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PMID	Title	PublicationDate	abstract
403921	Azathioprine in early rheumatoid arthritis. Comparison with gold and chloroquine.	1977 Mar	This study compares the effect of azathioprine with those of gold and chloroquine in early (Class II) rheumatoid arthritis (RA). Thirty-three similar patients with classic or definite RA of less than 5 years duration were randomly entered, 11 into each drug group. Assessment of standard clinical and laboratory measures at 12 and 24 weeks showed significant improvement in all three groups. In general, all three drugs were effective antirheumatic agents with low toxicity. However, because of serious potential toxicity, azathioprine could not be recommended over gold and chloroquine in early RA therapy.
6864680	Avascular necrosis of bone with rheumatoid vasculitis.	1983 Apr	A 76-year-old woman with classical rheumatoid arthritis presented with a left groin mass associated with radiologic erosion of the adjacent bony public ramus. The hip joint was not involved. Computerized tomography showed an encapsulated cyst of the pubic ramus that was surgically excised and measured about 6 x 8 cm. Histologic examination of the cystic mass and adjacent bone showed marked avascular necrosis, surrounded by an acute necrotizing vasculitis with fibrinoid necrosis. We postulate that, in this case, rheumatoid vasculitis caused an avascular necrosis of the pubic ramus.
6787722	Gold therapy in rheumatoid arthritis.	1981 Jun 27	During the period 1971-1979, 114 patients with rheumatoid arthritis attending the arthritis clinics at Groote Schuur Hospital and Princess Alice Orthopaedic Hospital were treated with gold sodium aurothiomalate (Myocrisin). Data obtained from 104 completed protocols showed that 70 patients (67,3%) benefited from chrysotherapy. Forty of these patients went into complete remission. Therapy was discontinued in 58 patients, side-effects accounting for this in 33 cases (31,8%). Adverse reactions included skin rashes in 41 (39%) and renal complications in 16 (14%); 7 (6%) developed haematological complications, which resulted in death in 2 cases. HLA tissue typing in 37 patients with side-effects showed no increase in the HLA Dw2 or HLA Dw3 antigen. There was, however, a significant increase in the HLA DRw4 antigen in both Whites and Coloureds (P less than or equal to 0,008 and P less than or equal to 0,001 respectively).
444314	Increased antibody-dependent cell-mediated cytotoxicity by monocytes from patients with rh	1979 May	Antibody-dependent cell-mediated cytotoxicity (ADCC) was studied in adult patients with rheumatoid arthritis (RA) and in healthy controls. Three effector cell populations from the peripheral blood were studied which included a mixed mononuclear population, a monocyte-depleted fraction, and a monocyte-enriched fraction. The monocyte-enriched fraction from patients with RA mediated a significantly increased degree of cytotoxicity. Enhanced cytotoxicity was more evident at low effector : target ratios. There was no significant difference in ADCC activity between patient cells and control cells when either the mixed mononuclear population or monocyte-depleted population was studied as effectors. The enhanced effector function of the peripheral blood monocyte in this system may be further indication that mononuclear phagocytes are "activated" in patients with RA.
6508514	Clinical observations on Blauth's total endoprosthesis of the knee joint.	1984	This article reports on 207 implantations of the Blauth hinged endoprosthesis of the knee joint. Follow-up was possible in 188 (91%) of the implanted cases. The results could be clearly evaluated with a comparison between the time before and after operation, by means of a four-point system. They were very good in 85% and good in 11% of the cases, with an average follow-up period of 33 months, maximum longer than 8 years. The rheumatoid patients showed somewhat better results than those with osteoarthrosis. One of the main features of the success of the implanation in our follow-up patients was the relief from pain. To date, neither aseptic loosening nor fracture of prosthesis has been observed. The follow-up results, based on clinical aspects and constructional characteristics of the model during an observation period as long as 8 years, were encouraging. There was convincing evidence that because of the efficiency and predominance of the Blauth endoprosthesis no modification of the model was needed for further implantations. Technical complications could be prevented by careful manipulation. However, infection was still the most serious complication, affecting predominantly rheumatoid arthritis patients [6]. It always caused troublesome problems in management and jeopardized the success of the arthroplasty. The patella syndrome was another postoperative problem, though it was less serious than infection.
6512792	Eosinophilia in rheumatoid patients treated with D-penicillamine.	1984 Oct	The prevalence of eosinophilia in 66 patients with rheumatoid arthritis receiving D-penicillamine was determined in a retrospective study. Eosinophilia occurred in 24%. The simultaneous occurrence of toxicity and eosinophilia occurred in 3%. In contrast, eosinophilia only occurred in 10% of those with suspected toxicity. The value of eosinophilia as a marker of toxicity is discussed.
1139830	Resection of the forefoot in rheumatoid arthritis.	1975 May	A long-term review of 272 resections of the metatarsal heads and bases of the phalanges in 128 patients with severe rheumatoid feet is presented. The longest follow-up is 11 years and the average follow-up was 4.7 years. Recurrent deformity and callus formation was usually due to a long metatarsal shaft. The operation, when properly performed, can correct severe deformities of the forefoot with a high percentage of satisfactory results.
819936	Arthritogenicity in rats of cell walls from several streptococci staphylococci and two oth	1976 Jun	Bacterial cell walls from Str. bovis, Str. lactis, Str. mutans, Str. thermophilus, Str. salivarius, and Str. pyogenes were able to produce polyarthritis in rats but Str. faecalis cell walls were nonarthritogenic. S. aureus cell walls produced extremely severe disease. It was also shown that cell walls from S. epidermidis, B. megaterium, and M. lysodeikticus were nonarthritogenic. A close correlation was observed between development of arthritis and the delayed hypersensitivity to bacterial peptidoglycans but not with the PPD hypersensitivity. It was suggested that the adjuvanticity of bacterial cell walls is needed to induce the disease and that arthritogenicity requires a specific antigen in addition to the presence of an adjuvant-inducing agent.
6709715	Ankle and subtalar motion during gait in arthritic patients.	1984 Apr	The purposes of this study were 1) to document ankle and subtalar motion during gait in 20 healthy subjects and in 25 patients with rheumatoid arthritis (RA) and 2) to determine stride characteristics with and without the use of an extended University of California Biomechanics Laboratory orthosis in RA patients with painful ankle and hindfoot deformity. An insole foot-switch system and ankle and subtalar electrogoniometers measured stride characteristics and dynamic range of motion (ROM). Arthritic patients demonstrated less ROM than healthy subjects except for ROM of hindfoot valgus. Arthritic patients also had slower gait velocity and less single limb support (SLS) time. In five new and five current orthotic wearers, a significant increase (p less than .01) in velocity and SLS time occurred with shoes and a further significant increase (p less than .01) occurred with the orthosis. Nine of 10 patients reported a decrease in ankle and hindfoot pain after using the orthosis. This study demonstrates the value of an orthosis for the treatment of arthritic patients with ankle and hindfoot pain and deformity.
500756	Late failure of the Manchester prosthesis. Its relationship to the disease process.	1979 Nov	The results of thirty-one Manchester knee arthroplasties performed on twenty-eight patients are reviewed. There were sixteen patients with rheumatoid arthritis all of whom were satisfactory at the time of follow-up. Of the fifteen patients with osteoarthritis over half the arthroplasties failed after between twelve and thirty-six months. We suggest that resurfacing arthroplasty of the knee using the Manchester prosthesis should be used only for rheumatoid patients.
6678700	Relationship between local and total bone mineral in patients with rheumatoid arthritis an	1983 Sep	Total body bone mineral (TBBM) measured by dual photon absorptiometry and local bone mineral (BMC) measured by single photon absorptiometry were determined in 55 patients with definite or classical rheumatoid arthritis. All of them had been on a steady dose of anti-inflammatory drugs for at least 12 months, and furthermore, 13 patients were on glucocorticoids. The results were compared with 49 normal persons matched for sex, age and menopausal state. A highly significant correlation was found between BMC and TBBM in the patients (r = 0.84, SEE = 13.0%) as well as in the controls (r = 0.77, SEE 10.5%). Moreover, the intercepts and the slopes were virtually of the same order. Subdividing the patients according to glucocorticoid treatment the same high correlations were shown in the two subgroups. As a group the patients on glucocorticoids had a highly significant generalized osteopenia (a reduction of TBBM of 26% compared to normals). The patients on other anti-inflammatory drugs had a significant, but less pronounced generalized osteopenia (a reduction of TBBM by 11% compared to normals). It is concluded, that BMC of the forearm can be used as a valid estimate of total body calcium in groups of patients with rheumatoid arthritis and in normal subjects.
7020612	Azathioprine in rheumatoid arthritis: double-blind study of full versus half doses versus	1981 Aug	To test whether azathioprine in effective in rheumatoid arthritis in doses smaller than those normally used the drug was tested at 2 dosage levels, 2.5 and 1.25 mg/kg/day (2.5 AZ and 1.25 AZ), against placebo under double-blind conditions over 24 weeks. Dropouts were 7 out of 15 in the 2.5 AZ group, 4 out of 14 in the 1.25 AZ group, and 2 out of 13 in the placebo group. Some significant improvement occurred in all 3 groups, including those on placebo. However, the 2.5 AZ group fared significantly better than the placebo group, while the 1.25 AZ group results tended to fall between the other 2 groups. We conclude that, in order to obtain the reported effectiveness of azathioprine in rheumatoid arthritis, it is necessary to start treatment with 2.5 mg/kg/day. Halving this dosage reduces the effectiveness of the drug.
6225437	Second course gold therapy in the treatment of rheumatoid arthritis.	1983 Sep	Twenty-three rheumatoid arthritis patients who had previously received gold therapy were selected for second course gold. Eleven patients had developed complete remission during the first course of gold therapy. Four of these had a complete response to second course gold. Of the 10 nonresponders and 2 partial responders to first course gold, none responded to second course gold. We conclude that individuals in whom first course gold is unsuccessful respond poorly to repeated gold treatments. In addition, only 36% of the patients who initially had a complete response sustained complete remission with second course gold.
4549610	Future cooperation in the field of rheumatoid arthritis and related diseases.	1974	This Memorandum discusses two areas of research into rheumatic disease in which it is considered international cooperation would be valuable. These are: (a) standardization and cooperative evaluation of immunological tests used in diagnosis, clinico-pathological assessment, and epidemiological work; and (b) standardization and cooperative assessment of criteria for application to disease classification, evaluation of therapeutic agents, epidemiological studies, and public health programmes.
7060824	Triamcinolone hexacetonide in the treatment of therapy-refractory gonitis.	1982	Thirty-seven patients suffering from sustained gonitis with recurrent hydrops, not satisfactorily controlled by systemic treatment, participated in the study. Twenty-three patients had bilateral and fourteen patients had unilateral gonitis. controls were obtained through the use of the contra-lateral knee joint in the twenty-three patients with bilateral gonitis. A total of 60 knees were randomized into three groups of 20 knees and received either 30 mg triamcinolone hexacetonide (TH), 60 mg methylprednisolone (MP) or 9 mg betamethasone (BM). The clinical parameters evaluated were: recurrence of hydrops, pain, local tenderness, range of joint movement and joint circumference. The period of time elapsing between the injection and the need for a new injection or other treatment was used as the criterion for the duration of effect. Relief lasting for an average of 176 days was obtained in the 20 knees treated with local injections of TH, compared to 125 days for MP and 79 days for BM. No general or local adverse effects were noted in the patients studied. The observed long duration of effect and the absence of adverse effects justify the use of TH in cases of therapy-refractory gonitis.
7183658	The Marmor knee prosthesis: long term results in 135 cases.	1982 Dec	The authors report the results of clinical and radiological follow up examinations carried out between six months and four years after the insertion of Marmor knee prostheses in 135 patients (ninety-three with rheumatoid arthritis and forty-two with osteoarthrosis) operated on at the Orthopaedic Clinic of the University of Uppsala between 1975 and 1979. The results were very good and the few complications that arose were easily resolved. The authors have therefore adopted the Marmor prosthesis for routine use. The only valid alternative to this type of prosthesis is the spherocentric prosthesis, which was applied after failures with the Marmor or other types of prosthesis, in cases involving varus or valgus deformity exceeding 30 degrees, and in cases of severe bone destruction.
959047	Prognostication of the results of immunosuppressive treatment by means of logical dendrite	1976 Apr	A logical dendrite was designed for establishing indications for immunosupressive treatment; it was applied in a group of 51 patients with rheumatoid arthritis. A nomogram was constructed for calculation of the expected therapeutic result, on the grounds of the indications, proposed duration of treatment and drug dosage. Comparison of the calculated and actual clinical results of treatment showed that in over 80% of cases the actual results were either consistent with or better than the expected ones. The application of prognostication seems to be particularly useful in the case of long-term treatment with highly toxic agents.
6867590	[Echopolycardiography in the detection of cardiac lesions in rheumatoid polyarthritis].	1983 Mar	In order to verify the extent and the frequency of cardiac complications in rheumatoid arthritis (RA), the authors performed mechanophonocardiographic studies and simultaneous mono- and bi-dimensional echocardiography in 28 patients with RA, 2 men and 26 women aged between 38 and 65 (mean = 51) (history of the disease ranging from 1 to 37 years). One case showed an increase in the PEP:LVET ratio on the polycardiogram and 18 cases showed echocardiographic alterations (64.3%), in particular: pericardial effusion in 6 cases (21.4%), thickening of the epicardium and the pericardium in 4 cases (14.3%), alterations in the mitral valve (reduction in the protodiastolic closing velocity of the anterior edge of the large mitral valve) in 10 cases (35.7%) and thickening of the interventricular septum in 5 cases (17.9%). These examinations are therefore good indicators of the cardiac complications of rheumatoid disease and allow a group of patients to be identified who would not otherwise be detectable. These patients can be followed up subsequently, in the light of the positive correlation between echocardiographic alterations and the duration and severity of the disease. The authors conclude that simultaneous mono-and bi-dimensional echocardiography represents the optimal investigation for defining the nature, the severity and the frequency of rheumatoid cardiac abnormalities.
114653	Effect of gold salts on adherent mononuclear cells in tissue culture.	1979	Adherent mononuclear cells from normals and patients with rheumatoid arthritis (RA) were isolated and effects of gold salts on cell cultures assessed in vitro. Phagocytic function of adherent mononuclear cells was assessed by the injestion of opsonized chicken red blood cells. Absolute numbers of phagocytic cells were higher in the RA patients than normals. Gold salts in concentrations 0.5-5.0 microgram/ml significantly reduced the numbers of both adherent and phagocytic cells when compared to control cultures. This suppression was particularily marked in the RA patients and was dose and time dependent. However, mononuclear cells surviving incubation with gold salts appeared to maintain phagocytic function in similar proportions to control cultures.
632551	An apparatus to assess function of the hand.	1978 Mar	An apparatus was developed to study the movement, strength, and manipulative ability of the hand. To obtain normal values, measurements were made on 80 women and 65 men between the ages of 17 and 70 years. As a comparison, 30 female patients with severe rheumatoid arthritis were studied. There was little difference in the motion between men and women and among the different age groups. In pinch strength men were 40 percent stronger than women, but in grip strength men were twice as strong. In manipulative ability, there was a decline with age. The arthritic patients were compromised severly in both active motion and strength. In the latter they were between one third and one tenth of normal. Manipulative ability was one half of normal. A measurement system, such as described, could be used for the evaluation of results of various operative procedures.