תרומתי לרפואה

מחקרים קליניים במחלות ראומטולוגיות שונות

עבודות מחקר קליני בנושאים ראומטולוגים כלליים ניתן למצוא ברשימת המאמרים המלאה, במאמרים הבאים: 13, 20, 21, 27, 35, 37, 38, 41, 74, 75, 83, 88, 104, 107, 112, 140, 146, 151, 153, 167, 168, 197, 206, 210, 226, 230, 235, 258, 281, 283, 292, 308, 344, 353, 367, 533, 535, (לרשימת המאמרים המלאה). להלן, מובאים תקצירים של 5 מאמרים נבחרים:

Arthritis Rheum. 1991 May;34(5):547-51.
A variant of HLA-DR4 determines susceptibility to rheumatoid arthritis in a subset of Israeli Jews.
Gao XJ, Brautbar C, Gazit E, Segal R, Naparstek Y, Livneh A, Stastny P.

Abstract
HLA-DR4 is associated with risk for developing rheumatoid arthritis (RA) in most populations. In Israeli Jews, in whom the Dw10 subtype of DR4 predominates, no association of RA with DR4 has been found. The inability to detect an association could be due to the high frequency of DR4-Dw10. We used DNA typing with amplification by the polymerase chain reaction and dot-blotting with allele-specific oligonucleotides to determine DR4 variants in 131 Jewish RA patients living in Israel and 134 controls. In both Ashkenazi Jews and non- Ashkenazi Jews, the rare variant Dw15 (previously identified in Japanese populations and in Japanese patients with RA) was found to be the main allele associated with the risk of developing RA (relative risk = 9.2, corrected P less than 0.001). However, this low-frequency allele could be responsible for susceptibility in only 11.5% of the patients. Susceptibility for rheumatoid factor-positive RA was associated with Dw4 and Dw15; the risk for rheumatoid
factor-negative RA was associated only with Dw14. The distribution of the HLA-DQ alleles associated with DR4 showed that more than half of the RA patients with Dw15 also had HLA-DQw2. The frequencies of DQw7 and DQw8 were not different in RA patients compared with controls. The results suggest that, as in other populations, susceptibility for the development of RA in Israeli Jews is associated with DRB1 locus alleles of the DR4 group.

J Am Acad Dermatol. 1994 Sep;31(3 Pt 1):459-61.
Prevention of recurrent aphthous stomatitis with colchicine: an open trial.
Katz J, Langevitz P, Shemer J, Barak S, Livneh A.

Abstract
BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common disorder with hitherto unsatisfactory drug therapy.
OBJECTIVE: Our purpose was to evaluate the prophylactic effect of colchicine in the treatment of RAS.
METHODS: An open, prospective, 4-month study was conducted in 20 patients with RAS who served as their own controls. During the first 2 months of the study no medications were given and in the last 2 months colchicine, 1.5 mg/day, was prescribed.
RESULTS: The mean number of aphthae per week and the subjective daily pain scores were reduced by 71% and 77%, respectively, during colchicine treatment as compared with the previous period (p < 0.001 for both). No serious side effects of colchicine were noted.
CONCLUSION: These findings suggest a role for continuous colchicine therapy in the prevention of RAS.

Clin Exp Rheumatol. 1996 Jul-Aug;14(4):407-12.
Increased prevalence of joint manifestations in patients with recurrent aphthous 
stomatitis (RAS)
Livneh A, Zaks N, Katz J, Langevitz P, Shemer J, Pras M.

Abstract
OBJECTIVE: To characterize the systemic manifestations and joint disease in patients with recurrent aphthous stomatitis (RAS).
METHODS: The presence and features of extra-oral manifestations were determined by a rheumatologist, who examined and interviewed 64 patients, referred during 1993 to the oral medicine clinic for treatment of RAS. Controls were 65 medical staff members of a military clinic associated with the hospital.
RESULTS: Based on the rheumatologist's findings and published criteria, the patients were diagnosed as suffering from RAS alone (24 patients), Reiter's syndrome (8), Behçet disease (8), familial Mediterranean fever (1), or RAS with undiagnosable extra oral manifestations (23). Thirteen patients in the last group had joint disease (p < 0.01 compared to the controls), characterized by recurrent mono- or oligoarthritis/arthralgia of short duration, affecting mostly the large joints. Conjunctivitis, pustular rash, lower back pain and urethritis/ cervicitis were also common in RAS patients, but only the latter was significantly more frequent in RAS patients than in controls (p < 0.02).
CONCLUSION: These findings suggest that patients with RAS have an increased frequency of a palindromic type joint disease.

J Pediatr. 1999 Jul;135(1):98-101.
Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome: clinical characteristics and outcome.
Padeh S, Brezniak N, Zemer D, Pras E, Livneh A, Langevitz P, Migdal A, Pras M, Passwell JH.

Abstract
We report 28 patients (20 male) with a syndrome characterized by abrupt onset of fever, malaise, aphthous stomatitis, tonsillitis, pharyngitis, and cervical adenopathy (PFAPA syndrome). Episodes of fever occurred at intervals of 5.1 +/- 1.3 weeks beginning at the age of 4.2 +/- 2.7 years. Fever, malaise, tonsillitis with negative throat cultures, and cervical adenopathy were reported in all 28 patients, aphthae in 19, headache in 5, abdominal pain in 5, and arthralgia in 3. Mild hepatosplenomegaly was observed in 6 patients. Mild leukocytosis, elevation of the erythrocyte sedimentation rate, and fibrinogen were found during attacks. These episodes of illness resolved spontaneously in 4.3 +/- 1.7 days. Serum IgD was found elevated (>100 U/mL) in 12 of the 18 patients tested (140.2 +/- 62.4 U/mL). Affected children grow normally, have no associated diseases, and have no long-term sequelae. Attacks were aborted by a single dose of oral prednisone (2 mg/kg) at the beginning of the attack in all 15 patients in whom this medication was prescribed. In 9 patients the syndrome has completely resolved (beginning at the age of 2.9 +/- 1.3 and lasting 8 +/- 2.5 years). In 3 other patients complete resolution of the attacks occurred after tonsillectomy was performed. PFAPA is sporadic, and no ethnic predilection was found. Increased awareness of the clinical syndrome has resulted in more frequent diagnosis and adequate treatment.

Clin Rheumatol. 2016 Jan;35(1):233-7. 
The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome.
Ben-Zvi I, Goldenberg I, Matetzky S, Grossman C, Elis A, Gavrielov-Yusim N, Livneh A.

Abstract
Patients with inflammatory rheumatic diseases (IRD) have a high burden of cardiovascular disease (CVD), leading to increased mortality and morbidity. However, it is not clear whether increased CVD mortality in IRD is due to a higher incidence or worse outcome of cardiovascular events (higher case fatality). In this observational case-control study, we assessed the outcome of acute coronary syndrome (ACS) in patients with IRDs compared to matched controls without IRD, using data from the Acute Coronary Syndrome Israeli Survey (ACSIS), a large, national, real-life registry detailing the extent, severity, and outcome of ACS. Of 2,193 subjects enrolled to the ACSIS, 20 (nine men) were identified with IRD, including 11 patients with rheumatoid arthritis, five patients with systemic lupus erythematosus (SLE), three patients with ankylosing spondylitis (AS), and one patient with psoriatic arthritis (PsA). The study patients were compared to 120 matched control patients (adjusted for age and risk factors for CVD) without IRD. Compared to controls, IRD patients had similar clinical
presentation and similar type of ACS and received identical initial treatment at the ER. The two groups had comparable rates of complications including major adverse cardiovascular events (death, recurrent myocardial infarction, stroke, major bleeding, and definite stent thrombosis) (10 vs. 11.7% in the study and control group, respectively, p > 0.05), re- hospitalization (20 vs. 21.1%, respectively, p > 0.05), and severe congestive heart failure (7.7 vs. 6.9%, respectively, p > 0.05) within 30 days. The outcome and prognosis of ACS in patients with IRD is not worse than that of control, supporting the higher prevalence of CVD in this population as the cause for their excess mortality.

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