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ID PMID Title PublicationDate abstract
28497220 CT-P10 (Truximaâ„¢): A Rituximab Biosimilar. 2017 Jun CT-P10 (Truximaâ„¢) is the first biosimilar of the reference monoclonal anti-CD20 antibody rituximab. It is approved for use in all indications for which reference rituximab is approved, including follicular lymphoma (FL), diffuse large B-cell non-Hodgkin's lymphoma, chronic lymphocytic leukaemia, rheumatoid arthritis (RA), granulomatosis with polyangiitis and microscopic polyangiitis. CT-P10 has similar physicochemical and pharmacodynamic properties to those of reference rituximab, and the pharmacokinetic biosimilarity of the agents has been shown in patients with RA or FL. CT-P10 demonstrated clinical efficacy equivalent to that of reference rituximab in patients with RA, and was generally well tolerated in this population as well as in patients with FL. The tolerability, immunogenicity and safety profiles of CT-P10 were similar to those of reference rituximab, and switching from reference rituximab to CT-P10 had no impact on safety or efficacy. The role of reference rituximab in the management of autoimmune conditions and cancers is well established and CT-P10 provides an effective biosimilar alternative for patients requiring rituximab therapy.
28484205 Clinical Outcome Evaluation of Primary Total Knee Arthroplasty in Patients with Diabetes M 2017 May 9 BACKGROUND The aim of this study was to evaluate the safety and clinical outcome of primary total knee arthroplasty in patients with diabetes mellitus. MATERIAL AND METHODS Among the patients who were treated with total knee arthroplasty, there were 98 patients (116 knees) associated with diabetes. Osteoarthritis was diagnosed in 90 patients and rheumatoid arthritis was diagnosed in 8 patients. Various degrees of preoperative knee deformities were found in 82 knees. The average fasting blood glucose was 9.8±3.6 mmol/L at admission. RESULTS The clinical efficacy of TKA was satisfactory in patients with diabetes mellitus. Diabetic patients do not seem to have a significantly higher risk for infection and DVT after TKA. At the final follow-up time point, no prosthesis loosening was found and no revision was needed in any patients. The mean HSS scores increased and the excellent rate was 100%. CONCLUSIONS Using perioperative comprehensive assessment of heart and lung function, and by preventing infection and the formation of DVT, we achieved satisfactory early clinical efficacy of TKA in patients with diabetes mellitus.
28203681 Small but mighty: Platelets as central effectors of host defense. 2017 Apr 3 Platelets actively participate in inflammatory processes and drive diseases such as atherosclerosis, rheumatoid arthritis and cancer metastasis. However, platelets also have anti-inflammatory and anti-infective properties, which have received less consideration in the past. In this review, we highlight recent findings on the role of platelets in host defense and describe regulatory pathways modulating immune responses. Furthermore, we discuss the role of platelets for the resolution of inflammation and tissue repair. These conceptual changes contribute to our understanding of platelet biology in disease.
29259741 2-Arylidene Hydrazinecarbodithioates as Potent, Selective Inhibitors of Cystathionine γ-L 2017 Dec 14 Hydrogen sulfide is produced from l-cysteine by the action of both cystathionine γ-lyase (CSE) and cystathionine β-synthase (CBS) and increasingly has been found to play a profound regulatory role in a range of physiological processes. Mounting evidence suggests that upregulation of hydrogen sulfide biosynthesis occurs in several disease states, including rheumatoid arthritis, hypertension, ischemic injury, and sleep-disordered breathing. In addition to being critical tools in our understanding of hydrogen sulfide biology, inhibitors of CSE hold therapeutic potential for the treatment of diseases in which increased levels of this gasotransmitter play a role. We describe the discovery and development of a novel series of potent CSE inhibitors that show increased activity over the benchmark inhibitor and, importantly, display high selectivity for CSE versus CBS.
29230082 Recent Advances in ADAM17 Research: A Promising Target for Cancer and Inflammation. 2017 Since its discovery, ADAM17, also known as TNFα converting enzyme or TACE, is now known to process over 80 different substrates. Many of these substrates are mediators of cancer and inflammation. The field of ADAM metalloproteinases is at a crossroad with many of the new potential therapeutic agents for ADAM17 advancing into the clinic. Researchers have now developed potential drugs for ADAM17 that are selective and do not have the side effects which were seen in earlier chemical entities that targeted this enzyme. ADAM17 inhibitors have broad therapeutic potential, with properties ranging from tumor immunosurveillance and overcoming drug and radiation resistance in cancer, as treatments for cardiac hypertrophy and inflammatory conditions such as inflammatory bowel disease and rheumatoid arthritis. This review focuses on substrates and inhibitors identified more recently for ADAM17 and their role in cancer and inflammation.
28404567 Accidental hydroxychloroquine overdose resulting in neurotoxic vestibulopathy. 2017 Apr 12 Hydroxychloroquine is an oral antimalarial medication commonly used off-label for a variety of rheumatological conditions, including systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and dermatomyositis. We present a case of a 64-year-old woman who presented with acute onset headache, bilateral tinnitus, and left-sided facial numbness and tingling in the setting of accidentally overdosing on hydroxychloroquine. By the next morning, the patient began to experience worsening in the tingling sensation and it eventually spread to her left arm, thigh and distal extremities. The patient also complained of new onset blurring of her peripheral vision and feeling 'off balance.' Despite a complete neurological and ophthalmological work-up with unremarkable imaging and blood work, the patient has had no improvement in her tinnitus, left-sided paresthesias, visual disturbance or ataxia. This is a unique case of hydroxychloroquine overdose resulting in permanent neurotoxic vestibulopathy.
28351454 Mechanistic Insights into Gold Organometallic Compounds and their Biomedical Applications. 2017 Mar 29 The application of gold in medicine can be traced back several thousand years and Au(i) compounds have been used in the treatment of rheumatoid arthritis since the last century. Recently research into gold-based drugs for a number of human diseases has seen a renaissance due to their markedly different modes of action with respect to the classical platinum chemotherapeutic compounds. Within this research area, organometallic gold complexes have been particularly explored, mainly due to their higher stability in physiological conditions guaranteed by the presence of a direct Au-C bond. Thus, a number of compounds have been tested for their uses as anticancer, antibacterial, antiprotozoal as well as anti-HIV agents. In this review a selection of the main results obtained on the synthesis, chemical properties and biological activities of two of the most explored families of organometallics - Au(i) N-heterocyclic carbenes (NHCs) and cyclometalated Au(iii) compounds - are summarized. Their structure-activity relationships and modes of action at the cellular level are also discussed, which constitute the basis for future drug design.
28148916 Innate lymphoid cells in autoimmunity: emerging regulators in rheumatic diseases. 2017 Mar Innate lymphoid cells (ILCs) are important in the regulation of barrier homeostasis. These cells do not express T cell receptors but share many functional similarities with T helper cells and cytotoxic CD8(+) T lymphocytes. ILCs are divided into three groups, namely group 1 ILCs, group 2 ILCs and group 3 ILCs, based on the transcription factors they depend on for their development and function, and the cytokines they produce. Emerging data indicate that ILCs not only have protective functions but can also have detrimental effects when dysregulated, leading to chronic inflammation and autoimmune diseases, including asthma, inflammatory bowel disease, graft-versus-host disease, psoriasis, rheumatoid arthritis and atopic dermatitis. Elucidation of the cytokine pathways involved in various autoimmune diseases - and the identification of ILCs as potent producers of these cytokines - points towards a potential role for these cellular players in the pathophysiology of these diseases. In this Review we discuss the current knowledge of the role of ILCs in the pathogenesis of rheumatic and other autoimmune diseases.
27786419 Medical arthroscopy: A tool for diagnosis and research in rheumatology. 2017 Feb Arthroscopy is an important diagnostic procedure which can be used in rheumatology practice to provide direct visualization of the joint cavity, permitting macroscopic evaluation of the synovium, sampling for histopathologic and microbiologic examination and the potential therapeutic benefit of lavage. The term 'medical arthroscopy' is used here to refer to arthroscopy performed by rheumatologists for these purposes. This term differentiates arthroscopy performed by orthopedic surgeons for structural interventions such as meniscal debridement and ligament repair. Medical arthroscopy finds a place in rheumatology as an aid to diagnosis, to confirm the presence of synovitis when not expected, to provide histologic or microbiologic diagnosis, and potential stratification for therapy, for example in rheumatoid arthritis, as well as a range of other research purposes. It is performed with local anesthetic using a small bore arthroscope, most usually inserted into the knee, although the wrist and metacarpophalangeal joints may also be inspected in this way. In experienced hands it is well tolerated, safe and complications are comparable to those reported by orthopedic surgeons.
29257293 Proteomic analysis of synovial fluid in osteoarthritis using SWATH‑mass spectrometry. 2018 Feb The lack of early diagnostic maneuvers and effective pharmacotherapy for osteoarthritis (OA) is predominantly attributed to current limited understanding of its pathogenesis. In the present study, the alteration of synovial fluid (SF) proteome in OA were analyzed using SWATH‑mass spectrometry (SWATH‑MS) to further elucidate the pathogenesis of OA. SF samples were collected from 10 OA and 10 rheumatoid arthritis (RA) patients undergoing arthroplasty and 10 patients undergoing arthroscopy for traumatic arthritis (meniscus injury without cartilage lesion). According to the Kellgren‑Lawrence (KL) radiographic grading criteria, all the OA and RA patients were classified as KL grade 4. SWATH‑MS was applied to identify differentially expressed proteins specifically regulated in OA. Differentially expressed proteins identified by SWATH‑MS were subjected to gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation. Proteins of interest were quantified by enzyme‑linked immunosorbent assay (ELISA) following identification. With the use of SWATH‑MS, 131 proteins were identified to be differentially expressed in OA, of which 93 corresponded to upregulation and 38 to downregulation. Complement C1r was the most significantly upregulated protein in OA. Twenty‑eight out of the 131 proteins were specifically regulated in OA, of which 17 were upregulated and 11 were downregulated. Dickkopf‑related protein 2 (DKK2) was one of the proteins specifically upregulated in OA. Furthermore, KEGG pathway annotation indicated that differentially expressed proteins in OA were enriched in complement and coagulation cascades. ELISA indicated that OA severity was positively correlated with the levels of complement C1r (r=0.549; P<0.001) and DKK2 (r=0.79; P<0.001) in the SF. The results indicate that complement and coagulation cascades are involved in the pathogenesis of OA. Differentially expressed proteins, including complement C1r and DKK2 may be used as potential biomarkers or drug targets, which may facilitate with intervention of OA.
28612459 Detection of dermatological abnormalities in the rheumatology clinic using a standardized 2018 Feb AIM: To develop a standardized practical screening tool for rheumatologists to assess for underlying dermatological manifestations of rheumatic conditions. METHODS: A relevant screening tool was developed by consensus between dermatology and rheumatology authors. Patients visiting the general rheumatology clinic for routine care were systematically assessed based on the standardized screening tool. RESULTS: One hundred patients were recruited with 76 being female. The most prevalent rheumatic conditions seen in the clinic were rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus. The standardized integumentary assessment took a mean of 2.75 (SD 1.61) min. Most patients, 74%, reported no concerns with their hair or nails, while 60% reported no concerns with their skin. The majority of patients had one abnormality identified, 65%, and of those diagnoses, most affected the skin with 71% of patients having an identified skin abnormality, compared with the hair (10%) or nails (13%). CONCLUSION: The standardized integumentary assessment tool can be successfully incorporated into routine clinical practice for rheumatologists without significant extension of consultation time and may detect relevant abnormalities important for diagnosis which may have been unnoticed by patients. It may encourage collaborative care and enhance clinical outcomes.
27863164 Telerheumatology: A Systematic Review. 2017 Oct OBJECTIVE: To identify and summarize the published and gray literature on the use of telemedicine for the diagnosis and management of inflammatory and/or autoimmune rheumatic disease. METHODS: We performed a registered systematic search (CRD42015025382) for studies using MEDLINE (1946 to July 2015), Embase (1974 to July 2015), Web of Science (1900 to July 2015), and Scopus (1946 to July 2015) databases. We included studies that demonstrated the use of telemedicine for diagnosis and/or management of inflammatory/autoimmune rheumatic disease. Following data extraction, we performed a descriptive analysis. RESULTS: Our literature search identified 1,468 potentially eligible studies. Of these studies, 20 were ultimately included in this review. Studies varied significantly in publication type, quality of evidence, and the reporting of methods. Most demonstrated a high risk of bias. Rheumatoid arthritis was the most commonly studied rheumatic disease (42% of patients). Studies demonstrated conflicting results regarding the effectiveness of telemedicine (18 found it effective, 1 found it effective but possibly harmful, and 1 found it ineffective). A limited number of studies included some component of a cost analysis (n = 6; 16% of patients); all of these found telemedicine to be cost-effective. CONCLUSION: Studies identified by this systematic review generally found telemedicine to be effective for the diagnosis and management of autoimmune/inflammatory rheumatic disease; however, there is limited evidence to support this conclusion. Further studies are needed to determine the best uses of telemedicine for the diagnosis and management of these conditions.
27966012 [Surface replacement of proximal interphalangeal joints using CapFlex-PIP]. 2017 Feb OBJECTIVE OF SURGERY: The cementless implantation of the surface replacement CapFlex-PIP enables pain relief, preservation of motion, improves lateral stability and corrects axis deviation in proximal interphalangeal (PIP) joints of patients with primary and secondary PIP osteoarthritis. INDICATIONS: Painful PIP joints as a result of degenerative or posttraumatic osteoarthritis with restriction of motion. Secondary inflammatory destruction of PIP joints in rheumatoid arthritis with low inflammatory activity and good bone conditions. CONTRAINDICATIONS: Destruction of PIP joints with severe bone loss, osseous defects and chronic joint luxation. Joint destruction induced by florid or subacute bacterial arthritis. Skin infections. SURGICAL TECHNIQUE: Dorsal or palmar incision over the affected PIP joint while sparing the peritendinous tissue. Exposure of the proximal phalangeal head and meticulous bone resection. Precontouring of the bone bed for proximal prosthesis. Insertion of the trial prosthesis. Exposure of the distal base and resection in the correct axis. Determination of distal prosthesis size and height of the polyethylene inlay. Insertion of the trial prosthesis without bone protrusion. After clinical and radiological control, implantation of the final prosthesis. FOLLOW-UP: Long finger splint, palmar flexor support splint for 2-3 weeks with active mobilization. Then active free mobilization with a twin bandage. After 6 weeks radiological check and free functional mobilization. RESULTS: The active range of motion of 50 patients increased from 43.4° before surgery to 55.9° after 1 year with concomitant pain relief (6.5 to 2.2). In one case revision surgery was required due to traumatic rupture of the radial collateral ligament and four secondary tenolyses were performed.
29403442 Lactobacillus helveticus SBT2171 Attenuates Experimental Autoimmune Encephalomyelitis in M 2017 We recently reported that Lactobacillus helveticus SBT2171 (LH2171) inhibited the proliferation and inflammatory cytokine production of primary immune cells in vitro, and alleviated collagen-induced arthritis (CIA) in mice, a model of human rheumatoid arthritis (RA). In this study, we newly investigated whether LH2171 could relieve the severity of experimental autoimmune encephalomyelitis (EAE), a murine model of multiple sclerosis (MS), which is an autoimmune disease, but develop the symptoms by different mechanisms from RA. In MS and EAE, main cause of the disease is the abnormality in CD4(+) T cell immunity, whereas in RA and CIA, is that in antibody-mediated immunity. The intraperitoneal administration of LH2171 significantly decreased the incidence and clinical score of EAE in mice. LH2171 also reduced the numbers of pathogenic immune cells, especially Th17 cells, in the spinal cord at the peak stage of disease severity. Interestingly, before the onset of EAE, LH2171 administration remarkably decreased the ratio of Th17 cells to CD4(+) T cells in the inguinal lymph nodes (LNs), where pathogenic immune cells are activated to infiltrate the central nervous system, including the spinal cord. Furthermore, the expression of interleukin (IL)-6, an inflammatory cytokine essential for Th17 differentiation, decreased in the LNs of LH2171-administered mice. Moreover, LH2171 significantly inhibited IL-6 production in vitro from both DC2.4 and RAW264.7 cells, model cell lines of antigen-presenting cells. These findings suggest that LH2171 might down-regulate IL-6 production and the subsequent Th17 differentiation and spinal cord infiltration, consequently alleviating EAE symptoms.
28647490 Sex-biased eicosanoid biology: Impact for sex differences in inflammation and consequences 2017 Dec 1 The incidence, severity and progression of autoimmune diseases (e.g. scleroderma, multiple sclerosis, rheumatoid arthritis) and certain inflammatory diseases (e.g. asthma) are sex-biased where these pathologies dominate in women. However, other immune disorders such as sepsis, post-surgery infections and gout display higher incidence and severity in men. The molecular and cellular basis underlying this sex dimorphism remains incompletely elucidated but may provide important insights for sex-specific pharmacotherapy. Nevertheless, the sex as a variable in biochemical and preclinical research on inflammation is often neglected. Thus, respective animal studies are routinely performed with males, and experiments with isolated cells rarely report the sex of the donor. However, sex differences on the cellular level do exist, in particular related to inflammatory processes that prompt for sex-specific appreciation of inflammation research. For instance, the biosynthesis of pro-inflammatory eicosanoids is sex-biased where leukotriene (LT) formation is under control of testosterone that regulates the subcellular localization of the key enzyme 5-lipoxygenase, with possible implications for gender-tailored pharmacotherapy of LT-related disorders (i.e. asthma). Moreover, prostaglandin (PG) production is sex-biased, and sex-dependent efficacy of aspirin was evident in several clinical trials. Here, we highlight the sex bias in eicosanoid biology possibly underlying the obvious sex disparities in inflammation, stimulating scientists to take sex into account when studying the pathophysiology and pharmacotherapy of inflammatory diseases.
29083070 Breastfeeding and autoimmunity: Programing health from the beginning. 2018 Jan Breast milk is not only a completely adapted nutrition source for the newborn but also an impressive array of immune-active molecules that afford protection against infections and shape mucosal immune responses. Decisive imprinting events might be modulated during the first months of life with potential health long-term effects, enhancing the importance of breastfeeding as a major influence on the immune system correct development and modifying disease susceptibility. The aim of this review was to clarify the link between breastfeeding and autoimmune diseases, inquiring the related mechanisms, based on data available in the literature. Being breastfed was associated with a lower incidence of diabetes, celiac disease, multiple sclerosis and asthma, explained by the protection against early infections, anti-inflammatory properties, antigen-specific tolerance induction, and regulation of infant's microbiome. The protective role of human milk in idiopathic juvenile arthritis, rheumatoid arthritis, and inflammatory bowel diseases remains controversial. On the other hand, the breastfeeding mother faces a health-challenging period in life. High levels of prolactin may lead either to the development of autoimmune diseases in susceptible mothers or exacerbations of current immune-mediated disorders. These features raise the question if mothers with autoimmune diseases, mainly systemic lupus erythematosus, should avoid breastfeeding.
28457528 Disease associations with isolated elevations of each of the four IgG subclasses. 2017 Oct PURPOSE: Immunoglobulin G4-related disease (IgG4-RD) is a relatively newly defined disease entity that refers to a group of immune-mediated disorders that have certain histopathologic, serologic, and clinical features in common. IgG4-RD is often associated with elevated serum IgG4. The discovery of IgG4-RD highlights the scarcity of literature examining elevations in other IgG subclasses and their potential associations to disease. In this retrospective chart review study, we aim to address that gap, by exploring disease associations in patients with isolated IgG subclass elevations. METHODS: We identified 552 patients with an isolated elevation of one of the IgG subclasses, and performed a systematic chart review to identify the diagnoses of those patients. We examined the distribution of diagnoses, using the Fisher's exact test to determine if a diagnosis was significantly associated with an isolated elevation in one of the subclasses. RESULTS: Autoimmune pancreatitis, aspirin-exacerbated respiratory disease (AERD), nasal polyps, eosinophilia, and celiac disease were significantly associated with an isolated elevation in IgG4. Hepatitis C and monoclonal gammopathy were significantly associated with isolated elevations in IgG1. Rheumatoid arthritis (RA) was associated with both an isolated elevation in IgG1 and IgG3. Hypothyroidism and irritable bowel syndrome (IBS) were significantly associated with isolated elevations in IgG2. CONCLUSION: These results confirmed some established associations between autoimmune pancreatitis, AERD, nasal polyps, and eosinophilia and elevated serum IgG4, and between monoclonal gammopathy and hepatitis C with elevated serum IgG1. It uncovered novel associations between RA and elevated IgG1 and IgG3, hypothyroidism and IBS and elevated IgG2, and between celiac disease and elevated IgG4.
28676830 Nyctanthes arbor-tristis Ameliorated FCA-Induced Experimental Arthritis: A Comparative Stu 2017 Nyctanthes arbor-tristis (NAT) is commonly used traditionally for the treatment of rheumatism and inflammatory diseases. Current study evaluates the antiarthritic potential of NAT using Freund's adjuvant-induced arthritic rat model. Treatments with methanolic, ethyl acetate, and n-hexane extracts were continued for consecutive 20 days. Macroscopic arthritic scoring and water displacement plethysmometry were used to evaluate arthritic development. Hematological and biochemical parameters were investigated and ankle joints were processed for histopathological evaluation. Qualitative phytochemical analysis and GC-MS analysis were conducted for identification of constituents. NAT extracts suppressed arthritic scoring, paw edema, infiltration of inflammatory cells, pannus formation, and bone erosion. The plant extracts ameliorated total leukocytes and platelet counts and nearly normalized red blood cells (RBC) counts and hemoglobin (Hb) content. The extracts were found safe in terms of hepatotoxicity and nephrotoxicity as determined by aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and urea levels. Comparative analysis showed that ethyl acetate extract produced the highest inhibition of paw edema. The major constituents found in ethyl acetate extract can be classified into three major classes, that is, terpenes, terpenoids, fatty acids, and iridoid glycosides. Current study showed that Nyctanthes arbor-tristis ameliorated experimental rheumatoid arthritis and ethyl acetate extract possessed the highest inhibitory activity.
28215968 Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthr 2017 Jun BACKGROUND: Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up. METHODS: A retrospective review was performed of all patients 75 years and older who underwent UKA or TKA at our institution between 2002 and 2012. All TKA preoperative X-rays were reviewed by a blind observer to identify knees with isolated medial compartmental arthritis considered acceptable candidates for UKA. Patients with less than 2 years of follow-up, flexion contracture greater than 10°, and rheumatoid arthritis were excluded. The final sample included 120 UKA (106 patients) and 188 TKA (170 patients) procedures. Patient records were reviewed to determine early postoperative recovery, complications, reoperations for any reason, and implant survivorship. RESULTS: UKA patients experienced significantly shorter operative time, shorter hospital stay, lower intraoperative estimated blood loss, lower postoperative transfusions, greater postoperative range of motion, and higher level of activity at time of discharge. Two UKA and 2 TKA patients required revision surgery. There was no statistically significant difference in postoperative Knee Society Scores. There were no differences in 5-year survivorship estimates. CONCLUSION: Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.
28176230 Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis. 2017 May OBJECTIVE: To evaluate the post treatment changes in disease activity and inflammatory markers over time in longitudinal follow-up involving different subtypes of juvenile idiopathic arthritis (JIA) patients. METHODS: This prospective longitudinal study, carried out over a period of 2 y, included JIA patients, both old and new, with high disease activity. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, CHAQ (Childhood Health Assessment Questionnaire) score and JADAS27 (Juvenile Arthritis Disease Activity score with 27 active joint counts) were estimated at the initial visit, 6 mo, 12 mo and 18 mo of follow-up. RESULTS: Out of 40 patients, 10 had persistent oligoarthritis, 11 had rheumatoid factor (RF) positive polyarthritis, 8 had RF negative polyarthritis and 11 had systemic JIA. Twenty-one of them were females. Serum ferritin was highly elevated in systemic JIA patients with a range of 750-7712 ng/ml at the initial visit. All three inflammatory markers with disease activity score decreased significantly over 18-mo-period in all four subtypes. At any visit, all these parameters had largest value in systemic arthritis and least in oligoarthritis variety. At 18 mo, all oligoarthritis and polyarthritis cases had low or inactive disease while none of the systemic JIA patients achieved inactive disease. Elevated ESR and serum ferritin was found in all at 18 mo. CRP normalized in some with low or moderate disease activity. CONCLUSIONS: Inflammatory markers and disease activity decreased in all subtypes of JIA with treatment without biologics. Acute phase markers often remain elevated in inactive disease state. Similarly, normal level of an inflammatory marker does not necessarily indicate absence of active disease.