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Biomedical subjects

H Mielants

Publications and source records attributed to H Mielants.

At least 127 records · Page 7Linked to original sources
PubMed1987

Repeat ileocolonoscopy in reactive arthritis.

Ileocolonoscopy on patients with HLA-B27 related disease, reactive arthritis and ankylosing spondylitis (AS) with peripheral arthritis, revealed the presence of inflammatory lesions in biopsy specimens from the ileum in 71 and 60% of the cases, respectively. A 2nd ileocolonoscopy was performed on 14 patients, 4 to 22 months after the first. In 6 of the 7 patients in articular clinical remission, the inflammatory gut lesions had disappeared. The gut biopsies of the 7 patients with active joint disease continued to show inflammatory lesions. One of these patients underwent a 3rd ileocolonoscopy after having gone into clinical remission, possibly secondary to treatment with sulfasalazine; the histology was completely normal. The strong relationship between clinical articular inflammation and gut inflammation seems to support the hypothesis that in B27 related diseases, repetitive exogenous triggering causing transgression of oral tolerance by increased gut permeability, provokes and maintains the joint inflammation.

Adolescent↗
PubMed1987

Late onset pauciarticular juvenile chronic arthritis: relation to gut inflammation.

Ileocolonoscopy with biopsy of the ileum, ileocecal valve and cecum was performed on 32 patients (22 males, 10 females) with juvenile chronic arthritis (JCA) with pauciarticular onset. Mean age at onset of disease was 12 years. Ankylosing spondylitis (AS) was diagnosed in 13 patients; the other 19 cases were classified as reactive arthritis with recurrent or persistent pauciarticular synovitis. Twenty-two patients (68%) were HLA-B27 positive; 8 patients (25%) carried the HLA-Bw62 antigen. Ileocolonoscopy was performed 6 months to 32 years after the initial manifestation of the disease (mean : 9 years). Fourteen patients had macroscopic lesions of the ileum and ileocecal valve although only 8 of these had a history of intestinal complaints. Twenty-six patients (81%) presented histological signs of gut inflammation. Most of the gut abnormalities were classified as active chronic or Crohn-like lesions (19/26). Only 7 patients had acute or bacterial enteritis-like lesions. Acute lesions were seen in only one patient with AS. All but 2 patients with sacroiliitis, in whom signs of gut inflammation were found, had active chronic lesions. All the 8 HLA-Bw62 positive patients had histological evidence of gut inflammation. Only chronic or Crohn-like lesions were found. In the majority of patients with JCA with pauciarticular onset, gut inflammation was found on ileum biopsy. Some of their lesions are related to Crohn's disease, and the presence of the HLA-Bw62 antigen could predispose to the arthritis seen in these cases.

Arthritis↗
PubMed1987

HLA antigens in seronegative spondylarthropathies. Reactive arthritis and arthritis in ankylosing spondylitis: relation to gut inflammation.

The prevalence of HLA-A, B, C and DR antigens was determined and compared in 94 patients with reactive arthritis, 54 patients with ankylosing spondylitis (AS), 37 patients with inflammatory bowel disease (IBD) and in 1,010 apparently normal blood donors. The 185 patients all underwent ileocolonoscopy with biopsy of ileum, ileocecal valve and cecum. HLA-B27 was found elevated in the groups with reactive arthritis (48%, chi 2 = 82, p less than 0.0005) and the AS groups (78%, chi 2 = 157, p less than 0.0005), compared to healthy controls. HLA-Bw62 was significantly raised in the patients with reactive arthritis (34%, chi 2 = 73, p less than 0.0005) (particularly the HLA-B27 negatives (48%, chi 2 = 90, p less than 0.0005) and in the HLA-B27 negative patients with AS (25%, chi 2 = 5.5, p less than 0.02). This did not apply to the other patients with AS (4.7% NS). HLA-Bw62 could be associated with a specific clinical picture of asymmetrical pauciarticular arthritis, accompanied by enthesopathies and sacroiliitis classified as idiopathic reactive arthritis, especially when the disease is of enterogenic origin. The frequency of HLA-Bw62 was very high in patients with reactive arthritis and in patients with AS with active chronic (n = 39, 23%, chi 2 = 13, p less than 0.0005) and Crohn-like lesions (n = 14, 50%, chi 2 = 35, p less than 0.0005) on gut biopsy, normal in patients with acute lesions (n = 35, 11%, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Clinical manifestations in HLA-B27-positive patients.

The clinical manifestations of rheumatic diseases have been studied in a population of 440 HLA-B27-positive patients. Fifty-eight per cent had peripheral joint involvement. After statistical analysis and clustering of characteristics, three patterns of peripheral joint involvement were found. They were referred to as the X, Y and Z type for mnemotechnical reasons. The X type includes male patients with sacroiliitis, spondylitis, uveitis and uni- or bilateral arthritis of hip and/or shoulder. Y type patients present sacroiliitis, pauci-articular asymmetrical joint involvement and tendinitis. Z type patients are characterized by sacroiliitis, polyarticular symmetrical joint involvement and a positive IgM rheumatoid factor. This classification enables a new approach to the pathology, diagnosis and therapy of the seronegative spondyloarthropathies.

Adolescent↗
PubMed1986

Sulphasalazine (Salazopyrin) in the treatment of enterogenic reactive synovitis and ankylosing spondylitis with peripheral arthritis.

Sulphasalazine was administered to 48 patients with reactive synovitis (RS) and ankylosing spondylitis (AS) with peripheral arthritis, resistant to nonsteroidal anti-inflammatory drugs. Thirty-seven patients underwent an ileocolonoscopy and in 33 patients signs of chronic or active inflammation of the ileum and/or ileocecal valve were found. Forty-two patients improved after 3 to 12 months of treatment; 50 per cent of them went into remission. In most of the patients improvement failed to occur in the first 2 months of treatment. There was no recurrent disease activity in patients responding to the treatment. Adverse reactions were rare and did not necessitate interruption of treatment. The beneficial effect of sulphasalazine in the treatment of RS and AS with peripheral arthritis needs to be confirmed in double-blind controlled studies.

Adolescent↗
PubMed1986

Peripheral blood T lymphocyte subpopulations determined by monoclonal antibodies in active rheumatoid arthritis.

The introduction of an automated flow cytofluorograph has facilitated the detection of T lymphocyte subsets because it enables a larger number of cells to be analyzed. Many authors have reported a decrease of cytotoxic/suppressor T lymphocytes in rheumatoid arthritis (RA), in contrast to the results of other workers. We believe that the discrepancy between the various studies is due to the fact that different methods and different criteria for patient selection were used. Our study comprised a larger number of patients which makes the results suitable for statistical inference. Disease activity is clearly defined and all drugs that could alter the results were excluded. The use of a flow cytometer enhances the reliability of T lymphocyte subset determination by monoclonal antibodies (OKT series). Our study confirms the reports, which suggested that the number of suppressor/cytotoxic T lymphocytes (OKT8+ cells/mm3) is decreased in patients with active RA, resulting in a high T helper/inducer lymphocyte/T suppressor/cytotoxic lymphocyte ratio (OKT4+:OKT8+). This immune balance represents an interesting feature of the disease, since several active antirheumatic drugs share a common immunomodulatory action, which normalizes the OKT4+:OKT8+ ratio. Finally, we found a good correlation between the OKT4+ cells and OKT8+ cells in the normal control population. This observation enabled us to isolate a subgroup of active patients with RA not responding to slow acting antirheumatic drugs and characterized by a low OKT4+:OKT8+ ratio.

Adult↗
PubMed1986

Familial aggregation in seronegative spondyloarthritis of enterogenic origin. A family study.

A family study of 2 probands, suffering from seronegative spondyloarthritis with ileocolonoscopic evidence of chronic inflammation of the ileum, is presented. On the father's side 2 brothers carry the HLA-Bw62 antigen. One developed typical Crohn's disease, the other showed chronic inflammatory signs of the ileum on biopsy. These lesions have frequently been demonstrated in reactive arthritis and ankylosing spondylitis (AS) with peripheral arthritis, in the absence of gastrointestinal symptoms. On the mother's side there were no clinical or histological signs of ileum inflammation, or spondyloarthritic features, although the mother carries the HLA-B27 antigen. The 4 children are all HLA-Bw62 and B27 positive, but only 2 of them have developed seronegative spondyloarthritis associated with histological evidence of chronic ileum inflammation. The familial aggregation of the seronegative spondyloarthritides is demonstrated. The lesions found on ileal biopsy in reactive synovitis and AS with peripheral arthritis may be related to Crohn's disease.

Adolescent↗
PubMed1985

HLA-B27 related arthritis and bowel inflammation. Part 1. Sulfasalazine (salazopyrin) in HLA-B27 related reactive arthritis.

In an open study, sulfasalazine was given to 15 HLA-B27 positive patients with asymmetrical pauciarticular arthritis and enthesopathies resistant to nonsteroidal antiinflammatory drugs (NSAID). In 11 patients, long lasting remission of inflammatory and biological variables was obtained after 3 to 12 months of treatment. In the other 4 patients significant improvement of the clinical and biological variables was observed. In the 7 patients on whom ileocolonoscopy was performed, inflammatory signs were seen in the terminal ileum or ileocecal valve, suggestive of inflammatory bowel disease (IBD). It is generally accepted that sulfasalazine improves the intestinal symptoms of IBD; our study suggests that it is also beneficial in HLA-B27 related arthropathies resistant to NSAID. No significant adverse reactions were encountered. These findings are encouraging but have to be confirmed in a double blind controlled study.

Adolescent↗
PubMed1985

HLA-B27 related arthritis and bowel inflammation. Part 2. Ileocolonoscopy and bowel histology in patients with HLA-B27 related arthritis.

Ileocolonoscopy and microscopic examination of ileum biopsies were performed on 35 patients with reactive arthritis, with asymmetrical pauciarticular arthritis and enthesopathies. Ileocolonoscopy was also performed on 26 patients with ankylosing spondylitis (AS) and on 19 control patients with rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus and psoriatic arthritis. In the reactive group, ileocolonoscopy showed macroscopic inflammation in 16 cases and abnormal microscopic examination in all but 2 cases, even in patients without gastrointestinal disorders. In the 2 patients with sexually acquired disease, the gut was normal. In the AS group, inflammation was observed in the B27 negative and positive patients with peripheral joint involvement. Occasionally, ileal signs were seen in the HLA-B27 positive patients without peripheral joint involvement. None of the controls showed signs of gut inflammation. Ilecolonoscopy may be of value in detecting subclinical forms of bowel inflammation.

Adolescent↗
PubMed1984

Lymphocyte sub-population counts after a single 40 mg administration of piroxicam in 20 patients with rheumatoid arthritis. A placebo-controlled study.

Patients with active rheumatoid arthritis are characterized by a decrease in the number of circulating T-suppressor lymphocytes (identified by OKT8), resulting in an imbalance between helper (identified by OKT4) and suppressor cells. Piroxicam is a non-steroidal anti-inflammatory agent which modulates lymphocytic functions, especially by reducing the concentration of the rheumatoid factor in vitro and in vivo. A double-blind placebo-controlled study was performed in 20 patients suffering from active RA to investigate the acute effect of a single administration of piroxicam 40 mg on the number of circulating OKT3, T4, T8 and IA1 positive cells. Blood samples were obtained 16 hours before and 0, 2, 6, 8, 24, 48, and 72 h after administration of piroxicam or placebo. There was a significant decrease (P less than 0.05) in T4/T8 cell ratio 48 and 72 h after piroxicam, whereas placebo had no effect. There were no significant changes in absolute numbers of total T-lymphocyte (OKT3 positive cells), T-helper-inducer (OKT4 positive cells) and T-suppressor cytotoxic lymphocytes (OKT8 positive cells). The number of IA1 positive cells (B-cells and activated T-lymphocytes) was significantly higher in the afternoon samples (at 14.00 and 16.00 hours) than in the morning samples (at 08.00 and 10.00 hours) after both placebo and piroxicam administration (P less than 0.05). These data show that piroxicam decreases the T4/T8 cell ratio in active RA, but only 48 h after the first administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Salicylate-induced occult gastrointestinal blood loss: comparison between different oral and parenteral forms of acetylsalicylates and salicylates.

Gastrointestinal fecal blood loss, determined by injecting 51Cr-labelled autologous red blood cells, was measured in 191 orthopaedic patients after oral or parenteral intake of different forms of acetylsalicylates or salicylates. Oral or parenteral administration of non-acetylated salicylates caused nearly no gastrointestinal bleeding, but the anti-inflammatory activity of these products can be questioned since they cannot inhibit prostaglandin synthetase. Buffered, soluble forms of acetylsalicylates caused gastrointestinal bleeding in more than 50% of the patients. However, enteric-coated and intravenous forms resulted in significantly less gastrointestinal bleeding. For both preparations a relationship between serum salicylate level and amount of fecal blood loss was found in the group of "bleeders" (an upper limit of physiological blood loss could definitely be determined by this method). The findings suggested a similar mode of action of enteric-coated and intravenous acetylsalicylates on gastric mucosa through a systemic action. It was concluded that in long-term anti-inflammatory salicylate treatment, enteric-coated forms are probably the galenic form of first choice.

Administration, Oral↗
PubMed1984

Macroscopic and histological changes of the ileum HLA-B27 related diseases: therapeutic consequences.

Ileocolonoscopy and microscopic examination of ileum biopsies have been performed on patients with reactive synovitis, ankylosing spondylitis (AS) and on a control group. Histological signs of gut inflammation were present in practically all patients with reactive synovitis, with the exception of the patients with sexually-acquired disease. In the AS group, inflammation of the ileum was observed in the HLA-B27 negative patients and in AS B27 positive patients with peripheral joint involvement. Occasionally, changes of the ileum were seen in the B27 positive AS patients without peripheral joint involvement. Signs of gut inflammation were absent in all controls. These data suggest that chronic inflammation of the ileum could be implicated in the pathogenesis of some cases of reactive synovitis and even in the peripheral joint involvement frequently seen in ankylosing spondylitis. In the second part of the study, sulfasalazine (Salazopyrin) was administered to 15 HLA-B27 positive patients with reactive synovitis, who had failed to respond to non-steroidal anti-inflammatory drugs. In 11 of the 15 patients, a clinical and biological remission occurred 3 to 11 months after the start of sulfasalazine treatment. The frequency of spontaneous remissions in reactive synovitis calls for confirmation of these encouraging results in double-blind controlled studies.

Adolescent↗