Bibliography August 05
- ASKLING J, FORED CM, BRANDT L, BAECKLUND E, BERTILSSON L, COSTER L, GEBOREK P, JACOBSSON LT, LINDBLAD S, LYSHOLM J, RANTAPAA-DAHLQVIST S, SAXNE T, ROMANUS V, KLARESKOG L, FELTELIUS N: Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum 52:7 1986-1992, 2005
Organism: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institute, Stockholm, Sweden johanaskling@medkskiseFAU - Askling, Johan
Abstract: OBJECTIVE: Because treatment with tumor necrosis factor (TNF) antagonists may increase the risk of tuberculosis (TB), and because knowledge of the risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce and of uncertain generalizability to low-risk populations, this study sought to determine the risk of TB among Swedish patients with RA. METHODS: Using data from Swedish nationwide and population-based registers and data from an ongoing monitoring program of TNF antagonists, the relative risks of TB in patients with RA (versus the general population) and of TB associated with TNF antagonists (versus RA patients not treated with biologics) were determined by comparing the incidence of hospitalization for TB in 3 RA cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed the characteristics of all reported cases of TB in RA patients treated with TNF antagonists in Sweden and calculated the incidence of TB per type of TNF antagonist between 1999 and 2004. RESULTS: During 1999-2001, RA patients who were not treated with TNF antagonists were at increased risk of TB versus the general population (relative risk 2.0, 95% confidence interval [95% CI] 1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated with TNF antagonists. The reported TB cases during 1999-2004 in RA patients exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were predominantly pulmonary. TB occurred up to 3 years following the start of treatment. CONCLUSION: Irrespective of whether TNF antagonists are administered, Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF antagonists were associated with an increased risk of TB, up to 4-fold in magnitude. This increased risk may persist over time during treatment and is related to both infliximab and etanercept - CHEDEVILLE G, QUARTIER P, MIRANDA M, BRAUNER R, PRIEUR AM: Improvements in growth parameters in children with juvenile idiopathic arthritis associated with the effect of methotrexate on disease activity. Joint Bone Spine .: 2005
Organism: Unite d'Immuno-Hematologie-Rhumatologie Pediatrique, hopital Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris cedex 15, France
Abstract: Objective. - To assess changes in growth parameters associated with the response to methotrexate (MTX) therapy in pre-pubertal children with juvenile idiopathic arthritis (JIA) and who had not been treated with steroids. Methods. - We enrolled 27 pre-pubertal children with JIA who had been treated with MTX but not with steroids. The children were considered to have responded to treatment if the number of joints with active disease decreased by at least 50% 1 year after treatment initiation. We compared growth parameters (height, growth rate, weight and body mass index (BMI)) in responders and non-responders. Results. - Twenty-one children (77.8%) responded to MTX therapy. The growth parameters were similar in the responders and non-responders before the onset of treatment. After 1 year, height (P=0.025), growth rate (P=0.03), weight (P=0.007) and BMI (P=0.05) increased significantly in the responder group, but not in the non-responder group. This increase was maintained for growth rate and weight after 2 and 3 years of treatment. After 1 year, height (P=0.023) and growth rate (P=0.0009) were significantly higher in the responders than in the non-responders, and these differences were still significant after 3 years (P=0.01 and P=0.033, respectively). Conclusion. - In pre-pubertal children with JIA, a clinical response to MTX therapy is associated with a significant increase in growth parameters - FRILING R, KRAMER M, SNIR M, AXER-SIEGEL R, WEINBERGER D, MUKAMEL M: Clinical Course and Outcome of Uveitis in Children. J AAPOS 9:4 379-382, 2005
Organism: Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Abstract: Purpose: We sought to evaluate the clinical course, complications, and visual outcome of pediatric uveitis. Methods: Our sample included 38 consecutive children with uveitis treated between 1986 and 2002: 15 with idiopathic uveitis, 10 with Behcet disease, 9 with juvenile rheumatoid arthritis, 4 with other diagnoses. The last group was excluded from the analysis because of its small size. Appropriate ophthalmologic and laboratory examinations were obtained. Treatment consisted of topical, periocular, or systemic steroids with or without immunosuppression. Results: Complications occurred in all 3 groups, although they tended to be more severe in the patients with juvenile rheumatoid arthritis. Visual acuity improved from presentation to final examination; the difference was statistically significant for the patients with idiopathic uveitis (P < 0.0005) and Behcet disease (P = 0.004). Conclusions: These findings support an intensive treatment approach to childhood uveitis. The visual prognosis is good even in patients with a severe clinical course - GLUECK D, GELLMAN H: Management of the upper extremity in juvenile rheumatoid arthritis. J Am Acad Orthop Surg 13:4 254-266, 2005
Abstract: Juvenile rheumatoid arthritis is a multifaceted disease. Average age of onset is 6 years, with peaks between 1 and 4 and between 9 and 14 years. Girls are affected more frequently than boys. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of antirheumatic drugs may be used early for progressive disease. Intra-articular corticosteroid injections should be considered to preserve joint mobility and muscle strength when medical treatment fails to control synovitis or when marked functional impairment exists. Historically, surgery has been a last resort, but in appropriate patients, it should be considered soon after failure of conservative management. However, when possible, reconstructive surgery should be delayed until completion of skeletal growth - HEALY PJ, HELLIWELL PS: Classification of the spondyloarthropathies. Current Opinion in Rheumatology 17:4 395-399, /7/5
Abstract: Purpose of review The spondyloarthropathies are a group of conditions which share similar clinical features. Classification criteria permit separation of the conditions, allow better targeting of therapies, better measurement of outcomes, and better prognostic information. Early diagnosis remains problematic, but validated criteria for established disease are now emerging,Recent findings Histopathology and histochemistry are providing a better understanding of the underlying process of inflammatory arthritis in spondyloarthropathy and other inflammatory arthritides. Early disease, however, continues to challenge current criteria. Sophisticated imaging with magnetic r esonance imaging is being increasingly used and is proving useful for early diagnosis as well as helping to understand the pathophysiology of disease. Juvenile idiopathic arthritis continues to provide problems and criteria have recently been modified to allow a greater clinical utility and inclusion of more patients. Poststreptococcal reactive arthritis appears to be a heterogenous clinical entity, with a group looking more like rheumatic fever and a group with spondyloarthropathy traits. It may be that the association is not streptococcal, but is a throat infection. Currently available criteria for psoriatic arthritis have been evaluated in a large cohort. Four of the criteria performed well with high specificity and sensitivity whereas the other two had moderate specificity and low sensitivity. It was shown that rheumatoid factor positivity does not exclude a diagnosis of psoriatic arthritis - the single most important clinical feature of this condition being the presence of psoriasis.Summary The spondyloarthropathy classification criteria continue to be an area of development. This is most apparent in juvenile arthritis and psoriatic arthritis. The latter is currently undergoing intense scrutiny to develop classification criteria and outcome measures - HOFER M, SOUTHWOOD TR: Classification of childhood arthritis. Best Practice and Research in Clinical Rheumatology (United Kingdom ), 16/3 (379-396) 16:3 379-396, 2002
Abstract: The classification of the juvenile arthritides is an evolving process which has yet to achieve its ultimate goal of delineating biologically distinct disease groups with predictable outcomes and responses to treatment. There have been considerable advances, however, since the first attempts at classification over 100 years ago, as the clinical heterogeneity of juvenile arthritis has become understood. The aim of this chapter is to highlight the historical milestones in classification, the most recent proposals for developing a unified, international classification, and the published literature aimed at evaluating the classification process. In conclusion, it is recom mended that all clinicians involved in paediatric rheumatology take part in the ongoing process of juvenile arthritis classification by the prospective collection of standardized clinical data. (c) 2002 Elsevier Science Ltd. All rights reserved - JARVIS JN: Gene expression profiling in pediatric rheumatic disease: what have we learned? what can we learn? Curr Opin Rheumatol 17:5 606-611, 2005
Organism: Department of Pediatrics, Pediatric Rheumatology Section, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USAFAU - Jarvis, James N
Abstract: PURPOSE OF THIS REVIEW: Gene expression profiling is emerging as a promising methodology in pediatric rheumatology research. There is considerable interest in using this technology as the basis for diagnostic assays. This review will summarize the new knowledge. RECENT FINDINGS: Most gene expression studies of children have been exploratory in nature. However, preliminary gene expression studies in juvenile dermatomyositis, systemic lupus erythematosus, and chronic forms of arthritis demonstrate both the promise and limits of this technology. It seems likely that gene expression profiling will significantly enhance our understanding of the immunopathology of childhood-onset rheumatic diseases; however, considerable impediments must be overcome before these assays move into the clinical arena. SUMMARY: Gene expression profiling carries considerable potential to provide novel insights into the rheumatic diseases of childhood. Future developments will determine whether these technologies provide new clinical diagnostic or prognostic tools - KATSICAS MM, RUSSO RA: Use of infliximab in patients with systemic juvenile idiopathic arthritis refractory to etanercept. Clin Exp Rheumatol 23:4 545-548, 2005
Organism: Service of Immunology, Hospital de Pediatria "Prof: Dr Juan P Garrahan", Buenos Aires, ArgentinaFAU - Katsicas, M M
Abstract: OBJECTIVE: To analyse the effectiveness and safety of Infliximab in a group of patients with systemic juvenile idiopathic arthritis (SJIA) who had failed treatment with etanercept in a single paediatric rheumatology clinic. METHODS: Patients with SJIA with active polyarthritis refractory to methotrexate (MTX) [> or = 20 mg/m2/week] for at least 3 months and to etanercept (up to 1 mg/kg twice weekly) for at least 6 months were included. All children received infliximab 3-10 mg per kg of body weight intravenously concomitantly with MTX 7.5-10 mg/week for 19 (2-113) weeks. Evaluation included ACR paediatric 30 criteria and presence of signs of systemic activity (fever, rash). RESULTS: Six patients were included. Three patients met ACR paediatric 30 criteria at 2 weeks (2 patients) and 10 weeks after initiation of infliximab. Improvement lasted for 4, 12, and 84 weeks respectively. The presence of fever/rash was not modified by the treatment. Infliximab was discontinued due to moderate side effects in 4 patients. No serious side effects were observed. CONCLUSIONS: Most patients with SJIA who fail to respond to etanercept may not reach sustained improvement when switched to infliximab. The only patient in our group who improved sustainedly with infliximab did not show any systemic features at the beginning of therapy. Further controlled studies are needed in order to assess efficacy of infliximab in children with refractory SJIA - KODSI SR, RUBIN SE, MILOJEVIC D, ILOWITE N, GOTTLIEB B: Time of onset of uveitis in children with juvenile rheumatoid arthritis. Journal of AAPOS (United States ) 6:6 373-376, 2002
Abstract: Background: Recently, it has been advocated to decrease the frequency of eye examinations to screen for uveitis in children with juvenile rheumatoid arthritis (JRA) because of the low yield of positive findings after an initial normal eye examination. This study was undertaken to determine the time interval for the development of uveitis after the diagnosis of JRA and to further describe patients who develop uveitis related to JRA. Methods: This was a retrospective chart review of all patients with JRA examined by either of 2 pediatric ophthalmologists from August 1984 to June 2001. All patients were also under the care of the Pediatric Rheumatology Division at Schneider Children's Hospital. Age of diagnosis of JRA, disease onset subtype of JRA, antinuclear antibody titers, age of diagnosis of uveitis, and complications from uveitis were recorded. Results: One hundred fifty eight patients with JRA had eye examinations; 39 (25%) developed uveitis. Sixteen patients had uveitis on the initial eye examination, and 23 subsequently developed uveitis. When uveitis was absent at the initial eye examination, the mean time to develop it was 20 months (range, 4-81 months). Conclusions: A normal initial eye examination does not preclude the development of uveitis in patients with JRA. We recommend continuing the current standards of ophthal mologic examinations to screen for uveitis in children with JRA as prescribed by the Section on Rheumatology and Ophthalmology of the American Academy of Pediatrics. Copyright (c) 2002 by the American Association for Pediatric Ophthalmology and Strabismus - KOFFEMAN EC, PRAKKEN B, ALBANI S: Recent developments in immunomodulatory peptides in juvenile rheumatic diseases: from trigger to dimmer? Curr Opin Rheumatol 17:5 600-605, 2005
Organism: aDepartment of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0731, USA; bDepartment of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0731, USA; cIACOPO Institute for Translational Medicine, La Jolla, CA, USA and Utrecht, The Netherlands, European Union; and dUniversity Medical Center, Utrecht, The Netherlands, European Union
Abstract: PURPOSE OF REVIEW: Current therapy for juvenile rheumatic diseases is based on general immune suppression or blocking inflammatory pathways. These treatments do not induce long-term disease remission and have a risk of side effects; this is especially unfavorable in children. It is better to focus on induction of tolerance mechanisms than on suppression of inflammation. This promotes epitope specific immunotherapy as a possible safe treatment option. RECENT FINDINGS: In the search for specific peptides for immunotherapy in autoimmunity, the focus is shifting from purported triggers of disease to peptides that regulate the ongoing inflammation. These so-called 'immunomodulatory peptides' are important in every healthy immune system. Several juvenile rheumatic diseases have been linked to certain immunomodulatory peptides. In juvenile dermatomyositis, peptides from human skeletal myosin play a role in the perpetuation of the disease. In systemic lupus erythematosus, the focus is mostly on DNA-derived peptides and peptides from anti-DNA antibodies. In juvenile idiopathic arthritis, heat shock proteins have been shown to contain important immunomodulatory epitopes. SUMMARY: Immunomodulatory peptides play an important role in juvenile rheumatic diseases. Promising candidates for immunotherapy have been identified. This opens the possibility of clinical testing in rheumatic diseases of childhood - KOFOD T, CATTANEO PM, DALSTRA M, MELSEN B: Three-Dimensional Finite Element Analysis of the Mandible and Temporomandibular Joint During Vertical Ramus Elongation by Distraction Osteogenesis. J Craniofac Surg 16:4 586-593, 2005
Organism: From the *Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Norrebrogade 44, Bygn 9D, 8000 Aarhus C, Denmark; and daggerDepartment of Orthodontics, Royal Dental College University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
Abstract: Distraction osteogenesis has been accepted as an alternative treatment modality for hypoplastic mandibles. Knowledge about the changes occurring in the temporomandibular joint region during mandibular distraction osteogenesis is, however, limited and controversial. Stress distribution in the temporomandibular joint region during unilateral vertical mandibular ramus distraction was studied using a finite element model. The finite element model was based on computed tomography scans and magnetic resonance imaging scans of a patient with unilateral hypoplasia of the right mandibular ramus caused by juvenile idiopathic arthritis. The character of stress distribution in the temporomandibular joint and mandible was analyzed quantitatively at different intervals of the vertical mandibular ramus elongation. During the distraction phase, the condyles, articular disks, and glenoid fossa regions were loaded with a differentiated stress pattern. The affected right condyle, disk, and fossa were submitted to increasing loads with increasing elongation compared with the contralateral temporomandibular joint. Loading on the unaffected left side shifted posteriorly and slightly laterally, because the left condyle was the center of rotation. The loading of the temporomandibular joint regions was low during the active distraction phase, although local areas were subjected to elevated peak stresses - KUZMINA NN, MOVSISYAN GR: System enzymotherapy in complex treatment of chronic juvenile arthritis. Pediatriya (Moscow)2 34-38, /3
Abstract: 60 children with juvenile chronic arthritis were included in the double blind placebo controlled 6-months study of the efficacy of systemic enzymotherapy (Flogenzym) in the course of combined therapy. Reliable positive effect of the drug on articular syndrome and laboratory parameters was found. Flogenzym demonstrated good result even in the long term. So, 25% of children demonstrated remission, 54% of children had stabilization of the pathological process. No side effects were registered - LEE CH, HAN SH, YOON BY, LEE YW: A case of adult-onset Felty syndrome in juvenile rheumatoid arthritis. Pediatr Int 47:4 463-465, 2005
Organism: Department of Internal Medicine, Division of Rheumatology, NHIC Ilsan Hospital, Korea chanheell@parancomFAU - Lee, Chan-Hee - LIU JB, LI M, YANG S, GUI JP, WANG HY, DU WH, ZHAO XY, REN YQ, ZHU YG, ZHANG XJ: Clinical profiles of vitiligo in China: an analysis of 3742 patients. Clin Exp Dermatol 30:4 327-331, 2005
Organism: Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, ChinaFAU - Liu, J-B
Abstract: Very few articles have aimed to illuminate the clinical profiles of vitiligo in China. We conducted this retrospective survey involving 4118 outpatients with vitiligo in order to identify the differences among various clinical types of vitiligo and their associated disorders. Completed questionnaires (3742) were validated and analysed. Of this large cohort, 1565 (41.8%) individuals presented vitiligo vulgaris, followed by focal, segmental, acrofacial, and universal, in that order. The mean age of vitiligo onset was 18.88 years. More than 60% of the patients were affected before 20 years of age. Patients with segmental vitiligo were affected earlier than those with other types of vitiligo (15.55 years; (P < 0.001). More than 74% of the patients presented with focal vitiligo at onset. After 3-5 years, 99% of active vitiligo was worse and shifted from one clinical type to another. However, there was no transformation between acrofacial vitiligo and segmental vitiligo. Compared with the general population, the patients with vitiligo were more likely to be affected by rheumatoid arthritis (P < 0.01), ichthyosis (P < 0.01), chronic urticaria (P < 0.01), or alopecia areata (P < 0.01) - MEIRA ZM, GOULART EM, COLOSIMO EA, MOTA CC: Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. Heart 91:8 1019-1022, 2005
Organism: Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte 31275030, Brazil zildamam@terracombrFAU - Meira, Z M A
Abstract: OBJECTIVES: To investigate the progress of rheumatic fever (RF) and the predictors of severe chronic valvar disease. DESIGN: Patients prospectively followed up since their first attack of acute RF (ARF). SETTING: Universidade Federal de Minas Gerais, Brazil. PATIENTS: 258 children and adolescents who met the revised Jones criteria for RF. The follow up period ranged from 2-15 years. MAIN OUTCOME MEASURES: The presence and severity of mitral or aortic valvar disease were determined by both clinical and Doppler echocardiographic examinations. The variables associated with severe chronic valvar disease were initially identified by the Kaplan-Meier method and, later, by multivariate analysis. RESULTS: Doppler echocardiography of 258 patients studied showed that 186 (72.1%) developed chronic valvar disease and 41 (15.9%) progressed to severe chronic mitral or aortic lesions. Of 146 patients who developed carditis, 49 (33.6%) had a normal clinical examination in the chronic phase but only nine (6.2%) had normal Doppler echocardiographic findings--that is, 40 (27.4%) patients progressed to chronic subclinical valvar disease. Moderate or severe carditis, recurrences of ARF, and mother's low educational level were risk factors in predicting severe chronic valvar diseases. CONCLUSION: The increased risk of progressing to severe chronic valvar disease was associated with moderate or severe carditis, recurrences of ARF, and mother's low educational level. Hence, in a country such as Brazil, the options available for disease control are mainly primary and secondary prophylaxis - MULLICK MS, NAHAR JS, HAQ SA: Psychiatric morbidity, stressors, impact, and burden in juvenile idiopathic arthritis. J Health Popul Nutr 23:2 142-149, 2005
Organism: Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka 1000, Bangladesh mullick@bdonlinecomFAU - Mullick, Mohammad S I
Abstract: Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the control group (p<0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA - NISHIMOTO N: [Anti-IL-6 receptor antibody]. Nippon Rinsho 63 Suppl 5:723-7.: 723-727, 2005
Organism: Laboratory of Immune Regulation, Graduate School of Frontier Biosciences, Osaka UniversityFAU - Nishimoto, Norihiro - OEN K: Long-term outcomes and predictors of outcomes for patients with juvenile idiopathic arthritis. Best Practice and Research in Clinical Rheumatology (United Kingdom ), 16/3 (347-360) 16:3 347-360, 2002
Abstract: Prediction of the long-term outcome for patients with juvenile idiopathic arthritis requires assessment of disability, psychosocial and socioeconomic function. Measures for the first have evolved from Steinbrocker functional classifications to validated self-administered questionnaires. The proportion of patients with severe disability has decreased during the past three decades but significant numbers of patients enter adulthood with some disability detected with the newer measures. Despite careful study, few early predictors of a poor outcome have been identified. The most consistent are early age at onset, persistent fever and thrombocytosis in patients with systemic juvenile idiopathic arthritis. Reports of psychosocial and socioeconomic outcomes are controversial and further analyses of these spheres are required. An increased risk of osteoporosis and osteopenia has been reported in adults with juvenile idiopathic arthritis. The most significant problem faced by patients during adulthood is persistent disease activity as disability, radiographic damage and the risk of osteoporosis all increase with increasing duration of disease. (c) 2002 Elsevier Science Ltd. All rights reser ved - PEDERSEN AB, JOHNSEN SP, OVERGAARD S, SOBALLE K, SORENSEN HT, LUCHT U: Total hip arthroplasty in Denmark: incidence of primary operations and revisions during 1996-2002 and estimated future demands. Acta Orthop 76:2 182-189, 2005
Organism: Department of Orthopaedics, Aarhus University Hospital, Denmark abp@sociaudkFAU - Pedersen, Alma B
Abstract: BACKGROUND: The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs. METHODS: We calculated the incidence rates (IR) of primary THA and revision in Denmark between 1996 and 2002 and estimated the demands for primary THA in Denmark until 2020. We used data from the Danish Hip Arthroplasty Registry, a nationwide and population-based clinical database, to identify patients who had undergone primary THA (n = 37,144) or revision arthroplasties (n = 6446). Age and sex-specific data on the Danish population were obtained from the StatBank Denmark. All IRs were standardized according to two standards, i.e. the Danish population in 1996 and the European standard population (18 age groups). The future demands for primary THA were estimated using the age and sex-specific incidence of primary THA for 2002 as a reference, and taking into account the expected changes in the age distribution of the population and the trend in IRs seen in Denmark between 1996 and 2002. RESULTS: The annual overall standardized IRs of primary THAs and revisions increased from 101 (95% confidence interval (CI): 97.6-104) to 134 (CI: 131-138) and from 19.2 (CI: 17.9-20.5) to 21.1 (CI: 19.8-22.4) per 100,000 inhabitants from 1996 to 2002, respectively (IRs adjusted to the Danish population in 1996). The IRs of primary THAs and revisions increased by 30% and 10% during this period. The relative increase in IRs of primary THAs was found to be similar in both women and men. The increase was higher among patients aged 50-59 years, however. Furthermore, a decrease in IRs was seen in patients who underwent primary THA due to rheumatoid arthritis. IRs of primary THAs have been estimated to increase by 22% in 2020 compared with 2002, based only on the expected changes in the age distribution of the population. However, assuming that the annual age and sex-independent increase in the IRs seen in the period 1996-2002 will continue, the IR of primary THA is estimated to increase by as much as 210% in 2020. INTERPRETATION: The overall annual standardized IRs of primary THAs and revisions in Denmark increased during the period from 1996 to 2002. Moreover, the demands for THA procedures in the coming decades may exceed the current capacity due to the ageing population and a continued age and sex-independent increase in surgical activity - PERRUCCIO AV, POWER JD, BADLEY EM: Arthritis onset and worsening self-rated health: a longitudinal evaluation of the role of pain and activity limitations. Arthritis Rheum 53:4 571-577, 2005
Organism: University of Toronto, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada perrucci@uhnresutorontocaFAU - Perruccio, Anthony V
Abstract: OBJECTIVE: To longitudinally explore the hypothesized role of worsening pain and development of activity limitations as mediators in the relationship between arthritis onset and worsening self-rated health (SRH). METHODS: Data was obtained from the 1998/1999 and 2000/2001 cycles of the population-based Canadian longitudinal National Population Health Survey (n = 10,859; ages > or = 18; response rate: time 1 = 81.6%, time 2 = 89.2%). Respondents were asked about chronic conditions, pain, activity limitations, and self-perceived health; change over time was assessed. Change in effect of arthritis onset on worsening SRH upon considering potential mediators was assessed through multivariate logistic regression, controlling for sociodemographic characteristics and onset of other conditions. RESULTS: Worsening pain fully explained the effect of arthritis onset on worsening SRH; a portion of the effect of worsening pain was mediated by the development of activity limitation. Residual direct effect of arthritis onset was statistically insignificant. Worsening pain and development of activity limitations also mediated a portion of the effects of onset of other chronic conditions but to a lesser extent than arthritis onset. CONCLUSION: This is the first study to examine these relationships longitudinally. Identifying the role of mediators is necessary if target areas of prevention and/or management are sought, either at the individual or population level. Our results indicate that the development of arthritis has a significant impact on worsening SRH. Pain and development of activity limitations fully account for the relationship between arthritis onset and worsening SRH. High priority should be placed on prevention and management strategies for pain among people with arthritis - PETERSEN C, SCHMIDT S, POWER M, BULLINGER M: Development and pilot-testing of a health-related quality of life chronic generic module for children and adolescents with chronic health conditions: a European perspective. Qual Life Res 14:4 1065-1077, 2005
Organism: Institute of Medical Psychology, University Clinic Hamburg-Eppendorf, Germany copeters@ukeuni-hamburgdeFAU - Petersen, Corinna
Abstract: Health-related quality of life (HRQOL) assessment in children and adolescents with chronic health conditions is increasingly considered as a relevant topic. The aim of the EU-funded DISABKIDS project is to develop, test, and implement European instruments for the assessment of HRQOL of children and adolescents with disabilities and their families. The current paper describes the development and pilot testing of a chronic generic HRQOL measure. Using literature searches, expert consulting and focus groups with children/adolescents and their families, items of the instruments were developed and translated into the respective languages. A pilot test with 360 children and adolescents was conducted. Children and adolescents (8-12, 13-16 years) with different chronic health conditions (asthma, epilepsy, diabetes, arthritis, atopic dermatitis, cerebral palsy, and cystic fibrosis) as well as their families were included. Data were analysed according to predefined psychometric and content criteria. Psychometric analyses resulted in a 56-item chronic generic HRQOL questionnaire with six domains ('Medication', 'Physical', 'Emotion', 'Independence', 'Social Inclusion', 'Social Exclusion') with acceptable internal consistency - RAUHANIEMI J, TIUSANEN H, SIPOLA E: Total wrist fusion: a study of 115 patients. J Hand Surg [Br] 30:2 217-219, 2005
Organism: Paimio Hospital, University of Turku, Finland Paimio Hospital, Alvar Aallon tie, Preitila, FinlandFAU - Rauhaniemi, J
Abstract: This retrospective study evaluated the outcome of total wrist fusion, predominantly using the Mannerfelt technique, in patients with rheumatoid arthritis. One hundred and fifteen patients were operated on for painful wrist destruction. The mean pain scores were 3.6 (1-4) pre-operatively, 1.9 (1-4) after 6 weeks and 1.3 (1-4) at 1 year. Although the radiological fusion rate was good, only 40% of the patients were very satisfied with the result. Ability to perform activities of daily living was only very much improved in 30% of the patients. Grip strength significantly improved after surgery - RENKE J, SZLAGATYS-SIDORKIEWICZ A, POPADIUK S, KORZON M, BUGAJCZYK B, SZUMERA M, WOZNIAK M: [Superoxide dismutase in children with juvenile idiopathic arthritis]. Med Wieku Rozwoj 9:2 205-212, 2005
Organism: Klinika Pediatrii, Gastroenterologii i Onkologii Dzieciecej, Akademia Medyczna, ul Nowe Ogrody 1-6, 80-803 Gdansk, PolandFAU - Renke, Joanna
Abstract: The use or antioxidants as drugs that may control the inflammatory process recently has become widely studied in adults. One of the most important components or antioxidant barrier in humans is enzyme superoxide dismutase. Experimental treatment with superoxide dismutase proved to be effective in animals. THE AIM of the present study was to estimate the activity of superoxide dismutase (SOD) in patients with rheumatoid disease of childhood -- juvenile idiopathic arthritis and to analyse it in different clinical aspects of the disease including its activity, course and time of duration. MATERIAL AND METHODS: A group of 70 children with juvenile idiopathic arthritis, age from 3 to 18 years, patients of Rheumatologic Hospital in Sopot was examined in years 1996-2001. Juvenile idiopathic arthritis was diagnosed according to the International League Against Rheumatism classification (Durban 1997). The control group consisted of 29 healthy children age from 3 to 18 years. Superoxide dismutase activity was determined in full, heparinised blood with the use of spectrophotometric method or Randox. The study was accepted by the Local Committee of Ethics. RESULTS: A statistically significant increase in superoxide dismutase activity was found in group of children with juvenile idiopathic arthritis compared to the control group. In the polyarthricular form of disease the activity of superoxide dismutase was also significantly higher than in the control group. CONCLUSIONS: In course of juvenile idiopathic arthritis, differently from rheumatoid arthritis of adults, superoxide dismutase activity seems to be stimulated in the majority of cases, so the treatment with egzogenoeus superoxide dismutase may not be effective - RONGALI AN, SINGH S, THAPA BR, VAIPHEI K: Asymptomatic gastritis in naproxen-treated North Indian children with juvenile rheumatoid arthritis. APLAR Journal of Rheumatology (Australia ) 7:1 19-23, 2004
Abstract: Aims: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the agents of choice in patients with juvenile rheumatoid arthritis (JRA). While NSAIDs have been associated with gastritis in adults with rheumatoid arthritis (RA), not much is known about children with JRA. In this prospective study we set out to evaluate 31 children with JRA, who fulfilled the diagnostic criteria given by the American College of Rheumatology (ACR). Methods: All patients had received naproxen for at least 3 months prior to their enrolment. Mean age of children was 9.02 years (range 2.5-16 years) with the male:female ratio being 1.8:1 (boys 20; girls 11). Eleven (35.5%) patients had polyarticular, 15 (48.4%) had pauciarticular and the remaining five (16.1%) had systemic onset JRA. Duration of disease varied from 5-84 months (mean +/- 2, SD = 25.32 +/- 20 months) with a mean duration of therapy of 14.19 months (range 4-72 months). Six patients had complaints of mild non-specific upper abdominal pain. Results: On upper gastrointestinal endoscopic examination none of the children showed any significant gross findings. However, histopathology of antral biopsies showed features of active and/or chronic gastritis in almost all the patients. Helicobacter pylori was identified in 16 (51.8%) of these on hematoxylin and eosin staining and the findings were confirmed with Giemsa/Gram staining. Fourteen (85.5%) were also positive by the rapid urease test (RUT). Ten of the 16 patients with H. pylori infection showed evidence of active inflammation in the antral biopsies. Conclusions: Asymptomatic gastritis is a common finding in children with JRA who are receiving naproxen. There appears to be no correlation between the presence of H. pylori infection or histological gastritis and presence of abdominal symptoms in children with JRA. (c)Asia Pacific League of Associations for Rheumatology - SARZI-PUTTINI P, ATZENI F, SCHOLMERICH J, CUTOLO M, STRAUB RH: Anti-TNF antibody therapy improves glucocorticoid- induced insulin-like growth factor-1 (IGF-1) resistance without influencing myoglobin and IGF-1 binding proteins 1 and 3. Ann Rheum Dis .: 2005
Organism: Rheumatology Unit, University Hospital L Sacco, Milan, Italy
Abstract: OBJECTIVE: Insulin-like growth factor-1 (IGF-1) is an important determinant of muscle mass because it promotes growth and suppresses protein degradation. IGF- 1 levels are decreased in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis due to inflammation-induced inhibition of IGF-1 synthesis. In parallel, glucocorticoids induce IGF-1 resistance and add to muscle degradation. This study aimed to investigate the influence of anti-TNF antibody therapy (anti-TNF) with adalimumab on levels of myoglobin (degradation marker) and IGF-1 in RA patients with and without prednisolone therapy. METHODS: In this longitudinal study with subcutaneous adalimumab, 32 long-standing RA patients were included (16 with and 16 without prednisolone). We measured IGF-1, IGF-1 binding protein-1 (IGFBP-1), IGFBP- 3, and myoglobin by ELISA techniques. RESULTS: RA patients demonstrated normal myoglobin serum levels. However, patients with prednisolone had elevated levels of myoglobin as compared to patients without prednisolone indicating increased muscle degradation. Upon treatment with anti- TNF, myoglobin levels did not change in both patient groups. Serum lev-els of IGF-1 were increased in patients with versus without prednisolone indicating IGF- 1 resistance (221 +/- 23 vs. 122 +/- 14 microg/l, p<0.001). Adalimumab therapy decreased elevated IGF-1 levels in patients with prednisolone, which after 12 weeks of treatment reached the level of patients without prednisolone. Serum levels of IGFBP-1 and IGFBP-3 were not different in the two groups and anti-TNF did not change these concentrations. CONCLUSIONS: Anti-TNF antibody therapy over 12 weeks seems to improve glucocorticoid-induced IGF-1 resistance without influencing myoglobin and IGF-1 binding proteins. Thus, in RA patients on glucocorticoids with generally decreased muscle mass anti-TNF therapy with adalimumab exerts favourable effects - SCOLOZZI P, BOSSON G, JAQUES B: Severe isolated temporomandibular joint involvement in juvenile idiopathic arthritis. J Oral Maxillofac Surg 63:9 1368-1371, 2005
Organism: Chief Resident, Department of Otolaryngology/Head and Neck Surgery, Division of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, SwitzerlandFAU - Scolozzi, Paolo - SELDIN MF, SHIGETA R, LAIHO K, LI H, SAILA H, SAVOLAINEN A, LEIRISALO-REPO M, AHO K, TUOMILEHTO-WOLF E, KAARELA K, KAUPPI M, ALEXANDER HC, BEGOVICH AB, TUOMILEHTO J: Finnish case-control and family studies support PTPN22 R620W polymorphism as a risk factor in rheumatoid arthritis, but suggest only minimal or no effect in juvenile idiopathic arthritis. Genes Immun .: 2005
Organism: 1Rowe Program in Genetics, Departments of Biochemistry and Medicine, University California Davis, Davis, CA, USA
Abstract: Several studies have identified the PTPN22 allelic variant 1858 C/T that encodes the R620W amino-acid change as a putative susceptibility factor in autoimmune diseases. The current study was undertaken to examine a large cohort of Finnish rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) subjects using both population control and, importantly, family-based association methods. The latter is particularly important when, as is the case for the 1858 C/T polymorphism, the frequency of the variant allele (T) differs in both major ancestral populations and in subpopulations. The analysis of rheumatoid factor-positive 1030 RA probands from Finland provides strong support for association of this variant in both population studies (allele specific odds ratio (OR)=1.47, 95% confidence interval (CI)=1.27-1.70, P=3 x 10(-7)) and in family studies (P<10(-6)). In contrast, no allelic association was seen with JIA (230 probands) and only weak evidence for a genotypic effect of 1858T homozygotes was observed in this population.Genes and Immunity advance online publication, 18 August 2005; doi:10.1038/sj.gene.6364255 - STAMM TA, CIEZA A, COENEN M, MACHOLD KP, NELL VP, SMOLEN JS, STUCKI G: Validating the International Classification of Functioning, Disability and Health Comprehensive Core Set for Rheumatoid Arthritis from the patient perspective: a qualitative study. Arthritis Rheum 53:3 431-439, 2005
Organism: Division of Rheumatology, Department of Internal Medicine III, Vienna Medical University, Vienna, Austria TanjaStamm@meduniwienacatFAU - Stamm, Tanja A
Abstract: OBJECTIVE: To validate the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for Rheumatoid Arthritis (RA) from the patient perspective. METHODS: Patients with RA were interviewed about their problems in daily functioning. Interviews were tape recorded and transcribed verbatim. Interview texts were divided into meaning units. The concepts contained in these meaning units were linked to the ICF according to 10 established linking rules. Of the transcribed data, 15% were analyzed and linked by a second health professional. The degree of agreement was calculated using the kappa statistic. RESULTS: Twenty-one patients were interviewed. Two hundred twenty different concepts contained in 367 meaning units were identified in the qualitative analysis of the interviews and linked to 109 second-level ICF categories. Of the 76 second-level categories from the ICF RA Core Set, 63 (83%) were also found in the interviews. Twenty-five second-level categories, which are not part of the current ICF RA Core Set, were identified in the interviews. The result of the kappa statistic for agreement was 0.62 (95% boot-strapped confidence interval 0.59-0.66). CONCLUSION: The validity of the ICF RA Core Set was supported by the perspective of individual patients. However, some additional issues raised in this study but not covered in the current ICF RA Core Set need to be investigated - STROBEL MJ, WEILER A, SCHULZ MS, RUSSE K, EICHHORN HJ: Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. Arthroscopy 19:3 262-268, 2003
Organism: Orthopadische Gemeinschaftspraxis, Straubing, Charite Campus Virchow Clinic, Humboldt-University, Berlin, Germany HStrobel@ogpdeFAU - Strobel, Michael J
Abstract: PURPOSE: The goal of this study was to gain more information on the likelihood of developing cartilage lesions in posterior cruciate ligament (PCL)-deficient knees. Type of Study: Retrospective clinical study. METHODS: Standardized arthroscopy records of 181 patients with a nonsurgically treated acute or chronic PCL injury were analyzed with respect to cartilage degeneration. Subgroups with different duration of PCL insufficiency, the influence of isolated PCL or combined PCL/posterolateral instability, and the grade of posterior laxity was analyzed. RESULTS: PCL insufficiency significantly increased the risk of developing medial femoral condyle and patellar cartilage degeneration over time. Of patients whose PCL deficiency was present for more than 5 years, 77.8% showed degenerative cartilage lesions of the medial femoral condyle and 46.7% showed cartilage degeneration of the patella. After 1 year of PCL insufficiency, the number of medial femoral cartilage lesions increased threefold (13.6% v 39.1%). With the presence of combined PCL/posterolateral insufficiency the amount of medial femoral degeneration was significantly increased (36.6% v 60.6%). CONCLUSIONS: We found that PCL insufficiency is not a benign injury with respect to the development of degenerative articular cartilage lesions. The early and continuous increase in cartilage degeneration at the medial femoral condyle and the patella should be considered when discussing operative versus conservative treatment for a PCL-deficient knee. The rapid development of medial arthritis should also be considered during decision making, particularly in patients with combined PCL/posterolateral instability or those who underwent previous partial medial menisectomy - TUSZKIEWICZ-MISZTAL E, POSTEPSKI J, ZAORSKA-RAJCA J, OPOKA-WINIARSKA V, CZEKAJSKA-CHEHAB E: Diseases of the respiratory system in patients with juvenile idiopatic arthritis
ZMIANY W UKl(stroke)ADZIE ODDECHOWYM U PACJENTOW Z Ml(stroke)ODZIENCZYM IDIOPATYCZNYM ZAPALENIEM STAWOW. Reumatologia (Poland ) 43:3 154-159, 2005
Abstract: In contrast to adult rheumatoid arthritis little is known about the prevalence, nature and cause of lung function abnormalities in children with juvenile idiopatic arthritis (JIA). Pulmonary manifestation in children with JIA include recurrent pneumonia or pleuritis lymphoid follicular pneumonitis, pulmonary nodules and pulmonary hemosiderosis. Rheumatoid pulmonary vasculitis is rare. Pulmonary abnormal function test in some children, may be the results of respiratory muscle weakness. Pulmonary parenchymal involvement is very uncommon. The temporal relationship of the pulmonary and articular disease is variable. Pulmonary involvement in juvenile arthritis is mainly manifested by abnormal pulmonary function tests, including mild airflow limitation decreased lung volumes and abnormal diffusion capacity have also been reported in children with JIA, even in the absence of pulmonary symptoms. Pulmonary toxicity occurs in 0.5% to 14% of patients receiving low-dose Mtx. Manifestations of pulmonary toxicity and include parenchymal inflammation, pneumonia, airway hyperreactivity, air trapping and possibility of neoplasm - WORKIE DW, DARDZINSKI BJ: Quantifying dynamic contrast-enhanced MRI of the knee in children with juvenile rheumatoid arthritis using an arterial input function (AIF) extracted from popliteal artery enhancement, and the effect of the choice of the AIF on the kinetic parameters. Magn Reson Med 54:3 560-568, 2005
Organism: Department of Physics, University of Cincinnati, Cincinnati, Ohio, USAFAU - Workie, Dagnachew W
Abstract: Quantification of dynamic contrast-enhanced (DCE) MRI based on pharmacokinetic modeling requires specification of the arterial input function (AIF). A full representation of the plasma concentration data, including the initial rise and decay parts, considering the delay and dispersion of the bolus contrast is important. This work deals with modeling of DCE-MRI data from the knees of children with a history of juvenile rheumatoid arthritis (JRA) by using an AIF extracted from the signal enhancement data from the nearby popliteal artery. Three models for the AIFs were considered: a triexponential (AIF1), a gamma-variate plus a biexponential (AIF2), and a biexponential (AIF3). The pharmacokinetic parameters obtained from the model were K(trans'), k(ep), and V(p) ('). The results from AIF1 and AIF2 showed no statistically significant difference. However, some statistically significant differences were seen with AIF3, particularly for parameters K(trans') and V(p) (') in the synovium (SNVM). These results suggest the importance of obtaining an appropriate AIF representation in pharmacokinetic modeling of JRA. Specifically, the initial rising part of the AIF should be incorporated for optimal pharmacokinetic modeling results. The pharmacokinetic parameters (mean +/- SD) derived from AIF1, using the average plasma concentration data, were as follows: SNVM K(trans')(min(-1)) = 0.52 +/- 0.34, k(ep)(min(-1)) = 0.71 +/- 0.39, and V(p) (') = 0.33 +/- 0.16, and for the distal femoral physis (DFP) K(trans')(min(-1)) = 1.83 +/- 1.78, k(ep)(min(-1)) = 2.65 +/- 1.80, and V(p) (') = 0.46 +/- 0.31. The pharmacokinetic parameters in the SNVM may be useful for investigating activity and therapeutic efficacy in studies of JRA. Longitudinal studies are necessary to find or demonstrate the parameter that is more sensitive to disease activity. Magn Reson Med, 2005. (c) 2005 Wiley-Liss, Inc - YOKOTA S, MIYAMAE T, IMAGAWA T, KATAKURA S, KUROSAWA R, MORI M: Clinical study of tocilizumab in children with systemic-onset juvenile idiopathic arthritis. Clin Rev Allergy Immunol 28:3 231-238, 2005
Organism: Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Kanagawa, JapanFAU - Yokota, Shumpei
Abstract: Systemic-onset juvenile idiopathic arthritis (sJIA) is a severe and steroid-dependent disease of unknown etiology that sometimes progresses to a fatal disease known as the macrophage activation syndrome. The investigation of inflammatory cytokines and receptor levels revealed an increase in interleukin (IL)-6 and soluble IL-6 receptor (sIL-6R) in serum of patients with active sJIA. The clinical symptoms and signs of the disease are presumably attributable to the continuous elevation of IL-6 and sIL-6R levels in serum. The characteristic fever spikes parallel IL-6 levels. In children, a long-term exposure to high levels of IL-6 causes severe growth impairment, as suggested by recently established studies of IL-6 transgenic mice. The biological functions of IL-6 are expressed through the binding of IL-6/IL-6R complex to gp130. The administration of tocilizumab (a recombinant humanized anti-IL-6R monoclonal antibody) exerts its action by preventing the binding of IL-6 to its receptor and, therefore, preventing the activation of gp130. After a few cases of compassionate use of tocilizumab, phase I and II studies of tocilizumab were conducted in children with sJIA, revealing that tocilizumab abruptly reduced the typical symptoms of inflammation and improved laboratory abnormalities. This article describes the experience in Japan regarding the treatment of sJIA with tocilizumab and supports the hypothesis that high levels of IL-6 may play an important role in the pathogenesis and maintenance of this disease. A confirmation of the role of tocilizumab in the treatment of sJIA will be provided by the results of the ongoing phase III study in Japan - YOUNG S: Ocular involvement in connective tissue disorders. Current Allergy and Asthma Reports (United Kingdom ) 5:4 323-326, 2005
Abstract: Connective tissue disorders have well-known ocular associations that may be presenting features of the disease or occur as complications during the course of the disorder. Keratoconjunctivitis sicca, keratitis, scleritis, uveitis, retinal vasculitis, choroidopathy, and their associations with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, psoriatic arthritis, juvenile idiopathic arthritis, and polymyositis are reviewed. Copyright (c) 2005 by Current Science Inc - ZENG QY, DARMAWAN J, XIAO ZY, CHEN SB, CHEN R, LIN K, WIGLEY R, CHEN SL, ZHANG NZ: Risk factors associated with rheumatic complaints: a WHO-ILAR COPCORD study in Shantou, Southeast China. J Rheumatol 32:5 920-927, 2005
Organism: Department of Rheumatology, Shantou University Medical College, Shantou, Guangdong, China qyzeng@stueducnFAU - Zeng, Qing Yu
Abstract: OBJECTIVE: To validate the differences of the prevalence of rheumatic symptoms between the north and south part of China and to investigate the associated risk factors for rheumatic complaints in Shantou, China. METHODS: Four samples together comprising 10,638 people > or = 16 years of age were surveyed in 1987, 1992, 1995, and 1999. The protocol of the ILAR-China Collaborative Study or the WHO-ILAR COPCORD Core Questionnaire was implemented. Data on rheumatic symptoms that were part of these surveys were collected and analyzed. RESULTS: The prevalence rate of rheumatic complaints was increasing in the Shantou area during the recent decade (in 1987 11.6%, 1992 12.5%, 1995 16.0%, and 1999 19.8%). However, it was still lower than the rate in Beijing, China, in 1987 (40.0%). Rheumatic symptoms were more prevalent in women than in men, and were more frequently seen in the elderly than in young people. The most frequently involved site was the low back followed by the knee and neck. Lumbar pain was more frequent among rural residents, while neck pain was more prevalent in the urban school-age population group. The prevalence of knee pain was significantly higher in people living in multi-story buildings without elevators compared with those living in single-story houses. The peak value of bone mineral density (BMD) in the Shantou population was 0.839 +/- 0.085 g/cm2 in men, and 0.723 +/- 0.064 g/cm2 in women, significantly higher than that reported in 13 other provinces and cities of China including Beijing. The sense of seeking a physician's care was higher in the population with a higher prevalence of rheumatic symptoms than that in the group with a lower prevalence of complaints. However, no significant difference was found in the rate of disability among the different population samples. CONCLUSION: The prevalence rate of rheumatic complaints was lower in Shantou than in Beijing. Socioeconomic status, environmental differences (e.g., Shantou in the southern and Beijing in the northern part of China), sex, age, occupation, ergonomics, BMD, and awareness of seeking medical care might all be risk factors associated with the prevalence of rheumatic complaints