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ID PMID Title PublicationDate abstract
20058403 Principles of surgical treatment of the cervical spine in rheumatoid arthritis. 1993 Dec About 20% of patients with rheumatoid arthritis complain about neck problems based on instability and deformity. As a consequence, pain, myelopathy, and severe neurological deficit may occur. Results reported in the literature were not encouraging as regards surgical decompression and stabilization. However, new surgical techniques allow a more aggressive strategy towards the complex problem of the instable cervical spine in rheumatoid arthritis. The most frequent instability of C1/2 can be stabilized by a posterior atlantoaxial screw fixation, a three-dimensional multidirectional construct with few complications. For the inclusion of the occiput into the fusion and the extension of the fusion down to the lower cervical spine, a titanium Y-plate is presented as a successful implant. While through a posterior approach, stability may be achieved, decompression is preferably done by anterior diskectomy or vertebrectomy. Encouraging results with a significant recovery of neurological deficits justify an early intervention in cases of instability of the cervical spine in rheumatoid arthritis.
9036717 [Does parenteral gold inhibit roentgen progression of chronic polyarthritis?]. 1996 Sep The retardation of radiological progression is one of the most important characteristics of a disease-modifying effect of an antirheumatic drug. For the following overview 10 trials were identified dealing with x-ray progression under treatment with parenteral gold. Nine of these trials were randomised parallel studies, one was a retrospective long-term observational study, all had a control group, in five this control group was treated with placebo, in two trials parenteral gold was compared with another DMARD (auranofin and methotrexate, respectively), in two trials different doses of gold were compared and in two trials the radiological progression during the first 6 months was compared with the following treatment period (in one of these trials gold was compared with methotrexate as well). The duration of treatment and follow-up was up to 1 year in two trials, up to 2 years in six, and over 2 years in only two studies. There is a great number of limitations in these studies: for instance, there was a large number of withdrawals who were not followed, x-rays were available for evaluation only in a relatively small proportion of treated patients in five studies, in six studies the disease duration was over 2 years at baseline, which limits the evaluability of x-ray progression for technical reasons. In one study juxta articular osteoporosis and joint swelling were evaluated; but these parameters are very difficult to evaluate in a multicenter study because of the different quality of the films. In spite of all limitations and reservations with the studies reviewed the published results indicate a reduction of radiological progression with parenteral gold treatment of rheumatoid arthritis patients: in the placebo-controlled studies outcome in the gold group was significantly better than in the placebo group. The study of the Empire Rheumatism Council failed to show a significant difference compared to the control group after 30 months, but the patients had been treated sufficiently only for 5 months. The study of Cats indicated a better outcome in the group of patients with a high gold dose, which is confirmed by the retrospective analysis of Luukkainen. In a comparison between 113 patients treated with parenteral gold and 119 patients treated with auranofin for 1 year Larsen found a significantly smaller progression in the patients treated with parenteral gold. In a patient population of 73 and 53 the difference between methotrexate and parenteral gold was too small to be detectable, but the progression curve was significantly flattened after the first 6 months, indicating a treatment effect. In a macroradiographic study the erosion surface area increased during the first 6 months of gold treatment, it did not change during the second 6 months, and decreased during the third 6 months together with healing of erosions. In conclusion, the studies reviewed in this paper indicate a disease-modifying potency of parenteral gold treatment, especially when the treatment is started early and sufficiently dosed.
8558068 The role of chemokines in inflammatory joint disease. 1996 Jan Rheumatoid arthritis (RA) is an autoimmune disease characterized by the elicitation and activation of a number of leukocyte populations within both the synovial space and joint tissue. The recruited leukocytes subsequently play an instrumental role in synovial cell proliferation, pannus formation, and bone erosion. Although it is know that leukocytes are important participants in the evolving joint pathology, the mechanism responsible for the successful elicitation of cells to the joint is not clear. A number of studies have identified an association of specific cytokines, including chemokines, with active arthritis, but longitudinal analyses of cytokine expression and the causal role of these mediators have not been defined. Animal models and cell culture systems have proved useful in identifying the expression of various cytokines during the maintenance of chronic joint inflammation. In addition, animal models have provided important information regarding the kinetic production and contribution of specific mediators to the development of experimental arthritis. These studies provide insights into the potential mechanisms for leukocyte involvement in inflammatory joint disease.
7973481 Low incidence of rheumatoid arthritis in France. 1994 The incidence of rheumatoid arthritis (RA) was estimated in the Lorraine district, eastern France, over the period 1986-1989. Cases were identified from in- and outpatients at the district Rheumatology Hospital Centre, private rheumatologists, general practitioners and by regional media announcements. Supplementary cases resident in the area were sought by extending the procedure to adjacent districts. The population count was obtained from the national Census. An overall age-adjusted incidence rate of 8.8/100,000 was found using the 1987 ACR criteria (12.7/100,000 in females, 4.7/100,000 in males; sex ratio = 2.65) and 9.5/100,000 using the 1958 ARA criteria (definite and classic RA). These rates were compared, using the same standard population, with the age-adjusted incidence rates in other incidence studies mainly conducted in Caucasian populations. The RA incidence rates appeared lower in France than in any other country in Europe, USA and Japan.
8345272 Capsular tissues of the proximal interphalangeal joint: normal composition and effects of 1993 Jun Three fibrocartilages associated with the proximal interphalangeal joint are described--at the attachment of the central slip to bone, within the slip where it passes over the joint, and the volar plate. Material was obtained at surgery following trauma, Dupuytren's disease and rheumatoid arthritis. The fibrocartilages were structurally distinct and immunolabelled differently with monoclonal antibodies to extracellular matrix components. All fibrocartilages from normal and Dupuytren's fingers contained chondroitin and keratan sulphate. Type II collagen was present in all attachment zones, although there was little in rheumatoid fingers. It was also present in the dorsal hood of some normal fingers, but not in pathological specimens or the volar plate. The results show that the fibrocartilages are dynamic tissues whose composition varies according to function and use, and changes in disease.
1633266 Characterization of monoclonal IgG antibodies produced by hybridomas derived from rheumato 1992 Apr IgM rheumatoid factors (RF) are the predominant autoantibody found in rheumatoid arthritis. They are polyclonal, fix complement, and are directed against epitopes in the Fc portion of IgG. One hypothesis regarding the induction and persistence of RF production in rheumatoid arthritis is that the Fc of IgG is somehow altered, rendering it antigenic. In this study, to better understand the derivation and pathogenicity of RF in rheumatoid arthritis, monoclonal IgG (mIgG) constitutively secreting hybridomas were established by fusing rheumatoid synovial mononuclear cells (RSC) from patients with a mouse/human heteromyeloma cell line, F3B6. To clarify the primary structure of IgG Fc constant regions produced locally by RSC, we amplified the cDNA corresponding to the CH2 and CH3 domains of an IgG1-, IgG2-, and an IgG3-producing hybridoma derived from RSC. The amplified DNA segments were cloned in M13 vectors and sequenced. Interestingly, very few differences in the nucleotide sequences were observed, and the deduced amino acid sequences were identical, except for the allotype, with those encoded by the human germline genes GEA and CL. Thus, the primary structure of the IgG1, IgG2, and IgG3 Fc regions produced by RSC were not altered when compared with those encoded by the unmutated human germline gene. These results suggest that factors other than altered IgG induce and sustain high avidity RF production in rheumatoid arthritis.
8965942 [Various opinions of family physicians and rheumatologists about the management of patient 1996 Oct 12 OBJECTIVE: To make an inventory of the opinions about professional duties and of the cooperation of general practitioners (GPs) and rheumatologists in the care of patients with rheumatoid arthritis (RA), after the publication of the standard 'Rheumatoid arthritis' issued by the Dutch College of General Practitioners in 1994. DESIGN: Descriptive. SETTING: Maastricht University, the Netherlands. METHOD: Information was collected by means of a written questionnaire submitted to a random sample of 500 GPs and all 148 (assistant) rheumatologists in the Netherlands, and by means of focus group interviews with GPs, rheumatologists and RA patients. This information focused on the opinion of both groups of professionals on their professional duties in diagnosis and management of RA, existing models of cooperation, the satisfaction with mutual consultations, experienced problems and possibilities to improve cooperation. RESULTS: Substantial differences existed between both groups of professionals in their views on the duties of the GP and the rheumatologist respectively, in the care of RA patients. GPs tended to an expectative policy in cases of suspected or even diagnosed RA, whereas rheumatologists preferred early referral. Hardly any cooperation model was found with agreements committed to paper on the mutual duties regarding RA patients. CONCLUSION: Inadequate mutual contacts and inadequate insight of both parties into each other's abilities appeared to be major problems impeding improvement of the mutual communication. Both groups recognized the need to improve the mutual cooperation.
9098447 Polymorphism of the tumour necrosis factor beta gene in multiple sclerosis and rheumatoid 1994 Oct We evaluated the TNF-beta gene polymorphism in two HLA-associated autoimmune diseases, multiple sclerosis (MS) and rheumatoid arthritis (RA). The TNF-beta allele and genotype frequencies were not significantly different in the patient populations, compared to controls. An increased frequency of the TNF-beta*2 allele was observed in HLA-DR2+ vs. HLA-DR2- MS patients. No such association was seen in HLA-DR4+ RA patients.
8978960 Laser Doppler perfusion imaging of proximal interphalangeal joints in patients with rheuma 1996 Nov OBJECTIVE: A non-invasive imaging technique (laser Doppler perfusion imaging-LDI) based on measurement of backscattered Doppler-broadened near infra-red laser radiation was used to provide two-dimensional images of perfusion over the proximal interphalangeal (PIP) joints of a group of normal subjects compared to a group of patients with rheumatoid arthritis (RA). RESULTS: Some PIP joints of the RA group showed areas of increased perfusion whereas normal subjects showed much less variation in perfusion between joints. These hyperaemic areas arose from the underlying joint, as scans taken with a less penetrating red laser did not show such areas. CONCLUSION: Apart from its obvious dermatological uses, LDI could be employed to image hyperaemia associated with a variety of inflammatory conditions affecting subcutaneous structures.
8230027 Rheumatoid arthritis and vertebral artery occlusion: a case report with angiographic and m 1993 Aug A 40-year-old woman with rheumatoid arthritis (RA) who presented with vertigo and nausea, was found to have left vertebral artery occlusion on angiography. There was minimal atlantoaxial subluxation and no odontoid herniation. Magnetic resonance imaging (MRI) was suggestive of a left vertebral artery dissection. This is the first report of MRI of vertebral artery occlusion in RA. It will be important to accumulate MR images of this complication in future cases.
8919443 Neurologic complications after total shoulder arthroplasty. 1996 Jan Three hundred sixty-eight patients underwent 417 total shoulder arthroplasties between 1975 and 1989. Seventeen patients with 18 operated shoulders had a neurologic deficit after surgery. Osteoarthritis and rheumatoid arthritis were the most common diagnoses. Twelve patients (13 shoulders) had neurologic deficits localized to the brachial plexus; the upper and middle trunks were most commonly affected. Three patients had idiopathic brachial plexopathy. One patient had an exacerbation of preexisting dysesthesias in the lower trunk/medial cord distribution. Another patient had a median neuropathy at the wrist. Four patients had lesions that interfered significantly with shoulder rehabilitation and general activity; six had lesions that temporarily interfered with their scheduled rehabilitation program. All but two of these patients were monitored to a point of maximum improvement. Neurologic recovery at 1 year was graded as good in 11 shoulders and fair in five shoulders. The long deltopectoral approach leaving the deltoid attached to the clavicle and acromion was found to be significant in the development of a postoperative neurologic complication (p = 0.003). Use of methotrexate was also significant (p < 0.0001). A correlation was found between operative time and postarthroplasty neurologic complication (p = 0.02), with shorter operative times being associated with more neurologic complications. No other statistically significant risk factors were identified. In most cases the presumed mechanism of injury was traction on the plexus occurring during the operation. In most cases the prognosis for neurologic recovery was good. In this series neurologic injury after total shoulder arthroplasty did not interfere with the long-term outcome of the arthroplasty itself.
7980676 In vivo production of interleukin-10 by non-T cells in rheumatoid arthritis, Sjögren's sy 1994 Nov OBJECTIVE: Interleukin-10 (IL-10) is a potent stimulator of B lymphocytes in vitro. In vivo dysregulation of IL-10 gene expression was therefore analyzed in patients with rheumatoid arthritis (RA), primary Sjögren's syndrome (SS), and systemic lupus erythematosus (SLE). METHODS: Spontaneous production of IL-10 by peripheral blood mononuclear cells was measured using reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay in untreated patients with either RA (n = 10), SS (n = 10), or SLE (n = 10), and in 15 normal control subjects. RESULTS: IL-10 production was dramatically higher in RA, SS, and SLE patients than in controls. In each group, both B lymphocytes and monocytes, but not T lymphocytes, produced IL-10. CONCLUSION: IL-10 production is increased in RA, SS, and SLE. It may play a role in B lymphocyte hyperactivity and in the development of autoimmunity.
7802676 Molecular cloning and sequence analysis of a human 372-kDA protein localized in the Golgi 1994 Dec 15 Autoantibodies from a patient with chronic rheumatoid arthritis recognized an antigen localized in the Golgi complex of various cells from different tissues and species. The autoantibodies were used as a probe for screening human QGP-1 cDNA library, resulting in identification of a 10.3-kb cDNA. The cDNA insert contained an open reading frame which encodes a 3225-residue protein with a calculated mass of 372 kDa. The predicted protein was found to have no NH2-terminal signal sequence but a single hydrophobic domain at the COOH terminus. These results indicate that the 372-kDa antigen is cytoplasmically disposed and anchored to the Golgi membrane by the COOH-terminal hydrophobic domain.
8101729 Multiplex ARMS-RFLP: a simple and rapid method for HLA-DR4 subtyping. 1993 Jun We have developed a simple and rapid non-radioactive technique for HLA-DR4 subtyping. A multiplex ARMS-RFLP (Amplification Refractory Mutation System--Restriction Fragment Length Polymorphism) system allows HLA-DR4 subtyping by analysis of the products of two multiplex ARMS reaction mixtures. For some cases, restriction enzyme digests (Hae II and/or SacII) of the products are analysed. The technique relies on the fact that an ARMS primer with a mismatch at its 3'-end with respect to the template will not be elongated under PCR conditions. Hence, by designing ARMS primers such that different HLA-DR4 alleles yield PCR products of different lengths, only two reactions, each using a mixture of different ARMS primers, are sufficient to type all of the known HLA-DR4 alleles. This system can distinguish between HLA-DR4 'homozygotes' and 'heterozygotes' since every HLA-DR4 allele can be detected. The ARMS conditions were optimized using DNA from cell lines. This technique has now been used to type a panel of rheumatoid arthritis patients and controls.
7848312 A genetic association between juvenile rheumatoid arthritis and a novel interleukin-1 alph 1995 Feb OBJECTIVE: The genetic factors that predispose to the development of juvenile rheumatoid arthritis (JRA) and its complications are not completely understood. The cytokine interleukin-1 (IL-1) has been implicated in the pathogenesis of JRA and other inflammatory diseases. This study was performed to test whether polymorphisms of the IL-1 alpha gene might be associated with JRA. METHODS: We sequenced the 5' regulatory region (containing the promoter) of the human IL-1 alpha gene in 18 normal subjects. This revealed a C (IL-1A1) to T (IL-1A2) transition polymorphism at position -889. We studied the frequencies of both alleles in patients with JRA (n = 269) and controls (n = 99). RESULTS: An increased gene carriage of IL-1A2 was found in patients with early-onset, pauciarticular JRA (EOPA-JRA; n = 103) compared with controls (0.66 versus 0.49; P = 0.01, odds ratio [OR] = 2.1). Within this subset of JRA, the association with IL-1A2 was particularly strong in the patients in whom chronic iridocyclitis developed (n = 28) compared with those without chronic iridocyclitis (0.89 versus 0.57; P = 0.002, OR = 6.2). Within the group of EOPA-JRA patients, IL-1A2 was also associated with elevation of the erythrocyte sedimentation rate (P < 0.0025). CONCLUSION: This is the first report of a cytokine gene association with JRA, and we conclude that IL-1 alpha itself, or a gene for which the IL-1 alpha polymorphism is a marker, may contribute to the pathogenesis of EOPA-JRA and the ocular complications found in this group.
8070160 A pilot study of the effect of an elemental diet in the management of rheumatoid arthritis 1994 May To evaluate the extent of food allergy/intolerance in rheumatoid arthritis, an elemental (hypoallergenic) diet was studied in a controlled, double-blind pilot study. Ten patients were allocated to an experimental group and 7 to a control group. The patients in the experimental group received an elemental diet for 3 weeks, whereas the patients in the control group received a control soup consisting of milk, meat, fish, shellfish, orange, pineapples, tomatoes, peas and flour of wheat and corn. During the 4th week of the study the patients in both groups resumed their regular diet. A significant improvement was found in the number of tender joints (p = 0.04) in the experimental group, whereas improvement was found in the erythrocyte sedimentation rate (ESR) (p = 0.03) and in the thrombocyte count (p = 0.02) in the control group. Three patients in the elemental diet group and 2 patients in the control group improved in all of the measured disease variables during the dietary treatment period. There was no significant difference in disease activity variables between the two groups. These results suggest that some RA patients may respond to the elimination of offending food items. However, the results do not encourage treatment with an elemental diet in unselected RA patients.
7850696 Clinical presentation and treatment of arthritis in the aged. 1994 Nov Arthritis is a common condition among older individuals; osteoarthritis is the most common. Other frequently encountered conditions are rheumatoid arthritis, polymyalgia rheumatica, gout, and pseudogout. The clinical presentation of these disorders may differ from those seen in younger patients. Therapeutic modalities, such as physical therapy, medications, and surgery should be modified sometimes to accommodate age-related changes in body mechanics and function.
1378496 Rheumatoid arthritis serum or synovial fluid and interleukin 2 abnormally expand natural k 1992 Feb We show that rheumatoid arthritis (RA) serum or synovial fluid (SF) increases the growth capacity of normal, interleukin 2 (IL-2) driven cell preparations, compared to normal human serum (NHS). Proliferation in RA serum and SF cultures was primarily associated with expansion of natural killer (NK)-like cells (CD16+, CD57+), and in NHS cultures, with T cell (CD3+ CD4+ CD8+) growth. The capacity of RA serum to promote NK cell growth was related to patient global clinical activity and rheumatoid factor (RF) titers. The NK-like cells, but not the T-like cells, induced high levels of IgM RF synthesis in autologous B cells. Thus, alteration in NK cell growth may disrupt NK-B cell circuits in RA and contribute to B cell dysfunction (RF synthesis).
8088069 Height loss rate as a marker of osteoporosis in postmenopausal women with rheumatoid arthr 1994 Jun The relation between the loss of height and bone mineral density (BMD) at the lumbar spine and proximal femur was determined in 61 women aged 56-70 years suffering from rheumatoid arthritis. Statistically highly significant negative correlations were found between the loss of height and the spinal and femoral BMD. A loss of 4 cm or more in height over 10 years seems to be associated with a significant decrease of BMD, and it can be recommended as a clinical marker of osteoporosis.
8925190 n-3 polyunsaturated fatty acids and human cytokine synthesis. 1996 Feb The cytokines interleukin-1 and tumor necrosis factor contribute to the pathogenesis of inflammatory diseases and, potentially, to atherogenesis. The synthesis of these cytokines in humans can be suppressed by oral intake of n-3 polyunsaturated fatty acids. This mechanism may contribute to the beneficial effect of long-term n-3 fatty acid supplementation in inflammatory diseases such as renal transplant rejection, immunoglobulin A nephropathy and rheumatoid arthritis.