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PMID	Title	PublicationDate	abstract
6791479	Improvement in peripheral blood lymphocyte response to concanavalin A and pokeweed mitogen	1980 Dec	Peripheral blood lymphocyte mitogen responsiveness was studied in 21 patients with rheumatoid arthritis being treated with sodium aurothiomalate. There was a significant increase in lymphocyte response to concanavalin A and pokeweed mitogen but not to phytohaemagglutinin. This observed increase in lymphocyte response contrasts with the suppressive effect of gold salts in vitro. We propose that this apparent contradiction may be explained by the relatively low serum gold levels measured in our patients, compared with expected levels in synovial membrane. Thus gold could suppress rheumatoid inflammation in the "target tissue" while having little suppressive action in the peripheral blood compartment, where a removal of suppressive influences due to active disease might then be seen as a net improvement in lymphocyte responsiveness.
809832	[Results of immunosuppressive therapy in 78 patients with rheumatoid polyarthritis, treate	1975 Jun	The authors report clinical, laboratory, and radiological results obtained by immunodepresant treatment of 78 patients suffering from rheumatoid polyarthritis, over a period of more than 4 years. In 27 of the patients the treatment had been followed for 4 to 8 years. Clinically the results were excellent in 36 cases, reasonably good in 23 cases; in 19 cases therapy was unsuccessful or had to to be stopped. There was a reduction in the sedimentation rate in cases with good results and in half the cases there was a reduction in the titre of the Waaler-Rose reaction. Studies on the evolution of radiological signs in 34 patients showed definite deterioration in only 2 cases out of 19 subjects having very good clinical results and definite deterioration in 7 of 15 subjects with less good clinical results or failure. Thus the immunodepressant treatment appeared capable of stopping or slowing down the osteoarticular destruction. The cessation of treatment in 28 patients was followed by a relapse in 14 patients (7 within 6 months, and 7 within 6 months to 2 years). In 14 patients there was no relapse and in 8 of these the improvement has lasted for more than 3 years. With the doses used, there were few short-term complications of treatment. Haematological tolerance appeared to vary according to the patient ; for prolonged treatment the dose should be adapted to the individual.
843109	Cell-mediated immunity in rheumatoid arthritis.	1977 Feb	Cell-mediated immunity in rheumatoid arthritis (RA) was assessed by skin testing with six antigens in 107 patients, 94 of whom were age, sex, and race-matched with healthy individuals or patients with diseases unrelated to immunological abnormalities. 20% of RA patients were anergic. Impaired cell-mediated immunity in the RA patients was manifested by a decrease in the magnitude of skin reactivity as well as a decrease in the incidence of positive reactions to multiple antigens. Depression in cell-mediated immunity was related to age but not to sex, duration of disease, or disease activity. A slight correlation was found between absolute peripheral lymphocyte counts and the number of positive skin tests, and was confirmed by finding an association between lymphocyte counts and the size of skin reactions. A correlation was also found between lymphocyte counts and disease activity. Four explanations of the observed depression in cell-mediated immunity in RA were considered: (1) a preoccupation of the immune mechanism of the host with cell-mediated immunity reactions related to the pathogenesis of the disease; (2) a depression of cell-mediated immune reactivity by a virus infection; (3) depression of cell-mediated immunity by therapy; and (4) immune complex suppression of cell-mediated immunity. No effect of gold therapy was found. The near universal use of salicylates or other anti-inflammatory drugs did not permit investigation of the effect of these drugs on cell-mediated immunity.
3876077	Bone turnover in early rheumatoid arthritis. 2. Longitudinal bone density studies.	1985 Sep	Serial measurements of bone mineral in 17 ambulant female patients with rheumatoid arthritis (RA) of recent onset and 19 age matched female controls were made in the radius by computed tomography and in the vertebrae by dual photon absorptiometry. Loss of trabecular bone from the distal radius was more rapid in RA (p = 0.0014), but there was no difference in the rate of loss of bone mineral from the radial midshaft or lumbar spine compared with the controls. This study is consistent with the hypothesis that the predominant form of bone loss early in the disease is the vicinity of affected joints.
6670514	Surface replacement arthroplasty of the hip. Experience with the ICLH method.	1983 Dec	Fifty-six ICLH-surface replacement arthroplasties of the hip were followed up prospectively for 1 to 6 years postoperatively, mean 2.5 years. Fifty-one hips had osteoarthritis and five rheumatoid arthritis. Pain, motion, walking ability, and function were considerably improved after surgery. It is our impression that the clinical results were equal to those obtained by conventional stemmed hip arthroplasties. Complications were recorded in nine hips, with femoral neck fracture in two, loosening of both components in two, and loosening of the acetabular component in five. Three of the failures occurred in the five hips with rheumatoid arthritis. The high failure rate is disturbing, and we now limit the indications for this procedure to patients with osteoarthritis, 40-60 years of age, and with good bone stock.
6712423	Synovectomy of the wrist in rheumatoid arthritis and related diseases. A follow-up study o	1984	Synovectomy of the wrist was done on 77 patients (97 wrists) during 1968-1981. The age of the patients at the time of operation ranged from 18 to 77 years, mean 44.9 yrs. Clinical and radiological follow-up examinations (90 wrists) or follow-up evaluation by questionnaire (7 wrists) were made by the authors in 1982. The mean length of the follow-up period was 8.5 years. Clinical symptoms of pain, swelling, restricted motion, instability and deformity of the wrist joint were evaluated and graded according to a special score. Radiological changes due to rheumatoid arthritis and osteoarthrosis were graded and analysed. Eight wrists were arthrodesed during the follow-up. Among the remaining wrists (89 cases) pain was absent or almost absent in 39%, was less than before the operation in 49% and was unchanged or worse in 12% of cases. The respective percentages for the presence of swelling were 47%, 36%, and 17%. The range of dorsiflexion was between 0 and 70 degrees, with an average of 27.9 degrees. The range of volar flexion was between 0 and 75 degrees, the mean being 28.2 degrees. The average ulnar and radial side motions were 12.9 degrees and 5.4 degrees, respectively. The radiological grading of RA remained about the same in 10 wrists and did not improve in a single wrist. In the other wrists the X-ray changes progressed. The results (patient's opinion) were subjectively good in 53%, fair in 32%, and poor in 15%.(ABSTRACT TRUNCATED AT 250 WORDS)
856216	Carrageenin-induced arthritis. IV. Rate changes in cartilage matrix proteoglycan synthesis	1977 Apr	A localized inflammatory response was initiated by both single and repeated injections of carrageenin into femorotibial joints. Histologic changes were observed 24 hours after a single intraarticular injection, and an inhibition in the in vitro rate of proteoglycan synthesis was detected 72 hours after the injection. This inhibition was relieved in vitro by the addition of beta-D-xyloside, an exogenous initiator of glycosaminoglycan biosynthesis. Following repeated carrageenin injections, most cells appeared to be dead on histologic examination and no in vitro proteoglycan synthesis could be detected; nor could any stimulation be achieved by adding exyloside.
4064588	C-reactive protein levels in patients with rheumatoid arthritis: the impact of therapy.	1985 Sep	C-reactive protein levels were measured in sera of 111 patients with rheumatoid arthritis and were compared with erythrocyte sedimentation rate. The patients were divided into six groups according to drug therapy. Comparison between the groups suggests that CRP correlates best with ESR in patients treated with penicillamine and in patients in clinical remission. Patients treated with gold, NSAID or methotrexate have a weaker correlation between the two parameters, while steroid therapy yields the poorest correlation which is not statistically significant. Our data suggest that although CRP is a sensitive index of disease activity, the specific drug taken by the patient must be considered before interpreting the results.
7095941	Mononuclear phagocytes, prostanoids and rheumatoid arthritis.	1982	We describe a new, simple procedure for obtaining and studying mononuclear phagocytes from inflammatory synovial fluid. The viability and functional characteristics of these macrophages have been carefully checked. This technique has been used to evaluate the macrophagic synthesis of prostaglandins in 16 patients with evolutive rheumatoid arthritis. Significant amounts of prostaglandins, mainly PGE2 and TxB2, are released and increased after zymosan administration. The three tested prostaglandins (PGE2, PGF2 alpha and TxB2) responded in a similar manner. The in vitro PG biosynthesis and the number of harvested adherent cells are negatively correlated with the synovial fluid volume but positively correlated with the disease activity. In fact, we found an heterogeneity among the analyzed macrophages; these can be divided into two populations with marked differences in their PG biosynthesis. The one with the highest synthesis corresponded to the more severe disease.
7285427	Total ankle arthroplasty: four years' experience.	1981 Oct	A review of 102 total ankle arthroplasties performed during a four-year period revealed that complications occurred in 41%. 22% with impingement of various types 6.9% with loosening and 2.9% with deep sepsis. The best results were obtained in patients with rheumatoid arthritis and those with posttraumatic osteoarthritis who were older than 60 years of age. Total ankle arthroplasty currently should not be considered in patients with posttraumatic osteoarthritis who are younger than 60 years old. Arthrodesis remains the only acceptable method of treatment in these individuals. Total ankle arthroplasty seems indicated in patients who have significant ankle joint disability secondary to rheumatoid arthritis and in elderly patients with disabling posttraumatic degeneration whose physical demands are limited.
6807470	Total body calcium in rheumatoid arthritis: effects of disease activity and corticosteroid	1982 Jul 31	Rheumatoid arthritis may be associated with generalised as well as periarticular osteoporosis. To assess the extent of bone loss and the influence of corticosteroid treatment total body calcium was measured by in-vivo neutron activation analysis in 63 patients with rheumatoid arthritis treated with non-steroidal anti-inflammatory drugs alone and 31 treated with additional low-dose corticosteroids. The results were compared with those in 40 normal controls matched for age, sex, and menopausal state. There were significant reductions in mean total body calcium in the group treated with non-steroidal anti-inflammatory drugs (5.3% in men; 6.8% in women) and greater reductions in the corticosteroid-treated patients (11.5% in men, 15.5% in women). The reduction was correlated with disease duration and activity in the patients treated with non-steroid anti-inflammatory drugs alone. Measured total body calcium was significantly less than the values predicted when this relation was used in the corticosteroid-treated patients. The data suggest that increased bone loss in patients with rheumatoid arthritis treated with corticosteroids is attributable to drug treatment rather than disease activity. Many patients with rheumatoid arthritis treated with low-dosage corticosteroids and some postmenopausal women with the disease are likely to be at risk from the complications of osteoporosis.
515744	The radiology of rheumatoid involvement of the cervical spine.	1979 Apr 10	The radiological features of cervical spine involvement in rheumatoid arthritis are described. These include atlanto-axial subluxation, in both the horizontal and vertical planes, sub-axial dislocation, erosions, and vertebral end plate sclerosis. Detailed radiological investigation, using inclined plane radiography, auto-tomography, tomography, and myelography may all be required to demonstrate the abnormalities. Disorders of mobility can only be assessed with dynamic views and fluoroscopy and the mechanics of these derangements vary depending on the type of subluxation encountered. The cumulative effects of the lesions conform to certain characteristic patterns and include marked reduction of neck height, disorders of mobility, and changes in the capacity of the spinal canal. The discrepancy between these changes and the clinical and neurological findings is discussed.
1062969	Myelomonocytic leukaemia following cyclophosphamide therapy of rheumatoid disease.	1975 Dec	A 69-year-old woman treated for 31 months with daily oral cyclophosphamide for refractory rheumatoid disease developed acute myelomonocytic leukemia 21/2 years after stopping the drug. The possibility of a casual association between the therapy and subsequent leukaemia is supported by the growing experience with cytotoxic agents.
6366989	The localization of fibronectin in rheumatoid arthritis synovium by light and electron mic	1983	The distribution of fibronectin in rheumatoid arthritis (RA) synovium has been investigated by light and electron microscopic immunohistochemistry using an antihuman fibronectin antibody. Heavy accumulation of fibronectin was observed in the lining layer and the areas of proliferation of fibroblasts. Rough endoplasmic reticulum (RER) and peripheral vesicles of proliferated type B lining cells and fibroblasts contained large amounts of fibronectin. Thus these cells seem to participate actively in the local synthesis and secretion of this glycoprotein. Type A lining cells and migrated mononuclear phagocytes contained many phagolysosomes in some of which dense accumulation of fibronectin was observed. Some of the materials in the phagolysosomes, with dense accumulation of fibronectin, resembled the fibrinous material-fibronectin complexes frequently seen in the pericellular spaces. Accordingly fibronectin seems to play a role in the clearance of fibrinous materials by these phagocytes. The proliferated capillaries and small vessels possessed multilamellated basement membranes with heavy accumulation of fibronectin. However, RER or Golgi apparatus of the endothelial cells contained no detectable amounts of fibronectin. This indicates that these cells do not actively participate in the synthesis of fibronectin and that the majority of this glycoprotein in the basement membranes originates in fibronectin from blood vessel exudate. Fibrinous material-fibronectin complexes were frequently seen on the endothelial cell surfaces. Circulating platelets and mononuclear cells occasionally came in contact with these complexes, suggesting an association of fibronectin with the formation and clearance of thrombi in the vascular lumina at the inflammatory sites of RA synovium.
4048811	[Influence of treatment on the chemotaxis of polymorphonuclear neutrophils in rheumatoid a	1985 Jun	The chemotaxis of neutrophil polymorphonuclear cells was measured in 56 patients with rheumatoid arthritis classified according to the treatment received. The presence of D-penicillamine in the serum affected the migration of the neutrophil polymorphonuclear cells in both the control subjects and the patients. In the patient group, the chemotaxis of the neutrophil polymorphonuclear cells was corrected non-significantly in the presence of control AB serum.
6965012	Erosive rheumatoid arthritis co-existing with systemic lupus erythematosus. A report of a	1982 Sep	A 28-year old female is described with a 12-year history of seropositive, erosive rheumatoid arthritis. Subsequently, she developed systemic lupus erythematosus diagnosed both serologically and on renal biopsy. As has previously been emphasised, these two diseases occur rarely in the same patient. HLA typing revealed the patient was HLA - B8 positive and that she had inherited this genetic marker from her mother who is Irish, rather than from her West Indian father. The patient has developed marked atlanto-axial subluxation, a feature not noted in six patients previously described as having both diseases.
6774903	Long-term management of rheumatoid arthritis with disalcid.	1980	Disalcid, a salicylic acid pro-drug, was administered for 3 months to eighteen rheumatoid arthritis patients, with monitoring of clinical response, side-effects and laboratory changes. The drug produced a satisfactory to excellent response in fourteen patients and was unsatisfactory in four. Gastric side-effects occurred in three patients and allergic reaction in one. Serum salicylic acid concentrations were adequately maintained between 15 to 25 mg/100 ml. Funduscopic monitoring revealed one retinal defect in a patient with hypertension. Laboratory examinations, blood chemistry and urine analyses remained within normal limits during the 12-week trial.
961399	Experience with knee synovectomy in Norwich, 1964-1973.	1976 Aug	Thirty-six patients (43 knees) who underwent anterior synovectomy for rheumatoid disease between 1964 and 1973 have been personaly reviewed. The notes and X-rays of a further seven patients (10 knees) have been examined. Twenty-five per cent of the knees were failures at the time of review, but only two were failures from the outset. The indications for the operation and also the contraindications are described and evaluated. It is concluded that: 1. In the rheumatoid knee, anterior synovectomy is a pain relieving operation. 2. The indications are wider than classically stated, and can include knees with full thickness cartilage destruction, and flexion deformities up to 20 degrees. 3. The majority of knees fail because of secondary degenerative change, and this is manifested by pain rather than stiffness. 4. Postoperative manipulation does not prejudice the final result. 5. Associated popliteal cysts (five in this series) can be cured by anterior synovectomy.
886549	Longterm evaluation of intermittent levamisole treatment in rheumatoid arthritis.	1977 Spring	Twenty-one patients with rheumatoid arthritis were treated discontinuously with levamisole overa prolonged period (150 mg/day, four days per week). Disease activity was completely suppressed or markedly improved in 18 patients, while three patients showed no improvement. Overall, a statistically significant improvement was recorded after six months in morning stiffness, Ritchie index, grip strength, and sedimentation rate. After 12 months treatment, the morning stiffness, Ritchie index, grip strength, and sedimentation rate were still significantly improved. After 18 months treatment, only the morning stiffness was still improved as compared to the initial evaluation. Improvement in the other indices was no longer significant. The beneficial effect of levamisole therapy occurred slowly, reaching a maximum after six months. Similar improvement was observed in patients with advanced disease as in the early stages. Intermittent levamisole administration would appear to be as effective as continuous treatment. While minor side effects occurred just as frequently as with continuous administration, the discontinuous treatment used in this study was free of serious side reactions.
535182	The association of cryoglobulinaemia with nodules, vasculitis and fibrosing alveolitis in	1979 Dec	Two measurements of serum immune complexes, cryoglobulinaemia and 125I-C1q binding, have been performed in patients with severe rheumatoid arthritis (RA) and compared with normal levels. Cryoglobulinaemia was present in 20 out of 28 patients (71%) with extra-articular disease (mean level 17 micrograms/ml) including nodules, digital vasculitis, cutaneous ulcers, rash, neuropathy, lung disease and scleritis, but in none of 32 patients with joint disease alone (uncomplicated RA) (mean level 3 micrograms/ml). Cryoglobulinaemia correlates with, but probably does not antedate, extra-articular disease, and may be useful in predicting morbidity and mortailty in this group of patients. In contrast, serum 125I-Clq binding was raised in patients with uncomplicated RA and those with extra-articular disease, although levels were higher in the latter group. Both tests showed a negative correlation with serum haemolytic complement and a positive correlation with IgM rheumatoid factor although there were some sera with raised levels of rheumatoid factor without cryoglobulinaemia. These results suggest that cryoglobulinaemia is a better test than Clq-binding for demonstrating the presence of circulating immune complexes involved in the pathogenesis of extra-articular lesions.