Bibliography August 2007

  1. Anonymous, Juvenile idiopathic arthritis: some progress but still many uncertainties, Prescrire.Int., Vol. 16(90), 168, 2007
    Organism:(1) Juvenile idiopathic arthritis is a chronic inflammatory rheumatic disorder of unknown cause. Spontaneous remission is frequent. Between 10% and 20% of patients have ocular involvement. (2) Nonsteroidal antiinflammatory drugs and physiotherapy are the cornerstones of patient management. Intra-articular steroid injection generally provides several months of relief. The place of immunosuppressants is difficult to ascertain, given their uncertain benefits and established long-term risks in children. There is no curative treatment at present

  2. ABEL'DIAEV DV, SHOSTAK NA, BRIKO NI, TIMOFEEV VT, AKSENOVA AVet FIL'SHINA VL: [Nosological diagnosis and outcomes of arthritis associated with streptococcal infection], Ter.Arkh., Vol. 79(5), 59-65., 2007
    Organism:AIM: To specify the course and outcomes of arthritides associated with streptococcal infection (AASI). MATERIAL AND METHODS: The trial comprised 60 patients with arthritis (mean age 26.8 +/- 14.0). The patients met the following criteria: arthritis, elevated (< 500 U) titers of antistreptolisin-0 in the absence of heart disorders detected at Doppler-echocardiography (2D-echoCG), urogenital infection, Yersinia infection, psoriasis. In addition to routine clinical tests, the following investigations were made: tests for alloantigen of B-lymphocytes D8/17 and antigen HLA-B27, antibodies to polysaccharide of streptococcus of group A, bacteriological test of laryngeal smears for streptococcal infection, prospective follow-up (mean 31.2 +/- 19.6 mon) with 2D-echoCG. RESULTS: Rheumatic arthritis was rejected in 33.3% patients. Other diseases were diagnosed: early rheumatoid arthritis (10%), seronegative spondylarthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, Still's disease, Konig's disease, sarcoidosis, gout, arthritis on the background of streptococcal nodular erythema. Acute rheumatoid fever (ARF) was diagnosed in 56.7% patients, poststreptococcal arthritis (PSA) in 10%. PSA differed from ARF by onset at the age of 36.0 +/- 10.2 years, short latent period (11.2 +/- 1.3 days), a significantly longer course of arthritis (95.0 +/- 3.9 days), recurrences. Alloantigen of B-lymphocytes was detected in 52.8% AASI patients (the difference from the control is highly significant (p < 0.001). Arthritis development was not associated with carriage of HLA-B27 carriage. CONCLUSION: In examination of AASI patients for diagnosis of ARV and PSA it is necessary to reject other diseases among which early RA (10%) is most frequent. It is recommended to make diagnosis of ARF in AASI patients with definition of risk factors (age 7-15 years, family history of rheumatic fever, carriage of alloantigen d8/17), 2.5-year and longer follow-up with 2D-echoCG. Diagnosis of PSA is made in rejection of ARF and in the presence of the following characteristics: development of the disease at the age 30-40 years, a short latent period of the infection, long-term persistent course of arthritis, insufficient effect of nonsteroid anti-inflammatory drugs, frequent affection of sacroiliac joints, recurrence, entezopathy

  3. AKINCI A, CAKAR N, UNCU N, KARA Net ACAROGLU G: Keratoconjunctivitis sicca in juvenile rheumatoid arthritis, Cornea., Vol. 26(8), 941-944., 2007
    Organism:Department of Pediatric Ophthalmology, Diskapi Children's Hospital, Ankara, Turkey arsenakinci@yahoocomFAU - Akinci, Arsen
    Abstract:    PURPOSE: To compare the symptoms, signs, and results of objective tests for keratoconjunctivitis sicca (KCS) in patients with juvenile rheumatoid arthritis (JRA) and controls. METHODS: Sixty-four patients with JRA and 64 age- and sex-matched controls were compared in terms of symptoms, signs, and results of objective tests for KCS. Relation between tear film breakup time (TBUT), Schirmer test results, and JRA-related variables such as age of onset, duration, and type of JRA; presence of antinuclear antibodies (ANAs); and history of uveitis were evaluated. Analysis of variance, multivariate regression analysis, Kruskall-Wallis, Student t tests, and chi tests were used for statistical analysis. RESULTS: Twelve and a half percent of patients with JRA complained of dry eye symptoms compared with 1.5% of the controls (P = 0.031). Dry eye signs were detected in 10.9% of patients with JRA compared with 1.5% of controls (P = 0.038). TBUT and Schirmer test results were lower in the JRA group than in controls (P = 0.032 and P = 0.029, respectively). Seven patients (10.9%) had definite and 1 (1.5%) had probable diagnosis of KCS in the JRA group compared with no children in the control group (P = 0.034). Within the JRA group, Schirmer test and TBUT results were significantly lower in male patients and ones with longer duration of disease. CONCLUSIONS: The prevalence of symptoms, signs, and definite diagnosis of KCS is higher and basal tear secretion and tear film stability are lower in children with JRA than in controls. Among children with JRA, male sex and longer duration of disease are independent risk factors for having decreased basal tear secretion and tear film stability

  4. AL WAHADNEH AM, ABU-ZEID AFet KHREISAT WH: Juvenile idiopathic oligoarthritis: analysis of 42 cases in Jordan, East Mediterr.Health J., Vol. 13(2), 461-464., 2007
    Organism:Paediatric Immunology Clinic, Department of Paediatrics, King Hussein Medical Centre, Royal Medical Services, Amman, Jordan awah88@hotmailcomFAU - Al-Wahadneh, A M
    Abstract:    We conducted a retrospective chart review for all 42 patients, 9 males and 33 females, diagnosed with juvenile idiopathic oligoarthritis between July 1995 and October 2004 at the paediatric rheumatology clinic in King Hussein Medical Centre. Age range was 1.2-15.2 years, mean 3.6 (standard deviation 2.4) years. Of those <6 years, 80% were females. Most patients (64%) had monoarthritis; the knee was the most common joint affected (71%). Two patients had developed extended oligoarthritis. Nine (21%) had asymptomatic uveitis: 6 females (P = 0.350), 7 (77%) <3 years of age (P = 0.301) and 7 (77%) with antinuclear antibodies (ANAs) (P = 0.071). Eighteen (43%) females were positive for ANAs. Most patients had undergone unnecessary, lengthy work-up and treatment before diagnosis

  5. ALLANTAZ F, CHAUSSABEL D, STICHWEH D, BENNETT L, ALLMAN W, MEJIAS A, ARDURA M, CHUNG W, WISE C, PALUCKA K, RAMILO O, PUNARO M, BANCHEREAU Jet PASCUAL V: Blood leukocyte microarrays to diagnose systemic onset juvenile idiopathic arthritis and follow the response to IL-1 blockade, J.Exp.Med., Vol. 204(9), 2131-2144., 2007
    Organism:Baylor National Institute of Allergy and Infectious Diseases Cooperative Center for Translational Research on Human Immunology and Biodefense, Dallas, TX 75204, USAFAU - Allantaz, Florence
    Abstract:    Systemic onset juvenile idiopathic arthritis (SoJIA) represents up to 20% of juvenile idiopathic arthritis. We recently reported that interleukin (IL) 1 is an important mediator of this disease and that IL-1 blockade induces clinical remission. However, lack of specificity of the initial systemic manifestations leads to delays in diagnosis and initiation of therapy. To develop a specific diagnostic test, we analyzed leukocyte gene expression profiles of 44 pediatric SoJIA patients, 94 pediatric patients with acute viral and bacterial infections, 38 pediatric patients with systemic lupus erythematosus (SLE), 6 patients with PAPA syndrome, and 39 healthy children. Statistical group comparison and class prediction identified genes differentially expressed in SoJIA patients compared with healthy children. These genes, however, were also changed in patients with acute infections and SLE. An analysis of significance across all diagnostic groups identified 88 SoJIA-specific genes, 12 of which accurately classified an independent set of SoJIA patients with systemic disease. Transcripts that changed significantly in patients undergoing IL-1 blockade were also identified. Thus, leukocyte transcriptional signatures can be used to distinguish SoJIA from other febrile illnesses and to assess response to therapy. Availability of early diagnostic markers may allow prompt initiation of therapy and prevention of disabilities

  6. AMER R, BAMONTE Get FORRESTER JV: Resolution of juvenile idiopathic arthritis-associated uveitis after development of common variable immunodeficiency, Eur.J.Ophthalmol., Vol. 17(4), 666-668., 2007
    Organism:Department of Ophthalmology, Aberdeen Royal Infirmary, Foresterhill - ScotlandFAU - Amer, R
    Abstract:    PURPOSE. To describe the occurrence of common variable immunodeficiency (CVID) in a patient with juvenile idiopathic arthritis (JIA) and JIA-associated uveitis. METHODS/RESULTS. Case report. A 29-year-old woman was followed-up since the age of 10 years because of right eye JIA-associated recurrent anterior uveitis. She was treated with steroids and immunosuppressants with good control of uveitis and arthritis. At the age of 17 years, she did not experience any further relapse of uveitis or arthritis and both diseases were considered to be in remission. Concomitantly, she started to have recurrent infections and later she underwent splenectomy because of autoimmune hemolytic anemia and thrombocytopenia. Liver biopsy disclosed granulomatous hepatitis. She was ultimately diagnosed with CVID at the age of 23 years when her blood tests revealed neutropenia and severe panhypogammaglobulinemia. She has been treated since then with intravenous immunoglobulins with good control of the disease. Since the development of CVID, she has had no relapses of uveitis or arthritis during a follow-up period of 12 years. CONCLUSIONS. Common variable immunodeficiency (CVID) is the most common primary immunodeficiency where defective antibody formation is the most common feature with B-cell differentiation failure. Ocular complications have been rarely documented and included bacterial conjunctivitis, retinal vasculitis and multifocal choroiditis. We herein report on the occurrence of JIA-associated uveitis as a comorbid manifestation of CVID. We speculate a role for B cells in the pathogenesis of JIA and JIA-associated uveitis here, as this patient had total remission of both conditions with the onset of CVID

  7. BEKKERING WP, TEN CATE R, VAN ROSSUM MAet VLIET VLIELAND TP: A comparison of the measurement properties of the Juvenile Arthritis Functional Assessment Scale with the childhood health assessment questionnaire in daily practice, Clin.Rheumatol., Vol. 26(11), 1903-1907., 2007
    Organism:Department of Physical Therapy (HO-Q), Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands, WPBekkering@LUMCNLFAU - Bekkering, W Peter
    Abstract:    We compared the measurement properties of a performance test (Juvenile Arthritis Functional Assessment Scale; JAFAS) with a questionnaire-based instrument (Childhood Health Assessment Questionnaire; CHAQ) to measure functional ability in patients with juvenile idiopathic arthritis on the level of individual items. In 28 consecutive children visiting an outpatient paediatrics clinic, the JAFAS (range 0-20) and CHAQ (range 0-3) were applied, and measures of disease activity and joint range of motion (ROM) were determined. Twenty-eight children with a median age of 10 years and median disease duration of 3.2 years were included. The median JAFAS score was 0, and the median CHAQ score was 0.125. Cronbach's alpha was 0.92 for the JAFAS and 0.96 for the CHAQ. The Spearman correlation coefficient between the JAFAS and the CHAQ was 0.55 (P < 0.01). With six out of ten items, the JAFAS classified the child as less disabled than with corresponding CHAQ activities. Overall, associations with measures of disease activity and ROM were higher for the CHAQ than for the JAFAS. A performance test (JAFAS) does not appear to have an added benefit over the questionnaire-based assessment (CHAQ) of physical function in a cross-sectional study

  8. BILLIAU AD, HU Y, VERDONCK A, CARELS Cet WOUTERS C: Temporomandibular joint arthritis in juvenile idiopathic arthritis: prevalence, clinical and radiological signs, and relation to dentofacial morphology, J.Rheumatol., Vol. 34(9), 1925-1933., 2007
    Organism:Department of Pediatric Rheumatology and Department of Orthodontics, University Hospital Leuven, BelgiumFAU - Billiau, An D
    Abstract:    OBJECTIVE: To perform a prospective, comprehensive, clinical, and radiological evaluation of temporomandibular joint (TMJ) involvement and its influence on craniofacial growth, in a cohort of patients with juvenile idiopathic arthritis (JIA), representing all JIA subtypes. METHODS: Clinical rheumatologic and orthodontic evaluations were performed in 100 patients with JIA [12 systemic arthritis, 24 rheumatoid factor (RF)-negative polyarthritis, 1 RF-positive polyarthritis, 39 oligoarthritis, 22 enthesitis-related arthritis, 2 psoriatic arthritis]. An orthopantomogram and lateral cephalogram were performed in 46 patients. The prevalence of TMJ arthritis was studied in relation to JIA subtype and disease characteristics; cephalometric measurements were compared to those from age- and sex-matched healthy controls. RESULTS: Whereas 55% of patients with JIA had at least one symptom/sign of TMJ arthritis, 78% of the radiographed group exhibited condylar lesions. The presence of condylar damage was not related to clinical orthodontic findings or to JIA subtype, disease activity, severity, or duration. Patients with JIA exhibited larger mandibular plane and A-nasion-B angles, larger total anterior facial height, smaller interincisal and sella-nasion-B angles, and shorter mandibular ramus lengths than their age- and sex-matched controls. Craniofacial alterations were clearly related to the presence of condylar damage, even when present at a minimal degree. CONCLUSION: Our data show that TMJ condylar damage occurs very frequently in JIA, and irrespective of JIA subtype; condylar lesions can present early, progress insidiously, and -- even at a minimal degree -- can severely alter the craniofacial profile. We propose that the followup of patients with JIA should include early and regular evaluation by an orthodontist, supplemented with radiographic TMJ imaging

  9. BRINKMAN DM, JOL-VAN DER ZIJDE CM, TEN DAM MM, TE BOEKHORST PA, TEN CATE R, WULFFRAAT NM, HINTZEN RQ, VOSSEN JMet VAN TOL MJ: Resetting the Adaptive Immune System After Autologous Stem Cell Transplantation: Lessons from Responses to Vaccines, J.Clin.Immunol., Vol. ., 2007
    Organism:Department of Pediatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands, dmcbrinkman@lumcnl
    Abstract:    Autologous stem cell transplantation (ASCT) to treat autoimmune diseases (AID) is thought to reset immunological memory directed against autoantigens. This hypothesis can only be studied indirectly because the exact nature of the pathogenetic autoantigens is unknown in most AID. Therefore, 19 children with juvenile idiopathic arthritis (JIA) or systemic lupus erythematodes (SLE) and 10 adults with multiple sclerosis (MS) were vaccinated with the T-cell-dependent neoantigen rabies and the recall antigen tetanus toxoid after, respectively before, bone marrow harvest. Both vaccinations were repeated after ASCT. All except two of the responders mounted a primary antibody response to rabies after revaccination, and 44% of the responders mounted a primary antibody response to tetanus boost after ASCT. These data show that immunological memory to a neoantigen is lost in most patients with AID after immunoablative pretreatment; however, memory to a recall antigen boosted before bone marrow harvest is only lost in part of the patients. Disease progression was arrested in all patients with JIA/SLE except one, but only in a minority of MS patients. Clinical outcome on a per case basis was not associated with the profile of the immune response toward the vaccination antigens after ASCT

  10. CHERRY DK, WOODWELL DAet RECHTSTEINER EA: National Ambulatory Medical Care Survey: 2005 summary, Adv.Data., Vol. (387), 1-39., 2007
    Organism:Division of Health Care Statistics, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USAFAU - Cherry, Donald K
    Abstract:    OBJECTIVES: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. METHODS: The data presented in this report were collected in the 2005 National Ambulatory Medical Care Survey (NAMCS), a national probability sample survey of visits to nonfederal office-based physicians in the United States. Sample data are weighted to produce annual national estimates of doctor visits. RESULTS: During 2005, an estimated 963.6 million visits were made to physician offices in the United States, an overall rate of 331.0 visits per 100 persons. In one-quarter of office visits, electronic medical records were utilized by physicians, while at 83.9 percent of visits, claims were submitted electronically. As the baby boomer generation aged, there was a shift in utilization, as the majority of visits in 1995 were by patients 25-44 years of age compared with 2005, when most visits were by patients 45-64 years of age. In 2005, 52.7 percent of office visits were made by patients with at least one chronic condition. Hypertension was the most frequent condition (22.8 percent), followed by arthritis (14.3 percent), hyperlipidemia (13.5 percent), and diabetes (9.8 percent). Medication therapy was reported at 679.2 million office visits, accounting for 70.5 percent of all office visits. In 2005, there were about 2.0 billion drugs prescribed, resulting in an overall rate of 210.7 drugs per 100 visits. Drugs with amoxicillin were more likely to be new prescriptions (85.4 percent), while ibuprofen and acetaminophen were just as likely to be a new or continued drug. The overall mean time spent with a physician, excluding psychiatrists, has not changed since 1995; however, visits with a duration of 6-10 minutes decreased by 28% from 1995, while visits lasting 16-30 minutes increased by 20%

  11. DASS S, VITAL EMet EMERY P: Development of psoriasis after B cell depletion with rituximab, Arthritis Rheum., Vol. 56(8), 2715-2718., 2007
    Organism:Academic Unit of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, UKFAU - Dass, Shouvik
    Abstract:    The B cell-depleting monoclonal antibody rituximab is a novel therapy for the rheumatic diseases, with an increasing body of evidence regarding its safety and efficacy in an expanding range of indications. However, there is uncertainty over its potential use in, and impact on, autoantibody-negative diseases. We describe 3 patients, with no known risk factor for psoriasis, who developed psoriasis (and 1 who also developed features of psoriatic arthritis) after receiving rituximab for a variety of indications, namely, seropositive and seronegative rheumatoid arthritis and systemic lupus erythematosus. In all cases, the underlying disease responded well to rituximab. The interpretation of this possible side effect of rituximab remains unclear, but a B cell-depleted environment may induce abnormal T cell responses, possibly provoked either by subclinical infection or by the removal of mechanisms whereby B cells regulate T cells. These cases suggest that the pathogenesis of psoriasis may not require normal numbers of B cells and that proposed treatment of psoriasis and psoriatic arthritis with rituximab may result in unpredictable responses

  12. FELDMAN DE, DE CIVITA M, DOBKIN PL, MALLESON PN, MESHEFEDJIAN Get DUFFY CM: Effects of adherence to treatment on short-term outcomes in children with juvenile idiopathic arthritis, Arthritis Rheum., Vol. 57(6), 905-912., 2007
    Organism:Universite de Montreal, the Montreal Children's Hospital, Quebec, Canada debbiefeldman@umontrealcaFAU - Feldman, Debbie Ehrmann
    Abstract:    OBJECTIVE: To determine the impact of adherence to treatment (medication and prescribed exercise) on outcomes in children with juvenile idiopathic arthritis (JIA). METHODS: In this longitudinal study, we studied parents of patients with JIA at the Montreal Children's Hospital and British Columbia Children's Hospital in Vancouver. Adherence was evaluated on a visual analog scale in the Parent Adherence Report Questionnaire. Outcomes of interest were active joint count, pain, child functional score on the Child Health Assessment Questionnaire, quality of life score on the Juvenile Arthritis Quality of Life Questionnaire, and parental global impression of overall well-being. The association between adherence to treatment and subsequent outcomes was evaluated using generalized estimating equations and logistic regression. RESULTS: Mean age and disease duration of our sample of 175 children were 10.2 and 4.1 years, respectively. Moderate adherence to medication was associated with lower active joint count (odds ratio [OR] 0.47, 95% confidence interval [95% CI] 0.22-0.99). Moderate adherence to exercise was associated with better functional score (OR 0.13, 95% CI 0.03-0.54), and lower pain during the last week (OR 0.14, 95% CI 0.04-0.50). Both high and moderate adherence to exercise were associated with parental perception of global improvement. CONCLUSION: Improved outcomes in patients who adhered to treatment underscores the need for clinicians to address adherence issues with their patients. Sustaining adherence, particularly to the more time-consuming treatment of exercise, is a challenge

  13. FILOCAMO G, SZTAJNBOK F, CESPEDES-CRUZ A, MAGNI-MANZONI S, PISTORIO A, VIOLA S, RUPERTO N, BUONCOMPAGNI A, LOY A, MARTINI Aet RAVELLI A: Development and validation of a new short and simple measure of physical function for juvenile idiopathic arthritis, Arthritis Rheum., Vol. 57(6), 913-920., 2007
    Organism:Istituto di Ricovero e Cura a Carattere Scientifico G Gaslini, Genoa, ItalyFAU - Filocamo, Giovanni
    Abstract:    OBJECTIVE: To develop and validate a new short and simple measure of physical function in children with juvenile idiopathic arthritis (JIA). METHODS: The Juvenile Arthritis Functionality Scale (JAFS) is a 15-item questionnaire that explores physical function in 3 body areas (lower limbs, hand/wrist, and upper segment). Validation of the Italian version of the instrument was accomplished by evaluating 211 consecutive JIA patients ages 2.2-18 years. The instrument's feasibility, face and content validity, construct and discriminative ability, internal consistency, interrater reliability, and responsiveness to clinical change were examined. JAFS psychometric properties were compared with those of the Childhood Health Assessment Questionnaire (C-HAQ). RESULTS: The JAFS was found to be feasible and to possess both face and content validity. The JAFS score correlated with most of the other JIA outcome measures in the range predicted, thereby demonstrating good construct validity, and discriminated well among different levels of disability. The internal consistency (Cronbach's alpha) was 0.82. The intraclass correlation coefficients between raters (mothers, fathers, and children) and between reported and observed level of function ranged from 0.65 to 0.84. The JAFS revealed fair responsiveness, with a standardized response mean ranging from 0.42 to 0.56. Comparison with the C-HAQ indicated that the JAFS may be superior in terms of construct validity and reliability, and at least as good in terms of discriminant validity and responsiveness. CONCLUSION: The JAFS exhibited good reliability, construct validity, and discriminative ability and fair responsiveness, and is therefore a valid instrument for the assessment of physical function in children with JIA

  14. FOSTER HE, ELTRINGHAM MS, KAY LJ, FRISWELL M, ABINUN Met MYERS A: Delay in access to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis, Arthritis Rheum., Vol. 57(6), 921-927., 2007
    Organism:Musculoskeletal Research Group, School Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK hefoster@nclacukFAU - Foster, H E
    Abstract:    OBJECTIVE: To document pathways of care, management, and interval from onset of symptoms to first pediatric rheumatology multidisciplinary team (PRhMDT) assessment for children with incident juvenile idiopathic arthritis (JIA). METHODS: We conducted a retrospective observational study of children with incident JIA over a 3-year period. RESULTS: The study included 152 patients with JIA (87 females). The median interval from symptom onset to first PRhMDT assessment was 20 weeks (range 0-416), with significant variation between JIA subtypes (P = 0.0097); children with extended oligoarticular JIA had the longest interval (median 60 weeks, range 12-320). Prior to pediatric rheumatology assessment, many children had referrals to multiple secondary care specialties and had been subjected to multiple and often invasive procedures including arthroscopy/synovial biopsy (18 [11.8%] of 152), but none were referred for ophthalmologic screening, physical therapy, or nursing input and a diagnosis of JIA was rarely made (98%). At first PRhMDT assessment, most patients had untreated active disease with active joint count >or=1 (135 [89%] of 152), restricted joint count >or=1 (135 [89%] of 152), and functional disability by Child Health Assessment Questionnaire score >0 (53 [68%] of 118); 1 child had undetected uveitis. Following PRhMDT assessment, interventions were invariably indicated, including joint injections (69 [45%] of 152), methotrexate (49 [32%] of 152), and physical therapy programs (all patients). CONCLUSION: Delay in access to pediatric rheumatology assessment is common with complex pathways of referral. Many children were subjected to inappropriate invasive investigations and many had prolonged untreated active disease at the initial PRhMDT assessment. This delay is likely to affect long-term outcome and warrants further exploration

  15. GARCIA-CARRASCO M, FUENTES-ALEXANDRO S, ESCARCEGA RO, ROJAS-RODRIGUEZ Jet ESCOBAR LE: Efficacy of thalidomide in systemic onset juvenile rheumatoid arthritis, Joint Bone Spine., Vol. 74(5), 500-503., 2007
    Organism:Systemic Autoimmune Diseases Research Unit, HGZ #36, CMN Manuel Avila Camacho, Instituto Mexicano del Seguro Social, Puebla, Mexico 30591mgc@combesFAU - Garcia-Carrasco, Mario
    Abstract:    Thalidomide is an immunomodulating agent which reverses many of the cytokine disturbances seen in systemic onset juvenile idiopathic arthritis (SoJIA) with inadequate response to other treatments. We report 3 cases of recalcitrant SoJIA which improved dramatically after treatment with thalidomide. PATIENTS: Three children aged 9, 8, and 6 years diagnosed with SoJIA treated with conventional therapy including NSAIDs, corticosteroids, methotrexate and etanercept failed to respond fully and their condition worsened. Thalidomide was begun based on two previous reports showing its efficacy in recalcitrant SoJIA. RESULTS: Thalidomide produced successful remission of the disease in all 3 patients according to the preliminary criteria for inactive disease and clinical remission of JIA. CONCLUSION: Thalidomide may be a viable, alternative corticoid-sparing therapy in patients with recalcitrant, multidrug-resistant SoJIA

  16. GAYLIS NB, NEEDELL SDet RUDENSKY D: Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis, Mod.Rheumatol., Vol. 17(4), 273-278., 2007
    Organism:Department of Rheumatology, Arthritis and Rheumatic Disease Specialties, 21097 NE 27th Court Suite 200, Aventura, FL 33180, USA ngaylis@aolcomFAU - Gaylis, Norman B
    Abstract:    The objective of this study was to compare standard hand radiographs with in-office 0.2 T magnetic resonance imaging (MRI) in monitoring response to therapy in patients with rheumatoid arthritis (RA) who were receiving infliximab, to evaluate the frequency and location of erosions, and to determine if there were differences in outcome based on disease duration at baseline. Patients who satisfied the American College of Rheumatology criteria for RA and were receiving infliximab therapy were evaluated with a baseline and 1-year follow-up MRI. Magnetic resonance images were interpreted by two blinded, board-certified radiologists. Bone erosions were identified as well-defined defects extending through the cortical margin. The mean age of the 48 patients was 58.5 years. The median infliximab dosage was 4 mg/kg. Baseline data showed that 41 patients had abnormal MRIs. The mean time between the baseline and follow-up MRI examinations was 10.5 months. Follow-up MRI revealed regression in 11 patients. Thirty-one patients had both MRIs and radiographs. Magnetic resonance imaging was approximately twice as sensitive as radiography in detecting erosions at baseline. In-office MRI was useful in monitoring disease response after the initiation of infliximab treatment. Magnetic resonance imaging is potentially a very valuable diagnostic tool and prognostic indicator for use in patients with RA

  17. GUELL C: Painful childhood: children living with juvenile arthritis, Qual.Health Res., Vol. 17(7), 884-892., 2007
    Organism:University of Edinburgh, United KingdomFAU - Guell, Cornelia
    Abstract:    In this article the author explores the everyday life and coping of children living with juvenile arthritis. The author considered the children as experts on their illness who can give valuable insights into illness management from a patient's perspective. This is in contrast to most research, which lets others, such as caregivers, speak in the place of children. She used an ethnographic approach with open-ended interviews and participant observation to capture the complexity of chronic illness's impact on everyday life. Results of the study indicate that living with juvenile arthritis entails a constant taking control over one's body and achieving normality in life. These children must negotiate between their protected status of being a sick child and their immense responsibility in illness management. The author suggests that existing research on adult chronic illness has only limited relevance to understanding children's illness experience and that further research with children is needed

  18. JIANG Y, CHEN Y, MANUEL D, MORRISON H, MAO Yet WORKING GROUP: Quantifying the impact of obesity category on major chronic diseases in Canada, ScientificWorldJournal., Vol. 7, 1211-1221., 2007
    Organism:Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Locator 6702A, Ottawa, Ontario, CanadaFAU - Jiang, Ying
    Abstract:    Adverse health effects differ with various levels of obesity, but limited national data existed previously for the Canadian population. We examined the associations of sociodemographic and behavioral factors with obesity levels in Canada, and measured the impact of each level on major chronic diseases. Data were extracted from the 2003 Canadian Community Health Survey. We grouped overweight/obese participants aged 18 years and over into four levels based on body mass index (BMI, kg/m2): overweight (25.0 C29.9), class I obesity (30.0 C34.9), class II obesity (35 C39.9), and class III obesity (extreme/clinical obesity, BMI > or = 40.0). We used logistic regression models to identify potential risk factors for the obesity levels and to estimate adjusted odds ratios (ORs) for major chronic diseases related to each level. We calculated population attributable risks (PARs) to help understand the impact of obesity levels on these chronic diseases. The overall prevalence of obesity was 16.2% in men and 14.6% in women, and the prevalence of obesity III was 1.0% in men and 1.4% in women. All levels of obesity increased with age, but then decreased in elderly participants. The prevalence of diabetes, hypertension, heart disease, arthritis, and asthma increased with increasing BMI level, and the highest values appeared in participants at the obesity III level. PAR was highest in the obesity III group for hypertension, followed by diabetes, and lowest for heart disease. When correlated with risk factors, fewer statistically significant ORs, comparing to the normal weight category, appeared for obesity II and III levels than for overweight and obesity I. ORs for the combination of low education level, infrequent exercise, and low household income rose significantly with BMI levels until the obesity II level, and in obesity III level, the OR remained at the same level as for obesity II, most significantly in women. These results suggest that the impact of obesity on Canadians inverted exclamation mark health should be studied and dealt with by obesity level. The greatest impact of clinical obesity was on hypertension and diabetes control in Canada

  19. KITSOULIS PB, SIAMOPOULOU A, BERIS AEet XENAKIS TA: Total hip and knee arthroplasty for juvenile rheumatoid arthritis, Folia Med.(Plovdiv.)., Vol. 48(3-4), 42-49., 2006
    Organism:Department of Orthopaedics, University of Ioannina, GreeceFAU - Kitsoulis, Panagiotis B
    Abstract:    We performed 23 total hip and knee arthroplasties (15 total hip and 8 total knee arthroplasties) in 18 children with juvenile rheumatoid arthritis between 1984 and 2001. The mean age at surgery was 17.8 years (range 13 to 24 years). The age of presentation of the disease was from 4 to 10 years with average 7.3 years. The average length of follow-up was 9.7 years (range 7 to 16 years). All patients conformed with the American Rheumatism Association criteria for juvenile rheumatoid arthritis. All patients had complete loss of joint space and various combination of subchondral sclerosis, flattening of the femoral head, anterior inclination of the neck. Three knees were diagnosed with bony ankylosis. Follow-up was based on the Merle d'Aubigne et Postel scale modified by Charnley. One acetabular component has been revised to date. No femoral or tibial components have been revised. No patient had pain post-operatively and function was very satisfactory. Total hip and knee arthroplasties are technically difficult to execute in this age and should be performed in specialized centers. With appropriate indications pain relief,decrease of deformity and improvement of quality of life can be achieved in most patients

  20. KLEPPER S: Making the case for exercise in children with juvenile idiopathic arthritis: what we know and where we go from here, Arthritis Rheum., Vol. 57(6), 887-890., 2007
    Organism:

  21. LORENTZEN JC, FLORNES L, EKLOW C, BACKDAHL L, RIBBHAMMAR U, GUO JP, SMOLNIKOVA M, DISSEN E, SEDDIGHZADEH M, BROOKES AJ, ALFREDSSON L, KLARESKOG L, PADYUKOV Let FOSSUM S: Association of arthritis with a gene complex encoding C-type lectin-like receptors, Arthritis Rheum., Vol. 56(8), 2620-2632., 2007
    Organism:Department of Medicine, Rheumatology Unit, Karolinska Institutet, Karolinska University Hospital, S-17176 Stockholm, Sweden JohnnyLorentzen@kiseFAU - Lorentzen, Johnny C
    Abstract:    OBJECTIVE: To identify susceptibility genes in a rat model of rheumatoid arthritis (RA) and to determine whether the corresponding human genes are associated with RA. METHODS: Genes influencing oil-induced arthritis (OIA) were position mapped by comparing the susceptibility of inbred DA rats with that of DA rats carrying alleles derived from the arthritis-resistant PVG strain in chromosomal fragments overlapping the quantitative trait locus Oia2. Sequencing of gene complementary DNA (cDNA) and analysis of gene messenger RNA (mRNA) expression were performed to attempt to clone a causal gene. Associations with human RA were evaluated by genotyping single-nucleotide polymorphisms (SNPs) in the corresponding human genes and by analyzing frequencies of alleles and haplotypes in RA patients and age-, sex-, and area-matched healthy control subjects. RESULTS: Congenic DA rats were resistant to OIA when they carried PVG alleles for the antigen-presenting lectin-like receptor gene complex (APLEC), which encodes immunoregulatory C-type lectin-like receptors. Multiple differences in cDNA sequence and mRNA expression precluded cloning of a single causal gene. Five corresponding human APLEC genes were identified and targeted. The SNP rs1133104 in the dendritic cell immunoreceptor gene (DCIR), and a haplotype including that marker and 4 other SNPs in DCIR and its vicinity showed an indication of allelic association with susceptibility to RA in patients who were negative for antibodies to cyclic citrullinated peptide (anti-CCP), with respective odds ratios of 1.27 (95% confidence interval [95% CI] 1.06-1.52; uncorrected P = 0.0073) and 1.37 (95% CI 1.12-1.67; uncorrected P = 0.0019). Results of permutation testing supported this association of the haplotype with RA. CONCLUSION: Rat APLEC is associated with susceptibility to polyarthritis, and human APLEC and DCIR may be associated with susceptibility to anti-CCP-negative RA

  22. LU S, ZHOU W, ZHANG Q, YU XY, LIU DMet LIU XY: [Juvenile psoriatic arthritis], Zhongguo Dang.Dai Er.Ke.Za Zhi., Vol. 9(4), 339-342., 2007
    Organism:Department of Pediatrics, Peking University Third Hospital, Beijing 100083, China lucm@ccpsgovcnFAU - Lu, Shan
    Abstract:    A case of juvenile psoriatic arthritis in a 12 year-old boy was reported. The patient had a history of one and half a year of bilateral heel pain, followed by pain in the right knee and ankle and right hip joint. He developed psoriatic lesions affecting his nails and skin. He had increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) contents. Human leukocyte antigen (HLA) B27 was detected but serum rheumatoid factor was not in the patient. A skin biopsy revealed psoriasis and ultrasonography demonstrated synovitis in right knee and ankle. Juvenile psoriatic arthritis was diagnosed based on his physical, laboratory and skin biopsy findings. A treatment with nonsteroidal anti-inflammatory drugs and sulfasalazine produced no effect. Leflunomide in conjunction with anti-TNF biologic agents (Etanercept) was administered, followed by symptomatic improvement 2 weeks later

  23. MCDONAGH JE: Transition of care from paediatric to adult rheumatology, Arch.Dis.Child., Vol. 92(9), 802-807., 2007
    Organism:Department of Paediatric and Adolescent Rheumatology, Institute of Child Health, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK jemcdonagh@bhamacukFAU - McDonagh, Janet E
    Abstract:    The origin of paediatric rheumatology in the UK mainly lies in adult rheumatology and this has proved invaluable in terms of transition provision, education and training, and collaborative research. The last 5 years have seen adolescent rheumatology gather momentum with the creation of an objective evidence base, a sound foundation for future work addressing the many unanswered questions and hypotheses in the area of transitional care. The aim of this paper is to review the evidence supporting the recent developments in transitional care within rheumatology. Acknowledging the non-categorical nature of transition, the author will also refer to evidence from other chronic illnesses which has informed these developments

  24. NIKITINA NM, SIMONOVA Iet REBROV AP: [Quality of life of Saratov region residents with rheumatoid arthritis], Klin.Med.(Mosk)., Vol. 85(6), 50-54., 2007
    Organism:The aim of the study was to evaluate quality of life (QL) of patients with rheumatoid arthritis (RA) in Saratov region. The study was conducted within the framework of the program MCSQL (multi-center study of quality of life). The work presents the results of an investigation of the center of Saratov. The subjects were 139 patients (117 women; 22 men) with a valid diagnosis of RA. Deteriorated QL indices were revealed in all the patients; these indices correlated with the duration and activity of the disease as well as with gender and age

  25. PIETREWICZ Eet URBAN M: [Early atherosclerosis changes in children with juvenile idiopathic arthritis], Pol.Merkur Lekarski., Vol. 22(129), 211-214., 2007
    Organism:Akademia Medyczna w Bialymstoku, II Klinika Chorob Dzieci klchdz2@cksracbialystokplFAU - Pietrewicz, Edyta
    Abstract:    Pathogenesis of the two diseases: juvenile idiopathic arthritis (JIA) and atherosclerosis are similar-they include increased inflammation markers, homocysteine and lipids levels, inflammatory cytokines. It seems to be important to look for new diagnostic methods to find atherosclerosis in early stage- ultrasonography of the carotid artery with intima-media thickness (IMT) measurement and serum homocysteine level. The aim of this study was assessment of preclinical markers of atherosclerosis--concentration of homocysteine and IMT MATERIAL AND METHODS: The study group consists of 40 children with JIA (20 girls and 20 boys) aged 4-16 years; 32 children with oligoarthritis JIA and 8--polyarthritis JIA. Control group consists of 23 healthy children aged 3-17 years. We investigated serum levels of homocysteine, CRP, lipids and also IMT of the carotid artery. Children with JIA had statistically significant increase of IMT compare to control group (0.43 mm vs. 0.40 mm) and higher IMT in polyarthritis group compare to oligoarthritis children (0.46 mm vs. 0.43 mm). We also find statistically significant correlation between IMT and disease duration (p = 0.003, r = 0.45). RESULTS: Children with JIA had also statistically significant increase of homocysteine level compare to control group (8.2 micromol/l vs. 6.05 micromol/l) and higher homocysteine level in polyarthritis group compare to oligoarthritis children (8.58 micromol/l vs. 7.88 micromol/l). We also find statistically significant correlation between IMT and homocysteine level (p = 0.02, r = 0.36). CONCLUSIONS: There is accelerated atherosclerosis in JIA children that's why we need to find new methods to evaluate it in very early stage so we could help these patients to prevent its complication such as heart disease, stroke etc in the future

  26. PRINGE A, TRAIL L, RUPERTO N, BUONCOMPAGNI A, LOY A, BREDA L, MARTINI Aet RAVELLI A: Macrophage activation syndrome in juvenile systemic lupus erythematosus: an under-recognized complication?, Lupus., Vol. 16(8), 587-592., 2007
    Organism:Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini, Genova, Italy, Hospital Pedro de Elizalde, Buenos Aires, ArgentinaFAU - Pringe, A
    Abstract:    Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases that is thought to be caused by the activation and uncontrolled proliferation of T lymphocytes and macrophages, leading to widespread haemophagocytosis and cytokine overproduction. It is seen most commonly in systemic juvenile idiopathic arthritis, but is increasingly recognized also in juvenile systemic lupus erythematosus (J-SLE). Recognition of MAS in patients with J-SLE is often challenging because it may mimic the clinical features of the underlying disease or be confused with an infectious complication. This review summarizes the characteristics of patients with J-SLE-associated MAS reported in the literature or seen by the authors and analyses the distinctive clinical, diagnostic and therapeutic issues that the occurrence of MAS may raise in patients with J-SLE

  27. QUARTIER Pet PRIEUR AM: [Juvenile idiopathic arthritis. II. Treatment and prognosis], Rev.Prat., Vol. 57(12), 1289-1293., 2007
    Organism:Unit d'immunologie-hematologie et rhumatologie pediatriques, Centre de reference national labellise Arthrites juveniles, hopital Necker-Enfants malades, 75743 Paris quartier@neckerfrFAU - Quartier, Pierre
    Abstract:    Immunosuppressants, including methotrexate and more recently anti-TNFalpha, have modified the prognosis of the most severe forms juvenile idiopathic arthritis. However, the therapeutic management is still challenging and adjuvant therapies, including physiotherapy, surgery, or even bisphosphonates and growth hormone, are still widely used to limit the negative impact of an extended general corticotherapy

  28. QUARTIER Pet PRIEUR AM: [Juvenile idiopathic arthritis. (I) Clinical aspects], Rev.Prat., Vol. 57(11), 1171-1178., 2007
    Organism:Unite d'immunologie-hematologie et rhumatologie pediatriques, Centre de reference national labellise "Arthrites juveniles , hopital Necker-Enfants malades, 75743 Paris 15 quartier@neckerfrFAU - Quartier, Pierre
    Abstract:    Juvenile idiopathic arthritis (JIA), formerly know as juvenile chronic arthritis, is a broad term encompassing several disorders starting before the age of 16. It is characterized by arthritis lasting more than 6 weeks, of unknown etiology, usually persisting for six month initially. Approximately 1 in 5 000 children are affected in France. Of the various distinguishable clinical forms, oligoarticular JIA is the most frequent one. It is characterized by an involvement of up to 4 joints during the first 6 months and is mostly observed in females. The prognosis may be further complicated by the presence of uveitis, associated with an insidious progression. In systemic JIA (also called Still's disease) as well as in some polyarticular forms, with or without rheumatoid factor, inflammation may continue in adulthood. Severe polyarticular involvement or hip involvement may be associated with a poor functional prognosis

  29. ROSA SB, VOLTARELLI JC, CHIES JAet PRANKE P: The use of stem cells for the treatment of autoimmune diseases, Braz.J.Med.Biol.Res., Vol. ., 2007
    Organism:Laboratorio de Hematologia, Faculdade de Farmacia
    Abstract:    Autoimmune diseases constitute a heterogeneous group of conditions commonly treated with anti-inflammatory, immunosuppressant and immunomodulating drugs, with satisfactory results in most cases. Nevertheless, some patients become resistant to conventional therapy. The use of high doses of drugs in such cases results in the need for bone marrow reconstitution, a situation which has stimulated research into the use of hematopoietic stem cells in autoimmune disease therapy. Stem cell transplantation in such diseases aims to destroy the self-reacting immune cells and produce a new functional immune system, as well as substitute cells for tissue damaged in the course of the disease. Significant results, such as the reestablishment of tolerance and a decrease in the recurrence of autoimmune disease, have been reported following stem cell transplantation in patients with autoimmune disease in Brazil and throughout the world. These results suggest that stem cell transplantation has the potential to become an important therapeutic approach to the treatment of various autoimmune diseases including rheumatoid arthritis, juvenile idiopathic arthritis, systemic lupus erythematosus, multiple sclerosis, systemic sclerosis, Crohn's disease, autoimmune blood cytopenias, and type I diabetes mellitus

  30. SARMA PK, MISRA Ret AGGARWAL A: Elevated serum receptor activator of NFkappaB ligand (RANKL), osteoprotegerin (OPG), matrix metalloproteinase (MMP)3, and ProMMP1 in patients with juvenile idiopathic arthritis, Clin.Rheumatol., Vol. ., 2007
    Organism:Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, amita@sgpgiacin
    Abstract:    We studied the serum levels of receptor activator of nuclear factor-kappaB ligand (RANKL), osteoprotegerin (OPG), pro-matrix metalloproteinase (MMP) 1, MMP3, and tissue inhibitor of metalloproteinase (TIMP) 1 in patients with juvenile idiopathic arthritis (JIA) and correlated these with different disease variables. Sera of 70 patients with JIA (ILAR 2001 criteria) and 33 age- and sex-matched controls were assayed by enzyme-linked immunosorbent assay. Nonparametric tests were used for analysis of data. The subtype distribution of the JIA patients was: enthesitis-related arthritis (ERA) 24, polyarticular 22, systemic onset 13, oligoarticular 8, and others 3. The median level of RANKL, OPG, pro-MMP1, MMP3, and TIMP-1 were elevated in JIA patients as compared to controls (p < 0.001). There was no difference in levels among different types of JIA. RANKL/OPG ratio was elevated in all subtypes of JIA. MMP3/TIMP-1 ratio correlated with measures of disease activity including swollen and tender joint count, erythrocyte sedimentation rate, and disease activity score (rS 0.28, p < 0.05). Ours is the first study to show elevated RANKL in serum of patients with JIA. Further, our data suggest that patients with ERA have similar levels to other forms of JIA. Association of the MMP3/TIMP-1 ratio with disease activity suggests that it may be a useful biomarker for follow-up

  31. SIJSSENS KM, ROTHOVA A, VAN DE VIJVER DA, STILMA JSet DE BOER JH: Risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis, Am.J.Ophthalmol., Vol. 144(4), 574-579., 2007
    Organism:FC Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands KSijssens@umcutrechtnlFAU - Sijssens, Karen M
    Abstract:    PURPOSE: To identify the possible risk factors for the development of cataract requiring surgery in children with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Retrospective cohort study. METHODS: Data of 53 children with JIA-associated uveitis, of whom 27 had undergone cataract extraction (CE), were obtained. The main outcome measure, the interval between the onset of uveitis and the first CE (U-CE interval), was examined in relation to clinical and ophthalmologic characteristics and treatment strategies before CE. RESULTS: A shorter U-CE interval was found for children with posterior synechia vs those without posterior synechia (hazard ratio [HR], 3.57; 95% confidence interval [CI], 1.33 to 10.00). No significant difference was found for children in whom the uveitis was the first manifestation of JIA vs those in whom arthritis was the first manifestation of JIA (HR, 1.59; 95% CI, 0.63 to 4.00) and children treated with periocular corticosteroid injections vs those not treated with periocular corticosteroid injections (HR, 3.23; 95% CI, 0.95 to 11.11). Children treated with methotrexate (MTX) had a longer U-CE interval than children not treated with MTX (HR, 0.29; 95% CI, 0.10 to 0.87). CONCLUSIONS: The risk factor for development of early cataract requiring surgery in children with JIA-associated uveitis is the presence of posterior synechia at the time of diagnosis of uveitis. However, early treatment with MTX is associated with a mean delay in the development of cataract requiring surgery of 3.5 years

  32. STINSON JN, STEVENS BJ, FELDMAN BM, STREINER D, MCGRATH PJ, DUPUIS A, GILL Net PETROZ GC: Construct validity of a multidimensional electronic pain diary for adolescents with arthritis, Pain., Vol. ., 2007
    Organism:Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ont, Canada; The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ont, Canada M5G 1X8
    Abstract:    The aim of this study was to evaluate the construct validity and feasibility of a multidimensional electronic pain diary (e-Ouch(c)) in adolescents with juvenile idiopathic arthritis (JIA). Two descriptive studies with repeated measures were conducted between January and December 2005. Participants were drawn from a large metropolitan rheumatology clinic in a university affiliated pediatric tertiary care centre. In Study 1, 76 adolescents with active arthritis recorded their pain three times a day for 2weeks using the e-Ouch(c). In Study 2, 36 adolescents recorded their pain three times a day for 1week before and 2weeks after joint injections. Adolescents in both studies completed multiple measures to determine the construct validity and feasibility of the e-Ouch(c). Adolescents reported mild levels of pain intensity, unpleasantness, and interference as well as stiffness, and mild to moderate levels of fatigue. e-Ouch(c) average weekly pain unpleasantness and interference scores were higher in adolescents with higher pain intensity scores. Correlations between average weekly pain ratings on the e-Ouch(c) and scores from: (a) recalled least, average and worst weekly pain, (b) health-related quality of life and pain coping, and (c) disease activity were as predicted. Pain ratings were significantly lower following joint injections with effect sizes in the low to moderate and moderate to high ranges at the first and second week post-injection, respectively. These findings provide evidence of the construct validity and feasibility of the e-Ouch(c) electronic diary in adolescents with JIA. Use of real-time data capture approaches should be considered in future studies of chronic arthritis

  33. VAN BRUSSEL M, LELIEVELD OT, VAN DER NJ, ENGELBERT RH, HELDERS PJet TAKKEN T: Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis, Arthritis Rheum., Vol. 57(6), 891-897., 2007
    Organism:University Hospital for Children and Youth Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, The NetherlandsFAU - van Brussel, M
    Abstract:    OBJECTIVE: To compare the aerobic and anaerobic exercise capacity of children with juvenile idiopathic arthritis (JIA) with healthy controls, to determine if there were differences based on disease onset type, and to examine the relationship between aerobic and anaerobic exercise capacity in children with JIA. METHODS: Sixty-two patients with JIA (mean +/- SD age 11.9 +/- 2.2 years, range 6.7-15.9) participated in this study. Aerobic exercise capacity was measured using a cardiopulmonary exercise test. Anaerobic exercise capacity was measured using the Wingate Anaerobic Exercise Test (WAnT). RESULTS: All patients were able to perform the cardiopulmonary exercise test and WAnT without adverse events. On average, the maximal oxygen uptake (VO(2peak)) and VO(2peak/kg) were 69.8% and 74.8%, respectively, of that predicted compared with healthy controls. Mean +/- SD power was 66.7% +/- 37.2% of that predicted compared with healthy children. Mean +/- SD peak power was 65.5% +/- 43.1% of that predicted compared with healthy children. There were significant differences between subgroups of JIA; the oligoarticular-onset group values did not significantly differ from healthy control values; the polyarticular rheumatoid factor positive-onset subgroup had the greatest impairment in both aerobic and anaerobic exercise capacity. The correlations of mean power and peak power with VO(2peak) were r = 0.884 and r = 0.697, respectively (P < 0.05). CONCLUSION: This study demonstrates that both the aerobic and anaerobic exercise capacity in children with JIA are significantly decreased. The WAnT might be a valuable adjunct to other assessment tools in the followup of patients with JIA

  34. VANG T, MILETIC AV, BOTTINI Net MUSTELIN T: Protein tyrosine phosphatase PTPN22 in human autoimmunity, Autoimmunity., Vol. 40(6), 453-461., 2007
    Organism:The Burnham Institute for Medical Research, La Jolla, CA, USAFAU - Vang, Torkel
    Abstract:    The discovery that a single-nucleotide polymorphism (SNP) in lymphoid tyrosine phosphatase (LYP), encoded by the PTPN22 gene, is associated with type 1 diabetes (T1D) has now been verified by numerous studies and has been expanded to rheumatoid arthritis, juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus, Graves' disease, generalized vitiligo and other human autoimmune diseases. In this paper, we discuss the association of PTPN22 with autoimmunity, the biochemistry of the PTPN22-encoded phosphatase, and the molecular mechanism(s) by which the disease-predisposing allele contributes to the development of human disease