Bibliography December 04- 14th Annual Meeting of the Arbeitsgemeinschaft fuer Kinder- und Jugendrheumatologie (Working Group for Pediatric and Adolescent Rheumatology), Berlin, Germany, June 12-13, 2004. Zeitschrift fuer Rheumatologie 63:3 260-275, 2004
Abstract: This meeting focuses on 6 rheumatoidal, urological and immunological topics within which there is 48 abstracts, 30 in German and 18 in English. The related diseases that are covered include: neonatal onset multisystem inflammatory disease, Takayasu arteritis, Cogan's syndrome, cryoglobulinemic vasculitis, lupus nephritis, systemic lupus erythematosus, mycophenolate mofetil, juvenile idiopathic arthritis, multifocal osteomyelitis, rheumatoid arthritis, Muckle-Wells syndrome, pseudoporphyria, Borrelia burgdorferi infection and Mediterranean fever. Pediatrics and the treatment and diagnosis of these diseases was the main focus of the meeting - 2004 Annual Meeting of the Finnish Society for Rheumatology, Helsinki, Finland, January 22-23, 2004. Scandinavian Journal Of Rheumatology 33:3 192-197, 2004
Abstract: This meeting contains 18 abstracts that focus on the clinical studies of rheumatoid arthritis (RA) in humans. Topics include a 5-year follow-up study on the frequency of remissions in early RA, a study of the predictive value of serum soluble interleukin-2 receptor in patients with refractory rheumatoid arthritis receiving infliximab, the efficacy and side effects of biological treatment of RA (based on data from a national database called ROB-FIN, Registry of Biological Treatment in Finland), the assessment of health related quality of life and disability levels in an outpatient population with RA, treatments for juvenile idiopathic arthritis (JIA), the safety and e fficacy of temporary epiphyseal stapling in management of leg length discrepancy and knee valgus deformity in children with JIA, and a comparison of five antinuclear antibody assays in patients with systemic lupus erythematosus (SLE) and other rheumatic diseases - ADAB P, RANKIN EC, WITNEY AG, MILES KA, BOWMAN S, KITAS GD, SITUNAYAKE D, BACON PA: Use of a corporate needs assessment to define the information requirements of an arthritis resource centre in Birmingham: comparison of patients' and professionals' views. Rheumatology (Oxford) 43:12 1513-1518, 2004
Organism: Department of Rheumatology, University Hospital Birmingham NHS Trust, Selly Oak, Birmingham B29 6JD, UKFAU - Adab, P
Abstract: OBJECTIVES: Education and information are important components of the management of chronic disease, though provision of these in the routine clinic setting may be suboptimal. We carried out a corporate needs assessment, both to evaluate stakeholders' perceived usefulness of potential facilities that could be offered by a community-based arthritis resource centre in Birmingham and to compare the views of patients with rheumatological conditions and health professionals. METHODS: Rheumatology patients (n = 201 responders/309 contacted) and health professionals (n = 232/430) were asked to complete a questionnaire to assess both current rheumatology service provision and perceived needs for further information that could be offered within the proposed resource centre. Views of patients and professionals were compared using odds ratios. Logistic regression analysis determined patient characteristics associated with perceived usefulness of various information types. RESULTS: The overall response rate was 58%. Most patients were currently receiving medication but only 38% received written information on arthritis. Over 80% of responders felt that more information would be useful, particularly information in written leaflets. Compared with professionals, patients gave higher value to certain types of medical, non-medical, support and skills information, particularly individual information from trained volunteers, and specific information on benefits, diet and alternative therapy, and symptom management. Non-Caucasian patients gave higher value to the provision of material in different languages and the availability of multilingual volunteer staff. CONCLUSION: Rheumatology patients and professionals identified a relative lack of information for patients. There was wide interest in the provision of more information, with value placed on the provision of material in different languages, at an educational resource centre. This work has been used to develop the facilities currently offered at the Birmingham Arthritis Resource Centre. Further research is needed to investigate the effectiveness of the provision of good quality information to patients with arthritis - ANDRE M, HAGELBERG S, STENSTROM CH: The juvenile arthritis foot disability index: development and evaluation of measurement properties. J Rheumatol 31:12 2488-2493, 2004
Organism: Physiotherapy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital-Solna, SE-171 76 Stockholm, Sweden marieandre@homeseFAU - Andre, Marie
Abstract: OBJECTIVE: To develop a new juvenile arthritis foot disability index (JAFI) and to test it for validity and reliability. METHODS: Samples of 14 children/adolescents and 30 children/adolescents with juvenile idiopathic arthritis (JIA) and 29 healthy children/adolescents participated. We used a questionnaire derived from the International Classification of Functioning, Disability and Health that included 27 statements divided into the dimensions Impairment, Activity Limitation, and Participation Restriction. Comments on the contents were invited from parents and adolescents. Convergent and divergent construct validity was examined by comparing the 3 JAFI dimensions to joint impairment scores, the Childhood Health Assessment Questionnaire (CHAQ), and self-rated, foot-related participation restriction. Known groups construct validity was assessed by comparing answers from children with JIA to those from healthy children. Test-retest stability was investigated over one week. RESULTS: One item was added after suggestions from 2 participants. A consistent pattern of increasing JAFI scores was found with increasing joint impairment scores, CHAQ scores, and self-rated foot-related participation restriction. Foot-related disability as assessed by JAFI was more pronounced in children with JIA than in healthy controls. One statement showing a floor effect was excluded. No internal redundancy (rs > 0.90) between items was found, and internal consistency within each subscale was satisfactory (rs > 0.50) for all items but one. No systematic differences were found between test and retest, and weighted kappa coefficients for the 3 JAFI dimensions were 0.90, 0.85, and 0.88. CONCLUSION: The JAFI appears to be valid and reliable for assessing foot-related disability among children/adolescents with JIA. Its sensitivity to change remains to be investigated - APPENZELLER S, COSTALLAT LT: Clinical implications of migraine in systemic lupus erythematosus: relation to cumulative organ damage. Cephalalgia 24:12 1024-1030, 2004
Organism: Unit of Rheumatology, Department of Internal Medicine State University of Campinas Faculty of Medical Sciences, Campinas, Brazil appenzel@unicampbrFAU - Appenzeller, S
Abstract: The aim of this study was to determine the clinical implications of migraine in systemic lupus erythematosus (SLE) using the cumulative organ damage scores (SLICC-DI). Eighty SLE, 40 rheumatoid arthritis (RA) patients and 40 controls (non SLE, nor RA out-patients), all women, were included. Migraine was defined according to the International Headache Society (IHS) criteria for neuropsychiatric SLE. Disease activity was measured by MEX-SLEDAI and cumulative organ damage by SLICC-DI. Statistics were obtained by Chi-square and Fischer's exact tests. anova was used for comparing means. Migraine was identified in 42.5% of SLE patients, compared to 12.5% of RA patients (P < 0.05) and 10.0% (P < 0.05) in the control group. In the SLE group, a significant association between migraine and Raynaud's phenomenon (P = 0.003, OR = 10.1; 95%CI 2.9-35) and antiphospholipid antibodies (P = 0.0012; OR = 7.5; 95%CI 2.5-22.9) was noted. SLE patients with active migraine had higher MEX-SLEDAI scores than SLE patients without migraine. SLE patients with past history of migraine had significantly higher SLICC scores than SLE patients without migraine. History of migraine was associated with greater organ damage. Active migraine was associated with higher disease activity, antiphospholipid antibodies and worsening of Raynaud's phenomenon. The increased cumulative organ damage in SLE patients with past history of migraine justifies the routine evaluation of migraine in clinical practice - BAEK HJ, SHIN KC, LEE YJ, KANG SW, LEE EB, YOO CD, SONG YW: Clinical features of adult-onset ankylosing spondylitis in Korean patients: patients with peripheral joint disease (PJD) have less severe spinal disease course than those without PJD. Rheumatology (Oxford) 43:12 1526-1531, 2004
Organism: Department of Internal Medicine, Seoul National University Hospital, 28 Yungon-dong, Chongno-gu, Seoul 110-744, KoreaFAU - Baek, H J
Abstract: OBJECTIVE: We investigated the clinical features of Korean patients with adult-onset ankylosing spondylitis (AAS) and examined the differences between AAS patients with and without peripheral joint disease (PJD). METHODS: We studied 67 consecutive patients with primary AAS who visited the rheumatology clinic of a tertiary referral hospital. All patients experienced joint symptoms after the age of 15 and fulfilled the modified New York criteria for ankylosing spondylitis. Hips and shoulders were not considered as peripheral joints. RESULTS: The male-to-female ratio was 8.6:1.0. Mean age at disease onset was 22.3 +/- 5.5 (mean +/- s.d.) yr and disease duration was 10.8 +/- 8.0 yr. Spinal symptoms were the first manifestations in 80.6% of patients. During the disease course, hip, shoulder and peripheral joint involvement were found in about 60% of patients. In patients with PJD, the most commonly affected joints were the knees and ankles. The pattern of PJD, in most cases, was asymmetrical and mono/oligoarticular. AAS patients with PJD had fewer spinal symptoms than those without PJD as a presenting feature (71.8 vs 92.9%, P = 0.035). The modified Schober test showed greater increments in patients with PJD (4.9 +/- 2.4 vs 3.0 +/- 2.4 cm, P = 0.002). Forced vital capacity was better in patients with PJD (79.0 +/- 11.4 vs 70.8 +/- 15.5% of predicted value, P = 0.016). Totally ankylosed sacroiliitis, spinal squaring and syndesmophytes on radiographs were less common in the patients with PJD than in those without PJD (33.3 vs 64.2%, P = 0.012; 20.5 vs 67.9%, P = 0.000; and 38.5 vs 71.4%, P = 0.008, respectively). CONCLUSION: Peripheral joints as well as shoulder and hip joints were more frequently involved during the disease course in Korean AAS patients compared with earlier reports in Caucasians. The general joint involvement pattern of PJD was similar to patterns reported previously. Our data suggest that, clinically and radiographically, AAS patients with PJD have a less severe spinal disease course than those without PJD - BARRON AC, LEE TL, TAYLOR J, MOORE T, PASSO MH, GRAHAM TB, GRIFFIN TA, GROM AA, LOVELL DJ, BRUNNER HI: Feasibility and construct validity of the parent willingness-to-pay technique for children with juvenile idiopathic arthritis. Arthritis Rheum 51:6 899-908, 2004
Organism: Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USAFAU - Barron, Andrea C
Abstract: OBJECTIVE: To assess the feasibility and construct validity of the willingness-to-pay (WTP) technique for measuring health care preferences in families of children with juvenile idiopathic arthritis (JIA). METHODS: Parents were asked to estimate the monthly US dollar amount they would be willing to pay to obtain for their child the following hypothetical drugs: ARTHRO, which guarantees complete clinical response; and NO-STOM-ACHE, a drug that eliminates gastrointestinal (GI) symptoms. A yes/no question was used with random assignment of the starting bids. Parents who agreed to pay the starting bid were then asked whether they would be willing to pay 200% and then 400% of this initial bid. Socioeconomic data and information on medications, disease activity, patient physical function, wellbeing, and health-related quality of life (HRQOL) were obtained. RESULTS: Sixty-two families of children with JIA were interviewed. GI symptoms were present in 54%, and 53% of the children had joints with active arthritis or limited range of motion. Four parents (7%) were unwilling to pay anything for any of the studied medications. The mean amount (median; mean percentage of available family income) families were willing to pay was $395 ($300; 15%) for ARTHRO and $109 ($80; 4%) for NO-STOM-ACHE. Correlation and regression analysis supported that, adjusted for the available family income, the WTP for ARTHRO was associated with disease activity, pain, and the HRQOL of the patients. After correction for the starting bids and the available family income, the WTP for NO-STOM-ACHE was associated with the patient's HRQOL, pain, and the amount of GI discomfort. CONCLUSION: The WTP technique is feasible and has construct validity for measuring health care preferences for children with JIA. Relatively large WTP estimates support a possible important negative impact of the disease on families of children with JIA - BECKER M, ROSE CD, MCILVAIN-SIMPSON G: Niacin-like reaction to infliximab infusion in systemic juvenile rheumatoid arthritis. J Rheumatol 31:12 2529-2530, 2004
- BJORNHART B, SVENNINGSEN P, GUDBRANDSDOTTIR S, ZAK M, NIELSEN S, BENDTZEN K, MULLER K: Plasma TNF binding capacity in patients with juvenile idiopathic arthritis. International Immunopharmacology (Netherlands ) 5:1 73-77, 2005
Abstract: Tumour necrosis factor (TNF)-alpha and TNF-beta, also called lymphotoxin (LT), are bound by soluble truncated TNF receptors (sTNFRI and II) that are released from cell surfaces and act as natural inhibitors of TNF-induced inflammation. We investigated the plasma levels of sTNFRI and II in parallel with LT binding capacity (LTBC) in 44 patients with juvenile chronic arthritis (JIA). LTBC was determined by spiking diluted plasma samples with 1000 pg/ml of human recombinant LT. Detectable LT was measured by an in-house ELISA and LTBC was expressed in arbitrary units (AU) as the percentage value of bound LT to added LT. The levels of sTNFRI and-II were measured by ELISA (R&D). We found slightly reduced sTNFRI and II levels in JIA patients (n=44) compared with healthy controls sTNFRI: 1118 pg/ml (656-2074) [mean (range)] vs. 1262 pg/ml (819-2280) p=0.015; sTNFRII: 1953 pg/ml (889-4476) vs. 2311 pg/ml (1309-4186) p=0.008. The sTNFRI levels correlated positively with morning stiffness (r=0.30, p=0.044), physician's global assessment (r=0.39; p=0.009) and CRP (r=0.43; p=0.0048). sTNFRII did not correlate with measures of disease activity. In contrast, patient LTBC values were elevated compared to controls: 44 AU (36-52) vs. 31 AU (13-41) [mean (range)], p<0.0001, but did not correlate with disease activity. Despite overall slightly reduced plasma levels of sTNFRI and II, the capacity to bind TNF appeared to be increased in plasma samples from JIA patients. (c) 2004 Published by Elsevier B.V - BONIN N, AIT SI ST, DONELL ST, DEJOUR H, NEYRET P: Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. Knee 11:6 431-437, 2004
Organism: Centre Livet, Lyon, France nbonin@chu-besanconfrFAU - Bonin, N
Abstract: A retrospective review of 29 patients (30 knees) was carried out who had previously undergone a single-stage combined ACL reconstruction with valgus upper tibial osteotomy for chronic ACL rupture coupled with early medial tibio-femoral arthritis. Of the 30 knees, 19 (63%) had had a previous medial meniscectomy. Major complications occurred in two knees resulting in stiffness. At a mean of 12 years follow-up (6-16 years) only five knees (17%) had progressed one arthritis grade. Fourteen patients (47%) returned to intensive sports, and a further 11 (37%) played moderate sports. The mean difference in anterior tibial translation with the opposite normal knee was 3 mm at review. It was concluded that the combined operation has a low morbidity, controls anterior laxity, allows many patients to return to sports, and does not result in a rapid progression of osteoarthritis - BUNN DK, SHEPSTONE L, GALPIN LM, WILES NJ, SYMMONS DP: The NOAR Damaged Joint Count (NOAR-DJC): a clinical measure for assessing articular damage in patients with early inflammatory polyarthritis including rheumatoid arthritis. Rheumatology (Oxford) 43:12 1519-1525, 2004
Organism: Norfolk Arthritis Register, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK diane@fs1sermanacukFAU - Bunn, D K
Abstract: OBJECTIVES: To evaluate the reliability and validity of the Norfolk Arthritis Register Damaged Joint Count (NOAR-DJC) in patients with early inflammatory polyarthritis (IP). METHODS: The NOAR-DJC examines deformity in 51 joints. Deformity is defined as inability to adopt the anatomical position, reduction in range of movement by at least one-third, and/or surgical alteration of the joint. Reliability was investigated by assessing intra- and inter-observer agreement in 40 and 32 patients, respectively. Validity was assessed by correlating the NOAR-DJC with the eroded joint count (criterion validity), the Health Assessment Questionnaire (HAQ) (convergent construct validity) and tender and swollen joint counts (divergent construct validity) and by discriminating between those who did and did not satisfy criteria for rheumatoid arthritis (discriminant validity). RESULTS: The intraclass correlation coefficient for the intra- and inter-rater studies were 0.88 [95% confidence interval (CI) 0.79, 0.94, P<0.00001] and 0.74 (95% CI 0.53, 0.86, P<0.00001), respectively. Correlations with eroded joint counts and HAQ scores after 5 yr follow-up were r(s) = 0.42 (95% CI 0.35, 0.49, P<0.01) and r(s) = 0.45 (95% CI 0.4, 0.5, P<0.01), respectively. Correlations with tender and swollen joint counts were weak (r(s) = 0.28 and r(s) = 0.33). CONCLUSION: The NOAR-DJC is a quick, reliable and valid tool for assessing articular damage in patients with early IP - CHAABOUNI L, BEN HAMOUDA S, ABDELMOULA L, BEN HADJ YC, KCHIR MM, ZOUARI R: [Reactive arthritis]. Tunis Med 82:12 1064-1069, 2004
Organism: Service de Rhumatologie, EPS Charles Nicolle, Tunis, TunisieFAU - Chaabouni, Lilia
Abstract: Reactive arthritis are definied as steriles arthropathies using classic bacteriological techniques. They are due to extra articular infection and are often associated with HLA B27. The outcome of these arthritis is characterised by the recurrence of flares with sometimes appearition of ankylosing spondylitis. The pathogenesis of reactive arthritis is modified when bacterial antigens or alive micro-organisms are discovered in involved joints. Several current works have underlined the interest of antibiotic therapy in the chlamydial reactive arthritis. Chronic forms can justify the use of anti-rheumatic drugs such as salazopyrine - CHEN DY, LAN JL, LIN FJ, HSIEH TY, WEN MC: Predominance of Th1 cytokine in peripheral blood and pathological tissues of patients with active untreated adult onset Still's disease. Annals of the Rheumatic Diseases 63:10 1300-1306, 2004
Abstract: Objective: To determine the type 1 T helper (Th1)/type 2 T helper (Th2) balance in the peripheral blood (PB) and pathological tissues of patients with active untreated adult onset Still's disease (AOSD). Methods: The percentages of interferon gamma (IFNgamma)- and interleukin (IL) 4-producing Th cells in the PB of 20 patients with active untreated AOSD, 20 patients with active rheumatoid arthritis ( RA), and 20 healthy controls were determined by intracellular staining and flow cytometry. Serum levels of IL18 and soluble IL2 receptor were measured by enzyme linked immunosorbent assay. Levels of IFNgamma and IL4 messenger ( m) RNA expression were examined by real time quantitative polymerase chain reaction in biopsy specimens of evanescent rash and synovitis from 8 patients with AOSD. Results: Significantly higher IFNgamma-producing Th cells and Th1/Th2 ratio in PB were found in patients with AOSD than in healthy controls. Percentages of IFNgamma-producing Th cells and Th1/Th2 ratio in PB correlated significantly with clinical activity score and serum IL18 levels in patients with AOSD. Increased ratio of Th1/Th2 cytokine transcripts was seen in the biopsy specimens of evanescent rash and synovitis from patients with AOSD compared with normal skin controls and patients with OA. Th cell cytokine pattern in PB and cytokine mRNA expression in synovium were similar for patients with AOSD and with RA. After 3 months' treatment, clinical remission was associated with a marked decrease in the percentages of cytokine-producing Th1 cells, but not of the Th2 cells. Conclusion: A predominance of Th1 cytokine may precipitate the pathogenesis of AOSD - CUNHA BA: Fever of unknown origin caused by adult juvenile rheumatoid arthritis: The diagnostic significance of double quotidian fevers and elevated serum ferritin levels. Heart and Lung: Journal of Acute and Critical Care (United States ) 33:6 417-421, 2004
Abstract: Fever of unknown origin (FUO) in adults is a commonly encountered clinical problem. Treatable causes of FUO in the adult should be the primary focus of the diagnostic workup. Neoplasms have replaced infectious diseases as being the most common cause of FUO in adults, and collagen vascular diseases are now relatively rare. The most important collagen vascular diseases presenting as an FUO include Takayasu's arteritis, Kikuchi's disease, polymyalgia rheumatica, and adult juvenile rheumatoid arthritis (JRA) (adult Still's disease). There are no specific diagnostic tests for these disorders, which commonly present as prolonged fevers that are not easily diagnosed (i.e., FUO). Adult JRA is a rare but important cause of FUO in adults. Typically, patients with adult Still's disease present with liver/spleen involvement, posi-articular arthritis, ocular involvement, and evanescent salmon-colored truncal rash. An important diagnostic finding in adult JRA is the presence of a double quotidian fever, which occurs in few other disorders. Only visceral leishmaniasis and adult JRA are causes of FUO in adults associated wi th double quotidian fevers. Highly elevated serum ferritin levels are the most important nonspecific diagnostic finding associated with adult JRA. We present a case of FUO caused by adult JRA presenting with diffuse polyarticular migrating arthritis, evanescent rash, and splenomegaly. The diagnosis of adult JRA was suggested by these findings in association with a double quotidian fever and a highly elevated serum ferritin level. Clinicians should appreciate the diagnostic significance of fever patterns and the diagnostic significance of elevated serum ferritin levels in patients with FUO - DE SMET L, WOUTERS C: Severe carpal tunnel syndrome in a patient with juvenile idiopathic arthritis due to proximal migration of hypertrophic lumbrical muscles. Clin Rheumatol 23:6 552-554, 2004
Organism: Department of Orthopedic Surgery, UZ Pellenberg, Weligerveld, 1, 3212 Lubbeek, Pellenberg, Belgium lucdesmet@uzkuleuvenacbeFAU - De Smet, L
Abstract: We report a new case of pediatric carpal tunnel syndrome in a patient with juvenile rheumatoid arthritis. Symptoms were mainly motor weakness and severe atrophy of the thenar - DE K, I, BRINKMAN DMC, FERSTER A, ABINUN M, QUARTIER P, DER NJ, TEN CATE R, WEDDERBURN LR, HORNEFF G, OPPERMANN J, ZINTL F, FOSTER HE, PRIEUR AM, FASTH A, VAN ROSSUM MAJ, KUIS W, WULFFRAAT N: Autologous stem cell transplantation for refractory juvenile idiopathic arthritis: analysis of clinical effects, mortality, and transplant related morbidity. Annals of the Rheumatic Diseases 63:10 1318-1326, 2004
Abstract: Objective: To evaluate the safety and efficacy of autologous stem cell transplantation ( ASCT) for refractory juvenile idiopathic arthritis (JIA). Design: Retrospective analysis of follow up data on 34 children with JIA who were treated with ASCT in nine different European transplant centres. Rheumatological evaluation employed a modified set of core criteria. Immunological reconstitution and infectious complications were monitored at three month intervals after transplantation. Results: Clinical follow up ranged from 12 to 60 months. Eighteen of the 34 patients (53%) with a follow up of 12 to 60 months achieved complete drug-free remission. Seven of these patients had previously failed treatment with anti-TNF. Six of the 34 patients (18%) showed a partial response ( ranging from 30% to 70% improvement) and seven (21%) were resistant to ASCT. Infectious complications were common. There were three cases of transplant related mortality (9%) and two of disease related mortality (6%). Conclusions: ASCT in severely ill patients with JIA induces a drug-free remission of the disease and a profound increase in general wellbeing in a substantial proportion of patients, but the procedure carries a significant mortality risk. The following adjustments are proposed for future protocols: ( 1) elimination of total body irradiation from the conditioning regimen; ( 2) prophylactic administration of antiviral drugs and intravenous immunoglobulins until there is a normal CD4+ T cell count - EBERHARD BA, SISON MC, GOTTLIEB BS, ILOWITE NT: Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis. J Rheumatol 31:12 2507-2512, 2004
Organism: Division of Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040, USA aeberhard@lijedFAU - Eberhard, Barbara A
Abstract: OBJECTIVE: To compare patients with juvenile rheumatoid arthritis (JRA) injected with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) with respect to time to relapse. METHODS: This was a retrospective chart review of 85 patients: 51 patients with JRA who had received a joint injection with TH during the period June 2000-April 2001 and 48 patients who had received a joint injection with TA during the period May 2001-March 2002 who were followed for a minimum of 15 months, after an intraarticular steroid injection. RESULTS: The primary endpoint variable for the study was the time to relapse of the arthritis in the affected joint following an intraarticular injection. A total of 227 joints were injected, 114 with TH and 113 with TA. In the TH group the mean time to relapse (+/- SE) was 10.14 +/- 0.49 months compared to the TA group at 7.75 +/- 0.49 months (p < 0.0001) using the log-rank test. A proportional hazards (Cox) regression analysis revealed no statistical association between sex, duration of illness, or type of arthritis and relapse time. An analysis was performed on the first intraarticular injection for each patient, with the average time to relapse for all joints injected of 10.36 +/- 0.72 months for TH compared to 8.45 +/- 0.78 months for TA (p < 0.02). A further analysis of the first knee injections showed a relapse time in the TH group of 11.11 +/- 0.81 months compared to 7.95 +/- 0.95 months for TA (p < 0.008). CONCLUSION: TH offers an advantage to TA, as there is a longer duration of action leading to an improved prolonged response rate in weight-bearing joints, particularly the knees. The results suggest that TH should be the intraarticular steroid of choice, particularly for the knee joint, in patients with JRA - FAINGOLD R, SAIGAL G, AZOUZ EM, MORALES A, ALBUQUERQUE PA: Imaging of low back pain in children and adolescents. Semin Ultrasound CT MR 25:6 490-505, 2004
Organism: Department of Medical Imaging, The Montreal Children's Hospital, Montreal, QC, CanadaFAU - Faingold, Ricardo
Abstract: In children with low back pain (LBP), a specific cause is often identified. LBP has a relatively high prevalence during school years. However, only a minority of the children suffering from LBP seek medical attention. Protracted back pain in childhood is a serious condition that should be thoroughly investigated. This article is a systematic review of the intrinsic causes of LBP. Imaging modalities are discussed, with emphasis on magnetic resonance imaging. We have divided the intrinsic causes of LBP into four main groups: mechanical, developmental, infectious/inflammatory, and neoplastic. Disk protrusion is prevalent in young athletes. Spondylolysis and spondylolisthesis are the most common causes of chronic LBP in children. Thoracic or thoracolumbar Scheuermann disease causes kyphosis while a lumbar localization is more painful. Childhood diskitis is associated with fever and leukocytosis. Spinal inflammatory arthritides in children include juvenile rheumatoid arthritis, the juvenile spondyloarthropathies, and SAPHO syndrome, where spine as well as sacroiliac joint changes may be seen. Cysts, tumors, tumor-like lesions, and metastases are infrequent causes of back pain in children. Several of these conditions are described and illustrated in this review of LBP in children and adolescents - FERNANDES JL, VIANA SL, ROCHA AL, RIBEIRO MC, CASTRO LC: Biphosphonate-induced radiographic changes in two pediatric patients with rheumatic diseases. Skeletal Radiol 33:12 732-736, 2004
Organism: Magnetic Resonance Department, Hospital Santa Lucia, Brasilia DF, BrazilFAU - Fernandes, Joao L
Abstract: Biphosphonates are now being used experimentally in children to increase bone mass, but their long-term effects remain an issue of concern. We report two cases of biphosphonate-induced radiographic changes in children with rheumatic diseases. Our experience supports the view that clinical improvement and radiographic findings after biphosphonate therapy are related to increased bone mineral density, without effects on the inflammatory process itself. Biphosphonates seem to act in rheumatic diseases by reducing bone turnover instead of improving disease activity - GAITATZIS A, CARROLL K, MAJEED A, SANDER W: The epidemiology of the comorbidity of epilepsy in the general population. Epilepsia 45:12 1613-1622, 2004
Organism: Institute of Neurology, University College London and Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery, London, UKFAU - Gaitatzis, Athanasios
Abstract: PURPOSE: To describe the epidemiology of somatic and psychiatric conditions in adults with epilepsy in the community and compare it to that of people without epilepsy. METHODS: A cross-sectional population-based study extracting data from the UK General Practice Research Database for the period 1995-1998. Age- and sex-standardized prevalence rates were estimated for selected conditions and groups of conditions (categorized by ICD-9 chapters) in adults with epilepsy registered with primary care physicians. Results were compared with those in adults without epilepsy in the cohort, and prevalence ratios were calculated according to two broad age groups (16-64 and older than 64 years). RESULTS: Conditions common in the general population also were common in adults with epilepsy. Psychiatric disorders occurred twice as often, and the risk of somatic disorders was increased in people with epilepsy, with the exception of musculoskeletal and connective tissue disorders in older adults. The prevalence ratio of neoplasia, excluding intracranial tumors, was not increased in epilepsy. The prevalence ratio of brain tumors was particularly increased in young adults [prevalence ratio (PR), 70.7] and of meningiomas in older adults (PR, 91.9). Neurodegenerative conditions, particularly dementias and Alzheimer' disease (PR, 6.3 and 8, respectively) and Parkinson' disease (PR, 3.2), appeared more frequently in people with epilepsy. Upper gastrointestinal bleed occurred more frequently in epilepsy (PR, 4.3), as did cardio- and cerebrovascular disorders, fractures, pneumonia and chronic lung diseases, and diabetes. Eczema, osteoarthritis, and rheumatoid arthritis did not occur more frequently in epilepsy. CONCLUSIONS: The prevalence ratio of many common psychiatric and somatic conditions is increased in adults with epilepsy who consult a primary care physician in the U.K. These findings may have implications in the diagnosis and management of epilepsy and coexisting conditions, as well as in health care provision - GOFFE B: Etanercept (Enbrel) -- an update. Skin Therapy Lett 9:10 1-4, 9, 2004
Organism: Department of Dermatology, University of Washington Medical School, Seattle, WA, USAFAU - Goffe, B
Abstract: Etanercept is a tumor necrosis factor antagonist with anti-inflammatory effects. It is currently approved in the US for psoriasis, psoriatic arthritis, ankylosing spondylitis, rheumatoid arthritis and juvenile rheumatoid arthritis. Clinical trials have shown this agent to have an excellent safety profile and to be well tolerated by both adult and pediatric patients - GOKSEL AK, SEVER L, KASAPCOPUR O, CALISKAN S, BALCI H, ARISOY N: Albuminuria and tubular markers in juvenile idiopathic arthritis. Pediatr Nephrol 20:2 154-158, 2005
Organism: Department of Pediatric Nephrology and Rheumatology, Cerrahpasa Medical School, Istanbul University, TurkeyFAU - Goksel, Ayla Kamburoglu
Abstract: This study investigates whether renal damage occurs in children with juvenile idiopathic arthritis (JIA) either secondary to the disease per se or due to the side effects of non-steroidal anti-inflammatory drugs (NSAIDs) and slow-acting anti-rheumatic drugs (SAARDs) used in treatment. In this cross-sectional study, albuminuria, N -acetyl glucosaminidase (NAG), beta(2)-microglobulin (beta(2)M), and creatinine (Cr) levels were measured in urine samples of 45 patients (23 female, 22 male, 9.4+/-3.9 years) with JIA and a sex- and age-matched control group of 33 healthy children. The urinary albumin/Cr, NAG/Cr, and beta(2)M/Cr ratios of children with JIA and of the control group did not differ statistically. No difference was noted between patient groups with different types of JIA (12 systemic, 18 polyarticular, and 15 oligoarticular JIA). JIA patients with active disease (n=16) had higher NAG/Cr values than patients with inactive disease (P=0.002). NAG/Cr levels correlated with erythrocyte sedimentation rate (r=0.66, P<0.001) and platelet count (r=0.61, P<0.001) and showed a slight correlation with the number of joints with active arthritis in children with polyarticular JIA (r=0.45, P=0.055). Neither beta(2)M/Cr nor albumin/Cr ratios were associated with disease activity. No difference was noted between patient groups treated with different NSAIDs and SAARDs. In children with JIA tubular enzymuria increases during the active phase of the disease; however, it seems that permanent renal damage does not occur - HAEFNER R, BEISKEN C: Clinical symptoms in rheumatoid pain - Physiotherapeutic intervention
<ORIGINAL> Klinische symptomatik bei entzundlich-rheumatischem schmerz - physiotherapeutische intervention. Aktuelle Rheumatologie 29:3 133-136, 2004
Abstract: Pain in children with rheumatoid disease shows manifold expressions. Acute pain is expressed by crying, moaning and groaning. It is seen in highly active arthritis. Chronic pain is more difficult to recognize. It is not expressed directly but nonverbally. The children have behavioral disturbances, are restless during their sleep and assume pain relieving malpositions. Besides analgesic medication, the pain therapy consists of pain relieving procedures, such as partial loading of affected jounts and careful moving of the joints as well as several physical measures. These therapies are part of the Garmisch Treatment Concept, which offers an effective therapy even for very painful joints and severe malpositions - HOLICK MF: Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80:6 Suppl 1678S-1688S, 2004
Organism: Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, MA 02118, USA mfholick@bueduFAU - Holick, Michael F
Abstract: Most humans depend on sun exposure to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by 7-dehydrocholesterol in the skin, leading to its transformation to previtamin D3, which is rapidly converted to vitamin D3. Season, latitude, time of day, skin pigmentation, aging, sunscreen use, and glass all influence the cutaneous production of vitamin D3. Once formed, vitamin D3 is metabolized in the liver to 25-hydroxyvitamin D3 and then in the kidney to its biologically active form, 1,25-dihydroxyvitamin D3. Vitamin D deficiency is an unrecognized epidemic among both children and adults in the United States. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus. Maintaining blood concentrations of 25-hydroxyvitamin D above 80 nmol/L (approximately 30 ng/mL) not only is important for maximizing intestinal calcium absorption but also may be important for providing the extrarenal 1alpha-hydroxylase that is present in most tissues to produce 1,25-dihydroxyvitamin D3. Although chronic excessive exposure to sunlight increases the risk of nonmelanoma skin cancer, the avoidance of all direct sun exposure increases the risk of vitamin D deficiency, which can have serious consequences. Monitoring serum 25-hydroxyvitamin D concentrations yearly should help reveal vitamin D deficiencies. Sensible sun exposure (usually 5-10 min of exposure of the arms and legs or the hands, arms, and face, 2 or 3 times per week) and increased dietary and supplemental vitamin D intakes are reasonable approaches to guarantee vitamin D sufficiency - JEON YK, PAIK JH, PARK S-S, PARK SO, KIM YA, KIM JE, SONG Y, KIM CW: Spectrum of lymph node pathology in adult onset Still's disease; analysis of 12 patients with one follow up biopsy. Journal of Clinical Pathology (London) 57:10 1052-1056, 2004
Abstract: Background: Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown aetiology, frequently accompanying multiple lymphadenopathy. It often mimics malignant lymphoma, and immunohistochemical and molecular studies are needed for definite diagnosis. Aims: To aid in diagnosis and understand the pathogenesis of the disease by clarifying lymph node (LN) pathology in AOSD. Methods: Thirteen biopsies (one follow up biopsy) and medical records of 12 patients were reviewed. Immunohistochemistry, polymerase chain reaction for T cell receptor gamma chain (TCRgamma) and immunoglobulin heavy chain gene rearrangement, and Epstein-Barr virus in situ hyb ridisation were performed. Results: Histologically, LN lesions were classified into four patterns. The most common ( six biopsies) showed paracortical hyperplasia, with prominent vascular proliferation, scattered large B/T immunoblasts, and infiltration by reactive lymphocytes and inflammatory cells. In the second pattern (two biopsies), paracortical hyperplasia was accompanied by massive sinus histiocytosis and S-100 positive histiocyte aggregates. The third pattern (three patients) showed an exuberant immunoblastic reaction, in the form of patchy/diffuse infiltration of large T immunoblasts with high mitotic activity, although clonal rearrangement of the TCRgamma gene was not detected. The fourth pattern showed distinct follicular hyperplasia (two cases). One patient with a follow up biopsy showed a pattern change from pronounced follicular hyperplasia to atypical paracortical hyperplasia. Conclusions: AOSD LN lesions show a dynamic histological spectrum, including atypical paracortical hyperplasia, burnt out histiocytic reaction, exuberant immunoblastic reaction, and follicular hyperplasia. During the course of disease, LN reactivity changes and mixed B and T cells are involved in the pathogenesis - KATZ JA, ANTONI C, KEENAN GF, SMITH DE, JACOBS SJ, LICHTENSTEIN GR: Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease and rheumatoid arthritis. Am J Gastroenterol 99:12 2385-2392, 2004
Organism: Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio 44106-5066, USAFAU - Katz, Jeffry A
Abstract: OBJECTIVES: Infliximab is approved for the treatment of rheumatoid arthritis (RA) and Crohn's disease (CD). We report the first large series of pregnancy outcomes in women with RA and CD exposed to infliximab. METHODS: The infliximab safety database was queried for all reports of pregnancy. Data were extracted regarding the indication for infliximab, timing of infliximab relative to conception, pregnancy course, and pregnancy outcome. The proportion of live births, miscarriages, and therapeutic terminations for women directly exposed to infliximab before or during confirmed pregnancy were compared to those expected for the general U.S. population of pregnant women and pregnant women with CD not exposed to infliximab. RESULTS: Of the 146 identified pregnancies, 131 involved women exposed directly to infliximab and outcome data were available for 96 of these women. Live births occurred in 67% (64/96), miscarriages in 15% (14/96), and therapeutic termination in 19% (18/96) of the pregnancies directly exposed to infliximab with available outcome data. These results are similar to those expected for the general U.S. population of pregnant women or pregnant women with CD not exposed to infliximab. CONCLUSION: Data from the infliximab safety database suggest that infliximab exposure during pregnancy results in outcomes that do not differ from those in the U.S. population of pregnant women and pregnant women with CD not exposed to infliximab. No increased risk of adverse outcome was detected, however, follow-up of larger numbers of pregnant women exposed to infliximab will be necessary to definitively exclude any fetal risk - KOBAYASHI Y, YASUBA H, KITA H, HAMADA K, CHIHARA J: [Serum rheumatoid factor and peripheral blood eosinophil counts in patients with bronchial asthma]. Arerugi 53:12 1210-1215, 2004
Organism: Department of Respiratory and Allergy Medicine, Takatsuki Red Cross HospitalFAU - Kobayashi, Yoshiki
Abstract: These days some reports say that bronchial asthma, especially severe asthma, is systemic inflammatory and its severity correlates with eosinophil counts. Some patients with asthma have positive tests for rheumatoid factor (RF) which is detected in systemic hyper immunoreactive desease such as rheumatoid arthritis. So we investigated each of these factors in asthmatic patients. We randomly selected 100 asthmatics from regular outpatients of our hospital. In a positive RF level group (over 21 IU/ml), Eosinophil counts were significantly higher than those in a negative RF level group. RF levels were significantly and positively correlated with the logarithm of eosinophil count. And in severe groups (patients with severe asthma, treated with high dose inhaled steroids, and with history of systemic steroids use for the last one month), RF levels were significantly higher than those in other groups. Our result suggested that RF levels reflect eosinophilia and asthma severity - KOPEC JA, SAYRE EC: Work-related psychosocial factors and chronic pain: a prospective cohort study in Canadian workers. J Occup Environ Med 46:12 1263-1271, 2004
Organism: Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada jkopec@arthritisresearchcaFAU - Kopec, Jacek A
Abstract: OBJECTIVE: The purpose of this study was to determine whether organizational and psychosocial aspects of work experience affect the risk of chronic pain conditions. METHODS: We used longitudinal data from the National Population Health Survey in Canada (n = 6571). The data were analyzed using the Cox model. RESULTS: Work-related stress was a risk factor for developing chronic pain or discomfort. The relative risk was 1.39 (95% CI = 1.01-1.91) for medium stress and 1.80 (95% CI = 1.28-2.52) for high stress. High psychological demands and low skill discretion were independently associated with pain/discomfort. There was no association between psychosocial factors at work and physician-diagnosed chronic back problems, arthritis, or migraine headaches. CONCLUSIONS: Work-related stress is a significant risk factor for nonspecific complaints of pain or discomfort among workers - KUMAR A, CLARK S, BOUDREAUX ED, CAMARGO CA, JR.: A multicenter study of depression among emergency department patients. Acad Emerg Med 11:12 1284-1289, 2004
Organism: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USAFAU - Kumar, Anita
Abstract: OBJECTIVES: The authors sought to determine the 12-month prevalence of depression among emergency department (ED) patients using a single-question screen. METHODS: This cross-sectional study was conducted in four Boston-area EDs. For two 24-hour periods, consecutive patients aged 18 years or older were interviewed, excluding those who were severely ill, potential victims of sexual assault, or emotionally disturbed. During the interview, patients were asked "Have you had any of the following problems during the past 12 months?" Patients answered "yes" or "no" to a list of health problems that included depression. In a validation study, the authors found that this simple approach correlated well with results from the validated Center for Epidemiologic Studies Depression Scale. RESULTS: Of 752 eligible patients, 539 (72%) were interviewed. Of these patients, 30% (95% confidence interval = 26% to 34%) reported depression within the past 12 months. Compared with their nondepressed counterparts, depressed patients were more likely middle-aged, female, and of lower socioeconomic status. Depressed patients were more likely to be smokers and to report a diagnosis of asthma or arthritis/rheumatism. In a multivariate analysis, factors that were independently associated with depression were lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems. CONCLUSIONS: A 30% 12-month prevalence of depression among ED patients was found. Depressed patients had a distinct sociodemographic and health profile. In the future, awareness of risk factors for depression in the ED setting and use of simple screening instruments could aid in the recognition of depression, with subsequent referral to mental health services - LEHMAN TJ, SCHECHTER SJ, SUNDEL RP, OLIVEIRA SK, HUTTENLOCHER A, ONEL KB: Thalidomide for severe systemic onset juvenile rheumatoid arthritis: A multicenter study. J Pediatr 145:6 856-857, 2004
Organism: Division of Pediatric Rheumatology, Hospital for Special Surgery, and the Department of Pediatrics, Sanford Weill Medical College of Cornell University, New York, New York, USAFAU - Lehman, Thomas J A
Abstract: Thirteen children with difficult systemic onset juvenile rheumatoid arthritis were treated with thalidomide. At 6 months, 11 of the 13 were able to reduce their use of prednisone ( P < .002), with a concurrent improvement in erythrocyte sedimentation rate ( P < .0001) and an increase in hemoglobin level ( P < 0.005). Juvenile rheumatoid arthritis improvement scores >/=50% were obtained by 10 of the 13 children - LERNER D, ADLER DA, CHANG H, LAPITSKY L, HOOD MY, PERISSINOTTO C, REED J, MCLAUGHLIN TJ, BERNDT ER, ROGERS WH: Unemployment, job retention, and productivity loss among employees with depression. Psychiatr Serv 55:12 1371-1378, 2004
Organism: Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA dlerner@tufts-nemcorgFAU - Lerner, Debra
Abstract: OBJECTIVE: This study comprehensively assessed the work outcomes of employees with depression. METHODS: We collected baseline and six-month follow-up survey data from 229 employees with depression and two employee comparison groups: a group of healthy patients for the control group (N=173) and a group with rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes included new unemployment and, within the employed subgroup, job retention (versus job turnover), presenteeism (that is, diminished on-the-job performance and productivity), and absenteeism. RESULTS: At the six-month follow-up, persons with depression had more new unemployment--14 percent for persons in the dysthymia group, 12 percent for persons in the major depression group, and 15 percent for persons in the group with both dysthymia and major depression, compared with 2 percent for persons in the control group and 3 percent for persons in the rheumatoid arthritis group. Among participants who were still employed, those with depression had significantly more job turnover, presenteeism, and absenteeism. CONCLUSIONS: In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences - LIAO CH, HUANG JL, YEH KW: Juvenile Reiter's syndrome: a case report. J Microbiol Immunol Infect 37:6 379-381, 2004
Organism: Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Taoyuan, Taiwan, ROCFAU - Liao, Chiang-Hua
Abstract: Reiter's syndrome (RS) is uncommon in children, and the classic triad manifestations of RS usually do not occur simultaneously in children. It is often clinically confused with other childhood illnesses. We report a case of RS in a 7-year-old boy with a family history of ankylosing spondylitis. He had developed intermittent arthralgia of the right knee for about 6 months and occasional bilateral eye pain for several months prior to admission. In the 5 days before admission, he developed multiple oral ulcers, weight loss from 25 to 22 kg and fever. Physical examination showed injected bilateral conjunctivae and the right knee joint with swelling, local warmth, and tenderness over the patellar ligament. Laboratory results revealed positive histocompatibility antigen-B27 (HLA-B27), negative rheumatoid factor (RF) and antinuclear antibody (ANA) and normal urinalysis. RS was diagnosed based on the findings of both arthritis and conjunctivitis. The arthritis was treated with acetaminophen and naproxen. In conclusion, juvenile RS should be considered in children with arthritis and conjunctivitis, positive HLA-B27, negative RF and ANA and a family history of related diseases - LISTERNICK R, KLEIN-GITELMAN M, CHADWICK E, DEAL B, TANZ R, LANE J: A 7-year-old girl with arthritis and hypertension. Pediatr Ann 33:12 802, 804-802, 806, 2004
Organism: Feinberg School of Medicine, Northwestern University, IL, USAFAU - Listernick, Robert - LOPPONEN T, KORKKO J, LUNDAN T, SEPPANEN U, IGNATIUS J, KAARIAINEN H: Childhood-onset osteoarthritis, tall stature, and sensorineural hearing loss associated with Arg75-Cys mutation in procollagen type II gene (COL2A1). Arthritis Rheum 51:6 925-932, 2004
Organism: University of Oulu, Oulu, Finland tuijalopponen@oulufiFAU - Lopponen, Tuija
Abstract: OBJECTIVE: To define the clinical, radiologic, and molecular genetic characteristics of a family with early progressive osteoarthritis mimicking childhood rheumatoid arthritis, Scheuermann-like changes of the spine, tall stature, short 3 and 4 metatarsals, and moderate sensorineural hearing loss. METHODS: We describe a 22-year-old woman and her 54-year-old mother with early progressive osteoarthritis mimicking childhood rheumatoid arthritis. The index case, her mother, and 3 other family members underwent a physical examination, anthropometric measurements, and radiologic studies. Their DNA was sequenced for the procollagen type II (COL2A1) gene. RESULTS: Mild scoliosis was noticed in the proband at the age of 6 years, and at the age of 7 years large Schmorl's nodes were found in the vertebrae L1-2. At the age of 11 years, changes resembling Scheuermann's disease were seen, mostly in the thoracic vertebrae. At the same age, she began to have arthralgia in the weight-bearing joints and osteoarthritis progressed fast, necessitating a hip prosthesis at the age of 18 years. The proband and her mother had bilateral sensorineural hearing loss of moderate degree. Both mother and daughter had an Arg75-Cys mutation in the COL2A1 gene. CONCLUSION: This family is the fourth example of the Arg75-Cys mutation in the COL2A1 gene, which appears to lead to a clearly recognizable phenotype. The finding suggests that sensorineural hearing loss may be a part of this syndrome - MASILAMANI M, NOWACK R, WITTE T, SCHLESIER M, WARNATZ K, GLOCKER MO, PETER HH, ILLGES H: Reduction of soluble complement receptor 2/CD21 in systemic lupus erythomatosus and Sjogren's syndrome but not juvenile arthritis. Scand J Immunol 60:6 625-630, 2004
Organism: Immunology, Department of Biology, Faculty of Sciences, University of Konstanz, Konstanz, GermanyFAU - Masilamani, M
Abstract: A soluble form of the complement receptor CD21 (sCD21) is shed from the lymphocyte surface. The amount of sCD21 in serum may modulate immunity as sCD21 levels are correlated with several clinical conditions. We report here the serum levels of sCD21 in juvenile arthritis (JA), systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS). Using enzyme-linked immunosorbent assay, we determined sCD21 levels in SLE, SS and JA patients. Mann-Whitney test for nonparametric two-tail P value was performed to obtain statistical significance. Cytometrical analysis of synovial fluid leucocytes of JA patients was done on a FACSsort. While sCD21 levels in SLE and SS are reduced to levels previously found in rheumatoid arthritis (RA), JA sCD21 levels were normal. sCD21 levels did not correlate with clinical parameters and immunophenotype of synovial cells. CD4 T cells in the synovium were almost all of the CD45RO memory type and 13 of 40 patients displayed synovial expansion of gammadeltaT cells. CD21 shedding in JA differs from RA/SS/SLE. JA sCD21 levels in synovial fluid are always lower compared to blood levels of the same patients. Analysis of JA synovial T cells indicates a T-cell driven response - MINDEN K, AGANNA E, MCDERMOTT MF, ZINK A: Tumour necrosis factor receptor associated periodic syndrome (TRAPS) with central nervous system involvement. Annals of the Rheumatic Diseases 63:10 1356-1357, 2004
- MOREL J, ROCH-BRAS F, MOLINARI N, SANY J, ELIAOU JF, COMBE B: HLA-DMA*0103 and HLA-DMB*0104 alleles as novel prognostic factors in rheumatoid arthritis. Ann Rheum Dis 63:12 1581-1586, 2004
Organism: Department of Immuno-Rheumatology, Hospital Lapeyronie 34295, Montpellier cedex 5, France j-morel@chu-montpellierfrFAU - Morel, J
Abstract: OBJECTIVE: To evaluate HLA-DM alleles as markers for disease severity in rheumatoid arthritis (RA). METHODS: Two distinct cohorts of patients with RA were oligotyped for HLA-DB1 and HLA-DM genes using PCR amplified genomic DNA with sequence specific oligonucleotide probes. Cohort 1 comprised 199 unselected patients with RA (mean (SD) age 45.5 (13.5) years; disease duration 11.9(8.8) years), whose disease severity was assessed using Larsen score on hand and foot radiographs. Cohort 2 comprised 95 patients with severe RA and 70 patients with benign RA according to the Larsen method. RESULTS: In cohort 1, after stratification according to DRB1 genotypes, patients positive for HLA-DMA*0103 and negative for HLA-DRB1*04 tended to have greater articular damage on hands and wrists (p = 0.07 by Mann-Whitney U test) and reached statistical significance for the Larsen score per year (p = 0.05). This association between HLA-DMA*0103 and articular damage was especially observed in patients with HLA-DRB1*01. Similarly, HLA-DMB*0104 positive patients had higher Larsen score on hands and wrists (p = 0.02). This association was even stronger in DRB1*04 positive patients (p = 0.005). In cohort 2, HLA-DMA*0103 was associated with severe RA in patients negative for HLA-DRB1*04 (OD = 5.4; p = 0.014). HLA-DMB*0104 allele frequency tended to be higher in patients with severe RA but without reaching significance. CONCLUSION: This is the first study evaluating the role of HLA-DM genes in the severity of RA. Our results suggest that HLA-DMA*0103 and HLA-DMB*0104 alleles may represent new genetic markers of RA severity. The HLA-DMA*0103 allele tends to be associated with patients with RA negative for DRB1*04 and could predict a more severe form of disease especially in HLA-DRB1*01 positive patients. The HLA-DMB*0104 allele could have an additive effect in HLA-DRB1*04 patients. Combined determination of HLA-DM and HLA-DRB1 alleles could facilitate identification of patients likely to have a poor disease course - ORTIZ-ALVAREZ O, MORISHITA K, AVERY G, GREEN J, PETTY RE, TUCKER LB, MALLESON PN, CABRAL DA: Guidelines for blood test monitoring of methotrexate toxicity in juvenile idiopathic arthritis. J Rheumatol 31:12 2501-2506, 2004
Organism: Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, CanadaFAU - Ortiz-Alvarez, Oliva
Abstract: OBJECTIVE: To assess the utility of the American College of Rheumatology guidelines for monitoring methotrexate (MTX)-related toxicity in a cohort of children with juvenile idiopathic arthritis (JIA). METHODS: Eighty-nine patients with JIA treated with MTX were monitored prospectively: aspartate aminotransferase (AST), alanine aminotransferase (ALT), complete blood count (CBC), and differential blood count were measured prior to starting MTX, and then monthly. Significantly abnormal blood tests (SABT) were prospectively defined as (1) significantly elevated liver enzymes (SELE) greater than twice the upper limit of normal; (2) granulocyte count < 1.5 109/l; (3) lymphocyte count < 0.9 109/l; or (4) hemoglobin decreased by > 2 g/l from previous level. Clinical interventions, current and cumulative MTX dose, duration of treatment, comorbidity, and concurrent medications at the time of the first SABT identification were recorded. Independent t tests and chi-squared tests were used for comparisons, and the probability of developing a SABT was calculated by Kaplan-Meier survival analysis. RESULTS: Forty percent of patients had a SABT: 26% had hematological abnormalities and 14% had SELE. Ninety-five percent of patients with SABT had symptoms consistent with a viral infection when the SABT was drawn and MTX dose was withheld until results had normalized on repeat testing. SABT persisting beyond one month occurred in only 2 patients, and their abnormalities resolved by 6 months with no specific identified cause; they resumed MTX at a later time without recurrence of SABT. There were no differences between patients with and without SABT with respect to current or cumulative MTX dose, duration of treatment, and concurrent medications at the time of the SABT. The probability of developing a SABT was estimated to be 11% at 3 months, compared to 10% probability of having an abnormal blood test by chance alone. CONCLUSION: Routine blood tests every 4 to 8 weeks in children with JIA are unnecessarily frequent - PETERSEN C, SCHMIDT S, BULLINGER M: Brief report: Development and pilot testing of a coping questionnaire for children and adolescents with chronic health conditions. J Pediatr Psychol 29:8 635-640, 2004
Organism: Center of Psychosocial Medicine, Institute and Policlinics of Medical Psychology, University Clinic Hamburg-Eppendorf, Germany copeters@ukeuni-hamburgdeFAU - Petersen, Corinna
Abstract: OBJECTIVE: The current paper describes the development, pilot testing, and item reduction process of a coping questionnaire for children and adolescents with chronic health conditions. METHODS: A pilot test with 188 children and adolescents was conducted in six European countries. Included in the test were children and adolescents (ages ranging 8-18 years) with various chronic health conditions-asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, or cystic fibrosis. Based on the focus groups with the children and adolescents and on expert consulting, items were developed and translated into the participants' respective languages. Data were analyzed according to predefined psychometric and content criteria. RESULTS: Analyses resulted in a selection of 29 out of 50 items for the final coping questionnaire with six domains: Acceptance alpha = .83, Avoidance alpha = .72, Cognitive-Palliative alpha = .69, Distance alpha = .70, Emotional Reaction alpha = .82, and Wishful Thinking alpha = .81. CONCLUSIONS: This study developed a short reliable international questionnaire to assess coping strategies of children and adolescents with chronic health conditions. Ongoing research will investigate the validity of this new coping questionnaire - PRAHALAD S, O'BRIEN E, FRASER AM, KERBER RA, MINEAU GP, PRATT D, DONALDSON D, BAMSHAD MJ, BOHNSACK J: Familial aggregation of juvenile idiopathic arthritis. Arthritis Rheum 50:12 4022-4027, 2004
Organism: University of Utah School of Medicine, Salt Lake City, UT 84132, USA sampathprahalad@hscutaheduFAU - Prahalad, Sampath
Abstract: OBJECTIVE: To estimate the degree of familial aggregation of juvenile idiopathic arthritis (JIA), determine whether the aggregation of JIA and the aggregation of type 1 diabetes mellitus (type 1 DM) overlap, and identify multiplex JIA pedigrees. METHODS: Records of individuals with JIA or type 1 DM were probabilistically linked with records in the Utah Population Database (UPDB), a large computerized family history database. For each case of JIA or type 1 DM, 10 matched controls or 5 matched controls, respectively, were selected. All familial relationships among cases of JIA or type 1 DM were established. A familial risk score was calculated for each subject. For various levels of familial exposure to JIA or type 1 DM, one's risk (odds ratio [OR]) of developing JIA or type 1 DM was established (cases compared with controls). Recurrence risks for JIA were computed for relatives of JIA cases compared with relatives of controls. Extended JIA families were identified from a list of common ancestors. RESULTS: Records of a total of 443 patients were linked with the UPDB. Of these, 381 (86.0%) met criteria for JIA. An increased risk for JIA was observed among relatives of probands with JIA. The prevalence of type 1 DM among JIA cases was higher than the US prevalence of type 1 DM (P < 0.003). The recurrence risk for JIA was significantly elevated among first-degree relatives of cases with JIA (OR 30.4). The overall prevalence of JIA was 28/100,000. Four extended JIA pedigrees were identified. CONCLUSION: There is familial aggregation of JIA in the Intermountain West region of the US. We have demonstrated that multiplex JIA pedigrees can be identified using a genealogic database - PRAS E, NEUMANN R, ZANDMAN-GODDARD G, LEVY Y, ASSIA EI, SHOENFELD Y, LANGEVITZ P: Intraocular inflammation in autoimmune diseases. Semin Arthritis Rheum 34:3 602-609, 2004
Organism: Department of Ophthalmology, Sapir Medical Center, IsraelFAU - Pras, Eran
Abstract: BACKGROUND: The uveal tract represents the vascular organ of the eye. In addition to providing most of the blood supply to the intraocular structures, it acts as a conduit for immune cells, particularly lymphocytes, to enter the eye. Consequently, the uveal tract is represented in many intraocular inflammatory processes. Uveitis is probably a misnomer unless antigens within the uvea are the direct targets of the inflammatory process. A better term of the condition is "intraocular inflammation" (IOI). OBJECTIVES: To review the presence of IOI in autoimmune diseases, the immunopathogenic mechanisms leading to disease, and treatment. METHODS: We reviewed the English medical literature by using MEDLINE (1984-2003) employing the terms "uveitis," "intraocular inflammation," and "autoimmune diseases." RESULTS: An underlying autoimmune disease was identified in up to 40% of patients with IOI, and included spondyloarthropathies, Behcets disease, sarcoidosis, juvenile chronic arthritis, Vogt-Koyanagi-Harada syndrome (an inflammatory syndrome including uveitis with dermatologic and neurologic manifestations), immune recovery syndrome, and uveitis with tubulointerstitial disease. The immunopathogenesis of IOI involves enhanced T-cell response. Recently, guidelines for the use of immunosuppressive drugs for inflammatory eye disease were established and include: corticosteroids, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, cyclophosphamide, and chlorambucil. New therapies with limited experience include the tumor necrosis factor alpha inhibitors, interferon alfa, monoclonal antibodies against lymphocyte surface antigens, intravenous immunoglobulin (IVIG), and the intraocular delivery of immunosuppressive agents. CONCLUSION: An underlying autoimmune disease was identified in up to 40% of patients with IOI. Immunosuppressive drugs, biologic agents, and IVIG are employed for the treatment of IOI in autoimmune diseases - ROCHAT I, SAYEGH Y, GERVAIX A, RIMENSBERGER PC, ARGIROFFO CB: Acute hypoxic respiratory failure as the first manifestation of systemic-onset juvenile rheumatoid arthritis in a child. Pediatr Pulmonol 38:6 483-487, 2004
Organism: Pediatric Pulmonology Unit, Department of Pediatrics, University Hospital, 6 Rue Willy Donze, 1211 Geneva, SwitzerlandFAU - Rochat, Isabelle
Abstract: Systemic onset juvenile rheumatoid arthritis is the most common rheumatologic disorder of childhood. Pleuropulmonary manifestations are rare in children in this multiorgan disease, and are usually not severe. The diagnosis of systemic onset juvenile rheumatoid arthritis is made by exclusion, in the presence of clinical findings constellation. We present the case of an 8-year-old girl who developed acute hypoxic respiratory failure as the first manifestation of systemic onset juvenile rheumatoid arthritis, then severe respiratory relapse 16 months later. Clinical and radiological improvement were achieved at both times after high dose pulse methylprednisolone therapy - TANZER M, NOISEUX N: Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res429 170-177, 2004
Organism: Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada mtanz@canadacaomFAU - Tanzer, Michael
Abstract: The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. In all three studies, a common etiology was identified. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. This impingement was caused by a pistol-grip deformity of the proximal femur in 97% of the cases in the arthroscopic labral study and 100% of the cases in the idiopathic arthritis study. The identification of anterior hip impingement as a cause of labral tears and idiopathic arthritis may allow surgeons to correct it early in its natural history and delay or prevent end-stage arthritis - TOLUSSO B, SACCO S, GREMESE E, LA TORRE G, TOMIETTO P, FERRACCIOLI GF: Relationship between the tumor necrosis factor receptor II (TNF-RII) gene polymorphism and sTNF-RII plasma levels in healthy controls and in rheumatoid arthritis. Hum Immunol 65:12 1420-1426, 2004
Organism: Division of Rheumatology, UCSC, Catholic University of Rome, Rome, ItalyFAU - Tolusso, B
Abstract: OBJECTIVE: To assess the relationship between tumor necrosis factor receptor II (TNF-RII) gene polymorphisms and sTNFRII plasma levels in healthy blood donors (HBDs) and in rheumatoid arthritis (RA) patients. 113 HBDs and 49 RA patients were genotyped for the T/G polymorphism in exon 6 of the TNF-RII gene. In the same cases, sTNF-RII plasma levels were determined by an enzyme-linked immunosorbent assay (ELISA) procedure. sTNF-RII levels were higher in RA patients than in HBDs (p < 0.0001). No difference in sTNF-RII levels arose between RA patients on low oral doses of glucocorticoids versus those not taking glucocorticoids. In healthy controls, we observed lower levels of the sTNF-RII in carriers of the TT genotype compared to TG/GG genotype (p = 0.04). In RA there was the same behaviour between TT and TG/GG carriers, even though the difference was not statistically significant. When analyzing the correlation between sTNF-RII plasma levels and disease activity parameters, significant correlations were seen with disease activity score (r = 0.40, p = 0.01), swollen joint count (r = 0.38, p = 0.01), and tender joint count (r = 0.42, p = 0.01), but not with erythrocyte sedimentation rate (r = 0.22, p = ns) nor with C-reactive protein (r = 0.14, p = NS). The correlation remained significant only in the RA subgroup carrying the TT genotype. Healthy donors carrying the TT genotype showed lower sTNF-RII plasma levels than carriers of the TG/GG genotypes, while in RA patients we observed only a trend - VARNI JW, BURWINKLE TM, SZER IS: The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability and validity. J Rheumatol 31:12 2494-2500, 2004
Organism: Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137, USA jvarni@archonetamueduFAU - Varni, James W
Abstract: OBJECTIVE:. The PedsQL (Pediatric Quality of Life Inventory) is a modular instrument designed to measure health related quality of life (HRQOL) in children and adolescents ages 2-18 years. The recently developed 18-item PedsQL Multidimensional Fatigue Scale was designed to measure fatigue in pediatric patients and comprises the General Fatigue Scale (6 items), Sleep/Rest Fatigue Scale (6 items), and Cognitive Fatigue Scale (6 items). The PedsQL 4.0 Generic Core Scales were developed as the generic core measure to be integrated with the PedsQL Disease-Specific Modules. The PedsQL 3.0 Rheumatology Module was designed to measure pediatric rheumatology-specific HRQOL. Methods. The PedsQL Multidimensional Fatigue Scale, Generic Core Scales, and Rheumatology Module were administered to 163 children and 154 parents (183 families accrued overall) recruited from a pediatric rheumatology clinic. Results. Internal consistency reliability for the PedsQL Multidimensional Fatigue Scale Total Score (a = 0.95 child, 0.95 parent report), General Fatigue Scale (a = 0.93 child, 0.92 parent), Sleep/Rest Fatigue Scale (a = 0.88 child, 0.90 parent), and Cognitive Fatigue Scale (a = 0.93 child, 0.96 parent) were excellent for group and individual comparisons. The validity of the PedsQL Multidimensional Fatigue Scale was confirmed through hypothesized intercorrelations with dimensions of generic and rheumatology-specific HRQOL. The PedsQL Multidimensional Fatigue Scale distinguished between healthy children and children with rheumatic diseases as a group, and was associated with greater disease severity. Children with fibromyalgia manifested greater fatigue than children with other rheumatic diseases. CONCLUSION: The results confirm the initial reliability and validity of the PedsQL Multidimensional Fatigue Scale in pediatric rheumatology - VOOG U, ALSTERGREN P, LEIBUR E, KALLIKORM R, KOPP S: Influence of serotonin on the analgesic effect of granisetron on temporomandibular joint arthritis. Mediators Inflamm 13:5-6 373-376, 2004
Organism: Department of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Box 4064, 141 04 Huddinge, SwedenFAU - Voog, Ulle
Abstract: The influence of circulating serotonin (5-HT) on the effects of intra-articular administration of granisetron on temporomandibular joint (TMJ) pain was investigated in 11 patients with chronic polyarthritides. An analgesic effect superior to placebo has been shown previously. The change in TMJ movement pain intensity was negatively correlated to circulating 5-HT; that is, the higher the 5-HT before injection, the greater the reduction of pain intensity. The resting pain intensity reduction was not related to 5-HT. In conclusion, this study indicates a stronger short-term analgesic effect on TMJ movement pain by intra-articular administration of the 5-HT3 receptor antagonist granisetron in patients with high levels of circulating 5-HT - WERTHEIM MS, MATHERS WD, PLANCK SJ, MARTIN TM, SUHLER EB, SMITH JR, ROSENBAUM JT: In vivo confocal microscopy of keratic precipitates. Arch Ophthalmol 122:12 1773-1781, 2004
Organism: Casey Eye Institute, Oregon Health & Science University, Portland 97201, USA rosenbaj@ohsueduFAU - Wertheim, Michael S
Abstract: OBJECTIVE: To evaluate the heterogeneity of keratic precipitates (KP) in varying subtypes of uveitis by in vivo confocal microscopy (IVCM). METHODS: The KP were viewed with a scanning confocal microscope in patients (n = 33) who sought care at a tertiary referral uveitis service for immune-mediated and infectious forms of uveitis, including HLA-B27-associated uveitis, sarcoidosis, Vogt-Koyanagi-Harada syndrome, juvenile chronic arthritis, Fuchs heterochromic iridocyclitis, cytomegalovirus retinitis, herpes zoster ophthalmicus, ocular toxoplasmosis, and idiopathic uveitis. Images were captured and digitalized in real time. RESULTS: Forty-two eyes of 33 patients were examined in this study. Patient age ranged from 22 to 84 years, with a mean age of 49.4 years. Seventeen (52%) of the patients were women, and 16 patients (48%) were men. The KP ranged in diameter from 10 to 350 mum. We observed the following absolute and speculative outcomes: KP are markedly heterogeneous and variable as documented by IVCM; KP in individual patients are consistent throughout the cornea; the morphologic features of KP change across time; infectious vs noninfectious causes of uveitis seem to be readily distinguishable by using IVCM; and KP may have consistency for specific disease states and therefore may have diagnostic importance. CONCLUSIONS: To our knowledge, this is the first time that IVCM has been used to describe the architecture and heterogeneity of KP in uveitis. Such observations reveal a heterogeneity that could not be appreciated by conventional slitlamp microscopy and may have diagnostic relevance - ZEBRACKI K, PALERMO TM, HOSTOFFER R, DUFF K, DROTAR D: Health-related quality of life of children with primary immunodeficiency disease: a comparison study. Ann Allergy Asthma Immunol 93:6 557-561, 2004
Organism: Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USAFAU - Zebracki, Kathy
Abstract: BACKGROUND: Many symptoms of primary immunodeficiency (PI) disease can be successfully managed with intravenous immunoglobulin infusion. Although survival rates and prognosis have greatly improved, children with PI disease are still at risk for physical, social, and psychological problems owing to their chronic health condition. However, to our knowledge, there are no empirical data concerning health-related quality of life (HRQOL) in children with PI disease receiving intravenous immunoglobulin infusion. OBJECTIVE: To compare parental reports of HRQOL of children with PI disease receiving intravenous immunoglobulin infusion with children with juvenile idiopathic arthritis (JIA) and a healthy sample. METHODS: Demographic, illness, and HRQOL data were collected from parents of 4- to 18-year-old children with PI disease (n = 36), children with JIA (n = 36), and healthy children (n = 36). The HRQOL was evaluated using the Child Health Questionnaire-Parent Report version. RESULTS: Compared with children with JIA, children with PI disease were similar in many aspects of their HRQOL. However, parents of children with PI disease reported greater limitations in their personal time, poorer general health of their children, greater limitations in their children's physical functioning and family activities, and less bodily pain than children with JIA. In contrast, children with PI disease scored lower on most HRQOL domains compared with healthy children. CONCLUSION: Children with PI disease experience similar HRQOL to children with JIA and poorer HRQOL than healthy children, indicating potential areas to be addressed by future medical and psychosocial interventions