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ID PMID Title PublicationDate abstract
10362033 Increased nitric oxide in expired air in patients with Sjögren's syndrome. BHR study grou 1999 Apr Nitric oxide has an important role in the regulation of airway function and can have pro-inflammatory effects. Bronchial hyperresponsiveness (BHR) and respiratory symptoms are common in patients with Sjögren's syndrome (SS). The aim of this study was to determine whether patients with SS have an increased amount of exhaled NO and whether this NO correlates with respiratory symptoms and BHR. Exhaled NO was measured in 18 patients with SS and 13 normal subjects on three different occasions with intervals of at least 3 days using a chemiluminescence method. Airway responsiveness was assessed with methacholine provocation. Serum levels of myeloperoxidase (MPO), human neutrophil lipocalin (HNL), eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO) were measured. Exhaled NO was significantly higher in patients with SS than in controls (147+/-82 versus 88+/-52 nL x min(-1); mean+/-SD; p=0.041). Exhaled NO was correlated with age (partial r=0.52, p=0.006) and serum HNL (partial r=0.46, p=0.014). There were no significant correlations between exhaled NO and respiratory symptoms, BHR or serum MPO, ECP or EPO. Disease duration was negatively associated with serum MPO (r=-0.47, p=0.043). In patients with SS, a positive correlation was found between symptom score and serum ECP (partial r=0.65, p=0.003) and EPO (partial r=0.62, p=0.004) and a negative correlation with age (partial r=-0.60, p=0.005). In conclusion, elevated levels of exhaled nitric oxide in patients with Sjögren's syndrome were demonstrated. The mechanism underlying this increase in exhaled nitric oxide in Sjögren's syndrome is not known.
10713648 Primary Sjögren's syndrome in men: clinical and immunological characteristics. 2000 OBJECTIVE: To determine the clinical and immunological characteristics of primary Sjögren's syndrome (SS) in men from a large series of unselected patients with this condition. METHODS: We studied 223 consecutive patients (204 women and 19 men; mean age at onset 53 y, range 15-87 y, mean disease duration 77 months) with primary SS visited in our units. All these patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. RESULTS: Nineteen (9%) patients were men and they represent the male group described in this paper. Extraglandular manifestations during the course of their disease were present in 10 (53%) of our male patients with primary SS: articular involvement in 4 (21%) patients, interstitial pneumopathy in 3 (16%) and peripheral neuropathy in 2 (11%). ANA were positive in 13 (68%) patients, RF in 5 (31%), anti-Ro/SS-A in 3 (16%) and cryoglobulins in 1/14 (7%). When compared with women, men with primary SS presented a lower prevalence of articular involvement (21 percent; vs 46%, P=0.03, OR 0.32, CI 0.07-0.97). CONCLUSION: Although primary SS is typically a disease of middle-aged women, clinicians should note that it may be diagnosed in male patients. Except for a lower prevalence of articular involvement, we could no find any notable differences in clinical and immunological characteristics between male and female patients with primary SS.
10616008 Association of the glutathione S-transferase M1 homozygous null genotype with susceptibili 1999 Dec OBJECTIVE: To investigate the role of polymorphisms of the glutathione S-transferase M1 (GSTM1) and GSTT1 genes in determining susceptibility to Sjögren's syndrome (SS) and autoantibody production. METHODS: Polymorphisms of the GSTM1 and GSTT1 genes in 106 Japanese patients with primary SS and in 143 healthy controls were analyzed by polymerase chain reaction. RESULTS: Frequency of the GSTM1 homozygous null genotype was significantly increased in SS patients compared with controls (57.5% versus 44.1%; P = 0.035). Moreover, a significantly greater frequency of SSA antibodies was found among SS patients with the GSTM1 null genotype than among those with the GSTM1 non-null genotype (P = 0.0013). Frequency of the GSTT1 polymorphism was not different between SS patients and controls. CONCLUSION: The GSTM1 homozygous null genotype could be a genetic factor that determines susceptibility to SS and may be involved in SSA antibody production.
9641517 Very low-dose cyclosporin treatment of steroid-resistant interstitial pneumonitis associat 1998 Cyclosporin is known to be effective for both transplantation and a spectrum of immune-mediated diseases. Because this agent also causes severe adverse effects, especially nephrotoxicity, careful monitoring is required for the development of such reactions. Here we report the successful treatment with extremely low-dose cyclosporin (1 mg/kg/day) of a patient who had steroid-resistant interstitial pneumonitis and Sjögren's syndrome.
9263166 Adult onset Still's disease associated hemophagocytosis. 1997 Aug Reactive hemophagocytosis is characterized by the activation of histiocytes with prominent hemophagocytosis in the reticuloendothelial system, and usually occurs in association with underlying disorders such as viral or bacterial infection and malignancy. We describe 3 cases of adult onset Still's disease (AOSD) who developed hemophagocytosis in bone marrow. Extensive studies could not identify any viral infection or other known underlying disorders for reactive hemophagocytosis except for active AOSD. Although the causative mechanisms of reactive hemophagocytosis in AOSD are not clear, our cases suggest the possibility of AOSD associated hemophagocytosis.
9666842 Peripheral ulcerative keratitis associated with erythema elevatum diutinum and a positive 1998 May Peripheral ulcerative keratitis (PUK) is a complication of collagen-vascular diseases such as rheumatoid arthritis (RA) and other systemic vasculitides. We report three cases of erythema elevatum diutinum with PUK. These patients presented with nodules and plaques consistent with erythema elevatum diutinum on the extremities and crusted or ulcerated purpuric lesions on the soles. Histopathological examination of these lesions revealed a dense neutrophilic infiltrate with nuclear dust and fibrin around blood vessels. All the patients developed PUK concomitant with the development of the skin lesions. The rheumatoid factor was positive at high titre in all three patients; this was associated with probable RA in one. Cutaneous lesions were dramatically improved by administration of dapsone in all cases. Dapsone was also effective in treating the ocular lesions in two patients.
9721560 [Two cases of adult Still's disease with atypical rash]. 1998 Jun Adult Still's disease is a febrile disorder of unknown etiology, characterized by spiking fever, arthralgia, leukocytosis and a typical rash. However, most of these clinical findings, except for the typical rash, are not specific to this disease: therefore, the typical rash is the most important clinical finding for diagnosing this disease and physicians often have difficulty in making a definite diagnosis without the typical rash. In our department and related institutions, we have encountered 10 patients with Adult Still's disease who fulfilled the preliminary criteria for classification as Adult Still's disease, proposed by the Adult Still's Research Committee in Japan. The three major criteria are fever, arthralgia and typical rash, and 8 of 10 patients had an atypical rash; one satisfied two major criteria, and had an atypical rash and the other satisfied three major criteria and had an atypical rash on her eyelids. Here, we present the two cases of Adult Still's disease with atypical rash. The first patient was a 36-year-old male with an itchy annular erythema chronicum migrans, frequently seen inpatients with Lyme's disease, on his back. His clinical symptoms improved and the erythema disappeared after treatment with corticosteroids. The second patient, a 17-year-old female, had three major findings. In addition to the typical rash on her face, she had a heliotrope rash, usually seen in patients with dermatomyositis, on her eyelids. The typical rash on her face was related to her other clinical manifestations, and improved after treatment with corticosteroids. However, the rash on her eyelids showed no improvement after steroid therapy, suggesting that the erythema was probably not related to Adult Still's disease. Typical rash in Adult Still's disease, defined as a macular or maculopapular nonpruritic salmon pink eruption, was demonstrated to have the highest relative value associated with relatively high sensitivity and specificity for the diagnosis of Adult Still's disease. However, we have to be aware that some patients with Adult Still's disease could also have an atypical rash.
9255377 [Severe pulmonary manifestation in adult-onset Still's disease]. 1997 Jul Adult onset Still's disease may sometimes be complicated by severe manifestations. We report here a case of adult Still's disease with acute respiratory failure requiring mechanical ventilation.
11535975 Sjogren's syndrome: direct immunofluorescence in diagnosis. 2001 Jun BACKGROUND: Sjogren's syndrome (SS) is an autoimmune inflammatory exocrinopathy. In the classical clinical presentation, diagnosis is readily achieved but this is less easy in early disease or oligosymptomatic forms. METHODS: We have used direct immunofluorescence (d.i.f.), with IgG antibodies, comparing salivary gland biopsies from subjects with SS compared with control subjects. RESULTS: Direct immunofluorescence, using antibodies anti-IgG and demonstrating positivity for all the examined champions of SS while it is negative for control biopsies. CONCLUSIONS: Direct immunofluorescence, on salivary glands by biopsy, can be considered a valid additional aid to the diagnosis of subclinical SS.
10893775 [Hypergammaglobulinemia D syndrome]. 2000 Apr The hyperimmunoglobulinemia D syndrome is characterized by early onset of attacks of periodic fever and an elevated serum polyclonal Ig D (> 100 U/ml). Symptoms during attacks include joint involvements (arthralgia/arthritis), skin lesions, swollen lymph nodes, headache and abdominal complaints (vomiting, diarrhea and pain). The ethiopathogenia is unknown. It is transmitted by autosomal recessive inheritance. The hyperimmunoglobulinemia D syndrome should be distinguished from other periodic febrile syndroms such as systemic-onset juvenile rheumatoid arthritis, CINCA syndrome, FADA syndrome, familial mediterranean fever and adult-onset Still disease. There is no therapy for the syndrome but the prognosis is good because the frequency and severity of the attacks tends to diaeminish with age.
14622831 Living with rheumatoid arthritis: the role of daily spirituality and daily religious and s 2001 Apr The objective of this preliminary study was to evaluate more fully the role of daily spiritual experiences and daily religious/spiritual coping in the experience of individuals with pain due to rheumatoid arthritis (RA). Thirty-five individuals with RA were asked to keep a structured daily diary for 30 consecutive days. The diary included standardized measures designed to assess spiritual experiences, religious and spiritual pain coping, salience of religion in coping, religious/spiritual coping efficacy, pain, mood, and perceived social support. The participants in this study reported having spiritual experiences, such as feeling touched by the beauty of creation or feeling a desire to be closer or in union with God, on a relatively frequent basis. These participants also reported using positive religious and spiritual coping strategies much more frequently than negative religious and spiritual coping strategies. Although most of the variance in these measures was due to differences between persons, each measure also displayed a significant variability in scores from day to day. Indeed, there was just as much (or more) variability in these measures over time as there was variability in pain. Individuals who reported frequent daily spiritual experiences had higher levels of positive mood, lower levels of daily negative mood, and higher levels of each of the social support domains. Individuals who reported that religion was very salient in their coping with pain reported much higher levels of instrumental, emotional, arthritis-related, and general social support. Coping efficacy was significantly related to pain, mood, and social support in that on days that participants rated their ability to control pain and decrease pain using spiritual/religious coping methods as high, they were much less likely to have joint pain and negative mood and much more likely to have positive mood and higher levels of general social support. Taken together, these results suggest that daily spiritual experiences and daily religious/spiritual coping variables are important in understanding the experience of persons who have RA. They also suggest that newly developed daily diary methods may provide a useful methodology for studying religious and spiritual dimensions of living with arthritis.
11600565 IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implica 2001 Oct Clinical observations indicate that some autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, frequently remit during pregnancy but exacerbate, or have their onset, in the postpartum period. The immune basis for these phenomena is poorly understood. Recently, excessive production of IL-12 and TNF-alpha was causally linked to rheumatoid arthritis and multiple sclerosis. We studied 18 women with normal pregnancies in their third trimester and during the early postpartum period. We report that during the third trimester pregnancy, ex vivo monocytic IL-12 production was about 3-fold and TNF-alpha production was approximately 40% lower than postpartum values. At the same time, urinary cortisol and norepinephrine excretion and serum levels of 1,25-dihydroxyvitamin were 2- to 3-fold higher than postpartum values. As shown previously, these hormones can directly suppress IL-12 and TNF-alpha production by monocytes/macrophages in vitro. We suggest that a cortisol-, norepinephrine-, and 1,25-dihydroxyvitamin-induced inhibition and subsequent rebound of IL-12 and TNF-alpha production may represent a major mechanism by which pregnancy and postpartum alter the course of or susceptibility to various autoimmune disorders.
16160943 Gene Therapy of Arthritis and Related Disorders--First International Meeting. 2-3 December 1999 Feb The number of publications on gene therapy for arthritis has shown a logarithmic growth curve during recent years. This has resulted in the need for an international platform to exchange new ideas and data. The National Institute of Health (NIH) was the host for the First International Meeting on Gene Therapy of Arthritis and Related Disorders, which was attended by over 150 participants (70% from academic, 30% from industry) from nine different countries. All the participants were active in the field, which resulted in a lively meeting that covered most aspects of this fast moving field. The meeting was organized in eight sessions (biology and targets, vectors, non-viral therapy, adenoviral therapy, rheumatoid arthritis, immunomodulation, cartilage-osteoarthritis and clinical trials). This meeting report will follow the format of the meeting.
15348029 Theoretical relationship between maximum pore size and toughness in experimental inflammat 2000 May Rheumatoid arthritis increases the risk of fracture. In an animal model of inflammatory arthritis, femoral diaphysis had a decreased toughness as well as increased cortical porosity, when compared to normal bone. Based on the hypothesis that stress concentration from the large porous defects reduces the ability of the cortical bone to resist failure, this work determined if the changes observed in porosity could explain the changes observed in toughness. Using theoretical relationships of the stress concentration and stress states, a model of the observed conditions was considered. A relationship was developed that indicated the relative difference in toughness between normal and arthritic specimens as a function of pore size. Results indicated that the increase in cortical pore size could theoretically reduce toughness by 55%. This decrease compares with the experimentally observed drop in toughness of 61%. Furthermore, the critical parameter for fracture in this situation is the ratio of pore diameter to cortical thickness. Efforts to reduce cortical porosity seen in inflammatory arthritis would be effective in enhancing the toughness of bone and may reduce morbidity in a human population.
12561996 Smears from rat liver suspension as modified substrate for antinuclear antibody test. 2001 Jan Immunofluorescence still remains a standard method for documenting antinuclear antibodies (ANA). Cryostat cut sections of rodent liver or Hep2 cell nuclei have been used as substrate in the test but are often difficult to arrange in laboratories in developing countries. Hence, a modification was developed using smears from rat liver suspensions. The smears were compared with the cryostat cut sections over 338 sera samples of suspected cases of collagen diseases, rheumatoid arthritis, thyroid disorders, hepatitis B, enteric fever, tuberculosis and normal subjects. The sera from suspected collagen diseases cases were also compared with ANA test using Hep2 cells. The modified smear technique was well comparable and the clarity of the immunofluorescence was even better than for cryostat cut sections. Using the modified smear technique 272 sera out of 2,851 sera gave positive test for ANA. The homogenous, speckled and peripheral patterns were seen for 203, 66 and 3 samples respectively. To conclude: The smears prepared from homogenised rat liver suspension and fixed like bacterial smears offer a very convenient and reliable tissue substrate for ANA test.
11273946 Local anesthesia does not block mustard-oil-induced temporomandibular inflammation. 2001 Apr Temporomandibular joint (TMJ) disorders and rheumatoid arthritis are two conditions in which neurogenic mechanisms may play a critical role. We investigated the neurogenic contribution underlying acute TMJ inflammation by evaluating effects of local anesthetic blockade of afferent innervation on the development of mustard oil (MO)-induced edema in the rat TMJ area. Groups of eight adult male Sprague-Dawley rats were anesthetized by intraperitoneal alpha-chloralose and urethane. A saline injection into the right TMJ followed by MO (1% to 60%) 6 min later elicited dose-dependent edema development (P < 0.05, repeated measures analysis of variance). Lidocaine (5%) or bupivacaine (0.5%) followed by MO (1% or 40%) did not produce edema development different from saline controls (P > 0.05, repeated measures analysis of variance). The failure of local anesthetic blockade to prevent MO-induced edema is not consistent with MO acting through a neurogenic mechanism, as traditionally perceived. IMPLICATIONS: Inflammation found in temporomandibular disorders and rheumatoid arthritis may result from mediators released by pain-sensing neurons. Local anesthesia failed to block simulated neurogenic temporomandibular inflammation in a rat model, suggesting that functional neuronal input may not be necessary for the promotion of inflammation.
10637672 [Rheumatic manifestations of Behçet's disease]. 1999 Nov Rheumatologic manifestations are common in Behçet's disease. Joint involvement takes the third place after mucocutaneous and ocular lesions and can be the inaugural manifestation. Monoarthritis and oligoarthritis affect essentially knees and ankles, with a marked male bias. They usually run an acute or recurrent course, with chronic forms being rare. Polyarthritis is not rare and involves the large limb joints and the small joints of the hands and feet. Arthritis in Behçet's disease heels usually without sequelea and the aggressive treatment is not necessary. Unusual forms include arthritis with deformities and/or destruction, pseudogout, rupture of popliteal cyst (imitating deep vein thrombosis) and myositis. The association with spondylarthropathy is not common. Behçet's disease is rarely associated with rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, relapsing polychondritis and amyloidosis. Children are more likely than adults to have joint manifestations and polyarthritis. CONCLUSION: Joint manifestations are common in Behçet's disease. Their unusual forms deserve to be known since they can raise diagnostic problems when they are inaugural.
9030200 Modulation of cytokine production by human mononuclear cells following impairment of Na, K 1997 Jan 10 Cytokines, including TNF alpha and IL-l beta, are central to the chronic inflammatory process and tissue damage that characterises diseases such as rheumatoid arthritis. The mechanisms responsible for long-term generation of these molecules are poorly understood. We have previously demonstrated impaired activity of Na, K-ATPase, a key enzyme regulating intracellular cation levels, on rheumatoid mononuclear cells. Mimicking this 'defect' on normal mononuclear cells with ouabain has been shown to induce TNF alpha and, in particular, IL-l beta production, whereas IL-6 synthesis was suppressed. A similar pattern of cytokine generation was noted when mononuclear cells were treated with the sodium ionophore, monensin. Induction of cytokine production was related to up-regulation of the appropriate mRNA, although enhanced secretion of processed IL-l beta was also observed. The mechanism underlying these cellular responses appears to involve sodium/calcium exchange across the cell membrane. Impaired Na,K-ATPase activity might promote pro-inflammatory cytokine secretion in patients with rheumatoid arthritis.
11136878 The diagnostic value of streptococcal serology in early arthritis: a prospective cohort st 2000 Dec OBJECTIVE: To evaluate the diagnostic value of streptococcal serology in adult early arthritis patients in discriminating between post-streptococcal reactive arthritis (PSRA) and arthritis with other causes. METHODS: The antistreptolysin-O (ASO) and anti-DNase B tests were performed at baseline in 366 consecutive, newly referred early arthritis patients. After 1 yr of follow-up the patients were classified according to international classification criteria and were evaluated for the presence of persistent arthritis. The outcome measures were the predictive value of streptococcal serology for the diagnosis of PSRA and the ability of this serology to discriminate at the first visit between the self-limiting and persistent forms of arthritis. RESULTS: With a positive serological result, the probability of having PSRA increased from 2 to 9%, whereas the probabilities of having rheumatoid arthritis or undifferentiated arthritis continued to be high (23 and 29%). The serological tests did not discriminate between the self-limiting and persistent forms of arthritis. The major Jones criteria apart from arthritis were not observed. CONCLUSION: Streptococcal serology has no diagnostic value in adult early arthritis patients in whom major Jones criteria other than arthritis are not present.
9058659 Highly increased levels of tumor necrosis factor-alpha and other proinflammatory cytokines 1997 Mar OBJECTIVE: To investigate the potential role of cytokines in psoriatic arthritis (PsA) by assessing the profiles of the proinflammatory cytokines in synovial fluid (SF) of PsA in comparison with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: Levels of tumor necrosis factor-alpha (TNF-alpha), interleukin 1 (IL-1), IL-6, and IL-8 were measured in SF using ELISA. RESULTS: Levels of TNF-alpha, IL-1beta, and IL-8 were significantly higher in PsA SF than in OA SF, although lower than in RA SF. No difference was detected in the IL-6 levels between PsA and RA SF, both of which were much higher than in OA SF. CONCLUSION: The pattern of expression of proinflammatory cytokines seen in PsA is similar to that in RA. Since PsA is also a destructive arthropathy, cytokines, in particular TNF-alpha and IL-1, may be principle factors in joint destruction.