Comparison of the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire, the functional status (HAQ) and utility (EQ-5D) measures in psoriatic arthritis: results from a cross-sectional survey.

OBJECTIVES: To compare the Psoriatic Arthritis Quality of Life (PsAQoL) instrument, the Health Assessment Questionnaire (HAQ) as a measure of functional status, and the generic health status (utility) measure the EuroQoL (EQ-5D) in terms of ability to assess disease severity in psoriatic arthritis (PsA). METHODS: The differences between known groups and correlations of the PsAQoL, the HAQ and the EQ-5D with clinical measures were analysed in a sample of 183 PsA patients. RESULTS: Different severities of PsA determined by known groups were distinguished well by all three questionnaires; more severe disease was associated with significantly worse values of the instruments. The correlations revealed a strong relationship between each of the measures, and with the patients' pain on the visual analogue scale (VAS), the patient global VAS, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and a weak relationship with the disease duration and the Psoriasis Area Severity Index (PASI). The PsAQoL also correlated strongly with the 28-joint Disease Activity Score (DAS28). CONCLUSIONS: The PsAQoL, the HAQ, and the EQ-5D are able to distinguish well across levels of PsA severity.

[Randomized, double blind, multicentre, parallel group study to compare efficacy and safety of acemetacin and indometacin in patients with activated osteoarthrosis of the knee]. / Wirksamkeit und Verträglichkeit einer Behandlung mit Acemetacin bei Patienten mit aktivierter Gonarthrose - Ergebnisse einer doppelblinden Vergleichsstudie mit Indometacin.

137 patients with active osteoarthritis of the knee joint were randomized in the ratio 2:1 to be treated with either one of the non-steroidal anti-inflammatory drugs acemetacin (180 mg/day) or indomethacin (150 mg/day). After 4 weeks of treatment, the complaints, as assessed by the patients by means of the Lequesne Index, decreased in both groups to a comparable extent. However, the overall assessment of the therapeutic success, both by patients and by physicians, showed a trend in favor of acemetacin: 70% of the patients in this group reported that their complaints were markedly improved or had subsided entirely, as opposed to 51% of the patients under indomethacin. As for adverse events, gastrointestinal complaints were dominant in both treatment groups, but significantly more patients interrupted the treatment in the indomethacin group (22.2%), than in the acemetacin group (5.4%). 83% of the patients declared the tolerance of acemetacin to be good or very good, in comparison to only 56 % of the patients in the indomethacin group, a highly significant difference (p = 0.0009). This significantly better tolerance of acemetacin in comparison to indomethacin confirms results from previous clinical studies.

Elevated levels of synovial fluid antibodies reactive with the small proteoglycans biglycan and decorin in patients with rheumatoid arthritis or other joint diseases.

OBJECTIVES: To determine whether patients with rheumatoid arthritis (RA) express humoral immunity to the small proteoglycans biglycan and decorin and to compare the response to that of patients suffering from other joint diseases. METHODS: Serum and synovial fluid IgG and IgM antibody levels were determined by enzyme-linked immunosorbent assay. Antibodies to biglycan and decorin as well as to other known and extensively investigated cartilage matrix components such as type II collagen, aggrecan and fibronectin were investigated. Patients suffering from RA, osteoarthritis (OA), psoriatic arthritis and other seronegative spondylarthropathies were included in the study. Correlation between antibody levels and clinical/laboratory parameters was determined. RESULTS: Patients with RA expressed an increased humoral immunity to biglycan, while patients with seronegative spondylarthropathies displayed elevated decorin-specific synovial antibody levels compared with OA patients. CONCLUSION: These results indicate a significantly higher immunity to small proteoglycans in RA and seronegative spondylarthropathies than in OA suggesting a possible involvement in the pathogenesis of inflammatory rheumatic diseases.

Soluble interleukin-6 receptor in plasma and in lymphocyte culture supernatants of healthy individuals and patients with systemic lupus erythematosus and rheumatoid arthritis.

The soluble IL-6 receptor (sIL-6R) occurring in various body fluids of healthy persons and patients with various diseases is an agonist since its complex with IL-6 binds to gp130 making IL-6 receptor negative cells responsive for IL-6. The generation as well as the functional role of soluble IL-6 receptor is poorly understood. We measured the sIL-6R levels by ELISA sandwich technology in sera and in supernatants of lymphocyte cultures without and after incubations with dexamethasone. Our results indicate, that the sIL-6R levels in sera of patients with inactive systemic lupus erythematosus (SLE) and active rheumatoid arthritis (RA) were higher than those of the control group, active SLE and inactive RA. In vitro dexamethasone treatment stimulated generation of sIL-6R in both healthy persons and in active SLE, however it strongly suppressed sIL-6R in both RA groups. At mRNA level, we found that in SLE both the mRNA coding the cell-bound and an alternatively spliced variant corresponding to soluble IL-6R transcript increases, however the strong decrease of sIL6R protein in RA was not found at mRNA level.

Cyclosporin and sulfasalazine combination in the treatment of early rheumatoid arthritis.

The aim of the study was to assess the efficacy of a new formulation of cyclosporin-A (CyA) and sulfasalazine (SASP) combination treatment in preventing disability and reducing inflammatory disease activity in patients with early rheumatoid arthritis, as well as to assess the tolerability, safety, and suitability for long-term treatment. Forty five patients with early, active rheumatoid arthritis, (RA) were treated with CyA and SASP combination therapy for 12 months. The patients were evaluated by disease activity and radiologic measurements. The combined CyA and SASP therapy seems to be effective. Disease activity parameters improved within 3 months. The individual treatment response rate according to EULAR response criteria was 78% after a one year treatment period. Five patients were withdrawn due to gastrointestinal side effect and two patients because of lack of efficacy. CyA and SASP combination treatment seems to be effective in early severe RA, and with careful monitoring, side effects can be kept under control.

[Fatal myocardial lesion in systemic lupus erythematosus]. / Halálos myocardialis elváltozás systemás lupus erythematodesben.

The authors present the case of a 47-year old female patient. She suffered from a moderate activity SLE for two years. The outcome of SLE was changed by an ulcer because of leg injury, which was repeatedly infected. Severe polyarthritis, leucopenia, thrombocytopenia, clinical signs of vasculitis and in the last two months fever, high ESR, and pericarditis appeared. The angina pectoris, the cardiac decompensation, the electrocardiogram, the echocardiogram was suspect to diffuse myocardial lesion. Cardiac decompensation caused the death of the patient. Besides the activation of her autoimmune disease, infection was suspect in the patient taken immunosuppressive and steroid drugs, though it could not be verified. Autopsy verified besides the recent necrosis of heart without reaction, and multifocal myocardial abscess, which appeared possible in the terminal phase.

Improving the risk-benefit ratio of NSAID therapy in the elderly.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed to elderly patients. This population may have a decreased capacity to metabolize and excrete NSAIDs and other agents. Furthermore, older patients frequently use NSAIDs concomitantly with other commonly prescribed drugs, thereby increasing the potential for drug interactions. A major challenge in rheumatology is to improve the risk-benefit ratio of NSAID therapy in older patients. Clinicians first must identify which patients are at increased risk. Several studies have shown that compromised cardiovascular and renal functions in older individuals may be important factors in increasing their vulnerability to the adverse effects of NSAIDs. Epidemiologic studies have provided valuable information concerning risk factors for adverse drug reactions in the elderly. Older patients with rheumatic diseases, osteoporosis, degenerative changes and certain autoimmune diseases and neoplasms should be treated less aggressively than younger patients. Statistical analyses of data bases correlating specific adverse events with NSAID use in the elderly may help clinicians in their therapeutic decisions. These data bases are now available in several readily accessible forms.

[Defects in opsonization activity of the serum of patients with chronic arthritis]. / Defekte Opsonisationsaktivität des Serums von Patienten mit chronischer Arthritis.

The opsonizing capacity of sera from 22 patients with rheumatoid arthritis (RA), from 14 with psoriatic arthritis (AP), from seven with ankylosing spondylitis, and from healthy control persons was investigated by luminol-dependent chemiluminescence, induced during yeast phagocytosis of normal polymorphonuclear leukocytes. The chemiluminescence response using opsonizing sera was compared to that induced by no-opsonized yeast and the opsonizing capacity was expressed as a percentage. For the opsonization, fresh native serum, in some experiments Mg2+-EGTA and EDTA-treated serum, was used. In RA and AP sera, a significantly diminished opsonizing capacity (p less than 0.005) was observed. In healthy controls and in SPA patients, the opsonizing capacity of their sera was over 200%, while in seronegative RA patients, it was only 175%, in seropositive RA 125%, and in AP 150% was measured. There was no correlation between opsonizing capacity and complement or immunoglobulin content of the investigated sera. The amount of C3b, IgG and IgM covalently bound to yeast particles was determined, too. Yeast particles bind significantly less (p less than 0.01) IgG when opsonized with RA and AP sera, while a higher relative amount of IgM (p less than 0.01) was bound to yeast incubated in the sera of seropositive RA patients. No significant differences in the C3b binding were observed.

Clinical and histological evaluation of synovial needle-biopsies in patients suffering from rheumatoid arthritis. I. Relationship between clinical activity and histological pattern.

In 50 patients suffering for 1-15 years from rheumatoid arthritis, needle-biopsy of the synovial membrane was carried out. The finding correlated with the general clinical activity of the disease. Each type of histological change was evaluated with regard to its diagnostic value in assessing clinical activity. Among the histological changes, oedema, synovial cell proliferation, lymphocyte-plasma cell proliferation and necrotic vasculitis showed a negative correlation with clinical activity, while a positive correlation was observed between clinical activity and the presence of fibrin (fresh and old), fibrinoid, fibrinoid basophilia, fibroblast proliferation, synovial cell desquamation, concentric perivascular sclerosis, fibrosis and hyalinosis. Vascular changes of the synovial membrane such as oedema, fresh fibrin exudate, necrotic vasculitis showed a negative correlation with clinical activity while hyalinization and concentric sclerosis and clinical activity were found to be in positive correlation. It is concluded that in the course of rheumatoid arthritis the histological changes do not necessarily run parallel with the clinical activity of the disease.

Clinical and histological evaluation of synovial needle-biopsies in rheumatoid arthritis. II. Relationship between local clinical activity and histological pattern.

The histological pattern of synovial needle-biopsies of 50 patients suffering from classical or definitive rheumatoid arthritis has been compared with the clinical activity of the disease. Each histological change was evaluated in terms of its value in characterizing local clinical activity. It was shown that most changes of the synovial ground tissue are in a positive correlation with local clinical activity. Among the vascular changes of the synovial membrane, oedema of vascular walls, exudation of fresh fibrin, leukocyte infiltration and thickening of vascular walls were in negative correlation, while chronic fibrin, lymphocytic or plasma cell infiltration and hyalinosis were in positive correlation with local clinical activity.

Levamisole-induced neutropenia and agranulocytosis: association with HLA B27 leukocyte agglutinating and lymphocytotoxic antibodies.

Among 37 patients treated with levamisole for rheumatoid arthritis (n = 19), for Reiter's disease (n = 4) and for chronic articular brucellosis (n = 14) followed up during 6-12 months, 3 developed agranulocytosis and 3 severe neutropenia. Serum samples drawn before and during treatment were tested for leukocyte agglutinating and lymphocytotoxic antibodies. Leukocyte agglutinating antibodies were induced in 8 patients, in 5 of them in association with agranulocytosis or neutropenia. In 1 patient with agranulocytosis and in another one with neutropenia lymphocytotoxic antibodies were also induced. Two agranulocytotic and one neutropenic patient possessed HLA B27 antigen. In altogether 11 HLA B27 carriers the number of circulating neutrophils were significantly reduced during levamisole treatment when compared with those of patients lacking HLA B27 antigen.

Skin manifestations and serum IgE levels in levamisole-treated rheumatoid arthritis patients.

Skin manifestations may occur as adverse effects of immunostimulant therapy with Levamisole. They are generally regarded as drug-induced hypersensitivity reactions. Our observations revealed that, in Levamisole-treated rheumatoid arthritis patients, urticaria was accompanied by an elevation of serum IgE, but other types of skin reactions were not. Moreover, elevation of IgE occurred without any skin reactions in some cases. It is suggested that Levamisole - stimulating T lymphocytes - may also stimulate IgE-mediated atopic responses.

Antibodies to native DNA in connective tissue disease. A comparison of radioimmunoassay, counterimmunoelectrophoresis and indirect immunofluorescence on Crithidia luciliae substrate.

Sera of patients with symptoms of connective tissue diseases were investigated for the presence of antinuclear antibodies by indirect immunofluorescence on rat liver substrate. In positive cases antibodies to native DNA were determined by radioimmunoassay and by counterimmunoelectrophoresis. Twenty seven selected sera were also tested by indirect immunofluorescence on Crithidia luciliae substrate to test the sensitivity and specificity of this method. Immunofluorescent antinuclear antibodies could be found in all groups of connective tissue diseases while anti-native DNA antibody was demonstrated in higher amount only in the cases of systemic lupus erythematosus and therefore determination of anti-native DNA antibody may be helpful in the diagnosis of oligosymptomatic SLE. Counterimmunoelectrophoresis and immunofluorescence on Crithidia smears may serve as screening methods for anti-native DNA while radioimmunoassay provides a quantitative determination, although there are minor differences in the sensitivity and the specificity of these three methods.