Coexisting hyperparathyroidism, renal osteodystrophy and psoriatic arthritis.

We report the case of a 60-year-old woman with hyperparathyroidism, renal osteodystrophy and psoriatic arthritis. The coexistence of findings of hyperparathyroidism and renal osteodystrophy has been described and there are also reports of patients suffering from renal arthropathy mimicking hyperparathyroidism. To our knowledge, there is no description to date of a case displaying findings of the co-occurrence of these conditions in a patient. We would like to emphasize that attention should be paid to the possible diagnosis of a coexisting inflammatory rheumatic disease when rheumatological symptoms of recent onset occur in patients with long-standing renal osteodystrophy and/or symptoms mimicking hyperparathyroidism occur in these patients.

Evidence of impaired cartilage/bone turnover in patients with active ankylosing spondylitis.

OBJECTIVES: To compare serum markers of bone formation with the urinary excretion of pyridinium crosslinks (PYR) as a possible measure of bone and cartilage degradation which would detect changes in bone metabolism in patients with ankylosing spondylitis (AS) and to relate them to influences of inflammatory disease activity, and to treatment. METHODS: In 62 patients with AS, serum osteocalcin, alkaline phosphatase (ALP), and skeletal ALP isoenzyme levels were evaluated concurrently in comparison with urinary excretion of pyridinium cross links and were compared with values in 50 healthy controls. RESULTS: Osteocalcin concentrations in AS patients were in the middle normal range (3.5 (SD 1.2) ng/ml) and did not differ significantly from those in control subjects (4.2 (1.3) ng/ml); the same was true for ALP and skeletal ALP isoenzyme fraction (AS: ALP 149 (50.3) U/l, skeletal ALP 12.8 (4.1) micrograms/l; controls: ALP 133 (25.2) U/l, skeletal ALP 11.9 (4.3) micrograms/l). The urinary levels of PYR in AS (51.2 (25.2) nmol PYR/mmol creatinine) were significantly increased compared with controls (33.9 (12.4) nmol PYR/mmol creatinine (p < 0.001)). In the AS group there was a positive correlation between urinary excretion of PYR and inflammatory disease activity (erythrocyte sedimentation rate (ESR)) (r = 0.6, p < 0.0001) and C reactive protein (CRP) (r = 0.3, p = 0.02), but no significant correlation was found with ESR, CRP, and markers of bone formation. CONCLUSIONS: Bone metabolism in patients with AS is characterised by normal bone formation and enhanced cartilage/bone degradation, suggesting that impaired bone turnover is pronounced in active disease. The results clearly indicate that this comparison can be used to demonstrate impairment of cartilage/bone metabolism which correlates with disease activity. The data obtained further emphasise the importance of measuring both serum variables and urinary excretion of PYR crosslinks to obtain adequate evaluation of cartilage/bone metabolism in patients with AS.

Monitoring of polymorphonuclear leukocyte functions in diabetes mellitus--a comparative study of conventional radiometric function tests and low-light imaging systems.

In this study neutrophil (PMN) phagocytic capacity was investigated using a conventional radiometric ingestion assay (IN) in comparison with PMN respiratory burst activity assessed by luminol-enhanced chemiluminescence (LCL) in response to phorbolesters and LCL induction during phagocytosis of opsonized Staphylococcus aureus (STLCL) in diabetes mellitus and healthy controls. PMN ingestion was measured with 3H-thymidine-labelled S. aureus in a kinetic radiometric assay. LCL and STLCL were assessed in a parallel detecting microtitre-plate luminometer (MTP-Reader). PMN of diabetic subjects showed a highly significant reduction of peak LCL in response to PMA as well as during phagocytosis of S. aureus (STLCL) compared to non-diabetic controls (p < 0.001 respectively). PMN ingestion in diabetic patients (51.8 +/- 4.6%) was significantly reduced compared to controls (78.3 +/- 6.2%) (p < 0.01). The in vitro data displayed impaired PMN oxidative burst activity at glucose concentrations > or = 13.8 mmol/L, whereas PMN IN was significantly reduced at glucose levels > or = 27.75 mmol/L. The control group showed a positive correlation of peak LCL response and IN (p < 0.05) but not of STCL and IN; in diabetic patients this was also true, but did not reach statistical significance. The data obtained in this study clearly demonstrated impaired PMN respiratory burst activity and markedly reduced phagocytic PMN functions in diabetic patients ex vivo and in vitro as measured by LCL and by ingestion of 3H-thymidine-labelled S. aureus suggesting inhibitory effects of elevated glucose concentrations on various PMN-functions, which might be of clinical importance concerning altered host defence.

[Impaired function of polymorphonuclear neutrophilic granulocytes in rheumatoid arthritis]. / Eingeschränkte Funktion polymorphkerniger neutrophiler Granulozyten bei rheumatoider Arthritis.

The aim of this study was to investigate the PMN functions ingestion (I), bacterial killing (BK) as well as the chemiluminescence response to phorbol esters (PMACL) as a measure of PMN respiratory burst activity in RA compared to osteoarthritis and controls. Our findings demonstrated a significant reduction of I and BK in RA compared to OA and controls (p < 0.01 resp.) but an enhanced PMACL (p < 0.01). There was no significant difference of I, BK and PMACL in OA and control subjects. These data clearly demonstrated impaired PMN ingestion and bacterial killing yet enhanced PMACL in RA, thus contributing at least in part to altered host defense in these patients.

Evidence of ex vivo and in vitro impaired neutrophil oxidative burst and phagocytic capacity in type 1 diabetes mellitus.

In this study neutrophil (PMN) oxidative burst activity was investigated ex vivo and in vitro in comparison to the PMN-phagocytic functions ingestion and bacterial killing in poorly-controlled type 1 diabetic patients. Luminol enhanced chemiluminescence in response to phorbolesters as a measure of oxidative burst was assessed in a parallel detecting microtiterplate luminometer in 40 poorly-controlled type 1 diabetic subjects. PMN ingestion was measured with [3H]thymidine-labelled Staphylococcus aureus in a kinetic radiometric assay. Microbicidal activity was determined by pure plate counting of surviving bacteria (colony forming units, cfu) after defined pmn challenge. PMNs of type 1 diabetic subjects showed a highly significant reduction of peak CL response in response to PMA compared to nondiabetic controls (P < 0.001) and PMN ingestion (51.8 +/- 4.6%) and bacterial killing (28.6 +/- 3.2%) were reduced as well (78.2 +/- 5.2% (IN) and 18.4 +/- 4.1% (BK), P < 0.01, respectively). The in vitro data displayed impaired PMN oxidative burst activity at glucose concentrations > or = 13.8 mmol/l whereas PMN IN and BK were significantly reduced at glucose levels > or = 27.75 mmol/l. In the control group there was a positive correlation of peak CL response and IN as well as BK (P < 0.05); in type 1 diabetic patients this was also true, but did not reach statistical significance. The data obtained in this study clearly demonstrated impaired PMN oxidative burst activity and markedly reduced ingestion and bacterial killing in type 1 diabetic patients ex vivo and in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

[Impaired induction of chemiluminescence and function of polymorphonuclear neutrophilic granulocytes in diabetes mellitus]. / Eingeschränkte Chemilumineszenzinduktion und Funktion polymorphkerniger neutrophiler Granulozyten bei Diabetes mellitus.

The aim of this study was to investigate PMN-chemiluminescence response as a measure of respiratory burst activity and the phagocytic PMN function "ingestion" with regard to metabolic control parameters in diabetes mellitus (d.m.) in comparison to healthy controls. Our findings demonstrated a significant reduction of chemiluminescence response and ingestion in diabetic patients compared to controls (p less than 0.01 resp.); further an inverse relation of metabolic control parameters in d.m. and PMN impairment, suggesting inhibitory effects on PMN function, thus leading or contributing at least in part to altered host defense.

Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes.

OBJECTIVE: In this study, ingestion of Staphylococcus aureus and "bacteria killing" (BK) were measured to evaluate polymorphonuclear leukocyte (PMN) phagocytic functions and chemiluminescence response (CL) to phorbol-myristic acetate (PMA) as respiratory burst activity with regard to metabolic control parameters in diabetic patients. RESEARCH DESIGN AND METHODS: PMN phagocytic functions were assessed in 40 diabetic patients, all receiving insulin and in poor metabolic control, with 3H-thymidine-labeled Staphylococcus aureus in a modified radiometric assay. Bacteria killing was determined by pure-plate counting of surviving bacteria (colony-forming units [cfu]) and luminol-enhanced CL in response to PMA as a measure of respiratory burst. PMN function data were correlated to HbA1 as parameter of recent metabolic control. RESULTS: PMN of diabetic patients showed a significant reduction in Staphylococcus aureus (50.7 +/- 4.1%) and BK (29.4 +/- 4.2%) compared with healthy nondiabetic control subjects (76.6 +/- 4.6% and 16.3 +/- 3.1%, respectively, P less than 0.001), and PMN CL response was markedly reduced in diabetic patients also. Linear regression analysis showed a highly significant negative correlation of HbA1 versus Staphylococcus aureus (r = -0.67, P = 0.001) and a positive correlation for BK (r = 0.73, P less than 0.001). This was also true for CL, although this did not reach statistical significance (P = 0.06). CONCLUSIONS: The data obtained demonstrate impaired PMN phagocytic functions and CL response in diabetic patients. These findings suggest inhibitory effects of elevated glucose concentrations on PMNs, a possible role of protein glycosylation for impairing PMN function, thus contributing in part to altered host defense.

[Reduced phagocytic capacity of circulating granulocytes in diabetes mellitus]. / Eingeschränkte Phagozytoseleistung zirkulierender Granulozyten bei Diabetes mellitus.

Impaired PMN function is regarded as a major cause for infectious complications in diabetes mellitus (d.m.). The aim of this study was to investigate the phagocytic PMN functions "ingestion" (IN) and "bacterial killing" (BK) with regard to metabolic control parameters and influences of variable glucose concentrations on these PMN functions in vitro. Our findings demonstrated a significant reduction of IN and BK in diabetic subjects compared to controls (p less than 0.001 resp.). The differences between type I and type II d.m. did not reach statistical significance. Linear regression analysis showed significantly negative correlations for fasting blood-glucose concentrations as well as glycosylated hemoglobin (HbA1) and IN (r = -0.34, p 0.03; r = -0.67, p = 0.001) and a highly positive for BK (r = 0.73, p = 0.0001). In vitro there was a significant decrease in IN and BK both in diabetic subjects and controls for glucose concentrations greater than 27.7 mmol/l (p = 0.01 resp.). These data clearly demonstrated impaired PMN ingestion and bacterial killing in diabetic patients, and the degree of PMN dysfunction is inversely related to the degree of metabolic control of diabetes. These findings suggest inhibitory effects of hyperglycemia on PMN functions, thus contributing at least partly to altered host defense in diabetes mellitus.

Serum osteocalcin levels in rheumatoid arthritis: a marker for accelerated bone turnover in late onset rheumatoid arthritis.

Levels of serum osteocalcin (OC) are increased in diseases with high bone turnover. We determined OC levels in (1) 15 patients with definite rheumatoid arthritis (RA) in early stages according to Steinbrocker's functional class FC I-II, (2) 40 patients at advanced stages (FC III-IV) and (3) 17 patients with late RA (onset at age of 65 or more). Sixty-two healthy volunteers, divided into 3 subgroups corresponding to the patients, and 19 patients with primary fibromyalgia syndrome (FMS) served as controls. All patients were included in a short term as well as a longitudinal study over one year. Mean OC levels were significantly elevated in patients with late onset RA compared with healthy controls (p = 0.037), while the OC values in early RA FC I-II and advanced RA FC III-IV did not differ significantly from the corresponding control group and the patients with FMS. The late RA group showed a positive correlation between OC and the erythrocyte sedimentation rate (ESR) (r = 0.641, p = 0.007) with a significant decrease of OC (p less than 0.01) as well as ESR (p = 0.047) over one year. We conclude increased OC levels correlate with disease activity in older patients with active RA, suggesting impaired bone turnover. This finding supports the picture of heterogeneity in RA with more late onset patients displaying "high bone turnover."

[Osteocalcin in rheumatoid arthritis--a marker for accelerated bone turnover in late-onset rheumatoid arthritis?]. / Osteocalcin bei rheumatoider Arthritis--ein Marker für erhöhten Knochenumsatz bei RA-Spätform?

Increased levels of OC can be detected in late RA with high disease activity, whereas no major bone impairment is detectable in early and advanced stages of RA suggesting a more serious bone involvement in this form of the disease. OC appears to be a good marker to identify osteopenia in late onset active RA.

[Insulin and immunology--a correlation]. / Insulin und Immunologie--eine Wechselbeziehung.

In comparison to former decenniums the relations between insulin and immunology have changed and continued to develop. Still up to 20 years ago the immunological side effects of an insulin therapy stood well to the fore concerning the clinical interest, nowadays, however, they are the autoantibodies against insulin and it is the role of insulin for a functioning immune system, which is not in the least exactly recognized.

Side effects in bicarbonate dialysis due to low dialysate pH.

In six commercially available bicarbonate containing dialysates pH and pCO2 were determined. Side effects resulted from low pH and high pCO2. Use of two of the six dialysates was associated with fatigue, muscle cramps and somnolence.