Showing papers in "Scandinavian Journal of Rheumatology in 1974"
TL;DR: It could be shown that incidence and prevalence figures and remission rates indicate clear sex differences in the natural history of selected, rheumatic diseases, implying different exposure to the wear and tear of daily life.
Abstract: An epidemiological survey of joint diseases was performed during the period 1965–68 covering 15000 subjects, age-range 34–74 years. For common degenerative joint syndromes or diseases criteria for epidemiological use are scarce and not generally accepted. A scheme of such criteria for 12 common rheumatic diseases or syndromes is presented. They were used to establish age- and sex-specific figures for prevalence, incidence, and estimates of remission rates. Special attention was paid to arthrosis of knee and hip joints and “tennis elbow”. Furthermore, the amount of “concealed” prevalence, i.e. a subjectively symptomless disease, was calculated for hallux valgus, hallux rigidus, hydrops of the knee, and Heberden's nodes. It could be shown that incidence and prevalence figures and remission rates indicate clear sex differences in the natural history of selected, rheumatic diseases, implying different exposure to the wear and tear of daily life. The annual incidence of painful shoulders was highest and more t...
362 citations
TL;DR: Grip strength is responsive to Sodium Salicylate and Prednisolone therapy but the change in association with the former was minimal—indicating insensitivity of the test.
Abstract: The intra-observer, inter-observer, day-to-day, week-to-week and diurnal variations in grip strength measurement have been studied in patients with rheumatoid arthritis. In addition, the changes in grip strength measurements in a double-blind, cross-over trial of Sodium Salicylate and Prednisolone are reported. An intra-observer error of up to 9 mmHg was found and, in addition, there was also considerable variation in grip strength measurements between different observers. Grip strength is responsive to Sodium Salicylate and Prednisolone therapy but the change in association with the former was minimal—indicating insensitivity of the test. In clinical trials, measurement of grip strength should not only be performed by one observer for each patient but measurements should be made at the same time of day because of its diurnal variation. The inherent errors in the method should be considered when interpreting results of grip strength measurement in such trials.
127 citations
TL;DR: In 31 female patients, aged between 38 and 63 years, all studied in the remission stage of 2nd and 3rd degree rheumatoid arthritis, physical performance capacity and some pertinent physiological factors were determined.
Abstract: In 31 female patients, aged between 38 and 63 years, all studied in the remission stage of 2nd and 3rd degree rheumatoid arthritis (RA), physical performance capacity and some pertinent physiological factors were determined. In all the functional tests, such as walking on level ground or on stairs, the RA patients performed worse (up to 60%) than a group of normals of the same age-range. This was due both to a low cardiovascular fitness (25% reduction) and a low muscle strength (between 33 and 52% lower), compared with normals.
125 citations
TL;DR: No correlation between the occurrence of side effects and duration of treatment or total drug dose was observed, and the influence of the daily dose of CQ or HCQ on the appearance of the side effects was demonstrable.
Abstract: Treatment of juvenile rheumatoid arthritis with antimalarial drugs, chloroquine and hydroxychloroquine, is widely accepted, but the dosages are arbitrary, and serum concentrations are not usually determined. In this study, 123 child patients, 119 with juvenile rheumatoid arthritis (JRA) and 4 with systemic lupus erythematosus (SLE) were treated with antimalarial drugs, 60 patients with chloroquine (CQ) diphosphate and 63 patients with hydroxychloroquine (HCQ) sulphate. Side effects were found in 36 patients in the CQ group and in 23 patients in the HCQ group. No correlation between the occurrence of side effects and duration of treatment or total drug dose was observed. The influence of the daily dose of CQ or HCQ on the appearance of the side effects was demonstrable. The maximum safe dose of CQ diphosphate is considered to be 4 mg/kg/day (100 mg/m2/ day) and that of HCQ sulphate 5 to 7 mg/kg/day (120 to 150 mg/rrr/day) in the treatment of children with JRA. With a dosage of 4 mg/kg/day of either CQ or H...
115 citations
TL;DR: Roentgenological observed morphological deviations of the mandibular condyles from presumably non-affected ones were divided into three types: minor lesions, flattening of the condyle, and grave lesions, which were predominantly found in the younger patients but the relative incidence was not concentrated in any particular age group.
Abstract: A roentgenological and clinical examination of the temporomandibular joint was carried out in 249 children, under 15 years of age, afflicted with rheumatoid arthritis. A total of 2244 presumed healthy school children served as controls. Roentgenological observed morphological deviations of the mandibular condyles from presumably non-affected ones were divided into three types: minor lesions, flattening of the condyle, and grave lesions. The changes were predominantly found in the younger patients but the relative incidence was not concentrated in any particular age group. The majority lesion was a flattening of the condyle; in the remaining cases grave lesions were more frequent than minor ones. The condyles were affected three times as often in girls as in boys. About 40% of the lesions were asymmetrical. Fewer than 40% of the patients with affected mandibular condyles displayed clinical symptoms', these were, on the other hand, manifest also in patients with no detectable condylar lesions. One of the 22...
88 citations
TL;DR: Thirteen patients with classical or definite rheumatoid arthritis (RA) have been investigated by the application of a battery of histochemical staining methods on muscle biopsy material, and a preferential atrophy of type II fibres is evident.
Abstract: Thirteen patients with classical or definite rheumatoid arthritis (RA) have been investigated by the application of a battery of histochemical staining methods on muscle biopsy material, viz myofibrillar ATPase, modified ATPase method with acid preincubation, phosphorylase, glycogen (PAS), succinic dehydrogenase, NADH2tetrazolium reductase, fat (sudan black B) Hematoxylin-eosin stain and a modified trichrome method were also used Based on their stainability for myofibrillar ATPase the muscle fibres are classified as type I (lightly stained) and type II (darkly stained) A preferential atrophy of type II fibres is evident A segmental degeneration of fibres accompanied by a segmental loss of enzyme activity is found in both types of fibre It is emphasized that the type II atrophy must be the result of a more complex mechanism than simple “disuse” One of the cases exhibits a pronounced change in the localisation of enzymes and substrates in atrophic as well as normal-sized fibres A reversal of normal
58 citations
TL;DR: In a series of 45 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA), the clinical course in four of six fatal cases was associated with malignancy, and in one case the poiymyalgic symptoms were clearly associated with the recurrence of a previously operated uterine carcinoma.
Abstract: In a series of 45 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA), the clinical course in four of six fatal cases was associated with malignancy. In one case the poiymyalgic symptoms were clearly associated with the recurrence of a previously operated uterine carcinoma. This case represented a paraneoplastic phenomenon and responded poorly to corticosteroid treatment. In another patient, who died of myocardial infarction one year after the onset of TA, a clinically silent brain tumour was found on autopsy. In the third patient a malignant lymphoma occurred 4 years after the diagnosis of PMR was made, and in the fourth case TA and PMR preceded the discovery of a metastasizing adenocarcinoma of unknown origin by 3 years. In the latter three cases the long interval between the onset of the poiymyalgic symptoms and the discovery of malignancy and the excellent response to steroid treatment were not consistent with a paraneoplastic mechanism of the rheumatic symptoms. The observed inc...
44 citations
27 citations
TL;DR: A total of 394 patients with rheumatoid arthritis were followed-up over a 10-year period from 1963 to 1973, particularly with reference to the aetiological circumstances and in particular, cancer.
Abstract: The authors report a significant increase in the rheumatoid factor titre in rheumatoid arthritis patients with vasculitis. A significant rise in IgG and IgA levels was found in uncomplicated RA, when compared with a normal population. The IgM levels were not found to be elevated in this group of RA patients. In the RA patients with vasculitis, on the contrary, the three Ig classes are increased when compared with the normal population, and the IgM level is increased when compared with the uncomplicated RA group. Significant relation was found between log IgM and log R.F. titre in the RA group with vasculitis. It is shown that the mild reduction of serum (by dithiothreitol 0.004 M) causes a complete negativity of the R. F. in all cases. It is concluded that the haemagglutination and the latex precipitation in vitro are induced by IgM-R. F. and not by IgG and IgA-R. F. molecules. Only free sites of IgM-R.F. play a functional role in the determination of the R. F. -titre. The authors postulated that increase in IgM in RA patients with vasculitis is partially due to the presence of free IgM-R. F. molecules in serum. Finally it is concluded that hidden IgM-R. F. molecules in patients with lower R. F. titre are not quantified by immunodiffusion methods.
25 citations
TL;DR: Investigation of the circadian change in plasmacortisol and an ACTH test found that patients receiving oral Prednisolone on three successive days per week or alternate-day oral corticosteroid therapy had some depression of their adrenocortical function, which was, however, significantly less than for patients on continuous oral cortICosteroid treatment.
Abstract: The adrenocortical function in 121 patients with juvenile rheumatoid arthritis (JRA) or other connective tissue diseases was investigated by determination of the circadian change in plasmacortisol and by an ACTH test. Eighty-eight children without rheumatoid arthritis, hospitalized for other diseases or under observation, acted as controls. Thirty-one patients with JRA but not receiving oral or intra-articular corticosteroid treatment had normal plasmacortisol values and normal results in ACTH tests. Nineteen patients with daily oral Prednisolone treatment demonstrated a weak circadian change and insufficient response in the adrenocortical function test. Patients receiving oral Prednisolone on three successive days per week or alternate-day oral corticosteroid therapy had some depression of their adrenocortical function, which was, however, significantly less than for patients on continuous oral corticosteroid treatment. Intraarticular corticosteroid treatment showed a depression in the circadian plasmaco...
18 citations
TL;DR: Since the purpose of this investigation was to clarify the significance of a severe trauma as an etiological factor in rheumatoid arthritis an unselected material with an average of 4.2 fractures, or severe trauma, during the period 1968-71 was gathered from the intensive therapy unit of a casualty hospital.
Abstract: Since the purpose of this investigation was to clarify the significance of a severe trauma as an etiological factor in rheumatoid arthritis an unselected material with an average of 4.2 fractures, or severe trauma, during the period 1968-71 was gathered from the intensive therapy unit of a casualty hospital. The material consisted of 204 patients, 26 % of them women, the average age being 31.1 years. Using a random sample method a comparison material of 103 subjects, of whom 32% were women, and whose age averaged 41.1, was gathered from the Helsinki city population at clinical health checks. A rheumatological examination was performed on the trauma subjects 2 years after the trauma, and the comparison subjects were examined in the same way. Previously existing rheumatoid arthritis (RA) was revealed in 2.5% of the casualty material and in 2.9% of the comparison subjects. Fresh cases of RA after the trauma, i.e. during the period 1968-71, were found in 2.9% of the trauma subjects but in none of the comparis...
TL;DR: 48 rheumatoid knee joints were treated with intra-articular 90Y resin colloid injections and the failure rate increased in the following cases: (1) in joints with signs of radiological damage, (2) in patients with a generally progressive disease, (3) in Joints with long-term effusions, and (4) in seropositive cases.
Abstract: 48 rheumatoid knee joints were treated with intra-articular 90Y resin colloid injections. The dose was 6 mCi, as a rule. The length of the follow-up period was from 1 to 3 years. The percentage of excellent and good improvements was 60 at 12 months, 49 at 18 months and 36 at 24 months. There were 8 primary failures (17%).The failure rate increased in the following cases: (1) in joints with signs of radiological damage, (2) in patients with a generally progressive disease, (3) in joints with long-term effusions, (4) in seropositive cases. Eight knee joints in which isotope therapy had failed were later operated on. The most serious findings were proliferative synovitis, erosions and degenerated menisci.Nearly half the patients had a slight flare-up of the synovitis shortly after 00Y injection. Acute crystal-induced synovitis was observed in one case 1 month after the isotope injection. No other side-effects were noticed.Osmic acid was injected simultaneously with 90Y in 7 patients with symmetrically affect...
TL;DR: To ascertain whether tritium-labeled cholesterol is transported into connective tissues, H3-cholesterol was injected into rabbit knees and found to enter cartilage and synovium, counts remaining above background for 40 days.
Abstract: Lipids are present in most connective tissues. Rheumatoid arthritis (RA) patients have high synovial and low serum cholesterol concentrations and occasional cholesterol crystal deposition. To ascertain whether tritium-labeled cholesterol is transported into connective tissues, H3-cholesterol was injected into rabbit knees. It was found to enter cartilage and synovium, counts remaining above background for 40 days. Cholesterol crystals injected similarly, produced acute synovitis, lasting at least 20 days. H3-cholesterol was injected into a cholesterol-crystal-forming RA patient's knee; H3-cholesterol remained in synovial fluid above background level counts for 10 days.
TL;DR: Rheumatoid arthritis (RA) may cause lower cervical subluxation associated with severe myelopathy and in cases with widespread erosion of the vertebral bodies an anterior approach with interbody fusion can be performed after the reposition.
Abstract: Rheumatoid arthritis (RA) may cause lower cervical subluxation associated with severe myelopathy. In cases with widespread erosion of the vertebral bodies an anterior approach with interbody fusion can be performed after the reposition. Indications for operation are briefly discussed. Three cases operated upon during 1973 are reported.
TL;DR: The authors report a specific immunological quantitative determination of IgG, IgM, IgA, transferrin and α2 microglobulin simultaneously in serum and in synovial fluid as well as the mechanisms by which the synthesis of immunoglobulins in rheumatoid synovia is masked when Ig levels are determined in synvial fluid.
Abstract: The authors report a specific immunological quantitative determination of IgG, IgM, IgA, transferrin and α2 microglobulin simultaneously in serum and in synovial fluid. The concentration of the protein fractions was determined by the linear plate immunodiffusion method. The log-normal frequency distribution of the protein levels in serum and in synovial fluid is clearly demonstrated. The authors found an increase of the serum and synovial fluid IgG, IgM and IgA levels in R. A. Furthermore, they investigated the relation between serum and synovial fluid levels for each protein fraction and they confirm that the permeability of the synovial membrane and molecular weight of the protein fraction are important parameters in the quantitative determination of a protein concentration in synovial fluid in non-rheumatoid synovial fluids. The mechanisms by which the synthesis of immunoglobulins in rheumatoid synovia is masked when Ig levels are determined in synovial fluid, receive mention.
TL;DR: In this paper, the Ankle and Tarsal Joints in Rheumatoid Arthritis were examined and the results showed that the joint involvement in rheumatic disease was positively associated with the ankle and tarsal joint.
Abstract: (1974). Ankle and Tarsal Joints in Rheumatoid Arthritis. Scandinavian Journal of Rheumatology: Vol. 3, No. 2, pp. 50-52.
TL;DR: Articular cartilage from the lower femoral epiphysis of an adult human was dissected out post mortem and a higher content of hexosamine-containing material was found in the frontal and caudal parts than on the posterior part of the cartilaginous articular surface.
Abstract: Articular cartilage from the lower femoral epiphysis of an adult human was dissected out post mortem. The glycosaminoglycans from biopsies of both epicondyles, taken in the sagittal and the frontal planes, were chromatographed on CPC- and on ECTEOLA-cellulose columns. A higher content of hexosamine-containing material was found in the frontal and caudal parts than on the posterior part of the cartilaginous articular surface. The same was observed on comparison with the marginal parts of the articular surface. The difference was due to changes in content of both chon-droitin sulphate and keratan sulphate. No change in the solubility profiles of the respective glycosaminoglycans was found.
TL;DR: Patients with rheumatoid arthritis and healthy controls have been studied with respect to the gastrointestinal excretion during 7 days of 51 Cr-activity after the intravenous administration of 51Cr-CrCl3 according to a method described by Rootwelt, 1966, to assess even small elevations of the gastrointestinal protein loss.
Abstract: Patients with rheumatoid arthritis and healthy controls have been studied with respect to the gastrointestinal excretion during 7 days of 51Cr-activity after the intravenous administration of 51Cr-CrCl3 according to a method described by Rootwelt, 1966. Most of the subjects included were simultaneously studied with respect to albumin pools and catabolism by l23I-labelled albumin.1. The control group had a mean cumulative 51Cr excretion during 7 days of 0.7±0.33 % of the dose.2. The patients with rheumatoid arthritis had a mean 51Cr excretion of 1.7±1.0% of the dose, which is significantly higher than the mean control value.3. The low normal chromium excretion makes it possible to assess even small elevations of the gastrointestinal protein loss.4. The possibility that the small gastrointestinal protein loss could be a symptom of early amyloid vascular lesion in patients with long-standing rheumatoid arthritis is pointed out.5. Intravenous injection of 51Cr-CrCl3 is a comparatively convenient method for th...
TL;DR: It could be estimated that the active and passive selection process of the healthcare organization filtered away 9 of 10 subjects eligible for reconstructive surgery.
Abstract: In spite of the increasing importance of reconstructive surgery for rheumatoid arthritis (RA), very few data, based on population surveys, exist on the medical needs of RA subjects. In a randomly selected population-based group of 293 RA persons, aged 31-74 years, the needs for reconstructive surgery of hands, feet, and knees were estimated. 33% of the 293 subjects needed some kind of surgical reconstructive procedure but one-third of the eligibles refused operation. A considerable proportion of those in need of reconstructive surgery fell outside the severely disabled group. It could be estimated that the active and passive selection process of the healthcare organization filtered away 9 of 10 subjects eligible for reconstructive surgery.
TL;DR: The adjuvant arthritis which developed in the irradiated joint was histologically dominated by a large accumulation of fibrin and byfibrinoid degeneration as well as by relatively little ce...
Abstract: Radioactive yttrium (90Y) resin was injected intra-articularly into the right hind ankle joints of adult albino rats. A number of animals were also injected at the same time with adjuvant in the left hind footpad. The remainder received this adjuvant injection either 2 or 4 weeks later. In the first group, in which both injections were administered simultaneously, adjuvant arthritis developed in a significantly larger number of rats than in the corresponding joints of the control rats. When irradiation was carried out 4 weeks before the adjuvant inoculation, there was insignificant difference between the development of arthritis in these animals and in the controls, but the difference between them and the animals irradiated simultaneously or 2 weeks before the adjuvant inoculation was statistically highly significant. The adjuvant arthritis which developed in the irradiated joint was histologically dominated by a large accumulation of fibrin and by fibrinoid degeneration as well as by relatively little ce...
TL;DR: A new method of elbow arthroplasty is presented, using the so-called GSB prosthesis, which requires minimal bone resection and offers therefore the possibility of a safe retreat in the case of severe complications such as infections.
Abstract: A new method of elbow arthroplasty is presented, using the so-called GSB prosthesis. This prosthesis requires minimal bone resection and offers therefore the possibility of a safe retreat in the case of severe complications such as infections. The technical features, the operative technique and an evaluation of the results in 17 cases are presented.
TL;DR: The effects of naproxen 250 mg b.i.d. and indomethacin 50 mg t.i .d.
Abstract: The effects of naproxen 250 mg b.i.d. and indomethacin 50 mg t.i.d. were compared in 21 patients with classical or definite RA. The study was designed as a randomized, double-blind crossover.
TL;DR: Three patients with severe affectioAs of juvenile rheumatoid arthritis were treated with 5-10 injections of transfer factor for 3–5 months, and there was a definite improvement in the general condition and changes in cell-mediated immunity occurred during the treatment.
Abstract: Three patients with severe affectioAs of juvenile rheumatoid arthritis were treated with 5-10 injections of transfer factor for 3–5 months. The results with this new principle of immunotherapy in rheumatoid arthritis are promising and can be summarized as follows: (1) The therapy has not in any case resulted in any flare-up of the disease. (2) There has been no clinical progression of the disease and none of the laboratory parameters, including X-ray findings and immunologic studfes, have indicated any further development of the disease during the therapeutic period. (3) There has been a definite improvement in the general condition including normalizing of the temperature, less morning stiffness and pain, improved ability for general activity and participation in physical treatment. (4) In two cases there was also an improvement of the joint function. Changes in cell-mediated immunity occurred during the treatment, as evidenced by conversion of previously negative antigen responses by in vitro and in viv...
TL;DR: Local Tc indices of patients with rheumatoid arthritis differed significantly from those of controls and were correlated with the systemic Tc index, which is the sum of the eight local indices.
Abstract: Joint inflammation of knees, hands, elbows and feet was assessed by measurement of local 99mTc indices. Local Tc indices of patients with rheumatoid arthritis differed significantly from those of controls and were correlated with the systemic Tc index, which is the sum of the eight local indices. The Tc indices of joints with local pain, swelling and stiffness differed significantly from those without symptoms. Tc indices of symptomless joints of rheumatoid patients did not differ from those of healthy controls. Like the systemic Tc index, the Tc index of knees responded to short-term administration of prednisolone (10 mg/day), but the other local indices did not. No changes in the Tc indices occurred during the administration of an anthran-ilic acid derivative (tolfenamic acid) or placebo. Our Tc index method has proved its usefulness in clinical routine (about 800 measurements during 4 years).
TL;DR: The progress of 6 cases of allograft arthroplasty of the knee was presented and showed some areas of chondrocyte death in the articular cartilage although the substance of its matrix remained intact.
Abstract: The progress of 6 cases of allograft arthroplasty of the knee was presented. The cases were performed between March 1967 and March 1970. The criteria of selection were treated. including the problems of matching for size, sex, and tissue antigens. The age of the donor had to be less than 45 years and the graft naturally free from contamination. The technique of preparing osteoarticular grafts consisting of the entire femoral condylar region and two separate tibia1 plateaux of thickness approx. 4 mm is described. Slides demonstrated the method of insertion during the course of one of the operative procedures. Case I demonstrated a vigorous antigenic reaction (tissue matching had not been carried out in this case). The graft gave good service for 2 years although it was plainly dead. and during the third year it gradually disintegrated. The joint was finally arthrodesed. Case I1 is still giving good service and shows no sign of deterioration 6 years after implantation. Case IZZ performed satisfactorily for 8 months before the patient succumbed to coronary thrombosis. The graft was retrieved and showed some areas of chondrocyte death in the articular cartilage although the substance of its matrix remained intact. The deeper layers of cartilage were alive and well; the bone showed a fracture union. Case IV was lost to follow-up 18 months after the operation and up to that date was giving satisfactory service. Case V gave good service for 18 months until the patient succumbed to bronchial carcinoma and an autopsy was refused. Case VI has been .working now for 3 years most satisfactorily although there are some radiographic signs of erosion of articular cartilage and loss ofjoint space.
TL;DR: There was a statistically and clinically significant preference for naproxen and no preference for either medication in a double-blind, crossover trial of patients with classical rheumatoid arthritis.
Abstract: An investigation has been carried out to test the anti-inflammatory effect of a new drug, naproxen, against placebo in a material of 24 patients with classical rheumatoid arthritis. The investigation was a double-blind, crossover trial and the evaluation was made by clinical examination (general condition, estimation of pain in the phalangeal joints of both hands, account of number of swollen inter phalangeal joints in both hands), thermographic recording (pictorial registration of heat emission), volumetric registration (measurement of hand volume). The results disclosed that there was a statistically and clinically significant preference for naproxen. This observation was substantiated by the thermographic recording, but volumetric registrations did not indicate any preference for either medication.