Hormones in self tolerance and autoimmunity: a role in the pathogenesis of rheumatoid arthritis?

Recent studies indicate that pituitary hormones play an important role in immunoregulation. The evidence that endocrine abnormalities are associated with, and may contribute to the development of autoimmune disease is reviewed and discussed. Patients suffering from rheumatoid arthritis show a number of endocrine abnormalities that indicate altered pituitary function. The decreased bioactivity of prolactin and possible inadequate glucocorticoid response to inflammation found in patients may have an etiological role in rheumatoid arthritis. The further clarification of the possible role of endocrine factors in the etiology of autoimmune disease is needed urgently.

Prolactin deficiency in rheumatoid arthritis.

Prolactin and growth hormone were determined from the sera of 48 patients with rheumatoid arthritis (RA) and 23 controls by radioimmunoassay and by the Nb2 lymphoma proliferation bioassay. A highly significant deficiency was found in the bioactivity of circulating prolactin (PRL) in patients with RA, whereas immunoactive PRL was near normal. Only age matched male patients showed significantly lower serum PRL levels by radioimmunoassay. Patients with RA with anemia and high reticulocyte counts had bioactivity of PRL elevated and those with anemia and low reticulocyte counts had a decreased bioactivity of PRL when compared to patients without anemia. Prolactin isolated from the sera of 5 patients with RA showed decreased bioactivity in comparison with PRL separated from 5 sex matched controls. Serum factors capable of enhancing or inhibiting the response of Nb2 cells to ovine PRL were also discovered. Our results indicate that RA is associated with PRL deficiency.

Psoriatic arthritis and myopathy.

We describe a patient with psoriatic arthritis and a myopathy. The myopathy did not follow the time course of topical steroid treatment, nor did the patient display any features of hypercorticolism or local steroid excess. No evidence was found to support the diagnosis of polymyositis. Psoriatic myopathy is an uncommonly described condition. Steroid induced myopathy shares some nonspecific features with psoriatic myopathy, but can be differentiated by the clinical response to cessation of steroid therapy. Myalgia and 24 h urine creatine elevation are 2 features not previously described in association with psoriatic myopathy. The latter appears to correlate with muscle weakness and may be useful in following the course of this disease.

Rheumatic diseases in an Inuit population.

Prevalence and incidence rates for rheumatic diseases were found to be minimal among the Inuit people in the Keewatin District of the Northwest Territories, Canada. Patient identification was achieved by a review of medical records. All identified patients were interviewed and examined by a participating rheumatologist. Among women, the prevalence of rheumatoid arthritis, adjusted for age of the Manitoba population, was 1,822 per 100,000 and was comparable with that observed in other populations; no cases of rheumatoid arthritis in men were confirmed. The age-adjusted prevalence of osteoarthritis, 1,219 per 100,000 in men and 2,144 per 100,000 in women, was apparently low. A moderately high incidence of Reiter's syndrome, 24.9 per 100,000, was found. The findings in children suggested a high frequency of seronegative spondylarthropathies (yearly incidence 60.1 per 100,000), although the adjusted yearly incidence for juvenile rheumatoid arthritis also appeared to be high, 23.6 per 100,000. The frequencies of HLA antigens in patient groups were compared with those found in 19 patients with musculoskeletal complaints but no rheumatic disease. Both HLA-B27 and HLA-DR4 appeared to be common in these controls, 36.8% and 63.2%, respectively. Nevertheless, there was a higher frequency of HLA-B27 in patients with seronegative spondylarthropathies (87%) than in controls (P = 0.001). Because of the small numbers of patients who had rheumatoid arthritis, no associations with HLA were made for this condition. Although the findings suggest differences in the distribution of rheumatic diseases compared with those found in other populations, more complete studies are required to confirm these observations.

Assessment of longterm benefit of total hip replacement in patients with ankylosing spondylitis.

Clinical and radiographic follow-up examinations were obtained on 12 patients with ankylosing spondylitis (AS) who had undergone total hip replacement (THR). Four of these patients had bilateral THRs performed. The mean follow-up of these 16 THRs was 89 months (range 7-144 months). The THR had achieved excellent pain relief in 15 hips. Postoperative ankylosis did not occur. One arthroplasty has to be removed because of the development of protrusio acetabulum.. Radiographic follow-up was obtained in 14 hips. Six were found to have moderate periarticular ossification which did not significantly affect function. In our experience the risk of postoperative periarticular ossification developing in patients with AS is not a contraindication to hip replacement.

Local skin sensory changes after acupuncture.

Forty normal subjects were assessed for local skin sensory changes of the knees after acupuncture needle insertion. Correct insertion sites were used on one knee and incorrect sites on the other knee. No significant change of sensation was found over the L3 and L5 dermatomes when incorrect sites were used. Pain sensation was markedly diminished on the side where correct sites were used; minimal transient diminished sensation of heat and vibration was noted.

The role of hypnotic suggestion in acupuncture.

Any form of treatment has some degree of psychosomatic component. A study of the role of hypnotic suggestion in acupuncture was done in a double-blind study setting, which revealed there were minimal effects of hypnosis and/or power of suggestion. Two cases are reported for further illustration.