Joint symmetry in early and late rheumatoid and psoriatic arthritis: Comparison with a mathematical model

Helliwell, Philip S.; Hetthen, J.; Sokoll, K; Green, M.; Marchesoni, Antonio; Lubrano, Ennio; Veale, Douglas J.; Emery, Paul

doi:10.1002/1529-0131(200004)43:4<865::aid-anr18>3.0.co;2-w

Cited by 88 publications

(58 citation statements)

References 10 publications

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“…This definition of symmetry was adapted from that used in adults with rheumatoid and psoriatic arthritis, which requires that at least 50% of involved joints are symmetric pairs (11). The following JIA outcome measures recorded at the last followup visit were also obtained from medical charts: the number of joints with active arthritis (defined as the number of joints with swelling and/or pain on motion/tenderness and limited range of motion), the number of joints with limited range of motion, the score on the Childhood Health Assessment Questionnaire (C-HAQ), Italian version (12), and the erythrocyte sedimentation rate (ESR; Westergren method).…”

Section: Methodsmentioning

confidence: 99%

Patients with antinuclear antibody–positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease

Ravelli

Felici

Magni‐Manzoni

et al. 2005

Arthritis & Rheumatism

211

134

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Objective. We recently hypothesized that in the International League of Associations for Rheumatology (ILAR) classification of juvenile idiopathic arthritis (JIA), the presumably homogeneous patient group characterized by early onset of disease, a female predilection, the presence of antinuclear antibodies (ANA), asymmetric arthritis, and the risk for iridocyclitis is classified into different categories. We sought to investigate whether ANA-positive patients belonging to the ILAR categories of oligoarthritis and rheumatoid factor (RF)-negative polyarthritis share homogeneous features and to compare these features with those of ANA-negative patients with JIA in the same categories.Methods. We identified patients who were followed up during a 15-year period. All patients had JIA according to the ILAR criteria, with oligoarticular or polyarticular onset. ANA positivity was defined as 2 or more positive results at a titer of >1:160. Demographic and clinical features, including the number of joints involved over time and measures of JIA severity at the last followup visit, were recorded retrospectively.Results. A total of 256 patients were included: 190 were ANA positive (109 had persistent oligoarthritis, 48 had extended oligoarthritis, and 33 had RF-negative polyarthritis), and 66 were ANA negative (35 had RFnegative polyarthritis, and 31 had oligoarthritis). All patients who were positive for ANA were similar in terms of age at disease presentation, female-to-male ratio, and frequency of symmetric arthritis and iridocyclitis. Compared with ANA-positive patients with polyarticular disease, ANA-negative patients with polyarticular arthritis were older at disease presentation and had a lower frequency of iridocyclitis, a higher frequency of symmetric arthritis, a greater cumulative number of joints affected over time, and a different pattern of joint disease, with a greater frequency of shoulder and hip involvement. The strong relationship between the presence of ANA and younger age at disease presentation, asymmetric arthritis, and development of iridocyclitis was confirmed by multivariate regression analysis.Conclusion. Our results support the hypothesis that patients with similar characteristics are currently classified into different JIA categories. The value of ANA positivity as a possible modifier of the current classification system deserves consideration.Juvenile idiopathic arthritis (JIA) is a heterogeneous condition that comprises all forms of arthritis of unknown etiology that begin before age 16 years and persist for Ͼ6 weeks. Over the years, several classification systems based on the clinical characteristics during the first 6 months of disease have been developed (1,2). The recent classification system proposed by the International League of Associations for Rheumatology (ILAR) (3) is intended to be a "work in progress" and is primarily aimed at identifying homogeneous disease groups for research purposes (4).We recently hypothesized that although some of the JIA categories in the ILAR classification ...

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Section: Methodsmentioning

confidence: 99%

Patients with antinuclear antibody–positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease

Ravelli

Felici

Magni‐Manzoni

et al. 2005

Arthritis & Rheumatism

211

134

View full text Add to dashboard Cite

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“…Rheumatoid arthritis (RA) is a chronic, inflammatory disease that principally affects diarthrodial joints, and the central pathology is synovitis (Helliwell et al, 2000;Yamamoto, 2009). The mechanism of RA is complicated and still unclear.…”

Section: Introductionmentioning

confidence: 99%

Methotrexate ameliorates pristane-induced arthritis by decreasing IFN-γ and IL-17A expressions

Hou

Meng

Zheng

et al. 2011

J. Zhejiang Univ. Sci. B

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Abstract:Objective: This study was carried out to test the effects of methotrexate (MTX) and black seed oil (BSO) on pristane-induced arthritis (PIA) in rats. Methods: Inbred dark agouti (DA) rats were induced by a single subcutaneous injection of pristane, and then treated with MTX or BSO. Arthritis severity was evaluated macroscopically and microscopically. Plasma nitric oxide (NO) concentration was determined by the Griess method and cytokine mRNA expression in the spleen was detected by the real-time reverse transcription-polymerase chain reaction (RT-PCR). Results: The clinical arthritis severity was decreased after MTX treatment, while the BSO groups did not show significant changes compared with the disease group. The plasma NO level of the MTX group was significantly decreased compared with the disease group, but the BSO groups showed no difference from the disease group in plasma NO levels. The interferon-γ (IFN-γ) and interleukin-17A (IL-17A) mRNA expressions in the spleens were significantly decreased in the MTX group, but only showed a declining trend in the BSO groups compared with the disease group. Neither MTX nor BSO had an effect on the mRNA expressions of IL-4, transforming growth factor β (TGF-β), and tumor necrosis factor-α (TNF-α) in the spleen. Conclusions: MTX, but not BSO, can reduce the arthritis severity and decrease the mRNA expressions of IFN-γ and IL-17A in pristane-induced arthritis of rats.

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“…This definition of joint symmetricity was previously adopted by Ravelli et al [8], which was used in adults with rheumatoid and psoriatic arthritis [29].…”

Section: Definitionmentioning

confidence: 99%

New Provisional Classification of Juvenile Idiopathic Arthritis Applying Rheumatoid Factor and Antinuclear Antibody

2018

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Objective. Previous classification systems for juvenile idiopathic arthritis (JIA) were based on the number of joints involved and did not categorize homogenous disease entities. Therefore, JIA patients were reclassified retrospectively by applying rheumatoid factor (RF) and antinuclear antibody (ANA), which have been proven to constitute a homogenous disease entity. Methods. The medical records of JIA patients were investigated retrospectively and reclassified into six categories using the new provisional classification. The nomenclature was based on Dr. Martini's proposal in the 23rd European Paediatric Rheumatology Congress (2016) at Genoa, Italy. New categories included systemic JIA (sJIA), RF-positive JIA (RF-JIA), early-onset ANA-positive JIA (eoANA-JIA), enthesitis/spondylitis-related JIA (ESR-JIA), "other JIA", and "unclassified JIA". Results. Of a total of 262 JIA patients, 71 (27.1%) were reclassified as sJIA, 31 (11.8%) as RF-JIA, 22 (8.4%) as eoANA-JIA, 63 (24.0%) as ESR-JIA, 65 (24.8%) as "other JIA", and 10 (3.8%) as "unclassified JIA". A comparison of RF-JIA, eoANA-JIA, and ESR-JIA revealed significant differences in the gender ratio, age of disease onset, and the cumulative number and type of joints involved among the three groups. "Other JIA" comprised a significant proportion (24.8%) and warrants the need for further classification. The characteristics of the RF-positive patients were comparable to those of the anti-cyclic citrullinated peptide antibody-positive patients. The ANA positivity was lower (28.2%) than that in Western studies but showed similar clinical features. Conclusion. This is the first study applying RF and ANA to classify JIA without considering the joint counts. The six new categories include sJIA, RF-JIA, eoANA-JIA, ESR-JIA, "other JIA," and "unclassified JIA". (J Rheum Dis 2018;25:34-46)

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Joint symmetry in early and late rheumatoid and psoriatic arthritis: Comparison with a mathematical model

Cited by 88 publications

References 10 publications

Patients with antinuclear antibody–positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease

Patients with antinuclear antibody–positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease

Methotrexate ameliorates pristane-induced arthritis by decreasing IFN-γ and IL-17A expressions

New Provisional Classification of Juvenile Idiopathic Arthritis Applying Rheumatoid Factor and Antinuclear Antibody

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