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PMID	Title	PublicationDate	abstract
2037631	Evaluation of joint disease in the adult hand and wrist.	1991 Feb	The radiographic evaluation of joint diseases in the adult hand and wrist is described in this chapter. The main focus is on the interpretation of plain radiographs of the hands and wrists in patients with joint symptoms. After considering the general approach to the analysis of the radiographs, the findings of the common forms of arthritis are illustrated and the differential diagnoses are discussed.
1930319	Secular changes in published clinical trials of second-line agents in rheumatoid arthritis	1991 Oct	The present investigation was undertaken to explore changes over time in the design and reporting of trials of second-line drugs in rheumatoid arthritis, in the characteristics of patients included in the trials, and in the sources of funding. We studied 105 trials of second-line agents for the treatment of rheumatoid arthritis, including placebo-controlled and comparative trials involving 8 different agents. Three time periods, 1945-1969, 1970-1979, and 1980-1989, were compared. We found little change in the standards for reporting on the design of trials or for reporting information on patient dropout and drug side effects, some increase in the complexity of the statistical methods used, but no increase in the use of power analysis (reported in only 13% of trials). The average age of patients in clinical trials has increased. In recent years, there has been a substantial shift from placebo-controlled to comparative trials, and it is increasingly common for trials to be financially supported by pharmaceutical companies. The possible effects of secular trends should be considered when combining or comparing results of trials conducted in different years.
1784888	S-ibuprofen versus ibuprofen-racemate. A randomized double-blind study in patients with rh	1991	Ibuprofen (ibu) is a racemic 2-arylpropionic acid non-steroidal anti-inflammatory drug whose activity is due mainly to the S-enantiomer. So far only the racemic compound is in clinical use. A double-blind randomized trial was carried out for a 2-week period in 50 patients with classical rheumatoid arthritis (RA) (Steinbrocker II-III) to compare the effectiveness and tolerance of S-ibu (400 mg T.I.D.) with that of the racemic compound (600 mg T.I.D.). Ritchie-index, limitation of movement, joint pain on pressure and pain at night decreased significantly in both groups. Due to lack of effectiveness, the dose had to be increased in 3 patients from the S-ibu group as well as in 6 patients from the racemic group resulting in mean daily doses of 1220 mg S-ibuprofen and 1870 mg racemic ibu. No statistically significant difference could be found between both groups concerning efficacy and unwanted effects. Therefore, S-ibu given alone may be advantageous because the metabolic load to the human body is reduced and patients are more likely to comply with drug doses of 1.2 g/day as compared to 1.8 g/day.
1918955	Synovial tissue macrophage as a source of the chemotactic cytokine IL-8.	1991 Oct 1	Cells of the synovial microenvironment may recruit neutrophils (PMN) and lymphocytes into synovial fluid, as well as lymphocytes into the synovial tissues, of arthritic patients. We have investigated the production of the chemotactic cytokine IL-8 by using sera, synovial fluid, synovial tissue, and macrophages and fibroblasts isolated from synovial tissues from 75 arthritic patients. IL-8 levels were higher in synovial fluid from rheumatoid (RA) patients (mean +/- SE, 14.37 +/- 5.8 ng/ml), compared with synovial fluid from osteoarthritis patients (0.135 +/- 17 ng/ml) (p less than 0.05) or from patients with other arthritides (5.52 +/- 5.11 ng/ml). IL-8 from RA sera was 8.44 +/- 2.33 ng/ml, compared with nondetectable levels found in normal sera. IL-8 levels from RA sera and synovial fluid were strongly positively correlated (r = 0.96, p less than 0.05). Moreover, RA synovial fluid chemotactic activity for PMN in these fluids was inhibited 40 +/- 5% upon incubation with neutralizing polyclonal antibody to IL-8. Synovial tissue fibroblasts released only small amounts of constitutive IL-8 but could be induced to produce IL-8 by stimulation with either IL-1 beta, TNF-alpha, or LPS. In contrast, unlike normal PBMC or alveolar macrophages, macrophages isolated from RA synovial tissue constitutively expressed both IL-8 mRNA and antigenic IL-8. RA synovial macrophage IL-8 expression was not augmented by incubation with either LPS, TNF-alpha, or IL-1 beta. Immunohistochemical analysis of synovial tissue showed that a greater percentage of RA macrophages than osteoarthritis macrophages reacted with anti-IL-8. Whereas macrophages were the predominant cell for immunolocalization of IL-8, less than 5% of synovial tissue fibroblasts were positive for immunolocalized IL-8. These results suggest that macrophage-derived IL-8 may play an important role in the recruitment of PMN in synovial inflammation associated with RA.
1365474	Four commonly prescribed non-steroidal anti-inflammatory drugs for rheumatoid arthritis.	1991	A four-way single-blind crossover study was used to compare the efficacy and tolerance of four non-steroidal anti-inflammatory drugs. In addition, pain intensity was compared during the day, at night, at rest, on walking, in the most painful joint, and with the patients most painful activity. Ninety-six patients with rheumatoid arthritis took single daily doses of controlled release naproxen (N), diclofenac S.R. (D), indomethacin S.R. (I) and standard piroxicam (P). The greatest changes from baseline after treatment were seen in those patients with the highest initial pain measurement scores. Assessments of pain in the morning, in the most painful joint and the most painful activity were more discriminating than those at noon or at rest. Of the treatments, 'N' and 'P' were the most effective in reducing pain, with statistically significant differences from baseline. 'I' was the most effective in reducing morning stiffness. Adverse experiences were generally mild, occurring more frequently on 'I' than on other treatments.
3813668	Measurement of the cross linking compound, pyridinoline, in urine as an index of collagen	1986 Dec	An enzyme linked immunoassay (ELISA) for the collagen cross link, pyridinoline, has been developed using affinity purified antibodies, with a sensitivity down to about 0.1 ng of cross link. Measurements of urinary pyridinoline were made in patients with rheumatoid arthritis (RA), osteoarthritis (OA), and a control group showing no signs of joint disease. Expressed relative to creatinine values, pyridinoline was significantly increased in both RA and OA groups compared with controls: these differences were much larger than could be attributed to any age related effects or to changes in urinary creatinine concentrations. These findings were confirmed by analysis of a series of 24 h urine collections which showed that the total pyridinoline excretions were significantly higher in both RA and OA groups than in the controls. As pyridinoline is much more prevalent in cartilage than in bone collagen, measurement of this compound in urine may provide an index for monitoring the increased joint destruction that occurs in arthritic disease.
3715026	High-field MR surface-coil imaging of the hand and wrist. Part II. Pathologic correlations	1986 Jul	High-resolution magnetic resonance (MR) images of the hands and wrists of 12 patients with a variety of suspected pathologic conditions were obtained at 1.5 T using a prototype surface coil. Lesions included ganglions, rheumatoid arthritis, carpal fractures, carpal tunnel syndrome, and arteriovenous malformations. In the selected cases studied, MR images provided potentially relevant information. Surgical, pathologic, and radiographic correlations were obtained. MR imaging affords delineation of soft-tissue structure that is unmatched by other imaging methods, including computed tomography. It is anticipated that MR imaging of the hand and wrist will afford sufficient valuable clinical information in certain conditions to justify its expense outside a research setting. Further clinical testing, however, is warranted.
2794707	Arthrodesis of the metacarpo-phalangeal joint of the thumb: a review of 42 cases.	1989 Aug	42 arthrodeses of the metacarpo-phalangeal joint of the thumb in 34 patients have been reviewed at a mean of 22.5 months after operation. Where bone stock allowed, Omer's chevron arthrodesis was used. 83% of these operations were judged to have been successful by our patients, most of whom were suffering from inflammatory joint disease. Some patients had very poor pinch pressures when reviewed, but only those with persistent instability or pain were disappointed. All arthrodeses were fixed in flexion; although the angle varied, no ideal position was identified.
3188676	[Clinical value of histomorphologic studies of joint capsules].	1988 Jul	The clinical significance of the histomorphological evaluation of synovial tissue from 389 patients with joint diseases was studied. From these data we conclude: (1) the histomorphological diagnosis in joint diseases is rarely of decisive value (6.2%); (2) in 23.1% of cases the histomorphological diagnosis is judged to be of clinical assistance; (3) the histomorphological grading of the inflammatory reaction in the joint under study corresponds in approximately two out of three cases to the clinical judgement.
3740999	Immune complexes and the pathogenesis of neutropenia in Felty's syndrome.	1986 Aug	The effect of the injection of serum from patients with rheumatoid arthritis (RA) and Felty's syndrome (FS) into mice on the number of circulating polymorphonuclear cells (PMN) was studied. The number of circulating PMN dropped to 61% (range 34-98%) of the initial counts after the injection of FS serum. This phenomenon was observed less frequently after injection of RA serum. In contrast, injection of serum from healthy controls always resulted in an immediate increase in the number of circulating PMN. No decrease in PMN counts was found after injection of FS sera pretreated with polyethylene glycol to precipitate immune complexes (IC). Gel filtration of FS sera on Sepharose 4B showed that the effect on the PMN counts in mice did not coincide with the 7S peak but occurred only in fractions containing larger material. Serum fractions from FS patients that contained IC were more active in producing neutropenia than the corresponding fractions from patients with RA. Microscopic and immunohistochemical examination of the organs from mice injected with FS serum showed sequestration of PMN and deposition of human IgG, IgA, and IgM in the vascular bed of the lungs. These results indicate that the interaction between PMN and IC of patients with FS leads to sequestration of PMN in mice and suggests that this interaction in humans may have a role in the pathogenesis of FS.
2317121	Measurement of joint inflammation in rheumatoid arthritis with indium-111 chloride.	1990 Feb	Studies in the collagen and rabbit models of arthritis have indicated that indium-111 chloride (111InCl3) scintigraphy objectively measures synovial inflammation. Indium-111 chloride scans, with imaging three days after 19 MBq intravenous injection, were performed on 21 patients with definite or classical rheumatoid arthritis (RA), all of whom were functional class II. Standard clinical indices of disease activity were recorded at the time of imaging by the same investigator, who was unaware of the results of joint scans. In addition, eight patients with severe osteoarthritis, four of whom were considered to need hip or knee joint replacement, were similarly scanned. In each patient 16 joints were graded as 0 to 5, based on increasing degrees of 111InCl3 uptake, by a single investigator blinded to the patient's diagnosis and clinical status. In the group with RA significant correlations were observed between individual joint uptake on scan and peripheral joints with swelling, joints reported to be painful, and joints with any abnormality on physical examination. In the group with osteoarthritis joints positive on scan correlated with the presence of pain. A total scan score (sum of individual joint scores) was calculated for each patient. In the patients with RA values ranged from 0 to 42 with a mean (SEM) of 20.7 (2.7) and correlated with the number of swollen joints and decreasing grip strength. In the group with osteoarthritis the mean total scan score (9.2 (1.5), range 3-14) was significantly lower than in the patients with RA. These data show that 111InCl3 scanning can measure joint involvement by RA.
3675657	Analyses of HLA linkage in white families with multiple cases of seropositive rheumatoid a	1987 Oct	Families with multiple cases of seropositive rheumatoid arthritis (RA), identified through 2 probands with the disease, were analyzed for genetic linkage between an autosomal susceptibility gene for RA and the HLA loci. These analyses were carried out over a wide range of penetrances (0.1-0.4), with prevalence for the disease fixed at 0.01 or 0.04. In some models, a sporadic frequency of 20% was assumed. Close linkage to the HLA loci was ruled out for all models where the gene was autosomal dominant, except for those with low penetrance and with prevalence set at 0.04. The models in which the gene was autosomal recessive produced results similar to those in models where it was autosomal dominant when prevalence was set at 0.01, and close linkage was ruled out, except at very low penetrances. With prevalence set at 0.04, the autosomal recessive gene model produced log odds scores which were all negative (-2.6 to -0.3). Therefore, the evidence in these families does not support close linkage with HLA, even though a significant DR4 RA population association exists. The data suggest that non-major histocompatibility complex (MHC) genes may contribute to the development of RA and, therefore, disease susceptibility may involve the genetic interaction of one or more MHC genes and non-MHC genes, in addition to environmental agents.
2805501	Intramedullary fixation for arthrodesis of the knee after infected total knee arthroplasty	1989 Nov	Knee arthrodesis with curved intramedullary rods was performed in 12 patients after infected total knee arthroplasty. The underlying pathologic condition was osteoarthritis in nine patients and rheumatoid arthritis in three patients. Nine patients with a postoperative follow-up time of greater than two years (average, 34 months; median, 29 months; longest, 55 months) were evaluated for functional results. Six patients obtained a satisfactory knee fusion in an average of 6.6 months (range, three to 11 months; median, five months). Those patients without massive bone loss preoperatively attained a fusion rate of 66.6%. Two thirds of the patients with massive bone loss attained fusion. Indications for surgery in addition to infection included massive bone loss, mixed infection with multiple organisms, infrapatellar tendon rupture, ligamentous instability, and severe valgus deformity with tibial fracture nonunion. Failure occurred in three cases. One was associated with rod breakage; another was due to massive bone resorption; and the third was in a diabetic female with infrapatellar tendon rupture. All patients with successful arthrodesis reported an absence of pain and the ability to ambulate with, at most, a walker. The use of curved intramedullary rods is a convenient technique for obtaining successful arthrodesis after infected total knee arthroplasty.
3098193	Demonstration of antiglobulin activity in the synovial membrane of patients with rheumatoi	1986 Oct	The results of immunofluorescence studies in nine cases of rheumatoid arthritis and nine cases of ankylosing spondylitis are presented. Antiglobulin activity was sought with fluorescein labelled, heat aggregated human IgG and rabbit immunoglobulin (indirect immunofluorescence). A similar degree of increased staining for rheumatoid factor activity was seen after pepsin digestion in all cases of rheumatoid arthritis and three of the ankylosing spondylitic cases. This staining for rheumatoid factor could also be shown in control tissue after pepsin digestion, suggesting that the enhanced staining was an artefact.
2778318	Thrombospondin and fibronectin are synthesized by neutrophils in human inflammatory joint	1989 Sep 15	Using 35S-methionine metabolic labeling, we studied de novo synthesis and secretion of proteins by activated polymorphonuclear neutrophils (PMN) from two different sources. PMN isolated from inflammatory synovial fluid of patients with inflammatory joint disease were first analyzed. The protein synthetic activity of these cells was compared with that of nonactivated PMN isolated from the peripheral blood of the same patient. Similar studies were conducted on glycogen-activated PMN from the peritoneal cavity of rabbits and results were compared with nonactivated peripheral blood PMN isolated from the same rabbit. Cells were labeled for a period of 16 to 20 h and supernatants were analyzed by one and two dimensional gel electrophoresis. In both models, the activated PMN showed a marked increase in the synthesis and secretion of thrombospondin as identified by immunoisolation with antibodies to this protein. The production of thrombospondin by activated cells paralleled a similar increase in production of another extracellular matrix and cell adhesion protein, fibronectin. The proportion of thrombospondin synthesis and secretion relative to total protein was approximately 1% in both human- and rabbit-activated PMN. For fibronectin, this proportion was in the 0.02% range. Although fibronectin mRNA accumulation in activated PMN could be demonstrated by Northern blots, we were not able to obtain similar results for thrombospondin mRNA. This could be caused by the rapid turnover of this transcript because it is known to contain an adenine uridine-rich 3' untranslated sequence. We conclude that activated PMN are capable of producing thrombospondin. Furthermore, glycogen-activated rabbit peritoneal fluid PMN represent a valuable and relevant source of activated PMN for studying the protein synthetic events of these cells in the context of inflammation.
2322026	Effect of weather conditions on rheumatic patients.	1990 Mar	In a one month prospective study of 62 rheumatic patients--16 with rheumatoid arthritis (RA), 24 with osteoarthritis (OA), 11 with inflammatory arthritis, 11 with fibromyalgia joint pain--swelling and everyday activity was compared with changes in daily weather conditions. In most patients weather changes increased arthritic symptoms. Women were more sensitive to weather than men (62% v 37%). Pain was affected positively by barometric pressure and temperature in RA, by temperature, rain, and barometric pressure in OA, and by barometric pressure in fibromyalgia. These results support the belief of most rheumatic patients that weather conditions significantly influence their day to day symptoms.
3317799	Clinical experience with tenoxicam: a review.	1987	Tenoxicam, a new non-steroidal anti-inflammatory agent (NSAID) with a long half-life, has been evaluated in a series of nine clinical studies over the last five years. Early studies against naproxen in osteoarthrosis (OA) and against ibuprofen in rheumatoid arthritis (RA) suggested the drug was efficacious in both of these conditions. A series of faecal blood loss studies showed that the drug produced less gastrointestinal blood loss than aspirin and comparable blood loss to piroxicam. Comparisons of tenoxicam and piroxicam in OA and ankylosing spondylitis (AS) showed both drugs to be approximately equally efficacious. A pharmacokinetic study showed a half-life for tenoxicam of 45 h in synovial fluid when the half-life was 42 h in plasma. A single and multiple oral dose pharmacokinetic study of tenoxicam in the elderly showed no progressive accumulation with peak plasma levels of 2.6 micrograms/ml after the single dose and 12.4 micrograms/ml at steady state.
2343281	[Principles of radiosynoviorthesis].	1990 May 5	Radiosynoviorthesis plays an important role in local treatment of rheumatoid arthritis. Radionuclides with different beta-energy are used according to the size of the joint. 90Y is used for the irradiation of chronic synovitis of the knee, 186Re for shoulder, elbow, wrist, hip and ankle; and 169Er for small finger joints. Side effects of radiosynoviorthesis such as irradiation synovitis can be avoided by synchronous injection of corticosteroids. About 60% of treated joints show good therapeutic results, early radiosynoviorthesis being the most successful. Best results are achieved in the early stages of disease in the treatment of ankle, knee and shoulder. Radiosynoviorthesis represents an alternative treatment for local therapy in rheumatoid patients.
3071410	Radiographic evaluation of inflammatory arthritis of the foot.	1988 Oct	This article provides a brief overview of the radiographic appearance of the more commonly encountered arthridities in the foot. Also reviewed is a stepwise approach to interpreting radiographs in a patient suspected of having a synovial-based disease.
3123112	Immunofixation improves the detection of monoclonal gammopathy of undetermined significanc	1987 Jul	Monoclonal gammopathy of undetermined significance (MGUS) was detected by immunofixation (IFX) in 6% of patients with rheumatoid arthritis (RA), whereas it was detected by immunoelectrophoresis in only 1% of these patients. Most of the patients with both RA and MGUS had polyclonal B cell activation, together with their monoclonal band, extra-articular features and long-lasting disease, which suggests a direct relationship between MGUS and RA status.