Bibliography June 2003
- Work group recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, Missouri. Session V: evidence of benefit of exercise and physical activity in arthritis. Arthritis Rheum 49:3 453-454, 2003
- ADAMS BS, CHA HC, CLEARY J, HAIYING T, WANG H, SITWALA K, MARKOVITZ DM: DEK binding to class II MHC Y-box sequences is gene- and allele-specific. Arthritis Res Ther 5:4 R226-R233, 2003
Organism: Department of Pediatrics, Division of Pediatric Rheumatology, University of Michigan School of Medicine, Ann Arbor, MI, USAFAU - Adams, Barbara S
Abstract: Using electrophoretic mobility shift assays, we examined sequence-specific binding of DEK, a potential autoantigen in juvenile rheumatoid arthritis, to conserved Y-box regulatory sequences in class II MHC gene promoters. Nuclear extracts from several cell lines of different phenotypes contained sequence-specific binding activity recognizing DRA, DQA1*0101, and DQA1*0501 Y-box sequences. Participation of both DEK and NF-Y in the DQA1 Y-box binding complex was confirmed by 'supershifting' with anti-DEK and anti-NF-Y antibodies. Recombinant DEK also bound specifically to the DQA1*0101 Y box and to the polymorphic DQA1*0501 Y box, but not to the consensus DRA Y box. Measurement of the apparent dissociation constants demonstrated a two- to fivefold difference in DEK binding to the DQA1 Y-box sequence in comparison with other class II MHC Y-box sequences. Residues that are crucial for DEK binding to the DQA1*0101 Y box were identified by DNase I footprinting. The specific characteristics of DEK binding to these related sequences suggests a potential role for DEK in differential regulation of class II MHC expression, and thus in the pathogenesis of juvenile rheumatoid arthritis and other autoimmune diseases - AGRAWAL S, DESAI MP: Simultaneous occurrence of type I diabetes mellitus and juvenile rheumatoid arthritis. Indian Pediatr 40:6 568-571, 2003
Organism: Sir Hurkisondas Nurrotumdas Hospital and Research Center, Raja Rammohan Roy Road, Mumbai 400 004, IndiaFAU - Agrawal, Surabhi
Abstract: The association of juvenile rheumatoid arthritis and type 1 diabetes mellitus is rare. These two diseases belong to different clusters of autoimmune diseases and it is uncommon for diseases belonging to different cluster occurring together. This is a case report of a fourteen-year-old girl having the above two disorders along with autoimmune thyroid disease - ALI M, VEALE DJ, REECE RJ, QUINN M, HENSHAW K, ZANDERS ED, MARKHAM AF, EMERY P, ISAACS JD: Overexpression of transcripts containing LINE-1 in the synovia of patients with rheumatoid arthritis. Ann Rheum Dis 62:7 663-666, 2003
Organism: Rheumatology and Rehabilitation Research and Molecular Medicine Units, University of Leeds, UK medma@leedsacukFAU - Ali, M
Abstract: OBJECTIVE: To identify novel diagnostic markers by comparing gene expression in rheumatoid (RA) and reactive arthritis (ReA) synovium. METHODS: Synovial biopsy specimens were obtained by needle arthroscopy from the knees of 10 patients with either RA or ReA. RNA was isolated from the biopsy specimens and cDNA synthesised for analysis using a customised cDNA macroarray. Confirmatory analysis was performed using in situ hybridisation on a second set of synovial samples. RESULTS: Two unique transcripts (ReXS1 and fibronectin) were consistently more abundant in ReA and three homologous transcripts were more abundant in RA. The latter all mapped within long interspersed nucleotide elements (LINE-1), that form one of the families of repetitive sequences in the human genome. CONCLUSIONS: The abundance of transcripts containing LINE-1 in the RA synovium may be an epiphenomenon or may have pathogenic significance. Further work is required to determine the identity of the full length transcript(s) before its use as a diagnostic marker in RA can be assessed - ANDREAKOS E: Targeting cytokines in autoimmunity: new approaches, new promise. Expert Opin Biol Ther 3:3 435-447, 2003
Organism: Kennedy Institute of Rheumatology Division, Faculty of Medicine, Imperial College of Science, Technology and Medicine, 1 Aspenlea Road, Hammersmith, London W6 8LH, UK evangelosandreakos@imperialacukFAU - Andreakos, Evangelos
Abstract: The increasing understanding of the pathophysiology of a number of human autoimmune diseases, and the realisation that cytokines play a major role, has provided the pharmaceutical industry with a wide array of new targets for therapeutic intervention. This has also resulted in a surge of interest for the development of ways of blocking cytokines and their actions in a specific and safe manner. This article reviews the current status of anticytokine therapy and the major efficacy that anti-TNF-a monoclonal antibodies (mAbs) and soluble TNF receptors have demonstrated in the clinic, which has led to their approval for the treatment of rheumatoid arthritis (RA), Crohn's disease (CD), juvenile arthritis and psoriatic arthritis. In addition, the development of novel approaches of cytokine blockade that are based on the characterisation of intracellular signalling pathways regulating cytokine expression (e.g., nuclear factor kappa B [NF-kB] and p38 mitogen activated protein kinase [MAPK]) and the use of small molecule inhibitors are discussed. Whether these approaches will keep up with their early promise and become a major and widespread treatment for several devastating autoimmune diseases will depend on specificity, safety, durability of the benefit, and pharmacoeconomic issues - BEREND KR, GUNNESON EE, URBANIAK JR: Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85-A:6 987-993, 2003
Organism: Joint Implant Surgeons, Incorporated, 720 East Broad Street, Columbus, OH 43215, USA berendkr@ortholinknetFAU - Berend, Keith R
Abstract: BACKGROUND: Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with collapse of the articular surface and subsequent arthrosis. Free vascularized fibular grafting has been reported to be successful for patients with early stages of osteonecrosis, but little is known about its efficacy after the femoral head has collapsed. METHODS: We retrospectively reviewed the results in a consecutive series of 188 patients (224 hips) who had undergone free vascularized fibular grafting, between 1989 and 1999, for the treatment of osteonecrosis of the hip that had led to collapse of the femoral head but not to arthrosis. The average duration of follow-up was 4.3 years (range, two to twelve years). We defined conversion to total hip arthroplasty as the failure end point, and we analyzed the contribution, to failure, of the size of the lesion, amount of preoperative collapse of the femoral head, etiology of the osteonecrosis, age of the patient, and bilaterality of the lesion. We used the Harris hip score to evaluate clinical status preoperatively and at the time of the most recent follow-up. RESULTS: The overall rate of survival was 67.4% for the hips followed for a minimum of two years and 64.5% for those followed for a minimum of five years. The mean preoperative Harris hip score was 54.5 points, and it increased to 81 points for the patients in whom the surgery succeeded; 63% of the patients in that group had a good or excellent result. There was a significant relationship between the outcome of the grafting procedure and the etiology of the osteonecrosis (p = 0.017). Patients in whom the osteonecrosis was idiopathic, associated with alcohol abuse, or posttraumatic fared worse than did those with other causes, including steroid use. Survival of the joint was not significantly related to the size of the femoral head lesion, but there was an increased relative risk of conversion to total hip arthroplasty with increasing lesion size and amount of collapse. Neither patient age nor bilaterality significantly affected outcome. CONCLUSIONS: Patients with postcollapse, predegenerative osteonecrosis of the femoral head appear to benefit from free vascularized fibular grafting, with good overall survival of the joint and significant improvement in the Harris hip score. The results of this femoral head-preserving procedure in patients with postcollapse osteonecrosis are superior to those of core decompression and nonoperative treatment, as reported in the literature. Patients with larger lesions and certain diagnoses, such as idiopathic and alcohol-related osteonecrosis, have worse outcomes - CHIA A, FRANCO, LEE V, GRAHAM EM, EDELSTEN C: Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program. Am J Ophthalmol 135:6 757-762, 2003
Organism: Medical Ophthalmology Department, Great Ormond Street Hospital, London, EnglandFAU - Chia, Audrey
Abstract: PURPOSE: To identify factors associated with severe uveitis at diagnosis of eye disease in children with juvenile idiopathic arthritis (JIA) who were observed in a screening program, and to identify temporal changes in findings associated with screening during the period 1986 to 2000. DESIGN: Case control study. METHOD: Uveitis was defined as being severe at diagnosis if there were associated synechiae, cataracts, or retinal edema. Clinical factors for all patients undergoing screening for JIA-associated uveitis from 1986 to 2000 at one institution were studied retrospectively. Children with severe uveitis at diagnosis (cases) were compared with those with mild uveitis at diagnosis and those who never developed uveitis during follow-up in the screening program (controls). RESULTS: Severe uveitis was present at diagnosis in 22 (5.4%) of 409 patients. Male patients were more likely to have severe uveitis at diagnosis (odds ratio [OR] 3.7 [95% confidence interval 1.3 to 10.7], P =.014). A longer interval from the onset of arthritis symptoms to the diagnosis of uveitis was associated with a reduced risk of severe uveitis at diagnosis (OR 0.95 [0.91 to 1.0], P =.044). There was no difference in the frequency of severe uveitis at diagnosis between two screening periods: 1986 to 1993 (before American screening guidelines were published) and 1994 to 2000. CONCLUSIONS: Male children are more likely than female children to have severe uveitis at diagnosis. The proportion of children with severe uveitis at diagnosis has not changed since current screening guidelines have been widely publicized, suggesting the need for refinements in screening procedures to target high-risk children with increased surveillance - CUSHMAN KE, MAQBOOL M, GERARD PD, BEDIR E, LATA H, MORAES RM: Variation of podophyllotoxin in leaves of Eastern Red Cedar (Juniperus virginiana). Planta Med 69:5 477-478, 2003
Abstract: Leaves of Eastern red cedar (Juniperus virginiana L. Cupressaceae) have been reported to contain podophyllotoxin, a pharmaceutical compound used to manufacture drugs for treatment of cancer, rheumatoid arthritis, genital warts, psoriasis, and multiple sclerosis. Podophyllotoxin content of leaves of immature, mature male, and mature female plants (approximately 1.45 mg x g -1) was significantly higher than that of leaves of juvenile plants (0.60 mg x g -1). Sampling date also affected podophyllotoxin content. Leaves harvested in January and April exhibited higher podophyllotoxin contents (1.56 and 1.45 mg x g -1, respectively) than leaves harvested in February and June (1.06 and 1.08 mg x g -1, respectively). There was no obvious pattern or trend in the data due to sampling date. There was no significant interaction between plant type and sampling date. These results indicate that foliage of mature Eastern red cedar, a waste product of the lumber industry, could be a low-yielding, but relatively stable, source of podophyllotoxin - DE BOER J, WULFFRAAT N, ROTHOVA A: Visual loss in uveitis of childhood. Br J Ophthalmol 87:7 879-884, 2003
Organism: FC Donders Institute of Ophthalmology, University Medical Center, Utrecht, Netherlands jdeboer-3@ooghazunlFAU - de Boer, J
Abstract: AIMS: To investigate the manifestations and severity of uveitis in children and to identify the risk and specific causes of blindness in this population. METHODS: Retrospective study of data of 123 consecutive patients examined with active uveitis and the onset of ocular disease before the age of 16 years. Numerous variables were assessed including age and sex distribution, laboratory data, the presence of systemic diseases, onset and course of ocular inflammation, clinical features and complications, therapeutic strategies and their outcomes, final visual acuity, and characteristics associated with poor visual outcome. RESULTS: Systemic disease was observed in 36/123 patients (29%), with juvenile idiopathic arthritis being the most frequent (25/123, 20%). Toxoplasma retinochoroiditis was diagnosed in 12/23 patients with posterior uveitis (52%; 10% of all with uveitis). Severe intraocular inflammation required systemic drugs in 57 (46%) patients. Ocular complications were observed in 93 patients (76%), of which the most common was cataract (43/123, 35%). Intraocular surgery was required in 35 patients (28%; in total 75 procedures). Three patients (2%) became legally blind and an additional 20/121 (17%) had one legally blind eye caused by uveitis. The most frequent causes of blindness were chorioretinal scars in the macular area and glaucoma in contrast with cystoid macular oedema (CMO) in adults. CONCLUSIONS: Uveitis in childhood is a potentially blinding disease, in the majority of patients characterised by a chronic course and a high complication rate - DE HOOGE AS, VAN DE LOO FA, BENNINK MB, ARNTZ OJ, FISELIER TJ, FRANSSEN MJ, JOOSTEN LA, VAN LENT PL, RICHARDS CD, VAN DEN BERG WB: Growth plate damage, a feature of juvenile idiopathic arthritis, can be induced by adenoviral gene transfer of oncostatin M: a comparative study in gene-deficient mice. Arthritis Rheum 48:6 1750-1761, 2003
Organism: Rheumatology Research Laboratory, University Medical Center Nijmegen, Nijmegen Center for Molecular Life Sciences, Nijmegen, The NetherlandsFAU - de Hooge, Alfons S K
Abstract: OBJECTIVE: To investigate the involvement of proinflammatory and destructive mediators in oncostatin M (OSM)-induced joint pathology, using gene-deficient mice. METHODS: An adenoviral vector expressing murine OSM was injected into the joints of naive wild-type mice and mice deficient for interleukin-1 (IL-1), IL-6, tumor necrosis factor alpha (TNFalpha), or inducible nitric oxide synthase (iNOS). Reverse transcription-polymerase chain reaction was used to study gene expression. Inflammation and cartilage proteoglycan (PG) depletion were assessed by histology. OSM and IL-1 levels in synovial fluid from patients with juvenile idiopathic arthritis (JIA) were measured by enzyme-linked immunosorbent assay. RESULTS: Adenoviral expression of murine OSM led to joint inflammation, bone apposition, chondrophyte formation, articular cartilage PG depletion, and VDIPEN neoepitope expression in wild-type mice. A unique and consistent observation was the focal PG depletion and disorganization of the growth plate cartilage during the first week of inflammation. Synovial IL-1beta, IL-6, TNFalpha, and iNOS gene expression was strongly induced. Of these factors, only deficiency in IL-1 markedly reduced inflammation and PG depletion and completely prevented growth plate damage. In addition, this is the first study in which OSM was detected in JIA synovial fluid. Most samples were also IL-1beta positive. CONCLUSION: IL-1, but not IL-6, TNFalpha, or iNOS, plays an important role in joint disease induced by intraarticular gene transfer of OSM in mice. The effect of OSM on murine connective tissue and the presence of OSM in human synovial fluid make involvement of OSM in human arthropathies very likely - EHL S, UHL M, BERNER R, BONAFE L, SUPERTI-FURGA A, KIRCHHOFF A: Clinical, radiographic, and genetic diagnosis of progressive pseudorheumatoid dysplasia in a patient with severe polyarthropathy. Rheumatol Int .: 2003
Organism: Center for Pediatrics and Adolescent Medicins, University Clinic, Mathildenstrasse 1, 79106, Freiburg, Germany
Abstract: A 14-year-old boy presented with a 10-year history of the "sicca" form of seronegative juvenile idiopathic polyarthritis. Severely limited range of motion, pain, and capsular swelling in both small and large weight-bearing joints left him wheelchair-bound. Erythrocyte sedimentation rate and C-reactive protein were normal. Two-phase bone scan revealed tracer uptake of almost every joint at both early and late time points, indicating pathologic exudation and enhanced bone metabolism consistent with severe arthritis. However, radiographic studies revealed no erosive arthropathy but severe osteopenia, dysplastic bone changes, mega os trigonum, and platyspondylia. A magnetic resonance imaging (MRI) scan of the hips showed no signs of synovitis, pannus, or effusion but cartilage irregularities and subchondral cysts. These findings strongly suggested the diagnosis of progressive pseudorheumatoid dysplasia of childhood, an autosomal-recessive disorder of cartilage homeostasis. The patient carries a novel homozygous two-nucleotide deletion in exon 4 of the WISP3 gene. This genetic disorder is an important differential diagnosis of sicca polyarthritis - EL MEIDANY YM, EL GAAFARY MM, AHMED I: Cross-cultural adaptation and validation of an Arabic Health Assessment Questionnaire for use in rheumatoid arthritis patients. Joint Bone Spine 70:3 195-202, 2003
Organism: Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt Miedanycrd@yahoocomFAU - El Meidany, Yasser M
Abstract: OBJECTIVE: To test the reliability and validity of a modified and translated version of the original Health Assessment Questionnaire (HAQ) on patients with rheumatoid arthritis (RA). METHOD: A cohort of 184 RA patients from different Arabic countries (Egypt, Saudi Arabia, Sudan, Syria, Bahrain, Kuwait and Morocco) were recruited and asked to participate in the study. Two questions had been changed to suit the Arabic culture and to tackle some aspects that are commoner to be performed in the Arabic culture. After modification, translation and retranslation of the questionnaire, it was administered to the selected patients and tested for internal consistency, reliability and construct validity by correlating the yield of the questionnaire with other disease activity parameters. The questionnaire was administered again after a 1-week interval for evaluation of the reliability of this test. The modified questions were tested for their loyalty to the principal component and comparing their correlation with that of the other unchanged items. RESULTS: Test-retest showed strong reliability with a high percentage of agreement and high values for Kappa. Internal consistency showed a high value for standardized alpha (Cronbach's): 0.979 that did not show any significant change if any of the 20 items had been eliminated. The modified questionnaire had shown a strong validity when correlating its results with other disease activity parameters. This correlation was the strongest with tender joint count (TJC), Ritchie articular index (RAI), morning stiffness (MS) and visual analogue scale (VAS) and the least (but still significant) with rheumatoid factor (RF). CONCLUSION: The Arabic HAQ is a reliable and valid instrument that can be self-administered to Arabic RA patients to evaluate their functional disability. Its measurement properties were comparable to versions in other languages - EL SAYED ZA, FARAG DH, EISSA S: Tumor suppressor protein p53 and anti-p53 autoantibodies in pediatric rheumatological diseases. Pediatr Allergy Immunol 14:3 229-233, 2003
Organism: Departments of Pediatrics, Clinical Pathology and Biochemistry, Ain Shams University, Cairo, Egypt msamir@pyamidsgeganetFAU - El-Sayed, Zeinab Awad
Abstract: The tumor suppressor protein p53 plays an important role in cell cycle regulation. One of the major features in rheumatic diseases is the abnormal proliferation of lymphocytes. p53 expression in peripheral blood mononuclear cells (by flowcytometry) and serum anti-p53 antibodies (by ELISA) were therefore measured in 18 children and adolescents with juvenile rheumatoid arthritis (JRA) and 17 with systemic lupus erythematosus (SLE) in comparison to 20 healthy controls, to determine their role. p53 expression in patients was insignificantly higher than that of controls (2.28 +/- 2.71% vs. 1.08 +/- 1.02%, respectively, p > 0.05) with 29.4% of the patients showing values above a cut-off level of 2.55% (95th percentile of controls). SLE patients with active disease had significantly higher p53 expression compared to controls and to patients with quiescent disease although no significant correlation with ESR or complement 3 was detected. Seropositivity to anti-p53 antibodies was observed in none of controls but in 22.8% of patients, all of whom, except one, had active disease. Seropositivity to anti-p53 antibodies was more prominent in lupus nephritis than in other presentations of SLE (p < 0.05). The mean p53 expression in seropositive patients was insignificantly higher than in seronegatives. p53 expression and seropositivity to anti-p53 were slightly higher in SLE than in JRA and were not significantly affected by the mode of therapy. Thus, the overexpression of p53 in some patients with active SLE and JRA might explain the abnormal proliferation of autoreactive lymphocytes that perpetuates the inflammatory response. The presence of anti-p53 antibodies might cause malfunctioning of p53 protein interfering with its regulatory functions - FISCHER T, BIEDERMANN T, HERMANN KG, DIEKMANN F, BRAUN J, HAMM B, BOLLOW M: [Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-Guided intra-articular corticosteroid injection]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 175:6 814-821, 2003
Organism: Institut fur Radiologie, Universitatsklinikum Charite, Campus Mitte, Humboldt-Universitat zu Berlin thomfischer@charitedeFAU - Fischer, T
Abstract: PURPOSE: The prospective investigation of the therapeutic effect of CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance imaging (MRI) in establishing the indication and monitoring the therapy. MATERIALS AND METHODS: The study comprises 89 children with known jSpA who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after the diagnostic MRI, two groups were distinguished according to the clinical response to NSAIDS, with group 1 consisting of 33 responders and group 2 of 56 non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months. Follow-up by dynamic MRI was performed in all 56 children of group 2 and in 15 of the 33 children of group 1 within 8 +/- 4 months of the initial examination. RESULTS: A total of 87.5% of the children in group 2 showed a statistically significant decrease in their subjective complaints from 6.9 +/- 3.4 to 1.8 +/- 1.7 (p < 0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5 +/- 1.0 weeks after the intervention and lasted for a mean of 12 +/- 6 months. The children in group 1 already showed similar improvement of the VAS from 6.8 +/- 3.2 to 1.5 +/- 1.4 (p < 0.05) during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period. The follow-up dynamic MRI (0.1 mmol/kg body weight) during therapy showed a statistically significant lower contrast-enhancement in both groups (group 1: 117 +/- 43 % versus 38 +/- 24 %, p < 0.05; group 2: 127 +/- 59 % versus 38 +/- 22 %, p < 0.05). One third of the patients of group 2 showed progression of joint destruction despite absence of subjective complaints. CONCLUSION: CT-guided intra-articular corticosteroid injection has proven an effective, symptomatic, and uncomplicated therapy of acute sacroiliitis in patients with jSpA. Dynamic MRI has a role in establishing the indication for intervention but its role for any follow-up is restricted to cases with inconclusive clinical response - GARCIA-CONSUEGRA MJ, MERINO MR, LAMA MR, COYA VJ, GRACIA BR: [Growth in children with juvenile idiopathic arthritis]. An Pediatr (Barc) 58:6 529-537, 2003
Organism: Unidades de Reumatologia Pediatrica Hospital Universitario Infantil La Paz Madrid Espana reumapedhulp@saludmadridorgFAU - Garcia-Consuegra Molina, J
Abstract: INTRODUCTION: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that often requires steroid therapy. Growth retardation can be a serious complication in some of these patients. OBJECTIVE: To study linear growth in patients with JIA and evaluate the factors involved in its disturbance. METHODS: We studied 91 patients with JIA with a follow-up of at least one year. A cross sectional study, a longitudinal retrospective study, and a longitudinal prospective study were performed. Height in the first consultation, in the cross sectional study, and one year previously was evaluated. Height velocity (HV) was calculated. Several parameters related to disease activity, corticosteroid therapy, nutritional and hormonal status, and bone mineral density (BMD) were analyzed. A correlation study and multivariate regression analysis were carried out. RESULTS: Height was < or = -2 SD in 14.3 % of the series and in 55.6 % of the systemic group. Variables independently associated with height were total corticosteroid dose, functional class, nutritional index, BMD, and age at onset of the disease. HV was < or = 2 SD in 25.3 % of the series and in 61 % of the systemic group. Variables independently associated with HV were corticosteroid dose and the number of swollen joints. CONCLUSIONS: Growth retardation in patients with JIA was associated with factors related to the disease, corticosteroid therapy, nutritional status, BMD, and earlier onset of the disease - HARMOINEN A, LEHTIMAKI T, KORPELA M, TURJANMAA V, SAHA H: Diagnostic accuracies of plasma creatinine, cystatin C, and glomerular filtration rate calculated by the Cockcroft-Gault and Levey (MDRD) formulas. Clin Chem 49:7 1223-1225, 2003
Organism: Centre of Laboratory Medicine, Department of Internal Medicine, Tampere University Hospital, PO Box 2000, FIN-33521 Tampere, Finland aimoharmoinen@taysfiFAU - Harmoinen, Aimo - HELGESON VS, JANICKI D, LERNER J, BARBARIN O: Brief report: adjustment to juvenile rheumatoid arthritis: a family systems perspective. J Pediatr Psychol 28:5 347-353, 2003
Organism: Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA vh2e@andrewcmueduFAU - Helgeson, Vicki S
Abstract: OBJECTIVE: To examine the relations of the family environment to adjustment to juvenile rheumatoid arthritis (JRA), and to examine how those relations are influenced by child sex and age. METHOD: Ninety-four children with JRA completed a questionnaire on family environment and adjustment. RESULTS: Family cohesion was related to good adjustment, whereas family conflict was related to poor adjustment. Some relations of family cohesion to adjustment were stronger for younger than for older children. The relations of child autonomy to adjustment depended on child sex and age. CONCLUSION: The relations of the family environment to adjustment to JRA are dependent on child sex and age - KLEIN CM, VERNINO S, LENNON VA, SANDRONI P, FEALEY RD, BENRUD-LARSON L, SLETTEN D, LOW PA: The spectrum of autoimmune autonomic neuropathies. Ann Neurol 53:6 752-758, 2003
Organism: Department of Neurology, Medical University of South Carolina, Charleston, SC, USAFAU - Klein, Caroline M
Abstract: We analyzed the clinical characteristics of 18 patients (13 female, 5 male) who had autoimmune autonomic neuropathy (AAN) and ganglionic acetylcholine receptor (AChR) autoantibodies. Mean age was 61.4 years (standard deviation, 12.0 years). Ten patients had subacute symptom onset, six with an antecedent event. Eight patients had chronic AAN, characterized by insidious symptom onset, without antecedent event, and gradual progression. A majority of patients with high antibody values (>1.00 nmol/L) had a combination of sicca complex (marked dry eyes and dry mouth), abnormal pupillary light response, upper gastrointestinal symptoms, and neurogenic bladder. Chronic AAN segregated into two subgroups. One subgroup (N = 4) had low antibody titer (0.09 +/- 0.01 nmol/L) and a paucity of cholinergic symptoms. It was indistinguishable from pure autonomic failure. The other subgroup (N = 4) had high antibody titer (11.6 +/- 2.08 nmol/L), sicca complex, abnormal pupils, and neurogenic bladder; three had severe upper gastrointestinal dysfunction. Higher antibody titers correlated with greater autonomic dysfunction and more frequent cholinergic dysautonomia. These observations expand the clinical spectrum of AAN to include chronic cases, some being indistinguishable from pure autonomic failure, and support the concept that ganglionic AChR antibodies are important diagnostically and pathophysiologically in acquired dysautonomia - KUCZYNSKI E, SILVA CA, CRISTOFANI LM, KISS MH, ODONE F, V, ASSUMPCAO FB, JR.: [Quality of life evaluation in children and adolescents with chronic and/or incapacitating diseases: a Brazilian study]. An Pediatr (Barc) 58:6 550-555, 2003
Organism: Servicio de Psiquiatria de la Infancia y de la Adolescencia Instituto de Psiquiatria del Hospital de las Clinicas de la Facultad de Medicina de la Universidad de Sao Paulo (SEPIA-IPq-HC-FMUSP) Brazil ekuczynski@uolcombrFAU - Kuczynski, E
Abstract: OBJECTIVE: To evaluate quality of life in children and adolescents with acute lymphocytic leukemia (ALL) and juvenile rheumatoid arthritis (JRA). MATERIAL AND METHODS: We administered the Children's Global Assessment Scale (CGAS), the Vineland Adaptative Behavior Scale (VABS) and the Autoquestionnaire qualite de vie enfant image (AUQEI) to a sample of 28 children with ALL, 28 children with JRA, and 28 healthy controls, aged 4 to 13 years old, who were diagnosed between 1 and 5 years previously. RESULTS: Slight differences were found in age between patients with ALL and those with JRA. No significant differences were found in time since diagnosis or in CGAS scores. A significant difference was found in VABS global scores, as well as in VABS communication domain scores. No significant differences were found in VABS daily living skills domain scores between patients with ARJ and healthy controls. No significant differences were found among the groups in VABS socialization domain scores or in AUQEI scores. CONCLUSION: In our study, chronically ill children clearly performed worse in adaptative behavior development. Nevertheless, their quality of life was similar to that of healthy controls. Appropriate methods to identify pediatric patients' perception of their illnesses and treatment should be urgently developed - LAM LA, LOWDER CY, BAERVELDT G, SMITH SD, TRABOULSI EI: Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis. Am J Ophthalmol 135:6 772-778, 2003
Organism: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USAFAU - Lam, Linda A
Abstract: PURPOSE: To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis. DESIGN: Interventional case series. METHOD: Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001. RESULTS: Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery. CONCLUSIONS: With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL - PARVIZI J, LAJAM CM, TROUSDALE RT, SHAUGHNESSY WJ, CABANELA ME: Total knee arthroplasty in young patients with juvenile rheumatoid arthritis. J Bone Joint Surg Am 85-A:6 1090-1094, 2003
Organism: Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAFAU - Parvizi, Javad
Abstract: BACKGROUND: Juvenile rheumatoid arthritis is a disabling and destructive condition that commonly affects the knee during childhood. Total knee arthroplasty occasionally may be necessary for the treatment of end-stage disabling arthritis of the knee in young patients. There is a paucity of available data on the results of total knee arthroplasty in adolescents. We report our experience with total knee arthroplasty in patients under the age of twenty years who had juvenile rheumatoid arthritis. MATERIALS AND METHODS: We reviewed the results of twenty-five consecutive total knee arthroplasties that had been performed at our institution between 1982 to 1997 in thirteen patients (mean age, seventeen years) with juvenile rheumatoid arthritis. The average duration of clinical follow-up was 10.7 years, and the average duration of radiographic follow-up was 6.5 years. RESULTS: The mean Knee Society pain score improved markedly from 27.6 to 88.3 points, and the mean Knee Society function score improved modestly from 14.8 to 39.2 points. There was a slight improvement in the range of motion. Symptomatic and progressive radiolucent lines were noted in two knees, one of which was revised. Two knees (one patient) required exchange of the polyethylene liner at thirteen years. There were four additional reoperations, including manipulation under general anesthesia (two knees in one patient), lysis of adhesions (one knee), and extensor mechanism realignment (one knee). CONCLUSIONS: Despite a substantial number of postoperative complications, total knee arthroplasty provided excellent relief of pain and improvement in function in this group of adolescent patients with juvenile rheumatoid arthritis - PETTY RE, SMITH JR, ROSENBAUM JT: Arthritis and uveitis in children. A pediatric rheumatology perspective. Am J Ophthalmol 135:6 879-884, 2003
Organism: Department of Pediatrics (Division of Rheumatology), University of British Columbia, Vancouver, Canada rpetty@cwbccaFAU - Petty, Ross E
Abstract: PURPOSE: We describe important characteristics of the chronic arthritides of childhood associated with anterior uveitis. DESIGN: Literature review and commentary based on the investigators' experiences. METHOD: A review of pertinent publications provides a background of current understanding of those forms of childhood arthritis that are of interest to ophthalmologists caring for children. Recommendations regarding screening for asymptomatic anterior uveitis in this patient group are reviewed, and current advances in therapy are noted. A new classification of childhood arthritis is compared with existing classifications. RESULTS: Uveitis complicates several forms of juvenile idiopathic arthritis (oligoarthritis, rheumatoid factor-negative polyarthritis, psoriatic arthritis, and enthesitis-related arthritis). Uveitis is a complication in up to 30% of children with chronic arthritis, particularly in those with oligoarticular disease. CONCLUSIONS: Visual prognosis is guarded for children with chronic arthritis and uveitis. Surveillance and early therapy are important factors for ensuring a good outcome - SAVICKIENE A, BARANAUSKAITE A: [Influence of glucocorticoids on bone mineral density in rheumatoid arthritis and seronegative spondyloarthropathies]. Medicina (Kaunas) 39:5 448-453, 2003
Organism: Clinic of Rheumatology, Kaunas University of Medicine, Lithuania astai@centrasltFAU - Savickiene, Asta
Abstract: Glucocorticoids are commonly used for treatment of rheumatoid arthritis and seronegative spondyloarthropathies. The aim of this study was to investigate the influence of the glucocorticoids for the bone mineral density of patients with chronic autoimmune arthritides, to evaluate the importance of the duration and dosage of the treatment, and to compare with well-known risk factors for osteoporosis: age and sex of patients, duration of menopause, length of the arthritis-related functional insufficiency. One-hundred-eighty-eight rheumatoid arthritis and 97 seronegative spondyloarthropathies patients were investigated. Bone mineral density was examined by the method of dual energy x-ray absorptiometry (Hologic QDR 4500 W) in the vertebral bodies of the lumbar spine and the hip. Relative risk of glucocorticoids for development of osteopenia and osteoporosis was moderate, less significant than the impact of patient's age. Negative influence of glucocorticoids on the bone mineral density was related with cumulative dose and duration of the treatment. In rheumatoid arthritis patients it was more significant, than in cases of seronegative spondyloarthropathies. Diminishing of the bone mineral density was more important in the lumbar spine, the changes in hip mineralization were less expressed in both diseases - SHERRY DD, SAPP LR: Enthesalgia in childhood: site-specific tenderness in healthy subjects and in patients with seronegative enthesopathic arthropathy. J Rheumatol 30:6 1335-1340, 2003
Organism: Department of Pediatrics, University of Washington, Seattle, USA sherry@emailchopeduFAU - Sherry, David D
Abstract: OBJECTIVE: The presence of pain over an enthesis defines enthesitis and is a major (or sole) clinical feature of childhood spondyloarthropathies. However, the presence or degree of tenderness of the entheses in healthy children is unknown. We studied the prevalence of enthesalgia and pain thresholds over entheses in healthy children and whether these sites are different from those in patients diagnosed with seronegative enthesopathic arthropathy (SEA syndrome). METHODS: We examined 234 schoolchildren aged 8 to 16 years for enthesalgia; those reporting tenderness were compared to randomly selected patients with SEA syndrome previously diagnosed in a tertiary outpatient clinic. RESULTS: Enthesalgia in at least one site was found in 68 children (29%). Schoolchildren had fewer sites than patients (mean 1.2 +/- 2.8 sites vs 8.1 +/- 4.5 sites; p < 0.0001). Enthesalgia was not associated with age, sex, or self-reported activity level. In schoolchildren, pressure thresholds were higher with age (p < 0.0001), and in boys (p = 0.014), and were decreased in those with enthesalgia (p = 0.003). The metatarsal heads had the lowest pain thresholds. Significant sites specific for SEA patients were: plantar fascial insertion (p < 0.0001), Achilles tendon insertion (p = 0.001), sacroiliac joint (p = 0.002), and inferior pole of the patella (p = 0.003). Of these 8 sites, only 10% of schoolchildren reported tenderness in 3 sites compared to 56% of children with SEA syndrome. CONCLUSION: Enthesalgia is not rare in children; metatarsalgia or a limited number of tender entheses should not define enthesitis. Enthesalgia in 3 of the 8 specific tender entheses noted above may better define childhood enthesitis - STEPANETS OV, CHICHASOVA NV, NASONOVA MB, SAMSONOV MI, NASONOV EL: [Soluble receptors of TNF-alpha with molecular mass 55 kDa in rheumatoid arthritis: clinical role]. Klin Med (Mosk) 81:4 42-46, 2003
Abstract: To evaluate clinical implications of the serum level of soluable receptors of tumor necrosis factor alpha (TNFa) with molecular mass 55 kDa (rTNF-55R) in rheumatoid arthritis, serum levels of rTNF-55R and rTNF-75R were measured with the use of radioimmunoassay in 76 RA patients, 38 donors and in 25 RA patients, 10 donors, respectively. RESULTS: Elevated serum level of rTNF-55R was recorded in 55.3% RA patients. This level correlated with basic clinical and laboratory parameters of RA, the disease activity, values of DAS indices. It is concluded that a serum level of rTNF-55R adequately reflects clinico-laboratory activity of RA and its measurement can be used for assessment of RA activity and treatment efficiency - THOMPSON DJ, BARRON KS, WHITCUP SM, ROBINSON MR: The safety and efficacy of chicken type II collagen on uveitis associated with juvenile rheumatoid arthritis. Ocul Immunol Inflamm 10:2 83-91, 2002
Organism: The EMMES Corporation, Rockville, MD 20850, USAFAU - Thompson, Darby J S
Abstract: PURPOSE: To investigate the safety and efficacy of chicken type II collagen in treating uveitis associated with juvenile rheumatoid arthritis (JRA). METHODS: A prospective dose-ranging (60 and 540 microg) pilot study of orally administered chicken type II collagen in 13 participants, aged 2-18 years, with JRA and uveitis and without prior exposure to collagens. Anterior chamber cells, flare, vitreous haze, visual acuity, and concomitant anti-inflammatory medications were the ophthalmic outcomes. Arthritis outcomes included the American College of Rheumatology (ACR) core set. RESULTS: No serious or related adverse events were reported. Four participants (2 low dose, 2 high dose) experienced improvement in ophthalmic outcome, while two participants (1 in each group) worsened (p > 0.5). According to ACR criteria, six participants showed improvement in JRA. CONCLUSIONS: Although appearing safe, clearly demonstrating the efficacy of this treatment for JRA or uveitis remains a challenge. Based on the results from this pilot study, a large positive treatment effect on uveitis is unlikely - TSE SM, LAXER RM: Juvenile spondyloarthropathy. Curr Opin Rheumatol 15:4 374-379, 2003
Organism: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada shirleytse@sickidscaFAU - Tse, Shirley M L
Abstract: The juvenile-onset spondyloarthropathies are a group of pediatric disorders characterized by arthropathy and enthesopathy and a variety of extra-articular symptoms. With the application of new classification criteria, there is an increasing recognition of these diseases. This review summarizes recent advances in etiologic factors, clinical manifestations, therapeutics, and prognosis. Improved recognition of juvenile-onset spondyloarthropathies has allowed systematic and rigorous treatment trials to evaluate clinical outcomes relevant to pediatric medicine. Thus far, current therapeutic options allow for symptomatic control only. Further treatment studies are needed to examine the possibility of disease modification of juvenile-onset spondyloarthropathies - ULVESTAD E: Modelling autoimmune rheumatic disease: a likelihood rationale. Scand J Immunol 58:1 106-111, 2003
Organism: Department of Microbiology and Immunology, The Gade Institute, Haukeland University Hospital, Bergen, Norway ellingulvestad@haukelandnoFAU - Ulvestad, E
Abstract: Immunoglobulins (Igs) and autoantibodies are commonly tested in sera from patients with suspected rheumatic disease. To evaluate the clinical utility of the tests in combination, we investigated sera from 351 patients with autoimmune rheumatic disease (ARD) rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) and 96 patients with nonautoimmune rheumatic disease (NAD) (fibromyalgia, osteoarthritis, etc.). Antinuclear antibodies (ANA), rheumatoid factor (RF), antibodies against DNA and extractable nuclear antigens (anti-ENA), IgG, IgA and IgM were measured for all patients. Logistic regression analysis of test results was used to calculate each patient's probability for belonging to the ARD or NAD group as well as likelihood ratios for disease. Test accuracy was investigated using receiver-operating characteristic (ROC) plots and nonparametric ROC analysis. Neither concentrations of IgG, IgA, IgM, anti-DNA nor anti-ENA gave a significant effect on diagnostic outcome. Probabilities for disease and likelihood ratios calculated by combining RF and ANA performed significantly better at predicting ARD than utilization of the diagnostic tests in isolation (P < 0.001). At a cut-off level of P = 0.73 and likelihood ratio = 1, the logistic model gave a specificity of 93% and a sensitivity of 75% for the differentiation between ARD and NAD. When compared at the same level of specificity, ANA gave a sensitivity of 37% and RF gave a sensitivity of 56.6%. Dichotomizing ANA and RF as positive or negative did not reduce the performance characteristics of the model. Combining results obtained from serological analysis of ANA and RF according to this model will increase the diagnostic utility of the tests in rheumatological practice - UNIKIENE D, MISIUNIENE N: [Antiphospholipid syndrome in patients with systemic connective tissue diseases]. Medicina (Kaunas) 39:5 454-459, 2003
Organism: Clinic of Rheumatology, Kaunas University of Medicine, Lithuania ramunas_unik@yahoocoukFAU - Unikiene, Dalia
Abstract: The present study evaluates the incidence of antiphospholipid antibody syndrome (APS) in systemic rheumatic diseases patients with anticardiolipin antibodies. Clinical presentations of systemic rheumatic diseases in patients with or without APS are examined as well. The data from 242 consecutive patients suffering from rheumatoid arthritis (158 pts), systemic erythematoid lupus (53 pts), or systemic sclerosis (31 pts) are studied. Enzyme immunoassay test for IgG-anticardiolipin antibodies was performed for all patients. The IgG-anticardiolipin antibodies were found in 38 (15.7%) patients. There were 16 (30.2%) patients in erythematoid lupus group, 9 (29%) patients in systemic sclerosis group, and 13 (8.2%) patients in rheumatoid arthritis group. The diagnosis of secondary APS according to classificational criteria (1998) was confirmed in 14 (36.8%) from 38 seropositive patients: ten patients (62.5%) in lupus group, 2 (22.2%) patients in systemic sclerosis group, and 2 (15.4%) patients in rheumatoid arthritis group were found as APS patients. The majority of these patients were female (92.9%). These patients were younger as compared with systemic rheumatic diseases patients without APS (p=0.005). There was no significant difference found between APS patients and patients without APS in respect to neither duration of primary disease, nor disease activity, nor course of the disease. There were significantly more cases of fibrotic heart valves (p=0.028), and thrombocytopenia (p=0.002), and livedo reticularis (p=0.058) in APS group - VUILLEUMIER C, SAUVAIN MJ, AEBI C, SAURENMANN T, BIANCHETTI MG: Systemic lupus erythematosus initially presenting as idiopathic juvenile arthritis with positive antinuclear antibodies. Acta Paediatr 92:4 512-513, 2003
- WELBURY RR, THOMASON JM, FITZGERALD JL, STEEN IN, MARSHALL NJ, FOSTER HE: Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis. Rheumatology (Oxford) .: 2003
Organism: Glasgow Dental Hospital and School, University of Glasgow and North Glasgow NHS Trust, Glasgow
Abstract: OBJECTIVES: Recent decades have seen a trend to treat juvenile idiopathic arthritis (JIA) with increasing immunosuppression to improve the long-term outcome. Poor oral hygiene and dental decay cause significant morbidity, and patients with chronic disease (who may be further immunocompromised by treatment) are at greater risk. This study investigated patients with JIA using standard measures of oral health. METHODS: One hundred and forty-nine patients with JIA were included. The children were attending a regional paediatric rheumatology service and the adults were attending an adult rheumatology clinic. Random age- and sex-matched healthy controls were recruited from a dental teaching hospital. The structured dental examination included standard epidemiological indices of oral hygiene (gingival index, plaque index, oral cleanliness index) and dental decay [DMFT (decayed, missing or filled teeth) index]. RESULTS: JIA patients, at all ages, had increased levels of dental decay and poor oral hygiene. This increased level of decay was statistically significant in the patients aged 0-11 yr. Significant levels of untreated caries and increased levels of missing teeth were found in JIA, suggesting that patients with JIA had less restorative dental treatment, with tooth extraction often the chosen option for the treatment of dental decay. CONCLUSIONS: This is the largest study of oral health in JIA and is cross-sectional with non-diseased controls. It shows significantly increased levels of poor oral hygiene and dental decay in patients with JIA. The high levels of untreated dental decay suggest barriers to dental care. These results emphasize the role of regular dental care in the multidisciplinary management of JIA - ZAK M, FLEDELIUS H, PEDERSEN FK: Ocular complications and visual outcome in juvenile chronic arthritis: a 25-year follow-up study. Acta Ophthalmol Scand 81:3 211-215, 2003
Organism: Clinic of Paediatrics II, Rigshospitalet, State University Hospital, Copenhagen, Denmark zak@dadlnetdkFAU - Zak, Marek
Abstract: OBJECTIVE: Assessment of longterm ophthalmic outcome in juvenile chronic arthritis (JCA) with emphasis on visual acuity and identification of disease-related parameters associated with rheumatic eye affection. MATERIAL: Sixty-five adults (52 females, 13 males) with a history of or still active JCA were assessed an average of 26.7 years after disease onset. METHODS: Cross-sectional, longterm, follow-up study including complete ophthalmological and rheumatological examinations. RESULTS: Evidence of ocular complications was found in 13 subjects (20%): 10 had had recurrent iritis, two band keratopathy, and one diplopia due to rheumatoid eye muscle involvement. The three single eyes with poor sight (<0.1) were all in the complication subgroup. Binocularly, all but one patient scored at least 6/9 as best corrected visual acuity; one, however, had severe glaucoma-impaired visual fields. The refractive range was -8.12 to +6.0 D. There were no cases of keratoconjunctivitis sicca. Iritis was associated with early disease onset (p = 0.02), longer disease duration (p = 0.02) and a positive antinuclear antibodies (ANA) (p = 0.02). CONCLUSION: Ophthalmic complications were recorded in 20% of the study group, primarily in ANA positive patients with pauciarticular onset JCA. In addition to the two patients with severely affected bilateral visual status (3%), one of the 65 patients had acquired unilateral blindness. Half of the complications were late in that they were first recorded after the age of 16 years. Otherwise, the findings were in keeping with other studies of visual prognosis using non-selected series - ZAVADOVSKAIA VD, PETROVA TB, KHODASHINSKAIA AV, USOV VI: [Arthrosonography in the diagnosis of rheumatoid arthritis of the knee joint]. Vestn Rentgenol Radiol1 49-53, 2003
Organism: Siberian State Medical University, Institutes of Cardiology of Tomsk Medical Reasearch Center, Russian Academy of Medical Sciences, TomskFAU - Zavadovskaia, V D
Abstract: The paper presents the capacities of echography in the estimation of the activity of rheumatoid gonitis. A study of knee joints in 126 patients with rheumatoid arthritis has provided the basic ultrasound criteria that are characteristic for the first, second, and third degrees of its progression, which include the pattern of proliferative changes in the synovium, the qualitative and quantitative assessments of intraarticular exudate and its viscosity. The capacities of X-ray study and MRI in the detection of the progression of rheumatoid arthritis are discussed. An algorithm of knee joint radiation study is proposed for patients with rheumatoid arthritis - ZULIAN F, MARTINI G, GOBBER D, AGOSTO C, GIGANTE C, ZACCHELLO F: Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 42:10 1254-1259, 2003
Organism: Department of Paediatrics, University of Padua, Italy zulian@pediatriaunipditFAU - Zulian, F
Abstract: OBJECTIVE: To compare the efficacy and safety of intra-articular triamcinolone hexacetonide (TH) and triamcinolone acetonide (TA) in children with oligoarticular juvenile idiopathic arthritis (JIA). METHODS: One hundred and thirty joints of 85 patients undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. The efficacy of both treatments was evaluated prospectively in a blinded fashion. A good response was defined as a decrease in the articular score of > or =60% from baseline. Clinical, laboratory and immunological variables were noted in order to examine possible factors, other than treatment, predictive of the result. RESULTS: Seventy injections were performed using TH and 60 with TA. The two groups were comparable for clinical, immunological and laboratory characteristics. The rate of response was significantly higher with TH than with TA: 81.4% vs 53.3% (P = 0.001) at 6 months, 67.1 vs 43.3% (P = 0.006) at 12 months, and 60 vs 33.3% (P = 0.002) at 24 months. CONCLUSION: At comparable doses TH appeared to be much more effective than TA for intra-articular use, in both short- and long-term follow-up. This result was not affected by disease duration or degree of local and systemic inflammation