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ID PMID Title PublicationDate abstract
8619093 T cells in rheumatoid arthritis. Paradigms and facts. 1995 Aug Rheumatoid arthritis is characterized by a strong HLA-DRB1 association and a histologic picture consistent with an antigen recognition event by tissue-infiltrating T cells. Basic immunology has seen major progress in the understanding of the T-cell receptor-MHC-antigen interaction; however, the role of T cells and disease-associated HLA-DRB1 alleles in rheumatoid arthritis remains elusive. Recent studies on the genetics of the HLA-DRB1 association and the diversity of the repertoire of synovial T cells, and treatment studies with T-cell depleting antibodies, have suggested that the model of T cells recognizing an arthritogenic antigen in association with a HLA-DR molecule is too simplistic. The findings are more consistent with a regulatory role of T cells. Patients with rheumatoid arthritis have a unique T-cell repertoire that not only reflects the influence of disease-associated HLA-DRB1 alleles but also is greatly skewed by the clonal expansion of few CD4+ and CD8+ T-cell specificities. Understanding these repertoire changes appears to be promising not only in permitting understanding of the pathogenesis of this disease but also in designing T-cell-targeted treatment strategies.
8952315 [Rheumatoid factor idiotypes in patients with Sjögren's syndrome]. 1996 Oct Sjögren's syndrome (SS) is a systemic as well as an organ-specific autoimmune disease, characterized by multiple organ damages, autoantibody production such as rheumatoid factor (RF), and also by the development of lymphoproliferative disorders such as monoclonal gammopathy or malignant lymphoma. We produced two monoclonal anti-idotypic (ld) antibodies (A-SF 18/2 and A-AMB 1/5) against monoclonal RFs (IgA-L and IgM-K) derived from patients with SS. Expression of the cross-reactive idiotype (CRI) of these monoclonal RFs was studied in 101 patients with SS, 71 with rheumatoid arthritis (RA) without complication of SS and 93 normal subjects. The results showed the followings: (1) By the enzyme-linked immunosorbent assay (ELISA), 17.8% and 15.8% of patients with SS and 15.5% and 21.7% of patients with RA showed CRI of SF 18/2 and AMB 1/5, respectively, whereas 6.5% and 5.7% of normal subjects showed these CRIs, respectively, (2) In the SF 18/2 Id system, there was one group (45%) in SS patients who showed weak positive CRI, whereas there was no such group in the AMB 1/5 Id system, (3) Out of 15 patients with SS, there were 4 patients whose peripheral blood lymphocytes had a significant amount of surface membrane Id of SF 18/2 (9.1-37.7%), suggesting the existence of a monoclonal population in the blood. These data suggest that clones with one particular SF 18/2 Id were markedly activated in SS patients and these may be related to the monoclonal proliferation of RF Id-positive B cells in patients with SS.
8607890 The effect of progressive resistance training in rheumatoid arthritis. Increased strength 1996 Mar OBJECTIVE: To demonstrate the feasibility of high-intensity progressive resistance training in rheumatoid arthritis (RA) patients compared with healthy control subjects. METHODS: Eight subjects with RA, 8 healthy young subjects, and 8 healthy elderly subjects underwent 12 weeks of high-intensity progressive resistance training, while 6 elderly subjects performed warm-up exercises only. Fitness, body composition, energy expenditure, function, disease activity, pain, and fatigue were measured at baseline and followup. RESULTS: All 3 training groups demonstrated similar improvements in strength compared with the change among control subjects (RA group 57% [P < 0.0005], young exercise group 44% [P < 0.01], elderly exercise group 36% [P < 0.05]). Subjects with RA had no change in the number of painful or swollen joints but had significant reductions in self-reported pain score (21% [P < 0.05]) and fatigue score (38% [P = 0.06]), improved 50-foot walking times (mean +/- SD 10.4 +/- 2.2 seconds versus 8.3 +/- 1.5 seconds [P < 0.005]), and improved balance and gait scores (48.9 +/- 3.8 versus 50.4+/- 2.0 [P = 0.07]). CONCLUSION: High-intensity strength training is feasible and safe in selected patients with well-controlled RA and leads to significant improvements in strength, pain, and fatigue without exacerbating disease activity or joint pain.
7482063 [Methotrexate and salazosulfapyridine in the long-term treatment of rheumatoid arthritis]. 1995 Aug Long term treatment of 190 cases of rheumatoid arthritis with either methotrexate or salazosulfapyridine was analyzed for their efficacy and adverse effects. Both treatment groups showed improvement of clinical symptoms, erythrocyte sedimentation rate, and CRP after 1 month of treatment, while RAHA titers decreased significantly after several months. Erythrocyte sedimentation rate and CRP of salazo-sulfapyridine group, once improved, deteriorated again after 12 months of treatment, while methotrexate group showed sustained improvement for 48 months. Radiologic progression estimated according to JF Fries was significantly less in MTX group than in SASP group. Life table analysis showed that the overall probability of continuing methotrexate or salazosulfapyridine at 4 years was 63% and 55%, respectively. The main reason of treatment termination in methotrexate group was adverse effects, while that in salazo-sulfapyridine group was inefficacy.
1440084 [Gold-induced severe cholestatic jaundice in rheumatoid arthritis patient and effect of re 1992 Oct A 32-year-old female with early stage of rheumatoid arthritis (RA) developed anorexia, pruritus, dark urine, pale stool and jaundice 3 weeks after initiation of chrysotherapy. She was administered a total of 35mg of gold sodium thiomalate (GST) intramuscularly and auranofin 6mg per day orally. Liver function tests and biopsy specimens showed severe cholestatic jaundice. Prednisolone 30mg per day and plasma exchange were started. No response however was obtained and the total bilirubin level gradually increased. Steroid pulse therapy, 1000mg methylprednisolone for successive 3 days as one therapy unit, was repeated 4 times. Liver functions were then gradually improved. Gold induced hepatotoxicity is a rare complication. We concluded that the hepatotoxicity in this case was caused by allergic reaction against GST and repeated steroid pulse therapy was very effective to these conditions.
8912776 Bronchiolar disease in rheumatoid arthritis. 1996 Nov The pulmonary manifestations of rheumatoid arthritis (RA) include bronchiolar diseases such as follicular bronchiolitis (FB) and bronchiolitis obliterans (BO). In this study, we investigated the clinical and pathologic features of FB and BO, as well as the effect of erythromycin (EM) on these diseases. The subjects included 15 RA patients with biopsy-proven bronchiolar disease (eight with FB, seven with BO). None of the patients had Sjögren's syndrome. Eleven patients (73%) had chronic sinusitis, and 14 (93%) had a chronic cough with sputum. Bacterial culture of sputum was positive in 50% and 71% of the FB and BO patients, respectively. High-resolution computed tomography (HRCT) revealed small nodular shadows in the centrilobular regions (FB and BO), patchy areas of low attenuation (BO), and peribronchial thickening (FB and BO). Eleven patients who received EM therapy showed a significant improvement of symptoms. In addition, none of the 15 patients died of the bronchiolar disease during follow-up. In conclusion, RA patients with FB or BO basically have a chronic clinical course with main complaint of productive cough, and EM may be useful for the management of these diseases.
8777846 Magnetic resonance imaging of the wrist in rheumatoid arthritis: comparison with other inf 1996 Mar The aim of this study was to evaluate magnetic resonance images (MRI) of the wrist of rheumatoid arthritis (RA) patients. MRI and plain X-ray of the wrists were performed in 15 patients with RA, 7 patients with another chronic inflammatory joint disease (CIJD), and 10 control subjects. Patients had only minor changes on plain X-ray. Coronal T1 weighted spin echo sequences were performed before and after an intravenous pulse of gadolinium (GD). Contiguous 3 mm thick slices were obtained. Synovitis was frequently objectivized in the two groups of patients. MRI detected far more erosions and central bone geodes than plain X-ray. Geodes were frequent among controls while cortical bone erosions were frequent in patients. Most of the erosions were enhanced after GD injection in the RA patients but not in the 2 other groups. Thus MRI is not only useful in diagnosing inflammatory changes of the wrist but also in distinguishing early stage RA from other CIJD.
8217098 Integrin-type extracellular matrix receptors in cancer and inflammation. 1993 Aug The integrins are a large family of cell adhesion receptors, involved in cell-cell and cell-matrix interactions. At present, 20 different integrin heterodimers are known. Integrins participate in a complex apparatus anchoring cells to their surroundings and transducting signals into the cells. These signals regulate many important aspects of cell behaviour, including growth, differentiation, and phenotype. This is an overview of the molecular and cellular biology of the integrin-type extracellular matrix receptors. Integrins may play a central role in the healing process of tissue injuries, and in many diseases, especially in human cancer.
7758883 Autoantibodies to the islet antigen ICA69 occur in IDDM and in rheumatoid arthritis. 1995 Mar Islet cell antigen (ICA) 69 is a newly-recognized islet cell antigen to which autoantibodies have been observed in prediabetic relatives of patients with insulin-dependent-diabetes mellitus (IDDM). Here we extend the earlier analysis of ICA69 antibodies to patients with recent-onset IDDM and to patients with other immune-mediated diseases. ICA69 antibodies were determined by Western blot using an affinity purified recombinant fusion protein of ICA69 and maltose binding protein. ICA69 antibody quantities were determined as titres using a titration curve of a standard serum as reference. Mean logarithmic ICA69 antibody titres were 3.4 (+/- 1.4) in 99 patients with acute IDDM compared to 2.8 (+/- 0.9) in 49 healthy blood donors (p < 0.001). A higher mean ICA69 antibody titre of 4.1 (+/- 0.8) was observed in 16 patients with rheumatoid arthritis in comparison to acute IDDM (p < 0.01) and healthy control subjects (p < 0.001). The percentage of sera with ICA69 antibody titres above the 2 SD level of normal subjects was 21% in IDDM, 31% in rheumatoid arthritis and 6% in healthy blood donors. None of the patients with autoimmune thyroid disease (n = 20), inflammatory bowel disease (n = 9) or multiple sclerosis (n = 7) had elevated ICA69 antibodies. In IDDM, presence of ICA69 antibodies persisted and the titre remained the same over 18 months of follow-up. The relationship of ICA69 antibodies to islet cell antibodies (ICA) or insulin autoantibodies (IAA) was tested. The production of ICA69 antibodies was not associated in diabetic patients with the presence of any of the two other autoantibodies.(ABSTRACT TRUNCATED AT 250 WORDS)
8617142 Pyoderma gangrenosum with hepatopancreatic manifestations in a patient with rheumatoid art 1996 Mar Pyoderma gangrenosum is a dermatological disease of unknown origin. We report the case of a 47-year-old woman with cutaneous lesions of pyoderma gangrenosum associated with hepaticopancreatic involvement. We found no other similar cases in the literature. The outcome was favorable with steroid therapy. She was free of symptoms after one year.
1739546 Delayed presentation of an extradural abscess complicating thoracic extradural analgesia. 1992 Jan Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.
8898142 Bipolar salvage shoulder arthroplasty. Follow-up in 14 patients. 1996 Jan A bipolar spacer was inserted for severe arthritic destruction of the shoulder in 14 patients, and followed up for a mean of 5.9 years. In one patient the operation failed because of infection. Two others required revision for loss of low-friction properties which caused loosening of the humeral component. At the end of the follow-up all the patients showed improvement. The Hospital for Special Surgery pain score had increased from 5.3 to 18.9 and the movement score from 7.5 to 20.1.
7710451 Conventional statistics and useful statistics. 1995 Feb Differences between conventional statistical methods and more useful, modern methods are demonstrated using a statistical analysis of data from therapeutic research in rheumatology. The conventional methods, t-test and graphs of mean values and the boxplot, detect almost no differences between treatment groups. A more recent procedure for analysing group differences is the Wilcoxon-Mann-Whitney test. The associated graphs are based on the cumulative distribution function of the two treatment groups and the synthetic Receiver Operating Characteristic (ROC). Special differences, namely baseline dependencies, can be visualized in this way.
8078189 [Rheumatoid arthritis terminating in multiple myeloma]. 1994 Jun A 65-year-old woman with a 25-year history of rheumatoid arthritis (RA) was admitted because of acute pneumonia in January, 1991. Then she was pointed out M proteinemia (IgG 3,220 mg/dl, IgA 139 mg/dl, IgM 216 mg/dl) for the first time. Serum IL-6 was below 4.0 pg/ml. She was followed up because of lack of bone change. Plasma cell count in bone marrow were 14.6%. She was re-admitted because of development of bone lesions March, 1992. There was no joint pains, and serum IgG, IgA and IgM were 5,148 mg/dl, 114 mg/dl and 106 mg/dl, respectively. CRP was negative. Serological tests of rheumatoid factor and antinuclear antibody were both positive. Serum IL-6 was elevated to 14.8 pg/ml. Bone marrow aspiration disclosed 30.6% myeloma cells. Serum IgG, A, and M were 5,148 mg/dl, 114 mg/dl and 106 mg/dl, respectively. Serum immunoelectrophoresis showed monoclonal IgG with kappa type light chain. X-ray findings revealed radiolucent myelomatous foci. From these findings, IgG kappa-type multiple myeloma with RA was diagnosed.
7674224 The value of percentage of CD8+ T lymphocyte levels in distinguishing polymyalgia rheumati 1995 Jun OBJECTIVE: To determine whether the low absolute numbers and percentages of CD8 positive T cells in the circulation of patients with polymyalgia rheumatica (PMR) could be used as a new diagnostic criterion for the disease. METHODS: The % CD4 and CD8 positive T lymphocyte sub-populations were measured in 37 patients with PRM before treatment and during steroid treatment over the subsequent 2 years, in 21 patients with rheumatoid arthritis (RA), and in 27 normal (N) control subjects. RESULTS: During the study, 10 patients, who were initially diagnosed as PMR, were reclassified as having had a myalgic onset of RA (PMR-RA), according to the American College of Rheumatology criteria for the diagnosis of RA. No decreased %CD8+ T lymphocyte subset had been observed in these patients at presentation, before steroid therapy, or during treatment with steroids when compared with the RA and N groups. CONCLUSION: The measurement of %CD8+ T cell subset may provide a simple method for determining whether patients presenting with myalgia are "true" PMR or are destined to develop RA.
8069278 Arthritis and mortality in the epidemiological follow-up to the National Health and Nutrit 1994 Summer Subsets were analyzed of respondents from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey I (NHANES I) who (1) answered a general arthritis question reflecting whether a doctor told the respondent that she or he had arthritis, (2) answered seven pain, swelling, and stiffness questions, and (3) had radiographs of knees and hips assessed for osteoarthritis at the time of the initial survey during the early 1970s. Data for the follow-up were collected between 1982 and 1984 and included 1,491 fatalities in the largest subsample analyzed here. The dependent variable was months of survival after the initial interview. No distinction was drawn between rheumatoid arthritis versus osteoarthritis. The NHANES I contained only limited information on rheumatoid arthritis versus osteoarthritis. Additional covariates included age, age squared, education, race, marital status, diastolic blood pressure, and body mass. After adjusting for age, no statistically significant associations emerged between answers to the general arthritis questions or any of the seven pain questions on the one hand, and mortality on the other. Similar statistically insignificant results were found when the association between radiographic diagnoses of osteoarthritis in the hips and months of survival was considered after adjusting for age. These statistically insignificant results persisted in repeated testing, which alternately included and excluded a number of covariates, and in separate subsamples of women, men, and persons older and younger than age 50. Some evidence was found, however, for a negative, statistically significant association between radiographic knee diagnoses of osteoarthritis and survival, especially among women, even after adjusting for covariates. These mixed results (1) do not discredit findings elsewhere suggesting that rheumatoid arthritis is associated with early death, since it is likely that the great majority of respondents answering in the affirmative to the general arthritis or seven pain questions in the NHANES I had osteoarthritis, and (2) suggest that future surveys should make greater attempts to distinguish between rheumatoid arthritis and osteoarthritis.
1642323 Erosive arthritis and spondyloarthropathy in Old World primates. 1992 Jul Presence of spine and sacroiliac involvement and the nature and distribution of the erosive lesions allow definitive diagnosis of spondyloarthropathy. Thus, spondyloarthropathy was identified in Theropithecus, Papio, Cercopithecus, Macaca, Colobus, Presbytis, and Hylobates. Only monarticular erosive disease was present in prosimians, precluding a diagnosis of spondyloarthropathy for that group. The distribution of erosive disease and axial joint involvement in 1,349 non-prosimian Old World primates is quite characteristic of that noted in human psoriatic arthritis. While Reiter's syndrome must also be considered, the histologic appearance of skin lesions in Macaca is characteristic of psoriasis. Evidence of spondyloarthropathy abounds in the literature of primate skeletal disease. Environmentally based contagions may be important in the pathophysiology of spondyloarthropathy. The wide geographic distribution of the phenomena in monkeys suggests a "panendemic," with limited individual susceptibility (compared to that noted in gorillas and chimpanzees). Identical occurrence of erosive arthritis/spondyloarthropathy in free-ranging and artificially restrained animals suggests that spondyloarthropathy can validly be studied in artificially restrained populations. This perspective should allow application of human therapeutic approaches to and perhaps improve the quality of life for artificially restrained, afflicted individuals.
8748788 Occipito-cervical fixation in rheumatoid arthritis--an analysis of surgical risk factors i 1995 163 patients with rheumatoid arthritis (RA) and atlanto-axial subluxation treated by posterior occipito-cervical fixation (OCF) over a period of twenty-one years (November 1970-January 1991) were followed. Common complaints prior to surgery were occipital headache, neck pain, radicular pain and myelopathy. The mean age at time of surgery was 61 years. The mean follow-up time was 54 months. Clinical improvement was obtained in 88% of the patients, whereas 7% were unchanged and 5% had progressive symptoms in spite of surgery. There was no pre-operative or immediate postoperative mortality. In 79 patients, one or more potential surgical risk factors were identified. Twenty-four reoperations were performed in the neck. The most common cause for reoperation was mechanical failure due to wire-break or spinous process fracture. Wound infection in the neck was recorded in 16 patients. Five were deep and required removal of the fixation material. Following OCF, new or progressive subaxial subluxation (SAS) led to further surgery in 4%. The study offers support for the beneficial effect of OCF in rheumatoid AAS. We conclude that, in spite of a number of identified risk factors, OCF with the Brattström-Granholm technique remains a safe and effective method for stabilization of upper cervical subluxations in RA.
8254025 T cell receptor V beta gene bias in rheumatoid arthritis. 1993 Dec Polymerase chain reaction (PCR) technology was employed to examine peripheral blood and synovial T cells in patients with rheumatoid arthritis (RA) for biased utilization of T cell receptor (TCR) variable region (V) genes. Oligonucleotide primers specific for individual TCR V beta gene families were used to amplify TCR gene products in a semiquantitative assay of their relative utilization in unselected T cell populations. Mean V beta expression in 24 RA peripheral blood samples was very similar to that in a panel of 15 normal subjects, except for a slight decrease in V beta 13.2 expression. V beta utilization in 8 RA synovial tissue samples and 13 synovial fluid samples was compared to simultaneously obtained blood samples. Although heterogeneous patterns of skewed V beta utilization were observed, several significant trends emerged. By a number of approaches to data analysis, a statistically significant increase in expression of V beta 6 and V beta 15 in synovial T cells was documented. In addition, increased synovial expression of V beta 14 was found, but only in the synovial fluid samples. Reduced expression of V beta 1, V beta 4, V beta 5.1, V beta 10, V beta 16, and V beta 19 was also observed in synovial T cells. These results indicate that biased V beta gene utilization in different peripheral compartments of RA patients can be observed in unselected T cell populations, and are consistent with the conclusion that populations of T cells expressing these V beta gene products may be involved in the pathogenesis of the disease.
8141560 [Comparative biomechanical evaluation of the immediate stability of three fixators in arth 1993 The best type of osteosynthesis for ankle arthrodesis is controversial. Arthrodesis was performed on 21 cadaveric ankles using either the T-plate compression device, crossed cancellous-bone screws or the Charnley external fixator. The instrumented ankles were tested in five degrees of freedom. Internal fixation was more stable. More specifically, the compression T-plate was the most stable, and the Charnley external fixator was the least stable, for all degrees of freedom tested. In addition to the multiple clinical advantages of internal fixation, the results of our study support its use as a method of obtaining the most stable immediate fixation for ankle arthrodesis.