bluuebunny/crossref_metadata_2025_split huggingface dataset:
T cell polarization identifies distinct clinical phenotypes in scleroderma lung disease
Authors: Boin Francesco , De Fanis Umberto , Bartlett Susan J. , Wigley Fredrick M. , Rosen Antony , Casolaro Vincenzo 
Published: March 2008

AbstractObjectiveLung involvement is the leading cause of morbidity and mortality in systemic sclerosis (SSc; scleroderma), and interstitial lung disease (ILD) is the most common pulmonary manifestation. An abnormal profibrotic Th2/Tc2‐polarized T cell response is postulated to mediate tissue damage and fibrosis. The aim of this study was to investigate whether a polarized T cell phenotype in SSc is associated with lung disease or other clinical manifestations of SSc.MethodsCirculating T cells were characterized by flow cytometry in 62 patients with SSc and 36 healthy control subjects, using antibodies against CD3, CD4, CD8, chemokine receptor CCR5 (Th1/Tc1‐specific), and prostaglandin D2 receptor CRTH2 (Th2/Tc2‐specific). The ratio between CCR5 and CRTH2 T cell frequencies was used to quantify type 1 (high‐ratio) or type 2 (low‐ratio) immune polarization.ResultsPatients with SSc exhibited lower CCR5/CRTH2 T cell ratios than those exhibited by control subjects (P < 0.0001), indicating a Th2/Tc2‐polarized phenotype. Markedly reduced CCR5/CRTH2 T cell ratios were observed in SSc patients with ILD compared with SSc patients without ILD (P < 0.0001), particularly in patients with active ILD (P < 0.0001) compared with those with stable lung function. Lower CCR5/CRTH2 ratios were strongly associated with a lower value for the percent predicted forced vital capacity (P < 0.0001). In patients with an estimated right ventricular systolic pressure >35 mm Hg, suggestive of pulmonary vascular disease, a lower value for the percent predicted diffusing capacity (DLCO) was associated with higher CCR5/CRTH2 T cell ratios (Th1/Tc1) (P = 0.009), while in those with right ventricular systolic pressure <35 mm Hg, a lower value for the percent predicted DLCO correlated with lower ratios (Th2/Tc2) (P < 0.0001), as observed for ILD.ConclusionT cell polarization in SSc is strongly associated with specific manifestations of lung disease. Measurement of T cell polarization may represent a valuable tool to monitor disease activity and predict clinical outcomes in SSc patients with lung disease.
Requirement of toll‐like receptor 7 for pristane‐induced production of autoantibodies and development of murine lupus nephritis
Authors: Savarese Emina , Steinberg Christian , Pawar Rahul D. , Reindl Wolfgang , Akira Shizuo , Anders Hans‐Joachim , Krug Anne 
Published: March 2008

AbstractObjectiveThe detection of high titers of antibodies against small nuclear ribonucleoproteins (snRNP) is a diagnostic finding in patients in whom systemic lupus erythematosus (SLE) is suspected. Endogenous RNA molecules within snRNP trigger Toll‐like receptor 7 (TLR‐7) activation in B cells and dendritic cells, leading to anti‐snRNP antibody production, which is associated with the development of immune complex nephritis in SLE. The purpose of this study was to investigate the role of TLR‐7 in anti‐snRNP antibody production and renal disease in SLE induced by an exogenous factor in the absence of genetic predisposition, using the pristane‐induced murine lupus model.MethodsSerum autoantibodies, IgG isotypes, and cytokine levels in pristane‐treated wild‐type and TLR‐7–deficient mice were analyzed by enzyme‐linked immunosorbent assay. Histopathologic changes in mouse kidneys were determined by light immunofluorescence microscopy. Cell subsets in splenocytes and peritoneal lavage cells from the mice were examined by flow cytometry.ResultsWe found that anti‐snRNP antibody production induced by pristane treatment was entirely dependent on the expression of TLR‐7, whereas anti–double‐stranded DNA antibody production was not affected by a lack of TLR‐7. Impaired anti‐snRNP antibody production in TLR‐7–deficient mice was paralleled by lower levels of glomerular IgG and complement deposits, as well as less severe glomerulonephritis.ConclusionTLR‐7 is specifically required for the production of RNA‐reactive autoantibodies and the development of glomerulonephritis in pristane‐induced murine lupus, a model of environmentally triggered SLE in the absence of genetic susceptibility to autoimmunity. Specific interference with TLR‐7 activation by endogenous TLR‐7 ligands may therefore be a promising novel strategy for the treatment of SLE.
Impact of ankylosing spondylitis on work and family life: Comparisons with the US population
Authors: Ward Michael M. , Reveille John D. , Learch Thomas J. , Davis John C. , Weisman Michael H. 
Published: March 2008

AbstractObjectiveTo examine the impact of ankylosing spondylitis (AS) on work disability, nonparticipation in the labor force, marriage, divorce, and childbearing.MethodsIn this cross‐sectional survey, we asked AS patients (n = 591, 72.8% men, mean age 48.9 years) from the Los Angeles, Houston, San Francisco, and Washington, DC metropolitan areas about work and family life. The proportion of patients who were work disabled, did not participate in the labor force, had never been married, were divorced, or had a biological child were compared with the proportions expected for each outcome based on data from population surveys.ResultsPatients with AS were more likely to be work disabled (13.3% versus 5.7%; P < 0.0001) and somewhat more likely to not participate in the labor force compared with the proportion expected (25.1% versus 21.8%; P = 0.07). These associations were stronger among patients age ≥45 years and those with AS for ≥20 years. AS patients were more likely than expected to have never been married (22.8% versus 15.4%; P < 0.0001) or to be divorced (13.2% versus 10.0%; P = 0.02). Women with AS were less likely than expected to have had children (54.7% versus 64.9%; P = 0.02), but the proportion of men with AS who had children was not different from that of the general population.ConclusionPatients with AS in this study were more likely to have never been married, more likely to be divorced, and more than twice as likely to be work disabled than members of the general population. Women with AS were also less likely to have had children than women in the general population.
Prevalence and clinical correlates of symptoms of depression in patients with systemic sclerosis
Authors: Thombs Brett D. , Hudson Marie , Taillefer Suzanne S. , Baron Murray ,   Canadian Scleroderma Research Group
Published: March 2008

AbstractObjectiveTo assess the prevalence and predictors of symptoms of depression in a large sample of patients with systemic sclerosis (SSc).MethodsWe conducted a cross‐sectional, multicenter study of 376 patients with SSc from the Canadian Scleroderma Research Group Registry. Patients were assessed with the Center for Epidemiologic Studies Depression Scale (CES‐D) and through extensive clinical histories and medical examinations. Hierarchical multiple linear regression was used to assess the relationship of sociodemographic and clinical variables with symptoms of depression.ResultsThe percentages of patients who scored ≥16 and ≥23 on the CES‐D were 35.1% and 18.1%, respectively. Patients with less education; patients who were not married; patients with higher physician‐rated overall disease severity; and patients with more tender joints, more gastrointestinal symptoms, and more difficulty breathing had significantly higher total CES‐D scores. As a group, specific symptom indicators (tender joints, gastrointestinal symptoms, breathing) predicted the most incremental variance in depressive symptoms (ΔR2 = 14.2%, P < 0.001) despite being added to the model after demographic, socioeconomic, and global disease duration/severity indicators.ConclusionHigh levels of depressive symptoms are common in patients with SSc and are related to overall SSc disease severity, as well as specific medical symptoms. Screening for depression among patients with SSc is recommended, although more research is needed to determine the best method for doing this. Successfully treating dyspnea, gastrointestinal symptoms, and joint pain may improve mood, although this has not yet been demonstrated.
Evaluation of the patient acceptable symptom state as an outcome measure in patients with ankylosing spondylitis: Data from a randomized controlled trial
Authors: Dougados Maxime , Luo Michelle P. , Maksymowych Walter P. , Chmiel Joseph J. , Chen Naijun , Wong Robert L. , Davis John C. , Heijde DÉsirÉe van der ,   ATLAS STUDY GROUP
Published: March 2008

AbstractObjectiveTo evaluate the feasibility/acceptability, reliability, external validity, and discriminant capacity of the Patient Acceptable Symptom State (PASS) concept in patients with active ankylosing spondylitis (AS).MethodsPASS was assessed by asking patients to respond yes or no to a single question: “Considering all the different ways your disease is affecting you, if you would stay in this state for the next months, do you consider that your current state is satisfactory?” during the 24‐week, randomized (2:1 ratio), double‐blind, placebo‐controlled portion of an adalimumab study of 315 patients.ResultsPASS reliability was high (κ = 0.86) in patients with stable disease. Significantly more patients who answered yes to PASS than patients who answered no to PASS were responders based on the ASsessment in Ankylosing Spondylitis (ASAS) International Working Group criteria for 20% improvement (75% who answered yes versus 29% who answered no), the ASAS criteria for 40% improvement (61% versus 16%), the ASAS partial remission criteria (37% versus 3%), and ≥50% improvement on the Bath Ankylosing Spondylitis Disease Activity Index (65% versus 19%; P < 0.001 for all comparisons), demonstrating external validity of the PASS concept. More adalimumab‐treated than placebo‐treated patients achieved PASS at week 12 (42.3% versus 22.4%; P < 0.001), and more adalimumab‐treated than placebo‐treated patients achieved sustained PASS through week 20 (34.6% versus 12.3%; P < 0.001), indicating excellent discriminant capacity.ConclusionPASS is a feasible, acceptable, reliable, and valid assessment of satisfactory health state in patients with AS.
Validity, reproducibility, and responsiveness of a twelve‐joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis
Authors: Naredo Esperanza , Rodríguez Manuel , Campos Cristina , Rodríguez‐heredia José Manuel , Medina Julio A. , Giner Emilio , Martínez Olga , Toyos Francisco Javier , Ruíz Teresa , Ros Inmaculada , Pujol Manuel , Miquel Xavier , García Luz , Aznar Juan José , Chamizo Eugenio , Páez Manuel , Morales Pilar , Rueda Amalia , Tuneu Roser , Corominas Hector , de Agustín Juan José , Moragues Carmen , Mínguez Dolores , Willisch Alfredo , González‐cruz Isabel , Aragón Angel , Iglesias Gerardo , Armas Carlos , Pablo valdazo Juan , Vargas Carmen , Calvo‐alén Jaime , Juan‐mas Antonio , Salvador Georgina , Puigdollers Angels , Galíndez Eva , Garrido Noemi , Salaberri José , Raya Enrique , Salles Meritxell , Díaz César , Cuadra José luis , Garrido Jesús ,   Ultrasound group of the spanish society of rheumatology
Published: March 2008

AbstractObjectiveTo investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44‐joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent.MethodsA total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated.ResultsA PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44‐joint count and index for synovitis and PD signal and the 12‐joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84–0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables.ConclusionA 12‐joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.
Determinants of the use of wrist working splints in rheumatoid arthritis
Authors: Veehof Martine M. , Taal Erik , Willems Marjanne J. , van de Laar Mart A. F. J. 
Published: March 2008

AbstractObjectiveTo gain insight into the determinants of the use of wrist working splints among patients with rheumatoid arthritis (RA).MethodsA qualitative descriptive study was performed among 18 patients with RA who recently received a fabric wrist working splint because of pain due to arthritis of the wrist. Patients were interviewed at home using semistructured in‐depth interviews. Interviews were audiotaped and transcribed verbatim and analyzed using the framework approach.ResultsThe majority of patients indicated that their splint use was dependent on the seriousness of the symptoms (pain, swelling, or tingling feelings) they perceived. Important reasons to wear the splint were reduction of symptoms, wrist support, and immobilization of the wrist. Important reasons to stop wearing the splint were reduced functional abilities using the splint and the performance of dirty or wet activities.ConclusionThe reasons for patients to wear and not wear wrist working splints are related to intentional decisions of the patients, which are primarily based on perceived benefits and barriers of splint wearing. The results of this study have been used to develop educational and behavioral strategies to increase adherence to wearing wrist working splints.
Long‐term followup of temporomandibular joint involvement in juvenile idiopathic arthritis
Authors: Twilt Marinka , Schulten Alcuin J. M. , Verschure Femke , Wisse Lauke , Prahl‐Andersen Birte , van Suijlekom‐Smit Lisette W. A. 
Published: March 2008

AbstractObjectiveTemporomandibular joint (TMJ) involvement is a frequent feature in cross‐sectional prevalence studies among patients with juvenile idiopathic arthritis (JIA). In this followup study, patients were reviewed after 5 years to study the course of TMJ involvement in relation to disease characteristics.MethodsChildren with JIA from a previous study on TMJ involvement were included. A rheumatologic evaluation including the 6 parameters of the JIA core set and an orthodontic evaluation including an orthopantomogram (OPT) were performed. OPTs were scored according to Rohlin's grading system (grades 0–5).ResultsThe overall prevalence of patients with condylar alterations decreased from 49% to 40%. Improvement of the alterations was seen in 69% of the initially affected condyles, and consequently improvement was seen in 83% of the initially affected patients. Normalization of the alterations was seen in 67% of the improved condyles, and consequently in 44% of the patients. This proves that the condyle has a regenerative capacity. Improvement was related to low disease activity and a less extensive therapeutic regimen.ConclusionIn patients with JIA, condylar alterations can improve and even regenerate. Condylar improvement is associated with a low disease activity.
Fitness, fatigue, disease activity, and quality of life in pediatric lupus
Authors: Houghton Kristin M. , Tucker Lori B. , Potts James E. , Mckenzie Donald C. 
Published: March 2008

AbstractObjectiveTo measure aerobic fitness (maximum oxygen consumption [VO2peak]), fatigue, quality of life (QOL), and disease activity in young persons with systemic lupus erythematosus (SLE), and to determine an equation for predicting VO2peak from the distance walked in 6 minutes (6MW).MethodsFifteen young patients ages 12–19 years with SLE participated. VO2 was measured by a graded treadmill exercise test. Submaximal exercise intensity was determined from the ventilatory anaerobic threshold. Submaximal aerobic capacity was measured using the 6MW. Patient questionnaires included measures of fatigue, QOL, and physical activity. Physician questionnaires included the Systemic Lupus Erythematosus Disease Activity Index and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.ResultsCompared with age‐matched norms, our patients had moderate impairment in aerobic fitness, with a mean ± SD VO2peak of 31.1 ± 7.9 ml/minute/kg and a mean 6MW distance Z score of −2.4 ± 2.3. The regression equation to predict VO2peak (ml/minute/kg) from 6MW was as follows: 57.1 + [0.038 × distance (meters)] + (−0.35 × maximal heart rate) (R = 0.67, P = 0.027). Ten subjects (67%) reported significant fatigue. There was no significant correlation of fatigue with fitness measures. Neither fatigue nor fitness was significantly correlated with disease activity, disease damage, or QOL measures.ConclusionYoung SLE patients have lower aerobic fitness than reference norms. The 6MW may be used as a marker of fitness, but it is preferable to determine VO2 with a graded exercise test. Fatigue is a significant symptom in young SLE patients. The application of fatigue measures in young persons is exploratory. The relationship between fatigue and aerobic fitness is not clear.
Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US
Authors: Allaire Saralynn , Wolfe Frederick , Niu Jingbo , Lavalley Michael P. 
Published: March 2008

AbstractObjectiveTo provide a contemporary estimate of the prevalence and incidence of rheumatoid arthritis (RA) work disability and examine its permanence over time.MethodsData were collected semiannually from 5,384 subjects with rheumatologist‐diagnosed RA. We examined prevalence in subgroups formed by ∼5‐year disease duration intervals using data from subjects age ≤64 years who were employed at disease onset. Annual incidence was examined longitudinally among subjects who supplied data in 2003, 2004, or 2005, were employed at disease onset and in a year's first survey, and were age ≤63 years. For work disability permanence we used longitudinal data from all subjects who became work disabled and observed whether they later returned to work.ResultsMean age of subjects was 52 years, 82% were female, 63% had more than a high school education, mean disease duration was 14 years, and mean Health Assessment Questionnaire score was 1.0. The prevalence of any premature work cessation was 23% in subjects with 1–3 years duration, 35% in those with 10 years, and 51% in those with ≥25 years RA duration. Arthritis‐attributed work cessation was 14%, 29%, and 42%, respectively. Annual incidence of any premature work cessation was ∼10% and arthritis‐attributed work cessation incidence was ∼6%. Thirty‐nine percent of subjects who stopped working later returned to work.ConclusionWork disability prevalence in this sample was high (35% within 10 years disease duration), but may represent a decline from the 50% prevalence reported in 1987. Annual incidence of work disability was higher than prior studies, but the return to work rate was also higher.
Two aspects of the clinical and humanistic burden of systemic lupus erythematosus: Mortality risk and quality of life early in the course of disease
Authors: Campbell Robert , Cooper Glinda S. , Gilkeson Gary S. 
Published: March 2008

AbstractObjectiveTo evaluate mortality risk and predictors among recently diagnosed systemic lupus erythematosus (SLE) patients.MethodsThe vital status of 265 SLE patients and 355 controls enrolled in the Carolina Lupus Study (median time since diagnosis 13 months) was determined ∼5 years after enrollment. We also assessed the utility of an 8‐item quality of life instrument, derived from the standard 36‐item Medical Outcomes Study Short Form 36, as an additional measure of disease impact.ResultsFive years after diagnosis, 9.7% of patients compared with 0.3% of controls had died (P < 0.0001). Increased mortality risk was seen among older patients (adjusted hazard ratio [HR] 1.03, 95% confidence interval [95% CI] 1.01–1.06 per 1‐year increment in age) and among men, African Americans, patients with lupus nephritis, and patients with anti–double‐stranded DNA antibodies (adjusted HR ∼2.0 for each of these factors). In addition, patients who did not provide a blood sample at study enrollment experienced increased mortality risk (age‐, sex‐, and race‐adjusted HR 3.7, 95% CI 1.5–9.1). Similar results were seen in analyses limited to time from study enrollment. Physical component scores of the quality of life measure were 7.7 points lower (P < 0.0001) and mental component scores were 1.8 points lower (P = 0.07) in patients compared with controls.ConclusionThe mortality risk among SLE patients is significant, particularly among African Americans, even early in the disease process and even with currently available treatments. Differences between cases and controls in health‐related quality of life using the Short Form 8 also demonstrate the multidimensional burden of SLE.
A pilot study of subclinical coronary atherosclerosis in systemic sclerosis: Coronary artery calcification in cases and controls
Authors: Khurma Vandana , Meyer Cris , Park Grace S. , McMahon Maureen , Lin Jan , Singh Ram Raj , Khanna Dinesh 
Published: March 2008

AbstractObjectiveSystemic sclerosis (SSc) is associated with vasculopathy and endothelial cell injury, which could potentially increase the risk of coronary atherosclerosis. Multidetector computed tomography, a noninvasive procedure, generates a coronary calcium score (CCS) as a marker for coronary atherosclerosis. Serum proinflammatory high‐density lipoprotein (piHDL) is a potential novel marker of atherosclerotic risk. The objective of the pilot study was to determine 1) the prevalence of subclinical coronary atherosclerosis in SSc and 2) serum piHDL levels as a potential novel marker of atherosclerotic risk in SSc.MethodsA cross‐sectional study of 17 patients with SSc and 17 age‐, sex‐, and race‐matched healthy controls in Cincinnati, Ohio, was conducted. Measurements included CCS; body mass index; lipid profile; and serum levels of high‐sensitivity C‐reactive protein, homocysteine, and piHDL.ResultsPatients with SSc were slightly older (mean 52.8 years) than control subjects (mean 50.6 years; P = 0.01). Coronary calcium was found in 12 participants (9 with SSc, 3 controls; P = 0.03). The mean ± SD CCS in patients with SSc was significantly greater than the controls (126.6 ± 251.0 versus 14.7 ± 52.2; P = 0.003). Five patients with SSc (29%), but no controls, had detectable levels of piHDL (P = 0.06).ConclusionPrevalence of subclinical coronary atherosclerosis is greater in patients with SSc compared with healthy controls. These findings should be confirmed in a larger study.