Browse

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

ID PMID Title PublicationDate abstract
7985400 [A new plate for dorsal occipito-cervical fusion. Design, surgical technique, initial clin 1994 Sep A survey of actually practiced methods for cranio-cervical fusion is presented, followed by the description of a new osteosynthesis-plate to solidly fuse this region. The new plate offers a number of advantages when compared with competing procedures. It is rigidly fixed to the occipital bone by five screws, sublaminar wireloops bond the vertebrae to be fused to both branches of the U-shaped plate where the individual loops are positioned into obliquely ascending slots. This safely prevents migration and disengagement resulting in a high initial horizontal and vertical stability allowing for a postoperative care without external support. During the procedure tightening of the wire loops may succeed on reposition of the deformity. The plate exists in two lengths allowing fusion of C0-C2 or more segments of the cervical spine. The typical indication is instability of C0-C2 in rheumatoid arthritis or tumoral lesions of the area. Clinical experience in 7 patients suffering from rheumatoid arthritis (follow-up: 6-31 months) is very positive, fusion has occurred in all cases.
8623582 Reactive arthritis, diagnosis and treatment: a review. 1996 Apr The diagnosis of reactive arthritis (ReA) is easy in typical cases with a history of an infection within 3 weeks in combination with an asymmetric mono or oligoarthritis with or without extra-articular manifestations. Subclinical microbial infections, a possible co-existing inflammatory bowel disease and the fact that in 25% of the cases the microbial agent remains unidentified, make the diagnosis more troublesome. The course of disease is usually self-remittent within 6 months but a less good long-term prognosis is pre-determined by two factors-namely, the presence of HLA-1327 and the recurrence of triggering infections. The finding of microbial fragments in the joint cavity have led to new treatment strategies especially in Chlamydia-triggered ReA. It must, however, be remembered that the antibiotics mostly used (namely, tetracyclines) also possess immunoregulatory and anticollagenolytic potential. In chronic destructive cases, antirheumatic treatment, similar to that used in rheumatoid arthritis, is recommended.
8146728 [Collagen diseases complicated with myelodysplastic syndrome (MDS)--report of three cases] 1994 Feb We presented three cases of collagen diseases complicated with myelodysplastic syndrome (MDS). To our knowledge, MDS following collagen disease is very rare, and only seven cases have been reported previously. First case (a 40-years old woman) had suffered from rheumatoid arthritis, systemic lupus erythematosus and Sjögren's syndrome for 16 years. Second case (a 65-years old woman) had suffered from rheumatoid arthritis for 15-years. Third case (a 63-years old woman) had suffered from progressive systemic sclerosis for 16 years. These patients developed MDS. After onset of MDS, cytopenia progressed rapidly within half a year. In the types of MDS, case 1 and case 2 had refractory anemia and case 3 had refractory anemia with excess of blasts and a preleukemic state. Case 2 had a clonal abnormality of haemopoietic stem cells. It is unlikely that MDS in our cases are caused by mutant agents or irradiation. These results suggest MDS may be contributed to long-term immunodysfunction found in these collagen diseases.
8864586 Viral arthritis. 1996 Jul Viral infections can present with different patterns of joint and soft tissue involvement, and the etiologic role of viruses in various rheumatic diseases is a subject of continued great interest. Recently, new immunoenzymatic assays have brought a better understanding of the relationship between hepatitis C virus serotypes and their immunologic manifestations. Our knowledge of the consequences of parvovirus B19 infection has broadened to include the variable clinical spectrum the role of inflammatory cytokine production in parvovirus-induced arthritis, a postulated causative role for B19 in rheumatoid arthritis, and a negative association between parvovirus and Still's disease as well as chronic fatigue syndrome. New, specific antibodies to nonstructural protein NS-1 in parvovirus B19-associated arthritis have been detected. Arthritis related to hepatitis B virus vaccination or measles and mumps vaccination was also reported. The papers reviewed here demonstrate the continuing efforts in defining the etiopathogenesis of virus-induced rheumatic diseases.
8453801 Influence of the bacterial flora on collagen-induced arthritis in susceptible and resistan 1993 Jan Collagen-induced arthritis is an experimental model for rheumatoid arthritis which can be elicited in susceptible strains of rats by intradermal injection of native type II collagen. In order to investigate whether bacterial flora may alter the pathogenic response to type II collagen, we have immunized germ-free (GF) male rats from either highly resistant Fisher (F344) or highly susceptible Dark Agouti (DA) strains. The disease was markedly enhanced in GF DA as compared to conventional (CV) DA rats. The humoral response was also stronger in GF rats of both strains. Neither GF nor CV F344 developed arthritis, although GF F344 exhibited later inflammation of the tail. These data support a suppressive influence of bacterial flora on collagen-induced arthritis.
8140375 [Chronic obstructive bronchopneumopathy, mitral valvulopathy and global cardiac insufficie 1994 Feb The case of a 61 year-old man is presented. This patient had a rheumatoid arthritis and a cardiac failure. Echocardiography and catheterization revealed a mitral valvulopathy, biventricular dysfunction and conduction abnormalities. Pericardial disease was also present. Differential diagnosis lead to the clinical diagnosis of rheumatoid non constrictive pericarditis, rheumatoid myocarditis, rheumatoid endocarditis and idiopathic calcification of the mitral valve. Anatomo-pathologic findings consisted in rheumatoid pancarditis.
7716092 Arthritis of recent onset. A guide to evaluation and initial therapy for primary care phys 1995 Apr Correct early diagnosis of acute and recent-onset arthritis is important to prognosis. The erosive damage done by rheumatoid arthritis occurs earlier in the disease course than previously realized, and more specific therapies to minimize damage are becoming available. Also, arthritis may be the initial clue to a serious systemic disease. Determining whether one, several, or many joints are affected can narrow the diagnostic possibilities. Arthrocentesis and synovial fluid testing provide much information and should be done at initial evaluation if possible. The presence or absence of fever, rash, family history of joint disease, and exposure to infective organisms can further direct diagnostic studies and treatment. In general, to avoid masking clues, drug therapy should be delayed for mild symptoms until diagnosis is complete.
1581152 Foot and ankle pain resulting from rheumatic conditions. 1992 Apr Pain in the foot and ankle is most frequently secondary to static and degenerative changes, eg, corns, hammer toes, bunions, anterior metatarsalgia, and heel pain. A second common group consists of rheumatologic disorders that encompass immune and hereditary factors. This group includes rheumatoid arthritis, the often underdiagnosed seronegative spondyloarthropathies, and, less commonly, crystalline deposit disorders and diffuse connective tissue diseases. Both the physician and the public need a heightened awareness of the existence and presence of these disorders, which may be devastating, eg, psoriatic arthritis and tenosynovitis. To these groups, we now must add Lyme disease and acquired immunodeficiency syndrome. The advances in testing, including immunologic and nuclear imaging (eg, magnetic resonance imaging), have permitted more rapid and specific diagnosis with earlier treatment.
8112144 [Adult onset Still's disease: review of 50 cases and evaluation of diagnostic criteria]. 1993 Sep On the basis of clinical and laboratory data of 50 patients with adult onset Still's disease (AOSD), we strictly examined 4 diagnostic criteria adopted by different authors: criteria of Calabro, ARA, Medsger and Liu Gui-xin. Our result shows that Calabro's criteria has the best specificity (100%) and a higher diagnosis index (0.90) among the 4 criteria. Liu's criteria provides the best sensitivity (98%), but a lower specificity (86.9%) with a misdiagnosis rate of 14%. The rate of missed diagnosis with the ARA criteria is 35.7%. According to the present study, we recommend Liu's criteria for preliminary screen diagnosis, while Calabro's criteria for confirmation and differential diagnosis. Of special interest is that serum ferritin (SF) determination showed significantly higher level in 20 patients with AOSD (average 1194.5mg/L) than that in 19 patients with other rheumatic diseases (average 94mg/L, P < 0.001). AOSD patients with active disease have higher SF levels than patients with inactive disease (average 2742.9mg/L & 291.25mg/L, P < 0.001). So this test might be useful in diagnosis in AOSD and assessment of disease activity.
7699642 Intravenous immunoglobulin in the treatment of systemic juvenile rheumatoid arthritis: a r 1994 Dec OBJECTIVE: To assess the efficacy and safety of intravenous immunoglobulin (IVIG) in juvenile rheumatoid arthritis (JRA). METHODS: Thirty-one children with active, refractory, systemic JRA were randomized into a multicentered, double blinded, placebo controlled trial. Patients received infusions of 1.5 g/kg of IVIG or placebo (0.1% albumin) every 2 weeks for 2 months, then monthly for 4 months (total: up to 9 infusions over 6 months). Twenty-nine of the 31 patients were included in the efficacy subset. RESULTS: Fourteen patients discontinued prematurely from study, 7 in each treatment group. A higher proportion of patients in the IVIG group improved (50 vs 27%) as assessed by the physician's global assessment. However, the sample size was small and this difference was not statistically significant. IVIG was not more effective than placebo in reducing the number of days with fever or other systemic manifestations. Changes from baseline in the joint count, hemoglobin, albumin, platelet count, and erythrocyte sedimentation rate did not differ between treatment groups. CONCLUSION: Our results suggest that high dose IVIG has limited clinical utility in systemic JRA. However, this trial failed to enroll adequate numbers of patients to permit valid statistical intergroup comparisons, and the results must be considered nondefinitive.
7886124 [Special qualification of a photometric procedure for determination of salicylic acid in t 1995 Jan A procedure for the determination of salicylic acid from human serum is presented. It is based on an acidic extraction, a basic reextraction and the detection of salicylic acid as its iron-III-complex by photometry. The procedure is quantitative over a wide range of linearity, easy to carry out and is especially suitable for therapeutic drug monitoring in the treatment of juvenile rheumatoid arthritis.
8164218 Plasma levels after oral methotrexate in children with juvenile rheumatoid arthritis. 1993 Sep Plasma levels of methotrexate (MTX) after oral administration of 6.4 to 11.2 mg/m2/week (mean 8.5 mg/m2/week) were studied in 33 children with severe juvenile rheumatoid arthritis (JRA). MTX concentrations were measured by a fluorescence polarization immunoassay (TDx) at 1, 2, 3, and 24 h after administration. The maximum level was observed in most patients after 1 h. No significant correlation was found between MTX dosage and the 1, 2, and 3-h plasma levels. No patient showed values in the range of probable toxicity 24 h after administration. A stepwise multiple regression analysis on 1, 2, and 3-h MTX levels, selected clinical features, dosage and duration of MTX therapy, and concomitant drug treatment showed that MTX concentrations at the different time points tend to be closely related; among the other variables, only concurrent treatment with salicylates was found to affect significantly the 3-h level. Serial determinations performed in 20 patients at the same oral dosage showed a wide interindividual and intraindividual variability of the plasma levels from the first dose to the next. Variable and unpredictable levels were observed also in most of the 8 patients studied after one or more increases of MTX dosage. No difference in MTX concentrations was observed between patients who responded to treatment and those who failed to respond, and between patients who had serum transaminase elevation and those who did not. Our results suggest that, until the pharmacokinetics of low dose MTX is clarified, routine therapeutic monitoring of MTX has a limited value in the clinical management of children with JRA.
1395270 Five-year follow-up evaluation of the noncemented press-fit titanium hip-joint endoprosthe 1992 Oct A series of 260 noncemented total hip arthroplasties with a titanium alloy stem and fixation by the Zweymüller press-fit and an Endler polyethylene threaded cup was reviewed in detail. The minimum follow-up period was 48 months and the maximum 72 months, with an average of 60 months. A scale from zero to five points was applied to evaluate pain, mobility, and motion for a total possible accumulation of 15 points. The global results of the different etiologic groups (arthrosis, femoral head necrosis, rheumatoid arthritis, and subcapital hip fractures) have been very good and good (12-15 points) in 67.5% of the cases and fairly good and bad in 32.3%. These results have been better in femoral head necrosis than in arthrosis or rheumatoid arthritis, but not as good in subcapital hip fractures. The age groups below 60 had better results than the above 60 groups. The Singh index higher than 3 was correlated with better-than-average results. The polyethylene cup migrated horizontally (more than 4 mm) in 7.6% of the cases and vertically (more than 5 mm) in 10%. The non-evolutionary cortical remodelation of the femur does not influence the results. Prosthetic stem sinking less than 4 mm has been found in 62% of the cases, from 4 to 9 mm in 21%, and greater than 9 mm in 6%. No alterations with clinical consequences attributable to stress-shielding have been detected.
1411582 Light and electron microscopic observations on the synovitis of ankylosing spondylitis. 1992 Aug Light microscopic studies on synovium obtained from seven knees and three hips of patients with ankylosing spondylitis and peripheral arthritis showed surface fibrin, proliferation of synovial lining cells, moderate infiltration with lymphocytes, and sometimes striking numbers of plasma cells. There was some vascular congestion and obliteration, occasional bone and cartilage debris, and a tendency toward increased fibrous tissue. Although the intensity of some findings varies from those in rheumatoid arthritis, there were no consistent distinguishing features. Electron microscopy of eight synovial tissue specimens showed increased type B or synthetic lining cells. Structures that could possibly have been organisms were seen among synovial cells in two patients. Immune complex-like deposits were not seen in vessel walls, although there were other vascular alterations. Synovial fluid studies showed 2,200 to 16,500 white blood cells/mm3 (mean, 8,236), 29% to 93% polymorphonuclear leukocytes (mean, 66%), and 0.5 to 32% lymphocytes (mean, 18%). The presence of at least some activated lymphocytes (lymphoblasts) in seven of nine patients in addition to the above findings in synovium suggest an immunological component to the driven process. No more than 32% lymphocytes was found in any synovial fluid despite the use of nonsteroidal antiinflammatory drugs. Thus no support for synovial fluid lymphocytosis, such as has been described in rheumatoid arthritis patients treated with nonsteroidal antiinflammatory drugs alone, is provided.
19078065 Leukocytosis in rheumatoid arthritis. 1996 Aug To determine the prevalence and clinical significance of leukocytosis in rheumatoid arthritis (RA), records of 98 consecutive outpatients with this disease were reviewed. Leukocytosis, defined as 2 or more white blood cell counts (WBC) greater than 10,000/mm, was found in 27%. Among patients currently receiving steroid therapy (mean dose prednisone 7 mg daily), the prevalence was 40%; in all others, the prevalence was 7.5%. The WBC elevation was primarily caused by an increase in neutrophils. Patients with leukocytosis tended to have more active arthritis, but there were no differences in extra-articular manifestations or drug therapy except for the use of corticosteroids.A review of the literature confirms the contributions of both disease activity and steroid therapy to WBC elevation. There is little published information on the effect of chronic, low dose corticosteroids on WBC counts, but our study suggests that this is an important factor in leukocytosis in RA.Newly detected leukocytosis in RA should alert the physician to the possibility of occult infection. In the absence of suggestive signs and symptoms, an infectious cause is seldom found, but, despite the few infections found in this series, continuing vigilance is recommended.
1574931 [Epidemiology of rheumatic diseases in the German Federal Republic-- current state and per 1992 Jan During the last few years epidemiologic research on rheumatic diseases in the Federal Republic of Germany has been sponsored, primarily, by the Ministry of Research and Technology. The projects, either completed, ongoing or planned, concentrate on health services research, population studies of the prevalence of specific diseases or complaints (rheumatoid arthritis, back pain, juvenile chronic arthritis, osteoarthritis) and clinical epidemiology, especially concerning early arthritis. As a result of the general shortage of public funds, less projects could be sponsored than expected. The aim of the Ministry to establish research organizations that will continue to exist even if public funding is curtailed seems to be jeopardized. Therefore, not only the federal government, but also the federal states and institutions like the Deutsche Forschungsgemeinschaft should be engaged in this field. More groups should have the opportunity to work in epidemiology of rheumatic diseases, and groups which are able to work in close connection with basic scientists and rheumatological clinicians should be institutionally affiliated on a permanent basis. This is critical for the further development of this discipline which is important for health services research, quality assurance, as well as for analytical research and prevention.
8878801 The clinical significance of cytoplasmic inclusions(CPI) in synovial fluid examination. 1996 Aug The clinical significance of cytoplasmic inclusions(CPI) in synovial fluid(SF) examination was evaluated. We examined SF specimens collected from major rheumatology clinics in the Philadelphia area during the period of January to December 1995. Among 759 patients in the initial study group, 419 cases with established diagnoses and full synovial analyses were included. Their diagnoses and SF analysis results including leukocyte counts, differential counts and wet preparations were collected and analysed. Ninety seven of the 419 SF specimens were found to have CPI. CPI were found in SF from almost all rheumatic diseases. They were most likely to be found in inflammatory arthropathy including rheumatoid arthritis(RA, 46%), juvenile rheumatoid arthritis(JRA, 78%) and psoriatic arthritis(55%). On the contrary, CPI were least common in crystal-induced arthropathy among the inflammatory arthropathy. CPI were found 8 out of 98 gout cases(8%) and 2 among 53 calcium pyrophosphate dihydrate(CPPD) deposition disease(4%). In noninflammatory arthropathy, CPI were found in only 6 cases(6%) out of the 103 osteoarthritis(OA). In RA cases with non-inflammatory SF, 4 of the 20 SF(20%) had CPI while only 6% of OA SF had CPI. OA SF with CPI were all noninflammatory SF. In summary, CPI were a common finding on SF examination. CPI were more likely to be found in inflammatory arthropathy than noninflammatory. Among inflammatory arthropathy, CPI can favor non-crystal arthropathy than crystal arthropathy. Awareness of the presence of CPI is suggested as an addendum to routine SF analysis. Renewed investigation of the several types of CPI may add further to the understanding of joint disease.
10119257 Observer variation in an audit of charts of patients with rheumatoid arthritis. 1992 Spring Arthritis Society physiotherapists (PTs) in Ontario adopted Problem Oriented Records (POR) to monitor patient care; goals were to encourage patient specific treatment plans and standardized records. After nine months in practice, the POR system was evaluated by an audit on charts of patients with Rheumatoid Arthritis. Audit teams of two PTs were created within each of five geographic areas. Auditors attended an audit instruction workshop. Two charts, selected randomly from the discharged patients of each of 38 therapists, were independently scored on 56 items by an audit team. The extent of agreement within the auditor team (observer variation) was measured, and adequacy scores computed for each chart. Adequate reliability of the audit instrument was established before examination of adequacy scores and making inferences about quality of care. The auditor agreement measures (kappa) varied from 0.13 to 0.97, mean = 0.74 and SD = 0.16; these estimates were indicative of adequate reliability of the audit form, although agreement scores were different amongst the five areas (P2 less than .01). POR adequacy scores varied from 10.0 to 93.1, mean = 64.5 and SD = 16.9. There were no differences in adequacy scores amongst the five areas (P2 = .61). To reduce observer variation, increased pre-audit emphasis is needed on auditor guidelines and training for items relating to assessment findings, problem identification, and treatment planning.
7608561 A cyclic adenosine 3',5'-monophosphate signal is required for the induction of IL-1 beta b 1995 Jul 15 IL-1 beta is a cytokine generally considered to be a major component involved in the pathogenesis of rheumatoid arthritis and other inflammatory diseases. Of the agents found in high concentrations in inflamed rheumatoid arthritis joints, TNF-alpha is among the most strongly implicated as an in vivo inducer of IL-1 beta. Here we report that in human PBMC and in a stable transfectant of the promonocytic cell line, THP-1, TNF-alpha indeed appears to be an inducer of IL-1 beta production, but only in the presence of dibutyryl cAMP or agents such as the PG that elevate intracellular cAMP levels. This TNF-alpha/cAMP pathway regulates IL-1 beta production at the level of transcription and requires a cAMP response element located between -2762 and -2755 bp in the upstream regulatory sequence of IL-1 beta. Because PG, which are known to elevate cAMP levels in vivo, and TNF-alpha are both found in significant quantities in the synovial fluid of rheumatoid arthritis joints, the observed synergistic up-regulation in IL-1 beta synthesis by TNF-alpha/cAMP (PG) may provide valuable insight into the potential pathways involved in the continuous production of IL-1 beta in the chronically inflamed joint.
8041573 Orthopaedic manifestations of Lyme disease. 1994 May Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted by the Ixodes tick. Early diagnosis is difficult because the tick bite may go unnoticed and the distinguishing rash, erythema chronicum migrans, often does not occur. Serologic tests are both sensitive and specific in the later stages of the disease but not in stage 1. Thus diagnosis of Lyme disease remains clinical. Knowledge of the orthopaedic manifestations of Lyme disease may aid in early diagnosis and help differentiate from possible cases of juvenile rheumatoid arthritis and septic arthritis. If septic arthritis is suspected, appropriate antibiotic therapy should be initiated while awaiting serology for Lyme disease. Recurrence of Lyme arthritis following antibiotic treatment is rare. Lyme disease should be considered in any patient with arthritis and a history of rash, fever, or neurologic or cardiac abnormality.