Browse

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

ID PMID Title PublicationDate abstract
8042727 Unilateral hypoglossal nerve paralysis following the use of the laryngeal mask airway. 1994 Jul We report a unilateral hypoglossal nerve paralysis following the use of a laryngeal mask airway in a 62-year-old woman with rheumatoid arthritis undergoing a shoulder joint replacement. Cervical epidural anaesthesia was combined with general anaesthesia using nitrous oxide administered via a laryngeal mask airway with the patient in the right lateral decubitus position. The next morning, the patient was noted to have a right hypoglossal nerve palsy. Compression of the nerve between the laryngeal mask airway cuff, distended with nitrous oxide, and the hyoid bone, was considered to be the cause of the nerve paralysis.
8480438 [Suppression of macrophage subpopulations in post-traumatic osteomyelitis]. 1993 Jan Similar to other chronic inflammatory diseases such as rheumatoid arthritis the distribution of macrophage subtypes seems to be disturbed in post-traumatic osteomyelitis. This atypical distribution is clearly locally restricted in osteomyelitis. 27E10-positive macrophages found only during the acute phase of inflammation were reduced in 39%, the 25F9-positive subtype, predominating in the late stage of inflammation, was missing in 33%. The antiinflammatory macrophage RM3/1 was decreased in 40% of the osteomyelitis biopsies. Local suppression of macrophage subsets has to be discussed as one of the reasons for the persistence of chronic inflammatory processes in osteomyelitis.
10795045 Periarticular Fractures After Total Knee Arthroplasty: Principles of Management. 1996 Mar Periarticular fractures about total knee replacements are sustained by 0.3% to 2% of patients who have undergone knee arthroplasty. The patient with such a fracture is usually a woman in her seventh decade who has osteoporosis and may also have rheumatoid arthritis that is being treated with corticosteroids. The treatment of such fractures is aimed at restoring the patient's functional status to the pre-fracture level. Accomplishing this requires healing of the fracture and retention of a mobile and painless prosthesis in correct alignment. These goals are often difficult to achieve because there is little experience with these uncommon fractures, the healing environment is suboptimal, and knee arthroplasties have a low tolerance for any resulting alteration in alignment. In general, nondisplaced fractures are treated nonoperatively, and displaced fractures require open reduction, rigid internal fixation, and bone grafting. If the prosthesis is loose, or if rigid fixation cannot be obtained, component revision is the treatment of choice.
20438693 [Changes of urinary hydroxylysylpyridinoline in patients with rheumatic diseases and after 1992 Urinary hydroxylysylpyridinoline (MHP), an indicator of the catabolism of cartilage and bone was assessed in patients with various rheumatic diseases - rheumatoid arthritis (RA) and ankylosing spopndylitis (AS). It was also assessed in patients with coxarthrosis (OA) and AS who had an endopro-thesis of the hip joint and in patients with OA who had a re-operation of a loosened total endoprothesis of the hip joint. A group of healthy subjects served as controls. In all groups of patients the MHP values were elevated as compared with controls. In operated patients different values were recorded - in patients with OA the values did not change after operation, while in AS a marked rise was found. Conversely, after re-operations a drop of MHP levels was observed. Key words: hydroxylysylpyridinoline, urinary excretion, rheumatic diseases, endoprothesis of the hip.
8775966 Bilateral patellar tendon rupture secondary to repeated local steroid injections. 1995 Dec A case is reported of bilateral patellar tendon rupture in a fit man after a fall. He had a history of repeated local steroid injections into both tendons and histology confirmed steroid-induced changes. The history of repeated local steroid administration has to be implicated as the cause of this extremely rare injury in this patient, which can also be associated with hyperparathyroidism, systemic lupus erythematosus, diabetes and rheumatoid arthritis. All doctors performing repeated local steroid injections into the patellar tendon should be aware of the possible dangers of inducing tendon rupture and should ensure that the steroids are not delivered into its substance.
8159450 Rhabdomyolysis. A primer for the orthopaedist. 1994 Jan Orthopaedic surgeons may be confronted with a variety of medical problems that demand recognition and treatment. These may range in severity from a mild case of rheumatoid arthritis to a life-threatening pulmonary embolism. Rhabdomyolysis is a serious problem that must be recognized early to avoid grave renal consequences. This disorder is characterized by significant muscle injury giving rise to nephrotoxic breakdown products in the bloodstream. As many as 33% of these patients will suffer acute renal failure. Many orthopaedic patients may be at high risk for rhabdomyolysis, and the orthopaedic surgeon should be familiar with its diagnosis and treatment.
8228799 Polyautoimmune syndrome in common variable immunodeficiency. 1993 Nov Common variable immunodeficiency (CVI) is a heterogenous disorder with hypogammaglobulinaemia and multiple bacterial infections primarily involving the sinopulmonary tract. CVI patients have been known to have an increased tendency to develop autoimmune manifestations. Commonly associated autoimmune diseases include immune thrombocytopenic purpura, autoimmune haemolytic anaemia, and rheumatoid arthritis. In this paper we report a case of CVI presenting with multiple unusual autoimmune diseases including parotitis, vitiligo, atrophic gastritis, pernicious anaemia, and primary biliary cirrhosis. To our knowledge, this is the first case of CVI with polyautoimmunity and antimitochondria antibody. Recognition of this association is important because early diagnosis and treatment can greatly influence the prognosis.
8466626 Sequence homologies between hsp60 and autoantigens. 1993 Mar The human heat shock protein (hsp) 60 shares sequence homology with a wide range of autoantigens including those of insulin dependent diabetes mellitus, Hashimoto's thyroiditis, glomerulonephritis, scleroderma, pemphigoid, rheumatoid arthritis, multiple sclerosis, chronic active hepatitis, primary biliary cirrhosis and Addison's disease. Here we show the extent of this homology and suggest that it contributes to autoimmunity through cross-reactivity between hsp60 and tissue-specific proteins containing similar epitope motifs. Differences between individuals in MHC class II may influence the selection of a particular hsp60 epitope and the corresponding target antigen that gives rise to an autoimmune disease.
1629556 Matched distal ulna resection for posttraumatic disorders of the distal radioulnar joint. 1992 Jul In 1985 we published the results of the matched ulna resection in 44 patients, the majority of whom had rheumatoid arthritis. The matched ulna resection maintains the continuity of the distal ulna to the ulnar sling mechanism, including the triangular fibrocartilage complex (TFCC), and resects the distal ulna in a smooth, curved, convex fashion to match the contour of the radius throughout forearm rotation. This article presents the results of the procedure in patients with posttraumatic and mechanical disorders of the distal radioulnar joint. Good to excellent results were noted in 24 of 32 patients. The outcome was related to the severity of the patient's initial problem.
1403258 Severe intracranial injury from a fall in the halo external fixator. 1992 This is a report of a rheumatoid arthritis patient after atlantoaxial stabilization and halo external fixator immobilization who presented with intracranial injury after an accidental fall. Global aphasia and an impaired consciousness resulted from a cerebral hemorrhagic contusion below an impressed bone chip at the left posterior halo-pin site. Cranial penetration of a halo pin has been previously reported; however, brain injury associated with it has not. Since there is a considerable risk of falls in the elderly and in patients with myelopathic gait disturbances, this rare but potentially hazardous complication should be kept in mind during the halo vest fixation.
1287818 Acquired bisalbuminemia in staphylococcal endocarditis treated with dicloxacillin. 1992 An albumin fraction with increased anodal mobility was observed on cellulose acetate electrophoresis, isoelectric focusing, and immunoelectrophoresis of serum obtained 1 month after a 68-year-old male patient had been treated with dicloxacillin for Staphylococcus epidermidis endocarditis. The patient also suffered from rheumatoid arthritis demanding hospital treatment. Normal albumin results from several earlier runs were thus available, and follow-up showed reversion to normal albumin mobility. Treating albumin with dicloxacillin in vitro produced a corresponding mobility increase.
7986226 Antibodies to histone (H2A-H2B)-DNA complexes in the absence of antibodies to double-stran 1994 Dec OBJECTIVE: To assess the role of antibodies to histones H2A, H2B, and anti-double-stranded DNA which form (H2A-H2B)-DNA complexes in patients with scleroderma-related disorders. METHODS: Antihistone antibodies were measured, by enzyme immunoassay, in 26 patients with scleroderma-related disorders, 100 patients with systemic lupus erythematosus (SLE), and 24 patients with rheumatoid arthritis. RESULTS: Antibodies to histone (H2A-H2B)-DNA complex were more commonly seen in patients with scleroderma-related disorders than in those with SLE (P < 0.0001). CONCLUSION: Scleroderma-related disorders should be included among conditions in which various types of antihistone antibodies are produced. A hypothesis to account for this finding is discussed.
8384452 Soluble tumor necrosis factor receptors in human inflammatory synovial fluids. 1993 Apr OBJECTIVE: To test synovial fluid (SF) for the presence of soluble fragments originating from distinct tumor necrosis factor receptors (TNF-sR55 and TNF-sR75) which bind to TNF and inhibit its biologic activity. METHODS: TNF-sR55 and TNF-sR75 were measured in 62 SF samples by specific immunoassays using monoclonal antibodies. RESULTS: Both TNF-sR were present in all of the SF tested. Their concentrations were higher in SF from patients with seropositive rheumatoid arthritis than in patients with other inflammatory arthritides. The relative amount of TNF-sR75, as compared with TNF-sR55, was higher in seropositive RA SF than in other SF. CONCLUSION: The balance between TNF and its specific inhibitors may be critical to the biologic outcome mediated by this cytokine.
1386763 Efficient clodronate entrapment within multilamellar and unilamellar liposomes. 1992 May Clodronate (dichloromethylene bisphosphonate) encapsulated within liposomes and administered intravenously eliminates resident macrophages within the liver and spleen. Macrophage depletion in the rat requires 20 mg of the encapsulated drug, and so far this has only been achieved using large multilamellar vesicles (MLV). Recent studies have shown that small unilamellar vesicles (SUV) when injected intravenously accumulate at inflamed joint sites in both animal models of arthritis and patients with rheumatoid arthritis; multilamellar vesicles were not able to do so. If phagocytic cells, such as macrophages, are responsible for SUV sequestration, then SUV containing clodronate may be targeted to the inflamed joint and may eliminate the macrophage population leading to reduction in the state of inflammation. We have adapted an existing technique to radiolabel clodronate with 99mTechnetium to use as a tracer to determine its encapsulation within liposomes, a technique that has advantages over other current methods. We have achieved a high-encapsulation efficiency of the drug within MLV and produced SUV containing sufficient clodronate to deplete macrophages in rats in a small enough volume to administer it intravenously as a single dose.
8856792 Effects of unsaturated fatty acids on expression of early response genes in human T lympho 1996 Administration of gamma-linolenic acid, which is converted rapidly to dihomo-gamma-linolenic acid (DGLA), reduces joint swelling and tenderness in patients with rheumatoid arthritis. Joint tissue inflammation in patients with rheumatoid arthritis is due in part to activation of T lymphocytes. DGLA suppresses T cell activation and production of interleukin-2 (IL-2). The protooncogenes c-myc and c-fos are early response genes which are critical to regulation of T cell proliferation. We therefore examined the effects of gamma-linolenic acid and other unsaturated fatty acids on c-myc and c-fos expression by means of the polymerase chain reaction and Northern blotting. IL-2 production by the human T cell line Jurkat is dependent on a fall in mRNA for c-myc and a rise in mRNA for c-fos. The data presented here indicate that reduction of steady-state levels of mRNA for c-myc and rises in steady-state levels of mRNA for c-fos are both reduced markedly in cells incubated with DGLA. Cells incubated with arachidonic acid, eicosapentaenoic acid or oleic acid exhibit more modest changes in expression of these early response genes.
8201177 Arthrodesis of the proximal interphalangeal joint of the finger: comparison of the use of 1994 Mar We report a retrospective review of 224 proximal interphalangeal joint arthrodeses in the digits using Herbert screws (37), Kirschner wires (100), tension band wiring (69), plates (11), and other miscellaneous techniques (7) for fixation. Average time to clinical union was 7 weeks and time to radiographic union was 10 weeks. Nonunion occurred in 31 cases (24 digits). The primary nonunion rate was highest in psoriatic arthritis, intermediate in rheumatoid arthritis, lower in acute trauma and post-traumatic reconstruction, and nonexistent in osteoarthritis. The primary nonunion rate was highest using Kirschner wires, intermediate using tension band wires, and lowest using Herbert screws. All Kirschner wires, six tension band wires and one Herbert screw were removed after fusion. The Herbert screw provides secure fixation, is easy to insert, and affords a rapid and reliable arthrodesis at the proximal interphalangeal joint.
8656446 Clinical immunotoxicity of pesticides. 1996 Jun 28 Because of the wide use of pesticides for domestic and industrial purposes, the evaluation of their immunotoxic effects is of major concern for public health. Despite the large amount of experimental data describing pesticide-induced immunosuppression, evidence that pesticides may severely impair immune functions in humans is lacking or scarce. Contact hypersensitivity is a well-identified immunotoxic effect of pesticides but remains a rare complaint in pesticide-exposed workers. By contrast, immunologically mediated systemic reactions have been described only as debatable case reports. The association between autoimmune diseases and pesticide exposure has more recently been suggested. Despite the lack of convincing human data, a potential risk for the immune system should not be excluded, especially during chronic exposure to pesticides or in otherwise (immuno) compromised patients (malnutrition, children, old patients). Epidemiological studies including markers of exposure and the assessment of immune competence in exposed individuals, or registries of sentinel diseases related to immunosuppression (e.g., non-Hodgkin's lymphoma, opportunistic infections) or autoimmunity (e.g. lupus erythematosus, rheumatoid arthritis), are warranted.
7490368 Serum tissue inhibitor of metalloproteinases in patients with systemic sclerosis. 1995 Dec BACKGROUND: One of the suggested contributory factors to the development of dermal fibrosis is a decrease in collagenase activity, which may be related to levels of serum tissue inhibitors of metalloproteinase-1 (TIMP-1). OBJECTIVE: The aim of this study was to determine the clinical significance of serum TIMP-1 levels in systemic sclerosis (SSc). METHODS: We measured serum TIMP-1 concentration in 62 patients with SSc, 11 patients with systemic lupus erythematosus, 14 patients with rheumatoid arthritis, and 22 members of a normal control group. The clinical features of the patients with SSc and elevated TIMP levels were examined. RESULTS: The mean TIMP-1 level in the patients with SSc was significantly higher than that in the members of the control group or the patients with systemic lupus erythematosus or rheumatoid arthritis. In 44% of the patients with SSc the serum TIMP-1 level was elevated. The mean serum TIMP-1 level in patients with diffuse cutaneous SSc (dSSc) was significantly higher than that in those with limited cutaneous SSc. The patients with dSSc and elevated serum TIMP-1 levels showed a significantly greater incidence of lung fibrosis and anti-topoisomerase I antibody than those with normal serum TIMP-1 levels. The TIMP-1 level and diffusing capacity for carbon monoxide in the patients with SSc were negatively correlated. Increased mitogenic activity on dermal fibroblasts caused by serum from patients with dSSc was partially blocked by anti-TIMP-1 IgG. CONCLUSIONS: These findings suggest that serum TIMP-1 level is a useful indicator of disease activity in patients with SSc and that TIMP is involved in the pathogenesis of SSc.
7729331 Epoetin alfa. A review of its pharmacodynamic and pharmacokinetic properties and therapeut 1995 Feb Epoetin alfa is a recombinant form of the principal hormone responsible for erythrogenesis, erythropoietin. Already an established treatment for anaemia associated with renal failure, epoetin alfa may also be used to correct anaemia in other patient groups. The drug increases the capacity for autologous blood donation in patients scheduled to undergo surgery and attenuates the decrease in haematocrit often seen in untreated autologous donors. However, transfusion requirements did not significantly decrease in many trials. Epoetin alfa also accelerates red blood cell recovery after allogeneic--but not autologous--bone marrow transplant. Limited data in patients with adult rheumatoid arthritis suggest that while epoetin alfa increases haematocrit/haemoglobin levels, overall clinical rheumatological status may not improve. However, the drug did improve quality of life in a small cohort of children with juvenile rheumatoid arthritis in addition to correcting anaemia. Response rates to treatment with epoetin alfa in patients with anaemia associated with cancer range between 32 and 85%. Anaemia associated with cancer chemotherapy also responds well to treatment with the drug as does anaemia associated with zidovudine therapy in patients with acquired immune deficiency syndrome (AIDS). Studies evaluating the use of epoetin alfa as treatment for anaemia of prematurity have used different methodologies and dosages, making overall analysis difficult. Nevertheless, it appears that high dosages are necessary for response. Results from 1 study suggest that treatment with epoetin alfa appears to be more costly than transfusional support in this application; the relevance of this finding is questionable, however, given that the aim of treatment with epoetin alfa is elimination of transfusion requirements. The incidence of many adverse events associated with epoetin alfa treatment in patients with renal failure (hypertension, seizures and thromboembolic events) has been minimal in patients without renal failure. Adverse events occurred at a similar rate in placebo and epoetin alfa recipients in placebo-controlled trials evaluating the use of the drug as treatment for anaemia in patients with cancer receiving chemotherapy or patients with AIDS receiving zidovudine. In summary, epoetin alfa is an effective alternative to blood transfusion, reducing anaemia and producing consequent improvements in quality of life in many nonrenal applications. It was more effective than placebo in a number of double-blind trials and may be particularly useful as treatment for anaemia associated with other drugs such as cisplatin and zidovudine.
8020670 Interstitial pneumonitis after low-dose methotrexate therapy in primary biliary cirrhosis. 1994 Jul Interstitial pneumonitis is an uncommon complication of low-dose methotrexate therapy in patients with psoriasis but occurs in 3%-5% of patients with rheumatoid arthritis. We found a higher incidence of interstitial pneumonitis in patients with primary biliary cirrhosis (14%) and describe its clinical manifestations, treatment, and possible etiology. Blood tests, arterial blood gas determinations, chest radiographs, bronchoscopy, tear production, autoantibody tests, and serum immunoglobulin levels were obtained in six women who developed interstitial pneumonitis while receiving methotrexate in a double-blind prospective trial of methotrexate vs. colchicine in 87 patients with primary biliary cirrhosis. Six of 43 patients (14%) who received methotrexate compared with no patients receiving colchicine developed interstitial pneumonitis 19-61 weeks after starting treatment. The pneumonitis was characterized by dyspnea, hypoxemia, and bilateral lung infiltrates, all of which responded within 24 hours to the administration of intravenous glucocorticoids. There was no correlation between the pneumonitis and pre-existing lung disease, the severity of the primary biliary cirrhosis, the titer of antimitochondrial antibody, or other diseases associated with primary biliary cirrhosis. Patients with primary biliary cirrhosis receiving low-dose methotrexate (15 mg/wk) are more susceptible to interstitial pneumonitis than patients with psoriasis or rheumatoid arthritis. The pneumonitis appears to be a hypersensitivity reaction and responds rapidly to intravenous glucocorticoid therapy.