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ID PMID Title PublicationDate abstract
19078032 Lymphoma and luekemia in rheumatoid arthritis: are they associated with azathioprine, cycl 1996 Apr Incident cases of lymphoma and leukemia in a cohort of 3824 rheumatoid arthritis (RA) patients from the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) database were identified, and the use of azathioprine, cyclophosphamide, and methotrexate was compared in a matched case-control study. Controls were matched on age, sex, year of study entry, disease duration, center, and years of follow-up. Twenty-four cases of lymphoma and 10 cases of leukemia were identified: 21% of patients with cancer versus 9% of controls had taken azathioprine [McNemar statistic 1.50 (p = 0.22), odds ratio 5.0 (95% confidence interval 0.6,236.5)]. Equal numbers of cases and controls (6% each) had taken cyclophosphamide and 18% of cases and 12% of controls had taken methotrexate [McNemar statistic 0.13 (p = 0.72), odds ratio 1.7 (0.3, 10.7)]. Results suggest but do not prove that RA patients taking azathioprine and methotrexate may have an increased risk of developing lymphoma. However, even if this increased risk can be confirmed, it accounts for only a small proportion of the greatly increased incidence of these malignancies in RA.
8633469 MR imaging of the parotid gland in Sjögren's syndrome: a proposal for new diagnostic crit 1996 Jun OBJECTIVE: Because classic diagnostic techniques for sjögren's syndrome (SS) are invasive and require radiation exposure, a noninvasive diagnostic method might benefit patients with SS. The purpose of this study was to determine whether quantitative analysis of MR images of the parotid gland can differentiate patients with SS from normal subjects. SUBJECTS AND METHODS: We performed quantitative analysis of MR images of the parotid gland for 40 patients with definite and probable SS, for 30 normal subjects matched by age and sex to the SS patients, and for 10 patients with parotid inflammation. MR images of teh parotid gland were assessed by calculating standard deviations (SD) of signal intensity. RESULTS: SD of signal intensity exclusively (p < .0001) separated MR images of the parotid glands of patients with definite SS from those of normal subjects. SD of signal intensity for the parotid glands of patients with probable SS also were significantly higher (p < .001) than those of normal subjects. Changes in signal intensity were specific for SS and did not occur with parotid inflammation. Tentative categorization on the basis of signal intensity patterns on MR images of the parotid glands of SS patients showed a high correlation with the results of labial gland biopsy (r = .834) and sialography (r = .936). CONCLUSION: Taken together, these results conclusively indicate that quantitative analysis of MR images for SD of signal intensity is useful method for diagnosing SS and can replace classic methods, which are invasive.
9275609 [Clinical and radiographic study of Sjögren syndrome in children]. 1996 Jan Eight cases of Sjögren syndrome in children were presented. Recurrent swelling of salivary glands was shown to be predominant findings in children with Sjögren syndrome. It was first reported that "lace-like" appearance of main duct was of great value in sialographic diagnosis of Sjögren syndrome in children. The differentiation between Sjögren syndrome and recurrent parotitis in children was discussed.
8835566 Antineutrophil cytoplasmic antibodies in reactive arthritis. 1995 Dec OBJECTIVE: To study the occurrence of antineutrophil cytoplasmic antibodies (ANCA) in reactive arthritis (ReA). METHODS: Sera from 22 patients with ReA were analyzed by ELISA for the presence of autoantibodies (IgG and IgA) against a proteinase-3 containing azurophilic granule extract ("alpha-antigen") from human polymorphonuclear leukocytes, myeloperoxidase (MPO), and lactoferrin (Lf), respectively. Rheumatoid factor (RF), antinuclear antibodies (ANA), and HLA-B27 were also tested. Erythrocyte sedimentation rate and serum levels of C-reactive protein were used to assess disease activity. The patients were divided into acute or chronic (> 1 year) disease. RESULTS: 12/22 patients (55%) had IgG ANCA (7 had MPO ANCA, 8 had Lf ANCA, and 4 had alpha-ANCA). Eight patients (36%) had IgA ANCA. One serum was positive only for IgA ANCA. 18/21 patients (86%) were HLA-B27 positive, and none had RF or ANA. The triggering infection was Chlamydia trachomatis in 6 cases. Campylobacter jejuni in 6, Yersinia enterocolitica in 4. In 6 patients the causative microorganism could not be determined. ANCA was more prevalent in chronic disease (6/7, 82%) compared to acute (7/15, 47%). No obvious correlation was seen between ANCA and disease activity. CONCLUSION: ANCA, predominantly those reacting with Lf and/or MPO preparations, are common in ReA.
8030543 Sjögren's syndrome: immunologic and neuroendocrine mechanisms. 1994 SS patients are characterized by decreased volume of lacrimal and salivary secretions. The dryness results from a combination of destroyed glandular elements as well as by interference with the neuro-endocrine innervation of the residual glands. Specific genetic factors (i.e. HLA class II alleles) have been associated with increased risk of SS in Caucasian (US), Chinese and Japanese populations. However, different class II MHC alleles are risk factors in each population. The environmental factors that precipitate SS remain unknown. Future understanding of the mechanisms of destruction of the salivary and lacrimal glands may provide a more rationale approach to therapy.
8221258 Nodules, eosinophilia, rheumatism, dermatitis and swelling (NERDS): a novel eosinophilic d 1993 Jul This study presents the clinical and laboratory findings of a novel syndrome associated with eosinophilia. Two young women presented with marked eosinophilia, and large, non-tender compressible articular nodules arising from the tenosynovium of extensor tendons, dermatitis, episodic swelling of the hands and/or feet and pain in adjacent muscles and joints. Tissue specimens were examined by routine haematoxylin and eosin staining, immunofluorescent staining for eosinophil granule major basic protein (MBP) and rhodamine-avidin or tryptase staining for mast cells. Plasma levels of MBP and eosinophil-derived neurotoxin (EDN) were quantitated by immunoassay. The first patient presented in 1967 at the age of 20 and had, in addition to nodules and eosinophilia, dermographism, recurrent episcleritis and axillary urticaria. Biopsy of a nodule showed tenosynovitis with necrotizing granulomas, non-specific vasculitis, eosinophils and eosinophil degranulation as shown by extracellular deposition of eosinophil granule MBP. Her symptoms responded to low-dose, alternate-day prednisone and have remained quiescent over the past 15 yr. The second patient presented in 1990 at the age of 28 with generalized pruritic dermatitis for 15 yr, eosinophilia for 2 yr, subcutaneous nodules and non-limiting pain in several joints. Biopsy of a nodule showed chronic mild tenosynovitis, numerous eosinophils and extracellular deposition of MBP. She remains untreated. Serum IgE values and plasma levels of MBP and EDN were elevated in both patients; mast cells were numerous in their synovial tissue. Based on their clinical courses, these patients reveal the existence of a distinctive, relatively benign eosinophilic disorder with good long-term prognosis.
1494250 [Two cases of adult onset of Still's disease in the elderly]. 1992 Dec Two cases of adult onset of Still's disease is in a 83-year-old and a 61-year-old women. Both cases complained of high fever, arthralgia, sore throat and maculae. Examinations on admission revealed leukocytosis and negative antinuclear antibody. Administration of prednisolone resulted in improvement of the clinical symptoms and laboratory data. In general, the onset of this disease is usually in early adulthood, but in these two cases the onset was at an advanced age. These results suggest that Still's disease of adult onset should be included in the differential diagnosis of fever of unknown origin, if the patient is elderly. In the treatment of the disease, proper attention to side effects of prednisolone and complications can be important.
7553057 [A case of Sjögren's syndrome complicated with cryoglobulinemia, nephrogenic diabetes ins 1995 Apr A 68-year-old woman had been complained of xerostomia since she was 30 years old. Further symptoms of polyuria, polyposia and insomnia had been developed since she was 35 years old. The biopsy material from a minor salivary gland demonstrated the infiltration of lymphocytes into mesenchyme which was compatible with Sjögren's syndrome. She admitted to our hospital because of myalgia in bilateral gastrocnemius and petechiae in both lower extremities in addition to the complaints described above. Complete blood cell counts on admission revealed hemoglobin 9.7 g/dl, platelet count 12.5 x 10(4)/microliters, and white blood cell count 3,300/microliters. Marked polyuria, polyposia (more than 5,000 ml/day, respectively) and low urine gravity (1.005) were observed, although the serum creatinine level showed normal value. Serologic examination showed that the elevation of total serum protein concentration (9.5 g/dl) with marked elevation of serum IgG level (6,190 mg/dl). Her immunoglobulins contained cryoglobulin (cryocrit 20%), and immunoelectrophoresis demonstrated the existence of IgG-kappa monoclonal protein. A positive anti-nuclear antibody at 1:320 dilution, a positive rheumatoid factor and a positive antibody to SS-A (Ro) were also observed. The serial studies of blood gas analysis could not demonstrated the presence of metabolic acidosis. Together with the result of elevated plasma antidiuretic hormone level and results of vasopressin test, Fishberg's concentrating test and the tests of the overload of NH4Cl or bicarbonate, she was diagnosed Sjögren's syndrome with both diabetes insipidus and subclinical renal tubular acidosis. She was initially medicated with prednisolone (40 mg/day, orally), then she was given six courses of intravenous cyclophosphamide (750 mg/body/month).(ABSTRACT TRUNCATED AT 250 WORDS)
8193233 [Immunogenetics of the Sjogren's syndrome in southern Spain]. 1994 Feb To establish the relation between HLA antigens, Primary Sjögren Syndrome (PSS) and autoantibodies production, in our geographical area, we undertook a case-control study with a consecutive sample of 30 patients with PSS (Fox's criteria) attending in a reference hospital. Two hundred and sixty-four local controls with no apparent pathology were included for comparison. In patients we evaluated clinical and analytical aspects about multisystem autoimmune disease. Anti-SSA/Ro and -SSB/La autoantibodies were determined by double immunodiffusion. HLA typing was serologically determined. In logistic regression multivariate analysis, there were significant association between PSS and specificities HLA-Cw7 (73% in cases, versus 35% in controls; RR = 8.0; 95% CI: 23.2-2.7), HLA-DR3 (63% vs 20%; RR = 3.4; 95% CI: 9.5-1.4) and HL-DR11 (43% vs 13%; RR = 4.1; 95% CI: 12.0-1.4). In patients, the anti-SSA/Ro autoantibodies production were associated with HLA-DR3 antigen (83% vs 25%; RR = 6./; 95% CI: 1.3-34.2). All HLA-DQ2/DQ6 heterozygotes patients (8 cases) had anti-SSA/Ro autoantibodies, versus only one half of the remainder (p = 0.029; RR = 6.3). In anti-SSA/Ro negative patients there weren't association with HLA-DR3 antigen (33% vs 20%). HLA-DR3 were associated with the presence of anti-SSB/La autoantibodies, but there wasn't signification (p = 0.081). We conclude that our patients with PSS present association with HLA-DR11 specificity, that it's a risk factor for the disease development. HLA-DR3 would determined the anti-SSA/Ro autoantibodies, and maybe also anti-SSB/La autoantibodies, production. Furthermore, HLA-DQ2/DQ6 heterozygosity would determined immune response to SSA/Ro autoantigen.
8129979 [Biopsy of minor salivary glands: indication and implementation]. 1993 Sep The biopsy of minor salivary glands has great value in the diagnosis of the pathology of salivary glands; however, this technique is little known and seldom used. During the last 18 months we have studied in order to describe the technique and its utility.
8712312 [Sjogren syndrome: clinics and ENT diagnosis]. 1996 Prospective study covering 38 cases of Sjögren's syndrome (S.S.) diagnosed after early clinical suspicion awaken for xerostomy and xerophtalmy, once excluded those cases which pathology was previously known. Thirty-two cases pertaining to primary malady (P.S.S.) being secondary (S.S.S.) the others. The clinical E.N.T.-symptomatology stand out in our series, because the throat dryness and taste and olfactory alterations. The 53 percent of patients have consulted with other specialists without actualizing the diagnosis. The AA. discuss complementary diagnostic methods (Schirmer's test, rose bengal stain, sialometry, auto-antibodies and biopsy of minor salivary glands) and diagnostic criteria, and fix the otolaryngologist role in the management of these patients.
8323400 Beta 2 microglobulin measurements in saliva of patients with primary Sjögren's syndrome: 1993 Jun OBJECTIVES: To determine the diagnostic value of beta 2 microglobulin in parotid saliva, its concentration in relation to salivary flow was determined in 29 patients with primary Sjögren's syndrome and in 30 normal controls. The specific secretion rate of beta 2 microglobulin was calculated. METHODS: Parotid saliva samples were collected within a 20 minute period directly from Stensen's duct with Lashley cups: sample 1 without gustatory stimulation during the first 10 minutes and samples 2 and 3 during the next five to 10 minutes, when saliva production was stimulated by a 500 mg vitamin C tablet. The sample volumes were measured and the beta 2 microglobulin concentration was determined by radioimmunoassay. RESULTS: During gustatory stimulation the mean beta 2 microglobulin secretion rate in patients with primary Sjögren's syndrome was 0.31 microgram/min; in normal controls it was 0.14 microgram/min. The sensitivity and specificity of this test were 56 and 87% respectively. The mean salivary flow without stimulation in patients with primary Sjögren's syndrome was lower than that in normal controls, but no difference was found during stimulation. CONCLUSIONS: Our results support the hypothesis of local beta 2 microglobulin production in the parotid gland of patients with primary Sjögren's syndrome. The test cannot be used as a screening test owing to low sensitivity, but it may be used as a supplementary diagnostic test as it has the advantage of being non-invasive.
8448614 The diagnostic value of salivary gland scintigraphy in patients suspected of primary Sjög 1993 Mar The diagnostic value of salivary gland scintigraphy in patients suspected of having primary Sjögren's syndrome (SS) was studied in 149 consecutive patients who presented with joint and/or muscle complaints in combination with dryness of the mouth and/or eyes and in 20 control subjects. The diagnosis primary SS could be established in 26 of these patients. Salivary gland scintigraphy scored by means of analogue pictures was abnormal in 19 out of 26 patients with primary SS but abnormal scintigrams were also found in 57 of the 123 patients without primary SS and in five of the controls. This resulted in a positive predictive value of an abnormal salivary gland scintigram of 25% and a negative predictive value of a normal investigation of 90%. From the high number of false positive test results in the patient population studied it is concluded that salivary gland scintigraphy has only a limited discriminatory value for the diagnosis of primary SS.
1461541 [Salivary and serum beta 2-microglobulin in the diagnosis of primary Sjögren's syndrome]. 1992 Nov beta 2-microglobulin (beta 2m) serum and salivary levels and total protein salivary levels were determined in 15 patients with primary Sjögren's syndrome (pSS), 14 patients with sicca syndrome and 11 healthy subjects. beta 2m serum and salivary levels were higher (p < 0.005) in the patients with pSS than in the healthy subjects and in the patients with sicca syndrome. The bioptic focus scores of minor salivary glands were correlated to beta 2m salivary levels with a high significance (p < 0.001) but were not correlated to beta 2m serum levels. The assessment of beta 2m serum and salivary levels is a non-invasive clinical investigation, which may be easily repeated. It is a very sensitive and highly specific test for the diagnosis of pSS. It may be therefore a useful mean to follow the natural course of pSS and to evaluate the effects of therapy.
1448655 [Dementia disclosing primary Gougerot-Sjögren syndrome]. 1992 Two cases of primary Sjögren's syndrome revealed by dementia are reported. The patients had progressive or subacute memory dysfunction and psychiatric disorders with depression and delirium. The diagnosis of Sjögren's syndrome was established by biopsy of the minor salivary glands. Both patients were treated with corticosteroids. The neuropsychiatric symptoms improved dramatically in one case and remained unchanged in the other case. Dementia in Sjögren's syndrome seems to be without aphasia, apraxia or agnosia, and associated with psychiatric features, particularly depressive symptoms, thus including some characteristics of subcortical dementia. Diagnosis may be difficult because, as shown in our cases, symptoms of ocular and buccal dryness can be absent. Salivary gland biopsy can be useful in the evaluation of patients with dementia of undetermined etiology.
8583178 Diffuse idiopathic skeletal hyperostosis (DISH): a review of radiographic features and rep 1995 Oct OBJECTIVE: To discuss the diagnostic criteria, clinical findings and radiographic findings of diffuse idiopathic skeletal hyperostosis (DISH). CLINICAL FEATURES: DISH is a disease that affects elderly persons and is characterized by a bone-forming tendency with prominent radiographic findings, including proliferation of bone throughout the ligaments and tendons of the spine and extremities. Clinical symptoms are often mild and include mild pain and stiffness. DISH can coexist with other articular diseases, such as degenerative joint disease and rheumatoid arthritis, or can be complicated with myelopathy and fracture. INTERVENTION AND OUTCOME: All four patients were men over the age of 75 and had DISH with associated neurological signs and symptoms. Three patients showed improvement after chiropractic manipulative treatment. One patient was referred for a surgical consultation for atlantoaxial instability from rheumatoid arthritis and was subsequently lost to follow-up. CONCLUSION: DISH is a common disease of the elderly; clinicians should recognize its radiographic and diagnostic features.
7869176 Anti-glycosphingolipid autoantibodies in rheumatologic disorders. 1994 Antibodies directed against ganglioside GM1 or sulfatides are frequently associated with motor or sensorimotor neuropathies. To establish the prevalence of such anti-glycosphingolipid autoantibodies in autoimmune disorders and to determine whether they contribute to neurologic symptoms in those individuals, we measured these antibodies by enzyme-linked immunosorbent assay (ELISA) in serum samples from rheumatologic patients with and without peripheral neuropathies (PN). We tested 21 patients with systemic lupus erythematosus (9 with PN), 26 with Sjögren's syndrome (12 with PN), 34 with scleroderma (28 with PN), and 14 with rheumatoid arthritis (4 with PN). Samples from 32 normal individuals were also tested. Patients with systemic lupus erythematosus and rheumatoid arthritis had elevated concentrations of GM1 antibodies and scleroderma patients had lower levels of sulfatide antibodies compared to healthy individuals. The presence of ganglioside or sulfatide antibodies did not correlate with the development of peripheral neuropathy in these patients. These findings suggest that relatively low-titer glycosphingolipid antibodies may arise as part of a nonspecific polyclonal gammopathy in rheumatologic disorders but generally without clinical manifestation.
1386940 Coding region polymorphisms of human T-cell receptor V beta 6.9 and V beta 21.4. 1992 Aug Two new TCRV beta coding region polymorphisms were identified: V beta 6.9a/b and V beta 21.4a/b. In both cases, a single nucleotide difference gives rise to an amino acid exchange. Genomic typing by the PCR/sequence-specific oligonucleotide probing technique was performed to study a possible contribution of these two new polymorphisms in susceptibility to autoimmune diseases. However, there was no association with insulin-dependent diabetes mellitus, rheumatoid arthritis, juvenile rheumatoid arthritis, multiple sclerosis, myasthenia gravis or coeliac disease. On the other hand, significant differences were found between Caucasoid and Oriental populations in frequencies of the V beta 6.9 and V beta 21.4 alleles.
7955619 Surgical treatment of juvenile rheumatoid arthritis. 1994 Sep There is no general agreement about the role of surgery in the treatment of juvenile chronic arthritis patients. It is very natural that in the case of the growing child, the surgical armament is limited to prophylactic procedures, and reconstructive operations are rather rare. In Finland, with a population of 5 million people, slightly less than 1,000 children under the age of sixteen suffer from juvenile chronic arthritis. Among these, about half need to be hospitalized every now and then. Our institution covers about 85% of hospital treatment. Consequently, most cases with severe disease necessitating surgery are treated in one hospital. The annual number of operations has decreased markedly during the last ten years due to the more aggressive and more effective medical as well as other kinds of non-surgical treatment. Despite the active use of local steroid injections, tenosynovectomy is still necessary. Joint synovectomies are carried out today, when necessary, mostly arthroscopically. Major surgery such as joint replacement is very rare in patients under the age of sixteen. If necessary, closure of the growth plates must be awaited, and special custom-made prostheses are used in most cases. The small bones and some particular deformities typical of JRA patients present special challenges to the surgeon's skill. Consequently, the conducting of these types of surgery should be centralized in specialized clinics.
8999569 [The influence of psychological factors on the immune system and immunological diseases]. 1996 Oct 30 During the last 10-20 years it has become clear that the immune system not only protects the individual against potentially harmful intruders but also interacts with both the nervous and endocrine systems. Today we know that immune competent cells have receptors for hormones and neurotransmitters, and that cytokine receptors are expressed in certain areas of the brain. Furthermore, in many animal models immune suppression has been induced by classical conditioning. Several in vitro studies have shown signs of reduced immunity in individuals during acute and chronic stress. Some studies have also indicated that chronic stress may increase the risk of infections and cancer. On the other hand, various psychotherapeutic techniques appear to strengthen the immune system. As for immunological disease, we know that psychological factors are important in the case of allergic asthma. Moreover, serious life events prior to onset of disease are reported more frequently by seronegative than by seropositive rheumatoid arthritis patients. Prospective studies have shown that psychotherapeutic intervention can reduce disability in rheumatoid arthritis patients, but disease activity is diminished only rarely.