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Biomedical subjects

D Wendling

Publications and source records attributed to D Wendling.

At least 55 records · Page 3Linked to original sources
PubMed1999

HLA-DRB1 alleles and shared amino acid sequences in disease susceptibility and severity in patients from eastern France with rheumatoid arthritis.

OBJECTIVE: To examine the effects of HLA-DRB1 alleles and amino acid sequences that carry the shared epitope (SE) upon rheumatoid arthritis (RA) susceptibility and disease severity in patients from Eastern France. METHODS: HLA-DRB1 alleles were determined in 120 patients and 104 healthy controls by polymerase chain reaction/sequence specific oligonucleotide probes. Subtyping of DRB1*01 and *04 were performed using sequence specific primers. Patients were retrospectively evaluated for disease duration, age at disease onset, presence of rheumatoid factors, subcutaneous nodules, vasculitis and other extraarticular diseases, for the need for arthroplasty and immunosuppressive/immunoregulatory agents, and for radiographic damage. RESULTS: The prevalence of HLA-DRB1*04 was significantly higher in patients (46.6%) than in controls (17.3%) (Pcorr = 0.000003). HLA-DRB1*0101 and *0401 were the most prominently associated subtypes in patients with RA (33.3%, Pcorr = 0.011, and 28.3%, Pcorr = 0.00008, respectively). A significant fraction of patients (72.5%) expressed one or 2 copies of the SE (p < 0.0000001; OR 4.77, CI 2.61-8.78). The presence of double SE was associated with a higher risk of developing RA (OR 4.83, CI 1.91-12.71; p = 0.0001). No significant differences in the clinical records among patients expressing no RA linked alleles, one and 2 copies of the SE, were observed. However, analyzing the specific effect of each amino acid sequence, we observed a significant association of the QKRAA motif with vasculitis (p = 0.03) and history of joint replacement surgery (p = 0.05), suggesting a role for lysine in position 71 of the shared sequence. CONCLUSION: These findings differ from those of previous HLA-DRB1 allele studies in patients with RA from other regions of France. Thus, the heterogeneity in both the expression of DRB1 alleles and the association of these alleles with disease severity could be relevant within a country such as France.

Adolescent↗
PubMed1999

Pneumococcal polyarticular septic arthritis in a patient with rheumatoid arthritis.

Rheumatoid arthritis is the most commonly reported host-related risk factor for septic arthritis. This risk is highest in severe, seropositive, long-standing (mean, 10 years) rheumatoid arthritis responsible for extraarticular symptoms and treated with systemic glucocorticoids. The clinical presentation of the joint infection is often atypical, leading to diagnostic wanderings. In 25% of cases, the infection is polyarticular, with 3.5 involved joints on average. Staphylococcus aureus is the most common causative organism. Streptococcus pneumoniae causes 5% of all cases of septic arthritis and is more often responsible for polyarticular infections than other organisms. Polyarticular septic arthritis carries a poor prognosis, with a mortality rate of 50% in rheumatoid arthritis patients. Despite its low incidence, polyarticular septic arthritis should be routinely considered in the differential diagnosis of rheumatoid flares. We report a case of pneumococcal septic arthritis involving five joints in a patient with known rheumatoid arthritis. Three other cases with involvement of more than four joints have been published.

Anti-Bacterial Agents↗
PubMed1998

[Acute benign edematous polyarthritis in the elderly (or RA3PE syndrome). Clinical course apropos of 13 cases].

OBJECTIVES: The position of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) among inflammatory rheumatic diseases. Is it a distinct syndrome or a clinical feature? PATIENTS AND METHODS: To answer this question a retrospective study was conducted in 13 elderly patients (mean age: 72 years). The clinical course and laboratory findings were followed for 3 to 172 months after disease onset. RESULTS: In two patients, another disease was diagnosed: polymyalgia rheumatica, late onset peripheral spondylarthropathy. Two relapses of RS3PE were noted. There was no clinical difference between initial RS3PE and relapsing RS3PE. In four cases, RS2PE syndrome revealed another disease: dermatopolymyositis, AL amyloidosis, polymyalgia rheumatica, late onset peripheral spondylarthropathy. No rheumatoid arthritis appeared, but one patient was positive for rheumatoid factors. A benign course was observed in all patients, without paraneoplastic syndrome and without death. CONCLUSION: Benign edematous polyarthritis in the elderly is a syndrome that may reveal connective tissue disease or inflammatory rheumatic disease.

Aged↗
PubMed1998

Soluble intercellular adhesion molecule 1 in spondylarthropathies.

The aim of the study was to evaluate the soluble form of intercellular adhesion molecule 1 (sICAM-1), a ligand of LFA-1, in the serum of patients with spondylarthropathies (SpA) and to look for a correlation with several inflammatory parameters. sICAM-1 levels were measured by ELISA in 25 SpA patients, 20 healthy controls and 20 patients with rheumatoid arthritis (RA). Results showed that sICAM-1 levels were increased (but not significantly) in SpA patients compared with controls; high levels (> 400 ng/ml) where found in 28% of SpA patients but in none of the RA or control groups. In SpA, correlations were found between sICAM-1 and erythrocyte sedimentation rate, C-reactive protein and interleukin 6, but not with tumour necrosis factor alapha or IgA. These correlations were absent in RA. In conclusion, these results suggest that sICAM-1 levels in SpA may reflect the acute phase of inflammation.

Adult↗
PubMed1998

Tenosynovitis due to Mycobacterium avium intracellulare and Mycobacterium chelonei: report of two cases with review of the literature.

Atypical mycobacteria can induce soft tissue infections such as tenosynovitis. We observed one case of finger flexor tendon tenosynovitis infected with Mycobacterium avium intracellulare and one case of knee and ankle arthritis with lateral peroneal tendon tenosynovitis due to M. chelonei. In the first patient, a tenosynovectomy only was performed leading to resolution of the infection. The second patient was immunocompromised as a result of corticosteroid therapy and the mycobacterial infection was treated with tenosynovectomy and multidrug chemotherapy. This patient died from infectious pneumonitis. Previously reported cases of infectious tenosynovitis due to these atypical mycobacteria are reviewed.

Aged↗
PubMed1998

HLA DRB1* alleles in rheumatoid nodulosis: a comparative study with rheumatoid arthritis with and without nodules.

Rheumatoid nodulosis (RN) is a rare condition associating rheumatoid nodules, episodes of arthritis, cystic bone lesions and, generally, positive rheumatoid factors (RF). It is considered a benign variant of rheumatoid arthritis (RA). In this study, we determined the HLA DRB1* alleles of our RN patients and compared the distribution of these alleles to those of 74 healthy controls and 104 RA patients with and without nodules. Four RN patients were observed. All had subcutaneous nodules and RF were negative in three patients. Of the 104 RA patients, 18 had nodules (nodRA). Systemic manifestation (including vasculitis, peripheral neuropathy or lung involvement) were found in seven of these nodRA cases (33.8%) and most had positive RF and erosive changes on X-rays. Only one RN patient had a RA-associated allele (DRB1*0101). The frequencies of the HLA DRB1* alleles encompassing the "rheumatoid" shared epitope were similar to those of other RA series: *0101, 34.6% (P = 0.03 compared with controls); *0401, 26.9% (P < 0.0001); *0404, 12.5% (P = 0.04); *0405, 4.8% (P = 0.8); *1001, 8.6% (P = 0.5). Of the nodRA and seronegative RA patients, 77.7% and 53.3%, respectively, presented the shared epitope. Thus, there was a tendency to decreased expression of the RA-associated alleles in RN (25%) compared with nodRA and seronegative RA patients. This study is restricted by the small number of tested RN patients, but the results suggest that the RA-associated alleles are poorly expressed in RN.

Adult↗
PubMed1998

[Aetiologic features of osteoporosis in male patients aged less than 50 years: study of 28 cases with a comparative series of 30 patients over the age of 50].

PURPOSE: To study the aetiologic factors of osteoporosis (OP) in young male patients, we conducted a retrospective study of male osteoporosis observed in our department during the past 20 years. METHODS: Patients included in the study were over 16 years of age and had a fracture or a decreased bone mineral density with a T score (assessed at the spine or at the spine and femoral neck) below -2.5 SD. The age and circumstances of diagnosis, serum and 24-hour urinary calcium and phosphorus investigations, hormonal measurements (including parathyroid hormone, thyroid hormones, cortisol and testosterone), bone biopsy and the final diagnosis were analyzed. RESULTS: One hundred and nineteen patients responded to the defined diagnosis criteria. Twenty-eight were less than 50 years of age (group I or young male osteoporosis). Data were compared with those of 30 patients more than 50 years of age (group II). In group I, an aetiology was found in 17 out of 28 cases (60.7%) (secondary osteoporosis: OP II), while 11 out of 28 patients (39.3%) had primary or idiopathic osteoporosis (OP I). In group II, the frequency of OP I was 19 out of 30 cases (63.3%) and 11 out of 30 patients (36.6%) had OP II. However, the frequency of OP II did not differ significantly between the two groups (P = 0.11). The aetiology in group I was either hypogonadism (6 out of 17), alcoholism (2 out of 17), mastocytosis (2 out of 17), primary biliary cirrhosis (1 out of 17), osteogenesis imperfecta (1 out of 17), idiopathic hypercalciuria (1 out of 17), corticosteroid treatment (1 out of 17) or ankylosing spondylitis (1 out of 17). Multiple causes were found in 5 out of 17 cases. The causes of osteoporosis in group II included hypogonadism (2 out of 11), alcoholism (2 out of 11), idiopathic hypercalciuria (2 out of 11), glucocorticosteroid therapy (6 out of 11) and rheumatoid arthritis (1 out of 11). CONCLUSIONS: Our results were compared to those of the various series reported in the literature which, though focusing on male osteoporosis, often included elderly patients. To determine whether osteoporosis in young male is more often OP II, further prospective studies are required.

Adult↗
PubMed1998

Insulin-like growth factor-I and insulin-like growth factor binding protein-3 serum levels in ankylosing spondylitis.

OBJECTIVE: Low bone mass, vertebral osteopenia and fractures have been described in patients with ankylosing spondylitis (AS), but the aetiology of this osteoporosis (OP) remains unknown. Insulin-like growth factor-I (IGF-I), a bone-promoting peptide, may be considered as reflecting osteoblast function as well as its main binding protein, insulin-like growth factor binding protein-3 (IGFBP-3). Both were found to be decreased in post-menopausal women and male patients with idiopathic OP. In this study, we aimed to measure the circulating IGF-I and IGFBP-3 in AS patients. METHODS: Thirty-three AS patients were compared to 23 healthy controls. Bone mineral density (dual X-ray absorptiometry) was measured at the spine and the femoral neck. We determined the serum levels of growth hormone (GH), insulin, glycaemia, and the IGF-I and IGFBP-3 serum concentrations. RESULTS: A lowered lumbar spine bone mineral density was found in the AS group (AS: 0.946 g/cm2, controls: 1.02 g/cm2; P = 0.05). AS patients had a higher glycaemia than controls, but results were in the normal range. There were no significant differences in the mean values for GH and insulin. Mean IGF-I serum levels were 218.3 ng/ml (+/-72.4) in patients and 212.1 (+/-71.1) in controls (P = 0.75). The serum concentrations of IGFBP-3 were significantly lower in AS (3.29+/-0.6 microg/ml) than in healthy subjects (3.63+/-0.6 microg/ml; P = 0.05). There was a negative correlation between the serum IGFBP-3 concentration and erythrocyte sedimentation rate (r = -0.39; P = 0.025). CONCLUSIONS: Since IGFBP-3 is an important cofactor for IGF-I and modulates its bioavailability and activity in bone, these data suggest that osteoblast cell function could be impaired in AS. Inflammation could play a role in this IGFBP-3/IGF-I axis involvement. However, further studies are warranted to determine the role of the other growth factors and their binding proteins in the OP of AS.

Adult↗
PubMed1998

Current guidelines for the drug treatment of ankylosing spondylitis.

Ankylosing spondylitis (AS) is a systemic inflammatory rheumatic disease involving spinal and sacroiliac joints. This condition is responsible for back pain, stiffness and discomfort. Several drugs are currently available in the management of AS, and may be divided into 3 groups. The first includes nonsteroidal anti-inflammatory drugs (NSAIDs), which are the main drug group used in AS because they reduce pain and stiffness in most patients. Several NSAIDs are available but phenylbutazone is considered the NSAID of choice in AS. However, other NSAIDs give similar beneficial results and the medication of preference in specific to each patient. All NSAIDs share common gastrointestinal toxicity, and they should be administered during periods of flare-up of the disease. The second drug group that has been used in the treatment of patients with AS comprises analgesics, muscle relaxants and low dose corticosteroids. They can be considered as adjuvant therapy. These drugs are helpful when NSAIDs are poorly tolerated or ineffective. Second-line treatments or disease modifying antirheumatic drugs (DMARDs) are included in the third group. These drugs are required in cases of longstanding severe or refractory AS. Sulfasalazine has proven to be effective in such cases, leading to improvement in clinical and laboratory indices of disease activity. Beneficial results are mainly evident in patients with AS who have peripheral disease involvement. Other medications (such as methotrexate or gold salts, for instance) require properly designed controlled studies to evaluate their effectiveness in the treatment of this disorder, while immunosuppressive agents have little to offer in the management of patients with AS and require further studies. Some specific clinical features are observed in AS: enthesopathy may be treated with local injection of corticosteroids; sacroiliac joint pain may be managed by corticosteroid injection performed under fluoroscopic control or guided by computed tomography. The management of patients with AS includes some other procedures such as patient education, rest, a programme of physical exercise and physiotherapy. In parallel with pharmacotherapy, these procedures are of great importance in reducing stiffness and spinal ankylosis, and thus improve the patient's quality of life.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

Anterior chest wall malignancies. A review of ten cases.

OBJECTIVES: To report the features of malignancies responsible for a chest wall mass and involving the sternum, the sternocostal and/or sternoclavicular joints, the chondrocostal junction and/or the adjacent soft tissues. METHODS: The medical records of patients with a chest wall mass due to malignant disease were reviewed retrospectively. The following data were abstracted from each record: characteristics of the pain and mass, constitutional symptoms, physical findings, laboratory test results, findings from imaging studies (plain radiographs, computed tomography and magnetic resonance imaging of the chest, radionuclide bone scan), histologic features of the biopsy specimen from the chest wall mass and origin of the mass. RESULTS: Seven men and three women with a mean age of 53.1 years were included in the study. A single patient had a history of malignant disease (lymphoma); in the remaining nine patients the chest wall mass was the first manifestation of the malignancy. All ten patients had pain with a mixed time pattern. The mass was located on the sternum in half the patients and in a parasternal location in the other half. Erythrocyte sedimentation rate elevation was found in seven patients, an increased serum level of lactate dehydrogenase in one and a monoclonal immunoglobulin in three. Sternal lesions were visible on plain radiographs in four patients. Computed tomography of the chest consistently disclosed sternal or sternocostal lytic lesions with spread to the adjacent soft tissues; in five cases, enlarged lymph nodes were visible in the anterior part of the mediastinum. Magnetic resonance imaging of the chest did not add to the information provided by computed tomography. Radionuclide uptake on the bone scan was increased, decreased, or normal at the site of the lesion. The cause was Hodgkin's disease in two cases, non-Hodgkin's lymphoma in three, metastatic bone disease in two (from an adenocarcinoma of the lung and a hepatocarcinoma, respectively), multiple myeloma in one, and solitary plasmacytoma in two. CONCLUSION: A chest wall mass can be caused by a known or as yet undiagnosed malignancy. Chest wall involvement due to malignant disease in rare, however. The specific features of sternal metastases, lymphomas involving the sternum, and sternal plasmacytomas are discussed. Nonmalignant chest wall lesions that can manifest as a bulging or swelling of the chest wall are reviewed.

Adenocarcinoma↗
PubMed1998

A randomized, double blind, placebo controlled multicenter trial of murine anti-CD4 monoclonal antibody therapy in rheumatoid arthritis.

OBJECTIVE: To assess safety and efficacy of a murine anti-CD4 monoclonal antibody (Mab) in a population of patients with rheumatoid arthritis (RA) compared to treatment with placebo. METHODS: Fifty-eight patients with defined RA were included in this placebo controlled, randomized, double blind, multicenter study. Of the 48 women and 10 men (mean age 54.5 years), 25 were functional class II and 31 were class III, with 9 years' disease duration; the mean of previous disease modifying antirheumatic drugs was 4; 49 were taking steroids (mean dosage 11 mg/day of prednisone). Eighty percent were rheumatoid factor positive. All were in an active state of the disease with: pain > 4 (mean at inclusion 6.6), tender joints > 4 (mean 12), swollen joint count > 3 (mean 9), morning stiffness > 45 min (mean 185), erythrocyte sedimentation rate > 30 mm (mean 59) or C-reactive protein (CRP) > 30 mg/l (mean 63). Treatment was randomized between murine anti-CD4 Mab (B-F5, Diaclone, 20 mg/day) or placebo intravenously for 10 consecutive days. Efficacy was assessed with a composite index (Paulus), with evaluation of number of patients with 20 or 50% improvement in each group. Changes in measures of single clinical or biological variables were also evaluated. RESULTS: The 2 groups were comparable at inclusion. Treatment was well tolerated. Mild side effects (chills, fever, rash) were seen in both groups. Percentage of patients with global 20 or 50% response did not differ between placebo and Mab groups at Day 10 or at Day 30. Evaluation of single variables showed reduced CRP, swollen joint count, and Ritchie index in some B-F5 patients at Day 10, although in the B-F5 group as a whole only CRP was significant. CONCLUSION: No significant improvement in RA after murine anti-CD4 Mab was observed.

Adult↗