Infectious arthritis in patients with rheumatoid arthritis.

Eleven cases of infectious arthritis occurring in patients with rheumatoid arthritis are reported. Staphylococcus aureus was the causative organism in eight patients. Streptococcus anginosus and Streptococcus agalactiae in one patient each, and Mycobacterium tuberculosis in two patients. The mean duration of symptoms before diagnosis was 16 days in patients with pyogenic arthritis. The diagnosis of joint infection caused by Mycobacterium tuberculosis was especially delayed (57 days). Four patients died; they were found to have a longer time to diagnosis and two of them had multiple joint infection. Although Staphylococcus aureus is the microorganism most often affecting patients with rheumatoid arthritis, infection caused by Mycobacterium tuberculosis must also be considered in such patients.     

Gallstones in patients with rheumatoid arthritis.

OBJECTIVE: We performed abdominal ultrasonography (US) on patients with rheumatoid arthritis (RA) to investigate the frequency and characteristics of gallstones (GS). METHODS: Patients with RA (n = 224; 42 male and 182 female) underwent abdominal US. RESULTS: The incidence of GS (including post-chorecystectomy patients) was significantly higher in female patients with RA (15.4%) than in female controls (5.2%, p < 0.01). There was no significant difference in GS incidence between male patients with RA (9.5%) and male controls (3.8%). The percentage of cholesterol stones was 100% in patients with RA with GS but only 66.7% in controls with GS (p < 0.01). Compared to patients with RA without GS, patients with RA with GS were older and had lower C-reactive protein levels, a decreased creatinine clearance and urinary calcium excretion, and an increased incidence of hypercholesterolemia. CONCLUSION: We observed a high incidence of GS in female patients with RA. With our previous observation of a high incidence of renal stones in patients with RA, these results suggest the importance of US as a diagnostic tool in the management of RA.     

Antibodies to DNA in patients with rheumatoid arthritis and juvenile rheumatoid arthritis.

Antibodies to double-stranded DNA (DSDNA) were found in 18 patients with RA, in 5 patients with JRA, and in 5 patients with undiagnosed connective tissue disease. Five patients had clinical features consistent with both RA and SLE, 11 with only RA, and 5 with only JRA. Based on these observations, the presence of serum anti-DSDNA antibodies should not be used as a sole criterion in the diagnosis of SLE.     

Nutritional status in patients with rheumatoid arthritis.

A nutritional assessment of 50 patients with rheumatoid arthritis (RA) showed evidence of malnutrition in 13 (26%), while all 50 control subjects had normal nutritional status. Of the anthropometric measurements the body-mass index and triceps skinfold thickness values in men and women were significantly reduced in RA patients compared with controls. Upper arm muscle circumference was significantly less in male but not female rheumatoid patients. In addition all six biochemical determinants of nutrition assayed-serum albumin, transferrin, retinol-binding protein, thyroxine-binding prealbumin, zinc, and folic acid-were significantly lower in the RA group of patients. Malnourished patients had more active disease than the remaining RA patients, with significantly higher ESR, C-reactive protein, and alpha 1 antichymotrypsin measurements. Significant inverse correlations were found between some biochemical measurements of nutrition and indices of disease activity. Our results suggest that in RA the severity of disease adversely affects the nutritional status.     

Pulmonary involvement in patients with rheumatoid arthritis.

Vital capacity (VC) and single-breath diffusing capacity for carbon monoxide of the lungs (Dco) were measured and chest X-ray evaluated in 129 patients with rheumatoid arthritis (RA). 123 of them represented average RA patients, either hospitalized (84 patients, Group I) or outpatient material (39 patients, Group II). The remaining six patients (Group III) represented cases with marked changes in chest X-ray detected in an earlier study. Deviating findings in the 123 cases of Groups I and II were observed as follows: in one the lung function tests or X-ray examinations, 35%; abnormal X-rays, 18%; reduced VC or Dco, 28%; simultaneously low VC and Dco, 7%; and pathological findings in all three tests, 2%. Group III showed extremely low VC and Dco values. Changes in respiratory function involved restrictive impairment and diffusion defects, and the results further implied that restrictive changes develop early, whereas decreased diffusing capacity is associated with more advanced "rheumatoid lung". The disparity abnormal findings in chest X-ray changes and in lung function tests suggests that in examining pulmonary manifestations in patients witu RA, both radiographic methods and pulmonary function tests should be used for relevant evaluation.     

Serum pyridoxal in patients with rheumatoid arthritis.

Abnormalities of tryptophan metabolism have been reported in patients with rheumatoid arthritis (RA) and it has been suggested that these abnormalities are the result of disordered vitamin B6 metabolism. Fasting serum pyridoxal, assayed by an automated microbiological system, was found to be below normal in 35 out of 42 patients with RA while a similar abnormality was found in 8 out of 35 patients with osteoarthrosis (OA). Within the RA group the abnormality could not be related to the age, sex, or drug therapy of individuals but of the 8 patients with OA and a low serum pyridoxal, 7 were receiving indomethacin either alone or in conjunction with aspirin.     

Erythropoietin in patients with anaemia in rheumatoid arthritis.

Iron status and erythropoietin (Ep) level in serum and urine were determined in 30 patients with anaemia in rheumatoid arthritis. The anaemia in these patients was mild and fulfilled the criteria for anaemia of chronic disorders. The iron status of these patients differed from the iron status in patients with sideropenic anaemia. Serum Ep, level, measured indirectly by the polycythaemic mouse bioassay, was either not detected or when detected it did not correspond to the degree of anaemia. The data suggest that the failure to produce sufficient amount of Ep, among other causes, could be important in the pathogenesis of anaemia in rheumatoid arthritis.     

Microalbuminuria: A marker of severe disease activity in rheumatoid arthritis

ObjectiveMicroalbuminuria is associated with increased risk for renal and cardiovascular mortality and morbidity in diabetes mellitus, hypertension, patients with acute myocardial infarction and elderly patients but the significance of microalbuminuria in rheumatoid arthritis and its correlation with disease activity is not well studied. The present study is therefore aimed to determine the microalbuminuria in rheumatoid arthritis patients and to correlate it with indicators of disease activity like CRP and ESR.MethodsHundred confirmed cases of Rheumatoid arthritis (2010 ACR-EULAR criteria) and hundred age and sex matched controls were taken. Those suffering from hypertension, diabetes mellitus and renal disease were excluded. Microalbumin was assessed by immunoturbidimetric method on Delta nephelometer. Disease activity was assessed by CRP and ESR.ResultsThe relative frequency of microalbuminuria in patients with rheumatoid arthritis was 26% as compared to 4% in controls. The median level of microalbuminuria in rheumatoid arthritis patients was significantly greater than in the controls (17 vs. 3.29, p < 0.01). Microalbuminuria significantly correlated with CRP (p < 0.001, r = 0.457) and ESR (p < 0.001, r = 0.361). A significant correlation was found with duration of disease (p < 0.05, r = 0.231) and number of joints involved (p < 0.05, r = 0.240).ConclusionsWe found increased prevalence of microalbuminuria in rheumatoid arthritis patients and it correlated with acute phase reactants.     

Serum osteocalcin concentrations in patients with rheumatoid arthritis.

Osteocalcin is a non-collagenous bone matrix protein which is released into the circulation and can be measured by radioimmunoassay. Recent studies indicate that serum osteocalcin concentrations are a marker of bone formation. Because bone demineralisation is a common finding in patients with rheumatoid arthritis (RA) the serum osteocalcin concentrations and, in addition, the serum concentrations of 25-hydroxyvitamin D, parathyroid hormone, and calcitonin were measured in 29 patients with RA and in 30 control subjects. Whereas serum osteocalcin concentrations were similar in patients with RA and in control subjects, serum 25-hydroxyvitamin D concentrations were significantly decreased in patients with RA. Serum concentrations of parathyroid hormone and calcitonin in patients with RA and in control subjects were not statistically different. The normal osteocalcin concentrations in patients with RA suggest a normal rate of bone formation in these patients.