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1.
Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis 总被引:4,自引:0,他引:4
Frediani B Falsetti P Storri L Allegri A Bisogno S Baldi F Marcolongo R 《Clinical rheumatology》2002,21(4):294-298
Enthesitis is an inflammatory lesion of the tendon, ligament and capsular insertions into the bone, and it is a fundamental
element in the diagnosis of spondyloarthropathies. Sonography is the method of choice for studying periarticular soft tissues
because it is capable of detecting both the early (oedema, thickening) and late alterations (erosions and enthesophytes);
it is also an inexpensive, biologically harmless and easily repeatable technique. The aim of this study was to compare the
prevalence of quadricipital enthesitis in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients, and to document
any clinical and echostructural differences in this lesion between the two diseases. The results show that enthesitis is more
frequent in PsA patients, more than half of whom are asymptomatic. Knee inflammation was found in the PsA patients with enthesitis
regardless of the concomitant presence of joint effusion; none of the RA patients suffered from enthesitis alone. Quadricipital
enthesitis is more frequent in male patients. There was no significant correlation between the presence of peripatellar psoriatic
lesions and enthesitis. Sonographic examinations of patients with enthesitis revealed that those with RA had predominantly
inflammatory lesions, whereas PsA patients also showed major new bone deposition.
Received: 24 January 2001 / Accepted: 16 January 2002 相似文献
2.
The aim of this study was to identify potential markers of aggressive joint manifestations and HLA associations in patients
with psoriatic arthritis (PsA) in northern Sweden. Patients with PsA were examined clinically, with laboratory tests and radiologically.
The classification of the disease was based on peripheral and/or axial engagement. HLA B17, B37 and B62 were significantly
increased in PsA patients. Univariate analyses suggest that the HLA antigens B37, B62 and some clinical variables were associated
with disease course. However, in multivariate analyses distal interphalangeal joint affliction and polyarticular manifestations
were the only variables remaining significantly associated with irreversible joint destruction or deformity. There were no
significant effects of HLA antigens. In this cross-sectional study, clinical manifestations were more reliable predictors
of aggressive joint damage than were specific HLA antigens. However, HLA antigens seemed to modify the expression of the joint
disease rather than being involved in joint disease susceptibility.
Received: 13 August 2001 / Accepted: 11 February 2002 相似文献
3.
Taccari E Spada S Giuliani A Riccieri V Sorgi ML Pecorella I Onetti Muda A 《Clinical rheumatology》2002,21(4):335-338
A 58-year-old man developed psoriatic arthritis and, after 6 months, persistent watery diarrhoea. Biopsies from the colorectal
mucosa showed thickened subepithelial collagen consistent with collagenous colitis. There also was an inflammatory cell infiltration
(mainly lymphocytes and monocytes) in the chorion. These findings and the parallel course of articular and bowel complaints
suggest a clinicopathologic correlation between arthritis and colic involvement.
Received: 19 July 2001 / Accepted: 2 January 2002 相似文献
4.
Cross-sectional and longitudinal study of osteoporosis in patients with rheumatoid arthritis 总被引:9,自引:0,他引:9
To elucidate the pathology of osteoporosis associated with rheumatoid arthritis (RA), bone mass measurements were performed
in 146 female patients with RA and compared with those in 150 age-matched female patients with osteoarthritis (OA) and postmenopausal
osteoporosis (OP). Bone mineral density (BMD) was measured at the lumbar spine (L-BMD), the mid-radius (MR-BMD) and the calcaneus
(C-BMD) by dual-energy X-ray absorptiometry (DXA), and at the distal radius by peripheral quantitative computed tomography
(pQCT). The RA group showed significantly lower BMD at all sites, except L-BMD, than the OA group. Compared with the OP group,
the RA group showed a significantly higher L-BMD but no difference at other sites. BMD in RA decreased with disease severity
at all sites and lean body mass was highly correlated with L-BMD and C-BMD. Cross-sectional analysis revealed early bone loss
at the distal radius and a decrease of L-BMD, MR-BMD, and C-BMD with disease duration. Longitudinal analysis showed that the
annual loss of L-BMD, MR-BMD and C-BMD tended to be lower with increasing disease duration. Glucocorticoid administration
had no influence on L-BMD, MR-BMD or C-BMD. We concluded that, unlike postmenopausal osteoporosis, osteoporosis associated
with RA is characterised by relatively preserved bone mass in the axial bone and marked loss in the peripheral bone. The risk
factors for generalised osteoporosis are a long disease duration, severity of disease, and decreased lean body mass.
Received: 8 May 2001 / Accepted: 18 September 2001 相似文献
5.
Corticosteroid usage was assessed in rheumatoid arthritis (RA) and psoriatic arthritis (PA) patients in Italy. A multicentre, observational study was undertaken in 10 Italian rheumatological centres from 1990 to 1992 using a computerised clinical data bank. Nine hundred and seven RA patients and 180 PA patients were studied; 510 (56.2%) RA patients and 44 (24.4%) PA patients were using corticosteroids. The percentage of patients taking corticosteroids ranged from 20.5 to 85.4% for RA patients and from 0 to 55% for PA patients for the different centres. Methylprednisolone was the most prescribed corticosteroid, both in RA patients (63.2%) and in PA patients (65.9%). The average methylprednisolone daily dose was 5.7±3.6 mg in RA patients and 4.5±1.4 mg in PA patients. The data provide evidence that corticosteroids are taken in an unexpectedly high percentage of patients with RA and PA in Italy. 相似文献
6.
Kiraz S Ertenli I Oztürk MA Haznedaroğlu IC Celik I Kirazli S Calgüneri M 《Clinical rheumatology》2002,21(6):453-456
Thrombopoietin (TPO) is the major regulator of growth and differentiation of megakaryocytes. Recent studies have shown that TPO may also act as an acute-phase reactant, and it has been suggested as a component of inflammatory reactions. In this study our objective was to investigate serum TPO levels in patients with rheumatoid arthritis, a complex chronic inflammatory disorder not uncommonly associated with thrombocytosis. Bloodstream TPO concentrations were assessed in 13 RA patients with platelet counts between 450 and 650 x 10(9)/l, 10 RA patients with platelet counts >650 x 10(9)/l, 15 RA patients with normal platelet counts and 12 healthy controls. RA patients with normal platelet counts had TPO levels comparable with healthy controls. TPO concentrations in patients with mild thrombocytosis were significantly elevated, whereas patients with markedly increased thrombocyte counts had prominently decreased TPO levels. These results indicate that TPO seems to be associated with reactive thrombocytosis in RA patients with active disease. In patients with extremely increased thrombocytosis serum TPO levels might be regulated by increased platelet mass via receptor-mediated uptake and metabolism. 相似文献
7.
Both rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have a negative impact on patients’ quality of life (QOL). The
aim of this study was to compare QOL and life satisfaction in patients with RA and PsA. Forty patients with PsA, 40 patients
with RA, and 40 healthy control subjects were included in the study. Demographic data and clinical characteristics including
age, sex, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), peripheral pain assessed by visual
analog scale (VAS) and Larsen scores of hand X-rays were recorded. Nottingham Health Profile (NHP) was used to evaluate QOL,
and Life satisfaction index (LSI) was used to measure psychological well-being in both groups. The demographic data of the
subjects were similar between the groups. The scores of all NHP subscales were significantly higher and the scores of LSI
were significantly lower in PsA and RA patients than in control subjects. The inflammation markers including ESR, CRP, pain
by VAS and Larsen scores were found to be significantly higher in RA patients. The scores of LSI were similar between the
groups. Although the scores of physical domains of NHP (pain and physical disability) were statistically higher in RA patients
(p<0.05), the scores of psychosocial subgroups of NHP were similar between RA and PsA patients (p>0.05). Both PsA and RA patients had disturbed QoL and decreased life satisfaction. In conclusion, peripheral joint damage,
inflammation, and physical disability are significantly greater in RA but psychosocial reflection of QOL and life satisfaction
are the same for both groups which can be explained by the additional impact of skin disease in patients with PsA. 相似文献
8.
Inanc N Dalkilic E Kamali S Kasapoglu-Günal E Elbir Y Direskeneli H Inanc M 《Clinical rheumatology》2007,26(1):17-23
Our aim is to assess the prevalence and associated clinical features of anti-CCP (cyclic citrullinated peptide) antibodies for RF (rheumatoid factor)-positive and RF-negative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In a prospective, cross-sectional, multi-centre study, we determined the titres of anti-CCP antibodies in 208 RA patients (129 RF-positive, 79 RF-negative), 56 PsA patients and 39 healthy controls (HC). Clinical parameters including disease activity (disease activity score 28-DAS28), physical disability (health assessment questionnaire-HAQ), functional capacity (functional class) and radiological erosions were investigated in patients with RA. In PsA patients, clinical and radiological features were determined. Anti-CCP2 antibodies were measured using a second-generation anti-CCP enzyme-linked immunosorbent assay (Euro-Diagnostica, Netherlands). One-hundred four of 129 RF-positive RA (81%), 16 of 79 RF-negative RA (20%), seven of 56 PsA patients (12.5%) and none of the HC had anti-CCP antibodies. RA patients with anti-CCP antibodies had significantly higher disease activity, greater loss of function and more frequent erosive disease than anti-CCP antibody-negative group. In subgroup analysis, anti-CCP antibodies in RF-negative patients were also associated with erosive disease. All PsA patients with anti-CCP antibodies had symmetric arthritis with higher number of swollen joints. The prevalence of anti-CCP antibodies in RF-positive RA patients was significantly higher than in RF-negative RA and PsA patients. Anti-CCP antibodies were also associated with erosive disease in RF-negative RA patients. Both anti-CCP and RF tests were negative in 30% of the patients. Anti-CCP positivity was a frequent finding in PsA and associated with symmetrical polyarthritis. 相似文献
9.
Adel M. Ali Sherin M. Hamza Fatma M. Aboud Nouran M. El-Shahat 《The Egyptian Rheumatologist》2019,41(4):303-307
IntroductionNailfold capillaroscopy (NFC) is simple technique for assessment of the microvascular changes recognized in both diseases can be used in helping the differential diagnosis.Aim of the workTo determine the nailfold capillaroscopic changes in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients and their relation to disease activity.Patients and methodsTwenty PsA and 20 RA patients were studied. Disease activity score (DAS28) was assessed. NFC examination was done to all patients.ResultsThere was a significant decrease in capillary density (8.65 ± 1.39 vs 9.5 ± 1/mm; p = 0.02) and increase in mean capillary width (28.4 ± 7.8 μm vs 22.9 ± 4.3 μm; p = 0.01) in PsA than RA patients. Hairpin, organized capillaries were found in all RA patients while in PsA patients tortuous capillaries were found in 100% and disorganized capillaries in 35%. A significant increase in hemorrhages (65% versus 10%; p < 0.0001) was present in PsA compared to RA patients. In PsA patients, there was a significant correlation between the tender joints count (TJC) and the width of the capillaries (r = 0.44, p = 0.047) and inversely with the capillary density (r = ?0.46, p = 0.04). The TJC significantly associated with the capillary disorganization (p = 0.035). A significant negative correlation between CRP titer and arterial diameter of capillaries (r = ?0.45, p = 0.045).ConclusionThe nailfold capillaroscopy in RA patients had no specific changes, While in PsA patients showed low density, dilated, tortuous and disorganized capillaries and hemorrhages. So, Nailfold capillaroscopy can be used in the differentiation between both diseases. NFC abnormalities may be related to the disease activity. 相似文献
10.
A 52-year-old woman with rheumatoid arthritis treated with low-dose steroids developed bilateral distal tibia and fibula
fractures over a 15-month period. Her bone density was within osteopenic levels. Such fractures are an unusual but increasingly
recognised complication of rheumatoid disease and its treatment, although there is often diagnostic delay. Bilateral fractures
are particularly rare. A high level of clinical suspicion is required for early diagnosis.
Received: 19 June 2000 / Accepted: 26 January 2001 相似文献
11.
To measure serum soluble transferrin receptor (s-TfR) levels in patients with rheumatoid arthritis (RA), sera were obtained
from 50 Japanese RA patients and 20 healthy subjects. Both s-TfR and serum erythropoietin (EPO) levels were measured by enzyme-linked
immunosorbent assay (ELISA). Routine laboratory tests were also performed, including peripheral blood analysis and determination
of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), serum iron levels, total iron-binding
capacity (TIBC) and serum ferritin levels. The s-TfR levels in the 50 RA patients (mean ± SD, 1801 ± 512 ng/ml) were significantly
higher than those in the 20 control subjects (1316 ± 345 ng/ml). There were no differences in the values of s-TfR between
men and women in either group, or between RA patients over and under 50 years old. Serum EPO levels in 47 RA patients were
as low as 14.0 ± 10.1 mIU/ml (mean ± SD), ranging from 3.9 to 58.7 mIU/ml (normal range 2.8–17.2 mIU/ml), unrelated to low
haemoglobin concentration. The s-TfR levels in RA patients showed negative correlations with red blood cell count, serum iron
level and haemoglobin concentration, and positive correlations with ESR and serum EPO levels. However, there were no correlations
between s-TfR level and markers of inflammation such as CRP, platelet count or RF titre. In conclusion, s-TfR level in RA
patients could be a marker of erythropoiesis rather than of joint inflammation.
Received: 14 September 2000 / Accepted: 15 March 2001 相似文献
12.
Pavelka K Forejtová S Pavelková A Zvárová J Rovenský J Tuchynová A 《Clinical rheumatology》2002,21(3):220-226
The aim of the study was to evaluate the efficacy and safety of disease-modifying drugs (DMARDs) in everyday clinical practice
in Central European States (the Czech and Slovak republics). This was a retrospective, multicentre study. With the help of
a special questionnaire, the medical files of 760 patients in 15 centres were analysed looking for reasons for DMARD discontinuation
(e.g. insufficient efficacy, toxicity). The secondary endpoints were duration of therapy with individual DMARDs and the influence
of other factors (demographic, disease specific, concomitant therapy) on duration of therapy. In 47.1 % of patients therapy
was interrupted because of lack of efficacy, in 43.2 % because of adverse events, and in 9 % for undefined reasons. Toxic
reactions leading to withdrawal were most common with gold (62.6 %) and methotrexate (62.5 %). Because of insufficient effect,
treatment was most frequently interrupted with antimalarials (62.3 %) and penicillamine (53.2 %), but in only 22% treated
with methotrexate. The mean duration of one treatment episode with DMARDs was 28.1 t 48.9 months. Surprisingly, it was longest
for cyclophosphamide (53.5 + 55.1 months) and shortest for cyclosporin (7.0 t 6.7 months). The mean duration of treatment
with methotrexate was only 14.9; t 16.2 months. The mean duration of treatment with one DMARD was statistically longer in
patients with positive rheumatoid factor, extra-articular disease and age lower than 50 years. There was no impact of sex,
concomitant steroid treatment and high or low sedimentation rate on treatment duration. Considerable differences in everyday
clinical practice with DMARDs between Central European states and published data from the US and western Europe have been
found. More education about modern strategies in the treatment of RA is probably necessary for practising rheumatologists.
Received: 31 January 2001 / Accepted: 22 November 2001 相似文献
13.
Iagnocco A Cerioni A Coari G Ossandon A Masciangelo R Valesini G 《Clinical rheumatology》2006,25(2):159-163
The aim of our study was to evaluate the effects of intra-articular methotrexate (MTX) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Twenty-three consecutive patients, 10 with RA and 13 with PsA, with prevalent or unique arthritic involvement of one knee, were treated with intra-articular injections of MTX 10 mg every 7 days for 8 weeks. Before the beginning of the treatment and after 9 and 17 weeks, the patients underwent a clinical evaluation measuring maximal knee flexion angle, visual analog scale (VAS) and erythrocyte sedimentation rate (ESR). On the same days, an ultrasonographic examination of the involved knee was performed by two independent experienced operators. Synovial thickness in the suprapatellar bursa and the presence of joint effusion and Bakers cyst were assessed. An increase of the mean value of maximal knee flexion angle and a reduction of the mean values of ESR and VAS between T0, T9 and T17 were demonstrated. Ultrasonographic evaluation showed significant reduction of synovial thickness and joint effusion. No differences were detected for the presence of Bakers cyst. We may conclude that repeated intra-articular injections of MTX resulted in a decrease of local as well as systemic inflammatory signs. As far as we know, this is the first study that explores the effects of intra-articular MTX in RA and PsA both clinically and by ultrasonography. 相似文献
14.
ACTH,cortisol and prolactin in active rheumatoid arthritis 总被引:5,自引:0,他引:5
Zoli A Lizzio MM Ferlisi EM Massafra V Mirone L Barini A Scuderi F Bartolozzi F Magaró M 《Clinical rheumatology》2002,21(4):289-293
Prolactin (PRL) and glucocorticoids are hormones involved in the regulation of the immune system. Rheumatoid arthritis (RA)
is an inflammatory condition that presents a diurnal rhythm of disease activity. ACTH, PRL, cortisol, IL-1β and TNF-α circadian
rhythms have been studied in active RA (aRA) to evaluate a possible relationship between the neuroendocrine system and immunological
activity in rheumatoid patients. ACTH, PRL, cortisol, PRL/cortisol ratio and IL-1β and TNF-α levels were determined in aRA
patients and in control subjects at 6.00, 10.00, 14.00, 18.00, 22.00 and 02.00 h. In aRA patients we observed lower ACTH and
cortisol levels at 22.00 h and 2.00 h, respectively and higher PRL and PRL/cortisol ratio at 2.00 h when compared to controls.
IL-1β and TNF-α reached their highest serum levels in aRA patients at 2.00 and 6.00 h. This study provides evidence that in
aRA there could be a temporary and probably causal relationship between diurnal disease activity, hormonal disequilibrium
and cytokine secretion. An imbalance in favour of proinflammatory hormones (PRL and cytokines) as opposed to levels of anti-inflammatory
hormones could be responsible for the diurnal rhythm of activity disease observed in aRA patients.
Received: 26 February 2001 / Accepted: 28 January 2002 相似文献
15.
Growth impairment has been described in patients with juvenile rheumatoid arthritis (JRA). Both the direct action of underlying
disease and prolonged corticosteroid usage for disease management may contribute to growth impairment. The purpose of this
retrospective study was to evaluate the effect of systemic corticosteroid treatment on attained adult height in patients with
JRA. We reviewed patients who first visited our hospital from 1973 to 1995 with a diagnosis of JRA. Adult height (AH) and
the reported parental heights of these patients were recorded. Target height (TH) is estimated according to midparental height.
Patients who never had or had only transient (less than 1 week) systemic corticosteroid therapy were classified as group 1.
Group 2 included patients who had corticosteroid therapy for more than 1 week but never continuously for more than 12 months,
and group 3 included patients on long-term steroid treatment (continuously for more than 1 year). Height data were analysed
using adult height and the difference between adult height and target height (AH minus TH). Thirty-three patients fulfilling
the diagnostic criteria for JRA were reviewed. Fourteen belonged to group 1, 13 to group 2 and six to group 3. The difference
between adult height and target height in group 1 was 2.96 ± 4.54 cm, in group 2 0.71 ± 6.08 cm (group 1 vs. group 2, P = 0.28), and in group 3 −11.65 ± 10.71 cm (group 1 vs. group 3, P<0.05). In 15 patients who never received corticosteroid therapy continuously for more than 1 year, AH–TH was statistically
correlated neither with the cumulative corticosteroid exposure dose nor with cumulative corticosteroid exposure period by
linear regression (P= 0.408, P= 0.278, respectively). We concluded that continuous systemic corticosteroid usage for less than 1 year does not affect attained
adult height in JRA patients; however, prolonged corticosteroid treatment for more than 1 year can lead to irreversible growth
impairment.
Received: 23 May 2001 / Accepted: 11 February 2002 相似文献
16.
Gunal EK Kamali S Gul A Ocal L Konice M Aral O Inanc M 《Rheumatology international》2008,28(10):959-964
Several criteria are being used for the classification of psoriatic arthritis (PsA) and there is a lack of consensus about PsA as a separate entity. Our aim is to investigate the clinical features of our patients with a clinical diagnosis of PsA, compare the sensitivities of different classification criteria and agreement between the criteria. In this study 86 PsA patients were investigated (48 female, mean age 44). Moll and Wright criteria were fulfilled by 91%, Vasey and Espinoza criteria by 94% and modified European SpA study group criteria by 59%, classification of PsA study group criteria by 86%, modified McGonagle criteria by 96%, Fournié et al. criteria by 84%, and Gladman criteria by 95%. Significant agreement was present between criteria but generally kappa values were less than 0.5. The pattern of PsA can differ with time and the implementation of the available classification criteria showed considerable differences. 相似文献
17.
Gunal EK Kamali S Gul A Ocal L Konice M Aral O Inanc M 《Rheumatology international》2009,29(4):365-370
Several criteria are being used for the classification of psoriatic arthritis (PsA) and there is a lack of consensus about
PsA as a separate entity. Our aim is to investigate the clinical features of our patients with a clinical diagnosis of PsA,
compare the sensitivities of different classification criteria, agreement between the criteria. In this study 86 PsA patients
were investigated (48 females, mean age 44). Moll and Wright criteria was fulfilled by 91%, Vasey and Espinoza criteria by
94% and modified European SpA study group criteria by 59%, classification of PsA study group criteria by 86%, modified McGonagle
criteria by 96%, Fournie et al. criteria by 84% and Gladman criteria by 95%. Significant agreement was present between criteria
but generally κ-values were less than 0.5. The pattern of PsA can differ with time and the implementation of the available classification
criteria showed considerable differences. 相似文献
18.
Psoriatic arthritis is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis
with psoriasis. In this paper, we explore the characteristics of joint and nail involvement in Turkish patients with psoriatic
arthritis. Forty patients with psoriasis (M/F, 18/22) and 49 (M/F, 25/24) subjects with psoriatic arthritis were included
in the study. Clinical characteristics of the patients were recorded. The distribution of the subjects with arthritis: (according
to the clinical and radiological findings): polyarticular, 65%; oligoarticular, 23%; isolated axial involvement, 7.7%; arthritis
mutilans, 3.8%; sacroiliitis, 19%. Nail involvement was significantly higher among patients with arthritis; i.e., 91 versus
32%; (P < 0.05). There were no correlation between the skin involvement pattern and the arthritis type (P > 0.05). Nevertheless, no relation was observed between the psoriasis duration and arthritis (P > 0.05). Nail involvement is a frequent feature of the psoriatic arthritis which may be a useful finding for differential
diagnosis of psoriatic arthritis from other inflammatory arthropathies. 相似文献
19.
Janice A. Husted Dafna D. Gladman Vernon T. Farewell Richard J. Cook 《Arthritis care & research》2001,45(2):151-158