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Biomedical subjects

H Mielants

Publications and source records attributed to H Mielants.

At least 91 records · Page 5Linked to original sources
PubMed1994

Current concepts in psoriatic arthritis.

Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis and characterized by absence of rheumatoid factor. Any form of psoriasis can be complicated by joint inflammation. Four groups have been identified: pauciarticular psoriatic arthritis, psoriatic spondylitis, symmetrical polyarticular psoriatic arthritis and arthritis mutilans. The etiology of psoriatic arthritis remains unclear. Genetic, immunologic and environmental factors are thought to be important in the development of the disease. The role of cytokines and adhesion molecules in the mechanism of joint destruction is highlighted, and recent therapeutic strategies are discussed.

Arthritis, Psoriatic↗
PubMed1993

Enteropathic arthritis, uveitis, Whipple's disease, and miscellaneous spondyloarthropathies.

Enteropathic arthritides, uveitis, and Whipple's disease all belong to the category of spondyloarthropathies. The exact mechanism of relationships among joint, tendon, and axial involvement in the spondyloarthropathies, and gut and eye involvement, is unsolved. Different hypotheses have been proposed to explain the role of enterogenic bacteria in interfering with the HLA system and causing inflammatory reactions in these organs. The microorganism responsible for Whipple's disease (Tropheryma whippelii) has been identified by sequencing the largest part of a bacterial 16S ribosomal RNA, followed by polymerase chain reaction amplification. Late-onset pauciarticular juvenile chronic arthritis should be included in the category of the spondyloarthropathies. New cases of ankylosing spondylitis associated with diffuse idiopathic skeletal hyperostosis have been reported.

Arthritis↗
PubMed1993

Gut inflammation in children with late onset pauciarticular juvenile chronic arthritis and evolution to adult spondyloarthropathy--a prospective study.

Ileocolonoscopy with biopsy of the colon and terminal ileum was performed prospectively on 12 patients under age 16 with late onset juvenile chronic arthritis (JCA). Inflammatory gut lesions were seen in 9 of these 12 patients; 4 were of the acute type, 5 of the chronic type. Chronic gut inflammation was related to axial inflammatory complaints, inflammatory serum variables, thrombocytosis and sacroiliac radiological abnormalities. A 2nd ileocolonoscopy was performed on 5 of the 12 patients, and a 3rd ileocolonoscopy on 2 of these with persistent synovitis. Gut inflammation and joint inflammation were related; moreover, all 5 patients had chronic inflammatory lesions by the time of the last investigation, one presented with Crohn's disease. The 12 patients were reviewed 3 to 9 years after the first ileocolonoscopy. Four patients were in remission, including the 3 patients with initial normal gut histology. Five patients had developed ankylosing spondylitis (AS), a 6th patient possible AS. Axial inflammatory complaints, a family history of spondyloarthropathies, HLA-B27 positivity, early sacroiliac and peripheral joints radiographic changes, persistence of inflammatory serum variables, thrombocytosis and chronic inflammatory lesions on gut biopsy, are predictive factors in juveniles for evolution to AS. Late onset pauciarticular JCA represents a form of spondyloarthropathy similar to adolescent forms. Persistent gut inflammation could play a role in the pathogenesis of the disease and persistent synovitis.

Adolescent↗
PubMed1993

A prospective study of patients with spondyloarthropathy with special reference to HLA-B27 and to gut histology.

Ileocolonoscopy was performed on 357 patients meeting the European Spondylarthropathy Study Group criteria for spondyloarthropathy. HLA loci A, B and C were determined in all patients; HLA-B27 was detected in 196 and was absent in the 161 remaining patients. A number of clinical, laboratory and radiological variables were determined before ileocolonoscopy and compared between the HLA-B27+ and HLA-B27- patients. The HLA-B27+ patients were mainly men, with significantly more family members with spondyloarthropathies. Clinical evidence of tendinitis and uveitis was more frequently found in these patients. Like several authors, we found that these patients were more severely affected since they presented more severe radiological involvement of the sacroiliac joints. Syndesmophytes, bamboo spine and erosive joint lesions were more frequent in this group, the hip involvement being of the concentric type. In HLA-B27+ patients ankylosing spondylitis was more prevalent, while in the B27- patients enterogenic, urogenital or undifferentiated spondyloarthropathy was diagnosed. The HLA-B27- patients experienced more episodes of diarrhea, and Crohn-like inflammatory gut lesions were more frequently seen on ileocolonoscopy. In this group a number of patients probably had a form of subclinical Crohn's disease of which the locomotor symptoms were the only clinical expression.

Adolescent↗
PubMed1993

Juvenile spondyloarthropathies in 1992.

There is some evidence that patients with late onset pauciarticular juvenile chronic arthritis (JCA) should be included among those with spondyloarthropathies, at least during the course of their disease, even if at the onset of the disease we prefer to label them as patients with JCA. The clinical symptoms which could allow us to classify them as spondyloarthritic are frequently absent at the onset of the disease. The gut seems to play a role in the pathogenesis of this form of JCA, though the exact mechanisms must be elucidated further.

Adolescent↗
PubMed1992

Evaluation of the involvement of axial entheses and sacroiliac joints in relation to diagnosis: comparison among diffuse idiopathic skeletal hyperostostis (DISH), osteoarthrosis and ankylosing spondylitis.

Since diffuse idiopathic skeletal hyperostosis (DISH) is frequently difficult to differentiate radiologically from the axial involvement of ankylosing spondylitis and osteoarthrosis, some features of these 3 different diseases were compared. The predominantly horizontal nature of the enthesiophyte in DISH and its right preponderance in the thoracic region were demonstrated. This right preponderance was due to the presence of the thoracic aorta located in the left thoracic side. A midthoracic notch was described in DISH which seemed to be confined to noninflammatory conditions, but was not found in ankylosing spondylitis. The importance of sacroiliac computerized tomography to differentiate sacroiliac joint abnormalities associated with DISH from the sacroiliitis of spondylarthropathies was stressed.

Adult↗
PubMed1992

Expression of T cell receptors alpha beta and gamma delta in the ileal mucosa of patients with Crohn's disease and with spondylarthropathy.

The expression of the alpha beta and gamma delta heterodimer of the T cell receptor (TCR) was studied in normal human ileal mucosa or in ileal biopsies featuring Crohn's disease or acute and chronic spondylarthropathy-related gut inflammation. With an immunohistochemical technique we demonstrated that the increase of mucosal lymphocytes per mm mucosa in Crohn's disease and spondylarthropathy-related ileitis is exclusively due to expansion of the alpha beta + T cell compartment. In Crohn's disease and chronic ileitis observed in some spondylarthropathy patients the alpha beta + T cells were increased amongst intraepithelial lymphocytes (IEL). The lamina propria lymphocytes (LPL) were augmented in all studied inflammatory conditions. The gamma delta + T cells showed no changes in IEL or LPL and their proportions were not altered. They were evenly dispersed throughout the ileal mucosa and did not seem to participate in the inflammatory process. This study confirms that gamma delta T cells are a distinct subset in the intestinal mucosa. The increase in alpha beta + T cells suggests augmented mucosal antigen handling and involvement of the major histocompatibility complex in the pathogenesis of spondylarthropathy-related gut inflammation and Crohn's disease.

Biopsy↗
PubMed1992

Simultaneous occurrence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis in the same patient.

Diffuse idiopathic skeletal hyperostosis (DISH) frequently gives rise to some diagnostic confusion, as it may radiologically mimic ankylosing spondylitis (AS). A patient with features of DISH and AS is described and the literature is reviewed. The diagnostic value of sacroiliac computerized tomography is emphasized. The role of spinal mobility in the appearance of the enthesiophytes is discussed since our patient, who underwent a segmental fusion, presented different radiological features in the mobile segment and the fused region.

Humans↗
PubMed1992

Spondylarthropathy and gut inflammation: immunopathogenetic mechanisms.

In 62% of patients with spondylarthropathy (SpA) we found clinically unsuspected gut inflammation to feature acute or chronic enterocolitis on ileocolonoscopy. A proportion of patients of the latter group had subclinical Crohn's disease as demonstrated clinically, endoscopically, genetically, histologically and immunopathologically. There is a relation between the activity of the gut inflammation and clinical rheumatic symptoms. A pathogenetic mechanism is increased handling of luminal (bacterial or nutritional) antigen, hence inducing T-cell activation and intestinal inflammation. In ileal mucosal biopsies we showed two different cellular events: increased enterocytic expression of class II molecules in active inflammation and an increase of membranous (M) cells overlying lymphocytes in inflamed mucosa. Although the number of intraepithelial lymphocytes was not increased in inflammation, intraepithelial T lymphocytes had protruding processes in close apposition to the tips of epithelial plasma membranes. Lymphocytes crossing the basement membrane were a frequent finding. These features indicate that the intestinal immune response caused by increased antigen processing in the terminal ileum induces an inflammatory immunocascade responsible for the clinical picture of SpA.

Adolescent↗
PubMed1991

Sulfasalazine treatment in juvenile chronic arthritis: an open study.

In an open study, the effect of sulfasalazine was evaluated in the treatment of juvenile chronic arthritis (JCA). Forty-one patients, i.e., 27 boys and 14 girls with JCA under 16 years of age, were included in the study. In all of them, treatment with nonsteroidal antiinflammatory drugs (NSAID) had been unable to control the disease. The patients were divided in 4 subgroups depending on the mode of onset and evolution (Type I = systemic onset, Type II = polyarticular form. Type IIIa and Type IIIb = pauciarticular form). Remission was achieved in 21 patients, significant improvement in 12. Status was unchanged in 4 patients and worsened in 3. In 5 patients side effects were observed, which forced interruption of treatment in 4. Sulfasalazine was stopped in 7 patients: for toxicity in 4 and for inefficacy in 3. In 7 other patients the treatment was terminated after a prolonged remission. These promising results must be confirmed in a double blind versus placebo study, preferably restricted to type III JCA.

Adolescent↗
PubMed1991

Gut inflammation in the spondyloarthropathies: clinical, radiologic, biologic and genetic features in relation to the type of histology. A prospective study.

Ileocolonoscopy was performed on 354 patients with spondyloarthropathies. Histologically, the population could be divided into 145 patients with normal gut histology, 88 patients with acute inflammatory lesions and 121 patients with chronic inflammatory lesions. A number of clinical, biologic, radiologic and genetic variables were determined before ileocolonoscopy. Chronic gut lesions were associated with a family history of ankylosing spondylitis (AS) and Crohn's disease, several episodes of diarrhea, an increased stool frequency, elevated inflammatory serum variables, reduced axial mobility, the presence of sacroiliitis, bamboo spine, destructive joint lesions, a diagnosis of AS and HLA-Bw62 positivity. As the frequency of HLA-Bw62 is also increased in proven Crohn's disease, this would suggest that chronic gut lesions are related to this disease. Acute inflammatory lesions were related to a higher fecal carriage of specific bacteria and to the diagnosis of undifferentiated spondyloarthropathy, especially the enterogenic forms of reactive arthritis. Consequently, these lesions also appear to be related to a bacterially induced gut inflammation. Gut histology was normal in urogenital inflammation and urogenital reactive arthritis, suggesting a different portal of entry for antigens. The 3 histologic pictures of the gut (normal, acute and chronic) inflammation seem to correlate with different clinical, biologic and radiologic manifestations of the disease concept of spondyloarthropathies.

Adolescent↗
PubMed1991

Intestinal mucosal permeability in inflammatory rheumatic diseases. I. Role of antiinflammatory drugs.

Using the 51Cr-EDTA resorption test, gut permeability was measured in 129 patients with inflammatory joint diseases and in 97 control patients (42 patients with no inflammatory rheumatic disorders taking antiinflammatory medication and 55 healthy controls). Thirty-two patients (30 arthritis and 2 control patients) taking nonsteroidal antiinflammatory drugs (NSAID) as well as corticosteroids were excluded from statistical analysis. The intake of NSAID significantly increased gut permeability in controls but not in the arthritis groups. The same applied to corticosteroid intake. This could be due to the restricted number of arthritis patients who had never taken antiinflammatory drugs or to a disease related increased permeability. There was no statistically significant difference in altered gut permeability between patients taking NSAID and patients taking corticosteroids. Our findings suggest that drug induced alteration of gut permeability may not only be accounted for by an inhibition of mucosal cyclooxygenase activity, but that other enzymatic pathways in the arachidonic cascade might be implicated.

Adrenal Cortex Hormones↗
PubMed1991

Intestinal mucosal permeability in inflammatory rheumatic diseases. II. Role of disease.

Gut permeability as measured by the 51Cr-EDTA resorption test was determined in 56 patients with rheumatoid arthritis (RA), 73 patients with spondyloarthropathies (SpA), 18 patients with inflammatory bowel disease (IBD) and 97 controls (42 patients with no inflammatory rheumatic diseases and 55 healthy controls). Gut permeability was found to be increased in the 3 patient groups, partially due to the intake of antiinflammatory drugs. When only patients not taking these drugs were considered, an increased gut permeability was found in patients with SpA and IBD. In patients with RA gut permeability could not be evaluated as they were all taking antiinflammatory medication. Ileocolonoscopy with biopsies of the gut was performed in 62 of the 73 patients with SpA and disclosed subclinical gut inflammation in 21. No difference in gut permeability was found between patients with or without gut inflammation. However, when the type of gut inflammation was considered, a significant increase of gut permeability was found in patients with chronic gut inflammation compared with patients presenting acute lesions. Our findings again suggest that the chronic gut inflammation seen in SpA is fundamentally different from acute gut inflammation and possibly related to the gut inflammation of IBD.

Adult↗