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ID PMID Title PublicationDate abstract
7766491 Current management of cervical spine instability. 1995 Mar Instability of the cervical spine is a frequently occurring problem in a number of rheumatologic conditions. The importance of recognizing cervical instability lies in its close association with severe, sometimes irreversible, neurologic compromise that can lead to paralysis or even death. Operative stabilization of cervical instability prior to the onset of irreversible neurologic changes has been advocated. The problem, however, has been that no reliable method has accurately predicted which patients with cervical instability are at risk for spinal cord compression. It has been determined in recent studies that specific measurements of radiographic instability are strongly associated with worsening neurologic compromise. These measurements assess the space available for the spinal cord, and recommendations can be made for surgical stabilization in patients with cervical instability, prior to the onset of neurologic changes.
9065026 [Proliferation of T-cells, macrophages, neutrophilic granulocytes and fibroblast-like cell 1996 The aim of this study was to determine the proliferation rates within the lining layer of the rheumatoid arthritis (RA) synovial membrane (SM) as opposed to the SM of other degenerative and neoplastic joint diseases and to characterize the proliferating cells. 13 RA, 23 osteoarthritis (OA), 21 joint trauma (JT), and 9 synovial sarcoma (SS) specimens were immunostained for Ki-67 and PCNA, silver-stained for nucleolar organizer regions (AgNORs), and double stained with either T-cell- (CD3), macrophage- (CD68), or polymorphonuclear neutrophilic leucocytes (PMN)-markers (CD15). The frequency of PCNA positive synovial lining cells (SLCs) varied from 15.7 +/- 8.7% in RA (mean +/- SEM), 30.97 +/- 4.13% in JT, and 48.55 +/- 3.66% in OA to more than half of all cells in SS (67.2 +/- 3.1%). MIB-1 labeling was observed in 20.0 +/- 8.4% of SS cells., but only in 0.6 +/- 0.2% RA or < or = 1.1% in JT and OA SLCs. Mean AgNOR number per cell ranged from 2.9 +/- 0.1 in JT, 3.6 +/- 0.05 in OA and 4.3 +/- 0.3 in RA to 7.3 +/- 0.3 in SS. Significant differences were observed for Ki-67 and AgNORs, between SS and all other diseases and also between RA and OA (p < 0.01, U-test). In RA, Ki-67 was solely expressed in lymphocytes of germinal centres, but not in macrophages or PMN; in the lining layer expression of Ki-67 was only found in fibroblast-like cells. Our study confirms that T-cell or macrophage proliferation is rare in the RA SM. Also, the proliferation rates of fibroblast-like cells in the RA lining layer are rather low, in particular when compared to a sarcoma in the same anatomical location.
8478854 Fibromyalgia and quality of life: a comparative analysis. 1993 Mar The quality of life of women with fibromyalgia was explored and compared to the quality of life of women with rheumatoid arthritis, osteoarthritis, permanent ostomies, chronic obstructive pulmonary disease, insulin dependent diabetes, and healthy controls. The women with fibromyalgia consistently scored among the lowest in all domains measured. These results suggest that fibromyalgia may adversely affect quality of life to an extent not previously recognized.
1455368 [Changes in the production of monokines and prostaglandin E2 by the peripheral blood monoc 1992 As many as 39 patients aged 16-70 years with rheumatoid arthritis (RA) lasting 3 months to 20 years were examined. The diagnostic titers of rheumatoid factor were discovered in 23 patients. The control group was made up of 26 healthy subjects (donors). The activity of IL-1 in supernatants of peripheral blood monocytes (PBM) was measured by bioassay resting on co-stimulation of mouse thymocytes; quantitative determination of tumor necrosis factor-alpha (TNF-alpha) was made by ELISA, PGE2 was determined by RIA. As compared to the controls, the RA patients manifested an increase of the production of IL-1 beta, TNF-alpha and PGE2 of PBM, which rose with the disease activity. The RA patients demonstrated direct correlations between the level of IL-1 beta, TNF-alpha and PGE2 in supernatants of PBM, whereas the donors showed up a negative correlation between IL-1 beta activity and PGE2.
9371977 Antineutrophil cytoplasm autoantibodies and vasculitis. 1995 Jan Antineutrophil cytoplasm autoantibodies are useful diagnostic serologic markers for a variety of well-known primary vasculitic syndromes, including Wegener's granulomatosis, microscopic polyangiitis, and idiopathic necrotizing and crescentic glomerulo-nephritis. More recently antineutrophil cytoplasm autoantibodies have been found in other vasculitic syndromes, such as Churg-Strauss syndrome, Henoch-Schönlein purpura, and some nonvasculitic diseases such as rheumatoid arthritis, inflammatory bowel disease, and autoimmune hepatobiliary diseases. There is now evidence to suggest that infection might be an important etiologic factor in the development of antineutrophil cytoplasm autoantibody-associated vasculitides. This link has been strengthened by in vitro data that suggest that antineutrophil cytoplasm autoantibodies are directly involved in the pathogenesis of antineutrophil cytoplasm autoantibody-associated vasculitides.
7808967 Expression of stromelysin 3 and tissue inhibitors of matrix metallo-proteinases, TIMP-1 an 1994 Aug Rheumatoid hyperplastic synovial lining cells and sublining fibroblasts are known to produce, in vivo and in vitro, matrix metallo-proteinases which degrade extracellular matrix components of joints. We have studied by immunohistochemistry and in situ hybridization the presence of matrix metallo-proteinase stromelysin 3 and its potential inhibitors TIMP-1 and TIMP-2 in 5 cases of normal synovia, 5 cases of chronic synovitis and 12 cases of rheumatoid arthritis. Few hyperplastic synoviocytes and some sparse fibroblasts have been found to produce stromelysin 3 in all rheumatoid arthritis and 2 chronic synovitis. Stromelysin 3 seems to have a limited role in the destructive process of extracellular matrix. TIMP-1 and TIMP-2 were largely expressed principally in hyperplastic synoviocytes and in endothelial cells of all rheumatoid synovitis and 2 chronic synovitis. These findings plead for a balance between matrix metallo-proteinases and their inhibitors in these inflammatory lesions.
1378312 Mast cells and angiogenesis. 1992 Apr Much data exists in the literature to suggest a correlation between mast cell accumulation and angiogenesis. This correlation exists for normal blood vessel growth as well as pathological vessel growth. The recruitment of mast cells to sites of angiogenesis is not completely understood. However, once at the site, mast cell products may act directly on endothelial cells to stimulate their migration and/or proliferation or may act indirectly by degrading connective tissue matrix to provide space for neovascular sprouts to form. Understanding the role of mast cells in angiogenesis may provide avenues for intervening in and manipulating the neovascularization process.
7763109 A stiff collar can restrict atlantoaxial instability in rheumatoid cervical spine in selec 1995 Apr OBJECTIVE: To study the efficiency of a stiff collar in restricting the instability of anterior atlantoaxial subluxation (AAS). METHODS: Twenty two successive patients with an unstable AAS were studied. Lateral view radiographs were taken of the cervical spine in flexion, extension, and neutral positions without a collar, and in full flexion with a custom made stiff collar. RESULTS: The collar restricted more than 30% of the maximal instability of the AAS in 50% of the patients. These patients had significantly shorter atlantoaxial distance in the neutral position than those in whom the collar was not able to restrict the instability. CONCLUSION: A stiff collar can restrict the atlantoaxial instability in selected rheumatic patients with an unstable AAS. Lateral view radiographs of the cervical spine in a neutral position can be used to identify the patients whom the collar will benefit.
1596702 Lyme borreliosis: a very infrequent cause of arthritis of undetermined aetiology in the so 1992 Jun Seventy-three patients with undiagnosed arthritis of undetermined aetiology, 94 patients with classified arthritis (rheumatoid arthritis, ankylosing spondylitis, etc.) and 70 controls were studied for clinical and serological manifestations of Lyme borreliosis. The patients were recruited from the three rheumatology units in the most southern part of The Netherlands. A clinical diagnosis of possible Lyme borreliosis was made in seven of 73 patients with arthritis of undetermined aetiology, in four of 94 patients with classified arthritis and in one of the controls. A definite diagnosis of Lyme borreliosis could be made in only one patient who belonged to the arthritis of undetermined aetiology group. This patient had erythema migrans, arthritis of the knee joint and showed positive antibodies to B. burgdorferi. In the southern part of The Netherlands, Lyme arthritis does not seem to be a frequent cause of arthritis of undetermined aetiology.
7492243 The semeiology of arthritis: discriminating between patients on the basis of their symptom 1995 Nov OBJECTIVES: To examine the intended meaning of words used by patients to describe arthritic symptoms, and to distinguish between different patient groups on the basis of these words. METHODS: A Joint Symptom Questionnaire, developed to resemble the McGill Pain Questionnaire, was given to health professionals (n = 50) and patients with rheumatoid arthritis (RA) (n = 100), fibromyalgia (FM) (n = 50), ankylosing spondylitis (AS) (n = 50), and osteoarthritis (OA) (n = 50). Respondents were invited to define each word by selecting an appropriate heading. Comparison of patient groups was based on the selection of words they chose to describe their joint symptoms. RESULTS: Between health professionals and patients there were no semantic differences in the words given. Patients with FM chose more words to describe their symptoms than the other patient groups (RA median nine words; AS nine words; OA 10 words; FM 12 words). Using receiver operating characteristic curves, a clear distinction between patients with RA, FM, and AS was found, but patients with RA were not readily separated from patients with OA. CONCLUSIONS: There appears to be no semeiological confusion between health professionals and patients regarding arthritic symptoms. However, the spectrum of words chosen by patients to describe the feelings in their joints permits a separation between patients with RA, AS, and FM. Using this questionnaire, patients with RA and OA are symptomatically similar.
8823989 Analysis of human 65 kD heat shock protein mRNA using polymerase chain reaction in synovia 1995 Dec To examine the role of 65kD heat shock protein (HSP) on the etiology of RA, we investigated the expression of 65kD HSP mRNA in the synovia of patients with rheumatoid arthritis (RA). Synovial membranes from 10 patients with RA and 2 patients with non-inflammatory arthritis were examined for the expression of the 65kD HSP mRNA by the reverse transcription-polymerase chain reaction (RT-PCR) method. The mRNA of 65kD HSP was detected in all 10 samples from the RA patients and in the 2 samples from the patients with non-RA using semi-quantitative PCR and the difference in its expression level between the two groups was found not to be significant. By sequence analysis of the 412 bp PCR products, the 65kD HSP protein was confirmed to be human-origin. These data suggest that the 65kD HSP expressed in rheumatoid synovia is human origin and the lymphocytic reaction to the HSP may play an important role in the pathogenesis of RA.
8442528 Value of finger arterial blood pressure in diagnosis of vascular changes in some connectiv 1993 Mar This study was performed in 60 patients with the following connective tissue diseases: rheumatoid arthritis (RA--20 patients), systemic lupus erythematosus (SLE--20), and progressive systemic sclerosis (scleroderma = PSS--20). Twenty normal persons served as controls. All patients and controls were subjected to complete history taking, complete physical examination, and laboratory investigations including: rheumatoid factor, anti-DNA, LE cell test, antinuclear factor (ANF), and ECG. Finger arterial blood pressure (FABP) readings using an 8 MHz Doppler flow detector with a 24-mm-diameter cuff at a temperature of 24 degrees C were made in all cases and controls. The mean age of incidence in patients with RA was 37.8 years; in those with SLE, 21.5 years; in those with PSS 34.6 years; and in the control group, 33.7 years. Women were predominant both in the diseases and the control groups. The FABP was measured in all groups and the range of difference between the brachial and finger arterial blood pressure in each group was estimated. In the control group the mean difference was 27.7 mm Hg; in the RA group, 45.8 mm Hg; in the SLE group, 58.1 mm Hg; and in the PSS group, 70.9 mm Hg. There were no significant peripheral vascular changes in the small arteries in the RA group, whereas in the SLE and PSS groups there was a significant difference, which suggests different underlying microvascular changes. The FABP appears to be a diagnostic tool in the diagnosis of PSS and it helps in differentiation between various types of collagen disease in equivocal cases.
8582152 Problems and suggested solutions in creating an archive of clinical trials data to permit 1995 Oct Because data archives contain patient-based rather than study-based data, they can address meta-analytic questions on uncommon outcomes and on predefined patient subsets, questions that are difficult to address using the traditional meta-analytic approach based on grouped data. We report the tasks involved in establishing the first data archive of rheumatoid arthritis trials. In general, problems stem from the heterogeneity of trials in the archive and we suggest some solutions. In the initial phases, difficulties include recruitment and incomplete participation of trial investigators, whereas later on, other issues arise, such as quality control, coping with different dataset designs, and incomplete documentation. Other issues include heterogeneous measures, missing variables, and comparing data across different visit intervals and trial lengths. Suggested solutions include requesting trial data in predefined archive-wide structures and asking for all possible documentation for each dataset. Data cleaning is necessary, as is rescaling of variables or developing unit-free outcomes, and estimating data for missing variables. Archive design should allow for referencing a patient's data among various datasets. Although one goal is to reduce the quantity of data in the archive while retaining information content, data from early stages of archive building must be accessible for developing new analysis datasets. Documentation of archive building and software choices are discussed. Our experience suggests data archiving for meta-analysis is time consuming and expensive, yet it provides a useful method for analyzing data from multiple trials.
8012341 [Erosive arthropathies in Crohn disease. Apropos of 3 cases]. 1993 Oct Three unusual cases of destructive joint lesions in patients with Crohn's disease are reported. One patient with chronic enteropathic polyarthritis developed erosions of the wrists. The other two patients had spondyloarthropathic disease; erosions developed in the right hip in one and in the hips, knees and tibiotarsal joints in the other. The few similar cases reported in the literature are reviewed.
7486562 V-gene repertoire and hypermutation of rheumatoid factors produced in rheumatoid synovial 1995 Sep 29 We have compared RF from normal, immunized donors and RF derived from the synovial tissues of RA patients. We have found a difference in the preferential use of VL and VH gene families. In both conditions, RFs were found to have accumulated somatic mutations. However, there was a striking difference in the patterns of mutation. RFs from normals were characterized by a very low R:S ratio in the CDR1+2, considerably lower than seen among the RARFs. In addition, there was little increase in affinity with increasing numbers of mutations in a group of clonally related RFs from an immunized normal. This contrasts with RF from RA, where there is evidence of both affinity maturation and class switching. Together these data suggest that in healthy persons there is a controlling mechanism to limit the affinity of RF autoantibodies, and that this is lost in RA. The higher affinity of the RA-derived RF may be of significance in the pathology of the disease.
8147928 HLA-DRB1 alleles in polymyalgia rheumatica, giant cell arteritis, and rheumatoid arthritis 1994 Apr OBJECTIVE: Immunogenetic analysis has demonstrated that giant cell arteritis (GCA) and rheumatoid arthritis (RA) are associated with 2 different domains of the HLA-DR4 molecule. The present study was undertaken to evaluate whether polymyalgia rheumatica (PMR) immunogenetically resembles GCA or RA and to determine whether expression of HLA-DRB1 alleles can be used to detect heterogeneity among PMR patients. METHODS: Forty-six patients with PMR, 52 with GCA, 122 with seropositive RA, and 72 normal individuals were genotyped for HLA-DRB1 alleles by allele-specific amplification and subsequent oligonucleotide hybridization. RESULTS: The HLA-DRB1*04 allele was the most frequent among PMR patients (67%). While the expression of allelic variants of the HLA-DR4 family was restricted to HLA-DRB1*0401 and *0404/8 in RA patients, all HLA-DRB1*04 alleles, including B1*0402 and B1*0403, were represented in the PMR group. The distribution of HLA-DRB1 alleles among HLA-DRB1*04 negative patients was similar in those with PMR and those with GCA, and could be distinguished from that in RA patients. In particular, HLA-DRB1*01 alleles, which were found in most HLA-DRB1*04 negative RA patients, were underrepresented in patients with PMR and GCA. CONCLUSION: The distribution of HLA-DRB1 alleles in PMR resembles that found in GCA. PMR and GCA share the associated sequence polymorphism encoded by the second hypervariable region (HVR) of the HLA-DRB1 gene. The HLA-DRB1 association of PMR and GCA can be distinguished from that of RA, which is linked to a sequence motif in the third HVR of DRB1 alleles. The differential role of distinct domains on HLA-DR molecules suggests that multiple biologic functions are regulated by these molecules and that they contribute differently to disease mechanisms. The similarities in the distribution of HLA-DRB1 alleles in PMR and GCA indicates that HLA-DRB1 alleles are not predictive for progression of PMR to the vasculitic lesions that are pathognomonic for GCA.
8458144 Total knee arthroplasty using an uncemented, polyethylene tibial implant. A seven-year fol 1993 Mar A seven-year postoperative evaluation of 54 patients with either osteoarthrosis or rheumatoid arthritis was conducted. Uncemented, posterior cruciate-retaining, pegged tibial implants produced clinical and roentgenographic results comparable to those seen with standard cemented total knee arthroplasty (TKA). Subsidence, however, seemed to be slightly increased in the uncemented group especially if there was incomplete coverage of the tibial plateau surface. The mere presence of subsidence was not correlated with any increase in pain, although the four implant failures in which the patients had painful loose prostheses all had some subsidence. The cumulative survival rate at seven years was 92.3%, with four arthroplasty failures. Roentgenographic appearance of condensation about the pegs was not statistically correlated with the presence or absence of pain or subsidence. The roentgenographic appearance of opacification in the declivities of the undersurface of the component, however, was associated with a statistically significant decrease in the incidence of subsidence.
8347458 Autoimmune disease and silicone breast implants. 1993 Jul An association between crystalline silica and immune disease has long been recognized. However, despite ongoing case reports of systemic autoimmune disease in silicone implant recipients, the available data has not been sufficient to prove or disprove a causal relationship. Silicone has been shown to "bleed" from the implants and can migrate to distant sites. There is evidence of cellular and humoral immune responses to silicone in vivo, but the role of these responses in the development of connective tissue disorders has not been determined. Further studies are necessary to elucidate the role of silicone, if any, in the pathogenesis of autoimmune connective tissue disease. Meanwhile, the implant population needs to be closely monitored; their clinical management should be based on a case by case evaluation.
8782126 Hepatitis C infection presenting with rheumatic manifestations: a mimic of rheumatoid arth 1996 Jun OBJECTIVE: To describe the clinical features of a group of patients presenting with rheumatic manifestations who were subsequently determined to have hepatitis C infection. METHODS: A case study of 19 consecutive patients referred to private practitioners in Tacoma and Federal Way, Washington, because of polyarthritis, polyarthralgia, or positive rheumatoid factor (RF) who were subsequently found to have hepatitis C. Patients were tested for hepatitis C when they met the following screening criteria: abnormal liver biochemical studies or history of transfusion, jaundice, or hepatitis. RESULTS: Risk factors for hepatitis C infection were present in 14 patients, including transfusions (8) or intravenous drug use (6). Eight patients gave a history of previous jaundice or hepatitis predating their articular complaints by intervals ranging from 3 mos to 23 yrs. Liver biochemical tests were normal in 6 patients. Serologic evidence of hepatitis B or human T lymphotrophic virus type II was present in 3 of 19 and 2 or 14 patients, respectively. Carpal tunnel syndrome (8 patients), palmar tenosynovitis (7 patients), fibromyalgia (6 patients), and nonerosive, nonprogressive arthritis typified the articular manifestations. Fifteen patients fulfilled diagnostic criteria for rheumatoid arthritis (RA). Three patients had small vessel skin vasculitis. The arthritis responded well to treatment with low dose prednisone and hydroxychloroquine. CONCLUSION: Hepatitis C infection can present with rheumatic manifestations indistinguishable from RA. The predominant clinical findings include palmar tenosynovitis, small joint synovitis, and carpal tunnel syndrome. Risk factors such as transfusions and IV drug abuse or a history of hepatitis or jaundice should be included in the history of present illness of any patient with acute or chronic polyarthritis or unexplained positive RF. In such patients, gammaglutamyl aminotransferase, serologic studies for hepatitis C, and other tests appropriate for chronic liver disease should be performed.
8849938 Skin disorders associated with rheumatic disease. 1996 Jan Skin manifestations of rheumatic diseases can include a spectrum of changes, ranging from purpura to ulcers. An understanding of the possible causes of these various dermatologic manifestations and a close cooperation between rheumatologist and dermatologist result in prompt diagnosis and treatment.