Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
9435396 [Intra-articular nitric oxide levels in patients with rheumatoid arthritis]. 1997 Mar The aim of this study was the appraisal of the nitrite and nitrate levels in the synovial fluid of patients with rheumatoid arthritis (RA). The synovial fluid of patients with osteoarthritis (OA) was also evaluated by comparison. Demographic characteristics such as age and sex, and clinical and laboratorial parameters like duration of disease, functional class and erythrocyte sedimentation rate (ESR) were evaluated too. In the synovial fluid of all patients the total and differential leukocyte count, and the nitrite and nitrate levels determined by Griess reaction were analyzed. The results were statistically analyzed by Student's t test and correlation test. We found a significant increase in the intraarticular nitrite and nitrate levels in patients with RA when compared with OA patients (30.68 +/- 2.94 microM x 16.15 +/- 2.73 microM). We did not find any correlation between intraarticular nitrite and nitrate levels and the ESR or the total and differential leukocyte count in the RA synovial fluid. In this study we clearly found an increase in the intraarticular nitrite and nitrate levels in patients with rheumatoid arthritis.
9777311 Rational drug therapy recommendations for the treatment of patients with Sjögren's syndro 1998 Sep The aetiology of Sjögren's syndrome (SS) is unknown, and consequently curative treatments are not available. The immunopathogenesis of SS is partly clarified and immune-regulating drugs (IR) may therefore be of therapeutic value. However, the present understanding of SS is still too unclear to allow an exact and evidence-based algorithm for therapeutic decision making. Rational drug recommendations for the therapy of SS must, therefore, rely mostly on empirical data. Several IR drugs have been shown to be able to downregulate the immunopathological activity of primary SS, but it is not certain whether the diagnostic and cardinal manifestations from the eyes and mouth can be improved. In primary SS the disease-modifying qualities of IR and cytotoxic drugs, therefore, largely apply to the treatment of severe internal organ involvement, inflammatory vascular disease and malignant B lymphocyte disease. In secondary SS the IR therapy is directed against the basic immunoinflammatory connective tissue disease. Symptom-modifying therapies include drugs to stimulate and substitute for exocrine functions, and drugs to treat complications of the exocrine disease manifestations and to improve the various nonexocrine disease manifestations. The main drugs available for increasing lacrimal and salivary gland output are bromhexine and pilocarpine, respectively. However, exocrine substitutes, and in particular eye drops, are still the most important means of alleviating the sicca symptoms. They are also indispensable local treatment measures which may help to prevent mucosal complications.
11490511 The diagnosis of Sjögren's syndrome: definition and validation of classification criteria 1998 Feb Classification criteria currently exist for most of the rheumatic diseases. Different criteria sets have also been proposed in the past for Sjögren's syndrome (SS), but none of these has been validated and no single one is in general use by the entire scientific community. Between 1988 and 1996 the European Study Group for the Classification Criteria for SS performed a multicenter study in which a new classification criteria set for this disease was defined and then validated. This European set of classification criteria for SS is rapidly becoming the most widely accepted procedure to classify patients with the primary and secondary variants of the syndrome.
10023850 An alternative perspective to the immune response in autoimmune exocrinopathy: induction o 1999 Jan Sjögren's syndrome is characterized by dryness of the eyes and the mouth due to mononuclear cell infiltration of the lacrimal and salivary glands. The aetiology is unknown but autoimmunity is considered to play a significant role in the pathogenesis. Recent studies have focused on the fact that tear and salivary flow involves an entire functional system that includes the mucosal surfaces with adnexes (the site of inflammation), efferent nerve signals sent to the midbrain (lacrimal and salivary response region), and afferent neural signals from the brain to the acinar/ductal epithelial structures in the gland. Mononuclear cell infiltration in exocrine glands can lead to glandular destruction, suggested to be mediated through apoptosis. However, the functional impairment of exocrine glands could be regulated by cytokines and/or antibodies against the muscarinic M3 receptor by inhibiting the neural stimulation of the residual glands. This review discusses the possibility that the pathogenesis of Sjögren's syndrome comprises aberrant immune-mediated neuro-hormonal events.
9235711 [Sjögren's syndrome. New diagnostic aspects]. 1997 Jun 10 European criteria for classification of Sjögren's syndrome have recently been developed and evaluated. We report the clinical and laboratory findings in 96 patients with primary Sjögren's syndrome who have been classified according to these new criteria. In our patient population the latency from appearance of the first symptom to diagnosis was 11 years. In addition to sicca symptoms in mucous membranes, the dominant symptoms were periodic fatigue (92%), arthralgia (82%), hoarse voice (71%), dry cough (54%) and diarrhoea (51%). Antibodies to the nuclear antigens SSA and SSB were found in respectively 22.2% and 15.6% of the patients. Two out of ten patients with both anti-SSA and anti-SSB antibodies gave birth to a child with heart block.
10628194 [Adult onset Still disease: comment on two cases]. 1999 Dec 5 The adult onset Still disease is a systemic disease of an unknown etiology. As a separate entity, it was described firstly in 1971. The diagnosis is problematic and based upon special criteria. In this study, we present the cases of two patients with adult onset Still's disease, causing several serious differential-diagnostic problems. In the beginning of the disease a high, remittent-intermittent fever was present which reacted well to salycilates. Almost simultaneously, a characteristic, confluent, no itching rash appeared on the trunk and limbs. Pain of little joints of the hands was an early symptom of the disease in both of the cases. Before the final diagnosis, the possibility of any infectious diseases, haematologic malignancies or other autoimmune disease had to be excluded. The aim of this work was to show an overall, up-to-date picture of the disease based on two typical cases.
9621783 [Two cases of Still disease in adults]. 1998 May 18 We describe two cases of adult onset Stills disease. Both patients presented with typical features of adult Stills disease: high spiking fever, arthralgia, oligo- and polyarticular arthritis, transient rash, sore throat, lymphadenopathy and leukocytosis. Both patients failed to improve when treated with nonsteroidal antiinflammatory drugs (NSAIDs) and azathioprine, but responded adequately when sulfasalazine was added to the medication. It is suggested that sulfasalazine is a useful adjunct if the clinical response to NSAIDs is not sufficient.
9259257 Sjögren's syndrome associated with autoimmune hepatitis. A case report. 1997 Jun Liver involvement in patients with primary Sjögren's syndrome is rare, usually without clinical significance and histologically characterized by a feature like stage 1 primary biliary cirrhosis. We describe herein a case of acute and severe autoimmune hepatitis in a patient suffering from primary Sjögren's syndrome. The diagnosis of Sjögren's syndrome was performed in 1989. In June 1995 the patient presented severe weakness, jaundice and elevation of transaminases; moreover IgG raised to 5560 mg/dl and ANA titre increased to 1:20480. The patient denied alcohol and drug use and a viral hepatitis was excluded. Antimitochondrial antibodies, anti-smooth muscle antibodies and antibodies against liver kidney microsomes were negative. An abdomen ultrasound examination revealed hepatomegaly, with irregular echogenic structure and lymphoadenomegaly near the celiac tripod. Liver biopsy demonstrated a picture of autoimmune hepatitis. The patient was treated with prednisone 50 mg/day and azathioprine 50 mg/day, with improvement in clinical and liver function indices. At present, the patient is given only 10 mg/day of prednisone. The association of Sjögren's syndrome with autoimmune hepatitis is very rare: in the literature only one other similar case has been reported.
9070962 Adult Still's disease with myocardial dysfunction induced by microangiopathy. 1997 Jan A 52-year-old man with inflammatory disease of unknown origin but no specific laboratory abnormalities was referred to our hospital. He has subsequently diagnosed as having adult Still's disease. During an episode of severe inflammation he suffered reversible myocardial damage as revealed by electrocardiography, echocardiography and 201Tl myocardial scintigraphy; this was ameliorated by treatment with steroids and immunosuppressive drugs. No significant stenosis of the coronary artery was observed on coronary angiography. Interstitial mononuclear infiltration was apparent in the right ventricle on endomyocardial biopsy. Myocardial injury with adult Still's disease, which may result in heart failure, has rarely been reported. We report a case of adult Still's disease with myocardial dysfunction that may have been caused by microangiopathy.
10572432 [Arthritic manifestations in ulcerative colitis]. 1999 Nov Ulcerative colitis (UC) is commonly associated with peripheral joint disease which correlates with the activity and extent of the inflammatory bowel disorder. They are generally divided into three clinical categories; peripheral arthritis, spondylitis, and sacroiliitis. The arthritis is usually pauciarticular, generally asymmetric, transient, and nondestructive. However, the peripheral arthritis becomes chronic and destructive in some cases. Rheumatoid arthritis has been reported to be seldom associated with UC. Inflammatory joint disease is considered an enteropathic arthritis if the gastrointestinal tract is directly involved in the pathogenesis. The occurrence of rheumatologic manifestations in UC is reviewed in this paper.
10911466 [Methotrexate treatment in refractory juvenile rheumatoid arthritis]. 1998 Dec 1 The mean time from initiation of methotrexate (MTX) treatment of juvenile rheumatoid arthritis (JRA) to partial remission of clinical symptoms and total clinical remission was assessed. 9 girls and 8 boys, from 3 to 18 years of age (mean 11.4 +/- 5.4) with active JRA by American College of Rheumatology (ACR) criteria (5 systemic, 8 polyarticular and 4 pauciarticular disease onset), who failed to respond to adequate courses of non-steroidal anti-inflammatory drugs (NSAID), steroids or disease-modifying drugs were studied. Clinic visits were scheduled at monthly intervals for physical and laboratory assessment of disease activity and drug safety. Partial response to MTX was defined a 25% reduction of the active joint count and/or articular severity score. Total clinical remission was defined as in adult rheumatoid arthritis. The duration of disease activity until enrollment ranged from 6 months to 14 years (4.5 +/- 3.7 yr); duration of therapy was 3 months to 3 years (14.6 +/- 9.3 mo) and dosage ranged from 5 to 15 mg/m2/week. Prednisone in doses below 10 mg/day and NSAID were permitted. 14 of 17 patients (82%) had a 25% reduction in joint activity after 6 weeks to 4 months (9.2 +/- 3.2 weeks); 10 (59%) went into full clinical remission after 5 to 26 months (14.3 +/- 9 months); 3 relapsed after an initial response to treatment, and 4 (23%) did not respond to MTX. The non-responders were males who required higher doses of prednisone (p < 0.0001). MTX appears to be effective therapy for children with JRA. An initial response can be expected in most patients after 9 weeks of treatment, and full clinical remission occurs after a mean of 14 months.
11771524 Adenosine deaminase activity and its isoenzyme pattern in patients with juvenile rheumatoi 2001 Adenosine deaminase (ADA) is involved in purine metabolism and plays a significant role in the mechanisms of the immune system. The aim of this study was to investigate the activity of total ADA (tADA) and its isoenzymes ADA1 and ADA2 in serum and peripheral blood lymphocytes (PBLs) of children with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE) in different phases of the diseases. The study comprised 34 patients with rheumatic disease, 24 with JRA and 10 with SLE, and 64 healthy controls. The tADA activity and its isoenzymes were measured in serum and PBLs of all patients by the method of Giusti and by the presence or absence of EHNA (erythro-9-(2-hydroxy-3-nonyl)adenine) during the active phase of the disease (before treatment), as well as during remission and relapse. Our data show that increased tADA activity in the serum and PBLs of patients with JRA and SLE is correlated mainly to increased levels of ADA2 activity in serum and ADA1 activity in PBLs. It also closely correlates with clinical disease activity and relapse. The cause of this increased tADA/ADA2 activity in serum and tADA/ADA1 activity in PBLs in JRA and SLE remains to be elucidated. Nevertheless, it may be noted that the measurement of tADA activity, together with ADA2 activity in serum and tADA with ADA1 activity in PBLs, could offer a biochemical approach to the assessment of the pathophysiology of JRA and SLE. Also, tADA and its isoenzymes could be used as alternative parameters representing disease activity.
9644740 [Criteria of aggressive rheumatoid arthritis course in children]. 1998 AIM: To ascertain criteria of aggressive course of juvenile rheumatoid arthritis (JRA) during 6-12 months since the disease onset, to measure the rate of destruction progression, to formulate indications for conduction of early immunosuppressive therapy. MATERIALS AND METHODS: The study included 30 patients (21 girls and 9 boys) aged 4-15 years with classic JRA. 25 children (76.2%) had systemic, 5 children--articular disease (23.8%). RESULTS: 50% and 20% of the examinees got the disease before they reached the age of 5 years and in puberty, respectively. Severe systemic disease in the debute was registered in 83.3% of patients, 16.7% developed primarily articular JRA. For 1 year the disease transformed into generalized and polyarticular in 43.3% and 56.7% of patients, respectively. Its activity reached the third degree in all the patients. IgG levels exceeded the age standards 1.5 times. Articular dysfunction occurred in 100% of the cases. Destruction in the joints was recorded in 37% and 92.5% of patients after 1 and 2 years of the disease, respectively. CONCLUSION: Early or in prepuberty, puberty onset of JRA, systemic variants of the debute, debute by classical seropositive RA without systemic symptoms, fast appearance of symmetric, generalized joint lesions, recurrent course with high ESR, C-reactive protein, IgG, growing joint functional insufficiency within the first year of the disease may severe criteria of aggressive course of RA in children. RESULTS: The presence of the above markers in RA patients is indication for administration of the disease-controlling drugs within the first 12 months before development of anatomic destruction and the patients' invalidation.
9512879 Prevalence and disease associations of certain autoantibodies in elderly patients. 1998 Feb OBJECTIVE: To determine the prevalence and association with various diseases of certain autoantibodies among elderly patients, in order to challenge the hypothesis that these autoantibodies are elevated generally in these patients as a result of immunosenescence. DESIGN: Prospective prevalence study. PATIENTS: A total of 399 elderly patients: 63 aging successfully (without chronic illness), 301 with a variety of chronic general illnesses (frail elderly) and 35 with a clinical diagnosis of rheumatoid arthritis. These were compared with 250 healthy adult blood donors. INTERVENTIONS: Measurement of autoantibodies to rheumatoid factor, antinuclear antibody, double-stranded (native) DNA (nDNA), extractable nuclear antigens and anticardiolipin antibodies. OUTCOME MEASURES: Prevalence of these autoantibodies and correlation with disease states. RESULTS: Antibodies to rheumatoid factor and antinuclear antibody were significantly more prevalent in the elderly patients with chronic illness or rheumatoid arthritis but were not disease-specific. The prevalence of nDNA and extractable nuclear antigens was not increased in either the healthy or frail elderly groups. Anticardiolipin antibodies were significantly more prevalent in the frail elderly group when compared with normal controls and the healthy elderly group. The prevalence of anticardiolipin antibodies correlated with clinical features of cerebrovascular disease, in particular multi-infarct dementia and stroke, but not with Alzheimer's disease. CONCLUSIONS: The prevalence of the autoantibodies measured was not elevated in healthy elderly subjects, and autoantibodies such as nDNA and extractable nuclear antigens are specific to disease states in all groups of elderly patients. Anticardiolipin antibodies correlate with cerebrovascular events. Therefore, the clinical significance of autoantibodies in elderly patients is related more to global health status than to the effects of aging.
10643702 Presence of antinucleosome autoantibodies in a restricted set of connective tissue disease 2000 Jan OBJECTIVE: To study the frequency and disease specificity of antinucleosome antibody reactivity in diverse connective tissue diseases (CTD), and to determine factors, such as antibody subclass, that may influence the pathogenicity of these antibodies in relation to disease activity. METHODS: IgG and IgM antinucleosome activities on nucleosome core particles from 496 patients with 13 different CTD and 100 patients with hepatitis C were measured by enzyme-linked immunosorbent assay (ELISA). Of the patients with CTD, 120 had systemic lupus erythematosus (SLE), 37 had scleroderma (systemic sclerosis; SSc), 20 had mixed connective tissue disease (MCTD), and 319 had other CTD, including Sjögren's syndrome, inflammatory myopathy, rheumatoid arthritis, primary antiphospholipid syndrome, Wegener's granulomatosis, Takayasu arteritis, giant cell arteritis, relapsing polychondritis, Behçet's syndrome, and sarcoidosis. Antinucleosome-positive sera were further analyzed, by isotype-specific ELISA, for antinucleosome and anti-double-stranded DNA (anti-dsDNA) IgG subclasses. RESULTS: SLE, SSc, and MCTD were the only 3 CTD in which antinucleosome IgG were detected (71.7%, 45.9%, and 45.0% of patients, respectively). Antinucleosomes of the IgG3 subclass were present at high levels in patients with active SLE and were virtually absent in those with SSc, MCTD, or inactive SLE, and their levels showed a positive correlation with SLE disease activity. Of note, an increase in levels of antinucleosome of the IgG3 isotype was observed during SLE flares, and this increase was found to be closely associated with active nephritis. Levels of antinucleosome of the IgG1 subclass showed a trend toward an inverse correlation with SLE disease activity. No significant fluctuation in the anti-dsDNA isotype profile was observed in relation to SLE severity or clinical signs. CONCLUSION: Our data suggest that IgG antinucleosome is a new marker that may help in the differential diagnosis of CTD; antinucleosome of the IgG3 isotype might constitute a selective biologic marker of active SLE, in particular, of lupus nephritis.
9746864 Intra-articular corticosteroids in the treatment of juvenile rheumatoid arthritis. 1998 Sep Intra-articular injection of long-acting insoluble corticosteroids produces rapid resolution of active arthritis in nearly all injected joints. Almost all of our information on the use of intra-articular corticosteroids in children comes from observational or retrospective analyses or, by inference, from studies in adult patients with arthritis. The duration of response has been found to vary according to the subtype of arthritis, the dose of injected steroids, the accuracy of injection, the duration of disease prior to injection, and possibly the age of the patient. Although the duration of follow-up in most studies has been short, intra-articular steroid therapy seems to be remarkably free of clinically important detrimental effects. Side effects are relatively uncommon and include subcutaneous atrophy and radiologically detectable structural changes or calcification. There is transient suppression of endogenous cortisol production, which may not be clinically important. Although intra-articular steroid therapy is most effective in pauciarticular juvenile rheumatoid arthritis, there are still no solid data to indicate whether it should be used earlier in the course of the disease instead of or along with systemic anti-inflammatory therapy. It has been suggested that repeated injection of the same joint decreases the likelihood of a favorable response. There are still many unanswered questions about how steroids exert their beneficial effects. Newer imaging techniques promise to provide insight into the mechanism of action and possibly to a more informed basis for the use of intra-articular steroids.
11168638 Regulation of human neutrophil-mediated cartilage proteoglycan degradation by phosphatidyl 2001 Jan The ability of neutrophils to degrade cartilage proteoglycan suggests that the neutrophils that accumulate in the joints of rheumatoid arthritis patients are mediators of tissue damage. The regulatory mechanisms which are relevant to the proteoglycan-degrading activity of neutrophils are poorly understood. Since phosphatidylinositol 3-kinase (PI3-K), protein kinase C (PKC), the extracellular signal-regulated protein kinase (ERK)1/ERK2 and cyclic adenosine monophosphate (cAMP) have been reported to regulate neutrophil respiratory burst and/or degranulation, a role for these signalling molecules in regulating proteoglycan degradation was investigated. Preincubation of human neutrophils with GF109203X (an inhibitor of PKC), PD98059 (an inhibitor of MEK, the upstream regulator of ERK1/ERK2) or with forskolin or dibutyryl cAMP, failed to suppress proteoglycan degradation of opsonized bovine cartilage. In contrast, preincubation of neutrophils with wortmannin or LY294002, specific inhibitors of PI3-K, inhibited proteoglycan degradation. Incubation of neutrophils with cartilage resulted in the activation of PI3-K in neutrophils, consistent with a role for PI3-K in proteoglycan degradation. Activation of PI3-K and proteoglycan degradation was enhanced by tumour necrosis factor-alpha. Degradation caused by neutrophils from the synovial fluid of rheumatoid arthritis patients was also inhibited by wortmannin. These data demonstrate that the proteoglycan degradative activity of neutrophils required PI3-K but not PKC or the ERK1/ERK2/ERK5 cascades and was insensitive to increases in intracellular cAMP concentrations.
10460329 The association between Turner's syndrome and juvenile rheumatoid arthritis. 1999 Sep BACKGROUND: Turner's syndrome (TS) is a chromosomal disease frequently associated with autoimmune conditions including thyroid disease, inflammatory bowel disease, and diabetes. Recent reports have described an association with juvenile rheumatoid arthritis (JRA) and psoriatic arthritis. We describe three additional cases of TS associated with JRA. OBJECTIVE: The objective of this report is to describe the radiographic and clinical features of TS associated with JRA to heighten awareness of this association and alert radiologists to recognize the superimposition of radiographic bony changes of chronic joint disease and the bone changes of TS. Patients and methods. Clinical history and radiographic images of three girls with TS and arthritis were reviewed. The radiographic findings typical of TS and juvenile arthritis are described. RESULTS: Of about 65 patients at our center with Turner's syndrome 3 had JRA (as described in this report), supporting the association between TS and JRA. All our patients who met American College of Rheumatology Classification criteria for JRA had radiographic and clinical findings consistent with both their JRA and Turner's syndrome. CONCLUSION: We believe that it is important to consider the diagnosis of Turner's syndrome in girls with JRA, recognizing that characteristic radiographic findings such as metacarpal shortening are usually present. Conversely, suspicion of an underlying inflammatory arthritis is warranted in search for radiological findings consistent with JRA in girls with TS and joint symptoms.
10665597 Subspecialty referrals for pauciarticular juvenile rheumatoid arthritis. 2000 Feb OBJECTIVES: To examine referral patterns from primary care physicians for children with pauciarticular juvenile rheumatoid arthritis (JRA) and to determine whether children with pauciarticular JRA referred to pediatric rheumatologists differ in clinical presentation from children referred to other specialists. DESIGN: A retrospective records review of 49 patients with pauciarticular jRA was performed. Records were reviewed to determine the specialty of the referring physician and whether the children referred had symptoms and signs compatible with a synovitis at the time primary care was sought. SETTING: Inner-city tertiary pediatric rheumatology referral center. PARTICIPANTS: Children with pauciarticular JRA. MAIN OUTCOME MEASURES: Identification of referral patterns of primary care physicians. Associated morbidity owing to JRA was ascertained at the time of referral. RESULTS: Most children with pauciarticular JRA (62%) were referred to orthopedic surgeons prior to referral for pediatric rheumatology care. No differences in clinical symptoms were seen between children referred to pediatric rheumatologists and those referred to orthopedic surgeons. Children referred initially to orthopedic surgeons were younger than those referred to pediatric rheumatologists. CONCLUSION: A notable number of children with pauciarticular JRA are referred to orthopedic surgeons prior to the establishment of that diagnosis, even when such children present with unequivocal signs of synovitis. This may be owing to the misconception that arthritis is rare in preschool-aged children or to the difficulty of ascertaining the presence of synovitis in younger children.
9611028 Total elbow arthroplasty in patients who have juvenile rheumatoid arthritis. 1998 May Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxation of the prosthesis, stiffness of the elbow, and problems with wound-healing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatment. Late complications (aseptic loosening, instability, and worn bushings) led to three poor results. None of the eighteen semiconstrained prostheses had radiographic evidence of loosening at the most recent follow-up evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a poor result.