bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of survival in systemic sclerosis (Scleroderma)
Authors: Altman Roy D. , Medsger Thomas A. , Bloch Daniel A. , Michel Beat A. 
Published: February 2007

AbstractWe conducted followup of 264 patients with definite systemic sclerosis (SSc) who were entered into the multicenter Scleroderma Criteria Cooperative Study (SCCS) during 1973–1977. At the end of the study (average 5.2 years of followup), 38% were known to be alive, 50% were dead (68% of these deaths definitely related to SSc), and 12% were lost to followup. Survival analyses of 484 demographic, clinical, and laboratory items recorded at entry into the SCCS (within 2 years of physician diagnosis of SSc) were performed. Survival declined linearly, and the cumulative survival rate was <80% at 2 years, 50% at 8.5 years, and 30% at 12 years after entry. Analysis using combinations of entry variables identifying organ system involvement confirmed that renal, cardiac, pulmonary, and gastrointestinal involvement in SSc predicted reduced survival; however, data on organ system involvement at study entry could not be used to consistently predict which organ system would ultimately be involved as the primary cause of death. By survival tree analysis, the individual entry variables best predicting reduced survival included older age (>64 years), reduced renal function (blood urea nitrogen >16 mg/dl), anemia (hemoglobin ≤11 gm/dl), reduced pulmonary diffusing capacity for carbon monoxide (≤50% of predicted), reduced total serum protein level (≤6 gm/dl), and reduced pulmonary reserve (forced vital capacity <80% with hemoglobin >14 gm/dl or forced vital capacity <65% with hemoglobin ≤14 gm/dl). Cox proportional hazards model analysis confirmed these results. Different combinations of variables led to markedly different survival rates. The poorest prospects for survival were in patients with SSc who were ≤64 years old with a hemoglobin level ≤11 gm/dl, and in those >64 years old with a blood urea nitrogen level >16 mg/dl. These results may be useful in predicting individual patients at risk for shortened survival.
Magnetic resonance imaging of central nervous system lesions in patients with lupus erythematosus. Correlation with clinical remission and antineurofilament and anticardiolipin antibody titers
Authors: Bell Carolyn L. , Robbins Mark , Graziano Frank , Partington Curtis , Turski Patrick , Kornguth Steven 
Published: February 2007

AbstractClinical, magnetic resonance imaging (MRI), and serologic studies were performed on 11 patients with diffuse central nervous system (CNS) systemic lupus erythematosus and 8 patients with focal CNS lupus. MRI of patients with diffuse clinical disease showed symmetrically distributed areas of increased signal intensity in the subcortical white matter; these resolved after treatment with high‐dose methylprednisolone. These patients' sera contained elevated levels of antineurofilament antibodies. Patients with focal CNS lupus had areas of increased signal intensity and atrophic changes in regions corresponding to the major cerebral vessels. These MRI abnormalities did not improve after treatment with high‐dose steroids. The sera of patients with focal CNS lupus had elevated levels of cardiolipin and lupus anticoagulant but normal levels of antineurofilament antibody. Our findings suggest that results of a combined clinical, MRI, and serologic evaluation of patients with CNS lupus may predict the response of patients to high‐dose steroid therapy.
Association of immunoglobulin Km and Gm allotypes with specific antinuclear antibodies and disease susceptibility among connective tissue disease patients
Authors: Hoffman Robert W. , Sharp Gordon C. , Irvin William S. , Anderson Sharon K. , Hewett John E. , Pandey Janardan P. 
Published: February 2007

AbstractThe distribution of the immunoglobulin Km(1) and Gm phenotypes was examined in patients with connective tissue diseases, including systemic lupus erythematosus, mixed connective tissue disease, and scleroderma, whose sera were characterized for antibodies against nuclear antigens and polypeptides of U small nuclear ribonucleoproteins. We found a strong association between the Km(1) phenotype and susceptibility to systemic lupus erythematosus (P < 0.00001, relative risk = 17). We also found a positive association between the Km(1) phenotype and the presence of anti–double‐stranded DNA antibodies. The presence of certain immunoglobulin genes or gene families may have a role in susceptibility to the development of autoantibodies and/or of connective tissue disease.
Restriction fragment length polymorphism of the tumor necrosis factor region in patients with ankylosing spondylitis
Authors: Verjans Georges M. G. M. , Kijlstra Aize , Van Linden Sjef M. Der , van Eys Guillaume J. J. M. , de Waal Leo P. 
Published: February 2007

AbstractAlthough ankylosing spondylitis (AS) is known to be strongly associated with the class I major histocompatibility complex antigen HLA–B27, B27 is probably not the only genetic factor involved in the pathogenesis of AS. Because of the involvement of tumor necrosis factor (TNF) in cartilage damage and the localization of the TNF genes in the proximity of the HLA–B locus, we investigated the association between AS and TNF alleles. The frequencies of the restriction fragment length polymorphisms linked to the TNF genes were determined in 73 AS patients and 81 controls. No differences were observed between AS patients and controls with respect to the frequencies of the TNF restriction fragment length polymorphisms.
Treatment of rheumatoid arthritis with monoclonal CD4 antibody M‐T151. Clinical results and immunopharmacologic effects in an open study, including repeated administration
Authors: Reiter Christian , Kakavand Bahram , Rieber Ernst Peter , Riethmüller Gert , Schattenkirchner Manfred , Krüger Klaus 
Published: February 2007

AbstractRecent experimental and clinical data point to the T helper lymphocyte subset as playing a central role in the pathogenesis of rheumatoid arthritis (RA). Thus, a therapeutic strategy aimed specifically at the CD4 T cell subset is warranted. We treated patients with active RA for 7 days with a daily dose of 20 mg of CD4 monoclonal antibody M‐T151, administered intravenously over 30 minutes. There were no negative side effects. According to changes in the combined parameters of Ritchie articular index, pain assessment, grip strength, and morning stiffness, 6 patients had a good response. Clinical improvement was greatest approximately 2 weeks after termination of the therapy and lasted from 4 weeks to 6 months. Of the serologic parameters of inflammation, only the C‐reactive protein level improved in the patients with a favorable response. Close immunologic monitoring revealed a transient, selective depletion of CD4+ T cells after each infusion. During the entire treatment period, residual circulating CD4+ cells were found to be coated with CD4 antibody, whereas free antibody was detected in the serum only for approximately 8 hours after each infusion. Immediately after infusion, soluble CD4 antigen appeared in the serum. In addition to the cell‐bound CD4 antibody, complement components could be detected on the surface of the remaining CD4+ cells. The proliferative response of peripheral blood mononuclear cells to purified protein derivative was significantly diminished 4 weeks after cessation of antibody treatment. Six patients showed a weak antibody response to mouse immunoglobulin. In 4 of the responders who received a second course of therapy (2 of them as outpatients), a therapeutic effect was noted that was similar to that after the first course. Only 1 patient, who had low titers of serum IgE anti‐mouse Ig antibodies, showed a mild anaphylactic reaction at the end of the second course of therapy. Treatment of RA with the monoclonal CD4 antibody M‐T151 seems to be a promising alternative, although the optimal dose and the regimen of administration are still to be defined.
A variant of HLA–DR4 determines susceptibility to rheumatoid arthritis in a subset of Israeli Jews
Authors: Gao Xiaojiang , Stastny Peter , Brautbar Chaim , Naparstek Y. , Gazit Ephraim , Livneh A. , Segal Raphael 
Published: February 2007

AbstractHLA–DR4 is associated with risk for developing rheumatoid arthritis (RA) in most populations. In Israeli Jews, in whom the Dw10 subtype of DR4 predominates, no association of RA with DR4 has been found. The inability to detect an association could be due to the high frequency of DR4‐Dw10. We used DNA typing with amplification by the polymerase chain reaction and dot‐blotting with allele‐specific oligonucleotides to determine DR4 variants in 131 Jewish RA patients living in Israel and 134 controls. In both Ashkenazi Jews and non‐Ashkenazi Jews, the rare variant Dw15 (previously identified in Japanese populations and in Japanese patients with RA) was found to be the main allele associated with the risk of developing RA (relative risk = 9.2, corrected P < 0.001). However, this low‐frequency allele could be responsible for susceptibility in only 11.5% of the patients. Susceptibility for rheumatoid factor–positive RA was associated with Dw4 and Dw15; the risk for rheumatoid factor–negative RA was associated only with Dw14. The distribution of the HLA–DQ alleles associated with DR4 showed that more than half of the RA patients with Dw15 also had HLA–DQw2. The frequencies of DQw7 and DQw8 were not different in RA patients compared with controls. The results suggest that, as in other populations, susceptibility for the development of RA in Israeli Jews is associated with DRB1 locus alleles of the DR4 group.
Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double‐blind, placebo‐controlled study
Authors: Russell I. Jon , Fletcher Ellen M. , Michalek Joel E. , McBroom Patrick C. , Hester G. Gene 
Published: February 2007

AbstractA multidimensional evaluation of 78 patients with primary fibrositis/fibromyalgia syndrome (PFS) revealed no significant relationship between clinical measures of physical discomfort and psychological measures. This observation provided evidence against the notion that the pain of PFS has a psychological etiology. The same patients were randomized into 4 groups for treatment with ibuprofen and/or alprazolam in a randomized, double‐blind, double‐dummy, placebo‐controlled pilot trial. Clinical improvement in patient rating of disease severity and in the severity of tenderness upon palpation was most apparent in the subgroup of patients who were receiving both ibuprofen and alprazolam. An 8‐week, open‐label study in which 52 patients received both drugs further documented improvement in outcome measures. These data indicate that treatment with a combination of ibuprofen and alprazolam can be beneficial for some patients with PFS.
Synovial T lymphocyte–specific immune response to Chlamydia trachomatis in Reiter's disease
Authors: Sieper Joachim , Kingsley Gabrielle , Palacios‐Boix Alberto , Pitzalis Costantino , Panayi Gabriel S. , Treharne John , Hughes Rod , Keat Andrew 
Published: February 2007

AbstractWe studied the lymphocyte proliferative response to Chlamydia trachomatis in Reiter's syndrome (RS) compared with that in other rheumatic diseases. RS patients showed significantly increased C trachomatis–specific synovial fluid (SF) T cell proliferation. Proliferating cells were found in both CD4+ and CD8+ T cell subsets. The SF lymphocyte proliferative response to C trachomatis in RS was inhibited by anti–class I and class II major histocompatibility complex monoclonal antibodies, while the response to tuberculin purified protein derivative was inhibited only by anti–class II monoclonal antibodies. T cell receptor γ/δ–bearing T cells were not consistently increased in RS SF compared with peripheral blood, nor did such cells consistently expand upon in vitro culture with C trachomatis. Finally, there was no correlation between the cellular immune response and levels of antibody to C trachomatis antigens. Our results indicate that a specific T cell response to C trachomatis within the joint plays a role in the pathogenesis of RS.
Collagen‐induced arthritis in an outbred group of rhesus monkeys comprising responder and nonresponder animals. Relationship between the course of arthritis and collagen‐specific immunity
Authors: Bakker Nicolaas P. M. , van Erck Monique G. M. , Botman Caroline A. D. , Jonker Margreet , Hart Bert A. 'T 
Published: February 2007

AbstractIt is speculated that the autoimmune response to type II collagen (CII) is a driving force in the pathogenesis of human rheumatoid arthritis (RA). In this report, we describe the relationship between the induction of collagen arthritis and the CII‐specific humoral, as well as cellular, immune response in rhesus monkeys. Ten of 14 monkeys immunized with bovine type II collagen (B‐CII) developed polyarthritis. Susceptible animals showed a T cell response to B‐CII; resistant animals did not. After the primary immunization, the humoral response to B‐CII, as well as to rhesus monkey type II collagen, was dominated by antibodies of the IgM isotype in the susceptible animals and by antibodies of the IgG isotype in the resistant animals. Because of the close phylogenic relationship between the rhesus monkey and humans, these data contribute valuable information about the role of CII‐specific immunity in the pathogenesis of human RA.
Reflex sympathetic dystrophy syndrome of the lower limbs in renal transplant patients treated with cyclosporin A
Authors: Muñoz‐Gomez Jose , Collado Antonio , Gratacós Jordi , Llena Joaquin , Campistol J. M. , Andreu Jordi , Lomeña Francisco 
Published: February 2007

AbstractIn a 36‐month period, 240 patients at our institution received kidney transplants from cadaver donors. Cyclosporin A (CsA) was used as the initial immunosuppressive therapy. Seven patients (5 men and 2 women) developed severe pain, periarticular soft tissue swelling with no effusion, and vasomotor changes in affected areas. Although articular mobility was conserved, most of the patients had great difficulty in walking. A patchy osteoporotic pattern was seen radiographically and increased uptake of 99mtechnetium with a periarticular distribution in the clinically affected areas were found. All of these symptoms and radiographic and scintigraphic signs are compatible with definite reflex sympathetic dystrophy syndrome (RSDS). Articular symptoms began within 3 months after kidney transplantation in all patients; all but 1 patient had plasma CsA levels >200 ng/ml at that time. When the dosage of CsA was reduced, there was concomitant improvement in the RSDS, which appeared when the plasma CsA levels declined to <200 ng/ml. The mean duration of the clinical symptoms of RSDS was 8 months. We believe RSDS should be added to the list of complications that may appear in kidney transplant patients who receive CsA treatment.
Treatment of rheumatoid arthritis by extracorporeal photochemotherapy. A pilot study
Authors: Malawista Stephen E. , Trock David H. , Edelson Richard L. 
Published: February 2007

AbstractIn a 6‐month pilot study of 7 patients with rheumatoid arthritis, we tested a treatment involving the extracorporeal photoactivation of biologically inert methoxsalen (8‐methoxypsoralen) by ultraviolet A energy to a form that covalently cross‐links lymphocyte DNA; the injured cells are reinfused into the patient. Prior experimental studies had indicated that this regimen produces an immune reaction against antigens on treated T cells, and a clinical trial in patients with cutaneous T cell lymphoma had been successful. The current study patients were treated monthly, on 2 successive days (or biweekly, later on). Between 12 and 16 weeks of therapy, there appeared to be a breakpoint, after which the joint counts and joint scores of 4 of the patients began to improve. In 3 of the 4 patients, these measures eventually diminished by a mean of 71% and 80% of baseline values, respectively, and there was variable improvement in less direct indicators of clinical response. The joint counts and scores of the fourth patient improved modestly (by 33% and 59% of baselines, respectively) but he required alternative therapy, and those of the remaining 3 study patients did not improve. Mean slopes for the joint counts were significantly different from zero after the apparent breakpoint (but not before), whether one examined the 4 apparent responders (P = 0.01) or the entire group of 7 patients (P = 0.01). After completion of therapy, there was also a delay, of 2–3 months, in the clinical deterioration of those patients who had improved. There was only 1 mechanical adverse effect—a single episode of transient hypotension in 102 treatment sessions–‐and no toxic effects. This preliminary study suggests that extracorporeal photochemotherapy may be effective, at least in the short term, in certain patients with rheumatoid arthritis, with less apparent toxicity than that of any of the drugs currently used for this disorder. It deserves further evaluation.
T cell responses to polypeptide fractions of Borrelia burgdorferi in patients with lyme arthritis
Authors: Yoshinari Natalino H. , Reinhardt Bruce N. , Steere Allen C. 
Published: February 2007

AbstractAmong 6 patients with prolonged episodes of Lyme arthritis, the mean response of peripheral blood lymphocytes (PBL) to all Borrelia burgdorferi antigens (stimulation index [SI] 46) was greater than that among 5 patients with brief attacks of Lyme arthritis (SI 13; P < 0.1), as well as that among 7 control patients with rheumatoid arthritis and among 6 normal control subjects (in both instances SI 3; P < 0.05). In individual patients with brief episodes of Lyme arthritis, PBL had similar low levels of reactivity with the 20‐kd, 31‐kd, 34‐kd, 41‐kd, 55/58‐kd, and 66‐kd spirochetal polypeptides. In individual patients with prolonged arthritis, PBL usually had similar marked responsiveness to the 34‐kd, 41‐kd, 55/58‐kd, and 66‐kd polypeptides, but they had greater reactivity with the 34‐kd outer surface protein B than with the 31‐kd outer surface protein A (P < 0.05). In the 2 patients tested, paired samples of synovial fluid lymphocytes and PBL had a similar pattern of reactivity, but the response was 2–100‐fold greater in synovial fluid lymphocytes. We conclude that patients with prolonged Lyme arthritis have T cell responses to multiple spirochetal polypeptides.
Arthritis in patients infected with human T lymphotropic virus type I. Clinical and immunopathologic features
Authors: Sato Kazuto , Maruyama Ikuro , Maruyama Yoshikazu , Kitajima Isao , Nakajima Yuko , Higaki Megumu , Yamamoto Kazuhiko , Miyasaka Nobuyuki , Osame Mitsuhiro , Nishioka Kusuki 
Published: February 2007

AbstractTen patients with chronic inflammatory arthropathy and the human T lymphotropic virus type I (HTLV‐I) are described. These patients showed chronic persistent oligoarthritis, associated with proliferative synovitis, in large joints. The place of birth or residence of these patients was within the area endemic for adult T cell leukemia (ATL) and HTLV‐I. The age at onset of articular symptoms tended to be higher in these patients than in typical rheumatoid arthritis patients. Anti–HTLV‐I antibodies were detected in both sera and synovial fluids from all patients. Western blot analysis revealed antibodies to viral gag proteins (p19, p24, and p28). Atypical lymphocytes with nuclear indentations, consistent with ATL‐like cells, were observed in both synovial fluid and synovial tissue. Furthermore, HTLV‐I proviral DNA was integrated into the DNA of synovial fluid cells and synovial tissue cells. These findings suggest that HTLV‐I might be involved in the pathogenesis of this unique arthropathy.
The clinical and health status of patients with recent‐onset rheumatoid arthritis
Authors: Meenan Robert F. , Kazis Lewis E. , Anthony John M. , Wallin Bruce A. 
Published: February 2007

AbstractThis study was designed to document the clinical and health status of patients with recent‐onset rheumatoid arthritis (RA). Three groups were studied: 108 patients who had had RA for >1 year (established RA group), 313 patients who had had RA for ≤ 1 year (recent‐onset RA group), and 188 healthy friends of the patients with recent‐onset RA (no RA group). Clinical status was measured using tender joint count, erythrocyte sedimentation rate, and overall physician assessment. Health status was measured using the physical, psychological, pain, and arthritis impact scores of the Arthritis Impact Measurement Scales. Scores on all clinical and health status measures indicated substantial disease effects in the group with recent‐onset RA. For most of these measures, effect size analysis indicated that clinical and health status impacts in the recent‐onset RA group were similar in magnitude to those found in the group with more established disease, with scores in both groups being substantially different from those found in the no RA group. These results document the magnitude of the clinical and health status impacts in recent‐onset RA. They lend support to recent arguments advocating aggressive therapy earlier in the course of this frequently disabling disease.
Treatment of de Quervain's tenosynovitis with corticosteroids. A prospective study of the response to local injection
Authors: Anderson Bruce Carl , Manthey Richard , Brouns Matthew C. 
Published: February 2007

AbstractFifty‐six cases of De Quervain's tenosynovitis (in 55 patients) were treated with a “long‐acting” corticosteroid, methylprednisolone acetate, and followed prospectively over a 4‐year period. Approximately 90% of these patients were effectively managed either with a single injection (58%) or with multiple injections (33%) of this compound. Seventeen patients experienced recurrence a mean of 11.9 months after the initial injection. Three had minor flares and were not reinjected; the others responded to reinjections. Ten percent of the cases could not be controlled with local injection, and these patients were referred for surgery. Adverse reactions were self‐limited and relatively minor; no tendon ruptures or local infections occurred. We present a discussion of our review of the literature regarding medical therapy and surgical release for this condition. Treatment of De Quervain's tenosynovitis with methylprednisolone acetate injection rapidly controls the signs and symptoms, does not lead to serious adverse reactions, and should be the preferred initial treatment.
Association of HLA–DR4 with a more progressive disease course in patients with rheumatoid arthritis. Results of a followup study
Authors: Van Zeben Derkjen , Hazes Johanna M. W. , Zwinderman Aeilko H. , Cats Arnold , Schreuder Geziena M. T. , D'Amaro Joe , Breedveld Ferdinand C. 
Published: February 2007

AbstractThe association between HLA–DR antigens and rheumatoid arthritis (RA) was investigated in a wellcharacterized cohort of RA patients who were followed from the beginning of the disease (mean followup 6 years). The frequencies of HLA–DR antigens in patients with possible or probable RA (n = 49) were similar to those in controls. In patients with definite RA (n = 134), the frequencies of DR1, DR4, and DRw53 were increased, whereas the frequencies of DR2, DR3, DRw6, DRw13, and DRw52 were decreased, compared with controls. Comparison of HLA–DR frequencies in patients with definite RA subclassified according to the severity of the disease at the end of the followup period revealed a difference only in the frequency of DR4, which was increased in patients with progressive RA (59.2%) compared with those who had mild RA (34.8%). Further analysis showed that, compared with DR4‐negative RA patients, DR4‐positive patients had more swollen joints, higher scores on the Ritchie articular index, the Health Assessment Questionnaire, and the Steinbrocker functional classification, more radiologic abnormalities, and more use of second‐line drugs. Also, the rate of progression of radiologic abnormalities, functional classification, and use of second‐line drugs was higher in DR4‐positive patients. We conclude that DR4 is associated with a more severe disease course, and is a prognostic marker in early RA.