Bibliography February 05

  1. ADAM V, ST PIERRE Y, FAUTREL B, CLARKE AE, DUFFY CM, PENROD JR: What is the impact of adolescent arthritis and rheumatism? Evidence from a national sample of Canadians. J Rheumatol 32:2 354-361, 2005
    Organism: Division of Clinical Epidemiology, McGill University Health Centre, The Montreal General Hospital, Montreal, CanadaFAU - Adam, Viviane
    Abstract: OBJECTIVE: Adolescent arthritis or rheumatism (AAR) has been shown to influence the activities, mental health, and healthcare utilization of affected individuals. However, these effects have never been estimated in a population-based sample. We examined the association of AAR with health status, health services use, health behaviors, and activity limitations. We also investigated the effect of socioeconomic status and family background on respondents with AAR. METHODS: The 1996 National Population Health Survey is a nationally representative survey exploring the health status and behaviors of Canadians. Among the 26,012 individuals aged 12 to 19 with complete responses on the presence of chronic illnesses, the 213 self-reporting arthritis or rheumatism (AAR) were compared to: (1) all other adolescents as a single group; or (2) the group of 9161 adolescents reporting other chronic diseases (OCD) but not AAR, and the group of 16,638 adolescents without chronic disease (WCD). Between-group differences were examined for the following variables: health status; use of health services; presence of activity limitations in school, work, or at home; and school enrollment and work status. RESULTS: Compared to those without, respondents with AAR reported more diagnoses of non-AAR chronic illnesses. Depression among AAR individuals was more prevalent than among non-AAR individuals, as was suffering from moderate or severe pain. Those with AAR were more likely than WCD individuals to use physician services, hospital services, and pain relief medications. AAR patients were more likely to be limited in their activities, and less likely to be enrolled in school than OCD or WCD individuals. CONCLUSION: This study indicates a broad range of effects of AAR in a nationally representative sample. Arthritis or rheumatism affected measures of mental health, health service use, and the school, work, and home activities of affected individuals, compared to individuals without chronic disease or with other chronic disease

  2. ALMODOVAR R, ZARCO P, QUIROS FJ, MAZZUCCHELLI R: Infliximab treatment efficacy in lymphoedema associated with ankylosing spondylitis. Rheumatology (Oxford) 43:11 1456, 2004

  3. ALSAEID K, HAIDER MZ, SHARMA PN, AYOUB EM: The prevalence of human leukocyte antigen (HLA) DR/DQ/DP alleles in Kuwaiti children with oligoarticular juvenile idiopathic arthritis. Rheumatol Int .: 2005
    Organism: Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait, khaledalsaeid@hotmailcom
    Abstract: We have determined the prevalence of human leukocyte antigen (HLA)-DR, DQ and DP alleles in Kuwaiti children with oligoarticular juvenile idiopathic arthritis (OA-JIA) and healthy controls using the PCR-SSP (sequence specific primers) method. The analysis took into account the presence of antinuclear antibodies and chronic anterior uveitis. DRB1*03 (RR 2.20, P<0.001), DRB1*08 (RR 5.280, P<0.026), DQA1*0501 (RR 1.930, P<0.001), DQB1*0304 (RR 7.920, P<0.002), DQB1*0501 (RR 3.080, P<0.007) and DPB1*0101 (RR 8.8, P<0.001) were the main HLA alleles associated with OA-JIA in Kuwaiti Arabs in this study. DRB1*03 was detected in 71% of children with positive ANA, and in 50% of children with anterior uveitis. DQA1 alleles *0501, *0103 and *0105 (P<0.001; 0.029 and 0.024 respectively) were found to be associated with OA-JIA. In contrast, DQA1*0301 and DQA1*0302 alleles appear to be protective in Kuwaiti children (RR 0.153, P<0.001 and RR 0.278, P<0.016 respectively). The DQB1 alleles *0304 and *0501 were associated with OA-JIA (P<0.002 and P<0.007 respectively). In the case of DPB1, only one allele (*0101) was associated with OA-JIA (P<0.001). Most Kuwaiti Arab patients with OA-JIA who carried a DQ or DP susceptibility allele also had an accompanying DRB1*03 or *8 allele

  4. BARZILAI A, HUSZAR M, SHPIRO D, NASS D, TRAU H: Pseudorheumatoid nodules in adults: a juxta-articular form of nodular granuloma annulare. Am J Dermatopathol 27:1 1-5, 2005
    Organism: Department of Dermatology, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel avivb@posttauacilFAU - Barzilai, Aviv
    Abstract: Pseudorheumatoid nodules are considered a deep form of granuloma annulare. Most cases are described in children, occur mainly on the lower legs and scalp, and have favorable prognosis. Their appearance in adults is rare. In this series, fourteen women with pseudorheumatoid nodules were studied. The average age of onset was 36 years old. Lesions consisted of erythematous, violaceous, or skin-colored nodules located mainly on the small joints of the hands. None of the patients developed collagen vascular disease. Persistence was common. Biopsy specimens showed deep dermal nodules composed of epithelioid granulomata separated by thickened collagen bundles. In some areas eosinophilic material was surrounded by histiocytes in a palisaded array. Granuloma annulare was present at the periphery of eight cases. Special stains revealed that most of the eosinophilic material was collagen and mucin was present in eleven cases. In sum these findings demonstrate that pseudorheumatoid nodules in adults are a distinct clinical and pathologic entity, which may be mistaken for rheumatoid nodules. They are probably a juxta-articular variant of granuloma annulare

  5. BHARTI BB, KUMAR S, KAPOOR A, AGARWAL A, MISHRA R, SINHA N: Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis. Journal of Postgraduate Medicine (India ) 50:4 262-265, 2004
    Abstract: Background and Aims: Recognizing the paucity of data regarding echocardiographic studies of Left ventricular (LV) systolic and diastolic function in patients with juvenile rheumatoid arthritis (JRA), a study was carried out to study these parameters in these subjects. Settings, Design and Methods: Thirty-five patients with JRA and an equal number of age- and sex-matched controls were studied by two-dimensional and Doppler echocardiography. Results: Patients with JRA had higher systolic and diastolic blood pressures, resting heart rates, LV systolic (26.9+/-4.3 vs. 22.4 +/- 4.1 mm, p=0.001) and diastolic size (42.3+/-;4.6 vs. 35.4+/-3.8 mm, p<=0.001) and volumes. Though ejection fraction (EF) and fractional shortening (FS) were normal, they were lower in those with JRA as compared to controls (EF: 62.9+/-4.47 vs. 67.5+/-3.63%, p<0.001; FS: 36.4+/-4.5 vs. 38.5 +/- 6.87, p=0.2). On Doppler analysis the JRA group had lower peak E velocity, higher peak A velocity, higher A VTI and more prolonged IVRT. Male patients had higher A VTI and IVRT as compared to females. Those with longer duration of disease had larger LV systolic (r=0.517, p=0.01) and diastolic dimension (r=0.40, p=0.05) and lower FS (r=-0.506, p=0.01). Patients with polyarticular JRA had higher E and A VTI as compared to those with systemic or oligoarticular types. Conclusion: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. The duration of the disease, mode of presentation, patient's age and gender have a significant impact on the left ventricular systolic and diastolic functions in patients with JRA

  6. BLOOM BJ, NELSON SM, EISENBERG D, ALARIO AJ: Soluble intercellular adhesion molecule-1 and E-selectin as markers of disease activity and endothelial activation in juvenile idiopathic arthritis. J Rheumatol 32:2 366-372, 2005
    Organism: Department of Pediatrics, Hasbro Children's Hospital, and Brown Medical School, Providence, Rhode Island, USAFAU - Bloom, Bradley J
    Abstract: OBJECTIVE: To determine whether soluble forms of the adhesion molecules intercellular adhesion molecule-1 (ICAM-1) and E-selectin correlate with clinical measures or other markers of endothelial activation in children with juvenile idiopathic arthritis (JIA) over time. METHODS: A total of 28 children with JIA were studied every 3 months over 2 years. At each interval, serum was tested for soluble (s)ICAM-1 and sE-selectin, plasma for fibrin d-dimer and von Willebrand factor (vWF), and the following clinical variables were recorded: erythrocyte sedimentation rate (ESR), physician and parent global assessments, swollen and limited joint counts, and functional assessment by Childhood Health Assessment Questionnaire. Concentrations of the adhesion molecules were also determined once in 30 age matched healthy children. RESULTS: Among all JIA subtypes, baseline sICAM-1 was elevated compared to controls; sE-selectin was higher in patients with systemic disease compared to other subtypes and controls. sE-selectin correlated with ESR, but there were no other correlations between concentrations of either adhesion molecule or any other clinical variables or vWF antigen. sICAM-1 was higher in those with elevated compared to normal d-dimer. There were no differences between mean sICAM-1 and sE-selectin before or during disease flare or improvement periods, except for an increase in sICAM-1 with flares in patients with systemic disease. CONCLUSION: sICAM-1 is elevated in children with active JIA. sE-selectin is only elevated in children with active systemic disease. Although some relationships were found between the adhesion molecules and other variables, they did not correlate with most variables, and did not parallel the disease course. Thus, we cannot recommend the routine use of these molecules as clinical biomarkers of disease activity. This study confirms that endothelial activation is key to the pathogenesis of JIA, especially in the systemic subtype

  7. BROGAN PA, DILLON MJ: Autoimmune diseases in children. Current Paediatrics (United Kingdom ) 15:1 23-31, 2005
    Abstract: Autoimmune diseases of children are on the whole, rare, but can be associated with not inconsequential morbidity and mortality when they occur. Moreover, they pose major diagnostic and therapeutic challenges for the paediatrician, and the decision to treat such diseases with corticosteroids and in some instances cytotoxic immunosuppressant drugs must balance morbidity from the underlying disease against significant toxicity and injury from therapy. A number of novel therapies including anti-tumour necrosis alpha therapy, and monoclonal antibodies against B cells are beginning to be used in children, although their efficacy and safety remains to be fully elucidated. (c) 2004 Elsevier Ltd. All rights reserved

  8. CAKMAK A, BOLUKBAS N: Juvenile rheumatoid arthritis: physical therapy and rehabilitation. South Med J 98:2 212-216, 2005
    Organism: Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyFAU - Cakmak, Aysegul
    Abstract: Juvenile arthritis is one of the most prevalent chronic diseases in the childhood period (ages 0 to 16 years). This disease was first defined in the first half of the 16th century. In the course of time, its differential diagnosis and characteristics have been determined, and it has been classified. Incidence and prevalence values are 10 to 20 in 100,000 and 56 to 113 in 100,000, respectively. Various factors are suggested for its underlying cause. Its denomination is also in dispute. Treatment of juvenile arthritis includes education, medical treatment, physical therapy, and occupational therapy. This article summarizes the objectives and methods of physical therapy and rehabilitation that are important parts of treatment

  9. CRISWELL LA, PFEIFFER KA, LUM RF, GONZALES B, NOVITZKE J, KERN M, MOSER KL, BEGOVICH AB, CARLTON VE, LI W, LEE AT, ORTMANN W, BEHRENS TW, GREGERSEN PK: Analysis of families in the multiple autoimmune disease genetics consortium (MADGC) collection: the PTPN22 620W allele associates with multiple autoimmune phenotypes. Am J Hum Genet 76:4 561-571, 2005
    Organism: Rosalind Russell Medical Research Center for Arthritis, Department of Medicine, University of California San Francisco, San Francisco, CA, USAFAU - Criswell, Lindsey A
    Abstract: Autoimmune disorders constitute a diverse group of phenotypes with overlapping features and a tendency toward familial aggregation. It is likely that common underlying genes are involved in these disorders. Until very recently, no specific alleles--aside from a few common human leukocyte antigen class II genes--had been identified that clearly associate with multiple different autoimmune diseases. In this study, we describe a unique collection of 265 multiplex families assembled by the Multiple Autoimmune Disease Genetics Consortium (MADGC). At least two of nine "core" autoimmune diseases are present in each of these families. These core diseases include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), type 1 diabetes (T1D), multiple sclerosis (MS), autoimmune thyroid disease (Hashimoto thyroiditis or Graves disease), juvenile RA, inflammatory bowel disease (Crohn disease or ulcerative colitis), psoriasis, and primary Sjogren syndrome. We report that a recently described functional single-nucleotide polymorphism (rs2476601, encoding R620W) in the intracellular tyrosine phosphatase (PTPN22) confers risk of four separate autoimmune phenotypes in these families: T1D, RA, SLE, and Hashimoto thyroiditis. MS did not show association with the PTPN22 risk allele. These findings suggest a common underlying etiologic pathway for some, but not all, autoimmune disorders, and they suggest that MS may have a pathogenesis that is distinct from RA, SLE, and T1D. DNA and clinical data for the MADGC families are available to the scientific community; these data will provide a valuable resource for the dissection of the complex genetic factors that underlie the various autoimmune phenotypes

  10. CUMMINGS JR, HERRLINGER KR, TRAVIS SP, GORARD DA, MCINTYRE AS, JEWELL DP: Oral methotrexate in ulcerative colitis. Aliment Pharmacol Ther 21:4 385-389, 2005
    Organism: Gastroenterology Unit, University of Oxford, Radcliffe Infirmary, Oxford, UK fraserc@welloxacukFAU - Cummings, J R F
    Abstract: BACKGROUND: We performed an audit of methotrexate for ulcerative colitis, because efficacy is unclear. Aim : To investigate the role of methotrexate in the management of ulcerative colitis. METHODS: Patients with ulcerative colitis treated with oral methotrexate at the inflammatory bowel disease clinics of Oxford and Wycombe General Hospital, UK, were evaluated. Efficacy was defined by remission (complete steroid withdrawal for >3 months) and response (good, partial or nil, proportionate reduction of steroids). RESULTS: There were 50 patients (42 ulcerative colitis alone; eight had rheumatoid arthritis associated with ulcerative colitis and were analysed separately). Indications for methotrexate in ulcerative colitis alone were azathioprine intolerance (31 of 42) and lack of benefit from azathioprine (11 of 42). The mean dose of methotrexate in ulcerative colitis alone was 19.9 mg/week for a median of 30 weeks (range: 7-395). Remission occurred in 42%. The response was good in 54% and partial in 18%. Side-effects occurred in 23%; 10% stopped treatment because of side-effects. Of those treated with methotrexate because of treatment failure with azathioprine, three of 11 achieved remission, but four came to colectomy within 90 days of starting methotrexate. The colitis remained in remission in seven of eight of those with RA treated with methotrexate and ulcerative colitis (mean dose 15.0 mg/week). CONCLUSION: Oral methotrexate (approximately 20 mg/week) is well-tolerated and moderately effective in steroid-dependent or steroid-refractory patients with ulcerative colitis

  11. DUFFY CM, COLBERT RA, LAXER RM, SCHANBERG LE, BOWYER SL: Nomenclature and classification in chronic childhood arthritis: time for a change? Arthritis Rheum 52:2 382-385, 2005
    Organism: Montreal Children's Hospital of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada ciaranduffy@muhcmcgillca <ciaranduffy@muhcmcgillca>FAU - Duffy, Ciaran M

  12. EFTHIMIOU P, MARKENSON JA: Role of biological agents in immune-mediated inflammatory diseases. South Med J 98:2 192-204, 2005
    Organism: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA pee2001@medcornelleduFAU - Efthimiou, Petros
    Abstract: A new era in the treatment of immune-mediated inflammatory disorders has begun with the clinical availability of anticytokine therapy. Biological agents that are currently available include 3 agents that decrease the activity of tumor necrosis factor-alpha (infliximab, adalimumab, etanercept) and an interleukin-1 receptor antagonist (anakinra), with many more in development. Those extraordinarily effective medications are an important addition to our therapeutic armamentarium, and, although originally developed for rheumatoid arthritis and Crohn disease, have been found to be efficacious in the treatment of seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis) and juvenile rheumatoid arthritis. Their role is currently being defined in other autoimmune disorders such as uveitis, sarcoidosis, interstitial lung disease, vasculitis, inflammatory myopathies, graft-versus-host disease, and Sjogren syndrome

  13. FOELDVARI I, WIERK A: Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol 32:2 362-365, 2005
    Organism: Pediatric Rheumatologic Clinic, Allgemeines Krankenhaus Eilbek, Hamburg, Germany Sprechstunde@kinderrheumatologiedeFAU - Foeldvari, Ivan
    Abstract: OBJECTIVE: To assess the effectiveness of methotrexate (MTX) in the treatment of juvenile idiopathic arthritis (JIA) associated uveitis, which is still one of the most common causes of visual impairment. METHODS: A retrospective chart review of patients with the diagnosis of uveitis associated with JIA between July 1, 2002, and December 31, 2002. RESULTS: Four hundred sixty-seven patients with JIA were followed. Thirty-eight had uveitis: 31 associated with oligoarticular JIA and 7 with psoriatic JIA. Twenty-five of the 38 patients received MTX; in 23 patients uveitis was the indication for MTX therapy. In the MTX treated group 46/50 eyes had uveitis, the mean (range) age at onset of uveitis was 7.82 years (1.8-15.8), and the mean age at onset of arthritis was 7.25 years (1.25-15.7). MTX treatment was started an average of 11.4 months (0-72) after the onset of uveitis. The mean MTX dose was 15.6 mg/m2. Remission occurred after 4.25 months (1-12). Mean duration of remission was 10.3 months (3-27). The total duration of MTX therapy was 661 months and patients were in remission for 417/661 months. In 6 patients MTX was discontinued after 12 months of remission. Four patients were still in remission after 7.5 months (1-14). CONCLUSION: MTX seems to be an effective therapy for JIA associated uveitis

  14. FOSTER H, KHAWAJA K: When to request a paediatric rheumatology opinion. Current Paediatrics (United Kingdom ) 15:1 1-8, 2005
    Abstract: Rheumatic diseases in children are common, have variable clinical presentations and a broad spectrum of outcome, ranging from benign and self-limiting to potentially fatal. Chronic rheumatic diseases can result in disability and invariably have a marked impact on the child and the family. Early diagnosis and appropriate multidisciplinary management does improve the long-term outcome. The paediatric rheumatologist provides support to the general paediatrician in making a diagnosis and working within a paediatric rheumatology multidisciplinary team, provides a comprehensive management programme. (c) 2004 Elsevier Ltd. All rights reserved

  15. GERLONI V, PONTIKAKI I, GATTINARA M, DESIATI F, LUPI E, LURATI A, SALMASO A, FANTINI F: Efficacy of repeated intravenous infusions of an anti-tumor necrosis factor alpha monoclonal antibody, infliximab, in persistently active, refractory juvenile idiopathic arthritis: results of an open-label prospective study. Arthritis Rheum 52:2 548-553, 2005
    Organism: Istituto G Pini, Milan, Italy gerloni@gpiniit <gerloni@gpiniit>FAU - Gerloni, Valeria
    Abstract: OBJECTIVE: To evaluate the efficacy and safety of a chimeric monoclonal anti-tumor necrosis factor alpha antibody (infliximab) with methotrexate (MTX) in juvenile idiopathic arthritis (JIA) with an active polyarticular course that is not responsive to MTX. METHODS: Twenty-four young adults with long-lasting, refractory JIA were enrolled in an open, prospective, 2-year pilot study. Patients received intravenous infliximab at 3 mg/kg of body weight at weeks 0, 2, and 6 and every 8 weeks thereafter, with weekly subcutaneous MTX. RESULTS: The median duration of therapy was 9.1 months. Significant improvements were observed in the number of joints (28-joint count) with active disease (median 6 at baseline, 2 at 2 weeks, 0 at 6 months, 0 at 1 year; P < 0.05). Pain as well as patient's and physician's global assessments of disease status were assessed on 0-100-mm (0 = best; 100 = worst) visual analog scales (VAS). There were significant improvements in VAS pain scores (45 at baseline, 25 at 2 weeks, 8.5 at 6 months, 10 at 1 year; P < 0.05), patient's global assessment of disease status (50 at baseline, 22 at 2 weeks, 11.5 at 6 months, 18 at 1 year; P < 0.05), and physician's global assessment of disease status (50.5 at baseline, 22.5 at 2 weeks, 6.5 at 6 months, 10 at 1 year; P < 0.01). In addition, there were significant improvements in the erythrocyte sedimentation rate (64 mm/hour at baseline, 36 mm/hour at 2 weeks, 23.5 mm/hour at 6 months, 35 mm/hour at 1 year; P < 0.01) and C-reactive protein level (4.9 mg/dl at baseline, 2.8 mg/dl at 2 weeks, 3.1 mg/dl at 6 months, 3.2 mg/dl at 1 year; P < 0.005). The percentage of patients meeting the American College of Rheumatology 20% improvement criteria at each assessment ranged from 54.2% to 86.7%. Of the responses on the Disease Activity Score in 28 joints, 37.5-63.6% were classified as "good," 14.3-33.3% were classified as "moderate," and 18-37.5% were classified as "no response." Twelve patients (50%) had adverse events, and 5 patients (20.8%) withdrew. CONCLUSION: Infliximab plus MTX showed high effectiveness and safety in short- and medium-term treatment of long-lasting refractory JIA. A controlled multicenter clinical trial is needed

  16. GIRSCHICK HJ, RAAB P, SURBAUM S, TRUSEN A, KIRSCHNER S, SCHNEIDER P, PAPADOPOULOS T, MULLER-HERMELINK HK, LIPSKY PE: Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 64:2 279-285, 2005
    Organism: Section of Paediatric Rheumatology, Children's Hospital, University of Wurzburg, Josef-Schneider-Strasse 2, 97080 Wurzburg, Germany HermannGirschick@mailuni-wuerzburgdeFAU - Girschick, H J
    Abstract: BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) in children is a chronic non-suppurative inflammation involving multiple sites. Some children affected by chronic non-bacterial osteomyelitis (CNO) do not have multiple lesions or a recurrent course. OBJECTIVE: To characterise the long term outcome of children with the full spectrum of CNO. METHODS: 30 children diagnosed with CNO were followed up for a mean of 5.6 years and their disease assessed using a clinical score, multiple imaging, and a diagnostic biopsy, including extensive microbial analysis. RESULTS: 9 patients had unifocal non-relapsing disease, 3 unifocal lesions with relapses, 9 multifocal lesions without relapses, and 9 multifocal lesions with relapses (CRMO). Granulocytes were present significantly more often in CRMO than in unifocal and non-recurrent lesions. Pustulosis was more common in multifocal cases regardless of recurrence. Mean duration of treatment in 15 children with a single occurrence was 9.2 months. Naproxen treatment was generally effective. Naproxen treatment in 12 patients with relapses lasted 25 months. However, 7 of these were not effectively treated with naproxen alone. Five were treated with oral glucocorticoids for 27 days in addition to naproxen, which induced remission in four, lasting for at least 1.5 years. Longitudinal growth of affected bones was not altered, except for the development of hyperostosis. CONCLUSION: CNO is a spectrum of inflammatory conditions, with CRMO being the most severe. Most children with CNO have a favourable outcome of the disease. Oral glucocorticoids may be necessary in severe recurrent cases

  17. GLUF WM, SCHMIDT MH, APFELBAUM RI: Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2:2 155-163, 2005
    Organism: Department of Neurosurgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132-2303, USAFAU - Gluf, Wayne M
    Abstract: OBJECT: In this, the first of two articles regarding C1-2 transarticular screw fixation, the authors assessed the rate of fusion, surgery-related complications, and lessons learned after C1-2 transarticular screw fixation in an adult patient series. METHODS: The authors retrospectively reviewed 191 consecutive patients (107 women and 84 men; mean age 49.7 years, range 17-90 years) in whom at least one C1-2 transarticular screw was placed. Overall 353 transarticular screws were placed for trauma (85 patients), rheumatoid arthritis (63 patients), congenital anomaly (26 patients), os odontoideum (four patients), neoplasm (eight patients), and chronic cervical instability (five patients). Among these, 67 transarticular screws were placed in 36 patients as part of an occipitocervical construct. Seventeen patients had undergone 24 posterior C1-2 fusion attempts prior to referral. The mean follow-up period was 15.2 months (range 0.1-106.3 months). Fusion was achieved in 98% of cases followed to commencement of fusion or for at least 24 months. The mean duration until fusion was 9.5 months (range 3-48 months). Complications occurred in 32 patients. Most were minor; however, five patients suffered vertebral artery (VA) injury. One bilateral VA injury resulted in patient death. The others did not result in any permanent neurological sequelae. CONCLUSIONS: Based on this series, the authors have learned important lessons that can improve outcomes and safety. These include techniques to improve screw-related patient positioning, development of optimal instrumentation, improved screw materials and design, and defining the role for stereotactic navigation. Atlantoaxial transarticular screw fixation is highly effective in achieving fusion, and the complication rate is low when performed by properly trained surgeons

  18. GUPTA M, RAO PS: Cardiac function in juvenile rheumatoid arthritis. Journal of Postgraduate Medicine (India ) 50:4 266-267, 2004

  19. IMASHUKU S, UEDA I, TERAMURA T, MORI K, MORIMOTO A, SAKO M, ISHII E: Occurrence of haemophagocytic lymphohistiocytosis at less than 1 year of age: analysis of 96 patients. Eur J Pediatr 164:5 315-319, 2005
    Organism: Division of Paediatrics, Takasago-Seibu Hospital, 1-10-41 Nakasuji, Takasago City, Hyogo Prefecture, Japan shinim95@mboxkyoto-inetorjpFAU - Imashuku, Shinsaku
    Abstract: We analysed data of 96 infants (under 1 year of age) with haemophagocytic lymphohistiocytosis (HLH) from the registry of an HLH study conducted during 1986-2002 in Japan. The cases were classified into five groups. The diagnosis of familial HLH (FHL) as group 1 (n = 27) was made with positive family history and/or recent molecular test for perforin and Munc13-4 mutations. Neonatal enterovirus- or herpes simplex virus-associated HLH as group 2a (n = 7), Epstein-Barr virus-associated HLH (n = 12) as group 2b, adenovirus- or cytomegalovirus-associated HLH as group 3 (n = 9) were mostly diagnosed by viral isolation or by the detection of viral genome. Juvenile rheumatoid arthritis-associated macrophage activation syndrome was classified as group 4 (n = 4) and the remaining without known triggers as group 5 (n = 37). The peak onset age was 1-2 months for group 1, 1-2 weeks for group 2a, 12 months for group 2b, none for group 3, 9 months for group 4 and 2 months for group 5. Future novel diagnostic measures are required to define the precise nature of HLH in group 5. CONCLUSION: These data may provide useful information for neonatologists/ paediatricians in the differential diagnosis of haemophagocytic lymphohistiocytosis in early infancy

  20. KASAPOPUR O, ALTUN S, ASLAN M, KARAARSLAN S, KAMBUROGLU-GOKSEL A, SARIBAS S, ARISOY N, KOCAZEYBEK B: Diagnostic accuracy of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis. Annals of the Rheumatic Diseases 63:12 1687-1689, 2004
    Abstract: Objective: To correlate serum anti-cyclic citrullinated peptide antibodies (anti-CCP) levels with juvenile idiopathic arthritis (JIA) subtypes and with an erosive disease course. Methods: The study group comprised 122 children with JIA; 16 were evaluated during both active disease and remission. Nineteen children with systemic lupus erythematosus (SLE), 27 with rheumatoid arthritis ( RA), and 15 healthy children were also included in the study. Twelve children with JIA were rheumatoid factor (RF) positive, and 34 patients had persistent erosive joint disease. Anti-CCP antibody levels were dete rmined by ELISA; values above 5 relative units were regarded as positive. Results: Three girls with seropositive polyarticular JIA and erosive joint disease had positive anti-CCP values. Children evaluated during active disease and remission, patients with SLE, and healthy children all had negative anti-CCP antibody levels. However, 19/27 (70%) adult patients with RA had positive anti-CCP antibody values. Conclusions: In contrast with RA, anti-CCP positivity is only rarely found in patients with JIA. In patients with RF positivity and/or in patients with erosive joint disease, anti-CCP can be detected

  21. KENNEDY T, MCCABE C, STRUTHERS G, SINCLAIR H, CHAKRAVATY K, BAX D, SHIPLEY M, ABERNETHY R, PALFERMAN T, HULL R: BSR guidelines on standards of care for persons with rheumatoid arthritis. Rheumatology (Oxford) 44:4 553-556, 2005
    Organism: Royal Liverpool and Broadgreen University Hospital, UK tomdken@hotmailcomFAU - Kennedy, T

  22. KIM WU, KIM KJ: T cell proliferative response to type II collagen in the inflammatory process and joint damage in patients with rheumatoid arthritis. J Rheumatol 32:2 225-230, 2005
    Organism: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Catholic University of Korea, St Vincent's Hospital, Suwon, South Korea wan725@catholicackrFAU - Kim, Wan-Uk
    Abstract: OBJECTIVE: To investigate the role of T cell responses to type II collagen (CII) in disease progression in patients with rheumatoid arthritis (RA). METHODS: T cell proliferative responses to bovine CII by peripheral blood mononuclear cells (PBMC) from patients with early RA (duration < 5 yrs) were assayed by mixed lymphocyte culture. Clinical and laboratory variables including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the time of sampling. Radiographic damage on hand radiographs was evaluated by the method of Steinbrocker and Sharp. RESULTS: In a cross sectional study, patients (n = 22) with positive T cell responses (stimulation index 2) had higher levels of CRP and ESR than those (n = 21) not showing T cell responses. The number of damaged joints (by Steinbrocker's method) and damaged joint scores (by Sharp's method) were significantly higher in patients with positive T cell responses than in those without. The joint space narrowing scores correlated well with T cell responsiveness to CII. Patients (n = 15) with both positive T cell responses and RA-susceptible allotypes HLA-DR1 or DR4 had higher damaged joint scores than the remainder of the patients (n = 24). CONCLUSION: T cell proliferative responses to CII are associated with inflammatory activity and radiographic severity in RA. RA-susceptible allotypes positively relate to the radiographic progression associated with T cell responses to CII. Our data suggest that CII-reactive T cells may play a role in the pathogenic process of joint damage, especially in genetically susceptible patients

  23. LEBOVIDGE JS, LAVIGNE JV, MILLER ML: Adjustment to chronic arthritis of childhood: the roles of illness-related stress and attitude toward illness. J Pediatr Psychol 30:3 273-286, 2005
    Organism: Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts 02115, USA jenniferlebovidge@childrensharvardeduFAU - LeBovidge, Jennifer Soriano
    Abstract: OBJECTIVE: To examine the relationship of psychosocial stress and attitude toward illness to psychological adjustment among youth with chronic arthritis. METHODS: Seventy-five youths with chronic arthritis aged 8-18 years were administered a semi-structured interview assessing illness-related and nonillness-related stressors in important life domains. Children also completed measures of attitude toward illness, depressive symptoms, and anxiety. Parents completed a measure of child psychosocial adjustment. RESULTS: Higher levels of illness-related and nonillness-related stress were associated with higher levels of anxiety and depressive symptoms and parent-reported adjustment problems, while a more positive attitude toward illness was associated with lower levels of anxiety and depressive symptoms. Attitude toward illness moderated the relationship between stress and depressive symptoms. CONCLUSIONS: Results suggest the importance of assessing life stress and attitude toward illness among youth with arthritis and developing interventions to help children cope with arthritis-related stressors and promote a more positive attitude toward illness

  24. LEEB BF, ANDEL I, SAUTNER J, BOGDAN M, MAKTARI A, NOTHNAGL T, RINTELEN B: Disease activity measurement of rheumatoid arthritis: Comparison of the simplified disease activity index (SDAI) and the disease activity score including 28 joints (DAS28) in daily routine. Arthritis Rheum 53:1 56-60, 2005
    Organism: Humanisklinikum Lower Austria, Lower Austrian Center for Rheumatology, Stockerau, Austria leebkhstockerau@aonatFAU - Leeb, Burkhard F
    Abstract: OBJECTIVE: To assess the reliability and congruency of the Simplified Disease Activity Index (SDAI) compared with the Disease Activity Score including 28 joints (DAS28) in daily practice. METHODS: In 399 consecutive rheumatoid arthritis patients (307 women, 92 men), the SDAI and the DAS28 were calculated. Additionally, 115 of them were observed for 1 year and changes of both values were recorded. Joint assessments were performed by 4 experienced physicians. DAS28 and SDAI values and the respective changes were compared by correlation and regression analyses. Reliability assessment and factor analyses were performed. Disease activity categorizing was compared by the Wilcoxon's rank sum test. RESULTS: The median +/- SD scores were 3.42 +/- 1.45 for the DAS28 and 11.50 +/- 11.50 for the SDAI. Spearman's rho was 0.897 (P < 0.0001). Score changes were also significantly correlated. Reliability testing and factor analysis revealed that both scores can be regarded as monocomponent. Categorizing patients according to the European League Against Rheumatism response criteria (EULARC) or the SDAI revealed statistically significant differences between the 2 scales (P < 0.0001). CONCLUSION: SDAI values are considerably shifted to the left compared with DAS28 levels. Internal consistency and reliability of both scores are comparable. For the differences in disease activity categorizing due to the SDAI compared with the EULARC, a major limitation of the application of this newly developed disease activity score is given, unless these incongruencies can be cleared

  25. MARADIT-KREMERS H, CROWSON CS, NICOLA PJ, BALLMAN KV, ROGER VL, JACOBSEN SJ, GABRIEL SE: Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 52:2 402-411, 2005
    Organism: Mayo Clinic, Rochester, Minnesota 55905, USAFAU - Maradit-Kremers, Hilal
    Abstract: OBJECTIVE: To examine the risk of clinical coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) compared with age- and sex-matched non-RA subjects, and to determine whether RA is a risk factor for CHD after accounting for traditional CHD risk factors. METHODS: We assembled a population-based incidence cohort of 603 Rochester, Minnesota residents ages >or=18 years who first fulfilled the American College of Rheumatology (ACR) 1987 criteria for RA between January 1, 1955 and January 1, 1995, and 603 age- and sex-matched non-RA subjects. All subjects were followed up through their complete inpatient and outpatient medical records, beginning at age 18 years until death, migration, or January 1, 2001. Data were collected on CHD events and traditional CHD risk factors (diabetes mellitus, hypertension, dyslipidemia, body mass index, smoking) using established diagnostic criteria. CHD events included hospitalized myocardial infarction (MI), unrecognized MI, coronary revascularization procedures, angina pectoris, and sudden CHD deaths. Conditional logistic regression and Cox regression models were used to estimate the risk of CHD associated with RA, both prior to and following RA diagnosis, after adjusting for CHD risk factors. RESULTS: During the 2-year period immediately prior to fulfillment of the ACR criteria, RA patients were significantly more likely to have been hospitalized for acute MI (odds ratio [OR] 3.17, 95% confidence interval [95% CI] 1.16-8.68) or to have experienced unrecognized MIs (OR 5.86, 95% CI 1.29-26.64), and less likely to have a history of angina pectoris (OR 0.58, 95% CI 0.34-0.99) compared with non-RA subjects. After the RA incidence date, RA patients were twice as likely to experience unrecognized MIs (hazard ratio [HR] 2.13, 95% CI 1.13-4.03) and sudden deaths (HR 1.94, 95% CI 1.06-3.55) and less likely to undergo coronary artery bypass grafting (HR 0.36, 95% CI 0.16-0.80) compared with non-RA subjects. Adjustment for the CHD risk factors did not substantially change the risk estimates. CONCLUSION: Patients with RA have a significantly higher risk of CHD when compared with non-RA subjects. RA patients are less likely to report symptoms of angina and more likely to experience unrecognized MI and sudden cardiac death. The risk of CHD in RA patients precedes the ACR criteria-based diagnosis of RA, and the risk cannot be explained by an increased incidence of traditional CHD risk factors in RA patients

  26. MARJANOVIC Z, GERBER I, TOLEDANO C, HEN-SOLAL J, DAMADE R, SAINT-CYR I, SARROT-REYNAULD F, ILIE D, DANESHPOUY M, MOUNIER N, RUIVARD M, TYNDALL C, VIDAL E, QUERE I, DURAND JM, CONSTANS J, FARGE D: [Therapeutic intensification and autologous stem cell transplantation in autoimmune diseases]. Presse Med 34:4 311-318, 2005
    Organism: Service de medecine interne, Service de greffe de moelle, Hopital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris, FranceFAU - Marjanovic, Z
    Abstract: THE PATHOPHYSIOLOGY of most autoimmune diseases is often poorly understood. EXPERIMENTAL CONSIDERATIONS and clinical experience suggest that high doses immunoablation followed by stem cell transplantation is a therapeutic option to consider for certain severe autoimmune disorders. THE CONCEPT OF RESTORING NORMAL IMMUNE REACTIVITY must in part br true since current results of 466 transplants (445 autologous, 21 allogeneic) patients suffering from various autoimmune diseases show a beneficial outcome in approximately 2/3 of the patients. TO IMPROVE THE EFFICACY AND SAFETY OF SUCH AN AGGRESSIVE PROCEDURE in patients with potentially affected vital organs by the underlying autoimmune disease, it is especially important to follow international consensus guidelines and to centrally collect clinical data for in depth analysis in the EBMT International Stem Cell Project for Autoimmune Disease in Basel, Switzerland. PHASE III STUDIES ARE RUNNING FOR SYSTEMIC SCLEROSIS (Astis, Autologous Stem cell Transplantation International Rheumatoid Arthritis Trial) started in 2003. A STUDY PROJECT IS PLANNED FOR MULTIPLE SCLEROSIS (Astims, Autologous Stem cell Transplantation International Multiple Sclerosis)

  27. MORETTI C, VIOLA S, PISTORIO A, MAGNI-MANZONI S, RUPERTO N, MARTINI A, RAVELLI A: Relative responsiveness of condition specific and generic health status measures in juvenile idiopathic arthritis. Ann Rheum Dis 64:2 257-261, 2005
    Organism: Dipartimento di Pediatria, Universita di Pavia, Istituto di Ricovero e Cura a Carattiere Scientifico, Policlinico S Matteo, Pavia, ItalyFAU - Moretti, C
    Abstract: OBJECTIVES: To compare the relative responsiveness of condition specific measures with that of a generic health status instrument for outcome assessment of intra-articular corticosteroid (IAC) injection in patients with juvenile idiopathic arthritis (JIA). METHODS: We examined 44 consecutive patients with oligoarticular JIA before an IAC injection and after 6 months. Condition specific measures included physician's and parent's global assessments, the Childhood Health Assessment Questionnaire (CHAQ), the articular indices, and laboratory indicators of systemic inflammation. The generic health status instrument was the Child Health Questionnaire (CHQ), which was divided into two parts: the physical score (PhS) and the psychosocial score (PsS). Responsiveness statistics were the standardised response mean, the effect size, and Guyatt's method. The discriminative ability of the clinical measures in distinguishing improved from non-improved patients was evaluated with the correlation and the receiver operating characteristic methods, using the physician's and the parent's judgements of the treatment outcome as external criteria. RESULTS: All responsiveness statistics and discriminative ability assessments consistently ranked the physician's global assessment of the disease activity as the most responsive measure. The CHQ-PhS revealed superior ability in detecting baseline versus 6 month change compared with the CHAQ and the CHQ-PsS; both summary scales of the CHQ revealed better discriminative ability than the CHAQ. CONCLUSIONS: The physician's global assessment of the disease activity proved the most responsive outcome measure in our patients with JIA. The relative evaluative properties of the generic health status instrument and the CHAQ should be further investigated

  28. MORRIS CR: Juvenile arthritis: "No child left behind" fits here, too. South Med J 98:2 136-137, 2005

  29. NIEHUES T, HORNEFF G, MICHELS H, HOCK MS, SCHUCHMANN L: Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria. Rheumatol Int 25:3 169-178, 2005
    Organism: Pediatric Immunology and Rheumatology, Department of Pediatric Oncology, Hematology and Immunology, Centre for Child Health, Heinrich-Heine-University, Dusseldorf, Germany, niehues@rzuni-duesseldorfdeFAU - Niehues, Tim
    Abstract: Juvenile idiopathic arthritis (JIA) is the most common diagnosis in children and adolescents with rheumatic disorders. In many children and adolescents, JIA is successfully treated with non-steroidal anti-inflammatory drugs (NSAID) and physiotherapy. However, in a significant number of cases the disease is resistant to this therapy, and treatment with "second line" disease-modifying antirheumatic drugs (DMARDs) is required. Methotrexate (MTX) is frequently referred to as "first-choice second-line agent" for the treatment of JIA. To increase drug safety, the Working Groups for Children and Adolescents with Rheumatic Diseases in Germany (AGKJR) and Pediatric Rheumatology Austria have initiated the formulation of evidence-based recommendations. Evidence is based on consensus expert meetings, a MEDLINE search with the key words "Methotrexate" and "juvenile arthritis" limited to age 0-18 years, standard textbooks and review articles, data from the central registry of the German Research Center for Rheumatic Diseases (Deutsches Rheumaforschungszentrum Berlin DRFZ), experience with MTX in adults with rheumatoid arthritis (RA), and recommendations of the German Society of Rheumatology (DGRh). Based on these data, evidence and recommendations are graded, and evidence-based recommendations for the use of MTX in children and adolescents with rheumatic disease are presented

  30. OZDAL PC, VIANNA RN, DESCHENES J: Visual outcome of juvenile rheumatoid arthritis-associated uveitis in adults. Ocul Immunol Inflamm 13:1 33-38, 2005
    Organism: McGill University, Department of Ophthalmology, Uveitis Service Montreal Canada pinarozdal@hotmailcomFAU - Ozdal, Pinar C
    Abstract: PURPOSE: Juvenile rheumatoid arthritis (JRA) is the systemic disease most frequently associated in childhood uveitis. The disease may cause several ocular complications, visual impairment, and blindness. Recent studies revealed a more favorable ocular prognosis. Our purpose was to analyze the long-term visual outcome of JRA-associated uveitis. METHODS: Ocular complications and visual outcome in adult patients with JRA-associated uveitis were evaluated. Among 18 patients included in the study, uveitis was bilateral in 12 (66.7%) and unilateral in six (33.3%), for a total of 30 eyes with ocular involvement. RESULTS: The mean durations of JRA and its associated uveitis were 24.9 and 20.5 years, respectively. All eyes (100%) had at least one ocular complication. The most frequently observed ocular complications were cataract (83.3%), band keratopathy (60%), posterior synechia (46.7%), glaucoma (33.3%), hypotony (16.7%), and macular pathology (13.3%). Final visual acuity was impaired in 40% of the eyes, poor in 20%, and totally lost in 10%. Therefore, 70% of the eyes were either visually handicapped or totally blind. Most eyes underwent at least one surgical procedure. Inflammation was active at last examination in 63.3% of eyes. All patients were still treated topically and with systemic NSAID. Sixty-one percent of the patients were using an immunosuppressive agent. CONCLUSION: JRA-associated uveitis still has a severe course and blinding potential. Patients suffer from uveitis and its complications even during the adulthood period. However, because our series represents a more severe subset of the disease, the outcome may be poorer than that of some other outcome studies

  31. PADMINI A, BABU R, PRATIBHA N: Complement C4 - A genetic marker in arthritides. International Journal of Human Genetics 4:3 193-196, 2004
    Abstract: The present study aims at evaluating the role of complement C4 and its specific eletromorphic association with arthritides. C4 typing of the serum samples was carried out by PAGE on 41 juvenile arthritis, 101 rheumatoid arthritis, 25 juvenile control subject and 76 adult control subjects. Complement C4 phenotype distribution revealed an increased preponderance of FS phenotype (61.0%) in juvenile arthritis, whereas in rheumatoid arthritis both FF (12.9%) and FS (70.3%) phenotypes were predominant with a significant association of FF phenotype with the condition. This reflects an association of the F allele with the condition. C4 may be one of the etiological factor in the arthritides and its role in handling the immune complex may be altered in rheumatoid arthritis

  32. PALUCKA AK, BLANCK JP, BENNETT L, PASCUAL V, BANCHEREAU J: Cross-regulation of TNF and IFN-alpha in autoimmune diseases. Proc Natl Acad Sci U S A 102:9 3372-3377, 2005
    Organism: Baylor Institute for Immunology Research, 3434 Live Oak Street, Dallas, TX 75214, USAFAU - Palucka, A Karolina
    Abstract: Cytokines, most particularly TNF and type I IFN (IFN-alphabeta), have been long considered essential elements in the development of autoimmunity. Identification of TNF in the pathogenesis of rheumatoid arthritis and TNF antagonist therapy represent successes of immunology. IFN-alphabeta plays a major role in systemic lupus erythematosus (SLE), a prototype autoimmune disease characterized by a break of tolerance to nuclear components. Here, we show that TNF regulates IFN-alpha production in vitro at two levels. First, it inhibits the generation of plasmacytoid dendritic cells (pDCs), a major producer of IFN-alphabeta, from CD34+ hematopoietic progenitors. Second, it inhibits IFN-alpha release by immature pDCs exposed to influenza virus. Neutralization of endogenous TNF sustains IFN-alpha secretion by pDCs. These findings are clinically relevant, as five of five patients with systemic juvenile arthritis treated with TNF antagonists display overexpression of IFN-alpha-regulated genes in their blood leukocytes. These results, therefore, might provide a mechanistic explanation for the development of anti-dsDNA antibodies and lupus-like syndrome in patients undergoing anti-TNF therapy

  33. PASOTO SG, ABRAO MS, VIANA VS, BUENO C, LEON EP, BONFA E: Endometriosis and systemic lupus erythematosus: a comparative evaluation of clinical manifestations and serological autoimmune phenomena. Am J Reprod Immunol 53:2 85-93, 2005
    Organism: Rheumatology Division, Medical School, University of Sao Paulo, Sao Paulo, Brazil reumato@eduuspbrFAU - Pasoto, Sandra G
    Abstract: PROBLEM: In view of evidences suggesting association between endometriosis (EM) and systemic lupus erythematosus (SLE), we have performed a comparative evaluation of clinical and humoral immunologic abnormalities in both diseases. METHOD OF STUDY: Forty-five women (18-40 years) with histologically confirmed pelvic EM, 21 healthy-women and 15 female SLE-patients (18-40 years) without surgically confirmed EM were prospectively evaluated. Immunologic investigations were performed by blinded researchers. RESULTS: None of the EM-patients fulfilled criteria for SLE. However, EM-patients presented higher frequencies of arthralgia (62%) and generalized myalgia (18%) superior than normal-controls (24%, P = 0.004/0%, P = 0.048) but comparable with SLE-patients (33%, P = 0.052/27%, P = 0.5). Similarly to SLE (7%), 9% of EM-patients presented fibromyalgia. Antinuclear antibodies (ANA) were detected in 18% of EM-sera, as compared with healthy-women (0%, P = 0.014) and SLE-patients (93%, P = 0.0005). In contrast with SLE, antibodies to dsDNA, Sm and U1RNP were negative in EM-sera. Anti-Ro and anticardiolipin antibodies were more often in SLE (40%, 33%) than in EM-patients (2%, P < 0.001/9%, P = 0.04). Elevated immune-complexes and low total complement were more frequent in SLE (40%, 13%) compared with EM-sera (7%, P = 0.005/0%, P = 0.01). CONCLUSIONS: Our data indicate differences of ANA antigenic specificity and complement consumption between EM and SLE. The high prevalence of generalized musculoskeletal complaints in EM justifies a multidisciplinary approach

  34. PAVIC M, SEVE P, MALCUS C, SARROT-REYNAULT F, PEYRAMOND D, DEBOURDEAU P, ANDRIAMANANTENA D, BOUHOUR D, PHILIPPE N, ROUSSET H, BROUSSOLLE C: [Common variable immunodeficiency with autoimmune manifestations: study of nine cases; interest of a peripheral B-cell compartment analysis in seven patients]. Rev Med Interne 26:2 95-102, 2005
    Organism: Service de medecine interne, hopital d'instruction des armees Desgenettes, 108, boulevard Pinel, 69003 Lyon, France mpavic@chellofrFAU - Pavic, M
    Abstract: PURPOSE: Autoimmune manifestations (AIM) are associated to common variable immunodeficiency (CVI) in about 20 to 25% of the cases. This study presents the clinical, biological characteristics and the evolution of nine patients developing CVI and AIM. A peripheral B-cell compartment analysis has been performed in seven cases. METHOD: This multicenter retrospective study analyses nine patients, six men and three women, within a population of 32 CVI. RESULTS: The mean age was 27 years at the time of diagnosis of AIM and 30 years at the time of diagnosis of CVI. The diagnosis of AIM preceded the diagnosis of CVI in five cases. Thirteen AIM of different types were observed: autoimmune hemolytic anemia (AHA, 3), immune thrombocytopenic purpura (ITP, 2), Evan's syndrome (2), primary biliary cirrhosis (1), rheumatoid arthritis (1), alopecia totalis (1), myasthenia gravis (1). The peripheral B-cell compartment was investigated in seven patients: five patients with autoimmune cytopenia presented with a diminution of memory B cells (CD27+IgD-) and immature B cells (CD21-) levels; the patient with primary biliary cirrhosis and myasthenia gravis had only a diminution of memory B cells level; the last patient with ITP presented with a normal level of memory B cells. Five among the seven patients with autoimmune cytopenia required a specific treatment using corticosteroids, high dosages of intravenous immunoglobulin, then splenectomy after failure of the medical management, with severe infectious complications in one case. CONCLUSION: The association of AIM and CVI is not fortuitous. The most common AIM is autoimmune cytopenia. The peripheral B-cell compartment analyses show that a majority of patients have a defect in memory B-cells. Treatment regimens are not standardized and splenectomy increases the risk of infectious complications

  35. RANGEL L, GARRALDA ME, JEFFS J, ROSE G: Family health and characteristics in chronic fatigue syndrome, juvenile rheumatoid arthritis, and emotional disorders of childhood. J Am Acad Child Adolesc Psychiatry 44:2 150-158, 2005
    Organism: Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UKFAU - Rangel, Luiza
    Abstract: OBJECTIVE: To compare family health and characteristics in children with chronic fatigue syndrome (CFS), in juvenile rheumatoid arthritis (JRA), and emotional disorders. METHOD: Parents of 28 children and adolescents aged 11 to 18 years with CFS, 30 with JRA, and 27 with emotional disorders (i.e., anxiety and/or depressive disorders) were recruited from specialty clinical settings and completed interviews and questionnaires assessing family health problems, parental mental distress, illness attitudes, and family burden of illness. RESULTS: Parents of children with CFS were significantly more likely than those of children with JRA to report a history of CFS-like illness, high levels of mental distress, and a tendency to experience functional impairment in response to physical symptoms. Families of children with CFS were characterized by significantly greater emotional involvement and reported greater family burden related to the child's illness in comparison with families of children with JRA. CONCLUSIONS: CFS in childhood and adolescence is associated with higher levels of parental CFS-like illness, mental distress, emotional involvement, and family illness burden than those observed in association with JRA, a chronic pediatric physical illness

  36. RETHY LA, BAL-BANGA JM: The allergic and other side effects of non-steroid antiinflammatory drugs and gold salts
    <ORIGINAL> Nem-szteroid gyulladascsokkentok es az aranysok allergies es egyeb mellekhatasai    . Orv Hetil 145:38 1943-1949, 2004
    Abstract: The wider usage of non steroid antiinflammatory drugs (NSAIDs) raises the significance of their side effects. The discovery of the two different cyclo-oxigenases (COX 1 and COX-2) led to the incorporation of more selective enzyme inhibitors into the therapeutic tools against disorders with pain and inflammation, in order to minimize the frequency of the side effects. Selective COX-2 inhibitors are well tolerated by most of the patients with a history of sensitivity against classical NSAIDs. The well-known gastrointestinal side effects (ulcers, bleedings) are much less frequent in the case of selective COX-2 inhibitors in comparison with non-selective COX inhibitors. However, the lack of "healing" prostaglandins as an effect of COX-2 antagonism may prevent the improvement of existing ulcers. In addition almost all other organs have been found to be affected in COX-2 knockout mice (COX-2 paradoxon). Hepatotoxicity is usually rare, its reason is most probably idiosyncrasy. Persistent nephropathy can be worsened by the inhibition of COX-2, however normal renal functions have not been changed in humans using selective COX-2 inhibitors. Authors' registry consists of 1000 patients with a history of suspected drug-allergy, during a 15 years' period. Approximately 30% of the cases have been connected with NSAIDs and with antirheumatic dr ugs. Because of functional similarities gold salts, proved suitable for the treatment of juvenile rheumatoid arthritis (JRA) and of osteoarthritis (OA) were included as well. Besides rheumatologic applications the second most common indication for these drugs was pain and/or fever. Among cutaneous symptoms intolerance was present at a relatively low frequency -as salicylates had not been taken into consideration. Next to salicylates the most frequent side effects were caused by pyrazolon derivates. Urticaria and angioedema were the most frequently observed symptoms on the skin - our observations are in accordance with other publications. Conclusions: Nonselective NSAIDs show a mixed effect of inhibitions of COX-1 and COX-2. The most important indications of modern selective COX-2 inhibitors are: 1. Prevention of the gastrointestinal side effects 2. Avoidance of cross-sensitivity against non-selective NSAIDs

  37. ROVENSKA E, STVRTINA S, GREGUSKA O, PRAVDA L, ROVENSKY J: Conspicuous synovial lymphatic capillaries in juvenile idiopathic arthritis synovitis with rice bodies. Ann Rheum Dis 64:2 328-329, 2005

  38. RUPERTO N, NIKISHINA I, PACHANOV ED, SHACHBAZIAN Y, PRIEUR AM, MOUY R, JOOS R, ZULIAN F, SCHWARZ R, ARTAMONOVA V, EMMINGER W, BANDEIRA M, BUONCOMPAGNI A, FOELDVARI I, FALCINI F, BAILDAM E, KONE-PAUT I, ALESSIO M, GERLONI V, LENHARDT A, MARTINI A, HANFT G, SIGMUND R, SIMIANER S: A randomized, double-blind clinical trial of two doses of meloxicam compared with naproxen in children with juvenile idiopathic arthritis: short- and long-term efficacy and safety results. Arthritis Rheum 52:2 563-572, 2005
    Organism: IRCCS G Gaslini, Pediatria II, Reumatologia, Genoa, Italy nicolaruperto@ospedale-gaslinigeit <nicolaruperto@ospedale-gaslinigeit>FAU - Ruperto, Nicolino
    Abstract: OBJECTIVE: In an international, multicenter, double-blind, randomized clinical trial we evaluated the short-term (3 months) and long-term (12 months) efficacy and safety of 2 different doses of meloxicam oral suspension compared with the efficacy and safety of naproxen oral suspension in children with oligoarticular-course (oligo-course) or polyarticular-course (poly-course) juvenile idiopathic arthritis (JIA). METHODS: Children ages 2-16 years who had active oligo-course or poly-course JIA and who required therapy with a nonsteroidal antiinflammatory drug were eligible for this trial. Patients were randomly allocated to receive therapy with meloxicam oral suspension, 0.125 mg/kg body weight in a single daily dose; meloxicam oral suspension, 0.25 mg/kg body weight in a single daily dose; or naproxen, 10 mg/kg body weight in 2 daily doses. The trial drugs were administered in a double-blind, double-dummy design for up to 12 months. Response rates were determined according to the American College of Rheumatology pediatric 30% improvement criteria (ACR pediatric 30). Safety parameters were assessed by evaluating the frequency of adverse events in the 3 groups. RESULTS: Of 232 patients enrolled, 225 received treatment, 6 were not eligible for randomization, and 1 randomized patient was not treated. One hundred eighty-two patients (81%) completed the 12-month treatment period. Response rates according to the ACR pediatric 30 criteria improved from month 3 to month 12, as follows: from 63% to 77% in the meloxicam 0.125 mg/kg group, from 58% to 76% in the meloxicam 0.25 mg/kg group, and from 64% to 74% in the naproxen group. No statistically significant differences in response rates were observed between the groups. There were no differences in the frequency of adverse events or abnormal laboratory values between the 3 groups. CONCLUSION: The short- and long-term safety and efficacy of meloxicam oral suspension appear to be comparable with the safety and efficacy of naproxen oral suspension in the treatment of oligo-course and poly-course JIA. The once-daily administration of meloxicam oral suspension might represent an improvement in the treatment of JIA

  39. SAARI T, CARLSSON L, KARLSSON J, KARRHOLM J: Knee kinematics in medial arthrosis. Dynamic radiostereometry during active extension and weight-bearing. J Biomech 38:2 285-292, 2005
    Organism: Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg University, Goteborg, S41345, SwedenFAU - Saari, Tuuli
    Abstract: We studied the kinematics of the knee during weight-bearing active extension in 14 patients with medial osteoarthrosis (OA) and in 10 controls using dynamic radiostereometry. Between 50 degrees and 20 degrees of extension the OA knees showed decreased internal tibial rotation corresponding to less posterior displacement of the lateral femoral flexion facet center. The midpoint between the two tips of the tibial intercondylar eminence occupied a more posterior position within the range of motion analyzed. The observed changes were similar to those previously recorded in chronic tear of the anterior cruciate ligament. Patients with medial arthrosis of the knee joint show a specific and abnormal pattern of joint motion

  40. SCHEEL AK, BACKHAUS M, KLOSE AD, MOA-ANDERSON B, NETZ UJ, HERMANN KG, BEUTHAN J, MULLER GA, BURMESTER GR, HIELSCHER AH: First clinical evaluation of sagittal laser optical tomography for detection of synovitis in arthritic finger joints. Ann Rheum Dis 64:2 239-245, 2005
    Organism: Department of Medicine, Nephrology and Rheumatology, Georg-August-University Gottingen, Robert-Koch-Strasse 40, D-37075 Gottingen, Germany ascheel@gwdgdeFAU - Scheel, A K
    Abstract: OBJECTIVE: To identify classifiers in images obtained with sagittal laser optical tomography (SLOT) that can be used to distinguish between joints affected and not affected by synovitis. METHODS: 78 SLOT images of proximal interphalangeal joints II-IV from 13 patients with rheumatoid arthritis were compared with ultrasound (US) images and clinical examination (CE). SLOT images showing the spatial distribution of scattering and absorption coefficients within the joint cavity were generated. The means and standard errors for seven different classifiers (operator score and six quantitative measurements) were determined from SLOT images using CE and US as diagnostic references. For classifiers showing significant differences between affected and non-affected joints, sensitivities and specificities for various cut off parameters were obtained by receiver operating characteristic (ROC) analysis. RESULTS: For five classifiers used to characterise SLOT images the mean between affected and unaffected joints was statistically significant using US as diagnostic reference, but statistically significant for only one classifier with CE as reference. In general, high absorption and scattering coefficients in and around the joint cavity are indicative of synovitis. ROC analysis showed that the minimal absorption classifier yields the largest area under the curve (0.777; sensitivity and specificity 0.705 each) with US as diagnostic reference. CONCLUSION: Classifiers in SLOT images have been identified that show statistically significant differences between joints with and without synovitis. It is possible to classify a joint as inflamed with SLOT, without the need for a reference measurement. Furthermore, SLOT based diagnosis of synovitis agrees better with US diagnosis than CE

  41. SHANIDZE ES, ZHVANIIA MA: [Activity of lipid peroxidation processes in children with rheumatic fever]. Georgian Med News2 55-57, 2005
    Abstract: Pathogenic mechanism of acute and chronic inflammation is connected to the increased production of superoxide anion, hydrogen peroxide, and other free radicals. Clinical role of lipid peroxidation (LPO) processes was studied in 38 patients in the age from 3 to 15 years old with different variants of Rheumatic Fever (RF). We have investigated the relationship between malonidialdehide (MDA) and RF. We measured the levels of MDA in the plasma in patients with acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD). Our study revealed that the levels of MDA in patients with ARF are significantly higher than in patients with CRHD. These levels were also significantly higher in patients with history of disease for up to 2 years, than in patients with history longer than 2 years. Thus, the measurement of MDA in the plasma could be used as a laboratory test for relation of active state of rheumatic fever

  42. SILVERMAN E, SPIEGEL L, HAWKINS D, PETTY R, GOLDSMITH D, SCHANBERG L, DUFFY C, HOWARD P, STRAND V: Long-term open-label preliminary study of the safety and efficacy of leflunomide in patients with polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum 52:2 554-562, 2005
    Organism: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada earlsilverman@sickkidsca <earlsilverman@sickkidsca>FAU - Silverman, Earl
    Abstract: OBJECTIVE: To obtain preliminary data regarding the efficacy and long-term safety of leflunomide in patients with refractory polyarticular-course juvenile rheumatoid arthritis (JRA). METHODS: Twenty-seven patients were entered into the initial 26-week open-label study of leflunomide therapy; 17 entered the extension phase (maximum 107 weeks). Mean disease duration at study entry was 7.0 years. All patients had >or=5 joints with active arthritis and had received methotrexate for a mean of 36.0 months. Following a loading dose, patients initially received leflunomide at a dosage of 10 mg/1.73 m(2)/day, which could be increased to 20 mg/1.73 m(2)/day (maximum 20 mg/day) beginning at week 8. The primary efficacy outcome was the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) criteria for improvement. Last observation carried forward (LOCF) analysis was used, and all patients were entered into an intent-to-treat analysis. Intraarticular corticosteroids (maximum of 2 in the initial 26 weeks) were allowed, but no new disease-modifying antirheumatic drug or change in nonsteroidal antiinflammatory drug was allowed throughout the study. RESULTS: Seventeen of the 27 patients (63%) completed the initial 26-week study. Fourteen patients (52%) met the ACR Pedi 30 response criteria at week 26. Seventeen patients entered into the extension phase (13 who met response criteria and 4 who failed to meet response criteria but decided to continue). Nine of the 17 patients (53%) who entered the extension phase either completed all 30 months of study or the study ended prior to the month 30 visit. Five patients withdrew because of failure to maintain efficacy, 2 withdrew their consent, and 1 withdrew because of an adverse event. Using LOCF analysis, 65% of patients met ACR Pedi 30 response criteria at 1 year and 2 years (weeks 50 and 106, respectively) and 53% at the end of the study. Good response rates were also seen using ACR Pedi 50 and ACR Pedi 70 criteria (47% and 24% at week 106, respectively). CONCLUSION: In this open-label study of JRA patients who either failed to respond to, or were intolerant of, methotrexate, the majority met the ACR Pedi 30 response criteria at week 26. The response was durable, since 53% of patients who entered into the extension phase (maximum 30 months) responded at the end of this phase. Our findings support the further study of the role of leflunomide in the treatment of polyarticular-course JRA

  43. SMITH JA, THOMPSON DJ, WHITCUP SM, SUHLER E, CLARKE G, SMITH S, ROBINSON M, KIM J, BARRON KS: A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis. Arthritis Rheum 53:1 18-23, 2005
    Organism: National Eye Institute, NIH, Bethesda, Maryland, USA smithj@neinihgovFAU - Smith, Janine A
    Abstract: OBJECTIVE: To investigate the safety and efficacy of etanercept in the treatment of uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Children who met the American College of Rheumatology diagnostic criteria for JIA with active uveitis, who had anterior chamber cells of >/=1+ or requiring topical corticosteroid >/=3 times daily, and who were on a stable regimen for arthritis treatment were eligible. Study participants received etanercept (0.4 mg/kg) or placebo administered subcutaneously twice weekly for 6 months. All participants received open-label etanercept for an additional 6 months. RESULTS: Five patients received placebo and 7 received etanercept. Three of the 7 patients treated with etanercept and 2 of the 5 placebo-treated patients were considered ophthalmic successes (P = 1.0). One patient in each treatment group was considered a treatment failure. Three of the 7 etanercept-treated and 2 of the 5 placebo-treated patients were neither successes nor failures by our definition. There were no serious adverse events for any patient during the entire study period. Reports of minor infections were comparable in each treatment group, 71% for etanercept and 60% for placebo (P = 0.58). CONCLUSION: In this small pilot study there was no apparent difference in the anterior segment inflammation between patients treated with etanercept and placebo. The stringent criteria used to measure ophthalmic success of treatment and the small patient population limit the implications of our findings

  44. SMOLEWSKA E, BROZIK H, SZEWCZYK M, BIERNACKA-ZIELINSKA M, NIWALD M, STANCZYK J: Safety and efficacy of methylprednisolone pulse therapy in children with systemic inflammatory connective tissue diseases
    BEZPIECZENSTWO I SKUTECZNOSC STOSOWANIA PULSOW Z METYLPREDNIZOLONU W UKl(stroke)ADOWYCH ZAPALNYCH CHOROBACH TKANKI l(stroke)ACZNEJ U DZIECI    . Reumatologia (Poland ) 42:4 515-524, 2004
    Abstract: The aim of this study was to evaluate the safety and efficacy of methylprednisolone pulse therapy (MPT) in children with systemic inflammatory connective tissue diseases. 22 children (18 girls and 4 boys) in the age from 4 to 18 with juvenile idiopathic arthritis (15), systemic lupus erythematosus (4), periarteritis nodosa (1), dermatomyositis (1) and erythema nodosum (1) were treated with methylprednisolone (20 mg/kg max. 1 g) in 3 hour intravenous infusion. Hemoglobin, red blood cells count, white blood cells and platelet count, ESR and CRP were measured on admission and before discharging, the level of serum electrolytes and glucose were measured prior and after the pulse. Holter ECG monitoring during the infusion and standard ECG before and after that were performed in every patient. Blood pressure was measured before, during and 6 hours after methylprednisolone infusion. 21 of 22 children responded to the therapy with clinical and laboratory improvement. A statistically significant reduction of ESR and CRP (p < 0.05) was obtained. Mild increase of glucose (p < 0.05) level was observed on the next day af ter the pulse. All adverse effects of the therapy were benign and transient. In 3 cases mild hypertension was observed during and on the next day after infusion which required short treatment with hypotensive drugs. Arrhythmias registered during Holter monitoring were not life-threatening, mostly supra- and ventricular extrasystolies, and short episodes of brady- and tachycardia. The results of our study revealed high efficacy of MPT. Such therapy seems to be safe but the possibility of severe adverse effects can not be fully excluded

  45. SMOLEWSKA E, BROZIK H, KIERZKOWSKA B, STANCZYK J, JANUS A, URBANSKA-RYS H, ROBAK T, SMOLEWSKI P: Reactive haemophagocytic syndrome with early relapse in the course of systemic juvenile idiopathic arthritis in a 16-year old patient
    ZESPOl(stroke) AKTYWACJI MAKROFAGOW Z WCZESNYM NAWROTEM U 16-LETNIEJ PACJENTKI W PRZEBIEGU UKl(stroke)ADOWEJ POSTACI Ml(stroke)ODZIEN CZEGO IDIOPATYCZNEGO ZAPALENIA STAWOW    . Acta Haematologica Polonica (Poland ) 35:4 567-575, 2004
    Abstract: Reactive haemophagocytic syndrome (RHS) is poorly known, life threatening complication of different disorders, occurring most often in both adult patients and children with connective tissue diseases. The main symptoms of RHS are high fever, hepatosplenomegaly and pancytopenia. Since the course of the disease tends to be dramatic, the syndrome has to be diagnosed early and very intensively treated. Authors present the case of a girl with juvenile idiopathic arthritis in whom RHS developed after approximately one year of treatment. Despite intensive treatment the patient died from multiple organ dysfunctions

  46. STAGI S, GIANI T, SIMONINI G, FALCINI F: Thyroid function, autoimmune thyroiditis and coeliac disease in juvenile idiopathic arthritis. Rheumatology (Oxford) 44:4 517-520, 2005
    Organism: Department of Paediatrics, University of Florence, ItalyFAU - Stagi, S
    Abstract: OBJECTIVES: Autoimmune diseases have been associated with some organ non-specific rheumatological disorders such as rheumatoid arthritis and systemic lupus erythematosus; however, few studies have been performed in an extensive cohort of children with juvenile idiopathic arthritis (JIA). Our objective was to evaluate the thyroid function and the prevalence of antithyroid antibodies, autoimmune thyroiditis and coeliac disease in children with JIA. METHODS: One hundred and fifty-one children (120 female, 31 male, median age 8.3 yr, range 2.4-16.9 yr) with JIA were evaluated. All patients underwent thyroid function tests (u-TSH, free T(4) and free T(3)), antithyroglobulin (TgA) and antiperoxidase (TPOA) antibodies, antigliadin, anti-endomysium and antitransglutaminase antibodies. All patients with raised thyroid stimulating hormone levels, low thyroid hormone levels or positive TPOA and/or TgA values had a thyroid high-resolution sonography examination. Coeliac disease was confirmed by jejunal biopsy if the specific antibodies profile was positive. One hundred and fifty-eight age- and sex-matched Caucasian children from the same geographical area acted as controls. RESULTS: Fourteen (9.3%) patients showed subclinical hypothyroidism, 17 (11.9%) patients showed autoimmune thyroiditis with nine patients also showing a non-homogeneous thyroid parenchyma at ultrasound evaluation. Coeliac disease was demonstrated in 10 (6.6%) patients. Compared with controls, JIA patients had higher prevalence of subclinical hypothyroidism (P < 0.01), autoimmune thyroiditis (P < 0.0001) and coeliac disease (P < 0.005). CONCLUSIONS: JIA children have an increased prevalence of autoimmune thyroiditis, subclinical hypothyroidism and coeliac disease. These data seem to suggest careful monitoring of thyroid function, thyroid autoantibodies and coeliac disease in JIA children

  47. STARK LJ, JANICKE DM, MCGRATH AM, MACKNER LM, HOMMEL KA, LOVELL D: Prevention of Osteoporosis: A Randomized Clinical Trial to Increase Calcium Intake in Children with Juvenile Rheumatoid Arthritis. J Pediatr Psychol 30:5 377-386, 2005
    Organism: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Division of Psychology, SEC-4, Cincinnati, Ohio 45229 loristark@chmccorg
    Abstract: OBJECTIVE:To test the efficacy of a behavioral intervention (BI) compared to an enhanced standard of care (ESC) dietary counseling on increasing dietary calcium (Ca) intake in children with juvenile rheumatoid arthritis (JRA). METHODS:Three-day food diaries collected at baseline and posttreatment were analyzed for Ca intake in 49 children with JRA randomly assigned to either BI or an ESC treatment. RESULTS:Children in the BI (N = 25) demonstrated a significantly greater increase in average dietary Ca intake (M = 839) than children in the ESC (N = 24; M = 420) (F = 14.39; p < .001). Post hoc analysis revealed that children in both groups demonstrated significant gains in dietary Ca intake baseline to posttreatment. A significantly greater percentage of children in the BI (92%) attained the goal of 1500 mg/Ca at posttreatment compared to the ESC (17%), X(2) = 28.09; p < .001. CONCLUSIONS:Behavioral intervention can have a positive impact on increasing dietary Ca intake. Future research will need to evaluate the maintenance of gains in dietary Ca intake following treatment cessation and the impact of increased Ca intake on bone mineral density

  48. TRAN TH, MILEA D, CASSOUX N, BODAGHI B, BOURGEOIS P, LEHOANG P: [Optic neuritis associated with infliximab]. J Fr Ophtalmol 28:2 201-204, 2005
    Organism: Service d'Ophtalmologie, 75013 Paris, FranceFAU - Tran, T H C
    Abstract: Infliximab is a chimeric human-murine monoclonal antibody of the IgG1 type with a high affinity and specificity for tumor necrosis factor alpha (TNFalpha). Infliximab was used in Crohn disease, rheumatoid arthritis, spondyloarthropathy, juvenile idiopathic arthritis, Behcet's disease, Wegener's granulomatosis, HLA-B27-associated uveitis and chronic severe refractory uveitis. Reported adverse effects of this treatment were infections, development of antinuclear antibodies and anti double-stranded DNA, lymphomas, and exacerbation of demyelinating disease. We report a case of infliximab-associated optic neuritis with favorable outcome after systemic steroid treatment