bluuebunny/crossref_metadata_2025 huggingface dataset:
Connective tissue activation
Authors: Myers Stephen L. , William Castor C.
Published: February 2007

Human synovial fibroblasts in culture have been stimulated to augment hyaluronate synthesis and glucose utilization by connective tissue activating peptides (CTAP) extracted from human spleen, lymphocytes, platelets, granulocytes, and tumor cells. The platelet‐derived mediator CTAP‐III also stimulated DNA synthesis in synovial fibroblasts, but CTAP‐I from lymphocytes and spleen did not. The present study demonstrates the mitogenic potential of a granulocyte mediator (CTAP‐PMN). Normal granuiocytes were prepared with Ficoll‐diatrizoate gradients, platelet contamination being estimated by phase microscopy and by radioimmunoassay for the platelet‐specific protein, β thromboglobulin. CTAP‐PMN preparations derived from 4 × 107 cells/ml stimulated culture 3H‐thymidine incoporation to 3.56 ± 1.32 (SD) times controls levels. Although exposure of praparations to thiols reduced their mitogenicity, CTAP‐PMN was relatively heat‐stable. SDS gel eletrophoresis of active fractions suggested a molecular weight between 12,700 and 12, 700 daltons. In doulbe immunodiffusion, antisera to CTAP‐III showed no reactivity with CTAP‐PMN. CTAP‐PMN or other granulocyte factors capable of stimulating fibroblast DNA synthesis may play a role in chronic proliferative synovitis or in other settings where exudative inflammation is accompanied by connective tissue growth.
Preliminary criteria for the classification of systemic sclerosis (scleroderma)
Authors: Masi Alfonse T. ,   Subcommittee For Scleroderma Criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee
Published: February 2007

A multicenter, ongoing study of early‐diagnosed cases of systemic sclerosis and comparison patients with systemic lupus erythematosus, polymyositis/dermatomyositis, and Raynaud's phenomenon was conducted in order to develop classification criteria for systemic sclerosis. Preliminary criteria are proposed, namely, the finding of either the sole major criterion, i.e.,1) sclerodactyly, 2) digital pitting scars of fingertips or loss of substance of the distal finger pad, and 3) bilateral basilar pulmonary fibrosis. When applied to the case and comparison patients included in this study, these proposed criteria had a 97% sensitivity for definite systemic sclerosis and 98% specificity.
Heterogeneity of hla associations in systemic onset juvenile rheumatoid arthritis
Authors: Glass David N. , Litvin David A.
Published: February 2007

Two genetic markers, HLA‐Bw35 and HLA‐B8, are found to be associated with “febrile” or “systemic” onset juvenile rheumatoid arthritis (JRA). Evidence is presented that JRA patients are probably heterogeneous with respect to these antigens.
Chronic arthritis of rabbits induced by mycoplasmas I. clinical, microbiologic, and histologic features
Authors: Washburn Leigh Rice , Cole Barry C. , Gelman Martin I. , Ward John R.
Published: February 2007

Mycoplasma arthritidis and Mycoplasma pulmonis induced chronic arthritis in rabbits on intraarticular injection, characterized by joint swelling and histologic evidence of chronic active inflammation persisting at least one year. Cartilage and bone destruction was a prominent late feature of M arthritidis but not M pulmonis disease. Despite the progressive nature of the disease and persistence of active inflammation for many months after inoculation, mycoplasmas and mycoplasma antigens were not found in joint tissues after 7 weeks.
Acute nongonococcal infectious arthritis
Authors: Rosenthal Jerome , Bole Giles G. , Robinson William D.
Published: February 2007

A retrospective analysis of 71 nongonococcal joint infections in 63 patients in reported. Staphylococcus aureus was isolated from 59% of the patients. Five patients died as a result of infections. The outcome in Gram‐n egative joint infections was similar to the overall outcome in the entire series of patients. All 11 joints with infected prostheses ultimately required removal of the prostheses. All patients were treated with appropriate parenteral antibiotics, and surgical intervention was used in 40 joints. Six patients underwent surgical treatment because of inability to sterilize the joint with antibiotics and because of repeated joint aspirations. The outcome with surgical intervention was good only in patients younger than 16 years of age. Medical therapy (parenteral antibiotics and frequent joint aspirations) led to good results in 74% of the patients. Outcome of joint infection was also influenced by factors which contribute to imparied host resistance.
Studies of murine complement
Authors: Fritchen Cathy , Kim Hong J. , Lightfoot Robert W.
Published: February 2007

We have utilized a new assay for murine complement components to explore the relationship of complement titers to other parameters of disease activity in individual NZB/W female mice. Titers had fallen significantly by 6 months of age, concomitantly with the appearance of antiDNA in serum and of C3 and immunolobulin in renal glomeruli. The period of hypocomplementemia antedating proteinuria was extremely variable. Heat stable anti‐c omplementary material was found in serum from older NZB/W mice.
Metabolism of c4 and factor b in rheumatoid arthritis
Authors: Kaplan Roy A. , Curd John G. , Deheer David H. , Carson Dennis A. , Pangburn Michael K. , Berhard HANS J. Müller‐E , Vaughan John H.
Published: February 2007

Metabolic turnover determined by radioiodide labeled C4 and Factor B was studied in 18 patients with rheumatoid arthritis (RA) and 19 normal control subjects as a means of estimating the relative ratio of consumption of components in the classical and alternative pathways of complement activation. Predominance of fractional catabolic rate (FCR) of C4 over Factor B was demonstrated with differentially labeled C4 and Factor B. The hypercatabolism occurred in the extravascular space. C4 FCR correlated significantly with rheumatoid factor (RF) determined in a hemolytic assay (rs = 0.72), measured as IgG RF (rs = 0.57), and as IgM RF (rs = 0.45). There were no significant correlations with several other antibodies measured. These results are consistent with the hypothesis that RA is a systemic, extravascular immune complex disease, in which RF immune complexes play a significant pathogenetic role principally via activation of the classical pathway of complement.
Effects of some nonsteroidal antiinflammatory drugs on proteoglycan metabolism and organization in canine articular cartilage
Authors: Palmoski Marshall J. , Brandt Kenneth D.
Published: February 2007

The effects on proteoglycan metabolism and aggregation of several nonsteroidal antiinflammatory drugs commonly used in the treatment of arthritis were examined in cultures of normal canine articular cartilage. Fenoprofen and ibuprofen inhibited net proteoglycan synthesis in a concentration‐dependent fashion. At concentrations in the culture medium comparable to plasma concentrations seen in patients after oral administration in humans, net protcoglycan synthesis in the presence of these drugs averaged 72% and 86% of the control values, respectively (P < 0.01). In contrast, indomethacin and sulindac sulfoxide had no effect on proteoglycan synthesis, while sulindac sulfide stimulated synthesis in a non‐concentration dependent fashion (average, 13%). In the presence of ibuprofen or sulindac sulfide, catabolism of sulfated glycosaminoglycans was the same as that in control cartilage, while fenoprofen decreased the rate of degradation slightly. The proportion of newly synthesized proteoglycans existing as aggregates and the average hydrodynamic size of disaggregated proteoglycans were unaffected by ibuprofen, indomethacin, sulindac sulfide, or sulindac sulfoxide. Fenoprofen, on the other hand, interfered with the ability of the cartilage hyaluronic acid to interact with proteoglycans to form aggregates, whereas it has no effect on the in vitro association of proteoglycans with hyaluronic acid from umbilical cord.
Bone tissue in paget's disease of bone ultrastructure and immunocytology
Authors: Rebel A. , Basle M. , Pouplard A. , Malkani K. , Filmon R. , Lepatezour A.
Published: February 2007

Ultrastructural observations in Paget's disease of bone clarify aspects of bone cells in bone tissue and demonstrate the presence of specific intranuclear inclusions composed of microcylinders in the osteoclasts. The morphologic analysis of these structures suggests an analogy with virus material of the measles group. Results obtained using indirect immunofluorescence and immunoperoxidase techniques lend further support to the hypothesis of a viral etiology in Paget's disease of bone.
Cell cultures from bone affected by pacet's disease
Authors: Mills Barbara G. , Singer Frederick R. , Weiner Leslie P. , Holst Patricia A.
Published: February 2007

Cells obtained from Paget's bone specimens were maintained in culture for up to 8½ months. The cells had several characteristics of bone cells including the presence of alkaline phosphatase, acid phosphatase, or succinic dehydrogenase as demonstrated histochemically. Electron microscopy revealed nuclear inclusions similar to those found in the osteoclasts of Paget's disease in 4 of 11 cultures. Immunohistology utilizing specific antisera demonstrated the presence of respiratory syncytial virus antigen(s) in 7 of 7 patients. Negative results were obtained with antisera to a variety of paramyxoviruses.
Musculoskeletal manifestations of paget's disease of bone
Authors: Altman Roy D. , Collins Barbara
Published: February 2007

A review of 290 patients with Paget's disease of bone revealed 83% had one or more rheumatic syndromes. The most common finding was back pain (37%), most often related to an independent osteoarthritic process or Paget's disease precipitating or complicating spinal osteoarthritis. Paget's disease as a sole source of back pain was distinctly uncommon (2%). Osteoarthritis related to Paget's disease was present in the hip (30%) and knee (11%). Paget's disease in spondylitis was present in 4 patients and in ankylosing hyperostosis in 4 patients. The latter group had very active Paget's disease. Rheumatoid arthritis (1%), hyperuricemia (20%), and gout (4%) did not appear increased in this group.
Orthopedic aspects of paget's disease of bone
Authors: Barry Hugh C.
Published: February 2007

The special features of fractures, usually in the femur or the tibia, and their treatment in Paget's disease of bone are discussed. Osteotomy of the femur or tibia for marked deformity, and joint replacement of the hip or knee for painful arthritis can be carried out quite successfully. The high incidence of sarcomas arising in the humerus, the development of multiple sites of malignant change, and some features of tumors on the skull are noted.
Chemistry, physiology, and therapeutic applications of calcitonin
Authors: Macintyre Iain , Evans IMOGEN M. A. , Hobitz HELMUT H. G. , Joplin Graham F. , Stevenson John C.
Published: February 2007

The chemistry and physiology of calcitonin are reviewed with particular emphasis on the evolution of the hormone and its modern role in humans. It seems likely that the relative deficiency of calcitonin in women may be important in postmenopausal bone loss. A major therapeutic application of calcitonin is in the treatment of Paget's disease of bone, and current recommendations for therapy are presented.
Salmon calcitonin therapy for paget's disease of bone the problem of acquired clinical resistance
Authors: Singer Frederick R. , Fredericks Robert S. , Minkin Cedric
Published: February 2007

During the initial months of long‐term treatment of Paget's disease of bone with salmon calcitonin, circulating alkaline phosphatase activity and urinary hydroxyproproline excretion usually decrease by about 50%. In 22 of 85 patients these parameters returned to pretreatment levels despite continuous therapy. Nineteen patients who were resistant to salmon calcitonin had salmon calcitonin antibodies in high titer. Human calcitonin has been effective in suppressing disease activity in these patients. The pathogenesis of calcitonin resistance in patients without antibodies is unknown.
Serologic subsets in systemic lupus erythematosus
Authors: Bell David A. , Maddison Peter J.
Published: February 2007

A search for anti‐Ro or anti‐nRNP antibodies by precipitin analysis among a population of 64 patients with systemic lupus erythematosus (SLE) or mixed connective tissue disease was undertaken. The 25% of SLE patients with anti‐Ro did not have any distinct clinical features, compared to patients without anti‐Ro or to anti‐nRNP patients with SLE or mixed connective tissue disease. However, these patients did have a significantly greater frequency of rheumatoid factor (80%). Most importantly however, patients with anti‐Ro had a significantly increased frequency of HLA‐B8 (81%) and HLA‐DRw3 (100%) compared to patients with anti‐nRNP (B8—29%; DRw3—33%) or SLE patients without such antibodies (B8—41%; DRw3—25%). These data suggest the existence of a specific immune response gene for Ro close to the D region of the major histocompatibility complex.
Immunization of patients with sjögren's syndrome with pneumococcal polysaccharide vaccine
Authors: Karsh Jacob , Pavlidis Nicholas , Schiffman Gerald , Moutsopoulos Haralampos M.
Published: February 2007

Thirty‐two patients with Sjögren's syndrome were randomly selected to receive either multivalent pneumococcal polysaccharide vaccine or saline placebo in a double‐blind study. Among placebo treated patients, levels of antipneumococcal antibodies remained constant. Immunized patients developed significant elevations of antibody concentrations against all 12 capsular serotypes measured. Levels fell, but persisted above baseline, for 8 of the serotypes 6 months after immunization. During the 6‐month study no clinical or serologic evidence of disease exacerbation occurred in either group. We conclude that pneumococcal vaccine can be safely and successfully administered to patients with Sjögren's syndrome.
Lack of platelet effect with the aspirin analog, salsalate
Authors: Estes Dorothy , Kaplan Karen
Published: February 2007

Platelet function as determined by platelet aggregation and the release reaction was found to be normal in 8 patients receiving a nonacetylated analog of aspirin, salsalate, while all 5 aspirin controls had abnormal platelet function. Mean bleeding time in patients taking salsalate was less than that in aspirin controls. This study demonstrates that salsalate, which has anti‐inflammatory activity and reduces prostaglandin synthesis, does not interfere with normal platelet function.
Ankylosing spondylitis in african blacks
Authors: Chalmers Ian M.
Published: February 2007

Over a period of 4 years in a large African teaching hospital, only 8 patients with ankylosing spondylitis were seen. This small number supports the impression that the disease is rare in African blacks. Patients tended to be relatively old and to have severe disease. None had iritis or a positive family history. The HLAB27 antigen was found in found in only 1 patient.
Lymphocytotoxicity of anti‐klebsiella antisera in ankylosing spondylitis and related arthropathies. patient and family studies
Authors: Edmonds John , Macauley David , Tyndall Alan , Liew Mark , Alexander Kerri , Geczy Andrew , Bashir Helen
Published: February 2007

Antisera to certain isolates of Klebsiella pneumoniae have a specific lymphocytotoxic effect on the HLA–B27 bearing lymphocytes in 83% of B27 positive patients with ankylosing spondylitis and about 60% of patients with HLA–B27 positive Reiter's syndrome and asymmetrical peripheral arthritis. These findings indicate cross‐reactivity between a Klebsiella antigen and a “modified” HLA–B27 or a closely associated structure in patients with ankylosing spondylitis and related arthropathies. Family studies indicate that the alteration in HLA–B27 is not a direct genetic effect.
Experimental intervertebral disc degeneration. morphologic and proteoglycan changes over time
Authors: Jay Lipson Stephen , Muir Helen
Published: February 2007

An animal model of intervertebral disc degeneration produced by surgical ventral disc herniation in the rabbit is described. Histologic studies showed proliferation of cells on the inner third of the annular wound, with metaplasia into fibrocartilage in the first 2 weeks following injury. Progressive fibrocartilaginous change occurred, reproducing the morphologic changes of disc degeneration over the first 6 weeks involving nearly the entire disc. Proteoglycans (total and newly synthesized) were studied qualitatively and quantitatively for periods of 1 to 200 days after herniation. There were two periods of time during the early course of degeneration when the ability of the proteoglycans to aggregate by interaction with hyaluronic acid was recovered, but this decreases progressively after 6–7 weeks. There was an immediate loss of water content from the injured disc which was restored only transiently during the first 2 days after herniation. Thereafter the water content progressively decreased. The uronic acid content of the disc changed in parallel with the changes in water content. The hyaluronic acid content decreased rapidly after herniation. However, the size of the proteoglycan monomers did not change with degeneration. The biochemical and morphologic changes are correlated, and an early repair mechanism is postulated to exist after injury.
The lubricating activity of synovial fluid glycoproteins
Authors: Swann David A , Hendren Robert B , Radin Eric L , Sotman Stuart L
Published: February 2007

Friction measurements were performed on fractions prepared from bovine synovial fluid by using a cartilage on glass apparatus. A fraction containing lubricating glycoprotein‐I (LGP‐I) as the only detectable component at concentrations of 30–50 μ/ml was able to lubricate in an identical manner to whole synovial fluid. These data indicate that LGP‐I is the molecule responsible for the lubricating ability of synovial fluid. 125Iodine‐labeled LGP‐I also lubricated in a manner similar to synovial fluid, whereas when this sample was reduced and alkylated or treated with neuraminidase, the lubricating activity was greatly decreased. In tests to measure binding of 125I LGP‐I to cartilage, an initial linear increase in binding was observed, followed by a decrease in binding at higher concentrations. In contrast, both the reduced and alkylated and the neuraminidase treated samples did not show the same concentration‐dependent binding to the cartilage. It is suggested, therefore, that at least part of the lubricating ability of LGP‐I is dependent upon its ability to bind to articular cartilage.
Prednisone and azathioprine for polymyositis. Long‐term followup
Authors: Bunch Thomas W
Published: February 2007

Two groups of patients with polymyositis have been followed for approximately 3 years. One group was treated with prednisone alone and the other with prednisone plus azathioprine. Although the polymyositis of both groups has improved, no statistically significant difference was noted at the end of 3 months, as previously reported. Longer followup, however, has shown that the group given prednisone plus azathioprine has improved more with respect to functional disability; this group also requires less prednisone for disease control.
Plasmapheresis in systemic lupus erythematosus. a cautionary note
Authors: Schlansky Ronald , Dehoratius Raphael J , Pincus Theodore , S. K. Tung Kenneth
Published: February 2007

Plasmapheresis was used as the sole treatment modality in 4 patients with systemic lupus erythematosus. The presence of circulating immune complexes in this group of patients was not predictive of response to plasmapheresis. Lymphocytotoxic antibody levels fell in 3 of the 4 patients, and no consistent changes in T lymphocytes, T lymphocyte subsets, complement, or immunoglobulin levels were observed. Followup during the subsequent 6 months showed deterioration in clinical and laboratory parameters in all 4 patients, and the protocol was discontinued. Plasmapheresis without concomitant therapy may be detrimental to certain patients with systemic lupus erythematosus.
Survivorship in systemic lupus erythematosus. effect of antibody to extractable nuclear antigen
Authors: Hochberg Marc C , Dorsch Carole A , Feinglass Edward J , Betty Stevens Mary
Published: February 2007

The course of 81 patients with systemic lupus erythematosus (SLE) who had sera tested for antibody to extractable nuclear antigen (ENA) was studied to determine the effect of the presence of antiENA antibody on survivorship. There were no differences in percent survival between the patients with and without antibody to ENA or those with and without antibody to the ribonucleoprotein (RNP) component of ENA. We conclude that there is no prognostic advantage to the presence of either antiENA or antiRNP antibody in patients with SLE.
“Milwaukee shoulder”—association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. i. clinical aspects
Authors: Mccarty Daniel J. , Halverson Paul B. , Carrera Guillermo F. , Brewer Bruce J. , Kozin Franklin
Published: February 2007

Four women, aged 63 to 90 years old, presented with mildly painful shoulders of decreased mobility or stability. Radiographic evidence of a complete tear of the fibrous rotator cuff was present in 7 of 8 shoulder joints. Microspheroids containing hydroxyapatite crystals were seen by scanning electronmicroscopy in 12 of 13 synovial fluid samples. All synovial fluids showed activated collagenase and neutral protease activity. This constellation of findings represents a heretofore undescribed syndrome which we have designated “Milwaukee shoulder.”
BINDING SITES FOR IMMUNE COMPONENTS IN HUMAN CHOROID PLEXUS
Authors: Peress Nancy S. , Roxburgh Vivian A. , Gelfand Michael C.
Published: February 2007

In immunologically mediated disorders such as systemic lupus erythematosus and experimental serum sickness, immunoglobulin and complement may be localized in the choroid plexus. This report demonstrates the presence of binding activity for the Fc fragment of IgG in 34 of 36 samples of human choroid plexus. We suggest that the number, distribution, and avidity of these Ig receptors may modulate the occurrence and/or severity of central nervous system symptoms in patients with immunologically mediated systemic diseases.
A sensitive solid phase microradioimmunoassay for anti‐double stranded DNA antibodies
Authors: Fish Falk , Ziff Morris
Published: February 2007

A sensitive solid phase microradioimmu‐noassay has been developed for measurement of antidouble stranded DNA (dsDNA) antibodies. In this procedure, advantage has been taken of the capacity of poly‐L‐lysine (PLL) to facilitate the binding of pure dsDNA to plastic surfaces. In the absence of PLL, binding did not occur. Diluted sera were incubated in PLL‐treated dsDNA‐coated microtitration trays and anti‐dsDNA Ig was measured using affinity purified125I‐anti‐Ig of high specific activity. The synthetic DNA, poly dA‐dT, was used as a model for dsDNA. In initial experiments, specific anti‐DNA binding could not be demonstrated because of high background binding of patient Ig to PLL‐treated surfaces. This was reduced by diluting test sera and anti‐Ig in buffer containing 2% BGG and 1% BSA. Specificity of the assay for DNA was demonstrated by absorbing the anti‐DNA activity on DNA‐coated plastic. The binding of systemic lupus erythema‐tosus (SLE) patient serum Ig to poly dA‐dT coated trays did not diminish after digestion with nuclease S1, suggesting that the synthetic polymer is an appropriate model for dsDNA. Patient and normal sera were screened for anti‐dsDNA activity using poly dA‐dT as antigen. None of the 38 normal sera, 23 of 35 active SLE sera, 1 of 25 treated SLE, 4 of 35 rheumatoid arthritis, 3 of 35 scleroderma, and 1 of 13 polymyositis sera demonstrated positive anti‐dsDNA activity. The anti‐dsDNA values obtained in the radioimmunoassay correlated significantly with those obtained in the Crithidia luciliae assay.
The impact of chronic disease
Authors: Meenan Robert F. , Yelin Edward H. , Nevitt Michael , Epstein Wallace V.
Published: February 2007

A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty‐five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty‐three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.
Reciprocal relationship of synovial fluid volume and Oxygen tension
Authors: Richman Alan I. , Su Eugene Y. , Ho George
Published: February 2007

To investigate the impact of synovial fluid volume on oxygen tension (PO2) and other metabolic correlates, 24 specimens of synovial fluid from the knees of 22 patients were analyzed for volume, number of leukocytes (WBC), pH, Po2, Pco2, glucose, protein, and complement (CH50) levels. Concurrent arterial blood samples were obtained in 21 instances. Synovial fluid Po2 values varied inversely with volumes of synovial fluid (r = −0.54, P < 0.01), but when patients with rheumatoid arthritis were excluded, the correlation was more significant (r = −0.76, P < 0.001). When synovial fluid Po2 dropped below 45 mm Hg, intraarticular acidosis resulted. The decrease in pH (r = 0.93, P < 0.001), the lowering of glucose values (r = 0.89, P < 0.001), and the rise in Pco2 (r = −0.79, P < 0.01) can be explained by a shift toward anaerobic metabolism coupled with the impaired elimination of its products. Systemic acidosis and hypoxia were not found. Intraarticular hypoxia most likely represents circulatory imbalance at the level of the synovial membrane, although an inverse relationship of synovial fluid Po2 and WBC was also noted. Complement and protein levels had no correlation with volume, pH, or respiratory gas tensions of synovial fluids. Our data support the importance of the effective blood flow to the joint in maintaining homeostasis. The volume of synovial effusion and the compliance of the joint capsule appear to be important determinants of the articular blood supply.
Trends in recent systemic lupus erythematosus mortality rates
Authors: Gordon Mark F. , Stolley Paul D. , Schinnar Rita
Published: February 2007

National death rates from systemic lupus erythematosus (SLE) were calculated for the period 1972 to 1976 according to age, sex, and race and were compared to rates for 1968 to mid‐1972. The time trend in the age‐adjusted death rates from SLE was also analyzed for the entire period 1968 to 1977. The previously reported variable sex and race ratios persist through the recent period, particularly the greater mortality rates among black women during middle and early adulthood. An overall decline in the adjusted death rates in the younger age groups (1–49 years old) in each race‐sex group is seen in the recent period.
Selective lymphocyte deficiency in seronegative rheumatoid arthritis
Authors: Pasquali J.‐L. , Fong S. , Tsoukas C. D. , Hench P. K. , Vaughan J. H. , Carson D. A.
Published: February 2007

Prior studies have shown that in vitro infection with the Epstein Barr virus (EBV) is able to induce IgM rheumatoid factor production by normal lymphocytes, with a higher degree of production by seropositive rheumatoid arthritis lymphocytes. The present investigation demonstrates that EBV‐infected lymphocytes from patients with seronegative rheumatoid arthritis produce in vitro significantly less IgM rheumatoid factor than do normal lymphocytes. The results suggest that the peripheral blood of seronegative patients is deficient in the rheumatoid factor precursor B cells responsive to stimulation by Epstein Barr virus.
The arthropathy of advanced progressive systemic sclerosis
Authors: Blocka Kenneth L. N. , Bassett Lawrence W. , Furst Daniel E. , Clements Philip J. , Paulus Harold E.
Published: February 2007

The peripheral joint radiographs of 55 carefully selected patients with classic progressive systemic sclerosis (PSS) and 10 patients with CREST syndrome were reviewed in a longitudinal fashion. Thirty‐three PSS and 7 CREST patients were available for followup (mean followup period 28.7 and 29.8 months, respectively). The high frequency of conventionally recognized abnormalities such as flexion contractures, digital tuft resorption, sclerodactyly, and subcutaneous calcinosis was reconfirmed. Additional hand findings included joint space narrowing (13%), juxtaarticular demineralization (4%), ankylosis (2%), marginal erosions (9%), and previously undescribed dorsal erosions (15%). All PSS findings showed progression, although isolated reversibility was noted. The CREST group showed a similar frequency and distribution of findings but with less tendency to progression. With the exception of an increased active joint count in PSS patients with erosions, computer‐assisted analysis of multiple clinical and laboratory variables showed no correlation with any radiographic abnormality. These results confirm the presence of an erosive arthropathy in PSS not attributable to overlap with either rheumatoid arthritis or systemic lupus erythematosus.
Antibiotic therapy of septic bursitis
Authors: Ho Jr George , Su Eugene Y.
Published: February 2007

Infected olecranon, prepatellar, and infrapatellar bursae offer a unique opportunity to study the response of a closed‐space infection to antibiotic therapy. Using percutaneous needle aspirations, serial bursal fluids were cultured. The length of time necessary to achieve culture sterility with antibiotic therapy (an average of 4 days in 25 patients) was correlated with the duration of symptoms prior to diagnosis (r = 0.68, P < 0.001). In patients treated within 2 weeks from onset of symptoms, bursal fluid sterility was achieved within 1 week of therapy, while longer duration of symptoms was associated with delayed response. When antibiotic therapy was continued for 5 additional days after documented culture sterility, all 19 patients in the prospective trial were cured (average followup period of 6.8 months). In septic bursitis, the effects of delay in treatment are deleterious by prolonging culture‐positivity despite adequate antibiotic therapy. By analogy, delay in treatment of septic arthritis may result in the persistence of an adverse environment which can lead to further articular damage. After accurate diagnosis of septic búrsitis, a therapeutic approach consisting of prompt and appropriate antibiotic usage, frequent needle drainage, and treatment duration based on the culture results of serial aspirations is effective and may be applicable in the management of certain nongonococcal bacterial joint infections.
The implications of procainamide metabolism to its induction of lupus
Authors: Uetrecht Jack P. , Freeman Richard W. , Woosley Raymond L.
Published: February 2007

The principal metabolic pathway of procainamide leads to formation of the less toxic N‐acetyl‐procainamide and the rapid acetylator phenotype is associated with a lower incidence of procainamide‐induced lupus. Another metabolic pathway forms a reactive metabolite which causes revertants in the Ames test and covalently binds to microsomal protein. A study of the metabolism of procainamide revealed three metabolites that have not been previously described. A comparison of the metabolites of N‐acetylprocainamide with those of procainamide suggests possibilities for the identity of the reactive metabolite. The hypotheses to be discussed explore the relationship between the formation of a reactive metabolite and the induction of lupus.
Plasmapheresis and immunosuppressive drug therapy in scleroderma
Authors: Dau Peter C. , Kahaleh M. B. , Sagebiel Richard W.
Published: February 2007

In an uncontrolled clinical trial, plasmapheresis combined with prednisone and cyclophosphamide therapy produced clinical improvement in 14 of 15 scleroderma patients with varying degrees of skin and internal organ involvement. All improved patients showed a gradual loosening of hide‐bound skin, relaxation of contractures, and healing of cutaneous ulcers, when present. Severe gastrointestinal symptoms were ameliorated in 4 patients, severe polymyositis was largely reversed in 2 patients, and pulmonary and cardiac function was improved in others. After initial improvement, however, 2 patients died during the period of study and another withdrew unimproved. Antinuclear antibody (ANA) liters declined relatively more than total IgG levels with plasmapheresis in 6 of the 9 patients who had elevated titers. Increased levels of endothelial cell cytotoxic activity found in 11 of the 15 patients were significantly reduced by plasmapheresis. Elevated levels of circulating immune complexes were found in only 4 of the 15 patients. Skin biopsies from adjacent sites taken before and after plasmapheresis in 10 patients all showed less swollen dermal collagen with increased ground substance between collagen bundles in the second biopsy. Although the effects of plasmapheresis cannot be dissociated from those of the immunosuppressive drug therapy, our results suggest that plasmapheresis combined with immunosuppressive drug therapy may find a place in the management of patients with moderate to severe scleroderma. This study implicates circulating factors in the pathogenesis of the disease.
Preliminary criteria for clinical remission in rheumatoid arthritis
Authors: Pinals Robert S. , Masi Alfonse T. , Larsen Richard A.
Published: February 2007

A study was conducted to develop criteria for clinical remission in rheumatoid arthritis (RA). Data were provided by 35 rheumatologists on 175 RA patients considered to be in complete remission (with or without antirheumatic therapy) and 169 RA patients in partial remission or with active disease. Six criteria yielded optimal discrimination: morning stiffness absent or not exceeding 15 minutes, no fatigue, no joint pain by history, no joint tenderness, no joint or tendon sheath swelling, and no elevation of erythrocyte sedimentation rate. In this study sample, the presence of five or more of these criteria in an individual patient yielded 72% sensitivity for clinical remission and 100% specificity in discriminating RA patients with active disease. In a population sample, it is estimated that the overall accuracy of these criteria would be more than 90% in RA patients.
Running Inhibits the Reversal of Atrophic Changes in Canine Knee Cartilage After Removal of a Leg Cast
Authors: Palmoski Marshall J. , Brandt Kenneth D.
Published: February 2007

The effect of vigorous exercise on the reversibility of canine knee cartilage atrophy produced by immobilization of the leg was studied. In comparison to cartilage from the contralateral control knees, cartilage from knees which had been immobilized in a cast for 6 weeks showed an increase in water content and decreases in thickness, Safranin O staining of the matrix, uronic acid content, and net proteoglycan synthesis. In addition, the ability of both newly synthesized (35S) and total tissue proteoglycans to interact with hyaluronic acid to form aggregates was diminished; this was apparently due to an abnormality in the hyaluronate‐binding region of the core proteins. If the casts were removed and the animals were then allowed to ambulate ad libitum for 3 weeks, all of these changes were reversed. However, knee cartilage from 3 dogs which had been run daily on a treadmill (6 miles/day) for 3 weeks after removal of the casts exhibited continuing decreases in thickness, Safranin O staining, and uronic acid content (mean 31%), even though net proteoglycan synthesis was increased (mean 16%) in comparison to that in control cartilage from the contralateral (nonimmobilized) knee. Furthermore, the abnormality in both 35S— and total tissue proteoglycans which precluded their interaction with high molecular weight hyaluronic acid persisted. In this respect, the proteoglycans were indistinguishable from those obtained from knee cartilage immediately following 6 weeks in a cast.
Native Type II Collagen‐Induced Arthritis in the Rat
Authors: Morgan Keith , Clague Roy B. , Shaw Mary J. , Firth Stephen A. , Twose Trevor M. , Holt P. J. Lennox
Published: February 2007

Antibodies to native bovine type II collagen may be important in initiating arthritis in rats immunized with this antigen. The cross‐reactivity of these antibodies with native rat type II collagen was higher in rats that developed arthritis than in those that did not. Depletion of serum C3 levels by cobra venom factor delayed the onset of arthritis until C3 levels were returning to normal; therefore, complement may be involved in initiation of the arthritis, and this arthritis may be an example of an immune complex‐mediated disease.
Ia+ T Cells in Synovial Fluid And Tissues of Patients with Rheumatoid Arthritis
Authors: Burmester Gerd R. , Yu David T. Y. , Irani Anne‐Marie , Kunkel Henry G. , Winchester Robert J.
Published: February 2007

Markedly elevated levels of T cells expressing Ia antigens were found in the synovial membranes and synovial fluids of patients with rheumatoid arthritis. The primary increase in expression of the la antigens was on the OKT 8+ (suppressor/cytotoxic) T cell subset. In addition, the total percentage of OKT 8+ T cells in intraarticular sites was usually greater than levels in peripheral blood. Small numbers of OKT 4+ (helper/inducer) cells bearing la antigens were also identified. The characteristic increase in the Ia+ T cells in peripheral blood was not encountered in most patients treated with D‐penicillamine.
Computed Tomography in the Diagnosis of Sacroiliitis
Authors: Kozin Franklin , Carrera Guillermo F. , Ryan Lawrence M. , Foley Denis , Lawson Thomas
Published: February 2007

Computed tomography (CT) and conventional radiography of the sacroiliac joint were compared in 43 patients. CT appeared to be far more sensitive and equally specific in the recognition of sacroiliitis. In a number of patients with sacroiliitis diagnosed by both techniques, CT demonstrated abnormalities that were not demonstrated by conventional radiographs. Of those patients with clinical evidence of sacroiliitis and HLA—B27 positivity, 50% had negative or equivocal radiographs compared to 19% who had negative computed tomographic images for sacroiliiti.
Evidence of a Generalized Metabolic Defect in Patients with Hereditary Chondrocalcinosis
Authors: Lust G. , Faure G. , Netter P. , Gaucher A. , Seegmiller J. E.
Published: February 2007

A gene in the heterozygous state appears responsible for a 2‐fold increase in pyrophosphate content of both fibroblasts and lymphoblasts cultured from patients who have dominantly inherited chondrocalcinosis. Cells from unaffected family members of this large kindred showed a pyrophosphate content in the same range as was found in unaffected, unrelated controls. Similar cells from individuals homozygous for the gene would be useful in delineating the precise biochemical abnormality responsible for the increased pyrophosphate content.
Permeability of Rheumatoid and Normal Human Synovium to Specific Plasma Proteins
Authors: Levick J. Rodney
Published: February 2007

A method is described for the determination of the permeability of the blood—joint barrier to specific plasma proteins, using the ratio of protein concentration in synovial fluid to that in plasma. The inadequacy of the ratio per se as a direct index of permeability is discussed. Permeabilities are evaluated for the normal and rheumatoid human knee. Permeability increases in the rheumatoid knee by approximately 6 times for albumin and over 40 times for macroglobulins. The effect of protein molecular dimensions upon permeability is analyzed. Permeability shows less dependence upon solute dimensions in the rheumatoid knee than in the normal knee, i.e., molecular selectivity is reduced. From these data and synovial morphology, a two‐membrane model of the blood—joint barrier is developed. The relative contribution of the component intimal and endothelial layers to the total barrier is found to depend upon solute dimensions.
Rheumatology Education in United States Medical Schools
Authors: Goldenberg Don L. , Mason John H. , Horatius Raphael De , Goldberg Victor , Kaplan Stephen R. , Keiser Harold , Lockshin Michael D. , Rynes Richard , Sandson John I. , Schumacher H. Ralph , Skosey John
Published: February 2007

Although rheumatology manpower in United States medical schools has dramatically increased in the past decade, 13% of medical schools did not have a full‐time staff rheumatologist in 1980. Thirty‐eight percent of medical schools had 2 or less full‐time rheumatologists. Staff rheumatologists and rheumatology fellows provided the majority of medical student education in the clinical aspects of rheumatic disease; however, rheumatologists in less than 50% of medical schools taught in the basic science curriculum or in related fields such as collagen biochemistry, metabolic bone disease, and orthopedic intervention in arthritis. The staff rheumatologists' time commitment to medical student education was inversely proportional to the rheumatology faculty size. At medical schools with no rheumatologists, however, there was little, if any, formal education in the rheumatic diseases. Most subjects are taught in systems‐oriented lectures. Education is currently limited to the common rheumatic conditions such as bursitis and back pain. Only 62% of medical schools provide a structured course on the musculoskeletal examination. Elective rotations in rheumatology, usually offered in the third or fourth year, are currently being provided to only 15% of U.S. medical students.
Immunomodulating effect of human placenta‐eluted gamma globulins in rheumatoid arthritis
Authors: Sany J. , Clot J. , Bonneau M. , Andary M.
Published: February 2007

Patients who had active and severe rheumatoid arthritis (RA) were treated with human placenta‐eluted gamma globulins (PEGG) composed of purified IgG eluted from trophoblastic cells. A control group of RA patients received retroplacental gamma globulins with no clinical effects. Seven of eleven treatments with PEGG showed good (4 patients) or very good (3 patients) clinical results. All patients had immunologic modifications demonstrated by a significant increase in active E‐rosette–forming cells and mitogen responsiveness. The precise mechanism of immunomodulating effect of PEGG should be further investigated.
A serial study of splenic reticuloendothelial system fc receptor functional activity in systemic lupus erythematosus
Authors: Hamburger Max I. , Lawley Thomas J. , Kimberly Robert P. , Plotz Paul H. , Frank Michael M.
Published: February 2007

A serial study of reticuloendothelial system splenic Fc receptor function was undertaken in 13 patients with systemic lupus erythematosus (SLE). Fc receptor function was assessed by measuring the clearance half‐times of IgG‐sensitized 51Cr‐labeled autologous erythrocytes from the circulation. Prolonged clearance half‐times were intially detected in all patients, and the magnitude of the clearance defect was significantly correlated with disease activity (P < 0.01, Spearman rank correlation) and immune complex levels (P < 0.01). Clinical course and changes in receptor functional activity over time were found to be significantly correlated. Clearance half‐times tended to return to normal in all 11 patients who clinically improved. The clearance half‐time remained unchanged in 1 patient whose disease activity was stable, and it worsened in 1 patient whose illness flared. Levels of immune complexes also changed concordantly with clearance half‐times and disease activity. These studies underscore the interrelationship between the presence of circulating immune complexes, defects in Fc receptor function that might lead to prolonged circulation of these complexes, and disease activity in SLE.
The incidence of sjögren's sicca complex in a population of patients with keratoconjunctivitis sicca
Authors: Forstot Joseph Z. , Lance Forstot S. , Greer Robert O. , Tan Eng M.
Published: February 2007

A prospective study was performed on patients who came to a university ophthalmology outpatient clinic with the complaint of dry eyes and who were documented to have keratoconjunctivitis sicca (KCS). Of 45 patients studied 1 had primary amyloidosis, and another 10 had KCS with a previously diagnosed connective tissue disease. Of the remaining 34 patients, 19 had KCS alone without xerostomia, and the remaining 15 had KCS in association with subjective or objective xerostomia. Eight of these 15 patients were subsequently shown to have clinical Sjögren's syndrome–sicca complex, and for the majority, serologic and biopsy findings supported this diagnosis.
Aspiration of the asymptomatic metatarsophalangeal joint in gout patients and hyperuricemic controls
Authors: Rouault Tracey , Caldwell David S. , Holmes Edward W.
Published: February 2007

Asymptomatic metatarsophalangeal joints were aspirated in a group of patients with gout, in 2 control groups with hyperuricemia, and in 1 normouricemic control group. Extracellular urate crystals were present in 70% of gout patients, in 1 of 19 patients with asymptomatic hyperuricemia, and in 2 of 9 patients with renal failure and hyperuricemia but no history of joint disease. Crystals were not found in the 10 normouricemic patients who had other types of arthritis. The presence of crystals in the subjects with gout was not correlated with a history of podagra, duration of gout, presence of tophi, or degree of control of hyperuricemia. Though crystals were found on rare occasions in joint fluid of asymptomatic hyperuricemic subjects, the presence of these crystals in asymptomatic joints was more common in subjects with gout.
Variable response to oral angiotensin‐converting‐enzyme blockade in hypertensive scleroderma patients
Authors: Whitman Hendricks H. , Case David B. , Laragh John H. , Christian Charles L. , Botstein Gary , Maricq Hildegard , Leroy E. Carwile
Published: February 2007

Twelve scleroderma patients with hypertension, seven of whom had malignant hypertension and renal failure or scleroderma renal crisis, were treated with captopril. The first dose lowered mean pressure in all patients by 21.3 mmHg; in 6 patients it relieved encephalopathy. Blood pressure was controlled in all patients. Two of 7 patients with scleroderma renal crisis had improvement in renal function; the 5 patients who did not have malignant hypertension improved or stabilized. Despite good pressure control, however, renal failure developed in 5 patients with scleroderma renal crisis. The data indicated that captopril is effective antihypertensive therapy in scleroderma and, when given early, may prevent renal failure and death.
Type II collagen—induced auricular chondritis
Authors: Mccune W. Joseph , Schiller Alan L. , Dynesius‐Trentham Roselynn A. , Trentham David E.
Published: February 2007

Sensitization to type II collagen induced inflammatory destruction of elastic ear cartilage, as well as arthritis, in Sprague—Dawley rats. This auricular lesion morphologically resembled relapsing polychondritis in humans. Moreover, in the experimental model, as has been reported in human disease, extraarticular chondritis occurred in the context of immunologic sensitivity to native type II collagen. These similarities suggest that type II collagen‐induced auricular chondritis may provide insights about the pathogenesis of relapsing polychondritis.