bluuebunny/crossref_metadata_2025 huggingface dataset:
Complement C3b receptors on erythrocytes, circulating immune complexes, and complement C3 split products in patients with primary Sjögren's syndrome
Authors: Thomsen Bjarne S. , Oxholm Peter , Manthorpe Rolf , Nielsen Henrik
Published: February 2007

Twenty‐one patients with primary Sjögren's syndrome (SS) and 22 age‐ and sex‐matched healthy controls were examined for levels of C3b receptors (CR1) on erythrocytes (by an enzyme‐linked immunosorbent assay), levels of circulating immune complexes (IC) (by a polyethylene glycol precipitation complement consumption method), and C3 split products, C3d and C3c (by intermediate gel rocket immunoelectrophoresis). CR1 varied within a wide range (20–124%), and a preponderance of low numbers was found among patients with primary SS (P < 0.05). The levels of circulating IC and C3d were elevated in primary SS patients (P < 0.01) and were mutually correlated (P < 0.01; τ = 0.5), but levels of circulating IC and C3d did not correlate with CR1 values. C3c concentrations were the same in patients and controls. It is possible that the CR1 level serves as a predictor for the development of IC‐induced manifestations, and the C3d concentration serves as an objective parameter for disease activity in primary SS.
Analysis of osteoarthritic cartilage using monoclonal antibodies reactive with rabbit proteoglycan
Authors: Kresina Thomas F. , Malemud Charles J. , Moskowitz Roland W.
Published: February 2007

Femoral and tibial cartilage specimens from nonoperated, sham operated, and partially meniscectomized knees of New Zealand white rabbits were studied, using fluorescein‐conjugated mouse IgG or 3 monoclonal antibodies (2G2, 2E9, and 6C9) that portrayed differing fine antigenic specificity for rabbit cartilage proteoglycan monomer. In nonoperated and sham operated animals, monoclonal antibodies 2G2 and 2E9 stained cellular/pericellular (C/PC) and matrix areas; antibody 6C9 stained only C/PC areas. Augmented C/PC and matrix staining of osteoarthritic femoral cartilage occurred with 2G2 and 6C9; tibial cartilage staining was reduced. Increased 2E9 staining of C/PC regions was seen in tibial cartilage. The differential staining patterns indicate that proteoglycan macromolecular changes occur in experimental osteoarthritis and that these monoclonal antibodies can be utilized as probes for the connective tissue changes observed.
Correlation between the presence of antibodies to the Epstein‐barr virus nuclear antigen type 2 and antibodies to the rheumatoid arthritis nuclear antigen in patients with rheumatoid arthritis
Authors: Sculley Thomas B. , Pope John H. , Hazelton Ron A.
Published: February 2007

The incidence of antibodies to Epstein‐Barr nuclear antigen type 2 (EBNA‐2) was determined in sera from rheumatoid arthritis (RA) patients and control subjects, by protein immunoblotting. Sixty‐eight percent of the RA patients and 48% of the controls possessed anti‐EBNA‐2 antibodies. The titer of anti‐rheumatoid arthritis nuclear antigen (RANA) in RA patient sera showed a stronger correlation with serum reactions to EBNA‐2 than with reactions to EBNA‐1. Our results indicate that the presence of EBNA‐2 may make a major contribution to the RANA reaction.
Retinopathy in systemic lupus erythematosus: Relationship to disease activity
Authors: Klinkhoff Alice V. , Beattie Craig W. , Chalmers Andrew
Published: February 2007

Forty‐three patients taking chloroquine for systemic lupus erythematosus were followed by one ophthalmologist over a 5‐year period. Visual field testing, color vision testing, and fluorescein angiography were performed. Retinopathy was detected in 7 patients (16%), none of whom had hypertension or diabetes mellitus. Retinal abnormalities included cotton‐wool spots in 4 patients, microaneurysms in 3, and vascular tortuosity in 4. In 4 patients, these abnormalities were associated with retinal dysfunction, measured in terms of abnormal hue discrimination. In 6 of the 7 patients, the finding of retinopathy coincided with a flare of lupus activity. In 5 patients, retinopathy improved when the disease was controlled.
The early diagnosis of ischemic necrosis of bone
Authors: Zizic T. M. , Marcoux C. , Hungerford D. S. , Stevens M. B.
Published: February 2007

One hundred sixty‐nine patients with radio‐graphic or histologic evidence of ischemic necrosis of bone (INB) were evaluated. Ninety‐nine (59%) of the 169 patients had multiple sites of INB, with 310 bones affected. Two hundred sixty‐three (85%) of the 310 ischemic bones were symptomatic. Routine radiography produced negative findings in 58 (20%) of the bones with histologically confirmed INB. Results of hemodynamic studies, including baseline bone marrow pressure, saline stress test, and/or intraosseous venography, were abnormal in 243 (94%) of 259 ischemic bones so evaluated. Most importantly, hemodynamic studies detected 51 (93%) of the 55 bones that were radiographically normal but had histologically confirmed INB.
Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status
Authors: Pincus Theodore , Callahan Leigh F. , Bradley Laurence A. , Vaughn William K. , Wolfe Frederick
Published: February 2007

The Minnesota Multiphasic Personality Inventory (MMPI) scales for Hypochondriasis, Depression, and Hysteria were studied in patients with rheumatoid arthritis (RA). The RA patients showed elevated scores on these scales, and these results are similar to those reported in each of 6 published studies. The elevated MMPI scale scores can be explained largely by 5 “disease‐related” MMPI statements which met 2 criteria: (a) they were among 11 of the 117 MMPI statements that two‐thirds of rheumatologists predicted would be RA‐associated; and (b) RA patients and normal subjects differed significantly in their responses to these statements. The responses of RA patients and normal subjects to most other statements in the MMPI Hypochondriasis, Depression, and Hysteria scales were quite similar. In RA patients, responses to “disease‐related” statements were correlated with results of measures of disease activity, which indicates that responses to these MMPI items reflect the severity, as well as the presence, of RA. These findings suggest that new criteria are needed for validation of the MMPI as a clinical tool for the recognition of hypochondriasis, depression, and hysteria in a patient who has RA.
Inorganic pyrophosphate release by rabbit articular chondrocytes in vitro
Authors: Prins A. Pieter A. , Kiljan Erno , van de Stadt Rob J. , van der Korst Jan K.
Published: February 2007

Release of inorganic pyrophosphate (PPi) by rabbit articular chondrocytes in vitro was measured by a newly developed assay which utilizes radioactive orthophosphate (32Pi) labeling and anion exchange high performance liquid chromatography. Chondrocytes in monolayer and high density culture failed to release PPi. Explants (cartilage fragments), however, released newly formed PPi into the culture medium. Trypsin treatment of cartilage fragments almost completely blocked the PPi extrusion. Collagenase treatment had no effect on PPi extrusion. There was no clear correlation between proteoglycan synthesis, measured by 35SO4 incorporation, and PPi release. Suppression of proteoglycan synthesis with tunicamycin did not influence the PPi release of the explants.
Protein traffic in human synovial effusions
Authors: Wallis Wayne J. , Simkin Peter A. , Nelp Wil B.
Published: February 2007

Concentrations of 5 marker proteins were measured in synovial fluid and serum samples from knee effusions of 11 patients with rheumatoid arthritis and 9 with osteoarthritis. Indirect determinations of synovial plasma flow and lymphatic drainage were obtained by measuring iodide clearance (ml/minute) and radio‐albumin clearance (ml/minute). Together with protein concentrations, these determinations allowed us to calculate: 1) the flux of each marker protein through synovial tissues (mg/minute); 2) the volume of plasma cleared by synovium per unit time (ml/minute); and 3) the fractional extraction per passage through the synovial microcirculation (protein permeance). These measures differed substantially between rheumatoid arthritis and osteoarthritis patient populations and quantified the severity of the microvascular lesion in rheumatoid synovitis.
Inclusion body myositis presenting as treatment‐resistant polymyositis
Authors: Calabrese Leonard H. , Mitsumoto Hiroshi , Chou Samuel M.
Published: February 2007

Inclusion body myositis (IBM) has been viewed as a distinct and rare form of inflammatory myopathy. Previously reported findings from series of IBM patients have suggested that clinical and pathologic features are present which readily distinguish it from idiopathic polymyositis. We report 4 cases of IBM presenting clinically and pathologically as polymyositis, each of which was refractory to therapy. Our data suggest that IBM may be a more common and heterogeneous form of inflammatory myopathy than has been previously suggested. Furthermore, IBM may be clinically and electrophysiologically indistinguishable from polymyositis. Reasons for failing to recognize IBM by pathologic studies appear to include: the skip lesion nature of the pathologic findings, failure to examine tissues by electron microscopy, and a low level of suspicion or lack of recognition. Because of its insidious clinical course and its failure to respond to immunosuppressive therapy, IBM may be an important variant of treatmentresistant polymyositis.
An antiserum to a disease‐associated factor from the cells of an hla–B27 positive patient with ankylosing spondylitis specifically recognizes an hla–B27 associated determinant
Authors: Sullivan J. S. , Geczy A. F.
Published: February 2007

Antiserum raised to a factor elaborated by a lymphoblastoid cell line derived from the peripheral blood cells of an HLA–B27 positive patient with ankylosing spondylitis specifically lyses the B27 positive, but not the B27 negative, cells of ankylosing spondylitis patients. The cells of B27 positive and B27 negative normal controls are not lysed. This serum has similar specificity to antisera against cross‐reactive bacteria.
Anticardiolipin antibodies in patients with rheumatic diseases
Authors: Fort John G. , Cowchock F. Susan , Abruzzo John L. , Smith J. Bruce
Published: February 2007

Recent attention has focused on the presence of anticardiolipin (ACL) antibodies and their possible role in recurrent thrombosis and abortions in patients with systemic lupus erythematosus. We analyzed ACL antibodies in 243 consecutive patients to determine their frequency in patients with different rheumatic disorders. A significantly elevated frequency was found in patients with systemic lupus erythematosus (38%), rheumatoid arthritis (33%), and psoriatic arthritis (28%). No correlation could be found between ACL antibody levels and recurrent thrombosis. In patients with rheumatoid arthritis there was a significant correlation between ACL antibodies and a history of repeated abortions. No significant association was found between ACL antibodies and other autoantibodies except in patients with rheumatoid arthritis; ACL antibody‐positive rheumatoid arthritis patients were much more likely to be antinuclear antibody‐positive (P < 0.0002).
Hyaluronate inhibition of cell proliferation
Authors: Goldberg Ronald L. , Toole Bryan P.
Published: February 2007

The proliferation of rabbit synovial cells, 3T3 cells, or simian virus–transformed 3T3 cells in cell culture was inhibited by the addition of hyaluronate to the culture medium. This effect was markedly dependent on the molecular weight and concentration of the hyaluronate. At the molecular weight and concentration of hyaluronate present in normal synovial fluid, proliferation was inhibited. At lower molecular weights or concentrations, as found in rheumatoid synovial fluid, hyaluronate was significantly less inhibitory. Thus, the changes in synovial fluid hyaluronate that are associated with arthropathies may contribute to a favorable environment for rheumatoid pannus expansion.
Frequency of infections among rheumatoid arthritis patients, before and after disease onset
Authors: Vandenbroucke Jan P. , Kaaks Rudolf , Valkenburg Hans A. , Boersma Johannes W. , Cats Arnold , Festen Johan J. M. , Hartman Arend P. , Huber‐Bruning Olga , Rasker Johannes J. , Weber Jacobus
Published: February 2007

The self‐reported frequency of genitourinary and bronchopulmonary infections in postmenopausal women with rheumatoid arthritis (RA) and in postmenopausal women with osteoarthritis and/or soft tissue rheumatism was compared. Neither before, nor after the onset of joint disease was a higher frequency reported by the RA patients. The previously established increased mortality from infectious disease among RA patients might be due to a more severe infectious disease course, leading to an increased case‐fatality rate.
Evidence of immune deposits and of basement membrane alterations in dermal vessels of normal skin of patients with essential mixed cryoglobulinemia
Authors: Gabrielli Armando , Sbarbati Andrea , Marchegiani Gabriele , Rupoli Serena , Montroni Maria , Cinti Saverio , Danieli Giovanni
Published: February 2007

To gain insight into the pathogenic mechanisms of immune complex–mediated vasculitis, clinically normal skin specimens from the forearms of 12 patients with essential mixed cryoglobulinemia were investigated by light microscopy, immunofluorescence microscopy, and electron microscopy. Basement membrane alterations were documented in 9 patients. Eleven patients had deposits in vessel walls, but only in 1 was there evidence of inflammation. The same immunoglobulins of the cryoproteins could be demonstrated in the tissue deposits by immunofluorescence analysis and by immunoelectron microscopy. These findings suggest that, in essential mixed cryoglobulinemia, immune reactants in dermal vessels of normal skin are more common than is evidenced by clinical examination. Moreover, it seems that cryoglobulins, as such, are not sufficient to trigger an inflammatory process: Additional local or plasma factors are required. Deposits were absent in 7 patients with cryoglobulinemia that was associated with a primary disorder. This could be ascribed to the lower cryocrit levels documented in this group of patients, or to the shorter duration of their disease.
Effects of dietary supplementation with marine fish oil on leukocyte lipid mediator generation and function in rheumatoid arthritis
Authors: Sperling Richard I. , Weinblatt Michael , Robin Jean‐Louis , Iii Joseph Ravalese, , Hoover Richard L. , House Frank , Coblyn Jonathan S. , Fraser Patricia A. , Spur Bernd W. , Robinson Dwight R. , Lewis Robert A. , Austen K. Frank
Published: February 2007

Twelve patients with active rheumatoid arthritis supplemented their usual diet with 20 gm of Max‐EPA fish oil, daily, for 6 weeks. Following this supplementation, the ratio of arachidonic acid to eicosapentaenoic acid in the patients' neutrophil cellular lipids decreased from 81:1 to 2.7:1, and the mean generation of leukotriene B4 (with calcium ionophore stimulation) significantly declined by 33%. The mean neutrophil chemotaxis to both leukotriene B4 and FMLP significantly increased toward the normal range at week 6. The generation of 5‐lipoxygenase products by calcium ionophore‐stimulated monocytes was not significantly suppressed, but a significant decline (37%) in plateletactivating factor generation was noted at week 6. The modulation of these measures of leukocyte inflammatory potential suggests that fish oil supplementation may have an antiinflammatory effect.
Arthroscopic and immunohistologic characterization of knee joint synovitis in osteoarthritis
Authors: Lindblad Staffan , Hedfors Eva
Published: February 2007

We studied 10 patients who had arthritis of the knee joint, but no other signs of rheumatic disease. The clinical diagnosis of osteoarthritis was corroborated by arthroscopic evidence of characteristic cartilage degeneration. Signs of inflammation were confined to areas of the synovial membrane that lay near the cartilage; thus, the major part of the joint cavity was not affected. The intensity of the synovial inflammation varied within the areas involved, but was always most pronounced in regions rimming the cartilage. Biopsy samples selected from regions of intensely inflamed synovium contained foci of T lymphocytes, which were bordered by immunoglobulin‐carrying B lymphocytes and plasma cells, as well as strongly HLA‐DR positive dendritic‐like cells adjoined to αLeu − 3a + T helper lymphocytes. In tissue samples taken from macroscopically noninflamed areas, only a few infiltrating lymphocytes were seen. Thus, the inflammatory synovial changes found in osteoarthritis appear to be anatomically restricted and of varied intensity but, when present, are microscopically indistinguishable from the changes that have been previously described as indicative of rheumatoid arthritis.
Hla‐dr4 in giant cell arteritis: association with polymyalgia rheumatica syndrome
Authors: Richardson Joan E. , Gladman Dafna D. , Fam Adel , Keystone Edward C.
Published: February 2007

Forty‐three patients with well‐documented giant cell arteritis (GCA) were studied clinically and with HLA typing. All patients were over age 40. Twenty‐two of the patients had coexistent polymyalgia rheumatica (PMR). No association with class I HLA antigens was detected. When compared with HLA findings in 243 healthy controls, HLA‐DR4 was increased in patients with GCA and PMR, but not in patients with GCA alone. Pooled analysis of data from 4 published papers confirmed the association of DR4 with GCA and PMR (P /0.00001). Patients with PMR but negative findings of temporal artery biopsies also showed an increased frequency of HLA‐DR4, but this did not reach statistical significance, probably because of the small number of subjects. It is likely that the increased frequency of DR4 in GCA patients is related to its association with PMR.
Dissection of the mechanisms of immune injury in rheumatoid arthritis, using total lymphoid irradiation
Authors: Gaston J. S. H. , Strober S. , Solovera J. J. , Gandour D. , Lane N. , Schurman D. , Hoppe R. T. , Chin R. C. , Eugui E. M. , Vaughan J. H. , Allison A. C.
Published: February 2007

Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation. After radiotherapy, there was a marked decrease in the number and function of peripheral blood helper/inducer (Leu‐3 +) T lymphocytes, in the spontaneous secretion of interleukin‐1 by synovial biopsy specimens, and in the activity of the joint disease. In contrast, levels of IgM, IgA, and IgG rheumatoid factors and C3 concentrations in blood and synovial fluid samples did not change significantly after therapy with total lymphoid irradiation.
Radiographic and joint count findings of the hand in rheumatoid arthritis. related and unrelated findings
Authors: Fuchs Howard A. , Callahan Leigh F. , Kaye Jeremy J. , Brooks Raye H. , Nance E. Paul , Pincus Theodore
Published: February 2007

Radiographic and physical joint count findings of the hands and wrists of 148 patients with rheumatoid arthritis (RA) were analyzed in a cross‐sectional study. Quantitative radiographic scores for joint space narrowing, erosion, and malalignment were correlated highly with joint count scores for limitation of motion and deformity, and were correlated at considerably lower levels with joint swelling scores. Radiographic scores, however, were not correlated at all with joint count tenderness scores. That 2 of the most widely used indices of RA disease activity, radiographic erosion scores and joint count scores for tenderness, were independent of one another at a selected timepoint, should be considered in the design of clinical trials and long‐term observation of patients with RA.
Arthritis in idiopathic hypereosinophilic syndrome
Authors: Manuel Martían‐Santo71s J. , Mulero Juan , Andréau J. Luis , De Villa Luis F. , Quiróas Luis Bernaldo‐De , Noguera Enrique
Published: February 2007

A 54‐year‐old man was admitted for tenosynovitis of the wrists, olecranon bursitis, stiffness, progressive flexion of the fingers, subcutaneous nodules, and persistent blood eosinophilia. A high eosinophil count was detected in his synovial fluid. We review the literature on idiopathic hypereosinophilic syndrome. This case provides evidence that nonerosive polyarthritis with periarticular involvement and nodules can be manifestations of this syndrome.
The ai/rheum knowledge‐based computer consultant system in rheumatology. performance in the diagnosis of 59 connective tissue disease patients from japan
Authors: Porter James F. , Kingsland Iii Lawrence C. , , Lindberg Donald A. B. , Shah Indravadan , Benge James M. , Hazelwood Susan E. , Kay Donald R. , Homma Mitsuo , Akizuki Masashi , Takano Makoto , Sharp Gordon C.
Published: February 2007

AI/RHEUM is a knowledge‐based computer consultant system for the diagnosis of rheumatic diseases. Its diagnostic accuracy was evaluated using information that was supplied by Japanese rheumatologists on 59 patients with connective tissue diseases. The diagnoses of the AI/RHEUM model were in full or partial agreement with those of the Japanese rheumatologists in 54 of 59 cases (92%). Preliminary evaluation of the criteria used by the model to diagnose mixed connective tissue disease showed a sensitivity of 90% and a specificity of 96%.
Abnormal glycosylation of serum igg from patients with chronic inflammatory diseases
Authors: Tomana Milan , Schrohenloher Ralph E. , Koopman William J. , Alarcän Graciela S. , Paul William A.
Published: February 2007

Results of carbohydrate analysis of serum IgG from patients with rheumatoid arthritis (RA) confirmed an earlier report that IgG from patients with RA is galactosylated to a lesser extent than IgG from healthy individuals. In contrast to the previous report, we found that the content of galactose in IgG from controls and RA patients was negatively correlated with age (P = 0.026 and P = 0.010, respectively). In RA patients, the IgG content of galactose was also negatively correlated with the pain index (P < 0.05) and was lower in the presence of rheumatoid factor (P < 0.05). No correlation was found between the galactose deficiency of IgG from RA patients and sex, race, duration of disease, packed red blood cell volume, radiographic grade, disability index, extraarticular manifestations, articular erosions, or treatment with steroids. Furthermore, no correlation was found between the galactose content of IgG and serum levels of IgM rheumatoid factor or the ability of IgG to bind IgM rheumatoid factor in vitro. Significant galactose deficiency was also detected in IgG from patients with systemic lupus erythematosus and Crohn's disease, which suggests that the defect in the galactosylation of IgG is a feature common to a variety of chronic inflammatory diseases. The biologic significance of this observation remains unclear.
Evidence for the presence of autoantibodies to the collagen‐like portion of c1q in systemic lupus erythematosus
Authors: Antes Ursula , Heinz Hans‐Peter , Loos Michael
Published: February 2007

We investigated the connection between the C1q solid‐phase binding assay (C1q SPBA) and doublestranded DNA antibodies, and analyzed the immune complex material in systemic lupus erythematosus (SLE) sera. Comparison with a new monoclonal assay for C1q‐bearing immune complexes (the 242G3 assay) revealed that the immune complexes in SLE bind specifically to solid‐phase C1q, and not to fluid‐phase C1q. The C1q solid‐phase binding activity sedimented as 7S IgG, was insensitive to DNase treatment, and could be selectively absorbed by C1q‐coupled beads and by bovine serum albumin–anti–bovine serum albumin C1q beads, but not by DNA. Thus, antibodies to doublestranded DNA do not interfere in the C1q SPBA. Isolated IgG from SLE serum precipitated the collagenlike portions, and not the globular, Fc‐recognizing portions, of C1q. F(ab')2 fragments of IgG from SLE patient serum were able to bind C1q. These data show that in SLE sera, especially in those with low levels of CH50 and C1q, autoantibodies that react with the collagen‐like part of C1q are detectable. Since in the C1q SPBA, the C1q molecule is randomly fixed to the solid phase, we can detect not only immune complexes, but also antibodies that react with the collagen part of C1q; this may explain the high percentage of positive results for SLE sera in the C1q SPBA, in contrast to results of other immune complex assays.
Serum keratan sulfate levels in osteoarthritis patients
Authors: Sweet M. Barry E. , Coelho Angelina , Schnitzler Christine M. , Schnitzer Thomas J. , Lenz Mary Ellen , Jakim Itzhak , Kuettner Klaus E. , Thonar EUGENE J.‐M. A.
Published: February 2007

Serum levels of keratan sulfate (KS), measured by an enzyme‐linked immunosorbent–inhibition assay, were found to be significantly higher in 31 patients with hypertrophic osteoarthritis (OA) than those in 41 adults without joint disease. Seventy‐seven percent of patients with OA, but only 12% of control subjects, had serum levels which were more than 1 SD above the mean of the control group. Following replacement of a single osteoarthritic hip joint, serum KS levels decreased, at first, in all patients. Subsequently, the concentration of serum KS progressively increased; 6 months following surgery, KS levels were similar or close to the preoperative levels in virtually all patients. The results suggest that patients with hypertrophic OA may have a generalized imbalance of cartilage proteoglycan metabolism. Measurements of serum KS are likely to prove most useful in studying this particular subset of patients with generalized OA.
Successful management of catastrophic gastrointestinal involvement in polyarteritis nodosa
Authors: Karp David R. , Kantor Owen S. , Halverson John D. , Atkinson John P.
Published: February 2007

A patient with polyarteritis nodosa developed necrotizing enterocolitis, as indicated by pneumatosis intestinalis seen on computed tomographic scans of the abdomen. Despite immunosuppressive therapy and concomitant resolution of the intramural and portal venous gas and general clinical improvement, on 2 occasions (between 20 and 30 days later) the patient developed bowel infarctions and perforations that necessitated bowel resection. Leaks developed at anastomotic sites, but were not closed surgically. However, these sites and the lower quadrants of the abdomen were drained, and the patient was given total parenteral nutrition. Over a 2‐month period the patient completely recovered from this nearly always fatal gastrointestinal complication of polyarteritis nodosa. The medical, surgical, and radiographic approach we used may be applicable to the management of similar cases in the future.
Clinical assessment of atlantoaxial instability using the sharp‐purser test
Authors: Uitvlugt Gregory , Indenbaum Samuel
Published: February 2007

Anterior atlantoaxial subluxation is common in rheumatoid arthritis patients with involvement of the cervical spine. Sharp and Purser have described a test for the clinical assessment of this instability. We assessed the validity of the Sharp‐Purser test in 123 outpatients with rheumatoid arthritis. Our findings indicate a predictive value of 85% and a specificity of 96%. The sensitivity was 88% when subluxation was > 4 mm. Our results show that the Sharp‐Purser test is a useful clinical examination to diagnose atlantoaxial instability.
The diagnosis of polyarteritis nodosa
Authors: Albert Daniel A. , Rimon David , Silverstein Marc D.
Published: February 2007

We investigated diagnostic testing in polyarteritis nodosa (PAN) by calculating, from published data, the sensitivity and specificity of visceral angiography and muscle, nerve, testicle, kidney, and liver biopsy. Test sequence strategies were constructed by Bayesian inference using a computer program written for this purpose. Test sequences were compared with an aggressive strategy consisting of repeated tests until there was a positive finding or until the available tests were exhausted, and a conservative strategy consisting of 1 biopsy procedure plus angiography. The Bayesian analysis agreed most closely with the conservative approach for most prior probabilities (degree of suspicion) that a patient had PAN. The aggressive strategy had an overall sensitivity of 90% and specificity of 91%, whereas the conservative strategy was 85% sensitive and 96% specific. Furthermore, the aggressive strategy was more costly ($2,986 versus $1,961) and had a higher rate of morbidity (3.8 versus 2.7 days of hospitalization per patient evaluated) than did the conservative strategy. The mortality rates of both strategies were equivalent (∼0.05 deaths per hundred patients evaluated). The per‐case cost of diagnosis increased as prevalence decreased, and at 10% prevalence, the aggressive strategy cost more than $17,000 per case diagnosed. Sensitivity analysis revealed that the strategies were moderately affected by the test characteristics, within reasonable assumptions, but that the differences in conservative and aggressive approaches remained. Thus, our analysis based on available data and the assumption of test independence suggests that the preferred diagnostic evaluation of patients with symptoms suggestive of PAN consists, in most cases, of a single biopsy procedure, with angiographic evaluation if necessary.
Systemic joint laxity (the hypermobile joint syndrome) is associated with temporomandibular joint dysfunction
Authors: Harinstein David , Buckingham Robert B. , Braun Thomas , Oral K. , Bauman Dorothy H. , Killian Paul J. , Bidula Leo P.
Published: February 2007

A consecutive series of 37 individuals admitted to the hospital for elective temporomandibular joint (TMJ) reconstructive surgery and 3 seen as outpatients with TMJ disease were evaluated for rheumatic disease or for another etiologic factor that might account for this problem. These 40 patients were screened by history, physical examination, and laboratory study. We soon noticed that many patients had generalized joint laxity. Eighteen of the first 40 individuals satisfied established criteria for the hypermobile joint syndrome. An additional 3 were found to have Ehlers‐Danlos syndrome or a forme fruste of this disorder. Many were markedly hypermobile and could perform a number of flexible maneuvers. Although excessive joint laxity is known to be associated with a variety of rheumatic conditions, TMJ disease has not been recognized as one of them. No patient in this series had a systemic inflammatory disorder or any other apparent etiologic factor for TMJ disease. We suggest that there is a cause‐and‐effect relationship between generalized joint laxity and TMJ disease.
Treatment with gamma‐interferon triggers the onset of collagen arthritis in mice
Authors: Mauritz Nils Johan , Holmdahl Rikard , Jonsson Roland , Van Meide Peter H. Der , Scheynius Annika , Klareskog Lars
Published: February 2007

We investigated the effect of gM‐interferon (gM‐IFN) on the development of type II collagen (CII)‐induced arthritis. DBA/1 mice were immunized with rat CII and 16 days later, were treated with subcutaneous injections of recombinant rat gM‐IFN into the right paws twice a week. Compared with controls, the gM‐IFN‐treated mice developed arthritis with a higher frequency and severity. Immunohistochemical analysis of gM‐IFN‐treated paws from CII‐immunized mice revealed an increase in the numbers of class II antigen‐expressing cells and an infiltration of CD4+ lymphocyte‐like cells. The auto‐antibody response toward CII was suppressed by gM‐IFN treatment. The findings implicate gM‐IFN in a role that triggers arthritis by enhancing local inflammatory processes in the joints, or possibly, by permitting homing of T cells to the joints.
Sequential development of antibodies to specific sm polypeptides in a patient with systemic lupus erythematosus: evidence for independent regulation of anti—double‐stranded dna and anti‐sm antibody production
Authors: Ter Borg E. J. , Horst G. , Hummel E. , Jaarsma D. , Limburg P. C. , Kallenberg C. G. M.
Published: February 2007

We describe a patient with systemic lupus erythematosus who, after a disease flare, sequentially produced antibodies to specific Sm polypeptides (demonstrated by counterimmunoelectrophoresis, immunoblotting, and RNA immunoprecipitation) concomitantly with the disappearance of anti—double‐stranded DNA antibodies. Immunoblotting studies revealed that antibodies to the D polypeptide appeared first, followed by antibodies to BB′ and E polypeptides, respectively. Our findings suggest that antibodies to the Sm‐specific polypeptides do not occur simultaneously and that the regulation of their production is independent of that of antibodies to double‐stranded DNA.
Induction of an acute erosive monarticular arthritis in mice by interleukin‐1 and methylated bovine serum albumin
Authors: Staite Nigel D. , Richard Karen A. , Aspar Danielle G. , Franz Katherine A. , Galinet Louise A. , Dunn Colin J.
Published: February 2007

We examined the effect of interleukin‐1 (IL‐1) administration on a mild and transient inflammatory response in the knees of mice injected intraarticularly with methylated bovine serum albumin (mBSA). Injection of mBSA on day 0 into nonsensitized mice caused a weak inflammatory response confined to the infrapatellar fat pads and involved infiltration by mononuclear cells, neutrophils, and eosinophils. The response developed between days 4 and 7 and resolved by day 28. No erosion of cartilage or subchondral bone was seen. In contrast, mBSA‐treated mice injected with recombinant human IL‐1β subcutaneously in the ipsilateral footpad on days 0–3 developed a severe monarticular arthritis in the antigen‐injected knee. Pannus developed, extending over the articular surfaces, and extensive erosion of cartilage and subchondral bone occurred. Multinucleated giant cells, together with fibrin‐like material, were observed at sites of active bone erosion and debris, and large numbers of neutrophils were seen in the joint space. These pathologic features represent a new arthritis model in which IL‐1 profoundly augments a weak inflammatory response and induces acute erosive joint destruction, supporting the hypothesis that IL‐1 is an important cytokine in the pathogenesis of arthritis.
Prolonged improvement of raynaud's phenomenon and scleroderma after recombinant tissue plasminogen activator therapy
Authors: Fritzler Marvin J. , Hart David A.
Published: February 2007

We describe a patient with systemic sclerosis (SSc; scleroderma) characterized by severe Raynaud's phenomenon, cutaneous sclerosis, and digital ulceration and subsequent amputation who was treated with recombinant tissue plasminogen activator (rt‐PA) after acute myocardial infarction. She showed prompt improvement of the Raynaud's phenomenon and healing of the digital ulceration. After 18 months of followup, the Raynaud's phenomenon has remained mild, and there has been improvement in the cutaneous sclerosis. Since the pathophysiology of SSc has been associated with disorders of fibrinolysis and coagulation, this patient represents an interesting index case that might prompt further evaluation of rt‐PA therapy in carefully selected patients.
Atypical presentations of polymyalgia rheumatica
Authors: Fitzcharles Mary‐Ann , Esdaile John M.
Published: February 2007

Seventy patients with polymyalgia rheumatica (PMR) were seen at a suburban rheumatology practice from July 1983 to December 1987. Six of these patients presented without the typical limb girdle features associated with PMR. Presenting symptoms included peripheral synovitis or unilateral shoulder pain (3 patients), lower leg pain (3 patients), carpal tunnel syndrome (1 patient), and abdominal pain (1 patient). The disease evolved into the recognizable syndrome of PMR over a period of 2–12 months. We suggest that PMR may present in a variety of guises, or have a “stuttering evolution” to the full syndrome. The presenting manifestations of these atypical cases result from peripheral synovitis and thus represent a variant of the more common subclinical proximal synovitis seen in PMR. Increased clinical awareness of atypical presentations may assist earlier diagnosis and effective treatment.
Inflammation and cartilage metabolism in rheumatoid arthritis. Studies of the Blood Markers Hyaluronic Acid, Orosomucoid, and Keratan Sulfate
Authors: Poole A. Robin , Witter James , Roberts Nancy , Piccolo Frank , Brandt Ragnhild , Paquin Julie , Baron Murray
Published: February 2007

Single analyses of peripheral blood of rheumatoid arthritis (RA) patients showed a significant reduction in the mean value for keratan sulfate (KS) compared with that in control subjects, but the mean value for orosomucoid (OM) was elevated compared with that in control subjects. Some RA patients displayed highly elevated levels of hyaluronic acid (HA), while others exhibited normal levels. There was a significant inverse correlation between OM and KS content in RA patients, as well as a direct correlation between HA and OM. In longitudinal studies of RA patients, parallel changes in OM and HA and inverse changes between KS and OM or HA were commonly observed. Clinical analyses revealed that there was an inverse correlation between KS and morning stiffness, and direct correlations between the number of tender joints and HA, and between HA or the erythrocyte sedimentation rate and the number of joints with effusions. The reason(s) for the inverse correlation between KS and OM as an index of systemic inflammation remains to be established. Circulating HA represents an index of joint inflammation, for which a marker has not been previously available.
Enhanced Production Of Interleukin‐1 And Tumor Necrosis Factor α By Cultured Peripheral Blood Monocytes From Patients With Scleroderma
Authors: Umehara Hisanori , Kumagai Shunichi , Murakami Masao , Suginoshita Toshihiko , Tanaka Koichiro , Hashida Seiichi , Ishikawa Eiji , Imura Hiroo
Published: February 2007

Cultured peripheral blood mononuclear cells from 20 patients with scleroderma were shown to produce high levels of interleukin‐1α, interleukin‐1β, and tumor necrosis factor α. There were positive correlations between the production of these 3 molecules. Purified monocytes from these patients produced much more tumor necrosis factor α than did those from normal subjects, even without lipopolysaccharide stimulation. These results show the hyperactivity of monocytes from scleroderma patients.
Idiotypic characteristics of immunoglobulins associated with human systemic lupus erythematosus: association of high serum levels of IdGN2 with nephritis but not with HLA class ii genes predisposing to nephritis
Authors: Hahn Bevra H. , Kalunian Kenneth C. , Fronek Zdenka , Panosian‐Sahakian Niver , Louie James S. , Mcdevitt Hugh O. , Ebling Fanny M.
Published: February 2007

Serum levels of IdGN2 (an idiotype enriched in nephritogenic antibodies), IdX (an idiotype not enriched in nephritogenic antibodies), IgG, and anti‐DNA were measured in 23 Caucasian patients with lupus nephritis, in age‐ and sex‐matched lupus patients without nephritis, and in similarly matched healthy individuals. Serum levels of IdGN2 were significantly higher in the patients with lupus nephritis than in those without, and they were higher in all lupus patients compared with the healthy control subjects. However, the same observations were true for serum levels of IdX. There were significant positive correlations between the serum levels of IgG, IdGN2, IdX, and anti‐DNA. HLA typing at the DR and DQ loci was performed in 105 lupus patients of different races (Caucasian, black, and Asian/Polynesian/Filipino). Serum levels of IdGN2 in 83 of these individuals did not correlate with any of the HLA class II haplotypes currently known to predispose to lupus nephritis. We conclude that the high serum levels of IdGN2, which are characteristic of some patients with lupus nephritis, may often result from polyclonal B cell activation rather than from idiotype‐specific up‐regulation associated with one or more of the class II genes that predispose to nephritis in this disease.
Low molecular weight serine proteinase inhibitors of human articular cartilage. Isolation, Characterization, and Biosynthesis
Authors: Andrews John L. , Ghosh Peter
Published: February 2007

The major low molecular weight serine proteinase inhibitor of human articular cartilage was purified to homogeneity as determined by single‐peak elution with 4 high resolution techniques. The purified protein was found to be a potent inhibitor of human leukocyte elastase and cathepsin G, as well as the native serine proteinases derived from human articular cartilage and intervertebral disc. The inhibitor and lysozymes were synthesized by human articular cartilage in vitro. These properties and the ability of this cationic inhibitor to bind to cartilage matrix components suggest a possible role in the modulation of matrix catabolism in normal and pathologic states.
Magnetic resonance imaging of articular destruction in juvenile rheumatoid arthritis
Authors: Verbruggen Leon A. , Shahabpour Maryam , Roy Peter Van , Osteaux Michel
Published: February 2007

We describe herein magnetic resonance imaging of the right knee of a patient affected by a severe form of juvenile rheumatoid arthritis. Magnetic resonance imaging findings of articular damage of the knee during the disease course and after arthroscopic synovectomy are described.
Activation of t cell subsets in the peripheral blood of patients with Sjögren's syndrome multicolor flow cytometric analysis
Authors: Ichikawa Yukinobu , Shimizu Hiroaki , Yoshida Miyoko , Arimori Shigeru
Published: February 2007

Using 3‐color flow cytometry, we determined the proportions of activated T cells (DR+), including CD4+ cells, CD8+ cells, and their subsets, in the peripheral blood of 17 patients with Sjögren's syndrome (SS). Activated T cells were significantly increased in CD4+ cells, CD8+ cells, and T suppressor inducer (CD4+, Leu‐8+), T helper (CD4+, Leu‐8‐), and T cytotoxic (CD8+, CD11‐) subsets, but not the T suppressor/natural killer subset (CD8+, CD11+), in patients with SS as compared with the controls. Furthermore, the proportions of activated T cells in the CD4+, Leu‐8‐subset, the CD8+ subset, or the CD8+, CD11‐ subset showed a positive correlation with serum gamma globulin levels in the SS patients. Our findings suggest that a certain immunoregulatory balance between T helper and T suppressor activities is maintained in SS patients, although this balance seems to occur at highly activated levels, and that quantitative changes of some lymphocyte subsets are important factors in maintaining this balance. We discuss the possibility that CD4+, Leu‐8+ cells recirculate into peripheral lymph nodes, while CD4+, Leu‐8‐ cells migrate into inflammatory tissues such as salivary glands, since the Leu‐8 antigen is reported to be a homing receptor in peripheral lymph nodes. This process might be accelerated in SS, and each T cell subset may further participate in immunologic activation in the lymph nodes or target tissues.
Nontropical pyomyositis as a cause of subacute, multifocal myalgia in the Acquired Immunodeficiency Syndrome
Authors: Wolf Rienhart F. , Sprenger Herman G. , Mooyaart Eduard L. , Tamsma Jouke T. , Kengen Roland A. , Weits Jan
Published: February 2007

We report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated Mycobacterium avium infection, in which severe myalgia was the presenting symptom over several weeks. Multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques. The epidemiology, possible pathogenesis, clinical features, diagnostic imaging, and therapy are reviewed. Early suspicion of nontropical pyomyositis in severely immunocompromised patients with “cryptic” myalgia is recommended.
Prognostic significance of anticentromere antibodies and anti–topoisomerase i antibodies in Raynaud's disease. A prospective study
Authors: Weiner Ethan S. , Hildebrandt Sabine , Senécal Jean‐Luc , Daniels Lesley , Noell Steven , Joyall France , Roussin André , Earnshaw William , Rothfield Naomi F.
Published: February 2007

Seventy‐seven patients with Raynaud's disease were studied for a mean of 4 years (range 1–11 years) to determine the relationship between autoantibodies and long‐term clinical outcome. Anticentromere antibodies (ACA) were assayed by indirect immunofluorescence and by immunoblotting of HeLa cell chromosome extracts. Antibodies to topoisomerase I (anti–topo I) were assayed by immunodiffusion and immunoblotting. Antibodies to the major centromeric protein, CENP‐B, and anti–topo I were studied by enzyme‐linked immunosorbent assay (ELISA). Eight patients developed telangiectasias, 4 developed skin tightening, and 4 developed a connective tissue disease other than scleroderma. The presence of ACA at the start of the study was associated with the development of telangiectasias (P < 0.003). An initial 100‐kd band on immunoblot in conjunction with a positive anti–topo I ELISA result was associated with the development of tight skin (P < 0.0025), while a 100‐kd band with a negative anti–topo I ELISA result was associated with the subsequent development of a connective tissue disease other than scleroderma (P < 0.0073). Patients who were initially ACA positive, had the 100‐kd band on immunoblot, or had positive ELISA results for anti–topo I or for anti‐CENP‐B were 63‐fold more likely to develop signs of connective tissue disease by the end of the study (P < 0.000009). The presence of any of these autoantibodies was more sensitive (100%), although less specific (75%), than were findings from nailfold capillaroscopy (sensitivity 67% and specificity 95%) in predicting subsequent clinical progression. We conclude that findings of assays for anti–topo I and ACA complement the findings from nailfold capillaroscopy in providing useful prognostic information in Raynaud's disease.
Treatment of rheumatoid arthritis with an anti‐CD4 monoclonal antibody
Authors: Horneff Gerd , Burmester Gerd R. , Emmrich Frank , Kalden Joachim R.
Published: February 2007

The effect of treatment with a monoclonal antibody against the CD4 antigen present on T helper cells was studied in 10 patients with severe intractable rheumatoid arthritis. In an open trial, monoclonal antibody 16H5 was infused at a dosage of 0.3 mg/kg of body weight on 7 consecutive days. Studies of the kinetics demonstrated a drastic depletion of CD4+ cells, to as low as 25 cells/μl, 1 hour after the first infusion. The subsequent recovery of the CD4+ cell numbers 24 hours after infusion did not reach initial levels, and after the full 7‐day treatment cycle there was a significant reduction of the number of CD4+ cells (mean ± SD 51 ± 28%; P < 0.02). There was a reduced or even inverse CD4:CD8 ratio, which generally persisted 3–4 weeks. Lymphocyte transformation assays demonstrated significantly reduced reactivity in 5 of the 9 patients who completed the 7‐day course, whereas 4 individuals exhibited an unexpected elevation in the T cell response to mitogens and common antigens. Parallel laboratory studies showed a significant decrease in the erythrocyte sedimentation rate (P < 0.05), rheumatoid factor titer (P < 0.04), and total immunoglobulin values (P < 0.01), as well as a reduction in C‐reactive protein levels, in 7 of the 9 patients. Clinically, there was a significant reduction in the Ritchie articular index (P < 0.05) and in the number of swollen joints (P < 0.04). Adverse effects were urticaria in 2 patients, which led to withdrawal of therapy in 1 of them, and chills with fever, suggestive of a lymphokine release syndrome, in another 2 patients. Only low levels of human anti‐mouse immunoglobulin antibodies developed (not exceeding 1.7 mg/liter). It was therefore possible to repeat the treatment cycle, achieving still better efficacy, in 4 of the patients (reductions in the Ritchie index and the number of swollen joints P < 0.02). Our findings indicate that treatment with monoclonal antibodies against the CD4 antigen leads to immunomodulation which results in clinical benefits, at least during initial observation periods (up to 6 months postinfusion). However, it remains to be determined whether long‐term remission can be induced with this therapeutic approach. The use of immunosuppressive therapies or repeated antibody treatments will have to be considered.