Biomedical subjects
Publications and source records attributed to A Cats.
Patients with HLA-B27 positive ankylosing spondylitis (AS) in a Swiss family study developed non-granulomatous acute anterior uveitis (AAU) 11 times more often than their healthy relatives sharing the same HLA-B27 positive haplotype (4.4% versus 0.4%; p less than 0.01) during a period of 6 months.
The occurrence of circulating immune complexes containing IgA (IgA-IC) was studied in groups of patients with ankylosing spondylitis (AS) selected for the presence or absence of hematuria. In studies done with 4 kinds of assays, IgA-IC were found more frequently and in higher titers in the 18 patients with AS with hematuria than in the 40 patients with AS without hematuria. Comparison of clinical indices of disease activity in these patient groups showed that the disease was more active in patients with AS with hematuria. Our findings confirm those made in a previous retrospective study on the relation between hematuria and circulating IgA-IC in AS and suggest that circulating IgA-IC play a role in the pathogenesis of hematuria in AS.
The prevalence of complaints of thoracic pain or stiffness in the past 6 months was assessed by examination, HLA typing and sacroiliac radiographs in 420 relatives of 275 B27+ probands with ankylosing spondylitis (AS). AS or sacroiliitis was found in 15 of 420 relatives (3.6%). The gender of the proband did not influence the probability of AS or sacroiliitis among the relatives. In the absence of sacroiliitis, B27+ relatives had chest pain more often (31 of 208, or 14.9%) than B27- relatives (13 of 197, or 6.6%) (p less than 0.01). Chest pain assessed by questionnaire was associated with pain on pressure at the costosternal junctions. The concept of AS as a combination of radiographic sacroiliitis plus clinical signs or symptoms may be too narrow.
Immunoglobulin synthesis by peripheral blood lymphocytes and serum IgA subclasses were investigated in patients with ankylosing spondylitis (AS) with and without accompanying microscopic hematuria, and HLA-B27 positive and negative healthy controls. An increase in serum IgA, restricted to subclass IgA1, was found in patients with AS, especially in those with microscopic hematuria. IgA synthesis was not increased, but a significant shift to subclass IgA1 was found. Our results resemble abnormalities previously noted in primary IgA nephropathy, and further support the pathogenetic role of IgA in AS.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The efficacy of bromocriptine, chloroquine, and Cs was quantitated in an in vitro system, with the use of mitogen-stimulated human PBMC. A concentration-dependent effect was found for each drug. Based on counts of blast cells, Cs was roughly 70 times more effective than either bromocriptine or chloroquine. Besides quantitative comparison of the effect of the drugs, the in vitro system permits conclusions concerning drug combinations. The effect of the combination of bromocriptine and Cs was equal to the expected effects of the separate drugs. However, the combined effect of chloroquine and Cs exceeded the sum of the effects of the individual drugs, which indicates synergy, not addition.
In the present study, we tested mononuclear phagocyte system function in nine healthy controls and 15 SLE patients with complement activating 123I-labelled aggregates of human IgG (AIgG). Clearance half-time of AIgG was 26 +/- 8 min in controls, compared to 58 +/- 27 min in patients (P less than 0.005). Binding of AIgG to erythrocytes was significantly lower in patients, 9.3 +/- 8.1 vs 24 +/- 20% (P less than 0.05). The increase of C3a-levels in plasma was significantly lower in patients than in controls (P less than 0.05 at 3 and 8 min), suggesting less complement activation. Liver and spleen uptake of 123I-AIgG was measured with a gamma camera and expressed as liver/spleen uptake ratios. In patients, the liver/spleen uptake ratios were significantly higher than in controls at 15 min, 3.8 +/- 2.0 vs 2.31 +/- 0.7 (P less than 0.05), due to less splenic uptake of AIgG. Correlations between clearance half-time or liver/spleen uptake ratios and immune complex levels or disease activity were not found. This study indicates that clearance of soluble AIgG is abnormal in patients with SLE, due to decreased splenic uptake of AIgG.
Explore the source record for details and available documents.
We used magnetic resonance imaging (MRI) to examine 21 patients with rheumatoid arthritis and vertebral subluxations of the cervical spine, in whom neurologic symptoms and signs indicated spinal cord compression. Based on neurologic signs, the patients were assigned to 1 of 3 classes: class I, no objective signs of cervical myelopathy (9 patients); class II, only 1 objective sign of cervical myelopathy (4 patients); or class III, 2 or more objective signs of cervical myelopathy (8 patients). Atlantoaxial subluxation (20 patients) and subluxations below C2 (6 patients) were detected equally well by MRI and radiography. MRI revealed physical distortion of the spinal cord in all class III patients with compressive myelopathy. This distortion was found less frequently in class II and class I patients (3 patients), and the difference was statistically significant (P less than 0.005, class III versus class I and class II). No correlation was found between the vertebral dislocation (measured in millimeters) on plain radiographs and the presence of cord distortion on MRI. Myelography in class III patients showed that passage of contrast medium was blocked at the same level as the cord distortion seen on MRI. These findings suggest that MRI can serve as a useful, noninvasive procedure in the diagnosis and management of rheumatoid arthritis patients in whom compressive cervical myelopathy is suspected.
The self-reported frequency of genitourinary and bronchopulmonary infections in postmenopausal women with rheumatoid arthritis (RA) and in postmenopausal women with osteoarthritis and/or soft tissue rheumatism was compared. Neither before, nor after the onset of joint disease was a higher frequency reported by the RA patients. The previously established increased mortality from infectious disease among RA patients might be due to a more severe infectious disease course, leading to an increased case-fatality rate.
Serum creatinine levels were measured before, during and after the administration of cyclosporin (Cy) in a double-blind placebo-controlled study in patients with rheumatoid arthritis (RA). The level rose significantly during and after Cy therapy, whereas the initial serum creatinine value did not change in the placebo group. The increase in the Cy group was not correlated with the mean Cy blood level. The rise in serum creatinine during Cy therapy was gradual and was not significantly correlated with the initial creatinine level; relative to the pretreatment value, the post-treatment increase was significantly correlated with the increase during Cy therapy. It is concluded that Cy administration for not more than 6 months, and at a maximum dosage of 10 mg/kg for 2 months, leads to an irreversible loss of more than 10% of renal function in RA patients. The damage may be ascribed to the combination of Cy with other factors compromising the kidneys, e.g., the use of non-steroidal anti-inflammatory drugs in the potentially systemic disorder of RA.
In a retrospective study the outcome of non-gonococcal infectious arthritis was evaluated in 76 adult patients admitted to the Leiden University Hospital between 1970 and 1984. The mortality rate was 12%, and complete recovery was achieved in only 19 of the 76 patients (25%). Each of the following had a significantly unfavourable influence on the residual joint function: duration of infection more than 14 days, female sex, presence of rheumatoid arthritis, and presence of a joint prosthesis.
The effect of treatment with bed rest only and bed rest combined with ACTH was studied retrospectively in 55 multiple sclerosis (MS) patients suffering from 99 relapses. No convincing arguments in favour of the combination with ATCH over bed rest alone were found. A review of the literature on the treatment of exacerbations in multiple sclerosis patients with bed rest and ATCH is given.
Fifty two patients with seropositive rheumatoid arthritis (RA) were studied over a period of one year to investigate possible relationships among changes of circulating immune complexes (CIC), deposits of immunoglobulins and complement around the cutaneous blood vessels, clinical activity of the disease, and the presence of extra-articular manifestations (EAM). The presence or absence of IgM and C3 in and around the cutaneous blood vessels correlated significantly with the presence or absence of extra-articular features in cross sectional and longitudinal studies. Patients with evidence of these cutaneous immune deposits also had a greater prevalence of CIC as determined by the Clq binding assay (ClqBA) or polyethylene glycol (PEG) assay for IC containing IgM (IgM IC). Although the degree of perivascular mononuclear cell infiltration around the blood vessels in the papillary dermis was related to the patients' clinical state at the initial assessment, it did not correlate with the later changes in the activity of the joint disease or the occurrence of EAM. Thus the deposition of immunoglobulin or complement, or both, seems to be independent of cellular infiltration. The meaning of these cellular infiltrates is not yet fully understood. Our study has shown that many patients with RA who appeared to have only joint disease in fact had subclinical systemic disease as reflected by a positive skin biopsy or CIC. Moreover, the disappearance of IgM deposits from the skin correlated with the disappearance of EAM and improvement of joint disease.
Renal abnormalities in 132 necropsied patients with rheumatoid arthritis were studied. Clinical findings before death included extra-articular manifestations of the disease (86% of patients), systemic vasculitis (6%), and uraemia (23%). Necropsy findings included nephrosclerosis (90%), systemic vasculitis (14%) with kidney involvement in 8%, amyloidosis (11%), membranous glomerulopathy (8%), and focal glomerular disease (8%). Association with clinical data suggests that both rheumatoid and non-rheumatoid disease may play a part in the cause of these abnormalities.
Aluminium (AlS) and zinc (ZnS) concentrations in serum were measured in patients with rheumatoid arthritis (RA) with and without Al-containing drugs and compared with levels in healthy controls. In RA patients without Al-containing antacids, the AlS levels did not differ from those of the healthy controls (mean 9.9, SEM 0.9 microgram/l and mean 8.6, SEM 0.5 microgram/l). However, the AlS levels in RA patients treated with Al-containing drugs were significantly (p less than 0.05) higher than in the other two groups (mean 14.1, SEM 1.1 microgram/l). Serum zinc (ZnS) levels in both RA groups were significantly (0.01 less than p less than 0.025) lower than in the healthy controls (mean 10.5, SEM 0.4 mumol/l and mean 10.2, SEM 0.4 mumol/l for the RA groups with and without Al-containing drugs, and in healthy volunteers mean 14.4, SEM 0.6 mumol/l). The difference in AlS levels might be due not only to the intestinal absorption of Al from Al-containing drugs, but also to a slightly impaired renal function, serum creatinine being slightly but significantly higher (p less than 0.05) in the Al-treated RA group than in non-Al-treated one. This difference in serum creatinine between the two RA groups might be explained by the more frequent use of cimetidine in the Al-treated RA group.