Primate spondyloarthropathy

Spondyloarthropathy is a common occurrence in Old World primates, with only limited presence in New World monkeys. Clearly distinguished from rheumatoid arthritis, this erosive arthritis afflicts 20% of great apes, baboons, and rhesus macaques and had been increasing in frequency. Habitat-dependent infectious agent diarrhea-induced reactive arthritis is implicated on a background of genetic predisposition. A gorilla-derived therapeutic preventative approach has possible application in human clinical medicine.     

Geographic distribution of rheumatoid arthritis in ancient North America: implications for pathogenesis.

The fifth centennial of Columbus stimulates renewed interest in New World origins of disease. The earliest documentation of rheumatoid arthritis was in the New World. Subsequent study of its distribution in the New World in antiquity defines localization to a very specific geographic region. The absence of rheumatoid arthritis in 63 archaeological sites surrounding the original "catchment area" and in five Old World sites, with documented spread over time, suggests that it is a vector (microorganism or allergen)-transmitted disease.     

Siebrandus Sixtius: evidence of rheumatoid arthritis of the robust reaction type in a seventeenth century Dutch priest.

Rheumatoid arthritis of the robust reaction type has been diagnosed in a seventeenth century Dutch priest, Siebrandus Sixtius, based on pictorial evidence of typical hand deformities and historical evidence affirming that he had chronic nodular rheumatism for many years. This case report, in conjunction with other pictorial depictions of probable rheumatoid arthritis, questions the view that rheumatoid arthritis is a modern disease which prevailed in the New World and was found in the Old World only after the discovery of America.     

Population analysis of symmetrical erosive arthritis in Ohio Woodland Indians (1200 years ago)

The antiquity of the symmetrical peripheral erosive arthritis generally classified as rheumatoid arthritis is extended substantially from previous perspectives based on European, Asian, and African studies. New evidence supports its New World origin and the likelihood of subsequent spread to the Old.     

Rheumatoid arthritis at a time of passage

OBJECTIVE: To determine the relationship of what has been called pre-Columbian Old World rheumatoid arthritis (RA) to the RA identified in pre-Columbian North America. METHODS: All published claims of pre-Columbian Old World RA were reviewed against the established North American standard for its recognition in archeologic sites. Those characteristics included polyarticular symmetrical marginal erosions [in the absence of subchondral erosions, peripheral joint fusion, or axial skeletal involvement (C1-2 excepted)], but requiring the presence of perilesional osteopenia on radiographic examination. T test and Fisher's exact test were used to assess the significance of the extent of joint distribution and the presence of subchondral erosions, peripheral joint fusion, and axial disease in the Old World cases that some have claimed represent RA. RESULTS: Old World reports of alleged RA often describe isolated bones or isolated "finds" without epidemiologic consideration. Subchondral erosions were present in 95%. The 2 cases without subchondral erosions had peripheral joint fusion and axial joint disease. Peripheral joint fusion and axial joint involvement were present in almost all cases. Perilesional sclerosis was actually quite prominent, as was other evidence of reactive new bone formation, but not perilesional osteopenia. CONCLUSION: As the pre-Columbian Old World erosive arthritis is clearly a different phenomenon from what has been documented in the New World, the issue appears to relate to criteria for naming RA. There clearly are 2 distinct groups that some classify under the broad banner of RA. As the Old World variety is indistinguishable from spondyloarthropathy, it is suggested that the Old World cases should be recategorized with spondyloarthropathy and that only the variety reported in archeologic sites in North America be classified as RA.     

Impact of Psoriatic Arthritis on the Patient: Through the Lens of the WHO International Classification of Functioning, Health, and Disability

Psoriatic arthritis is associated with a broad range of problems from the perspective of the patient. These include symptoms relating to skin and musculoskeletal disease to difficulties with day-to-day activities, social interactions, paid employment, and community participation. Additional problems related to frequent comorbidities impose further impact. It has been shown that individuals with psoriatic arthritis have similar or worse disability than men older than 75 years of age in the general population, and psoriatic arthritis confers worse health status than many other common chronic diseases. The World Health Organization International Classification of Functioning, Disability, and Health provides a useful framework for considering the impact of this disease. Ideal clinical management of psoriatic arthritis would provide access to an interdisciplinary team with expertise in functional, social, vocational, and community issues, as well as to medical expertise.     

The philatelic rheumatologist.

Many postage stamps illustrate themes, persons, or topics with rheumatologic connections. Examples include scientists from related disciplines, victims of rheumatic diseases, drugs used for arthritis, and stamps commemorating events such as World Rheumatism Year. A brief orientation to postage stamps and philately is given, and a small collection of rheumatologically related stamps is illustrated.     

Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care

PURPOSE OF REVIEW: To examine the recent literature on rheumatoid arthritis in relation to functioning and disability, highlighting it from the perspective of the biopsychosocial model of functioning, disability, and health of the World Health Organization. This review focuses on longitudinal studies because they clarify associations found in cross-sectional studies and are useful in shedding light on the mechanisms that explain functioning and disability. RECENT FINDINGS: The studies that contribute best to understanding of functioning and disability in patients with rheumatoid arthritis are studies that (1) incorporate a comprehensive model to integrate different variables of interest, (2) use a longitudinal design to examine the potential casual relationships among the variables, and (3) use hierarchical regression analyses or path analysis to study the relation among variables. SUMMARY: It is time to rethink and redefine what should be measured when addressing functioning and disability of patients with rheumatoid arthritis. The use of a universally agreed framework and classification, such as the International Classification of Functioning, Disability and Health, a universally agreed-on comprehensive list of variables potentially relevant to functioning and disability in rheumatoid arthritis, and a greater focus on functioning-oriented versus disability-oriented perspectives constitute a solid foundation for such a rethinking process.     

Translation and validation of Arthritis Impact Measurement Scales 2 into Chinese: CAIMS2

OBJECTIVE: To evaluate the validity, reliability, and cultural relevance of the Arthritis Impact Measurement Scales 2 (AIMS2) as a health assessment tool for Chinese-speaking patients with arthritis. METHODS: The cultural relevance, language equivalency, and content validity of the AIMS2, Chinese version (CAIMS2) were evaluated by an expert panel. Measurement performance was tested on 240 subjects (rheumatoid arthritis = 81, osteoarthritis = 77, healthy = 82). Subjects (n = 175) were retested within 2 weeks for testing of reliability. RESULTS: Three items were modified and 2 items were added, as suggested by the expert panel. Interitem reliability was satisfactory (intraclass correlation coefficient 0.8552-0.9594). Test-retest reliability of the CAIMS2 subscales ranged from 0.770 to 0.952 in subjects in whom the CAIMS2 was self administered. Significant score differences between patients with arthritis and healthy subjects were found in all 12 subscales, except for the support from family and friends and tension subscales. CAIMS2 subscale scores correlated with clinical and laboratory measures of disease activity and patients' perceived quality of life as measured using the Chinese version of the World Health Organization Quality of Life instrument. CONCLUSION: Empirical data support CAIMS2 is a valid and reliable health status measure for Chinese speaking patients with arthritis.     

Metabolic syndrome in inflammatory rheumatic diseases

Toward the end of the last century a better knowledge of cardiovascular (CV) risk factors and their associations led investigators to propose the existence of a unique pathophysiological condition called "metabolic" or "insulin resistance syndrome". Among all, insulin-resistance and compensatory hyperinsulinemia are considered its most important treatment targets. Different definitions have been provided by World Health Organization (WHO) and by The Third Report of The National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP III). In particular, abdominal obesity, hypertension, low HDL cholesterol and hyperglicemia are the most common items used for its definition. The presence of MetS is effective in predicting the future risk of diabetes and coronaropathies. The evidence of a higher CV risk rate among different rheumatic inflammatory diseases has recently been associated with high prevalence of MetS in some cases. Rheumatoid or psoriatic arthritis have the large series among arthritis, whereas systemic lupus erythematosus among connective tissue disorders. This review analyses all most important studies about the evidence of MetS in rheumatic patients and the main clinical and prognostic significance of this relation.     

Spondyloarthropathy as an Old World phenomenon.

The presence of spine and sacroiliac involvement and the nature and distribution of erosive lesions allowed definitive diagnosis of spondyloarthropathy in the great apes (Gorilla and Pan [chimpanzee]), the lesser ape (Hylobates), and Old World monkeys (Theropithecus, Papio, Cercopithecus, Macaca, Colobus, Presbytis, and Erythrocebus). Analysis of lesional character, distribution, radiological appearance, and sex ratios showed a picture indistinguishable from human spondyloarthropathy. This contrasts with orangutans (Pongo), who lack reactive bone or sacroiliac involvement. A different pathophysiology, as yet undefined, is implied for their erosive arthritis. Limited individual susceptibility to spondyloarthropathy in humans (1% to 4%), Old World monkeys (2.4%), and lesser apes (2.4%) contrasts with the high frequency of disease in the great apes (20% to 28%). The wide geographic distribution of this phenomenon suggests an African and perhaps Asian "panendemic." This natural disease state provides a unique model for in-depth analysis of the contribution of genetic and environmental factors to disease pathophysiology.     

Wars in the history of rheumatology

Some important discoveries in the history of rheumatology happened during war periods. It is well known that arthritis associated with conjunctivitis and urethritis, following dysenteric episodes, has been described during the First World War from the German Hans Reiter and, nearly contemporarily, from the French N?el Fiessinger and Edgar Leroy. Less known is instead the fact that the first cases of sympathetic algoneurodystrophy have been reported by the American Silas Weir Mitchell in soldiers wounded by fire-arms, during the Civil War of Secession. Other war episodes have been crucial for the development of some drugs now abundantly applied to the care of rheumatic diseases. The discovery of therapeutic effects of immunosuppressive agents, in fact, happened as an indirect consequence of the use of poison gas, already during the First World War (mustard gas), but above all after an episode in the port of Bari in 1943, where an American cargo boat was sunk. It had been loaded with a quantity of cylinders containing a nitrogenous mustard, whose diffusion in the environment provoked more than 80 deaths owing to bone marrow aplasia.Moreover, the history of the cortisone shows a strict link to the Second World War, when Germany imported large quantities of bovine adrenal glands from Argentina, with the purpose of producing some gland extracts for the Luftwaffe aviators, in order to increase their performance ability.     

Quality of life of people with rheumatoid arthritis as measured by the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF): score distributions and psychometric properties

OBJECTIVE: To assess the psychometric properties, including responsiveness, of the World Health Organization Quality of Life instrument, short form (WHOQOL-BREF) in people with rheumatoid arthritis. METHODS: A sample of 142 persons with rheumatoid arthritis were randomly selected from a regional disease register and completed questionnaires by postal survey. An additional sample of 72 consecutive inpatients completed questionnaires a few days prior to admission, the day of admission, the day of discharge, and 2 weeks following discharge. RESULTS: Test-retest reliability was adequate (intraclass correlation coefficient 0.71-0.91). Internal consistency was adequate except for the social relationships domain (Cronbach's alpha 0.64-0.87). Factor structure was fairly similar to that previously reported. Correlation with other measures of quality of life was supportive of concurrent validity. Indices of responsiveness were satisfactory except for the social relationships and environment domains, although there was actually no statistical difference in the area under a receiver operating characteristic plot between the WHOQOL-BREF domains and the Health Assessment Questionnaire. CONCLUSION: The WHOQOL-BREF has adequate psychometric properties in people with rheumatoid arthritis and should be considered a valid outcome measure for interventions that aim to improve quality of life for people with this disease.     

Epidemiology of psoriasis and psoriatic arthritis

Psoriasis is widely diffused in the World, with the exception of a few populations, such as the natives from Alaska and Australia, where it is unknown. Its average prevalence is about 3-4%. This is probably an underestimate, for it is mostly based on self-reports. In fact, on the one hand minimal psoriasis, e.g. nail disease, could remain undiagnosed; on the other, precise classification criteria for psoriatic arthritis (PsA) are lacking and the skin disease is often of elusive nature. The frequency of PsA may be higher than commonly believed, as suggested by recent studies reporting a prevalence of up to 0.42%. There are no major differences in the frequency of psoriasis between sexes, nor specific time trends. Indirect data suggest that PsA may be more frequent in the old than in the new World, a point that could be clarified only by standardized international studies. In practice, both psoriasis and PsA are relatively common conditions, with major impact on the patients'quality of life, and requiring appropriate intervention strategies. An important advance should be the adoption of univocal definitions of psoriasis and PsA, including guidelines for patterns of skin and joint involvement.     

Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome

OBJECTIVE: To examine the clinical and functional outcome of adults with juvenile idiopathic arthritis (JIA) using the recent World Health Organization/International League Against Rheumatism (ILAR) classification. PATIENTS AND METHODS: Two hundred and fifty-nine adults with long-standing JIA (average disease duration 28.3 yr) were eligible for the study; 246 (95%) attended for an interview, clinical examination and notes review and 231 (89.2%) returned a comprehensive functional and psychosocial self-assessment questionnaire. RESULTS: Of all patients, 43.3% had active arthritis clinically and 54.4% on laboratory measures (C-reactive protein). Clinical inflammation was less common in systemic-onset JIA. The percentage of all patients with severe disability (Health Assessment Questionnaire score >1.5) was 42.9. Uveitis occurred frequently in the oligoarticular-onset and enthesitis-related subsets. Over 30% of the extended oligoarticular group with uveitis developed glaucoma compared with none of the enthesitis group. CONCLUSIONS: Adults with JIA often have significant levels of disability, often related to continuing active disease over prolonged periods. There is a clear need for good transition from paediatric to high-quality adult rheumatology care.     

The clinimetric properties of the World Health Organization Disability Assessment Schedule II in early inflammatory arthritis

OBJECTIVE: To assess the clinimetric properties of a new health-related quality of life (HRQOL) instrument, the World Health Organization Disability Assessment Schedule II (WHODAS II), in patients with early inflammatory arthritis. METHODS: Internal consistency as well as criterion, construct, and discriminative validity of the WHODAS II were assessed in 172 patients with early inflammatory arthritis who completed the WHODAS II, the Medical Outcomes Study Short Form 36 (SF-36), and other measures of disease severity, functioning, pain, depression, and resource use. Test-retest reliability of the WHODAS II was assessed by having a subset of 20 patients complete the WHODAS II a second time, 1 week after the first assessment. RESULTS: The WHODAS II had high internal consistency (Cronbach's alpha = 0.96 for patients working or in school and 0.93 for patients not working or in school). Test-retest intraclass correlation coefficients of the WHODAS II total score and subscales ranged from 0.82-0.96. The WHODAS II total score was strongly correlated with the SF-36 physical component score (Kendall's tau-b 0.51, P < 0.001) and moderately correlated with the SF-36 mental component score (tau-b 0.43, P < 0.001). WHODAS II correlations with disease outcomes ranged from Kendall's tau-b 0.15-0.55. The WHODAS II significantly differentiated between every aspect of disease severity assessed with the exception of measures of health resource use. CONCLUSION: The WHODAS II is a valid and reliable measure of HRQOL in cross-sectional studies of patients with early inflammatory arthritis. Research is still required to investigate potential item redundancy and determine its usefulness in longitudinal studies.     

British anti-Lewisite (dimercaprol): an amazing history

Emergency physicians are familiar with British anti-Lewisite (BAL) because it is a heavy metal-chelating agent that is recommended in some cases of metal poisoning, especially arsenic. Although there are more modern chelating agents, the fact that BAL is still recommended and stocked by hospital pharmacies more than 60 years after its initial synthesis is itself remarkable. During World War II, BAL minimized the risk to the Allied infantry of injury or death from Lewisite, a very potent arsenic-based chemical warfare agent. Once developed, BAL revolutionized the treatment of heavy metal poisonings, both accidental and iatrogenic (eg, toxicity from treatment of arthritis with gold salts). In 1951, BAL was used to treat Wilson's disease with striking success. Today, BAL might again become prominent should terrorists or governments use Lewisite against civilians or military forces.     

Predictors of functional disability in patients with rheumatoid arthritis

Objective . Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status. Method . A secondary data analysis of 85 adults hospitalized for exacerbations in arthritis was undertaken. Disability was assessed with the Health Assessment Questionnaire. Physical impairment was measured with the Keitel Function Test and Pain Analog Scales, and psychological impairment was measured with the Center for Epidemiologic Studies Depression Scale and the Perceived Self-Efficacy Scale for People with Arthritis. Results . Our findings indicated that physical impairment, demographic, and disease variables accounted for 64% of the explained variance in disability during the concurrent episode. Psychological impairment as well as demographic and disease variables accounted for 49% of the explained variance in future disability status. Conclusion . The combined influence of demographic characteristics and the consequences of the pathology of RA experienced as physical and psychological impairments contributed differentially to disability during concurrent and future time periods.