Pain and disability are cardinal symptoms in osteoarthritis. The literature is reviewed in order to identify causes of these symptoms at the articular, kinesiological, and psychological level. It is concluded that pain and disability are associated with degeneration of cartilage and bone (articular level), with muscle weakness and limitations in joint motion (kinesiological level), and with anxiety, coping style, attentional focus on symptoms, and possibly depression (psychological level). Biobehavioral mechanisms of pain and disability which explain the observed associations are described and the empirical evidence for these mechanisms is evaluated. Methodological and conceptual deficiencies in the research reviewed are pointed out and suggestions for further research are given.

Adaptation, Psychological↗

PubMed1992

Effects of different regimes of corticosteroid treatment on calcium and bone metabolism in rheumatoid arthritis.

A clinical study of 30 patients with rheumatoid arthritis was undertaken in order to assess the acute effects of corticosteroids on calcium and bone metabolism. The patients were randomly divided into 3 groups. The first group was not treated with corticosteroids, the second group was treated with 3 oral pulses of 100 mg prednisolone and the third group received 3 intravenous pulses of 1000 mg methylprednisolone (MP) on alternate days during one week. In both steroid treated groups the serum parathyroid hormone concentration tended to increase. In the MP treated group an increase in the 1,25-dihydroxyvitamin D concentration after the first pulse was followed by a significant drop; this effect was also seen, but somewhat retarded and less distinct, in the orally treated group. In the MP treated group the urinary calcium excretion raised significantly 6 hrs after the first pulse and then dropped significantly. In all groups no changes were found in the serum calcium level and the urinary excretion of hydroxyproline. We conclude that, acute changes in calcium and bone metabolism occur during treatment with intravenous pulses of methylprednisolone and with oral pulses of prednisolone. These changes are small and reversible in a few days.

Administration, Oral↗

PubMed1992

Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa.

A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.

Administration, Oral↗

PubMed1992

The impact of endpoint measures in rheumatoid arthritis clinical trials.

In clinical trials on the effectiveness of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), it is common to apply a large number of endpoint measures. This practice has several disadvantages. To determine which endpoint measures are most valuable, reports of 32 clinical trials on six DMARDs were reviewed. The frequency with which each endpoint measure was used is described and discussed, as well as the frequency with which the values of each endpoint were significantly different in statistical comparisons within or between groups, thus showing ability to discriminate between drugs not equally effective. The results of this review are discussed and compared with other reports in the literature on the choice of endpoint measures in RA clinical trials. The authors conclude that it is still common practice to evaluate multiple outcome measures. The number of measures could be reduced by using only those that are generally considered important, are sensitive to change, and are able to differentiate between drugs in clinical trials. A joint count, assessment of pain, a questionnaire on functional status, and measurement of erythrocyte sedimentation rate are sufficient.

Anti-Inflammatory Agents↗

PubMed1992

Influence of steroid hormones on proliferation of peripheral blood mononuclear cells in patients with rheumatoid arthritis.

Sex steroids are believed to modulate the immune system in rheumatoid arthritis (RA). Since receptors for sex steroids are present on T-lymphocytes, which are thought to play a major role in the pathogenesis of RA, it is suggested that gonadal steroids can mediate their immunomodulating effect directly on T-lymphocytes. Recently a specific method for activating T-lymphocytes with immobilized anti-CD3 monoclonal antibodies was described. We investigated the influence of oestradiol, progesterone, testosterone and cortisol on lymphocytes stimulated by anti-CD3 mAb and PHA of postmenopausal women, comparing female patients with rheumatoid arthritis and age-matched control patients. The results show that oestradiol, progesterone and testosterone do not influence lymphocyte proliferation when stimulated with anti-CD3 mAb or phytohaemagglutinin (PHA). Cortisol, however, can suppress lymphocyte proliferation even at physiological concentrations in both patients with RA and controls. Inhibition of proliferation by cortisol is dose-related and has no significant correlation with RA disease activity. This inhibition differs individually and might explain the often variable response to corticosteroids in vivo.

Aged↗

PubMed1992

Intermittent hydrostatic compressive force stimulates exclusively the proteoglycan synthesis of osteoarthritic human cartilage.

In paired observations the in vitro proteoglycan turnover was studied of human normal and osteoarthritic cartilage in the absence and presence of intermittent hydrostatic compressive force. Shortly after collection, osteoarthritic cartilage showed a higher proteoglycan synthesis rate than normal cartilage, whereas after culture the reverse was found. Exposure during culture to hydrostatic intermittent compression of a low physiological magnitude enhanced the proteoglycan synthesis rate for osteoarthritic cartilage, whereas normal was unaffected by this hydrostatic intermittent compression. This enhancing effect was reversible. We conclude that human osteoarthritic cartilage is in vivo synthetically more active than normal cartilage, but loses this increased activity in vitro. Enhanced sensitivity of osteoarthritic cartilage to compressive forces may contribute to the increased proteoglycan synthesis of osteoarthritic cartilage.

Adult↗

PubMed1992

Antigen-activated T cells inhibit cartilage proteoglycan synthesis independently of T-cell proliferation.

Previously we have shown that blood mononuclear cells (MNC) obtained from patients with rheumatoid arthritis (RA) have the capacity to induce depletion of proteoglycans (PG) in human cartilage explants. This was observed especially after stimulating MNC with mycobacterial antigens, rather than with the mitogen Concanavalin A (Con A). We have now co-cultured cartilage explants in the presence of T-cell clone A2b obtained from the rat model of adjuvant arthritis (AA). We show that inhibition of the cartilage PG synthesis is a consequence of antigen-specific T-cell activation and that it is mediated by a humoral factor. This seems to be a cytokine rather than an enzyme. Moreover, at the level of polyclonally responding T cells, inhibition of PG synthesis due to T-cell activation by mycobacterial antigens was shown to depend on prior mycobacterial immunization. Arthritogenic T-cell clone A2b also showed PG synthesis inhibitory effects when co-cultured with cartilage alone. The inhibitory activity was shown to be unrelated to the degree of T-cell proliferation. We conclude that antigen-specific T-cell activation may be one of the initiating events leading to cartilage damage in arthritic processes. The measurement of T-cell-mediated PG synthesis inhibition may be a more sensitive and relevant assay for the detection of pathogenic T cells than T-cell proliferation.

Animals↗

PubMed1992

Human osteoarthritic cartilage is synthetically more active but in culture less vital than normal cartilage.

The proteoglycan turnover of human osteoarthritic (OA) cartilage was compared to that of normal (N) cartilage. The cartilage was obtained postmortem from human femoral knee condyles. Short term cultures were compared to longterm cultures, and proteoglycan synthesis rate, content and release determined. Proteoglycan synthesis rate, determined shortly after collection of the cartilage, was higher in OA cartilage than in N cartilage. After longterm culture, the initially higher proteoglycan synthesis rate of OA cartilage became lower than that of N cartilage. An increased percentage release of proteoglycans from OA cartilage compared to N cartilage was apparent both shortly after collection of the cartilage and after culture. Thus, although OA cartilage in vivo is synthetically more active, in vitro it has an increased catabolic and a decreased anabolic activity, from which we conclude that OA cartilage is less vital than N cartilage.

Aged↗

PubMed1992

Morbus Sjögren, more than a dry syndrome.

Explore the source record for details and available documents.

Adult↗

PubMed1992

Neuro-musculo-skeletal manifestations in primary Sjögren's syndrome.

Primary Sjögren's syndrome is a systemic autoimmune disorder whose main characteristics are dryness of the eyes and mouth, caused by lymphocytic infiltration of the exocrine glands. Patients may also show signs of extraglandular involvement of lung, liver, kidney and vessel walls, as well as of the central and peripheral nervous systems, muscles and joints. This article presents a review of the literature on extraglandular involvement of the peripheral and central nervous systems, muscles and joints. Several data support the hypothesis that vasculitis is the underlying mechanism. The need for an extended inventory of the extraglandular manifestations, preferentially linked to immunoserological and -histological investigations to gain more insight into the aetiology and pathogenesis is stressed. As far as the clinical picture is concerned, myalgia and arthralgia are often reported, but myositis and arthritis are rare. Data about the prevalence of peripheral and central nervous system involvement are conflicting: factors contributing to these differences are discussed. As insight into prognosis and therapy will strongly depend on the diagnostic criteria used, the need for international agreement on these is emphasized.

Humans↗

PubMed1992

Local changes in proteoglycan synthesis during culture are different for normal and osteoarthritic cartilage.

Proteoglycan synthesis of mild-to-moderate osteoarthritic human knee cartilage was compared with that of normal cartilage of the same donor. Immediately after cartilage was obtained, the synthesis rate of proteoglycans was higher for osteoarthritic cartilage than for normal cartilage. Proteoglycan synthesis was then located, for both normal and osteoarthritic cartilage, in the middle and deep zone. However, after 4 days of culture, proteoglycan synthesis rate was higher for normal cartilage than for osteoarthritic cartilage. The reason for this transition from a lower to a higher proteoglycan synthesis rate was a strong increase in the proteoglycan synthesis in the superficial zone of normal cartilage. This was not observed for the osteoarthritic cartilage. The chondrocytes in the superficial zone of osteoarthritic cartilage, in contrast to normal cartilage, were mainly joined in cell clusters and proliferating. This may explain their inability to contribute to proteoglycan synthesis.

Aged↗

PubMed1991

Recognition of human 60 kD heat shock protein by mononuclear cells from patients with juvenile chronic arthritis.

A postulated mechanism for autoimmune disorders is that the immunoreactivity develops against bacterial antigens which show a high degree of sequence homology with mammalian proteins. The mycobacterial 65 kD heat shock protein (hsp) has been implicated in several forms of arthritis. Substantial amounts of the human 60 kD homologue (hsp60) were produced by insertion of the gene into Escherichia coli. To investigate the hypothesis that T-cell reactivity is directed against the endogenous hsp, T-cell proliferation of synovial-fluid and peripheral-blood mononuclear cells in response to hsp60 was studied in samples from six patients with juvenile chronic arthritis (JCA) and nine adult patients with rheumatoid arthritis (RA). There was no T-lymphocyte proliferative response to purified fractions of hsp60 in mononuclear cells from RA patients or healthy children and young adults. However, both synovial-fluid and peripheral-blood mononuclear cells from JCA patients showed substantial proliferative responses. There was a significant correlation between the stimulation indices for human hsp60 and for mycobacterial hsp65 (r = 0.948, p less than 0.02). A similar correlation for hsp60 and mycobacterial hsp70 did not achieve significance. Immunohistochemistry showed that hsp65 and hsp70 homologues were expressed in the synovial membrane in these patients but not in controls. These findings suggest a sequence of events in which hsps become expressed during synovial inflammation and function as autoantigens. In JCA this may be manifested by specific T-cell reactivity which apparently is lost in the more bone-eroding and non-remitting adult disease.

Adolescent↗

PubMed1991

[Therapeutic protocol in ulcers due to non-steroidal anti-inflammatory drugs].

Explore the source record for details and available documents.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1991

[Dyspnea during administration of methotrexate: not anything to treat casually].

An important complication of methotrexate (MTX) treatment is illustrated by two case histories. Until recently pneumonitis was believed to be associated only with high dose MTX. Lately several cases of pneumonitis during treatment with low intermittent doses have been reported. The use of low dose intermittent MTX treatment in non-malignant diseases is growing fast and an increasing incidence of MTX pneumonitis is to be expected. Early recognition of the disorder may result in adequate treatment. The clinical picture varies from transient mild dyspnoea to progressive, sometimes fatal respiratory insufficiency. All 'new' pulmonary signs of patients treated with MTX should raise suspicion of MTX pneumonitis. Before treatment with MTX is instituted a chest radiograph should be made and pulmonary function testing should be performed. It is of great importance to inform patients carefully about the possibility of MTX pneumonitis and its symptoms. The prognosis of MTX pneumonitis is usually favourable.

Aged↗