Polyarthritis Research Articles

An additional X chromosome.

A 35-year-old man presented with symmetrical inflammatory polyarthritis of the small and large joints and associated early-morning stiffness. He was assessed as having features in keeping with Klinefelter’s syndrome. It is evident from the literature that there is a relationship between Klinefelter’s syndrome and developing rheumatic conditions.

Poliartrite em cães - 27 casos (2007-2013)

O objetivo deste estudo foi identificar cães com poliartrite e obter informações a respeito da idade, sexo, raça, peso corporal, queixa principal, alterações no exame físico, do líquido sinovial e resposta à terapia instituída. Os cães sem raça definida e acima de seis anos de idade foram os mais acometidos e o principal sinal clínico observado foi dificuldade de locomoção (71,5%), seguido de dor articular (52,3%) e claudicação (33,3%). Febre e inapetência foram observadas em cinco (18,5%) e quatro cães (14,8%), respectivamente. As principais alterações hematológicas encontradas foram anemia não regenerativa (29,6%), leucocitose (26%) e trombocitopenia (18,5%). Os resultados da bioquímica sérica foram considerados normais em sete de 27 cães (26%) e as principais alterações foram hiperproteinemia (55,5%) e hipoalbuminemia (37%). A inflamação sinovial foi considerada acentuada em 17 cães (77,5%), sendo os neutrófilos predominantes em 52,4% dos casos (n=14). O tratamento foi realizado em 18 cães com doses imunossupressoras de corticosteroides, sendo efetivo em 89% dos casos

Atypical Manifestation of Whipple’s Disease

Introduction: Whipple’s disease is a multi-system, chronic infectious disease with a classic presentation of recurrent arthralgias/arthritis, weight loss, and diarrhea. Diagnosis can be challenging in patients with atypical presentations. We share our experience of pulmonary manifestations as the presenting symptoms. A 59-year-old African American male with a history of seronegative inflammatory polyarthritis, chronic smoking, and remote alcohol dependence presented with nonproductive cough, chest pain, and shortness of breath for 3 weeks. The review of system revealed intermittent non-bloody diarrhea, leg swelling, abdominal pain at right upper and right lower abdomen, and a 10-pound weight loss. Exam was pertinent for no fever, mild tachycardia of 110 beats/minute, and no desaturation. He had bibasilar crackles and wheezing, abdominal tenderness without signs of peritoneal irritation, bilateral pretibial pitting edema, and bilateral inguinal lymphadenopathy. Labs showed new microcytic anemia (hemoglobin 10 g/dL, MCV 78 fl, low iron 28 mcg/dL, normal TIBC 283 mcg/dL, low iron saturation 10%, and ferritin 85 ng/mL) normal liver enzymes except mildly elevated alkaline phosphatase (174 U/L), and hypoalbuminemia (2.9 g/dL). Imaging studies showed a small pleural effusion, granuloma in the right upper lung field, diffuse anasarca, and generalized lymphadenopathy. Other investigations for a rheumatologic condition, chronic infection, and malignancy were all negative. He underwent upper endoscopy for the unexplained microcytic anemia and weight loss, which revealed marked chronic active gastritis with focal intestinal metaplasia in the antrum and prepyloric region, and a macroscopically normal duodenum. Ileo-colonoscopy showed only 2 3-5-mm tubular adenoma without dysplasia in the transverse and descending colon. Duodenal biopsies revealed focal collections of histiocytes within the superficial lamina propria with widening and flattening of the villi. Periodic acid-Schiff (PAS) was positive and immunohistochemical stains for Trepheryma whipplei were strongly positive. His pulmonary symptoms, diarrhea, weight loss, joint pain, and hypoalbuminemia were resolved at 3 weeks after initiation of antibiotics. Pulmonary involvement is an uncommon presentation of Whipple’s disease, and duodenal biopsies with PAS staining is indicated in suspected cases, even in the absence of profound gastrointestinal symptoms. Whipple’s disease can be fatal without treatment, but is responsive to a prolonged course of antibiotic treatment.

Measurement of Anti-Cyclic Citrullinated Peptide, Leptin Hormone, and Lipoprotein (a) In Iraqi Female Patients with Rheumatoid Arthritis

Back ground:-Rheumatoid arthritis is one of the most common forms of inflammatory polyarthritis, with a prevalence of approximately 0.8% of adults worldwide, Rheumatoid arthritis patients may become disabled within few years if untreated that may lead to permanent disability. Different biomarkers have been assessed for the improved diagnosis of Rheumatoid arthritis, including a wide range of autoantibodies. However, only rheumatoid factor (RF) and anti-cyclic citrullinated peptide (ACCP) have gained wide acceptance.
 Aim of the study to investigate the levels of ACCP, Leptin, and Lipoprotein (a) in females with RA to provide information on possible pathophysiologic mechanisms, and to give recommendations for determination of these parameters in diagnosis and follow up of Rheumatoid arthritis patients.
 Patients and methods:- The study included Forty women with RA and Thirty apparently healthy women with matching age and weight as controls.The patients were selected at the outpatient clinic of Rheumatology & Rehabilitation in Medical City/ Baghdad Teaching Hospital during the period from (May2013 ) to (December2013 ). 
 Results:-The results showed that levels of ACCP antibodies in serum of patients with RA were significantly higher than in serum of healthy control. Also there were significant differences between mean of serum leptin level and Lp (a) in patients compared to the control group.
 Conclusion:- Serum biomarkers like ACCP, Leptin, & Lipoprotein (a) assays are becoming increasingly available and may help in early diagnosis and assessment of complications in Rheumatoid arthritis patients.

Is Polymyalgia Rheumatica a Paraneoplastic Syndrome

The onset of polyarthritis and myalgias in elders raises the specter not only of rheumatoid arthritis (RA), polyarticular crystal disease, and

Rebamipide attenuates autoimmune arthritis severity in SKG mice via regulation of B cell and antibody production.

Oxidative stress is involved in the pathophysiology of rheumatoid arthritis (RA). We investigated the therapeutic potential of rebamipide, a gastroprotective agent with a property of reactive oxygen species scavenger, on the development of inflammatory polyarthritis and the pathophysiological mechanisms by which rebamipide might confer anti-arthritic effects in SKG mice, an animal model of RA. Intraperitoneal (i.p.) injection of rebamipide attenuated the severity of clinical and histological arthritis. Rebampide treatment reduced the number of T helper type 1 (Th1), Th2, Th17, inducible T cell co-stimulator (ICOS)(+) follicular helper T (Tfh) transitional type (T2) and mature B cells in the spleen, but increased the number of regulatory T (Treg ), CD19(+) CD1d(high) CD5(high) , CD19(+) CD25(high) forkhead box protein 3 (FoxP3)(+) regulatory B (Breg ) cells, memory B cells, and transitional type 1 (T1) B cells. In addition, flow cytometric analysis revealed significantly decreased populations of FAS(+) GL-7(+) germinal centre B cells and B220(-) CD138(+) plasma cells in the spleens of rebamipide-treated SKG mice compared to controls. Rebamipide decreased germinal centre B cells and reciprocally induced Breg cells in a dose-dependent manner in vitro. Rebamipide-induced Breg cells had more suppressive capacity in relation to T cell proliferation and also inhibited Th17 differentiation from murine CD4(+) T cells. Together, these data show that i.p. administration of rebamipide suppresses arthritis severity by inducing Breg and Treg cells and suppressing Tfh and Th17 cells in a murine model of RA.

English

SUMMARY: Atypical presentations of tuberculosis are known. We present here a case of reactive polyarthritis due to tuberculosis. Patient was treated with four drugs anti Tuberculous regime which led to complete resolutions of symptoms. INTRODUCTION: Tuberculosis (TB) is a major public health problem. It ranks second leading cause of death from infectious diseases. In year 2012 estimated global annual incidence of TB was 8.6 million cases, out of which 2.3 million were occurred in India and 1.3 million death occurred globally. 1,2 Atypical presentation of TB can be contributing factor for delayed diagnosis, morbidity and mortality.3 We reporting here case of inflammatory polyarthritis turned out to be reactive polyarthritis due to tuberculosis. So high index of suspicion and early treatment led to successful outcome.

OP0150 Long-Term Persistence with Oral Methotrexate in Patients with Early Inflammatory Arthritis

BackgroundPersistence with methotrexate (MTX) therapy is longer compared to other conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in patients with rheumatoid arthritis (RA). The majority of patients with RA stop MTX...

FRI0089 Respiratory Morbidity and Mortality in Early Rheumatoid Arthritis

BackgroundRespiratory disease is the second commonest cause of death after cardiovascular disease in patients with inflammatory polyarthritis (IP) and its subset rheumatoid arthritis (RA). However, limited data are available on...

AB0935 Musculoskeletal Involvement in A Study of 50 Patients with Sarcoidosis

BackgroundSarcoidosis is a multisystem disease of unknown etiology. Patients with sarcoidosis may develop extrapulmonary organ involvement, including rheumatologic complications. Joint manifestations, including arthritis and periarthritis, occur in 14–38%.ObjectivesTo analyze the...

FRI0212 What Are the Effects of Interventions Targetting Medication Adherence in Rheumatic Diseases: A Systematic Review

BackgroundRecent medication adherence rates reported as low 30% in rheumatoid arthritis (RA),1 49% in systemic lupus erythematosus (SLE),1 and 17% in gout2 highlight the importance of understanding how health care...

OP0073 Peripheral Blood Gene Expression Profiling of Psoriatic Arthritis Patients

BackgroundAlthough PsA is heterogeneous and shows signs of rheumatoid arthritis (RA) and psoriasis (PsO), genetic studies indicate that PsA is a distinct disease with a strong heritable component. PsA is...

Trueperella pyogenes infections in swine: clinical course and pathology.

Trueperella pyogenes is an opportunistic pathogen causing purulent infections in pigs and other animal species. T. pyogenes infections in pigs are local and/or generalized depending on the immune status of the animals, their individual susceptibility and environmental factors. The occurrence of these infections on pig farms causes substantial economic losses in breeding and rearing. In sows from the breeding herd, the disease leads to infertility, embryonic death, abortion, and disorders of the menstrual cycle and lactation. Mastitis is the major cause of losses in piglets. Disorders of the musculoskeletal system, including inflammatory polyarthritis, fractures and degenerative joint disease results in the culling of animals with high breeding value. In other technological groups, multi-organ inflammations and movement disorders dominate, leading to a reduction of the slaughter value and elimination of pigs from breeding. Understanding of the clinical and pathological aspects of T. pyogenes infections in pigs will enable the development of effective methods of combating this disease on pig farms.

THU0394 Long-Term Therapy with Canakinumab in Two Patients with Refractory Chronic Autoinflammatory Arthritis

BackgroundCanakinumab, a human anti-IL-1β monoclonal antibody, has been licensed for the treatment of cryopyrin-associated periodic syndrome (CAPS), while few reports have shown benefit in patients with refractory familial Mediterranean fever...

Health Assessment Questionnaire disability progression in early rheumatoid arthritis: Systematic review and analysis of two inception cohorts

ObjectiveThe Health Assessment Questionnaire is widely used for patients with inflammatory polyarthritis (IP) and its subset, rheumatoid arthritis (RA). In this study, we evaluated the progression of HAQ scores in RA (i) by systematically reviewing the published literature on the methods used to assess changes in functional disability over time and (ii) to study in detail HAQ progression in two large prospective observational studies from the UK. MethodsData from two large inception cohorts, ERAS and NOAR, were studied to determine trajectories of HAQ progression over time by applying latent class growth models (LCGMs) to each dataset separately. Age, sex, baseline DAS28, symptom duration, rheumatoid factor, fulfilment of the 1987 ACR criteria and socio-economic status (SES) were included as potential predictors of HAQ trajectory subgroup membership. ResultsThe literature search identified 49 studies showing that HAQ progression has mainly been based on average changes in the total study population. In the HAQ progression study, a LCGM with four HAQ trajectory subgroups was selected as providing the best fit in both cohorts. In both the cohorts, older age, female sex, longer symptom duration, fulfilment of the 1987 ACR criteria, higher DAS28 and lower SES were associated with increased likelihood of membership of subgroups with worse HAQ progression. ConclusionFour distinct HAQ trajectory subgroups were derived from the ERAS and NOAR cohorts. The fact that the subgroups identified were nearly identical supports their validity. Identifying distinct groups of patients who are at risk of poor functional outcome may help to target therapy to those who are most likely to benefit.

Disseminated Mycobacterium genavense infection in a patient with immunosuppressive therapy and lymphoproliferative malignancy

We present the case of a 51-year-old woman who presented a right supraclavicular mass corresponding to lymphadenitis with atypical mycobacterium (Mycobacterium genavense). Later, she developed subcutaneous purulent small nodules containing the same germ. The presence of this mycobacterium was in the context of recurrent peripheral T-cell lymphoma and immunosuppressive therapy for seronegative inflammatory polyarthritis.

A patient with joint pains, skin changes and clubbing

Primary hypertrophic osteoarthropathy (PHO) is a rare syndrome with variable clinical and radiological presentations such as joint pains and swelling, clubbing, seborrheic and thickened facial skin and hyperostosis. We present such a case of PHO who was previously diagnosed and treated as inflammatory polyarthritis.

Case report: passive transfer of hepatitis B antibodies from intravenous immunoglobulin

BackgroundPrior to initiating immunosuppressive therapy in the treatment of autoimmune inflammatory conditions, it is a requirement to screen for certain viral serology, including hepatitis B (HBV). A positive result may indicate the need for antiviral therapy, or contraindicate immunosuppression all together. An accurate interpretation of serological markers is therefore imperative in order to treat patients appropriately. We present a case of passive anti-HBV antibody transfer following intravenous immunoglobulin (IVIg) infusion, in which misinterpretation of serology results almost led to inappropriate treatment with antiviral therapy and the withholding of immunosuppressive agents. This phenomenon has been previously reported, but awareness remains limited.Case presentationA 50 year old Caucasian gentleman with a history of allogeneic haematopoietic stem cell transplant for transformed follicular lymphoma was admitted to hospital with recurrent respiratory tract infections. Investigation found him to be hypogammaglobulinaemic, and he was thus given 1 g/kg of intravenous immunoglobulin. The patient also disclosed a 3-week history of painful, swollen joints, leading to a diagnosis of seronegative inflammatory polyarthritis. Prior to initiating long term immunosuppression, viral screening found hepatitis B serology suggestive of past infection, with positive results for both anti-HBc and anti-HBs antibody, but negative HBV DNA. In response, prednisolone was weaned and the local hepatology team recommended commencement of lamivudine. Having been unable to identify a source of infection, the case was reported to the local blood centre, who tested a remaining vial from the same batch of IVIg and found it to be anti-HBc and anti-HBs positive. Fortunately the blood products were identified and tested prior to the patient initiating HBV treatment, and the effect of a delay in starting disease-modifying therapy was inconsequential in light of an excellent response to first-line therapies.ConclusionMisinterpretation of serology results following IVIg infusion may lead to significant patient harm, including unnecessary antiviral administration, the withholding of treatments, and psychosocial damage. This is especially pertinent at a time when we have an ever increasing number of patients being treated with IVIg for a wide array of immune-mediated disease. Passive antibody transfer should be considered wherever unexpected serological changes are identified.

Survey Research Concerning the Main Items of Clinical Suspicion in Dog Lyme Borreliosis and its Options of Confirmation

Dog Lyme borreliosis is a tick-borne disease caused by spirochete species of the Borrelia burgdorferi group, commonly expressed by lameness, swollen joints, and fever. The real image of the disease within the group of small animal practitioners is not known in Romania. A wright starting point is to develop a survey research, using telephone interview or internet survey. To describe the attitudes and opinions of the veterinary medicine practitioners concerning the main clinical signs associated with Lyme borreliosis and diagnostic tools used if the disease is suspected in dogs, 20 veterinary clinics from Romania where included in a survey research by telephone interview. The interview consists in ten simple questions; eight questions were focused on clinical features and two questions on confirmatory procedure of diagnostic. Clinical syndromes commonly associated with canine Lyme disease by veterinary practitioners in small animals were neuronal disorders (80%), fever (75%), polyarthritis (70%) and glomerulopathy (65%). Only 50% veterinary clinics are able to perform serological test for Lyme disease in dogs and 70% of clinics collaborate with specialized laboratory of diagnostic. Serological testing was made for dogs with history of tick attack in 15% cases, for dogs with febrile syndrome in 20%, and lameness in 70%. The clinical signs of Lyme disease in dogs still rise questions in order to be suspected by the Romanian veterinarians. However, several veterinary clinics are still reluctant to hold screening tests in own clinics, but in 70% require confirmatory diagnostic in specialized laboratories.

Irregular gout

Irregular gout