Rheumatology Research Papers - Academia.edu (original) (raw)

Textbook in Internal medicine consists of 30 chapters. This textbook is made up of text material and enough illustrations, including clinical findings and schematic figures. The textbook is intended for English-speaking students of... more

Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work,... more

Your article is protected by copyright and all rights are held exclusively by Springer-Verlag. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your work, please use the accepted author's version for posting to your own website or your institution's repository. You may further deposit the accepted author's version on a funder's repository at a funder's request, provided it is not made publicly available until 12 months after publication.

Background: Low back pain is a significant health problem condition due to high prevalence among the general population. Emotions and physical factors are believed to play a role in chronic low back pain. Kinesiophobia is one of the most... more

Background: Low back pain is a significant health problem condition due to high prevalence among the general population. Emotions and physical factors are believed to play a role in chronic low back pain. Kinesiophobia is one of the most extreme forms of fear of pain due to movement or re-injury. The purpose of this study was to investigate the association between kinesiophobia and pain intensity, disability and quality of life in people with chronic low back pain. Methods: The study included 132 individuals with chronic back pain, with ages between 18 and 65 years old. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia, pain intensity was measured using the Numeric Rating Scale with a cutoff more than 3 for inclusion in the study, disability was assessed using the Roland Morris questionnaire, quality of pain was assessed using the McGill questionnaire, and quality of life was assessed using the Quality of Life questionnaire SF-36. Results: The results are statistically significant, but with weak associations were found between kinesiophobia and pain intensity (r = 0.187), quality of pain (sensory, r = 0.266; affective, r = − 0.174; and total r = 0.275), disability (r = 0.399) and physical quality of life (emotional r = − 0.414). Conclusion: Kinesiophobia is an important outcome to assess in patients with chronic low back pain. The results suggest that correlations between kinesiophobia and disability and quality of life are statistically significant.

There are only a few studies dealing with the detection and clinical impact of calcium pyrophosphate (CPPD) crystals in patients with rheumatoid arthritis (RA) published to date. In particular, data determined by the cytospin technique,... more

There are only a few studies dealing with the detection and clinical impact of calcium pyrophosphate (CPPD) crystals in patients with rheumatoid arthritis (RA) published to date. In particular, data determined by the cytospin technique, which is an effective tool to enhance the crystal detection rate, are lacking. The objectives of this study were to determine the prevalence of CPPD crystals in the synovial fluid (SF) of patients with RA and to investigate whether the detection of CPPD crystals is correlated with demographic, clinical and serological features. We examined 113 consecutive SF samples of patients with RA, obtained from therapeutic arthrocentesis of knee joints. After cytocentrifugation, the sediments were examined by polarized microscopy for the occurrence of CPPD crystals. Demographic, clinical and serological data, acquired from the medical records, were compared between crystal-positive and crystal-negative subjects. CPPD crystals were observed in 20 of the 113 cases, representing 17.7 %. CPPD-positive and CPPD-negative subjects did not differ significantly in sex, duration of disease, Steinbrocker radiologic stage, disease activity score 28, as well as serum rheumatoid factor and anti-CCP positivity. Patients positively tested for CPPD crystals had a significantly higher age than CPPD-negative patients (p \ 0.0001). An age-independent association of long-time treatment with diuretics and CPPD crystal formation was not found. In conclusion, demographic, clinical and serological characteristics of patients with RA were not associated with the occurrence of CPPD crystals. Age was the only significant influencing factor on CPPD crystal formation in patients with RA.

Fractional tubular reabsorption (FTR) of free and acyl carnitine was measured in 15 patients with various selective tubular transport defects and in 19 patients with more generalized tubular dysfunction (Fanconi syndrome). FTR of free... more

Fractional tubular reabsorption (FTR) of free and acyl carnitine was measured in 15 patients with various selective tubular transport defects and in 19 patients with more generalized tubular dysfunction (Fanconi syndrome). FTR of free carnitine was normal in all patients with a selective tubulopathy, FTR of acyl carnitine was normal in most, and plasma carnitine levels were normal without exception. In these patients, there was no evidence for the existence of a defective renal transport mechanism shared by carnitine. In the patients with Fanconi syndrome, mean FTR of free and acyl carnitine was low; their plasma carnitine levels were lowered and correlated with the FTR. In individual patients, FTR of free and acyl carnitine also correlated with the severity of the disease. In the group of Fanconi syndrome patients, FTR of free and acyl carnitine correlated linearly with that of valine. We concluded that the lowering of plasma carnitine in the patients with Fanconi syndrome was caused by excessive loss of carnitine in urine. Its pathophysiological significance remained to be established.

Low body mass index (BMI) is a well-documented risk factor for future fracture. The aim of this study was to quantify this effect and to explore the association of BMI with fracture risk in relation to age, gender and bone mineral density... more

Low body mass index (BMI) is a well-documented risk factor for future fracture. The aim of this study was to quantify this effect and to explore the association of BMI with fracture risk in relation to age, gender and bone mineral density (BMD) from an international perspective using worldwide data. We studied individual participant data from almost 60,000 men and women from 12 prospective population-based cohorts comprising Rotterdam, EVOS/EPOS, CaMos, Rochester, Sheffield, Dubbo, EPIDOS, OFELY, Kuopio, Hiroshima, and two cohorts from Gothenburg, with a total follow-up of over 250,000 person years. The effects of BMI, BMD, age and gender on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson regression model in each cohort separately. The results of the different studies were then merged. Without information on BMD, the age-adjusted risk for any type of fracture increased significantly with lower BMI. Overall, the risk ratio (RR) per unit higher BMI was 0.98 (95% confidence interval [CI], 0.97-0.99) for any fracture, 0.97 (95% CI, 0.96-0.98) for osteoporotic fracture and 0.93 (95% CI, 0.91-0.94) for hip fracture (all p <0.001). The RR per unit change in BMI was very similar in men and women (p >0.30). After adjusting for BMD, these RR became 1 for any fracture or osteoporotic fracture and 0.98 for hip fracture (significant in women). not linearly distributed across values for BMI. Instead, the contribution to fracture risk was much more marked at low values of BMI than at values above the median. This nonlinear relation of risk with BMI was most evident for hip fracture risk. When compared with a BMI of 25 kg/m 2 , a BMI of 20 kg/m 2 was associated with a nearly twofold increase in risk ratio (RR=1.95; 95% CI, 1.71-2.22) for hip fracture. In contrast, a BMI of 30 kg/ m 2 , when compared with a BMI of 25 kg/m 2 , was associated with only a 17% reduction in hip fracture risk (RR=0.83; 95% CI, 0.69-0.99). We conclude that low BMI confers a risk of substantial importance for all fractures that is largely independent of age and sex, but dependent on BMD. The significance of BMI as a risk factor varies according to the level of BMI. Its validation on an international basis permits the use of this risk factor in case-finding strategies.

We aimed to evaluate the effectiveness of balneotherapy in fibromyalgia management. Fifty women with fibromyalgia under pharmacological treatment were randomly assigned to either the balneotherapy (25) or the control (25) group. Four... more

We aimed to evaluate the effectiveness of balneotherapy in fibromyalgia management. Fifty women with fibromyalgia under pharmacological treatment were randomly assigned to either the balneotherapy (25) or the control (25) group. Four patients from the balneotherapy group and one patient from the control group left the study after randomization. The patients in the balneotherapy group (21) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center. The patients in the control group (24) continued to have their medical treatment and routine daily life. An investigator who was blinded to the study arms assessed the patients. All patients were assessed four times; at the beginning of the study, at the end of the 2nd week, the 1st month, and the 3rd month after balneotherapy. Outcome measures of the study were pain intensity, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), patient's global assessment, investigator's global assessment, SF-36 scores, and tender point count. Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity, FIQ, Beck Depression Inventory, patient's global assessment, investigator's global assessment scores, and tender point count as compared to the control group. The superiority of balneotherapy lasted up to the end of the 3rd month, except for the Beck Depression Inventory score and the investigator's global assessment score. Significant improvements were observed in PF, GH, and MH subscales of SF-36 during the study period in the balneotherapy group; however, no such improvement was observed in the control group. Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls. It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia.

Background: Prompt identification and treatment of psoriatic arthritis (PsA) in patients with psoriasis is critical to reducing the risk of joint damage, disability, and comorbidities. Objective: We sought to estimate PsA prevalence in... more

Background: Prompt identification and treatment of psoriatic arthritis (PsA) in patients with psoriasis is critical to reducing the risk of joint damage, disability, and comorbidities. Objective: We sought to estimate PsA prevalence in patients with plaque psoriasis in 34 dermatology centers in 7 European and North American countries. Methods: Consecutive patients were evaluated by dermatologists for plaque psoriasis and subsequently by rheumatologists for PsA. PsA prevalence was estimated primarily based on rheumatologists' assessment of medical history, physical examination, and laboratory tests. Results: Of 949 patients evaluated, 285 (30%) had PsA (95% confidence interval 27-33) based on rheumatologists' assessment. PsA diagnosis changed in 1.2% of patients when diagnostic laboratory tests were added to medical history and physical examination. Of 285 patients given the diagnosis of PsA, 117 (41%) had not been previously given the diagnosis. Limitations: Bias may have been introduced by lack of standardized diagnostic criteria and unbalanced recruitment based on country populations. Conclusions: In this study, almost a third of patients with psoriasis seen in dermatology centers had PsA as determined by rheumatologists. More than a third of patients with PsA had not been previously given the diagnosis. Clinical evaluation alone is often sufficient basis for PsA diagnosis, but laboratory test results may be helpful in some patients.

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with... more

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the ...

Progression of Rheumatoid arthritis (RA) and osteoarthritis (OA) is associated with inflammation and oxidative stress. Previous studies have shown that there was no difference between RA and OA patients regarding the percentages of the... more

Progression of Rheumatoid arthritis (RA) and osteoarthritis (OA) is associated with inflammation and oxidative stress. Previous studies have shown that there was no difference between RA and OA patients regarding the percentages of the different lymphocytes subsets reflecting the abnormalities in T cells and its subsets that may contribute to the pathogenesis of OA as in RA. Therefore, the present study was aimed to analyze that whether disease activity of OA is able to affect a few serological and biochemical parameters in the same way as RA does or differently. The study was done on 36 asymptomatic controls (25 women), 28 patients with OA (20 women), 36 patients with RA (22 women). Patients with OA were screened according to radiological and clinical finding of Kellgren and Lawrence grade and ACR criteria and assessed by VAS and WOMAC score. Patients with RA were selected who were fulfilling 4/5 symptoms of ACR criteria, and their DAS28-CRP, VAS score, and RF positivity were evaluated. Participants of the groups were matched for sex, age, weight, and height (body mass index). The BMI of all three groups was also found to be the same (P > 0.05). The mean level of LDL, Cholesterol, MDA, CRP, and Triglyceride was significantly (P < 0.05 or P < 0.01) higher in both OA and RA as compared to control. The mean level of total lipid, cholesterol, MDA, CRP, and triglyceride was found to be significantly (P < 0.05 or P < 0.01) higher in RA as compared to OA. The pre-treatment CRP level of both groups of patients showed significant and direct relation with total lipid (r = 0.27, P < 0.05) and cholesterol (r = 0.66, P < 0.01). Inverse relation was observed between Uric acid and Creatinine (r = −0.26, P < 0.05) and cholesterol and HDL (r = −0.34, P < 0.01). Our study shows the similar trend in lipid profile and other parameters studied in both patients with OA and patients with RA with more pronounced changes in RA.

Objective. To analyze our fi ve-year experience with a telephone helpline service for patients suffering from chronic rheumatic diseases and provide the patients ' perspective derived from a dedicated survey. Methods. A telephone service... more

Objective. To analyze our fi ve-year experience with a telephone helpline service for patients suffering from chronic rheumatic diseases and provide the patients ' perspective derived from a dedicated survey. Methods. A telephone service (contact center) was set up in the rheumatology unit at Sapienza University of Rome, Italy, in September 2007. It is managed by operators from a medical service society who collect the patients ' calls. Daily reports with medical issues are transmitted to the physicians who are supposed to call back shortly. A year after the institution of the contact center, a questionnaire was administered to a group of patients to address the level of satisfaction. Results. A total of 39,076 calls were registered between September 2007 and August 2012. Each month, an average of 20% of the calls were made by patients referring to our rheumatology unit for the fi rst time and an average of 68.5% patients phoned to request medical consultation. Demographic analysis demonstrated a prevalence of middle-aged female patients. The majority of patients fi lling in the questionnaire declared an intention to use it again in the future. Furthermore, 85.7% of callers reported full satisfaction with respect to the responses received to their requests.

To design and test the performance of a new knee pain screening tool (KNEST), both separately and together with a combination of existing questionnaires, which will be used to assess the general health status of knee pain sufferers in... more

To design and test the performance of a new knee pain screening tool (KNEST), both separately and together with a combination of existing questionnaires, which will be used to assess the general health status of knee pain sufferers in primary care. A postal survey of knee pain and disability was sent to a random sample of 240 individuals aged over 55 yr registered with two general practices in North STAFFORDSHIRE: The survey questionnaire consisted of the KNEST; a pain manikin; the Short Form 36 (SF-36); the Hospital Anxiety and Depression Scale (HADS); demographic questions; and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for those who reported knee pain. A second, identical questionnaire was sent 2 weeks later to a random subsample of responders (n=80) to test repeatability. An 85% baseline response rate was achieved for the first questionnaire. The 12-month prevalence of knee pain identified from baseline responders to the survey was 45%. A response rate of 74% was achieved for the repeatability questionnaire. Each section of the questionnaire was well completed and repeatability was good for nearly all measures (most reliability scores exceeded 0.6). A new core question about knee pain showed good internal reliability, with an agreement score of 91% between baseline and retest assessment, and good construct validity in relation to knee pain identified on the pain manikin (agreement 95%). Good agreement was found between recalled consultation for knee pain in the questionnaire and evidence of consultation for knee pain in general practice records. The KNEST appears to be a reliable and valid composite tool for the study of population needs and outcomes of care for people aged over 55 yr with knee pain.

Systemic lupus erythematosus (SLE) is regarded as a classical autoimmune disease. Despite this belief, no one has been able to induce the disease in naive animals, neither with DNA nor with anti-DNA antibodies. We report on the induction... more

Systemic lupus erythematosus (SLE) is regarded as a classical autoimmune disease. Despite this belief, no one has been able to induce the disease in naive animals, neither with DNA nor with anti-DNA antibodies. We report on the induction of SLE in BALB/c mice following immunization with a pathogenic anti-DNA idiotype (16/6 Id) or its anti-Id. We also report on a specific treatment with T suppressor cells specific for the 16/6 Id. The induction of SLE in naive mice with a pathogenic anti-DNA Id suggests an additional mechanism for the diversity of manifestations in this disease.

Summary Vitamin D deficiency is associated with increased fracture risk. The observational study aimed to investigate vitamin D status and supplementation in ambulatory patients. Only 20% of patients had optimal serum 25-hydroxyvitamin D... more

Summary Vitamin D deficiency is associated with increased fracture risk. The observational study aimed to investigate vitamin D status and supplementation in ambulatory patients. Only 20% of patients had optimal serum 25-hydroxyvitamin D [25(OH)D] levels. Commonly recommended dosages were insufficient to achieve clinically relevant increase of 25(OH)D levels. Higher dosages were safe and effective under clinical practice conditions. Introduction Vitamin D deficiency

The co-occurrence of autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes mellitus (DM) has been reported in individuals and families. In this study, the strength and nature of this association were investigated at... more

The co-occurrence of autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes mellitus (DM) has been reported in individuals and families. In this study, the strength and nature of this association were investigated at the population level in a Swedish case-control cohort. Methods. For this case-control study, 1,419 patients with incident RA diagnosed between 1996 and 2003 were recruited from university, public, and private rheumatology units throughout Sweden; 1,674 matched control subjects were recruited from the Swedish national population registry. Sera from the subjects were tested for the presence of antibodies to cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), and the 620W PTPN22 allele. Information on a history of diabetes was obtained by questionnaire, telephone interview, and/or medical record review. The prevalence of type 1 DM and type 2 DM was compared between patients with incident RA and control subjects and further stratified for the presence of anti-CCP, RF, and the PTPN22 risk allele. Results. Type 1 DM was associated with an increased risk of RA (odds ratio [OR] 4.9, 95% confidence interval [95% CI] 1.8-13.1), and this association was specific for anti-CCP-positive RA (OR 7.3, 95% CI 2.7-20.0), but not anti-CCP-negative RA. Further adjustment for the presence of PTPN22 attenuated the risk of anti-CCP-positive RA in patients with type 1 DM to an OR of 5.3 (95% CI 1.5-18.7). No association between RA and type 2 DM was observed. Conclusion. The association between type 1 DM and RA is specific for a particular RA subset, anti-CCPpositive RA. The risk of developing RA later in life in patients with type 1 DM may be attributed, in part, to the presence of the 620W PTPN22 allele, suggesting that this risk factor may represent a common pathway for the pathogenesis of these 2 diseases. Autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes mellitus (DM) have been observed to co-occur within individuals and families (1-4). Although the exact etiologies of RA and type 1 DM are unknown, they are likely attributable to a combination of genetic susceptibility and interactions between environmental risk factors and genes. Thus far, one established genetic risk factor is shared by RA and type 1 DM: the 620W allele of the protein tyrosine phosphatase N22 gene (PTPN22) (5-9). Other genes involved in the pathogenesis of RA and type 1 DM have

Activation of nuclear factor kappa B (NF-jB) in synovial cells is seen in RA and OA patients. Caffeic acid phenethyl ester (CAPE) is a specific and potent inhibitor of NF-jB. We aimed to determine the in vivo effects of intra-articular... more

Activation of nuclear factor kappa B (NF-jB) in synovial cells is seen in RA and OA patients. Caffeic acid phenethyl ester (CAPE) is a specific and potent inhibitor of NF-jB. We aimed to determine the in vivo effects of intra-articular injections of CAPE on cartilage in an ...

Scleroderma renal crisis (SRC) has been associated with the use of corticosteroids (CS) in retrospective studies. Using an evidence-based approach, we undertook a systematic review of the literature to identify prospective studies in... more

Scleroderma renal crisis (SRC) has been associated with the use of corticosteroids (CS) in retrospective studies. Using an evidence-based approach, we undertook a systematic review of the literature to identify prospective studies in which scleroderma patients were administered CS to ascertain the risk of SRC in those patients. A comprehensive search was conducted using Medline, EM-BASE, the Cochrane Library, and Web of Science. All original prospective clinical studies were eligible if they enrolled SSc patients newly treated with CS. Selected studies were reviewed, and data extraction was systematically performed for the dose and duration of the CS intervention as well as the occurrence of SRC. Twenty-six studies with a total of 500 SSc patients commencing new CS therapy were included in the systematic review. Ten definite cases of SRC, equivalent to a rate of 2%, were identified. In the subset of early diffuse patients, the rate of SRC was 4%. All 10 definite cases of SRC occurred in patients who received medium-to high-dose CS therapy. Seven cases occurred in the setting of stem cell transplant. CS are associated with SRC, although this may be due to confounding by disease severity and/or co-intervention. Great caution must continue to be exerted when initiating such therapy, especially in high doses and in the early diffuse subset of SSc patients.

O n t a r i o , Canada Technetium-99m l a b e l l e d Salbutamol was administered through a tracheostomy t o v e n t i l a t e d r a b b i t s by e i t h e r an MDI (5 puffs,lOOpg/puff) aided with a s p a c e r (MV15 Aemhantber, T r u d e... more

O n t a r i o , Canada Technetium-99m l a b e l l e d Salbutamol was administered through a tracheostomy t o v e n t i l a t e d r a b b i t s by e i t h e r an MDI (5 puffs,lOOpg/puff) aided with a s p a c e r (MV15 Aemhantber, T r u d e l l , Canada) (Groupl, n=7); o r by n e b u l i z a t i o n (10DpgIkg i n 3ml Technetium-9% l a b e l l e d 5% albumin). Nebulization was c a r r i e d o u t f o r 20 min. with a J e t (Hudson, USA) (Group 2, n = l l ) o r U l t r a s o n i c d e v i c e (Siemens, Sweden) using e i t h e r a s t a n d a r d (Group 3, n=6) o r a small (Group 4, n=7) r e s e r v o i r .

To calculate the frequency of clinically important improvement in function over 30 months and identify risk factors in people who have or are at risk of knee OA. Subjects were from MOST, a longitudinal study of persons with or at high... more

To calculate the frequency of clinically important improvement in function over 30 months and identify risk factors in people who have or are at risk of knee OA. Subjects were from MOST, a longitudinal study of persons with or at high risk of knee OA. We defined Minimal Clinically Important Improvement (MCII) with WOMAC physical function using three different methods. Baseline risk factors tested for improvement included age, gender, educational attainment, presence of radiographic knee OA (ROA), the number of comorbidities, Body Mass Index (BMI), knee pain, walking speed, isokinetic knee extensor strength, depressive symptoms, physical activity, and medication usage. We used logistic regression to evaluate the association of baseline risk factors with MCII. Of the 1801 subjects (age= 63, BMI= 31, 63% female), most had mild limitations in baseline function (WOMAC = 19 +/− 11). Regardless how defined, a substantial percentage of subjects (24%-39%) reached MCII at 30 months. Compared to their counterparts, people with MCII were less likely to have ROA and to use medications, and were more likely to have a lower BMI, less knee pain, a faster walking speed, more knee strength, and fewer depressive symptoms. After adjustment, MCII was 40% to 50% less likely in those with ROA, and 1.9 to 2.0 times more likely in those walking 1.0 m/s faster than counterparts. Clinically important improvement is frequent in people with or at high risk of knee OA. The absence of ROA and a faster walking speed appear to be associated with clinically important improvements.

The differentiation of mouse T H 17 cells requires transforming growth factor β and iL-6, whereas human naive T cells can develop into T H 17 cells in the presence of iL-1β and iL-23 alone, transforming growth factor β having an indirect... more

The differentiation of mouse T H 17 cells requires transforming growth factor β and iL-6, whereas human naive T cells can develop into T H 17 cells in the presence of iL-1β and iL-23 alone, transforming growth factor β having an indirect role in their development via the selective inhibition of T H 1 cell expansion. in both mice and humans, a late developmental plasticity of T H 17 cells towards the T H 1 lineage has been shown. Mainly based on mouse gene knockout studies, T H 17 lymphocytes have been found to have a pathogenic role in several autoimmune disorders; however, whether human autoimmune disorders, including rheumatoid arthritis (rA) and psoriasis, are prevalently T H 1-mediated or T H 17-mediated, is still unclear. research suggests that both T H 1 and T H 17 cells are involved in rA pathogenesis, raising the possibility that interventions that target both the iL-23-iL-17 (T H 17) and the iL-12-interferon γ (T H 1) axes might be successful future therapeutic approaches for rA.

Summary: To initiate an investigation into the biochemistry and mechanism of group B [beta]-hemolytic Streptococcus virulence, bacterial cultures grown in suspension were centrifuged, and the bacteria and media were subjected to extensive... more

Summary: To initiate an investigation into the biochemistry and mechanism of group B [beta]-hemolytic Streptococcus virulence, bacterial cultures grown in suspension were centrifuged, and the bacteria and media were subjected to extensive fractionation. Each ...

To find the incidence of juvenile arthritis according to the ILAR and EULAR criteria within defined areas in the Nordic countries, and to study the validity of the ILAR and EULAR criteria from this perspective. A longitudinal,... more

To find the incidence of juvenile arthritis according to the ILAR and EULAR criteria within defined areas in the Nordic countries, and to study the validity of the ILAR and EULAR criteria from this perspective. A longitudinal, prospective, population based study with patients enrolled according to the ILAR and EULAR criteria. Twenty doctors in Iceland, Norway, Sweden, Denmark, and Finland collected data from the incidence cases within their catchment areas over a period of 1.5 years, beginning July 1, 1997. Clinical and serological data from the first year of the disease were collected. In the whole group of 315 patients, the incidence rate was 15 per 100,000 children/year (95% CI 13-17) according to the ILAR criteria, varying from 7 (1-13) in Iceland, 19 (7-31) and 23 (10-36) from 2 different regions in Norway, and 9 (5-12) and 16 (9-23) from 2 different areas in Denmark, to 15 (12-18) in Sweden and 21/100,000/year (15-26) in the Helsinki region in Finland. An early peak in distrib...

Objective Evaluations of the wellbeing of children with Juvenile Idiopathic Arthritis (JIA) typically rely on parents as proxy respondents. An assumption of several studies appears to be that mothers' and fathers' ratings are... more

Objective Evaluations of the wellbeing of children with Juvenile Idiopathic Arthritis (JIA) typically rely on parents as proxy respondents. An assumption of several studies appears to be that mothers' and fathers' ratings are interchangeable, as reports do not always specify which parent completed the assessments nor, in repeated measures, if they were completed by the same parent. The aim of this study was to examine the level of agreement between mothers' and fathers' ratings of their child's quality of life (QoL) and to identify possible predictors of disagreement. Methods

Accepted: 10 December 2011© Springer-Verlag 2012 20-year-old South Indian girl presented to us with generalized body pain and stooping posture, and examination revealed dry, small, and branny scales consistent with ichthyosis vulgaris... more

Accepted: 10 December 2011© Springer-Verlag 2012 20-year-old South Indian girl presented to us with generalized body pain and stooping posture, and examination revealed dry, small, and branny scales consistent with ichthyosis vulgaris (Photograph 1 and 2). ...

Objective. To evaluate the sensitivity and specificity of the Gait, Arms, Legs, and Spine (GALS) examination to screen for signs and symptoms of rheumatoid arthritis (RA) when used by family physicians and nurse practitioners. Methods.... more

Objective. To evaluate the sensitivity and specificity of the Gait, Arms, Legs, and Spine (GALS) examination to screen for signs and symptoms of rheumatoid arthritis (RA) when used by family physicians and nurse practitioners. Methods. Participating health care professionals (2 rheumatologists, 3 family physicians, and 3 nurse practitioners) were trained to perform the GALS examination by viewing an instructional DVD and attending a training workshop. One week after training, the health care professionals performed the GALS examination on 20 individuals with RA and 21 individuals without RA. All participants were recruited through 2 rheumatology practices, and each participant was assessed by 4 health care professionals. The health care professionals were asked to record whether observed signs and symptoms were potentially consistent with a diagnosis of RA. The health care professionals understood the study objective to be their agreement on GALS findings among one another and were unaware that one-half of the participants had RA. Sensitivity and specificity were calculated to determine the ability of the GALS examination to screen for RA using the rheumatologist as the standard for comparison. Results. Sensitivity and specificity values varied from 60-100% and 70-82%, respectively, for the 3 family physicians, and 60-90% and 73-100%, respectively, for the 3 nurse practitioners. Conclusion. Following a very short training period, family physicians and nurse practitioners appeared to be able to use the GALS examination as a screening tool for RA signs and symptoms, particularly for identifying an individual with positive results who will benefit from further investigation or rheumatology referral.

Objective. To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee. Methods. Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee... more

Objective. To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee. Methods. Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee undergoing total joint arthroplasty were examined histopathologically. Morphologic changes were assessed in relation to clinical features that might have contributed to muscle injury. Results. All muscle specimens exhibited atrophy of type 2 fibers. In 32% of the patients, atrophy of type 1 fibers was also noted. Fiber type grouping of type 1 fiber in 15% of the patients and type 2 fiber in 37%, indicating reinnervation, led to the diagnosis of neurogenic muscular atrophy in 32% of the patients; selective atrophy of type 2 fiber in 68% of the specimens was interpreted as possibly resulting from pain-associated disuse. Signs of muscle degeneration and regeneration were found in 65% and 96% of the samples, respectively. Soft tissue changes indicating long-term disease, such as calcification, fibrosis, and lipomatosis, were frequently observed (in 69%, 71%, and 94% of the patients, respectively). Statistical analysis of clinical and morphologic parameters revealed a significant association between degenerative muscle changes and the presence of a varus deviation of the leg axis. Conclusion. Patients with OA of the knee frequently exhibit muscle changes, with probable multifactorial etiology. Selective atrophy of type 2 fibers might

A large quantity of research concerning issues of patient compliance with medications has been produced in recent years. The assumption in much of this work is that patients have little option but to comply with the advice and... more

A large quantity of research concerning issues of patient compliance with medications has been produced in recent years. The assumption in much of this work is that patients have little option but to comply with the advice and instructions they receive. Studies have shown, however, that between one third and one half of all patients are non-compliant, but different authors cite different reasons for this high level of non-compliance. In this paper, the concept of compliance is questioned. It is shown to be largely irrelevant to patients who carry out a 'cost-benefit' analysis of each treatment, weighing up the costs/risks of each treatment against the benefits as they perceive them. Their perceptions and the personal and social circumstances within which they live are shown to be crucial to their decision-making. Thus an apparently irrational act of non-compliance (from the doctor's point of view) may be a very rational action when seen from the patient's point of view. The solution to the waste of resources inherent in non-compliance lies not in attempting to increase patient compliance per se, but in the development of more open, co-operative doctor-patient relationships.

To evaluate the short-and long-term efficacy of exercise therapy in a warm, waist-high pool in women with fibromyalgia. Methods. Thirty-four women (mean ؎ SD tender points 17 ؎ 1) were randomly assigned to either an exercise group (n ‫؍‬... more

To evaluate the short-and long-term efficacy of exercise therapy in a warm, waist-high pool in women with fibromyalgia. Methods. Thirty-four women (mean ؎ SD tender points 17 ؎ 1) were randomly assigned to either an exercise group (n ‫؍‬ 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n ‫؍‬ 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60°/second and 210°/second, and in the shoulder abductors and adductors in concentric contractions. Health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months. Results. The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de-training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P ‫؍‬ 0.007) and pain was reduced by 29% (P ‫؍‬ 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de-training. However, there were no changes in the control group during the entire period. Conclusion. The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.

ObjectiveTo test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery.To test the reproducibility of the finding that early intensive care for whiplash injuries is... more

ObjectiveTo test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery.To test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery.MethodsWe analyzed data from a cohort study of 1,693 Saskatchewan adults who sustained whiplash injuries between July 1, 1994 and December 31, 1994. We investigated 8 initial patterns of care that integrated type of provider (general practitioners, chiropractors, and specialists) and number of visits (low versus high utilization). Cox models were used to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.We analyzed data from a cohort study of 1,693 Saskatchewan adults who sustained whiplash injuries between July 1, 1994 and December 31, 1994. We investigated 8 initial patterns of care that integrated type of provider (general practitioners, chiropractors, and specialists) and number of visits (low versus high utilization). Cox models were used to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders.ResultsPatients in the low-utilization general practitioner group and those in the general medical group had the fastest recovery even after controlling for important prognostic factors. Compared with the low-utilization general practitioner group, the 1-year rate of recovery in the high-utilization chiropractic group was 25% slower (adjusted hazard rate ratio [HRR] 0.75, 95% confidence interval [95% CI] 0.54–1.04), in the low-utilization general practitioner plus chiropractic group the rate was 26% slower (HRR 0.74, 95% CI 0.60–0.93), and in the high-utilization general practitioner plus chiropractic combined group the rate was 36% slower (HRR 0.64, 95% CI 0.50–0.83).Patients in the low-utilization general practitioner group and those in the general medical group had the fastest recovery even after controlling for important prognostic factors. Compared with the low-utilization general practitioner group, the 1-year rate of recovery in the high-utilization chiropractic group was 25% slower (adjusted hazard rate ratio [HRR] 0.75, 95% confidence interval [95% CI] 0.54–1.04), in the low-utilization general practitioner plus chiropractic group the rate was 26% slower (HRR 0.74, 95% CI 0.60–0.93), and in the high-utilization general practitioner plus chiropractic combined group the rate was 36% slower (HRR 0.64, 95% CI 0.50–0.83).ConclusionThe observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.

This study aimed to identify subgroups with distinct trajectories of functional (HAQ) progression over 10 years following diagnosis of RA and identify baseline characteristics associated with the trajectories and their prognostic value... more

This study aimed to identify subgroups with distinct trajectories of functional (HAQ) progression over 10 years following diagnosis of RA and identify baseline characteristics associated with the trajectories and their prognostic value for mortality. Between 1986 and 1998, 1460 patients with RA symptoms <2 years and prior to disease-modifying treatment (DMARDs) were recruited to an inception cohort (Early RA Study). Standard clinical, functional and laboratory assessments were performed at presentation and annually. Deaths were tracked by the National Health Service Central Register. Growth mixture modelling was used to identify distinct trajectories of HAQ score progression and survival analysis employed to compare all-cause mortality across the trajectory classes. Four HAQ score progression classes were identified: moderate increasing (46%), low stable (6%), moderate stable (28%) and high stable (20%). Only the moderate-increasing class exhibited an accelerated decline in funct...

The eYcacy of balneotherapy in Wbromyalgia syndrome (FS) has been well demonstrated, while controlled studies using mud packs are lacking. We performed a randomized clinical trial to evaluate the eVects and the tolerability of mud-bath... more

The eYcacy of balneotherapy in Wbromyalgia syndrome (FS) has been well demonstrated, while controlled studies using mud packs are lacking. We performed a randomized clinical trial to evaluate the eVects and the tolerability of mud-bath treatment in FS patients, who are poor responders to pharmacological therapy. Eighty patients with primary FS, according to ACR criteria, were randomly allocated to two groups: 40 were submitted to a cycle of 12 mud packs and thermal baths, and 40 were considered as controls. At baseline, after thermal treatment and after 16 weeks, patients were evaluated by FIQ, tender points count, VAS for "minor" symptoms, AIMS1 and HAQ. Control patients were assessed at the same time periods. A signiWcant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed. Mud packs were well tolerated and no drop-outs were recorded. Our results suggest the eYcacy and the tolerability of mud-bath treatment in primary FS.

In this case-control study, our first aim was to evaluate the bone mineral density (BMD) in women with systemic sclerosis (SSc) and its correlates. Secondarily, we aimed to evaluate 25-hydroxyvitamin D3 status and its relationships with... more

In this case-control study, our first aim was to evaluate the bone mineral density (BMD) in women with systemic sclerosis (SSc) and its correlates. Secondarily, we aimed to evaluate 25-hydroxyvitamin D3 status and its relationships with disease parameters and BMD. Sixty patients with SSc and 60 age-and gender-matched controls were included in the absence of confounding factors that interfere with bone metabolism. Body mass index, menopausal status, familial history of osteoporosis and/or fractures; personal fracture history; exercise activity and laboratory parameters of bone metabolism were assessed in patients and controls. BMD was measured by using a dualenergy X-ray absorptiometry in lumbar spine (L1-L4) and femoral neck. The 25-hydroxyvitamin D3 was measured in a subgroup of 30 patients and in a subgroup of 30 matched controls. Systemic manifestations of SSc, biological inflammatory parameters, functional disability (scleroderma health assessment questionnaire (S-HAQ)) and immunological status of disease were collected in patients' group. The mean age of patients was 49.44 ± 13.07 years versus 49.55 ± 12.11 in controls. The mean disease duration was 9.63 ± 5.9 years. SSc patients had a significantly earlier age and longer duration of menopause than controls (P = 0.003). Phosphocalcic metabolism parameters were within normal ranges in both groups. BMD was significantly lower in SSc patients than in controls both in lumbar spine (-2.97 ± 0.25 in patients vs. 0.46 ± 0.11 in controls) and femoral neck (-1.93 ± 0.32 in patients vs. -0.81 ± 0.69 in controls) (P \ 0.01). Thirty-six (60%) patients versus 15 (25%) controls had osteoporosis and 19 (31.7%) patients versus 13 (21.7%) controls had osteopenia (P \ 0.01). In correlation analysis and in multiple regression models, there were significant correlations between BMD and longer duration of SSc, severe joint involvement (severe joint pain and erosive arthropathy), malabsorption syndrome and the positivity of anti-DNA topoisomerase I antibodies. Also, we found very low levels of vitamin D (10.88 ± 2.68 ng/ml) comparing to controls (57.41 ± 4.18 ng/ml) (P = 0.001). Vitamin D levels were correlated with the severity of joint pain, with immunological status and with BMD in lumbar spine and femoral neck (P \ 0.01). In our sample, we state the importance of decreased BMD in Moroccan women with SSc with a high frequency of osteoporosis comparing to healthy controls. Bone loss seems to be associated with prolonged disease duration, severe joint involvement, malabsorption syndrome and immunological status. Also, SSc patients had lower levels of 25-hydroxyvitamin D3 than controls. Larger studies are needed to confirm those findings.

The importance of exercise and regular physiotherapy in patients with ankylosing spondylitis (AS) under treatment with tumor necrosis factor alpha inhibitors (TNFa inhibitors) was reported in some studies, but the literature on this topic... more

The importance of exercise and regular physiotherapy in patients with ankylosing spondylitis (AS) under treatment with tumor necrosis factor alpha inhibitors (TNFa inhibitors) was reported in some studies, but the literature on this topic is still scarce. The aim of this study was to assess the effects of home-based exercise therapy on functional capacity, disease activity, spinal mobility, quality of life, emotional state and fatigue in patients with AS receiving TNFa inhibitors. Forty-two AS patients were trained on the disease, and home-based exercise program was demonstrated to all the patients. At baseline and at the end of 10 week, we evaluated Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Multidimensional Assessment of Fatigue Scale, Beck Depression Inventory and Short-Form 36. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) were compared with those exercising less than five times a week (control group). At baseline, exercise and control group had similar demographic features. After 10 weeks, all outcome parameters showed statistically significant improvements in exercise group. There were significant differences in all the parameters except social functioning subscale of Short-Form 36 between groups in favor of exercise group at 10th week (P \ 0.05). Home-based exercise program is an effective therapy in increasing functional capacity and joint mobility, decreasing disease activity, improving emotional state, fatigue and quality of life for AS patient receiving TNFa inhibitors. We need to find out new ways to provide continuity of AS patients with it.

WHO declared SARS-CoV-2 as a pandemic disease on 11 th March 2020. Due to global lockdown and restricted social movements, there is a rising curve in the morbidity of health of non-SARS-CoV-2 orthopaedic rheumatology patients and an... more

WHO declared SARS-CoV-2 as a pandemic disease on 11 th March 2020. Due to global lockdown and restricted social movements, there is a rising curve in the morbidity of health of non-SARS-CoV-2 orthopaedic rheumatology patients and an impairment in the functional quality of life necessitating a pandemic response protocol into action in all fields of patient care. The development of ideal strategies and recommendations for the management of orthopaedic rheumatologically predisposed population and principles to be followed in their practice is the need of the hour. We hereby give a comprehensive list of strategies that can be followed in orthopaedic rheumatology practice by encompassing the recommendations given by the European League Against Rheumatism (EULAR), The American College of Rheumatologists (ACR), and Indian Association of Orthopaedic Rheumatology-Indian Orthopaedic Association (IORA-IOA). SARS-CoV-2 pandemic has put enormous pressure on patients with Rheumatic Diseases (RD) due to their innate weakness and shared treatment protocols in management. Though RD needs a multidisciplinary approach, which remains a challenge in this pandemic scenario, these strategic recommendations would aid in their optimal care amidst the adversity of SARS-CoV-2.

This study aimed at understanding the perception and perspectives of rheumatology trainees about specialist training in India. Rheumatology trainees (Doctorate of Medicine, Diplomate of National Board) in Indian universities (2010... more

This study aimed at understanding the perception and perspectives of rheumatology trainees about specialist training in India. Rheumatology trainees (Doctorate of Medicine, Diplomate of National Board) in Indian universities (2010 onwards) were contacted to complete a validated e-survey consisting of 41 questions to evaluate the current rheumatology training in India. Of 53 respondents (M:F 3.4:1, mean age 37 years ± 12.7), 81.1% trained at government hospitals, and 15.1% trained at private hospitals. During training period, 37.5% respondents were exposed to 6-7 h of didactics/week. They treated nearly 175 patients (175 ± 35.4) per week and reported a reasonable level of independence in management of patients with common rheumatic diseases (RDs) during their training (7.5 ± 0.7 SD). However, nearly one-third of the trainees were not exposed to basic immunology and laboratory techniques. Similarly, placement in the radiology department was not a part of the curriculum for nearly half of the trainees, 80% were not confident to manage paediatric RDs and soft tissue rheumatism. Almost 60% did not feel comfortable in addressing ancillary care including patient counselling as they had not received formal training. Among the participants, 59% were not satisfied by the current system of assessment, 86.8% suggested for multiple time point-based assessment systems and 45.3% preferred objective and subjective assessment in final examinations. Rheumatology training in India offers notable exposure to patients and independence in managing cases. However, there is an unmet need for improvement in training in the field of laboratory, radiology and ancillary care, and to overhaul assessment system by including objective evaluation.

In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature... more

In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature coupled with technological developments in US imaging has necessitated an update of these guidelines. To update the existing MSUS guidelines in rheumatology as well as to extend their scope to other anatomic structures relevant for rheumatology. The project consisted of the following steps: (1) a systematic literature review of MSUS evaluable structures; (2) a Delphi survey among rheumatologist and radiologist experts in MSUS to select MS and non-MS anatomic structures evaluable by US that are relevant to rheumatology, to select abnormalities evaluable by US and to prioritise these pathologies for rheumatology and (3) a nominal group technique to achieve consensus on the US scanning procedures and to produce an electronic illustrated manual (ie, App o...

Five per cent of patients with primary Sjogren's syndrome (pSS) develop malignant non-Hodgkin's lymphoma (NHL), usually of the mucosa-associated lymphoid tissue (MALT) and most frequently located in the major salivary glands. Rituximab... more

Five per cent of patients with primary Sjogren's syndrome (pSS) develop malignant non-Hodgkin's lymphoma (NHL), usually of the mucosa-associated lymphoid tissue (MALT) and most frequently located in the major salivary glands. Rituximab (RTX), a chimeric monoclonal antibody against the CD20 molecule expressed on the surface of mature B cells that has been approved for the treatment of NHL, has been used to treat pSS-associated lymphoma. We have described two cases: one with MALT lymphoma in the parotid glands and the other with a rare thymus lymphoma accompanied by the rare complication of a bullous pneumopathy. Both were treated with RTX at haematological doses, which was unsuccessful in the patient with a salivary lymphoma; in the case of the patient with a thymus lymphoma, the mediastinum mass disappeared and did not relapse. Both patients experienced an improvement in the subjective symptoms of dryness, and their Schirmer's test and scialoscintigraphy results stabilised. The pulmonary bullae remained unchanged.

To study the combined effect of both genetic and environmental factors in the age of rheumatoid arthritis onset. Patients (n = 507). Shared epitope characterization was performed using Lifecodes HLA-SSO. Genotyping of protein tyrosine... more

To study the combined effect of both genetic and environmental factors in the age of rheumatoid arthritis onset. Patients (n = 507). Shared epitope characterization was performed using Lifecodes HLA-SSO. Genotyping of protein tyrosine phosphatase non-receptor 22 (PTPN22) rs2476601 and signal transducers and activators of transcription 4 (STAT4) rs7574865 polymorphism was performed using fast real-time PCR System. Shared epitope, antibodies directed against cyclic citrulinated peptide (anti-CCP) antibodies and a higher level of education were associated with a younger age at disease onset (P = 0.033, P = 0.004 and P \ 0.0001, respectively). Neither carriers of the minor allele of PTPN22 rs2476601 nor STAT4 rs7574 polymorphisms showed a significant association with a younger age at disease onset (P = 0.355, P = 0.065, respectively). We found an additive effect of the three genetic markers in the age at onset: subjects with three markers were associated with a disease onset 9.56, 8.61, and 6.41 years before than those with none, one, or two genetic markers (P = 0.004, P = 0.006 and P = 0.043, respectively). We also described the additive effect of shared epitope, anti-CCP antibodies, educational level, PTPN22, and STAT4 polymorphisms in age at onset. Patients with two, three, four, or five variables were associated with a significant younger age of disease onset (4.72 [0.05-9.38] years (P = 0.048), 9.56 [4.72-14.40] years (P \ 0.0001), 12.74 [6.84-18.64] years (P \ 0.0001), and 20.87 [10.40-37.17] years (P \ 0.0001)). Risk factors for the development of rheumatoid arthritis are also associated, with an additive effect, with a younger age at disease onset.