bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A department of veterans affairs cooperative study
Authors: Clegg Daniel O. , Reda Domenic J. , Weisman Michael H. , Blackburn Warren D. , Cush John J. , Cannon Grant W. , Mahowald Maren L. , Schumacher H. Ralph , Taylor Thomas , Budiman‐Mak Elly , Cohen Miriam R. , Vasey Frank B. , Luggen Michael E. , Mejias Edwin , Silverman Stuart L. , Makkena Rama , Alepa F. Paul , Buxbaum Joel , Haakenson Clair M. , Ward Richard H. , Manaster B. J. , Anderson Robert J. , Ward John R. , Henderson William G. 
Published: February 2007

AbstractObjective. To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active ankylosing spondylitis (AS) that is not controlled with nonsteroidal antiinflammatory drug therapy.Methods. Two hundred sixty‐four patients with AS were recruited from 15 clinics, randomized (double‐blind) to SSZ or placebo treatment, and followed up for 36 weeks. Treatment response was based on morning stiffness, back pain, and physician and patient global assessments.Results. While longitudinal analysis revealed a trend favoring SSZ in the middle of treatment, no difference was seen at the end of treatment. Response rates were 38.2% for SSZ and 36.1% for placebo (P = 0.73). The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). AS patients with associated peripheral arthritis showed improvement that favored SSZ (P = 0.02). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints.Conclusion. SSZ at a dosage of 2,000 mg/day does not seem to be more effective than placebo in the treatment of AS patients with chronic, longstanding disease. SSZ is well tolerated and may be more effective than placebo in the treatment of AS patients with peripheral joint involvement. This effect is more pronounced in treatment of the peripheral arthritis in this subgroup of AS patients.
Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide
Authors: Ciruelo Elena , de la Cruz Javier , López Ignacio , Gómez‐reino Juan J. 
Published: February 2007

AbstractObjective. To determine the cumulative rate of relapse of lupus nephritis that has been treated successfully with cyclophosphamide (CYC), and to estimate the association between time to relapse and demographic, clinical, laboratory, and treatment variables.Methods. This was an observational study of 48 systemic lupus erythematosus (SLE) patients who were treated successfully with CYC between 1979 and 1993 and followed up thereafter at 3 university hospitals. Demographic and clinical variables, laboratory data during the first month of nephritis, and therapy‐related variables were recorded from charts. Renal biopsy specimens were retrieved and analyzed by a pathologist. Relapse of nephritis was the outcome of interest. Descriptive analysis of patients who did and those who did not have a relapse was performed by chi‐square test, Fisher's exact test, and Wilcoxon 2‐sample test. The cumulative rate of relapse was computed using the actuarial method. Univariate comparisons of time to relapse were computed by log‐rank test. Proportional hazards modeling was used to assess the combined effect of patient characteristics that have been hypothesized to be prognostic factors.Results. Nephritis relapsed in 11 patients. Previous hematologic disorder, arthritis or arthralgia, and the use of CYC in oral form were more frequent in patients who had a relapse. The cumulative rate of relapse was 25% and 46% at 5 years and 10 years, respectively. A significant univariate difference in time to relapse was found when patients were stratified by time from diagnosis to initiation of CYC treatment (⩽ 5 months versus >5 months;P= 0.02). By multivariate analysis, age <29 years at nephritis onset (relative risk [RR] 6.29, 95% confidence interval [95% CI] 1.13–34.94,P= 0.03) and delay of >5 months from onset of nephritis to initiation of CYC therapy (RR 3.66, 95% CI 1.06–12.63,P= 0.04) were independently associated with time to relapse.Conclusion. A selected population of SLE patients may have long‐term remission of renal disease following successful CYC therapy. Patients in whom CYC treatment is delayed or who are young at the time of nephritis onset are at increased risk of relapse.
Mannose‐binding protein genetic polymorphisms in black patients with systemic lupus erythematosus
Authors: Sullivan Kathleen E. , Wooten Candra , Goldman Daniel , Petri Michelle 
Published: February 2007

AbstractObjective. To determine whether dysfunctional or deficient mannose‐binding protein (MBP) variants are found with increased frequency in black patients with systemic lupus erythematosus (SLE) compared with controls.Methods. Allele‐specific polymerase chain reaction amplification of 4 different polymorphic sites was performed on samples from 92 black SLE patients and 86 geographically matched black controls.Results. Two structural polymorphisms of MBP, associated with low serum levels of MBP, were found with significantly increased frequency in the SLE patient population compared with controls. In contrast, a promoter haplotype associated with particularly high serum levels of MBP was negatively associated with SLE.Conclusion. Deficiencies of MBP predispose individuals to SLE.
Therapy for the maintenance of remission in sixty‐five patients with generalized Wegener's granulomatosis. Methotrexate versus trimethoprim/sulfamethoxazole
Authors: de Groot Kirsten , Reinhold‐Keller Eva , Tatsis Efstratios , Paulsen Jens , Heller Martin , Nölle Bernhard , Gross Wolfgang L. 
Published: February 2007

AbstractObjective. To compare the efficacy of low‐dose intravenous (IV) methotrexate (MTX; 0.3 mg/kg once weekly), both with and without concomitant prednisone, versus daily oral trimethoprim/sulfamethoxazole (T/S; 160 mg of trimethoprim + 800 mg of sulfamethoxazole twice a day), with and without prednisone, in maintaining remission in patients with generalized Wegener's granulomatosis (WG).Methods. In this study, 65 patients with generalized WG whose disease had entered remission with cyclophosphamide (CYC) and prednisone therapy were started on one of the following remission‐maintenance regimens: MTX alone (group A; n = 22), T/S alone (group B; n = 24), MTX plus concomitant prednisone (group C; n = 11), and T/S plus concomitant prednisone (group D; n = 8). Clinical, radiographic, and seroimmunologic data were evaluated to assess the efficacy of the 4 regimens and to seek possible predictive factors concerning outcome in each group.Results. Partial or complete remission was maintained in 86% of the patients in group A, but in only 58% of those in group B (P < 0.05). In group C, 91% of patients remained in remission, which is in sharp contrast to group D, in which all patients experienced a relapse after a median of 14.5 months (P < 0.005). Side effects occurred twice as often with MTX (n = 12) as with T/S (n = 6) treatment and could usually be resolved by supplemental folinic acid. Two patients taking MTX and 3 patients taking T/S were withdrawn from the study medication because of side effects. In none of the patients were the adverse effects life threatening. No statistically significant factors predictive of poor outcome emerged in any group.Conclusion. Low‐dose MTX was found to be superior to T/S for the safe and effective maintenance of remission in patients with generalized WG. The use of concomitant prednisone was not associated with a worse outcome with MTX treatment. Since T/S, especially with concomitant prednisone, seemed to increase the chance of relapse, neither T/S alone nor T/S plus prednisone can be recommended for the maintenance of remission in patients with generalized WG.
Hypercalcemia and systemic lupus erythematosus
Authors: Deftos Leonard J. , Burton Douglas W. , Baird Stephen M. , Terkeltaub Robert A. 
Published: February 2007

AbstractHypercalcemia is commonly caused by the increased production of parathyroid hormone—related protein (PTHrP) by a malignancy. In fact, the demonstration of increased PTHrP production in a patient with hypercalcemia is virtually pathognomonic of malignancy. We studied a patient with systemic lupus erythematosus (SLE), generalized lymphadenopathy, and hypercalcemia. Immunohistology of 2 biopsied lymph nodes revealed the abundant expression of PTHrP and the absence of malignant transformation. Although apparently rare, PTHrP production by nonmalignant lymphoid tissue may occur in SLE and should be considered in the differential diagnosis of hypercalcemia.
Disease patterns and tissue cytokine profiles in giant cell arteritis
Authors: Weyand Cornelia M. , Tetzlaff Naomi , Björnsson Johannes , Brack Alexander , Younge Brian , Goronzy Jörg J. 
Published: February 2007

AbstractObjective. To determine whether clinical heterogeneity in patients with giant cell arteritis (GCA) is correlated with different patterns in the tissue‐specific inflammatory response.Methods. Twenty‐three patients with typical histomorphologic findings of GCA were grouped according to the presence or absence of jaw claudication and/or visual abnormalities, fever, concomitant polymyalgia rheumatica (PMR), and histologic evidence of giant cell formation. The inflammatory response in temporal artery biopsy specimens was characterized by semiquantification of cytokine messenger RNA (mRNA) transcripts using reverse transcriptase‐polymerase chain reaction, followed by oligonucleotide hybridization with cytokine‐specific probes. Clinical patterns were then correlated with profiles of tissue cytokines.Results. Inflammatory cytokines were expressed in all temporal artery tissues. In situ synthesis of interleukin‐2 (IL‐2), interferon‐γ (IFNγ), and IL‐1β mRNA, but not of IL‐10 and IL‐12 mRNA, distinguished different patterns of inflammation, and these patterns correlated with clinical manifestations of the disease. Patients with evidence of ischemic symptoms, indicated by jaw claudication and/or visual symptoms, typically expressed higher concentrations of IFNγ mRNA (P = 0.008) and IL‐1β mRNA (P = 0.02). Presence of fever was correlated with lower copy numbers of IFNγ (P = 0.02). Formation of giant cells in the granulomatous infiltrates was associated with the local synthesis of IFNγ mRNA (P = 0.003). Tissue from GCA patients with concomitant PMR contained higher levels of IL‐2 mRNA transcripts (P = 0.001).Conclusion. Variations in the clinical presentation of GCA were correlated with cytokine mRNA expression in the affected temporal arteries. Differences in the effector functions of tissue‐infiltrating T cells distinguished disease patterns in which either local ischemic symptoms or systemic involvement was dominant, or in which there was co‐occurrence of PMR. Definition of different patterns of inflammation in GCA might, therefore, facilitate the design of differentiated therapeutic approaches.
Long‐term treatment of systemic lupus erythematosus with cyclosporin A
Authors: Caccavo Domenico , Laganà Bruno , Mitterhofer Anna P. , Ferri Giovanni M. , Afeltra Antonella , Amoroso Antonio , Bonomo Lorenzo 
Published: February 2007

AbstractObjective. To evaluate the efficacy of long‐term treatment with cyclosporin A (CSA) in systemic lupus erythematosus (SLE).Methods. Thirty patients with SLE whose condition was either poorly responsive or unresponsive to treatment with steroids and/or cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with hypertension or hypercreatinemia were excluded. Disease activity was evaluated according to the systemic lupus activity measure. Assessments were made prior to study entry and after 6, 12, 18, and 24 months.Results. Twenty‐seven patients completed at least 24 months of treatment with CSA. The mean disease activity score significantly decreased after 6 months of therapy (P < 0.01); this result was maintained throughout the study. A conspicuous steroid‐sparing effect was observed following administration of CSA (P < 0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%), gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors (7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were observed.Conclusion. CSA represents a helpful second‐choice treatment for patients with active SLE. Administration of CSA necessitates expert and careful followup of patients.
Magnetic resonance imaging of the brain and cerebral proton spectroscopy in patients with systemic lupus erythematosus
Authors: Chinn R. J. S. , Wilkinson I. D. , Hall‐Craggs M. A. , Paley M. N. J. , Shortall E. , Carter S. , Kendall B. E. , Isenberg D. A. , Newman S. P. , Harrisonfrcp M. J. G. 
Published: February 2007

AbstractObjective. To investigate the prevalence and extent of cerebral changes in patients with systemic lupus erythematosus (SLE) by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS).Methods. SLE patients (47 women) and controls (25 women) underwent 1.5T MRI. A semiautomated segmentation technique calculated cerebrospinal fluid (CSF) and brain volumes. Proton MRS of the frontal and parieto‐occipital white matter yielded metabolite ratios of N‐acetyl groups (NA), choline, and creatine.Results. Compared with the control group, the SLE patients more often had cerebral atrophy on MRI (32% versus 0%), confirmed by an increase in the CSF to intracranial volume ratio. The patients also had old infarcts and hemorrhages (8.5% versus 0%) and more small white matter lesions (23% versus 8% had > 5 such lesions). MRS showed relative reduction of NA peaks. Although no patient was studied when acutely ill, prior neurologic involvement was related to abnormal findings.Conclusion. MRI and MRS are helpful in the investigation of cerebral complications of SLE. There are chronic changes which may be ischemic in nature. Their precise cause, consequences, and prevention are current challenges.
The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus
Authors: Karlson Elizabeth W. , Daltroy Lawren H. , Lew Robert A. , Wright Elizabeth A. , Partridge Alison J. , Fossel Anne H. , Roberts W. Neal , Stern Steven H. , Straaton Karin V. , Wacholtz Mary C. , Kavanaugh Arthur F. , Grosflam Jodi M. , Liang Matthew H. 
Published: February 2007

AbstractObjective. To study the relationship of race, socioeconomic status (SES), clinical factors, and psychosocial factors to outcomes in patients with systemic lupus erythematosus (SLE).Methods. A retrospective cohort was assembled, comprising 200 patients with SLE from 5 centers. This cohort was balanced in terms of race and SES. Patients provided information on socioeconomic factors, access to health care, nutrition, self‐efficacy for disease management, health locus of control, social support, compliance, knowledge about SLE, and satisfaction with medical care. Outcome measures included disease activity (measured by the Systemic Lupus Activity Measure), damage (measured by the SLICC/ACR damage index), and health status (measured by the SF‐36).Results. In multivariate models that were controlled for race, SES, center, psychosocial factors, and clinical factors, lower self‐efficacy for disease management (P ≤ 0.0001), less social support (P < 0.005), and younger age at diagnosis (P < 0.007) were associated with greater disease activity. Older age at diagnosis (P ≤ 0.0001), longer duration of SLE (P ≤ 0.0001), poor nutrition (P < 0.002), and higher disease activity at diagnosis (P < 0.007) were associated with more damage. Lower self‐efficacy for disease management was associated with worse physical function (P ≤ 0.0001) and worse mental health status (P ≤ 0.0001).Conclusion. Disease activity and health status were most strongly associated with potentially modifiable psychosocial factors such as self‐efficacy for disease management. Cumulative organ damage was most highly associated with clinical factors such as age and duration of disease. None of the outcomes measured were associated with race. These results suggest that education and counseling, coordinated with medical care, might improve outcomes in patients with SLE.
Assessment of systemic lupus erythematosus disease activity by medical record review compared with direct standardized evaluation
Authors: Wluka Anita E. , Liang Matthew H. , Partridge Alison J. , Fossel Anne H. , Wright Elizabeth A. , Lew Robert A. , Karlson Elizabeth W. 
Published: February 2007

AbstractObjective. Clinical studies of systemic lupus erythematosus (SLE) often necessitate assessment of previous disease activity, which is sometimes only possible by retrospective evaluation of information from the medical record. Using the Systemic Lupus Activity Measure (SLAM), the present study compared an assessment of disease activity obtained by chart abstraction with a direct clinical assessment.Methods. A chart SLAM was obtained using information abstracted from the clinic notes of 46 patients with SLE who were being followed up at a referral center. Chart SLAM scores were compared with SLAM scores derived from an independent assessor's direct clinical evaluation.Results. Direct SLAM and chart SLAM scores were correlated (r = 0.67 by Spearman's rank correlation, P = 0.0001). Chart review scores for disease activity tended to be lower, but to an inconsistent degree, reflecting both under‐ and overestimation of disease activity. The overall misclassification rate on a 3‐category scale (mild, moderate, or severe activity) was 59%.Conclusion. Although chart SLAM scores were highly correlated with direct SLAM scores, misclassification of disease activity by chart review cannot be rectified. Thus, in research, medical record review should not be used as a proxy for the direct SLAM, nor should it be considered comparable with clinical assessments in the analysis of disease activity.
Accumulation of soluble fas in inflamed joints of patients with rheumatoid arthritis
Authors: Hasunuma Tomoko , Kayagaki Nobuhiko , Asahara Hiroshi , Motokawa Satoru , Kobata Tetsuji , Yagita Hideo , Aono Hiroyuki , Sumida Takayuki , Okumura Ko , Nishioka Kusuki 
Published: February 2007

AbstractObjective. To examine the concentration of the soluble form of the Fas molecule (sFas) in the serum and synovial fluid of patients with rheumatoid arthritis (RA) and osteoarthritis (OA).Methods. The concentration of sFas in the serum of 15 normal subjects and in the synovial fluid and serum of 45 RA patients and 13 OA patients was determined. The erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) level, and the level of several cytokines in serum and synovial fluid were also determined.Results. The synovial fluid concentration of sFas was higher in RA than in OA patients (P < 0.005). The synovial fluid level of sFas correlated weakly with serum levels of CRP (r = 0.541), the ESR (r = 0.499), and with synovial fluid levels of interleukin‐2 (IL‐2) receptor (r = 0.544), IL‐6 (r = −0.529), and intercellular adhesion molecule 1 (r = 0.514). Reverse transcription‐polymerase chain reaction analysis revealed that synovial cells and infiltrating mononuclear cells expressed sFas messenger RNA in RA patients.Conclusion. Our data suggest that accumulation of sFas in the joint cavity of RA patients may inhibit apoptosis and exacerbate the inflammatory process.
Fas and Fas ligand expression in the salivary glands of patients with primary Sjögren's syndrome
Authors: Kong Liping , Ogawa Noriyoshi , Nakabayashi Toru , Liu George T. , D'Souza Errol , McGuff H. Stan , Guerrero Daniel , Talal Norman , Dang Howard 
Published: February 2007

AbstractObjective. To assess the role of Fas‐mediated apoptosis in the salivary glands of patients with primary Sjögren's syndrome (SS).Methods. Expression of Fas, Fas ligand (FasL), and bcl‐2 in salivary gland biopsy material was detected in situ by immunohistochemical staining and reverse transcriptase‐polymerase chain reaction. DNA fragmentation in apoptotic cells was assessed by the enzymatic incorporation of labeled nucleotides (digoxigenin‐dUTP).Results. The acinar epithelial cells in SS were Fas+ and FasL+, and these cells died by apoptosis. The majority of infiltrating lymphocytes in SS were Fas+ and bcl‐2+, while few lymphocytes expressed FasL. In situ detection of apoptosis showed minimal cell death of lymphocytes, particularly in dense periductal foci. Lymphocytic cell death was significantly lower (P < 0.0001) in these foci compared with that in the interstitium.Conclusion. Infiltrating lymphocytes in the focal lesions of the salivary glands of patients with SS are blocked in their ability to commit to apoptosis, even though they may express Fas. The presence of bcl‐2 in these cells may explain their inability to undergo apoptosis. The acinar epithelial cells, in contrast, may undergo Fas‐mediated apoptosis. These results suggest that the Fas death pathway may be an important mechanism leading to the glandular destruction found in SS.
Incidence and disease associations of a proteinase 3−antineutrophil cytoplasmic antibody idiotype (5/7 Id) whose antiidiotype inhibits proteinase 3−antineutrophil cytoplasmic antibody antigen binding activity
Authors: Strunz Hendryk P. , Csernok Elena , Gross Wolfgang L. 
Published: February 2007

AbstractObjective. To evaluate the potential of a monoclonal proteinase 3‐antineutrophil cytoplasmic antibody (PR3‐ANCA) antiidiotype autoantibody (5/7 anti‐Id) as a candidate for specific immunotherapy in Wegener's granulomatosis (WG), and to estimate the immuno‐diagnostic value of the corresponding idiotype (5/7 Id).Methods. We analyzed the incidence of 5/7 Id in patients with ANCA‐associated vasculitides (WG, microscopic polyangiitis, Churg‐Strauss syndrome), in disease controls (systemic lupus erythematosus patients), and in healthy donors. We then investigated the presence of 5/7 Id in relation to disease stage, clinical activity, and organ manifestations in 86 patients with WG. Finally, we investigated the ability of the 5/7 anti‐Id reagent to inhibit the binding of PR3‐ANCA to corresponding antigen in 19 WG patients.Results. The incidence of 5/7 Id was significantly more frequent in WG patients (43 of 86; 50%). We did not find a significant correlation between the prevalence of idiotype expression and disease activity or organ manifestations. Further, we demonstrated in vitro suppression of PR3‐ANCA antigen binding activity by 5/7 anti‐Id in 11 of 19 WG patients who were positive for 5/7 Id.Conclusion. This study shows that 5/7 Id is a common idiotype with a significantly increased incidence in WG and that 5/7 anti‐Id inhibits PR3‐ANCA antigen binding activity. Based on these observations, we conclude that 5/7 anti‐Id is a promising tool for the development of a specific immunotherapy for WG.
Systemic vasculitis and myelodysplastic syndromes. A report of two cases
Authors: Philippe Bruno , Couderc Louis‐Jean , Droz Dominique , Charlotte Frédéric , Choukroun Georges , Epardeau Bernard , Bletry Olivier , Caubarrere Isabelle , Varet Bruno , Hermine Olivier 
Published: February 2007

AbstractTwo cases of systemic vasculitis associated with myelodysplastic syndromes are reported. Vasculitis may develop either before or after the diagnosis of a hematologic disorder, and it responds to treatment with high‐dose corticosteroids.