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ID PMID Title PublicationDate abstract
11733624 Clinical and morphological features of kidney involvement in primary Sjögren's syndrome. 2001 Dec BACKGROUND: Primary Sjögren's syndrome is a connective tissue disorder affecting primarily the lacrimal and salivary glands, resulting in xerophtalmia and xerostomia. Extraglandular manifestations are frequent and may include renal involvement. METHODS: We studied the prevalence and nature of kidney involvement in 60 Italian patients with primary Sjögren's syndrome, diagnosed according to the European classification criteria. The following renal laboratory tests were performed in all patients: electrolytes in serum and in 24-h urine, creatinine in serum and in 24-h urine, venous pH and HCO(3)(-), urinalysis, urine culture, urinary osmolality and urine pH. A water deprivation test was performed in patients with morning urine osmolalities below the reference values adjusted for age. An oral ammonium chloride loading test was performed in patients with urine pH above 5.5 from morning samples. Renal biopsy was performed in patients with renal involvement. RESULTS: Sixteen patients (27%) had laboratory evidence of tubular and/or glomerular dysfunction. A variable degree of creatinine clearance reduction was found in eight patients (13%); frank distal tubular acidosis in three (5%); hypokalaemia in four (7%); and pathological proteinuria in 12 (20%). Urine concentrating capacity was defective in 10 out of 48 (21%) tested patients. Only four patients presented with overt clinical manifestations, including hypokalaemic tetraparesis (1), nephrotic syndrome (2), recurrent renal stones with flank pain and haematuria (1). In two patients, signs of renal involvement preceded the onset of sicca syndrome. Renal biopsies from nine patients showed tubulo-interstitial nephritis in six and glomerular disease in three. Patients with renal involvement had a significantly shorter disease duration compared with patients without renal abnormalities. CONCLUSIONS: Kidney involvement is a frequent extraglandular manifestation of primary Sjögren's syndrome. It is rarely overt and may precede the onset of subjective sicca syndrome.
11322005 [Hashimoto's thyroiditis and Sjögren syndrome. Association or autoimmune multiple syndrom 2001 Feb A case of Hashimoto's thyroiditis associated with incomplete Sjögren's syndrome is revised. Both immune disorders are together not just as a casual event, but literature says that common mechanisms could have something to be. Previous publications express that autoimmune thyroid dysfunction is frequently associated with primary Sjögren's syndrome and should be sought clinically and by laboratory test in all these patients.
11244728 [Sjögren's syndrome with multiple bullae and pulmonary nodular amyloidosis]. 2000 Dec We report a case of Sjögren's syndrome with pulmonary involvement diagnosed by open lung biopsy. The patient was a 62-year-old woman with antiphospholipid antibody syndrome. Her chest radiograph and CT scan showed multiple bullae diffusely scattered throughout the lung. The open lung biopsy specimens revealed marked inflammatory mononuclear cell infiltration and nodular amyloid deposits in the bronchiolar walls. The mechanism of bulla formation appeared to be the check valve mechanism caused by the narrowing of the airway by the bronchiolitis. The patient was treated with oral corticosteroids, and her symptoms and laboratory findings became stable.
9746680 Diagnosing and Treating the Predominantly Female Problems of Systemic Autoimmune Diseases. 1997 Feb Autoimmune diseases with rheumatic manifestations are predominantly diseases of women. Any woman with new onset arthralgia or arthritis should have a thorough history and physical to rule out autoimmune connective-tissue disease. Screening serologic tests, however, are not necessarily recommended because of high false-positive rates. Serologic tests are most useful in confirming or ruling out the diagnosis; for example, systemic lupus erythematosus (SLE) is rarely present when antinuclear antibodies (ANAs) are absent; the absence of rheumatoid factor will not rule out rheumatoid arthritis (RA), but its presence confirms it. Most autoantibodies (RF [rheumatoid factor], ANA, ENA [extractable nuclear antigen], anti-Jo-1, etc) do not vary with disease flare-ups and remissions. Plain radiographs of the joints are not useful except as a baseline and in detecting erosion at end of long bones associated with RA. Polymyalgia rheumatica and RA, with an incidence of 1 in 2000 to 3000, are the most common autoimmune disorders. Other autoimmune diseases such as SLE, vasculitis, polymyositis, and dermatomyositis are seen infrequently in general practice. Pregnancy, menopause, or breast implantation may affect disease prognosis and treatment. For example, in pregnancy, RA symptoms generally improve, whereas those of SLE may worsen; both diseases may flare postpartum. Oral contraceptives have been associated with an increase in disease flare-ups, but there is little or no evidence that estrogen in the dose level used for replacement is harmful to SLE patients. Although relatively rare, autoimmune diseases can be devastating to the patient if not promptly recognized and properly treated.
11603465 Multilocular thymic cyst associated with Sjögren's syndrome. 2001 Oct A 61-year-old woman, who had been diagnosed as having Sjögren's syndrome, developed an anterior mediastinal mass. She was diagnosed with Sjögren's syndrome with thymoma, preoperatively. Extended thymectomy was performed. Macroscopically, the mediastinal mass showed thick-walled multiloculated cavities filled with turbid yellow fluid. Microscopically, the cyst lining was continuous with thymic lobules in the wall with inflammatory process, cholesterol granuloma formation, and prominent lymph follicular hyperplasia. She was diagnosed with multilocular thymic cysts associated with Sjögren's syndrome.
11354918 A comparison of salivary gland hypofunction in primary and secondary Sjögren's syndrome. 2001 Jan OBJECTIVE: A commonly held view by clinicians is that the salivary gland hypofunction associated with primary Sjögren's syndrome (SS-1) is more severe than that associated with secondary Sjögren's syndrome (SS-2). This study aimed to determine if this view could be substantiated, when applied to a large sample group. METHOD: Unstimulated and paraffin wax-stimulated whole salivary flow rates were retrospectively compared for age and gender matched, patients diagnosed with SS-1 or SS-2 according to the preliminary European criteria. The patients had attended the Xerostomia Clinic, in the Oral Medicine Department, at the Liverpool University Dental Hospital. RESULTS: Sixty-seven patients with SS-1 (average age 57.1 years) were matched with 67 patients with SS-2 (average age 57.6 years), according to gender and age, within 5 years. The mean unstimulated whole salivary flow rates (+/- s.d.) for patients with SS-1 and SS-2 were 0.11 (+/- 0.15) and 0.12 (+/- 0.18) mL min-1 respectively. The mean paraffin wax stimulated, whole salivary flow rates (+/- s.d.) for patients with SS-1 and SS-22 were 0.45 (+/- 0.02) and 0.47 (+/- 0.49) mL/min-1 respectively. No significant differences, in either stimulated (P = 0.54) or unstimulated (P = 0.60) whole salivary flow rates were found between individuals with SS-1 or SS-2. CONCLUSION: The severity of salivary gland hypofunction does not appear to be related to the clinical variant of Sjögren's syndrome.
11155596 [A case of Sjögren's syndrome associated with inflammatory pseudotumor of the liver]. 1998 Dec A 71-year-old man had noticed a dry sensation in the mouth with swelling of bilateral parotid glands in 1988. He was given a diagnosis of Sjögren's syndrome (SS) on the basis of characteristic findings of sialography and a minor salivary gland biopsy. He was admitted to our department in Febuary 1995 because of general fatigue of 2 month's duration. Laboratory data showed both positive anti-SSA and anti-SSB antibodies, liver dysfunction, hypoalbuminemia, and thrombocytopenia. Abdominal CT and MRI demonstrated a 2-cm intrahepatic mass (S 6) with enhanced areas at the periphery. The liver biopsy yielded fragments from the intrahepatic mass and hepatic parenchyma. The former was composed of plasma cells, lymphocytes, and histiocytes, compatible with the diagnosis of inflammatory pseudotumor of the liver. The pathological diagnosis of the latter specimen was primary biliary cirrhosis, although antimitochondrial antibody was negative. The intrahepatic mass gradually decreased in size without treatment. Inflammatory pseudotumor is considered to be a benign inflammatory condition simulating a neoplasma and the possibility of an autoimmune reaction is suggested on the basis of etiology. This is the first report of an inflammatory pseudotumor associated with Sjögren's syndrome developing in the liver. The inflammatory pseudotumor should be considered as a possible diagnosis in cases where the tumor is embedded in the liver.
10583122 Adult-onset Still's disease with persistent plaques. 1999 Oct Adult-onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, arthralgias or arthritis and predominantly neutrophilic leucocytosis. We report on a 16-year-old woman with Still's disease who developed, in addition to the typical rash, persistent papular lesions on her face, neck and upper and lower back. Although the presence of fixed skin lesions is not a characteristic feature of AOSD, their appearance at the onset of the disease and their evolution suggest that they represent a specific manifestation of the disease.
9591573 Technetium-99m-HMPAO brain SPECT in Sjögren's syndrome. 1998 May Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in Sjögren's syndrome patients. METHODS: Forty-eight female Sjögren's syndrome patients with normal brain CT or magnetic resonance imaging findings were enrolled in this study and were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. These patients were separated into two subgroups. Group 1 consisted of 38 patients with definite neuropsychiatric symptoms/signs and Group 2 consisted of 10 patients without any neuropsychiatric symptoms/signs. RESULTS: Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia and thalamus in 14% and 0% of patients in Groups 1 and 2, respectively. Using surface three-dimensional display of the brain, local hypoactivity anomalies were found in the brain cortex of 53% and 20% of patients in Groups 1 and 2, respectively. In Group 1 patients, parietal lobes were the most common areas of brain involvement. The cerebellum and thalamus were the least common areas of brain involvement. In Group 2 patients, parietal and temporal lobes were the most common areas of brain involvement. CONCLUSION: This study suggests that 99mTc-HMPAO brain imaging with fanbeam SPECT, in combination with surface three-dimensional display, is a sensitive tool for detecting regional cerebral anomalies in Sjögren's syndrome patients with and without neuropsychiatric symptoms/signs.
9330951 Liver transplant in adult Still's disease. 1997 Oct Adult Still's disease (ASD) is an uncommon form of polyarthritis associated with numerous systemic manifestations, including hepatic involvement. Rarely, liver involvement can be fatal. We describe the case of a young man with ASD with terminal liver failure who required a life saving liver transplant.
10441180 Human retrovirus-5 in rheumatic disease. 1999 Aug It has long been suggested that retroviral infection may play a role in the pathogenesis of autoimmune rheumatic disease. Particles resembling retroviruses have been reported in tissue from patients with Sjögren's syndrome, lupus and rheumatoid arthritis, and molecular mimicry between retroviral antigens and host proteins has been proposed as a mechanism of induction of autoimmunity. Since 1980, four distinct human infectious retroviruses have been discovered, HTLV-I, HTLV-II, HIV-1 and HIV-2. We recently cloned part of a new human retrovirus genome, designated human retrovirus-5 (HRV-5) and demonstrated that this is not endogenous and is therefore a novel infectious retrovirus. Because symptoms resembling arthritis, polymyositis and Sjögren's syndrome occur in individuals infected with HTLV-I and HIV-1, we investigated the possibility that HRV-5 was associated with idiopathic rheumatic disease. Using nested PCR, HRV-5 we demonstrated that proviral DNA was present in approximately 50% of synovial samples of arthritic joints and was also found in over 10% of blood samples of patients with rheumatoid arthritis and systemic lupus erythematosus. HRV-5 proviral DNA was not detectable in affected tissues of autoimmune diseases and was found in only one of over 200 tissues taken at autopsy from non-rheumatoid patients. Sequence analysis of the amplified viral segment showed genetic variation between samples with maintenance of the open reading frame typical of a replicating infectious retrovirus. Thus HRV-5 appears to be a human retrovirus found with a very low genome copy number in most tissues, but which is increased to detectable levels in inflamed joints and blood from patients with rheumatic disease. Whether HRV-5 is aetiologically important in these diseases remains to be determined.
24383590 Study on sensitivity and specificity of diagnostic criteria for early rheumatoid arthritis 2000 Sep Abstract Sensitivity and specificity were compared among the American College of Rheumatology (ACR) 1987 classification criteria, the Yamasaki diagnostic criteria, and the Japan Rheumatism Association (JRA) diagnostic criteria for early rheumatoid arthritis (RA). The study included 90 patients who consulted our department for the first time within 1 year after onset and were suspected of having RA (final diagnosis: RA 45 cases, non-RA 45 cases). We investigated whether physical and laboratory findings at the first examination met these three sets of criteria to determine the sensitivity and specificity of each set of diagnostic criteria. Moreover, the sensitivity and specificity of each item in the diagnostic criteria set were similarly determined. The sensitivity of the ACR 1987 classification criteria, the Yamasaki diagnostic criteria, and the JRA diagnostic criteria for early RA were 71.1%, 88.9%, and 95.6%, respectively, and their specificities were 100%, 93.3%, and 77.8%, respectively. In a study on each diagnostic item, observation for 1 week was considered to be sufficient for morning stiffness, swelling in three joint areas, and symmetrical swelling, while observation for a more prolonged period seemed to be necessary for swelling of the finger and hand joints. The Yamasaki diagnostic criteria are appropriate for the diagnosis of early RA, while the JRA diagnostic criteria are suitable for screening.
19078343 Rheumatoid arthritis complicated by mycobacterium tuberculosis are there characteristics p 1999 Feb Several studies have reported that the emergence of mycobacterium tuberculosis (TB) is increasing, and that it may be a critical complication of rheumatoid arthritis (RA). Thus, we assessed the clinical and immune status of RA patients with TB to look for features that might favor infection. Seven RA patients with a history of TB and 62 RA patients without TB were compared in terms of background, RA disease activity, and the concentrations of serum soluble cell surface markers (sCD4, sCD8 and sCD23). There were no differences in RA activity between the two groups. It is noteworthy that the RA patients with TB had not been treated with immunosuppressives. Counts of lymphocytes, but not neutrophils, were significantly less in the RA patients with previous TB than in those without TB. The serum concentration of sCD23, a marker of B cell activation, was significantly higher in the RA with TB group. There was also a nonsignificant but considerable difference in the mean sCD8 concentration between the two groups. These results suggest that B cell and possibly also T cell activation is prominent in the RA patients with a history of TB, and that lymphocyte activation might explain in part the high susceptibility of RA patients to TB.
9676774 Contrasting cytokine profiles in the synovium of different forms of juvenile rheumatoid ar 1998 Jul OBJECTIVE: To determine the pattern of expression of Type 1 and Type 2 cytokines in synovial tissues and fluids (SF) of patients with different forms of juvenile rheumatoid arthritis (JRA) and juvenile spondyloarthropathy (JSpA), and to contrast these with findings in adult patients with RA. METHODS: Sixty-three SF mononuclear cell preparations and synovial tissue samples from 50 patients with JRA or JSpA and 7 synovial tissues from patients with adult onset RA were analyzed by reverse transcription polymerase chain reaction for the presence or absence of interleukin 2 (IL-2), tumor necrosis factor-beta (TNF-beta), interferon-gamma (IFN-gamma), and IL-10 and IL-4 mRNA. RESULTS: IL-4 mRNA was identified significantly more often in the synovial compartment of patients with pauciarticular onset disease (JRA or JSpA) compared with polyarticular onset JRA (58 vs 14%; p < 0.01) or RA (29%). Similarly, IL-4 mRNA was detected more often in those with a persistently pauciarticular disease course compared to those with a polyarticular course (68 vs 30%; p < 0.01). Furthermore, the combination of IL-4 and IL-10 mRNA was found more frequently in nonerosive compared with erosive disease (38 vs 15%; p < 0.05). IL-2 and TNF-beta mRNA were found in all groups. IFN-gamma mRNA was detected in 33% of those with systemic onset JRA compared with 85% of other types of JRA (p < 0.01). CONCLUSION: This study provides further evidence of immunopathological differences between chronic forms of arthritis with childhood onset, and highlights similarities with and differences from adult RA. Our findings suggest that IL-4, possibly in combination with IL-10, has an antiinflammatory or disease restricting role.
12973440 The SCID mouse--a novel experimental model for gene therapy in human rheumatoid arthritis. 1999 Apr Rheumatoid arthritis (RA) is characterized by a progressive destruction of joints accompanied by synovial hyperplasia, inflammation and autoimmune phenomena. RA is a common disease, but current animal models resemble human RA only to a limited extent. As recent experimental approaches support the concept that T-cell-independent pathways may play a major role in RA, we developed a severe combined immunodeficient (SCID) mouse model to study the molecular and cellular interaction between RA synovium and cartilage. Both RA synovium as well as isolated RA synovial fibroblasts were able to invade and degrade normal human cartilage when coimplanted under the renal capsule of the SCID mice. Subsequently, we used this model to study the effects of retrovirus-based gene transfer of potentially inhibitory molecules into human RA synovial fibroblasts. Overexpression of interleukin (IL)-1 receptor antagonist reduced perichondrocytic cartilage degradation, but did not affect the invasiveness of RA synovial fibroblasts. Overexpression of tumor necrosis factor (TNF)-alpha receptor p55 revealed only a marginal effect. However, overexpression of IL-10 showed a most remarkable inhibition of cartilage destruction mediated by synovial fibroblasts. The SCID mouse model is a most useful tool not only to study the molecular basis of cartilage destruction, but also to evaluate novel approaches of gene therapy.
9795783 CRP levels in autoimmune disease can be specified by measurement of procalcitonin. 1998 Sep Autoimmune diseases (AID) are prone to infection particularly under immunosuppression. The differentiation of infection from active AID is often difficult. In order to specify the diagnostic value of measurement of procalcitonin (PCT) in AID 81 patients with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis were analyzed, 27 with rheumatoid arthritis and 25 patients with systemic lupus erythematosus at various stages of the disease. Although PCT levels (95th percentile) were below 0.5 ng/ml in patients with active systemic lupus erythematosus and rheumatoid arthritis, the cutoff for normal values (95th percentile) in patients with active ANCA-positive vasculitis was 0.89. Therefore PCT levels of < 1 ng/ml are recommended as cutoff for invasive infections in patients with ANCA-positive vasculitis. In view of the increased mortality under immunosuppression in patients with AID and additional bacterial infection the measurement of PCT is helpful when an infectious origin is suspected.
9400823 Rapid induction of neutrophil apoptosis by sulfasalazine: implications of reactive oxygen 1997 Dec Accumulating evidence indicates that neutrophils are crucially involved in the pathogenesis of inflammatory bowel diseases and rheumatoid arthritis. We therefore investigated the effect of sulfasalazine (SSZ), which is widely used in the treatment of these diseases, on neutrophil apoptosis in vitro. The apoptosis of neutrophils was determined by morphology, a DNA histogram of propidium iodide-stained nuclei, and DNA fragmentation. SSZ rapidly accelerated the rate of spontaneous neutrophil apoptosis within clinically relevant concentrations. This effect is unique to neutrophils because other types of leukocytes and a number of leukocyte cell lines are resistant to SSZ. Neutrophil apoptosis caused by SSZ was abrogated by a tyrosine kinase inhibitor, a protein kinase A inhibitor, and antioxidants. The subsequent results provided pharmacological evidence that the phosphorylation of tyrosine kinase and protein kinase A and generation of reactive oxygen species are involved in SSZ-mediated neutrophil apoptosis. These data suggest that SSZ-induced neutrophil apoptosis may account, in part, for the clinical benefits of SSZ on inflammatory bowel diseases and rheumatoid arthritis.
24383635 Renal function estimated from serum creatinine is overestimated in patients with rheumatoi 2000 Dec Abstract We evaluated the reliability of serum creatinine concentration (Scr) to estimate renal function in patients with rheumatoid arthritis (RA). To quantify muscle volume (study 1) the lean body mass (LBM) in 25 women RA patients and 10 controls was measured using dual X-ray absorptiometry (DEXA). The 60-min creatinine clearance (Ccr60) and 60-min urinary excretion of creatinine (Ucr60) were also determined. The Ucr60 and LBM of the extremities, which were significantly correlated (r = 0.757, P < 0.0001), were lower in patients with long-standing and advanced RA than in controls. In study 2, the 24-h creatinine clearance (Ccr24) and 24-h urinary excretion of creatinine (Ucr24) were determined retrospectively in 82 women RA patients and 120 controls with normal Scr. The Ccr of long-standing and advanced RA patients was significantly lower than that of the controls, although the Scr of the long-standing RA patients was significantly lower than that of the advanced RA patients. The upper limit of the normal Scr for RA patients was calculated as being approximately 10% lower than that for controls. Thus, the renal function estimated from Scr may be overestimated in patients with long-standing and advanced RA because of their muscle atrophy.
18465594 Potential of phosphodiesterase type of IV inhibitors in the treatment of rheumatoid arthri 1998 Sep Rheumatoid arthritis (RA) is a crippling autoimmune disease which afflicts over 1% of the population. Non-steroidal anti-inflammatory drugs are widely used palliatives, but these disease-modifying drugs are of variable and limited efficacy, and are frequently associated with side-effects which restrict their use. Agents that elevate cAMP, including cAMP-specific phosphodiesterase (PDE) inhibitors, possess a profile of anti-inflammatory activities which suggest potential benefit in RA. In several rodent RA models, PDE IV inhibitors reduce the incidence and severity of disease symptoms and histological analysis reveals a significant, beneficial effect on joint pathology. Several potential mechanisms may underpin the anti-arthritic actions of PDE IV inhibitors. These include inhibition of tumor necrosis factor (TNF)-alpha release, increase of interleukin (IL)-10 release, and suppression of T-lymphocyte function, as well as direct, protective effects on cartilage and bone. Although stimulation of the hypothalamic-pituitary-adrenal axis in rodents has previously been suggested as a possible mechanism by which PDE IV inhibitors exert their anti-arthritic effects, recent data question its importance. For example, RP-73401 ameliorates disease severity in Streptococcal cell wall-induced arthritis in Lewis rats, a strain whose susceptibility to this disease has been attributed to a defective HPA response, without affecting either ACTH or corticosterone levels. In a small clinical study, RA patients treated with low doses of RP-73401, showed a positive (non-significant) trend in respect of serum concentrations of IL-6 and CRP. Although levels of TNFalpha and IL-1beta were unaffected, patients reported some symptomatic relief. The administration of higher doses was prohibited due to side-effects and compounds with an improved therapeutic window will have to be identified to further explore the potential of PDE IV inhibitors in the treatment of RA.
9762808 Polypoid bronchial lesions due to Scedosporium apiospermum in a patient with Mycobacterium 1998 Sep A 69 yr old female was hospitalized for further examination of abnormal shadows on chest radiographs. She had a history of tuberculous pleurisy, rheumatoid arthritis and gold-induced interstitial pneumonia. On admission she still suffered from rheumatoid arthritis. A chest computed tomography scan on admission showed clusters of small nodules in subpleural regions of both lungs combined with bronchiectasis. Mycobacterium avium complex was cultured repeatedly from the sputum. Bronchoscopic examination disclosed white-yellow polypoid lesions in the orifice of the left B4 bronchus. Cultures of the brushing specimen of the polypoid lesions and bronchial aspirates from the B4 bronchus yielded smoky-grey mycelial colonies that were later identified as Scedosporium apiospermum. It was concluded that the polypoid bronchial lesions due to Scedosporium apiospermum were formed in the preexisting dilated bronchus caused by Mycobacterium avium complex pulmonary disease.