AbstractThe aim of the present work was to study correlations between self-assessment of symptoms of depression, anxiety, rheumatic pain and functional disability. One hundred patients admitted to a university rheumatology clinic were tested in a consecutive manner, applying the Hospital Anxiety and Depression Scale (HADS). In addition, the patients were asked to express a quantitative measure of their subjective pain and functional disability on visual analogue scales (VAS). Regression analysis (analysis of variance) showed significant correlation between rheumatic pain and depression (P=0.04), between rheumatic pain and anxiety (P=0.03) and between rheumatic pain and functional disability (P<0.000). Significant correlations were also seen between depressive symptoms and functional disability (P=0.01) and between anxiety and functional disability (P=0.002). The correlation between symptoms of anxiety and depression was at a P=0.000 level. Applying the experience from this study and introducing, as part of a clinical examination, a minimum of psychiatric investigation based on self-assessment of anxiety and depression will provide relevant and reliable information sufficient for following up with specific psychiatric investigations and therapy. This in turn will be positive for those of the rheumatic patients having a comorbid mental health problem.AnxietyDepressionFunctional disabilityRheumatic pain
Abstract Objective To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis (JIA) in order to identify patients who will develop bone mass reductions. Methods We conducted a prospective cohort study of 108 children with early JIA (ages 6–18 years; mean disease duration 19.3 months) who were individually matched with 108 healthy children for age, sex, race, and county of residence. Bone mass and changes in total body, spine, femur, and forearm bone mineral density and bone mineral content (BMC), body composition, growth, and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later. Low bone mass was defined as a Z score >1 SD below the reference population. Results Of the 200 children evaluated at followup, the 100 healthy children had greater gains in total body BMC ( P = 0.035), distal radius BMC ( P < 0.001), and total body lean mass ( P < 0.001) than did the 100 JIA patients. Low or very low total body BMC was observed in 24% of the patients and 12% of the healthy children. Bone formation, bone resorption, and weight‐bearing activities were reduced in the patients compared with the healthy children. Multiple regression analysis showed that in patients with JIA, serum bone‐specific alkaline phosphatase, serum C‐telopeptide of type I collagen, and weight‐bearing activities were independent predictors of changes in total body BMC. Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset. Conclusion Patients with JIA have moderate reductions in bone mass gains, bone turnover, and total body lean mass early in the disease course.
Previous studies have identified a non-phagocytic dendritic cell (DC) in the synovium of patients with rheumatoid arthritis (RA). These cells do not bear conventional markers of B cells, T cells or monocytc/macrophages (MO) but do express MHC class II antigen (HLA-DR). They are potent stimulators of allogeneic and autologous mixed lymphocyte reactions and are efficient accessory cells for T-cell responses to mitogen and antigen Here we report that they also produced interleukin-1 (IL-1) activity in vitro and this could be stimulated further with bacterial lipopolysacchandc (LPS). DC supernatants contained no detectable interleukin-2(IL-2) activity. The role of this cell in vivo is unknown but its accessory function and IL-I production suggest that it could contribute to immune and inflammatory-mediated tissue damage in the rheumatoid joint
Abstract Objective . To evaluate the therapeutic efficacy of 46 weeks of treatment with cyclosporine (5 mg/kg/day) in patients with rheumatoid arthritis (RA). Methods . A 48‐week randomized, double‐blind, placebo‐controlled, multicenter study of cyclosporine was conducted in 122 patients with active RA. Patients were evaluated by objective and subjective clinical and radiologic measurements at baseline and at the end of the study. Results . Statistically significant improvement and clinically important changes were seen for the number of tender joints, number of swollen joints, pain score, duration of morning stiffness, and Lee's functional index in the cyclosporine‐treated group at the end of the study. Radiographic examination showed that cyclosporine was capable of retarding joint destruction. In the cyclosporine‐treated group, serum creatinine levels increased by 17.5 μmoles/liter (23%) at week 24 and by 21.8 μmoles/liter (26%) at week 48. There was no significant difference in mean serum creatinine levels in patients treated with cyclosporine alone and those treated with cyclosporine plus nonsteroidal antiinflammatory drugs. Five patients had to be treated with antihypertensive drugs, and 2 patients were withdrawn from the study because of increased serum creatinine. Conclusion . The study shows that cyclosporine seems to have disease‐modifying effects in RA.
A method for applying 99mTc-MDP for dynamic and static quantitative radioisotope scanning (QRS) of the sacroiliac joints (SI) in early progressive sacroiliitis in ankylosing spondylitis (AS) is described. In a prospective study, 2 groups of male AS patients were investigated, one with increased elevated erythrocytic sedimentation rate (ESR) (group A, n = 7) and one with normal ESR (group B, n = 8). In both groups an increased uptake of the radiotracer was found in the static part of the study versus a control group C (n = 9). An increased uptake versus group C was also found for group A in the dynamic part of the study (p = 0.01) while there was no significant difference dynamically between groups B and C. The results of the dynamic study in group A indicate ESR to be a parameter of inflammatory activity in the SI joints. The study also seems to indicate QRS to be a valuable diagnostic method in early AS without definite radiographic changes in the SI joints.