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ID PMID Title PublicationDate abstract
8187440 Lymphocytotoxic antibodies in SLE: a review of the literature. 1994 Mar In a great majority of patients with systemic lupus erythematosus (SLE) lymphocytotoxic antibodies (LCA) are detected. The reported prevalence depends on the methods of detection and definition of test-positivity. The pathogenetic role of LCA remains unclear. Different reports show that LCA can have an influence on mononuclear cell function, e.g., on production of interferon, or specifically on T-cell function. In several studies T-cell specificity of LCA cannot be shown. Sometimes an overlap between LCA and anti-B2M antibodies is found, suggesting that LCA have anti-B2M activity. Anti-B2M activity might have an impact on T-cell as well as on B cell function. Next to the anti-B2M activity, binding to nuclear material is claimed. Investigating the role of LCA in respect to lymphopenia, a direct relationship cannot be found; however, LCA might induce interferon production, resulting in lymphopenia. Several studies show or claim a relationship between the presence of LCA and neurological manifestations in SLE patients; the results, however, remain questionable due to the difference in detection methods as well as in definition of central nervous system (CNS) involvement. In other studies, an increased incidence of LCA is reported in relatives of SLE patients as well. In addition, LCA are reported in quite a lot of other diseases such as rheumatoid arthritis, ankylosing spondylitis, malignancies and viral illnesses. This latter association has led to the assumption that LCA might have a virus-related origin.
8057974 Mild adrenocortical deficiency, chronic allergies, autoimmune disorders and the chronic fa 1994 Mar The possibility that patients with disorders that improve with administration of large, pharmacologic dosages of glucocorticoids, such as chronic allergies and autoimmune disorders, might have mild deficiency of cortisol production or utilization has received little attention. Yet evidence that patients with rheumatoid arthritis improved with small, physiologic dosages of cortisol or cortisone acetate was reported over 25 years ago, and that patients with chronic allergic disorders or unexplained chronic fatigue also improved with administration of such small dosages was reported over 15 years ago, suggesting that these disorders might be associated with mild adrenocortical deficiency. The apparent reasons for the failure of these reports to be confirmed or mentioned in medical textbooks and the facts needed to restore perspective are reviewed, and the need for further studies of the possible relationship of a mild deficiency of the production or utilization of cortisol and possibly other normal adrenocortical hormones to the development of these disorders is discussed.
8480533 The use of angiostatic steroids to inhibit cartilage destruction in an in vivo model of gr 1993 Jan Angiogenesis is an important component of the development of chronic inflammatory diseases such as rheumatoid arthritis. It is known that clinically used anti-rheumatic drugs exert, in part, effects on the angiogenic response. Little work, however, has investigated the potential of experimental angiostatic therapies in chronic inflammatory disease models. The effect of one such angiostatic treatment, cortisone combined with heparin, was tested in an in vivo model of granuloma-mediated cartilage degradation. Angiostatic treatment significantly retarded the growth of granulomatous tissue, mononuclear cell influx into the granuloma, and the degradation of juxtaposed cartilage. This correlated with a decrease in the vascularity of the granulomatous tissue. Modulation of this component of pathogenesis of "angiogenesis-dependent disease" may be useful as a new therapeutic approach.
1395272 Occipital-cervical instability. 1992 Oct A retrospective clinicoroentgenographic study was done on 26 patients with atlantoaxial instability, 17 traumatic and nine nontraumatic. All were treated by means of surgical C1-C2 and occipital-C2 stabilization. The traumatic instability was associated with lesions of the odontoid process and the atlas transverse ligament. Instability may be endogenous or associated with fracture of the atlas. Surgical indication was determined by the level of the fracture line, neurologic symptoms, age, and presence of multiple lesions. C1-C2 stabilization by means of wiring and iliac graft was the selected treatment. Fusion between the occipital and C2 segment was indicated in case of irreducible dens pseudoarthrosis. Fracture on the os odontoideum was very unstable and required greater C1-C2 fusion. Nontraumatic C1-C2 instability was either congenital or secondary to pathologic fractures. Rheumatoid arthritis, which produces anterior displacement of the atlas over the dens to more than 10 mm, neurologic symptoms, or untreatable pain must be stabilized by means of C1-C2 fusion. When elevation of the dens or irreducible displacement of the atlas exists, the results were relatively poor. Tumorous instability produced pathologic fracture of the body of the axis and had to be treated with C1-C2 wiring on bone cement. Down's syndrome instability required occipitoaxial fusion and strict postoperative immobilization.
1499200 Stress fracture of the hip. An unusual complication of total knee arthroplasty. 1992 Aug Stress fracture of the hip is a rare complication of total knee arthroplasty (TKA). Only eight cases seem to have been reported in the literature. A ninth case is reported in the present study. A 76-year-old obese woman was treated by right TKA for osteoarthrosis with cementing of the tibial component because of insufficient primary fixation. One year after TKA, she complained of tenderness above the right adductor tendons. There was no history of trauma. One month later, bone scintigrams and roentgenograms demonstrated a stress fracture of the femoral neck. Conservative management was successful. Etiologic factors such as rheumatoid arthritis, osteoporosis, steroid medication, or changes in static or dynamic forces of the hip secondary to knee arthroplasty could not be demonstrated in this patient. The increase in activity after TKA may be a factor in the incidence of these stress fractures of the hip. Radionuclear-type bone scan is helpful in diagnosis. The foci of increased isotope uptake are not always seen at the site of the stress fracture and only later visualized by roentgenograms.
1418288 Antibodies to mycobacterial 65 kDa heat shock protein in systemic sclerosis (scleroderma). 1992 Aug It has been reported that immunity to the 65 kDa heat shock protein of Mycobacterium tuberculosis (MT-hsp65) not only accompanies rheumatoid arthritis (RA), but may also be characteristic of chronic inflammation. We now report serum antibodies to MT-hsp65 in 47% of systemic sclerosis (SSc), 38% of primary Raynaud's phenomenon (PRP) and 5% of systemic lupus erythematosus (SLE). Antibody levels were higher in patients with active or progressive SSc and correlated with the degree of skin fibrosis. Thus, immunity to MT-hsp65 appears in SSc and is not limited to RA. However, it does show some degree of specificity beyond chronic inflammation: PRP patients have a higher reactivity than do SLE patients.
1312485 Inhibition of neutrophil superoxide production by human plasma alpha 1-antitrypsin. 1992 Mar 23 We report here that human plasma alpha 1-antitrypsin (alpha 1-AT) inhibited human neutrophil O2.- release elicited by a variety of stimulants. In comparison, the inhibitory capacities of two serine protease inhibitors, L-1-tosylamide 2-phenylethyl chloromethyl ketone (TPCK) and soybean trypsin inhibitor (SBTI), and the human recombinant alpha 1-AT mutant, alpha 1-AT-Arg358 were in the order: alpha 1-AT = TPCK much greater than alpha 1-AT-Arg358 greater than SBTI when cells were stimulated with concanavalin A plus cytochalasin E. These data suggest that, in human inflammatory fluids containing relatively high concentrations of alpha 1-AT (such as rheumatoid arthritis synovial fluid), (i) alpha 1-AT may down-regulate the inflammatory process by inhibiting the neutrophil respiratory burst and (ii) serpin oxidation by neutrophil-released reactive oxygen species is unlikely to occur.
1550403 Survey of satisfaction with care in a rheumatology outpatient clinic. 1992 Feb Consumer satisfaction is increasingly recognised by hospital administrators and health care providers as an important aspect of health care. A study was undertaken to investigate the satisfaction with care among patients with rheumatoid arthritis (RA) attending a rheumatology outpatient clinic at Leeds General Infirmary. The Leeds satisfaction questionnaire was developed and rigorously tested for reliability (Cronbachs alpha) and stability (test/retest). The Leeds satisfaction questionnaire was then completed by 70 patients with RA who had attended the Leeds General Infirmary on at least three previous occasions. The results showed that patients were, in general, satisfied with the care they received. The highest satisfaction scores were obtained on the scale for technical quality and competence of health professionals. The least satisfaction was accredited to the difficulty of unscheduled access to the clinic and the lack of continuity with the providers of care. The time spent in the waiting area before consultation was highlighted as the one aspect which caused the greatest dissatisfaction.
18475454 The in vitro free radical scavenging activity of tenidap, a new dual cyclo-oxygenase and 5 1992 Tenidap, a new anti-inflammatory drug, is presently undergoing clinical studies as a treatment for rheumatoid arthritis (RA). Early pilot work has shown it to be of some benefit. Tenidap is a dual inhibitor of cyclo-oxygenase and 5-lipoxygenase enzymes. It has also been shown to modify white blood cell behaviour such as interleukin-1 production, monocyte differentiation and neutrophil degranulation. As free radicals (FRs) have been implicated in the pathogenesis of RA, we used an in vitro assay system developed by Misra and Fridovich to assess if tenidap has FR scavenging effects. Our study shows, for the first time, that tenidap has general FR scavenging effects although no effect on the superoxide anion (O2.-) could be demonstrated. This effect occurred in a dose-dependent manner at concentrations above 20 mug/ml (p < 0.005, Mann-Whitney U-test). As the therapeutic range of tenidap in serum is between 15 and 30 mug/ml such FR scavenging activity may be clinically relevant in the treatment of RA. Ex vivo confirmation of this possibility is underway.
8939860 Induction of autoimmune diabetes by oral administration of autoantigen. 1996 Dec 6 An antigen administered orally can induce immunological tolerance to a subsequent challenge with the same antigen. Evidence has been provided for the efficacy of this approach in the treatment of human autoimmune diseases such as rheumatoid arthritis and multiple sclerosis. However, oral administration of autoantigen in mice was found to induce a cytotoxic T lymphocyte response that could lead to the onset of autoimmune diabetes. Thus, feeding autoantigen can cause autoimmunity, which suggests that caution should be used when applying this approach to the treatment of human autoimmune diseases.
8727146 Atlantoaxial arthrodesis using Halifax interlaminar clamps reinforced by halo vest immobil 1996 Jun Thirty-two patients who underwent atlantoaxial arthrodesis using Halifax interlaminar clamps and halo vests between January 1989 and December 1992 were reviewed. The atlantoaxial instabilities were related to trauma in 16 patients, including 14 patients with unstable odontoid fractures, 1 patient with a complex C2 fracture, and 1 patient with a disrupted transverse ligament. Of the other 16 patients, whose atlantoaxial instabilities were nontraumatic in origin, 9 had instabilities that were secondary to rheumatoid arthritis, 1 had instability that was secondary to tuberculous infection, and 6 had instabilities that were caused by os odontoideum. The patients were followed postoperatively with lateral cervical radiographs for an average of 37 months (range, 16-59 mo). Solid atlantoaxial arthrodeses were achieved in all (100%) of these 32 patients after 32 to 111 days (average, 84.5 d) of halo immobilization, indicating atlantoaxial arthrodeses can be reasonably anticipated when Halifax interlaminar clamps with autogenous iliac bone grafting are reinforced by halo vest immobilization for 3 months.
8620660 The immune response to implant materials in humans. 1996 May The etiology of aseptic loosening of prosthetic joint replacement components is unclear. Implant materials have been considered biologically inert, but recently studies indicate that inflammatory reactions directed against the implanted materials may contribute to aseptic loosening. Data suggesting a progression from a simple inflammatory reaction to complex immune responses against the biomaterials are reviewed. The cellular responses to particles of polymethylmethacrylate, ultrahigh molecular weight polyethylene, and alloys of cobalt-chromium and titanium were assayed in vitro to determine cell proliferation in patients with underlying diagnoses of osteoarthrosis, rheumatoid arthritis, and avascular necrosis who had joint replacement. Control populations were provided by patients with similar diagnoses who were preoperative surgical candidates. The underlying diagnoses did not seem to influence responses to particle stimulation. Elevated responses to both acrylic and cobalt-chromium were observed in patients with aseptically loosened prostheses. These findings suggest that the development of a cellular response to particulate debris may be significant in the pathogenesis of aseptic loosening.
8612349 Adhesion and TNF priming in neutrophil-mediated cartilage damage. 1996 Apr Neutrophils predominate in the acute stages of rheumatoid arthritis and are implicated in the cartilage damage which is characteristic of this disease. In vitro neutrophils can be primed for increased ability to damage host tissues by a number of cytokines including tumor necrosis factor-alpha (TNF). The role of adherence in this process was investigated. Opsonization of cartilage with aggregated IgG (HAGG) and complement promoted neutrophil damage to cartilage. Adherence was increased by HAGG and TNF. Separation of neutrophils from cartilage markedly reduced the neutrophil-mediated injury and abolished the priming effect of TNF. Inactivation of complement or antibodies against CD11a or CD11b reduced neutrophil-mediated cartilage damage and markedly reduced TNF-priming of this damage and yet did not alter adherence of control or TNF-primed cells. These results suggest that neutrophil damage to cartilage is promoted by agents that favor adherence. The failure to block adhesion of neutrophils by complement inactivation or antibodies to CD11a or CD11b suggests that neutrophil adherence to cartilage occurs simultaneously through several different receptors. The massive reduction of TNF enhancement of neutrophil damage to cartilage by preventing adhesion suggests that adherence is required for this action of TNF.
8927789 [Iatrogenic drug-induced bronchospasm, cough, and bronchiolitis. Etiologic and physiopatho 1996 Iatrogenic respiratory disorders include bronchic manifestations (asthma, bronchospasm, cough) and bronchiolar manifestations (constrictive or proliferative bronchiolitis). Many pharmacologic agents can induce a bronchospasm. The bronchospasm induced by acetylsalicylic acid and nonsteroidal anti-inflammatory agents, often severe, is mediated by the inhibition of the cyclooxygenase enzyme; it can be prevented by eviction of the drug or desensitization. Leukotriene receptor antagonists and 5-lipoxygenase inhibitors may also be useful. Beta-blockers including cardioselective beta-blockers, cholinergic agonists, inhaled agents, angiotensin-converting enzyme inhibitors (ACE), vindesine, histamine liberators, etc..., can also induce a bronchospasm. Most of the same agents can also induce an isolated cough, particularly beta-blockers, inhaled agents, and ACE, which cause 75% of the reported cases of iatrogenic cough. ACE-induced cough usually disappears within 1 to 4 days after withdrawal of the treatment, confirming the diagnosis; ACE-induced cough may be prevented by sodium cromoglycate. The risk of obliterans bronchiolitis with expiratory airflow impairment during rheumatoid arthritis is increased by D-penicillamine. Many drugs can be involved in the pathogenesis of bronchiolitis obliterans organizing pneumonia, which presents with various clinical and radiological aspects. The physician has to keep in mind that bronchospasm, cough, or bronchiolitis of unknown origin, may have a iatrogenic cause.
7890047 Inhibition of the DNA-binding activity of NF-kappa B by gold compounds in vitro. 1995 Mar 13 Nuclear factor kappa B (NF-kappa B) is a transcription factor that is critical for the inducible expression of multiple cellular and viral genes. DNA binding activity is essential for its function. Here, we report that gold compounds, especially aurothioglucose (AuTG), have a strong inhibitory effect on NF-kappa B-DNA binding. Our finding also reveals that Zn2+ is a necessary component of NF-kappa B for its DNA binding activity and that gold ion can efficiently block NF-kappa B-DNA binding, presumably through oxidation of the cysteins associated with zinc. This redox mechanism may provide an explanation for the observed efficacy of gold compounds in the treatment of rheumatoid arthritis.
7718423 Musculoskeletal syndromes associated with malignancies. 1995 Jan Literature on the association of malignancies with various rheumatic disorders published over the past year is summarized in this review. The possible roles of methotrexate treatment in predisposing to the development of lung cancer and Felty's syndrome in predisposing to non-Hodgkin's lymphoma in rheumatoid arthritis patients are discussed. The increased occurrence of monoclonal gammopathies and non-Hodgkin's lymphoma in patients with Sjögren's syndrome is reported. The possible increased frequency of malignancies among patients with systemic lupus erythematosus (SLE), scleroderma, and polymositis-dermatomyositis is revisited; of interest, the overlapping clinical features of non-Hodgkin's lymphoma and SLE are presented, as well as the increased occurrence of ovarian cancer in patients (especially older women) with dermatomyositis. The proceedings of the first International Workshop on Hypertrophic Osteoarthropathy, as well as the association of this syndrome with nasopharyngeal carcinoma in the childhood years, are presented. Finally, postchemotherapy and post-bacille Calmette-Guérin rheumatism are described.
7899153 Bipolar hemiarthroplasty for primary osteoarthritis of the hip. 1994 Dec One hundred twenty-five bipolar hemiarthroplasties of the hip were performed at the authors' hospital. Although the procedure was performed for acute femoral neck fractures, rheumatoid arthritis, revision hemiarthroplasty, and primary osteoarthritis, only the latter is the subject of this review. A modified Harris hip score (HHS) was used to evaluate the patients both preoperatively and postoperatively. Radiographs were taken preoperatively as well as postoperatively at 2-, 4-, 6-, and 24-month intervals. A total of 68 patients underwent bipolar hemiarthroplasty for primary hip osteoarthritis. The mean preoperative HHS was 35.5 (SEM = 1.86); the mean postoperative score was 81.2 (SEM = 1.64) with an average improvement of 45.7 (SEM = 2.03). The results of this review were compared to a control group of conventional total hip arthroplasties performed at the same institution. The mean postoperative HHS for the group of conventional arthroplasties was 87.2 (SEM = 1.07). The results of this review indicate a good clinical result from bipolar hemiarthroplasty, but significantly less postoperative function when compared to conventional total hip arthroplasty.
8070193 The operative treatment of acquired hallux varus. 1994 Sep Forty two patients (45 feet) who underwent operative correction of acquired hallux varus were retrospectively evaluated. The causes of hallux varus included complications after hallux valgus surgery (36), trauma (3), rheumatoid arthritis (3), unknown (2), and osteoarthritis (1). The methods of surgical correction were determined by the underlying etiology, the age and activity level of the patient, and the site of primary deformity. Surgical corrections included medial soft tissue release alone (2), medial soft tissue release combined with tendon transfer (17), metatarsal osteotomy with (1) or without (1) additional tendon transfer, arthrodesis (17), and resection arthroplasty (7). The tendon transfers used included a split extensor hallucis longus (6), an extensor hallucis longus transfer in combination with interphalangeal joint arthrodesis (7), and an extensor hallucis brevis (4). All patients were evaluated at a mean of 3.8 years (range, 1-7 years) after surgery. Pain, problems with shoe wear, and metatarsophalangeal joint instability, if present preoperatively, were improved in all treatment groups. An algorithm for the operative management of hallux varus is presented.
8065031 [Detection of Aspergillus fumigatus DNA by polymerase chain reaction in the clinical sampl 1994 Jul Aspergillosis is a disastrous cause of mortality and morbidity in patients in an immunocompromised state and old lung tuberculosis. However, the diagnosis of aspergillosis remains unsettled. In the present study, we developed a test to detect the Aspergillus fumigatus DNA using polymerase chain reaction (PCR) in clinical samples including sputum and bronchial aspirations from the patients with aspergillosis. We selected 2 pairs of oligonucleotide primers and the DNA for the small subunit ribosomal RNA of aspergillus fumigatus and they were significantly amplified. Although isolation of Aspergillus DNA may reflect contamination and colonization without infection, no aspergillus DNA was found in sputum or bronchial aspirations from the patients with lung cancer or interstitial lung diseases except a case of pulmonary fibrosis associated with rheumatoid arthritis chronically received 20 mg of corticosteroid. There was a 100% correlation between the culture results and the nested PCR results in the patients with pulmonary aspergillosis. These findings indicate that PCR detection of aspergillus fumigatus might be valuable for the diagnosis of aspergillosis.
8292300 Prosthetic osteomyelitis with special reference to the knee: risks, treatment and costs. 1993 Dec The overall incidence of osteomyelitis following primary knee arthroplasty is 1-2%. Major risk factors are large prostheses, rheumatoid arthritis, postoperative wound-healing complications, skin infections, and prior deep infections. The major infecting organism is Staphylococcus aureus. Healing of the infection is to be expected in 20% when systemic antibiotics alone are used, in 24% when soft tissue surgery is used, in 50% when resection arthroplasty is used, in 76% when revision arthroplasty is used, in 90% when arthrodesis is used, and in 100% when amputation is used. The direct medical costs average US$ 62,100 for an infected patient and US$ 8600 for a non-infected patient. Attention should focus on prophylactic measures directed towards the soft tissue problems: by avoiding conflicting skin incisions, by gentle handling of the periarticular soft tissues, by avoiding the use of constrained prostheses and oversized compartmental prostheses, by letting wound healing take priority over motion in knees with compromised soft tissues, and by using prophylactic antibiotic treatment for skin ulcers until these have healed.