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ID PMID Title PublicationDate abstract
1398356 Long-term follow-up of the Conaxial (Beck-Steffee) total ankle arthroplasty. 1992 Jul Between 1975 and 1977, 30 patients with traumatic arthritis or rheumatoid arthritis underwent 36 Conaxial (Beck-Steffee) ankle replacements (DePuy, Warsaw, IN). Thirty-two were primary replacements and four were revisions of previous ankle arthroplasties. Twelve patients had traumatic osteoarthritis and 18 patients had rheumatoid arthritis. The average age at operation of patients with rheumatoid arthritis was 61 years (range 28-67 years) and with osteoarthritis was 52.9 years (range 32-72 years). The average follow-up was 10.8 years, with a range of 10 to 13 years. Early postoperative complications included wound dehiscence in 39% of patients (14 patients), deep wound infection in 6%, fractures of the medial or lateral malleolus in 22%, and painful talofibular impingement in 14%. At 2-year follow-up, 27% of the ankle replacements were loose. Sixty percent were loose at 5 years and 90% were loose at the 10-year follow-up. Ten patients had implant removal and attempted fusion. Six, or 60%, fused in an average of 5 months. Of those patients who achieved ankle fusion, four had internal fixation and iliac crest autografting, one had a Charnley compression apparatus with allograft bone, and one had internal fixation with allograft bone. The constrained Conaxial ankle replacement should no longer be implanted because of a 90% loosening rate at 10 years and an overall complication rate of 60%.
8048468 Treponematosis and Lyme borreliosis connections: explanation for Tchefuncte disease syndro 1994 Apr A convergence of evidence from macroscopic, radiographic and histologic examination indicates that treponemal infection was present in the 16ST1 Tchefuncte Indian burial population, dated 500 B.C. to 300 A.D. Pattern and nature of lesions suggests that chronic infection induced by variants of the spirochete Treponema pallidum, causing endemic syphilis and/or yaws, resulted in third-stage osseous response. It is suggested that Tchefuncte Indians acquired partial immunity to treponemal infection by exposure to a variant of the related spirochete, Borrelia burgdorferi, the causative agent of Lyme disease. Partial immunity would help explain the relatively mild expression of the treponemal disease process in the 16ST1 skeletal population and the apparent absence of venereal syphilis. Presence of the Borrelia burgdorferi spirochete might be linked to a single incidence of juvenile rheumatoid arthritis.
7492237 Application of markers of collagen metabolism in serum and synovial fluid for assessment o 1995 Nov OBJECTIVE: To assess the potential of markers of collagen metabolism to reflect disease processes in rheumatoid arthritis (RA). METHODS: Serum (S) and synovial fluid (SF) from 59 patients with RA, and a knee joint effusion and serum from 90 control subjects were studied with radioimmunoassays for the aminoterminal propeptides of type I and type III procollagens (PINP and PIIINP, respectively). The breakdown of type I collagen was quantified with a radioimmunoassay for the cross linked carboxyterminal telopeptide of type I collagen (ICTP). RESULTS: About 50% of the patients had increased S-ICTP and S-PIIINP values, whereas S-PINP was increased in only 20% of the patients. The mean SF:S ratios of these markers varied between 4 (for ICTP) and 340 (for PIIINP), indicating that markers of collagen metabolism are formed locally and then released into the circulation. SF-PINP and SF-PIIINP correlated with each other (rs = 0.86, p < 0.001) and with SF-ICTP (rs = 0.69, p < 0.001, and rs = 0.65, p < 0.001, respectively). SF-ICTP was clearly related to radiographic findings in the corresponding knee joint, patients with gross bone deformation having the greatest SF-ICTP concentrations. S-ICTP and S-PIIINP also correlated with conventional markers of disease activity, such as C reactive protein and joint swelling score. CONCLUSION: Markers of collagen metabolism both in serum and synovial fluid can be measured to provide an assessment of disease process in patients with RA. ICTP and PIIINP are the most informative.
7577314 [Allelic variations of DPB1, DQA1, DQB1 and DRB1 and rheumatoid arthritis: further genetic 1995 Jul We used polymerase chain reaction amplification and hybridization with specific oligonucleotides to analyze the distribution of DPB1, DQA1, DQB1, and DRB1 allelic variants in 48 patients with rheumatoid arthritis (RA) and compared our results with those from 109 randomly chosen, healthy control subjects. Our work confirms a previously reported increase in DR4 specificity in RA: in particular, we found a statistically significant positive association of the DRB1*0401 and DRB1*0404 alleles with RA. When we compared the DR4 groups, however, none of the DRB1*04 alleles were increased in the RA group. Molecular analysis of the other DRB1 polymorphic variants disclosed the trend of a positive association of DRB1*0101 (DR1) in DR4 negative patients vs DR4 negative healthy control subjects, and an increase in DRw6 (DRB1*13,*14) in the DR4 and/or DR1 negative patient group. Moreover, analysis of the association between RA and a heptapeptide motif (positions 67-74) in the third hypervariable region confirmed that this epitope confers enhanced risk for the development of RA with respect to the allele DRB1*0404 (etiologic fraction = 0.53 vs 0.12). We also observed a statistically significant increase in DQA1*0301 and DQB1*0302 accompanied by a significant decrease in DQA1*0202, DQA1*0501 and DQB1*0201 in RA patients. Analysis of DPB1 alleles disclosed no significant differences between RA patients and healthy control subjects.
7585093 Positive selection in autoimmunity: abnormal immune responses to a bacterial dnaJ antigeni 1995 May A novel 'multistep molecular mimicry' mechanism for induction of rheumatoid arthritis (RA) by bacterial antigens that activate T lymphocytes previously 'educated' by peptides derived from a class of human histocompatibility antigens is reported here. These antigens have the amino acid sequence QKRAA, which is also present on the Escherichia coli heat-shock protein dnaJ. Synovial fluid cells of early RA patients have strong immune responses to the bacterial antigen, but cells from normal subjects or controls with other autoimmune diseases do not. The activated T cells may cross-react with autologous dnaJ heat-shock proteins that are expressed at synovial sites of inflammation. Our findings may have direct relevance to new strategies for the immune therapy of RA.
20058461 Ossification of the transverse atlantoid ligament in rheumatoid arthritis. 1993 Aug Ossification of the transverse atlantoid ligament (TAL) is rare. A few cases have been reported by Wackenheim and Dietemann and others. Calcification of the TAL has also been seen in calcium pyrophosphate dihydrate deposition disease. It is important to differentiate this condition from traumatic lesions of the dens axis.
8742072 Cytokine production by SV40-transformed adherent synovial cells from rheumatoid arthritis 1996 Jan We examined the mRNA levels for various cytokines, including IL-1 alpha, IL-1 beta, TNF alpha, TGF-beta 1, GM-CSF, IL-6, IL-8, bFGF, PDGF-A, PDGF-B and IL-1ra, and IL-1 beta converting enzyme, and the protein levels of some of these cytokines in 19 SV40-transformed synovial cell clones. Among those tested, the mRNA levels for IL-6, bFGF and PDGF-A in rheumatoid arthritis (RA) cell clones were greater than those in non-RA cell clones. Moreover, except for one osteoarthritis (OA) cell clone, the mRNA levels for IL-8 in RA cell clones were also greater than those in non-RA cell clones. Although the protein levels were not always correlated with the mRNA levels, the exception being the same OA cell clone, the protein levels of cytokines, such as IL-1 alpha, IL-1 beta, IL-6 and IL-8, in RA cell clones were greater than those in non-RA cell clones. TNF-a was not detected in any cells tested at either the mRNA or the protein level. TNF-alpha upregulated the expression of GM-CSF mRNA in both RA cell clones and one OA cell clone, but not in the other OA cell clone or the normal cell clone. Taken together, these SV-40 transformed synovial cell clones retained many of the original characteristics in terms of cytokine production.
8324945 Early clinical studies of IL-2 fusion toxin in patients with severe rheumatoid arthritis a 1993 Mar DAB486IL-2 is the first of a new class of targeted biologicals called fusion toxins. This agent is an interleukin-2 receptor (IL-2R)-targeted cytotoxin which kills activated IL-2R-expressing lymphocytes at 10(-10) M concentrations. Since activated lymphocytes are thought to play a role in many autoimmune conditions, DAB486IL-2 has been evaluated in patients with severe rheumatoid arthritis and recent onset autoimmune insulin-dependent diabetes mellitus. Initial safety, pharmacokinetics and evidence of IL-2R specific cytotoxicity were obtained in patients with IL-2 receptor expressing malignancies; these studies served as a basis for the initiation of an open label phase I/II evaluation of DAB486IL-2 in patients with severe, methotrexate refractory rheumatoid arthritis. This pilot study provided preliminary evidence of acceptable safety at doses which induced meaningful (> 25%) or substantial (> 50%) improvement in 9 of 18 patients who received a mid (130 kU/kg/d) or a high (260 kU/kg/d) dose daily for 5 to 7 days. The most frequent adverse effects were transient hepatic transminase elevation and fever. Although some patients noted a transient increase in joint pain, onset of improvement occurred within 7 to 14 days of initiation of DAB486IL-2. Because of these results, a two-center, double-blind, placebo-controlled trial was conducted from December 1991 to December 1992. Forty-five patients with active severe RA unresponsive to at least 2 DMARDS were randomized to placebo or DAB486IL-2 following a 3 to 4 week washout/run-in period to establish a stable baseline (< 40% fluctuation in swollen and painful, tender joint counts).(ABSTRACT TRUNCATED AT 250 WORDS)
8587071 Evaluation of disease activity in rheumatoid arthritis and other arthritides using 99mtech 1995 May OBJECTIVE: To determine the usefulness of 99mtechnetium (99mTc) immunoglobulin scintigraphy (99mTc IgG) in rheumatoid arthritis (RA) and in other arthritides. METHODS: Scintigraphic scores were compared with the Ritchie index and biochemical variables of disease activity. RESULTS: In RA, scintigraphic scores were reproducible and seemed to perform better than clinical scores. Moreover, the scores of synovial uptake correlated significantly with systemic variables of inflammation. Other inflammatory arthritides also disclosed uptake of 99mTc IgG but noninflammatory joints did not. CONCLUSION: Although nonspecific for RA, 99mTc IgG scintigraphy is a reliable tool to evaluate the degree and extent of joint inflammation.
7944616 Altered Ca2+ signalling in human neutrophils from inflammatory sites. 1994 Jul OBJECTIVES: To determine whether the intracellular store release of Ca2+ in neutrophils from patients with rheumatoid arthritis, other joint disease and active leg ulceration was different from normal neutrophils. METHODS: The release into the cytosol of Ca2+ from stores within individual neutrophils was determined using ratiometric imaging of fura2. The size of the elevated Ca2+ 'cloud' and its concentration were quantified in neutrophils from the circulation of patients with rheumatoid arthritis, other joint diseases, and leg ulcers and from the joints of those with joint disease. RESULTS: In neutrophils isolated from both the synovial fluid of patients with rheumatoid arthritis and other joint conditions, and also arising from leg ulcers, the amount of the cell cytosol occupied by elevated Ca2+ was significantly increased compared with neutrophils from healthy subjects; for neutrophils from rheumatoid, non-rheumatoid joints and leg ulcers p values were 0.0006, < 0.0001, 0.016 respectively (Student's t test). There was also a significant increase in Ca2+ release from circulating neutrophils from patients with rheumatoid arthritis (p = 0.09), but not in circulating neutrophils from patients with leg ulcers or non-rheumatoid joint conditions. CONCLUSIONS: It is proposed that the increased release of free Ca2+ into the cytosol of neutrophil at inflammatory sites results in increased oxidase activation.
8214997 Treatment of rheumatoid arthritis with gammalinolenic acid. 1993 Nov 1 OBJECTIVE: To assess the clinical efficacy and side effects of gammalinolenic acid, a plant-seed-derived essential fatty acid that suppresses inflammation and joint tissue injury in animal models. DESIGN: A randomized, double-blind, placebo-controlled, 24-week trial. SETTING: Rheumatology clinic of a university hospital. PATIENTS: Thirty-seven patients with rheumatoid arthritis and active synovitis. INTERVENTION: Treatment with 1.4 g/d gammalinolenic acid in borage seed oil or cotton seed oil (placebo). MEASUREMENTS: Physicians' and patients' global assessment of disease activity; joint tenderness, joint swelling, morning stiffness, grip strength, and ability to do daily activities. RESULTS: Treatment with gammalinolenic acid resulted in clinically important reduction in the signs and symptoms of disease activity in patients with rheumatoid arthritis (P < 0.05). In contrast, patients given a placebo showed no change or showed worsening of disease. Gammalinolenic acid reduced the number of tender joints by 36%, the tender joint score by 45%, swollen joint count by 28%, and the swollen joint score by 41%, whereas the placebo group did not show significant improvement in any measure. Overall clinical responses (significant change in four measures) were also better in the treatment group (P < 0.05). No patients withdrew from gammalinolenic acid treatment because of adverse reactions. CONCLUSION: Gammalinolenic acid in doses used in this study is a well-tolerated and effective treatment for active rheumatoid arthritis. Gammalinolenic acid is available worldwide as a component of evening primrose and borage seed oils. It is usually taken in far lower doses than used in this trial. It is not approved in the United States for the treatment of any condition and should not be viewed as therapy for any disease. Further controlled studies of its use in rheumatoid arthritis are warranted.
7641517 Iliopsoas bursa of the rheumatoid hip joint. A case report and review of the literature. 1995 May Presented is the case of a 63-year-old woman, with a 30-year history of rheumatoid arthritis, whose hip was completely destroyed and accompanied with enlargement of the iliopsoas bursa. Preoperative diagnosis was confirmed by computed tomography, magnetic resonance (MR) imaging and arthrography. She was treated by resection of the iliopsoas bursa and total prosthetic replacement of the hip joint. The pathogenesis is uncertain. In the literature, enlargement of the iliopsoas bursa with rheumatoid arthritis, osteoarthritis, pigmented villonodular synovitis, and synovial chondromatosis had been reported. Nevertheless, a correct preoperative diagnosis of the enlargement of the iliopsoas bursa is very difficult. MR imaging with enhanced Gadolinium-DTPA (Gd-DTPA) is proposed as the most useful examination for preoperative diagnosis.
8070991 Life change, irrational attitudes and disease impacts in patients with ankylosing spondyli 1993 The present study is concerned with (1) the question whether patients with ankylosing spondylitis (AS) are different from patients with rheumatoid arthritis (RA) reported previously, with respect to the personality trait of irrational attitudes and to disease impacts, and (2) how the socio-psychological variables of life stress and irrational attitudes relate to disease impacts. Subjects were 197 patients with definite AS from a rheumatic treatment center. AS-patients scored lower in irrationality, pain-intensity, sensory pain, pain avoidance and disability than RA-patients but were not different in affective pain and in general health condition. Relations between negative events and avoidance behavior were stronger in AS-patients. The associations between irrationality versus pain intensity, affective pain and disability were lower (but significant) in AS-patients compared to RA. Of equal strength were correlations between irrationality and avoidance as well as general symptoms. Hierarchical regression analyses with disease activity as control variables revealed 2.2% to 7.1% common variance between life stress and disease impacts (affective pain, avoidance behavior, general symptoms). Irrational attitudes explained 8.9% to 18.3% of disease impact variation. The results suggest influences of social and personality variables on suffering of AS-patients and expect these patients to be good treatment candidates-though they seem stable and non-neurotic in their personality.
7981988 Circulating concentrations and production of cytokines and soluble receptors in rheumatoid 1994 Nov Methotrexate (MTX) is an effective treatment for RA and its effects may be partly due to cytokine modulation. Herein, we assessed the effects of a single MTX dose on the production and circulating concentrations of several cytokines and soluble receptors in 42 RA patients on three consecutive days. Three patient groups were studied: (a) 16 patients taking the first MTX dose, (b) 11 patients on chronic MTX treatment and (c) a control group of 15 patients not treated with MTX. Cytokine production was studied in peripheral blood mononuclear cells (PBMNC) and in a whole-blood culture system (WBCS). Group (a) had a more active disease according to laboratory parameters as well as higher circulating IL-6 levels (P = 0.002). The secretion of IL-1 beta by stimulated PBMNC (P = 0.008) was higher in this group and decreased significantly (P = 0.03) after a single MTX dose. No significant change in any parameter was observed after MTX in group (b). In the total patient group, circulating concentrations of IL-1 beta and TNF-alpha were low but blood cells showed a high capacity of production for these cytokines. In contrast for sTNFRs, high circulating levels but a limited in vitro production were observed. In conclusion, a single MTX dose may result in decreased production of IL-1 beta by PBMNC in patients with active RA. Furthermore, we observed an imbalance in the production of TNF-alpha and sTNFRs by peripheral blood cells of RA patients and propose that the WBCS is convenient for studying cytokine production in RA.
8288669 An alternative method for determination of the carpal height ratio. 1994 Jan Radiographs of the wrist often do not include the entire third metacarpal, so the standard method for measurement of the carpal height ratio (the carpal height divided by the length of the third metacarpal) cannot be used. In this study, the ratio of the carpal height relative to the length of the capitate was evaluated for its suitability as a reproducible alternative. The revised carpal height ratio (the carpal height divided by the capitate length) was evaluated for reproducibility and clinical utility in both in vitro and in vivo studies: it was determined from the radiographs of ten cadaveric wrists; those of 100 wrists (fifty pairs) of normal volunteers, made with controlled positioning; those of 100 wrists, drawn at random from radiographs that had been previously interpreted as showing normal findings; and those of fifty wrists of twenty-nine patients who had documented rheumatoid arthritis. The new ratio was found to be constant in the normal population, consistent bilaterally, decreased in patients who had carpal collapse, and reproducible.
8340176 The development of juxta-articular osteoporosis after synovectomy of the knee. A prospecti 1993 In a prospective study 9 patients, who were going to have a synovectomy for rheumatoid arthritis of the knee, underwent dual photon absorptiometry before, and at intervals after, operation. This determined the degree of juxta-articular osteoporosis quantitatively. The density was compared to a control group with normal knees. The follow up measurements showed an improvement in the juxta-articular bone mineral content after the 6th month. This demonstrates that bone densitometry is an objective indicator of the development of juxta-articular osteoporosis in inflammatory joint disease.
1738729 Total ankle joint replacement: a clinical follow up. 1992 Feb The TPR total ankle joint replacement system (Smith & Nephew Richards) was implanted in 30 ankles in 25 patients. Twenty-three ankles in 18 patients were followed; 21 had rheumatoid arthritis and two had osteoarthritis. The average age at surgery was 62 years (range: 37 to 77), and the average follow up was 59 months (range: 37 to 89). The improvement was especially obvious with respect to pain and function. The average walking distance improved from 260 m preoperatively to 975 m postoperatively. Even though there was some improvement with respect to pain and function, the results of the study are disappointing in comparison to studies of ankle arthrodesis.
8091135 A human rheumatoid factor C304 shares VH and VL gene usage with antibodies specific for ub 1994 Sep Analysis of the variable region gene sequences of a human hybridoma rheumatoid factor (RF), derived from a patient with rheumatoid arthritis (RA), revealed the expression of genes from the V lambda I and VH3 families. Specifically, the C304 RF had rearranged the DPL8/Humlv1042 and VH26 germline VL and VH genes, respectively. This gene usage has been observed in the rearrangement of human anti-viral antibodies specific for the herpes group of viruses. This overlap between the autoimmune and anti-viral antibody gene repertoires suggests a possible structural relationship between the immune response directed against ubiquitous pathogens and the induction of RF production.
8907389 Penicillin-resistant Streptococcus pneumoniae keratitis. 1996 Jan Although Streptococcus pneumoniae is usually extremely sensitive to penicillin, recent reports in the nonophthalmic literature indicate a rise in the prevalence of penicillin-resistant pneumococci. We report a case of penicillin-resistant S. pneumoniae keratitis in a 51-year-old woman with severe rheumatoid arthritis. This report is only the second such case in the ophthalmic literature and may indicate the emergence of penicillin-resistant strains of S. pneumoniae as ocular pathogens.
8366804 13C NMR investigation of synovial fluids. 1993 Aug 13C NMR spectra of synovial fluids from 20 patients suffering from rheumatic diseases have been recorded. Structural changes in hyaluronic acid, the main carrier of the viscoelastic properties of synovial fluid, could be observed in the NMR spectra of the native biological fluid. By comparing these spectra with those of purified hyaluronic acid, a rough estimation of the degree of depolymerization of synovial hyaluronic acid was possible. The patients with rheumatoid arthritis appeared to have a lower degree of polymerization compared to patients with osteoarthrosis. Thus, 13C NMR spectroscopy provides useful information about biophysical properties of synovial fluid.