ProNGF-p75NTR axis plays a proinflammatory role in inflamed joints. A novel pathogenic mechanism in chronic arthritis

To identify the role of mature nerve growth factor (mNGF), its immature form proNGF and their receptors in arthritis inflammatio

Delineating the application of ultrasound in detecting synovial abnormalities of subtalar joint in juvenile idiopathic arthritis

Objective: To investigate the frequency of ultrasound (US)\u2013detectable involvement of the subtalar joint (STJ), to compare clinical versus US assessment of the STJ, and to compare different scanning approaches to the STJ in juvenile idiopathic arthritis (JIA). Methods: Clinical and US assessments were performed independently in 50 ankles with clinically active JIA. US abnormalities of the STJ were investigated using a lateral, medial, and posterior scanning approach and scored semiquantitatively. Agreement was tested using kappa statistics. A control group of 10 healthy subjects was examined. Results: Clinical and US evaluations detected synovitis in 24 of 50 (48.0%) and 27 of 50 (54.0%) of STJs, respectively. US detected synovitis in 10 of 26 STJs (38.5%) recorded as normal on clinical evaluation, but was negative in 7 of 24 STJs (29.2%) diagnosed as having involvement on clinical examination. Agreement between clinical and US assessments was fair (\u3ba = 0.32). US abnormalities were more frequently detectable using the lateral scanning approach. All patients with US abnormalities in the medial and/or posterior side of the STJ had also US abnormalities on the lateral scanning approach, but the reverse was not true. Intra- and interobserver agreements for the lateral scanning approach were satisfactory for both detecting involvement and scoring US abnormalities. None of the 17 STJs of healthy controls showed US abnormalities. Conclusion: US may increase the precision of the evaluation of the STJ in JIA. The observed high frequency of STJ involvement on US suggests to include this joint in US scanning protocols devised for children with JIA. Synovitis is more frequently detected using the lateral scanning approach. \ua9 2016, American College of Rheumatolog

Development and validation of a composite disease activity score for juvenile idiopathic arthritis

Objective. To develop and validate a composite disease activity score for juvenile idiopathic arthritis (JIA), the Juvenile Arthritis Disease Activity Score (JADAS). Methods. The JADAS includes 4 measures: physician global assessment of disease activity, parent/patient global assessment of well-being, active joint count, and erythrocyte sedimentation rate. These variables are part of the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30), Pedi 50, and Pedi 70 criteria for improvement. Validation analyses were conducted on >4,500 patients and included assessment of construct validity, discriminant validity, and responsiveness to change. Three versions of the JADAS were tested based on 71-joint (range 0 \u2013101), 27-joint (range 0 \u201357), or 10-joint (range 0 \u2013 40) counts. Statistical performances of the JADAS were compared with those of 2 rheumatoid arthritis composite scores, the Disease Activity Score in 28 joints (DAS28) and the Clinical Disease Activity Index (CDAI). Results. The JADAS demonstrated good construct validity, yielding strong correlations with JIA activity measures not included in the score and moderate correlations with the Childhood Health Assessment Questionnaire. Correlations obtained for the 3 JADAS versions were comparable, but superior to those yielded by the DAS28 and CDAI. The area under the curve of the JADAS predicted long-term disease outcome, measured as radiographic progression over 3 years. In 2 clinical trials, the JADAS discriminated well between ACR Pedi 30, Pedi 50, and Pedi 70 response and revealed strong responsiveness to clinical change. Conclusion. The JADAS was found to be a valid instrument for assessment of disease activity in JIA and is potentially applicable in standard clinical care, observational studies, and clinical trials