[A case of combined inflammatory rheumatic and neuropathic joint changes].
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Biomedical subjects
Publications and source records attributed to R Eberl.
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Serum, synovial fluid and synovial fluid cells of 14 patients with classic rheumatoid arthritis and of 5 controls were investigated serologically in regard to rheumatoid factors and collagen antibodies and by immunofluorescence double staining in regard to localization of collagen and gammaglobulin in fluid cells. Three patterns of staining were observed: a) gammaglobulin inclusions, b) gammaglobulin and collagen in identical localization, c) collagen inclusions. While distinct staining for gammaglobulin appeared only in seropositive cases, collagen inclusions were only observed in RA, however in seropositive and seronegative cases. In 5 RA cases collagen and gammaglobulin were demonstrated additionally in such identical localization that conclusion in regard to collagen-anticollagen immune complexes seems justified. 9 of 14 RA cases had collagen antibodies, all cases were collagen antibody positive which had collagen and gammaglobulin in identical localization in same inclusions.
Synovial effusions from various kinds of arthritis have been examined both morphologically and histochemically. These two methods give complementary evidence, and show (i) that there are two fundamentally different types of cell present in rheumatoid arthritis (ii) that the synovial fluid from septic arthritis can clearly be separated from that of all other forms of arthritis and (iii) that intracellular crystals can be demonstrated in gout. Laboratory methods also give information on the polysaccharide and fat content of synovial fluid, in particular on the lipid material in the cell free supernatant. Large mononuclears in the fluid are probably generated in the local tissue and reflect minimal differentiation from a basic cell type.
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By means of radio-immunoassay the concentration of human growth hormone (HGH) was measured in the blood plasma of 61 patients with psoriasis (21 suffering from psoriasis vulgaris and 40 with psoriatic arthritis), 30 patients with ankylosing spondylitis, 9 with atypical spondylarthritis and 34 patients with diseases of the soft tissue or degenerative joint and spinal column disease. No connection was found between the HGH concentration and the skin lesions in psoriasis. On the other hand a correlation between HGH and the sacroiliitis in psoriatic arthritis and seronegative spondyloarthropathies may be possible. In contrast to the plasma of psoriatics, the mean HGH concentration was higher in the plasma of patients with degenerative joint diseases. Therefore the results of this paper confirm those opinions in the literature which deny increased HGH concentrations in psoriatics. The beneficial effect of the therapeutic administration of somatostatin, an inhibitor of the release of HGH, in psoriasis vulgaris and psoriatic arthritis is - if indeed it occurs - attributable to other hitherto unidentified mechanisms.
Protein synthesis in lymphocytes of patients suffering from rheumatoid arthritis shows various levels according to the stage of the disease. Incorporation of 3H-isoleucine is markedly increased in progredient cases (compared to normal subjects + 75%). Additional treatment of these patients with corticosteroids has no effect on the protein synthesis in the lymphocytes. This seems to be in contrast to investigations using in vitro incubation of lymphocytes in media containing steroids. Because of completely different conditions in these investigations exact comparison of the results is not possible. Protein synthesis in lymphocytes from patients with early stages of rheumatoid arthritis or ankylosing spondylitis shows no statistically significant difference to normal controls.