bluuebunny/crossref_metadata_2025 huggingface dataset:
Reankylosis of the hip joint in ankylosing spondylitis after total hip replacement
Authors: Wilde Alan H. , Collins H. Royer , Mackenzie Allen H.
Published: February 2007

A case of osseous reankylosis occurred after total replacement of one hip in a patient having ankylosing spondylitis. Not only did the ankylotic disease involve the vertebral column, but the severity of this process had been manifest through osseous ankylosis of bilateral cup arthroplasties. We believe this to be the first report of reankylosis involving total hip replacement.
Possible adverse effect of phenoxybenzamine therapy in a patient with progressive systemic sclerosis
Authors: Parker Lewis P. , Hahn Bevra H. , Osterland C. Kirk
Published: February 2007

A 52‐year‐old male was observed with the recent development of progressive systemic sclerosis (PSS). The most prominent symptoms of the PSS were circulatory, with pain in the digits, severe Raynaud's phenomenon and associated atrophic changes and ulcerations of the fingertips. Therapy with phenoxybenzamine was instituted in an attempt to improve digital blood flow. Rapid development of dry gangrene of several digits was observed over the following month. A possible association between phenoxybenzamine therapy and decreased digital circulation is discussed.
Takayasu's arteritis: Frequency of systemic manifestations (study of 22 patients) and favorable response to maintenance steroid therapy with adrenocorticosteroids (12 patients)
Authors: Fraga Antonio , Mintz Gregorio , Valle Lorenzo , Flores‐Izquierdo Gilberto
Published: February 2007

Of 22 patients with Takayasu's arteritis, systemic manifestations, such as headache, tiredness, parasthesia and dizziness, were as prevalent as those due to localized arterial insufficiency. General symptoms disappeared rapidly in 20 patients treated with prednisone, and in 7 instances, peripheral pulses reappeared after an average of 24.5 months. On an average maintenance dose of 7.5 mg/day of prednisone, there were no deaths nor evidence of vascular deterioration in these patients. The encouraging result is in sharp contrast to previous reports in the literature. It appears that maintenance steroid therapy lengthens the life‐span of these patients by causing remission of both systemic manifestations and those due to arterial insufficiency. The sedimentation rate is an excellent index both to disease activity and to a favorable response to adrenocorticosteroid therapy.
The arthritis of leukemia
Authors: Spilberg Isaias , Meyer Gerd J.
Published: February 2007

Arthritis related to the primary disease was detected in 10 of 74 (13.5%) patients seen primarily for leukemia [2 of 12 patients with acute (16.6%) and 8 of 62 (12.4%) with chronic leukemia]. To these were added 18 additional patients previously diagnosed of having arthritis of leukemia. Clinical analyses of 28 patients with arthritis of leukemia showed that the arthritis of acute leukemia was commonly asymmetric, additive, polyarticular and often part of the initial manifestation of the disease. The arthritis of chronic leukemia was similar to the acute but was often symmetric and usually appeared as a late manifestation. X‐ray films of affected joints were abnormal in 7 patients. Mild hyperuricemia was found in 15.8%, rheumatoid factor in none and antinuclear antibodies in 11% of patients with arthritis of leukemia. Leukemic infiltration of the synovial membrane was found in all 3 of the patients who underwent synovial biopsy and is believed to be the cause of the arthritis.
Epstein‐barr virus antibody levels in systemic lupus erythematosus
Authors: Phillips Paul E , Hirshaut Yashar
Published: February 2007

Mean Epstein‐Barr virus antibody was not significantly elevated in sera from 50 patients with systemic lupus erythematosus compared to 50 age‐ and sex‐matched blood donor controls. As shown previously for measles and parainfluenza type 1 antibodies, there was a significant direct correlation between Epstein‐Barr virus antibody and IgG levels. The variable elevations of virus antibodies found so far in systemic lupus erythematosus probably result from hyperactivity of the humoral immune system.
Degradation of proteoglycans in human osteoarthritic cartilage
Authors: Altman Roy D , Pita Julio C , Howell David S
Published: February 2007

New ultramicro modifications of a hypertonic salt extraction and purification schemes for proteoglycans were applied to the study of proteoglycans in discolored marginal lesions cartilage of patients with osteoarthritis, and the results were compared to a control group of normal appearing cartilage samples from the same patients or from patients with relatively noninflammatory diseases involving the lower extremities. Histologic studies of portions of the same sample used for chemical analysis revealed only minor morphologic changes without leukocytic infiltration. Considerable aberrations from control bovine nasal cartilages were exhibited by normal human articular cartilage samples in respect to the proteoglycan fractionation. Additional abberations of behavior in respect to proteoglycan fractionation were observed in samples of osteoarthritic cartilage and samples from patients with vascular necrosis. Accelerated degradation of proteoglycans with probable alteration of synthetic pathways was postulated to explain these findings.
A millipore filter assay for antibodies to native dna in sera of patients with systemic lupus erythematosus
Authors: Ginsberg Barry , Keiser Harold
Published: February 2007

Serum levels of antibody to native DNA (nDNA) in patients with systemic lupus erythematosus (SLE) correlate with disease activity. We describe a sensitive, simple and rapid assay for these antibodies based on the observation that 3H‐labeled nDNA passes through Millipore filters while 3H‐nDNA complexed with specific antibody is retained. The simplicity and rapidity of this assay should allow general utilization of serum anti‐nDNA antibody determinations for monitoring disease activity in patients with SLE.
Synovial Iron Deposition in Rheumatoid Arthritis
Authors: Bennett Robert M. , Williams E. D. , Lewis S. M. , Holt P. J. L.
Published: February 2007

An isotope ferrokinetic study has been used to study the rate of iron deposition in 13 rheumatoid knees. Iron accumulation occurred only after incorporation of labelled iron into circulating erythrocytes, suggesting that intermittent intraarticular hemorrhages were the source of the deposits. The mean iron accumulation was 1.25 mg/knee/day representing a mean intraarticular blood loss of 3.58 ml. There was no correlation between the degree of iron deposition and the hemoglobin, platelet count or serum iron.
Polyarthritis and Subcutaneous Nodules Associated with Carcinoma of the Pancreas
Authors: Virshup Arthur M. , Sliwinski Anthony J.
Published: February 2007

A 52‐year‐old male developed subcutaneous nodules and polyarthritis in association with an acinar cell carcinoma of the pancreas. The arthritis did not respond to aspirin, phenylbutazone, indomethacin or corticosteroid therapy. Typical changes of pancreatic enzyme‐induced injuries in the subcutaneous nodules and around the joints were found at autopsy.
The Past Four Decades of Progress in the Knowledge of Gout, With an Assessment of the Present Status
Authors: Gutman Alexander B.
Published: February 2007

Advances in management of acute gouty arthritis, tophaceous gout and uric acid nephrolithiasis are briefly reviewed. With respect to pathogenesis, specific enzyme abnormalities have been demonstrated in rare monogenic cases but the presumptive polygenic and multifactorial pathogenesis in most cases of primary gout remains uncertain. The hypothesis favored here is that, possibly secondary to altered glutamate catabolism, glutamine apparently is overutilized for urate overproduction by the liver, underutilized for reduced renal ammonia formation. The kidneys, modulating urinary uric acid excretion, sustain the hyperuricemia.
High prevalence of rheumatoid arthritis in yakima indians
Authors: Palmer Beasley R. , Willkens Robert F. , Bennett Peter H.
Published: February 2007

A survey among Yakima Indian women, ages 18 to 79, in central Washington State revealed a prevalence of definite rheumatoid arthritis of 3.4%. compared with 1.4% among American women in the National Health Examination Survey (NHES). The prevalence is higher than has been observed in any previously studied population. Men were not studied. The prevalence was high in all age groups, but was most excessive among women under age 35.
Mobilization and extracellular release of granular enzymes from human leukocytes during phagocytosis: inhibition by colchicine and cortisol but not by salicylate
Authors: Wright Daniel G. , Malawista Stephen E.
Published: February 2007

Granular (lysosomal) enzymes are released from phagocytizing human leukocytes and are believed to be important in the tissue damage of acute inflammation. Antiinflammatory drugs such as colchicine, cortisol, and salicylate have been reported to “stabilize” isolated lysosomes or to inhibit degranulation within cells. These drugs, by altering mobilization of granular enzymes within cells, might be expected to affect the release of these enzymes outside of cells. Human blood leukocytes, isolated by dextran sedimentation, were incubated in autologous serum‐buffer media, with or without colchicine (2.5 × 10−5M), cortisol (5 × 10−4M), Na salicylate (2.2 × 10−3M), or acetylsalicylic acid (10−3M), for 30 minutes, 37.5° C, and then with or without heat‐killed staphylococci. Both cellular and extracellular activities of granular enzymes (lysozyme, acid phosphatase, cathepsin) were measured. Both intracellular mobilization and extracellular release of granular enzymes by phagocytizing leukocytes are inhibited by colchicine and cortisol. Salicylate, contrary to suggestions based on studies with isolated lysosomes from liver, did not show these effects. These results may account in part for antiinflammatory effects of colchicine and cortisol, but not of salicylate.
Incidence of infection in systemic lupus erythematosus
Authors: Staples Parker J. , Gerding Dale N. , Decker John L. , Gordon Robert S.
Published: February 2007

Twenty‐three patients with systemic lupus erythematosus (SLE), 20 with rheumatoid arthritis (RA), and 11 with the nephrotic syndrome (NPS) were selected for study of factors affecting the incidence of infection in these diseases. The overall infection rate (infections per 100 hospital days) in patients with SLE was significantly higher than it was in patients with RA or NPS. Infection rate and the number of disseminated infections were found to increase in lupus patients with increasing doses of corticosteroids and decreasing renal function. Lupus patients with normal renal function on no or low‐dose corticosteroid therapy had an infection rate significantly higher than the infection rate of the control patient groups. This study suggests that the observed high infection rate in SLE cannot be attributed to steroid therapy and renal disease alone.
Nonphagocytic release of neutral protease and β‐glucuronidase from human neutrophils regulation by autonomic neurohormones and cyclic neucleotides
Authors: Ignarro Louis J.
Published: February 2007

Human neutrophils released lysosome granule‐associated neutral protease and β‐glucuronidase, but not cytoplasmic lactate dehydrogenase, during cell contact with immobilized heat‐aggregated human IgG treated with RA serum. Treatment of aggregated IgG with RA serum was more effective than treatment with normal serum with regard to stimulation of enzyme release. Epinephrine, isoproterenol, cyclic 3′,5′‐adenosine monophosphate (cyclic AMP), and analogs of cyclic AMP inhibited the nonphagocytic release of enzyme. The action of epinephrine was blocked by propranolol but not by phentolamine. Acetylcholine, acetyl β‐methylcholine, cyclic 3′,5′‐guanosine monophosphate (cyclic GMP) and analogs of cyclic GMP enhanced lysosomal, but not cytoplasmic, enzyme release. The action of acetylcholine was blocked by atropine but not by hexamethonium. Calcium was required for both the nonphagocytic release of lysosome granule enzymes and for the stimulation of this enzyme release process by cholinergic agents and cyclic GMP. Thus it appears that human neutrophils are capable of responding to autonomic agents and to cyclic nucleotides by quantitative changes in the nonphagocytic release of lysosomal enzymes.
The antiquity of rheumatoid arthritis
Authors: Short Charles L.
Published: February 2007

The antiquity of rheumatoid arthritis, first clearly set off as an entity by Landre‐Beauvais in 1800, is of more than historic interest. If the disease is actually of relatively recent origin, an environmental cause becomes likely. It is reasonably certain that it was identified by Sydenham in 1676. But studies in human palaeopathology, while revealing unmistakable examples of ankylosing spondylitis dating back to prehistoric times, have as yet failed to provide convincing evidence of the existence of rheumatoid arthritis prior to Sydenham's description.
In vitro rabbit articular cartilage organ model I. Morphology and glycosaminoglycan metabolism
Authors: Lane Joseph M. , Brighton Carl T.
Published: February 2007

A new in vitro adult articular cartilage organ model is described. Cartilage explants from adult rabbits have maintained a maximum glycosaminoglycan synthetic rate from day 7 to day 14 of incubation and normal morphology through day 10. The metabolic and histologic stability of this articular cartilage model suggests its suitability for investigating synthesis and degradation in normal, pharmacologically altered, and diseased cartilage.
In vitro rabbit articular cartilage organ model II. 35S incorporation in various oxygen tensions
Authors: Brighton Carl T. , Lane Joseph M. , Koh James K.
Published: February 2007

Adult rabbit articular cartilage slice and plug explants were cultured in MEM/NCTC 109/fetal calf serum at 37°C in various oxygen tensions. In both the slice and plug explants, 35SO4 incorporation exhibited a broad tolerance to oxygen tensions varying from 5 (38 mm. Hg) to 60 (456 mm Hg) per cent. Significantly (P 0.01) less 35SO4 was incorporated in 1 (7.6 mm Hg) and 90% (684 mm Hg) oxygen than in 21% (160 mm Hg) oxygen. No histologic or autoradiographic differences, and only slight histochemical differences, were discernible after seven days culture in the various oxygen tensions. It is suggested that low synovial fluid oxygen tension is detrimental to articular cartilage glycosaminoglycan metabolism.
Stretch gloves. A study of objective and subjective effectiveness in arthritis of the hands
Authors: Askari Ali , Moskowitz Roland W. , Ryan Charlotte
Published: February 2007

The effect of stretch gloves in treatment of arthritis affecting the hands was evaluated in 9 hospitalized and 14 ambulatory patients. Eighteen patients had rheumatoid arthritis, 2 had other forms of connective tissue disease, and 3 had degenerative joint disease. No statistically significant improvement in ring size, range of motion or grip strength was noted. Moderate or marked subjective improvement in morning stiffness and/or night pain was observed in 5 of 9 hospitalized patients, and in 7 of 14 ambulatory patients. It is suggested that stretch gloves provide a safe addition to the management of arthritis of the hands which will be effective to some degree in a majority of patients.
Hepatitis B antigen and antibody in patients with systemic lupus erythematosus
Authors: Shorey James , Cheatum Don E. , Combes Burton , Ziff Morris
Published: February 2007

Sera of 50 patients with systemic lupus erythematosus (SLE) were examined for the presence of hepatitis B antigen (HBAg) and antibody (HBAb) by radioimmunoassay (RIA). All single serum specimens from 48 patients examined by the basic double‐antibody method for HBAg gave negative results. The “heated” double‐antibody technique, which detects HBAg in the presence of HBAb or other heat‐labile interfering factors, was also negative. When 151 sera from the 50 patients with SLE were tested for HBAg using solid‐phase RIA, a positive reaction was observed in only one specimen. The specificity of the reaction for HBAg in this serum was confirmed. Three other serum specimens subsequently obtained from the patient were HBAg negative. The prevalence and titers of hepatitis B antibody detected by RIA among 48 of the patients with SLE were similar to those observed among healthy blood donors. No special relationship between hepatitis B virus and systemic lupus erythematosus was demonstrated.
Hodgkin's disease presenting as relapsing polychondritis a previously undescribed association
Authors: Miller Stephen B. , Donlan Charles J. , Roth Steven B.
Published: February 2007

Relapsing polychondritis is a rare syndrome thought to be autoimmune in nature and characterized by inflammation and degeneration of cartilage. The association with a reticuloendothelial malignancy has not previously been reported. A 46‐year‐old man presented typical clinical manifestations of relapsing polychondritis requiring 30 mg of prednisone daily for suppression. However within 6 months he developed chronic fatigue, fevers, night sweats, adenopathy, and splenomegaly leading to the diagnosis of Hodgkin's disease.
A double‐blind controlled trial comparing cyclophosphamide, azathioprine and placebo in the treatment of lupus glomerulonephritis
Authors: Steinberg Alfred D. , Decker John L.
Published: February 2007

Thirty‐eight patients with lupus glomerulonephritis entered a 10‐week in‐hospital trial of immunosuppressive therapy. They were permitted prednisone ≤ 0.5 mg/kg/day for extrarenal manifestations and were randomly assigned to receive, in addition, cyclophosphamide or azathioprine or placebo. Renal function, urine sediment, proteinuria, anti‐DNA, C3, and symptoms were assessed before and after therapy. This represents the first double‐blind controlled comparison of two immunosuppressive drugs commonly used in nonmalignant diseases. Cyclophosphamide was significantly superior to both azathioprine and placebo for all six measures together and for the three renal measures alone. Cyclophosphamide was significantly better than placebo with regard to proteinuria, urinary RBC, and serum C3. Azathioprine was not significantly better than placebo in any individual measure. Although cyclophosphamide led to somewhat greater improvement than did azathioprine, additional long‐term data will be necessary to establish the role of either drug in the routine management of lupus glomerulonephritis.
Qualitative characteristics of anti‐DNA antibodies in lupus nephritis
Authors: Gershwin M. Eric , Steinberg Alfred D.
Published: February 2007

Sera from 38 patients with systemic lupus erythematosus, known from previous determinations to contain antibodies to native DNA (deoxyribonucleic acid), were studied using a modification of the Farr technique, with 14C‐DNA as ligand. The sera fell into three groups with regard to antibodies to DNA: a) precipitating, b) nonprecipitating, and c) a mixture of both. Eighteen of these sera were studied further and titrated to obtain measures of their antigen binding capacity and estimates of avidity for DNA. Patients with lupus nephritis had either precipitating antibodies to DNA, or a mixture of precipitating and nonprecipitating, whereas those patients without nephritis had only nonprecipitating, antibodies to DNA. Furthermore the avidity for DNA was greatest in sera from patients with nephritis. The antigen binding capacity of sera from patients with and without lupus nephritis was similar, suggesting that qualitative differences in anti‐DNA activity may be as important as quantitative ones.
Significance of eosinophilia during gold therapy
Authors: Davis P. , Hughes G. R. V.
Published: February 2007

Adverse clinical reactions (predominantly skin rashes) were seen in 14 of 50 patients receiving gold therapy for rheumatoid arthritis. In 11 of the 14 eosinophilia either accompanied or preceded the reaction. A further 9 patients who received gold developed eosinophilia alone. IgE levels were increased in 17 of the 20 patients with eosinophilia but were normal in 24 of 27 patients who received gold without apparent adverse effects. In only 1 patient on gold was a skin rash not accompanied by either eosinophilia or a raised IgE level. All eosinophil counts and IgE levels fell to normal after therapy was discontinued. It is suggested that eosinophilia may be the most common side effect of gold therapy and provides a useful guide for monitoring patients receiving gold salts. The strong association with raised IgE levels suggests that type 1 hypersensitivity may be the mechanism of these reactions.
Therapeutic studies in NZB/W MICE
Authors: Steinberg Alfred D. , Gelfand Michael C. , Hardin John A. , Lowenthal David T.
Published: February 2007

Female NZB/W mice develop a disease closely resembling human systemic lupus and serve as an animal model for therapeutic studies. Several previous studies have demonstrated the efficacy of different immunosuppressive drug regimens in the therapy of glomerulonephritis in NZB/W mice. After the onset of immune complex deposition, treatment with intermittent high doses of cyclophosphamide or daily low doses of the combination of cyclophosphamide, azathioprine, and methylprednisolone has been effective. The present study was designed to compare such effective regimens in mice early in the course of their renal disease versus mice late in the course of glom‐erulonephritis. One to three injections of high‐dose cyclophosphamide during active immune complex deposion and early histologic changes were significantly effective in prolonging survival, whereas treatment late in the course of glomerulonephritis was less effective. Even more striking was the result of low‐dose combination therapy. Daily treatment with cyclophosphamide, azathioprine, and methylprednisolone (C + A + M) effectively prolonged survival when started in mice 5 months old, but was of no benefit when started in those 8 months of age. In a concluding experiment, older mice were selected on the basis of degree of renal disease and studied with regard to proteinuria and survival. Those with mild renal disease responded to daily treatment for 6 months with C + A + M at 1 mg/kg of each drug, whereas those with advanced renal disease at the onset of therapy did not benefit.
The arthritis of sweet's syndrome
Authors: Krauser Ronald E. , Ralph Schumacher H.
Published: February 2007

A detailed evaluation of the articular manifestations of Sweet's syndrome is described in a 24‐year‐old man. Fever, mild leukocytosis, tender cutaneous erythematous plaques or nodules with neutrophilic infiltration were accompanied by multiple painful, swollen joints. A knee effusion contained 1,575 leukocytes with many large phagocytic cells. Since it may include significant articular disease, rheumatologists should be aware that this syndrome does exist.
Rheumatoid nodulosis an unusual variant of rheumatoid disease
Authors: Ginsberg Mark H. , Genant Harry K. , Yü T'Sai Fan , Mccarty Daniel J.
Published: February 2007

A middle‐aged man developed multiple subcutaneous nodules associated with palindromic rheumatism. There was little evidence of synovitis; however multiple cyst‐like intraosseous radiolucencies were noted. Nodules from two sites were histologically typical rheumatoid nodules. Subjective and objective improvement occurred during penicillamine therapy. This clinical presentation seems sufficiently distinctive to warrant characterization as a variant of rheumatoid disease termed by us: rheumatoid nodulosis..
Treatment of septic arthritis
Authors: Goldenberg Don L. , Brandt Kenneth D. , Cohen Alan S. , Cathcart Edgar S.
Published: February 2007

Surgery and needle aspiration have been evaluated as initial modes of drainage in 59 patients with acute septic arthritis. Full recovery was noted in 42% treated surgically at the outset. On the other hand, 67% of those treated by needle aspiration recovered without sequelae, despite the greater prevalence in this group of adverse host factors‐eg, serious underlying illness, concommitant extraarticular infection, prior arthritis in the infected joint, and recent antibiotic or immunosuppressive therapy.
Metastatic adenocarcinoma of synovium presenting as an acute arthritis. diagnosis by closed synovial biopsy
Authors: Goldenberg Don L. , Kelley William , Gibbons Robert B.
Published: February 2007

An acute arthritis may accompany the onset of cancer. A case of metastatic adenocarcinoma of the synovium presenting as an acute arthritis is described. The diagnostic importance of a careful synovial fluid analysis and the use of closed synovial biopsy are emphasized.
Effect of ibuprofen dosage on patient response in rheumatoid arthritis
Authors: Godfrey Robert G. , Cruz Susano De La
Published: February 2007

In a 4‐week double‐blind trial in 41 patients with rheumatoid arthritis, ibuprofen (Motrin®) decreased the swollen joint count significantly at a dosage level of 2400 mg/day, but not at 1200 mg/day. Ibuprofen probably does have antiinflammatory effects in man, but only at higher dosages; antiarthritic activity at lower dosages reflects primarily analgesia and perhaps antipyretic effects. Complaints and clinical laboratory findings did not differ significantly between the dosage groups.
Pathogenic implications of age of onset in juvenile rheumatoid arthritis
Authors: Sullivan Donita B. , Cassidy James T. , Petty Ross E.
Published: February 2007

An analysis of age of onset in juvenile rheumatoid arthritis was performed in the last 300 children seen in our clinic. There was a peak age of onset in girls at 1 to 3 years. Distribution of age of onset in boys was bimodal with the first peak at 2 years of age and the second at 9 years. There was no accentuation of frequency in either sex in the 10‐ to 14‐year age group. The distribution of age of onset was bimodal in both monarticular and polyarticular onset of disease, but no particular modal age of onset was seen with systemic onset of disease. It is possible that these data reflect that JRA is not a homogeneous disease, or that there are age‐sex related differences in host susceptibility or pathogenoc agents.
Selective suppression of autoantibody responses in NZB/NZW MICE treated with long‐term cyclophosphamide
Authors: Walker Sara Ellen , Bole Giles G.
Published: February 2007

Autoimmune responses were assayed in 80 cyclophosphamide‐treated and control NZB/NZW mice over a period of 1 year. Fluctuation between positive and negative immunofluorescent heterogeneous ANA tests and daily alterations of ANA titers were detected in young mice of both sexes. Although highdose cyclophosphamide therapy (8 mg/kg/day) failed to prevent the spontaneous appearance of ANA, titered ANA values were partially suppressed in highdose treated mice. This study permitted sequential comparisons between ANA titers and anti‐DNA as useful indices of cyclophosphamide‐induced suppression of autoimmune disease. ANA titers were relalively resistant to cyclophosphamide therapy. Antibodies directed specifically against DNA were suppressed in mice receiving high‐dose cyclophosphamide. In treated animals, decreased anti‐DNA levels were associated with protection from severe glomerulonephritis and renal vasculitis. Treatment with lowdose cyclophosphamide (1 mg/kg/day) appeared paradoxically to stimulate autoantibody production and renal disease/vasculitis.
Septic arthritis in sickle‐cell thalassemia
Authors: Palmer Donald W.
Published: February 2007

The knee of a boy with sickle‐cell thalassemia became infected with Salmonella enteritidis, sensitive to ampicillin. Doses of ampicillin that achieved antibacterial titers of 32 in synovial fluid failed to eradicate the organism. The synovial fluid exhibited severe hypoxia, hypercapnia, and lactic acidosis. Methods were developed to estimate the oxygen saturation of blood in regional venous capillaries, the degree of periarticular sickling, changes in the viscosity of local blood, and the articular ratio of blood flow to oxygen utilization. The results suggest that local vascular insufficiency associated with sickling may affect host response to infection and efficacy of antibiotics. The Salmonella C1 readily transformed to an L form on hypertonic medium, thus acquiring resistance to ampicillin and other cell‐wall inhibitors.
Thiemann' disease a brief reminder
Authors: Rubinstein Herbert M.
Published: February 2007

Two brothers with Thiemann' disease are described and the accumulated world literature is briefly reviewed. Thiemann' disease is considered to be a form of idiopathic avascular necrosis of the PIP joints of the hands, with occasional involvement of other joints. The characteristic deformity and x‐ray findings are reviewed. Thiemann' disease is a genetic disorder and, in families in which detail is available, is inherited as an autosomal dominant with virtual complete penetrance.
Wrist arthropathy in calcium pyrophosphate dihydrate deposition disease
Authors: Utsinger Peter D. , Resnick Donald , Zvaifler Nathan J.
Published: February 2007

Calcium pyrophosphate dihydrate deposition disease is associated with chondrocalcinosis and a characteristic radiographic abnormality. In the wrist this abnormality consists of radiocarpal joint narrowing, sclerosis, and subchondral cystic degeneration of the carpal bones. These changes sometimes occur in the absence of chondrocalcinosis. To investigate the significance of this occurrence, 18 patients with the radiographic abnormality of radiocarpal joint narrowing, sclerosis, and subchondral cystic degeneration were examined. Six had neither local wrist nor distant chondrocalcinosis. Five of the latter had wrist arthrocentesis and 4 had calcium pyrophosphate dihydrate crystals. Calcium pyrophosphate dihydrate deposition disease can occur in the absence of chondrocalcinosis and the diagnosis is strongly suggested by a characteristic radiographic picture.
Development of antibodies to ribonucleoprotein following short‐term therapy with procainamide
Authors: Winfield John B. , Koffler David , Kunkel Henry G.
Published: February 2007

An autoimmune response to certain nuclear antigens frequently develops in patients receiving prolonged therapy with procainamide. In order to define events involved in the initiation of this immune response, patients with myocardial infarction were studied early after starting procainamide and at later times. Polynucleotide antibodies and circulating polynucleotide antigens were sought by sensitive assay techniques in the sera of these patients. Very high titers of antiribonucleoprotein developed selectively in the majority of these patients after short‐term therapy with procainamide. Such antibodies were infrequent in the long‐term therapy group, most of whose members exhibited anti‐single‐strand DNA and were symptomatic with overt procainamide‐induced lupus. Patients with acute myocardial infarction who did not receive procainamide did not develop anti‐polynucleotide antibodies, but rather had high levels of free ribonucleoprotein antigen in their serum. Various interpretations of these data are discussed.
Association of cold‐reactive antilymphocyte antibodies with lymphopenia in systemic lupus erythematosus
Authors: Winfield John B. , Winchester Robert J. , Kunkel Henry G.
Published: February 2007

In a prospective study 26 of 29 patients with systemic lupus erythematosus had cold‐reactive antilymphocyte antibodies cytotoxic for autologous lymphocytes and lymphocytes from normal subjects. The level of antilymphocyte antibodies was highly correlated, by linear regression analysis, with lymphopenia in these patients. The data suggested that both the avidity and the concentration of these antibodies were important determinants in this relationship. A clear association between increased antilymphocyte antibody activity and exacerbation of SLE was demonstrated. Apart from lymphopenia, however, neither type of clinical manifestation nor any particular serologic abnormality appeared to be related to the presence of antilymphocyte antibodies.
Crystal shedding and acute pseudogout. An hypothesis based on a therapeutic failure
Authors: Bennett Robert M. , Lehr James R. , McCarty Daniel J.
Published: February 2007

Four patients with chondrocalcinosis of the knees volunteered for joint lavage. Preliminary experiments indicated that disodium EDTA and magnesium ions were potent solubilizers of CPPD crystals. The procedure was a therapeutic failure in that insignificant amounts of CPPD were removed and all 4 subjects developed postlavage attacks of pseudogout. It is hypothesized that the acute attack of pseudogout is a result of crystal shedding and may be triggered by any factor that enhances CPPD solubility.
Coexistence of ankylosing spondylitis and rheumatoid arthritis
Authors: Luthra Harvinder S. , Ferguson Richard H. , Conn Doyt L.
Published: February 2007

Ankylosing spondylitis and rheumatoid arthritis share many common features. However the presence of rheumatoid factor, histologically classic rheumatoid nodules, and the histocompatibility cell wall antigen (HLA‐B27) helps distinguish one from the other. Two cases are reported in which these features established the coexisting diagnoses of ankylosing spondylitis and rheumatoid arthritis.
Histocompatibility antigens in systemic lupus erythematosus
Authors: Goldberg Marc A. , Arnett Frank C. , Bias Wilma B. , Shulman Lawrence E.
Published: February 2007

Histocompatibility (HL‐A) antigens were determined in 120 patients with systemic lupus erythematosus (SLE) and 120 matched controls. Increased frequencies of HL‐A1 and HL‐A8 were found. HL‐A1 was more strongly associated with SLE in black patients (71 patients), whereas HL‐A8 was more impressively associated with SLE in white patients (49 patients). In addition HL‐A1 appeared more frequently in those with early onset of disease in both races; and HL‐A1, HL‐A8, and the HL‐A1,8 phenotype seemed to be associated with severe SLE (renal and central nervous system involvement) in white patients. These data support the proposal that there are genetic influences in the pathogenesis and expression of SLE.
Lupus erythematosus in a patient with amyloidosis, adrenal insufficiency, and subsequent immunoblastic sarcoma. Demonstration of the le phenomenon in the lung
Authors: Schleissner L. A. , Sheehan William W. , Orselli Richard C.
Published: February 2007

A patient with systemic lupus erythematosus of long duration developed secondary amyloidosis and finally died after the additional complication of malignant lymphoproliferative disease. Multiple system involvement, typical serologic findings, and postmortem evidence substantiated the diagnosis of lupus erythematosus. Amyloid deposition was found in several organs, but was notably extensive in the adrenal cortex. This extensive deposition resulted in adrenal insufficiency, which was diagnosed clinically and treated until the patient's death from lymphoma. The particular nature of the malignant lymphoma is emphasized; a distinctive feature was the disappearance of positive lupus erythematosus cells from the buffy coat and the reduction in titers of relevant serologic tests toward the end of the illness. In spite of this reduction, many hematoxylin bodies and abundant complete lupus erythematosus cells were found in the lungs on postmortem examination.
Effect of prophylactic colchicine therapy on leukocyte function in patients with familial mediterranean fever
Authors: Dinarello Charles A. , Chusid Michael J. , Fauci Anthony S. , Gallin John I. , Dale David C. , Wolff Sheldon M.
Published: February 2007

Patients with familial Mediterranean fever (FMF) who were part of a double‐blind trial of daily colchicine as prophylaxis for their disease had leukocyte functions studied while receiving colchicine or placebo. Leukocytes taken from these patients while on prophylactic doses of colchicine produced normal quantities of leukocytic pyrogen, ingested bacteria normally, and migrated normally in chemotactic chambers. In addition these patients had normal numbers of circulating T and B lymphocytes as well as normal blastogenic responses of their peripheral lymphocytes to mitogenic stimuli. The patients on colchicine, however, had significantly fewer neutrophils and monocytes accumulating at skin‐window sites 24 hours after the initial abrasion. Because the early phase of the skin‐window response was normal in these patients, the decreased late response may be related to a failure to amplify the initial inflammatory reaction. The reduced capacity to generate a normal inflammatory response may account for the failure of these patients to develop full attacks while taking colchicine.
Comparison of the complement‐fixing activity of antinuclear antibodies in lupus nephritis, mixed connective tissue disease, and scleroderma
Authors: Parker Michael Dean , Turner Robert A.
Published: February 2007

Complement‐fixing antinuclear antibody (CFANA) titers were measured in 18 patients with lupus nephritis and were compared to titers in 22 patients with scleroderma and mixed connective tissue disease (MCTD) who had comparable ANA titers but lacked nephritis. CFANA titers were higher in SLE patients with nephritis than in a control group of SLE patients without nephritis but were no higher than in scleroderma or MCTD. Thus the striking differences in the prevalence of nephritis among these patients with high titer ANA cannot be explained by differences in complement fixation by these antibodies.
Carcinomatous polyarthritis. The presenting symptom of an ovarian tumor and association with a platelet activating factor
Authors: Bennett Robert M. , Ginsberg Mark H. , Thomsen Sharon
Published: February 2007

A 59‐year‐old white female presented with an acute polyarthritis, fever, and mental confusion. Accompanying blood changes included positive tests for rheumatoid factor and antinuclear factor, anemia, leukocytosis, thrombocytosis, and a circulating factor that stimulated serotonin release from normal platelets. Exploratory laporatomy for a mobile pelvic mass revealed an adenocarcinoma of the left ovary which was completely resected. Shortly thereafter the patient's acute symptoms subsided. After 2 years of follow‐up the patient has remained free of symptoms and the serologic changes have reverted to normal.
An epidemic of oligoarticular arthritis in children and adults in three connecticut communities
Authors: Steere Allen C. , Malawista Stephen E. , Snydman David R. , Shope Robert E. , Andiman Warren A. , Ross Martin R. , Steele Francis M.
Published: February 2007

An epidemic form of arthritis has been occurring in eastern Connecticut at least since 1972, with the peak incidence of new cases in the summer and early fall. Its identification has been possible because of tight geographic clustering in some areas, and because of a characteristic preceding skin lesion in some patients. The authors studied 51 residents of three contiguous Connecticut communities—39 children and 12 adults—who developed an illness characterized by recurrent attacks of asymmetric swelling and pain in a few large joints, especially the knee. Attacks were usually short (median: 1 week) with much longer intervening periods of complete remission (median: 2.5 months), but some attacks lasted for months. To date the typical patient has had three recurrences, but 16 patients have had none. A median of 4 weeks (range: 1–24) before the onset of arthritis, 13 patients (25%) noted an erythematous papule that developed into an expanding, red, annular lesion, as much as 50 cm in diameter. Only 2 of 159 family members of patients had such a lesion and did not develop arthritis (P < 0.000001). The overall prevalence of the arthritis was 4.3 cases per 1,000 residents, but the prevalence among children living on four roads was 1 in 10. Six families had more than 1 affected member. Nine of 20 symptomatic patients had low serum C3 levels, compared to none of 31 asymptomatic patients (P < 0.005); no patient had iridocyclitis or a positive test for antinuclear antibodies. Neither cultures of synovium and synovial fluid nor serologic tests were positive for agents known to cause arthritis. “Lyme arthritis” is thought to be a previously unrecognized clinical entity, the epidemiology of which suggests transmission by an arthropod vector.
Stimulatory effect of metoclopramide on the esophagus and lower esophageal sphincter of patients with pss
Authors: Ramirez‐Mata Manuel , Ibanez Graciela , Alarcon‐Segovia Donato
Published: February 2007

Metoclopramide has been shown to stimulate motility of the gastrointestinal tract, including the esophagus. The authors therefore tested the effect of intravenous injections of metoclopramide on the sphincteric pressure and esophageal motility in 14 patients with esophageal dysfunction due to progressive systemic sclerosis (PSS). Isotonic saline similarly injected in a control period in 7 of the patients showed no effect. None of the 14 patients had a detectable pressure zone at the sphincteric area in basal conditions, but following the injection of metoclopramide, one appeared in 7 patients. Metoclopramide also caused the appearance of pressure waves in 5 of 11 patients who had aperistalsis, and caused up to a threefold increase in the amplitude of the pressure waves in the 3 patients who had hypomotility of the esophagus.
Lactoferrin and lysozyme levels in synovial fluid
Authors: Bennett Robert M. , Skosey John L.
Published: February 2007

Lysozyme and lactoferrin levels were measured in 71 synovial fluids (SF) of patients with traumatic effusions, osteoarthritis, rheumatoid arthritis, pseudogout, septic arthritis, and gout, as well as in 91 synovial fluids graded according to their neutrophil count. Elevated lysozyme levels were found in all the inflammatory arthritides and also in osteoarthritis. Lactoferrin levels were not increased in osteoarthritis but displayed a close correlation to the extent of the inflammatory response as judged by SF neutrophilia. The ratio of lysozyme to lactoferrin decreased progressively with increasing SF neutrophilia. In vitro experiments showed that lactoferrin is released from neutrophils isochronously with lysozyme and β‐glucuronidase. Lactoferrin was not found in hyaline cartilage, a tissue known to contain lysozyme. These results are consistent with the belief that SF lysozyme has a major derivation from both cartilage and neutrophils, and that lactoferrin arises only from neutrophils. These findings indicate that the simultaneous measurement of lysozyme and lactoferrin provides a potentially useful index of both joint inflammation and cartilage degradation.
Chronic arthropathy associated with rubella vaccination
Authors: Spruance Spotswood L. , Metcalf Robert , Smith Charles B. , Griffiths Marie M. , Ward John R.
Published: February 2007

Eleven children suffered recurrent episodes of knee stiffness (“catcher's crouch syndrome”) after receiving HPV‐77DK12 rubella vaccine. One was evaluated by arthroscopy and the synovium was found to be hypertrophied posteriorly and to protrude in folds into the intercondylar notch and lateral joint space. Culture for rubella virus was unsuccessful. The authors' observations provide evidence that “catcher's crouch syndrome” is a synovial disease and that chronic joint disease can be a sequela of rubella immunization.
Spontaneous rupture of the liver
Authors: Levitin Peter M. , Sweet Donald , Brunner Carolyn M. , Katholi Richard E. , Bolton W. Kline
Published: February 2007

A patient with systemic lupus erythematosus developed an acute surgical abdomen secondary to spontaneous rupture of the liver and died. Postmortem examination revealed an arteritis of the liver, pancreas, adrenal gland, skeletal muscle, and spleen. It appeared that an arteritis of the liver produced areas of infarction that ruptured and caused the clinical findings.
Homozygosity For HLA‐B27
Authors: Arnett Frank C. , Schacter Bernice Z. , Hochberg Marc C. , Hsu Susan H. , Bias Wilma B.
Published: February 2007

The effect of homozygosity for HLA‐B27 on the clinical expression of rheumatic disease was studied in two families. The 1 homozygous patient in each of two families demonstrated extraordinarily severe peripheral and axial arthritis compared to other affected heterozygous relatives. In addition, predominant peripheral or axial disease appeared to segregate with different B27 haplotypes. The 2 homozygous patients were not homozygous at the HLA‐A, C, or D loci.
Central nervous system involvement in sle
Authors: Small Peter , Mass M. F. , Kohler Peter F. , Harbeck Ronald J.
Published: February 2007

The clinical course and diagnostic profile of 13 patients with central nervous system involvement and systemic lupus erythematosus (CNS‐SLE) are presented. The diagnostic yield for each procedure was measured as the percent abnormal: CSF total protein was 38%; increased CSF IgG 69%; decreased CSF hemolytic C4 10%; increased CSF anti‐DNA 64%; electroencephalogram 80%; flow brain scan 50%; and static brain scan 0%. No single procedure was consistently abnormal, but the battery of tests provided a useful and specific CNS‐SLE diagnostic profile.
Preliminary criteria for the classification of the acute arthritis of primary gout
Authors: Wallace Stanley L. , Robinson Harry , Masi Alfonse T. , Decker John L. , Mccarty Daniel J. , Yü T'sai‐fan
Published: February 2007

The American Rheumatism Association subcommittee on classification criteria for gout analyzed data from more than 700 patients with gout, pseudogout, rheumatoid arthritis, or septic arthritis. Criteria for classifying a patient as having gout were a) the presence of characteristic urate crystals in the joint fluid, and/or b) a tophus proved to contain urate crystals by chemical or polarized light microscopic means, and/or c) the presence of six of the twelve clinical, laboratory, and X‐ray phenomena listed in Table 5.
Hand flexor tenosynovitis in rheumatoid arthritis
Authors: Gray Robert G. , Gottlieb Norman L.
Published: February 2007

Tenosynovitis of one or more flexor tendons of the hand (mean 3.1 tendons per patient) was noted in 55% of 100 patients with rheumatoid arthritis (RA) examined periodically during a mean period of 5 years. The third flexor tendon was involved most frequently (71% of patients), followed by the second (62%), fourth (53%), fifth (27%), and first (13%). Patients with flexor tendonitis (FT) had a significantly higher prevalence of rheumatoid nodules (56% vs 33%), carpal tunnel syndrome (47% vs 13%), wrist extensor tenosynovitis (47% vs 9%), and elbow epicondylitis (22% vs 7%) than patients without FT. Dupuytren's contracture, DeQuervain's tenovaginitis, flexor carpi radialis and ulnaris tendonitis, and Achilles tendonitis were found exclusively in patients with FT. A control group of 50 non‐RA patients with FT had statistically fewer diseased tendons per patient (mean 1.5) and a different digital distribution, the thumb being affected more frequently (P < 0.05) than in RA patients.