-
Rheumatology (Oxford, England) Jan 2021Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared... (Review)
Review
Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren's syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved.
Topics: Ankle Joint; Arthritis; Diagnosis, Differential; Humans
PubMed: 33097958
DOI: 10.1093/rheumatology/keaa531 -
Tidsskrift For Den Norske Laegeforening... May 2000Palindromic rheumatism is an inflammatory rheumatic disease characterised by recurrent attacks of arthritis confined to one or more peripheral joints. Each episode of...
BACKGROUND
Palindromic rheumatism is an inflammatory rheumatic disease characterised by recurrent attacks of arthritis confined to one or more peripheral joints. Each episode of arthritis rarely lasts more than 14 days, and subsides without leaving any residues.
MATERIAL AND METHODS
Three patients with palindromic arthritis are presented, and the literature reviewed.
RESULTS
The clinical and laboratory characteristics of the three patients were similar to those generally described for palindromic rheumatism. Two patients developed seropositive rheumatoid arthritis and one patient developed chronic seronegative polyarthritis.
INTERPRETATION
Palindromic rheumatism may evolve into chronic polyarthritis.
Topics: Arthritis; Arthritis, Rheumatoid; Diagnosis, Differential; Female; Humans; Middle Aged; Recurrence
PubMed: 10916474
DOI: No ID Found -
Nihon Rinsho Men'eki Gakkai Kaishi =... 2011Spondyloarthritis (SpA) includes reactive arthritis (ReA) and enteropathic arthritis (EA), which are clinically important but often misdiagnosed. ReA, sterile... (Review)
Review
Spondyloarthritis (SpA) includes reactive arthritis (ReA) and enteropathic arthritis (EA), which are clinically important but often misdiagnosed. ReA, sterile inflammatory arthritis, arises after certain genitourinary or gastrointestinal infections. Chlamydia are the most common pathogens causing ReA; ReA due to Chlamydia infection is called Chlamydia-associated arthritis (Chl-AA). Recently, Chlamydia trachomatis was detected in the synovial tissue from patients with ReA by electronmicroscopy. In addition, mRNA as well as DNA has been detected in the synovial tissue, suggesting that Chlamydia are viable in inflamed joints. Thus, the notion that ReA is a sterile inflammation should be reconsidered. Chl-AA patients, especially women, often show no symptoms and signs of genitourinary infection. Thus, Chl-AA should be suspected in patients with inflammatory arthritides that is difficult to diagnose. EA is accompanied by inflammatory bowel diseases (IBD). In Japan, over 130,000 individuals have IBD; IBD is diagnosed in 6,500 individuals every year. Around 10% IBD patients develop arthritis, suggesting that 13,000 patients develop arthritis every year. SpA includes peripheral and axial arthritis; axial arthritis includes spondylitis and sacroiliac arthritis. Sacroiliac joint tests need to be performed to diagnose sacroiliac arthritis. Rheumatologists should be aware of the pathogenesis of Chl-AA and EA and diagnose and treat these diseases appropriately.
Topics: Adult; Arthritis; Arthritis, Reactive; Chlamydia Infections; Chlamydia trachomatis; Diagnosis, Differential; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Prohibitins; Spondylarthritis; Young Adult
PubMed: 21720100
DOI: 10.2177/jsci.34.121 -
Translational Research : the Journal of... Dec 2019RNA interference (RNAi) is a cellular mechanism for post-transcriptional gene regulation mediated by small interfering RNA (siRNA) and microRNA. siRNA-based therapy... (Review)
Review
RNA interference (RNAi) is a cellular mechanism for post-transcriptional gene regulation mediated by small interfering RNA (siRNA) and microRNA. siRNA-based therapy holds significant promise for the treatment of a wide-range of arthritic diseases. siRNA selectively suppresses the expression of a gene product and can thus achieve the specificity that is lacking in small molecule inhibitors. The potential use of siRNA-based therapy in arthritis, however, has not progressed to clinical trials despite ample evidence for efficacy in preclinical studies. One of the main challenges to clinical translation is the lack of a suitable delivery vehicle to efficiently and safely access diverse pathologies. Moreover, the ideal targets in treatment of arthritides remain elusive given the complexity and heterogeneity of these disease pathogeneses. Herein, we review recent preclinical studies that use RNAi-based drug delivery systems to mitigate inflammation in models of rheumatoid arthritis and osteoarthritis. We discuss a self-assembling peptide-based nanostructure that demonstrates the potential of overcoming many of the critical barriers preventing the translation of this technology to the clinic.
Topics: Animals; Arthritis; Cell Engineering; Gene Transfer Techniques; Humans; Inflammation; RNA Interference; Signal Transduction
PubMed: 31351032
DOI: 10.1016/j.trsl.2019.07.002 -
Current Opinion in Rheumatology Sep 2015To review recent advances in the management strategies of polyarticular course juvenile idiopathic arthritis (JIA) and identify unanswered questions and avenues for... (Review)
Review
PURPOSE OF REVIEW
To review recent advances in the management strategies of polyarticular course juvenile idiopathic arthritis (JIA) and identify unanswered questions and avenues for further research.
RECENT FINDINGS
There is evidence for an early, aggressive, treat-to-target approach for polyarticular JIA. Clinical disease activity criteria have been recently defined and validated, including criteria for inactive disease and the juvenile arthritis disease activity score (JADAS). There is a need for evidence-based, defined disease targets and biomarkers for prediction of response, including targets for remission induction, and guidelines on drug withdrawal. Recent treatment consensus plans and guidelines are discussed and compared, including the 2015 NHS England clinical policy statement, the 2014 Childhood Arthritis and Rheumatology Research Alliance (CARRA) treatment plans and the 2011 American College of Rheumatology (ACR) guidelines. Evidence for new agents such as tocilizumab, rituximab, golimumab, ustekinumab, certolizumab and tofacitinib is promising: the recent clinical trials are summarized here. Stratification of individual patient treatment remains a goal, and predictive biomarkers have been shown to predict success in the withdrawal of methotrexate therapy.
SUMMARY
There are promising advances in the treatment approaches, disease activity criteria, clinical guidelines, pharmaceutical choices and individually stratified therapy choices for polyarticular JIA.
Topics: Antibodies, Monoclonal; Arthritis; Arthritis, Juvenile; Child; Enzyme Inhibitors; Guidelines as Topic; Humans; Treatment Outcome
PubMed: 26147756
DOI: 10.1097/BOR.0000000000000206 -
Biological Chemistry Aug 2015Cathepsin S is a member of the cysteine cathepsin protease family. It is a lysosomal protease which can promote degradation of damaged or unwanted proteins in the... (Review)
Review
Cathepsin S is a member of the cysteine cathepsin protease family. It is a lysosomal protease which can promote degradation of damaged or unwanted proteins in the endo-lysosomal pathway. Additionally, it has more specific roles such as MHC class II antigen presentation, where it is important in the degradation of the invariant chain. Unsurprisingly, mis-regulation has implicated cathepsin S in a variety of pathological processes including arthritis, cancer, and cardiovascular disease, where it becomes secreted and can act on extracellular substrates. In comparison to many other cysteine cathepsin family members, cathepsin S has uniquely restricted tissue expression and is more stable at a neutral pH, which supports its involvement and importance in localised disease microenvironments. In this review, we examine the known involvement of cathepsin S in disease, particularly with respect to recent work indicating its role in mediating pain, diabetes, and cystic fibrosis. We provide an overview of current literature with regards cathepsin S as a therapeutic target, as well as its role and potential as a predictive diagnostic and/or prognostic marker in these diseases.
Topics: Animals; Arthritis; Cardiovascular Diseases; Cathepsins; Humans; Hydrogen-Ion Concentration; Neoplasms; Prognosis
PubMed: 25872877
DOI: 10.1515/hsz-2015-0114 -
Arthritis Research & Therapy May 2011Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years,... (Review)
Review
Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years, partially due to increased understanding of the pathogenesis of these diseases at the cellular and molecular levels. These conditions share some common mechanisms. Biologic therapies have provided a clear advance in the treatment of rheumatological conditions. Currently available TNF-targeting biologic agents that are licensed for at east one of the above-named diseases are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Biologic agents with a different mechanism of action have also been approved in rheumatoid arthritis (rituximab, abatacept, and tocilizumab). Although these biologic agents are highly effective, there is a need for improved management strategies. There is also a need for education of family physicians and other healthcare professionals in the identification of early symptoms of inflammatory arthritides and the importance of early referral to rheumatologists for diagnosis and treatment. Also, researchers are developing molecules - for example, the Janus kinase inhibitor CP-690550 (tofacitinib) and the spleen tyrosine kinase inhibitor R788 (fostamatinib) - to target other aspects of the inflammatory cascade. Initial trial results with new agents are promising, and, in time, head-to-head trials will establish the best treatment options for patients. The key challenge is identifying how best to integrate these new, advanced therapies into daily practice.
Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Psoriatic; Arthritis, Rheumatoid; Clinical Trials as Topic; Cytokines; Humans; Models, Immunological; Protein Kinase Inhibitors; Rheumatology; Spondylitis, Ankylosing; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 21624184
DOI: 10.1186/1478-6354-13-S1-S5 -
Best Practice & Research. Clinical... Apr 2012The inflammatory arthritides are a diverse group of conditions characterised by joint inflammation which can lead to pain, deformity and disability. Of these diseases,... (Review)
Review
The inflammatory arthritides are a diverse group of conditions characterised by joint inflammation which can lead to pain, deformity and disability. Of these diseases, rheumatoid arthritis (RA) and spondyloarthritis are two of the most common. While the clinical and demographic features of these diseases differ, the central role of inflammation in their pathogenesis has allowed the development of highly effective treatment strategies with wide applicability. These strategies include the use of biological agents which target the cytokine tumour necrosis factor (TNF), a key mediator of inflammation. With the advent of effective agents, therapy has become more aggressive, reducing disease activity and allowing, at least in RA, remission in many patients. While the array of available effective treatments is extensive, the use of objective measures of disease activity can guide treatment decisions (treat to target) and lead to improved outcomes.
Topics: Antirheumatic Agents; Arthritis; Arthritis, Rheumatoid; Biological Products; Humans; Inflammation; Tumor Necrosis Factor-alpha
PubMed: 22794097
DOI: 10.1016/j.berh.2012.03.001 -
Clinical and Experimental Rheumatology 2016Musculoskeletal ultrasound (MSUS) has become a relevant part of rheumatology practice and research because it substantially allows us to optimize management of rheumatic... (Review)
Review
Musculoskeletal ultrasound (MSUS) has become a relevant part of rheumatology practice and research because it substantially allows us to optimize management of rheumatic and musculoskeletal diseases. This non-invasive imaging modality is a valuable point-of-care tool to accurately evaluate intra-articular and periarticular structures involved in a wide range of rheumatic diseases in adults and children. In addition, MSUS is an invaluable bedside aid for guiding accurate and safe musculoskeletal aspirations, injections and biopsies. This review provides an overview of the literature of the last year on the role of MSUS in arthritis.
Topics: Adult; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Echocardiography, Doppler; Humans; Musculoskeletal System; Osteoarthritis; Point-of-Care Systems; Point-of-Care Testing; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index
PubMed: 26892798
DOI: No ID Found -
Pediatric Rheumatology Online Journal Sep 2020Juvenile spondyloarthritis (JSpA) represents a group of inflammatory arthritides with several distinctive features (enthesitis, involvement of spine and sacroiliac...
BACKGROUND
Juvenile spondyloarthritis (JSpA) represents a group of inflammatory arthritides with several distinctive features (enthesitis, involvement of spine and sacroiliac joint, HLA-B27 association and development of uveitis). There are limited data on the course of uveitis in children with JSpA. This study aims to estimate the prevalence of uveitis and to look at the presence of HLA-B27 in relation to uveitis occurrence and ocular symptoms in a cohort of JSpA patients.
FINDINGS
This is a cross sectional/retrospective study involving patients with JSpA followed in a tertiary referral hospital. Two hundred twenty-three patients were enrolled in the study. The prevalent diagnosis was enthesitis-related arthritis (ERA) (62%) followed by juvenile psoriatic arthritis (PsA), undifferentiated arthritis (UA), and the arthropathies associated with inflammatory bowel disease (IBD-A) (18, 14, 6%, respectively). Uveitis was reported in twenty-four patients (11%) of the JSpA cohort (JSpA-U). ERA patients had the highest uveitis prevalence (ERA-U) (13%) with similar prevalences in UA, PsA and in IBD-A (7% each). The prevalence of HLA-B27 positivity was similar amongst the entire JSpA-U cohort (N = 22, 45%) and those with ERA-U (N = 8, 44%). The overall prevalence of symptomatic uveitis was 79%. Neither the likelihood of uveitis, nor of symptomatic uveitis, varied by HLA-B27 status either in the entire cohort nor in those with ERA.
CONCLUSIONS
About one-tenth of patients developed uveitis, the majority of which was symptomatic. Fewer than half of the patients with uveitis were HLA-B27 positive. HLA-B27 status was not statistically associated with either the development of uveitis or symptomaticity of uveitis.
Topics: Adolescent; Arthritis, Juvenile; Arthritis, Psoriatic; Child; Child, Preschool; Cross-Sectional Studies; Female; HLA-B27 Antigen; Humans; Inflammatory Bowel Diseases; Male; Prevalence; Retrospective Studies; Spondylarthropathies; Uveitis
PubMed: 32912296
DOI: 10.1186/s12969-020-00463-4