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ID PMID Title PublicationDate abstract
1615775 A longitudinal study of the occurrence of joint complaints in elderly people. 1992 May Joint complaints were studied in two cohorts longitudinally followed at 4-5 year intervals between the ages of 70 and 79, representative of the elderly population of Göteborg, Sweden. Joint complaints were reported by 30-43% of the women and by 15-25% of the men. A significant increase of joint complaints was found in both sexes between the ages of 70 and 75 but not thereafter. The knee joints were the most common site of complaints in both sexes. Complaints were not consistently reported by the probands at all examinations, however, and a 'disappearance' of complaints with age was found. Complaints on all three occasions were reported by 15% of the women and 3% of the men. An association was observed between repeatedly reported complaints and radiographic osteoarthritis as well as with self-reported rheumatoid arthritis.
8891979 High implant fracture incidence with Sutter silicone metacarpophalangeal joint arthroplast 1996 Sep We performed a retrospective review of Sutter silicone metacarpophalangeal (MP) joint arthroplasties in 34 patients (42 hands, 168 implants) with rheumatoid arthritis. Patients were evaluated at an average of 27 months (minimum follow-up period, 12 months). Twenty percent of the implants were shown to be definitely fractured on final follow-up examination, and 45% followed for more than 3 years were definitely fractured. At the final follow-up examination, the average ulnar drift in intact implants was 11 degrees and in the fractured implants, 23 degrees. However, there was no correlation between implant fracture and patient satisfaction. Eighty percent of patients said they would undergo the procedure again. Because of a significantly higher implant fracture incidence at a relatively shorter follow-up period than that of most studies of silicone MP implants of the Swanson design, we have abandoned the use of the Sutter implant.
8000342 High frequency of specific T cell receptor rearrangements in rheumatoid arthritis: analysi 1994 May 1. We have searched for rearrangements in the beta chain T cell receptor genes to identify clonal T lymphocyte populations in the synovial fluid of 10 patients with well established rheumatoid arthritis, using a T cell population unbiased by preselection. 2. Analysis of the restriction fragments with the beta chain constant region probe C beta 2 disclosed a rearranged band in 50% of cases (5/10). No significant differences in age, duration of the disease, treatment employed and presence of articular deformities or erosion upon X-ray examination were observed when patients with or without rearrangements were compared. 3. The rearranged band observed after BamH I digestion was of the same size in the 5 patients (14 kb). In addition, two patients presented a 10-kb rearranged band upon restriction with Hind III. 3. These data indicate that a significant number of rheumatoid arthritis patients probably present oligoclonal T cell proliferation of their synovial fluid lymphocytes.
8023586 [Human parvovirus B19 (HPV-B19), a clinical overview with emphasis of rheumatologic manife 1994 Mar The human parvovirus B19 (HPV-B19) causes a spectrum of diseases: Erythema infectiosum (fifth disease), aplastic crises in patients with chronic hemolytic anemias, chronic bone marrow failure in patients with congenital or acquired immune deficiency, vascular purpura, hydrops fetalis, abortion, intrauterine fetal death and HPV-19-arthropathy. In this review we will discuss the clinical pattern, the diagnostic questions and therapeutic possibilities particularly relating to rheumatic manifestations.
8156287 Symmetry of radiological features in the wrist and hands of patients with early to moderat 1994 Mar Quantitative microfocal radiography was used to assess the degree of symmetry in radiological features between the dominant and non-dominant wrist and hands of 51 patients with early to moderately advanced RA. With few exceptions, erosion size and joint space width were bilaterally symmetrical between the dominant and non-dominant side in: total erosion area and total joint space width; area at each of the separate sites of erosion formation, and width at each joint space; and the change in these X-ray features over an 18-month study period. Asymmetry in the number and size of erosions and joint space occurred in a small number of patients within either extremity; these differences were not sustained over the study period. In view of this degree of bilateral symmetry, the extent and progression of the radiographic features in RA can be assessed from a single macroradiograph of either the left or right wrist and hand.
7653488 Hematologic malignancies and the use of methotrexate in rheumatoid arthritis: a retrospect 1995 Sep PURPOSE: To evaluate the relationship between use of methotrexate in rheumatoid arthritis patients and development of hematologic malignancies. PATIENTS AND METHODS: We retrospectively analyzed all patients registered at the Mayo Clinic from 1976 through 1992 with rheumatoid arthritis (n = 16,263) cross-indexed with patients registered during the same period with a hematologic malignancy (n = 21,270). Adult patients were selected who had rheumatoid arthritis, were treated with a disease-modifying antirheumatic drug, and subsequently developed a hematologic malignancy. RESULTS: Thirty-nine patients met the selection criteria. Twelve of them had been given methotrexate. The characteristics of those who received methotrexate, including the type of hematologic malignancy, did not differ from those of patients who received other disease-modifying antirheumatic drugs. CONCLUSIONS: Hematologic malignancies are uncommon in patients with rheumatoid arthritis treated with disease-modifying antirheumatic drugs, including methotrexate. There does not appear to be a relationship between the peak or cumulative dose or the duration of methotrexate therapy and the subsequent development of hematologic malignancy. The histologic types of hematologic malignancy seen in the methotrexate-treated patients did not differ from those of patients treated with other disease-modifying antirheumatic drugs.
8014926 Evaluation of joint mobility in rheumatoid arthritis trials: the value of the EPM-range of 1993 Dec OBJECTIVE: Evaluation of joint range of motion (ROM) is important in the therapeutic approach to patients with rheumatoid arthritis (RA). The reliability, construct validity and sensitivity to change of the Escola Paulista de Medicina (EPM)--range of motion scale that measures 10 distinct movements of small and large joints were examined. METHODS: Fifty patients with active RA who were participating in an inpatient multidisciplinary treatment program were examined by 2 investigators. Twenty-five of the patients were examined both at admission and at discharge from the hospital. RESULTS: The mean EPM-ROM score at study entry was 11.52 (SD +/- 3.80). The intra and inter-observer reliability of the EPM-ROM scale was high, with correlations of r = 0.91 and r = 0.85, respectively. There was a good correlation between the EPM-ROM scale and measures of functional ability. Correlations with measures of disease activity were poor. After a mean duration of the treatment program of 4.2 weeks, patients generally improved in variables of functional status and disease activity. The improvement of the EPM-ROM score (mean difference 1.58, 95% CI 0.84-2.32) was generally larger than improvement in other variables of functional status. CONCLUSION: The EPM-ROM scale is a reliable instrument, and according to its correlation with measures of functional status, relevant to the performance of activities of daily living. It showed a good response to improvement of functional status and disease activity and was more sensitive to changes than other variables of functional status.
7910125 Soluble intercellular adhesion molecule-1 in arthritis. 1994 May The objective of this study is to determine whether soluble intercellular adhesion molecule-1 (sICAM-1) is found in rheumatoid arthritis (RA) and other inflammatory disorders and to identify which cells are responsible for sICAM-1 production. Synovial fluid, blood and cells isolated from RA synovial fluids, and synovial tissues from 59 patients were studied. In addition, normal peripheral blood was obtained. sICAM-1 was assayed by an enzyme-linked immunoabsorbent assay. Synovial fluids from patients with RA and other inflammatory arthritides had significantly higher sICAM-1 levels than did osteoarthritis (OA) synovial fluids. Synovial fluid sICAM-1 levels were significantly positively correlated with synovial fluid leukocyte counts. RA synovial tissue fibroblasts released low levels of sICAM-1. Neutrophils (PMNs) isolated from synovial fluids of RA patients spontaneously released sICAM-1. However, mononuclear cells isolated from RA synovial fluid produced the largest quantities of sICAM-1. Phytohemagglutinin but not lipopolysaccharide enhanced mononuclear sICAM-1 release. sICAM-1 was increased in synovial fluids from RA compared to OA. This sICAM-1 may be important in modulating the trafficking of inflammatory leukocytes into diseased RA synovial tissue and fluid.
1540018 Adhesion of rheumatoid peripheral blood and synovial fluid mononuclear cells to high endot 1992 Jan Mononuclear cells isolated from paired blood and synovial fluid of seven patients with rheumatoid arthritis showed cytoadherence to porcine Peyer's patch high endothelial venules using the Stamper-Woodruff method. A significantly greater proportion of binding was found among the synovial fluid lymphocytes. These would appear to be a population of cells that share adherence characteristics with cells known to be of gut mucosal origin, suggesting that in rheumatoid arthritis some lymphocytes derived from mucosa migrate to joints.
8311553 Zonal distribution of chondroitin-4-sulphate/dermatan sulphate and chondroitin-6-sulphate 1994 Jan OBJECTIVES: Chondroitin sulphate is the major sulphated glycosaminoglycan present in the extracellular matrix of soft connective tissues and the aim of this study was to investigate the distribution of chondroitin sulphate species in normal and diseased synovium. METHODS: Distribution of chondroitin-4-sulphate/dermatan sulphate (Ch4S/DS) and chondroitin-6-sulphate in normal (n = 6), osteoarthritic (n = 4) and rheumatoid (n = 10) synovium was determined using an immunoperoxidase technique and specific monoclonal antibodies to chondroitinase ABC-digested preparations. RESULTS: Ch4S/DS was expressed throughout the interstitium of all tissues and was also present on blood vessels in rheumatoid samples only. Ch6S was expressed in the lining layer of normal synovium but was absent from this site in osteoarthritic and rheumatoid tissues. Ch6S was also present on all blood vessels in all tissues. CONCLUSIONS: The distinct zonal distributions of Ch4S/DS and Ch6S and their alteration in disease suggest these molecules have different and specific functions in normal and diseased synovium.
7801059 Side effects of sulphasalazine in patients with rheumatic diseases or inflammatory bowel d 1994 We compared sulphasalazine (SSZ) toxicity in 140 patients (196 treatment periods) of two patient groups, those with rheumatoid disease (RD) (rheumatoid arthritis, RA, ankylosing spondylitis, AS), and those with inflammatory bowel disease (IBD). Adverse events occurred in 64% of all patients (highest 85% in AS and lowest 50% in ulcerative colitis, CU). There were more recorded adverse events in patients with RD than in patients with IBD. Hepatic side effects were more frequent in patients with IBD than in patients with RD. Adverse events were the most common reason for discontinuing the treatment (in 34.8% of AS patients, in 46.2% of RA patients, in 21.7% of the Crohn's disease patients and in 32.6% of CU patients). There were no lethal or permanent adverse events. Age, sex, rheumatoid factor and HLA-B27 antigen positivity did not influence on the appearance of adverse events.
1413680 [The importance of osteoscintigraphy for the early detection of rheumatic joint lesions]. 1992 Mar The scintigraphic semeiotics was investigated of involvement of osteoarticular system in rheumatoid polyarthritis in 186 patients (79 of them suffered of rheumatoid arthritis, 62 of systemic lupus erythematosus, 34 of systemic scleroderma, 11 of dermatomyositis). Roentgenological examination was supplemented by consecutive local scintigraphy of axial skeleton and peripheral joint by of gamma rays with labeled 99mTc phosphate complexes. Isoactive zones with subsequent quantitative evaluation of the information were obtained as a result of computerized processing of the scintigraphic images of the joints. The results were compared with those obtained in patients with rheumatoid arthritis. It was established that inspite of the similarity of the scintigraphic manifestations, each of them has its regularities due to differences of the pathomorphological processes in the joints.
7863383 [Amyloidosis in rheumatoid arthritis--clinical study of 124 histologically proven cases]. 1994 Dec The diagnosis of secondary amyloidosis due to rheumatoid arthritis (RA) was confirmed by positive tissue staining using Congo-red and antiserum to amyloid A protein. Biopsied specimens were obtained mainly from gastro-intestinal tracts; small salivary glands of the lips as well as abdominal adipose tissues were also studied in a small number. The results were as follows: 1. Gastro-intestinal fiberscopies and biopsies were performed on 789 RA patients for the purpose of routine screening and follow-up for amyloidosis. Seventy-seven cases (10.5%) turned out positive for amyloid. Among the biopsied specimens taken from three different sites, the proportion of amyloid-positivity was 68.9% for gastric antrum, 76.5% for duodenal cap and 88.6% for the second portion of the duodenum, suggesting the higher sensitivity and efficacy of duodenal biopsy in studying secondary amyloidosis in RA. 2. 124 patients of RA complicated with secondary amyloidosis were studied clinically with special reference to its clinical characteristics and prognosis. (1) The mean duration of RA at diagnosis of amyloidosis was 15.4 years and all patients but two were in stage III or IV (Steinbrocker). (2) Gastro-intestinal symptoms were present in 58.1% of the cases, abnormal renal signs in 58.9%, cardiac symptoms in 39.5%, respectively. All of these findings had a significant association with poorer prognosis in secondary amyloidosis due to RA. (3) The 4-year survival rate of all the cases was 57.8%, while the 3-year survival rate for the group without symptoms and signs about amyloidosis was 100%. (4) The causes of death in 36 cases were renal failure (14 cases), infection (13 cases), cerebral bleeding (2 cases), myocardial infarction (1 case), pulmonary infarction (1 case), suicide (1 case) and unknown (4 cases). Patients with intractable diarrhea were mostly susceptible to the ensuing fatal bacterial infection.
8389553 Spontaneous production of Epstein-Barr virus by B lymphoblastoid cell lines obtained from 1993 Jun OBJECTIVE: To investigate the involvement of Epstein-Barr virus (EBV) in the pathogenesis of Sjögren's syndrome (SS) and to examine whether the spontaneous production of EBV is unique to SS B cell lines. METHODS: B cell lines were established from peripheral blood mononuclear cells (PBMC) of patients with systemic lupus erythematosus, rheumatoid arthritis, and SS. The cord blood immortalization assay, flow cytometric analysis, and polymerase chain reaction (PCR) were used to detect EBV production by B cell lines. RESULTS: SS B cell lines produced EBV at a higher frequency, and in significantly larger amounts, than did other B cell lines. However, no correlation with the amount of EBV DNA in the genome of B cell lines was found. PCR analysis revealed that EBV with a B95-8--like U2 region was dominant in SS B cell lines. CONCLUSION: Spontaneous, massive production of EBV by B cell lines is unique to SS, and may contribute to the polyclonal B cell activation seen in this disease.
8872860 Analysis of autoantibodies to plasminogen in the serum of patients with rheumatoid arthrit 1996 Aug Sera from patients with rheumatoid arthritis containing high titers of anti-streptokinase antibodies were found to contain anti-plasminogen antibodies of the IgG and IgA classes. High titers of anti-plasminogen autoantibodies of the IgA class were also found in sera from patients with systemic lupus erythematosus and Sjögren syndrome. Studies of the immune response to thrombolytic therapy with streptokinase in patients with no prior history of autoimmune disease suggest a strong correlation between streptokinase administration and the appearance of autoantibodies to plasminogen of the IgA class. The IgA anti-plasminogen autoantibody is specific for an epitope in a region of plasminogen which binds streptokinase and the IgG autoantibody reacts with an epitope in the C-terminal region corresponding to the catalytic domain of the plasminogen zymogen. Our findings suggest a different origin for the two classes of anti-plasminogen immunoglobulins in rheumatoid arthritis patients. Since plasminogen binding to rheumatoid synovial fibroblasts is enhanced, the high titers of both classes of anti-plasminogen autoantibodies may add to the localization and perpetuation of the immune response. We suggest that plasminogen may be a target of the immune response in autoimmune disease.
7985034 Twin studies in rheumatic diseases. 1994 Aug Twin studies attract both clinicians and geneticists because of the value of the twin method in helping unravel the genetic predisposition to diseases and the role of environment in their causation. In the field of rheumatology, there are many case reports on twins concordant or discordant for diseases. Interesting as such reports may be, very few generalizations can be made from them. The concordance rate among monozygotic (MZ) twins indicates the maximum level of genetic contribution. Based on studies of systematically compiled twin series, the concordance rate is about 15% for rheumatoid arthritis; the rate is probably of the same order of magnitude for systemic lupus erythematosus (SLE). The fine specificity of antinuclear antibodies of MZ twins at least one of whom is affected by SLE is very similar, despite somatic generation of immune diversity. Up to now, twin studies have provided little information on the role of environmental factors in rheumatic diseases. A notable exception is a case-control study of MZ twins discordant for smoking that reinforced the role of smoking as a cause of lumbar intervertebral disc degeneration.
8613658 Day-to-day variation in iron status indexes is similar for most measures in elderly women 1996 Mar OBJECTIVE: To determine the day-to-day variation in biochemical measures of iron status in a group of elderly women with rheumatoid arthritis compared with a group of healthy elderly women. DESIGN: Venous blood samples were collected from each subject on 3 nonconsecutive days during a 2-week study period; subjects had fasted overnight. Variability in hemoglobin level, hematocrit value, serum iron concentration, total iron-binding capacity, transferrin saturation, serum ferritin concentration, and plasma transferrin receptor level was determined. SUBJECTS: Two groups of women, one with rheumatoid arthritis (n=10) and another that was apparently healthy (n=10). STATISTICAL ANALYSES: Variance component analysis was used to estimate the biological variation (sigma square day) and analytic variation (sigma square rep) for each iron index. The coefficient of variation (CV) for each variance component was calculated: coefficient of biological variation = CV day, coefficient of analytic variation = CV rep, and coefficient of a single future determination = CV fd. RESULTS: The CV rep for all iron indexes was smaller than the CV day in both groups. The CV day was considerably higher for serum iron concentration and for transferrin saturation than for the other indexes in both groups (16.6% and 16.6% in healthy subjects and 33.6% and 28.2%, respectively, in subjects with rheumatoid arthritis). The higher CV day for serum iron concentration and transferrin saturation translated into a higher CV fd for these indexes. Because of the higher variance for these two indexes, more sampling days were required for reliable estimates. CV day and CV fd for plasma transferrin receptor level were relatively low. CONCLUSIONS: These findings corroborate our previous finding that variation of serum ferritin concentration in the elderly is lower than that demonstrated in younger populations. This aging effect persists in the presence of rheumatoid arthritis. Fasting appeared to improve reliability in the determinations for serum iron concentration and transferrin saturation. Variability estimates for the indexes other than serum iron concentration and transferrin saturation were not altered by the inflammation of rheumatoid arthritis. Plasma transferrin receptor level is a reliable index for assessing iron status in populations with rheumatoid arthritis.
8164204 The relative importance of pain and functional disability to patients with rheumatoid arth 1993 Sep OBJECTIVE: Pain and functional disability are 2 major factors influencing the health status of patients with rheumatoid arthritis (RA). To determine the relative importance ascribed to these factors by patients, we examined the relationship of levels of both pain and functional disability to self-reported global arthritis status in patients with RA. METHODS: Pain, disability and global arthritis status were measured prospectively in 305 patients with RA using the Health Assessment Questionnaire, which was completed by patients every 6 months for up to 9.5 years. The relative importance of pain and functional disability was determined by the relative magnitude of their association with global arthritis status, as estimated by pooled time series regression analysis. RESULTS: At study entry, median levels of pain, functional disability, and global arthritis status for the cohort were 1.1 (possible range: 0-3.0), 1.25 (possible range: 0-3.0), and 35 (possible range: 0-100), respectively, indicating moderate arthritis severity. Both pain (p < 0.0001) and functional disability (p < 0.0001) were significantly related to changes in global arthritis status over time. The standardized regression coefficient of pain was 1.2 times larger than that of disability, indicating that patients' ratings of their arthritis status was only slightly more heavily weighted by changes in pain than by changes in functional disability. Pain was a more important feature than disability among nonwhites (pain/disability standardized coefficient ratio = 2.7), while disability appeared to be more important for males (ratio = 0.8). The duration of RA did not influence the relative importance of pain and disability. CONCLUSION: Pain and functional disability were of similar importance to this group of patients with RA, and the relative importance of pain and disability did not vary with the duration of RA.
7679713 Beta 1 integrin-mediated interaction with extracellular matrix proteins regulates cytokine 1993 Mar 1 Inflammatory cytokines have been implicated in the pathogenesis of rheumatoid arthritis (RA), whereas the mechanisms for constitutive production of inflammatory cytokines in affected joints are largely unknown. Recently, integrin-mediated interaction with extracellular matrix (ECM) proteins has been demonstrated to play a role in regulating cytokine production in T cells and monocytes. In this study, we investigated the contribution of the beta 1 integrin-mediated interaction with ECM proteins to the persistent cytokine gene expression in RA synovial fluid mononuclear cells (SFMNC). We examined mRNA expression of 14 cytokines in the SFMNC of three RA patients, which were either fresh or cultured overnight in serum-free medium on ECM-coated plates, by polymerase chain reaction with a panel of oligonucleotide primers specific for each cytokine. The persistent expression of various cytokine mRNA found in fresh SFMNC was maintained after overnight culture in serum-free medium on ECM proteins, especially on laminin (LM), but not on serum albumin. This effect of LM was inhibited by an anti-integrin beta 1 chain (CD29) mAb, as well as by an anti-CD3 mAb, indicating an important role of the beta 1 integrin-mediated interaction with ECM proteins in regulating persistent cytokine gene expression in RA SFMNC, and a key role of T cells in regulating inflammatory monokine production.
7973585 [Current value of arthrosonography in diagnosis of rheumatic diseases]. 1994 Aug Arthrosonography is now firmly established in the diagnosis of rheumatic diseases. Apart from revealing disorders of soft tissue it can also demonstrate bone defects. Arthrosonography is one of the very few imaging methods that enable observation of joint motions to complete the examination. Only a widespread technique like arthrosonography can improve the diagnostics of joint disorders from which millions of people suffer.