Bibliography March 2007

1. AGGARWAL A, AGARWAL Set MISRA R: Chemokine and chemokine receptor analysis reveals elevated interferon-inducible protein-10 (IP)-10/CXCL10 levels and increased number of CCR5+ and CXCR3+ CD4 T cells in synovial fluid of patients with enthesitis-related arthritis (ERA), Clin.Exp.Immunol., Vol. 148(3), 515-519., 2007
   Organism:Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India amita@sgpgiacinFAU - Aggarwal, A
   Abstract:Chemokines and chemokine receptors play a major role in homing of cells to the site of inflammation. Enthesitis-related arthritis (ERA) is a chronic inflammatory arthritis and no data are available on chemokines and their receptors in ERA. Blood (20) and synovial fluid (SF) (11) was collected from patients with ERA, and peripheral blood (PB) was collected from 12 patients with polyarticular juvenile idiopathic arthritis (JIA), nine patients with systemic onset and 18 healthy controls. Chemokines [interleukin (IL)-10/CXCL10, thymus and activation-regulated chemokine (TARC)/CCL17 and regulated upon activation normal T cell expressed and secreted (RANTES)/CCL5] were measured in serum and SF. Chemokine receptor expression was measured by flow cytometry. There was no difference in blood CD4(+) T cells bearing CCR5, CCR4 and CXCR3 in ERA and healthy controls. In paired samples the median frequency of CCR5(+) CD4(+) T cells was higher in SF compared to PB (15.8 versus 3.9%, P < 0.005), as was the frequency of CXCR3(+) T cells (21.61% versus 12.46%, P < 0.05). Median serum interferon-inducible protein-10 (IP-10)/CXCL10 levels were higher in patients with ERA compared to controls (139 versus 93 pg/ml; P < 0.05). Further median SF IP-10/CXCL10 levels were higher than the serum levels (2300 pg/ml versus 139 pg/ml; P < 0.01). Serum levels of RANTES/CCL5 were higher in patients (150 ng/ml) compared to control (99 ng/ml; P < 0.01). The SF levels were significantly lower compared to serum (P < 0.05). TARC/CCL17 levels in SF were lower than serum. There is increased homing of CCR5 and CXCR3(+) CD4 cells to the SF. Increased SF levels of IP-10/CXCL10 may be responsible for this migration in patients with ERA

2. ANICHKOV DA, SHOSTAK NAet IVANOV DS: Heart rate variability is related to disease activity and smoking in rheumatoid arthritis patients, Int.J.Clin.Pract., Vol. 61(5), 777-783., 2007
   Organism:Department of Faculty Therapy, Russian State Medical University, Moscow, Russia dmitriianichkov@mtu-netruFAU - Anichkov, D A
   Abstract:We investigated the heart rate variability (HRV) parameters in patients with rheumatoid arthritis (RA) and assessed their relationship with disease characteristics. Twenty-three female patients with RA [age 48+/-7 (mean+/-SD) years] free of cardiovascular diseases and 23 age- and gender-matched healthy controls were evaluated. After careful clinical examination, the following parameters were obtained after 24-h Holter recordings: average of all normal-to normal (NN) intervals over the entire 24-h ECG recording (meanNN, ms); the standard deviation for the time between NN complexes (SDNN, ms); the standard deviation of the average NN intervals for each 5-min period (SDANN, ms) and the square root of the mean-squared differences of successive NN intervals (rMSSD, ms). We also assessed quantitative parameters of the Poincare plot: the standard deviation of the points perpendicular to the line-of-identity (SD1, ms); the standard deviation along the line-of-identity (SD2, ms) and their ratio (SD12). HRV parameters excluding SD2 were significantly lower in patients with RA, than in control group (p<0.05). Significant correlations of SDNN and SDANN with swollen joints count, Ritchie articular index, disease activity score (DAS) and disease duration were found. SDNN also correlated with leucocyte count and smoking. SD1 significantly correlated only with disease duration. Relationships between SDNN and smoking, swollen joints count and DAS were confirmed using multivariate analysis. Our data indicate that in patients with RA reduced HRV is independently associated with high disease activity and smoking. HRV assessment may be useful as a part of cardiovascular risk stratification in RA patients

3. BACKMAN CL, SMITH LF, SMITH S, MONTIE PLet SUTO M: Experiences of mothers living with inflammatory arthritis, Arthritis Rheum., Vol. 57(3), 381-388., 2007
   Organism:University of British Columbia and the Arthritis Research Centre of Canada, Vancouver, British Columbia, CanadaFAU - Backman, Catherine L
   Abstract:OBJECTIVE: To describe the impact of chronic, inflammatory arthritis on parenting and to develop a conceptual framework for subsequent study of mothering. METHODS: A qualitative, grounded theory design guided data collection and analysis. In-depth interviews were conducted with a purposive sample of 12 women with either rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, or systemic lupus erythematosus who were mothers of at least 1 child living at home. Transcripts were analyzed using a systematic approach of coding and forming concepts and key categories to construct an explanatory framework. Peer checking and member checking enhanced analytical rigor. RESULTS: Analysis of participants' experiences resulted in 4 interrelated categories describing the impact of arthritis on their role as mothers: participation in mothering tasks, best described as "sometimes I can, sometimes I can't"; different types and levels of support from others; the influence of the mother's arthritis on the family; and the challenge of balancing energy and fatigue. Individuals' arthritis story, life stage, their children's developmental stage, and daily routine described the context in which mothers experienced elements of each of the 4 main categories. CONCLUSION: Inflammatory arthritis has a dramatic impact on the experience of motherhood, with both positive and negative influences. The perspectives shared by study participants may inform practice regarding problem identification and adaptive strategies, and the explanatory model generated from the data proposes hypotheses for further study

4. BANKS KP, BEALL DP, MCCOLLUM MJ, LY JQ, JONES TP, PORTER WD, THOMPSON DB, SHINAULT SS, LASTINE CL, WOLFF JDet WU DH: The accuracy of magnetic resonance imaging in the assessment of glenohumeral articular degenerative disease, J.Okla.State Med.Assoc., Vol. 100(2), 52-56., 2007
   Organism:Department of Radiology (MCHE-DR), Brooke Army Medical Center, Fort Sam Houston, TX 78234, USAFAU - Banks, Kevin P
   Abstract:Degenerative joint disease is a major source of disability in the world with over 43 million individuals suffering from the affliction in the United States alone. It is the most common cause of activity limitation in individuals over 65 years of age. While much of the focus in recent years has been on osteoarthritis of the hips and knees, shoulder degenerative disease is becoming a more commonly recognized source of morbidity with a wide range of associated lifestyle-limiting disabilities. At the same time therapeutic options for treatment of degenerative joint disease are rapidly increasing, both medically and surgically. This combination of factors makes it necessary to determine a reliable, noninvasive means by which to accurately diagnose the early changes of shoulder degenerative disease. The clinical diagnosis of shoulder osteoarthritis is extremely challenging. There are numerous existing mimickers such as rotator cuff injuries, bursitis, and impingement syndrome. While the conventional radiographic findings are well recognized, they are generally late developments in the course of the disease when therapeutic options are more limited and less effective. Additionally, plain film evaluation has poor sensitivity for the detection of many of the alternative diagnoses that may underlie chronic shoulder pain. Though correlative findings are seen in MR imaging, its role in evaluating glenohumeral degenerative changes has been limited, with much of the focus being on the identification of tendinous and ligamentous disease or osseous tumors. A retrospective analysis is presented which demonstrates the efficacy of MR imaging in assessing GHJ OA, as well as shows that dedicated evaluation for specific degenerative findings results in improved detection rates of GHJ degenerative disease. It is believed that with improved detection and reporting, improved clinical care for this prevalent disorder may be achieved

5. BECKER ML, MARTIN TM, DOYLE TMet ROSE CD: Interstitial pneumonitis in Blau syndrome with documented mutation in CARD15, Arthritis Rheum., Vol. 56(4), 1292-1294., 2007
   Organism:Section of Rheumatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, and Oregon Health and Science University, Portland, USA mlbecker@cmheduFAU - Becker, Mara L
   Abstract:This is the first report of a CARD15 mutation-positive patient with Blau syndrome who exhibited interstitial lung disease, a feature historically considered absent from Blau syndrome, while typical of the adult form of sarcoidosis. This case illustrates the continued evolution of the phenotype of a disease initially conceived as a familial inflammatory granulomatous disease limited to the triad of synovitis, dermatitis, and uveitis

6. BEHRENS EM, BEUKELMAN T, PAESSLER Met CRON RQ: Occult macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis, J.Rheumatol., Vol. 34(5), 1133-1138., 2007
   Organism:Departments of Pathology and Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4318, USAFAU - Behrens, Edward M
   Abstract:OBJECTIVE: Macrophage activation syndrome (MAS) is a well described, but purportedly uncommon manifestation of systemic juvenile idiopathic arthritis (SJIA). There is evidence to suggest that macrophage activation is integral to the pathogenesis of SJIA. Accordingly, many patients with SJIA may have evidence of mild MAS that is not appreciated clinically. We investigated the prevalence of occult MAS in children with SJIA by reviewing bone marrow aspirates (BMA). METHODS: Patients diagnosed with SJIA who underwent bone marrow aspiration were identified retrospectively. Patients admitted with a diagnosis of fever of unknown origin and discharged with a diagnosis other than SJIA or malignancy, and who had a BMA, were identified as controls. The BMA were reviewed by a single hematopathologist for evidence of MAS, ranging from activated macrophages to frank hemophagocytic cells. RESULTS: Eight of 15 (53%) patients with SJIA had BMA suggestive of MAS. Two of 15 patients (13%) were diagnosed clinically with MAS. Three patients (20%) were noted to have frank hemophagocytosis, only one of whom was diagnosed with MAS clinically. There were no statistically significant differences in the laboratory values for the patients with and without evidence of MAS on BMA. There was no evidence of increased macrophage activity or hemophagocytosis in any of the control BMA. CONCLUSION: Occult MAS appears to be common in patients with SJIA who undergo BMA. This suggests that macrophage activation may be integral to the pathogenesis of SJIA, with implications for treatment

7. BLEESING J, PRADA A, SIEGEL DM, VILLANUEVA J, OLSON J, ILOWITE NT, BRUNNER HI, GRIFFIN T, GRAHAM TB, SHERRY DD, PASSO MH, RAMANAN AV, FILIPOVICH Aet GROM AA: The diagnostic significance of soluble CD163 and soluble interleukin-2 receptor alpha-chain in macrophage activation syndrome and untreated new-onset systemic juvenile idiopathic arthritis, Arthritis Rheum., Vol. 56(3), 965-971., 2007
   Organism:Children's Hospital Medical Center, Cincinnati, Ohio 45229, USAFAU - Bleesing, Jack
   Abstract:OBJECTIVE: Macrophage activation syndrome is characterized by an overwhelming inflammatory reaction driven by excessive expansion of T cells and hemophagocytic macrophages. Levels of soluble interleukin-2 receptor alpha (sIL-2Ralpha) and soluble CD163 (sCD163) may reflect the degree of activation and expansion of T cells and macrophages, respectively. This study was undertaken to assess the value of serum sIL-2Ralpha and sCD163 in diagnosing acute macrophage activation syndrome complicating systemic juvenile idiopathic arthritis (JIA). METHODS: Enzyme-linked immunosorbent assay was used to assess sIL-2Ralpha and sCD163 levels in sera from 7 patients with acute macrophage activation syndrome complicating systemic JIA and 16 patients with untreated new-onset systemic JIA. The results were correlated with clinical features of established macrophage activation syndrome, including ferritin levels. RESULTS: The median level of sIL-2Ralpha in the patients with macrophage activation syndrome was 19,646 pg/ml (interquartile range [IQR] 18,128), compared with 3,787 pg/ml (IQR 3,762) in patients with systemic JIA (P = 0.003). Similarly, the median level of sCD163 in patients with macrophage activation syndrome was 23,000 ng/ml (IQR 14,191), compared with 5,480 ng/ml (IQR 2,635) in patients with systemic JIA (P = 0.017). In 5 of 16 patients with systemic JIA, serum levels of sIL-2Ralpha or sCD163 were comparable with those in patients with acute macrophage activation syndrome. These patients had high inflammatory activity associated with a trend toward lower hemoglobin levels (P = 0.11), lower platelet counts, and significantly higher ferritin levels (P = 0.02). Two of these 5 patients developed overt macrophage activation syndrome several months later. CONCLUSION: Levels of sIL-2Ralpha and sCD163 are promising diagnostic markers for macrophage activation syndrome. They may also help identify patients with subclinical macrophage activation syndrome

8. BRITTO MT, SLAP GB, DEVELLIS RF, HORNUNG RW, ATHERTON HD, KNOPF JMet DEFRIESE GH: Specialists understanding of the health care preferences of chronically ill adolescents, J.Adolesc.Health., Vol. 40(4), 334-341., 2007
   Organism:Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA mariabritto@cchmcorgFAU - Britto, Maria T
   Abstract:PURPOSE: Doctors must understand patients' priorities to create an effective treatment partnership. Little is known about whether subspecialist pediatricians understand chronically ill adolescents' preferences. METHODS: A survey was conducted of 155 adolescents with chronic illnesses and 52 subspecialty physicians recruited from the same clinics of a children's hospital. Adolescents and physicians rated the importance that adolescents place on items relating to quality of care and physician-patient communication styles using a previously validated measure. RESULTS: For quality of care items, rank order correlation between physicians and patient responses was high (r = .63, p < .001) and both rated pain management items as most important. Physicians underestimated the importance adolescents placed on communicating with the physician as a friend and medical-technical aspects of care. For communication items, physicians' responses were significantly different than adolescents for 13 of 17 items. Except for three items pertaining to autonomy, physician and patient responses were in the same direction, but adolescent responses were less extreme. CONCLUSIONS: Physicians understood the importance of pain management to adolescents with chronic illnesses, but overestimated their desired level of autonomy. Asking adolescents for their preferences may be the first step in improving adolescents' experience of care

9. BROSTROM E, ORTQVIST M, HAGLUND-AKERLIND Y, HAGELBERG Set GUTIERREZ-FAREWIK E: Trunk and center of mass movements during gait in children with juvenile idiopathic arthritis, Hum.Mov Sci., Vol. 26(2), 296-305., 2007
   Organism:Department of Woman and Child Health, Karolinska Institute, Sweden evabrostrom@kiseFAU - Brostrom, Eva
   Abstract:Motion of the body center of mass (CoM) can often indicate the overall effect of the strategy of forward progression used. In the present study, focus is placed on trunk movements in the sagittal, coronal, and transverse/rotation plane, as well as placement of the CoM, during gait in children with juvenile idiopathic arthritis (JIA). Seventeen children with JIA, all with polyarticular lower extremity involvement were examined before and approximately two weeks after treatment with intra-articular cortico-steroid injections. Movement was recorded with a 6-camera 3D motion analysis system in both the children with JIA and in 21 healthy controls. Trunk and center of mass movements were compared between JIA and controls, and effects of intra-articular cortico-steroid treatment were evaluated. Children with JIA were more posteriorly tilted in the trunk, contrary to the common clinical impression, and had their CoM placed more posterior and off-centred, which may have been a result of pain. With such knowledge, it might be possible to better understand the effects of their pain and involvement, and ultimately to plan a treatment strategy for improving their gait patterns

10. DE CIVITA M, FELDMAN DE, MESHEFEDJIAN GA, DOBKIN PL, MALLESON Pet DUFFY CM: Caregiver recall of treatment recommendations in juvenile idiopathic arthritis, Arthritis Rheum., Vol. 57(2), 219-225., 2007
    Organism:McGill University Health Centre, Division of Clinical Epidemiology, Montreal, Quebec, Canada mirella@epimghmcgillcaFAU - De Civita, Mirella
    Abstract:OBJECTIVE: Health care providers in juvenile idiopathic arthritis (JIA) might refer to caregivers' self-report of children's treatment-related behaviors to assist in clinical decisions. However, caregivers may believe that they are adhering to treatment even though they have a different understanding of recommendations than that intended by the medical team. We examined whether caregiver recall of children's JIA treatment matched actual recommendations at baseline and 3, 6, 9, and 12 months. METHODS: A total of 235 primary caregivers were recruited from rheumatology clinics at 2 pediatric university-based teaching hospitals in Canada. Using the Parent Adherence Report Questionnaire, caregivers indicated whether their child was prescribed medications and/or exercises. Medical charts were reviewed to determine the prescribed treatment. Level of agreement between both sets of data was then examined. RESULTS: A total of 175 caregivers provided complete data. Mean age of the children was 10.2 years (68.6% girls); 44.6% were diagnosed with oligoarthritis. Kappa coefficients for medication represented substantial to almost perfect agreement beyond chance, with better levels of agreement at 12 months (kappa = 0.81, 95% confidence interval [95% CI] 0.68, 0.94) than at baseline (kappa = 0.61, 95% CI 0.47, 0.76). Kappa coefficients for exercise represented slight to moderate agreement beyond chance, with better agreement at 12 months (kappa = 0.44, 95% CI 0.24, 0.63) than at baseline (kappa = 0.27, 95% CI 0.08, 0.47). CONCLUSION: Weaker agreement for the exercise regimen raises concern that caregivers may pay less attention to exercise recommendations or that these recommendations may not be easily understood

11. DORFMULLER P, HUMBERT M, PERROS F, SANCHEZ O, SIMONNEAU G, MULLER KMet CAPRON F: Fibrous remodeling of the pulmonary venous system in pulmonary arterial hypertension associated with connective tissue diseases, Hum.Pathol., Vol. 38(6), 893-902., 2007
    Organism:Service d'Anatomie et de Cytologie Pathologiques, Centre Hospitalier Universitaire Pitie-Salpetriere, 47-83, Boulevard de l'Hopital, F-75651 Paris Cedex 13, France peterdorfmuller@pslaphpfrFAU - Dorfmuller, Peter
    Abstract:Pulmonary arterial hypertension is a severe complication of connective tissue diseases. It is currently well established that pulmonary arterial hypertension associated with connective tissue diseases such as systemic sclerosis is frequently less responsive or even refractory to pulmonary vasodilator therapies. In that setting, pulmonary venoocclusive disease is believed to contribute to treatment failures. We therefore hypothesized that pulmonary arterial hypertension associated with connective tissue diseases may be associated with obstructive lesions of pulmonary veins. Lung samples from 8 patients with pulmonary arterial hypertension associated with connective tissue disease (4 limited systemic sclerosis, 2 systemic lupus erythematosus, 1 mixed connective tissue diseases, and 1 rheumatoid arthritis) were studied by light microscopy and analyzed by immunohistochemistry (5 postmortem samples, 3 explants after lung transplantation). Findings were compared with 29 pulmonary arterial hypertension cases from patients displaying neither connective tissue diseases nor associated conditions. We found that (a) 6 (75%) of 8 patients with pulmonary arterial hypertension associated with connective tissue diseases showed significant obstructive pulmonary vascular lesions predominating in veins/preseptal venules, as compared with 5 (17.2%) of 29 non-connective tissue diseases control pulmonary arterial hypertension; (b) lesions of small muscular arteries were consistently present in pulmonary arterial hypertension associated with connective tissue diseases, showing mostly intimal fibrosis and thrombotic lesions; and (c) 6 of 8 lung samples from patients with pulmonary arterial hypertension associated with connective tissue diseases revealed perivascular inflammatory infiltration. In conclusion, our study highlights the fact that pulmonary arterial hypertension complicating the course of connective tissue diseases may be characterized by a more frequent involvement of pulmonary veins and may thus explain why these patients are less prone to respond to specific pulmonary arterial hypertension treatment as compared with idiopathic pulmonary arterial hypertension

12. FELDMAN DE, DE CIVITA M, DOBKIN PL, MALLESON P, MESHEFEDJIAN Get DUFFY CM: Perceived adherence to prescribed treatment in juvenile idiopathic arthritis over a one-year period, Arthritis Rheum., Vol. 57(2), 226-233., 2007
    Organism:Universite de Montreal, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada debbiefeldman@umontrealcaFAU - Feldman, Debbie Ehrmann
    Abstract:OBJECTIVE: To document perceived adherence to treatment (taking medications and performing exercises) in patients with juvenile idiopathic arthritis (JIA) over a 1-year period and to identify related factors. METHODS: We surveyed parents of patients with JIA at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Parents were asked to respond to a series of questionnaires every 3 months over a 12-month period. Perceived adherence was evaluated on a 100-mm visual analog scale (VAS) in the Parent Adherence Report Questionnaire (PARQ). Parental coping, distress, child function, disease severity and duration, perceived helpfulness of treatment, problems encountered, and sociodemographic data were also assessed. RESULTS: The mean age of our sample of 175 children was 10.2 years; mean age at diagnosis was 6.1 years and mean disease duration was 4.1 years. Perceived adherence to medications was consistently high, with average adherence at baseline, 3, 6, 9, and 12 months being 86.1, 91.7, 90.4, 92.0, and 88.8, respectively, on the PARQ VAS. Perceived adherence to exercise was lower but remained steady, with corresponding means of 54.5, 64.1, 61.2, 63.0, and 54.3, respectively. Using generalized estimating equation analysis, factors associated with higher perceived adherence to medications included perceived helpfulness of medications and lower disease severity; those associated with higher perceived adherence to exercise were younger age of the child, child involvement in responsibility for treatment, and higher perceived helpfulness of the treatment. CONCLUSION: Belief in helpfulness of treatment is associated with higher parental perceived adherence to treatment

13. FELIN EM, PRAHALAD S, ASKEW EWet MOYER-MILEUR LJ: Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis, Arthritis Rheum., Vol. 56(3), 984-994., 2007
    Organism:University of Utah, Salt Lake City, UT 84158, USAFAU - Felin, Elena M O
    Abstract:OBJECTIVE: To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x-ray absorptiometry (DXA), and to assess their relationship to disease-related factors in children with juvenile rheumatoid arthritis (JRA). METHODS: Forty-eight children ages 4-18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age-matched healthy controls (n = 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole-body, lumbar spine, and femoral neck measurements by DXA. RESULTS: Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size-adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength. CONCLUSION: Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity

14. FERNANDES TA, CORRENTE JEet MAGALHAES CS: Remission status follow-up in children with juvenile idiopathic arthritis, J.Pediatr.(Rio J.)., Vol. 83(2), 141-148., 2007
    Organism:Departamento de Pediatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, BrazilFAU - Fernandes, Taciana A P
    Abstract:OBJECTIVE: To characterize articular and systemic inflammatory activity in juvenile idiopathic arthritis (JIA), identifying remission status with and without medication. METHODS: A total of 165 JIA cases, followed for a mean period of 3.6 years, were reviewed in order to characterize episodes of inactivity and clinical remission on and off medication. The resulting data were analyzed by means of descriptive statistics, survival analysis, by comparison of Kaplan-Meier curves, log rank testing and binary logistic regression analysis in order to identify predictive factors for remission or persistent activity. RESULTS: One hundred and eight of the cases reviewed fulfilled the inclusion criteria: 57 patients (52.7%) exhibited a total of 71 episodes of inactivity, with a mean of 2.9 years per episode; 36 inactivity episodes (50.7%) resulted in clinical remission off medication, 35% of which were of the persistent oligoarticular subtype. The probability of clinical remission on medication over 2 years was 81, 82, 97 and 83% for cases of persistent oligoarticular, extended oligoarticular, polyarticular and systemic JIA, respectively. The probability of clinical remission off medication 5 years after onset of remission was 40 and 67% for patients with persistent oligoarticular and systemic JIA, respectively. Persistent disease activity was significantly associated with the use of an anti-rheumatic drug combination. Age at JIA onset was the only factor that predicted clinical remission (p = 0.002). CONCLUSIONS: In this cohort, the probability of JIA progressing to clinical remission was greater for the persistent oligoarticular and systemic subtypes, when compared with polyarticular cases

15. FIFE MS, GATHERCOLE L, OGILVIE EM, STOCK CJ, MACK LF, DONN RP, THOMSON Wet WOO P: No evidence for genetic association of interferon regulatory factor 1 in juvenile idiopathic arthritis, Arthritis Rheum., Vol. 56(3), 972-976., 2007
    Organism:University College London, London, UK mfife@uclacukFAU - Fife, Mark S
    Abstract:OBJECTIVE: Juvenile idiopathic arthritis (JIA) comprises several clinically distinct subgroups and is the most widespread cause of chronic childhood disability. A significant association between JIA and a polymorphism in the interferon regulatory factor 1 (IRF-1) gene has previously been reported, implicating IRF1 in disease susceptibility. The aim of this study was to replicate the IRF1 association in JIA using single-marker and haplotype analyses in a case-control study, using control subjects different from those in the previous study and a larger cohort of patients (n = 765). METHODS: DNA from 765 patients with JIA and 508 unaffected control subjects was genotyped for 4 single-nucleotide polymorphisms in the IRF-1 gene. Association of genotypes at the IRF1 loci was assessed using single-marker and haplotype analyses. RESULTS: No significant differences in genotype frequency or allele frequency were observed between patients and control subjects. CONCLUSION: This replication study used a much larger patient cohort to examine the association of IRF1 in JIA. However, despite the increased statistical power, we observed no significant association for IRF1 markers, either individually or as haplotypes. It is therefore unlikely that this gene is involved in JIA susceptibility

16. FOELDVARI I, NIELSEN S, KUMMERLE-DESCHNER J, ESPADA G, HORNEFF G, BICA B, OLIVIERI AN, WIERK Aet SAURENMANN RK: Tumor necrosis factor-alpha blocker in treatment of juvenile idiopathic arthritis-associated uveitis refractory to second-line agents: results of a multinational survey, J.Rheumatol., Vol. 34(5), 1146-1150., 2007
    Organism:Department of Pediatric Rheumatology, Hamburger Zentrum fur Kinder und Jugendrheumatologie, Klinikum Eilbek, Hamburg, Germany sprechstunde@kinderrheumatologiedeFAU - Foeldvari, Ivan
    Abstract:OBJECTIVE: Uveitis occurs in 10%-15% of patients with juvenile idiopathic arthritis (JIA). If topical treatment fails, second-line agents are used to control the disease. However, some patients need the addition of tumor necrosis factor-alpha (TNF-alpha) antagonist (anti-TNF). We organized a cross-sectional cohort to investigate use and efficacy of anti-TNF treatment in patients with JIA-associated uveitis. METHODS: The international pediatric rheumatology community was queried about the use and efficacy of anti-TNF in treatment of JIA-associated uveitis using an E-mail survey. RESULTS: Of the 33 responding centers following 884 patients with uveitis, only 15 centers, following 404 patients, were using anti-TNF for this indication. A total of 47 patients with JIA-related uveitis treated with anti-TNF because of an insufficient response to previous therapy were reported. The mean age of the patients was 12.5 years. The mean duration from onset of uveitis to start of anti-TNF treatment was 45.1 months. Three different anti-TNF agents were used: etanercept in 34 cases, infliximab in 25 cases, and adalimumab in 3 cases. In 12 of the 34 patients etanercept was inefficacious and patients were switched to infliximab. The final response was rated according to a composite index as 53%/12%/32%, and according to physician rating as 47%/12%/38% representing good, moderate, and poor, respectively, in the etanercept group; and 70%/30%/0% and 68%/24%/0% in the infliximab group. All 3 patients taking adalimumab were responders. Infliximab was statistically significantly more efficacious for the treatment of JIA-associated uveitis than etanercept (chi-square p = 0.004). CONCLUSION: Anti-TNF seems to be an effective treatment for refractory JIA-associated uveitis. In this cohort infliximab was more efficacious than etanercept

17. FONOLLOSA A, SEGURA A, GIRALT Jet GARCIA-ARUMI J: Tuberculous uveitis after treatment with etanercept, Graefes Arch.Clin.Exp.Ophthalmol., Vol. 245(9), 1397-1399., 2007
    Organism:Hospital Vall d'Hebron, Barcelona, Spain
    Abstract:BACKGROUND: Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept. METHODS: We performed a clinical chart review. CASE: A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear. DISCUSSION: To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation

18. GEDDES R: Minocycline-induced lupus in adolescents: clinical implications for physical therapists, J.Orthop.Sports Phys.Ther., Vol. 37(2), 65-71., 2007
    Organism:Bucks County Intermediate Unit 22, Doylestown, PA, USA rfgeddespt@aolcomFAU - Geddes, Rita
    Abstract:STUDY DESIGN: Resident's case problem. BACKGROUND: In the United States, minocycline is a frequently prescribed medication for the treatment of moderate to severe acne, a common condition in adolescents. The use of minocycline has been associated with severe adverse effects that frequently comprise a musculoskeletal component, including drug-induced lupus. Physical therapists have the responsibility to identify drug reactions that mimic musculoskeletal symptoms. The patient described herein was a 15-year-old adolescent boy who had taken minocycline for 14 days. He was initially treated by his primary physician on the 15th day of minocycline therapy for symptoms of fever, joint swelling, and a rash. The patient presented to a physical therapist on the 22nd day with complaints of severe myalgia, arthralgia, and severely limited mobility secondary to pain. The patient was referred to a pediatric rheumatologist because of the systemic nature and severity of the symptoms. DIAGNOSIS: The patient was subsequently diagnosed as having drug-induced lupus by a pediatric rheumatologist. The patient's myalgia and arthralgia subsided within 6 weeks, but his strength, coordination, and endurance did not reach their prior levels for 3 to 4 months. DISCUSSION: Physical therapists who include a comprehensive pharmacovigilance component in their patient examination may recognize musculoskeletal symptoms that arise from a nonmusculoskeletal origin. Minocycline is commonly prescribed in the United States as an antibiotic and for treatment of acne and rheumatoid arthritis. Therefore, physical therapists should screen for minocycline use when an adolescent patient or a patient with rheumatoid arthritis presents with diffuse musculoskeletal symptoms. An automated medication monitoring system would provide physical therapists with a means of accessing current information on medication use

19. GRASSI A, CORONA F, CASELLATO A, CARNELLI Vet BARDARE M: Prevalence and outcome of juvenile idiopathic arthritis-associated uveitis and relation to articular disease, J.Rheumatol., Vol. 34(5), 1139-1145., 2007
    Organism:Pediatric Rheumatology Centre, Clinica Pediatrica De Marchi, Milan, Italy angelagrassi@liberoitFAU - Grassi, Angela
    Abstract:OBJECTIVE: To determine prevalence and complications of juvenile idiopathic arthritis (JIA)-associated uveitis, and to evaluate risk factors for uveitis and its relation to articular disease. METHODS: Records of 309 patients with JIA (244 female, 65 male, mean age at onset 4.9 yrs) were retrospectively reviewed. Occurrence of uveitis and complications were assessed among oligoarticular-onset JIA (193 patients), polyarticular-onset JIA (66 patients), and systemic-onset JIA (50 patients). The presence of antinuclear antibodies (ANA) was determined in patients with oligoarticular-onset JIA. Therapy and relapses of uveitis and arthritis were recorded at each visit during the followup (mean followup 7.6 yrs). RESULTS: Sixty-two patients developed uveitis (20.1%); 57 patients had oligoarticular-, 3 polyarticular-, and 2 systemic-onset JIA. Uveitis was asymptomatic in 56/62 cases. Fifty-five of the 62 patients (88.7%) developed uveitis within 4 years from disease onset. In patients with oligoarticular-onset JIA, an early age at disease onset and the presence of ANA (p < 0.05) and DRB1*11 (p < 0.03) were the best predictors of uveitis, while a polyarticular course was not associated to uveitis (p > 0.05). Active arthritis was present at the first episode of uveitis in 46/62 patients. Forty-four of the 62 patients experienced relapses of uveitis: in 20/62, relapses were concomitant to arthritis relapses; in 24/62 relapses presented without active arthritis. Complications of uveitis developed in 35.5% of the patients (22/62), leading to visual impairment in 13 patients. CONCLUSION: Current guidelines provide early identification of uveitis in 90% of patients. With the exception of the first episode of uveitis, uveitis and arthritis seem to run different courses; close ophthalmologic scrutiny then should also be maintained during arthritis remission

20. HAVEMOSE-POULSEN A, SORENSEN LK, BENDTZEN Ket HOLMSTRUP P: Polymorphisms within the IL-1 gene cluster: effects on cytokine profiles in peripheral blood and whole blood cell cultures of patients with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis, J.Periodontol., Vol. 78(3), 475-492., 2007
    Organism:Department of Periodontology, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark ah@odontkudkFAU - Havemose-Poulsen, Anne
    Abstract:BACKGROUND: Genetic polymorphisms of cytokines have been associated with the susceptibility, severity, and clinical outcome of inflammatory diseases, such as periodontitis and chronic arthritis. An important question to address is how interleukin (IL)-1 polymorphisms affect the cytokine profiles of patients with such diseases. METHODS: The study population consisted of Danish white adults, <35 years of age, who were diagnosed with localized aggressive periodontitis (LAgP, n = 18), generalized aggressive periodontitis (GAgP, n = 27), juvenile idiopathic arthritis (JIA, n = 10), and rheumatoid arthritis (RA, n = 23) and healthy individuals with no systemic or oral diseases (n = 25). Genotypes of IL-1A-889, IL-1A+4845, IL-1B-511, and IL-1B+3954 were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism, and IL-1RN variable number tandem repeat (VNTR) was detected by PCR amplification and fragment size analysis. Analysis of variance was used to evaluate the effects of IL-1 genotypes on the levels of IL-1alpha, -1beta, -1 receptor antagonist, -6, and -10; tumor necrosis factor-alpha (TNF-alpha); and lymphotoxin-alpha in peripheral blood (plasma) and in unstimulated and stimulated whole blood cell cultures from the same blood collection. RESULTS: The frequencies of IL-1 genotypes investigated did not differ significantly between diseased and control individuals. In LAgP patients, allele 2 of IL-1RN VNTR was associated with significantly higher levels of IL-1alpha, -6, and -10 and TNF-alpha, whereas allele 2 of IL-1B+3954 was associated with significantly lower levels of the same cytokines. In GAgP patients, a general lack of association was found. In JIA and RA patients, IL-1RN VNTR also influenced the cytokine levels. CONCLUSIONS: IL-1 genotypes were associated with cytokine levels in patients with aggressive periodontitis and chronic arthritis. No associations were observed in control individuals

21. HUTTUNEN R, LAINE J, LUMIO J, VUENTO Ret SYRJANEN J: Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia, BMC.Infect.Dis., Vol. 7, 13, 2007
    Organism:Department of Internal Medicine, Tampere University Hospital, PL 2000, FIN-33521 Tampere, Finland ReettaHuttunen@utafiFAU - Huttunen, Reetta
    Abstract:BACKGROUND: Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients. METHODS: The study involved 149 patients (79 male and 70 female) with bacteraemia caused by Staphylococcus aureus (S. aureus) (41 patients), Streptococcus pneumoniae (Str. pneumoniae) (42 patients), beta-hemolytic streptococcae (beta-hml str.) (23 patients) and Eschericia coli (E. coli) (43 patients). Underlying diseases, alcohol and tobacco consumption and body mass index (BMI) were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10-14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model. RESULTS: Nineteen patients (12.8%) died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3), smoking (p < 0.001, RR 16.9; 95% CI 2.1 to 133.5), alcohol abuse (p = 0.008, RR 3.9; 95% CI 1.3 to 11.28), COPD (p = 0.01, RR 8.4; 95% CI 1.9 to 37.1) and rheumatoid arthritis (p = 0.045, RR 5.9; 95% CI 1.2 to 28.8) to be significantly associated with case fatality in bacteraemia in univariate model. The median BMI was significantly higher among those who died compared to survivors (33 vs. 26, p = 0.003). Obesity and smoking also remained independent risk factors for case fatality when their effect was studied together in a multivariate model adjusted with the effect of alcohol abuse, age (continuos variable), sex and causative organism. CONCLUSION: Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit

22. HWA V, CAMACHO-HUBNER C, LITTLE BM, DAVID A, METHERELL LA, EL KHATIB N, SAVAGE MOet ROSENFELD RG: Growth hormone insensitivity and severe short stature in siblings: a novel mutation at the exon 13-intron 13 junction of the STAT5b gene, Horm.Res., Vol. 68(5), 218-224., 2007
    Organism:Department of Pediatrics, Oregon Health and Sciences University, Portland, OR 97239-3098, USAFAU - Hwa, Vivian
    Abstract:BACKGROUND/AIMS: Growth hormone insensitivity (GHI) is characterized by severe short stature, high serum growth hormone (GH), low serum IGF-I and IGFBP-3 levels and is classically associated with genetic defects of the GH receptor (GHR). Recently, mutations of the STAT5b gene have been identified and shown to be associated with GHI and severe IGF deficiency. We investigated 2 sisters from a consanguineous family from Kuwait, with clinical and biochemical features of GHI, in whom no molecular defects in the GHR were identified. METHODS: Serum and DNA were analyzed. RESULTS: In addition to GHI, siblings 2 and 1 presented with, respectively, a diagnosis of juvenile idiopathic arthritis and recurrent pulmonary infections. Molecular analysis of the STAT5b gene revealed a novel homozygous deletion of a G at the junction of exon 13-intron 13. The parents, who are of normal height, were heterozygous for the mutation. CONCLUSIONS: This is the first STAT5b defect to be identified in siblings, further supporting the autosomal recessive mode of transmission of STAT5b deficiency. The results affirm that defective STAT5b is an etiology for IGF deficiency and the GHI phenotype, and emphasize the importance of considering this diagnosis in patients with IGF deficiency, especially when associated with diverse immunological problems

23. JACOBSSON G, DASHTI S, WAHLBERG Tet ANDERSSON R: The epidemiology of and risk factors for invasive Staphylococcus aureus infections in western Sweden, Scand.J.Infect.Dis., Vol. 39(1), 6-13., 2007
    Organism:From the Department of Infectious Diseases, Research and Development Centre, Skaraborg Hospital, Skovde, Sweden gunnarjacobsson@vgregionseFAU - Jacobsson, Gunnar
    Abstract:We conducted a prospective study of all cases of invasive Staphylococcus aureus infections (ISA) in the catchment area of Skaraborg Hospital (population 255,109) in western Sweden from March 2003 to February 2005. The annual incidence was 33.9 cases/100,000 population. Of these, 49% were classified as community-acquired, 32% as nosocomial and 19% as health care-associated. The mean age was 65 y. We registered children (age < or = 18 y) in 13 episodes. The most common predisposing illnesses/conditions were persons undergoing haemodialysis (relative risk 291), peritoneal dialysis (relative risk 204), persons with rheumatoid arthritis (relative risk 9), diabetes mellitus (relative risk 8), and cancer (relative risk 7). The patients were treated at various departments; only 18% of the episodes were primarily cared for at a department of infectious diseases. The most common diagnosis was soft tissue infection (27% of the episodes), bacteraemia without focus (19%), arthritis (15%), and line-associated infection (14%). A total of 197 invasive isolates was obtained, the vast majority from blood, in 141 of 170 episodes. We documented the wide spectrum of signs and symptoms. One- quarter of the patients had no history of fever, and one-third of the bacteraemia patients had normal white blood cell count (<10 x 10(9)/l) at presentation. All cases were of MSSA (methicillin-sensitive Staphylococcus aureus)

24. JANK S, HAASE S, STROBL H, MICHELS H, HAFNER R, MISSMANN M, BODNER G, MUR Eet SCHROEDER D: Sonographic investigation of the temporomandibular joint in patients with juvenile idiopathic arthritis: a pilot study, Arthritis Rheum., Vol. 57(2), 213-218., 2007
    Organism:Medical University of Innsbruck, Innsbruck, Austria siegfriedjank@gmxdeFAU - Jank, Siegfried
    Abstract:OBJECTIVE: To evaluate whether there are any correlations between the clinical parameters of temporomandibular joint (TMJ) arthritis and pathologic ultrasound (US) findings of the TMJ in patients with juvenile idiopathic arthritis (JIA). METHODS: We conducted prospective clinical and US investigations of the TMJs of 48 patients with JIA. The US investigation was performed by a 12-MHz high-resolution transducer, which was positioned parallel to the ramus of the mandible overlying the zygomatic arch in a closed-mouth position and maximum open-mouth position. RESULTS: Patients with > or = 5 peripheral affected joints showed significantly more sonographically diagnosed destructive changes in the TMJ than did patients with <5 affected joints. There was no significance between the number of affected peripheral joints and disc dislocation in the closed-mouth position. In the maximum open-mouth position, there was a significant correlation between the number of affected peripheral joints and disc dislocation. Patients with a JIA duration >23 months had a significantly higher rate of disc dislocation and destructive changes. Patients with a JIA duration >60 months had a significantly higher rate of destructive changes of the TMJ than patients with a disease duration <60 months, but no statistical significance was found concerning disc dislocation. CONCLUSION: The significant correlation between pathologic sonographic findings, duration of JIA, and the number of affected peripheral joints make the technique interesting for use as a diagnostic screening method

25. JANSEN Jet SJAASTAD O: Cervicogenic headache. Smith/Robinson approach in bilateral cases, Funct.Neurol., Vol. 21(4), 205-210., 2006
    Organism:Department of Neurosurgery, Georg-August Universitat, Gottingen, GermanyFAU - Jansen, Jurgen
    Abstract:The aim was to follow the postoperative fate of cervicogenic headache (CEH) patients with a hard-to-treat, bilateral headache, operated upon by the Smith/Robinson procedure, a stabilization and decompression operation in the cervical spine. CEH is a typically unilateral headache, but in this study, bilateral cases were deliberately selected (n=28). The patients were, otherwise, diagnosed according to the Cervicogenic Headache International Study Group (CHISG) CEH criteria. In most cases, the discs C(4-5), C(5-6) and C(6-7) were affected, and one or two discs were removed by anterior approach; an interbody fusion was carried out. Immediately postoperatively - up to 2-3 months - there was pain freedom. Secondary deterioration was reported to us in 10 patients, in nine of whom it occurred within three years. The remaining 18 patients were followed up for 2-100 months; the mean duration of improvement was 22.7 months. Bilateral, Smith/Robinson operated CEH patients seemed to fare as well as unilateral ones

26. KASHIKAR-ZUCK S, LYNCH AM, GRAHAM TB, SWAIN NF, MULLEN SMet NOLL RB: Social functioning and peer relationships of adolescents with juvenile fibromyalgia syndrome, Arthritis Rheum., Vol. 57(3), 474-480., 2007
    Organism:Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA SusmitaKashikar-Zuck@cchmcorgFAU - Kashikar-Zuck, Susmita
    Abstract:OBJECTIVE: To assess peer relationships of adolescents with juvenile primary fibromyalgia syndrome (JPFS) compared with matched classroom comparison peers (MCCPs) without a chronic illness. JPFS is characterized by chronic musculoskeletal pain, sleep disturbance, fatigue, and difficulty with daily functioning. Adolescents with JPFS often report problems with school and participating in peer activities, placing them at risk for social isolation from their peers and psychosocial adjustment problems. METHODS: Participants were 55 adolescents with JPFS (ages 12-18 years) from a pediatric outpatient rheumatology clinic and 55 MCCPs. Data on peer reputation and peer acceptance were collected from teachers, peers, and self report in a classroom setting with no focus on JPFS. RESULTS: Adolescents with JPFS were perceived (by peer and self reports) as being more isolated and withdrawn and less popular. Adolescents with JPFS were less well liked, were selected less often as a best friend, and had fewer reciprocated friendships. CONCLUSION: Our findings suggest that adolescents with JPFS are experiencing problems with peer relationships. Given the central role that peer relationships play in psychological development of children, and because peer rejection and isolation have been associated with subsequent adjustment problems, these findings are concerning. Longitudinal studies of adolescents with JPFS are needed to ascertain whether these patients are at long-term risk and will provide a foundation for the need for early interventions. Results are discussed within the context of earlier findings for other adolescents with chronic illness and rheumatic conditions, such as juvenile idiopathic arthritis, who demonstrated no social problems

27. KIMURA Yet WALCO GA: Treatment of chronic pain in pediatric rheumatic disease, Nat.Clin.Pract.Rheumatol., Vol. 3(4), 210-218., 2007
    Organism:Joseph M Sanzari Children's Hospital of Hackensack University Medical Center, Hackensack, and University of Medicine and Dentistry, New Jersey 07601, USA ykimura@humedcomFAU - Kimura, Yukiko
    Abstract:Pain in children with rheumatic disease is common, and is most often caused by arthritis. Despite the widespread use of effective new biologic agents, pain continues to be a problem in these patients, and it greatly impairs their daily functioning and quality of life. The pathogenesis of pain in children with rheumatic diseases is multifactorial, and disease treatment alone is often not enough to alleviate it. No standard of care or detailed algorithm for managing pain in these patients exists. Specific pain treatments often include acetaminophen, NSAIDs and medications that treat arthritis, such as methotrexate and etanercept. Other approaches should include nonpharmacologic interventions, for example exercise and cognitive-behavioral therapy, as well as the use of analgesics such as opioids in patients whose pain is refractory to standard therapies. The use of systemic corticosteroids to treat pain in children with arthritis should be avoided

28. KOTIL K, KALAYCI Met BILGE T: Management of cervicomedullary compression in patients with congenital and acquired osseous-ligamentous pathologies, J.Clin.Neurosci., Vol. 14(6), 540-549., 2007
    Organism:Haseki Educational and Research Hospital, Department of Neurosurgery, Istanbul, Turkey kadirkotil@superonlinecomFAU - Kotil, Kadir
    Abstract:We present our experience in the diagnosis, surgical management and long-term follow-up of congenital and acquired osseous-ligamentous abnormalities or pathologies of the craniovertebral junction. The purpose of this study was: (i) to determine the incidence and degree of cervicomedullary compression in pediatric and young adult patients with congenital and acquired abnormalities, and (ii) to correlate cervicomedullary compression with other imaging and clinical factors to determine to what extend cervicomedullary compression is successfully treated with a posterior decompressive procedure, transoral decompression, and medical management. Between January 1995 and December 2004, 26 cases were managed in our department. These patients had: rheumatoid arthritis (RA) (3); traumatic injury (2); congenital basilar impression (5, in 2 cases a posteriorly oriented or retroflexed odontoid); infection (10); craniovertebral junction Pott's disease (9); os odonteideum (3); condylus tertius (1); and tumor (2). Six of the patients (23.1%) had syringomyelia. Only three (11.3%) were in the pediatric age group. Symptoms and signs included headache (72%), ataxia (38%), lower cranial nerve dysfunction (54%), quadriparesis (44%), hyperreflexia (76%), Hoffman positivity (72%), achilles clonus (72%) nystagmus (33%) and dysphagia (22%). The mean follow-up time was 44 months (range 3-85). Twelve (46.2%) had undergone posterior fossa decompression; seven (26.6%) had ventral decompression. Seven of the patients (26.6%) had medical management. The major morbidity included pharyngeal wound sepsis leading to dehiscence (3.8%), valopharyngeal insufficiency (3.8%), cerebrospinal fluid leakage (3.8%), postoperative macroglossia (3.8%) and inadequate anterior decompression (3.8%). Transient neurological deterioration occurred in two patients (7.6%). Our management paradigm will result in some neurologic improvements and limit the progression of symptoms. Patients with these pathologies are likely to show a good neurologic outcome when treatment, whether with or without surgery, is administered early in the course of the disease

29. LAMB R, THOMSON W, OGILVIE EMet DONN R: Positive association of SLC26A2 gene polymorphisms with susceptibility to systemic-onset juvenile idiopathic arthritis, Arthritis Rheum., Vol. 56(4), 1286-1291., 2007
    Organism:Arthritis Research Campaign Epidemiology Unit and Centre for Molecular Medicine, University of Manchester, Manchester, UKFAU - Lamb, Rebecca
    Abstract:OBJECTIVE: To investigate SLC26A2, the gene that causes diastrophic dysplasia, in juvenile idiopathic arthritis (JIA). METHODS: Nine polymorphisms across the SLC26A2 gene locus were investigated using MassArray genotyping in 826 UK Caucasian JIA cases and 617 ethnically matched healthy controls. RESULTS: Significant associations between multiple single-nucleotide polymorphisms (SNPs) across SLC26A2 and systemic-onset JIA were found. In each case, homozygosity for the minor allele conferred the increased risk of disease susceptibility: rs1541915 (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.4-3.7, P=0.0003), rs245056 (OR 2.8, 95% CI 1.7-4.6, P=0.00002), rs245055 (OR 2.5, 95% CI 1.2-5.0, P=0.004), rs245051 (OR 2.3, 95% CI 1.4-3.7, P=0.0005), rs245076 (OR 2.7, 95% CI 1.3-5.4, P=0.0015), and rs8073 (OR 2.3, 95% CI 0.9-5.6, P=0.04). CONCLUSION: These findings show the value of using monogenic disease loci as candidates for investigation in JIA. We identified a subgroup-specific association between SNPs within the SLC26A2 gene and systemic-onset JIA. Our findings also highlight systemic-onset JIA as being a distinctly different disease from that in the other JIA subgroups

30. LOTITO AP, CAMPA A, SILVA CA, KISS MHet MELLO SB: Interleukin 18 as a marker of disease activity and severity in patients with juvenile idiopathic arthritis, J.Rheumatol., Vol. 34(4), 823-830., 2007
    Organism:Department of Pediatrics, University of Sao Paulo, Sao Paulo, BrazilFAU - Lotito, Ana Paola N
    Abstract:OBJECTIVE: To verify the importance of interleukin 18 (IL-18) in the pathogenesis of juvenile idiopathic arthritis (JIA). We measured IL-18 levels in synovial fluid (SF) and serum, and determined their correlation with measures of disease activity and severity. METHODS: Fifty patients with JIA (13 systemic, 13 polyarticular, 24 oligoarticular) and 25 matched controls were analyzed. Cytokine levels (IL-1beta, IL-1Ra, IL-6, and IL-18) were quantified in serum and SF by ELISA, and disease activity measures were evaluated immediately after knee articular puncture. Radiological assessment was made according to the Steinbrocker method. Statistical analysis was performed by Spearman's rank-order correlation and Mann-Whitney rank test. RESULTS: All the analyzed cytokine levels (IL-1, IL-1Ra, IL-6, and IL-18) were higher in patients' sera than in controls. Remarkably, in patients with JIA, IL-18 SF levels did not differ from those of serum; they were positively correlated. The levels of IL-18 (SF and serum) were positively correlated with measures of disease activity: C-reactive protein, number of active joints, and radiological score, as well as with levels of IL-1, IL-1Ra, and IL-6. Moreover, IL-18 and IL-6 levels in SF and serum were much higher in patients with systemic disease compared to the other types of disease onset. In contrast, IL-1 and IL-1Ra were not different among JIA subtypes. CONCLUSION: Our results strongly suggest the participation of IL-18 in the pathophysiology of JIA. The positive correlation of this cytokine with several measures of articular inflammation and disease severity suggests that IL-18 could be a better target for the treatment of arthritis

31. LYONS JSet SEVERNS ML: Detection of early hydroxychloroquine retinal toxicity enhanced by ring ratio analysis of multifocal electroretinography, Am.J.Ophthalmol., Vol. 143(5), 801-809., 2007
    Organism:Program in Ophthalmology, Georgetown University/Washington Hospital Center, Washington, DC, USA JSLAMI@aolcomFAU - Lyons, Jonathan S
    Abstract:PURPOSE: To assess decreased retinal function associated with high cumulative doses of hydroxychloroquine using multifocal electroretinography (mfERG). DESIGN: Retrospective cross-sectional study. METHODS: Sixty-two patients referred for evaluation of hydroxychloroquine retinal toxicity. Controls were 67 normal eyes of 67 patients referred for a variety of conditions in the other eye. Visual symptoms, duration of treatment, daily hydroxychloroquine dose (milligrams and milligrams per kilogram), cumulative dose, condition for which the drug was taken, visual acuity, retinal examination, visual fields, and mfERG amplitude. The average mfERG amplitude was calculated for five concentric rings. The age-corrected amplitude of the central hexagon (R(1)) and the ratios of R(1) to each of the other rings (e.g., R(1)/R(2), R(1)/R(3)) were compared with limits derived from control eyes. RESULTS: The incidence of characteristic mfERG abnormalities in patients referred for evaluation with cumulative hydroxychloroquine doses of more than 1250 g was nearly 50%. It was 2.8 times that found in patients with cumulative doses less than 1250 g. Significant abnormalities were seen with cumulative doses as low as 400 g. The mfERG abnormality most commonly detected was an increased R(1)/R(2) ratio. Cumulative dose was more predictive of mfERG abnormalities than daily dose (either in milligrams or milligrams per kilogram) or duration of treatment. CONCLUSIONS: Functional testing of the retina with mfERG shows locally decreased retinal function in a large fraction of patients referred for evaluation who have taken high cumulative doses of hydroxychloroquine. A prudent mfERG testing strategy is proposed

32. MARTIN M, KOSINSKI M, BJORNER JB, WARE JE, Jr., MACLEAN Ret LI T: Item response theory methods can improve the measurement of physical function by combining the modified health assessment questionnaire and the SF-36 physical function scale, Qual.Life Res., Vol. 16(4), 647-660., 2007
    Organism:QualityMetric Incorporated, 640 George Washington Highway, Suite 201, Lincoln, 02865, RI, USAFAU - Martin, Marie
    Abstract:OBJECTIVE: To compare the measurement properties of the Modified Health Assessment Questionnaire [MHAQ], the SF-36((R)) Health Survey 10 item Physical Functioning scale [PF10], and scores from an item response theory (IRT) based scale combining the two measures. STUDY DESIGN: Rheumatoid arthritis (RA) patients (n = 339) enrolled in a multi-center, randomized, double-blind, placebo-controlled trial completed the MHAQ and the SF-36 pre- and post-treatment. Psychometric analyses used confirmatory factor analysis and IRT models. Analyses of variance were used to assess sensitivity to changes in disease severity (defined by the American College of Rheumatism (ACR)) using change scores in MHAQ, PF10, and IRT scales. Analyses of covariance were used to assess treatment responsiveness. RESULTS: For the entire score range, the 95% confidence interval around individual patient scores was smaller for the combined (total) IRT based scale than for other measures. The MHAQ and PF10 were about 70% and 50% as efficient as the total IRT score of physical functioning in discriminating among ACR groups, respectively. The MHAQ and PF10 were also less efficient than the total IRT score in discriminating among treatment groups. CONCLUSIONS: Combining scales from the two short forms yields a more powerful tool with greater sensitivity to treatment response

33. MARTINI A: What is juvenile psoriatic arthritis? Comment on the article by Stoll et al, Arthritis Rheum., Vol. 56(4), 1368, 2007
    Organism:

34. MCCANN LJ: Should children under treatment for juvenile idiopathic arthritis receive flu vaccination?, Arch.Dis.Child., Vol. 92(4), 366-368., 2007
    Organism:Royal Liverpool Children's Hospital, UK lizamccann@rlcnhsukFAU - McCann, Liza J
    Abstract:

35. MEL PA, STEENKS MH, DE WIJER A, KRUIZE AAet VAN DER BA: [Post-academic dental specialties 7. Masticatory function of patients with juvenile idiopathic arthritis], Ned.Tijdschr.Tandheelkd., Vol. 114(2), 82-86., 2007
    Organism:Uit de zorglijn Gnathologie, zorgeenheid Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde, divisie Heelkundige Specialismen van het Universitair Medisch Centrum Utrecht pmel@kmbazunlFAU - Mel, P A L
    Abstract:In a pilot study, the masticatory function of patients with juvenile idiopathic arthritis was studied.The chewing efficiency and maximum bite force were measured in five adult patients and compared with a control group consisting of healthy individuals.The chewing efficiency of the patients with juvenile idiopathic arthritis was statistically significantly compromised compared to that of the control group. The maximum bite force was not statistically significantly smaller within this small group.The results of this pilot study support the hypothesis that the masticatory function of patients with juvenile idiopathic arthritis is compromised.We concluded that a more extensive study is necessary to investigate the masticatory function of patients with juvenile idiopathic arthritis and to evaluate the consequences with regard to the quality of life

36. MINDEN K, NIEWERTH M, BORTE M, SINGENDONK Wet HAAS JP: [Immunization in children and adolescents with rheumatic diseases], Z.Rheumatol., Vol. 66(2), 111-8, 120., 2007
    Organism:Deutsches Rheuma-Forschungszentrum Berlin und Universitatskinderklinik Charite, Campus Virchow-Klinikum, Otto-Heubner-Centrum, SPZ, Augustenburger Platz 1, 13353 Berlin kirstenminden@charitedeFAU - Minden, K
    Abstract:Vaccinations represent a special problem in children and adolescents with inflammatory rheumatic diseases. There are very limited data on the safety and efficacy of vaccines in these patients, and guidelines for immunization are missing. The immunosuppressive therapy often necessary for these patients gives rise to additional uncertainty. In addition, many colleagues consider vaccination to increase the risk of relapse of the rheumatic illness. As a consequence, there are substantial variations in practicing vaccination in these patients, resulting in insufficient vaccination coverage rates. For example, every third patient with juvenile idiopathic arthritis is incompletely vaccinated; this even includes toxoid vaccines for tetanus and diphtheria. The benefit of vaccinations, which far outweighs their potential risks, is well recognized even in patients with autoimmune diseases. These patients in particular require a special protection from infections due to their immunosuppressive therapies. Therefore, children and adolescents with rheumatic diseases should be immunized according to the Standing Immunization Commission of the Robert Koch Institute recommendations whenever possible. However, the time of vaccination must be carefully selected, taking disease activity and treatment into account

37. MONAGHAN SM, SHARPE L, DENTON F, LEVY J, SCHRIEBER Let SENSKY T: Relationship between appearance and psychological distress in rheumatic diseases, Arthritis Rheum., Vol. 57(2), 303-309., 2007
    Organism:The University of Sydney, New South Wales, AustraliaFAU - Monaghan, Sally M
    Abstract:OBJECTIVE: To examine the relationship between physical appearance concerns and psychological distress in patients with rheumatic diseases. METHODS: A total of 60 patients with systemic lupus erythematosus (SLE), 44 with chronic rheumatoid arthritis (RA), and 53 with recent-onset RA were evaluated for levels of appearance concern and a range of illness-specific measures to determine how these demographic and clinical variables were related to the dependent variable psychological distress. RESULTS: Using hierarchical multiple regression analyses, we found that both appearance concerns and levels of disability were predictive of depression in patients with RA. In the SLE sample, physical disability was predictive of depression when appearance concerns were not included in the analysis. However, disability did not predict depression when appearance concerns were entered into the analysis. This indicates that appearance concerns mediated the relationship between disability and depression in SLE. There was no association between appearance concerns and anxiety in either sample. CONCLUSION: The results suggest that appearance concerns are strongly related to depression in patients with rheumatic diseases and should be routinely assessed

38. NEMET AY, RAZ J, SACHS D, FRILING R, NEUMAN R, KRAMER M, PANDI SK, SHARMA Vet ASSIA EI: Primary intraocular lens implantation in pediatric uveitis: a comparison of 2 populations, Arch.Ophthalmol., Vol. 125(3), 354-360., 2007
    Organism:Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel nemeta@yahoocomFAU - Nemet, Arie Y
    Abstract:OBJECTIVE: To evaluate the visual outcome and postoperative complications of cataract surgery with posterior chamber intraocular lens implantation in children with uveitis. DESIGN: A multicenter, retrospective, interventional case series. The setting included 3 medical centers in Israel. The interventions were cataract surgery and intraocular lens implantation. Aggressive preoperative and postoperative systemic and topical anti-inflammatory treatment was instituted. The main outcome measures included postoperative inflammation, complications, and visual outcome. RESULTS: Children with juvenile rheumatoid arthritis (JRA)-associated uveitis were seen and underwent cataract surgery at an earlier age, and had a lower preoperative visual acuity and more severe uveitic complications when first seen, than those with non-JRA-associated uveitis. Visual acuity improved by 2 or more lines in all patients, and in 13 eyes the final visual acuity was 20/40 or better. Postoperative complications included elevated intraocular pressure, posterior and anterior capsular opacities, and macular dysfunction. CONCLUSIONS: Compared with those with non-JRA-associated uveitis, children with JRA-associated uveitis tend to have more severe manifestations of disease when first seen and after surgery, but there is no significant difference in postoperative course or complications. Intraocular lens implantation, including small-incision, foldable, intraocular lenses, is well tolerated, when combined with aggressive medical treatment, for controlling inflammation. We believe that intraocular lens implantation is not contraindicated in those with pediatric uveitis, including uveitis associated with JRA

39. NGUYEN TT, GEHRMANN M, ZLACKA D, SOSNA A, VAVRINCOVA P, MULTHOFF Get HROMADNIKOVA I: Heat shock protein 70 membrane expression on fibroblast-like synovial cells derived from synovial tissue of patients with rheumatoid and juvenile idiopathic arthritis, Scand.J.Rheumatol., Vol. 35(6), 447-453., 2006
    Organism:Cell Biology Laboratory, Department of Paediatrics, University Hospital Motol, 2nd Medical Faculty, Charles University, V Uvalu 84, Prague 5 15006, Czech Republic thuhien71@yahoocomFAU - Nguyen, T T H
    Abstract:OBJECTIVE: To screen fibroblast-like synovial cells derived from synovial tissue of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) patients for the membrane expression of the heat shock protein Hsp70. METHODS: We performed flow cytometric (fluorescence-activated cell sorting, or FACS) analysis on fibroblast-like synovial cells of 15 RA patients and three JIA patients to investigate Hsp70 membrane expression. Skin fibroblasts derived from the operation wound (n = 4) and peripheral blood mononuclear cells (PBMC) of seven RA and three JIA patients were also tested. Peripheral blood lymphocytes (PBL) and skin fibroblasts of 10 healthy individuals were used as negative controls. RESULTS: A significantly higher percentage of Hsp70 membrane expression was found on fibroblast-like synovial cells derived from arthritis-affected joints in RA patients (mean 47.7%) when compared with autologous skin fibroblasts (mean 9.5%, p < 0.001) and control skin fibroblasts (mean 5.6%, p < 0.001) or autologous PBL (mean CD45/Hsp70-positive 10.4%, p < 0.001) and control PBL (mean CD45/Hsp70-positive 7.7%, p < 0.001). A high percentage of Hsp70 membrane expression was also observed on fibroblast-like synovial cells derived from three patients with JIA (mean 35.2%) when compared with autologous PBL (mean CD45/Hsp70-positive 10.4%). Synovial cells derived from non-affected joints in a patient with RA who underwent synovectomy for trauma showed low expression of Hsp70 (10.9%). CONCLUSION: Fibroblast-like synovial cells derived from patients with severe course of RA and JIA are strongly positive for membrane-expressed Hsp70

40. NISIHARA RM, SKARE TL, SILVA MB, MESSIAS-REASON IT, OLIVEIRA NP, FIEDLER PTet UTIYAMA SR: High positivity of anti-CCP antibodies in patients with Down syndrome, Clin.Rheumatol., Vol. ., 2007
    Organism:Laboratory of Immunopathology, Department of Clinical Pathology, Clinical Hospital, Federal University of Parana, Curitiba, Brazil
    Abstract:The aim of the present study was to evaluate the prevalence of anti-cyclic citrullinated peptide (CCP) antibodies in patients with Down's syndrome (DS) previously tested for IgM rheumatoid factor (RF) and to correlate the results with clinical findings. Eighty-eight patients with DS previously tested for IgM-RF were divided into two groups matched for sex and age. Group A consists of 42 RF positive patients and group B of 44 RF negative patients. The presence of anti-CCP antibody was determined using a second-generation enzyme-linked immunosorbent assay. A total of 52.3% (45/86) of DS patients were positive for anti-CCP antibodies. Twenty-four patients (57.1%) of the RF positive group and 21 (47.7%) of the RF negative group presented anti-CCP circulating antibodies. The concordance between both tests was 54.6%. None of the patients had clinical evidence of rheumatoid arthritis or juvenile idiopathic arthritis. Although a high prevalence of anti-CCP antibodies was observed in DS patients, no association has been found presently with clinical disease. Careful follow-up of these patients will be necessary to clarify the real significance of these findings

41. OGRENDIK M: Effects of clarithromycin in patients with active rheumatoid arthritis, Curr.Med.Res.Opin., Vol. 23(3), 515-522., 2007
    Organism:Division of Rheumatology, Nazilli State Hospital, Nazilli, Turkey prevotella@mynetcom <prevotella@mynetcom>FAU - Ogrendik, Mesut
    Abstract:OBJECTIVE: To evaluate the clinical efficacy, safety, and tolerability of clarithromycin in patients with rheumatoid arthritis. RESEARCH DESIGN AND METHODS: This was a 6-month, monocenter, randomized, double-blind, placebo-controlled study. A total of 81 patients with early rheumatoid arthritis were treated with either once-daily oral clarithromycin (500 mg) or daily oral placebo for 6 months. MAIN OUTCOME MEASURES: The primary efficacy variable was the percentage of patients who had a 20% improvement according to American College of Rheumatology (ACR) criteria (an ACR 20 response) at 6-months. Secondary outcome measures were 50% improvement and 70% improvement according to ACR criteria (an ACR 50 response and an ACR 70 response, respectively). RESULTS: A significantly greater percentage of patients treated with 500 mg clarithromycin met the ACR 20 response at 6 months compared with patients who received placebo (59 vs. 33%; p < 0.001). Greater percentages of patients treated with 500 mg clarithromycin also achieved ACR 50 responses (34 vs. 10%; p < 0.001) and ACR 70 responses (20 vs. 3%; p = 0.003) compared with patients who received placebo, respectively. Clarithromycin was well tolerated. There were no dose-limiting toxic effects. CONCLUSIONS: In patients with early active rheumatoid arthritis, treatment with clarithromycin significantly improved the signs and symptoms of rheumatoid arthritis. Clarithromycin has been shown to be effective against rheumatoid arthritis

42. OSTLIE IL, DALE Oet MOLLER A: From childhood to adult life with juvenile idiopathic arthritis (JIA): a pilot study, Disabil.Rehabil., Vol. 29(6), 445-452., 2007
    Organism:Department of Nursing, Gjovik University College, Norway ingridoestlie@hignoFAU - Ostlie, Ingrid L
    Abstract:PURPOSE: To explore the experiences of the health service provision in the transition process from childhood to adult life from the perspective of young patients with juvenile idiopathic arthritis (JIA) and health professionals working in this field. METHOD: Two groups of young persons with JIA and two groups of health professionals were interviewed in focus groups. The data were analysed according to approved guidelines for qualitative analysis. RESULTS: 'Capability to lead a meaningful adult life' emerged as a core category; capability as a consequence of 'being enabled' from the youths' point of view, and 'enabling the young patients' from the health professionals' perspective. Preparation for the transition and transfer process was perceived as inadequate and seemed dependent on enthusiastic health professionals both in the children's and adult wards. Suggestions for formal improvements were required in four main areas. CONCLUSION: This pilot study has identified inadequacies in the transition management provided for young people with JIA. Acceptance of the young persons as active participants in their own transition process might strengthen these young persons' experience of an autonomous identity and enable participation socially and in society, thus enhancing the ability to achieve a meaningful adult life. Further investigations should focus on adults living with JIA, how they lead their lives physically and psychosocially

43. PAPAPOULOS SEet CREMERS SC: Prolonged bisphosphonate release after treatment in children, N.Engl.J.Med., Vol. 356(10), 1075-1076., 2007
    Organism:

44. POUREL J: [Clinical diagnosis of Lyme borreliosis in case of joint and muscular presentations], Med.Mal Infect., Vol. 37(7-8), 523-531., 2007
    Organism:Service de rhumatologie et UMR CNRS 7561, CHU de Nancy, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France jpourel@chu-nancyfrFAU - Pourel, J
    Abstract:The diagnosis of Lyme borreliosis in case of joint and muscular presentations is generally suggested by epidemiological factors. However, as a rule, laboratory testing is required to confirm the diagnosis. When considering the epidemiology of Lyme borreliosis in France, the only areas free of ticks infected by Borrelia burgdorgeri sl, are those close to the Mediterranean sea or at high altitude. The risk is greatest in the Alsace region. Exposure is particularly high among forest workers and people who use the countryside for their leisure activities. The likelihood of infection following a tick bite is difficult to assess; indeed, the bite site may remain unnoticed. A medical history of erythema migrans, if untreated, is a major diagnostic clue, although the association appears to be less consistent in France than in the US. Lyme arthritis generally arises apparently spontaneously. It is characteristically mono- or oligo-articular, asymmetrical, predominantly affects the knee, and has an intermittent course. Synovial cysts and enthesitis are common. Myositis is rare, polymorphic, and has been linked to other symptoms in the same localizations. Minor arthralgia and myalgia frequently occur, principally early in the course of the infection. It was suggested that sequels of the disease include so-called fibromyalgic syndromes. The principal differential diagnosis as far as arthritis is concerned, is made on spondylarthropathy and chronic juvenile arthritis. Rheumatoid arthritis is another pathology, although Lyme arthritis does sometimes evolve to chronicity

45. RAVELLI Aet MARTINI A: Juvenile idiopathic arthritis, Lancet., Vol. 369(9563), 767-778., 2007
    Organism:Department of Paediatrics, University of Genoa and Institute G Gaslini, Genoa, Italy angeloravelli@ospedale-gaslinigeitFAU - Ravelli, Angelo
    Abstract:Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. This term encompasses several disease categories, each of which has distinct methods of presentation, clinical signs, and symptoms, and, in some cases, genetic background. The cause of disease is still poorly understood but seems to be related to both genetic and environmental factors, which result in the heterogeneity of the illness. Although none of the available drugs has a curative potential, prognosis has greatly improved as a result of substantial progresses in disease management. The most important new development has been the introduction of drugs such as anticytokine agents, which constitute a valuable treatment option for patients who are resistant to conventional antirheumatic agents. Further insights into the disease pathogenesis and treatment will be provided by the continuous advances in understanding of the mechanisms connected to the immune response and inflammatory process, and by the development of new drugs that are able to inhibit selectively single molecules or pathways

46. SANTINI AJet RAUT V: Ten-year survival analysis of the PFC total knee arthroplasty-a surgeon's first 99 replacements, Int.Orthop., Vol. ., 2007
    Organism:Lower Limb Arthroplasty Unit, The Royal Liverpool and Broadgreen University Hospitlal, Liverpool, UK
    Abstract:Ninety-seven patients with 99 total knee arthroplasties were operated on by a surgeon in the first 3 years of his surgical career. Complete survival data were available for all 99 knees. The cases were reviewed at a minimum of 10 years after their initial operation, but as 37 patients had died before reaching 10 years, the average follow-up was 8 years 8 months with a maximum of 12 years 4 months. Ninety-one patients had osteoarthritis, five had rheumatoid arthritis, and three had juvenile chronic arthritis. No patients were lost to follow-up. Four required revision. The 10-year survival rate, using revision for all causes as an end-point, was 94.96%. The survival rate for aseptic loosening was 97.04%. The survival rate for loose joints that had not been revised was 94.13%. Three of the four revisions occurred in the first 6 patients operated upon, suggesting there may be a learning curve for surgeons at this stage in their career

47. SIMON D: rhGH treatment in corticosteroid-treated patients, Horm.Res., Vol. 68(1), 38-45., 2007
    Organism:Service d'Endocrinologie et de Diabetologie Pediatrique, Hopital Robert Debre, Assistance Publique-Hopitaux de Paris, Paris, France dominiquesimon@rdbaphpfrFAU - Simon, Dominique
    Abstract:Children and adolescents treated for chronic diseases have non-specific metabolic abnormalities that lead to decreased growth velocity and abnormal body composition, including severe osteoporosis, muscle wasting and increased fat mass. Glucocorticoid (GC) therapy plays a major role in the complex pathogenesis of these metabolic abnormalities. Recombinant human growth hormone (rhGH) therapy was introduced a few years ago to reduce the severe disease- and GC-related metabolic consequences of juvenile idiopathic arthritis, other chronic diseases, and renal transplantation. Short- and mid-term rhGH treatment has consistently proved effective in overcoming GC-induced growth suppression, with a marked interindividual variability in the growth response to rhGH treatment. Safety of rhGH treatment, concerning the progression of the disease and glucose tolerance, was good. Prolonged follow-up until achievement of adult height is needed to better evaluate the impact of rhGH treatment on growth and body composition and the long-term consequences of hyperinsulinism

48. THONG BY, KOH ET, CHNG HHet CHOW WC: Outcomes of chronic hepatitis B infection in Oriental patients with rheumatic diseases, Ann.Acad.Med.Singapore., Vol. 36(2), 100-105., 2007
    Organism:Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore bernard_thong@ttshcomsgFAU - Thong, Bernard Y H
    Abstract:INTRODUCTION: The aim of this study was to ascertain the outcomes of chronic hepatitis B (CHB) infection following immunosuppressive therapy in 38 consecutive oriental patients with systemic rheumatic diseases. MATERIALS AND METHODS: This is a retrospective consecutive, non-comparative study. RESULTS: The majority of patients were female (26, 68.4%), predominantly Chinese (92.1%), with a mean age 54 +/- 14 years (range, 16 to 87). The mean duration of rheumatic disease was 9 +/- 11 years (range, 0.1 to 48), with rheumatoid arthritis (52.6%) and systemic lupus erythematosus (23.7%) being the most common. The mean duration of CHB infection was 6 +/- 5 years (range, 0.1 to 17), with the majority diagnosed during pre-methotrexate screening (50.0%) and asymptomatic transaminitis following initiation of immunosuppressive therapy (23.7%). Upon diagnosis of rheumatic disease, all patients had normal alanine aminotransferase (ALT). Of these, 18.2% were positive for hepatitis B e antigen (HBeAg) and 78.1% were positive for anti- HBe antibody. Twenty (52.6%) developed ALT elevation, which was more than twice the upper limit of normal in 12 patients. ALT normalised spontaneously in 12 patients without hepatic decompensation or change in therapy. Seven (18.4%) patients received lamivudine for 18 +/- 22 months (range, 2 to 61). Two patients developed YMDD mutation subsequently treated with adefovir (1) and adefovir/lamivudine (1). There were 3 (7.9%) hepatitis B virus (HBV)-unrelated deaths [infection (2), genitourinary malignancy (1)], and 1 from HBV-reactivation complicated by septicaemia. None have developed hepatocellular carcinoma. CONCLUSION: Elevated ALT occurred in 52.6% of patients, with only 18.4% requiring anti-viral therapy for HBV reactivation. HBV-related mortality was low. With the appropriate precautionary measures, prednisolone and immunosuppressants (except methotrexate and leflunomide) may be used safely in patients where clinically indicated

49. THORNE JE, WORETA F, KEDHAR SR, DUNN JPet JABS DA: Juvenile idiopathic arthritis-associated uveitis: incidence of ocular complications and visual acuity loss, Am.J.Ophthalmol., Vol. 143(5), 840-846., 2007
    Organism:Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA jthorne@jhmieduFAU - Thorne, Jennifer E
    Abstract:PURPOSE: To estimate the incidences of ocular complications and vision loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe risk factors for vision loss, and to describe the association between therapy and complications and vision loss. DESIGN: Retrospective cohort study. METHODS: setting: Single-center, academic practice. study population: A total of 75 patients with JIA-associated uveitis evaluated between July 1984 and August 2005. procedures: Clinical data on these patients were analyzed. outcome measures: Occurrence of ocular complications and visions of 20/50 or worse and 20/200 or worse. RESULTS: Over a median follow-up of three years, the incidence of any ocular complication was 0.33/eye-year (EY). Rates of vision loss to 20/50 or worse and 20/200 or worse were 0.10/EY and 0.08/EY, respectively. Risk factors at presentation for incident vision loss included presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal intraocular pressure (IOP). During follow-up, ocular inflammation > or = 0.5+ cells was associated with an increased risk of visual impairment (relative risk [RR] = 2.02, P = .006) and of blindness (RR = 2.99, P = .03). Immunosuppressive drug therapy reduced the risk of hypotony by 74% (P = .002), epiretinal membrane formation by 86% (P = .05), and blindness in the better eye by 60% (P = .04). CONCLUSIONS: Incident vision loss and complications were common. Presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal IOP at presentation were associated with vision loss during follow-up. Use of immunosuppressive drugs reduced the risk of some ocular complications and of blindness in the better-seeing eye

50. WANGKAEW S, KASITANON N, SIVASOMBOON C, WICHAINUN R, SUKITAWUT Wet LOUTHRENOO W: Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables, Asian Pac.J.Allergy Immunol., Vol. 24(4), 213-221., 2006
    Organism:Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, ThailandFAU - Wangkaew, Suparaporn
    Abstract:This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl). The ocular symptoms and sign (the Schirmer's 1 test) and the oral sicca symptoms and sign (the Saxon's test) in each of 50 RA, SLE and Scl patients were compared with their age-matched controls. The correlation between the presence of sicca symptoms and signs with their clinical activity was also determined. Ocular sicca symptoms were found more common in patients with RA (38% vs 18%, p < 0.05), SLE (36% vs 14%, p < 0.05) and Scl (54% vs 16%, p < 0.01), and oral sicca symptoms were found more common in SLE (22% vs 0%, p < 0.01), and Scl (16% vs 4%, p < 0.05) than their controls. However, only RA patients had a significantly higher proportion of positive Schimer-1 test compared with their controls (p < 0.01). There was no strong correlation between sicca symptoms or signs and other clinical or laboratory variables (age, disease duration, disease activity, disease severity, and antibody to Ro and La antigens) in these three groups. In conclusion, sicca symptoms were seen significantly more common in Thai patients with connective tissue diseases, but the symptoms did not show a good correlation with the clinical and laboratory variables

51. YU EN, PAREDES Iet FOSTER CS: Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis, Ocul.Immunol.Inflamm., Vol. 15(1), 11-17., 2007
    Organism:Massachusetts Eye Research & Surgery Institute, Ocular Immunology and Uveitis Foundation, Harvard Medical School, Cambridge, MA 02142, USAFAU - Yu, Ellen N
    Abstract:PURPOSE: To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. METHODS: The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. RESULTS: Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0-5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. CONCLUSIONS: Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur