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ID PMID Title PublicationDate abstract
11225487 [Forms of polyarthritis in idiopathic juvenile arthritis]. 2001 Jan 27 DEFINITION: Idiopathic juvenile polyarthritis includes a group of inflammatory diseases that affect at least five joints, either from onset or within the first six months of the disease course in children under 16 years of age. Diagnosis is arrived at by elimination. Besides malignant disease, always to be considered as a differential diagnosis, idiopathic juvenile polyarthritis can be divided into rheumatoid factor (RF)-positive and RF-negative polyarthritis and extended forms of oligoarthritis. RF-NEGATIVE POLYARTHRITIS: Antinuclear antibody (ANA)-positive polyarthritis must be distinguished from extended forms of oligoarthritis which are also ANA-positive. ANA-positive polyarthritis generally begins early, at the age of 2 or 3 years, predominantly in girls. Characteristic torpid uveitis is frequent, requiring regular systematic screening. Joints are minimally painful with symmetrical involvement, usually of the knees and wrists. Progressive joint destruction and/or growth disorders are common. The disease progresses by acute episodes. Nonsteroidal antiinflammatory drugs are used, associated with a specific treatment and local care as needed. General corticosteroids may be required in certain cases but should be avoided if possible. SERONEGATIVE FORMS: Certain patients have no detectable antibodies. These patients generally have fewer ocular problems and less severe joint disease. The treatment is the same as in ANA-positive forms. RF-positive polyarthritis: RF-positive polyarthritis is exceptional and occurs early in young girls. SPECIALIZED CARE: Irrespective of the type of disease, all children with idiopathic juvenile polyarthritis require multidisciplinary specialized care for their chronic and severe, potentially invalidating disease.
9378125 On simple repetitive DNA sequences and complex diseases. 1997 Aug Simple repetitive DNA sequences are abundantly interspersed in eukaryote genomes and therefore useful in genome research and genetic fingerprinting in plants, fungi and animals, including man. Recently, simple repeats were also identified in some prokaryotic genomes. Hence the same probes can be applied for multilocus DNA fingerprinting in medically relevant bacteria. Simple repeats including composite dinucleotide microsatellites are differentially represented in different compartments of eukaryote genomes. Expanded triplet blocks in and around certain genes may, for example, cause so-called trinucleotide diseases in man. As a consequence, simple repetitive sequences should also be characterized with respect to their influences on the DNA structure, gene expression, genomic (in)stability and their development on an evolutionary time scale. Here three examples of microsatellites in the human major histocompatibility complex (HLA) are investigated, a (GT)n microsatellite situated 2 kb 5' off the lymphotoxin alpha (LTA) gene, a (GAA)n block in the 5' part of the HLA-F gene and a composite (GT)n(GA)m stretch in the second intron of HLA-DRBl genes. Grossly differing mutation rates are evident in these elements as well as varying linkage disequilibria. The unfolding of these simple repeats in distant human populations is covered including Caucasians, Bushmen and South American Indians. Furthermore, implications of simple repeat neighboring genes are discussed for the multifactorial diseases multiple sclerosis (MS), rheumatoid arthritis (RA) and early onset pauciarticular arthritis (EOPA). Polymorphisms of HLA-DRBl and T cell receptor beta variable (TCRBV) genes confer susceptibility for these autoimmune diseases as demonstrable by intronic simple repeat variability. Microsatellite polymorphisms within the TNF region reveal linkage disequilibria with HLA-DRBl and different promotor alleles of the TNFA gene. Disease associations with TNFA microsatellite alleles are, on the one hand, secondary to associations with HLA-DRBl genes (in MS) or they represent additional risk factors (in RA, EOPA) on the other hand. Evolutionary persistence, various structural conformations and the specific binding of nuclear proteins to several simple repeat sequences refute the preconceptions of biological insignificance for all of these ubiquitously interspersed elements.
11431421 Identification of conformation-dependent epitopes and V gene selection in the B cell respo 2001 Jul Collagen-induced arthritis (CIA) is a widely used model for rheumatoid arthritis. Induction of CIA in rats using rat type II collagen (CII) results in a chronic arthritis in which anti-CII antibodies are believed to play a pathogenic role. In this study, we analyzed the epitope selection and V gene usage in the anti-CII response in the DA rat. A panel of CII-reactive B cell hybridomas was established from the draining lymph nodes 11 days after immunization. All of the CII-specific antibodies bound cartilage in vivo, showing that these are true autoantibodies. These antibodies were all IgG and specific for several distinct triple helical epitopes on CII. Interestingly, the major epitope, recognized by four different antibodies, was identical with the major B cell epitope in the mouse CII located at position 359--369 (denoted as C1(III)). The Q52 and PC7183 V(H) gene families encoded 12 out of 14 sequenced heavy chains. There was a relatively more heterogeneous usage of V(L) genes as the antibodies were encoded by four different V(kappa) families (V(kappa)1, V(kappa)2, V(kappa)12/13 and V(kappa)RF). As in the mouse, some of the V genes used showed germline characteristics. We conclude that the immune response in the rat shares epitope specificity and a constrained V gene repertoire with the mouse. However, the V genes used for recognition of the closely related collagen structures differed considerably between mouse and rat, indicating an influence of the species-specific variation in the V gene repertoire.
9489817 Early undifferentiated connective tissue disease. V. An inception cohort 5 years later: di 1998 Feb OBJECTIVE: To review the diagnoses after 5 years in patients who were identified within 12 months of the onset of well established and undifferentiated connective tissue diseases (CTD); to examine death rates and disease remissions in these patients. METHODS: This inception cohort of 410 patients was identified in 10 academic rheumatology practices. They had less than one year of signs and/or symptoms of CTD. Diagnoses of specific well established CTD were made using accepted diagnostic and classification criteria. The diagnoses after 5 years were determined. RESULTS: Patients with well established CTD tended to remain with the original diagnosis. The progression of unexplained polyarthritis to rheumatoid arthritis occurred infrequently. Ten percent of patients with isolated Raynaud's phenomenon progressed to systemic sclerosis (SSc). The 5 year survival was over 90% in all diagnostic categories, with the exception of SSc, in which it was 64%. CONCLUSION: Patients with a well established CTD usually continued with the same diagnosis. Patients with undifferentiated CTD tended to remain undifferentiated or to remit.
17986977 The morphology and selected biological properties of articular cartilage. 2001 Apr 30 The purpose of this article is to present the current state of knowledge regarding the structure and functions of articular cartilage. Articular cartilage is constructed with hyaline cartilage tissue. It is composed of chondrocytes located in lacunae and the extracellular matrix. The chondrial matrix contains water, collagen, proteglycans, non-collagenous matrix proteins, and lipids. Articular cartilage is devided into four zones - superficial, intermediate, deep, and calcified - on the basic of morphology, the orientation of collagen fiber, and the proteoglycan content. The dominant collagen of this tissue is Type II collagen, which, together with smaller quantities of other collagens (i.e. Types IX and XII), forms a network of fibers, with large, aggregating proteoglycans and smaller, non-aggregating proteoglycans. Proteoglycans are proteins that contain covalently attached glycosaminoglycans (GAGs), with water between them. The large aggregating proteoglycans, called "aggrecans", form aggregates that bind hyaluronic acid, and together with collagen they are responsible for the mechanical properties of cartilage. The smallnonaggregating proteoglycans, decorin and fibromodulin, limit the formation of collagen fibres. Other proteins in the cartilage matrix - chondrocalcin and the N-propetide of Type II collagen - participate in fiber formation. Yet other proteins - chondronectin, fibronectin, vitronectin and thrombospondin - take part in the interaction between the chondrocytes and the matrix. Cartilage oligomeric matrix protein (COMP) prevents the vascularization of the cartilage and, perhaps, is responsible for the repair process. The proteins known as Cart-1 and CEP-68 participate in chondrogenesis, while tenascin and Mgp are considered to be cartilage calcification inhibitors. Apart from the structural elements, chondrocytes produce substances that fulfill purely physiological functions: enzymes and cytokines. The enzymes - which include metalloproteinases, adamalysins, serine and cysteine proteases and their inhibitors - participate in cartilage matrix reconstruction. The cytokines - IL-1, TNF-alfa, IL-6, IL-8, and LIF - stimulate the chondrocytes to produce an increased amount of enzymes, while IL-4 inhibits this process. Human articular chondrocytes exibit the constitutive expression of class I molecules of the major histocompatibility complex (MHC), molecules regulating the activation of the complement, and after activation (e.g. under the influence of IFN-alfa, IL-1, TNF-a or in the course of arthritis), also MHC class II and ICAM-1 intracellular adhesion molecules. Numerous studies have shown that chondrocytes also have tissue-specific antigens, which induce the production of antibodies in patients with cartilage grafts, as well as those with rheumatoid arthritis and osteoarthritis. Some of these antibodies react with type II collagen, others are directed against other proteins i.e. anchorin CII and CH65. the role of these diverse molecules, which are present in cartilage cells and separated from the immune system by the matrix, remains unclear.
10377223 Design and synthesis of potent, selective, and orally bioavailable tetrasubstituted imidaz 1999 Jun 17 Novel potent and selective diarylimidazole inhibitors of p38 MAP (mitogen-activated protein) kinase are described which have activity in both cell-based assays of tumor necrosis factor-alpha (TNF-alpha) release and an animal model of rheumatoid arthritis. The SAR leading to the development of selectivity against c-Raf and JNK2alpha1 kinases is presented, with key features being substitution of the 4-aryl ring with m-trifluoromethyl and substitution of the 5-heteroaryl ring with a 2-amino substituent. Cell-based activity was significantly enhanced by incorporation of a 4-piperidinyl moiety at the 2-position of the imidazole which also enhanced aqueous solubility. In general, oral bioavailability of this class of compounds was found to be poor unless the imidazole was methylated on nitrogen. This work led to identification of 48, a potent (p38 MAP kinase inhibition IC50 0.24 nM) and selective p38 MAP kinase inhibitor which inhibits lipopolysaccharide-stimulated release of TNF-alpha from human blood with an IC50 2.2 nM, shows good oral bioavailability in rat and rhesus monkey, and demonstrates significant improvement in measures of disease progression in a rat adjuvant-induced arthritis model.
11435459 c-Jun N-terminal kinase is required for metalloproteinase expression and joint destruction 2001 Jul Mitogen-activated protein kinase (MAPK) cascades are involved in inflammation and tissue destruction in rheumatoid arthritis (RA). In particular, c-Jun N-terminal kinase (JNK) is highly activated in RA fibroblast-like synoviocytes and synovium. However, defining the precise function of this kinase has been difficult because a selective JNK inhibitor has not been available. We now report the use of a novel selective JNK inhibitor and JNK knockout mice to determine the function of JNK in synoviocyte biology and inflammatory arthritis. The novel JNK inhibitor SP600125 (anthra[1,9-cd]pyrazol-6(2H)-one) completely blocked IL-1--induced accumulation of phospho-Jun and induction of c-Jun transcription in synoviocytes. Furthermore, AP-1 binding and collagenase mRNA accumulation were completely suppressed by SP600125. In contrast, complete inhibition of p38 had no effect, and ERK inhibition had only a modest effect. The essential role of JNK was confirmed in cultured synoviocytes from JNK1 knockout mice and JNK2 knockout mice, each of which had a partial defect in IL-1--induced AP-1 activation and collagenase-3 expression. Administration of SP600125 modestly decreased the rat paw swelling in rat adjuvant-induced arthritis. More striking was the near-complete inhibition of radiographic damage that was associated with decreased AP-1 activity and collagenase-3 gene expression. Therefore, JNK is a critical MAPK pathway for IL-1--induced collagenase gene expression in synoviocytes and in joint arthritis, indicating that JNK is an important therapeutic target for RA.
10070272 Cryoglobulinaemia and rheumatic manifestations in patients with hepatitis C virus infectio 1998 Dec OBJECTIVES: To investigate the association of cryoglobulinaemia and rheumatic manifestations in Korean patients with hepatitis C virus (HCV) infection. METHODS: Forty nine Korean patients with HCV infection were recruited. The prevalence, concentration, and type of cryoglobulin (by immunofixation), rheumatoid factor (RF), antinuclear antibody (ANA), and various rheumatological symptoms were investigated and HCV genotype was determined by polymerase chain reaction with genotype specific primer. RESULTS: The prevalence of cryoglobulin was 59% in Korean HCV patients and the concentration of cryoglobulin was 9.8 (7.9) g/l (mean (SD)). The type of cryoglobulinaemia was identified in 23 (80%) of 29 HCV patients with cryoglobulinaemia and they were all type III. There were no differences in age, sex, history of operation and transfusion, proportion of liver cirrhosis between the patients with cryoglobulinaemia and those without cryoglobulinaemia. The frequencies of RF and ANA were 14% and 3.4% respectively in HCV patients with cryoglobulinaemia. There was no difference in HCV genotype between the patients with cryoglobulinaemia and those without cryoglobulinaemia. Clinical features of HCV patients were as follows: arthralgia/arthritis (35%), cutaneous manifestation (37%), Raynaud's phenomenon (8%), paresthesia (44%), dry eyes (22%), dry mouth (10%), oral ulcer (33%), and abdominal pain (14%). However, these rheumatological symptoms did not differ between the two groups. CONCLUSION: Although the rheumatological symptoms were not different between HCV patients with and without cryoglobulinaemia, HCV patients showed various rheumatological manifestations. These result suggests that HCV infection could be included as one of the causes in patients with unexplained rheumatological symptoms.
10632675 Treatment with anti-CD86 costimulatory molecule prevents the autoimmune lesions in murine 2000 Feb Intraperitoneal administration with anti-CD86 (B7.2) MoAb into the murine model for primary SS in NFS/sld mutant mice resulted in dramatically inhibitory effects on the development of autoimmune lesions, while no significant effects were observed when the mice were administered with anti-CD80 (B7.1) MoAb. We found that spleen cells in the murine SS model treated with anti-CD86 MoAb showed a significant impairment of autoantigen-specific T cell proliferation. T cell activation markers (CD44high, CD45RBlow, Mel-14low) were significantly down-regulated in the spleen cells gated on CD4 in anti-CD86-treated mice. We detected a higher level of cytokine production of IL-4 from splenic T cells in anti-CD86-treated mice, but not of IL-2, and interferon-gamma (IFN-gamma), compared with those in the anti-CD80- and PBS-treated SS model. Moreover, serum autoantibody production against alpha-fodrin autoantigen was almost entirely suppressed in anti-CD86-treated mice. These data provide strong evidence that in autoimmune exocrinopathy resembling SS in NFS/sld mutant mice, the CD86 costimulatory molecule plays a crucial role in the initiation and subsequent progression of Th1-mediated autoimmunity in the salivary and lacrimal glands.
10513819 Mixed cryoglobulinemia secondary to visceral Leishmaniasis. 1999 Sep We describe a case of type II mixed cryoglobulinemia, with monoclonal IgMkappa rheumatoid factor, associated with visceral leishmaniasis caused by Leishmania infantum. Involvement of Leishmania antigen(s) in the formation of cryoprecipitable immune complexes was suggested by the fact that cryoglobulinemic vasculitis subsided after antiparasite therapy and that anti-Leishmania antibodies, as well as rheumatoid factor, were enriched in the cryoprecipitate. We observed 2 additional patients with visceral leishmaniasis and cryoglobulinemic vasculitis. All 3 patients had seemingly contracted leishmaniasis in Italy, were hepatitis C virus negative, and were initially diagnosed as having autoimmune disorders. These findings indicate that Leishmania can be an etiologic agent of type II mixed cryoglobulinemia. This parasitosis should be taken into consideration in the differential diagnosis of vasculitides in endemic areas.
11526412 Congenital complete heart block in the fetus: hemodynamic features, antenatal treatment, a 2001 Sep Congenital heart block (CHB) can result in intrauterine cardiac failure leading to fetal or neonatal loss. To establish perinatal hemodynamic factors which might predict adverse outcome, six fetuses with CHB diagnosed between 20 and 30 gestational weeks were examined by echocardiography at 2-week intervals. Neonatal morbidity and outcome in infancy are detailed. The fetuses showed a significant decrease in ventricular rate (VR) with advancing gestation (60 +/- 7 vs 51 +/- 4 beats/min, p = 0.03). Cardiac decompensation defined as hydrops or pericardial effusion was associated with VR of lower than 55 beats/min in two fetuses. Three mothers had a therapeutic trial with a sympathomimetic and digoxin. Salbutamol increased VR 10% in one of three fetuses treated. Digoxin decreased pericardial effusion in one hydropic fetus with autoimmune myocarditis. In this fetus, poor left ventricular fractional shortening (LVFS) was accompanied with high umbilical artery resistance index (RI). High amniotic fluid erythropoietin indicated severe hypoxia preceding death. Pacemaker was indicated in all the newborns. At the age of 2 weeks all the surviving infants had tricuspid regurgitation and a shunt through foramen ovale due to asynchronized atrioventricular contraction. During the 12-month follow-up two of five surviving infants had no symptoms. One had symptomatic neonatal lupus. Two infants had patent ductus arteriosus, one with dilated cardiomyopathy. In conclusion, poor fetal outcome was associated with low VR, low LVFS, and high RI. Despite early pacing, morbidity was high in infancy due to cardiomyopathy and associated heart defects. Regular echocardiographic monitoring during pregnancy and after delivery is required in order to optimize care and timing of any interventions.
11334497 Epidemiology of autoimmune reactions induced by vaccination. 2001 May In order for vaccinations to 'work', the immune system must be stimulated. The concern that immunizations may lead to the development of autoimmune disease (AID) has been questioned. Since AID occur in the absence of immunizations, it is unlikely that immunizations are a major cause of AID. Epidemiological studies are needed, however, to assess whether immunizations may increase the risk in some susceptible individuals. This paper discusses the evidence for and against vaccination as a risk factor for AID. Evidence for immunizations leading to AID come from several sources including animal studies, single and multiple case reports, and ecologic association. However more rigorous investigation has failed to confirm most of the allegations. Unfortunately the question remains difficult to address because for most AIDs, there is limited knowledge of the etiology, background incidence and other risk factors for their development. This information is necessary, in the absence of experimental evidence derived from controlled studies, for any sort of adequate causality assessment using the limited data that are available. Several illustrative examples are discussed to highlight what is known and what remains to be explored, and the type of epidemiological evidence that would be required to better address the issues. Examples include the possible association of immunization and multiple sclerosis (and other demyelinating diseases), type 1 diabetes mellitus, Guillain-Barre Syndrome, idiopathic thrombocytopenic purpura, and rheumatoid arthritis.
11261778 Lymphoid neogenesis: de novo formation of lymphoid tissue in chronic inflammation through 2001 Mar Chronic inflammation is a complex pathophysiological process with accumulation of mononuclear cells seen in response to invading pathogens, neoplastic transformation, or autoimmune recognition of self-antigens. The inflammatory process has evolved to facilitate effective elimination of pathogens and tumors and it is normally transient and turned off when the causative stimulus has been eliminated. Occasionally, however, the process is sustained for a long time and can lead to severe tissue damage. This is seen in organ-specific autoimmune diseases such as rheumatoid arthritis, Sjögren's syndrome, and Hashimoto's thyroiditis, but also in infectious diseases such as Helicobacter pylori-induced gastritis. Disturbingly, many of these chronic inflammatory diseases are associated with an increased risk for neoplastic transformation and development of lymphomas. This review summarizes experimental evidence suggesting that chronic inflammation involves ectopic de novo formation of organized lymphoid tissue and that this lymphoid neogenesis is regulated by expression of homing chemokines.
10660150 Autoimmune diseases in families of French patients with multiple sclerosis. 2000 Jan Multiple sclerosis (MS) is associated with autoimmune disorders (AIDs) in individual patients, and limited data suggest a possible familial association of MS and AIDs; however, no systematic study has been conducted on the occurrence of AIDs in the families of MS patients. Using a standardized interview focused on AIDs, we obtained the family histories of 357 consecutive patients from our MS clinic. Adequate information was obtained on 1971 first-degree relatives. Fifty-five patients (15.4%) had first-degree relatives with MS (n=22, 6.2%) another AID (n = 30, 8.4%), or both (n = 3, 0.8%). In 16 families (4.5%), at least 3 first-degree relatives had MS or another AID. MS, Grave's disease, rheumatoid arthritis, vitiligo, type 1 insulin-dependent diabetes mellitus, and uveitis, were the most common AIDs in these families. Such multiplex families (families with MS plus AID) are appropriate for identifying susceptibility genes that may be common to MS and other AIDs.
10503652 Evaluation of recent clinical trials in lupus. 1999 Sep Clinical trials in lupus pose many challenges, ranging from small numbers of subjects to endpoints that are difficult to quantify. Improved standardization of both design and appropriate endpoints is necessary. Recent trials have been small in number, with few randomized controlled trials. These trials have evaluated therapies such as methotrexate, cyclosporine A, bromocriptine, immunoadsorption columns, and hydroxychloroquine withdrawal. With the advent of improved techniques as well as newer therapeutic agents, options for the treatment of lupus should begin to grow over the next several years in a fashion similar to that which has been seen in rheumatoid arthritis.
10468173 Adhesion and lymphocyte costimulatory molecules in systemic rheumatic diseases. 1999 Adhesion molecules expressed on the surface of immune cells transduce a variety of cell-activating signals and mediate important interactions by binding to multiple specific counter-receptors expressed on other cells or on extracellular matrix components. A large number of aberrations in the expression of cell-bound molecules at the mRNA and protein level in vivo have been described in patients with autoimmune connective tissue diseases. In vitro studies suggest the presence of functional abnormalities of adhesive pathways, at least at some points of the disease. Increased circulating levels of isoforms of several adhesion molecules have also been demonstrated in these patients. The possible involvement in the pathogenesis of rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome and systemic sclerosis of E-, P- and L-selectins, of some integrins and of several adhesion molecules of the immunoglobulin superfamily that in addition participate in lymphocyte costimulation will be discussed in this review. Further studies on migration and recruitment patterns of immune cells into inflamed tissues, as well as on possible defects of lymphocyte activation in these patients, are expected to expand our knowledge on systemic autoimmune responses and identify targets for specific immunotherapy.
10361404 Normal structure and morphological effects of a corticosteroid on the peripatellar synovia 1999 Apr We observed the peripatellar synovial membranes of normal and betamethasone-treated rats with a scanning electron microscope (SEM), light microscope (LM) and transmission electron microscope (TEM). On the basis of SEM findings, the peripatellar synovial membrane is divided into two distinct regions; an upper, smaller, round, non-folded region which is covered with small excrescences, and a lower, larger, horseshoe-shaped region which has numerous folds consisting of cobblestone-like oval cells. These SEM findings were well confirmed by parallel LM and TEM observations of both regions. The synovial membrane of rats treated with intra-articular injections of betamethasone, an anti-inflammatory agent for rheumatoid arthritis, showed cell-sized excrescences on the surface of the non-folded regions. Under LM and TEM, the synovial membrane of treated rats showed an expansion of the intercellular spaces with collagen fibers, swelling of vacuoles in the cytoplasm in the type M synoviocytes, and increases in the number and elongation of microvilli of the type M synoviocytes. These observations suggest that repeated betamethasone injection therapy may result in unnecessary damage to the synovial membrane.
10340395 Erythropoietin production in anemia associated with experimental cancer. 1999 May Serum erythropoietin (EPO) concentrations reportedly are depressed in patients with chronic disorders such as cancer, rheumatoid arthritis, and acquired immunodeficiency syndrome. We evaluated serum EPO levels in mice with tumors and found that the EPO response was appropriate for the associated anemia during the major part of the disease process. The levels of the hormone increased as the anemia worsened in association with progression of the disease. The increased EPO levels were comparable to those of controls with a similar degree of experimentally induced anemia. Only during the terminal stages of cancer, when the animals were severely cachectic, were serum EPO concentrations lower than in controls with a similar degree of anemia. These findings suggest that a blunted EPO response in experimental cancer occurs only in association with advanced disease.
10048527 Limited wrist fusions: comparison of results 22 and 89 months after surgery. 1999 Jan Limited wrist arthrodeses were performed to treat wrist diseases other than rheumatoid arthritis. The purpose of this study was to evaluate whether clinical and radiographic results noted 22 months after the procedure were maintained on re-examination an average of 89 months (range, 66-148 months) after the procedure. The study comprised 17 wrists. The average patient age was 42 years (range, 11-65 years). Two patients, both with Kienböck's disease, were lost to follow-up. Four radiocarpal and 11 intercarpal arthrodeses were performed. The range of motion between the first and second follow-up examination showed no significant difference. Grip strength likewise was nearly identical at both visits. At the last follow-up visit, progression of osteoarthrosis about the fusion area was noted in only 1 patient. These results suggest that the clinical and radiographic results at 22 months were maintained at the final follow-up visit and that the effect of limited wrist fusion does not deteriorate.
9818056 The assessment of autonomic function in patients with systemic amyloidosis: methodological 1998 Sep Autonomic neuropathy is a well-known and prognostically important feature of systemic amyloidosis. In other conditions, autonomic function is commonly assessed by cardiovascular reflex tests, described by Ewing, but the feasibility of these tests has not been investigated in patients with systemic amyloidosis. We studied autonomic function in amyloidotic patients using cardiovascular tests and assessed their feasibility. Patients with AA, AL and ATTR amyloidosis participated. In all patients, cardiovascular reflex testing (mental arithmetic stress test and head-up tilting, besides the Ewing-tests) was performed. Of the 46 patients included, only 28 patients could perform all 4 Ewing-tests. In particular, patients with AA amyloidosis secondary to rheumatoid arthritis could not perform standing up and the isometric handgrip test. However, when the mental stress test replaced the handgrip test and head-up tilting replaced standing up, in 45 of the 46 patients, autonomic function could be assessed with cardiovascular reflex tests. Half of the patients with AA amyloidosis had signs of autonomic neuropathy--which was more than expected. We propose to replace the isometric handgrip test with the mental arithmetic stress test and standing up with head-up tilting if a patient is not able to perform these tests.