Correlation of circulating interleukin 16 with proinflammatory cytokines in patients with rheumatoid arthritis.
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Adult↗
Biomedical subjects
G Hein
Publications and source records attributed to G Hein.
[Laparoscopic appendectomy in a general hospital].
Appendectomy is one of the most commonly performed surgical procedures in general surgery. Minimally invasive operative procedures are now generally accepted first-choice treatments for certain indications (bile stone disease, reflux disease). At the present time only about 20% of appendectomies are started laparoscopically in Germany. The results of our 255 open appendectomies and 131 laparoscopic approaches are summarized. After the minimally invasive procedure we can describe a significantly lower incidence of wound infections, a shorter operating time, better intraoperative differential diagnostic possibilities and a shorter postoperative time of hospitalisation. Therefore, laparoscopic appendectomy is the method of choice.
Appendectomy↗
[Microcirculatory changes over the tender points in fibromyalgia patients after acupuncture therapy (measured with laser-Doppler flowmetry)].
Apart from widespread pain which is the main symptom of fibromyalgia, a great variety of functional and vegetative changes occur in the presence of this disease. Such changes include alterations in microcirculation, which may cause pain. A preliminary study demonstrated a reduction in regional blood flow above "tender points" in fibromyalgia patients compared with healthy controls. A consensus statement of the National Institutes of Health (NIH) states that acupuncture is a sufficient adjuvant method to treat patients with fibromyalgia. The aim of the present study was to determine parameters to measure the effectiveness of a specific treatment modality (such as acupuncture) in addition to the patient's subjective assessment of acupuncture treatment. Twenty patients with fibromyalgia according to the ACR and the Müller/Lautenschläger criteria were included in the study. Acupuncture was performed and adapted to individual needs in accordance with a specific protocol. Five representative "tender points" were examined before and after therapy by laser flowmetry, and the data were compared with temperature measurement and dolorimetry. Increased blood flow was registered above all "tender points" after acupuncture. Skin temperature had increased in 10/12 tender points by a mean of 0.45 degree C. The number of "tender points" were reduced from 16.1 to 13.8 after therapy. The pain threshold increased in 10/12 "tender points". These data suggest that acupuncture is a useful method to treat patients with fibromyalgia. Besides normalisation of clinical parameters, the improvement in microcirculation above "tender points" may alleviate pain.
Acupuncture Therapy↗
High-dose clodronate therapy prevents joint destruction in chronic antigen-induced arthritis of the rat but inhibits bone formation at the axial skeleton.
OBJECTIVE: To investigate the effects of clodronate on clinical disease activity, inflammatory alterations and cartilage destruction, periarticular and axial bone volume and bone turnover in chronic antigen-induced arthritis (AIA; day 28). METHODS: Rats with AIA were treated with clodronate (5 mg/kg/day continuously; 20 mg/kg/day intermittently or high-dose with 300 mg/kg 3 hours after arthritis induction +20 mg/kg/day continuously, respectively). Joint pathology was examined by histology. Bone volume and cellular turnover parameters of the right tibia head and the third lumbar vertebra were evaluated by histomorphometry. The findings were compared with those of healthy controls, sham-treated AIA and AIA treated continuously with 250 microg/kg of dexamethasone. RESULTS: All three therapy regimens with clodronate resulted in a significant reduction of joint swelling, histopathological inflammatory changes and cartilage destruction in comparison with sham-treated AIA. The antiinflammatory effect of high-dose clodronate was comparable with dexamethasone. The intermittent administration of 20 mg/kg/day of clodronate completely prevented periarticular bone loss by reduction of bone resorption without affecting bone formation at the periarticular and axial bone. Both continuous treatment with 5 mg/kg/day of clodronate and high-dose clodronate therapy partially prevented periarticular bone loss and reduced parameters of bone formation at the axial bone to values below those of healthy controls. CONCLUSION: High-dose clodronate therapy exerts an excellent preventive effect on clinical disease activity and on joint destruction in AIA. However, continuous treatment with high doses of clodronate may result in a low turnover state of bone remodelling.
Animals↗
[Vitamin D metabolites in rheumatoid arthritis: findings--hypotheses--consequences].
Active vitamin D metabolites are not only involved in the regulation of bone metabolism but exerts immunomodulatory effects important in the regulation of inflammatory processes. The purpose of the present study was to evaluate the effects of a short-time treatment with 1 alpha-hydroxycholecalciferol on both disease activity and bone metabolism in patients with rheumatoid arthritis (RA). The effects of an adjuvant therapy with 1 microgram 1 alpha-hydroxycholecalciferol over eight weeks on conventional parameters of disease activity (Ritchie index, duration of morning stiffness, C-reactive protein, ESR), serum levels of cytokines and soluble cytokine receptors (TNF-alpha, IL-6, IL-4, sIL-2R, sIL-6R) and parameters of bone metabolism (bone-specific alkaline phosphatase, osteocalcin, renal excretion of pyridinolin- and desoxypyridinolin-collagen-crosslinks, serum levels of parathormon, 1,25-dihydroxycholecalciferol and calcium, daily urinary calcium excretion) were investigated in 20 patients with RA. The treatment with 1 alpha-hydroxycholecalciferol resulted in an insignificant decrease in the number of swollen and tender joints, morning stiffness, CRP and ESR. Furthermore, a non-significant decrease in serum levels of TNF-alpha and IL-6 and an increase in IL-4 was observed. The treatment led to a significant decrease of bone-specific alkaline phosphatase (p = 0.001), osteocalcin (p = 0.04) and renal excretion of pyridinolin-crosslinks (p = 0.022) and to an increase of both serum calcium (p = 0.01) and daily urinary calcium excretion (p = 0.004). The results of this pilot study in a small group of RA patients indicate that an adjuvant therapy with active vitamin D metabolites may not only have preventive effects on systemic bone loss but also may inhibit the inflammatory and destructive process in RA in a limited degree.
Adult↗
Immunochemical detection of imidazolone in uremia and rheumatoid arthritis.
The advanced glycation end-product imidazolone is formed by reaction of arginine with 3-deoxyglucosone (3-DG), a reactive intermediate of the Maillard reaction, whose formation is non-oxidative. Using an antibody specific to this 3-DG-derived AGE, we demonstrated the presence of imidazolone-modified proteins in vivo in the urine and dialysate of patients with chronic renal failure, in the synovial fluid of patients with rheumatoid arthritis, as well as in vitro in human serum and human serum albumin incubated with glucose. Furthermore, we could show that in uremic patients the dimeric form of beta(2)-microglobulin is more susceptible to imidazolone modification than the monomeric one. Thus, the immunochemical detection of imidazolone may be a good marker for 3-DG-derived AGE modification in vivo and in vitro permitting a differentiation between the oxidative and the non-oxidative pathway of AGE generation.
Adult↗
31P magnetic resonance spectroscopy in fibromyalgic muscle.
OBJECTIVE: To measure inorganic phosphate (Pi), phosphocreatine (PCr), ATP and phosphodiesters (PDE) in fibromyalgic muscle tissue by (31)P magnetic resonance spectroscopy. METHODS: A 1.5 Tesla scanner with a P 100 surface coil was used to examine 15 patients (mean age 49.9+/-14.3 yr) with fibromyalgia, according to the American College of Rheumatology criteria, and 17 healthy controls (mean age 30.2+/-5.8 yr). RESULTS: Compared with the controls, there were increases in the levels of PDE (+22%, P = 0.032) and Pi (+19%, P = 0.019) in the spectra of fibromyalgia patients, but there was no difference in pH. CONCLUSION: The metabolic differences we found may have been related to weakness and fatigue in the fibromyalgia patients, but they do not fully explain the fibromyalgia symptoms.
Adenosine Triphosphate↗
Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia.
OBJECTIVE: Skin temperature and skin blood flow were studied above different tender points in 20 patients with fibromyalgia (FM) and 20 healthy controls. METHODS: Blood flow was measured by laser Doppler flowmetry and skin temperature was measured with an infrared thermometer. RESULTS: In the skin above the five tender points examined in each subject, we found an increased concentration of erythrocytes, decreased erythrocyte velocity and a consequent decrease in the flux of erythrocytes. A decrease in temperature was recorded above four of the five tender points. CONCLUSION: Vasoconstriction occurs in the skin above tender points in FM patients, supporting the hypothesis that FM is related to local hypoxia in the skin above tender points.
Adult↗
Gabapentin "add-on therapy" for idiopathic chronic hiccup (ICH).
The efficacy of cisapride, omeprazole, and baclofen (COB) for treatment of idiopathic chronic hiccup (ICH). was proven in several studies. The combination is considered, at present, to be "therapy of choice" for this condition. Substituting gabapentin for baclofen in baclofen resistant ICH cases can occasionally be successful. We present here cases where gabapentin was used successfully in combination with cisapride and omeprazole (COG/one patient) or as an "add-on" with cisapride, omeprazole, and baclofen (COBG/three patients). We conclude that, with baclofen and gabapentin, we are in possession of two substances that are, as a part of a combination therapy, quite effective for ICH. Because of the far more extensive experience with baclofen, we use it as a first-line therapy, together with omeprazole and cisapride. In cases where the results are not entirely satisfactory, the addition of gabapentin should be considered.
Acetates↗
[Update of rheumatology--II. State and prospectives of chemotherapy in chronic arthritis].
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Arthritis, Rheumatoid↗
Influence of methotrexate and azathioprine on radiologic progression in rheumatoid arthritis.
We investigated 43 patients with seropositive rheumatoid arthritis (RA) under a therapy with methotrexate (MTX) or azathioprine (AZA). All patients fulfilled the American Rheumatism Association criteria. It has been a retrospective study over 2.6 years (MTX: 26 patients, average age 54 +/- 14.6 years, female/male 19:7, AZA: 17 patients, average age 59.4 +/- 12.5 years, female/male 12:5). The mean duration of disease was 8 years (+/- 5.3) in the MTX-group and 7 years (+/- 7.3) in the AZA-group. The mean dose of MTX was 13. 3mg/week and of azathioprine 142.6mg/ daily. The drugs were administered orally. - Radiographs of hands, wrists and feet obtained at enrollment and at review were scored by a rheumatologist according to a modified Larsen score. Radiographic damages were counted in 25 joints of each hand and in 25 joints of each foot. The change in radiological score was calculated by subtracting the joint damage scores at follow up with first damage score at inclusion. The rate of radiological progression (YP) was calculated by dividing the change in radiological score by the number of years during the period of study. - Only 3 patients with MTX showed no radiologic progression. All other patients of both groups showed progressive radiological changes. - The study demonstrated no significant difference in the rate of radiologic progression between the different treatment-groups. However, there was a trend that MTX treated patients (YP 5 +/- 4.4) had a slower radiographic progression compared with those treated with AZA (YP 8.5 +/- 7.7). MTX may be more effective in patients at an earlier stage of rheumatoid arthritis. - When we started a therapy with AZA or MTX in a later period of disease we revealed a better influence of radiologic progression under AZA and a trend towards an increase of the radiologic progression under MTX. - Probably there is a decreasing effect of MTX in later periods of the disease. - The corticoid dose reduction was higher under AZA (AZA: Reduction about 58.6%, MTX: 25%) over the study duration. - Our investigation demonstrated a trend towards reduced radiological progression in MTX treated patients compared to AZA, however statistic analysis showed no significant difference in the rate of radiologic progression. At an earlier stage of the disease there is a better influence of MTX in radiologic progression, at the later stage we showed a slowing of radiological deterioration in AZA treated group.
Adult↗
[Rheumatology update. Current knowledge of etiology, pathophysiology, diagnosis, and therapy of selected arthritic disorders. Part I: pathogenesis and differential diagnosis].
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Arthritis, Rheumatoid↗
Is there a psoriatic osteopathy? -- the activity of bone resorption in psoriatics is related to inflammatory joint process.
The aim of this study was to examine former own histomorphological results by using biochemical markers of bone collagen catabolism in patients with psoriasis vulgaris and psoriatic arthritis and to compare these results with those from rheumatoid arthritis. - The diagnosis of PsA was made according to the diagnostic criteria of Moll and Wright modified by Bennet. Urine was collected from 99 patients with PsA, 21 patients suffering from PS without articular manifestations, 154 patients with RA fulfilling the ACR criteria of 1987, and 80 healthy controls. Pyridinoline and deoxypyridinoline in urine were analyzed by HPLC, levels of CrP and ESR were estimated using laboratory assessment. - Both crosslinks show a elevated excretion in PsA (particularly in active PsA / aPsA) as well as in RA. PS and Controls show no significant difference in the elimination of crosslinks. The levels of both crosslinks are higher in females than males in all groups. With the exception of Dpyd levels in urine which only show a tendency to correlate with ESR, there are positive correlations between measured crosslink-levels in urine and markers of inflammation. The Pyd/Dpyd ratio displays a significant correlation with ESR. - An increased breakdown of collagen I and II was found only in active forms of psoriatic arthritis and in rheumatoid arthritis. Our biochemical results do not demonstrate a complete agreement with former scintigraphic or histological investigations of other authors and own histomorphological results.
Adult↗
[Acne and thoracic pain].
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Acne Vulgaris↗
Investigations of bone turnover in renal osteopathy.
The renal bone disease which develops in chronic renal failure (CRF) is not an uniform disorder. Histomorphometry is accepted to be the best method for characterising the state of disease. The purpose of this study was to evaluate the suitability of pyridinium crosslinks in serum and urine as indicators of bone degradation processes. Patients with CRF had significantly higher Pyridinoline (Pyd) and Deoxypyridinoline (Dpyd) levels in serum and urine compared to normal controls except the urinary excretion in the subgroup of glomerulonephritis. A correlation was found between the serum levels of crosslinks and those of both creatinine and parathormone. The Pyd and Dpyd serum levels in patients under dialysis treatment were significantly higher than those of normal controls. With regard to bone turnover urinary crosslink measurements are of minor importance in CRF. In contrast, serum measurements could be helpful in revealing bone resorption both in patients with CRF and those under dialysis treatment.
Adult↗
[Nail changes in rheumatic disease].
Clinically the nail organ ist easy to investigate. When estimating dermato-rheumatological diseases, knowledge of important associated nail symptoms is extremely helpful. In some diseases like osteoarthropathia psoriatica and special variants, Reiter's syndrome and connective tissue disease, typical or even characteristic symptoms can be found. In other disorders like rheumatoid arthritis, goal and systemic vasculitis, associated nail disorders are not uncommon, but of less diagnostic specificity. We review data from the literature and from our dermato-rheumatological outpatient clinic.
Collagen Diseases↗
[Progressive systemic sclerosis - treatment results of extracorporeal photopheresis].
The treatment of progressive systemic sclerosis (PSS) is still unsatisfactory. We report on clinical, laboratory and immunological findings in 26 patients with PSS (6 males, 20 women) treated with extracorporeal photopheresis (ECP) for 8 cycles in a nonrandomized, uncontrolled study. ECP was performed on two consecutive days once a month. 8-methoxypsoralen concentrations in plasma and buffy coat were monitored by HPLC. We performed a standardized examination programme and determined parameters of inflammation and immune function. Global assessment revealed a partial remission in 18 patients, a stable disease in 8 patients and a slight progression in one patient. In the peripheral blood count a significant increase of CD3-positive NK cells was noted (p=0.03) although the leukocyte count decreased from 2,255 to 1,156 cells/microl. There was a non-significant decrease of elastase (102. 9 vs. 90.4 ng/ml), sulfidoleukotriens (2,255.4 vs. 1,688.9 pg/ml), ICAM-1 (301.9 vs. 276.6 ng/ml), soluble IL-2 receptor (609.0 vs. 422. 3 U/ml), and IL-10 (164.7 vs. 138.7 pg/ml). IL-6 and IL-8 did not show significant changes. The ECP treatment of patients with PSS shows immunomodulatory effects changing levels of pro-inflammatory and cytokine substances. Even after 8 cycles partial remission or stable disease is seen in patients as shown by global assessment and certain clinical symptoms. On the other hand, sufficient data on the long-term outcome are still missing.
Adult↗
Fibromyalgia in lupus erythematosus.
Fibromyalgia has been reported to occur with high prevalence in systemic lupus erythematosus. Data on fibromyalgia in other subsets of lupus erythematosus are not available. Risk factors for fibromyalgia have not been defined. We investigated 60 patients with different subsets of lupus erythematosus for the presence of fibromyalgia, association with clinical and laboratory parameters and disease activity. Our data were compared with the multicentre lupus erythematosus registry at the Free University of Berlin. Ten out of 60 patients with more than 11 tender points and widespread pain for more than 3 months were classified as positive for fibromyalgia. All of them were female. Fibromyalgia-positive patients suffered significantly more often from headache, morning stiffness, diffuse alopecia, muscle pain, arthralgia, renal involvement, and disclosed peripheral blood cell cytopenia, rheumatoid factor, hypergammaglobulinaemia and intake of corticosteroids and azathioprine. Fibromyalgia was more frequent in systemic lupus than in other lupus subsets. Evaluation of fibromyalgia symptoms and lupus disease activity was performed in 30 patients in a 1-year (range 9-13 months) follow-up. These 30 patients consisted of 9 fibromyalgia-positive and 21 fibromyalgia-negative patients. Both groups were characterized by stable clinical features such as number of tender points and ECLAM index. Fibromyalgia did not show a correlation with lupus activity. We suggest that fibromyalgia and lupus erythematosus are distinct complaints. Patients with lupus are at risk of developing secondary fibromyalgia. The clinical features of fibromyalgia-positive patients may contribute to misinterpretation of lupus activity.
Adult↗