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

There are many measures that can be used for the short and longterm monitoring of patients with rheumatoid arthritis (RA). An important requirement for such assessments is the development of new pharmacologic therapies. It is important to assess the need for and the outcome of therapy. In recent years, it has been realized that subjective assessments have many advantages over objective ones. However, in the majority of cases subjective measures and objective measures parallel each other closely. The measurement of acute phase protein, in particular C-reactive protein (CRP), is helpful as an indicator of successful therapy. From data regarding axial osteoporosis, CRP has been shown to be a convenient marker indicating persistent active disease that will produce catabolic effects. Dual energy X-ray absorption scans have also been shown to be promising in objectively measuring change in the hand for patients with inflammatory arthritis. In patients presenting early with RA, it is necessary to have accurate indicators. In this respect, genetic predictors have a particular value. The most important aspect of the assessment of RA is subjective impressions. Therefore, a functional questionnaire such as the health assessment questionnaire combined with the objective measure of choice, CRP levels, are the assessments of choice.
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PMID:Assessment of rheumatoid arthritis--a clinician's viewpoint. 782 15

Since 1973, assessment of serum concentrations of C-reactive protein (CRP) has been advocated as a objective measure of disease activity in rheumatoid arthritis (RA). Our review of clinical experience with CRP measurement suggests it has at least two important roles to play in the management of RA. First, persistently elevated CRP levels have prognostic value. In general, such elevated levels are found in those patients who are at greater risk for continuing joint deterioration and therefore may need more aggressive treatment and supportive care. Second, in general, improvement in CRP levels is an objective indication that a drug has produced a beneficial effect and thus may be useful to the physician for monitoring effects of therapy. Since CRP may be elevated in a number of conditions besides RA, a diagnosis of RA must be made before using CRP as a prognostic factor.
Semin Arthritis Rheum 1994 Oct
PMID:The value of C-reactive protein measurement in rheumatoid arthritis. 783 58

Quantitative bone scan (QBS), computed tomography (CT), and magnetic resonance imaging (MRI) have each been used to confirm the diagnosis of active sacroiliitis (SI) in patients with low back pain (LBP). The authors prospectively evaluated 19 patients referred for symptoms of possible inflammatory LBP (group I), 26 seronegative spondyloarthropathy (SNSP) patients with LBP (group II, inflammatory or mechanical), and 5 SNSP patients without LBP (group III) to determine which radiological scan alone or in combination with other serological tests (Westergren erythrocyte sedimentation rate, C-reactive protein, HLA-B27, immunoglobulin A) was most useful in confirming a clinical diagnosis of active inflammatory SI. All patients were followed up for a minimum of 1 year to confirm the clinical diagnosis and evaluate response to therapy. Eight of 19 group I patients had active SI clinically or on plain radiographs on follow-up evaluation. Of these patients, 5 had abnormal QBS (71%), 3 had abnormal CT scans (38%), and 8 had abnormal MRI scans (100%, type I lesions). These type I MRI lesions were indicative of active inflammation manifested as subcortical bone marrow edema. The remaining 11 group I patients had negative scans for SI. Ten of 26 group II patients with LBP had SI diagnosed clinically and confirmed with positive QBS (60%), CT (100%), and MRI (100%, type I lesions). The remaining 16 group II patients had mechanical LBP without active SI clinically and had negative QBS (88%), CT (19%), and MRI (100%, normal or type II lesions). These type II MRI lesions represented old postinflammatory lesions with either fibrosis or fat replacement. All 5 group III patients had negative scans for active SI. Three patients (2 group I and group II) with inflammatory SI treated with sulfasalazine showed marked improvement on serial MRI scans. Westergren erythrocyte sedimentation rate, C-reactive protein, immunoglobulin A, and CT scan alone or in combination with other tests were not reliable predictors of active SI. Positive QBS and HLA-B27 tests were the best combination of screening tests with 82% predictability of inflammatory SI in whites, and QBS alone had an 80% predictability in black patients. However, MRI, which had 100% predictability, was the best single test for confirming active inflammatory SI.
Semin Arthritis Rheum 1993 Dec
PMID:Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. 812 19

This brief review was inspired by discussions relating to the IIIrd. International C1 Workshop (this volume) and the realization that certain functional properties of the C1q molecule are limited exclusively to the A-chain. The collagen-like region of the A-chain contains a major binding site for non-immunoglobulin substances, which include C-reactive protein, serum amyloid P, LPS and DNA. This binding site is immediately adjacent to, and partially overlapping with, an arthritis-modulating epitope common to the C1q A-chain and various types of collagen, including cartilage type II collagen. At the N-terminal end of the C1q A-chain is a leader peptide sequence that anchors the intact C1q molecule firmly in the membrane of macrophages, the C1q molecule can thus be classified as a type II membrane protein, functioning as an additional receptor for molecules known to react with C1q in fluid phase such as the Fc region of IgG, LPS and polyanionic molecules (e.g. chondroitin sulphate, heparin, dextran sulphate etc.). The various domains within the A-chain, and their respective functions (or potential functions), are presented and discussed in the context of the intact C1 molecule and with regard to any wider functional relevance.
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PMID:Functional domains of the human C1q A-chain. 817 66

Over a 9-year period, twelve patients (8 boys, 4 girls), from 3 to 14 years old, were diagnosed as having Still's disease. Intermittent spiking high fever, poly- or pauci- articular arthritis, and typical evanescent skin rash were the most prominent clinical features. Hemogram examinations showed that 36% of the patients had anemia, ninety-two percent had neutrophilic leukocytosis and 78% had thrombocytosis. Serologically, none had positive results of rheumatoid factor and anti-nuclear antibody. Serum ferritin level was obtained from six patients and all revealed marked elevation during active disease. C-reactive protein and erythrocyte sedimentation rate were both invariably elevated. Immunologically, elevated serum concentrations of IgG, IgA, and complements (C3, C4) were found in 33%, 20%, and 17%, respectively. Furthermore, eighty percent of patients showed an increased serum level of circulating immune complexes. Aspirin (ASA) was used in all patients, but 92% of them required non-steroid antiinflammatory drugs (NSAIDs) in combination to get a better response. Sixty-seven percent of patients needed corticosteroids to control the acute systemic manifestations. Other disease-modifying agents were also used in 33% of our patients. ASA-induced liver function impairment was found in two cases. In addition, one patient experienced an episode of upper gastrointestinal bleeding. Generally speaking, the overall prognosis was good. One patient (8%) died of internal bleeding after a needle liver biopsy.
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PMID:Still's disease: experience in 12 children. 823 59

It is reported that most of the causative organisms of suppurative arthritis complicating rheumatoid arthritis (RA) is Staphylococcus aureus and that Streptococcus pneumoniae is rare, representing less than 5% of cases of suppurative arthritis complicating RA. We here report two cases of pneumococcal septic arthritis complicating RA. Both were female, and 68 and 64 years old, respectively. They had active, long-standing RA with destructed changes. Infected joints included both knees (case 1) and right knee (case 2). Pain and loss of motion in the septic joints were prominent. On admission, the physical examination showed severe redness, swelling and tenderness of the septic joints and the range of motion of those was markedly decreased. The radiograph of affected joints showed stage III. Laboratory data showed markedly elevated ESR of 127 mm/hr (case 1) and 142 mm/hr (case 2) and C-reactive protein of 49.91 mg/dl (case 1) and 30.36 mg/dl (case 2). Aspirate of the left knee of case 1 showed numerous neutrophils. Cultures of the joint fluid grew S. pneumoniae. Grossly purulent material was aspirated from the right knee of case 2 and cultures also grew S. pneumoniae. They were started on intravenous antibiotics with a good response and the function of involved joints returned to preseptic condition. The source of infection on case 1 was presumed to be otitis media because she had discharge from left ear concurrently with the exacerbation of joint symptoms. Case 2 had productive cough and cultures of sputum also disclosed S. pneumoniae when pain of right knee joint developed. The suggested source of infection was upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of pneumococcal septic arthritis complicating rheumatoid arthritis]. 831 8

The immuno-reactive human epidermal growth factor (h-EGF) level, measured by a sensitive enzyme immunoassay, was significantly higher in synovial fluids or synovial tissue extracts from 89 patients with rheumatoid arthritis (RA) than in those from 53 patients with osteoarthritis. RA synovial immuno-reactive h-EGF was predominantly of a low molecular weight form (LMW h-EGF) on gel filtration chromatography. Furthermore, in the RA group, the synovial immuno-reactive h-EGF correlated positively with C-reactive protein, an acute-phase reactant, in the blood examination and with synovial immunoglobulin M. These results suggest that synovial h-EGF is specifically produced by RA synovium from the initial stage of arthritis, and that the measurement of synovial h-EGF serves as an early indicator to appraise the RA activity. A pathogenesis of RA including growth factors and growth inhibitory factors are discussed.
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PMID:Immuno-reactive human epidermal growth factor (h-EGF) in rheumatoid synovial fluids. 840 46

Analysis of the synovial fluid is the major investigation of monoarthritis. Appearance, viscosity (low if inflamed), cell number and differential, presence of crystals or organisms are all relevant. If septic arthritis is suspected, culture of other sites such as blood, urine, sputum etc. is essential, and may alone yield the organism. If mycobacterium is possible, synovial membrane staining and culture is usually necessary. Gonococcal may be lost in culture if the specimen is not immediately processed. Partially treated sepsis may produce sterile culture, and early work suggests that P.C.R. may diagnose these cases. Other investigations such as erythrocyte sedimentation rate, C-reactive protein indicate inflammatory activity, though they are not specific. Antibodies such as antinuclear antibodies, rheumatoid factors lead towards an "autoimmune" disease diagnosis, that do not alone measure activity. Specific antibodies to virus e.g. parvovirus may be diagnostic. The monoarthritis must be seen in the total patient context, where often clues e.g., asymptomatic uveitis (in juvenile chronic arthritis) and psoriasis may give the diagnosis.
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PMID:[Laboratory diagnosis of monarthritis: how much, what for, when?]. 850 31

To determine the impact of the HLA B27 antigen on the expression of spondylarthropathies, we conducted a retrospective cross-sectional study of the 116 spondylarthropathy patients whose HLA B27 phenotype was determined during a stay in the Morvan Hospital rheumatology department, Brest, France, between January 1, 1986, and December 31, 1994. Age at disease onset was younger in the HLA B27-positive patients (31.5 +/- 14 years versus 40 +/- 15 years; p = 0.008), who were more likely to have buttock pain (odds ratio, 4.84; p < 0.001) and roentgenographic evidence of sacroiliitis (odds ratio, 5.34; p < 0.001) and less likely to have psoriasis (odds ratio, 0.15; p < 0.0001), as compared with their HLA B27-negative counterparts. Peripheral arthritis occurred in similar proportions of patients with and without the HLA B27 antigen. Presence of HLA B27 was of little value for the diagnosis of spondylarthropathy in patients with inflammatory joint disease involving peripheral joints (sensitivity 50%, specificity 92%, positive predictive value 53%, negative predictive value 91%). Higher mean values of the erythrocyte sedimentation rate (40.3 versus 30.6 mm/h; p < 0.05) and serum C-reactive protein level (29.8 versus 16.8 mg/L, p < 0.005) were seen in patients with the HLA B27 antigen. Our data from patients with any form of spondylarthropathy show that the HLA B27 antigen is associated with earlier-onset disease, involvement of the sacroiliac joints and more severe inflammation.
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PMID:The HLA B27 antigen-spondylarthropathy association. Impact on clinical expression. 857 9

Twelve patients of leprosy with arthritis and 161 patients without arthritis were studied for immunological parameters like immunoglobulins (IgG, IgM, IgA), C-reactive proteins and rheumatoid factor. There was increase in the levels of IgG, IgA value in leprosy patients with and without arthritis compared to healthy control. IgM level was decreased in both the groups compared to control, but significant decrease was observed (p < .01) in patients with arthritis. C-reactive protein was significantly positive in leprosy with arthritis group (p < .01) and positive in 12 cases of leprosy without arthritis group compared to negative control group. Rheumatoid factor was present in leprosy with arthritis (16.6%) compared to both the control group and leprosy without arthritis group. This study concluded the presence of arthritis in leprosy patients as a definite entity which showed changes in immunological parameters.
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PMID:Immunological parameters in leprosy patients with and without arthritis. 857 90


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