Benefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis: A systematic literature review.

The aim of this study was to systematically review the literature available about the benefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis in the framework of the drawing up of the axial spondyloarthritis and psoriatic arthritis guidelines of the "Spanish Society of Rheumatology". Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, Medline/PubMed, CINAHL) were systematically searched from inception to 2014 using medical subject headings and keywords. Only articles in English, Spanish and French were included. The patients studied had to be diagnosed of psoriatic arthritis (all ages, both sexes) with axial involvement and/or peripheral arthritis who had received health education by a specialized nurse. We included in the search randomized clinical trials, cohort observational studies, descriptive studies and case series and qualitative research studies. Measured outcomes were those related to the education provided in a nursing consultation such as increased adherence to biological therapy, conducting exercises, smoking cessation and patient satisfaction. Eight studies were included, five randomized clinical trials with moderate level of quality and three intervention studies with no control group with low level of quality. Meta-analyses were not undertaken due to clinical heterogeneity. According to our results, it can be concluded that although there is little evidence on the role of a trained nurse in patients with psoriatic arthritis, this role can be beneficial to the patients because it can increase the rate of adherence to treatment prescribed by a rheumatologist, promotes patient self-management of their disease and increases patient satisfaction.

Nodular pulmonary amyloidosis in a patient with rheumatoid arthritis.

We describe a 67-year-old white woman with a long-standing active rheumatoid arthritis who refused treatment. Chest roentgenograms performed in 2000 revealed a pulmonary nodule in the mid-left lung. Progression of the nodule was followed annually by computerized tomography (CT). In the last CT in 2002, we observed multiple nodules in both lungs in the absence of lymph gland involvement. The patient was operated by video-thoracoscopy to resect one of the pulmonary nodules. Pathological examination of the excised tissue revealed amyloid A-type (AA) amyloidosis. Although pulmonary amyloidosis is rare in patients with systemic AA amyloidosis, we recommend that this possibility be considered when confronted with a patient with these characteristics.

Small ampullate glands of Nephila clavipes.

The small ampullate glands of the orb-web spider, Nephila clavipes, have been studied and compared to other of the silk producing glands from this organism. They exhibit the same gross morphological features of the other glands. Electrophoretic analyses show that the gland's luminal contents migrate as a single band, while the contents of the secretory epithelium reveal a step-ladder array of peptides in addition to the full size product. Previous studies from our laboratory identified these peptides as products generated by translational pauses. This alternate mode of translation is typical of fibroin synthesis in all the spider glands thus far studied as well as in those of the silkworm. The correlation of the peptides to the process of fibroin synthesis is shown through experimental evidence in this paper. The gradual ultrastructural changes in Golgi vesicles elicited by the fibroin synthesis stimulus can be seen in this paper. The response to stimulation is of a higher magnitude in these glands than in any of those previously analyzed. These studies show the small ampullate glands are a promising and certainly exploitable model system for studies on the synthesis of tissue-specific protein product and its control. J. Exp. Zool. 286:114-119, 2000.

A spider tRNA(Ala) requires a far upstream sequence element for expression.

Within the series of timed differential accumulations of small RNAs we have shown to prelude the synthesis of fibroin in the large ampullate glands of Nephila clavipes (Nc), we are currently directing our attention to the alanine tRNAs. This work reports the subcloning of the members of a tRNAAla gene cluster and the optimization of their transcription in a heterologous cell-free system derived from Bombyx mori (Bm) silkglands. Our data show that the heterologous cell-free system supports the faithful and differential transcription of the individual spider alanine tRNA genes. We are thus making use of the extract to characterize the individual genes with respect to flank-contained regulatory elements through cell-free transcription of gene derivatives. The work has been initiated with pNTA3 because of its high transcriptional activity. Interestingly, the transcription of this gene requires a far upstream sequence, an uncommon modality in tRNA genes.

Perforation of the sigmoid colon in a rheumatoid arthritis patient treated with methylprednisolone pulses.

We describe a 61 year-old caucasian male diagnosed with rheumatoid arthritis. He was started on methylprednisolone pulses because of a severe flare of symmetric polyarthritis while he was on weekly intramuscular methotrexate and low-dose oral prednisone. After the second pulse of methylprednisolone the patient suddenly developed severe abdominal pain with free air under the right hemidiaphragm in the chest roentgenogram. The emergency surgery revealed the perforation of a colonic diverticulum. We suggest that methylprednisolone pulses should be carefully used in those patients over 50 years of age and/or people with demonstrated or suspected diverticular disease.

An alanine tRNA gene cluster from Nephila clavipes.

We report the sequence of a 2.3-kb genomic DNA fragment from the orb-web spider, Nephila clavipes (Nc). The fragment contains four regions of high homology to tRNA(Ala). The members of this irregularly spaced cluster of genes are oriented in the same direction and have the same anticodon (GCA), but their sequence differs at several positions. Initiation and termination signals, as well as consensus intragenic promoter sequences characteristic of tRNA genes, have been identified in all genes. tRNA(Ala) are involved in the regulation of the fibroin synthesis in the large ampullate Nc glands.

Flagelliform or coronata glands of Nephila clavipes.

The flagelliform or coronata glands of the orb-web spider, Nephila clavipes, have been studied and compared to other silk-producing glands from the organism. The glands, which produce silk for the double filament of the core thread in the sticky spiral, exhibit three distinct morphological areas: tail, sac, and duct. Electrophoretic separation of the solubilized contents of the glands yields an uppermost diffuse band of high molecular size, preceded by a stepladder of well-defined peptides, which have been shown to be products of discontinuous translation in three other sets of glands. The luminal contents do not migrate as a discrete and well-defined band as those of the other glands, but rather as a diffuse area, typical of glycosylated proteins. Fibroin synthesis is stimulated by the mechanical depletion of the organism's stored silks, as in other Nephila glands, judged by the increased intensity of the bands and also by the structural alterations seen in cross sections of the glands' tails.

Prelude activities in the synthesis of tissue-specific secretory protein products.

In studying the process of protein synthesis of a silk-producing organism we have found that several macromolecules must be synthesized in order for the process to occur. Through time course studies, we have found that small RNAs may play a paramount role in directing the finely orchestrated process. Alanine tRNA, U1 snRNA, and 5S RNA have been identified through Northern blotting as molecules timely and tissue-specific synthesized and upgraded as a prelude activity for the silk being produced.

Stimulation of fibroin synthesis elicits ultrastructural modifications in spider silk secretory cells.

Electron microscopic studies of unstimulated and stimulated spider fibroin glands show that the fibroin synthesis stimulus evokes visible changes in both the endoplasmic reticulum and Golgi apparatus of their secretory epithelium. Gradual increase in distension of the reticulum accompanies the increase of evoked fibroin synthetic activity. The flattened translucent Golgi vesicles, seen in inactive cells, display a gradual increase in size and number, also with time. The stimulation also elicits a gradual transition in the gland's luminal membrane, during which the microvilli on the lining gradually disappear acquiring an electron dense appearance. Correlations of the observed transitions to the gland's increase in rate of elicited synthetic activity are discussed. The parallelisms between the ultrastructural modifications observed in the spider secretory cells with those described in the silkworm glands during their progression through the fifth instar have been stressed.

Spider silkglands contain a tissue-specific alanine tRNA that accumulates in vitro in response to the stimulus for silk protein synthesis.

The large ampullate glands of the orb-web spider, Nephila clavipes provide massive amounts of fibroin throughout the lifetime of the adult female. We have developed methods to culture the glands and manipulate their biosynthetic activity. This has allowed us to monitor a series of molecular events that precede silk production in glands excised from appropriately stimulated animals. In this paper, we demonstrate that prior to the transient dramatic production of fibroin, such glands accumulate large amounts of tRNAs cognate to the abundant amino acids in spider silk. One of these, alanine tRNA, appears to consist of two isoaccepting forms--one constitutive, and the other silkgland specific. Moreover, the silkgland-specific form appears to accumulate preferentially in response to stimulation. This phenomenon of tissue-specific tRNA production appears similar to that found in the silkglands of Bombyx mori, but the spider system has the unique property of permitting manipulation in vitro. Thus, it provides an unusual opportunity to study the mechanism of regulated tRNA synthesis.

Features of the cell-free translation of a spider fibroin mRNA.

The massive production of fibroin by the large ampullate glands of the spider, Nephila clavipes, serves as a model system in which to study the synthesis and control of a large secretory protein. Their tissue-specific product, fibroin, produced during the entire adult life of the female, is approximately 320 kilodaltons, and rich in glycine and alanine. Highly purified fibroin mRNA from the glands has been translated in a rabbit reticulocyte cell-free system with variable supplements. The translational products analyzed by SDS-PAGE display two features, tRNA modulation and discontinuous pauses during elongation. tRNA complements exert their effects both in the translational efficiency and in the size of the peptides generated. The pauses observed during translation generate subsets of smaller discrete peptides, visualized in the gels as ladders of variable relative intensities, appearing exclusively and concomitantly with the fibroin. Definitive linkage between the discrete peptides and fibroin synthesis process has been established by their selective labeling with specific radioactive amino acids.

The cylindrical or tubiliform glands of Nephila clavipes.

The cylindrical or tubiliform glands of the spider Nephila clavipes have been studied and compared to the large ampullates on which we have previously reported. The three pairs of cylindrical or tubiliform glands secrete the fibroin for the organism's egg case. Their solubilized luminar contents migrate as a homogeneous band in Sodium dodecyl sulfate polyacrylamide gel electrophoresis and turn out to be a larger protein than that produced by the large ampullates. The excised cylindrical glands remain metabolically active for several hours in a simple culture medium, where fibroin synthesis can be monitored through the incorporation of 14C alanine. The glands' response to a fibroin production stimulus does not reach the magnitude displayed by the large ampullates, but this is to be expected since their products supply different functions in this organism. This fibroin also seems to be elongated discontinuously. Translational pauses have been detected in the secretory epithelium of cylindrical and large ampullate glands of Nephila as well as in the silk glands of Bombyx mori. Since these glands produce the fibroin for the females egg case, they should prove to be an interesting model system.

Translational pauses during a spider fibroin synthesis.

The large ampullate glands of Nephila clavipes synthesize a tissue-specific fibroin for the web and dragline. Its secretory product migrates as one homogeneous band of approximately 320,000 daltons in denaturing electrophoresis. Similar analyses of the secretory epithelium reveal, in addition to the final product, a step ladder array of peptides in a highly reproducible and consistent pattern. We have correlated these peptide ladders with the process of fibroin synthesis. First, the peptides are very prominent in stimulated glands and quite dim in non stimulated ones. Secondly, by offering the cultured glands different amino acids in the incubating medium, we have linked the presence of the bands with those amino acids which abound in the fibroin. The evidence correlates the peptides with active fibroin synthesis, thus they are products of translation, and possibly reflect discontinuities in the translational process such as those demonstrated during the synthesis of Bombyx fibroin.

Discontinuous translation of silk fibroin in a reticulocyte cell-free system and in intact silk gland cells.

Silk fibroin mRNA was translated in a rabbit reticulocyte cell-free system. Addition of tRNA from silk glands was essential for complete translation of the fibroin polypeptide. (Mr approximately 400,000). Synthesis of full-sized product took at least 85 min. In addition to full-size product, a large number of smaller polypeptides were observed upon analysis by sodium dodecyl sulfate/polyacrylamide gel electrophoresis. Evidence is presented that these smaller polypeptides are growing fibroin chains that transiently accumulate as discrete size classes due to discontinuities in the translation process. These discontinuities, or pauses, occur at specific sites in the fibroin mRNA template. The relative duration of the pauses can be experimentally modulated by changing the source of the supplementary tRNA added to the in vitro system. Silk glands were incubated in organ culture under conditions where essentially exclusive labeling of newly synthesized fibroins was attained. Analysis in sodium dodecyl sulfate gels showed that the labeling pattern of nascent silk fibroins is similar to the pattern observed in the reticulocyte cell-free system. This result suggests that discontinuities or pauses in polypeptide chain elongation also occur in vivo under conditions of organ culture.