Arthritis and rheumatism最新文献

{"title":"Role of psychiatric comorbidity in chronic Lyme disease.","authors":"Afton L Hassett,&nbsp;Diane C Radvanski,&nbsp;Steven Buyske,&nbsp;Shantal V Savage,&nbsp;Michael Gara,&nbsp;Javier I Escobar,&nbsp;Leonard H Sigal","doi":"10.1002/art.24314","DOIUrl":"https://doi.org/10.1002/art.24314","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD).</p><p><strong>Methods: </strong>We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease).</p><p><strong>Results: </strong>After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients.</p><p><strong>Conclusion: </strong>Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1742-9"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861484","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":"Health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus.","authors":"Pantelis Panopalis,&nbsp;Jinoos Yazdany,&nbsp;Joann Zell Gillis,&nbsp;Laura Julian,&nbsp;Laura Trupin,&nbsp;Aimee O Hersh,&nbsp;Lindsey A Criswell,&nbsp;Patricia Katz,&nbsp;Edward Yelin","doi":"10.1002/art.24063","DOIUrl":"https://doi.org/10.1002/art.24063","url":null,"abstract":"<p><strong>Objective: </strong>To estimate health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus (SLE) in the US.</p><p><strong>Methods: </strong>Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants provided information on their health care resource use and employment. Cost estimates were derived for both direct health care costs and costs related to changes in work productivity. Direct health care costs included costs for hospitalizations, emergency department services, physician visits, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared with normal US population data.</p><p><strong>Results: </strong>For the total population of participants, the mean annual direct cost was $12,643 (2004 US dollars). The mean annual productivity cost for subjects of employment age (>or=18 and <65 years) was $8,659. The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; older age predicted lower direct costs. Older age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity.</p><p><strong>Conclusion: </strong>Both direct health care costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1788-95"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861383","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}

{"title":"Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis.","authors":"Clara Malattia,&nbsp;Maria Beatrice Damasio,&nbsp;Francesca Magnaguagno,&nbsp;Angela Pistorio,&nbsp;Maura Valle,&nbsp;Carlo Martinoli,&nbsp;Stefania Viola,&nbsp;Antonella Buoncompagni,&nbsp;Anna Loy,&nbsp;Angelo Ravelli,&nbsp;Paolo Tomà,&nbsp;Alberto Martini","doi":"10.1002/art.24313","DOIUrl":"https://doi.org/10.1002/art.24313","url":null,"abstract":"<p><strong>Objective: </strong>To compare magnetic resonance imaging (MRI), conventional radiography, and ultrasonography in identifying bone erosions in patients with juvenile idiopathic arthritis (JIA), and to determine the validity and reliability of an MRI scale in detecting and grading joint damage.</p><p><strong>Methods: </strong>In 26 JIA patients, the clinically more affected wrist was studied with MRI, radiography, and ultrasonography, coupled with standard clinical assessment and biochemical analysis. MR images were assessed independently by 2 readers according to an apposite devised scoring system.</p><p><strong>Results: </strong>Of 26 patients, 25 (96.1%) had 1 or more erosions as detected by MRI, whereas conventional radiography and ultrasonography revealed erosions in 13 (50%) of 26 and 12 (50%) of 24 patients, respectively. The ability of MRI to detect erosive changes was significantly higher with respect to conventional radiography (P = 0.002 with Bonferroni correction [P(B)]) and ultrasonography (P(B) = 0.0002) in the group of patients with <3 years' disease duration. Ultrasonography and conventional radiography were of equivalent value for the detection of destructive changes. Wrist MRI score correlated highly with radiographic erosion score (r(s) = 0.82) and with wrist limited range of motion score (r(s) = 0.69). The interreader intraclass correlation coefficient (ICC) for MRI score was excellent (0.97); intrareader ICCs were good for both investigators (0.97 and 0.79).</p><p><strong>Conclusion: </strong>MRI seems to be a powerful tool to detect early structural damage in JIA. The proposed MRI scale for bone erosions appears promising in terms of reliability and construct validity. The pathophysiologic meaning and the prognostic value of bone erosions revealed only by MRI remain to be established in longitudinal studies.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1764-72"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861488","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":"Short-term improvement of endothelial function in rituximab-treated rheumatoid arthritis patients refractory to tumor necrosis factor alpha blocker therapy.","authors":"Carlos Gonzalez-Juanatey,&nbsp;Javier Llorca,&nbsp;Tomas R Vazquez-Rodriguez,&nbsp;Nicolas Diaz-Varela,&nbsp;Hermitas Garcia-Quiroga,&nbsp;Miguel A Gonzalez-Gay","doi":"10.1002/art.24308","DOIUrl":"https://doi.org/10.1002/art.24308","url":null,"abstract":"<p><strong>Objective: </strong>Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA) and endothelial dysfunction plays a key role in atherosclerosis. The aim of the present study was to assess whether rituximab therapy was able to improve endothelial function in RA patients refractory to tumor necrosis factor alpha (TNFalpha) blockers.</p><p><strong>Methods: </strong>Six consecutive RA patients (5 women; age range 55-79 years) with active disease refractory to TNFalpha inhibitor therapy were studied. Patients received intravenous rituximab (1 course, consisting of 2 infusions of 1,000 mg each separated by 2 weeks). Flow-mediated endothelium-dependent vasodilatation (FMD%) and endothelium-independent vasodilatation (postnitroglycerin) were measured at day 0 prior to the first rituximab infusion, at week 2 (before the second infusion), and at month 6.</p><p><strong>Results: </strong>At week 2, a dramatic increase in FMD% values was observed in all patients (mean +/- SD 7.02 +/- 2.31%, median 7.29%, range 3.2-9.75%) compared with those observed before the first infusion (mean +/- SD 3.35 +/- 1.58%, median 3.04%, range 1.69-5.89%). In addition, at month 6, FMD% values in all patients (mean +/- SD 7.66 +/- 1.73%, median 7.64%, range 5.61-9.98%) were greater than those found before the first infusion (P = 0.03). The dramatic improvement of FMD% was associated with a significant decrease in C-reactive protein level and Disease Activity Score in 28 joints.</p><p><strong>Conclusion: </strong>Our study demonstrates an active effect of rituximab on endothelial function in RA patients refractory to TNFalpha blockers.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1821-4"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861489","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":"Absence of ethical discourse in the rheumatology literature: comment on the article by Caplan et al.","authors":"C Ronald MacKenzie","doi":"10.1002/art.24081","DOIUrl":"https://doi.org/10.1002/art.24081","url":null,"abstract":"As an internist-rheumatologist with an interest in medical ethics, I read with some attention the article by Caplan et al published in a recent issue of Arthritis Care & Research describing the startling want of ethical discourse in the rheumatic disease literature (1). Given the prominence of bioethics in modern medicine and the often complex and challenging illness experience of those with chronic rheumatic diseases, it is all the more surprising that these conditions have engendered so little ethical inquiry in our literature. On this point alone, the report makes a contribution. Nonetheless, I have concerns arising from the formulation of bioethics employed in the study and, as a consequence, of the perception of the field that this article may foster. The authors’ choice of Beauchamp and Childress’ principle-based approach to bioethics (2) imparts an overly constrained sense of what constitutes modern ethical inquiry, and moreover, may have seriously limited their methodology. As demonstrated, principlism places priority on 4 principles: autonomy, beneficence, nonmaleficence, and distributive justice, concepts believed to demarcate the boundaries of ethical discourse. Although certainly an important and influential paradigm in modern ethics, it is far from the only approach. Indeed, principlism is viewed by many to have serious limitations (3,4), which would have been evident if the authors had used broader search terms and assumed a broader concept of what is considered ethical inquiry. For instance, where is medical professionalism (5) in this construct? What of virtue ethics with its emphasis on character and such traits as compassion, trustworthiness, integrity, and conscientiousness? There are also the feminist approaches focused on caring, nurturance, and kindness, the stories of narrative ethics and the cases of the casuists, or the pragmatists who begin with the problem (rather than the principle) and then seek satisfactory solutions. Each of these perspectives has their own vocabulary upon which a methodology for this study might have been developed. Furthermore, a host of specific subjects of an ethical nature could have also been included. For instance, what of informed consent, confidentiality, bioethics, truth telling, and quality of life? Finally, it is important to distinguish the fields of clinical or medical ethics from research ethics, as the latter is tacitly overrepresented in the article by Caplan et al. Note how in Table 1 in the article, virtually all of the examples cited as challenges to the ethical principles are derived from the arena of clinical research. Whether broadening the search terms would have significantly altered the general message of the study is not clear; perhaps not. Nonetheless, I believe it important that the journal’s readership appreciate that, in the view of many critics, the practical and philosophic underpinnings of bioethics are not fully captured by a principlist paradigm. Therefore, the pr","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1835; author reply 1835-6"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861385","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":"Ability of oblique foot radiographs to detect erosions in early arthritis: results in the ESPOIR cohort.","authors":"Valerie Devauchelle-Pensec,&nbsp;Thierry Josseaume,&nbsp;Isabelle Samjee,&nbsp;Maxime Dougados,&nbsp;Bernard Combe,&nbsp;Alain Saraux","doi":"10.1002/art.24310","DOIUrl":"https://doi.org/10.1002/art.24310","url":null,"abstract":"<p><strong>Objective: </strong>To assess the usefulness of using oblique foot radiographs in addition to posteroanterior radiographs of the hands and feet for detecting erosions in patients with recent-onset arthritis.</p><p><strong>Methods: </strong>We included 813 patients from the prospective French ESPOIR cohort with arthritis of <6 months' duration and >or=2 swollen joints. Baseline standardized posteroanterior radiographs of the hands and feet and oblique radiographs of the feet were assessed by 2 blinded readers for erosions typical for rheumatoid arthritis (ETRA) and the Sharp score as modified by van der Heijde.</p><p><strong>Results: </strong>A total of 715 complete sets were available. Mean +/- SD total Sharp scores were 3.6 +/- 6.6, 2.5 +/- 6.3, and 1.8 +/- 5 for the hand and wrist, foot, and oblique foot, respectively. ETRA were visible in 160 (22.4%) of 715 patients (95% confidence interval [95% CI] 19.4-25.6). They were seen on hand radiographs in 86 (53.7%) of 160 patients (95% CI 45.7-61.6), on posteroanterior foot radiographs in 91 (56.9%) of 160 patients (95% CI 48.8-64.6), and on oblique foot radiographs in 84 (52.5%) of 160 patients (95% CI 44.5-60.4). ETRA were visible at the feet, but not at the hands, in 74 (46%) of 160 patients (95% CI 38.4-54.3), among whom 22 (30%) had erosions only on the posteroanterior view, 16 (21%) only on the oblique view, and 36 (48.6%) on both.</p><p><strong>Conclusion: </strong>ETRA were found in 22.4% of patients. Adding an oblique foot radiograph identified 16 (10%) of 160 additional patients (95% CI 6-16), compared with 27.5% and 13.8% identified by adding posteroanterior radiographs of the hands and feet, respectively.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1729-34"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861387","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":"C-reactive protein and systemic lupus erythematosus.","authors":"Shilpa Gaitonde,&nbsp;David Samols,&nbsp;Irving Kushner","doi":"10.1002/art.24316","DOIUrl":"https://doi.org/10.1002/art.24316","url":null,"abstract":"Introduction Although serum levels of the acute-phase reactant C-reactive protein (CRP) usually parallel disease activity in inflammatory states, it is widely believed that systemic lupus erythematosus (SLE) is an exception. It has long been observed that many patients with active SLE display only modestly elevated or even normal CRP levels during periods of intense disease activity (1–3), particularly when compared with patients with rheumatoid arthritis (RA) (4). Indeed, this observation has led to the suggestion that marked CRP elevation in a patient with SLE indicates infection (3,5,6). The explanation for the relatively low levels of CRP in many patients with SLE has remained unclear despite many years of study. In this review, we critically reevaluate this belief and review possible mechanisms that could cause a muted CRP response. In addition, we briefly survey recent evidence raising the possibility that low CRP levels may predispose to or aggravate SLE.","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1814-20"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861485","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":"An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms.","authors":"Helen I Keen,&nbsp;Richard J Wakefield,&nbsp;Andrew J Grainger,&nbsp;Elizabeth M A Hensor,&nbsp;Paul Emery,&nbsp;Philip G Conaghan","doi":"10.1002/art.24312","DOIUrl":"https://doi.org/10.1002/art.24312","url":null,"abstract":"<p><strong>Objective: </strong>Few studies have examined hand osteoarthritis (OA) pathology using sensitive imaging techniques. The aim of this study was to determine the extent of ultrasound (US)-detected pathology and investigate its relationship with symptoms in hand OA.</p><p><strong>Methods: </strong>Subjects with symptomatic hand OA and controls were recruited. All underwent clinical and US examination of the small joints of both hands and completed a range of measures of hand pain, stiffness, and function.</p><p><strong>Results: </strong>Thirty-six subjects with symptomatic OA and 19 control subjects with similar demographics were recruited. US-detected pathology (osteophytes, joint space narrowing, gray-scale synovitis, and power Doppler signal) occurred frequently in symptomatic hand OA (41%, 40%, 46%, and 7% of joints, respectively), and significantly less often in controls (P < 0.001 for all comparisons). Symptomatic joints were more likely to demonstrate US-detected changes of gray-scale synovitis, power Doppler signal, or osteophytes (P < 0.001, P = 0.002, and P < 0.001, respectively). Neither the number of affected joints per individual nor the summative semiquantitative scores for synovitis per individual correlated with symptoms (pain visual analog scale [VAS], global VAS, or Australian/Canadian Osteoarthritis Hand Index).</p><p><strong>Conclusion: </strong>This study demonstrated extensive synovitis changes as well as the traditional structural radiographic findings of hand OA. Symptomatic joints were significantly more likely to demonstrate US-detected structural changes or inflammation in symptomatic hand OA; however, the extent of changes in individual joints or in individuals did not correlate with the degree of symptoms, which may relate to both the assessment tools and the complex nature of pain.</p>","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1756-63"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861848","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":"A 73-year-old woman with chronic pelvic pain, burning toes, and an eighty-pound weight loss.","authors":"Julius Birnbaum,&nbsp;Toby C Chai,&nbsp;Tehmina Z Ali,&nbsp;Michael Polydefkis,&nbsp;John H Stone","doi":"10.1002/art.24051","DOIUrl":"https://doi.org/10.1002/art.24051","url":null,"abstract":"A 73-year-old woman developed malaise and a wasting illness that led to a weight loss of 80 pounds over the 5 years before presentation. During this time, her body mass index declined from 30.3 to 17.0 kg/m (1). At approximately the same time her weight loss began, the patient began to experience chronic pelvic and bladder pain. These symptoms, particularly uncomfortable when she was sitting, were partly relieved by micturition. The pain was associated with intermittent dysuria, severe urinary urgency, and frequency. She urinated approximately 9 times a day, and also awoke to urinate approximately 9 times at night. She denied incontinence and did not have recurrent urinary tract infections. However, her symptoms were associated with dyspareunia. She was not sexually active because of pain. Gynecologic and urologic evaluations revealed that the external genitalia, perineum, anus, and rectum were normal, as was the strength of the pubococcygeal and external anal sphincter muscles. Her gynecologist had detected mild urethral tenderness on palpation, but there was no urethral or bladder prolapse. The cul-desac between the posterior vagina and anterior rectum was normal, without nodularity or an enterocele. Catheterized urine specimens showed reactive uroepithelial cells, many neutrophils, and some red blood cells, suggesting abundant acute inflammation. A computed tomography (CT) scan of the pelvis showed generalized thickening of the bladder wall (Figure 1). A cystoscopic examination revealed no uroepithelial masses, but demonstrated a trabeculated bladder surface. Biopsies obtained at cystoscopy revealed nonspecific bladder inflammation. No neoplasm was identified. Following these urologic evaluations, the patient was diagnosed with interstitial cystitis/painful bladder syndrome (IC/PBS) (2). Over the next 5 years, she was treated with a variety of medications, including neurontin, pentosan polysulfate sodium, oxybutynin, and dimethyl sulfoxide. She also underwent cystoscopy with hydrodistention. None of these interventions provided more than mild, temporary relief of her bladder symptoms. In this same 5-year period, the patient had a variety of persistent abdominal symptoms. She reported loose bowel movements but denied diarrhea, constipation, hematochezia, fevers, arthritis, or eye problems. She noted consistent anorexia and early satiety, and reported a band-like abdominal pain that started just above her umbilicus. She had grown increasingly weak since becoming ill, and usually required assistance for ambulation. Over the course of her abdominal symptoms, she had undergone upper and lower endoscopy, as well as sonograms and CT scans of her abdomen. Biopsies of the small intestine had been negative for Tropheryma whipplei. Assays for IgA anti-endomysial antibodies, IgA antibodies to transglutaminase, and IgG and IgA directed against gliadin were all negative. A variety of diagnoses for her gastrointestinal symptoms had been entertained, includin","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"59 12","pages":"1825-31"},"PeriodicalIF":0.0,"publicationDate":"2008-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/art.24051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27861851","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":"Biomarkers of cartilage and bone damage as a measure of joint damage in haemophilia","authors":"N. Jansen, G. Roosendaal, B. Lundin, L. Heijnen, J. Bijlsma, F. Lafeber","doi":"10.1182/BLOOD.V112.11.1214.1214","DOIUrl":"https://doi.org/10.1182/BLOOD.V112.11.1214.1214","url":null,"abstract":"Purpose Biomarkers of bone and cartilage turnover have frequently been evaluated for joint diseases such as rheumatoid arthritis (RA) and osteoarthritis (OA). Results have thus fare not been very conclusive. Some biomarkers such as urinary CTXII and serum COMP appear to correlate with severity of joint degeneration, whereas other are less distinctive. Hemophilic arthropathy (HA) is a very progressive joint degeneration as a result of frequent joint bleeds. From clinical practice it is concluded that the rate of degeneration exceeds that of OA and RA joints. This degeneration has characteristics of both inflammation mediated (as seen in RA) and degenerative (as seen in OA) joint disease. Furthermore, the joint damage is largely restricted to 3 major joints (ankle, knees, and elbows). Therefore, it might be that this rapidly progressive, localized joint degeneration can be used for the evaluation and validation of biomarkers of cartilage and bone turnover. In the present study we therefore investigated whether commercially available biomarkers of cartilage and bone in blood and/or urine are associated with severity of joint damage in patients with haemophilic arthropathy. Methods Blood and urine were collected from 36 patients suffering from haemophilia. Urine samples were assessed for the amount of CTX-I and CTX-II. Serum samples were assessed for the amount of CTX-I, CTX-II, COMP, C1,2C, C2C, and CS846. Radiographs of ankles, knees and elbows were scored according to Pettersson, a radiographic joint score specific for haemophilic arthropathy based on cartilage and bone changes. Results U-CTX-II (R=0.39; p=0.01), C1,2C (R=0.31; p=0.04) and CS846 (R=0.31; p=0.03) showed (marginal) correlations with the Pettersson score. Slightly better correlations were obtained when only narrowing of joint space width (JSW) as one of the items in the Pettersson score was used. The other biomarkers showed no correlation with the Pettersson score. Also the bone biomarkers did not correlate with specific bone changes. Interestingly, combined indexes of different markers, based on linear stepwise regression analysis, increased the correlation significantly up to R=0.65; p≤0.001) for the combination of U-CTX-II, COMP and CS846. Conclusions The present results show that even despite this rapidly progressive degeneration of 6 large joints, from the individual biomarkers determined only U-CTX-II, C1,2C and CS846 show correlation with the severity of arthropathy. Importantly, a relation improved when the markers were related to the process they are supposed to describe (cartilage degeneration markers with JSW narrowing). Most important, combination of markers, significantly improve the relation with the radiographically determined joint degeneration. In general however, it may be concluded that these markers alone seem not of sufficient value for evaluation of joint damage yet.","PeriodicalId":8405,"journal":{"name":"Arthritis and rheumatism","volume":"58 1","pages":"655-656"},"PeriodicalIF":0.0,"publicationDate":"2008-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65547456","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}