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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
8053949 Using inhibitors of metalloproteinases to treat arthritis. Easier said than done? 1994 Aug Collagenase and stromelysin have a premier role in the irreversible degradation of the extracellular matrix seen in rheumatic disease. It is therefore no surprise that considerable attention has been devoted to developing strategies to reduce their levels in diseased joints. Most efforts have focused on inhibiting the activity of the enzymes, either by increasing the concentration of natural inhibitors such as the TIMPs or by introducing into the joint synthetic compounds that will complex with the enzymes and inactivate them. There have also been studies directed at inhibiting enzyme synthesis. These preclinical studies have been carried out in cell-free and/or cell culture systems and in animal models. Despite promising preclinical data, there have been no stunning successes in the clinical arena. The reasons for this are several. In part, they are rooted in the technical difficulties associated with designing inhibitors of enzyme activity that are of high affinity, and then delivering them to the affected joints while still maintaining specificity and efficacy. The complicated structure of the proteoglycan and collagen that comprise articular cartilage, along with the biochemistry of inflamed synovial tissue, only compound the difficulties. In addition to these technical problems, the lack of fundamental knowledge about the biochemistry and molecular biology of the enzymes has handicapped our efforts. We are just resolving the crystal structure of the metalloproteinases (108) and beginning to understand the mechanisms controlling gene expression (67, 68, 70-72). These advances represent significant achievements in metalloproteinase enzymology and biology and should form the scientific basis for a new generation of effective therapies. For example, knowledge of the active site as derived from the crystal structure of the enzymes may facilitate the development of tightly-binding specific inhibitors which function well in vivo. Similarly, based on our current understanding of mechanisms controlling the regulation of both the TIMP genes and the MMP genes, we are beginning to elucidate how to turn these genes on or off, and hopefully, to modulate disease accordingly. Indeed, although some studies are still at a preclinical level, these possible approaches are becoming a reality (109). Arthritic diseases in general, and rheumatoid arthritis in particular, represent a complicated multifaceted set of clinical disorders. The clinical symptoms and pathologic features result from a cascade of biologic pathways that involve acute and chronic inflammation, the immune response, and metalloproteinase biochemistry.(ABSTRACT TRUNCATED AT 400 WORDS)
7921763 Cirrhosis in patients with rheumatoid arthritis receiving low dose methotrexate. 1994 Oct We describe three patients with RA who developed cirrhosis while taking low dose methotrexate (MTX). This report includes a review of the risk factors for cirrhosis occurring in association with MTX. Two of these patients were part of a prospective study to quantify changes in pericellular and total collagen in 76 patients with RA receiving low dose pulse MTX, giving a point prevalence of cirrhosis of 2.63%.
8235288 Long-term experience with low dose methotrexate in rheumatoid arthritis. 1993 One hundred twenty-six patients with rheumatoid arthritis (RA) were treated with weekly low doses of methotrexate (MTX) for a mean period of 36.8 months (range 13-110 months). The overall probability of continuing with MTX therapy was 72% at 2 and 3 years, 67% at 4 years and 65% at 5-7 years. Seronegative patients had a higher probability of continuing therapy than seropositive patients (P < 0.05). Out of the whole group, 8% showed no improvement, 16% showed mild improvement, 30% showed moderate improvement, and 45% experienced marked improvement. Eight patients (6%) of the latter group achieved complete clinical remission. In the course of the follow-up period there was a significant decrease in the mean daily dosage of prednisone and NSAIDs. Minor side effects were common (68%), but therapy was discontinued in only 27 patients (21%) because of major complications. In most of them (25 out of 27) these occurred within the first 24 months of therapy. Although malignancy was revealed in 5 patients during the follow-up period, its occurrence did not differ from expected rates.
1535295 Impaired generation of high-affinity interleukin-2 receptors in the autologous mixed lymph 1992 May We examined the expression of high-affinity interleukin (IL)-2 receptors (IL-2R) as well as Tac and HLA-DR antigens on peripheral blood (PB) T cells from 11 rheumatoid arthritis (RA) patients and 8 healthy controls induced in the autologous mixed lymphocyte reaction (AMLR). The proportion of HLA-DR- and Tac-bearing T cells and expression of these activation antigens were higher in patients relative to controls (P less than 0.01) in freshly isolated unstimulated PB mononuclear cells. AMLR stimulation of RA T cells failed to induce an increase in the proportion of HLA-DR and Tac-bearing T cells which was observed in health controls. After AMLR stimulation the number of high-affinity IL-2R were significantly lower in RA patients compared with controls (P less than 0.01). The number of high-affinity IL-2R on patient T cells correlated strongly with AMLR reactivity as measured by [3H]thymidine incorporation (r = 0.821, P = 0.002). The results suggest that the AMLR defect in RA may result from impaired generation of high-affinity IL-2R.
8911730 Significance of serine proteinase and matrix metalloproteinase systems in the destruction 1996 Oct 1. During the destruction of articular cartilage, fibrinolytic enzymes and matrix metalloproteinases (MMP) may contribute to the related pathology. The activities, antigens and messenger RNA (mRNA) levels of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in articular cartilage were measured in patients with no history of joint diseases (control), those with osteoarthritis (OA) classified into osteophyte-formed site (OS) and weight-bearing site (WS), and in patients with rheumatoid arthritis (RA). 2. The uPA content was higher in WS and RA compared to normal. The PAI-1 content was higher in OS and RA compared to normal. Weight-bearing site patients expressed a high uPA mRNA level but a low PAI-1 mRNA level. Osteophyte-formed site patients expressed a low uPA mRNA level but a high PAI-1 mRNA level. 3. The levels of the MMP and mRNA of tissue inhibitors of metalloproteinases (TIMP) were measured in WS, OS, and RA. In WS, the levels of MMP were high and levels of TIMP mRNA expression low. In OS, the levels of TIMP were high and levels of MMP mRNA were low. In RA, the levels of MMP and TIMP mRNA were high. 4. These findings suggest that regulation of fibrinolysis may play an important role in the matrix of articular cartilage with arthropathy.
1386098 Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance 1992 Aug Little is known of clinical disease due to Mycobacterium chelonae chelonae. One hundred skin, soft tissue, or bone isolates of this rapidly growing mycobacterium were identified over 10 years. Clinical disease included disseminated cutaneous infection (53%); localized cellulitis, abscess, or osteomyelitis (35%); and catheter infections (12%). Underlying conditions with disseminated infection included organ transplantation, rheumatoid arthritis, and autoimmune disorders; 92% involved corticosteroid use. Trauma and medical procedures were risk factors for localized infections. Corticosteroids and chronic renal failure were risk factors for catheter infections. Overall, 62% of patients were receiving corticosteroids and 72% were immunosuppressed. MICs of six oral antimicrobials were obtained for 180 isolates by broth microdilution. Up to 20% of isolates were susceptible to doxycycline, ciprofloxacin, ofloxacin, and sulfamethoxazole. In contrast, 100% were susceptible to clarithromycin (MICs less than or equal to 1 microgram/mL). Disease due to M. chelonae chelonae usually occurs in the setting of corticosteroid therapy and is often disseminated; the organisms require high MICs of oral antimicrobials other than clarithromycin.
7987717 [The molecular basis of HLA DR4 alleles associated with rheumatoid arthritis in a Chinese 1994 Jul HLA-DR4 gene was studied by polymerase chain reaction method in 95 patients with rheumatoid arthritis(RA) and 130 normal controls in a Shanghai population. The results showed that the DR4 was significantly associated with RA(RR = 3.1, chi 2 = 13.8, P < 0.005). The second exon of DR4 gene was also analysed by PCR-RFLP technique. There were at lest eight DR4 subtypes in this Chinese population. The DRB1 *0405 (Dw15) was the most common allele, accounting for 48% of DR4 positive normal individuals and also is a principal subtype associated with RA susceptibility (RR = 3.1, P < 0.005). Analysis of the third hyperpolymorphic region of DR4 positive samples showed that 92% of patients had a sequence encoding amino acids RRAA or KRAA compared with 56% of the DR4 positive controls (chi 2 = 10.29 P < 0.005). All subtypes that were positively associated with RA susceptibility had the RRAA (DRB1* 0404, 0405. 0408 and 0410) or KRAA (DRB1 * 0401) sequences, while the negatively associated ones (DRB1 0402, 0403 and 0406) had not. As a further evidence, it strongly supported the "shared epitope" hypothesis. The different DR4 subtype structures and frequencies may account for the different associations of DR4 with RA in various ethnic groups.
8886088 Joint fluid carboxy-terminal type II procollagen peptide as a marker of cartilage collagen 1993 Apr Joint fluid levels of carboxy-terminal type II procollagen peptide (pCOL II-C) were measured in osteoarthritis, rheumatoid arthritis and traumatic arthritis by a newly developed one-step enzyme immunoassay (EIA). The detection limit of the new method was as low as 0.2 ng/ml. The levels of pCOL II-C were significantly (P < 0.001) higher in osteoarthritis and traumatic arthritis than in rheumatoid arthritis. In osteoarthritis, pCOL II-C levels were higher in moderately afflicted patients. Since type II collagen is a unique component of cartilage, pCOL II-C levels in joint fluids could reflect the synthetic activity of type II collagen of chondrocytes in the diseased joint and therefore could be utilized as a simple marker of type II collagen synthesis in articular cartilage in joint diseases.
8539375 Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging. 1996 Jan PURPOSE: To investigate the role of magnetic resonance (MR) imaging in diagnosing early rheumatoid arthritis (RA). MATERIALS AND METHODS: Twenty patients (three men, 17 women; age range, 21-72 years) with clinically and radiologically proved RA underwent evaluation to define an MR imaging criterion for diagnosing synovial inflammation due to RA. Twenty-seven patients (16 with RA, 11 without RA [control patients]; three men, 24 women; age range, 19-75 years) suspected to have early RA but without radiographic abnormalities underwent evaluation to test the accuracy of using the criterion to diagnose RA. In each patient, coronal, fat-suppressed, and gadolinium contrast material-enhanced, T1-weighted images of both hands were obtained. RESULTS: The MR imaging criterion was periarticular contrast material enhancement of the wrists or the metacarpophalangeal and/or proximal interphalangeal joints in both hands. In the diagnosis of early RA, sensitivity and negative predictive value were both 100%, specificity was 73%, and accuracy was 89%. CONCLUSION: MR imaging is extremely useful in diagnosing early RA.
8569477 Low occurrence of arthritic manifestations in patients with pulmonary tuberculosis. T cell 1995 Sep Given the suspected role of mycobacteria in the establishment of disorders with an autoimmune background and joint damage, a study was conducted to analyze whether rheumatic symptoms were likely to be present in tuberculosis (TB) patients. To this end, 330 patients with a bacteriologic confirmation of tuberculosis were investigated for the presence of arthritic complaints. The latter were recorded in five of them with rheumatic symptoms mostly involving interphalangeal and metacarpophalangeal joints, and preceding the clinical manifestations of the TB illness. Three out of these five patients remained arthritic by the time of the bacteriologic conversion and fulfilled the criteria for the diagnosis of rheumatoid arthritis. In the two remaining patients sputum negativization was accompanied by a disappearance of rheumatic manifestations. These patients were also assessed for their peripheral levels of major T cell subsets as well as for the presence of autoantibodies. Comparisons with a series of non-arthritic TB cases, rheumatoid arthritis patients, and controls revealed that presence of rheumatic manifestations was associated with a different profile of autoantibody formation and T cell subset changes. Evidence recorded in the present study indicates that joint affectation in TB is a rare event, being rather the exception than the rule.
8507222 Differential effects of diclofenac and aspirin on serum glutamic oxaloacetic transaminase 1993 Jun OBJECTIVE: To examine elevations in levels of serum glutamic oxaloacetic transaminase (SGOT) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) taking placebo, aspirin, or diclofenac, and to seek possible explanations for the occurrence of these elevations. METHODS: We conducted a meta-analysis of individual case reports from 3 RA protocols and 5 OA protocols, encompassing 814 diclofenac-treated patients, 443 aspirin-treated patients, and 359 placebo-treated patients. All of the RA protocols had nearly identical inclusion and exclusion criteria, as well as safety studies and followup; the same was true for the OA protocols. Analysis included correlation analysis and multiple linear and logistic regression, accounting for numerous potential confounding variables, with the SGOT as the dependent variable. F tests were used for hypothesis testing. RESULTS: By several analytic approaches, the principal determinants of SGOT concentrations were found to be baseline SGOT value, the use of aspirin in RA patients, and the use of diclofenac in OA patients. Other significant factors contributing to an increase in SGOT concentrations were duration of therapy and, perhaps, daily dosage (mg/lb). Hypothesis testing supported these results. Given a statistically average patient, we predicted a 1-2% chance of a mildly elevated SGOT level occurring among placebo-treated patients, a 6-7% chance among diclofenac- or aspirin-treated patients with RA, a 12% chance among diclofenac-treated patients with OA, and a 2% chance among aspirin-treated patients with OA. CONCLUSION: This study demonstrates a powerful method for performing meta-analysis, using available individual patient data to examine numerous factors that may affect an outcome of interest. In this case, mild elevations of SGOT were examined and found to be related to baseline SGOT levels, diclofenac use (in OA), and aspirin use (in RA). Of numerous other potential factors examined, including age, sex, alcohol use, concomitant medications, and concomitant diagnoses, only duration of therapy and, to a small extent, daily dosage, were also consistent determinants of SGOT elevation. The SGOT elevations were minimal and were not related to the occurrence of clinical hepatitis: No clinical hepatitis occurred.
7960380 Mortality from rheumatoid arthritis in France, 1970-1990. 1994 Jun BACKGROUND: The degree to which rheumatoid arthritis (RA) influences life expectancy and mortality remains controversial. There have been few attempts to analyse death certificate data for this condition. Despite limitations, the information derived from detailed death certificate analysis for a large population over a long period allows the examination of aspects of the disease process and its impact. METHODS: The mortality related to RA in France was investigated for 1970-1990 inclusive. A multiple cause of death analysis was conducted, based on information recorded in death certificates. RESULTS: Death from RA represented 0.22% of all deaths. Mortality due to RA was strongly influenced by sex (female/male ratio of number of deaths = 3.3) and age (proportional mortality ratios higher in the 65-74 and 75-84 year age groups). In women, the mean age at death for RA was slightly lower than the mean age at death from all causes, while the difference was clearly opposite in men. The impact of RA remained relatively constant during the study period, both in terms of proportional mortality and age at death. The analysis of associated causes of death did not yield significant changes in the pattern of death from RA. CONCLUSIONS: The study demonstrates the significant and relatively constant impact of RA on mortality in France over the study period. This suggests that the introduction of new treatment regimens or other environmental factors has had little influence on the impact of RA mortality in the community.
9091957 [Etiopathogenesis of rheumatoid arthritis]. 1996 Rheumatoid arthritis is a disease, which etiopathogenesis depends on genetic and environment factors. Little is the progress of knowledge the environment factors but the strong is association with HLA DR4/DR1. The hypothesis being proposed is that RA is a chronic immune-mediated disease whose initiation and perpetuation is dependent on T-cell CD4 helper is connected by activation monocyte/macrophage cells which per production proteolytic enzymes and prostaglandins way to local inflammation and destruction articular cartilage and bone. Lymphocytes B proliferate to plasmocytes, which produce rheumatoid factor and other antibodies. Production of antibodies leads to production immune complexes, activation complement and migration and activation granulocytes. In the end of the process of RA occurs destruction articular cartilage and osteoclasts activated to erode bone together with mastocytes and growing pannus leads to synostosis. Like self perpetuation inflammation never disappears.
8591645 The epidemiology of drug treatment failure in rheumatoid arthritis. 1995 Nov The length of time that patients remain on anti-rheumatic therapy is an important measure of the effectiveness of that therapy since length of time on therapy is a composite measure that accounts for sustained, positive therapeutic benefit as well as negative therapeutic benefit (e.g. adverse reactions, unacceptable costs and loss of efficacy), and accounts for noise (non-compliance, psychological factors, misunderstanding, etc.). Effectiveness is a measure of how well a drug does work, while efficacy, the measure used in randomized controlled trials, means that a drug can work; however, efficacy may or may not translate to usefulness in the clinic. To understand drug effectiveness we reviewed studies of 5809 patients receiving various SMARDs. The average median time on drug ranged from 1.10 to 2.27 years, excluding methotrexate, with shortest survival times falling to sulfasalazine (1.10) and auranofin (1.16), intermediate times to hydroxychloroquine (1.59), penicillamine (1.42), IM gold (1.40), and the longest time to azathioprine (2.27). Overall, excluding methotrexate, the average median survival time was 1.41 for 3998 patients. Median time on drug was 3.3 times greater for all other drugs combined, averaging 4.61 years. Expressed in terms of '5-year survival,' an average of 55.7% of patients remained on methotrexate 5 years after it was started. Better results noted here for methotrexate stand in contradistinction to short-term randomized controlled trials which find most SMARDs to be equal in efficacy. Other factors that may influence drug survival time include age, age, education level, psychological status, presence of fibromyalgia, rank order of SMARD administration, disease severity or corticosteroid administration. Studies can provide more information if they also measure clinical variables as well as time on drug, providing area-under-the-curve measurements.
8477862 Inactivation of synovial fluid alpha 1-antitrypsin by exercise of the inflamed rheumatoid 1993 Apr 26 alpha 1-Antitrypsin (alpha 1AT) is known to be oxidised by reactive oxygen species both in vitro and in vivo, leading to its inactivation. We report here that synovial fluid (SF) alpha 1AT is inactivated during exercise of the knee-joints of rheumatoid arthritis (RA) patients. Sequential SF sampling from exercised RA patients showed a marked decrease in the mean activity of alpha 1AT after exercise with no change in the molecular forms of alpha 1AT. No such inactivation was found in the control (continuously resting) RA patients. We suggest that oxidation may contribute to alpha 1AT inactivation as a consequence of 'hypoxic-reperfusion' injury after exercise of the inflamed joint.
7610428 The measurement of social support in the 'European Research on Incapacitating Diseases and 1995 May Social support is supposed to have a beneficial effect on the health and wellbeing of people. It is a central concept in the 'EUropean Research on Incapacitating DIseases and Social Support' (EURIDISS). In general, two main distinctions concerning social support are made in the literature, providing four basic dimensions or types of social support: a social-emotional vs an instrumental type of social support, and a 'crisis' or 'problem-oriented' vs 'everyday' or 'daily' type of social support. Based on these types of social support, a series of items were formulated to measure actual supportive interactions or exchanges of resources. The items were spread over five scales. The social-emotional type of social support comprised three scales: daily emotional support; problem-oriented emotional support; and social companionship, while the instrumental type of social support consisted of two scales: the daily instrumental support and the problem-oriented instrumental support. Together, these items and scales constitute the so-called 'Social Support Questionnaire for Transactions' (SSQT). The main objective of this paper is to investigate whether one and the same instrument, i.e. the SSQT, allows for meaningful comparisons between patients with rheumatoid arthritis from different countries. More specifically, the dimensionality and invariance of the dimensions across countries of the SSQT are explored. To this end, patients from four different European countries (France, Norway, The Netherlands and Sweden) were asked to fill in the SSQT. The analysis of the data using principal component analysis (PCA) and simultaneous component analysis (SCA), did yield the intended scales, although the internal consistency of one of them, the daily instrumental support scale, is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)
7512531 Isolation and characterization of a cartilage-specific membrane antigen (CH65): comparison 1994 Feb We report the isolation and characterization of a 65,000 MW chondrocyte autoantigen (CH65) which may be involved in rheumatoid arthritis. This chondrocyte-specific antigen reacted with sera from patients with rheumatoid arthritis (RA). CH65 did not cross-react with a polyclonal antibody raised against microbial heat-shock protein (hsp) 65, anti-human hsp 65 monoclonal antibodies (mAb) (LK1 and LK2), anti-microbial hsp 65 mAb (IA10, IIC8 and WTB-78H1) and anti-cytokeratin 8, 18, 19 mAb (NCL5D3MAb). CH65 could be purified from chicken chondrocyte membranes by ammonium sulphate precipitation and a novel electro-gel-filtration method. The amino acid analysis yielded an unusually high degree of glycine, serine and asparagine residues. The internal amino acid sequence obtained by tryptic digestion revealed homologies with the cytokeratin family. Despite these homologies, CH65 lacked immunological cross-reactivity with commercial anti-cytokeratin antibodies. Mice mAb generated against the purified CH65 (C6) were used to identify the protein as a tissue-specific constitutive protein membrane from chondrocytes. Sera from patients with RA cross-reacted with purified CH65. The stress or heat-shock protein (hsp 65), implicated in the development of experimental and clinical arthritis, showed no immunological cross-reactivity with CH65 in Western blots. These findings suggest that CH65 may represent an interesting cartilage-specific new antigen in RA. The availability of this antigen in purified form and specific mAb may offer useful tools in arthritis research.
8838504 Tenidap reduces the level of interleukin 1 receptors and collagenase expression in human a 1996 Jan OBJECTIVE: To investigate the effects of tenidap, a new antirheumatic drug, sodium diclofenac, a non-steroidal antiinflammatory drug, and a disease modifying antirheumatic drug, hydroxychloroquine, on the level and expression of interleukin 1 receptors (IL-1R) on synovial fibroblasts from patients with osteoarthritis (OA) and rheumatoid arthritis (RA). In addition, the effect of tenidap on IL-1 stimulated collagenase gene expression was studied. METHODS: Binding assays were performed using [125I]-IL-1 beta as radioligand. Flow cytometry was done using a specific antibody against type I IL-1R. Protein synthesis was determined by [3H]-leucine incorporation. Levels of expression were determined by Northern Blot for collagenase and by reverse transcription polymerase chain reaction (RT-PCR) for type I IL-1R. RESULTS: Tenidap produced for both OA and RA synovial fibroblasts a dose dependent decrease in the number of IL-1 binding sites/cell. A reduction of 41% (2.5 micrograms/ml) to 81% (at therapeutic concentration, 20 micrograms/ml) was noted for OA, while 29% (2.5 micrograms/ml) to 89% (20 micrograms/ml) was found for RA cells. Diclofenac produced no effect on OA cells, and minimal inhibition of RA synovial fibroblasts was observed only at pharmacological concentration (12%, 300 mg/ml). Hydroxychloroquine had effects similar to diclofenac. The decreased number of IL-1 binding sites/cell by tenidap was time dependent and reached 93% inhibition after 48 h. The effect of tenidap appears to be posttranscriptional, judged by the marked reduction of the type I IL-1R protein/cell and the absence of effect on its mRNA level. Tenidap also markedly reduced the IL-1 induced collagenase expression in synovial fibroblasts. CONCLUSION: At therapeutic concentrations tenidap is a potent inhibitor of type I IL-1R in OA and RA synovial fibroblasts. The effect of tenidap was considerably more marked than diclofenac or hydroxychloroquine.
7837332 Prospective sonographic and arthroscopic evaluation of proliferative knee joint synovitis. 1994 Nov The objective of this study was to verify the accuracy of ultrasonography in assessing the topography, morphology, and extent of synovial proliferation in rheumatoid and psoriatic knee joint synovitis. Findings were compared to those obtained using prospective arthroscopy as the gold standard; in addition, topographically defined sonographic findings before and after arthroscopic synovectomy were compared. Sonographic examination was performed in 12 patients with rheumatoid arthritis (13 knees) and 13 patients with psoriatic arthritis (14 knees) who had synovitis of the knee using an electronic linear transducer (7.5 MHz) or a mechanical sector transducer (10 MHz). This examination was followed within 1 week by arthroscopy, to compare the topography (intra-articular localization) and the morphology (sonographic patterns) of synovial proliferation. In 15 knees undergoing arthroscopic synovectomy, preoperative sonographic measurement of synovial thickness in the suprapatellar, medial parapatellar, and lateral parapatellar recesses was compared with arthroscopic visualization of synovial proliferation; 13 knees were reevaluated 2 months after arthroscopic synovectomy by sonography at the same sites. Three distinct sonographic patterns of synovial proliferation were confirmed by arthroscopic examination: a villonodular aspect in 12 knees; uniform thickening in eight knees, and overlapping layers in seven knees. About 50% of the knees showed more than one sonographic pattern, with no differences in pattern distribution between rheumatoid arthritis and psoriatic arthritis patients. A significant correlation was found between sonographic and arthroscopic evaluations of synovial thickness in the suprapatellar (P < 0.02) and medial parapateoffr recesses (P < 0.02), the sites of maximal synovial proliferation in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)
8938868 Four new cases of collagenous colitis with joint symptoms. 1996 Oct Collagenous colitis is characterized by chronic watery diarrhea and a greater than 10 micron-thick collagen deposit in the subepithelial layer of the colonic mucosa. Rheumatic and autoimmune diseases have been reported to occur in patients with collagenous colitis. In 1993, we managed four patients with collagenous colitis and joint diseases. One had rheumatoid arthritis, one had a spondylarthropathy and two had seronegative polyarthritis without joint destruction. Three patients had dryness of the eyes and/or mouth and two had Raynaud's phenomenon. These four cases and data from a literature review provide a basis for discussing possible links between collagenous colitis and a number of joint diseases. Although some anecdotal case-reports may reflect a chance association with inflammatory joint diseases, available evidence suggests that collagenous colitis may be a cause of enteropathic arthropathy. Recent data point to an abnormality in the differentiation of fibroblasts in the colonic mucosa, although the mechanism that initiates this abnormality remains unknown.