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ID PMID Title PublicationDate abstract
8341752 Extensor digiti minimi tendon transfer to prevent recurrent ulnar drift. 1993 Sep Thirty percent of patients with rheumatoid arthritis develop ulnar drift. Although numerous operations have been described, recurrence of the deformity is frequent. We recommend use of the extensor digiti minimi tendon transfer to prevent recurrent ulnar deviation. The tendon insertion is moved from a dorsal location to a dorsal-radial position. In this new location, the tendon produces both extension and radial deviation. Moreover, this transfer is maximally effective in extension when ulnar drift is greatest. We have used this transfer 28 times during the past 6 years. In evaluating patients more than 1 year after surgery, metacarpal phalangeal joint extension averaged 52 degrees and there was no evidence of recurrent ulnar drift of the little finger. The only problem was slight hyperextension of less than 5 degrees in approximately half of the patients. However, in no patient was this functionally a problem. We recommend the use of this tendon transfer in all patients with ulnar drift undergoing metacarpal phalangeal joint replacement for rheumatoid arthritis.
8448638 The optimal use of cyclosporin A in rheumatoid arthritis: efficacy and outcome measures in 1993 Mar The debate as to which outcome measures are appropriate in clinical trials involving RA has been in progress for some time. A recent critique (Felson DT et al. Arthritis Rheum 1990;33:140-9) addressed some of the problems that have been raised and suggested solutions. Shortcomings noted included multiple measures, lack of standardization and insensitive measures. This paper discusses those and other areas of concern in the light of the findings of consensus meetings that have taken place recently and which suggest that agreement is within reach.
1282009 Antilactoferrin antibodies in patients with rheumatoid arthritis are associated with vascu 1992 Dec OBJECTIVE: To determine the occurrence of antineutrophil cytoplasmic antibodies (ANCA) and the specificity of these antibodies (Ab) in serum from patients with rheumatoid arthritis (RA) and patients with rheumatoid arthritis complicated by vasculitis (rheumatoid vasculitis [RV]). METHODS: ANCA was detected with an indirect immunofluorescence test on ethanol-fixed granulocytes. Ab against the cytoplasmic antigens proteinase-3, elastase, lactoferrin (LF), and myeloperoxidase were measured by enzyme-linked immunosorbent assay. RESULTS: ANCA were found in the serum of 43% of 49 patients with RV and in 36% of 50 patients with RA. Anti-LF Ab occurred more frequently in RV patients (45%) than in RA patients (4%), whereas reactivity against the other cytoplasmic antigens did not differe significantly between these groups. CONCLUSION: Anti-LF Ab in serum of patients with RA may be useful in the diagnosis of vasculitis in RA.
9065028 [Inflammatory cytokine mediated anti-anabolic effects: a potential mechanism in rheumatoid 1996 Increased levels of inflammatory cytokines such as II-1 and TNF-alpha are described in rheumatoid and osteoarthritic synovial fluid. These mediators are also very well established anti-anabolic modulators of chondrocyte synthetic activity in vitro. Our study aimed to investigate, whether chondrocytes in rheumatoid and osteoarthritic cartilage in situ show reaction pattern compatible with the putative effects of these modulatory agents. Immunohistochemical analysis using type II collagen specific antibodies showed considerable loss of staining in many sites of osteoarthritic and rheumatoid articular cartilage. mRNA analysis showed besides an overall activation of synthetic activity in rheumatoid and osteoarthritic cartilage, a decreased expression of cartilage matrix proteins in the upper zone. The cease of the anabolic activity of rheumatoid and osteoarthritic chondrocytes and the increased catabolism of matrix components contributes to the anabolic-catabolic imbalance in rheumatoid and osteoarthritic cartilage and is suggestive to be a crucial event in the progress of the disease. It correlates well to the putative anti-anabolic effect of inflammatory cytokines such as II-1 and TNF-alpha and could indicate a potential role of these mediators in rheumatoid and osteoarthritic cartilage destruction.
8105737 Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid a 1993 Nov 15 OBJECTIVE: To determine the effects of a short course of a low dose of a glucocorticoid agent on bone mass. DESIGN: Double-blind, placebo-controlled, randomized study. SETTING: Outpatient clinic of a university hospital. PATIENTS: Forty patients with active rheumatoid arthritis. INTERVENTION: All patients started receiving intramuscular gold salts. In addition, they were randomly allocated to receive either prednisone or placebo. The initial dose was 10 mg/d, which was tapered between weeks 12 and 20. Thereafter, patients were followed for an additional 24 weeks. MEASUREMENTS: Lumbar bone mineral density was measured with dual-energy, quantitative computed tomography in a trabecular and a cortical region of interest. RESULTS: Despite favorable effects on disease activity and functional capacity, trabecular bone mineral density decreased in the prednisone-treated patients between baseline and week 20 (mean change, -8.2%; 95% CI, -12.7% to -3.7%; P = 0.001). Little change was found in the placebo-treated patients (P > 0.2), and the prednisone group had a greater mean bone loss than the placebo group (9.5%; CI, 3.4% to 15.6%; P = 0.003). After discontinuation of prednisone, an increase was found in trabecular bone mineral density between weeks 20 and 44 (mean change, 5.3%; CI, 0.7% to 9.9%; P = 0.03). Little change was found after withdrawal of placebo (P > 0.2). The mean improvement in the prednisone group was 6.8% (CI, 0.8% to 12.8%; P = 0.03) greater than for placebo. In both treatment groups, cortical bone mineral density did not change markedly in either period (P > or = 0.2). CONCLUSIONS: Low doses of glucocorticoid agents cause marked vertebral trabecular bone loss in the initial months of therapy in patients with active rheumatoid arthritis. After discontinuation of treatment, this bone loss seems to be (partially) reversible.
1475638 Synovial fluid leukocytosis in bacterial arthritis vs. reactive arthritis and rheumatoid a 1992 In this comparative analysis of laboratory data, we examined the characteristics of synovial fluid leukocytosis in eighty adult patients with bacterial arthritis, reactive arthritis or rheumatoid arthritis of the knee joint. Synovial fluid leukocyte count and the percentage of polymorphonuclear cells seemed to perform well as a discriminator between bacterial infection and acute flare of the underlying disease in patients with rheumatoid arthritis. In contrast, there were no definite difference in the intensity of synovial fluid leukocytosis between patients with bacterial arthritis caused by living bacteria and patients with reactive arthritis probably caused by bacterial antigens.
8182647 Inclusion body myositis in association with rheumatoid arthritis. 1994 Feb We describe 2 patients with rheumatoid arthritis (RA) and inclusion body myositis (IBM). Examination and laboratory tests including muscle biopsy with frozen section and electron microscopy were performed. Both patients fulfilled diagnostic criteria for IBM, which is increasingly recognized in association with autoimmune disease. A high index of suspicion and early thorough investigation are required to diagnose IBM in patients with RA.
1347487 Suppression of collagen arthritis with antibodies to an arthritogenic, oligoclonal T cell 1992 Apr Rats immunized with type II collagen (CII) develop an immunologically mediated polyarthritis. T cells have been implicated in the pathogenesis of this model since they can adoptively transfer the disease. A CII-specific T cell line (VA), consisting of three distinct clones by Southern blot analysis, has been shown to be arthritogenic. Antibodies specific for this line were generated by immunizing rabbits. In an attempt to prevent collagen-induced arthritis (CIA), Louvain rats were injected with 1 ml of anti-VA ip on Days -1, +1, +3 and 0.5 ml on Day +5 (early treatment). To evaluate its effect on existing disease, rats received anti-VA on the day of arthritis onset and subsequently on 4 successive alternate days using the same dosage protocol (late treatment). Control rats received no therapeutic injections or were administered normal rabbit serum. All rats were immunized with CII on Day 0 to induce CIA. Rats administered antibodies using the early anti-VA treatment protocol had a significantly diminished incidence of arthritis compared to controls. Established arthritis was significantly diminished compared to controls in rats given the late anti-VA treatment. In both protocols, radiographic evidence of joint destruction was significantly reduced compared to controls. T cell phenotyping using flow cytometry analysis demonstrated that the anti-VA antibody therapy selectively eliminated a small subset of T cells since there was little difference in total T cell counts in the experimental versus control groups. Delayed type hypersensitivity and IgG antibody titers to CII were minimally decreased in the experimental versus control group. These results suggest that antibodies raised to an oligoclonal arthritogenic T cell line can suppress collagen arthritis. This may have implications with respect to 1) the size of the T cell receptor repertoire involved in the pathogenesis of collagen arthritis and 2) immunospecific protocols for CIA and other autoimmune diseases.
7697679 Membranous glomerulonephritis in patients with rheumatoid arthritis. 1994 Nov We investigated the cause of membranous glomerulonephritis (MGN) in 24 patients with rheumatoid arthritis (RA). The class or stage of RA was diagnosed using the criteria of the American Rheumatism Association, and MGN was diagnosed using renal biopsy. Renal biopsy and laboratory findings, including serologic analysis, were evaluated. Eighteen patients had previously received one of the following antirheumatic agents: bucillamine (n = 13), D-penicillamine (n = 3), or gold (n = 2). The renal lesions of all 24 patients resembled lesions seen with idiopathic MGN on examination by light microscopy, electron microscopy, and immunofluorescence. We concluded that patients with RA are predisposed to develop MGN, whether or not they receive antirheumatic agents.
1474530 New approaches to the management of rheumatoid arthritis. 1992 Nov The approach to the treatment of rheumatoid arthritis is currently undergoing fundamental change. The demonstration of erosions by magnetic resonance imaging early in the disease, when conventional radiographs only show soft tissue swelling, demands rapid intervention with more effective drugs. The increasing use of methotrexate earlier in the course of the disease is justified, in view of the favorable benefit/risk ratio. New experimental therapies, such as photopheresis, the fusion protein, DAB486 interleukin 2, FK 506, and monoclonal CD4+, may also be utilized earlier if their safety profiles permit. Conventional therapeutic regimens are being administered differently in an attempt to improve efficacy and safety.
8933485 Effects of progressive resistance training on immune response in aging and chronic inflamm 1996 Nov The effects of 12 wk of progressive resistance strength training on in vivo and in vitro immune parameters were evaluated in a controlled study of eight subjects with rheumatoid arthritis (RA), eight healthy young (22-30 yr), and eight healthy elderly (65-80 yr) individuals. Six healthy elderly (65-80 yr) nontraining control subjects were also evaluated to account for seasonal and psychosocial effects. Training subjects exercised at 80% of their one-repetition maximum and performed eight repetitions per set, three sets per session on a twice weekly basis. Peripheral blood mononuclear cell (PBMC) subpopulations, cytokine and prostaglandin (PG) E2 production, proliferative response, and delayed type hypersensitivity (DTH) skin response were measured before and after 12 wk of training. Training did not induce changes in PBMC subsets, interleukin (IL)-1 beta, tumor necrosis factor-alpha (TNF), IL-6, IL-2, or PGE2 production, lymphocyte proliferation, or DTH response in any of the training groups, compared with control subjects. These data suggest that 12 wk of high-intensity progressive resistance strength training does not affect immune function in young or elderly healthy individuals or subjects with RA.
8647517 Expansion of large granular lymphocyte subsets in Wiskott-Aldrich syndrome. 1995 Nov We describe a 9-year-old boy with Wiskott-Aldrich syndrome and IgM-rheumatoid factor-positive arthritis who presented expansion of two distinct subsets (one CD8dim and the other CD8-) of large granular lymphocytes. Natural killer activity against the K-562 cell line was absent. An increased percentage of CD5+ B cells was also observed. Since patients with Wiskott-Aldrich syndrome are at risk of developing autoimmune disorders - conditions in which increased CD5+ B cells have been observed - the high percentage of CD5+ B cells together with the presence of IgM-rheumatoid factor and anti-platelet antibodies may represent an early manifestation of an autoimmune process. The possible relationship between CD5+ B cells and large granular lymphocyte expansion is discussed.
1371388 Mycobacteria and human heat shock protein-specific cytotoxic T lymphocytes in rheumatoid s 1992 Mar OBJECTIVE: To study the cytotoxic capacity of mycobacteria-specific T lymphocyte lines and clones from sites of inflammation in patients with rheumatoid arthritis (RA). We also studied antigen specificity, surface phenotype, expression of T cell receptors (TCR), and HLA restriction. METHODS: Autologous macrophages (M phi) from the synovial membrane (SM), synovial fluid (SF), or peripheral blood (PB) were used as target cells in cytotoxicity assays. RESULTS: All SM and SF cell lines tested thus far have shown specific lysis of the autologous M phi from SM or PB that had been pulsed with BCG (bacillus Calmette-Guerin), but no cytotoxicity when the targets were pulsed with irrelevant antigens such as tetanus toxoid and Chlamydia. Both CD4+ and CD8+ cells were shown to be involved in the specific cytolysis. The majority of the cytotoxic T lymphocyte (CTL) lines were TCR alpha/beta + cells. However, both TCR alpha/beta + and TCR gamma/delta + clones (TCR delta 1+) from one RA patient showed antigen-specific lysis. Antigen-specific recognition by a number of CTL lines and clones generated from SF and SM was restricted by HLA-DR molecules. Two Mycobacterium bovis 65-kd heat shock protein (HSP)-specific TCR alpha/beta + SF T cell clones also lysed M phi that had been pulsed with a recombinant human 65-kd HSP. CONCLUSION: Joint inflammation and destruction might be partly attributable to a cross-reaction of mycobacteria-induced cytotoxic T cells with self HSP.
8124906 The absence of antibodies to malaria and human immunodeficiency virus, and the presence of 1993 Dec Rheumatoid factor is of limited value in the diagnosis of rheumatoid arthritis (RA) in West Africa. Consequent upon previous findings, we have studied the role of the absence of antibodies to malaria and human immunodeficiency virus (HIV) as well as the presence of the hepatitis B surface antigen (HBsAg) as diagnostic markers of rheumatoid arthritis in West Africa. We have found a significant association (p < 0.001) between RA and titre of HBsAg, but only between RA and malaria (p < 0.05) when sera with low malaria antibodies were studied. No correlation between either HBsAg or malaria and rheumatoid factor was found and no RA patient was either HIV-1 or HIV-2 positive.
8971230 A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. 1996 Jun OBJECTIVE: The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise. It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately. METHODS: One hundred thirty-nine patients with chronic rheumatoid arthritis were randomly assigned to hydrotherapy, seated immersion, land exercise, or progressive relaxation. Patients attended 30-minute sessions twice weekly for 4 weeks. Physical and psychological measures were completed before and after intervention, and at a 3-month followup. RESULTS: All patients improved physically and emotionally, as assessed by the Arthritis Impact Measurement Scales 2 questionnaire. Belief that pain was controlled by chance happenings decreased, signifying improvement. In addition, hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement (women only). At followup, hydrotherapy patients maintained the improvement in emotional and psychological state. CONCLUSIONS: Although all patients experienced some benefit, hydrotherapy produced the greatest improvements. This study, therefore, provides some justification for the continued use of hydrotherapy.
7668901 Clinical implications of IgA rheumatoid factor subclasses. 1995 Jul OBJECTIVES: To evaluate the diagnostic and pathogenetic significance of IgA rheumatoid factor (RF) subclasses in rheumatoid arthritis (RA). METHODS: Rheumatoid factors of the IgA class and IgA1 and IgA2 subclasses were measured by enzyme linked immunosorbent assay in 58 patients with RA, 31 patients with other rheumatic diseases, 30 non-rheumatic individuals with increased concentrations of IgA RF, and in 100 randomly selected healthy controls. RESULTS: Using a 95% cut off for the controls, 55% of the RA patients had increased total IgA RF, 64% IgA1 RF, and 60% IgA2 RF. RA patients with extraarticular manifestations more often had increased concentrations of IgA RF and both subclasses than patients without such manifestations (p < or = 0.01). Nearly all (31/32) RA patients with increased IgA RF had increases in both IgA RF subclasses, compared with 67% (20/30 of nonrheumatic symptom free individuals with increased IgA RF (p = 0.002). CONCLUSION: Increased concentrations of the IgA2 RF subclass appears to be more specific for RA than increased IgA1 RF. Measurement of IgA RF subclasses may be clinically useful.
1588728 [Contribution of genetic factors to RA]. 1992 Mar Multiplex families of rheumatoid arthritis (RA) and concordance of the development of RA in monozygotic twins strongly suggest the relationship of genetic factor to the onset of RA. Among many genetic markers, HLA shows the strongest association with RA and association between RA and HLA-DR4 has been reported in many ethnic groups. DNA typing of HLA class II genes revealed that DRB1 * 0405 (Dw 15) is the most susceptible DRB1 allele for RA in the Japanese. The particular epitope sequence at the third hypervariable region (position 70-74, and 86) and DR beta chain, expressed with the structure of the DR4 molecule seems to be important for the susceptibility to RA.
7788145 Interleukin-6 (IL-6) induces the proliferation of synovial fibroblastic cells in the prese 1995 Apr A number of investigators have reported that there are detectably elevated levels of interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) in the synovial fluids of rheumatoid arthritis (RA) patients. However, the precise role of IL-6 and sIL-6R in the pathogenesis of RA remains unclear. In the present study we examined whether IL-6 and/or sIL-6R could induce the proliferation of synovial fibroblastic cells (SFC) obtained from a RA patient. Co-existence of IL-6 and sIL-6R induced SFC proliferation without needing any further stimulation. This proliferation was completely blocked by either anti-IL-6 or anti-sIL-6 antibody. In contrast, neither IL-6 nor sIL-6R alone induced SFC proliferation. Although sIL-6R alone could not induce SFC proliferation, it did however augment IL-1 beta-induced SFC proliferation in a dose-dependent manner, but not tumour necrosis factor alpha-, platelet-derived growth factor-AB- or b-fibroblast growth factor-induced proliferation. This augmentation was completely neutralized by the addition of anti-IL-6 or anti-sIL-6R antibodies. This may be explained by the fact that an amount of IL-6 sufficient to induce SFC proliferation in the presence of sIL-6R was found to be detectable in the IL-1 beta-stimulated-culture supernatant. This evidence suggests that IL-6 is very likely to be involved in synovial cell proliferation in the synovium of RA patients in co-operation with sIL-6R.
8053798 Elbow kinematics during sit-to-stand-to-sit of subjects with rheumatoid arthritis. 1994 Aug Independence in mobility is dependent on the ability to rise from a chair. Elbow kinematics of subjects with rheumatoid arthritis were compared to those of subjects with no known elbow pathology. Through a case study approach, four subjects with varying elbow pathology and symptoms, were compared with a control group of 10 subjects on four kinematic variables. Results indicated that whereas the overall movement pattern was similar between the two groups, a trend toward increased deviation occurred with increased elbow involvement (as measured using the Morrey Elbow Evaluation). The total time taken to complete the task increased and the maximum velocity decreased as scores on the Morrey Evaluation decreased. When the minimum flexion angle (maximum extension) used during the activity was compared with the minimum flexion angle available, the angle used was consistently 15 degrees to 20 degrees less than that available. This possible need for a residual range raises questions about the generally accepted belief that activities require between 30 degrees to 130 degrees of flexion and 100 degrees of rotation.
8835600 Syndrome of inappropriate secretion of antidiuretic hormone in elderly patients with rheum 1996 Jun Two rheumatoid arthritis (RA) patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) during the course of infection are herein reported. One patient developed SIADH during the course of a localized cutaneous herpes zoster infection while the other developed SIADH in conjunction with Staphylococcus simulans septicemia. We consider that the development of SIADH was strongly associated with superimposed infections in the underlying RA. This is the first report discussing the association of SIADH and infections in RA patients in which SIADH is diagnosed by measurement of plasma ADH.