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ID PMID Title PublicationDate abstract
19487274 Diagnostic value of salivary gland ultrasonographic scoring system in primary Sjogren's sy 2009 Jul OBJECTIVE: To compare an ultrasonographic (US) scoring system of salivary glands with scintigraphy and salivary gland biopsy, in order to evaluate its diagnostic value in primary Sjögren's syndrome (SS). METHODS: In 135 patients with suspected SS, the grades of 5 US measures of both parotid and submandibular salivary glands were scored (0-48 scale). Diagnosis of primary SS was established following the American-European Consensus Group criteria of 2002. The patients' total scintigraphic score (0-12 scale) was determined and the histopathological changes of minor salivary glands graded. Area under the receiver-operating characteristic (ROC) curve was employed to evaluate the diagnostic value of the US scoring system. RESULTS: Primary SS was diagnosed in 107 (79.2%) patients and the remaining 28 subjects (20.8%) constituted the control group. US changes of salivary glands were established in 98/107 patients with SS and in 14/28 controls. Mean US score was 26 in SS patients and 6 in controls. Through ROC curves, US arose as the best performer (0.95 +/- 0.01), followed by scintigraphy (0.86 +/- 0.31). Setting the cutoff score for US at 19 resulted in the best ratio of specificity (90.8%) to sensitivity (87.1%), while setting the cutoff scintigraphic score at 6 resulted in specificity of 86.1% and sensitivity of 67.1%. Among 70 patients with US score >or= 19, a scintigraphic score > 6 was recorded in 54/70 (77.1%) and positive biopsy findings in 62/70 (88.5%) patients. CONCLUSION: We show high diagnostic accuracy of a novel US scoring system of salivary glands (0-48) in patients with primary SS comparable to invasive methods, i.e., scintigraphy and salivary gland biopsy.
19776694 Sarcoidosis: selected clinical cases. 2009 Jul Two interesting cases of sarcoidosis and associated diagnostic challenges have been presented. Clinical similarities and disparities in the course of sarcoidosis and systemic connective tissue diseases, particularly Sjögren's syndrome, have been addressed. It has been highlighted that all organs, not only the lungs but also for example the liver, can be involved in sarcoidosis. Prompt diagnosis and a proper therapeutic approach are of vital importance.
20384543 Emerging biotherapies for Sjögren's syndrome. 2010 Jun IMPORTANCE OF THE FIELD: Sjögren's syndrome (SS) is an autoimmune epithelitis. This exocrinopathy is frequently associated with extraglandular complications, and the patients are at risk of developing B cell lymphoma. Given the lack of disease-modifying drugs, and the fact that SS is a quintessential B-cell mediated disease, attention has recently been focused on biotherapies. AREAS COVERED IN THIS REVIEW: Despite negative grounds, TNF-alpha antagonists have been tested in the disease, and proven not be efficient. However, B-cell depleting therapy using anti-CD20 antibodies such as rituximab, which is a chimeric mAb, has shown promise in the field, while anti-CD22 mAb seems to be less active. WHAT THE READER WILL GAIN: New treatments against the B-cell activating factor of the TNF family are about to be tested, or replaced by receptor immunoglobulin decay protein. TAKE HOME MESSAGE: B-cell depleting therapies seem promising in SS, but no data are, thus far, available on treatments targeting B-cell activating factor of the TNF family.
20231196 Serum calprotectin as a marker for disease activity and severity in adult-onset Still's di 2010 May OBJECTIVE: Calprotectin is a calcium-binding cytosolic protein of the neutrophil, monocyte, and macrophage, and its secretion increases during activation of these cells. Our objective was to measure serum calprotectin concentrations in patients with adult-onset Still's disease (AOSD) and to correlate serum calprotectin with the activity and severity of AOSD. METHODS: We enrolled 25 patients with AOSD and 30 age- and sex-matched healthy controls. Thirty-one serum samples were obtained from patients with AOSD during active or inactive disease and were assayed for calprotectin by ELISA. Clinical and laboratory data related to disease activity and severity were collected at the same time, and systemic scores for disease severity were calculated. RESULTS: Mean calprotectin levels in patients with AOSD were significantly higher than in controls (57.11 +/- 25.38 ng/ml vs 34.90 +/- 4.85 ng/ml, respectively; p < 0.05). Patients with active AOSD had a significantly higher mean calprotectin level than those with inactive disease (61.26 +/- 25.59 ng/ml vs 35.32 +/- 5.90 ng/ml; p < 0.05). Calprotectin levels decreased significantly after treatment in all 6 patients with AOSD from whom followup samples were obtained (p = 0.028). Serum calprotectin showed strong correlations with serum ferritin (r = 0.686, p < 0.001), lactate dehydrogenase (r = 0.647, p < 0.001), leukocyte count (r = 0.774, p < 0.001), aspartate aminotransferase (r = 0.387, p = 0.042), and C-reactive protein (r = 0.588, p = 0.001), but not with erythrocyte sedimentation rate, arginine aminotransferase, hemoglobin, or platelet count. Serum calprotectin showed a significant correlation with AOSD systemic scores, reflecting disease severity (r = 0.803, p < 0.001). CONCLUSION: Serum calprotectin increased in patients with AOSD, in close correlation with disease activity and severity. These findings suggest that serum calprotectin can provide a reliable clinical marker for monitoring the disease activity and severity of AOSD.
19776706 Potential benefit of paracetamol administration in adult-onset Still's disease. 2009 Sep Still's disease is a rare, systemic inflammatory disease of unknown etiology, characterized by daily high fever, transient rash, arthritis, and organ involvement including lymphadenopathy, hepatosplenomegaly, pleuritis or pericarditis. The diagnosis of the disease is based on clinical signs and symptoms, and requires exclusion of infectious, neoplastic, and other autoimmune diseases. Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, sometimes in combination with immunosuppressive agents. We report the case of a 21-year-old man with a recent diagnosis of Still's disease. The fever, resistant to NSAIDs, resolved after treatment with paracetamol and the patient's general condition also improved. The present case has been the first to demonstrate that paracetamol may be an effective agent in adult-onset Still's disease.
20734215 A case of refractory adult-onset Still's disease successfully controlled with tocilizumab 2010 Dec Adult-onset Still's disease (AOSD) is an uncommon systemic inflammatory disease of unknown aetiology. Up to 80% of AOSD cases can be controlled with corticosteroids; however, reports on those unresponsive to corticosteroids, conventional disease modifying drugs and biological agents, including anti-IL1 inhibitors, are emerging. We present a case of AOSD with severe poylarthritis unresponsive to corticosteroids, methotrexate, anakinra and etanercept, but successfully stabilised with a humanized monoclonal anti-IL-6 receptor antibody, tocilizumab, administered once monthly. Thereafter, we compare our case with case reports available in the literature and suggest that for anakinra refractive AOSD patients with arthritis, tocilizumab could be the drug of choice.
20461384 A case of primary Sjögren's syndrome complicated with inflammatory myopathy and interstit 2012 Nov We experienced a case of a 63-year-old woman with primary Sjögren's syndrome (pSS) complicated with inflammatory myopathy and interstitial lung disease (ILD). She had suffered from morning stiffness and dry mouth for 1 year without being medically examined. A chest CT scan demonstrated ground glass opacity and a reticular shadow in the lower lung field. A diagnosis of SS was made based on positive findings from Schirmer's test, sialography of the parotid gland, a labial salivary gland biopsy and the presence of anti-SS-A antibody. Musculoskeletal symptoms were absent; however, the elevation of creatine kinase (CK) as well as magnetic resonance imaging (MRI)-proven inflammatory change of bilateral muscles of the thigh was evident. Histological examination of the thigh revealed diameter variation, degeneration of muscle fibers and inflammatory cell infiltration in the perivascular area, corresponding to the inflammatory myopathy of pSS. Oral prednisolone 30 mg/day was introduced, and serum CK rapidly decreased within 2 weeks. ILD also responded well to prednisolone without relapse. These clinical outcomes are consistent with extraglandular organ involvement of pSS.
20620226 Cigarette smoke condensate extracts augment collagen-induced arthritis in mice. 2010 Oct Although cigarette smoking is a solid environmental risk factor for rheumatoid arthritis (RA) as revealed by epidemiological studies, the scientific basis has not been provided. Proinflammatory cytokines produced by synoviocytes are implicated in the pathogenesis of RA. As cigarette smoke condensate (CSC) is able to up-regulate the production of proinflammatory cytokines from human fibroblast-like synoviocytes, we studied the effect of CSC on induction of arthritis in the mouse model of collagen type II-induced arthritis (CIA). When mainstream CSC or sidestream CSC was administered into DBA/1J mice at the time of immunization with collagen and complete Freund adjuvant, CSC dose-dependently augmented the induction and clinical development of arthritis at both young and older mice. Peritoneal injected mainstream CSC one day before immunization also exhibited the augmenting effect, suggesting the systemic effect of CSC. These results support the etiological role of cigarette smoking in RA.
20494593 Massive bilateral tarsal ankylosis and surgical correction: a case report. 2010 Jul Tarsal ankylosis is described as a feature of advanced juvenile or rheumatoid arthritis. Ankylosis involving more then one tarsal segment is uncommon. Incidental reports of massive tarsal ankylosis have been described in a case of juvenile spondyloarthropathy, a case of familial tarsal ankylosis, and, more recently, it was discovered in a prehistoric skeleton dating back to the Iron Age. We describe a rare case of bilateral massive tarsal ankylosis, and the surgical intervention used to treat the condition, in a 21-year-old female with no other features of any known forms of arthritis and no family history of the condition.
19849816 Genetics of rheumatic disease. 2009 Many of the chronic inflammatory and degenerative disorders that present to clinical rheumatologists have a complex genetic aetiology. Over the past decade a dramatic improvement in technology and methodology has accelerated the pace of gene discovery in complex disorders in an exponential fashion. In this review, we focus on rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis and describe some of the recently described genes that underlie these conditions and the extent to which they overlap. The next decade will witness a full account of the main disease susceptibility genes in these diseases and progress in establishing the molecular basis by which genetic variation contributes to pathogenesis.
19366566 Infectious pulmonary complications in patients treated with anti-TNF-alpha monoclonal anti 2009 May Tumor necrosis factor (TNF)-alpha inhibitors (infliximab, adalimumab, and etanercept) used in immune-mediated inflammatory diseases such as rheumatoid arthritis, Crohn's disease, or psoriatic arthritis have the potential to increase the risk of infectious complications. Pulmonary infections are one of the most frequent complications associated with the use of TNF inhibitors. This article provides an overview of the distinct types of infectious pulmonary complications seen in patients using these anticytokine drugs.
19232068 Gene therapy of the rheumatic diseases: 1998 to 2008. 2009 During the decade since the launch of Arthritis Research, the application of gene therapy to the rheumatic diseases has experienced the same vicissitudes as the field of gene therapy as a whole. There have been conceptual and technological advances and an increase in the number of clinical trials. However, funding has been unreliable and a small number of high-profile deaths in human trials, including one in an arthritis gene therapy trial, have provided ammunition to skeptics. Nevertheless, steady progress has been made in a number of applications, including rheumatoid arthritis and osteoarthritis, Sjögren syndrome, and lupus. Clinical trials in rheumatoid arthritis have progressed to phase II and have provided the first glimpses of possible efficacy. Two phase I protocols for osteoarthritis are under way. Proof of principle has been demonstrated in animal models of Sjögren syndrome and lupus. For certain indications, the major technological barriers to the development of genetic therapies seem to have been largely overcome. The translational research necessary to turn these advances into effective genetic medicines requires sustained funding and continuity of effort.
21171673 Tofacitinib. 2010 Tofacitinib (CP-690,550; CP-690550; CP690550), an orally active immunosuppressant, is being developed by Pfizer for the treatment of rheumatoid arthritis, inflammatory bowel disease, dry eyes, ankylosing spondylitis, psoriasis, psoriatic arthritis, and for the prevention of transplant rejection. Tofacitinib specifically inhibits Janus activated kinase 3 (JAK3), which has a pivotal role in cytokine signal transduction that governs lymphocyte survival, proliferation, differentiation, and apoptosis. This review discusses the key development milestones and therapeutic trials of this drug.
20521926 Are anti-infectious vaccinations safe and effective in patients with autoimmunity? 2010 Jun Vaccinations have been traditionally considered a risk factor for the induction/reactivation of autoimmune diseases. A Medline search through key words "vaccinations and autoimmune diseases" from 1947 through December 2009 was conducted. Until now, vaccination effects in autoimmune diseases have only been studied in over 5000 patients. Vaccinations generally did not induce worsening of disease activity in patients with multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent-diabetes-mellitus, chronic arthritis in children, vasculitides, and myasthenia gravis, whereas immunogenicity, although protective, was generally lower than in normal controls, depending on disease severity and immunosuppressive therapy. Data are very poor on the efficacy.
21436970 Etanercept in the treatment of plaque psoriasis. 2009 May 19 Etanercept is approved for the treatment of moderate to severe plaque psoriasis at a dose of 50 mg twice weekly for 3 months followed by a maintenance dosage of 50 mg weekly thereafter. Clinical studies have shown excellent efficacy, favorable benefit to side-effects ratio, and safe long-term usage. Extensive information on safety is available as etanercept has been used for many years for other indications such as rheumatoid arthritis and psoriatic arthritis and is the first of the tumor necrosis factor antagonists to gain approval in psoriasis.
18696073 Osteopoikilosis coexistent with ankylosing spondylitis and familial Mediterranean fever. 2009 Jan Osteopoikilosis (OPK) is a rare benign sclerosing disease of the skeleton and inherited as an autosomal dominant trait. OPK is associated with inflammatory rheumatic disorders, such as rheumatoid arthritis, scleroderma, reactive arthritis and familial Mediterranean fever (FMF). We report a rare case of OPK coexistent with ankylosing spondylitis and FMF. The patient presented multiple sclerotic lesions within and around the sacroiliac joints and a series of radiological diagnostic challenges.
20067708 Norepinephrine transporter is involved in down-regulation of beta1-adrenergic receptors ca 2009 PURPOSE: Inflammation in forms of rheumatoid and experimental arthritis cause not only joint pain but also excessive cardiovascular mortality. The condition also reduces response to calcium channel and beta-adrenergic (beta1-AR) antagonists. For calcium channel inhibitors, the reduced response is shown to be due to the reduced expression of target proteins. Hydroxymethylglutaryl CoA reductase inhibitors (statins) restore response to propranolol and verapamil. We tested the effect of adjuvant arthritis on the norepinephrine (NE) transporter (NET) density since altered sympathetic nervous system innervation has been observed in rheumatoid arthritis. METHODS: Male Sprague-Dawley rats were divided into the following groups: Healthy/Placebo, Healthy/Statin, Pre-AA/Placebo, and Pre-AA/Statin (n=7-8/group). On Day 0, to the Pre-AA and Healthy groups, was injected Mycobacterium butyricum or saline, respectively. On Days 4-8, Statin and Placebo groups received either pravastatin (6 mg/kg) or placebo twice daily, respectively. On day 8, heart and blood samples were collected. The density of NET and 1-AR in heart homogenate; NE in plasma and heart and inflammatory mediators (nitrite and interferon-gamma) in serum were determined. RESULTS: Inflammation was associated with a significant reduction in both beta1-AR and NET density with a positive correlation between the two proteins (r=0.978, p<0.0001). The down-regulating effect of inflammation was not reversed by pravastatin. Inflammation had no significant effect on the plasma or heart NE concentration. CONCLUSION: The close relations of NET and beta1-AR implicates altered sympathetic innervation and/or local NE handling in pharmacotherapeutic desensitization observed in arthritis.
20069930 [Assessment of health-related quality of life of patients with chronic arthritis]. 2009 Nov The assessment of the quality of life as a subjective measure of therapeutic intervention outcome appears to be increasingly adopted by different fields of medicine. In contrast to conventional indicators of condition, which are recognized as objective outcomes, the health-related quality of life (HRQoL) focuses on the patient himself. HRQoL has been determined as the perception of the individual of his or her situation in the current culture and value system; it includes wishes, expectations and emotional responses of the individual related to his or her health. Chronic arthritis leads to irreversible structural changes in joints and consequently to impaired physical function and reduced HRQoL. Today there are validated disease specific ("target") questionnaires to assess HRQoL in patients with rheumatoid arthritis and ankylosing spondylitis, but not yet in patients with psoriatic arthritis. A disease specific questionnaire makes easier approach to patients suffering from a specific rheumatic condition; it enables the comparison of HRQoL among patients suffering from the different types of chronic arthritis. The most frequently used questionnaire in the assessment of the HRQoL of patients suffering from chronic arthritis is the generic MOS 36-Item Short-Form Health Survey (SF-36) which is considered as the "gold standard". It is a generic questionnaire for the assessment of HRQoL in patients with chronic arthritis. To our knowledge, there are only a few studies focused on the HRQoL of patients suffering from chronic arthritis in Serbia and Montenegro.
19211289 WITHDRAWN: Human leukocyte antigen DRB1*04 is associated with rheumatoid arthritis in Kuwa 2009 Feb 10 This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
19826925 Treatment of adjuvant-induced arthritis with the combination of methotrexate and probiotic 2009 A certain relationship was observed between the gastrointestinal system, arthritis and immune system. Patients with rheumatoid arthritis have an altered microflora composition and disturbed intestinal defensive barrier. Effect of probiotic bacteria (Colinfant; COL) with known favorable effect on intestinal microflora was determined on the methotrexate (MTX) treatment of adjuvant arthritis. Rats with adjuvant arthritis were administered methotrexate 0.5 mg/kg body mass 2-times weekly per os, COL 1 mL/kg body mass every second day per os, and a combination of MTX+COL for a period of 28 d from the immunization. Levels of serum albumin, body mass, changes in hind paw swelling, and arthrogram score were estimated in rats as variables of inflammation and destructive arthritis-associated changes. Treatment with MTX, as well as with the combination treatment with MTX+COL significantly inhibited both inflammation and destructive arthritis-associated changes. The combination treatment inhibited both the hind paw swelling and arthrogram score more remarkably than MTX alone; on the other hand, the difference between combination treatment and MTX alone was not significant. Treatment with COL alone had no effect on adjuvant arthritis in rats. Colinfant can increase the preventive effect of MTX treatment in rat adjuvant arthritis by improving its antiarthritic effects.