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Biomedical subjects

H Mielants

Publications and source records attributed to H Mielants.

At least 109 records · Page 6Linked to original sources
PubMed1991

The efficacy and toxicity of a constant low dose of methotrexate as a treatment for intractable rheumatoid arthritis: an open prospective study.

Ninety-two patients with intractable rheumatoid arthritis (RA) participated in an open prospective study of the longterm efficacy and toxicity of methotrexate (MTX), administered orally at a constant dosage of 7.5 mg/week. Twenty-four patients (25%) had to be withdrawn from the study within the first 12 months because of inefficacy or adverse reactions with a fatal outcome in 2 patients. In the remaining 68 patients, the mean duration of therapy was 19 months. Sixty-three of 92 patients (68%) experienced significant clinical improvement after one year, 23 (25%) were in clinical remission. Twenty-three of these patients initially responded well but relapsed after a median of 15 months of therapy. In 5 patients (5%) the disease activity remained status quo. Toxicity was noted at some time in 51 patients (54%), consisting of clinical side effects in 37 patients (40%) and biological abnormalities in 36 patients (39%), including 9 patients (10%) with blood and bone marrow toxicity, in whom renal function at start was normal. Two of these latter 9 patients had a fatal outcome because of an unexpected renal deterioration due to intercurrent disease. Thus, MTX at this constant low dose appears to be a temporarily valuable therapy for intractable RA. Careful monitoring is necessary in view of the potentially dangerous side effects.

Adult↗
PubMed1990

Major histocompatibility complex class II antigen (HLA-DR) expression by ileal epithelial cells in patients with seronegative spondylarthropathy.

Major histocompatibility complex molecules act as non-specific receptors for antigenic proteins and present them to T-cells. Presented antigen together with class II molecules activates antigen specific T-helper cells and may trigger a cellular immune response. The expression of HLA-DR antigens by epithelial cells was examined with an indirect peroxidase technique in ileal biopsies from 38 patients with seronegative spondylarthropathy and features of acute or chronic gut inflammation on biopsy, 14 patients with chronic inflammatory bowel disease, 10 rheumatic and 10 non-rheumatic controls. In acute ileitis, there was more HLA-DR expression in villous and crypt epithelial cells than in non-inflamed controls (p less than 0.01). In chronic inflammation and in chronic inflammatory bowel disease, class II antigens were more expressed in villus (p less than 0.02) and crypt epithelium (p less than 0.01). Strong HLA-DR expression in crypt epithelial cells was connected with active inflammation (p less than 0.02). These findings suggest binding of unknown enterobacterial or nutritional luminal antigens to HLA-DR antigens normally present in enterocytes. The enterocytes act as antigen presenting cells causing a local increase of targets for activated T-cells and trigger the gut inflammation responsible for the clinical symptoms of the seronegative spondylarthropathy.

Adolescent↗
PubMed1990

Onset of symptoms of rheumatoid arthritis in relation to age, sex and menopausal transition.

In a population of 564 patients with rheumatoid arthritis (RA), the onset of symptoms has been studied in relation to age, sex and last menstrual period for women. Median age of menopause was 49 years (3rd percentile: 32 years and 97th percentile: 56 years). Median age of first symptoms was 45 years in women and 50 in men. The individual interval between menopause and first symptoms has a Gaussian distribution with mean at time 0, implying that the average woman develops the first symptoms at the time of her menopause. The F:M ratio of all patients was 2.3; with increasing age the F:M ratio decreased from 3.7 before 30 years of age to 1 after the 6th decade of life, with a peak at the age of 40-44 years. A possible effect of age related changes in sex hormone levels on the pathogenesis of RA is suggested.

Adult↗
PubMed1990

Destructive hip lesions in seronegative spondyloarthropathies: relation to gut inflammation.

In the seronegative spondyloarthropathies the hip lesions can be subdivided into a concentric type progressing to ankylosis and an eccentric type leading to joint destruction. Radiologic examination of the hips was performed in 177 of 211 patients suffering from seronegative spondyloarthropathies on whom ileocolonoscopy with biopsies of ileum and colon was performed; in 27 of these 177 patients, hip lesions were demonstrated. The concentric form seems to be radiologically, clinically and genetically more related to axial involvement; moreover, the frequency of subclinical gut inflammation was the same as in the group of patients with ankylosing spondylitis (AS) without peripheral arthritis, and thus significantly lower than in patients with AS with peripheral arthritis. Eccentric, destructive hip lesions seem to be unrelated to axial involvement, but they are associated with the presence of HLA-Bw62 and gut inflammation (100%), mainly of the chronic, Crohn disease-like type.

Biopsy↗
PubMed1990

HLA-B27 positive idiopathic acute anterior uveitis: a unique manifestation of subclinical gut inflammation.

Ileocolonoscopy was performed on 2 HLA-B27 positive patients with idiopathic acute anterior uveitis neither of whom had articular or intestinal complaints. Microscopic examination of the biopsy specimens revealed the presence of chronic inflammatory lesions in the ileum. Since these lesions have also been described in other forms of spondyloarthropathy, we postulate the presence of gut inflammation was related to the uveitis.

Acute Disease↗
PubMed1989

Ileocolonoscopy in seronegative spondylarthropathy.

A prospective endoscopic and histologic study of terminal ileum and colorectum in 211 patients with seronegative spondylarthropathy revealed macroscopic inflammatory lesions varying from erythema to superficial erosions in 30% of the patients and microscopic inflammation in 61%. Two types of inflammation were observed: an acute inflammation resembling an infectious enterocolitis and a chronic inflammation. In idiopathic reactive arthritis both types of inflammation were equally present, whereas chronic inflammation predominated in patients with ankylosing spondylitis. In 32% of patients with chronic inflammation, the lesions particularly resembled early Crohn's disease. Repeat ileocolonscopy on 19 patients demonstrated a parallel evolution of joint symptoms and histologic lesions. All patients with acute inflammation went into clinical and histologic remission, whereas lesions persisted in patients with Crohn-like inflammation. In patients with chronic inflammation, remission and persistence were observed equally. This study identified a group of patients with seronegative spondylarthropathy which, even in the absence of gastrointestinal symptoms, showed evidence of gut inflammation, probably inducing an increased gut permeability with transgression of the oral tolerance and absorption of provocative antigens into the circulation. It is also possible that both diseases reflect a common underlying process.

Arthritis↗
PubMed1988

Ileocolonoscopic findings in seronegative spondylarthropathies.

Ileocolonoscopy with biopsy of caecum, ileocaecal valve and terminal ileum were performed on 232 patients with seronegative spondylarthropathies and on 65 control patients. Inflammatory gut lesions were found in 65% of the patients with reactive arthritis (ReA) and in 57% of the patients with ankylosing spondylitis (AS), especially in those with peripheral arthritis. The controls had a normal gut. This finding would suggest that exogenous factors causing inflammation of the gut lead to a disturbed permeability of the gut wall or to a deficient local immunological defence mechanism permitting antigens to enter the circulation, inducing the joint and tendon inflammation. Support for this hypothesis was provided by the results of a repeat ileocolonoscopy, disclosing a strong association between the presence of gut inflammation on biopsy and the persistence of joint inflammation. Patients presenting some of the histological lesions found on biopsy (especially active chronic lesions) and patients with proven Crohn's disease were found to share a genetic marker (HLA-BW62). This would suggest that some of the patients with seronegative spondylarthropathies suffer from a subclinical form of Crohn's disease of which the joint symptoms are the unique clinical manifestation.

Adult↗
PubMed1988

Immunoglobulin containing cells in terminal ileum and colorectum of patients with arthritis related gut inflammation.

In 40 distal ileal and 40 colonic biopsies of arthritic patients mostly without gastrointestinal symptoms, but with histological evidence of acute or chronic inflammation of the gut, the number of immunoglobulin (Ig) containing plasma cells was studied morphometrically using a peroxidase antiperoxidase technique. Compared with controls, the ileal mucosal biopsies showed an increase of IgA and IgG in acute ileitis. In chronic ileitis there was an increase of IgA, IgG, and IgM similar to Crohn's disease. In colonic biopsies there was a significant increase of all immunoglobulin classes in acute inflammation. In chronic inflamed mucosa there was also an increase of all three Ig classes. The Ig distribution, however, was significantly different in acute and chronic colitis. These findings give immunohistochemical evidence of the existence of two different types of inflammation related to reactive arthritis or the peripheral joint involvement of ankylosing spondylitis. The Ig pattern in acute colitis is similar to that found in infectious colitis, suggesting an enterobacterial origin of the arthritis in this group of patients although bacteriological and serological investigations were negative. In the chronic type of arthritis related ileocolitis, the pattern of Ig containing cells is similar to that found in Crohn's disease but different from infectious and ulcerative colitis, which makes the hypothesis that a great number of these arthritis patients suffer from asymptomatic or subclinical Crohn's disease acceptable.

Adolescent↗
PubMed1988

Thymic hormones and interferons in the treatment of rheumatoid arthritis.

Interferon gamma (IFN-gamma) is known to increase the rate of biosynthesis and membrane density of Ia in cells that have normal basal expression of Ia such as Ia+-monocytes and thymic epithelium. IFN-gamma also induces de novo expression of Ia in other cell types such as Ia- macrophages, vascular endothelium, fibroblasts, a.o. Consequently, IFN-gamma enhances the activation of specific T-helper cells and the immunity that is dependent on T-helper cells. If the antigen is a viral product expressed on the membrane of an infected cell, IFN-gamma inducing an aberrant Ia expression, will produce a T-helper cell activation from which the host will benefit. If the antigen presented by the newly Ia+ cell is an autologous cell membrane molecule, one that is unique to a particular tissue and of which the host T-helper cells are not tolerant, IFN-gamma can trigger an autoimmune attack. Several recent reports have described a decreased level and activity of IFN-gamma in the rheumatoid joint environment, in vitro as well as in vivo. It is still unknown whether these findings are due to a defective production or to a physiological down regulation of IFN-gamma in rheumatoid arthritis (RA). Consequently it is not clear whether the pharmacologic administration of IFN-gamma to RA patients would reduce the disease activity or induce a disease exacerbation. Initially, short term assays were performed with daily subcutaneous injections of IFN-gamma (50 micrograms or 100 micrograms). As some encouraging results were obtained, two double-blind long-term studies were started.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Interferon gamma in rheumatoid arthritis--a double blind study comparing human recombinant interferon gamma with placebo.

A double blind trial comparing recominant interferon gamma (IFN gamma) with placebo in rheumatoid arthritis is presented. Twenty-six patients entered the study and 22 completed the 6-month period. IFN gamma was administered subcutaneously as was placebo; the 1st week, patients treated with the active compound received a daily subcutaneous injection of 100 micrograms of IFN gamma and for the following 23 weeks the schedule was decreased to 2 injections of 100 micrograms every week. No serious side effects were observed. After Week 24 the group treated with the active compound showed a significant decrease of the joint tenderness score and the placebo group showed a significant increase of the number of subcutaneous nodules. All other variables shifted in favour of the active compound but not significantly. More double blind trials with a larger number of patients and using other treatment schedules or other routes of administration are required.

Arthritis, Rheumatoid↗
PubMed1987

Intra-articular treatment of inflammatory arthritis: double-blind trial comparing bufexamac with methylprednisolone acetate.

A double-blind trial was carried out to weigh the effectiveness and tolerance of intraarticular injections of bufexamac (20 mg) against methylprednisolone (40 mg) in 40 patients with an acute bout of inflammatory arthritis. Leucocyte and polymorphonuclear counts and viscosity measurement of the synovial fluid were performed before and 14 days after injection, which showed methylprednisolone to be significantly superior to bufexamac in suppressing inflammation. In both groups a statistically significant improvement of pain on mobilisation and pain index was noted, but the number of clinical remissions was significantly higher in the methylprednisolone group. The blind investigator found a statistically significantly greater improvement with methylprednisolone than with bufexamac, and patients' opinion on effectiveness did not differ significantly. Important local or general side-effects were not observed. It was concluded that, although both drugs appeared to exert a considerable anti-inflammatory effect in inflammatory arthritis, methylprednisolone was more effective.

Anti-Inflammatory Agents↗
PubMed1987

Disease manifestations of progressive systemic sclerosis: sensitivity and specificity.

The authors conducted a study of 47 patients with a diagnosis of systemic sclerosis in order to determine the sensitivity, specificity and Youden index and consequently the diagnostic value of the generally accepted criteria and of some other common disease features. The control population consisted of 324 patients with rheumatoid arthritis and 35 patients with systemic lupus erythematosus. In addition to proximal scleroderma, the presence of which was required for inclusion in this study, other disease features score a high to moderate Youden index: sclerodactyly, Raynaud's phenomenon, appearance of perioral grooves, cinematographic evidence of esophageal hypomotility, periarticular calcifications, widening of the periodontal membrane on teeth radiographs and specific histologic changes on fingertip biopsy. Finally, a good correlation was found with most of the ARA subcommittee criteria.

Adult↗
PubMed1987

The effect of low doses of prednisolone on T-cell subsets in rheumatoid arthritis.

Prednisolone intake causes a drop in the absolute numbers of circulating T-cell populations. OKT4+ (helper-inducer) cells are more susceptible to this. Higher doses are needed to depress OKT8+ (suppressor-cytotoxic) cell numbers. Administration of up to 10 mg prednisolone affects the suppressor-cytotoxic (OKT8+) absolute cell numbers only in patients with initially low OKT4+/OKT8+ ratios and not the values of OKT8+ cells in patients with high OKT4+/OKT8+ ratios, since these patients already have low OKT8+ cell counts.

Administration, Oral↗
PubMed1987

Histopathology of intestinal inflammation related to reactive arthritis.

This study has identified a group of patients with inflammatory chronic, or relapsing acute arthritis who even in the absence of gastrointestinal symptoms have histological evidence of ileocolitis. At colonoscopy simultaneous biopsies of the terminal ileum and colon were taken from 108 patients with reactive arthritis (n = 55) or ankylosing spondylitis (n = 53), 47 patients with other rheumatic diseases and 19 control patients suffering from colonic polyps, adenocarcinoma, or chronic constipation. All control patients and all but one patient with rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, lumbar back ache, and psoriatic arthritis did not have histological evidence of acute or chronic inflammatory bowel disease. In contrast, in 30 of 35 (56.6%) patients with ankylosing spondylitis, and in 37 of 55 (67%) patients with reactive arthritis, regardless of HLA B27 phenotype, there was histological evidence of inflammatory bowel disease with features either of acute enterocolitis, or early Crohn's disease. Only 18 of 67 (27%) of the patients with histological gut inflammation, however, had intestinal symptoms.

Adolescent↗