Clinical Rheumatology (CLIN RHEUMATOL )

Publisher: International League of Associations for Rheumatology, Springer Verlag


Clinical Rheumatology is an international journal devoted to publishing in the English language original clinical investigation and research in the general field of rheumatology with accent on clinical aspects at postgraduate level. Studies carried out anywhere in the world will be considered the basic criterion for acceptance being the medical and scientific standard of the work described.

  • Impact factor
    Show impact factor history
    Impact factor
  • 5-year impact
  • Cited half-life
  • Immediacy index
  • Eigenfactor
  • Article influence
  • Website
    Clinical Rheumatology website
  • Other titles
    Clinical rheumatology (Online)
  • ISSN
  • OCLC
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors own final version only can be archived
    • Publisher's version/PDF cannot be used
    • On author's website or institutional repository
    • On funders designated website/repository after 12 months at the funders request or as a result of legal obligation
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (The original publication is available at
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Survival and outcomes have improved considerably among patients with juvenile dermatomyositis (JDM) in the west. However, mortality continues to be high in the developing world. There is paucity of literature on this aspect of JDM from developing countries. We reviewed case files of all patients with JDM registered in the Pediatric Rheumatology Clinic, Advanced Pediatrics Centre at the Post Graduate Institute of Medical Education and Research, Chandigarh, during the period 1993-2013. Seventy-six children were diagnosed to have inflammatory myopathy during this period. Of these, 63 had JDM, 3 had polymyositis while 10 had an overlap syndrome. We had reported 2 deaths out of 33 (8.3 %) patients with JDM in 2004, and over the last 9 years, we have encountered five more deaths in this group, thereby accounting for a mortality rate of 11.1 % (7/63) over two decades of follow-up. In these five children now being described, the mean duration between onset of symptoms and institution of appropriate therapy was 9.2 months. Four children (80 %) had severe muscle weakness needing nasogastric tubes at the onset, three (60 %) had cutaneous ulcers and three (60 %) had superadded infections. Two children (40 %) had gastrointestinal vasculitis and one of these developed an intestinal perforation. Three patients (60 %) had progressive pulmonary disease and air leak was identified in two of them. Although the prognosis for survival in JDM has steadily improved, in our experience the disease remains a serious illness and still carries significant mortality in the context of a developing country.
    Clinical Rheumatology 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Effects of retinoic acid on collagen synthesis and cartilage have previously been shown. However, its effects on cartilage and tendons in humans have not been studied yet. Therefore, in order to provide a morphologic insight, the aim of this study was to measure femoral cartilage, Achilles and supraspinatus tendon thicknesses in patients under systemic isotretinoin treatment by using ultrasound. Fifteen patients (nine F, six M) who used isotretinoin for their acnes were included. All patients were treated with isotretinoin 0.5 mg/kg/day for the first month, and the dosage was escalated up to 1 mg/kg/day thereafter. Distal femoral cartilage, supraspinatus, and Achilles tendons thicknesses have been evaluated both before the treatment and at the end of the third month. Femoral cartilage thicknesses were assessed from three midpoints bilaterally; medial condyle, lateral condyle, and intercondylar area. Short/long-axis diameters and cross-sectional area of the Achilles tendons and axial tendon thicknesses of supraspinatus tendon were evaluated from the nondominant side. The mean age of the patients was 20.1 ± 4.9 years, and body mass index was 21.7 ± 2.5 kg/m(2). Although posttreatment cartilage measurements of 30 knees were lower for the three midpoints, it reached significance only for lateral condyle (p = 0.05). In addition, posttreatment tendon measurements were not statistically significant compared with pretreatment values (all p > 0.05). Systemic isotretinoin treatment seems to make cartilage thinner. Further studies considering histological and molecular evaluations with more sample sizes are awaited.
    Clinical Rheumatology 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The major breakthrough in the treatment of ankylosing spondylitis (AS) came in 2003 with the approval of the first two TNF inhibitors (TNFi) [1]. Since then, three additional TNFi have been approved for the treatment of AS, but biologics with different mechanisms of action (e.g., anakinra, abatacept, tocilizumab) were found to be not efficacious in these patients [2]. In 2009, the Assessment of SpondyloArthritis International Society (ASAS) redefined the spectrum of axial inflammatory diseases by developing classification criteria for axial spondyloarthritis (axSpA), an umbrella term that includes AS and non-radiographic axSpA (nr-axSpA) [3]. Only a few trials since the reclassification have included subjects from the entire spectrum of axSpA or those with nr-axSpA [4–6].Despite these advances, pharmaceutical interventions for axSpA are quite limited compared with other chronic inflammatory diseases such as rheumatoid arthritis (RA). Some major unresolved questions and possible challen
    Clinical Rheumatology 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Results on the effects of lateral wedge insoles (LWIs) in patients with medial knee osteoarthritis (OA) are ambiguous and not fully understood. Because of the low cost of this intervention and its clinical utility, attention to LWIs is worth considering. Current insights on the efficacy of LWIs are mainly focused on changing biomechanical aspects, such as the external knee adduction moment, in an attempt to influence pain, functional ability and structural progression. It is however appropriate to interpret the effectiveness of LWIs in a broader concept than the pure biomechanical approach. Given our current understanding of OA-related pain, including the involvement of the central nervous system and nociception-motor interactions, concepts of pain neuroscience should be taken into account. The purpose of this review is to summarize the current state of knowledge regarding the biomechanical effect of LWIs. It aims to discuss the degree to which such biomechanical effect translates to clinical effects (symptom relief, function recovery and reduction of structural progression). In order to explain these clinical effects, this paper balances biomechanics with pain neuroscience. A literature search was performed and reviewed using a narrative approach. Many studies investigated the effect of LWIs on dynamic knee joint loading and beneficial biomechanical effects (reduction in knee adduction moment) were observed in patients with mild to moderate medial knee OA, in particular when using full-length LWIs. However, despite beneficial biomechanical effects, there is insufficient evidence for clinically important effects or significant reductions in disease progression. Evaluating the effects of LWIs, our current understanding of OA pain should be taken into account, as LWIs may be part of a comprehensive biopsychosocial treatment. Future work on all of the variables that could influence clinical outcomes in order to decide in which subgroups of patients LWIs are (most) effective is necessary.
    Clinical Rheumatology 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent attacks of fever, peritonitis, pleuritis, arthritis, or erysipelas-like skin lesion. FMF is the most common periodic febrile syndrome affecting more than 150,000 people worldwide. The majority of patients develop FMF before the age of 20. FMF may cause amyloidosis, which mainly affects the kidneys but may also be accumulated in other organs such as the heart, gastrointestinal tract, and reproductive organs. FMF being a systemic disorder with a risk for amyloidosis, affecting patients in their childbearing years, and with its lifelong colchicine therapy raises concern about its effect on the reproductive system. In this article, we review the impact of FMF and its treatment to the reproductive system of male and female patients, pregnancy, and lactation.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Two-tier serology is often used to confirm a diagnosis of Lyme disease. One hundred and four patients with physician diagnosed erythema migrans rashes had blood samples taken before and after 3 weeks of doxycycline treatment for early Lyme disease. Acute and convalescent serologies for Borrelia burgdorferi were interpreted according to the 2-tier antibody testing criteria proposed by the Centers for Disease Control and Prevention. Serostatus was compared across several clinical and demographic variables both pre- and post-treatment. Forty-one patients (39.4 %) were seronegative both before and after treatment. The majority of seropositive individuals on both acute and convalescent serology had a positive IgM western blot and a negative IgG western blot. IgG seroconversion on western blot was infrequent. Among the baseline variables included in the analysis, disseminated lesions (p < 0.0001), a longer duration of illness (p < 0.0001), and a higher number of reported symptoms (p = 0.004) were highly significantly associated with positive final serostatus, while male sex (p = 0.05) was borderline significant. This variability, and the lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Furthermore, these findings underline the difficulty for rheumatologists in identifying a prior exposure to Lyme disease in caring for patients with medically unexplained symptoms or fibromyalgia-like syndromes.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The tight national drug reimbursement regulations in the treatment of ankylosing spondylitis (AS) in Finland lead to the practice that at least one traditional disease-modifying antirheumatic drug (DMARD), if not contraindicated, has been tried and has failed before a patient can be eligible for reimbursement of anti-tumour necrosis factor (TNF) treatment. The aim of the present study is to evaluate drug survival of the firstly prescribed DMARDs in patients with AS. All AS patients from January 1, 2000 to December 31, 2007 were collected from the nationwide drug reimbursement registry maintained by the Social Insurance Institution (SII). Data on antirheumatic medication came from the prescription registry of SII. A total of 2,890 AS patients (60 % males) were identified. Sulfasalazine (SSA) monotherapy was the most common first antirheumatic treatment (2,319 patients, 87 %), followed by methotrexate (MTX) monotherapy (230 patients, 9 %) and by hydroxychloroquine monotherapy (77 patients, 3 %). A combination of two or more DMARDs was used by 44 patients (2 %). Only seven patients (0.3 %) had biological (etanercept or adalimumab) started as the first antirheumatic drug. Median survival time of SSA monotherapy was 4.5 years (95 % CI 4.2 to 4.8) and that of MTX was 1.9 years (95 % CI 1.5 to 2.1). SSA is almost the standard as the first antirheumatic treatment of AS in Finland. Although the clinical efficiency of SSA was not evaluable in the present study, these data suggest that the use of SSA can at least postpone the need and start of TNF inhibitors with marked economic consequences.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Takayasu arteritis (TA) patients with active disease often have elevated serum C-reactive protein (CRP) levels, which usually decline with the disease remission. The serum CRP concentration has been showed to be related to CRP gene polymorphisms in previous studies. The present study aims to investigate the associations of serum level of CRP and CRP polymorphisms with TA. A total of 178 unrelated Chinese Han TA patients and 229 unrelated Chinese Han individuals without documented disease were enrolled in our studies. After a systemic search in the HapMap database, four single-nucleotide polymorphisms (SNPs) were selected, namely, rs1800947, rs3093077, rs1205, and rs2808630. The ligase detection reaction (LDR) was used in genotyping. CRP concentrations were determined using turbidimetric immunoassay. Genotype frequencies and allele frequencies of CRP variations were similar between TA patients and controls. CRP haplotype frequencies in patients were not significantly different from those of controls. No significant association between serum CRP concentrations and genotypes was found. Moreover, no association was found in CRP concentration between patients with types I, II, and III TA or between patients with or without pulmonary involvement. By contrast, serum CRP concentration was directly correlated with disease severity. In conclusion, CRP polymorphisms were not associated with TA susceptibility or serum CRP levels in the Chinese Han population. However, higher CRP level was correlated with a more serious disease status, which implies that CRP possibly contributes to the progression of TA.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute rheumatic fever (ARF) is a non-suppurative complication of pharyngeal infection with group A streptococcus. Signs and symptoms of ARF develop 2 to 3 weeks following pharyngitis and include arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. In developing areas of the world, ARF and rheumatic heart disease are estimated to affect nearly 20 million people and remain leading causes of cardiovascular death during the first five decades of life. ARF still represents one of the quintessential examples of a pathogenic trigger culminating in autoimmune manifestations. In this review, we will focus on the pathogenesis and etiology of ARF and its complications, along with diagnostic and treatment approaches to both ameliorate and prevent long-term sequelae of this potentially debilitating disease.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present the case of a 61-year-old female with an acute onset of polyarthritis involving the wrists, hands, knees, and ankles. Associated systemic symptoms included fever, weight loss, and lymphadenopathy. Serologic workup revealed positive rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) antibodies. Radiograph imaging of her bilateral hands and wrists showed erosive joint disease and lymph node, and bone marrow biopsy confirmed a diagnosis of T cell lymphoblastic leukemia. Our case demonstrates a unique clinical phenotype of paraneoplastic arthritis and is only the second reported case of RF, anti-CCP-positive arthritis related to a hematological malignancy. We review the only three published cases of seropositive paraneoplastic arthritis. In each case, systemic symptoms or a poor response to steroid treatment triggered additional workup. These cases highlight the importance of careful clinical assessment and vigilance to rule out secondary causes of inflammatory arthritis, even in patients with seropositive erosive arthritis.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of this paper are to to measure levels of perceived injustice in whiplash victims and determine the relationship to recovery at 6-month post-injury. Consecutive acute whiplash patients completed the Injustice Experience Questionnaire, at presentation, and also 3- and 6-month post-injury. At each of these two follow-up points, participants were examined for recovery. Of an initial 134 participants, 130 participants were followed up at 3 months and 124 at 6 months. At the 3-month follow-up, 62 % (80/130) of participants reported recovery from their injuries. At 6 months, 80 % (99/124) reported recovery. The initial Injustice Experience Questionnaire score was low, with a mean score of 6.0 ± 1.0 (range 5–10) out of a maximum of 48. The mean score at 3-month follow-up had increased in the cohort to 7.4 ± 1.6 (range 5–11). At 6-month post-injury, the mean of the Injustice Experience Questionnaire score for the cohort who still reported lack of recovery (25/124 participants) was 15.0 ± 6.0 (range 5–31), while that for the recovered group remained low at 8.2 ± 3.9 (range 5–11). In the primary care setting, a significant proportion of whiplash patients who have not recovered by 3-month post-injury subsequently develop higher levels of perceived injustice by 6-month post-injury. The development of high levels of perceived injustice at 6-month post-injury appears to follow the development of chronic pain and a lack of recovery at 3 months and, at that point, becomes a risk factor for lack of recovery thereafter.
    Clinical Rheumatology 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known regarding the environmental factors at play in igniting rheumatoid arthritis (RA) autoimmunity, although an association between Mycobacteria and RA has been documented. This pilot study focused on examining a possible involvement of Mycobacterium tuberculosis (MTB) and Mycobacterium avium ss. paratuberculosis (MAP) in RA. We measured out the serum levels of IgG antibody against different mycobacterial antigens in Sardinian patients and controls, by an enzyme-linked immunosorbent assay. The population study was composed of 61 RA patients under different therapies and 52 healthy controls, whereas the antigens tested were MTB lipoarabinomannan (ManLAM), MAP heath shock protein 70, and MAP protein tyrosine phosphatase. The frequencies of anti-ManLAM antibodies were higher in the RA group (23 %) compared to the healthy controls (5.7 %) (AUC = 0.7; p < 0.0001), whereas serum reactivity to MAP antigens was not observed. ManLAM antigen was also detected in the plasma of three RA patients (which were anti-ManLAM antibody positive) by Western blot analysis using anti-Man-LAM monoclonal antibodies. The data produced corroborate the hypothesis of a potential association between MTB ManLAM and RA disease, but so far, further studies are necessary to understand its role in RA pathogenesis.
    Clinical Rheumatology 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aims of this study were to evaluate the association between potential risk factors and the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis (RA). A total of 9,987 patients (82.0 % female; mean age, 55.7 years) with RA were enrolled in a prospective, observational study from 2000 to 2011. Self-reported distal radius fractures were verified using patient medical records. Cox proportional hazards models were used to analyze independent contributions of various risk factors to distal radius fracture occurrence. During a mean follow-up of 5.7 years, 139 patients reported 153 distal radius fractures. Among these patients, 85 distal radius fractures following minor trauma in 85 patients (6 men, 79 women) were verified with medical records. Female gender (hazard ratio [HR], 2.96; 95 % confidence interval [CI], 1.18–7.45; P = 0.021), age (per 10 years, HR 1.55; 95 % CI, 1.24–1.95, P = 0.00016), body mass index (BMI) (per 1 kg/m2, HR, 1.11; 95 % CI, 1.03–1.19; P = 0.0034), daily prednisolone dose (per milligram per day, HR, 1.10; 95 % CI, 1.05–1.16; P = 0.00015), and physician global visual analog scale (0–10 cm, HR, 0.98; 95 % CI, 0.96–1.00; P = 0.034) were significantly associated with the occurrence of distal radius fractures in Japanese patients with RA. A reduction in the daily prednisolone dose, together with the prevention of falls in female patients of advanced age with RA and a high BMI may be important in preventing distal radius fractures.
    Clinical Rheumatology 01/2014; 33(4).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol consumption had been linked to the risk of gout theoretically, but the results from observational studies were conflicting. Hence, a meta-analysis was conducted to assess the effect of alcohol consumption on the risk of gout. A comprehensive search was performed to identify all eligible studies on the association of alcohol consumption with gout risk. Pooled relative risks (RRs) with 95 % confidence intervals (CIs) from fixed and random effects models were calculated. A total of 12 articles with 17 studies involving 42,924 cases met the inclusion criteria. The pooled RR for highest vs. non/occasional alcohol drinking in every study was 1.98 (95 % CI, 1.52–2.58). The RRs for light (≤1 drink/day), moderate (>1 to <3 drinks/day), and heavy drinking (≥3 drinks/day) vs. non/occasional alcohol drinking were 1.16 (95 % CI, 1.07–1.25), 1.58 (95 % CI, 1.50–1.66), and 2.64 (95 % CI, 2.26–3.09), respectively. The results suggested that alcohol consumption might be associated with increased risk of gout.
    Clinical Rheumatology 11/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: In systemic sclerosis (SSc), impaired diffusing capacity for carbon monoxide (DLCO) can indicate interstitial lung disease (ILD), pulmonary hypertension (PH), and/or other disease manifestations, including anemia. We undertook this study to compare the various measures of DLCO in the setting of a complex disease like SSc. We analyzed the pulmonary function tests of a cohort of SSc subjects, as a whole and among subjects with isolated PH and ILD separately. Associations were assessed using Spearman correlation coefficients, Student’s t tests, and F tests by one-way ANOVA. P values <0.05 were considered statistically significant. This study included 225 subjects (mean age, 57 years; 88 % women; mean disease duration, 9.6 years; 32 % with diffuse disease, 44 % with ILD, and 17 % with PH). Mean percent predicted DLCO values were 75 % for DLCOsb and 83 % for DLCOrb. Adjustment for alveolar volume (VA) resulted in near normalization of both DLCOsb/VAsb (91 %) and DLCOrb/VArb (91 %). Subjects with ILD had significantly lower DLCOsb but not DLCOsb/VAsb, whereas those with PH had significantly lower DLCOsb and DLCOsb/VAsb. Among the various measures of DLCO, DLCOsb had the strongest and most consistent associations with clinical outcomes of interest. Adjusting for alveolar volume dampened the associations except with PH, with which DLCOsb/VAsb was more strongly associated than DLCOsb. Low DLCOsb is the most sensitive measure to detect abnormalities in gas exchange in SSc but reflects both parenchymal lung disease and pulmonary vascular disease. Low DLCOsb/VAsb is more specific for pulmonary vascular disease and should be the preferred measure of gas exchange in SSc.
    Clinical Rheumatology 06/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim was to investigate circulating levels of interelukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α, chemokine (C-X-C motif) ligand (CXCL)10, CXCL11 and chemokine (C-C motif) ligand (CCL)2 in "mixed cryoglobulinemia and hepatitis C" (MC + HCV). Serum levels of CXCL11, IL-1β, TNF-α, IL-6, and CCL2 were evaluated in 52 MC + HCV vs 52 sex- and age-matched controls to correlate them to the clinical features of mixed cryoglobulinemia. CXCL11 was significantly higher in MC + HCV than in controls (264 ± 279 vs 70 ± 16 pg/mL, respectively; P = 0.0002; univariate analysis of variance (ANOVA)), in particular in 23 MC + HCV with active vasculitis vs those without (293 ± 221 vs 168 ± 57 pg/mL, respectively; P < 0.001; ANOVA). Significantly high IL-1β, IL-6, TNF-α, CXCL10, and CCL2 in MC + HCV vs healthy controls were confirmed. In a multiple linear regression model (CXCL11 or CCL2, vs age, alanine aminotransferase, IL-1β, IL-6, TNF-α, and CXCL10), CXCL11 was significantly associated with high CXCL10 (P < 0.001), while CCL2 with high IL-6 (P < 0.001). This study demonstrates in MC + HCV high serum levels of (a) T-helper 1 chemokines, CXCL11 and CXCL10 (related to each other) and (b) proinflammatory cytokines IL-6 and CCL2 (related to each other).
    Clinical Rheumatology 04/2013;

Related Journals