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ID PMID Title PublicationDate abstract
21826190 Optical imaging of rheumatoid arthritis. 2011 Feb Optical Imaging (OI) for rheumatoid arthritis is a novel imaging modality. With the high number of people affected by this disease, especially in western countries, the availability of OI as an early diagnostic imaging method is clinically highly relevant. In this article we describe the current techniques of OI and discuss potential future applications of this promising technology. Overall, we demonstrate that OI is a fast, inexpensive, noninvasive, nonionizing and accurate imaging modality. Furthermore, OI is a clinically applicable tool allowing for the early detection of inflammation and potentially facilitating the monitoring of therapy.
21660199 Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma. 2011 Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Diagnosis can be challenging since patients are unlikely to report dyspnea due to an overall decrease in physical activity with advanced arthritic symptoms. Additionally, infections, drug toxicity, and environmental toxins can mimic ILD, creating significant diagnostic dilemmas for the clinician. In this paper we will explore an effective clinical algorithm for the diagnosis of RA-ILD. We will also discuss features of drug-related toxicities, infections, and environmental toxins that comprise the main entities in the differential diagnosis of RA-ILD. Finally, we will explore the known and experimental treatment options that may have some benefit in the treatment of RA-ILD.
22683700 Non-synonymous single nucleotide polymorphisms in genes for immunoregulatory galectins: as 2012 Oct BACKGROUND: Galectins are potent immune regulators, with galectin-8 acting as a pro-apoptotic effector on synovial fluid cells and thymocytes and stimulator on T-cells. To set a proof-of-principle example for risk assessment in autoimmunity, and for a mutation affecting physiological galectin sensor functions, a polymorphism in the coding region of the galectin-8 gene (rs2737713; F19Y) was studied for its association with two autoimmune disorders, i.e. rheumatoid arthritis and myasthenia gravis. METHODS: A case-control analysis and a related quantitative trait-association study were performed to investigate the association of this polymorphism in patients (myasthenia gravis 149, rheumatoid arthritis 214 and 134 as primary and repetitive cohorts, respectively) and 365 ethnically matched (Caucasian) healthy controls. Distribution was also investigated in patients grouped according to their antibody status and age at disease onset. Comparative testing for lectin activity was carried out in ELISA/ELLA-based binding tests with both wild-type and F19Y mutant galectin-8 from peripheral blood mononuclear cell lysates of healthy individuals with different genotypes as well as with recombinant wild-type and F19Y mutant galectin-8 proteins. RESULTS: A strong association was found for rheumatoid arthritis, and a mild one with myasthenia gravis. Furthermore, the presence of the sequence deviation also correlated with age at disease onset in the case of rheumatoid arthritis. The F19Y substitution did not appear to affect carbohydrate binding in solid-phase assays markedly. GENERAL SIGNIFICANCE: This is the first report of an association between a galectin-based polymorphism leading to a mutant protein and autoimmune diseases, with evidence for antagonistic pleiotropy.
22364193 PTPN22 splice forms: a new role in rheumatoid arthritis. 2012 Feb 24 Genetic variation in the protein tyrosine phosphatase non-receptor type gene 22 (PTPN22, encoding lymphoid tyrosine phosphatase, LYP) influences the risk of developing multiple autoimmune diseases, but the underlying mechanisms are not completely understood. In a recent study published in Genome Medicine, Ronninger et al. showed that there are differences in the expression of PTPN22 isoforms between peripheral blood mononuclear cells from rheumatoid arthritis patients and those of healthy controls. This study provides new insights into the role of PTPN22 in autoimmune diseases.
22165698 [Is retardation of radiologic progression of ankylosing spondylitis possible?]. 2011 Nov In the introduction is the author dealing with problems of early diagnosis of ankylosing spondylitis and he is explaining the advantages of new ASAS/EULAR criteria for diagnosis of axial spondylarthritis. Than he continues with discussion about new "Recommendations for treatment of ankylosing spondylitis", stressing the modification of recommendations for anti-TNF therapy. Despite the fact, that high symptomatic efficacy of anti-TNF therapy was confirmed, there is no clear evidence that anti-TNF drugs delay radiologic progression. On the contrary, study with nonsteroidal antirheumatic drugs in duration 24 months was performed and have documented that patients treated continuously by celecoxib had smaller radiographic progression than patients treated with celecoxib on demand. Anti-TNF therapy delays radiographic progression in rheumatoid arthritis, but not NSAID, in ankylosing spondylitis it is opposite. The differences may be caused by different pathophysiology of rheumatoid arthritis and ankylosing spondylitis as it is explained in the next part of publication. Combination therapy of AS with anti-TNF and continuous celecoxib therapy could be very interesting.
23140489 Gene expression profiling of macrophages: implications for an immunosuppressive effect of 2012 Nov 9 BACKGROUND: Gold salts has previously been used in the treatment of rheumatoid arthritis but have been replaced by biologicals such as TNF-α inhibitors. The mechanisms behind the anti-inflammatory effect of metallic gold ions are still unknown, however, recent data showed that charged gold atoms are released from pure metallic gold implants by macrophages via a dissolucytosis membrane, and that gold ions are taken up by local macrophages, mast cells and to some extent fibroblasts. These findings open the question of possible immunomodulatory effects of metallic gold and motivate efforts on a deeper understanding of the effect of metallic gold on key inflammatory cells as macrophages. METHODS: Human macrophage cells (cell line THP-1) were grown on gold foils and intracellular uptake was analysed by autometallography. The impact of phagocytised gold ions on viability of THP-1 cells was investigated by trypan blue staining and TUNEL assay. The global gene expression profile of THP-1 cells after incorporation of gold ions was studied using microarray analysis comprising approximately 20,000 genes. The gene expression data was confirmed by measurement of secreted proteins. RESULTS: Autometallography showed intracellular uptake of gold ions into THP-1 cells. No significant effect on viability of THP-1 cells was demonstrated. Our data revealed a unique gene expression signature of dissolucytotic THP-1 cells that had taken up gold ions. A large number of regulated genes were functionally related to immunomodulation. Gold ion uptake induced downregulation of genes involved in rheumatoid arthritis such as hepatocyte growth factor, tenascin-C, inhibitor of DNA binding 1 and 3 and matrix metalloproteinase 13. CONCLUSION: The data obtained in this study offer new insights into the mode of action of gold ions and suggest for the investigation of effects on other key cells and a possible future role of metallic gold as implants in rheumatoid arthritis or other inflammatory conditions.
22696776 2012 Apr OBJECTIVES: Compare the benefits and harms of corticosteroids, oral and biologic disease-modifying antirheumatic drugs (DMARDs) for adults with rheumatoid arthritis. DATA SOURCES: English-language articles from 1980 to February 2011 identified through PubMed, Embase, Cochrane Library, and International Pharmaceutical Abstracts; unpublished literature including dossiers from pharmaceutical companies. METHODS: Two people independently selected relevant head-to-head trials of any sample size, prospective cohort studies with at least 100 participants, and relevant good- or fair-quality meta-analyses that compared benefits or harms of 14 drug therapies. Retrospective cohort studies were also included for harms. For biologic DMARDs, placebo-controlled, double-blind RCTs were also included. We required trials and cohort studies to have a study duration of at least 12 weeks. Literature was synthesized qualitatively within and between the two main drug classes (oral and biologic DMARDs). Network meta-analysis also was performed to examine the relative efficacy of biologic DMARDs and comparing withdrawal rates from placebo controlled trials. RESULTS: Head-to-head trials showed no clinically important differences in efficacy among oral DMARD comparisons (methotrexate, sulfasalazine, leflunomide). The only head-to-head trial comparing biologic DMARDs (abatacept vs. infliximab) found no clinically important differences. Combination therapy of biologic DMARDs plus methotrexate improved clinical response rates and functional capacity more than monotherapy with methotrexate. Network meta-analyses found higher odds of reaching ACR 50 response for etanercept compared with most other biologic DMARDs (abatacept, adalimumab, anakinra, infliximab, rituximab, tocilizumab) for methotrexate-resistant patients with active rheumatoid arthritis. Similar overall tolerability profiles were found among oral and biologic DMARDs, but short-term adverse events were more common with biologic DMARDs. Adjusted indirect comparisons of biologic DMARDs found that certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates due to lack of efficacy than adalimumab, anakinra, and infliximab. Certolizumab and infliximab had more, while etanercept had fewer withdrawals due to adverse events than most other drugs. Evidence was insufficient to assess comparative risk of serious adverse events among biologic DMARDs. Combinations of biologic DMARDs have higher rates of serious adverse events than biologic DMARD monotherapy. Limited data existed for subgroups. CONCLUSIONS: Limited head-to-head comparative evidence does not support one therapy over another for adults with rheumatoid arthritis. Network meta-analyses from placebo-controlled trials of biologics suggest some differences, including higher odds of reaching ACR 50 response, but strength of evidence was low.
22934118 Evaluation of anti-mutated citrullinated vimentin antibodies, anti-cyclic citrullinated Pe 2012 Rheumatoid factor (RF) is currently used in the diagnosis of rheumatoid arthritis (RA). The discovery of anticitrullinated protein autoantibodies has led to the development of various new tests, such as anti-cyclic citrullinated peptide (anti-CCP) antibodies, and anti-mutated citrullinated vimentin (anti-MCV) antibodies, to diagnose RA. The aims of this study were to determine the sensitivity and specificity of anti-MCV antibodies in comparison with anti-CCP antibodies and RF in Omani Arab patients with RA and compare our findings with published values from different ethnic groups. The sensitivity of anti-MCV antibodies was 72% with 87% specificity. For anti-CCP antibodies the sensitivity was 52% and the specificity was 97%. The sensitivity of RF was 57% with 94% specificity. Anti-CCP antibodies have higher diagnostic specificity and positive predictive value than RF and anti-MCV antibodies. Anti-MCV antibodies have the highest sensitivity when compared to anti-CCP antibodies and RF. Anti-MCV antibodies do not appear to be very useful in the diagnosis of RA. However, long-term study is required to find out whether anti-MCV antibodies can be used as predictive test for incidence of RA.
22279508 The normal synovium. 2011 This paper describes the structure and function of the normal synovium including the cellular content, nerve and vascular supply and how normal synovium maintains homeostasis within the joint. It is important to understand normal synovium before appreciating the changes that occur in the synovial membrane which leads to the pathology seen in inflammatory arthritides such as Rheumatoid Arthritis.
21466723 [Anakinra in refractory adult onset Still's disease]. 2011 BACKGROUND: Adult onset Still's disease (AOSD) is a rare--but potentially dangerous and difficult to treat--generalized auto-inflammatory disease which shares some similarities with the systemic form of juvenile idiopathic arthritis (SoJIA or Still's disease). CASE DESCRIPTION: AOSD was diagnosed in 2 young adult women of 21 and 23 years old. The disease was found to be resistant to treatment in these patients. The patients were treated successively with NSAIDs, glucocorticoids, methotrexate and anti tumour necrosis factor(TNF)-α antagonists, with only partial effects or none at all. Treatment with the interleukin-1 receptor antagonist anakinra was subsequently started, which led to remission of AOSD. CONCLUSION: These cases illustrate the clinical spectrum of AOSD and the possibility of an important addition to the therapeutic arsenal for treatment of refractory AOSD.
21358013 Prevalence of IgA deficiency in children with juvenile rheumatoid arthritis. 2011 Mar The purpose of this study was to investigate any association between IgA deficiency (IgAD) and juvenile rheumatoid arthritis (JRA) among Iranian children.This case-control study was carried out on 83 children who were diagnosed as JRA according to American College of Rheumatology (ACR) criteria; Patients were admitted at the rheumatology clinic of Children's Medical Center, (Tehran). Serum immunoglobulins concentrations were determined by nephelometry method. Control group was 112 healthy children who were matched for age and gender. Informed consent obtained from all parents.Selective IgA deficiency (sIgAD) was found only in a boy (1.2%) among JRA children; however, partial IgA deficiency was found in 6(7.1%) of patients with JRA and in 12(10.7%) of control subjects, this difference was not statistically significant (p=0.46). Immunoglobulins levels in patients with JRA (IgM: 126.7±57.2, IgG: 1182.3±351 and IgA:169.3±98) were significantly higher than their controls (IgM: 104±52, IgG:802±220 and IgA: 94.6±47) (p<0.05). Patients with growth failure had higher IgM, IgG and IgA levels in comparison with patients without growth failure; however, this difference was significant about IgM and IgG levels (p<0.05).In contrast to other similar studies, the number of IgAD did not differ significantly between JRA patients and their control counterpart; this might be partly due to the high rate of consanguineous marriages in Iran that resulted in increased prevalence of clinically undiagnosed partial IgAD in general population. Hence, future epidemiological studies are warranted to make it clear.
21216872 Intracranial hypertension as the first manifestation of primary Sjogren's syndrome. 2011 Apr BACKGROUND: Central nervous system involvement with primary Sjögren's syndrome (pSS) is rare, and often undiagnosed. Sjögren's syndrome and concomitant intracranial hypertension is a very rare event. CASE: We describe a patient with pSS who presented with intracranial hypertension as the initial symptom of the disease. CONCLUSION: This is the first case report of a patient with pSS that presented with intracranial hypertension only.
22889617 Diagnostic value of labial minor salivary gland biopsy for Sjögren's syndrome: a systemat 2013 Jan OBJECTIVES: To assess the diagnostic value of minor salivary gland biopsy (MSGB) for primary Sjögren's syndrome (pSS). METHODS: Systematic review of studies retrieved from PUBMED and EMBASE using the terms 'salivary glands' AND 'Sjögren's syndrome' AND 'biopsy', conducted in patients with suspected pSS, and defining positive biopsies as a focus score (FS)≥1. Sensitivity and specificity of MSGB were abstracted from the articles or calculated when possible. RESULTS: Of 238 publications identified initially, 9 were included in the study. MSGB sensitivity ranged from 63.5% to 93.7% and specificity from 61.2% to 100%. Specificity was >89% in six studies. An attempt to separate patients with and without pSS without using MSGB findings or via clinical re-evaluation was made in only two studies, in 73 and 120 patients, respectively, with sicca syndrome in the first study and suspected pSS in the other. The reference standard for diagnosing pSS was a set of criteria that did not include MSGB in the first and patient re-evaluation by three experienced rheumatologists who were aware of MSGB findings in the other. In these studies, sensitivity was 63.9% and 85.7% and specificity was 91.9% and 89.7%, respectively. CONCLUSIONS: Few published studies have evaluated the diagnostic usefulness of MSGB in pSS. Only two studies used a methodology that precluded circular reasoning. Our study indicates a lack of information about the diagnostic value of MSGB. Specificity and positive predictive values (PPV) are high and sensitivity is variable.
22041359 Small intestine Crohn's disease presenting as fever mistaken for adult onset Still's disea 2011 Crohn's disease (CD) is not rare in recent years, but it is sometimes difficult to make a definite diagnosis particularly if it is in the small intestine. We report a patient with fever for 8 months whose disease was mistaken to be Adult onset Still's disease. The patient was diagnosed small intestine Crohn's disease at last by pathology. We want to emphasize that doctors should not forget small intestine Crohn's disease when encountering an unidentified feverish patient, they should not diagnose a feverish patient of Adult onset Still's disease at once. It is important to note that corticosteroids can conceal many diseases and they should not be considered lightly even if the patient is diagnosed with Adult onset Still's disease.
23431740 Ultrasound features of lacrimal gland in Sjogren's syndrome: case report. 2012 Dec A case is presented of bilateral lacrimal gland hypertrophy with secondary glaucoma due to the increased episcleralvenous pressure. Diagnostic work-up included clinical methods associated with ultrasound (A- and B-scan, Doppler ultrasound) and magnetic resonance imaging techniques. Clinical data revealed proptosis, episcleral congestion, and elevated intraocular pressure. Abnormal Schirmer's test and xerophthalmia were also present. Ultrasound examination identified enlarged masses of a cystic structure in lacrimal fossae bilaterally, superotemporally to the globe, more pronounced on the left side. Doppler ultrasound revealed vascularization and magnetic resonance imaging completed the findings offered by ultrasound methods. Based on the clinical aspect and the possible visual impairment due to secondary glaucoma, the mass lesion on the left side was removed by neurosurgical approach. Histopathology confirmed destruction of the lacrimal gland and immunohistochemistry indicated Sjogren's syndrome lesions. Sonography is able to provide noninvasively much of the information needed by the clinician. The A-scan and B-scan ultrasound techniques and color Doppler allow tracking and discrimination of orbital diseases, such as lacrimal gland lesions. Associated with clinical features, these methods provide the basis of correct diagnosis and appropriate therapy for lacrimal gland pathology.
23288799 Unusual presentation of Sjögren syndrome: multiple parotid cysts. 2012 Nov Sjögren syndrome is a chronic autoimmune exocrinopathy that destroys salivary and lacrimal gland tissue. We report an unusual case of this disease in a 40-year-old woman who presented with bilateral parotid cystic masses. As this case illustrates, Sjögren syndrome should be included in the differential diagnosis of bilateral cystic parotid lesions.
23019918 [Progress in understanding the pathogenesis of Sjögren's syndrome in non-obese diabetic m 2012 Jun Sjögren's syndrome is a chronic autoimmune disease, the pathogenesis of which still remains to be explored. Non-obese diabetic (NOD) mouse, presenting impairment of secretory function as well as the development of sialoadenitis, which is in common with human Sjögren's syndrome, is considered as one of the appropriate animal models for the study of Sjögren's syndrome. With regard to genetic factors, apoptosis, autoantibodies and cytokines, this paper reviewed the progress in understanding the pathogenesis of Sjögren's syndrome in NOD mice.
22450393 How to assess treatment efficacy in Sjögren's syndrome? 2012 May PURPOSE OF REVIEW: This article critically reviews the current views and discusses the future challenges with regard to assessing disease progression and disease activity in Sjögren's syndrome, as a decrease of disease progression and activity is what an effective Sjögren's syndrome therapy aims for. This topic has recently gained renewed attention as targeted treatment modalities have become available in primary Sjögren's syndrome, while the lack of well established outcome parameters interferes with a straightforward comparison of the outcomes of the various trials. RECENT FINDINGS: Recent advances in how to assess changes in disease progression and activity objectively (via repeated biopsies of salivary glands, sialometry, sialochemistry, biomarkers, secretion and composition of tears, EULAR Sjögren's Syndrome Disease Activity Index: ESSDAI) and subjectively (EULAR Sjögren's Syndrome Patient Related Index: ESSPRI) have opened new ways to reliably assess the outcome of a particular treatment. SUMMARY: Newly applied tools are instrumental, both for clinical research and clinical practice, in reliably judging and comparing the value of well established and newly developed therapies in Sjögren's syndrome.
21873147 [Still disease in subSaharan Africa: report of four cases in Gabon]. 2011 Apr Still disease is an inflammatory rheumatism occurring predominantly in children and adolescents, but which is sometimes diagnosed in adults. A combination of fever, arthralgia, transient dermatological lesions, hyperleucocytosis predominantly neutrophilic, and ferritinaemia greater than 1,000 μg/L is suggestive of this disease, but infectious, haematological, immunological, and tumor diseases must first be ruled out. Accordingly, patients' financial limitations keep this disease from being diagnosed often in sub-Saharan Africa. We report four cases of Still disease with favourable outcome after corticosteroid therapy.
21735697 [Pregnancy and possible complications in a patient with Sjögren's syndrome--a case report 2011 Apr This article presents a case of a 29-year-old pregnant woman with Sjögren's syndrome, regardless of her first pregnancy loss, conceived and delivered a healthy baby. The authors have also reviewed available medical literature and have indicated problems that typically occur in such patients. Diagnostic methods, therapeutic possibilities, and common complications that obstetrician have to deal with while taking care of pregnant women with Sjögren's syndrome have been shown.