Hintergrund: Der Einfluss von rheumatoider Arthritis auf Psyche, Lebensqualität und Alltag der Patienten ist groß. Für eine positive Langzeitprognose sind frühzeitige Diagnosestellung und Therapieeinleitung entscheidend. Diese werden maßgeblich von den strukturellen Gegebenheiten der ambulanten rheumatologischen Versorgung beeinflusst. Hier zeigen sich trotz großer Fortschritte in den letzten Jahren weiterhin Defizite. Anhand einer Patientenbefragung in Leipzig sowie ländlichen Gebieten Sachsens sollen regionale Unterschiede und eventuelle Mängel in der ambulanten Versorgung sowie deren Einfluss auf die Lebensqualität, psychische Gesundheit und Entscheidungsfindungsprozesse untersucht werden. Methoden: Aus sechs Praxen in der Stadt Leipzig und drei Praxen in Kleinstädten (Naunhof, Plauen und Hoyerswerda) wurden Patienten mit der Erstdiagnose rheumatoide Arthritis im ersten Quartal 2011 mittels Fragebögen zu psychischer Gesundheit (Hospital Anxiety and Depression Scale und Short-Form-36-Health-Survey) sowie Entscheidungsfindungsprozessen (Decision Making Preference Scale) befragt. Ein eigens entwickelter Fragebogen erhob Beschwerde- und Behandlungsdauer sowie allgemeine medizinische Daten und Medikation. Ergebnisse: 19 Land- und 38 Stadtpatienten wurden eingeschlossen. Landpatienten suchten signifikant später den Hausarzt auf (Land 15, Stadt 12 Monate, p= .023). Die hausärztliche Behandlungsdauer bis zur Überweisung zum Rheumatologen betrug auf dem Land 5,4 und in der Stadt 2,4 Monate. Bei 70% der Stadt- und 40% der Landpatienten erfolgte die Überweisung innerhalb der ersten sechs Wochen. Die Gesamtdauer von Beschwerdebeginn bis zur Überweisung zum Rheumatologen war mit 20 Monaten auf dem Land signifikant länger als in der Stadt (15 Monate, p= .043). Die Wahl der Medikation durch den Rheumatologen hing signifikant mit der Herkunft der Patienten zusammen (p= .006). Nach Erstkontakt erhielten 65% der Land- und 55% der Stadtpatienten ein DMARD. In beiden Regionen wurde überwiegend mit Glukokortikoiden behandelt (Stadt 82%, Land 71%). Auf dem Land zeigten die Patienten weniger Interesse an Mitwirkung im partizipativen Entscheidungsfindungsprozess und waren mehrheitlich bereit, sich der Meinung des Arztes auch gegen den eigenen Willen anzuschließen. In der Stadt war der Wunsch nach aktiver Teilhabe an medizinischen Entscheidungen bei jüngeren und höher gebildeten Patienten signifikant größer als bei älteren oder bildungsfernen Erkrankten. Mit 21% wiesen tendenziell mehr Landpatienten depressive Symptome auf als in der Stadt (14%). Auf dem Land bestand häufiger der Verdacht auf krankheitsassoziierte Angststörungen. Zusätzlich litten die Patienten hier signifikant stärker unter ihren Schmerzen als in der Stadt (p= .026), wobei sich kein grundsätzlicher Unterschied in der gesundheitsbezogenen Lebensqualität ergab. Schlussfolgerung: In Stadt und Land zeigen sich Defizite in der ambulanten rheumatologischen Versorgung, wobei der Grad der Unterversorgung mit der Herkunft assoziiert ist und Landpatienten signifikant länger bis zum ersten Rheumatologenkontakt brauchen. Maßgeblich verantwortlich hierfür ist die verspätete Vorstellung der Patienten beim Hausarzt ebenso wie die ungleiche Facharztverteilung in Stadt und Land. Patienten auf dem Land sind tendenziell depressiver, passiver und schmerzgeplagter, wobei sich keine grundsätzlichen Unterschiede in der gesundheitsbezogenen Lebensqualität ergeben. Die Ergebnisse spiegeln Ärztemangel und infrastrukturelle Probleme wider. Weiterer Schulungs- und Aufklärungsbedarf zur verstärkten Bildung eines öffentlichen Bewusstseins für die Erkrankung rheumatoide Arthritis wird ebenso deutlich wie die Notwendigkeit für die Bahnung schnellerer Zugangswege zu rheumatologischer Behandlung.

Contexte : Pour les patients atteints d’une polyarthrite rhumatoïde débutante (PARD), l’utilisation de médicaments antirhumatismaux à longue durée d’action améliore les résultats pour les patients de manière significative. Les patients traités par un rhumatologue ont une plus grande probabilité de recevoir des traitements et donc d’avoir de meilleurs résultats de santé. Toutefois, les délais observés entre le début des symptômes et une première visite avec un rhumatologue sont souvent supérieurs à la recommandation de trois mois énoncée par les guides de pratiques. Au Québec, le temps d’attente pour voir un rhumatologue à la suite d’une demande de consultation est généralement long et contribue aux délais totaux. Objectifs : Nous avons évalué la capacité d’un programme d’accès rapide avec un triage effectué par une infirmière à correctement identifier les patients avec PARD et à réduire leur temps d’attente, dans le but d’améliorer le processus de soin. Méthodes : Une infirmière a évalué tous les nouveaux patients référés en 2009 et 2010 dans une clinique de rhumatologie située en banlieue de Montréal. Un niveau de priorité leur a été attribué sur la base du contenu de la demande de consultation, de l’information obtenue à la suite d’une entrevue téléphonique avec le patient et, si requis, d’un examen partiel des articulations. Les patients avec PARD, avec une arthrite inflammatoire non différentiée, ou atteints d’une autre pathologie rhumatologique aiguë étaient priorisés et obtenaient un rendez-vous le plus rapidement possible. Les principales mesures de résultat étudiées étaient la validité (sensibilité et spécificité) du triage pour les patients atteints de PARD ainsi que les délais entre la demande de consultation et la première visite avec un rhumatologue. Résultats : Parmi les 701 patients nouvellement référés, 65 ont eu un diagnostic final de PARD. Le triage a correctement identifié 85,9% de ces patients et a correctement identifié 87,2% des patients avec l’une des pathologies prioritaires. Le délai médian entre la demande de consultation et la première visite était de 22 jours pour les patients atteints de PARD et de 115 pour tous les autres. Discussion et conclusion : Ce programme d’accès rapide avec triage effectué par une infirmière a correctement identifié la plupart des patients atteints de PARD, lesquels ont pu être vus rapidement en consultation par le rhumatologue. Considérant qu’il s’agit d’un programme qui requiert beaucoup d’investissement de temps et de personnel, des enjeux de faisabilités doivent être résolus avant de pouvoir implanter un tel type de programme dans un système de soins de santé ayant des ressources très limitées. / Background : In patients with early rheumatoid arthritis (ERA), use of disease-modifying anti-rheumatic drugs substantially improves patient outcomes. Patients treated by rheumatologists are more likely to receive these treatments and to have better disease outcomes. However, delays from symptoms onset to first rheumatologist visit often exceed the guideline recommendations of 3 months. Waiting time to see a rheumatologist after a referral is made, is generally long in Quebec and contributes to those delays. Objectives : We evaluated the ability of a nurse-led triage and rapid access program to identify patients with ERA and reduce their waiting time, in order to improve process of care. Methods : A nurse assessed all new referrals received between 2009 and 2010, in a suburban Montreal rheumatology clinic. Priority level was assigned based on the written content of the referral, a telephone interview with the patient and, if needed, an partial joint examination. Patients with ERA, including undifferentiated inflammatory arthritis, and other acute rheumatologic conditions were prioritized and given an appointment as early as possible. The main outcome measures were validity (sensibility and specificity) of the priority level for patients with ERA and delay from referral to first visit with rheumatologist. Results : Of 701 newly referred patients, 65 had a final diagnosis of ERA. The triage correctly identified 85.9% of patients with ERA and 87.2% of patients with other high priority conditions. The median delay between referral date and first visit was 22 days for patients with ERA and 115 days for all others. Discussion and implications : This nurse led triage and rapid access program correctly identified most patients with ERA and resulted in rapid consultation for these patients. Since this is a labor intensive program, feasibility issues need to be resolved before implementing this type of triage in a resource constrained healthcare system.

A artrite idiopática juvenil (AIJ) constitui um grupo heterogêneo de doenças que se caracteriza por inflamação crônica em uma ou mais articulações, com diagnóstico em menores de 16 anos de idade. A poluição atmosférica tem sido responsabilizada pelo aumento da morbidade e mortalidade em doenças cardiorrespiratórias, mas poucos estudos avaliaram os efeitos da exposição prolongada sobre doenças inflamatórias crônicas. Alguns estudos demonstram associação entre fumo e início da doença reumatológica em adultos e outros mostram associação de mães fumantes durante a gravidez com desenvolvimento de AIJ nos filhos. Entretanto, existem poucos estudos na literatura avaliando a exposição à poluição do ar e AIJ. Objetivo: avaliar a influência de poluentes ambientais inalatórios como fatores de risco no desenvolvimento da AIJ em pacientes residentes na Região Metropolitana de São Paulo, acompanhados em um serviço terciário de Reumatologia Pediátrica. Metodologia: Este foi um estudo retrospectivo, do tipo caso-controle, que incluiu 66 pacientes com AIJ e 124 controles saudáveis, semelhantes em idade e gênero, residentes na Região Metropolitana de São Paulo, desde a gestação até o diagnóstico da doença. Um questionário estruturado e com alto índice de confiabilidade (índice kappa para teste-reteste 0,80) avaliou dados demográficos, fatores relacionados à gestação e ao período perinatal, exposição ocupacional materna durante a gravidez a partículas inaláveis e/ou vapor volátil, exposição ao tabaco e exposição à inalação ambiental durante a gravidez e após o nascimento (presença de atividades industriais, pedreiras ou postos de gasolina perto do domiícilio/ trabalho/ creche/ escola). Foram também analisados poluentes troposféricos nos dois períodos: material particulado (PM10), dióxido de enxofre (SO2), dióxido de nitrogênio (NO2), ozônio (O3) e monóxido de carbono (CO). Resultados: Durante a gravidez, o fumo fetal (OR= 3,43, IC 95%: 1,45-8,12, p=0,005) e a exposição ocupacional materna (OR= 13,69, IC95%: 4,43-42,27, p < 0,001) se mostraram fatores de risco independentes para AIJ. Em contrapartida, o fato de a mãe trabalhar fora de casa (OR= 0,06, IC 95%: 0,02- 0,16, p < 0,001) e o ganho de peso ideal da mãe (OR = 0,36, IC 95%: 0,16-0,83, p= 0,017) apresentaram associação negativa. Para o período após o nascimento até o diagnóstico de AIJ, fumo passivo (OR= 3,6, IC 95%: 1,76- 7,31, p < 0,0001) e exposição ao ozônio durante o segundo ano de idade (OR= 2,76, IC 95%: 1,20-6,37, p= 0,017) foram fatores de risco independentes e significativos para o diagnóstico da AIJ. Conclusão: O fumo passivo, a exposição ao ozônio no segundo ano de vida e a exposição ocupacional materna são destacados como importantes fatores de risco para a AIJ / Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by chronic inflammation in one or more joints with onset in children under 16 years of age. Air pollution has been blamed for increased morbidity and mortality in cardiorespiratory diseases, but few studies have evaluated the effects of prolonged exposure on chronic inflammatory diseases. Some studies show an association between smoking and onset of rheumatologic illness in adults, and others show an association of smoking mothers during pregnancy with the development of JIA in children. However, there are few studies in the literature to date evaluating exposure to air pollution and JIA. Objective: To evaluate the influence of exposure to inhalable environmental factors during pregnancy and after birth until JIA diagnosis in residents of the São Paulo metropolitan area. Methods: Case-control study comprising 66 JIA patients and 124 healthy controls matched by age and gender, living in the Sao Paulo metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (kappa index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, mothers\' work-related exposure during pregnancy to inhalable particles and / or volatile vapor, exposure to inhalable elements during pregnancy and after birth (work-related exposure to inhalable particles and/or volatile vapor, exposure to tobacco and the presence of industrial activities, quarries or gas stations near the home/ work/ daycare/ school). Tropospheric pollutants included: particulate matter (PM10), sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO). Results: During pregnancy, fetal smoking (OR=3.43, 95%CI: 1.45-8.12, p=0.005) and mothers\' work-related exposure (OR=13.69, 95%CI: 4.43-42.27, p < 0.001) were independent significant risk factors for JIA diagnosis. In contrast, working mother (OR=0.06, 95% IC: 0.02-0.16, p < 0.001) and ideal mother weight gain (OR=0.36, 95% IC:0.16-0.83, p=0.017) presented a negative association. After birth until JIA diagnosis, secondhand smoking (OR=3.6, 95% IC: 1.76-7.31, p < 0.0001) and exposure to O3 during the second year of age (OR=2.76, 95% IC: 1.20-6.37, p=0.017) were independent and significant risk factors for JIA diagnosis. Conclusion: Secondhand smoking, exposure to O3 during the second year of age and mothers\' work-related exposure are highlighted as important risk factors to JIA

In den humanen Leukozyten-Antigenen (HLA) wird die wichtigste genetische Ursache von rheumatoider Arthritis gesehen. Es wurden bisher mehrere Mechanismen beschrieben, wie diese HLA-Moleküle die Entstehung und den Verlauf der Erkrankung beeinflussen. Im Rahmen dieser Arbeit wurde die differentielle Expression von HLA-DRB-Genen in unterschiedlichen Antigen-präsentierenden Zellen als möglicher Mechanismus untersucht. Dabei wurden strukturelle Unterschiede zwischen den Promotoren des krankheitsassoziierten HLA-DR4-Haplotyps und den neutralen Haplotypen DR7 und DR9 eingehender betrachtet. Allen drei Haplotypen ist gemein, daß sie das DRB4-Gen als zweites funktionelles DRB-Gen tragen, wobei das DRB4-Gen entweder den DRB4A oder den -B-Promotor besitzt. Um den Einfluß einzelner Promotorelemente auf die mit dem Luziferase-Assay bestimmten Transkriptionsaktivitäten näher zu untersuchen, wurde mit Hilfe der surface plasmon resonance die Bindung der Transkriptionsfaktoren aus den Zellkernlysaten von der humanen Monozytenzellinie THP-1 und von der humanen B-Lymphom-Zellinie BJAB an die unterschiedlichen S-, X-, Y-, CCAAT- und TATA-Boxen analysiert. Es konnte gezeigt werden, daß die unterschiedliche Expression von DRB4A und DRB4B durch die ubiquitäre TATA-Box vermittelt wird. Dagegen wurde die INF-gamma-Stimulation der HLA-DR-Expression von THP-1- aber auch von BJAB-Zellen durch die für die HLA-DR-Promotoren spezifische X-Box vermittelt. Bei der Analyse von DR4-, DR7- und DR9-positiven Patienten einer bereits gut charakterisierten RA-Kohorte stellte sich heraus, daß der DRB4B-Promotor, welcher im Vergleich zu DRB4A eine höhere transkriptionelle Aktivität besitzt, mit einem schweren Krankheitsverlauf assoziiert ist, so daß eine erhöhte HLA-DR-Expression den Krankheitsverlauf negativ zu beeinflussen scheint. / Disease associated human leukocyte antigen (HLA) genes have been identified in humans where they are assumed to promote the susceptibility and/or progression of rheumatoid arthritis. Several mechanisms have been described how these HLA haplotypes impact on the disease. Among them the differential expression of HLA-DRB molecules in different types of antigen-presenting cells, which was investigated here in detail. The promoters of the disease associated HLA-DR4 to the neutral DR7 and DR9 haplotypes were analyzed for sequence polymorphisms resulting in functional differences. All three haplotypes carry as a second functional DRB gene the DRB4 gene, which is regulated by the DRB4A or -B promoter. To determine the impact of the promoter elements on the transcriptional activities measured by luciferase assay the surface plasmon resonance technology was employed. To this end, nuclear extracts from the monocytic cell line THP-1 and from the B lymphoma cell line BJAB were used to analyze their binding to the various S-, X-, Y-, CCAAT-, and TATA boxes. It could be demonstrated that the differential expression of DRB4A and -B was regulated via the ubiquitous TATA box. By contrast, the INF-gamma stimulation of HLA expression in THP-1 and BJAB was mediated via the unique X box. Analyzing the DR4, DR7 and DR9 positive patients of an RA cohort, the DRB4B promoter, which has a higher transcriptional activity than the DRB4A promoter, is associated with radiographic progression of RA. This data is thus indicative of an impact of elevated HLA-DR expression on the progression of the disease.

Die rheumatoide Arthritis (RA) ist die häufigste entzündliche Gelenkerkrankung der Welt. Sie verläuft meist chronisch-progressiv und kann schließlich zu Gelenkdestruktion und Invalidität führen. Trotz intensiver Forschungen bleibt die Pathogenese der RA weiterhin unklar. Neuere Untersuchungen weisen auf die wichtige Rolle des angeborenen Immunsystems hin, insbesondere der Toll-like-Rezeptoren (TLRs) TLR2 und TLR9. Genetische Polymorphismen in TLR2 und TLR9 könnten daher zur Erkrankung einer RA prädisponieren, davor schützen oder den Verlauf der RA beeinflussen. Zielsetzung dieser Arbeit war es, die Assoziation zwischen RA-Erkrankung, dem Rheumafaktor (RF)-Serostatus und der Höhe des RF im Serum und genetischen Polymorphismen im TLR2- und TLR9-Gen zu analysieren. Zur Untersuchung der TLR9-Polymorphismen T-1237C und T-1486C wurde ein real-time-PCR-basiertes Verfahren am LightCycler (LC) etabliert, das den schnellen Nachweis beider Polymorphismen in einer Reaktion mittels fluoreszenzmarkierter Hybridisierungssonden ermöglicht. Desweiteren wurde ein neues Puffersystem verwendet, das die LC-PCR unter Verwendung einer konventionellen Taq-Polymerase zu erheblich günstigeren Kosten ermöglicht. Die Genotypisierung der DNA von 118 RA-Patienten (89 weiblich, 29 männlich, Durchschnittsalter 56,2 Jahre) und einer geschlechtsgematchten Kontrollgruppe von 118 Personen (Durchschnittsalter 44,1 Jahre) zeigte, dass die TLR9-Polymorphismen T-1486C und T-1237C sowie der TLR2-Polymorphismus G2408A nicht für das Auftreten von RA prädisponieren. Träger des seltenen C-Allels sind signifikant häufiger RF-positiv (p=0,049) und ihre RF-Antikörperspiegel sind höher als bei Patienten, die das C-Allel nicht aufweisen (p=0,023). Der TLR9-Polymorphismus T-1486C könnte daher die Krankheitsausprägung beeinflussen. / Rheumatoid arthritis (RA) is the most common inflammatory joint disease worldwide. It is a chronic progressive disease which can eventually lead to joint destruction and disability. The pathogenesis of RA remains uncertain in spite of the intensive research in this field. Recent data indicate the important role of the innate immune system, especially of the toll like receptors (TLRs) TLR2 and TLR9 in the pathogenesis of RA. Genetic polymorphisms in the TLR2 and TLR9 gene could therefore predispose to RA, protect against it or influence its course. The aim of this work was to analyse the association of RA, the serostatus of rheumatoid factor (RF) and its levels with genetic polymorphisms in the TLR2 and TLR9 gene. A new real time PCR based method was developed on the LightCycler (LC) in order to analyse the TLR9 polymorphisms T-1237C and T-1486C. This method permits the fast detection of both polymorphisms in a single reaction using fluorescence labelled hybridization probes. Furthermore, a new reaction mix was developed which allows the use of a conventional Taq polymerase for the LC-PCR at much lower costs. The genotyping of 118 RA patients (89 female, 29 male; average age 56.2 years) and a control group of 118 healthy individuals (average age 44.1 years) showed that the TLR9 polymorphisms T-1237C and T-1486C and the TLR2 polymorphism G2408A do not predispose to RA disease. The TLR9 polymorphism T-1486C might influence the course of the disease as individuals with the rare C-allele are significantly more frequent RF-positive (p=0.049) and their RF-antibody levels are higher than in patients who do not bear the C-allele (p=0.023).

Investigar a eficácia da lama negra brasileira como tratamento para inflamação em modelos experimentais de artrite. O efeito antiinflamatório de aplicações de lama foi comparado ao tratamento com água aquecida e ausência de tratamento em modelos experimentais de artrite e osteoartrite induzidas em coelhos e em ratos, visando parâmetros inflamatórios e cartilagem. O tratamento com lama melhorou a infiltração de leucócitos e exerceu um efeito protetor parcial na sinóvia e cartilagem. Nossos resultados sugerem que a lama brasileira apresenta efeito antiinflamatório e pode ser útil como um método complementar ao tratamento de pacientes com doenças articulares crônicas / Investigate the effectiveness of a Brazilian black mud as treatment for inflammation in experimental models of arthritis. Effects of mud applications was compared with warm water and no treatment in experimental models of arthritis and osteoarthritis induced in rabbits and in rats, regarding inflammatory parameters and cartilage. Treatment with mud impaired leukocyte infiltration which was followed by a partial protective effect on synovium and cartilage. Our results show that Brazilian mud presents an anti-inflammatory effect and can be useful as a complementary approach to treat patients with chronicle articular diseases

Eighty-two patients with breast cancer, twenty-seven patients with nasopharyngeal carcinoma and sixty-five patients with rheumatoid arthritis in this study were selected based on voluntary, randomization and double blind grouping criteria. / In nasopharyngeal carcinoma patients, the decrease in percentage and the absolute count of T lymphocytes in the TCM group was significantly lower than those in the placebo group. Besides, the decrease of the absolute count of T helper and T suppressor in the TCM group was significantly lower than that in the placebo group (all p &lt; 0.05). The decrease may be due to radiotherapy. However, there was no significant difference in plasma sIL-2R and soluble tumor necrosis factor receptor 2 (sTNFR2) between the TCM group and the placebo group. / In rheumatoid arthritis patients, there was no significant difference in plasma. C-reactive protein (CRP), in the percentage, absolute count, and the ratio of CD4+/CD8+/NK/B lymphocytes between the TCM group and the placebo group. / Results showed that the absolute count of T helper lymphocytes (CD4+), the ratio of T helper lymphocytes (CD4+)/T suppressor and cytotoxic lymphocytes (CD8+), and the percentage and the absolute count of B lymphocytes were significantly elevated in the patients with breast cancer after taking Yunzhi-Danshen capsules, while plasma soluble interleukin-2 receptor (sIL-2R) concentration was significantly decreased (all p &lt; 0.05). / This study shows that the selected traditional Chinese medicine have determinable immunomodulatory effects in patients with cancer and rheumatoid arthritis. (Abstract shortened by UMI.) / Traditional Chinese medicine (TCM) has been used to treat chronic diseases and tumor allegedly by immunomodulatory mechanisms. Breast cancer and nasopharyngeal cancer are prevalent carcinoma diseases in Hong Kong. The immune system of such patients could be adversely affected during the course of conventional chemotherapy or radiotherapy. Rheumatoid arthritis is an inflammatory autoimmune disease of the joints. The aim of this study was to assess the immunomodulatory effects of TCM Yunzhi-Danshen in auxiliary treatment of both kinds of cancer patients, and Lingzhi (Ganoderma Lucidum)-San Miao San ( Atractylodes lancea, Phellodendron amurense and Achyranthes bidentata B1) in supplementation treatment of patients with rheumatoid arthritis. / by Bao Yixi. / "July 2005." / Adviser: Wai-Kei Lam. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0166. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 150-167). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Investigar a eficácia da lama negra brasileira como tratamento para inflamação em modelos experimentais de artrite. O efeito antiinflamatório de aplicações de lama foi comparado ao tratamento com água aquecida e ausência de tratamento em modelos experimentais de artrite e osteoartrite induzidas em coelhos e em ratos, visando parâmetros inflamatórios e cartilagem. O tratamento com lama melhorou a infiltração de leucócitos e exerceu um efeito protetor parcial na sinóvia e cartilagem. Nossos resultados sugerem que a lama brasileira apresenta efeito antiinflamatório e pode ser útil como um método complementar ao tratamento de pacientes com doenças articulares crônicas / Investigate the effectiveness of a Brazilian black mud as treatment for inflammation in experimental models of arthritis. Effects of mud applications was compared with warm water and no treatment in experimental models of arthritis and osteoarthritis induced in rabbits and in rats, regarding inflammatory parameters and cartilage. Treatment with mud impaired leukocyte infiltration which was followed by a partial protective effect on synovium and cartilage. Our results show that Brazilian mud presents an anti-inflammatory effect and can be useful as a complementary approach to treat patients with chronicle articular diseases

A artrite idiopática juvenil (AIJ) constitui um grupo heterogêneo de doenças que se caracteriza por inflamação crônica em uma ou mais articulações, com diagnóstico em menores de 16 anos de idade. A poluição atmosférica tem sido responsabilizada pelo aumento da morbidade e mortalidade em doenças cardiorrespiratórias, mas poucos estudos avaliaram os efeitos da exposição prolongada sobre doenças inflamatórias crônicas. Alguns estudos demonstram associação entre fumo e início da doença reumatológica em adultos e outros mostram associação de mães fumantes durante a gravidez com desenvolvimento de AIJ nos filhos. Entretanto, existem poucos estudos na literatura avaliando a exposição à poluição do ar e AIJ. Objetivo: avaliar a influência de poluentes ambientais inalatórios como fatores de risco no desenvolvimento da AIJ em pacientes residentes na Região Metropolitana de São Paulo, acompanhados em um serviço terciário de Reumatologia Pediátrica. Metodologia: Este foi um estudo retrospectivo, do tipo caso-controle, que incluiu 66 pacientes com AIJ e 124 controles saudáveis, semelhantes em idade e gênero, residentes na Região Metropolitana de São Paulo, desde a gestação até o diagnóstico da doença. Um questionário estruturado e com alto índice de confiabilidade (índice kappa para teste-reteste 0,80) avaliou dados demográficos, fatores relacionados à gestação e ao período perinatal, exposição ocupacional materna durante a gravidez a partículas inaláveis e/ou vapor volátil, exposição ao tabaco e exposição à inalação ambiental durante a gravidez e após o nascimento (presença de atividades industriais, pedreiras ou postos de gasolina perto do domiícilio/ trabalho/ creche/ escola). Foram também analisados poluentes troposféricos nos dois períodos: material particulado (PM10), dióxido de enxofre (SO2), dióxido de nitrogênio (NO2), ozônio (O3) e monóxido de carbono (CO). Resultados: Durante a gravidez, o fumo fetal (OR= 3,43, IC 95%: 1,45-8,12, p=0,005) e a exposição ocupacional materna (OR= 13,69, IC95%: 4,43-42,27, p < 0,001) se mostraram fatores de risco independentes para AIJ. Em contrapartida, o fato de a mãe trabalhar fora de casa (OR= 0,06, IC 95%: 0,02- 0,16, p < 0,001) e o ganho de peso ideal da mãe (OR = 0,36, IC 95%: 0,16-0,83, p= 0,017) apresentaram associação negativa. Para o período após o nascimento até o diagnóstico de AIJ, fumo passivo (OR= 3,6, IC 95%: 1,76- 7,31, p < 0,0001) e exposição ao ozônio durante o segundo ano de idade (OR= 2,76, IC 95%: 1,20-6,37, p= 0,017) foram fatores de risco independentes e significativos para o diagnóstico da AIJ. Conclusão: O fumo passivo, a exposição ao ozônio no segundo ano de vida e a exposição ocupacional materna são destacados como importantes fatores de risco para a AIJ / Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by chronic inflammation in one or more joints with onset in children under 16 years of age. Air pollution has been blamed for increased morbidity and mortality in cardiorespiratory diseases, but few studies have evaluated the effects of prolonged exposure on chronic inflammatory diseases. Some studies show an association between smoking and onset of rheumatologic illness in adults, and others show an association of smoking mothers during pregnancy with the development of JIA in children. However, there are few studies in the literature to date evaluating exposure to air pollution and JIA. Objective: To evaluate the influence of exposure to inhalable environmental factors during pregnancy and after birth until JIA diagnosis in residents of the São Paulo metropolitan area. Methods: Case-control study comprising 66 JIA patients and 124 healthy controls matched by age and gender, living in the Sao Paulo metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (kappa index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, mothers\' work-related exposure during pregnancy to inhalable particles and / or volatile vapor, exposure to inhalable elements during pregnancy and after birth (work-related exposure to inhalable particles and/or volatile vapor, exposure to tobacco and the presence of industrial activities, quarries or gas stations near the home/ work/ daycare/ school). Tropospheric pollutants included: particulate matter (PM10), sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO). Results: During pregnancy, fetal smoking (OR=3.43, 95%CI: 1.45-8.12, p=0.005) and mothers\' work-related exposure (OR=13.69, 95%CI: 4.43-42.27, p < 0.001) were independent significant risk factors for JIA diagnosis. In contrast, working mother (OR=0.06, 95% IC: 0.02-0.16, p < 0.001) and ideal mother weight gain (OR=0.36, 95% IC:0.16-0.83, p=0.017) presented a negative association. After birth until JIA diagnosis, secondhand smoking (OR=3.6, 95% IC: 1.76-7.31, p < 0.0001) and exposure to O3 during the second year of age (OR=2.76, 95% IC: 1.20-6.37, p=0.017) were independent and significant risk factors for JIA diagnosis. Conclusion: Secondhand smoking, exposure to O3 during the second year of age and mothers\' work-related exposure are highlighted as important risk factors to JIA

Ko, Wai Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 243-257). / Abstracts in English and Chinese. / Publications Based On The Work In This Thesis --- p.i / Abstract --- p.ii / Acknowledgements --- p.ix / Abbreviations --- p.x / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Prevalence of arthritis --- p.1 / Chapter 1.2 --- Pathogenesis of arthritis --- p.4 / Chapter 1.2.1 --- Histological changes --- p.6 / Chapter 1.2.1.1 --- Synovium changes --- p.6 / Chapter 1.2.1.2 --- Articular cartilage degradation --- p.8 / Chapter 1.2.1.3 --- Bone erosions --- p.10 / Chapter 1.3 --- Western medicines for arthritis --- p.14 / Chapter 1.3.1 --- Nonsteroidal anti-inflammatory drugs (NSAIDs) --- p.15 / Chapter 1.3.2 --- Glucocorticoids (GCs) --- p.18 / Chapter 1.3.3 --- Disease modifying antirheumatic drugs (DMARDs) --- p.20 / Chapter 1.3.4 --- Biological therapies --- p.22 / Chapter 1.4 --- Traditional Chinese medicines for arthritis --- p.24 / Chapter 1.4.1 --- Ganoderma lucidum (靈芝））) --- p.26 / Chapter 1.4.1.1 --- Major chemical constituents --- p.27 / Chapter 1.4.1.2 --- Functions --- p.27 / Chapter 1.4.2 --- Cortex Phellodendri (黃柏） --- p.28 / Chapter 1.4.2.1 --- Major chemical constituents --- p.29 / Chapter 1.4.2.2 --- Traditional description --- p.29 / Chapter 1.4.2.3 --- Functions --- p.30 / Chapter 1.4.3 --- Atractylodisa Rhizoma (蒼术) --- p.31 / Chapter 1.4.3.1 --- Major chemical constituents --- p.31 / Chapter 1.4.3.2 --- Traditional description --- p.32 / Chapter 1.4.3.3 --- Functions --- p.32 / Chapter 1.4.4 --- Radix Achyranthis Bidentatae (牛膝) --- p.33 / Chapter 1.4.4.1 --- Major chemical constituents --- p.34 / Chapter 1.4.4.2 --- Traditional description --- p.34 / Chapter 1.4.4.3 --- Functions --- p.34 / Chapter 1.5 --- Animal models of arthritis --- p.36 / Chapter 1.5.1 --- Adjuvant-induced arthritis --- p.37 / Chapter 1.6 --- Aims of study --- p.42 / Chapter Chapter 2 --- Materials and Drugs --- p.44 / Chapter Chapter 3 --- Methodology --- p.49 / Chapter 3.1 --- Induction of anaesthesia --- p.49 / Chapter 3.2 --- Induction of monoarthritis --- p.49 / Chapter 3.3 --- Measurements of knee extension angles --- p.50 / Chapter 3.4 --- Measurements of knee joint sizes --- p.51 / Chapter 3.5 --- Assessment of changes in articular blood flow --- p.52 / Chapter 3.6 --- Assessment of morphological changes --- p.53 / Chapter 3.6.1 --- Fixation --- p.53 / Chapter 3.6.2 --- Decalcification --- p.53 / Chapter 3.6.3 --- Processing --- p.54 / Chapter 3.6.4 --- Embedding --- p.54 / Chapter 3.6.5 --- Sectioning --- p.55 / Chapter 3.6.6 --- Staining --- p.55 / Chapter 3.6.7 --- Scoring --- p.56 / Chapter 3.7 --- Statistical analysis --- p.57 / Chapter Chapter 4 --- Adjuvant-induced Monoarthritic Rats / Chapter 4.1 --- Adjuvant-induced monoarthritic rats (1 week) --- p.58 / Chapter 4.1.1 --- Method --- p.58 / Chapter 4.1.2 --- Results --- p.59 / Chapter 4.1.2.1 --- Body weight --- p.59 / Chapter 4.1.2.2 --- Knee joint sizes --- p.59 / Chapter 4.1.2.3 --- Knee extension angles --- p.59 / Chapter 4.1.2.4 --- Knee joint blood flow --- p.60 / Chapter 4.1.2.5 --- Histological evaluation --- p.60 / Chapter 4.1.2.5.1 --- Cell infiltration --- p.60 / Chapter 4.1.2.5.2 --- Synovial tissue proliferation --- p.61 / Chapter 4.1.2.5.3 --- Cartilage degradation --- p.61 / Chapter 4.2 --- Adjuvant-induced monoarthritic rats (2 weeks) --- p.68 / Chapter 4.2.1 --- Method --- p.68 / Chapter 4.2.2 --- Results --- p.69 / Chapter 4.2.2.1 --- Body weight --- p.69 / Chapter 4.2.2.2 --- Knee joint sizes --- p.69 / Chapter 4.2.2.3 --- Knee extension angles --- p.69 / Chapter 4.2.2.4 --- Knee joint blood flow --- p.70 / Chapter 4.2.2.5 --- Histological evaluation --- p.70 / Chapter 4.2.2.5.1 --- Cell infiltration --- p.70 / Chapter 4.2.2.5.2 --- Synovial tissue proliferation --- p.71 / Chapter 4.2.2.5.3 --- Cartilage degradation --- p.71 / Chapter 4.3 --- Discussions --- p.78 / Chapter Chapter 5 --- Effects of intra-articular injection of LS in adjuvant-induced monoarthritic rats --- p.82 / Chapter 5.1 --- Method --- p.82 / Chapter 5.2 --- Results --- p.83 / Chapter 5.2.1 --- Body weight --- p.83 / Chapter 5.2.2 --- Knee joint sizes --- p.83 / Chapter 5.2.3 --- Knee extension angles --- p.85 / Chapter 5.2.4 --- Knee joint blood flow --- p.87 / Chapter 5.3 --- Discussions --- p.98 / Chapter Chapter 6 --- Effects of oral administration of LS in adjuvant-induced monoarthritic rats --- p.102 / Chapter 6.1 --- Oral administration of LS for 6 days after induction of arthritis --- p.102 / Chapter 6.1.1 --- Method --- p.102 / Chapter 6.1.2 --- Results --- p.103 / Chapter 6.1.2.1 --- Body weight --- p.103 / Chapter 6.1.2.2 --- Knee joint sizes --- p.103 / Chapter 6.1.2.3 --- Knee extension angles --- p.105 / Chapter 6.1.2.4 --- Knee joint blood flow --- p.106 / Chapter 6.1.2.5 --- Histological evaluation --- p.107 / Chapter 6.1.2.5.1 --- Cell infiltration --- p.107 / Chapter 6.1.2.5.2 --- Synovial tissue proliferation --- p.107 / Chapter 6.1.2.5.3 --- Cartilage degradation --- p.108 / Chapter 6.2 --- Oral administration of LS for 7 days before and 7 days after induction of arthritis --- p.131 / Chapter 6.2.1 --- Method --- p.131 / Chapter 6.2.2 --- Results --- p.132 / Chapter 6.2.2.1 --- Body weight --- p.132 / Chapter 6.2.2.2 --- Knee joint sizes --- p.132 / Chapter 6.2.2.3 --- Knee extension angles --- p.134 / Chapter 6.2.2.4 --- Knee joint blood flow --- p.137 / Chapter 6.2.2.5 --- Histological evaluation --- p.137 / Chapter 6.2.2.5.1 --- Cell infiltration --- p.137 / Chapter 6.2.2.5.2 --- Synovial tissue proliferation --- p.138 / Chapter 6.2.2.5.3 --- Cartilage degradation --- p.138 / Chapter 6.3 --- Oral administration of LS for 13 days after induction of arthritis --- p.165 / Chapter 6.3.1 --- Method --- p.165 / Chapter 6.3.2 --- Results --- p.166 / Chapter 6.3.2.1 --- Body weight --- p.166 / Chapter 6.3.2.2 --- Knee joint sizes --- p.166 / Chapter 6.3.2.3 --- Knee extension angles --- p.168 / Chapter 6.3.2.4 --- Knee joint blood flow --- p.169 / Chapter 6.3.2.5 --- Histological evaluation --- p.170 / Chapter 6.3.2.5.1 --- Cell infiltration --- p.170 / Chapter 6.3.2.5.2 --- Synovial tissue proliferation --- p.170 / Chapter 6.3.2.5.3 --- Cartilage degradation --- p.171 / Chapter 6.4 --- Discussions --- p.194 / Chapter Chapter 7 --- Effects of intra-peritoneal administration of LS in adjuvant-induced monoarthritic rats --- p.203 / Chapter 7.1 --- Method --- p.203 / Chapter 7.2 --- Results --- p.204 / Chapter 7.2.1 --- Body weight --- p.204 / Chapter 7.2.2 --- Knee joint sizes --- p.205 / Chapter 7.2.3 --- Knee extension angles --- p.207 / Chapter 7.2.4 --- Knee joint blood flow --- p.209 / Chapter 7.2.5 --- Histological evaulation --- p.209 / Chapter 7.2.5.1 --- Cell infiltration --- p.209 / Chapter 7.2.5.2 --- Synovial tissue proliferation --- p.210 / Chapter 7.2.5.3 --- Cartilage degradation --- p.210 / Chapter 7.3 --- Discussions --- p.237 / Chapter Chapter 8 --- Conclusions --- p.239 / References --- p.243