OBJECTIVE:To describe, in a 7-year follow-up study, the use of infliximab in patients with refractory posterior uveitis and scleritis.METHODS:A 7-year follow-up case series study was performed. Patients with posterior uveitis and scleritis refractory to conventional therapies (steroids and at least one immunosuppressive agent) were included. Three infliximab intravenous doses of 5 mg/kg were administered at weeks 0, 2, and 6. Further infusions were allowed in patients undergoing a relapse of the uveitis after initial remission. All patients were followed up for at least 8 months. We defined uveitis improvement as an increase in the best-corrected visual acuity or an objective and significant improvement in retinal exudates and/or haemorrhages, cystoid macular oedema (CME), and vitreous haze. Infliximab-related adverse events, final prednisone doses, and the number of immunosuppressive agents used were recorded. A descriptive analysis was performed.RESULTS:A total of 11 patients (17 eyes were affected at baseline) were included, 63% were women, the mean age was 43+/-14 years, and the median follow-up was 80 months (p25-p75: 50-80). After infliximab treatment, six eyes maintained their basal visual acuity, nine eyes showed improvement, and two worsened (in the two patients diagnosed with choroiditis). Vitreous haze, active retinal vasculitis, and CME, but not chorioretinal lesions, improved in all patients. All patients tapered their daily steroid dose and the number of immunosuppressive agents. No infliximab-related adverse events were reported.CONCLUSIONS:Infliximab could be an effective and safe treatment in patients with posterior uveitis and scleritis refractory to conventional therapy.

OBJECTIVE:To evaluate the variability in the characteristics and management of rheumatoid arthritis (RA) patients between rheumatology attending physicians and training residents in Spain.METHODS:A retrospective medical record (MR) review was performed in a probabilistic sample of 1379 RA patients from 46 centres distributed in 16 of the 19 autonomous communities (AC) of Spain. RA patients' sociodemographic and clinical characteristics, healthcare resources use, and their single responsible physician's (defined as an identifiable single physician who attended the patient in more than 75% of visits) characteristics were recorded following a standardized protocol. Multivariate analyses were performed to assess differences in the characteristics and management of RA patients between attending physicians and training residents.RESULTS:A total of 1205 RA patients had a single responsible physician and were analysed (nearly 75% women with rheumatoid factor positive and more than 25% with persistent active disease), 49 of whom were followed by training residents and 1156 by attending physicians. In the multivariate analyses, irrespective of patient and disease characteristics, training residents' patients reported more hospital admissions, laboratory tests, and imaging techniques compared to attending physicians. Training residents also less frequently used combined therapy with disease-modifying antirheumatic drugs (DMARDs).CONCLUSION:Training residents and attending physicians differ in RA patients' care. More efforts in training programmes are necessary to guarantee proper RA management and to improve the profile of the future rheumatologists.

Objective: To investigate whether there is a possible viral transmission using mesenchymal stem cells (MSCs) in autologous or allogeneic transplantation in the context of osteoarthritis (OA) patients. The presence of parvovirus B19 (B19), varicella zoster virus (VZV), and human herpesvirus-6 (HHV-6) was studied in MSCs from bone marrow of patients with OA and healthy controls.Methods: MSCs were prepared from bone marrow aspirates obtained from 18 patients undergoing joint replacement as a result of OA and from 10 healthy controls. DNA was extracted from primary MSCs' culture established from these cells and quantitative real-time polymerase chain reaction was performed to analyse the prevalence and viral load of B19, VZV and HHV-6.Results: The prevalence of total viral DNA among patients with OA was 16.7% (3/18), with a mean viral load of 29.7 copies/mu g of DNA. One out of 18 was positive for B19 (viral load, 61.2 copies/mu g of DNA), two for VZV (mean viral load, 14.4 copies/mu g of DNA), and none for HHV-6. The prevalence of total viral DNA in the control group was 20% (2/10), with a mean viral load of 13.4 copies/mu g of DNA. Both positive results were of B19 parvoviruses. There were no statistically significant differences among patients and controls.Conclusions: This first approach to the viral prevalence in MSCs of bone marrow in OA patients and healthy controls seems to show a very low risk of viral transmission or reactivation in a possible MSCs' transplantation. (C) 2006 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

RHOB promoter polymorphisms cooperate in regulating RHOB transcriptional activity and thus chondrocyte apoptosis whereby an increase in chondrocyte apoptosis is predicted to result in the net loss of articular cartilage.

Background: Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product.Objective: To evaluate whether a population-based clinical program offered to patients with recent-inset work disability caused by MSDs is cost-effective.Design: Randomized controlled intervention study. The inclusion and follow-up periods each lasted 12 months.Setting: Three health districts in Madrid, Spain.Patients: All patients with MSD-related temporary work disability in 1998 and 1999.Intervention: The control group received standard primary care management, wit referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties.Measurements: Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis.Results: 13 077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16 297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (man, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, $6.00 had to be invested in the program. Each dollar invested generated a benefit of $11.00. The program's net benefit was in excess of $5 million.Limitations: The study was unblinded.Conclusions: Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

OBJECTIVE:To describe the incidence and characteristics of the infection caused by Mycobacterium tuberculosis in patients with autoimmune diseases.PATIENTS AND METHODS:Searching in the database of the department at our institution, all new cases of tuberculosis from 1991 to 2000 were identified in patients with autoimmune diseases; the total follow-up time was calculated as the difference between first and last visits. Time with immunosuppressive drug therapy was obtained for patients with rheumatoid arthritis from a database oriented to the longitudinal follow-up of these patients. The incidence density was calculated as the quotient between the absolute frequency of cases and the sum of individual periods at risk for each subgroup.RESULTS:Fifteen cases of tuberculosis were identified from 3,634 risk patients followed for an accumulated period of 9,795 years (overall incidence 153 per 100,000 patients-year). Fourteen patients were receiving disease-modifying drugs and eleven were receiving corticosteroids at diagnosis. The location of tuberculosis infection was the lung for 33.3% of cases. The incidence by drugs in patients with rheumatoid arthritis was 143 per 100,000 patients-year with methotrexate, 2,703 per 100,000 patients-year with azathioprin, 7,692 per 1,000 patients-year with cyclophosphamide, and 4,878 per 100,000 patients-year for anti-TNFalpha.CONCLUSIONS:Compared with the general population, the incidence density of tuberculosis is increasing in our population, with a higher frequency of extrapulmonary involvement. The incidence density is variable among patients with rheumatoid arthritis depending upon the used drugs.

Describir la incidencia y las caracteristicas de la infeccion por Mycobacterium tuberculosis en pacientes con enfermedades autoinmunes. Se identificaron los casos nuevos de tuberculosis desde 1991 a 2000 en pacientes con enfermedad autoinmune a partir de la base de datos del servicio; se calculo el tiempo total de seguimiento como la diferencia entre la primera y la ultima visita. El tiempo de tratamiento con farmacos inmunosupresores se obtuvo en pacientes con artritis reumatoide de una base de datos orientada al seguimiento longitudinal de estos pacientes. Se calculo la densidad de incidencia como el cociente entre la frecuencia absoluta de casos y la suma de los periodos individuales de riesgo en cada subgrupo. Se identificaron 15 casos de tuberculosis en 3.634 pacientes en riesgo seguidos durante un periodo acumulado de 9.795 anos (incidencia global: 153 por 100.000 pacientes-ano). Catorce pacientes estaban recibiendo farmacos modificadores de la enfermedad y once corticosteroides en el momento del diagnostico. La localizacion de la infeccion tuberculosa fue pulmonar en el 33,3% de los casos. La incidencia por farmacos en pacientes con artritis reumatoide fue de 143 por 100.000 pacientes-ano con metotrexato, 2.703 por 100.000 pacientes-ano con azatioprina, 7.692 por 1.000 pacientes-ano con ciclofosfamida y 4.878 por 100.000 pacientes-ano con anti-TNFα. La densidad de incidencia de tuberculosis esta aumentada en nuestra poblacion comparado con la de la poblacion general, existiendo una mayor frecuencia de afectacion extrapulmonar. La densidad de incidencia es variable en pacientes con artritis reumatoide en funcion de los farmacos utilizados. To describe the incidence and characteristics of the infection caused by Mycobacterium tuberculosis in patients with autoimmune diseases. Searching in the database of the department at our institution, all new cases of tuberculosis from 1991 to 2000 were identified in patients with autoimmune diseases; the total follow-up time was calculated as the difference between first and last visits. Time with immunosuppressive drug therapy was obtained for patients with rheumatoid arthritis from a database oriented to the longitudinal follow-up of these patients. The incidence density was calculated as the quotient between the absolute frequency of cases and the sum of individual periods at risk for each subgroup. Fifteen cases of tuberculosis were identified from 3,634 risk patients followed for an accumulated period of 9,795 years (overall incidence 153 per 100,000 patients-year). Fourteen patients were receiving disease-modifying drugs and eleven were receiving corticosteroids at diagnosis. The location of tuberculosis infection was the lung for 33.3% of cases. The incidence by drugs in patients with rheumatoid arthritis was 143 per 100,000 patients-year with methotrexate, 2,703 per 100,000 patients-year with azathioprin, 7,692 per 1,000 patients-year with cyclophosphamide, and 4,878 per 100,000 patients-year for anti-TNFα. Compared with the general population, the incidence density of tuberculosis is increasing in our population, with a higher frequency of extrapulmonary involvement. The incidence density is variable among patients with rheumatoid arthritis depending upon the used drugs.