July 2003

Bibliography July 2003

ALSAEID KM, HAIDER MZ, AL AWADHI AM, SRIVASTVA BS, AYOUB EM: Role of human leukocyte antigen DRB1*0307 and DRB1*0308 in susceptibility to juvenile rheumatoid arthritis. Clin Exp Rheumatol 21:3 399-402, 2003
Organism: Kuwait University, Faculty of Medicine, Pediatrics Department, PO Box 24923, Safat 13110, Kuwait khaled7691@hotmailcomFAU - Alsaeid, K M
Abstract: OBJECTIVE: To study the prevalence of Human Leukocyte Antigen (HLA) DR alleles in children with juvenile rheumatoid arthritis (JRA). METHODS: DNA samples from 64 children with oligoarticular and seronegative polyarticular JRA and 64 controls of the same ethnic background were analyzed using PCR-sequence specific primers (PCR-SSP) method. Analysis took into account the onset subtype, the presence of antinuclear antibodies (ANA) and the presence of chronic anterior uveitis, a recognised serious complication of JRA. RESULTS: A high prevalence of DR3 alleles were detected in children with oligoarticular JRA compared to controls (p < 0.05). DR3 alleles were the commonest also in patients with positive ANA as well as those with chronic anterior uveitis. The interesting finding in this study is the absence of two DR3 alleles, namely DRB1*0307 and DRB1 *0308 in the control group while present in significant proportion in children with JRA. DRB1*0307 was present in 16% of children with oligoarticular subtype and 15% of those with polyarticular JRA. DRB1*0308 was only detected in children with oligoarticular JRA, none of the children with polyarticular JRA or the controls had this allele. CONCLUSION: These findings support earlier observations linking these two DR3 alleles, namely 0307 and 0308, to the genetic susceptibility to JRA
ASHORN M, VERRONEN P, RUUSKA T, HUHTALA H: Upper endoscopic findings in children with active juvenile chronic arthritis. Acta Paediatr 92:5 558-561, 2003
Organism: Department of Paediatrics, University of Tampere, Medical School, Tampere, Finland merjaashorn@utafiFAU - Ashorn, M
Abstract: AIM: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA). METHODS: This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. RESULTS: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02). CONCLUSION: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases
BALL E, NEWBURGER A, ACKERMAN AB: Degos' disease: a distinctive pattern of disease, chiefly of lupus erythematosus, and not a specific disease per se. Am J Dermatopathol 25:4 308-320, 2003
Organism: Department of Dermatology, University Hospital of Caracas, Central University of Venezuala picon_ball@hotmailcomFAU - Ball, Elizabeth
Abstract: Degos' disease, known confusingly as malignant strophic papularis, is an uncommon condition of unknown cause characterized by distinctive infarctive lesions in the skin, gastrointestinal tract, and central nervous system; the lesions at the two latter sites often result in death. We deem Degos' disease to be analogous to lupus erythematosus in the sense that each is fundamentally a systemic pathologic process involving several organs, among them the skin, but, moreover, we regard Degos' disease, in most instances, to be an actual manifestation of lupus erythematosus. Histopathologically, the findings in sections of tissue of skin lesions of Degos' disease are indistinguishable from those of one expression of cutaneous lupus erythematosus; immunopathologically, some patients with morphologic findings stereotypical of Degos' disease display signs characteristic of lupus erythematosus. For these reasons, we consider Degos' disease to be a distinctive pattern of disease, rather than a specific disease per se, just as are erythema multiforme, erythema nodosum, leukocytoclastic vasculitis, Sweet's syndrome, and pyoderma gangrenosum, to name but five of scores of them. The singular pattern that is designated Degos' disease usually is an expression of lupus erythematosus, but, episodically, of conditions like dermatomyositis and rheumatoid arthritis
BARONCELLI G, I, FEDERICO G, BERTELLONI SILVANO, SODINI F, DE TERLIZZI F, CADOSSI R, SAGGESE GIUSEPPE: 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. Pediatric Research 54:1 125-136, 2003
Abstract: Bone quality by quantitative ultrasound and fracture rate were assessed in 135 (64 males) children and adolescents 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 BMDarea, or lumbar BMD corrected for bone sizes estimated by a mathematical model (BMDvolume), 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 BMDarea (r = 0.62, p < 0.0001), or lumbar BMDvolume (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 BMDarea, or lumbar BMDvolume, 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
BODOLAY E, CSIKI Z, SZEKANECZ Z, BEN T, KISS E, ZEHER M, SZUCS G, DANKO K, SZEGEDI G: Five-year follow-up of 665 Hungarian patients with undifferentiated connective tissue disease (UCTD). Clin Exp Rheumatol 21:3 313-320, 2003
Organism: Division of Immunology, 1st Department of Medicine, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary bodolai@iiibeldotehuFAU - Bodolay, E
Abstract: OBJECTIVE: To determine the clinical symptoms and the panel of autoantibodies of patients with early undifferentiated connective tissue disease (UCTD) followed for at least 1 year. METHODS: 716 UCTD patients with manifestations suggestive but not diagnostic of specific connective tissue disease (CTD) were recruited and followed up between 1994-1999. The patients with early UCTD were subdivided into those with isolated Raynaud's phenomenon (RP) (50 patients), unexplained polyarthritis (31 patients) and "true" UCTD (665 patients). UCTD was diagnosed on the basis of clinical manifestations suggestive of a connective tissue disease and the presence of at least one non-organ specific autoantibody. The patients' sera were tested for anti-nuclear (ANA), as well as for nine different specific autoantibodies (anti-dsDNA, -Sm, -RNP, -SSA, -SSB, -Scl-70, -centromere, -Jo1 and -PM-Scl). RESULTS: The most common clinical manifestations of UCTD included RP, arthritis/arthralgias, pleuritis/pericarditis, sicca symptoms, cutaneous involvement (photosensitivity, rash), central nervous symptoms, peripheral neuropathy, fever, vasculitis, less pulmonary involvement and myositis. 230 of the 665 true UCTD patients (34.5%) developed a defined CTD (28 systemic lupus erythematosus [SLE], 26 mixed connective tissue disease [MCTD], 19 progressive systemic sclerosis [PSS], 45 Sjogren's syndrome, 3 polymyositis/dermatomyositis [PM/DM], 87 rheumatoid arthritis [RA], and 22 systemic vasculitis. 435 of 665 patients (65.4%) remained in the UCTD state, and 82 of 665 patients (12.3%) achieved complete remission with symptoms not reappearing within the 5-year period. The highest probability of evolution to a defined CTD was during the first 2 years after onset: of 230 UCTD patients 183 (79.5%) developed major organ symptoms and signs. In particular skin and cardiac complications seemed to spread during the follow-up period in those patients who progressed to SLE. The condition of 18/50 patients with isolated RP evolved to UCTD and 3 of 31 patients with unexplained polyarthritis progressed to definite CTD (2 patients RA and one MCTD). CONCLUSION: In our study most of the UCTD patients did not develop a definite CTD, but during the follow-up period we found new clinical and serological manifestations. One-third of the UCTD patients showed progress into different types of specific CTD
BOUSKRAOUI M: A rare observation associating acute viral hepatitis A to chronic juvenile arthritis and a hemophagocytic syndrome
UNE OBSERVATION EXCEPTIONNELLE ASSOCIANT UNE HEPATITE AIGUE VIRALE A, UNE ARTHRITE CHRONIQUE JUVENILE ET UN SYNDROME D'ACTIVATION MACROPHAGIQUE. Medecine et Maladies Infectieuses (France ) 33:7 358-360, 2003
CANETE JD, RODRIGUEZ JR, SALVADOR G, GOMEZ-CENTENO A, MUNOZ-GOMEZ J, SANMARTI R: Diagnostic usefulness of synovial vascular morphology in chronic arthritis. A systematic survey of 100 cases. Semin Arthritis Rheum 32:6 378-387, 2003
Organism: Rheumatology Department, Institut Clinic de l'Aparell Locomotor (ICAL), Hospital Clinic de Barcelona, and Institut d'Investigacions Biomediques Agusti Pi i Suner (IDIBAPS), Universitat de Barcelona, Barcelona, SpainFAU - Canete, Juan D
Abstract: OBJECTIVES: To assess the diagnostic usefulness of the systematic analysis of synovial vascular morphology in various inflammatory, early, and longstanding arthropathies, and to examine the validity of the vascular patterns in predicting the evolution of a group of patients with undifferentiated arthritis (UA). METHODS: One hundred patients who underwent rheumatologic arthroscopy of a symptomatic joint (85 knees, 11 wrists, 3 elbows, 1 metacarpophalangeal joint) were evaluated. The same observer, blinded to patient diagnosis, analyzed the video recordings of the arthroscopies. Vascular morphology was classified into 3 patterns: straight, tortuous, and mixed. RESULTS: Eighty-one patients had inflammatory arthritis: 35 rheumatoid arthritis (RA), 16 psoriatic arthritis (PsA), 13 spondyloarthropathies (SpA), and 17 UA. Forty-nine percent of patients with RA had a straight pattern, 28% a mixed, and 23% a tortuous one. The sensitivity rate of the straight pattern for RA was 77% and the specificity rate was 70%. Seventy-six percent of RA patients with a straight pattern were rheumatoid factor positive (RF+) against 25% of RA patients with a tortuous pattern. The odds ratio for RA associated to straight compared with tortuous pattern was 57.3 (95% confidence interval, 6.6 to 499.5; P <.001). Patients with PsA and SpA shared the same pattern and were analyzed as 1 group. Ninety-three percent of patients with PsA/SpA had a tortuous pattern, 4% a straight pattern, and 3% a mixed pattern. The sensitivity rate of the tortuous pattern for PsA/SpA was 61% and the specificity rate was 95%. During 2 years of follow-up, 6 of 17 patients with UA were definitely diagnosed: 4 RA (2 RF+ and straight pattern; 2 with a tortuous pattern, 1 with RF+ and HLA-B27+); 1 SpA and 1 PsA, both with a tortuous pattern. No differences in vascular patterns were observed according to disease duration. Our results indicate that vascular patterns are not modified by disease modifying antirheumatic drug (DMARD) treatment. The other 19 patients had osteoarthritis (n = 8) and calcium pyrophosphate dihydrate crystal deposition disease (n = 11) and their predominant vascular pattern was tortuous-like. CONCLUSIONS: Arthroscopic assessment of synovial vascular changes in chronic arthritis may be of diagnostic and pathogenetic interest, although differences between published studies suggest a need for consensus in evaluating vascular patterns. A straight pattern is strongly associated with RF + RA whereas a tortuous pattern is generally associated with PsA or SpA; these associations are independent of disease duration. The vascular pattern likely does not change qualitatively with DMARD therapy. The application of this technique to the diagnosis or prognosis of patients with UA may be a complementary tool for the treatment of these patients, but larger, prospective studies are necessary to confirm this hypothesis
CELIKER R, BAL S, BAKKALOGLU A, OZAYDIN E, COSKUN TURGAY, CETIN A, DINCER F: Factors playing a role in the development of decreased bone mineral density in juvenile chronic arthritis. Rheumatol Int Berlin 23:3 127-129, 2003
Abstract: Objective The aims of this study were to evaluate bone mineral density (BMD) in patients with juvenile chronic arthritis (JCA), compare them with healthy controls, and assess the effects of disease activity and corticosteroid treatment on BMD. Methods Twenty-eight patients diagnosed with JCA and 45 healthy controls were included in this study. Disease activity was determined by clinical and laboratory evaluation, Articular Disease Severity Score (ADSS), and the Juvenile Arthritis Functional Assessment Report (JAFAR). Bone mineral density of the lumbar spine was measured by dual energy X-ray absorptiometry (DEXA). Results Patients with JCA showed significant decreases in BMD compared with healthy controls. The JCA patients treated with corticosteroids showed significantly lower BMDs than the healthy control group. Age of the patients and age of onset were found to correlate with BMD. Conclusion Our study showed that glucocorticoids were involved in the development of osteoporosis in JCA, with many other factors affecting bone mineralization. We could not demonstrate any relationship between BMD and disease activity, but the study data suggest that early onset disease is also an important factor in the development of osteoporosis in JCA
CHAUD DM, HIL RIO MO, YANAGUIBASHI G, AMANCIO OM: [Dietetic and anthropometric assessment in juvenile rheumatoid arthritis patients]. Rev Assoc Med Bras 49:2 181-184, 2003
Organism: Universidade Federal de Sao Paulo/ Escola Paulista de Medicina, Sao Paulo, SP, BrasilFAU - Chaud, Daniela Maria Alves
Abstract: OBJECTIVES: to evaluate the dietary intake and the anthropometry of children and adolescents with juvenile rheumatoid arthritis - JRA, considering the pauciarticular and the polyarticular types. METHODS: Evaluation of the dietary intake of calories and macronutrients by the Food Register method compared with the Recommended Dietary Allowances - RDA, and the anthropometric evaluation by the z score of the height-for-age relationship and body mass index. RESULTS: The pauciarticular or polyarticular type did not determine any difference in calories, carbohydrates, proteins, and lipids intake, being the total caloric value, in both groups, bellow recommendations. Low-stature was observed in patients of the 2 groups, while leanness and obesity status were found in patients of the polyarticular group. CONCLUSIONS: JRA patients, particularly of the polyarticular group, can present compromised nutritional status and growth, probably owing to an inadequate dietary intake and increased need of calories and specific nutrients, which occur during the periods of the disease's activity
CHIA A, 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
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. METHODS: 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
CHOUNG YH, PARK K, MOON SK, KIM CH, RYU SJ: Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol 67:8 889-894, 2003
Organism: Department of Otolaryngology, Ajou University School of Medicine, 5 Woncheon-Dong, Paldal-Gu, Suwon 442-721, South Korea yhc@ajouackrFAU - Choung, Yun-Hoon
Abstract: OBJECTIVE: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. METHODS: The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. RESULTS: The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. CONCLUSIONS: The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed
DE BENEDETTI F, PIGNATTI P, BIFFI M, BONO E, WAHID S, INGEGNOLI F, CHANG SY, ALEXANDER H, MASSA M, PISTORIO A, MARTINI A, PITZALIS C, SINIGAGLIA F, ROGGE L: Increased expression of alpha(1,3)-fucosyltransferase-VII and P-selectin binding of synovial fluid T cells in juvenile idiopathic arthritis. J Rheumatol 30:7 1611-1615, 2003
Organism: Pediatria Generale e Reumatologia, Dipartimento di Pediatria, IRCCS Policlinico San Matteo, Pavia, ItalyFAU - De Benedetti, Fabrizio
Abstract: OBJECTIVE: The mechanisms controlling the recruitment of T helper type 1 (Th1) cells to the inflamed synovium are not fully understood. Here, we focus on alpha(1,3)-fucosyltransferase-VII (FucT-VII), an enzyme responsible for the generation of functional P- and E-selectin ligands that is upregulated in Th1 cells. METHODS: Expression of transcripts encoding FucT-VII, interferon-gamma (IFN-gamma), and interleukin 12Rbeta2 (IL-12Rbeta2) were analyzed in T cells purified from synovial fluid (SF) and from peripheral blood (PB) of children with juvenile idiopathic arthritis (JIA) using kinetic reverse transcriptase polymerase chain reaction analysis. Binding of SF and PB T cells to P-selectin was determined by flow cytometry using a soluble P-selectin/IgG1 fusion molecule. Recruitment of T cells to synovial tissue in vivo was studied by analyzing the migration of FucT-VII transfected Jurkat T cells into human rheumatoid synovial tissue grafted into SCID mice. RESULTS: In patients with JIA, the mRNA levels of FucT-VII, as well as of IFN-gamma and IL-12Rbeta2, were up-regulated in SF T cells compared to paired PB T cells. A higher expression of FucT-VII mRNA in SF T cells was associated with increased binding of T cells to P-selectin. Moreover, FucT-VII expression and increased P-selectin binding capacity of T cells were associated with a polyarticular course of oligoarticular JIA. Expression of FucT-VII in Jurkat T cells resulted in an increased accumulation of these cells in human rheumatoid synovial tissue grafted into SCID mice. CONCLUSION: Our data indicate an important role of FucT-VII in the enhanced homing of T cells to the inflamed synovium
DE KLEER IM, KAMPHUIS SM, RIJKERS GT, SCHOLTENS L, GORDON G, DE JAGER W, HAFNER R, VAN DE ZR, VAN EDEN W, KUIS W, PRAKKEN BJ: The spontaneous remission of juvenile idiopathic arthritis is characterized by CD30+ T cells directed to human heat-shock protein 60 capable of producing the regulatory cytokine interleukin-10. Arthritis Rheum 48:7 2001-2010, 2003
Organism: University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The NetherlandsFAU - de Kleer, I M
Abstract: OBJECTIVE: To test the hypothesis that T cell reactivity to self heat-shock protein 60 (Hsp60) in patients with remitting juvenile idiopathic arthritis (JIA) is part of an antiinflammatory, regulatory mechanism. METHODS: Using peripheral blood-derived mononuclear cells (PBMCs) and synovial fluid-derived mononuclear cells (SFMCs) obtained from patients with JIA, we analyzed the expression of CD30 and the induction of regulatory cytokines in response to human and mycobacterial Hsp60. RESULTS: In oligoarticular JIA patients, in vitro activation of PBMCs and SFMCs with Hsp60 induced a high expression of CD30 on CD4+, activated (HLA-DR-positive), memory (CD45RO+) T cells. The expression of CD30 induced by human Hsp60 was much higher than that induced by mycobacterial Hsp60. In oligoarticular JIA patients with active disease, the expression of CD30 in response to human Hsp60 was paralleled by a high interleukin-10 (IL-10):interferon-gamma (IFNgamma) ratio. In addition, restimulated human Hsp60-specific T cell lines from oligoarticular JIA patients showed a high production of IL-10 and a low production of IFNgamma. In contrast, PBMCs and SFMCs from polyarticular JIA patients responded to human Hsp60 with virtually no expression of CD30 and a low IL-10:IFNgamma ratio. CONCLUSION: The results show that T cells responding to human Hsp60 in oligoarticular JIA patients express CD30, and during active phases of the disease, these T cells have a cytokine profile with a high IL-10:IFNgamma ratio. These findings suggest that in oligoarticular JIA patients, human Hsp60-specific CD4+ cells have a regulatory function and contribute to disease remission
EL MIEDANY YM, YOUSSEF SS, EL GAAFARY M: Cross cultural adaptation and validation of the Arabic version of the Childhood Health Assessment Questionnaire for measuring functional status in children with juvenile idiopathic arthritis. Clin Exp Rheumatol 21:3 387-393, 2003
Organism: Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt miedanycrd@yahoocomFAU - el Miedany, Y M
Abstract: OBJECTIVE: To cross culturally adapt the American-English version of the Childhood Health Assessment Questionnaire (CHAQ) and to evaluate the validity and reliability of the modified translated version on children with juvenile idiopathic arthritis (JIA). METHODS: A cohort of 62 children suffering from JIA (32 Egyptian, 30 Saudi Arabian) 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 more typical of the Arabic culture. After modification, translation and back translation of the questionnaire, it was administered to the selected patients as well as their parents 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 one-week interval for evaluation of the reliability of this test. The modified questions were tested for their loyalty to the principal component and their correlation with that of the other unchanged items was compared. RESULTS: CHAQ proved to be valid in clinically discriminating between healthy subjects and patients with different patterns of JIA. Test-retest showed strong reliability with a high percentage of agreement and high kappa values. Internal consistency showed a high value for the standardized Cronbach's alpha (0.951), and this value did not show any significant change when any one of the items was eliminated. The modified questionnaire showed a strong and significant validity when its results were correlated with disease activity parameters. CONCLUSION: The Arabic CHAQ is a reliable and valid instrument that can be administered to Arabic children suffering from JIA and to their parents, to evaluate the patients' functional disability. Its measurement properties were comparable to versions in other languages
GALEAZZI M, MOROZZI G, PICCINI M, CHEN J, BELLISAI F, FINESCHI S, MARCOLONGO R: Dosage and characterization of circulating DNA: present usage and possible applications in systemic autoimmune disorders. Autoimmun Rev 2:1 50-55, 2003
Organism: Institute of Rheumatology, University of Siena, Siena, Italy galeazzimail@tinitFAU - Galeazzi, M
Abstract: The discovery of extracellular nucleic acids in the circulation was firstly reported in 1948. In the last few years it has been demonstrated that the entire spectrum of genetic changes seen in primary tumors could also be detected in the serum of patients with solid tumors. This observation has also opened up exciting possibilities for tumor detection and monitoring. More recently investigators started looking for other forms of non-host DNA in the plasma/serum so that in 1997 the presence of fetal DNA in the plasma/serum of pregnant women was demonstrated. This finding suggested that maternal plasma fetal DNA would be a very valuable material for noninvasive prenatal diagnosis and monitoring. It has been also postulated that the presence of the two-way trafficking of nucleated cells and free DNA between the mother and fetus may have potential implications for the development of certain autoimmune diseases. Concerning autoimmune disorders, Tan was the first author to describe the presence of high levels of circulating DNA in patients with systemic lupus erythematosus (SLE) in 1986. Later on different authors demonstrated that elevated levels of serum DNA was also present in patients with other diseases including rheumatoid arthritis. We have analyzed both circulating free DNA and DNA extracted from nucleated blood cells in scleroderma and in lupus patients but, by using gel electrophoresis, we were able to define the pattern of the DNA, instead of simply dosing its amount in the circulation. We have found that SLE and SSc have anomalous patterns of DNA both in serum and in the Buffy-coat and that these patterns are typical for each disorder. It is possible that understanding the biological significance of the diversity in DNA pattern exhibition in white blood cells may give new insights into the pathophysiology of autoimmune disorders. It is also conceivable that circulating and immune-competent cellular DNA markers might offer the promise of precise quantitative analysis useful for diagnostic purposes, without the need to establish difficult cutoffs as is necessary for protein markers
GARCIA-CONSUEGRA MJ, MERINO MUN T, LAMA MR, COYA V, GRACIA BR: Growth in children with juvenile idiopathic arthritis
CRECIMIENTO EN NIN(tilde)OS CON ARTRITIS IDIOPATICA JUVENIL. Anales de Pediatria (Spain ) 58:6 529-537, 2003
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 <= -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 <= -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
KNIPP S, FEYEN O, NDAGIJIMANA J, NIEHUES T: Ex vivo apoptosis, CD95 and CD28 expression in T cells of children with juvenile idiopathic arthritis. Rheumatol Int Berlin 23:3 112-115, 2003
Abstract: We hypothesise that T-cell apoptosis and the percentage of T cells expressing molecules involved in apoptosis modulation (CD95, CD28) are altered at the inflammation site and in peripheral blood (PB) of children with juvenile idiopathic arthritis (JIA). Paired JIA samples of synovial fluid (SF) and PB (n = 7) and PB samples from age-matched normal children (n = 23) were analysed immediately ex vivo. Apoptosis was measured by detection of phophatidylserine (PS) externalisation on T cells. CD95 or CD28 was detected by FACS, and soluble CD95 and CD95 ligand levels were detected by enzyme-linked immunosorbent assay (ELISA). In SF, the mean percentage of apoptotic T cells was somewhat higher than in PB. However, the percentages of T cells expressing CD95 and soluble CD95 levels were markedly higher in SF (CD4 cells 96+-2%, CD8 91+-6%, soluble CD95 6,420+-2,571 pg/ml) than in PB (CD4 32+-10%, CD8 36+-9%, soluble CD95 4,296+-2,142 pg/ml). Peripheral blood T-cell apoptosis in JIA (CD4 20+-8%, CD8 42+-19%) was higher than in the control group (CD4 5+-2%, CD8 9+-6%). Interestingly, the percentage of PB CD4 cells expressing CD28 was lower in JIA than controls. In conclusion, systemic T-cell apoptosis was higher in JIA while a substantial number of SF T cells survived locally, despite the fact that almost all cells express CD95
KOTANIEMI K, SAVOLAINEN A, AHO K: Severe childhood uveitis without overt arthritis. Clin Exp Rheumatol 21:3 395-398, 2003
Organism: Department of Ophthalmology, Rheumatism Foundation Hospital, 18120 Heinola, Finland kaisukotaniemi@scifiFAU - Kotaniemi, K
Abstract: OBJECTIVE: To look for forme fruste (incomplete) forms of juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS: The study involved 6 patients (3 girls and 3 boys) without overt arthritis who had been sent for ophthalmologic and rheumatologic evaluation because of uveitis resembling that seen in JIA. RESULTS: Two patients evinced no evidence of arthritis, 3 had non-specific signs and symptoms such as pains or valgus ankle and one may have had an episode of arthritis. Five patients carried the HLA allele B27 and 4 were positive for antinuclear antibodies. The mean age at diagnosis of uveitis was 8.4 years (range 3.5-14.2 years) and the mean follow-up period was 6.2 years (range 3.8-7.3 years). All patients had obviously had their uveitis for a long period prior to the first contact with an ophthalmologist. In 3 patients uveitis was asymptomatic when diagnosed, 2 had mild conjunctival injection and one had exacerbation of the disease process. Subsequently the uveitis was asymptomatic and bilateral in all patients. Complications of uveitis were common: cataract was found in 4 patients, glaucoma in 1 patient, cystoid macular edema in 4, posterior synechiae in 5 and band keratopathy in 3. The final visual acuity was poor in one eye of 1 patient despite effective treatment of uveitis. Uveitis was still active in all patients at the close of follow-up. CONCLUSION: Asymptomatic uveitis, which is frequently positive for antinuclear antibodies, can occur in children who show no clear evidence of arthritis. Complications occur in consequence of a delay in the diagnosis of insidious uveitis
KOTANIEMI K: [Juvenile rheumatoid arthritis-associated uveitis]. Duodecim 119:11 1065-1071, 2003
Organism: kaisukotaniemi@scifiFAU - Kotaniemi, Kaisu
KUCZYNSKI E, SILVA CAA, CRISTOFANI LM, KISS MHB, ODONE F, V, ASSUMPCA T: Quality of life evaluation in children and adolescents with chronic and/or incapacitating diseases: A Brazilian study
EVALUACION DE LA CALIDAD DE VIDA EN NIN(tilde)OS Y ADOLESCENTES PORTADORES DE ENFERMEDADES CRONICAS Y/O INCAPACITADORAS: UN ESTUDIO BRASILEN(tilde)O. Anales de Pediatria (Spain ) 58:6 550-555, 2003
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 S, TRABOULSI E, I: Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis. Am J Ophthalmol 135:6 772-778, 2003
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. METHODS: 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
LEHMANN HW, VON LANDENBERG P, MODROW S: Parvovirus B19 infection and autoimmune disease. Autoimmunity Reviews (Netherlands ) 2:4 218-223, 2003
Abstract: Human parvovirus B19 infections may cause a widespread benign and self-limiting disease in children and adults, known as erythema infectiosum or fifth disease. A variety of further manifestations are associated with the infection such as arthralgias, arthritis, leukopenia and thrombocytopenia, anemia and vasculitis, spontaneous abortion and hydrops fetalis in pregnant women. Both in children and adults parvovirus B19 infections have been frequently implicated as a cause or trigger of various forms of autoimmune diseases affecting joints, connective tissue and large and small vessels. In addition, autoimmune neutropenia, thrombocytopenia and hemolytic anemia are known as sequelae of B19 infection. The molecular basis of the autoimmune phenomena and resultant pathogenesis is unclear. The involvement of molecular mimicry between cellular and viral proteins, the induction of enhanced cytokine production via the viral transactivator protein NS1 and the phospholipase A2-like activity of the capsid protein VP1 may contribute to the induction of autoimmune reactions. All the known data and the potential mechanisms involved in the pathogenesis will be discussed in this review. (c) 2003 Elsevier Science B.V. All rights reserved
LEPPILAHTI M, TAMMELA TL, HUHTALA H, KIILHOLMA P, LEPPILAHTI K, AUVINEN A: Interstitial cystitis-like urinary symptoms among patients with Sjogren's syndrome: a population-based study in Finland. Am J Med 115:1 62-65, 2003
Organism: Division of Urology, Seinajoki Central Hospital, Seinajoki, Finland mikaelleppilahti@epshpfiFAU - Leppilahti, Mikael
LEWIS DK, CALLAGHAN M, PHIRI K, CHIPWETE J, KUBLIN JG, BORGSTEIN E, ZIJLSTRA EE: Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi. Trans R Soc Trop Med Hyg 97:1 91-96, 2003
Organism: Department of Medicine, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, MalawiFAU - Lewis, David K
Abstract: Despite high seroprevalence there are few recent studies of the effect of human immunodeficiency virus (HIV) on hospitals in sub-Saharan Africa. We examined 1226 consecutive patients admitted to medical and surgical wards in Blantyre, Malawi during two 2-week periods in October 1999 and January 2000: 70% of medical patients were HIV-positive and 45% had acquired immune deficiency syndrome (AIDS); 36% of surgical patients were HIV-positive and 8% had AIDS. Seroprevalence rose to a peak among 30-40 year olds; 91% of medical, 56% of surgical and 80% of all patients in this age group were HIV-positive. Seropositive women were younger than seropositive men (median age 29 vs. 35 years, P < 0.0001). Symptoms strongly indicative of HIV were history of shingles, chronic diarrhoea or fever or cough, history of tuberculosis (TB), weight loss and persistent itchy rash (adjusted odds ratios [AORs] all > 5). Clinical signs strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi's sarcoma, oral thrush and hair loss (AORs all > 10). Of surgical patients with 'deep infections' (breast abscess, pyomyositis, osteomyelitis, septic arthritis and multiple abscesses), 52% were HIV-positive (OR compared with other surgical patients = 2.4). Severe bacterial infections, TB and AIDS caused 68% of deaths. HIV dominates adult medicine, is a major part of adult surgery, is the main cause of death in hospital and affects the economically active age group of the population
MAENPAA H, KUUSELA P, LEHTINEN J, SAVOLAINEN A, KAUTIAINEN H, BELT E: Elbow synovectomy on patients with juvenile rheumatoid arthritis. Clin Orthop412 65-70, 2003
Organism: Rheumatism Foundation Hospital, Heinola, Finland heikkimaenpaa@scanpointfiFAU - Maenpaa, Heikki
Abstract: Twenty-four primary elbow synovectomies were done between 1991 and 1998 at the authors' institution on 19 patients (15 females, four males) with juvenile rheumatoid arthritis. Five bilateral and 14 unilateral procedures were done. The mean age of the patients was 29 years (range, 11-64 years) at the time of surgery and the mean disease duration was 19 years (range, 2-51 years). Preoperatively radiographic destruction of Larsen Grade 1 was detected in 21% of elbows, Grade 2 in 54%, and Grade 3 in 4%. In 21% of elbows no radiographic destruction was present (Grade 0). The cumulative survival rate of elbow synovectomy was 84% (95% confidence interval, 68-98) at 5 years. Four resynovectomies and two elbow replacement arthroplasties were done during the followup period. Complete pain relief was documented in 44% of patients and subjective outcome was excellent or good in 72% of patients. No significant improvement was observed in functional ability or range of motion in extension and flexion or pronation and supination. The results of the current study (mean followup, 5 years; range, 2-9 years) are slightly worse compared with the short-term results of elbow synovectomy in patients with adult-onset rheumatoid arthritis
MANSAT P, ALQOH F, MANSAT M, RONGIERES M, BELLUMORE Y, BONNEVIALLE P: [GUEPAR I total elbow arthroplasty in rheumatoid arthritis: 19 implants followed an average of 67 months]. Rev Chir Orthop Reparatrice Appar Mot 89:3 210-217, 2003
Organism: Service d'Orthopedie-Traumatologie, Hopital Universitaire de Toulouse, CHU Purpan, place du Docteur-Baylac, 31059, Toulouse Cedex mansat@cictfrFAU - Mansat, P
Abstract: INTRODUCTION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant used since 1985. Only one multicenter study has reported the mid-term results of this implant in rheumatoid arthritis. We presented a monocentric retrospective study evaluating the results of 19 GUEPAR I total elbow arthroplasty in rheumatoid arthritis with a mean follow-up of 67 months. MATERIALS AND METHODS: Between 1988 and 1996, 19 GUEPAR I total elbow arthroplasties have been performed on 16 patients (3 bilateral). There were 15 women and one man, averaged age 58 years. Radiographically, the elbow was classified as stage IIIA in 8 cases, and stage IIIB in 11 cases, according to the Mayo Clinic classification. A triceps splitting approach with tendon reflection was performed in all cases. A postoperative immobilization at 45 degrees extension was used for all patients during 21 days averaged, and active mobilization was then started. RESULTS: At 67 months averaged follow-up (range, 2 to 12 years) the Mayo Elbow score improved from 36 to 75 points. The overall results were considered as excellent for 8, good for 5, fair for 2, and poor for 4. Nine elbows were totally painfree and six had minimum pain. Postoperative arc of motion reached 36 to 126 degrees in extension-flexion and 147 degrees in rotation. Eleven out of 19 elbows had a normal functional score. Two elbows dislocated and two others had a valgus instability lower than 10 degrees. There were thirteen complications affecting 11 of the 19 elbows (68%), and six of these eleven elbows had a revision procedure (31%): 3 peroperative medial column fractures, one postoperative medial column fracture which has been fixed, two elbow dislocated with one ulnar component revision, and 3 loosed implants which has been revised. There were persistent ulnar paresthesiae in two cases with a secondary neurolysis performed in one. Finally two infections developed 6 years after the initial procedure, one superficial, and one deep, which lead to removal of the total elbow arthroplasty. DISCUSSION-CONCLUSION: The GUEPAR I total elbow arthroplasty is a nonconstrained implant indicated essentially in rheumatoid arthritis. Without intrinsic stability this implant must be contraindicated in front of bone stock deficiency, or chronic instability of the elbow. In selected cases the GUEPAR I total elbow arthroplasty offers a painfree elbow with a functional range of motion
MAVRIKAKIS I, SFIKAKIS PP, MAVRIKAKIS E, ROUGAS K, NIKOLAOU A, KOSTOPOULOS C, MAVRIKAKIS M: The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 110:7 1321-1326, 2003
Organism: Department of Ophthalmology, Athens Eye Hospital, Athens, Greece jmavrikakis@yahoocomFAU - Mavrikakis, Ioannis
Abstract: PURPOSE: To define the risk of hydroxychloroquine (HCQ)-related retinal toxicity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who are receiving recommended dosages of the drug (< or =6.5 mg/kg/day). DESIGN: Prospective cohort study, from 1985 to 2000. PARTICIPANTS: Greek patients with RA (n = 335) and SLE (n = 191) treated with HCQ, 400 of whom had completed at least 6 years of treatment. METHODS: Ophthalmologic evaluation was performed every 6 months from 1985 to 1995, and yearly thereafter. This consisted of best-corrected visual acuity, color vision testing, static central visual field testing, fundoscopy, electroretinography, and fluorescein angiography, when indicated. MAIN OUTCOME MEASURES: Fundus lesions attributed to HCQ. RESULTS: No HCQ retinal toxicity was noted in any of the 526 patients during the first 6 years of treatment. Two (3.4%) of the first 58 long-term (>6 years) treated patients developed HCQ-related maculopathy at 8 and 6.5 years of treatment, despite regular ophthalmologic evaluation. On follow-up 7 and 9 years after cessation of HCQ treatment, both patients had stable eye disease. No HCQ retinal toxicity was observed in the subsequent 342 patients who were treated for >6 years. Overall, the incidence of HCQ-related retinopathy in 400 patients who were treated with recommended dosages of the drug for a mean of 8.7 years was reduced to 0.5%. CONCLUSIONS: After a baseline ophthalmic examination to confirm the absence of preexisting fundus pathology, patients with normal renal function may receive HCQ at a maximal daily dosage of 6.5 mg/kg and continue safely for 6 years. However, annual screening is recommended in patients who have taken the drug, even in recommended doses, for >6 years
OYE F, BJORNLAND T, STORE G: Mandibular osteotomies in patients with juvenile rheumatoid arthritic disease. Scandinavian Journal of Rheumatology (Norway ) 32:3 168-173, 2003
Abstract: Objective: This retrospective study evaluates the results after orthognathic surgery in a group of patients with juvenile rheumatoid arthritis. Methods: The material comprised sixteen patients where genioplasty with or without bilateral sagittal split (BSSO) had been performed during a 10-year period between 1991 and 2000. The patients were recalled for follow-up examination and the clinical records and radiographs of the patients were analysed. Results: All patients reported an improved facial esthetics. Sixty-two% reported altered neurosensory dysfunction in the inferior alveolar nerve, but no patients reported altered feelings to interfere with function. Two patients reported reduction in pain in the TMJ from a score 10 and 7 in the VAS-scale preoperatively, to 0 after the orthognathic surgery. Eight of the patients reported this to be less uncomfortable compared to other surgical procedures because of their JRA. Ninety-four% noted a positive social change after the operation. Conclusion: Orthognathic surgical treatment of the JRA patient improves the facial profile. The described procedures are safe and serious complications were not seen in our study
OZCAKAR L, DINCER F, OZCAKAR ZB: Juvenile chronic arthritis in a monozygotic twin couple. Rheumatol Int Berlin 23:3 149-150, 2003
PACKHAM JC, HALL MA: Premature ovarian failure in women with juvenile idiopathic arthritis (JIA). Clin Exp Rheumatol 21:3 347-350, 2003
Organism: Rheumatology Department, Wexham Park Hospital, Slough, UK jonpackham@nstaffshwmidsnhsukFAU - Packham, J C
Abstract: OBJECTIVE: To examine the effect of longstanding juvenile idiopathic arthritis (JIA) on menstrual irregularity and the incidence of premature ovarian failure in women. METHODS: Women with longstanding JIA who had abnormal or absent menstrual cycles had their circulating levels of gonadotrophins measured to check for the presence of ovarian failure. Disease demographics and subsets, function, age at onset of menstrual irregularity, previous medical intervention, concurrent diseases and history of pregnancy/delivery were documented. RESULTS: 177/187 (95%) of female adults with JIA who were identified and contacted, participated in the study. The average age at review was 35.4 years (19-78) with average disease duration of 28.7 years. 47.4% of all patients had clinically active arthritis. 44.6% of all patients had severe disability (HAQ score > 1.5). Six patients had premature ovarian failure unrelated to medication use, comprising 3.4% of the females in the study, compared to an expected incidence of 1% in the general population (p < 0.01). In addition, three (1.7%) of these had onset of symptoms before age 30, compared to an expected incidence of 0.1% in the general population (p < 0.01). The average maternal age at first delivery in women with JIA (27.2 years) was higher than the general population (23.5 years). CONCLUSION: Idiopathic premature ovarian failure was more commonly found in individuals with juvenile idiopathic arthritis. In addition a small number of patients had iatrogenic premature ovarian failure related to chlorambucil use
PAK CY, POINDEXTER JR, ADAMS-HUET B, PEARLE MS: Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115:1 26-32, 2003
Organism: Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8885, USA charlespak@utsouthwesterneduFAU - Pak, Charles Y C
Abstract: PURPOSE: To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa. METHODS: We studied 1392 patients with kidney stones who underwent a complete ambulatory evaluation and who submitted one or more stones for analysis. We ascertained the associations between medical diagnosis and stone composition. RESULTS: The most common kidney stones were composed of calcium oxalate (n = 1041 patients [74.8%]), mixed calcium oxalate-calcium apatite (n = 485 [34.8%]), and calcium apatite alone (n = 146 [10.5%]). The most common medical diagnoses were hypocitraturia (n = 616 patients [44.3%]), absorptive hypercalciuria (n = 511 [36.7%]), and hyperuricosuria (n = 395 [28.4%]). Calcium apatite and mixed calcium oxalate-calcium apatite stones were associated with the diagnoses of renal tubular acidosis and primary hyperparathyroidism (odds ratios >/=2), but not with chronic diarrheal syndromes. As the phosphate content of the stone increased from calcium oxalate to mixed calcium oxalate-calcium apatite, and finally to calcium apatite, the percentage of patients with renal tubular acidosis increased from 5% (57/1041) to 39% (57/146), and those with primary hyperparathyroidism increased from 2% (26/1041) to 10% (14/146). Calcium oxalate stones were associated with chronic diarrheal syndromes, but not with renal tubular acidosis. Pure and mixed uric acid stones were strongly associated with a gouty diathesis, and vice versa. Chronic diarrheal syndromes and uric acid stones were associated with one another, and brushite stones were associated with renal tubular acidosis. As expected, there was a very strong association between infection stones and infection, and between cystine stones and cystinuria. CONCLUSION: Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones
PETERS U, ASKLING J, GRIDLEY G, EKBOM A, LINET M: Causes of death in patients with celiac disease in a population-based Swedish cohort. Arch Intern Med 163:13 1566-1572, 2003
Organism: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7273, USA petersu@mailnihgovFAU - Peters, Ulrike
Abstract: BACKGROUND: Patients with celiac disease have an increased risk of death from gastrointestinal malignancies and lymphomas, but little is known about mortality from other causes and few studies have assessed long-term outcomes. METHODS: Nationwide data on 10 032 Swedish patients hospitalized from January 1, 1964, through December 31, 1993, with celiac disease and surviving at least 12 months were linked with the national mortality register. Mortality risks were computed as standardized mortality ratios (SMRs), comparing mortality rates of patients with celiac disease with rates in the general Swedish population. RESULTS: A total of 828 patients with celiac disease died during the follow-up period (1965-1994). For all causes of death combined, mortality risks were significantly elevated: 2.0-fold (95% confidence interval [CI], 1.8-2.1) among all patients with celiac disease and 1.4-fold (95% CI, 1.2-1.6) among patients with celiac disease with no other discharge diagnoses at initial hospitalization. The overall SMR did not differ by sex or calendar year of initial hospitalization, whereas mortality risk in patients hospitalized with celiac disease before the age of 2 years was significantly lower by 60% (95% CI, 0.2-0.8) compared with the same age group of the general population. Mortality risks were elevated for a wide array of diseases, including non-Hodgkin lymphoma (SMR, 11.4), cancer of the small intestine (SMR, 17.3), autoimmune diseases (including rheumatoid arthritis [SMR, 7.3] and diffuse diseases of connective tissue [SMR, 17.0]), allergic disorders (such as asthma [SMR, 2.8]), inflammatory bowel diseases (including ulcerative colitis and Crohn disease [SMR, 70.9]), diabetes mellitus (SMR, 3.0), disorders of immune deficiency (SMR, 20.9), tuberculosis (SMR, 5.9), pneumonia (SMR, 2.9), and nephritis (SMR, 5.4). CONCLUSION: The elevated mortality risk for all causes of death combined reflected, for the most part, disorders characterized by immune dysfunction
PETTY RE, SMITH JR, ROSENBAUM JT: Arthritis and uveitis in children: A pediatric rheumatology perspective. Am J Ophthalmol 135:6 879-884, 2003
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. METHODS: 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
POWELL KE, DISEKER RA, III, PRESLEY RJ, TOLSMA D, HARRIS S, MERTZ KJ, VIEL K, CONN DL, MCCLELLAN W: Administrative data as a tool for arthritis surveillance: estimating prevalence and utilization of services. J Public Health Manag Pract 9:4 291-298, 2003
Organism: Chronic Disease, Injury, and Environmental Epidemiology Section, Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources, 2 Peachtree Street, Room 14-392, Atlanta, GA 30303, USAFAU - Powell, Kenneth E
Abstract: The public health burden of arthritis and related conditions is incompletely described by commonly used public health surveillance systems. We examined the potential of administrative data as a supplement. The administrative data sources we used underestimated the prevalence of arthritis and overestimated service utilization for persons with arthritis when data from only one year were used. The use of five year's data doubled the prevalence estimate and reduced the service utilization estimate by half. The demographics of the population covered by administrative data also influence the prevalence estimate. Administrative data may usefully supplement routine public health surveillance systems but must be used with caution
POWER TG, DAHLQUIST LM, THOMPSON SM, WARREN R: Erratum: Interactions between children with juvenile rheumatoid arthritis and their mothers (Journal of Pediatric Psychology (28:3) 213-221)). Journal of Pediatric Psychology (United States ) 28:5 374, 2003
ROVENSKA E, ROVENSKA E, NEUMULLER J: Structure of synovial lymphatic capillaries in rheumatoid arthritis and juvenile idiopathic arthritis. Int J Tissue React 25:1 29-39, 2003
Organism: National Institute of Rheumatic Diseases, Piestany, Slovak Republic rovenska@vurchskFAU - Rovenska, E
Abstract: 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 comparison of the structure of the same vessel under light and electron microscope and clear differentiation between lymphatic and blood capillaries and venules. Synovial LC were localized in the subintimal connective tissue of the SM in the vicinity of venules. The shape of some LC was irregular, suggesting edema of the interstitium. Lymphatic endothelium has extremely attenuated cytoplasm with the 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. Mononuclear cells were accumulated adjacent to some LC. Specialized interendothelial junctions (endothelial microvalves) were observed in the LC walls. Their structure and function in the migration of cells and 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. We suggest that reported alterations of the fine synovial lymphatic vessels can contribute to the progression of the inflammatory process to chronicity
ROVENSKY J, KOSKOVA E, PAYER J: Some remarks on incidence of juvenile idiopathic arthritis and rheumatoid arthritis in Turner's syndrome
K OTAZKE VYSKYTU JUVENILNEJ IDIOPATICKEJ ARTRITIDY A REUMATOIDNEJ ARTRITIDY PRI TURNEROVOM SYNDROME. Lekarsky Obzor (Slovakia ) 52:4 112-114, 2003
Abstract: The authors describe a course of rheumatoid arthritis in Turner's syndrome. A 26 year old patient developed progressive course of the disease and therefore a combined therapy by antimalarial drugs and methotrexate had to be administered. RA was seronegative. Turner's syndrome was diagnosed at the age of 8. In another patient with Turner's syndrome diagnosed at the age of 13, polyarthritic syndrome and exsudative pleuropericarditis due to infection appeared at the age of 17. The authors suggested a development of juvenile idiopathic arthritis with systemic manifestations, the disease yielded to 1-year therapy. The paper outlines the existing relations between Turner's syndrome and the development of juvenile idiopathic arthritis and/or arthritis of the RA type
RUNSTADLER JA, SAILA H, SAVOLAINEN A, LEIRISALO-REPO M, AHO K, TUOMILEHTO-WOLF E, TUOMILEHTO J, SELDIN MF: Analysis of MHC region genetics in Finnish patients with juvenile idiopathic arthritis: evidence for different locus-specific effects in polyarticular vs pauciarticular subsets and a shared DRB1 epitope. Genes Immun 4:5 326-335, 2003
Organism: Rowe Program in Human Genetics and Molecular Medicine, Department of Biological Chemistry, University of California, Davis, USA jarunstadler@ucdaviseduFAU - Runstadler, J A
Abstract: This study used Finnish juvenile idiopathic arthritis (JIA) probands with pauciarticular and rheumatoid factor (RF) negative polyarticular subtypes of JIA to further define the genetic susceptibility to JIA. We examined 16 markers spanning an 18 cM region of chromosome 6 encompassing the MHC and surrounding genomic region in a set of 235 Finnish JIA nuclear families and 639 Finnish control individuals. Analysis by case/control association and transmission disequilibrium test (TDT) methods each demonstrated strong evidence for a susceptibility locus near the D6S2447 microsatellite (P<10(-6) for both methods) that is flanked by DQB1 and DRB1. Analysis of the DRB1 locus suggested that DRB1*0801 and DRB1*1101 rather than DQA1 or other HLA alleles may be responsible for conferring susceptibility to disease. These findings are consistent with the most compelling results of previous reports on HLA associations and suggest a JIA DRB1 shared epitope encompassing critical amino-acid residues in the third hypervariable region of this molecule. Most importantly, in pauciarticular patients, the strong association does not extend to proximal markers as it does in polyarticular patients (P<0.00001). Analysis strongly suggests that the difference is because of additional JIA susceptibility loci within the MHC being present in polyarticular RF negative patients
RYSAVA R, SPICKA I, MERTA M, TESAR V, TRNENY M: Is current treatment of primary and secondary amyloidosis effective?
JE SOUCASNA LECBA PRIMARNI A SEKUNDARNI AMYLOIDOZY UCINNA? Casopis Lekaru Ceskych (Czech Republic ) 142:6 370-372, 2003
Abstract: Background. Retrospective study about results of treatment of patients (pts) with primary (AL) and secondary (AA) amyloidosis is given. 31 pts with systemic forms of amyloidosis have been treated and followed-up in our department since 1993. Methods and Results. 6 men and 11 women were in the AL group with the mean age of 59 years. Multiple myeloma was diagnosed in 9 pts, monoclonal gammapathy of undetermined significance (MGUS) was found in 8 pts. The kidneys were affected in all pts, heart in 59% of pts, liver, joints and skin in 26% of pts and polyneuropathy was detected only in 1 pt. Progression of renal insufficiency with decrease of glomerular filtration rate (GFR) was detected in the AL group at the end of follow-up period compared with the initial level (p<0.05) despite the intensive treatment. The difference did not reach statistical significance in other investigated parameters. Median of survival was 13 months from the assessment of diagnosis. Partial remission of amyloidosis was achieved in 9 pts, stable disease was in 5 pts and in 3 pts the disease progressed. 4 men and 10 women were in the AA group with mean age of 58 years. Underlying disease was rheumatoid arthritis in 7 pts, ankylosing spondylitis in 2 pts, juvenile chronic arthritis in 1 pt, Crohn's disease in 2 pts, eosinophilic fasciitis in 1 pt and chronic abscesses in NK cell deficiency in 1 pt. The kidneys were affected in all pts, bowels and heart in 36% of pts. GFR (p<0.05) and plasma creatinine (p<0.01) significantly decreased at the end of follow-up period compared with initial levels. Median of survival was 30 months. Partial remission was achieved in 2 pts, stable disease was in 3 pts and progression was detected in 9 pts despite the use of various treatment regimens. Conclusions. Both forms of systemic amyloidosis represent severe disease with limited response to treatment. The use of new drugs is promising and could lead to better response to treatment
SELVAAG AM, FLATO B, LIEN G, SORSKAAR D, VINJE O, FORRE O: Measuring health status in early juvenile idiopathic arthritis: determinants and responsiveness of the child health questionnaire. J Rheumatol 30:7 1602-1610, 2003
Organism: Department of Rheumatology, Rikshospitalet University Hospital, Oslo, Norway annemaritselvaag@rikshospitaletnoFAU - Selvaag, Anne M
Abstract: OBJECTIVE: To assess the determinants and responsiveness of the Norwegian version of the Child Health Questionnaire (CHQ) in patients with early juvenile idiopathic arthritis (JIA) and to compare health status in patients and controls. METHODS: A total of 116 children (median age 8.4 yrs) with JIA and < 2.5 years of disease duration (median 11.0 mo) were examined by a pediatric rheumatologist and reassessed after a median of 10.0 months. Physical and psychosocial health were assessed by means of the CHQ, which provides summary scores for physical and psychosocial health, the Childhood Health Assessment Questionnaire (CHAQ), and the Child Behavior Checklist (CBCL, n = 32). Matched controls (n = 116), randomly selected from the general population, completed the CHQ at baseline. RESULTS: The patients with JIA had poorer physical health and slightly impaired psychosocial health compared with the controls [41.2 +/- 13.6 vs 55.2 +/- 7.3 (p < 0.001) and 51.0 +/- 7.5 vs 54.1 +/- 5.7 (p = 0.002), respectively]. The most important determinants of the CHQ physical summary score were the child's pain, morning stiffness, the CHAQ disability index, erythrocyte sedimentation rate (ESR), overall well-being, and physician's global assessment of disease activity. The psychosocial summary score correlated with the CBCL level of internalizing, externalizing, and total behavior problems. The standardized response mean for the physical summary score was large (0.96) for those who improved, and moderate (-0.60) for those who became worse. CONCLUSION: The CHQ discriminated between patients with early JIA and controls. The most important determinants of the CHQ physical summary score were the child's pain, morning stiffness, CHAQ, ESR, overall well-being, and physician's global assessment of disease activity. The CHQ was sensitive to clinical changes in children with JIA
SMERDEL A, LIE BA, FINHOLT C, PLOSKI RAFAL_(A), FORRE O, UNDLIEN DE, THORSBY E: An additional gene in the HLA class I region confers risk for juvenile idiopathic arthritis on the DR5 and DR6 haplotypes. Genes and Immunity 4:Supplement 1 S5, 2003
SMOLEWSKA E, BROZIK H, SMOLEWSKI P, BIERNACKA-ZIELINSKA M, DARZYNKIEWICZ Z, STANCZYK J: Apoptosis of peripheral blood lymphocytes in patients with juvenile idiopathic arthritis. Ann Rheum Dis 62:8 761-763, 2003
Organism: Department of Paediatric Cardiology, Institute of Paediatrics, Medical University of Lodz, Poland piotr_smolewski@wpplFAU - Smolewska, E
Abstract: BACKGROUND: Recent data suggested that abnormalities in mechanisms regulating apoptosis may have a role in the development of the rheumatoid process. OBJECTIVE: To evaluate different aspects of apoptosis in children with juvenile idiopathic arthritis (JIA). METHODS: The frequency of TUNEL positive peripheral blood (PB) lymphocytes (apoptotic index (AI)), as well as serum CD95 (APO1/Fas) antigen expression and serum levels of sFas and interleukin 15 (IL15), were examined in 44 cases of JIA. Results were correlated with type of onset, activity of JIA, and acute phase indicators. RESULTS: The AI of lymphocytes was significantly higher in patients with JIA than in controls (p=0.020). The mean AI of lymphocytes was increased in JIA with systemic type of onset and high activity (p=0.001). Moreover, IL15 levels in systemic disease were higher than in controls (p=0.012). An increased AI correlated with raised IL15 (p=0.046), erythrocyte sedimentation rate (p=0.005) and C reactive protein (CRP; p=0.017). Additionally, correlation was found between IL15 and CRP levels (p=0.039). CD95 and sFas levels were unchanged compared with controls. CONCLUSION: PB lymphocytes of children with JIA have an increased tendency to undergo apoptosis. The degree of apoptosis depends on the type of onset and activity of JIA and correlates with serum levels of IL15. Further studies are needed to explain whether this is an epiphenomenon of the disease activity or is related to the pathogenesis of JIA
STATHOPULU E, BAILDAM E: Gower's sign in children with juvenile idiopathic arthritis. Rheumatology (Oxford) 42:8 1002-1003, 2003
TAKKEN T, VAN DER NJ, HELDERS PJM: Relationship between functional ability and physical fitness in juvenile idiopathic arthritis patients. Scandinavian Journal of Rheumatology (Norway ) 32:3 174-178, 2003
Abstract: Objective: To determine the relationship between aerobic and anaerobic physical fitness and functional ability in children with juvenile idiopathic arthritis (JIA). Methods: Eighteen children with JIA (age 7 to 14 yr., 3 male/15 female) performed a maximal aerobic exercise test and a Wingate anaerobic exercise test. Functional ability was concurrently assessed using the Childhood Health Assessment Questionnaire (CHAQ). Results: A low relationship between aerobic fitness and functional ability was found (r=0.0 to 0.4, p>0.05, except for eating r=0.46, p<0.05). The correlations between anaerobic physical fitness and functional ability in JIA patients were strong (r=0.5 to 0.75, p<0.05). This indicated a good relationship between anaerobic fitness and functional ability. Conclusion: The strong association between anaerobic physical fitness and functional ability showed the importance of anaerobic physical fitness for children with JIA
TAKKEN T, VAN DER NJ, KUIS W, HELDERS PJ: Aquatic fitness training for children with juvenile idiopathic arthritis. Rheumatology (Oxford) 42:11 1408-1414, 2003
Abstract: OBJECTIVE: To evaluate the effects of an aquatic training programme for JIA patients. METHODS: Fifty-four patients with JIA (age range 5 to 13 yr) participated in this study and were randomized into an experimental (n = 27) and a control (n = 27) group. The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions. Effects were analysed on the following domains: functional ability, health-related quality of life, joint status and physical fitness. RESULTS: Although all measures improved more in the experimental group than the control group, none of the differences was statistically significant. CONCLUSIONS: The current research found no significant effect of an aquatic fitness training programme in children with JIA. Since there were no signs of worsening in health status, one can conclude that this was a safe exercise programme
THOMAS J, JONES G, SCARINCI I, BRANTLEY P: A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care 26:8 2311-2317, 2003
Organism: Mayo Clinic, Nicotine Dependence Center, Rochester, Minnesota 55905, USA thomasjanet@mayoeduFAU - Thomas, Janet
Abstract: OBJECTIVE: To determine whether type 2 diabetes contributes to the presence of depressive and anxiety disorder diagnoses in low-income adults with hypertension, asthma, and/or arthritis. RESEARCH DESIGN AND METHODS: Using a cross-sectional design, this study administered a structured diagnostic interview to low-income primary care patients diagnosed with type 2 diabetes, hypertension, arthritis, and asthma, as well as to those with no chronic illness (n = 326), to determine the 12-month prevalence of depressive and anxiety disorders. A logistic regression (LR) model was used to assess whether a diagnosis of depression and/or anxiety was associated with type 2 diabetes after adjusting for known risk factors. RESULTS: A high prevalence rate of depressive and/or anxiety disorders was found in the total sample (29%) and in all three illness groups: type 2 diabetes (36%), other chronic illnesses (24%), and no chronic illness (31%). Using LR, a main effect was detected for illness group when age and education were controlled (chi(2) = 22.66, df 4, P = 0.000). Specifically, the odds of occurrence of a depressive and/or anxiety disorder in those with comorbid type 2 diabetes were twice that in the nondiabetic, chronically ill comparison group (odds ratio 2.26, 95% CI 1.28-4.01, P = 0.005). CONCLUSIONS: These results suggest a positive contribution of type 2 diabetes to increased rates of depressive and/or anxiety disorders in patients with hypertension, asthma, and/or arthritis and support prior research that type 2 diabetes may serve as an indicator of depression and anxiety in low-income adults treated in primary care clinics
TRULLEMANS F, SENESAEL J, SCHOTS R: Intense immune suppression and hematopoietic stem cell transplantation for severe autoimmune disease: Current status
INTENSIEVE IMMUNOSUPPRESSIE EN STAMCELTRANSPLANTATIE VOOR ERNSTIGE AUTO-IMMUUNZIEKTEN: STAND VAN ZAKEN. Tijdschrift voor Geneeskunde (Belgium ) 59:13 859-868, 2003
Abstract: Several phase II studies have demonstrated the feasibility of high-dose immunosuppression followed by autologous stem cell rescue as a treatment strategy for severe autoimmune diseases. Disease stabilisation or remission was observed in 20-60% of patients with advanced multiple sclerosis, rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus and juvenile chronic arthritis. The transplant-related mortality of 5-15% constituted a limiting factor and was mostly due to infectious complications. The results of this approach are likely to be improved by a more adequate patient selection and a refinement of stem cell mobilization and conditioning regimens according to the underlying disease type. Prospective, randomized studies with long-term follow-up are required to define the place of autologous stem cell transplantation in the treatment of severe autoimmune disorders
VON LANDENBERG P, LEHMANN HW, KNOLL A, DORSCH S, MODROW S: Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with parvovirus B19 infection. Arthritis Rheum 48:7 1939-1947, 2003
Organism: Klinik and Poliklinik fur Innere Medizin I, Universitatsklinikum Regensburg, Regensburg, GermanyFAU - Von Landenberg, Philipp
Abstract: OBJECTIVE: To show a possible association between parvovirus B19 infection and the presence of antiphospholipid antibodies (aPL) in patients with rheumatic diseases. METHODS: Serum samples obtained from 88 children with various forms of juvenile rheumatic disease and from 40 adults with systemic lupus erythematosus, the antiphospholipid syndrome, or other rheumatic disease, who had previously been tested and shown to be positive for IgG aPL, were analyzed for the presence of B19 DNA, for antibodies against the B19 viral proteins VP1, VP2, and NS1, and for IgG aPL (anticardiolipin, anti-beta(2)-glycoprotein I, and antiphosphatidylserine). As controls, serum samples obtained from 135 children with noninflammatory bone diseases or growth retardation were also analyzed. RESULTS: Twenty-four (27%) of the 88 children with rheumatic diseases had detectable amounts of IgG aPL. Fourteen (58%) of these 24 IgG aPL-positive patients showed IgG against VP1/VP2 and viral genomes, indicating the presence of acute (2 patients) or persistent (12 patients) infection. Past parvovirus B19 infection was identified in 7 (29%) of 24 IgG aPL-positive children, as indicated by VP1/VP2-specific IgG in the absence of viral DNA. Three (12%) of 24 IgG aPL-positive children had not been infected with B19. Sixty-nine (51%) of 135 control children displayed VP1/VP2-specific IgG. Three (2%) of these 135 children were IgG aPL positive (2 children had past parvovirus B19 infection, and 1 was negative for parvovirus B19). Analysis of the parvovirus B19 status of 40 adult IgG aPL-positive patients showed that 33 (83%) were anti-IgG VP1/VP2-positive, and viral DNA was detected in 11 patients (28%). Ten of these 11 viremic patients were in the subgroup of 28 IgG aPL-positive SLE patients. CONCLUSION: Antiphospholipid antibodies are preferentially found in serum of children with juvenile idiopathic arthritis who have been previously infected with parvovirus B19 and have established, persistent infection. Adult patients with IgG aPL positivity have a high incidence of persistent parvovirus B19 infection. We conclude that parvovirus B19 might be directly involved in the elicitation of autoimmune reactions partly mediated by aPL
WELBURY RR, THOMASON JM, FITZGERALD JL, STEEN IN, FOSTER HE: Type and extent of enamel defects in juvenile idiopathic arthritis (JIA). Eur J Paediatr Dent 3:4 217-221, 2002
Organism: Glasgow Dental Hospital and School, University of Glasgow and North Glasgow NHS Trust, GlasgowFAU - Welbury, R R
Abstract: AIM: To establish whether there is an increased prevalence and extent of enamel defects associated with Juvenile Idiopathic Arthritis (JIA) in patients in the North of England. STUDY DESIGN: clinical examination of subjects and age and sex matched controls. METHODS: The labial surfaces of all erupted permanent teeth in subjects, as well as age and sex matched controls, were examined. They were classified for type and extent of defects according to the Modified DDE index. The records of 146 subjects and 142 controls were available for analysis. STATISTICS: defects were expressed as the percentage of subjects or controls with or without any defects or specific types of defect. Fisher's exact test was used to compare the prevalence of disease in the two groups with significance being accepted at the 5% level. In addition, 95% confidence intervals for the relative risk of disease in the two groups were derived. RESULTS: There was no significant difference between subjects and controls for the presence of any type of defect (p=0.48), demarcated opacities (p=0.39), diffuse opacities (p=0.71), or hypoplasias (p=0.19). There was no significant increase in severity of defects in subjects compared with controls. There was also no significant difference when comparing the group diagnosed before the age of 4 (0-3) and the group diagnosed after the age of 4 (>4) years. CONCLUSION: There was no greater overall prevalence of enamel defects or specific type of defects and no greater extent of them in subjects with JIA compared with age and sex matched controls
WIECHENS B, REICHELT JA, URBAT C, NOLLE B: Pars plana vitrectomy in cystoid macular edema of different forms of chronic uveitis
PARS-PLANA-VITREKTOMIE BEI ZYSTOIDEM MAKULAODEM BEI VERSCHIEDENEN FORMEN DER CHRONISCHEN UVEITIS. Ophthalmologe (Germany ) 100:1 33-43, 2003
Abstract: Background. Cystoid macular edema (CME) is a common complication in different forms of chronic uveitis. In spite of immunosuppressive and anti-inflammatory therapy, chronic or relapsing courses can occur which may have a negative impact on visual prognosis. Pars plana vitrectomy (PPV) is known to positively influence chronic uveitis. This retrospective study was performed to investigate the role of PPV in the therapy refractive uveitic CME. Patients and methods. PPV for CME was performed in eyes with CME in intermediate uveitis (IMU, n=42), chronic iridocyclitis in juvenile rheumatoid arthritis (CIC, n=14) and multifocal chorioretinitis (MFC, n=12). In none of the eyes had immunosuppressive and/or anti-inflammatory therapy or antiedema treatment (e.g. acetazolamide) led to regression of the CME. After a postoperative follow-up period of 7 and 106 months all patients were re-examined. Results. Postoperative complete or partial regression of CME was observed as follows: IMU: 25/42 (59.5%), CIC: 8/14 (57.1%), MFC: 5/12 (41.7%). A significant increase in visual acuity of 2 lines and more was observed in 50%, 71.4% and 41.7% of eyes, respectively. In the long-term follow-up best functional results were achieved in eyes with IMU. Conclusions. Response to PPV was variable according to the type of underlying form of uveitis. The lowest success rate could be observed in eyes with MFC. Although the postoperative regression rate of CME was satisfactory in eyes with CIC, long-term visual acuity results were disappointing due to secondary complications of CIC in this young age group. Best results were achieved in patients with IMU (statistically not significant). A multicenter study in a larger series of patients is needed to investigate the exact role of PPV in different forms of chronic uveitis
YOKOTA S: [Cytokines and transitional progression of diseases]. Nihon Rinsho Meneki Gakkai Kaishi 26:3 96-102, 2003
ZENG X, AI M, TIAN X, GAN X, SHI Y, SONG Q, TANG F: Diagnostic value of anti-cyclic citrullinated Peptide antibody in patients with rheumatoid arthritis. J Rheumatol 30:7 1451-1455, 2003
Organism: Department of Rheumatology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, Beijing, ChinaFAU - Zeng, Xiaofeng
Abstract: OBJECTIVE: To explore the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) detected by ELISA in patients with rheumatoid arthritis (RA). METHODS: The synthesized cyclic citrullinated peptide was used as substrate for ELISA. Anti-CCP antibody was detected by ELISA in 191 patients with RA, 132 with rheumatic diseases other than RA, and 98 with nonrheumatic diseases. The antiperinuclear factor (APF), anti-keratin antibody (AKA), rheumatoid factor (RF), and HLA-DR4 gene complex were also tested in each RA patient. The results of these tests were compared with anti-CCP antibody to examine the correlation between them. RESULTS: Ninety (47.1%) patients with RA, 4 (3.0%) with other rheumatic diseases, and 2 (2.0%) with nonrheumatic diseases were found to be anti-CCP antibody positive by ELISA. The sensitivity of anti-CCP antibody was 47.1%, with a high specificity (97.4%) in RA. Anti-CCP antibody correlated with APF, AKA, RF, and HLA-DR4 gene complex. CONCLUSION: A new modified anti-CCP antibody test had a moderate sensitivity (47.1%) but a high specificity (97.4%) in patients with RA and was found as a valuable supplement to diagnosis of RA. Anti-CCP correlated with APF, AKA, RF, and HLA-DR4 gene complex, but did not completely overlap with them. Anti-CCP antibody could be regarded as a new diagnostic marker for RA