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

ID PMID Title PublicationDate abstract
2603807 The effect of cyclosporine on urinary kallikrein excretion in patients with rheumatoid art 1989 The effect of cyclosporine (6 to 8 mg/kg/24 hr) on urinary kallikrein excretion is summarized for 9 patients with rheumatoid arthritis using a specific kallikrein radioimmunoassay. Baseline serum creatinine and BUN values were within the normal range for all patients, and baseline kallikrein excretion rates were either normal (n = 5) or more than two S.D. below the mean of the normal group (n = 4). The patients with normal baseline values excreted significantly less urinary kallikrein three and six months after cyclosporine therapy was started, but all of them completed the six-month protocol. Patients in the subgroup with low baseline values also decreased their kallikrein excretion in response to cyclosporine therapy, and two of the four in this group experienced elevations of BUN such that therapy was terminated. In a low-dose (3 mg/kg/24 hr) open extension that followed the initial trial, kallikrein excretion decreased by almost 50% at least one month before any change in serum creatinine was observed. The data suggest that changes in urinary kallikrein excretion rates may be an indicator or predictor of cyclosporine nephrotoxicity. Decreased kallikrein excretion rates could also be a factor in the diminished renal blood flow reported in patients treated with cyclosporine.
3382267 Peptic ulcer in rheumatoid arthritis. 1988 Jun In a study of patients attending a rheumatology clinic 230 unselected patients, 185 with rheumatoid arthritis (RA) and 45 with other rheumatic disorders (non-RA), were examined by endoscopy and a detailed history of symptoms referable to the gastrointestinal tract was taken. A peptic ulcer was found in 67 (36%) of the patients and in 13 (29%) of the non-RA group. Gastric ulceration was more common in the group with RA (32 patients (17%) compared with three patients (7%) in the non-RA group); 17/32 (53%) patients with RA and gastric ulcer were asymptomatic. In the group with RA, of those with gastric ulcer 20/32 (63%) were smokers, compared with only 40/118 (34%) of the non-ulcer group. There was no difference in the duration of rheumatic disease or non-steroidal anti-inflammatory drug (NSAID) treatment between the ulcer and non-ulcer groups. Treatment with H2 receptor antagonist and maintenance of NSAID treatment resulted in healing in 26 out of 29 (90%) patients with gastric ulcer and 23 out of 27 (85%) patients with duodenal ulcer.
2245530 Immunity to heat shock proteins in rheumatoid arthritis. 1990 Jul Heat shock proteins (hsp) or "stress proteins" are a group of highly conserved proteins which are important in the day to day function of all cells. Early studies by others have indicated that immunity to the 65 kDa hsp of mycobacteria is important in the development of arthritis in the adjuvant arthritis model in rats. In this paper, we review the evidence suggesting that, as for the rat model, immune reactivity to hsp is of importance in the human disease. Elevated levels of IgG antibodies to the 65 kDa hsp of mycobacteria are characteristic of rheumatoid arthritis (RA) patients. Much of this antibody cross-reacts with human 65 kDa hsp and is therefore autoreactive. The 65 kDa hsp is found in synovial fluid and is therefore a potential target for antibody. Antibodies to the 70 kDa hsp (both of mycobacterial and human origin) are elevated, but not specifically, in RA. Increased T cell responses to the 65 kDa hsp are also found in synovial fluid of RA patients. Although gamma delta T cells are present in the synovial joint of RA patients, they do not appear to be particularly increased in frequency although the subset distribution of these cells is clearly different from that seen in the circulation. In fact, the synovium looks like the "gut" with regard to these subsets!
1994917 HLA-D region antigens in patients with rheumatoid arthritis. 1991 Feb We studied the distribution of HLA-D region antigens in 2 groups of rheumatoid arthritis (RA) patients: those with mild, nonprogressive disease, and those with severe disease. The results demonstrate that DR4 was significantly increased in both RA patient populations. The frequencies of DR1 and DR4-associated DQw7 alleles, however, were different in these 2 groups of patients. DR1 was significantly increased only in patients with mild RA, and DR4-associated DQw7 was significantly increased only in patients with severe disease. The results of the present study, together with previous data from our laboratory and from other investigators on the incidence of HLA-D region antigens in RA, suggest that both DR and DQ (A and B) genes may be important in conferring susceptibility to RA; DR in the mild forms of the disease, and DQ in severe RA.
2091616 Brown's syndrome: an unusual ocular complication of rheumatoid arthritis. 1990 Mar A 55 year old man with rheumatoid vasculitis and an apparent left inferior oblique palsy is described. This unusual extraocular complication of rheumatoid arthritis probably resulted from a tenosynovitis of the superior oblique tendon sheath, and resolved with steroid treatment.
2609795 [Epidemiology of the treatment of patients with chronic polyarthritis in Hannover]. 1989 Sep Between 1984 and 1988 a community-based study of rheumatoid arthritis (RA) was undertaken in Hannover (Federal Republic of Germany) to determine patient characteristics and the patterns of antirheumatic treatment. Among 8044 randomly chosen German residents aged 25 to 74 years, we identified 45 persons suffering from RA; minimal prevalence 0.56% +/- 0.19%. Of these 45 RA-suffers only seven (16%) had consulted a rheumatologist (internist) "during the past 12 months". Only four (9%) persons were currently being treated with remission-inducing drugs (RIDs), e.g., chloroquine, gold. We could also ascertain low rates of physiotherapeutic treatment; "during the past 12 months" seven persons (16%) had received remedial gymnastics, one (2%) had received local application of cold. Our findings indicate that the treatment of RA in the population of Hannover is insufficient.
3787086 Pericarditis in rheumatoid arthritis. A clinical and radiological study. 1986 The annual incidence of clinically manifest pericarditis was found to be 0.34% in 157 females and 0.44% in 77 males with rheumatoid arthritis, observed for a mean time of 5.7 years. The development of pericarditis was independent of disease duration, but was related to extensive joint involvement, subcutaneous nodules, and a high Waaler Rose titre. Concomitant pleural effusion was present in four of five patients. Pericarditis in rheumatoid arthritis may indicate a serious prognosis quo ad vitam. Four of the five patients died within eight years, but their age at death was relatively high (62-73 years).
3701744 Comparison of immune complexes and complement components in arterial and venous blood of p 1986 Feb Immune complexes (IC) are frequently found in the venous blood and synovial fluid of patients with rheumatoid arthritis (RA). Although IC are claimed to have a pathogenetic role in RA, there is generally poor correlation between different IC tests and between individual tests and clinical features. We have therefore sought differences in the levels of IC detected by the Clq binding assay (ClqBA) and the indirect polymorphonuclear phagocytosis test (IPPT) in the arterial and venous blood of 16 patients with RA and 6 disease control subjects to determine which IC are pathogenetically important. Complement components, IgA, IgG, and rheumatoid factor were also measured. Eight of 10 patients with clinically active RA had higher ClqBA results in arterial blood while IgA IC in the IPPT and most complement components were higher in venous blood. No such differences were seen in patients with inactive RA or controls. These results suggest that IC other than those containing IgA are not formed in limb tissues including the synovium and may explain the variable results previously seen in patients with RA.
3617786 [Psychosocial status of arthrosis and rheumatoid arthritis patients in advanced age]. 1987 May The present paper explains "control of reality" and "isolation" as alternative developments of the personality in higher age, suffering from chronic disease. The paper shows ranges of characteristics and aim-variables for the research of both ways. Hypothetical connections are discussed between the psychosocial situation of the patient and his physical condition and possibilities of their research.
2317221 The spectrum of atlantoaxial facet joint involvement in rheumatoid arthritis. 1990 Mar Six hundred fifty outpatients with rheumatoid arthritis (RA) were evaluated and followed up during a 7-year period. As part of their routine evaluation or because of neck-shoulder girdle symptoms, 48% of the patients underwent routine cervical spine radiography. Sixty-one RA patients (9% of the total population) had C1-C2 involvement. Compared with the 589 patients with no evidence of C1-C2 involvement, these 61 patients were significantly more likely to be younger, female, and seropositive, and they had significantly more nodules and erosions, as well as a longer disease duration. Based on radiographic evidence of C1-C2 disease severity, 3 groups emerged. Group 1 (28 patients) had lateral mass collapse, group 2 (27 patients) had lateral facet joint sclerosis, erosion, or loss of joint space with no collapse, and group 3 (6 patients) had lateral subluxation with no bone or cartilage changes. Nine patients in group 1 had severe pain, and 25 had a nonreducible rotational tilt of the head. None of the patients in the other 2 groups had either of these signs or symptoms. Moreover, patients in group 1 were more likely to have other C1-C2 or subaxial subluxations and were more likely to have myelopathy. C1-C2 lateral facet joint involvement is common in RA, correlates with disease severity generally and specifically with that in the cervical spine, and, when severe, causes nonreducible rotational tilt of the patient's head.
2346518 Relationship between clinical efficacy and laboratory correlates of inflammatory and immun 1990 May Eighteen rheumatoid arthritis (RA) patients, who had been treated with nonsteroidal antiinflammatory drugs (NSAIDs) only, were enrolled in a 12-week, open-label, randomized protocol to determine whether clinical responses might be associated with improvement in laboratory measures of inflammation and immunologic activity in RA patients treated with NSAIDs. Following a 2-week drug washout period, patients were given either long-acting ibuprofen (2,400 mg/day) or flurbiprofen (200 mg/day); clinical, laboratory, and immunologic assessments were done biweekly for 10 weeks. A clinical efficacy index, utilizing a combination of measures of disease activity, identified 7 "responders" and 10 "nonresponders" (1 patient discontinued therapy because of a rash). Flow cytometric analysis revealed no abnormalities in the numbers of circulating CD3+, CD4+, or CD8+ lymphocytes in the 17 patients. The density of these T cell markers at enrollment was similar in patients and control subjects. However, following the 2-week drug washout, significant worsening of morning stiffness, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was accompanied by a significant decrease (P less than or equal to 0.05) in the density of these T cell surface determinants, as is characteristic of activated T cells. After 10 weeks of NSAID therapy, increased density of CD3, CD4, and CD8 was observed in 47%, 73%, and 50% of the patients, respectively. However, in only the responders was the density of these T cell surface markers increased significantly (P less than or equal to 0.04). The responders, but not the nonresponders, also demonstrated significant reductions in the ESR, CRP level, serum IgM rheumatoid factor (RF) titer, and spontaneous synthesis of RF by lymphocytes in vitro (P less than or equal to 0.05). There were significant correlations between improvements in the clinical parameters (50-foot walk time, joint score, and global assessment) and reductions in the ESR, CRP level, and serum RF titer (P less than or equal to 0.05). These findings demonstrate that clinical improvement in RA patients treated with NSAIDs may be associated with the disappearance of phenotypically activated circulating T cells and functionally activated B cells, as well as with reductions in acute-phase reactants and serum RF titers.
2883443 Long-term outcome of treating rheumatoid arthritis: results after 20 years. 1987 May 16 Outcome of therapy, in terms of functional capacity, radiological measures of joint damage, erythrocyte sedimentation rate (ESR), rheumatoid factor, and mortality, was determined prospectively in 112 consecutive rheumatoid arthritis (RA) patients treated for 20 years at one centre, where a policy of active treatment was pursued with the use of gold, chloroquine, steroids, and, in resistant cases, penicillamine or cytotoxic drugs. By 20 years 35% were dead. Mortality was often attributable to RA. Function improved in the early years of treatment but declined considerably between 10 and 20 years. At 20 years 19% were severely disabled. Radiographs showed related evidence of increasing joint destruction. The ESR and rheumatoid factor levels changed little. Age, late presentation, and rheumatoid factor seropositivity at presentation were poor prognostic factors. The concept of "remission-inducing" drugs is fallacious. Early treatment may be advantageous, but the prognosis of RA is not good.
3731600 Dislocation of the sacroiliac joint associated with rheumatoid arthritis. A case report. 1986 Aug Rheumatoid arthritis (RA) affects the articular surfaces and the ligamentous supporting structures of synovial-lined joints. In approximately one-fourth of the patients with RA, the sacroiliac joints demonstrate radiographic changes of subchondral bony erosions and articular destruction, as well as ankylosis. Subluxation or dislocation of the sacroiliac joint usually is associated with significant trauma to the pelvis. Nontraumatic disruption of the sacroiliac joint is a rare occurrence, but it should be considered in evaluating a patient with longstanding RA, sacroiliac joint tenderness, and radiating lower extremity symptoms.
3178910 Serum immunoreactive erythropoietin in rheumatoid arthritis: impaired response to anemia. 1988 Oct Serum immunoreactive erythropoietin (EP) levels were measured in 116 patients with rheumatoid arthritis (RA) and 20 control patients with iron deficiency anemia. Serum EP levels were significantly higher in the 46 anemic RA patients than in the 70 nonanemic RA patients (mean +/- SD 31.0 +/- 19.8 mU/ml versus 16.8 +/- 12.4 mU/ml; P less than 0.0001). Furthermore, although a significant inverse correlation between the serum EP level and the hemoglobin value was present in the anemic RA patients (r = -0.57, P less than 0.0001), the regression coefficient describing the relationship between serum EP and hemoglobin was significantly lower for the anemic RA patients than for patients with iron deficiency anemia (F = 6.01, P less than 0.025).
3766606 Apical fibrocavitary lesions of the lung in rheumatoid arthritis. Report of two cases and 1986 Oct Two patients with rheumatoid arthritis and fibrocavitary lesions in the upper lobes of the lungs are described. Postmortem pathologic studies of the lungs revealed the presence of clinically unsuspected necrobiotic nodules with cavitation and excluded other possible causes such as infections and vasculitis. These findings support the view that apical fibrocavitary disease is a clinically distinct pattern of lung involvement in rheumatoid arthritis.
2077077 [Arthroscopic findings of the rheumatoid knee mode of cartilage changes and synovial proli 1990 Dec To establish a more objective evaluation of the arthroscopic findings in knees affected by rheumatoid arthritis (RA), the degrees of synovial proliferation and cartilage change were classified semiquantitatively. In 73 knees out of 41 cases with RA, the joint surface was divided into 6 regions. The cartilage changes and synovial proliferation at each region was classified into 5 ranks. Plain X-ray findings were evaluated by Larsen's grading system. The cartilage changes found by arthroscopy were more advanced than expected from the radiographical findings. Also, plain radiographical films did not accurately show the degree of synovial proliferation. In cases with Larsen grade III or below, the lateral compartment of the knee, in particular, the lateral meniscus often demonstrated advanced cartilage changes. In cases with Larsen grade IV or above, cartilage loss was uniformly noted in all 6 regions. Advanced cartilage changes were found mostly medially in knees with genu varum and laterally in knees with genu valgum, and were related to the femoro-tibial angle. Advanced synovial proliferation was mostly seen in the lateral gutter regions and the periphery of the menisci regardless of alignment.
3361532 Atlantoaxial facet joint arthritis in the rheumatoid cervical spine. A panoramic zonograph 1988 Feb Twenty-three patients with severe, longterm (22 years, range 8-36) rheumatoid arthritis were evaluated for rheumatoid changes in the atlantoaxial facet joints using a panoramic zonography program. Ten patients had vertical subluxation of the odontoid process. In 9 of 10 cases this mode of subluxation was associated with grade 3-4 arthritis in the facet joints. Our findings indicate atlantoaxial facet joint arthritis with bilateral collapse of the lateral facet joint masses as a cause of vertical subluxation. Furthermore, we suggest that panoramic zonography investigation is a valuable contribution to the pattern of radiographic examination of the atlantoaxial facet joint arthritis, especially for evaluation of its clinical counterparts: nonreducible lateral head tilt and vertical atlantoaxial subluxation.
1661709 Relationship between leukotriene B4 and immunological parameters in rheumatoid synovial fl 1991 Dec Leukotriene B4 (LTB4) was measured in synovial fluid from 20 patients with rheumatoid arthritis and 15 patients with osteoarthritis. The level of LTB4 was significantly higher in synovial fluid from rheumatoid arthritis patients as compared with synovial fluid from osteoarthritis patients. LTB4 levels also significantly correlated with cell numbers, rheumatoid factor, and immune complexes in synovial fluid from rheumatoid arthritis patients. There was an inverse correlation between LTB4 levels and complement components. The high-pressure liquid chromatography peak of immunoreactivity extracted from the synovial fluid occurred at a retention volume identical to that of authentic LTB4. These results suggest that the increased level of this mediator in synovial fluid may contribute to perpetuation of inflammation and tissue destruction in rheumatoid arthritis.
3127104 ELISA assays for IgM and IgG rheumatoid factors: their clinical correlations during therap 1987 Sep A longitudinal study of changes in rheumatoid factor levels and their correlations with other clinical and laboratory assessment of disease activity followed 45 rheumatoid arthritis patients during 12 months continuous therapy with gold and penicillamine. Rheumatoid factors were measured by the titred latex assay and by ELISA assays for IgM and IgG rheumatoid factor. The IgM ELISA assay correlated strongly with the titred latex assay and weakly with the IgG rheumatoid factor assay at 0, 6 and 12 months. All showed significant falls with treatment, and ELISA assays were not more sensitive indicators than the latex assay. Correlations of initial rheumatoid factor levels by all 3 assays to 34 other clinical and laboratory assessments showed that only a small number of weak correlations existed; there were more at 6 and 12 months, but still not many. Changes in rheumatoid factor levels over 0-6 months showed no significant correlation to changes in other variables. There were no more correlations with ELISA assays than with titred latex rheumatoid factor. We conclude that ELISA rheumatoid factor assays have no clinically relevant advantage over the titred latex assay when following rheumatoid patients treated with gold or penicillamine.
2031156 Counselling women with rheumatic disease--how many children are desirable? 1991 The interaction of pregnancy and the rheumatic diseases has been described for most of the inflammatory joint disorders. However, the patient response to the challenge of motherhood and child rearing has seldom been taken into consideration. The current study presents data derived from a patient inquiry on these issues. The results demonstrate that while a wish for children is present even in disabled patients, the number of children regarded feasible depends largely on coping strategies, external help and the patient's own resources. Information before pregnancy is crucial, but often insufficient. Counselling should rely not only on medical facts, but also on patient experience.