Bibliography April 05

1. ADIB N, SILMAN A, THOMSON W: Outcome following onset of juvenile idiopathic inflammatory arthritis: I. Frequency of different outcomes. Rheumatology (Oxford) .: 2005
   Organism: Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester Medical School, Manchester M13 9PT, UK
   Abstract: Objective. To determine the outcome, following the onset of juvenile idiopathic inflammatory arthritis, in terms of remission of disease activity, loss of function and structural damage based on a review of the available published data. Methods. Electronic databases were searched for major studies publishing outcome data in the past 10 yr in juvenile idiopathic arthritis, juvenile rheumatoid arthritis and juvenile chronic arthritis, and 21 studies were selected. The proportions of children in the different categories of the outcomes of interest are described. Data were stratified where possible by disease subtype. Results. There were major differences between the studies reviewed in terms of study design, case selection and the results obtained. In general, children with systemic- or polyarticular-onset disease were much less likely to go into remission than those with oligoarticular onset, although the remission rates in the latter group ranged from 36 to 84%. Several different approaches were used to assess functional outcome but the pattern of results between the different subgroups was the same as with remission. Similarly, children with polyarticular disease in all the cohorts reviewed were substantially more likely to have erosive radiological damage on follow-up. The rates of individual outcomes, even within a subgroup, varied considerably between studies and this does not appear to be explained solely by differences in methodology. Conclusions. There remains a considerable lack of clarity in the prognosis following onset of juvenile idiopathic arthritis for the major outcomes considered, although those with oligoarthritis at presentation have the best outcome. The ability to offer accurate prognosis is particularly important to both reassure parents and guide treatment at disease onset. To achieve this, large definitive prospective studies will be required

2. ADIB N, SILMAN A, THOMSON W: Outcome following onset of juvenile idiopathic inflammatory arthritis: II. Predictors of outcome in juvenile arthritis. Rheumatology (Oxford) .: 2005
   Organism: Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester Medical School, Manchester M13 9PT, UK
   Abstract: Objective. To assess the relative contributions of demographic, clinical and laboratory variables in predicting outcome in juvenile idiopathic inflammatory arthritis (JIA), based on a review of the existing literature. Methods. Electronic reference database searches for the previous 10 yr were conducted and studies examining the role of major potential predictors of main outcomes were identified. Where possible, subjects were grouped by JIA disease subtype. In addition to demographic variables, the following disease-related predictors were assessed: nature of joint involvement, acute-phase response, and presence of autoantibodies. These were then analysed for three main outcomes of interest: remission as assessed by disease activity; functional impairment; and structural damage as assessed by radiological joint erosions. Results. In general, female gender, polyarticular and symmetrical joint involvement, elevated inflammatory markers and rheumatoid factor positivity were the most consistent predictors of a poor outcome, although the studies were frequently inconsistent in both the direction and the magnitude of the effects. Conclusions. These data are too variable to accurately identify those predictors associated with poor outcome following the onset of JIA. Although some of this variation may be the result of true differences between study populations, the vast majority of inconsistencies are explainable by the absence of standardized classification systems, outcome definitions, therapeutic approach and research tools. More comprehensive prospective evaluation is required before robust prediction models can be generated

3. ANTHONY KK, SCHANBERG LE: Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am 52:2 611-39, vii, 2005
   Organism: Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3527, Durham, NC 27710, USAFAU - Anthony, Kelly K
   Abstract: This article introduces important issues related to pain in children with musculoskeletal pain syndromes and rheumatic disease, using juvenile primary fibromyalgia syndrome (JPFS) and juvenile idiopathic arthritis (JIA) as models. A brief summary of the prevalence of pain in healthy children is followed by a summary of existing pain-assessment techniques. The remainder of the article describes the pain experience of children with JPFS and JIA and discusses issues related to pain management

4. BABYN P, DORIA AS: Radiologic investigation of rheumatic diseases. Pediatr Clin North Am 52:2 373-411, vi, 2005
   Organism: Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada paulbabyn@sickkidsoncaFAU - Babyn, Paul
   Abstract: This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis

5. BENEZRA D, COHEN E, MAFTZIR G: Uveitis in children and adolescents. Br J Ophthalmol 89:4 444-448, 2005
   Organism: Pediatric Ophthalmology and Immuno-Ophthalmology Unit, Hadassah Hebrew University Hospital, PO Box 12000, Jerusalem 91120, Israel benezra@mdhujiacilFAU - BenEzra, D
   Abstract: AIMS: To study the relative occurrence of uveitis (intraocular inflammation) and its causes in children and adolescents. METHODS: Patients with uveitis examined and followed during a period of 10 years were categorised by age and sex. All underwent ocular examination and an individually tailored battery of laboratory tests. The intraocular manifestations were classified according to the anatomical location of the inflammation and their most probable cause. The final diagnosis was based on typical clinical ocular and extraocular symptoms and signs and on the results of specific laboratory investigations. RESULTS: Out of 821 patients, 276 (33.1%) were 18 years of age or younger with a male to female ratio of 1 to 1. In these 276 children and adolescents, 70.3% had bilateral ocular involvement. Intermediate uveitis was the most frequent anatomical diagnosis. In many cases, symptoms were mild despite the prominent signs and marked decrease of vision. The underlying cause for the uveitis was evaluated as non-infectious in 184 cases (66.7%) and infectious in 92 cases (33.3%). A potential aetiology and/or a definite clinical diagnosis were established in 74.6% of the cases and only 25.4% of the 276 patients were classified as idiopathic. Juvenile idiopathic arthritis (JIA) was the most common systemic disease association diagnosed in 14.9% of these children. Parasite infestation was the most common infectious association. CONCLUSIONS: Uveitis in children and adolescents is not as low as previously reported. Parasite infestation on the one hand and JIA on the other hand are the most common aetiologies associated with the uveitis in these young patients

6. BHATTACHARYA N: Placental umbilical cord whole blood transfusion: a safe and genuine blood substitute for patients of the under-resourced world at emergency. J Am Coll Surg 200:4 557-563, 2005
   Organism: Bijoygarh State Hospital, and Moore Avenue Government Specialist Polyclinic, Calcutta 700040, IndiaFAU - Bhattacharya, Niranjan
   Abstract: BACKGROUND: Afterbirth or placenta is normally discarded. But placental cord blood, because of its rich mix of fetal and adult hemoglobin, plasma, and high platelet count has the potential to be a safe alternative to adult blood. STUDY DESIGN: We transfused 413 U (range 50 mL to 146 mL; mean 86 mL+/-7.6 mL SD; median 80 mL; mean packed cell volume 48+/-4.1% SD; mean hemoglobin concentration 16.2 g/dL+/-1.8 g/dL SD) of placental umbilical cord whole blood, after lower uterine cesarean section from consenting mothers, to 129 informed consenting patients, after screening by the institutional ethics committee, from April 1, 1999, until the present. RESULTS: The list of consenting patients included 54 men and 75 women. Patient age varied from 2 years to 86 years. Seventy-three patients (56.58%) suffered from advanced cancer and 56 (43.42%) patients had other diseases like ankylosing spondylitis, lupus erythematosus, rheumatoid arthritis, aplastic anemia, and thalassemia major. We have not encountered a single case of immunologic or nonimmunologic reaction so far. CONCLUSIONS: We suggest that medical institutions could use this gift of nature, which is free from infection, hypoantigenic with altered metabolic profile, filled with growth factor and cytokine-filled plasma, with the potential of higher oxygen-carrying capacity than adult blood, as an emergency source of blood for the management of disaster or crises anywhere in the world. It also may be safely used for the treatment of malignant and nonmalignant disorders

7. CHINNIAH K, MODY GM, BHIMMA R, ADHIKARI M: Arthritis in association with human immunodeficiency virus infection in Black African children: causal or coincidental? Rheumatology (Oxford) .: 2005
   Organism: Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Private Bag X7, Congella, 4013, South Africa
   Abstract: Objectives. To compare human immunodeficiency virus (HIV)-infected and HIV-uninfected children with arthritis of unknown origin to determine whether the association between HIV infection and arthritis is causal or coincidental. Method. Retrospective review of 132 children with arthritis who were tested for HIV infection. Results. Thirty-five (27%) of the children were HIV infected and the male to female ratio was 2.5:1 (P = 0.02). Arthritis was the presenting feature of HIV infection in 78% of these children. The remaining 97 (73%) were diagnosed as having juvenile idiopathic arthritis. 'Spondyloarthropathy-like' features were found in 34% of HIV-infected children compared with 5% of uninfected children. Conclusion. The high prevalence of HIV infection in 27% of children, the predominance of males and the increased prevalence of 'spondyloarthropathy-like' features, supports a causal relationship between HIV infection and arthritis

8. CULLIGAN B: Orbital myositis following streptococcal pharyngitis in a pediatric patient. Optometry 76:4 250-258, 2005
   Organism: US Public Health Service, Indian Health Service, Tohatchi Health Center, Tohatchi, New Mexico 87325, USA brianculligan@gimcihsgovFAU - Culligan, Brian
   Abstract: BACKGROUND: Orbital myositis is a relatively rare ocular inflammatory disease. It is currently classified as an idiopathic orbital inflammatory disease, but has been associated with ocular and systemic disorders, including scleritis, rheumatoid arthritis, Crohn's disease, and systemic lupus erythematosis. Orbital myositis has also been associated with infectious disease such as streptococcal pharyngitis, viral upper respiratory infection, and Borrelia burgdorferi infection. CASE REPORT AND DISCUSSION: This report documents treatment and imaging of a 13-year-old boy who had an episode of right-sided orbital myositis following streptococcal pharyngitis with anti-streptolysin-o (ASO) titer elevation to 1,188 IU/ml. Clinically, this patient demonstrated acute onset of marked restriction and mild under-action of the lateral rectus muscle of the right eye. Thickening of the lateral and medial recti was demonstrated on computed tomography. The mild orbital myositis was treated with oral nonsteroidal anti-inflammatory drug therapy. The nonconcomitant strabismus resolved approximately 7 weeks after initial presentation. General orbital inflammatory disease management and the association of upper respiratory tract infection with orbital myositis are discussed. CONCLUSION: Orbital myositis is a distinct clinical entity that can occur after streptococcal upper respiratory infection, consisting of pain on ocular movement, localized swelling, restrictive strabismus, and inflammatory signs of the involved muscle(s)

9. DUFFY CM: Measurement of health status, functional status, and quality of life in children with juvenile idiopathic arthritis: clinical science for the pediatrician. Pediatr Clin North Am 52:2 359-72, v, 2005
   Organism: Division of Paediatric Rheumatology, Montreal Children's Hospital, 2300 Tupper Street, Room C503, Montreal, Quebec, H3H 1P3 Canada ciaranduffy@muhcmcgillcaFAU - Duffy, Ciaran M
   Abstract: Several groups have undertaken research on health status, functional status, and quality of life in the pediatric rheumatic diseases, particularly juvenile idiopathic arthritis (JIA) and juvenile rheumatoid arthritis. This article highlights the principles involved in this type of measurement, discusses the measures that have been developed for JIA, and describes the outcomes determined from recent retrospective and prospective longitudinal outcome studies. These studies suggest that although there has been improvement in overall outcomes, significant numbers of individuals persist with active disease into adulthood and have significant damage, reduced functional ability, and disability

10. FERREIRA AC, ALMEIDA S, TAVARES M, CANEDO P, PEREIRA F, REGALO G, FIGUEIREDO C, TRINDADE E, SERUCA R, CARNEIRO F, AMIL J, MACHADO JC, TAVARELA-VELOSO F: NOD2/CARD15 and TNFA, but not IL1B and IL1RN, are associated with Crohn's disease. Inflamm Bowel Dis 11:4 331-339, 2005
    Organism: Institute of Molecular Pathology and Immunology of the University of Porto, Porto, PortugalFAU - Ferreira, Antonio Carlos
    Abstract: BACKGROUND: NOD2/CARD15 was described as the first susceptibility gene to Crohn's disease (CD). Polymorphisms in the TNFA gene and in the IL1 gene cluster, which are associated with an enhanced chronic inflammatory response, may also play a role in the development of CD. The aim of this study was to determine the association of polymorphisms in the CARD15, TNFA, IL1B, and IL1RN genes with risk of development of CD and with the clinicopathological profile of CD patients. METHODS: In a case-control study including 235 CD patients and 312 controls (929 controls for TNFA genotyping), the CARD15 (R702W, G908R, and 1007fs), TNFA (-308G/A and -857C/T), IL1B (-511C/T), and IL1RN (intron 2 variable number of tandem repeats) polymorphisms were genotyped. RESULTS: We observed a significant association between CD and the CARD15 polymorphisms, with an odds ratio (OR) of 2.9 [95% confidence interval (CI), 1.9 to 4.6] for carriers of 1 variant allele and an OR of 11.8 (95% CI, 3.5 to 40.4) for carriers of 2 variant alleles. Patients with CARD15 polymorphisms had more frequently ileal or ileocolonic disease location, stricturing phenotype, abdominal surgery, and no extraintestinal manifestations. The TNFA-308A/A genotype was associated with susceptibility to CD with an OR of 3.0 (95% CI, 1.2 to 7.2). TNFA-308A/A homozygotes showed a higher frequency of erythema nodosum and arthritis, colonic disease location, and absence of abdominal surgery. No associations were found with the TNFA-857, IL1B-511, and the IL1RN VNTR polymorphisms. CONCLUSIONS: These findings suggest that CARD15 and TNFA-308 genetic polymorphisms are associated with increased risk of CD displaying distinct clinicopathological profiles

11. FROSCH M, METZE D, FOELL D, VOGL T, SORG C, SUNDERKOTTER C, ROTH J: Early activation of cutaneous vessels and epithelial cells is characteristic of acute systemic onset juvenile idiopathic arthritis. Exp Dermatol 14:4 259-265, 2005
    Organism: Institute of Experimental Dermatology, University of Munster, GermanyFAU - Frosch, Michael
    Abstract: In biopsies of 16 patients (mean: 5.2 years) with acute systemic onset juvenile idiopathic arthritis (SOJIA), we analysed the initial cellular events during the characteristic cutaneous rash for composition of the infiltrate and for expression of activation markers on epithelial and endothelial cells. Despite the fleeting nature of the rash, there was a characteristic infiltration of neutrophils and monocytes, accompanied by a marked expression of endothelial adhesion receptors. In addition, we found a general activation of the cutaneous epithelium reflected by the expression of the pro-inflammatory S100-proteins - myeloid-related protein 8 (MRP8) and MRP14. In responders to therapy, follow-up biopsies showed a complete normalization of these inflammatory parameters, whereas non-responders presented with continuous signs of activation. In conjunction with the high level of epithelial activation, we detected an infiltrate of leucocytes within epithelium of sweat gland ducts during active SOJIA. Such a pattern has not been described for other inflammatory skin diseases nor did we find it in biopsies from nine patients with acute urticaria. It was accompanied by exclusive expression of MRP8, but not MRP14 by the secretory cells of sweat glands. Because MRP8 and MRP14, released by epithelial cells, exhibit pro-inflammatory effects on endothelial cells and leucocytes, the particular expression pattern of MRP8 and MRP14 in SOJIA is likely to represent a decisive early constitutive component in this inflammatory disease. Their differential expression further points to distinct roles of the individual molecules in inflammatory processes

12. KILIC SS: Anti-tumour Necrosis Factor-Alpha Treatment of Juvenile Idiopathic Arthritis in a Patient with Common Variable Immunodeficiency. J Trop Pediatr 51:3 194-195, 2005
    Organism: Uludag University Medical Faculty, Department of Pediatrics, Bursa, TurkeyFAU - Kilic, Sara Sebnem

13. LELIEVELD OT, TAKKEN T, VAN DER NJ, VAN WEERT E: Validity of the 6-minute walking test in juvenile idiopathic arthritis. Arthritis Rheum 53:2 304-307, 2005
    Organism: University Hospital Groningen, Groningen, The Netherlands OTHMLelieveld@revazgnlFAU - Lelieveld, Otto T H M

14. MACKIE S, KEAT A: Poststreptococcal reactive arthritis (PSRA): a plea for diagnostic criteria: reply. Rheumatology (Oxford) 44:1 136-137,

15. MERKESDAL S, RUOF J, HUELSEMANN JL, MITTENDORF T, HANDELMANN S, MAU W, ZEIDLER H: Indirect cost assessment in patients with rheumatoid arthritis (RA): comparison of data from the health economic patient questionnaire HEQ-RA and insurance claims data. Arthritis Rheum 53:2 234-240, 2005
    Organism: Division of Rheumatology, Hannover Medical School, Hannover, Germany MerkesdalSonja@Mh-HannoverdeFAU - Merkesdal, Sonja
    Abstract: OBJECTIVE: To render information on the accuracy of patient-reported indirect cost data compared with payer-derived data of the real indirect costs on a patient-by-patient basis concerning disease-related productivity losses in rheumatoid arthritis (RA). METHODS: The assessment of indirect cost data was part of a clinical, multicenter, randomized RA trial. A total of 234 patients of working age with a diagnosis of RA (according to 1987 American College of Rheumatology criteria) were recruited. Demographics of the cohort were mean age 53 years, mean disease duration 8 years, 76% were women, and all had membership in the regional statutory health insurance plan. Every 3 months corresponding indirect cost data were derived for the cohort from a health economic questionnaire for cost assessment in patients with RA and the payer's database over a period of 18 months. Comparative statistical analyses were performed between patient-reported and insurance claims data. RESULTS: The mean annual productivity losses due to sick leave amounted to 14 and 17 days per patient (questionnaire versus payer data), and productivity losses due to work disability amounted to 3 days (both); monetary valuation renders overall costs of 1,240 and 1,590, respectively. The difference of 17% in overall productivity losses is not significant. Comparison of productivity losses reveals a strong correlation of r = 0.83 in those due to sick leave and of kappa = 0.84 in those due to work disability between questionnaire and payer data. CONCLUSION: The comparison of questionnaire and payer data shows that RA patients report their productivity losses adequately. Indirect cost assessment should therefore be included in further RA trials and observational studies

16. MISRA A, EDELSTEN C: Orbital varices diagnosed as episcleritis in a child with juvenile idiopathic arthritis. J Pediatr 146:4 574, 2005
    Organism: Ophthalmology Department, Ipswich Hospital, Ipswich, Suffolk, UK aseemamisra@doctorsorgukFAU - Misra, Aseema

17. MOR A, BINGHAM C, III, BARISONI L, LYDON E, BELMONT HM: Proliferative lupus nephritis and leukocytoclastic vasculitis during treatment with etanercept. J Rheumatol 32:4 740-743, 2005
    Organism: Division of Rheumatology, Department of Medicine, New York University School of Medicine/Hospital for Joint Diseases, New York, New York, USA mora01@mednyueduFAU - Mor, Adam
    Abstract: Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine. Agents that neutralize TNF-alpha are effective in the treatment of disorders such as rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), spondyloarthropathies, and inflammatory bowel disease. TNF-alpha antagonist therapy has been associated with the development of antinuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies, as well as the infrequent development of systemic lupus erythematosus (SLE)-like disease. We describe the first case of biopsy-confirmed proliferative lupus nephritis and leukocytoclastic vasculitis in a patient treated with etanercept for JRA

18. MULLER-GODEFFROY E, LEHMANN H, KUSTER RM, THYEN U: [Quality of life and psychosocial adaptation in children and adolescents with juvenile idiopathic arthritis and reactive arthritis]. Z Rheumatol 64:3 177-187, 2005
    Organism: Universitatsklinikum Lubeck, Klinik fur Kinder- und Jugendmedizin, Ratzburger Allee 160, 23538 Lubeck, GermanyFAU - Muller-Godeffroy, E
    Abstract: OBJECTIVE : We sought to measure self-reported health related quality of life (HRQOL) and psychosocial adaptation in children and adolescents with juvenile idiopathic arthritis (JIA) and reactive arthritis and to determine factors associated with these outcomes. METHODS : We interviewed 72 children and adolescents with chronic arthritis, age 8-16, about HRQOL (KINDL-R-Questionnaire) and functional ability in activities of daily living (Childhood Health Assessment Questionnaire-CHAQ). Mothers reported behavior problems (Child Behavior Checklist-CBCL). RESULTS : Children and adolescents with juvenile idiopathic arthritis and reactive arthritis reported lower HRQOL compared to normative data in several areas. Children reported lower QOL in the dimensions self-esteem; adolescents reported lower QOL in the dimensions physical well being and total QOL. Almost 20% of the sample appeared to have serious behavior problems, mostly social isolation and depression/anxiety. Functional limitations affected HRQOL and behavior problems. Inpatient children and adolescents and those with shorter disease duration reported lower QOL than outpatient children and adolescents and those with longer disease duration. Best predictors for impaired HRQOL were functional limitations, social isolation and depression/anxiety. CONCLUSIONS : Self-reported HRQOL and behavior problems may be relevant outcome measures in children and adolescents with chronic arthritis and useful to monitor psychosocial support in this population

19. OKAMOTO Y: [Development of the method for analysis of the cytokine balance shift associated with diseases]. Yakugaku Zasshi 125:4 355-361, 2005
    Organism: Faculty of Pharmacy, Meijo University, Nagano 468-8503, Japan yokamoto@cisacjpFAU - Okamoto, Yoshihiro
    Abstract: A dual-color enzyme-linked immunospot (ELISPOT) assay enabled us to analyze three types of cytokine-secreting cells simultaneously. T helper (Th) cells can be subdivided into at least two distinct functional subsets based on their cytokine secretion profiles. The first type of clones (Th1) produces interleukin-2 (IL-2) and interferon-gamma (IFN-gamma), but not IL-4 or IL-5. The second type of clones (Th2) produces IL-4 and IL-5, but not IL-2 or IFN-gamma. Furthermore, the presence of the third type (Th0) of cell, which is a precursor of Th1 or Th2 cells, has been demonstrated to produce both Th1- and Th2-type cytokines. The dual-color ELISPOT assay was developed to differentiate these three subtypes of Th cells in an identical well. In the system, the red spots corresponding to IL-2-secreting cells (Th1) were developed with horseradish peroxidase and aminoethylcarbazole/H(2)O(2). The light-blue spots corresponding to IL-4-secreting cells (Th2) were developed with alkaline phosphatase and Vector blue (chromogenic substrate for alkaline phosphatase). The mixed-colored (indigo) spots corresponding to both types of cytokine-secreting cells (Th0-cells) were developed with both chromogenic substrates. With this system, we could detect the IL-2- and/or IL-4-secreting cells simultaneously in a murine spleen cell or human peripheral mononuclear cell preparation

20. PASCUAL V, ALLANTAZ F, ARCE E, PUNARO M, BANCHEREAU J: Role of interleukin-1 (IL-1) in the pathogenesis of systemic onset juvenile idiopathic arthritis and clinical response to IL-1 blockade. J Exp Med 201:9 1479-1486, 2005
    Organism: Baylor Institute for Immunology Research, Dallas, TX 75204, USA virginip@BaylorhealtheduFAU - Pascual, Virginia
    Abstract: Systemic onset juvenile idiopathic arthritis (SoJIA) encompasses approximately 10% of cases of arthritis that begin in childhood. The disease is unique in terms of clinical manifestations, severity of joint involvement, and lack of response to tumor necrosis factor blockade. Here, we show that serum from SoJIA patients induces the transcription of innate immunity genes, including interleukin (IL)-1 in healthy peripheral blood mononuclear cells (PBMCs). Upon activation, SoJIA PBMCs release large amounts of IL-1beta. We administered recombinant IL-1 receptor antagonist to nine SoJIA patients who were refractory to other therapies. Complete remission was obtained in seven out of nine patients and a partial response was obtained in the other two patients. We conclude that IL-1 is a major mediator of the inflammatory cascade that underlies SoJIA and that this cytokine represents a target for therapy in this disease

21. PIPITONE MA, ADAMS B, SHETH A, GRAHAM TB: Crusted scabies in a patient being treated with infliximab for juvenile rheumatoid arthritis. J Am Acad Dermatol 52:4 719-720, 2005

22. SCHANBERG LE, GIL KM, ANTHONY KK, YOW E, ROCHON J: Pain, stiffness, and fatigue in juvenile polyarticular arthritis: contemporaneous stressful events and mood as predictors. Arthritis Rheum 52:4 1196-1204, 2005
    Organism: Duke University Medical Center, Durham, North Carolina 27710, USA schan001@mcdukeeduFAU - Schanberg, Laura E
    Abstract: OBJECTIVE: To analyze patterns of stress, mood, disease symptoms, and activity reduction in children with polyarticular arthritis, using a prospective daily diary method. METHODS: For a 2-month period, 51 children with polyarticular arthritis (mean age 12.4 years, 65% female) completed daily diaries that included measures of symptoms of pain, stiffness, and fatigue, as well as stress, mood, and activity reduction. Functional status and disease activity were assessed at the initial and followup evaluations with use of the Childhood Health Assessment Questionnaire, physician global assessment, joint count, and laboratory testing. RESULTS: Children reported having pain, stiffness, and fatigue on >70% of days, with significant variability in symptom levels. Results revealed significant same-day relationships between stress, mood, and disease symptoms, after controlling for covariates. Specifically, daily fluctuations in both stress and mood were predictive of increased pain, stiffness, and fatigue. Increases in daily stress, mood, and disease symptoms were also significantly related to decreased participation in social activities on a day-to-day basis. Only mood and stiffness were predictors of a cutback in school attendance. CONCLUSION: Stress and mood are important predictors of daily disease symptoms in children with polyarticular arthritis. Moreover, daily fluctuations in stress, mood, and disease symptoms are predictive of aspects of daily function, including participation in school and social activities. Thus, health care providers should solicit daily symptom reports when making decisions regarding clinical management. Nonpharmacologic interventions such as cognitive-behavioral therapy and stress management may be useful adjuvant therapy when treating the disease symptoms of children with polyarticular arthritis

23. SCHMELING H, HORNEFF G: Etanercept and uveitis in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) .: 2005
    Organism: Department of Paediatrics, Martin Luther University, Halle-Wittenberg, Halle, Germany
    Abstract: Objectives. Etanercept has been shown to be effective for the treatment of juvenile idiopathic arthritis (JIA). The therapeutic efficacy of etanercept for chronic uveitis, a major complication of JIA, has not been evaluated so far. Therefore, the appearance of chronic anterior uveitis and associated complications in JIA patients treated with etanercept was evaluated. Methods. Questionnaires were sent to paediatric rheumatologists treating a total of 310 JIA patients with etanercept. Results. Two hundred and twenty-nine questionnaires (74%) were returned. Before institution of etanercept, 31 patients (13.5%) had a history of uveitis with a total of 102 flares. Twenty-eight patients belonged to the high-risk groups of the oligoarticular and seronegative polyarticular subtypes. Upon commencing etanercept, 32 courses of uveitis occurred in 19 patients and in two further patients (1%) in whom uveitis occurred for the first time. Twenty of them belonged to the high-risk group. Uveitis during etanercept therapy occurred in 12 of 15 patients (80%) with more than one course of uveitis, and in seven of 16 patients (44%) with only one course before etanercept therapy. Complications were noted in 12 patients before and in eight during etanercept treatment. In 87% of the uveitis patients, arthritis demonstrated a significant or complete response. Conclusion. During treatment with etanercept, there were both relapses and first courses of uveitis. In addition, the frequency and severity of uveitis seemed not to be influenced by etanercept. In particular, patients with relapsing uveitis before institution of etanercept treatment remain at high risk of the development of uveitis flares despite etanercept treatment

24. SEN O, AYDIN MV, BAGDATOGLU C, ERTORER ME, BOLAT FA, YALCIN O, CANER H, ALTINORS N: Can E-selectin be a reliable marker of inflammation in lumbar disc disease? Neurosurg Rev 28:3 214-217, 2005
    Organism: Department of Neurosurgery, Baskent University, 01250, Yuregir, Adana, Turkey, oraysen@yahoocomFAU - Sen, Orhan
    Abstract: The cause of sciatica and low back pain associating with lumbar disc herniation has not been clearly identified until now. Inflammation has been shown to occur via immunohistochemical and biochemical methods in herniated disc tissues. The important prognostic role of E-selectin has recently been substantiated by other studies in early rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). The important role of adhesion molecules in the initiation and progression of the inflammatory response is well known for infectious diseases and autoimmune disorders. In our study, we aimed to show the role of E-selectin as an inflammatory marker and the correlation of inflammation with straight-leg raise (SLR) test findings and subtype of disc herniation. We found that the cases with positive SLR test had higher rates of immunostaining with E-selectin. This led us to think that E-selectin might play an important role in the activity status of the disease, meaning patients with more limited movement capacity might benefit from E-selectin antagonist therapy. Among the many studies performed to identify the relationship between the inflammation markers and activity of lumbar disc herniation, this is the first investigation held with E-selectin

25. SILVERMAN E, MOUY R, SPIEGEL L, JUNG LK, SAURENMANN RK, LAHDENNE P, HORNEFF G, CALVO I, SZER IS, SIMPSON K, STEWART JA, STRAND V: Leflunomide or methotrexate for juvenile rheumatoid arthritis. N Engl J Med 352:16 1655-1666, 2005
    Organism: Department of Pediatrics, University of Toronto, Toronto esilverman@sickkidscaFAU - Silverman, Earl
    Abstract: BACKGROUND: We compared the safety and efficacy of leflunomide with that of methotrexate in the treatment of polyarticular juvenile rheumatoid arthritis in a multinational, randomized, controlled trial. METHODS: Patients 3 to 17 years of age received leflunomide or methotrexate for 16 weeks in a double-dummy, blinded fashion, followed by a 32-week blinded extension. The rates of American College of Rheumatology Pediatric 30 percent responses (ACR Pedi 30) and the Percent Improvement Index were assessed at baseline and every 4 weeks for 16 weeks and every 8 weeks during the 32-week extension study. RESULTS: Of 94 patients randomized, 86 completed 16 weeks of treatment, 70 of whom entered the extension study. At week 16, more patients in the methotrexate group than in the leflunomide group had an ACR Pedi 30 response (89 percent vs. 68 percent, P=0.02), whereas the values for the Percent Improvement Index did not differ significantly (-52.87 percent vs. -44.41 percent, P=0.18). In both groups, the improvements achieved at week 16 were maintained at week 48. The most common adverse events in both groups included gastrointestinal symptoms, headache, and nasopharyngeal symptoms. Aminotransferase elevations were more frequent with methotrexate than with leflunomide during the initial study and the extension study. CONCLUSIONS: In patients with polyarticular juvenile rheumatoid arthritis, methotrexate and leflunomide both resulted in high rates of clinical improvement, but the rate was slightly greater for methotrexate. At the doses used in this study, methotrexate was more effective than leflunomide

26. STOLT P, KALLBERG H, LUNDBERG I, SJOGREN B, KLARESKOG L, ALFREDSSON L: Silica exposure is associated with increased risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis 1919
    Organism: Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden patrikstolt@swipnetseFAU - Stolt, P
    Abstract: OBJECTIVE: To study the association between silica exposure and rheumatoid arthritis and how it is modified by cigarette smoking. METHODS: Data were analysed from 276 male cases and 276 male controls aged 18 to 70 years, included in a Swedish population based study between May 1996 and June 2001. A case was defined as a person recently diagnosed with rheumatoid arthritis according to the ACR criteria. Controls were selected from the study base as a stratified random sample accounting for age, sex, and residency. Men with a self reported history of work with rock drilling, stone crushing, or exposure to stone dust in general were defined as silica exposed. Rheumatoid factor (RF) status among cases was recorded. RESULTS: Silica exposed men had increased risk of rheumatoid arthritis, with an odds ratio (OR), adjusted for age, residential area, and smoking, of 2.2 (95% confidence interval, 1.2 to 3.9) among men aged 18 to 70 years, and 2.7 (1.2 to 5.8) among those aged 50 to 70 years. Men who had worked with rock drilling or stone crushing (regarded as highly exposed) had a slightly greater increase in risk of rheumatoid arthritis than silica exposed men in general, with an OR of 3.0 (1.2 to 7.6). The joint effects of silica exposure and smoking were compatible with synergy between these two exposures in the development of rheumatoid arthritis but this was not conclusive. CONCLUSIONS: Silica exposure is associated with increased risk of developing rheumatoid arthritis. This association is not explained by smoking habits

27. SULLIVAN KE: Inflammation in juvenile idiopathic arthritis. Pediatr Clin North Am 52:2 335-57, v, 2005
    Organism: University of Pennsylvania School of Medicine, Division of Allergy and Immunology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA sullivak@mailmedupenneduFAU - Sullivan, Kathleen E
    Abstract: Inflammation evolved to aid in the clearance of microorganisms. In pediatric arthritides, the inflammation persists and causes damage to the joint. The contribution of the innate immune system to inflammation is significant and can be exploited therapeutically. Although cells of the adaptive immune system such as T cells and B cells participate in the disease process, many of the features of arthritis are directly attributable to inflammatory mediators. Recent advances in the understanding of these processes have led to dramatic improvements in treatment

28. SYMMONS D: Commentary: Juvenile idiopathic arthritis--issues of definition and causation. Int J Epidemiol 34:3 671-672, 2005
    Organism: ARC Epidemiology Unit, School of Epidemiology and Health Sciences, Room 2600 Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK deborahsymmons@manchesteracukFAU - Symmons, Deborah

29. THASTUM M, HERLIN T, ZACHARIAE R: Relationship of pain-coping strategies and pain-specific beliefs to pain experience in children with juvenile idiopathic arthritis. Arthritis Rheum 53:2 178-184, 2005
    Organism: University of Aarhus, Aarhus, Denmark mikael@psyaudkFAU - Thastum, Mikael
    Abstract: OBJECTIVE: To examine whether pain-specific beliefs and coping strategies of patients with juvenile idiopathic arthritis (JIA) independently predict their reported pain, while controlling for relevant demographic variables, disease activity, and parent-rated disability. To compare use of pain-coping strategies and pain-related beliefs of a selected subgroup of patients with high pain and low disease activity (high pain group) with the remaining patients. METHODS: Children with JIA (n = 56) completed the Pain Coping Questionnaire, a revised version of the Survey of Pain Attitudes, and a 3-week pain diary. The parents completed the Childhood Health Assessment Questionnaire (CHAQ). Second order principal component analyses were conducted in order to reduce the number of independent variables. Regression analyses of the dependent measure were performed. The use of coping strategies and health beliefs were compared using t-tests for independent samples. Pearson's correlation coefficients were calculated to examine the direct associations between each individual coping and belief scale, and the pain measure. RESULTS: Only the CHAQ and the cognitive belief composite factor score made statistically significant contribution to the prediction of pain after controlling for other variables. Significant differences were found between the scores of high pain patients and the rest of the group for the health belief subscale of disability (mean +/- SD 2.0 +/- 0.6 and 1.2 +/- 0.7, respectively), and for the health belief subscale of harm (mean +/- SD 2.7 +/- 0.6 and 1.8 +/- 0.7, respectively). Significant correlations were obtained between the pain measure and the pain-coping subscale of catastrophizing, the pain belief subscales of disability, harm, solicitude (inverse), control, and medical cure. CONCLUSION: These results support a model of pain experience in patients with JIA where psychological factors are strongly influential. It may be efficient to focus behavioral interventions on a subgroup of children where the pain experience seems to be in discordance with the disease activity

30. THOMAS A, ROJER D, IMRIE S, GOODMAN SB: Cemented total knee arthroplasty in patients with juvenile rheumatoid arthritis. Clin Orthop Relat Res433 140-146, 2005
    Organism: Department of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USAFAU - Thomas, Adrian
    Abstract: The optimal techniques and implants for total knee arthroplasty in patients with juvenile rheumatoid arthritis are controversial. We report the functional outcomes and complications of a series of 17 cemented total knee arthroplasties done by one surgeon during a 10-year period in which off-the-shelf implants were used, the posterior cruciate ligament was excised, and a lateral retinacular release was done. Preoperatively, all knees had severe loss of normal joint space and osteopenia on 3-foot, standing AP radiographs, lateral radiographs, and patellofemoral views. The patients were evaluated after a mean followup of 74 months (range, 36-116 months). The Knee Society scores improved from a mean of 38.9 +/- 23.9 points (range, 10-81 points) preoperatively to 81.9 +/- 16.6 points (range, 39-99 points) postoperatively. Range of motion showed significant improvement in all patients at the most recent followup. Ambulation scores improved significantly; nine of 10 patients (15 knees) were ambulatory after surgery. Complications included two transient regional pain syndromes and one patellofemoral subluxation requiring realignment. Cemented total knee arthroplasty with off-the-shelf implants, excision of the posterior cruciate ligament, and lateral retinacular release in patients with juvenile rheumatoid arthritis can provide substantial improvement in pain, deformity, ambulation, and function. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence

31. TUCKER LB, CABRAL DA: Transition of the adolescent patient with rheumatic disease: issues to consider. Pediatr Clin North Am 52:2 641-52, viii, 2005
    Organism: Division of Pediatric Rheumatology, Centre for Community Child Health Research, British Columbia Children's Hospital, 4880 Oak Street, Room K4-120, Vancouver, BC V6H 3V4, Canada ltucker@cwbccaFAU - Tucker, Lori B
    Abstract: This article discusses the definitions of transition and models for providing transition care to youth and young adults with rheumatic diseases in the context of differing cultural and health care systems. Issues and questions relating to pediatric rheumatology transition programming are outlined, and a model program of pediatric rheumatology transition is presented

32. WEISS JE, ILOWITE NT: Juvenile idiopathic arthritis. Pediatr Clin North Am 52:2 413-42, vi, 2005
    Organism: Division of Pediatric Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040, USAFAU - Weiss, Jennifer E
    Abstract: Juvenile idiopathic arthritis (JIA), a term referring to a group of disorders characterized by chronic arthritis, is the most common chronic rheumatic illness in children and is a significant cause of short- and long-term disability. This article discusses the classification, differential diagnosis, and treatment of JIA

33. YILDIRIM Y: Primary ovarian large B-cell lymphoma in patient with juvenile rheumatoid arthritis treated with low dose Methotrexate. Gynecol Oncol 97:1 249-252, 2005
    Organism: Department of Gynecologic Oncology, SSK Agean Obstetric and Gynecology Teaching Hospital, Department of Gynecologic Oncology, Yenisehir, Izmir, Turkey Ykuzeyli@mynetcomFAU - Yildirim, Yusuf
    Abstract: BACKGROUND: Primary ovarian lymphoma is an extremely rare disease and limited count reports about it have been reported in the literature. Traditionally, patients with rheumatoid arthritis (RA) have increased risk of nodal and extranodal lymphoid malignancies such as non-Hodgkin's lymphoma (NHL). Recently, some studies have also reported association between patients with juvenile rheumatoid arthritis (JRA) treated with Methotrexate (MTX) and malignant lymphoma developing. CASE: We report a 17-year old JRA patient with primary ovarian diffuse large B-cell non-Hodgkin's lymphoma (NHL). The patient had seronegative (rheumatoid factor negative) poliarticular form of JRA and was receiving low dose weekly Methotrexate (MTX) during the past 2 years. Initial presentation was adnexial mass and chronic pelvic pain. The patient was treated with surgery and combined cytotoxic chemotherapy. CONCLUSION: In conclusion, because of increased lymphoid malignancy risk, ovarian masses in JRA patients should be carefully evaluated

34. ZHANG Z, YANG PZ, ZHOU HY, YU Q, HUANG XK, LI B: [The clinical feature, diagnosis and treatment of uveitis associated with juvenile chronic arthritis.]. Zhonghua Yan Ke Za Zhi 41:4 346-349, 2005
    Organism: Zhongshan Ophthalmic Center, Zhongshan University, Guangzhou 510060, ChinaFAU - Zhang, Zhen
    Abstract: OBJECTIVE: To investigate the clinical features, diagnosis and treatment of uveitis associated with juvenile chronic arthritis (JCA). METHODS: A retrospective study was performed on the clinical data of 26 patients with uveitis associated with JCA, referred to Zhongshan Ophthalmic Center from 1996 to 2002. Taking of history, examination with slit-lamp microscope and ophthalmoscope were carefully performed in all of these patients. Laboratory tests including antinuclear antibodies, erythrocyte sedimentation rate, rheumatoid factor, C reactive protein and antistreptolysin O were used to disclose possible causes. Human leukocyte antigen B 27 and X-ray examination of sacroiliac joints and spine were carried out if necessary. Data about the treatment, visual outcome and complications were analyzed. RESULTS: Twenty-six patients, 11 males and 15 females, were included in the present studies. Age of onset of JCA and uveitis averaged 8 years and 9 years, respectively. Twenty-one patients had chronic anterior uveitis. Acute anterior uveitis and chronic panuveitis were noted in 3 and 2 patients, respectively. Twenty-two patients had bilateral uveitis, the other 4 had unilateral involvement. The ophthalmologic examination revealed that 33 of the 48 affected eyes showed mild aqueous humor flare, 24 had few cells in the anterior chamber. Complicated cataract, band keratopathy and secondary glaucoma were noted in 30, 20 and 12 eyes, respectively. The laboratory examination revealed positive antinuclear antibodies in 18 cases and rheumatoid factor positive in one case. In acute episode, patients were treated with extensive topical cycloplegic agents and corticosteroids eyedrops. In the 6 cases with severe uveitis, 3 patients were treated with cyclosporine A (5 mg.kg(-1).d(-1)) and the other 3 were treated with chlorambucil (0.1 mg.kg(-1).d(-1)). The intraocular inflammation in all of these patients was satisfactorily controlled with these treatments. Visual acuity improvement was noted in 32 affected eyes but not in the other 16 eyes which had already serious complications before the treatment. CONCLUSIONS: Uveitis associated with JCA is characterized by a chronic and recurred iridocyclitis, which usually developed within 5 year after JCA onset. Although the intraocular inflammation associated with JCA is usually white uveitis, complications such as cataract, secondary glaucoma and keratopathy occur frequently in these patients. The diagnosis is mainly based on typical clinical manifestations, the history of arthritis and positive antinuclear antibodies. Adequate application of cycloplegic agents, corticosteroids eyedrops, immunosupressives and the regular follow-up should be kept in mind in the treatment of these patients

35. ZIERHUT M, MICHELS H, STUBIGER N, BESCH D, DEUTER C, HEILIGENHAUS A: Uveitis in children. Int Ophthalmol Clin 45:2 135-156, 2005
    Organism: Department of Ophthalmology, University of Tuebingen, Schleichstrasse 12-16, 72976 Tuebingen, GermanyFAU - Zierhut, Manfred