bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin D Deficiency and Insufficiency in 2 Independent Cohorts of Patients with Systemic Sclerosis
Authors: VACCA ALESSANDRA , CORMIER CATHERINE , PIRAS MARTINA , MATHIEU ALESSANDRO , KAHAN ANDRE , ALLANORE YANNICK 
Published: August 2009

Objective.To investigate 25-OH vitamin D concentrations in 2 independent systemic sclerosis (SSc) populations from France and Italy.Methods.We studied 156 consecutive SSc patients comparable for demographic characteristics: 90 from Northern France and 66 from Southern Italy. 25-OH vitamin D, intact parathyroid hormone, and serum total calcium and phosphorus were measured in all patients. Vitamin D concentrations < 30 ng/ml were considered insufficiency, while values < 10 ng/ml were classified as deficiency.Results.Vitamin D insufficiency and deficiency rates were very high and comparable between the 2 populations: 74/90 (82%) versus 57/66 (86%) for insufficiency and 29/90 (32%) versus 15/66 (23%) for deficiency, respectively, in the French and Italian patients. They were not influenced by vitamin D supplementation, which was not statistically different in the 2 groups. In the combined populations, a significant negative correlation was found between low vitamin D levels and European Disease Activity Score (p = 0.04, r = −0.17) and an even more significant correlation was found with acute-phase reactants (p = 0.004, r = −0.23 for erythrocyte sedimentation rate), and low levels of vitamin D were associated with the systolic pulmonary artery pressure (sPAP) estimated by echocardiography (p = 0.004). In multivariate analysis, vitamin D deficiency was associated with sPAP (p = 0.02).Conclusion.Vitamin D deficiency was very common in the 2 SSc populations, independent of geographic origin and vitamin D supplementation. This suggests that common vitamin D supplementation does not correct the deficiency in SSc patients, and that a higher dose is probably needed, especially in those with high inflammatory activity or severe disease.
Comparison of Screening Procedures for Mycobacterium tuberculosis Infection Among Patients with Inflammatory Diseases
Authors: SOBORG BOLETTE , RUHWALD MORTEN , HETLAND MERETE LUND , JACOBSEN SØREN , ANDERSEN AASE BENGAARD , MILMAN NILS , THOMSEN VIBEKE OSTERGAARD , JENSEN DORTE VENDELBO , KOCH ANDERS , WOHLFAHRT JAN , RAVN PERNILLE 
Published: August 2009

Objective.To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression.Methods.The interferon-γ response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests.Results.QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5–18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6–13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1–11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6–10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1–1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02–0.3, p = 0.002).Conclusion.The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.
Diclofenac Sodium Gel in Patients with Primary Hand Osteoarthritis: A Randomized, Double-blind, Placebo-controlled Trial
Authors: ALTMAN ROY D. , DREISER RENÉE-LILIANE , FISHER CHESTER L. , CHASE WALTER F. , DREHER DONATUS S. , ZACHER JOSEF 
Published: August 2009

Objective.To measure the efficacy and safety of diclofenac sodium gel in patients with primary hand osteoarthritis (OA).Methods.In a randomized, double-blind, placebo-controlled trial, men and women aged ≥ 40 years diagnosed with primary OA in the dominant hand were randomly assigned to self-apply topical 1% diclofenac sodium gel (Voltaren® Gel) (n = 198) or vehicle (n = 187) to both hands 4 times daily for 8 weeks. Primary outcome measures included OA pain intensity (100-mm visual analog scale), total Australian/Canadian Osteoarthritis Hand Index (AUSCAN) score, and global rating of disease activity at 4 and 6 weeks. Secondary outcomes included onset of efficacy in Weeks 1 and 2, durability of efficacy at 8 weeks, measures of disease activity in the dominant hand, pain intensity in the non-dominant hand, AUSCAN subindices, end of study rating of efficacy, and Osteoarthritis Research Society International response criteria.Results.Diclofenac sodium gel decreased pain intensity scores by 42%–45%, total AUSCAN scores by 35%–40%, and global rating of disease by 36%–40%. Significant differences favoring diclofenac sodium gel over vehicle were observed at Week 4 for pain intensity and AUSCAN, with a trend for global rating of disease activity. At Week 6, diclofenac sodium gel treatment significantly improved each primary outcome measure compared with vehicle. Secondary outcomes generally supported the primary outcomes. The most common treatment-related adverse event (AE) was application-site paresthesia. Most AE were mild. No cardiac events, gastrointestinal bleeding, or ulcers were reported.Conclusion.Topical diclofenac sodium gel was generally well tolerated and effective in primary hand OA. (NCT ID: NCT00171665)
Can Magnetic Resonance Imaging Differentiate Undifferentiated Arthritis Based on Knee Imaging?
Authors: EMAD YASSER , RAGAB YASSER , SHAARAWY AHMED , ABOU-ZEID ALAA , SAAD AHMED , FAWZY MAGDY , JOKHDAR HANI , RASKER JOHANNES J. 
Published: August 2009

Objective.To compare findings as observed on enhanced magnetic resonance imaging (MRI) of the knee joints, in oligoarticular-undifferentiated arthritis (UA) in those with established rheumatoid arthritis (RA) and spondyloarthropathy (SpA).Methods.A total of 55 patients with knee arthritis were consecutively recruited for the study, including 25 with undifferentiated oligoarthritis of the knee joint(s), 15 fulfilling the American College of Rheumatology criteria for RA and 15 with SpA. Laboratory investigations included erythrocyte sedimentation rate, C-reactive protein, complete blood count, aspartate aminotransferase, alanine aminotransferase, serum creatinine, and urine analysis. In all patients in the UA and in the RA group, rheumatoid factor and anti-CCP2 antibody (ELISA) were tested. All patients underwent enhanced MRI of the more symptomatic knee. All groups were compared in terms of demographics, laboratory investigations, and MRI findings.Results.Synovial thickness differed significantly in the RA group compared to UA and SpA groups (p < 0.001). The RA group showed a higher rate of bony and cartilaginous erosions and bone marrow edema compared to UA and SpA groups (p < 0.001). Enthesitis was found in all patients in the SpA group (100%) and differed from RA and UA groups (p < 0.001).Conclusion.Patients with RA showed more destructive changes in terms of synovial thickening, bone marrow edema, cartilaginous and bone erosions compared to UA and SpA groups. Enthesitis is a common feature on MRI in SpA, while absent in the RA and UA groups. This latter finding may have important clinical implications for classification purposes, and can help to determine the evolving pattern of patients with UA of the knee joint.
Do Rheumatoid Arthritis Patients Have a Higher Risk for Sleep Apnea?
Authors: READING STEPHANIE R. , CROWSON CYNTHIA S. , RODEHEFFER RICHARD J. , FITZ-GIBBON PATRICK D. , MARADIT-KREMERS HILAL , GABRIEL SHERINE E. 
Published: August 2009

Objective.Patients with rheumatoid arthritis (RA) have an increased risk for developing cardiovascular disease (CVD) compared to subjects in the general population. The development of CVD has also been linked to chronic sleep apnea. The purpose of this study was to examine the risk for sleep apnea in patients with RA compared to subjects without RA.Methods.We recruited RA patients and non-RA subjects who were age and sex matched from the same population. These persons completed the Berlin Sleep Questionnaire, which evaluated their level of risk (high or low) for sleep apnea. In addition, there were 3 subscales evaluating snoring, fatigue, and relevant comorbidities [i.e., high blood pressure and obesity [body mass index (BMI) ≥ 30 kg/m2)]. Chi-squared tests were used for comparisons.Results.The study population consisted of 164 patients with RA and 328 patients without RA. Age, sex and BMI were similar for both groups. There was no difference in snoring (p = 0.31) or in the comorbidities subscale (p = 0.37). However, RA patients reported more fatigue (38%) than subjects without RA (13%; p < 0.001). Overall, the risk for sleep apnea was significantly higher for the RA patients (50%) than the non-RA subjects (31%; p < 0.001).Conclusion.Patients with RA may be at a higher risk for sleep apnea compared to non-RA subjects. This apparent risk difference may be attributed to reports of fatigue in RA patients, which may be associated with sleep apnea or RA disease itself.
Increased Cardiovascular Disease in Patients with Inflammatory Arthritis in Primary Care: A Cross-sectional Observation: Table 1.
Authors: PETERS MIKE J.L. , NIELEN MARK M.J. , RATERMAN HENNIE G. , VERHEIJ ROBERT A. , SCHELLEVIS FRANCOIS G. , NURMOHAMED MICHAEL T. 
Published: August 2009

Objective.To compare the prevalence of cardiovascular disease (CVD) in patients with inflammatory arthritis and control subjects registered in primary care.Methods.Conditional logistic regression analyses were used to compare the CVD prevalence in patients and controls, aged 50–75 years.Results.Overall, the CVD prevalence was 66.1 per 1000 patients in inflammatory arthritis and 37.3 per 1000 patients in controls, resulting in an odds ratio of 1.83 (95% confidence interval 1.33–2.51).Conclusion.Inflammatory arthritis patients registered in primary care are associated with an increased cardiovascular burden, which emphasizes the need for cardiovascular risk management in the primary care setting.
Does Sonographic Needle Guidance Affect the Clinical Outcome of Intraarticular Injections?
Authors: SIBBITT WILMER L. , PEISAJOVICH ANDRES , MICHAEL ADRIAN A. , PARK KYE S. , SIBBITT RANDY R. , BAND PHILIP A. , BANKHURST ARTHUR D. 
Published: August 2009

Objective.This randomized controlled study addressed whether sonographic needle guidance affected clinical outcomes of intraarticular (IA) joint injections.Methods.In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were confirmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0–10 cm visual analog pain scale (VAS).Results.Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week outcome (p < 0.001), 75% reduction in significant pain (VAS pain score ≥ 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score ≥ 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%.Conclusion.Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.
Palindromic Rheumatism: Longterm Outcomes of 60 Patients Diagnosed in 1967–84
Authors: KOSKINEN ESSI , HANNONEN PEKKA , SOKKA TUULIKKI 
Published: August 2009

Objective.To study longterm outcomes of 60 patients with palindromic rheumatism (PR) diagnosed in 1967–1984.Methods.A cohort of patients with PR was identified in Jyväskylä Central Hospital in 1967–84, and reexamined in 1984–86. In 2006, medical records of the patients were reviewed to analyze the proportion of patients who had developed chronic rheumatoid arthritis (RA), had joint replacement surgery, or had died. Patients’ health status was reviewed by mail questionnaires including functional status on the Health Assessment Questionnaire (HAQ), pain, and the number of painful joints.Results.Forty patients developed chronic RA over the observation period of over 20 years, among whom 38 patients within 10 years and 2 patients after 10 years. Twenty-four patients had died by 2006, 17 (42%) in the RA group and 7 (35%) in the non-RA group. Nine patients, all in the RA group (23%), had received 1 or more joint replacements. The mean HAQ score was 0.57 in the non-RA survivors (mean age 70 yrs), compared to 0.89 in the RA group (mean age 66 yrs) (p = 0.020, adjusted for age). Pain scores and the number of painful joints were similar between the groups.Conclusion.Two-thirds of the patients with PR developed chronic arthritis. The risk to develop chronic arthritis remained over 10 years. The RA group was characterized with functional declines and having joint replacements as longterm outcomes of the disease.
Arterial Events in Persons with Dermatomyositis and Polymyositis
Authors: TISSEVERASINGHE ANNALIESE , BERNATSKY SASHA , PINEAU CHRISTIAN A. 
Published: August 2009

Objective.To assess arterial events in dermatomyositis (DM) and polymyositis (PM), and associated factors.Methods.We studied a cohort of persons with DM and PM, assembled from provincial administrative databases. New cases of ischemic heart disease, cerebrovascular accidents (CVA), and peripheral arterial disease were ascertained from billing and hospitalization data. We performed case-control analyses to assess the effects of clinical factors and medication exposures.Results.Incident arterial events occurred in 80 subjects, including 34 acute myocardial infarctions (13.8/1000 person-years) and 13 CVA (5.1/1000); these rates are higher than available Canadian figures. Nested case-control analyses, with risk-set sampling, revealed an increased incidence of arterial events associated with hypertension [adjusted rate ratio (RR) 2.6; 95% confidence interval (CI) 1.2–5.5] and lipid disorders (adjusted RR 2.6, 95% CI 1.0–6.5), whereas nonsteroid immunomodulators (methotrexate, azathioprine, antimalarial agents, or cyclophosphamide) were inversely associated with arterial events (adjusted RR 0.5, 95% CI 0.2–1.0).Conclusion.We found a high incidence of arterial events in this cohort of persons with inflammatory myopathy. Traditional risk factors, particularly hypertension and lipid disorders, were predictors of arterial events, while nonsteroid immunomodulators were inversely associated. Our work suggests a rationale for aggressive risk reduction strategies in persons with inflammatory myopathies.
Th17 Transcription Factor RORC2 Is Inversely Correlated with FOXP3 Expression in the Joints of Children with Juvenile Idiopathic Arthritis
Authors: OLIVITO BIAGIO , SIMONINI GABRIELE , CIULLINI SARA , MORIONDO MARIA , BETTI LETIZIA , GAMBINERI ELEONORA , CANTARINI LUCA , DE MARTINO MAURIZIO , AZZARI CHIARA , CIMAZ ROLANDO 
Published: August 2009

Objective.To investigate the relationship between interleukin 17 (IL-17) producing T cells (Th17) and CD4+CD25+FOXP3+ regulatory T cells (Tregs) in blood and synovial fluid (SF) of patients with juvenile idiopathic arthritis (JIA).Methods.Sixty-five children with JIA (18 males and 47 females, median age 6.2 yrs; 45 with oligoarticular and 20 with polyarticular course) and 75 age- and sex-matched healthy controls were studied. Flow cytometry was used to analyze the forkhead box P3 (FOXP3)-positive Treg cells in peripheral blood (PB) and synovial fluid mononuclear cells (SFMC). FOXP3 and retinoic-acid related orphan receptor C isoform 2 (RORC2) messenger RNA (mRNA) were assessed by real-time polymerase chain reaction analysis. Cytokines (IL-17 and Th1/Th2 related cytokines) were measured in culture supernatants of 11 paired PBMC and SFMC activated with PMA and ionomycin.Results.FOXP3+ T cells and FOXP3 mRNA amounts were significantly lower in PB of children with JIA as compared with controls (p = 0.0002 and p = 0.001, respectively) and a higher percentage of Treg cells with concomitant higher level of FOXP3 transcript levels were observed in SF when compared with their PB counterparts (both p < 0.0001). SF CD4+FOXP3+ T cells were characterized by higher amounts of FOXP3 protein per cell when compared with peripheral CD4+FOXP3+ T cells, as revealed by the difference in FOXP3 median fluorescence intensity (median ± SD, arbitrary units, 54 ± 22.6 vs 19.5 ± 4.2; p < 0.001). RORC2 transcript levels were higher in JIA joints when compared with matched PB samples (median fold increase 3.9, p < 0.0001) but negatively correlated with FOXP3 mRNA levels (r = −0.623, p = 0.04). Stimulated SFMC displayed an impaired ability to produce IL-17 when compared with PBMC and, interestingly, an inverse relationship between IL-17 levels and the percentage of CD4+CD25+FOXP3+ SF T cells (r = −0.510, p = 0.047) was seen.Conclusion.We demonstrated for the first time an increased synovial expression of the transcription factor of Th17, RORC2, in JIA, and its inverse relationship with FOXP3 mRNA. These results extend research on “Th17” and Tregs in JIA.
Noninfectious Ascending Aortitis: A Case Series of 64 Patients
Authors: LIANG KIMBERLY P. , CHOWDHARY VAIDEHI R. , MICHET CLEMENT J. , MILLER DYLAN V. , SUNDT THORALF M. , CONNOLLY HEIDI M. , CROWSON CYNTHIA S. , MATTESON ERIC L. , WARRINGTON KENNETH J. 
Published: August 2009

Objective.To identify the clinical presentation and histopathologic characteristics of noninfectious ascending aortitis.Methods.A retrospective medical record and histopathology review was performed of patients with histologic evidence of active noninfectious aortitis who underwent ascending aortic aneurysm resection at Mayo Clinic between January 1, 2000, and February 28, 2006. Clinicopathologic features were recorded, including demographics, clinical presentation, laboratory, imaging findings, histopathology, complications, treatment, and outcome.Results.Sixty-four patients (50% women) were identified; the majority were Caucasian (83%) and elderly (mean age 69.1 yrs). Upon initial presentation, 45% had aneurysm-related symptoms, 33% were asymptomatic, 12.5% had constitutional symptoms, 4.7% had symptoms referable to cranial arteries, and 9.4% had polymyalgia rheumatica (PMR) symptoms. The majority (81%) were of “isolated” variant, with no rheumatologic history. Mean preoperative erythrocyte sedimentation rate was 16.2 ± 23.3 mm/h (n = 20). Additional vascular imaging abnormalities were present in 72% of patients, including stenoses and/or ectasia of major aortic branches and descending thoracic or abdominal aneurysms. Giant cells were seen in 71.9%. Median followup time was 15.4 months, during which 6 (9.4%) patients died. Only 22 (34%) patients received corticosteroids, with uncertain effect on development of recurrent aneurysms, rupture, or dissections.Conclusion.Noninfectious ascending aortitis frequently occurs even in the absence of history, symptoms, or signs of giant cell arteritis (GCA) or PMR. When discovered, such patients should be followed closely, as a majority have additional vascular abnormalities. More studies are needed to determine optimal strategies for surveillance, detection, and treatment of ascending aortitis, which may represent a clinical entity distinct from classical GCA.
Purified Protein Derivative Response in Juvenile Idiopathic Arthritis
Authors: KIRAY EVRIM , KASAPCOPUR OZGUR , BAS VEDAT , KAMBUROGLU-GOKSEL AYLA , MIDILLI KENAN , ARISOY NIL , TASTAN YUCEL 
Published: August 2009

Objective.To examine the purified protein derivative (PPD) response that develops depending upon Th1 immune response in children with juvenile idiopathic arthritis (JIA).Methods.PPD skin test was performed in 115 children with JIA who were vaccinated with bacillus Calmette-Guerin (BCG), and then they were compared to the PPD response of 45 healthy children of the same age who were vaccinated with BCG. Children with a PPD induration ≥ 5 mm were accepted as PPD-positive. PPD induration ≥ 10 mm was accepted as a limit for suspecting tuberculosis.Results.PPD induration size and PPD positivity rates (PPD ≥ 5 mm) of children with JIA were significantly lower than those of healthy children. The mean of PPD induration size was significantly lower (p < 0.0001) in patients with either 1 BCG vaccine (3.7 ± 3.6) or more than 1 BCG vaccine than controls with either 1 BCG vaccine (7.10 ± 3.2) or more than 1 BCG vaccine (10.05 ± 4.1). PPD was positive in 35.9% of patients with JIA vaccinated once (n = 32), in 50% of patients with JIA vaccinated more than once (n = 13), in 82.1% of controls vaccinated once (n = 23), and in 88.2% of controls vaccinated more than once. This result was statistically significant (patients, p = 0.03; controls, p = 0.039). It was determined that neither the activity of the disease nor the use of corticosteroid and methotrexate affected the PPD response.Conclusion.The response to PPD, which is one of the Th1 cell-type responses, was significantly lower in BCG-vaccinated children with JIA compared to healthy children.
TLR Triggering on Tolerogenic Dendritic Cells Results in TLR2 Up-Regulation and a Reduced Proinflammatory Immune Program
Authors: Chamorro Sonia , García-Vallejo Juan J. , Unger Wendy W. J. , Fernandes Rosette J. , Bruijns Sven C. M. , Laban Sandra , Roep Bart O. , 't Hart Bert A. , van Kooyk Yvette 
Published: August 2009

Abstract
Tolerogenic dendritic cells (TDC) offer a promising therapeutic potential to ameliorate autoimmune diseases. Reported to inhibit adaptive immune responses, little is known about their innate immunity receptor repertoire. In this study, we compared three types of human TDC (IL-10-DC, dexamethasone (DX)-DC, and 1,25(OH)2D3-DC) by their TLR expression and response to a set of TLR ligands. TDC are endowed with the same TLR set as standard monocyte-derived dendritic cells but respond differentially to the TLR stimuli Pam3CSK4, polyinosinic-polycytidylic acid, LPS, and flagellin. TDC expressed low or no IL-12-related cytokines and remarkably elevated IL-10 levels. Interestingly, only TDC up-regulated the expression of TLR2 upon stimulation. This boosted the tolerogenic potential of these cells, because IL-10 production was up-regulated in TLR2-stimulated, LPS-primed DX-DC, whereas IL-12 and TNF-α secretion remained low. When comparing the TDC subsets, DX-DC and 1,25(OH)2D3-DC up-regulated TLR2 irrespective of the TLR triggered, whereas in IL-10-DC this effect was only mediated by LPS. Likewise, DX-DC and 1,25(OH)2D3-DC exhibited impaired ability to mature, reduced allostimulatory properties, and hampered capacity to induce Th1 differentiation. Therefore, both DX-DC and 1,25(OH)2D3-DC display the strongest tolerogenic and anti-inflammatory features and might be most suitable tools for the treatment of autoimmune diseases.