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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
9857552 [Mecring threaded cup in total arthroplasty of the hip with acetabular protrusion]. 1998 Results of total arthroplasty of the hip with acetabular protrusion with the use of Mecring cup in 21 patients (25 hips) aged 25-75 years (mean 62) are reported. Morsalised impacted autografts were used to fill acetabular defect in all cases. There were 14 rheumatoid arthritis patients, 4 cases of osteoarthritis and 3 cases of Otto-Chrobak disease. Mean follow-up was 2.5 years (range 6 months-5 years). All autografts were incorporated after 6-9 months. Only one loosening and migration of the cup occurred. One patient died because of pulmonary embolism. Harris Hip Score increased from 37 points (22-49) preoperatively to 81 points (65-89) at the latest follow-up. Incorporation of autografts reinforced acetabular bottom and prevented recurrence of protrusion. Bone remodeling indicates restoring normal biomechanics of the hip.
9361160 Methotrexate hepatotoxicity. 1997 Nov Hepatoxicity is a major adverse reaction that can occur during methotrexate treatment of the rheumatic diseases. The pathologic lesions are nonspecific and the pathogenesis is poorly understood. Early studies in psoriasis clearly established a relationship between hepatic injury and several risk factors, particularly alcohol use. Methotrexate hepatoxicity occurs less frequently in rheumatoid arthritis than previously reported in psoriasis patients. Consequently, the American College of Rheumatology guidelines for methotrexate monitoring do not recommend baseline and surveillance liver biopsies in low-risk patients. These guidelines seem to be useful and cost-effective.
10447018 Postpartum autoimmune thyroid syndrome: a model of aggravation of autoimmune disease. 1999 Jul Postpartum thyroid dysfunction is rather a common problem during the postpartum period being found in approximately 5% of mothers in the general population. It occurs from subclinical autoimmune thyroiditis that is aggravated after parturition and causes various types of thyroid dysfunction. Immune activity is physiologically suppressed during pregnancy so that the fetus is not rejected, and rebounds above the normal level after parturition. Graves' disease and Hashimoto's thyroiditis also spontaneously ameliorate during pregnancy, and are often aggravated after parturition. The high-risk mothers for postpartum thyroid dysfunction are well screened by antithyroid microsomal antibody (MCAb) and 60% to 70% of MCAb-positive mothers develop postpartum thyroid dysfunction, which is transient in most cases. New onset of Graves' disease may be screened by thyroid-stimulating antibody (TSAb) and 70% of TSAb-positive mothers develop either transient or persistent postpartum Graves' disease that usually occurs 3 to 6 months postpartum. Immune rebound after parturition may cause not only autoimmune thyroid diseases but other autoimmune diseases, which may be investigated with similar strategies to those in postpartum autoimmune thyroid disease. Thus, we found that postpartum onset of rheumatoid arthritis was found in 0.08% of women in the general population and could be partially predicted by measuring rheumatoid factors in early pregnancy. There are several case reports of other autoimmune diseases that develop after delivery; postpartum renal failure or postdelivery hemolytic-uremic syndrome, postpartum idiopathic polymyositis, postpartum syndrome with antiphospholipid antibodies, postpartum autoimmune myocarditis. Many other possible postpartum autoimmune diseases are still unexplored. Puerperal diseases should be carefully examined in relation to autoimmune abnormalities in the affected organs.
9182884 Expression of molecules involved in B lymphocyte survival and differentiation by synovial 1997 Jun The synovitis of rheumatoid arthritis (RA) is one of few pathological lesions in which B lymphocyte accumulation progresses to the extent of germinal centre formation. The present study was designed to assess the ability of synovial fibroblasts to express molecules implicated in B lymphocyte survival and differentiation, both in vivo, and in response to cytokines in vitro. Normal and diseased synovia were examined by indirect immunofluorescence. In all tissues synovial intimal fibroblasts showed co-expression of vascular cell adhesion molecule-1 (VCAM-1) and complement decay-accelerating factor (DAF) comparable to that of follicular dendritic cells (FDC), but not complement receptor 2 (CR2). In rheumatoid synovia, subintimal cells showed variable expression of VCAM-1 and DAF, with bright co-expression of VCAM-1, DAF and CR2 in lymphoid follicle centres. B lymphocytes, some of which were proliferating cell nuclear antigen-positive, were present in contact with subintimal cells expressing VCAM-1 with or without DAF or CR2. B lymphocytes were rarely present in the intimal layer, and, where present, showed fragmentation. In vitro, synovial fibroblasts exposed to tumour necrosis factor-alpha (TNF-alpha) in combination with interferon-gamma (IFN-gamma) showed enhanced expression of VCAM-1, in comparison with fibroblasts from skin and lung and, unlike skin and lung fibroblasts, also expressed DAF and CR2. These findings support the hypothesis that synovial targeting in RA involves an enhanced ability of synovial fibroblasts to support B lymphocyte survival. This appears to be dependent, not on the constitutive expression of VCAM-1 and DAF on intimal cells, but on the increased ability of subintimal cells to respond to proinflammatory cytokines, perhaps critically in the expression of VCAM-1.
9137391 [Respiratory function surveillance during prolonged treatment with low-dose methotrexate]. 1997 Mar 22 Long-term low-dose methotrexate (MTX) has a proven beneficial effect in patients with rheumatoid arthritis; the main drawback being the risk of interstitial pneumonia. Although estimations have varied, in our recent prospective analysis we observed 4 cases among 124 receiving MTX for rheumatological disorders, i.e. a risk rate of 3.2% Age, sex, disease duration, administration route and daily or cumulative dose do not appear to affect risk, but recent work suggest that renal failure, concomitent use of nonsteroid anti-inflammatory drugs, smoking, past pulmonary history or radiographic anomalies as well as recent withdrawal of corticosteroids are risk factors. Pulmonary function tests can be used to detect acute disorders and regular testing has been proposed to help predicted pulmonary complications in patients receiving long-term MTX. Unfortunately, minimal variations observed to date, for example in forced vital capacity or expiratory volume, do not appear to occur prior to clinical manifestations and may be due to normal aging processes or the pathological effect of the rheumatoid disease itself. In addition, due to the proven efficacy of MTX, randomized trials against a control group not given MTX would be ethically unacceptable. We are thus still unable to predict development of secondary pulmonary complications to long-term low-dose MTX. We therefore recommend testing pulmonary function at treatment onset to establish a reference for subsequent tests performed in case of clinical manifestations during MTX therapy. Patients should be counselled to consult in case of pulmonary symptoms in order to allow diagnosis as early as possible. The most recent data also would suggest that MTX may induce infraclinical alterations of pulmonary function although their significance remains to be clarified.
10985917 Iron catalyzed oxidative damage, in spite of normal ferritin and transferrin saturation le 2000 Sep Iron loading in hemochromatosis attains extremely high levels and is accompanied by many signs (ferritin >300 microg/l, hematocrit >50%, transferrin saturation >70%, etc.). Nevertheless, the disease is often overlooked by physicians, until several organs have been damaged permanently (heart, liver, brain, pancreas, kidneys, spleen, etc.). Therefore, severe oxidative damage catalyzed by Fe could occur, without the extremely high ferritin, hematocrit and transferrin saturation levels of hemochromatosis, and it is unlikely that it would ever be detected or even suspected. I postulate a mechanism, by which a cell can continue to express transferrin receptors, without producing ferritin, even when it is saturated with iron. Furthermore, I suggest that this silent iron loading, induced by cadmium and other metals, plays an important role in many degenerative diseases involving free radicals, DNA damage and peroxynitrite, all of which are intimately linked to iron.Moreover, since ferritin, transferrin saturation and hematocrit levels are not directly related to cellular iron levels, and since excess iron can wreak havoc in the cell, we can conclude that there is a need for a better way to evaluate intracellular iron levels and especially the intracellular free iron levels by a non-invasive technique.Finally, phlebotomy is suggested as the best way to reduce Fe and Mo stores, and chelation with succimer is recommended in order to eliminate Cd.
10961253 Other rheumatic diseases in adolescence. Dermatomyositis, scleroderma, overlap syndromes, 1998 Feb In addition to juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), dermatomyosytis, scleroderma, overlap syndromes, systemic vasculitis, and panniculitis also present in adolescence. The authors discuss the complex epidemiology, diagnosis, clinical features, diagnostic testing, treatment, and prognosis of these diseases.
10903814 Chronic inflammatory stress. 1999 Dec A major mechanism involved in maintaining homeostasis in response to chronic inflammation is the hypothalamo-pituitary-adrenal (HPA) axis, resulting in the release of anti-inflammatory glucocorticoids from the adrenal cortex. An inadequate HPA axis response may result in the development of a pathology or an increase in susceptibility and/or severity of disease. Other neuroendocrine systems are also implicated. Increasingly considered important are circadian rhythms, not only of hormones, but also of components of the immune system. Recent evidence concerning changes in hypothalamic control of the HPA axis following development of disease, the implication of these for the response to stress and the use of the HPA axis as a predictor of susceptibility to disease will also be considered. Finally, the influence of stress on autoimmune disease will be discussed. This chapter will concentrate principally on rheumatoid arthritis, although other autoimmune diseases and animal models will be discussed.
10822618 Concluding remarks and the challenge from the immune system. 1998 This meeting has covered a wide range of approaches to the study of interactions of biomembranes and one is struck by the progress in their analysis and the application of many new methods. The main theme of the meeting has been the structure of biomembranes and their components. Rather than pick highlights of these or attempt to summarise the findings in these Concluding remarks, I will instead summarise some of the interactions of the cells of the immune systems for which immunologists would like explanations at a molecular level. One of the features of the immune system is that it involves a variety of populations of cells that have complex migratory patterns and interactions that occur throughout life. The surfaces of these cells--the leukocytes--mediate interactions that are essential for the fine control of the immune system that ensures the rapid but controlled rejection of foreign materials such as viruses and bacteria. At the same time it must ensure that reactivity against self is prevented, otherwise autoimmune diseases such as rheumatoid arthritis and multiple sclerosis may result. Some of the features of the interactions involved are outlined in this short overview with more detailed analysis of the leukocyte cell surface given in ref. 1.
10794225 White blood cell counts and differential in synovial fluid of aseptically failed total kne 2000 Apr A cell count and differential was obtained on synovial fluid samples from 79 total knee arthroplasties undergoing revision for aseptic failure over a 5-year period. The mean white blood cell count (WBC) was 782/mL (range, 11-7,200/mL). The mean percentage of monocyte cells was 87%, and the mean polymorphonuclear leukocyte (PML) cell count was 13%. Eight patients (10.4%) had leukocyte cell counts >2,000. Five knees in 4 patients with rheumatoid arthritis had PML counts >50%. There was a single postoperative infection. In patients with osteoarthritis as a primary diagnosis, a synovial WBC of <2,000 and a differential with <50% PMLs had a 98% negative predictive value for the absence of infection. Key words: synovial fluid, cell count and differential, failed total knee arthroplasty, revision total knee arthroplasty.
10705717 Shoulder arthroplasty. Indications, contraindications and complications. 1999 Dec Prosthetic substitution of the glenohumeral joint, begun at the end of the last century, has developed greatly in recent years. Today the most widely used shoulder prostheses are defined as "modular" because of their extensive adaptability. The capacity to adapt to anatomic variations must be incorporated within their structure, and normal articular biomechanics must be respected. The choice of prosthesis must be based on the condition of the joint surfaces, on the anatomic and functional condition of the rotator cuff. So endoprosthesis of the shoulder is indicated for avascular necrosis of the head of the humerus, fractures and pseudoarthrosis of the extreme proximal end of the humerus, arthropathy following rotator cuff rupture. Total shoulder prosthetization is indicated for glenohumeral osteoarthritis, rheumatoid arthritis and outcomes of endoprosthesis. The principal contraindications for shoulder replacement include an infection in progress, Charcot's arthropathy and severe neurological pathologies. The complications of shoulder prostheses include infection, dislocation, loosening of a component, periprosthetic humeral and glenoid fractures, nerve injuries, fractures of a prosthetic component and ectopic ossification. At present prosthetic substitution of the glenohumeral joint offers good results. Indispensable conditions for these results include anatomic and functional integrity of the musculature, good bone quality, correct positioning of the prosthetic components and a proper rehabilitation program.
10503620 Factors that influence serum hyaluronan levels in hemodialysis patients. 1999 Sep Serum hyaluronan levels are increased in dialysis patients. We evaluated several factors that influence serum hyaluronan levels in 184 patients on chronic hemodialysis (duration 2.3 +/- 2.3 [SD] years). The levels were higher than normal in the whole group and in a subgroup of 133 patients without chronic infection, liver disease, or rheumatoid arthritis (215 +/- 19 and 205 +/- 22 microg/L, respectively). There was a tendency for the levels to be higher in a subgroup of patients with hepatitis c virus (HCV) infection. There was no correlation between hyaluronan levels, alanine aminotransferase (ALT), and duration or dose of dialysis. A weak but highly significant negative correlation between serum albumin levels and serum hyaluronan and ferritin levels was seen. The data suggest that chronic inflammation may explain, at least in part, the increased hyaluronan levels found in chronic dialysis patients.
10431309 [Arthroscopic ankle surgery. Indications, methods, results, complications]. 1999 Jun Based on the one experience and the information that is available in the literature indications for ankle arthroscopy are given, surgical equipment, patient placement and surgical technique of different procedures are described. Finally the results and possible complications are presented. Removal of loose bodies as well as synovectomies in case of an acute infection or rheumatoid arthritis are good indication. Arthroscopic treatment of anterior pathology in the athletic ankle need a thorough diagnostic work-up; the results of the treatment do not always meet the expectations of this especially demanding population. Cartilage treatment is technically possible, however, long term results are still missing. This is also true for the treatment on osteochondritis dissecans. In patients with degenerative joint disease arthroscopic debridement can only lead to a temporary benefit. Arthroscopic assisted arthrodeses (AAA) is technically demanding, but can serve as an excellent alternative to conventional open techniques. The complication rate in ankle arthroscopy is high compared to other joints, which is especially true for neurologic complications and postoperative infections. This should be addressed when performing the informed consent.
9919786 Chronic uveitis in Kinshasa (D R Congo). 1998 PURPOSE: To determine frequencies of different types of chronic uveitis and the possible associated conditions. METHODS: In the retrospective study a review is made of all 336 consecutive patients with chronic uveitis seen during 1983 through 1993. All patients were evaluated ophthalmologically and most of them medically. Traumatic uveitis was excluded from this study. RESULTS: There were 171 (51%) males and 165 (49%) females. Of 336 patients with chronic uveitis, 194 (58%) had anterior uveitis, 76 (23%) had isolated posterior uveitis, 38 (11%) had panuveitis and 28 (8%) intermediate uveitis. Associated conditions were found in 151 (46%) of 336 patients. AIDS, Herpes Zoster Ophthalmicus, toxoplasmosis, tuberculosis, rheumatoid arthritis and onchocerciasis were the most common associated disease respectively in 12.5%, 6.4%, 6%, 6%, 6% and 4% of cases. CONCLUSION: The findings of this study were different from those of other studies published in Europe and the United States.
9708868 Increased capsaicin-induced secondary hyperalgesia as a marker of abnormal sensory activit 1998 Jul 10 In this study, capsaicin-induced secondary hyperalgesia was assessed as a marker of abnormal nociceptive processing in patients with fibromyalgia (FM). The area of mechanical secondary hyperalgesia induced by a standard solution of capsaicin placed on the volar forearm was measured in ten patients with FM and the results compared to those obtained in ten patients with rheumatoid arthritis (RA) and ten normal subjects. The area of secondary hyperalgesia was found to be substantially increased in both the FM and RA groups compared with controls. In the FM group the area of hyperalgesia correlated with the overall pain score and with the joint tenderness score. The results suggest that in FM there is enhanced sensitivity of nociceptive neurones at a spinal level, thereby supporting the concept of a generalised disturbance of pain modulation in this disorder.
9239408 Microglial production of TNF-alpha is induced by activated T lymphocytes. Involvement of V 1997 Aug 1 TNF-alpha is a proinflammatory cytokine involved in many inflammatory conditions such as Crohn's disease, rheumatoid arthritis, cachexia, AIDS, and multiple sclerosis (MS). TNF-alpha is produced mainly by cells of the macrophage lineage, which includes microglia in the central nervous system. Here, we describe a mechanism through which TNF-alpha is generated by microglia. We show that activated human T lymphocytes induce the microglial production of TNF-alpha, and that is attenuated by a functional blocking antibody to CD49d, the alpha chain of the VLA-4 integrin on T cells. We also report that interferonbeta-1b (IFNbeta-1b), a drug that alleviates symptoms in MS, downregulates the expression of CD49d and reduces TNF-alpha production, mechanisms which can help account for its efficacy in MS.
24383588 Matrix-degrading metalloproteinases and their roles in joint destruction. 2000 Sep Abstract Progressive degradation of the extracellular matrix (ECM) of articular cartilage and bone by enhanced activities of proteinases is an essential step for joint destruction in rheumatoid arthritis (RA) and osteoarthritis (OA). Among the proteinases, matrix-degrading metalloproteinases play a key role in joint destruction. Recent studies have indicated that these metalloproteinases comprise members of the matrix metalloproteinase (MMP) and a disintegrin and metalloproteinase (ADAM) gene families. The MMP family is composed of 19 different members and classified into five subgroups of collagenases, gelatinases, stromelysins, membrane-type MMPs, and other MMPs. They have the ability to digest almost all ECM components in human tissues when they act in concert. Their prospective roles in RA and OA joint destruction have been well established. On the other hand, the ADAM family members are classified into ADAM metalloproteinases and catalytically inactive nonproteolytic homologues. The ADAM metalloproteinases contain ADAM with a transmembrane domain (membrane-type ADAM) and ADAM with thrombospondin motifs (ADAMTS). Although members in both groups are known to degrade ECM components, ADAMTS species may be especially important for the aggrecan (cartilage proteoglycan) degradation of articular cartilage in RA and OA, since aggrecanases-1 and -2 are included in this group. This review outlines the characters of the MMP and ADAM gene family members and their roles in joint destruction in RA and OA.
11458186 [Myelopathy - Sjogren's syndrome association: analysis of clinical and radiological findin 2001 Jul Myelopathies associated with Sjögren's syndrome has been rarely described especially concerning magnetic resonance imaging (MRI) and treatment aspects. The aim of this study was to determine the clinical, laboratory and radiological features of myelopathies occurring in Sjögren's syndrome. Eleven patients were studied, 7 with an acute myelopathy and 4 with a chronic form. Acute myelopathy were clinically severe with a feature of transverse myelitis necessitating immunosuppressive drugs. On the other hand, chronic forms were closely similar to progressive multiple sclerosis (MS), for clinical and laboratory data. In 7 cases optic neuritis was found associated with myelopathy and fulfilled the diagnostic criteria of Devic's syndrome in 4 cases. The diagnosis of myelopathy associated with Sjögren's syndrome may be difficult especially compared with MS, HTLV1 or HIV myelopathy and sarcoidosis, in the chronic form but also with other vasculitis, MS or viral infection in the acute forms. However, in this last form, magnetic resonance imaging and cerebrospinal fluid data should bring to the diagnosis of Sjögren syndrome and confirmed by appropriate tests. This diagnosis will have direct consequences for an early treatment by immunosuppressive drugs.
10692824 Large annular purpura and paraneoplastic purpura in a patient with Sjögren's syndrome and 2000 Jan We report a 79-year-old female with anaphylactoid purpura on her legs and unusual large annular purpura on the trunk. Histopathological characteristics of leukocytoclastic vasculitis were observed in the upper and middle dermis of both types of skin lesions. She was complicated by Sjögren's syndrome and advanced cervical cancer. The annular purpura spontaneously resolved in a week and did not recur. However, the anaphylactoid purpura relapsed more frequently and spread more widely following the elevation of her serum SCC antigen levels from the onset of purpura until her death. We consider that the characteristic annular configuration was caused by the complication of Sjögren's syndrome and that the recurrent anaphylactoid purpura indicated paraneoplastic vasculitis primarily caused by the tumor specific protein immune complexes. Complication by Sjögren's syndrome many also play a role in the development of allergic vasculitis.
9196867 Practical usefulness of IgA-containing immune complex determination in the serum of patien 1997 Mar OBJECTIVE: To evaluate the relevance of IgA-containing immune complexes (IC) as a predictor of lymphocytic infiltration of the minor salivary glands, and thus to determine the necessity of the minor salivary gland biopsy as a diagnostic test for primary Sjögren's syndrome (SS) in patients complaining of dryness of the mouth. METHODS: IgA-containing IC, as well as anti-SSA and anti-SSB antibodies, were measured using enzyme-linked immunosorbent assays in 116 consecutive patients presenting with dry mouth but no connective tissue disease. The specificity, sensitivity, and positive (PPV) and negative predictive values (NPV) of these tests were calculated in relation to the results of the minor salivary gland biopsy and to the criteria for primary SS. RESULTS: Sixty-five patients had a focus score > or = 1.IgA-containing IC were detected in 45 of them, compared with five of the remainder (specificity 89%, sensitivity 69%, PPV = 88% and NPV = 69%). When the IgA-containing IC, and the anti-SSA and anti-SSB tests were associated, the sensitivity and NPV were improved (81 and 79%, respectively), while specificity and PPV were maintained (88 and 90%, respectively). CONCLUSION: Given the reliability of this combination of tests for the diagnosis of primary SS, the minor salivary gland biopsy might be indicated only in those patients without any serological abnormality.