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Search Results for : Reactive Arthritis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Statin treatment of rheumatoid arthritis: comment on the editorial by Ridker and Solomon.
Author(s): Peters, MJ; Nurmohamed, MT; Kitas, GD; Sattar, N
Journal: Arthritis Rheum 2010 Mar 12; Vol. 62, Issue 1; Page(s) 302-3
[Medline ID - 19404973]

ABSTRACT NOT AVAILABLE

Identification of citrullinated vimentin peptides as T cell epitopes in HLA-DR4-positive patients with rheumatoid arthritis.
Author(s): Feitsma, AL; van der Voort, EI; Franken, KL; el Bannoudi, H; Elferink, BG; Drijfhout, JW; Huizinga, TW; de Vries, RR; Toes, RE; Ioan-Facsinay, A
Journal: Arthritis Rheum 2010 Mar 12; Vol. 62, Issue 1; Page(s) 117-25
[Medline ID - 20039411]

OBJECTIVE: Antibodies directed against citrullinated proteins (ACPAs) are highly specific for rheumatoid arthritis (RA). The production of ACPAs is most likely dependent on the presence of T cells, since ACPAs undergo isotype switching and are associated with the shared epitope (SE)-containing HLA-DRB1 alleles. Vimentin is a likely candidate protein for T cell recognition, since > 90% of patients positive for ACPAs that are reactive with (peptides derived from) citrullinated vimentin carry SE-containing HLA-DRB1 alleles. The aim of this study was to identify citrullinated vimentin peptides that are presented to HLA-DRB1*0401-restricted T cells. METHODS: HLA-DR4-transgenic mice were immunized with all possible citrulline-containing peptides derived from vimentin, and T cell reactivity was analyzed. Peptides recognized in a citrulline-specific manner by T cells were selected and analyzed for their ability to be processed from the entire vimentin protein. A first inventory of the selected epitopes recognized by T cells was performed using peripheral blood mononuclear cells (PBMCs) from ACPA+, HLA-DR4+ patients with RA. RESULTS: A citrulline-specific response was observed for 2 of the peptides analyzed in DR4-transgenic mice. These peptides were found to be naturally processed from the vimentin protein, since citrullinated vimentin was recognized by peptide-specific T cells. T cell reactivity against these peptides was also observed in cultures of PBMCs from RA patients. CONCLUSION: This study identifies, for the first time, 2 naturally processed peptides from vimentin that are recognized by HLA-DRB1*0401-restricted T cells in a citrulline-specific manner. These peptides can be recognized by T cells in ACPA+, HLA-DR4+ patients with RA, as shown in a first inventory.

A case of post-streptococcal reactive arthritis in which lesions were detected with [18F]-fluorodeoxyglucose positron emission tomography-CT imaging and magnetic resonance imaging.
Author(s): Horino, T; Takao, T; Terada, Y
Journal: Mod Rheumatol 2009 Dec 30; Vol. 20, Issue 3; Page(s) 287-90
[Medline ID - 20039186]

A 55-year-old man with lumbago and polyarthralgia was admitted to our hospital. Laboratory data showed elevated levels of anti-streptolysin O and C-reactive protein. Throat swab culture revealed beta-hemolytic streptococcal infection. Magnetic resonance imaging detected effusion of the lumbar bone and the left hip joint. Positron emission tomography-computed tomography (PET-CT) demonstrated increased fluorodeoxyglucose activity in the bilateral s houlder and hip joints and the interspinal ligament between L2 and L3. He was diagnosed as having post-streptococcal reactive arthritis (PSReA) and treated with amoxicillin hydrate. Polyarthralgia improved and did not relapse. To our knowledge, no results of PET-CT have previously been reported in patients with PSReA. We propose that PET-CT might be a useful tool for diagnosing PSReA.

Tumor necrosis factor-alpha antagonists improve aortic stiffness in patients with inflammatory arthropathies: a controlled study.
Author(s): Angel, K; Provan, SA; Gulseth, HL; Mowinckel, P; Kvien, TK; Atar, D
Journal: Hypertension 2010 Feb 23; Vol. 55, Issue 2; Page(s) 333-8
[Medline ID - 20038753]

The chronic inflammatory state of rheumatoid arthritis and other inflammatory arthropathies, such as ankylosing spondylitis and psoriatic arthritis, contributes to the accelerated atherosclerosis associated with these conditions. This study evaluates the effect of treatment with tumor necrosis factor (TNF)-alpha antagonists on arterial stiffness in patients with inflammatory arthropathies. A total of 60 patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis and clinical indication for anti-TNF-alpha therapy were included. Thirty-five patients started with anti-TNF-alpha therapy and were compared with a nontreatment group of 25 patients. Aortic stiffness (aortic pulse wave velocity), augmentation index, and disease activity were assessed at baseline and after 3 months. Aortic pulse wave velocity (mean+/-SD) was reduced in the treatment group but not in the control group (-0.50+/-0.78 m/s versus 0.05+/-0.54 m/s, respectively; P=0.002). Concomitantly, C-reactive protein and the disease activity score were reduced in the treatment group (-9.3+/-20.2 mg/L [P < 0.001] and -0.74+/-0.91 [P=0.004]). Augmentation index remained unchanged in both groups (0.1+/-7.1% versus -1.0+/-5.8%, respectively; P=0.53). In a multivariate linear regression model, only treatment with TNF-alpha antagonist and change in mean arterial pressure predicted alterations in aortic pulse wave velocity. In summary, anti-TNF-alpha therapy improved aortic stiffness in patients with inflammatory arthropathies. These findings support the idea that anti-inflammatory treatment has a favorable effect on cardiovascular risk in patients with inflammatory arthropathies.

Prevalence and significance of MEFV gene mutations in a cohort of patients with rheumatoid arthritis.
Author(s): Koca, SS; Etem, EO; Isik, B; Yuce, H; Ozgen, M; Dag, MS; Isik, A
Journal: Joint Bone Spine 2010 May 5; Vol. 77, Issue 1; Page(s) 32-5
[Medline ID - 20031469]

OBJECTIVES: Pyrin/marenostrin, an inhibitory regulator of inflammation, is encoded by MEditerranean FeVer (MEFV) gene. Mutations of this gene are the cause of familial Mediterranean fever (FMF). A connection between MEFV gene mutations and rheumatic diseases has been suggested. The aim of this study was to explore the frequency and cli nical significance of MEFV gene mutations in a cohort of Turkish patients with rheumatoid arthritis (RA). METHODS: The study included 103 patients with RA and 103 age-, sex- and origin-matched healthy controls (HC). In all participants, genomic DNA was isolated and genotyped using amplification refractory mutation system or restriction fragment length polymorphism for the eight MEFV gene mutations (E148Q, M694V, M694I, M680I, V726A, A744S, R761H, and P369S). In the RA group, disease activity was determined using the disease activity score-28 (DAS-28), and radiological damage was evaluated by the modified Larsen scoring method. RESULTS: Carrier rates of MEFV gene mutations were 26/103 (25.2%) and 24/103 (23.3%) in the RA and HC groups, respectively (p > 0.05, OR: 0.9, 95% CI: 0.48-1.71). In the RA group, while deformed joint count was significantly higher in the mutation carrier group than those of the non-carrier group (p < 0.05), the level of C-reactive protein, DAS-28 and modified-Larsen scores were slightly but not significantly higher in the carrier group. CONCLUSION: The results of this study suggest that MEFV gene mutations appear to be an aggravating factor for the severity of RA, and consequently, patients with RA might be screened for MEFV gene mutations in countries where FMF is frequent. Whether the searching of MEFV gene mutations in RA patients is cost-effective deserves further investigations.

Effects of sesame oil in the model of adjuvant arthritis.
Author(s): Sotnikova, R; Ponist, S; Navarova, J; Mihalova, D; Tomekova, V; Strosova, M; Bauerova, K
Journal: Neuro Endocrinol Lett 2010 May 25; Vol. 30 Suppl 1; Page(s) 22-4
[Medline ID - 20027138]

OBJECTIVES: The goal of this study was to evaluate the effect of sesame oil on functional damage induced by adjuvant arthritis (AA) and on changes of selected biochemical parameters reflecting oxidative tissue injury. DESIGN: Mycobacterium butyricum in incomplete Freund's adjuvans was intradermally administered to Lewis male rats. Hind paw edema and endothelium-dependent relaxation of the aorta were determined on day 28. Further, plasmatic levels of TBARS, gamma-glutamyltransferase (GGT) activity in the joint and spleen tissues, level of protein carbonyls and total antioxidant capacity (TAC) in plasma, as well as activity of the lysosomal enzyme N-acetyl-glucosaminidase (NAGA) in serum were assessed. The effect of sesame oil (SO, 1ml/kg, daily oral administration) was evaluated on day 28. RESULTS: The beneficial effect of sesame oil on markers of oxidative stress accompanying AA was demonstrated by decrease of plasma TBARS and decrease of GGT activity in the joint and spleen tissues. Level of protein carbonyls, TAC in plasma and activity of NAGA in serum and in the kidney were improved, yet not significantly. In the hind paw edema the maximal increase was found on day 28 of AA, and in the same time we observed a significant decrease of aortic endothelium-dependent relaxation. Adm inistration of SO resulted in mild, non-significant decrease of hind paw swelling and in significantly increased acetylcholine-evoked relaxation. CONCLUSION: We conclude that SO has beneficial effects on oxidative stress induced biochemical changes occurring in AA, moreover it improves endothelium-dependent relaxation of the aorta and tends to decrease hind paw edema.

Reactive arthritis after enteric infections in the United States: the problem of definition.
Author(s): Townes, JM
Journal: Clin Infect Dis 2010 Mar 4; Vol. 50, Issue 2; Page(s) 247-54
[Medline ID - 20025528]

Bacterial enteric infections cause substantial morbidity in the United States both from acute illness and sequelae that follow. Reactive arthritis (ReA) is a poorly defined term that is used to describe a variety of rheumatologic phenomena that may occur after Salmonella, Shigella, Campylobacter, and Yersinia infection, as well as other types of infections (eg, Chlamydia). This review focuses on clinical and epidemiologic investigations of ReA following bacterial enteric infection in the United States. Only 2 population-based studies of ReA following enteric infection have been performed in the United States. ReA following outbreaks of Campylobacter and Yersinia infection has not been studied, and investigations following Shigella and Salmonella outbreaks have focused primarily on the more narrowly defined, but now outdated, concept of "Reiter's syndrome" rather than ReA. Additional epidemiologic studies are needed to determine the burden of illness due to ReA following enteric infection, but a clearer definition of the term is a prerequisite.

Effects of the anti-interleukin-6 receptor antibody, tocilizumab, on serum lipid levels in patients with rheumatoid arthritis.
Author(s): Kawashiri, SY; Kawakami, A; Yamasaki, S; Imazato, T; Iwamoto, N; Fujikawa, K; Aramaki, T; Tamai, M; Nakamura, H; Ida, H; Origuchi, T; Ueki, Y; Eguchi, K
Journal: Rheumatol Int 2009 Dec 22
[Medline ID - 20024554]

We investigated the effects of anti-IL-6 receptor antibody, tocilizumab (TCZ), on lipid metabolism. Nineteen patients with rheumatoid arthritis (RA), entered in clinical case-control study of SAMURAI trial at Sasebo Chuo Hospital, were examined. Nine patients received TCZ monotherapy at 8 mg/kg intravenously every 4 weeks (TCZ group) and 10 patients received conventional DM ARDs (control group). Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoprotein (Apo) A-1, Apo A-2 and Apo B as well as disease activity score (DAS), C-reactive protein and serum amyloid A protein were examined at baseline and after 3 months of the treatment. IL-6 inversely was correlated with LDL, Apo A-1 and Apo A-2, and also tended to correlate with Apo B. In TCZ group, serum levels of TC, HDL, LDL, Apo A-1 and Apo A-2 were significantly increased after 3 months treatment with TCZ. There was no significant change in Apo B, the atherogenic index, and TC/HDL by the TCZ treatment. Changes in the DAS28-ESR negatively correlated with those in TC. In one patient, whose serum level of TCZ was not detected after 3 months of the treatment, the absence of the increment in serum levels of Apo A-1 and A-2 in the patient was remarkable. All of the markers did not change during 3 months in control group. These data may raise an important issue to evaluate the impact of these alternations in lipid metabolism for longer periods in RA patients treated with TCZ.

Impairment of static upright posture in subjects with undifferentiated arthritis in sacroiliac joint in conjunction with elevation of streptococcal serology.
Author(s): Chang, CC; Chu, HY; Chiang, SL; Li, TY; Chang, ST
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 1; Page(s) 33-41
[Medline ID - 20023362]

BACKGROUND AND OBJECTIVES: Our latest work has demonstrated a strong correlation between the anti-streptolysin O (ASO) titer and the sacroiliac (SI) joint scintigraphy in subjects with undifferentiated arthritis [Journal of Rheumatology 34 (2007), 1746-1752]. Of a significant percentage in those subjects with sacroiliac disorder reported suffering from postural abnormality. The purpose of this study was to determine whether there was an abnormality of upright postural sway in those subjects. METHODS: All subjects who have been examined for ASO titer levels and SI joint scintigraphy were divided into two groups according to the reference level of ASO titer in our central laboratory, and were subjected to ten sway tests to assess static postural sway when they w ere standing upright. The comparisons of the sway parameters were analyzed by using two sample t-test for continuous variables and repeated-measures analysis of variance (ANOVA) for the degree effect and interaction effect (sloped degree x group) in varying stressful conditions (eyes open vs closed, plantar flexion or dorsiflexion of feet). RESULTS: In a total of 84 subjects, mean age was 23 years (range 18.0-36.4). Compared with the low ASO (ASO titer < or=116 IU/mL) group, the two sample t-test showed that high ASO (ASO titer > 116 IU/mL) group had 2.76-, 4.46- and 4.59-fold in sway area, 1.32-, 1.50- and 1.61-fold in sway velocity, and 2.02-, 1.97- and 1.70-fold in sway intensity, over the study period at 0 degrees, 10 degrees, and 20 degrees in conditions of eyes open and plantar flexion. The values of sway velocity/intensity obtained with eyes open and plantarflexion/dorsiflexion had lower intensity values when compared with those obtained in closed eyes and plantar flexion/dorsiflexion in high ASO group, but not the same as in low ASO group. Repeated-measures ANOVA showed that the sloped degree only affected the sway area in condition of eyes closed and dorsiflexion (P = 0.016), and affected the velocity/intensity in all conditions tested (all P < 0.0001). In consideration of interaction effect, the sloped degree showed significant difference in sway area in conditions of eyes open and plantar flexion/dorsiflexion (P = 0.03 and P = 0.0113), in sway velocity in most conditions tested (P < 0.05), and in sway intensity in condition of eyes open and dorsiflexion only (P = 0.0004). CONCLUSION: Subjects with high level of streptococcal serology demonstrated increased sway on all postural control measures as compared to those with low serology. Proprioceptive deficits in the SI joint might contribute to the postural impairment measured in this study.

Sacroiliac joint pathologies in low back pain.
Author(s): Gupta, AD
Journal: J Back Musculoskelet Rehabil 2010 Apr 7; Vol. 22, Issue 2; Page(s) 91-7
[Medline ID - 20023336]

OBJECTIVE: The study describes the clinical spectrum of patients with low back pain due to sacroiliac joint (SIJ) involvement with the proposition of a diagnostic scheme. METHODS: In this retrospective review, 61 patients with SIJ pain (unilateral or bilateral) greater than six weeks duration were evaluated by pain history, clinical examination including SIJ provocative tests, laboratory investigations and skeletal imaging. RESULTS: Fifty two patients (M: F, 31:21) were diagnosed to have specific SIJ pathologies amongst 61 patients presenting between 2002 to 2004. Forty patients (65%) were diagnosed with rheumatic conditions - ankylosing spondylitis (AS) - 21, undifferentiated spondyloarthropathy (UspA) - 11, psoriatic arthropathy (PS) - 5, reactive arthropathy (ReA) - 1 and juvenile spondyloarthropathy (JS)-2. Non rheumatic conditions were involved in 12 patients (20%) - osteitis condensus ilii (OCI) - 4, osteomalacia - 2, tuberculosis - 2, pyogenic arthritis - 1, pregnancy related sacroiliac joint pain - 2 and malignancy in 1 patient. The diagnosis could not be confirmed in 9 patients (15%). CONCLUSIONS: Medical history, clinical examination including SIJ tests, plain radiography and laboratory investigations were helpful in diagnosing SIJ pathology in 39% cases (n = 24), 46% (n = 28) needed CT or MRI. A diagnostic scheme of dividing the SIJ pathologies into rheumatic and non-rheumatic conditions was helpful in evaluating patients with suspected SIJ pathologies.
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