Bibliography May 2001

  1. Anonymous[In Process Citation]. Vestn.Oftalmol. 2001, 117:30-33.
    Abstract:     Variability of clinical manifestations of rheumatoid uveitis, possibility of an atypical course (peripheral or panuveitis), and greater severity and specific features of the disease in case of its early (before the age of 3 years) manifestation are demonstrated on the basis of observations of 79 patients with rheumatoid uveitis. Despite systemic therapy with corticosteroids and cytostatics, no manifest post-steroid immunodeficiency was observed. Moderately expressed gammapathies were detected in 60% cases; hypoimmune states predominated, which were more often detected in children aged under 6 years. No cases of pronounced suppression of functional activity of lymphocytes were observed. Humoral and cellular response to persistent ophthalmotropic infections were observed more rarely than in children with uveitis of other etiology. Positive rheumatoid factor was detected in 9% cases, antinuclear antibodies in 60%. Antibodies to DNA were detected in the sera of 10% examinees, to native and denatured DNA in the lacrimal fluid of 21.2 and 16.7%, respectively. The causes of absence of obvious post-steroid immunodeficiency and relatively low rate of interorgan autosensitization in children with juvenile rheumatoid arthritis and uveitis are discussed. Further investigation of clinical and immunological correlations are needed for improving the prediction of the course of rheumatoid uveitis and development of treatment strategy


    Internet : PM:11339037

  2. BEKKERING WP, TEN CATE R, SUIJLEKOM-SMIT LWA, MUL D, VAN DER VELDE EA, VAN DEN ENDE CHM: The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis. Rinsho Ganka 2001, 28:1099-1105.
    Organism:W.P. Bekkering, Department of Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden
    Abstract:     Objective. Knowledge about the impact of joint impairment on functional ability is needed in planning care and setting treatment goals in children with juvenile idiopathic arthritis (JIA). We investigated the relationship between joint impairments and upper and lower limb function. Methods. Twenty-one children with systemic JIA with an average age of 9.2 years and a mean disease duration of 4.8 years participated in this study. Joint impairments were assessed by the following variables: joint counts on swollen (JCS) and tender (JCT) joints and the loss of joint motion as determined by the Joint Alignment and Motion scale (JAM). Functional performance and functional ability were determined by the Juvenile Arthritis Functional Assessment Scale (JAFAS) and Childhood Health Assessment Questionnaire (CHAQ), respectively. The relationship between impairments and functional disabilities was studied at the level of (1) the complete instruments, (2) upper and lower limb function separately, and (3) the individual joints and items. Results. Regarding complete instruments, the Spearman rank correlation between functional disabilities and loss of joint motion was moderate to good (JAM/CHAQ rSUBs = 0.66, JAM/JAFAS rSUBs = 0.77). A fair correlation was found between functional disabilities and the joint count on swollen joints (JCS/CHAQ rSUBs = 0.45, JCS/JAFAS rSUBs = 0.52), but no significant relationship was found with the number of tender joints (JCT/CHAQ rSUBs = 0.02, p > 0.05, and JCT/JAFAS rSUBs = 0.14, p > 0.05). At the extremity level (upper and lower limb function), the relationship between functional disabilities and the loss of joint motion appeared to be stronger in the leg than in the arm. At the level of the individual joints and questionnaire items, loss of joint motion in hip or shoulder joint appeared to be the most important factor in predicting limitation in leg or arm function. Conclusion. Our study shows that with respect to joint impairments, loss of joint motion is the strongest indicator of functional disability in children with systemic JIA. Loss of joint motion has a greater effect on lower limb function

  3. BENEZRA D, COHEN E, MAFTZIR G: Patterns of intraocular inflammation in children. Bull.Soc.Belge Ophtalmol. 2001, 35-38.
    Organism:Pediatric Ophthalmology and Immuno-Ophthalmology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel benezra@md2hujiacil
    Abstract:     AIM: To report on the causes of uveitis in children and young adults and their effects on visual functions. MATERIALS AND METHODS: Two hundred and seventy six patients, 18 years old or younger, with uveitis were included in this study. The intraocular inflammation (uveitis) was classified according to anatomical site of ocular involvement and the most probable etiological factor. The final diagnosis was based on clinical manifestations and the results of specific laboratory investigations. RESULTS: Bilateral intraocular inflammation was observed in 70.3% of the cases and 29.7% had either the left or the right eye involved. The symptomatology was relatively mild in most cases despite the fact that the visual acuity was markedly affected. An associated systemic disease was detected in 40.2% of the cases classified as non-infectious. Of this group, juvenile rheumatoid arthritis was the most common single systemic associated cause detected in 41 children. In 110 children (59.8%), the uveitis was strictly confined to the eyes with 70 of these (25.4% of the total group) classified as idiopathic. Parasites were the most common infectious-associated cause for the uveitis followed by viruses and bacteria. CONCLUSION: Uveitis is highly prevalent among children. In children, symptomatology of the intraocular inflammation may be very mild. However, visual acuity is markedly reduced leading to amblyopia in the young children. Early detection and treatment is therefore of utmost importance


    Internet : PM:11344713

  4. BONDESON J, MAINI RN: Tumour necrosis factor as a therapeutic target in rheumatoid arthritis and other chronic inflammatory diseases: the clinical experience with infliximab (REMICADE). Int.J.Clin.Pract. 2001, 55:211-216.
    Organism:Kennedy Institute of Rheumatology Division, Imperial College School of Medicine, 1 Aspenlea Road, London W6 8LH, UK
    Abstract:     Therapeutic strategies that aim to neutralise the important pro-inflammatory cytokine tumour necrosis factor alpha (TNF alpha) have gained considerable prominence in the therapy of chronic inflammatory diseases, notably rheumatoid arthritis and Crohn's disease. This drug focus review will concentrate on the antitumour necrosis factor antibody infliximab (Remicade), which has been approved for the treatment of rheumatoid arthritis and Crohn's disease in both the US and Europe. In addition, infliximab is under investigation for several other indications, mainly inflammatory rheumatic diseases. Clinical trials have been persuasive that infliximab is both safe and effective, and it has been proven to be far superior to the conventional drug therapy in both rheumatoid arthritis and Crohn's disease. Remarkably, infliximab in combination with methotrexate controls both the inflammatory joint symptoms and the progression of joint damage, which renders it a very attractive therapeutic option in moderate to severe, therapy-resistant rheumatoid arthritis


    Internet : PM:11351775

  5. CHKIRATE B, JOB-DESLANDRE C: [Fibroblastic rheumatism: a case report]. Arch.Pediatr. 2001, 8:389-392.
    Organism:Service de pediatrie IV, hopital d'Enfants, centre hospitalier universitaire, lbn Sina, Rabat, Maroc
    Abstract:     Fibroblastic rheumatism is a rare entity. Nineteen cases were reported in the literature, and among them, only one in a child. CASE REPORT: Cam. (born August 19, 1988) had an onset of disease in October 1996 with nodules on the MCP and PIP, elbows and tibia, with partial improvement after three months. In April 1997, she suffered from arthralgia and stiffness of both wrists, and then of the big toes. X-rays showed destructive and erosive lesions on both wrists and on the PIP of the second and third fingers and the big toes. Laboratory investigations disclosed normal values for ESR and CRP and negative results for ANA and RF. The diagnosis of fibroblastic rheumatism was based on the typical histologic pattern of a nodule. The treatment associated colchicin and rehabilitation. In August 1998, the wrists' stiffness began to improve, though the big toes remained totally stiff. The radiologic erosive lesions did not show progress. COMMENTS: The diagnosis of fibroblastic rheumatism is based on the histologic pattern of the nodules. The erosive evolution of the arthropathies is infrequent (8/15 cases in adults). Juvenile onset is very rare; only one case has been reported, in a 10-year-old boy. The mechanism of the disease remains unknown. As it is very rare, the therapeutic strategies are not well established. CONCLUSION: This disease should be considered among the causes of juvenile arthritis with erosion


    Internet : PM:11339131

  6. CRAWLEY E, KON S, WOO P: Hereditary predisposition to low interleukin-10 production in children with extended oligoarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2001, 40:574-578.
    Organism:Department of Molecular Pathology, University College London Medical School, 46 Cleveland Street, London W1T 4JF, UK
    Abstract:     OBJECTIVE: To determine whether children with extended oligoarticular juvenile idiopathic arthritis (JIA) produce less of the anti-inflammatory cytokine interleukin-10 (IL-10) than those with persistent oligoarticular JIA. METHODS: We measured IL-10 production in the parents of children with oligoarticular or extended oligoarticular JIA, from whole-blood cultures stimulated with lipopolysaccharide. RESULTS: IL-10 production was lower in the parents of children with extended oligoarticular JIA compared with those of children with oligoarticular JIA (P=0.034). There was an increase in the percentage of ATA-containing genotypes (i.e. genotypes ATA/ATA, ATA/ACC or ATA/GCC) in the parents of children with extended oligoarticular JIA compared with healthy controls (P<0.02) but not in the parents of children with oligoarticular JIA. CONCLUSIONS: As approximately 84% of the variation in IL-10 production is thought to be genetically regulated, these results suggest that stimulated IL-10 production would be lower in children with extended oligoarticular JIA. Because IL-10 is an anti-inflammatory cytokine, this may partly explain why this group of children has more severe disease


    Internet : PM:11371669

  7. EL CHENNAWI F, ADS AA-R, HASSAN AM: Differential contribution of HLA-DR, DQ to systemic lupus erythematosus susceptibility in Egyptian patients. Eur.J.Immunogen. 2001, 28:295
    Organism:Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura Egypt15th European Histocompatibility Conference
    Granada, Spain
    March 27-30, 2001

  8. GARCIA-CONSUEGRA MJ, MERINO MUN t: Treatment of idiopathic juvenile arthritis with intraarticular triamcinolone acetonide injections. Anales Espanoles de Pediatria 2000, 53:314-317.
    Organism:Dr. J. Garcia-Consuegra Molina, Unidad de Reumatologia Pediatrica, Hospital Infantil La Paz, 28046 Madrid
    Abstract:     Objective To evaluate the therapeutic response to intraarticular triamcinolone acetonide injections in patients with juvenile idiopathic arthritis. Method Eight-eight patients were prospectively evaluated after receiving one or more intraarticular triamcinolone acetonide injections. A total of 194 joints were injected: 68 joints in 39 children with oligoarticular onset juvenile idiopathic arthritis, 36 joints in 17 children with polyarticular onset, 67 joints in 20 children with systemic onset, and 23 joints in 12 children with spondyloarthropathy. Results Full resolution of signs of inflammation was achieved in 131 of 194 joints (67.5%). The percentage of remission was significantly lower in patients with systemic onset of the disease (36% versus 80% in the other groups). At the 6-month follow-up, 70% of the joints remained in remission. No significant complications were observed. Conclusion Intraarticular triamcinolone injections are safe and effective in children with chronic arthritis


    Internet : reumped@hulp.es

  9. GARCIA LA, ESPIGADO T, I: Autologous hematopoietic progenitor transplantation in autoimmune diseases
    <ORIGINAL> Trasplante autologo de progenitores liematopoyeticos en las enfermedades autoinmunes    . Revista Espanola de Reumatologia 2000, 27:355-359.
    Organism:Seccion de Reumatologia, Hospital Universitario Virgen del Rocio, Avda. Manuel Siurot, s/n., 41013, Sevilla Spain

  10. GEDALIA A, MENDEZ EA, CRAVER R, VEHASKARI M, ESPINOZA LR: Renal involvement in juvenile rheumatoid arthritis: Report of two cases. Journal of developmental and behavioral.pediatrics 2001, 20:153-156.
    Organism:Dr. A. Gedalia, Department of Pediatrics, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112-2822
    Abstract:     Renal involvement is a rare occurrence in juvenile rheumatoid arthritis (JRA). We report on two JRA patients with kidney disease. The first was a 14-year-old African-American female with a 12-month history of polyarthritis. On presentation she was found to have an ESR of 127 mm/h and a positive ANA, rheumatoid factor (RF), perinuclear antineutrophil cytoplasmic antibodies (pANCA), haematuria, proteinuria with normal BUN and creatinine. Renal biopsy showed focal segmental glomerulosclerosis. Her renal function deteriorated to end-stage renal failure requiring dialysis within a few months, despite aggressive treatment with steorids and monthly i.v. pulses of cyclophosphamide. The second patient presented with a 6-week history of polyarthritis and intermittent fever, and had a salmon-coloured evanescent rash. On presentation his laboratory evaluation was significant for elevated ESR and negative ANA, RF and ANCA tests. Within 8 months the patient had developed a persistent microscopic haematuria. Renal biopsy showed mild mesangial glomerulonephritis. On low-dose methotrexate therapy his JRA went into remission and his renal function remained normal. The haematuria persisted for 1 year and then resolved spontaneously. This is the first time that focal segmental glomerulosclerosis and mesangial glomerulonephritis have been described in JRA. Although the association may be just coincidental, further studies are needed to define the role of JRA in these renal conditions. In patients with JRA, urinalysis and renal function should be routinely monitored


    Internet : a61543@pol.net

  11. HOFER MF, MOUY R, PRIEUR A-M: Juvenile idiopathic arthritides evaluated prospectively in a single center according to the durban criteria. Rinsho Ganka 2001, 28:1083-1090.
    Organism:Dr. M.F. Hofer, Service de Pediatrie BHII, CHUV, CH-1011 Lausanne
    Abstract:     Objective. Chronic arthritis in children represents a nonhomogeneous group of diseases with unknown etiology. To classify these patients in well defined diagnostic categories, a task force of the International League Against Rheumatism proposed a new classification with precise criteria. We analyzed the new criteria in children with chronic arthritis. Methods. A cohort of children was prospectively and sequentially examined in a pediatric rheumatology clinic from April to June 1997. Results. One hundred ninety-four children fulfilled the criteria of juvenile idiopathic arthritis and 80% of them (155 children) were classified in one of the 6 diagnostic categories. Seventeen children (9%) did not fit any other category and 22 (11%) could be classified in more than one category. The proportion of children fitting only one category was much lower for psoriatic arthritis and enthesitis related arthritis than for the other categories. Conclusion. Based on the results, we propose some modifications to the classification criteria. This new classification is an important tool for the diagnosis of chronic arthritis in children, but the criteria need further adjustments to improve the percentage of patients classified in one defined category


    Internet : michael.hofer@chuv.hospvd.ch

  12. HUANG JL, KUO ML, HUNG IJ, WU CJ, OU LH, CHENG JH: Lowered IL-4-producing T cells and decreased IL-4 secretion in peripheral blood from subjects with juvenile rheumatoid arthritis. Chang Gung.Med.J. 2001, 24:77-83.
    Organism:Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu-Shin Street, Kweishan, Taoyuan, Taiwan, ROC long@cgmhorgtw
    Abstract:     BACKGROUND: To evaluate T helper 1 (Th1)/Th2 cells and cytokines in patients with three different subtypes of juvenile rheumatoid arthritis (JRA). METHODS: Peripheral blood was obtained from 25 children with JRA suffering from active arthritis (8 systemic, 9 pauciarticular and 8 polyarticular). Eight healthy children were recruited as controls. T helper cells from peripheral blood mononuclear cells (PBMC) were evaluated by using intracellular staining analysis of cytokine production with 3-colored flow cytometry. A Th1 cell was defined as an interferon-gamma (IFN-gamma) producing CD4+ cell, and a Th2 cell as an interleukin-4 (IL-4) producing CD4+ cell. The production of IL-2, IL-4, IL-5 and IFN-gamma from PBMC was measured by ELISA. RESULTS: In comparison with normal controls, the patients with JRA had significantly fewer Th2 cells among their PBMC (0.78 +/- 0.56% vs. 5.44 +/- 2.33%, p < 0.001). The percentage of Th1 cells among PBMC was not different between patients and normal controls (4.32 +/- 3.24% vs. 4.52 +/- 2.56%, p > 0.5). The ratio of Th1/Th2 cells in the patient group was significantly higher than the control group (8.38 +/- 8.63 vs. 0.95 +/- 0.66, p < 0.001). After 24-hour culture, the PBMC from JRA patients produced less IL-4 than that of controls (3.61 +/- 0.56 pg/mL vs. 4.29 +/- 0.68 pg/mL, p = 0.002). The production of IL-2, IL-5, and IFN-gamma did not show significant differences between JRA patients and normal controls. CONCLUSION: Decreased IL-4 producing T-helper cells were identified in all three subtypes of JRA. This implicates that an imbalance of Th sub-populations might be a predominant factor in JRA pathogenesis


    Internet : PM:11360405

  13. KOGAWA K, LEE S, VILLANUEVA J, MARMER D, FILIPOVICH AH: Facs analysis of perforin in cytotoxic lymphocytes from patients with Hemophagocytic Lymphohistiocytosis (HLH) and their family members. Medical and Pediatric Oncology 2001, 36:416
    Organism:National Defense Medical College, Tokorozawa Japan16th Annual Meeting of the Histiocyte Society held jointly with the Nikolas Symposium
    Amsterdam, Netherlands
    September 29-October 02, 2000

  14. MANUEL JC: Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis. J.Pediatr.Psychol. 2001, 26:237-246.
    Organism:Wake Forest University School of Medicine
    Abstract:     OBJECTIVE: To examine the importance of illness severity, child functional status, psychosocial stress, intrapersonal factors, stress processing, and social-ecological factors in predicting psychological symptoms among mothers of children with juvenile rheumatoid arthritis (JRA). METHODS: Mothers of 92 children with JRA completed surveys while waiting with their children for physician appointments or during JRA meeting breaks. RESULTS: Mothers reported higher mean levels of psychological symptoms than a normative group. Higher levels of psychosocial stress predicted increased psychological symptoms after accounting for disease severity and functional status. Maternal appraisal of the illness tended to moderate the relationship between illness stress and psychological symptoms, and maternal education moderated the relationship between daily hassles stress and psychological symptoms. CONCLUSIONS: These data indicate that mothers of children with JRA are at risk for psychological distress. Inteventions that take into account the buffering effects of maternal education and appraisal may serve to decrease the effects of maternal stress


    Internet : PM:11329483

  15. MARTINI A: Etanercept improves active polyarticular juvenile rheumatoid arthritis. Clin.Exp.Rheumatol. 2001, 19:122-124.
    Organism:Dipartimento di Scienze Pediatriche Universita di Pavia, Piazzale Golgi 2 27100 Pavia, Italy
    Internet : PM:11326472

  16. MODESTO C, WOO P, GARCIA-CONSUEGRA J, MERINO R, GARCIA-GRANERO M, ARNAL C, PRIEUR A-M: Systemic onset juvenile chronic arthritis, polyarticular pattern and hip involvement as markers for a bad prognosis. Clinical And Experimental Rheumatology 2001, 19:211-217.
    Organism:C. Modesto, Rheumatology Department, Hospital Vall d'Hebron, Barcelona
    Abstract:     Objective. To explore all the common clinical and biological variables that are characteristics of Systemic onset Juvenile Chronic Arthritis (SoJCA) in order to determine which of them are suitable as predictors of a bad articular outcome (persistence of inflammatory symptoms and/or established limitation of the range of motion (ROM). Material and methods. Clinical charts for 124 SoJCA patients were retrospectively reviewed. From them, 91 were finally included in the study because they had all of the clinical and biological data at disease onset properly recorded. All have been followed for at least 3 years since the beginning of the disease. Data collected at onset, and after 3 and 6 months of the disease included: 1) systemic symptoms; 2) joint involvement, using both the usual articular count and the value of an articular index (Helsinki Index = HI) which intentionally excludes those joints that are not uniformly recorded in clinical charts; and 3) biological data. HI was used to separate the patients into two groups. When applied 3 years after the disease onset, HI >= 10 represented a bad articular outcome while HI < 10 meant a good prognosis. SPSS for Windows 6.1 was used for both the univariate and multivariate analyses. Results. From the multivariate logistic regression analysis, two different "clusters" of clinical data were found to be the best predictors of a bad articular outcome. A bad prognosis was linked at onset with the presence of generalized lymphadenopathies, age < 8 years and an HI > 6; at six months a bad outcome was linked with the presence of a polyarticular pattern plus hip involvement. Conclusion. Clinical parameters at the beginning of the disease were shown to be extremely useful in predicting the articular outcome of SoJCA. Therefore, they could constitute a good instrument to help clinicians tailor the best therapy for their patients

  17. MOORE TB, SHERRY D, DEODHAR A, TILFORD DL, JOHNSON FL, JONES GR, NICHOLSON HS, THOMAS GA, WOLFF LJ, BRADY K: Stem cell transplantation for severe juvenile rheumatoid arthritis. Blood 2000, 96:373b
    Organism:Pediatric Hematology/Oncology, Oregon Health Sciences University, Portland, OR USA
    Abstract:     Autologous stem cell transplantation offers potential as a treatment for refractory juvenile rheumatoid arthritis (JRA). We report our experience in the treatment of a ten year old girl with an eight year history of severe systemic JRA using high dose cytotoxic/immunosuppressive therapy and autologous CD34+ selected stem cell support. Initially diagnosed at 2 years of age, her JRA was completely refractory to conventional therapy including corticosteroids, methotrexate and low dose cyclophosphamide. Pain reduction including narcotics was ineffective. She required biannual corticosteroid injections of as many as 24 joints at a time. Peripheral blood stem cells were collected after 5 days of 10 mcg/kg/d of G-CSF. There was no exacerbation of arthritis during the G-CSF administration. Four collections and CD34+ selection were performed yielding a final product of 2 X 10e6 CD34+ cells/kg and less than 10e5 CD3+ cells/kg. Conditioning prior to stem cell infusion consisted of ATG 20 mg/kg, cyclophosphamide 200 mg/kg and TBI 400 cGy. She achieved neutrophil engraftment by day 17 and platelet transfusion independence by day 18. Serologic markers of her JRA including C-reactive protein became normal. She was readily weaned off all pain medications by 4 months and tapered off prednisone rapidly over the first month to 5 mg/d, and by 7 months following transplant was off all immunosuppressive drugs. She is currently pain-free and off all medications. The affected joint count dropped from greater than 11 (pre-transplant) to zero. The Karnoffsky score is currently 100. By 6 months post-transplant, she had normal IgG, IgM, and IgA levels, and normal B cell number. There was a normal proliferative response to mitogens PHA, CON-A, and PWM. T cells show a persistent inversion of the helper-suppresser ratio with a follow up of 8 months

    42nd Annual Meeting of the American Society of Hematology
    San Francisco, California, USA
    December 01-05, 2000
    American Society of Hematology_

  18. PATHAN EM, OAK JL, JAKAREDDY R, SATHE S, KEJRIWAL A: Upper airway obstruction due to cricoarytenoid arthritis in a case of systemic onset juvenile rheumatoid arthritis. J.Assoc.Physicians India 2001, 49:566-567.
    Organism:Department of Medicine, LTM Medical College, Sion, Mumbai
    Internet : PM:11361275

  19. PETTY RE: Growing pains: The ILAR classification of juvenile idiopathic arthritis. Rinsho Ganka 2001, 28:927-928.
    Organism:Dr. R.E. Petty, Division of Rheumatology, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4

  20. RAVELLI A, CARIA MC, BURATTI S, MALATTIA C, TEMPORINI F, MARTINI A: Methotrexate as a possible trigger of macrophage activation syndrome in systemic juvenile idiopathic arthritis. J.Rheumatol. 2001, 28:865-867.
    Organism:Dipartimento di Scienze Pediatriche, Universita di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico S Matteo, Italy
    Abstract:     Macrophage activation syndrome (MAS) is a potentially life threatening complication of chronic rheumatic diseases, particularly systemic juvenile idiopathic arthritis (JIA). A number of triggers have been related to the development of MAS, including viral infections, nonsteroidal antiinflammatory drug therapy, and gold salt injections. We describe a patient with systemic JIA who developed MAS shortly after receiving methotrexate, suggesting that this drug can be regarded as a potential trigger of MAS in children with JIA


    Internet : PM:11327264

  21. ROMERO JM, COLLANTES EE: Associated fibromyalgia. Dolor 2000, 15:289-296.
    Organism:M. Romero Jurado, Servicio de Reumatologia, Hospital Universitario Reina Sofia, Av. Menendez Pidal, s/n, 14004 Cordoba
    Abstract:     Fibromyalgia is a form of non-articular rheumatism that presents with chronic diffuse musculoskeletal pain in addition to symptoms such as sleep and mood-related disorders. Fibromyalgia has been classified into various groups, namely: a) primary; b) secondary; c) concomitant; d) localized; e) senile and f) juvenile fibromyalgia. At present, this disease is diagnosed by using the 1990 classification criteria of the American College of Rheumatology (ACR). The term associated fibromyalgia is used to describe a clinical picture that meets the ACR criteria and where the disease is concomitant with another pathology with which it may or may not be related. In any case, special emphasis should always be placed on two final aspects, namely: a differential diagnosis with other entities included in its clinical spectrum that exhibit various manifestations and frequently lead to a confusing diagnosis in patients presenting with pain in the musculoskeletal system; also, the clinician should determine whether the disease occurs in isolation or associated to other pathologies such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, the Sjogren syndrome, rheumatic polymyalgia, etc. Both aspects are highly significant with a view to ensuring accurate diagnosis and treatment

  22. SAILA HM, SAVOLAINEN HA, KOTANIEMI KM, KAIPIAINEN-SEPPANEN OA, LEIRISALO-REPO MT, AHO KV: Juvenile idiopathic arthritis in multicase families. Clinical And Experimental Rheumatology 2001, 19:218-220.
    Organism:H.A. Savolainen, Rheumatism Foundation Hospital, FIN-18120 Heinola
    Abstract:     Objective. To characterize juvenile idiopathic arthritis (JIA) patients from multicase families. Methods. The study series comprised 80 affected siblings belonging to 37 families. Comparisons were made with a population-based series of JIA patients from Finland and with a sibling series from the United States. Results. The distribution of cases according to onset type was similar in the sibling and population-based series. The age at diagnosis was significantly lower in the sibling series (4.8 years vs 7.4 years; p < 0.001). There was more intra-pair similarity in onset and course types in the United States series compared to the Finnish series and the proportion of girls was higher in the former. Conclusion. The only significant difference between familial and sporadic cases with JIA is an earlier onset of disease in familial cases. There is no essential difference in clinical features of the disease between patients in the multicase and sporadic groups. Differences between the Finnish and US series may be due to selection bias in the latter

  23. SAVOLAINEN A, SAILA H, NISSINEN R, PALOSUO T, AHO K: C-reactive protein as measured by a sensitive enzymelinked immunosorbent assay in patients with juvenile idiopathic arthritis [12]. Clinical And Experimental Rheumatology 2001, 19:235
    Organism:Dr. A. Savolainen, Rheumatism Foundation Hospital, 18120 Heinola

  24. SEYMOUR HE, WORSLEY A, SMITH JM, THOMAS SHL: Anti-TNF agents for rheumatoid arthritis. British Journal of Clinical Pharmacology 2001, 51:201-208.
    Organism:H.E. Seymour, Reg. Drug and Therapeutics Centre, Wolfson Unit, Claremont Place, Newcastle upon Tyne NE2 4HH
    Abstract:     Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disease with a prevalence of approximately 1% and an annual incidence of 0.04%. Up to 50% of patients with RA are unable to work 10 years after diagnosis. The disease is associated with significant morbidity and mortality with associated medical costs to the UK of between Pound Sterling240 M and Pound Sterling600 M per year. Non steroidal anti-inflammatory drugs (NSAIDs) have little effect on the underlying course of RA, but they have some anti-inflammatory and analgesic properties. Disease modifying antirheumatic drugs (DMARDs) have been shown to slow progression of RA and are currently recommended early in the course of treatment of RA which is when disease progression is most rapid. Etanercept and infliximab belong to a new group of parentally administered antitumour necrosis factor (TNF) drugs. Etanercept is licensed in the UK for the treatment of active rheumatoid arthritis in patients who have not responded to other DMARDs and in children with polyarticular-course juvenile arthritis who have not responded to or are intolerant of methotrexate. In adults it produces significant improvements in all measures of rheumatic disease activity compared to placebo. In patients whose disease remains active despite methotrexate treatment, further improvement in control is obtained with the addition of etanercept without an increase in toxicity. In one small trial, etanercept was found to be more effective than placebo in a selected group of children. Infliximab is a monoclonal antibody which is currently licensed in the UK for Crohn's disease and, in combination with methotrexate for the treatment of rheumatoid arthritis in patients with active disease when the response to disease-modifying drugs, including methotrexate, has been inadequate. In clinical trials infliximab produced significant improvements in all measures of rheumatic disease activity compared with placebo. Infliximab in combination with methotrexate was shown to be superior to methotrexate or infliximab alone. There are currently no predictors of a good response to anti-TNF drugs and a percentage of patients fail to respond to treatment (25% to 38% of etanercept patients; 21% to 42% of infliximab patients). Infliximab monotherapy induces the production of anti-infliximab antibodies, which may reduce its effectiveness. Adding methotrexate to infliximab therapy may prevent this response. Anti-TNF drugs may affect host defences against infection and malignancy; whether these agents affect the development and course of malignancies and chronic infections is unknown and safety and efficacy in patients with immunosuppression or chronic infections has not been investigated. With infliximab, upper respiratory tract infections, general infections and those requiring antimicrobial treatment were more common in patients than placebo. Likewise, upper respiratory tract infections were more common in patients treated with etanercept than with placebo. Injection site reactions occur with both infliximab (16%-20%) and etanercept (37%). There are approximately 600 000 patients with RA in the UK, and of these between 2% and 3.5% may have severe disease which has failed to respond to conventional treatment and who might be eligible for anti-TNF therapy. If between 50% and 70% of patients treated with anti-TNF drugs respond and continue on long-term treatment then the recurrent annual cost to the NHS could be between Pound Sterling48 M and Pound Sterling129 M


    Internet : h.e.seymour@ncl.ac.uk

  25. THASTUM M, ZACHARIAE R, HERLIN T: Pain experience and pain coping strategies in children with juvenile idiopathic arthritis. Rinsho Ganka 2001, 28:1091-1098.
    Organism:Prof. M. Thastum, Institute of Psychology, Aarhus University, Asylvej 4, DK8240 Risskov
    Abstract:     Objective. To compare reactions to cold pressor pain and pain coping strategies of patients with juvenile idiopathic arthritis (JIA), healthy children, and their parents. Methods. We studied 16 children with JIA and one of their parents and 14 healthy children and one of their parents. Patients with JIA were selected from the patient population by fulfilling criteria for inclusion in a "high pain" group (n = 7) of patients with modest clinical arthritis activity, but who presented daily reports of pain in connection with everyday activities, and a "low pain" group (n = 9) who presented significant clinical arthritis activity, but who had only a few complaints of pain related to everyday activities. Dependent variables included pain threshold, discomfort, intensity and tolerance to cold pressor pain, and pain coping strategies. Results. Patients with JIA exhibited significantly lower mean pain tolerance than healthy children. Disease duration correlated with both experimental and clinical pain measures, and JIA patients used significantly more Behavioral Distraction than healthy children. Correlations were found between children's and parents' use of Approach and Distraction related coping strategies. Correlations were also found for the coping strategy of Catastrophizing in the JIA patient group. For experimental pain coping strategies, a significant correlation was found between the JIA patients' and their parents' use of Distraction. For the JIA patients Positive Self-statements and Behavioral Distraction were inversely correlated with the clinical pain measures. In both children and parents the experimental pain coping strategies of Catastrophizing and Distraction were associated with the experimental pain response measures, and low pain JIA patients tended to use more Distraction pain coping strategies than high pain patients. Conclusion. The results indicate that JIA patients may differ from healthy children with regard to their responses to experimental pain as well as to their use of pain coping strategies. Pain coping strategies of JIA patients were associated with pain coping strategies of their parents, and use of pain coping strategies was associated with both experimental and clinical pain experience


    Internet : mikael@psy.au.dk

  26. THOMPSON SD, LUYRINK LK, GRAHAM TB, TSORAS M, RYAN M, PASSO MH, GLASS DN: Chemokine Receptor CCR4 on CD4(+) T Cells in Juvenile Rheumatoid Arthritis Synovial Fluid Defines a Subset of Cells with Increased IL-4:IFN-gamma mRNA Ratios. J.Immunol. 2001, 166:6899-6906.
    Organism:William S Rowe Division of Rheumatology, Children's Hospital Medical Center, Cincinnati, OH 45229
    Abstract:     To understand the mechanisms that promote recruitment and survival of T cells within the pediatric inflamed joint, we have studied the expression of CCR4 and CCR5 on synovial fluid T cells and matched peripheral blood samples from juvenile rheumatoid arthritis (JRA) patients using three-color flow cytometric analysis. Th


    Internet : PM:11359851

  27. WARGULA JC, LOVELL DJ: Use of etanercept in children. Bulletin on the Rheumatic Diseases 2000, 49:1-4.
    Organism:William S. Rowe Division of Rheumatology, Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA

  28. WIHLBORG C, BABYN P, RANSON M, LAXER R: Radiologic mimics of juvenile rheumatoid arthritis. Pediatr.Radiol. 2001, 31:315-326.
    Organism:P. Babyn, Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8
    Abstract:     Established criteria for diagnosis of juvenile rheumatoid arthritis require consideration of a number of other joint arthropathies and arthritides. In this pictorial essay, we present an approach to those common and uncommon disorders that should be considered and may be mistaken for juventile rheumatoid arthritis


    Internet : paul.babyn@sickkids.on.ca

  29. WULFFRAAT NM, KUIS W: Treatment of refractory juvenile idiopathic arthritis. Rinsho Ganka 2001, 28:929-931.
    Organism:Dr. N.M. Wulffraat, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508AB Utrecht
    Internet : N.Wulffraat@wkz.azu.nl