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ID PMID Title PublicationDate abstract
8014947 Sequential development of 2 connective tissue diseases in juvenile patients. 1993 Dec The sequential development of two connective tissue diseases in the same patient has been rarely reported. We describe 2 juvenile patients, a 15-year-old girl who, after having juvenile rheumatoid arthritis (JRA) for a 7-year period presented with clearly defined features of systemic lupus erythematosus with diffuse proliferative glomerulonephritis. The 2nd case, a 9-year-old boy developed erosive polyarticular JRA after having had a clear picture of dermatomyositis in infancy. In both cases there was a lengthy disease free period between the 2 diseases.
7932727 Crystallization and preliminary X-ray analysis of the Fab fragment of a human monoclonal I 1994 Oct 7 Crystals of the Fab fragment of a human monoclonal IgM rheumatoid factor have been obtained and are suitable for X-ray structure determination. This molecule, derived from the synovial B cells of a patient with rheumatoid arthritis, is an autoantibody with specificity for IgG Fc. The crystals have space group P2(1), cell dimensions a = 69.0 A, b = 76.6 A, c = 98.8 A and beta = 90.6 degrees, and diffract to a resolution of at least 2.8 A.
7538776 Immunolocalization of adhesion molecules in psoriatic arthritis, psoriatic and normal skin 1995 Jan Adhesion molecule expression in synovial membrane obtained from patients with psoriatic arthritis (PA) has previously been compared with rheumatoid arthritis (RA). Although expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was similar in both psoriatic and rheumatoid synovium, in contrast, little or no endothelial leucocyte adhesion molecule-1 (ELAM-1) was observed in psoriatic synovium. In the present study, the expression of ICAM-1, ELAM-1 and VCAM-1 was examined in the involved and uninvolved skin from patients with PA (n = 15), patients with psoriasis (Ps) but no arthritis (n = 5) and in normal skin (n = 4). ICAM-1 was intensely expressed on endothelium and keratinocytes of involved skin from patients with Ps with or without arthritis. There was constitutive expression of ICAM-1 on endothelium only in uninvolved and normal skin. In contrast, ELAM-1 expression was restricted to endothelial cells; it was widespread and intense in involved skin, but was minimal in uninvolved and normal skin. VCAM-1 was expressed on endothelium, and also on some dendritic cells in involved psoriatic skin. There was minimal VCAM-1 staining on endothelial cells in uninvolved and normal skin. In conclusion, in involved psoriatic skin from patients with and without arthritis ICAM-1, ELAM-1 and VCAM-1 expression is up-regulated on vascular endothelium, and ICAM-1 is expressed on keratinocytes. However, ELAM-1 and VCAM-1 expression seen in dermal vessels is not found in psoriatic synovial vessels. These differences suggest a mechanism for controlling cellular traffic in Ps and in PA.
8188841 Pediatric Lyme arthritis: clinical spectrum and outcome. 1994 Mar A cohort of children with Lyme arthritis was used to evaluate the clinical and serologic profile of the disease. During a 42-month period (June 1989 to December 1991), 44 patients (13 girls and 31 boys, ages 4-18 years) were included and followed for 6-36 months. Inclusion required the presence of arthritis, as well as positive serology. Thirty-four children with juvenile rheumatoid arthritis or spondyloarthropathy were used as a serologic comparison group. Five different patterns of arthritis were found. Preceding erythema migrans was seen in seven children. Antinuclear antibodies were positive in 30% of the patients. Three treatments were used and selected according to physician preference, patient age, and presence of extraarticular disease: amoxicillin, doxycycline, and ceftriaxone. Articular disease reached complete resolution in all patients within 2-12 weeks. Lyme arthritis in children may mimic other pediatric arthritides. Prognosis for children with clearly defined Lyme arthritis was excellent.
8338992 Anti-alpha-gliadin antibodies are not predictive of celiac disease in juvenile chronic art 1993 Jun Some authors have recently reported an increased level of antigluten antibodies in rheumatoid arthritis, both in the adult and juvenile form. The real meaning of these antibodies is still unclear. We ascertained the levels of antigluten antibodies in a group of children with juvenile chronic arthritis to determine if these antibodies were linked with celiac disease and/or to increased intestinal permeability. In 18 of 53 patients (33.9%), the levels of antigluten antibodies (IgA or IgG) were higher than normal. No correlation was found between the increase in antigluten antibodies and the positive lactulose/mannitol test, used for determining increased intestinal permeability. In all eight patients undergoing intestinal biopsy due to abnormal levels of antigluten antibodies (IgA class), intestinal mucosa was normal. In conclusion, our study shows that in patients with juvenile chronic arthritis, immunological response to gluten is neither related to celiac disease nor to increased intestinal permeability.
7664485 Antimycobacterial hsp65 and rheumatoid factor titres in a population of normal twins: evid 1995 Sep Rheumatoid arthritis (RA) is an autoimmune disease and rheumatoid factor (RF), anti-IgG, has been implicated in the pathogenesis, but the exact etiology remains unclear. There are data to suggest and infectious trigger to the autoimmune process, and mycobacteria are considered a candidate. Immunization of various animals with mycobacterial heat shock protein 65 (mhsp65) protects against subsequent autoimmune arthritis in a number of experimental models. Elevated anti-mhsp65 titres have been demonstrated in RA patients, together with specific T cells isolated from inflamed synovium. Mycobacterial hsp65 has also been implicated in other autoimmune disease and in atherosclerosis. The anti-mhsp65 and RF (IgG, IgM and IgA isotypes) titres were assayed by ELISA in 123 pairs of normal twins (61 monozygotic and 62 dizygotic, age 14-79 years), to examine the population distribution and inter-relationship of these antibodies. In addition, we studied the effects of age, sex, genetics and environment on antibody titres. IgG-RF and IgM-RF were detectable in all subjects and IgA-RF in 41 subjects. None of the RF isotypes showed any significant dependence on age or sex. There was a statistically significant correlation between twins for the IgG-RF and IgM-RF, and a positive but not significant correlation for the IgA-RF. All three correlations were stronger for monozygotic than dizygotic twins, reaching statistical significance for IgM-RF (P < 0.001), and this indicates that there is a genetic influence on RF titres. Anti-mhsp65 titres were detectable in 90.5% of the study group with a range of 0.15-19.7 AU/ml. There were weak correlations between twins, stronger for dizygotic than monozygotic twins. This suggests that familial influences on anti-mhsp65 titres are very small, with no evidence of any genetic influence at all. There was no significant relationship of anti-mhsp65 titre with age, sex or RF titres.
18475737 Detection of serum soluble markers of immune activation in rheumatoid arthritis. 1996 The mutual correlation among soluble CD4 (sCD4), soluble CD8 (sCD8), and soluble CD23 (sCD23) has not yet been studied in patients with rheumatoid arthritis (RA), although previous studies have demonstrated that certain soluble markers of immune activation are elevated in RA. Thus, we examined this correlation based on the serum levels of sCD4, sCD8 and sCD23, and that of their levels with other serum markers such as immunoglobulin (Ig) subtypes (IgG, IgM and IgA), IgM-rheumatoid factor (IgM-RF) and C-reactive protein (CRP) in 25 RA patients, sCD4 was not elevated, whereas both sCD8 and sCD23 increased in RA patients compared with the healthy controls; a majority of RA patients, in particular, showed a high sCD23 level. The level of sCD23 showed a correlation with that of IgM-RF, but not with those of IgG, IgM, IgA and CRP. Importantly, a high level of sCD23 was not always accompartied with that of sCD8. The independent change between sCD23 and sCD8 levels was also observed in a one-year follow-up study of the two RA patients. These findings indicate that B cells might be generally activated in RA, whereas T-cell activation in variable in each patient with RA, suggesting that sCD23 is a more indicative marker for the immune status of RA patients than sCD8 from the clinical aspects.
1629846 Urinary incontinence among patients with arthritis--a neglected disability. 1992 Jul Urinary tract pathology may be no more common in patients with arthritis than among the general population, but its impact may be enhanced by disability. In this survey of 247 patients, as many as 38% of patients with rheumatoid arthritis (RA), 47% of patients with osteoarthritis (OA) and even 34% of patients with soft tissue rheumatism (STR) reported difficulty controlling their urine, confirming that incontinence is a widespread and often under-reported problem. More detailed enquiry in a sample of 90 patients with OA or RA did not suggest specific urinary tract pathology related to the underlying arthritis. Those who reported problems with urinary control were more disabled, and took longer to get to the toilet in their own environment than those without control problems. Twenty-seven per cent of patients felt that their problems would be solved by provision of a downstairs toilet. Timing of tasks performed by patients within their home is suggested as a method for assessing functional ability which encompasses both patient disability and environmental factors.
19077953 Serum Interleukin-6 Level is a Sensitive Parameter of Disease Activity in Rheumatoid Arthr 1995 Apr In rheumatoid synovium, interleukin-6 (IL-6) is the most abundantly expressed cytokine. Therefore, we investigated whether serum IL-6 levels could be clinically useful parameters of disease activity in rheumatoid arthritis (RA). The serum IL-6 levels were measured by enzyme-linked immunosorbent assay. The IL-6 levels were significantly higher in sera from patients with RA (n = 108, 13.3 +/- 14.0 pg/mL) than in those from the normal controls (n = 10, < 3.13 pg/mL). The IL-6 levels significantly correlated with conventional parameters, such as the Lansbury index, joint score, erythrocyte sedimentation rates, and C-reactive protein. In addition, the serum IL-6 level was useful to determine clinical remission. Advantages of serial measurement of IL-6 were observed in two cases. These findings suggested that the serum IL-6 level may be clinically useful as a sensitive parameter of disease activity in RA.
1612762 Histopathological and serological progression of experimental Staphylococcus aureus arthri 1992 Jul In a newly developed mouse model of Staphylococcus aureus arthritis the kinetics of joint destruction and serological manifestations as well as the clinical course of arthritis and osteitis were studied. Almost all mice developed histopathological signs of arthritis upon a single intravenous injection of 10(7) S. aureus LS-1 cells. There was rapid joint destruction, with synovial hypertrophy already visible, within 24 h after injection of the bacteria. Cartilage and/or bone erosions were seen in a majority of the mice within 72 h. Extra-articular manifestations, especially signs of bone infection, were also found soon after inoculation of the bacteria. Tail osteitis was frequent (50% of the mice) but appeared later than arthritis. Polymorphonuclear cells prevailed in the early joint lesions and were also common in the extra-articular manifestations. Within 3 days, mononuclear cells were also seen in the inflamed synovium, gaining a dominant position 3 weeks after the start of the disease. Serum interleukin-6 levels were already increased within 6 h after bacterial injection and remained elevated throughout the course of arthritis. Serum tumor necrosis factor levels were increased within 24 h. There was a tremendous induction of immunoglobulin production, especially of the immunoglobulin G1 isotype. This was paralleled by the production of specific antibodies to S. aureus (cell walls and toxin), as well as autoantibodies (rheumatoid factors and anti-single-stranded DNA antibodies), all predominantly of the immunoglobulin G isotype. The type and magnitude of the immunoglobulin G response together with the elevated interleukin-6 levels speak in favor of both antigen-specific and polyclonal B-cell activation during S. aureus arthritis. This study points out important similarities between our new model of S. aureus arthritis and human S. aureus arthritis. This resemblance will enable controlled studies of pathogenetic mechanisms of septic arthritis as well as therapeutic and prophylactic approaches.
8864827 Detection of autoantibodies to the pancreatic islet heat shock protein 60 in insulin-depen 1996 Aug Autoantibodies against heat shock protein (hsp) 60 have been reported to be detected in sera of non-obese diabetic mice, in an experimental model of IDDM. However, there are only a few studies which have examined IDDM patients for antibodies against mammalian hsp60. We produced murine hsp60 derived from pancreatic beta cells which has high homology to human hsp60 and examined antibodies against the hsp60 in IDDM patients using an enzyme-linked immunosorbent assay. We extended the analysis to patients with other immune-mediated diseases and non-insulin-dependent diabetes mellitus (NIDDM). Positive sera for hsp60 antibody were more frequently detected in 13 out of 84 IDDM (15.5%) and 5 out of 25 rheumatoid arthritis patients (20%), when compared to healthy subjects (1/85; 1.2%, P < 0.001 and P < 0.01, respectively). The levels of hsp60 antibodies of IDDM (0.218 +/- 0.227) and rheumatoid arthritis patients (0.259 +/- 0.191) were significantly higher than those of healthy subjects (0.076 +/- 0.131, P < 0.001, P < 0.01, respectively). Patients with slowly progressive IDDM (n = 26), autoimmune thyroid disease (n = 42), or NIDDM (n = 40) had levels of hsp60 antibodies similar to those in healthy subjects. We found no relationship between the levels of hsp60 antibodies and islet cell antibodies (ICA) or antibodies to glutamic acid decarboxylase (GAD65) in IDDM patients. In conclusion, hsp60 antibodies were detected in Japanese IDDM as well as in rheumatoid arthritis patients. Although the positivity was low, the detection of hsp60 antibodies may be helpful for diagnosis of IDDM especially in GAD65 Ab- or JCA-negative Japanese patients.
8493587 [Three cases of multicentric reticulohistiocytosis with arthritis]. 1993 Feb Multicentric reticulohistiocytosis (MR) is a rare systemic disease of unknown origin that is characterized by a proliferation of histiocytes and multinucleated giant cells. Such changes in the synovium can result in a destructive arthritis, although the mechanism of arthritis in MR is poorly understood. In this paper we present three cases of MR with arthritis. In all three cases, articular symptoms preceded to skin lesions. Articular manifestations of MR were similar to those of rheumatoid arthritis; bilateral symmetric involvement, marginal erosions, and severely destructive arthritis in one case. The diagnosis was confirmed by biopsies of the cutaneous nodules and the synovial tissues of the knee joints. A light microscopic examination of the synovial tissue revealed a proliferation of histiocytes with multinucleated giant forms in the synovial stroma. Further, in one case, a proliferation of synoviocytes with a stratification of lining cells and small vessels were found in the synovium. Prednisolone was administered to all cases, though, the responses were not satisfactory. Further investigation about their clinical courses is necessary.
8702448 Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology chang 1996 Aug OBJECTIVE: To examine trends in the incidence and prevalence of juvenile rheumatoid arthritis (JRA) in Rochester, Minnesota, over 33 years. METHODS: The diagnostic retrieval system of the Rochester Epidemiology Project was utilized to screen medical records of all Rochester residents with any potential diagnoses of JRA from 1978 to 1993 (based on the American College of Rheumatology 1977 revised criteria). In addition, all cases of JRA from our previously identified cohort from 1960-1979 were verified, and the 2 data sets were combined, resulting in an incidence cohort spanning 33 years (1960-1993). RESULTS: Of the 1,240 medical records screened, we identified 65 cases of JRA diagnosed between 1960 and 1993 (48 females, 17 males). The average followup for cases was 12.7 years (range 0-34 years) for a total of 833 person-years of observation. A bimodal distribution of age at diagnosis was observed, with peaks between 0 and 4 years and 9 and 15 years. Seventy-two percent of patients had pauciarticular-onset, 17% had polyarticular-onset, and 11% had systemic-onset disease. Progression of pauciarticular to polyarticular disease occurred in 11% of the cases. The overall age- and sex-adjusted incidence rate was 11.7 per 100,000 population (95% confidence intervals 8.7, 14.8). The incidence rate per 100,000 population was 15.0, 14.1, and 7.8 for the time periods 1960-1969, 1970-1979, and 1980-1993, respectively (P = 0.024). A 3-year, centered, moving average, which was used to display time trends in incidence, suggested a cyclical pattern, with incidence peaks in 1967, 1975, and 1987. CONCLUSION: An overall decrease in the incidence rate over the last decade was observed, most marked in the pauciarticular- and systemic-onset subtypes. This decrease, along with the observed cyclical pattern, suggest that environmental factors may influence disease frequency.
8842722 Surgery of systemic lupus erythematosus arthritis of the hand. 1996 Aug Systemic lupus erythematosus (SLE) is one of a group of three uncommon arthritic diseases, including psoriatic arthritis and scleroderma, that superficially resemble rheumatoid arthritis (RA). These diseases frequently involve the hand and wrist and therefore are significant to the hand surgeon. SLE has certain specific characteristics that separate it from the other two conditions. Each of these diseases has distinct features affecting the nature of the deformities as well as the treatment indicated to adequately care for these patients.
7547112 Viral arthritis including HIV. 1995 Jul Viruses are attractive candidates for infectious etiologic agents or cofactors in the development of rheumatic diseases. The epidemic of HIV infection and the recognition of "emerging viruses" continues to fuel interest in the possible role of viruses in the pathogenesis of diseases without defined etiologies. During 1994, roles for parvovirus B19 in vasculitis and erosive rheumatoid arthritis were entertained. We were reminded that rubella infection may present with polyarthritis. Our understanding of the rheumatic disease manifestations of hepatitis C virus infection was broadened to include polyarthritis. A possible role for herpesviruses in Sjögren's syndrome continued to be explored without definite resolution. Paramyxoviruses were offered as an agent in the development of Paget's disease. The retroviruses continued to attract attention because of rheumatic disease syndromes in AIDS patients and the ability of retroviruses to latently infect the host and alter host immune responses. This review highlights efforts made in the past year to elucidate the role of viral infection in rheumatic disease.
7671128 [The association of the disease activity of rheumatoid factor positive vasculitis and the 1995 Jun Rheumatoid factor (RF), an autoantibody against the Fc portion of denatured IgG, has long been recognized as an important biologic marker not only for rheumatoid arthritis but also for other auto-immune diseases. In this study, we measured the level of serum RF in four patients with RF positive systemic vasculitis using laser nephelometry. Three patients were diagnosed as polyarteritis nodosa and the other patient was diagnosed as systemic vasculitis without the finding of typical necrotizing vasculitis from biopsies. In the result, we found that the level of RF paralleled the disease activity in these cases. When active phase of the disease, the level of RF showed very high, and after the treatment combined with plasmapheresis, corticosteroid and immunosuppressive agent, the level of RF decreased in accordance with CRP, ESR and clinical features. These suggested that RF was the disease specific marker for RF positive vasculitis and beneficial informations for proper diagnosis and better treatment could be provided by measurement of the level of RF in patients with RF positive systemic vasculitis.
8008441 Total ankle arthroplasty. Indications, techniques, and results. 1994 Apr A high rate of complications and failure have limited the indications for total ankle replacement to older patients with rheumatoid arthritis, especially those with multiple joint involvement and limited physical activity. Recommended surgical technique for total ankle arthroplasty includes proper patient positioning, an anterior surgical approach, meticulous bone resection, and cemented fixation of components. Results of published studies suggest total ankle arthroplasty should not be performed in patients with posttraumatic arthritis who are younger than 60 years of age.
8599385 Characterization of gout in a skeletal population sample: presumptive diagnosis in a Micro 1995 Dec Characterization of the nature and skeletal distribution of gout was accomplished in a Chamoru (Chamorros) population with predilection to the disease. Uniform excavation by the gouty diathesis produces a punched-out appearance to these predominantly monarticular lesions. The lesion is distinct from that seen in rheumatoid arthritis, spondyloarthropathy, or infection. Reactive new bone formation in some gouty lesions also has an apparently unique, ivory-like discoloration (contrasted with the adjacent bone), which facilitates diagnosis.
9293073 Human parvovirus B19 infection: clinical and epidemiological study of 24 cases. 1996 Sep From March 1994 to November 1995 24 cases of human parvovirus B19 infection were seen at the Infectious Diseases Department of the Hospital Universitário Antônio Pedro, Niterói-RJ. Serum samples for IgM detection (capture enzyme immunoassay) were positive from the 1st to the 27th day after the onset of the exathema. The classical features of erythema infectiosum (slapped cheecked syndrome) were observed in 8 (33.3%) cases all of them children. Eight patients (6 adults and 2 children) presented a symmetrical polyartropathy, seen more frequently in women. These results show that B19 infection diagnosis is difficult when the disease does not present the classical features and because of the frequent involvement of the joints this infection should be considered in the differential diagnosis of early rheumatoid arthritis.
8535643 The history of the use of sulphasalazine in rheumatology. 1995 Nov Sulphasalazine was initially used more than 50 yr ago to treat inflammatory arthritis but fell into disuse, only to be revived 25 yr ago for rheumatoid arthritis. Since then its place as a second-line agent has been established and its toxicity profile has been outlined. Subsequently, its use has been widened to include other inflammatory rheumatic diseases, with strong suggestions that it may be useful for several indications. The history of its initial use, its reintroduction and the establishment of its place in modern rheumatology are reviewed.