bluuebunny/crossref_metadata_2025_split huggingface dataset:
Description of Active Joint Count Trajectories in Juvenile Idiopathic Arthritis
Authors: Berard Roberta A. , Tomlinson George , Li Xiuying , Oen Kiem , Rosenberg Alan M. , Feldman Brian M. , Yeung Rae S.M. , Bombardier Claire 
Published: October 2014

Objective.To describe the trajectories of longitudinal joint disease activity in juvenile idiopathic arthritis (JIA), and to examine associations of clinical and laboratory characteristics with the identified trajectories.Methods.A retrospective cohort study at 2 Canadian centers was performed. The longitudinal trajectories of active joint counts were described in a proof-of-concept study using a latent growth curve analysis. Baseline patient characteristics were compared across trajectory groups.Results.Data were analyzed on 659 children diagnosed with JIA between March 1980 and September 2009. The median age at diagnosis was 10.0 years (interquartile range 3.7–13.4) and 61% (402/659) were female. The International League of Associations for Rheumatology (ILAR) diagnoses were as follows: oligoarthritis (36%), enthesitis-related arthritis (20%), rheumatoid factor (RF)-negative polyarthritis (13%), undifferentiated arthritis (12%), psoriatic arthritis (8%), systemic arthritis (7%), and RF-positive polyarthritis (4%). Based on the trajectories of their active joint counts, the 659 patients were each classified in 1 of 5 latent classes (which can be described as high decreasing, moderate increasing, persistent moderate, persistent low, and minimal joint activity). These latent classes were clinically and statistically distinct from the ILAR categories.Conclusion.In this proof-of-concept study, in which we used an analytic methodology in a novel way, we identified 5 clinically and statistically distinct trajectories of disease course. The subsets of patients within each class were different from those described by the ILAR classification criteria. This successful application of this method supports its use in a chronic disease with a fluctuating course such as JIA. These methods should be expanded for the purposes of predictive modeling.
Anticyclic Citrullinated Peptide Antibodies in Rheumatoid and Nonrheumatoid Rheumatic Disorders: Experience with 1162 Patients
Authors: Payet Judith , Goulvestre Claire , Bialé Lisa , Avouac Jérôme , Wipff Julien , Job-Deslandre Chantal , Batteux Frédéric , Dougados Maxime , Kahan André , Allanore Yannick 
Published: October 2014

Objective.Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory rheumatism. Our objectives were to identify the prevalence of positive anti-CCP patients in non-RA diseases, to determine the diagnostic value of anti-CCP for the diagnosis of RA, to specify the clinical characteristics of non-RA patients positive for anti-CCP, and to determine the discriminatory value of the levels of anti-CCP in patients among the various diseases.Methods.We carried out an observational and descriptive study. All the determinations of anti-CCP requested by the 2 rheumatology departments at Cochin Hospital over a period of 18 months were analyzed. Such determinations were requested for 1162 patients in total. Anti-CCP levels were determined with the Euro Diagnostica ELISA kit, with values ≥ 25 U for this test being considered positive. The diagnosis of rheumatic conditions was the responsibility of the treating physician.Results.Anti-CCP antibodies were detected in 357 (30.7%) of the 1162 patients. The prevalence of anti-CCP was 292/417 (70.0%) in RA, 13/122 (10.6%) in patients with psoriatic arthritis, 13/62 (20.9%) in patients with unclassified rheumatism, 11/33 (33.3%) in patients with primary Sjögren syndrome, 5/30 (16.6%) in patients with systemic lupus erythematosus, 3/28 (10.7%) in patients with mixed connective tissue disorder, 3/36 (8.3%) in patients with systemic sclerosis, 7/44 (15.9%) in patients with juvenile arthritis, and 6/220 (2.7%) in patients with noninflammatory diseases. In the population of patients positive for anti-CCP, mean anti-CCP levels were 869.4 (± 978.4) U/ml, with no significant difference between RA [854.8 (± 959.8) U/ml] and any of the non-RA conditions [922.7 (± 1070.0) U/ml].Conclusion.Anti-CCP are a hallmark of RA, but may be observed in other inflammatory, systemic, or mechanical diseases. In this large cohort of patients, the presence of second-generation anti-CCP (anti-CCP2) antibodies is useful in diagnosing RA (70% sensitivity, 91.3% specificity), but examining the levels of these antibodies does not appear to offer further discriminatory power among patients who are anti-CCP2-positive.
Evaluation of Germinal Center-like Structures and B Cell Clonality in Patients with Primary Sjögren Syndrome with and without Lymphoma
Authors: Johnsen Svein Joar , Berget Ellen , Jonsson Malin Viktoria , Helgeland Lars , Omdal Roald , Jonsson Roland 
Published: October 2014

Objective.Germinal center (GC)-like structures have previously been observed in minor salivary glands (MSG) of patients with primary Sjögren syndrome (pSS). The aim of our study was to explore the prevalence and features of GC-like structures and B cell clonality in patients with pSS with and without lymphoma.Methods.Based on a nationwide survey in Norway, we included 21 patients with pSS and with a concomitant lymphoma from whom MSG and/or lymphoma biopsies were available. Tonsil biopsies and MSG from 28 patients with pSS without lymphoma were used as controls. The presence of GC-like structures was investigated with H&E staining and double staining for CD21/IgD and CD38/IgD. B cell clonality in MSG and tumors were investigated with analysis of immunoglobulin gene rearrangements.Results.H&E labeling of MSG revealed GC-like structures in 17/40 (43%) of the patients: 4/12 (33%) with and 13/28 (46%) without lymphoma. Staining for CD21/CD38/IgD demonstrated CD21+ networks in 27/40 (68%) of the patients. CD21+/CD38– infiltrates were seen in 25/40 (63%) of the patients, and 16 of these were IgD+ within the infiltrate. Five percent (2/40) of the patients presented with CD21+/CD38+ infiltrates resembling tonsillar GC. Monoclonal B cell infiltration in MSG was present in 5/12 patients (42%) with and 5/28 patients (18%) without lymphoma (p = 0.12). In 2/10 (20%) of cases where both MSG and lymphoma biopsies were available, identical clonal rearrangements were detected.Conclusion.GC-like structures seen in H&E-stained MSG may represent various subtypes of CD21+ infiltrates. We were unable to detect a clear association between cellular infiltrates, B cell clonality, and lymphoma development.
Detection of Subclinical Synovitis with Macrophage Targeting and Positron Emission Tomography in Patients with Rheumatoid Arthritis without Clinical Arthritis
Authors: Gent Yoony Y.J. , Ahmadi Nazanin , Voskuyl Alexandre E. , Hoetjes Nikie , van Kuijk Cornelis , Britsemmer Karin , Turkstra Franktien , Boers Maarten , Hoekstra Otto S. , van der Laken Conny J. 
Published: October 2014

Objective.To determine whether macrophage targeting by (R)-11C-PK11195 positron emission tomography (PET) can visualize subclinical joint inflammation in patients with rheumatoid arthritis (RA) without clinical arthritis during or after treatment, with flare as clinical outcome measure.Methods.(R)-11C-PK11195 PET and contrast-enhanced magnetic resonance imaging (MRI) of hands/wrists were performed in 29 patients with RA without clinical arthritis. (R)-11C-PK11195 PET uptake (semiquantitative score 0–3) in metacarpophalangeal, proximal interphalangeal, and wrist joints (i.e., 22 joints per patient) was scored and summed to obtain a cumulative PET score (range 0–66). Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) was performed on similar joints. Synovitis and bone marrow edema scores (> 1) were summed to obtain a cumulative MRI score (range 0–288). Occurrence of flare was determined during 3-year followup.Results.Flare was observed in 17/29 patients (59%). (R)-11C-PK11195 PET showed enhanced tracer uptake in 16/29 patients (55%), of which 11 (69%) developed a flare. Highest cumulative PET scores (> 6, n = 3) corresponded with highest cumulative MRI scores (> 39) and were related to development of flare in hands/wrists within 6 months. Cumulative PET scores of patients developing a flare were higher than those of patients without a flare [median (interquartile range) 2 (0–4.5) vs 0 (0–1), p < 0.05]. In contrast, no significant differences were found between cumulative MRI scores of patients with and without a flare.Conclusion.(R)-11C-PK11195 PET showed enhanced uptake, pointing to presence of subclinical synovitis in over half of patients without clinical arthritis. (R)-11C-PK11195 PET may be of value for prediction of exacerbation of RA, since cumulative PET scores > 1 were associated with development of flare within 3 years.
Prognosis of Seronegative Patients in a Large Prospective Cohort of Patients with Early Inflammatory Arthritis
Authors: Barra Lillian , Pope Janet E. , Orav John E. , Boire Gilles , Haraoui Boulos , Hitchon Carol , Keystone Edward C. , Thorne J. Carter , Tin Diane , Bykerk Vivian P. ,   and the CATCH Investigators
Published: October 2014

Objective.Rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe rheumatoid arthritis; however, studies in early inflammatory arthritis (EIA) have yielded conflicting results. Our study determined the prognosis of baseline ACPA-negative and RF-negative patients.Methods.Patients enrolled in the Canadian Early Arthritis Cohort had IgM RF and IgG anticyclic citrullinated peptide antibodies 2 (anti-CCP2) measured at baseline. Remission was defined as a Disease Activity Score of 28 joints (DAS28) < 2.6 using logistic regression accounting for confounders at 12-month and 24-month followup.Results.Of the 841 patients, 216 (26%) were negative for both RF and anti-CCP2. Compared to seropositive subjects, seronegative subjects were older (57 ± 15 vs 51 ± 14 yrs), more males proportionately (31% vs 23%), and had shorter length of symptoms (166 ± 87 vs 192 ± 98 days), and at baseline had higher mean swollen joint count (SJC; 8.8 ± 6.8 vs 6.5 ± 5.6), DAS28 (5.0 ± 1.6 vs 4.8 ± 1.5), and erosive disease (32% vs 24%, p < 0.05). Treatment was similar between the 2 groups. At 24-month followup, seronegative compared to seropositive subjects had greater mean change (Δ ± SD) in disease activity measures: ΔSJC counts (−6.9 ± 7.0 vs −5.1 ± 5.9), ΔDAS28 (−2.4 ± 2.0 vs −1.8 ± 1.8), and ΔC-reactive protein (−11.0 ± 17.9 vs −6.4 ± 17.5, p < 0.05). Accounting for confounders, antibody status was not significantly associated with remission. However, at 12-month followup, ACPA-positive subjects were independently more likely to have new erosive disease (OR 2.94, 95% CI 1.45–5.94).Conclusion.Although seronegative subjects with EIA have higher baseline DAS28 compared to seropositive subjects, they have a good response to treatment and are less likely to develop erosive disease during followup.
Earlier Time to Remission Predicts Sustained Clinical Remission in Early Rheumatoid Arthritis — Results from the Canadian Early Arthritis Cohort (CATCH)
Authors: Kuriya Bindee , Xiong Juan , Boire Gilles , Haraoui Boulos , Hitchon Carol , Pope Janet , Thorne John Carter , Tin Diane , Keystone Edward C. , Bykerk Vivian 
Published: October 2014

Objective.To evaluate the prevalence and predictive factors of sustained remission in an early rheumatoid arthritis (ERA) population. Predictive factors of sustained remission in ERA are unknown. We hypothesized that a short time to remission is an important predictor of sustained clinical remission.Methods.Patients in the Canadian Early Arthritis Cohort were included. Remission was defined by Boolean-based American College of Rheumatology/European League Against Rheumatism clinical trial and clinical practice definitions and Simplified Disease Activity Index (SDAI). Logistic regression analysis identified predictors of sustained remission and influence of time to remission.Results.Of 1840 patients, 633 (34%) achieved clinical trial remission, 759 (41%) clinical practice remission, and 727 (39%) SDAI remission. Over half of those meeting remission criteria achieved sustained remission based on clinical trial (55%), clinical practice (60%), and/or SDAI (58%). Corticosteroid use and lack of initial disease-modifying antirheumatic drug (DMARD) were associated with decreased probability of sustained remission, while initial combination DMARD increased this probability. Female sex, greater pain, and longer time to first remission made sustained remission less likely.Conclusion.Female sex, greater pain, and lack of initial DMARD therapy reduced the probability of sustained remission. A shorter time to remission is related to sustainability and supports striving for early remission.
Coronary and Abdominal Aorta Calcification in Rheumatoid Arthritis: Relationships with Traditional Cardiovascular Risk Factors, Disease Characteristics, and Concomitant Treatments
Authors: Paccou Julien , Renard Cédric , Liabeuf Sophie , Kamel Said , Fardellone Patrice , Massy Ziad A. , Brazier Michel , Mentaverri Romuald 
Published: October 2014

Objective.To assess the influence of traditional cardiovascular (CV) risk factors, disease characteristics, and concomitant treatments in patients with rheumatoid arthritis (RA) on coronary artery calcification (CAC) and abdominal aorta calcification (AAC).Methods.In our cross-sectional study, 75 patients with RA were compared with 75 age-matched and sex-matched control participants. The CAC and AAC scores were measured by computed tomography in patients with no clinical evidence of coronary artery disease. The relationships between the presence or absence of CAC and AAC and traditional CV risk factors, disease characteristics, and concomitant treatments in patients with RA were assessed in a multiple logistic regression analysis.Results.The RA and control groups did not differ significantly in terms of age, sex composition, or the prevalence of traditional CV risk factors. AAC and CAC were more prevalent and severe in patients with RA than in controls. Older age (OR = 1.15, p < 0.01) and hypertension (OR = 3.77, p = 0.04) were found to be independently associated with CAC, whereas current use of methotrexate (MTX; OR = 0.12, p = 0.01) was found to be associated with the absence of CAC. Older age (OR per yr = 1.17, p < 0.001) and erosive arthritis (OR = 3.78, p = 0.03) were found to be independently associated with AAC.Conclusion.Our study demonstrates that in patients with RA, (1) CAC and AAC are more prevalent and more severe compared with age-matched and sex-matched control participants, (2) current use of MTX is a major determinant of the absence of CAC, and (3) erosive arthritis is a major determinant of AAC.
Failure in Longterm Treatment is Rare in Actively Treated Patients with Rheumatoid Arthritis, But May Be Predicted by High Health Assessment Score at Baseline and by Residual Disease Activity at 3 and 6 Months: The 5-year Followup Results of the Randomized Clinical NEO-RACo Trial
Authors: Rantalaiho Vappu , Kautiainen Hannu , Järvenpää Salme , Korpela Markku , Malmi Timo , Hannonen Pekka , Kaipiainen-Seppänen Oili , Yli-Kerttula Timo , Möttönen Timo , Mustila Anu , Karjalainen Anna , Paimela Leena , Uutela Toini , Leirisalo-Repo Marjatta ,   for the NEO-RACo Study Group
Published: October 2014

Objective.With modern initial aggressive combination treatments with synthetic disease-modifying antirheumatic drugs (sDMARD), most patients with rheumatoid arthritis (RA) achieve remission, have marginal radiographic progression, and sustain normal function. Here we aim to identify the patients failing these targets even after aggressive treatment.Methods.Ninety-nine patients with early, active RA were treated with a combination of 3 sDMARD and prednisolone (PRD), and either infliximab or placebo infusions during the first 6 months, aiming at strict remission. After 24 months, the treatments became unrestricted. At 60 months, 4 evident clinical features of treatment failure were defined: area under curve (AUC) between 6–60 months for disease activity score assessing 28 joints > 2.6; AUC 6–60 for health assessment questionnaire > 0.5; progression in total Sharp/van der Heijde score 0–60 months > 3 units; and need of PRD or biologic DMARD treatment at 60 months.Results.A total of 93 patients were followed up for 60 months. Of them, 45 had no features of treatment failure, 30 had 1, 10 had 2, 7 had 3, and 1 patient had all 4 features. Having 2–4 features of treatment failure at 5 years was predicted by the health assessment score at baseline, and by even low residual disease activity at 3 and 6 months.Conclusions.Only 20% of the patients with RA treated early with combination sDMARD and PRD have more than 1 clinical feature of treatment failure at 60 months. Residual clinical disease activity at 3–6 months was the most important predictor for identifying these patients. The study was registered at www.clintrials.gov (NCT00908089).
Development of a Modified Hand Mobility in Scleroderma (HAMIS) Test and its Potential as an Outcome Measure in Systemic Sclerosis
Authors: Sandqvist Gunnel , Nilsson Jan-Åke , Wuttge Dirk M. , Hesselstrand Roger 
Published: October 2014

Objective.To modify the hand mobility in scleroderma (HAMIS) test by reducing the number of items and amount of equipment needed, and to evaluate the construct validity of this modified HAMIS (mHAMIS).Methods.Our retrospective study is based on 266 patients previously examined using the original HAMIS test. Data were divided into 3 groups depending on disease duration after onset: (1) 0–3 years, (2) 3.1–5 years, and (3) 5.1–9 years. Disease variables included were skin involvement using the disease subset and the modified Rodnan skin score (mRSS), and digital lesions. Cronbach’s alpha coefficient was calculated separately for limited (lcSSc) and diffuse systemic sclerosis (dcSSc) for the right and left hand, and for the groups with different disease duration. The construct validity of the mHAMIS was assessed by searching for a correlation with hand skin score.Results.An mHAMIS test consisting of finger flexion, finger extension, finger abduction, and dorsal extension was developed. The internal consistency of this test was 0.78, 0.83, and 0.73 in the 3 groups with different disease duration. In the whole study group, mHAMIS showed a significant correlation with mRSS and hand skin score (rs = 0.39 and 0.43, respectively), and was able to discriminate between lcSSc and dcSSc (p = 0.001), and between patients with and without ulcers (p = 0.015).Conclusion.The mHAMIS involves 4 easily measurable items and has the potential to be a relevant clinical measure of outcome in the evaluation of fibrotic skin involvement in SSc.
The Effect of Antiestrogen Agents on Risk of Autoimmune Disorders in Patients with Breast Cancer
Authors: Chen Jason Y. , Ballou Stanley P. 
Published: October 2014

Objective.To investigate the relationship between antiestrogen therapy in women with breast cancer and risk of autoimmune disease.Methods.We used a national database to assess the incidence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) following treatment with selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) in women with breast cancer. The total number of patients in our study was 190,620.Results.We observed highly significant, cumulative dose-dependent increased OR of incidence of both SLE and RA following treatment with SERM (p < 0.0001). The odds of developing RA were also increased following AI therapy (p < 0.001), but there was a trend for reduced odds of SLE, though this trend did not attain statistical significance (p = 0.070 for 2–11 months of treatment and p = 0.254 for 12+ months of treatment).Conclusion.Antiestrogen agents may have an important effect on risk of autoimmune disease.
Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies
Authors: Anandarajah Allen , Thiele Ralf , Giampoli Ellen , Monu Johnny , Seo Gwy-Suk , Feng Changyong , Ritchlin Christopher T. 
Published: October 2014

Objective.The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.Methods.We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.Results.Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.Conclusion.Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
Une production islamique de la mondialisation
Authors: Otayek René 
Published: October 2014

Les relations entre l’Afrique subsaharienne, singulièrement la zone sahélo-saharienne, et le « monde arabe » s’articulent autour de dynamiques de transnationalisme aussi complexes que protéiformes, de plus en plus marquées par la récurrence de la référence islamique. L’action des Etats et celle des réseaux de toutes natures, le commerce des biens de salut et la circulation des hommes et des services reconfigurent ainsi l’oumma comme communauté imaginée et dessinent une production islamique de la mondialisation.
De l'Egypte à l'Ethiopie, quand la puissance se déplace en Afrique nilotique
Authors: Blanc Pierre 
Published: October 2014

« L’Egypte est un don du Nil ». Cette formule qui nous vient d’Hérodote a été encore vraie dans la période contemporaine, tellement l’Egypte a fait de ce fleuve l’allié de son développement. Profitant de son avance politique et militaire et de ses atouts géostratégiques, le pouvoir central égyptien a pu valoriser les ressources qu’offre le fleuve en termes de sécurisation alimentaire et énergétique. Mais l’affirmation des Etats en amont du bassin du Nil modifie aujourd’hui le statu quo . Sortie de ses vicissitudes d’un « présent historique » à tout le moins tragique, l’Ethiopie est à l’avant-garde des Etats d’amont qui remettent en cause l’avantage de l’Egypte. En surplomb de la question de l’eau, c’est tout un réaménagement du rapport de force qui se noue dans le bassin du Nil, et c’est donc en ces termes que nous décryptons ici la donne hydropolitique ; en sachant que les rapports de puissance n’ont pas forcément le dernier mot dans les relations internationales.