Algodystrophy in pregnancy. Three case reports.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
R J Coughlan
Publications and source records attributed to R J Coughlan.
7S IgM in the sera of patients with arthritis.
Using radial immunodiffusion in 7% agarose, 7S IgM was quantified in the sera of 45 normal individuals, 37 patients with rheumatoid arthritis (RA), 18 patients with psoriatic arthritis and 11 patients with ankylosing spondylitis. 7S IgM was only found in the sera of patients with RA, 43% of whom had detectable levels of 7S IgM (median 47.5 micrograms/ml). The patients with 7S IgM had significantly higher IgM rheumatoid factor (IgM RF) and C-reactive protein levels in their sera (p less than 0.005). There was a strong correlation between 7S IgM and IgM RF levels in the sera of these patients. These data demonstrate that patients with more active and severe disease have 7S IgM present in their sera but the absence of 7S IgM from the sera of some patients with high levels of IgM RF and CRP suggest that additional factors may influence the synthesis and secretion of 7S IgM by B cells in RA.
Arthritis↗
Algodystrophy: a common unrecognized cause of chronic knee pain.
Thirty-three patients with undiagnosed chronic knee pain had features of autonomic disturbance. Thermography is a useful imaging technique for demonstrating this abnormality. The patients lacked the thermographic symmetry observed in 16 normal controls but this returned with resolution of the pain. Recognized radiological and scintigraphic features of algodystrophy were found. The long duration of symptoms, high proportion of young females and the severity of the associated disability were notable. It is suggested that algodystrophy is a more frequent cause of chronic knee pain than previously recognized. Autonomic abnormalities may be less intense in disease at this site, particularly in young females and may be overlooked. This characteristic of algodystrophy of the knee may contribute to chronicity and subsequent disability.
Adolescent↗
Dietary manipulation in rheumatoid arthritis.
Explore the source record for details and available documents.
Arthritis, Rheumatoid↗
Is there more than one signal for an acute phase response?
Prealbumin was shown to be a sensitive indicator of disease activity in a prospective study of 21 patients with active ankylosing spondylitis (AS) who were treated with 3 intravenous pulses of methylprednisolone and its concentration was found to change at a different rate to C-reactive protein (CRP). In those diseases in which CRP concentration rises with active disease, i.e., rheumatoid arthritis, AS and Crohn's disease, prealbumin fell, but in those diseases in which CRP rises only slightly, i.e., systemic lupus erythematosus, progressive systemic sclerosis and ulcerative colitis, there was nevertheless a fall in serum prealbumin, indicating that there was an acute phase response occurring. Fever, arthritis and infection were the only disease manifestations that were associated with an elevated CRP in both groups of diseases. There is therefore more than one signal for an acute phase response depending on the nature of the disease pathology.
Acute-Phase Proteins↗
Changes in mononuclear cell function in patients with rheumatoid arthritis following treatment with auranofin.
Gold salts in vitro modulate lymphocyte proliferation to mitogens and antigens and macrophage phagocytosis. These effects are not confined to gold salts; D-penicillamine and chloroquine as well as some of the non-steroidal anti-inflammatory drugs (NSAIDs) have in vivo immunoregulatory effects. Peripheral blood mononuclear cells during treatment with Myocrisin (gold sodium thiomalate, GSTM) show changes that differ from in vitro effects and are related to therapeutic response rather than GSTM administration. This discrepancy between in vitro and ex vivo responses prompted us to measure cellular functions during auranofin therapy. Twenty-nine patients with rheumatoid arthritis took part in a placebo-controlled trial of auranofin. We examined the spontaneous immunoglobulin (IgG and IgM) and IgM rheumatoid factor (IgM RF) production by cultured mononuclear cells, lymphocyte transformation to concanavalin A and macrophage phagocytosis of Candida albicans. There was a significant fall in IgG synthesis (p less than 0.005) and IgM RF synthesis (p less than 0.005) over the first 4 months of treatment, whereas in the control group there were no significant changes. There was no significant change in IgM production. In the auranofin-treated group the lymphocyte response to concanavalin A fell progressively during 6 months of therapy (at 2 months p less than 0.05, at 4 months p less than 0.01, and at 6 months p less than 0.005). Auranofin therapy had variable effects on monocyte phagocytosis of C. albicans. Therefore, in contrast to GSTM, auranofin suppressed both in vitro and ex vivo lymphocyte functions. This effect is probably related to the direct effect of auranofin on lymphocyte membranes.
Anti-Inflammatory Agents↗
A single step radial immunodiffusion (RID) method for the quantitation of monomeric IgM.
Monomeric IgM (7S IgM) is present in the serum of patients with certain inflammatory and neoplastic conditions. In the past it has been necessary to separate 7S IgM from 19S IgM by chromatography or ultra-centrifugation prior to its quantification, however, 7% agarose gels allow migration of 7S molecules while retarding the migration of larger (19S) molecules. We describe the development of a RID method on 7% agarose and detail the optimum conditions for the preparation of gels and standards in order to quantify 7S IgM present in serum in a single step without prior separation from 19S IgM. The major difficulties encountered were in the preparation of the agarose gels and the conditions necessary to overcome the difficulties are described. A linear relationship was found between the ring diameter squared and the 7S IgM concentration. The assay could detect as little as 15 micrograms/ml of 7S IgM. Within assay variability was 15.4%. In the sera of 45 normal individuals monomeric IgM was not detected whereas 15 (43%) of an unselected group of patients with rheumatoid arthritis had measurable levels of 7S IgM. This method for quantifying 7S IgM is both simple and inexpensive, and because of the ease with which large numbers of sera can be processed in a single assay it is less time consuming than other methods used to quantify 7S IgM.
Humans↗
Failure of sodium aurothiomalate and triethyl phosphine gold to cause renal tubular injury in rheumatoid arthritis: implications for the aetiology of gold-related nephropathy.
The urinary excretion of two proteins, B-2-microglobulin (beta 2M) and N-acetyl-B-D-glucosaminidase (NAG) was measured in 25 patients with rheumatoid arthritis (RA) on nonsteroidal anti-inflammatory drugs (NSAID). Although beta 2M excretion was normal NAG excretion was raised. As NAG excretion by a group of osteoarthritis patients receiving similar doses of NSAIDs was normal, it is concluded that rheumatoid disease per se may be associated with mild renal tubular dysfunction. Twelve of the above 25 patients were then given oral triethylphosphine-gold (auranofin) 6 mg daily and urinary beta 2M and NAG were measured after 6 months' treatment. Urinary excretion of beta 2M and NAG was also measured in 13 patients with RA established on intramuscular sodium aurothiomalate (MGST) and NSAIDs. Neither auranofin nor myocrisin were found to further significantly increase beta 2M and NAG excretion. These results suggest that gold compounds are not toxic to renal tubular epithelium.
Acetylglucosaminidase↗
beta 2 microglobulin plasma levels reflect disease activity in rheumatoid arthritis.
Elevated plasma levels of beta 2 microglobulin have been described in rheumatoid arthritis (RA) but their relationship to disease activity is unclear. In patients treated for 6 months with auranofin (AF) there was a significant fall (p less than 0.05) in beta 2M levels pari passu with improvement in disease activity as measured by a fall in C-reactive protein. In addition, 26 patients with mild RA had beta 2M levels within the normal range. It is concluded that beta 2M plasma levels reflect disease activity in RA.
Anti-Inflammatory Agents↗
Ankylosing spondylitis: a two-year experience.
Explore the source record for details and available documents.
Adolescent↗
Ankylosing spondylitis. A comparison of clinical and radiographic features in men and women.
The clinical and radiographic features of 83 patients with a diagnosis of Ankylosing Spondylitis conforming to Rome criteria were reviewed. There was 64 males and 19 females attending for a mean duration of 13 and 11 years. Females presented with more peripheral arthritis (X2 = 3.15464, DF = 1, P < .05 (one sided) and more asymptomatic sacroiliitis (X2 = 6.70172; DF = 1, P < .01 (two sided)). Spinal involvement occurred with a similar frequency in men and women, no increase in cervical spine involvement in women was identified. Four males and one female of 83 patients, developed radiographically proven spinal fusion. One male patient developed upper lobe pulmonary fibrosis, one male patient developed the cauda equina syndrome, one male patient required a total hip replacement. No statistically significant difference in the rate of complications in men and women was identified.
Adult↗