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ID PMID Title PublicationDate abstract
24383591 The relationship between fatigue, coping behavior, and inflammation in patients with rheum 2000 Sep Abstract This research investigated the relationships among the severity of inflammation, the extent of fatigue, and fatigue symptoms, and the relationship between fatigue and coping behavior in patients with rheumatoid arthritis (RA). Our study group consisted of 177 female patients with RA (105 women with CRP > 0.5 mg/dl and ESR > 30 mm/h (inflammatory group) and 72 women with CRP ≦ 0.5 and ESR ≦ 30 (noninflammatory group)) and 81 age-matched healthy women (control group) who were given self-assessment questionnaires. The extent of fatigue was higher in the inflammatory group than in the noninflammatory and control groups. The characteristics of fatigue symptoms in the inflammatory group were "decline in the strength to carry on the activities of daily life" and "difficulty in performing daily activity." The patients in the inflammatory group adopted a technique of "reducing the burden on the body" as a pattern of coping behavior for reducing fatigue. The extent of fatigue and fatigue symptoms perceived by RA patients is strongly related to the severity of inflammation, and these patients adopt a coping behavior in response to the extent of fatigue and subjective symptoms.
10529110 Arginine carboxypeptidase (CPR) in human plasma determined with sandwich ELISA. 1999 There are two types of carboxypeptidases present in human blood, carboxypeptidase N (CPN) and arginine carboxypeptidase (CPR). CPR is generated during coagulation from a precursor (proCPR) which can be converted to the active form by trypsin in vitro. Since it is difficult to distinguish the two types of carboxypeptidases in human blood by the measurement of enzyme activity, we established a quantitative sandwich ELISA by which CPR can be quantitated. The amount of CPR in plasma, fresh serum and heated serum were essentially the same. Therefore the ELISA assay does not distinguish proCPR, activated CPR and inactivated CPR. With the ELISA method, CPR was quantitated in plasma from fifty patients with rheumatoid arthritis and eleven patients with severe hepatitis as well as healthy individuals. The amount of CPR in plasma obtained from patients with rheumatoid arthritis was not found to be lower than that of normal subjects. Furthermore, the patients who suffered severe hepatitis and had very low levels of CPR-total were fatal. This suggests that a decrease of CPR level might be a good indication of a patient's prognosis to death by hepatitis.
10319213 Health services research. 1999 Mar In the past year, several publications have reported on aspects of health services research in regard to musculoskeletal disorders. Utilization studies in the elderly have shown that an effective procedure such as hip arthroplasty may be underused in this population. As well, surgical complications in these patients appear to vary according to the number of procedures performed in a hospital, with high-volume hospitals showing better outcomes. Studies of practice patterns show variations among rheumatologists in the treatment of various rheumatic diseases. Practice variations between physician groups, in particular, rheumatologists versus primary care providers, have also been reported. Several studies show that primary care physicians may have some difficulties in diagnosing common rheumatic disorders. There is some evidence as well that rheumatologists may provide better care for some conditions, such as rheumatoid arthritis. These findings have major implications for restrictions to patient access to specialist care by health organizations. A variety of clinical practice guidelines have been developed and tested, most aimed at general practitioners. Physician compliance with guidelines continues to be low for most implementation strategies. Multidisciplinary programs for the treatment of rheumatoid arthritis appear to have a somewhat beneficial effect. Programs based only on patient education appear to have short-term gains, and longer-term effects are diluted because of noncompliant behaviors.
10065630 Genetic regulation of macrophage activation: understanding the function of Nramp1 (=Ity/Ls 1999 Jan The Nramp1 gene was originally described as Ity/Lsh/Bcg, a single gene controlling resistance and susceptibility of inbred mice to a range of intramacrophage pathogens. Functional studies demonstrated that Ity/Lsh/Bcg had multiple pleiotropic effects on macrophage activation pathways, broadening interest in the gene to include its candidacy as an autoimmune disease susceptibility gene. In 1993 the gene was positionally cloned and found to encode a polytopic integral membrane protein of unknown function. Subsequent studies have localized the protein to late endosomal and lysosomal compartments, and demonstrated that it functions as an iron transporter. Precisely how this function influences macrophage activation pathways is still under investigation, but is likely to include direct effects on pathogen survival in the endosomal/lysosomal compartment as well as influences on intracellular signalling pathways and in regulating mRNA stability. Several studies now provide evidence for a role for NRAMP1 in determining human susceptibility to autoimmune (rheumatoid arthritis. juvenile rheumatoid arthritis, diabetes, Crohn's disease) and infectious (tuberculosis, leprosy) diseases. Amongst these. data are accumulating to support the hypothesis that a functional Z-DNA forming repeat polymorphism in the promoter region of human NRAMP1 contributes directly to disease susceptibility. Four alleles have been observed, alleles 1 and 4 are rare (gene frequencies approximately equal to 0.001), alleles 2 and 3 occur at gene frequencies approximately 0.25 and approximately 0.75, respectively. In the absence of exogenous stimuli, alleles 1, 2 and 4 are poor promoters of gene expression in a luciferase reporter gene system; allele 3 drives high expression. Allele 3 shows allelic association with autoimmune disease susceptibility, allele 2 with infectious disease susceptibility. Hence, balancing selection is likely to be maintaining these two alleles in human populations. Although the association of NRAMP1 with autoimmune disease susceptibility may be related to any one of the multiple pleiotropic effects associated with macrophage activation, the function of NRAMP1 as an iron transporter now prompts more interesting speculation that regulation of iron transport may contribute directly to the disease phenotype in arthritic disease. Patients suffering from rheumatoid arthritis show increased deposition of iron in the synovial membrane, which may contribute to free radical generation and local inflammation. Further analysis of NRAMP1 function will continue to be of importance in understanding the molecular basis to autoimmune and infectious disease susceptibility.
9416862 Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthrit 1997 Dec OBJECTIVE: The goal of this study was to evaluate the physical and psychosocial impact of juvenile rheumatoid arthritis (JRA) among a population-based cohort of adults who had the disease during childhood, compared with a control cohort of subjects with no history of JRA. METHODS: The Rochester Epidemiology Project database was used to identify all cases of JRA (based on the American College of Rheumatology [formerly, the American Rheumatism Association] 1977 criteria) among Rochester, Minnesota residents first diagnosed between January 1, 1960 and December 31, 1993. Controls were age- and sex-matched to the cases as of the date of diagnosis of JRA. A pretested postal survey was mailed to all adult cases (whose date of birth was before December 31, 1975) and matched controls from the same population, to obtain information on socioeconomic issues and functional status (using the Health Assessment Questionnaire and the Health Status Questionnaire). The complete medical records of all cases and controls were reviewed to obtain information on demographics and clinical manifestations of JRA. RESULTS: Of the 50 eligible cases, 44 (88%) responded to the survey. There were 102 age- and sex-matched controls (2-3 per case) who responded to the survey. Seventy-three percent of the cases had pauciarticular-onset JRA, 16% had polyarticular-onset JRA, and 11% had systemic-onset JRA. Average followup was 24.7 years and 24.5 years after the index date for cases and controls, respectively. Greater disability (P = 0.0002), more bodily pain (P = 0.0002), increased fatigue (P = 0.0112), poorer health perception (P = 0.0004), and decreased physical functioning (P = 0.0002) were reported by the cases compared with the controls. JRA cases reported significantly lower rates of employment (P = 0.015) and lower levels of exercise (P = 0.0002) than did controls. Level of educational achievement, annual income, health insurance status, and rate of pregnancy and childbirth were similar for both cases and controls. CONCLUSION: Adults who have had JRA during childhood experience long-term physical and psychosocial impairment.
9041945 Juvenile rheumatoid arthritis. Effects of disease activity and recombinant human growth ho 1997 Feb OBJECTIVE: To investigate possible mechanisms of growth impairment in children with juvenile rheumatoid arthritis (JRA). METHODS: Eighteen prepubertal children with JRA and growth retardation received recombinant human growth hormone (rHuGH) for 1 year. Growth hormone profiles over 24 hours were obtained before treatment in 12 patients; the levels did not differ from those in "short normal" children. Levels of insulin-like growth factor 1 (IGF-1), IGF binding proteins (IGFBPs) 1 and 3, insulin, osteocalcin, and C-reactive protein (CRP), as well as the erythrocyte sedimentation rate were measured serially. Pretreatment levels were compared with control levels. RESULTS: In JRA patients, IGF-1, IGFBP-3, and osteocalcin levels were significantly lower and insulin levels significantly higher than those in controls, but there was no significant difference in the level of IGFBP-1. With rHuGH treatment, height velocity and mean levels of IGF-1, osteocalcin, and insulin increased significantly, while mean levels of IGFBP-1 fell significantly. Levels of IGFBP-3 correlated with those of IGF-1. The height velocity correlated positively with IGF-1 and osteocalcin, and negatively with IGFBP-1. Levels of IGFBP-1 were inversely related to those of insulin and IGF-1. There was a significant negative correlation between the CRP and height velocity, IGF-1 level, and osteocalcin level. CONCLUSION: IGF-1 production is impaired in children with active JRA. Treatment with a therapeutic dose of rHuGH can rectify the IGF-1 deficiency within 4 days, but its effect is adversely influenced by the acute-phase response, as reflected by an elevated CRP level.
24387015 The possible role of c-fos expression in rheumatoid joint destruction. 2001 Mar Abstract At present, although the etiology of rheumatoid arthritis (RA) remains unknown, most investigators believe that it is primarily an inflammatory disease of the synovial membrane of the joints. However, we have recently focused on the pathology of the early changes in articular cartilage and subchondral bone in RA patients, and have shown that RA involves articular cartilage and subchondral bone, not synovia. This research direction may lead to the development of a new specific treatment for the disease.
9416861 The long-term effect of methotrexate therapy on the liver in patients with juvenile rheuma 1997 Dec OBJECTIVE: To determine if the long-term use of methotrexate (MTX) in juvenile rheumatoid arthritis (JRA) is associated with the development of significant liver fibrosis, and to describe the presence of risk factors for liver fibrosis in patients with JRA. METHODS: Needle biopsies of the liver were performed on a cross-section cohort of 14 patients with JRA who had received a total cumulative dose of MTX that was either > 3,000 mg or > 4,000 mg/1.73 m2 of body surface area. Biopsy samples were independently graded according to the Roenigk Classification Scale by 2 pathologists. The presence of risk factors for MTX hepatotoxicity, especially biochemical abnormalities reflective of liver injury and alcohol consumption, were assessed. RESULTS: Thirteen biopsy samples (93%) were classified as grade I, and 1 (7%) as grade II; none demonstrated significant fibrosis. However, histologic abnormalities were found in 13 biopsy samples (93%). Only 2 patients (14%) consumed more than 1 alcoholic drink per month. Thirteen patients (93%) had biochemical abnormalities while being treated with MTX, but only 5 patients (36%) had at least 1 determination in which the aspartate or alanine aminotransferase elevation was > 3 times the upper limit of normal. CONCLUSION: Long-term use of MTX for JRA does not appear to be associated with the development of significant liver fibrosis. Although nearly all patients had minor histologic changes, no significant clinical consequences were apparent. A prospective study of a larger population will more accurately define the incidence of MTX-related liver fibrosis and appropriate monitoring guidelines in JRA.
9214249 Proximal bursitis in active polymyalgia rheumatica. 1997 Jul 1 BACKGROUND: The cause of musculoskeletal symptoms in the proximal extremities of patients who have polymyalgia rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. OBJECTIVE: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of polymyalgia rheumatica. DESIGN: Case-control study. SETTING: 2 secondary referral centers of rheumatology. PATIENTS: 13 case-patients who had active symptoms of polymyalgia rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. MEASUREMENTS: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. RESULTS: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had polymyalgia rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. CONCLUSIONS: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with polymyalgia rheumatica.
10728757 Myeloid-related proteins 8 and 14 are specifically secreted during interaction of phagocyt 2000 Mar OBJECTIVE: To analyze which physiologic stimuli induce secretion of myeloid-related protein 8 (MRP8) and MRP14, two S100 proteins expressed in neutrophils and monocytes, and to determine whether serum concentrations of these proteins are reliable parameters for monitoring inflammatory activity in pauciarticular juvenile rheumatoid arthritis (JRA). METHODS: Secretion of MRP8 and MRP14 was analyzed using a coculture system of endothelial cells and monocytes. Concentrations of MRP8/MRP14 in the serum and synovial fluid of JRA patients or culture medium were determined by enzyme-linked immunosorbent assay. The expression of MRP8 and MRP14 by leukocytes in synovial tissue or fluid was investigated using immunohistochemistry. RESULTS: MRP8 and MRP14 were specifically released during interaction of activated monocytes with tumor necrosis factor-stimulated endothelial cells. Secretion was mediated via an increase in intracellular calcium levels in monocytes. In contrast, contact with resting endothelium inhibited protein kinase C-induced secretion of the proteins by monocytes. In JRA patients, MRP8 and MRP14 were strongly expressed in infiltrating neutrophils and monocytes within the inflamed joints and could be found in significantly higher concentrations in synovial fluid (mean 42,800 ng/ml) compared with serum (2,060 ng/ml). Concentrations of MRP8/MRP14 in serum correlated well with those in synovial fluid (r = 0.78) and showed a strong correlation with disease activity (r = 0.62). After intraarticular triamcinolone therapy, the serum concentrations of MRP8/MRP14 decreased significantly in therapy responders, whereas no differences were found in patients who showed no clinical benefit. CONCLUSION: MRP8 and MRP14 are specifically released during the interaction of monocytes with inflammatory activated endothelium, probably at sites of local inflammation. Their serum concentrations represent a useful marker for monitoring local inflammation in JRA.
9751094 Transmission disequilibrium as a test of linkage and association between HLA alleles and p 1998 Sep OBJECTIVE: To determine if HLA class I and II alleles previously found to be associated with (or protective against) pauciarticular-onset juvenile rheumatoid arthritis (pauci-onset JRA) in population-association studies are transmitted from heterozygous parents to an extent different from the expected 50%. METHODS: One hundred one Caucasian North American families that had a child with pauci-onset JRA and at least 1 parent who was heterozygous for the allele of interest were available for analysis. Both biologic parents and all children (affected and unaffected) were typed for HLA class I and II alleles. The transmission disequilibrium test (TDT) was used to determine if affected offspring received the disease-associated (or protective) allele more (or less) frequently than its alternate allele. In families in which an unaffected sibling was available, the unmatched chi-square test was used to determine if a meiotic segregation distortion bias existed. RESULTS: HLA class I alleles A2, B27, and B35 showed a significantly higher than expected frequency of transmission to affected offspring, as did class II alleles DR5 and DR8. HLA-DR4 was found to be transmitted significantly less frequently than expected to affected, but not unaffected, offspring. All alleles that showed an excess transmission to affected offspring were transmitted to unaffected offspring at expected rates. When the data were stratified by age and sex, the likelihood of transmission of some of the alleles was strongly influenced by these variables. For example, excess transmission of HLA-DR5 was found exclusively in female patients who were younger at the time of disease onset. CONCLUSION: Results from these family-based studies rule out the possibility that HLA disease associations found in earlier studies were a result of population stratification and establish linkage and association between the major histocompatibility complex and pauci-onset JRA.
11036842 Parvovirus arthropathy outbreak in southwestern United States. 2000 Oct OBJECTIVE: We describe an outbreak of parvovirus (PV) arthropathy that was detected in a rheumatology clinic in San Antonio, Texas, during the winter of 1994. Parvovirus B19 causes acute symmetric polyarthritis (ASPA) in adults. In the US, the majority of cases described are from the northern US. METHODS: An outbreak of PV arthropathy was monitored in a San Antonio area rheumatology clinic. RESULTS: Of the 16 affected patients, 69% were female, ages ranging from 23 to 60 years; 75% had close contact with children, 58% of whom were exposed to children with clinical PV. All patients noted an acute arthritis except for 2 patients with polyarthralgias. The most common presentation was ASPA (9/16), with 10/16 complaining of viral prodrome, and 5/16 having a nonspecific rash, but none with the typical "slapped cheek" appearance. Eleven patients had an ASPA at some time in their illness. Of these, 3 had a true migratory arthritis that developed into an ASPA and another 2 were additive. Two additional patients had persistent asymmetric polyarthritis. The most common joints involved were the metacarpophalangeals, proximal interphalangeals, wrists, and knees. Most patients' syndromes lasted < 6 weeks, but 3 patients had symptoms that lasted longer than 6 months. Eight of 10 had elevated erythrocyte sedimentation rate. Rheumatoid factor was detected in 3 patients and antinuclear antibody in 2. All patients were treated symptomatically with nonsteroidal antiinflammatory drugs and a few also received low dose corticosteroids. Because of suspicious clinical presentations, 2 patients were presumed to have gonococcal arthritis before PV titers were available. CONCLUSION: This is the first large series on adults with PV arthropathy reported in the southern US. In contrast to the usual features of ASPA, the outbreak appears unique in that almost 40% of cases presented with a true migratory arthritis.
9153553 Reduction in the incidence and severity of collagen-induced arthritis in DBA/1 mice, using 1997 May OBJECTIVE: This study examined the effect of exogenous dehydroepiandrosterone (DHEA) on the onset, incidence, and severity of collagen-induced arthritis (CIA). METHODS: DHEA was administered subcutaneously prior to arthritis induction in DBA/1 mice, and the severity of the subsequent arthritis was monitored. Serum levels of total IgG and IgG isotype-specific anti-murine type II collagen were measured. RESULTS: Repeated administration of DHEA during arthritis induction delayed the onset and decreased the severity of arthritis in male and female DBA/1 mice. DHEA failed to have an observable effect on established arthritis. IgG isotype autoantibody levels were found to be decreased in the sera of DHEA-treated mice. CONCLUSION: Administration of exogenous DHEA offered protection against the development of CIA. These data support the results of human studies in which low DHEA levels have been identified as a potential risk factor for the development of rheumatoid arthritis. These findings also highlight DHEA as a potential therapy worthy of further investigation.
17039176 Open trial of leflunomide for refractory psoriasis and psoriatic arthritis. 2001 Dec Leflunomide was recently approved for the treatment of rheumatoid arthritis. Its role in the treatment of psoriasis and psoriatic arthritis is unclear. Twelve consecutive psoriatic arthritis patients who had not responded to at least one disease modifying anti-rheumatic drug (DMARD) were started on leflunomide alone or in addition to another DMARD. Global assessment of improvement in psoriasis and psoriatic arthritis by the treating rheumatologist was scored on a 0-3 scale. After 2-3 months of treatment, 8 patients had moderate to marked improvement in both psoriasis and psoriatic arthritis. The improvement in modified tender joint counts, patient's global assessments, and grip strengths was statistically significant. However, physicians' global assessments and the modified swollen joint counts did not reach a significant difference. Three patients whose toxicity necessitated the temporary discontinuation of the drug were able to resume the drug at lower dosage with clinical benefit. Leflunomide may prove to be a useful agent for the treatment of recalcitrant cases of psoriasis and psoriatic arthritis.
10375868 HLA-DMA and HLA-DMB genotyping in patients with rheumatic diseases. 1999 May To investigate the correlation of HLA-DMA and DMB alleles to some rheumatic diseases, HLA-DMA and DMB genes were detected in 11 patients with juvenile rheumatoid arthritis (JRA), 22 patients with psoriatic arthritis, 26 patients with Behcet's disease, 62 patients with ankylosing spondylitis (AS), and 138 unrelated healthy controls. There was no significant difference in phenotypic frequencies of HLA-DMA and DMB alleles between controls and patients with these rheumatic diseases. HLA-DMA and DMB genes are not related to the susceptibility of JRA, psoriatic arthritis, Behcet's disease, and AS.
9216639 Effects of cytogenin, a novel microbial product, on embryonic and tumor cell-induced angio 1997 May Cytogenin (8-hydroxy-3-hydroxymethyl-6-methoxyisocoumarin) is a new microbial product with antitumor and antirheumatoid arthritis effects in vivo when administered orally, although its mechanism(s) of action is not known well. Both neoplasia and rheumatoid arthritis are referred to as angiogenesis-dependent diseases. The aim of the present study was to investigate the effects of cytogenin on both physiological and pathological angiogenesis, using the growing chick embryo chorioallantoic membrane and mouse dorsal air sac assay systems, respectively. The microbial product at doses up to 100 micrograms/egg did not significantly affect embryonic angiogenesis when topically placed on the surface of the chorioallantoic membrane, suggesting that it has no effect on the physiological (or normal) angiogenic response. By contrast, systemic administration of cytogenin (100 mg/kg p.o., for 5 consecutive days) significantly suppressed angiogenesis induced by malignant tumor cells (S-180), one of pathological neovascularization, in a mouse dorsal air sac assay system. Pharmacokinetic studies in mice revealed that the maximal concentration of cytogenin in plasma after a single 100 mg/kg oral dose of the compound was 32 microM. In vitro experiments involving cultured vascular endothelial cells showed that cytogenin at concentrations determined by pharmacokinetic study, had little effect on plasminogen activator secretion, tube formation and the proliferation of endothelial cells. These results suggest that cytogenin is a novel oral antiangiogenic agent, that the mechanism of its antiangiogenic action contributes to its suppressive effects on both tumor growth and rheumatoid arthritis that we previously found, and that it could be developed as a potential therapeutic agent for cancer, rheumatoid arthritis and other angiogenesis-dependent disorders such as diabetic retinopathy.
17039147 Pyogenic arthritis caused by capnocytophaga gingivalis in an immunocompetent three-year-ol 2001 Aug Capnocytophaga gingivalis is most often isolated as normal oral flora or with periodontal disease. This organism is also associated with sepsis usually in immunocompromised hosts. We identified pyogenic arthritis caused by C. gingivalis in a 3-year-old immunocompetent male, whose clinical course closely resembled monoarticular onset pauciarticular juvenile rheumatoid arthritis. This is the first report of C. gingivalis septic arthritis in the world literature, but there are increasing reports of infections with this carbon dioxide-loving organism at other sites in non-immunocompromised individuals. The subacute presentation of the monoarthritis with this organism of low virulence led to a long delay in diagnosis and treatment. Any monoarthritis must continue to raise concern about infection.
10996515 Antioxidant enzymes; possible mechanism of gold compound treatment in rheumatoid arthritis 2000 Sep Reactive oxygen species play a critical role in inflammatory processes including rheumatoid disorders. Antioxidant therapy strategies have been postulated for the treatment of rheumatoid diseases. In this study, we investigated activities and therapeutic implications of antioxidant enzymes in rheumatoid disorders. Activities of antioxidant enzymes glutathione peroxidase, glutathione reductase and catalase were examined in the blood of rheumatic patients and healthy controls. Activity of catalase was decreased significantly, while activities of glutathione peroxidase and glutathione reductase remained unchanged. Thioredoxin reductase is an antioxidant enzyme having an important regulatory task of thiol redox status and intracellular signaling processes coupled with the glutathione system. We also observed that in liver mitochondrial calf thioredoxin reductase was inhibited by antirheumatic drug goldthioglucose in the manner similar to intracellular thioredoxin reductase. Furthermore, during the treatment by goldthioglucose, gold is accumulated in lysosomes of macrophages. Our results suggest that although antioxidant enzyme activities were down-regulated in rheumatoid patients, we can decrease ROS generation by macrophages via inhibition thioredoxin reductase by goldthioglucose.
15989645 Gene therapy for arthritis. 1997 Jul In the two years since arthritis gene therapy was last reviewed in this journal, there has been rapid progress on several fronts. Although vector development remains a slow process and long-term gene expression is not easily obtained, very encouraging preclinical data in animal models of arthritis are now emerging. Collectively, these demonstrate the principle that transfer of cytokine antagonist genes to joints has a marked anti-arthritic effect. Other options under active investigation are the transfer of cytotoxic genes to effect a surgical synovectomy, and the transfer of oligonucleotides that antagonise the actions of transcription factors. Two human clinical trials of gene therapy for rheumatoid arthritis have been initiated. There are now preliminary data suggesting that gene therapy may also be helpful in osteoarthritis, as well as in the repair of cartilage, meniscus, ligaments, tendons and bones.
9304271 [Mycobacterium marinum. A rare cause of infection of the skin and joints]. 1997 Sep 1 Mycobacterium marinum is a rare cause of disseminated infection in man. The case report describes an 80-year-old woman, who had been treated with oral corticosteroids for bronchial asthma for 40 years, and in the same period had been swimming daily in swimming pools. At the first admission, the symptoms and clinical findings were interpreted as seronegative rheumatoid arthritis. After eight years of disease with recurrent infections of the skin, periarticular tissues and joints in the hands and one elbow, a biopsy specimen from an abscess showed granulomatous inflammation and acid fast bacilli. Culture for mycobacteria grew M. marinum. There was a severe, destructive monoarthritis in the right second metacarpophalangeal joint. The patient recovered completely on treatment with clarithromycin and doxycycline.