The predictive value of the HLA shared epitope for severity of radiological joint damage in patients with rheumatoid arthritis. A 10 year observational prospective study.

OBJECTIVE: To evaluate the clinical importance of the RA "shared epitope" (SE) as a prognostic marker of radiological severity and extension of the disease to large joints in patients with rheumatoid arthritis (RA). METHODS: Eighty-two patients who met the American College of Rheumatology criteria for RA with a disease duration < 2 years at presentation were included in the study. Radiographs of hands, wrists, feet, shoulders, elbows, hips, and knees were taken at study entry and 8-10 years later. HLA-DRB1 genotypes were determined by polymerase chain reaction-sequence-specific oligonucleotide probes. Radiological severity was assessed in small joints of hands, wrists, and feet. Extension of the disease to large joints was evaluated in radiographs of shoulders, elbows, hips, and knees. RESULTS: At the end of the study, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) titer, and percentage of maximum radiological score at baseline were significantly associated with RA severity (p < 0.01, p < 0.01, p < 0.05, respectively). Extension of RA to large joints was related to a higher ESR (p < 0.001) and a lower hemoglobin level (p < 0.01) at baseline. Neither at entry nor at the end of the study was the RA shared epitope predictive for radiologic severity or extension of disease to large joints (p = 0.8, p = 0.3, respectively). CONCLUSION: Presence of the SE in patients with RA is not a good prognostic marker of radiological severity after a mean followup period of 9 years.

Comparison of tenoxicam and bromazepan in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled trial.

Fibromyalgia is a painful syndrome of non-articular origin, predominantly involving muscles, and the commonest cause of chronic widespread musculoskeletal pain. The diversity of therapeutic programs for patients with fibromyalgia reflects both the lack of a known pathophysiology for this disorder and the low efficacy of the current therapies. We studied the efficacy of tenoxicam and bromazepan in the treatment of patients with fibromyalgia. One hundred and sixty-four patients from our Rheumatology Outpatient Clinic fulfilling the American College of Rheumatology criteria for the classification of fibromyalgia, with widespread pain at study entry. Each of the 164 patients was randomly assigned to 1 of 4 treatment groups: double placebo (P), tenoxicam (20 mg) + placebo (T), bromazepan (3 mg) + placebo (B)m or tenoxicam (20 mg) + bromazepan 3 mg (TB). Patient global assessment of disease, pain, sleep quality, morning stiffness, and number of tender points were evaluated at baseline and 8 weeks afterwards. At the end of the trial, 17%, 10%, 12%, and 29% of the P, T, B, and TB patients, respectively, had clinical improvement. A statistically significant difference was found only between the T and TB groups. Our data indicate that treatment with tenoxicam + bromazepan can be effective for some patients with fibromyalgia, but the differences with the placebo group were neither clinically nor statistically significant.

Mixed systemic amyloidosis in a patient receiving long term haemodialysis.

A 64 year old woman had been receiving haemodialysis for 11 years. She had a history of chronic renal failure, caused by probable chronic pyelonephritis, and dialysis arthropathy. She died of acute pulmonary oedema and haemorrhage. At necropsy, histological, immunohistochemical, and ultrastructural studies showed widespread visceral deposits of beta 2-microglobulin (beta 2-M) and AA amyloid.

Pseudotumoral amyloidosis of beta 2-microglobulin origin in the buttock of a patient receiving long term haemodialysis.

A 52 year old man who had been receiving haemodialysis for 13 years, with a history of renal tuberculosis, right ischial tuberculous osteomyelitis, and dialysis arthropathy, developed a soft tissue tumour in his left buttock. Histological analysis, immunohistological staining, and electron microscopic examination of the surgically removed tumour showed massive deposits of beta 2-microglobulin (beta 2-M) amyloid. This case shows the expanding clinical spectrum of this type of amyloidosis, and it is suggested that amyloid infiltration should be considered in the differential diagnosis of gluteal tumours in these patients.

[Clinico-radiological correlation of the dorsal spine in a population of workers]. / Corrélation clinico-radiologique du rachis dorsal dans une population ouvrière.

A prospective study of the dorsal spine was done in 337 workers chosen at random, in the aim of determining whether there was a clinical and radiological correlation, and the possible influence of the type and duration of work done on the appearance of the disorders. The series was composed of 265 men (19-63 years old) and 72 women (27-63 years old). Thirty-five per cent of the overall series complained of dorsal pain (53% in the women, 30% in the men). In one third of cases, the problems lead to work stoppage, and about 8% had to change jobs. Sixty-six per cent of the overall group showed some radiological change, without there being a significanct difference between the two clinical groups. Sixty-two point five per cent of the symptomatic group showed some radiological change. The presence of dysplasia, static changes and arthroses was observed in similar percentages in the symptomatic and asymptomatic groups. The exercise index has no relation with the symptoms since it was very similar in the two groups. The individuals with an above-average exercise index showed a higher incidence of arthrosis, but only in the group of men more than forty years old (this was statistically significant). As was to be expected, the incidence of arthrosis increases with age, without a difference between the two groups. Arthrosis was much more frequent in cases of major vertebral dysplasia (cuneiform or trapezoid vertebra), 56% of cases, than in those with minimal dysplasia (Schmorl's nodule, irregularities of the apexes), 24%, and in cases of dysplasia, 29%.