Browse

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

ID PMID Title PublicationDate abstract
7841553 Current concepts in psoriatic arthritis. 1994 Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis and characterized by absence of rheumatoid factor. Any form of psoriasis can be complicated by joint inflammation. Four groups have been identified: pauciarticular psoriatic arthritis, psoriatic spondylitis, symmetrical polyarticular psoriatic arthritis and arthritis mutilans. The etiology of psoriatic arthritis remains unclear. Genetic, immunologic and environmental factors are thought to be important in the development of the disease. The role of cytokines and adhesion molecules in the mechanism of joint destruction is highlighted, and recent therapeutic strategies are discussed.
8533479 [Femoral neck fracture in the elderly--differential procedure]. 1995 Recent investigations and new devices allow specific regimens in the management of dislocated femoral neck fractures. Very old, immobile patients with a bad prognosis should be treated with a femoral head prosthesis. Patients with either arthritis, osteopenia, dysplasia or rheumatoid arthritis should receive a total hip prosthesis. The remaining population (age > 65 years) with dislocated femoral neck fractures and intact acetabulum should be managed with a bipolar hemialloarthroplasty. The protrusion rate is not significant.
8364054 [Typical nuclear spin tomographic intensity distribution patterns in different knee joint 1993 Jul The knee joints of 31 patients and 3 volunteers were examined with a 1.5 T Magnetom using 3D-gradient echo sequences. We measured for the most widespread diseases: the gonarthrosis (n = 23) and rheumatoid arthritis (n = 8) the signal intensities in all joint parts and the typical signal plots were worked out. In case of minimal changes at the articular cartilage, the method developed and tried out by us can facilitate diagnosis. A special aspect of this method is also the patient follow-up which is now possible quantitatively and objectively.
8186540 Optimal management of gout in older patients. 1994 Feb Gout in older patients tends to be sub-acute to chronic, often tophaceous, polyarticular, erosive, symmetrical, and causes persistent, recurrent and chronic arthritis. Clinically, it may closely mimic rheumatoid arthritis; thus, a correct diagnosis requires a high index of clinical suspicion and the identification of uric acid crystals. An optimal therapeutic strategy for most older patients with chronic tophaceous gout could involve the following: avoidance of alcohol and diuretic use if possible; avoidance of long term nonsteroidal anti-inflammatory drug (NSAID) therapy; use of short term corticosteroids (systemic or intra-articular) for acute exacerbations; prophylactic colchicine daily or every other day according to the degree of renal dysfunction present; and long term allopurinol therapy in dosages adjusted to the degree of hyperuricaemia and renal dysfunction.
8842723 Surgery of psoriatic arthritis of the hand. 1996 Aug Psoriatic arthritis is an uncommon form of arthritis that poses specific problems for the hand surgeon. Although there are similarities between this form of arthritis and the more common rheumatoid or degenerative arthritis, this particular entity is unique, and physicians or surgeons treating these patients should be aware of the differences to advise or carry out appropriate treatment. Before embarking upon specifics, it is fitting to review some of the fundamentals of this condition.
8137534 Photodynamic therapy; a comparison with other immunomodulatory treatments of adjuvant-enha 1994 Mar Although numerous experimental immunomodulatory regimens have been reported to be effective in the treatment of rheumatoid arthritis, they also produce undesirable side effects. An alternative specific modality of localized treatment is photodynamic therapy (PDT). In this study we treated 13-week-old MRL-lpr mice whose spontaneous arthritis was enhanced by intradermal injection of Freund's complete adjuvant (FCA). One group received transcutaneous photodynamic therapy at days 0, 10, and 20, following the FCA injection. The other groups were injected with 1 mg/kg per day indomethacin, 40 mg/kg per day cyclosporin A (CsA), or treated with 3 Gy sublethal whole body irradiation (WBI). The development of swelling was monitored for 1 month, at which time proteinuria, lymphadenopathy and the histopathology of the joints and kidneys were assessed. The results demonstrated that PDT and the conventional treatments significantly ameliorated swelling of the hindlimbs from 70% in the untreated FCA-injected animals to below the 19% level characteristic of the unmanipulated control. Histological examination showed a reduction in pannus formation, and cartilage and bone destruction, the characteristics of adjuvant-enhanced arthritis. PDT did not affect the survival rate, lymphoproliferation, or proteinuria of the treated animals. However, indomethacin increased proteinuria, and was less effective in preventing cartilage and bone destruction. Furthermore, lower doses of CsA and WBI exacerbated arthritis activity. These results indicate that photodynamic therapy can inhibit the development of adjuvant-enhanced arthritis in MRL-lpr mice with similar effectiveness to the conventional treatments, but without their negative side effects.
7562772 Patterns of T lymphocyte clonal expansion in HLA-typed patients with juvenile rheumatoid a 1995 Jul OBJECTIVE: The presence of clonally expanded T lymphocytes appears to be a characteristic feature of autoimmune diseases, including juvenile rheumatoid arthritis (JRA), although the relevance of such clones to immunopathogenesis is not clear. Identification of clones specific for a disease and/or particular MHC haplotypes should help differentiate those of pathogenic importance. METHODS: A reverse transcriptase polymerase chain reaction assay for T cell receptor (TCR) complementarity determining region 3 (CDR3) length heterogeneity and cDNA sequencing were used to identify clonal expansion in synovial fluid (SF) samples obtained from 36 patients with JRA. RESULTS: The majority of patients had multiple synovial T cell clones using different TCR V beta families. Fifty-eight percent of these clonally expanded T cell populations used one of six TCR V beta families (V beta 2, V beta 8, V beta 14, V beta 16, V beta 17, and V beta 20). Patients with polyarticular, as opposed to pauciarticular, JRA had higher numbers of clones in joints. TCR V beta 8, V beta 14, V beta 16, and V beta 17 families were most frequently found in these clones. Overall, the most frequently used V beta family was V beta 20, which was observed in 18 of 36 SF samples. Of 18 patients exhibiting TCR V beta 20 clonal expansion, 14 (78%) had pauciarticular onset JRA. The V beta 20 association was especially strong in patients who possessed HLA-DR8+ haplotypes (p = 0.01, Fisher's exact test). SF from the patients who had other types of JRA (and other MHC haplotypes) did not show this association. CONCLUSION: The distinct clinical subtypes of JRA are characterized by different patterns of synovial T cell clonality. These findings imply that different molecular pathways underlie the development of arthritis in each subtype of JRA.
7980216 Septic arthritis: a second decade of experience. 1994 Jun AIMS: To review the diagnostic features, treatment and outcomes of all cases of septic arthritis presenting to a major Australian rheumatology unit, between 1982 and 1991. These were compared with the previous decade's experience. METHODS: The medical records of all cases of septic arthritis presenting to the Combined Centre for Rheumatic Diseases, The Rachel Forster Hospital between 1982 and 1991 were reviewed and compared with the experience of the previous decade (1971-1981). RESULTS: Twenty-seven episodes of septic arthritis were diagnosed in 27 patients. There were 18 females and nine males. The average age was 62 (21-83) with three patients less than 30. Their rheumatological diagnoses were: rheumatoid arthritis (RA) in 15, osteoarthritis in five, gout in two, and one each of mixed connective disease, sarcoid, tenosynovitis of the forearm, seronegative spondyloarthropathy, and non specific polyarthritis. Eleven patients were on oral corticosteroids. Four patients had intra-articular injections within two months of the onset of the septic episode. Sixteen out of 19 aspirates on the wards were positive. The organisms identified were Staphylococcus aureus in ten (one multiply resistant S. aureus (MRSA), Streptococcus four, Mycobacterium three (one atypical), two Pseudomonas and one each of Citrobacter, Enterobacter, Gram negative bacillus. Five patients did not have a causative organism identified. The site of involvement and the causative organisms were similar in both decades. All patients received intravenous antibiotics for at least two weeks and oral antibiotics for at least another four weeks. Twenty-two per cent had regular aspirations on the wards and 26% had surgical drainage performed. Only 59% of all joints returned to good function. Fifty per cent of infected arthroplasties required arthrodesis and only a third of these returned to acceptable function. CONCLUSION: Septic arthritis in subjects with previous rheumatic disease continues to have a poor prognosis, especially in cases of infected arthroplasties. There has been no change in the types of causative organisms or sites of involvement over the last two decades.
1458782 Bacterial arthritis in a district hospital. 1992 Sep Between 1977 and 1988 in the Enschede hospital 72 patients were seen with bacterial arthritis of one or more joints. Staphylococcus aureus was most frequently the causative agent (52%) and the knee was the most frequently infected joint (42%); the mortality rate was 11%. Complete restoration of pre-existent function was seen in 52% of the affected joints. In patients with severe deterioration of joint function after the bacterial infection, the period between the first symptoms and start of treatment (mean 30 days) was significantly longer than in patients with no or moderately deteriorated joint function (mean 10 days). The primary focus was mostly a skin infection, predominantly localized on the lower extremities. Half of all cases of bacterial arthritis occurred in patients with rheumatoid arthritis (RA). We therefore conclude that patients with RA and skin infections, especially if localized on legs or feet, should be treated without delay and that one should not hesitate to prescribe antibiotics. Erythrocyte sedimentation rate (ESR) was less than 20 mm after one hour in 13% and blood leucocyte count less than 10 x 10(9)/liter in 55% of all patients, showing that a normal ESR and/or blood leucocyte count do not exclude bacterial arthritis. In 4 out of 9 patients with infected prosthetic joints the infection resulted in loosening of the joint, before antibiotic treatment was started. In the other 5 patients bacterial arthritis recurred, in one patient resulting in loosening of the joint, only shortly after stopping long-term successful antibiotic treatment (6-24 months). Thus, we feel that lifelong treatment with antibiotics is a reasonable alternative in cases, where the risk of surgery is very high.
1622745 The M20 IL-1 inhibitor prevents onset of adjuvant arthritis. 1992 Cytokines, specifically IL-1 and TNF, have been implicated as important mediators of joint destruction in rheumatoid arthritis (RA). Elevated levels of IL-1 in the joint fluid of patients with RA have been reported, as well as the presence of IL-1 inhibitory activity. We have reported the characterization of an inhibitor derived from a myelomonocytic cell line cloned in our laboratory which is specific for IL-1. This IL-1 inhibitor is protein in nature which specifically inhibits activity in vitro and in vivo. Previous studies showed that the inhibitor reduced acute inflammatory reactions associated with IL-1 (fever, leukocytosis, local foot pad swelling, lymph node enlargement and acute phase reactants). Thus it was of interest to study whether the M20 IL-1 inhibitor could modify adjuvant-induced chronic inflammation in rats, which is often used as a model for human RA. Administration of complete Freund's adjuvant (CFA) into Lewis rats, resulted in a severe adjuvant arthritis (AA) which reached peak severity after 14 days. Daily administration of IL-1 inhibitor, beginning after injection of CFA, abolished the appearance of AA. The parameters investigated were: joint swelling (the increase in diameter of joints), peri-articular erythema, limping of the rats and histological examination. The effect of the M20 IL-1 inhibitor was shown to be dose dependent and the IL-1 inhibitor alone had no adverse effects. These results indicate that the M20 IL-1 inhibitor may have a role in the treatment of AA and may be used to reduce pathological processes in joint inflammation.
1455374 [Pulse therapy with methylprednisolone and cyclophosphamide in systemic juvenile rheumatoi 1992 The treatment for systemic JRA is among actual problems of pediatric rheumatology. To evaluate the effectiveness of pulse therapy (PT) with methylprednisolone 25-30 mg/kg/day for 3 consecutive days combined with cyclophosphamide 0.4-0.5 g/sq. m body surface area (BSA) on the 3rd day, repeated quarterly for 12 months, 30 patients with systemic JRA were randomized into 3 groups: 1--those with disease duration (DD) less than 2 years receiving PT (n = 13), 2--with DD 2 years and more (n = 8) receiving PT, and 3--with DD less than 2 years receiving no PT. Children in all 3 groups received concomitant medication (one of nonsteroidal anti-inflammatory drugs, methotrexate 10 mg/sq. m BSA/week and oral steroids). A rapid and significant improvement, according to systemic and articular manifestations as well as laboratory indices occurred in the 1st group, in most of the measured parameters exceeded effects in the other two groups and gave the opportunity to avoid the administration of oral steroids or to give the lesser initial dose. Side effects were minor and completely reversible.
8578312 The etiopathogenesis of Sjögren's syndrome. 1995 Oct With increasing awareness and improved diagnostic tests, Sjögren's syndrome (SS) is becoming recognized as a common autoimmune disease, affecting as many as 3% of women over age 55 years. Apart from keratoconjunctivitis sicca, systemic features are common, leading to considerable morbidity and occasionally mortality. Predisposing factors for SS include HLA determinants that have been linked to DR3 and heterozygosity for DQ-1 and DQ-2. There is accumulating evidence that activated epithelial cells and their interaction with T cells play a central role in pathogenesis. Some restriction of T-cell receptor gene usage to V beta 6.7b and V beta 13.2 and a profile of cytokine production consistent with Th-1-type cells has been observed in affected tissues. Antibodies to Ro (SS-A) and La (SS-B) are found in about 50% of patients and are associated with more severe glandular and extraglandular manifestations. There is evidence that the antibodies are pathogenic, not only in patients, but in their infants born with congenital heart block. Studies of herpesviruses have led to conflicting results, and interest has recently focussed on retroviruses, based on the findings of the expression of retroviral elements in salivary glands of SS patients and antiretrovial antibodies in serum. Mice infected with or transgenic for retroviruses develop SS-like pathology and are currently being studied as animal models of the disease. In the last few years, considerable progress has been made in the understanding of the pathogenesis of SS, and the disease has become the prototype for the investigation of a viral etiology for autoimmune rheumatic disease. Study of its etiopathogenesis may be the key to understanding autoimmune disease in general.
7755980 Effects of calprotectin in avridine-induced arthritis. 1995 Mar Plasma levels of calprotectin correlate with disease activity and clinical assessments of arthritis in various rheumatic diseases, and high levels have been demonstrated in the synovial fluid of patients with rheumatoid arthritis. However, the role of calprotectin in rheumatic inflammation is unclear. The purpose of the present study was to investigate potential intra-articular effects of calprotectin. Calprotectin was injected into joints of healthy male Lewis rats and into joints of rats in the latency period before onset of avridine-induced arthritis. In addition, a group of animals had IgG antibodies to rat calprotectin injected into joints before onset of avridine-induced arthritis. Injection of 0.2 or 10 micrograms calprotectin into the ankles of healthy male Lewis rats resulted in histologically minor and reversible inflammatory changes, but without any circulating antibodies to calprotectin. Furthermore, animals with 40 micrograms calprotectin injected into ankles before the expected onset of avridine-induced arthritis had lower scores for cellular infiltration than were seen in control joints. This difference did not quite reach statistical significance in the two-sided test used. However, the induced arthritis increased in joints injected with IgG antibodies to calprotectin. These findings may indicate that increased local concentrations of calprotectin are partially protective against avridine-induced arthritis. In contrast, reduced local concentrations appear to exacerbate the severity of arthritis. Calprotectin may thus be involved in the regulation of inflammatory processes in joints.
8506173 Arthropathy and HIV infection. A muddle of mimicry. 1993 Jun Several rheumatic diseases are associated with human immunodeficiency virus (HIV) infection. The most common are reactive and psoriatic arthritis. Classic septic arthritis caused by Staphylococcus aureus and other common organisms is very rare: Instead, infectious arthritis caused by unusual organisms is the rule. Some of the HIV-related rheumatic syndromes behave like classic rheumatic diseases, while others may actually be new forms of disease. Often, one of the rheumatic syndromes is the presenting manifestation of underlying HIV infection. HIV-infected patients and patients with rheumatic disease often have similar laboratory abnormalities. Systemic lupus erythematosus, in particular, may be mistaken for HIV infection, in part because of cross-reactivity of antibodies. However, coexistence of systemic lupus erythematosus and rheumatoid arthritis with HIV infection is a rare occurrence. Traditional therapy for rheumatic diseases may not be indicated in HIV-infected patients and in fact may even be contraindicated.
8236553 [Late vascular lesions after cemented hip alloplasty]. 1993 Sep 6 We describe a case of a 69 year-old woman with rheumatoid arthritis, who following hip replacement surgery experienced a late migration of the cup of the hip arthroplasty into the pelvis, with ensuing vascular disaster. Procedures for treatment of intra-pelvine cup migration are briefly discussed.
18611625 Minocycline: old and new therapeutic uses. 1994 Since the introduction of minocycline HCl in the late 1960's, it has been used for disease states that have ranged from typical community-acquired infectious diseases to others that are non-infectious, such as resistant rheumatoid arthritis. Owing to its high penetration characteristics throughout the body, minocycline can be used in the treatment of a wide variety of extracellular and intracellular pathogens. This review examines the known and potential therapeutic uses of minocycline in a clinical setting.
7895404 Benign edematous polysynovitis in the elderly (RS3PE syndrome). 1994 Nov The Authors provide an update on benign edematous polysynovitis in the elderly and propose clinical and laboratory criteria for a correct diagnosis. They also propose the use of the term "polysynovitis" rather than polyarthritis, as they think it describes the histopathological findings of the disease better. Finally, they attempt to correctly distinguish RS3PE syndrome from polymyalgia rheumatica, rheumatoid arthritis and chondrocalcinosis.
8249425 [Raynaud's syndrome during the course of polymyalgia rheumatica]. 1993 Apr A case is described of polymyalgia rheumatica in which Raynaud's sign appeared at the beginning of the disease parallel with changes of rheumatoid arthritis type without other features of arterial system involvement in particular without clinical features of the involvement of the subclavian or axillary artery. The sign of temporal artery involvement appeared only after 18 months of disease duration. Steroid-therapy produced complete regression of both articular muscular and vascular changes.
8093136 The persistence of spirochetal nucleic acids in active Lyme arthritis. 1994 Mar 15 Six of seven patients with Lyme arthritis were positive by PCR. In contrast, all 18 synovial fluid samples from patients with other disorders, including rheumatoid arthritis, spondyloarthropathy, gout, pseudogout, hemarthrosis, degenerative joint disease, lupus, papillary synovitis, and trauma, were negative by PCR (P < 0.001, Lyme arthritis compared with controls, Fisher exact test). All 38 laboratory controls were negative by PCR. The assay reproducibly detected 20 or fewer B. burgdorferi cells directly or when added to extracted synovial fluid that was previously negative by PCR. Polymerase chain reaction was done four times with identical results, including analyses with both outer surface protein A primer sets.
1604223 [Alpha-1-antitrypsin deficiency in chronic inflammatory rheumatism and mechanical arthropa 1992 Feb Alpha-1-antitrypsine (AAT) plasmatic level is higher (p less than 0.01) in 85 chronic inflammatory arthropathies than in 238 non inflammatory arthropathies (2.5+/0.7 versus 2.1+/0.4 g/l). Among 15 rheumatoid arthritis (RA) with evaluated phenotype, alleles M2 are less frequent and M3 more frequent than in 22 non inflammatory arthropathies (p less than 0.02). Some abnormal phenotype are observed: M2Z (AAT = 1.7) without pulmonary involvement (1 RA); M3S in 2 seronegative spondylarthropathies (1 pulmonary involvement without tobacco intoxication: DLCO/VA: 69% of theoric value; AAT = 1.4); ZZ in a systemic lupus erythematosus with panlobular emphysema and hepatic cirrhosis (AAT = 0.4). An AAT deficiency could explain some pulmonary involvements in chronic inflammatory arthropathies.