June 2006

Bibliography June 2006

Anonymous, Growing up and moving on in rheumatology: development and preliminary evaluation of a transitional care programme for a multicentre cohort of adolescents with juvenile idiopathic arthritis, Child Care Health Dev., Vol. 32(4), 501, 2006
Organism:Growing up and moving on in rheumatology: development and preliminary evaluation of a transitional care programme for a multicentre cohort of adolescents with juvenile idiopathic arthritis. McDonaghJ.E., ShawK.L. & SouthwoodT.R. (2006) Journal of Child Health Care, 10, 22-42
Anonymous, Juvenile idiopathic arthritis: Children with rheumatism are often treated too late, 2006
Organism:
ALLAIRE S, WOLFE F, NIU J, BAKER N, MICHAUD Ket LAVALLEY M: Extent of occupational hand use among persons with rheumatoid arthritis, Arthritis Rheum., Vol. 55(2), 294-299., 2006
Organism:OBJECTIVE: Occupational hand use is increasing due to increased computer use and could place persons with rheumatoid arthritis (RA) at risk for work disability. Although hand involvement in RA is typical, there is little information about occupational hand use in relation to RA. Study objectives were to describe the extent of occupational hand use by persons with RA; the types of jobs that require extensive hand use; the relationship between occupational hand use and joint pain; and the extent of occupational hand use among persons with shorter versus longer disease duration. METHODS: Cross-sectional survey data from 2,761 employed participants with RA from a US national cohort were used. Extent of occupational hand use was measured by the hand-use item from a job physical demand scale used in prior RA studies. Analyses included descriptive statistics and chi-square tests. RESULTS: The mean age was 50.6 years, 78.5% were women, 91.8% were white, and 68.8% had more than a high school education. Eighty-three percent of participants reported extensive occupational hand use. Large portions of participants in all types of jobs reported extensive hand use, 92% with administrative support jobs and 69% with operator/laborer jobs. Participants with extensive occupational hand use were more likely to have hand joint pain than those with moderate hand use (66% versus 58%; P = 0.004). Extensive hand use did not vary by disease duration (83% and 84% in participants with < or =15 and >15 years' duration, respectively). CONCLUSION: Extensive occupational hand use was ubiquitous among employed persons with RA and was associated with greater hand pain
ALSAEID K, ALAWADHI A, AL SAEED Oet HAIDER MZ: Human leukocyte antigen DRB1*04 is associated with rheumatoid arthritis in Kuwaiti patients, Joint Bone Spine., Vol. 73(1), 62-65., 2006
Organism:OBJECTIVES: Rheumatoid arthritis (RA) is a common, complex autoimmune disease known to be associated with inheritance of certain human leukocyte antigen (HLA)-DR alleles in different populations. This study investigated the association of DRB1 alleles in Kuwaiti patients with RA. MATERIALS AND METHODS: DRB1 alleles were analyzed in 47 Kuwaiti patients and 70 ethnically matched controls using a DNA-based sequence specific primer (SSP) method. RESULTS: The frequency of DRB1*04 allele was higher in patients compared to the controls (P < 0.012). The association with of HLA-DRB1*04 allele in our patients with RA was accounted for mainly by the seropositive group of patients (P < 0.05). Moreover, five patients were homozygous for DRB1*4 compared to none in the controls. None of the other DRB1 alleles tested was significantly higher in the patients. All patients homozygous for the DRB1*04 allele were females. There was no statistically significant difference in the frequency of DRB1*04 allele in patients classified according to presence of erosive disease or extra-articular manifestations. CONCLUSION: Our results indicate that in Kuwaiti patients, RA is associated with the presence of DRB1*04 allele. The lack of association with severity or the phenotype of RA is not surprising since this is a hospital-based study where patients tend to have a more severe disease
ARDIC F, GOKHARMAN D, ATSU S, GUNER S, YILMAZ Met YORGANCIOGLU R: The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis, Aust.Dent.J., Vol. 51(1), 23-28., 2006
Organism:BACKGROUND: We studied clinical signs and symptoms of temporomandibular disorders and radiological changes in the temporomandibular joint from patients with rheumatoid arthritis (RA) compared to patients with myofascial pain dysfunction of the temporomandibular system and control patients to evaluate clinical and radiological relationships. METHODS: A cross-sectional, controlled, clinical and radiological study was planned and 99 subjects (69 patients and 30 controls) were included in the study. RESULTS: Twenty-three patients with RA (69.7 per cent) had painful temporomandibular joint. Fifty-five per cent had myofascial pain dysfunction according to the research diagnostic criteria for temporomandibular disorders (TMD). Nearly all of our patients with RA (93.9 per cent) had symptoms, and almost all of them had positive findings of TMD in high resolution computed tomography. Condylar head resorption, joint space narrowing and degeneration were statistically more prominent features in patients with rheumatoid arthritis compared with controls (p < 0.05). The pain score on active palpation correlated with the number of the mandibular subchondral cysts on high resolution computed tomography (r = 0.6, p < 0.05). CONCLUSION: Although the myofascial pain of the temporomandibular system is an important cause of pain in rheumatoid arthritis, prospective controlled studies are needed to develop effective therapeutic strategies for these patients
ARKELA-KAUTIAINEN M, HAAPASAARI J, KAUTIAINEN H, LEPPANEN L, VILKKUMAA I, MALKIA Eet LEIRISALO-REPO M: Functioning and Preferences for Improvement of Health Among Patients with Juvenile Idiopathic Arthritis in Early Adulthood Using the WHO ICF Model, J.Rheumatol., Vol. ., 2006
Organism:OBJECTIVE: To evaluate functioning and preferences for health among young adult patients with juvenile idiopathic arthritis (JIA) and controls. The WHO International Classification of Functioning, Disability and Health (ICF) was used as a framework. METHODS: The patient files of a rheumatology hospital were screened to identify patients with juvenile arthritis born 1976 to 1980. Functioning was measured by the Finnish version of the Multidimensional Health Assessment Questionnaire (MDHAQ) within the framework of the ICF. Preferences in improvement of health were measured by the Finnish version of the Arthritis Impact Measurement Scales 2. Age and sex matched controls from the community were selected from the Finnish population registry. RESULTS: In all, 123 patients with a mean age of 23 (SD 21-26) years participated in the followup study. The mean time from diagnosis to followup was 16.2 years. Among them, 35% (n = 43) were in remission at followup. Lower levels of functioning for 3 ICF components were found in patients with active disease compared to controls. JIA patients with active disease had more pain and lower levels of mobility, self-care, and domestic and social life compared to controls. Patients with active disease differed from those in remission with pain in preferences for improvement of health. CONCLUSION: Patients with active disease need active treatment and rehabilitation to maintain functioning and decrease pain. The ICF offers a promising model to examine the outcomes of adult patients with JIA. Application of the MDHAQ is supported by our evaluation studies in young adults with JIA
AVC c, TSE SML, SCHNEIDER R, NGAN Bet SILVERMAN ED: Macrophage activation syndrome as the presenting manifestation of rheumatic diseases in childhood, 2006
Organism:Dr. E.D. Silverman, Division of Rheumatology, Department of Pathology, The Hospital for Sick Children, Toronto, Ont
Abstract:We describe 3 patients who presented with features of macrophage activation syndrome (MAS) at the time of presentation of systemic lupus erythematosus (SLE), systemic juvenile idiopathic arthritis, and Kawasaki disease. Immunohistochemical studies in the patient with SLE demonstrated extensive expression of CD163 on hemophagocytic macrophages, suggesting a possible role as a marker of MAS. (c) 2006 Elsevier Inc. All rights reserved
AVCIN T, TSE SM, SCHNEIDER R, NGAN Bet SILVERMAN ED: Macrophage activation syndrome as the presenting manifestation of rheumatic diseases in childhood, J.Pediatr., Vol. 148(5), 683-686., 2006
Organism:We describe 3 patients who presented with features of macrophage activation syndrome (MAS) at the time of presentation of systemic lupus erythematosus (SLE), systemic juvenile idiopathic arthritis, and Kawasaki disease. Immunohistochemical studies in the patient with SLE demonstrated extensive expression of CD163 on hemophagocytic macrophages, suggesting a possible role as a marker of MAS
BAEVSKY RH, ISHIDA JTet LIEBERMAN SA: Group A beta-hemolytic streptococcal glossal necrotizing myositis--case report and review, MedGenMed., Vol. 7(2), 8, 2005
Organism:We report the first case of glossal necrotizing myositis by group A beta-hemolytic Streptococcus in an 8-year-old girl on chronic nonsteroidal anti-inflammatory drugs, immunomodulators, and steroids for juvenile rheumatoid arthritis. Treatment included partial glossectomy and parenteral antibiotics. After a critical course, full recovery ensued. The subject of necrotizing myositis is reviewed
BENSMAN Aet ULINSKI T: Renal involvement in systemic diseases, 2006
Organism:A. Bensman, Service de nephrologie pediatrique, hopital d'enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris
Abstract:
BIERBAUM S, SENGLER C, GERHOLD K, BERNER Ret HEINZMANN A: Polymorphisms within interleukin 15 are associated with juvenile idiopathic arthritis, Clin.Exp.Rheumatol., Vol. 24(2), 219, 2006
Organism:
BJORNADAL L, BRANDT L, KLARESKOG Let ASKLING J: Impact of parental history on patients' cardiovascular mortality in rheumatoid arthritis, Ann.Rheum.Dis., Vol. 65(6), 741-745., 2006
Organism:BACKGROUND: Patients with rheumatoid arthritis are at increased risk of death from cardiovascular disease (CVD). This risk is influenced by the inflammatory activity of the rheumatoid arthritis as well as by traditional risk factors for CVD. However, little is known about whether or to what extent hereditary factors for CVD contribute additional risk in patients with rheumatoid arthritis. OBJECTIVE: To assess the clinical impact of a parental history of CVD in patients with rheumatoid arthritis. METHODS: Population based cohort study of 10,805 Swedish patients with rheumatoid arthritis aged 16-67 years during follow up (1990-2000). Parents, and cardiovascular deaths among patients and parents, were identified through register linkages. Relative risk of death v the general population was assessed using standardised mortality ratios (SMR), which were compared by Poisson regression. RESULTS: Rheumatoid patients with a parental history of fatal CVD had an SMR of death from CVD of 2.9 (95% confidence interval, 2.5 to 3.4). By contrast, rheumatoid patients without a parental history of fatal CVD had an SMR of 1.7 (1.2 to 2.3). A parental death from CVD was associated with a 70% increase in the risk of fatal CVD in rheumatoid arthritis (SMR ratio = 1.7 (1.2 to 2.4), and an increase in the 10 year mortality from CVD from 5% to 10% in men and from 2% to 4% in women aged 50 to 67 years. CONCLUSIONS: Parental history of death from CVD is an important (and easily assessable) risk factor for fatal CVD in rheumatoid arthritis
BRISTER H, TURNER JA, AARON LAet MANCL L: Self-efficacy is associated with pain, functioning, and coping in patients with chronic temporomandibular disorder pain, J.Orofac.Pain., Vol. 20(2), 115-124., 2006
Organism:AIMS: To examine the psychometric characteristics of a measure of self-efficacy for managing temporomandibular disorders (TMD) and to determine whether scores on this measure were related to pain, disability, and psychological distress in patients with chronic TMD pain. METHODS: Patients seeking treatment for chronic TMD pain (n = 156, 87% female, mean age = 37 years) completed measures assessing pain, disability, mental health, pain-coping strategies, and self-efficacy for managing their pain. RESULTS: The self-efficacy measure, which was adapted from arthritis research, demonstrated good psychometric characteristics (Cronbach's alpha = 0.91, minimal floor and ceiling effects, and validity). Greater self-efficacy was associated with significantly (P < .05) lower levels of pain, disability, and psychological distress. Self-efficacy remained significantly associated with disability and mental health measures even after controlling for demographic variables and pain intensity. In addition, patients with higher self-efficacy reported significantly (P < .05) greater use of an active, adaptive chronic pain-coping strategy (task persistence) and less use of a passive, maladaptive chronic pain-coping strategy (rest). CONCLUSION: Self-efficacy for managing pain appears to be important in the adjustment of patients with chronic TMD pain. Research is needed to determine whether treatments designed to increase self-efficacy improve TMD patient outcomes
BRUNNER HI, TAYLOR J, BRITTO MT, CORCORAN MS, KRAMER SL, MELSON PG, KOTAGAL UR, GRAHAM TBet PASSO MH: Differences in disease outcomes between medicaid and privately insured children: possible health disparities in juvenile rheumatoid arthritis, Arthritis Rheum., Vol. 55(3), 378-384., 2006
Organism:OBJECTIVE: To determine the relationship between health insurance status and disease outcome in children with juvenile rheumatoid arthritis (JRA). METHODS: JRA patients followed at a tertiary pediatric rheumatology center were assessed for the number of active joints and number of joints with limited range of motion. Disease activity, patient well-being, and pain were measured. Disability was assessed by the Childhood Health Assessment Questionnaire, health-related quality of life by the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale, and the PedsQL Rheumatology Module. Health care resource utilization was estimated based on the number of billing events for health services coded in administrative databases; these databases also provided information on patient health insurance status. Children insured by Medicaid or similar state programs for low-income families were considered to have Medicaid status. Disease outcomes of children with Medicaid status was compared with that of children with private health insurance. RESULTS: Forty (14%) of the 295 children with JRA had Medicaid status. Patients with Medicaid status were more often of nonwhite race (P < or = 0.04) and more frequently had a polyarticular or systemic disease course (P = 0.04) compared with other patients (n = 255). After correction for differences in disease duration, race, JRA onset, and JRA course between groups, children with Medicaid status continued to have significantly higher disability (P < 0.0003), and lower mean PedsQL Generic Core Scale scores (P < 0.05), while health resource utilization appeared similar between groups. CONCLUSION: Despite apparently similar health resource utilization and joint involvement, Medicaid status is associated with significantly lower health-related quality of life and higher disability in JRA
CAO LF, LU YM, MA M, XUE HY, ZHAO Y, YU HQ, MAO HYet GU YY: [Levels of serum interleukin-15 and the expression of T-helper lymphocyte subsets in peripheral blood of children with juvenile rheumatoid arthritis], Zhongguo Dang.Dai Er.Ke.Za Zhi., Vol. 8(1), 9-12., 2006
Organism:OBJECTIVE: To study the changes of serum interleukin-15 (IL-15) levels and the expression of CD4(+)T (T-helper lymphocyte) subsets CD4(+)CD45RA(+) and CD4(+)CD45RO(+) in peripheral blood of children with juvenile rheumatoid arthritis (JRA). METHODS: The serum concentration of IL-15 was detected using ELISA in 39 children with JRA. The expressions of CD4(+)CD45RA(+)T and CD4(+)CD45RO(+)T in peripheral blood were detected by flow cytometry in 24 out of the 39 patients with JRA. Twenty-six age and sex-matched healthy children were used as the Control group. RESULTS: The mean serum IL-15 level in JRA patients was significantly higher than that in controls (1.37 +/- 0.98 pg/mL vs 0.96 +/- 0.41 pg/mL, P <0.05). Among the 39 JRA patients, the serum IL-15 level in 17 patients with systemic JRA increased remarkably (P < 0.01), but not in patients with the other two types of JRA, the oligoarthritis and polyarthritis (n=13, n=9, respectively), compared with that in controls. The mean serum IL-15 level of the JRA patients was significantly reduced after conventional treatment (P < 0.01). The serum IL-15 level in JRA patients positively correlated with white blood cell count (r=0.347, P <0.05) and C reactive protein (r=0.452, P < 0.01) but not with the erythrocyte sedimentation rate. The patients with high serum IL-15 levels (> or = medium level 1.73 pg/mL) had higher expression of CD4(+)CD45RO(+)T than those with low serum IL-15 levels (< medium level) (16.29 +/- 5.46% vs 11.75 +/- 3.15 %, P < 0.05). CONCLUSIONS: The serum IL-15 levels in JRA patients increased significantly. An increased IL-15 level can transform CD45RA into CD45RO in peripheral blood of patients with JRA, and then result in T lymphocyte activation and mediate the immunopathological impairment. IL-15 may be used a marker for the evaluation of severity of JRA
CARVOUNIS PE, HERMAN DC, CHA Set BURKE JP: Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature, Graefe's Archive for Clinical and Experimental Ophthalmology, Vol. 244, 281-290., 2006
Organism:Mayo Clin and Mayo Fdn, Dept Ophthalmol, 200 1st St SW, Rochester, MN 55905 USA USA
Abstract:Background: Juvenile rheumatoid arthritis (JRA) is the most common systemic cause of pediatric uveitis in Europe and North America. Uveitis is commonly perceived as a frequent sequela of JRA and JRA-associated uveitis is commonly considered to have a complicated course with frequent adverse visual outcomes. Methods: We performed a systematic literature search for series of consecutive patients with JRA (as defined by the American College of Rheumatology criteria) reporting on the frequency of uveitis and/or complications of uveitis, published between January 1980 and December 2004. The main outcome measures were: the cumulative incidence of uveitis in JRA, the cumula tive incidence of adverse visual outcome and that of complications in JRA-associated uveitis. Additionally, the influence of gender, presence of antinuclear antibody (ANA) and disease onset subtype to the likelihood of developing uveitis were examined. Results: Analysis of pooled data from the 26 eligible series suggested a cumulative incidence of uveitis in JRA of 8.3% [95% confidence intervals (CI), 7.5-9.1%]. The cumulative incidence of uveitis varied according to geographic location, being highest in Scandinavia, then the US, then Asia and lowest in India. JRA-associated uveitis was more common in pauciarticular than polyarticular onset patients [odds ratio (OR)=3.2, 95% CI, 2.33-4.36] and in ANA-positive than ANA-negative patients (OR=3.18, 95% CI, 2.22-4.54). Female gender was only a weak risk factor for the development of uveitis in JRA patients (OR=1.69, 95% CI 1.09-2.62) and was not statistically significant after considering disease onset subtypes. In JRA-associated uveitis the cumulative incidence of cumulative incidence of adverse outcome (visual acuity < 20/40 OU) was 9.2% (95% CI: 4.7-15.8) of cataracts 20.5% (95% CI: 15.5-26.3), of glaucoma 18.9% (95% CI: 14.4-24.2) and of band keratopathy 15.7% (95% CI: 10.9-21.7). Conclusion: The cumulative incidence of uveitis in JRA varies according to geographic location, presence of ANA, type of JRA onset and gender. Uveitis, adverse visual outcome, and complications in JRA are less frequent than commonly accepted
CHEN JY, WANG CM, WU JM, HO HHet LUO SF: Association of rheumatoid factor production with FcgammaRIIIa polymorphism in Taiwanese rheumatoid arthritis, Clin.Exp.Immunol., Vol. 144(1), 10-16., 2006
Organism:Fcgamma receptors (FcgammaR) impact upon the development of inflammatory arthritis through immune complex stimulation and proinflammatory cytokine production. FcgammaRIIa, FcgammaRIotaIotaIotaa and FcRgammaIIIb polymorphisms were genotyped in 212 rheumatoid arthritis (RA) patients and 371 healthy control subjects using an allelic-specific polymerase chain reaction (PCR). No significant skewing in the distribution of FcgammaRIIa H/R131, FcgammaRIIIa F/V158 and FcgammaRIIIb NA1/NA2 was found between RA patients and healthy control subjects. However, a significant skewing distribution of the FcgammaRIIIa F/V158 polymorphism was observed between rheumatoid factor (RF)-positive versus RF-negative RA patients (P = 0.01). The low-affinity FcgammaRIIIa F158 allele seems to have a protective role in RF production, in comparison with the FcgammaRIIIa V158 allele (P = 0.004; OR = 0.485; 95% CI: 0.293-0.803). A high frequency of FcgammaRIIIa F/F158 was identified in RA patients with negative RF compared with RF-positive patients (for FF158 versus FV158 + VV158; P = 0.002; OR = 0.372; 95% CI: 0.194-0.713). In addition, no association was found between FcgammaRIIa H/R131, FcgammaRhoIIIa F/V158 and FcgammaRIIIb NA1/NA2 polymorphisms and other clinical parameters. The results of this study suggest that three activating FcgammaRs polymorphisms lack association with RA but FcgammaIIIa F/V158 polymorphism may influence RF production and IgG RF immune complex handling in Taiwanese RA patients
CHOUDHARY A, HARDING SP, BUCKNALL RCet PEARCE IA: Mycophenolate mofetil as an immunosuppressive agent in refractory inflammatory eye disease, J.Ocul.Pharmacol.Ther., Vol. 22(3), 168-175., 2006
Organism:Purpose: The aim of this study was to assess the role of mycophenolate mofetil (MMF) in refractory inflammatory eye disease. Methods: Retrospective, noncomparative, interventional case series of all patients commenced on MMF between 1999 and 2005 for refractory inflammatory eye disease at St Paul's Eye Unit (Liverpool, UK). Main outcome measures noted were control of inflammation, steroid-sparing effect, and adverse effects of MMF therapy. Results: Ten (10) patients (2 with sarcoid, 2 with intermediate uveitis, 1 with Vogt-Koyanagi Harada (VKH) syndrome, 1 with ankylosing spondylitis, 1 with juvenile chronic arthritis (JCA), and 3 with scleritis) who were unresponsive or intolerant to previous therapy and/or as a steroid-sparing agent, received 2-3 g of MMF per day for a mean period of 40.5 months (range, 3-67). Nine (9) patients had a favorable response, with diarrhea and insomnia being the main side-effects. MMF had to be withdrawn in 1 patient because of side-effects and in another because of active arthropathy (with stable uveitis). Average number of relapses was reduced from 3.1 per patient per year to 0.8 per patient per year (P < 0.005). A steroid-sparing effect was achieved in all patients. Visual acuity improved in 8 patients. Conclusions: MMF appears to be a safe and effective second- or third-line adjunct/alternative immunosuppressant in these difficult cases and works well in combination with cyclosporin A, tacrolimus, and antitumor necrosis factor (TNF) agents. It has potential as a firstor second-line agent and can be considered at a dose of 3 g/day in refractory cases
CIMAZ R, VIJAY S, HAASE C, COPPA GV, BRUNI S, WRAITH Eet GUFFON N: Attenuated type I mucopolysaccharidosis in the differential diagnosis of juvenile idiopathic arthritis: a series of 13 patients with Scheie syndrome, Clin.Exp.Rheumatol., Vol. 24(2), 196-202., 2006
Organism:OBJECTIVE: Mucopolysaccharidosis type I (MPS I) is a genetic lysosomal storage disorder caused by deficient activity of the enzyme alpha-L-iduronidase. Incomplete breakdown of glycosaminoglycans leads to progressive accumulation of these substances in many tissues throughout the body. Patients with the less severe form of MPS I (Scheie syndrome) usually present in the first decade of life with frequent articular involvement, and may survive into adulthood. Especially in these attenuated phenotypes, a definitive diagnosis may be delayed for years because clusters of early symptoms are difficult to recognize for physicians not familiar with the disease, and since the disease progresses slowly over decades. We would like to increase the awareness of this type of MPS I disease among rheumatologists and unravel diagnostic pitfalls. METHODS: We have reviewed medical histories of 13 patients (6 males and 7 females) with Scheie syndrome seen in 5 European centers. RESULTS: All patients had prominent musculoskeletal involvement at the onset of their disease in childhood. Diagnosis was delayed in almost all cases (range 4-54 years). CONCLUSION: We suggest that patients who present with progressive non-inflammatory joint involvement in the first decade of life, particularly with stiffness of the fingers and difficulty using the hands, should be screened for metabolic diseases, including MPS I. MPS I should be considered if patients with arthropathy lack the typical characteristics of inflammatory arthropathy
CONTI F, BORRELLI O, ANANIA C, MAROCCHI E, ROMEO EF, PAGANELLI M, VALESINI Get CUCCHIARA S: Chronic intestinal inflammation and seronegative spondyloarthropathy in children, Dig.Liver Dis., Vol. 37(10), 761-767., 2005
Organism:BACKGROUND: Spondyloarthropathy in adults has been shown to be associated with either clinical or subclinical intestinal inflammation, however this association has rarely been described in children. AIM: To report paediatric patients primarily referred to a paediatric gastroenterology centre for suspected inflammatory bowel disease and found to be affected by a seronegative spondyloarthropathy. Intestinal inflammatory lesions and rheumatological features have been described in them. SUBJECTS: During a 18-month period, 129 children were referred because of symptoms and signs suggesting an inflammatory bowel disease; 31 of them (range age: 5-17 years) were selected because they also had signs of axial and/or peripheral arthropathy and form the basis of our study. METHODS: The investigated patients underwent ileo-colonoscopy with biopsy and rheumatological assessment that also included X-ray and magnetic resonance imaging of the sacroiliac joints. RESULTS: Only seven children had a classical inflammatory bowel disease (four had ulcerative colitis, three had Crohn's disease), 12 had an indeterminate colitis, 12 a lymphoid nodular hyperplasia of the distal ileum as main feature. In the latter two groups, endoscopy and histology revealed an intestinal inflammation of chronic type distinct from the classical pattern found in inflammatory bowel disease. All were HLA B27 negative and fulfilled the European Spondyloarthropathy Study Group criteria for spondyloarthropathy (except five children classified as undifferentiated spondyloarthropathy). CONCLUSIONS: In a group of children primarily investigated for suspected inflammatory bowel disease and also presenting a seronegative spondyloarthropathy we have described both intestinal and rheumatological features. The majority of them exhibited either an indeterminate colitis or a lymphoid nodular hyperplasia of the distal ileum as main feature. These patients may be a population at risk of developing a full inflammatory bowel disease phenotype
CUNHA BA: Fever of unknown origin caused by adult juvenile rheumatoid arthritis: the diagnostic significance of double quotidian fevers and elevated serum ferritin levels, Heart Lung., Vol. 33(6), 417-421., 2004
Organism:Fever of unknown origin (FUO) in adults is a commonly encountered clinical problem. Treatable causes of FUO in the adult should be the primary focus of the diagnostic workup. Neoplasms have replaced infectious diseases as being the most common cause of FUO in adults, and collagen vascular diseases are now relatively rare. The most important collagen vascular diseases presenting as an FUO include Takayasu's arteritis, Kikuchi's disease, polymyalgia rheumatica, and adult juvenile rheumatoid arthritis (JRA) (adult Still's disease). There are no specific diagnostic tests for these disorders, which commonly present as prolonged fevers that are not easily diagnosed (i.e., FUO). Adult JRA is a rare but important cause of FUO in adults. Typically, patients with adult Still's disease present with liver/spleen involvement, posi-articular arthritis, ocular involvement, and evanescent salmon-colored truncal rash. An important diagnostic finding in adult JRA is the presence of a double quotidian fever, which occurs in few other disorders. Only visceral leishmaniasis and adult JRA are causes of FUO in adults associated with double quotidian fevers. Highly elevated serum ferritin levels are the most important nonspecific diagnostic finding associated with adult JRA. We present a case of FUO caused by adult JRA presenting with diffuse polyarticular migrating arthritis, evanescent rash, and splenomegaly. The diagnosis of adult JRA was suggested by these findings in association with a double quotidian fever and a highly elevated serum ferritin level. Clinicians should appreciate the diagnostic significance of fever patterns and the diagnostic significance of elevated serum ferritin levels in patients with FUO
FERREIRA RA, VASTERT SJ, ABINUN M, FOSTER HE, MODESTO C, OLIVE T, KUIS Wet WULFFRAAT NM: Hemophagocytosis during fludarabine-based SCT for systemic juvenile idiopathic arthritis, Bone Marrow Transplant., Vol. ., 2006
Organism:
FRANKLIN J, LUNT M, BUNN D, SYMMONS Det SILMAN A: Incidence of lymphoma in a large primary care derived cohort of cases of inflammatory polyarthritis, Ann.Rheum.Dis., Vol. 65(5), 617-622., 2006
Organism:OBJECTIVE: To determine the risk of lymphoma in a primary care derived cohort of new onset cases of inflammatory polyarthritis and assess the contribution of disease severity and standard immunosuppressive treatment. DESIGN: Prospective cohort study. METHODS: 2105 subjects with new onset inflammatory polyarthritis were recruited to the Norfolk Arthritis Register (NOAR) and followed annually for (median) 8.4 years. Occurrence of lymphoma was determined by annual morbidity review and linkage to the central hospital database serving the NOAR area. Cases of lymphoma were verified by record review. Standardised incidence ratios (SIRs) for lymphoma were calculated compared with the local, age, sex, and calendar year expected rates. Stratified analyses were undertaken for various markers of disease severity and treatment history. RESULTS: There were 11 cases of lymphoma during 15,548 person years of follow up, the majority of which were of large B cell type. Compared with the local population the SIR was 2.4 (95% confidence interval, 1.2 to 4.2). The risks in cases classified as rheumatoid arthritis, ever rheumatoid factor positive, or ever treated with DMARDs were all higher, the highest risk group being those treated with methotrexate: SIR = 4.9 (1.8 to 10.6). CONCLUSIONS: There was a doubling in risk of lymphoma in new onset cases of inflammatory polyarthritis. Patients with the most severe disease were twice as likely as other patients to develop lymphoma. These results need to be taken into account when considering reported increased risks of lymphoma compared to background population risk in users of new biological agents
GEDIK GK, UGUR O, ATILLA B, PEKMEZCI M, YILDIRIM M, SEVEN Bet VAROGLU E: Comparison of extraarticular leakage values of radiopharmaceuticals used for radionuclide synovectomy, Ann.Nucl.Med., Vol. 20(3), 183-188., 2006
Organism:OBJECTIVES: Radionuclide synovectomy is a reliable therapy in patients with chronic synovitis. However, radiation doses delivered to non-target organ systems due to leakage of radioactive material from the articular cavity are an important disadvantage of this procedure. In this study we compared extraarticular leakage values of the 3 commonly used radiopharmaceuticals; 90Y-citrate, 90Y-silicate and 186Re-sulfide colloid. MATERIALS AND METHODS: Thirty-five patients with persistent synovitis were enrolled in the study. Twenty-two hemophilic, 8 rheumatoid arthritis and 5 patients with pigmented villonodular synovitis were studied. 90Y labeled silicate and citrate were used for knee joints and 186Re-sulfide for intermediate sized joints. Radiocolloid leakage values were evaluated using a gamma camera with 20% window centered over the bremsstrahlung photopeak of 90Y and a respective window over the 137 keV photopeak of 186Re. Regions of interest were drawn over the injection site, the regional lymph nodes and the background areas. Leakage of radiocolloid was calculated by dividing the counts/pixel in the regional lymph node area to the counts/pixel in the injection site. RESULTS: No visible leakage was observed. The median leakage values calculated for 90Y-citrate, 90Y-silicate and 186Re-sulfide were found as 1.9%, 2.4% and 2.7%, respectively. The difference between the variability of leakage values was not statistically significant (p > 0.05). CONCLUSION: There was no significant difference in terms of extraarticular leakage between 9Y-citrate, 9Y-silicate and 186Re-sulfide radiocolloids
GOGALNICEANU D, TRANDAFIR V, CHIRIAC Ret GOGALNICEANU P: Temporomandibular joint ankylosis. A possible complication in juvenile psoriatic rheumatism, Rev.Med.Chir Soc.Med.Nat.Iasi., Vol. 109(3), 652-659., 2005
Organism:The authors present a rare case of bilateral temporomandibular joint ankylosis secondary to polyarticular juvenile psoriatic arthritis in a 24 year-old man. The patient first presented with arthritis of his right elbow joint at the age of 9, followed by involvement of the distal inter-phalangeal joints of his right foot and both sacroiliac joints. Serum rheumatoid factor was not detected. At the age of 16 he developed psoriatic lesions affecting his nails and skin. By the age of 20, clinical and radiological evidence of arthritis was detected in his temporomandibular joint (TMJ). Subsequently, the patient developed bilateral TMJ ankylosis over a period of 4 years. The patient was managed by bilateral resection of the ankylosis bone blocks, mobilization of the mandible and interposition of Dacron material between the two neo-articular surfaces. 10 months postoperatively the patient maintained an inter-incisal distance of 3 cm. Postoperative mechano-therapy was hindered by the limited use of the patients' hands
HE W, ZHANG Jet GU SZ: [Clinical observation on needle-sticking method for treatment of rheumatoid arthritis of wind-cold-damp retention type], Zhongguo Zhen.Jiu., Vol. 26(5), 331-334., 2006
Organism:OBJECTIVE: To observe clinical therapeutic effect of needle-sticking method on rheumatoid arthritis (RA) of wind-cold-damp retention type. METHODS: Fifty cases of such disease were divided into 2 groups in order of visiting. The treatment group (n = 30) were treated with needle-sticking method, and the control group (n = 20) with routine filiform needle therapy for 2 therapeutic courses. Total cumulative scores, numbers of both the pressure-pain joint and the swollen-distention joint, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C reaction protein (CRP) before and after treatment were investigated. RESULTS: Both the needle-sticking method and the filiform needle therapy had an apparent therapeutic effect on RA of wind-cold-damp retention type, and the therapeutic effect for the clinical indexes in the treatment group was better than the control group, with a very significant difference in improvement of RF, the number of pressure-pain joints and the total cumulative scores as the treatment group compared with the control group (P < 0.01). CONCLUSION: Needle-sticking method has definite therapeutic effect on RA of wind-cold-damp retention type with obvious superiority
HINKS A, WORTHINGTON Jet THOMSON W: The association of PTPN22 with rheumatoid arthritis and juvenile idiopathic arthritis, Rheumatology.(Oxford)., Vol. 45(4), 365-368., 2006
Organism:
HINKS A, WORTHINGTON Jet THOMSON W: The association of PTPN22 with rheumatoid arthritis and juvenile idiopathic arthritis, Rheumatology (Oxford), Vol. 45, 365-368., 2006
Organism:
HUNG Jet HUANG J: Etanercept therapy in children with juvenile rheumatoid arthritis, Journal of Microbiology Immunology and Infection, Vol. 38, 444-446., 2005
Organism:Chang Gung Childrens Hosp, Dept Pediat, Div Allergy Asthma and Rheumatol, Taoyuan, Taiwan Taiwan
Abstract:Etanercept is an effective inhibitor of tumor necrosis factor that has shown a beneficial effect in patients with juvenile rheumatoid arthritis (JRA) that did not respond to other disease-modifying drugs. Here we report 3 patients with JRA who were refractory to traditional therapy; 1 with systemic JRA and 2 with polyarticular JRA. They received etanercept 0.4 mg/kg (maximum 25 mg) subcutaneously, twice a week for 3 months. The symptoms of arthritis improved significantly except that the patient with systemic JRA had disease flare-up during etanercept therapy. Two patients had upper respiratory tract infection during etanercept therapy and 1 suffered from seizure attack. The 2 patients with polyarticular JRA had disease flare-up within 2 months after etanercept was discontinued. This is the first report of etanerc ept treatment in JRA patients in Taiwan
JAIN V, MAHESHWARI A, GULATI S, KABRA Met KALRA V: Juvenile rheumatoid arthritis with myelofibrosis with myeloid metaplasia, Indian J.Pediatr., Vol. 72(9), 789-791., 2005
Organism:Myelofibrosis with myeloid metaplasia is defined as a myeloproliferative disorder characterized by leukoerythroblastosis, tear drop erythrocytes, extramedullary hematopoesis and varying degree of myelofibrosis. It may be idiopathic or secondary to a large number of conditions. Here is a rare case of myelofibrosis occurring in a patient with juvenile rheumatoid arthritis
JANKOWSKI R, NOWAK Set ZUKIEL R: [The indications for occipito-cervical fixation. A report of three cases], Neurol.Neurochir.Pol., Vol. 40(1), 66-71., 2006
Organism:Lesions of the cranio-vertebral junction which affect bony structures and ligaments may cause instability and compression of the nervous and vascular structures. The goal of surgery is decompression of these structures and stabilization. The paper presents indications for performing the stabilisation procedure with CCD implementation in three patients suffering respectively from rheumatoid arthritis and neoplastic disease. In one patient spinal instability and spinal cord compression were due to rheumatoid disease and surgery included anterior spinal decompression in connection with posterior stabilisation. In two patients with neoplasms the retromandibular decompression with posterior stabilisation was performed
JARVIS JN: Gene expression arrays in juvenile rheumatoid arthritis: will the blind men finally see the elephant?, Curr.Probl.Pediatr.Adolesc.Health Care., Vol. 36(3), 91-96., 2006
Organism:
JARVIS JN: The unique clinical presentation of children with chronic arthritis: putting the pediatrics in pediatric rheumatology, Curr.Probl.Pediatr.Adolesc.Health Care., Vol. 36(3), 80-82., 2006
Organism:
JOHNSON K: Imaging of juvenile idiopathic arthritis, Pediatr.Radiol., Vol. ., 2006
Organism:Over the past decade there have been considerable changes in the classification and imaging of juvenile idiopathic arthritis (JIA). Radiology now has a considerable role in the management of JIA, the differential diagnosis, monitoring disease progression and detecting complications. The different imaging modalities available, their role and limitations are discussed in this article and the various disease features that the radiologist should be aware of are described. An approach to the imaging of the child with joint disease and in the monitoring of disease complications are also discussed
KAMPHUIS S, ALBANI Set PRAKKEN BJ: Heat-shock protein 60 as a tool for novel therapeutic strategies that target the induction of regulatory T cells in human arthritis, Expert.Opin.Biol.Ther., Vol. 6(6), 579-589., 2006
Organism:In health, immune responses to self are abundantly available, but under strict control of mechanisms of peripheral tolerance. Occasionally the immune system loses control and an autoimmune disease develops. At present, treatment of autoimmune disease is based on generalised suppression of all immune responses, and is often needed to be lifelong, leading to long-term toxicities and suppression of protective immune responses against pathogens. A more targeted approach would be to reset the immune system via restoration of failing regulatory mechanisms, and redirect the immune system to a state of tolerance. Over the past decade there have been enormous advances in the understanding of basic processes that control immune tolerance, pushing regulatory T cells forward as targets for novel therapeutic strategies. This review describes the development of antigen-specific immunotherapy that targets the antigen-specific induction of regulatory T cells as a means to treat autoimmune disease. The 'holy grail' for autoimmunity is not the disease-causing antigen, but the disease-curing antigen
KAPITANY A, ZILAHI E, SZANTO S, SZUCS G, SZABO Z, VEGVARI A, RASS P, SIPKA S, SZEGEDI Get SZEKANECZ Z: Association of rheumatoid arthritis with HLA-DR1 and HLA-DR4 in Hungary, Ann.N.Y.Acad.Sci., Vol. 1051, 263-270., 2005
Organism:Susceptibility to and outcome for rheumatoid arthritis (RA) have been associated with particular HLA-DR alleles, but these alleles vary among ethnic groups and geographic areas. The frequency of HLA-DR1 (HLA-DRB1*0101, DRB1*0102) and HLA-DR4 (DRB1*0401, DRB1*0404) alleles is elevated among Caucasian patients with RA. We studied a northeastern Hungarian population of RA patients to determine the frequency of HLA-DR1 and HLA-DR4 phenotypes in this population and to compare it with healthy control subjects, as well as to investigate whether the presence of these alleles could be a marker for RA. We performed HLA-DRB1 genotyping (DRB1*01-DRB1*16) in 83 RA patients and 55 healthy controls using polymerase chain reaction with sequence-specific primers (PCR-SSP). In the case of HLA-DR1- or HLA-DR4-positive patients, the DR1 and DR4 subtypes were also determined. The frequency of HLA-DR4 alleles was significantly higher in RA patients than in controls (31.3 vs. 10.9%; P <.05). HLA-DR1, in particular, tended to be more frequent in patients than in controls (32.5 vs. 18.1%). Among the HLA-DR4 subtypes, DRB1*0401 and DRB1*0404 were the most common alleles found in both groups. However, no significant differences were seen in the frequency of HLA-DRB1*0401 and HLA-DRB1*0404 between RA patients and controls. In contrast, HLA-DRB1*0405 and HLA-DRB1*0408 were significantly more common in RA patients than in control subjects. Among HLA-DR1 subtypes, the DRB1*0101 allele was most commonly detected, but HLA-DRB1*0101 as well as DRB1*0102 and DRB1*0105 were similarly frequent in RA patients and controls. HLA-DR12 was more common among controls than in RA patients (18.1 vs. 0%; P <.05). Our results generally agree with the findings in other Caucasian populations. Nonetheless, we found differences in the frequency of HLA-DR1 and HLA-DR4 subtypes among Hungarian patients compared with reports from other geographic regions (e.g., Finland and Asia). Our data suggest that in northeastern Hungary, HLA-DR4 as well as its subtypes DRB1*0405 and DRB1*0408 may be involved in susceptibility to RA, but HLA-DR1 may not. In addition, the presence of HLA-DR12, at least in Hungary, may protect from this disease
KELES c, AYDIN G, TOSUN A, INAL E, KELES cet ORKUN S: Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: A case report and review of the literature, 2006
Organism:I. Keles(cedil), Kirkkonaklar Mah. S(cedil)emsettin Gunaltay Cd. 246 Sk., Simkent sitesi 7. Blok no: 4/22, C(cedil)ankaya, 06610 Ankara
Abstract:The association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously. (c) Springer-Verlag 2005
KHWAJA HAet GREEN FR: An accurate, high-throughput method for genotyping the-373AnTn polymorphism in the interleukin-6 promoter, International Journal of Immunogenetics, Vol. 33, 65-67., 2006
Organism:Univ Surrey, Sch Biomed and Mol Sci, Guildford GU2 7XH, Surrey, UK UK
Abstract:Interleukin-6 (IL-6) is a pro-inflammatory cytokine implicated in inflammatory diseases. The four promoter polymorphisms (-174G/C, -373AnTn, -572G/C, -597G/A) have been shown to function as a haplotype in determining IL-6 gene transcription. Using a capillary-based electrophoresis system, high-throughput genotyping for the -373AnTn polymorphism was achieved, thus facilitating IL-6 promoter haplotype determination
KOBAYASHI N, YASUI K, NAGUMO H, AGENATSU Ket KOIKE K: Successful treatment with methotrexate of a child with atlantoaxial subluxation from enthesitis-related arthritis, Clin.Exp.Rheumatol., Vol. 24(2), 211-212., 2006
Organism:
LEE YH, RHO YH, CHOI SJ, JI JD, SONG GG, NATH SKet HARLEY JB: The PTPN22 C1858T functional polymorphism and autoimmune diseases--a meta-analysis, Rheumatology.(Oxford)., Vol. ., 2006
Organism:Objective. To assess whether combined evidence shows the association between the protein tyrosine phosphatase non-receptor 22 (PTPN22) C1858T polymorphism and autoimmune diseases, and to summarize the effect size of the polymorphism associated with susceptibility of autoimmune diseases. Methods. We surveyed studies on the PTPN22 C1858T polymorphism and autoimmune diseases using comprehensive Medline search and review of the references. Meta-analysis was performed for genotypes T/T (recessive effect), T/T + C/T (dominant effect) and T-allele in random effects models. Results. Twenty-nine studies with 43 comparisons including 13 rheumatoid arthritis (RA), six systemic lupus erythematosus (SLE), six type-1 DM (T1D), three Grave's disease (GD), four inflammatory bowel diseases (IBD), three juvenile idiopathic arthritis (JIA), two psoriasis, two multiple sclerosis, two Addison's disease and two Celiac disease were available for the meta-analysis. The overall odds ratios (ORS) for T-allele, T/T and T/T + C/T genotypes were significantly increased in RA, SLE, GD and T1D (OR for T-allele = 1.58, 1.49, 1.85, 1.61, respectively, P < 0.00001). This meta-analysis showed the association between the T-allele and the T/T genotype and JIA (OR = 1.34, P = 0.03; OR = 1.97, P = 0.02) but did not reveal the association between the PTPN22 C1858T polymorphism and IBD, psoriasis, multiple sclerosis, Addison's disease and Celiac disease. Conclusion. This meta-analysis demonstrates that the PTPN22 1858T allele confers susceptibility to RA, SLE, GD, T1D and JIA, supporting evidence of association of the PTPN22 gene with subgroup of autoimmune diseases
LIANG T, YANG Y, LIN Yet CHIANG B: Treatment with etanercept for patients with juvenile rheumatoid arthritis in Taiwan - a preliminary report, Journal of Microbiology Immunology and Infection, Vol. 38, 447-450., 2005
Organism:Natl Taiwan Univ Hosp, Dept Pediat, 7 Chung Shan S Rd, Taipei, Taiwan Taiwan
Abstract:Tumor necrosis factor (TNF) is a major inflammatory cytokine involved in the pathogenesis of juvenile rheumatoid arthritis (JRA). Etanercept, approved in the United States and in Europe for use in patients with rheumatoid arthritis (RA) and JRA, is an effective inhibitor of TNF that has been shown to provide rapid and sustained improvement in both diseases. Here we report the preliminary results of etanercept use in 3 cases of JRA with poor response to traditional therapy including non-steroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs. Two of the patients had polyarticular JRA and 1 had systemic JRA. Etanercept was administered at a dosage of 0.4 mg/kg (maximum 25 mg) subcutaneously twice a week. Clinical as well as inflammatory parameter improvement was noted after use of etanercept in all cases. The preliminary results of etanercept use in these 3 cases showed significant clinical benefit without obvious adverse effects
LO SF, HUANG CM, TSAI CH, CHIEN WC, LAI CC, TSAI Yet TSAI FJ: Androgen receptor gene polymorphism and rheumatoid arthritis in Taiwan, Clin.Exp.Rheumatol., Vol. 24(2), 209-210., 2006
Organism:
LOPEZ-OLIVO MA, GONZALEZ-LOPEZ L, GARCIA-GONZALEZ A, VILLA-MANZANO AI, COTA-SANCHEZ AR, SALAZAR-PARAMO M, VARON-VILLALPANDO E, CARDONA-MUNOZ EGet GAMEZ-NAVA JI: Factors associated with hyperhomocysteinaemia in Mexican patients with rheumatoid arthritis, Scand.J.Rheumatol., Vol. 35(2), 112-116., 2006
Organism:BACKGROUND: Hyperhomocysteinaemia is a factor related to the development of atherosclerosis in rheumatoid arthritis (RA). However, Hispanics with RA develop high rates of coronary disease; there are no studies about the frequency and factors related to high levels of homocysteine in Mexican patients. OBJECTIVE: To evaluate the prevalence and characteristics associated with hyperhomocysteinaemia in Mexican patients with RA. METHODS: One hundred and fifty-two patients with RA were compared with 153 controls. The assessment in RA included clinical characteristics, disease activity (RADAR), functioning (HAQ-Di and global functional status), comorbidity, and radiological damage. Laboratory determinations included total serum homocysteine (tHcy), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and lipid profile. RESULTS: Median levels of homocysteine were higher in RA compared with controls (11.3 vs. 9.3, p<0.001). Twenty per cent of the patients with RA had hyperhomocysteinaemia (>15 micromol/L) compared with 6% in controls (p<0.001). There was statistical association between hyperhomocysteinaemia in RA with male gender (p<0.001), impairment in the global functional status (p = 0.004), higher radiological damage (p = 0.001), and CRP (p = 0.04). There was no association with RADAR, HAQ-Di, or RF, methotrexate dose or duration of use. In the adjusted multivariate model, the two variables associated with higher risk for hyperhomocysteinaemia were male gender (OR = 4.2, 95% CI 2 to 12, p = 0.006) and higher radiological damage (III-IV) (OR = 3.4, 95% CI 1.3 to 9, p = 0.01). CONCLUSIONS: Our data show a high prevalence of hyperhomocysteinaemia in Mexican patients with RA. More effort is required to evaluate and treat earlier this coronary risk factor
LOVELL DJ, GLASS D, RANZ J, KRAMER S, HUANG B, SIERRA RI, HENDERSON CJ, PASSO M, GRAHAM B, BOWYER S, HIGGINS G, RENNEBOHM R, SCHIKLER KNet GIANNINI E: A randomized controlled trial of calcium supplementation to increase bone mineral density in children with juvenile rheumatoid arthritis, Arthritis Rheum., Vol. 54(7), 2235-2242., 2006
Organism:OBJECTIVE: To examine the effects of daily supplementation with calcium (Ca) in combination with vitamin D on total body and lumbar spine bone mineral density (BMD) in patients with juvenile rheumatoid arthritis (JRA) who had not taken corticosteroids for at least 3 months prior to the beginning of the study. METHODS: One hundred ninety-eight children and adolescents (141 girls and 57 boys) with JRA, ages 6 to 18 years, with a mean +/- SD age of 11.7 +/- 3.3 years and a mean +/- SD disease duration of 5.6 +/- 3.8 years at the beginning of the study, were enrolled in this randomized double-blind, placebo-controlled trial to receive either daily oral supplements of 1,000 mg of Ca and 400 IU of vitamin D (n = 103) or matched placebo tablets and 400 IU of vitamin D (n = 95) for 24 months. Total body BMD (TBBMD) was measured by dual x-ray absorptiometry at baseline and every 6 months for 24 months. RESULTS: At baseline, the mean +/- SD TBBMD was 0.89 +/- 0.14 gm/cm(2) among patients randomized to the Ca group and 0.87 +/- 0.14 gm/cm(2) among those randomized to placebo (P = 0.445). At 24 months, the mean +/- SD TBBMD among those receiving Ca was 0.95 +/- 0.13 gm/cm(2), compared with 0.92 +/- 0.14 gm/cm(2) among those receiving placebo. A longitudinal random-effects mixed model analysis that controlled for differences in the subject's initial BMD, sex, Tanner stage, adherence to the study medication regimen, and body composition revealed significantly higher TBBMD among patients who received Ca compared with patients who received placebo during the study period (P = 0.03). CONCLUSION: Ca supplementation resulted in a small, but statistically significant, increase in TBBMD compared with placebo in children with JRA
LU TYTet HILL C: Managing patients taking tumour necrosis factor inhibitors, 2006
Organism:T.Y.-T. Lu, Department of Rheumatology, Queen Elizabeth Hospital, Adelaide, SA
Abstract:Patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or juvenile chronic arthritis that is unresponsive to standard disease-modifying antirheumatic drugs can now be treated with tumour necrosis factor inhibitors. These biological drugs all antagonise the actions of tumour necrosis factor, a key cytokine central to the inflammatory cascade. Their adverse effects can be severe and include sepsis, reactivation of pulmonary tuberculosis, blood dyscrasias, demyelinating syndromes, lymphoproliferative disease and precipitation of cardiac failure. Careful monitoring of patients is important
MACHADO SH, VON MUHLEN CA, BRENOL JC, BISOTTO Let XAVIER RM: [The prevalence of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis], J.Pediatr.(Rio J.)., Vol. 81(6), 491-494., 2005
Organism:OBJECTIVES: To assess the presence of anti-cyclic citrullinated peptide antibodies in a cohort of patients with juvenile idiopathic arthritis. METHODS: Anti-cyclic citrullinated peptide antibodies was tested for with an enzyme linked immunoabsorbent assay (ELISA) in serum samples of patients from the Hospital de Clinicas de Porto Alegre, all less than 18 years old and with previous diagnosis for at least 6 months. IgMRF (rheumatoid factor) and antinuclear antibodies in Hep-2 cells were also assayed. RESULTS: Serum samples were analyzed from 45 patients. The presence of high levels of anti-cyclic citrullinated peptide antibodies was found in the serum of just one child (2%), who presented sero-positive polyarthritis. CONCLUSIONS: Anti-cyclic citrullinated peptide antibodies can be detected in children with juvenile idiopathic arthritis, but much less frequently than in adults with rheumatoid arthritis. It still remains to be determined whether anti-cyclic citrullinated peptide antibodies can identify a subset of juvenile idiopathic arthritis patients with the potential to progress to adult rheumatoid arthritis
MAHARAJ RG, REID SD, MISIR Aet SIMEON DT: Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad, West Indian Med.J., Vol. 54(6), 369-374., 2005
Organism:This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60% and a specificity of 94%. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76%. The patients were primarily Indo-Trinidadian (70%), over 50 years (76.4%) and female (72.3%). The prevalence of depression was 28.3%. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics
MANFRINI Oet BUGIARDINI R: [Rheumatic fever and rheumatic heart disease], G.Ital.Cardiol.(Rome)., Vol. 7(4), 266-272., 2006
Organism:Rheumatic heart disease, the sequel of acute rheumatic fever, is a very common cause of cardiovascular mortality and morbidity all over the world, and is the predominant indication for cardiac surgery in the industrialized countries. Diagnosis of rheumatic chronic carditis may sometimes be difficult because valvular regurgitation may not always be detected by routine clinical auscultation. A recent report from the World Health Organization Expert Committee recognizes the usefulness of echocardiography Doppler in providing supporting evidence for diagnosis of rheumatic carditis in the presence of equivocally pathological murmur, and recommends that patients with subclinical carditis should be managed as rheumatic heart disease until proven otherwise, because the disease still represents a major health problem. The aim of this review is to give an update on the disease by underlining changes made by the World Health Organization on disease diagnosis and patient management
MCCULLOUGH CJ, REMEDIOS D, TYTHERLEIGH-STRONG G, HUA Jet WALKER PS: The use of hydroxyapatite-coated CAD-CAM femoral components in adolescents and young adults with inflammatory polyarthropathy: TEN-YEAR RESULTS, J.Bone Joint Surg.Br., Vol. 88(7), 860-864., 2006
Organism:Between June 1991 and January 1995, 42 hydroxyapatite-coated CAD-CAM femoral components were inserted in 25 patients with inflammatory polyarthropathy, 21 of whom had juvenile idiopathic arthritis. Their mean age was 21 years (11 to 35). All the patients were reviewed clinically and radiologically at one, three and five years. At the final review at a mean of 11.2 years (8 to 13) 37 hips in 23 patients were available for assessment. A total of four femoral components (9.5%) had failed, of which two were radiologically loose and two were revised. The four failed components were in patients aged 16 years or less at the time of surgery. Hydroxyapatite-coated customised femoral components give excellent medium- to long-term results in skeletally-mature young adults with inflammatory polyarthropathy. Patients aged less than 16 years at the time of surgery have a risk of 28.5% of failure of the femoral component at approximately ten years
MCDONAGH JE, SOUTHWOOD TRet SHAW KL: The impact of a coordinated transitional care programme on adolescents with juvenile idiopathic arthritis, Rheumatology.(Oxford)., Vol. %20;., 2006
Organism:Objective. There is an extensive evidence base for the need of transitional care, but a paucity of robust outcome data. The aim of the study was to determine whether the quality of life of adolescents with juvenile idiopathic arthritis (JIA) could be improved by a co-ordinated, evidence-based programme of transitional care. Methods. Adolescents with JIA aged 11, 14 and 17 yrs and their parents were recruited from 10 rheumatology centres in the UK. Data were collected at baseline, 6 and 12 months including core outcome variables. The primary outcome measure was health-related quality of life (HRQL): Juvenile Arthritis Quality of Life Questionnaire (JAQQ). Secondary outcome measures included: knowledge, satisfaction, independent health behaviours and pre-vocational experience. Results. Of the 359 families invited to participate, 308 (86%) adolescents and 303 (84%) parents accepted. A fifth of them had persistent oligoarthritis. Median disease duration was 5.7 (0-16) yrs. Compared with baseline values, significant improvements in JAQQ scores were reported for adolescent and parent ratings at 6 and 12 months and for most secondary outcome measures with no significant deteriorations between 6 and 12 months. Continuous improvement was observed for both adolescent and parent knowledge with significantly greater improvement in the younger age groups at 12 months (P = 0.002). Conclusions. This study represents the first objective evaluation of an evidence-based transitional care programme and demonstrates that such care can potentially improve adolescents' HRQL
MICHELS H, MENGEL E, HUPPERTZ Het SCHAEFER R: Gaucher disease, mucopolysaccharidosis type I (Scheie disease) and Fabry disease. Lysosomal storage diseases treatable by specific therapies and the importance of differential diagnosis against inflammatory rheumatic diseases, 2006
Organism:Dr. H. Michels, Kinderklinik Garmisch-Partenkirchen, Rheumaklinik fur Kinder und Jugendliche/Allgemeinklinik, Gehfeldstrasse 24, 82467 Garmisch-Partenkirchen
Abstract:Enzyme replacement therapies with the potential to improve prognosis are available for the lysosomal storage disorders Gaucher disease, mucopolysaccharidosis type I (MPS I-S; Scheie disease) and Fabry disease. Differential diagnosis is required to exclude a number of other conditions, including some rheumatic diseases. The bone pain associated with Gaucher disease can be misdiagnosed as juvenile idiopathic arthritis (JIA), and hepatosplenomegaly and pancytopenia may suggest collagen disorders. Symptoms such as contractures of the finger joints caused by Scheie disease can also imitate JIA. Fabry disease can also be confused with systemic JIA, collagen or vascular disorders, because of the pain it causes in hands and feet, sometimes associated with fever episodes, and renal and cerebrovascular symptoms. Critical evaluation of the clinical symptoms of lysosomal storage disorders in association with laboratory and test results should allow diagnosis of these diseases at an early stage, thereby facilitating better treatment and avoiding their misdiagnosis as any of several rheumatic diseases. (c) Springer Medizin Verlag 2006
MIRANDA-CARUS ME, BENITO-MIGUEL M, BALSA A, COBO-IBANEZ T, PEREZ dA, PASCUAL-SALCEDO Det MARTIN-MOLA E: Peripheral blood T lymphocytes from patients with early rheumatoid arthritis express RANKL and interleukin-15 on the cell surface and promote osteoclastogenesis in autologous monocytes, Arthritis Rheum., Vol. 54(4), 1151-1164., 2006
Organism:OBJECTIVE: To investigate the osteoclastogenic potential of T cells from the peripheral blood (PB) and synovial fluid (SF) of patients with rheumatoid arthritis (RA) on autologous monocytes, and to study the cytokines implicated in this process. METHODS: T cells and monocytes were isolated from the PB of 20 healthy subjects and 20 patients with early RA, and from the SF of 20 patients with established RA. Autologous T cell/monocyte cocultures were established in the absence of exogenous cytokines or growth factors in order to examine spontaneous ex vivo osteoclast differentiation by tartrate-resistant acid phosphatase staining and calcified matrix resorption activity. RESULTS: Surface RANKL was expressed on freshly isolated T cells from the PB of patients with early RA and the SF of patients with established RA. In addition, surface interleukin-15 (IL-15) was detected on freshly isolated T cells and monocytes from the PB of patients with early RA and the SF of patients with established RA. Autologous T cell/monocyte cocultures derived from the SF of patients with established RA and from the PB of patients with early RA, but not from the PB of healthy controls, resulted in osteoclast differentiation that was significantly inhibited by osteoprotegerin (OPG) and by neutralizing monoclonal antibodies to IL-15, IL-17, tumor necrosis factor alpha (TNFalpha), and IL-1beta. OPG, anti-TNFalpha, and anti-IL-1beta demonstrated a cooperative inhibitory effect. At 1-year followup, surface RANKL and IL-15 and ex vivo osteoclastogenesis were no longer observed on PB T cells or monocytes from patients with early RA in whom clinical remission had been achieved with treatment. CONCLUSION: T cells are important contributors to the pathogenesis of bone erosions in RA through interaction with osteoclast precursors of the monocyte/macrophage lineage
MULLER-GODEFFROY E, LEHMANN H, KUSTER RMet THYEN U: Psychosocial adaptation in chronic arthritis. Behavioural characteristics of children and adolescents with juvenile idiopathic arthritis and reactive arthritis, 2006
Organism:E. Muller-Godeffroy, Klinik fur Kinder- und Jugendmedizin, Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Ratzeburger Allee 160, 23538 Lubeck
Abstract:We sought to measure psychosocial adaptation in children and adolescents with different forms of chronic arthritis and to determine associated factors. Mothers of 68 children aged 8-17 years with juvenile idiopathic arthritis (JIA) or reactive arthritis reported behaviour problems (CBCL), children reported their actual stress level (SSK), functional disability in conducting activities of daily living (CHAQ) and health-related quality of life (HRQOL) including self-esteem (KINDL-R). Children and adolescents with JIA or reactive arthritis reported lower self-esteem compared to normative data. Al most 20% of the samples were reported to have serious behaviour problems, mostly social isolation and depression/anxiety. Children with lower HRQOL, more functional limitations and a higher stress level showed more behaviour problems. Self-esteem and behaviour problems may be relevant outcome measures in children and adolescents with chronic arthritis and useful to monitor psychosocial support in this population. (c) Springer Medizin Verlag 2004
NELSON F, BILLINGHURST RC, PIDOUX I, REINER A, LANGWORTHY M, MCDERMOTT M, MALOGNE T, SITLER DF, KILAMBI NR, LENCZNER Eet POOLE AR: Early post-traumatic osteoarthritis-like changes in human articular cartilage following rupture of the anterior cruciate ligament, Osteoarthritis.Cartilage., Vol. 14(2), 114-119., 2006
Organism:OBJECTIVE: Injury to the anterior cruciate ligament (ACL) frequently leads to post-traumatic osteoarthritis (OA). In this study we determined whether early degenerative changes characteristic of idiopathic OA are induced in articular cartilage following ACL injury. METHODS: A small sample of femoral articular cartilage was removed at surgery, as part of ACL reconstruction, from a total of 50 patients with ACL injuries. Of these, 28 underwent surgery less than 1 year post-injury. Control cartilages were obtained from the same site from 21 persons at autopsy. All cartilages were examined for molecular changes. The content of type II collagen, its cleavage by collagenases and its denaturation were determined by immunoassay. The total content of glycosaminoglycan (GAG), which is principally aggrecan, was measured colorimetrically. Data were expressed per unit DNA (GAG and collagen content) or as a percentage of total collagen cleaved or denatured. Other cartilages from the same site (8 controls, 12 less than 1 year and 8 more than 1 year post-injury) were frozen sectioned and examined histologically to determine by Mankin grading cartilage degeneration. RESULTS: Histological analyses revealed that control subjects exhibited staining for proteoglycan, which was reduced in some patients following ACL rupture. Degeneration of the articular surface was sometimes observed 1 year after ACL rupture. Although the Mankin grade increased with time after rupture these changes were not significant. Immunoassays, however, revealed an increase in GAG content within 1 year which was maintained after 1 year although no longer significant. No changes in total type II collagen content were observed during the period of study. However, there were significant increases in the denaturation and cleavage of type II collagen less than and more than 1 year post-ACL rupture. Total type II collagen content was directly correlated with GAG content in all three groups, with the significance being weakest at more than 1 year. After 1 year an inverse correlation was observed between total type II collagen content and collagen cleavage as well as denaturation. CONCLUSIONS: These observations reveal that joint instability resulting from ACL injury rapidly results in degenerative changes characteristic of those seen in idiopathic OA at arthroplasty and in experimental OA following ACL surgery. These changes may contribute to the development of post-traumatic OA that is commonly observed following ACL injury. The observations support and extend conclusions from other studies on human and animal articular cartilage and synovial fluids post-ACL injury that have revealed a rapid onset of damage to type II collagen and an initial increase in proteoglycan content characteristic of experimental OA post-ACL injury. This study provides direct evidence for the rapid development of degenerative changes characteristic of OA following ACL injury
NGUYEN TT, ZLACKA D, VAVRINCOVA P, SEDLACEK Pet HROMADNIKOVA I: Detection of antibodies against 60-, 65- and 70-kDa heat shock proteins in paediatric patients with various disorders using Western blotting and ELISA, Clin.Chem.Lab Med., Vol. 44(4), 442-449., 2006
Organism:BACKGROUND: We examined antibodies against 60-, 65- and 70-kDa heat shock proteins (HSPs) in paediatric healthy individuals, patients with juvenile idiopathic arthritis (JIA) and those undergoing allogeneic stem-cell transplantation for various malignant and non-malignant diseases. METHODS: Western blotting and ELISA were used to examine HSP-directed humoral immune responses. RESULTS: Using ELISA we detected anti-Hsp60, -Hsp65 and -Hsp70 IgG antibodies in patient sera before, during and after conditioning and at all post-transplant times, as well as in JIA patients and controls. Western blotting showed positivity for anti-Hsp60 and anti-Hsp65 antibodies in all samples with a HSP concentration of 0.5 microg/lane. However, anti-Hsp70 antibodies were not detected at all when both sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and native PAGE were used, except for one JIA patient, for whom a positive signal was only achieved in native PAGE when Hsp70 was increased to 2 microg/lane and serum dilution decreased to 1:10. CONCLUSION: Western blotting is convenient for the detection of anti-Hsp60 and anti-Hsp65 antibodies, but it is not sensitive enough for the detection of anti-Hsp70 antibodies. ELISA, which is more sensitive, might be preferentially used to screen anti-Hsp60, -Hsp65 and -Hsp70 antibodies in sera of children with various disorders
NIEHUES T, HORNEFF G, MICHELS H, HOCK MSet SCHUCHMANN L: Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria, Rheumatol.Int., Vol. 25(3), 169-178., 2005
Organism:Juvenile idiopathic arthritis (JIA) is the most common diagnosis in children and adolescents with rheumatic disorders. In many children and adolescents, JIA is successfully treated with non-steroidal anti-inflammatory drugs (NSAID) and physiotherapy. However, in a significant number of cases the disease is resistant to this therapy, and treatment with "second line" disease-modifying antirheumatic drugs (DMARDs) is required. Methotrexate (MTX) is frequently referred to as "first-choice second-line agent" for the treatment of JIA. To increase drug safety, the Working Groups for Children and Adolescents with Rheumatic Diseases in Germany (AGKJR) and Pediatric Rheumatology Austria have initiated the formulation of evidence-based recommendations. Evidence is based on consensus expert meetings, a MEDLINE search with the key words "Methotrexate" and "juvenile arthritis" limited to age 0-18 years, standard textbooks and review articles, data from the central registry of the German Research Center for Rheumatic Diseases (Deutsches Rheumaforschungszentrum Berlin DRFZ), experience with MTX in adults with rheumatoid arthritis (RA), and recommendations of the German Society of Rheumatology (DGRh). Based on these data, evidence and recommendations are graded, and evidence-based recommendations for the use of MTX in children and adolescents with rheumatic disease are presented
PASSO M: Emerging therapies in juvenile rheumatoid/idiopathic arthritis, Curr.Probl.Pediatr.Adolesc.Health Care., Vol. 36(3), 97-103., 2006
Organism:
PIPER KE, HANSSEN AD, LEWALLEN DG, MATTESON EL, OSMON DR, DUFFY MC, HAGAN RA, STECKELBERG JMet PATEL R: Lack of detection of human retrovirus-5 proviral DNA in synovial tissue and blood specimens from individuals with rheumatoid arthritis or osteoarthritis, Arthritis Rheum., Vol. 55(1), 123-125., 2006
Organism:OBJECTIVE: Prior studies have suggested an association of human retrovirus 5 with rheumatoid arthritis. The purpose of this study was to determine if human retrovirus-5 proviral DNA is present in synovial tissue and blood specimens from patients with rheumatoid arthritis or osteoarthritis, or those without joint disease. METHODS: Synovial tissue and whole blood from 75 patients with rheumatoid arthritis, 75 patients with osteoarthritis, and 50 patients without a primary arthritis diagnosis were assayed by real-time quantitative polymerase chain reaction (PCR) using primers that amplify a 186-bp fragment of human retrovirus-5 proviral DNA. RESULTS: A total of 200 tissue specimens, 200 mononuclear cells, and 196 of 200 granulocyte specimens tested negative for human retrovirus-5 proviral DNA. No association between human retrovirus 5 and rheumatoid arthritis or osteoarthritis (P = 0.516) was identified. Granulocyte specimens from 4 patients, 2 with rheumatoid arthritis and 2 with osteoarthritis, yielded a low positive human retrovirus-5 proviral DNA signal (83-1,365 copies of human retrovirus-5 proviral DNA/ml blood). CONCLUSION: Contrary to prior reports, we did not find an association between human retrovirus 5 and rheumatoid arthritis or osteoarthritis using a real-time PCR assay. Our findings are consistent with the recent finding that human retrovirus 5 is actually rabbit endogenous retrovirus H
POLLARD TC, BAKER RP, EASTAUGH-WARING SJet BANNISTER GC: Treatment of the young active patient with osteoarthritis of the hip. A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing, J.Bone Joint Surg.Br., Vol. 88(5), 592-600., 2006
Organism:We compared the five- to seven-year clinical and radiological results of the metal-on-metal Birmingham hip resurfacing with a hybrid total hip arthroplasty in two groups of 54 hips, matched for gender, age, body mass index and activity level. Function was excellent in both groups, as measured by the Oxford hip score, but the Birmingham hip resurfacings had higher University of California at Los Angeles activity scores and better EuroQol quality of life scores. The total hip arthroplasties had a revision or intention-to-revise rate of 8%, and the Birmingham hip resurfacings of 6%. Both groups demonstrated impending failure on surrogate end-points. Of the total hip arthroplasties, 12% had polyethylene wear and osteolysis under observation, and 8% of Birmingham hip resurfacings showed migration of the femoral component. Polyethylene wear was present in 48% of the hybrid hips without osteolysis. Of the femoral components in the Birmingham hip resurfacing group which had not migrated, 66% had radiological changes of unknown significance
POPKO J, MARCINIAK J, ZALEWSKA A, MALDYK P, ROGALSKI Met ZWIERZ K: The activity of exoglycosidases in the synovial membrane and knee fluid of patients with rheumatoid arthritis and juvenile idiopathic arthritis, Scand.J.Rheumatol., Vol. 35(3), 189-192., 2006
Organism:Objective: To determine the activities of the five exoglycosidases that catabolize glycoconjugates (proteoglycans, glycoproteins, and glycolipids) in the synovial membrane and knee joint fluid of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA).Methods: The following exoglycosidases were analysed with the p-nitrophenyl derivatives of appropriate sugars as substrates: hexosaminidase (HEX) and its isoenzymes A and B, beta-glucuronidase, beta-galactosidase, alpha-mannosidase, and alpha-fucosidase.Results: Our results show that the activity of all exoglycosidases tested in the synovial membrane of patients with RA and JIA was significantly higher than in synovial fluid. We demonstrated that only the enzymatic activity of HEX was significantly higher in the tissue of patients with inflammatory diseases in comparison to the activity in the control group.Conclusion: These data support the concept that the synovial cells of patients with RA and JIA are the main source of exoglycosidases, which catabolize glycoconjugates of cartilage
PRAHALAD S, BOHNSACK JF, JORDE LB, WHITING A, CLIFFORD B, DUNN D, WEISS R, MOROLDO M, THOMPSON SD, GLASS DNet BAMSHAD MJ: Association of two functional polymorphisms in the CCR5 gene with juvenile rheumatoid arthritis, Genes Immun., Vol. ., 2006
Organism:Juvenile rheumatoid arthritis (JRA) is mediated by Th1-immune responses. In children with JRA, synovial T cells express high levels of the Th1-chemokine receptor CC chemokine receptor 5 (CCR5), which has been implicated in susceptibility to rheumatoid arthritis. To test the hypothesis that genetic variation in CCR5 is associated with susceptibility to JRA, we analyzed patterns of variation in the 5'cis-regulatory region of CCR5 in 124 multiplex families from a JRA-affected sibpair registry. After sequencing the upstream region of CCR5, variants were tested for association with JRA by transmission disequilibrium testing. A single nucleotide polymorphism, C-1835T, was significantly undertransmitted to children with early-onset JRA (P<0.01). C-1835T was genotyped in 424 additional simplex and multiplex families. CCR5-1835T allele was undertransmitted in the cohort of all probands with JRA (P<0.02), as well as in those with early-onset (P<0.01) or pauciarticular JRA (P<0.05). Another variant, a 32-bp deletion in the open reading frame of CCR5 (CCR5-Delta32) was also tested in approximately 700 simplex and multiplex families. CCR5-Delta32 was also significantly undertransmitted to probands with early-onset JRA (P<0.05). Both variants are in regions under natural selection, and result in functional consequences. Our results suggest these CCR5 variants are protective against early-onset JRA.Genes and Immunity advance online publication, 15 June 2006; doi:10.1038/sj.gene.6364317
PRAHALAD S: Genetic analysis of juvenile rheumatoid arthritis: approaches to complex traits, Curr.Probl.Pediatr.Adolesc.Health Care., Vol. 36(3), 83-90., 2006
Organism:
REICHERT S, MACHULLA HK, FUCHS C, JOHN V, SCHALLER HGet STEIN J: Is there a relationship between juvenile idiopathic arthritis and periodontitis?, J.Clin.Periodontol., Vol. 33(5), 317-323., 2006
Organism:AIM: The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years). MATERIAL AND METHODS: In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M. RESULTS: JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP> or =5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019). CONCLUSION: After adjustment for microbial plaque, JIA is not a risk factor for periodontitis
ROSE CD: Epidemiology of juvenile rheumatoid arthritis in the Americas: an update, J.Clin.Rheumatol., Vol. 12(3), 129-130., 2006
Organism:
ROTH J, BECHTOLD S, BORTE G, DRESSLER F, GIRSCHICK HJet BORTE M: Osteoporosis in juvenile idiopathic arthritis. Recommendations for diagnosis, prevention and therapy - Consensus statement of the German Society for Pediatric Rheumatology, 2006
Organism:Dr. J. Roth, SPZ Rheumatologie, Abt. Padiatrische Pneumologie and Immunologie, Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin
Abstract:In a high percentage of patients with juvenile idiopathic arthritis (JIA) a pathologic loss of bone or the failure of bone mass to increase has been described, even with new therapeutic approaches. The decrease in bone mass correlates with the duration of active disease, and to some degree with the number of joints affected. In several studies, muscle mass has been found to be the strongest predictor of bone mass. A standardized diagnostic approach to the musculoskeletal system plus prophylactic measures and therapy are therefore mandatory in all children with JIA who do not achieve rapid remission. This review describes the options for diagnosis and treatment, and they are summarized in an algorithm. (c) Springer Medizin Verlag 2006
SCHUBERT K, VON BONNSDORF H, BURKE M, AHLERT I, BRAUN S, BERNER R, DEICHMANN KAet HEINZMANN A: A comprehensive candidate gene study on bronchial asthma and juvenile idiopathic arthritis, Dis.Markers., Vol. 22(3), 127-132., 2006
Organism:Bronchial asthma and juvenile idiopathic arthritis (JIA) are complex genetic diseases. As both represent chronic inflammatory diseases it is likely that they are at least partially influenced by the same genetic variants. One goal in dissecting the genetics of complex diseases is to identify a genetic risk profile. Therefore it is necessary to genotype polymorphisms in many different pathways. Thus we investigated 48 polymorphisms in 24 genes for association with asthma and/or JIA. Genotpying was performed on 231 asthmatic children, 86 children with JIA and 270 controls. Association analysis was performed by the Armitage's trend test. Furthermore haplotypes were calculated by FAMHAP. We found association of polymorphisms within IL-4, CTLA4 and TNFalpha with asthma and/or JIA. Furthermore, the polymorphisms showed an inverse distribution between children with asthma and JIA. However, we were not able to confirm association of most of the previously described candidate genes. We conclude from our data that it might be very difficult to identify genetic risk profiles for the development of asthma and/or JIA that would be valid across different populations. However, this study adds further evidence that the common genetic background of asthma and JIA is mainly based on polymorphisms in important TH1 and TH2 cytokines
SEDLACKOVA L, VELEK J, VAVRINCOVA Pet HROMADNIKOVA I: Peripheral blood mononuclear cell responses to heat shock proteins and their derived synthetic peptides in juvenile idiopathic arthritis patients, Inflamm.Res., Vol. 55(4), 153-159., 2006
Organism:BACKGROUND: Sequence homology and cross reactivity between microbial and human heat shock proteins (hsps) led to the concept that hsps might be involved in the etiopathogenesis of autoimmune diseases. OBJECTIVE: In our study we stimulated peripheral blood mononuclear cells (PBMC) of patients with juvenile idiopathic arthritis (JIA) and healthy controls with various hsp-derived peptides together with the whole molecules of corresponding hsp. METHODS: PBMC were cultured with recombinant human hsp60 (rh-hsp60), rh-hsp70, Mycobacterium bovis hsp65 (M.bovis hsp65), P562-571 human hsp60, P180-188 M. bovis hsp65, P450-463 human hsp70 and P545-554 cytokeratin derived synthetic peptides. Cell responses were measured after incorporation of (3)H-thymidine and expressed as stimulation indices. RESULTS AND CONCLUSION: We found elevated proliferative response to rh-hsp60, M. bovis hsp65 and P562-571 human hsp60 derived peptide in patients with JIA polyarthritis. Significantly elevated proliferation to P180-188 M. bovis hsp65 was found in JIA lasting more than 2 years. None of the particular clinical characteristics (RF, ANA, HLA B27 and disease activity) seemed to be associated with hsp or hsp-derived synthetic peptide proliferative response in the JIA cohort
SELVAAG A, FLATO B, DALE K, LIEN G, VINJE O, SMERDEL-RAMOYA Aet FORRE O: Radiographic and Clinical Outcome in Early Juvenile Rheumatoid Arthritis and Juvenile Spondyloarthropathy: A 3-Year Prospective Study, J.Rheumatol., Vol. ., 2006
Organism:OBJECTIVE: To describe radiographic findings at disease onset and 3-year followup in patients with juvenile rheumatoid arthritis (JRA) and juvenile spondyloarthropathy (JSpA), to assess radiographic progression and its predictors, and to prospectively assess clinical outcome and predictors of persistent disease at 3-year followup. METHODS: A total of 197 patients with JRA/JSpA were examined every 6 months for 3 years. Radiographic examination was performed at baseline and 3-year followup of knees and ankles (all patients) and of other joints on clinical indication. Remission was defined as minimum 6 months without medication and no clinical signs of active disease. RESULTS: Radiographic abnormalities were found in 88% of the patients at onset and in 81% after 3 years. Frequency of swelling/osteoporosis decreased and frequency of abnormal growth increased from baseline to followup. Knees, hands, and wrists had most frequently radiographic abnormalities. Radiographic progression occurred in 38% of the patients. Joints with swelling/osteoporosis on radiographs, young age, and a large number of mobility-restricted joints at baseline were predictors of radiographic progression. At 3 years, 26% of the patients were in remission and 75% had been treated with disease-modifying antirheumatic drugs. Reduced well-being, a large number of active joints and negative antinuclear antibody at baseline were predictors of persistent disease after 3 years. CONCLUSION: After 3 years most patients had radiographic abnormalities and persistent disease. Young age, many affected joints, reduced well-being, and negative antinuclear antibody at onset increased the risk of radiographic progression and persistent disease after 3 years
SHAW KL, SOUTHWOOD TRet MCDONAGH JE: Growing up and moving on in rheumatology: parents as proxies of adolescents with juvenile idiopathic arthritis, Arthritis Rheum., Vol. 55(2), 189-198., 2006
Organism:Institute of Child Health, University of Birmingham, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United KingdomFAU - Shaw, K L
Abstract:OBJECTIVE: To examine agreement about physical health, functional ability, and health-related quality of life (HRQOL) between adolescents with juvenile idiopathic arthritis (JIA) and their parents. METHODS: The study group comprised 303 adolescent-parent dyads who completed individual questionnaires, including the Childhood Health Assessment Questionnaire with visual analog scales for pain and general well-being, and the Juvenile Arthritis Quality of Life Questionnaire. Agreement was determined using the Bland and Altman method. RESULTS: Approximately half of the adolescent-parent dyads showed clinically acceptable agreement for pain, general well-being, functional disability, and HRQOL. Where discrepancies occurred, there were similar numbers of parental overestimation and underestimation, with the exception that parents rated functional ability worse than did adolescents. Parents were also consistent with respect to overestimation or underestimation, irrespective of the health domain in question. Agreement was associated with better disease-related outcome variables, but was not significantly influenced by demographic factors. Agreement between adolescents and parents was dependent on the level of disease outcome and the health domain under scrutiny, and was less for moderate disease outcomes (as compared with mild or severe) and less visible phenomena (e.g., pain, global well-being). CONCLUSION: There is a wide variation in agreement between adolescents with JIA and their parents that is dependent on which health-related variable is under scrutiny. Proxy report is likely to be valid for adolescents with JIA at either the mild or severe end of the spectrum and/or for the visible manifestations of the disease. Consideration of both adolescent and parent-proxy reports is therefore important in future research
SHAW KL, SOUTHWOOD TR, DUFFY CMet MCDONAGH JE: Health-related quality of life in adolescents with juvenile idiopathic arthritis, Arthritis Rheum., Vol. 55(2), 199-207., 2006
Organism:OBJECTIVE: To describe the health-related quality of life (HRQOL) of adolescents with juvenile idiopathic arthritis (JIA), and to examine the usefulness of the Juvenile Arthritis Quality of Life Questionnaire (JAQQ) in a UK context. It was hypothesized that HRQOL would decrease with worsening disease and disability. METHODS: Patients with JIA ages 11, 14, and 17 years were recruited from 10 major rheumatology centers. HRQOL was measured using the JAQQ. Other data were core outcome variables including the Childhood Health Assessment Questionnaire, demographic characteristics, arthritis-related knowledge, and satisfaction with health care. RESULTS: Questionnaires were completed by 308 adolescents. One-fifth had persistent oligoarthritis. Median disease duration was 5.7 years (range <1-16 years). The JAQQ was shown to have good psychometric properties when used in the UK, but was not without limitations. HRQOL of adolescents with JIA was less than optimal, particularly in the domains of gross motor and systemic functioning. Items most frequently rated as adolescents' biggest psychological problems were "felt frustrated" and "felt depressed," rated by 30.2% and 23.4%, respectively. These were particularly problematic for the 17-year-olds, with 39% reporting frustration as one of their biggest problems and 63.6% reporting depression. Variation in the adolescent JAQQ scores was explained by functional disability, pain, and disease activity. CONCLUSION: JIA can have a significant adverse effect on the HRQOL of adolescents. The JAQQ is a useful tool to assess the HRQOL of UK adolescents with JIA, but there is need for improved measures that incorporate developmentally appropriate issues
SINGER SL, SOUTHALL PJ, ROSENBERG I, GILLETT Det WALTERS M: Mandibular distraction osteogenesis and maxillary osteotomy in a class II division 1 patient with chronic juvenile arthritis, Angle Orthod., Vol. 76(2), 341-348., 2006
Organism:A patient with juvenile chronic arthritis presented with a malocclusion characterized by mandibular hypoplasia, symphysial deficiency, and an increased mandibular occlusal plane angle. Correction of the mandibular defect required both the horizontal advancement of the mandible and a counterclockwise rotation of the proximal segment to reduce the mandibular occlusal plane angle. This was achieved by a combination of distraction osteogenesis to horizontally advance the mandible (14 mm), followed by manipulation of the postdistraction regenerate to reduce the mandibular occlusal plane and increase the symphysial projection. The counterclockwise rotation of the mandibular body resulted in the creation of a posterior open bite. After a three-month period to allow consolidation of the mandibular distraction osteogenesis, secondary maxillary surgery at the Le Fort 1 level was performed to reestablish maxillary occlusal contact at the new mandibular occlusal plane. A genioplasty was also performed to improve chin projection
SINGH-GREWAL D, WRIGHT V, BAR-OR Oet FELDMAN BM: Pilot study of fitness training and exercise testing in polyarticular childhood arthritis, Arthritis Rheum., Vol. 55(3), 364-372., 2006
Organism:OBJECTIVE: To 1) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis (JIA), 2) test the safety and feasibility of a 3-month exercise program in JIA, 3) assess pain during exercise in JIA, 4) compare ratings of perceived effort (RPE) with heart rate (HR) achieved, and 5) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing. METHODS: Nine children with JIA were enrolled in a 12-week circuit training program involving pool, stationary bicycle, treadmill, and Fitball. They underwent formal exercise testing before and after the program, underwent a full joint assessment, were administered the Childhood Health Assessment Questionnaire and Juvenile Arthritis Functional Status Index, and were assessed for overall quality of life and health-related quality of life. A visual analog scale was used to assess pain during testing and training, and the Borg scale was used to measure RPE. RESULTS: Children with JIA were able to participate in exercise testing without any significant problems. Children with severe hip disease dropped out of the exercise program due to pain during the exercise sessions and worsened arthritis symptoms. Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions. Submaximal exercise testing showed an improvement with a small to moderate effect size. CONCLUSION: This study suggests that it is safe, feasible, and acceptable for children with arthritis, in the absence of severe hip involvement, to participate in formal exercise testing and structured fitness programs
STECKEL H, STANKOVIC O, KLINGER HM, BAUMS MH, SCHMID Aet SCHULTZ W: [Current status of wrist arthrodesis], Z.Orthop.Ihre Grenzgeb., Vol. 144(2), 212-217., 2006
Organism:AIM: In order to ascertain the value and future of wrist arthrodesis we assessed the results of 47 wrist arthrodeses performed at the Departments of Orthopaedic and Trauma Surgery of the University of Goettingen between 1980 and 1998. METHOD: In a retrospective analysis we examined the patients clinical and radiological records. Evaluating the results we used the score described by Lohmann and Buck-Gramcko in order to consider function, pain, strength and assessment of the patient him/herself. RESULTS: 93.6 % of all cases could be examined. We found a wrist arthrodesis in posttraumatic arthritis in 22 cases and in rheumatoid arthritis in 25 cases. Plate (n = 30) and Rush-Pin osteosynthesis (n = 17) were used as surgical procedures. In all patients we found a successfully stabilised wrist, although in 3 trauma cases a further surgical procedure was necessary. A better function of the wrist was reached in every patient. The majority of the patients had no pain and an acceptable strength. The results obtained showed good and excellent results in 86.4 % of the wrist arthrodesis for post-traumatic arthritis and in 90.9 % for rheumatoid arthritis. CONCLUSION: The increase in quality of life, especially in patients suffering from rheumatoid arthritis, shows the procedure of wrist arthrodesis to be a still worthwile surgery
STEGEMAN M, RIJNBERG WJet VAN LOON CJ: Biaxial total wrist arthroplasty in rheumatoid arthritis. Satisfactory functional results, Rheumatol.Int., Vol. 25(3), 191-194., 2005
Organism:We reviewed 16 uncemented biaxial total wrist arthroplasties (TWA) in 14 patients with rheumatoid or juvenile arthritis. The mean follow-up was 25 months (range 5-60). According to the Hospital for Special Surgery scoring system (HSS), good-to-excellent results were accomplished in 69%, moderate in 19%, and poor in 12%. The mean pain score was 0.4 on a visual analog scale from 0-10 (0=no pain). The Wrightington activities of daily life assessment chart showed a 63% improvement, and we found a threefold increase in range of motion at follow-up. Four TWAs showed early dislocation, one of which was revised. Biaxial TWA yields good short-term results in rheumatoid patients, although instability is a frequent complication
SUH CH, CHUN HY, YE YMet PARK HS: Unresponsiveness of C-reactive protein in the non-infectious inflammation of systemic lupus erythematosus is associated with interleukin 6, Clin.Immunol., Vol. 119(3), 291-296., 2006
Organism:C-reactive protein (CRP) response is abnormal to a non-infectious inflammation in systemic lupus erythematosus (SLE). We evaluated the role of cytokines in this CRP unresponsiveness. The sera of 138 SLE patients and 71 rheumatoid arthritis patients were collected prospectively. SLE with infection had higher WBC count, ESR, CRP and C4 levels than those without infection. IL-6, IL-10 and IFN-gamma levels were higher in SLE with infection than SLE without infection. In SLE with infection, the CRP was correlated with the IL-6 (r = 0.77, P < 0.001) but not correlated with IL-10 and IFN-gamma. These data suggest that IL-6 may have a role in the unresponsiveness of CRP to a non-infectious inflammation of SLE
SUPPIAH V, O'DOHERTY C, HEGGARTY S, PATTERSON CC, ROONEY Met VANDENBROECK K: The CTLA4+49A/G and CT60 polymorphisms and chronic inflammatory arthropathies in Northern Ireland, Experimental and Molecular Pathology, Vol. 80, 141-146., 2006
Organism:Queens Univ Belfast, Sch Pharm, McClay Res Ctr, Appl Genom Res Grp, Belfast BT9 7BL, Antrim, UK UK
Abstract:Rheumatoid and juvenile idiopathic arthritis (RA, JIA) are chronic inflammatory arthropathies with an autoimmune background. The cytotoxic T-lymphocyte antigen-4 (CTLA-4) protein plays a key role in the down-regulation of T cell activation.We analyzed the CTLA4 +49A/G and CT60 polymorphisms in cohorts of Northern Irish RA and JIA patients and healthy control subjects using restriction fragment length polymorphism methods.The +49 A allele was increased in RA (61.2%; P = 0.02; OR = 1.28; 95% C.I. = 1.04-1.58) and JIA (61.8%; P = 0.14) patients compared to the control population (55.3%). No signi ficant association was observed for the CT60 polymorphism. Haplotype analysis revealed a significantly different distribution of +49 A/G-CT60 haplotypes in RA and JIA patients compared to controls (P value < 0.00001 and 0.030 for comparison of RA and JIA patients with controls, respectively).Our results suggest that the CTLA-4 gene is involved in predisposition to inflammatory artbropathies in the Northern Irish population. (c) 2005 Elsevier Inc. All rights reserved
SZTAJNBOK F, CORONEL-MARTINEZ DL, DIAZ-MALDONADO A, NOVARINI C, PISTORIO A, VIOLA S, RUPERTO N, BUONCOMPAGNI A, MARTINI Aet RAVELLI A: Discordance between physician's and parent's global assessments in juvenile idiopathic arthritis, Rheumatology.(Oxford)., Vol. ., 2006
Organism:Objective. To investigate the discrepancy between physician's and parent's global assessments of disease status and the factors explaining discordance in patients with juvenile idiopathic arthritis (JIA). Methods. The mothers of 197 patients with JIA rated the child's overall well-being on a 10 cm visual analogue scale (VAS) and the attending physician rated the child's overall disease activity on a 10 cm VAS. A discordance score was calculated by subtracting the physician's global assessment from that of the parent's, leading to the definition of three patient groups: (1) no discordance, when physician's and parent's assessments were within 1 cm of each other; (2) negative discordance, when parent's assessment was underrated relative to the physician; and (3) positive discordance, when parent's assessment was over-rated relative to the physician. Negative and positive discordance was defined as 'marked' when the difference between the two assessments was greater than 3 cm. Results. No discordance was found in 40.6% of the patients. Negative discordance was found in 51.3% of the patients, with 34% showing marked discordance. Positive discordance was found in 8.1% of the patients, with 2% showing marked discordance. Significant differences between groups included a shorter disease duration among patients with a markedly positive discordance (P = 0.02) and a greater frequency of ongoing second-line drug therapy among patients with no discordance or with positive discordance (P = 0.008). Patients with no discordance or with marked positive discordance had a significantly lower joint counts (P = 0.02-0.004). Conclusion. Parents and physicians often perceive the health status of children with JIA differently, with parents providing most frequently lower rating
TEFFERI A, DINGLI D, LI CYet MESA RA: Microcytosis in agnogenic myeloid metaplasia: prevalence and clinical correlates, Leuk.Res., Vol. 30(6), 677-680., 2006
Organism:Microcytosis is a characteristic laboratory feature for both iron deficiency anemia and thalassemia. It is also infrequently seen in "anemia of chronic disease" that accompanies a spectrum of chronic conditions including rheumatoid arthritis, polymyalgia rheumatica, diabetes mellitus, connective tissue disease, and protracted infection. In addition, there is a well established but pathogenetically obscure association of microcytosis with Hodgkin's lymphoma, Castleman's disease, and renal cell carcinoma. In the current study, we show that microcytosis is a frequent laboratory feature in agnogenic myeloid metaplasia and investigate its clinical relevance in the particular setting
THEWISSEN M, LINSEN L, SOMERS V, GEUSENS P, RAUS Jet STINISSEN P: Premature immunosenescence in rheumatoid arthritis and multiple sclerosis patients, Ann.N.Y.Acad.Sci., Vol. 1051, 255-262., 2005
Organism:Patients with T-cell-mediated autoimmune diseases show immune system abnormalities that resemble the typical characteristics of autoimmune dysfunction described in the elderly. In addition, the incidence of autoimmune disease increases with advancing age. To evaluate whether patients with rheumatoid arthritis (RA) and multiple sclerosis (MS) have premature immuno-senescence, we measured two indicators of aging: the number of T-cell-receptor excision circles (TRECs) and the percentage of CD4+CD28(null) T cells. We studied them in the peripheral blood mononuclear cells (PBMCs) of 60 RA patients, 32 MS patients, and 40 healthy controls (HCs). We found that TREC numbers were lower in RA and MS patients than in age-matched HCs, indicating premature thymic involution. Moreover, a subset of these patients contained age-inappropriate high frequencies of CD4+CD28(null) T cells. This study provides evidence of premature immune system senescence in both RA and MS patients. Premature aging could be a risk factor for developing autoimmune disorders in genetically predisposed individuals in a susceptible environment
THOMMASEN HVet ZHANG W: Impact of chronic disease on quality of life in the Bella Coola Valley, Rural.Remote.Health., Vol. 6(2), 528, 2006
Organism:INTRODUCTION: North American rural residents have higher rates of chronic disease and they report being ill more frequently compared to their urban counterparts. We recently studied health-related quality in residents living in the isolated, rural community of Bella Coola, Canada. OBJECTIVE: To assess health-related quality of life parameters in adults suffering from chronic disease and living in the rural, remote community of Bella Coola. METHODS: Design, mixed methods: (1) mailed health-related survey; (2) retrospective chart review. Study population: people aged 17 years and older living in the Bella Coola Valley and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed health-related quality of life survey during the period August to December 2001. Main outcome measures: demographics (age, sex, weight [BMI], ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. Chronic diseases studied included diabetes mellitus, hypertension, chronic obstructive lung disease, coronary artery disease, hyperlipidemia, depression/anxiety, cancer, osteoarthritis, inflammatory arthritis and chronic back/neck pain. RESULTS: Response rate to the survey was 38% (675/1770). Compared to total clinic population relatively more female (57% vs 49%), non-Aboriginal (63% vs 57%) and older people (48.9 vs 43.5 years) answered the survey. The most prevalent chronic diseases among the survey respondents were hypertension (17%), depression/anxiety (13%), hyperlipidemia (11%), chronic back/neck pain (11%), and osteoarthritis (9%). Linear regression analysis was performed for each of the SF-36 domains and CDC healthy day items. The presence of chronic disease is associated with significant differences in HRQOL item scores and the greater the number chronic diseases present the worse the HRQOL item scores. CONCLUSION: People living in the rural remote community of Bella Coola who have chronic disease experience significant impairment in their health-related quality of life. The greater the number of coexisting chronic diseases a person has, the more likely that poor HRQOL scores will be reported
TSE SM, LAXER RM, BABYN PSet DORIA AS: Radiologic Improvement of juvenile idiopathic arthritis-enthesitis-related arthritis following anti-tumor necrosis factor-alpha blockade with etanercept, J.Rheumatol., Vol. 33(6), 1186-1188., 2006
Organism:Children with juvenile spondyloarthropathy, classified as enthesitis-related arthritis (ERA) under the International League of Associations for Rheumatology classification of juvenile idiopathic arthritis, usually experience both arthritis and enthesitis. Treatment with anti-tumor necrosis factor-alpha (TNF-alpha) agents has resulted in dramatic clinical improvement. Radiologic imaging methods useful in the detection, diagnosis, and grading of arthritis and enthesitis include magnetic resonance imaging and ultrasonography. We describe the serial radiologic improvements of arthritis and enthesitis in a child with ERA in response to treatment with the anti-TNF-alpha agent etanercept
TSITSAMI H: Pediatric rheumatic diseases: Epidemiology, genetics and environmental factors, 2006
Organism:H. Tsitsami, 6 Matthopoulou Street, GR-413 35 Larisa
Abstract:Pediatric rheumatic diseases represent the commonest chronic diseases of pediatrics as well as one of the most significant causes of children's disability. The registries of pediatric rheumatic patients that have been organized during the last decade, allowed a more detailed study and a more effective treatment of these diseases. As a result and despite the fact that many methodological problems remain as yet unresolved, significant progress has been achieved regarding their epidemiology. Moreover, large population and familial genetic studies have been undertaken, either in single gene or in genome-wide level, resulting in a much better understanding of their genetic basis. Noteworthy, these studies determined precisely the contribution of environmental factors in the etiology of these diseases, even if the research towards the detection of these factors is still undeveloped
VAN LAAR JMet TYNDALL A: Adult stem cells in the treatment of autoimmune diseases, Rheumatology.(Oxford)., Vol. ., 2006
Organism:During the past 10 yrs, over 700 patients suffering from severe autoimmune disease (AD) have received an autologous haematopoietic stem cell transplant as treatment of their disorder with durable remission being obtained in around one-third. The most commonly transplanted ADs have been systemic sclerosis (scleroderma), multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis and systemic lupus erythematosus. A fewer number of patients have received an allogeneic transplant. The initially reported overall treatment-related mortality of 7% has since fallen, with no further cases being reported in systemic sclerosis or multiple sclerosis in the past 3 yrs. This is thought to be due to more careful patient selection.The phase I/II data has led to currently running prospective randomised trials in systemic sclerosis, multiple sclerosis and systemic lupus erythematosus in Europe and North America. Immune reconstitution data suggests a 'resetting' of autoimmunity in those patients achieving stable remission, rather than simply prolonged immunosuppression. Recent results from in vitro experiments, animal models and early human experience in severe acute graft vs host disease suggest that multipotent mesenchymal stromal cells obtained from the bone marrow and expanded ex vivo, may exert a clinically useful immunomodulatory effect. Such cells are immune privileged and apparently of low toxicity. Further characterization of these cells and consideration of their possible clinical application in AD is underway
WIRRELL E, CHEUNG Cet SPIER S: How do teens view the physical and social impact of asthma compared to other chronic diseases?, J.Asthma., Vol. 43(2), 155-160., 2006
Organism:We surveyed cognitively normal teens with and without chronic illness regarding the perceived physical and social impact of various chronic diseases including asthma. The overall physical impact of asthma was perceived equivalently to diabetes and arthritis, but less than epilepsy, Down's syndrome, leukemia, and human immunodeficiency virus infection. However, asthma was rated to more commonly cause physical disability (p < 0.001) and restrict activities (p < 0.0005). The social impact of asthma was perceived equivalently to diabetes, but more favorably than the other chronic diseases surveyed. Specifically, teens with asthma were perceived as having fewer behavior problems, being more honest, popular, and fun to be around, but less adept at sports. Only 6 of 149 (4%) teens surveyed expressed any degree of reluctance to befriend peers with asthma
ZHERNAKOVA A, EERLIGH P, BARRERA P, WESELOY JZ, HUIZINGA TW, ROEP BO, WIJMENGA Cet KOELEMAN BP: CTLA4 is differentially associated with autoimmune diseases in the Dutch population, Hum.Genet., Vol. 118(1), 58-66., 2005
Organism:Cytotoxic T lymphocyte-associated antigen 4 (CTLA4) is an important negative regulator of T-cell response and its genetic association with type 1 diabetes (T1D) has recently been demonstrated. The frequent co-association of autoimmune diseases (AID) and the implication from multiple genome scans that the CTLA4 gene region is a general autoimmune region, led us to study the role of CTLA4 in independent cohorts of T1D, coeliac disease (CD) and rheumatoid arthritis (RA) patients. We present independent data that confirm the association of CTLA4 in Dutch patients with juvenile onset T1D and show differential association of CTLA4 with CD and RA. The CTLA4 gene polymorphisms were tested for association in 350 T1D, 310 CD, 520 RA patients and 900 controls. In addition, 218 families were tested by the transmission disequilibrium test (TDT). T1D patients showed the highest association with the MH30*G: -1147*C: +49*G: CT60*G: JO37_3*G (haplotype 2) in both a case/control cohort (P=0.002, OR=1.42) and by TDT (P=0.02, OR=1.43). In contrast, this haplotype showed no association in the RA and CD cohorts. However, we observed an increased frequency of the MH30*G: -1147*T: +49*A: CT60*G: JO37_3*A (haplotype 3) in the CD patients diagnosed at a young age (OR=1.6, P=0.026, P (c)=0.052). Furthermore, when T1D and CD patients were stratified based on the HLA risk, the T1D susceptible CTLA4 haplotype 2 was over-represented in the high HLA-risk T1D and CD groups. In conclusion, we confirmed association between CTLA4 haplotype 2 and T1D in the Dutch population. Association with another CTLA4 haplotype (haplotype 3) was confirmed for CD, but only in those patients who had an early age of expression. No effect was found between RA and CTLA4. The association of the CTLA4 haplotype 2 with the high-risk HLA genotype in T1D and CD, which share DQ2 as the one of high-risk alleles, might provide a clue to understanding the common genetic background of AID
ZURAWA-JANICKA D, RENKE J, POPADIUK S, SKORKO-GLONEK J, SZUMERA M, PLATA-NAZAR K, ULKO P, WOZNIAK Met LIPINSKA B: Preferential immunoglobulin oxidation in children with juvenile idiopathic arthritis, Scand.J.Rheumatol., Vol. 35(3), 193-200., 2006
Organism:Objective: Juvenile idiopathic arthritis (JIA) is a rare chronic inflammatory disorder of the joints. There is strong evidence that oxidative damage occurs in rheumatoid diseases, including JIA. The increased level of protein oxidation products in total plasma proteins has recently been reported in children with diagnosed JIA. The objective of this study was to find out which fraction of plasma proteins is mostly damaged by oxidative stress and whether the damaging effect correlates with certain clinical or laboratory parameters.Methods: A new approach to estimate the carbonyl content of plasma protein fractions was developed, based on two-stage electrophoresis and immunochemical detection of the carbonyl derivatives of the proteins. This method allowed us to detect and quantitate carbonyl groups in the albumin, alpha-2, beta and gamma-globulin fractions. Sera of 25 children with JIA and 13 healthy controls were tested.Results: Albumin and gamma-globulins were found to be most modified by oxidation. In a group of children with systemic JIA, both albumin and gamma-globulins were oxidized while plasma gamma-globulin fraction damage was prevalent in pauciarticular JIA.Conclusions: Among plasma proteins of children with JIA, gamma-globulins were preferentially oxidized, whereas most of the other proteins did not seem to be affected. Oxidative modification of plasma proteins was correlated with the type of JIA. These findings may allow the use of carbonyls as clinical markers of inflammatory process activity in patients with different types of JIA. It is also a potential tool for monitoring oxidative protein damage in other diseases and therapies