bluuebunny/crossref_metadata_2025 huggingface dataset:
Joint motion in the absence of normal loading does not maintain normal articular cartilage
Authors: Palmoski Marshall J. , Colyer Robert A. , Brandt Kenneth D.
Published: February 2007

Articular cartilage from the knees of 4 dogs whose ipsilateral paws had been transected 6 weeks earlier (kneetrans), and from their contralateral knees (kneecon), was examined. Kneetrans did not bear weight as a result of the surgical procedure but active motion of the joint, determined with an angular displacement monitor during walking, was comparable to that of kneecon. In comparison to kneecon cartilage, kneetrans samples showed decreases in thickness, Safranin‐O staining of the matrix, and uronic acid content (mean, 24.4%), and increase in water content (mean, 5.9%). Incorporation of 35S into proteoglycans was 34–67% less in kneetrans than in kneecon cartilage. Proteoglycan (PG) aggregation in kneecon cartilage was normal, whereas in kneetrans cartilage the bulk of the proteoglycans, and also those that had been newly synthesized (35S‐proteoglyeans), did not exist in aggregates. This defect in aggregation was due, at least in part, to an abnormality in the hyaluronatebinding region of the core protein of the proteoglycans, since they did not interact in vitro with hyaluronic acid. These changes are essentially identical to those shown to occur in canine knee cartilage after immobilization of the leg in a cast. Thus, the loading of the joint which occurs from contraction of the muscles that span the knee and stabilize the limb in stance, and not merely joint movement, may be required to maintain the integrity of the articular cartilage.
Gold therapy in the management of juvenile rheumatoid arthritis
Authors: Brewer Earl J. , Giannini Edward H. , Barkley Elizabeth
Published: February 2007

Gold therapy for 6 months was shown to be efficacious in reducing the severity of articular manifestations in 32 (63%) of 51 juvenile rheumatoid arthritis patients reviewed retrospectively. Similarly, reductions in the total number of involved joints were seen in 25 (49%) patients. Patients in whom a favorable response to therapy was noted had more severe joint involvement at the start of therapy than did nonresponders. In general, patients who responded experienced considerable improvement. Duration of disease prior to gold therapy initiation and disease onset type were not related to the probability of favorable response. Incidence of adverse side effects was low. Gold has recently been approved by the Food and Drug Administration for use in children.
Lymphocyte transformation to denatured type i collagen and b lymphocyte alloantigens in rheumatoid arthritis
Authors: Smolen J. S. , Menzel E. J. , Scherak O. , Kojer M. , Kolarz G. , Steffen C. , Mayr W. R.
Published: February 2007

Peripheral blood lymphocytes transformed significantly to denatured type I collagen in 22 of 38 patients with rheumatoid arthritis (58%), 1 of 9 patients with Reiter's disease (P < 0.05), and 9 of 32 controls (28%) (P < 0.01). Determination of HLA antigens revealed significant differences between 24 rheumatoid arthritis (RA) patients and a control population for HLA‐DRw4 (75% versus 23%). No correlation was observed between lymphocyte transformation to collagen and antibodies to collagen, rheumatoid factor, stage or duration of RA, or HLA antigens.
Inhibition of adenosine triphosphatases by gold
Authors: Nechay Bohdan R.
Published: February 2007

Inhibition of adenosine triphosphatase (ATPase) by chlorauric acid (Au3+) and gold sodium thiomalate (Au+) was studied in dog brain and kidney and in human kidney enzyme preparations. Au3+ indiscriminately affected ouabain‐sensitive (Na+ + K+‐dependent) ATPase and ouabain‐insensitive (Mg2+‐dependent) ATPase with concentrations for 50% inhibition (I50) approximately 10‐6 M. The I50 of Au3+ for Na+ + K+ ATPase was several‐fold higher in homogenates than in microsomal fractions. The enzyme was protected by bovine serum albumin. Although Au3+ and Au+ were equipotent against Mg2+ ATPase, Au+ inhibited Na+ + K+ ATPase 2 to 3 times more effectively than did Au3+. The inhibitory action of Au3+ (but not Au+) was potentiated by ascorbic acid, suggesting reduction of Au3+ to Au+ by ascorbic acid. The fractional inhibition of Na+ + K+ ATPase by Au3+ or Au+ was not affected by changing concentrations of NaCl, KCl, MgCl2, ATP, and MgATP. Decreasing pH from 8.0 to 6.8 enhanced both Au+ and Au3+ inhibition. We conclude that gold is one of the most potent nonspecific of Na+ + K+ ATPase, with characteristics differing from other metallic inhibitors of this enzyme system.
Studies on the nucleation of monsodium urate at 37°C
Authors: Tak Hyon‐Ki , Cooper Sheldon M. , Wilcox William R.
Published: February 2007

Factors influencing the nucleation of monosodium urate (NaHU) were studied with supersaturated solutions of sodium urate at physiologic conditions of temperature, pH, and ionic strength. Spontaneous nucleation of NaHU did not occur at urate concentrations of 5mM (84mg%) in the presence of 140 mM Na ion. Addition of synovial fluids from gout patients greatly enhanced nucleation, whereas fluids from degenerative joint disease patients moderately enhanced nucleation, and fluids from rheumatoid arthritis patients had only a slight effect. Hyaluronic acid and purines minimally enhanced urate crystallization, whereas other connective tissue components had no effect.
Myocarditis in mixed connective tissue disease
Authors: Whitlow Patrick L. , Gilliam James N. , Chubick Andrew , Ziff Morris
Published: February 2007

A young black woman with clinical and serologic features of mixed connective tissue disease (MCTD) developed myocarditis with congestive heart failure and ventricular ectopic activity. Despite treatment with steroids and cyclophosphamide, progressive myocarditis resulted in death 20 months after cardiomegaly first developed. Necropsy findings in the myocardium included multiple areas of extensive lymphocytic infiltration and patches of fibrosis. Myocarditis has not previously been described in the adult with MCTD but may be an important complication in patients with a high titer of antibody to nuclear ribonucleoprotein.
Evaluation of a continuing education program in rheumatoid arthritis
Authors: Stross Jeoffrey K. , Bole Giles G.
Published: February 2007

A continuing medical education (CME) program in rheumatoid arthritis was implemented and evaluated in six community hospitals. It was targeted at primary care physicians and utilized physicians identified by their peers as being educationally influential for the dissemination of content knowledge. Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians. CME delivered through community‐based educationally influential physicians is an effective way to change physician behavior in small communities with no prior ongoing educational programs. This approach should improve the primary care given to patients with rheumatoid arthritis and reduce the need for participation of academic faculty in traditional CME programs.
Familial discoid lupus erythematosus associated with heterozygote c2 deficiency
Authors: Belin Daniel C. , Bordwell Bonnie J. , Einarson Mindy E. , Mclean Robert H. , Weinstein Arthur , Yunis Edmond J. , Rothfield Naomi F.
Published: February 2007

Two siblings with chronic discoid lupus erythematosus and several family members were found with heterozygous C2 deficiency. An association with histocompatibility markers HLA‐B 18 and HLA‐D w2 was demonstrated, and the slow allotype of factor B was present. Linkage studies in this family suggested a close linkage between the C2 deficiency gene and genes coding for B18, Dw2, and BfS antigens. One HLA‐A CB/DBF recombinant was observed showing closer linkage between HLA‐D and Bf than between HLA‐B and Bf.
Juvenile rheumatoid arthritis a comparison of patients from the ussr and usa
Authors: Baum John , Alekseev Lev S. , Brewer Earl J. , Dolgopolova Aleksandra V. , Mudholkar Govind S. , Patel Kartik
Published: February 2007

Juvenile rheumatoid arthritis (JRA) in the Union of Soviet Socialist Republics (USSR) and the United States (USA) shows a remarkable similarity in age of disease onset, subtype onset, frequency, and most laboratory measurements. There is variation in the therapeutic approach with heavier reliance on aspirin in the USA. The evolution of JRA from onset subtype to final subtype over 5 years was the same in both groups and was independent of the type of therapy.
Bone histomorphometry in pacet's disease quantitative and dynamic analysis of pagetic and nonpagetic bone tissue
Authors: Meunier Pierre J. , Coindre Jean M. , Edouard Claude M. , Arlot Monique E.
Published: February 2007

Transiliac bone biopsies from 136 untreated pagetic patients, taken from both pagetic (72 cases) and nonpagetic bone (64 cases), were quantitatively analyzed. Tetracycline double labeling analysis demonstrated that osteosclerosis of pagetic bone results from an overproduction of woven bone by the osteoblasts. Increased bone cell populations appeared as the consequence of an increased birthrate of the basic multicellular units. In 45% of patients biopsied in nonpagetic bone, there were prints of an increased bone remodeling attributed to a hyperparathyroidism secondary to the high calcium demand of pagetic bones.
Use of etidronate (ehdp) in paget's disease of bone
Authors: Johnston C. Conrad , Khairi M. R. A. , Meunier P. J.
Published: February 2007

Etidronate used in recommended doses (usually 5 mg/kg/day for 6 months) produces symptomatic improvement in approximately 60% of patients. The serum alkaline phosphatase and urinary hydroxyproline are reduced to about 50% of initial values. A sustained remission occurs in many patients and retreatment is usually effective upon relapse. The abnormally elevated osteoclast count and resorption surfaces are reduced, and at the low dose there is no accumulation of osteoid. The medication is generally well tolerated and at the recommended dosage there is no evidence of increased fracture rate.
Long‐term therapy of paget's disease of bone with ehdp
Authors: Siris Ethel S. , Canfield Robert E. , Jacobs Thomas P. , Baquiran Delia C.
Published: February 2007

Forty patients with Paget's disease of bone were treated with intermittent courses of the diphosphonate, EHDP. Seven individuals had prolonged remissions after their initial course of therapy, nineteen responded to retreatment with 5 mg/kg of EHDP for 6 months of each year, while 14 patients required cycles of 20 mg/kg for 1 month of every 4. Improvement was indicated by alleviation of symptoms and reduction in serum alkaline phosphatase and urinary hydroxyproline. Data suggesting a possible role for parathyroid hormone in the expression of Paget's disease are also discussed.
Biochemical and clinical responses to dichloromethylene diphosphonate (cl2mdp) in paget's disease of bone
Authors: Douglas D. L. , Duckworth T. , Kanis J. A. , Preston C. , Beard D. J. , Smith T. W. D. , Underwood I. , Woodhead J. S. , Russell R. G. G.
Published: February 2007

Dichloromethylene diphosphonate (Cl2MDP, or clodronate disodium) is one of the most potent of the known diphosphonates as an inhibitor of bone resorption and differs from EHDP in that it does not inhibit skeletal mineralization. It is one of the second generation diphosphonates now undergoing clinical evaluation. In the study described here Cl2MDP was given by mouth (800‐1600 mg/day for 6 months) to 35 patients with symptomatic Paget's disease of bone. Cl2MDP induced a marked fall in serum alkaline phosphatase and urinary hydroxyproline to normal or near normal values in all patients. This was accompanied by clinical improvement in all but 4 patients. Cl2MDP appears to be another effective oral drug for the treatment of Paget's disease of bone and compares favorably with the calcitonins and EHDP.
Impaired response to pneumococcal vaccine in systemic lupus erythematosus
Authors: Jarrett Mark P. , Schiffman Gerald , Barland Peter , Grayzel Arthur I.
Published: February 2007

An immunization proram with pneumococcal vaccine was carried out in 38 patients with systemic lupus erythematosus (SLE). Mean antibody levels at 1 month and 1 year were significantly lower than in normal controls. This decreased response did not correlate with drug therapy at the time of immunization. Other parameters such as anergy state, renal function, and serum immunoglobulin levels also did not correlate with antibody response. There were no adverse effects noted in the vaccinated group in comparison to matched non‐vaccinated SLE patients.
Effect of Psychological Stress on the Induction of Arthritis in Rats
Authors: Rogers Malcolm P. , Trentham David E. , Mccune W. Joseph , Ginsberg Barry I. , Rennke Helmut G. , Reich Peter , David John R.
Published: February 2007

To determine whether emotional states could influence susceptiblity to type II collagen‐induced arthritis in rats, we studied the effects of experimentally produced psychological stress on the clinical, histologic, and immunologic manifestations of this autoimmune disease. Stress, induced by exposure to a cat, abrogated the development of arthritis in rats immunized with type II collagen. The incidence of arthritis was also decreased in rats subjected to transportation and handling. These environmental factors dissociated the development of humoral and cellular sensitivity to collagen from the occurrence of arthritis. This study provides a unique demonstration that psychosomatic processes can influence an animal model of autoimmunity.
Erosive arthritis associated with apatite crystal deposition
Authors: Ralph Schumacher H , Miller Jeffrey L , Ludivico Charles , Jessar Ralph A
Published: February 2007

Apatite crystals can be associated with erosive arthritis. This report describes 3 such patients, 2 of whom had idiopathic apatite crystal deposition and 1 who had apatite related to renal failure and chronic dialysis. Diagnosis was delayed for several years in 1 patient. Roentgenograms showed calcifications in all patients. Synovial fluid had non‐birefringent chunks and globules suggestive of apatite. Diagnosis was established by electron microscopy in all 3 patients and verified by x‐ray diffraction in 2.
Measuring functional ability in chronic arthritis. a critical review
Authors: H Liang Matthew , M Jette Alan
Published: February 2007

Functional assessment instruments used in rheumatology are critically evaluated against five basic criteria: whether they allow for quantification, whether they have been tested for reliability, validity, and precision, and whether the data collection procedures are specified. No one instrument completely fulfills all criteria. Few adequately address the issues of measurement reliability and validity; none have sufficient measurement precision to detect subtle but clinically significant changes in function. Issues to be addressed in future research are discussed.
Successful treatment of sudden hearing loss in cogan's syndrome with corticosteroids
Authors: Haynes Barton F. , Pikus Anita , Kaiser‐Kupfer Muriel , Fauci Anthony S.
Published: February 2007

Cogan's syndrome (CS) is the association of acute nonsyphilitic interstitial keratitis and acute episodes of vertigo, tinnitus, and hearing loss. We have prospectively followed 6 patients with CS who were treated within 4 weeks after the acute onset of hearing loss. Within 1 to 2 weeks after the initiation of cortico‐steroid therapy, all 6 patients demonstrated improved hearing thresholds for pure tones and supra‐threshold speech discrimination results. These patients have been followed an average of 2.5 years (range 0.25–9 years); all have only mild to moderate hearing impairment in the mid (1,000 to 2,000 Hz) and low (250 to 500 Hz) frequency sound ranges. Three of the patients have been tapered off steroids completely with no subsequent permanent decrement of hearing. Thus, early oral cortico‐steroid administration to patients with sudden hearing loss associated with Cogan's syndrome may preserve auditory function.
CLINICAL SIGNIFICANCE OF ANTI–DOUBLE‐STRANDED DNA ANTIBODIES DETECTED BY A SOLID PHASE ENZYME IMMUNOASSAY
Authors: Miller Thomas E. , Lahita Robert G. , Zarro Vincent J. , Macwilliam Joanne , Koffler David
Published: February 2007

A solid phase enzyme immunoassay (EIA) detected anti‐double‐stranded (ds) DNA antibodies in 88% of sera from patients classified clinically as having active systemic lupus erythematosus (SLE) without renal symptoms and 93% with renal disease. Fifty‐six percent of sera from patients with inactive SLE were EIA positive for anti‐dsDNA antibodies. The EIA had a sensitivity and specificity comparable to radioimmunoassay (RIA) and hemagglutination for patients with active SLE with or without renal disease, but it detected anti‐dsDNA antibodies more frequently in patients with inactive SLE than the latter procedures. Precipitating antibodies detected by counterimmunoelectrophoresis (CIE) were less common in patients with renal disease (23% incidence) than clinically active patients without renal disease (79% incidence). Twenty‐four SLE sera with elevated levels of CIq binding showed a 96% concordance for a positive EIA for anti‐dsDNA antibodies in contrast to 66% concordance by RIA or hemagglutination. These findings suggest that the EIA is a sensitive and specific method for detection and measurement of anti‐dsDNA antibodies. Several clinical applications of the EIA are discussed.
STUDIES ON TYPE II COLLAGEN–INDUCED POLYARTHRITIS IN RATS. Effect of Antiinflammatory and Antirheumatic Agents
Authors: Sloboda Adolph E. , Birnbaum Jay E. , Oronsky Arnold L. , Kerwar S. S.
Published: February 2007

The effect of a variety of antiinflammatory and antirheumatic agents on both developing and established lesions of type II collagen induced polyarthritis in rats was examined. Administration of the nonsteroidal antiinflammatory agents indomethacin or phenylbutazone suppressed the paw inflammation associated with the disease without affecting type II collagen antibody titers. Radiographic analysis of the joints showed suppression of several parameters related to joint destruction. This was most probably related to the antiinflammatory properties of the two drugs. Administration of prednisolone, a steroidal antiinflammatory agent, suppressed paw inflammation; type II collagen antibody titers were significantly decreased in the developing lesion, but the drug had no effect on antibody titers in the established lesion. Radiographic analysis of the joints showed decreases in several parameters of joint destruction. Cyclophosphamide, an immuno‐suppressive agent, completely suppressed the inflammation associated with the developing lesion but had only minimal effect against the established disease. Collagen antibody titers were decreased and an improvement in only one radiologic parameter (periostitis) was detected. Treatment with antirheumatic agents such as gold thioglucose or levamisole enhanced severity of inflammation in the established lesion and caused increases in collagen antibody titers. Radiographic analysis of the joints indicated that while gold had no effect, levamisole enhanced joint destruction. Treatment with D‐penicillamine had no effect on paw inflammation, despite increases in collagen antibody titers. Radiographic analysis of the joints indicated an improvement in all parameters related to joint destruction in animals treated with penicillamine.
DNA/ANTI‐DNA complexes
Authors: Waller Steven J. , Taylor Ronald P. , Wright Eleanor L. , Morley Kathi W. , Johns Mark
Published: February 2007

The hydrodynamic sizes of antibody/3H‐dsDNA immune complexes are correlated with their ability to fix complement in a red blood cell‐complement linked binding assay. The results with PM2 dsDNA and a sonicated preparation (with a molecular weight of approximately 5 . 105) suggest that packing considerations are also important in the complement binding reaction. The relevance of these findings with respect to the role of antibody/dsDNA immune complexes in the pathogenesis of glomerulonephritis in systemic lupus erythematosus is discussed.
Eosinophilic fasciitis
Authors: Kent Lawrence T. , Cramer Stewart F. , Moskowitz Roland W.
Published: February 2007

Two patients with clinical and pathologic features of eosinophilic fasciitis manifested serologic and systemic abnormalities that raised the question of the fundamental nature and relationship of eosinophilic fasciitis to scleroderma. In addition to the characteristic features of eosinophilic fasciitis, both patients exhibited arthritis, a predominantly mononuclear cell infiltration of muscles with normal serum muscle enzyme levels, weakly positive serum antinuclear factor, IgA deficiency, and abnormalities of pulmonary function. In addition, one patient had wide‐mouthed colonic diverticulae and synovial deposits consistent with amyloid; the second patient had bone marrow hypoplasia. Although corticosteroid therapy was of benefit, hydroxychloroquine and potassium para‐aminobenzoate were of further help in controlling the disorder. Biopsies from the two patients revealed inflammatory lesions to be heaviest deep in the skeletal muscle; fascia was only minimally inflamed with mild fibrosis. The findings suggest that striking fibroinflammatory lesions noted in the fascia in some patients with eosinophilic fasciitis may derive largely from spillover of lesions in neighboring skeletal muscle.
The intestinal bypass arthritis–dermatitis syndrome
Authors: Stein Howard B. , Schlappner Otto L. A. , Boyko William , Gourlay Robert H. , Reeve C. E.
Published: February 2007

Of the 31 patients who developed polyarthritis following jejunoileal bypass for obesity, 24 had cutaneous vasculitis (urticarial, pustular, and nodular), 11 paresthesias, 10 Raynaud's phenomenon, and 1 pericarditis. Blind loop symptoms (14 of 26 patients), cryoglobulinemia (10 of 28), and immune deposits in biopsied skin lesions (5 of 7) support the theory of a relationship between bowel bacteria and immune complexes. Treating the blind loop with antibiotics and sphincteroplasty to prevent bacterial reflux into the blind loop helped 5 of 10 and 6 of 9 patients, respectively. A comparison is made to other bowel associated arthritides.
Rheumatoid arthritis in a chippewa band
Authors: Harvey Joan , Lotze Michael , Stevens Mary Betty , Jacobson Dennis
Published: February 2007

The Mille Lacs Band of Chippewa Indians in central Minnesota was screened for rheumatoid arthritis, with a 77% completion rate of the reservation census. Rheumatoid arthritis was found in marked excess, namely 6.8% of those evaluated or, minimally, 5.3% of the total band if all persons had been evaluated with no additional cases identified. This relatively closed population thus provides an opportunity to assess genetic and environmental factors of significance in this disease.
Immunogenetic control of experimental type ii collagen‐induced arthritis
Authors: Griffiths Marie M. , Eichwald Ernst J. , Martin James H. , Smith Charles B. , Dewitt Charles W.
Published: February 2007

Seven inbred rat strains were tested for susceptibility to experimental type II collagen‐induced arthritis and for development of cellular immunity to type II collagen by delayed hypersensitivity skin testing. WF (RT1u), LEW (RT1l), and DA (RT1a) were the most susceptible of the strains tested with respect to incidence ( > 95%) and severity of disease. LEW and DA were strongly skin test reactive to calf type II collagen. BUF (RT1b) developed moderate skin test responses to calf type II collagen and showed low susceptibility to collagen arthritis (1/8). MAXX (RT1n), LEW.B3 (RT1nv1), and AUG (RT1c) were not susceptible to collagen arthritis and showed negative to very weak skin test responses to type II collagen. Disease susceptibility was inherited as a dominant trait in the F1 progeny of (WF × LEW.B3) matings. These data suggest that clinical expression of experimental collagen‐induced arthritis and immune responsiveness to type II collagen are controlled in part by genes within or closely linked to the rat major histocompatibility complex—RT1.
Reiter's syndrome
Authors: Willkens Robert F. , Arnett Frank C. , Bitter Thomas , Calin Andrei , Fisher Lloyd , Ford Denys K. , Good Armin E. , Masi Alfonse T.
Published: February 2007

A retrospective evaluation of 83 patients with Reiter's syndrome (RS) and 166 comparison arthritis patients was conducted in order to assess the preliminary criteria for definite RS. Data analysis was based on the statement that Reiter's syndrome consists of an episode of peripheral arthritis of more than 1 month duration occurring in association with urethritis and/or cervicitis. During the initial episode of RS, 70 of the 83 RS patients satisfied the criteria, yielding a sensitivity of 84.3%.
Lymphapheresis in rheumatoid arthritis
Authors: Karsh Jacob , Klippel John H. , Plotz Paul H. , Decker John L. , Wright Daniel G. , Flye M. Wayne
Published: February 2007

The antirheumatic effects of lymphocyte depletion in rheumatoid arthritis were confirmed in a randomized, double‐blind trial. Six patients assigned to lymphapheresis demonstrated statistically significant decrements in counts of active joints, swollen joints, and a graded articular index compared to 6 patients similarly treated by a control procedure restricted to the removal of the volume of plasma incidentally lost during lymphapheresis. All patients treated by lymphapheresis developed lymphopenia, and in 4 the percentage of circulating T cells fell disproportionately by 26–58%. Serum IgM declined by 30% in lymphocyte depleted patients. Despite these changes in measures of cellular and humoral immunity, the mechanism of action of lymphapheresis remains obscure. The magnitude of change in synovitis did not correlate with the absolute numbers of mononuclear cells removed nor with the percent reduction in circulating lymphocytes, T cells, or IgM.
Bone loss in adults receiving alternate day glucocorticoid therapy
Authors: Gluck Oscar S. , Murphy William A. , Hahn Theodore J. , Hahn Bevra
Published: February 2007

Bone mineral content was measured by photon absorption densitometry in 25 patients with rheumatic diseases receiving glucocorticoids on an alternate day treatment schedule, and in 25 age‐, sex‐, and race‐matched patients receiving daily steroid therapy. Mean values for cortical (diaphyseal) mass, trabecular (metaphyseal) mass, and the cortical/trabecular mass ratios were not different in the two groups. Steroid‐induced osteopenia, defined as an elevated ratio of cortical to trabecular mass, occurred in both therapeutic regimens (8 of 25 on alternate day; 11 of 25 on daily). Therefore, bone loss was demonstrable in individuals on alternate day regimens. Serum levels of calcium, ionized calcium, alkaline phosphatase, and parathyroid hormone were similar in the two groups.
Histone reactivity of drug‐induced antinuclear antibodies
Authors: Grossman Leonard , Barland Peter
Published: February 2007

Anti‐histone antibodies were measured in a group of patients with drug‐induced lupus erythematosus and in asymptomatic patients with drug‐induced antinuclear antibodies (DANA). Anti‐histone antibodies were found in the majority of drug‐induced lupus patients. DANA patients had lower titers of ANA and no detectable anti‐histone activity. Longitudinal studies of the drug‐induced lupus patients showed a gradual fall in the ANA and anti‐histone titers. Our data suggest that the immune response in the drug‐induced lupus patients is similar to but more intense than that seen in the DANA patients. Possible factors altering the immune response in these 2 groups are discussed.
Variability of plasma hydralazine concentrations in male hypertensive patients
Authors: Ludden T. M. , Mcnay J. L. , Shepherd A. M. M. , Lin M. S.
Published: February 2007

The efficacy and toxicity of hydralazine differ widely among individual patients, possibly because of different sensitivities to drug effect or as a reflection of pharmacokinetic differences. Therefore, the variability in plasma hydralazine concentrations after single intravenous and single and multiple oral doses was studied in 9 male hypertensive patients. After an intravenous dose of 0.3 mg/kg the area under the plasma concentration time curve (AUC) varied over less than a twofold range 17.5–29.4 μM‐minute. However, after a single oral dose, 1 mg/kg, and after at least the fifth dose of a regimen consisting of 1 mg/kg given every 12 hours, there were much wider variations in AUC values: 4.0–30.4 and 3.2–38.5 μM‐minute, respectively. Similar ranges in peak hydralazine concentration, Cp, were also noted, 0.12–1.31 μM after the single oral dose and 0.10–1.39 μM after the multiple dose regimen. A significant portion of the observed interpatient variability could be explained by differences in acetylation ability. The AUC and Cp values for both the single and multiple oral doses were significantly lower (P < 0.001) in rapid than in slow acetylators. Therefore, determining the acetylation ability of patients requiring hydralazine may help to optimize therapeutic benefit and minimize toxicity.
Therapeutic plasmapheresis in systemic lupus erythematosus. effect on immune complexes and antibodies to dna
Authors: Jones John Verrier , Robinson Michael F. , Parciany Rosanne K. , Layfer Lawrence F. , Mcleod Bruce
Published: February 2007

The effect of plasmapheresis in 8 patients with systemic lupus erythematosus (SLE) was investigated. Drug treatment was maintained at a constant level for at least 4 weeks before plasmapheresis. Levels of immune complexes were measured by a Raji cell radioimmunoassay, and by a solid‐phase Clq‐binding assay. Antibodies to ds‐DNA and ss‐DNA were measured by the Farr assay. In all cases, immune complexes and antibodies were lowered by plasmapheresis. In 5 patients, plasmapheresis was followed by a rapid rebound of complexes and antibody to pretreatment levels. In 3 in whom plasmapheresis was followed by treatment with cyclophosphamide for 1 month, a sustained immunochemical and clinical improvement followed, lasting in 2 cases for up to 3 years.
Dna in synovial fluid and the circulation of patients with arthritis
Authors: Leon Shalom A. , Revach Moshe , Ehrlich George E. , Adler Rachel , Petersen Virginia , Shapiro Bernard
Published: February 2007

DNA levels were measured in synovial fluids and sera of 106 patients with rheumatoid arthritis (RA), osteoarthritis (OA), gout, pseudogout, and post‐traumatic arthritis (TRA). In synovial fluids, the highest concentration was found in rheumatoid arthritis (mean ± SE 18 ± 3 μ/ml for seropositive and 9 ± 1 μ/ml for seronegative variants), gout and pseudogout (17 ± 3 μ/ml). In contrast, the levels in patients with OA or acute TRA were very low: 0.8 ± 0.1 μ/ml and 1.1 ± 0.2 μ/ml, respectively. The difference between the means of the first disease group and OA or TRA is statistically significant. A similar pattern was observed for DNA levels in the circulation: in rheumatoid arthritis, the mean concentration was 135 ± 28 ng/ml and 164 ± 39 ng/ml for seropositive and seronegative RA, respectively. Again the levels in OA and TRA were much lower, 52 ± 18 ng/ml and 0 ng/ml, respectively. The latter are not significantly different from the mean levels of 95 normal, healthy controls (14 ± 3 ng/ml), whereas the concentration of DNA in the serum of RA patients is significantly higher than in OA, TRA, or normal controls. Serial determinations of DNA and other criteria of disease activity (leukocytes and protein levels in synovial fluid, blood sedimentation rate) in individual patients revealed a strong correlation of elevated values with active episodes. The results suggest that these parameters reflect tissue damage.
Age influences the clinical and serologic expression of systemic lupus erythematosus
Authors: Wilso H. Alexander , Hamilton Maurice E. , Spyker Daniel A. , Brunner Carolyn M. , O'Brien William M. , Davis Iv John S. , , Winfield John B.
Published: February 2007

The clinical and serologic characteristics of 17 patients with onset of systemic lupus erythematosus (SLE) after age 50 were compared with those of 49 younger patients. All patients were followed prospectively for a mean duration of 47 months. A clinical and serologic data base was established for each patient, and information collected at each visit to a lupus clinic was analyzed by computer. The clinical features distinguishing old‐age SLE were a low incidence of significant renal disease and prominent pleuropericarditis and arthritis throughout the period of followup. Serologic abnormalities were milder in older patients. Thus, hypocomple‐mentemia, anti‐DNA antibodies, and Clq precipitins occurred less frequently, and rheumatoid factor was more often present than in younger patients with SLE. Regression analysis suggested linear change in disease expression with age rather than distinct age‐related subgroups.
Antibodies to sm in patients with systemic lupus erythematosus. correlation of sm antibody titers with disease activity and other laboratory parameters
Authors: Barada Franc A. , Andrews Brian S. , Davisiv John S. , Taylor Ronald P.
Published: February 2007

Thirty patients with systemic lupus erythematosus (SLE( were studied over a 2.5‐year period. The group was divided into 14 patients with antibodies to Sm and a control group which failed to exhibit antibodies to Sm over the study period. The titer of antibodies to Sm fluctuated in all 14. A rising titer of antibodies to Sm 1) predicted a flare of disease in 50% and 2) correlated with an exacerbation of disease in 60%. Patients with antibodies to Sm had a comparable incidence of severe disease, renal disease, and central nervous system disease. They exhibited significantly more leukopenia and antibodies to non‐Sm, non‐RNP extractable nuclear antigen. In only 1 patient, a rise in titer of antibodies to Sm did not correlate with or predict a disease flare in contradistinction to other serologic markers of SLE, specifically antibodies to double‐stranded DNA and cryoglobulins. Though infrequently detected, antibodies to Sm can help in the management of patients with SLE.
Release of Collagenase, Neutral Protease, and Prostaglandins From Cultured Mammalian Synovial Cells by Hydroxyapatite and Calcium Pyrophosphate Dihydrate Crystals
Authors: Cheung Herman S. , Halverson Paul B. , Mccarty Daniel J.
Published: February 2007

Hydroxyapatite (HA) and calcium pyrophosphate dihydrate (CPPD) crystals were phagocytosed when added to cultured human rheumatoid or normal canine synovial cells. Collagenase and neutral protease secretion into the culture medium was increased 5‐ to 8‐fold over control values in the presence of HA and increased 3‐fold in the presence of CPPD crystals. HA but not CPPD crystals induced a 300‐fold increase in human rheumatoid synovial cell culture fluid prostaglandin (PG) E2 levels and an 8‐fold increase in PGFα levels. This mechanism may be important in the pathogenesis of the destructive arthropathies associated with HA and CPPD crystals.
Central Nervous System Involvement in Childhood Systemic Lupus Erythematosus
Authors: Yancey Carolyn L. , Doughty Robert A. , Athreya Balu H.
Published: February 2007

The records of 37 patients with systemic lupus erythematosus (SLE) followed at The Children's Hospital of Philadelphia between 1968 and 1978 were reviewed for evidence of central nervous system (CNS) involvement. Criteria for CNS involvement included evidence of organic brain syndrome, electroencephalographic abnormalities with symptoms referable to CNS, or objective neurologic signs. Sixteen of 37 children had CNS involvement (43%). Thirteen patients had CNS involvement at the onset of SLE. Three patients had late onset CNS manifestations 1 to 2 years after the diagnosis of SLE. The most frequently observed symptoms were headache, behavior disorder, lethargy, diplopia, blurred vision, memory alteration, dizziness, and alteration of consciousness. The most frequently observed neurologic signs were seizures, cranial nerve palsy, ataxia, papilledema, nystagmus, meningitis, tremor, rigidity, cortical blindness, and coma. Neuropsychiatric manifestations included organic brain syndrome, functional psychosis, and personality disorder. Laboratory tests showed elevated cerebrospinal fluid opening pressure and protein, negative cultures, and abnormal electroencephalograms and computerized axial tomography scans. Fourteen of 16 children with CNS manifestations are alive. Thirteen had a mean IQ of 89 by the Wechsler Intelligence Tests. Twelve are in educational programs. One required long‐term psychiatric care. A residual neurologic abnormality, a seizure disorder, was present in 3. CNS involvement with SLE in children carries a favorable prognosis.
Giant Cell Arteritis (Temporal Arteritis) Presenting as Fever of Undetermined Origin
Authors: Calamia K. T. , Hunder G. G.
Published: February 2007

A retrospective study of the histories of 100 patients with biopsy‐proven giant cell arteritis was performed. Fifteen of these patients had “fever of unknown origin” as the initial manifestation of this disease. All 15 had normal leukocyte counts; however, they had significantly lower hemoglobulin and albumin levels (P > 0.01) and significantly higher platelet counts, erythrocyte sedimentation rates, and alkaline phosphatase values (P ∼ 0.05) compared to the other 85 patients. In 4 patients, random temporal artery biopsies were performed despite persistently negative results from diagnostic evaluations and in the absence of any symptoms or findings suggestive of arteritis.
HLA—Bw35 and Prognosis in Adult Still's Disease
Authors: Terkeltaub Robert , Esdaile John M. , Décary Francine , Harth Manfred , Lister John , Lapointe Normand
Published: February 2007

Twenty‐five patients with adult Still's disease were studied to determine clinical course and possible HLA associations. Two types of disease evolution were distinguishable clinically: a self‐limited remitting disease with or without recurrent cyclic exacerbations was found in 11 patients, and a persistent disease with continuous activity for more than 1 year, generally accompanied by progressive joint disease, was determined in 8. Disease course could not be classified in 6 patients. The antigen frequencies of HLA—Bw35 (40%, P < 0.05) and Cw4 (44%, P < 0.05) were increased in adult Still's disease as compared to controls (18% and 20%, respectively). Because HLA—Bw35 was associated with the self‐limited remitting type disease (P < 0.02), this antigen may be a favorable prognostic marker in adult Still's disease.
Schönlein‐henoch syndrome in patients with familial mediterranean fever
Authors: Flatau Edith , Kohn David , Schiller Dan , Lurie Miriam , Levy Emanuel
Published: February 2007

Ten episodes of Schönlein‐Henoch purpura (SHP) in 8 patients with familial Mediterranean fever (FMF) were observed. Five episodes developed 3–14 days after penicillin injections, suggesting an etiologic association. FMF and SHP have clear clinical similarities, and if the frequency of association of the 2 diseases is indeed high, perhaps a common etiologic factor should be sought. An immune complex mechanism might be the link between these 2 disease entities.
Clinical features of systemic lupus erythematosus
Authors: Ballou Stanley P. , Khan Muhammad A. , Kushner Irving
Published: February 2007

We compared the frequency of clinical features of systemic lupus erythematosus (SLE) and determined survival in 113 patients with younger‐onset lupus (age ⩾ < at clinical diagnosis) and 25 patients with older‐onset disease (age ⩾55 at diagnosis). The most striking difference was in the racial distribution; 59% of the younger patients were black, compared with only 20% of the older‐onset patients (P < 0.001). Major manifestations of lupus (including clinically evident renal disease, central nervous system involvement, cutaneous involvement, and hemocytopenia) occurred with similar frequency in both age groups. Antibodies to DNA were detectable equally often in both groups, but hypocomplementemia was more common in the younger patients. Five‐year survival in the younger‐onset group (79%) was similar to that of the older‐onset group (72%); there was a tendency toward relatively improved survival in patients in the latter group when compared with the expected survival of appropriately matched control populations. Major significant differences in racial distribution included 1) a higher incidence of serositis in older whites and in blacks regardless of age, and 2) more frequent hypocomplementemia in younger patients within both racial groups.
Articular cartilage atrophy in lower limb amputees
Authors: Benichou C. , Wirotius J. M.
Published: February 2007

A retrospective and radiologic survey of the hips of 53 above‐knee amputees showed that none of these hips was normal. Osteoporosis was present in all subjects, and cartilage thickness was reduced in 27 cases. This reduced thickness was inversely correlated with stump length, since it occurred in 11 of 13 upper‐third amputees, but in none of 10 lower‐third amputees. The mechanisms of cartilage atrophy are discussed.
Predictive value of radionuclide joint scintigrams
Authors: Shearman John , Esdaile John , Hawkins David , Rosenthall Leonard
Published: February 2007

Twenty‐two patients with normal or “noninflammatory” 99mtechnetium‐labeled polyphosphate (TPP) peripheral joint scintigrams taken between 1974 and 1976 were reevaluated clinically. Retrospective chart review revealed that all initially had persistent polyarthralgia of more than 3 months duration. At followup, a mean of 3.6 years later, none had evidence of inflammatory joint disease, although 1 patient had systemic lupus erythematosus and 2 had polymyalgia rheumatica. A noninflammatory joint scintigram as part of a thorough rheumatologic evaluation may be a useful procedure in excluding inflammatory joint disease in selected patients with chronic persistent polyarthralgia.
An evaluation strategy for rheumatology education
Authors: Meenan Robert F. , Goldenberg Don L. , Murrman Marita K. , Cohen Alan S.
Published: February 2007

The number of professional education programs in rheumatology is increasing at a rapid rate. All efforts to establish such programs should include a formal evaluation plan to assess their value. Clear definitions of program objectives and an understanding of the concepts of education program evaluation should be the basis of planning. We have developed an evaluation approach that focuses on education impact as the key measure of program benefits. Impact is measured in three critical areas: knowledge, clinical performance, and professional behavior. The tools used in this approach include two questionnaires and a trained patient. Educators may use these measures together to generate an overall estimate of education benefits, or they can use them separately to evaluate specific program objectives. This theory‐based strategy can serve as a general model for approaching the evaluation of professional education programs in rheumatology.
Clinical and pathogenetic implications of histopathology in childhood polydermatomyositis
Authors: Crowe William E. , Bove Kevin E. , Levinson Joseph E. , Hilton Pamela K.
Published: February 2007

Childhood dermatomyositis is a distinct subset of dermatomyositis with highly variable outcome. We reviewed our experience with 29 patients observed over a period of 22 years and attempted to correlate tissue manifestations with outcome. Distinctive vascular lesions included non‐necrotizing lymphocytic vasculitis and a unique spectrum of endovascular injury producing temporary or permanent occlusion of small arteries and capillaries. Vessels with noninflammatory endovasculopathy were often reactive with fluorescein‐conjugated antisera to IgM, C3d, and/or fibrin. Lesions linked to endovascular injury include infarction, zonal myopathy, and loss of capillary network. We were able to identify half of the children destined to have persistent morbidity on the basis of severity of vasculopathy in pretreatment muscle‐biopsy specimens. Our observations support a central role for endothelial cell injury in the pathogenesis of childhood dermatomyositis, suggest a basis for assessing the efficacy of therapy, and provide a focus for investigation of basic mechanisms.
Ankylosing spondylitis and motherhood
Authors: Østensen Monika , Romberg Øistein , Husby Gunnar
Published: February 2007

The influence of pregnancy on the course of ankylosing spondylitis (AS) was evaluated for 87 pregnancies of 50 patients. Remission of AS was recorded in 18 pregnancies, exacerbation in 21, and no change in 48. A short flareup of AS was noticed postpartum in 45% of the patients. Postpartum anterior uveitis occurred frequently (20%). The first symptoms of AS were often (20%) related to pregnancy. AS had no harmful effect on pregnancy, the fetus, or the newborn. Twelve percent of the offspring who were 18 years old or older have developed definite ankylosing spondylitis.
Fibroblast selection in scleroderma
Authors: Botstein Gary R. , Sherer Glenn K. , Carwile Leroy E.
Published: February 2007

Human preputial skin fibroblasts were cloned in vitro, and studies in 21 clones were shown to exhibit a 3‐fold difference in collagen synthesis; this heterogeneity of phenotypic expression was conserved over multiple population doublings. When the clones were exposed to sera from 10 scleroderma patients, selective growth of high‐collagen‐producing fibroblasts was observed. Prostaglandin E2 abrogated the selective effect of scleroderma serum on high‐collagen‐producing fibroblast clones. Besides enhanced collagen synthesis, these clones of normal fibroblasts shared an insensitivity to feeding schedule with fibroblasts from scleroderma skin. These data raise the possibility that scleroderma represents a process of selection of fibroblasts programmed to produce increased amounts of collagen.
Fibrositis and psychologic disturbance
Authors: Payne Timothy C. , Leavitt Frank , Garron David C. , Katz Robert S. , Golden Harvey E. , Glickman Paul B. , Vanderplate Cal
Published: February 2007

Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms.
Followup study on patients with reiter's disease and reactive arthritis, with special reference to HLA—B27
Authors: Leirisalo Marjatta , Skylv Grethe , Kousa Merja , Voipio‐Pulkki Liisa‐Maria , Suoranta Hannu , Nissilä Martti , Hvidman Lone , Nielsen Erik Damm , Svejgaard Arne , Tiilikainen Anja , Laitinen Ossi
Published: February 2007

An analysis of 160 patients with Reiter's disease, 144 with yersinia arthritis, and 9 with salmonella arthritis was performed. Complete or incomplete Reiter's syndrome was observed in one‐third of the patients with yersinia arthritis and in most of those with salmonella arthritis. During the followup period, chronic back pain and joint symptoms were frequent in all the patient groups. Patients who were HLA—B27 positive had a more severe acute disease (more frequent back pain, urologic symptoms, mucocutaneous manifestations, and a longer duration of the disease) and more frequent chronic back pain and sacroiliitis.