[Sonography of the foot in rheumatology : Ultrasound diagnostics of the ankle joint and foot in the rheumatological routine]. / Fußsonographie in der Rheumatologie : Sonographische Diagnostik des Sprunggelenks und des Fußes im rheumatologischen Alltag.

Ultrasound examination of the joints is an essential component of diagnostics in rheumatology. Due to its easy accessibility, excellent image definition of soft tissue and bone surfaces with standardized scan sections and scoring systems, ultrasound examination of the joints enables decisions to be made on early and differential diagnostics, treatment monitoring and prognosis. Involvement of the ankle and foot is a common problem in both inflammatory and degenerative rheumatological diseases. Persisting inflammatory processes and bone destruction increase the burden of disease by causing a loss of mobility due to pain. As treatment is often prolonged it is an important issue for both the quality of life of affected patients and a burden on the resources of the healthcare system. The anatomical characteristics of the foot make it difficult to draw diagnostic conclusions by physical examination only. These diagnostic gaps in the remaining rheumatological questions can often be answered by ultrasound examination of the joint.

New onset or exacerbation of psoriatic skin lesions in patients with definite rheumatoid arthritis receiving tumour necrosis factor alpha antagonists.

BACKGROUND: Blockage of tumour necrosis factor alpha (TNFalpha) is highly effective in rheumatic diseases, especially in rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis. Furthermore, TNFalpha antagonists have also been shown to significantly reduce psoriatic skin lesions. CASE REPORTS: A series of nine patients with RA who were treated with different types of TNFalpha antagonists and who unexpectedly developed either a new onset or an exacerbation of psoriatic skin lesions are reported.

[Circulating CD8 as an indicator of inflammatory rheumatic disease]. / Zirkulierendes CD8 als Aktivitätsparameter bei entzündlich-rheumatischen Erkrankungen.

An enzyme-linked immunoassay detecting soluble CD8 (s-CD8) was applied to study activation of CD8(+)-(suppressor/cytotoxic) T-cells in patients with rheumatic diseases. Compared with normals, s-CD8 levels were elevated in patients with rheumatoid arthritis, ankylosing spondylitis, and polymyositis. In contrast, low s-CD8 values were observed in patients with progressive systemic sclerosis/scleroderma. In systemic lupus erythematosus (SLE), s-CD8 values were correlated with C-reactive protein. This finding and an association with other parameters of clinical activity were confirmed by longitudinal studies. In summary, our findings support the view that implication of CD8(+)-T-cell activation is different in the pathogenesis of each rheumatic disease. Elevated s-CD8 indicates active disease, and can be used to monitor CD8(+)-T-cell activation in SLE while determination of s-CD8 seems to be of little clinical value in the other rheumatic diseases studied.

[T-helper cell subsets in patients with inflammatory rheumatic diseases undergoing immunosuppressive therapy]. / T-Helferzell-Subpopulationen von Patienten mit entzündlich-rheumatischen Erkrankungen unter immunsuppressiver Therapie.

To determine the influence of immunosuppressive therapy on T-helper-cell subsets in patients with systemic lupus erythematosus and rheumatoid arthritis flow cytometric analysis was performed. Longitudinal studies showed reduced numbers of CD45R+CD4+ lymphocytes in patients treated with cyclophosphamide or azathioprine. Patients receiving steroids had low frequencies of CD29+CD4+ cells. The data suggest that cytotoxic drugs and steroids affect T-helper cells at different activation stages.

[Hemodynamic and lung function analytic findings in so-called collagen diseases]. / Hämodynamische und lungenfunktionsanalytische Befunde bei sogenannten Kollagenosen.

Twenty-four patients with connective tissue disease as defined by ARA criteria were submitted to a thorough cardiological and pulmonary diagnostic evaluation. Mean pulmonary arterial pressure was elevated in 54 per cent of the patients, a left-ventricular functional disorder taking the form of elevated pulmonary capillary occlusive pressure was almost equally as frequent. Interindividual comparisons suggest only a low progressivity of the cardiac involvement, while pulmonary involvement progresses rapidly, to become the prognostically predominating factor. This suspicion must be checked by performing follow-up examinations with repeated cath. examinations of the right heart in individual patients. In common with ACE determinations, haemodynamically effective pericardial disorders are of no significance in connective tissue diseases. Patients with "collagenosis" should be submitted to right-heart catheterisation early on. Attempts at therapy taking the form of aggressive treatment of the underlying disease or administration of nitrates or calcium antagonists, would appear meaningful.

[Polyclonal activated circulating B-lymphocytes in patients with rheumatoid arthritis]. / Polyklonal aktivierte zirkulierende B-Lymphozyten bei Patienten mit rheumatoider Arthritis.

Peripheral B lymphocytes were studied to investigate the role of polyclonal B-cell activation in the pathogenesis of rheumatoid arthritis (RA). Proliferative responses to anti-mu antibodies coupled to sepharose used as a B-cell-specific mitogen were reduced as compared to healthy controls. When cell surface antigens were studied by flow cytometry employing monoclonal antibodies, B cells from patients with RA showed enhanced expression of Interleukin-2 (IL-2) receptor. In-vivo-activated, in-vitro spontaneously proliferating Epstein-Barr virus transformed B cells positive for immunoglobulin M, G, and A were obtained from patients with RA. In summary, our findings suggest the presence of polyclonal activated B cells in the peripheral blood of patients with RA, and a close relationship of polyclonal activated B cells and the activity of the disease process.