A differential diagnosis of polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) can be difficult in elderly patients, especially at the prodromal phase of RA. Furthermore, it was felt that there might be a diagnostic criteria for PMR specific to the Japanese. Accordingly, we have retrospectively studied the PMR patients who had come to our hospital, for making a diagnostic criteria. We especially stressed the distinguishing of PMR from RA in elderly patients. The criteria proposed are as follows: 1. Bilateral muscular pain persisting for 2 weeks at least in more than two of the following areas; neck, shoulders or shoulder girdle, upper arms, hips or pelvic girdle and thighs. 2. Normal serum myogenic enzymes. 3. ESR of more than 40 mm/h. 4. No swelling in the hand joints. PMR is defined by the presence of all of the 4 items. The criteria demonstrated a 93.1% sensitivity and 98.3% specificity for PMR.

Adult↗

PubMedDate not supplied

Sjögren's syndrome and mixed connective tissue disease.

We investigated the clinical significance of the close association of Sjögren's syndrome (SS) with mixed connective tissue disease (MCTD) by analyzing the clinical manifestations, sialographic findings and immunological parameters of MCTD and primary SS. The prevalence of sialectasia or SS in MCTD was significantly higher than in any other connective tissue diseases. The prevalence of Raynaud's phenomenon, swollen fingers, arthralgias, lymphadenopathy, sclerodactyly, muscle weakness, fever and erythema was significantly higher in MCTD than in primary SS. There were no significant differences between these manifestations in MCTD patients with sialectasia or SS, and those in MCTD patients without sialectasia or SS. Although the levels or prevalence of the erythrocyte sedimentation rate, CRP, antinuclear factor, anti-DNA antibody and anti-RNP antibody were significantly greater in MCTD than in primary SS, there were no significant differences in the levels or the prevalence of laboratory abnormalities between MCTD with sialectasia or SS, and MCTD without sialectasia or SS. Moreover, there was a strict dissociation between the occurrence of anti-RNP antibody and anti-SS-B antibody both in MCTD and primary SS. These results suggest that the association of secondary SS or sialectasia in MCTD, although more common than in other connective tissue diseases, is merely a consequence of MCTD and does not influence the clinical course of MCTD.

Adult↗

PubMedDate not supplied

Correlation of metal-binding proteins and proteinase inhibitors with immunological parameters in rheumatoid synovial fluids.

Metal-binding proteins (ceruloplasmin, transferrin, ferritin, and lactoferrin), proteinase inhibitors (alpha 1-antitrypsin, alpha 2-macroglobulin and inter-alpha-trypsin inhibitors), and albumin were assayed in synovial fluid obtained from 20 patients with rheumatoid arthritis (RA) and 15 with osteoarthritis (OA). The levels of proteinase inhibitors and metal-binding proteins, except transferrin, were significantly increased in synovial fluid from RA patients as compared with synovial fluid from OA patients. Metal-binding proteins significantly correlated with rheumatoid factor and immune complexes in synovial fluid from RA patients. Proteinase inhibitor levels also significantly correlated with C-reactive protein, and complement components. These results suggest that the raised level of metal-binding proteins and proteinase inhibitors in synovial fluid from RA patients reflect inflammatory activity, and hence may play an important role in the pathogenesis of inflammatory joint diseases.

Adult↗