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ID PMID Title PublicationDate abstract
8796978 Biologic agents in the treatment of inflammatory rheumatic diseases. 1996 May As in previous years, throughout 1995 biologic agents have been explored and tested in open and controlled clinical trials with regard to their efficacy in treating autoimmune rheumatic diseases, especially rheumatoid arthritis. Promising data have been collected from a placebo-controlled double-blind four-center study of a monoclonal anti-tumor necrosis factor-alpha antibody in rheumatoid arthritis patients. This type of treatment was demonstrated for the first time to effectively interfere with ongoing inflammatory processes in this disease entity. That anti-tumor necrosis factor-alpha treatment principles are of clinical value has also been shown in open trials applying tumor necrosis factor receptor constructs. Although undoubtedly the progress in the development of biologic agents for the treatment of inflammatory rheumatic diseases is steadily improving, new and unexpected side effects must be carefully controlled.
7631031 Why should rheumatologists collect patient self-report questionnaires in routine rheumatol 1995 May In this article, a rationale for routine use of self-report questionnaires in rheumatology clinical care is presented. Studies performed according to structured clinical research methodologies, including population-based studies, inception cohort studies, randomized controlled clinical trials, and meta-analyses of these trials, have significant limitations in describing accurately the long-term natural history and results of treatment of rheumatoid arthritis; the most accurate data have been derived from clinical observations of consecutive, nonselected patients in routine clinical settings. Self-report questionnaires provide accurate and representative data concerning clinical status and traditional laboratory and variables in large numbers of patients can be developed using microcomputer hardware and software available only over the last decade. Further collection of self-report data in rheumatology clinical care should result in more informative descriptions of the long-term natural history and results of therapy in rheumatoid arthritis.
1543668 Endocrine disorders. 1992 Feb The effect of thyroxine replacement therapy on bone mass continues to attract attention. Although the advice of the American Thyroid Association to normalize serum thyroxine and thyroid-stimulating hormone concentrations is recommended, even physiologic doses of thyroxine may have an adverse effect on bone mass. The diagnosis and treatment of osteomyelitis in the diabetic foot is aided by magnetic resonance imaging, and long-term review of cases of diabetic femoral neuropathy emphasizes the good prognosis. Adrenal insufficiency as a complication of antiphospholipid syndrome is reviewed, and a useful physical sign, the acromegalic rosary, rediscovered. The association of sex steroids, oral contraception, and parity with rheumatoid arthritis is discussed. The outcome of pregnancy in women with juvenile rheumatoid arthritis is good, and quiescent disease does not appear to be permanently reactivated. Calcium deficiency, rather than vitamin D deficiency, is a cause of rickets in some Nigerian children.
8559150 Structural, immunological and functional comparisons of factor H, rheumatoid arthritis pro 1995 Nov The isolation and characterization of two human serum proteins, RHP and N-RHP, are described. N-RHP appears to be the normal counterpart of RHP which is found at elevated levels in sera of patients with rheumatoid arthritis [Rosano et al. (1988b) Inflammation 12, 351 - 360]. Although both proteins crossreact with anti-Factor H and have identical N-terminal amino acid sequences, they differ from Factor H in pI, solubility at low ionic strength, and in glycosylation. RHP differs from Factor H and N-RHP in antigenicity in the rabbit, in effect on the C1q-anti-C1q precipitin reaction, and in ability to disaggregate C1, the first component of the complement system. Removal of RHP, N-RHP and Factor H from binding to C1q is a prerequesite for separation of RHP and N-RHP from Factor H by anion exchange chromatography and isoelectric focusing. The finding of uniquely demonstrable RHP activity (enhancement of C1q-anti-C1q precipitin activity) in unfractionated sera from patients with rheumatoid arthritis, but not in normal sera, suggests that RHP is not an artefact of Factor H produced during isolation.
8512765 Immunosuppressive drug therapy for rheumatic disease. 1993 May The role of intravenous and oral cyclophosphamide in treating systemic lupus and Wegener's granulomatosis was examined in several large studies during the past year. Oral cyclophosphamide for 2 months followed by prednisone alone was relatively ineffective in preventing disease progression in lupus nephritis patients with initially abnormal serum creatinine values. A controlled trial in which three regimens for treating lupus nephritis were compared resulted in superiority of long-term intravenous cyclophosphamide therapy over pulse prednisone or short-term intravenous cyclophosphamide. Two open studies describe treatment of neuropsychiatric lupus with pulse cyclophosphamide. Patients with clinical evidence of inflammatory disease of the central nervous system appeared to respond to this therapy even if antiphospholipid antibodies were present. Analysis of a large cohort of patients with Wegener's granulomatosis showed a high incidence of cancer at long-term follow-up as well as a high incidence of recurrence, often several years after induction of remission with cyclophosphamide plus prednisone. Much progress was made in defining the mechanisms of action of cyclosporine. Additional studies examine the role of cyclosporine in necrotizing scleritis complicating rheumatoid arthritis. Concomitant administration of nonsteroidal anti-inflammatory drugs and cyclosporine to rheumatoid arthritis patients resulted in increased short-term deterioration of renal function. Studies of patients with various autoimmune diseases showed an association of the mean, maximal, and cumulative doses of cyclosporine with biopsy-proven nephropathy. Cytarabine was tried at low doses in the treatment of rheumatoid arthritis with improvement in some patients.
8371498 [Recent problems in laboratory tests for rheumatoid factor]. 1993 Aug Conventional laboratory tests for detection of rheumatoid factor (RF) have changed because of the demands of recently-developed rheumatologic therapy. Quantitative analysis of the RA test by turbidimetry and nepherometry of latex agglutination or turbidity immunoassay (TIA) was recently introduced and popularized in Japan. Although the RF standards provided by WHO have become quite common, RF values obtained by quantitative analysis in various laboratories are not consistent with each other. We established a murine monoclonal rheumatoid factor (mRF) and recommend this as the national RF standard to replace the WHO standard. We believe that the RF titer of a clinical serum should be expressed as the corresponding concentration of mRF which agglutinates IgG-coated latex to the same degree as the serum in quantitative analysis. When possible, inconsistency of RF titers among various laboratories must be eliminated. Detection of IgG-RF has recently been included among tests available for medical insurance reimbursement. The test is very useful to diagnose malignant rheumatoid arthritis associated with vascular damage and extra-articular disorders.
9746657 Autoimmunity: The Female Connection. 1996 Nov The prevalence of autoimmune diseases in women may be the consequence of a bidirectional signaling network between hormones and the immune system that regulates female reproductive life. Two prototypical autoimmune diseases, rheumatoid arthritis and systemic lupus erythematosus, arise from 2 different immune responses that generate mutually exclusive signals in response to different inflammatory triggers. Certain estrogens may ameliorate the rheumatoid-arthritis-like TH1 response while exacerbating the lupus-like TH2 response. Studies of sex hormone metabolism in lupus patients reveal increased 16-hydroxylation of estrone in some patients and decreased levels of androgens as a result of increased oxidation at C17. These occurrences result in low serum levels of dehydroepiandrosterone (DHEA). Both the increase of 16-hydroxylation of estrone and the depletion of DHEA have immune effects that would tend to exacerbate a lupus-like TH2 response. This theoretical framework provides a rationale for ongoing initial clinical trials of exogenous hormones in autoimmune diseases.
7870631 Corticosteroids: do they damage the cardiovascular system? 1994 Dec Since their introduction for the treatment of rheumatoid arthritis, corticosteroids have become widely used as effective agents in the control of inflammatory diseases. Although there have been undoubted benefits upon mortality in diseases such as systemic lupus erythematosus, many patients survive only to suffer a high incidence of premature atherosclerosis. There is also evidence of increased rates of vascular mortality in other corticosteroid-treated diseases, such as rheumatoid arthritis, reversible airways obstruction and transplant recipients. Possible mechanisms of damage include elevated blood pressure, impaired glucose tolerance, dyslipidaemia, and imbalances in thrombosis and fibrinolysis. This paper reviews the clinical evidence supporting the contention that there is an excess cardiovascular mortality in steroid-treated patients and the underlying mechanisms, and points to further areas of research.
1401015 Surface immunofluorescence assay for diagnosis of Lyme disease. 1992 Sep A surface immunofluorescence assay (SIFA) was analyzed and compared with a conventional indirect immunofluorescence assay (IFA) and whole-cell enzyme-linked immunosorbent assay (ELISA) for detecting immunoglobulin G (IgG) antibodies to Borrelia burgdorferi in sera from patients with Lyme disease. Fifty-five patients with syphilis and 33 patients with rheumatoid arthritis were used as disease controls. The sensitivity of the SIFA was low during the acute phase of Lyme disease (sera from seven of nine patients presenting with erythema chronicum migrans were negative during the first 2 months of illness); later, seroconversion was observed in all patients at various times during convalescence. Sera from five patients with complicated Lyme disease were strongly positive. SIFA was found to be highly specific, since sera from all patients with secondary or latent syphilis and patients with rheumatoid arthritis did not react in the test. Strong cross-reactivity occurred when these sera were tested in conventional IFA and ELISA; sera from 38 (69%) patients with syphilis were positive by IFA and sera from 51 (93%) patients were positive by ELISA, whereas 7 (21%) and 12 (36%) of the serum samples from patients with rheumatoid arthritis were positive by IFA and ELISA, respectively. Immunoblot analysis of SIFA-positive sera showed that the 31- and 34-kDa outer surface proteins (proteins A and B, respectively) of B. burgdorferi were the major reactive antigens involved in the test. The results support a role for SIFA in the investigation of complicated Lyme disease as well as in the differentiation of Lyme disease from other diseases associated with B. burgdorferi cross-reactive antibodies.
1434881 Conditions associated with carpal tunnel syndrome. 1992 Jun With use of a comprehensive medical records-linkage system, we identified the comorbid conditions and risk factors in the residents of Rochester, Minnesota, who had a diagnosis of carpal tunnel syndrome during 1961 through 1980. In 43.2% of the 1,016 patients, no associated conditions were found on review of the medical records, whereas associated conditions were documented in 56.8%. The most frequent of these conditions were Colles' fracture, rheumatoid arthritis, hormonal agents or oophorectomy (or both), diabetes mellitus, and, among men, occupations that involved excessive use of the hands. Rheumatoid arthritis, diabetes mellitus, and pregnancy were significantly more frequent among the study patients with carpal tunnel syndrome than in the general population of Rochester, Minnesota. The standardized morbidity ratio was 3.6 for rheumatoid arthritis, 2.3 for diabetes mellitus, and 2.5 for pregnancy. The population attributable risk for pregnancy among women 15 to 44 years old was 7.0%. The standardized morbidity ratio for polymyalgia rheumatica was not significantly increased.
29542458 Peripheral neuropathy due to rheumatoid vasculitis : a clinical neuro-electrophysiological 1996 Apr Peripheral neuropathy is an important manifestation of rheumatoid vasculiitis. It occurs in severe, long standing, seropositive, nodular, erosive rheumatoid arthritis (RA). A 56 year old female patient with fulminant RA, who developed a mononeuritismultiplex evolving into an asymmetrical neuropathy is described. The technique and utility of superficial peroneal nerve biopsy in patients with systemic vasculitis is discussed.
8668620 Unusual presentations of gout. Tips for accurate diagnosis. 1996 Jul In cases of unusual presentations, such as the three cases described here, gout or gouty arthritis may be misdiagnosed as rheumatoid arthritis, septic arthritis, or other rheumatic conditions and thus inappropriately treated. Microscopic analysis using compensated polarized light and culture of synovial fluid helps distinguish gouty arthritis from other arthropathies, and the presence of monosodium urate crystals establishes the diagnosis of gout. When gout is suspected, yet the initial examination does not reveal the telltale crystals, reexamination of synovial fluid is warranted. It is important for physicians to remember, though, that diagnosis of gout does not rule out the possibility of concurrent arthritic conditions.
8184597 Prospective evaluation of the chemiluminescence test for the detection of granulocyte anti 1994 A series of 213 neutropenic patients were tested for the presence of granulocyte antibodies using the granulocyte chemiluminescence test (GCLT) and the granulocyte immunofluorescence test (GIFT). Sera containing lymphocyte (HLA) antibodies were excluded from the study. A direct GIFT was performed on granulocytes from 56 patients. Samples were obtained from patients with a range of clinical conditions including primary adult autoimmune neutropenia, autoimmune neutropenia of infancy, autoimmune neutropenia secondary to Felty's syndrome, rheumatoid arthritis, idiopathic thrombocytopenic purpura, systemic lupus erythematosus, proliferative disorders, bone marrow transplantation and patients with documented febrile or pulmonary transfusion reactions. Overall, granulocyte antibodies were detected in 52.1% of patient sera. Results for the GCLT and GIFT (IgG) were strongly correlated (p < 0.001) for both primary and secondary immune neutropenias. The results confirm the applicability of the GCLT in the granulocyte serology laboratory.
8639171 Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthr 1996 May OBJECTIVE: To identify mechanisms of the osteopenia associated with juvenile rheumatoid arthritis (JRA) by determining parameters of bone mineralization, and bone mineral content and density (BMC and BMD), in children with JRA. METHODS: BMC and BMD were measured by dual x-ray absorptiometry in 41 children with JRA and 62 healthy children. Serum samples were analyzed for concentrations of minerals, vitamin D, parathyroid hormone, osteocalcin, bone-specific alkaline phosphatase (BAP), procollagen I carboxy-terminal propeptide, and tartrate-resistant acid phosphatase (TRAP), and urinary excretion of deoxypyridinoline crosslinks and calcium. RESULTS: BMD was decreased in all sites in JRA patients. BMD, corrected for age, height, weight, and bone area, was decreased at cortical bone sites (1/3 radius, upper and lower extremities, and whole body). Low concentrations of osteocalcin and BAP suggested reduced bone formation, and low TRAP levels suggested decreased resorption. Clinical scales of disease severity were negatively correlated with measures of bone mass. Laboratory markers of disease severity were highly correlated with decreases in markers of bone formation, but not with those of resorption. Although laboratory findings were similar for children with oligoarticular and polyarticular disease, differences in bone mass were greater in children with polyarticular disease. CONCLUSION: These data suggest an association between decreased bone mineralization in JRA and low bone formation that is related to disease severity. Efforts to stimulate bone formation, therefore, need to be considered clinically in prepubertal children with active JRA.
7653943 Central nervous system disease in Sjögren's syndrome. 1995 Our prospective study consisted of a general and neurological evaluation in 48 patients (41 females, 7 males; mean age: 58.2 years) with primary Sjögren's syndrome (PSS). We performed serologic studies and cranial magnetic resonance imaging (MRI). Main extraglandular features were arthralgias and non-erosive arthritis (37.5%). Raynaud (21%) and pulmonary fibrosis (12.5%). Antinuclear antibodies were positive in 42.5% and anti-SS-A (Ro) in 20%. Migraine (52%), neuropsychiatric disease (29%) and a past history of focal acute neurological deficits (23%), were the central nervous system (CNS) manifestations more frequently observed. Cranial MRI examination detected hyperintense small subcortical lesions in 51.3% of patients and in 36.6% of age and sex matched controls (P < 0.001). CNS disease was not serious concerning vital prognosis, but produced significant morbidity in some patients. Late onset "migraine-like" episodes with prolonged sensoromotor deficits and coexisting neuropsychiatric disease emerged as a characteristic clinical spectrum in those patients diagnosed in a neurological setting. Cranial MRI was frequently abnormal, but findings were not specific. Neurologic manifestations reminiscent of multiple sclerosis were rarely seen.
8151575 Nodular regenerative hyperplasia of the liver and primary Sjögren's syndrome. 1994 Jan Nodular regenerative hyperplasia (NRH) of the liver is a rare entity associated with autoimmune diseases, hematologic disorders and therapy with immunosuppressive agents. We describe a patient with primary Sjögren's syndrome and NRH of the liver, the first report of this association. The pathogenesis of NRH is not clear, but the presence of some type of circulatory disorder is suspected.
8506054 [Salivary immunoglobulins in the diagnosis of primary Sjögren's syndrome]. 1993 Apr The salivary concentrations of immunoglobulins and total proteins and the salivary flow rate (measured by the method of Deniker et al.) were determined in 29 patients with keratoconjunctivitis sicca and xerostomia and in 11 healthy subjects. According to Fox criteria the group pf 29 patients was divided into two groups: 14 patients with primary Sjögren's syndrome (pSS) and 15 patients with sicca syndrome (SS). The IgA salivary levels were significantly higher in the patients with pSS than in the patients with SS (p < 0.05) and in the healthy subjects (p < 0.001). Moreover the IgG and IgM salivary levels in the first group of patients were higher than in the group of patients suffering from sicca syndrome (p < 0.05) and in the control group (p < 0.02). The salivary flow rate of the patients with pSS and sicca syndrome was lower when compared with the control group (p < 0.005). No significant correlation was found between the salivary flow rate and the immunoglobulins in the three groups of patients. The salivary flow was inversely correlated (p < 0.01) only with the IgA levels in all 40 subjects. The salivary total proteins were significantly elevated in pSS patients when compared with the SS patients (p < 0.04) and with the control group (p < 0.01). The immunoglobulins/total proteins ratios in saliva were significantly higher in the first group than in the other groups (p < 0.005) for the IgG and in the first group than in the SS patients (p < 0.05) for the IgM; no significant differences were noted for the IgA. The bioptic focus scores, graded according Greenspan's criteria, of minor salivary glands of 20 patients with pSS or sicca syndrome were directly correlated with a high significance (p < 0.001) to IgG salivary levels and with a lower significance (p < 0.05) with IgM salivary levels. No significant correlation was found between the bioptic focus scores and the IgA levels. The present results demonstrated a high specificity (100%) and a good sensitivity (86%) of the assessment of salivary IgG for the diagnosis of pSS. The sensitivity of the salivary levels of IgA was higher than that of IgG (93%) but the specificity was low (50%); on the contrary the specificity of the assessment of salivary IgM was good (92%) but the sensitivity was low (60%). This study therefore indicated that the assessment of salivary IgG has a great value for the diagnosis of pSS because IgG levels are related to the amount of lymphoplasmocytic infiltration.(ABSTRACT TRUNCATED AT 400 WORDS)
1582341 [The manifestations of the nervous system in primary Sjogren syndrome]. 1992 Oct We reported 9 cases of primary Sjogren syndrome (SS) who were complicated with nervous system involvement. All were women. Age between 24 to 58 years old. Their clinical symptoms of the nervous system varied widely, 7 of them manifested with the involvement of central nervous system, the main features were in case 1 bouts of seizures, case 2 multi-level damage of the brain and spinal cord which was similar to multiple sclerosis, case 3 recurrent hemiplegia caused by cerebral thrombosis then fatal vascular hemorrhage, case 4 sudden hemiplegia, case 5 persistent psychological disturbance, case 6 cranial neuropathy of V and VII, case 9 multi-focal symptoms of ataxia, myelopathy and transient blindness. 5 of the 9, case 3, 6-9 all appeared with the symptoms of peripheral neuropathy, case 7 also complicated with carpal tunnel syndrome. 4 of the 9 cases also complicated with renal tubular acidosis and/or chronic active hepatitis and/or fibrosing alveolitis and/or thrombocytopenic purpura and/or myositis. No differences of the positivity of autoantibodies was observed between those with or without nervous system involvement.
7944621 Serial measurements of soluble interleukin 2 receptor levels (sIL2-R) in children with juv 1994 Jul OBJECTIVE: To investigate the potential clinical utility of serial levels of sIL2-R as a marker of disease activity among children with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX). METHODS: sIL2-R levels, measured by ELISA, were evaluated in 16 JRA patients (10 polyarticular, six systemic-onset) treated with oral, weekly MTX. sIL2-R values were compared with those of 49 normal controls. Medical record review was used to obtain relevant clinical data. Joint counts (number of swollen joints) were used as indicators of clinical change. A reduction of 50% in joint counts between pre and post treatment measurements was considered a clinically significant response. RESULTS: The mean (SEM) sIL2-R value of pre treatment JRA of 1728(290) U/ml was significantly higher than the post treatment value of 921(229) U/ml (Wilcoxon Rank test, p < or = 0.001). Pre treatment values were also significantly different from the mean(SEM) of healthy controls of 519(19) U/ml (p < 0.001). Pre treatment sIL2-R levels of 2417(291) U/ml in systemic-onset JRA were significantly higher than sIL2-R values in polyarticular JRA patients of 1218(884) U/ml (Mann-Whitney rank test p < 0.001). Among the 13/16 children with good therapeutic responses (> or = 50% improved), the range of sIL2-R decreases was 154-2641 U/ml (mean 842 U/ml); sIL2-R levels increased in the three children with poor clinical responses to methotrexate. CONCLUSIONS: sIL2-R levels paralleled the course of disease in all patients. sIL2-R levels may be useful for monitoring therapeutic responses in children with JRA.
7567195 Rehabilitation of the child with a rheumatic disease. 1995 Oct This article discusses the principles of rehabilitation of the most common childhood rheumatic diseases, especially juvenile rheumatoid arthritis, dermatomyositis, and scleroderma. Any rehabilitation program must be undertaken in conjunction with understanding of disease processes, appropriate medical management, and patient and family education. Investing effort into avoiding contractures, weakness, osteoporosis, and disability is considerably less time-consuming, painful, and costly than trying to reverse established problems.