Contribution of the N-acetyltransferase 2 polymorphism NAT2*6A to age-related hearing impairment

BACKGROUND

Age-related hearing impairment (ARHI) is the most common sensory impairment in older people, affecting 50% of those aged 80 years. The proportion of older people is increasing in the general population, and as a consequence, the number of people affected with ARHI is growing. ARHI is a complex disorder, with both environmental and genetic factors contributing to the disease. The first studies to elucidate these genetic factors were recently performed, resulting in the identification of the first two susceptibility genes for ARHI, NAT2 and KCNQ4.

METHODS

In the present study, the association between ARHI and polymorphisms in genes that contribute to the defence against reactive oxygen species, including GSTT1, GSTM1 and NAT2, was tested. Samples originated from seven different countries and were combined into two test population samples, the general European population and the Finnish population. Two distinct phenotypes for ARHI were studied, Z(low) and Z(high), representing hearing in the low and high frequencies, respectively. Statistical analysis was performed for single polymorphisms (GSTM1, GSTT1, NAT2*5A, NAT2*6A, and NAT2*7A), haplotypes, and gene-environment and gene-gene interactions.

RESULTS

We found an association between ARHI and GSTT1 and GSTM1 in the Finnish population sample, and with NAT2*6A in the general European population sample. The latter finding replicates previously published data.

CONCLUSION

As replication is considered the ultimate proof of true associations in the study of complex disorders, this study provides further support for the involvement of NAT2*6A in ARHI.

Familial aggregation of tinnitus: a European multicentre study

INTRODUCTION AND AIM

Tinnitus is a common condition affecting approximately 20% of the older population. There is increasing evidence that changes in the central auditory system following cochlear malfunctioning are responsible for tinnitus. To date, few investigators have studied the influence of genetic factors on tinnitus. The present report investigates the presence of a familial effect in tinnitus subjects.

METHODS

In a European multicentre study, 198 families were recruited in seven European countries. Each family had at least 3 siblings. Subjects were screened for causes of hearing loss other than presbyacusis by clinical examination and a questionnaire. The presence of tinnitus was evaluated with the question "Nowadays, do you ever get noises in your head or ear (tinnitus) which usually last longer than five minutes". Familial aggregation was tested using three methods: a mixed model approach, calculating familial correlations, and estimating the risk of a subject having tinnitus if the disorder is present in another family member.

RESULTS

All methods demonstrated a significant familial effect for tinnitus. The effect persisted after correction for the effect of other risk factors such as hearing loss, gender and age. The size of the familial effect is smaller than that for age-related hearing impairment, with a familial correlation of 0.15.

CONCLUSION

The presence of a familial effect for tinnitus opens the door to specific studies that can determine whether this effect is due to a shared familial environment or the involvement of genetic factors. Subsequent association studies may result in the identification of the factors responsible. In addition, more emphasis should be placed on the effect of role models in the treatment of tinnitus.

Good results from combining etanercept to prevailing DMARD therapy in refractory juvenile idiopathic arthritis

OBJECTIVE

To assess the effect of etanercept added to prevailing drug therapy in patients with juvenile idiopathic arthritis (JIA) whose disease was refractory to conventional disease-modifying antirheumatic drug (DMARD) treatment, including combinations of different DMARDs.

METHODS

Data on 31 JIA patients with a disease resistant to conventional DMARD treatment were retrospectively collected from medical records and assessed for a one-year period after the introduction of etanercept or to the time of cessation of the drug due to a lack of efficacy or side effects. Efficacy was assessed based on the normal laboratory indexes of inflammation and changes in the following parametres: number of DMARDs used and intraarticular (i.a.) glucocorticoid injections. The numbers of inpatient days needed were also recorded.

RESULTS

Etanercept was well tolerated. Only two patients stopped discontinued the treatment because of allergic rash, after 3 weeks of treatment in one case and after 4 months in another. In two cases the treatment was discontinued because of a lack of efficacy. During the treatment, there was a significant decrease in the number of DMARDs used and the i.a. glucocorticoid injections needed as well as in the dose of per oral glucocorticoids. The laboratory parameters also improved. In addition, there was a significant decrease in the number of inpatient days per 3-month period before and during the etanercept treatment.

CONCLUSION

The addition of etanercept to conventional DMARD therapy in children with the most severe cases of JIA leads to an excellent clinical response during the first 12 months. The tolerability of the drug is good in combination therapy with various DMARDs.

The Finnish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ)

We report herein the results of the cross-cultural adaptation and validation into the Finnish language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Finnish CHAQ-CHQ were validated with 3 forward and 1 backward translations. A total of 161 subjects were enrolled: 89 patients with JIA (9% systemic onset, 44% polyarticular onset, 26% extended oligoarticular subtype, and 21% persistent oligoarticular subtype) and 72 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Finnish version of the CHAQ-CHQ is a reliable and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Cervical spine in patients with juvenile chronic arthritis and amyloidosis

OBJECTIVE

To describe cervical spine abnormalities in a group of adult patients with refractory juvenile chronic arthritis (JCA) complicated by secondary amyloidosis (SA).

METHODS

The series consists of 49 patients who fulfilled the diagnostic criteria of the European League Against Rheumatism for JCA, here complicated by secondary amyloidosis (SA). We evaluated their clinical records and most recent cervical spine radiographs taken in adult age (> 18 years) at or after the diagnosis of SA.

RESULTS

Forty-two (86%) patients evinced inflammatory changes in the cervical spine. Apophyseal joint ankylosis was seen in 31 (63%) and atlantoaxial impaction (AAI) in 28 (57%) patients; anterior atlantoaxial subluxation (aAAS) was noted in 17 (35%) patients, and 19 (39%) had the combination of AAI and apophyseal joint ankylosis. The size of the 4th vertebral body was small or narrow in 14 (29%) patients with JCA onset at a median of 3 years of age (range 1-12).

CONCLUSION

Inflammatory cervical spine disorders are common and may be detected along the entire length of the cervical spine in patients with severe refractory JCA. The disorders tend to ankylose the apophyseal joints and destroy the atlantoaxial joints, resulting in aAAS or impaction. These changes will restrict rotatory and bending movements in the cervical spine. A peculiarly small or narrow cervical vertebral body was seen mainly in patients with early onset disease. The present findings shed light on the characteristics and course of the inflammatory changes in the cervical spine in patients with refractory JCA.