Tocilizumab for juvenile idiopathic arthritis: a single-center case series

ABSTRACT BACKGROUND: Juvenile idiopathic arthritis (JIA) is the commonest chronic rheumatic disease among children. When not treated effectively, JIA can lead to functional disability, due to joint damage, along with long-term morbidities. OBJECTIVES: To describe the use of tocilizumab therapy for 11 patients with polyarticular JIA (pJIA) and systemic JIA (sJIA) who presented inadequate response or were refractory to disease-modifying anti-rheumatic drugs (DMARDs) and/or other biological therapies; and to evaluate its benefits, safety and tolerability. DESIGN AND SETTING: Observational retrospective case series at a tertiary-level training and research hospital. METHODS: We reviewed the medical records of 11 consecutive patients with JIA who received tocilizumab (anti-IL-6) therapy in our pediatric nephrology and rheumatology outpatient clinic. We analyzed their demographic data, clinical and laboratory findings, treatment response and adverse reactions. We determined the efficacy of tocilizumab treatment using the American College of Rheumatology (ACR) pediatric (Pedi) response criteria, including ACR Pedi 30, 50, 70 and 90 scores. We used the Wilcoxon test to compare measurements before and after treatment. RESULTS: Tocilizumab was given to seven patients with sJIA and four with pJIA (one of the pJIA patients was rheumatoid factor-positive). In most patients, we observed improvement of symptoms, absence of articular and extra-articular inflammation and continued inactive disease. ACR Pedi 30, 50 and 70 scores were achieved by 90.9% of the patients. Five patients showed minor side effects, possibly due to use of tocilizumab. CONCLUSIONS: Tocilizumab therapy should be considered for treating patients with diagnoses of pJIA or sJIA who are resistant to non-biological DMARDs and/or other biological therapies.

Serum neopterin level in children with juvenile idiopathic arthritis

Background: Juvenile idiopathic arthritis [JIA] is generally considered a clinical syndrome involving several disease subsets, with a number of inflammatory flows, leading to an eventual common pathway in which persistent synovial inflammation and associated damage to articular cartilage and underlying bone are present. Neoptrin is a reliable marker in the assessment of the rate of IFN-gamma production. Levels of neoptrin increase in direct proportion with the level of interferon. Measurement of neopterin level is useful because of its relative stability also it is a prognostic indicator for cell-mediated immunity

Aims: This study aims to assess serum level of neopterin in patients with Juvenile Idiopathic Arthritis [JIA] in relation to the disease activity, severity and response to conventional and biological therapy

Methodology: The study was conducted on 30 patients [Group A] previously diagnosed as SoJIA, they were divided into two subgroups according to their therapy into Group AI on biological therapy [15 patients] and Group AII on conventional therapy [15 patients]. These in addition to 20 healthy controls [Group B]

Results: Basic clinical evaluation and laboratory investigations were done. We found that JIA patients had significantly higher levels of serum neopterin than healthy controls. We also found a highly significant difference between neopterin levels in the activity and remission states among all patients [Group AI and Group AII]

Conclusion: We concluded that serum neopterin is a useful marker for cellular immune activation and also indicative of the activity of JIA. Our findings are supported by positive correlations between serum neopterin levels and other markers of activity as TLC, PLT counts, ESR, and CRP. We also concluded that serum neopterin is a sensitive and accurate predictor of disease activity where sensitivity of that test was 93.3% and accuracy was 72.5%

Recommendations: Investigating the serum neopterin measurement in other autoimmune collagen diseases. Assessment the influence of biological therapy on neopterin levels in relation to disease progression

Extremely elevated IL-18 levels may help distinguish systemic-onset juvenile idiopathic arthritis from other febrile diseases

The aim of this research was to explore whether IL-18 can be a serological marker for the diagnosis of systemic-onset juvenile idiopathic arthritis (sJIA). A total of 23 sJIA patients (13 males, median age 8.2), 20 acute lymphoblastic leukemia (ALL) patients, 18 patients with severe infections (SIF), 26 Kawasaki disease (KD) patients, 18 juvenile idiopathic arthritis (JIA) patients, and 25 healthy control patients were selected for this study. Enzyme-linked immunosorbent assays (ELISAs) were used to determine the serum concentrations of the S100A8, S100A9, and IL-6 proteins. The serum IL-18 levels were detected by a cytometric bead array (CBA). The serum IL-6 concentrations in various disease groups were significantly higher than that in the healthy control group. The IL-6 concentrations exhibited no significant difference between disease groups. The S100A8 level in the sJIA group was significantly higher than those of the ALL, JIA, and healthy control groups but showed no significant difference compared to the SIF and KD groups. The S100A9 serum concentration in the sJIA group was significantly higher than those in the ALL and healthy control groups and exhibited no significant difference from the SIF, KD, and JIA groups. The IL-18 level of the sJIA group was significantly higher than that of the other febrile disease groups. The IL-18 serum concentration may be used as a biological serum marker to distinguish sJIA from other febrile diseases.

Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity / Associação de neopterina como marcador de ativação do sistema imunológico e atividade da artrite reumatoide juvenil

OBJECTIVE: To evaluate neopterin plasma concentrations in patients with active juvenile idiopathic arthritis (JIA) and correlate them with disease activity.METHODS: Sixty patients diagnosed as active JIA, as well as another 60 apparently healthy age- and gender-matched children as controls, were recruited from the Pediatrics Allergy and Immunology Clinic, Ain Shams University. Disease activity was assessed by the Juvenile Arthritis Disease Activity Score 27 (JADAS-27). Laboratory investigations were performed for all patients, including determination of hemoglobin concentration (Hgb), erythrocyte sedimentation rate (ESR), and C-reactive protein. Serum concentrations of tumor necrosis factor-alpha (TNF-a), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and neopterin were measured.RESULTS: Significant differences were found between JIA patients and controls with regard to the mean levels of Hgb, ESR, TNF-a, IL-6, and MCP-1 (p < 0.05). A statistically significant higher mean level serum neopterin concentration (p < 0.05) was found in JIA patients (20.43 ± 8.73 nmol/L) than in controls (6.88 ± 2.87 nmol/L) (p < 0.05). Positive significant correlations were detected between serum neopterin and ESR, TNF-a, IL-6, MCP-1, and JADAS-27 (p < 0.05). No correlation was found between serum neopterin and CRP (p > 0.05). Multiple linear regression analysis showed that JADAS- 27 and ESR were the main variables associated with serum neopterin in JIA patients (p < 0.05).CONCLUSION: The elevation of plasma neopterin concentrations in early JIA patients may indicate stimulation of immune response. Serum neopterin can be used as a sensitive marker for assaying background inflammation and disease activity score in JIA patients.

OBJETIVO: Avaliar as concentrações plasmáticas de neopterina em pacientes com artrite idiopática juvenil (AIJ) ativa e correlacioná-las com a atividade da doença.MÉTODOS: Foram recrutados da clínica de Alergia e Imunologia Infantil da Universidade Ain Shams 60 pacientes diagnosticados com AIJ ativa, bem como 60 crianças aparentemente saudáveis com a mesma idade e o mesmo sexo no grupo de controle. A atividade da doença foi avaliada pelo Escore de Atividade da Doença da Artrite Juvenil em 27 Articulações (JADAS-27). Foram feitas investigações laboratoriais em todos os pacientes, incluindo a determinação da concentração de hemoglobinas, a taxa de sedimentação de eritrócitos e a proteína C-reativa. Foram mensuradas as concentrações séricas do fator de necrose tumoral alfa, interleucina-6 e proteína quimiotática de monócitos-1 e neopterina.RESULTADOS: Foi encontrada uma diferença significativa entre os pacientes com AIJ e os controles quanto às médias de Hb, TSE, FNT-a, IL-6 e MCP-1 (p < 0,05). Foi encontrado um nível estatística e significativamente maior de concentração média de neopterina sérica (p < 0,05) em pacientes com AIJ (valor médio de 20,43 ± 8,73 nmol/L) do que em controles (valor médio de 6,88 ± 2,87 nmol/L) (p < 0,05). Foram detectadas correlações positivas significativas entre a neopterina sérica e TSE, FNT-a, IL-6, MCP-1 e JADAS-27 (p < 0,05). Não foi encontrada correlação entre a neopterina sérica e a PCR (p > 0,05). A análise de regressão linear múltipla mostrou que o JADAS-27 e a TSE foram as principais variáveis associadas à neopterina sérica em pacientes com AIJ (p < 0,05).CONCLUSÃO: A elevação das concentrações plasmáticas de neopterina em pacientes com AIJ precoce pode indicar um estímulo de resposta imune. A neopterina sérica pode ser usada como um indicador sensível para analisar o histórico de inflamações e o escore de atividade da doença em pacientes com AIJ.

Serum 25-hydroxyvitamin D and biochemical markers of bone metabolism in patients with juvenile idiopathic arthritis

Our objective was to evaluate the concentrations of serum 25-hydroxyvitamin D [25(OH)D], serum calcium, serum phosphorus, alkaline phosphatase, and parathormone (PTH) in patients with polyarticular juvenile idiopathic arthritis (JIA) and to associate them with disease duration and activity, bone mineral density and use of medications. In a cross-sectional and controlled study, 30 patients with polyarticular JIA were evaluated and compared to 30 healthy individuals matched for age and gender. Clinical status, anthropometry, laboratory markers in both patients and controls, and bone mineral density, only in the patients, were measured. Of the 30 patients included in the study, 23 (76.7%) were female and 16 (53.3%) non-Caucasian; mean age was 14 years (range = 4 to 20 years). Mean disease duration was 5 years (range = 1 to 12 years). The mean concentrations of serum albumin-corrected calcium (9.04 ± 0.41 mg/dL) and alkaline phosphatase (153.3 ± 100.1 IU) were significantly lower in patients with JIA than in controls (P < 0.0001 and P = 0.001, respectively). No differences in 25(OH)D, PTH or serum phosphorus were observed between JIA and control subjects. Regarding 25(OH)D concentration, 8 patients (26.7%) and 5 controls (16.7%) had 25(OH)D concentrations compatible with deficiency (lower than 20 ng/mL) and 14 patients (46.7%) and 18 controls (60%) had concentrations compatible with insufficiency (20-32 ng/mL). These values were not associated with disease activity, use of medications or bone mineral density. We observed a high frequency of 25(OH)D insufficiency and deficiency in the study sample. The compromised bone metabolism emphasizes the importance of follow-up of JIA patients.

Discrimination of acute lymphoblastic leukemia from systemic-onset juvenile idiopathic arthritis at disease onset

OBJECTIVE: To assess clinical and laboratory features that differentiate acute lymphoblastic leukemia from systemic juvenile idiopathic arthritis at disease onset. METHODS: Fifty-seven leukemia patients with musculoskeletal involvement, without blasts on peripheral blood and without glucocorticoid therapy at disease onset and 102 systemic juvenile idiopathic arthritis patients (International League of Associations for Rheumatology criteria) were retrospectively evaluated. The following features were examined: fever, rheumatoid rash, arthritis, limb pain, hepatomegaly, splenomegaly, pericarditis, myocarditis, pleuritis, weight loss, bleeding, anemia, leukopenia, neutropenia, thrombocytopenia, erythrocyte sedimentation rate, and lactic dehydrogenase levels. RESULTS: The median age at disease onset was significantly higher in leukemia patients than in those with systemic-onset juvenile idiopathic arthritis (5.8 vs. 3.8 years). In addition, the frequencies of limb pain, hepatomegaly, weight loss and hemorrhagic manifestations were significantly higher in leukemia patients than in systemic-onset juvenile idiopathic arthritis patients (70 percent vs. 1 percent, 54 percent vs. 32 percent, 30 percent vs. 8 percent, and 9 percent vs. 0 percent, respectively). Likewise, the frequencies of anemia, leukopenia, neutropenia, thrombocytopenia and high lactic dehydrogenase levels were statistically higher in leukemia patients than in patients with systemic-onset juvenile idiopathic arthritis (88 percent vs. 57 percent, 39 percent vs. 1 percent, 60 percent vs. 1 percent, 77 percent vs. 1 percent, and 56 percent vs. 14 percent, respectively). Remarkably, multivariate analysis revealed that limb pain (OR = 553; 95 percent CI =46.48-6580.42) and thrombocytopenia (OR = 754.13; 95 percent CI =64.57-8806.72) were significant independent variables that differentiated leukemia from systemic-onset juvenile idiopathic arthritis. The R2 of the Nagelkerke test was 0.91, and the Kaplan-Meier survival curves were similar for acute lymphoblastic leukemia patients with and without limb pain. CONCLUSION: Our study emphasizes the importance of investigating leukemia in patients presenting with musculoskeletal manifestations and, in particular, limb pain associated with thrombocytopenia.

Decreased high-density lipoprotein cholesterol levels in polyarticular juvenile idiopathic arthritis

OBJECTIVES: To investigate the prevalence of dyslipoproteinemia in a homogeneous cohort of polyarticular juvenile idiopathic arthritis patients. METHODS: Based on the National Cholesterol Education Program, fasting lipoprotein levels and risk levels for coronary artery disease were determined in 28 patients with polyarticular juvenile idiopathic arthritis. The exclusion criteria included diabetes, thyroid dysfunction, smoking, proteinuria, lipid-lowering drugs, and hormone/diuretic therapy. Disease activity, disease duration, and therapy with corticosteroids and/or chloroquine were defined at the time of lipid measurements. RESULTS: Dyslipoproteinemia was identified in 20 of the 28 (71 percent) patients with polyarticular juvenile idiopathic arthritis. The primary lipoprotein risk factor was decreased high-density lipoprotein cholesterol (57 percent), followed by elevated levels of low-density lipoprotein cholesterol (18 percent), triglycerides (14 percent), and total cholesterol (7 percent). The male patients had decreased high-density lipoprotein cholesterol levels than the female patients (p<0.05). The incidence of decreased high-density lipoprotein cholesterol levels did not seem to be affected by disease activity or therapy because the incidence was similar in patients with active or inactive disease, with or without corticosteroid use and with or without chloroquine use. In addition, the frequency of decreased high-density lipoprotein cholesterol levels was similar in patients with short (≤5 years) vs. long (>5 years) disease duration. CONCLUSIONS: Dyslipoproteinemia is highly prevalent in patients with polyarticular juvenile idiopathic arthritis and is primarily related to decreased high-density lipoprotein cholesterol levels; therefore, early intervention is essential.

Clinico-serological profile of juvenile idiopathic arthritis.

We report clinico-serological profile of 210 children with Juvenile idiopathic arthritis (JIA), diagnosed as per ILAR classification criteria. Polyarticular, oligoarticular, and systemic onset disease was observed in 72, 69, and 40 children, respectively. The knee joint was the most frequently involved joint. Antinuclear factor and Rheumatoid factor were positive in 10 and 8, 6 and 20, and 7 and 7 percent children with polyarticular, oligoarticular, and systemic disease, respectively.

Growth and bone mineralization in patients with juvenile idiopathic arthritis.

OBJECTIVE: To investigate growth, development and bone mineralization of children with juvenile idiopathic arthritis (JIA). METHODS: Thirty patients between 4-17 years of age (mean 11.34 +/- 3.88) resistant to therapy were studied. Enrollment began in November 1999 and continued through November 2004 and children with chronic disease were excluded. Data like height, weight, medications and acute phase reactants were obtained from medical records. On study-visit, puberty was assessed by physical examination and bone mineral density (BMD) was measured. Serum Ca, P, ALP, insulin-like growth factor-1 (IGF-1) and urinary Ca/Cr and hydroxyproline /Cr levels were measured. Results were compared with the control group that consisted of 30 cases of similar age and gender. RESULTS: Patients with JIA had decreased height standard deviation score (SDS) and growth retardation. BMD of the cases in the study group was lower than the control group (p< 0.05). Patients who were at younger age at the onset of the disease had lower BMD. Among the drugs, only steroids had a negative effect on growth. Serum IGF-1 levels of the study group were significantly lower than the control group (p< 0.0001). CONCLUSION: Early diagnosis and suppression of disease activity is important in prevention of osteoporosis and growth retardation in children with JIA. BMD has to be measured yearly in patients for accurate diagnosis of osteoporosis. Vitamin D and Ca-rich nutrition with promotion of physical activity and controlled use of steroids may protect the children against bone loss.

Prevalência de anticorpos contra peptídeos cíclicos citrulinados na artrite idiopática juvenil / The prevalence of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis

OBJETIVOS: Avaliar a presença de anticorpos contra peptídeos cíclicos citrulinados em uma coorte de pacientes com artrite idiopática juvenil. MÉTODOS: A presença de anticorpos contra peptídeos cíclicos citrulinados foi avaliada por ensaio imunoenzimático (ELISA) no soro de pacientes com artrite idiopática juvenil com idade inferior a 18 anos, acompanhados no ambulatório de reumatologia pediátrica do Hospital de Clínicas de Porto Alegre, com tempo de diagnóstico de doença de, no mínimo, 6 meses. Também foi estudada a presença do fator reumatóide IgM e do fator antinuclear em células Hep-2 RESULTADOS: Foram analisadas amostras séricas de 45 pacientes com artrite idiopática juvenil. A presença de títulos elevados de anticorpos contra peptídeos cíclicos citrulinados foi encontrada somente no soro de uma criança (2 por cento), a qual apresentava quadro de poliartrite com fator reumatóide reagente. CONCLUSÕES: O anticorpo contra peptídeos cíclicos citrulinados pode ser detectado em crianças com artrite idiopática juvenil, mas em freqüência muito inferior aos adultos com artrite reumatóide. Torna-se importante avaliar se anticorpos contra peptídeos cíclicos citrulinados podem identificar os pacientes com artrite idiopática juvenil com potencial de evolução para artrite reumatóide do adulto.

Macrophage Activation Syndrome in a Child with Systemic Juvenile Rheumatoid Arthritis

Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of rheumatic disorders in children. We describe a 13-month-old boy in whom MAS developed as a complication of systemic juvenile rheumatoid arthritis (S-JRA). He suffered from fever and generalized rash followed by multiple joints swelling for four months before admission. Physical examination revealed cervical lymphadenopathy and hepatosplenomegaly. Laboratory findings were: abnormal liver enzymes, increased triglyceride and ferritin levels, coagulopathies resembling disseminated intravascular coagulation, anemia and thrombocytopenia. Hyperplasia of hemophagocytic macrophages was remarkable in his bone marrow. Methylprednisolone and cyclosporin therapy resulted in clinical and laboratory improvements. This is the third case of MAS associated with S-JRA in Koreans, and the first one, in which hemophagocytic macrophages were proven in bone marrow.

Anticardiolipin antibodies in juvenile rheumatoid arthritis and systemic lupus erythematosus

Antiphospholipid antibody syndrome [APS] can either occur as a primary syndrome or associated with other autoimmune diseases such as systemic lupus erythematosus [SLE]. Anticardiolipin antibody [aCL] of IgG and/or IgMisotype in blood, measured by a standardized ELISAis the most acceptable laboratory criteria. APS IgGisotype, particularly IgG2 subclass is more strongly associated with thrombosis. This study was done to determine the prevalence of IgG aCL and its subclasses in relation to APS symptoms, in a group of juvenile rheumatoid arthritis [JRA] and juvenile systemic lupus erythematosus [SLE] patients. In this prospective study, 28 JRAand 16 SLE patients, aged 3-18 years, were enrolled. IgG aCLwas assayed by standard aCL ELISA. IgG subclasses were also assayed by ELISA on sera with medium to high titers of aCL.ACL assay was performed on at least two occasions for each patient, over 3-6 months period of follow up. 29% [8/28] of JRApatients and 44% [7/16] of SLE patients had aCL. Six of SLE patients displayed APS related manifestations: hemolytic anemia, thrombocytopenia, arterial occlusion, valvular heart disease, livedo reticularis and pulmonary hypertension, but none of them had persistant medium or high titer of aCL. The lack of association of high titer of aCL with APS related symptoms was observed in two patients. The IgG subclasses were primarily IgG1 and IgG3. The prevalence of IgG aCL in this group of pediatric SLE and JRA is not uncommon but it's relation to clinical manifestations is not clear. IgG1 and IgG3 subclasses were not associated with thrombosis, which is in agreement with previous studies

Role of IgM & IgA rheumatoid factors in complement activation in patients with juvenile rheumatoid arthritis.

We studied the relationship between the degree of complement activation in juvenile rheumatoid arthritis (JRA) with the levels of circulating IgM and IgA rheumatoid factors (RF). Forty children with JRA and 25 matched controls were included in the study. Levels of C3d (a degradation product of complement component C3), circulating immune complexes (CICs), IgM RF and IgA RF were measured by ELISA. Levels of C3d, CICs, IgM RF and IgA RF were elevated in patients with JRA as compared to controls. Levels of C3d had a linear relationship with levels of CICs (P < 0.05) but not with levels of circulating IgM RF and IgA RF. Thus, complement activation occurs in children with JRA and is associated with raised levels of CICs but not with levels of circulating IgM and IgA RF. Circulating IgM and IgA RF have little, if any, role in complement activation observed in patients with JRA.

study of anticardiolipin antibodies in patients with adult and juvenile rheumatoid arthritis

The level of anticardiolipin antibodies [ACA] was determined in 40 patients with adult and juvenile onset rheumatoid arthritis [RA] using ELISA technique. Patients were examined for different manifestations of antiphospholipid [APS]. Beside the laboratory and immunological studies, Doppler echo-cardiographic study and Doppler study of the peripheral vessels were performed. 35% of the female patients had a history of recurrent abortions. Thrombotic episodes were not a frequent presentation. ACA were elevated on both groups. Patients with positive antinuclear antibodies [ANA] as well as patients with active disease showed higher levels of ACA. Platelet count did not change significantly, however, there was a significant increase in the mean platelet factor 4 [PF4] which correlated positively with the ACA levels. Doppler study of the peripheral vessels revealed significant decrease in the blood velocity. An abnormal waveform pattern was found in 20% of the patients. These changes together with the minor cardiac abnormalities detected by Doppler echocardiography did not correlate significantly with the ACA levels

Artropatías seronegativas infantiles / Seronegative artropathies in children

Se analizaron las características clínicas, de laboratorio y radiológicas en 35 niños afectados por oligoartritis crónicas que fueron controlados entre los años 1980 y 1989, con el próposito de identificar en ellos las diferentes formas de artropatías seronegativas infantiles, a lo largo de un seguimiento de 3,3 años (media). 63 por ciento de los pacientes eran varones, en 88,6 por ciento de los casos la enfermedad comenzó después de los 8 años de edad, todos tuvieron síntomas articulares, siendo tobillos y rodillas los sitios más afectados. Se registraron manifestaciones de compromiso del esqueleto axial en 71,44 por ciento y entesitis en igual porcentaje de los pacientes, 45 por ciento de los cuales tenían antecedentes familiares de afección reumatológica, 34,3 por ciento de diarrea precedente y 85,7 por ciento manifestaciones mucocutáneas. La velocidad de sedimentación era mayor a 50 mm en 57 por ciento de estos niños y HLA B27 positivo en 45,7 por ciento de ellos. Entre los 28 pacientes en quienes se efectuó radiológico y cintigráfico, en 32 por ciento se encontraron alteraciones radiológicas y en 50 por ciento cintigráficas. El diagnóstico definitivo se pudo hacer en 43 por ciento de los pacientes, permaneciendo el resto como espondiloartropatías indiferenciadas. Los niños que sufren oligoartritis predominantemente en las extremidades inferiores asociadas a entesopatía deben ser evaluados y controlados en el tiempo para pesquisar las espondiloartropatías

Tumor necrosis factor-alpha and interleukin-1-beta in rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus and scleroderma: Correlations with clinical, laboratory and radiological indices of disease severity

This study included 84 patients with arthritis; 34 with rheumatoid arthritis [RA], 16 with juvenile rheumatoid arthritis [RA], 24 with systemic lupus erthematosus [SLE] and 10 with scleroderma. In addition, 25 normal healthy subjects' age and sex matched were included as controls. All studied cases have been subjected to careful history and clinical examination to joints to assess disease activity. They were also subjected to laboratory investigations which included hologram, acute phase reactants [erythroytic sedimentation rate: EST; C-reactive protein: CRP and alpha-macroglobulin: alpha-MG, rheumatoid factor: RF, antinative DNA ntibodies, LE cells and serum determination of tumor necrosis factor-alpha [TNF-alpha] and interleukin-1-beta [IL-1-beta]. Radiographic examination to the affected joints with quantitavite evaluation of joints erosin and narrowing in hands and feet were done. The results of the study revealed significantly higher serum levels pf TNF-alpha and IL-1-beta [p< 0.01 for each] in patients compared with controls. RA patients showed significantly higher serum levels of TNF-alpha than SLE scleroderma group [p< 0.01 for each]. The mean serum level of IL-1-beta was significantly higher in cases with RA than each of JRA, and scleroderma [p< 0.05, p< 0.001 respectively]. Significant positive correlation was found between the two cytokines; TNF-alpha and IL-1-beta [r=0.937, p< 0.001] and both showed positive significant correlation with ESR but not with CRP and alpha2mg, in spite of the significant correlation which were found between ESR and either CRP or alpha2m. Scores for bone erosions and joint space narrowing were significantly higher in RA group than either SLE or sclroderma group [p< 0.001 for each], but no significant difference was found between RA group and JRA group. Scores for bone erosins and joint space narrowing showed significant positive correlations with serum levels of either TNF-alpha or IL-1-beta in RA group [r=0.443 and 0.458, p< 0.04 and < 0.003 respectively], and in JRA group [r=0.451 and 0.416, p< 0.04 and < 0.05 respectively]. In conclusion, serum levels of TNF-alpha and IL-1-beta were found to be correlated with the degree of severity of arthritis as assessed clinically, laboratory and radiologically and the significantly higher levels of both TNF-alpha and IL-1-beta in RA and JRA can be attributed to more severe joints affection in both of them than SLE and scleroderma

Artrite reumatóide juvenil: alteraçöes da quimiotaxia de leucócitos / Juvenile rheumatoid arthritis: changes in leukocyte chemotaxis

A migraçäo estimulada e espontânea dos leucócitos do sangue periférico foi estudada em 15 pacientes com ARJ e em 15 controles. As célulasdos pacientes mostraram capacidade de migraçäo igual à das células dos controles. Entretanto, frente ao soro ativado dos pacientes, foi observada diminuiçäo significante da migraçäo dos leucócitos, tanto de pacientes como de controles, sugerindo a existência de fator sérico responsável pelo comprometimento da quimiotaxia nesses indivíduos. Para avaliar os efeitos da lavagem das células sobre a migraçäo das mesmas, foram estudadas paralelamente células lavadas e näo lavadas. Diferença significante foi observada, tendo sido menor a migraçäo espontânea e estimulada (tanto com soro de controles como de pacientes) das células lavadas. A determinaçäo de C3 por imunodifusäo radial e de imunocomplexos pelo ensaio com C1q mostrou níveis maiores nos pacientes do que nos controles

Pattern of rheumatic diseases in south India. IV. Clinical profile of juvenile rheumatoid arthritis.

An analysis of 100 consecutive cases of juvenile rheumatoid arthritis from South India revealed a male preponderance (62%), a lower incidence of the systemic onset variety (10%) and equal incidence of systemic features when compared with the West. Knees and ankles were the joints commonly involved. The incidence of elevated erythrocyte sedimentation rate and C reactive protein, with haemoglobin levels below 10 g/dl was highest in the systemic onset variety. The polyarticular and systemic onset group responded well to aspirin, while the pauciarticular group responded well to indomethacin.

Auroterapia precoce na artrite reumatóide juvenil / Early aurotherapy in youth rheumatoid arthritis

Estuda o presente trabalho o resultado do tratamentoa áurico precoce em onze pacietnes portadores de artrite reumatóide juvenil. Avalia a evoluçäo clínica e laboratorial dos doentes observados ao longo de oito anos e conclui que a precocidade do tratamento modifica a evoluçäo natural da artrite reumatóide. Ressalta a importância da história psicossomática das crianças observadas e o trauma familiar conseqüente desempenhando papel de relevo na gênese e na evoluçäo da artrite reumatóide