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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spondylarthropathies consist of several disorders: reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, a subgroup of juvenile chronic arthritis, and ankylosing spondylitis. Their clinical presentation may consist in the following inter-related features: axial involvement, peripheral articular involvement, enthesiopathic lesions, extra-articular disease. The monitoring of these diseases is related more to their clinical presentation than to the precise diagnosis. Modalities for monitoring peripheral arthritis are similar to those of rheumatoid arthritis (essentially based on the number of tender and swollen joints). The modalities of the monitoring of extra-articular features (uveitis, psoriasis,...) are specific to these clinical features and can be categorized in 2 ways: the first one consists in considering the occurrence of the episodes (for example, number of acute anterior uveitis per year), the second one consists in the evaluation of the severity of the clinical features (for example the area of psoriatic skin lesions). Numerous tools have been proposed to evaluate the axial involvement of the disease. The international rheumatologic community (ILAR for International League Against Rheumatism) via specific task force (ASAS for Assessment in Ankylosing Spondylitis) tried to standardize the medical language (at least in clinical research studies) by giving recommendations to evaluate specific domains and within each domain specific tools. Currently, it is generally agreed that pain and functional impairment are the two main domains to consider. For each of these domains, different tools have been proposed (for example the ASFI: Ankylosing Spondylitis Functional Index and the BASFI: Bath Ankylosing Functional Index are both tools proposed to evaluate the functional impairment). The domain "range of motion" is probably one of the most important for long term outcome in clinical research studies and for facilitating the orthopedic indications in daily practice. Finally, radiological tools permitting the evaluation of the structural damage of the disease are available. They take into account the presence and/or the severity of hip and sacroiliac involvement and also the extent of the spinal syndesmophytes. Longitudinal studies are required to evaluate their clinical relevance.
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PMID:[Follow-up of the patient with spondyloarthropathy]. 1149 May 37

Optimal management of childhood rheumatic diseases requires an appreciation of their multisystem nature. The eye represents an important site of involvement, and inflammation of the uveal tract is a particularly frequent and potentially debilitating extra-articular feature of some childhood rheumatic diseases. Anterior uveitis associated with oligoarticular juvenile idiopathic arthritis is an especially distinctive entity. Other disorders in children, however, can be associated with posterior and intermediate uveal tract inflammation. The potentially debilitating consequences of uveitis associated with childhood rheumatic diseases, the inadequacies of existing therapies, and the immunopathogenic basis for particular forms of uveitis have prompted the use of immunomodulatory therapy, including new biologic agents, to treat childhood uveitis. This review summarizes recent contributions to the literature that help to clarify the spectrum of conditions associated with uveitis in children, consider evidence for immunopathogenic processes associated with uveitis, and address new approaches to therapy.
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PMID:Uveitis associated with childhood rheumatic diseases. 1219 52

The concept of spondyloarthropathy was recognized first by clinicians based on the aggregation of several diseases occurring either sequentially in the same patient or simultaneously in a family. This concept was thereafter confirmed by the higher prevalence of the HLA-B27 antigen, not only in the group of patients suffering from an axial involvement of ankylosing spondylitis but also in other diseases belonging to the concept of spondyloarthropathy, i.e. psoriatic arthritis, reactive arthritis, inflammatory-bowel-disease-related arthritis and/or other clinical manifestations such as acute anterior uveitis. Recognition of the concept of the spondyloarthropathy is of great importance not only for research purposes but also in daily practice because such recognition has at least a threefold effect: (a) it permits earlier diagnosis, (b) it facilitates patients' education and monitoring, and (c) it has prognostic implications
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PMID:Why is the concept of spondyloarthropathies important? 1240 23

Approximately 40% of patients with ankylosing spondylitis or reactive arthritis will experience the sudden onset of a unilateral anterior uveitis sometime during the course of their spinal disease. In most instances, this inflammation resolves within several weeks and responds to corticosteroid and mydriatic eye drops without the need for additional therapy. A small percentage of patients with either Crohn's disease or psoriatic arthropathy will have a bilateral, chronic, anterior and/or posterior uveitis that is more refractory to therapy. A similar clinical challenge is occasionally encountered in patients with ankylosing spondylitis or reactive arthritis. In this manuscript, we review briefly the clinical manifestations of the uveitis associated with spondyloarthropathy and discuss several potential novel therapeutic approaches, primarily anti-tumor necrosis factor (TNF) therapy.
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PMID:Anti-TNF therapy for eye involvement in spondyloarthropathy. 1246 66

Juvenile-onset spondyloarthritides (SpA) is a term for a group of HLA-B27 related disorders. The hallmark signs and symptoms of this group of disorders include peripheral arthritis and enthesitis while sacroiliitis and spondylitis develop in some cases later on and extrarticular manifestations such as anterior uveitis occurs occasionally. Conventional medical therapy in children consists of non-steroidal anti-inflammatory drugs and corticosteroids that are administered intraarticulary, even in the sacroiliac joints. Sulfasalazine and methotrexate are given in cases of chronic synovitis or enthesitis. Unfortunately, these forms of therapy have limited efficacy in many cases and disease activity and damage may lead to various degrees of functional impairment. Recently, experience with TNFalpha-antagonists in adults has opened new perspectives for treating patients with refractory SpA, particularly ankylosing spondylitis (AS). So far there is only little experience in the treatment of juvenile-onset SpA, consisting of case reports and case series where etanercept or infliximab have been given to children suffering from refractory juvenile-onset AS and psoriatic arthritis. From these observations there is evidence that treatment seems to be as effective as in adults. Risks are likely to be the same as in patients suffering from other forms of juvenile idiopathic arthritides. However, without further studies no recommendations can be provided for indication for treatment, dosing, intervals and duration of treatment.
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PMID:TNF-alpha antagonists for the treatment of juvenile-onset spondyloarthritides. 1246 65

Spondyloarthropathies are characterized by both axial and peripheral joint involvement, by the association with "other diseases" mainly Psoriasis, Crohn's and Anterior Uveitis and by the high prevalence of HLA B-27. While disease modifying drugs, such as Methotrexate or Sulfasalazine, are only partially effective in controlling peripheral arthritis, the treatment of the axial part remained only symptomatic. The recently introduced anti-TNF-alpha drugs Infliximab (Remicade) and Etanercept (Enbrel) for the treatment of Crohn's disease and Rheumatoid Arthritis has been expended to Spondyloarthropathies with highly promising results. The rationale and the early beneficial results of this new approach in spondyloarthropathies are reviewed.
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PMID:[Anti-TNF-alpha treatment and spondyloarthropathies]. 1247 31

A pediatric patient with prolonged seronegative polyarticular juvenile idiopathic arthritis (JIA) and concomitant aggressive, anterior uveitis refractory to any conventional antirheumatic therapy was treated with infliximab. Arthritis and C-reactive protein (CRP) values showed prompt positive effects but, after 6 weeks, returned gradually to initial values despite ongoing therapy. In contrast, a more sustained therapeutic effect was observed on the uveitis, with increased visual acuity and reduced inflammatory signs of the affected eye. However, this benefit was also lost at week 30, after which infliximab had to be discontinued due to side effects. To conclude, in polyarticular seronegative JIA, infliximab showed a transient beneficial effect which was more pronounced on uveitis than arthritis.
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PMID:Therapeutic experience with infliximab in a patient with polyarticular juvenile idiopathic arthritis and uveitis. 1268 88

Chronic scarring-type uveitis is a frequent extra-articular manifestation of juvenile idiopathic arthritis. It occurs in about 20% of children with this disease, commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis, usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition, routine screening of juvenile idiopathic arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics, in severe cases with immunosuppressive agents, and surgical management of complications. Although the prognosis of uveitis is improving, there are cases refractory to standard regimens. Patients in whom uveitis commences prior to the onset of arthritis present a special problem.
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PMID:Recent advances in uveitis of juvenile idiopathic arthritis. 1449 17

OBJECTIVE: To evaluate the frequency of chronic anterior uveitis in patients with juvenile idiopathic arthritis and its association with the presence of antinuclear antibodies. PATIENTS AND METHODS: We retrospectively studied 72 patients with juvenile idiopathic arthritis. All of them were submitted to slit-lamp examination of the anterior chamber at diagnosis. Both antinuclear antibodies and rheumatoid factor were determined. Patients with positive results for antinuclear antibodies were evaluated every three months and those with negative results were assessed every six months. RESULTS: Forty patients were male (55.5%) and 36 were Caucasoid (50%). The mean age at the onset of juvenile idiopathic arthritis was 6.4 years (range = 1 to 14 years) and the mean age at the beginning of the study was 10.4 years (1 to 19 years). According to the type of disease at onset, 32 were pauciarticular (44.4%) (17 boys and 15 girls), 30 were polyarticular (41.6%) (17 boys and 13 girls) and 10 were systemic (14%) (6 boys and 4 girls). We observed chronic anterior uveitis in five patients (6.5%) (mean age = 11.4 years). Among them, four (80%) had pauciarticular juvenile idiopathic arthritis at disease onset (three girls with type I juvenile idiopathic arthritis and positive antinuclear antibodies and one boy with type I juvenile idiopathic arthritis and negative antinuclear antibodies) and one girl with polyarticular juvenile idiopathic arthritis (negative antinuclear antibodies and rheumatoid factor). In this group, the mean age at the onset of juvenile idiopathic arthritis was 5.1 years and the mean age of uveitis onset was 9 years. Antinuclear antibodies were positive in 3/5 patients (60%) with uveitis. Antinuclear antibodies were positive in 12% of the patients without uveitis (n = 67). Among the patients with uveitis, three had only one flare and the other two had four flares with cataract. The frequency of antinuclear antibodies was statistically higher in the patients with uveitis (P< 0.05). CONCLUSION: Although the incidence of uveitis in our study was lower than that reported in the literature, the frequency of uveitis was higher in females, in those with pauciarticular juvenile idiopathic arthritis and in patients with positive antinuclear antibodies.
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PMID:[Uveitis in juvenile idiopathic arthritis] 1464 14

The spondyloarthritides (SpA) comprise ankylosing spondylitis (AS), psoriatic SpA (PsSpA), reactive SpA (ReSpA), arthritis associated with chronic inflammatory bowel disease (SpAIBD) and undifferentiated SpA (uSpA). There are characteristic clinical features of SpA: inflammatory back pain (IBP), asymmetric peripheral arthritis, enthesitis, anterior uveitis, positive family history and others. The SpA, mainly AS, are strongly associated with HLA B27. AS is the most frequent and potentially most severe subtype, next to PsSpA. The prevalence of all SpA is rather high and not much different from rheumatoid arthritis (RA) and AS patients carry a burden of disease similar to RA patients. The prognosis of AS has not been extensively studied but some factors have been identified. There is a clear role for imaging modalities in the diagnosis of AS. Changes in the sacroiliac joint as detected by radiography still constitute the basis for the diagnosis of AS (New York criteria 1984). A diagnosis of sacroiliitis as made by magnetic resonance imaging (MRI) provides more objective evidence to a diagnosis of IBP arguing in favour of SpA which is defined on the basis of the ESSG criteria 1991 mainly on a clinical basis. Radiographic spinal changes such as syndesmophytes are important for the staging and outcome of AS. MR based assessment of spinal changes in are now being increasingly used to assess disease activity of AS patients. The presence of spinal radiographic changes at time of presentation was found to be the best predictor of further deterioration using the score modified SASSS' in a recent study. Other clinical features such as hip arthritis, early onset of disease, dactylitis, oligoarthritis, limitation of spinal mobility and poor efficacy of nonsteroidal antiinflammatory drugs were found to also have negative prognostic value.
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PMID:[Epidemiology and prognostic aspects of ankylosing spondylitis]. 1528 56


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