (-3) mm (2) /sec (p = 0.002) before and 1.01 x 10 (-3) mm (2) /sec (p < 0.001) after stimulation). CONCLUSION: DW-EPI seems to display functional changes of the parotid gland affected by Sjögren's disease. Combined with MR sialography, it might be a useful tool for discriminating healthy from affected glands and seems to allow differentiation between the early and advanced disease.
20837500 Potential role of Th17 cells in the pathogenesis of adult-onset Still's disease. 2010 Dec OBJECTIVE: To investigate the potential role of Th type 17 (Th17) cells and Th17-related cytokines in the pathogenesis of adult-onset Still's disease (AOSD). METHODS: The frequencies of circulating Th17 cells in 24 patients with active untreated AOSD, 16 patients with active SLE and 12 healthy volunteers were determined using intracellular cytokine staining and flow cytometry. Serum levels of Th17-related cytokines, including IL-1β, IL-6, IL-17, IL-18, IL-21 and IL-23 were measured by ELISA. RESULTS: Significantly higher median frequencies of circulating Th17 cells were found in active untreated AOSD patients (1.01%) and active SLE patients (1.26%) than in healthy volunteers (0.12%, both P<0.001). The frequencies of circulating Th17 cells were positively correlated with activity score (r=0.527, P<0.01) and serum ferritin levels (r=0.724, P<0.001) in AOSD patients, and correlated with SLEDAI (r=0.663, P<0.01) in SLE patients. Additionally, the frequencies of circulating Th17 cells were positively and significantly correlated with serum levels of IL-1β, IL-6, IL-17, IL-18, IL-21 and IL-23 in both AOSD and SLE patients. The frequencies of circulating Th17 cells and serum IL-17 levels significantly decreased after effective therapy in AOSD patients (both P<0.001). CONCLUSION: Elevated frequencies of circulating Th17 cells and a positive correlation with disease activity in our AOSD patients suggest that Th17 cells contribute to the pathogenesis of this disease. Dysregulation of Th17 cells may be a common pathogenic mechanism that underlies the development of both AOSD and SLE.
19729367 Periodontal disease and sjogren syndrome: a possible correlation? 2010 Apr Sjögren syndrome (SS) is a chronic autoimmune rheumatic disease characterized by a progressive lymphocytic infiltration of exocrine glands, especially salivary and lachrymal ones, leading to xerostomia, parotid gland enlargement, and xerophthalmia. The aim of this study is to describe the capillaroscopic pattern of the interdental papilla in patients with SS and to evaluate a possible correlation with periodontal disease. METHODS: A total of 25 patients affected by SS and 25 healthy controls were examined. The patients with conditions that compromise microcirculation, such as diabetes, hypertension, hyperlipidemia, or some pharmacological treatments, were not included in the study. All the patients were nonsmokers. Periodontal capillaroscopy has been used to investigate the features of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhage, the average caliber of the capillary loops, and the number of visible capillary loops per square millimeter were evaluated for each patient. RESULTS: The results show evident alterations to the capillaries and a typical conformation of the interdental papilla microcirculation in patients with SS; it was possible to observe a reduced caliber of capillaries, as well as a greater number and tortuosity of capillary loops. CONCLUSION: This study shows that capillary alterations to patients with SS occur in gingival microcirculation.
22043335 The spectrum of rheumatoid arthritis in patients attending rheumatology clinic in nizwa ho 2010 Jul OBJECTIVES: To determine the spectrum and expression of rheumatoid arthritis (RA) in patients attending the rheumatology clinic in Nizwa hospital, Oman. SUBJECTS AND METHODS: 66 patients fulfilling the American College of Rheumatology (ACR) criteria for the diagnosis of RA were included in the study. The patients were either attending for the first time or were already diagnosed and attending for follow up. The demographic, clinical, laboratory and radiological findings are reported. RESULTS: Of the 66 patients studied, 16 were males and 50 were females. The mean age of patients at onset was 44.5 ±14.5 years, and the females were younger than males at presentation. 38 (57.57%) were seropositive and two (3.03%) only had rheumatoid nodules. The majority of the patients were considered as class 1 or 2 according to the ACR functional classification. The commonest extra-articular manifestation was anaemia (27.27%) followed by keratoconjuctivitis sicca (24.42%). The upper limb joints were affected more than the lower limbs and the most commonly involved joint was the wrist (81%) followed by the metacarpophalangeal (MCP) (66.66%) joints, the knee (57.57%), ankle (45.45%), elbow (42.42%), shoulder (42.42%), and the proximal interphalangeal (PIP) (36.36%) joints. The main associated diseases were hypertension (21%), ischemic heart disease (13.63%) and diabetes mellitus (9.03%). Systemic features were predominantly morning stiffness (84.5%) and fatigue (45.45%). Reported deaths were due to sepsis and cardiac arrhythmia. Thus 63 (95.45%) of the patients were on conventional disease modifying antirheumatic drugs. CONCLUSIONS: Demographic characteristics were similar to those reported by others, the seropositivity rate and nodular form of the disease was less in the studied patients and the disease seemed milder than that reported in western countries.
19482442 Will Jill come tumbling after? The case for a JAK2-type mutation as a prequel to the conne 2009 Nov The JAK2 [V617F] mutation has recently been recognised as critical to the pathogenesis of the myeloproliferative disorders (MPDs). Thus, a common mutation affecting a haematopoietic precursor stem cell is capable of giving rise to diverse clinical phenotypes. In this hypothesis paper, we propose that a similar mutation affecting a stem cell precursor, most likely of the B cell lineage, could underlie the development of the connective tissue disorders which could be regarded as "lymphoproliferative" disorders. Consistent with this hypothesis is the observation that there are similarities between the myeloproliferative disorders and the connective tissue disorders in terms of their biological behaviour. Diseases within each family can transform into each other and sometimes into haematological malignancies (most often B cell origin non-Hodgkins lymphoma for the connective tissue disorders and acute myeloid leukemia for the myeloproliferative disorders). The timecourse for development of the connective tissue disorders involves a long latent period when autoantibodies are present (anti-CCP and ANA) possibly reflecting production by a B cell clone. A similar time-dependent increase in clonal dominance has been described in erythroblastic clones taken from the bone marrow of polycythemia vera patients, long before the onset of clinical disease. Evidence of B cell clonality has been described in bone marrow samples from rheumatoid arthritis patients and from glandular biopsies from those with Sjogren's syndrome. Moreover, pseudofollicles containing activated B cells are features of rheumatoid synovial membrane and have also recently been described in subchondral bone where they are associated with macrophages, T cells and osteoclasts. The success of B cell depletion therapy in rheumatoid arthritis and systemic lupus erythematosus is also strong circumstantial evidence for this hypothesis.
21794570 [The therapeutic blockade of TNF reduces serum levels of interleukin 15 in patients with r 2009 Feb OBJECTIVE: To analyze the effect of the TNF blocking agents (aTNF) on the serum levels of interleukin 15 (IL-15). To determine whether baseline IL15 serum levels or their response to aTNF therapy can predict the clinical response to this treatment. PATIENTS AND METHOD: We studied 75 patients suffering from rheumatoid arthritis that were selected to start aTNF therapy. Serum samples were obtained at baseline visit and after three months of aTNF treatment. Measurement of IL-15 serum concentration was performed through immune-enzyme assay. We collected the clinical and analytical parameters needed to calculate DAS28 both at baseline and final visit, as well as sociodemographic variables and other such as rheumatoid factor, previous disease modifying anti-rheumatic drugs (DMARD), etc. We defined remission as a DAS28 < 2.6 and clinical response when the decrease in DAS28 value was higher than 1.2. RESULTS: There was a significant correlation between IL-15 serum level and the number of previous DMARD. We also detected a significant decrease in the concentration of serum IL-15 after three months of treatment with aTNF. However, neither the baseline IL-15 serum level nor the decrease in the concentration of IL-15 were associated with a specific pattern of response to aTNF. CONCLUSIONS: Our data seem to support previous in vitro findings suggesting that TNF is involved in the regulation of IL-15 expression. Nevertheless, the measurement of IL-15 serum levels does not seem to be a useful tool to select those patients that should be treated with aTNF therapy.
19342640 A positive feedback loop of IL-21 signaling provoked by homeostatic CD4+CD25- T cell expan 2009 Apr 15 Rheumatoid arthritis is a joint-specific autoimmune inflammatory disease of unknown etiology. The K/BxN mouse is a model of rheumatoid arthritis that is thought to be mainly due to autoantibody-mediated inflammatory responses. We showed previously that homeostatic proliferation of autoreactive CD4(+) T cells is required for disease initiation in the K/BxN mice. In this study, we show that the homeostatically proliferating CD4(+)CD25(-) T cells produce IL-21. We generated IL-21R-deficient (IL-21R(-/-)) K/BxN mice and found that these mice were completely refractory to the development of spontaneous arthritis. They contained fewer CD4(+) T cells with a reduced proportion of homeostatically proliferating cells, fewer follicular Th cells, and, surprisingly, more Th17 cells than their control counterparts. They also failed to develop IgG1(+) memory B cells and autoantigen-specific IgG1 Ab-secreting cells. IL-21 induced expression of receptor activator of NF-kappaB ligand (RANKL) a regulator of osteoclastogenesis, and few RANKL-expressing infiltrates were found in the synovia of IL-21R(-/-) K/BxN mice. Thus, our results demonstrate that IL-21 forms a positive feedback autocrine loop involving homeostatically activated CD4(+) cells and that it plays an essential role in the development of autoimmune arthritis by mechanisms dependent on follicular Th cell development, autoreactive B cell maturation, and RANKL induction but independent of Th17 cell function. Consistent with this, in vivo administration of soluble the IL-21R-Fc fusion protein delayed the onset and progression of arthritis. Our findings suggest that effective targeting of IL-21-mediated processes may be useful in treating autoimmune arthritis.
19505394 The safety of anti-TNF agents in the elderly. 2009 Apr Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are commonly thought of as inflammatory diseases that affect younger individuals. Although the initial presentation of these diseases is common in a patients twenties or thirties, they usually persist for the duration of the patients life. In addition, up to one-third of patients with RA have disease onset after 60 years of age. Anti-TNF-a therapies now have well-recognized safety profiles that have been demonstrated in the usual clinical trial populations for these diseases, but such populations under-represent patients > or =65 years of age. This retrospective study aims to determine the safety profiles for etanercept, infliximab and adalimumab in patients of 65 years or more, undergoing anti-TNF treatment for an active inflammatory disease such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis, or skin disease like psoriasis. Our data show that admitting elderly patients into anti-TNF therapeutic regimens is a safe option and that it grants these patients access to the best current therapeutic option, possibly leading to better disease outcome. Quality of life in elderly patients affected by arthritis or psoriasis, often reduced by comorbidities, is as important as quality of life in younger patients. Applying the recommended screening before using biological treatment helps to reduce adverse events related to the therapy, and the application of the same screening in elderly patients seems to lead to comparable results.
19888509 [Rheumatic diseases at the court of the Medici of Florence: the so-called "gout" of the Me 2009 Jul According to the archive documents several members of the Medici family of Florence suffered from gout. The word "gout", with which the Renaissance physicians indicated pain episodes localised to hands, feet, spine and shoulders, was in general improperly used, and hint other nosological entities. A paleopathological investigation carried out on the skeletal remains of the Grand Dukes of Florence and their relatives, revealed the true nature of the diseases they suffered from, allowing to diagnose two cases of diffuse idiopathic skeletal hyperostosis (DISH), a case of rheumatoid arthritis in an advanced stage, and a case of gout.
19490599 What epidemiology has told us about risk factors and aetiopathogenesis in rheumatic diseas 2009 This article will review how epidemiological studies have advanced our knowledge of both genetic and environmental risk factors for rheumatic diseases over the past decade. The major rheumatic diseases, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, osteoarthritis, gout, and fibromyalgia, and chronic widespread pain, will be covered. Advances discussed will include how a number of large prospective studies have improved our knowledge of risk factors, including diet, obesity, hormones, and smoking. The change from small-scale association studies to genome-wide association studies using gene chips to reveal new genetic risk factors will also be reviewed.
21053462 [Ultrasonographic differentiation of painful hip in developmental age]. 2010 Mar INTRODUCTION: The most common diseases in the group of painful hip are transient synovitis, rheumatoid arthritis, infective (septic) arthritis, Perthes disease and slipping of the upper femoral epiphysis. METHODOLOGY: The algorhythm covers the first and control examinations in certain time intervals (after: 3-7, 7-15, 21-30 days; as well as 2-4 months). RESULTS AND DISCUSSION: The most frequent feature of painful hip is transient synovitis with 65%, Perthes disease with 13%, septic arthritis with 6%, rheumatoid arthritis and slipping of the upper femoral epiphysis with 2.5%. The ratio boys and girls was 2.3:1. The average age in the group of the painful hip was 6.8 years, in the group of TS 6.5 years. The most frequent clinical signs were limping in 84.2% and hip pain in 79.6%. Through the follow up period the difference of the anterior capsular distance was established for symptomatic hip: the average value on the first exam was 8.1 mm, and on the final exam 4.7 mm 3.6 mm. In transient synovitis, there was no difference in measured values of the anterior and lateral femoral head distance for both hips. The medial duration of synovial effusion, measured ultrasonographically, was 10.6 days, and the duration of the clinical signs was 8.7 days. The prolongated synovitis was recorded in 17.6%, and Perthes disease in 8.4%. The average value of anterior capsular distance in these patients was 5.4 mm. In group of Perthes disease the values of anterior capsular distance during control examinations showed increase that implicated the lateralisation or extrusion of the femoral head. The values of anterior distance of the femoral head were without significant difference. CONCLUSION: The ultrasonography should be the method of choice in painful hip differentiation regardless of the age. The ultrasonography can replace radiography safely in the primary diagnostic procedure as well as through the control examination.
20665039 [Genetic background of juvenile idiopathic arthritis]. 2010 Aug Several genetic factors have recently been observed as having an influence on susceptibility, course and prognosis of juvenile idiopathic arthritis (JIA): 1. Affected sib pairs were observed to have a low concordance in terms of disease incidence, but significant concordance in terms of subtype and course of disease. 2. Each subtype of JIA was observed to have a distinct genetic background. 3. Some JIA patients do not carry any of the defined risk genes. 4. Most subtypes of JIA have a distinct different genetic background to rheumatoid arthritis in adults. 5. Multiple factors have been observed to be involved in pathogenesis implying genetic and environmental factors. 6. Systemic JIA differs from all other subtypes in terms of genetic background and treatment options. It is currently assumed to be an autoinflammatory disease. 7. Genetic factors not only affect the course of the disease, but also response and complication rate. Increasing knowledge on the factors involved in the pathogenesis of JIA as well as analysis of large patient cohorts in consortiums cooperating on an international level have helped define many important polymorphisms; these are currently the subject of further investigation.
20734164 Approach to polyarthritis. 2010 Sep A child with polyarthritis is always a diagnostic challenge for the treating physician. By definition, polyarthritis, taken in context as a subgroup of juvenile idiopathic arthritis, is defined as inflammation of more than 4 joints on physical examination. Though the exact incidence and prevalence of polyarthritis in childhood is not known, it is not uncommon in pediatric practice. Polyarthritis can be a clinical manifestation of diverse disease processes and the differential diagnosis is understandably very broad. It can be caused directly by an infectious agent or indirectly by immune mechanisms, may be a component of a systemic disease process or may be idiopathic. The presentation can be acute or chronic. It can represent a benign self limiting illness requiring no specific treatment or may be a severely disabling condition with significant morbidity and, in some cases, even mortality. While in some situations it may be possible to arrive at a provisional clinical diagnosis right at the outset, in others the diagnosis gradually evolves over a period of time. As in most other arthritides, the most important aspects of the diagnosis are a thorough history and a detailed clinical examination. Relevant laboratory investigations can help in facilitating the diagnosis but can often also mislead the treating physician. Hereby we present a clinical approach to a child with polyarthritis.
20663815 General characteristics of an early arthritis cohort in Argentina. 2011 Jan OBJECTIVE: The aim of the present study is to describe the general characteristics of a cohort of patients with early arthritis in Argentina. METHODS: CONAART (Consorcio Argentino de Artritis Temprana--Argentine Consortium for Early Arthritis) is an initiative of seven rheumatology centres across Argentina. Patients were included if they had at least one or more swollen joints and <2 years of disease duration. Social, demographic, familiar, hereditary, clinical and laboratory data were recollected. At first visit and every year, X-rays of hands and feet were performed and working characteristics and pharmaco-economic data were re-collected. RESULTS: A total of 413 patients were included. Of them, 327 (79.2%) were women with a median age of 49 years and a median disease duration of 6 months. Of the total, 183 (44.3%) had RA (ACR 1987) and 167 (40.4%) undifferentiated arthritis (UA). Other diagnoses included: 12 crystalics, 11 PsA, 6 uSpA, 6 other CTD, 1 AS and 27 other diagnosis. As 85% of our population had RA and UA, we only compared these two groups of patients. Patients with RA had significantly worse activity parameters of the disease (DAS of 28 joints), functional capacity (HAQ) and quality of life (Rheumatoid Arthritis Quality of Life) than patients with UA. The frequency of RF and anti-CCP, and symmetrical distribution were also significantly higher in patients with RA compared with UA patients. All patients with RA initiated early specific treatment, in a period no longer than 6 months from the beginning of the disease. CONCLUSION: Early arthritis clinics are a useful tool to identify and treat patients with different forms of joint involvement.
20492818 Diffuse large B-cell lymphoma with lung involvement in a psoriatic arthritis patient treat 2010 May 15 Non-Hodgkin lymphoma (NHL) occurs in the setting of methotrexate (MTX) therapy for rheumatoid arthritis. However, it has been very rarely reported in subjects with psoriatic arthritis treated with MTX. We report here a case of a 70-year-old woman with psoriatic arthritis who presented with bilateral lung infiltrates, pleural effusion, splenomegaly, and inguinal lymphadenopathy during treatment with MTX. The diagnosis of diffuse large B-cell lymphoma was made by analysis of the pleural fluid via thoracentesis and biopsy of an enlarged inguinal lymph node. Clinicians should consider the possibility of a NHL complicating psoriasis and with MTX therapy in order to prevent treatment delays.
19494327 Alpha9 integrin and its ligands constitute critical joint microenvironments for developmen 2009 Jun 15 Osteopontin is critically involved in rheumatoid arthritis; however, the molecular cross-talk between osteopontin and joint cell components that leads to the inflammatory joint destruction is largely unknown. We found that not only osteopontin but also tenascin-C and their common receptor, alpha(9) integrin, are expressed at arthritic joints. The local production of osteopontin and tenascin-C is mainly due to synovial fibroblasts and, to a lesser extent, synovial macrophages. Synovial fibroblasts and macrophages express alpha(9) integrin, and autocrine and paracrine interactions of alpha(9) integrin on synovial fibroblasts and macrophages and its ligands contribute differently to the production of proinflammatory cytokines and chemokines. alpha(9) integrin is also involved in the recruitment and accumulation of inflammatory cells. Inhibition of alpha(9) integrin function with an anti-alpha(9) integrin Ab significantly reduces the production of arthrogenic cytokines and chemokines and ameliorates ongoing arthritis. Thus, we identified alpha(9) integrin as a critical intrinsic regulator that controls the development of autoimmune arthritis.
19853825 An overview of genetics of paediatric rheumatic diseases. 2009 Oct The evidence so far suggests that the paediatric inflammatory diseases encountered in rheumatology practice may be largely genetic in origin, where common single nucleotide polymorphisms (SNPs) in multiple genes contribute to risk, with real but variable environmental components. As far as genetic susceptibility to common paediatric rheumatic diseases is concerned, only juvenile idiopathic arthritis (JIA) has been investigated in any substantial way so far. This article discusses susceptibility for different types of JIA, the different methods used and their advantages and disadvantages. The genetic code is also modifiable by epigenetic mechanisms and examples of these in immunity and rheumatoid arthritis are given to indicate another area of research in the elucidation of the genetics of paediatric rheumatic diseases.
21234449 Detection of inflammatory processes during various diseases by the method of flow cytofluo 2010 Oct Oxidative (respiratory) burst is an important manifestation of inflammation. Precise quantitative assessment of this reaction by flow cytometry made it possible to record and evaluate the severity of the inflammatory processes in a wide spectrum of diseases including diphtheria, hepatitis, pneumonia, bronchial asthma, arthritis, vasculitis, postoperative complications, tuberculosis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, and myocardial infarction. This approach can be employed as a highly sensitive method of detection of inflammatory reactions and monitoring of their course in various pathological processes.
20130798 Biologic agents-a panacea for inflammatory arthritis or not? 2009 Aim. To describe the retention rates for biological therapies in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in a clinical setting. Methods. All patients managed in a dedicated biological therapy clinic in a teaching hospital in Australia were assessed for continuation on biological treatments and reasons for switching to an alternative biological agent or cessation of treatment. Results. There was a lower retention rate for RA patients on biological therapies compared to PsA and AS patients and the retention rate for RA patients was lower than that reported in RCTs. Conclusions. The retention rate on biological therapies for RA patients was lower in the clinic setting than what is reported in RCTs. The reasons for the lower retention rate in the clinical setting are discussed but no clear determinants for nonresponse to biological agents were identifiable. These agents have very limited steroid sparing effects.