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ID PMID Title PublicationDate abstract
1392409 Prevention and treatment of ulcers induced by nonsteroidal anti-inflammatory drugs. 1992 Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause varying degrees of gastroduodenal mucosal damage. These agents are most frequently used for the treatment of rheumatic diseases because they are highly effective in reducing joint pain and swelling. Histamine H2-receptor antagonists, omeprazole, sucralfate, and misoprostol are drugs available for the treatment of gastric mucosal damage caused by NSAIDs. In controlled clinical studies, all these drugs effectively heal gastric and duodenal injury if NSAIDs are discontinued. However, current data suggest that if NSAIDs are continued while gastrointestinal damage is present, only misoprostol and omeprazole have demonstrated efficacy in healing gastric mucosal injury. Misoprostol also effectively heals NSAID-induced duodenal injury. At this time, no data exist on the efficacy of other antiulcer drugs in healing duodenal erosions or ulceration if NSAID administration is continued. Regarding prevention of NSAID-induced gastric ulcer, controlled clinical studies with H2 antagonists and sucralfate have failed to show any therapeutic benefit. Ranitidine, however, has shown efficacy in preventing NSAID-induced duodenal ulcers. The coadministration of misoprostol with NSAIDs to patients who have either osteoarthritis or rheumatoid arthritis prevents the development of gastric and duodenal ulcers. Based on current published information, this property distinguishes misoprostol from other antiulcer drugs.
7569187 [Arthrodesis of the ankle under arthroscopy. Apropos of 10 cases reviewed after a year]. 1995 PURPOSE OF THE STUDY: The technique, results and indications for arthroscopic ankle fusion are detailed and compared with open technics. MATERIAL AND METHODS: 10 arthroscopic ankle fusions were performed between 1991 and 1993. This procedure was used in 4 cases of rheumatoid arthritis, 5 cases of osteoarthritis and 1 case of joint destruction consecutive to hemophilia. All patients were followed until fusion with an average follow-up of 12 months. The quality and position of the fusion were analyzed clinically and on radiograms. RESULTS: 9 patients obtained fusion in a neutral position and were able to walk with normal shoes. The average time to fusion was 14.5 weeks (8 to 40). 1 case failed and required reoperation after 15 months. No local complications were observed. DISCUSSION: Arthroscopic ankle fusion is a safe procedure with good results in cases with relatively little deformities. Its main interest lies in the low rate of complications. The technique does not increase the rate of fusion when compared to open technics. CONCLUSION: Arthroscopic fusion is recommended in cases with little to moderate deformities in the presence of poor wound healing factors.
23916350 Knee effusion and quadriceps muscle strength. 1994 Nov Ten healthy subjects with no musculoskeletal problems were tested using a computerized exercise dynamometer. Quadriceps femoris concentric performance was examined during maximal effort isokinetic knee extension at joint angular velocities of 2.09 and 4.18 rad s(-1). A saline and dextrose solution was injected into the knee joint cavity in 30-ml increments, and peak torque and power tests were undertaken with knee effusions of 0, 30, 60, and 90 ml. A protocol which included and excluded a local skin anaesthetic and submaximal exercise prior to the maximal effort test was also undertaken. The results showed that quadriceps peak torque and power were not significantly affected by the amount of knee effusion at either joint angular velocity when submaximal exercise was performed prior to the maximal effort test. However, peak torques were significantly decreased during isokinetic muscle action without prior submaximal muscle work. It was suggested that these findings may be related to fluid movement in the knee joint compartments, the compliance of the joint capsule, and the location that fluid was injected into the joint cavity. Joint swelling is a common symptom of individuals with osteoarthritis and rheumatoid arthritis, as well as those suffering acute joint trauma. This study has extended previous work on joint swelling by examining quadriceps function during joint movement, thus moreeffectivelysimulating joint and muscle activity which occursduring functional activities. Patients with knee joint swelling are thought to experience greater difficulty undertaking quadriceps exercises, and will not perform these exercises effectively until swelling in the joint is reduced. The current study provides some evidence to suggest that a moderate amount of swelling does not impair performance. Assuming that patients do not have other symptoms that contraindicate exercise, they can be encouraged to do more active muscle work.
7916207 Evidence for selective in vivo expansion of synovial tissue-infiltrating CD4+ CD45RO+ T ly 1994 Jun In this study we have analyzed the TCR V alpha and V beta regions at the DNA level in the CD4+CD45RO+ memory T cell population of synovial tissue infiltrating T lymphocytes of three rheumatoid arthritis (RA) patients and one patient with chronic arthritis. Cell lines of CD4+CD45RO+, CD4+CD45RO-, CD8+CD45RO+ and CD8+CD45RO- T lymphocyte populations were generated following FACS cell sorting of freshly isolated synovial tissue mononuclear cell infiltrates (STMC) and of freshly isolated peripheral blood mononuclear cells (PBMC) of these patients. The phenotypic and molecular analyses have revealed the following. (i) The TCR repertoires of tissue infiltrating T lymphocytes in the various subsets were extensive on the basis of TCR V gene family usage. (ii) Furthermore, each patient displayed individual specific TCR V gene expression patterns in the various STMC and PBMC derived T cell subsets. However, the majority of these arthritis patients manifested increased expression of multiple TCR V gene families in the synovial tissue derived CD4+CD45RO+ T cell population when compared with the peripheral blood derived CD4+CD45RO+ subset. Of these gene families, we found enhanced expression of the TCR V alpha 7 and V beta 11 gene segments in synovial tissue to be shared by all four patients analyzed. (iii) Nucleotide sequence analysis of the CDR3 regions of a number of TCR V regions in the CD4+CD45RO+ T cell subsets has revealed that the CDR3 regions comprised within synovial tissue derived TCR V regions differed from those found in peripheral blood derived TCR V regions. These differences in CDR3 diversity might be the consequence of a specific interaction with particular MHC-peptide complexes expressed at the site of inflammation. (iv) The CDR3 region analysis also showed individual specific amino acid motifs within the N-D-N regions of all analyzed TCR V beta genes derived from PBMC as well as STMC.
8762323 Hoarseness as the initial manifestation of systemic lupus erythematosus. 1996 May A 51-year-old woman complained of hoarseness of two years duration. The patient's past medical history was significant for autoimmunological hepatitis and arthritis for which she had not received treatment. Laryngoscopy and laryngeal stroboscopy revealed 'bamboo joint-like nodules' on both true vocal folds. These nodules resembled rheumatoid nodules and were suggestive of a collagen disease. Previous reports have documented that the treatment for such conditions related to collagen diseases is surgical resection. However, we initially attempted to treat the laryngeal lesions systemically with prednisolone. The hoarseness and the bamboo-like nodules disappeared six months after the treatment. Furthermore, the liver function test returned to normal and arthritis completely resolved. Based on our patient's response to this treatment, we diagnosed atypical-SLE and a lupus laryngitis. This case suggests that studies of the larynx may be helpful in the early diagnosis of collagan diseases and that such conditions may respond to systemic treatment.
1727284 Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features. 1992 Jan Twenty-seven cases of an unusual, poorly recognized destructive hip arthropathy with radiographic findings of rapid severe joint destruction are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. All patients underwent hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average, 18 months) in nine patients documented rapid hip destruction. Involvement was unilateral in 89% (24 of 27 cases). Twenty patients (83%) were elderly women. The authors postulate that these cases represent an uncommon, rapidly destructive subset of osteoarthritis.
8942087 Hearing and Sjögren's syndrome. 1996 Oct Immune sensorineural hearing loss is manifested in several systemic immune diseases. Although hearing loss has been previously documented in patients with Sjögren's syndrome (SS), the effect of SS on hearing is unclear. This prospective study was designed to assess the presence of hearing loss in 14 patients with SS and, if sensorineural hearing loss was present, to determine if the hearing loss was immune-mediated. Patients were evaluated with basic audiologic tests as well as for cellular immune inner ear reactivity as measured by the lymphocyte transformation test (LTT). Three patients had evidence of sensorineural hearing loss. Two patients had a positive LTT without evidence of sensorineural hearing loss. This preliminary study suggests that SS may not directly cause sensorineural hearing loss, immuno-mediated or otherwise.
8882038 Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands. 1996 Feb OBJECTIVE: To investigate whether reflex tearing measured by the Schirmer test with nasal stimulation is better correlated with lymphocytic infiltration of the lacrimal gland and is thus a more appropriate test for Sjögren's syndrome (SS). METHODS: 272 patients with dry eye (age 55.5 +/- 13.5 years) with regular Schirmer test results < 10 mm were recruited for the study. They were divided into 2 groups depending on the results of the Schirmer test with nasal stimulation. 24 age and sex matched patients from each group were selected for lacrimal gland biopsy and 10 patients for salivary gland biopsy, and the levels of systemic autoantibodies and degrees of ocular surface staining and lymphocytic infiltration of the lacrimal and salivary glands were compared. RESULTS: Of the 272 patients, 187 (68.8%) had good reflex tearing (GT) and 85 (31.2%) had poor reflex tearing (PT). There were no significant differences in the age or sex of the 2 groups. Lymphocytic infiltration of the lacrimal gland was observed in 7 GT cases and 22 PT cases out of 24 cases. Lymphocytic infiltration of the salivary gland was also higher in the PT (6 of 10) than the GT group (2 of 10). CONCLUSION: Evaluation of reflex tearing by the Schirmer test with nasal stimulation identifies 2 groups of patients with dry eye. Those with poor reflex tearing were more likely to have autoantibodies and lymphocytic infiltration of the exocrine glands consistent with SS.
8722203 B-cell lymphoproliferation in primary Sjögren's syndrome. 1996 Jan Sjögren's syndrome (SS) is characterized by lymphocytic infiltration of the exocrine glands, along with a polyclonal B-cell activation which is illustrated by the presence of multiple autoantibodies against organ and non-organ specific autoantigens. Lymphoproliferative disorders present with a higher frequency in patients with Sjögren's syndrome. The spectrum of lymphoproliferation extends from an increased frequency of circulating monoclonal immunoglobulins, free light chains and mixed monoclonal cryoglobulins (type II cryoglobulinemia) to an increased frequency of non-Hodgkin's lymphoma. In fact, patients with Sjögren's syndrome have a 44-times higher risk of developing lymphoma compared to the normal population. Several studies have shown that the affected exocrine glands are the major site of monoclonal B-cell proliferation in SS. This has been demonstrated by both immunophenotyping (an increased proportion of kappa:lambda light chains in the B-cells infiltrating the salivary glands) and immunogenotyping studies (monoclonal or oligoclonal light chain gene rearrangements in the salivary glands). The monoclonal rheumatoid factors in the sera of patients with SS share common cross-reactive idiotypes. The presence of these cross-reactive idiotypes is correlated with a higher frequency of extraglandular manifestations, circulating monoclonal immunoglobulins and autoantibodies. The lymphomas, which appear, may vary in type and location; immunocytomas, and intermediate grade and high grade non-Hodgkin's lymphomas have been described. Predictive factors for the development of lymphoma in SS include clinical signs such as lymphadenopathy, splenomegaly, and parotid gland enlargement, as well as laboratory parameters such as the presence of mixed monoclonal cryoglobulinemia and the presence of immunoglobulins bearing the cross-reactive idiotypes 17109 (Vk IIIb-related) and G-6 (VH1-related).
8835579 Sjögren's syndrome presenting as hypokalemic paralysis due to distal renal tubular acidos 1995 Dec A 57-year-old woman presented with a flaccid paralysis, muscle tenderness, and respiratory depression. Laboratory results demonstrated severe hypokalemia with hyperchloremic metabolic acidosis and abnormally acidified urine. The urinary anion gap was positive in the presence of acidemia, thus establishing the diagnosis of distal renal tubular acidosis (DRTA). The patient fully recovered after potassium and alkali replacement. Further investigation revealed Sjögren's syndrome as the underlying cause of DRTA.
7666624 [Spontaneous regression in a case of primary pulmonary lymphoma with Sjögren's syndrome]. 1995 Jun A 62-year-old asymptomatic woman had a nodular shadow approximately 3 cm in diameter in the middle lung field on chest roentgenogram. The shadow gradually grew over 1.5 years. She was then admitted to our hospital for evaluation of the abnormal shadow. Transbronchial biopsy specimens showed a diffuse, small, lymphoid infiltrate with predominance of B-cells. These findings suggested neoplastic proliferation. Further examinations revealed the presence of Sjögren's syndrome. Four months later, she was readmitted for surgical resection. Chest roentgenogram on the second admission disclosed that the mass shadow had shrunk slightly. Histopathological examination of the resected specimen led to the diagnosis of malignant lymphoma, diffuse small cell type (IgG kappa type). Gene analysis revealed the presence of heavy chain gene rearrangements, which confirmed the diagnosis of B-cell lymphoma. In this case, no contraction or necrosis of the lesion was observed, and the change in the shadow size was probably due to partial or transient spontaneous regression.
7489649 [An immunohistochemical study of HLA-DR expression in salivary glands from patients with S 1995 May Specimens of salivary gland tissue from 21 cases of SS were analyzed by ABC immunohistochemistry technicue with a monoclonal antibody to HLA-DR. The results showed that positive immunostaining for HLA-DR were found in duct cells, acinar cells and a part of infiltrating cells respectively. The proportions of duct and acinar cells expressing HLA-DR were not increased between SS and controls. However, there are differences in their staining intensity. The HLA-DR expression on the epithelial cells in SS was most intense than in controls. Our data suggest that the HLA-DR expression of SS may be regarded as an important factor in local immune rections.
7883593 Tumor necrosis factor alpha-308 gene variants in relation to major histocompatibility comp 1994 Dec The location of the human TNF genes within the MHC complex has prompted much speculation about the role of TNF alleles in the etiology of MHC-associated autoimmune diseases. On sequencing the 5' regulatory region of the human TNFA gene a G (TNFA-308G) to A (TNFA-308A) transition polymorphism at position -308 was discovered. We have developed a simple PCR assay to facilitate the screening of the -308 polymorphism at the DNA level. In view of the possible linkage between the TNFA-308A allele and a certain MHC type, TNFA-308 genotypes in HLA-typed healthy individuals (n = 88) were determined. A statistically significant association between the TNFA-308A allele and HLA-DR3, DQB1*0201, DQA1*0501, A1, B8, and the NcoI 5.5-kb RFLP of the TNFB gene was observed. In addition, we determined the frequency of the TNFA-308A allele in patients with FS (n = 13), an HLA-DR4-associated disease. In this study, no association was found of Felty's syndrome with the TNFA-308A allele, indicating that this allele does not appear to be a susceptibility factor for FS.
8202316 A case report of Sjögren's syndrome with repeated false cord swelling. 1994 May We present a 42-year-old female patient who had repeated swelling of the bilateral false cords. The patient complained of dryness of the eyes and oral mucosa, and was diagnosed as having Sjögren's syndrome. She underwent partial resections of the bilateral false cords 4 times in 3 years to evaluate the nature of the disease and to relieve airway obstruction. Histologic examinations revealed severe atrophic changes of the laryngeal glands and cystic dilation of the ducts of the glands, associated with marked lymphocytic infiltration and lymphoid hyperplasia. These findings suggest that the etiology of the swelling of the false cords was related to Sjögren's syndrome.
8039416 Ulcerative and oral lichen planus associated with sicca syndrome and primary biliary cirrh 1994 May The following case report supports the hypothesis that the coexistence of lichen planus, primary biliary cirrhosis, and sicca syndrome is not co-incidental. The fact that all three diseases are manifest in the same patient substantiates a theory of pathogenesis based on a cell-mediated immune response analogous to that in allogeneic bone marrow transplant recipients with chronic graft-versus-host disease.
8164214 Antinuclear antibodies and connective tissue disease features in fibromyalgia syndrome: a 1993 Sep OBJECTIVE: The objective was to investigate the prevalence of antinuclear antibodies (ANA) and of connective tissue disease (CTD) features in patients with fibromyalgia syndrome (FS) compared with healthy, pain-free controls. METHODS: One hundred ninety-two patients with FS and 80 pain-free healthy controls were studied by a protocol that included features of FS and those of a CTD, e.g., Raynaud's phenomenon (RP) and dry mouth. ANA was tested by indirect immunofluorescence assay with mouse kidney substrate. Patients with an initial positive ANA were followed after a mean period of 3.3 years. RESULTS: ANA was positive in 11.5% of all patients, 11.3% of 160 female patients and 10.0% of 80 female controls, with no significant differences between the groups. Among the women, RP was present in 8.8% of patients and 2.5% of controls (p < 0.07), whereas subjective dry mouth without an obvious cause occurred in 12% of patients and none of the controls (p < 0.005). The frequency of other CTD features was similar in both groups. Diagnosis of a CTD was not made in any patient initially or in those seen on followup. CONCLUSIONS: Prevalence of ANA and of CTD features was similar in patients with FS and healthy controls, with the exception of subjective dry mouth, the frequency of which was significantly greater among the patients.
8394065 Multiple clinical and biological autoimmune manifestations in 50 workers after occupationa 1993 Jul OBJECTIVES: A self referred group of four workers from a factory producing scouring powder with a high silica content showed a surprisingly high number of features compatible with a connective tissue disease. Further subjects working at the same factory were subsequently studied to evaluate the relation between this exposure and the development of autoimmune processes. METHODS: A total of 50 subjects (44 women, six men; mean (SD) age 43.7 (5.5) years; mean duration of employment 6.1 years) underwent a prospective study including clinical history and physical examination, an immunobiological study, HLA typing, radiological and functional oesophageal and respiratory examination, ophthalmological examination, and isotopic testing of salivary glands. RESULTS: Symptoms of a systemic illness were present in 32 (64%) subjects: six with Sjögren's syndrome; five with the criteria for systemic sclerosis; three with systemic lupus erythematosus (SLE); five with an 'overlap syndrome'; and 13 with undifferentiated findings not meeting the criteria for a defined disease. Antinuclear antibodies were present in 36 (72%) subjects; four had antibodies to native DNA, including two subjects with SLE, one with systemic sclerosis associated with secondary Sjögren's syndrome, and one with overlap syndrome. Anticentromere antibodies were not detected. The frequency of HLA-DR3 was increased in the clinically affected subjects, but did not reach statistical significance. CONCLUSIONS: This descriptive study emphasises the high probability of workers occupationally exposed to silica developing a multiple spectrum of clinical and serological autoimmune manifestations.
8358990 A case of Sjögren's syndrome complicating immune-mediated aplastic anaemia. 1993 Jun A 78-year-old Japanese woman with Sjögren's syndrome complicating immune-mediated aplastic anaemia is described. A diagnosis of aplastic anaemia was made from severe pancytopenia with hypoplastic marrow. Laboratory studies suggested an association of bone marrow suppressive T-lymphocytes with the pathogenesis of aplastic anaemia. Following the administration of mepithiostan and prednisolone, pancytopenia improved gradually. Two years after the onset of aplastic anaemia, Raynaud's phenomenon developed and examinations revealed the existence of keratoconjunctivitis sicca and anti-SSA/Ro and anti-SSB/La antibodies.
1582067 Natural killer cell functions are related to the cell membrane composition of essential fa 1992 May To examine whether abnormalities in essential fatty acid (EFA) metabolism are associated with the impaired natural killer (NK) cell functions in primary Sjögren's syndrome, we measured the levels of phospholipid fatty acids in blood mononuclear cells with (MD) and without monocyte depletion (MC), and NK cell activity before and after indomethacin-boosting. We found MD levels of 20:3n6 (dihommo-gamma-linolenic acid), and basal and indomethacin-enhanced NK cell activity significantly reduced, in 10 primary Sjögren's syndrome patients as compared with 10 healthy controls. In the controls the relative (%) increase in indomethacin-enhanced NK cell activity correlated with the level of MD 18:2n6 (linoleic acid) (r = 0.97, p less than 0.001). In the patients the relative (%) indomethacin-enhanced NK cell activity correlated with the 20:4n6 (arachidonic acid)/20:3n6 ratio in the MC (r = 0.90, p less than 0.001). This ratio has been assumed to be an important determinant for the production of prostaglandin 1 and 2. The present data suggest that in healthy persons, as opposed to primary Sjögren's syndrome patients, the level of MD 18:2n6 is a determinant for the sensitivity of NK cells to monocyte-derived prostaglandins. Furthermore, in patients with primary Sjögren's syndrome the MC levels of 20:3n6 and 20:4n6 may be regulating factors for the production of NK cell suppressing prostaglandins.
8763442 A case of Sjögren's syndrome, sarcoidosis, previous ulcerative colitis and gastric autoan 1996 Jun We describe a patient with sicca syndrome, Raynaud's phenomenon and fixed waxy skin lesions. Investigations confirmed both Sjögren's syndrome and sarcoidosis. The patient had previously had ulcerative colitis and other antibody evidence of autoimmunity. The spectrum of disorders reported in association with Sjögren's syndrome and sarcoidosis is wider than suggested in the acronym TASS syndrome (thyroiditis, Addison's disease, Sjögren's syndrome and sarcoidosis), and we suggest that the acronym TOASSUC (thyroiditis, other autoimmunity, Sjögren's syndrome, sarcoidosis, ulcerative colitis) includes a wider range of disorders and may be more memorable.