Problematic and positive support in relation to depression in people with rheumatoid arthritis.

This study focuses on the associations of both positive and problematic aspects of social support with depression in patients with rheumatoid arthritis. In a hierarchical multiple regression analysis we found that stressors such as functional limitations and pain are strongly related to depression. Positive and problematic support each explain an additional significant portion of the variance in depression. More positive support is associated with fewer feelings of depression and more problematic support is associated with more feelings of depression. An interaction effect between positive and problematic social support indicates that the negative aspects of problematic support may be partly diminished by positive support (buffering effect). Patients receiving more problematic support and less positive support experience the most feelings of depression.

[Paget's disease of the bones: diagnosis and treatment]. / De ziekte van Paget van bot: diagnostiek en behandeling.

Paget's disease of bone affects one or more bones and is characterized by increased bone turnover (remodelling) with hypertrophy and abnormal bone structure with diminished strength leading to deformity and fracture. The cause of the disease is not known, possibly is a slow virus infection. For diagnosis and follow-up the conventional bone markers, serum alkaline phosphatase and urine hydroxyproline, are still useful. Paget's disease cannot be cured, but it may be suppressed. Specific drug treatment aims at reducing the increased bone remodelling. New and potent biphosphonates enable early and more effective treatment of Paget's disease than in the past and better prevention of late complications of the disease.

The supply of and demand for informal and professional care for patients with rheumatoid arthritis.

The objective of this study is to determine supply of, and demand for, informal care for rheumatoid arthritis (RA) patients and to evaluate the factors that contribute to the amounts of help needed and received from professional and informal care providers at home. Data were collected by questionnaire from 229 RA patients and 174 informal caregivers. Most of the help required is also received, though 24% of the patients did not receive help for one or more tasks. Most help given at home is by informal caregivers. The amount of help needed is related primarily to the patient's physical condition, sex, and self-efficacy expectations towards coping with RA. The amount of help received from informal caregivers is largely explained by the physical condition and the marital status of the patient, the sex of the caregiver, the patient's self-efficacy expectations towards coping with RA, and the age of the patient. The amount of help received from health professionals is related primarily to the marital status and the physical condition of the patient.

Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis.

DUTCH-AIMS2, a Dutch version of AIMS2 and successor to DUTCH-AIMS, is an instrument to assess health status among patients with rheumatic diseases. It provides measurements of 12 areas of health status on scales for health status proper, satisfaction, attribution and arthritis impact. We assessed the reliability of its scales in terms of internal consistency and their validity according to both internal standards and external standards. Correctly completed questionnaires were returned by 231 RA patients and 131 controls. Internal consistency coefficients for the health status scales ranged from 0.66 and 0.89, but most exceeded 0.80. Within-scale factor analyses produced single factors in all composite health status scales for both patients and controls, with only two exceptions. Factor analysis also identified a physical, social and psychological dimension among 11 areas of health. External validity was established by strong correlations between DUTCH-AIMS2 health status scales and functional class, laboratory parameters, and self-assessments of fatigue, loneliness, pain, functional disability and social support. DUTCH-AIMS2 is acceptably reliable and valid for use in a variety of settings.

[The remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome]. / Het 'remitting seronegative symmetrical synovitis with pitting edema' (RS3PE)-syndroom.

RS3PE syndrome was diagnosed in a 83-year-old man with seronegative symmetrical polysynovitis with pitting oedema, which presented after a vehement acute beginning a remarkably favourable course. RS3PE syndrome, recently described, is characterized by a transient seronegative symmetrical synovitis with pitting oedema. The syndrome appears mainly in the aged. After a frequently acute crippling beginning, the prognosis is good. Plain and brief treatment will suffice.

Increased bone mass with pamidronate treatment in rheumatoid arthritis. Results of a three-year randomized, double-blind trial.

OBJECTIVES: Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We therefore investigated the effect of oral pamidronate therapy as a specific bone-sparing agent in RA. METHODS: The study design was a 3-year randomized, double-blind trial of 300 mg oral pamidronate/day compared with placebo in 105 RA patients. Bone mineral density (BMD) measured at 12-month intervals was the primary efficacy parameter. RESULTS: In 3 years, lumbar spine and forearm BMD increased significantly in the pamidronate-treated group (by 8.4 +/- 6.9% [mean =/- SEMI] [P < 0.00011 and 5.2 =/- 6.5% [P < 0.005], respectively), compared with nonsignificant changes in the placebo-treated patients (increase of 0.6 =/- 5.2% and decrease of 1.2 =/- 5.8%, respectively). Femoral neck BMD increased in the pamidronate-treated group (by 2.6 =/- 8.6%) and decreased significantly in the placebo-treated group (by 4.0=/- 1.3% [P < 0.005]). The changes in BMD with time at all 3 measurement sites were significantly different between the treatment groups (P < 0.0001). Changes in radiographic signs of joint damage and in disease activity were similar in the 2 groups. CONCLUSION: The present study provides the first evidence that long-term treatment with an orally administered bisphosphonate overcomes bone loss and increases bone mass when compared with placebo. This finding may have significance with regard to the treatment of patients with RA.

Presence of bacterial flora-derived antigen in synovial tissue macrophages and dendritic cells.

In previous studies using and animal model human bacterial flora-derived peptidoglycan Polysaccharides were shown to be arthropathic after a single subcutaneous injection. A prerequisite for proof of the hypothesis that bacterial products from the normal resident flora are involved in the immune reaction of human chronic polyarthritis of unknown aetiology is the presence of these antigens in synovial tissue. 2E9, a monoclonal antibody we developed against intestinal peptidoglycan polysaccharides was used in a histochemical study in rats and stained macrophages in the spleen red pulp. In this study human synovial tissues from 10 rheumatoid arthritis (RA) and 20 non-RA patients were stained with 2E9. We found that eight out of 10 RA patients had 2E9-positive macrophages and dendritic cells in their synovia. A significant difference was observed with the control group in which seven out of 20 were positive. No positive cells or staining of the matrix was found in the cartilage of six RA patients. These results show that exogenous bacterial antigens are present in synovial tissue macrophages and dendritic cells. It was concluded that the unknown antigen in the immune reaction in RA is not necessarily endogenous.

Clinical and biochemical response to single infusion of pamidronate in patients with active rheumatoid arthritis: a double blind placebo controlled study.

OBJECTIVE: To assess the effects of 3-amino-1-hydroxypropylidine-1,1-bisphosphonate (pamidronate) in rheumatoid arthritis (RA). METHODS: Thirty patients with active RA were randomly allocated to receive a single intravenous infusion of placebo, 20 mg pamidronate, or 40 mg pamidronate. RESULTS: Pamidronate treatment resulted in a rapid and sustained reduction in urinary calcium and hydroxyproline excretions. A sustained reduction in serum corrected calcium was only noted in the group treated with 40 mg pamidronate. In both groups treated with pamidronate a temporary increase in serum parathyroid hormone was noted. Compared to the placebo group clinical variables of disease activity improved significantly in both groups treated with aminohydroxypropylidine bisphosphonate. The erythrocyte sedimentation rate and serum C-reactive protein levels improved significantly in patients treated with 40 mg pamidronate. No serious side effects were documented. CONCLUSION: A single infusion of pamidronate in patients with RA is safe, suppresses bone resorption, and reduces disease activity. It is suggested that the effect on disease activity is dose dependent.

Bone metabolism in rheumatoid arthritis; relation to disease activity.

Biochemical parameters of bone metabolism were investigated in 105 ambulant, non-steroid treated patients with RA and compared with parameters of disease activity. Urinary calcium (Ca) and hydroxyproline (OHP) excretions, as parameters of bone resorption and serum alkaline phosphatase (AP), as a parameter of bone formation, were positively related to parameters of disease activity. Serum osteocalcin, another parameter of bone formation, was not related to parameters of disease activity. Patients with active disease (ESR > or = 28 mm and Ritchie articular index > or = 8) had a significant higher urinary Ca and OHP excretion (62 and 42% higher, respectively) than patients with inactive disease. Serum AP and OC were slightly higher (19 and 16%, respectively) in patients with active disease. These results suggest that in RA patients bone metabolism is related to disease activity. In active disease bone resorption seems to be increased more than bone formation, suggesting that prolonged disease activity may contribute to generalized and/or localized osteopenia.

Failure of anterior cruciate-ligament reconstruction using tendon xenograft.

From January 1981 to September 1983 forty knees had replacement of a torn anterior cruciate ligament with a tendon xenograft. In six of the first thirty knees that were operated on severe synovitis developed within eight months after the operation, and total synovectomy and removal of the graft was required. Because of this complication we changed the recommended rinsing procedure for the graft in the last ten knees, and no synovitis occurred in these. Approximately half of all of the grafts ruptured between twelve and twenty months after the operation.

Oestrogens and bone metabolism: a hypothesis.

The explanations so far proposed for the effects of oestrogens on bone metabolism in post-menopausal women have been based on the changes seen in calciotrophic hormones. However, we demonstrated in a previous study [6] that there is a decrease in the concentration of somatomedin (an insulin-like growth factor) and an increase in that of growth hormone (GH) in oestrogen-treated post-menopausal women. On the basis of those findings and the relevant data published in the literature, we advance a hypothesis to the effect that the bone-metabolism changes that occur in post-menopausal women following oestrogen replacement therapy come about via changes in serum somatomedin and growth hormone concentrations.

Changes in serum somatomedin and growth hormone concentrations after 3 weeks oestrogen substitution in post-menopausal women; a pilot study.

Oestrogens have a preventive effect on bone loss in post-menopausal women; however, little is known about their mechanism of action. The aim of this study was to investigate the changes in somatomedins (SM) and growth hormone (GH) concentrations in serum in post-menopausal women after 3 weeks of substitution with 20 micrograms ethinyloestradiol. A significant decrease was observed in the mean serum levels of SM, measured by bioassay (0.66 +/- 0.07 vs 0.38 +/- 0.07, P less than 0.01), radioimmunoassay (0.62 +/- 0.08 vs 0.34 +/- 0.03, P less than 0.01) and radioreceptorassay (1.14 +/- 0.11 vs 0.90 +/- 0.09, P less than 0.01). The mean serum GH concentration increased (9.4 +/- 3.2 vs 16.5 +/- 4.6, P less than 0.01). A positive role of SM and GH in the changes of bone metabolism after oestrogen substitution in post-menopausal women is discussed.

In vitro effect of (3-amino-1-hydroxypropylidene)-1,1-bisphosphonic acid (APD) on the function of mononuclear phagocytes in lymphocyte proliferation.

The effect of (3-amino-1-hydroxypropylidene)-1,1-bisphosphonic acid (APD) on pokeweed mitogen-stimulated and non-stimulated cultures of peripheral blood mononuclear cells was studied in vitro. It is shown that APD can inhibit partially lymphocyte proliferation when added to a suspension of mononuclear cells before stimulation, but that lymphocyte proliferation can continue when the drug is withdrawn. In contrast; when APD is added to the cell suspension together with the mitogen, lymphocyte proliferation remains low even when the drug is withdrawn. Addition of different concentration of mononuclear phagocytes (MNP) to non-adherent cells, followed by stimulation in the presence of APD, indicates that APD acts on MNP function preferentially and does not affect lymphocyte proliferation.

Oestrogen binding proteins in bone cell cytosol.

Attempts were made to demonstrate the presence of specific oestrogen binding proteins ("receptors") in bone cells. High speed cytosol preparations of bone were incubated with several concentrations of radioactive oestradiol alone and with radioactive oestradiol in the presence of a specific antioestrogen, Nafoxidine. Separation of bound and free oestradiol was carried out by dextran coated charcoal treatment and by sucrose gradient ultracentrifugation. Several types of bones likely to be oestrogen-sensitive were investigated: human femoral heads, human phalanx, rat and rabbit calvaria, humeri and femora of female rats. In all experiments we were unable to demonstrate the presence of specific oestrogen receptors in bone cell cytosol indicating that the direct effect of oestrogens on bone, if present, is not mediated by specific oestrogen receptors.