Radiographic assessment in relation to clinical and biochemical variables in rheumatoid arthritis.

Radiographs of hands and feet were obtained from 125 consecutive patients with rheumatoid arthritis (RA) and the degree of destruction was assessed numerically on a 200-point scale using Larsen's standard radiographs as reference. The method is shown to possess a satisfactory degree of reproducibility. In 96 of these 125 patients, values of another 15 simultaneously determined clinical and biochemical variables were obtained. On applying linear and quadratic multiple regression analysis to this set as well as to the male and female subsets, an 'automatic' selection procedure (stepwise regression) proved duration of disease to be the most important factor relating to the 'Larsen index'. The 96 patients were therefore ranked with respect to duration of disease and divided into 4 subsets of equal magnitude. In the 3 subsets with duration of disease less than 21 years, stepwise regression produced in the final step linear or quadratic combinations not containing duration of disease but correlating quite well with the 'Larsen index' (R = 0.64-0.96). A similar result was obtained upon performing an analogous procedure in the female subset. In all instances, positive contributions of varying degree were obtained from Ritchie's index, ESR, a-antitrypsin (A1-AT), orosomucoid, fibrinogen, and IgM, while negative correlations were associated with ceruloplasmin, IgG, and IgA.

Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint.

Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.

Factors related to the progression of joint destruction in rheumatoid arthritis.

In 103 (M = 25, F = 78) of 150 consecutive RA patients, values of the following variables were obtained at the start and end of a 2-year follow-up period: radiographic destruction score of hands and feet according to Larsen (Larsen index), Ritchie index, B-hemoglobin, ESR and plasma proteins (alpha 1-antitrypsin, ceruloplasmin, CRP, fibrinogen, haptoglobin, orosomucoid, IgA, IgG, IgM, C3 and C4). 60% of the values of delta LI (final minus initial value of Larsen index) were significantly larger than zero (11-44 units, p less than 0.05). delta LI was larger in females than in males (p = 0.11). Comparing women with duration of disease (DoD) 1-6 years versus 7-52 years. delta LI was larger in the former group (p = 0.005). Comparing women with the largest delta LI (19-44 units) with the remainder ones (delta LI = -9-18 units), CRP and haptoglobin was higher and IgM lower in the former group (p = 0.03, 0.02 and 0.03 respectively). In women with DoD 1-6 years (and only in this interval) significant linear relationships were found between delta LI and hemoglobin (r = 0.52, p less than 0.01) Ritchie index, haptoglobin, CRP (r = 0.41-0.46, p less than 0.05) and IgM (r = -0.43, p less than 0.05). The mean of repeated hemoglobin values correlated even more strongly with delta LI (r = 0.70, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Protease inhibitors in rheumatoid synovial fluid: a quantitative analysis.

The concentrations of the main endogenous inhibitors of granulocyte proteases (anti-leukoprotease, alpha 1-antitrypsin, alpha 1-antichymotrypsin, and alpha 2-macroglobulin) were estimated in paired samples of synovial fluid and serum/plasma from seropositive rheumatoid arthritics and controls. Rheumatoid synovial fluid contained significantly higher levels of all inhibitors except antileukoprotease. The influence of the synovial membrane on these concentrations was taken into account by comparing the ratio between the observed concentration and that predicted from a certain regression curve fitted to a set of non-inhibitory reference proteins of extra-articular origin (orosomucoid, albumin, and ceruloplasmin). Divergences were interpreted as the net result of intra-articular production or consumption of the inhibitor in question. The results suggested a consumption of antileukoprotease and alpha 1-antitrypsin in the rheumatoid joint, while the increased levels of alpha 1-antichymotrypsin and alpha 2-macroglobulin probably reflected the altered trans-synovial membrane protein flux with some reservation for alpha 2-macroglobulin.

Plasma levels of beta 2-microglobulin in rheumatoid arthritis.

A simple and inexpensive method is described for the determination of beta 2-microglobulin (beta 2-MG) by enzyme-amplified single radial immunodiffusion. The values obtained with this method correlate well with those determined by means of a commerical RIA kit. Using the immunodiffusion method we have measured the plasma levels of beta 2-MG in 135 patients with rheumatoid arthritis (RA) and normal serum creatinine levels. 33% of the patients had increased concentrations of beta 2 MG, but the levels were found to correlate poorly with the values of several variables generally used as indices of the degree inflammatory activity in RA. Furthermore, in contrast to earlier claims to the contrary, beta 2-MG correlated positively with age. The value of beta 2-MG in plasma as an index of inflammatory activity in RA is questioned.

Abnormal axillary lymph nodes in rheumatoid arthritis.

Mammary radiography was performed in 56 patients with arthritis, predominantly rheumatoid arthritis. Definite abnormal axillary lymph nodes were found in 24 and probably abnormal nodes in 8. Abnormal nodes were characterized by increased attenuation, rounded shape and absence of fatty replacement.

Plasma salicylate levels in rheumatoid arthritis: a comparison between micro-encapsulated and conventional aspirin.

Ten patients with rheumatoid arthritis were given identical amounts of conventional aspirin (Magnecyl) tablets and micro-encapsulated aspirin (Reumyl) capsules. Steady-state salicylate levels were determined after 4 days' treatment at 8 a.m., 12 noon, 4 p.m., 10 p.m. and again at 8 a.m. No difference was noted between the levels at 12 noon or 4 p.m. The 10 p.m. levels were slightly though not significantly higher and the last set of 8 a.m. levels were significantly higher during the capsule administration. A criterion for inclusion was good tolerance of Magnecyl. The clinical effectiveness was not evaluated, but the observed good absorption features of Reumyl indicate that this preparation may prove to be of value in long-term treatment.

A comparison of ketoprofen and naproxen in rheumatoid arthritis.

Ketoprofen, 50+50+100 mg, was compared to naproxen, 250+250+250 mg, in a double-blind, cross-over twice 4-weeks' study on patients with RA. There was no significant difference in the effect on morning stiffness, pain at rest, joint count, grip strength or ESR. Among 28 patients 10 preferred ketoprofen and 7 naproxen. Two ketoprofen and 1 naproxen periods were interrupted owing to intolerable side-effects. Twenty of the patients experienced some side-effect from at least one drug. The most common complaints were gastrointestinal, seen in 12 patients on ketoprofen and 9 on naproxen. Most side-effects were mild. No abnormality in blood morphology, liver function tests, serum creatinine or fasting blood glucose was observed. No occult bleeding was detected on routine stool examination.