Bibliography July 2007

  1. Anonymous, Apology, CMAJ., Vol. 177(1), 66, 2007
    Organism:

  2. AMERNIK K, TARNOWSKA C, BRZOSKO I, GRZELEC Het BURAKL M: [Glottis morphology in rheumatoid arthritis], Otolaryngol.Pol., Vol. 61(1), 85-90., 2007
    Organism:Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej PAM w SzczecinieFAU - Amernik, Katarzyna
    Abstract:    Rheumatoid arthritis (RA) is an inflammatory disease of the connective tissue, which can affect larynx and cricoarytenoid (CA) joints, as well. The AIM of this study was assessment of 1) glottis morphology and frequency of laryngeal structures involvement in RA of peripheral joints and 2) evaluation of rheumatoid patients' complaints which can indicate the laryngeal involvement. MATERIAL: 77 patients were examined (71 women and 16 men) in the age from 19 to 77 (mean 56,69). RA duration was from 1 month to 29 years (mean 9,38). RA was active in 61% of patients. Method: Anamnesis, physical examination, videolaryngoscopy, computer tomography, electromyography. RESULTS: The most frequent complaints were: foreign body sensation in the throat (51%), hoarseness (47%) with accompanying weakness of voice and dysphagia. In videolaryngoscopic examination swelling and/or redness of mucosal tissue in CA area was observed in 45% of patients. In 3 women impairment of vocal folds was stated, in 1 it was limitation of right vocal fold mobility and in 2 bilateral vocal folds immobility and tracheotomy was necessary. In patients with active RA and with foreign body sensation in the throat significantly more often inflammatory changes in larynx were visible. CONCLUSIONS: 1. Rheumatoid inflammation in the larynx is demonstrated by swelling and/or redness of mucosal tissue in CA area and in some individuals by its immobilization. 2. In the periods of RA intensification complains of foreign body sensation in the throat and hoarseness may indicate on laryngeal involvement. Our study results justify a suggestion of continuation of the morphological and functional changes estimation in patients with peripheral RA

  3. BALOUSEK S, PLANE MBet FLEMING M: Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain, J.Gen.Intern.Med., Vol. 22(9), 1268-1273., 2007
    Organism:Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USAFAU - Balousek, Stacey
    Abstract:    BACKGROUND: Interpersonal abuse is associated with clinical problems including chronic pain disorders. OBJECTIVES: The objective of this study is to describe 30-day and lifetime prevalence of emotional, physical, and sexual abuse found in men and women prescribed opioids for chronic pain. DESIGN: Cross-sectional interview is the design of this study. PARTICIPANTS: Patients, 1,009, currently prescribed opioids for chronic noncancer pain. They were recruited from the practices of 235 Family Physicians and Internists in Wisconsin. The most common pain diagnoses were arthritis, low back pain, headache, and fibromyalgia/myofascial pain. MEASUREMENT: Data for this secondary analysis on rates of interpersonal abuse were based on 3 questions from the Addiction Severity Index (ASI) regarding 30-day and lifetime emotional, physical, and sexual abuse. RESULTS: Forty-seven percent of women and 22% of men reported a history of lifetime physical abuse. Thirty -five percent of women and 10% of men reported lifetime sexual abuse. Binary logistic regression identified the following variables associated with lifetime physical abuse: female gender (RR 2.81, CI 2.01-3.94), age 31-50 (RR1.77, CI 1.30-2.41), Caucasian (RR1.67, CI 1.19-2.35), increased psychiatric symptoms as measured by the ASI (RR 2.14, CI 1.56-2.94), and lifetime suicide attempts (RR 3.98, CI 2.76-5.74). CONCLUSIONS: This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health

  4. BARTOLI M, TARO M, MAGNI-MANZONI S, PISTORIO A, TRAVERSO F, VIOLA S, MAGNANI A, GASPARINI C, MARTINI Aet RAVELLI A: The magnitude of early response to methotrexate therapy predicts long-term outcome of patients with juvenile idiopathic arthritis, Ann.Rheum.Dis., Vol. ., 2007
    Organism:IRCCS Policlinico S Matteo, Pavia, Italy
    Abstract:    OBJECTIVE: To investigate the relationship between the magnitude of clinical response in the first 6 months of methotrexate (MTX) therapy and the long-term outcome in children with juvenile idiopathic arthritis (JIA). METHODS: The clinical charts of 125 JIA patients who were started with MTX and were then followed for at least 5 years were reviewed. Based on the level of American College of Rheumatology (ACR) Pediatric response at 6 months, patients were divided in 4 mutually exclusive groups: 1) nonresponders; 2) responders at 30%; 3) responders at 50%; 4) responders at 70%. The long-term outcome in each response group was evaluated by calculating the percentage change in active and restricted joint counts from baseline to 1, 2 and 5 years and the frequency of inactive disease at 5 years. RESULTS: At 6 months, 42 patients were classified as nonresponders, 24 as 30% responders, 26 as 50% responders, and 33 as 70% responders. Patients who had achieved a 70% response showed a significantly greater percentage improvement in active joint count between baseline to 5 years compared with nonresponders and 30% responders, and a significantly greater percentage improvement in restricted joint count between baseline to 5 years compared with 30% responders. The 70% responders also had a greater frequency of inactive disease at 5 years compared with 30% responders. CONCLUSIONS: Our results show that the achievement of an ACR Pediatric 70 response at 6 months after start of MTX therapy predicts a more favorable long-term outcome of patients with JIA

  5. CHEN HH, KUO HC, WANG L, YU HR, SHEN JM, KWANG KPet YANG KD: Childhood macrophage activation syndrome differs from infection-associated hemophagocytosis syndrome in etiology and outcome in Taiwan, J.Microbiol.Immunol.Infect., Vol. 40(3), 265-271., 2007
    Organism:Division of Pediatric Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, TaiwanFAU - Chen, Hsin Hsu
    Abstract:    BACKGROUND AND PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome composed of macrophage activation syndrome (MAS), infection-associated hemophagocytosis syndrome (IAHS), malignancy-associated HLH and genetic HLH. Differentiation of MAS from IAHS and other HLH is important for early appropriate treatment. METHODS: A retrospective analysis was used to differentiate childhood MAS from IAHS and other HLH in Chang Gung Memorial Hospital (CGMH), Kaohsiung. All relevant clinical features, laboratory data, treatments and outcomes were analysed. RESULTS: Seventeen patients with childhood HLH were found at CGMH, Kaohsiung in the past decade, and could be classified into 3 categories: IAHS (9 patients), MAS (5 patients), and HLH of unknown etiology (3 patients). The diagnosis of MAS first appeared in this hospital in 2001. Patients with IAHS tended to be younger than those with MAS. Boys were more frequently found in the IAHS group whereas girls (with systemic lupus erythematosus or juvenile idiopathic arthritis) were more frequently found in the MAS group. The majority of mortality cases were noted in the IAHS group (44%, 4/9). All patients with MAS survived with early cyclosporine A treatment. CONCLUSIONS: Childhood MAS is different from IAHS in terms of age, gender, etiology and mortality. Early administration of cyclosporine A for MAS results in a lower mortality. Further prospective studies are required to confirm these findings

  6. CHEN JJ, WANG JY, CHANG YM, SU SY, CHANG CT, SUN SS, KAO CHet LEE CC: Regional cerebral blood flow between primary and concomitant fibromyalgia patients: a possible way to differentiate concomitant fibromyalgia from the primary disease, Scand.J.Rheumatol., Vol. 36(3), 226-232., 2007
    Organism:Section of Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan d91842001@ntuedutwFAU - Chen, J J H
    Abstract:    OBJECTIVES: Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) has been used to detect abnormal regional cerebral blood flow (rCBF) in women with primary fibromyalgia (FM). The main aim of this study was to investigate the rCBF deficit in concomitant FM patients and compare it with primary FM. METHODS: An observational study was designed to analyse the SPECT findings in 92 female patients recruited from January 2002 to January 2004. Differences in the rCBF hypoperfusive areas between 49 primary and 29 concomitant FM patients were assessed in different areas of the brain using the chi(2)-test for statistical significance. RESULTS: Tc-99m ECD brain SPECT in 71 FM patients revealed heterogeneous rCBF in comparison to the homogeneous scan in 14 control patients. The most prominent rCBF hypoperfusive region in both primary and concomitant FM groups was the left temporoparietal area, followed by the thalamus, right temporoparietal, frontal, and basal ganglia areas. Differences in rCBF hypoperfusion in these areas for both FM groups were not significant (all p>0.5). CONCLUSIONS: Reduced rCBF at cortical regions, in addition to previously reported areas at the thalamus and the subcortical nucleus, in FM patients was demonstrated in this study. The perfusion deficit areas were similar between primary and concomitant FM when the underlying disease activity was quiescent. The feasibility of using this neuroimaging study to differentiate FM from the primary disease, such as rheumatoid arthritis (RA)-associated depression and neuropsychiatric lupus, should be considered

  7. CONSOLARO A, VITALE R, PISTORIO A, LATTANZI B, RUPERTO N, MALATTIA C, FILOCAMO G, VIOLA S, MARTINI Aet RAVELLI A: Physicians' and parents' ratings of inactive disease are frequently discordant in juvenile idiopathic arthritis, J.Rheumatol., Vol. 34(8), 1773-1776., 2007
    Organism:Istituto di Ricovero e Cura a Carattere Scientifico G Gaslini, Genova, ItalyFAU - Consolaro, Alessandro
    Abstract:    OBJECTIVE: To investigate discrepancies between physicians' and parents' ratings of inactive disease in children with juvenile idiopathic arthritis (JIA) and the determinants of the discrepancy. METHODS: Study data were obtained from the clinical database generated at the study unit. Each patient visit included a standardized assessment of JIA outcome measures. One visit for each patient was selected for analysis. Three definitions of inactive disease were applied to the data: a physician-based definition (physician global assessment = 0); a parent-based definition (parent global assessment = 0); and a formal definition, based on fulfillment of newly developed criteria for inactive disease in JIA. RESULTS: Of 1237 visits made by 537 patients that included both physician and parent global assessments, 265 fulfilled the physician-based definition and/or the parent-based definition of inactive disease. Concordance between physicians and parents in rating the disease as inactive was seen in 40% of the visits, whereas in 60% of visits the 2 assessments were discordant. Parents tended to disagree with physicians in rating the disease as inactive if the child had pain or functional impairment, whereas physicians tended to disagree with parents in the presence of active joint symptoms. Only 2/3 of the 79 visits that fulfilled the formal definition of inactive disease also met the parent-based definition of inactive disease. CONCLUSION: We found frequent discordance between physicians' and parents' ratings of inactive disease in children with JIA, which suggests that the parent's rating of a child's disease activity should be considered for inclusion in the definition of clinical remission for JIA

  8. DI GANGI M, FOTI R, LEONARDI R, LEONETTI Cet CASTELLINO P: [Recurrent new-onset uveitis in a patient with rheumatoid arthritis during anti-TNFalpha treatment], Reumatismo., Vol. 59(2), 169-172., 2007
    Organism:Unita Operativa di Reumatologia, Azienda Ospedaliera Universitaria V Emanuele, Ferrarotto, S Bambino, CataniaFAU - Di Gangi, M
    Abstract:    Inflammation involving the uveal tract of the eye, termed uveitis, is frequently associated with various rheumatic disease, including seronegative spondylarthropathies, juvenile rheumatoid arthritis, Crohn's disease and Behcet's disease. Scleritis and keratitis may be associated with rheumatoid arthritis and systemic vasculitides such as Wegener's granulomatosis. Immune-mediated uveitis can have a chronic relapsing course and produce numerous possible complications, many of which can result in permanent vision loss. Treatment typically includes topical or systemic corticosteroids with cycloplegic-mydriatic drugs and/or noncorticosteroid immunosuppressants, but often there is an insufficient clinical effectiveness. Anti-TNFalpha therapy is promising in the treatment of sight threatening uveitis, particularly in patients with Behcet's disease. However, there have been also reports of new-onset uveitis during treatment of joint disease with TNFalpha inhibitors. We describe a case of new-onset uveitis in a patient with rheumatoid arthritis during therapy with etanercept at first and infliximab at last. Although we cannot exclude uveitis as linked to rheumatoid arthritis, it is unlike that the uveitis arises when the joint disease is well controlled. The hypothetical paradoxical effect of anti-TNF is here discussed

  9. EGUCHI K: [Efficacy and adverse events of etanercept in patients with rheumatoid arthritis: reports of postmarketing surveillance in Japan], Nippon Rinsho., Vol. 65(7), 1259-1266., 2007
    Organism:Graduate School of Biomedical Sciences, Nagasaki UniversityFAU - Eguchi, Katsumi
    Abstract:    Etanercept is a soluble tumor necrosis factor (TNF) receptor fusion protein that binds and inactivates TNF. Since etanercept was just approved in January 2005 in Japan, a strict postmarketing surveillance has been undertaken. In this trial, initial 3,319 patients with rheumatoid arthritis were collected, and the adverse events and efficacy of etanercept were evaluated. The frequency of adverse events were found in 30.9 %, among total patients particularly severe adverse effects in 4.2 %. Among severe adverse events, 83 patients experienced infection. They included 25 patients with bacterial pneumonia. Interstitial pneumonia, pneumocystis jiroveci and tuberculosis were observed in 11 cases (0.3 %), 5 cases (0.2 %) and 2 cases (0.1%), respectively. Patients who received etanercept had a more rapid rate of improvement in disease activity determined by DAS 28 ESR and DAS28 CRP. These improvements continued through 24 months of etanercept exposure. Using the analysis of EULAR response criteria, the good or moderate response in the DAS 28 ESR response and DAS 28 CRP was found in more than 80% of patients with RA

  10. GROOTENHUIS MA, KOOPMAN HM, VERRIPS EG, VOGELS AGet LAST BF: Health-related quality of life problems of children aged 8-11 years with a chronic disease, Dev.Neurorehabil., Vol. 10(1), 27-33., 2007
    Organism:Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands magrootenhuis@amcuvanlFAU - Grootenhuis, M A
    Abstract:    In paediatric research, Health-Related Quality-of-Life (HRQoL) has received increasing recognition as an important health outcome. This study aimed to investigate the nature and prevalence of HRQoL problems in children with different chronic diseases. Data were available on 318 children aged 8-11 years with different diseases: congenital heart disease (n = 50); coeliac disease (n = 105); asthma (n = 32); cancer (n = 23); juvenile chronic arthritis (n = 45); children with capillary haemangioma (n = 25) and severe meningococcal disease (n = 38). They all answered a validated generic instrument [TNO-AZL Children's Quality of life questionnaire] (TACQoL), in the outpatient clinic or at home. Analyses of variance were performed to investigate differences in mean scores for children with chronic conditions in comparison to healthy children. Prevalence of children at risk for substantial HRQoL problems was based on the 25th percentile in the norm population. In comparison to healthy children, only a small number of differences were found in mean scores of children studied. In contrast, prevalence of HRQoL problems in children with chronic diseases was higher in several domains. It is concluded that using an indicator variable of the norm 25th percentile seems important in identifying at-risk children with chronic disease

  11. ISAACS JD: T cell immunomodulation--the Holy Grail of therapeutic tolerance, Curr.Opin.Pharmacol., Vol. 7(4), 418-425., 2007
    Organism:Wilson Horne Immunotherapy Centre and Musculoskeletal Research Group, Institute of Cellular Medicine, Catherine Cookson Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, United Kingdom jdisaacs@nclacukFAU - Isaacs, John D
    Abstract:    The concept and practice of therapeutic tolerance has successfully been applied to animal models of autoimmunity and transplantation for more than 2 decades. Finally, there are encouraging signs of its translation to clinical practice. Short courses of anti-CD3 monoclonal antibody therapy have provided lasting benefits in recent-onset type 1 diabetes in association with evidence for the induction of immunoregulatory mechanisms. Co-stimulation blockade with abatacept (CTLA4-Ig) will soon be licensed for the treatment of rheumatoid arthritis - over the past year phase III studies have demonstrated impressive improvement in subjective and objective signs of the disease. T cell depletion is in development for several conditions, again with recent studies demonstrating evidence of immune regulation in some instances. More specific antigen-directed peptide therapies have also been applied to atopic asthma, type 1 diabetes, and adult and juvenile arthritis. The tragic sequelae of the phase I trial of TGN1412 at Northwick Park demonstrated the delicate, but unpredictable, therapeutic ratio of some T-cell-directed treatments and, in the UK, have led to new guidelines for early-phase clinical trials of immune-directed therapies

  12. KUEMMERLE-DESCHNER JBet HORNEFF G: Safety and efficacy of once-weekly application of Etanercept in children with juvenile idiopathic arthritis, Rheumatol.Int., Vol. %20;., 2007
    Organism:Division of Pediatric Rheumatology, University Children's Hospital Tubingen, Hoppe-Seyler-Strasse 1, 72076, Tubingen, Germany, kuemmerledeschner@uni-tuebingende
    Abstract:    Etanercept-a recombinant TNF receptor fusion protein-has been approved for the treatment of resistant polyarticular juvenile idiopathic arthritis. In children with JIA, 0.4 mg/kg is given subcutaneously twice weekly. In adult patients efficacy and safety of etanercept, 25 mg twice weekly was comparable to 50 mg once weekly. In the German paediatric Etanercept registry six patients with JIA were identified, who received Etanercept once weekly primarily and six patients who received Etanercept initially twice weekly and later once weekly with increased dose per injection. In both groups, treatment was efficacious and well tolerated. In patients switching from twice to once weekly administration, there was no loss of efficacy and no increase in toxicity. At last observation 10/12 patients achieved an ACR-JRA 30 and 8/12 achieved an ACR-JRA70 response. These data indicate that once weekly application of etanercept is safe and efficacous in children

  13. LEVALAMPI T, HONKANEN V, LAHDENNE P, NIEMINEN R, HAKALA Met MOILANEN E: Effects of infliximab on cytokines, myeloperoxidase, and soluble adhesion molecules in patients with juvenile idiopathic arthritis, Scand.J.Rheumatol., Vol. 36(3), 189-193., 2007
    Organism:The Immunopharmacology Research Group, Medical School, University of Tampere and Research Unit, Tampere University Hospital, Tampere, FinlandFAU - Levalampi, T
    Abstract:    OBJECTIVE: Infliximab is effective and well tolerated in the treatment of juvenile idiopathic arthritis (JIA). The aim of the present study was to measure circulating levels of inflammatory mediators in patients with JIA during treatment with infliximab. METHODS: Eight patients with active JIA refractory to standard treatments were treated with infliximab (3-4 mg/kg) at weeks 0, 2 and 6 and thereafter at approximately 6-week intervals up to 24 weeks. RESULTS: All patients (n = 8) responded to the treatment. By 6 weeks of treatment the number of active joints had reduced from 16+/-4 (mean+/-SEM) to 4+/-1 (p<0.01) and C-reactive protein (CRP) levels had fallen from 31+/-8 to 8+/-3 (p<0.001). Infliximab treatment also reduced the serum concentrations of interleukin-6 (IL-6), myeloperoxidase (MPO), and soluble adhesion molecules ICAM-1 (intercellular adhesion molecule-1), and E-selectin. Tumour necrosis factor-alpha (TNFalpha) levels tended to increase while the concentrations of endogenous TNF antagonists (sTNF-RI and sTNF-RII) reduced in most patients during treatment. CONCLUSIONS: Infliximab reduced serum levels of IL-6, MPO and soluble adhesion molecules in JIA patients, producing a good clinical response to the treatment

  14. MCDONALD K, TOMS AP, ARMON K, JOHNSON Ket MARSHALL TJ: Carpal-tarsal osteolysis with elbow involvement, Skeletal Radiol., Vol. 36(11), 1097-1101., 2007
    Organism:Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK, andonitoms@nnuhnhsukFAU - McDonald, Kirsteen
    Abstract:    Carpal-tarsal osteolysis is a rare condition that manifests as the progressive resorption of carpal and tarsal bones in young children. The diagnosis of this condition is often difficult and delayed as the initial clinical presentation is non-specific. Radiographic changes occur gradually, are often not seen at presentation and depend on recognising loss of bone in the ossification centres of the carpus and tarsus. MRI demonstrates morphological abnormalities in the cartilaginous, as well as the osseous components, of the developing carpal and tarsal bones and therefore may be helpful in predating the radiographic changes. Ultrasound appears to contribute little to the diagnosis and may be misleading. Exclusion of other conditions, particularly juvenile idiopathic arthritis, is important in making the diagnosis. MRI can be useful in excluding an inflammatory arthropathy, and suggesting the diagnosis of carpal-tarsal osteolysis

  15. MENTLEIN R: Targeting pleiotropin to treat osteoarthritis, Expert.Opin.Ther.Targets., Vol. 11(7), 861-867., 2007
    Organism:University of Kiel, Department of Anatomy, Olshausenstrasse 40, 24098 Kiel, Germany rment@anatuni-kieldeFAU - Mentlein, Rolf
    Abstract:    Pleiotropin (PTN) is a secreted heparin-binding peptide expressed in mesodermal and neuroectodermal cells during development, but rarely in adult tissues. Although PTN is abundant in fetal or juvenile cartilage, it is undectable in mature cartilage. However, PTN is re-expressed in chondrocytes in early stages of osteoarthritis where it is detectable in situ and in synovial fluids from patients. PTN enhances chondrogenesis by stimulation of extra-cellular matrix synthesis, reduction of degrading matrix metalloproteases and induction of their inhibitors; PTN also slightly reduces pro-inflammatory factors, such as nitric oxide and vascular endothelial growth factor. Furthermore, PTN stimulates chondrocyte clustering and proliferation. Thus, PTN appears to mediate repair and protective processes in osteoarthritic cartilage and appears to be a promising factor to treat osteoarthritis

  16. O'DOHERTY C, HAWKINS S, ROONEY Met VANDENBROECK K: The MHC2TA-168A/G and +1614G/C polymorphisms and risk for multiple sclerosis or chronic inflammatory arthropathies, Tissue Antigens., Vol. 70(3), 247-251., 2007
    Organism:Department of Molecular Therapeutics, Applied Genomics Research Group, School of Pharmacy, Queen's University of Belfast, 97 Lisburn Road, Belfast, UKFAU - O'Doherty, C
    Abstract:    The -168A-G polymorphism has been shown to influence transcription of the MHC2TA gene and has been implicated in several inflammatory/autoimmune disorders. Attempts to reproduce these findings have been inconclusive. We investigated the role of this promoter single nucleotide polymorphism (SNP) in 440 multiple sclerosis (MS), 293 rheumatoid arthritis (RA), 74 juvenile idiopathic arthritis (JIA) patients and 316 healthy controls from Northern Ireland. We also genotyped a non-synonymous SNP in exon 11, +1614G/C. There was no significant difference in the -168G allele frequencies and carriage rates in the separate RA, JIA, or MS collections compared with the control group [odds ratio (OR) = 1.1, 95% confidence intervals (CI) = 0.86-1.44; OR = 1.1, 95% CI = 0.75-1.68; OR = 1.1, 95% CI = 0.84-1.35, respectively]. Assessment of the common phenotype (chronic inflammatory disease; n = 807 vs 316 controls) was negative as well. Carriage of +1614C was protective against JIA (OR = 0.6, 95% CI = 0.3-1.0) and showed a similar trend in RA and MS (OR = 0.7, 95% CI = 0.5-1.0; OR = 0.8, 95% CI = 0.6-1.0, respectively). The common phenotype (chronic inflammatory disease) was also significant (OR = 0.7, 95% CI = 0.6-1.0)

  17. RAMOS-CASALS M, BRITO-ZERON P, MUNOZ S, SORIA N, GALIANA D, BERTOLACCINI L, CUADRADO MJet KHAMASHTA MA: Autoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases, Medicine (Baltimore)., Vol. 86(4), 242-251., 2007
    Organism:Department of Autoimmune Diseases, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Hospital Clinic, Barcelona, Spain mramos@clinicubesFAU - Ramos-Casals, Manuel
    Abstract:    Tumor necrosis factor (TNF)-targeted therapies are increasingly used for a rapidly expanding number of rheumatic and autoimmune diseases. With this use and longer follow-up periods of treatment, there are a growing number of reports of the development of autoimmune processes related to anti-TNF agents. We have analyzed the clinical characteristics, outcomes, and patterns of association with the different anti-TNF agents used in all reports of autoimmune diseases developing after TNF-targeted therapy found through a MEDLINE search of articles published between January 1990 and December 2006. We identified 233 cases of autoimmune diseases (vasculitis in 113, lupus in 92, interstitial lung diseases in 24, and other diseases in 4) secondary to TNF-targeted therapies in 226 patients. The anti-TNF agents were administered for rheumatoid arthritis (RA) in 187 (83%) patients, Crohn disease in 17, ankylosing spondylitis in 7, psoriatic arthritis in 6, juvenile RA in 5, and other diseases in 3. The anti-TNF agents administered were infliximab in 105 patients, etanercept in 96, adalimumab in 21, and other anti-TNF agents in 3. We found 92 reported cases of lupus following anti-TNF therapy (infliximab in 40 cases, etanercept in 37, and adalimumab in 15). Nearly half the cases fulfilled 4 or more classification criteria for systemic lupus erythematosus (SLE), which fell to one-third after discarding preexisting lupus-like features. One hundred thirteen patients developed vasculitis after receiving anti-TNF agents (etanercept in 59 cases, infliximab in 47, adalimumab in 5, and other agents in 2). Leukocytoclastic vasculitis was the most frequent type of vasculitis, and purpura was the most frequent cutaneous lesion. A significant finding was that one-quarter of patients with vasculitis related to anti-TNF agents had extracutaneous involvement. Twenty-four cases of interstitial lung disease associated with the use of anti-TNF agents were reported. In these patients, 2 specific characteristics should be highlighted: the poor prognosis in spite of cessation of anti-TNF therapy, and the possible adjuvant role of concomitant methotrexate. In conclusion, the use of anti-TNF agents has been associated with an increasing number of cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, SLE, and interstitial lung disease

  18. SHAPIRO C, MAENZ L, HOSSAIN A, PAHWA Pet ROSENBERG A: Onset to first visit intervals in childhood rheumatic diseases, J.Rheumatol., Vol. 34(9), 1913-1917., 2007
    Organism:Department of Pediatric and Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaFAU - Shapiro, Cal
    Abstract:    OBJECTIVE: To determine time intervals between onset of symptoms of a childhood rheumatic disease and first visit to a pediatric rheumatology clinic and to evaluate factors influencing onset to first visit intervals. METHODS: Onset to first visit intervals were analyzed in 836 children representing the 10 most common diseases in a pediatric rheumatology clinic population of 1093. RESULTS: Among 836 subjects, 469 (56.1%) could identify month of symptom onset. Among patients with juvenile rheumatoid arthritis (JRA) 125 of 195 (64.1%) with pauciarticular, 58 of 105 (55.2%) with polyarticular, and 28 of 36 (77.8%) with systemic subtypes were able to determine time interval between symptom onset and first visit. Month intervals were confidently established in 80 of 250 with a spondyloarthropathy (32.4%), 19 of 52 (36.5%) with psoriatic arthropathy, 65 of 72 (90.3%) with Henoch-Schonlein purpura (HSP), 50 of 56 (89.3%) with Kawasaki disease, 22 of 34 (64.7%) with systemic lupus erythematosus, 13 of 18 (72.2%) with dermatomyositis, and 9 of 18 (50%) with localized scleroderma. Determination of onset was significantly more likely in HSP than in other diagnostic categories except systemic JRA, and more likely in Kawasaki disease than other disease categories except systemic JRA and dermatomyositis. In the group of 469, 287 (61.2%) were seen within 2 months of symptom onset and 447 (95.3%) within 1 year of symptom onset. CONCLUSION: Diseases ordinarily typified by an abrupt and acute onset of symptoms were referred most promptly, suggesting that acuity of symptoms at disease onset is the factor that most influences promptness of referral. Prospective studies are required to establish how onset to first visit intervals might influence disease outcomes and to devise best practice referral guidelines

  19. STICHERLING M, MINDEN K, KUSTER RM, KRAUSE Aet BORTE M: [Psoriasis und Psoriasis arthritis in childhood and adolescence : Overview and consensus statement of the 9th Worlitz Expert Round Table Discussion 2006 for the Society for Child and Adolescent Rheumatology.], Z.Rheumatol., Vol. 66(4), 349-354., 2007
    Organism:Hautklinik, Universitatsklinikum Erlangen, Hartmannstrasse 14, 91052, Erlangen, Deutschland, michaelsticherling@dermaimeduni-erlangende
    Abstract:    There are about 1.2-1.6 million psoriasis sufferers in Germany. In about a third of these, the disease manifests before the age of 20. A classic complication of psoriasis is psoriasis arthritis (PsA), which, from the latest figures, effects about 20% of all psoriasis patients. PsA also starts in childhood and is included under the term juvenile idiopathic arthritis (JIA).The expert round table discussion which took place in 2006 in Worlitz elaborated the recommendations for the classification, comprehensive diagnostics and therapy of effected children and adolescents.As controlled studies are lacking, the treatment of PsA has been empirically based and carried out in analogy with the treatment of other forms of JIA. The use of methotrexate (MTX) shows a good success rate. In 2004, about a third of the patients found in the core documentation, including over 80% of children and adolescents undergoing a primary therapy, were treated with MTX, a quarter in combination with other medication. A total of 7% of all and 16% of those undergoing primary therapy were treated with etanercept, most (>80%) in combination with basis medication, usually MTX. Consensus opinion indicated that an early, and intensive local skin therapy should be applied in order to reduce inflammatory activity. If PsA is present, the early use of non-steroid anti-inflammatories as well as local therapy of the joints with the intra-articular application of glucocorticosteroids is recommended. The primary medication should preferentially be MTX, if necessary combined with other therapies. In cases of a severe, episodic progression as well as high inflammatory activity, systemic glucocorticosteroids should be considered.Further studies addressing both the clinical course of jPsA compared to the adult manifestation as well as optimal therapeutic procedures should be initiated in the near future

  20. TWILT M, ARENDS LR, CATE RTet SUIJLEKOM-SMIT LW: Incidence of temporomandibular involvement in juvenile idiopathic arthritis, Scand.J.Rheumatol., Vol. 36(3), 184-188., 2007
    Organism:Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands ntwilt@erasmusmcnlFAU - Twilt, M
    Abstract:    OBJECTIVE: Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among juvenile idiopathic arthritis (JIA) patients. The cross-sectional design makes it almost impossible to study the incidence. Follow-up data on TMJ involvement are sparse. In this study patients were reviewed with an interval of a minimum of 1 year and a maximum of 2 years to study the yearly incidence of TMJ involvement and to obtain follow-up data on TMJ involvement and orthopantomogram (OPT) alterations. METHODS: Children with JIA from a previous study on TMJ involvement were included. OPTs were scored according to Rohlin's grading system (grade 0-5). A paediatric rheumatologist measured the level of disease activity during the interval. RESULTS: Eighty-nine of the 97 patients were included in this study with a mean follow-up of 14 months. The yearly incidence of TMJ involvement was 7.1% in patients with JIA. Improvement on the OPT was seen in 27 patients (66%), and 19 of these patients no longer showed any signs of TMJ involvement. Worsening on the OPT was seen in four patients (10%). Disease activity was significantly lower in the improved patients than in the patients with worsening. CONCLUSION: Condylar lesions due to arthritis can improve over time, indicating a regenerative capacity of the mandibular condyle. As condylar improvement seems to be associated with low disease activity, it is important to consider the TMJ when deciding on a therapeutic regimen

  21. VAN DER MA, WULFFRAAT NM, PRAKKEN BJ, GIJSBERS B, RADEMAKER CMet SINNEMA G: Psychological side effects of MTX treatment in juvenile idiopathic arthritis: a pilot study, Clin.Exp.Rheumatol., Vol. 25(3), 480-485., 2007
    Organism:Department of Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, The NetherlandsFAU - van der Meer, A
    Abstract:    OBJECTIVE: To document the psychological side effects of methotrexate (MTX) treatment in children with juvenile idiopathic arthritis (JIA) and to explore the usefulness of psychological therapy to ameliorate these side effects. METHODS: The patients included in this study consisted of 29 patients with JIA using MTX. Of these, ten were referred to a pediatric psychologist because of MTX side effects, and had behavioural therapy to cope with these side effects with a strong behavioural component (anticipatory nausea, anxiety). The behavioural therapy was adapted to age and used systemic desensitization (distraction in a positive atmosphere) or cognitive behavioural therapy (relaxation and overruling negative thoughts by positive ones). The parents of the 29 children were interviewed about MTX treatment and the side effects their child had developed. Parents of children referred to the psychologist were also interviewed for their impression of the results of the behavioural therapy. RESULTS: Prior to the behavioural therapy, nine out of 10 children reported MTX related nausea. Six of these ten were nauseous even before the administration and developed anticipatory nausea. Nine out of ten patients also showed some sign of distress in anticipation of MTX treatment, either orally of via injections. The behavioural therapy they had fully abolished side effects in five children and decreased the severity of nausea and distress in two children. Of the remaining nineteen children, not referred to the pediatric psychologist, 11 reported nausea after MTX treatment and four of these developed anticipatory nausea. In addition, eight of these 18 developed behavioural distress in anticipation of the treatment. CONCLUSION: This study showed that children with JIA who receive MTX treatment frequently develop psychological side effects, such as anticipatory nausea and behavioural distress in anticipation of treatment. This is true for patients selected for reported MTX side effects, as well as for randomly chosen JIA patients using MTX. As MTX is still the first choice in the treatment of severe JIA, more attention should be given to the treatment and prevention of side effects. Psychological intervention can be of help, but further studies are needed on the nature of the side effects, as well as on the prerequisites and efficacy of behavioural therapy

  22. VIKEN MK, OLSSON M, FLAM ST, FORRE O, KVIEN TK, THORSBY Eet LIE BA: The PTPN22 promoter polymorphism -1123G>C association cannot be distinguished from the 1858C>T association in a Norwegian rheumatoid arthritis material, Tissue Antigens., Vol. 70(3), 190-197., 2007
    Organism:Institute of Immunology, Faculty Division Rikshospitalet, University of Oslo, Sognsvannsveien 20, Oslo 0027, Norway mkviken@medisinuionoFAU - Viken, M K
    Abstract:    The protein tyrosine phosphatase nonreceptor 22 (PTPN22) gene has, during the last 2 years, been recognized as a susceptibility gene for numerous autoimmune diseases, including rheumatoid arthritis (RA) and type 1 diabetes. An association between the exonic 1858C>T single nucleotide polymorphism (SNP) and RA has repeatedly been replicated in several Caucasian populations. The SNP is not associated with autoimmune diseases in Asian populations, as the 1858T allele is almost absent. Recently, a promoter polymorphism -1123G>C was proposed to be associated with acute-onset type 1 diabetes in Japanese and Korean populations. Furthermore, in Caucasian populations, the presence of additional PTPN22 risk variants has been suggested, indicating that the 1858C>T risk variant cannot explain the entire disease association observed in the region. In this study, we wanted to jointly address and integrate these separate findings to further elucidate the association between the PTPN22 gene and RA in a Norwegian material of 861 RA patients and 559 healthy controls. Our results revealed that the strength of the association with the PTPN22 promoter polymorphism, -1123G>C, is analogous to that observed for 1858C>T. As the -1123G>C variant is also polymorphic in Asian populations, our data underpin the need to further explore the association between this variant and autoimmune diseases in different populations

  23. VUORIMAA H, HONKANEN V, KONTTINEN YT, KOMULAINEN Eet SANTAVIRTA N: Improved factor structure for self-efficacy scales for children with JIA (CASE) and their parents (PASE), Clin.Exp.Rheumatol., Vol. 25(3), 494-501., 2007
    Organism:Department of Rheumatology, Rheumatism Foundation Hospital, Heinola, and Department of Pediatric Rheumatology, Helsinki University Central Hospital, Finland hannavuorimaa@reumafiFAU - Vuorimaa, H
    Abstract:    OBJECTIVE: Self-efficacy is an important factor in helping children to cope with a chronic disease. In order to study it, we have to be able to develop a valid and reliable scale. We validated and further developed the CASE (Children's Arthritis Self-Efficacy) and PASE (Parent's Arthritis Self-Efficacy) scales in a Finnish juvenile idiopathic arthritis (JIA) patient and parent population. METHODS: One hundred and twenty JIA children and their parents completed the CASE and PASE assessments, respectively. Exploratory Factor Analysis (EFA) applying the Principal Axis Factoring method was conducted and extended by the use of Confirmatory Factor Analysis (CFA) to allow a theory-driven approach to determine the latent dimensions for both CASE and PASE scales. Construct validity was analysed by measuring the extent to which the CASE and PASE variables correlated with variables of children's and parents' depression scales and with the clinical parameters of the child in a way that can be explained theoretically. RESULTS: A two-factor solution in PASE corresponding to Barlow's factor solution did not fit the sample of Finnish parents. Instead, a three-factor model similar to that of the CASE scale fitted the data for the PASE scale with self-efficacy in somatic symptoms and psychological and social functioning as subscales. Construct validity was confirmed for both scales. CONCLUSION: The refined three-factor structure of the PASE scale and the slightly modified three-dimensional CASE scale were found to be robust scales enabling disease-specific analysis of somatic, psychological and social self-efficacy and comparisons between the patients and parents

  24. WASKO MC, HUBERT HB, LINGALA VB, ELLIOTT JR, LUGGEN ME, FRIES JFet WARD MM: Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis, JAMA., Vol. 298(2), 187-193., 2007
    Organism:Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA wasko@pitteduFAU - Wasko, Mary Chester M
    Abstract:    CONTEXT: Hydroxychloroquine, a commonly used antirheumatic medication, has hypoglycemic effects and may reduce the risk of diabetes mellitus. OBJECTIVE: To determine the association between hydroxychloroquine use and the incidence of self-reported diabetes in a cohort of patients with rheumatoid arthritis. DESIGN, SETTING, AND PATIENTS: A prospective, multicenter observational study of 4905 adults with rheumatoid arthritis (1808 had taken hydroxychloroquine and 3097 had never taken hydroxychloroquine) and no diagnosis or treatment for diabetes in outpatient university-based and community-based rheumatology practices with 21.5 years of follow-up (January 1983 through July 2004). MAIN OUTCOME MEASURES: Diabetes by self-report of diagnosis or hypoglycemic medication use. RESULTS: During the observation period, incident diabetes was reported by 54 patients who had taken hydroxychloroquine and by 171 patients who had never taken hydroxychloroquine, with incidence rates of 5.2 per 1000 patient-years of observation compared with 8.9 per 1000 patient-years of observation, respectively (P < .001). In time-varying multivariable analysis with adjustments for possible confounding factors, the hazard ratio for incident diabetes among patients who had taken hydroxychloroquine was 0.62 (95% confidence interval, 0.42-0.92) compared with those who had not taken hydroxychloroquine. In Poisson regression, the risk of incident diabetes was significantly reduced with increased duration of hydroxychloroquine use (P < .001 for trend); among those taking hydroxychloroquine for more than 4 years (n = 384), the adjusted relative risk of developing diabetes was 0.23 (95% confidence interval, 0.11-0.50; P < .001), compared with those who had not taken hydroxychloroquine. CONCLUSION: Among patients with rheumatoid arthritis, use of hydroxychloroquine is associated with a reduced risk of diabetes

  25. YAMADA H, KAIBARA N, OKANO S, MAEDA T, SHUTO T, NAKASHIMA Y, OKAZAKI Ket IWAMOTO Y: Interleukin-15 selectively expands CD57+ CD28- CD4+ T cells, which are increased in active rheumatoid arthritis, Clin.Immunol., Vol. 124(3), 328-335., 2007
    Organism:Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan hisakata@bioregkyushu-uacjpFAU - Yamada, Hisakata
    Abstract:    Proinflammatory cytokines as well as CD4(+) T cells play critical roles in the pathogenesis of rheumatoid arthritis (RA). Recently, an increase of CD57(+) or CD28(-)CD4(+) T cells was demonstrated in RA, although the mechanism of the increase of these T cells is unclear. In this study, we first examined the relationship between CD57(+)CD4(+) T cells and CD28(-)CD4(+) T cells and found CD57(+)CD28(-)CD4(+) T cells, but neither CD57(+)CD28(+) nor CD57(-)CD28(+) cells, expanded in the peripheral blood of active RA. In vitro experiments revealed that CD57(+)CD28(-)CD4(+) T cells selectively expanded in response to IL-15. Furthermore IL-15-stimulated CD57(+)CD28(-)CD4(+) T cells induced TNF-alpha production from monocytes. These results suggest that CD57(+)CD28(-)CD4(+) T cells are involved in the pathogenesis of RA by responding to IL-15

  26. YOKOTA S: [Biologic response modifiers for juvenile idiopathic arthritis], Nippon Rinsho., Vol. 65(7), 1331-1335., 2007
    Organism:Department of Pediatrics, Yokohama City University School of MedicineFAU - Yokota, Shumpei
    Abstract:    Among the subtypes of juvenile idiopathic arthritis (JIA), systemic JIA and arthritic JIA are different each other from many points of view such as clinical symptoms and course, laboratory findings, and drug response. The diagnostic process and treatment strategy should be discussed upon each characteristics. The diagnosis of arthritic JIA depends on the physical examination to reveal arthritis in each joints, blood examinations, and X-ray and MRI examination. The primary treatment includes low-dose methotrexate pulse therapy, and about 70% of the affected children will be improved. Other 30 % of children will be the objectives for the biologic response modifiers such as etanercept and infliximab. For the diagnosis of systemic JIA, clinical symptoms and signs including spiking fever pattern, skin rash, and arthritis are the first to be recognized, and pediatrician needs to exclude other febrile disease such as infectious disease, leukemia, Castleman disease, and other rheumatic diseases. For the children with systemic JIA, corticosteroids have been the only effective agents. Recently, IL-1Ra was reported to be effective for these children. Moreover, tocilizumab, anti-IL-6 receptor monoclonal antiboby developed in Japan, was revealed to be effective and safe

  27. YOSHIDA N, HASHIMOTO T, ATSUMI Tet KOIKE T: [Infliximab], Nippon Rinsho., Vol. 65(7), 1251-1258., 2007
    Organism:Department of Medicine II, Hokkaido University Graduate School of MedicineFAU - Yoshida, Nobuya
    Abstract:    A number of over-sea study showed the immediate and dramatic anti-inflammatory effects of infliximab(IFX) in patients with rheumatoid arthritis (RA). In addition, significant reduction of bone/joint destruction by IFX was proven in RA patients. On the other hand, some serious adverse effects of IFX were documented. In Japan, IFX was approved as a biological reagent against RA on 2003, and nationwide post marketing surveillance was conducted in the consecutive 5,000 RA patients on IFX. The data showed that 91.6% of patients had overall efficacy as "marked improvement" or "improvement". Serious adverse reaction was reported in 6.2%. Therefore, IFX is very effective and well tolerated in Japanese patients with RA

  28. ZEBRACKI K, HOLZMAN K, BITTER KJ, FEEHAN Ket MILLER ML: Brief report: use of complementary and alternative medicine and psychological functioning in Latino children with juvenile idiopathic arthritis or arthralgia, J.Pediatr.Psychol., Vol. 32(8), 1006-1010., 2007
    Organism:Loyola University Chicago, Department of Psychology, IL 60626, USA kzebrac@luceduFAU - Zebracki, Kathy
    Abstract:    OBJECTIVE: To describe the use of complementary and alternative medicine (CAM) and its relationship to symptoms of anxiety, depression, and dysthymia in Latino children with juvenile idiopathic arthritis (JIA) or arthralgia. METHODS: Parents of 36 children between the ages of 6 and 16 years with either JIA (n = 17) or arthralgia (n = 19) completed questionnaires during routine pediatric rheumatology clinic visits assessing use of CAM and psychological functioning. RESULTS: CAM was used by the majority of children primarily to treat pain episodes. The most common modalities were prayer and massage therapy. CAM use was associated with decreased symptoms of anxiety and dysthymia in children with arthralgia, but not in children with JIA. CONCLUSION: Preliminary findings suggest that CAM use is associated with improved psychological functioning in children with arthralgia. Healthcare providers are encouraged to routinely screen for CAM usage and to educate families about the potential benefits and limitations of CAM