Oligoarticular Juvenile Rheumatoid Arthritis Research Articles

Monitoring neutrophil activation in juvenile rheumatoid arthritis by S100A12 serum concentrations.

Phagocytes are extensively involved in the synovial inflammation associated with chronic arthritis. The aim of our study was to determine neutrophil activation in juvenile rheumatoid arthritis (JRA) by analyzing S100A12 (EN-RAGE; calgranulin C), a proinflammatory protein secreted by human neutrophils. S100A12 serum concentrations were determined in 124 patients with chronic active polyarticular-, oligoarticular-, or systemic-onset JRA. S100A12 was also analyzed in synovial fluid obtained from 22 patients. Changes in S100A12 levels in response to anti-tumor necrosis factor alpha (anti-TNF alpha) therapy, intraarticular injections of corticosteroids, and methotrexate (MTX) treatment were analyzed. Forty-five patients were followed up after successful antiinflammatory treatment, for a mean period of 2.8 years. The mean serum level of S100A12 was 395 ng/ml in patients with active polyarticular JRA and 325 ng/ml in patients with active oligoarticular JRA (normal <120 ng/ml). The level of S100A12 was approximately 10-fold higher in synovial fluid than in serum, indicating release at sites of local inflammation. In patients with systemic-onset JRA, the mean level of S100A12 was 3,700 ng/ml. Moreover, serum levels decreased in response to different antiinflammatory therapies (i.e., intraarticular injections of corticosteroids, MTX, or etanercept). S100A12 levels were elevated in 20 patients who experienced disease flares after the initial induction of remission, even weeks before the relapses became clinically apparent. S100A12 serum concentrations indicate neutrophil activation in JRA and correlate with disease activity. S100A12 may indicate synovial inflammation even when other signs of arthritis are absent. Its function as a proinflammatory factor secreted by activated neutrophils makes this protein a potential target for future therapies.

Uveitis in juvenile arthritis

Purpose: To evaluate the clinical features of and determine the risk factors for uveitis in patients with juvenile arthritis. Methods: The prevalence and clinical characteristics of uveitis were studied retrospectively in 90 children diagnosed with arthritis. Patients with uveitis were compared with those who did not have eye involvement. Results: Uveitis was diagnosed in 11 patients (12.2%). Of these, seven (63.6%) had oligoarticular, two (36.4%) had polyarticular, and one (9.1%) had systemic-onset juvenile rheumatoid arthritis (JRA). One patient (9.1%) was diagnosed with enthesitis-related arthritis (ERA) (9.1%). The prevalence of uveitis was significantly higher in patients with oligoarticular JRA. The mean age at onset of arthritis in the uveitis patients was 4.39 years, which was significantly lower than in the non-uveitis group. There was no gender difference in the risk of developing uveitis. Antinuclear antibodies (ANA) was positive in seven (63.6%) of the 11 uveitis patients, confirming ANA as a significant determinant for uveitis in juvenile arthritis. Rheumatoid factor was not found to be a risk factor. One (9.1%) of the 11 patients developed serious sight-threatening complications during the follow-up period. Conclusion: This study confirmed that oligoarticular onset, ANA positivity, and young age are risk factors for developing uveitis in patients with juvenile arthritis. Gender was not found to be a determining factor. Prompt treatment of uveitis effectively decreased the prevalence of visual impairment.

7 Juvenile idiopathic arthritis

# 7.1 Changes of antioxidative status and free radical damage in subsets of juvenile idiopathic arthritis (JIA) over a period of three months {#article-title-2} JIA is an inflammatory disease in...

Autoreactivity to human heat-shock protein 60 predicts disease remission in oligoarticular juvenile rheumatoid arthritis.

To determine whether T lymphocyte reactivity to endogenous human hsp60 plays a regulatory role in the course of oligoarticular juvenile rheumatoid arthritis (JRA). A prospective, longitudinal study of T cell reactivity to HSP in 15 patients with newly diagnosed HLA-B27 negative oligoarticular JRA was performed. Results were compared with those in a group of 20 patients with newly diagnosed polyarticular or systemic JRA or with acute arthritis caused by other systemic diseases or viral infections, as well as with those in a group of 9 healthy control subjects. In 86% of the patients with oligoarticular JRA (13 of 15), significant T lymphocyte proliferative responses to hsp60 were found in peripheral blood mononuclear cells and/or synovial fluid mononuclear cells within 3 months after the onset of arthritis. Only 5% of the patients in the rheumatologic disease control group (1 of 20) showed such positivity. All patients with oligoarticular JRA and positive responses to human hsp60 developed a remission of their disease within 12 weeks. During this period of remission, blood samples were taken from 8 patients and showed significantly lower and even negative responses to hsp60, compared with active disease, when all 8 patients had good responses. The results show that significant proliferative responses to human hsp60 can be found early in the course of oligoarticular JRA. Furthermore, these responses correlate with disease activity in such a manner that T cell reactivity to human hsp60 seems to be associated with disease remission.

Reduced bone mineral content and normal serum osteocalcin in non-steroid-treated patients with juvenile rheumatoid arthritis.

To distinguish the effects of juvenile rheumatoid arthritis (JRA) on bone mineralisation from those possibly caused by steroid therapy. Bone mineral status was evaluated in 20 children (five boys and 15 girls) with active JRA who never received steroids. Seven had oligoarticular, nine had polyarticular, and four had systemic JRA. Bone mineral content (BMC) was assessed by single beam photon absorptiometry and expressed as a Z score relative to normal values in healthy children. Serum calcium, phosphate, and alkaline phosphatase were measured by colorimetric methods. Whole parathyroid hormone was assayed by Immuno Radiometric Assay. Serum osteocalcin was measured by specific radioimmunoassay. Nutrient intake was assessed by a 24 hours dietary recall. BMC and nutrient intake were also assessed in an age and sex matched control group. BMC was -1.5 (SEM 0.8) Z scores in patients and 0.4 (0.3) in the control group (p = 0.02). BMC averaged -4.9 (2) Z scores in the systemic JRA group, -1 (0.6) in the polyarticular group and 0.3 (0.7) in oligoarticular JRA patients. Serum calcium, phosphate and osteocalcin values were normal in all patients. No significant difference was found between JRA patients and controls in calcium, phosphate, energy, and protein intake. JRA subjects have significantly reduced BMC even in the absence of any steroid therapy. Bone demineralisation appears to depend more on disease activity and on reduced motility than on reduced nutrient intake.