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ID PMID Title PublicationDate abstract
8162642 The treatment of Sjögren's disease in NZB/NZW F1 hybrid mice with azathioprine: a two-sta 1994 Jan NZB/NZW mice exhibit changes in their salivary and lacrimal glands similar to those occurring in Sjögren's syndrome (SS) in humans. The aim of this study was to determine the efficacy of azathioprine in the treatment of SS in NZB/NZW mice. The experimental animals comprised three groups; the first received the drug daily from 14 weeks of age, the second started therapy at 26 weeks of age and the third group remained untreated. The animals, in groups of five, were killed at four-weekly intervals, up to 42 weeks, using ether. The submandibular and lacrimal glands were assessed for the extent of lymphocytic infiltration using a modified focus scoring system, with light microscopy. During the progression of the disease, azathioprine produced a reduction in the number of lymphocytic foci. This reduction occurred when azathioprine was used both early and late in the condition.
7871957 Long-term remission of neutropenia in Felty's syndrome after a short GM-CSF treatment. 1994 We report a case of Felty's syndrome in which neutropenia was corrected by a short-term treatment with recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF, 5 micrograms/kg/day s.c. for 14 days). Absolute neutrophil counts rose from 0.1 to 2.2 x 10(9)/l and remained > 1.0 x 10(9)/l 8 weeks after discontinuation of the GM-CSF therapy. A flare-up of arthritis and a decrease in platelet counts were observed.
1395218 Sjögren's syndrome and mixed connective tissue disease. 1992 Jul We investigated the clinical significance of the close association of Sjögren's syndrome (SS) with mixed connective tissue disease (MCTD) by analyzing the clinical manifestations, sialographic findings and immunological parameters of MCTD and primary SS. The prevalence of sialectasia or SS in MCTD was significantly higher than in any other connective tissue diseases. The prevalence of Raynaud's phenomenon, swollen fingers, arthralgias, lymphadenopathy, sclerodactyly, muscle weakness, fever and erythema was significantly higher in MCTD than in primary SS. There were no significant differences between these manifestations in MCTD patients with sialectasia or SS, and those in MCTD patients without sialectasia or SS. Although the levels or prevalence of the erythrocyte sedimentation rate, CRP, antinuclear factor, anti-DNA antibody and anti-RNP antibody were significantly greater in MCTD than in primary SS, there were no significant differences in the levels or the prevalence of laboratory abnormalities between MCTD with sialectasia or SS, and MCTD without sialectasia or SS. Moreover, there was a strict dissociation between the occurrence of anti-RNP antibody and anti-SS-B antibody both in MCTD and primary SS. These results suggest that the association of secondary SS or sialectasia in MCTD, although more common than in other connective tissue diseases, is merely a consequence of MCTD and does not influence the clinical course of MCTD.
8988874 Expression of TNF alpha in arthritis caused by caprine arthritis encephalitis virus. 1996 Nov Goats infected with caprine arthritis encephalitis virus (CAEV) develop chronic arthritis sharing many features with human rheumatoid arthritis (RA). TNF is thought to be a key mediator contributing to the formation of the arthritic lesion in RA. We studied this cytokine in goats suffering from chronic arthritis. TNF alpha expressing cells were detected by in situ hybridization in synovial membranes of arthritic carpal joints. Expression of TNF alpha did not correlate with the degree of viral replication as assessed by in situ hybridization for viral RNA. In line with the lack of correlation between the degree of viral replication and TNF expression in vivo, we failed to detect increased cytokine RNA in goat macrophages infected with CAE virus in vitro and no TNF protein was found in culture supernatants. In addition, virus infection failed to prime goat macrophages for enhanced TNF expression in response to lipopolysaccharide. Taken together, these findings argue against a direct role of CAE virus in increasing the expression of TNF alpha in caprine arthritis.
1503874 Bacterial arthritis. 1992 Aug The 1991 literature on septic arthritis included a concise review of adult septic arthritis, examples of pseudoseptic arthritis, and two interesting animal studies. One animal study examined the induction of acute synovitis by the intra-articular injection of bacterial endotoxin and the cytokines tumor necrosis factor-alpha, and interleukin-1 beta; and the other studied the effects of early and delayed synovectomy in the management of septic arthritis. The predispositions to septic arthritis can be divided into local joint abnormalities, systemic factors, or both. Examples of the local joint abnormalities include osteoarthritis of the hip and apatite-associated arthropathy. Septic arthritis in a patient with rheumatoid arthritis, in a patient with diabetes mellitus and hip arthropathy associated with hemochromatosis, or in a patient with acquired immunodeficiency syndrome and hemophilic arthropathy are examples of how systemic predisposition is coupled with local joint pathology to increase the vulnerability of the host to joint infection. Other examples of systemic disease that predispose to septic arthritis are systemic lupus erythematosus, hypogammaglobulinemia, and human immunodeficiency virus infection, as well as intravenous drug abuse. Unusual microorganisms causing septic arthritis in the adult include Achromobacter xylosoxidans, Moraxella catarrhalis, meningococci, and diphtheroids. Uncommon pathogenesis is represented by a case of intra-articular inoculation of Mycobacterium gastri into the small joint of the hand and a case of mixed bacterial infection of the hip resulting from an extension of a contiguous pelvic infection associated with trauma. Two cases of immune complex glomerulonephritis illustrate the extra-articular complications of septic arthritis: one due to group G streptococcus and the other due to pneumococcus. Finally, septic bursitis is reviewed from the community practice perspective.
8555033 Anti-Ro/SSA-associated annular erythema in childhood. 1995 Nov We report four children with anti-Ro/SSA positive who presented with an annular erythema as a manifestation of Sjögren's syndrome. One patient had an aseptic meningoencephalitis as well as cutaneous lesions. Children with annular erythema should be carefully followed for features of Sjögren's syndrome, which is believed to be a rare condition in children.
7493453 Sjögren's syndrome--a house of cards. 1995 Jul Sjögren's syndrome is an autoimmune rheumatic disease that is the result of the interplay between a number of environmental and genetic factors. In this short review an analogy is suggested with a game of cards in which each card is marked with a particular feature. A particular set of cards when dealt together could constitute Sjögren's syndrome if the hand includes cards marked for female sex, HLA DRS, anti Ro antibodies, anti La antibodies, exposure to retroviruses etc.
8506915 Conjunctival biopsy in scleroderma and primary Sjögren's syndrome. 1993 Jun 15 Keratoconjunctivitis sicca complicates both scleroderma and Sjögren's syndrome. Scleroderma of recent onset is difficult to diagnose, but is easily recognized late in its course. To assess the value of the conjunctival biopsy in the diagnosis of scleroderma, we used light, scanning, and transmission electron microscopy to compare in a masked fashion specimens from 21 patients with scleroderma and 14 patients with primary Sjögren's syndrome. Epithelial changes permitted diagnosis of early scleroderma in the two groups of patients. Lymphocytic infiltrate was always present in Sjögren's syndrome, but not in scleroderma. Fibrosis was always found in scleroderma, even in scleroderma of recent onset, but was absent in Sjögren's syndrome. The fibrosis was distributed around capillaries in a band-like pattern and was associated with degranulating mast cells. Conjunctival biopsy is valuable for the early diagnosis of scleroderma and for differentiating between scleroderma and primary Sjögren's syndrome.
8255585 [The ultrasound examination of salivary gland]. 1993 The results obtained after the examination of 107 ultrasound cases of changed salivary glands were presented. The characteristic features for changes most often appearing in salivary glands were presented. In case of tumours and cysts the diagnosis was formed on the basis of the ultrasound character of the change (low homogenas, density in cysts, higher density, non homogenous character in tumours), the degree of separation from the surrounding tissue (clear capsule in cyst and benign tumours, lack of capsule, indistinctive image in change of malignant character, in case of infiltration of surrounding tissues). The diagnosis of inflammation was made depending on the character of the change of the parenchyma of salivary gland--the increase of the gland with the lowering of density characteristic for acute inflammation, the reduction of size, increased sonographic density, enlarged leading out (duct), the echo of concrement is characteristic together with the accompanying acoustic shade for bigger concrements.
1323135 Pathogenesis of Sjögren's syndrome. 1992 Aug Sjögren's syndrome is a systemic autoimmune disease characterized by lymphocytic infiltrations of lacrimal and salivary glands. SS patients produce a variety of autoantibodies, including RF and ANA. Genetic factors, including HLA-DR3, predispose to primary SS. In contrast to normal SGs, the SS SG epithelial cells express high levels of HLA-DR antigens. This class II gene expression on the target organ may represent the structural basis for HLA-associated disease susceptibility. The glands are infiltrated with CD4+ T cells that can produce cytokines, including IL-2 and interferon-gamma. B cells within the SG produce autoantibodies, including RF. These SG B cells frequently use the VKIIIb subgroup of kappa light chain, a feature that SS patients share with Waldenstrom's macroglobulinemia patients. B cells undergo small clonal expansions that can be detected on Southern blot as immunoglobulin gene rearrangements, and SS patients have a markedly increased risk of developing non-Hodgkin's B-cell lymphoma involving the SGs and cervical lymph nodes. Due to accessibility of the SG for biopsy and the characteristic patterns of autoantibody production, SS provides an opportunity to study the target organ for autoimmune destruction and the transition from autoimmunity to lymphoma.
8950390 Test and symptoms in keratoconjunctivitis sicca and their correlation. 1996 Oct Results of dry eye tests and ocular symptoms were compared and correlated in patients with primary Sjögren's syndrome (1 degree SS), in patients with connective tissue disease differing from 1 degree SS, and in normal controls. Patients with 1 degree SS had many and pronounced ocular complaints, however, non-diagnostic for the disease. Break-up time and Schirmer-1 test results below 10 mm/5 min both had high sensitivity but low specificity, whereas the reverse was true for Rose-Bengal score and Schirmer-1 test below 5 mm/5 min. Presence of snake-like chromatin in conjunctival imprints and the lactotest on tear fluid did not qualify as alternative tests since they had very low specificity and were less sensitive than the Schirmer-1 test and break-up time. Cornea sensitivity was not found to be an appropriate test at all. In 21% of eyes the presence of keratoconjunctivitis sicca changed from one consultation to the next in patients with 1 degree SS. Examination for keratoconjunctivitis sicca should therefore be repeated in test negative cases where symptoms indicate 1 degree SS.
1728981 Prolonged survival of MRL-lpr/lpr mice treated with Tripterygium Wilfordii Hook-F. 1992 Jan MRL-lpr/lpr mice were treated with Tripterygium Wilfordii Hook-F (TWHF), a Chinese herbal medicine successfully used for human rheumatoid arthritis. Dramatic prolongation of survival and the reduction of urinary protein were observed in mice treated with a high dose of TWHF (20 mg/kg, three times a week) compared to the control animals receiving solvent alone. A slight but significant reduction was also seen in the degree of lymphadenopathy and arthritis with the high dose treatment. Surprisingly, no significant difference was present in IgM rheumatoid factor and IgG anti-double-stranded DNA antibody levels or in the histopathology of lupus nephritis. These results indicate the dissociation of histopathological renal disease and the degree of proteinuria or the life span. Although further pharmacological analysis is required, TWHF might be potentially useful for diseases such as systemic lupus erythematosus or nephrotic syndrome.
8527536 Enterococcal arthritis: case report and review. 1995 Sep We report a case of septic arthritis due to Enterococcus species and review 18 additional cases reported in the literature from 1966 through 1993 for which clinical or treatment data were available. In 11 of the 19 cases, prosthetic joints were affected (9 knees, 2 hips) and in 8 cases, native joints were affected. Of those patients with prosthetic joint infections, 6 had preexisting osteoarthritis and 3 had rheumatoid arthritis; only one patient with native joint infection had a recognized (although unspecified), preexisting joint abnormality. Pain, fever (temperature, > 37 degrees C), and tenderness were the most common clinical findings in patients with native joint infections. The microbiological diagnosis was made by culture of synovial fluid or synovial tissue (16 of 19), blood (1 of 19), or an unstated specimen (2 of 19). Polymicrobial infection was present in 6 (32%) of 19 patients. Of fourteen patients treated with either a parenteral penicillin (11 of 19) or a glycopeptide (3 of 19), 11 made an uncomplicated recovery. An aminoglycoside was also used to treat 7 of these 14 patients (4 of these 7 had prosthetic joints). All 11 prosthetic joint infections were ultimately clinically cured; for most of these patients, the original prosthesis was removed. For two patients with native joint infections, amputation of the infected limb was necessary to cure the infection.
8256578 Nervous system involvement in systemic lupus erythematosus, Sjögren syndrome and sclerode 1993 Oct INTRODUCTION: The purpose of this study was to determine, whether there are any differences in the occurrence of nervous system involvement in different systemic rheumatic diseases. The further aim of the present study was to identify and distinguish primary involvement of the nervous system by these diseases and involvement that may be secondary to confounding factors. MATERIAL AND METHODS: The patient population consisted of 122 patients with a connective tissue disease (42 with systemic lupus erythematosus (SLE), 48 with Sjögren's syndrome and 32 with scleroderma). The methods included neurological examination and standard electrophysiological tests. RESULTS: At least one neurological defect was diagnosed in 69% of SLE patients, in 71% of Sjögren's syndrome patients and in 66% of scleroderma patients. Secondary factors might have contributed to the pathogenesis of neurological symptoms and signs in up to 25-34% of events. CONCLUSION: No significant differences were noted in the occurrence of neurological events in patients with SLE, Sjögren's syndrome and scleroderma. The necessity to differentiate between neurological phenomena directly attributed to the systemic rheumatic disease and those which are totally unrelated or secondary events resulting indirectly from involvement of other organ systems is emphasized.
1483307 Non-Hodgkin's lymphoma and Sjögren's syndrome. An immunopathological study of 113 patient 1992 Nov One hundred and thirteen patients with untreated non-Hodgkin's lymphoma were evaluated for Sjögren's syndrome (SS) using clinical and biological parameters, and a minor salivary gland biopsy. Concomitant immunophenotyping for T and B cells, and kappa and lambda chains was performed on both minor salivary gland and lymphomatous tissues. Patients with a positive focus score on examination of their minor salivary gland biopsy had a second biopsy, when possible, at the end of induction therapy. Fourteen of the 113 patients had SS according to the Greek criteria, and 4 of these 14 patients had an identical monotypic infiltrate in both their minor salivary gland and lymphomatous tissues. In all four cases this infiltrate disappeared from both locations when the lymphoma was in complete remission (CR). The 10 other patients with criteria for SS had a mixed infiltrate which persisted unchanged when the lymphoma was in CR. Among the 99 patients without SS, 12 had a positive focus score and an identical monotypic infiltrate in both their minor salivary gland and lymphomatous tissue. This infiltrate disappeared from both locations when the lymphoma was in CR. Among the remaining 87 patients, 82 had no minor salivary gland infiltrate, and 5 had a positive focus score with mixed lymphocytic infiltrate. Long term follow up and a large cooperative study are needed to better understand the immunopathologic lesions of patients of this latter type.
1341461 Non-Hodgkin's lymphoma associated with primary Sjögren's syndrome. 1992 Oct OBJECTIVES: To evaluate the prevalence, the incidence and clinical presentation of non-Hodgkin's lymphoma associated with primary Sjögren's syndrome. METHODS: Sixty-two patients with primary Sjögren's syndrome were analyzed retrospectively in an open investigation. RESULTS: Of 62 patients with primary Sjögren's syndrome, 4 of them (6.4%) developed non-Hodgkin's lymphoma (6.9 cases per 1000 per year). All of them were women. Non-Hodgkin's lymphoma always developed after the onset of primary Sjögren's syndrome with a time interval ranging from 3 to 27 years. Pathological findings showed two diffused mixed small and large cell cleaved lymphomas and two diffused large cell cleaved lymphomas. Three cases had extra-nodular localizations. All of these 4 patients are still alive and in complete remission 2 to 8 years after the diagnosis of non-Hodgkin's lymphoma. CONCLUSION: This study confirms the association of non-Hodgkin's lymphoma in primary Sjögren's syndrome. These non-Hodgkin's lymphomas frequently had extra-nodal localizations. Good sensitivity to treatment, when necessary, provided good prognosis.
8348746 IL-2 enhances polyclonal IgM but not IgM-rheumatoid factor synthesis by activated human pe 1993 Aug IgM-rheumatoid factor (RF) is thought to be involved in the pathogenesis of rheumatoid arthritis (RA). Several cytokines are known to regulate immunoglobulin synthesis. In this study the effects of IL-2 on polyclonal IgM and IgM RF synthesis were compared. Cytokines were added to peripheral blood B cells from normal subjects and patients with RA after activation by Staphylococcus aureus Cowan 1 (SAC). The addition of IL-2, but not IL-4 or IL-6, resulted in significant enhancement of IgM synthesis in cultures from both healthy subjects and patients with RA. Similar degrees of enhancement were seen in both peripheral blood mononuclear cell and highly purified B cell cultures. IgM-RF was synthesized after activation in cultures from healthy subjects and spontaneously in cultures from RA patients. In contrast to polyclonal IgM synthesis, IL-2 failed to augment IgM-RF synthesis in cell cultures from either healthy subjects or RA patients. This study demonstrates different effects of IL-2 on IgM and IgM-RF synthesis.
8303459 Nonrheumatoid cranial settling. 1993 Dec Cranial settling is a condition in which erosive changes of the atlantal lateral masses result in downward telescoping of the atlas onto the axis body, anterior displacement of the atlantal posterior arch, and subsequent ventral and dorsal cervicomedullary compression. Cranial settling is described in conjunction with rheumatoid basilar invagination and atlanto-axial instability, possibly representing the most life-threatening abnormality associated with rheumatoid arthritis. The authors describe a case of symptomatic cranial settling in a nonrheumatoid patient with chronic, severe, spasmodic torticollis resulting in erosive changes in the occipito-atlanto-axial complex.
24234930 A domestic assistive device for rheumatoid hands. 1996 Jun A domestic aid capable of squeezing water from a dishcloth is currently not available and such a task is performed in most households. The need for such a device was investigated. To establish the need, 54 rheumatoid arthritis patients were surveyed through a structured questionnaire for hand impairment and difficulty in this task. While 27% of the participants reported normal hand ability, 28% had minimal impairment, 39% moderate impairment, and 7% severe impairment. Sixty-one percent reported having difficulty with their hands and wrists. The mobility deficit was the cause of difficulty among 59%, and strength deficit in 80%. Ninety-three percent of patients had difficulty due to pain. The activity was avoided by 43%. If a device was available, 74% would use it. A water-squeezing device was designed and a prototype fabricated which eliminated finger and wrist stress in this task.
8774556 Pancreatic exocrine involvement in primary Sjögren's syndrome. 1996 Exocrine pancreatic involvement of primary Sjögren's syndrome (SS) was studied. Pancreatic enzyme levels (total amylase, pancreatic isoamylase and immunoreactive trypsin) along with anti-ductuli antibodies (Ab) were studied in 77 patients with primary SS. In 10 patients with normal and 10 with abnormal enzyme levels pancreatic CT scans were also obtained. All enzyme levels were significantly increased in comparison to the control group. Immunoreactive trypsin was found to be the most frequently increased enzyme (35.3% of pSS patients). Anti-ductuli Ab were not found in any patient. Pancreatic CT scans were normal in all subjects with enzymatic increase, whereas 2 abnormal scans were demonstrated in patients without enzyme changes. Our study suggests that exocrine pancreatic involvement is frequent when measured by enzyme levels. Nevertheless, we were unable to demonstrate any morphological lesion by CT scan.