Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 8095086 | [Serologic activity against retrovirus in patients with Sjögren syndrome]. | 1993 Jan 30 | BACKGROUND: The primary Sjögren's syndrome (SS) is a systemic disease which destroys the exocrine glands by autoimmune mechanisms. The etiology of this syndrome is unknown although different virus are involved in its genesis. METHODS: The presence of serologic reactivity IgG and IgM versus the human immunodeficiency virus (HIV-1), HIV-2, HTLV-I and HTLV-II were studied in 14 patients with SS and in 15 controls. Likewise, the presence of retroviral genomic sequences was analyzed in 7 of these patients by polymerase chain reaction (PCR). RESULTS: All the patients with SS were negative by enzymoimmunoassay (EIA) versus known retrovirus. However, more than 70% presented reactivity versus different nuclear proteins, particularly versus p24 of HTLV-I in Western blot (WB). These results were negative in the control group. Genomic analysis by PCR did not confirm the presence of specific sequences in any of the known human retroviruses in the patients with SS, nonetheless, in 3 of the 7 samples analyzed by PCR, related retroviral sequences were detected. CONCLUSIONS: The presence of serologic reactivity in Western blot versus some viral proteins and the similarity of genomic sequences in some cases suggests that a retrovirus related with those which are currently known, particularly with the HTLV-I, may be involved in the genesis of Sjögren's syndrome. | |
| 1419798 | Quantitation of granulocyte antibodies in sera and determination of their binding sites. | 1992 Sep | An enzyme immunoassay using eluates was developed for the quantitation of granulocyte antibodies in sera. Incubation of donor granulocytes with sera containing granulocyte alloantibodies (NA1, NA2, NB1, 5b, HLA) or autoantibodies resulted in a significantly higher amount of immunoglobulin G (IgG) per cell than did incubation with control sera. Ultracentrifugation of the sera prior to testing reduced unspecific binding of IgG to granulocytes. In eight of 10 assessed sera from patients with Felty's syndrome eluted IgG decreased from elevated to normal levels. Ultracentrifugation further allowed determination of the binding sites of granulocyte-reactive alloantibodies. Using sera containing NA1- and NA2-specific alloantibodies 173,000-188,000 binding sites on homozygous and 84,000-110,000 on heterozygous cells were determined. A similar number was found using a Fc gamma receptor III (FcRIII)-specific monoclonal antibody. Granulocytes from patients with paroxysmal nocturnal haemoglobinuria showed greatly reduced binding sites for NA-specific alloantibodies. The binding sites for the human alloantibody NB1 ranged from 36,000 to 318,000 and for the 5b alloantibody from 44,000 to 65,000. Mean values of 139,000 binding sites for HLA antigens and 27,000 binding sites for the FcRII were determined using monoclonal antibodies. | |
| 8783913 | Primary biliary cirrhosis--an uncommon disease in Singapore. | 1996 Feb | Primary biliary cirrhosis (PBC) is uncommon in Singapore. Twelve consecutive patients with PBC were seen between 1987 and 1994 at the National University Hospital. Eleven were women and the mean age at presentation was 53 years. Three patients presented with pruritus and jaundice whilst three had decompensated cirrhosis. The remaining six patients had no symptoms attributed to their liver disease when first detected, three of them presented with associated conditions including sicca syndrome and interstitial lung fibrosis, lichen planus, and carcinoma of breast. All patients had elevated serum alkaline phosphatase and positive anti-mitochondrial antibodies. Liver histology (10/12) showed Stage II disease (2), Stage III (5) and Stage IV (3). Three patients also had co-existing gall bladder stones but their endoscopic retrograde cholangiograms were normal. The mean follow-up period was 32.6 months and four patients died during follow-up. The only male patient had liver transplantation, two patients had symptomatic treatment while the rest were treated with ursodeoxycholic acid. In conclusion, local patients tended to presented relatively early in the course of the disease with 50% being asymptomatic and in the precirrhotic Stages. | |
| 8745593 | [Extrahepatic manifestations related to hepatitis C virus]. | 1995 Oct | The hepatitis C virus infects mononuclear cells and, like other viruses, can be responsible for immune disorders. The immune abnormalities described in the course of hepatitis C consist of nonspecific immunological disorders (cryoglobulinaemia, autoimmune disorders, generally associated with the presence of organ-specific or nonspecific autoantibodies). The association between mixed cryoglobulinaemia and hepatitis C has been clearly established, as 50% of patients with essential cryoglobulinaemia suffer from hepatitis C and 50% of patients with hepatitis C suffer from cryoglobulinaemia. The relationships between hepatitis C and other autoimmune disorders is less clear. The association between hepatitis C and anti-smooth muscle and antinuclear antibodies has been emphasized. However, the frequency of these autoantibodies in hepatitis C does not appear to be significantly different from than observed in other forms of viral hepatitis, especially hepatitis B. However, patients with hepatitis C have a higher incidence of anti-LKM1 antibodies than patients with other forms of viral or alcoholic liver disease. A high prevalence of hepatitis C viral infection has also been reported in Sjögren's syndrome, lichen planus and thyroid disorders. However, the relationship between viral infection and these immune disorders has not been demonstrated by large-scale epidemiological surveys or by basic virological studies. The development or exacerbation of immune disorders in patients treated by interferon has also been clearly demonstrated, which means that an autoimmune assessment, especially looking for anti-tissue and anti-thyroid antibodies, should be performed before prescribing interferon. | |
| 7947204 | Significance of tubuloreticular structures forming in Daudi cells cultured with sera from | 1994 Oct | It is known that infants with neonatal lupus erythematosus (NLE) may be born to mothers whose sera are positive for the anti-Ro/SSA antibody. However, women who have this antibody do not always give birth to children with NLE. We have demonstrated tubuloreticular structures in vascular endothelial cells in the skin lesions of infants with NLE. Tubuloreticular structures could no longer be detected at the site of the lesions once the annular erythema had resolved, and the anti-Ro/SSA antibody test had become negative. The probability of a child being born with NLE was assessed by observing whether tubuloreticular structures were formed in Daudi cells cultured with sera from eight mothers who were anti-Ro/SSA antibody positive. Tubuloreticular structures formed in Daudi cells cultured with sera from four mothers who bore infants with NLE, but not in Daudi cells cultured with sera from four other mothers who bore normal infants. These results suggest that women who are positive for the anti-Ro/SSA antibody have a higher risk of bearing infants with NLE if tubuloreticular structures are formed in Daudi cells cultured with sera from these women, whereas this risk is lower if tubuloreticular structures do not develop in Daudi cells. | |
| 8436832 | Autoantibodies directed against different classes of Fc gamma R are found in sera of autoi | 1993 Mar 1 | Serum samples from 147 patients with different systemic autoimmune diseases (SLE, Sjögren's syndrome, and progressive systemic sclerosis) were tested for anti-Fc gamma R activity using mouse rFc gamma RII in an ELISA. High reactivity compared to normal individuals was found for patients with all three diseases. The anti-Fc gamma R antibody was purified from several serum samples by affinity chromatography on a Sepharose column coupled with denatured, murine rFc gamma RII. Both IgM and IgG antibodies were found. To analyze the specificity of the affinity-purified autoantibody, cells (human neutrophils, IFN-gamma-stimulated neutrophils, monocytes, and the THP-1 monocytic cell line) that express different combinations of Fc gamma R (CD64, CD32, CD16) were stained with the affinity purified Ig. Ig directed against all three types of Fc gamma R were found. The results may reflect on the role of Fc gamma R-specific antibodies in the pathology of autoimmune diseases. | |
| 8644501 | Band 3 and its peptides during aging, radiation exposure, and Alzheimer's disease: alterat | 1995 | An aging antigen, senescent cell antigen, resides on the 911 amino acid membrane protein band 3. It marks cells for removal by initiating specific IgG autoantibody binding. Band 3 is a ubiquitous membrane transport protein found in the plasma membrane of diverse cell types and tissues, and in nuclear, mitochondrial, and golgi membranes. Band 3 in tissues such as brain performs the same functions as it does in red blood cells forming senescent cell antigen. Oxidation is a mechanism for generating senescent cell antigen. The aging antigenic sites reside on human band 3 map residues 538-554, and 812-830. Carbohydrate moieties are not required for the antigenicity or recognition of senescent cell antigen. Anion transport site were mapped to residues 588-594, 822-839, and 869-883. The aging vulnerable site which triggers the antigenic site and the transport sites of band 3 were mapped using overlapping synthetic peptides along the molecule. Naturally occurring autoantibodies to regions of band 3 comprising both senescent cell antigen and B cells producing these antibodies were demonstrated in the sera of normal, healthy individuals. The presence of these antibodies tend to increase with age. Individuals with autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus) have increased antibodies to senescent cell antigen peptides. Radiation exposure results in an increase in antibodies to peptides 588-602 which lies in a transport region containing the aging vulnerable site. Band 3 ages as cells and tissues age. Our studies, to date, indicate, that the anion transport ability of band 3 decreases in brains and lymphocytes from old mice. This decreased transport ability precedes obvious structural changes such as band 3 degradation and generation of SCA, and is the earliest change thus far detected in band 3 function. Other changes include a decreased efficiency of anion transport (decreased Vmax) in spite of an increase in number of anion binding sites (increased Km), decreased glucose transport, increased phosphorylation, increased degradation to smaller fragments as detected by quantitative binding of antibodies to band 3 breakdown products and residue 812-830, and binding of physiologic IgG autoantibodies in situ. The latter 3 findings indicate that post-translational changes occur. In Alzheimer's Disease (AD), our results indicate that post-translational changes occur in band 3. These include decreased band 3 phosphorylation of a 25-28kD segment, increased degradation of band 3, alterations in band 3 recognized by antibodies, and decreased anion and glucose transport by blood cells. Serum autoantibodies were increased in AD patients compared to controls to band 3 peptide 822-839. This band 3 residue lies in an anion transport/binding region. | |
| 9010052 | Large granular lymphocyte expansions in Felty's syndrome have an unusual phenotype of acti | 1996 Dec | One-third of patients with Felty's syndrome (FS) have significant clonal expansions of CD3+ CD8+ large granular lymphocytes (LGLs) in their peripheral blood. The reasons for this are unclear, but one hypothesis is that they are activated antigen-specific cells of pathogenic relevance. Cytofluorographic analysis of activation markers demonstrated that the cell surface phenotype of these expansions was CD57+, HLA-DR+, IL-2R-, Leu-8+, CD69+, LFA-1+, ICAM-1+, VLA-4+, i.e. 'activated' T cells. However, they also expressed the phenotype CD45RA+, CD45RBbright, CD45RO-, usually associated with 'naive' cells. This could result from aberrant activation, malignant transformation or from a 'reversal' of CD45 phenotype following chronic antigenic stimulation. In three patients with RA and non-clonal LGL expansions, a more variable phenotype was found. In one of these patients, the expanded population was identified in the peripheral blood, but not the synovial fluid. This may suggest that, at least in this individual, any pathogenic effect is exerted systemically. | |
| 8832984 | Anti-52 kDa Ro(SSA) autoantibodies in different autoimmune diseases preferentially recogni | 1996 Mar | OBJECTIVE: Antibodies against the 52 kDa Ro(SSA) protein are an important laboratory variable in autoimmune diseases, most notably in the diagnosis of primary Sjogren's syndrome (SS), congenital heart block (CHB), and certain varieties of systemic lupus erythematosus (SLE). However, there is controversy about the differential reactivity of these sera, both with regard to immunogenic regions on the target protein and the respective antibody titers. Therefore, sera from various autoimmune diseases were tested against a broad panel of recombinant 52 kDa Ro(SSA) fusion proteins. METHODS: Sera were obtained from 20 patients with SLE, 10 with primary SS, 15 children with CHB, 6 healthy anti-52 kDa Ro(SSA) positive infants born to mothers with SLE and 7 anti-52 kDa Ro(SSA) positive patients with primary biliary cirrhosis/secondary SS. Epitope mapping was performed using different fusion proteins in ELISA and immunoblot. RESULTS: All sera reacted with whole recombinant antigen as well as with the protein carrying the amino acid sequence (AA) 1-245. The proportion of positive sera against the 52kDa Ro fusion proteins tested was found in descending order in patients with CHB, down to primary SS, the healthy infants group, patients with SLE and finally primary biliary cirrhosis/secondary SS. In general, CHB and primary SS sera exhibited the broadest reactivity against the recombinant protein compared to the limited and lower reactivity of sera from patients with primary biliary cirrhosis. Sera from infants with CHB had significantly higher antibody levels to AA 1-245 compared to SLE sera (p < 0.0005) and to sera from healthy infants born to SLE mothers (p < 0.05), as well as to serum samples from patients with primary biliary cirrhosis/SS (p < 0.005). The strongest antigenicities recognized by anti-52 kDa Ro(SSA) autoantibodies are located within the AA 197-245 region that represents an essential epitope. Further antigenic sites preferentially recognized by SS, CHB, and healthy infant sera are located within AA 153-196. CONCLUSION: Thus, the central region AA 153-245 is the major immunogenic region of the 52 kDa Ro(SSA) antigen containing a strong antigenic epitope between AA 197-245. The antibody response is directed to this major antigenic region regardless of the underlying autoimmune disease. However, the strikingly different quantities of antibody levels and the recognition of epitopes on AA 153-196 may be associated with different disease expressions. | |
| 7728396 | Interferon-gamma and epithelial cell activation in Sjögren's syndrome. | 1995 Mar | We have examined the hypothesis that interferon-gamma (IFN-gamma) and its interaction with epithelium may play a role in the perpetuation of inflammation in Sjögren's syndrome (SS). Labial salivary gland primary cell cultures from 16 patients with primary SS (pSS) and eight cultures from patients with SS symptoms but histologically normal biopsies were examined for expression of HLA-DR and cytoplasmic La (SS-B). Epithelial HLA-DR expression was found in 80% of cultures from pSS patients and 38% of those from patients not fulfilling diagnostic criteria. Cytoplasmic La was detected in 50 and 38% of cultures, respectively. Treatment of 14 of the cultures with IFN-gamma increased HLA-SR and cytoplasmic La expression above that of untreated cultures. Depletion of IFN-gamma using neutralizing antibody had the reverse effect. These findings suggest that the perpetuation of chronic inflammation of pSS may be due to the induction of HLA-DR and La antigen expression on epithelial cells by IFN-gamma. | |
| 7534284 | Does Sjögren's syndrome predispose surgical patients to acquired hemophilia? | 1995 Feb | The authors report the first American case of a factor VIII inhibitor found in a patient with Sjögren's syndrome. The inhibitor was isolated from a patient with no known hematologic disorder who was seen with a compartment syndrome of the left thigh after sustaining a fall from bed. The Sjögren's syndrome had been previously diagnosed via lower lip biopsy. After fasciotomy, signs and symptoms of intra-abdominal hemorrhage developed, and the patient was taken to laparotomy, where no hemorrhage was found. A coagulopathy developed, and the patient's hemoglobin continued to fall. A complete factor analysis revealed a factor VIII inhibitor that was quantified at 40 Bethesda units. After vigorous therapy--which included factor concentrates, immunoglobulins, steroids, antifibrinolytic agents, and blood replacement--the patient's bleeding stopped and she continued to convalesce under hospital care until her ultimate death from respiratory problems. Acquired hemophilia with a factor VIII inhibitor may be associated with Sjögren's syndrome. | |
| 8024614 | Expression of granzyme A in salivary gland biopsies from patients with primary Sjögren's | 1994 Jul | OBJECTIVE: To determine whether the destruction of salivary gland epithelial cells in Sjögren's syndrome (SS) could be mediated by granzyme A, a serine protease that is contained in the granules of activated lymphocytes. METHODS: We used in situ hybridization and polymerase chain reaction amplification to determine the expression of granzyme A messenger RNA (mRNA) in salivary gland biopsy samples. RESULTS: Granzyme A mRNA expression was detected in salivary glands from SS patients, but not in those from normal controls. Granzyme A mRNA content was significantly correlated (P < 0.001) with the size of lymphocytic infiltrates in the salivary glands and with the clinical activity of the disease. CONCLUSION: Cells that express granzyme A mRNA may play a role in the destruction of the target organ (i.e., the salivary gland) in patients with SS. The strong association of granzyme A mRNA expression and larger lymphoid infiltrates in the patients' salivary glands suggests that granzyme A mRNA is expressed at a relatively late stage of the local inflammatory process. Therapies designed to modulate or block granzyme A induction and action should be investigated in SS patients. | |
| 8252803 | A calreticulin-like protein co-purifies with a '60 kD' component of Ro/SSA, but is not rec | 1993 Dec | In this study, we used human tonsils for the isolation of the 60 kD component of the Ro/SSA autoantigen, following the method described by Wu et al. (J Immunol Methods 1989; 121:219-24). Western blot analyses were carried out using Ro/SSA-reactive human Sjögren's syndrome sera, to follow the autoantigen through the purification procedure. A 60 kD Ro/SSA component was eluted as a broad peak from a Mono Q column. Within this peak, a much more abundant protein, co-migrating with the Ro/SSA component on SDS-PAGE, was also eluted. The more abundant protein was further purified on a Superose 12 column and its N-terminal sequence was shown to be identical to that of human calreticulin. The 60 kD Ro/SSA autoantigen was also further purified on the Superose 12 column and was eluted as an asymmetric peak, with the majority being eluted at a position corresponding to 60 kD, whereas the calreticulin-like protein was eluted from the same column as an apparent dimer of approximately 120 kD. A panel of five Ro/SSA-reactive human sera reacted with the purified Ro/SSA antigen, but not with the calreticulin-like protein. Therefore, it is clear that the calreticulin-like protein is not a Ro autoantigen and is distinct from the 60 kD Ro/SSA antigen. As the calreticulin-like protein is a much more abundant protein than the 60 kD Ro/SSA component, its co-purification with the autoantigen on ion-exchange and its close migration with the autoantigen on SDS-PAGE may explain why peptide sequences for human calreticulin were derived from apparent 60 kD Ro/SSA antigen preparations. | |
| 8245519 | Human oropharyngeal lesions with a defective Epstein-Barr virus that disrupts viral latenc | 1993 Dec | The Epstein-Barr virus (EBV), a human herpesvirus that is predominantly latent after infection, can be induced to replicate by deleted, rearranged EBV DNA from cultures of laboratory strain P3HR-1. Because mucosal surfaces are permissive of EBV replication, 101 oral biopsies from 70 Chinese and 5 American patients were examined for natural counterparts to tissue culture defective virus (WZhet), using as marker the abnormal juxtaposition of BamHI W and Z EBV DNA restriction fragments. Of the 49 oral biopsies that contained EBV DNA, 12 (24%) had the rearranged WZ fragment by polymerase chain reaction analysis: 3 (42%) of 7 EBV-positive epithelial dysplasias or carcinomas, 6 (38%) of 16 hairy leukoplakias, and 3 (12%) of 25 nonmalignant salivary gland biopsies. Accompanying viral replication was confirmed by in situ cytohybridization and demonstration of the linear configuration of the genome in select WZhet-positive lesions. These findings indicate that defective EBV with the unusual property of disrupting EBV latency is prevalent in natural infections and may contribute to EBV's pathogenic diversity. | |
| 8213678 | Neonatal hemochromatosis associated with maternal autoantibodies against Ro/SS-A and La/SS | 1993 Oct | Liver disease in the fetus and neonate may be associated with maternal Sjögren's syndrome (neonatal lupus erythematosus). The infant of a mother with Sjögren's syndrome and high anti-Ro/SS-A and anti-La/SS-B antibody titers presented at 2 1/2 weeks of age with overwhelming hepatic insufficiency and died at 6 weeks of age. Autopsy confirmed the antemortem diagnosis of neonatal hemochromatosis. We discuss the possibility of a relationship between these two conditions. | |
| 8485911 | Increased epithelial expression of HLA-DQ and HLA-DP molecules in salivary glands from pat | 1993 May | Salivary gland specimens from 10 patients with primary Sjögren's syndrome (pSS) were examined by two-colour immunofluorescence with various combinations of monoclonal and polyclonal antibody reagents of the following specificities: human leucocyte antigen (HLA) class I and II (DR, DP and DQ), CD3, CD45 (leucocyte common antigen), various cytokeratins, and factor VIII-related antigen. Tissue specimens from 10 normal glands and 10 glands with obstructive sialadenitis (no known autoimmunity) served as controls. Only some intercalated ducts and scattered acini of the normal major glands expressed HLA class II determinants (< 5% of total epithelial area); the relative proportion of positive elements indicated differential expression (DR > DP > DQ). SS glands contained substantial T cell infiltrates and increased numbers of activated (DR+) T cells; adjacent epithelium showed extensive differential expression of HLA class II determinants (DR > DP > DQ). Glands with obstructive sialadenitis showed similarly increased epithelial expression of HLA-DR but with surprisingly small amounts of concomitant HLA-DP and -DQ expression. Epithelial HLA class II expression probably depends on cytokines as an inductive event, which is not unique for SS but particularly prominent in this disorder. Our results suggest that epithelial expression of HLA-DP or -DQ, rather than -DR, might be a prerequisite for the autoimmune process of SS to develop in genetically susceptible individuals. | |
| 7801201 | [A case of systemic lupus erythematosus (SLE) successfully treated with mizoribine (Bredin | 1994 Oct | Mizoribine, a novel immunosuppressive agent developed in Japan, was administered as a monotherapy to a systemic lupus erythematosus (SLE) patient with the clinical symptoms and immunological abnormalities accompanying SLE showing marked improvement. The result of prolonged administration over 22 months in this case showed neither relapse nor side-effects. Reports have been made about mizoribine used concomitantly with steroids in the treatment of SLE; however, there have not been any reports of mizoribine as a monotherapy for SLE being effective. In this case, mizoribine (150 mg/day) was administered without steroids as a monotherapy on a outpatient basis since the patient's condition overall was relatively good and the serious complications of the heart, kidneys, and lungs that accompany SLE were not observed. The results of this treatment showed improvements in alopecia, arthritis, and systemic malaise from about the 4th week after the start of administration, and the clinical symptoms that accompany SLE had completely disappeared in the 8th week. Also, the immunological tests markedly improved. Four months after the start of administration the immunological abnormalities in the anti-DNA antibody, rheumatoid factor, and immune complex were completely corrected. This case showed dramatic improvement in the SLE clinical symptoms and immunological abnormalities with the mizoribine monotherapy as well as the potential for mizoribine monotherapy to maintain a state of remission over the long term. | |
| 7905491 | Expression of the 60 kDa heat shock protein in normal and inflamed liver. | 1993 Aug | The 60 kDa heat shock proteins (HSP 60) have been well conserved throughout evolution and are highly immunogenic. Cross-reactivity between bacterial and mammalian HSP 60 is considered a likely mechanism in the pathogenesis of autoimmune diseases. T cell and B cell reactivity to HSP 60 is found in patients with rheumatoid or juvenile arthritis, and the expression of HSP 60 in the inflamed joint is found to be increased. In this study the presence of HSP 60 was demonstrated in normal and inflamed lives. HSP 60 was found to be predominantly expressed in hepatocytes and Kupffer cells, and mainly localized in mitochondria. Heat stress in the form of a 1 h incubation at 42 degrees C increased HSP 60 expression. The expression of HSP 60 in chronic active hepatitis was found to be markedly increased, with predominant expression in areas of inflammatory infiltrates. This increased expression in the inflamed liver was found both in viral and autoimmune hepatitis. High expression of HSP 60 in chronic active hepatitis was entirely due to self (i.e. human) HSP 60; no additional bacterial HSP 60 could be detected. Increased expression of HSP 60 in chronic active hepatitis suggests that immune reactions to HSP 60 may play a role in the immunopathogenesis and perpetuation of chronic inflammatory liver disease. | |
| 8162453 | Immune responses to canine distemper virus in joint diseases of dogs. | 1994 Jan | Measurement of immune complexes, antibodies against canine distemper virus (CDV) and anti-CDV antibodies in immune complexes were made in sera and SF from 'normal' dogs and from dogs with joint diseases. These data were compared with cytological analyses of SF samples. In dogs with canine rheumatoid-like arthritis (CRA) there were correlations between circulating anti-CDV antibody levels and circulating immune complex levels (P < 0.001) and between SF anti-CDV antibody levels and SF immune complex levels (P < 0.01). Furthermore, the SF PMN count in dogs with CRA correlated with both the SF anti-CDV antibody levels (P < 0.001) and the SF immune complex anti-CDV antibody levels (P < 0.001). The results demonstrated a relationship between CDV and ongoing synovial inflammation in dogs with CRA. | |
| 8560021 | [Uncemented knee prosthesis. Results apropos of 58 cases with a minimum of 5-year follow-u | 1995 | PURPOSE OF THE STUDY: The aim of this study was to evaluate, after at least 5 year's follow-up, the results of 64 PCA (TM) cementless total knee prostheses. MATERIAL: From 1984 to 1988, 13 male and 45 female patients (a total of 64 prostheses including 6 bilateral) received PCA Primary prostheses. Both femoral and tibial components were implanted without cement. Mean age of patients was 68.9 years (range: 35-81); mean patient height was 164.41 cm and mean weight 76.74 Kg. The most frequent pathology was gonarthrosis: 43 cases of medial gonarthrosis and 15 of lateral gonarthrosis. There were 4 cases of rheumatoid arthritis and two post-traumatic degenerative arthritis. 52 knees were free of any previous surgical procedure. Of the 64 prostheses and the 58 patients: 6 died and 2 were lost to follow-up; 56 knees were reviewed. The longest follow-up is 9 years for an average of 6.8 years. METHODS: Prosthetic review included clinical evaluation (Hungerford score based on 100 points, ISK rate based on 200 points) and complete radiological evaluation enabling the postoperative position of the implants to be examined. Radiolucencies were examined according to Ewald. X-ray study of polyethylene wear was performed based on the distance between the prosthetic condyle to the height of the metal tibial plateau. All patients were operated on by the same surgeon using the same procedure, and the same postoperative outcome. RESULTS: There were no local postoperative complications or any early reoperations. PHlebitis occurred in 12 per cent of cases. With the exception of 8 patients who were reoperated due to mechanical complications, the Hungerford score raised from 37.5 preoperatively to 88.3 postoperatively. The results of 43 of the 48 patients were rated good or excellent. The 200 point score rating gave 91 per cent of good and excellent results for knee examination, and 69 per cent of good and excellent results for knee function. Mean flexion angle was 107.8 degrees mean pain scored 45/50. Radiologically 75 per cent of operated patients had postoperative varus or valgus in the range 0-5 degrees as against 24 per cent preoperatively. The study of edge defects revealed the absence of any radiological abnormality on the femoral lateral projection in 85 per cent of cases, and the absence of abnormality on the tibial anteroposterior and lateral projections in more than 60 per cent of cases. X-ray study of polyethylene wear was conducted on 49 cases: polyethylene wear was observed radiologically in 1 of 4 cases. There was no correlation between polyethylene wear and polyethylene thickness, postoperative axes, body weight or clinical results. 8 patients had to be reoperated due to mechanical complications: 2 because of a tilting tibial plateau (due to a technical fault), 4 because of polyethylene wear and 2 because of patellar loosening (uncemented metal-back patellar implant). DISCUSSION: The implantation of femoral and tibial components of cementless PCA Primary fitted seems very satisfactory. With longer follow-up, we noted no tibial or femoral osteolysis signs such as those described by Engh, Peters or Berry in the USA. Stability of mid term radiographical results was commonly observed throughout our study. Only 5 very slight lateral displacements were noted: 3 cases of secondary LCP insufficiency with tibial posterior subluxation; in 2 cases the cause was R.A. CONCLUSION: The implantation of uncemented PCA Primary prosthesis caused non complications with respect to the femur. Regarding the tibia, only two reoperations were required because of tibial fixation failure due to a technical fault. The use of a hybrid prosthesis is not required. The microbeads used in PCA are effective but current availability of other materials promoting better bone growth (such as hydroxyapatite, titanium mesh) allows safe implantation of uncemented prostheses. PCA Primary polyethylene wear seems to develop steadily. This is why it should be replaced by the less |