Eosinophilic airway inflammation as an underlying mechanism of undiagnosed prolonged cough in primary healthcare patients.

Prolonged cough is a common problem in patients seen in general practice. Using a simple method of sputum induction and processing of sputum samples, we determined whether eosinophilic airway inflammation could be a cause of undiagnosed prolonged cough. Eighty-two patients who had had cough for more than 1 month were enrolled into the study, in six primary healthcare centres. Patients with known pulmonary disease, including asthma or chronic obstructive pulmonary disease (COPD), or who were known to have another cause of cough, or to have recently suffered from a respiratory infection, were excluded. Fifty-three healthy individuals served as controls. Sputum was induced by inhalation of 3% saline. Inflammatory cells in smears were studied semi-quantitatively. Concentrations of eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), myeloperoxidase (MPO) and human neutrophilic lipocalin (HNL) were determined. Sputum induction proved safe and adequate samples were obtained from 91%. Sputum eosinophilia (eosinophils accounting for more than 5% of all cells in smears) was present in 14 patients with prolonged cough (19%) but in no healthy individual (P=0.001). Five of the 14 individuals (36%) who exhibited sputum eosinophilia appeared to have asthma, while nine of the 14 (64%) did not. Concentrations of ECP and EPO were higher in patients with prolonged cough than in healthy individuals (P=0.02 for ECP; 0.005 for EPO). We conclude that eosinophilic airway inflammation is a fairly common cause of prolonged cough, even in patients not suffering from asthma or COPD, or in whom no other cause of cough is known to be present. Induced sputum samples obtained in health centres can be studied in a central laboratory. Detection of eosinophilic airway inflammation could aid the decision regarding treatment.

Activity of arthritis.

Factor analysis was used in clarifying the picture of joint inflammation. 376 arthritis patients were examined at the onset of the disease and after three years. The six factors produced are interpreted to represent six components of joint inflammation, namely the anaemic factor, the factors of clinical joint inflammation gammaglobulin activity, complement activity and acute phase, and the factor of alfa-beta globulin activity. The factor structure remained quite similar during the follow-up. This would indicate that there are certain basic aspects of inflammation which remain fairly stable from year to year.

Predicting the outcome of rheumatoid arthritis. A Soviet-Finnish co-operative study.

The prognostically important signs and symptoms in the early stage of rheumatoid arthritis were studied in 136 patients selected and treated in Moscow and in 139 patients in Heinola, Finland. The follow-up time was 3 years. The outcome was poor in patients with early signs of radiological destruction in the joints, with rheumatoid factor in serum, with early functional disability or deficient flexion of the fingers, with multiple affliction of the finger, metatarsophalangeal or wrist joints, with marked morning stiffness, and with CRP in the serum. The age of the patients did not influence the outcome in Moscow, whereas in Heinola the mean age was higher in patients with a poor outcome. Despite the marked differences in the therapeutic methods and the outcome for patients, the prognostically important signs and symptoms were very similar in both centres.

The prediction of radiological destruction during the early stage of rheumatoid arthritis.

A total of 107 patients with definite rheumatoid arthritis of no longer than six months' duration were observed for three years. The radiological destruction of the hand and foot joints after the follow-up time was compared with 65 anamnestic, clinical, laboratory and radiological variables at the onset of the disease. Of the individual variables, early radiological changes in the joints showed the best correlation with the progress of joint destruction. Grip strength, ESR, serum iron, serum C1 esterase inhibitor, rheumatoid factor and old age also had prognostic value. In multiple regression analysis 15 variables explained about 50% of the variance in the progress of joint destruction.

Relationship between clinical synovitis and radiological destruction, in rheumatoid arthritis.

The clinical synovitis and radiological destruction of wrist and subtalar joints were followed over a 3-year period in 107 patients with rheumatoid arthritis of no longer than 6 months' duration. The joints were examined clinically and by X-ray on entry to study, at one year and at three years of study. The progress of joint destruction was highly significantly correlated with the frequency of clinical synovitis at the three examinations in both wrist and subtalar joints.

Prognosis of inflammatory joint diseases. A three-year follow-up study.

The prognosis 3 years after the onset of the disease was studied in 107 patients with definite rheumatoid arthritis, 161 with probable RA or non-specific arthritis, 84 with either ankylosing spondylitis, Reiter's disease or reactive arthritis, 14 with psoriatic arthritis and 10 with a systemic connective tissue disease. Prognosis was measured by clinical involvement of joints, radiological erosions in joints, deterioration in joint function, ESR, and working ability. A total of 44% of all patients were symptomless after 3 years. The prognosis was best in patients with an "HLA B 27-associated" disease and non-specific arthritis, and worst in RA. Two patients died during the follow-up of systemic connective tissue disease and one committed suicide with an overdose of hydroxychloroquine. Two HLA B27-positive patients developed systemic amyloidosis.

Early rheumatoid arthritis in the USSR and in Finland.

In 1974-76 patients with early rheumatoid arthritis (duration less than or equal to 6 months) were investigated at the Institute for Rheumatism, Moscow, and at the Rheumatism Foundation Hospital, Heinola, Finland. Of 200 patients in each centre, 142 sex- and age-matched patients were chosen and followed up for one year. Despite common selection criteria, appreciable differences were found in clinical involvement, X-ray findings and laboratory results. Many of these may be due to difficulties in the standardization of methods rather than to actual national differences in the clinical picture and course of the disease. In both institutions, almost every patient was given systemic antirheumatic drugs, but there were notable differences in the choice of drugs: gold was preferred at Heinola, chloroquine or cytostatics were more commonly used in Moscow. The use of both local and peroral corticosteroids was similar, while surgery was used only in Heinola and spa treatment only in Moscow.