[Knee radiosynovectomy with Y90 in patients with rheumatoid arthritis: our experiences]. / La sinoviectomia isotopica del ginocchio con Y90 in pazienti affetti da artrite reumatoide: nostre esperienze.

In this study we resume the results of a twenty year-long experience with knee radiosynoviorthesis in patients with rheumatoid arthritis. We treated 840 patients; the total of treated knees was 1030; from our experience it arises that best and fastest results come from patients in stage I and higher; improvement is between 1st and 3rd year from first treatment in all patients considered. Best improvements occur in less severe patients; in most severe patients they last longer in time. Radioisotopic synoviectomy represents a good therapeutic goal; about 75% of patients shows a significant reduction in presenting numbers of knee swelling events and a benefit on the quality of life.

[Automation and computerization of the articular and Ritchie's indexes calculation]. / Automazione ed informatizzazione del calcolo dell'indice articolare e di Ritchie.

Compilation and calculation of some articular indexes is time consuming. Therefore the authors present a data base for automatic compilation and calculation of articular and Ritchie's indexes. Moreover the program allows to determine the number of the swollen and painful joints.

[Specific inhibitors of cyclooxygenase-2 (COX-2): current knowledge and perspectives]. / Gli inibitori specifici della cicloossigenasi-2 (COX-2): acquisizioni attuali e prospettive.

The Authors summarize the current knowledge on a new class of nonsteroidal anti-inflammatory drugs (NSAIDs), the coxib (celecoxib and rofecoxib), in the treatment of rheumatic diseases. Celecoxib and rofecoxib are selective cyclooxygenase-2 (COX-2) inhibitors which possess the same anti-inflammatory and analgesic activities, but a better gastric tolerability compared to the non-selective COX-1 and COX-2 inhibitors. The Authors also report other possible therapeutic effects of these NSADIs as evidenced by the more recent data of the literature. Celecoxib seems to reduce the incidence of new polyps in patients with familial adenomatous polyposis. It has been suggested the use of celecoxib as a protective drug against the development of colorectal cancer. Other (neoplastic) or pre-neoplastic conditions, such as bladder dysplasia, Barret esophagus, attinic keratosis and Alzheimer's disease seem to have benefit from this class of drugs.

[Computerized acquisition and elaboration of clinical data in Rheumatology during ten years: state of art and prospectives] / Dieci anni di nostre esperienze nell'acquisizione ed elaborazione informatizzata dei dati clinici in reumatologia: stato dell'arte e prospettive.

The well known complexity to collect the clinical data of patients and in particular in the area of rheumatology push us to develop a computerized clinical chart in order to facilitate the classification, evaluation and monitoring of these patients. The proposed computerized clinical chart is easy to use but at the same time is a very potent tool that allow the clinicians to organize the classic rheumatological pathologies as well as the more complexes or even rare. The proposed clinical chart is based on a relational database (FileMaker Pro 5.0v1) available for both the actual operative systems implemented on personal computers (Windows and Macintosh); this allow the full compatibility among the two systems, the possibility of exchanging data without any loss of information. The computerized clinical chart is structured on modules for specific pathologies and for homogeneous groups of illnesses. Basically the modules are defined correlated files of data for a specific pathology but that can be used also as a common pool for different pathologies. Our experience, based on ten years of use, indicates in the computerized rheumatological clinical chart an indispensable tool for rheumatologists with a real friendly use.

A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis.

OBJECTIVE: To determine the frequency of osteoporosis in a large cohort of women with rheumatoid arthritis (RA) and to investigate the main determinants of bone mineral density (BMD) and risk factors for vertebral fractures in this population. METHODS: We recruited 925 consecutive female patients with RA at 21 Rheumatology Centers in Italy. For each patient pre-registered demographic, disease, and treatment-related variables were collected. BMD was measured at lumbar spine and proximal femur by dual x-ray absorptiometry technique. Collected variables underwent a univariate and multivariate statistical procedure. Osteoporosis was defined as BMD > -2.5 T score. RESULTS: The frequency of osteoporosis in the whole sample was 28.8% at lumbar spine and 36.2% at femoral neck and increased linearly from Steinbrocker's functional stage I to IV (p = 0.0001). Patients with spinal or femoral osteoporosis were significantly older (p = 0.0001), had a lower body mass index (BMI) (p < 0.02), a significantly longer disease duration (p < 0.02) and a significantly higher Health Assessment Questionnaire (HAQ) score (p = 0.0001). These differences were significant, even after adjusting for age. Steroid use was associated with significantly lower lumbar and femoral BMD (p = 0.0001) even after adjusting for the main confounding covariates. Analysis of lateral spine radiographs revealed 74 women with at least one vertebral fracture. These women had a significantly lower lumbar and femoral BMD (p = 0.0001). The generalized linear model showed that steroid use, menopause, BMI, age, and HAQ were all significant independent predictors of lumbar and femoral BMD. The logistic procedure showed that age (OR 1.05, 95% CI 1.03-1.07), HAQ (OR 1.3, 95% CI 1.07-1.7), menopause (OR 1.9, 95% CI 1.1-3.2), use of steroids (OR 1.5, 95% CI 1.07-2.1), and BMI (OR 0.8, 95% CI 0.8-0.9) were significantly associated with the risk for osteoporosis. The only variables associated with an increased risk for vertebral fracture were age (OR 1.04, 95% CI 1.01-1.08), HAQ (OR 1.7, 95% CI 1.08-2.09), and cumulative steroid intake (OR for 1 g of prednisone 1.03, 95% CI 1.006-1.07). CONCLUSION: To prevent osteoporosis and its dramatic complications in RA the therapeutic challenge is to preserve functional capacity using the lowest possible dosage of corticosteroids.

[Peripheral neuropathy with mixed cryoglobulinemia]. / La neuropatia periferica della criglobulinemia mista.

Among 54 patients with mixed cryoglobulinemia a peripheral neuropathy was demonstrated in 23 patients (42.6%). Five patients had a secondary form while the majority (18) had essential cryoglobulinemia. The immunoglobulin components were polyclonal in 5 cases, only present in trace amounts in 5 and of type II in 13 patients. Fifteen patients had symptoms of polyneuropathy, but in 18 cases the symptomatology had symmetrical features and in two cases asymmetrical characteristics. In 8 patients a mono-polyneuropathy was observed. The most significant electrophysiological finding was the decreased amplitude of the sensory action potential of the sural nerve, which we observed in 95% of the instances, whereas a decreased sensory conduction velocity was seen in 8/23 cases only. A biopsy of the sural nerve, performed in eleven cases, always showed abnormal epi- and endoneurial vessels. Epineurial vessel vasculitis was found in 4 cases and fibrous thickening of the vessel wall in two cases. Endothelial swelling of the endoneurial vessels was observed in 7 patients and luminal obliteration in 3 samples. Axonal degeneration demonstrated in 7 of the 11 processed sample tissues was the main pathological finding. Signs of de/remyelination were associated in 3 cases, and were the dominant lesions in a single specimen. The simultaneous biopsy of the peroneus brevis muscle showed signs of denervation in all samples, vasculitis in 7 cases and deposits of filaments plus annular bodies of the vessel wall in 2 samples. All these data support the hypothesis that ischaemic damage may be the final common pathway of the majority of peripheral neuropathies in mixed cryoglobulinemia patients.

Long-term outcome with gold thiosulphate and tiopronin in 200 rheumatoid patients.

Two hundred rheumatoid patients were prospectively studied over a five-year period. One hundred and three received tiopronin (T) and 97 were treated with gold thiosulphate (GTS). At the end of the five-year period, similar percentages of patients dropped out because of lack of efficacy or because of major toxicities. Likewise, the percentages of patients still receiving the original drug in the two drug regimens at the 5th year of follow-up were 27.8% (GTS) vs. 25.2% (T), respectively.

Morphometric study of salivary glands in primary Sjögren's syndrome.

The relationship between structural changes of the minor salivary glands with age was evaluated by morphometric analysis in twenty patients with primary Sjögren's syndrome (prim. SS) (Group I) and in twenty sex and age-matched normal subjects (Group II). No statistically significant differences were found in the acinar tissue, intralobular ducts (ILD) and fibrous tissue between the two Groups. In contrast, there was a 5-fold increase in the volume fraction of inflammatory cells in Group 1. In both Groups the percentage of fibrous tissue and ILD increases and the percentage of acinar tissue decreases linearly with age. In Group I the increase in the volume percentage of fibrous tissue and the decrease in the volume fraction of the acinar tissue were not related to the volume percentage of inflammatory cells. These results demonstrate that in prim. SS the acinar atrophy is not related to the inflammatory process but is an age-dependent phenomenon.

[Rheumatic polymyalgia and temporal arteritis. Case contribution and bibliographic review]. / La polimialgia reumatica e l'arterite temporale. Contributo casistico e revisione bibliografica.

Polymyalgia rheumatica (PMR) is a frequent clinical syndrome in the elderly, characterised by morning aching and stiffness in the shoulder and girdle muscles associated with an elevated erythrocyte sedimentation rate and responsive to low-dose corticosteroid therapy. PMR may be associated with temporal arteritis (AT), a systemic granulomatous vasculitis predominantly affecting branches of the carotid artery in patients over the age of 50. Recent studies suggest an immunological pathogenesis for PMR and TA. Personal experience on 56 cases of PMR and TA, and a survey of the literature is reported and the articular manifestations and the differential diagnosis, are underlined. Polymyalgia rheumatica and temporal arteritis. Personal experience and survey of the literature.

Relationship between areas of popliteal cysts and radiological damage in rheumatoid arthritis and in osteoarthritis.

Fifty-five patients, (30 Rheumatoid Arthritis (RA) and 25 Osteoarthritis (OA], with knee synovial effusion and popliteal cysts, visualized through arthrograms, were studied. A relationship was sought between radiological findings and area of the cysts, measured through a millimeter grid. Ten radiological parameters were graded and summed up to obtain a "total knee score". A "total geode score" was also obtained by scoring, separately, the geodes. In addition two specific indexes were used--for comparison--the erosive index, modified after Berens and Lin, in RA and the Kelligren's index in OA. In RA a statistically significant, inverse correlation was found between the x-ray scores and the area of the cysts, while such a relationship was not observed in OA. However, only a third of the cysts accounted for the inverse relationship in RA. Furthermore, two control groups of RA and OA patients revealed a striking association between degree of radiological damage and frequency of popliteal cysts. Therefore, the hypothesis that popliteal cysts might have a protective effect against the articular-bone damage in RA, can be held only in few cases.

Serum IgA levels and ANA behaviour in rheumatoid patients with and without toxicity to remission-inducing drugs.

IgA levels and ANA behaviour were studied in twenty-five patients suffering from toxicity to remission-inducing drugs (Tiopronin or Gold thiosulphate) and in thirty-two without any evidence of toxicity. A comparable number of patients with low IgA levels were found in the two groups. ANA test positivity correlated better with the appearance of toxicity, but the low specificity and predictivity hinder its application as a screening parameter.

Toxicity due to remission inducing drugs in rheumatoid arthritis. Association with HLA-B35 and Cw4 antigens.

Twenty-five patients with rheumatoid arthritis (RA) who developed toxicity while taking remission inducing drugs and 30 without toxicity were studied for possible associations with class I and II HLA antigens. A strong association has been found between nephritis and dermatitis due to Tiopronin (a D-Penicillamine like compound) and class I antigens B35-Cw4, and between dermatitis due to gold thiosulphate and B35. Compared to healthy controls a lower DR5 frequency was observed in patients with RA except for the Tiopronin related nephritis group.

Tiopronin-nephropathy: clinical, pathological, immunological and immunogenetic characteristics.

Nine patients who developed proteinuria while on Tiopronin (a D-Penicillamine-like drug) have been studied. Nephrotic syndrome was observed in six cases. Immunologic analysis revealed a high frequency of ANA positivity and RF seronegativity by the time nephropathy appeared. Six patients were biopsied. Immunofluorescence, electron and light microscopy studies showed: glomerulonephritis with segmental deposits in the mesangium and along the capillary walls in one patient, mesangioprolipherative glomerulonephritis in one case and stage 1 membranous glomerulonephritis in four cases. Immunogenetic typing disclosed a strong association with B35-Cw4 class I antigens.

[Opaque arthrography in the evaluation of gonarthrosis]. / l'artrografia opaca nella valutazione della gonartrosi.

The Authors have studied, by means of the arthrographic technique, 24 cases of knee osteoarthrosis in various clinical phases. In the diagnosis of the early phases of the disease, this technique as been helpful in showing alterations, as the widening of the intercartilaginous space, the irregularities of synovial outlines, the enlargement of the normal popliteal space, which common techniques, unusually cannot display. The assay is not needed in the most advanced phases of the disease but it could here as well supply further diagnostic data (i.e. popliteal cyst, etc.). Therefore the authors suggest the arthrographic technique as a complementary assay to the roentgenological one, as well as an elective technique in the early phases of the knee osteoarthrosis.

Demonstration of articular effusions and popliteal cysts with ultrasound.

Echography has been employed in 10 patients with knee effusions and in two patients with Baker's cysts. In all instances, echography clearly identified the effusions. In four patients, the presence of connective tissue septa were also shown. This technique appears to be preferred to arthrography or the intra-articular injection of isotopes. Nevertheless, echography provides only "morphologic" information which complements other methods of investigation.