Increase in the expression of alpha E beta 7, characteristic of intestinal intraepithelial lymphocytes, on T cells in the lung epithelium of patients with interstitial lung diseases and in synovial fluid of patients with rheumatic diseases.

The intestinal epithelium contains a distinct group of lymphocytes (iIEL). The majority of iIEL are T cells characterized by a phenotype different from PBL. This phenotypic peculiarity has led to the hypothesis that iIEL, develop in a thymus-independent fashion, that they may develop locally in the gut epithelium itself and that they have the distinct function of providing a first line of defense in the gut. We looked at the expression of the gut-associated surface molecule alpha E beta 7 on T cells in inflamed tissues outside the gut epithelium. The already high frequency of 41.8% alpha E beta 7+ T cells in bronchoalveolar lavage from healthy lungs rises to a median of 61% in a fibrotic lung. In synovial fluid the percentage of T cells expressing alpha E beta 7 was diverse; it was not as high as in the lung but was elevated compared to PBL levels. In both tissues, the increase in alpha E beta 7 expression correlated with an increase in CD8+ cells. We discuss our data in the context of a model in which iIEL can leave the gut epithelium and become involved in inflammatory processes, possibly related to autoimmune disease.

Oral type II collagen treatment in early rheumatoid arthritis. A double-blind, placebo-controlled, randomized trial.

OBJECTIVE: To investigate the efficacy of oral type II collagen in the treatment of early rheumatoid arthritis (RA). METHODS: Ninety patients with RA (disease duration < or = 3 years) were treated for 12 weeks with oral bovine type II collagen at 1 mg/day (n = 30) or 10 mg/day (n = 30) or with placebo (n = 30), in a double-blind randomized study. RESULTS: There were no significant difference between the 3 groups in terms of response to treatment. However, we observed a higher prevalence of responders in the type II collagen-treated groups: 7 responders in the 10-mg type II collagen group and 6 in the 1-mg group, versus 4 in the placebo group. Furthermore, 3 patients in the 10-mg type II collagen group and 1 patient in the 1-mg type II group, but no patients in the placebo group, had very good response. A total of 14 patients had to be withdrawn from the study: 2 because of side effects (nausea) and 12 because of lack of efficacy. CONCLUSION: Only a minority of patients responded to treatment with oral type II collagen. These results justify further efforts to identify which patients will have good response to such therapy.

[Psoriasis arthropathica and seronegative rheumatoid arthritis--differential diagnostic considerations]. / Die Psoriasis arthropathica und die seronegative Rheumatoid-Arthritis--Differentialdiagnostische Erwägungen.

For differential-diagnostic considerations concerning seronegative arthritides two groups of patients with 25 patients each of the disease groups psoriasis arthropathica and serologically negative rheumatoid arthritis were selected. The differentiation of the two diseases was performed by clinical, paraclinical and radiological findings. When there are no typical psoriatic changes of skin and/or nails and there is an empty family anamnesis concerning this dermatosis, respectively, the coordination of seronegative arthritides is considerably rendered more difficult. Here the radiomorphological investigations particularly of the sacroiliacal joint and/or of the spine essentially contribute, since the arthritis of the sacroiliacal joint is to seen in high incidence in psoriasis arthropathica. Out of the number of the paraclinical values the determination of the complement factor C 4 and of immunoglobulin M gets the importance of a sign of differentiation, in which case C 4 in the psoriasis arthropathica and the immunoglobulin M in the seronegative rheumatoid arthritis are statistically significantly increased. The problems of the often difficult differential diagnosis between the two groups of disease can be clarified only by complex clinical examinations, paraclinical parameters and subtile radiodiagnosis. A close interdisciplinary cooperation between experienced dermatologists, rheumatologists and radiologists seems reasonable.

Diclofenac and piroxicam in a double-blind trial results and methodological problems. Working Party of the Society for Rheumatology of the GDR for the Testing of Anti-rheumatic Drugs.

Diclofenac (150 mg/d) and piroxicam (20 mg/d) were compared in a cross-over trial with 12-day periods of double-blind treatment and 3-day wash-out periods. The following open phase of the trial lasted for two months and served to assess the tolerance. For this the dosage of diclofenac was reduced to 100 mg/d. 134 volunteers from 5 departments of rheumatology participated in the study. Statistical analysis showed that the two groups were of homogenous composition and that--with certain limitations--the necessary assumptions for the evaluation as a cross-over experiment were fulfilled. All tests used to determine the efficacy showed approximately parallel improvement with both formulations and in the wash-out phase this was followed by marked deterioration. The sum of the parameters for individual improvement showed a tendency in favour of piroxicam. However, clear superiority of one trial formulation over the other with respect to efficacy or tolerance could not be demonstrated by the statistical analysis.

[Hematotoxic lesions caused by non-steroidal antirheumatic agents]. / Hämatotoxische Schäden durch nichtsteroidale Antirheumatika.

Among the lesions of haematopoiesis conditioned by medicaments the lesions by non-steroidal antirheumatic drugs occupy the first place. They get their significance by the fact that they are not so infrequently irreparable and thus show an unfavourable prognosis. On principle in pathogenetic respect lesions by immunologic reactions which vastly do not depend on the dosage, are to be demarcated from the toxically conditioned side-effects which depend on dosage. Conditioned by drugs aplastic syndromes of the bone marrow are not in every case strongly depending on dosage. For this is to be assumed an individual, particular sensitivity of the haematopoietic stem cells (stem cell defect). Of the anti-rheumatic drugs used for the basic therapy chloroquine derivations, gold, D-penicillamine, immunosuppressives and levamisol may effect disturbances of the haematopoiesis, for which facts are examples are given. This concerns also the symptomatically acting antirheumatic drugs. An overestimation of rare side-effects of drugs should not block the application of certain medicaments, however, they should be given only in such a high dosage as it is necessary. In combinations of antirheumatic drugs every individual drug is considered as causative factor. Interactions are particularly be taken into consideration. Control programmes, particularly with certain laboratory parameters, give the early recognition of side-effects and render possible to avoid severe effects.

[Arteriitis temporalis--a major disease developing in advance age (author's transl)]. / Die Arteriitis temporalis--eine bedeutsame Erkrankung des höheren Lebensalters.

Arteriitis temporalis, a disease that was largely unknown in the early fifties, has gained importance in recent years. In the past ten years 32 patients suffering from arteriitis temporalis were diagnosed and treated both in the eye hospital and in the rheumatic-cardiological hospital of the Berlin-Buch Municipal Hospital. The following clinical findings were essential for the diagnosis: advanced or old age of the patient, massive headache in the temporal and/or occipital regions, myalgia primarily in the shoulders and the neck that responded relatively poorly to treatment, reduced eyesight, loss of weight and decrease in vitality. Extremely high BSR, an increased amount of alpha-2 and an increased level of alkaline phosphatase were most important among the laboratory findings. Corticosteroids have proved to be the medicine of choice for treating this condition.

[Acute courses of sarcoidosis which clinically appeared as rheumatic diseases (author's transl)]. / Akute Verläufe der Sarkoidose unter dem Klinischen Bild einer rheumatischen Erkrankung

After a short review on the manifold relations between rheumatic and pulmonary diseases this aspect is exemplified in detail by acute sarcoidosis. Report on 31 patients with Loefgren-Syndrome, admitted to the rheumatologic-cardiological clinic between 1968 to 1973, nearly all with the suspicion of rheumatic fever. Their symptoms, clinical findings as well as the diagnostic programme carried out is described.