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ID PMID Title PublicationDate abstract
10332975 T cell receptor repertoire in B cell lymphoproliferative lesions in primary Sjögren's syn 1999 May OBJECTIVE: Studies have analyzed T cell receptor (TCR)-Vbeta in benign, minor salivary or lacrimal gland, or kidney lesions in Sjögren's syndrome (SS). We investigated SS related lymphoproliferative lesions. METHODS: By "family" reverse transcriptase polymerase chain reaction, we studied the expression of 20 different TCR-Vbeta families in parotid lymphoproliferative lesions and peripheral blood lymphocytes (PBL) from 7 patients with primary SS, in PBL from 6 primary SS patients with no associated lymphoproliferative disorder, and in activated PBL from 2 healthy controls. T cell clonal expansion was investigated in 10 Vbeta families (i.e., the most expanded ones and those previously implicated in SS pathogenesis) by single strand conformation polymorphism (SSCP) analysis. Frozen sections from parotid gland specimens were tested by immunohistochemistry for the expansion of selected Vbeta families. Viral infection within the parotid lesions and serum autoantibody response were also studied. RESULTS: An unrestricted Vbeta pattern was observed. The most widely expressed Vbeta family in parotid lesions was Vbeta2, and Vbeta immunohistochemistry results were concordant with Vbeta mRNA findings. A similar pattern was observed in PBL, although the Vbeta2 family was expressed at lower levels. The parotid/PBL ratio was occasionally > 1.8-2.0 (indicative of local Vbeta overexpression) in different Vbeta families. T cell expansion proved to be largely polyclonal by SSCP analysis, and scattered T cell clonotypes were detected within different Vbeta families, with a different pattern from patient to patient. CONCLUSION: Our observations in SS related lymphoproliferative lesions largely reflect previous evidence in fully benign lesions. The pathogenetic events involved in autoimmune benign lesions in SS may then persist and play a role in SS related lymphoproliferative disorders. The link between the observed TCR-Vbeta repertoire and specific local triggering (auto)antigens remains to be elucidated.
9863898 Anticardiolipin antibodies in childhood rheumatic disorders. 1998 Anticardiolipin antibodies (aCL) have been reported to occur in a wide variety of autoimmune and non-autoimmune disorders in adults. Our objective was to investigate the prevalence and isotype distribution of aCL and its relationship with the features of antiphospholipid syndrome (APS) in childhood rheumatic disorders. Between November 1995 and May 1996, all patients who visited our paediatric rheumatology clinic whose guardians signed a consent form participated in the study. The study population included 106 patients (36 systemic lupus erythematosus (SLE), 28 juvenile rheumatoid arthritis (JRA), 11 fibromyalgia, 7 sarcoidosis, 5 dermatomyositis, 3 rheumatic fever (RF), 3 vasculitis, 2 scleroderma, and 11 miscellaneous). aCL measurements were performed by enzyme linked immunoabsorbent assay (ELISA). All patients were carefully evaluated for symptoms and signs of APS. Eighteen of the 106 patients (17%) were tested positive for one or more of the three aCL isotypes. In SLE, aCL were found positive in 13 of 36 (37%); in JRA 2 of 28 (7%); in sarcoidosis 2 of 7; and in RF 1 of 3. aCL of IgG isotype were found positive in 16 patients (11 SLE, 2 sarcoidosis, 2 JRA, and 1 RF). This isotype was usually detected at low titers (16-24 GPL). aCL of IgM isotype were found positive in five patients (2 sarcoidosis, 2 SLE, 1 JRA), and aCL of IgA isotype were found positive in only three patients (2 SLE, 1 sarcoidosis). Clinical features of APS were rarely seen in our SLE population and were not associated with the presence of aCL. None of the patients in the other groups exhibited any clinical manifestations of APS. In conclusion, aCL were found in 37% of our childhood SLE patients as compared with only 7% in JRA. These were mostly aCL of IgG isotype of low titers and therefore were not associated with the main features of APS. Prospective studies with a larger sample size may be needed to ascertain the exact prevalence and clinical significance of aCL in childhood-onset SLE.
10673582 Laboratory aspects of rheumatologic disease. 2000 Mar Assessment of laboratory values is an important function of nursing practice. Rheumatologic laboratory assessment, in particular, can be complex because few findings are actually pathognomonic. This article provides a perspective on an interpretive approach to laboratory assessment of rheumatologic disease. In conjunction with the patient's clinical status, these values can provide helpful information for monitoring or predicting the course of disease.
11078023 Anti-interleukin-1 and anti-tumor necrosis factor-alpha synergistically inhibit adjuvant a 2000 Sep Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) play dominant roles in mediating the progression of many inflammatory joint diseases, including rheumatoid arthritis in humans, collagen-induced arthritis in mice and rats, and adjuvant arthritis in rats. Blockade of either cytokine partially controls these diseases. The present study investigated the value of combination anti-cytokine therapy in arthritis: the efficacy of IL-1 receptor antagonist (IL-1ra) and 30 kDa polyethylene glycol (PEG)-conjugated soluble TNF receptor type I (PEG sTNF-RI) given together was assessed in Lewis rats with adjuvant arthritis. Administration of either IL-1ra or PEG sTNF-RI partially alleviated joint inflammation, loss of bone mineral density, and loss of body weight. In contrast, combination of these anti-cytokine treatments exhibited a synergistic capacity to inhibit these changes, even when combining doses of IL-1ra and PEG sTNF-RI that did not affect lesion severity when used alone. Statistical analysis of these adjuvant arthritis data using the isobologram method proved that IL-1ra and PEG sTNF-RI were clearly synergistic in inhibiting inflammation, loss of bone mineral density, loss of body weight, and histopathologic parameters of inflammation and joint destruction. These results suggest that treating autoimmune arthritic diseases with combinations of anti-IL-1 and anti-TNF molecules will achieve superior efficacy compared to the use of a single class of anti-cytokine agent and may allow for dose reductions that could prove useful in minimizing potential side effects.
11708431 Evaluation of the ILAR criteria for juvenile idiopathic arthritis. 2001 Nov OBJECTIVE: A pediatric rheumatology committee of ILAR has proposed new classification criteria for chronic childhood arthritis. The umbrella term "juvenile idiopathic arthritis (JIA)" was chosen and the disease was subdivided into 7 categories. Evaluation for these criteria is under way. METHODS: We analyzed data of 200 consecutive children with rheumatic diseases. RESULTS: In total 172 patients fulfilled criteria for JIA. Twenty-seven of these (15.7%) had to be grouped into the category "other arthritis": 16 met criteria for 2 categories; the other 11 did not fit into any category. CONCLUSION: We suggest minor changes in the classification in order to classify 24 of these 27 patients into one of the specific categories without losing the claim for homogeneity in the different patient groups. Among the 44 patients with rheumatoid factor negative polyarthritis, 26 resembled oligoarthritis, with an extended oligoarticular joint pattern of 5 to 8 involved joints within the first 6 months. 18 had positive antinuclear antibodies, and 7 chronic uveitis. For these patients the introduction of a separate category "extended oligoarthritis at onset" should be considered to establish comparable patient groups.
10723237 [Total hip and knee arthroplasty for arthropathy in a hemophiliac]. 2000 Feb We evaluated the medium-term follow-up results, effectiveness, and suitability of arthroplasty for hemophilic arthropathy. We performed 26 total knee and 9 total hip arthroplasty operations on hemophilic patients between 1988 and 1998 under general anesthesia and appropriate hemostatic management. Postoperative treatment for hemophilic arthropathy is the same as that for osteoarthritis and rheumatoid arthritis. After their operations, patients experienced relief from pain and intra-articular bleeding in affected joints but only marginal improvement in the range of motion. In general, total joint arthroplasty is not indicated for young patients. However, arthropathy can have a severe impact on the active life of patients during their youth. For severe hemophilic arthritis, total knee and hip arthroplasty can lead to a pain-free and improved quality of life. We believe total knee and hip arthroplasty is a good solutions for hemophiliac arthropathy before severe deformity occurs. Although treated relatively young hemophilic patients, age was not considered to be a contraindication.
28246979 The evolution of ankle arthroplasty. 1999 Sep The results of ankle arthroplasty have generally been disappointing compared to other forms of arthroplasty. The present survey of results of ankle arthroplasty deals with the anatomical, the kinemasiological the biomechanical and the biological features of the ankle joint. These features all seem important prerequisites for a successful total ankle prosthesis design. From the study of the results displayed in the literature and those of my own series it can be stated that a modern ankle arthroplasty should respect the normal anatomy and kinemasiology. Biomechanically it should work as a normal ankle joint i. e. cylindrical mobility, congruency and a possibility for normal torque within the ankle mortise. The prosthesis components should only be fixed in solid subchondral bone, and preferably without cement. Only compressible forces should act at the bone-prosthesis interface. The axis of the ankle joint as well as of that of the hindfoot should be aligned to normal. Meticulous surgery and special guide instruments are absolute necessities. Restoration of muscle power and gait postoperatively are essential for a good and lasting result. The indication for ankle arthroplasty is mainly cases of osteoarthritis (primary or traumatic) and rheumatoid arthritis. Contraindications are talus necrosis, Charcot joints, extreme osteoporosis, severe arteriosclerosis, and very aggressive arthritis. Mental disorders and neurological disorders may also be contraindications. Furthermore, the patients should agree not to perform sports involving jumping and running or other ankle demanding activities. The average annual failure rate should not exceed 1 % if these recommendations are followed.
19078320 The epidemiology of NSAID gastropathy: the ARAMIS experience. 1998 Oct The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) is a national database for longitudinal outcome information obtained form the long-term follow-up of patients with rheumatic disease. This database has been used to investigate the parameters associated with nonsteroidal anti-inflammatory drug (NSAID) gastropathy in a population of 2747 patients with rheumatoid arthritis (RA). Theses patients were found to have a 1.3% higher risk of hospitalization each year because of a gastrointestinal (GI) adverse event than the general population. In these patients with RA, there was a five fold higher risk of hospitalization and a twofold increase in GI mortality among NSAID users compared with the general population. Age was the most significant predictor of serious GI events in our study' disability, prednisone therapy, and previous NSAID-related GI events were also identified as risk factors. An objective index of drug toxicity was developed to facilitate comparisons of the potential risks involved with specific drug regimens. consistent toxicity scores were obtained for NSAIDs, with threefold to fourfold difference between drugs having low risk versus high risk. These studies indicate a need for changes in management practices in at-risk patients and a potential role for better tolerated NSAIDs, such as the recently developed cyclooxygenase-2 selective or preferential drugs.
11741261 Preparation and characterization of gelatin surface modified PLGA microspheres. 2001 This study optimized conditions for preparing and characterizing gelatin surface modified poly (lactic-co-glycolic acid) (PLGA) copolymer microspheres and determined this system's interaction with fibronectin. Some gelatin microspheres have an affinity for fibronectin-bearing surfaces; these microspheres exploit the interaction between gelatin and fibronectin. PLGA copolymer microspheres were selected because they have reproducible and slow-release characteristics in vivo. The PLGA microspheres were surface modified with gelatin to impart fibronectin recognition. Dexamethasone was incorporated into these microspheres because dexamethasone is beneficial in chronic human diseases associated with extra fibronectin expression (eg, cardiovascular disease, inflammatory disorders, rheumatoid arthritis). The gelatin surface modified PLGA microspheres (prepared by adsorption, conjugation, and spray coating) were investigated and characterized by encapsulation efficiency, particle size, in vitro release, and affinity for fibronectin. The gelatin-coated PLGA microspheres had higher interaction with fibronectin compared with the other gelatin surface modified PLGA microspheres (adsorption and conjugation). Dexamethasone was released slowly (over 21 days) from gelatin surface modified PLGA microspheres.
10458088 Methotrexate nodulosis. 1999 Jul Methotrexate (MTX) nodulosis in patients with rheumatoid arthritis treated with MTX has become a well recognized phenomenon. It has not been described in patients receiving MTX for treatment of other diseases, e.g., dermatological or malignant diseases. Recently, MTX nodulosis was described in a patient with psoriasis and arthritis. The pathophysiology and treatment of MTX nodulosis are yet unsettled. We experienced a case with dermatomyositis who developed multiple subcutaneous nodules after treatment with MTX. In our patient, numerous, small, symmetrically distributed, grouped subcutaneous nodules were seen on a V-shaped area of the anterior chest, both axillary areas, and the medial sides of both upper arms and thighs. We histopathologically examined a nodule and started treatment with hydroxychloroquine after discontinuation of MTX. The histopathology revealed septal panniculitis, and the nodules have been under regression. MTX nodulosis may be a drug-specific phenomenon. Discontinuation of MTX and replacement with hydroxychloroquine are recommended in severe cases. Awareness of this entity is important for diagnosing and treating cases of multiple nodules developing after the administration of MTX, which is widely used for many dermatological diseases.
9029456 Minocycline-induced intraoral pharmacogenic pigmentation: case reports and review of the l 1997 Jan Minocycline, a semi-synthetic tetracycline antibiotic, is well documented as being associated with pharmacogenic pigmentation of various tissues in humans and other mammals. The most obvious of these are skin pigmentation, but intraorally include "green" roots of erupted teeth, "black" roots of extracted teeth, a dark stain of the crowns of fully developed teeth, and "black" alveolar bone. This article presents five cases of "black" alveolar bone with photographic documentation of its progress. It also reviews the available English language literature on this phenomenon. The incidence of minocycline staining of alveolar bone is probably 2% of that population taking the drug for 2 months or longer. Presently, minocycline is most widely used in the young adult population for the treatment of acne. With the recent interest in minocycline as a palliative treatment for rheumatiod arthritis, an entirely different population could be experiencing this effect. If minocycline use becomes widespread as a treatment for rheumatoid arthritis, it is likely that more practitioners will be asked to diagnose this sometimes striking, though apparently benign, condition. Recognition of this condition will save the practitioner and the patient from unnecessary concern and surgery.
9575686 Four cases of pustulotic arthro-osteitis. 1998 Mar We describe four cases of pustulotic arthro-osteitis. All of them suffered from anterior chest wall symptoms, such as swelling and pain on the sternoclavicular joint, sternal angle area, sternocostal joint, and costochondral junction. Although chest X-ray findings were all normal, 99mTc-scintigraphy revealed increased uptake in the affected areas in all cases. Laboratory examinations including rheumatoid factor were negative or normal except for elevation of the erythrocyte sedimentation rate and C-reactive protein in 2 cases. After treatment with non-steroidal anti-inflammatory drugs and etretinate or topical PUVA, the skin lesions on the palms and soles and the arthro-osteitis were moderately improved. Pustulotic arthro-osteitis should be considered when a patient with pustulosis palmoplantaris complains of anterior chest wall pain and other joint pain.
10406405 Rheumatic diseases in North America's indigenous peoples. 1999 Jun OBJECTIVES: There are at least 3 million North American Indians and Eskimos in North America. The epidemiology of rheumatic diseases in Native North Americans differs from that described for the remainder of the North American population. An enhanced understanding of rheumatic diseases in these indigenous people may provide valuable clues to the cause of these disorders and improve rheumatologic care. METHODS: The world literature was searched for all reports of rheumatic diseases in North American Indians and Eskimos. The reports were reviewed and the findings summarized by disease process. RESULTS: Many Native American groups have high prevalence rates of rheumatoid arthritis (RA), systemic lupus erythematosus, connective tissue diseases, and spondyloarthropathies. There appears to be a correlation between the pattern of rheumatic diseases in Native North Americans and the patterns of migration and ancestry. In general, Amerind Indians have increased rates of RA and connective tissue disease, while Na-Dene Indians and Eskimos have high rates of spondyloarthropathies. The RA seen in Native Americans is generally severe, seropositive, with an early age of onset, and frequent extraarticular manifestations. Many Native American groups have very high frequencies of the RA shared epitope. The majority of Native American and Eskimo groups also have high frequencies of HLA-B27, and some of the world's highest prevalence rates of spondyloarthropathies are described in these groups. Although some groups show a marked tendency to develop either Reiter's syndrome or ankylosing spondylitis, psoriatic and enteropathic arthritis are rare. CONCLUSIONS: The excess rheumatic disease seen in this population is most likely genetic in origin. Because of the combination of high rates of rheumatic disease and relative genetic homogeneity, Native North Americans represent a singular opportunity to study genetic contributions to rheumatic disease. For clinicians, the index of suspicion for rheumatic diseases in North American Indians and Eskimos should be high, and the severe disease and sometimes atypical presentations kept in mind.
11874644 Unconstrained shoulder arthroplasty. 2000 May 15 OBJECTIVE: To evaluate the results of 36 unconstrained shoulder arthroplasties. METHODS: In the series, 24 total and 12 hemi-arthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2 years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain, strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays. RESULTS: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47 in forward flexion, 43 in abduction, 30 in external rotation, and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1 humeral component and 9 glenoid components. One humeral and 2 glenoid components loosened. CONCLUSIONS: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.
10100175 Postmenopausal estrogen therapy and selected (less-often-considered) disease outcomes. 1999 Spring OBJECTIVE: To review the association between postmenopausal estrogen therapy and chronic conditions not usually considered in risk-benefit reviews. DESIGN: Ten-year literature review (1989-1998) of case series and epidemiologic studies with risk estimates and 95% confidence intervals. RESULTS: Osteoarthritis and rheumatoid arthritis, the most extensively studied conditions, show no consistent association with hormone therapy. Two studies of systemic lupus erythematosus show a nearly three-fold increased risk apparent after 2 or more years of hormone therapy. Single studies suggest an increased risk of pancreatitis, asthma, and Raynaud's syndrome. Evidence for a reduced risk of diabetes mellitus is not compelling. Cataracts and migraine are either increased or decreased by hormone therapy. Among the associations considered here, only an increased risk of gallbladder disease and venous thromboembolic disease have been confirmed in clinical trials of hormone replacement therapy. CONCLUSIONS: Further studies are needed.
11878090 [Methodological reflections on 20 randomized clinical hydrotherapy trials in rheumatology] 2001 Nov The aim of this study was to estimate the level of scientific evidence contributed by randomized clinical trials in rheumatologic indication of spa therapy. A literature search was made of computer data banks, with analysis of 20 randomized hydrotherapy trials. On the 20 identified randomized hydrotherapy trials, four were carried out double-blind; nine included a comparison of inter-groups evolution. The indications assessed are chronic low back pain, osteoarthritis of the knee and hip joints, osteoarthritis of fingers, fibromyalgia, rheumatoid arthritis and psoriasis arthritis. The results suggest durable, persisting improvement several months after balneological care, in accordance with the following evaluation criteria: pain, handicap, quality of life, consumption of analgesics and of nonsteroidal anti-inflammatory drugs (NSAIDs). It was concluded that randomized evaluations, demonstrating a beneficial and prolonged clinical effect of balneologic treatments, exist in respect of the main indications for rheumatologic hydrotherapy. These results acknowledge the medical help given by hydrotherapy within the aforesaid parameters, to which may be added a reduction of the adverse gastrointestinal events of NSAIDs. Evaluation needs to be continued to clarify the medical benefit offered by rheumatologic hydrotherapy.
11452912 [Clinical patameters associated with oxygen-dependent metabolism in neutrophils in patient 2000 Sep The article presents results of examination designed to study parameters characterizing the peripheral blood neutrophils functional activity in leukocytopenia in patients with diffusive disorders of the connective tissue (systemic lupus erythematosus and rheumatoid arthritis), with the above values having come to be used in the assessment of severity of the course, differential diagnosis of complications, and prognostication of the condition. Such cytochemical indices as activity of myeloperoxidase, amounts of cationic proteins, capability of neutrophils to reduce nitroblue tetrazolium to diphormazine (NBT-test) are considered to be of much informative value which have come to be widely used in the diagnosis and prognosis of a great many of various medical problems. Defects in neutrophils are shown, disturbances are pointed out in their functional activity evidenced by the decline in their capability of reducing NBT. Poststimulation metabolic activity is but inadequately increased as compared to results in the control group. Of practical value is screening of patients presenting with low values for the functional reserve of heterophilic leucocytes, the purpose of which screening being early prognostication of the course of pyo-inflammatory complications.
10607014 New vessels, new approaches: angiogenesis as a therapeutic target in musculoskeletal disor 1999 Oct Musculoskeletal disorders such as rheumatoid arthritis (RA) and osteoarthritis are a common cause of pain and disability. The vasculature is an important component of the musculoskeletal system, and vascularization is a key event in the development of normal cartilage and bone. By promoting the delivery of nutrients, oxygen and cells, blood vessels help maintain the structural and functional integrity of joints and soft tissue and may facilitate tissue repair and healing. The identification of pro-angiogenic mediators such as vascular endothelial growth factor (VEGF) has led to the development of antiangiogenic therapies for the treatment of neoplastic diseases. The important role of angiogenesis, and especially VEGF, in the pathogenesis of joint disorders such as RA suggests that antiangiogenic therapy may be a useful adjunct to existing approaches in RA.
12799814 [Paracetamol and metamizol in the treatment of chronic pain syndromes]. 1997 Aug 25 In a medline search (covering 1966 to Sept. 1996) 32 clinical studies were identified, in which the efficacy of paracetamol or matamizol per se, or in comparison to other analgesics, in various chronic pain states, such as migraine, dysmenorrhoea, arthritis and osteoarthritis pain and cancer pain had been examined. In patients with migraine (4 studies) several other analgesics (ibuprofen, mefenamic acid, flupirtin) were slightly more effective than paracetamol, however, the efficacy of paracetamol itself had not been assessed. In patients with chronic tension headache (1 study) paracetamol was superior to placebo, but less effective than naproxen. Pain of dysmenorrhoea was not, or only marginally improved by paracetamol in 3 studies, efficacy was reported in 1 study. Similarly, pain in rheumatoid arthritis was not significantly alleviated when paracetamol was given alone (3 studies) and marginally improved, when combined with naproxen and tested against naproxen alone (1 study). Some improvement by paracetamol of pain scores in patients with osteoarthritis (5 studies) requires further clinical confirmation. No studies were found, in which metamizol had been studied in chronic non-cancer pain. Paracetamol and/or metamizol have been included in 14 studies on cancer pain, most of these studies attempting to validate the WHO analgesic ladder for cancer pain treatment. However, except for one study, in which metamizol was comparable in efficacy to morphine, all other publications do not provide detailed information on the efficacy of individual analgesics. Therefore it is not possible at present, to assess the possible merits of paracetamol or metamizol in the treatment of cancer pain from published studies.
11696430 TRANCE/RANKL knockout mice are protected from bone erosion in a serum transfer model of ar 2001 Nov There is considerable evidence that osteoclasts are involved in the pathogenesis of focal bone erosion in rheumatoid arthritis. Tumor necrosis factor-related activation-induced cytokine, also known as receptor activator of nuclear factor-kappaB ligand (TRANCE/RANKL) is an essential factor for osteoclast differentiation. In addition to its role in osteoclast differentiation and activation, TRANCE/RANKL also functions to augment T-cell dendritic cell cooperative interactions. To further evaluate the role of osteoclasts in focal bone erosion in arthritis, we generated inflammatory arthritis in the TRANCE/RANKL knockout mouse using a serum transfer model that bypasses the requirement for T-cell activation. These animals exhibit an osteopetrotic phenotype characterized by the absence of osteoclasts. Inflammation, measured by clinical signs of arthritis and histopathological scoring, was comparable in wild-type and TRANCE/RANKL knockout mice. Microcomputed tomography and histopathological analysis demonstrated that the degree of bone erosion in TRANCE/RANKL knockout mice was dramatically reduced compared to that seen in control littermate mice. In contrast, cartilage erosion was present in both control littermate and TRANCE/RANKL knockout mice. These results confirm the central role of osteoclasts in the pathogenesis of bone erosion in arthritis and demonstrate distinct mechanisms of cartilage destruction and bone erosion in this animal model of arthritis.