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ID PMID Title PublicationDate abstract
7698000 MRI of the knee: a simplified approach. 1995 Jan Magnetic resonance imaging (MRI) of the knee is the most frequently performed musculoskeletal MRI examination and, after initial study with plain radiographs, has supplanted arthrography and arthroscopy as the imaging procedure of choice in the investigation of internal derangement and arthritic disorders of the knee. Knee MRI is a highly accurate, noninvasive procedure that provides exquisite depiction of the soft tissues and bone marrow. In this article a simplified approach to knee MRI is presented, including a practical discussion on the basics of MRI physics, review of the normal anatomy, and illustration of the most commonly encountered pathologic conditions.
7914408 Evidence of a local intestinal immunomodulatory effect of sulfasalazine in rheumatoid arth 1994 Aug OBJECTIVE: To analyze whether the intestinal mucosa in rheumatoid arthritis (RA) is immunologically abnormal and whether sulfasalazine (SSZ) possesses any local intestinal immunoregulatory effect. METHODS: Lymphocyte subpopulations and HLA-DR expression were evaluated in biopsy specimens from the duodenal-jejunal mucosa and in peripheral blood samples obtained from 17 patients with RA, both before and after 16 weeks of SSZ treatment. The same mucosal assays were also performed in 7 controls. RESULTS: The mucosa of the small intestine in RA patients showed no differences in morphology, HLA-DR expression, or the amounts and distribution of CD3+, CD4+, CD8+, and gamma/delta + lymphocytes compared with the control group. However, there was a reduction in mucosal CD3+ and gamma/delta + lymphocyte numbers after SSZ therapy, which did not correspond to a change in peripheral blood CD3+ lymphocyte number. SSZ treatment also tended to diminish the peripheral blood CD4+:CD8+ cell ratio (P = 0.05). CONCLUSION: No signs of inflammation or immunologic abnormalities were seen in RA duodenal-jejunal mucosa. In this part of the intestine, however, SSZ exerted immunoregulatory effects that were not encountered in the peripheral blood.
8343182 Antineutrophil cytoplasmic antibodies in rheumatoid arthritis. Characterization and clinic 1993 Aug OBJECTIVE: To study the prevalence, interrelationships, and target antigens of antineutrophil cytoplasmic antibodies (ANCA) in rheumatoid arthritis (RA) and to relate their presence to disease duration and to the occurrence of extraarticular manifestations, including vasculitis. METHODS: Sera from 94 patients with RA (31 with recent-onset disease, 35 with longstanding disease but without extraarticular manifestations, and 28 with extraarticular disease) were studied for the presence of ANCA by indirect immunofluorescence. All sera were tested by enzyme-linked immunosorbent assay (ELISA) for the presence of antibodies to proteinase 3, myeloperoxidase (MPO), elastase, lactoferrin (LF), and cathepsin G (CG), and by Western blotting for antibodies to neutrophil proteins. RESULTS: Seventy percent of the 94 sera showed staining of the nuclei of ethanol-fixed neutrophils; 32% of the 94 were proven to have ANCA, as manifested by their cytoplasmic staining pattern on paraformaldehyde-fixed neutrophils. In the ELISA, 19 sera reacted with LF, 1 with MPO, and 1 with CG. By Western blotting, 21 sera reacted with LF, and 15 reacted with previously unknown polypeptides (7 sera with a 67/66-kd doublet and 8 with a 63/54-kd doublet). Neither of these antibodies was associated with a particular subset of the disease, but the prevalence of the antibodies tended to increase among patients with longstanding disease. CONCLUSION: ANCA in RA patients are directed toward diverse cytoplasmic antigens of the neutrophil, in particular, LF and other, not yet fully characterized polypeptides. The antibodies are not a marker for a disease subset, but are probably a corollary of chronic inflammation.
8346464 [Terminal phalangeal osteosclerosis in rheumatoid arthritis]. 1993 Jun OBJECTIVE: Osteosclerosis of the terminal phalanges of the hand has been reported in the collagen diseases including rheumatoid arthritis (RA). The current study was made to clarify the significance of terminal phalangeal osteosclerosis in RA. METHODS: Hand x-ray films of 108 patients (male 13, female 95) with RA for more than 10 years were assessed by Halim's grading. Grade 2, (Distance between both cortices is < 1 mm but there is still an intermediate space discernible), and grade 3, (Complete fusion of both cortices, but the base of the terminal phalanx is open), were classified as the positive group. Grades 0 and 1 were classified as the negative group. Both groups were compared and sigma GS/D values was measured at terminal phalanges, middle phalanges and metacarpuses of right middle fingers using digital image processing method. sigma GS/D index was calculated as being equal to the ratio of sigma GS/D value of the terminal or middle phalanx to sigma GS/D value of the metacarpus. RESULTS: Thirty cases (28%) were positive (male 1, female 29). Osteosclerosis of terminal phalanges usually appeared in more than two digits bilaterally. It was located as follows; thumb-1 case, index-13 cases, middle-24 cases, ring-51 cases, little-58 cases. Obliteration of the medullary space of middle phalanges was seen in 5 cases. No difference was observed between the positive and negative groups about sex, age, the mean value of C-reactive protein, the incidence of Steinblocker's class classification and the rate of seropositive patients. Osteosclerosis of terminal phalanges was observed at first consultation in 93% of positive cases. Osteosclerosis is expected to appear in the early phase of RA and to last for more than 10 years. sigma GS/D index of the positive group (1.03 +/- 0.24, mean +/- SD) was greater than that of the negative group (0.63 +/- 0.25) (p < 0.05).
1473875 Serum and synovial fluid osteocalcin in rheumatic diseases. 1992 The mechanisms involved in juxta-articular bone destruction are poorly understood. Osteocalcin or gamma-carboxyglutamic acid (GLA) protein is a small non-collagenous bone protein. It is a sensitive marker of osteoblastic bone formation. Its seric variations in the serum in such rheumatisms as rheumatoid arthritis remain unclear. Further information on local osteoblastic activity may be obtained by assaying the level of osteocalcin in the synovium. Its serum level can be evaluated by radioimmunoassay. The same method can be used in the synovial fluid. Paired serum and synovial fluid samples have been assayed from 63 patients, 33 patients with inflammatory arthritis (rheumatoid arthritis, psoriasis, chondrocalcinosis, pyogenic arthritis) and 30 patients with mechanical joint effusion (osteoarthritis, meniscal lesions). Serum levels of osteocalcin were the same in the inflammatory group (m: 8.69 +/- 0.68 ng/ml) and in the mechanical group (m: 10.2 +/- 0.67 ng/ml). In the synovial fluid, the levels of osteocalcin were significantly lower in the inflammatory group (m: 3.27 +/- 0.40 ng/ml) than in the mechanical group (m: 6.91 +/- 0.47 ng/ml). The same results were obtained with the ratio of synovial fluid osteocalcin on serum osteocalcin. There was a significant correlation between serum and synovial fluid osteocalcin and an inverse correlation between synovial fluid osteocalcin and the number of synovial fluid cells. The present study suggests that periarticular osteoblastic depression, among patients with inflammatory arthritis, is likely.
8720265 [Comparison between the arthroscopic and open synovectomies for rheumatoid knee--a retrosp 1995 Dec Knee joints affected by rheumatoid arthritis (RA) were randomized to either arthroscopic or open synovectomy, and the postoperative results were compared retrospectively. The materials consisted of 58 patients with 75 surgically treated knees. Arthroscopic synovectomy was performed on 37 knees of 30 patients, who were followed for five years and four months on average. Open synovectomy was performed on 38 knees of 28 patients, who were followed for five years and five months on average. The results were evaluated for ; recurrence of synovitis ; duration of the symptom-free period ; progressive bone changes on radiography ; range of motion (ROM) ; duration of hospital stay ; duration of surgery. Due to the less invasive surgical procedure, arthroscopic synovectomy resulted in less post operative pain, and there was no restriction of ROM after surgery, no need for postoperative rehabilitation, shorter hospital stay, lower incidence of osteoarthritic changes, and earlier return to the daily life. However, as synovial membrane removal was unavoidably insufficient, the effect of surgery lasted for only 18 months on average and recurrence of synovitis was observed in 73 % of patients. Open synovectomy meant relatively greater invasion and postoperative pain. Due to the restricted ROM in some cases, postoperative treatment was required and the hospital stay tended to be prolonged. Nevertheless, the recurrence rate was only 37 % during follow-up and the effect of surgery persisted for an average of 75 months, much better than that of arthroscopic synovectomy. In the treatment of RA knees, the indications for arthroscopic and open synovectomies should be carefully studied in the light of the merits and for demerits of each procedure.
7502963 Bilateral retrosomatic clefts at multiple lumbar levels. 1995 Sep Low back pain developed in a 44-year-old woman with a history of rheumatoid arthritis. Radiographs of the lumbar spine revealed bilateral pedicle defects at L-3, L-4, and L-5, with widening of the spinal canal and spondylolisthesis of L-5 on S-1. CT more clearly demonstrated bilateral retrosomatic clefts at multiple levels.
8670319 Protein metabolism in rheumatoid arthritis and aging. Effects of muscle strength training 1996 Jul OBJECTIVE: To determine the effects of rheumatoid arthritis (RA) on whole-body protein metabolism. METHODS: We examined protein metabolism and its hormonal and cytokine mediators before and 12 weeks after progressive resistance muscle strength training in 8 healthy young (mean +/- SD age 25 +/- 2 years) and 8 healthy elderly (70 +/- 5 years) men and women, and in 8 adults with RA (42 +/- 13 years). An additional 6 healthy elderly subjects (69 +/- 3 years) served as a swimming-only control group. RESULTS: Subjects with RA had higher rates of protein breakdown than did young or elderly healthy subjects (79.9 +/- 17.2 versus 60.3 +/- 5.8 and 63.7 +/- 12.4 mumoles/gm total body potassium/hour, respectively, P < 0.05), while there was no effect of age per se. Patients treated with methotrexate had normal rates of protein breakdown (P < 0.01 versus RA without methotrexate; P not significant versus healthy young subjects). Increased protein catabolism in RA was no longer evident after strength training. In multiple regression analysis, levels of tumor necrosis factor alpha (TNF alpha) (r = 0.47, P = 0.01) and growth hormone (r = -0.51, P = 0.006) were associated with protein breakdown, and plasma glucagon levels were inversely correlated with protein synthesis (r = -0.45, P = 0.02). Growth hormone (r = -0.56, P = 0.002) and glucagon (r = 0.45, P = 0.04, levels were associated with protein oxidation. CONCLUSION: Adults with RA have increased whole-body protein breakdown, which correlates with growth hormone, glucagon, and TNF alpha production.
8991976 Costimulatory activity of human synovial fibroblasts. 1995 Oct T cell activation initiated via the CD3/TCR complex requires signals provided by the interaction between costimulatory receptors on T cells and their corresponding ligands on accessory cells. Human dermal fibroblasts are reported to be deficient in this costimulatory activity and normally cannot serve as accessory cells for activation of resting T cells. We examined the contribution of human synovial fibroblasts to costimulatory activity for resting T cells. METHODS: Synovial fibroblast, dermal fibroblast, and umbilical cord endothelial cell cultures were established. These cell lines were co-cultured with purified peripheral T cells; and T cell activation was assayed using 3H-thymidine. RESULTS: Culturing resting T cells with synovial fibroblasts resulted in T cell proliferation with either mitogenic (periodate) or alloantigenic stimulation. This activation was dependent on the addition of interleukin 1 and/or gamma interferon. CONCLUSION: In contrast to dermal fibroblasts, synovial fibroblasts are able to provide costimulatory activity for activation of resting T cells.
8480144 The course of erythropoietin in patients with rheumatoid arthritis with normal and low blo 1993 A consistent elevated level of erythropoietin was found in eight patients with R.A., who continuously for 10 years had a low hemoglobin (< 8 mmol/l) compared with nine patients with R.A., who had a normal hemoglobin (> or = 8 mmol/l) (p = 0.017). A significant inverse correlation between erythropoietin and hemoglobin (r = -0.61) was found in the low-hemoglobin group, but not in the normal-hemoglobin group. Erythropoietin was not found to be correlated to clinical variables.
8916298 Cytokine inhibitors in autoimmune disease. 1996 Oct The cytokine network participates in the modulation of the immune system. Furthermore, the formation of the cytokine-receptor complex, as well as the transcription, translation, secretion, or degradation of cytokines interfere with the functions of cytokines. Cytokine inhibitors include antagonists, soluble receptors, cytokine-binding proteins, and cytokines that block other cytokines. In autoimmune diseases, an abnormal production of proinflammatory cytokines, or a reduced inhibition of their actions, may lead to an imbalance. The main cytokine inhibitors include interleukin-1 receptor antagonist (IL-1ra), soluble IL-1 receptor (sIL-1R), soluble TNF-alpha receptors (soluble TNF-Rs), and certain cytokines, such as IL-4, TGF beta, and IL-10. The combination of cytokine inhibitors is a potential therapeutic approach in the treatment of immunoinflammatory diseases. The nonspecific effects of immunosuppressive drugs are improved by using inhibitors with more specific actions on the functions of proinflammatory cytokines.
8934405 An examination of one-piece metacarpophalangeal joint implants using finite element analys 1996 Jul Reconstruction of the rheumatoid metacarpophalangeal (MCP) joint is generally achieved by means of implantation of a hinged silastic prosthesis. These implants reduce the pain in joint and restore some degree of mobility. However, they are prone to failure after a relatively short life-span. In this study, two popular designs of MCP implant, the Swanson and the Sutter, were compared by means of three-dimensional finite element analysis. The aim was to examine how the differing geometry effected their relative stiffness as replacement joints, and whether they were inherently prone to high stress concentrations during flexion. Although the Swanson design implant exhibited relatively greater resistance to flexion, both designs showed regions of high stress concentration and it was noted that neither was without its limitations. The use of the finite element technique was found to be an excellent way to provide preliminary design evaluation information, allowing further evolution before clinical trials.
8189101 [A histochemical study on the acidic glycoconjugates of the synovial membrane in rheumatoi 1994 Apr The localization and the nature of glycosaminoglycans (GAGs) in the synovial membrane in 30 patients with rheumatoid arthritis (RA) involving 40 knees were studied by newly developed histochemical methods. To detect the acidic glycoconjugates, sensitized diamine procedures were employed based upon high and low iron diamine stainings. To identify the various molecular species of the GAGs, enzyme (chondroitinase ABC and B, testicular hyaluronidase and keratanase) digestion and chemical modification (nitrous acid treatment) procedures were performed prior to the diamine stainings. The sensitized diamine methods could clearly stain the acidic glycoconjugates contained in the synovial tissue components in shades of brown to black, and could detect the precise distribution patterns of the GAGs. The results obtained in the present study confirmed that the tissue in RA synovial membranes contained various amounts of each GAG molecular species such as dermatan sulfate, chondroitin sulfate A/C, hyaluronic acid and heparan sulfate. Furthermore, the distribution patterns of dermatan and chondroitin sulfates in the diseased synovial tissues were pathophysiologically interesting; in the inflammatory areas, the molecular species of GAGs was primarily dermatan sulfate, whereas in the fibrotic areas, it was mainly chondroitin sulfate A/C. Such results appear to be useful for pathophysiological studies on the synovial tissues of RA.
8124913 The effect of methylprednisolone pulse therapy on methotrexate treatment of rheumatoid art 1993 Dec We randomly assigned 30 active rheumatoid arthritis (RA) patients who started oral methotrexate (MTX, 7.5 mg/week) treatment, into 3 groups. Group I received no additional corticosteroids; Group II was treated with 3 oral pulses of 100 mg prednisolone and Group III with 3 intravenous pulses of 1000 mg methylprednisolone (MP) on alternate days during the first week. Parameters of disease activity were measured at the start, after 10 days and at regular intervals up to 1 year. In Group I maximal improvement occurred after 18 weeks and in Group III after 6 weeks. This effect was sustained during the study. The initial effects in Group II were not as strong as in Group III and of shorter duration. No serious side effects were noticed. Our results suggest, that MP-pulse therapy seems to be useful in bridging the gap between the introduction of MTX and the response to this drug. Furthermore, we found that patients who were HLA-DR4-positive showed a better clinical response after 1 year than HLA-DR4-negative patients.
8372737 Paracetamol in rheumatoid arthritis. 1993 The need for supplementary analgesic treatment in RA has partially been neglected. Increasing evidence now support that paracetamol supplementation can increase the effect of NSAIDs. A hypothesis may be postulated that prostaglandin (PG) mediated anti-inflammatory effects of NSAIDs are only marginally increased by higher NSAID doses and that non PG mediated analgesic effects obtained at higher NSAID doses may instead be obtained by supplementing NSAIDs with paracetamol. Combined paracetamol treatment may increase the effect and decrease dose-dependent side-effects of NSAIDs.
8898952 Attenuation of collagen-induced arthritis in mice by treatment with vector cells engineere 1996 Oct The anti-inflammatory effects of the recently identified cytokine interleukin (IL)-13 on collagen-induced arthritis (CIA) was explored and compared to those of IL-4 using systemic administration of these cytokines via two injections of xenogeneic vector cells transfected with a plasmid construct. CIA was induced in DBA/I mice by immunization with native bovine type II collagen (CII). Chinese hamster ovary (CHO) fibroblasts transfected with the mouse IL-13 or IL-4 genes were inoculated subcutaneously on days 10 and 25 post-priming with CII and mice were monitored for signs of arthritis by observers unaware of the status of the animal. Incidence and severity of CIA were significantly reduced in the groups of mice treated with IL-13 and IL-4 gene-transfected CHO cells compared to control groups receiving nontransfected cells. Expression of various cytokines in spleen cells from individual mice was assessed by quantitative reverse transcriptase-polymerase chain reaction at different times after immunization. Our data show that IL-13-induced suppression of CIA coincided with a decreased TNF-alpha mRNA expression in the spleen of treated animals. This may explain at least partially the anti-inflammatory effects of IL-13 in CIA. Thus, our results may have important implications for the clinical use of T helper (Th)1/TH2 modulatory cytokines as therapeutic agents in the treatment of autoimmune diseases.
1533505 Skin rashes and stomatitis due to parenteral treatment of rheumatoid arthritis with sodium 1992 Mar In a prospective study of 45 patients with rheumatoid arthritis mucocutaneous symptoms and signs were evaluated before and during treatment with intramuscular sodium aurothiomalate (Myocrisin). The work, performed in close collaboration between dermatology and rheumatology departments, showed that there was no significant increase in mucocutaneous side effects in patients with pre-existing mucocutaneous disease. It is concluded that pre-existing dermatitis is not a contraindication for treatment with gold salts and that a previous mucocutaneous reaction to gold salts is not an absolute contraindication for a new trial of chrysotherapy.
8194224 Survival of the Lubinus hip prosthesis. An eight- to 12-year follow-up evaluation of 444 c 1994 Jun The Kaplan-Meier survival method was used to analyze 444 Lubinus arthroplasties in 398 patients who were observed between eight and 12 years. The indication for arthroplasty was osteoarthrosis in 316 hips, rheumatoid arthritis in 84 hips, and various other conditions for the other 44 hips. Survival was determined for the entire prosthesis, as well as separately for the femoral stem, the acetabulum cup, and their four subgroups. Four patient-related variables (diagnosis, gender, age, and weight) were analyzed. The overall survival of the Lubinus implants was 97.1% at five years and 87.1% at ten years. No significant difference in survival was found between the acetabular and femoral components. Survival was not significantly better with a new anatomic (SP1) stem than with the old curved one (IP). Of the four patient-related variables studied, only diagnosis and age had a significant effect on prosthesis survival. There was no difference in survival between osteoarthrosis and rheumatoid arthrosis hips, but survival was clearly poorer at ten years in the miscellaneous diagnosis group. The authors obtained a significantly lower survival percentage for patients younger than 65 years of age than for those 65 years and older. There were no deep postoperative infections in this series. The revision rate was 11.5%. The wear seen at the lower front edge of cups that were removed is discussed.
1587409 Long-term nonsteroidal anti-inflammatory drug use and gastroduodenal injury: the role of H 1992 Jun To evaluate the association of Helicobacter pylori infection with gastroduodenal ulceration and symptoms in rheumatoid arthritis patients chronically ingesting nonsteroidal anti-inflammatory drugs (NSAIDs), a population-based study was performed. Residents of Olmsted County, Minnesota, and surrounding counties, 40 years of age and over with active rheumatoid arthritis taking therapeutic dose of NSAIDs daily for 6 months or more were evaluated (n = 50). An endoscopic score from 0 to 5 was assigned and independently confirmed. Biopsies were obtained from the antrum and gastric body for the presence of H. pylori. A symptom score based on the frequency and severity of dyspeptic symptoms was calculated. Substantial mucosal injury (greater than or equal to grade 2) was observed at endoscopy in 33 patients (66%); 14 (28%) had chronic ulcers. Eleven of the community patients with rheumatoid arthritis (22%) were H. pylori positive; adjusting for age, the prevalence of H. pylori was not significantly different to that in 67 health controls (25%). One or more upper gastrointestinal symptoms were reported by 19 of the community patients (38%). Adjusting for age, community rheumatoid arthritis patients with H. pylori were not more likely to have visible mucosal damage or dyspepsia, but were significantly more likely to have histological gastritis (P less than 0.01). The results suggest that, in primarily asymptomatic persons from the community with rheumatoid arthritis taking daily NSAIDs for 6 months or more, H. pylori infection is not related to the severity of visible mucosal injury.
7740942 Intraoperative monitoring of ulnar nerve function during replacement of the rheumatoid elb 1995 Apr Neurography of the ulnar nerve was performed pre-, intra- and postoperatively in 8 arms of 7 patients with rheumatoid arthritis operated on with total elbow replacement via the lateral approach. Ulnar nerve decompression was performed in 4 elbows before implantation. A reduction in the amplitude of compound muscle action potential (CMAP) recorded from the abductor digiti minimi on stimulation of the ulnar nerve in the axilla, was observed during elbow dislocation at surgery in all patients, in 5 cases transiently and in 3 cases until the end of surgery. The ulnar nerve had been decompressed in all patients with lasting amplitude reduction. One of them had a mild sensory ulnar nerve palsy, while the other 2 had normal nerve function at the postoperative clinical examination. All 3 had a reduction in the amplitude of compound sensory nerve action potential (SNAP) and 2 of them also in CMAP amplitude at the postoperative neurographic examination. In patients with transient reduction during surgery, the CMAP amplitude quickly normalized on relocation of the elbow and both the SNAP and the CMAP were preserved at the postoperative neurographic examination. The authors conclude that dislocation of the laterally approached elbow carries a risk of ulnar nerve injury, which is not prevented by decompression of the ulnar nerve, but frequent relocation of the elbow during surgery seems important. It is suggested that the ulnar nerve should not be decompressed routinely, and that the dislocated elbow should be frequently relocated.