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ID PMID Title PublicationDate abstract
1411673 Radiologic manifestations of rheumatic joint diseases in the plain radiograph. 1992 Aug In the assessment of radiologic manifestations of joint diseases, rheumatoid arthritis (RA) is the disease to which all others are compared. Knowledge of its characteristics form the basis of the other conditions. To understand the changes seen on the plain radiograph, it is essential to understand its pathophysiology first so that the manifestations of each disease can be appreciated more fully. Due to space constraint, I shall only discuss the main forms of rheumatic joint disease. Other examples of erosive arthropathies, although not rheumatic in origin, will also be included as they form part of the differential diagnosis of an erosive arthropathy, eg gout and psoriasis.
1393371 Influence of steroid hormones on proliferation of peripheral blood mononuclear cells in pa 1992 Oct Sex steroids are believed to modulate the immune system in rheumatoid arthritis (RA). Since receptors for sex steroids are present on T-lymphocytes, which are thought to play a major role in the pathogenesis of RA, it is suggested that gonadal steroids can mediate their immunomodulating effect directly on T-lymphocytes. Recently a specific method for activating T-lymphocytes with immobilized anti-CD3 monoclonal antibodies was described. We investigated the influence of oestradiol, progesterone, testosterone and cortisol on lymphocytes stimulated by anti-CD3 mAb and PHA of postmenopausal women, comparing female patients with rheumatoid arthritis and age-matched control patients. The results show that oestradiol, progesterone and testosterone do not influence lymphocyte proliferation when stimulated with anti-CD3 mAb or phytohaemagglutinin (PHA). Cortisol, however, can suppress lymphocyte proliferation even at physiological concentrations in both patients with RA and controls. Inhibition of proliferation by cortisol is dose-related and has no significant correlation with RA disease activity. This inhibition differs individually and might explain the often variable response to corticosteroids in vivo.
9035781 [Backache in East and West Germany]. 1996 Oct On the basis of data of the East German Health Survey (1991/92) and regional studies from West Germany (Bad Säckingen 1990, Lübeck 1991/92, Bad Säkingen 1993/94) results on the prevalence of back pain, other rheumatic complaints and general health problems are compared. East German respondents report on back pain and all other rheumatic complaints definitely less often than West German respondents but suffer equally from general health complaints. Apart from the differences in the prevalence of rheumatic complaints there are remarkable structural analogies between East Germany and the West German cities. In any region, the back is the most often affected part of the body, followed by the neck, the shoulder, and the knee. Beyond that, there are similar age-related and sex-specific differences in prevalence rates of rheumatic complaints. In the groups of elderly people, a pattern of declining or constant prevalence rates can be noticed with many complaints. However, there are differences in pain intensity and functional limitations between East and West. The East German respondents particularly mention mild pain more rarely than respondents of the West German cities. They also report fewer functional limitations. This may indicate that in East Germany people attach less importance to rheumatic pain and deal with it in a different way. Possibly, the differences in prevalence can be explained thereby. To what extent they reflect real differences in morbidity cannot be clarified by the present data.
8568057 Social support: how does it really work? 1995 Nov This study examines social support effect on stress and adaptation through the mediating effect of control. Participants in the study were 12 male and 65 female rheumatoid arthritis patients who were being treated in the outpatient clinics of three large hospitals in Israel. Findings suggest that social support did have a significant effect on stress and adaptation, though this effect was through the mediating effect of control and not as a buffer as was suggested previously. Implications of the results for nursing science are discussed.
7679634 Recurring bacterial infection in a teenager: an Ethiopian case of common variable immunode 1993 Jan A case of common variable immunodeficiency observed in an Ethiopian 13 year old girl who, from the age of 9 months, suffered from repeated, severe bacterial infections, but overcame viral infections normally, is reported. The immune defect bore upon the terminal stage of the differentiation of the B-lymphocytes, whose number was normal but which were unable to synthesize immunoglobulin in vitro. Replacement therapy with gammaglobulins controlled infection. The differential diagnosis of recurrent bacterial infection in the tropical context and means of early diagnosis are discussed.
8546532 Predominance of HLA-DRB1*0405 in Korean patients with rheumatoid arthritis. 1995 Dec OBJECTIVE: To identify the association of HLA-DR4 subtypes with rheumatoid arthritis (RA) in Koreans. METHODS: Ninety five patients with RA and 118 normal control subjects were examined for HLA-DR antigens by serology. Subtypes of HLA-DR4 were determined by allele specific oligonucleotide typing. RESULTS: The phenotype frequency of HLA-DR4 in RA patients was significantly greater than that in controls (60.0% versus 31.4%, odds ratio (OR) 3.28, 95% confidence interval (CI) 1.79 to 6.02 (p < 0.001)), but HLA-DR6 was decreased in RA patients (15.8% versus 32.2%, OR 0.39, 95% CI 0.19 to 0.81 (p < 0.001)). When DR4 was excluded from analysis of patients and controls, the allele frequency of DR1 was significantly increased in the patients compared with controls (11.3% versus 4.5%, OR 2.73, 95% CI 0.87 to 5.95 (p < 0.001)). Forty two of 57 DR4 positive patients (73.7%) possessed DRB1*0405, which was strongly associated with RA (44.2% of patients, versus 11.9% of controls: OR 5.88, 95% CI 2.81 to 12.47 (p < 0.001)). DRB1*0403 was not found in the patients, but was present in 8.5% of controls. Examining the third hyper-variable region at position 70-74 in the DRB1*04 chain by oligotyping, we found that 52 of 57 DR4 positive patients (91.2%) carried one of the conserved amino acid sequences QRRAA or QKRAA, known to be the epitope conferring predisposition to RA. CONCLUSION: This study confirms that RA is strongly associated with DR4, especially with DRB1*0405, and that the presence of the inferred QRRAA sequence may be important in susceptibility to RA in Koreans.
8181523 The biased V gamma gene usage in the synovial fluid of patients with rheumatoid arthritis. 1994 May Taking advantage of the reverse transcriptase-polymerase chain reaction (RT-PCR), we have analyzed T cell receptor gamma-chain mRNA of synovial fluid gamma/delta T cells from patients with rheumatoid arthritis (RA) in comparison with those of peripheral blood mononuclear cells (PBMC) from RA patients and healthy individuals. The quantitative RT-PCR method in conjunction with nucleotide sequencing revealed the frequent usage of the V gamma 3 gene segment in RA synovial fluid mononuclear cells (SFMC) (p < 0.01) which in PBMC of healthy individuals occurred rarely. PBMC of most healthy individuals expressed the V gamma 9 gene predominantly (p < 0.01) as expected. However, only half of RA patients showed elevated levels of the V gamma 9 gene expression in their PBMC. The gamma-chain mRNA containing the V gamma 3 gene in RA SFMC showed no conserved junctional sequence (complementarity-determining region 3). To investigate the nature of ligands recognized by the V gamma 3-bearing T cells, we analyzed V gamma gene usage of RA SFMC, RA PBMC, and normal PBMC stimulated with Mycobacterium tuberculosis (MT) or MT plus interleukin-2 since there is mounting evidence of high reactivity of RA SFMC to MT and mycobacterial heat-shock protein 65. However, the V gamma usage appeared to be mostly V gamma 9 in RA SFMC, RA PBMC and normal PBMC. Taken together these results suggest that an as yet unknown antigen(s) (other than MT) might select gamma/delta T cells expressing the V gamma 3 gene in RA SFMC.
8503395 Atypical arthropathy associated with Crohn's disease. 1993 Jun Inflammatory bowel disease may be associated with a variety of rheumatologic abnormalities. The patterns of described enteropathic arthritis, not associated with the HLA B27 antigen, include non-deforming peripheral arthritis, bilateral, symmetric sacroiliitis, an on occasion, destructive monoarthritis. We report three patients with Crohn's disease and patterns of joint disease that have not been previously described. The patients ranged in age from 16 to 31 yr. In all cases, both joint and bowel disease were present since childhood. Antinuclear antibody, rheumatoid factor, and HLA B27 antigen determinations were negative. The distribution and pattern of joint disease were similar to that seen in rheumatoid arthritis. We propose that these cases do not represent coincident rheumatoid arthritis and Crohn's disease, but, rather, atypical manifestations of enteropathic arthritis.
8187433 Chronic interstitial cystitis occurring during the shift between rheumatoid arthritis and 1994 Mar This case reports documents the progressive development of chronic interstitial cystitis during the overlapping process from rheumatoid arthritis to lupus. Concomitantly high titer antinuclear antibody with an anti-68 KD RNP pattern and other biological markers of lupus were observed in the blood. The symptoms dramatically improved under methotrexate therapy. The pathogenic mechanism is discussed.
8055856 Cognitive distortion, helplessness, and depressed mood in rheumatoid arthritis: a four-yea 1994 May Cognitive models of depression have been invoked to explain the development of depressive symptoms and disorders in patients with chronic pain. However, few long-term, prospective studies have examined A. T. Beck's (1967, 1987) model in this context. Seventy-two patients with rheumatoid arthritis completed the Beck Depression Inventory, the Cognitive Errors Questionnaire, and the Arthritis Helplessness Index during an initial assessment and again 4 years later. Initial levels of cognitive distortion were significantly related to follow-up levels of depressed mood, controlling for initial depression levels. This was also true for perceptions of helplessness. In contrast, initial depression levels did not predict changes in these cognitive processes. These results suggest that cognitive distortion and helplessness contribute to depressed mood among patients with arthritis.
8222414 Use of a Herbert screw for interphalangeal joint arthrodesis. 1993 Nov Fifty-one Herbert-screw fixation procedures were performed for interphalangeal fusion in the hand. The preoperative diagnoses included rheumatoid arthritis, degenerative arthritis, posttraumatic arthritis, and chronic mallet finger. All patients were observed until there was clinical and radiographic evidence of union. Solid osseous union occurred in all patients. Herbert screw fixation for interphalangeal arthrodesis was a simple, effective technique permitting early mobilization; complications were minimal.
8337198 Psychological reactions in patients with early rheumatoid arthritis. 1993 May We report the interaction of RA and psychological factors over 2 years in a group of 89 patients with newly established disease. Short-time outcome regarding physical features was fairly good. Disease activity decreased, and disability evaluated by HAQ remained at a low level. Psychological distress as measured by the depression and anxiety subscales of SCL 90 (Symptom Check List) was not very pronounced and not related to disease state factors. A slight decrease of anxiety was recorded after 2 years. A new adjustment test was applied. It contained 13 items focused mainly on negative illness effects such as loss of independence, feelings of guilt, and change of social and leisure time activities. Three factors (regret of lost life values, dysphoric mood, and acceptance) explained 48% of the variance of the 13 items. The validity of the test was acceptable. The patients' degree of adjustment changed slowly or not at all during the 2 years.
8245994 Total knee arthroplasty in patellectomized patients. 1993 Oct Thirty-two total knee arthroplasties (TKAs) in patellectomized patients were evaluated with recent clinical and radiographic examinations. Eighteen patients had a primary TKA with a mean follow-up period of 49 months, and 14 patients had a revision TKA with a mean follow-up period of 36 months. A control group of 13 TKA patients with intact patellae were randomly generated but matched for age, sex, follow-up data, diagnosis, and prosthesis. Posterior cruciate ligament-retaining types of prostheses were used in the primary knees, while the revision knees underwent arthroplasties with the more constrained, posterior cruciate ligament-substituting prostheses. All knees were evaluated based on the Knee Society's clinical and radiographic scoring system. In addition, 18 patients (9 primary, 9 revision) underwent isokinetic dynamometer testing for quantitation of peak quadriceps and hamstring torque. The knee score, indicative of pain relief, averaged 82.5 in the primary group (16 good/excellent, 1 fair, 1 poor), 86.5 in the revision group (12 good/excellent, 1 fair, 1 poor), and 93.9 in the control group (13/13 excellent). The function score averaged 59.7 in the primary group (6 good/excellent, 6 fair, 6 poor), 60.0 in the revision group (5 good/excellent, 2 fair, 7 poor), and 80.9 in the control group (12 good/excellent, 1 fair). The lower function scores predominantly reflected the patients' difficulty in independently climbing or descending stairs. This was also reflected in their higher flexion to extension peak torque ratios. There was one failure in the primary group requiring a revision and one failure in the revision group requiring a knee fusion. There was no radiographic evidence of impending failure in any of the remaining knees. No clinical or radiographic differences were found between the patients with osteoarthritis or rheumatoid arthritis. Although the knee and function scores were lower in the patellectomized patients, the overall results were generally satisfactory without a high incidence of failures. Satisfactory results were obtained in the primary TKAs using the minimally constrained prostheses when the posterior cruciate ligament was intact. Revision TKAs, in which the posterior cruciate ligament was absent, also demonstrated satisfactory results with the more constrained, posterior cruciate ligament-substituting prostheses.
7965373 [Tonsillectomy and osteoarthritic disease]. 1994 Sep We investigated the clinical outcome of tonsillectomy in 89 cases out of 100 cases of sternocostoclavicular hyperosteosis (SCCH) and 18 cases of rheumatoid arthritis (RA) who went through the operation more than 3 months before in our hospital between April 1984 and May 1993. The effect of tonsillectomy was associated with a decrease in the degree of pain. The symptom improvement was defined as a degree of pain less than 50% of the pre-operative level. The rates of improvement were 80.9% (72/89) in SCCH and 66.7% (12/18) in RA, whole 79% of SCCH patients had pustulosis palmaris et plantaris, a known focal infection of the tonsil. Eight of nine (88.9%) patients and eleven of 13 (84.6%) patients who were positive for the tonsillar provocation test and the annulation test, respectively, showed improved SCCH postoperatively. These results suggest that focal infection of the tonsil may be one of the etiologies of SCCH and RA.
8452764 Clinical trials in rheumatology. 1993 Mar The randomized controlled trial continues to be the standard for evaluating the clinical utility of new procedures or treatments. The randomized controlled trial seems to affect the clinical practice of physicians. Although the design of the randomized controlled trial is well described, consideration should be given to the questions asked and whether the trial is conducted and analyzed so that the questions can be answered. Comparative trials have become more frequent than placebo trials in the past decade, and clinical research financing is falling increasingly to the pharmaceutical industry. Process and outcome measures are receiving more attention. Various groups and committees are evaluating disease activity measures to delineate a small number that can become core or foundation measures. These measures are also being defined and standardized. The process is much further advanced for rheumatoid arthritis than for other diseases, and some common and perhaps "mundane" disease states are being neglected.
8882029 Diminished autonomic nervous system responsiveness in rheumatoid arthritis of recent onset 1996 Feb OBJECTIVE: To investigate responsiveness of the autonomic nervous system in rheumatoid arthritis (RA) of recent onset. METHODS: 21 patients (17 women, mean age 55.7 years) and 20 healthy controls (16 women, mean age 52.7 years) were subjected to 4 tasks eliciting divergent autonomic reactions: film watching, mild physical exercise, cognitive discrimination, and the Stroop color-word interference test. Changes in heart rate, diastolic (DBP) and systolic (SBP) blood pressure, and skin conductance relative to pretask baseline values were computed and related to erythrocyte sedimentation rate, pain, mobility, and dexterity. RESULTS: Mean autonomic levels of patients were normal, as well as autonomic responses to film watching and mild physical exercise. Diminished autonomic responses were observed during cognitive discrimination and during the Stroop test. Blood pressure responses were negatively related to pain severity, but positively to impaired dexterity. CONCLUSION: Diminished autonomic nervous system response is observed in RA of recent onset, most clearly in patients with more severe pain. This suggests that it is associated with primary pathophysiological mechanisms.
8646432 Expression of the multidrug resistance glycoprotein 170 in the peripheral blood lymphocyte 1996 May The objective was to evaluate the expression of the multidrug resistance P-glycoprotein (P-gp) in peripheral blood lymphocytes (PBL) of patients with rheumatoid arthritis (RA). PBL from 68 RA patients and 44 controls were evaluated. RA patients had a mean disease duration of 10.7 yr, with a mean number of past resistances to DMARDs of 0.82, and were treated with NSAIDs (n = 34), DMARDs (n = 25) and prednisolone (n = 40). Fluorescence flow cytometry was used to assess P-gp membrane expression on PBL. In the RA group, the percentage of PBL expressing P-gp was higher in patients treated with prednisolone than in other patients [mean +/- S.D.: 10.7 +/- 15.8% vs 3.3 +/- 7.6%, P < 0.03, Student] and was not related to other therapies, age, sex, RA duration, number of past resistances to DMARDs, activity, ESR, CRP. The percentage of PBL expressing P-gp did not differ in RA and control groups, but was higher in the prednisolone-treated RA patients than in controls. Prednisolone could induce a rise in the percentage of PBL expressing P-gp. On the contrary, patients with a high percentage of PBL expressing P-gp could be more resistant to DMARDs and need prednisolone earlier. Further studies are needed to address this question and to evaluate the potential implication of P-gp in drug resistance in RA.
7799340 Cyclosporine in common clinical practice: an estimation of the benefit/risk ratio in patie 1994 Sep OBJECTIVE: To investigate in common clinical practice the toxicity/efficacy ratio of low dose cyclosporine A (CsA) in patients with advanced rheumatoid arthritis (RA) after 12 months CsA administration. METHODS: One hundred and two patients with RA were included in the study. The initial dose of CsA was 2.5 mg/kg/day, the mean maximum dose was 3.2 mg/kg/day and the dose at 12 months was 2.8 mg/kg/day. RESULTS: Sixty-nine (68%) patients completed 12 months of treatment. Seventeen (17%) patients discontinued for lack of efficacy and 16 (16%) for toxicity (of which 50% for gastrointestinal intolerance). The clinical efficacy variables improved significantly by 36-42% between entry and Month 6 and remained stable thereafter. The C-reactive protein decreased from 43 U/ml at entry to 22 U/ml (p < 0.0001) at 12 months. Forty-four percent of the patients and 47% of the physicians judged the efficacy as good or very good. The median number of adverse events/patient was 3 but most adverse events were either not clinically important or disappeared after dose reduction. Gastrointestinal (GI) intolerance and nephrotoxicity (> 30% increase in serum creatinine) each occurred in 50% of the patients. GI intolerance was transient in 80% of the patients but accounted for 50% of the premature discontinuations for toxicity. Nephrotoxicity persisted in the 50% of the patients in whom it occurred, despite dose reduction. The mean serum creatinine rose from 70 (13) mumol/l at entry to 86 (23) mumol/l at 12 months (23% increase; p < 0.0001), and this increase had been entirely reached after 3 months. Variables that could significantly predict the occurrence of nephrotoxicity could not be identified. CONCLUSION: CsA can be safely and effectively administered to patients with RA for a duration of at least 12 months. An acceptable renal function at entry, close monitoring of the serum creatinine concentration and dose reductions when appropriate are prerequisities.
8012142 [Diagnosis of keratoconjunctivitis sicca in rheumatoid arthritis. The value of various tes 1994 Apr In this study we examined 85 patients in the range of 25 to 60 years with rheumatoid arthritis (RA) and a control group of 35 persons without any systemic diseases. The 85 patients with RA were split into two groups: first group was made up of 32 patients with keratoconjunctivitis sicca (KCS) and the second of 53 patients without KCS. The aim was to decide whether the simple ocular ferning test has more diagnostic value than the "classical" tests: break-up time (BUT), Schirmer-1-test and concentration of lysozyme in the tear fluid. Therefore, we compared the tests with reference to sensitivity, specificity and prognostic value in the three groups. The results of the ocular ferning test are markedly better than the results of the other tests: sensitivity is 82.2%, specificity 92.5% and prognostic value 86.6%. The corresponding values are: BUT: 51.6%-77.8%-63.1%; Schirmer-1-test: 34.4%-90.8%-73.5%, lysozyme concentration: 73.4%-51.0%-52.7%. The ocular ferning test is an easy, practical, cheap, and reliable completion to the conventional tests; it is also easy on the patients.
8054251 Methotrexate disposition following concomitant administration of ketoprofen, piroxicam and 1994 May The effects of three non-steroidal anti-inflammatory drugs (NSAIDs) on the pharmacokinetics of methotrexate were studied in 10 patients with rheumatoid arthritis. Ketoprofen (3 mg kg-1 day-1), flurbiprofen (3 mg kg-1 day-1), piroxicam (20 mg day-1), or a non-NSAID control (paracetamol/acetaminophen) were administered to patients for at least 6 days (13 days in the case of piroxicam to establish steady state) in a randomized crossover design prior to receiving a weekly oral dose of methotrexate. In the non-NSAID control portion of the study, MTX oral clearance (CLo) was 11.0 +/- 3.9 l h-1, renal clearance (CLR) was 7.9 +/- 2.8 l h-1, percent excreted unchanged was 72 +2- 19% and fraction unbound (fu) was 0.54 +/- 0.11. Values of oral clearance, renal clearance, fraction unbound and percentage excreted unchanged of methotrexate varied no more than 12.2% from non-NSAID control during concomitant administration of ketoprofen, flurbiprofen or piroxicam and were not statistically different from non-NSAID control. In contrast to other NSAIDs such as ibuprofen and salicylates, ketoprofen, flurbiprofen or piroxicam in clinically relevant doses do not appear to affect methotrexate disposition and may be used safely in combination with methotrexate.