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ID PMID Title PublicationDate abstract
775252 Relapsing polychondritis: prospective study of 23 patients and a review of the literature. 1976 May Relapsing polychondritis (RP) is not a totally rare rheumatic disease. We have seen 23 patients from 1960-1975, and there are now a total of 159 reported cases, which form the basis of this study. RP occurs equally in both sexes, and has a maximum frequency in the fourth decade. 2) Empirically defined diagnostic criteria are proposed, to include the most common clinical features: a) Bilateral auricular chondritis b) Nonerosive sero-negative inflammatory polyarthritis c) nasal chondritis d) Ocular inflammation e) Respiratory tract chondritis f) Audiovestibular damage The diagnosis is based primarly upon the unique clinical features, and is quite certain if three or more criteria are present together with histologic confirmation. 3) Fifty percent of patients present with either auricular chondritis or the arthropathy of RP; but with prolonged follow-up, a majority of patients develop four or more of the above mentioned criteria. 4) Approximately 30 percent of patients have a preceding or coexistent rheumatic or autoimmune disease, which can lead to initial diagnostic confusion. 5) Laboratory and radiographic investigations help mainly to rule out other diagnostic possibilities, with no characteristic abnormalities being present in a majority of patients. 6) On follow-up, three-fourths of our patients required chronic corticosteroid therapy with an average dose of 25 mg per day of prednisone. Corticosteroids decrease the frequency, duration, and severity of flares, but do not stop disease progression in severe cases. 7) The mortality rate has been 30 percent in our series and 22 percent in the other 136 reported cases. Of the 29 cases where the cause of death was known, 17 were from respiratory tract involvement and 9 from cardiac valvular or vasculitic involvement, emphasizing the need to search for critical involvement of either of these organ systems in each patient. 8) Detailed reports of selected cases are presented to illustrate the clinical diagnosis and differential diagnosis, and to demonstrate the need for careful prolonged follow-up. 9) Although the etiology remains unknown, there is a frequent association with, and clinical similarity to, other rheumatic diseases. 10) Careful clinicopathological study of our 23 patients leads us to postulate an underying systemic vascultis as an important pathologic mechanism in RP.
1097233 Naproxen: a review of its pharmacological properties and therapeutic efficacy and use. 1975 Naproxen2, (+)-6-methoxy-alpha-methyl-2-naphthalene acetic acid, is a new non-steroidal anti=inflammatory agent advocated for use in rheumatiod arthritis, degenerative joint disease and ankylosing spondylitis. Published data suggest that in rheumatiod arthritis, naproxen 500mg daily comparable in efficacy with moderate doses of aspirin (3.6 to 4g daily) or 150mg daily of indomethacin, but generally causes fewer and milder side-effects than these drugs at the dosages used and can be given less frequently (12-hourly). Encouraging intial results have been reproted from its use in other inflammatory joint disorders, including acute gout and juvenile rheumatiod arthritis. It has compared favourably with indomethacin in ostioarthrosis of the hip of knee. Its exact place in the management of ankylosing spondylitis remains to be determined.
6593813 Simultaneous quantification of red cell and platelet surface-bound IgG & IgM by an ELISA t 1984 In vivo red cell-bound (RBC-) and platelet-bound (P-) IgG and IgM were measured by an enzyme-linked immunosorbent assay (ELISA) using washed cells as solid phase and alkaline phosphatase conjugated antiglobulins (Fc-specific). With this technique cells from normal donors had small amounts of RBC-IgG ranging from 0.02 to 0.41 A405 (absorbance at 405 nm wavelength) (10(8) h)-1, of RBC-IgM ranging from 0.01 to 0.13 (10(8)h)-1, of P-IgG ranging from 0.00 to 0.16 (10(7)h)-1 and of P-IgM ranging from 0.00 to 0.05 (10(7)h)-1. 13 of 14 patients with positive RBC direct antiglobulin test had increased RBC IgG and/or RBC IgM (P less than 0.01). 14 of 16 patients with idiopathic autoimmune thrombocytopenic purpura had increased P-IgG and/or P-IgM (P less than 0.01). 10 of 13 patients with circulating immune complexes had increased RBC-IgG and/or IgM (P less than 0.01) and 12 of 13 patients increased P-IgG and/or IgM (P less than 0.01). The direct ELISA is useful for quantification of in vivo surface-bound RBC-Ig and P-Ig autoantibodies and receptor-bound immune complex-associated Ig and requires only standard laboratory equipment.
3903379 Mechanisms of action and clinical applications of cytotoxic drugs in rheumatic disorders. 1985 Jul Failure to suppress disease activity in certain rheumatic disorders such as systemic lupus, polyarteritis nodosa, or Wegener's granulomatosis may significantly heighten the probability of a fatal outcome. In other rheumatic disorders (for example, rheumatoid or psoriatic arthritis) the disease left unchecked may indeed be severely crippling but rarely is it fatal. Thus the decision on whether to add a cytotoxic drug often evolves into a benefit-to-risk analysis, a decision in which the patient must also be intimately involved. There are two few well-controlled studies of the use of cytotoxic agents to make dogmatic statements regarding their use in the treatment of rheumatic disorders. Nevertheless, a review of the literature, some of which has been cited above, does permit one to make some reasoned judgments in choosing a drug for a particular disease (Table 2).
184745 Cytology of rheumatoid synovial cells in culture. IV. Further investigations of cell lines 1976 Aug A previous report described a cell isolate presumed to have arisen by accidental cocultivation (contamination) of the Chang 'liver' cell line and rheumatoid synovial cells. This cell isolate had the same glucose-6-phosphate dehydrogenase isoenzyme as the Chang cell and also some shared antigens. It clearly differed in its karyotype, its ability to grow in semisolid agar, and in the possession of bleb-like projections of the cytoplasmic membrane filled with collections of beaded or granular material. In addition, it had a novel antigen(s) not present in the Chang cell. As these properties might have been acquired from the synovial cells and because the bleb structures resembled those seen in some cell lines transformed by leucovirus the cell isolate has been further studied. Cytochemical methods at the light and electron microscope level showed that the granular material was polysaccharide in nature, probably glycogen. No evidence was found of the presence of a virus or a viral genome using a variety of techniques including attempted induction followed by 3H-uridine labelling of the cultures, and assay of the supernatant fluid from the culture for viral RNA-dependent DNA polymerase. In addition, cell extracts were not found to contain viral RNA-dependent DNA polymerase or RNA-dependent RNA polymerase. No rubella virus or leucovirus interspecies antigens were detected on the cell membranes.
6302006 Infectious mononucleosis fifty years after the discovery of the Paul-Bunnell test. 1983 Jan The Paul-Bunnell test, now 50 years old, is still of fundamental importance in the diagnosis of infectious mononucleosis, even though various immunologic methods have been developed in clinical practice to identify constituents of the Epstein-Barr virus (EBV). The demonstration of sheep red cell agglutinins in infectious mononucleosis (Paul-Bunnell) was in fact the first observation of the presence of heterophil antibodies in this viral disease which was later shown to evoke a polyclonal antibody response to a wide spectrum of autoantigens as well. The selective tropism of EBV for B lymphocytes and the reactivity of T lymphocytes to these infected B lymphocytes are the pathophysiological elements characteristic of infectious mononucleosis, and are the reason for this massive antibody response.
6382418 Systemic disorders affecting the thoracic cage. 1984 Sep Conventional chest roentgenograms provide an opportunity to study changes in the thoracic cage produced by systemic or localized disorders. Careful evaluation of abnormalities often gives a clue to the diagnosis of clinically unsuspected disorders. In this article, the authors present a review of developmental, granulomatous, collagen vascular, hematopoietic, metabolic, endocrine, and neoplastic disorders affecting the thoracic cage.
6392368 Cyclophosphamide (Cytoxan). A review on relevant pharmacology and clinical uses. 1984 Dec Cyclophosphamide (Cytoxan; Cy) is an alkylating agent with cytotoxic and immunosuppressive activities. The parent compound is inactive in vitro and exerts its biologic activity through metabolites, mainly phosphoramide mustard generated by hepatic microsomal enzymes. The exact mode of cytotoxic and immunosuppressive action of Cy at cellular level is not completely understood. Myelosuppression, hemorrhagic cystitis, alopecia, and gonadal damage are the main toxic effects. Available data suggest that Cy has carcinogenic potential in humans. Cy is widely used for cancer chemotherapy. As an immunosuppressive agent, it is successfully used in certain nonmalignant diseases in which autoimmune phenomena are established or suspected in the pathogenesis of the disease. It is the drug of choice in Wegener's granulomatosis. Extensive efforts are being made to synthesize Cy analogues with greater selective cytotoxic and immunosuppressive activity. Ifosfamide, a Cy analogue, appears to possess similar cytotoxic activity with less myelosuppression. Further research will help in synthesizing a Cy analogue with specific pharmacologic activity and reduced or absent harmful effects.
7181241 [Biopsy of the accessory salivary glands in Sjögren's disease. Value in the diagnosis and 1982 Biopsies of the labial accessory (144 cases) or principal (4 cases) salivary glands were performed in 139 patients with clinically and biologically confirmed Sjögren's syndrome, and 9 patients with rheumatoid arthritis alone to act as control. Confirmation of diagnosis was obtained in both isolated cases (31 p. cent) and those with associated collagen disease (69 p. cent). Histological lesions were classified in 3 stages of increasing severity. Stage I cases had ectasia of several distal canals which, in the absence of significant lymphocytic reactions, permitted early diagnosis. In stage II, a typical appearance was noted: abundant nodular or diffuse lymphocytic infiltration with an increase in numbers of ectasias. In stage III of acini destruction, the dominant feature was diffuse peri- and intralobular sclerosis and only rare lymphocytes. Is, therefore, distal canal dilation the most reliable diagnostic sign of the syndrome, which has been shown by ultrastructural studies to arise from massive destruction, followed by anarchic regeneration, of myoepithelial cells that ensure canal contractility. These 3 histologically-defined stages generally correlate well with those normally employed to grade sialographic images (stage I, initial, showing miliary filling defects; stage II with larger rounded areas and penetration of the contrast medium into tissues around the canal; stage III demonstrating the "dead tree" appearance together with lack of contrast medium extension beyond Stenon's duct and its main branches). However, certain discordances were noted, histological signs sometimes preceding sialographic modifications. Biopsy of accessory salivary glands could be the most simple, reliable method for confirming diagnosis of Sjögren's syndrome in its early stages.
6788859 IgM antibody to hepatitis B core antigen as a diagnostic parameter of acute infection with 1981 Jun Because many patients with acute hepatitis B lack detectable hepatitis B surface antigen (HBsAg), a radioimmunoassay for IgM antibody to hepatitis B core antigen (anti-HBc) was developed and evaluated as a diagnostic test. IgM anti-HBc was detected in each of 47 patients with acute hepatitis and transient HBsAg (geometric mean titer, greater than or equal to 1:191,000), but also in five of 12 HBsAg carriers (geometric mean titer, 1:459) and one of 46 healthy individuals positive for anti-HBc. However, it was not present in one patient during the first six months of a persistent infection. Of 255 patients with acute hepatitis and HBsAg and/or anti-HBc, 210 were HBsAg-positive whereas 230 had IgM anti-HBc. The latter was the only specific marker in 12.3% of all cases of acute hepatitis B. Thus, IgM anti-HBc is a valuable marker for the diagnosis of acute infection with hepatitis B virus.
6085502 [High-dose immunoglobulin therapy in autoimmune diseases]. 1984 Apr High-dose intravenous immunoglobulin is being used increasingly as a new therapeutic approach towards various autoimmune diseases, yielding encouraging results predominantly in idiopathic thrombocytopenic purpura (ITP). A marked initial increase of the platelet count has been observed in the majority of patients with acute and chronic ITP alike after high-dose immunoglobulin. In contrast to acute ITP, where full or partial remissions have been achieved in nearly all cases, long-term results reached in chronic ITP, where lasting increases of platelet counts have been observed predominantly in splenectomized patients, have proved to be less favourable. Correspondingly, several cases of other forms of autoimmune thrombocytopenia and neutropenia successfully treated by high-dose immunoglobulin have been reported. We contribute our own experience in 4 patients with myasthenia gravis, where administration of 7S-immunoglobulin but not of 5S-immunoglobulin was followed by both a clinical remission as well as a decrease of specific autoantibody concentration. While several mechanisms of action of high-dose immunoglobulin are discussed, there is evidence for an immunosuppressive effect and for the Fc-fragment dependency of the therapeutic efficacy. Although high-dose immunoglobulin has proved to be a promising therapeutic option especially in ITP, indications will have to be defined yet by further investigations and may be restricted to emergency and refractory cases.
547755 [Anatomo-clinical study of a case of regenerative nodular hyperplasia of the liver with Fe 1979 Regencrative nodular hyperplasia (RHN) is a rare condition, the diagnosis of which is based upon histological findings. It is seen in Felty's syndrome with portal hypertension (PHT), as was the case in the patient reported here. This was a 72-year-old man, with long standing rheumatoid arthritis, hepatosplenomegaly, a neutrophil leucopaenia and oesophageal varices responsible for recurrent haematemeses. Despite a portocaval anastomosis, the patient died from postoperative acute hepatic failure. Histological study revealed changes in the hepatocytes and the reticulin system typical of RNH without cirrhosis. The relationship between Felty's syndrome and RHN, as well as the mechanism of the hypertension, are discussed in the light of cases from the literature.
4359340 Hormonal control of neutrophil lysosomal enzyme release: effect of epinephrine on adenosin 1974 Mar 1 Human neutrophilic leukocytes release neutral protease and beta-glucuronidase during cell contact with, and phagocytosis of, zymosan particles treated with rheumatoid arthritic serum. Release of lysosomal enzymes is inhibited by epinephrine and adenosine 3',5'-monophosphate (cyclic AMP), but not by phenylephrine or adenosine 5'-monophosphate. Inhibition of enzyme release by epinephrine may be mediated by cyclic AMP because the cyclic AMP in the neutrophils is increased by epinephrine treatment at the time when enzyme release is reduced.
1058609 The clinical significance of serum alkaline phosphatase isoenzymes in locomotor diseases. 1975 Jul AP isoenzymes were estimated in 292 patients with locomotor diseases and in 124 healthy controls. The diagnostic usefulness of AP determination is increased by estimation of isoenzymes. Investigations were made to study the biological profile of organ specific AP activities: 1. Rheumatoid arthritis and Reiter's syndrome - the total AP and L-AP activities were increased. 2. Ankylosing spondylitis treated by physiotherapy - the total AP, B-AP and I-AP activities were increased. After drug therapy an increase occurred also in L-AP activity while I-AP activity showed no significant change. 3. Progressive OA of hip and knee showed increased levels of total AP and B-AP activities. 4. Degenerative diseases of the spine, chiefly cases of discopathy, showed significantly reduced levels of AP and B-AP activities. 5. In osteoporosis there was an increase in total AP, L-AP, B-AP and I-AP activities. 6. In the active generalised form of Paget's disease, increased levels were found of total AP, B-AP, I-AP and L-AP activities. 7. In neoplastic diseases the isoenzymes can help to reveal metastatic dissemination and thus aid preoperative evaluation. 8. In gout and hyperuricemic syndromes there was a relative increase of B-AP activity and non-significant fall of L-AP activity. Increased levels of L-AP occured in patients with gallbladder disease, after immunosuppressive therapy or after infectious hepatitis. A fall of L-AP levels was found after Corticotrophin and after intraarticular administration of Kenalog. Increased B-AP activities occurred after total hip replacement, in acute or chronic pyelonephritis and in active osteonecrosis and osteoporosis. Anabolic therapy caused a significant fale of B-AP activity to fall significantly. Reduced B-AP levels were also found after antibiotic therapy. Increased I-AP activity was found in cases of osteoporosis, and in secondary amyloidosis; reduced I-AP activity was seen in mucous colitis. The activity of I-AP is assumed to increase as a result of the changed intestinal calcium and phosphorus regulation occurring in association with the enhanced bone tissue metabolism. From this point of view an order of significance is given for the activity of bone pathology in the separate diagnostic groups of locomotor diseases.
710027 Protein binding of tolmetin. 1978 Dec The protein binding of the new nonsteroidal anti-inflammatory agent tolmetin to human serum albumin (HSA) and to the plasma of 8 healthy subjects was studied by equilibrium dialysis at 37 degrees and pH 7.4 with 14C-tolmetin. Over the total concentration (Ct) range 3.0 to 28.7 microgram/ml (therapeutic range), the fraction of tolmetin unbound to 4% HSA was largely invariant at 0.3%. At 100 microgram/ml the unbound fraction rose to 0.8 and at 434 microgram/ml to 3.6%. Within the therapeutic concentration range, tolmetin binding to 0.4% HSA was reduced in accordance with the law of mass action and at Ct = 26.2 microgram/ml, 10.5% was free. Analysis of the 0.4% HSA data showed tolmetin had 3 classes of binding sites (n1 = 1, K1 = 8.3 X 10(5) M-1; n2 = 4, K2 = 2.4 X 10(4) M-1; n3 = 44, K1 = 7.9 X 10(1) M-1). By studying the binding to 0.4% HSA at 23 degrees, it was established that the free energy change in binding for the first two classes of sites was entirely entropic in nature. Albumin accounted for almost all the binding of tolmetin in human plasma. The effect of other drugs, the tolmetin metabolite McN 2987 (5-p-carboxybenzoyl-1-methylpyrrole-2-acetic acid), tryptophan, and oleic acid on tolmetin binding to 4% HSA was studied using ultrafiltration and 14C-tolmetin. Aspirin and salicyclic acid decreased tolmetin binding and a combination of aspirin and salicyclic acid exerted a synergistic displacing effect. Indomethacin and ibuprofen had no effect while phenylhbutazone and acetaminophen increased tolmetin binding slightly. Tolmetin binding was decreased slightly by McN 2987 and tryptophan and markedly increased by oleic acid. McN 2987 was not bound as extensively as tolmetin. Binding of 14C-tolmetin to the plasma of 4 arthritic patients was studied by ultrafiltration and found to be less than to normal plasma and 4% HSA. Distribution of tolmetin in the whole blood of 8 healthy subjects using a centrifugation technique showed that the drug was not taken up by red blood cells at therapeutic concentrations.
234264 Aminopyrine--an effective modifier of liver and serum gamma glutamyl transpeptidase. 1975 Feb Serum activities of gamma glutamyl transpeptidase, alanine and aspartate aminotransferases, and alkaline phosphatase were determined in children on long-term treatment with aminopyrine. Gamma glutamyl transpeptidase activity was increased up to 15 times above the upper normal limit in children, who received aminopyrine for two weeks or longer. Livers of rats treated with aminopyrine (600 mg/kg/day for 18 to 25 days) had an exceedingly increased activity of gamma glutamyl transpeptidase and a slightly elevated microsomal cytochrome P-450 content. Apparently isolated enhancement of serum gamma glutamyl transpeptidase during aminopyrine medication represents a drug-induced increase of microsomal liver enzymes without clinical relevance and without evidence of damage of liver cells.
6989372 The specificity and clinical usefulness of the lupus band test. 1980 Apr Granular deposition of immunoglobulin at the dermoepidermal junction is characteristic, but not pathognomonic, of lupus erythematosus. When rigid criteria for the lumpus band test are used, a positive result is highly specific. A positive band test is found in clinically normal skin and lesional skin of systemic lupus patients, and in lesional skin of discoid lupus patients. A positive band test is found infrequently in clinically normal skin of patients with other connective tissue disorders. Cutaneous lupus may be difficult to separate from other morphologically similar disorders. The lupus band test is useful in differential diagnosis because other disorders have either a specific pattern of immunoglobulin deposition or no immunoglobulin deposition. The mechanisms of immunoglobulin deposition at the epidermal basement membrane zone are discussed as well as pertinent clinical correlations of the positive band test.
6222543 Autologous mixed lymphocyte reaction in health and disease states in man. 1983 In this review are discussed the nature of T cell subsets, defined with monoclonal antibodies, responding in T-non-T and T-T autologous mixed-lymphocyte reactions (AMLR) and antigens stimulating in AMLR, soluble products of AMLR and generation of suppressor, helper and cytotoxic functions. On the basis of these data a model of immunoregulation in vivo can be proposed. We believe that AMLR is a real-phenomenon and not an artefact and perhaps represents a mechanism by which various immune functions are regulated, including feedback regulation of AMLR. The significance of AMLR is further supported by studies in various human and animal diseases.
6089674 Salivary scanning in rheumatoid arthritis with sicca syndrome. 1984 Aug Forty-nine patients were studied prospectively by salivary scanning to assess the value of this investigation in possible Sjögren's syndrome (SS). Twenty-three had rheumatoid arthritis (RA) with sicca symptoms and a positive Schirmer's test. Fifteen had RA with no sicca symptoms and a negative Schirmer's test. Eleven had osteoarthrosis (OA) with no sicca symptoms and a negative Schirmer's test. Scanning differentiated only poorly between the three groups. We conclude that it has only limited application in the diagnosis of SS associated with RA.
174393 Plasma myeloperoxidase and lactoferrin measured by radioimmunoassay: relations to neutroph 1975 Dec In 31 patients, covering a wide range of blood neutrophil counts and turnover rates, the plasma concentrations of myeloperoxidase and lactoferrin have been measured with radioimmunoassays and compared to neutrophil kinetic parameters, measured with DF32P-labeled neutrophils. It was found that the plasma concentrations of both proteins correlated significantly with the total number of neutrophils in the blood (TBGP=total blood granulocyte pool) as well as with the neutrophil turnover rate (GTR=granulocyte turnover rate), which is evidence that neutrophilic granulocytes are the main suppliers of myeloperoxidase and lactoferrin to the plasma. In contrast to the previously demonstrated better relationship between the GTR and plasma lysozyme, a protein also originating in neutrophil granules, both myeloperoxidase and lactoferrin correlated better with the TBGP. These differences may reflect differences in the mode of release of intragranular proteins from neutrophils to the plasma. The correlation of the plasma lactoferrin concentration with the TBGP was so good as to suggest its use in the clinical assessment of the TBGP.