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ID PMID Title PublicationDate abstract
8186453 Zinc aspartate in vivo and in vitro modulation of reactive oxygen species production by hu 1993 Apr The involvement of zinc ions in cell metabolic processes and the immunopathologic consequences of zinc deficiency are well known. We investigated the effect of zinc aspartate upon production of reactive oxygen species (ROS) by monocytes and polymorphonuclear cells isolated from healthy subjects and patients with leukemia and rheumatoid arthritis. The cells were stimulated in vitro with serum-treated zymosan, aggregated IgG, aggregated and opsonized IgG and digitonin. Zinc concentrations of 10(-4)M do not influence the in vitro release of ROS by polymorphonuclears but moderately activate the monocytes. Following treatment with orally administered zinc aspartate, monocytes from leukemia patients reveal an increased capacity to release ROS after in vitro stimulation. In patients with rheumatoid arthritis monocytes usually produce abnormally high ROS amounts after in vitro stimulation; the treatment with zinc aspartate does not induce considerable alterations of this capacity; however a tendency to restore the normal values is manifest.
1471435 The outcome of traditional or comprehensive outpatient care for rheumatoid arthritis (RA). 1992 This work presents results of a quasiexperimental prospective cohort study of the medium-term course of chronic rheumatoid arthritis (RA) under two different conditions of care. During 1984-1986 a total of 262 patients was recruited. All were new referrals to a university outpatient department. 121 came from the city of Hannover, FRG, and were assigned to comprehensive team care (cc) provided by two rheumatologists, a nurse, physician's assistant, occupational therapist, psychologist, and social worker; 141 came from outside Hannover and received care from a physician in training for internal medicine/rheumatology and a nurse, supervised by a senior registrar (TC). The patients in the first group were significantly older (57 vs 51 years), had more active disease (ESR 44 vs 31 mm/h), were more disabled (functional capacity 69 vs 78%), more often lived alone (27 vs 10%) and were more depressed compared with patients in the second group. There were no significant differences in gender (80% female), number of Rome criteria (5.2), and disease duration (6 years) between the two groups. 179 patients were followed for 2 years. There was no demonstrable difference between those who dropped out and those who continued in the study. Patients from both groups showed significant and clinically important improvements in ESR and number of swollen joints, whereas functional capacity and pain intensity did not change. Depression and patients' global self-rating improved only in the CC-group. Analyses adjusting for differences between the two groups were unable to show a different efficacy for either form of care.(ABSTRACT TRUNCATED AT 250 WORDS)
8403585 The significance of enthesopathy as a skeletal phenomenon. 1993 Jul Enthesophytes and enthesopathy, while easy to define, represent a phenomenon of unclear clinical significance. As the high frequency in skeletal populations suggests that enthesopathy may not be disease-specific, the nature of the reaction was assessed in 872 individuals from a representative skeletal population, subdivided into groups characterized by the presence or absence of rheumatoid arthritis, spondyloarthropathy, calcium pyrophosphate deposition disease and diffuse idiopathic skeletal hyperostosis (DISH). Achilles, plantar fascia, patellar and iliac crest entheses were examined for evidence of calcific overgrowth or "erosions." Enthesophytes were found to be a phenomenon of aging in individuals, and unrelated to the presence of inflammatory arthritis or DISH. The frequency increased with age, independent of sex or the site examined, plateauing in frequency after age 60. Enthesophytes in individuals under age 60 were usually unrelated to any underlying disorder. The absence of effect of underlying forms of arthritis on the frequency of enthesophytes at the patellar, Achilles and plantar sites suggests that mechanical factors outweigh the "enthesis calcifying" impact of such disorders as spondyloarthropathy, calcium pyrophosphate deposition disease and DISH. Individuals with rheumatoid arthritis, however, manifested a less severe iliac crest enthesial reaction, in keeping with the minimal reactive new bone formation characteristic of its erosions. Analysis of Achilles, plantar, and patellar enthesial reactions as a function of underlying inflammatory arthritis or DISH also revealed no significant variation with the underlying process. Cortical discontinuity at enthesial sites was a relatively infrequent phenomenon. While calcaneal discontinuities were originally thought to be erosive in nature, these observations suggest the possibility of tendon avulsion injuries.
8016414 Diagnostic arthroscopy in the arthritis patient. 1994 May The arthroscope can play an important diagnostic role in the arthritis patient. The major utility of this procedure is in the patient with unexplained knee pain and swelling or in the patient with an established knee arthritis whose symptoms are disproportionate to radiographic findings or refractory to standard-course medical therapy. Technologic advances have led to the production of smaller instruments, making office-based diagnostic arthroscopy a practical, cost-effective alternative in the evaluation of these patients, and supporting the clinical argument for it as a procedure distinct from conventional arthroscopy. Separate clinical scenarios further subdivide the indications for diagnostic arthroscopy and define potential intra-articular abnormalities that, if found, can justify alterations in or additions to therapeutic plans, including arthroscopically directed tissue resection and modification or application of tissue-modifying agents. The research capabilities of needle arthroscopy are only just beginning to be realized; opportunities now exist for design of prospective clinical trials in which patients are randomized based on intra-articular abnormalities, and for the serial assessment of specific treatment effects on gross, microscopic, and molecular features of target tissue as identified by the arthroscope.
1418183 Re-evaluation of ELISA and latex agglutination test for rheumatoid factor detection in the 1992 Jun An indirect ELISA for the determination of each isotype (IgM, IgG, IgA, IgD, IgE) of rheumatoid factors (RF) was performed with sera obtained from 77 patients with either classical or definite rheumatoid arthritis (RA) and 319 controls, using rabbit IgG as the antigen. The results were compared with those of a commercial latex agglutination test, using denatured human gamma globulin as the antigen for rheumatoid factor determination. At the cut-off level at which positive results were found in less than 5% of normal controls, ELISA for IgM RF determination had sensitivity, specificity, efficiency, positive predictive value and negative predictive value of 46.75%, 98.12%, 88.13%, 85.71%, 88.41%, while those for IgA RF were 46.75%, 93.42%, 84.34%, 63.16%, 87.91% and for IgG RF were 59.74%, 92.16%, 85.86%, 64.78%, 90.46%, respectively. These indices by latex agglutination test were 83.11%, 93.73%, 91.67%, 76.19% and 95.83%, respectively. IgD RF titre greater than or equal to 1:5 was detected in 19/77 RA patients and 4/200 normal controls while IgE RF titre greater than or equal to 1:5 was detected only in 7/77 RA patients. Thus, ELISA did not appear to have any advantage over latex agglutination test for diagnosis of RA.
7858568 [Duration of use of non-steroidal anti-inflammatory agents in patients with rheumatoid art 1994 Dec 15 Many new nonsteroidal antiinflammatory agents are available for the treatment of rheumatoid arthritis. Although they all seem effective and reasonably safe, it is difficult to determine whether some are superior over others under real life conditions of use. Currently available study designs for answering this question were evaluated. Results demonstrated the value of treatment duration as a measure of the efficacy and safety of nonsteroidal antiinflammatory drugs. An earlier retrospective study using treatment duration is described and its results compared with those reported by other investigators. Treatment duration was subjected to survival analysis, and the Cox proportional hazards model was used to adjust for disease severity and concomitant treatments. One hundred sixteen patients with rheumatoid arthritis meeting American College of Rheumatology criteria received 188 courses of nonsteroidal antiinflammatory drugs over the four-year study period. Regardless of the nonsteroidal antiinflammatory agent used, treatment duration was longer in patients receiving steroid therapy, a second-line drug, or a narcotic analgesic. Treatment duration was not influenced by disease severity, the number of nonsteroidal antiinflammatory agents used, the number of previously used second-line drugs, the dosage, or the prescribing physician. Treatment duration was significantly (p < 0.001) longer for naproxen than for the other antiinflammatory agents (sulindac, piroxicam, indomethacin, tolmetin, and ibuprofen). This difference persisted after adjustment for concomitant use of prednisone, second-line drugs, or analgesics. Other studies support our findings, although they found no statistically significant differences, for a number of reasons. In our study, naproxen was used longer than any other nonsteroidal antiinflammatory drug. Continued work is needed to confirm our findings.
7531625 Carbohydrate-mediated recognition of a circulating placental alkaline phosphatase-immunogl 1994 Oct 14 We detected an abnormal alkaline phosphatase (AP) electrophoretically in the serum of a patient with rheumatoid arthritis, who had a macromolecular AP linked with immunoglobulin M (IgM) bearing a kappa light chain. The IgM isolated from the AP-IgM complex in the patient's serum reacted apparently with all of the AP isozymes tested, i.e. those originating in the liver, bone, intestine and placenta, but the alpha-mannosidase-treated IgM from the patient's serum bound to placental AP (PAP) alone. This suggests that untreated IgM recognizes multivalent epitopes of the AP and that the complex of AP with alpha-mannosidase-treated IgM is a specific antibody-antigen complex. In order to investigate further the multivalent binding capacity for the PAP-untreated IgM complex, we prepared a monoclonal antibody (MoAb) against PAP and identified it as an IgM with a kappa light chain. The binding affinities and their circulating half-lives of the synthetic complexes of PAP and respective MoAbs were examined with and without treatment with several glycosidases. The untreated MoAb bearing IgM had binding affinity for all of the AP isozymes tested, while alpha-mannosidase-treated IgM attached only to PAP, the same as the IgM isolated from the PAP-IgM complex in the patient's serum. The circulating clearance of the PAP-IgM complex in rabbits was faster than either component alone. In addition, the PAP-IgM complex treated with alpha-mannosidase was found to have the shortest half-life of all the complexes of PAP and Igs treated with the several glycosidases tested. These results suggest that the formation of the PAP-IgM complex as an enzyme-linked antibody and the clearance of the complex in vivo are dependent on the sugar moieties of the Igs.
8432561 Alpha 1-acid glycoprotein expression in human leukocytes: possible correlation between alp 1993 Feb alpha 1-Acid glycoprotein is an acute-phase reactant that becomes markedly elevated in serum during inflammation and has an immunosuppressive effect on lymphocyte functions. Patients with collagen diseases had significant increases of alpha 1-acid glycoprotein in their serum and on the surface of peripheral leukocytes compared with controls. The levels from patients with rheumatoid arthritis were higher than those from patients with systemic lupus erythematosus, mixed connective tissue disease, and Behçet's disease. In patients with rheumatoid arthritis, the value of serum alpha 1-acid glycoprotein correlated with disease activity. Among leukocyte subpopulations, monocytes showed more alpha 1-acid glycoprotein on their surface than polymorphonuclear leukocytes and lymphocytes. The cell surface expression of alpha 1-acid glycoprotein on cultured monocytes surface peaked after 48 h. Interleukin-1 beta and tumor necrosis factor-alpha stimulated the production of alpha 1-acid glycoprotein RNA message in peripheral blood mononuclear cells over 18-24 h during cell culture. The results show that serum alpha 1-acid glycoprotein reflects systemic disease activity in rheumatoid arthritis. Furthermore, monocytes may serve as a source of production of alpha 1-acid glycoprotein.
8508279 Detection of anti-Ro(SSA) antibodies in autoimmune diseases: comparison of five methods. 1993 Jun Counterimmunoelectrophoresis (CIE), RNA precipitation, ELISA and immunoblotting against cytoplasmic HeLa cell extract (IB-HeLa) and erythrocyte extract (IB-RBC) were applied to detect anti-Ro(SSA) antibodies in 93 sera selected from patients with various autoimmune diseases [47 were anti-Ro(SSA) positive by CIE]. The RNA precipitation assay, which demonstrated the highest sensitivity was selected as the reference method. CIE was found to be reliable with a specificity of 100% and a sensitivity of 89%. ELISA showed a comparable specificity (95%) but somewhat lower sensitivity (72%). Antibodies to 52 or 60 kDa Ro(SSA) proteins by IB-HeLa demonstrated a high specificity (95 and 97% respectively) but a low overall sensitivity (36 and 17% respectively). Anti-Ro(SSA) antibodies to 52, 54 and 60 kDa erythrocyte proteins by IB-RBC, had a variable overall specificity (95, 97 and 57%) and sensitivity (51, 13 and 34%). The anti-52 kDa antibodies detected by IB-HeLa correlated to those found by IB-RBC (P < 0.001) and occurred predominantly in primary Sjögren's syndrome (P < 0.001, sensitivity: 71 and 77%) as well as in sera with anti-Ro(SSA) and anti-La(SSB) antibodies (P < 0.001). These findings confirm that RNA precipitation assay has the highest sensitivity and specificity for anti-Ro(SSA) antibody detection. However, until a more sensitive ELISA is available, CIE because of its reliability appears to be the method of choice. Finally IB-RBC was found to be more sensitive than IB-HeLa for the detection of anti-Ro52 kDa antibodies.
8603539 The effects of the immunosuppressant rapamycin on the growth of rheumatoid arthritis (RA) 1996 Apr RA is a chronic inflammatory disease characterized by mononuclear cell infiltration and the overgrowth of synovial fibroblast. This invasive growth of synovial tissues corresponds with the progressive destruction of articular cartilage and bone. Several immunosuppressive agents, such as cyclophosphamide, cyclosporin A and mizoribine, have been clinically used to control disease progression, though relatively little is known of their effects on rheumatoid synovium. Rapamycin exhibits a strong immunosuppressive activity by acting on T cell signalling pathways. In the present study we examined the effects of rapamycin on the growth of synovial fibroblast isolated from RA patients. Platelet-derived growth factor (PDGF) is a potent growth factor in synovial fibroblasts isolated from RA patients. PDGF and serum stimulation resulted in a rapid phosphorylation of tyrosine and activation of mitogen-activated protein kinase (MAP kinase), 70-kD-S6 kinase (P70S6k) and 90-kD-S6 kinase (P90rsk). Rapamycin, a macrolide immunosuppressant, inhibited completely growth factor-induced synovial fibroblast proliferation and P70S6k activation. In contrast, tyrosine phosphorylation and activation of MAP kinases and P90rsk were not influenced by rapamycin treatment. Our data demonstrate that growth factor-mediated P70S6k activation is closely related to the growth of synovial fibroblast, and suggest the efficacy of rapamycin for controlling synovial hyperplasia in RA.
7676135 [Myasthenia induced by tiopronin in the treatment of rheumatoid arthritis]. 1995 Jan Myasthenia gravis (MG) is a well known side-effect of D-Penicillamine used in the treatment of rheumatoid polyarthritis. Tiopronin is another drug available in France, which can also induce MG. Drug-induced MG are characterized by frequent involvement of facial and oropharyngeal muscles. Moreover, the generalization is scarce and the outcome always quite good. No thymoma is present, anti-acetylcholine receptors antibodies are often highly positive. Furthermore, some HLA phenotypes are most frequently found among patients with drug-induced MG suggesting a genetic predisposition. This observation underlines the interest of careful management of patients treated by tiopronin.
8921919 Clinical assessment of the 1987 American College of Rheumatology criteria for rheumatoid a 1996 The 1987 American College of Rheumatology (ACR) criteria for the classification of rheumatoid arthritis (RA) were clinically assessed. These criteria do not include findings of synovial fluid (SF) analysis and require no exclusion criteria. We have studied sequential patients with arthritis seen in four rheumatology centers in the Philadelphia area. Classifications by the ACR criteria were compared with our clinical diagnoses. Two hundred ninety eight patients were evaluated, 113 with RA and 185 with other diagnoses. Classifications as RA by the ACR criteria corresponded to our clinical diagnosis in 95% of the cases, corroborating the high sensitivity previously reported. However, we found a lower specificity (73%) than that reported (89%). False positive classifications as RA were found in 71% of patients with psoriatic arthritis, 48% of patients with SLE, and 31% of patients with gout. The specificity could be improved to 89% by excluding disorders with obvious distinguishing extraarticular features such as psoriasis or by SF findings of monosodium urate crystals. Awareness of these possible sources of confusion will further increase the teaching and epidemiologic value of these useful simplified criteria.
7682746 [Reactive arthritis associated bacteria as the etiology of undifferentiated oligoarthritis 1993 Jan Undifferentiated oligoarthritis (UOA) resembles clinically reactive arthritis (ReA), but does not fulfill the diagnostic criteria. In 46 patients with UOA, in 16 with ReA, and in 15 with rheumatoid arthritis (RA) the humoral and cellular immune response to the ReA-associated bacteria Chlamydia trachomatis, Yersinia enterocolitica, Shigella flexneri, Salmonella enteritidis, Campylobacter jejuni and Borrelia burgdorferi was investigated in paired samples of synovial fluid and peripheral blood. An antigen-specific lymphocyte proliferation in SF was found in 75% of the ReA and in 39% of UOA patients, but in none with RA. Shigella and Chlamydia in ReA and Yersinia and Chlamydia in UOA were the most frequent stimulating antigens. There was a poor correlation between antigen specific lymphocyte proliferation and specific antibodies. We conclude that these bacteria might have a pathogenetic role, not only in ReA, but also in UOA.
8974860 [Total knee joint replacement with a rotating hinge endoprosthesis in light of late result 1996 Results of 15 total knee replacements with rotating hinge endoprosthesis in 13 rheumatoid patients with an average follow-up of 7 years and 11 months are presented. C.R.S. point scale served to assess results. As to pain, range of motion, stability and alignment good results have been achieved in all cases. Ability to ambulate was diminished due to general condition of rheumatoid patients (8 of them had total hip and/or contralateral total knee replacement). Results of hinge tkr with the same follow-up yielded 33% failures. In conclusion rotating hinge tkr is markedly better than hinge type knee arthroplasty.
7685670 Detection of a circulating form of vascular cell adhesion molecule-1: raised levels in rhe 1993 Jun We have developed a panel of MoAbs against four separate but overlapping epitopes on endothelial cell (EC) vascular cell adhesion molecule-1 (VCAM-1). Two of the MoAbs (1G11 and 1E5) inhibited T cell adhesion to tumour necrosis factor (TNF)-activated EC, whilst two MoAbs (1.4C3 and 6D9) did not. Using these MoAbs we have identified a circulating form of VCAM-1 (cVCAM-1) which has identical epitope distribution to the EC form, and which is able to support the adhesion of the human lymphoblastoid cell line Jurkat J6 by a VLA-4- and VCAM-1-dependent mechanism when immobilized from plasma. cVCAM-1 isolated by immunoaffinity and size-exclusion chromatographies was shown by SDS-PAGE to have an apparent mol. wt of 85-90 kD. Levels of cVCAM-1 were significantly raised (P < 0.001) in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) compared with normal individuals. It is possible that cVCAM-1 may be a useful plasma marker for the diagnosis and management of patients with inflammatory diseases. Furthermore, detection of elevated cVCAM-1 levels may act as a guide to the importance of VCAM-1-dependent cell adhesion in different pathological settings.
7964094 A study of the dynamic relationship of the lumbrical muscles and the carpal tunnel. 1994 Aug The dynamic relationship of the lumbrical muscles to the carpal tunnel was studied in 35 hands in 32 patients and their movement into the tunnel on finger flexion was examined with a view to its use as a diagnostic provocation test in carpal tunnel syndrome.
1424283 IgA rheumatoid factor in mucosal fluids and serum of patients with rheumatoid arthritis: i 1992 Nov In order to gain insight into the production and clinical significance of IgA rheumatoid factor (IgA-RF) in mucosal fluids of patients with rheumatoid arthritis (RA), we examined tear fluid, saliva and serum from 80 patients with RA. Significant correlations were found between IgA-RF levels in tear fluid and saliva (P = 0.002, r = 0.57), saliva and serum (P < 0.001, r = 0.79), and serum and tear fluid (P < 0.001, r = 0.31). No significant correlations were found between total IgA levels in these fluids. Comparison between circulating and mucosal IgA-RF levels after correction for total IgA, revealed that mucosal IgA-RF levels are on average 2.5 times higher than circulating IgA-RF levels. Analysis of IgA-RF specificity showed that lacrimal and salivary IgA-RF reactivity with various IgG subclasses is similar and differs from serum IgA-RF specificity. These results indicate local production of IgA-RF in salivary and lacrimal glands and support the view of a common origin of IgA-RF producing B cells present in mucosal tissues. Mucosal and circulating levels of IgA and IgA-RF were not associated with tests that quantify tear fluid production. This indicates that mucosal and circulating levels of IgA and IgA-RF in patients with RA cannot be regarded as markers for the development of secondary Sjögren's syndrome.
8717285 [Immunohistochemical study of fibrosis and S-100 protein-positive cells in idiopathic pulm 1996 Jan Immunohistochemical methods were used to distinguish idiopathic pulmonary fibrosis (IPF) from interstitial pneumonia associated with rheumatoid arthritis (RA lung). The subjects were six patients with IPF and seven with RA lung, in whom the pathological findings were consistent with usual interstitial pneumonia. Antibodies to vimentin (Vim), alpha-smooth muscle actin (alpha-SMA), and S-100 protein were used for immunohistochemical studies done by the streptavidin-biotin-peroxidase complex method. In fibrosis associated with RA lung, proliferation of both Vim and alpha-SMA-positive myofibroblasts was widely observed, despite pathological findings of honeycombing, usual interstitial pneumonia, and BOOP. Fibrosis in cases of IPF was found to be characterized mainly by Vim-positive fibroblasts, and on occasion was associated with hyperplasia of smooth muscle. Lung tissues from patients with acute exacerbations of RA lung, especially when associated with a BOOP pattern, had many cells positive for S-100 protein. However, such cells were generally hard to find in cases of IPE. Similar results were obtained with regard to the honeycomb pattern in both IPF and RA lung. These findings suggest that IPF and RA lung can be fairly clearly differentiated based on the proliferation of myofibroblasts and on the presence or absence of cells positive for S-100 protein.
8059412 [The von Willebrand factor antigen in patients with rheumatoid arthritis: a method for its 1993 The data are available on concentrations of Willebrand factor antigen (FVIII Ag) in 43 patients with rheumatoid arthritis (RA), 19 patients with livedo vasculitis (LV) and 56 donors. The measurements were made with solid-phase enzyme immunoassay. RA patients were found to display significantly higher concentrations of FVIII Ag (1.88 +/- 0.17 IU/ml) versus donors (1.06 +/- 0.05 IU/ml, p < 0.001) and LV patients (1.08 +/- 0.09 IU/ml, p < 0.001). No significant differences existed between FVIII Ag concentrations in LV patients and donors (p > 0.05). In 12 (28%) out of 43 RA patients FVIII Ag levels rose to 3 standard deviations from the mean in donors. Hyperproduction of FVIII Ag was associated with skin vasculitis symptoms in RA patients (p = 0.0004), more frequent occurrence of antinuclear factor (p = 0.02). Elevated concentrations of FVIII Ag did not relate to other extraarticular RA symptoms and general rheumatic inflammation, X-ray stage, RF titer, cryoglobulins, enhanced ESR, C-reactive protein.
8578950 Urinary excretion of melanocyte metabolites during treatment with chloroquine phosphate. 1995 Jul The antimalarial drug chloroquine is also used in the prevention of photodermatoses and in patients with inflammatory connective diseases. The drug binds strongly to melanin. Melanocytic activity can be studied by analysis of the urinary markers of eumelanin (6-hydroxy-5-methoxyindole-2-carboxylic acid, 6H5MI-2-C) and phaeomelanin (5-S-cysteinyl-dopa, 5-S-CD). To determine whether chloroquine interacts with this activity, we measured the urinary excretion of the two metabolites in 16 patients with either systemic or discoid lupus erythematosus, polymorphic light eruption or rheumatoid arthritis, during a period with and without treatment with chloroquine phosphate. Two control groups consisting of 7 untreated patients and 10 healthy subjects were also included in the study. During medication, there was a significant increase in 5-S-CD excretion, while the excretion of 6H5MI-2-C was not significantly affected. No significant changes in the excretion of any of the two urinary markers were found in the untreated patients, while a non-significant increase in 5-S-CD excretion was seen in the healthy controls at the follow-up.