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ID PMID Title PublicationDate abstract
8608358 Diagnostic associations with hypermobility in rheumatology patients. 1995 Dec Although we have considerable knowledge of the demographic characteristics of hypermobile individuals in population studies, we have little understanding of the implications of hypermobility. In this rheumatology clinic-based study we assessed the prevalence, diagnostic associations and clinical features of hypermobility in consecutive newly referred patients. Hypermobility was identified in 50 of 378 patients (13.2%). The most common clinical diagnosis in the hypermobile patients, compared with controls (those without hypermobility), was soft tissue rheumatism observed in 67% vs 25% (P<0.001). Fibromyalgia syndrome was the common specific rheumatological diagnosis in 30% vs 8% (P<0.001) and inflammatory arthritis the least common diagnosis in 4% vs 32% (P<0.001) of hypermobile versus non-hypermobile patients, respectively. Hypermobile patients complained of previous pain, including widespread or multiple localized sites of pain and spinal pain. Although clinic-based studies may not accurately reflect disease patterns as seen in the population, these results suggest an association between hypermobility and soft tissue rheumatic complaints and should be useful to the clinical rheumatologist.
8006886 The longterm effect of pulsed corticosteroids on the efficacy and toxicity of chrysotherap 1994 Mar OBJECTIVE: To follow those patients who participated in a randomized, double blind placebo controlled trial investigating the effect of pulse methylprednisolone treatment in 60 patients with rheumatoid arthritis (RA) starting chrysotherapy. METHODS: Following completion of the original 24-week trial, 47 of the original 60 patients were reexamined between 32 and 67 weeks after completion of the original study. Patients were assessed by a composite clinical score, the Health Assessment Questionnaire (HAQ), erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor levels. RESULTS: At the end of the 24-week trial, the number of patients who responded well to therapy was significantly greater (p < 0.05) in the patients who had received methylprednisolone (17/30) compared with the placebo group (8/30). At the longterm followup assessment, the mean disability score (HAQ) was significantly less (p < 0.05) in patients receiving the initial steroid pulses. No significant difference in drug toxicity or the length of time that patients remained on gold, was observed between the 2 treatment groups. CONCLUSION: Our study supports a beneficial adjunctive role of pulse corticosteroids in patients with RA starting gold therapy.
8770701 Interleukin-6 and soluble interleukin-6 receptors in the synovial fluids from rheumatoid a 1996 Jan Chronic immune responses and inflammatory reactions in rheumatoid arthritis (RA) often cause severe destruction of cartilage and bone, but its mechanism is still a matter of controversy. We reported that interleukin-6 (IL-6) alone does not induce osteoclast formation, but soluble interleukin-6 receptors (sIL-6R) triggered the formation in the presence of IL-6 in cocultures of murine osteoblastic cells and bone marrow cells. In this study, we examined the involvement of sIL-6R and IL-6 in joint destruction in patients with RA. Although the frequency of patients having osteoclast-like multinucleated cells in synovium derived from the knee joint was not significantly different between RA (65%) and osteoarthritis (OA) patients (43%), the number of osteoclast-like cells found in the synovium was greater in the former than in the latter. Multinucleated cells obtained from RA synovium expressed the osteoclast-specific phenotype such as tartrate-resistant acid phosphatase, carbonic anhydrase II, vacuolar proton-ATPase and vitronectin receptors at similar levels to those from a human giant cell tumor of bone. The concentration of both IL-6 and sIL-6R was significantly higher in the synovial fluids from patients with RA than with OA. The concentration of IL-6 and sIL-6R correlated well with the roentgenologic grades of joint destruction. Dose-response curves for human IL-6 and human sIL-6R in inducing osteoclast-like cell formation in cocultures indicated that the RA synovial fluids contained sufficient IL-6 and sIL-6R to induce osteoclastogenesis. When synovial fluids from RA and OA patients were added to the cocultures, some of the RA synovial fluids containing high levels of IL-6 and sIL-6R stimulated osteoclast-like cell formation, which was strikingly inhibited by adding anti-IL-6R antibody simultaneously. These results suggest that IL-6 in the RA synovial fluids is at least in part responsible for joint destruction in the presence of sIL-6R through osteoclastogenesis.
8947005 Hepatic hemorrhage in malignant rheumatoid arthritis. 1996 Dec Intrahepatic hemorrhage is a serious and life-threatening complication in liver disease. We describe a patient who had two episodes of intrahepatic hemorrhage after having malignant rheumatoid arthritis for 8 yr. Abdominal CT scans revealed a large intrahepatic, subcapsular hematoma. Arteriography demonstrated irregularity, caliber change, and pseudoaneurysms of the right hepatic artery, suggesting vasculitis as a cause of the bleeding. The hemorrhage was first treated with transcatheter arterial embolization, which failed to exert long term control, but arterial infusion of a large dose of prednisolone when the hemorrhage appeared was successful in managing it.
8803909 Role of antimalarials in rheumatoid arthritis--the British experience. 1996 Jun Antimalarials have been used to treat rheumatoid arthritis (RA) for over 40 years, the first report of suggestive efficacy being published in 1951. Over the years they have become part of the established treatment of RA being one of a category of drugs referred to as disease modifying anti-rheumatic drugs (DMARDs). The onset of action with antimalarials is slow. Most patients use these drugs in combination with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. This article reviews the evidence for the efficacy of antimalarials, their place in comparison to other DMARDs and comments on the current use in RA as perceived in British rheumatology.
8077820 Measurement of ulnar translation and carpal height. 1994 Jun Ulnar translation, carpal height and carpal collapse are methods of measurement described by Youm, by Chamay and by DiBenedetto. The accuracy of these methods has been statistically examined using 65 normal X-rays. The lines of measurement were correlated with each other and more lines were sought to demonstrate better correlation. The validity of these methods was tested on 40 X-ray films from rheumatoid patients. The greater accuracy of the recommended lines of measurement was confirmed.
8957236 Action of anti-inflammatory drugs on interleukin-1 beta-mediated glucose uptake by synovio 1996 Oct 24 Synovial cell cultures prepared from samples taken from osteoarthritic and rheumatoid patients were treated with different anti-inflammatory agents (cortisol, indomethacin, ibuprofen and piroxicam) to determine their 'anti-interleukin-1 beta' action, using inhibition of interleukin-1 beta-mediated glucose uptake stimulation as a biological test. Confluent cells were treated for 24 h with different concentrations of these drugs (10(-5), 10(-6) and 10(-7) mol/l) to study their effect on the inflammation process. 6 h before glucose uptake studies, interleukin-1 beta (1 ng/ml) was added. Whereas non-steroid anti-inflammatory agents were inefficient, cortisol inhibited the action of interleukin-1 beta on glucose uptake. In osteoarthritic cells, cortisol, 10(-5) mol/l, reduced interleukin-1 beta-mediated glucose uptake by 27% after a 24-h incubation. In rheumatoid cells, stimulated 2-deoxy-D-glucose uptake was reduced by 40.6%. Results were similar when interleukin-1 beta and cortisol were added simultaneously, 6 h before glucose uptake was measured. This rapid effect of cortisol was protein synthesis-dependent (inhibited by cycloheximide). Cortisol decreased glucose uptake by synoviocytes by acting on basal and interleukin-1 beta-mediated glucose uptake. This effect was more pronounced in rheumatoid synovial cells. The inhibition of interleukin-1 beta-mediated glucose uptake could be proposed as a new model for studying the anti-interleukin-1 beta effects of anti-rheumatic drugs.
1417132 Decreased level of antibodies against Helicobacter pylori in patients with rheumatoid arth 1992 Sep BACKGROUND: Sodium aurothiomalate has been reported to have in vitro activity against Helicobacter pylori. Intramuscular gold, as given to patients with rheumatoid arthritis (RA), may therefore influence the colonisation of the gastric mucosa with H pylori. METHODS: Two groups were compared. One group of 42 patients was treated with intramuscular gold; the other group of 58 patients was treated with antimalarial drugs. Antibodies to H pylori (IgA and IgG) were assessed by an enzyme linked immunosorbent assay (ELISA) and total IgA and IgG were measured by nephelometry. RESULTS: IgA and IgG antibody titres against H pylori and total IgA and IgG levels were lower in the patients treated with gold than in the group treated with antimalarial drugs. The ratio of IgA antibodies to H pylori to total IgA antibodies and the ratio of IgG antibodies to H pylori to total IgG antibodies were lower in the group treated with gold. The percentage of seropositivity to H pylori was significantly lower in the group treated with gold than in the group treated with antimalarial drugs for the two IgA antibodies (35 and 55% respectively) and IgG antibodies to H pylori (40 and 65% respectively). CONCLUSIONS: Although this study cannot completely exclude the possibility that a suppressive effect of intramuscular gold on total immunoglobulin production plays a part in the decrease in the titres of IgA antibodies to H pylori and IgG antibodies to H pylori, the lower ratios of antibodies to H pylori to total immunoglobulin antibodies and the lower percentages of seropositivity to H pylori in the group treated with gold suggests that treatment with intramuscular gold decreases H pylori colonisation.
1458789 Decreased interleukin-1 beta levels in plasma from rheumatoid arthritis patients after die 1992 Sep The effects of dietary supplementation with n-3 fatty acids on the level of cytokines and complement activation in plasma from patients with rheumatoid arthritis were examined. Thirty-two patients with active rheumatoid arthritis were included in a 12-week double-blind, randomized study of dietary supplementation with n-3 fatty acids (3.6 g per day) or placebo. The cytokines were measured in plasma before and after treatment with fish oil or placebo. In general, cytokine values at the upper limits of the calculated normal areas were found. The Interleukin-1 beta concentration in plasma was reduced significantly after 12 weeks of dietary supplementation with fish oil (p < 0.03). No significant difference was observed in the placebo group. The tumour necrosis factor alpha activity in plasma did not change significantly (p = 0.167). No significant changes were observed in the degree of complement activation. The clinical status of the patients was improved in the fish oil group, but not in the placebo group, judged by Ritchie's articular index (p < 0.02). We conclude that dietary supplementation with n-3 fatty acids results in significantly reduced plasma IL-1 beta levels in patients with rheumatoid arthritis. Even though the cytokine levels were low, the anti-inflammatory effect of n-3 fatty acids could in part be explained by their ability to decrease cytokine production.
7632087 Ceiling effects of the Health Assessment Questionnaire and its modified version in some am 1995 Jun OBJECTIVE: To examine if the reduced number of items in the modified version of the Health Assessment Questionnaire (MHAQ) concerning difficulty of performing activities of daily living may lead to a reduced ability to detect clinical changes compared with the original HAQ. METHODS: In 56 consecutive ambulatory patients with rheumatoid arthritis, we examined the mean change in clinical and laboratory parameters for those who recorded improved, unchanged, or worse MHAQ scores one year after a baseline assessment. RESULTS: At baseline, about 50% of the patients had an MHAQ score < 0.3 and clustered at the normal end of the scale. Because of a ceiling effect, the MHAQ failed to detect clinical improvement in 18% of the patients. Changes in clinical and laboratory parameters were associated with improved, unchanged, or worse scores with the HAQ but not the MHAQ. CONCLUSION: Although the format of the MHAQ has the advantage of eliciting a 'satisfaction' score, limitations in its sensitivity to detect clinical improvement in patients with relatively little difficulty in activities of daily living may not justify the use of this particular version of shorter questionnaire in certain clinical settings.
8261668 Distribution of glycosylation abnormality among serum IgG subclasses from patients with rh 1994 Jan IgG from patients with rheumatoid arthritis possess significantly fewer galactose residues in its sugar chains. We made an attempt to analyze the distribution of a galactosylation defect among IgG subclasses by immunoassay using PVL, a recently described lectin specific for N-acetylglucosamine (GlcNAc). A distinct difference between RA and normal controls was present in IgG2 (P = 0.0007). A less remarkable but significant difference was seen in IgG1 (P = 0.0118) and in IgG4 (P = 0.022). A significant difference was not observed in IgG3 (P = 0.169). The possible relationship between such a glycosylation abnormality and RF production was discussed.
7849974 Forefoot arthroplasty and changes in plantar foot pressures. 1994 Nov The aim of this study was to determine how effective forefoot arthroplasty is at reducing the pressures under the forefoot. The EMED F pressure measuring system was used. Fifteen patients (23 feet) were included in the study. All patients had foot pressure studies performed before and after surgery. Our results show a significant increase in total pressure and pressure-time integral under the foot after surgery. This increase was most marked under the first metatarsal head region (P < .005). However, the midmetatarsal region showed a slight decrease in pressure, but this was not significant. Symptomatically, 13 patients felt improved by the operation. The results suggest that the procedure is successful because it transfers the pressure to areas better able to tolerate it, rather than reduces the total pressure.
8978965 Y box-binding trans-regulatory nuclear proteins and susceptibility to rheumatoid arthritis 1996 Nov OBJECTIVE: Inappropriately high levels of expression of HLA-DR molecules or their expression on inappropriate cells, e.g. synovial tissue and T cells, may result in an aberrant tissue-destructive immune response and thus cause susceptibility to rheumatoid arthritis (RA). METHODS: Patients and controls were typed for HLA-DR antigens by oligonucleotide typing of PCR-amplified DNA. Trans-regulatory nuclear proteins that bind to the Y box in DRB promotors were examined by the gel-mobility shift assay. RESULTS: We found that the trans-regulatory nuclear protein (NF-Y), which binds to the Y box in DRB promoters and which plays a dominant role on the level of the expression and inducibility of DR genes, was absent in 50% of RA patients but not in healthy individuals (0%). Furthermore, we observed that all patients (100%) either lacked the NF-Y protein and/or carried the disease susceptibility DRB1 gene, which gives the highest relative risk value (RR = 46.6; p < 1.6 x 10(-6)) reported so far for susceptibility to RA. CONCLUSION: The absence of the trans-regulatory nuclear protein that binds to the Y box with an inverted CCAAT motif in DRB promotors and the presence of the DRB1 gene with the amino acid motif QKRAA and QRRAA cause susceptibility to RA.
8761185 Does exposure to immunosuppressive therapy increase the 10 year malignancy and mortality r 1996 Aug Rheumatoid arthritis (RA) is associated with increased mortality and an increased risk of neoplasms of the immune system (NIM). To establish whether immunosuppressive therapy alters these risks, a matched cohort study was conducted. The exposed cohort were 259 RA patients, resident in the UK, who first received immunosuppressive drugs (mainly azathioprine, cyclophosphamide and chlorambucil) between 1979 and 1982. The unexposed cohort were 259 patients matched for age, sex and disease, resident in the USA, who had never received immunosuppressives. Both cohorts had no prior reported malignancies and were followed for 10 yr. There was a small increase in mortality in the exposed compared to the unexposed cohort. Most of the excess deaths were due to malignancy. The relative risk (RR) of developing malignancy [1.5 (95% CI 0.9-2.3)] was lower than the RR of dying from malignancy [4.2 (95% CI 1.7-10.0)]. The RR of developing a NIM in the immunosuppressive-exposed group was 7.0 (95% CI 0.9-56.5). These results may be explained in part by differences in cancer registration and death rates between the UK and the USA. Nevertheless, the results suggest that exposure to immunosuppressive therapy increases the 10 yr malignancy risk in RA, but not mortality from other causes.
1609598 The Souter-Strathclyde elbow replacement in rheumatoid arthritis. 13 patients followed for 1992 Jun 13 Souter-Strathclyde unconstrained elbow prostheses for rheumatoid arthritis were followed for 5 (1-9) years. Pain relief was achieved in all the patients. Flexion-extension was increased by 22 degrees, and pronation/supination by 27 degrees. There were no infections. Three humeral components were radiographically loose, but no patient had any symptoms. One patient sustained a fracture of the distal humeral epicondyle, two patients developed neuropathies and one patient had a postoperative dislocation that needed treatment with an external Hoffman fixator.
7520595 Activation of T cells to peptides that span the 19 kDa protein of Mycobacterium tuberculos 1993 Oct It has been suggested that the cellular immune response to mycobacterial antigens, is implicated in the pathogenicity of inflammatory joint diseases such as rheumatoid arthritis. Therefore, the aim of this study was to identify T-cell epitopes in a series of 20-mer peptides spanning the entire 19-kDa protein of M. tuberculosis. Mononuclear cells obtained from six rheumatoid arthritis (RA) patients, were analyzed for their proliferation to both the 19-kDa containing immunoblot fraction and to the synthetic peptides. Mononuclear cells from three rheumatoid arthritis patients responded in a dose-dependent manner to peptides 1-20, 60-79, 71-90, 82-101, 90-109 and 121-140, whereas the other eight peptides: 11-30, 21-40, 41-60, 50-69, 100-119, 112-131, 131-150 and 140-159 did not stimulate significant proliferative responses in any of the patients tested. These results indicate, for the first time, the presence of dominant epitopes in the cellular immune response to the 19-kDa M. tuberculosis antigen by rheumatoid T cells.
1629836 Chronic syphilitic polyarthritis mimicking systemic lupus erythematosus/rheumatoid arthrit 1992 Feb Syphilitic arthritis has been well characterized but not previously described as the initial presentation of human immunodeficiency virus (HIV) infection. Our patient presented with chronic symmetric polyarthritis and autoimmune abnormalities, including positive rheumatoid factor, antinuclear antibody, dsDNA, and initially negative syphilis serologies. Subsequent investigations revealed HIV seropositivity, depletion of CD4 cells, and strongly positive syphilis serologies. Our patient's arthritis completely resolved with penicillin therapy.
8588120 Aceclofenac in comparison to ketoprofen in the treatment of rheumatoid arthritis. 1995 The efficacy and tolerability of aceclofenac, a new non-steroidal anti-inflammatory drug (NSAID) was compared to that of ketoprofen in a multicentre, double-blind, prospective, randomized study of 3-months duration in patients with rheumatoid arthritis. One hundred and sixty-nine patients, aged between 22 and 70 years, were included in the study. Patients were randomly assigned to two treatment groups; either aceclofenac 100 mg b.i.d. (87 patients) or ketoprofen 50 mg t.i.d. (82 patients). A placebo tablet was administered to aceclofenac-treated patients to maintain the double-blind conditions of the study. Patients were examined at 15 days and at 1, 2 and 3 months. Efficacy was assessed by the following clinical parameters: Ritchie index, pain on a visual analogue scale, grip strength, morning stiffness, spontaneous morning pain, pain on movement and nocturnal pain, together with functional capacity. Efficacy was demonstrated for both drugs, with progressive improvement in the main clinical evaluation parameters until the end of the treatment period. This was particularly pronounced at 15 days in the aceclofenac group, with a rapid improvement in the Ritchie index (baseline vs 15 days: P < 0.001). Laboratory analyses performed were all within the normal range for both drugs. Eleven patients in the ketoprofen group abandoned the study because of inefficacy, whilst only 4 patients discontinued the treatment for this reason in the aceclofenac group. Eleven patients in the ketoprofen group and 2 patients in the aceclofenac group withdrew from the study because of adverse events. In summary, this study demonstrated that aceclofenac, a new NSAID, is effective in the symptomatic treatment of RA with a minor number of patient withdrawals because of inefficacy and a better safety profile than ketoprofen.
8834061 Female hormone therapy and the risk of developing or exacerbating systemic lupus erythemat 1996 Jan Clinical and animal studies suggest a role for female hormones in preventing or ameliorating rheumatoid arthritis and, on the other hand, increasing the risk for systemic lupus erythematosus. However, the body of the epidemiological studies do not support these observations except for one study showing that hormonal replacement therapy increases the risk of developing systemic lupus-erythematosus. Counseling of women on the use of oral contraceptives or postmenopausal hormones should include a discussion of these risks and benefits in addition to the risks of cardiovascular disease, uterine and breast cancer, and osteoporosis.
8202661 Distribution of macrophages in rheumatoid synovial membrane and its association with basic 1994 Rheumatoid arthritis (RA) is an inflammatory disease of the synovial membrane, which results in the destruction of joints by inflammatory pannus. The synovial membrane shows proliferation and cellular infiltrates on microscopy with signs of chronic and acute inflammation. Macrophages are thought to play a central role in the pathogenesis of RA. We examined synovial membrane specimens of 21 RA patients using morphological, immunohistological and enzyme histochemical methods for number and distribution of macrophages. We were able to identify 41.5 +/- 8.8% of lining cells as macrophages, depending on the method used. In abundant diffuse lymphocellular infiltrates, 23.4 +/- 11.1% of mononuclear cells were macrophages. In addition, most cells in the region of tumorlike proliferation and a stromal population of fibroblastlike cells were detected by macrophage markers. Although cell number in synovial membrane increases drastically, we did not find correlations between the relative amount of macrophages in these regions and basic activity. Basic activity includes proliferative reaction as well as lymphoplasmacellular and mononuclear infiltration--both signs of an immunopathological process. In contrast, using enzymes or activation markers, there was a clear correlation. We consider that a constant high percentage of macrophages in RA synovial membrane is present regardless of any actual inflammatory process.