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ID PMID Title PublicationDate abstract
8970038 Incidence of rheumatoid arthritis is not related to indicators of socioeconomic deprivatio 1996 Dec OBJECTIVE: To evaluate the role of socioeconomic factors in susceptibility to rheumatoid arthritis (RA). METHODS: A prospective population based register of inflammatory joint disease (NOAR) recruited 687 adults between 1990 and 1992, of whom 50% satisfied ARA criteria for RA at presentation. Using census data, social class specific incidence rates were calculated for both sexes. A correlation analysis was undertaken examining the association between incidence rates and 5 indicators of socioeconomic status. RESULTS: There was no trend of increasing incidence with declining social class. None of the 5 indicators examined showed any evidence of association with incidence (rs range 0.0-0.3). CONCLUSION: In contrast to the data on factors influencing outcome in established RA, the socioeconomic status variables examined did not explain susceptibility patterns in the population studied.
7818590 Thymopentin treatment of rheumatoid arthritis. 1994 Oct Although the etiology of rheumatoid arthritis (RA) is unknown, there is solid evidence that immunological factors play a pivotal role in its pathogenesis. It seems that a hyporeactivity of local (intraarticular) T-suppressor cells would permit an excessive immune response that ultimately leads to the classical symptoms and signs of inflammation and cartilage damage. Thymopentin is a synthetic pentapeptide (Arg-Lys-Asp-Val-Tyr) which represents the active biologic site (sequence 32-36) of the native thymic hormone thymopoietin, containing 49 amino acids. Thymopoietin and thymopentin have been shown to possess immuno-normalizing properties in a number of animal model systems. Low concentrations of the hormone characteristically stimulate the OKT4-positive cells, whereas higher concentrations additionally induce stimulation of OKT8-positive cells. This report summarizes the clinical experience collected by Italian investigators, and discusses the results with a view to previously published papers.
7675733 [Advances in pathogenesis of anemia in rheumatoid arthritis]. 1994 The growing importance of anaemia in rheumatoid arthritis (RA) let us to analyze the problems connected with etiopathology and diagnosis of this disease. The main attention was put on iron metabolism disturbances in the pathomechanism of the anaemia in RA.
8100750 Anti-CD4 therapy in rheumatoid arthritis. 1993 Mar In recent years, there has been a dramatic rise in the number of trials using monoclonal antibodies, especially those directed against the CD4 molecule, in the treatment of RA. Thus far, the numbers of patients treated in the individual studies have generally been small, and the study designs sometimes not comparable. All of the trials have so far been conducted in a non-blinded, uncontrolled fashion. The patient populations usually represented the far end spectrum of individuals who had failed all other conventional and/or experimental approaches. Clearly, therefore, larger controlled double blind studies in patients with less advanced stages of RA are needed. Moreover, with the exception of one or two reagents (MAX.16H5 and possibly B-F5) apparently routine laboratory parameters determining disease activity usually remain unaltered upon anti-T cell therapy. In addition, in some individuals there has been no clinical improvement despite sometimes severe CD4 cell depletion. Nevertheless, the available data indicate that this form of treatment leads to significant immunomodulation with marked changes in clinical and laboratory parameters and may therefore be a promising approach to the treatment of RA.
7799336 Phenotypic characteristics of bone marrow cells in patients with rheumatoid arthritis. 1994 Sep OBJECTIVE: Our previous study showed the presence of abnormal myeloid lineage cells in the epiphyseal bone marrow adjacent to joints affected with severe rheumatoid arthritis (RA). Now, we investigated whether there were any changes of other marrow cell populations related to RA, and whether there were any pathologically characteristic changes in the iliac bone marrow, which is one of the major systemic hematopoietic organs. METHODS: 2-Color flow cytometry was carried out to analyze the phenotypes of mononuclear cells (MNC) fractions in bone marrow aspirates and venous blood from 56 patients with RA and 7 non-RA controls. RESULTS: The absolute number of MNC in the iliac bone marrow was increased by 3-fold in the RA patients compared with the non-RA controls. In contrast, no significant increase of MNC was observed in the tibial epiphyseal bone marrow or peripheral blood. The ratio of each MNC fraction in the iliac bone marrow did not differ significantly between the RA patients and the non-RA controls. In lymphocyte subsets, the percentage of HLA-DR+CD8+ cells to all CD8 cells in the iliac bone marrow increased significantly in the RA patients compared with the non-RA controls. Abnormal myeloid cells (MX-GA+MY4+ cells), specific to severe RA, were found to be more concentrated in the iliac bone marrow than in the tibial epiphyseal bone marrow. CONCLUSION: Characteristic pathologic changes of the iliac bone marrow suggest an important role of systemic bone marrow in the progression of RA.
8498189 Radiographic assessment of component orientation in elbow arthroplasty. A technical descri 1993 Apr We describe an alternative method of taking standardized radiographs of the elbow in patients with rheumatoid arthritis, taking into account fixed deformities. The technique enables assessment of the orientation of joint replacement components, including their axial rotational alignment. The accuracy of the method for calculating axial rotational alignment has been evaluated using a skeleton model. Within the 20 degrees limits of arm position the accuracy was found to be on average 1.4 degrees for the humerus and 2.2 degrees for the ulna.
8350344 Stress caused by rheumatoid arthritis: relation among subjective stressors of the disease, 1993 Jun Two integrated studies, examining the chronic stressors specific to the disease rheumatoid arthritis, are described. Pain, limitation, and dependence were rated as the most annoying chronic stressors of the disease. Pain was measured with the Visual Analog Scale and the McGill Pain Questionnaire. Both pain scores were only weakly related to the medical assessment variables. New scales were developed to measure perceived limitation and dependence. Perceived limitation was inversely related to both mobility and self-care, but this association was not strong. Perceived dependence was unrelated to any of the health status measures. All three stressors were associated with indicators of quality of life even after controlling for interaction with clinical assessment and functional status variables. It was concluded from these studies that patients with rheumatoid arthritis must cope simultaneously with pain, limitation, and dependence.
1428456 Pyoderma gangrenosum treated with hyperbaric oxygen therapy. 1992 Aug The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones, or immunosuppressants, either alone or in combination. Inconsistent response to therapy is a source of frustration to both patient and physician. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our patient, a woman with severe rheumatoid arthritis and diabetes mellitus, hyperbaric oxygen therapy not only promoted healing of pyoderma gangrenosum but permitted reduction of systemic corticosteroids.
8259721 Combination therapy with hydroxychloroquine and methotrexate in rheumatoid arthritis. 1993 Sep The aim of the study was to compare the efficacy of hydroxychloroquine (HCQ) alone and in combination with methotrexate (MTX) in a randomized placebo-controlled study lasting 6 months. Forty patients with rheumatoid arthritis participated in the study and were randomly assigned to two groups--20 patients were treated with HCQ (200 mg daily) and placebo, 20 patients with HCQ and MTX (7.5 mg) once a week. Patients were assessed at regular intervals of 1 month up to 6 months using six clinical and five laboratory tests and one radiological measure. All six clinical variables and two laboratory variables were favorably influenced by combination therapy during the 6-month period. HCQ alone significantly influenced only three clinical variables and none of the laboratory parameters. There was a greater number of patients without radiological progression in the combination group. There was one drop-out in combination group due to general allergic reaction; otherwise the treatment was well tolerated. The results suggest that a combination of HCQ and MTX is more potent than HCQ alone.
1458680 An altered repertoire of T cell receptor V gene expression by rheumatoid synovial fluid T 1992 Dec The pattern of T cell receptor V gene expression by lymphocytes from rheumatoid synovial fluid and paired peripheral blood samples was compared using a polymerase chain reaction (PCR)-based assay. Eight rheumatoid arthritis (RA) patients who had varying durations of disease (from 2 to 20 years) were studied. In all patients there was evidence of a different pattern of V gene expression between the two compartments. Significantly increased expression of at least one V alpha or V beta gene family by synovial fluid T cells was observed in all the patients studied. Three different V alpha (V alpha 10, 15 and 18) and three V beta (V beta 4, 5 and 13) families were commonly elevated. Sequencing of synovial V beta transcripts demonstrated that the basis of increased expression of selected V gene families in the synovial fluid was due to the presence of dominant clonotypes within those families, which constituted up to 53% of the sequences isolated from one particular synovial V gene family. There were considerable differences in the NDJ sequences found in synovial and peripheral blood T cell receptor (TCR) transcripts of the same V beta gene family. These data suggest that the TCR repertoire in the two compartments differs, and that antigen-driven expansion of particular synovial T cell populations is a component of rheumatoid synovitis, and is present in all stages of the disease.
8660102 Signalling through neutrophil Fc gamma RIII, Fc gamma RII, and CD59 is not impaired in act 1996 May OBJECTIVE: To compare neutrophil Fc receptor (Fc gamma R) and CD59 signalling responses in normal healthy subjects and patients with active rheumatoid arthritis (RA). METHODS: Intracellular free calcium concentrations were measured in neutrophils loaded with the fluorescent calcium indicator fura-2, using a spectrofluorimeter. RESULTS: Basal intracellular calcium ion concentrations were similar in both groups when no primary antibody, CD59, or CD32 (Fc gamma RIII) antibody was added. When CD16 (Fc gamma RIII) antibody was added, there was a significantly greater basal calcium concentration in the patient group compared with the control group. Transient cytosolic calcium ion fluxes were observed after binding Fc gamma RII, Fc gamma RIII, or CD59 with specific monoclonal antibodies and cross linking with the F(ab)2 fragment of sheep antimouse IgG. Peak concentrations of intracellular free calcium, [Ca2+]i, after cross linking each of the three receptors, were comparable between normal healthy donors and patients with RA. The lag period between addition of cross linking antibodies and the increase in calcium was also similar between normal individuals and patients. CONCLUSION: Contrary to previous reports, these results demonstrate that Ca2+ signalling responses of cross linked Fc receptors in blood neutrophils from patients with RA are identical to those in neutrophils of normal subjects. Signalling responses of cross linked CD59 are also unaltered.
8210921 Meta-analysis of two double-blind comparative studies with the sustained-release form of e 1993 A meta-analysis was done with the data from two studies that provided the first efficacy and safety results for the new sustained-release (SR) formulation of etodolac versus established nonsteroidal anti-inflammatory drugs in patients with rheumatoid arthritis (RA). The studies were 4-week, double-blind, multicenter, randomized, parallel-group comparisons of etodolac SR 600 mg (102 patients) with either diclofenac SR 100 mg (65 patients) or piroxicam 20 mg (35 patients). The data for etodolac SR were pooled and compared with the pooled data for the comparators. The primary efficacy assessments (weeks 2 and 4) were physician and patient overall evaluation of the patient's condition, number of painful/tender joints, and number of swollen joints. Patients met at least five of the American Rheumatism Association diagnostic criteria and were within Steinbrocker progression stage I, II, or III and functional class I, II, or III. The homogeneity of the treatment groups across studies and the changes from baseline between groups were tested using a Cochran-Mantel-Haenszel test and an analysis of variance including "study," "treatment," and "center within treatment" factors and their interaction. The efficacy analysis was based on the final assessment during therapy (last visit). The patients in the etodolac SR group were older than those in the comparators group (P = 0.032), and there were more patients over 65 years of age in the etodolac SR group than in the comparators group (31% versus 14%, respectively; P = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)
7617379 [Tendon diseases in chronic rheumatoid arthritis]. 1995 Jun Rheumatoid arthritis is basically a disease of the synovium and involves the synovium-lined sheaths that surround many of the tendons in the hand and wrist. Proliferative synovitis affects the tendons, infiltrates the tendons, causes formation of nodules, changes their ultrastructure, and eventually leads to spontaneous rupture. The three common sites of tendon sheath involvement are the dorsal and palmar aspect of the wrist, and the palmar aspect of the digits. Early tenosynovectomy can prevent tendon ruptures and should therefore be the cornerstone of treatment. Once spontaneous rupture has occurred, early diagnosis and treatment are important to prevent further rupture. Reconstruction of isolated ruptures of extensor or flexor tendons gives good results. Multiple tendon ruptures, however, are difficult to treat and have a worse prognosis. The severity of the patient's disease and the degree of articular involvement have a greater effect on the outcome of surgery than reconstruction techniques. Our current approach to the management of this difficult problem is presented.
7529986 Immunoblotting detection of so-called 'antikeratin antibodies': a new assay for the diagno 1994 Nov OBJECTIVES: To assess the diagnostic value for rheumatoid arthritis (RA), of an immunoblotting assay based on the rat oesophagus epithelium antigens recognised by the so-called 'antikeratin antibodies' ('AKA'), antigens that have been identified as three non-cytokeratin proteins (referred to as A, B and C proteins). METHODS: After polyacrylamide gel electrophoresis in non-denaturing conditions and electrotransfer of an epithelial extract, the immunoreactivities to the A, B and C proteins of a series of serum samples from 88 patients with RA and 100 patients with non-rheumatoid rheumatic diseases, were semiquantitatively evaluated. RESULTS: A total of 81.8% of RA serum samples recognised the three proteins, while 91% of non-RA serum samples only weakly recognised the A and B proteins but not the C protein. Only in the group of RA patients, were the titres of the antibodies to the A, B and C proteins found to be significantly correlated with each other and with the titres of 'AKA' detected by the standard indirect immunofluorescence (IIF) method. For a diagnostic specificity of 99%, the diagnostic sensitivities of the detection of the A and B proteins were 50% and 43.2%, respectively, when those of the detection of 'AKA' by IIF and of IgM-rheumatoid factor by enzyme-linked immunosorbent assay were 42% and 54%, respectively. In contrast, at a same specificity of 99%, the diagnostic sensitivity of the detection of the C protein was significantly higher with a value of 70.5%. CONCLUSION: This immunoblotting assay which is the first immunochemical method proposed for the detection of 'AKA, should be validated on larger series of patients but can already be considered as a very powerful test for the serological diagnosis of RA.
7886019 [Fatal vacuolar cardiomyopathy in chronic chloroquine drug treatment]. 1995 Jan Clinical and morphological findings recorded in an 81-year-old woman patient with a 45-year history of rheumatoid arthritis treated with long-term chloroquine therapy are reported. The cause of death was low cardiac output syndrome, which upon autopsy and postmortem toxicological analyses was classified as vacuolar chloroquine-induced cardiomyopathy. The pathogenesis and the morphological and clinical characteristics of cardiotoxic effects of chloroquine are reviewed.
7531580 Acute-phase response in early refractory rheumatoid arthritis: long-term follow-up study. 1994 Jul In order to investigate the role of the acute-phase response in early rheumatoid arthritis (RA), we followed the changes of alpha 1-acid glycoprotein (AGP), alpha 1-antitrypsin (AT) and alpha 1-antichymotrypsin (ACT) in the sera of 25 patients with refractory rheumatoid arthritis (RA) during the first 3 years of the disease. Serum levels of AGP, ACT and AT were measured using rocket immunoelectrophoresis, and AGP, ACT and AT microheterogeneities were performed using two-dimensional immunoelectrophoresis with concanavalin A (Con A) as ligand. On average, serum levels of AGP, ACT and AT proteins were higher at the onset of the disease as compared with healthy controls. After 3 years, a significant decrease in serum levels of all three acute-phase proteins (APPs) was observed, but only in patients without anatomical progression was this decrease statistically significant. At the beginning of the study, only the AT reactivity coefficient (RC) was decreased in comparison with healthy subjects. However, after 3 years of disease, AGP, ACT and AT RCs all decreased. This investigation provided two new observations. The first is that only AT RC is significantly lower in comparison with normal values at the beginning of RA, whereas AGP RC and ACT RC remain within the normal range of values; a decrease in AGP RC and ACT RC appeared later. The second observation is that the highly elevated levels of APPs at the onset of RA decrease during the course of the disease. Moreover, this decrease does not depend on the disease activity, but a relationship with radiological progression was shown.
7487368 Lymphocyte phenotype studies of rheumatoid arthritis patients treated with methotrexate. 1994 Seventy nine patients with rheumatoid arthritis (RA) were monitored for 12 months. Forty eight individuals were treated weekly with a low dose of methotrexate (MTX), and 31 received nonsteroid antiinflammatory drugs (NSAID) only. The mean total dose of MTX was 413 mg with a range from 250 to 735 mg. The phenotype of lymphocytes was analyzed using double immunofluorescence and a panel of monoclonal antibodies. The clinical status of 33 MTX-treated patients improved, in 9 neither clinical nor laboratory improvement was noticed. Six patients were withdrawn from the study because of adverse reactions. We observed no changes in the percentage of CD3, CD4, CD8 and CD25 positive lymphocytes in both MTX and NSAID-treated groups. However, the percentage of CD19 positive cells significantly decreased during 12 month observation (15.1 +/- 6.5% v.s. 10.2 +/- 5.0, p < 0.01) in MTX-treated subjects. Moreover, this percentage increased (9.4 +/- 6.7% v.s. 17.1 +/- 1.1%, p < 0.01) in NSAID-treated patients.
8296118 [Compliance to therapy in daily practice--rheumatologic diseases]. 1993 Nov 30 An insufficient compliance is regularly observed in 30% of outpatients. In chronic rheumatic diseases such as rheumatoid arthritis a poor compliance is often associated with alleviation of symptoms whereas symptomatic patients tend to take their medication more regularly. Drug abuse, mainly corticosteroids, can often not be avoided. The latter may 'particularly in women' lead to osteoporosis with subsequent fractures. In patients with fibrositis compliance is often a poor because of digestive problems associated with NSAIDs and the bad response to drugs and adjuvant therapies.
7744126 Epidemiology of musculoskeletal conditions in the geriatric population. 1994 Geriatric rheumatology and the epidemiology of musculoskeletal diseases in elderly persons constitute a new field. Although difficult to estimate, the prevalence rate of disabling joint diseases increases as people age. Osteoarthritis (OA) is the most common type of joint disease in geriatric patients. Symptomatic OA has a much lower prevalence rate than does radiographic OA. However, symptomatic disease is important in that it may motivate a patient to seek medical attention. The prevalence of rheumatoid arthritis (RA) also increases with advancing age. The onset of RA in both large and small joints in patients older than 60 years is more frequent and begins with greater disease activity as compared to patients younger than 60. Moreover, RA runs a more severe course in older than in younger patients. Thus, epidemiologic data suggest that elderly individuals could be major consumers of nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in the management of musculoskeletal disorders. The prevalence of these disorders increases with advancing age and, coupled with increasing longevity, poses a growing challenge to practicing physicians in their treatment of these patients.
1730100 IL-1 secreting cell assay and its application to cells from patients with rheumatoid arthr 1992 Jan The cells within a population that were secreting interleukin-1 (IL-1) were enumerated and visualized by an ELISA-SPOT assay. Initial experiments designed to validate the assay revealed that the number of IL-1 beta spot forming cells was increased by exposing normal blood monocytes to LPS and that spot formation was prevented by incubating the cells with cycloheximide. Normal blood polymorphonuclear leucocytes (PMNs) produced IL-1 alpha and IL-1 beta in response to recombinant granulocyte monocyte colony stimulating factor (rhGMCSF) but not to cytochalasin B, calcium ionophore or LPS. Monocytes and PMN were isolated from the synovial fluid (SF) and blood of patients with rheumatoid arthritis (RA) and the ability of these cells to secrete IL-1 alpha and IL-1 beta compared. A higher proportion of SF derived monocytes were found to secrete IL-1 beta spontaneously compared to the corresponding blood cells. IL-1 alpha secreting monocytes were not detected although high numbers of IL-1 alpha secreting cells were found among cells isolated from rheumatoid synovium. By contrast SF PMNs did not produce IL-1 alpha or IL-1 beta whereas blood PMNs from some (3/8) RA patients produced IL-1 alpha and/or IL-1 beta. It is considered that the IL-1 ELISA-SPOT is a highly sensitive technique for detecting IL-1 secreting cells.