MD, PhD Jürgen Wollenhaupt (Senior Lecturer in Rheumatology), MD Sebastian Schnarr (Clinical Fellow and Research Fellow), MD Jens G. Kuipers (Clinical and Research Fellow)
{"title":"5 Bacterial antigens in reactive arthritis and spondarthritis. Rational use of laboratory testing in diagnosis and follow-up","authors":"MD, PhD Jürgen Wollenhaupt (Senior Lecturer in Rheumatology), MD Sebastian Schnarr (Clinical Fellow and Research Fellow), MD Jens G. Kuipers (Clinical and Research Fellow)","doi":"10.1016/S0950-3579(98)80041-1","DOIUrl":"10.1016/S0950-3579(98)80041-1","url":null,"abstract":"<div><p>An aetiological diagnosis of reactive arthritis is based on the demonstration of recent or ongoing infection with the causative bacterium. This may be done by serological demonstration of antibacterial antibodies, demonstration of the causative microorganism at an extra-articular site or by identification of bacterial nucleic acids or antigens in joint material from patients with aseptic arthritis. The finding of elevated titres of bacteria-specific IgG- and IgA-class antibodies may indicate recent or persistent infection, but has some limitations due to the prevalence of such antibodies among apparently healthy individuals and the persistence of such antibodies after the infection. While <em>Chlamydia</em> can be demonstrated in urogenital specimens in at least one-third of patients with <em>Chlamydia</em>-induced arthritis, the triggering microorganisms are usually no longer detectable in post-dysenteric reactive arthritides. Assays involving molecular amplifications have been successfully used to demonstrate bacterial nucleic acids in joint specimens from patients with reactive arthritis. In addition, bacterial antigens have been detected by immunofluorescence tests. Even though examination of synovial fluid and synovial membrane specimens for bacterial DNA by the polymerase chain reaction is increasingly used to diagnose reactive arthritis, such assays have not been standardized and are not generally available. While some problems remain, these techniques will facilitate the exact diagnosis of reactive arthritides in the near future.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 4","pages":"Pages 627-647"},"PeriodicalIF":0.0,"publicationDate":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80041-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20834448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, PhD Jan Tore Gran (Professor and Head, Department of Rheumatology), MD, PhD Monika Østensen (Professor and Head, Department of Rheumatology)
{"title":"9 Spondyloarthritides in females","authors":"MD, PhD Jan Tore Gran (Professor and Head, Department of Rheumatology), MD, PhD Monika Østensen (Professor and Head, Department of Rheumatology)","doi":"10.1016/S0950-3579(98)80045-9","DOIUrl":"10.1016/S0950-3579(98)80045-9","url":null,"abstract":"<div><p>Few studies have been performed regarding clinical, radiological and prognostic features of females with spondyloarthropathies other than ankylosing spondylitis (AS). In AS, clinical manifestations appear similar in men and women, whereas radiological features appear more frequent and severe in males. However, no consistent differences in outcome and mortality between men and women have been disclosed.</p><p>Although fetal outcome is not compromised in women with spondyloarthropathy (SpA), the interaction of pregnancy and SpA has been studied in detail only in AS. Spinal disease is unchanged while peripheral arthritis and uveitis are suppressed during childbearing. Due to possible maternal and fetal side-effects, NSAIDs must be discontinued during the last 8 weeks of pregnancy, but during lactation several NSAIDs can be used. Treatment with sulphasalazine is compatible with pregnancy and lactation. Children of AS patients exhibit a slightly increased risk of developing SpA later in life.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 4","pages":"Pages 695-715"},"PeriodicalIF":0.0,"publicationDate":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80045-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20834452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Introduction: A new look at the spondyloarthritides","authors":"H. Zeidler, H.R. Schumacher","doi":"10.1016/S0950-3579(98)80036-8","DOIUrl":"10.1016/S0950-3579(98)80036-8","url":null,"abstract":"","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 4","pages":"Pages ix-xi"},"PeriodicalIF":0.0,"publicationDate":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80036-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"94576700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, FRCPC Murray B. Urowitz (Associate Dean for Post-Graduate Affairs, Director), MD, FRCPC Dafna D. Gladman (Deputy Director)
{"title":"2 Measures of disease activity and damage in SLE","authors":"MD, FRCPC Murray B. Urowitz (Associate Dean for Post-Graduate Affairs, Director), MD, FRCPC Dafna D. Gladman (Deputy Director)","doi":"10.1016/S0950-3579(98)80027-7","DOIUrl":"10.1016/S0950-3579(98)80027-7","url":null,"abstract":"<div><p>Criteria for the classification of systemic lupus erythematosus (SLE) are not sufficient to describe the degree of disease activity. Several instruments to assess disease activity have been developed. This chapter reviews the derivation, validation, and clinical application of current disease activity measures in SLE, as well as comparison among them. As patients with lupus survive longer, the sequelae of the disease activity and its therapy are becoming more common. The derivation and validation of the single, generally accepted SLICC/ACR damage index is also discussed.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 3","pages":"Pages 405-413"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80027-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20796192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD David Wofsy (Professor of Medicine and Microbiology/Immunology), MD, PhD David I. Daikh (Assistant Professor of Medicine)
{"title":"9 Opportunities for future biological therapy in SLE","authors":"MD David Wofsy (Professor of Medicine and Microbiology/Immunology), MD, PhD David I. Daikh (Assistant Professor of Medicine)","doi":"10.1016/S0950-3579(98)80034-4","DOIUrl":"10.1016/S0950-3579(98)80034-4","url":null,"abstract":"<div><p>The development of monoclonal antibodies and the emergence of recombinant DNA technology has made it possible to identify and selectively inhibit distinct cell subsets, surface molecules and secreted products that contribute to normal and pathological immune responses. These advances have helped to clarify the mechanisms that promote autoimmune diseases. As a result, it is now possible to contemplate rational strategies for the treatment of these diseases. Some of these strategies are designed to influence the cell surface interactions that determine whether potentially autoreactive T cells become activated or tolerant following antigen stimulation. Other strategies are designed to augment or inhibit distinct cytokines that regulate autoimmunity. All of these strategies have shown promise in animal models for systemic lupus erythematosus, and they may soon be translated into effective new therapies for people.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 3","pages":"Pages 529-541"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80034-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20796814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, MRCPI, FRCPC John G. Hanly (Professor of Medicine, Head, Director, Clinical Associate)
{"title":"3 Evaluation of patients with CNS involvement in SLE","authors":"MD, MRCPI, FRCPC John G. Hanly (Professor of Medicine, Head, Director, Clinical Associate)","doi":"10.1016/S0950-3579(98)80028-9","DOIUrl":"10.1016/S0950-3579(98)80028-9","url":null,"abstract":"<div><p>Patients with systemic lupus erythematosus (SLE) may present with a wide array of neuropsychiatric (NP) clinical features. This may either be a primary manifestation of SLE, the result of a complication of the disease or its therapy, or a concurrent disease process. As there is no single diagnostic gold standard for NP-SLE, the assessment of individual patients is heavily dependent upon clinical evaluation in addition to information from studies of autoantibodies, brain structure and function. Despite their lack of diagnostic sensitivity and specificity, these tests frequently provide information that can be used to support or refute the clinical impression. They may also provide a basis for the prospective evaluation of the efficacy of therapeutic interventions in individual patients with NP-SLE.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 3","pages":"Pages 415-431"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80028-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20796193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, MPH Michelle Petri (Associate Professor of Medicine)
{"title":"5 Pregnancy in SLE","authors":"MD, MPH Michelle Petri (Associate Professor of Medicine)","doi":"10.1016/S0950-3579(98)80030-7","DOIUrl":"10.1016/S0950-3579(98)80030-7","url":null,"abstract":"<div><p>The effect of pregnancy on disease activity in systemic lupus erythematosus remains controversial. Studies on lupus flares in pregnancy are discussed, including prospective data on severity of flares and organ involvement from the Hopkins Lupus Pregnancy Center. The major fetal concerns of miscarriage (due to the antiphospholipid antibody syndrome), pre-term birth (largely due to pre-eclampsia or premature rupture of membranes) and neonatal lupus, are reviewed.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 3","pages":"Pages 449-476"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80030-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20796195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, MPH Ellen M. Ginzler (Professor of Medicine), MD Cynthia Aranow (Assistant Professor of Medicine)
{"title":"7 Prevention and treatment of adverse effects of corticosteroids in systemic lupus erythematosus","authors":"MD, MPH Ellen M. Ginzler (Professor of Medicine), MD Cynthia Aranow (Assistant Professor of Medicine)","doi":"10.1016/S0950-3579(98)80032-0","DOIUrl":"10.1016/S0950-3579(98)80032-0","url":null,"abstract":"<div><p>Corticosteroid therapy has had a major impact on improvement in disease activity and long-term survival in patients with systemic lupus erythematosus (SLE). Unfortunately, the therapeutic advantages are accompanied by many manifestations of toxicity, some of which are short term and potentially reversible, while others cause chronic irreversible damage. Many of these features of toxicity have similar presentations to manifestations of SLE disease activity, and must be distinguished in the individual patient. The features of corticosteroid toxicity are reviewed in this chapter, and means of prevention and/or treatment are discussed.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"12 3","pages":"Pages 495-510"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(98)80032-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20796197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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