Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society.

OBJECTIVE: The Japan Ankylosing Spondylitis Society conducted a nationwide questionnaire survey of spondyloarthropathies (SpA) in 1990 and 1997, (1) to estimate the prevalence and incidence, and (2) to validate the criteria of Amor and the European Spondylarthropathy Study Group (ESSG) in Japan. METHODS: Japan was divided into 9 districts, to each of which a survey supervisor was assigned. According to unified criteria, each supervisor selected all the clinics and hospitals with potential for SpA patients in the district. The study population consisted of all patients with SpA seen at these institutes during a 5 year period (1985-89) for the 1st survey and a 7 year period (1990-96) for the 2nd survey. RESULTS: The 1st survey recruited 426 and the 2nd survey 638 cases, 74 of which were registered in both studies. The total number of patients with SpA identified 1985-96 was 990 (760 men, 227 women). They consisted of patients with ankylosing spondylitis (68.3%), psoriatic arthritis (12.7%), reactive arthritis (4.0%), undifferentiated SpA (5.4%), inflammatory bowel disease (2.2%), pustulosis palmaris et plantaris (4.7%), and others (polyenthesitis, etc.) (0.8%). The maximum onset number per year was 49. With the assumption that at least one-tenth of the Japanese population with SpA was recruited, incidence and prevalence were estimated not to exceed 0.48/100,000 and 9.5/100,000 person-years, respectively. The sensitivity was 84.0% for Amor criteria and 84.6 for ESSG criteria. CONCLUSION: The incidence and prevalence of SpA in Japanese were estimated to be less than 1/10 and 1/200, respectively, of those among Caucasians. The adaptability of the Amor and ESSG criteria was validated for the Japanese population.

Changes in the incidence and prevalence of rheumatoid arthritis in Kamitonda, Wakayama, Japan, 1965-1996.

OBJECTIVE: To evaluate secular trends in the incidence and prevalence of rheumatoid arthritis (RA) in Japan. METHODS: The incidence and prevalence of RA were determined in a longitudinal population based study in the Kamitonda district, Wakayama, Japan, from 1965 to 1996. RESULTS: In the study area consisting of about 3000 inhabitants, 16 incident cases, satisfying definite RA by the Rome criteria were detected during the study period. The age and sex adjusted incidence in both men and women combined and the age adjusted incidence in women significantly decreased (p<0.025 and p<0. 01, respectively). The age and sex adjusted prevalence in all inhabitants tended to decrease (p<0.1), and the age adjusted prevalence in women significantly declined (p<0.025). In men, however, neither incidence nor prevalence showed significant change. CONCLUSIONS: The decline of incidence and prevalence of female RA may be reducible to some environmental changes preferentially occurring more obviously in Japanese women than in men. Because the use of oral contraceptives has been extremely low in Japan, the decline should be explained by other factors.

Increase in age at onset of rheumatoid arthritis in Japan over a 30 year period.

OBJECTIVES: To determine changes in demographic variables and severity of rheumatoid arthritis (RA) that may have occurred during the 30 year period from 1960 to 1990 in Japan. METHODS: Using records of patients diagnosed with RA from two hospitals, demographic and clinical features at initial visit were compared between two groups, one from 1960 to 1965 (group I) and the other from 1985 to 1990 (group II). RESULTS: Mean age at the time of onset of the disease increased significantly from 37.5 years in group I to 46.9 in group II. The peak age at onset of RA shifted from the third to the fifth decade between group I and group II. There was no obvious change in morbidity as determined by seropositivity, rheumatoid nodules, and assessments of hip involvement. CONCLUSION: The age at onset of RA was delayed during a recent 30 year period in Japan. This increase in age at onset might result from environmental changes that occurred in Japan or may reflect a birth cohort phenomenon. Improvement of severity of disease was not found in this study.

Increased rate of hysterectomy in women undergoing surgery for osteoarthritis of the knee.

We performed a case-controlled study to determine whether previous gynecological surgery is associated with severe osteoarthritis (OA) of the knee, the hip or the spine, as well as mild OA of the knee. Patients who underwent surgical treatment for OA were defined as having severe OA. Patients with knee pain and radiographic grade 2 OA in a tibiofemoral joint on the Kellgren and Lawrence scale were defined as having mild knee OA. An increased rate of hysterectomy was observed in the severe knee OA group after adjustment for age and number of children, or even after adjustment for body mass index. Hysterectomy in this group was most often performed for myoma uteri. Patients with mild knee OA tended to have previous hysterectomy. From the results, we speculate that certain subsets of OA which often take a progressive course might be related to hysterectomy.

A giant thigh mass in a patient with total knee arthroplasty for Charcot joint.

A painless and progressively growing mass consisting of fibronecrotic quadriceps femoris muscles with a giant multilobular cystic cavity formed 15 years after total knee arthroplasty for Charcot joint. It was considered to be a cyst from the knee joint accompanied by compartmental muscular necrosis. The painless and progressively growing nature of the mass seemed to be largely attributable to a neuropathic joint. Computed tomography proved to be helpful for diagnosis. Conservative management was unsuccessful in relieving the symptoms.

Variant type of congenital stomatocytosis.

A 52-year-old female with congenital stomatocytosis showed hemolytic anemia, an increased mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and an increased osmotic fragility. Lipid and protein content of membranes, the activities of membrane-associated enzymes in erythrocytes and the elution pattern of hemoglobin were normal. Erythrocyte Na+ influx was moderately increased and Na+ efflux, particularly ouabain-insensitive Na+ "leak-out" was also increased. K+ concentration of erythrocytes was abnormally low with a slightly increased Na+ content. These phenotypes are very rare, and should be classified as a variant type.

Levels of urinary polyamines in patients with rheumatoid arthritis.

OBJECTIVE: To compare urinary polyamine levels in patients with rheumatoid arthritis (RA), with osteoarthritis (OA), and in healthy controls and examine the relationship between urinary polyamine levels and several disease variables in patients with RA. METHODS: We determined the concentrations of urinary polyamines in 33 patients with RA, 24 with OA, and 20 healthy controls, using the enzymatic assay method. For patients with RA relevant clinical and laboratory variables were obtained and functional and radiologic scores determined for the joints. RESULTS: Urinary polyamine levels were significantly higher in patients with RA versus those with OA and healthy controls. In patients with RA the levels of urinary polyamines correlated significantly with the concentrations of serum C-reactive protein (CRP); there was also a statistically significant negative correlation between their urinary polyamine levels and average grip strength in either hand. Moreover, the levels of urinary polyamines in patients with RA showed an increase in proportion to the degree of joint functional damage and radiologic progression. CONCLUSION: Our results confirm our previous report of an increase in the amount of free putrescine in synovial fluids and a significant correlation between the putrescine contents of synovial tissues and the serum CRP concentrations in patients with RA; they also suggest that urinary polyamine levels may be related to the activity and progression of RA, indicating that polyamine may play an important role in RA.

Rheumatoid nodules at the cement-bone interface in revision arthroplasty of rheumatoid patients.

We studied the histology of the cement-bone interface and the regenerated synovium in ten aseptically loosened arthroplasties in rheumatoid patients. In two patients we found rheumatoid nodules at the cement-bone interface and marked lymphoplasmacytic infiltration in another three. Failed joints in osteoarthritic patients did not show these changes, and it seems likely that the presence of abundant immunocompetent cells was due to the background disease. We speculate that rheumatoid inflammation contributed to the process of loosening.

[Arthritis and polyenthesitis after viral pleuro-pneumopathy due to Coxsackie virus]. / Arthrites et polyenthésites après pleuro-pneumopathie virale à virus Cocksakie.

A sixty-one year-old male developed subacute polyenthesitis one month after the onset on pleuropulmonary disease. This last manifestation resolved completely six months later, whereas the enthesopathy ran a subacute course, improving over time. Three years after onset, the patient had monoarthritis of the left elbow and tendinitis of both Achilles tendons. During the course of the disease, neutralizing antibodies against Coxsackie virus A9 rose significantly then returned to normal when clinical manifestations improved. This finding suggests that viral infections may cause enthesopathy.

Polyamine levels in synovial tissues and synovial fluids of patients with rheumatoid arthritis.

We determined the polyamine contents of the synovial tissues from 11 patients with rheumatoid arthritis (RA), and the free putrescine levels in the synovial fluids (SF) from 10 patients with RA, 7 with osteoarthritis (OA), 5 with posttraumatic arthritis, and 3 with infectious arthritis. Putrescine levels in the synovial tissues correlated with serum C reactive protein concentration in patients with RA. Free putrescine levels in SF were significantly elevated in patients with infectious arthritis, compared with those found in RA, OA, and posttraumatic arthritis. Free putrescine levels in SF from patients with RA were significantly higher than in those with OA. Our findings suggest that polyamines may play an important role in RA.

Polyenthesitis.

We described the clinical symptoms and signs of 11 cases of polyenthesitis, confirmed by the presence of inflammation in biopsies and increased activity in scintigraphy. All cases are negative for HLA-B27, and there is no presence of systemic inflammatory reaction, radiographic sacroiliitis, or chronic arthritis. The enthesitis is not ossifying and follows a rather benign clinical course. In one case, herpes virus-like particles were detected in the fibroblast debris of the tissue removed from Achilles tendon insertion. This fact suggests that polyenthesitis may be a clinical manifestation due to a reaction to an infectious agent.

Production of interleukin-1 beta-like factor with synovial cell growth promoting activity from adult T-cell leukemia cells.

We observed a case of adult T-cell leukemia (ATL) with proliferative synovitis. Culture supernatants from ATL cells (ATL-SN) obtained from the peripheral blood constitutively produced an interleukin-1 (IL-1)-like factor in vitro, as shown by the growth inhibition factor (GIF) assay using the A375 melanoma cell line and the lymphocyte activating factor (LAF) assay using C3H/HeJ thymocytes. Neutralization studies indicated that polyclonal antibodies against IL-1 beta blocked most (80%) of the activity in ATL-SN. In addition, increased amounts of IL-1 beta mRNA were found in the ATL cells by dot blot analysis. Sephacryl S-200 chromatography showed that the molecular weight of this factor was approximately 17.5 kDa, and Western blot analysis revealed that this factor reacted with polyclonal anti-IL-1 beta antibody under the reduced condition. The isoelectric point was 7.5. Furthermore, ATL-SN showed significant activity in promoting the growth of synovial cells in parallel with IL-1 activity. These data suggest that the constitutive production of this IL-1 beta-like factor might be responsible for proliferative synovitis in this case.

Nerve supply to the posterior longitudinal ligament and the intervertebral disc of the rat vertebral column as studied by acetylcholinesterase histochemistry. I. Distribution in the lumbar region.

The nerve supply to the posterior longitudinal ligament (PLL) and the intervertebral disc (IVD) of the lumbar vertebra was investigated by acetylcholinesterase (AchE) enzyme histochemistry in the rat. The meningeal branch of the spinal nerve (the sinuvertebral nerve) enters the vertebral canal and divides into ascending and descending branches which fuse with those from adjacent vertebrae. They give off transverse branches, connecting with those from the opposite side to form the superficial nerve fibre network in the intervertebral segment, which spreads to the vertebral segment of the PLL. Apart from this superficial nervous network, many nerve fibres enter through the posterolateral portion of the annulus fibrosus (AF) and form a dense, fine nerve fibre network in the deep layer of the intervertebral portion of the PLL and the superficial layer of the AF. Nerve fibres and terminals cannot be found in the deep layer of the AF or the nucleus pulposus. In the central part of the deeper nerve network there are few nerve terminals whereas there are abundant free nerve endings in the peripheral zones. It is suggested that these abundant nerve fibres may be correlated with various functions characteristic of this region and that they may be important in the regulation of movement and posture in the vertebral column.

Nerve supply to the posterior longitudinal ligament and the intervertebral disc of the rat vertebral column as studied by acetylcholinesterase histochemistry. II. Regional differences in the distribution of the nerve fibres and their origins.

Regional differences of the distribution and the origin of the nerve fibres of the posterior longitudinal ligament (PLL) and the intervertebral disc (IVD) were investigated by acetylcholinesterase (AchE) enzyme histochemistry in the rat. The deeper nerve network was well-developed at the lower thoracic and the upper lumbar vertebral levels, but it was hardly seen at the mid-thoracic level. This difference can be correlated with the extensibility of the PLL. The experimental study revealed that the AchE-positive nerve fibres in the PLL and the IVD were mostly derived from the spinal ganglia, that the superficial nerve network was supplied by the spinal ganglia bilaterally and polysegmentally, and that the deeper nerve network was supplied bilaterally but unisegmentally.