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ID PMID Title PublicationDate abstract
12553242 [Clinical application of hydrogel membrane of silicone rubber for preventing adhesion in o 1998 Sep Grafting hydrogels onto silicone rubber membranes were prepared by radiation technique for medical application. This material is characterized by high purity, hydrophilia, formation of stable hydrogel after water absorption, good biocompatibility, etc. Clinical application was initiated on the basis of animal experiments. The material was used in 47 cases of joint and tendon injuries, in 9 cases of rheumatoid arthritis, and in 4 other cases; totaling 60 cases. All patients were followed up for three and a half years after surgical operation. A general effectiveness of above 86% was noted.
11480331 Progression of hydroxychloroquine retinopathy after discontinuation of therapy: case repor 2001 May Chloroquine and its derivative, hydroxychloroquine sulfate, have been used in treating malaria, dermatitides of systemic lupus erythematosus and rheumatoid arthritis. Hydroxychloroquine retinopathy is uncommon in Taiwan. Here we report a patient with hydroxychloroquine retinopathy which progressed even after discontinuation of hydroxychloroquine. A 42-year-old woman had systemic lupus erythematosus for twenty years. She had been treated with 200 to 400 mg of hydroxychloroquine per day (4 to 8 mg/kg of body weight/day) with a cumulative dose of 657 g. After bull's-eye maculopathy was found, hydroxychloroquine was discontinued. Her medical history revealed no chloroquine administration and no other systemic disease. Five years after cessation of the therapy, her visual acuity and visual fields continued to deteriorate. Ophthalmoscopic examination revealed the hydroxychloroquine retinopathy had advanced. To the best of our knowledge, the progression of hydroxychloroquine retinopathy after discontinuation of medications is a rare phenomenon. Regular ophthalmologic examinations should be performed for patients on hydroxychloroquine regimens because there is no satisfactory treatment for hydroxychloroquine retinal toxicity. Ophthalmologists, dermatologists and rheumatologists should monitor for ocular toxicity of hydroxychloroquine carefully.
11471871 Biochemical analysis of pleural fluid: what should we measure? 2001 Jul Biochemical examination of pleural fluid is usually done to try to identify the cause of a pleural effusion. The various analytes that have been suggested for this are reviewed and evaluated. Distinguishing whether the effusion is an exudate or transudate is a pragmatic first step. with further investigations dictated by the clinical features and these results. Total protein and lactate dehydrogenase were used first; Light's criteria were published in 1972 and since then additional markers including cholesterol, bilirubin and albumin gradient plus combinations of these have been proposed. Although combination testing does improve the sensitivity for diagnosis of an exudate. this is at the expense of specificity. Measurement of fluid to serum ratios appears to confer no advantage, and if a single test is required total protein performs as well as any. Additional tests may be useful in specific circumstances: pleural fluid pH may aid decisions over drainage of a parapneumonic effusion; glucose may indicate an effusion associated with rheumatoid arthritis; and adenosine deaminase may help with the diagnosis of tuberculous effusions.
11470607 The next generation of PDE4 inhibitors. 2001 Aug A number of highly potent PDE4 inhibitors are being developed for the treatment of asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, multiple sclerosis and Crohn's disease. Cilomilast (Ariflo, SB 207499, SmithKline Beecham), the most advanced member of the class in Phase III clinical trials, was reported to have a limited therapeutic window. Other inhibitors with improved profiles in preclinical models are entering into (or are in) clinical trials. The recent developments in understanding PDE4 catalysis, inhibitor binding and their emetic response should facilitate the design of the next generation of PDE4 inhibitors.
11458198 The role of metals in autoimmunity and the link to neuroendocrinology. 1999 Current available literature indicates a risk for metal-induced autoimmunity in man. Metal pathology may be due to toxic or allergic mechanisms where both may play a role. The main factors decisive for disease induced by metals are exposure and genetics which determine the individual detoxifying capacity and sensitivity to metals. This paper reviews the possible mechanisms which may play a role in metal-induced autoimmunity with the emphasis on multiple sclerosis (MS), rheumatoid arthritis (RA) and amyotrophic lateral sclerosis (ALS). We also discuss the role of inflammation-induced changes in the hypothalamus-pituitary-adrenal (HPA) axis as a possible explanation of fatigue, depression and other psychosomatic symptoms observed in these diseases. The increased knowledge about individual sensitivity based on genotype and phenotype variability together with the use of biomarkers for the diagnosis of this individual susceptibility seems to be the key in elucidation of the operating mechanisms. Since metal-induced sensitization may be induced by chronic low-dose exposure, the conventional toxicological approach comparing concentrations of metals in brain autopsies, organ biopsies and body fluids in patients and controls may not provide answers regarding the metal-pathology connection. To address this issue, longitudinal studies of metal-sensitive patients are preferable to the traditional case-control studies.
11312388 Nosology versus pathology, two approaches to rheumatic diseases illustrated by Alfred Bari 2001 Apr OBJECTIVES: To show why and how, without underestimating the popular perception of the word 'rheumatism', a medical approach to rheumatic diseases needs to consider the distinction between nosology (the study of diseases) and pathology [anatomopathology (the study of lesions) and physiopathology (the study of functional disturbances)]. METHODS: Selected quotations reflecting the thought processes of two famous physicians whose clinical activity (orientated towards nosology) was firmly based on pathology (mainly physiopathology in the case of A. B. Garrod and mainly anatomopathology in the case of J.-M. Charcot) are discussed. RESULTS: Starting from the physiopathological criterion of hyperuricaemia in gout, Garrod's thought processes led him to name and study rheumatoid arthritis. Alongside his neurological work, Charcot's thought processes led him to underline the common anatomical changes which could be observed in some nosologically distinct forms of chronic rheumatism. CONCLUSIONS: Selected older texts of both authors provide good examples of a methodology which can still be useful for present-day rheumatologists, particularly during their training period. They could serve as a guide to clarify some semantic ambiguities concerning nosology and pathology and for a better understanding of some clinical and radiological overlaps between distinct nosological entities.
10958232 Smoking-related interstitial lung diseases. 2000 Sep Interstitial lung diseases (ILDs) encompass diverse clinicopathological disease entities ranging from idiopathic interstitial pneumonia (IIP) to interstitial pneumonia accompanied by collagen vascular diseases and diseases related to smoking, drug reactions, occupational environments, infections, and malignancies. Our focus is on the smoking-related interstitial lung diseases. Specifically, we focus on reports suggesting that chronic smoking is deeply involved in the disease pathogenesis and on reports suggesting that chronic smoking may influence the clinical course in terms of either disease severity or progression. Pulmonary Langerhans' cell granulomatosis (PLCG), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis with interstitial lung diseases (RB-ILD), interstitial pneumonia associated with rheumatoid arthritis, acute respiratory distress syndrome (ARDS), and idiopathic pulmonary fibrosis (IPF) are covered.
10616054 Fusion and instrumentation at C1-3 via the high anterior cervical approach. 2000 Jan OBJECT: The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. METHODS: Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1-3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. CONCLUSIONS: Fusion and instrumentation at C1-3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital-C1 mobility.
10578424 [Cytokines and immunotherapy in infectious diseases]. 1999 Nov 6 Cytokines are essential mediators in infection and inflammation. Almost all cytokines have not only positive but also noxious effects: the proinflammatory cytokines released during severe infections in high concentrations lead to organ damage and death. The antagonistic anti-inflammatory cytokines inhibit the defense against infections. Immunotherapy through modulation of the cytokine response may aim at inhibition of the proinflammatory and reinforcement of the anti-inflammatory cytokine response, so as to limit the damage of inflammation. In patients with sepsis this has so far been little successful, probably owing to the multiple effects of the cytokines. Inhibition of proinflammatory cytokines was successful, on the other hand, in patients with rheumatoid arthritis or Crohn's disease. Another possibility is to aim, on the contrary, at reinforcement of the proinflammatory and inhibition of the anti-inflammatory cytokine response, to strengthen the resistance of the host. This has given favourable results in a limited number of infections.
10562368 The occurrence and impact of generalized pain. 1999 Sep A major problem with estimating the impact of chronic generalized pain is that the term remains undefined. It appears to encompass several distinct clinical entities, including rheumatoid arthritis and fibromyalgia, which can exist alone or together in a given individual. Nonetheless, chronic generalized pain appears to have a sizable impact on both the individual and society. Although little is known about causal relationships, demographic risk factors for chronic generalized pain are female sex, age in the forties and fifties, lower income, lower education, and being divorced or separated. Chronic generalized pain affects the individual in several ways, including physical and psychological distress, losses of function, quality of life, employment and income, and prolonged litigation for many. Its impact on society includes increased utilization of health care resources, loss of work productivity, disability and insurance costs, costs of litigation and social policy. Future research into the impact of chronic generalized pain must begin by defining this term in a way that is both valid in construct and convenient to use. Research is also warranted to develop and validate diagnostic tools that may better distinguish various subsets of chronic generalized pain, both to better understand the pathological processes involved and to allow for estimates of the relative contribution of each subset to societal costs.
10550345 [Experience with the therapy of acute finger ischemia by high-dose intra-arterial infusion 1999 Oct We present five patients with serious ischemia of the fingers caused by intra-arterial injection injury, trauma, rheumatoid arthritis, chronic myeloid leukemia with thrombocytosis and thoracic-outlet syndrome. The treatment consisted of thrombectomy and intra-arterial lysis if possible and intra-arterial infusion of 80 microg PGE1/24 h in combination with 25,000 U of heparin/24 h for 6-10 days. PGE1 and heparin were administered through a 3-F catheter introduced surgically into a forearm artery. In three cases a complete remission was possible, in the other two cases the therapy led to significant improvement. No side effects or complications were noticed.
10097808 Acquired haemophilia. 1998 Jun Acquired haemophilia is a rare but life-threatening acquired bleeding diathesis caused by autoimmune depletion of factor VIII. This occurs most frequently in elderly patients who lack disease associations. Acquired haemophilia may also arise in association with SLE rheumatoid arthritis, Sjögren's syndrome, other autoimmune conditions, lymphoproliferative malignancy, pregnancy and as a drug reaction. Acquired haemophilia has an equal sex distribution. The aims of treatment are to eliminate the inhibitor by immunosuppression and to treat the bleeding, which is the most common cause of death in patients with acquired haemophilia. The inhibitor is abolished in up to 70% of patients using prednisolone and cyclophosphamide, although other immunosuppressive regimens may also be used. These include azathioprine, vincristine and other cytotoxic agents, high-dose immunoglobulin and cyclosporin A. Bleeding may be controlled using porcine factor VIII or recombinant factor VIIa, although human factor VIII and prothrombin complex concentrates also have a limited role as haemostatic agents in this condition.
9708620 Mycophenolate mofetil therapy for lupus nephritis refractory to intravenous cyclophosphami 1998 Aug Intravenous (i.v.) cyclophosphamide has been the treatment of choice for diffuse proliferative glomerulonephritis (DPGN) in patients with systemic lupus erythematosus (SLE). However, there is little guidance in the medical literature about what to do when this therapy fails. Mycophenolate mofetil (MMF), a new immunosuppressive agent, has been used successfully in patients with solid organ transplants and rheumatoid arthritis. We report two patients with diffuse proliferative glomerulonephritis who responded favorably to MMF therapy after i.v. cyclophosphamide failed.
9219798 Dysphagia induced by chronic ingestion of benzodiazepine. 1997 Jul We report a case of a 57-yr-old woman with a complaint of dysphagia of 2-wk duration. She had rheumatoid arthritis and had been taking 10 mg of prednisone and 2 mg of lorazepam daily for 2 yr. Radiologic examination showed partial retention of barium sulfate in the pharynx, which was confirmed by scintigraphic examination of the oral and pharyngeal phases of swallowing. This retention was about 47% of the volume swallowed. The benzodiazepine was withdrawn, and 2 wk later she had no symptoms. We repeated the scintigraphic study, and it showed no retention. We conclude that chronic ingestion of benzodiazepine may cause dysphagia.
9291850 The Michael Mason Prize Essay 1997. Nitric oxide and bone: what a gas! 1997 Aug Nitric oxide (NO) is an important signalling molecule in bone which is produced in response to diverse stimuli such as pro-inflammatory cytokines, mechanical strain and sex hormones. Recent work suggests that NO exerts biphasic effects on bone cell activity: high concentrations of NO inhibit bone resorption by inhibiting osteoclast formation and by inhibiting the resorptive function of mature osteoclasts, whereas lower NO concentrations potentiate cytokine-induced bone resorption and may be essential for normal osteoclast function. Similarly, growth and differentiation of osteoblasts are inhibited by high concentrations of NO which may partly be responsible for the inhibitory effects of pro-inflammatory cytokines on bone formation. In contrast, lower amounts of NO produced by constitutive nitric oxide synthase (NOS) enzymes may play a role in regulating normal osteoblast growth and in mediating the effects of oestrogens on bone formation. Evidence of inducible nitric oxide synthase (iNOS) expression has been found in the rheumatoid joint and patients with active rheumatoid arthritis (RA) have raised levels of NO breakdown products in blood and urine. This indicates that NO may be involved in the pathogenesis of bone disease and tissue damage associated with inflammatory conditions such as RA, and raises the possibility that iNOS inhibitors may be of therapeutic value in this situation. The observation that both oestrogen and mechanical strain increase NO production by activating constitutive NOS further suggests that bone loss associated with oestrogen deficiency and immobilization may be related to production of NO and may hence be amenable to treatment with pharmacological NO donors.
11388094 Clinical and histopathologic features and immunologic variables in patients with severe ch 2001 May We investigated 33 patients affected with chilblain lesions following a persisting course of more than 1 month. We focused on the incidence of an underlying connective tissue disease, mostly lupus erythematosus (LE), and we analyzed features of idiopathic chilblains compared with those of chilblain lesions associated with connective tissue disease. We also carried out a prospective follow-up of patients. Eleven patients included in the study were free of any clinical and/or laboratory abnormality suggestive of connective tissue disease, while 22 of 33 patients showed 1 or several abnormalities raising suspicion for connective tissue disease, and among them 8 had a diagnosis of systemic lupus erythematosus (SLE) established at initial evaluation based on the American College of Rheumatology revised criteria. The comparative analysis of patients with idiopathic chilblains and patients with chilblains associated with LE showed that female sex and persistence of lesions beyond cold seasons were significantly associated with chilblain LE. Histopathologic studies of chilblain lesions did not reveal features typical of LE in any case, but revealed a higher incidence of a deep perisudoral infiltrate in idiopathic chilblains. In patients showing signs of connective tissue disease, positive cutaneous immunofluorescence was correlated with the presence of circulating antinuclear antibodies. Two patients had an ascertained diagnosis of SLE with severe manifestations during prospective follow-up, requiring treatment with oral steroids in both cases. Chilblains following a chronic course may reveal connective tissue disease, and patients affected with chilblains associated with autoimmune abnormalities may develop severe SLE. Accordingly, long-term follow-up of these patients is warranted.
11246681 Primary Sjögren's syndrome--treatment of fetal incomplete atrioventricular block with dex 2001 Feb Pregnancies in women with autoantibodies against Ro/SSA and/or La/SSB may be associated with permanent and treatment resistant fetal atrioventricular (AV) block. We describe a patient with primary S ogren's syndrome and anti-Ro (60 kDa and 52 kDa) and anti-La autoantibodies, in whom fetal bradycardia with second-degree AV block was detected at 19 + 0 weeks of gestation. Maternal treatment with dexamethasone (4 mg/day po) was started 2 days later. The baby's heart rate improved gradually, returning to normal after about 6 weeks of treatment. Our case illustrates the importance of close monitoring of the fetal heart rate in risk-pregnancies from about week 16 of gestation and initiation of dexamethasone treatment without delay when a block is detected.
10464559 Expression of metalloproteinase-2 (gelatinase A) in labial salivary glands of patients wit 1999 Jul OBJECTIVE: To determine whether gelatinase A (MMP-2) plays a significant role in the pathogenesis of Sjögren's syndrome (SS) with or without HTLV-I infection. METHODS: We examined 24 patients with SS (14 HTLV-I-seropositive and 8 HTLV-I-seronegative). Labial salivary gland tissue samples were analysed immunohistochemically using anti-MMP-2 monoclonal antibodies. RESULTS: In normal salivary glands, MMP-2 expression was not detected. All biopsy samples of 8 SS patients with HTLV-I-associated myelopathy (HAM) and 3 of 6 HTLV-I-seropositive SS patients without manifestation of HAM stained positively for MMP-2. However, the other samples were negative for MMP-2. CONCLUSION: Our study showed the MMP-2 expression in labial salivary glands of HTLV-I seropositive SS patients, especially in all SS patients with HAM. The presence of MMP-2 in the salivary glands of these patients suggests that it may play a role in cellular infiltration and destruction in salivary glands of SS.
10488185 Serodiagnosis of Epstein-Barr virus infection by using recombinant viral capsid antigen fr 1999 Oct Using recombinant 15- to 30-kDa fragments and fusion with glutathione S-transferase (GST), we investigated the seroreactivity of three large structural proteins of Epstein-Barr virus (EBV), p150 (BcLF1, capsid), p143 (BNRF1, tegument), and gp125 (BALF4, membrane) in Western blots. None of 13 fragments tested, however, was qualified for diagnostic application. In contrast, the two small viral capsid antigens (VCA), p18 (BFRF3) and p23 (BLRF2), demonstrated sensitive (100%) EBV-specific immunoglobulin G (IgG) reactivities. While p18 additionally showed maximum sensitivity for IgM detection, the IgM sensitivity of p23 was restricted (44%). An autologous fusion protein, p23-p18, which consists N-terminally of full-length p23, followed by the carboxy half of p18, was constructed. This antigen was subjected to indirect VCA enzyme-linked immunosorbent assays (ELISAs), for IgG and IgM, as well as to a micro-capture (microc) IgM ELISA. All assays were found to be 100% specific when EBV-negative sera were tested. Using sera from previously infected individuals, the p23-p18 fusion revealed an improved IgG sensitivity of 99% compared to sensitivities of 97 and 93% for the single antigens p18 and p23, respectively. The sensitivity and specificity of the indirect IgM ELISA with samples of primary and past infections, respectively, were 100%. The microc principle for IgM overcame completely the interference by rheumatoid factors. Compared to the specificity of the indirect IgM version, the specificity with sera collected from rheumatoid arthritis patients increased from 48 to 100%. In summary, the p23-p18 IgG and microc IgM ELISAs showed excellent performances and are promising new diagnostic tests for the detection of EBV-specific antiviral capsid antibodies.
9881951 Vascular turnover during carrageenan synovitis in the rat. 1998 Dec Inhibition of angiogenesis has been proposed as a novel therapeutic approach to the treatment of chronic inflammatory diseases such as rheumatoid arthritis. We have assessed carrageenan synovitis in male Wistar rats as a potential model of the increased vascular turnover observed in human synovitis. Intra-articular injection of 100 microl of 2% carrageenan in the right knee on Day 0 was followed by acute joint swelling through Day 3 and persistent macrophage infiltration at Day 28. Endothelial cell proliferation and endothelial cell death each peaked during the acute phase and remained elevated during persistent synovitis. Vascular densities were high in normal synovia, decreased during the acute phase, transiently increased at Day 14, and then returned to control values by Day 28. Lower doses of carrageenan, which stimulated acute joint swelling and macrophage infiltration but not endothelial cell proliferation at Day 3, were not associated with persistent macrophage infiltration at Day 28. Intra-articular injection of substance P or vascular endothelial growth factor, angiogenic factors that are present in normal synovia or are up-regulated during inflammation, respectively, each stimulated endothelial cell expression of proliferating cell nuclear antigen. Increased vascular turnover during acute and persistent phases of synovitis may be regulated by different factors and may serve different roles. The late phase (Day 28) of carrageenan synovitis displays similarities with rheumatoid synovitis, in which endothelial cell turnover is persistently increased despite little overall change in vascular density.