Bibliography March 2003
- AFANASEV SS, ALESHKIN VA, FEKLISOVA LV, RUBALSKII OV, DAVYDKIN VI: [Interferon-based immunobiological preparations. An outlook of their use in the treatment of patients with infections]. Vestn.Ross.Akad.Med.Nauk 2003, 44-48.
Abstract: The paper contains the generalizing results of many-year research related with using various ready-made medication forms (RMF) of human genetic-engineering interferon-alpha 2 and of methods of its administration into the body. Extensive clinical materials were made use of to show convincingly that the most effective therapy for infectious diseases is ensured within a short time period and with a consequent long-term rehabilitation effect by using separate RMFs and methods of application of interferon-alpha 2, when their impact on the lesion focus is monitored by the parameters of the cellular-and-humoral chains of the general and local immunity. It is noteworthy, that a selection of RMF adequate for an actual nosologic form or of an administration method can reduce the medication dose of interferon-alpha 2 (thus, the incidence of complications to the drug goes down), it can also eliminate the influenza-like syndrome and production of autoantibodies related with the intramuscular administration of interferon-alpha 2, besides, it essentially prolongs the presence of interferon-alpha 2 in the body. It is important that the application of interferon-based preparations for infectious diseases can eliminate, in a number of cases, the use of antibiotics and other antibacterial drugs, it enhances the efficacy of antibacterial and antiviral therapy within a comprehensive treatment scheme, it contributes to a higher resistance of normal flora to the action of antibiotic and antibacterial drugs, and, finally, it arrests quicker the manifestations of dysbacterioses of various localizations
Internet : PM:12608085 - BINGEN E: [Acute streptococcal sore throats in children, state of the present situation. Interview with Pr. E Bingen by Marie Solignac]. Presse Med. 2003, 32:186-187.
Organism:Hopital Robert Debre, Paris
Internet : PM:12610476 - BOSACKI C, RICHARD O, FREYCON F, MOSNIER JF, CATHEBRAS P: The association of polyarthritis nodosa and familial Mediterranean fever. Presse Medicale 2003, 32:24-26.
Organism:P. Cathebras, Service de Medecine Interne, Hopital Nord, 42055 Saint-Etienne Cedex 2
Abstract: Introduction: Some necrotizing vasculitis may be associated with familial Mediterranean fever (FMF). We report a new case of polyarteritis nodosa (PAN) that preceded the diagnosis of FMF. Observation: A young woman of Turkish origin had a long childhood history of inflammatory arthralgia and myalgia, leading to the provisional diagnosis of chronic juvenile arthritis, then, after a confirmative muscle biopsy, to the diagnosis of PAN, whose outcome remained benign. At the age of 19, she was diagnosed as having FMF on clinical and genetic grounds, and colchicine led to the regression of most symptoms. Discussion: As with Henoch-Schonlein's purpura, PAN seems significantly associated with FME Its characteristics are a younger age at onset, more frequent peri-renal hematoma, overlap between classical PAN and micropolyangeitis, and overall better prognosis. In its muscular form, PAN is difficult to distinguish from protracted febrile myalgia, a recently described manifestation of FMF, in which pathological findings are poorly documented
Internet : pascal.cathebras@chu-st-etienne.fr - BRASINGTON J, KAHL LE, RANGANATHAN P, LATINIS KM, VELAZQUEZ C, ATKINSON JP: 14. Immunologic rheumatic disorders. Journal of Allergy and Clinical Immunology 2003, 111:S593-S601
Organism:Dr. J.P. Atkinson, Washington Univ. School of Medicine, Campus Box 8045, 660 South Euclid Ave, St. Louis, MO 63110
Abstract: We provide the basics for the clinician who might be called on to consider the diagnosis of diseases such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) in their practice. We will emphasize clinical recognition and first-line laboratory testing. Only characteristics of the classic rheumatic inflammatory diseases, RA, SLE, Sjogren syndrome, scleroderma, and dermatomyositis/polymyositis, will be covered. In the past decade, RA is the only disease for which treatment has substantially improved. The treatment of RA has been revolutionized by the use of methotrexate and, more recently, tumor necrosis factor inhibitors. The goal of RA treatment today is to induce a complete remission as early as possible in the disease process, with the mantra being "elimination of synovitis equals elimination of joint destruction." The hope is that if the major mediators of Sjogren syndrome or SLE or scleroderma can be identified and then blocked, as in the example of tumor necrosis factor inhibitors in RA, more specific treatments will become available. Thus, RA has become an excellent model of this evolving paradigm. Through the identification of major mediators in its pathogenesis, novel and highly efficacious therapeutic agents have been developed - CHRISTODOULOU A, PLOUMIS A, KARKAVELAS G, TERZIDIS I, TSAGIAS I: A rare case of juxtaarticular osteoid osteoma of the calcaneus initially misdiagnosed as juvenile chronic arthritis. Arthritis And Rheumatism 2003, 48:776-779.
Organism:Dr. A. Christodoulou, 58 John Kennedy Street, Pilea, 55535 Thessaloniki
Abstract: Juxtaarticular osteoid osteoma is frequently misdiagnosed because the symptoms may mimic arthritis, and radiographs may not be characteristic. A rare case of subtalar pain lasting 5 years in a female teenager is presented here. The initial diagnosis was monarticular juvenile chronic arthritis. Family history was misleading because her mother had rheumatoid arthritis (RA)
Internet : ploumis@otenet.gr - COOMBES AG, ZAMAN A, HALL M, CAWLEY MI: Preseptal cellulitis in systemic onset Juvenile Idiopathic Arthritis. Eye 2003, 17:258-260.
Internet : PM:12640422 - CULY CR, KEATING GM: Spotlight on etanercept in rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. BioDrugs. 2003, 17:139-145.
Organism:Adis International Limited, Auckland, New Zealand
Abstract: Etanercept (Enbrel((R))) is a subcutaneously administered biological response modifier that binds and inactivates tumour necrosis factor-alpha, a proinflammatory cytokine. In patients with early active rheumatoid arthritis, etanercept 25mg twice weekly was associated with a more rapid improvement in disease activity and a significantly greater cumulative response than methotrexate over 12 months of treatment in a randomised, double-blind trial. In addition, etanercept recipients showed a slower rate of radiographic progression and a more rapid improvement in quality of life than methotrexate recipients. The efficacy of etanercept was maintained at 3 years' follow-up. Etanercept was also significantly better than placebo at reducing disease activity in patients who had an inadequate response to previous treatment with disease-modifying antirheumatic drugs (DMARDs) in several well controlled trials. At study end (after 3 or 6 months' treatment), the percentage of patients achieving an American College of Rheumatology 20% (ACR20) response with etanercept (25mg or 16 mg/m(2) twice weekly) was 59-75% as monotherapy and 71% in combination with methotrexate; corresponding placebo response rates were 11-14% and 27%, respectively. Response has been maintained in patients who continued treatment for up to 5 years. In patients with psoriatic arthritis, etanercept 25mg twice weekly significantly reduced disease activity and improved skin lesions in two double-blind, placebo-controlled, 12- to 24-week trials. In the 24-week study, ACR20 response rates (50 vs 13%), psoriatic arthritis response rates (70 vs 23%) and the median improvement in skin lesions (33 vs 0%) were significantly greater in etanercept than in placebo recipients. In patients with polyarticular-course juvenile rheumatoid arthritis, etanercept resulted in improvements in all measures of disease activity and was significantly more effective than placebo at reducing disease flare. Eighty percent of patients receiving etanercept achieved a >/=30% reduction in disease activity over 7 months of treatment, and this was maintained for up to 2 years in a trial extension. Etanercept was generally well tolerated in children and adults in clinical trials; the most commonly occurring adverse effects included injection site reactions, infection, headache, rhinitis and dizziness. In conclusion, etanercept has emerged as an important new treatment option in inflammatory arthritis. Etanercept provides rapid and sustained improvements in disease activity in patients with early and DMARD-refractory rheumatoid arthritis and has been shown to inhibit radiographic progression in those with early disease. Well controlled studies have also demonstrated the efficacy of etanercept in patients with psoriatic arthritis or polyarticular-course juvenile rheumatoid arthritis
Internet : PM:12641492 - FANTINI F, GERLONI V, GATTINARA M, CIMAZ R, ARNOLDI C, LUPI E: Remission in juvenile chronic arthritis: A cohort study of 683 consecutive cases with a mean 10 year followup. Rinsho Ganka 2003, 30:579-584.
Organism:Dr. R. Cimaz, Clinica Pediatrica, ICP, via Commenda 9, 20122 Milano
Abstract: Objective. As continuity of care in our institution allows longterm followup studies, we reviewed the files of all consecutive patients with juvenile chronic (idiopathic) arthritis (JCA) followed since 1970 to establish the frequency of remission. Methods. Charts of all patients with JCA were reviewed. Relevant variables were entered into a customized database. The presence of remission (lack of signs of disease activity in the absence of antirheumatic therapy for at least 6 mo) during the disease course and at the last visit was assessed. Results. The cohort included 683 patients, 463 females and 220 males. According to the disease onset, 420 had oligoarticular, 108 polyarticular (23 rheumatoid factor positive), and 88 systemic disease; 67 had a juvenile spondyloarthropathy (SpA). For all 4 categories the mean followup period was about 10 years. At the last visit 224 cases were in remission (32.8%). Remission rate was scarcely influenced by age at disease onset, but differed in the different disease categories. Of the total group of 683 patients, 153 (22.4%) were lost to followup (no control for at least 2 years). For all 4 categories the remission rate at the last visit was higher in patients who had been lost to followup: 42.3% versus 29.0% for systemic onset JCA, 20.8% versus 16.5% for polyarticular onset JCA, 44.7% versus 33.6% for pauciarticular onset JCA, and 66.7% versus 26.8% for juvenile SpA. The probability of attaining remission decreased in proportion to delay in entering the tertiary care center (from 35.7% to 22.8%). The rate of remission reached its peak after 5-10 years of followup, after which the trend reversed. Conclusion. Childhood arthritis achieved remission in only about one-third of our cases, with differences among disease categories based on the diagnosis - FOSTER HE, MARSHALL N, MYERS A, DUNKLEY P, GRIFFITHS ID: Outcome in adults with juvenile idiopathic arthritis: A quality of life study. Arthritis And Rheumatism 2003, 48:767-775.
Organism:Dr. H.E. Foster, School of Clinical Medical Sciences, 4th Floor Catherine Cookson Building, Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH
Abstract: Objective. To evaluate quality of life (QOL) in adults with juvenile idiopathic arthritis (JIA), using validated measures of functional disability and generic health status, and to quantify their educational attainment and employment status. Methods. The adult rheumatology departmental database was used to identify patients. Functional disability and generic health status/QOL were assessed by the Health Assessment Questionnaire (HAQ) and the Short Form 36-item health profile (SF-36), respectively. Educational achievement and employment status were assessed by questionnaire. Results. Complete data were available for 82 of the 101 patients identified. The median age of patients was 30 years, and the median disease duration was 21 years. No deaths were recorded. All subtypes of JIA were represented. Thirty-nine percent of patients had active disease (based on the physician global assessment scale score). The median HAQ score was 1.125 (range 0-3). SF-36 scores for bodily pain, general health, physical functioning, vitality, emotion, and social isolation were significantly worse in patients compared with controls, and this trend increased with increasing age of the patients and disease duration. The SF-36 mental summation scores of patients were low compared with those of controls, for all subtypes of JIA, and this finding was independent of the degree of functional disability (by HAQ and SF-36 physical summation scores). The educational attainment of patients was comparable to that of local controls, but unemployment rates for patients were 3-fold higher than those for controls. Conclusion. This is the largest study in which the SF-36 was used to assess generic health status and QOL in adults with JIA. Many patients had active disease in adulthood, and although the physical outcome of adults with JIA is relatively good, a profound effect on generic health status and QOL was demonstrated for all types of JIA. Furthermore, despite excellent educational attainment, there was a high rate of unemployment among patients
Internet : h.e.foster@ncl.ac.uk - GROM AA, VILLANUEVA J, LEE S, GOLDMUNTZ EA, PASSO MH, FILIPOVICH A: Natural killer cell dysfunction in patients with systemic-onset juvenile rheumatoid arthritis and macrophage activation syndrome. J.Pediatr. 2003, 142:292-296.
Organism:William S Rowe Division of Rheumatology, and the Division of Hematology/Oncology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA groma0@chmccorg
Abstract: OBJECTIVES: To assess natural killer (NK) and cytotoxic functions in patients with systemic-onset juvenile rheumatoid arthrithis (soJRA) complicated by macrophage activation syndrome (MAS). METHODS: NK cells (CD56+/TCRalphabeta-), NK T cells (CD56+/TCRalphabeta+) and CD8+ cells were assessed for perforin expression by flow cytometry. NK cytotoxic activity was measured after coincubation of mononuclear cells with an NK-sensitive K562 cell line. RESULTS: Two major patterns of immunologic abnormalities were detected. Four of 7 patients had decreased NK activity, low NK cell numbers, and mildly increased levels of perforin expression in CD8+ and CD56+ cytotoxic cells. Three remaining patients with MAS, however, had decreased NK activity associated with low levels of perforin expression in all cytotoxic cell populations, a pattern indistinguishable from that in carriers of perforin-deficient familial hemophagocytic lymphohistiocytosis. Remarkably, two of these patients had previous episodes of MAS. CONCLUSIONS: NK dysfunction is an immunologic abnormality common to both familial hemophagocytic lymphohistiocytosis and MAS of soJRA. The extent of NK cell abnormalities in soJRA needs to be further investigated
Internet : PM:12640378 - HASHKES PJ: Profile of a pediatric rheumatology practice in Israel. Clinical And Experimental Rheumatology 2003, 21:123-128.
Organism:Dr. P.J. Hashkes, Department Rheumatic Diseases A-50, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195
Abstract: Background. Several studies from Western countries have analyzed the profile of pediatric rheumatology practices. Due to differences in demography and health care systems the profile in Israel may differ from those countries. Objective. To describe the profile of a pediatric rheumatology practice in Israel. Methods. All new patients seen during the course of 2000 as part of my pediatric rheumatology practice in Northern Israel were registered at their initial encounter. Recorded were demographic data, referral patterns, diagnoses, and disease-related data. Diagnoses were grouped together by types of condition. Results. 242 new patients were seen. 39% of the patients had a rheumatic condition, 39% had non-inflammatory conditions, 12% had periodic fever syndromes and for 10% no definitive diagnosis was determined 14% had chronic rheumatic diseases. The time until diagnosis was significantly greater and more physicians were involved in the evaluation of periodic fever syndromes than in other disease groups. Seventeen (7%) patients had juvenile rheumatoid arthritis (JRA). The minimum estimated incidence of JRA was 8.8 per 100,000 children. Conclusions. Most patients seen did not have classic inflammatory rheumatic diseases, similar to data from other Western countries. Distinctive to Israel and the Middle East, periodic fever syndromes comprise a large proportion of the pediatric rheumatology practice. These syndromes are relatively difficult for community physicians to diagnose
Internet : hashkep@ccf.org - KADAR J, PETROVICZ E: [Adult-onset Still-disease: survey of 18 cases]. Orv.Hetil. 2003, 144:173-178.
Organism:Fovarosi Szent Laszlo Korhaz, VI Fertozo Belgyogyaszati Osztaly, Budapest
Abstract: INTRODUCTION: Adult onset Still's disease (juvenile rheumatoid arthritis with septic appearance) is rare, leading to clinical signs similar to those seen in bacterial sepsis, lymphomas, rheumatological, or systemic autoimmune diseases. The disease can present with a fever of unknown origin, and can cause difficulties in the diagnosis. It is based upon, partly, the exclusion of other diseases and on diagnostic criteria. Its characteristic feature is the rise of acute phase proteins. Exanthemata are temporary. The basis of treatment is immunosuppression, however relapses can occur. AIM: The aim of the authors was to evaluate on the most characteristic clinical signs and laboratorical data of their patients, and to examine the revealing parameters of the course of the disease. METHOD: Retrospective epidemiological survey of the data obtained from 18 patients. RESULTS: The characteristic signs of the disease were, fever, sore throat, arthritis, joint pain, exanthemata, hepato-splenomegaly, lymphadenomegaly, pleurisy. The typical laboratorical data were: elevated CRP, low PCT, negative Waaler-Rose and ANA test, low serum iron level, leukocytosis, thrombocytosis, elevated alkalic phosphatase activity, high LDH, positive bone scintigraphy. The fever was steroid dependent. Generally, the illness was recognised after 2-3 months, and relapses were frequent. CONCLUSIONS: Still's disease has an important role in the differential diagnosis of fever of unknown origin. The diagnosis is based upon the evaluation of clinical signs and laboratorical data together. Prolonged immunosuppressive therapy is required
Internet : PM:12621815 - KAKAR S, BURGART LJ: Sinusoidal dilatation and congestion in liver biopsy: Is it always due to venous outflow impairment? Modern Pathology 2003, 16:278A
Organism:UCSF and VA Medical Center, San Francisco, CA, USA USA - LAM LA, LOWDER CY, SMITH SD, TRABOULSI E, I, BAERVELDT G: Surgical Management of Children withJuvenile Rheumatoid Arthritis-associated Uveitis. ARVO Annual Meeting Abstract Search and Program Planner 2002, 2002:Abstract
Organism:Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA USA
Abstract: Introduction: Patients with Juvenile Rheumatoid Arthritis (JRA) associated uveitis often develop cataracts and secondary glaucoma due to chronic inflammation and corticosteroid use. Intraocular lens (IOL) implantation is controversial in these patients. Purpose: To describe the surgical outcome of cataract surgery with IOL and/or trabeculectomy in pediatric patients with JRA-associated uveitis. Design: Interventional case series. Methods: Chart review of all patients younger than age 18 with the diagnosis of JRA-associated uveitis who underwent cataract surgery with IOL and/or glaucoma surgery between December 1995 and August 2001. Results: Ten eyes of eight patients (7 girls, 1 boy), age 7 - 17 years (median 9.5 years at time of surgery) were included. Seven of eight patients had a positive antinuclear antibody titer and were on systemic methotrexate therapy for a median of 1.25 years prior to surgery. In addition, patients were on naproxen (3), hydroxychloroquine (2), prometheus (2) and etanercept (1). Two patients had bilateral surgeries. Two patients (3 eyes) underwent phacoemulsification cataract extraction with IOL (CE/PCIOL), 4 eyes had combined trabeculectomy with CE/PCIOL and 3 had trabeculectomy alone. Of the 7 eyes that received an IOL implant, 4 achieved 20/20 vision, 2 have 20/25 and 1 eye, 20/40 (follow-up 6 - 69 months; median 24 months). Four patients underwent combined CE/PCIOL and trabeculectomy, and 3 patients underwent trabeculectomy alone. Of the patients who underwent trabeculectomy, the preoperative intraocular pressure ranged from 28 - 49 (average 36.6) and improved to 3-24 ( average 9.9). Conclusion: Children with JRA-associated uveitis can do well following CE/PCIOL and/or trabeculectomy when the intraocular inflammation is adequately controlled - LUO N, CHEW LH, FONG KY, KOH DR, NG SC, YOON KH, VASOO S, LI SC, THUMBOO J: Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore. Qual.Life Res. 2003, 12:87-92.
Organism:Department of Pharmacy, National University of Singapore, Singapore
Abstract: Validity and reliability of a Singaporean English EQ-5D self-report questionnaire (EQ-5D) were evaluated among consecutive outpatients with rheumatic diseases attending a tertiary referral hospital in Singapore (a multi-ethnic, urban Asian country). Subjects were interviewed twice within a 2-week period using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36) and assessing demographic and psychosocial characteristics. To assess validity of the EQ-5D, 13 hypotheses relating responses to EQ-5D dimension/Visual Analogue Scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann-Whitney test, Kruskal-Wallis test, or Spearman's correlation coefficient. Test-retest reliability was assessed using Cohen's kappa. Sixty-six subjects were studied (osteoarthritis: 9, rheumatoid arthritis: 26, systemic lupus erythematosus: 23, spondyloarthropathy: 8; female: 72.7%; mean age: 44.3 years). Ten of 13 a-priori hypotheses relating EQ-5D responses to external variables were fulfilled, supporting the validity of the EQ-SD. Cohen's kappa for test-retest reliability (n = 52) ranged from 0.29 to 0.61. The Singaporean English EQ-5D appears to be valid in measuring quality of life in Singaporeans with rheumatic diseases; however, its reliability requires further investigation. These data provide a basis for further studies assessing the validity of the EQ-5D in Singapore
Internet : PM:12625521 - MCGILL PE, OYOO GO: Rheumatic disorders in Sub-saharan Africa. East Afr.Med.J. 2002, 79:214-216.
Organism:Musculoskeletal Unit, Stobhill Hospital, Glasgow, Scotland
Abstract: OBJECTIVE: To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision. DATA SOURCES: Medline, (English, French). Pre-Medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full. CONCLUSIONS: The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and South Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements. Suggestions made to address the challenge posed by the burden of rheumatic disorders
Internet : PM:12625680 - MENICONI ME, YU EN, TUFAIL F, CHRISTEN WG, FOSTER CS: Outcomes of Treatment with Immunomodulatory Therapy in Juvenile Idiopathic Arthritis-Associated Chronic Iridocyclitis. ARVO Annual Meeting Abstract Search and Program Planner 2002, 2002:Abstract
Organism:Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA USA
Abstract: Purpose: To evaluate the outcomes of patients with juvenile idiopathic arthritis (JIA)-associated chronic iridocyclitis, and to compare the outcomes of "early" and "late" immunomodulatory therapy.Methods: Medical records of patients with JIA-associated chronic iridocyclitis seen on the Ocular Immunology & Uveitis Service of the Massachusetts Eye and Ear Infirmary between 1981 and 1997 were reviewed. Results: Twenty-three patients (45 eyes) were included in the study. Patient eyes were assigned to Groups A (early treatment), B (late treatment) or C (very late treatment) depending on the timing of initiation of effective chemotherapy in the disease course. All except one eye in Group A (94%) had 20/20 to 20/40 visual acuity at final visit. Twenty percent and 36% of eyes from Groups B and C, respectively, had 20/20 to 20/40 vision. About half of the eyes from these two latter groups had 20/200 or worse vision at the time of data analysis. Less than half (44%) of eyes in Group A developed cataract requiring cataract extraction, while 100% and 86% of the patients in Groups B and C, respectively, required surgery. None of the eyes of patients in Group A progressed to hypotony and phthisis over the course of follow-up, whereas eight of the 29 eyes in Groups B and C did. Conclusion: JIA-associated chronic iridocyclitis is a potentially blinding disease. Better outcomes occur when steroid-sparing immunomodulatory therapy is given early in the disease course in patients who continue to have inflammation despite treatment with steroids - OEN K, MALLESON PN, CABRAL DA, ROSENBERG AM, PETTY RE, REED M, SCHROEDER ML, CHEANG M: Early predictors of longterm outcome in patients with juvenile rheumatoid arthritis: Subset-specific correlations. Rinsho Ganka 2003, 30:585-593.
Organism:Dr. K. Oen, RR149 Rehabilitation Centre, Health Sciences Centre, 800 Sherbrook Street, Winnipeg, Man. R3A 1M4
Abstract: Objective. To determine early predictors of longterm outcome in juvenile rheumatoid arthritis (JRA) in a multicenter cohort. Methods. Patients were selected if they were >= 8 years of age; the onset of arthritis occurred >= 5 years before study; and a diagnosis of JRA was made at a participating center. Outcome variables were scores on self-administered Childhood Health Assessment Questionnaires (CHAQ) and active disease duration. Possible explanatory variables assessed included characteristics present at onset, HLA alleles, in particular the rheumatoid arthritis associated shared epitope (RASE), and radiographic indicators of joint damage within 2 years of onset. Data for 393 patients were available. Multivariate analyses were performed for the total group and for each onset subtype. Results. Male sex correlated with worse disability in systemic onset JRA but less disability in RF negative, and a shorter active disease duration in RF positive polyarticular onset JRA. Positive antinuclear antibody correlated with a longer active disease duration in patients with pauciarticular onset JRA. Younger age at onset predicted longer active disease duration in pauciarticular and RF negative polyarticular, and a shorter active disease duration in systemic onset JRA. Residence on a reserve, rather than native North American race, correlated with worse disability. The RASE correlated with less disability in systemic JRA; but no correlation with outcome was evident for patients with rheumatoid factor positive polyarticular JRA. Conclusion. Variables predictive of longterm outcome in JRA are specific for each onset subtype. The most important early predictors were age at onset and sex of the patient. Place of residence may have a greater effect on disability than race. RASE may associate with a more favorable outcome in systemic onset disease - PARISINI P, DI SILVESTRE M, GREGGI T, BIANCHI G: C1-C2 posterior fusion in growing patients: long-term follow-up. Spine 2003, 28:566-572.
Organism:Spine Surgery Department, Istituti Ortopedici Rizzoli, Bologna, Italy patrizioparisini@iorit
Abstract: STUDY DESIGN: A retrospective review of patients undergoing C1-C2 posterior fusion during childhood was undertaken. OBJECTIVES: The aim of this study was to investigate the change in the sagittal curvature of the cervical spine in children after C1-C2 posterior fusion. SUMMARY OF BACKGROUND DATA: There have been only a few reports on postoperative changes in the sagittal curvature of the cervical spine after C1-C2 posterior fusion in children. However, they have all described the onset of sagittal postoperative cervical deformities. METHODS: Between January 1977 and December 1992, a total of 12 children underwent C1-C2 posterior fusion for atlantoaxial instability resulting from congenital malformation in eight, juvenile rheumatoid arthritis in one, and rotatory subluxation in three. The average age at the time of surgery was 10.9 years (range 7-12 years). All children underwent a similar treatment program with gradual preoperative reduction in halo cast, followed by C1-C2 posterior fusion with Mersilene loops in two cases, wiring in eight (Gallie's or Brooks' techniques), and interlaminar clamps in the remaining two. The halo cast made it possible to avoid a hyperextended or hyperflexed C1-C2 position while performing the atlantoaxial fusion, thus ensuring a more anatomic position during C1-C2 fusion. In the postoperative period, the halo cast was maintained for 7 to 9 weeks.RESULTS Follow-up ranged from 7 years to 13 years. Preoperative alignment of the cervical spine was classified into two groups: lordosis (eight patients) and straight (four patients). Postoperative subaxial malalignment (kyphosis) occurred in four cases (33%): these patients showed evidence of spontaneous and gradual sagittal improvement and presented either a straight (two cases) or a lordotic (two cases) cervical spine at follow-up. Immediately after surgery, the cervical spine was normally aligned in the remaining eight patients (lordosis and straight alignment in six and two cases, respectively) and was unchanged at follow-up. At follow-up, none of the 12 patients had a cervical deformity on sagittal plane. CONCLUSION: In children, a spontaneous realignment of the subaxial kyphosis observed after C1-C2 posterior fusion can be noted at follow-up, when a postoperative deformity occurs (33% in the present series). According to the present findings, it is not always mandatory to perform occipitocervical fusion in children with atlantoaxial instability just to prevent subaxial deformity in the cervical spine
Internet : PM:12642763 - POWER TG, DAHLQUIST LM, THOMPSON SM, WARREN R: Interactions between children with juvenile rheumatoid arthritis and their mothers. J.Pediatr.Psychol. 2003, 28:213-221.
Organism:Washington State University University of Maryland Baltimore County St Louis Children's Hospital Baylor College of Medicine and Texas Children's Hospital
Abstract: Objective To determine the degree to which mothers of children with juvenile rheumatoid arthritis (JRA) show an overprotective or highly controlling interaction style. METHOD: We videotaped 84 mother-child pairs (42 JRA and 42 healthy, ages 6 to 13) while working on a collaborative problem-solving task. Based on physical therapy evaluations, children in the JRA group were assigned to "more severe" (n = 19) and "milder" (n = 22) arthritis subgroups. RESULTS: Results showed numerous differences between mothers of children with more severe arthritis and the other mothers (no differences between the milder arthritis and healthy comparison groups were found). Compared to mothers in the other two groups, mothers of children with more severe arthritis were more directive of their children's behavior during the task, showing higher rates of structure and rule setting, general clues, and prompting the child for an answer. Discussion Sequential analyses showed that mothers in the more severe group appeared to treat the task in a more evaluative manner, being more likely than other mothers to respond to correct answers with positive feedback and to incorrect answers with structure and rule setting. Mothers in the other groups were more likely to respond to both correct and incorrect answers with specific clues. CONCLUSIONS: We discuss how these differences in interactional style might impact the social development of children with JRA
Internet : PM:12654947 - RAMANAN AV, WYNN RF, KELSEY A, BAILDAM EM: Systemic juvenile idiopathic arthritis, Kikuchi's disease and haemophagocytic lymphohistiocytosis-is there a link? Case report and literature review. Rheumatology (Oxford) 2003, 42:596-598.
Organism:Departments of Paediatric Rheumatology Paediatric Haematology and Paediatric Histopathology, Royal Manchester Children's Hospital, Charlestown Road, Blackley, UK
Internet : PM:12649409 - RANGEL L, GARRALDA ME, HALL A, WOODHAM S: Psychiatric adjustment in chronic fatigue syndrome of childhood and in juvenile idiopathic arthritis. Psychological Medicine 2003, 33:289-297.
Organism:Prof. M.E. Garralda, Acad. Unit Child/Adolesc. Psychiat., Faculty of Medicine, Imperial College, St Mary's Campus, London W2 1PG
Abstract: Background. High rates of psychopathology and of personality problems have been reported in children an adolescents with chronic fatigue syndrome (CFS). It is not clear whether this is consequent on the experience of chronic physical ill health. We compare psychiatric adjustment in children with CFS and in children suffering from another chronic physical disorder (juvenile idiopathic arthritis or JIA). Method. Our sample consisted of 28 children with CFS and 30 with JIA attending tertiary paediatric centres (age range, 11 to 18 years, mean 15, S.D. 2.3). In order to assess psychiatric status and functioning, we used the K-SADS psychiatric interviews, CGAS and Harter Self-Esteem Questionnaire with child subjects; behavioural questionnaires (CBCL) and child personality assessment interviews (PAS) with parent informants. Results. Psychiatric disorders in the year prior to interview had been present significantly more commonly in the CFS group (72% v. 34% in JIA) and were more impairing to them (CGAS scores of 45 v. 77). Most common diagnoses in both groups were depressive and anxiety disorders. Personality problems were also significantly more frequent in CFS subjects (48% disorder and 26% difficulty v. 11% and 11% in JIA). There were few differences between the two groups in Self-esteem. Conclusions. Psychopathology and personality problems are common in children and adolescents with severe forms of CFS and cannot be explained strictly through the experience of chronic physical illness - SAMBORSKI W: [Sandimmun Neoral in the treatment of rheumatic diseases.]
<ORIGINAL> Zastosowanie preparatu Sandimmun Neoral w leczeniu chorob reumatycznych. Reumatologia (Warsaw) 2002, 40:307-314.
Organism:Klinika Reumatologii i Immunologii, Klinicznej AM im. K. Marcinkowskiego w Poznaniu, ul. Winogrady 144, 61 - 626, Poznan, Poland Poland
Abstract: Clinical trials conducted over last 10 years have demonstrated that cyclosporin A (CsA), administrated as commersially available Sandimmun soft gelatin capsules, is effective in improving subjective and objective clinical parameters in patients with severe active and refractory rheumatoid arthritis (RA) in advanced stages of disease. Recently a new formulation of CsA called Sandimmun Neoral was developed, which is based on microemulsion technology. The principal mechanism by which CsA exerts its immunosuppressive action is by inhibiting the transcription of a group of T-cell cytokine genes. Although the inhibition of interleukin-2 (IL-2) has been documented most extensively, these agents also inhibit IL-3, IL-4. IL-15, tumor necrosing factor alpha (TNFalpha), and interferon gamma (IF-gamma). CsA is the most extensively investigated of the immunomodulatory drugs. Significant efficacy of CsA as monotherapy as well as in combination with methotrexate for treatment of early and established RA has been demonstrated in studies world-wide. It is also effective in other autoimmune diseases, such as systemic lupus erythematosus, polymyosits, Behcet disease, juvenile chronic arthritis or psoriatic arthritis. CsA is characterized by efficacy as well as by safety and tolerability - SMERDEL A, LIE BA, FINHOLT C, PLOSKI R, FORRE O, UNDLIEN DE, THORSBY E: An additional susceptibility gene for juvenile idiopathic arthritis in the HLA class I region on several DR-DQ haplotypes. Tissue Antigens 2003, 61:80-84.
Organism:A. Smerdel, Institute of Immunology, Rikshospitalet University Hospital, 0027 Oslo
Abstract: Juvenile idiopathic arthritis (JIA) is an HLA-associated rheumatic disease with onset in childhood. We recently reported that allele 5 at microsatellite D6S265 in the HLA class I region is associated with JIA, independent of linkage disequilibrium with the high risk DR8-DQ4 haplotype. In the present study, we investigated whether alleles at D6S265, or other markers in this region, also modify the risk for JIA on other haplotypes, i.e., DRB1*1301-DQB1*0603 or DRB1*1101/4-DQB1*0301. We observed a significant association with allele 6 at D6S265 on the DRB1*1301-DQB1*0603 haplotype. We also noted an association with allele 3 at D6S265, when carried on the DRB1*1101/4-DQB1*0301 haplotype. Our results further support an additional JIA susceptibility gene in the HLA class I region in linkage disequilibrium with alleles at D6S265
Internet : anna.smerdel@klinmed.uio.no - TAKKEN T: Studies on physical performance and functional ability in Juvenile Idiopathic Arthritis. Geneeskunde en Sport 2003, 36:20-21.
Organism:Dr. T. Takken, Afd. Kinderfysiother. W. K., Universitair Medisch Centrum Utrecht, Kamer KB.02.056, Postbus 85090, 3508 AB Utrecht
Internet : t.takken@wkz.azu.nl - THURLER F, RIVIER G, GUERNE PA, SAUVAIN MJ, SAURENMANN T, BOLZ D, HOFER M: [Chronic arthroses in children: practical approach and epidemiological data]. Rev.Med.Suisse Romande 2002, 122:602-605.
Organism:Departement de Pediatrie, CHUV, Lausanne
Abstract: Osteo-articular symptoms are frequent in pediatrics, but chronic arthritis is rare in childhood. Arthritis may be difficult to recognize in children and there is a large differential diagnosis including infectious and neoplastic diseases. Even if juvenile arthritis has often a favourable course, significant functional damage may occur. The diagnosis and the follow-up of chronic arthritis should be performed in collaboration with a specialized consultation in pediatric rheumatology, in order to allow access to multidisciplinary medical care and help to increase the clinical and epidemiological knowledge in these rare diseases. A study is starting this fall aimed at collecting epidemiological datas on childhood arthritis in the french part of Switzerland
Internet : PM:12611185 - TRAN VT, BODAGHI B, CASSOUX N, PRIEUR A-M, LEHOANG P, HERBORT CP: Use of Laser Photometry in the Management and Monitoring of Juvenile Idiopathic Arthritis (JIA) Related Uveitis. ARVO Annual Meeting Abstract Search and Program Planner 2002, 2002:Abstract
Organism:Inflammatory Eye Diseases, La Source Eye Center, Lausanne, Switzerland Switzerland
Abstract: Purpose: The exquisite sensitivity of laser flare photometry (LFP) to detect subclinical changes in inflammation levels has been well demonstrated. Our aim here was to study the use of LFP in monitoring inflammation quantitatively in our collective of JIA related uveitis. Methods: Charts of patients seen at La Source Eye Center and in the Department of Ophthalmology of La Pitie-Salpetriere Hospital from 1995 to 2001 with the diagnosis of JIA associated uveitis were reviewed. Epidemiological and clinical characteristics were analysed and LFP values at presentation and during follow-up were recorded. LFP was done at each visit, using a Kowa-FM-500 or FC-1000 photometer (Kowa Co, Tokyo Japan) and correlated with clinical evolution and treatment. Mean flare values were compared statistically using Student's t test. Patients were divided into severe cases with a bad visual outcome (VA < 0.2) and benign cases with a maintained visual acuity of 0.3 or better. Results: Thirty-six patients with JIA associated uveitis, 12 severe cases and 24 "benign" cases, were identified. Mean follow-up was 3.5 +- 4.9 years. Mean flare values were high at presentation (189.7 +- 92 ph/ms) in the severe disease group and reduction after maximal therapy was unsactisfactory (121.33 ph/ms ; -30%). For the benign cases mean flare at presentation was less high (110 +- 32 ph/ms) although not statistically significantly lower than for the severe disease group because of the high standard deviations However flare reduction was spectacular and significant (29.1 +- 25.7; -75% ; P< 0.05) with good restitution of blood-aqueous barrier. Conclusion: Laser flare photometry was able to predict the outcome of JIA related uveitis which was deleterious in all patients that had not undergone adequate blood-aqueous barrier restitution after maximal therapy. It was further found to be useful to correctly monitor tapering and obtain minimally effective treatment - TWILT M, VAN DER GE, MOBERS SM, TEN CATE R, SUIJLEKOM-SMIT LW: Abrupt condylar destruction of the mandibula in juvenile idiopathic arthritis. Ann.Rheum.Dis. 2003, 62:366-367.
Organism:Department of Paediatrics, Erasmus MC/Sophia Children's Hospital, The Netherlands Department of Orthodontics, Erasmus MC/Sophia Children's Hospital, The Netherlands Department of Paediatrics, Leiden University Medical Centre, The Netherlands
Internet : PM:12634241 - UZIEL Y, BERKOVITCH M, GAZARIAN M, KOREN G, SILVERMAN ED, SCHNEIDER R, LAXER RM: Evaluation of eutectic lidocaine/prilocaine cream (EMLA(R)) for steroid joint injection in children with juvenile rheumatoid arthritis: A double blind, randomized, placebo controlled trial. Rinsho Ganka 2003, 30:594-596.
Organism:Dr. R.M. Laxer, Division of Rheumatology, Hospital For Sick Children, 555 University Avenue, Toronto, Ont. M5G IX8
Abstract: Objective. To evaluate the efficacy of eutectic lidocaine/prilocaine cream (EMLA(R)) in reducing the pain associated with steroid joint injection in children with juvenile arthritis. Methods. A randomized, double blind, placebo controlled parallel group trial. Thirty-one children (ages 8-18 yrs) scheduled for steroid injection into a knee were randomized into groups having either 2.5 g lidocaine/prilocaine cream or placebo cream applied to the injection site 60-90 min before the procedure. Patients assessed the pain associated with initial needle insertion and subsequent steroid injection using a 10 cm visual analog scale. Results. No significant difference was found in the pain reported after needle insertion or steroid injection between the lidocaine/prilocaine cream group (n = 17) and the placebo group (n = 14). There was a trend toward an association of lower median scores with the pain of steroid injection in the lidocaine/prilocaine group (6 mm) compared with the placebo group (22 mm). Conclusion. Application of 2.5 g lidocaine/prilocaine cream for 60-90 min had no statistically significant analgesic effect on pain associated with injections of steroids into the knees of children with juvenile arthritis
Internet : ronald.laxer@sickkids.ca - VALLON D, AKERMAN S, NILNER M, PETERSSON A: Long-term follow-up of intra-articular injections into the temporomandibular joint in patients with rheumatoid arthritis. Swed.Dent.J. 2002, 26:149-158.
Organism:Department of Stomatognathic Physiology, Faculty of Odontology, Malmo University, Malmo, Sweden danilavallon@odmahse
Abstract: A long-term (12 years) follow-up of treatment with intra-articular injections into the temporomandibular joint (TMJ) of steroid or non-steroid agents was performed in 21 patients with rheumatoid arthritis (RA) and symptomatic TMJs. The aim of the study was to compare symptoms, signs and radiological appearance of the TMJ initially and at the follow-up in this group of patients. Eleven patients were assigned to a steroid group and 10 patients to a non-steroid group. Initial and follow-up clinical and radiological examination procedures were the same. The radiological evaluation was based on a grading system using standard reference films. At follow-up, 14 patients reported no pain from the TMJ and positive changes in most clinical variables were found in both groups. Radiographic follow-up examination was performed on 12 patients. Initially, all but 4 of the 24 joints had structural bone changes. At follow-up, 2 joints had lower, 11 joints had unchanged and 11 joints had higher radiological grades. Two out of 5 and 3 out of 10 joints in the steroid and non-steroid group, respectively, showed progression of structural bone changes. Among 9 untreated joints, 6 had higher radiological grades and 3 were unchanged. In the 11 TMJs with higher radiological grades at follow-up, there was in most cases moderate progression of erosive changes. The results suggest that the long-term development of symptoms and signs from the TMJ in patients previously treated was good and the long-term progression of joint destruction was low for both steroid and non-steroid agents in this patient group with RA
Internet : PM:12611144 - VAN DER NET J., PRAKKEN ABJ, KUIS W, HELDERS PJM: Autoimmune disease of the postural and locomotor apparatus: Juvenile idiopathic arthritis. Tijdschrift voor Kindergeneeskunde 2003, 71:8-12.
Organism:Dr. J. Van Der Net, Afdeling Kinderfysiotherapie, UMCU, Wilhelmina Kinderziekenhuis, Postbus 85090, 3508 AB Utrecht
Abstract: Juvenile idiopathic arthritis (JIA) is a systemic autoimmune disease affecting primarily the joints. The disease has many consequences especially on growth, psychosocial and physical development. This review article discusses new developments in classification, aetiology, pathophysiology, prognosis and treatment of JIA
Internet : j.vandernet@wkz.azu.nl - VARSANI H, PATEL A, VAN KOOYK Y, WOO P, WEDDERBURN LR: Synovial dendritic cells in juvenile idiopathic arthritis (JIA) express receptor activator of NF-kappaB (RANK). Rheumatology (Oxford) 2003, 42:583-590.
Organism:Rheumatology Unit, Institute of Child Health, University College London, London, UK
Abstract: OBJECTIVES: To analyse the expression of receptor activator of NF-kappaB (RANK) and RANK ligand (RANKL) in the joints of children with juvenile idiopathic arthritis (JIA), to characterize the phenotype of RANK(+) cells and to test the hypothesis that some RANK(+) cells are of the dendritic type. METHODS: Paired samples of peripheral blood mononuclear cells (PBMC) and synovial fluid mononuclear cells (SFMC) from children with oligoarticular (n=14) or polyarticular (n=4) JIA and PBMC from 10 control subjects were studied for expression of RANK, RANKL and dendritic cell-specific ICAM (intercellular adhesion molecule)-grabbing non-integrin (DC-SIGN) by the reverse transcriptase-polymerase chain reaction and three-colour flow cytometry. Expression of DC-SIGN and RANK was followed after 1 week of culture with granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin 4 (IL-4). RESULTS: mRNA for RANK was detected in both adherent cells and T cells from PBMC and SFMC of patients with JIA and in control PBMC, while mRNA for RANKL was detectable in the T-cell fraction from JIA patients but not in that from controls. By flow cytometry, a large number of RANK(+) cells were detected in the joint; these cells had the phenotype HLA-DR(hi)CD86(hi) CD11c(+) and expressed low levels of DC-SIGN. CONCLUSIONS: There is increased expression of RANKL and RANK in the juvenile arthritic joint. RANK is expressed on a population of cells with features of dendritic cells. RANK/RANKL interactions may contribute to the survival of inflammatory cells within the joint, as well as to erosions and osteoporosis in juvenile arthritis
Internet : PM:12649407 - ZABEK J, BIERNACKA E, GUTOWSKA-GRZEGORCZYK G, MICHALAK-WIEJAK H: [Antibodies to cytokeratin (AKA) in sera and synovial fluids of patients with Juvenile idiopathic arthritis (JIA).]
<ORIGINAL> Przeciwciala przeciwko cytokeratynie (AKA) w mlodzienczym idiopatycznym zapaleniu stawow (mizs.). Reumatologia (Warsaw) 2002, 40:222-228.
Organism:Zaklad Mikrobiologii i Serologii, Instytut Reumatologiczny, ul. Spartanska 1, 02-637, Warszawa, Poland Poland
Abstract: RA is the most frequent chronic inflammatory autoimmune disease with still unknown etiology. Between autoantibodies occuring in RA the most useful is so called classical rheumatoid factor (IgM class). But unfortunately RF-IgM is present only in about 75% of RA cases and in early RA (6 to 12 months duration) only in 25-30% of cases. In JIA (Juvenile idiopathic arthritis) the frequencies of RF-IgM are much lower than in adults - ranging about 30%. The most promising group of the autoantibodies is group of so called anti-keratin antibodies (AKA), but there is a lot of controverses concerning the frequency, sensitivity, specificity and also the "marker" meaning of these antibodies. The aim of the presented study was to compare all (above mentioned) parameters, especially the frequencies of AKA-s in the cohort of 18 patients (11 female and 7 male) with established JIA. The AKA was tested by IIF - method (acc. to Young) and also by immunoperoxidase staining method. In both methods air-dried cryostat-sections of the rat oesophageus were used. For the final confirmation Western-blott and ELISA method have been used. In 33% of 18 JIA pts. sera and 11% of synovial fluids have been found to be AKA-positive and none in the sera of healthy blood donors. What is more important, in this same group RF-IgM only in 11% of the sera and 16.5% of synovial fluid is present. These preliminary data showed that AKA-antibodies are a very promising "marker" of RF-IgM seronegative, early and active RA, and we intend to confirm these data in the large groups of children with undifferentiated connective tissue diseases