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ID PMID Title PublicationDate abstract
9172155 HLA-DR antigens associated with major genetic risk for late-onset Alzheimer's disease. 1997 Apr 14 Hla-dr antigen types were determined from DNA isolated from post-mortem brain tissue of age-matched groups of 78 patients with pathologically confirmed late-onset Alzheimer's disease (AD) and 50 controls. The results suggest that for individuals with no apolipoprotein E epsilon 4 alleles the presence of either DR1, 2 or 3 antigens is associated with a significantly increased risk for development of late-onset AD. Conversely the DR4 or 6 antigens are associated with a decreased risk of similar magnitude. This DR effect, rather than prolonged use of non-steroidal anti-inflammatory drugs, could be responsible for the reported lower prevalence of AD in rheumatoid arthritis (a condition associated with an increased frequency of DR-4).
9214166 [Current role of ultrasonography in orthopedics. Results of a nationwide survey]. 1997 Mar The purpose of this study was to determine the current position of diagnostic ultrasound imaging in the day to day orthopaedic practice. A questionnaire was sent to all the 387 conservative and operative orthopaedic hospitals and orthopaedic university departments in Germany. 167 of these hospitals completed the forms and provided the basis for this evaluation (response rate 43.2%). Screening of the fetal hip for CDH was by far the most common indication, the shoulder was ranking second, the knee and the hip joint in children and adults rank third and fourth. Other frequent indications were injuries of the achilles tendon, the menisci of the knee, the knee in rheumatoid arthritis and muscle injuries. Ultrasound imaging is clearly established as a diagnostic tool at least in the named areas. It is therefore of importance to include ultrasound examination techniques in the curriculum of the orthopaedic training scheme.
9057567 Heterotopic ossification after total knee arthroplasty. 54/615 cases after 1-6 years' foll 1997 Feb We found heterotopic ossifications in 54 (9%) of 615 cases after total knee arthroplasty. The largest ossifications were located in the anterior distal femur. In 12 cases smaller ossifications were found in other knee regions. The development of heterotopic ossification showed a positive correlation with hypertrophic arthrosis and a negative correlation with rheumatoid arthritis. We propose a new 3-grade classification which refers only to the anterior distal femoral region. Grade III heterotopic ossifications occurred in 4 patients (4 knees) who had clinical symptoms; 2 were successfully reoperated with removal of the ossifications. Prophylaxis should be considered in patients with marked hypertrophic arthrosis or marked periosteal damage to the anterior distal femur.
9071170 [Radiographic and pathological findings in 4 patients with pulmonary cryptococcosis]. 1997 Jan We reviewed the records of 4 patients with pathologically diagnosed pulmonary cryptococcosis to determine whether there was any relationship between radiographic and pathological findings. The underlying disease were diabetes mellitus (patient 1), rheumatoid arthritis treated with glucocorticoids (patient 2), and adultonset T cell leukemia (patients 3 and 4). All radiographs showed multiple nodules, and patchy and localized infiltrates, which progressed to diffuse interstitial infiltration. According to Mark's classification, the pathological findings in patients 1 and 2 showed granulomatous pneumonia, those in patient 3 showed histiocytic pneumonia, and patient 4 had intercapillary cryptococci with no inflammatory response. The granuloma appeared larger in patient 1 than in patient 2. This concurred with the clinical findings, i.e. large granulomas formed in immunocompetent patients, and diffuse pulmonary infiltrates developed in those whose immune systems had been compromised. When a granuloma formed, roentgenograms showed a well defined nodular shadow, with some nodules developing in the cavity. When granuloma formation became unclear, roentgenograms tended to show localized-to-diffuse infiltration, or interstitial shadows.
24383730 Analysis of autoantibodies to cell cycle-associated antigens. 2001 Sep Abstract To determine the specificities of autoantibodies targeting cell cycle-associated antigens in rheumatic diseases, we studied 30 sera which were obtained from patients visiting our hospital and which exhibited a variegated speckled pattern in indirect immunofluorescence (IF). The immunoreactivities of the sera were analyzed by Western blotting (WB) and IF. Various reactivities to cellular components were observed in IF. The sera reacted with proteins of various molecular weights in WB. Serum OH from a patient with rheumatoid arthritis showed fine speckled nucleoplasmic and nucleolar staining at interphase, discrete dot staining associated with chromosomes and the midbody at mitosis, and reacted with a 34-kD polypeptide in WB. The target antigen was different from proliferating cell nuclear antigen (PCNA). The 34-kD antigen was characterized by IF using double staining procedures and cell synchronization. The results showed that the expression of the antigen was mainly observed between the late G1 and M-phases. This study indicated that various cell-cycle-associated antigens were recognized in sera from patients with rheumatic diseases, and suggested that a 34-kD antigen recognized by serum OH was a novel cell cycle-associated autoantigen.
9715832 Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. 1998 Jul 27 Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated. The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) Post-Marketing Surveillance Program (PMS) has prospectively followed patient status and outcomes, drug side effects, and the economic impact of illness for >11,000 arthritis patients at 8 participating institutions in the United States and Canada. Analysis of these data indicates that: (1) osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5-5.5 times more likely than the general population to be hospitalized for NSAID-related GI events; (2) the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time; (3) there are no reliable warning signals- >80% of patients with serious GI complications had no prior GI symptoms; (4) independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and (5) antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications. Currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events. Ongoing ARAMIS research is aimed at developing a simple point-score system for estimating individual risks of developing serious NSAID-related GI complications.
11815747 The esophageal tracheal combitube as a non-invasive alternative to endotracheal intubation 2001 Dec The esophageal tracheal combitube (ETC) is a supraglottic airway device that functions as an effective alternative to ventilation via mask and tracheal intubation and is therefore a valuable tool in difficult and emergency airway management. The Com-bitube has proven to be a valuable tool for securing the airways and providing adequate ventilation. Its advantages are that it is easy to insert quickly, it may be inserted blindly or with the aid of a laryngoscope, and it provides adequate ventilation and oxygenation in both esophageal and tracheal position. The combitube allows application of high ventilatory pressures and it minimises the risk of aspiration. Several guidelines including European Resuscitation Council, Ame-rican Heart Association, American Society of Anesthesiologists have included the combitube as a primary rescue device in cannot ventilate cannot intubate situations. It has been used in elective patients as well as in emergency situations in- and out-of-hospital. The combitube can be inserted with minimal movement of the cervical spine and is therefore indicated whenever cervical spine movement is anatomically restricted (e.g. rheumatoid arthritis) or should be functionally restricted (e.g. trauma). Since the combitube isolates the lungs from the esophagus it is especially useful in patients at risk for aspiration (e.g., caesarean section, morbid obesity). The combitube is available in two sizes: 37 F SA (Small Adult) and 41 F. Unfortunately, a pediatric size is not commercially available. Training in the use of the combitube under controlled conditions is prerequisite to being expert in an emergency situation. The combitube is another non-surgical airway in the armamentarium of the anaesthesiologist or emergency provider in case of foreseen or unforeseen difficult airways in patients who can neither be intubated or mask ventilated.
10332984 Generic health instruments do not comprehensively capture patient perceived improvement in 1999 May OBJECTIVE: To assess the sensitivity to change of general quality of life indices in patients with rheumatic diseases, we assessed the performance of 4 instruments in patients with carpal tunnel syndrome (CTS) treated with local injection of corticosteroid. METHODS: We administered visual analog scales (VAS) incorporating measures of overall well being, discomfort, frequency of symptoms, and physical activity; 2 generic instruments [the Nottingham Health Profile (NHP), the Medical Outcomes Study 36 Item Short Form (SF-36)]; and a rheumatoid arthritis-specific instrument, the modified Health Assessment Questionnaire, at baseline and one month after injection. We assessed 30 patients. RESULTS: VAS were significantly better at determining improvement than the generic instruments or the arthritis specific instrument. For the generic scales, only the pain scales of NHP and SF-36 showed moderate or greater change using standardized response means. CONCLUSION: These results suggest that standard tools may not be sufficiently sensitive to show clinically significant change in this common rheumatological problem.
10189244 Pseudoporphyria associated with Relafen therapy. 1999 Jan Various oral medications including nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with pseudoporphyria, although the pathogenetic basis has not been elucidated. A novel NSAID nabumetone (Relafen) has become popular because of its minimal gastrointestinal side effects. Its association with pseudoporphyria is not reported save for its listing in the Physician's Desk Reference (PDR) as a possible side effect. Biopsies of lesional skin from 4 patients manifesting blisters and erosions on the hands and face within 4 months of starting nabumetone were submitted for light microscopic and immunofluorescent (IF) studies. Histories and serology were obtained. Two patients had rheumatoid arthritis (RA), 1 had mixed connective tissue disease (MCTD), and 1 received diltiazem. All 4 had antinuclear antibodies. Characteristic clinical, light microscopic and IF features in the absence of elevated urine porphyrin levels confirmed a diagnosis of pseudoporphyria in all 4 patients. Biopsies in three patients showed features attributed to underlying connective tissue disease (CTD), including ectasia of the superficial vascular plexus, mild leukocytoclastic vasculitis, superficial and deep perivascular lymphocytic infiltrates with dermal mucinosis, granular deposition of IgM along the dermoepidermal junction indicative of a positive lupus band test, and of IgG and C5b-9 within keratinocytes. Nabumetone (Relafen) can provoke pseudoporphyria; an underlying CTD diathesis may be a predisposing factor.
9629235 Hormones, pregnancy, and autoimmune diseases. 1998 May 1 Hormonal factors linked to age, gender, and reproductive status are undoubtedly involved in regulating the onset of numerous autoimmune diseases. For example, systemic lupus erythematosus (SLE), a disease characterized by immune complex-mediated pathology linked to excess Th2 cytokine production (e.g., IL-10) primarily affects women in the reproductive years. Rheumatoid arthritis (RA), a disease characterized primarily by cell-mediated joint immunopathology linked to deficient Th2 cytokine production, is also more common in women, but, in contrast to SLE, the highest incidence is at menopause. Pregnancy-associated changes in these diseases, however, provide the most compelling evidence that hormonal factors play a major role in modulating the expression of these diseases. SLE often flares during pregnancy, whereas RA commonly remits during pregnancy and flares or initially develops in the postpartum period. These observations appear to be explained by the accumulating data indicating that during pregnancy cell-mediated immune function and Th1 cytokine production (e.g., IL-12, interferon-gamma) are suppressed, and humoral immunity and Th2 cytokine production (e.g., IL-4, IL-10) are enhanced. These patterns reverse in the postpartum period. In other words, antithetical Th1/Th2 cytokine profiles appear to characterize pregnancy and the postpartum period. Strong evidence now indicates that changes in the production of cortisol, progesterone, and estrogen play a major role in modulating Th1/Th2 cytokine balance.
9562819 [Current status of shoulder arthroscopy]. 1998 Mar Arthroscopic and open shoulder surgery have to be combined for a successful surgical therapy of the shoulder joint. A surgeon performing open surgery only or just treating by arthroscopic measurements can not cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilisation of chronic anterior posttraumatic dislocations fail to compare with high success rates of open procedures. Better patient selection will probably be the key to improving results. In case of acute traumatic first time dislocation in young highly sportive athletes the arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy of shrunk capsule in frozen shoulder and tenodesis for lesions of the long head of the biceps. The arthroscopic subacromial decompression according to Ellman is the most often and successful performed procedure at the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon the arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with an mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In case of associated or isolated AC-joint arthritis an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.
9324012 A summary of economic evaluations published in the field of rheumatology and related disci 1997 Sep INTRODUCTION: The relationship between the effectiveness of health care interventions and their costs is of increasing interest. The goal of the present study was to summarize the economic evaluations (EEs) published in the field of rheumatology and related disciplines, and to focus in particular on methodologic issues. METHODS: MEDLINE was searched in order to identify all relevant EEs published between 1966 and February 1995. Titles and abstracts of 1,435 articles were retrieved and independently reviewed by 2 assessors. Overall, 63 articles were identified by either assessor as being definite or possible full EEs (defined as an analysis comparing 2 or more strategies involving the assessment of both costs and consequences), and were assessed independently. RESULTS: Thirty-six articles were determined to be full EEs (33 cost-effectiveness and 3 cost-utility analyses). Most were published in the periods 1984-1990 (31%) and 1991-1995 (61%). Main areas covered were methods of prevention (44%), treatment (31%), and treatment-prevention (22%). Disorders most frequently studied were osteoarthritis (36%), osteoporosis (22%), and rheumatoid arthritis (14%). Direct and indirect costs were measured or estimated in 100% and 28% of the EEs, respectively. The viewpoint of the analysis was stated explicitly in 12 studies (33%). Incremental and sensitivity analyses were presented in 17 (47%) and 23 (64%), respectively. Inadequate use of economic terms was also documented. CONCLUSION: The EE articles reviewed adhered partially to basic analytic methods. Economic evaluations in the field of rheumatology need to be improved to comply with current standards for the evaluation of health care interventions.
9266490 Identification of new autolytic sites of recombinant truncated mature human fibroblast str 1997 Jun Stromelysin has been proposed to play a major role in the pathologic degradation of diseased cartilage of osteoarthritis and rheumatoid arthritis patients. A truncated, recombinant form of this enzyme, with the sequence Phe83 to Thr260 (mSL-t), has been expressed and purified from E. coli to investigate its biochemical and biophysical properties, and to develop inhibitors for arthritis treatment. LC/ESI-MS technique was utilized for the characterization of mSL-t. The mass spectra of mSL-t showed the presence of a number of different protein components in addition to the full-length mSL-t form. We have demonstrated that protein degradation arose from autolysis. Molecular weights determined by LC/ESI-MS of these autolysis products allowed for the identification of new autolytic sites in mSL-t. Furthermore, two strategies were undertaken to prepare mSL-t free of degradation products. These include preparation of a mutant form of the enzyme in which Arg163 was substituted for Leu163 and purification of mSL-t using affinity chromatography. The LC/ESI-MS data of the mutant protein confirmed the Leu to Arg mutation. The affinity-purified material showed only one LC peak in the LC/MS chromatograms, and the mass spectrum of the peak identified only the intact protein, demonstrating that the full-length protein has been successfully separated from the autodegradation products and further autolysis of the enzyme has been prevented.
9195428 Development of a surface replacement arthroplasty for proximal interphalangeal joints. 1997 Mar Sixty-six surface replacement proximal interphalangeal prostheses with a CrCo proximal and an ultrahigh-molecular-weight polyethylene distal component were used in the hands of 47 patients (mean age, 58 years) over a 14-year period. There were 37 fingers with degenerative arthrosis, 16 with traumatic arthrosis, and 13 with rheumatoid arthritis. The mean follow-up period was 4.5 years (range, 1-14 years). The results based on pain relief, motion, and deformity were good in 32 fingers, fair in 19, and poor in 15. Poor results occurred primarily in fingers with previous extensive injury or static deformity. Results with a dorsal approach were better than those with a lateral or palmar approach. Component loosening at the bone-cement junction beyond a minimal radiolucent line was seen in one late x-ray. Results in individuals changed little after the first year of follow-up care, but results overall improved during the course of the study, perhaps because of improvements in surgical technique and experience.
10842890 [The limits of controlled clinical studies: the case of rheumatology]. 2000 Jan The double blind, placebo controlled, randomized clinical trial is the best tool for gathering evidence concerning the efficacy and safety of a drug. However, in some clinical situations--rheumatology is one--these trials have an intrinsic difficulty in representing the clinical reality: e.g., indicating how a drug influences course of a disease over the long-term. Beginning with the distinction between the "activity" of a drug as confirmed by randomized clinical trials, and its "efficacy" over time, as desired by the patient, we attempt to question why this difficulty arises. Several differentiating elements are involved. The objective of the randomized clinical trial design, that is, activity on acute parameters, may not coincide with the interests of the patient, i.e., efficacy in controlling disability or chronic pain. The duration of a randomized clinical trial is sufficient to measure drug activity but not to provide an indication of its effects on the course of the disease. In the randomized clinical trial, the size of the sample, generally from 10(2)-10(3) patients can, at the most, lead to the conclusion that a drug is "active" while the measurement of efficacy is based on a much greater number of observations. With regard to recruitment criteria, clinical trial patients are chosen on the basis of defined disease severity and activity, while in clinical practice, it is known that this often waxes and wanes. The presence of co-morbidity often leads to the exclusion of patients, yet it is known that up to 17% of rheumatoid arthritis patients are depressed. While concomitant therapy is not permitted during randomized clinical trials, it is generally almost always implemented in normal clinical practice. Drug dosage in a clinical trial is not variable, while in practice it is. The greatest difference is found in the measurement of efficacy, where the randomized clinical trial emphasizes the number of tender and swollen joints, acute phase reactants, disease activity indexes, to assess improvement, while for a typical patient, efficacy is measured in terms of non-evolution of radiologic alterations, work capacity and deformity, and/or the need for a joint prosthesis. The objective of the clinical trial is to seek improvement, while a patient with rheumatoid arthritis may consider simply the lack of worsening over a 5-10 year period as a success. Contrary to clinical trials, observational studies function well in this situation. In response to the difficulty that randomized trials have in reflecting the clinical reality of rheumatological outcomes, the solution is to utilize within the trial, the aspects of the disease course considered fundamental by the patient (that is, chronic pain, disability, radiographic alterations), parameters that are generally omitted from trials. A radical alternative, already proposed, is to abandon the randomized clinical trial model completely and adopt open approaches--much less stringent than randomized trials although as stringent as possible outside the framework of the trial model--that are able to reflect the problems of the patient and to respond to them.
11059096 Low dose treatment with methotrexate-adverse drug reactions survey. 2000 Jul Antineoplastic drugs caused various and frequent adverse drug reactions (ADR) in connection with their pharmacodynamics. Methotrexate (MTX) ADRs are preferably gastrointestinal disorders and hepatotoxicity (hepatic enzyme abnormalities). The aim of this study was to detect and analyse ADR induced by low-dose MTX treatment in rheumatology. We observed 94 patients, 63 with rheumatoid arthritis and 31 with psoriatic arthritis. All patients were co-medicated with nonsteroidal anti-inflammatory drugs (NSAID) as Diclofenacum, Indomethacinum, Piroxicamum and 51% with glycocorticosteroides. During the follow-up study we collected 18 case-reports with ADR for 17% of the patients. From the patients with registered ADR, 11 was treated with standard dose of 7.5 mg MTX for a week and 7 patients received from 10 to 15 mg for a week. The distribution of the cases according patients' gender was 9 females and 7 males. Prevail individuals in age groups' 41-50 and over 61 years. The most frequent adverse drug reactions were leucopenia, trombocytopenia, skin reactions and gastrointestinal disorders as vomiting, melaena, epigastrial pain, etc. The primary risk connected with long therapy of low doses MTX is hepatotoxicity that diagnose and treatment are painful and expensive. As a result of the appearance of ADR in 5 patients the therapy with MTX was not changed, in two cases MTX is stopped timely or the dosage is changed and in the rest 11 patients MTX was excluded from the therapeutic scheme.
10966213 Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. 2000 Aug OBJECTIVE: To review the value of magnetic resonance imaging (MRI) in diagnosis and evaluation of rheumatic diseases of the spine and sacroiliac joints. METHODS: A review of the literature on MRI of the spine and sacroiliac joints in rheumatoid arthritis (RA), ankylosing spondylitis (AS), infectious spondylodiscitis, infection of the sacroiliac joint (SIJ), gout, calcium pyrophosphate deposition disease, nontraumatic vertebral compression fractures, insufficiency fracture of the sacrum, avascular necrosis of the vertebral body, sarcoidosis, and Paget's disease was performed. The reports were obtained from a Medline search. RESULTS: In RA, AS, and crystal deposition disease, synovial tissue, atlantoaxial and subaxial subluxations, crystal deposition, and neurologic compromise can be adequately diagnosed with MRI of the cervical spine. Studies on MRI of SIJs in AS indicate that MRI enables early diagnosis of sacroiliitis. In most cases of infectious spondylodiscitis, avascular necrosis of the vertebral body, nontraumatic vertebral compression fractures, and insufficiency fractures of the sacrum characteristic findings on MRI suggest the correct diagnosis. Moreover, soft tissue abnormalities and neurologic compromise can be visualized. In infection of the SIJ, MRI shows findings suggesting an inflammatory process. In Paget's disease, MRI does not provide additional information as compared with plain radiography (PR) or computed tomography (CT). CONCLUSION: In evaluation of spinal and SIJ abnormalities in many rheumatic diseases, MRI, in addition to PR, can replace conventional tomography, CT, and myelography. Moreover, MRI can visualize soft tissue abnormalities and neurologic compromise without use of intrathecal contrast.
10423160 Antirheumatic agents and leukocyte recruitment. New light on the mechanism of action of ox 1999 Jul 15 Most anti-inflammatory agents used in the treatment of joint diseases exert inhibitory effects on leukocyte infiltration. Methotrexate, a disease-modifying drug, and corticosteroids also inhibit leukocyte accumulation during inflammation. However, the mechanisms of action of these different compounds on leukocytes vary and in the case of non-steroidal anti-inflammatory drugs (NSAIDs) the mechanism(s) may be indirect. No current drug for inflammatory or degenerative joint disease has been proposed to act specifically by an inhibitory action on neutrophilic leukocytes. Oxaceprol is an amino acid derivative that has been used for several years for the treatment of osteoarthritis and rheumatoid arthritis, ameliorating pain and stiffness and showing good gastrointestinal safety, particularly in comparison with NSAIDs. Recent experimental studies have shown that oxaceprol does not inhibit the synthesis of prostaglandins in vitro, but markedly inhibits neutrophil infiltration into the joints of rats with adjuvant arthritis. These results support earlier screening data showing inhibition by oxaceprol of leukocyte infiltration into sites of acute inflammation. In studies on surgical ischemia reperfusion in hamsters in vivo, oxaceprol was an effective inhibitor of leukocyte adhesion and extravasation. It is proposed that oxaceprol represents a therapeutic agent for degenerative and inflammatory joint diseases, which acts predominantly by inhibiting leukocyte adhesion and migration.
9699418 Multiple nuclear dot antinuclear antibody in patients without primary biliary cirrhosis. 1998 Feb Multiple nuclear dot (MND), or pseudocentromere, anti-nuclear antibody (ANA) is an uncommon pattern associated primarily with primary biliary cirrhosis (PBC) and anti-mitochondrial antibody (AMA). A 53 kDa antigen with an apparent molecular mass of 100 kDa as found on sodium dodecyl sulphate-polyacrylamide gel electrophoresis is thought to be responsible for the uncommon pattern. This study analyzes sera from 21 patients without PBC or AMA that produced the uncommon MND ANA immunofluorescence pattern. Diseases present include lupus, rheumatoid arthritis and scleroderma. On immunoblotting nineteen of 21 (91%) bound a 70 kDa protein. Western blot analysis showed that this nuclear antigen was different from pyruvate dehydrogenase, p80 coilin and the antigen responsible for MND ANA in those with PBC. Affinity purified anti-70 kDa reproduced the MND ANA immunofluorescence pattern. Thus, the MND ANA in patients without PBC/AMA is associated with binding to a 70 kDa nuclear protein and not with a 53 kDa antigen (that runs at 100 kDa) found in those with MND and PBC/AMA. The data demonstrate the MND antigen without PBC/AMA is immunologically distinct from the pattern when found with PBC/AMA.
11060534 Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers 2000 Nov OBJECTIVE: To extend the information base on cutaneous manifestations of neonatal lupus erythematosus (NLE) with regard to maternal disease, sex of child, onset, localization, influence of UV light, prognosis, and recurrence rates in subsequent pregnancies. METHODS: Review of records from the Research Registry for Neonatal Lupus. RESULTS: The cohort includes 47 mothers (83% white) whose sera contain anti-SSA/Ro, anti-SSB/La, and/or anti-U1-ribonucleoprotein antibodies and their 57 infants (20 boys and 37 girls) diagnosed with cutaneous NLE (absent heart disease) between 1981 and 1997. At detection of the child's rash, 13 mothers were asymptomatic, 11 had an undifferentiated autoimmune syndrome (UAS), 9 had systemic lupus erythematosus (SLE), 7 Sjögren's syndrome (SS), 6 SLE/SS, and 1 rheumatoid arthritis/SS; 20 reported photosensitivity. Within 5 years, 7 asymptomatic mothers experienced disease progression: 1 developed photosensitivity, 2 SLE, 3 SS, 1 SLE/SS; in 2 mothers UAS progressed to SLE; and 2 mothers with SS developed SLE. The infant's rash often followed UV light exposure; mean age at detection was 6 weeks, and mean duration was 17 weeks. All had facial involvement (periorbital region most common) followed by the scalp, trunk, extremities, neck, and intertriginous areas. In 37, the rash resolved without sequelae, 43% of which were untreated. A quarter had residual sequelae that included telangiectasia and dyspigmentation. One child developed Hashimoto's thyroiditis, and 2 developed systemic-onset juvenile rheumatoid arthritis. Of 20 subsequent births, 7 children were healthy, 2 had congenital heart block (CHB) only, 4 CHB and skin rash, and 7 skin rash only. CONCLUSIONS: Future pregnancies should be monitored by serial echocardiograms, given the substantial risk for heart block. Affected children should be observed for later development of a rheumatic disease.