Protective effect of gold rings and rheumatoid arthritis.
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Biomedical subjects
Publications and source records attributed to H D Boloşiu.
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The paper reports on the authors' own experience on the effect of therapy with methotrexate (MTX) in 18 patients with invalidant psoriatic arthritis (PA). The therapeutic scheme was of the weekly "mini-pulse" type (three doses of 2.5 mg administered at 12-hour interval, with a gradual increase to 15 mg/week). The results were very good in 12 cases (66.6%), good in 3 cases (16.6%) and absent in other two cases (11.1%). These results and the data in the literature lead to the conclusion that MTX is a valuable therapeutic alternative for severe P.A. under the conditions of a correct surveillance with the observance of the contraindications.
Antibodies against rat myocardium were studied by means of histoimmunfluorescence (indirect technique) in 32 rheumatic fever patients. Antibodies were found in 54% of the cases without carditis or active rheumatic valvulitis and in 83% of those with carditis. The fluorescent patterns observed were : sarcolemmal, sarcoplasmic (intermyofibrillar) and smooth muscle of vessels. The sarcolemmal pattern was more frequently observed in rheumatic carditis while the intermyofibrillar one was more common in rheumatic fever without evidence of carditis as well as rheumatic valvulitis. The serum factors involved in the sarcolemmal fluorescence were inhibitied by the insoluble saline myocardium extract.
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The authors present a dynamic observation of a patient with advanced rheumatic polyarthritis that developed considerable hydrathrosis of the left knee and popliteal deep cyst of the Backer type. The general treatment was completed with radioisotopic synoviorthesis with Au198 that administered directly in the articulation and in the cavity of the cyst, resulting in the rupture of its wall. The symptomatology of the dissecting popliteal cyst was similar to that of thrombophlebitis. Posterior incision and drainage of the cyst collection have resulted in the disappearance of the local phenomena.
BACKGROUND: The Diagnostic workup of patients with fever of unknown origin is a challenge, due to the great number of possible etiologies. After we studied the etiologic spectrum of fever of unknown origin in Romania, we tried to evaluate the diagnostic procedures used and their efficiency. METHODS: A multicenter cohort study of two years, with another two years of follow-up was carried out on 164 consecutive patients who met the classic, modified criteria of fever of unknown origin. We used a standardised diagnostic protocol. MAIN OUTCOME MEASURED: The role of every diagnostic procedure in establishing the final diagnosis. RESULTS: The diagnosis was made by microbiology and serology in 41 cases (25%), by histopathology in 22 cases (18%), with the help of imaging techniques in 30 cases (1.3%), based on the clinical evolution and response to treatment in 54 cases (33%) and by other methods in 12 cases (7.3%). The abdomino-pelvic ultrasonography had a sensitivity of 60%, a specificity of 70%, a positive likelihood ratio of 2.02 and a negative likelihood ratio of 0.57, while the scanner had a sensitivity of 81%, a specificity of 64%, a positive likelihood ratio of 2.23 and a negative likelihood ratio of 0.29. CONCLUSIONS: Of all the diagnostic procedures used, none had a good sensitivity/specificity. The clinical evolution and the treatment response had an important role in the diagnostic workup.
BACKGROUND: The spectrum of fever of unknown origin seems to be determined by geographic and economic factors, and it appears to change in time. Excepting a small retrospective study, no other study on fever of unknown origin has been performed in Central or Eastern Europe. METHODS: A multicenter cohort study was carried out on 164 consecutive patients who met the classic, modified criteria of fever of unknown origin. The study lasted 2 years (1997-1998) and included a follow-up period of another 2 years. MAIN OUTCOME MEASURED: The final diagnosis at the end of follow-up. RESULTS: 74 (45%) patients had infections (tuberculosis: 27 patients, 16%), 41 patients (25%) had neoplasms, 30 (18%) had non-infectious inflammatory diseases, three (2%) drug fever, and four (2%) other causes. The etiology remained obscure for 12 patients (7%). CONCLUSIONS: Infections represent the most important etiology, among them predominating tuberculosis.
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Activation of the terminal complement pathway leads to formation of the C5b--9 complex. The main effects of C5b--9 generation are tissue injury by cell lysis or by stimulation of proinflammatory mediators. In a study carried out in 42 patients, using polyclonal antibodies against C5b--9 neoantigens and C9 in an ELISA assay, we found significantly higher levels of SC5b--9 complex in plasma from the 18 patients with active systemic lupus erythematosus than those found in 10 healthy controls (p less than 0.005). In the 18 patients presenting rheumatoid arthritis and the 6 with progressive systemic sclerosis the plasma levels of SC5b--9 complex did not differ significantly from those in controls. The SC5b--9 levels found in the synovial fluid samples from the 16 rheumatoid arthritis patients were higher than the corresponding plasma ones. The ratio between synovial fluid and plasma levels was 1.2. Immunoperoxidase staining for C5b--9 was intense in three rheumatoid synovial membranes and absent in two normal synovial membranes obtained during meniscectomy. Increased levels of plasma and synovial fluid SC5b--9 reflect pathologic systemic or local activation of the complement carcase in systemic lupus erythematosus and respectively rheumatoid arthritis. Synovial membrane deposits of C5b--9 are indicative for the lytic and proinflammatory effects of complement activation.
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von Willebrand factor (vWf), an endothelial cell product, was evaluated in 39 patients with rheumatoid arthritis, 19 patients with connective tissue diseases and vasculitis, 21 patients with nonrheumatoid inflammatory arthritides, 14 patients with osteoarthritis and 19 controls. High plasma vWf levels were found in rheumatoid arthritis patients: 196.35 +/- 85.8 (p less than 0.001 versus control) connective tissue diseases and vasculitides: 306.50 +/- 43.4 (p less than 0.001 versus control) and inflammatory nonrheumatoid arthritides: 193.35 +/- 90.6 (p less than 0.01 versus control). Highly increased vWf concentrations of more than 300%, were found in one patient presenting Wegener granulomatosis, 6 patients with vasculitis associated to connective tissue diseases, 7 patients with rheumatoid arthritis and 2 patients with active forms of inflammatory arthritides. vWf was correlated with fibrinogen in the subgroup of systemic lupus erythematosus patients. Elevated vWf levels may reflect vascular damage as well as the acute phase reaction. Highly elevated levels of vWf appear to indicate a poor prognosis.
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Fibronectin is a high molecular weight glycoprotein from plasma and other body fluids, connective tissue matrix and basement membranes. No significant differences in the mean values of plasma fibronectin were found in patients with rheumatic diseases compared to control subjects. The fibronectin in synovial fluids in these patients presented higher levels than in plasma. No other protein from the synovial fluid presented such a peculiar behaviour. The synovial fluid fibronectin/plasma fibronectin ratio is 2.49 in patients with rheumatoid arthritis, 1.56 in those with inflammatory nonrheumatoid arthritides and 1.60 in those with osteoarthritis. Statistically significant higher values of synovial fibronectin were found in patients with rheumatoid arthritis compared to those with osteoarthritis. No significant statistical correlations were found between the synovial fibronectin concentrations and the other clinical or biological parameters of the rheumatoid arthritis patients, but for synovial fluid C3. Immunohistochemical localization of fibronectin in the rheumatoid synovium showed more intense and extended specific deposits than in the control patients. These results suggest a local synthesis of fibronectin related to the chronic inflammatory process.