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ID PMID Title PublicationDate abstract
12375317 Longitudinal measurement of methotrexate liver concentrations does not correlate with live 2002 Oct OBJECTIVES: In patients with rheumatoid arthritis (RA), we examined whether methotrexate (MTX) and MTX polyglutamate accumulation in the liver correlated with clinical efficacy or clinical/laboratory toxicity. We also began preliminary examination of a new histologic index of liver histology (the Iowa Score) relative to the Roenigk grading system. METHODS: Forty patients with RA participated in a prospective, double blind, 3.5 year study of MTX treatment. Liver biopsies, liver MTX and MTX polyglutamate concentrations, laboratory tests, evaluation of disease activity, and evaluation of adverse events were done prospectively at baseline and at 1, 2, and 3.5 years. Biopsies were examined using the Roenigk grading system and an additional histological scoring system. Radiochemical ligand binding assays and HPLC methods were used to measure MTX and MTX polyglutamates. Statistical analysis included ANOVA, linear regression, and logistic regression modeling. RESULTS: No significant changes in the mean values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, albumin, or hemoglobin occurred. A significant percentage of patients had at least one abnormal alkaline phosphatase, AST, or ALT (25 to 52%), although most abnormalities were small and transient. Histological abnormalities did not progress using either the Roenigk or the Iowa score. The last abnormal AST, the number of abnormal AST and ALT, and female sex correlated with histological liver abnormalities (r2 = 0.41) using a new preliminary histologic scoring system (the Iowa Score). Amount of alcohol use correlated with fatty change, and the MTX dose at biopsy was associated with liver histological abnormalities (p = 0.03 and 0.049, respectively). Total liver MTX concentrations were stable from Year 1 to Year 3.5 and the percentage of higher order polyglutamates was relatively high (38 to 56%) relative to monoglutamates. No correlation of these concentrations with clinical response or toxicity, histology, or liver function tests could be documented. CONCLUSION: This analysis describes the accumulation and stabilization of MTX concentrations in the liver and examined correlations between MTX liver concentrations, patient demographics, liver histology, concomitant medications, and disease activity. No such correlations were found, decreasing the likelihood that MTX concentrations in serum would be useful measures to predict significant hepatotoxicity.
15140767 Appropriate and effective management of rheumatoid arthritis. 2004 Jun Early referral (at <3 months) and early DMARD treatment enable the course of RA to be changed. Once the disease has become aggressive it is much harder to treat and improvements will not be as great as they would have been with earlier treatment. The latest strategies and treatments enable remission to be achieved in many more patients than formerly.
12873645 Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement reci 2003 Jun This analysis was performed to examine whether Medicare claims accurately document underlying rheumatologic diagnoses in total hip replacement (THR) recipients. We obtained data on rheumatologic diagnoses including rheumatoid arthritis (RA), avascular necrosis (AVN), and osteoarthritis (OA) from medical records and from Medicare claims data. To examine the accuracy of claims data we calculated sensitivity and positive predictive value using medical records data as the "gold standard" and assessed bias due to misclassification of claims-based diagnoses. The sensitivities of claims-based diagnoses of RA, AVN, and OA were 0.65, 0.54, and 0.96, respectively; the positive predictive values were all in the 0.86-0.89 range. The sensitivities of RA and AVN varied substantially across hospital volume strata, but in different directions for the two diagnoses. We conclude that inaccuracies in claims coding of diagnoses are frequent, and are potential sources of bias. More studies are needed to examine the magnitude and direction of bias in health outcomes research due to inaccuracy of claims coding for specific diagnoses.
15249089 A prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rhe 2004 Jul PURPOSE: Destruction and dislocation of the metacarpophalangeal (MCP) joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. METHODS: We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. RESULTS: Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24 degrees and MCP joint range of motion increased, but this change was not significant. CONCLUSIONS: Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term.
14985107 The exon 4 variations of Tim-1 gene are associated with rheumatoid arthritis in a Korean p 2004 Mar 19 The family of T-cell immunoglobulin domain and mucin domain (TIM) proteins is identified to be expressed on T cells. A member of Tim family, TIM-1, is considered as a membrane protein that is associated with the development of Th2 biased immune responses and selectively expressed on Th2 cells. In the present study, we analyzed the association of genotype and allele frequencies between rheumatoid arthritis (RA) patients and the controls without RA using large samples size at 5383_5397del and 5509_5511delCAA variations of Tim-1 gene. We further investigated the relationships among these variations to C-reactive protein (CRP) and rheumatoid factor (RF) levels in RA patients. Although these factors were not associated with exon 4 variations in RA patients, the genotype and allele frequencies of 5383_5397del variation site (P = 0.015 and 0.014, respectively) as well as 5509_5511delCAA variation site (P = 0.0002 and 0.0001, respectively) in RA patients were significantly different from those in the non-RA controls. Our results strongly suggest that the variations of Tim-1 exon 4 might be associated with the susceptibility to RA.
12030433 Shift in Th1 (IL-2 and IFN-gamma) and Th2 (IL-10 and IL-4) cytokine mRNA balance within tw 2002 May Cytokines are the main mediators of inflammation in rheumatoid arthritis (RA). Thus, Th2 cytokines--such as IL-4 and IL-10--have protective properties to this disease. In opposite, the Th1 cytokines--such as IL-2 and IFN-gamma--are supporting proinflammatory microenvironment in joints from patients with RA. The imbalance of Th1/Th2 cytokine steady state may play an important role in the pathogenesis of rheumatoid arthritis. The evaluation of this imbalance leads up to the possibility of pathohistological discrimination in this disease. In this context, we investigated Th1- (IFN-gamma, IL-2) and Th2 (IL-10, IL-4)-cell-derived cytokine mRNA expression in two novel pathohistological main-types of RA synovial membrane (SM). These main-types are characterized by different tissue-infiltrating inflammatory cells and different extent of SM destruction. Our findings showed that expression of IL-10 mRNA was an outcome of histological main-type I (p<0.001), whereas expression of IFN-gamma and IL-2 were mainly associated with pathohistological main-type II (p<0.005, p<0.05). Surprisingly, IL4 was not differential expressed and could be associated with another special T cell subset in this disease. These results suggest that Th1/Th2 balance is biased to Th2 cytokines within main-type I and Th1 cytokines in main-type II.
14532144 British Society for Rheumatology Biologics Register. 2003 Nov The British Society for Rheumatology (BSR) established a register of patients newly treated with biological agents, the BSR Biologics Register (BSRBR), which became active in January 2002. The goal is to register all patients in the United Kingdom with rheumatic diseases, newly starting treatment with these agents and to follow them up to determine the incidence of any short and long term hazards to health. The Register is also recruiting a comparison cohort of patients with rheumatoid arthritis treated with standard disease modifying antirheumatic drugs to determine the relative contributions of disease factors and other treatments apart from biological agents on any risks observed.
12486541 [The rheumatoid wrist. Pathobiomechanics and therapy]. 2002 Dec A stable and pain-free wrist is a prerequisite for normal hand function. Since the wrist joint is involved early in rheumatoid disease and progress is rapid, operative treatment is of major importance. It is indicated not only for treatment of established osseous changes with instability, deformation, and extensor tendon ruptures but for early treatment of drug-resistant synovitis and monarthritis of the wrist.A considerable number of operative procedures is available: arthroscopic or open synovectomy of the radio- and midcarpal as well as the distal radioulnar joint, possibly with resection of the ulna head, partial arthrodeses, complete arthrodeses,and arthroplasty. When choosing the procedure, type and stage of wrist changes as well as the pathobiomechanic situation have to be considered. The individual course of the disease and patient requirements have to be taken into account.Thus, for long periods of time a pain-free stable wrist can be preserved, albeit sometimes with only limited but functional mobility.
14583923 Balneotherapy for rheumatoid arthritis. 2003 BACKGROUND: Balneotherapy (spa therapy) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain, improve joint motion and as a consequence to relieve people' suffering and make them feel well. OBJECTIVES: To perform a systematic review on the effectiveness of balneotherapy for rheumatoid arthritis. SEARCH STRATEGY: Using the Cochrane search strategy, studies were found by screening: 1) The MEDLINE CD-ROM database from 1966 to June 2002 and 2) the database from the Cochrane 'Rehabilitation and Related Therapies' Field, the Pedro database up to June 2002. Also, 3) reference checking and 4) personal communications with authors was carried out to retrieve eligible studies. Date of the most recent literature search: June, 2002 SELECTION CRITERIA: Studies were eligible if they were randomised controlled trials (RCTs) comparing balneotherapy with any other intervention or with no intervention. Included participants all suffered from definite or classical rheumatoid arthritis (RA) as defined by the American Rheumatism Association Criteria (ARA) or by the criteria of Steinbrocker. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be among the main outcome measures. DATA COLLECTION AND ANALYSIS: The Delphi list was the criteria list used to assess the components of methodological quality. Two reviewers carried out quality assessment and data extraction of the studies. Disagreements were solved by consensus. MAIN RESULTS: Six trials, representing 355 people, were included in this review. Most trials reported positive findings (the absolute improvement in measured outcomes ranged from 0 to 44%), but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. None of the trials performed an intention-to-treat analysis and only two performed a comparison of effects between groups. Pooling of the data was not performed; because of heterogeneity of the studies, multiple outcome measurements, and the overall data presentation was too scarce. REVIEWER'S CONCLUSIONS: One cannot ignore the positive findings reported in most trials. However the scientific evidence is insufficient because of the poor methodological quality, the absence of an adequate statistical analysis, and the absence, for the patient, of most essential outcome measures (pain, self assessed function, quality of life). Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws an answer about the apparent effectiveness of balneotherapy cannot be provided at this moment. A large, methodological sound trial is needed.
15529392 The presence of citrullinated proteins is not specific for rheumatoid synovial tissue. 2004 Nov OBJECTIVE: Antibodies directed toward citrullinated proteins (e.g., anti-cyclic citrullinated peptide antibodies) are highly specific for rheumatoid arthritis (RA) and are produced locally at the site of inflammation. Although the presence of citrullinated proteins in rheumatoid synovium has been described in the literature, it is uncertain whether their presence is specific for RA. The present study was undertaken to investigate this. METHODS: The local production of the anti-citrullinated protein antibodies was investigated by comparing the concentration of the antibodies (corrected for the total amount of IgG present) in paired samples of serum and synovial fluid from RA patients. The presence of citrullinated proteins in the synovial tissue was investigated by immunohistochemical analysis of synovial tissue from RA patients and from patients with other arthropathies, using a variety of specific antibodies to citrullinated proteins. RESULTS: In RA patients, anti-citrullinated protein antibodies constituted a 1.4-fold higher proportion of IgG in synovial fluid compared with serum, which is indicative of a local production of the antibodies. Immunohistochemical staining of citrullinated proteins was observed in the lining layer, the sublining layer, and in extravascular fibrin deposits in inflamed synovial tissue from RA as well as non-RA patients. CONCLUSION: The presence of citrullinated proteins in the inflamed synovium is not specific for RA, but rather, it may be an inflammation-associated phenomenon. The high specificity of the anti-citrullinated protein antibodies is, therefore, most likely the result of an abnormal humoral response to these proteins.
15229968 Bilateral giant iliopsoas bursitis presenting as refractory edema of lower limbs. 2004 Jul A 69-year-old man with rheumatoid arthritis presented with bilateral leg swelling. Magnetic resonance studies revealed bilateral giant iliopsoas bursitis with intrapelvic expansion and compression of pelvic vessels and bladder. The case was refractory to intensive systemic and local medical treatment.
12355477 A pilot randomized trial comparing CD34-selected versus unmanipulated hemopoietic stem cel 2002 Sep OBJECTIVE: Evidence from animal studies, case reports, and phase I studies suggests that hemopoietic stem cell transplantation (HSCT) can be effective in the treatment of rheumatoid arthritis (RA). It is unclear, however, if depletion of T cells in the stem cell product infused after high-dose chemotherapy is beneficial in prolonging responses by reducing the number of infused autoreactive T cells. This pilot multicenter, randomized trial was undertaken to obtain feasibility data on whether CD34 selection (as a form of T cell depletion) of an autologous stem cell graft is of benefit in the HSCT procedure in patients with severe, refractory RA. METHODS: Thirty-three patients with severe RA who had been treated unsuccessfully with methotrexate and at least 1 other disease-modifying agent were enrolled in the trial. The patients received high-dose immunosuppressive treatment with 200 mg/kg cyclophosphamide followed by an infusion of autologous stem cells that were CD34 selected or unmanipulated. Safety, efficacy (based on American College of Rheumatology [ACR] response criteria), and time to recurrence of disease were assessed on a monthly basis for up to 12 months. RESULTS: All patients were living at the end of the study, with no major unexpected toxicities. Overall, on an intent-to-treat basis, ACR 20% response (ACR20) was achieved in 70% of the patients. An ACR70 response was attained in 27.7% of the 18 patients who had received CD34-selected cells and 53.3% of the 15 who had received unmanipulated cells (P = 0.20). The median time to disease recurrence was 147 days in the CD34-selected cell group and 201 days in the unmanipulated cell group (P = 0.28). There was no relationship between CD4 lymphopenia and response, but 72% of rheumatoid factor (RF)-positive patients had an increase in RF titer prior to recurrence of disease. CONCLUSION: HSCT can be performed safely in patients with RA, and initial results indicate significant responses in patients with severe, treatment-resistant disease. Similar outcomes were observed in patients undergoing HSCT with unmanipulated cells and those receiving CD34-selected cells. Larger studies are needed to confirm these findings.
12888406 Self-image of adolescents with diabetes mellitus type-I and rheumatoid arthritis. 2003 The purpose of this research was to determine possible differences in the self-concept of chronically ill and healthy adolescents. A group of adolescents with diabetes mellitus type-I (DM) and a group with rheumatoid arthritis (RA) were chosen for the study, together with a control group without any chronic illness. The groups were matched for gender, age (DM 17.8, RA 17.9, control group 17.6 years) and social class. The Offer Self-Image Questionnaire (OSIQ) was used to estimate differences between the groups of 23 DM adolescents, 25 RA adolescents and 26 control group adolescents. The scores are reversed; thus the higher the score, the better the self-image. The results indicate that Body Image, and Vocational and Educational Goals were lower in the groups of chronically ill adolescents than in the control group; however, no statistically significant differences were found between the groups on the OSIQ scales. The self-image of adolescents with DM with good metabolic control and moderate and long-lasting RA is relatively well developed.
12184439 Yellow nail syndrome associated with thiol compound therapy for rheumatoid arthritis. Two 2002 Jun Yellow nail syndrome is characterized by ungual dystrophy, lower limb lymphedema, and pleural effusions or bronchiectasis. Rheumatoid arthritis is the autoimmune disorder most often associated with yellow nail syndrome. We report two new cases of yellow nail syndrome in patents receiving thiol compound therapy for rheumatoid arthritis. Eight similar cases have been reported since 1979, suggesting a possible causative effect of this class of drugs.
14872486 Detection of major histocompatibility complex/human cartilage gp-39 complexes in rheumatoi 2004 Feb OBJECTIVE: Peptide 263-275 is the immunodominant epitope of human cartilage (HC) gp-39, a candidate autoantigen in rheumatoid arthritis (RA). We recently generated and characterized a monoclonal antibody (mAb) called 12A, which is directed against HLA-DR4/HC gp-39(263-275) complexes and inhibits specific T cell responses in vitro. The aim of the present study was to analyze whether presentation of the immunodominant epitope of HC gp-39 by shared epitope-positive synovial dendritic cells is a specific event in the development of chronic synovial inflammation in RA. METHODS: Staining with mAb 12A was performed on synovium obtained from clinically swollen joints in 65 patients with RA and 67 non-RA controls and from joints without clinical effusion in 9 additional patients with RA. RESULTS: Monoclonal antibody 12A staining was observed in the synovium of 40 of the 65 patients with RA. Histologically, expression of HC gp-39, lymphoid aggregates, CD3, and CD1a as well as the global inflammation score were higher in mAb 12A-positive RA synovium than in mAb 12A-negative synovium, indicating a follicular synovitis in these samples. Accordingly, mAb 12A stained dendritic cells in the close vicinity of lymphoid aggregates. No mAb 12A staining was detected in synovium obtained from RA joints without effusion. Clinically, there were no correlations between mAb 12A staining and clinical or biologic parameters in RA. However, positive staining was observed in 61.5% of the inflamed RA synovial samples compared with only 3.0% of the control samples (P < 0.001). This mAb 12A staining was not related to intracellular citrullinated peptides, which are another specific histologic marker for RA. CONCLUSION: Presentation by synovial dendritic cells of the immunodominant epitope of HC gp-39, in the context of the shared epitope, is associated with characteristic histologic features of follicular synovitis and is highly specific for RA. This suggests a contribution to the autoimmune-related tissue inflammation and provides a new and independent tool for the immunopathologic diagnosis of RA.
12486545 [The treatment of rheumatoid foot deformities]. 2002 Dec Rheumatoid hindfoot deformity presents with hindfoot eversion, flattening of the longitudinal arch and abduction of the forefoot. Splayfoot, as the typical rheumatoid forefoot deformity, is mostly associated with various toe malformations, i.e. hallux valgus,hammer toe and claw toe,which may either be attributed to hindfoot malalignment or develop as a separate entity. The algorithm of treatment, comprising clinical assessment of both lower limbs, includes both orthotic shoe devices and surgical treatment. In rheumatoid flatfoot, arthrodesis of the hindfoot with lengthening of the lateral column and reorientation of joint congruency represent the gold standard of treatment. Despite this principle, the ankle joint should be kept mobile to facilitate standing and walking. Therefore, total ankle prosthesis is thought to be superior. Methods involving the preservation of the lesser metatarsophalangeal joints may be of benefit in providing sufficient ground contact with the toes. Nevertheless, resection arthroplasties are frequently required in cases of arthritic joint destruction. Arthrodesis of the first metatarsophalangeal joint may provide an adequate push-off for the big toe which can not be expected from resectional arthroplasties.
11981316 Stem cell transplantation for autoimmune disease: progress and problems. 2002 May The current status of stem cell transplantation in rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis are reviewed. From a large European bone marrow transplant registry, a birds' eye view of stem cell transplantation for autoimmune disease can be obtained. Among 43 rheumatoid arthritis patients, 35 juvenile chronic arthritis patients, 34 systemic lupus erythematosus patients, and 58 systemic sclerosis patients who underwent stem cell transplantation, initial responses in most patients were good to excellent. Although initial transplant related mortality was low for rheumatoid arthritis, somewhat higher rates for juvenile chronic arthritis, systemic lupus erythematosus, and systemic sclerosis may be falling with modifications in the stem cell transplantation regimens. In rheumatoid arthritis and systemic lupus erythematosus treatment, the criteria for patient selection are still not clear and the therapeutic regimens for stem cell transplantation (and whether follow-up treatment is necessary) are not fully defined. In juvenile chronic arthritis, responses are encouraging although little fully published data beyond that from the European Bone Marrow Transplant Registry exist. In systemic sclerosis, criteria for patient selection and a limited number of stem cell transplantation regimens have been agreed on and controlled trials are underway.
15022317 Additional genetic susceptibility for rheumatoid arthritis telomeric of the DRB1 locus. 2004 Mar OBJECTIVE: Rheumatoid arthritis (RA) has an estimated genetic contribution of 30-50%, approximately one-third of which arises from the major histocompatibility complex on 6p21.3. Many studies have implicated alleles of DRB1 that encode a shared epitope. However, several recent studies have suggested that additional telomeric genetic influences may exist. In this study, we sought to investigate whether a separate non-DRB1 effect could be detected and to determine its likely location. METHODS: We typed 13 single-nucleotide polymorphisms, located mainly in the telomeric class III region of the major histocompatibility complex, in 164 British Caucasian families with RA that had at least 1 affected offspring and used unconditioned and DRB1-conditioned transmission disequilibrium tests (TDTs). RESULTS: Unconditioned TDTs revealed overtransmission of shared epitope alleles (P = 2.12 x 10(-5)) and an allele of the HLA-B-associated transcript 1 (BAT1) gene in the telomeric class III region (P = 0.009). Using a DRB1-conditioned TDT to assess whether an independent effect existed, we detected unequal transmission of alleles of lymphocyte-specific transcript 1 (P = 0.004), BAT1 (P = 0.003), and PG8 (P = 0.003). CONCLUSION: At least 1 additional non-DRB1 susceptibility locus for RA exists in an interval that encompasses the junction of the class III and I regions. This is a genomic segment of high linkage disequilibrium containing a large number of poorly characterized immunomodulatory genes.
12168808 The role of the angiogenic molecule VEGF in the pathogenesis of rheumatoid arthritis. 2002 The expansion of the synovial lining of joints in rheumatoid arthritis (RA), and the subsequent invasion by the pannus of underlying cartilage and bone, necessitates an increase in the vascular supply to the synovium, to cope with the increased requirement for oxygen and nutrients. New blood vessel formation - 'angiogenesis' - is now recognised as a key event in the formation and maintenance of the pannus in RA. Although many pro-angiogenic factors have been demonstrated to be expressed in RA synovium, the potent pro-angiogenic cytokine vascular endothelial growth factor (VEGF) has been demonstrated to have a central involvement in the angiogenic process in RA. The additional activity of VEGF as a vascular permeability factor may also increase oedema and hence joint swelling in RA. Several studies, including those from the Kennedy Institute of Rheumatology Division, have shown that targeting angiogenesis in animal models of arthritis ameliorates disease. Inhibition of angiogenesis, as an adjunct to existing therapy of RA, or even as a stand-alone treatment, would not only prevent delivery of nutrients to the synovium, but could also lead to vessel regression and possibly reversal of disease.
12087904 [Antineutrophil cytoplasmic antibodies in patients with diffuse diseases of connective tis 2002 AIM: To investigate the significance of antibodies against neutrophil cytoplasmic antigens (ANCA) in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SS), their relations with the syndromes and laboratory indices. MATERIAL AND METHODS: The sera from 277 patients suffering from connective tissue disease and 31 healthy persons were examined. Of patients, 103, 126 and 48 had RA, SLE and SS, respectively. The patients in each group were subdivided into ANCA positive (ANCA+) and ANCA negative (ANCA-). The patients were matched within the groups by age, sex and disease duration. There were 41 such pairs in RA group, 23 in SLE and 13 in SS group. Questionnaires and laboratory tests (ANA, RF, a-DNA, a-MPO, a-Scl-70, a-PR3, a-CL) were used in the examination. RESULTS: The sensitivity of ANCA in SLE patients group was as high as 58.7%, specificity--93.5%. In other groups ANCA were less frequent. ANCA were significantly associated with skin vasculitis and ANA prevalence but the disease activity in SLE was not related to this feature. Anemia and antibodies against cardiolipin were found significantly more frequently in ANCA positive RA group. In SS group the inverted clinical association with kidney damage was seen but a-DNA were more prominent in ANCA+ group. Subspecificity for a-MPO and a-PR3 and lactoferin by ELISA were revealed less often than a-ANCA by immunofluorescence. Only two SLE patients with a-lactoferin antibodies were evidently different in prognosis while the other ones did not differ in the disease course within their group. CONCLUSION: The ANCA pattern in connective tissue diseases is found rather often but only few clinical and laboratory associations could be established such as skin vasculitis and ANA domination in SLE group, anemia and a-CL in RA group and a-DNA in SS ANCA+ groups. The validity of ANCA test is not so significant as it is in vasculitis patients.