bluuebunny/crossref_metadata_2025 huggingface dataset:
Takayasu's arteritis associated with crescentic glomerulonephritis
Authors: Hellmann David B. , Hardy Kenneth , Lindenfeld Stan , Ring Ernest
Published: February 2007

We describe the initial course and followup of a 16‐year‐old white female patient who presented in 1983 with aortitis and rapidly progressive renal failure. Renal biopsy revealed crescentic glomerulonephritis. Segmental occlusions of the distal aorta and both common iliac arteries were demonstrated on aortography. Initially, her renal function and arterial occlusions markedly improved with pulse prednisolone therapy, but 34 months later, the glomerulonephritis and aortitis worsened. This case report, the first of its kind, documents both the association of Takayasu's arteritis with crescentic glomerulonephritis and a marked, though incomplete, response to pulse therapy.
Histopathologic evaluation of the effects of etodolac in established adjuvant arthritis in rats: evidence for reversal of joint damage
Authors: Weichman Barry M. , Chau Thuy T. , Rona George
Published: February 2007

Histopathologic evaluation of hindpaws from control rats with established adjuvant arthritis showed severe alterations in soft tissue and bone, as well as progressive, moderate‐to‐severe articular changes. Following treatment with etodolac for 28 days, soft tissue and articular changes were rated mild, and bone changes were rated moderate, but with remodeling. These findings indicate that etodolac partially reversed the joint damage in these rats.
Immunologic studies of rheumatoid arthritis patients treated with methotrexate
Authors: Olsen Nancy J. , Callahan Leigh F. , Pincus Theodore
Published: February 2007

Immunologic functions of peripheral blood mononuclear cells were studied in rheumatoid arthritis (RA) patients treated with methotrexate (MTX). Spontaneous IgM rheumatoid factor (IgM‐RF) synthesis by unstimulated cultured blood mononuclear cells was seen in only 3 of 18 MTX‐treated patients, compared with 31 of 54 RA patients who were not receiving long‐acting drugs. Total IgM production by unstimulated cultured mononuclear cells, pokeweed mitogen‐induced antibody synthesis, and plasma levels of IgM‐RF were also lower in MTX‐treated patients than in other RA patients. The numbers of circulating B cells, T4 and T8 cells, the T4:T8 cell ratio, and mitogen‐induced proliferation indices were similar in MTX‐treated and non‐MTX‐treated patients. Eleven additional patients were studied prospectively after initiation of MTX therapy. All showed significant decreases in spontaneous IgM‐RF synthesis, with declining IgM‐RF:IgM ratios, including all of the 9 who were studied during the first 24 hours of treatment. The results indicate that MTX has rapid effects on IgM‐RF synthesis, and this action might be associated with its therapeutic efficacy in RA.
Microheterogeneity of alpha1‐acid glycoprotein in the detection of intercurrent infection in systemic lupus erythematosus
Authors: Mackiewicz Andrzej , Marcinkowska‐Pieta Renata , Ballou Stanley , Mackiewicz Stefan , Kushner Irving
Published: February 2007

We evaluated the clinical usefulness of determinations of α1‐acid glycoprotein microheterogeneity patterns in distinguishing patients who have active systemic lupus erythematosus (SLE) from those who have SLE with intercurrent infection. We used agarose affinity electrophoresis with concanavalin A (Con A) as a ligand. Results were expressed as reactivity coefficients (RC), which are the ratios of variants reactive with Con A to the variants not reactive with Con A. No significant differences were found between the mean RC (±SD) in healthy individuals (1.35 ± 0.26) and that in patients with various degrees of SLE activity. In contrast, a significantly higher mean RC was found in sera from patients with intercurrent infection (2.70 ± 0.76) compared with each of the other groups studied (P < 0.001). An RC > 2.25 was found in none of 42 sera from patients without infection and in 15 of 18 sera from patients with infection (sensitivity 83%, specificity 100%). C‐reactive protein (CRP) levels were also significantly higher in SLE patients with intercurrent infection than in patients with very active disease (P < 0.05). Levels of CRP >60 mg/liter were found in 3 of 42 SLE patients without infection and in 8 of 18 patients with infection (sensitivity 39%, specificity 93%). The results show that in SLE patients, the finding of a relative increase in Con A—bound serum α1‐acid glycoprotein is a more sensitive indicator of intercurrent infection than is the finding of increased levels of CRP.
Proteoglycan‐degrading acid metalloprotease activity in human osteoarthritic cartilage, and the effect of intraarticular steroid injections
Authors: Pelletier J. P. , Martel‐Pelletier J. , Cloutier J. M. , Woessner J. F.
Published: February 2007

Cartilage samples from both the immediate and remote lesion areas were obtained from the tibial plateaus of 21 patients with osteoarthritis, and were subjected to histologic and enzymatic study. There was a frequent loss of pericellular metachromatic staining in the OA cartilage. Seven patients had received intraarticular injections of steroids, and in 21% of those cartilage samples, a pericellular halo was seen. This halo was seen in 71% of patients who had not received steroid injections. The total acid metalloprotease activity was increased more than twofold in specimens from OA lesions and in those samples graded moderate, as compared with age‐matched control cartilages. These differences were greater when the specimens from patients who had received steroid therapy were excluded from the data. The cartilage specimens from steroid‐treated patients were not significantly different from those of controls with respect to the enzyme activity in the lesions or in cartilage with moderate disease. The active form of the protease was suppressed by steroids. In samples from patients who did not receive steroid injections and who had a moderate grade of OA, a significantly elevated level of the active protease was present, as compared with control samples. Those samples graded moderate which came from patients who received steroid treatments showed no difference in the active protease level versus that of controls. Our results are consistent with the hypothesis that acid metalloprotease activity is involved in the degradation of the cartilage matrix in OA. Since the protease retains a significant fraction (40%) of its activity at neutral pH, its physiologic role might occur either at acid pH or at neutral pH. The halo surrounding the chondrocytes (the result of a local loss of proteoglycan) might be related to the action of this enzyme. Preliminary evidence has suggested that steroids reduce cartilage enzyme activity.
Ultraviolet‐a light prolongs survival and improves immune function in (new zealand black × new zealand white)F1 hybrid mice
Authors: Jr Hugh Mcgrath, , Bak Elizabeth , Michalski Joseph P.
Published: February 2007

Although ultraviolet (UV) light is generally harmful to patients with systemic lupus erythematosus, most clinical and immunologic studies of UV exposure have evaluated the effects of UV‐B (280–320 nm). The long‐wavelength UV‐A band (320–400 nm), however, is less toxic than UV‐B and has different immunologic actions. Therefore, we studied the effect of UV‐A irradiation on survival and immunologic function in the (New Zealand black x New Zealand white)F1 hybrid mouse model of systemic lupus erythematosus. Twenty‐one (New Zealand black x New Zealand white)F1 mice were treated with 3.5 joules/cm2/day of UV‐A light for 5 days each week, beginning at age 10 weeks. A control group consisted of 20 untreated animals. All UV‐A‐irradiated mice survived to 32 weeks, compared with 12 of 20 mice in the nonirradiated group (P = 0.0013). Splenomegaly was significantly decreased in the irradiated mice (P = < 0.03). Mice that received UV‐A treatment combined with depilcation had significantly improved lymphocyte responses to phytohemagglutinin and lipopolysaccharide and significantly decreased levels of anti‐DNA antibodies compared with mice that received neither treatment. Reductions in spleen size and anti‐DNA antibody titer were significantly correlated with improved parameters of lymphocyte function. These results suggest that a relatively small dose of UV‐A exerts significant therapeutic action in murine lupus, perhaps through an effect on immunologic regulation.
Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. A controlled, prospective study of forty‐four women
Authors: Petri Michelle , Golbus Mitchell , Anderson Robert , Whiting‐O'Keefe Quinn , Corash Laurence , Hellmann David
Published: February 2007

In a controlled, prospective study of 44 consecutive women with idiopathic habitual abortion, only 5% had symptoms of rheumatic disease. Patients did not differ from control subjects in the frequency of positive results on tests for antinuclear antibody or anti‐double‐stranded DNA. Levels of C3 and C4 were higher in the habitual aborters. No patients had anti‐Ro. The antiphospholipid antibody results were analyzed using 2 methods: the frequency of antiphospholipid antibodies was 9% by lupus anticoagulant using the Russell viper venom time (95% confidence interval 22–2.5) and 11% by anticardiolipin antibody assay (95% confidence interval 25–3.7), which was not significantly different from that in control subjects. However, the mean levels in the aborters (although within the normal range) were significantly higher than those in control subjects for anti‐double‐stranded DNA (P = 0.004), lupus anticoagulant (by Russell viper venom time; P = 0.05), and anticardiolipin antibody (P = 0.0007), when examined by multiple linear regression analysis corrected for age and concurrent pregnancy. Of the 3 patients with antiphospholipid antibodies and subsequent successful pregnancies, only 1 was treated with prednisone and aspirin. We conclude that, in the majority of women, subclinical lupus, anti‐Ro, the lupus anticoagulant, and anticardiolipin antibodies are not associated with idiopathic habitual abortion.
Variation in synovial fluid analysis by hospital laboratories
Authors: Hasselbacher Peter
Published: February 2007

A survey of 42 hospitals revealed that the frequency of synovial fluid analysis was low (mean 3.9 per month). The mean was skewed upward by a higher frequency in 3 teaching hospitals, such that the overall median was 1.5 per month, with 15 hospitals studying 1 or less per month. There did not appear to be any consensus regarding what constitutes a routine synovial fluid analysis. Technical errors occurred, including dilution with acetic acid for cell counts and inappropriate use of automated cell counters. Twenty‐six laboratories studied 4 “unknown” fluids for crystals. In 50 opportunities to detect each crystal type, calcium pyrophosphate was detected only 6 times, and sodium urate was detected 39 times. The white blood cell count reported for a single fluid ranged from 2, 467–12,000/mm3 (mean ± SD 6,683 ± 1,992). The proportion of neutrophils identified varied from 0–30% (mean ± SD 13.8 ± 8.6). The majority of respondents believed that training and reference materials related to synovial fluid analysis should be improved.
Monoclonal murine anti‐dna antibody interacts with living mononuclear cells
Authors: Okudaira Kunio , Yoshizawa Hisayoshi , Williams Ralph C.
Published: February 2007

A monoclonal mouse antibody, 4‐B‐5, that reacted with both single‐stranded DNA (ssDNA) and double‐stranded DNA showed direct reactivity and cell association with mouse thymocytes, as well as peripheral blood mononuclear cells. Absorption of 4‐B‐5 with peripheral blood mononuclear cells or with mouse thymocytes markedly reduced reactivity with both ssDNA and double‐stranded DNA. However, treatment of mouse thymocytes or human T cells with DNase completely eliminated monoclonal anti‐DNA reactivity with cells. The cellular reactivity was completely restored when monoclonal anti‐DNA was incubated with DNase‐treated cells in the presence of normal human serum. Normal human serum was found to contain 574 ± 639 ng/ml of ssDNA. Coincubation or cell preincubation of mouse thymocytes with ssDNA produced a marked increase in 4‐B‐5 cell association. These findings indicate that mouse monoclonal anti‐DNA can react with and can penetrate both mouse and human mononuclear cells, and that this reactivity may depend on the presence of cell membrane DNA on both types of target cells.
Experimental arthritis induced by polysaccharide macromolecules
Authors: Aaron Roy K. , Sledge Clement B. , Shortkroff Sonya
Published: February 2007

Several polysaccharide macromolecules are capable of inducing synovial inflammation. Characteristics of polysaccharides that have this capacity were studied in an in vivo rabbit model. The ability to induce synovial inflammation was positively correlated with the presence of sulfate and with high molecular weight. Understanding the characteristics of molecules that produce inflammation may help in the investigation to determine what mechanisms initiate the inflammatory response.
Macrophage migration and maturation within rheumatoid nodules
Authors: Palmer David G. , Hogg Nancy , Highton John , Hessian Paul A. , Denholm Ian
Published: February 2007

In long‐established rheumatoid nodules, monocytes continue to be recruited and to migrate from the outer vascular zone toward the palisade and central necrotic area. Maturation of these cells is shown to take place during tissue migration. We found that the great majority of palisade cells express exclusive mononuclear phagocyte phenotypes. Among this mononuclear phagocyte population are many cells that bear the receptor for iC3b (CR3), but few that bear the receptor for C3b (CR1). HLA–D region molecule expression is intense and widespread.
Assessment of the reliability and validity of the arthritis impact measurement scales for children with juvenile arthritis
Authors: Coulton Claudia J. , Zborowsky Elizabeth , Lipton Judith , Newman Arthur J.
Published: February 2007

There are few multidimensional measures of functional status in children, and none have been developed for children with juvenile arthritis (JA). This report describes an attempt to apply selected components of the Arthritis Impact Measurement Scales (AIMS), which were developed and validated for adults, to a sample of children with active JA (n = 60) or inactive JA (n = 17). Our results suggest that the Pain scale and the Physical Activity scale are the most reliable measures for children with JA; the correlations of the Pain scale, Physical Activity scale, and Dexterity scale results with the clinical measures of JA diagnostic category and joint count support the convergent validity of these scales for the active JA group; and the AIMS revised Physical Disability dimension and the Pain dimension, used to predict the children's classification in the active or inactive JA group, evidence discriminant validity. Additional studies of children with a wider range of impairments are needed to further assess the usefulness of the AIMS for children with JA.
Hypertrophic osteoarthropathy, cutaneous vasculitis, and mixed‐type cryoglobulinemia in a patient with nasopharyngeal carcinoma
Authors: Miyachi Hayato , Akizuki Masashi , Yamagata Hajime , Mimori Tsuneyo , Yoshida Shunji , Homma Mitsuo
Published: February 2007

We describe a 27‐year‐old woman with a primary nasopharyngeal carcinoma who developed hypertrophic osteoarthropathy and cutaneous vasculitis. Her serum contained antibodies to Epstein‐Barr virus and U1 RNP antigens. Cryoproteins isolated from her serum contained antibodies to U1 RNP and a protein with a molecular weight of 32 kd which reacted specifically with antibodies to U1 RNP. HLA typing revealed HLA‐B7 and DR1; these have been reported to be increased in Japanese patients with rheumatic diseases who have autoantibodies to U1 RNP. These findings indicate that some features of the paraneoplastic syndrome in this patient might have been caused by immune complexes, part of which were formed by specific autoantibodies produced under genetically controlled conditions of immune responsiveness.
Marked increase in the frequency of psoriatic arthritis in psoriasis patients with hla–dr+ keratinocytes
Authors: Gottlieb Alice B. , Fu Shu Man , Carter D. Martin , Fotino Marilena
Published: February 2007

Immunocytochemical studies with a monoclonal anti–HLA–DR antibody were performed on skin sections and keratinocyte (KTC) suspensions obtained from suction blisters of active psoriatic plaques. HLA–DR+ KTCs were found in the plaques of 23 of 38 patients with active psoriasis. Of these 23, 16 had clinical findings typical of psoriatic arthritis (PA); none of the 15 patients who lacked HLA–DR+ KTCs had PA. Although KTC HLA–DR expression was more prevalent in patients with severe skin disease, 7 of the 23 patients with HLA–DR + KTCs in active psoriatic plaques had mild skin disease; 4 of these 7 had PA. Nail pitting or duration of skin disease did not account for increased incidence of PA in patients with HLA–DR+ KTCs. All psoriasis patients with arthritis received nonsteroidal antiinflammatory drug therapy; 14 received additional therapy directed primarily to the cutaneous manifestations of psoriasis. Nine of these noted arthritis improvement with concurrent skin response; however, in 5 patients, arthritis activity increased, despite improvement of the cutaneous disease. Two other patients, treated with methotrexate, also had concurrent skin and joint improvement. These data suggest that psoriasis patients with HLA–DR + KTCs are at increased risk for the development of associated arthritis.
Attributional processes in rheumatoid arthritis patients
Authors: Affleck Glenn , Pfeiffer Carol , Tennen Howard , Fifield Judith
Published: February 2007

In a study of 92 patients with rheumatoid arthritis, we examined patients' beliefs about the causes of their illness, disease flares, and disease remissions, and about the selective incidence of the disease. Numerous self‐report measures were used to elucidate the patients' attitudes and perceptions; the tendency of patients to present themselves in socially desirable ways was taken into account and was found not to influence the study results. The causes for the illness that were most frequently cited by patients were heredity (34.7%), autoimmune factor (24.4%), personal behaviors (22.8%), and psychological stress (22.8%). Patients who were more actively searching for the causes of the illness and who continued to ask “Why me?” reported greater functional problems and a greater sense of helplessness. The most frequently cited causes for symptom flares were psychological stress (45.5%), changes in weather (34.0%), and excessive physical activity (34.1%). Symptom remissions were most frequently believed to be related to medication changes (49.4%) and the absence of psychological stress (21.0%). Several of these causal beliefs were related to perceptions of helplessness and the illness' predictability and to health care providers' assessments of disease severity and patients' psycho‐social adjustment.
Transverse myelitis and optic neuritis in systemic lupus erythematosus: a case report with magnetic resonance imaging findings
Authors: Kenik Jay G. , Krohn Kelly , Kelly Richard B. , Bierman Martin , Hammeke Michael D. , Hurley John A.
Published: February 2007

We describe a patient with systemic lupus erythematosus who developed transverse myelitis and optic neuritis. Magnetic resonance imaging showed the presence of an abnormal signal in a normal‐sized spinal cord which corresponded to the patient's neurologic deficit. No abnormality was recognized in either optic nerve. Magnetic resonance may prove to be a useful imaging modality for the diagnosis of a transverse myelopathy in systemic lupus erythematosus.
Inherited deficiency of erythrocyte complement receptor type 1 does not cause susceptibility to systemic lupus erythematosus
Authors: Moldenhauer F. , David J. , Fielder A. H. L. , Lachmann P. J. , Walport M. J.
Published: February 2007

There is a deficiency of complement receptor type 1 (CR1) on the erythrocytes of patients with systemic lupus erythematosus (SLE). This receptor is involved in the processing of immune complexes. Whether the deficiency is inherited or acquired has been the subject of controversy. A restriction fragment length polymorphism (RFLP), identified using a complementary DNA probe for CR1, has been correlated with the numeric expression of CR1 on normal erythrocytes. The gene frequency for the 2 alleles defined by this RFLP was compared in 44 patients with SLE (from 42 families), 43 of their consanguineous relatives, and 50 nonrelated normal subjects. The gene frequency for the alleles correlating with high and low expression of CR1 was 0.73 and 0.27, respectively, in the normal subjects. The gene frequency was not significantly different in the SLE patients. However, the SLE patients expressed fewer CR1 molecules per erythrocyte within each genotype, compared with normal subjects and compared with their consanguineous relatives. The low allele for numeric expression of CR1 on erythrocytes is not a disease susceptibility gene for SLE.
Cartilage proteoglycans in synovial fluid and serum in patients with inflammatory joint disease. relation to systemic treatment
Authors: Saxne Tore , ård Dick Heineg , Wollheim Frank A.
Published: February 2007

Proteoglycan concentrations in knee joint synovial fluid and in serum from patients with various inflammatory arthritides were studied using an enzymelinked immunosorbent assay. Patients with reactive arthritis, calcium pyrophosphate arthropathy, and juvenile rheumatoid arthritis (age < 20 years) had the highest synovial fluid concentrations. These values differed significantly (P < 0.001) from those in patients with rheumatoid arthritis, psoriatic arthropathy, and chronic HLA–B27–associated arthropathy. Rheumatoid arthritis patients receiving low‐dose prednisolone treatment had higher synovial fluid (P = 0.006) and serum (P < 0.001) proteoglycan concentrations than did those taking nonsteroidal antiinflammatory drugs or slowacting antirheumatic drugs. Serum proteoglycan concentrations were near the detection limits, and did not correlate with levels found in paired samples of knee joint synovial fluid. Patients with calcium pyrophosphate arthropathy had the highest mean serum level of proteoglycan. This assay of proteoglycan antigens is a useful tool in the study of proteoglycan metabolism in patients with joint disease. With its use, differences between disease groups and effects of theapy can be distinguished.
Deletion of C4A genes in patients with systemic lupus erythematosus
Authors: Kemp Michele E. , Atkinson John P. , Skanes Verna M. , Levine R. Paul , Chaplin David D.
Published: February 2007

To define the relationship between inheritance of major histocompatibility complex (MHC) alleles and susceptibility to the development of systemic lupus erythematosus (SLE), we examined the MHC class I, II, and III phenotypes of white SLE patients and characterized the structures of their class III MHC genes, using Southern blotting. Nine of 88 SLE patients (10.2%) were C4A null. As detected by Southern blot analysis, the C4A gene was deleted from both chromosomes in 8 of the 9 C4A‐null patients. Deletions affecting only 1 chromosome (heterozygous) were detected in the remaining C4A‐null patient and in 34.5% of SLE patients who were not C4A deficient (compared with 12.5% of controls; P < 0.05). These results indicate that deletion of the C4A gene is a common genetic marker for SLE. Deletions of C4A were observed most commonly as part of the HLA–B8;DR3 extended haplotype, although deletions were also detected in different HLA haplotypes. Because of the critical role of C4A in the processing of immune complexes, deficiency of C4A may, itself, confer susceptibility to the development of SLE.
Thromboangiitis obliterans (buerger's disease) and smokeless tobacco
Authors: O'dell James R. , Linder James , Markin Rodney S. , Moore Gerald F.
Published: February 2007

Thromboangiitis obliterans, a distinct clinical and pathologic entity characterized by segmental inflammatory and proliferative lesions of the tunica media of small arteries and veins, has been reported frequently in men who have a history of heavy cigarette smoking. We report a case of thromboangiitis obliterans in a 38‐year‐old man that was clearly associated with the use of smokeless (chewing) tobacco. In addition to a physical history and examination and laboratory evaluation, a biopsy of the skin and deep subcutaneous tissue of the patient's left thigh was performed, and this revealed occlusion of 2 large dermal blood vessels by a highly organized thrombus. A regimen of nifedipine and antiplatelet therapy, plus complete abstinence from tobacco, resulted in resolution of the patient's symptoms and pain. Our findings may be of particular importance in view of the increasing popularity of smokeless tobacco and the complications which may result from its use.
Systemic lupus erythematosus with jaccoud's arthropathy mimicking juvenile rheumatoid arthritis
Authors: Martini Alberto , Ravelli Angelo , Viola Stefania , Burgio Roberto G.
Published: February 2007

We describe a girl who presented at age 5 with objective signs of arthritis and was initially diagnosed as having juvenile rheumatoid arthritis. Over the following years, she developed slowly progressive joint deformities indicative of Jaccoud's arthropathy. When she was 11 years old, symptoms typical of systemic lupus erythematosus appeared, accompanied by anti‐DNA antibodies. This case illustrates that in children also, Jaccoud's arthropathy may be a precocious manifestation of systemic lupus erythematosus.
Sickle cell crisis following intraarticular steroid therapy for rheumatoid arthritis
Authors: Gladman Dafna D. , Bombardier Claire
Published: February 2007

We describe 2 patients who had coexistent rheumatoid arthritis and sickle cell disease. Both patients developed sickle cell crises following intraarticular injection of corticosteroids to control their arthritis. The mechanism of this phenomenon is not clear, but it is suggested that intraarticular steroids be used with caution in patients with sickle cell disease.
Glutathione peroxidase activity in patients with rheumatoid arthritis and in normal subjects: effects of long‐term selenium supplementation
Authors: Tarp Ulrik , Hansen Jens C. , Overvad Kim , Thorling Eivind B. , Tarp Britta D. , Graudal Hans
Published: February 2007

The effects of dietary supplementation with selenium were studied in 6 patients with severe, active rheumatoid arthritis (RA) and in 6 healthy control subjects. Initial concentrations of Se in red blood cells and in serum, and the activity of the Se‐dependent enzyme glutathione peroxidase (GSH‐Px) in red blood cells, serum, and granulocytes were significantly lower in RA patients compared with controls. During Se supplementation, however, the differences in Se levels and in GSH‐Px activity between the 2 groups disappeared, except that, in RA patients, GSH‐Px activity in granulocytes increased but remained significantly lower than in controls.
Hemodialysis is not essential for the development of destructive spondylarthropathy in patients with chronic renal failure
Authors: Alcalay Michel , Goupy Marie‐Christine , Azais Isabelle , Bontoux Daniel
Published: February 2007

Since 1984, there have been several reports of a destructive spondylarthropathy occurring in patients who have received hemodialysis over a long period of time. Two cases of a similar syndrome were observed in nonhemodialyzed patients with chronic renal failure, one of whom underwent a lumbar disc excision. The results of disc examination and of radiographic and biologic investigations prompted reconsideration of factors previously considered to be pathogenetic (amyloidosis, hydroxyapatite crystal deposition, aluminum toxicity), except one: secondary hyperparathyroidism.
Remission of rheumatoid arthritis with the successful treatment of acute myelogenous leukemia with cytosine arabinoside, daunorubicin, and m‐AMSA
Authors: Roubenoff Ronenn , Jones Richard J. , Karp Judith E. , Stevens Mary Betty
Published: February 2007

We describe 2 patients in whom a sustained remission of longstanding rheumatoid arthritis occurred with treatment for acute myelogenous leukemia (cytosine arabinoside, daunorubicin, and m‐AMSA), even though both illnesses had been refractory to therapy with standard disease‐modifying agents. These 2 patients represent the first successful treatment of rheumatoid disease using such an approach.
Radiographic assessment of progression in osteoarthritis
Authors: Altman Roy D. , Fries James F. , Bloch Daniel A. , Carstens John , Derek Mb T. Cooke , Genant Harry , Gofton Philip , Groth Harry , Mcshane Dennis J. , Murphy William A. , Sharp John T. , Spitz Patricia , Williams Catherine A. , Wolfe Frederick
Published: February 2007

We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 12–60 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0–3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight‐bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.
Localization of ro (ss‐a) antigen in the cardiac conduction system
Authors: Deng Jau‐Shyong , Bair Louis W. , Shen‐Schwarz Susan , Ramsey‐Goldman Rosalind , Medsger Thomas
Published: February 2007

The presence of anti‐Ro (SS‐A) antibody in maternal serum has been associated with congenital heart block. Using human sera monospecific for anti‐Ro (SS‐A) antibodies in an indirect immunofluorescence assay, Ro (SS‐A) antigen was found to be present in the nuclei of myocardial cells and cells of the cardiac conduction system. The possible relationship between the location of Ro (SS‐A) antigen, anti‐Ro (SS‐A) antibody, and heart block is discussed.
Functional disability due to back pain. a population‐based study indicating the importance of socioeconomic factors
Authors: Deyo Richard A. , Tsui‐Wu Yuh‐Jane
Published: February 2007

Using national survey data, we examined correlates of disability due to low back pain in 1,516 persons who had back pain. Greater education level correlated significantly (P < 0.001) with fewer disability days (i.e., days of activity limitation, absence from work, confinement to bed, or reduced housework), even after controlling for severity, sciatica, occupation, and age. Findings in men differed from those in women; education level was a strong correlate for men only. For work absenteeism, low income was a stronger correlate than education. These data support the importance of social factors in the prognosis of some musculoskeletal diseases.
Survival in systemic lupus erythematosus. a multivariate analysis of demographic factors
Authors: Studenski Stephanie , Caldwell David S. , Allen Nancy B. , Rice John R. , Polisson Richard P.
Published: February 2007

We analyzed survival rate and important clinical outcomes in 411 patients with systemic lupus erythematosus who were seen at our center between 1969 and 1984. All eligible subjects met 4 of the revised American Rheumatism Association criteria for systemic lupus erythematosus and all were seen within 2 years of diagnosis. Mean followup was 75.6 months. Multivariate analysis suggested significant independent effects of race (P = 0.0139) and socioeconomic status (P = 0.0326) on survival. No evidence of diminished lupus‐related mortality with age was documented. Previously reported findings of improved survival rate with age may have been confounded by differences in race distribution between the younger‐ and older‐onset groups.
Inhibitor of interleukin‐2 synthesis and response in rheumatoid synovial fluid
Authors: Kashiwado Takamichi , Miossec Pierre , Oppenheimer‐Marks Nancy , Ziff Morris
Published: February 2007

We studied the effects of a factor present in rheumatoid arthritis (RA) synovial fluid (SF) on interleukin‐2 (IL‐2)‐dependent cell proliferation and on the production of IL‐2 by mitogen‐stimulated peripheral blood mononuclear cells. RA SF suppressed the responsiveness of a mouse T cell line (HT‐2) to IL‐2, indicating that it contained an inhibitor of the IL‐2 response. When RA SF was fractionated by Sephadex G‐200 gel filtration, the inhibitory activity was detected mainly in fractions with a molecular weight of approximately 150,000, but was also found in a 15—19‐kd fraction. Removal of IgG from the 150‐kd fraction, by means of an anti‐IgG affinity column, did not reduce the activity of the fraction, nor was activity found in the eluted IgG. The inhibitory fractions reduced mouse thymocyte pro‐liferative responses to IL‐1 in the presence of phytohemagglutinin, and reduced the production of IL‐2 by human peripheral blood mononuclear cells, but did not inhibit IL‐1‐induced human foreskin fibroblast proliferation; this suggests that the factor was not an IL‐1 inhibitor. The inhibitory activity of the RA SF factor was blocked by an antibody against an inhibitor of IL‐2 that was purified from a culture of the human monocytic leukemia cell line, THP‐1. This finding also supports the conclusion that RA SF contains an IL‐2 inhibitory factor. The observed inhibition of both IL‐2 synthesis and IL‐2 response suggests that the target of the inhibition was the T lymphocyte.
Metacarpophalangeal arthropathy associated with manual labor (missouri metacarpal syndrome). clinical, radiographic, and pathologic characteristics of an unusual degenerative process
Authors: Williams William V. , Cope Ray , Gaunt William D. , Adelstein Edward H. , Hoyt Terry S. , Singh Amolak , Pressly Thomas A. , Bs Roy English, , Ralph H. Schumacher , Walker Sara E.
Published: February 2007

We describe 7 manual laborers with painful, palpably enlarged metacarpophalangeal joints. Characteristic radiographic changes were joint space loss, prominent osteophytes, and cystic metacarpal heads most prominent in the second and third metacarpophalangeal joints. In 3 of 4 patients, joint biopsy specimens showed subsynovial fibrosis and villous hyperplasia. All 7 patients had similar backgrounds of heavy work demanding sustained gripping motions of both hands, for periods that exceeded 30 years. We designated their condition metacarpophalangeal arthropathy associated with manual labor.
Effect of synthetic calcium pyrophosphate and hydroxyapatite crystals on the interaction of human blood mononuclear cells with chondrocytes, synovial cells, and fibroblasts
Authors: Dayer Jean‐Michel , Evêquoz Vlasta , Zavadil‐Grob Carolyn , Grynpas Marc D. , Cheng Pei‐Tak , Schnyder Jörg , Trechsel Ulrich , Fleisch Herbert
Published: February 2007

Synthetic calcium pyrophosphate dihydrate crystals and, to a lesser extent, synthetic hydroxyapatite crystals increased the amount of interleukin‐1/mononu‐clear cell factor released by human blood monocytes, as measured by collagenase and prostaglandin E2 production by rabbit chondrocytes, human dermal fibroblasts, and adherent rheumatoid synovial cells. The same crystals also directly induced collagenase and prostaglandin E2 secretion by rabbit chondrocytes, and potentiated the action of interleukin‐1/mononuclear cell factor on chondrocytes. These mechanisms may be important in the pathogenesis of the destructive arthropathies associated with these crystals.
Correlation between systemic lupus erythematosus and T4 epitope phenotype
Authors: Stohl William , Singer Joyce Z.
Published: February 2007

Three groups of black subjects (systemic lupus erythematosus patients, patients with nonrheumatic disease, and normal subjects) were screened for the expression of the T4 epitope, as recognized by the monoclonal antibody OKT4. We found that the T cell subsets within each group were similar, regardless of the T4 epitope phenotype (intact, intermediate, or deficient). In the subgroup of Jamaican subjects, there was an association between systemic lupus erythematosus and the T4 epitope—intermediate and T4 epitope—deficient phenotypes; this association was not detected in the non‐Jamaican population.
Evidence for local synthesis of antibodies to denatured collagen in the synovium in rheumatoid arthritis
Authors: Rowley Merrill J. , Williamson D.James , Mackay Ian R.
Published: February 2007

Synovial fluid samples from 36 patients with rheumatoid arthritis (RA) and 31 patients with other articular diseases (OAD) were examined for the presence of antibodies to denatured or native human type II collagen. Levels of IgG antibodies to denatured or native human type II collagen, rheumatoid factor, immunoglobulins, and total proteins were assessed in paired samples of serum and synovial fluid from 21 patients with RA and from 14 patients with OAD. Solid‐phase radioimmunoassay showed that levels of antibodies to denatured collagen in synovial fluid were significantly higher in RA patients than in OAD patients (median 3,270, range 44‐‐16,816 versus median 919, range 119—5,814; P < 0.001). These antibody levels were higher in synovial fluid than in the serum of RA patients, but not in patients with OAD. Paired serum and synovial fluid samples showed no correlation between the level of antibodies to denatured collagen and levels of either IgG, IgA, IgM, or rheumatoid factor. Synovial fluid antibodies to native collagen were higher in RA patients. Antibodies to collagen may be synthesized preferentially in synovial tissues and, hence, participate in the perpetuation of RA.
Clonal proliferation of large granular lymphocytes in rheumatoid arthritis
Authors: Loughran Thomas P. , Starkebaum Gordon , Kidd Pamela , Neiman Paul
Published: February 2007

Some patients with chronically elevated large granular lymphocyte (LGL) numbers have rheumatoid arthritis (RA). Since these patients also may have neutropenia and splenomegaly, their symptoms resemble those of patients diagnosed as having Felty's syndrome (FS). We studied the immunophenotypic and genotypic characteristics of mononuclear cells from patients with RA and neutropenia to better determine the extent of heterogeneity in this condition. Four patients had markedly increased numbers of LGLs, which expressed HNK‐1 antigen and IgG Fc receptors. In contrast, the remaining 8 patients, who had FS, had normal LGL counts, and surface marker studies showed normal numbers of HNK‐1 and IgG Fc receptor positive cells. Clonal rearrangement of the T cell receptor β chain gene was demonstrated in all 4 patients with excess LGLs, whereas a germline configuration of this gene was present in all 6 FS patients in whom this was studied. These results suggest that there are diverse groups among patients with RA and neutropenia. Since prognosis may differ, it is important to recognize that some patients who are considered to have Felty's syndrome may have a clonal proliferation of LGLs.
B cell hyperactivity and its relation to distinct clinical features and the degree of disease activity in patients with systemic lupus erythematosus
Authors: Sakane Tsuyoshi , Suzuki Noboru , Takada Shinsuke , Ueda Yuji , Murakawa Yohko , Tsuchida Tomiko , Yamauchi Yasutaka , Kishimoto Tadamitsu
Published: February 2007

Peripheral blood B cells that were actively proliferating, those actively secreting immunoglobulin, and those expressing an early activation marker, Ba antigens, on the surfaces were quantitated in 25 patients with systemic lupus erythematosus (SLE). B cell hyper‐activity was found in almost all of the SLE patients, as demonstrated by any one of these measures of B cell activity. Moreover, we observed a strong positive correlation between the degree of disease activity and the amount of spontaneous incorporation of 3H‐thymidine by B cells; the magnitude of the increase in frequency of spontaneous Ig‐secreting cells in peripheral blood correlated strikingly with certain clinical features in these patients. Our findings suggest that there is heterogeneity of B cell hyperactivity in individual patients with SLE and, thus, that clinical subsets of SLE can be identified on the basis of B cell hyperactivity.
Impaired mobility of human t lymphocyte surface molecules during inactive systemic lupus erythematosus. relationship to a defective camp pathway
Authors: Kammer Gary M. , Mitchell Elizabeth
Published: February 2007

The T lymphocytes of patients with active systemic lupus erythematosus (SLE) exhibit impaired capping of the surface molecules CD3, CD4, and CD8 and a defective cAMP‐dependent pathway. Since the mobility of these molecules is regulated in part by cAMP, we sought to determine whether there is a specific defect(s) along the T cell cAMP pathway that contributes to the persistent capping disorder observed during inactive SLE. The data suggest that a defect may exist at the level of cAMP‐dependent protein kinase activation or at a point distally. We propose that a disorder of cAMP‐dependent protein kinase activity might account for the defect of capping observed in both the CD3, CD4 (helper/inducer) and CD3,CD8 (suppressor) subsets observed in SLE.
Nailfold capillary microscopy in polymyositis and dermatomyositis
Authors: Ganczarczyk M. Lynn , Lee Peter , Armstrong Sara K.
Published: February 2007

Nailfold capillary microscopy was performed in 19 patients with polymyositis (PM) and 16 with dermatomyositis (DM). Enlarged capillary loops were seen more frequently in patients with DM (56%) than in those with PM (21%). Avascular lesions occurred in both PM and DM, but were more prevalent and more severe in patients with DM. Raynaud's phenomenon, arthritis, and pulmonary involvement were associated with greater numbers of enlarged capillary loops and more severe avascular lesions. The severity of the observed microvascular abnormalities did not correlate with the occurrence of malignancy or active myositis, but appeared to lessen with prolonged disease remission.
Hla and immunoglobulin allotypes in mixed connective tissue disease
Authors: Black C. M. , Maddison P. J. , Welsh K. I. , Bernstein R. , Woodrow J. C. , Pereira R. S.
Published: February 2007

A group of patients with mixed connective tissue disease (MCTD) were HLA and immunoglobulin allotyped. We found that the incidence of DR4 in the patient group was increased compared with that in the normal controls, but the increase was restricted to the subgroup of patients with arthritis. The age at onset of MCTD was lower in patients with DR4 and higher in patients with DR2 compared with patients who did not have these antigens. A1, B8, and DR3 were more frequent, but not significantly so, in the MCTD patient group. We also found that there was a significant perturbation of the Gm allotype frequencies in patients with MCTD.
The terminal complement complex, c5b–9, a marker of disease activity in patients with systemic lupus erythematosus
Authors: Gawryl Maria S. , Chudwin David S. , Langlois Paul F. , Lint Thomas F.
Published: February 2007

Concentrations of the terminal complement complex (TCC), C5b–9, were examined in 120 serum samples from 28 patients with systemic lupus erythematosus. Eleven patients with various manifestations of the disease were followed longitudinally for a 2‐year period during active and inactive phases of the disease. In 9 of the 11 patients, elevations in TCC concentrations correlated with disease exacerbations. In many of these patients, C3 and C4 levels remained normal during the study and were less sensitive indicators of disease activity than were TCC concentrations. We believe that measurements of TCC are useful in monitoring patients with rheumatic diseases in which complement activation is a component.
Stimulation of rabbit synoviocyte prostaglandin e2 SYNTHESIS BY LIPOPOLYSACCHARIDES AND THEIR SUBUNIT STRUCTURES
Authors: Rothenberg Ralph J. , England Douglas , Qureshi Nilofer , Takayama Kuni
Published: February 2007

Lipopolysaccharides (LPS) induce synoviocyte activation and may lead to destruction of synovial joint tissues. We assessed the production of prostaglandin E2 (PGE2) as a measure of synoviocyte activation by LPS and their subunit structures. Diphosphoryl lipid A was the smallest portion of lipid A tested that stimulated PGE2 production. The polysaccharide fraction of LPS, containing the O antigen, was also active. Intraarticular injections of the polysaccharide resulted in a synovitis very similar to that found in association with the intact LPS molecule. These observations suggest that both parts of LPS might be involved in gram‐negative, organism‐associated synovitis.
Human parvovirus b19 dna in synovial fluid
Authors: Dijkmans B. A. C. , Van Elsacker‐Niele A. M. W. , Salimans M. M. M. , Van Albada‐Kuipers G. A. , De Vries E. , Weiland H. T.
Published: February 2007

We describe a 33‐year‐old woman with a serologically proven human parvovirus B19 infection, who developed synovitis. Using a dot‐blot hybridization technique, we detected B19 DNA in her synovial fluid. To our knowledge, this is the first report of the isolation of B19 from synovial fluid.
Synovial complications of spondylepiphyseal dysplasia of late onset
Authors: Sambrook P. N. , De Jager J. P. , Champion G. D. , Doust B. D. , Mcgirr E. E. , Kozlowski K. S. , Sillence D. O.
Published: February 2007

We describe 2 patients with a late‐onset type of spondylepiphyseal dysplasia who developed multiple synovial complications. The synovial manifestations in the first patient included recurrent episodes of acute arthritis due to calcium pyrophosphate dihydrate crystal deposition and, later, chronic synovitis with radiologically evident chondrocalcinosis. In the second patient, cholesterol crystals in synovial fluid, multiple osteochondromata, and a histologic appearance resembling pigmented villonodular synovitis on synovial biopsy were seen. Osteochondromata were identified in 4 other members of this patient's family. Synovial manifestations in the osteochondrodysplasias may be more common than previously recognized.