Subject(s)
Antibodies, Monoclonal/adverse effects , Arthritis, Rheumatoid/drug therapy , Death, Sudden/etiology , Heart/drug effects , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Antibodies, Monoclonal/administration & dosage , Clinical Trials, Phase II as Topic , Contraindications , Electrocardiography , Humans , Infliximab , Infusions, Intravenous , Male , Middle Aged , Tumor Necrosis Factor-alpha/pharmacologyABSTRACT
Anti-synthetase antibodies are found in 20 to 25% of all idiopathic inflammatory myopathies and allow identification of a syndrome associating myositis with interstitial pulmonary disease (50 to 70%), polyarthritis, Raynaud's phenomenon and mechanic's hands. Anti-Jo-1 is the most common anti-synthetase antibody. If anti-Jo-1 is present, interstitial lung disease must be looked for, because this is the most important determinant of the outcome. Treatment with high doses of corticosteroids is required. Immunosuppressive drugs are added in resistant cases or as corticosteroid-sparing agents.
Subject(s)
Ligases/antagonists & inhibitors , Muscle Weakness/etiology , Polymyositis/etiology , Adult , Antibodies, Antinuclear/isolation & purification , Cough/etiology , Dyspnea/etiology , Female , Humans , Ligases/immunology , Male , Middle Aged , Polymyositis/immunologyABSTRACT
OBJECTIVE: To investigate the role of citrate in the pathophysiology of arthritides with calcium pyrophosphate dihydrate (CPPD) crystals and/or apatite-like material. METHODS: We measured citrate concentrations in the plasma and synovial fluid (SF) of 23 joints whose SF contained these crystals and 33 joints without crystals. The SF originated from 25 joints each of patients with rheumatoid arthritis (RA) and primary osteoarthritis (OA) and 10 patients with various other inflammatory joint diseases. RESULTS: There was significant correlation between citrate concentrations in the SF and plasma with values globally twice as high in the SF as in the plasma. Citrate concentrations in the SF of patients whose SF contained CPPD crystals and/or apatite-like material were not significantly lower than those without crystals. On the other hand, citrate concentrations were significantly lower in the SF of patients with RA and other inflammatory joint diseases versus those with OA. CONCLUSION: We have no evidence that lower amounts of citrate in SF favor the presence of CPPD crystals or apatite-like material. Our results, however, do suggest a complex regulation of the citrate concentration in SF where cellular metabolic processes and citrates arising from the plasma and neighboring tissues probably interact to produce the levels recorded.
