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Biomedical subjects

H M Markusse

Publications and source records attributed to H M Markusse.

At least 37 records · Page 2Linked to original sources
PubMed1996

Parasympathetic dysfunction in rheumatoid arthritis patients with ocular dryness.

OBJECTIVE: To determine whether abnormalities in the function of the autonomic nervous system are associated with oral and ocular dryness in rheumatoid arthritis. METHODS: Pupillography was done using an infrared light reflection method (IRIS) to measure both parasympathetic function (constriction latency and the latency of maximum constriction velocity (MCV)) and sympathetic function (dilatation latency) in rheumatoid arthritis patients with and without ocular dryness. The Schirmer and Saxon tests were used to measure the tear and saliva production respectively. RESULTS: The Schirmer and Saxon test results in rheumatoid arthritis patients with ocular dryness were reduced (P < 0.05) compared with rheumatoid arthritis patients without ocular dryness and healthy controls. Constriction latency and MCV latency were prolonged in rheumatoid arthritis patients with ocular dryness compared to the other two groups (P < 0.05). A negative correlation was found between the degree of ocular dryness and both constriction latency and MCV latency. No correlation was found between the results of pupillography and saliva production. CONCLUSIONS: Parasympathetic dysfunction may play a role in ocular dryness in patients with rheumatoid arthritis.

Adult↗
PubMed1995

A randomized, double-blind, placebo-controlled study of CD4 monoclonal antibody therapy in early rheumatoid arthritis.

OBJECTIVE: To assess the efficacy of the CD4 monoclonal antibody (MAb) cM-T412 in the treatment of early rheumatoid arthritis (RA). METHODS: Sixty patients were enrolled in a 6-week randomized, double-blind, placebo-controlled study investigating multiple dose regimens of cM-T412. Thirty patients subsequently were enrolled in a 9-month randomized, double-blind, placebo-controlled study investigating monthly single-dose administrations of cM-T412. RESULTS: Analysis of clinical parameters revealed no changes in arthritis activity in the groups that received CD4 MAb or the placebo group, and no difference between the groups, in either in the first or the second part of the study. The number of circulating CD4+ cells decreased substantially in the patients treated with CD4 MAb. CONCLUSION: CD4 MAb treatment of patients with early RA induced no therapeutic effect.

Adolescent↗
PubMed1995

Campylobacter jejuni arthritis in secondary amyloidosis.

We describe a case of infectious arthritis caused by C. jejuni which developed after C. jejuni enteritis in a patient with rheumatoid arthritis and hypogammaglobulinaemia. Extraintestinal infections of this enteropathogen are rare, but in patients with hypogammaglobulinaemia C. jejuni bacteriaemia is relatively common. The present patient suffered from hypogammaglobulinaemia due to a nephrotic syndrome in secondary amyloidosis. C. jejuni infection must be considered in patients with hypogammaglobulinaemia and arthritis.

Agammaglobulinemia↗
PubMed1995

C5 deficiency in a patient with primary Sjögren's syndrome.

We report a case of C5 deficiency in combination with Sjögren's syndrome (SS). Our patient presented with polyarthritis and complaints of oral and ocular dryness. In the serum there was a very low titer of total hemolytic complement (CH50) due to a deficiency of the fifth complement component. C5 deficiency is often associated with recurrent life threatening infections, membranous glomerulonephritis, and discoid lupus erythematosus, but it has not been described in association with primary SS.

Adult↗
PubMed1995

Normal pressure hydrocephalus associated with rheumatoid arthritis responding to prednisone.

We describe 2 patients with longstanding rheumatoid arthritis (RA) complicated by normal pressure hydrocephalus. After treatment with prednisone, both patients improved remarkably with respect to mental status, urinary control, and gait. We suggest that normal pressure hydrocephalus may occur as an extraarticular manifestation of RA, and studies are warranted to confirm a beneficial response to prednisone.

Aged↗
PubMed1994

Vascular somatostatin receptors in synovium from patients with rheumatoid arthritis.

The peripheral nervous system and its neuropeptidergic pathways may play an important role in the pathogenesis and development of rheumatoid arthritis. In the present study, the role of the neuropeptide somatostatin (SRIF), which was recently shown to be implicated in inflammatory diseases of the gastrointestinal tract, was evaluated by measuring the expression of somatostatin receptors in synovium from patients with rheumatoid arthritis. Somatostatin receptors were detected using in vitro receptor autoradiography in the synovium from five patients with active disease. No receptors were found in one case, a successfully treated patient with quiescent disease. The receptors were of high affinity and specific for biologically active somatostatin analogs. Displacement by nanomolar concentrations of somatostatin-14, somatostatin-28, and octreotide was observed, suggesting that most of the receptors identified belong to the SRIF1A subtype. The somatostatin receptors were preferentially located in blood vessels, with specific labeling of the veins but not of the arteries. The whole vessel wall was homogeneously labeled including the smooth muscle cells and probably the endothelium. These data suggest that the synovium in active rheumatoid arthritis expresses a high density of somatostatin receptors. Somatostatin may act through these venous receptors to influence the inflammatory process by induction of vasoconstriction, inhibition of plasma extravasation and cell migration, or inhibition of neovascularization.

Aged↗
PubMed1994

Somatostatin receptor imaging. The presence of somatostatin receptors in rheumatoid arthritis.

OBJECTIVE: To investigate the in vivo and in vitro expression of somatostatin receptors (SS-R) on synovial membranes of patients with rheumatoid arthritis (RA). METHODS: The joints of 14 consecutive patients with active RA, 4 patients with severe osteoarthritis (OA), and 30 control patients were studied. The somatostatin analog [111In-DTPA-D-Phe1]-octreotide was used for in vivo SS-R scintigraphy, and the somatostatin analog [125I-Tyr3]-octreotide for in vitro SS-R autoradiography. RESULTS: Seventy-six percent (220 of 290) of the painful joints and 76% (207 of 274) of the swollen joints of the patients with RA were visualized by SS-R scintigraphy. The degree of pain and swelling correlated well with positive scintigraphy findings in the joints (P < 0.0001). In 2 of the RA patients who underwent scintigraphy, as well as in 4 of 5 other patients, in vitro studies of the synovial membranes showed the presence of specific SS-R. In patients with OA, uptake of radioactivity in the affected joints was significantly lower than that in patients with RA. None of the joints of the control patients demonstrated uptake of radioactivity. CONCLUSION: SS-R are present in the synovial tissue of patients with active RA, as demonstrated by both in vivo and in vitro techniques. The potential value of SS-R scintigraphy in the clinical evaluation of patients with active RA is presently unknown.

Adult↗
PubMed1994

Leucocytoclastic vasculitis as presenting feature of primary Sjögren's syndrome.

Described are two patients whose primary Sjögren's syndrome presented as leucocytoclastic vasculitis of the skin. One patient initially admitted complaints of dryness of the eyes and the mouth after direct questioning, and serologic testing revealed the presence of Ro/SS-A and La/SS-B antibodies. In the other patient the presence of antinuclear antibodies and rheumatoid factors in serum were the only suggestions of the presence of primary Sjögren's syndrome. Primary Sjögren's syndrome should be considered in patients presenting with leucocytoclastic vasculitis.

Adult↗
PubMed1993

Characterization of Epstein-Barr viral strains in parotid gland saliva and peripheral blood of patients with primary Sjögren's syndrome and healthy EBV carriers.

Increased Epstein-Barr virus (EBV) replication has been reported in the salivary and lacrimal glands in Sjögren's syndrome (SS). We studied whether or not certain EBV strains would occur preferentially in the peripheral blood and parotid gland saliva of 18 EBV-seropositive patients with primary Sjögren's syndrome (pSS) and 12 EBV-seropositive control persons. Transforming EBV was detected in the blood of 11 of 18 (61%) pSS patients and 9 of 12 controls (75%). Unexpectedly, neither transforming nor Raji-superinfecting EBV strains were detected in SS parotid saliva, whereas these EBV types were detected in control saliva in 7 and 8 cases, respectively (P < 0.001). Transforming EBV strains were further characterized by 'Ebno-typing,' i.e., analysis of the size spectrum of the viral antigens EBNA 1, 2, 3, and 6 in immunoblots of lymphoblastoid cell lines (LCL). Previous work has shown that a single EBV strain (Ebnotype) dominates the blood and oropharynx of healthy carriers and that unrelated individuals carry different EBV strains, reflecting the vast polymorphism of Ebnotypes in the general population. Two unexpected observations were made. First, an identical Ebnotype was detected in 4 unrelated individuals, i.e., in the blood of 1 pSS patient and in the saliva of 3 control persons. Second, carriage of 2 to 4 different Ebnotypes by a single individual was observed in 4 cases, i.e., in the blood of 1 pSS patient, and in the blood and saliva of 3 control persons.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Rheumatoid factor isotypes in serum and salivary fluid of patients with primary Sjögren's syndrome.

Salivary fluid and serum levels of immunoglobulin and rheumatoid factor (RF) isotypes were measured in patients with primary Sjögren's syndrome (SS) as well as in patients suspected of the syndrome in whom the diagnosis could be excluded (NON-SS) in order to investigate the site of RF production in primary SS and to determine the diagnostic value of determination of salivary fluid levels of RF. Increased salivary fluid levels of IgA-RF were found in 46% of 39 primary SS patients, 14% of 42 NON-SS patients, and in 2% of 41 healthy controls. Salivary fluid levels of other RF isotypes were not increased in the patient groups. The frequency of elevated titers of IgA-, IgG-, and IgM-RF in serum of primary SS patients was 51, 7, and 59%, respectively. The levels of IgA, IgG, and IgM in salivary fluid of primary SS patients were increased in 36, 31, and 23%, respectively. Comparison of RF levels in samples of serum and saliva from primary SS patients after correction for immunoglobulin levels indicated local production of IgA-RF in salivary glands. Significant positive correlations were found between IgA-RF levels in serum and saliva but not between the levels of immunoglobulin isotypes in the two compartments. The results of this study show that (1) increased levels of IgA-, but not IgG- and IgM-RF occur in saliva of primary SS patients; (2) IgA-RF is locally produced in the salivary glands; (3) the stimuli for IgA-RF production in the systemic and secretory compartment may be similar; and (4) measurement of both IgA- and IgM-RF in serum may be used as adjunctive diagnostic procedure for primary SS.

Adult↗
PubMed1993

The clinical significance of the detection of anti-Ro/SS-A and anti-La/SS-B autoantibodies using purified recombinant proteins in primary Sjögren's syndrome.

Recently, an enzyme-linked immunosorbent assay (ELISA), using purified recombinant non-fusion proteins, has been introduced to detect and quantify Ro/SS-A and La/SS-B autoantibodies. We compared this method with anti-Ro/SS-A and anti-La/SS-B detection by means of counterimmunoelectrophoresis and immunoblotting in patients with primary Sjögren's syndrome (SS), patients suspected of the syndrome and controls. The sensitivity and specificity of the newly developed ELISA for anti-Ro/SS-A were 53% and 100%, respectively, and for anti-La/SS-B, 40% and 98%, respectively. No significant difference was found between these results and those obtained from both other assays. Titres of Ro/SS-A and La/SS-B autoantibodies correlated with the presence of an abnormal parotid gland sialogram and hypergammaglobulinaemia. We concluded that the new ELISA did not enhance the diagnostic yield in cases of suspicion of primary Sjögren's syndrome. Longitudinal studies of large groups of patients with primary Sjögren's syndrome are necessary to demonstrate whether following the course of the titres of these autoantibodies would be of value for prediction of disease exacerbations.

Adult↗
PubMed1993

The diagnostic value of salivary gland scintigraphy in patients suspected of primary Sjögren's syndrome.

The diagnostic value of salivary gland scintigraphy in patients suspected of having primary Sjögren's syndrome (SS) was studied in 149 consecutive patients who presented with joint and/or muscle complaints in combination with dryness of the mouth and/or eyes and in 20 control subjects. The diagnosis primary SS could be established in 26 of these patients. Salivary gland scintigraphy scored by means of analogue pictures was abnormal in 19 out of 26 patients with primary SS but abnormal scintigrams were also found in 57 of the 123 patients without primary SS and in five of the controls. This resulted in a positive predictive value of an abnormal salivary gland scintigram of 25% and a negative predictive value of a normal investigation of 90%. From the high number of false positive test results in the patient population studied it is concluded that salivary gland scintigraphy has only a limited discriminatory value for the diagnosis of primary SS.

Adult↗
PubMed1993

Beta 2 microglobulin measurements in saliva of patients with primary Sjögren's syndrome: influence of flow.

OBJECTIVES: To determine the diagnostic value of beta 2 microglobulin in parotid saliva, its concentration in relation to salivary flow was determined in 29 patients with primary Sjögren's syndrome and in 30 normal controls. The specific secretion rate of beta 2 microglobulin was calculated. METHODS: Parotid saliva samples were collected within a 20 minute period directly from Stensen's duct with Lashley cups: sample 1 without gustatory stimulation during the first 10 minutes and samples 2 and 3 during the next five to 10 minutes, when saliva production was stimulated by a 500 mg vitamin C tablet. The sample volumes were measured and the beta 2 microglobulin concentration was determined by radioimmunoassay. RESULTS: During gustatory stimulation the mean beta 2 microglobulin secretion rate in patients with primary Sjögren's syndrome was 0.31 microgram/min; in normal controls it was 0.14 microgram/min. The sensitivity and specificity of this test were 56 and 87% respectively. The mean salivary flow without stimulation in patients with primary Sjögren's syndrome was lower than that in normal controls, but no difference was found during stimulation. CONCLUSIONS: Our results support the hypothesis of local beta 2 microglobulin production in the parotid gland of patients with primary Sjögren's syndrome. The test cannot be used as a screening test owing to low sensitivity, but it may be used as a supplementary diagnostic test as it has the advantage of being non-invasive.

Biomarkers↗
PubMed1993

Antineuronal antibodies in patients with neurologic complications of primary Sjögren's syndrome.

Neurologic complications of both the central and peripheral nervous systems occur frequently in patients with primary Sjögren's syndrome (primary SS), but the underlying cause of these complications is unknown. We studied the presence of antineuronal antibodies in relation to neurologic complications in a consecutive series of 45 patients with primary SS. Twenty-five patients had neurologic complications: 12 patients with polyneuropathy, three with psychiatric disorders, four with carpal tunnel syndrome, seven with migraine, seven with myalgia, and four with other complications (transverse myelitis, stroke, Bell's palsy, and pyramidal signs). Ten patients had more than one neurologic complication. Eleven patients had major and 14 had minor complications according to criteria used for rating neurologic complications in patients with systemic lupus erythematosus. Antineuronal antibodies were present in six of 11 (55%) patients with major neurologic complications and in four of 34 (11%) of patients without major neurologic complications (p = 0.001). This difference could be attributed mainly to the group of patients with polyneuropathy. Three of the 10 sera of patients with positive antineuronal antibodies had antibodies reacting with a 38-kd neuronal protein on immunoblotting, identical to the anti-Hu antibody reactivity in paraneoplastic neurologic disease associated with small-cell lung cancer.

Adult↗
PubMed1993

Digital subtraction sialography of the parotid glands in primary Sjögren's syndrome.

Digital subtraction sialography of the parotid glands was performed in 34 patients with primary Sjögren's syndrome (SS) and 78 patients suspected of having primary SS in whom the diagnosis could be excluded (NON-SS). The following sialographic features were found more frequently in the patients with primary SS than in the NON-SS patients: a sparse overall branching pattern of the ducts, progressive widening and irregularity of the duct walls, disappearance of a homogeneous parenchyma blush and the occurrence of peripheral acinar dilations. The most discriminating findings between the 2 patient groups were the presence of acinar dilations and the disappearance of the homogeneous parenchyma blush. The sensitivity and specificity of the presence of acinar dilatations were 79 and 95%, respectively. Both the sensitivity and specificity of the presence of an irregular or absent parenchyma blush were 91%. The concurrent finding of acinar dilatations and an irregular or absent parenchyma blush had a sensitivity of 77% and a specificity of 95%. We conclude that digital subtraction sialography is a useful adjunctive diagnostic procedure for primary SS.

Adult↗
PubMed1992

The diagnostic value of salivary fluid levels of beta 2-microglobulin, lysozyme and lactoferrin for primary Sjögren's syndrome.

In search of a simple non-invasive diagnostic test for primary Sjögren's syndrome (SS) the concentration of beta 2-microglobulin (beta 2-m), lysozyme (LZM) and lactoferrin (Lf) was measured in stimulated parotid saliva of 39 patients with primary SS, 42 patients suspected of the syndrome in whom the diagnosis could be excluded (NON-SS) and in 41 normal control individuals. Salivary fluid levels of beta 2-m, LZM and Lf exceeding the mean + 2 x standard deviation of healthy control values were found in respectively 58%, 23%, and 26% of the primary SS patients and in 7%, 11% and 0% of the NON-SS patients. The results of this study indicate that due to the low sensitivity the tests are not suitable as a screening procedure for patients suspected of having primary SS. However, measurement of beta 2-m in stimulated parotid saliva may be used as an adjunctive diagnostic test for primary SS.

Adult↗