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ID PMID Title PublicationDate abstract
21707494 The rationale of targeting neutrophils with dapsone during glioblastoma treatment. 2011 Oct Data from past research is presented showing that neutrophils are active participants in new vessel formation in normal physiology, in proliferating human endometrium, in non-cancer pathologies as in the pannus of rheumatoid arthritis, and in various cancers, among them glioblastoma. These data show that interleukin-8 (IL-8) is a major chemokine attracting neutrophil infiltrates in these states. Since the old anti-Hansen's disease drug dapsone inhibits neutrophil migration along an IL-8 gradient towards increasing concentrations, and is used therapeutically for this attribute to good effect in dermatitis herpetiformis, bullous pemphigoid and rheumatoid arthritis, we suggest dapsone may deprive glioblastoma of neutrophil-mediated growth promoting effects. We review past research showing that vascular endothelial growth factor, VEGF, is carried predominantly intracellularly within neutrophils--only 2% of circulating VEGF is found free in serum. Based on the available evidence summarized by the authors, dapsone has a strong theoretical potential to become a useful anti-VEGF, anti-angiogenic agent in glioblastoma treatment.
21349677 Quantitation of total and free teriflunomide (A77 1726) in human plasma by LC-MS/MS. 2011 May 15 The clinical activity of leflunomide, a drug used in the treatment of rheumatoid arthritis, is due to its active metabolite, teriflunomide. In vitro studies indicate that at least 99% of teriflunomide is expected to be protein bound in human plasma in vivo, leaving<1% in the unbound or 'free' state for clinical activity. To examine details of the relationships between leflunomide dosing and patient response, it is necessary to have an assay that is sufficiently sensitive to measure the minor fraction of free teriflunomide in patient samples. Therefore, we aimed to develop and validate an LC-MS/MS method for the measurement of teriflunomide, and use it to determine the total and free teriflunomide concentration in patients with rheumatoid arthritis. Teriflunomide and its deuterated internal standard were extracted from human plasma and separated using a reversed phase method with a C18 column. Detection was conducted with an API 3000 LC-MS/MS System by monitoring selected ions in negative ion MRM. Optimal detection occurred at m/z 269.1/160.0 (teriflunomide) and m/z 273.1/164.0 (teriflunomide-D4). Over a linear range of 5-500 μg/L, the inter-batch precision ranged from 1.9 to 8.8% and accuracy from -8.4 to 8.0%. The intra- and inter-batch assay precision for quality control samples ranged from 2.1-5.4% and 5.7-7.1% respectively. The procedure was applied to assess total and free plasma concentrations of teriflunomide in patients with rheumatoid arthritis. Free teriflunomide was approximately 0.11% of total teriflunomide, and there was a significant correlation (r2=0.724) between free and total teriflunomide concentrations. A validated, accurate and sensitive method was developed and successfully applied for the measurement of total and free teriflunomide concentration in human plasma samples. This method has been shown to be reproducible and sensitive and can be applied to clinical samples.
22931307 Telerheumatology: an idea whose time has come. 2012 Oct Australia is a vast country with one-third of the population living outside capital cities. Providing specialist rheumatologist services to regional, rural and remote Australians has generally required expensive and time-consuming travel for the patient and/or specialist. As a result, access to specialist care for remote Australians is poor. Rheumatoid arthritis is a common disease, but like many rheumatic diseases, it is complex to treat. Time-dependent joint damage and disability occur unless best evidence care is implemented. The relatively poor access to rheumatologist care allotted to nonmetropolitan Australians therefore represents a significant cause of potentially preventable disability in Australia. Telehealth has the potential to improve access to specialist rheumatologists for patients with rheumatoid arthritis and other rheumatic diseases, thereby decreasing the burden of disability caused by these diseases. Advances in videoconferencing technology, the national broadband rollout and recent Federal government financial incentives have led to a heightened interest in exploring the use of this technology in Australian rheumatology practice. This review summarises the current evidence base, outlines telehealth's strengths and weaknesses in managing rheumatic disease, and discusses the technological, medicolegal and financial aspects of this model of care. A mixed model offering both face-to-face and virtual consultations appears to be the best option, as it can overcome the barriers to accessing care posed by distance while also mitigating the risks of virtual consultation.
22937987 Foot health education for people with rheumatoid arthritis - some patient perspectives. 2012 Aug 31 BACKGROUND: Patient education is an important component of foot health management for people with rheumatoid arthritis (RA). The content and strategies for delivery require investigation in relation to the patients' needs. This study explores patients' experiences of foot health education, to inform how the patients' needs could be identified in clinical practice and inform effective education delivery. METHOD: A focus group was used to collect data. The dialogue was recorded digitally, transcribed verbatim and analysed using a structured thematic approach. Member checking and peer review added to credibility of the data.Six themes emerged; (i) content and purpose of patient education - what it should be, (ii) content of patient education - what it should not be, (iii) timing of information on foot health, (iv) method of delivery, (v) ability to engage with foot health education and (vi) the patient/practitioner relationship. CONCLUSIONS: This study identified aspects of patient education considered important by this group of patients in relation to content, timing and delivery, forming the basis for further research on clinical and patient focussed outcomes of patient education.Identifying health education needs and provision of supportive verbal and written information can foster an effective therapeutic relationship, supporting effective foot health education for people with RA.
22536280 Network-based gene expression biomarkers for cold and heat patterns of rheumatoid arthriti 2012 IN TRADITIONAL CHINESE MEDICINE (TCM), PATIENTS WITH RHEUMATOID ARTHRITIS (RA) CAN BE CLASSIFIED INTO TWO MAIN PATTERNS: cold-pattern and heat-pattern. This paper identified the network-based gene expression biomarkers for both cold- and heat-patterns of RA. Gene expression profilings of CD4+ T cells from cold-pattern RA patients, heat-pattern RA patients, and healthy volunteers were obtained using microarray. The differentially expressed genes and related networks were explored using DAVID, GeneSpring software, and the protein-protein interactions (PPI) method. EIF4A2, CCNT1, and IL7R, which were related to the up-regulation of cell proliferation and the Jak-STAT cascade, were significant gene biomarkers of the TCM cold pattern of RA. PRKAA1, HSPA8, and LSM6, which were related to fatty acid metabolism and the I-κB kinase/NF-κB cascade, were significant biomarkers of the TCM heat-pattern of RA. The network-based gene expression biomarkers for the TCM cold- and heat-patterns may be helpful for the further stratification of RA patients when deciding on interventions or clinical trials.
22430889 Microscopic colitis in patients with chronic diarrhea and normal colonoscopic findings in 2012 Sep BACKGROUND AND OBJECTIVES: Microscopic colitis includes lymphocytic colitis and collagenous colitis. The entity is considered as an important cause for unknown chronic diarrhea, but rarely reported in China before. This study aimed to determine the prevalence of microscopic colitis in patients with chronic diarrhea and normal colonoscopy findings in Southern China, and to reveal the clinical feature of microscopic colitis in these patients. METHODS: Patients with chronic diarrhea and normal colonoscopic findings were enrolled from three hospitals in Southern China from January, 2009 to June, 2010. Multiple colorectal biopsies were obtained in these patients and histological examination was underwent with hematoxyin and eosin stain, Masson's trichrome stain and immunohistochemistry for tenascin to screen lymphocytic colitis and collagenous colitis. The clinical symptom and risk factor of microscopic colitis were assessed by comparing with controls. The diagnostic overlap between microscopic colitis and irritable bowel syndrome or functional diarrhea was also analyzed. RESULTS: Randomly mucosal biopsies were performed in 613 patients with chronic diarrhea and normal or near normal colonoscopic finding. Fifty-nine cases of lymphocytic colitis and 28 cases of collagenous colitis were found by histological examination. The rates of rheumatoid arthritis in lymphocytic colitis group (15.4 %) and collagenous colitis group (14.3 %) were significant higher than in control group (2.2 %). Rheumatoid arthritis was confirmed as the risk factor of microscopic colitis by logistic regression analysis. There was no difference on the symptoms among the controls, patients with lymphocytic colitis, and patients with collagenous colitis. There were 13.8 % (12/87) of patients with microscopic colitis fulfilled Rome III criteria of irritable bowel syndrome and 42.5 % (37/87) fulfilled the criteria of functional diarrhea. CONCLUSIONS: Microscopic colitis is not an uncommon disorder in Chinese population. Rheumatoid arthritis is the risk factor of microscopic colitis. Microscopic colitis has a symptomatic overlap with irritable bowel syndrome and functional diarrhea. It is reasonable to obtain multiple biopsies in patients with chronic diarrhea when the mucosa grossly normal at colonoscopy.
21959118 Impact of albumin on drug delivery--new applications on the horizon. 2012 Jan 10 Over the past decades, albumin has emerged as a versatile carrier for therapeutic and diagnostic agents, primarily for diagnosing and treating diabetes, cancer, rheumatoid arthritis and infectious diseases. Market approved products include fatty acid derivatives of human insulin or the glucagon-like-1 peptide (Levemir(®) and Victoza(®)) for treating diabetes, the taxol albumin nanoparticle Abraxane(®) for treating metastatic breast cancer which is also under clinical investigation in further tumor indications, and (99m)Tc-aggregated albumin (Nanocoll(®) and Albures(®)) for diagnosing cancer and rheumatoid arthritis as well as for lymphoscintigraphy. In addition, an increasing number of albumin-based or albumin-binding drugs are in clinical trials such as antibody fusion proteins (MM-111) for treating HER2/neu positive breast cancer (phase I), a camelid albumin-binding nanobody anti-HSA-anti-TNF-α (ATN-103) in phase II studies for treating rheumatoid arthritis, an antidiabetic Exendin-4 analog bound to recombinant human albumin (phase I/II), a fluorescein-labeled albumin conjugate (AFL)-human serum albumin for visualizing the malignant borders of brain tumors for improved surgical resection, and finally an albumin-binding prodrug of doxorubicin (INNO-206) entering phase II studies against sarcoma and gastric cancer. In the preclinical setting, novel approaches include attaching peptides with high-affinity for albumin to antibody fragments, the exploitation of albumin-binding gadolinium contrast agents for magnetic resonance imaging, and physical or covalent attachment of antiviral, antibacterial, and anticancer drugs to albumin that are permanently or transiently attached to human serum albumin (HSA) or act as albumin-binding prodrugs. This review gives an overview of the expanding field of preclinical and clinical drug applications and developments that use albumin as a protein carrier to improve the pharmacokinetic profile of the drug or to target the drug to the pathogenic site addressing diseases with unmet medical needs.
21453973 Recurrent fever of unknown origin (FUO): aseptic meningitis, hepatosplenomegaly, pericardi 2012 Mar BACKGROUND: Fever of unknown origin (FUO) has been defined as a fever of ≥101°F that persists for 3 weeks or more. It is not readily diagnosed after 1 week of intensive in-hospital testing or after intensive outpatient or inpatient testing. Fevers of unknown origin may be caused by infectious diseases, malignancies, collagen vascular diseases, or a variety of miscellaneous disorders. The relative distribution of causes of FUOs is partly age-related. In the elderly, the preponderance of FUOs is attributable to neoplastic and infectious etiologies, whereas in children, collagen vascular diseases, neoplasms, and viral infectious disease predominate. The diagnostic approach to FUOs depends on a careful analysis of the history, physical findings, and laboratory tests. Most patients with FUOs exhibit localizing findings that should direct the diagnostic workup and limit diagnostic possibilities. The most perplexing causes of FUOs involve those without specific diagnostic tests, e.g., juvenile rheumatoid arthritis (JRA) or adult Still's disease. In a young adult with FUO, if all of the cardinal symptoms are present, JRA may present either a straightforward or an elusive diagnosis, if key findings are absent or if the diagnosis goes unsuspected. METHODS: We present a 19-year-old man with a recurrent FUO. His illness began 3 years before admission and has recurred twice since. In the past, he did not manifest arthralgias, arthritis, or a truncal rash. On admission, he presented with an FUO with hepatosplenomegaly, aseptic meningitis, and pericarditis. An extensive diagnostic workup ruled out lymphoma and leukemia. Moreover, a further extensive workup eliminated infectious causes of FUO appropriate to his clinical presentation, ie, tuberculosis, histoplasmosis, brucellosis, Q fever, typhoid fever, Epstein-Barr virus, infectious mononucleosis, cytomegalovirus, human herpes virus (HHV)-6, babesiosis, ehrlichiosis, viral hepatitis, and Whipple's disease. RESULTS: The diagnosis of JRA was based on the exclusion of infectious and neoplastic disorders in a young adult with hepatosplenomegaly, aseptic meningitis, pericarditis, and a double quotidian fever. With JRA, tests for rheumatic diseases are negative, as they were in this case. The only laboratory abnormalities in this patient included elevated serum transaminases, a mildly elevated erythrocyte sedimentation rate, and a moderately elevated level of serum ferritin. CONCLUSION: Diagnostic fever curves are most helpful in cases where the diagnosis is most elusive, as was the case here. Relatively few disorders are associated with a double quotidian fever, ie, visceral leishmaniasis, mixed malarial infections, right-sided gonococcal acute bacterial endocarditis, and JRA. Because the patient received antipyretics during the first week of admission, fever was not present. After infectious disease consultation during week 2 of hospitalization, antipyretics were discontinued, and a double quotidian fever was present, which provided the key diagnostic clue in this case.
23063938 Systemic metabolism of tryptophan and its catabolites, kynurenine and 3-HAA, in mice with 2013 Jan 1 Tryptophan is an essential amino acid. The liver is primary organ involved the oxidative catabolism of tryptophan. However, in the immune system, tryptophan and its catabolites, kynurenine and 3-hydroxyanthranilic acid (3-HAA), play an anti-inflammatory role. Rheumatoid arthritis (RA) is an autoimmune disease. Collagen induced arthritis (CIA) is an animal model of RA. Therefore, it was of interest to measure concentration of tryptophan, kynurenine and 3-HAA in mice with CIA. Concentration of tryptophan and 3-HAA was measured with HPLC methods. Concentration of kynurenine was measured with colorimetric test. mRNA expression for the kynurenine pathway genes was assessed using qRT-PCR. It has been found that in sera from diseased mice concentration of tryptophan was not changed. Concentration of kynurenine and 3-HAA was decreased. Moreover, in the livers from mice with CIA, concentration of tryptophan and kynurenine was decreased. These observations coincided with decreased mRNA expression for Ido2 and Afm and increased mRNA expression for Kynureninase in the liver. It has been also shown that in CIA the concentration of 3-HAA was increased in the kidneys.
21108570 A case of bovine valve endocarditis caused by Engyodontium album. 2011 May We report the first case of Engyodontium album bioprosthetic valve endocarditis in a 44-year-old male with a history of juvenile rheumatoid arthritis. There is only one other report of Engyodontium album as a human pathogen. The present case supports the increased incidence of fungal endocarditis especially in patients receiving immunotherapy.
23182291 [Severe hepatitis in a patient with adult-onset Still's disease treated with anakinra]. 2013 Mar INTRODUCTION: Adult-onset Still's disease is characterized by non-specific polymorphic features. The efficacy of anakinra, an IL-1 receptor antagonist, has been shown in several studies. This medication is well-tolerated, and only one case of severe hepatitis has been previously reported. CASE REPORT: A 22-year-old woman presented with fever, rash, arthritis, and pericarditis, associated with systemic inflammatory response syndrome and elevated ferritin serum level with low glycosylated ferritin. Adult-onset Still's disease was diagnosed, but treatment with steroids did not achieve remission. The patient was then treated with anakinra, which resulted in spectacular improvement, but 3 weeks after the initiation of the treatment she experienced severe hepatitis that resolved after the discontinuation of anakinra. CONCLUSION: Hepatitis is a rare side effect of anakinra and the monitoring of liver tests should be recommended during anakinra therapy.
21469942 Pressure generated by syringes: implications for hydrodissection and injection of dense co 2011 OBJECTIVE: Hydrodissection and high-pressure injection are important for the treatment of dense connective tissue lesions including rheumatoid nodules, Dupuytren's contracture, and trigger finger. The present study determined the optimal syringes for high-pressure injection of dense connective tissue lesions. METHODS: Different sizes (1, 3, 5, 10, 20, and 60 mL) of a mechanical syringe (reciprocating procedure device) with a luer-lock fitting were studied. Twenty operators generated maximum pressure with each mechanical syringe size, and pressure was measured in pounds per square inch (psi). Subsequently, 223 dense connective tissue lesions were injected with different sizes of syringes (1, 3, or 10 mL). Outcomes included (i) successful intralesional injection and (ii) clinical response at 2 weeks. RESULTS: Smaller syringes generated significantly more injection pressure than did larger syringes: 1 mL (363 ± 197 psi), 3 mL (177 ± 96 psi), 5 mL (73 ± 40 psi), 10 mL (53 ± 29 psi), 20 mL (32 ± 18 psi), and 60 mL (19 ± 12 psi). Similarly, smaller syringes were superior to larger syringes for intralesional injection success: 10 mL: 34% (15/44) vs. 1 mL: 100% (70/70) (p < 0.001) and 3 mL: 91% (99/109) (p < 0.001). CONCLUSION: Smaller syringes (≤ 3 mL) are superior to larger syringes (≥ 5 mL) for successful hydrodissection and high-pressure intralesional injection of dense connective tissue lesions.
20393864 Clinical manifestations of neurological involvement in primary Sjögren’s syndrome. 2011 Apr The aim of this study was to evaluate neurological manifestations of primary Sjögren’s syndrome (pSS) and investigate the etiology and pathogenesis of peripheral and central nervous complications in pSS. Thirty-two patients with pSS were enrolled in the present study, 20 of whom had neurological involvement plus sicca symptoms. The clinical features were evaluated by neurological examinations including nerve conduction study, magnetic resonance imaging, cerebrospinal fluid, and electroencephalogram. The frequency of fever was significantly higher (P = 0.006) in pSS with neurological involvement than in pSS without neurological involvement. There was no statistical significance in other factors between the two groups. Peripheral nervous system (PNS), central nervous system (CNS), and both PNS and CNS involvements were revealed in 14, 3, and 3 patients, respectively. Optic neuritis and trigeminal neuralgia were revealed frequently in cranial neuropathy. Anti-aquaporin 4 antibody was detected in one patient with optic neuritis. Of the nine patients with polyneuropathy, eight patients presented pure sensory neuropathy including small fiber neuropathy (SFN). pSS with SFN appeared to have no clinically abnormal features, including muscle weakness and decreasing deep tendon reflex. Skin biopsy revealed epidermal nerve fiber degenerated in one pSS patient with pure sensory neuropathy who was diagnosed as having SFN. Our observations suggest that a number of mechanisms can be attributed to neurological involvements in pSS rather than just the mechanisms previously described (i.e., vasculitis and ganglioneuronitis). Presumably, specific autoantibodies may directly induce injury of the nervous system.
21651503 Primary Sjogren's syndrome: cognitive symptoms, mood, and cognitive performance. 2012 Apr OBJECTIVE: To investigate the relationships between self-reported cognitive abilities, psychological symptoms and neuropsychological outcomes in PSS. METHODS: Patients with Primary Sjogren's syndrome (PSS) and healthy controls completed a comprehensive neuropsychometric battery and questionnaires: the Centers for Epidemiological Scale-Depression, the Profile of Fatigue-mental domain (Prof-M) for cognitive symptoms, Fatigue Severity Scale, and the Short-Form McGill Pain Questionnaire. RESULTS: Female patients with PSS (N = 39) were similar to controls (N = 17) in estimated premorbid intellectual function, age and education. Depression (P = 0.002), cognitive symptoms (P = 0.001), fatigue (P = 0.000003), and pain (P = 0.024) scores were greater in the patient group. Patients with PSS demonstrated inferior performance relative to controls in psychomotor processing (P = 0.027) and verbal reasoning (P = 0.007). Patients with PSS with and without depression had similar performance on multiple tests, but depressed patients had significantly lower scores for executive function (P = 0.041). Cognitive symptoms correlated with verbal memory (P = 0.048), whereas pain correlated with executive function measures (Stroop, P = 0.017) and working memory (Trails B, P = 0.036). In the regression model, depression and verbal memory were independent predictors that accounted for 61% of the variance in cognitive symptoms. CONCLUSION: The Prof-M is a simple self-report measure which could be useful in screening PSS subjects who may benefit from detailed psychometric evaluation. Our results are consistent with the hypothesis that depression and verbal memory impairment are overlapping but independent aspects of neural involvement in PSS. While pain and depression are significant confounders of cognitive function in PSS, this study suggests that impaired verbal reasoning ability in PSS is not attributable to pain or depression.
22976609 A case of juvenile Sjögren's syndrome with interstitial nephritis. 2012 Primary Sjögren's syndrome (SS) is a rare autoimmune disease, especially in children. Juvenile primary SS with interstitial nephritis is rare in Japan. We report on a 12-year-old girl in whom salivary gland swelling had recurred from the age of 5 years, SS was diagnosed at the age of 10 years, and interstitial nephritis developed at the age of 12 years. The patient presented with a chief complaint of swelling of both parotid glands. The patient had a history of recurrent parotitis from 5 years of age, with episodes recurring 5 to 6 times a year and resolving within 3 days each time. However, at the age of 11 years, the patient had continuous mild swelling of the parotid glands. Examination on admission showed bilateral nontender parotid gland swelling; mild swelling of the lower extremities, xerostomia, and xerophthalmia but no exanthem. Laboratory findings were as follows: serum protein, 10.1 g/dL; immunoglobulin (Ig) G, 3,828 mg/dL; antinuclear antibodies, 1,280-fold; anti-Ro/SS-A antibody, 512-fold; anti-Ro/SS-B antibody, 4-fold; creatinine, 0.45 mg/dL; blood β2-microglobulin, 2.2 mg/L (slightly elevated); and cystatin C, 0.86 mg/L. Urinalysis showed proteinuria and a β2-microglobulin concentration of 11,265 mg/L. Thus, this patient had low molecular weight proteinuria. Schirmer's test showed decreased tear secretion (5 mm), and fluorescein staining showed marked bilateral superficial punctate keratitis. A lip biopsy showed infiltration by small round cells (mild to moderate), interstitial fibrosis, loss of salivary gland parenchyma, and atrophy, with no obvious epimyoepithelial islands, leading to a diagnosis of SS. Light microscopic examination of the renal biopsy specimens showed expansion of mononuclear cell infiltration in the renal interstitium, inflammatory cell infiltration of interstitial areas with edema and mild fibrosis, and tubulitis and mononuclear cell infiltration that included many lymphocytes and plasma cells. There were no pathological findings of glomerulonephritis. Small arteries showed no obvious abnormalities. Immunofluorescent staining showed slight, nonspecific deposition of IgM, but no deposition of IgG, complement 1q, 3, or 4. On the basis of the renal biopsy showing nonspecific chronic interstitial nephritis, renal tubular atrophy, and interstitial enlargement, tubulointerstitial nephritis associated with SS was diagnosed.
21566864 [The curative effects of bone mesenchymal stem cells transplanted into rats with Sjogren's 2011 Apr PURPOSE: To study the curative effects, survival rate, migration and differentiation of bone mesenchymal stem cells (BMSCs) transplanted into rats with Sjogren's syndrome. METHODS: Model of Sjogren's syndrome was created in rats. BMSCs were isolated and cultured by using the preceding method. Then the pretreated BMSCs were identified and labeled by enhanced green fluorescent protein. BMSCs marked with enhanced green fluorescent protein (EGFP) or PBS were injected into the SMG of the Sjogren's syndrome rats via open surgery.Total static saliva flow rate was determined in rats. The daily amount of water in the normal group, the model group, the model treatment group and the model treatment control group was recorded. The survival rate, migration and differentiation of the BMSCs transplanted in the treatment group under fluorescence microscope was recorded. Student's t test was used for data analysis using SPSS 12.0 software package. RESULTS: Compared with the model treatment control group, the total static saliva flow rate of the model treatment group increased significantly, and the water they drank decreased significantly (P<0.05). In addition, BMSCs were distributed along the injection tract mostly in the first week,then BMSCs were mainly distributed in the stroma between the acinar in the second week and were distributed over other areas four weeks later. Immunohistochemical staining of amylzyme was not observed at the first week after transplantation. And at the 8th week the expression of amylzyme in the cytoplasm of the transplanted BMSCs was observed by immunohistochemical only in the model treatment group. CONCLUSION: Transplantation of BMSCs has certain treatment effect on Sjogren's syndrome.
22790581 Case of Sjögren's syndrome presenting as trigeminal nerve palsy. 2012 We herein report the case of a female with Sjogren's syndrome (SS) complicated with trigeminal nerve palsy. Although her sicca symptoms had been unnoticed, head magnetic resonance imaging (MRI) for detecting brain abnormalities revealed parotid gland changes associated with SS. SS should be considerd as a possible cause of trigeminal nerve disturbances. In addition, parotid gland changes related to SS should be aware in examination of cranial nerve disturbances with MRI.
22025573 Upper and lower tear menisci in Sjögren's syndrome dry eye. 2011 Dec 9 PURPOSE: To measure the tear menisci in Sjögren's syndrome dry eye (SSDE) by optical coherence tomography (OCT) and to determine its relationships with the clinical tests. METHODS: Twenty-six SSDE, 26 non-SSDE, and 26 control subjects completed the Ocular Surface Disease Index (OSDI) before OCT determination of upper tear meniscus volume (UTMV), lower tear meniscus volume (LTMV), and total tear meniscus volume (TTMV). These were followed by measurements of noninvasive tear breakup time (NITBUT), fluorescein tear breakup time (FTBUT), fluorescein staining, Schirmer test, and corneal confocal microscopy. RESULTS: UTMV, LTMV, and TTMV were the lowest in SSDE among the three groups (P < 0.05). High sensitivity and specificity of UTMV (1.0; 0.96), LTMV (0.92; 0.92), and TTMV (0.96; 0.96) were found in the diagnosis of SSDE. For SSDE, the areas under the UTMV, LTMV, and TTMV receiver operating characteristic curves were larger than those in NITBUT, FTBUT, and Schirmer test (P < 0.005). In the SSDE group, NITBUT was correlated with UTMV (R = 0.41) and TTMV (R = 0.39) (P < 0.05). Fluorescein staining score was significantly correlated with UTMV (R = -0.46), LTMV (R = -0.41), and TTMV (R = -0.53) (P < 0.05). Superficial epithelial cell density was correlated with UTMV (R = 0.18), LTMV (R = 0.51), and TTMV (R = 0.44) (P < 0.05). CONCLUSIONS: Tear menisci volumes estimated by OCT may have great potential in the diagnosis and monitoring of SSDE. They can also reflect ocular surface damage and tear film stability.
21927943 [Sensory neuronopathy of Sjögren's syndrome. A diagnostic challenge]. 2012 Feb Sjögren's syndrome is an important differential diagnosis in patients with sensory neuronopathy because immunosuppressive therapy may prevent progressive degeneration of sensory fibres, ganglions and axons. Due to the challenges in the diagnostic process the diagnostic criteria have repeatedly changed over the past few years. In patients with negative antibodies (SSA, SSB antibodies) biopsy of the salivary glands of the lip and the parotid gland can be useful to diagnose Sjögren's syndrome. We report on four patients in whom biopsy of the salivary gland was helpful in establishing the diagnosis of Sjögren's syndrome and consequently immunosuppressive therapy was initiated. One of these patients suffered from hypersalivation. This was probably due to denervation hypersensitivity. To our knowledge this has not been reported yet.
21285163 Evaluation of clinical measures and different criteria for diagnosis of adult-onset Still' 2011 Apr OBJECTIVE: To determine the value of clinical measures in diagnosis of adult-onset Still's disease (AOSD), and to identify the optimal set of proposed classification criteria, in a Chinese population. METHODS: A total of 70 patients with AOSD and 140 non-AOSD inpatients with fever were retrospectively identified at Zhongshan Hospital, Shanghai, from January 2003 to December 2009. Clinical measures and 4 sets of diagnostic criteria (Yamaguchi, Calabro, Cush, and Reginato) were evaluated by sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratio (PLR, NLR) for diagnosis of AOSD. RESULTS: In our series, higher sensitivity included hyperpyrexia (temperature ≥ 39°C, 94.29%), arthralgia (80.0%), polymorphonuclear neutrophils (PMN) ≥ 75% (84.29%), serum ferritin ≥ 2-fold the upper normal value (90.0%), negative antinuclear antibodies (85.29%), and rheumatoid factor (84.38%); while higher specificity included transient erythema (98.57%), sore throat (85.0%), leukocytes ≥ 15,000/mm(3) (87.86%), and PMN ≥ 85% (85.0%). Rash, arthralgia, and sore throat were found to have better sensitivity and specificity (PLR 3.29-4.86). Leukocytes ≥ 10,000/mm(3), PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were set as critical points. The Reginato criteria set had the highest specificity, 99.29%. The Yamaguchi set had the highest sensitivity, 78.57%, with a better accuracy of 87.14%. CONCLUSION: The Yamaguchi diagnostic criteria had better accuracy in Chinese patients. Indicators such as rash, arthralgia, sore throat, leukocytes ≥ 10,000/mm(3), PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were helpful for diagnosis of AOSD. We recommend using these indicators in combination instead of alone.