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ID PMID Title PublicationDate abstract
10873181 The stress response and the hypothalamic-pituitary-adrenal axis: from molecule to melancho 2000 Jun Organisms survive by maintaining equilibrium with their environment. The stress system is critical to this homeostasis. Glucocorticoids modulate the stress response at a molecular level by altering gene expression, transcription, and translation, among other pathways. The effect is the inhibition of the functions of inflammatory cells, predominantly mediated through inhibition of cytokines, such as IL-1, IL-6, and TNF-alpha. The central effectors of the stress response are the corticotrophin-releasing hormone (CRH) and locus coeruleus-norepinephrine (LC-NE)/sympathetic systems. The CRH system activates the stress response and is subject to modulation by cytokines, hormones, and neurotransmitters. Glucocorticoids also modulate the growth, reproductive and thyroid axes. Abnormalities of stress system activation have been shown in inflammatory diseases such as rheumatoid arthritis, as well as behavioural syndromes such as melancholic depression. These disorders are comparable to those seen in rats whose CRH system is genetically abnormal. Thus, the stress response is central to resistance to inflammatory and behavioural syndromes. In this review, we describe the response to stress at molecular, cellular, neuroendocrine and behavioural levels, and discuss the disease processes that result from a dysregulation of this response, as well as recent developments in their treatment.
11405954 Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in 2001 BACKGROUND: The effect of low dose corticosteroids, equivalent to 15 mg prednisolone daily or less, in patients with rheumatoid arthritis has been questioned. We therefore performed a systematic review of trials which compared corticosteroids with placebo or non-steroidal, anti-inflammatory drugs. OBJECTIVES: To determine whether short-term (i.e. as recorded within the first month of therapy), oral low-dose corticosteroids (corresponding to a maximum of 15 mg prednisolone daily) is superior to placebo and nonsteroidal, antiinflammatory drugs in patients with rheumatoid arthritis. SEARCH STRATEGY: Medline Silverplatter, The Cochrane Controlled Trials Register, reference lists and a personal archive. SELECTION CRITERIA: All randomised studies comparing an oral corticosteroid (not exceeding an equivalent of 15 mg prednisolone daily) with placebo or a nonsteroidal, antiinflammatory drug were eligible if they reported clinical outcomes within one month after start of therapy. DATA COLLECTION AND ANALYSIS: Decisions on which trials to include were made independently by two observers based on the methods sections of the trials only. Standardised effect measures were used for the statistical analyses; the random effects model was used if P<0.10 for the test of heterogeneity. MAIN RESULTS: Ten studies, involving 320 patients, were included in the meta-analysis. Prednisolone had a marked effect over placebo on joint tenderness (standardised effect size 1.31, 95% confidence interval 0.78 to 1.83), pain (standardised effect size 1.75, 0.87 to 2.64) and grip strength (standardised effect size 0.41, 0.13 to 0.69). Measured in the original units, the differences were 12 tender joints (6 to 18) and 22 mm Hg (5 to 40) for grip strength. Prednisolone also had a greater effect than nonsteroidal, antiinflammatory drugs on joint tenderness (standardised effect size 0.63, 0.11 to 1.16) and pain (standardised effect size 1.25, 0.26 to 2.24), whereas the difference in grip strength was not significant (standardised effect size 0.31, -0.02 to 0.64). Measured in the original units, the differences were 9 tender joints (5 to 12) and 12 mm Hg (-6 to 31). The risk of adverse effects, also during moderate- and long-term use, seemed acceptable. REVIEWER'S CONCLUSIONS: Prednisolone in low doses (not exceeding 15 mg daily) may be used intermittently in patients with rheumatoid arthritis, particularly if the disease cannot be controlled by other means. Since prednisolone is highly effective, short-term placebo controlled trials studying the clinical effect of low-dose prednisolone or other oral corticosteroids are no longer necessary.
11762933 High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by 2001 Dec OBJECTIVE: To compare the incidence of cardiovascular (CV) events in persons with rheumatoid arthritis (RA) with that in people from the general population, adjusting for traditional CV risk factors. METHODS: Two hundred thirty-six consecutive patients with RA were assessed for the 1-year occurrence of 1) CV-related hospitalizations, including myocardial infarction, stroke or other arterial occlusive events, or arterial revascularization procedures, or 2) CV deaths. Both outcomes were ascertained by medical records or death certificates. For comparison, we used CV events that occurred during an 8-year period among participants in an epidemiologic study of atherosclerosis and CV disease who were ages 25-65 years at study entry. We calculated the age- and sex-stratified incidence rate ratio (IRR) of CV events between the 2 cohorts and used Poisson regression to adjust for age, sex, smoking status, diabetes mellitus, hypercholesterolemia, systolic blood pressure, and body mass index. RESULTS: Of the 236 RA patients, 234 were observed for 252 patient-years, during which 15 CV events occurred. Of these, 7 incident events occurred during the 204 patient-years contributed by patients ages 25-65 years, for an incidence of 3.43 per 100 patient-years. In the comparison cohort, 4,635 community-dwelling persons were followed up for 33,881 person-years, during which 200 new events occurred, for an incidence of 0.59 per 100 person-years. The age- and sex-adjusted IRR of incident CV events associated with RA was 3.96 (95% confidence interval [95% CI] 1.86-8.43). After adjusting for CV risk factors using Poisson regression, the IRR decreased slightly, to 3.17 (95% CI 1.33-6.36). CONCLUSION: The increased incidence of CV events in RA patients is independent of traditional CV risk factors. This suggests that additional mechanisms are responsible for CV disease in RA. Physicians who provide care to individuals with RA should be aware of their increased risk of CV events and implement appropriate diagnostic and therapeutic measures.
9433869 Antiinflammatory and immunoregulatory action of methotrexate in the treatment of rheumatoi 1998 Jan OBJECTIVE: To look for in vitro modulation of the main immunoregulatory and antiinflammatory cytokines by methotrexate (MTX) during the course of rheumatoid arthritis (RA). METHODS: We quantified interleukin-2 (IL-2), IL-4, IL-10, and interferon-gamma (IFNgamma) gene expression by peripheral blood mononuclear cells ex vivo under basal conditions and in vitro after stimulation with phytohemagglutinin (PHA) or PHA plus MTX, by competitive reverse transcriptase-polymerase chain reaction (RT-PCR), in 12 patients with untreated active RA (group 1), 10 patients with MTX-treated disease in partial remission (group 2), and 11 healthy control subjects. Simultaneously, under the same experimental conditions, we quantified cytokine production by specific enzyme-linked immunosorbent assays (ELISAs). RESULTS: Under basal conditions, we found no differences in IL-2, IL-10, and IFNgamma gene expression in the 3 groups, while IL-4 gene expression was significantly decreased in RA patient group 1 compared with the control group. In vitro, under the action of MTX, IL-10 gene expression was significantly increased in the 3 groups, IL-4 gene expression was significantly increased in RA group 1 and in the control group, and IL-2 and IFNgamma gene expression was significantly decreased in RA group 1. Cytokine gene expression assessed by RT-PCR and cytokine production assessed by specific ELISAs were highly correlated. CONCLUSION: In vitro modulation of the cytokine network by MTX, increasing Th2 cytokines and decreasing Th1 cytokines, could explain its antiinflammatory and immunoregulatory actions in vivo during the treatment of RA.
9144020 Co-existence of non-Hodgkin's lymphoma in the leukemic phase and polyarthritis simulating 1997 Mar The patient, a 64-year-old male, complained of morning stiffness, polyarthralgia and bilateral knee joint swelling with leukocytosis (24,200/microliter) in peripheral blood. The leukocyte differentiation revealed 54% medium-size immature lymphocytes. The majority of lymphocytes showed the B-cell characteristics of IgGk monoclonality, and CD19+ and CD20+ in cell surface phenotype, suggesting a B-cell malignancy, non-Hodgkin lymphoma in the leukemic phase. Arthropathy associated with lymphoid malignancy was suspected. However, the infiltrated leukocytes in the synovial fluid of the left knee joint were dominantly neutrophils and CD3+ T-cells, and compatible with the findings in rheumatoid arthritis (RA). The association of B-cell malignancy and RA is not frequently reported. We discuss the common underlying immunological abnormalities in both B-cell malignancy and RA.
11247319 Influence of cyclic intravenous pamidronate on proinflammatory monocytic cytokine profiles 2001 Jan OBJECTIVES: The aim of this work was to evaluate in a randomised double-blind prospective study the effect of pamidronate on intracellular monocytic cytokine profiles (IL-1, IL-6, TNF-alpha) and bone density in rheumatoid arthritis patients. METHODS: Twenty rheumatoid arthritis patients were treated for one year with methotrexate and a low dose of prednisolone. Double blind randomisation was performed for either i.v. pamidronate (at 3-month intervals) or placebo. The effect of pamidronate was evaluated on intracellular cytokine profiles (IL-1, IL-6, TNF-alpha), disease activity and bone mass measurements. The human monocytic cell line THP-1 was used to evaluate in vitro apoptosis by pamidronate. RESULTS: Spontaneous production of interleukin-1 beta by patient blood monocytes was lower in the pamidronate group and was associated with an increase in bone density of the spine after 12 months of therapy. In vitro a dose-related increase in pamidronate induced apoptosis was found in THP-1 cells. CONCLUSIONS: This prospective double-blind randomised study demonstrated that pamidronate therapy resulted in an increase of bone density despite treatment with steroids. This rise is associated with a suppression of interleukin-1 beta production in monocytes of patients treated with pamidronate. Our in vitro experiments suggest that this anti-inflammatory effect could be due to an increase in the apoptosis of monocytic cells.
11370716 Radical scavenging and xanthine oxidase inhibitory activity of phenolic compounds from Bri 2001 May Bridelia ferruginea Benth. (Euphorbiaceae) is a subtropical medicinal plant widely used in traditional African medicine against various diseases, including rheumatic pains. Seven of its constituents (3-O-methylquercetin (1), 3,7,3',4'-tetra-O-methylquercetin (rutisin, 2), myricetin (3), 3',4',5'-tri-O-methylmyricetin (ferrugin, 4), 3,3',4',5'-tetra-O-methylmyricetin (5), quercetin 3-O-glucoside (6), and a biflavanol gallocatechin-[4'-O-7]-epigallocatechin (7)) have been evaluated in-vitro in the xanthine-xanthine oxidase enzymatic system for inhibition of xanthine oxidase and radical scavenging activity. Results indicated that compounds 1, 3, 4 and 6 exhibited, at different levels, xanthine oxidase inhibiting and superoxide scavenging activity at micromolar concentrations, whereas compound 7 showed scavenging activity only. Compounds 2 and 5 were inactive in both cases. Study of the structure-activity relationship demonstrated that for flavonoids the xanthine oxidase inhibitory activity was reduced by methylation of the hydroxyl functionality at C-3 and in rings A and B. These results may partly explain and support the use of B. ferruginea stem bark for the treatment of rheumatic pains in traditional medicine.
9035015 Comparison of the efficacy and safety of etodolac and piroxicam in patients with rheumatoi 1997 Feb The efficacy and safety of etodolac and piroxicam in patients with active rheumatoid arthritis were compared. A 12 week, double blind, parallel group study was conducted at 28 centers in patients 18 to 75 yrs old, randomized to receive etodolac or piroxicam. Primary efficacy criteria were investigators' and patients' global assessments and numbers of painful and swollen joints. Secondary criteria were duration of morning stiffness, grip strength, time to walk 50 feet. Westergren erythrocyte sedimentation rate (ESR), pain intensity, painful and swollen joint scores, and articular index. Of 426 patients enrolled, 140 received etodolac 200 mg bid (E200), 147 received etodolac 300 mg bid (E300), and 139 received piroxicam 20 mg qd (P20). Efficacy analyses included data from 361 patients. No significant differences occurred between the E300 and piroxicam groups in change from baseline for the primary efficacy variables. All treatments produced significant (p < 0.01) improvement from baseline in all efficacy variables, except that only E300 produced a significant decrease from baseline in ESR. No significant differences occurred in the incidence of any specific adverse event. Six patients given E200, 7 given E300, and 10 given piroxicam withdrew because of adverse reactions. The incidence of patients with hemoglobin and hematocrit results below the normal range was significantly higher for piroxicam than for either etodolac regimen. Three patients receiving piroxicam had gastrointestinal ulcers. Thus, E300 and P20 provided comparable efficacy. E200 was less effective for some variables early in the study.
9227163 Serum immunoglobulins and the risk of rheumatoid arthritis. 1997 Jun OBJECTIVE: Rheumatoid arthritis (RA) is associated with several autoantibodies that can precede the clinical disease. The immunoglobulin concentrations in serum samples before illness were studied to learn more about the immunological process before RA. METHODS: A case-control study was nested within a Finnish cohort of 19,072 adults who had neither arthritis nor a history of it at the baseline examination during 1973-1977. By late 1989, 124 had developed RA, of which 89 were positive for rheumatoid factor (RF). Three controls per each incident case were individually matched for sex, age, and municipality. The concentrations of IgG, IgA, and IgM were measured from stored serum samples. RESULTS: Serum IgG before illness was found to be directly proportional to the risk of RF positive RA, and a non-linear association was present between serum IgA and the risk of RF positive RA. These associations were constant between men and women and other subgroups of the study population and not confounded by serum orosomucoid concentration, level of education, smoking, alcohol intake or body mass index. As adjusted for these factors, the odds ratios (95% confidence intervals) of RF positive RA in the lowest, mid, and highest tertiles of IgG distribution were 1.00, 1.55 (0.81, 2.97), and 2.22 (1.16, 4.26), and in the tertiles of IgA 1.00, 2.23 (1.14, 4.36), and 1.78 (0.89, 3.57), respectively. The associations persisted throughout the entire observation period but were most distinct when the period to the onset of clinical RA was > or = 10 years. IgM carried no predictive significance. None of the serum immunoglobulins predicted the development of RF negative RA. CONCLUSIONS: Increased IgG levels may reflect some, at present unknown process in the early events leading to the development of RA, typically occurring > or = 10 years before the onset of clinical disease.
9421490 Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid 1998 Jan 1 Only a few autoantibodies that are more or less specific for RA have been described so far. The rheumatoid factor most often tested for is not very specific for RA, while the more specific antiperinuclear factor for several reasons is not routinely used as a serological parameter. Here we show that autoantibodies reactive with synthetic peptides containing the unusual amino acid citrulline, a posttranslationally modified arginine residue, are specifically present in the sera of RA patients. Using several citrulline-containing peptide variants in ELISA, antibodies could be detected in 76% of RA sera with a specificity of 96%. Sera showed a remarkable variety in the reactivity pattern towards different citrulline-containing peptides. Affinity-purified antibodies were shown to be positive in the immunofluorescence-based antiperinuclear factor test, and in the so-called antikeratin antibody test, and were reactive towards filaggrin extracted from human epidermis. The specific nature of these antibodies and the presence of these antibodies early in disease, even before other disease manifestations occur, are indicative for a possible role of citrulline-containing epitopes in the pathogenesis of RA.
9461144 Synovial fluid cytokines and proteinases as markers of temporomandibular joint disease. 1998 Feb PURPOSE: In this article, biochemical markers in the synovial fluid (SF) for detecting intraarticular inflammation and early cartilage degradation of the temporomandibular joint (TMJ) disease were examined. PATIENTS AND METHODS: SF was obtained from 25 TMJs in 22 patients with internal derangement (ID) or osteoarthritis (TMJ-OA), 15 asymptomatic TMJs in 11 normal volunteers, and 10 osteoarthritic knee joints (KNEE-OA). Cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA), and the proteinase activities were detected by enzymography. RESULTS: SF from TMJs with ID and OA showed higher (P < .05) levels (330.1 +/- 347.7 pg/100 microg SF protein) of IL-1beta than the asymptomatic control TMJs (76.7 +/- 95.3 pg/100 microg of SF protein). SF from TMJs with OA contained significantly (P < .05) higher levels of IL-1beta (531.8 +/- 379.6 pg/100 microg of SF protein) and IL-6 (979 +/- 552 pg/100 microg SF protein) than those with ID (IL-1beta: 216.7 +/- 280.1 pg, IL-6: 293 +/- 434 pg). Two matrix metalloproteinases (MMPs) with gelatinolytic activities at 92 kDa and 72 kDa were consistently detected in both the TMJ-SF (either normal or disease) and SF from KNEE-OA. Also detected were weak bands with molecular weight of 83 and 66 kDa. These bands were clearly shown, particularly in knee joints with advanced stages of OA. Western blot analysis delineated that these were active forms of MMP-9 (83 kDa) and MMP-2 (66 kDa). The same bands were also detected in TMJs with OA that showed high levels of IL-1beta and IL-6. CONCLUSION: These findings suggest that concomitant increases in the levels of cytokines (IL-1 and IL-6) and active forms of MMPs could be potential catabolic markers for cartilage degradation in the TMJ.
10728755 Induction of tumor necrosis factor alpha production by adhered human monocytes: a key role 2000 Mar OBJECTIVE: Small IgG rheumatoid factor immune complexes may provide the trigger for macrophage-derived tumor necrosis factor alpha (TNFalpha) production in rheumatoid arthritis. Immune complexes may bind to any of 3 IgG Fc receptors (FcgammaR). Therefore, the ability of monocyte-derived macrophages to produce TNFalpha was examined following ligation of each of the 3 human FcgammaR, using murine monoclonal antibodies (mAb) to each receptor as a model for small immune complexes. METHODS: Adhered human monocytes expressing all 3 FcgammaR were incubated with murine anti-FcgammaR mAb directed against FcgammaRI, FcgammaRII, or FcgammaRIII. Supernatants were collected at various time points and tested for the presence of TNFalpha and interleukin-1alpha (IL-1alpha) by enzyme-linked immunosorbent assay. RESULTS: The anti-FcgammaRIII mAb induced adhered human monocytes to release TNFalpha. However, F(ab)2 and Fab fragments of the anti-FcgammaRIII mAb failed to induce TNFalpha production. TNFalpha was undetectable following incubation with the anti-FcgammaRI or anti-FcgammaRII mAb. Furthermore, blocking FcgammaRI or FcgammaRII had no effect on the levels of TNFalpha released in response to the anti-FcgammaRIII mAb. Of the 3 anti-FcgammaR mAb, only anti-FcgammaRIII induced IL-1alpha production from adhered human monocytes, and this was inhibited by the presence of a neutralizing anti-TNFalpha mAb. CONCLUSION: This study suggests a dominant role for FcgammaRIIIA in the induction of both TNFalpha and IL-1alpha production by human macrophages in rheumatoid arthritis following receptor ligation by small immune complexes. The signaling of TNFalpha production may require the ligation of either 3 FcgammaRIIIA receptors or only 2 FcgammaRIIIA receptors, where one interaction must involve binding via an Fc domain. In addition, IL-1alpha production following FcgammaRIIIA ligation appears to be dependent on the presence of TNFalpha.
11302867 Prevalence and clinical significance of antikeratin antibodies and other serological marke 2001 May OBJECTIVES: To assess the clinical value of several serological markers in Lithuanian patients with rheumatoid arthritis (RA) compared with control patients with rheumatic disease and age matched healthy controls. METHODS: Serum samples from 96 patients with RA of approximately 8 years' duration, 90 rheumatic disease controls, and 37 healthy subjects were tested. Antikeratin antibody (AKA), antineutrophil cytoplasmic antibody (ANCA), and antinuclear antibody (ANA) titres were estimated by indirect immunofluorescence (IIF) and serum samples positive for ANA and ANCA were further studied by enzyme linked immunosorbent assay (ELISA). IgA and IgM rheumatoid factors (RF) were measured by ELISA. RESULTS: A positive AKA test was highly specific for RA (diagnostic specificity 97%), being found in 44% of the patients. Although both RF tests had a higher sensitivity, they were less specific for RA. ANCA was detected in 33% of patients with RA but lacked diagnostic specificity. AKA and ANCA were associated with more erosive disease and the presence of extra-articular manifestations. Positivity for AKA, IgA RF, and ANCA was significantly associated with disease activity and worse functional capacity. However, in multiple regression analysis only positivity for AKA was significantly correlated with functional disability (p=0.0001), evaluated by the Steinbrocker functional classification, and no single marker had any relation with radiological damage. CONCLUSION: Although AKA showed the highest disease specificity, all serological markers studied except ANA exhibited interesting associations with important clinical and paraclinical parameters of RA.
9566103 [Basic therapeutic combination therapy in chronic polyarthritis: an overview]. 1998 Feb Therapy of rheumatoid arthritis with a combination of several disease-modifying drugs aims towards better control of the disease than achievable by monotherapy. Based on a broad variety of clinical studies, revealing more or less positive results, several combinations have been suggested: the inclusion of cyclosporin into combinations with methotrexate, the inclusion of sulfasalazine into combinations with methotrexate, the combined use of two chemotherapeutic substances, including methotrexate, azathioprine and cyclophosphamide, the inclusion of chloroquine derivatives into such or other combinations, and the combination of methotrexate with injectable gold. The validity of some of the studies is affected by high drop out rates and by the unknown influence of concomitant therapy with corticosteroids. Our own beneficial experience with the triple combination of methotrexate with azathioprine and chloroquine in 21 patients with refractory rheumatoid arthritis is summarized.
11081004 Cross-cultural equivalence of a brief helplessness scale for Spanish-speaking rheumatology 1999 Oct OBJECTIVE: To show evidence of the cross-cultural equivalence between the original English version of a 5-item scale for measuring helplessness and a translated Spanish version. METHODS: English and Spanish versions of the 5 items that constitute the helplessness factor of the Rheumatology Attitudes Index were tested in 3 separate groups of patients: 1) 20 bilingual rheumatology patients; 2) 100 consecutive English- and 50 consecutive Spanish-speaking monolingual rheumatology patients; and 3) 192 English- and 44 Spanish-speaking patients with rheumatoid arthritis who were consecutively enrolled in a cohort to study disease outcomes. English-Spanish concordance among bilingual subjects was measured using intraclass correlation coefficients (ICC). Internal consistency was measured by Cronbach's coefficient alpha. Associations between the helplessness scale and variables measured simultaneously in English- and Spanish-speaking patients were measured by correlation analysis. RESULTS: Agreement between the English and Spanish versions of the helplessness scale among bilingual subjects was excellent (ICC = 0.87), and internal consistency among monolingual subjects was acceptable (coefficient alpha = 0.73 in English and 0.87 in Spanish). The correlation between helplessness and most other measured variables was of similar size and direction in English as in Spanish (10-point pain scale r = -0.53 and -0.52; modified Health Assessment Questionnaire physical disability r = -0.45 and -0.43; self-assessed joint count r = 0.36 and 0.36; Medical Outcomes Study Short Form 36 [SF-36] physical function r = 0.37 and 0.39; SF-36 mental health r = 0.27 and 0.35; Center for Epidemiological Studies Depression scale r = -0.37 and -0.33, respectively). CONCLUSION: The evidence shown supports the cross-cultural equivalence between the original 5-item helplessness scale developed in English and our translated Spanish version.
9621778 [Still disease in adults]. 1998 May 18 Adult onset Stills disease (ASD), an adult variant of systemic onset juvenile rheumatoid arthritis, is a rare disease entity. The diagnosis is solely a clinical one and often difficult. Clinical and laboratory features are not pathognomonic. The diagnosis of ASD has to be considered in patients with high spiking fever, transient rash, arthralgias, oligo- or polyarticular arthritis, leukocytosis, sore throat, lymphadenopathy and/or splenomegaly, liver dysfunction and high serum ferritin levels. We give a brief review of the clinical features, differential diagnosis, treatment and prognosis.
9639945 [Inflammation phenomena in vasculitis: from immune complexes to less immune forms]. 1998 Apr Immune complexes are involved in the pathogenesis of Henoch-Schönlein purpura, essential mixed cryoglobulinemia, hepatitis B-associated periarteritis nodosa and hypersensitivity vasculitis (related to infection or medications). ANCA's probably play a pathogenic role in Wegener's Granulomatosis, microscopic polyangiitis and renal-limited vasculitis. Pathologic responses of T-lymfocytes and granuloma formation have been demonstrated in temporal arteritis, Takayasu arteritis, Wegener's Granulomatosis, Chürg-Strauss syndrome and Kawasaki syndrome. The eventual pathogenic role of AECA's is less clear, with the possible exception of rheumatoid arthritis and systemic lupus erythematosus. These four pathogenic factors are not mutually exclusive: several mechanisms may play in one disorder, as has been demonstrated for Wegener's Granulomatosis. From these new insights in the pathogenesis of vasculitis, new therapies with better efficacy and fewer side effects may arise.
10381038 Serum concentrations of interleukin 6, osteocalcin, intact parathyroid hormone, and marker 1999 Jun OBJECTIVE: To analyze serum concentrations of interleukin 6 (IL-6), osteocalcin, intact parathyroid hormone (PTH), and type 1 collagen carboxyterminal telopeptide (ICTP) as well as the urinary concentrations of crosslinked N-telopeptides of type 1 collagen (NTx) and deoxypyridinoline (Dpd) in patients with rheumatoid arthritis (RA) to investigate their role in the etiology of the osteopenia in this disease. METHODS: Using ELISA and radioimmunoassay methods, we estimated serum concentrations of IL-6, osteocalcin, ICTP, intact PTH, and spot urine concentrations of NTx and Dpd in 25 female patients with active RA, 25 female patients with suppressed disease, and 25 age matched healthy female controls. RESULTS: Patients with active RA had significantly higher (p < 0.001) concentrations of IL-6 (94.0+/-12.1 pg/ml) compared to patients with suppressed disease (13.2+/-0.8 pg/ml) and healthy controls (12.3+/-0.8 pg/ml). Serum osteocalcin was significantly lower (p < 0.001) in patients with active RA (1.9+/-0.2 ng/ml) compared to patients with suppressed disease (2.7+/-0.2 ng/ml) and the controls (2.9+/-0.2 ng/ml). Similarly, serum intact PTH was significantly lower (p < 0.001) in patients with active disease (29.9+/-1.5 ng/ml) compared to patients with suppressed RA (38.0+/-1.6 ng/ml) and controls (49.8+/-2.4 ng/ml). Serum ICTP was also significantly higher (p < 0.01) in patients with active RA (9.5+/-0.3 microg/l) versus patients with suppressed disease (4.1+/-0.2 microg/l) and controls (3.4+/-0.2 microg/l). In patients with active disease, spot urine concentrations of NTx (123.1+/-5.1 nmol bone collagen equivalent/mmol creatinine) and Dpd (15.1+/-0.7 nmol/mmol creatinine) were significantly higher (p < 0.001) than in patients with suppressed disease (58.4+/-2.5 nmol bone collagen equivalent/mmol creatinine and 10.1+/-0.5 nmol/mmol creatinine, respectively) and healthy controls (53.4+/-2.1 nmol bone collagen equivalent/mmol creatinine and 9.7+/-0.5 nmol/mmol creatinine, respectively). There were no significant correlations between serum IL-6 and serum ICTP (r = 0.2357, p = 0.257) or urinary NTx (r = 0.1436, p = 0.494) or between serum intact PTH and ICTP (r = 0.0206, p = 0.922) in patients with active RA. CONCLUSION: There are no significant correlations between bone resorption markers and serum IL-6 and intact PTH in patients with RA.
9292791 Musculoskeletal pain and quality of life in patients with noninflammatory joint pain compa 1997 Sep OBJECTIVE: To establish the prevalence of different types of noninflammatory musculoskeletal pain in the general population, to determine the sociodemographic characteristics of persons reporting such pain, and to compare the epidemiological features in a population setting between different types of noninflammatory musculoskeletal pain and patients with confirmed rheumatoid arthritis (RA). METHODS: A cross sectional postal survey of 20,000 (response rate 59%) randomly selected adults in 2 counties of Norway. Patients with RA were identified by a clinical and laboratory examination. RESULTS: The self-reported one month prevalence was 15.4% for noninflammatory neck pain, 21.6% for noninflammatory low back pain, and 17.0% for noninflammatory widespread pain. Neck pain was significantly associated to younger, lower educated, working, and married women; low back pain to higher educated and non-working men; and widespread pain to lower educated middle aged, divorced or widowed, and non-working women. Patients with RA and widespread pain experienced similar pain intensity, mental distress levels, problems with insomnia, and similar scores on global health satisfaction, whereas pain as well as reported health consequences were less pronounced in subjects with regional pain. Disability levels were highest in RA, followed by widespread pain, low back pain, and neck pain. CONCLUSION: This population study supports the hypothesis of a continuum for most health related quality of life measures, starting with noninflammatory regional musculoskeletal pain and ending with multiple periarticular or inflammatory disease (widespread pain and RA). This study also shows that widespread pain and RA had similar health effect, except for levels of disability.
9208289 Anterior sliding graft for tibiotalar arthrodesis. 1997 Jun The results using the anterior sliding graft technique with rigid internal fixation for tibiotalar arthrodesis were reviewed. The indications for anterior sliding graft technique included posttraumatic arthritis, rheumatoid arthritis, pseudarthrosis following prior attempt at arthrodesis, and postinfectious arthrosis. The arthrodesis rate was 95%. The overall prevalence of complications was 33%. The complications related to this method were minor and easily managed. The authors concluded that the anterior sliding graft technique is performed with readily available resources, has a high rate of union, and avoids the routine use of iliac bone graft.