Reactive arthritis after pharyngeal infection: report of two siblings

Abstract

?In this report we describe the cases of two siblings with reactive arthritis (ReA) induced by pharyngeal infections. The patients were a man and his sister living with their parents. He developed arthritis in August 1997, and his younger sister developed similar symptoms in September 1998. Their disease conditions were both severe and required hospitalization. Their conditions improved with the administration of nonsteroidal anti-inflammatory drugs together with antibiotics, and both fully recovered within 1–2 weeks. Rheumatic fever was ruled out since streptococcal infections were not demonstrated with antistreptolysin O (ASO) or antistreptokinase (ASK) titers, or with pharyngeal culture. The sister suffered from a rash which was similar to erythema nodosum on her lower extremities, but neither chorea nor carditis was observed. Both human leukocyte antigen (HLA) typing analyses revealed positive results for HLA-B40 and -B39 for the brother and sister, respectively. Both HLA-B40 and -B39 are considered to be related to HLA-B27-negative ReA, most likely poststreptococcal reactive arthritis (PSRA). Therefore, the two patients were tentatively diagnosed as suffering from PSRA.     

Leflunomide: an immunosuppressive drug with multiple effects on T cell function

Abstract

Leflunomide has recently been introduced as a new treatment for rheumatoid arthritis. Although its immunosuppressive effect has been well demonstrated in experimentally induced autoimmune diseases and in organ transplant rejection in animal models, the exact mechanisms mediating its immunomodulatory effect are not fully understood. As T cells play a central role in the orchestration of immune responses in both physiological and pathological conditions, it has been proposed that the ability of leflunomide to suppress inappropriate and unwanted immunity is related to a functional inhibition of T cells. A precise knowledge of the mechanisms of leflunomide's action on T cells is therefore necessary. As the clinical effect of leflunomide has been well described elsewhere, this review will focus on, and will discuss, current data on the different aspects of leflunomide's effect on T cell function.     

Hand ultrasound: Comparative study between “no rhupus” lupus erythematosus and rheumatoid arthritis

Abstract

Objective. To compare hand US between systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients.

Methods. Hands (1st–5th metacarpophalangeal [MCP] and 1st–5th proximal interphalangeal [PIP] joints) and wrists (radiocarpal and distal radioulnar joints) of 62 “no rhupus” SLE and 60 RA patients were compared through US (linear probe, 6–18 MHz). The findings were compared to clinical, functional, serological outcomes, and disease activity indices.

Results. 2108 and 2040 joint recesses were evaluated in SLE and AR patients, respectively. Synovitis was found in 46.8% and 75% of wrists, 83.9% and 86.7% of MCPs and 58.1% and 70% of PIPs in the SLE and RA groups, respectively. More significant US findings were found in RA group. Greater values of synovitis (mm) in RA group were only found in the joint recesses of wrist (p < 0.001–0.002). In SLE group, US findings were associated with “puffy hands,” Health Assessment Questionnaire score and dynamometry. Twenty-two SLE patients (35.5%) had erosion in any of joints studied. SLE patient subgroup with US erosion was associated with hematological involvement and Jaccoud's arthropathy.

Conclusions. US of “no rhupus” SLE and RA patients is different, especially in wrists. In SLE patients the clinical variable most associated with US findings was “puffy hands.”     

Pharmacokinetics,efficacy and safety profiles of etanercept monotherapy in Japanese patients with rheumatoid arthritis: review of seven clinical trials

Abstract

Conventional synthetic disease-modifying anti-rheumatic drugs, including methotrexate, may not be tolerated by all patients with rheumatoid arthritis (RA), and limited international data for etanercept (ETN) monotherapy are available. The aim of this review was to summarize the clinical program for ETN monotherapy in Japanese patients with RA, which has included a pharmacokinetic study, clinical trials for registration, long-term studies, and once-weekly dosing studies. Pharmacokinetic results showed that serum concentrations of ETN were linear with dose levels and were similar to other international studies. Across interventional studies, 652 Japanese patients with active RA were treated with ETN. In the registration studies, ETN treatment led to consistent improvement in American College of Rheumatology 20/50/70 scores, European League Against Rheumatism Good Response, Disease Activity Score 28 erythrocyte sedimentation rate remission, and Health Assessment Questionnaire disability index. In the long-term studies, efficacy was maintained for up to 180 weeks. Similar results were seen in the once-weekly studies. Across the studies, more than 870 patient-years of exposure to ETN were recorded. Discontinuations owing to lack of efficacy or adverse events were modest and no new safety signals were recorded. These studies demonstrated that ETN monotherapy is efficacious and well-tolerated in Japanese patients with RA.     

Obstacles to the implementation of the treat-to-target strategy for rheumatoid arthritis in clinical practice in Japan

Abstract

Objective. To clarify the obstacles preventing the implementation of the treat-to-target (T2T) strategy for rheumatoid arthritis (RA) in clinical practice.

Methods. A total of 301 rheumatologists in Japan completed a questionnaire. In the first section, participants were indirectly questioned on the implementation of basic components of T2T, and in the second section, participants were directly questioned on their level of agreement and application.

Results. Although nearly all participants set treatment targets for the majority of RA patients with moderate to high disease activity, the proportion who set clinical remission as their target was 59%, with only 45% of these using composite measures. The proportion of participants who monitored X-rays and Health Assessment Questionnaires for all their patients was 44% and 14%, respectively. The proportion of participants who did not discuss treatment strategies was 44%, with approximately half of these reasoning that this was due to a proportion of patients having a lack of understanding of the treatment strategy or inability to make decisions. When participants were directly questioned, there was a high level of agreement with the T2T recommendations.

Conclusion. Although there was a high level of agreement with the T2T recommendations, major obstacles preventing its full implementation still remain.     

Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis

Abstract

The objective of this study was to compare standard hand radiographs with in-office 0.2?T magnetic resonance imaging (MRI) in monitoring response to therapy in patients with rheumatoid arthritis (RA) who were receiving infliximab, to evaluate the frequency and location of erosions, and to determine if there were differences in outcome based on disease duration at baseline. Patients who satisfied the American College of Rheumatology criteria for RA and were receiving infliximab therapy were evaluated with a baseline and 1-year follow-up MRI. Magnetic resonance images were interpreted by two blinded, board-certified radiologists. Bone erosions were identified as well-defined defects extending through the cortical margin. The mean age of the 48 patients was 58.5 years. The median infliximab dosage was 4?mg/kg. Baseline data showed that 41 patients had abnormal MRIs. The mean time between the baseline and follow-up MRI examinations was 10.5 months. Follow-up MRI revealed regression in 11 patients. Thirty-one patients had both MRIs and radiographs. Magnetic resonance imaging was approximately twice as sensitive as radiography in detecting erosions at baseline. In-office MRI was useful in monitoring disease response after the initiation of infliximab treatment. Magnetic resonance imaging is potentially a very valuable diagnostic tool and prognostic indicator for use in patients with RA.