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ID PMID Title PublicationDate abstract
9448191 Gastrointestinal infarction as a manifestation of rheumatoid vasculitis. 1998 Jan We report a case of combined small and large intestinal infarction caused by rheumatoid vasculitis in a 60-yr-old man who had a long history of rheumatoid arthritis and presented with abdominal pain and constipation. Eventually, he developed signs of peritonitis and underwent exploratory laparotomy and was found to have sigmoid and ileal infarction secondary to rheumatoid vasculitis.
9268788 Safety and efficacy of bilateral total knee arthroplasty. 1997 Aug Recent studies have reported increased morbidity associated with bilateral simultaneous total knee arthroplasty (TKA). The purpose of this study was to evaluate the morbidity and clinical outcome associated with simultaneous bilateral TKA in contrast to unilateral TKA. All primary TKAs, either unilateral or simultaneous bilateral, performed between May 1988 and July 1993 were retrospectively reviewed. Patients were evaluated using Knee Society scores both before surgery and a minimum of 6 months after surgery. In addition to routine demographics, patients were evaluated for the incidence of both local wound and systemic complications. It is concluded that performing simultaneous bilateral TKA does not result in any significant increase in patient morbidity or compromise in postoperative function when compared with unilateral TKA.
11555626 High resolution linkage and association mapping identifies a novel rheumatoid arthritis su 2001 Sep 1 Rheumatoid arthritis (RA) is an oligogenic autoimmune disease but, to date, linkage and association to major histocompatibility complex (MHC) has been the only consistent finding in genetic studies. However, MHC is estimated to contribute only 30-40% of the total genetic component to disease susceptibility. Studies in animal models of inflammatory arthritis have identified a number of putative vulnerability loci but the homologous regions in the human genome have not previously been investigated as candidate RA susceptibility loci. We have investigated linkage to five regions homologous to those identified in animal models of inflammatory arthritis in RA affected sibling pair (ASP) families. Linkage to 17q22 syntenic to a susceptibility locus common to two experimental rat models was detected in 200 RA ASP families and replicated in a further 100 RA ASP families. Linkage to additional markers mapping to the area has refined the extent of linkage to a 4 cM region. Association to one of the markers (D17S807) was demonstrated in this cohort using extensions of the transmission disequilibrium test. Association to two 2-marker haplotypes including this marker was detected in an independent cohort of single-case RA families, thus narrowing the region harbouring the aetiological mutation to approximately 1 cM. This is the first time that an arthritis susceptibility locus mapped in experimental animal models of disease has been used to identify a novel RA susceptibility locus in humans. The difficult task of identifying a disease mutation from a linkage result should, in this case at least, be facilitated by the combined use of animal and human based investigations.
10722830 Ulnar nerve function following total elbow arthroplasty: a prospective study comparing pre 2000 Mar A study was conducted to determine the incidence of ulnar and peripheral neuropathy in patients with rheumatoid arthritis undergoing total elbow arthroplasty and the effect it has on ulnar nerve function after surgery. Preoperative and postoperative clinical and electrodiagnostic examinations were completed in 10 patients. Before surgery 4 patients had clinical and electrophysiologic evidence of a neuropathy (2 each with a peripheral neuropathy and an ulnar neuropathy). One patient had subclinical evidence of a chronic T-1 radiculopathy. After surgery 2 patients showed neurologic improvement (1 had ulnar neuropathy and 1 had diabetic neuropathy). One patient who had normal test results before surgery developed transient ulnar sensory symptoms after surgery. An electrodiagnostic study confirmed an ulnar neuropathy that was not detected on physical examination; the electrodiagnostic findings improved 4 months later. We found that a large percentage of patients (40%) with rheumatoid arthritis had evidence of ulnar or peripheral neuropathy before surgery. The presence of an ulnar or peripheral neuropathy did not predispose patients to develop postoperative ulnar nerve dysfunction either clinically or electrophysiologically. Preoperative and postoperative physical and electrodiagnostic examination results correlated in 9 of the 10 patients.
10752910 New medications for use in patients with rheumatoid arthritis. 2000 Mar INTRODUCTION: Several new medications have become available to physicians for the treatment of patients with rheumatoid arthritis (RA). LEARNING OBJECTIVES: To familiarize the reader with these new medications, including their benefits and side effects. DATA SOURCES: Data sources include published articles regarding the use of these medications. Study selection includes available information obtained from an online literature search (Mayo Search) regarding these agents, with additional information from the manufactures and our pharmacy. CONCLUSION: The results of this review indicate that leftunomide (Arava) and etanercept (Enbrel) are useful new agents for treatment of patients with rheumatoid arthritis.
11465706 Role of Notch-1 intracellular domain in activation of rheumatoid synoviocytes. 2001 Jul OBJECTIVE: Notch family proteins are transmembrane receptors that control cell fate and proliferation. Rheumatoid arthritis (RA) is characterized by activation and abnormal proliferation/differentiation of synoviocytes. We examined the expression of Notch-1 and its role in the activation of RA synoviocytes. METHODS: The expression of Notch-1 protein was detected by a specific antibody raised against the Notch-1 intracellular domain. Notch-1 messenger RNA (mRNA) expression in synoviocytes was analyzed by Northern blotting. Notch-1 protein expression was confirmed by Western blotting with anti-Notch-1 antibody. To analyze the role of Notch-1 in synoviocyte proliferation, we examined the effects of antisense Notch-1 oligonucleotides (ODNs) and MW167, a gamma-secretase inhibitor. RESULTS: Notch-1 protein and mRNA were detected in synovium from all study subjects. The nucleus of RA synoviocytes showed strong staining with anti-Notch-1 antibody, whereas there was predominantly cytoplasmic staining of normal and osteoarthritis (OA) synoviocytes. Western blotting showed a distinct approximately 63-kd protein detected by anti-Notch-1 antibody in nuclear extracts from RA synoviocytes, indicating that nuclear staining of RA synovium and synoviocytes is likely to be the result of nuclear localization of Notch-1 intracellular domain (NICD). Furthermore, tumor necrosis factor alpha (TNFalpha) increased NICD nuclear translocation in a dose-dependent manner. Antisense Notch-1 ODNs partially blocked the proliferation of RA synoviocytes and inhibited TNFalpha-induced proliferation in both OA and RA synoviocytes. In addition, gamma-secretase inhibitor, which blocks the production of NICD, also inhibited TNFalpha-induced proliferation of RA synoviocytes. CONCLUSION: Our results demonstrate the expression of Notch-1 in synoviocytes and the presence of Notch-1 fragment in the nuclei of RA synoviocytes and suggest the involvement of Notch-1 signaling in the TNFalpha-induced proliferation of RA synoviocytes.
10080363 Learning from unreliability: the importance of inconsistency in coping dynamics. 1999 Mar The role of response stability in the measurement of coping is examined with a focus on the unique information that can be gleaned from low test retest reliability ('inconsistency'). Data from two studies are presented in which a card sort measure of coping flexibility was used on people with three different chronic diseases and the elderly (n = 219). We begin by testing the hypothesis that the low stability reflects unreliability due to measurement artifacts, such as random error, low ecological validity, long test retest interval, surrogate assistance, or error due to completing the questionnaire in multiple sittings. Our findings suggest that surrogate assistance in completing questionnaires was the only measurement artifact associated with low stability. We then tested the proposition that low stability reflects a genuine behavior pattern (i.e. inconsistency). Hierarchical modeling revealed that measurement artifact accounted for less than one percent of the variance in inconsistency in reported coping behavior and that an additional 21% of the variance could be explained by the behavioral factors, including neuropsychological problems (9%), psychological morbidity (4%), locus of control (3%) and eudaimonistic well-being (5%). Thus inconsistency in reported coping behavior was better explained by behavioral and psychosocial factors than by the tested measurement artifacts. We conclude that inconsistency in reported coping behavior does indeed reflect a meaningful behavior pattern, rather than simply measurement artifact.
9558179 Antibodies to Klebsiella pneumoniae in Dutch patients with ankylosing spondylitis and acut 1998 Apr OBJECTIVE: To determine whether the association between increased humoral reactivity against Klebsiella and HLA-B27 associated diseases could be confirmed in Dutch patients with ankylosing spondylitis (AS) and acute anterior uveitis (AAU). METHODS: Under coded conditions sera from Dutch patients with AS, AAU, and rheumatoid arthritis (RA) and from HLA-B27 positive and negative healthy controls were studied for IgA anti-Klebsiella (K54) and IgG anti-Proteus antibodies with the indirect immunofluorescence assay on whole bacteria fixed in suspension with paraformaldehyde. Each group consisted of at least 17 sera. RESULTS: IgA anti-Klebsiella antibody titers were elevated in AS and HLA-B27 negative AAU compared to the HLA-B27 positive and negative controls or patients with active RA (p < 0.001). Furthermore, patients with active RA had elevated levels of IgG antibodies against P. mirabilis compared to every other test or control group (p < 0.001). There was no significant difference between the AS and RA patients in terms of serum C-reactive protein levels, although these were significantly elevated in both compared to healthy controls (p < 0.001), suggesting that the antibody elevations were not due to a nonspecific inflammatory effect. The same sera were blindly tested with negative results by 2 other centers. The discrepancies are probably the result of differences in the methods used. CONCLUSION: Our data support the hypothesis that Klebsiella are involved in the pathogenesis of AS and AAU and that the same might be true for Proteus in RA.
10701683 FK506 augments glucocorticoid-mediated cyclooxygenase-2 down-regulation in human rheumatoi 2000 Feb Prostaglandins (PG) formed by cyclooxygenase (COX) enzymes are important mediators of inflammation in rheumatoid arthritis. The contribution of the inducible COX-2 to inflammation in the rheumatoid synovium is well documented. We examined the regulation of COX-2 mRNA and protein expression in response to both glucocorticoids (GC) and FK506 using rheumatoid synovial fibroblasts. Combined treatment of FK506 and a low concentration of dexamethasone (DEX) (10(-9) M) down-regulated synovial COX-2 mRNA and protein expression. In contrast, neither FK506 nor DEX (10(-9) M) alone influenced COX-2 expression. Immunocytochemical studies showed that pretreatment with FK506 enhanced the nuclear translocation of the glucocorticoid receptor (GR) in synovial fibroblasts in the presence of low concentrations of DEX (10(-9) M). Transient transfection experiments showed that treatment of cells with FK506 enhanced the expression of glucocorticoid-responsive gene reporter in the presence of DEX (10(-9) M). NF-kappaB is known to mediate the transcriptional activation of the COX-2 gene. Electrophoretic mobility shift assay demonstrated that DNA-binding activity of NF-KB was suppressed more profoundly by FK506 plus DEX (10(-9) M) treatment with those of DEX (10(-9)M) alone in IL-1beta-stimulated synovial cells. Our results indicated that FK506-induced potentiation of GR-mediated repression of synovial COX-2 gene transcription is the result of increased translocation of GR to the nucleus and subsequent repression of NF-kappaB transactivation. Our results also suggest that FK506 may exert anti-inflammatory effects in the rheumatoid synovium by potentiating GR-mediated signal transduction.
9840249 Alveolar-interstitial pneumopathy after gold-salts compounds administration, requiring mec 1998 Oct The pulmonary toxicity of gold salts is an uncommon cause of life-threatening respiratory failure. Currently, patients who suffer from this do not need mechanical ventilation, and the toxicity can be difficult to diagnose when it occurs in patient with an illness producing pulmonary manifestations. We report a case of severe respiratory failure due to gold salt toxicity in a patient suffering from rheumatoid arthritis requiring mechanical ventilation. At such a time, the poor respiratory function makes some diagnostic procedures harmful. The diagnosis can be made after the exclusion of other causes of rheumatoid lung when the patient's poor respiratory status precludes invasive exploration. The clinical findings, radiological features, and results of pulmonary function tests may be enough to diagnose gold-related pneumopathy. This avoids the need for bronchoscopic examination or transfer of the patient for computed tomography. Attention must be paid to this complication because the outcome and functional prognosis are better when pulmonary involvement is gold related: in our case steroid therapy was life-saving and induced complete recovery of the lung damage.
10653104 The kinematic total knee arthroplasty. A 10- to 15-year follow-up and survival analysis. 2000 In 86 patients 102 consecutive cemented Kinematic total knee arthroplasties were reviewed 10-15 years after surgery to determine the clinical and radiographic results and to assess the survival rate. The average age of the 65 female and 21 male patients at the time of surgery was 63 years. Forty-six knees were affected by rheumatoid arthritis (RA), 46 by osteoarthritis (OA), 7 by haemophilic arthropathy and 3 by osteonecrosis. One patient (1 knee) was lost to follow-up, and 31 patients (38 knees) died. Eleven knees had been revised for deep infection (4), wear (4), malposition (2) or persistent pain (1). Fifty-two knees were examined at an average follow-up period of 12 years. The mean Knee Society Score of 89 points was the same for RA and AO knees. Also, 92% of the knees caused no pain or only occasional mild pain. There were no cases of aseptic loosening of any component. Progressive radiolucent lines were not seen on the follow-up radiographs (43 knees, mean follow-up 12 years) The 10- and 14-year survival rates with revision as the end-point were 90% (confidence interval, CI: 81%-95%) and 82% (CI: 67%-92%), respectively. In the worst case scenario, with knees lost to follow-up and knees with moderate pain considered as failures, the 10- and 14-year survival rates were 80% (CI: 69%-88%) and 62% (CI: 46%-77%), respectively. The Kinematic total knee arthroplasty yields equally good long-term results in patients with RA and those with OA. Deep infection and wear were the main reasons for revision.
9726313 Intraoperative flexion against gravity as an indication of ultimate range of motion in ind 1998 Aug To assess a method of predicting the final postoperative flexion in individual cases after total knee arthroplasty, 364 primary posterior cruciate-retaining total knee arthroplasties were reviewed retrospectively. The knees were subdivided into three preoperative flexion groups--I: poor motion (0 degrees to 85 degrees), II: intermediate motion (90 degrees to 110 degrees), and III: good motion (115 degrees to 140 degrees). There were 302 cases of osteoarthritis and 62 rheumatoid knees (12 juvenile rheumatoid). Correlation was made between preoperative; intraoperative, and postoperative (minimum 2-year follow-up) passive knee flexion for individuals. Intraoperative flexion against gravity was measured after capsular closure by passively flexing the patient's hip 90 degrees and allowing the weight of the lower leg to flex the knee joint. The overall mean value of postoperative flexion for all three groups was similar to preoperative and intraoperative flexion in both osteoarthritis and rheumatoid arthritis. In the poor motion group (I), postoperative flexion (103 degrees) was increased over preoperative flexion (84 degrees) but similar to intraoperative flexion (104 degrees). In the intermediate group (II), postoperative flexion (110 degrees) was similar to both the preoperative flexion (108 degrees) and intraoperative flexion (110 degrees). In the good group (III), postoperative flexion (119 degrees) tended to be less than preoperative flexion (123 degrees) and more than intraoperative flexion (116 degrees), but the differences were not statistically significant. When comparing preoperative and intraoperative flexion to postoperative flexion for individual cases, 55% of knees had postoperative flexion +/-10 degrees of their preoperative value, while 97% of knees had postoperative flexion +/-10 degrees of their intraoperative value. This study indicates that the final postoperative mean flexion for a group of patients with poor preoperative flexion (<85 degrees) and for individual cases (regardless of their preoperative mobility) can best be predicted by intraoperative flexion against gravity rather than by a preoperative value.
11224734 Epidemiology and impact of rheumatic disorders in the United States Hispanic population. 2001 Mar The emergence of a sizable Hispanic population in the US is a relatively recent historical phenomenon, and thus much is still unknown about this group of North Americans. Data from national surveys suggest small differences between Hispanic and non-Hispanic white populations in the age-adjusted prevalence of self-reported arthritic conditions. However, the rate of activity-limitation attributable to arthritis is higher among Hispanic patients. This likely reflects the poorer socioeconomic conditions and lack of health insurance that prevail among Hispanic populations, which may limit their access to rheumatologic care. Osteoporotic vertebral and hip fractures are less frequent, and proximal femoral mineral density is higher, in Hispanic individuals than in non-Hispanic white individuals. The mechanisms for these observations are currently under investigation. There have been no studies of the prevalence of osteoarthritis, rheumatoid arthritis, or systemic lupus erythematosus among Hispanic populations. However, important immunogenetic, clinical, and psychosocial differences between Hispanic and non-Hispanic patients in regard to rheumatoid arthritis and systemic lupus erythematosus have been reported. There is no published information on the prevalence or characteristics of other rheumatic diseases in the US Hispanic population. Emerging evidence suggests considerable underuse of certain health services for arthritis among Hispanic patients, likely due in part to socioeconomic factors. Further research is needed to determine whether biologic, cultural or psychosocial factors contribute to underuse as well. There is clearly a need for data on the prevalence and characteristics of arthritis and other rheumatic and musculoskeletal diseases in this emerging US population.
9779302 Experimentally induced stress in rheumatoid arthritis of recent onset: effects on peripher 1998 Sep OBJECTIVE: To examine the effects of experimentally-induced stress on the mobilization of peripheral blood lymphocytes (PBL) in patients with rheumatoid arthritis (RA) of recent onset. METHODS: Twenty-two (16 F, 6 M) patients (mean age 57.6 yrs.) and 23 (15 F, 8 M) healthy subjects (mean age 54.7 yrs.) were subjected to experimental stressors. The numbers of T-cells, B-cells, and NK-cells were determined before and after the completion of tasks inducing physical and mental effort. RESULTS: The change in PBL in response to stress was about equal for patients and healthy subjects (p > 0.75 in all PBL subsets). In patients as well as in healthy subjects, the correlations between PBL and cortisol changes in response to stress tended to be positive, while the correlations between PBL and cardiovascular changes were positive in healthy subjects, but zero or negative in patients. Moderate to high (0.32 < or = r < or = 0.55) correlations between PBL changes and pain were observed. CONCLUSION: Experimentally-induced changes in PBL (as well as cortisol) are normal in patients with early RA who are receiving long term medication, but correlations between these changes and autonomic nervous system responses are zero or negative. This apparent shift in the control of the change in PBL in response to stress is observed in particular in patients with more pain. The pathophysiological significance of these findings should be clarified in longitudinal studies.
11350843 Analysis of the cell infiltrate and expression of matrix metalloproteinases and granzyme B 2001 Jun OBJECTIVES: Examination of synovial tissue (ST) obtained at surgery because of end stage destructive rheumatoid arthritis (RA) showed that macrophages and fibroblasts are the major cell types at the cartilage-pannus junction (CPJ). This study aimed at defining the cell infiltrate and mediators of joint destruction in ST selected at arthroscopy from the CPJ in patients with RA who did not require joint surgery. METHODS: Paired synovial biopsy specimens were obtained at arthroscopy from ST adjacent to the CPJ and the suprapatellar pouch from the knee joints of 17 patients with RA. Immunohistological analysis was performed using monoclonal antibodies to detect T cells, B cells, plasma cells, macrophages, fibroblast-like synoviocytes, mast cells, and granzyme B+ cytotoxic cells as well as the expression of metalloproteinase (MMP)-1, MMP-3, and MMP-13. The sections were evaluated by computer assisted image analysis and semiquantitative analysis. RESULTS: The cell infiltrate comprised mainly T cells, macrophages, and plasma cells. The ST was also infiltrated by the other cell types, but at lower numbers. Expression of MMPs was abundant, especially MMP-3. The features of ST at the CPJ were generally similar to those at the suprapatellar pouch. CONCLUSIONS: The synovium at the CPJ in patients with RA who did not require joint surgery exhibits, in general, the same type of cell infiltrate and expression of MMPs and granzymes as ST from the suprapatellar pouch. The pathological changes that have been described at the CPJ in patients with RA with end stage, destructive disease may well reflect the transition to a process in which macrophages, fibroblast-like synoviocytes, and other cell types become increasingly important.
10357121 Efficacy and safety of a combination therapy of methotrexate, chloroquine and cyclophospha 1999 The efficacy and safety of a combination of methotrexate (MTX), chloroquine (CQ) and cyclophosphamide (CYC) were studied in patients with refractory rheumatoid arthritis. A single-centre, matched-pair observational study with prospectively gathered data was performed. Fifty-six patients who had previously failed with MTX were treated with 15 mg MTX per week, 50 mg CYC three times a week and 250 mg CQ per day (group A). A 50% improvement of the swollen joint count was required to continue therapy. Data were compared with the results of the previous MTX therapy in the same group and with a matched-patient cohort receiving MTX monotherapy for the first time (group B). In group A, the combination therapy resulted in a significant decline of the swollen joint count after 1 year, in contrast to the previous MTX monotherapy in the same group. Complete remission of joint swelling was achieved in 13 patients (23%), compared with 26 patients in group B (47%). The median duration of effective combination treatment in group A was significantly longer than preceding therapies with MTX alone (19 vs 13 months, p<0.05). However, patients in group B could be treated for a median of 57.5 months (p<0.0001 compared with group A). Side-effects were comparable in both groups. The applied DMARD combination is safe and beneficial in a significant proportion of patients if MTX monotherapy is ineffective.
10453676 Treatment of a patient with severe osteoporosis and chronic polyarthritis with fixed impla 1999 Jul This article reports the treatment and 5-year follow-up of an 80-year-old female with a history of severe osteoporosis and chronic polyarthritis. Treatment included methotrixate disodium and acemetacin. After the last tooth was removed from the mandible, the patient was successfully treated with a fixed mandibular prosthesis supported by 6 implants placed between the mental foramina. The implants have remained osseointegrated, and peri-implant smears have been negative for bacterial colonization. Radiographic follow-up examination has revealed bone loss that is slightly greater than expected. This article focuses on the placement of implants in a patient receiving medication for chronic polyarthritis and osteoporosis.
10232419 High pleural fluid hyaluronan concentrations in rheumatoid arthritis. 1999 Mar Previous studies have shown that high pleural fluid (Pf) hyaluronan (HYA) concentrations may be due not only to malignant mesothelioma but also to inflammatory diseases. The objective of this study was to evaluate Pf-HYA in various nonmalignant inflammatory pleural disorders. A radiometric assay was used to determine HYA in Pf and serum (S) of 126 patients, 12 of whom had rheumatoid arthritis (RA), 22 tuberculosis, 22 pneumonia, 41 lung cancer, 10 malignant mesothelioma and 19 congestive heart failure. Pf-HYA values were correlated with values for Pf-tumour necrosis factor (TNF)-alpha and Pf-interleukin (IL)-1beta, as determined by radioimmunoassay. The highest median Pf-HYA (125.6 mg x L(-1), range 0.04-386.5 mg x L(-1)) occurred in patients with malignant mesothelioma. Among patients with nonmalignant inflammatory diseases, significantly higher median Pf-HYA were observed in those with rheumatoid arthritis (64.2 mg x L(-1), range 25.8-106.9 mg x L(-1)) than in those with tuberculosis (25.5 mg x L(-1), range 14.9-57.1 mg x L(-1), p<0.0005) or pneumonia (20.9 mg x L(-1), range 9.5-129.4 mg x L(-1), p<0.005). There was no correlation between Pf-HYA and S-HYA. Pf-HYA correlated positively with Pf-TNF-alpha (r=0.62) and Pf-IL-1beta (r=0.52). High pleural fluid hyaluronan occurs not only in malignant mesothelioma, but also in certain nonmalignant inflammatory diseases, especially rheumatoid arthritis. One explanation for the increase in pleural fluid hyaluronan may be local production of proinflammatory cytokines, such as tumour necrosis factor-alpha and interleukin-1beta.
11192489 Efficacy of sulphasalazine plus methotrexate in rheumatoid arthritis. 2000 Apr Early intervention with slow acting anti-rheumatic drugs (SAARDs) has led to improvement in substantial proportion of rheumatoid arthritis (RA) patients. The present open, controlled study was designed to assess whether a combination of SAARDs offer any added benefit. Fifty-four adult RA patients were randomly allocated to methotrexate (MTX) (n = 27) and MTX plus sulphasalazine (SSZ) (n = 27) groups. The subjects were followed-up fortnightly for four weeks then monthly for six months. The disease activity was assessed with the help of 10 clinical and four laboratory indices. The improvement was graded as: minor, mild decreases in indices, non-steroidal anti-inflammatory drugs (NSAIDs) continued, physician's global assessment (PGA) decreased by one; marked, acceptable decreases in indices, NSAIDs being taken sparingly, PGA decreased by at least 2, and complete, all indices normalised and patients discontinued NSAIDs completely. The improvement was considered clinically important when marked or complete improvement occurred. Adverse drug reactions resulted in withdrawal of 4 subjects from the MTX + SSZ group and 1 from the control groups. Four and three subjects in the combined and MTX groups respectively were lost to follow-up. Subjects in both groups showed significant decline in all indices except hemoglobin and neutrophil count. The differences between the two groups in the pre-treatment and post-treatment values were insignificant. Complete, marked, minor and no improvement occurred in 4 (21%), 12 (63%), 3 (16%) & 0 in the MTX and in 11 (48%), 7 (30%), 4 (17%) & 1 (4%) in MTX + SSZ groups respectively. The differences in the rates of complete and clinically important improvement between the two groups were insignificant (P 0.1398 and 0.7092). The incidence of side effects was insignificantly higher in the MTX + SSZ group. Most of them were mild and transient. The combination of SAARDs offered little added advantage in RA. However, the higher rate of complete improvement in the combination group justifies trials including larger samples.
9613342 The diagnostic value of perivascular infiltrates in muscle biopsy specimens for the assess 1998 Feb OBJECTIVE: To determine the diagnostic value of perivascular infiltrates (PVI) in randomly obtained muscle biopsy specimens for the assessment of rheumatoid vasculitis (RV). METHODS: The number and size of PVIs, defined as the presence of mononuclear or polymorphonuclear cells around > or = 50% of the circumference of a vessel wall, as well as the presence of fibrinoid necrosis were determined in frozen sections of muscle samples of RV patients with histologically confirmed vasculitis in fixed muscle tissue (n = 12). The findings were compared with those observed in frozen sections of muscle biopsy specimens of rheumatoid arthritis (RA) patients not suspected of vasculitis (n = 14) and patients with osteoarthritis (OA) (n = 11). The presence of PVIs and of fibrinoid necrosis were sought in four frozen sections of the muscle biopsy specimen. RESULTS: PVIs were observed in 75% of the RV patients, which was significantly (p < 0.05) higher than the frequency found in RA (14%) or OA (18%) patients. PVIs with > or = three cell layers were found in 67% of the RV patients and in none of the RA and OA patients (p < 0.05). Fibrinoid necrosis was found in least one of four frozen section in 33% of the RV patients. There was a good intra-observer and inter-observer concordance on the presence of fibrinoid necrosis and of PVIs with > or = three cell layers. CONCLUSIONS: The assessment of PVIs with > or = three cell layers in a muscle biopsy specimen is a specific and reliable test in discriminating RV from RA without vasculitis. The demonstration in muscle of PVIs with > or = three cell layers is more sensitive than that of fibrinoid necrosis in the diagnosis of RV.