Bibliography July 04- ALTUN S, KASAPCOPUR O, ASLAN M, KARAARSLAN S, KOKSAL V, SARIBAS S, ERGIN S, ARISOY N, KOCAZEYBEK B: Is there any relationship between Chlamydophila pneumoniae infection and juvenile idiopathic arthritis? J Med Microbiol 53:Pt 8 787-790, 2004
Organism: Departments of Microbiology and Clinical Microbiology and Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, TurkeyFAU - Altun, Sibel
Abstract: The role of Chlamydophila pneumoniae in the development and exacerbation of juvenile idiopathic arthritis (JIA) was investigated. Blood samples were taken from 60 JIA patients during an active disease period and for 4 weeks after. Synovial fluid samples were obtained from 20 of the 60 patients. In addition, 22 patients with familial Mediterranean fever (FMF) during the active period and 35 healthy children were included in the study as control groups. Synovial fluid samples were also obtained from three children with FMF. IgG, IgM and IgA levels against C. pneumoniae in serum samples were studied by immunofluorescence and IgG antibody and PCR studies were performed for C. pneumoniae DNA in synovial fluid samples. Twenty-nine (48.3 %) patients with JIA, 18 (81.8 %) patients with FMF and 22 (62.8 %) healthy children were found to be pre-infected with C. pneumoniae. Pre-infection with C. pneumoniae among FMF patients was found to be significantly higher than among those with JIA. We did not find a significant difference between JIA patients and healthy children. Chronic C. pneumoniae infection was observed only in six JIA patients, one FMF patient and two healthy children. Synovial fluid antibodies were found at higher than 1/512-fold dilution in one JIA patient and four times higher than normal serum in three JIA patients. C. pneumoniae DNA was not detected in any synovial fluid sample from FMF or JIA patients by PCR. In conclusion, C. pneumoniae infection does not have a triggering or a progressive effect on the clinical situation in JIA aetiopathogenesis, as a result of a multifactorial aetiology. New, extensive and serial studies (especially PCR studies of synovial tissue) are needed in order to confirm the indirect results - ANDRADE R, MOYA-MACHADO A, GOMEZ-CONDE S, GARCIA-ESPINOSA A, MOLINA-DIAZ M, MACHADO-ROJAS A, GONZALEZ-RODRIGUEZ I: Neuropathies due to vasculitis in infancy
NEUROPATIAS POR VASCULITIS EN LA INFANCIA. Revista de Neurologia (Spain ) 38:7 619-624, 2004
Abstract: Introduction. Vasculitis are characterised by the inflammatory infiltrate, chiefly of mononuclear cells, in the walls of the blood vessels, which can lead to occlusion with necrosis and the subsequent infarction of the affected tissue. Aims. The objective of this study was to determine the clinical, anatomicopathological and neurophysiological aspects of vasculitic neuropathies in infancy. Patients and methods. Each patient was submitted to the following tests: a complete hemogram, systemic lupus erythematosus cells, lupus anticoagulant, antinuclear antibodies, neutrophil anticytoplasmic antibodies, venereal disease research laboratory test, erythrocyte sedimentation rate, liver transaminases, serological testing for hepatitis C, B and A, cytochemical study of the cerebrospinal fluid, study of motor and sensory conduction, electromyography and nuclear magnetic resonance, when required; a biopsy of the sural nerve was performed, which was replaced by a necropsy if the patient died. Results. 15 patients from a total of 25 who were studied had vasculitic neuropathies; the most usual presentation was multiple mononeuropathy; aetiologies found included microscopic polyangiitis, systemic lupus erythematosus, juvenile rheumatoid arthritis, overlap syndrome and several undetermined vasculitis. Of the patients who were submitted to a biopsy, 75% showed signs of vasculitis, which affected the small and medium-sized vessels in 62.5% of patients. Conclusions. The presence of neuropathy in association with symptoms and signs of systemic involvement suggested the possibility of a neuropathy in the course of a vasculitis. The examination of biopsy specimens of the sural nerve is useful for the diagnosis and classification of the aetiology of vasculitis. Response to treatment with immunosuppressant drugs was good, both in the case of the neuropathy and of the underlying disease - ANTON J: Introduction to the treatment of juvenile idiopathic arthritis
INTRODUCCIO AL TRACTMENT DE L'ARTRITIS IDIOPATICA JUVENIL. Pediatria Catalana (Spain ) 64:SUPPL. 1 S9-S15, 2004 - BECHTOLD S, RIPPERGER P, BONFIG W, SCHMIDT H, BITTERLING H, HAFNER R, SCHWARZ HP: Bone mass development and bone metabolism in juvenile idiopathic arthritis: treatment with growth hormone for 4 years. J Rheumatol 31:7 1407-1412, 2004
Organism: Endocrine Division, University Children's Hospital, Dr von Haunersches Kinderspital, Lindwurmstrasse 4, 80337 Munich, Germany SusanneBechtold@meduni-muenchendeFAU - Bechtold, Susanne
Abstract: OBJECTIVE: To study the acquisition of bone mass and changes in bone mineral density (BMD) related to age, bone age, pubertal status, and growth hormone (GH) therapy in 11 children with juvenile idiopathic arthritis (JIA) longitudinally over 4 years, in comparison to healthy children. METHODS: Bone mineral content (BMC), BMD, and vertebral area were measured by dual energy x-ray absorptiometry. Since BMC and BMD increase with size, BMD was converted to volumetric BMD (vBMD) after adjustment for vertebral size. RESULTS: At inclusion all patients (7 female, 4 male, mean age 10.3 +/- 2.1 yrs) had low BMD, with a mean z-score for area BMD (aBMD) of -2.04 +/- 0.8 SD. After adjustment for size, vBMD was 0.198 g/cm3, and after 4 years of GH treatment it increased significantly to 0.232 g/cm3 (p < 0.03), expressed as SD scores that increased from -2.97 +/- 0.81 SD to -2.83 +/- 0.67 SD. In relation to bone age, vBMD SD increased from -2.53 +/- 0.85 to -2.41 +/- 0.79. Compared to pretreatment values, bone formation and resorption markers increased significantly during treatment. CONCLUSION: Our results reflect an increase in bone turnover under GH therapy in these patients. Despite biochemical changes there was a stabilization of vBMD for age and bone age, with a percentage increase comparable to healthy children. Longterm GH treatment will be necessary to evaluate a potential positive effect of GH on bone density and metabolism in patients with JIA - BENNETT AN, PETERSON P, SANGLE S, HANGARTNER R, ABBS IC, HUGHES G R V, D'CRUZ DP: Adult onset Still's disease and collapsing glomerulopathy: successful treatment with intravenous immunoglobulins and mycophenolate mofetil. Rheumatology (Oxford) 43:6 795-799, 2004
Abstract: In this Grand Round we present a 32-yr-old African man who became severely ill after a 5-month history of weight loss, pyrexia, arthralgia, sweats and rash. He went on to develop pericarditis, pericardial effusion with tamponade, hepatomegaly with abnormal liver function tests, lymphadenopathy, massive proteinuria and required ventilatory, circulatory and renal support. The differential diagnosis was adult onset Still's disease, systemic lupus erythematosus (SLE), infection and lymphoma. Primary infection and lymphoma were excluded and he was treated, with dramatic success, with intravenous immunoglobulins (IVIG). Subsequent renal biopsy excluded SLE but confirmed collapsing glomerulopathy. The proteinuria improved dramatically following treatment with mycophenolate mofetil. We discuss some of the difficult diagnostic and management issues raised by this patient and the different uses and mechanisms of action of IVIG - BROSTROM E, HAGELBERG S, HAGLUND-AKERLIND Y: Effect of joint injections in children with juvenile idiopathic arthritis: Evaluation by 3D-gait analysis. Acta Paediatr International Journal of Paediatrics (Norway ), 93:7 906-910, 2004
Abstract: Aim: To investigate how gait patterns change after intra-articular corticosteroid injections (ICIs) in the lower extremities. Methods: Eighteen children, aged 5-16 y, with juvenile idiopathic arthritis (JIA) and lower extremity involvement participated in the study. Sixty-four joints in the lower extremities were treated with ICIs. The Visual Analogue Scale (VAS, 0-100 mm) was used to assess pain. A 3D motion analysis system and two force plates were used to measure gait parameters, kinematics and kinetics. The first gait analysis was performed before treatment with ICIs, and a second one was done 8-17 d after treatment. Results: The participants' average rating of pain decreased from 26 mm on the VAS before ICI to 11 mm (p = 0.001) after treatment. The self-chosen walking velocity was significantly faster (p = 0.02) after treatment. The range of knee and ankle joint angles during gait increased significantly (p = 0.03 and 0.04) after treatment. At loading response, the hip extension moment increased (p = 0.01) as did knee flexion moment, and plantar flexion moment at pre-swing increased significantly (p = 0.02 and 0.002) after treatment. The ankle also generated more power (p = 0.005) after treatment. Conclusion: The study shows positive effects of treatment with ICIs in the lower extremities - especially regarding pain, walking velocity and joint moments. The data indicate that ICI treatment influences the gait pattern also in joints that have not been injected - CAO D, VOLLENHOVEN RR, KLARESKOG L, TROLLMO C, MALMSTROM V: CD25brightCD4+ regulatory T cells are enriched in inflamed joints of patients with chronic rheumatic disease. Arthritis Res Ther 6:4 R335-R346, 2004
Organism: Rheumatology Unit, Department of Medicine at Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden viviannemalmstrom@cmmkiseFAU - Cao, Duojia
Abstract: CD25+CD4+ regulatory T cells participate in the regulation of immune responses. We recently demonstrated the presence of CD25brightCD4+ regulatory T cells with a capacity to control T cell proliferation in the joints of patients with rheumatoid arthritis. Here, we investigate a possible accumulation of these regulatory T cells in the inflamed joint of different rheumatic diseases including rheumatoid arthritis. The studies are also extended to analyze whether cytokine production can be suppressed by the regulatory T cells. Synovial fluid and peripheral blood samples were obtained during relapse from 36 patients with spondyloarthropathies, 21 adults with juvenile idiopathic arthritis and 135 patients with rheumatoid arthritis, and the frequency of CD25brightCD4+ T cells was determined. Of 192 patients, 182 demonstrated a higher frequency of CD25brightCD4+ T cells in synovial fluid than in peripheral blood. In comparison with healthy subjects, the patients had significantly fewer CD25brightCD4+ T cells in peripheral blood. For functional studies, synovial fluid cells from eight patients were sorted by flow cytometry, and the suppressive capacity of the CD25brightCD4+ T cells was determined in in vitro cocultures. The CD25brightCD4+ T cells suppressed the production of both type 1 and 2 cytokines including interleukin-17, as well as proliferation, independently of diagnosis. Thus, irrespective of the inflammatory joint disease investigated, CD25brightCD4+ T cells were reduced in peripheral blood and enriched in the joint, suggesting an active recruitment of regulatory T cells to the affected joint. Their capacity to suppress both proliferation and cytokine secretion might contribute to a dampening of local inflammatory processes - CHEN CC, YANG YH, LIN YT, HSIEH SL, CHIANG BL: Soluble decoy receptor 3: increased levels in atopic patients. J Allergy Clin Immunol 114:1 195-197, 2004
- CHEN Y-S, YANG Y-H, LIN Y-T, CHIANG B-L: A patient diagnosed with pauciarticular juvenile rheumatoid arthritis after a mechanical prosthetic valve replacement due to aortic regurgitation. Journal of Microbiology Immunology and Infection (Taiwan ), 37:3 200-202, 2004
Abstract: Valvular heart disease is a rare complication of juvenile rheumatoid arthritis (JRA), with most cases associated with polyarticular JRA. The aortic valve is most commonly affected, and valvular involvement occurs months or years after the onset of JRA. Reported cases of valvular heart disease in patients with JRA in a pauciarticular pattern are rare. We report a case of severe aortic insufficiency in a 12-year-old boy who underwent aortic valve replacement before diagnosis of JRA with a pauciarticular pattern - CHIRA P, SANDBORG C: Adolescent rheumatology transitional care: steps to bringing health policy into practice. Rheumatology (Oxford) 43:6 687-689, 2004
- CHUNG MH, LEE HG, KWON SS, PARK SH, KIM KJ, JUNG JI, SUNG MS, YOO WJ: Airway obstruction in rheumatoid arthritis: CT manifestations, correlated with pulmonary function testing. Yonsei Med J 45:3 443-452, 2004
Organism: Department of Radiology, Holy Family Hospital, The Catholic University of Korea, 2, Sosa-dong, Wonmi-gu, Pucheon-si, Kyunggi-do, Korea mhchung@catholicackrFAU - Chung, Myung Hee
Abstract: In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF(25-75%)) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF(25-75% ) (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only - DUGGAL L, BHARIJA SC, VASDEV N: Connective tissue lipoatrophic panniculitis. J Assoc Physicians India 51:632-3.: 632-633, 2003
Organism: Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110 060FAU - Duggal, L
Abstract: A 23 years old girl with a past history of sero-positive oligoarticular juvenile idiopathic arthritis developed nodules and depressed scars over face and limbs. Biopsy from the lesion revealed mixed panniculitis. She responded to steroids and hydroxychloroquine but has residual lipoatrophic scars needing reconstructive surgery - GRIGOR C, CAPELL H, STIRLING A, MCMAHON AD, LOCK P, VALLANCE R, KINCAID W, PORTER D: Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364:9430 263-269, 2004
Organism: Gartnavel General Hospital, Glasgow G12 0YN, UKFAU - Grigor, Catriona
Abstract: BACKGROUND: Present treatment strategies for rheumatoid arthritis include use of disease-modifying antirheumatic drugs, but a minority of patients achieve a good response. We aimed to test the hypothesis that an improved outcome can be achieved by employing a strategy of intensive outpatient management of patients with rheumatoid arthritis--for sustained, tight control of disease activity--compared with routine outpatient care. METHODS: We designed a single-blind, randomised controlled trial in two teaching hospitals. We screened 183 patients for inclusion. 111 were randomly allocated either intensive management or routine care. Primary outcome measures were mean fall in disease activity score and proportion of patients with a good response (defined as a disease activity score <2.4 and a fall in this score from baseline by >1.2). Analysis was by intention-to-treat. FINDINGS: One patient withdrew after randomisation and seven dropped out during the study. Mean fall in disease activity score was greater in the intensive group than in the routine group (-3.5 vs -1.9, difference 1.6 [95% CI 1.1-2.1], p<0.0001). Compared with routine care, patients treated intensively were more likely to have a good response (definition, 45/55 [82%] vs 24/55 [44%], odds ratio 5.8 [95% CI 2.4-13.9], p<0.0001) or be in remission (disease activity score <1.6; 36/55 [65%] vs 9/55 [16%], 9.7 [3.9-23.9], p<0.0001). Three patients assigned routine care and one allocated intensive management died during the study; none was judged attributable to treatment. INTERPRETATION: A strategy of intensive outpatient management of rheumatoid arthritis substantially improves disease activity, radiographic disease progression, physical function, and quality of life at no additional cost - HEINZMANN A, GERHOLD K, GANTER K, KURZ T, SCHUCHMANN L, KEITZER R, BERNER R, DEICHMANN KA: Association study of polymorphisms within interleukin-18 in juvenile idiopathic arthritis and bronchial asthma. Allergy 59:8 845-849, 2004
Organism: University Children's Hospital, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, GermanyFAU - Heinzmann, A
Abstract: BACKGROUND: Interleukin-18 (IL-18) plays an important role in the regulation of TH1 as well as TH2 immunologic responses and thus in the development of chronic inflammatory diseases. Positive association studies of polymorphisms in IL-18 with different diseases have underlined the involvement of IL-18 in the pathogenetics processes. Our interest was to test polymorphisms of IL-18 for association with a typical TH1-mediated disease--juvenile idiopathic arthritis--and the TH2-mediated disease bronchial asthma in Caucasian children. METHODS: We genotyped five polymorphisms that were in association with chronic inflammatory diseases (-607C, -137C, 113G, 127T, and -133G). This was performed by restriction fragment length polymorphism in populations of asthmatic children, control individuals, and children with antinuclear antibodies (ANA)-positive juvenile idiopathic arthritis. Statistical analysis was performed by the Armitage trend test; haplotypes were calculated by the Arlequine program. RESULTS: No significant association was found between any single nucleotide polymorphism or any haplotype and bronchial asthma or ANA-positive juvenile idiopathic arthritis. CONCLUSION: We conclude that the effect of IL-18 in the immunologic context of diseases like bronchial asthma or juvenile arthritis might be too complex to be reflected in a simple one-way association study. Furthermore, the polymorphisms under investigation might be nonfunctional - HUANG C-M, YANG Y-H, CHIANG B-L: Different familial association patterns of autoimmune diseases between juvenile-onset systemic lupus erythematosus and juvenile rheumatoid arthritis. Journal of Microbiology Immunology and Infection (Taiwan ), 37:2 88-94, 2004
Abstract: The aim of this study was to determine if the prevalence of autoimmune disorders in the relatives of patients with systemic lupus erythematosus (SLE) is greater than that of relatives of patients with juvenile rheumatoid arthritis (JRA). Interviews were used to obtain histories of the following autoimmune disorders among living or deceased first-, second-, and third-degree relatives of 91 SLE and 110 JRA families: ankylosing spondylitis, SLE, rheumatoid arthritis (RA), JRA, multiple sclerosis, juvenile dermatomyositis, Sjogren's syndrome, myasthenia gravis, psoriasis, and thyroid diseases. There were statistically significant differences between the SLE and JRA probands in mean age and gender ratio (19.1 +/- 4.8 vs 14.0 +/- 5.5 years; M (male)/F (female): 17/74 vs 62/48, p<0.005). The prevalence rate of autoimmune diseases in relatives of SLE families (20.9%) was greater than in JRA families (11.8%), but not statistically significantly so. The mean age (18.0 +/- 5.3 vs 14.0 +/- 4.3 years), mean age at diagnosis (13.4 +/- 4.3 vs 7.9 +/- 3.9 years) and gender ratio (F/M, 16/3 vs 5/8) of the patients with affected relatives between these 2 groups all had statistically significant differences. A higher prevalence of SLE in relatives was found in SLE families than in JRA cases. Furthermore, this study revealed a higher incidence of autoimmune disorders among second- and third-degree relatives of SLE or JRA probands versus first-degree ones, especially sisters (including 1 pair of twins) and the maternal aunt in SLE families. These data demonstrate that the prevalence of autoimmune disorders in the relatives of patients with SLE is greater than those of relatives of patients with JRA. This suggests that clinically different autoimmune phenotypes may share common susceptibility genes, which may act as risk factors for autoimmunity - KOSMALA E, KOROBOWICZ A, OLESINSKA E: Personal adjustment of girls with juvenile idiopathic arthritis
PSYCHOLOGICZNE ASPEKTY FUNKCJONOWANIA DZIEWCZAT Z Ml(stroke)ODZIENCZYM IDIOPATYCZNYM ZAPALENIEM STAWOW. Przeglad Pediatryczny (Poland ) 34:1 26-31, 2004
Abstract: Juvenile idiopathic arthritis /JIA/ is a chronic disease with spontaneous exacerbations and remissions, and requires complex diagnostic and therapeutic management. This disease is a source of difficult situations for patients and affects the emotional sphere and social relations. The social support is of special importance in the adaptation of patients with JIA. It reduces negative psychological consequences of stress. The present study describes the problem of the influence of the disease on the psychosocial adjustment of girls with JIA. The examination included 50 girls aged 12-18 years, treated in the Dept. of Paediatrics, Pulmonary Diseases and Rheumatology, University Children's Hospital, Medical University of Lublin. The patients had to fill in the Questionnaire. It included information on difficult situations connected with the disease, and on the importance of social support in coping with the disease. It contains questions about the disease influence on different psychological spheres (ex. family relations, peer relations, life-plan realization) and about emotions related to the disease. Our results suggest that the disease is of greater influence on emotional sphere then social adaptation of girls with JIA. Fear, sadness and distress were predominant negative emotions (69%) and among positive (31%): hope. We conclude that social support and psychological intervention must be an integral part of management to achieve success and improve the quality of life for individuals with JIA - LESCAUT W, BROCQ O, ALBERT C, PLUBEL Y, FLORY P, EULLER-ZIEGLER L: [Juvenile idiopathic polyarthritis in monozygotic twins with congenital C4 deficiency]. Rev Med Interne 25:8 604-606, 2004
- LYBACK CO, LEHTO MU, HAMALAINEN MM, BELT EA: Patellar resurfacing reduces pain after TKA for juvenile rheumatoid arthritis. Clin Orthop423 152-156, 2004
Organism: Porvoo District Hospital, Porvoo, FinlandFAU - Lyback, C O
Abstract: Influence of patellar resurfacing after knee replacement and the frequency of patella infera and its relation to the postoperative appearance of the knee pain were assessed in patients with juvenile rheumatoid arthritis. Seventy-seven total knee arthroplasties using the AGC prosthesis with nonconstrained components were done on 52 patients with a mean followup of 7.3 years (range, 3-13 years). Anterior knee pain was present in 14 of 30 patients (47%) with an unreplaced patella and in two of 18 patients (11%) with patella resurfacing. The patella was replaced in 18 patients (35%) and in 23 of 77 knees (30%). Neither revision surgery of implanted patellar components nor any later resurfacing of an unreplaced patella were done during the followup. Preoperatively using the Insall-Salvati ratio, the majority of knees (54 of 77) had a low-riding patella. Patella infera occurred commonly in patients with juvenile rheumatoid arthritis. No connection between patella infera and anterior knee pain was found - MAENO N, TAKEI S, FUJIKAWA S, YAMADA YUJI, IMANAKA H, HOKONOHARA M, KAWANO Y, ODA H: Antiagalactosyl IgG antibodies in juvenile idiopathic arthritis, juvenile onset Sjogren's syndrome, and healthy children. Rinsho Ganka 31:6 1211-1217, 2004
Abstract: Objective. To determine the normal range of antiagalactosyl IgG antibodies in healthy children, and to investigate the utility of determination of antiagalactosyl IgG antibodies in patients with juvenile idiopathic arthritis (JIA) and juvenile onset Sjbgren's syndrome (SS). Methods. Serum concentrations of antiagalactosyl IgG antibodies were measured in 225 healthy children, 68 patients with JIA (systemic arthritis in 21, polyarthritis in 29, oligoarthritis in 18), and 15 patients with juvenile onset SS, using a lectin-enzyme immunoassay employing prepared human agalactosyl IgG as antigen. A comparison was made between the, prevalence and utility of antiagalactosyl IgG antibodies in patients and those of conventional rheumatoid factors (RF) determined by laser nephelometry. Results. The average serum concentration of antiagalactosyl IgG antibodies for healthy controls was 2.41 +/- 0.93 arbitrary units (AU)/ml, and the cutoff value of the normal range was set at 4.3 AU/ml (mean + 2 SD). As a result, antiagalactosyl IgG antibodies were positive in 25 (37%) of 68 patients with JIA, and 14 (93%) of 15 patients with juvenile onset SS, in whom values were much higher than the frequencies of RF positivity. The serum concentrations of antiagalactosyl IgG antibodies in patients were closely correlated with those of RF. Thirteen patients with JIA and 6 patients with juvenile onset SS were positive for antiagalactosyl IgG antibodies despite being negative for R.F. With regard to prognosis during followup periods of at least 5 years, JIA patients positive for antiagalactosyl IgG antibodies, even if negative for RF, were resistant to treatment. However, positivity for antiagalactosyl IgG antibodies had no relation to joint destruction. Conclusion. Our data suggest that antiagalactosyl IgG antibodies, compared with RF, show higher sensitivity to detect immunological disorders in JIA and juvenile onset SS - MANOLOVA IM: Anti-lactoferrin antibodies in patients with connective tissue diseases. Folia Med (Plovdiv) 45:4 25-30, 2003
Organism: Laboratory of Clinical Immunology, Department of Molecular Biology, Immunology and Medical Genetics, Faculty of Medicine, Thracian University, Stara Zagora, BulgariaFAU - Manolova, Irena M
Abstract: AIM: To study the prevalence of antineutrophil cytoplasmic antibodies against lactoferrin in patients with connective tissue diseases and to characterize the antibody response to lactoferrin in these patients. METHODS: Sera from 60 patients with systemic lupus erythematosus, 98 with rheumatoid arthritis, 11 with systemic sclerosis, and 6 with mixed connective tissue disease were studied. The presence of anti-lactoferrin antibodies was detected by enzyme-linked immunosorbent assay. The IgG subclass reactivity of antibodies to lactoferrin was analyzed by biotin-extravidin amplified enzyme-linked immunosorbent assay and monoclonal antibodies to human IgG subclasses. RESULTS: Anti-lactoferrin antibodies were found in 15 patients (5 patients with rheumatoid arthritis and 10 with systemic lupus erythematosus). IgG1 was the predominant subclass for antibodies to lactoferrin. CONCLUSION: Patients with connective tissue diseases are known to develop multiple auto-antibodies; anti-lactoferrin antibodies mainly of IgG1 isotype can also be found in patients with rheumatoid arthritis and more often in patients with systemic lupus erythematosus - MCGHEE JL, KICKINGBIRD LM, JARVIS JN: Clinical utility of antinuclear antibody tests in children. BMC Pediatr 4:1 13, 2004
Organism: Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK, USA julie-mcghee@ouhsceduFAU - McGhee, Julie L
Abstract: BACKGROUND: Antinuclear antibody (ANA) tests are frequently used to screen children for chronic inflammatory diseases such as systemic lupus erythematosus (SLE). However, the diagnostic utility of this test is limited because of the large number of healthy children who have low-titer positive tests. We sought to determine the clinical utility of ANA tests in screening children for rheumatic disease and to determine whether there are specific signs or symptoms that enhance the clinical utility of ANA tests in children. METHODS: We undertook a retrospective analysis of 509 new patient referrals. Charts of patients referred because of results of ANA testing were selected for further analysis. Children with JRA, SLE, and other conditions were compared using demographic data, chief complaints at the time of presentation, and ANA titers. RESULTS: One hundred ten patients were referred because of an ANA test interpreted as positive. Ten patients were subsequently diagnosed with SLE. In addition, we identified one patient with mixed connective tissue disease, and an additional child with idiopathic Raynaud's phenomenon. Eighteen children of the children referred for a positive ANA test had juvenile rheumatoid arthritis (JRA). Another 80 children with positive ANA tests were identified, the majority of whom (n = 39, 49%) had musculoskeletal pain syndromes. Neither the presence nor the titer of ANA served to distinguish children with JRA from children with other musculoskeletal conditions. Children with JRA were readily identified on the basis of the history and physical examination. Children with SLE were therefore compared with children with positive ANA tests who did not have JRA, designated the "comparison group." Non-urticarial rash was more common in children with SLE than in children without chronic inflammatory disease (p = 0.007). Children with SLE were also older (mean +/- sd = 14.2 +/- 2.5 years) than the comparison group (11.0 +/- 3.6 years; p = 0.001). ANA titer was also a significant discriminator between children with SLE and children without chronic inflammatory disease. The median ANA titer in children with SLE was 1: 1,080 compared with 1:160 for other children (p < 0.0001). ANA titers of >/=1,080 had a positive predictive value for SLE of 1.0 while titers of </=1: 360 had a negative predictive value for lupus of 0.84. CONCLUSION: Age and ANA titer assist in discriminating children with SLE from children with other conditions. ANA tests are of no diagnostic utility in either making or excluding the diagnosis of JRA - MCINNES IB, GRACIE JA: Interleukin-15: a new cytokine target for the treatment of inflammatory diseases. Curr Opin Pharmacol 4:4 392-397, 2004
Organism: Centre for Rheumatic Diseases, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK ibmcinnes@clinmedglaacukFAU - McInnes, Iain B
Abstract: Interleukin (IL)-15 is a pleiotropic pro-inflammatory cytokine that is expressed in several inflammatory disorders, including rheumatoid arthritis, psoriasis and pulmonary inflammatory diseases. IL-15 promotes activation of T cells, neutrophils and macrophages, and is critical to dendritic cell function in several model systems. Recent emerging data suggest that IL-15 may serve as a useful therapeutic target across a range of disease states. Advances in the past year highlight the beneficial effect of IL-15 neutralisation in models of psoriasis and diabetes. Further evidence for IL-15 expression and effector function has emerged across a range of rheumatic disorders, including juvenile inflammatory arthritis, rheumatoid arthritis and Kawasaki disease. These data hold promise for therapeutic targeting in ongoing human studies and those in the near future - MODESTO C: Concept and classification of juvenile idiopathic arthritis
CONCEPTE I CLASSIFICACIO DE L'ARTRITIS IDIOPATICA JUVENIL. Pediatria Catalana (Spain ) 64:SUPPL. 1 S6-S8, 2004 - MUTA T, YAMANO Y: Fulminant hemophagocytic syndrome with a high interferon gamma level diagnosed as macrophage activation syndrome. Int J Hematol 79:5 484-487, 2004
Organism: Department of Internal Medicine, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan TsuyoshiMuta@ma8seikyounejpFAU - Muta, Tsuyoshi
Abstract: A 26-year-old woman presented with general fatigue, persistent fever, nuchal lymphadenitis, thrombocytopenia, and liver damage. From the bone marrow finding, we diagnosed her condition as hemophagocytic syndrome. Steroid pulse therapy, cyclosporin A treatment, and combined chemotherapy generated no response. The patient showed severe mucosal bleeding, rapidly experienced multiple organ failure, and finally died of a brain hemorrhage on the 13th hospital day. Epstein-Barr virus, cytomegalovirus, human herpes virus type 6, human parvovirus B19, and herpes simplex virus were not detected. Autopsied samples of the spleen, bone marrow, and liver showed extreme proliferation of activated macrophages, so-called histiocytes, without lymphoid malignancy. The interferon gamma level at presentation was prominently high. The continuously elevated levels of ferritin and soluble interleukin 2 receptor were correlated with the catastrophic outcome. The disease in our case mimicked infantile hemophagocytic lymphohistiocytosis. However, there was neither a family history of the disease nor a mutation in the perforin gene. So, it is reasonable to categorize our case as macrophage activation syndrome. Although our patient lacked arthritis or eruption, we cannot deny the possibility that an oligoarthritis type of systemic-onset juvenile rheumatoid arthritis or, considering the patient's age, adult-onset Still disease lies at the base of our case - NISHIMOTO N, KISHIMOTO T: Inhibition of IL-6 for the treatment of inflammatory diseases. Curr Opin Pharmacol 4:4 386-391, 2004
Organism: Laboratory of Immune Regulation, Graduate School of Frontier Biosciences, Osaka University, 1-3 Yamada-oka, Suita-City, Osaka, 565-0871, Japan norihiro@fbsosaka-uacjpFAU - Nishimoto, Norihiro
Abstract: Interleukin-6 (IL-6) is a pleiotropic cytokine with various biological activities. Deregulated overproduction of IL-6 has been found to play pathological roles in chronic inflammatory diseases such as rheumatoid arthritis, Castleman's disease, juvenile idiopathic arthritis and Crohn's disease. Humanized anti-IL-6 receptor antibody has been developed as a therapeutic agent for these diseases, and therapeutic benefits have been revealed in clinical studies - POKHARNA RK, KABRA PK, SHARMA R, KOCHAR DK: Extraintestinal manifestations of idiopathic ulcerative colitis in northwestern India. Indian J Gastroenterol 23:3 89-90, 2004
Organism: Departments of Gastroenterology, Medicine, and Physical Medicine and Rehabilitation, S P Medical College, Bikaner, Rajasthan rkpokharna2@rediffmailcomFAU - Pokharna, R K
Abstract: OBJECTIVE: To determine the frequency of extraintestinal manifestations in patients with idiopathic ulcerative colitis. METHODS: 46 patients underwent detailed clinical, biochemical and radiological evaluation. RESULTS: One patient (2%) had peripheral arthritis and two patients (4%) had ocular involvement in the form of anterior uveitis. No patient had mucocutaneous, vascular, or hepatobiliary manifestations, or sacroiliitis. CONCLUSIONS: The frequency of extraintestinal manifestations in patients with IUC in northwestern India is low - PORTER P, STONE MH: Total hip arthroplasty using the Wroblewski golf ball cup inserted through the posterior approach. A high rate of dislocation. J Bone Joint Surg Br 86:5 643-647, 2004
Organism: Department of Orthopaedics, Leeds General Infirmary, Leeds, EnglandFAU - Porter, P
Abstract: The Wroblewski golf ball acetabular cup was introduced by surgeons using the trochanteric osteotomy approach for revision total hip replacement (THR) in order to reduce the rate of dislocation. We have routinely used the Ogee long posterior wall (Ogee LPW) and the Wroblewski angle bore cups in THR. Although the new Wroblewski golf ball cup performed well there was a significant early rate of dislocation of 20%. Our rate of dislocation over a period of ten years using the Ogee LPW and Wroblewski angle bore cups had been 0.52%. We present our findings and an investigation as to why the new cup has such a high rate of dislocation when used with the posterior approach. We show that a relatively small change in the design of the acetabular component resulted in significant adverse clinical results - RAJENDRAN CP, LEDGE SG, RANI KP, MADHAVAN R: Psoriatic arthritis. J Assoc Physicians India 51:1065-8.: 1065-1068, 2003
Organism: Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamil Nadu, IndiaFAU - Rajendran, C P
Abstract: AIM OF THE STUDY: To evaluate the clinical pattern of psoriatic arthritis in patients attending a tertiary referral centre in South India. METHODOLOGY: Case records of one hundred and sixteen patients with psoriatic arthritis (PsA) who had attended our Rheumatology Department were analysed using demographic, clinical, laboratory and radiographic variables and the data were compared with other studies. RESULTS: Among 116 patients, 78 were males and 38 were females (ratio 2:1). Peak incidence (69%) was in the fourth and fifth decades. One patient had juvenile psoriatic arthritis (onset <16 years of age). Symmetric polyarthritis (48.3%) was the commonest subtype. Arthritis followed the skin lesions in 50.8% of patients, preceded in 12.1% and occurred simultaneously in 37.1%. Knee (66.4%) was the commonest joint involved. Extra-articular features like sausage digits (19%), enthesitis (7.8%) and eye manifestations (1.7%) like conjunctivitis and uveitis were observed. Psoriasis vulgaris (81%) was the commonest psoriatic lesion. Scalp (57.8%) was the most common hidden site. All the three patients with DIP arthritis alone had nail lesions. ESR and C-reactive protein were elevated in 51.7% and 43.9% of patients respectively. Rheumatoid factor was positive in 3.4 % and antinuclear antibody (ANA) was present in 5.4% (3/56) of patients. HIV infection was detected in 2.3% (1/44) of patients. Radiographic features like sacroiliitis (11.2%), calcaneal spur (7.8%), erosions (5.2%) and syndesmophytes (5.2%) were observed. One patient had 'pencil-in-cup deformity'. CONCLUSION: Psoriatic arthritis is more common in males. Symmetric polyarthritis is the commonest subtype. Arthritis commonly follows the skin lesions. Psoriasis vulgaris is the most common skin lesion and scalp is the commonest hidden site. ESR and CRP can be normal in psoriatic arthritis - ROBERTSON L, DE BERKER D: Skin and bones - mind the gap. Rheumatology (Oxford) 43:6 690-691, 2004
- RUEMMELE FM, PRIEUR AM, TALBOTEC C, GOULET O, SCHMITZ J: Development of Crohn disease during anti-TNF-alpha therapy in a child with juvenile idiopathic arthritis. J Pediatr Gastroenterol Nutr 39:2 203-206, 2004
Organism: Paediatric Gastroenterology, Hepatology and Nutrition, Hopital Necker-Enfants Malades, Paris, France frankruemmele@nckap-hop-parisfrFAU - Ruemmele, F M - RUPERTO N, MURRAY KJ, GERLONI V, WULFFRAAT N, DE OLIVEIRA SK, FALCINI F, DOLEZALOVA P, ALESSIO M, BURGOS-VARGAS R, CORONA F, VESELY R, FOSTER H, DAVIDSON J, ZULIAN F, ASPLIN L, BAILDAM E, CONSUEGRA JG, OZDOGAN H, SAURENMANN R, JOOS R, PISTORIO A, WOO P, MARTINI A: A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum 50:7 2191-2201, 2004
Organism: IRCCS G Gaslini, University of Genoa, Genoa, Italy nicolaruperto@ospedale-gaslinigeitFAU - Ruperto, Nicolino
Abstract: OBJECTIVE: To compare the safety and efficacy of parenteral methotrexate (MTX) at an intermediate dosage (15 mg/m(2)/week) versus a higher dosage (30 mg/m(2)/week) in patients with polyarticular-course juvenile idiopathic arthritis (JIA) who failed to improve while receiving standard dosages of MTX (8-12.5 mg/m(2)/week). METHODS: In the screening phase, 595 patients who were newly started on a standard dose of MTX were followed up for 6 months. Subsequently, the nonresponders, defined according to the American College of Rheumatology (ACR) pediatric 30% improvement criteria (pediatric 30), were randomized to receive an intermediate dose or higher dose of parenteral MTX for an additional 6 months. Improvement in the screening and randomization phase was defined by the ACR pediatric 30 response, as well as by the 50% and 70% response levels (ACR pediatric 50 and ACR pediatric 70, respectively). RESULTS: In the screening phase, after receiving standard doses of MTX, 430 patients (72%) improved according to the ACR pediatric 30, while 360 (61%) met the ACR pediatric 50 and 225 (38%) met the ACR pediatric 70; among these patients, 69 (12%) also met the definition of complete disease control. Of the 133 nonresponders, 80 were randomized to receive an intermediate dose or higher dose of MTX. In the randomization phase, the ACR pediatric 30 response rate was 25 of 40 children (62.5%) in the intermediate-dose group versus 23 of 40 children (57.5%) in the higher-dose group. An ACR pediatric 50 response rate was attained by 23 patients (57.5%) receiving an intermediate dose versus 22 (55%) in the higher-dose group. An ACR pediatric 70 response rate was seen in 18 children (45%) receiving an intermediate dose versus 19 (47.5%) receiving a higher dose. Five children (12.5%) in the intermediate-dose group versus 4 (10%) receiving the higher dose of MTX also met the definition of complete disease control. None of the intergroup differences in response rate were significant. There were no significant differences in the frequency of adverse events or laboratory abnormalities between the 2 randomized groups. CONCLUSION: This study shows that the plateau of efficacy of MTX in JIA is reached with parenteral administration of 15 mg/m(2)/week and that a further increase in dosage is not associated with any additional therapeutic benefit. MTX should be administered for up to 9-12 months to appreciate its full therapeutic effect - SAHA MT, HAAPASAARI J, HANNULA S, SARNA S, LENKO HL: Growth hormone is effective in the treatment of severe growth retardation in children with juvenile chronic arthritis. Double blind placebo-controlled followup study. J Rheumatol 31:7 1413-1417, 2004
Organism: Tampere University Hospital, Department of Paediatrics, PO Box 2000, FIN 33521 Tampere, FinlandFAU - Saha, Marja-Terttu
Abstract: OBJECTIVE: To assess the efficacy of growth hormone (GH) treatment in severe growth retardation in prepubertal children with juvenile chronic arthritis (JCA). METHODS: In a randomized, double-blind placebo-controlled study, we treated 25 prepubertal children (7 boys, 18 girls, mean age 9.0 yrs) with severe growth retardation due to JCA with human recombinant GH (6 months) and placebo (6 months). RESULTS: A significant response to GH treatment, compared with placebo, was seen in most children. The median height velocity standard deviation score was +2.09 (range -7.18 to +9.49) during the 6 month period of GH therapy and -1.11 (range -10.00 to +1.11) during placebo treatment (p = 0.0002). The median height standard deviation score increased from -2.08 to -1.79 during GH treatment and from -2.18 to -2.02 during placebo (p = 0.0268). All children except one completed the study, showing high compliance. The treatment was well tolerated, and no significant alterations in the disease activity were recorded during the study. CONCLUSION: We conclude that human recombinant GH may be of benefit in the treatment of severe growth retardation in children with JCA. The response was seen after only 6 months and was independent of initial growth hormone status of the child - SAVAGE MO, CAMACHO-HUBNER C, DUNGER DB: Therapeutic applications of the insulin-like growth factors. Growth Horm IGF Res 14:4 301-308, 2004
Organism: Research Centre in Clinical and Molecular Endocrinology, William Harvey Research Institute, Queen Mary's School of Medicine and Dentistry, Queen Mary's, University of London, London, UK mosavage@qmulacukFAU - Savage, Martin O
Abstract: The potential therapeutic applications of the insulin-like growth factors (IGFs) are broad. This review focuses on treatment of humans with recombinant human IGF-I (rhIGF-I), and with a rhIGF-I/IGF binding protein-3 (IGFBP-3) complex. Several groups of patients have been treated effectively, including individuals with growth hormone insensitivity syndrome (GHIS) secondary to GH receptor deficiency, to IGF-I gene deletion, or to defects in GH signal transduction pathways, patients with type 1 and type 2 diabetes mellitus, or individuals with severe insulin resistance syndromes. In each of these conditions rhIGF-I therapy has been demonstrated to be of clear clinical benefit. Other conditions, which may potential targets for therapy with rhIGF-I or rhIGF-I/IGFBP-3, include chronic inflammatory or nutritional disorders such as Crohn's disease, juvenile chronic arthritis, or cystic fibrosis. Therapy with IGFs has not been attempted in these disorders yet, in part because of lack of adequate supplies. Recently, the newly developed rhIGF-I/IGFBP-3 complex has been used in early clinical studies. Pharmacokinetic analyses in patients with diabetes mellitus and GHIS have suggested that a more physiological profile of serum IGF-I results. Improved glycaemic control has been reported in type 1 and type 2 diabetes in adults. A therapeutic trial in naive children with GHIS is currently under way - SCHWARTZMAN S, FLEISCHMANN R, MORGAN GJ, JR.: Do anti-TNF agents have equal efficacy in patients with rheumatoid arthritis? Arthritis Res Ther 6 Suppl 2:S3-S11. Epub@2004 Jun 21.: S3-S11, 2004
Organism: Hospital for Special Surgery, New York, NY, USA schwartzmans@hsseduFAU - Schwartzman, Sergio
Abstract: Tumor necrosis factor (TNF) antagonists have dramatically improved the outcomes of rheumatoid arthritis (RA). Three agents currently available in the USA - infliximab, etanercept, and adalimumab - have been designed to modify the biologic effects of TNF. Infliximab and adalimumab are monoclonal antibodies, and etanercept is a soluble protein. The pharmacokinetic and pharmacodynamic properties of each differs significantly from those of the others. All three agents are effective and safe, and can improve the quality of life in patients with RA. Although no direct comparisons are available, clinical trials provide evidence that can be used to evaluate the comparative efficacy of these agents. Infliximab, in combination with methotrexate, has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, prevent joint erosions and joint-space narrowing, and improve physical function for up to 2 years. Etanercept has been shown to relieve the signs and symptoms of RA, decrease total joint score progression, and slow the rate of joint destruction, and might improve physical function. Etanercept is approved with and without methotrexate for patients who have demonstrated an incomplete response to therapy with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs), as well as for first-line therapy in early RA, psoriatic arthritis, and juvenile RA. Adalimumab relieves the signs and symptoms of RA with and without methotrexate and other DMARDs, decreases total joint score progression, prevents joint erosions and joint-space narrowing in combination with methotrexate, and might improve physical function. When selecting a TNF antagonist, rheumatologists should weigh evidence and experience with specific agents before a decision is made for use in therapy - SHAW KL, SOUTHWOOD TR, MCDONAGH JE: User perpectives of transitional care for adolescents with juvenile idiopathic arthritis. Rheumatology (United Kingdom ) 43:6 770-778, 2004
Abstract: Objectives. To gain insight into the transitional needs of adolescents with juvenile idiopathic arthritis (JIA) and to examine how these needs may be addressed within a structured programme of transitional care. Methods. A qualitative study using focused group discussions was performed. Groups comprised (i) adolescents with JIA aged 12-18 yr, (ii) young adults with JIA aged 19-30 yr, (iii) parents of adolescents with JIA, and (iv) parents of young adults with JIA. Results. Transitional needs included aspects of participants' physical, social, psychological and vocational lives. Participants (n = 55) called for developmentally appropriate care based upon shared decision-making, continuity of health professionals, and wider access to information and community services. Suggestions for improved care included individualized assessment of patient's holistic needs and increased transfer preparation. Conclusions. These results provide a useful guide to transitional care and suggest an approach that is adolescent-focused and evidence-based. (c) British Society for Rheumatology 2004; all rights reserved - SPIEWAK R, STOJEK NM, CHMIELEWSKA-BADORA J: Antinuclear antibodies are not increased in the early phase of Borrelia infection. Ann Agric Environ Med 11:1 145-148, 2004
Organism: Instytut Medycyny Wsi, ul Jaczewskiego 2, 20-090 Lublin, Poland spiewak@galenimwlublinplFAU - Spiewak, Radoslaw
Abstract: In the literature, there are case reports suggesting that Borrelia burgdorferi infection may induce autoimmune diseases dependent on antinuclear antibodies (ANA). The present study was undertaken in order to verify this possibility in a prospective manner. The study group comprised 78 consecutive patients (51 women and 27 men, median age 41.5 years) referred to our Department for the serologic diagnosis of Borrelia infection. The patients' sera were tested for Borrelia-specific IgM and IgG (Recombinant Antigen Enzyme Immunoassays, Biomedica). Antibodies against Borrelia were detected in 31 (39.7 %) persons. 15 persons (19.2 %) had positive IgM, another 15 (19.2 %)--positive IgG, and 1 person (3.2 %)--both IgM and IgG. Frequent positivity of IgM antibodies suggests that persons in the early phase of infection prevailed in the group. Tests for anti-dsDNA, anti-RNP, anti-Sm antibodies, and a screening test for systemic rheumatic diseases (ANA Rheuma Screen) were carried out using Varelisa Enzyme Immunoassays (Pharmacia and Upjohn). The spectrum of autoimmune diseases covered by these tests included SLE, MCTD, Sjogren's syndrome, scleroderma, polymyositis, and dermatomyositis. ANA were detected in 15 persons (19.2 %): anti-dsDNA in 7 (9.0 %), anti-RNP in 1 (1.3 %), anti-Sm in 2 (2.6 %), and ANA Rheuma Screen was positive in 6 persons (7.7 %). Statistical analysis of differences in the ANA frequency between Borrelia-positive and -negative groups was carried out using Fisher's exact chi-square test (both without and with gender and age matching). No significant differences were found between the groups. Based on the above results, we conclude that there is no increase in the frequency of antinuclear antibodies in the early phase of Borrelia infection - SU EP, KAHN B, FIGGIE MP: Total ankle replacement in patients with rheumatoid arthritis. Clin Orthop424 32-38, 2004
Organism: Hospital for Special Surgery-Weill Medical College of Cornell University, 535 East 70th Street, New York City, NY 10021, USAFAU - Su, Edwin P
Abstract: Patients with rheumatoid arthritis commonly experience involvement of the ankle and hindfoot. Severe pain and functional limitations may develop as a result of tibiotalar arthritis, requiring surgical treatment. The advantages of total ankle arthroplasty over ankle arthrodesis include preservation of motion and decreased stresses on the midfoot and subtalar joints. Previous experience with early design ankle replacements revealed high complication rates and as much as 75% of component loosening. Modern ankle implants have been designed to achieve uncemented fixation with less articular constraint. Patients with rheumatoid arthritis who had total ankle replacement using two different types of second-generation ankle implants were examined clinically and radiographically. The average postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 81 of a possible 100, at a mean of 6.4 years after surgery. Radiographically, 88.5% of implants were stable without evidence of subsidence at a mean of 6.3 years. Three tibial components had subsided at an average of 7 years. There was evidence of tibial osteolysis with the Buechel Pappas Low Contact Stress implant in 11.5% of patients. Total ankle replacement in patients with rheumatoid arthritis, using a second-generation prosthesis, can provide reliable relief of pain and good functional results at intermediate-term followup, although the incidence of osteolysis warrants close followup - TAGIL M, REIMERTZ J, ELBORGH R, KOPYLOV P: Intravenous regional administration of corticosteroids in juvenile chronic arthritis. Acta Orthop Scand 75:3 352-354, 2004
Organism: Hand and Upper Extremity Unit, Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden magnustagil@ortluseFAU - Tagil, Magnus
Abstract: BACKGROUND: Treatment of juvenile chronic arthritis patients with longstanding multiple joint or tendon involvement that is resistant to medication remains a challenge. For 20 years, we have been treating these severely ill patients with intravenous regional glucocorticoids (a modified Bier's block). PATIENTS AND METHODS: Since 1996, all juvenile chronic arthritis patients have been followed prospectively by an occupational therapist who has registered the grip strength and range of motion at an average of 6 months after treatment. RESULTS: In 22/40 wrists and hands, increased grip strength was recorded. The mean grip strength increased for the whole group from 47 to 59 N and the flexion lag decreased. INTERPRETATION: The effect of intravenous regional steroid treatment may be limited from a long-term perspective, but in our series, half of the patients showed a considerable improvement after 6 months. Surgical synovectomy can be postponed and perhaps even be omitted - TAGIL M, REIMERTZ J, ELBORGH R, KOPYLOV P: Intravenous regional administration of corticosteroids in juvenile chronic arthritis. Acta Orthopaedica Scandinavica (Norway ) 75:3 352-354, 2004
Abstract: Background: Treatment of juvenile chronic arthritis patients with longstanding multiple joint or tendon involvement that is resistant to medication remains a challenge. For 20 years, we have been treating these severely ill patients with intravenous regional glucocorticoids (a modified Bier's block). Patients and methods: Since 1996, all juvenile chronic arthritis patients have been followed prospectively by an occupational therapist who has registered the grip strength and range of motion at an average of 6 months after treatment. Results: In 22/40 wrists and hands, increased grip strength was recorded. The mean grip strength increased for the whole group from 47 to 59 N and the flexion lag decreased. Interpretation: The effect of intravenous regional steroid treatment may be limited from a long-term perspective, but in our series, half of the patients showed a considerable improvement after 6 months. Surgical synovectomy can be postponed and perhaps even be omitted - TWILT M, MOBERS SM, ARENDS LR, TEN CATE R, SUIJLEKOM-SMIT L: Temporomandibular involvement in juvenile idiopathic arthritis. J Rheumatol 31:7 1418-1422, 2004
Organism: Department of Pediatrics, Sp 1545, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands mtwilt@erasmusmcnlFAU - Twilt, Marinka
Abstract: OBJECTIVE: To study occurrence as well as clinical signs and symptoms of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) in a population representing all subtypes of JIA. METHODS: Ninety-seven consecutive children with JIA underwent orthodontic evaluation including an orthopantomogram (OPG). Further evaluation included patient characteristics, disease onset, course, and medical treatment. RESULTS: Forty-five percent of all children had TMJ involvement. Frequencies according to JIA subtypes: systemic 67%, oligoarticular (persistent and extended) 39%, rheumatoid factor (RF) negative polyarticular 59%, RF positive polyarticular 33%, enthesitis related arthritis 13%, psoriatic arthritis 33%, and other arthritis 50%. In children with a polyarticular course, irrespective of their disease onset, TMJ involvement was more frequent (55% vs 31% in oligoarticular course). In children with disease onset at a young age and/or an extended course of the disease, TMJ involvement was also more frequent. Pain during jaw excursion, absence of translation, asymmetry during maximal opening and protrusion, as well as crepitation during evaluation are predictors for TMJ involvement with a good specificity but a low sensitivity. Not all patients with TMJ involvement have clinical signs. CONCLUSION: Because of the high prevalence and discrepancy between clinical signs and presence of arthritis of the TMJ, regular orthodontic evaluation and OPG is recommended to recognize TMJ involvement and enable early intervention - VAN GAALEN FA, VAN AKEN J, HUIZINGA TW, SCHREUDER GM, BREEDVELD FC, ZANELLI E, VAN VENROOIJ WJ, VERWEIJ CL, TOES RE, DE VRIES RR: Association between HLA class II genes and autoantibodies to cyclic citrullinated peptides (CCPs) influences the severity of rheumatoid arthritis. Arthritis Rheum 50:7 2113-2121, 2004
Organism: Leiden University Medical Center, Leiden, The Netherlands favan_gaalen@lumcnlFAU - van Gaalen, Floris A
Abstract: OBJECTIVE: The functional role of HLA class II molecules in the pathogenesis of rheumatoid arthritis (RA) is unclear. HLA class II molecules are involved in the interaction between T and B lymphocytes required for long-lived B cell responses and generation of high-affinity IgG antibodies. We undertook this study to investigate the relationship between HLA class II gene polymorphisms and RA-specific IgG antibodies against cyclic citrullinated peptides (anti-CCP antibodies). METHODS: High-resolution HLA-DR and DQ typing and anti-CCP-2 antibody testing were performed on 268 RA patients from the Early Arthritis Clinic cohort at the Department of Rheumatology of the Leiden University Medical Center. The presence of anti-CCP antibodies was analyzed in carriers of the different DR and DQ alleles. Disease progression was measured over a period of 4 years by scoring radiographs of the hands and feet using the Sharp/van der Heijde method. RESULTS: Carriership of the individual alleles HLA-DRB1*0401, DRB1*1001, DQB1*0302, and DQB1*0501 was associated with the presence of anti-CCP antibodies. Carriers of DQ-DR genotypes containing proposed RA susceptibility alleles were significantly more often anti-CCP antibody positive. Carriership of one or two HLA-DRB1 shared epitope (SE) alleles was significantly associated with production of anti-CCP antibodies (odds ratio [OR] 3.3, 95% confidence interval [95% CI] 1.8-6.0 and OR 13.3, 95% CI 4.6-40.4, respectively). An increased rate of joint destruction was observed in SE+, anti-CCP+ patients (mean Sharp score 7.6 points per year) compared with that in SE-, anti-CCP+ patients (2.4 points per year) (P = 0.04), SE+, anti-CCP- patients (1.6 points per year) (P < 0.001), and SE-, anti-CCP- patients (1.6 points per year) (P < 0.001). CONCLUSION: HLA class II RA susceptibility alleles are associated with production of anti-CCP antibodies. Moreover, more severe disease progression is found in RA patients with both anti-CCP antibodies and SE alleles - VAN RIJN RR, GROOTFAAM DS, LEQUIN MH, BOOT AM, VAN BEEK RD, HOP WC, VAN KUIJK C: Digital radiogrammetry of the hand in a pediatric and adolescent Dutch Caucasian population: normative data and measurements in children with inflammatory bowel disease and juvenile chronic arthritis. Calcif Tissue Int 74:4 342-350, 2004
Organism: Department of Radiology, Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands rrvanrijn@amcuvanlFAU - van Rijn, R R
Abstract: We have evaluated the applicability of a new Digital X-ray Radiogrammetry (DXR) system in a Dutch Caucasian pediatric population. For this study we enrolled 535 healthy participants who all signed an informed consent form. In addition, 20 children suffering from inflammatory bowel disease (IBD) and juvenile chronic arthritis (JCA) were enrolled. Radiographs of the left hand were obtained from all participants. From the healthy population a subset of children with a history of forearm fractures were separately analyzed. Measurements consisted of DXR (X-posure; Pronosco-Sectra, Linkoping, Sweden). Five hundred thirty-five subjects were enrolled in the study. Twenty-two subjects (4.3%) were discontinued (age 3-10 years), all because of a nonrecognizable radiograph by the DXR system. The short-term coefficient of variation of DXR in this population was 0.59%. Significant differences in DXR-BMD between boys and girls for the ages of 11, 12, 16, 17, and 18 years were found. There were also significant differences in DXR-BMD between the sequential Tanner stages. For 88 subjects repeat radiographs were available (mean interval 1.8 years). In all cases an increase in DXR-BMD was seen. Girls with IBD, JCA, or a history of forearm fractures and boys with IBD showed a significantly lower DXR-BMD compared with healthy controls. We show that DXR is an applicable technique in children. Also, in a small subpopulation it is possible to discriminate children with a high risk of low BMD - ZHOU X, ZHOU Z, JIN M, WANG H, WU M, SONG Y, CHENG H: Clinical study of qingluo tongbi granules in treating 63 patients with rheumatoid arthritis of the type of yin-deficiency and heat in collaterals. J Tradit Chin Med 24:2 83-87, 2004
Organism: The First Clinical Medicine College, Nanjing University of Traditional Chinese Medicine, No 282, Hanzhong Street, Nanjing, Jiangsu Province 210020FAU - Zhou, Xueping
Abstract: The study is to observe the therapeutic effects of qingluo tongbi granules (QTG) in patients with rheumatoid arthritis (RA) and the changes of immune indexes. In this series there are 63 patients with RA of the type of yin-deficiency and heat in collaterals treated with QTG as the treated group and 55 patients of the same type treated with Tripterygium glycosides as the control group. As a result, in the treated group, the curative rate is 9.52% and markedly effective rate 38.10%, with a total effective rate of 90.48%, while the corresponding rates in the control group are 0, 20.00% and 83.64%, respectively. The curative effect in the treated group is better than that in the control group (P<0.05). Besides, no obvious adverse reactions are found in the treated group. Therefore it is concluded that as a new medicinal preparation QTG is safe and effective in the treatment of RA - ZULIAN F, MARTINI G, GOBBER D, PLEBANI M, ZACCHELLO F, MANNERS P: Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology (Oxford) 43:10 1288-1291, 2004
Organism: Rheumatology Unit, Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padova, Italy zulian@pediatriaunipditFAU - Zulian, F
Abstract: OBJECTIVE: Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide (TA) is equivalent to that of triamcinolone hexacetonide (TH), if used at double the dosage. In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints, in children with juvenile idiopathic arthritis (JIA). METHOD: Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study. The symmetry was assessed by both clinical examination and synovial fluid analysis. The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA. The identity of injected compound was blinded to the patient and to the physician. RESULTS: Thirty-seven patients, 30 female, seven male, with JIA, entered the study. A total of 86 joints were injected. Twenty-one (53.8%) of the joints injected with TA relapsed first compared with only six (15.4%) of the joints injected with TH. In three (7.7%) relapse occurred simultaneously. Nine (23%) were still in remission after 24-month follow-up. The percentage of joints with lasting remission was higher with TH than with TA (80 vs 47.5% after 12 months and 63.6 vs 32.4% after 24 months, respectively; log rank test P = 0.003). CONCLUSION: Even when TA is given at higher doses, TH is more effective and should be considered the drug of choice for intra-articular treatment of JIA