Biomedical subjects
Publications and source records attributed to E L Semble.
Gastric mucosal damage is a common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs may cause gastrointestinal symptoms, gastric erosions, peptic ulcers or upper gastrointestinal bleeding. Therefore, NSAIDs should be used cautiously in patients with a history of gastrointestinal lesions. Drugs that may be useful in preventing or treating NSAID-induced gastric mucosal injury are under intensive clinical investigation.
The clinical records of randomly selected patients receiving both the sheep cell agglutination test (SCAT) and the latex agglutination test (RA latex) for rheumatoid factor (RF) were analyzed for the presence of American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA). When both tests were positive there was a 3-fold increase compared to only one test positive in the relative risk that a patient met ARA criteria for RA, and there was a 2-fold increase in the probability that a patient with 2 positive tests had classical RA compared to only a positive RA latex. The occurrence of RF reactive with both human and rabbit IgG identifies a population of patients likely to have more ARA criteria for RA and classical disease.
Clinical and genetic studies were analyzed in 47 patients with rheumatoid arthritis (RA) who had upper gastrointestinal (GI) endoscopies. Fifty-three percent of patients with RA had peptic ulcers and/or erosions. Sixty percent of patients with ulcers and/or erosions had a history of peptic ulcer disease. Although a greater number of patients with ulcers and/or erosions was taking regular aspirin or indomethacin, comparable numbers of patients with abnormal and normal endoscopies were using nonsteroidal antiinflammatory drugs. Nineteen of the 25 patients (76%) with ulcers and/or erosions had type O blood. Patients with abnormal and normal endoscopies had similar frequencies of GI complaints and fecal blood loss. GI symptoms and occult fecal blood loss, therefore, are not prominent features of upper GI disease in RA. ABO screening may be helpful in determining which patients with RA are at risk for developing peptic ulcers and/or erosions.
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Since vascular proliferation may be important in the pathogenesis of rheumatoid arthritis (RA) and/or osteoarthritis (OA), this study examined the induction of angiogenesis by these synovial fluids (SF). Four of 11 (36%) RA and 2 of 6 (33%) OA SF caused early morphological changes in human endothelial cell cultures. SF from 7 of 11 (63%) RA and 4 of 8 (50%) OA patients resulted in the late formation of tabular networks morphologically resembling capillaries observed in vivo. Early morphological changes in cultures were associated with a significantly (p less than 0.05) longer duration of disease in patients with RA. Factors present in the SF of RA and OA patients may play a role in the excessive vascularization which often occurs in these arthropathies.
The sensitive pulmonary function tests of change in maximum expiratory flow (delta Vmax 50) and volume of isoflow were used to determine the effects of rheumatoid arthritis (RA), smoking, and alpha 1-antitrypsin deficiency phenotypes on peripheral airways. Patients were prospectively divided into 4 groups: 14 smokers with RA, 12 nonsmokers with RA, 11 smokers without RA, and 13 nonsmokers without RA. delta Vmax 50 was the most discriminating variable and demonstrated significant small airway obstructive disease in the first 3 groups, with an additive effect in the group of smokers with RA. An increased incidence of the alpha 1-antitrypsin-deficient MS phenotype was seen in the RA smoker group, and this phenotype was associated with severe pulmonary disease.
A 31-year-old man with rheumatoid arthritis, who had previously been treated with sulindac, fenoprofen calcium, high dose salicylates and gold salts, developed renal papillary necrosis (RPN) 4 months after institution of naproxen therapy. No other factor predisposing to RPN could be discovered. Sulindac was substituted for naproxen and no further adverse renal effects occurred over the next 12 months. We review previous reports linking RPN to antiinflammatory drug use and discuss possible advantages of sulindac in patients who have experienced renal toxicity from other antiinflammatory agents.
In vitro assays of human neutrophil phagocytosis, adherence, enzyme release, and response to chemotactic factors were utilized to determine the effects of benoxaprofen on these cells. At concentrations of 30 and 300 micrograms/ml benoxaprofen partially inhibited phagocytosis without affecting adherence. High concentrations (300 micrograms/ml) of benoxaprofen, but not aspirin or gold, enhanced the release of the granular enzymes beta-glucuronidase and lysozyme, but not the release of the cytoplasmic enzyme lactic dehydrogenase from both resting and phagocytosing neutrophils. High concentrations (300 micrograms/ml) of benoxaprofen also inhibited the response of neutrophils to chemotactic factors as determined by both the leading front and leukotactic index methods. These unique in vitro effects of this antiinflammatory agent are compatible with recent clinical reports concerning its efficacy and toxicity.
A recently reported technique employing the leukotactic index which represents all migrating cells in vitro neutrophil chemotaxis systems, was compared to the leading front technique for assaying antirheumatic drug effects on this important neutrophil function. Normal human neutrophils were treated with therapeutic concentrations of aspirin, gold sodium thiomalate, D-penicillamine, and azathioprine. The responses of these cells and of control cells to neutrophil-immune complex-serum-derived chemotactic factors were assayed in Boyden chambers. Significant (P less than 0.05) inhibition was observed by the leading front technique only for D-penicillamine at high concentrations. Significant (P less than 0.01) inhibition was seen with D-penicillamine at therapeutic plasma levels with the leukotactic index technique. Gold sodium thiomalate and aspirin at high concentrations also produced significant (P less than 0.01 and P less than 0.05) inhibition of chemotaxis as assayed by the leukotactic index procedure. Azathioprine had no significant effects when studied with either technique. These results indicate that the leukotactic index may be a more sensitive technique for quantitating neutrophil migration in response to chemotactic factors and may therefore provide useful additional information for determining the effects of antirheumatic drugs on this important neutrophil function.
IgG autoantibodies against antigen in the cytoplasm of cells of the neutrophil-monocyte cell lineage have been found in the sera of patients with Wegener's granulomatosis (WG). The indirect immunofluorescence test (IFT) is proving to be a valuable screening test for these antibodies, but obtaining neutrophils for substrate is time-consuming, and interpretation of the fluorescence patterns in ethanol-fixed cells requires considerable experience. We report an improved IFT using HL-60 cells as substrate. The myeloid reactivity of HL-60 cells was characterized and compared to that of neutrophils, with and without prior ethanol fixation. In contrast to neutrophils, myeloperoxidase (MPO) was more completely extracted from HL-60 cells by prior ethanol fixation, eliminating the confusion inherent in trying to distinguish anti-MPO antibodies from Wegener's granulomatosis associated anti-neutrophil cytoplasmic autoantibodies (WG-ANCA) in the IFT. The WG-ANCA reactivity remained intact with ethanol fixation, producing a distinct crescent and half-moon pattern of specific immunofluorescence. This WG-ANCA positive pattern was found in 25 sera from 11 WG patients and was absent in over 1200 control sera from patients referred for autoantibody testing.
Four rheumatologists and 2 radiologists utilized 3 reading techniques to evaluate clinical radiographic progression in selected serial hand and wrist films from 5 rheumatoid arthritis patients. The carpometacarpal radio determinations were the most internally consistent; global assessment and total erosion + joint space narrowing scores showed the best between-method correlations; and the erosion + joint space narrowing scores depicted most sensitively the progression over time which was not affected by immunomodulating agent or non-steroidal anti-inflammatory agent therapy. In this study, instructed, non-experienced readers detected rheumatoid radiographic progression utilizing readily available scoring techniques.
Melorheostosis is an unusual sclerotic dysplasia of bone. We describe a patient with melorheostosis who showed improvement in pain and vasomotor function after treatment with nifedipine. Peripheral vascular disturbances may be responsible for the pain associated with this disorder and vascular abnormalities could possibly be related to the pathogenesis of this disease.
We report the first case of co-existing temporal arteritis and Sjögren's syndrome in the English language literature. Characteristic clinical and laboratory findings of both disorders were present. The combination of these two illnesses could be on the basis of chance alone or there may be a common etiology. Temporal arteritis could therefore be an addition to the spectrum of vasculitis diseases seen in Sjögren's syndrome.