bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Salicylate and Indomethacin on Glycosaminoglycan and Prostaglandin E2 Synthesis in Intact Canine Knee Cartilage Ex Vivo
Authors: Palmoski Marshall J. , Brandt Kenneth D.
Published: February 2007

The effects of salicylate and indomethacin on glycosaminoglycan synthesis by intact articular cartilage were examined ex vivo. Distal femora of normal dogs were transected at the diaphysis and incubated in medium containing sodium salicylate or indomethacin and 35SO4. Uronic acid contents of habitually loaded and habitually unloaded regions of the condyles averaged 4.2% and 3.1% of the tissue dry weight, respectively. Salicylate had no effect on glycosaminoglycan synthesis in cartilage from loaded sites but suppressed synthesis by 18% (P < 0.01) in cartilage from unloaded sites, while indomethacin had no effect on glycosaminoglycan synthesis in either region. Evidence that the drugs indeed diffused into the cartilage, even when no effects on glycosaminoglycan metabolism were noted, was provided by measurements of prostaglandin E2. At the concentrations used, both indomethacin and salicylate markedly reduced prostaglandin E2 synthesis by the cartilage. In studies with 14C‐acetylsalicylic acid or 14C‐indomethacin, the concentration of each drug in cartilage was calculated to be about 3 logs lower than that in the culture medium. Furthermore, drug concentrations in cartilage from loaded zones were consistently lower than those in cartilage from unloaded sites.
Work Disability Before and After Total Hip Arthroplasty
Authors: Nevitt Michael C. , Epstein Wallace V. , Masem Mathias , Murray William R.
Published: February 2007

We evaluated the impact of total hip arthroplasty (THA) on work disability among working age persons. Just over one‐third of those totally work disabled prior to THA were working at 1 or at 4 years after surgery. A significant long‐term decrease in work disability after surgery was demonstrated by estimating disability prevented by THA, but the decrease was less than suggested by the literature. Preoperative work status and the number of painful joints were significant predictors of return to work.
Human IgG aggregates induce selective stimulation of IgM rheumatoid factor synthesis by rheumatoid blood mononuclear cells
Authors: Tao Xue Lian , Olsen Nancy , Ziff Morris , Jasin Hugo E.
Published: February 2007

Peripheral blood mononuclear cells (PBM) from patients with active rheumatoid arthritis (RA) contain precursor B lymphocytes specific for IgM rheumatoid factor (IgM‐RF) synthesis. In this study, human IgG aggregates (HaIgG) were used to stimulate monocytedepleted PBM from 46 patients with RA and 21 normal controls. The cells were incubated with HaIgG and pokeweed mitogen for 72 hours, washed, and then cultured in microwells for an additional 11 days. HaIgG induced an increase in IgM‐RF synthesis by RA cells with optimum response at 0.1 μg/ml (P<0.001). Total IgM synthesis remained unchanged. In contrast, HaIgG did not stimulate IgM‐RF production by normal cells. Specificity of the IgM‐RF response was shown by the concomitantly increased IgM‐RF/IgM ratios, while IgM anti‐trinitrophenyl antibodies did not increase. Aggregation of the IgG was required for it to be an effective stimulus. The findings suggest that circulating immune complexes in RA patients may provide the stimulus for sustained production of IgM‐RF in vivo.
A comparison of the sensitivity of the 1971 and 1982 american rheumatism association criteria for the classification of systemic lupus erythematosus
Authors: Levin Robert E. , Weinstein Arthur , Peterson Margaret , Testa Marcia A. , Rothfield Naomi F.
Published: February 2007

The sensitivity of the American Rheumatism Association's preliminary and revised criteria for the classification of systemic lupus erythematosus (SLE) was tested in 156 of our SLE patients. Eighty‐eight percent met the 1971 preliminary criteria. Eighty‐three percent fulfilled the 1982 revised criteria when arthritis was strictly defined (nonerosive arthritis) and 91% when arthritis was more liberally defined (nondeforming arthritis). Analysis revealed that of the 3 serologic tests added in the revised criteria (antinuclear antibody, anti‐Sm, anti‐DNA), the antinuclear antibody test accounted for the increased sensitivity of the revised criteria.
Lymphocytes in the skin of patients with progressive systemic sclerosis
Authors: Roumm Alan D. , Whiteside Theresa L. , Medsger Thomas A. , Rodnan Gerald P.
Published: February 2007

Mononuclear cells (MNC) present in the dermis of the forearm and in the blood of patients with progressive systemic sclerosis (PSS) were quantified and analyzed for subsets using monoclonal antibodies. The findings were correlated with cutaneous and systemic features of the disease. Total T lymphocytes and their subsets, B cells, and macrophages were enumerated in the skin samples of 21 patients with PSS. The dermal MNC infiltrates consisted mostly of activated T lymphocytes with a mean T helper/T suppressor (T4/T8) ratio of 2.4 ± 1.3 SD. Few B1‐positive or T6‐positive cells (macrophages) were observed. There was no correlation between the skin or blood T4/T8 ratios and the degree of skin thickening. On histologic examination, 58 of 115 (50%) untreated patients with PSS had prominent dermal MNC infiltration. Significant correlations between the degree of MNC infiltration and both the degree (P < 0.05) and progression (P < 0.05) of skin thickening were observed. No correlations with other systemic disease features of PSS were noted. These results suggest that cutaneous T lymphocytes may play a role in mediating dermal sclerosis in PSS.
Effects of static and cyclic compressive loading on articular cartilage plugs in vitro
Authors: Palmoski Marshall J. , Brandt Kenneth D.
Published: February 2007

The influence of static and intermittent stress on articular cartilage metabolism was examined in vitro. Full‐thickness plugs of cartilage from femoral condyles of normal adult dogs were cultured while static or cyclic stresses were applied for 2 hours. The plugs were then incubated under atmospheric pressure for 2 hours in medium containing radioactive label, to provide measurements of net synthesis of glycosaminoglycan (GAG) or protein. As a control, cartilage from the same knee was cultured in the apparatus at atmospheric pressure. When cartilage plugs were exposed to static stress, or to cyclic stresses at a duty cycle of 60 seconds on/60 seconds off, net GAG synthesis was suppressed to 30—60% of that in controls. In contrast, when a duty cycle of 4 seconds on/11 seconds off was used, GAG synthesis was increased by 34%. The duty cycle which increased GAG synthesis did not affect protein synthesis or tissue contents of DNA, uronic acid, or water. At the cycle which suppressed GAG synthesis, protein synthesis and uronic acid content were decreased, and water content was increased. As judged by uptake of 14C‐aminoisobutyric acid and 14C‐xylose, the above changes in GAG synthesis do not appear to have been due to changes in diffusion of nutrient molecules through the cartilage during loading.
Protective factors against oxygen free radicals and hydrogen peroxide in rheumatoid arthritis synovial fluid
Authors: Biemond Pieter , Swaak Antonius J. G. , Koster Johan F.
Published: February 2007

Oxygen free radicals are probably involved in the pathogenesis of rheumatoid arthritis (RA). The enzymes involved in protection against oxygen free radicals and H2O2 (superoxide dismutase, catalase, and glutathione peroxidase) were measured. Superoxide dismutase was not increased, glutathione peroxidase was slightly and catalase was strongly elevated in RA synovial fluid (SF) compared with control SF. Although these enzymes are present in SF, the activities are insufficient to protect against oxygen free radicals and H2O2. In contrast to transferrin, ferritin was increased in RA synovial fluid. Ceruloplasmin was also elevated. When rat liver microsomes were used as a target for oxygen free radicals, serum and SF were both protective. Gel filtration experiments showed that the fraction pattern in which there was maximal protective potential against lipid peroxidation corresponded closely to the level of ceruloplasmin. After removal of ceruloplasmin from serum or SF, about 70% of the protective capacity disappeared. It is concluded that ceruloplasmin is an important protector against oxygen free radicals.
Numa protein is a human autoantigen
Authors: Price Carolyn M. , Mccarty Gale A. , Pettijohn David E.
Published: February 2007

Routine examination of sera from patients with suspected or confirmed connective tissue disease has revealed the presence of autoantibodies directed against an unusual nuclear antigen. As characterized by immunofluorescence studies, the antigen is found exclusively in the nuclei of interphase cells, but appears to be part of the spindle pole in mitotic cells. Similar distributions in interphase and mitotic cells have been reported for the recently discovered nuclear mitotic apparatus (NuMA) protein. Using immunoblot analysis we have demonstrated that the autoantibodies that decorate the mitotic spindle poles are specific for the NuMA protein. Therefore, we conclude that the NuMA protein is a human autoantigen.
Articular mastocytosis in rheumatoid arthritis
Authors: Crisp Adrian J. , Chapman Clifford M. , Kirkham Sara E. , Schiller Alan L. , Krane Stephen M.
Published: February 2007

The number and distribution of mast cells were assessed in 116 synovial membranes from patients with rheumatoid arthritis and in 30 control specimens. Rheumatoid synovial membranes contained a mean of 48.5 mast cells per 20 high‐power fields (HPF) (range 0–252), and control synovial membranes had a mean of 3.9 mast cells per 20 HPF (range 0–13) (P < 0.001). In a comparison of high and low mast cell subgroups in rheumatoid arthritis, counts were directly related to the intensity of clinical synovitis in the affected joint, but not to hemoglobin concentration or erythrocyte sedimentation rate. Joints excised from 5 patients with rheumatoid arthritis were characterized by active bone remodeling with increased osteoid, active resorption by osteoclasts, and trabecular osteoporosis. Mast cells were prominent in both extraosseous pannus and intraosseous invasive tissue. The possible roles of mast cells in the pathogenesis of rheumatoid arthritis are discussed.
Laryngeal involvement in rheumatoid arthritis
Authors: Lawry George V. , Finerman Matthew L. , Hanafee William N. , Mancuso Anthony A. , Fan Peng Thim , Bluestone Rodney
Published: February 2007

Laryngeal involvement was evaluated in 45 patients with moderately severe rheumatoid arthritis (RA). RA duration and severity, prior laryngeal symptoms, and abnormalities detected by concurrent indirect laryngoscopy (IL) and computerized tomography (CT) were noted and correlated with changes of basilar interstitial fibrosis (BPF) found by chest radiograph. Thirty‐two percent had abnormalities detected by IL, 54% had abnormalities by CT, and 36% had BPF on chest radiographs. Comparison of these groups revealed: only two symptoms (sore throat and difficulty during inspiration) were predictive of abnormalities detected by IL; no symptoms predicted abnormalities on CT; IL and CT may show abnormalities in a large percentage of RA patients even in the absence of symptoms; IL tends to detect mucosal and gross functional abnormalities while CT detects structural lesions; BPF shown on chest radiographs in RA patients does not appear to be correlated with cricoarytenoid arthritis as defined by IL and CT.
Arthropathy of down's syndrome
Authors: Yancey Carolyn L. , Zmijewski Chester , Athreya Balu H. , Doughty Robert A.
Published: February 2007

Down's syndrome (trisomy 21) is associated with a variety of skeletal abnormalities and an increased incidence of joint hypermobility. Children with Down's syndrome are known to have a number of immunologic abnormalities and an increased incidence of autoimmune phenomena. We report 7 patients with Down's syndrome and arthritis. Four children had polyarticular disease and 3 had pauciarticular disease at onset. Only 1 child had significant cardiac disease. HLA typing in 5 children did not show specific correlations. Mean duration of followup was 3 years and 7 months. All children responded to nonsteroidal antiinflammatory drugs, but only 1 child is in clinical remission. Two children have died: 1 secondary to cervical spine instability and the other secondary to cardiac compromise. Arthropathy associated with Down's syndrome should be an additional exclusion for the diagnosis of juvenile rheumatoid arthritis. Further investigation of this association may give clues to the relationship between genetic and immunologic factors in the pathogenesis of joint inflammation.
Low incidence of calcium pyrophosphate dihydrate crystal deposition in rheumatoid arthritis, with modification of radiographic features in coexistent disease
Authors: Doherty Michael , Dieppe Paul , Watt Iain
Published: February 2007

A negative correlation between rheumatoid arthritis (RA) and calcium pyrophosphate dihydrate (CPPD) crystal deposition was demonstrated in separate controlled radiographic and synovial fluid surveys of RA patients aged 55–75 years. Knee chondrocalcinosis was detected in 14% of 135 normal controls and 28% of 87 post‐meniscectomy (“joint damage”) controls (P < 0.05), but only 3% of 100 RA patients (P < 0.01). Microscopic examination of fluids from symptomatic knees of an additional 100 RA and 75 osteoarthritis patients revealed CPPD crystals in 1% and 23%, respectively (P < 0.01). Ten subjects with coexistent RA and CPPD deposition were also studied; 7 showed radiographic features atypical of RA, including patchy, asymmetric disease, retained bone density, prominent osteophytosis, well‐corticated cysts, and paucity of progressive erosive disease. It is suggested that rheumatoid joint damage, unlike that in osteoarthritis, is not conducive to CPPD crystal formation. When RA and CPPD coexist, atypical radiographic features reflecting a hypertrophic reparative response may occur.
Psychological factors associated with primary fibromyalgia syndrome
Authors: Ahles Tim A. , Yunus Muhammad B. , Riley Sue D. , Bradley John M. , Masi Alfonse T.
Published: February 2007

Forty‐five ambulatory patients with primary fibromyalgia syndrome (PFS), 30 with rheumatoid arthritis, and 32 normal controls were administered 3 psychological tests: the Minnesota Multiphasic Personality Inventory (MMPI), the Life Events Inventory, and the Assertiveness‐Aggressiveness Inventory. The PFS patients scored significantly higher on 8 MMPI scales when compared with the normal control group and on 4 MMPI scales when compared with the rheumatoid arthritis group. Further subgrouping of PFS patients according to MMPI scores showed that only 31% were “psychologically disturbed,” 33% had a typical chronic pain profile, and 36% were within the normal range. The PFS patients scored higher than the rheumatoid arthritis and normal control groups on the Life Events Inventory but not the Assertiveness‐Aggressiveness Inventory.
Thalidomide a promising new treatment for rheumatoid arthritis
Authors: Gutiérrez‐Rodríguez Oscar
Published: February 2007

In an open study, oral administration of thalidomide to 7 female patients with classic or definite rheumatoid arthritis, in doses ranging from 6.9 to 15 mg/kg/day, led to clinical improvement within several weeks. In 4 women, remission lasted long after discontinuation of the drug. All patients showed normalization or marked reduction of the erythrocyte sedimentation rate, and several showed a significant decrease in rheumatoid factor titer. Adverse side effects included drowsiness, constipation, and edema of the lower limbs, which disappeared after discontinuation of the drug.
A critical review of compliance studies in rheumatoid arthritis
Authors: Belcon Michael C. , Brian Haynes R. , Tugwell Peter
Published: February 2007

Nineteen studies of treatment compliance in rheumatoid arthritis (RA) patients have been critically appraised to assess the magnitude and determinants of noncompliance in this population. Deficiencies in study methodology undermined the possibility of firm conclusions on the influence of various factors on compliance in RA populations. Nevertheless, it is apparent that noncompliance with treatments for RA is a major problem that hitherto has not been widely considered. Compliance with prescribed drug regimens varied from 16% to 84% among these studies. With physiotherapy regimens, compliance rates varied from 39% to 65%, while for splint‐usage, rates varied from 25% to 65%. No consistent correlation has been demonstrated between compliance and age, sex, treatment side effects, disease severity, or drug dose frequency. Gaps in our present day knowledge have been detailed and the need for further research is outlined.
Interstitial lung disease in scleroderma analysis by bronchoalveolar lavage
Authors: Silver Richard M. , Metcalf John F. , Stanley John H. , Carwile Leroy E.
Published: February 2007

Interstitial pulmonary fibrosis is a common feature of scleroderma (systemic sclerosis) which may result in impairment of pulmonary function and may be a major determinant of morbidity and mortality. Clinicopathologic observations suggest that interstitial and alveolar inflammation may appear prior to fibrosis. Using the bronchoalveolar lavage (BAL) technique, we have characterized the nature of the inflammatory process in the lower respiratory tracts of 19 nonsmoking scleroderma patients. Eleven of 19 patients (58%) had increased percentages of neutrophils and/or eosinophils in BAL fluid. Five of 10 patients (50%) had elevations of IgG in BAL fluid. The presence of neutrophils was associated with a decreased lung diffusing capacity for carbon monoxide (P < 0.05) and with more advanced radiographic features of interstitial fibrosis in patients with disease of more than 1 year's duration. This study suggests that scleroderma lung involvement may be characterized by an inflammatory alveolitis and that the presence of such inflammation may relate to the severity of the pulmonary disease.
The incidence of systemic lupus erythematosus in baltimore, maryland, 1970–1977
Authors: Hochberg Marc C.
Published: February 2007

The incidence of systemic lupus erythematosus, based on first hospital discharge diagnosis, in Baltimore, Maryland for the years 1970 through 1977 was determined for individual sex‐race groups and the total population. Age‐specific incidence rates were consistently highest among black females and lowest among white males: rates for white females exceeded those for black males through age 54, but then declined for ages ⩽55. Mean age at diagnosis was significantly lower for black females versus white females (35.5 versus 41.7 years, P = 0.005) and for all females versus all males (37.2 versus 44.2 years, P = 0.012). There were no temporal trends noted in yearly age‐adjusted incidence rates during the 8‐year study period. The overall population incidence of systemic lupus erythematosus was 4.6 per 100,000 per year, representing a twofold increase over a comparable study done in New York City 15 years ago.
Clinical characteristics of fibrositis. II. A “Blinded,” controlled study using standard psychological tests
Authors: Clark Sharon , Campbell Stephen M. , Forehand Mary E. , Tindall Elizabeth A. , Bennett Robert M.
Published: February 2007

Twenty‐two patients with fibrositis and 22 control patients selected from a general medical outpatient population were given 3 standardized psychological questionnaires: the Beck Depression Inventory, the Spielberger State and Trait Anxiety Inventory, and the SCL‐90‐R. There were no statistically significant differences between fibrositis patients and control patients on any of these tests, a finding at variance with a commonly held belief that patients with fibrositis have an underlying psychological disorder. While psychological factors may be important in some patients with fibrositis, these results indicate that the presence of a psychopathologic condition is not mandatory for the persistence of fibrositis.
Juvenile primary fibromyalgia syndrome. A clinical study of thirty‐three patients and matched normal controls
Authors: Yunus Muhammad B. , Masi Alfonse T.
Published: February 2007

Primary fibromyalgia syndrome (PFS) is a common and characteristic rheumatologic condition manifested by diffuse musculoskeletal aches, pains, and stiffness frequently modulated by various factors, e.g., weather, physical activity, sleep quality, and anxiety/ stress, and accompanied by discrete tender points at typical soft tissue sites. Although well‐recognized in adults, this entity has not been reported separately in juveniles. This study documents PFS in 33 juveniles who presented at age 17 or younger and compares their findings with those in age‐ and sex‐matched normal control subjects. As in adult PFS patients, associated non‐musculoskeletal symptoms were common, including fatigue, poor sleep, anxiety/stress, headaches, and paresthesias. Physical examination revealed multiple tender points at characteristic soft tissue sites and no objective evidence of arthritis. Routine laboratory test results were normal or negative. Juvenile PFS is often misdiagnosed. Recognition of this common rheumatologic condition in juveniles is important in order to avoid unwarranted investigations and improper management.
Immunogenetic studies of juvenile dermatomyositis. III. Study of antibody to organ‐specific and nuclear antigens
Authors: Pachman Lauren M. , Friedman Jan M. , Maryjowski‐Sweeney Mona L. , Jonnason Olga , Radvany Ruta M. , Sharp Gordon C. , Cobb Mike A. , Battles Norma D. , Crowe William E. , Fink Chester W. , Hanson Virgil , Levinson Joseph E. , Spencer Charles H. , Sullivan Donita B.
Published: February 2007

Ninety children with definite juvenile dermatomyositis (JDMS), who had been HLA typed, were tested for the presence of tissue or organ‐specific antibodies. Sixty had active disease at the time of study. The mean disease duration was 4 years, and 30 had soft tissue calcifications. The following autoantibodies were sought: thyroid, gastric parietal cells, smooth muscle, striated muscle, microsomes, mitochondria, DNA, extractable nuclear antigen, Sm, PM‐1, antinuclear antibody (ANA), and rheumatoid factor. Only the ANA and PM‐1 were more frequent in patients than in controls (P < 0.0002 and P < 0.001, respectively). Higher levels of immune complexes (P < 0.01) were found in sera from patients with JDMS than in sera from controls and were correlated with the presence of ANA in patients (P < 0.01). Soft tissue calcification was not associated with any autoantibody or HLA antigen, but with disease duration and activity (P < 0.001 and P < 0.05, respectively). There was no association between the occurrence of any autoantibody and the presence of HLA‐B8 or DR3 among the white patients with JDMS. The frequency of autoantibodies in 43 full siblings of children with JDMS was not increased. We conclude that children with JDMS, with or without HLA‐B8/DR3, do not show evidence of a generalized nonspecific antibody response to tissue antigens. The significance of the increased antibody to nuclear antigens ANA and PM‐1 remains to be determined.
The diagnostic value of antihistone antibodies in drug‐induced lupus erythematosus
Authors: Epstein Alan , Barland Peter
Published: February 2007

This study was undertaken to see whether the presence of antihistone antibodies, measured by indirect immunofluorescence assay, could distinguish between patients who were symptomatic from a drug‐induced lupus‐like illness (DILE) and asymptomatic patients who had drug‐induced antinuclear antibodies (DANA). In this study, 82% of the patients with DILE had antihistone antibodies detectable in their sera, compared with 32% of the patients in the DANA group (P < 0.01). When the patients taking procainamide were analyzed separately, it was found that 92% of the patients with DILE had demonstrable antihistone antibodies, contrasted with 33% of the patients in the DANA group (P < 0.01). In those patients with antihistone antibodies (DILE versus DANA patients), there were no differences in the mean antibody titers. We conclude that the presence of antihistone antibodies is strong, statistically significant evidence that the symptoms of a given patient are due to drug‐induced lupus erythematosus.
Soluble mediators from mononuclear cells increase the synthesis of glycosaminoglycan by dermal fibroblast cultures derived from normal subjects and progressive systemic sclerosis patients
Authors: Whiteside Theresa L. , Worrall Jennifer G. , Prince Robert K. , Buckingham Robert B. , Rodnan Gerald P.
Published: February 2007

Dermal fibroblast cultures from patients with progressive systemic sclerosis (PSS) synthesize up to 5 times more glycosaminoglycan (GAG) than normal cultures. In an in vitro model of fibroblast‐lymphocyte interactions, we show that the supernatants of activated mononuclear cells (MNC) modulate GAG synthesis, as measured by the incorporation of 3H‐glucosamine into GAG following incubation of the confluent fibroblast monolayers with active supernatant preparations. GAG accumulation was selectively increased up to 18 times in normal dermal fibroblast cultures. Cell viability was not affected, and 3H‐thymidine uptake and cell numbers were depressed in cultures treated with the supernatants. In contrast to normal dermal fibroblast cultures, PSS fibroblasts responded to MNC supernatants by only a 1–2‐fold increase in GAG. Supernatants of concanavalin A‐activated PSS MNC had higher stimulatory activity than those of normal MNC. Supernatants made with MNC that had been depleted of monocytes on Sephadex G‐10 columns were only minimally stimulatory. The GAG‐stimulatory supernatants modulated the synthesis, but not the degradation of GAG. Gel filtration on a calibrated Sephadex G‐100 column indicated the presence of stimulatory activity in both the 50,000 and 15,000 molecular weight fractions. These activities were trypsin‐sensitive, but had different susceptibilities to heat. The active column fractions also contained interleukin‐1 activity, as shown in an assay measuring proliferation of mouse thymocytes. Like our factors, interleukin‐1 preparations increased GAG in normal and PSS dermal fibroblasts. Products of activated MNC may modulate normal and pathologic processes in human skin.
Prognostic factors in polymyositis/dermatomyositis. A computer‐assisted analysis of ninety‐two cases
Authors: Benbassat Jochanan , Gefel Dov , Larholt Keren , Sukenik Shaul , Morgenstern Vladimir , Zlotnick Avinoam
Published: February 2007

An effort was made to identify all patients with polymyositis/dermatomyositis (PM/DM) admitted to hospitals in Israel from 1956–1976. The diagnosis of PM/DM was retrospectively reviewed in 92 (46 definite, 26 probable, and 20 possible) cases. The most common complaints and physical findings in the course of the disease were muscle weakness (86 patients), rash (53 patients), arthritis or arthralgia (39 patients), and dysphagia (35 patients). Elevated serum aldolase levels were found in 64% of the patients for whom data were available; 92% had abnormal electromyogram results, and 60.9% had muscle histopathology consistent with PM/DM. Malignancy was diagnosed in 13 patients. Malignancy, ischemic heart disease, and pulmonary complications were the most common causes of death. The actuarial survival curve was heterogeneous, with an accelerated mortality during the first year after diagnosis and a slower mortality during the following 7 years. Independent unfavorable prognostic signs were: failure to induce remission, leukocytosis, fever, older age, a shorter disease history, and dysphagia.
Subset specificity of antilymphocyte antibodies in systemic lupus erythematosus. Preferential reactivity with cells bearing the T4 and autologous erythrocyte receptor phenotypes
Authors: Yamada Akira , Cohen Philip L. , Winfield John B.
Published: February 2007

The relative specificity of systemic lupus erythematosus antilymphocyte antibodies for T cell subsets bearing the OKT4, OKT8, or autologous erythrocyte rosette (A‐RFC) markers was examined in complement‐dependent microcytotoxicity assays and by indirect immunofluorescence. Target cells included normal OKT4 + or OKT8 + T cell clones established from mitogen‐activated blasts, resting or phytohemagglutinin‐activated peripheral T cells highly enriched for OKT4 + cells or OKT8 + cells, and A‐RFC + and A‐RFC– populations. In the majority of sera, cytotoxicity for T4 + cells was greater than that for T8 + cells regardless of cellular activation status. Overall cytotoxicity was considerably higher for activated cells, however, especially when warm assay temperatures were used. A‐RFC + targets were more reactive than nonrosetting T cells, and this was associated with strikingly higher relative fluorescence intensity of IgM staining. Despite these consistent differences in relative cytotoxicity or staining, antibody titers against all cell types were strongly correlated in individual sera. Absorption experiments failed to demonstrate distinct antibody specificities for T4 + and A−RFC + cells. These data suggest that the major determinant of cytotoxic reactivity may be a single or limited number of surface antigens common to all T cells. Superimposed on this dominant system(s) is a special reactivity with certain distinct subsets and with activated T cells generally.
Neonatal lupus erythematosus occurring in one fraternal twin. Serologic and immunogenetic studies
Authors: Callen Jeffrey P. , Fowler Joseph F. , Kulick Kevin B. , Stelzer Gregory , Smith Stephen Z.
Published: February 2007

Neonatal lupus erythematosus (LE) is a syndrome that is manifested by LE skin lesions and/or congenital heart block, occurring in infants at, or shortly after, birth. The syndrome is believed to be caused by transplacental passage of an IgG antibody, usually the anti‐Ro (SS‐A) antibody, from the mother to the infant. Although the mother may have a connective tissue disease or may be healthy, the common characteristic is the presence of maternal circulating anti‐Ro antibody. It has been believed that the HLA determinants demonstrated in children who have neonatal LE were not a factor in the expression of the syndrome. We report the occurrence of neonatal LE, manifested by photosensitivity and discoid LE skin lesions, in one fraternal twin. HLA studies of this affected twin demonstrated the presence of DR3. Anti‐Ro antibody was present in the mother, but was not present in either child at 4 months post‐delivery. HLA determinants may be involved in the expression of disease in neonates who have been exposed to the anti‐Ro antibody. Furthermore, the presence of circulating antibodies in the unaffected twin causes us to question the assumption that the anti‐Ro antibody is the causative factor for the occurrence of tissue injury in children with neonatal LE.
Double‐blind, multicenter controlled trial comparing topical dimethyl sulfoxide and normal saline for treatment of hand ulcers in patients with systemic sclerosis
Authors: Williams H. James , Furst Daniel E. , Dahl Stephen L. , Steen Virginia D. , Marks Carolly , Alpert Elaine J. , Henderson Avery M. , Samuelson Cecil O. , Dreyfus James N. , Weinstein Arthur , Maclaughlin Edmund J. , Alarcón Graciela S. , Kaplan Stanley B. , Guttadauria Maria , Luggen Michael E. , Reading James C. , Egger Marlene J. , Ward John R.
Published: February 2007

A prospective, randomized, double‐blind trial compared topical therapy with 0.85% normal saline, 2% dimethyl sulfoxide (DMSO), and 70% DMSO for treatment of digital ulcers in 84 patients with systemic sclerosis. There were no statistically significant differences among the 3 treatment groups in the improvement in the total number of open ulcers, total surface area of open ulcers, average surface area per open ulcer, number of infected ulcers, number of inflamed ulcers, or patient pain assessment. While some patients improved during the study, improvement could not be attributed to a specific treatment. Over one‐quarter of the patients treated with 70% DMSO were withdrawn for significant skin toxicity.
Evaluation of factors associated with glucocorticoid‐induced osteopenia in patients with rheumatic diseases
Authors: Dykman Thomas R. , Gluck Oscar S. , Murphy William A. , Hahn Theodore J. , Hahn Bevra H.
Published: February 2007

In 161 ambulatory rheumatic disease patients receiving long‐term prednisone therapy, diaphyseal mass (DM) and metaphyseal mass (MM) of the forearm were measured by single photon absorptiometry, and bone radiographs were reviewed when available. Multivariate analysis of treatment and patient characteristics demonstrated that glucocorticoid‐induced osteopenia (defined as an elevated DM:MM ratio) and bone fractures occurred with similar frequency in patients of each sex, in whites and blacks, in patients with various rheumatic diseases, and in patients receiving different regimens of prednisone therapy. However, large cumulative doses of prednisone were associated with elevated DM:MM ratios as well as with bone fractures, and menopause or age ⩾ 50 years (males or females) was associated with bone fractures. We conclude that longterm therapy with various prednisone regimens results in glucocorticoid‐induced osteopenia and fractures. This affect is cumulative, occurs in all patient groups, and results in more bone fractures in certain groups.
Evaluation of d‐penicillamine in juvenile chronic arthritis. A double‐blind, multicenter study
Authors: Prieur A. M. , Piussan C. , Manigne P. , Bordigoni P. , Griscelli C.
Published: February 2007

Seventy‐four children with juvenile chronic arthritis were entered into a 6‐month, multicenter, comparative double‐blind study of the efficacy of D‐penicillamine versus placebo. The results were evaluated in 70 patients, 55 of whom completed 6 months of the study. Improvement was observed in the total number of stiff joints, total number of painful joints, and total severity index measuring joint pain. There was also a significant reduction in the concurrent use of nonsteroidal antiinflammatory drugs. D‐penicillamine was well‐tolerated in all but 2 patients. Some children in the placebo group exhibited definite improvement; however, relapses that were observed were mainly in that group. These results confirm the efficacy of D‐pencillamine for the treatment of joint involvement in juvenile chronic arthritis.
Intraarticular volume and clearance in human synovial effusions
Authors: Wallis Wayne J. , Simkin Peter A. , Nelp Wil B. , Foster David M.
Published: February 2007

Intraarticular volumes were measured by radiolabeled albumin (RISA) distribution in chronic knee effusions from 11 rheumatoid arthritis patients and 9 osteoarthritis patients. Volumes of synovial fluid obtained at joint aspiration were substantially less than those found by RISA dilution. Up to 24 hours was needed for full distribution of RISA throughout the intraarticular compartment. Measured 123I and RISA radioactivity over the knee described monoexponential rate constants, λ (minute−1). The clearance of 123I and RISA from synovial effusions was derived by the formulation volume (ml) × λ (minute−1) = clearance (ml/minute). RISA clearance in rheumatoid effusions was significantly greater than that found in osteoarthritis effusions. Intraarticular volume and isotope clearance were easily quantified and provide measures for further evaluating the microvascular physiology of synovial effusions.
Rheumatology training at internal medicine and family practice residency programs
Authors: Goldenberg Don L. , Dehoratius Raphael J. , Kaplan Stephen R. , Mason John , Meenan Robert , Perlman Susan G. , Winfield John B.
Published: February 2007

The Medical Research Education Subcommittee of the American Rheumatism Association surveyed a random selection of large and small programs in internal medicine and family practice residency programs in order to evaluate their rheumatology training. Formal rheumatology training is offered in 90% of these residency programs, but many available positions are not being filled. A full‐time staff rheumatologist was present at 69% of large internal medicine programs, 32% of small internal medicine programs, and 11% of family practice programs. The methods of rheumatology training are similar in most programs, although small internal medicine programs and family practice programs more often utilize physicians' offices or outside medical centers for the rheumatology elective training. A majority of the directors of these residency programs thought that many basic skills and techniques were not taught adequately and that the training of their rheumatology residents was not equal to that of residents in cardiology or gastroenterology.
When does rheumatoid disease start?
Authors: Aho K. , Palosuo T. , Raunio V. , Puska P. , Aromaa A. , Salonen J. T.
Published: February 2007

Stored serum specimens collected in connection with a community‐oriented epidemiologic study were available from 30 subjects who later developed seropositive rheumatoid arthritis. In 9 of these pre‐rheumatoid specimens, the Rose‐Waaler test result was positive, and in 16, the latex fixation test was positive. Two‐thirds of the samples were positive when the interval between taking the blood specimen and onset of the disease was <4 years, and one‐third were positive when the interval was ≧4 years. The occurrence of rheumatoid factor preceded the onset of clinical disease more often in males than in females.
Synovial fluid crystals in osteoarthritis
Authors: Gibilisco Paul A. , Schumacher H. Ralph , Hollander Joseph L. , Soper Keith A.
Published: February 2007

Apatite crystals, calcium pyrophosphate dihydrate crystals, or both were observed in knee joint effusions from 60% of 100 consecutive osteoarthritis (OA) patients. Crystals were more common in patients with more severe OA and in joints that had received previous intraarticular steroid injections. Whether the latter was predominantly related to an effect of the steroid or to the fact that steroids were used in more severe cases was not clear. Crystals existed in many effusions without elevated synovial fluid leukocyte counts. A subgroup of 7 patients had both types of crystals, more crystal phagocytosis, and more severe OA.
A comparison of the specificity of the 1971 and 1982 American Rheumatism Association criteria for the classification of systemic lupus erythematosus
Authors: Passas Contance M. , Wong Robert L. , Peterson Margaret , Testa Marcia A. , Rothfield Naomi F.
Published: February 2007

The specificity of the preliminary and the revised American Rheumatism Association criteria for the classification of systemic lupus erythematosus (SLE) was tested in 207 of our patients with other rheumatic diseases which were considered to be important in the differential diagnosis of SLE. Using the preliminary criteria, the data revealed that 5 patients were falsely classified as having SLE (2 with scleroderma, 2 with Raynaud's disease, and 1 with systemic necrotizing vasculitis), whereas using the revised criteria, only 2 patients (1 with scleroderma and 1 with systemic necrotizing vasculitis) were falsely classified. The calculated specificity was 99% for the revised criteria and 98% for the preliminary criteria. Thus, the data revealed that the specificity of the revised criteria is high and comparable with that of the preliminary criteria when applied to a group of patients with related rheumatic diseases.
Sex ratio and sibship size in juvenile rheumatoid arthritis kindreds
Authors: Aaron Stephen , Fraser Patricia A. , Jackson Jean M. , Larson Martin , Glass David N.
Published: February 2007

In a study of sibship size and sex ratio in juvenile rheumatoid arthritis, the anticipated sex ratios, including a marked female predominance in early onset pauciarticular disease and in polyarticular disease, were found. The size of the sibship showed a progressive increase with increasing age of the proband at onset of disease. In addition, the sex ratios of the sibs deviated from expected, among families where the proband's disease was characterized as either early onset pauciarticular or polyarticular in its presentation.
Antineuronal antibodies in neuropsychiatric systemic lupus erythematosus
Authors: How Angela , Dent Peter B. , Liao Shuen‐Kuei , Denburg Judah A.
Published: February 2007

The diagnosis of neuropsychiatric systemic lupus erythematosus (NP‐SLE) is clinical and one of exclusion. Brain cross‐reactive lymphocytotoxins or neuronal antibodies have been proposed as a mechanism underlying NP‐SLE. We assessed the clinical relevance of neuronal cell binding antibodies using a standardized clinical definition of NP‐SLE. Serum from 54 SLE patients and 77 controls were tested for binding to 3 neuroblastoma and 3 glioblastoma cell lines. Thirty‐three SLE patients (61%) fulfilled clinical criteria for the diagnosis of NP‐SLE; of these, 55% had serum binding activity to both neuroblastoma and glioblastoma cell lines, compared with 33% of the other SLE patients. When reactivity to neuroblastoma cell lines only was assessed, 43% of NP‐SLE patient sera demonstrated binding activity, versus 14% of sera from the remaining SLE patients. Control subjects' reactivity to neuroblastoma cell lines was positive in 12% of sera. Analysis of serum reactivity using non‐neuronal cell lines revealed that neuroblastoma, but not glioblastoma, cell binding was specific. NP‐SLE patients with evidence of diffuse symptomatology had a higher mean titer of neuroblastoma cell line binding than those with focal symptomatology. Using a panel of substrates, one can identify a significant proportion of patients who are independently defined as having NP‐SLE, who demonstrate specific serum neuronal antibodies.
Phosphorylation of proteoglycans. Identification of phosphorylation sites in chondroitin sulfate‐rich region of core protein
Authors: Anderson Roger S. , Schwartz Edith R.
Published: February 2007

Serine residues, which are the sites of phosphorylation in proteoglycans, were demonstrated to be located on chondroitin sulfate–containing peptides. These peptides appeared to be derived primarily from the chondroitin sulfate–rich region of the proteoglycan core protein. The localization of phosphate moieties in the chondroitin sulfate–containing peptides was observed in all experiments. The phosphate moieties were retained on chondroitin sulfate–containing peptides after the protein core was treated with either papain or trypsin. Two phosphopeptide preparations, derived from chondroitin sulfate–containing peptides of proteoglycan subunits, were extensively purified. These 2 phosphopeptide preparations were shown by carbohydrate analysis to be free of keratan sulfate–containing peptides or peptides from the hyaluronic acid binding region of the core protein. One of the phosphopeptide preparations had a phosphate: serine molar ratio of 0.40. This indicated that nearly one‐half of the serine residues were phosphorylated rather than glycosylated. Peptides derived from the core protein that contained keratan sulfate had no phosphate moieties.
Anticytoskeletal autoantibodies in the connective tissue diseases
Authors: Senécal Jean‐Luc , Oliver Janet M. , Rothfield Naomi
Published: February 2007

The sera of 103 patients with connective tissue diseases were studied for the presence of anticytoskeletal antibodies by using an indirect immunofluorescence method. PTK2 cells fixed with paraformaldehyde and digitonin were used as substrate. Antibodies to intermediate filaments were detected in sera of 85.7% of polymyositis/dermatomyositis (PM/DM), 62.8% of systemic sclerosis, 54.5% of rheumatoid arthritis, and 37.5% of systemic lupus erythematosus patients, and in 42.5% of normal sera. High titers of these antibodies, which were IgM, were present in 30% of patients' and 5% of normal sera. Antibodies to microfilaments were present in 11.6% of patients' sera and absent in all control sera. These antibodies were IgM or IgG. The switch from an IgM to an IgG antibody was observed in 1 patient. An IgG antibody to the spindle poles and midbody of mitotic cells was present in the serum of 1 patient with the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias). Antibodies to intermediate filaments and to microfilaments occur commonly in the connective tissue diseases, particularly in PM/DM, and are not detected with substrates or fixation methods used in routine antinuclear antibody testing.
The leukergy test in rheumatic diseases. New implications for an old test
Authors: Berliner Shlomo , Abramovitz Moshe , Kariv Naam , Weinberger Abraham , Yaron Michael , Lavie Gad , Pinkhas Jacob , Aronson Moshe
Published: February 2007

In order to assess the value of the leukergy test in which leukocytes aggregate in citrated whole blood, we examined 65 patients with various rheumatic conditions. In addition, plasma samples from 40 patients were examined for neutrophil aggregation activity in vitro. Results of the leukergy test were found to be in very good correlation with disease activity (P = 0.0001), whereas no increased neutrophil aggregation activity was found in the 40 plasma samples examined. The value of the leukergy test in assessing patients with rheumatic disease and its theoretical etiopathogenic role in these diseases are discussed.
Intraarticular variation in synovitis. Local macroscopic and microscopic signs of inflammatory activity are significantly correlated
Authors: Lindblad Staffan , Hedfors Eva
Published: February 2007

Multiple biopsy specimens from various parts of the synovial membrane were sampled under direct vision during arthroscopic surveying of the inflamed knee joints of 12 patients with various arthritides. Considerable variation in the macroscopic signs of inflammatory activity was found within the single joint. However, there was a highly significant correlation (P < 0.001) between local macroscopic signs of inflammatory activity and microscopic signs (by immunohistochemical analysis of the corresponding tissue sample). The profound intraarticular variation in inflammatory activity was seen irrespective of clinical diagnosis. An immunohistologic pattern comprising foci of T helper cells, associated immunoglobulin‐bearing cells, and HLA‐DR‐expressing dendritic cells was not specific for rheumatoid arthritis or any other diagnosis, but was found in the biopsy samples from sites that macroscopically demonstrated maximal inflammatory activity.
Rheumatic fever‐associated B cell alloantigens as identified by monoclonal antibodies
Authors: Zabriskie J. B. , Lavenchy D. , Williams R. C. , Fu S. M. , Yeadon C. A. , Fotino M. , Braun D. G.
Published: February 2007

Mice immunized with B lymphocytes obtained from patients who had had well‐documented rheumatic fever in the past yielded 2 monoclonal antibodies, termed 83S19.23 and 256S10, which identified certain alloantigens present on the B cells of these patients. The frequency of the B cell marker detected by clone 83S19.23 in rheumatic fever patients was found to be 59%, 77%, and 74% in India, New Mexico, and New York, respectively. Monoclonal antibody 256S10 identified 75% of those rheumatic fever patients who were nonreactive to clone 83S19.23. Thus, the 2 antibodies identify approximately 92% of all rheumatic fever patients and suggest the presence of a diallelic genetic marker for susceptibility to rheumatic fever.