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ID PMID Title PublicationDate abstract
8970039 Assessment of shoulder function in rheumatoid arthritis. 1996 Dec OBJECTIVE: (1) To develop a simple outcome measure of shoulder function in rheumatoid arthritis (RA), the Shoulder Function Assessment (SFA) Scale; (2) to compare the properties of this scale with those of 2 existing measures of shoulder function, the Constant Scale and the Hospital for Special Surgery (HSS) Scale. METHODS: Fifty consecutive patients with RA participated in an inpatient multidisciplinary treatment program. The SFA Scale was constructed by selecting items considered simple to assess and relevant to shoulder function by a team consisting of a rheumatologist, an orthopedic surgeon, a physical therapist, and an occupational therapist. To examine the intra and interobserver reliability in 25 patients the SFA Scale, the Constant, and the HSS Scale were assessed twice by examiner CHME, in the other 25 patients once by examiner CHME, and once by examiner EMV. The validity of all 3 scales was determined by calculating the correlation with (1) the observed shoulder function, (2) the patient's opinion of shoulder function, and (3) shoulder joint deformity. A receiver operating characteristic curve was constructed to determine the accuracy of all scales to discriminate between differences in the shoulder function of the "best" and "worst" shoulder as reported by the patient. RESULTS: The validity and the reliability of the SFA Scale were equivalent to or better than the validity and reliability of the Constant and the HSS scale. The discriminative ability of the SFA Scale was superior to both other scales. CONCLUSION: The SFA Scale is a reliable, valid, and accurate measure of shoulder function in patients with RA that can be completed within 3 minutes.
8235911 [Bronchoalveolar lavage fluid analysis in rheumatoid arthritis]. 1993 Aug In order to clarify the pulmonary involvement in rheumatoid arthritis (RA), bronchoalveolar lavage (BAL) was performed in 52 RA patients, in conjunction with pulmonary function test (PFT) and high-resolution CT (HRCT) of the chest. The results were as follows: 1. Out of nine RA patients with no evidence of lung involvement on HRCT, six (66.7%) showed abnormal differentials of the cells obtained through BAL. 2. RA patients with advanced interstitial lung disease on HRCT had significantly higher BAL fluid (BALF) cellular concentrations, increased percentage of BALF neutrophils and decreased BALF CD 4/CD 8 ratio, as compared with those with no or mild lung involvement. 3. In the non-smoking RA patients who also demonstrated no obstructive patterns on PFT, positive correlations were observed between %VC and the BALF CD4/CD 8 ratio (R = 0.481) as well as the BALF CD4+Leu8- (helper T) cell ratio (R = 0.497). On the other hand, a negative correlation was detected between %VC and the BALF CD8+CD11b- (cytotoxic T) cell ratio (R = -0.533). 4. In those with the increased percentage of BALF eosinophils and/or with increased BALF CD4/CD8 ratio, V25/Ht was depressed significantly, as compared with other patients. Likewise, those with severely depressed value of V25/Ht tended to have significantly elevated BALF CD4/CD8 ratio, as compared with other patients with normal V25/Ht value. Thus, through these detailed studies of BAL cellular differentials and BALF lymphocyte subsets, the diversity of pulmonary involvement was well demonstrated in RA.
7650724 The detection of raised levels of IgM to Proteus mirabilis in sera from patients with rheu 1995 Sep An analysis by ELISA of 100 rheumatoid factor (RF)-positive sera selected at random from a collection of sera from patients with various auto-immune diseases and joint pains, and 100 RF-negative sera from the same collection matched by patient age and gender, showed that the RF-positive sera had highly significantly (p < 0.0001) raised levels of IgM antibody, but not IgG antibody, to Proteus mirabilis over those of the RF-negative sera. This response was subsequently found to be associated with sera from patients who clinically had rheumatoid arthritis (RA). Sera from the RA patients had significantly greater amounts (p = 0.026) of IgM antibody to P. mirabilis than to the other organisms tested and these values were also highly significantly different (p < 0.0001) from P. mirabilis IgM antibody levels in matched RF-negative sera. Sera from RA patients also had significantly greater amounts of IgA to P. mirabilis (p < 0.0001) and greater amounts of IgM to Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p < 0.0001) than those in matched RF-negative sera. Other classes of antibody to these organisms and all classes of antibody to Pseudomonas aeruginosa were not raised in the sera of RA patients over those of RF-negative controls. The IgM response in RA patients was not specific for only one O serotype of P. mirabilis but was associated with all 11 different O serotypes of P. mirabilis tested and those of other Proteus spp. Moreover, the IgM antibodies to Proteus spp. appeared to be independent from C-reactive protein and RF.(ABSTRACT TRUNCATED AT 250 WORDS)
1458698 Anti-enterobacteria antibodies in psoriatic arthritis. 1992 Sep The occurrence of certain antibacterial antibodies was studied in the sera of 22 healthy donors (HD) and 66 patients with different diseases. The cases investigated included 22 rheumatoid arthritis (RA), 22 non-arthritic-psoriasis (NAP), and 22 psoriatic arthritis (PA) patients. A complement fixation test was used with Yersinia enterocolitica 0:3 type (YEC), Yersinia pseudotuberculosis (YPT), Campylobacter jejuni (CJ), and Campylobacter fetus (CF) antigens; the detection of anti-Chlamydia trachomatis (CT) antibodies was carried out using an immunoperoxidase colorimetric slide test that allowed the detection of isotypes of specific antibodies. It was found that the synthesis of anti-CF, CJ, YEC, and YPT antibodies in NAP patients does not differ significantly from that of the HD group; on the contrary, the antibody levels were statistically higher in PA than in the other disease groups or in the healthy controls, although only anti-CF antibodies seemed to significantly differentiate (p = 0.000003) the PA group from the others. Anti-CT IgA antibody titers were found to be significantly higher in the PA as well as in the RA groups when compared with the controls, while the antibody levels in NAP patients showed no clear-cut difference with respect to those of either the arthritic patients or the healthy controls. By showing that anti-enterobacterial antibodies are increased in PA but not in NAP patients, our data furnish additional support to the thesis of a pathogenic role of bacterial infections in psoriatic arthritis.
7864914 Clinical measures in rheumatoid arthritis: which are most useful in assessing patients? 1994 Jan OBJECTIVE: To determine the relative accuracy and sensitivity to change of 14 measures commonly used to assess arthritis activity in patients with rheumatoid arthritis (RA). METHODS: Twenty-four patients with RA were prospectively examined every 2 weeks for up to 60 weeks. At each examination, arthritis activity was assessed using 5 physician determined measures (global assessment, swollen joint count, weighted swollen joint count, tender count, weighted tender joint count), 3 patient determined measures (global assessment, pain score, duration of morning stiffness), 3 functional measures (Health Assessment Questionnaire Disability Index, grip strength, 50' walk time), and 3 laboratory measures [Westergren erythrocyte sedimentation rate (ESR), hemoglobin, platelet count]. Accuracy was determined by the degree to which changes in each measure over time were related to changes in other measures (i.e., correlational validity). Sensitivity to change was measured using standardized response means. RESULTS: Over the course of the study, each patient had at least 6 measures change more than 50% from their baseline values. The most highly intercorrelated measures were the physician global assessment (range of partial correlations r = 0.4-0.7), patient global assessment and pain scores (r = 0.2-0.7), the Disability Index (r = 0.3-0.7), and ESR (r = 0.2-0.4). Physician and patient global assessments, pain scores, and the Disability Index were more sensitive to change than other measures, while laboratory measures were generally less sensitive to change. CONCLUSION: Based on the relative accuracy and sensitivity to change of these 14 clinical measures, the physician global assessment, a functional status questionnaire, and the patient global assessment or pain score should be the principal measures used to assess arthritis activity in patients with RA. Recognizing its limitations, the ESR could be included if a laboratory measure is needed.
8608353 Analysis of cell types and mediator production from tissues around loosening joint implant 1995 Dec Quantitative immunophenotypic analysis of cell types present in peri-prosthetic tissue [pseudosynovial membrane (PSM)] from aseptically loose joint implants revealed considerable heterogeneity between tissues from different individuals. The monocyte/macrophage was the commonest leucocyte type; however, its proportion varied widely. T cells normally accounted for approximately 5% of cells, but in a few cases formed > 20% of cells. In all cases, there was a high ratio of CD4 to CD8 cells. PSM leucocytes were activated in most PSMs as judged by surface expression of CD23, CD25 and CD71. Analysis of the proportions of cell types in PSM, OA synovium and RA synovium revealed similarities between the different tissue types. The levels of IL-1, IL-6 and prostaglandin E produced by the PSM were correlated, but only IL-1 and IL-6 levels correlated with markers of the monocyte/macrophage lineage. This result suggests that prostaglandin E is produced in vivo by many PSM cell types.
8988328 Lipocortin 1 binding sites on human T-cells: the population of cells with the binding site 1996 Dec Lipocortin 1 (LC1) is believed to be a mediator of glucocorticoids in displaying anti-inflammatory and immune suppressive responses. The existence of specific LC1 binding sites (putative receptor) on monocytes and neutrophils has been reported. We have studied the distribution of LC1 binding sites in human peripheral blood leukocytes by flow cytometry. The population of cells with LC1 binding sites was much larger in monocytes than in lymphocytes in both rheumatoid arthritis patients (93.1 +/- 2.3% vs 8.8 +/- 1.0%) and healthy volunteers (97.0 +/- 0.9% vs 9.9 +/- 1.5%). The LC1 binding cell population was larger in CD8+ T-lymphocytes than in CD4+ T-lymphocytes in both healthy volunteers (26.4 +/- 4.5% vs 10.6 +/- 2.0%) and rheumatoid arthritis patients (28.8 +/- 4.7% vs 8.7 +/- 2.1%). No difference in LC1 binding cell populations was found between rheumatoid arthritis patients and healthy controls.
1618924 Leukemia inhibitory factor/differentiation-stimulating factor (LIF/D-factor): regulation o 1992 Jul Leukemia inhibitory factor/differentiation-stimulating factor (LIF/D-factor), expression of its mRNA, and possible roles in bone metabolism were studied in murine primary and clonal osteoblast-like cells. Local bone-resorbing factors such as IL-1, TNF alpha, and LPS strongly induced expression of LIF/D-factor mRNA in both clonal MC3T3-E1 cells and primary osteoblast-like cells. Neither parathyroid hormone nor 1 alpha,25-dihydroxyvitamin D3 stimulated expression of LIF/D-factor mRNA. LIF/D-factor per se did not stimulate expression of its own mRNA. Appreciable amounts of LIF/D-factor were detected in synovial fluids from rheumatoid arthritis (RA) patients but not in those with osteoarthritis (OA). Simultaneous treatment with LIF/D-factor, IL-1, and IL-6 at the concentrations found in synovial fluids from RA patients greatly enhanced bone resorption, though these cytokines did not stimulate bone resorption when separately applied. This suggests that LIF/D-factor produced by osteoblasts is in concert with other bone-resorbing cytokines such as IL-1 and IL-6 involved in the bone resorption seen in the joints of RA patients. LIF/D-factor specifically bound to MC3T3-E1 cells with an apparent dissociation constant of 161 pM and 1,100 binding sites/cell. LIF/D-factor dose-dependently suppressed incorporation of [3H]thymidine into MC3T3-E1 cells. In addition, it potentiated the alkaline phosphatase activity induced by retinoic acid, though LIF/D-factor alone had no effect on enzyme activity. These results suggest that LIF/D-factor is involved in not only osteoclastic bone resorption but also osteoblast differentiation in conjugation with other osteotropic factors.
7552076 Hormonal control of rheumatoid inflammation. 1995 Apr As other contributors to this volume have discussed, the genetic basis of rheumatoid arthritis (RA) is multifactorial. One aim of this chapter is to propose that perhaps an additional, non-MHC genetic factor contributing to the pathogenesis of RA may reside in a defective response of the neuroendocrine system to inflammatory stimuli. This proposal is based on work carried out in patients with RA and on lessons learned from animal models of chronic inflammatory disease. This chapter will not consider the effect of sex hormones on the pathogenesis of RA because the data are often contradictory and have yet to crystallize into a coherent hypothesis with testable predictions.
1485132 [Specific rheumatologic disorders in musicians]. 1992 Sep The author reviews the locomotor problems observed in performing musicians. The overall frequency of these problems is high. Three presentations exist: overuse, entrapment and dystonic syndromes. Treatment of these problems implies not only a technical approach, but also consideration of life experience and individual personality.
8782127 Lack of interaction between bromfenac and methotrexate in patients with rheumatoid arthrit 1996 Jun OBJECTIVE: To compare the pharmacokinetics of methotrexate (MTX) and bromfenac administered separately or coadministered in patients with rheumatoid arthritis (RA). METHODS: Patients received their usual weekly oral dose of MTX on Days 1 and 8 and bromfenac 50 mg every 8 h from Days 4 to 9. On Days 1 and 8 serial blood and urine samples were collected to study the pharmacokinetics of MTX and 7-hydroxymethotrexate (7-OHMTX). Bromfenac pharmacokinetics were studied on Days 7 and 8. Concentrations of the analytes were assayed using validated high performance liquid chromatography methods. RESULTS: Nine patients, 5 women and 4 men, completed the study. No statistically significant changes were observed in any of the pharmacokinetic variables evaluated for bromfenac with or without MTX. Bromfenac also did not alter the pharmacokinetics of low dose MTX. However, some significant changes were observed in the pharmacokinetics of 7-hydroxymethotrexate: a 30% increase in dose normalized area under the serum concentration time curve (mean +/- SD) to 3102 +/- 1397 micrograms.h/l and a 16% decrease in renal clearance to 10.0 +/- 6.7 ml/h/kg. Eight patients had mild or moderate adverse events: most were considered unrelated to the study drug by the investigator. One patient did not complete the study because of moderate hypertension. No patient had clinically important abnormal laboratory test results. CONCLUSION: No clinically significant changes in MTX pharmacokinetics were detected in patients with RA when bromfenac was added to MTX therapy. Although 7-OHMTX concentrations were elevated, the changes were small and unlikely to be of clinical significance. MTX did not alter the pharmacokinetics of bromfenac.
8671664 HLA-DQ-binding peptide motifs. 1. Comparative binding analysis of type II collagen-derived 1996 May The frequency of the HLA-DR4-DQ4 haplotype (DRB1(*)0405-DQA1(*)0302-DQB1(*)0401) is significantly increased in Japanese patients with rheumatoid arthritis (RA) and DRB1(*)0405-binding peptide motifs were identified in our previous studies. To clarify the DQ4-binding peptide motifs, the primary structure of DQ4-binding peptides was determined by affinity-based selection of a phage random peptide library. Analog peptides of a high-affinity DQ4 binder revealed that two major anchors (VxxxxxxxR; where x is any amino acid) play an essential role in binding to DQ4. The affinity of synthetic VAAAAAAAR-based analog peptides showed that substituting V to W, G, L, I, M, P, F, Y or A and R to H, M, L, I or V allows binding. The involvement of the ninth residue of the peptides, especially Arg, was critical for high-affinity binding. In comparison with other class II-binding peptide motifs reported to date, peptide motifs for DQ4 were unique, in that Gly and Pro are allowed as low-affinity N-terminal anchors. Interestingly, 94 putative DQ4-binding motifs were detected in the human type II collagen molecule, since it is composed of (Gly-X1-X2)n and is rich in R and P at positions X2. However, no significant differences were observed between the affinities of the collagen-derived peptides with DR or DQ molecules of RA-susceptible DR4-DQ4 and with those of non-susceptible DR4-DQ8 (DRB1(*)0406-DQA1(*)0301-DQB1(*)0302) haplotypes, indicating that the susceptibility to RA is not a simple immune response gene phenomenon specific to collagen. The immunogenetic implications of the unique peptide motifs for DQ are discussed.
1535494 Impairment of neutrophil Fc gamma receptor mediated transmembrane signalling in active rhe 1992 May Neutrophil Fc gamma receptor (Fc gamma R) signalling responses were compared in healthy subjects, patients with definite rheumatoid arthritis (RA), ankylosing spondylitis, and osteoarthritis. The patients with A were subdivided into those with active synovitis and those with quiescent disease. Basal intracellular calcium ion concentrations in patients with inactive RA were significantly higher than in control subjects, which in turn were greater than in patients with active RA. Transient cytosolic calcium ion fluxes were observed after binding Fc gamma RII or Fc gamma RIII with specific monoclonal antibodies and cross linking with the F(ab')2 fragment of antimouse IgG. Response times were significantly faster for Fc gamma RII than for Fc gamma RIII. Peak concentrations of intracellular calcium ions after neutrophil stimulation were comparable for Fc gamma RII and RIII in healthy subjects. Neutrophils in patients with ankylosing spondylitis and osteoarthritis responded to Fc gamma R triggering, but in the group with active RA fluxes of calcium ions were severely depressed. Neutrophils isolated from patients with RA with quiescent disease showed exaggerated responses when compared with controls. Expression of all three Fc gamma R types on neutrophils from patients with active RA, as measured by monoclonal antibody binding, was comparable with control cells. Impairment of neutrophil Fc gamma R cytosolic signalling in active RA could reflect a receptor signalling defect with potential effects on Fc mediated functions, or a fundamental defect in calcium ion homeostasis within these cells.
8107935 Pleuro-pulmonary involvement in patients with connective tissue disease. The role of open 1993 Dec Pleuro-pulmonary involvement is frequently encountered in connective tissue disease. The pathological changes due to connective tissue disease are multifold. They include pleural, interstitial and nodular manifestations as well as airway lesions and vascular changes. In clinical decision making it is important to differentiate between effects of the underlying connective tissue disease, complications due to treatment, such as opportunistic infections, toxic and idiosyncratic drug reactions, and unrelated primary pulmonary diseases. We describe 2 patients with a connective tissue disease and pleuro-pulmonary complications. The diagnostic procedures are discussed. The result of the open lung biopsy was consistent with the diagnosis of rheumatic disease and also Sjögren's disease in the first patient and excluded infection and vasculitis in the second patient. Whenever histological investigation is needed to establish and/or exclude a diagnosis of pulmonary involvement in connective tissue disease, the open lung biopsy remains the "gold standard". We therefore propose a flow-chart for use in the clinical approach to the patient with interstitial lung disease of unknown origin.
8833060 Initial experience combining methotrexate with biologic agents for treating rheumatoid art 1996 Mar The combination of traditional disease modifying antirheumatic drugs such as methotrexate (MTX) with biologic agents for treating rheumatoid arthritis (RA) has thus far been limited. The combination of MTX and a depleting anti-CD4 monoclonal antibody (cM-T412) has been evaluated in phase I and II trials in patients with refractory RA. The potential of combining MTX with other biologic agents is reviewed.
8472508 [The role of disease-modifying antirheumatic drugs (DMARDs) in the therapy of rheumatoid a 1993 Jan The destructive process seen on the cartilage and on the sub-chondral bone of patients with rheumatoid arthritis, which is a chronic inflammatory disease of unknown aetiology, is in part unavoidable. The aim of the treatment is not only to reduce articular inflammation and/or to relieve pain, but also to prevent or delay articular damage and to improve quality of life of rheumatoid patients. The use of new available drugs, with a modern therapeutic approach, seems to be apt to improve considerably the outcome in rheumatoid patients.
8409503 Role of arthrography in non-traumatic painful wrist. 1993 Jun The arthrographic examination was carried out in 25 patients with non-traumatic painful wrist of more than 6 weeks duration. Plain x-rays were non-contributory in making any diagnosis in 20 cases. Arthrography was performed even when plain x-rays were normal and it revealed the soft tissue abnormalities and early phases of cartilage destruction not visible on routine roentgenograms. The extent of synovial involvement demonstrated on arthrography proved useful when synovectomy was planned. After operation pain and swelling disappeared and functions of the joint improved considerably.
1294735 Longterm drug therapy for rheumatoid arthritis in seven rheumatology private practices: II 1992 Dec The probability of continuation of 1,077 courses of 2nd line drugs taken by 532 patients with rheumatoid arthritis treated in 7 rheumatology private practices was examined. This probability was that 50% of courses were continued over 10 months for oral gold, 20 months for hydroxychloroquine, 21 months for penicillamine, 25 months for parenteral gold, 27 months for azathioprine, and more than 60 months for methotrexate (MTX). MTX and prednisone were the only drugs continued by more than 50% of patients after 60 months, while about 20% of courses of other 2nd line drugs other than oral gold were estimated to be continued at 60 months. Estimated drug continuation did not differ significantly according to age, duration of disease, or whether the drug was the first, second, or 3rd 2nd line drug used. Some patients took each 2nd line drug for more than 5 years, suggesting a favorable experience, but most courses were not continued beyond 2 years.
8186371 Selective presence of IgG2b inducing factor in synovial fluid of patients with rheumatoid 1993 Nov The factor, that we have defined and called IgG2b inducing factor, in synovial fluid of rheumatoid arthritis patients (RA-SF) has previously been well characterized both in vitro and in vivo revealing that RA-SF induces a significantly higher IgG2b antibody production in LPS activated murine spleen cells. This activity was separated from the hitherto identified cytokines or factors in RA-SF. In this study we have compared the IgG2b inducing activity in RA-SF with synovial fluid from patients with non-RA arthritides. Here we show that the IgG2b inducing activity is significantly enriched in patients with RA compared to patients with non-RA arthritides and it is not found in healthy, post-traumatic, control groups. We do not yet know the implications of this finding for the disease progress of rheumatoid arthritis, but we believe that the identification of this B cell differentiation factor might elucidate the mechanism leading to hyperactivation of B cells in rheumatoid arthritis.
1462118 Anti-Golgi antibody in rheumatoid arthritis patients recognizes a novel antigen of 79 kDa 1992 Dec We have detected cytoplasmic anti-Golgi antibody (AGA) during a routine immunofluorescence test for detecting autoantibodies. Two sera from patients with rheumatoid arthritis (RA) reacted to the Golgi complex by an indirect immunofluorescence technique on HEp-2 cells. Localization of AGA in the Golgi complex was confirmed by double-staining with antibodies to beta-COP. The effect of monensin on the integrity and morphology of the Golgi complex was also studied. To confirm the presence of AGA further, we performed immuno-electron microscopy. Both sera reacted with cytoplasmic antigen located in the Golgi complex of various animal tissues. Furthermore, by using the Western blot technique, both sera reacted to a relative molecular weight (MW) of 79 kDa (doublet) Golgi antigen purified from rat liver. To our knowledge, this study may be the first to identify the relative MW of Golgi antigen by the Western blot method. Identification of this antibody could provide better understanding of protein synthesis and secretion. The presence of AGA in RA patients further substantiates the diversified nature of autoantibody production seen in this disease.