Bibliography May 2002

 
  1. BILLIAU AD, CORNILLIE F, WOUTERS C: Infliximab for systemic onset juvenile idiopathic arthritis: Experience in 3 children [7]. Rinsho Ganka 2002, 29:1111-1114.
    Organism:Dr. A.D. Billiau, Pediatric Rheumatology, University Hospital Gasthuisberg, Leuven

  2. BLACK APB, BHAYANI H, RYDER CAJ, GARDNER-MEDWIN JMM, SOUTHWOOD TR: T-cell activation without proliferation in juvenile idiopathic arthritis. Arthritis Research 2002, 4:177-183.
    Organism:Prof. T.R. Southwood, Department of Rheumatology, University of Birmingham, St. Vincent's Drive, Edgbaston, Birmingham
    Abstract:     A study was done to determine if the differentiation and activation phenotype of T cells in synovial fluid (SF) from patients with juvenile idiopathic arthritis (JIA) is associated with T-cell proliferation in situ. Mononuclear cells were isolated from 44 paired samples of peripheral blood and SF. Differentiation and activation markers were determined on CD4 and CD8 T cells by flow cytometry. Cell-cycle analysis was performed by propidium iodide staining, and surface-marker expression was also assessed after culture of the T cells under conditions similar to those found in the synovial compartment. The majority of the T cells in the SF were CD45ROSUP+CD45RBSUPdull. There was greater expression of the activation markers CD69, HLA-DR, CD25 and CD71 on T cells from SF than on those from peripheral blood. Actively dividing cells accounted for less than 1% of the total T-cell population in SF. The presence or absence of IL-16 in T-cell cultures with SF or in a hypoxic environment did not affect the expression of markers of T-cell activation. T cells from the SF of patients with JIA were highly differentiated and expressed early and late markers of activation with little evidence of in situ proliferation. This observation refines and extends previous reports of the SF T-cell phenotype in JIA and may have important implications for our understanding of chronic inflammation
    Internet : t.r.southwood@bham.ac.uk

  3. BOECKX WD, DE LORENZI F, VAN DER HULST RR, SAWOR JH, VAN DE KT: Free fascia temporalis interpositioning as a treatment for wrist ankylosis. J.Reconstr.Microsurg. 2002, 18:269-274.
    Organism:Department of Plastic and Reconstructive Surgery, University Hospital of Maastricht, P Debyelaan 25, Postbus 8500, 6203 AZ Maastricht, The Netherlands
    Abstract:     The fascia temporalis is a thin and well-vascularized tissue and, for this reason, its use in reconstructive surgery is versatile. It can be used as an island flap in defects of the head and neck or as a free flap in reconstructions of different anatomic regions. As a "living" spacer in the treatment of wrist ankylosis, its use has not yet been described. The authors present the transfer of the free fascia temporalis into the wrist as a treatment of wrist ankylosis in patients affected by severe rheumatoid arthritis. Four flaps in three patients were performed. Preoperative flexion/extension in the wrist was absent or almost absent and painful, resulting in severely impaired daily activities. After resection of the distal ulna, distal radius, and the proximal surfaces of the proximal row of the carpal bones was performed, the free fascia was used to replace the wrist joint. Postoperative wrist flexion/extension was 45 to 50 degrees on average. In all patients, this procedure allowed painless motion of the wrist, and in all patients, daily activities were improved. A 2-year follow up showed no recurrence of wrist problems and a maintained articular space. In the treatment of wrist ankylosis, the use of the free fascia temporalis offers a good alternative to arthrodesis, maintaining sufficient function for daily activities
    Internet : PM:12022031

  4. BRUNNER HI, LOVELL DJ, FINCK BK, GIANNINI EH: Preliminary definition of disease flare in juvenile rheumatoid arthritis. Rinsho Ganka 2002, 29:1058-1064.
    Organism:Dr. H.I. Brunner, William S. Rowe Div. of Rheumatology, Cincinnati Children's Hospital, Medical Center PAV 2-I29, 3333 Burnet Avenue, Cincinnati, OH 45229
    Abstract:     Objective. To develop preliminary criteria for defining disease flare in patients with polyarticular-course juvenile rheumatoid arthritis (JRA). Methods. Data from a randomized clinical trial of etanercept in JRA (51 patients) and the 6 core response variables (CRV) for JRA were used to derive flare definitions. The criterion standard of flare was treatment with placebo. Candidate flare definitions were assessed by receiver-operator characteristic (ROC) curve properties and other statistics for diagnostic tests. Results. Of the possible flare definitions tested with acceptable statistical properties, the one that seemed to be the most useful was worsening in any 2/6 CRV by >= 40% without improvement in more than 1 of the remaining CRV by >= 30%. Two other superior flare definitions were (1) worsening in 3/6 CRV by >= 30% and (2) any worsening of the Childhood Health Assessment Questionnaire, worsening of erythrocyte sedimentation rate by >= 30% and worsening of the active joint count by >= 10%. Conclusions. CRV are useful for defining flare in JRA. Worsening in any 2/6 CRV by >= 40% without concomitant improvement of more than one of the remaining CRV by >= 30% appears to be the most suitable preliminary flare definition. Because the proposed flare criteria were derived from a small number of patients, it is essential to perform more definitive testing of this and several alternative flare definitions in larger patient populations
    Internet : brus9z@chmcc.org

  5. BURGOS-VARGAS R, RUDWALEIT M, SIEPER J: The place of juvenile onset spondyloarthropathies in the Durban 1997 ILAR classification criteria of juvenile idiopathic arthritis. Rinsho Ganka 2002, 29:869-874.
    Organism:Dr. R. Burgos-Vargas, Faculty of Medicine, Hospital General de Mexico, Univ. Nacional Autonoma de Mexico, Dr Balmis 148, Mexico DF 06726
    Internet : burgosv@attglobal.net

  6. CHIKANZA IC: Juvenile rheumatoid arthritis: therapeutic perspectives. Paediatr.Drugs 2002, 4:335-348.
    Organism:Bone and Joint Research Unit, St Bartholomew's and Royal London School of Medicine and Dentistry, and Department of Paediatrics, Royal London Hospital, London, United Kingdom
    Abstract:     Juvenile rheumatoid arthritis (JRA) is the most common childhood chronic systemic autoimmune inflammatory disease. The therapeutic approach to JRA has, to date, been casual and based on extensions of clinical experiences gained in the management of adult rheumatoid arthritis (RA). The physiology of inflammation has been systemically studied and this has led to the identification of specific therapeutic targets and the development of novel approaches to the management of JRA. The classical treatments of the disease such as methotrexate, sodium aurothiomalate and sulfasalazine, are not always effective in controlling RA and JRA. This has necessitated the development of novel agents for treating RA, most of which are biological in nature and are targeted at specific sites of the inflammatory cascades. These biological therapeutic strategies in RA have proved successful and are being applied in the management of JRA. These developments have been facilitated by the advances in molecular biology which have heralded the advent of biodrugs (recombinant proteins) and gene therapy, in which specific genes can be introduced locally to enhance in vivo gene expression or suppress gene(s) of interest with a view to down-regulating inflammation. Some of these biodrugs, such as anti-tumor necrosis factor alpha (anti-TNFalpha), monoclonal antibodies (infliximab, adalimumab), TNF soluble receptor constructs (etanercept) and interleukin-1 receptor antagonist (IL-1Ra) have been tested and shown to be effective in RA. Etanercept has now been licensed for JRA. Clinical trials of infliximab in JRA are planned. Studies show that the clinical effects are transient, necessitating repeated treatments and the risk of vaccination effects. Anti-inflammatory cytokines such as IL-4, IL-10, transforming growth factor-beta and interferon-beta (IFN-beta) are undergoing clinical trials. Many of these agents have to be administered parenterally and production costs are very high; thus, there is a need, especially for pediatric use, to develop agents that can be taken orally. Long-term studies will be required to assess the tolerability and toxicity of these approaches in JRA, since cytokines and other mediators play important roles in host defenses, and the chronic inhibition, exogenous administration or constitutive over-expression of some cytokines/mediators may have undesirable effects
    Internet : PM:11994038

  7. CLEARY AG, RAMANAN AV, BAILDAM E, BIRCH A, SILLS JA, DAVIDSON JE: Nitrous oxide analgesia during intra-articular injection for juvenile idiopathic arthritis. Arch.Dis.Child 2002, 86:416-418.
    Organism:Department of Paediatric Rheumatology, Royal Liverpool Children's Hospital, UK gavincleary@talk21com
    Abstract:     AIMS: To evaluate the efficacy and safety of nitrous oxide-oxygen for children with juvenile idiopathic arthritis (JIA) undergoing intra-articular corticosteroid injection. METHODS: A total of 55 consecutive patients with JIA undergoing intra-articular corticosteroid injection, using self administered nitrous oxide-oxygen for analgesia were studied. Patient, nurse, and parent pain scores were compared using a 0-10 cm visual analogue scale (VAS) immediately after the procedure. RESULTS: A total of 70 joints were injected in 55 patients (median age 13.54 years). The median pain score for patient, nurse, and parent was 1 (0-10 cm VAS). The mean rank patient score was 2.12, which was greater than the nurse score (1.97), which was greater than the parent score (1.91). These differences were significant. There were no serious adverse events in any patient. CONCLUSIONS: Nitrous oxide-oxygen provides safe and effective analgesia for intra-articular injection in children. In some cases, nurses and parents underestimated pain related to the procedure compared to the child
    Internet : PM:12023171

  8. DE RAVEL TJL, AZOU M, FRYNS JP: Cohen syndrome and rheumatoid arthritis. Genetic Counseling 2002, 13:63-64.
    Organism:Center for Human Genetics, UZ Gasthuisberg, 49 Herestraat, B-3000, Leuven Belgium

  9. DOLEZ c, TELEKES c, NE c, HOZA J: Soluble adhesion molecules ICAM-1 and E-selectin in juvenile arthritis: Clinical and laboratory correlations. Clinical And Experimental Rheumatology 2002, 20:249-254.
    Organism:Dr. P. Dolez(caron)alova, Dept. of Paediatrics/Adolescent Med., Charles University in Prague, 1st Medical Faculty, Ke Karlovu 2, 121 09 Prague 2
    Abstract:     Objective. To determine serum and synovial fluid (SF) concentrations of soluble intercellular adhesion molecule-1 (ICAM-1) and E-selectin (E-sel) in patients with active juvenile idiopathic arthritis (JIA) and in paediatric controls and correlate them with clinical and laboratory variables. Methods. Total of 30 JIA patients were evaluated: 15 with polyarticular disease course (JIA-poly) and 15 with oligoarthritis (JIA-oligo). Paediatric age-matched control groups consisted of 11 Henoch-Schonlein purpura (HSP) and 10 febrile patients (FC) and 28 healthy children (HC). Current medication, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and full blood count (FBC) were recorded. Soluble ICAM-1 and E-sel in serum and SF were measured by a sandwich ELISA kit. Results. In the JIA-poly group the concentration of ICAM-1 was significantly higher than in healthy (p < 0.01), but not febrile controls. Both ICAM-1 and E-selectin correlated with the active joint count (p < 0.01). In 13 JIA patients no correlation was found between SF ICAM-1 and E-sel levels and the SF leucocyte counts. No significant differences were seen in the disease control and JIA-oligo groups compared to HC. A significant negative correlation with age was observed for the group as a whole (ICAM-1: p < 0.05, E-sel: p < 0.01); E-sel correlated with the leucocyte and thrombocyte counts (p < 0.01), and both molecules with CRP (p < 0.05) and with each other (p < 0.01). Conclusion. A high concentration of soluble ICAM-1 in JIA patients with polyarthritis is reported here for the first time. None of the patients showed signs of infection or vasculitis, where generalised endothelial activation could be its main source. Our finding of correlations between both ICAM-1 and E-sel levels and joint counts supports the hypothesis of their synovial origin. ICAM-1 and E-sel could serve as a marker of aggressive disease, but their predictive value needs to be further studied
    Internet : dolezalova.pavla@vfn.cz

  10. ERASO R, GEDALIA A, ESPINOZA LR, RAVELLI A, MARTINI A: Methotrexate as a possible trigger of macrophage activation syndrome in systemic juvenile idiopathic arthritis [1] (multiple letters). Rinsho Ganka 2002, 29:1104-1105.
    Organism:Dr. R. Eraso, Children's Hospital, LSU Health Sciences Center, New Orleans, LA

  11. FOELDVARI I, BURGOS-VARGAS R, THON A, TUERCK D: High response rate in the phase I/II study of meloxicam in juvenile rheumatoid arthritis. Rinsho Ganka 2002, 29:1079-1083.
    Organism:Dr. I. Foeldvari, Kinder/Jugendrheumatol. Sprechstunde, Am Allgemeinen Krankenhaus Eilbek, Friedrichsberger Str. 60, 22081 Hamburg
    Abstract:     Objective. Use of meloxicam as a selective COX-2 inhibitor for treatment of adult rheumatic diseases decreases the frequency of gastrointestinal (GI) side effects in comparison with nonselective COX inhibitors. Up to 50% of children with juvenile rheumatoid arthritis (JRA) also develop GI side effects through nonselective COX inhibitors. In this 12 week Phase I/II study, with an additional open extension lasting up to 52 weeks, the safety, efficacy, and pharmacokinetics of meloxicam in JRA were investigated. Methods. Meloxicam suspension 0.25 mg/kg once daily was given to 36 patients with JRA who required a nonsteroidal antiinflammatory drug. Safety evaluation and periodic measurement of efficacy were carried out using the Pediatric Rheumatology International Trials Organisation (PRINTO) criteria. Eighteen patients underwent pharmacokinetic (PK) evaluation. Results. Thirty-one patients completed the study. Four were dropped due to administrative reasons. One patient, who found the drug ineffective, discontinued participation. A response was seen according to PRINTO outcome criteria in 44% of the patients at Week 4, 62% at Week 12, and 74% at Week 52. Drug related adverse events were observed in 5 patients. PK evaluation showed that the maximum plasma concentration CSUBmax of -34% and AUCSUB0-(infinity) of -28% tended to be lower in younger children (2-6 years) versus older children. Plasma elimination half-life (13 h) was similar in all patients. Conclusion. Meloxicam suspension 0.25 mg/kg once daily seems to be effective and safe for treating active JRA over a period of 52 weeks
    Internet : sprechstunde@kinderrheumatologie.de

  12. FREEDMAN SF, RODRIGUEZ-ROSA RE, ROJAS MC, ENYEDI LB: Goniotomy for glaucoma secondary to chronic childhood uveitis. Am.J.Ophthalmol. 2002, 133:617-621.
    Organism:Dr. S.F. Freedman, Duke University Eye Center, Box 3802, Durham, NC 27710
    Abstract:     PURPOSE: To evaluate the safety and efficacy of standard goniotomy surgery for young patients with refractory glaucoma associated with chronic childhood uveitis. DESIGN: Interventional case series. METHODS: We retrospectively reviewed all goniotomies performed at our institution for patients with a diagnosis of refractory glaucoma associated with chronic childhood uveitis from 1994 to 2000 (this was our first-line surgery for such patients during these years). Uveitis was medically controlled in all cases for at least 6 weeks before surgery. The main outcome measure was time after surgery without failure. Success was defined as final intraocular pressure (IOP) <= 21 mm Hg after one or two goniotomies without need for further surgical intervention. Follow-up was >=6 months or until surgical failure. RESULTS: Nineteen goniotomies were performed on 16 eyes (12 patients). Diagnoses included uveitic glaucoma associated with juvenile rheumatoid arthritis, sarcoidosis, and idiopathic uveitis. The mean patient age at first goniotomy was 15.3 years (range, 6.5-30), with mean follow-up 32.4 months (range, 6-84). Cases included were phakic (10 eyes), aphakic (four eyes), and pseudophakic (two eyes). The mean preoperative IOP was 32.3 +/- 4.6 mm Hg. Surgical success was achieved in 12 of 16 (75%) eyes with a mean postoperative IOP of 12 +/- 2.5 mm Hg for these eyes (mean IOP reduction, 20.0 mm Hg, P < .0001). In 10 of 16 eyes (60%), surgical success was achieved after a single goniotomy. Uveitis was stable in all patients after the early post-operative period. Successful eyes used, on average, 1.4 +/- 1.1 glaucoma medications after goniotomy. Complications were mild and included transient hyphema in nine cases (56%) and worsening of a preexisting cataract in a single case (6%). CONCLUSIONS: Goniotomy represents a safe and effective first-line surgery for young patients with refractory glaucoma associated with chronic uveitis, although the majority of patients require glaucoma medication after the procedure. (c) 2002 Elsevier Science Inc. All rights reserved
    Internet : freed003@mc.duke.edu

  13. FRENCH AR, MASON T, NELSON AM, CROWSON CS, O'FALLON WM, KHOSLA S, GABRIEL SE: Osteopenia in adults with a history of juvenile rheumatoid arthritis. A population based study. Rinsho Ganka 2002, 29:1065-1070.
    Organism:Dr. S.E. Gabriel, Dept. of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
    Abstract:     Objective. To determine the extent of osteopenia in a population based cohort of adults with a history of juvenile rheumatoid arthritis (JRA). Methods. The Rochester Epidemiology Project database was used to identify all cases of JRA diagnosed among Rochester, Minnesota residents under the age of 16 years between January 1, 1960, and December 31, 1993. Thirty-two of the 57 adult patients in this population based cohort (ages 19-53 years, mean 35) participated in this study. Average length of followup from the time of diagnosis was 27.1 years (median 26.9, range 7.7-39.1). Dual energy x-ray absorptiometry scans were used to assess bone density of the lumbar spine, hip, distal one-third radius, and whole body. In addition, a number of variables that influence bone mass were analyzed. Results. Although many participants had T scores within the normal range (T score > -1) at all measured sites, 41% (n = 13) were osteopenic (T score <= -1) at either the lumbar spine or femoral neck. Twenty-eight percent (n = 9) had T scores <= -1 in the lumbar spine (p = 0.058 relative to expected). Thirty-two percent (n = 10) had T scores <= -1 in the femoral neck (p = 0.012 relative to expected). Several variables were significantly (p < 0.05) associated with low bone density in this cohort of adults with a history of JRA, including: (1) revised Steinbrocker functional class >= 2 during adolescence, indicating poorer physical functioning; (2) lack of participation in organized sports during adolescence (a surrogate measure of physical activity); (3) tobacco use during adolescence; and (4) lower calcium intake during adolescence. Conclusion. Although many adults with a history of JRA have normal bone density, a substantial subset are osteopenic, placing them at increased risk of fractures later in life. This observation is particularly striking given the predominance of patients with pauciarticular JRA in this population based group. We identified several variables associated with osteopenia in this cohort. Further work is needed to identify those patients with JRA who may benefit from aggressive therapy targeted at preventing the longterm morbidity associated with osteopenia
    Internet : gabriel.sherine@mayo.edu

  14. FURST DE: Stem cell transplantation for autoimmune disease: Progress and problems. Current Opinion in Rheumatology 2002, 14:220-224.
    Organism:Dr. D.E. Furst, UCLA Medical School, Rheumatology Division, 1000 Veteran Avenue Rehab. Center, Los Angeles, CA 98101
    Abstract:     The current status of stem cell transplantation in rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis are reviewed. From a large European bone marrow transplant registry, a birds' eye view of stem cell transplantation for autoimmune disease can be obtained. Among 43 rheumatoid arthritis patients, 35 juvenile chronic arthritis patients, 34 systemic lupus erythematosus patients, and 58 systemic sclerosis patients who underwent stem cell transplantation, initial responses in most patients were good to excellent. Although initial transplant related mortality was low for rheumatoid arthritis, somewhat higher rates for juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis may be falling with modifications in the stem cell transplantation regimens. In rheumatoid arthritis and systemic lupus erythematosus treatment, the criteria for patient selection are still not clear and the therapeutic regimens for stem cell transplantation (and whether follow-up treatment is necessary) are not fully defined. In juvenile chronic arthritis, responses are encouraging although little fully published data beyond that from the European Bone Marrow Transplant Registry exist. In systemic sclerosis, criteria for patient selection and a limited number of stem cell transplantation regimens have been agreed on and controlled trials are underway. (c) 2002 Lippincott Williams & Wilkins, Inc
    Internet : defurst@mednet.ucla.edu

  15. GAMIR ML, CEBALLOS E, HORTAL R, SANCHEZ CO: Treatment of juvenile idiopathic arthritis. Acta Pediatrica Espanola 2002, 60:123-138.
    Organism:M.L. Gamir, Servicio de Reumatologia, Hospital Ramon y Cajal, Madrid
    Abstract:     The objectives of the treatment of juvenile idiopathic arthritis (JIA) are, over the short term, to manage t he inflammation, alleviate the pain and discomfort, prevent deformities and preserve function. The long-term objectives include avoiding the secondary effects of the disease and its treatments, reducing the impact of chronic disease on the family, and promoting the normal growth, development, education and rehabilitation of the child. Long-term follow-up studies demonstrate that the prognosis in the different clinical subgroups is not a favorable as it was initially thought to be. Thus, in recent years, the therapeutic strategy has changed and JIA is now treated earlier and more actively. Intraarticular corticosteroid injection, a more rational use of systemic glucocorticoids, methotrexate (alone or in combination with other disease-modifying drugs) and the introduction of biological agents have greatly improved the prognosis, achieving remission in the majority of cases

  16. HAAPASAARI J, KAUTIAINEN H, HAKALA M: Combining cyclosporine with prevailing antirheumatic drug therapy in the treatment of juvenile idiopathic arthritis [6]. Clinical And Experimental Rheumatology 2002, 20:259
    Organism:Dr. J. Haapasaari, Rheumatism Foundation Hospital, FIN-18120 Heinola
    Internet : jarkko.haapasaari@reuma.fi

  17. HAAPASARI J, SOINI I, KAUPPI M: MRI diagnosis and successful treatment of upper cervical spine synovitis in a patient with juvenile chronic arthritis [3]. Clinical And Experimental Rheumatology 2002, 20:256-257.
    Organism:Dr. M. Kauppi, Rheumatism Foundation Hospital, FIN-18120 Heinola
    Internet : markku.kauppi@reuma.fi

  18. KONERMANN W, GRUBER G: [In Process Citation]. Orthopade 2002, 31:288-292.
    Organism:Orthopadische Klinik Hessisch Lichtenau, Am Muhlenberg 3, 37235 Hessisch Lichtenau lichtenau@lichtenau-evde
    Abstract:     A total of 329 children with hip pain were examined by ultrasound, which indicated transient synovitis (n = 161), rheumatoid arthritis (n = 16), tuberculoid arthritis (n = 3), septic arthritis (n = 16), Legg-Calve-Perthes disease (n = 102), and slipped capital femoral epiphysis (n = 31). Using the standard planes described by DEGUM and DGOOC, it is possible to analyze the joint capsule, the surface of the femoral head, and the periarticular structures. In cases of synovitis or joint effusion, a capsular distension can be diagnosed by ultrasound. This distension is typical in transient synovitis, septic and tuberculoid arthritis, juvenile rheumatoid arthritis, and the onset phase of Perthes disease. Because capsular distension exhibits no significant differences in the various diseases, differentiation is not possible with ultrasound in the absence of osseous abnormalities. In cases with both capsular distension and osseous abnormalities, ultrasound usually allows a differentiation between slipped capital femoral epiphysis and Perthes disease as well as septic and unspecific arthritis
    Internet : PM:12017857

  19. MATSUSHITA E, FUKUSHIMA A, HAYASHI N, MASAOKA N, UENO H, WAKIGUCHI H: Panuveitis in a case of juvenile rheumatoid arthritis. Japanese Journal of Clinical Ophthalmology 2002, 56:617-620.
    Organism:A. Fukushima, Department of Ophthalmology, Kochi Medical School, Kohasu Oko-cho, Nankoku-shi 783-8505
    Abstract:     A 4-year-old girl was referred to us for bilateral hyperemia since 8 weeks before. She had been found positive for antinuclear antibody by the referring physician. Both eyes showed iridocyclitis, vitreous opacity, and exudates in the inferior fundus. Signs of arthritis developed 6 weeks later, leading to the diagnosis of juvenile rheumatoid arthritis. The intraocular inflammation improved after systemic prednisolone but recurred after tapering of the dosis. Complications of corticosteroid developed also. Additional cyclosporin A induced control of intraocular inflammation with reduced dosis of prednisolone. This case illustrates that panuveitis is a liability in juvenile rheumatoid arthritis and that it may respond to systemic cyclosporin A

  20. MILZ S, REGNER F, PUTZ R, BENJAMIN M: Expression of a wide range of extracellular matrix molecules in the tendon and trochlea of the human superior oblique muscle. Investigative Ophthalmology and Visual Science 2002, 43:1330-1334.
    Organism:S. Milz, Anatomische Anstalt, Ludwig-Maximilians-Universitat, Pettenkoferstr. 11, D-80336 Munchen
    Abstract:     PURPOSE. To show that the molecular composition of the extracellular matrix of the trochlea and its associated tendon may explain the link between some cases of acquired Brown syndrome and rheumatoid arthritis. METHODS. One trochlea and its tendon from 11 dissecting-room cadavers were fixed in methanol, cryosectioned, and immunolabeled with a panel of monoclonal antibodies against types I, II, III, V, and VI collagens, chondroitin-4 and -6, keratan and dermatan sulfates, aggrecan, link protein, versican, and tenascin. Labeling was detected with an avidin-biotin-peroxidase detection kit. RESULTS. The trochlea had a central core of hyaline cartilage surrounded by a band of fibrocartilage, but the tendon had no cartilage cells. Significantly, however, both structures immunolabeled for aggrecan, link protein, and type II collagen-molecules typical of articular cartilage. CONCLUSIONS. The presence of aggrecan, link protein, and type II collagen may account for the coincidence between transient attacks of acquired Brown syndrome in patients with juvenile and adult forms of chronic rheumatoid arthritis. Cleavage of aggrecan by aggrecanase in articular cartilage characterizes cartilage degeneration in rheumatoid arthritis. Thus, it is possible that aggrecan cleavage also occurs in the trochlea and tendon and contributes to their degeneration or to a local inflammatory reaction that may swell and thicken the tendon. In this context, it is also significant that link protein and type Il collagen are now regarded as relevant antigenic targets for autoimmune responses in rheumatoid arthritis
    Internet : stefan.milz@anat.med.uni-muenchen.de

  21. MUZAFFER MA, DAYER J-M, FELDMAN BM, PRUZANSKI W, ROUX-LOMBARD P, SCHNEIDER R, LAXER RM, SILVERMAN ED: Differences in the profiles of circulating levels of soluble tumor necrosis factor receptors and interleukin 1 receptor antagonist reflect the heterogeneity of the subgroups of juvenile rheumatoid arthritis. Rinsho Ganka 2002, 29:1071-1078.
    Organism:Dr. E.D. Silverman, Division of Rheumatology, Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8
    Abstract:     Objective. To determine whether levels of soluble tumor necrosis factor receptor 55 (sTNFR55), sTNFR75, and interleukin I receptor antagonist (IL-IRa) can differentiate different subtypes of juvenile rheumatoid arthritis (JRA), and to determine if the levels of these proteins correlate with disease activity. Methods. Serum sTNFR (55 and 75) and IL-1Ra levels were measured by ELISA in 34 patients with JRA and these values were correlated with disease subtype and activity. Results. Serum sTNFR55 levels were significantly elevated in patients with systemic onset JRA (SoJRA) (mean +/- 2 SD, 2.9 +/- 1.8 ng/ml) (p <= 0.05) compared to rheumatoid factor positive (RF+) polyarticular JRA (2.1 +/- 0.6),

  22. PRICE FW, Jr., ZIEMBA SL: Placement of a collagen glaucoma drainage device to control intraocular pressure and chronic iritis secondary to juvenile rheumatoid arthritis. Ophthalmic Surg.Lasers 2002, 33:233-236.
    Organism:Price Vision Group, Indianapolis, Indiana 46260-5354, USA
    Abstract:     A patient with juvenile rheumatoid arthritis and chronic iritis is reported with intraocular pressure near 30 mm Hg and previous episodes of intraocular pressure as high as 50 mm Hg despite maximally tolerated medical therapy. Because of the potential risk involved with a full-thickness filtration procedure, it was decided that a nonpenetrating deep sclerectomy would be appropriate, followed by placement of a collagen glaucoma drainage device to maintain aqueous outflow. Immediately postoperatively, intraocular pressure was stabilized. At 24 months postoperatively, intraocular pressure was well controlled at 15 mm Hg with patient receiving only Lotemax. No significant complications were noted at any point in the postoperative course. Because of the patient's predisposition for serious complications frequently associated with trabeculectomy, nonpenetrating deep sclerectomy with the collagen glaucoma drainage device was an effective alternative for this patient
    Internet : PM:12027105

  23. PYNE D, EHRENSTEIN M, MORRIS V: The therapeutic uses of intravenous immunoglobulins in autoimmune rheumatic diseases. Rheumatology (Oxford) 2002, 41:367-374.
    Organism:Centre for Rheumatology, University College London, 40-50 Tottenham Street, Arthur Stanley House, London, W1P 9PJ UK

  24. REED AM, LOPEZ M: Juvenile dermatomyositis: recognition and treatment. Paediatr.Drugs 2002, 4:315-321.
    Organism:Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
    Abstract:     Juvenile dermatomyositis (JDM) is a multisystem disease characterized by acute and chronic lymphocytic inflammation of the skeletal muscle and skin. The disease is marked early in its course by the presence of a vasculopathy or vasculitis, and later by the development of calcinosis. Research has focused on the epidemiology, etiology, and pathogenesis of the disease with, until more recently, limited therapeutic interventions. This article highlights treatment regimens, both traditional and more recent interventions. Traditional treatment for JDM includes high dose corticosteroid treatment with additional agents used in resistant disease or children with unwarranted adverse effects. Traditional therapy begins with daily oral corticosteroids, with intravenous corticosteroids utilized in severe disease; however, recent data suggests that short-term use of intravenous cortcosteroids will allow a short-term improvement in strength, with no long-term change in outcome. More recent investigations suggest that early intervention with additional immunomodulatory agents will allow for a faster recovery, with less medication and disease sequelae. Use of methotrexate as an agent early in the disease course is becoming common place. Methotrexate, in conjunction with oral corticosteroids, allows a rapid improvement in symptoms, and allows for a more rapid reduction in corticosteroid dose. Methotrexate is considered as a steroid sparing agent, whether oral or intravenous corticosteroids are used. Additional immunomodulatory agents include the use of cyclosporine with or without methotrexate. Intravenous immunoglobulin has been reported to have benefit in resistant disease. There are exciting new agents which have great potential in treating JDM. Many of these agents are termed biologics and are being tested in adult myositis and juvenile arthritis. These include tumor necrosis factor (TNF)-alpha inhibitors, such as a chimeric monoclonal antibody to TNF-alpha, and a recombinant soluble human TNF receptor (p75)-Fc fusion protein. Many other new biological agents are also being tested in myositis
    Internet : PM:11994036

  25. SCHMELING H, STEPHAN V, BURDACH S, HORNEFF G: Pulmonary function in children with juvenile idiopathic arthritis and effects of methotrexate therapy. Zeitschrift Fur Rheumatologie 2002, 61:168-172.
    Organism:Dr. G. Horneff, Department of Paediatrics, Martin-Luther Univ. Halle-Wittenberg, 06120 Halle
    Abstract:     Objective: To evaluate impairment of lung function as an adverse effect associated with methotrexate therapy in patients with juvenile idiopathic arthritis (JIA). Methods: We performed pulmonary function testing including diffusion capacity for carbon monoxide as measured by the single breath method (DLCO-SB) in 89 children with juvenile idiopathic arthritis. Forty (45%) were treated with methotrexate for a median of 24 months (range 3 to 120 months). Except for the presence of asthma in two children, there was no clinical or radiological evidence of pulmonary disease. Results: Pulmonary function testing demonstrated moderate airway obstruction in two children with known bronchial asthma. Neither obstructive nor restrictive alteration of ventilation was found in any other patient. Two juvenile idiopathic arthritis patients showed a reduced CO diffusion capacity of 64 and 67%. One of them was treated with methotrexate. Conclusions: With regard to lung function impairment treatment with low dose methotrexate appears to be safe even when performed for several years reaching a total amount of up to 3.5 g. In contrast to studies performed in adult rheumatoid arthritis patients, in children with juvenile idiopathic arthritis impairment of lung function is a rare event
    Internet : gerd-horneff@medizin-uni-halle.de

  26. TAKAHASHI K, TATSUZAWA O, YANAGI K, HAYASHI Y, TAKAHASHI H: Alpha-fodrin auto-antibody in Sjogren syndrome and other auto-immune diseases in childhood. European Journal Of Pediatrics 2001, 160:520-521.
    Organism:Mitsubishi Kasei Institute of Life Sciences, 11 Minamiooya, Machida-shi, Tokyo, 194-8511 Japan^E-Mail: hiroshi@libra.ls.m-kagaku.co.jp

  27. UENO H, KATAMURA K, HATTORI H, YAMAGUCHI Y, NAKAHATA T: Acute lethal encephalopathy in systemic juvenile rheumatoid arthritis. Pediatric Neurology 2002, 26:315-317.
    Organism:Dr. H. Ueno, Baylor Inst. for Immunology Research, 3434 Live Oak, Dallas, TX 75204
    Abstract:     Macrophage activation syndrome is the most common cause of death in children with systemic juvenile rheumatoid arthritis. We present a first patient with systemic juvenile rheumatoid arthritis in which acute necrotizing encephalopathy developed as a complication of macrophage activation syndrome but not of Reye's syndrome. The suspected mechanism of this lethal complication is discussed. (c) 2002 by Elsevier Science Inc. All rights reserved

  28. WITTER J: Drug development in rheumatoid arthritis. Current Opinion in Rheumatology 2002, 14:276-280.
    Organism:Dr. J. Witter, Food and Drug Administration, 9201 Corporate Blvd., Rockville, MD 20850
    Abstract:     In the United States, therapies to treat rheumatoid arthritis and juvenile rheumatoid arthritis are approved and regulated by the Food and Drug Administration. This article explores certain aspects of the current Food and Drug Administration guidance for drugs, devices, and biologic products intended to treat these diseases (in this article, the term "drug" refers to any therapy in rheumatoid arthritis). Newer therapeutics are targeting not only important molecular pathways but also new labeling claims intended to represent clinically relevant outcomes. Questions regarding whether the risks of these new therapies are balanced by their effectiveness will evolve. The process of improvement in clinical trial design and metrics, along with improved therapies, will undoubtedly present both familiar and new challenges in the future. (c) 2002 Lippincott Williams & Wilkins, Inc
    Internet : witterJ@cder.fda.gov

  29. WORKING GROUP FOR PEDIATRIC AND ADOLESCENT RHEUMATOLOGY: 11th Conference of the Arbeitsgemeinschaft fuer Kinder- und Jugendrheumatologie (Working Group for Pediatric and Adolescent Rheumatology), Bad Bramstedt, Germany, November 7-10, 2001. Zeitschrift fuer Rheumatologie 2001, 60:390-394.
    Abstract:     This meeting contains 15 abstracts on topics in pediatric and adolescent rheumatology. The abstracts are all written in German, except for one in English. Topics handled in the meeting included ankylosing spondylitis, enthesitis-associated arthritis, backaches in children, T-cell behavior in juvenile idiopathic arthritis, antineutrophile cytoplasmic antibody-associated vasculitis, juvenile dermatomyositis treatment with steroids, polyarteritis nodosa clinical manifestations, iliosacral joint imaging or puncture biopsy, quality of life, femur head necrosis, non-drug management of active chronic juvenile arthritis, Wegener's granulomatosis manifestations, long-term etanercept treatment of juvenile idiopathic arthritis, and sulfasalazine-induced macrophage activation syndrome

  30. WOUTERS CHP, CEUPPENS JL, STEVENS EAM: Different circulating lymphocyte profiles in patients with different subtypes of juvenile idiopathic arthritis. Clinical And Experimental Rheumatology 2002, 20:239-248.
    Organism:Dr. C. Wouters, Department of Paediatrics, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven
    Abstract:     Objective. To determine the immunophenotypic profiles of circulating lymphocytes in patients with different disease types of Juvenile Idiopathic Arthritis (JIA). Methods. Peripheral blood lymphocyte subsets from 19 patients with oligoarticular JIA (o-JIA), 10 patients with polyarticular JIA (p-JIA), 12 patients with systemic JIA (s-JIA) and from 41 age-matched healthy controls were characterized by two color immunofluorescence flow cytometry analysis. Results. Patients with o-JIA and p-JIA had increased numbers of HLA-DR+T cells and T cells co-expressing CD57 and CD16/56, indicating T cell activation and terminal differentiation of CD8+ T cells respectively. By contrast, in patients with s-JIA there was no increase in the activation or differentiation markers on T cells, but a profound decrease in circulating NK cells. All patients had hypergammaglobulinemia consistent with B cell hyperactivity, but increased numbers of CD5+ B cells were found only in o-JIA and p-JIA. Conclusion. Distinct immunophenotypic lymphocyte profiles in patients with o-JIA and p-JIA compared to patients with s-JIA as demonstrated in this study, are consistent with a fundamental heterogeneity of the disease
    Internet : Carine.Wouters@uz.kuleuven.ac.be

  31. WYSZYNSKA E, ROMICKA AM, ZIOLKOWSKA M: [Cyclosporine A in the treatment of patients with juvenile idiopathic arthritis.]
    <ORIGINAL> Cyklosporyna a w leczeniu mlodzienczego idiopatycznego zapalenia stawow (Czesc II)    . Reumatologia (Warsaw) 2001, 39:335-343.
    Organism:Klinika Reumatologii Wieku Rozwojowego Instytutu Reumatologicznego, ul. Spartanska 1, 02-637, Warszawa Poland
    Abstract:     This study presents an open, prospective trial evaluating the effectiveness, safety and tolerance of cyclosporine A (CyA) in 16 patients with juvenile idiopathic arthritis-systemic or polyarticular onset. All patients had severe course of the disease with active arthritis. In 6 children CyA was the first choice of the antirheumatic drugs, in 10-reason for CyA treatment was resistance to previous therapy or adverse events during it. The duration of CyA treatment was from 4 to 18 months. The evaluation of clinical status and laboratory data (including several proinflammatory cytokines) was assessed before the trial, 3 and 6 months after beginning of treatment. (A good clinical control of the disease was achieved in all patients). In 11 patients a significant improvement of clinical status and laboratory data was observed with a reduction of the IL-15, and IL-6 level. In the majority of the patients steroid doses were markedly decreased. The adverse effects were observed in 6 patients (including the disturbances of tolerance in 1); in 4 of them the therapy was withdrawn. The results of this study confirmed the effectiveness of CyA in systemic and joint manifestation of juvenile idiopathic arthritis, especially in the disease of recent onset