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ID PMID Title PublicationDate abstract
22342996 The role of neutrophils in autoimmune diseases. 2012 Mar 30 Though chronic autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus affect a significant percentage of the human population and strongly diminish the quality of life and life expectancy in Western societies, the molecular pathomechanisms of those diseases are still poorly understood, hindering the development of novel treatment strategies. Autoimmune diseases are thought to be caused by disturbed recognition of foreign and self antigens, leading to the emergence of autoreactive T-cells (so-called immunization phase). Those autoreactive T-cells then trigger the second (so-called effector) phase of the disease which is characterized by immune-mediated damage to host tissues. For a long time, neutrophils have mainly been neglected as potential players of the development of autoimmune diseases. However, a significant amount of new experimental data now indicates that neutrophils likely play an important role in both the immunization and the effector phase of autoimmune diseases. Here we review the current literature on the role of neutrophils in autoimmune diseases with special emphasis on rheumatoid arthritis, systemic lupus erythematosus, autoimmune vasculitides and blistering skin diseases. We also discuss the role of neutrophil cell surface receptors (e.g. integrins, Fc-receptors or chemokine receptors) and intracellular signal transduction pathways (e.g. Syk and other tyrosine kinases) in the pathogenesis of autoimmune inflammation. Though many of the results discussed in this review were obtained using animal models, additional data indicate that those mechanisms likely also contribute to human pathology. Taken together, neutrophils should be considered as one of the important cell types in autoimmune disease pathogenesis and they may also prove to be suitable targets of the pharmacological control of those diseases in the future.
22144996 Prevalence and risk factors of gastrointestinal disorders in patients with rheumatoid arth 2011 Objectives. To compare the prevalence of gastrointestinal (GI) disorders in rheumatoid arthritis (RA) versus non-RA subjects and to describe determinants of GI disorders in RA. Methods. The bowel disease questionnaire was completed by RA and non-RA subjects. RA patients also completed the health assessment questionnaire (HAQ). Results. The study responders included 284 RA and 233 non-RA subjects. Abdominal pain/discomfort, postprandial fullness, nausea, and stool leakage were significantly more common in RA versus non-RA (odds ratios [OR] = 1.8; 1.9; 4.0; 8.2, resp.). The use of laxatives, proton pump inhibitors, NSAIDs, acetaminophen, and narcotics was more commonly reported in RA versus non-RA (OR = 2.0; 1.7; 3.0; 2.0; 1.9, resp.). Age < 60 and HAQ ≥ 1 were associated with dyspepsia, irritable bowel syndrome, gastroesophageal reflux disease, and GI symptom complex overlap in RA. Conclusion. Several upper and lower GI disorders were significantly more prevalent in RA versus non-RA subjects. Age <60 and physical function impairment (HAQ ≥ 1) were associated with GI disorders in RA.
21885485 Early management of newly diagnosed rheumatoid arthritis by Canadian rheumatologists: a na 2011 Nov OBJECTIVE: To describe early rheumatologic management for newly diagnosed rheumatoid arthritis (RA) in Canada. METHODS: A retrospective cohort of 339 randomly selected patients with RA diagnosed from 2001-2003 from 18 rheumatology practices was audited between 2005-2007. RESULTS: The most frequent initial disease-modifying antirheumatic drugs (DMARD) included hydroxychloroquine (55.5%) and methotrexate (40.1%). Initial therapy with multiple DMARD (15.6%) or single DMARD and corticosteroid combinations (30.7%) was infrequent. Formal assessment measures were noted infrequently, including the Health Assessment Questionnaire (34.6%) and Disease Activity Score for 28 joints (8.9%). CONCLUSION: Initial pharmacotherapy is consistent with guidelines from the period. The infrequent reporting of multiple DMARD combinations and formal assessment measures has implications for current clinical management and warrants contemporary reassessment.
22931121 Profiling anti-cyclic citrullinated peptide antibodies in patients with juvenile idiopathi 2012 Aug 29 BACKGROUND: Anti-citrullinated protein/peptide antibodies (ACPA), have high specificity for rheumatoid arthritis (RA). Some children with juvenile idiopathic arthritis (JIA), phenotypically resemble RA and test positive for rheumatoid factor (RF) a characteristic biomarker of RA. We investigated the prevalence of ACPA and its relationship to other serologic markers associated with RA in a well-characterized JIA cohort. METHODS: Cases were 334 children with JIA, 30 of whom had RF + polyarticular JIA. Sera from all cases and 50 healthy pediatric controls were investigated by ELISA at a single time point for anti-cyclic citrullinated peptide (anti-CCP) IgG, RF IgM, IgA and IgG, anti-RA33 IgG, and antinuclear antibodies (ANA). Comparisons between cases and controls were made using Chi-square or Fisher exact tests and T-tests. RESULTS: The prevalence of RF was 8% among controls, and 12% among cases (ns). The prevalence of ACPA was 2% in controls and 14.3% in cases (OR 8.2, p <0.01). Children who were ACPA-positive and RF-negative (n = 23) had a significantly earlier onset-age (4.6 years vs. 12.1 years, p <0.00001) and had fewer HLA-DRB1 shared epitope alleles than those positive for both RF and ACPA (n = 25). Prevalence of anti-RA33 was not different between cases and controls. CONCLUSIONS: ACPAs are detectable in 14% of children with JIA. Children with positive ACPA but negative RF are frequent, and may define a distinct subset of children with JIA. ACPA testing should be included in the classification of JIA.
21985823 Antiarthritic activity of majoon suranjan (a polyherbal Unani formulation) in rat. 2011 Sep BACKGROUND & OBJECTIVES: Majoon Suranjan (MS) is a polyherbal formulation used in Unani system of medicine for the treatment of rheumatoid arthritis (RA). The present study evaluates the antiarthritic efficacy of this formulation in three different experimental models. METHODS: The anti-inflammatory activity of MS (in doses of 450, 900 and 1800 mg/kg body wt) was evaluated using the turpentine oil induced paw oedema model and the antiarthritic efficacy was evaluated using the formaldehyde and complete Freund's adjuvant (CFA) induced arthritis models. Aspirin (100 mg/kg body wt) was used as the standard drug in all the models. In order to assess the safety of the test drug, oral acute and 28 day toxicity studies were also carried out. RESULTS: MS produced a dose dependent protective effect in all the experimental models. Its antiarthritic efficacy was comparable to aspirin in formaldehyde induced arthritis and was superior to aspirin in turpentine oil induced paw oedema and CFA induced arthritis. MS also inhibited the delayed increase in joint diameter as seen in control and aspirin treated animals in CFA induced arthritis. Oral LD 50 of MS was found to be >5000 mg/kg in rats. Chronic administration did not produce any significant physiological changes in the tested animals. INTERPRETATION & CONCLUSIONS: Results of the present study suggest that the antiarthritic activity of MS was due to the interplay between its anti-inflammatory and disease modifying activities, thus supporting its use in traditional medicine for the treatment of RA.
21288961 Prevalence of spondyloarthritis and its subtypes in southern Sweden. 2011 Jun OBJECTIVE: To estimate the prevalence of spondyloarthritis and its subtypes. METHODS: The Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar years 2003-7, all residents aged ≥ 15 years in the southernmost county of Sweden (1.2 million inhabitants) diagnosed by a physician with spondyloarthritis (ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory arthritis associated with inflammatory bowel disease (Aa-IBD) or undifferentiated spondylarthritis (USpA)) were identified. To obtain valid point estimates of prevalence by the end of 2007, identification numbers were cross-referenced with the population register to exclude patients who had died or relocated. RESULTS: The authors estimated the prevalence of spondyloarthritis (not including chronic reactive arthritis) as 0.45% (95% CI 0.44% to 0.47%). The mean (SD) age of patients with prevalent spondyloarthritis by the end of 2007 was 53 (15) years. Among the component subtypes, PsA accounted for 54% of cases, AS 21.4%, USpA 17.8% and Aa-IBD 2.3% with a prevalence of 0.25%, 0.12%, 0.10% and 0.015%, respectively. The remaining 6.4% had some form of combination of spondyloarthritis diagnoses. The prevalence of spondyloarthritis at large was about the same in men and women. However, the subtype PsA was more prevalent in women and AS was more prevalent in men. CONCLUSION: In Sweden the prevalence of spondyloarthritis leading to a doctor consultation is not much lower than rheumatoid arthritis. PsA was the most frequent subtype followed by AS and USpA, and the two most frequent subtypes PsA and AS also display some distinct sex patterns.
22819090 Early psoriatic arthritis. 2012 May Psoriatic arthritis is an inflammatory musculoskeletal disease associated with psoriasis that is usually seronegative for rheumatoid factor. Psoriatic arthritis affects men and women equally, usually during the fourth decade, although it may affect children and octogenarians. Psoriatic arthritis may lead to deformities, joint damage, reduced quality of life and function. Early detection and treatment may prevent untoward outcomes.
21455765 Antisynthetase syndrome. 2011 Jun Autoantibodies to eight of the aminoacyl-transfer RNA synthetases-the most well-recognized of which is anti-histidyl (Jo-1)-have all been implicated in the pathogenesis of antisynthetase syndrome (AS). AS is characterized by varying degrees of interstitial lung disease, myositis, arthropathy, fever, Raynaud's phenomenon, and mechanic's hands, and the morbidity and mortality of the disease are usually linked to the pulmonary findings. The value of a lung biopsy in AS cannot be overemphasized, as it serves to describe the underlying etiology of the interstitial lung disease, guide therapy, and estimate prognosis. Muscle disease shares many clinical features of polymyositis, yet histologically, the inflammatory involvement resembles that of dermatomyositis. Because inflammatory arthritis mimics rheumatoid arthritis, AS should be considered in atypical cases. Corticosteroids are the mainstay of acute therapy, although treatment often requires immunosuppressant medications such as cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, or rituximab.
23097751 Pregnancy amelioration of arthritis in SKG mice corresponds with alterations in serum amyl 2012 Jun 30 OBJECTIVES: Pregnancy leads to rheumatoid arthritis remission in humans. The objective of this study was to determine if the SKG mouse could serve as a model for pregnancy-associated inflammatory arthritis amelioration. In addition, the maternal peripheral blood mononuclear cell (PBMC) transcriptome was assessed to define a biomarker associated with remission. METHODS: Cohorts of zymosan-treated pregnant SKG mice and controls were monitored for arthritis progression. Microarray analysis evaluated alterations in gene expression in maternal PBMCs at embryonic day 14.5 (E14.5) between arthritic and pregnancy-remitted mice. A selected target, serum amyloid A3 (SAA3), was further investigated using quantitative reverse transcriptase PCR (qRT-PCR) and an enzyme-linked immunosorbent assay (ELISA). RESULTS: Pregnancy resulted in complete or partial remission in the majority of the zymosan-treated SKG mice. Twenty-seven transcripts were differentially expressed in the PBMCs between arthritic and pregnancy-remitted mice. Expression and plasma SAA3 levels decreased with pregnancy-induced arthritis amelioration and plasma SAA3 levels correlated with arthritis severity. CONCLUSIONS: These results establish the SKG mouse as a model system to study pregnancy-induced amelioration of arthritis. These studies also establish SAA3 as a biomarker of arthritis amelioration in SKG mice. This model can be used to elucidate the molecular and cellular mechanisms underlying the impact of pregnancy on the maternal immune system that results in arthritis amelioration.
21722498 Ultrasound imaging for the rheumatologist XXXIII. Sonographic assessment of the foot in ea 2011 May OBJECTIVES: To investigate the ability of ultrasonography (US) to detect synovitis in metatarsophalangeal joints (MTP) in patients with suspicion of early arthritis, and to discriminate between diagnoses. METHODS: Patients referred to early arthritis clinics for differential diagnosis were enrolled, and clinical and laboratory measures were recorded. Ultrasonography of MTPs was performed searching for synovial hypertrophy (SH), joint effusion (JE) and power Doppler (PD), graded from 0 to 3 on a semi-quantitative scale. Patients were classified according to definite classification criteria, or as undifferentiated arthritis or non-inflammatory pathology. US findings were compared across different diagnoses and diagnostic accuracy was calculated taking clinical diagnosis as reference. RESULTS: Out of 427 patients (71% rheumatoid arthritis (RA), 20% undifferentiated arthritis (UA), 15% spondyloarthritides (SpA), 13% non-inflammatory), 307 (71.9%) showed SH, 120 (25.5%) JE, 77 (18.0%) PD. RA patients had median JE, SH and PD scores significantly higher than non-inflammatory and other diseases. Patient with UA and SpA had higher scores of SH and JE compared to non-inflammatory, no significant differences were present among different diagnosis. In RA, SH and JE were more frequently detected in the second MTP, and PD in the fifth. Crystal-related arthritis showed a tendency towards a more frequent involvement of the first MTP. The diagnostic accuracy of single US measures was moderate, but the detection of a PD of 2 or more provided a high specificity for the diagnosis of RA. CONCLUSIONS: US can be used as additional information in patients evaluated in an early arthritis setting. High scores of JE, SH and PD, together with the pattern of involvement are suggestive of RA.
22774981 K/B×N serum transfer arthritis is delayed and less severe in leukaemia inhibitory factor 2012 Aug This study is investigating the role of leukaemia inhibitory factor (LIF) in the development of inflammation and joint damage in the mouse K/B×N serum transfer arthritis model. LIF knock-out (LIF(-/-)) mice were generated by mating heterozygote females (LIF(+/-)) with heterozygote males. Arthritis was induced in 8-20-week-old LIF knock-out mice (LIF(-/-)) by intraperitoneal injection of pooled K/B×N sera (50 µl) on days 0 and 2. Clinical disease was scored daily for 6 days. Safranin-O and haematoxylin-stained sections were scored for synovitis, joint space exudate, cartilage degradation and bone damage. RNA was extracted from ankle joints and used to investigate gene expression levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1, LIF, LIF receptor, oncostatin M (OSM), OSM receptor, IL-6 and their common receptor subunit gp130 by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The results show that wild-type mice developed severe clinically overt polyarthritis. In contrast, LIF(-/-) mice showed a more than 50% reduction in clinical arthritis severity. Significantly lower histological scores were observed in LIF(-/-) mice compared to wild-type disease controls. LIF(-/-) mice had histopathological scores that were similar to normal healthy mice. IL-6 subfamily cytokine and receptor subunit expression remained unchanged. The expression levels for IL-6 were reduced significantly in all the diseased mice, whether wild-type or LIF(-/-) mice (P < 0·001), compared to healthy wild-type mice. We conclude that LIF contributes to the development of disease in the K/B×N serum transfer model of arthritis. These results provide further evidence for the role of LIF in inflammation and cartilage bone resorption and provide impetus to test the effects of LIF blockade as a therapeutic strategy in rheumatoid arthritis.
23030670 Lactobacillus casei and Lactobacillus acidophilus regulate inflammatory pathway and improv 2013 Jan In view of well-established immunomodulatory properties of Lactobacillus, present investigation was carried out to evaluate antioxidant and anti-inflammatory potential of Lactobacillus casei and Lactobacillus acidophilus, against inflammatory pathway and oxidative stress developed in an experimental model of arthritis. Collagen-induced arthritis (CIA) model was used. Oral administration of L. casei, L. acidophilus, standard antiarthritic drug indomethacin, and vehicle were started after induced arthritis and continued up to day 28. Interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-1β, IL-17, IL-4, and IL-10 levels were estimated in serum. In parallel, oxidative stress parameters were also measured from synovial effsuate. All rats were graded for arthritis score at the end of each week. L. casei, L. acidophilus, and indomethacin treatment significantly downregulated proinflammatory and upregulated anti-inflammatory cytokines at P<0.0001. They have significantly decreased oxidative stress in synovial effsuate (P<0.0001) and also arthritis score (P<0.05). Protection provided by L. casei and L. acidophilus was more pronounced than that of indomethacin. These lines of evidence suggest that L. casei and L. acidophilus exert potent protective effect against CIA. It further establishes effective anti-inflammatory and antioxidant properties of Lactobacillus. However, additional clinical investigations are needed to prove the efficacy of Lactobacillus in treatment/management of rheumatoid arthritis.
22933386 Collagen antibody-induced arthritis evokes persistent pain with spinal glial involvement a 2012 Dec OBJECTIVE: Pain is one of the most debilitating symptoms reported by rheumatoid arthritis (RA) patients. While the collagen antibody-induced arthritis (CAIA) model is used for studying the effector phase of RA pathologic progression, it has not been evaluated as a model for studies of pain. Thus, this study was undertaken to examine pain-like behavior induced by anticollagen antibodies and to assess the effect of currently prescribed analgesics for RA. In addition, the involvement of spinal glia in antibody-induced pain was explored. METHODS: CAIA was induced in mice by intravenous injection of a collagen antibody cocktail, followed by intraperitoneal injection of lipopolysaccharide. Disease severity was assessed by visual and histologic examination. Pain-like behavior and the antinociceptive effect of diclofenac, buprenorphine, gabapentin, pentoxifylline, and JNK-interacting protein 1 were examined in mechanical stimulation experiments. Spinal astrocyte and microglia reactivity were investigated by real-time polymerase chain reaction and immunohistochemistry. RESULTS: Following the induction of CAIA, mice developed transient joint inflammation. In contrast, pain-like behavior was observed prior to, and outlasted, the visual signs of arthritis. Whereas gabapentin and buprenorphine attenuated mechanical hypersensitivity during both the inflammatory and postinflammatory phases of arthritis, diclofenac was antinociceptive only during the inflammatory phase. Spinal astrocytes and microglia displayed time-dependent signs of activation, and inhibition of glial activity reversed CAIA-induced mechanical hypersensitivity. CONCLUSION: CAIA represents a multifaceted model for studies exploring the mechanisms of pain induced by inflammation in the articular joint. Our findings of a time-dependent prostaglandin and spinal glial contribution to antibody-induced pain highlight the importance of using appropriate disease models to assess joint-related pain.
21113809 Melatonin attenuates clock gene cryptochrome1, which may aggravate mouse anti-type II coll 2012 Feb Very recently, the circadian rhythm was proved to play an important role in the pathogenesis of arthritis. The role of melatonin in the development and progress of rheumatoid arthritis has been implicated for decades. This study was aimed to investigate the effect of melatonin on the expression of circadian clock genes in mouse anti-type II collagen antibody-induced arthritis (CIA). Mice were divided into 3 groups: control, CIA, and CIA + melatonin treatment (MLT). Both mRNA and protein levels of circadian clock gene Cryptochrome1 (Cry1) were markedly decreased in CIA + MEL group compared with those in control and CIA groups. MLT increased paw thickness. Histologic and X-ray assessment also revealed increased infiltration of inflammatory cells, synovial hyperplasia, and the destruction of articular cartilage and bone by MLT. The concentrations of anti-type II collagen antibody in CIA + MEL group mice were significantly higher than those in control and CIA groups (P < 0.05). Serum concentrations of TNF-α (P < 0.005) and IL-6 (P < 0.05) in CIA + MLT group were also increased. Taken together, these results implicate that clock gene Cry1 may be involved in the aggravation of MLT-mediated arthritis in mice anti-type II collagen antibody-induced arthritis.
21467745 Changes in expression of hepatic cytochrome P450 subfamily enzymes during development of a 2011 Apr An animal model of rheumatoid arthritis can be elicited in male Lewis rats by a single intradermal injection of liquid paraffin containing dead Mycrobacterium tuberculosis (MT adjuvant) into the planar surface of the right hind-foot. In the present study, we used this animal model to examine the changes in expression of hepatic cytochorme P450 (CYP) enzymes during the development of the arthritis. Swellings of the MT adjuvant-injected hind-foot initially occurred at 1-8 days after the injection. Thereafter, the swelling gradually become more severe up to 13 days later and was maintained for up to 25 days. Swellings of the other hind-foot was also observed after 12 days and gradually become more severe up to 15 days with maintenance of the severe swelling for up to 25 days. The gene expression levels and enzyme activities of hepatic CYP 3A and CYP2B subfamily enzymes at 1, 12, and 25 days after the MT adjuvant injection were significantly decreased, compared with the corresponding time-matched controls. The decreases in the gene expression levels and activities of all the enzymes examined were closely correlated with increases in the expression levels of the inflammatory cytokines, tumor necrosis factor (TNF)-α, interleukin (IL)-1α, interleukin-1β and interleukin-6, which were produced in the liver. All of the present findings demonstrate that hepatic CYP3A and CYP2B subfamily enzymes are decreased during the development of MT adjuvant-induced arthritis and further suggest that the decreases are dependent on the production of inflammatory cytokines in the liver.
22653553 The relationships between adult juvenile idiopathic arthritis and employment. 2012 Sep OBJECTIVE: The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient- and disease-specific factors on education and employment outcomes in a group of adult patients with JIA. METHODS: We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA. RESULTS: The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P = 0.03) and in those with oligoarticular JIA (t = 2.29, P = 0.02). Educational achievement was not influenced by JIA subtype (F = 1.18, P = 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F = 11.63, P = 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t = 10.94, P = 6.36 × 10(-16) ). CONCLUSION: Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.
22134197 The N-methyl-d-aspartic acid receptor antagonist memantine ameliorates and delays the deve 2012 The neuroendocrine impact on rheumatoid arthritis is not yet fully described although numerous neurotransmitters are shown to act as inflammatory modulators. One of these is the excitatory transmitter glutamate (Glu). In this study, the influence of the Glu receptor (GluR)-mediated effects on collagen-induced arthritis (CIA) was investigated. CIA was induced in DBA/1 mice by immunization with chicken collagen type II (CII). Mice were exposed to the following GluR antagonists: group 1, the N-methyl-D-aspartic acid (NMDA) receptor channel blocker memantine; group 2, the metabotropic GluR antagonist AIDA, and group 3, the excitatory amino acid receptor antagonist kynurenic acid (KA). Arthritis was evaluated clinically and histologically and compared to PBS-treated controls. The effects of treatment on T cell populations and the levels of anti-CII and anti-citrullinated peptide antibodies were evaluated. Memantine treatment significantly improved the course of CIA, reducing synovitis (p = 0.007) and the frequency of erosions (p = 0.007). Memantine treatment up-regulated the expression of Foxp3 in spleen CD4+ T cells followed by an increase in CD4+CD25+ regulatory T cells. The other GluR antagonists, AIDA and KA, had no effect on CIA. These results demonstrate that blockade of the NMDA receptor channel with memantine delays and attenuates the development of arthritis, probably by promoting the development of regulatory T lymphocytes.
23149634 [Validity and reliability of the Portuguese version of the Pain Coping Inventory]. 2012 Apr OBJECTIVE: To analyze the validity and reliability of the Portuguese version of the Pain Coping Inventory (PCI) in order to perform a cultural adaptation to permit its use in Portuguese population of non-oncological chronic pain patients. METHODS: The PCI was translated to Portuguese and then again to English; moreover a spoken reflection was made. 180 participants with clinical diagnosis associated to chronic pain (namely, fibromyalgia and rheumatoid arthritis) were asked to fill in the self-report measure. Procedures of exploratory factorial analysis, confirmatory factorial analysis, and internal consistency were performed. RESULTS: Based on the methodological procedures, results have shown evidence of a factorial structure comprised by five factors which assess distinct chronic pain coping strategies namely, withdrawal, worrying, distraction, pain transformation, and reducing demands. CONCLUSIONS: The Portuguese version of PCI has shown evidence of validity and reliability which supports the relevance of its use in both research and clinical context.
21710854 Synovial fluid adenosine deaminase activity to diagnose tuberculous septic arthritis. 2011 Mar There are reports of a correlation between high adenosine deaminase (ADA) levels in body fluid and tuberculosis (TB) infection, but none have evaluated synovial fluid ADA and TB arthritis. The objectives of this study were to determine the proper cut-off level for synovial fluid adenosine deaminase (SF-ADA) and the sensitivity and specificity of SF-ADA to diagnose TB arthritis. Between January 2006 and December 2007, SF-ADA were determined using the modified Giusti's method on patients over 15 years of age with clinically suspected TB arthritis or having an unknown etiology of their arthritis. Synovial fluid culture for TB was performed in all patients as a gold standard test. Forty cases were included in the study, with a female to male ratio of 1.7:1 and a mean age of 52.3 +/- 17.4 years (range, 16-80). The median duration of symptoms was 60 days. The prevalence of TB arthritis was 16.7% (6 cases) while the remaining cases were rheumatoid arthritis (8), non-TB bacterial septic arthritis (3), and miscellaneous (23). The mean SF-ADA levels in patients with TB arthritis and non-TB arthritis were 35.7 +/- 10.4 (range, 20-51) and 15.4 +/- 9 (range, 2-34) U/1, respectively. The cut-off value for the diagnosis of TB arthritis was 31 U/1, with a sensitivity of 83.3% (95% CI 35.9-99.6), a specificity of 96.7% (95% CI 82.8-99.9) and an agreement Kappa of 0.8 (p < 0.001). SF-ADA levels higher than 31 U/1 were highly correlated with a diagnosis of TB arthritis, with a high sensitivity and specificity. SF-ADA may be considered as a less invasive and time-consuming diagnostic tool for TB arthritis.
22263211 Idiopathic chronic calcific periarthritis in a child. 2011 Nov Calcific periarthritis is a calcium deposition disease of the periarticular tissues. Deposits of calcium from calcific periarthritis can be found in the periarticular tissues of the shoulders, hips, elbows, wrists, and knees. This disease is often the manifestation of another primary process, such as end-stage renal disease, collagen vascular disease, and systemic diseases (eg, diabetes mellitus, rheumatoid arthritis), among others. Furthermore, calcific periarthritis has been linked to certain areas of the body because of pathologic stress related to repetitive motions, microtrauma, and local hypoxia. This type of soft-tissue mass is usually found in older men and women. In addition, its incidence, calcium deposits related to calcific periarthritis, and soft-tissue masses in general, are rare in children. Here we present the first report of idiopathic chronic calcific periarthritis in a child. The diagnosis was suspected on the basis of clinical and radiographic appearance and despite the rarity of the disease in children. The patient underwent surgical treatment and was free of local recurrence. The cause of this case was never determined.