Showing papers in "The Journal of Rheumatology in 1985"

The measurement of helplessness in rheumatoid arthritis. The development of the arthritis helplessness index.

Abstract: We describe the development of the Arthritis Helplessness Index (AHI), a self-report instrument designed to measure patients' perceptions of loss of control with arthritis. The participants in this research were 219 patients with rheumatoid arthritis (RA) who completed a quantity of mailed materials, including the AHI, functional measures and other psychological scales. Significant evidence of reliability and validity of the AHI was found. Greater helplessness correlated with greater age, lesser education, lower self-esteem, lower internal health locus of control, higher anxiety, and depression, and impairment in performing activities of daily living using a health assessment questionnaire. Over one year, changes in helplessness correlated with changes in difficulty in performing activities of daily living. The AHI appears to be a useful measure for further studies in RA and a valuable clinical tool in monitoring the psychological status of patients with RA.

Phospholipase A2 activity in sera and synovial fluids in rheumatoid arthritis and osteoarthritis. Its possible role as a proinflammatory enzyme.

Abstract: Phospholipase A2 (PLA2) activity was found in the sera and synovial fluids (SF) in rheumatoid arthritis (RA) and osteoarthritis (OA). PLA2 activity in RA SF was 6158 +/- 549 (SEM) U/ml (n = 48) and in RA sera 554 +/- 175 U/ml (normal sera-115 +/- 12 U/ml). In OA SF PLA2 activity was 5069 +/- 542 U/ml (n = 28), and in OA sera 268 +/- 55 U/ml. There was no significant difference between SF PLA2 activity in RA and OA. PLA2 activity in SF did not correlate with muramidase (lysozyme), beta-glucuronidase, total protein or white cell count, which were all significantly higher in RA SF than OA. A positive correlation between PLA2 in SF and matched sera was found in both RA and OA. It may be concluded that significant elevation of extracellular PLA2 occurs in both RA and OA, especially in the SF. The fact that high PLA2 did not correlate with other enzymes such as lysozyme and beta-glucuronidase, which are usually high in RA and low in OA SF, may mean that the handling of PLA2 in the joint space is different from other enzymes.

Dermatopolymyositis and other connective tissue diseases: a review of 105 cases.

Abstract: Of 105 cases seen over 12 years with mean 4 years followup, there were 69 with polymyositis (PM) and 36 with dermatomyositis (DM). and in 43 this complicated another connective tissue disease (CTD). Primary PM had onset a decade later than others and most severe myopathy occurred in DM. Earliest symptoms were polyarthritis and Raynaud's phenomenon with frequent sicca syndrome (51%). The less than universal prevalence of elevated muscle enzymes (68%), myopathic electromyography (86%). and abnormal muscle biopsy (78%) emphasizes the need for complete evaluation in all cases. Improvement occurred in 69% overall, including all 23 given no therapy or low dose corticosteroids and 59% of the remainder who received high dose corticosteroids with added cytotoxics in one-quarter. Outcome was worse in older patients and in those where weakness exceeded 4 months before diagnosis. Eight of 19 deaths were due to myositis or its therapy which also caused considerable morbidity. Malignancy in 16 cases was temporally related to myositis in half of these cases.

A double blind crossover trial of prednisone versus placebo in the treatment of fibrositis.

Abstract: Twenty patients with a diagnosis of fibrositis were entered into a double blinded crossover study to compare the effects of prednisone versus placebo. Each patient was randomly assigned to either prednisone 15 mg/day or placebo for 14 days of therapy and then therapy was switched for a further 14 days. The following measurements were assessed at baseline, end of Week 2 and end of Week 4: analogue scores for pain, sleep disturbance, morning stiffness and fatiguability, and dolorimetry readings of pain tolerance over 14 representative tender points. Overall there was no improvement while taking prednisone, indeed most measured variables showed a trend towards deterioration with this therapy.

Hypothesis: the nervous system may contribute to the pathophysiology of rheumatoid arthritis

Abstract: No current theory of the mechanisms involved in the pathophysiology of rheumatoid arthritis (RA) explains its important clinical features. We hypothesize that neural mechanisms are involved in this pathophysiology and they explain at least 3 clinical features: specific high risk joints are more likely to develop arthritis; specific high risk joints have more severe arthritis; and RA is bilaterally symmetric. If our hypothesis is correct, it will provide a rationale for the development of new therapies for what is now an inadequately treated disease.

Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity.

Abstract: We assessed the frequency of retinal toxicity in patients receiving either chloroquine or hydroxychloroquine and factors which may predict patient susceptibility to toxicity. The overall frequency of retinopathy was 6% (7 of 110 patients). Of the 31 patients receiving chloroquine alone, 6 developed toxicity (19%). In contrast, of the 66 patients receiving hydroxychloroquine, none developed retinopathy. Retinopathy was associated with greater age and with greater accumulative doses of chloroquine. Thus, hydroxychloroquine can be used safely with minimal risk of toxicity.

Remission in rheumatoid arthritis.

Abstract: Four hundred and fifty-eight patients whose clinical data had been prospectively entered into a rheumatic disease databank were studied for remission utilizing remission criteria of the American Rheumatism Association and criteria modified for chart review. During the period of observation 86 of 458 or 18.8% had at least one remission by investigators' assessment on chart review and 18.1% by application of ARA criteria. Patients were followed for 1131 patient years and remission occupied 97 patient years. For patients achieving remission this period represented 34.5% of their followup duration. The median length of remission was 10 months. Nineteen (18.6) percent of gold treatment courses and 16.7% of penicillamine courses resulted in remission. Fourteen (13.6) percent of patients who never received remittive therapy also had remissions. The ARA Preliminary Criteria for Clinical Remission in Rheumatoid Arthritis displayed a sensitivity of 80.2% and a specificity of 96.2% in this population. In patients receiving remittive therapy, female sex, disease onset before age 60, and early development of erosions were associated with decreased proportion of remission.

HLA-B27 related arthritis and bowel inflammation. Part 2. Ileocolonoscopy and bowel histology in patients with HLA-B27 related arthritis.

Abstract: Ileocolonoscopy and microscopic examination of ileum biopsies were performed on 35 patients with reactive arthritis, with asymmetrical pauciarticular arthritis and enthesopathies Ileocolonoscopy was also performed on 26 patients with ankylosing spondylitis (AS) and on 19 control patients with rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus and psoriatic arthritis In the reactive group, ileocolonoscopy showed macroscopic inflammation in 16 cases and abnormal microscopic examination in all but 2 cases, even in patients without gastrointestinal disorders In the 2 patients with sexually acquired disease, the gut was normal In the AS group, inflammation was observed in the B27 negative and positive patients with peripheral joint involvement Occasionally, ileal signs were seen in the HLA-B27 positive patients without peripheral joint involvement None of the controls showed signs of gut inflammation Ilecolonoscopy may be of value in detecting subclinical forms of bowel inflammation

Measurement of exercise tolerance in patients with rheumatoid arthritis and osteoarthritis.

Abstract: We evaluated the effect of strenuous aerobic exercise on joint symptoms and compared the functional capacity and muscle strength among patients with rheumatoid arthritis (RA) and osteoarthritis (OA), and very sedentary matched controls. Strenuous ergometer exercise did not exacerbate joint symptoms in these patients. Isotonic leg extension and flexion as well as grip strength were diminished in the RA and OA subjects compared to controls (p less than 0.05). All subjects displayed low maximum oxygen consumption indicating reduced functional capacity. Acute bouts of strenuous exercise performed on bicycle ergometer do not appear harmful to the nonacute arthritis patient.

Incidence of lung cancer in systemic sclerosis.

Abstract: During a study of lung function in patients with systemic sclerosis, we followed 71 patients with this diagnosis for a mean of 5 years. During this period, 3 cases of lung cancer were observed in the group, giving a post hoc incidence of lung cancer of 8.6 cases/1000 persons/year compared to an expected incidence of 0.52 cases/1000 persons/year. The relative risk ratio for lung cancer in systemic sclerosis patients is 16.5. There was no definite association of lung cancer with cigarette smoking, but all 3 patients had either radiographic or pulmonary function evidence of interstitial pulmonary fibrosis. Although bronchoalveolar carcinoma is the most prevalent histologic type of lung cancer associated with systemic sclerosis in the reported cases in the literature, this was not present in any of our patients.

Fibrositis: symptom frequency and criteria for diagnosis. An evaluation of 291 rheumatic disease patients and 58 normal individuals.

Abstract: We administered a 17-item symptom questionnaire modified from Campbell to 155 patients with fibrositis diagnosed at 3 centers, each using different criteria sets. A high degree of agreement in symptom proportions was found among centers. "Fibrositic" symptoms were also common in 136 patients with a variety of rheumatic diseases but not in the 58 normal individuals studied. Symptoms distinguished fibrositis patients from normals easily, but had insufficient specificity to distinguish them from other rheumatic disease patients. The tender point count better separated fibrositic and nonfibrositic patients than historical criteria. No combination of questions and tender point count performed better than the tender point count alone.

Rare adverse reactions to nonsteroidal antiinflammatory drugs.

Abstract: Excluding the most frequent kinds of problems seen with the nonsteroidal antiinflammatory drugs (NSAID)--gastritis, peptic ulceration and renal effects--published reports indicate that these drugs may cause a wide variety of rare adverse reactions. The most serious of these are hypersensitivity reactions: blood dyscrasias (aplastic anemia, thrombocytopenia, agranulocytosis, hemolytic anemia), erythema multiforme and hepatitis. Aseptic meningitis and anaphylactoid reactions may strike patients with underlying immunologic abnormalities; urticaria, bronchospasm and proctocolitis may affect aspirin-sensitive patients. Other unusual reactions include several kinds of bullous dermatitis, febrile reactions, pneumonitis, esophageal ulceration, parotitis, pancreatitis and neurological or psychological effects.

Disseminated Sporothrix schenckii infection with arthritis in a patient with acquired immunodeficiency syndrome.

Abstract: Patients with the acquired immune deficiency syndrome are susceptible to a wide spectrum of opportunistic infections. We report a 34-year-old man who developed systemic sporotrichosis involving the skin and joints, and whose illness terminated in subacute encephalopathy and Pneumocystis carinii pneumonia. Fungal arthritis is another infection to which patients with this syndrome are subject.

Fatal pulmonary hemorrhage in systemic lupus erythematosus. Occurrence without hemoptysis.

Abstract: We describe 12 patients with systemic lupus erythematosus (SLE) who developed massive pulmonary hemorrhage with very active disease. Other causes of pulmonary bleeding were excluded. Eleven of the 12 patients died, but only 4 had hemoptysis. Massive pulmonary hemorrhage should be suspected, even in the absence of hemoptysis, in severely ill patients with lupus who develop acute respiratory distress with bilateral pulmonary infiltrates and a drop in hemoglobin of 3 or more g/dl. Because of the deadly nature of this complication of SLE, when it is suspected, intensive corticosteroid and immunosuppressive treatment should be instituted.

Abnormal bowel permeability in ankylosing spondylitis and rheumatoid arthritis.

Abstract: Intestinal permeability was measured using a low molecular weight polyethylene glycol as a permeability marker in patients with osteoarthritis, ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Patients with AS showed a significant increase in bowel permeability when compared to controls. Intestinal permeability was also increased in patients with active RA but was less than the control group in RA patients who did not have active joint disease.

Grading of tenderness as a source of interrater error in the Ritchie articular index.

Abstract: To assess the effect of grading of tenderness on the interrater reliability of the Ritchie articular index (RAI), 3 physicians recorded independent joint scores on each of 18 patients, examined in random order Our results indicate that close agreement (Intraclass Correlation Coefficient = 085) can be achieved on global RAI scores, and that raters can achieve reasonable agreement (kappa = 040-059) on the absolute presence or absence of tenderness of individual joints By contrast, interrater agreement hardly exceeds the chance level (kappa = 0008-0148) when degree of tenderness is independently assessed The grading system of the RAI may thus be implicated as an important source of the instrument's interrater error

Persistent low back pain and leg length disparity.

Abstract: Patients with low back pain who were found to have a leg length discrepancy were treated with a lift to the shoe on the short side. A small group of such patients with longstanding pain had major or total relief over a long period of followup. Clinical characteristics of the low back pain symptoms were distinctive. A useful method to establish leg length discrepancy clinically is described.

The epidemiology of joint complaints in patients with psoriasis.

Abstract: Joint complaints of 1285 patients treated for cutaneous psoriasis were analyzed to better define the epidemiology of arthritis among psoriasis patients selected on the basis of cutaneous rather than rheumatologic disease. Nearly 40% of patients suffered from arthralgia, and 20% had been diagnosed as having psoriatic arthritis (PA). Patients with PA had more extensive cutaneous disease and more frequently had a family history of PA. PA patients frequently noted an association between the activity of their arthritis and the activity of their cutaneous disease. Antinuclear antibodies, uric acid, and white blood cell count had little predictive value in PA.

Evaluation of a computer based education lesson for patients with rheumatoid arthritis.

Abstract: A computer based education (CBE) lesson was developed for patients with rheumatoid arthritis (RA) and evaluated using a controlled experiment. There were statistically significant differences in the CBE group compared with controls in knowledge gained (p less than 0.01), improved outlook on life (p less than 0.01), hopefulness of a good prognosis (p less than 0.01), decreased belief in the role of luck or fate in determining their health (p less than 0.05) and reported increase in use of behaviors such as joint protection (p less than 0.02) and rest (p less than 0.05). The lesson was accepted and enjoyed by the patients.

Epidemiology of musculoskeletal disorders (complaints) and related disability in Canada.

Abstract: Data on musculoskeletal disorders (complaints), collected as part of the Canada Health Survey were analyzed Sixteen percent of those sampled reported having arthritis, rheumatism or back, limb or joint disorders with a greater prevalence among females and in the older population In 21% this was associated with limitation of activity with an average of 11 disability days/person/year Serious back disorders were reported in 44% of the population While the majority of health consultations (53%) were with a physician, a substantial number (34%) were with chiropractors

The epidemiology of tender points: a prospective study of 1520 patients.

Abstract: Tender point examinations were performed on 1520 consecutive patients with various rheumatic diseases. The mean tender point count was 2.1 (3.6 SD). Four or more tender points were found in 22.9%, 7 or more in 13.6%, 12 or more 4.3%, but 60.1% had no tender points. The tender point count increased gradually with age, reaching a maximum at age 70. Women had more tender points than men, Caucasians more than blacks or Hispanics. Isolated regional clusters of tender points occurred at the shoulder girdle in 7.8%, and the knees in 7.4%. Correlation between tender points and associated peripheral joint tenderness was poor.

Pneumococcal immunization in patients with systemic lupus erythematosus treated with immunosuppressives.

Abstract: Immunogenicity of 14 valent pneumococcal vaccine was evaluated in a placebo controlled, double blind, randomized study involving 77 patients with systemic lupus erythematosus (SLE). Antibodies to 12 type specific capsular antigens were measured prior to and one and 6 months post injection. In 17 patients treated with prednisone plus cyclophosphamide and/or azathioprine, mean body concentrations (ng antibody nitrogen/ml serum) increased from 528 to 1328 and 852, respectively, in vaccinated patients compared to 307, 308 and 344 following placebo. In 60 patients not receiving immunosuppressives, mean antibody concentrations were 355, 1361 and 920 post vaccine and 401, 473 and 377 post placebo. Our study demonstrates that antibody responses to pneumococcal vaccine in SLE patients is unaffected by these immunosuppressive agents.

A clinical comparison between males and females with ankylosing spondylitis.

Abstract: Forty-four females and 82 male patients with ankylosing spondylitis (AS) were compared in a retrospective study. No differences were found with respect to age at onset of disease, initial symptoms, work performance or peripheral joint involvement. Furthermore, males and females did not differ in restriction of spinal mobility, chest expansion, frequency of acute anterior uveitis or mean concentration of IgA. Males had significantly higher frequency of elevated C-reactive protein whereas mean erythrocyte sedimentation rate showed no such difference.

Hydrogen peroxide suppresses the proteoglycan synthesis of intact articular cartilage.

Abstract: The effects of oxygen derived metabolites on intact murine patellar cartilage were investigated. Hydrogen peroxide was found to suppress the chondrocyte proteoglycan synthesis as measured by 35SO4 incorporation. Superoxide or hydroxyl radicals were not involved in chondrocyte damage. Autoradiography showed a severe inhibition of 35SO4 uptake by the chondrocytes in the central area of the patella. Histological examination did not show acute effects on the morphology of the affected cartilage. When kept in tissue culture up to 96 h, patellae exposed to hydrogen peroxide still showed considerable suppression of 35SO4 uptake and occasional cell death was observed. These data support the concept that cartilage damage, as a result of inflammation, may be related to the generation of toxic oxygen metabolites.

HLA antigens associated with systemic lupus erythematosus in Japan.

Abstract: We studied whether or not HLA-A,B,C and DR antigens were associated with clinical and immunological findings in 116 patients with systemic lupus erythematosus (SLE) in Japan. SLE patients tended to be associated with HLA-DR2, compared with 75 healthy individuals. Among the SLE patients, there was an association between HLA antigens and the presence or absence of certain clinical or immunological features. Different HLA antigens might have a predictive value for SLE and/or the same clinical and immunological abnormalities between Caucasian and Japanese SLE patients.

Some nonsteroidal antiinflammatory drugs inhibit the generation of superoxide anions by activated polymorphs by blocking ligand-receptor interactions.

Abstract: Representatives of the major classes of nonsteroidal antiinflammatory drugs (NSAID) were assessed for their effects on superoxide anion (O2-.) production by human polymorphonuclear leukocytes stimulated with phorbol myristate acetate or N-formyl methionyl-leucyl phenylalanine (fMLP). Three levels of effects were studied: (1) overall inhibition of O2-. production, (2) the inhibition of interaction between fMLP and specific receptors at the cell surface, and (3) intermediate proenzyme and enzyme effects. Some, but not all drugs inhibited O2-. production. In general, drugs that inhibited O2-. production inhibited fMLP-receptor interactions in a consistent dose dependent fashion, showing noncompetitive kinetics. Drugs that failed to inhibit O2-. production showed weak and variable effects on receptor binding and on the intermediate enzymes. Clinical observations suggest that inflammation in diseases such as gout respond differently to NSAID than diseases such as rheumatoid arthritis; studies of drug effects may help to clarify the differences in pathogenesis of these inflammatory diseases.

Relation between meteorological factors and pain in rheumatoid arthritis in a marine climate.

Abstract: Reports indicate that weather conditions may affect some symptoms of rheumatoid arthritis (RA) but not the disease itself. Eighty-eight patients living in the marine climate of the Dutch coastal provinces scored their pain symptoms daily during a full year. Correlation analyses of monthly patient averaged pain scores against each of 6 weather factors indicated that RA pain associates positively and quite significantly (p less than 0.01) with temperature and with vapour pressure, negatively and significantly (p less than 0.02) with relative humidity and not with any of the other factors. The fact that the relation between the temperature/vapour pressure complex and RA pain is stronger in summer than in winter is discussed.

Lichen myxedematosus (scleromyxedema) serum stimulates hyaluronic acid and prostaglandin E production by human fibroblasts.

Abstract: Serum from a 45-year-old patient with scleromyxedema (withdrawn prior to therapy) was added to synovial and foreskin human fibroblast cultures and its effect compared to that of normal human serum. The patient's serum stimulated production of both hyaluronic acid and prostaglandin E by fibroblast cultures. This stimulation was inhibited by hydrocortisone and indomethacin and was not accompanied by stimulation of cell proliferation.

Sibling pairs affected by chronic arthritis of childhood: evidence for a genetic predisposition.

Abstract: Twelve families with a sibling pair affected by seronegative juvenile chronic arthritis (JCA) were studied. The ratio of HLA haplotype sharing was significantly different from that expected. No common haplotype was found. All 10 sibling pairs concordant for pauciarticular disease shared 2 haplotypes and the other 2 pairs shared one haplotype. These findings are evidence of a genetic predisposition to develop pauciarticular onset JCA in the families studied and suggest the presence of a disease susceptibility gene or genes within the major histocompatability complex.

Studies on the effect of low dose methotrexate on rat adjuvant arthritis.

Abstract: Adjuvant arthritis in rats was induced by the intradermal administration of Freund's complete adjuvant. When these immunized rats were treated orally with low doses of methotrexate (150-600 micrograms/kg/week) a statistically significant suppression of paw inflammation was observed. This low dose of methotrexate was comparable to that used in the treatment of human rheumatoid arthritis (RA). Our results are the first demonstration of the efficacy of low dose methotrexate in an animal model of human RA.