Bibliography April 2007

1. AIGNER E, SCHMID I, OSTERREICHER CH, ZWERINA J, SCHETT G, STRASSER M, NIKSIC F, HOHLA F, RAMSAUER T, DORN U, PATSCH Wet DATZ C: Contribution of anti-cyclic citrullinated peptide antibody and rheumatoid factor to the diagnosis of arthropathy in haemochromatosis, Ann.Rheum.Dis., Vol. 66(9), 1249-1251., 2007
   Organism:Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of Paracelsus Medical University Salzburg, Oberndorf, AustriaFAU - Aigner, E
   Abstract:OBJECTIVE: To investigate the prevalence of antibodies to cyclic citrullinated peptide (anti-CCP) and rheumatoid factor in patients with hereditary haemochromatosis (HHC) and to evaluate their diagnostic reliability in distinguishing HHC-associated arthropathy from rheumatoid arthritis. METHODS: Anti-CCP antibodies and rheumatoid factor levels were determined by ELISA in sera from 87 patients with HHC homozygous for the C282Y mutation of the HFE gene, 31 patients with rheumatoid arthritis and 162 healthy controls. RESULTS: Of the 87 patients with HHC, 32 (36.8%) had joint involvement. Anti-CCP antibodies were detected in only 1 patient (1.1%) with HHC, who had no joint disease, and in (1.2%) healthy controls. In total, 18 (58.1%) patients with rheumatoid arthritis displayed anti-CCP reactivity (p<0.001). Rheumatoid factor was detected in 10 (11.5%) patients with HHC compared with 7 (4.3%) healthy control subjects (p = 0.03) and 21 of 31 (65.6%) patients with rheumatoid arthritis. CONCLUSIONS: Testing for anti-CCP antibodies discriminates HHC arthropathy from rheumatoid arthritis, as these patients were consistently anti-CCP negative. Thus, HHC arthropathy should be considered in the differential diagnosis of CCP-negative arthritis

2. ALTOBELLI E, MACCARONE M, PETROCELLI R, MARZILIANO C, GIANNETTI A, PERIS Ket CHIMENTI S: Analysis of health care and actual needs of patients with psoriasis: a survey on the Italian population, BMC.Public Health., Vol. 7, 59, 2007
   Organism:Department of Internal Medicine and Public Health, University of L'Aquila, Coppito-Delta 6, 67100 L'Aquila, Italy emmaalto@tinitFAU - Altobelli, Emma
   Abstract:BACKGROUND: Over recent years the public health system has shown increasing interest in patients' views for use as guideline criteria in evaluating the quality of assistance above all for those patients with chronic diseases. Hence the interest in psoriasis, which is a chronic disease frequently associated with diabetes mellitus, hypertension, obesity, and cardiovascular diseases. The aims of our study were to describe clinic characteristics of patients with psoriasis, the quality of the assistance perceived by patients arrived at outpatients clinics and the information received, in order to identify areas in Italy requiring improvement. METHODS: 1954 patients, aged between 18 and 85 years, were consecutively enrolled at outpatients clinics across 21 Italian provinces over the period December 2004-January 2006. A standardized questionnaire was developed in collaboration with an Italian Association of Psoriatic Patients (A.DI.PSO) and tested in a pilot study. The questionnaire was divided into three sections: the first section included social, demographic and individual variables; the second concerned the quality of the assistance perceived by the patients at public dermatologic clinics and the third focused on the need of information requirements of patients with psoriasis. The chi2 test was used to estimate the association between the categorical variables under study. Kruskal-Wallis test was applied to the interval and ordinal variables. RESULTS: The presence of psoriatic arthritis was reported in 26.0% of patients. Associated chronic diseases included depression (15.4%), hypertension (13.3%), obesity (8.9%) and type 2 diabetes mellitus (7.3%). The study highlighted the need of improvements of health care services at public dermatologic clinics especially in overcoming architectonic barriers and reducing appointment wait-times, particularly in South Italy. However, patients reported a positive relationship with Health System employers due to the confidentiality. This positive impression was confirmed by the observation that dermatologists were considered the best source of information about therapies on psoriasis. CONCLUSION: Our study allowed to identify critical aspects which could be tackled through initiatives with the aim of improving these emerged needs

3. ARIMITSU S, MURASE T, HASHIMOTO J, OKA K, SUGAMOTO K, YOSHIKAWA Het MORITOMO H: A three-dimensional quantitative analysis of carpal deformity in rheumatoid wrists, J.Bone Joint Surg.Br., Vol. 89(4), 490-494., 2007
   Organism:Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka 565-0871, Japan sayu@df6so-netnejpFAU - Arimitsu, S
   Abstract:We have measured the three-dimensional patterns of carpal deformity in 20 wrists in 20 rheumatoid patients in which the carpal bones were shifted ulnarwards on plain radiography. Three-dimensional bone models of the carpus and radius were created by computerised tomography with the wrist in the neutral position. The location of the centroids and rotational angle of each carpal bone relative to the radius were calculated and compared with those of ten normal wrists. In the radiocarpal joint, the proximal row was flexed and the centroids of all carpal bones translocated in an ulnar, proximal and volar direction with loss of congruity. In the midcarpal joint, the distal row was extended and congruity generally well preserved. These findings may facilitate more positive use of radiocarpal fusion alone for the deformed rheumatoid wrist

4. ARMAGAN O, EKIM A, DINC Aet ONER C: Ankylosing spondylitis in a patient with Turner syndrome: a case report, Rheumatol.Int., Vol. 27(12), 1177-1180., 2007
   Organism:Departments of Physical Therapy and Rehabilitation, Faculty of Medicine, Eskisehir Osmangazi University Medical School, Meselik Campus, 26480, Eskisehir, Turkey, aoarmagan@superonlinecomFAU - Armagan, Onur
   Abstract:Turner's syndrome (TS) is a chromosomal disorder where phenotypic females have either a missing chromosome (45 X0) or a structural aberration of one of the chromosomes. It is possible for TS to accompany such autoimmune diseases as thyroid diseases, inflammatory intestinal diseases, diabetes mellitus, psoriatic arthritis and juvenile rheumatoid arthritis. Herein, we present an unusual case with Ankylosing spondylitis (AS) and autoimmune thyroiditis associated with TS. We suggest that the possibility that TS patients may also develop such other diseases as AS apart from the already known accompanying autoimmune diseases should not be ruled out when monitoring TS patients

5. BIENVENU-PERRARD M, DE SUREMAIN N, WICART P, MOULIN F, BENOSMAN A, KALIFA G, COSTE Jet ADAMSBAUM C: [Benefit of hip ultrasound in management of the limping child], J.Radiol., Vol. 88(3 Pt 1), 377-383., 2007
   Organism:Service de Radiologie, Universite Paris Descartes, Feculte de Medecine, AP-HP, Hopital Saint Vincent de Paul, Paris, FranceFAU - Bienvenu-Perrard, M
   Abstract:OBJECTIVE: To evaluate the contribution of sonography of the hip in the management of nontraumatic limping in children. PATIENTS AND METHODS: Prospective study including children consulting for nontraumatic limping (n=93). These children had a clinical examination, a biological and imaging workup (pelvis x-rays (n=88), initial sonograph of the hip (n=93), and follow-up sonograph of the hip (n=29)). RESULTS: Ninety-three children (69 boys, 24 girls) aged from 10 months to 13 years (median, 4 years) were included and divided into two groups: The sensitivity and specificity of sonography in establishing a serious diagnosis was 57% and 59%, respectively. CONCLUSION: The advantage of systematic hip sonography is challenged in this study because of low sensitivity and specificity. Its main advantage seems to be in its negative results, which prompt other investigations

6. BOVIN LF, BRYNSKOV J, HEGEDUS L, JESS T, NIELSEN CHet BENDTZEN K: Gene expression profiling in autoimmune diseases: chronic inflammation or disease specific patterns?, Autoimmunity., Vol. 40(3), 191-201., 2007
   Organism:Rigshospitalet National University Hospital, Institute for Inflammation Research, Copenhagen, DenmarkFAU - Bovin, Lone Frier
   Abstract:A central issue in autoimmune disease is whether the underlying inflammation is a repeated stereotypical process or whether disease specific gene expression is involved. To shed light on this, we analysed whether genes previously found to be differentially regulated in rheumatoid arthritis (RA) patients and healthy individuals were specific for the arthritic process or likewise altered in other chronic inflammatory diseases such as chronic autoimmune thyroiditis (Hashimoto's thyroiditis, HT) and inflammatory bowel disease (IBD). Using qPCR for 18 RA-discriminative genes, there were no significant differences in peripheral blood mononuclear cell (MNC) gene expression patterns between 15 newly diagnosed HT patients and 15 matched healthy controls. However, the MNC expression levels of five genes were significantly upregulated in 25 IBD patients, compared to 18 matched healthy controls (CD14, FACL2, FCN1, RNASE2, VNN2). There was concordance in the directional change for all genes between IBD and RA patients, i.e. increased expression compared to controls. These data show that one third of the genes significantly upregulated in MNC from RA patients were upregulated in patients with other chronic immunoinflammatory diseases, but only if accompanied by pronounced systemic manifestations. This suggests that at least some of the genes activated in RA are predominantly or solely related to general and disease-nonspecific autoimmune processes

7. BRAMBILLA G, BRUCATO A, ADLER Y, BOSETTI M, COPPINI P, CAFORIO A, SPODICK Det CANESI B: [Recurrent acute idiopathic pericarditis: rheumatologic therapy, autoantibodies and long term outcome], Reumatismo., Vol. 59(1), 25-31., 2007
   Organism:Dipartimento di Reumatologia,Ospedale Niguarda Ca' Granda, Milano giovannibrambilla@ospedaleniguardaitFAU - Brambilla, G
   Abstract:OBJECTIVE: To evaluate therapy and rheumatologic aspects of recurrent acute idiopathic pericarditis (RAIP). METHODS: We studied 46 patients. We used non-steroidal anti-inflammatory drugs (NSAIDs) at high dosage. We did not start corticosteroid: if already started, we planned a very slow tapering; 37 patients (80.4%) were treated with colchicine. We also assessed the frequency of ANA, anti-SSA and Rheumatoid factor. RESULTS: With our protocol recurrences dropped from 0.46 to 0.03 attacks/patient/month (p<0.00001) within 12 months and remained at the same level (0.024) till the end of the follow-up (mean 8 years). In the 37 patients treated with colchicine recurrences dropped from 0.5 to 0.03 (p<0.0001) within 12 months, and in 9 patients not given colchicine from 0.27 to 0.045 (p<0.005). When colchicine was used the decrease was significantly higher (0.47 vs 0.23) (p<0.001). In 27 (58.7%) patients ANA were positive at a titre >1/80, in 7 (15.2%) >1/160. Rheumatoid factor was positive in 7 (15.2%) and anti-SSA in 4 (8.7%). During the follow-up 4 (8.7%) new diagnosis of Sjogren and 1 (2.2%) of Rheumatoid Arthritis were made. CONCLUSION: NSAIDs at high dosage, slow tapering of corticosteroid and colchicine are very effective in RAIP. The improvement is more dramatic in colchicine treated patients, but also other patients can achieve good control of the disease. The finding of ANA, anti-SSA and the new rheumatological diagnoses support the involvement of autoimmunity

8. BRENNER JS: Pigmented villonodular synovitis causing painless chronic knee swelling in an adolescent, Clin.Pediatr.(Phila)., Vol. 46(3), 268-271., 2007
   Organism:Department of Pediatrics, Sports Medicine and Adolescent Medicine Division, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA jsbrenner@aapnetFAU - Brenner, Joel S
   Abstract:It is uncommon for an adolescent to present with a painless chronic knee effusion without a history of trauma. Acute knee effusions are usually caused by internal derangement, patellar dislocations, or fractures. The differential diagnosis of a chronic knee effusion must include the more uncommon diagnoses of juvenile rheumatoid arthritis, septic arthritis, reactive arthritis, synovial osteochondromatosis, synovial hemangioma, synovial sarcoma, or pigmented villonodular synovitis. Radiographic imaging, plain radiographs, and magnetic resonance imaging in addition to a biopsy specimen are most helpful in differentiating these diagnoses. Pigmented villonodular synovitis is an uncommon diagnosis that is rarely seen in an adolescent. Treatment includes synovectomy via arthroscopy or open arthrotomy

9. BROUGH Ret CLEARY G: When does a knee "need" a "joint" assessment?, Arch.Dis.Child Educ.Pract.Ed., Vol. 92(2), ep44-ep49, 2007
   Organism:Department of Rheumatology, Royal Liverpool Children's Hospital-Alder Hey, Liverpool, UKFAU - Brough, Richard
   Abstract:

10. CAHILL AM, CHO SS, BASKIN KM, BEUKELMAN T, CRON RQ, KAYE RDet TOWBIN RB: Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis, Pediatr.Radiol., Vol. 37(6), 544-548., 2007
    Organism:Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA cahill@emailchopeduFAU - Cahill, Anne Marie
    Abstract:BACKGROUND: Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies. OBJECTIVE: We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion. RESULTS: Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 +/- 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02). CONCLUSION: Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability

11. CARTER JD, LODHI AB, NAGDA SR, RICCA L, WARD C, TRAINA E, THOMPSON ZJ, HUANG Y, VALERIANO Jet VASEY FB: Determining rheumatologists' accuracy at assessing functional disability in rheumatoid arthritis patients using the Health Assessment Questionnaire-Disability Index, J.Rheumatol., Vol. 34(5), 958-963., 2007
    Organism:Department of Internal Medicine, Division of Rheumatology, University of South Florida, Tampa, Florida, USA jocarter@hscusfeduFAU - Carter, John D
    Abstract:OBJECTIVE: To test rheumatologists' accuracy in determining functional disability of their patients with rheumatoid arthritis (RA). METHODS: We used the Health Assessment Questionnaire-Disability Index (HAQ-DI) as our guide at assessing functional disability in patients with RA. Included were male and female patients, 18 to 65 years of age, diagnosed with RA. Demographic data collected included the patients' age, disease duration, rheumatoid factor (RF) status, presence of rheumatoid nodules, absence or presence of erosive disease, and class and stage of their disease. The primary endpoint was the mean difference in the patients' HAQ-DI scores versus that of the physicians' (mHAQ-Diff). Secondary endpoints were the mean difference in pain assessment scale (mPAS-Diff) score; and assessing to see if the physicians' HAQ-DI was altered by the patients' age, disease duration, RF status, rheumatoid nodules, absence or presence of erosive disease, and class or stage of the patient's RA. RESULTS: A total of 223 patients (139 female, 84 male) were evaluated. The mHAQ-Diff score was statistically significant at -0.3 (p = 0.03) with the rheumatologists more often overestimating the degree of functional disability in their RA patients. The mPAS-Diff score was 0.16, but this was not significant (p = 0.53). There was no significant difference between the scores based on sex, presence or absence of RF, erosions, or rheumatoid nodules. However, the rheumatologists' estimated HAQ and PAS did seem to be more accurate in patients with lower class and stage of their RA. CONCLUSION: Our results indicate that there is a clear difference between patients' and rheumatologists' assessment of patients' functional disability in RA, with the rheumatologists significantly overestimating the degree of this disability. Although the rheumatologists' accuracy at determining the amount of their patients' functional disability was poor overall, they were somewhat more accurate in patients with RA having less severe disease

12. CRAVEN S, DEWAR L, YANG X, GINSBERG Jet OFOSU F: Altered regulation of in-vivo coagulation in orthopedic patients prior to knee or hip replacement surgery, Blood Coagul.Fibrinolysis., Vol. 18(3), 219-225., 2007
    Organism:Canadian Blood Services, Hamilton, CanadaFAU - Craven, Sharon
    Abstract:Up to 20% of patients develop venographically proven deep-vein thrombosis after elective orthopedic surgery even under the cover of heparin or low molecular weight heparin. The extent to which the chronic inflammation of osteoarthritis requiring elective orthopedic surgery alters in-vivo coagulation and whether any specific alteration influences the development of postoperative thrombosis are unknown. This study compared the concentrations of activated factor VII (FVIIa), tissue factor pathway inhibitor (TFPI), activated factor X (FXa)-TFPI, thrombin-antithrombin, and prothrombin fragment 1+2 (F1+2) in plasmas of 535 healthy individuals (ages 17-76) with those in the preoperative plasmas of 306 arthritis patients (ages 30-92) scheduled for elective knee or hip replacement surgery. C-reactive protein was also measured in the plasmas of approximately 15% of the participants. Age-adjusted concentrations of FVIIa, F1+2, and C-reactive protein were higher in patients than controls, while the concentrations of thrombin-antithrombin, TFPI and FXa-TFPI were similar. Chronic inflammation in the patients was thus associated with increased coagulation in vivo. Without compensatory increases in the concentrations of TFPI (natural inhibitor of prothrombinase), the elevated concentrations of FVIIa in the preoperative plasmas and the trauma associated with surgery may enhance the risk for developing postoperative deep-vein thrombosis

13. DE MARCO G, GERLONI V, PONTIKAKI I, LURIATI A, TERUZZI B, SALMASO A, VALCAMONICA E, GATTINARA Met FANTINI F: [Long-term evaluation of infliximab in the treatment of persistently active juvenile idiopathic arthritis refractory to conventional therapy.], Reumatismo., Vol. 59(1), 50-56., 2007
    Organism:Ist Ortopedico Gaetano Pini, UO di Reumatologia e UOS Reumatologia Infantile, Cattedra di Reumatologia, Universita di Milano ghebri78dema@msncomFAU - De Marco, G
    Abstract:OBJECTIVES: To evaluate, in long-term open label prospective study, infliximab as therapeutic choice for Juvenile Idiopathic Arthritis (JIA) non responsive to conventional therapy. METHODS: We enrolled to treat with infliximab 78 JIA patients (66 females, 12 males): the mean age was 20.7+/-7.1 years (median 20.9, range 5.4-34.9); mean JIA duration was 13.6+/-7.6 years (median 13.5, range 0.4-31.4). Infliximab, at dose of 3-10 mg/kg/infusion added to weekly subcutaneous Methotrexate or other previous DMARDs, was administered by intravenous infusions at weeks 0, 2, 6 and every 8 weeks thereafter. Chest X-ray, Mantoux's test, electrocardiogram were performed at baseline; laboratory tests and clinical evaluation were performed at each infusion. Response was evaluated according to ACR improvement criteria. RESULTS: Mean treatment period was 21.6 months+/-18.8 (median 14.7, range 1.4-72.4). Just after first infusion most of patients reported significant improvement in pain, fatigue, morning stiffness. Infliximab is still successfully administered to 23 patients (29.5%); 55 (70.5%) patients suspended because of: inefficacy (7), infusion reactions (17), adverse events (9), disease flare-up after a period of effectiveness on synovitis, pain, and morning stiffness (19), remission (2), lack of compliance to treatment (1). Infusion reactions, like dyspnea, flushing, chills, headache, hypotension, anxiety, throat oedema, were observed in 29 patients (34.5%). Anti-DNA antibodies were present in 7 patients (none developed Systemic Lupus Erythematous). CONCLUSIONS: Infliximab showed impressive effectiveness treating refractory JIA, although most of patients had to discontinue treatment because of disease flare-up or adverse events. Infliximab may represent a good therapeutic choice in patients non-responders to Methotrexate

14. FERENS-SIECZKOWSKA M, KOSSOWSKA B, GANCARZ R, DUDZIK D, KNAS M, POPKO Jet ZWIERZ K: Fucosylation in synovial fluid as a novel clinical marker for differentiating joint diseases--a preliminary study, Clin.Exp.Rheumatol., Vol. 25(1), 92-95., 2007
    Organism:Department of Chemistry and Immunochemistry, Medical Univesity, Wroclaw, PolandFAU - Ferens-Sieczkowska, M
    Abstract:OBJECTIVE: To investigate fucosylation of synovial fluid glycoproteins in patients with rheumatoid arthritis (RA), juvenile arthritis (JIA), gonarthrosis (GA) and reactive arthritis (ReA), referred to traumatized knee (TK). METHODS: Synovial fluid glycoproteins were separated by SDS-PAGE and either silver stained or blotted onto nitrocellulose and probed with the fucose-specific Aleuria aurantia lectin. Five bands were chosen for densitometric analysis. Total fucose content and density of fucosylated epitopes were analyzed. RESULTS: Fucose content was elevated in all patient groups and almost all bands, comparing to TK. The density of fucosylated epitopes was increased in the 42-kDa band of RA and JIA cases, and lowered in the 26-kDa band of RA and JIA, but not in GA. In all RA cases FR 42-kDa > FR 26-kDa. The relation was opposite in 8 out of 9 GA cases. CONCLUSION: The density of fucosylated epitopes differs significantly in particular glycoproteins of synovial fluid in joint diseases and may be of potential diagnostic value in differentiating diseases of inflammatory and degenerative origin

15. GOMES JA: [Biologic agents in juvenile idiopathic arthritis], Acta Reumatol.Port., Vol. 32(1), 13-14., 2007
    Organism:

16. HEILIGENHAUS A, NIEWERTH M, GANSER G, HEINZ Cet MINDEN K: Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines, Rheumatology (Oxford)., Vol. 46(6), 1015-1019., 2007
    Organism:Department of Ophthalmology, St Franziskus Hospital, University of Duisburg-Essen, Hohenzollernring 74, 48145 Muenster, Germany arndheiligenhaus@uveitis-zentrumdeFAU - Heiligenhaus, A
    Abstract:OBJECTIVES: To analyse the prevalence and complications of uveitis and their predictors in a large cohort of patients with juvenile idiopathic arthritis (JIA). METHODS: Data of 3271 JIA patients as classified by International League of Associations for Rheumatology (ILAR) criteria included in a national database during 1 yr were analysed. RESULTS: Uveitis prevalence was 12% of all JIA patients. The most frequent were oligoarthritis extended (25%) and persistent (16%). JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs 7.0 yrs) or ANA-positive (86% vs 42%) than the patients without uveitis. Predictors of uveitis included age at onset (P= 0.03) and ANA-positivity (P< 0.01) besides the presence of a certain JIA subgroup (P= 0.04). Uveitis was clinically silent in 75% of the oligoarthritis but in none of the enthesitis-related arthritis patients. The median onset of uveitis was 5.5 months after arthritis manifestation. In 73%, 77% and 90%, uveitis developed within 1, 2 and 4 yrs after arthritis, respectively. Anterior uveitis was the most common anatomic type of uveitis (83%). Uveitis complications at mean follow-up of 5.6 yrs were common (56%), and predictors for complications included presence of complications at first visit (P< 0.001) and uveitis manifestation before arthritis (P= 0.001), but not ANA positivity. CONCLUSIONS: The JIA subgroups markedly differ with respect to the prevalence and course of associated uveitis. Ophthalmological screening should be initiated early after arthritis onset and the intervals be related to the JIA subgroup. A modification of the current screening guidelines is suggested

17. HEITKEMPER S, PINGSMAN A, QUITMANN Aet PATSALIS T: [Correction of rheumatic forefoot. The value of a combined arthrodesis of the first toe and resection of metatarsal heads 2-5], Orthopade., Vol. 36(5), 478-483., 2007
    Organism:Orthopadische Universitatsklinik Essen, Hufelandstrasse 55, 45147, Essen heitkemper@gmxdeFAU - Heitkemper, S
    Abstract:INTRODUCTION: Resection of the metatarsal heads is an established procedure for the therapy of rheumatic forefoot deformations. However, a recurrence of lateral deviation of the lesser toes and painful plantar keratosis remain a challenging problem for the treatment of these patients. The aim of this study was to evaluate our results in cases of rheumatoid forefoot deformities. We performed a resection of the metatarsal heads 2-5 in combination with an arthrodesis of the first toe and resection of keratosis by the plantar approach. MATERIAL AND METHODS: Fifteen patients (20 feet) were followed-up clinically and radiologically using the American Orthopedic Foot and Ankle Society (AOFAS), Miehlke-, and Larsen scores. RESULTS: Average follow-up time was 3.5 years (range: 1.5-7.5 years). An average AOFAS score of 81/90 was found for the hallux and 90/100 for the lesser toes. A total of 18 feet were rated as pain free, while two feet showed some residual pain. Every case showed an harmonic cascade of the resection. All patients stated that the operation had improved their quality of life and that they would consent to undergoing it again. CONCLUSION: Our results after arthrodesis of MP-1 and resection of the metatarsal heads 2-5 using the plantar approach were good compared to the data published in the literature

18. HOLL-WIEDEN A, SUERBAUM Set GIRSCHICK HJ: Seronegative Lyme arthritis, Rheumatol.Int., Vol. 27(11), 1091-1093., 2007
    Organism:Children's hospital, Section of Pediatric Rheumatology, Immunology and Infectious diseases, University of Wuerzburg, Josef-Schneider-Str 2, 97090 Wuerzburg, GermanyFAU - Holl-Wieden, A
    Abstract:We present a 10-year-old girl who had been diagnosed with juvenile idiopathic arthritis 5 years before and who experienced a flare of arthritis affecting one knee while she was off medication for almost 3 years. Seronegative Lyme arthritis had to be diagnosed based on the detection of Borrelia burgdorferi DNA in synovial fluid. No humoral immune response to Borrelia burgdorferi was detectable before, at the time of diagnosis and up to 3 years later

19. HUBER AM, TOMLINSON GA, KOREN Get FELDMAN BM: Amitriptyline to relieve pain in juvenile idiopathic arthritis: a pilot study using Bayesian metaanalysis of multiple N-of-1 clinical trials, J.Rheumatol., Vol. 34(5), 1125-1132., 2007
    Organism:Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada adamhuber@iwknshealthcaFAU - Huber, Adam M
    Abstract:OBJECTIVE: Using serial N-of-1 trials and subsequent analysis with Bayesian methods may allow study of therapies using small numbers of subjects. Our research questions were: (1) Can serial N-of-1 trials analyzed with Bayesian statistical techniques be used to estimate the population effect of a therapeutic intervention? (2) Compared to placebo, how likely is it that low-dose amitriptyline therapy in children aged 10-18 years with active polyarticular-course juvenile idiopathic arthritis (JIA) results in a significant improvement in pain? METHODS: Six children (age 10.3-16.3 yrs, 4 girls) were enrolled. There were 3 pairs of randomized, double-blinded treatments (amitriptyline 25 mg or placebo) per participant. Each treatment lasted 2 weeks, with a 1 week washout. The primary outcome was pain, measured by 10 cm visual analog scale. Assessments were at the beginning and end of each treatment. A Bayesian statistical model was used to determine the treatment effect. Values < 0 indicated superiority of amitriptyline. RESULTS: Bayesian techniques were used successfully to obtain estimates of population effect, despite the small number of participants. The mean treatment effect for pain was 0.67 (SD 0.89, 95% credible interval -0.99, 2.55). The probability that the treatment effect was < 0 was only 16%. CONCLUSION: These methods can be used successfully to estimate population effects when sample sizes are small. It is unlikely that amitriptyline reduced pain by a clinically significant amount in these children with polyarticular JIA. These methods may be particularly suited to pilot studies and the study of rare illnesses

20. IDEGUCHI H, OHNO Set ISHIGATSUBO Y: Risk factors associated with the cumulative survival of low-dose methotrexate in 273 Japanese patients with rheumatoid arthritis, J.Clin.Rheumatol., Vol. 13(2), 73-78., 2007
    Organism:Chronic Intractable Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, JapanFAU - Ideguchi, Haruko
    Abstract:BACKGROUND: Methotrexate (MTX) has become the most commonly prescribed disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). In the Western countries, the MTX dosage is safely increased to a maximum of 25 mg/wk until a significant response is observed. On the contrary, in Japan, MTX has been approved only as a second-line agent, and the approved maximum MTX dosage is only 8 mg/wk. This suboptimal dosage may affect MTX survival in Japanese RA patients. OBJECTIVES: To study risk factors associated with the cumulative survival of MTX in Japanese RA patients. METHODS: Data on 273 patients (male 44, female 229) with RA treated with MTX between January 1, 2000 and September 30, 2004 in our center were studied. RESULTS: Two hundred seventy-three patients were followed for 437 person-years of MTX exposure. Mean MTX dosage was 5.5 +/- 1.9 mg/wk. The cumulative MTX survival probability after 5 years was 61.9%. Univariate Cox regression analysis showed a significant correlation between MTX survival probability and use of fewer previous DMARDs, higher dose of MTX, inclusion of folate supplementation, and shorter disease duration. In the multivariate Cox regression model, use of fewer previous DMARDs remained significantly related to MTX survival. Reasons for discontinuation included adverse effects in 34 patients (12.5%) and inefficacy in 6 patients (2.2%). CONCLUSIONS: Cumulative survival was the same or slightly better than those in reports from Western countries, with less withdrawals reported due to adverse events or inefficacy. Whether these results are due to different MTX needs in Japanese or to acceptance of less clinical efficacy will require further studies. The use of fewer previous DMARDs was associated with longer MTX survival

21. IKING-KONERT C, OSTENDORF Bet SCHNEIDER M: [Management of early rheumatoid arthritis], Med.Monatsschr.Pharm., Vol. 30(3), 94-100., 2007
    Organism:Klinik fur Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universitat Dusseldorf iking-konert@meduni-duesseldorfdeFAU - Iking-Konert, Christof
    Abstract:Rheumatoid arthritis (RA) affects 1% of the adult population and is a chronic disease lasting for many decades. RA often results, despite therapy, in progressive joint destruction, deformity and disability, causing a major economic loss for the patients and the society. Most common the onset of the disease is between the 4th and 5th decade: RA affects 3 times more women than men. Both, the diagnostic as well as the therapeutic opportunities, have greatly improved over the last years. Nevertheless, there are still deficiencies in the care of patients with early RA (ERA). Consequently, the "German Society for Rheumatology" has set up recommendations for "The management of early RA", which are introduced in this article

22. KALLBERG H, PADYUKOV L, PLENGE RM, RONNELID J, GREGERSEN PK, VAN DER HELM-VAN MIL AH, TOES RE, HUIZINGA TW, KLARESKOG Let ALFREDSSON L: Gene-gene and gene-environment interactions involving HLA-DRB1, PTPN22, and smoking in two subsets of rheumatoid arthritis, Am.J.Hum.Genet., Vol. 80(5), 867-875., 2007
    Organism:Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden henrikkallberg@kiseFAU - Kallberg, Henrik
    Abstract:Gene-gene and gene-environment interactions are key features in the development of rheumatoid arthritis (RA) and other complex diseases. The aim of this study was to use and compare three different definitions of interaction between the two major genetic risk factors of RA--the HLA-DRB1 shared epitope (SE) alleles and the PTPN22 R620W allele--in three large case-control studies: the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, the North American RA Consortium (NARAC) study, and the Dutch Leiden Early Arthritis Clinic study (in total, 1,977 cases and 2,405 controls). The EIRA study was also used to analyze interactions between smoking and the two genes. "Interaction" was defined either as a departure from additivity, as interaction in a multiplicative model, or in terms of linkage disequilibrium--for example, deviation from independence of penetrance of two unlinked loci. Consistent interaction, defined as departure from additivity, between HLA-DRB1 SE alleles and the A allele of PTPN22 R620W was seen in all three studies regarding anti-CCP-positive RA. Testing for multiplicative interactions demonstrated an interaction between the two genes only when the three studies were pooled. The linkage disequilibrium approach indicated a gene-gene interaction in EIRA and NARAC, as well as in the pooled analysis. No interaction was seen between smoking and PTPN22 R620W. A new pattern of interactions is described between the two major known genetic risk factors and the major environmental risk factor concerning the risk of developing anti-CCP-positive RA. The data extend the basis for a pathogenetic hypothesis for RA involving genetic and environmental factors. The study also raises and illustrates principal questions concerning ways to define interactions in complex diseases

23. KARMAZYN B, BOWYER SL, SCHMIDT KM, BALLINGER SH, BUCKWALTER K, BEAM TTet YING J: US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis, Pediatr.Radiol., Vol. 37(5), 475-482., 2007
    Organism:Radiology, Riley Hospital for Children, Indianapolis, IN 46202-5200, USA bkarmazy@iupuieduFAU - Karmazyn, Boaz
    Abstract:BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children, with frequent involvement of the metacarpophalangeal joints (MCPJ). OBJECTIVE: To compare US findings with those of radiography and clinical examination. MATERIALS AND METHODS: All MCPJs in 20 children with JIA (17 females, median age 9.7 years, range 3.6 to 16.8 years) were evaluated clinically and imaged with gray-scale and color Doppler US, and 90 MCPJs were also imaged radiographically. Each MCPJ was graded on physical examination from 0 (normal) to 4 (severe) by the patient's rheumatologist. RESULTS: US demonstrated abnormalities in 64 of 200 MCPJs (32.0%), including pannus vascularity and/or tenosynovitis in 55 joints (27.5%) (pannus vascularity in 43, tenosynovitis in 40) and bone destruction in 25 joints (12.5%). Overall, US abnormalities and physical examination scores were significantly associated (P < 0.001). However, interobserver agreement between US and clinical evaluation was poor (kappa 0.1) and between US and radiography was only fair (kappa 0.4). CONCLUSION: US of the MCPJ in children with JIA can demonstrate cartilage thinning, bone erosions, and pannus vascularity. Abnormal US findings are significantly correlated with severity of disease as evaluated clinically

24. KONE-PAUT I, RETORNAZ K, GARNIER JMet BADER-MEUNIER B: Visceral leishmaniasis in a patient with systemic juvenile arthritis treated by IL-1RA agonist (Anakinra), Clin.Exp.Rheumatol., Vol. 25(1), 119, 2007
    Organism:

25. LACHIEWICZ PF: Periprosthetic fracture between a constrained total knee arthroplasty and a long-stem total hip arthroplasty: treatment with a novel device, J.Arthroplasty., Vol. 22(3), 449-452., 2007
    Organism:Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAFAU - Lachiewicz, Paul F
    Abstract:Supracondylar fracture of the femur occurred in a patient with a well-fixed constrained condylar total knee arthroplasty and an 8-in total hip femoral revision component. This unusual fracture was treated with a novel interpositional femoral intramedullary device that connected the total knee to total hip arthroplasty. The result was good at 5 years, with healed fracture and no loosening or osteolysis of either component

26. LIPIEC E, GRALEK Met NIWALD A: [Assessment of the ocular changes in children with juvenile idiopathic arthritis], Klin.Oczna., Vol. 108(10-12), 416-419., 2006
    Organism:Kliniki Okulistyki Ozieciecej SP ZOZ Uniwersyteckiego Szpitala Klinicznego nr 4 Uniwersytetu Medycznego w LodziFAU - Lipiec, Ewa
    Abstract:PURPOSE: To analyse the frequency of uveitis and other ocular changes in children with juvenile idiopathic arthritis. MATERIAL AND METHODS: We carried out ophthalmologic examination in children and adolescents with juvenile idiopathic arthritis, in age between 3 and 20 years. During the examination we evaluated vision acuity, refraction, anterior and posterior part of the eye and intraocular pressure. RESULTS: A total of 48 (68%) girls and 22 (32%) boys participated in our study, whose mean age was 13.2 years (SD = 3.8). The most frequent onset of juvenile idiopathic arthritis was oligoarticular form of the disease (62%). Only in 42% of the studied group there were no significant abnormalities of the ocular system. Anterior uveitis was diagnosed in 5 patients (7%) including 4 (5.7%) girls and 1 (1.4%) boy. Complications appeared in 2 children in the form of cataract and band keratopathy which both resulted in considerable impairment of visual acuity. Mean duration of juvenile idiopathic arthritis before the onset of uveitis was 5.2 years. There were other ocular changes in the studied group, among which the most common were: conjunctivitis--24%, abnormalities of the retina--11%, glaucoma--4% and other changes. CONCLUSIONS: In majority of the children with juvenile chronic arthritis different abnormalities of the eyes were diagnosed. All the patients with juvenile idiopathic arthritis should be under close surveillance of the ophthalmologist, irrespective of the disease duration

27. LIU J, ZHU P, PENG J, LI K, DU J, GU Jet OU Y: Identification of disease-associated proteins by proteomic approach in ankylosing spondylitis, Biochem.Biophys.Res.Commun., Vol. 357(2), 531-536., 2007
    Organism:Center of Medical Genetics, Department of Hematology, Peking University First Hospital, Peking University, No 8, Xishiku Street, West District, Beijing 100034, ChinaFAU - Liu, Jing
    Abstract:Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder of the axial skeleton and shows significant inherited susceptibility. Auto-immune responses have been traditionally considered as a putative pathogenetic event in AS. However, no consistent self-antigen has been identified to responsible for the disorders in AS to this day. In this study, serum protein profiles of AS patients and healthy controls from a large Chinese AS family were investigated by two dimensional electrophoresis analysis. A group of four highly expressed protein spots was observed in all AS patients' profiles and subsequently identified as isoforms of haptoglobin precursor (pre-Hp) by ESI-Q-TOF MS/MS. Increased expression of haptoglobin precursor were also observed in sera of sporadic AS patients. Moreover, bioinformatics analysis revealed epitopes derived from haptoglobin precursor with high affinity binding to HLA-B( *)2705, a primary subtype associated with AS. These results indicate that pre-Hp may be involved in the pathogenesis of AS

28. MARTINEZ P, AGGIO Met ROZENFELD P: High incidence of autoantibodies in Fabry disease patients, J.Inherit.Metab Dis., Vol. 30(3), 365-369., 2007
    Organism:Servicio de Hematologia, Hospital Penna, Bahia Blanca, ArgentinaFAU - Martinez, P
    Abstract:Fabry disease (FD) is an X-linked disorder of glycosphingolipid catabolism that results from a deficiency of the lysosomal enzyme alpha-galactosidase A. This defect leads to the accumulation of its substrates, mainly globotriaosylceramide, in lysosomes of cells of different tissues. Different studies have shown the involvement of immunopathologies in different sphingolipidoses. The coexistence of FD and immune disorders such as systemic lupus erythematosus, rheumatoid arthritis and IgA nephropathy, has been described in the literature. The aim of this study was to evaluate the prevalence of a group of autoantibodies in a series of Argentine FD patients. Autoantibodies against extractable nuclear antigens (ENAs), double-stranded DNA, anticardiolipin and phosphatidylserine were assayed by ELISA. Lupus anticoagulants were also tested. Fifty-seven per cent of the samples showed reactivity with at least one autoantigen. Such reactivities were more frequent among males than among females. Antiphospholipid autoantibodies were detected in 45% of our patients. The high rate of thrombosis associated with FD could be related, at least in part, to the presence of antiphospholipid autoantibodies in Fabry patients. We found the presence of ENAs, which are a characteristic finding of rheumatological diseases, previous a frequent misdiagnosis of FD, in around 39% of the cases. The detection of a high level of autoantibodies must be correlated clinically to determine the existence of an underlying autoimmune disease. With the recent development of therapy, the life expectancy in FD will increase and autoimmune diseases might play an important role in the morbidity of FD

29. MATOUSSI N, BEN SLIMA S, FITOURI Z, MARRAKCHI Set BEN BECHER S: [Uveitis of children: a report of 18 cases], Arch.Pediatr., Vol. 14(7), 856-860., 2007
    Organism:Service de pediatrie, d'urgences et de consultations, hopital d'enfants de Tunis, 1007, rue Jabbari-Bab-Saadoun, Tunis, TunisieFAU - Matoussi, N
    Abstract:Childhood uveitis is a rare but serious disease that may causes visual loss. Causes are various and an underlying disease is not always found. PURPOSE: To analyse clinical features and prognosis of uveitis in children. PATIENTS AND METHODS: A retrospective, descriptive study of cases observed in a general pediatric unit over a period of 15 years (1990-2005) at Tunis. RESULTS: We gathered 18 cases of uveitis (girls 55.6% ,boys 44.4%). Mean age at the diagnosis was 8+/-3 years. Diagnosis was made after a decreased of visual acuity in 55.6% of cases. Localization of uveitis was anterior (6 cases), intermediate (1 case), posterior (3 cases) and total (8 cases). An underlying disease was found in only 5 patients: Behcet's disease (3 patients), juvenile chronic arthritis (1 patient), possible dermatopolymyositis (1 patient). The evolution was favorable in 10 cases with local treatment, systemic corticotherapy and/or immunosuppressive agents. Complications occurred in 3 cases. CONCLUSION: Causes of uveitis in childhood remains most often undiagnosed Our study illustrates the pending risk of severe visual impairment and strict ophtalmology follow-up is mandatory

30. MCCANN LJet WOO P: Biologic therapies in juvenile idiopathic arthritis: why and for whom?, Acta Reumatol.Port., Vol. 32(1), 15-26., 2007
    Organism:Royal Liverpool NHS Trust,Alder Hey, Liverpool lizamccann@rlcnhsukFAU - McCann, L J
    Abstract:With greater understanding of pathophysiological, genetic and environmental influences on juvenile arthritis, there is an opportunity to develop new targets for therapy and greater control of disease. Early, aggressive control of arthritis is essential in order to prevent long-term disability. For those children that are resistant to standard therapy, new and exciting alternative medications are emerging. However, continued research is needed to gain a greater understanding of immunological and genetic profiles of the disease. Pharmaco-vigilance is essential to establish efficacy and side effect profiles. Physiotherapy, occupational therapy, nursing issues, and psychology remain integral to the management of JIA, along with liaison with ophthalmology, orthopaedic and dental colleagues. This article reviews the current biologic treatment options available for children with arthritis and the evidence base that supports their use

31. MODER KG, WENER MH, WEISMAN MH, ISHIMORI ML, WALLACE DJ, BUCKERIDGE DLet HOMBURGER HA: Measurement of antinuclear antibodies by multiplex immunoassay: a prospective, multicenter clinical evaluation, J.Rheumatol., Vol. 34(5), 978-986., 2007
    Organism:Department of Rheumatology, Mayo College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USAFAU - Moder, Kevin G
    Abstract:OBJECTIVE: We conducted a prospective, multicenter evaluation of autoantibody testing by multiplex immunoassay in patients with known or suspected connective tissue diseases (CTD). We evaluated agreement between multiplex immunoassay and enzyme immunoassay (EIA) and assessed the diagnostic utility of autoantibody profiles. METHODS: Samples from 908 patients with suspected CTD seen in rheumatology clinics were collected prospectively at 3 tertiary care centers. Diagnoses were established according to recognized classification criteria. Tests for autoantibodies were obtained by multiplex immunoassay and by EIA. The results of the multiplex immunoassay were analyzed using a previously validated interpretative algorithm, MDSS (Medical Decision Support Software), that suggests possible disease associations based on the pattern of results for the autoantibodies. RESULTS: The median patient age was 49.7 years; 83% were female. The most common diagnoses were rheumatoid arthritis in 352 patients and systemic lupus erythematosus (SLE) in 332 patients. Agreement between multiplex and EIA testing ranged from a high of 99% (95% CI 98% to 100%) for Jo-1 to a low of 79% (95% CI 76% to 82%) for antinuclear antibodies. The MDSS algorithm suggested an appropriate disease association in 75% to 100% of patients with SLE. The results varied depending on the disease and the autoantibodies present. CONCLUSION: These results suggest that patterns of autoantibodies detected by multiplex immunoassay testing, when analyzed by an interpretative algorithm, are useful in the evaluation of patients with CTD in situations of high disease prevalence. Further testing is necessary to determine its utility in settings of low disease prevalence

32. MUKHOPADHYAY S, SEN S, MAJHI B, DAS KPet KAR M: Methyl glyoxal elevation is associated with oxidative stress in rheumatoid arthritis, Free Radic.Res., Vol. 41(5), 507-514., 2007
    Organism:Department of Biochemistry, NRS Medical College & Hospital, Kolkata, India somashis@vsnlnetFAU - Mukhopadhyay, S
    Abstract:Methyl glyoxal (MG), a metabolic hazard plays a role in pathogenesis of different diseases. We studied the role of MG in cellular oxidative and carbonyl stress in rheumatoid arthritis (RA). 148 RA patients were divided into subgroups according to disease severity, RA factor status and age. They were acute, remission, seropositive, seronegative and JRA group. About 88 normal, young, healthy individuals were taken as control. We estimated serum level of total antioxidant status (TAS), total thiol, GSH, MG, carbonyl compounds and TBARS level of normal control and RA. The synovial fluid (SF) level of above parameters have been also evaluated in RA. Our observation suggests that MG elevation is associated with increased level of TBARS and decreased level of GSH in all RA subgroups than normal control. The elevation of MG along with declination of GSH and antioxidant status may be associated with free radical damage in RA

33. NORAMBUENA R, X, MALLOL J, RIOS MG, QUEVEDO RFet QUEZADA LA: Therapeutic effects of the anti-tumor necrosis factor monoclonal antibody, infliximab, in four children with refractory juvenile idiopathic arthritis, Allergol.Immunopathol.(Madr.)., Vol. 35(2), 52-56., 2007
    Organism:Pediatric Unit, Hospital Dr, Exequiel Gonzalez Cortes, ChileFAU - Norambuena R, X
    Abstract:OBJECTIVE: To report the results of treatment with infliximab in patients with refractory juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: A prospective study of four children with refractory JIA was carried out. Infliximab (100 mg) was administered in weeks 0, 2 and 6. Subsequently, the drug was administered every 8 weeks. The following parameters were assessed at the beginning and at the end of the follow-up period: number of joints with active arthritis, number of joints with a limited range of motion, physician overall assessment of disease activity, parent assessment of the child's overall well-being, pain assessment scores, and erythrocyte sedimentation rate. Improvement was rated according to the definition of the American College of Rheumatology (ACR 30). Paired sample tests were used for statistical analysis. RESULTS: Three girls and one boy aged between 10 and 16 years old with a history of JIA ranging from 1 to 9 years were included. The patients received infliximab for a period of 11 to 33 months (average 22 months). There was a significant decrease in the number of swollen joints (p < 0.05), joints with a limited range of movement (p < 0.04), pain score assessment (p < 0.005), physician overall assessment (p = 0.002), maternal evaluation (p < 0.001), the patient's own evaluation (p < 0.001), and duration of morning stiffness (p < 0.001). Both steroids and methotrexate dosages were reduced and no adverse effects or infections were registered. CONCLUSIONS: Infliximab improved joint inflammatory indexes and clinical assessments. This improvement increased the quality of life of the patients and their families, suggesting that the use of biological therapy is a good option in refractory JIA

34. PFEIL A, BOTTCHER J, SEIDL BE, SCHAFER ML, HANSCH A, HEYNE JP, PETROVITCH A, MENTZEL HJ, EIDNER T, WOLF G, HEIN Get KAISER WA: Computer-aided joint space analysis (CAJSA) of the proximal-interphalangeal joint-normative age-related and gender specific data, Acad.Radiol., Vol. 14(5), 594-602., 2007
    Organism:Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747 Jena, Germany PfeilA@gmxdeFAU - Pfeil, Alexander
    Abstract:RATIONALE AND OBJECTIVES: To provide reference data for computer-aided joint space analysis (CAJSA) based on a semiautomated and computer-aided diagnostic system for the measurement of joint space widths (ie, proximal-interphalangeal joint), considering gender-specific and age-related differences. MATERIALS AND METHODS: A total of 869 subjects were enrolled (351 females/518 males) with radiographs of the hand. All participants underwent measurements of joint space distances at the proximal-interphalangeal articulation (JSD-PIP) of the second to fifth finger using CAJSA technology. RESULTS: The data verify a notable age-related decrease of CAJSA parameters, showing an accentuated age-related joint space narrowing in women. Additionally, males showed a significant wider JSD-PIP (+15.4%) compared with the female cohort for all age groups. CONCLUSIONS: Our data present gender-specific and age-related normative reference values for computer-aided joint space analysis of JSD-PIP and provide a valid and reliable quantification of disease-related joint space narrowing, particularly in patients with osteoarthritis and rheumatoid arthritis involving the peripheral small hand joints

35. PRIEUR AM, DESLANDRE Cet LEMELLE I: [Transition care in pediatric rheumatology], Arch.Pediatr., Vol. 14(6), 665-667., 2007
    Organism:Centre de reference national pour l'arthrite juvenile, Assistance-publique-Hopitaux de Paris, hopital Necker-Enfants-malades, 149, rue de Sevres, 75015 Paris, France anne-marieprieur@nckaphpfrFAU - Prieur, A-M
    Abstract:

36. PRUUNSILD C, UIBO K, LIIVAMAGI H, TARRASTE S, TALVIK Tet PELKONEN P: Incidence of juvenile idiopathic arthritis in children in Estonia: a prospective population-based study, Scand.J.Rheumatol., Vol. 36(1), 7-13., 2007
    Organism:Department of Paediatrics, Tartu University, Lunini 6 Tartu 51014, Estonia ChrisPruunsild@klinikumeeFAU - Pruunsild, C
    Abstract:OBJECTIVE: To study the incidence rate of juvenile idiopathic arthritis (JIA) and its clinical subtypes in Estonia, to follow the course of the disease in newly diagnosed patients for 2 years, and to find the frequency of human leucocyte antigens (HLA) B27, DR1 and DR4 in JIA patients. METHOD: A population-based study involving prospective registration of new cases of JIA in 1998-2000 and their clinical follow-up for 2 years. RESULTS: In 1998-2000, 162 new cases of JIA were diagnosed. The mean annual incidence rate of JIA was 21.7 per 100 000 children aged 0-15 years (22.9 in girls and 19.3 in boys). During the investigation period, the incidence rate rose 3.5-fold. Oligoarthritis was the most frequent subtype (mean annual incidence rate of 11.7 per 100 000), followed by seronegative polyarthritis (4.4 per 100 000). HLA-DR1, B27 and DR4 were found respectively in 44.4, 28.6 and 11.1% of cases in which the analysis was performed. In HLA-B27-positive patients, inflammation markers of blood remained at a high level for a longer period compared with HLA-B27-negative patients. CONCLUSIONS: This is the first population-based study on the epidemiology of juvenile arthritis in Estonia in which the new classification criteria defined by the International League of Associations for Rheumatology (ILAR) have been used. In addition to environmental factors, an increase in awareness among family doctors is a probable reason for the rise in incidence during the study period. HLA-B27 might have predictive value as a marker of chronicity of inflammation

37. RENKE J, SZLAGATYS A, HANSDORFER-KORZON R, SZUMERA M, KAMINSKA B, KNAP N, POPADIUK S, SZARSZEWSKI Aet WOZNIAK M: Persistence of protein oxidation products and plasma antioxidants in juvenile idiopathic arthritis. A one-year follow-up study, Clin.Exp.Rheumatol., Vol. 25(1), 112-114., 2007
    Organism:Department of Pediatrics, Pediatric Gastroenterology and Oncology, Medical University of Gdansk, Gdansk, PolandFAU - Renke, J
    Abstract:OBJECTIVE: Plasma protein oxidation products and blood antioxidants, like superoxide dismutase (SOD), glutathione peroxidase (GPx) and total antioxidant status (TAS) were investigated in children with juvenile idiopathic arthritis (JIA) in a year follow-up study. METHODS: Carbonyl group content within plasma proteins, activity of red blood cell SOD and GPx, as well as the blood TAS level were determined in 14 children with JIA twice, namely at the admission to the hospital (Time 0 = T0) and then after a year of treatment (Time 1 = T1). RESULTS: An increased level of plasma protein carbonyls was observed in both assessments (T0 and T1) as compared to control. However there was no significant difference in plasma carbonyls level between the initial (T0) and final (T1) examination of the patients. Similarly, SOD activity was higher in children with JIA as compared to control subjects and did not change significantly after a year of follow-up. Red blood cell GPx activity remained within the normal range throughout the study. Interestingly, the blood TAS level was initially comparable to control and rose significantly after the year of treatment. CONCLUSION: A level of plasma protein oxidation products remains significantly higher in children with JIA as compared to healthy subjects. The lack of accumulation of plasma protein carbonyls may result from efficient proteolysis in childhood and/or adaptive increase of the blood TAS level in the course of effective anti-inflammatory therapy. Analysis of plasma oxidative stress markers and antioxidant potential of the blood might be helpful in monitoring the clinical treatment of children suffering from JIA

38. ROTH J, BECHTOLD S, BORTE G, DRESSLER F, GIRSCHICK HJet BORTE M: Osteoporosis in juvenile idiopathic arthritis--a practical approach to diagnosis and therapy, Eur.J.Pediatr., Vol. 166(8), 775-784., 2007
    Organism:Department of Pediatric Pneumology and Immunology, Charite University Medicine, Berlin, Germany johannesroth@charitedeFAU - Roth, Johannes
    Abstract:In all subgroups of juvenile idiopathic arthritis, a decrease in bone mass has been described in a high percentage of children. Recently, new pathogenetic concepts have identified muscle mass as the strongest predictor of bone mass and bone is now recognized as part of the musculoskeletal system. In addition, the sophisticated use of bone densitometry in pediatrics, including new measurement techniques, has provided the tools for a reliable assessment. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis and therapy, is, therefore, mandatory in all children with JIA who do not achieve rapid remission. In this review, diagnostic and therapeutic options are being described and possibilities to incorporate them into clinical practice are suggested

39. SANTOS MJ, FONSECA JE, CANHAO H, CONDE M, JOSE VM, COSTA L, COSTA M, SALGADO Met MELO GOMES JA: [Guidelines for prescribing and monitoring biologic therapies in juvenile idiopathic arthritis], Acta Reumatol.Port., Vol. 32(1), 43-47., 2007
    Organism:Sociedade Portuguesa de Reumatologia, LisboaFAU - Santos, Maria Jose
    Abstract:The Pediatric RheumatologyWorking Group of the Portuguese Society of Rheumatology recommends the use of biological treatments in children with polyarticular course Juvenile Idiopathic Arthritis (JIA) with active disease (5 or more active joints) refractory to subcutaneous or intramuscular methotrexate (MTX) 15 mg/m(2)/week during 3 to 6 months. If toxicity occurs, or if there is contraindication for the use of MTX in this optimum dose, biological treatment can be started, as a first option, or the use of other conventional Disease ModifyingAnti Rheumatic Drug (DMARD) either alone or in combination with MTX might be considered. Prior to starting treatment, children should be screened for latent tuberculosis through clinical evaluation, chest X ray and PPD skin test. The suspension of the biological treatment should be considered if the American College of Rheumatology (ACR) definition of improvement in JIA is not fulfilled in two consecutive visits 3 months apart. Etanercept is the only biological agent currently approved for JIA in Portugal. In refractory cases the use of infliximab is accepted, in accordance with preliminary published evidence. In case of systemic manifestations of JIA refractory to conventional treatment, anakinra can be considered

40. SARMA PK, AGRAWAL S, AGGARWAL Aet MISRA R: Systemic lupus erythematosus with major organ involvement in a patient with systemic-onset juvenile idiopathic arthritis, J.Rheumatol., Vol. 34(4), 893-894., 2007
    Organism:

41. SCHULZ AP, GOTZE S, SCHMIDT HG, JURGENS Cet FASCHINGBAUER M: Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen, Am.J.Sports Med., Vol. 35(7), 1064-1069., 2007
    Organism:MRCS (Glasgow Department of Trauma and Orthopaedic Surgery, BG Trauma Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany ortho@apschulzdeFAU - Schulz, Arndt P
    Abstract:BACKGROUND: Septic arthritis is a rare complication after anterior cruciate ligament surgery. All case series reported so far have been retrospective, and case numbers of septic arthritis have ranged from 4 to 11. HYPOTHESIS: A stage-adapted treatment regimen for septic arthritis after anterior cruciate ligament surgery can provide reliable results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From June 1993 to May 2003, 24 patients met the inclusion criteria for this study. The average age at trauma was 32.5 years. Treatment protocol was based on the grade of infection. Options included transarthroscopic treatment for Gaechter grades 1 and 2 infections or medial and lateral arthrotomy for grades 3 and 4 infections. Graft retention was decided based on clinical findings. The setting was a specialized trauma hospital. Follow-up included International Knee Documentation Committee forms, radiographs, and the Tegner and Lysholm scores at a mean of 66 months (range, 11-142) after treatment. RESULTS: In all cases, treatment of infection was successful; overall, a mean of 2.2 operations were required. In 7 cases, it was possible to salvage the graft. The Tegner activity level before the knee injury was 6.1 points. At follow-up, the average score was 3.8 points. The postoperative subjective International Knee Documentation Committee score averaged 64. The mean Lysholm score was 65.6. On clinical examination, a mean extension deficit of 3 degrees and a mean maximum flexion of 120 degrees were found. In the single-legged hop test, a mean capacity of 63% compared with the uninjured side was measured. CONCLUSION: The described treatment regimen gives reliable results for this complication. There were no recurrences of septic arthritis or bone infection. Early infection can be managed arthroscopically with satisfactory results regarding the treatment of infection. In advanced or chronic infection, a more radical approach seems favorable. Results in these cases are overall only fair compared with patients with an uncomplicated anterior cruciate ligament reconstruction

42. SIMEONI MC, SCHMIDT S, MUEHLAN H, DEBENSASON Det BULLINGER M: Field testing of a European quality of life instrument for children and adolescents with chronic conditions: the 37-item DISABKIDS Chronic Generic Module, Qual.Life Res., Vol. 16(5), 881-893., 2007
    Organism:Public Health Department, University Hospital of Marseille, Marseille, France marie-claudesimeoni@medecineuniv-mrsfrFAU - Simeoni, Marie-Claude
    Abstract:OBJECTIVES: The aim of this study was to shorten the Health-Related Quality of Life (HRQL) DISABKIDS Chronic Generic Measure (DCGM) for children and adolescents and to test its reliability, construct, and external validity. STUDY DESIGN: 1153 children and adolescents (8-16 years) with chronic health conditions (asthma, arthritis, epilepsy, cerebral palsy, diabetes, atopic dermatitis, cystic fibrosis) and their family were recruited from different paediatric clinical settings in seven European countries. A two-time assessment comprised reports on sociodemographics, health status and HRQL of children/adolescents. RESULTS: The 37-item DCGM describes six dimensions (Independence, Physical Limitation, Emotion, Social Inclusion, Social Exclusion and Treatment) confirmed by Confirmatory Factor Analysis, multi-item scaling and item-goodness of fit to Rasch model. Internal consistency (Cronbach's alpha: 0.70-0.87) and test-retest reliability (ICC: 0.71-0.83) were satisfactory. Correlations between DCGM-37 and other HRQL instruments were the highest between dimensions evaluating similar concepts. Regarding discriminant validity of the DCGM-37, girls and older adolescents reported lower emotional we ll-being. Children belonging to families with low level of affluence and those with severe health conditions were found to have worse HRQL in all domains. CONCLUSION: Reliability, construct validity as well as convergent and discriminant validity of the DCGM-37 were shown

43. SIMSEK I, ERDEM H, PAY S, SOBACI Get DINC A: Optic neuritis occurring with anti-tumour necrosis factor alpha therapy, Ann.Rheum.Dis., Vol. 66(9), 1255-1258., 2007
    Organism:Gulhane Military School of Medicine, Division of Rheumatology, Ankara, TurkeyFAU - Simsek, Ismail
    Abstract:OBJECTIVE: Various demyelinating disorders have been reported in association with anti-tumour necrosis factor alpha (TNFalpha) agents. The objective of this study was to review the occurrence, clinical features and outcome of optic neuritis (ON) during treatment with anti-TNFalpha agents. METHODS: A PubMed search was conducted to identify literature addressing the potential association between anti-TNFalpha agents and ON, following our experience with a patient having rheumatoid arthritis in whom ON developed while being treated with infliximab. RESULTS: 15 patients including the case presented here with ON in whom the symptoms developed following TNFalpha antagonist therapy were evaluated. Eight of these patients had received infliximab, five had received etanercept and two patients had received adalimumab. Among them, nine patients experienced complete resolution, and two patients had partial resolution, while four patients continued to have symptoms. DISCUSSION: Patients being treated with a TNFalpha antagonist should be closely monitored for the development of ophthalmological or neurological signs and symptoms. Furthermore, consideration should be given to avoiding such therapies in patients with a history of demyelinating disease. If clinical evaluation leads to the diagnosis of ON, discontinuation of the medication and institution of steroid treatment should be a priority

44. SUDHARSHAN S, BISWAS Jet GANESH SK: Analysis of juvenile idiopathic arthritis associated uveitis in India over the last 16 years, Indian J.Ophthalmol., Vol. 55(3), 199-202., 2007
    Organism:Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India skg@sankaranethralayaorgFAU - Sudharshan, S
    Abstract:AIM: Juvenile idiopathic arthritis (JIA) associated uveitis is one of the most common causes of visual morbidity in children. We report the systemic, clinical and investigational features of a cohort of all cases of JIA associated uveitis seen at our referral uveitis clinic between 1988 and 2004. STUDY DESIGN: Retrospective case series MATERIALS AND METHODS: All patients of JIA seen at the uveitis clinic of tertiary eye care hospital, between 1988 and 2004 with minimum follow up of 3 months were included. Complete history and ophthalmic evaluation and findings on each visit were noted. Ocular complications were identified and recorded. Results of laboratory investigations and diagnostic as well as therapeutic procedures were analyzed. A rheumatologist managed systemic status. RESULTS: There were 40 patients (64 eyes) with JIA. Thirty four patients (85%) had pauciarticular type and 6 patients (15%) had polyarticular type of JIA. Complicated cataract and band shaped keratopathy were seen in 38 eyes (63%) and 37 eyes (62%) respectively. Twenty-two patients (17 bilateral and 5 unilateral) were treated with immunosuppressives and in 19 of these patients, the disease went into remission. Twenty-three eyes (38%) had improvement in visual acuity while in 27 eyes (45%), the vision remained stable and in 10 eyes (17%), vision deteriorated despite therapy. CONCLUSION: In India, JIA associated uveitis commonly presented in pauciarticular type with preponderance in males. Rheumatoid arthritis factor and anti nuclear antibodies were not as common as compared to the western population. Among long-term treatment options, immunosuppressives are a better choice. Ocular surgery was performed when mandatory for visual rehabilitation

45. TAMASI Let SZEKANECZ Z: [Biological therapy of arthritis and systemic autoimmune diseases], Orv.Hetil., Vol. 148 Suppl 1, 63-70., 2007
    Organism:Szent Ferenc Korhaz Reumatologiai Osztaly, MiskolcFAU - Tamasi, Laszlo
    Abstract:The concept of biological therapy arises from the specific targeting of a factor, e.g. a cytokine, involved in the inflammatory cascade. Thus, biologicals disrupt the complex network of autoimmune-inflammatory events. Today, rheumatoid arthritis is a prototype disease in this context as most compounds have been tried in this disease. Recently, biological therapy has been introduced to the treatment of other diseases including various forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, as well as systemic autoimmune disorders, such as systemic lupus erythematosus, scleroderma, inflammatory myopathies and Sjogren's syndrome. Anti-tumor necrosis factor-alpha (TNF-alpha) agents play a central role in biological therapy as these agents have been successfully tried in most of these diseases. When seeking for specific targets for biologicals, pathogenic factors of the disease, such as Th1 or Th2 type responses, should be evaluated. Some mostly T-cell mediated diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, polymyositis, polyarticular juvenile arthritis respond well to anti-TNF agents and T cell targeting, while others, such as lupus, Sjogren's syndrome, dermatomyositis may rather respond to anti-B cell biologicals. In this review, authors discuss the most recent advances in the biological therapy of arthritis and systemic autoimmune diseases including issues of efficacy and safety

46. THEODOSSIADIS PG, MARKOMICHELAKIS NNet SFIKAKIS PP: Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation, Retina., Vol. 27(4), 399-413., 2007
    Organism:Second Department of Ophthalmology, Laikon Hospital, Athens University Medical School, GreeceFAU - Theodossiadis, Panagiotis G
    Abstract:The anti-tumor necrosis factor (TNF) monoclonal antibody infliximab and the soluble TNF receptor etanercept inhibit the pleiotropic actions of TNF and are widely used for the treatment of rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), spondyloarthropathies (SpA), Crohn's disease, and psoriasis with an acceptable safety profile. A pathogenetic role of TNF in ocular inflammatory conditions has recently emerged from small trials reporting preliminary results on the efficacy of these agents in patients with noninfectious uveitis, regardless of the origin of the disease. The authors review the published experience, derived mostly from investigator-sponsored trials and uncontrolled case series, on the use of TNF antagonists in approximately 280 patients with various ocular conditions who were inadequately controlled on currently available therapy. These reports suggest that TNF antagonists, mainly infliximab, which may have better efficacy than etanercept, are useful in the treatment of ocular inflammation associated with Adamantiades-Behcet's disease, RA, JIA, SpA, Crohn's, sarcoidosis, and Graves' disease ophthalmopathy. Infliximab was also beneficial in small numbers of patients with idiopathic uveitis or scleritis, birdshot retinochoroiditis, uveitic and diabetic cystoid macular edema, and age-related macular degeneration. The currently available data are nonrandomized and thus preliminary, providing the foundation and justification for randomized trials to assess efficacy and safety. Until such results are available, knowledge regarding the use of anti-TNF regimens in ophthalmology is incomplete. However, the preliminary evidence points to a growing optimism for targeting TNF in patients with ocular inflammation

47. WEINBLATT MEet KURITZKY L: RAPID: rheumatoid arthritis, J.Fam.Pract., Vol. 56(4 Suppl), S1-S7, 2007
    Organism:Harvard Medical School, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USAFAU - Weinblatt, Michael E
    Abstract:

48. WENG X, LIU L, BARCELLOS LF, ALLISON JEet HERRINTON LJ: Clustering of inflammatory bowel disease with immune mediated diseases among members of a northern california-managed care organization, Am.J.Gastroenterol., Vol. 102(7), 1429-1435., 2007
    Organism:Division of Research, Kaiser Permanente, Oakland, California 94612, USAFAU - Weng, Xiaoping
    Abstract:BACKGROUND AND AIMS: Previous studies provide evidence that some immune-mediated diseases occur at greater frequency among inflammatory bowel disease (IBD) patients than in the general population. The present study examined the co-occurrence of IBD with common immune-mediated disorders including asthma, psoriasis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, vitiligo, autoimmune thyroiditis (Grave's and Hashimoto's), and chronic glomerulonephritis. METHODS: We conducted a cross-sectional study among members of the Kaiser Permanente Medical Care Program for the period 1996-2005. A total of 12,601 patients with at least two IBD diagnoses in computerized visit data were ascertained. Four persons without IBD were matched to each IBD patient on age, gender, and length of enrollment. Information on co-occurring diseases was obtained from computerized visit data for 1996-2005. Conditional logistic regression was used to estimate the odds ratio and 95% confidence interval for the association of IBD with immune-mediated disorders after adjusting for smoking. RESULTS: Seventeen percent of the IBD patients and 10% of the persons without IBD had a diagnosis for at least one immune-mediated disease. IBD patients were more likely to have asthma (1.5, 95% CI 1.4-1.6), psoriasis (1.7, 95% CI 1.5-2.0), rheumatoid arthritis (1.9, 95% CI 1.5-2.3), and multiple sclerosis (2.3, 95% CI 1.6-3.3). CONCLUSIONS: Among the immune-mediated diseases we studied, most were more common in IBD patients than in persons without IBD, suggesting that IBD shares common etiologic factors with other immune-mediated diseases

49. WHITE AP, BISWAS D, SMART LR, HAIMS Aet GRAUER JN: Utility of flexion-extension radiographs in evaluating the degenerative cervical spine, Spine., Vol. %20;32(9), 975-979., 2007
    Organism:Department of Orthopaedic and Neurological Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USAFAU - White, Andrew P
    Abstract:STUDY DESIGN: Retrospective cohort of 258 consecutive patients. OBJECTIVE: The purpose of this study is to determine the: (1) percentage of flexion-extension radiographs that revealed pathology not appreciated on neutral radiographs in the nontrauma population, and (2) frequency that these views led to a change in the management of these patients. SUMMARY OF BACKGROUND DATA: The utility of flexion-extension radiographs in the evaluation of the spine trauma or preoperative patient is well accepted, but the role of dynamic radiographs in the degenerative population is not well defined. METHODS: Consecutive patients presenting with axial cervical, upper extremity radicular, or myelopathic symptoms underwent upright anteroposterior, neutral lateral, and flexion-extension lateral radiographs. Patients with recent trauma, rheumatoid arthritis, prior cervical fracture, prior cervical surgery, inadequate radiographs, or congenital anomalies were excluded. Three observers reviewed all radiographs after determining the best measurement method by a priori analysis of interobserver reliability. RESULTS: Listhesis was observed on 23 of the neutral lateral images; 6 of these were found to have changes between flexion and extension (2-4 mm). Two patients (1%) had spondylolisthesis on flexion-extension radiographs not visualized on neutral lateral radiographs. A subsequent review of these patients' charts revealed no change in management based on these findings. CONCLUSIONS: Cervical flexion-extension radiographs are a method of assessing potential instability. In the degenerative population studied here, 1% had spondylolisthesis noted only on the flexion-extension images, and 3% had a change in spondylolisthesis. None of these, however, led to a changes in clinical management. These data, in conjunction with the extra cost and radiation exposure associated with additional views, led us to no longer regard dynamic radiographs as a useful part of the initial imaging for the patient with degenerative cervical conditions

50. WORKIE DW, GRAHAM TB, LAOR T, RAJAGOPAL A, O'BRIEN KJ, BOMMER WA, RACADIO JM, SHIRE NJet DARDZINSKI BJ: Quantitative MR characterization of disease activity in the knee in children with juvenile idiopathic arthritis: a longitudinal pilot study, Pediatr.Radiol., Vol. 37(6), 535-543., 2007
    Organism:Department of Physics, University of Cincinnati, Cincinnati, OH, USAFAU - Workie, Dagnachew W
    Abstract:BACKGROUND: The development of a quantifiable and noninvasive method of monitoring disease activity and response to therapy is vital for arthritis management. OBJECTIVE: The purpose of this study was to investigate the utility of quantitative dynamic contrast-enhanced MRI (DCE-MRI) based on pharmacokinetic (PK) modeling to evaluate disease activity in the knee and correlate the results with the clinical assessment in children with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: A group of 17 children with JIA underwent longitudinal clinical and laboratory assessment and DCE-MRI of the knee at enrollment, 3 months, and 12 months. A PK model was employed using MRI signal enhancement data to give three parameters, K(trans') (min(-1)), k(ep) (min(-1)), and V(p) (') and to calculate synovial volume. RESULTS: The PK parameters, synovial volumes, and clinical and laboratory assessments in most children were significantly decreased (P < 0.05) at 12 months when compared to the enrollment values. There was excellent correlation between the PK and synovial volume and the clinical and laboratory assessments. Differences in MR and clinical parameter values in individual subjects illustrate persistent synovitis when in clinical remission. CONCLUSION: A decrease in PK parameter values obtained from DCE-MRI in children with JIA likely reflects diminution of disease activity. This technique may be used as an objective follow-up measure of therapeutic efficacy in patients with JIA. MR imaging can detect persistent synovitis in patients considered to be in clinical remission

51. WROBLEWSKI BM, SINEY PDet FLEMING PA: Charnley low-frictional torque arthroplasty in young rheumatoid and juvenile rheumatoid arthritis: 292 hips followed for an average of 15 years, Acta Orthop., Vol. 78(2), 206-210., 2007
    Organism:The John Charnley Research Institute, Wrightington Hospital, Hall Lane, Appley Bridge, N Wigan, UKFAU - Wroblewski, B Michael
    Abstract:INTRODUCTION: In the early 1960s, Charnley was cautious with his patient selection for total hip replacement. As follow-up increased and confidence in the operation grew, younger patients were selected. We present our results of the Charnley LFA in young patients with rheumatoid and juvenile rheumatoid arthritis with a followup of up to 36 years. PATIENTS: We studied 292 Charnley low-friction arthroplasties in 195 young patients with an established diagnosis of rheumatoid arthritis. Their mean age at operation was 38 (12-50) years; 168 (58%) were receiving steroids and 79 (27%) were on non-steroidal antiinflammatory medication. The mean follow-up for the whole group was 15 (1-36) years. 24 patients could not be traced (33 hips), and 61 patients died (88 hips). RESULTS: 25 patients (41 hips) had had a revision. The main indication for revision was cup loosening. In the 85 patients (130 hips) attending follow-up, their mean age at surgery was 36 (17-50) years and the mean follow-up was 20 (10-36) years. 98% were pain-free or had no more than occasional discomfort, 44% claimed to have normal or near-normal function, while 62% had full or almost full range of movement of the replaced hip. Radiographically, 29 cups (22%) were considered to be loose. 1 stem (1%) was definitely loose and 2 stems (2%) were probably loose. With revision for any indication as the endpoint, the survival was 74% at 25 years follow-up. INTERPRETATION: The Charnley LFA continues to be an excellent hip replacement, even for very young rheumatoid arthritis patients. Wear and aseptic cup loosening are the main long-term problems

52. WU R, SHOVMAN O, ZHANG Y, GILBURD B, ZANDMAN-GODDARD Get SHOENFELD Y: Increased prevalence of anti-third generation cyclic citrullinated peptide antibodies in patients with rheumatoid arthritis and CREST syndrome, Clin.Rev.Allergy Immunol., Vol. 32(1), 47-56., 2007
    Organism:Pathway Diagnostics Inc, Malibu, CA, USAFAU - Wu, R
    Abstract:To investigate the prevalence of anti-third generation cyclic citrullinated peptide antibodies (anti-CCP3) in patients with systemic connective tissue diseases, we assembled a training set consisting of 115 patients with rheumatoid arthritis (RA), 52 with Calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia (CREST) syndrome, 21 with scleroderma, 20 with ankylosing spondylitis, 18 with reactive arthritis, 25 with juvenile rheumatoid arthritis (RA), 51 with osteoarthritis, 26 with mixed connective tissue disease, 23 with primary Sjogren's syndrome, 74 with systemic lupus erythematosus, 49 with Polymyalgia rheumatica, and 39 with polymyositis/dermatomyositis. The commercial enzyme-linked immunosorbent assay (ELISA) was used to detect anti-CCP antibodies, including anti-CCP2 (regular, second generation of CCP antigen) and anti-CCP3 (third generation of CCP antigen) in disease-related specimens and normal controls. These serum samples were also evaluated for anti-centomere antibodies by anti-centromere ELISA kit. The higher frequencies of anti-CCP3 and anti-CCP2 were detected in 75.6 and 70.4% patients with RA, respectively. At the same time, anti-CCP3 (not anti-CCP2) was significantly increased in samples isolated from patients with CREST syndrome. The clinical sensitivity of IgG anti-CCP3 for the patients with CREST syndrome was 29% (15 of 52) and the specificity was 96% (384 of 397), with the exception of the RA group. The anti-centromere antibodies were significantly higher in patients with CREST only. The results of our study suggest that compared to anti-CCP2 assay, the new anti-CCP3 assay can enhance the clinical sensitivity for diagnosis of RA and, as an associate marker combined with anticentromere, can distinguish CREST syndrome from other systemic connective tissue diseases, especially RA. The clinical specificity of anti-CCP3 was lower than anti-CCP2 assay in diagnosis of RA because of the crossreaction to the patients with CREST syndrome

53. YEAP SS, MOHD A, KUMAR G, KONG KF, CHOW SK, GOH EMet PHIPPS ME: The association between HLA genes and radiological erosions in Malaysian patients with rheumatoid arthritis, Autoimmunity., Vol. 40(3), 187-190., 2007
    Organism:Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia yeapss@myjaringnetFAU - Yeap, S S
    Abstract:OBJECTIVE: To assess the relationship between the HLA-DRB1 genes with disease severity as assessed by radiological erosions in Malaysian patients with rheumatoid arthritis (RA). METHODS: In this cross-sectional study, we studied 61 RA patients who fulfilled the ACR criteria for the diagnosis of RA. HLA-DRB1 genotyping was performed by sequence specific primer (SSP) - PCR. Radiological grading and erosive score of the hands and wrists was calculated according to the Larsen-Dale method. Demographic data and treatment given to the patients were obtained from their case records. RESULTS: Fifty-six females and five males were studied from three ethnic groups. In 57 patients with erosions, rheumatoid factor was detected in 80%, HLA-DR4 in 40%, HLA-DRB1*0405 in 24% and shared epitope (SE) in 31%. The median delay in starting DMARDs was 24 months. The presence of rheumatoid factor, HLA-DR4 and HLA-DRB1*0405 were not significantly associated with a worse erosive score. Patients who possessed the SE had a higher erosive scores, compared to those who did not (p = 0.05). Concurrently, a delay in starting DMARD was associated with a high erosive score (p = 0.023, r = 0.348). However, after adjustment for the delay in starting DMARD, SE was no longer significantly associated with the erosive score. CONCLUSIONS: In these patients, the delay in starting DMARDs had a greater influence on the erosive score than SE alone. Whilst we cannot discount the contribution of the SE presence, we would advocate early usage of DMARDs in every RA patient to reduce joint erosions and future disability

54. YENIAY BS, KARACA NE, YUKSEL SE, MIDYAT Let KUTUKCULER N: Juvenile psoriatic arthritis carrying familial Mediterranean fever gene mutations in a 14-year-old Turkish girl, J.Dermatol., Vol. 34(5), 344-348., 2007
    Organism:Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, TurkeyFAU - Yeniay, Betul Sozeri
    Abstract:Juvenile psoriatic arthritis (JPsA) is characterized by asymmetric arthritis of big and small joints, enthesitis, dactylitis, psoriatic skin lesions and nail pitting. Investigators agree that JPsA is a relatively common chronic arthropathy of childhood that differs clinically, serologically, and genetically from both juvenile idiopathic arthritis and juvenile ankylosing spondylitis. Familial Mediterranean fever (FMF) is a multisystemic autosomal recessive disease occasionally accompanied by sacroiliitis. This is characterized by recurrent self-limited attacks of fever and accompanying abdominal, chest and arthricular pain. We present a 14-year-old Turkish girl with JPsA and carrying FMF gene mutations. In this patient, JPsA was diagnosed according to her physical, laboratory and skin biopsy findings and a treatment with methotrexate and sulfasalazine was started. As an inadequate clinical and laboratory response was obtained after the first month of therapy, the patient was investigated for FMF, and was diagnosed by molecular analyses of related gene (E148Q heterozygous/V726A homozygous mutation) besides clinical findings. After 2 weeks of the colchicine treatment, symptoms of the patient regressed and acute phase reactants decreased. To our knowledge, this is the first case presenting with psoriatic arthritis and FMF gene mutations together and responds to colchicine, methotrexate and sulfasalazine dramatically in clinical and laboratory findings. This case has been presented to remind that cases with psoriatic arthritis may also carry mutations in the MEFV gene

55. YU L, WANG J, O'DELL JR, OATES J, AREND WPet EISENBARTH GS: Anti-dsDNA antibody assay: high specificity and sensitivity with a filtration radioassay in comparison to low specificity with the standard ELISA, J.Rheumatol., Vol. 34(4), 734-739., 2007
    Organism:Barbara Davis Center for Childhood Diabetes and the Division of Rheumatology, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USAFAU - Yu, Liping
    Abstract:OBJECTIVE: To evaluate whether a new fluid-phase filtration radioassay possesses both high sensitivity and specificity compared with the currently used ELISA and Farr assays. METHODS: Sequential sera (25 samples) from 9 patients with systemic lupus erythematosus (SLE), sera from 20 patients with SLE possessing anti-dsDNA antibodies by the Crithidia assay, 75 patients with rheumatoid arthritis possessing rheumatoid factors, 50 healthy control subjects, 767 from patients with type 1 diabetes, and a commercial standard serum sample were tested for anti-dsDNA antibodies with the 3 different assays. RESULTS: Of serial dilutions of a standard anti-dsDNA antibody sample, only the highest positive sample (50 IU/ml) in the ELISA and the highest 2 positive samples (50 and 25 IU/ml) in the Farr assay were above the normal range. In contrast, all dilutions (to 2.5 IU/ml) of the standard anti-dsDNA antibody sample were above the normal range in the filtration radioassay. Using the values of 50 healthy control subjects in each assay to define the normal range, all 25 sequential sera from 9 patients with SLE were positive. In addition, 20/20 of the SLE individual sera, 2/75 (2.7%) of the RA sera, and 12/767 (1.6%) of the diabetes sera were positive (signal above normal range) in the filtration radioassay. The SLE sera were further examined in 2 additional assays, ELISA and Farr assay, and both assays were less sensitive and specific compared with the filtration radioassay. CONCLUSION: The fluid-phase filtration radioassay demonstrated high sensitivity and specificity for the detection of anti-dsDNA antibodies in SLE, with the standard ELISA exhibiting lower specificity. We suggest that testing for anti-dsDNA antibodies can be improved using a fluid-phase filtration radioassay in comparison to commercial assays