Common Rheumatologic Disease Research Articles

Current Perspectives on Ophthalmic Manifestations of Childhood Rheumatic Diseases

Inflammatory eye diseases are an important manifestation of many pediatric rheumatologic conditions. Early screening and diagnosis are imperative as these illnesses can not only result in significant visual morbidity but are also an indicator of systemic inflammation. Time to presentation of ocular inflammation varies significantly and can range from many years prior to the onset of systemic symptoms to well after the diagnosis of the rheumatologic disorder. Due to this variability in presentation, careful monitoring by an ophthalmologist is vital to preventing ocular complications and preserving vision. Both local and systemic immunosuppressive medications have been effective in the management of ocular disease. In this review, we will focus on the known ophthalmologic manifestations of common pediatric rheumatologic diseases and discuss recent advances in therapeutic considerations for these conditions.

Evaluation of Tuberculin Skin Test Response and Interfering Factors in Patients with Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disease in pediatric age group. Mycobacterium tuberculosis infection (TB) is an important cause of mortality and morbidity in patients with inflammatory rheumatologic disease. The objective of this study is to determine to what extent active disease and use of drugs in JIA affects response to PPD skin test and thus to investigate the significance of PPD skin test in the diagnosis of latent TB. 77 children diagnosed with JIA according to ILAR diagnostic criteria and routinely followed by our rheumatology clinic were included in the patient group. Patients were grouped according to subtypes of disease, activity status and drugs they used. Control group was formed from 58 healthy children. PPD skin test was applied to each subject and the number of BCG scars of all cases was recorded. We found no significant difference in PPD induration diameters between JIA and control group (p > 0.05). The number of BCG scar is similar in both groups. In the control group, age and number of BCG scars and PPD skin test diameter are positively correlated. But there is no such significant relationship in patients with JIA (p > 0.05). PPD induration diameter of patients with active disease is significantly shorter than patients in remission (p > 0.05). PPD induration diameter of patients treated with steroid and disease modifying anti-rheumatic drug (DMARD) and underwent remission were not significantly different from the control group. When compared with patients using other drugs, patients on remission using steroid and DMARD have shorter PPD induration diameter. Activity of disease and drugs used (steroid, DMARD) affects PPD response. In the diagnosis of latent TB, normal range of PPD diameter in healthy child changes in JIA patient with active disease. That the PPD diameter is shorter than normal range could indicate underlying TB infection. This fact should be considered in the follow-up of the patients with JIA.

Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi‐ethnic, urban Asian population in Singapore

To describe the spectrum of diseases seen in an outpatient setting in the Singapore General Hospital, the largest tertiary referral centre in Singapore. In this cross-sectional study, medical records of patients scheduled for an appointment at the rheumatology specialist outpatient clinics over a 4-month period (10 August 2010-31 December 2010) were reviewed. Primary diagnoses documented by the attending physician at the latest visit were recorded. Among 4180 patients (29.5% male; mean [SD] age: 53.5 [15.1] years; 77.0% Chinese, 8.0% Malay, 8.8% Indian and 6.2% others), the spectrum of diseases seen was as follows [disease - definite n (%), probable n (%)]: Arthritis: rheumatoid arthritis - 958 (22.9%), 68 (1.6%); osteoarthritis - 452 (10.8%), 39 (0.9%); crystal arthritis - 417 (10.0%), 18 (0.4%); spondyloarthritis - 227 (5.4%), 61 (1.5%); psoriatic arthritis - 158 (3.8%), 9 (0.2%); other inflammatory arthritis - 153 (3.7%), 94 (2.2%); Connective tissues diseases: systemic lupus erythematosus - 412 (9.9%), 26 (0.6%); vasculitis - 105 (2.5%), 22 (0.5%); Sjögren's syndrome - 81 (1.9%), 32 (0.8%); overlap syndromes - 73 (1.8%); scleroderma - 50 (1.2%), 4 (0.1%); undifferentiated connective tissue diseases - 45 (1.1%), 106 (2.5%); myositis - 41 (1.0%), 12 (0.3%); antiphospholipid syndrome - 22 (0.5%), 7 (0.2%); polymyalgia rheumatica - 16 (0.4%); Others: soft tissue rheumatism - 155 (3.7%); osteoporosis - 61 (1.5%); other non-rheumatologic conditions - 189 (4.5%); other rheumatologic conditions - 67 (1.6%). Rheumatoid arthritis, osteoarthritis and crystal arthritis were the three most common rheumatological diseases seen in a tertiary referral centre serving a multi-ethnic urban Asian population in Singapore.

Comparison of healthy and normative aging reveals a metabolic component in hand oa and oa biochemical marker profiles

Comparison of healthy and normative aging reveals a metabolic component in hand oa and oa biochemical marker profiles

Can inflammatory markers predict response to methotrexate in JIA? Results from the CHARM study

Background Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatological disease with an incidence of 1 in 1000. Methotrexate is the primary DMARD given to patients with JIA but approximately 30% of children fail to respond. The SPARKS CHARM study enrolls patients with JIA about to start MTX with the aim to discover predictors of response to MTX, to distinguish patients who will respond well to MTX from non-responders.

Management of rheumatologic disorders during pregnancy

Rheumatologic disorders disproportionally affect women during their childbearing years. In addition, rheumatologic disorders behave differently and unpredictably during pregnancy. This article will discuss the management of the more common rheumatologic diseases during pregnancy. An approach to the pregnant patient with an underlying rheumatic disorder will be discussed as well as a review of medications and their safety for use during pregnancy and lactation.

NEUROLOGIC COMPLICATIONS OF SJÖGREN SYNDROME AND RHEUMATOID ARTHRITIS

ABSTRACTSjogren syndrome and rheumatoid arthritis are common autoimmune rheumatologic diseases that can be associated with neurologic complications, which can sometimes be the presenting manifestation of the systemic disease. Sjogren syndrome can be associated with prominent peripheral nervous syste

Diffusion-Weighted and Diffusion Tensor Imaging in Fibromyalgia Patients: A Prospective Study of Whole Brain Diffusivity, Apparent Diffusion Coefficient, and Fraction Anisotropy in Different Regions of the Brain and Correlation With Symptom Severity

Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain and tenderness that afflicts 2%–4% of the population in industrialized countries (1). It is the second most common rheumatologic disease after osteoarthritis. Although the underlying pathology, mediating the allodynia and hyperalgesia of FM remains poorly understood, a dysfunction in central neurobiologic structures is suspected. In addition to pain, FM patients often present with other syndromes such as irritable bowel syndrome, idiopathic low back pain, and temporomandibular disease syndrome, suggesting a common underlying pathology across these conditions (2).

Lymphocytic interstitial pneumonitis (LIP) in Sjögren’s syndrome: a case report and a review of the literature

Sjõgren's disease is one of the most common rheumatological diseases and can present with a variety of extra-glandular manifestations. Lymphocytic Interstitial Pneumonitis (LIP) is the most common lung pathology in these patients. It is important to know and recognize this condition because it is potentially treatable. It is also frequently misdiagnosed and treated as infectious pneumonia multiple times before the correct diagnosis is made. It is a benign lymphoproliferative disorder characterized histologically by interstitial infiltration with polyclonal lymphocytes and plasma cells. High-resolution CT scan of the lungs shows extensive areas of ground-glass attenuation and interlobular septal thickening with scattered thin-walled cysts. An open-lung biopsy is the best method of diagnosing this condition, as less invasive techniques do not provide an adequate tissue specimen. LIP occurs in a wide variety of settings such as autoimmune disease, HIV disease, and as an adverse reaction to some medications; it is, therefore, considered to be a nonspecific response to many stimuli. The treatment usually consists of corticosteroids and other immunosuppressants, though there have been no controlled trials to date. Establishment of a registry may help better evaluate and treat this disease. We present the case of a patient who was diagnosed with LIP secondary to Sjögren's syndrome and also review the literature available.

Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee

Osteoarthritis (OA) of the knee is a very common rheumatological disease, and there are various treatment modalities for it. The aim of this study was to investigate the effects of home-based exercise and walking programs in the treatment of OA. A total of 90 patients with knee osteoarthritis were included. Their ages ranged between 48 and 71 years. The patients were separated into three groups. None of them had practiced a daily simple exercise program during the previous year. Group 1 ( n=30) was given a home-based exercise program. Group 2 ( n=30) had regular a walking program three times per week, starting with 10-min duration. Group 3 ( n=30) was accepted as the control group. Patients were assessed according to pain, functional capacity, and quality of life parameters. Pain was evaluated by the Western Ontario McMaster osteoarthritis index (WOMAC) of pain score and visual analogue scale (VAS). Functional capacity was measured by WOMAC physical function index. Quality of life was assessed by the Nottingham Health Profile questionnaire (NHP). All groups continued the program for 3 months. At the end of the therapy, the patients were called and 81 were accepted to come to the hospital. Although WOMAC pain and physical functional scores and VAS scores were statistically lower in both groups than in the control group ( P<0.001), the difference between groups 1 and 2 was not statistically significant ( P>0.05). But the result of the NHP showed a statistically significant improvement in the walking group when compared to the home-based exercise and control groups ( P<0.001). As a result, we conclude that a simple home-based exercise therapy and a regular walking program are effective in treating the symptoms of OA.

Genetic studies of common rheumatological diseases

Genetic studies of common rheumatological diseases

Immunologic Mechanisms in Common Rheumatologic Diseases

Rheumatoid arthritis and seronegative spondyloarthropathies are rheumatologic diseases that likely are caused by inflammatory reactions occurring in genetically predisposed individuals mounting an immune response to the antigen. Understanding the immunopathology of these diseases provides insight into their etiology, pathogenesis, and a rationale for therapies targeting immune component interactions. Although the antigen in rheumatoid arthritis is not known, several bacterial antigens have been associated with seronegative spondyloarthropathies. These antigens result in an interaction between the human leukocyte antigen-B27 restricted CD8 positive T lymphocytes and the antigen presenting cell, producing an inflammatory response. Rheumatoid factors are autoantibodies directed against the fragment crystallizable portion of the immunoglobulin G. Rheumatoid factor immunoglobulin G immune complexes contribute to the inflammatory events in the rheumatoid joint, and may play an important role in antigen presentation. A novel antigen capture enzyme linked immunosorbent assay was developed that mimicked B cell surface expressed rheumatoid factor. Conversely, a direct binding enzyme linked immunosorbent assay mimicked secreted rheumatoid factor. Comparison of rheumatoid binding enzyme linked immunosorbent assays showed that the physical state of rheumatoid factor can affect binding characteristics. The state of glycosylation of immunoglobulin G may contribute to its antigenic structure. These physical characteristics may be important in rheumatoid factor's pathogenic role in rheumatoid arthritis.

New Perspectives on Osteoarthritis

Osteoarthritis (OA) is the most common rheumatologic disease, afflicting tens of millions of U.S. citizens. It is not an inevitable consequence of aging; rather, it is a degenerative process acquired because of metabolic, mechanical, genetic, and other influences. It is characterized by progressive loss of cartilage and bony overgrowth. Because cartilage is not innervated, the pain of OA arises from secondary effects, such as joint capsule distention, stretching of periosteal nerve endings, and, possibly, synovial inflammation. Psychologic factors, including stress and depression, may influence the perception of pain by OA patients. The risk of OA apparently is not increased by normal joint use, but persons who participate in competitive sports or who play with abnormal or injured joints are at increased risk. Obesity increases OA risk, and weight loss has been found to decrease it. Some forms of premature OA appear to be inherited. The objective diagnosis of OA is made on the basis of radiography. However, many individuals with radiographic evidence of OA are asymptomatic in the affected joint. It is essential to ensure that pain in the affected joint is attributable to OA and not another cause. The management of OA should include physical medicine measures such as heat or cold therapy and often neglected environmental measures, such as reducing chair height and using shoe orthotics. Therapeutic exercise is beneficial for many patients and includes an initial warm-up with range of motion, muscle strengthening, and aerobic activity (such as swimming). A major question in the pharmacologic management of OA is whether nonsteroidal anti-inflammatory drugs (NSAIDs) are superior to analgesics in terms of symptomatic relief; studies indicate that they are not. The question is relevant because of the adverse effects of NSAID use, particularly in the elderly population.

Common Rheumatologic Diseases in Elderly Patients

To review common rheumatologic disorders that affect elderly patients and emphasize the unique diagnostic and therapeutic challenges inherent in the management of rheumatologic diseases in this age-group. We summarize our approach to treatment and management of specific rheumatologic problems in geriatric patients and discuss pertinent studies from the literature. Among the spectrum of rheumatologic disorders frequently encountered in the elderly population are polymyalgia rheumatica, fibromyalgia, giant cell arteritis, crystalline arthropathies (gout and pseudogout), and degenerative joint disease. The initial manifestations of these rheumatologic diseases in elderly patients may differ from the typical findings in younger patients. Geriatric patients may have nonspecific complaints, a decline in physical function, or even confusion. Because of physiologic changes associated with aging and a decrease in functional reserves, elderly patients are susceptible to adverse effects of pharmacologic therapy (including nonsteroidal anti-inflammatory medications, corticosteroids, narcotic analgesics, allopurinol, and colchicine). Clinicians should be alert for such problems as hepatotoxicity and occult gastrointestinal blood loss. Comorbid conditions such as cardiovascular disease and cognitive impairment may complicate management strategies and may limit the goals of both surgical intervention and rehabilitation programs in elderly patients. Rheumatologic disorders in geriatric patients pose special challenges to primary-care physicians. In the selection of optimal pharmacologic and nonpharmacologic therapeutic modalities, clinicians should focus on maintaining or improving the patient's quality of life and level of independent function.

Evaluation of the Elderly Driver with Arthritis

Examination focusing upon the two clusters of function necessary for turning and braking is important as is nonthreatening questioning about driving. The effects of drugs used for arthritis on the CNS and a heightened emphasis upon the psychosocial implications of immobility complicate the management of older drivers with arthritis. Assuming optimal treatment of the arthritis, the two most important management tools are actually power-steering and automatic transmission. Less expensive adaptive available thorough rehabilitation services (e.g., auxiliary mirrors) are also of value.

Nutritional Aspects of Juvenile Rheumatoid Arthritis

This article focuses on the factors contributing to increased risk for malnutrition in juvenile rheumatoid arthritis patients, the methods of identifying and treating nutritional problems (including protein-energy malnutrition and obesity), and outlines national statistics demonstrating that the pediatric rheumatic patient population is nutritionally underserved. The dietitian, in conjunction with the interdisciplinary treatment team, should be involved in the initial evaluation of all juvenile rheumatoid arthritis patients to facilitate early detection of nutritional problems and initiate nutritional intervention strategies.

Diagnosis-related group regulations. Implications for the practicing rheumatologist.

Data from our university hospital on the 2 most common rheumatologic diseases that require hospitalization indicate that total charges for patients admitted with rheumatoid arthritis or systemic lupus erythematosus break down as follows: room, board, and nursing, 55%; tests/procedures, 30%; drugs, 5%; physical and occupational therapy, 5%; and miscellaneous, 5%. Thus, shortening the length of stay would be the most effective mechanism to reduce total charges. We also found marked heterogeneity in the single diagnosis-related group containing rheumatoid arthritis and systemic lupus erythematosus inpatients under 70 years old who had no comorbid conditions. Planners should be sensitive to this as prospective reimbursement is extended beyond Medicare patients.