Bibliography April 2003
- ALEXEJEVA YI, SHACHBASJAN IY, ROSVADOVSCAJA OS, YELJASHEVICH VY: Immunosuppressive Therapy with Cyclosporin A of Severe Treatment Refractory Juvenile Rheumatoid Arthritis. Russ.J.Immunol. 1996, 1:49-54.
Organism:Moscow Sechenov Medical Academy, Moscow, Russia
Abstract: Rheumatoid arthritis is severe destructive inflammatory joint disease which usually leads to invalidisation of patient in spite of current therapies. The aim of the trial was to assess the effect of Cyclosporin A (Sandimmun (SIM), Sandos Pharma) in prevention of disability, reduction of inflammatory disease activity, tolerability, safety and suitability for a long treatment in severe treatment refractory juvenile rheumatoid arthritis (JRA). Fifteen patients of 7-15 years old (12 girls and 3 boys), of whom 6 had systemic seronegative and 9 had poliarticular seropositive severe JRA with anatomical stage 2-4 and functional capacities 2-3, were treated with Cyclosporin A in open self-controlled trial of 6 months duration for 15 patients and of 12 months duration for 7, All of them received non-steroid anti-inflammatory drugs and were regularly intra-articularly injected with corticosteroids and 6-prednisolone at a mean dose of 8.0 mg/day. Cyclosporin A was administrated in a dose of 3.5-4.5 mg/kg/day. Efficacy control was carried out according to dynamics of clinical and laboratory criteria of the disease activity, functional capacities and radiographic data. The results of the trial have shown that Cyclosporin A therapy led to statistically significant improvement in almost all clinical outcome variables (the number of swollen joints, p < 0.01, the number of painful joints, p < 0.001; pain score, p < 0.01; duration of morning stiffness, p < 0.001; volume of proximal interphalangeal joints, p < 0.001) and several laboratory parameters (ESR, p < 0.001; IgG level, p < 0.05; 6 seropositive patients became seronegative). All the patients exhibited significant increase in functional abilities and stabilization of joint destruction process. Response was considered as very good in 70% of patients and good in 20%, Prednisolone dose and the number of corticosteroid injections were reduced (p < 0.05). Adverse effects of Cyclosporin A included hypertrichosis, gingivitis, increase in appetite and weight, transitory increase in creatinin serum level of 30% over baseline, relapse of bacterial viral infection. These patients required temporal withdrawal of Cyclosporin A. It is concluded that Cyclosporin A therapy is effective in severe JRA, is well tolerated by patients, is suitable for a long-term treatment and has probable disease modifying effect in JRA
Internet : PM:12687042 - BARBER J, SHEERAN T, MULHERIN D: Anti-tumour necrosis factor treatment in a patient with anorexia nervosa and juvenile idiopathic arthritis. Ann.Rheum.Dis. 2003, 62:490-491.
Organism:Department of Rheumatology, Cannock Chase Hospital, Brunswick Road, Cannock, WS11 2XY, UK
Internet : PM:12695170 - BARONCELLI GI, FEDERICO G, BERTELLONI S, SODINI F, DE TERLIZZI F, CADOSSI R, SAGGESE G: Assessment of Bone Quality by Quantitative Ultrasound of Proximal Phalanges of the Hand and Fracture Rate in Children and Adolescents with Bone and Mineral Disorders. Pediatr.Res. 2003,
Organism:Endocrine Unit, Division of Pediatrics, Department of Reproductive Medicine and Pediatrics, University of Pisa, Pisa, IT-56125, Italy
Abstract: Bone quality by quantitative ultrasound and fracture rate were assessed in 135 (64 males) children aged 3-21 y with bone and mineral disorders such as chronic anticonvulsants or glucocorticoids treatment, juvenile rheumatoid arthritis, celiac disease, paucity of intrahepatic bile ducts, autoimmune hepatitis, genetic diseases, idiopathic juvenile osteoporosis, disuse osteoporosis, beta-thalassemia major, survivors of acute lymphoblastic leukemia, liver transplantation, calcium deficiency, and nutritional or X-linked hypophosphatemic rickets. Amplitude-dependent speed of sound through the distal end of the first phalangeal diaphysis of the last four fingers of the hand was measured by an ultrasound device. In the majority of patients cortical area to total area ratio by metacarpal radiogrammetry (n = 120) and lumbar bone mineral density (BMD) by dual-energy x-ray absorptiometry (n = 99) were also assessed. In patients with X-linked hypophosphatemic rickets radial BMD by single-photon absorptiometry instead of lumbar BMD was measured. Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMD area, or lumbar BMD corrected for bone sizes estimated by a mathematical model (BMD volume), as well as mean values of radial BMD in patients with X-linked hypophosphatemic rickets, expressed as z score, were significantly reduced (p < 0.0001) in comparison with their reference values (-1.7 +/- 1.0, -2.0 +/- 0.9, -3.0 +/- 1.3, -1.9 +/- 1.0, -2.7 +/- 0.7, respectively). A positive relationship was found between amplitude-dependent speed of sound and cortical area to total area ratio (r = 0.90, p < 0.0001), lumbar BMD area (r = 0.62, p < 0.0001), or lumbar BMD volume (r = 0.66, p < 0.0001). Fifty-two patients (38.5%) had suffered fractures in the 6 mo preceding the bone measurements, the radial distal metaphysis being the most frequent fracture site (28.8%). Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMD area, or lumbar BMD volume, expressed as z score, of fractured patients were significantly lower (p < 0.0001) than those of fracture-free patients (-2.2 +/- 1.0 and -1.4 +/- 0.8, -2.6 +/- 0.9 and -1.7 +/- 0.7, -3.5 +/- 1.2 and -2.5 +/- 1.0, -2.5 +/- 1.0 and -1.3 +/- 0.7, respectively). Phalangeal quantitative ultrasound may be a useful method to assess bone quality and fracture risk in children and adolescents with bone and mineral disorders
Internet : PM:12700367 - BERLUCCHI M, MEINI A, PLEBANI A, BONVINI MG, LOMBARDI D, NICOLAI P: Update on treatment of Marshall's syndrome (PFAPA syndrome): Report of five cases with review of the literature. Annals of Otology, Rhinology and Laryngology 2003, 112:365-369.
Organism:Dr. P. Nicolai, Department of Otorhinolaryngology, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia
Abstract: Marshall's syndrome or PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is a recently described pediatric periodic disease characterized by recurrent febrile episodes associated with head and neck symptoms. The origin of this syndrome is unknown, and it can last for several years. During healthy periods, patients grow normally. The differential diagnosis includes other diseases characterized by periodic fevers, such as familial Mediterranean fever, familial Hibernian fever, hyperglobulinemia D syndrome, Behc(cedil)et's disease, cyclic neutropenia, juvenile rheumatoid arthritis, and several infectious diseases. Many treatments have been used, with various results, including antibiotics, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, colchicine, antiviral medicines, steroids, cimetidine, and tonsillectomy. We describe 5 new patients affected by PFAPA syndrome who were observed at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy, from November 2000 to August 2001. All children underwent physical examination, bacterial, fungal, and viral cultures, chest radiography, and several laboratory studies. The patients were treated by successful tonsillectomy, and after a mean follow-up of 10 months, no recurrence was observed. An analysis of the literature is also presented with particular emphasis on the differential diagnosis of this rare illness and the results of the different therapeutic options - BOYKINOV I: IL-1, II-18, IL-15, their receptors and autologous stem-cells transplantation in the treatment of systemic autoimmune diseases /SAD/. Pediatriya 2003, 43:53-55+6.
Organism:I. Boykinov, University Pediatric Hospital, Acad. Iv. Gechov, str. 11, Sofia 1606
Abstract: The great progress of Immunology in the Rheumatology made clear e role of the proinflammatory cytokins IL-1, IL-18, IL-15 in the pathogenecy of the Juvenile idiopathic chronic arthritis /JIA, = JRA/ and other SAD. The soluble receptors /sRc/ binding the interleukins block their inflammatory potential. The binding protein /BP/ of IL-18 and especially the comercial accessible recombinant human receptor antagonist of IL-1 anakinra /kineret/ founded therapeutic application in SAD Autologous transplantation of Stem-cells proved as powerful therapeutic method in JIA as well - BOYKINOV I: Biological therapeutic methods of systemic autoimmune diseases/AID/: Blocking agents of TNF-alpha. Pediatriya 2003, 43:49-6.
Organism:I. Boykinov, University Pediatric Hospital, Acad. Iv. Gechov, str. 11, Sofia 1606
Abstract: TNF-alpha is a cytokin with a very pawerful proinflammatory potential. Its soluble recetors established in the blood and body fluids act as blocking agents of the TNF-alpha activity. A new biological therapeutic method in the treatment of Juvenile idiopathic chronic arthritis /=JRA/, Rheumatoid arthritis, Systemic Lupus erythematosus, and other SAD improve refractory patients using either a chimeric monoclonal antibody /Influximab, adalimumab/ or a recombinant human soluble TNF-alpha receptor /etanercept/. These blocking agents may be performed as single or in combination with previosly used drugs. A spectrum of side effects were founded, the most of them were transient. However, it should be noted that SLE, three lymphomas and one case of a cute myeloic leukaemia were seen - BRUINOOGE LN, EL MOUSSAOUI R, TAAL E, DIJKMANS BAC, VAN SOESBERGEN RM: Outcome in adults with juvenile idiopathic arthritis: Comparison of the DUTCH-AIMS2 between JIA and RA. Scandinavian Journal Of Rheumatology 2003, 32:89-94.
Organism:R.M. Van Soesbergen, Department of Rheumatology, Slotervaart Hospital, Louwesweg 6, NL-1066 EC Amsterdam
Abstract: Objectives: To compare outcome in adult patients with JIA in childhood with outcome in young adults with RA and to evaluate the use of the DUTCH-AIMS2 in adult JIA patients. Methods: A questionnaire containing the DUTCH-AIMS2 to assess health outcomes (answers ranging from 0-10:0=best) was sent to 142 adults with JIA (18-40 years). These health outcomes were compared with those of 34 young RA patients (<=40 years) from former studies. The DUTCH-AIMS2 was tested for its reliability and validity in adult JIA patients. Results: The response rate was 71%. Disease duration of JIA patients (mean 19.2+/-9.5 years) was longer than in young RA patients (mean 7.8+/-5.3 years). RA patients scored worse than JIA patients in all health status areas with the exception of mobility. The mean health outcome scores were low for all groups (<=4.80). The internal consistency and the validity of the DUTCH-AIMS2 were satisfactory. Conclusions: Overall, the health outcome of oligoarticular and polyarticular adult JIA and young RA patients was quite good. The DUTCH-AIMS2 can be used as an instrument in outcome studies in JIA patients
Internet : r.m.van.soesbergen@freeler.nl - DOLEZALOVA P, YOUNG SP, BACON PA, SOUTHWOOD TR: Nailfold capillary microscopy in healthy children and in childhood rheumatic diseases: a prospective single blind observational study. Ann.Rheum.Dis. 2003, 62:444-449.
Organism:Department of Paediatrics and Adolescent Medicine, Charles University in Prague, 1st Faculty of Medicine, Prague, Czech Republic Department of Rheumatology, University of Birmingham, B15 2TT, UK
Abstract: OBJECTIVES: To develop an objective method of nailfold capillaroscopy (NFC), applicable to a wide age range of paediatric patients. To compare the morphological characteristics of the nailfold capillaries in different rheumatology patient groups and controls. METHODS: A colour digital video camera attached to a stereomicroscope was used to capture nailfold capillary images. Computerised image processing was used to analyse and store data. Subsequent quantitative and qualitative morphological analysis was performed in the following paediatric patient and control groups: 18 children with connective tissue diseases (CTD: juvenile dermatomyositis, systemic sclerosis, and undifferentiated connective tissue disease), eight with systemic lupus erythematosus, nine with primary Raynaud's disease, three with primary vasculitis, 15 with juvenile idiopathic arthritis, 17 healthy children and 20 healthy adults. Images were analysed by a single assessor who was unaware of the patient details. RESULTS: The NFC technique was simple to perform and gave reproducible results, although some i
Internet : PM:12695158 - EDELSTEN C, REDDY MA, STANFORD MR, GRAHAM EM: Visual loss associated with pediatric uveitis in english primary and referral centers. Am.J.Ophthalmol. 2003, 135:676-680.
Organism:Medical Ophthalmology Department (CE), Great Ormond Street Hospital, London, United Kingdom
Abstract: Pediatric uveitis is rare and has been reported to cause increased rates of visual loss compared with adult patients. The reasons for this are unclear. Only one study has been population-based, so the effect of referral bias is not known. We examined the pattern of disease in primary and referral centers to establish the unique characteristics of uveitis in children.Case control study.Retrospective, multicenter, observational study of uveitis starting before the age of 20 years. Two hundred forty-nine patients were recruited from three primary and two referral ophthalmic units. Age-related differences in types of uveitis and systemic disease between hospitals were characterized, as were associations with visual loss.The incidence of uveitis in district hospitals at less than 16 years of age was 4.9/100,000: the most frequent diagnosis was idiopathic uveitis (78%). In referral cohorts the most frequent diagnosis was juvenile idiopathic arthritis-associated uveitis (67%). Other systemic diseases were rare. The most frequent type of uveitis at 0 to 7 years of age was chronic anterior uveitis, posterior uveitis
Internet : PM:12719076 - EKSTROM K, HJALGRIM H, BRANDT L, BAECKLUND E, KLARESKOG L, EKBOM A, ASKLING J: Risk of malignant lymphomas in patients with rheumatoid arthritis and in their first-degree relatives. Arthritis Rheum. 2003, 48:963-970.
Organism:Karolinska Institutet, Stockholm, Sweden karinekstrom@mepkise
Abstract: OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk for malignant lymphomas. Both conditions display a familial aggregation, and there are reports of RA and malignant lymphomas occurring in the same families. This study was undertaken to determine the risk of malignant lymphomas in first-degree relatives of RA patients, in order to investigate whether the increased risk of malignant lymphomas in RA could be due to genetic or environmental risk factors common to both conditions, rather than being a consequence of the rheumatic disease. METHODS: Using Swedish nationwide and population-based registers, we identified 76,527 patients hospitalized with RA in 1964-1999 and 70,290 first-degree relatives of a subset of these patients. These subjects were followed up for more than 3 decades, and information on cancer occurrence was recorded. RESULTS: Patients with RA had a significantly increased risk of malignant lymphomas (535 cases; standardized incidence ratio [SIR] 2.00, 95% confidence interval [95% CI] 1.83-2.17), which was apparent for up to 2 decades of followup. Among the first-degree relatives without RA, no increased risk of malignant lymphomas was found overall, although modest and nonsignificantly elevated risk estimates were observed in subgroups. With respect to childhood cancer (0-14 years of age), we observed an increased risk of Hodgkin's lymphoma (5 cases; SIR 3.18, 95% CI 1.03-7.42). CONCLUSION: Patients with RA are at a markedly, but possibly time-limited, increased risk for malignant lymphomas. There is little to suggest a prominent role for coinherited or common environmental risk factors in malignant lymphomas arising in the context of RA. Instead, lymphomas complicating RA appear to be a direct consequence of the inflammation or its treatment
Internet : PM:12687538 - ELWOOD RL, PELSZYNSKI MM, CORMAN LI: Multifocal septic arthritis and osteomyelitis caused by group A Streptococcus in a patient receiving immunomodulating therapy with etanercept. Pediatr.Infect.Dis.J. 2003, 22:286-288.
Organism:Dr. R.L. Elwood, Department of Pediatrics (SGOC), David Grant Medical Center, 101 Bodin Circle, Travis AFB, CA 94535
Abstract: A12-year-old girl with juvenile rheumatoid arthritis presented with signs of infection of the proximal interphalangeal joint of her left great toe 1 week after a flu-like illness. Several joints and one bone were subsequently found to be infected with group A beta-hemolytic streptococci. Despite appropriate antibiotic therapy, synovial fluid cultures remained positive for 2 weeks. We believe that the antiinflammatory medications, including etanercept (a tumor necrosis factor antagonist), used to treat this patient's arthritis contributed to the severity and unusual course of her infection
Internet : Robert.Elwood@60mdg.travis.af.mil - ENOCAK O, UNSAL E, AKALIN E, ERGOR G: Interobserver reliability of articular examination in juvenile idiopathic arthritis. Turk.J.Pediatr. 2003, 45:29-32.
Organism:O. S(cedil)enocak, Dept. of Physical Medicine/Rehab., Dokuz Eylul Univ. Faculty of Med., Izmir
Abstract: Diagnosis, treatment and follow-up of children with juvenile idiopathic arthritis are based upon the articular examination. The objective of the current study was to assess the interobserver agreement in grading the joint with arthritis and limited range of motion, and to detect the sources of disagreement. Twenty children with juvenile idiopathic arthritis were included. Assessment parameters were a) Physician Global Assessment, b) number of joints with active arthritis, and c) number of joints with limited range of motion. A total number of 1,320 joints were examined by both observers, blinded to each other. Each observer marked the involved joints as active arthritis, as limited range of motion, or as both. Interobserver agreement was determined by using Kappa statistics and Wilcoxon signed rank test. The statistical analysis was performed by SPSS 10.0. There was no statistical difference in the comparison of Physician Global Assessment of the two observers. There was substantial agreement in both arthritis and limited range of motion scores. Chance corrected agreement for the interobserver reliability was also performed for frequently involved joint such as neck, wrist, hip and knee. A substantial agreement was found. The close agreement between the observers could be attributed to standardization of examination techniques and to using objective variables - GENEL F, ARSLANOGLU S, HIZARCIOGLU M, DURMAZ B, URAN N, AKTAS S: Steroid myopathy in a child with juvenile rheumatoid arthritis. Case report. Panminerva Med. 2003, 45:75-77.
Organism:Department of Pediatrics and Pathology, Dr Behcet Uz Children's Hospital, Izmir, Turkey
Abstract: An 8-year-old boy who had been diagnosed as systemic-onset juvenile rheumatoid arthritis were on treatment for 8 months with methotrexate and additional steroids during activation. At the end of the 8th month when the corticosteroid dose was 12.5 mg/day, he began to suffer from numbness and weakness in his hands. Physical examination, laboratory findings and electromyography results demonstrated myopathy. Steroid myopathy was considered. Corticosteroids were tapered and stopped. At follow-up clinical findings remitted and electromyography became normal at the 4th month. We present here this case to direct attention to drug-induced myopathy besides myopathy due to primary disease in connective tissue disorders whenever myopathy exists
Internet : PM:12682624 - GOODMAN S, HOWARD P, HAIG A, FLAVIN S, MACDONALD B: An open label study to establish dosing recommendations for nabumetone in juvenile rheumatoid arthritis. Rinsho Ganka 2003, 30:829-831.
Organism:A. Haig, GlaxoSmithKline Pharmaceuticals, 1250 S. Collegeville Road, Collegeville, PA 19426-0989
Abstract: Objective. Once-a-day dosing with nabumetone has been shown to be effective in adults with rheumatoid arthritis. We establish dosing recommendations for nabumetone in children and adolescents with juvenile rheumatoid arthritis (JRA). Methods. An open label, multicenter study was conducted in children with JRA aged 2-16 years, weighing > 14 kg, and requiring nonsteroidal antiinflammatory drugs (NSAID) for control of symptoms. NSAID were discontinued one day prior to study initiation to minimize disease flare. Patients received nabumetone 30 mg/kg once daily (as a tablet or a slurry) for 12 weeks. Efficacy assessment evaluations were performed at Weeks 1, 3, 6, and 12, based on the mean change from baseline at the study endpoint for 6 standard rheumatology variables. An overall assessment of efficacy was determined based on the percentage of patients who did not experience a flare, using the 6 rheumatology variables. Since this was an open label study, only descriptive statistics were obtained for efficacy variables. Routine safety assessments were completed for all patients. Results. In total, 99 patients with JRA were enrolled and 89 completed the study; mean age was 9.2 years. The proportion of nabumetone treated patients with no flare in disease activity during the nabumetone treatment period was 92/99 (93%). Improvement was noted in each efficacy assessment, although statistical evaluations were not performed. The adverse event profile was similar to that reported for nabumetone in adults with RA. Conclusion. Nabumetone 30 mg/kg/day (up to 2000 mg/day) demonstrated a safe profile with no loss of efficacy compared to previous treatment in children with JRA. The dose can be administered by suspending tablets in warm water to create a slurry - GRATEAU G: Where has reactive amyloidosis gone? Revue du Praticien 2003, 53:516-519.
Organism:G. Grateau, Service de Medecine Interne, L'Hotel-Dieu, 75181 Paris Cedex 04
Abstract: Inflammation associated amyloidosis (AA amyloid) remains a severe complication of chronic inflammatory diseases, namely of rheumatoid arthritis and of juvenile arthritis. Infectious causes of AA amyloid have become uncommon. In the course of chronic inflammatory diseases, amyloid should be regularly screened by proteinuria. The proof of amyloidosis requires tissue analysis examplifying specific apple-green birefringence after staining with Congo red. When amyloidosis is progressive in the course of one chronic disease, powerful anti-inflammatory and immunosuppressive drugs can be used
Internet : gilles.grateau@htd.ap-hop-paris.fr - GRAUL AI, REVEL L, PROUS J: Annual update 2003 musculoskeletal drugs. Drugs of the Future 2003, 28:69-108.
Organism:A.I. Graul, Prous Science, P.O. Box 540, 08080 Barcelona
Abstract: The Annual Update 2003 of Musculoskeletal Drugs is comprised of a Compendium of drug R&D in the areas of musculoskeletal and connective tissue diseases, including 86 drugs for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, osteoarthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma and Sjogren's syndrome, and Monograph Updates on the following drugs that have been published in previous issues of the journal: abetimus sodium, adalimumab, etoricoxib, iguratimod, licofelone, lumiracoxib, prasterone, tacrolimus and valdecoxib. The Annual Update also includes a comprehensive table listing the drugs, their manufacturers, indications and developmental phases - HALL JG: So you think your mother is always looking over your shoulder? She may be in your shoulder! Journal of Pediatrics 2003, 142:233-234.
Organism:British Columbia's Children's Hospital, 4480 Oak St, Room 2D19, Vancouver, BC, V6H 3V4, Canada Canada - KADAR J, PETROVICZ E: [Adult onset Still's disease: A survey of 18 cases.]
<ORIGINAL> Felnottkorban megjeleno Still-betegseg: 18 Eset kapcsan. Orv.Hetil. 2003, 144:173-178.
Organism:VI. Fertozo Belgyogyaszati Osztaly, Fovarosi Szent Laszlo Korhaz, Budapest, Hungary Hungary
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 - KANAMORI Y, MIYAMOTO K, HOSOE H, FUJITSUKA H, TATEMATSU N, SHIMIZU K: Transoral approach using the mandibular osteotomy for atlantoaxial vertical subluxation in juvenile rheumatoid arthritis associated with mandibular micrognathia. Journal of Spinal Disorders and Techniques 2003, 16:221-224.
Organism:Dr. K. Shimizu, 40 Tsukasa-machi, Gifu 500-8705
Abstract: We report a case of atlantoaxial vertical subluxation with mandibular micrognathia associated with juvenile rheumatoid arthritis. The patient was treated by odontoidectomy via the transoral approach and required a sagittal split mandibular osteotomy because of the mandibular micrognathia. The clinical outcome was excellent
Internet : shim@cc.gifu-u.ac.jp - KATZ PP, PASCH LA, WONG B: Development of an instrument to measure disability in parenting activity among women with rheumatoid arthritis. Arthritis Rheum. 2003, 48:935-943.
Organism:Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, USA pkatz@itsaucsfedu
Abstract: OBJECTIVE: To develop a method of assessing and summarizing parenting function and disability, and to use that method to describe parenting disability among a group of women with rheumatoid arthritis (RA). METHODS: The study group comprised 231 women with RA who are members of the University of California, San Francisco RA Panel Study. Parenting disability scales were developed by first asking open-ended questions and then, based on the responses, constructing closed-ended questions. Separate sets of questions were asked concerning young (ages 0-5 years) and older (ages 6-18 years) children. Parenting disability indices (PDIs), scored in a manner similar to that for the Health Assessment Questionnaire (HAQ) (range 0-3), were developed (total, and for young and older children). Associations of PDIs with demographic, health, and symptom measures were assessed. RESULTS: Substantial proportions of women with RA experienced disability in parenting activities. Greater disability was reported for activities related to parenting young children. Doing less of parenting functions because of RA was commonly reported. The mean total PDI of women who currently had children under age 18 years, taking into account "doing less" of activities because of RA, was 0.76 (range 0-2.08). Greater parenting disability was associated with poorer general function (HAQ; P < 0.0001), more severe pain (P = 0.002), greater fatigue (P = 0.0005), greater parenting stress (P = 0.005), and greater psychological distress (depressive symptoms; P < 0.0001). DISCUSSION: The PDI appears to be valid. This method can provide the means of assessing parenting disability, its risk factors, and its effects, which may assist in identifying ways of helping individuals with RA cope more effectively with parenting
Internet : PM:12687535 - KOLAROV Z, NIKOLOV K, VARBANOVA B, BALEVA M: IgM-rheumatoid factor in patients with rheumatoid arthritis and juvenile idiopathic/chronic arthritis. Rheumatology 2002, 10:50-54.
Organism:Dr. Zl. Kolarov, Clinic of Rheumatology, Medical University, 13, Urvich Str., Bg - 1612 Sofia
Abstract: With the introduction of the immunoenzyme assay (ELISA) for detection of rheumatoid factors (RF) it was established that IgM-RF was found in about 90% of the patients with rheumatoid arthritis (RA), including the "seronegative " patients according the agglutination tests as well as in children with juvenile chronic arthritis. This study was aimed to make a comparative analysis and evaluation of the clinical associations of IgM-RF (ELISA) in patients with RA and children with oligoarticular and polyarticular form of juvenile idiopathic/chronic arthritis (JIA/JCA). We studied IgM-RF by means of ELISA in 151 RA patients, 79 children with JIA/JCA, 36 healthy adults, 58 healthy children, 50 patients with osteoarthritis and 67 children with autoimmune and rheumatic disorders. We found increased serum levels of IgM-RF in RA patients and children with JIA/JCA. The vast majority (93%) of the RA patients and one third (34%) of the children with JIA were positive for IgM-RF. The highest IgM-RF levels were detected in the seropositive RA patients, followed by the children with polyarticular form of JIA. The increased serum concentration of IgM-RF correlated with the radiological progression of RA and JIA and the severity of joint erosions. IgM-RF levels in RA patients with erosive disease were found to be significantly higher as compared to the children with erosive JIA - LEEDER JS: Developmental and pediatric pharmacogenomics. Pharmacogenomics. 2003, 4:331-341.
Organism:Section of Developmental Pharmacology and Experimental Therapeutics, Division of Pediatric Pharmacology and Medical Toxicology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA sleeder@cmhedu
Abstract: Children, as well as adults, should benefit from the discoveries of the genomic era. Many diseases with complex etiologies originate during childhood (e.g., asthma, autism, attention deficit/hyperactivity disorder, epilepsy and juvenile rheumatoid arthritis) and persist into adulthood. Attempts to better understand the genetic basis of age-specific disease processes requires an appreciation that the period of human development encompasses the prenatal period through adolescence, and is a rapidly changing, dynamic process. As a result, pharmacologic modulation of developing gene networks may have unintended and unanticipated consequences that do not become apparent or relevant until later in life. Thus, there is considerable potential for large-scale pharmacogenomic technologies to impact the development and utilization of new therapeutic strategies in children
Internet : PM:12718723 - MANGGE H, HEINZL B, GRUBBAUER HM, EL SHABRAWI Y, SCHAUENSTEIN K: Therapeutic experience with infliximab in a patient with polyarticular juvenile idiopathic arthritis and uveitis. Rheumatol.Int. 2003,
Organism:Clinical Institute of Medical and Chemical Laboratory Diagnosis and Pediatric Rheumatology/Immunology, University Clinic of Graz, 8036, Graz, Austria
Abstract: A pediatric patient with prolonged seronegative polyarticular juvenile idiopathic arthritis (JIA) and concomitant aggressive, anterior uveitis refractory to any conventional antirheumatic therapy was treated with infliximab. Arthritis and C-reactive protein (CRP) values showed prompt positive effects but, after 6 weeks, returned gradually to initial values despite ongoing therapy. In contrast, a more sustained therapeutic effect was observed on the uveitis, with increased visual acuity and reduced inflammatory signs of the affected eye. However, this benefit was also lost at week 30, after which infliximab had to be discontinued due to side effects. To conclude, in polyarticular seronegative JIA, infliximab showed a transient beneficial effect which was more pronounced on uveitis than arthritis
Internet : PM:12687288 - MULLEROVA H, PRIXOVA M, VLCEK J, MOKROSOVA K, REHORKOVA P, PALICKA V: [Characteristics of patients with osteopenia treated with glucocorticoids at the Osteoporosis Clinic of the Medical Faculty Hospital in Hradec Kralove]. Vnitr.Lek. 2003, 49:32-36.
Organism:Katedra socialni a klinicke farmacie Farmaceuticke fakulty UK, Hradec Kralove
Abstract: One-hundred-ninety-seven osteopenic or osteoporotic patients registered at the University hospital osteology outpatient clinic during 1995-1999 and exposed to glucocorticoids were included in the cohort. Prevalence of glucocorticoid treatment (of all patients) was 12.4%. The patients diagnosed with rheumatoid arthritis showed the greatest reduction in bone density (average T-score = -2.70), fractures were most frequently recorded in patients suffering from asthma or lupus erythematodes
Internet : PM:12666431 - OEN K, REED M, MALLESON PN, CABRAL DA, PETTY RE, ROSENBERG AM, CHEANG M: Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. Rinsho Ganka 2003, 30:832-840.
Organism:Dr. K. Oen, RR149 Rehabilitation Centre, Health Sciences Centre, 800 Sherbrook Street, Winnipeg, Man. R3A 1M4
Abstract: Objective. To determine the radiologic outcome in juvenile rheumatoid arthritis (JRA) and the relationship of radiologically detected joint damage to functional disability using multivariate analyses. Methods. Selection criteria included a diagnosis of JRA made by 1977 American College of Rheumatology criteria, onset of arthritis >= 5 years prior to study, current age >= 8 years, a minimum grade 3 reading ability, and the availability of radiographs. Disability was measured by the Childhood Health Assessment Questionnaire (CHAQ) and Steinbrocker classifications. Radiographs taken within 2 years after onset (early) and the most recent radiographs (late) were examined by a single pediatric radiologist blinded to patients' identities, diagnoses, and outcomes. Multiple regression analyses were performed. Results. On late radiographs the frequencies of joint space narrowing were 38, 14, 43, and 79%, respectively, among patients with systemic, pauciarticular, rheumatoid factor (RF) negative polyarticular, and RF positive polyarticular onset; erosions occurred in 63, 25, 39, and 75%, respectively. Early erosions were most frequent in patients with RF+ polyarticular onset, while both joint space narrowing and erosions occurred early in systemic onset. Radiologic signs of joint damage were most frequent at hips and wrists, while knees and ankles were relatively spared. Based on patients who had radiographs performed within one year of clinical study, 17.7% of the variation in CHAQ score was explained by joint space narrowing, 32.4% by pain, and 5% by a severe rating on physician's global estimate of disease activity. The odds of a Steinbrocker class > I were increased by joint space narrowing, pain, systemic onset, and active joint count. Conclusion. Differences in the frequencies and patterns of joint damage occur both among JRA onset subtypes and among individual joints. Radiographic damage, especially joint space narrowing, correlates with functional disability. However, pain is the major contributor to variation in CHAQ scores - PEREZ MG, V, RODWIG FR: Chronic relapsing thrombotic thrombocytopenic purpura in adult onset Still's disease. Southern Medical Journal 2003, 96:46-49.
Organism:Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA USA^E-Mail: brodwig@ochsner.org
Abstract: We report the first known case of chronic relapsing thrombotic thrombocytopenic purpura associated with adult-onset Still's disease. The patient presented with diffuse arthralgias, sore throat, and a maculopapular rash involving the trunk and extremities; she was hospitalized with fever and confusion. Thrombocytopenia, renal failure, and microangiopathic hemolytic anemia developed within several days. After a diagnosis of thrombotic thrombocytopenic purpura was made, she responded well to a series of plasma exchanges. Evaluation for infection, autoimmune disorders, and malignancy was negative. She was discharged to home in good condition, with normal renal function and normal platelet count. Two more episodes of TTP developed 7 and 9 months after the first hospitalization. The diagnosis of adult-onset Still's disease was then determined on the basis of clinical and laboratory criteria. She was successfully treated with plasma exchange, prednisone, and azathioprine. She later had splenectomy and has subsequently been without recurrence of thrombotic thrombocytopenic purpura for 2 years - QUARTIER P, TAUPIN P, BOURDEAUT F, LEMELLE I, PILLET P, BOST M, SIBILIA J, KONE-PAUT I, GANDON-LALOUM S, LEBIDEAU M, BADER-MEUNIER B, MOUY R, DEBRE M, LANDAIS P, PRIEUR A-M: Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type. Arthritis And Rheumatism 2003, 48:1093-1101.
Organism:Dr. P. Quartier, U. Immuno-Hematol./Rhumatol. Pediat., Hopital Necker-Enfants Malades, 149 rue de Sevres, 75 743 Paris Cedex 15
Abstract: Objective. To assess the efficacy of etanercept in patients with juvenile idiopathic arthritis (JIA), and to assess the tolerance of these patients to etanercept. Methods. All JIA patients with active chronic polyarthritis, who were first treated with etanercept between November 1999 and June 2001 in 18 French centers because of poor response or intolerance to methotrexate, were included in this open-label, prospective, multicenter study. A standardized questionnaire was sent to the treating physicians. We assessed the validated international core-set score for JIA activity every 3 months and performed an intent-to-treat analysis. We also compared the risk of treatment failure in patients defined as having systemic-onset, oligoarticular-onset, or polyarticular-onset JIA. Results. Sixty-one patients were enrolled and were followed up for a median of 13 months. Treatment had to be stopped in 1 patient who became pregnant and in 12 patients due to severe side effects, including neurologic or psychiatric disorders, retrobulbar optic neuropathy, major weight gain, severe infection, cutaneous vasculitis with systemic symptoms, hemorrhagic diarrhea, uveitis flare, and pancytopenia. All of these side effects disappeared after discontinuation of etanercept. Crohn's disease was subsequently diagnosed in 1 child. Scores improved by >=30% in 73% of patients after 3 months, but this proportion decreased to 39% after 12 months. The response rate was significantly lower in patients with systemic-onset JIA than in those with oligoarticular- or polyarticular-onset JIA. Conclusion. Treatment of JIA with etanercept may be associated with a wide spectrum of severe side effects. Although most patients initially respond to etanercept, this initial response is not always followed by sustained improvement over longer periods of time. In addition, the higher rate of treatment failure in the group with systemic-onset JIA indicates that these patients in particular may require alternative treatments
Internet : quartier@necker.fr - ROVENSKA E: On structure and function of synovial lymphatic capillaries in rheumatoid synovitis. Rheumatologia 2003, 17:7-14.
Organism:Dr. E. Rovenska, Narodny Ustav Reumatickych Chorob, Nabrez(caron)ic I. Krasku 4, 921 01 Pies(caron)tany
Abstract: Objective: To visualise and describe lymphatic capillaries in rheumatoid arthritic synovium. Methods: The structure of lymphatic capillaries (LC) of the synovial membrane (SM) from patients with rheumatoid arthritis and juvenile idiopathic arthritis obtained by synovectomy was investigated by transmission electron microscopy. This method allows to compare the structure of the same vessel under light and electron microscope and to differentiate clearly between lymphatic and blood capillaries and venules. Results: Synovial LCs were localized in the subintimal connective tissue of the SM in the vicinity of venules. The shape of some LC was irregular, suggesting oedema of the interstitium. Lymphatic endothelium had extremely attenuated cytoplasm with exception of the perinuclear region. Many nuclei of endothelial cells had distinct nucleoli. The basal lamina was discontinuous. The walls of LC showed close connection with the interstitium represented by anchoring filaments that were attached to the endothelial cells and to the surrounding connective tissue. In some LC connective tissue appeared to be disconnected from endothelium and gaps between their walls and the interstitium were seen. Adjacent to some LC mononuclear cells were accumulated. In the LC walls specialized interendothelial junctions (endothelial microvalves) were observed. Their structure and function, in migration of cells and drainage of debris from synovial interstitium into LC lumina in rheumatoid arthritic synovium, deserves further investigation. In the lumina of some of the LC lymphocytes, monocytes, macrophages, cell debris and enlarged endothelium were observed. Accumulation of such material may cause obstruction of tiny LC. Conclusion: It is possible that reported morphological alterations of the fine synovial lymphatic vessels might contribute to the progression of the inflammatory process in diarthrodial joints to chronicity - SENOCAK O, UNSAL E, AKALIN E, ERGOR G: Interobserver reliability of articular examination in juvenile idiopathic arthritis. Turk.J.Pediatr. 2003, 45:29-32.
Organism:Department of Physical Medicine and Rehabilitation, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
Abstract: Diagnosis, treatment and follow-up of children with juvenile idiopathic arthritis are based upon the articular examination. The objective of the current study was to assess the interobserver agreement in grading the joint with arthritis and limited range of motion, and to detect the sources of disagreement. Twenty children with juvenile idiopathic arthritis were included. Assessment parameters were a) Physician Global Assessment, b) number of joints with active arthritis, and c) number of joints with limited range of motion. A total number of 1,320 joints were examined by both observers, blinded to each other. Each observer marked the involved joints as active arthritis, as limited range of motion, or as both. Interobserver agreement was determined by using Kappa statistics and Wilcoxon signed rank test. The statistical analysis was performed by SPSS 10.0. There was no statistical difference in the comparison of Physician Global Assessment of the two observers. There was substantial agreement in both arthritis and limited range of motion scores. Chance corrected agreement for the interobserver reliability was also performed for frequently involved joint such as neck, wrist, hip and knee. A substantial agreement was found. The close agreement between the observers could be attributed to standardization of examination techniques and to using objective variables
Internet : PM:12718368 - SINGH SK, RICKARDS L, APFELBAUM RI, HURLBERT RJ, MAIMAN D, FEHLINGS MG: Occipitocervical reconstruction with the Ohio Medical Instruments Loop: results of a multicenter evaluation in 30 cases. J.Neurosurg. 2003, 98:239-246.
Organism:Division of Neurosurgery, University of Toronto, Ontario, Canada
Abstract: OBJECT: Stabilization of the craniocervical junction (CCJ) remains a significant challenge. In this multicenter study, the authors present the results of an evaluation of a precontoured titanium implant, the Ohio Medical Instruments (OMI) Loop, for craniocervical fixation. METHODS: In this multicenter retrospective study the authors evaluated 30 patients (16 female, 14 male; mean age 53.8 years) with rheumatoid arthritis (15 cases), traumatic occipitoatlantoaxial instability (six cases), congenital vertebral anomalies (two cases), instability due to basilar invagination in the setting of Chiari malformation (two cases), or Down syndrome (one case), tumor (one case), os odontoideum (two cases), and pseudarthrosis/other (one case), who underwent OMI Loop-assisted occipitocervical reconstruction. The mean follow-up period was 25.4 months (range 6-60 months). A solid reconstruction was achieved in 29 of 30 cases; there was only one case of hardware failure requiring reoperation. Noncritical hardware failure occurred in two patients in whom partial occipital screw backout occurred but did not necessitate reoperation. There were no perioperative neurological complications. One patient (3.3%) experienced a delayed postoperative worsening of myelopathy at 1 year that resolved with further surgery. Postoperatively, in 66.6% of patients the degree of myelopathy remained stable (as measured by American Spinal Injury Association [ASIA] scores), whereas 30% improved by one or more ASIA grade. The rate of osseous fusion was 96.6% at a mean follow-up period of 25.4 months. CONCLUSIONS: The authors found that the OMI Loop is a versatile precontoured occipitocervical fixation device that can be applied to a wide range of CCJ lesions. It provides excellent immediate rigid fixation of the CCJ, a high rate of osseous fusion, and a low rate of hardware failure
Internet : PM:12691378 - TUSZKIEWICZ-MISZTAL E, ROLINSKI J, KRAWCZYK P, BOJARSKA-JUNAK A, OPOKA-WINIARSKA W: Expression of Bcl-2 in juvenile idiopatic arthritis. Central-European Journal of Immunology 2001, 26:115-123.
Organism:Department of Pediatrics, Pulmonology and Rheumatology, Medical School of Lublin, Chodzki 2, 20-093, Lublin, Poland Poland^E-Mail: immunolo@hipokrates.am.lublin.pl
Abstract: Dysregulation of apoptosis of T lymphocytes may be involved in the pathogenesis of juvenile idiopatic arthritis (JIA). Apoptosis is involved in the regulation of an immune response to foreign or autoantigens. It has been speculated that altered expression of apoptosis-regulating proteins such as Bcl-2 family may cause autoimmune disease by inhibiting apoptosis of lymphoid cells. Therefore, the present study has investigated expression of Bcl-2 in the two subgroups patients with JIA: a polyarticular onset and pauciarticular onset in comparison with normal peripheral blood lymphocytes of healthy children. To elucidate the significance of expression of this molecule, we examined the expression of Bcl-2 in B cells and subpopulation of T lymphocytes from peripheral blood of 38 patients with JIA and 15 healthy children, using flow cytometry. Peripheral blood T lymphocytes of patients with polyarticular onset JIA expressed a significantly higher amount of the Bcl-2 protein than T lymphocytes from children with pauciarticular onset JIA (p.<0.05). This difference concerns significantly CD4+ subpopulations of T cells. This proportion was different in CD4+ lymphocytes of healthy donors where expression Bcl-2 was significantly higher compared with T helper cells from patients with pauciarticular onset. There was positive correlation between expression of CD25 antigen (IL-2 receptor) on activated CD3+ T lymphocytes and Bcl-2 protein expression level in T helper cells in children with pauciarticular onset JIA (21, 24). There was not such a correlation in the patients with polyarticular onset JIA. These data suggest that the Bcl-2 protein may interact in regulating apoptosis of lymphocytes taking part in autoactivity of pauciarticular onset JIA. Our data supported the notion that disturbances in T-cell apoptosis may play a role in the immunopathologic processes leading to clinical JIA. These data suggest also that both polyarticular onset and pauciarticular onset JIA have different pathogenesis and probably distinct aetiologies - ULLRICH G, DRESSLER F, THON A, MATTUSSEK S: Information needs of parents of children with juvenile idiopathic arthritis and their interest in services related to self-management and coping. Pravention und Rehabilitation 2003, 15:34-46.
Organism:Dr. G. Ullrich, Kinderklinik der MHH, Carl-Neuberg-Strasse I, D-30623 Hannover
Abstract: Aims: To explore the information needs of parents of children and adolescents with juvenile idiopathic arthritis (JIA) in order to tailor our services. Methods: Standardized, cross-sectional survey with subjective evaluation of knowledge, importance of information, further information needs, the topics of these needs as well as the way they should be delivered. Sample: N = 118 parents of 121 JIA children (response rate 72%); mean age of children 10.3 y (+/- 4.5 y); 61% of all children were female; diagnostic classification of JIA subtypes: 46% oligoarthritis, 20% spondyloarthritis, 19% polyarticular and systemic JIA, 14% other chronic rheumatic diseases. Results: All parents considered complete information as very important (85% with maximum value of 10). The majority felt being well-informed, although 80% mentioned one or more issues of further information needs. These were primarily disease-centered (characteristics and course of the disease, therapy). Regarding service needs there was a strong preference of highly structured services (seminars versus patient and self-help groups). One third showed no interest in any of the services. Conclusions: Corresponding to studies on adults with rheumatoid arthritis our results show scepticism towards services in a group setting, even in groups with professional support. Therefore particular emphasis on patient motivation is required if successful group services are to be implemented - VAN ROSSUM M, VAN SOESBERGEN R, DE KORT S, TEN CATE R, ZWINDERMAN AH, DE JONG B, DIJKMANS B, VAN VENROOIJ WJ: Anti-cyclic citrullinated peptide (anti-CCP) antibodies in children with juvenile idiopathic arthritis. Rinsho Ganka 2003, 30:825-828.
Organism:Dr. M. Van Rossum, Leiden University Medical Center, J-6-S, Department of Pediatrics, PO Box 9600, 2300 RC Leiden
Abstract: Objective. To determine if anti-cyclic citrullinated peptide antibodies (anti-CCP) can be detected in sera of patients with juvenile idiopathic arthritis (JIA) and if they can be used to identify patients with a more destructive course of disease. Methods. One hundred serum samples of 71 patients with JIA taken at different time points in their disease course were analyzed by a commercially available anti-CCP ELISA. Followup serum samples from 28 patients were also tested. Correlations between anti-CCP and disease characteristics, medication, and radiological damage (presence of joint space narrowing and/or erosions) were also determined. Results. The serum samples came from patients of all 8 different subtypes of JIA (mean age: 9.6 years, median: 10.5; disease duration mean: 39 months, median: 24) including 11 polyarticular rheumatoid factor positive (IgM-RF) patients. Anti-CCP was positive in 73% of the IgM-RF positive JIA patients and in 3% of the other JIA patients (p < 0.0001). Disease duration, medication, and anti-nuclear antibody positivity did not differ significantly between anti-CCP positive and negative patients. Testing of followup samples showed almost identical anti-CCP results. All IgM-RF positive JIA patients had radiological damage (p < 0.001). Of the anti-CCP positive patients, 80% had radiological damage resulting in a significant difference between anti-CCP positive and negative patients (p = 0.009) with an odds ratio (OR) of 12.7, but corrected for IgM-RF, the OR was no longer significant (p = 0.88). Conclusion. Anti-CCP antibodies can be detected in the sera of patients with JIA but almost exclusively in the subset of patients with polyarticular IgM-RF
Internet : m.van_rossum@lumc.nl - VARBANOVA B, KOLAROV Z, POPOVA D, GALABOV I, BALEV S: Changes in lymphocyte subpopulation from synovial fluid in patients with rheumatoid arthritis and juvenile chronic/idiopathic arthritis. Rheumatology 2002, 10:55-61.
Organism:Dr. B. Varbanova, Department of Pediatry, Medical University, 55, Marin Drinov Blvd., Bg - 9000 Varna
Abstract: Lymphocytes have been recognized to play an important role in the mechanism of the immune processes in rheumatoid inflammation of the synovial tissue and fluid. We studied lymphocyte subpopulations from synovial fluid of 49 patients with rheumatoid arthritis (RA) and 26 children with pauciarticular and polyarticular form of juvenile chronic/idiopathic arthritis (JCA/JIA) by the means of flowcytometric analysis. We established the following analogous changes in the synovial fluid of RA and JCA as compared to the peripheral blood: T-cell (CD3+) elevation with a domination of the activation molecules HLA-DR; increase of suppressor/cytotoxic (CD8+) cells resulting from the significant prevalence of cytotoxic subpopulation; significant decrease of the helper/suppressor ratio and B-cell population. The differences between both diseases were related to the more prominent T-cell elevation mainly due to the cytotoxic subpopulation in JCA and, on the other hand, stronger expression of CD5+ and IL-2R markers in the synovial fluid of RA patients. These results showed significant similarities and some differences between the cellular interactions in the synovial fluid in RA and JCA, however their exact pathogenetic importance is still unrevealed - YOSHIKAWA T, AKIMOTO S, NISHIMURA N, OZAKI T, IHIRA M, OHASHI M, MOROOKA M, SUGA S, ASANO Y, TAKEMOTO M, NISHIYAMA Y: Evaluation of active human herpesvirus 6 infection by reverse transcription-PCR. J.Med.Virol. 2003, 70:267-272.
Organism:Laboratory of Virology, Research Institute for Disease Mechanism and Control, Nagoya University School of Medicine, Nagoya, Aichi, Japan
Abstract: Monitoring of active human herpesvirus 6 (HHV-6) infection is important for distinguishing between reactivation and latency of the virus. The reverse transcription polymerase chain reaction (RT-PCR) may be a useful tool in order to distinguish active and latent HHV-6 infection. An RT-PCR assay detecting 4 different HHV-6 gene transcripts was established. Samples of peripheral blood mononuclear cells (PBMCs) were collected from patients with exanthem subitum and used to evaluate the reliability of the assay. After confirming the reliability of the assay, RT-PCR was used to determine whether HHV-6 reactivation occurs in children with hypercytokinemia. Three gene transcripts (U31, U39, and U94) were detected in 90-100% of the PBMC samples collected from febrile period of exanthem subitum patients, from which HHV-6 was isolated. The two gene transcripts encoding the late proteins U31 and U39, however, were not detected in samples collected during the convalescent period that contained no infectious virus. The putative latency associated gene transcript, U94, was detected in 2 (10%) of the 20 convalescent samples, and another immediate early gene transcript, U90, was also detected in 3 (15%) of the 20 convalescent samples. The frequency of HHV-6 reactivation in patients with hypercytokinemia, suggesting monocyte/macrophage activation, was studied. Only 9 of 17 patients diagnosed with Kawasaki disease and 1 patient diagnosed with juvenile rheumatoid arthritis were positive for HHV-6 DNA in their PBMCs samples. Neither the U31 gene nor the U94 gene transcript was detected in any of the 10 samples. An RT-PCR assay screening for both immediate early and late genes may be useful for monitoring active HHV-6 infection. No HHV-6 reactivation was found in patients with hypercytokinemia using the RT-PCR assay. J. Med. Virol. 70: 267-272, 2003
Internet : PM:12696115