Echocardiographic diastolic abnormalities of the left ventricle in inflammatory joint disease.

Echocardiographic early diastolic abnormalities have been shown recently in 50% of men with ankylosing spondylitis. Similar techniques were used to investigate subjects with rheumatoid arthritis and psoriatic arthritis with or without spondylitis. These subjects had no clinical, radiographic, or electrocardiographic evidence of cardiac or respiratory disease. Echocardiographic abnormalities seen resembled those of ankylosing spondylitis in that the interval between minimum left ventricular dimension and mitral valve opening was prolonged in 12 of 22 subjects with rheumatoid arthritis and in seven of 11 subjects with psoriatic arthritis. Isovolumic relaxation time was significantly prolonged in four subjects with rheumatoid arthritis and one with psoriatic arthritis. Unlike ankylosing spondylitis, however, there was consistent reduction in peak rate of left ventricular dimension increase in subjects with rheumatoid arthritis and psoriatic arthritis. In addition, the dimension increase during atrial systole was greater than normal in nine subjects with rheumatoid arthritis and two with psoriatic arthritis. The most likely cause of these abnormalities is increased connective tissue deposition in the myocardium.     

Ankylosing spondylitis with subsequent development of rheumatoid arthritis, Sj?gren's syndrome, and rheumatoid vasculitis

Twelve years after the onset of ankylosing spondylitis, a patient developed severe seropositive rheumatoid arthritis with subcutaneous nodules. This was subsequently complicated by Sj?gren's syndrome and rheumatoid vasculitis. The literature is reviewed, and the nature of the association between ankylosing spondylitis and rheumatoid arthritis is discussed.     

Comparative investigations on vitamin A level of plasma in some rheumatic diseases

Summary The vitamin A levels in the plasma of patients suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis, ankylosing hyperostosis (whether or not connected with diabetes) were investigated. Somatically healthy neurotic patients and patients suffering from diabetes without rheumatological problems served as controls. It was found that the retinol level of plasma decreased in patients of both sexes suffering from rheumatoid arthritis and clinically active ankylosing spondylitis, but increased in female patients suffering from ankylosing hyperostosis connected with diabetes, and also in the diabetes group. The retinyl-esters content of plasma dereased in the rheumatoid arthritis group and increased in female patients suffering from spondylosis and in the clinically inactive ankylosing spondylitis group. The total vitamin A content changed only in the rheumatoid arthritis group where a lower level was found compared to a somatically healthy control group.     

Acute-phase proteins and serum immunoglobulins in ankylosing spondylitis.

The erythrocyte sedimentation rate (ESR) and the serum acute-phase proteins (APP), C-reactive protein (CRP), fibrinogen, 9th component of complement (C9), and alpha, antitrypsin were measured on 231 occasions in 80 patients with ankylosing spondylitis and compared with those in 30 controls. APP levels did not correlate with clinical assessment of disease activity. However, there were significant correlations between CRP, C9, and fibrinogen (p = less than 0.01), suggesting that these APP may be more reliable indicators of disease activity. The mean values of the APP in those patients with a peripheral arthritis were significantly higher than in those with pelvospondylitis alone for ESR (p less than 0.01), CRP (p less than 0.01), and fibrinogen (p less than 0.05). The only significant difference between those patients with an iritis and those with only pelvospondylitis was an elevated CRP in the iritis group (p less than 0.01). This suggests that a peripheral arthritis is the most important cause of an elevated ESR or APP in ankylosing spondylitis. Serum immunoglobulins were also measured and they showed a significant elevation of IgA in all 3 patients groups, there being no difference between each group. Serum IgG was raised only in those patients with an iritis or peripheral arthritis, the IgM levels being within the normal range for all patient groups.     

Cell-mediated immunity to collagen and collagen α chains in rheumatoid arthritis and other rheumatic diseases

Peripheral blood mononuclear cells from patients with rheumatoid arthritis, gout, ankylosing spondylitis and degenerative joint disease were cultured in the presence of native types I, II and III collagens and α chains from each of these types of collagen. The culture supernatant fluids were harvested and assayed for lymphocyte-derived chemotactic factor for monocytes. Reactions to one or more of the native collagens was found in 50 per cent (10 of 20) of the patients with rheumatoid arthritis, 20 per cent (two of 10) of the patients with gout and ankylosing spondylitis but in none of the 10 patients with degenerative joint disease or in normal subjects. Reaction to one or more α chains was found in 90 per cent (18 of 20) of the patients with rheumatoid arthritis, 60 per cent (six of 10) of the patients with gout, 50 per cent (five of 10) of the patients with ankylosing spondylitis, 30 per cent (three of 10) of the patients with degenerative joint disease and in 10 per cent of the normal subjects (one of 10). All the reactions were quantitatively stronger in patients with rheumatoid arthritis. These results indicate that patients with rheumatoid arthritis have cell-mediated immunity to homologous native and denatured collagens but that the reaction is not specific for rheumatoid arthritis. Some patients with gout, ankylosing spondylitis and degenerative joint disease also have low levels of immunity.     

Histopathology of the synovial membrane of peripheral joints in ankylosing spondylitis.

The histological features of the synovial membrane of peripheral joints in ankylosing spondylitis are similar to those seen in rheumatoid arthritis. There is intimal cell hyperplasia, a diffuse lymphocyte and plasma cell infiltrate, and formation of lymphoid follicles. Peroxidase-antiperoxidase staining shows the presence of IgG-, IgA-, and IgM-containing plasma cells in ankylosing spondylitis. The percentage of IgM-containing cells is significantly lower in ankylosing spondylitis than in rheumatoid arthritis.     

Coexistence of ankylosing spondylitis and rheumatoid arthritis.

Ankylosing spondylitis and rheumatoid arthritis share many common features. However the presence of rheumatoid factor, histologically classic rheumatoid nodules, and the histocompatibility cell wall antigen (HLA-B27) helps distinguish one from the other. Two cases are reported in which these features established the coexisting diagnoses of ankylosing spondylitis and rheumatoid arthritis.     

Coexistence of ankylosing spondylitis and rheumatoid arthritis

Ankylosing spondylitis and rheumatoid arthritis share many common features. However the presence of rheumatoid factor, histologically classic rheumatoid nodules, and the histocompatibility cell wall antigen (HLA-B27) helps distinguish one from the other. Two cases are reported in which these features established the coexisting diagnoses of ankylosing spondylitis and rheumatoid arthritis.     

Diet and disease symptoms in rheumatic diseases — Results of a questionnaire based survey

Summary Experiences with food intake, diet manipulations and fast were registered in rheumatic patients. The study was a questionnaire-based survey in which 742 patients participated. It comprised 290 patients with rheumatoid arthritis, 51 patients with juvenile rheumatoid arthritis, 87 patients with ankylosing spondylitis, 51 patients with psoriatic arthropathy, 65 patients with primary fibromyalgia and 34 patients with osteoarthritis. One third of the patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthropathy reported aggravation of disease symptoms after intake of certain foods while 43% of the patients with juvenile rheumatoid arthritis and 42% of the patients with primary fibromyalgia stated the same. Twenty-six percent of the patients with juvenile rheumatoid arthritis and 23% of the patients with rheumatoid arthritis, ankylosing spondylitis and primary fibromyalgia had previously tried certain diets in the attempt to alleviate disease symptoms, whereas 13% of the patients with sporiatic arthropathy and 10% with osteoarthritis had tried diet therapy. Less pain and stiffness were reported by 46% of the patients and 36% reported reduced joint swelling. Similar beneficial effects of diet were also reported in other rheumatic disease groups. Fifteen percent of the patients with rheumatoid arthritis and ankylosing spondylitis had been through a fasting period. Less pain and stiffness were reported by 2/3 of the patients in both groups and half of the patients in both groups reported a reduced number of swollen joints.     

Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey

OBJECTIVE: To gain insight into patient experience of the disease course and health related quality of life during and after pregnancy in women with rheumatoid arthritis and ankylosing spondylitis. METHODS: 10 patients with rheumatoid arthritis, 10 patients with ankylosing spondylitis, and 29 age matched healthy pregnant controls were evaluated by the medical outcomes study short form 36 (SF-36) health survey once at each trimester and at 6, 12, and 24 weeks postpartum. A group of non-pregnant age matched female patients (40 rheumatoid arthritis, 16 ankylosing spondylitis) was studied for comparison. RESULTS: Impaired physical dimensions as well as increased bodily pain was observed in healthy women in late pregnancy. Patients with rheumatoid arthritis showed improved physical functioning scores in the second trimester and reduced pain in the third trimester. Among pregnant patients, those with ankylosing spondylitis suffered the greatest impairment of health related quality of life during pregnancy. In all patient groups the physical impairment in the third trimester was less pronounced than in healthy controls. Mental health scores remained stable even with persisting active disease during pregnancy, or with a postpartum flare. CONCLUSIONS: Pregnancy reduced physical functioning in healthy women and patients, but had no impact on mental and emotional health, even at times of disease aggravation. The pregnancy experience documented in our patients may be helpful when counselling patients contemplating pregnancy.     

Cellular hypersensitivity in rheumatoid arthritis,ankylosing spondylitis,and anterior nongranulomatous uveitis

The humoral and cellular responses to normal human ocular and joint tissue antigens were studied in rheumatoid arthritis, ankylosing spondylitis, and anterior non-granulomatous uveitis. No free-circulating autoantibodies could be detected by hemagglutination, immunodiffusion, and immunofluorescence. Uvea-retina, synovial membrane, and articular cartilage antigen preparations inhibited the migration of leukocytes from patients with rheumatoid arthritis. In ankylosing spondylitis inhibition could be induced only by synovial membrane antigens. Patients with anterior nongranulomatous uveitis were hypersensitive to uvea-retina antigens alone.     

The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter''s syndrome, and generalized osteoarthrosis.

This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus.     

Rheumatoid arthritis associated with ankylosing spondylitis defined by scintigraphic and CT abnormalities

Summary Rheumatoid arthritis and ankylosing spondylitis were detected in the same patient after a long period of observation of the disease. X-ray studies demonstrated the characteristic rheumatoid arthritis changes in peripheral joints. By contrast, few X-ray changes of ankylosing spondylitis were detected, during follow-up. Diagnostic approach through scintigraphic studies disclosed a symmetric uptake of the radionuclide in sacroiliac joints, and computed tomography revealed bilateral ankylosis. The combination of these tests was useful to define the presence of axial disease. This patient was both HLA B27 and DR4 positive. Rheumatoid arthritis occurred before ankylosing spondylitis, that interestingly was defined as a late onset disease.     

Demonstration of increased influenza-A-antibody levels in the serum of patients with chronic polyarthritis

Patients with rheumatoid arthritis show increased levels of anti-influenza-A antibodies in their sera compared to healthy controls and patients with other inflammatory rheumatic diseases (systemic lupus erythematosus, ankylosing spondylitis and psoriatic arthritis). These antibody levels are dependent on the activity of rheumatoid arthritis.     

Upward subluxation of the axis in ankylosing spondylitis. A clinical pathologic report.

Upward subluxation of the axis associated with cord compression and death was noted in a patient with a long history of idiopathic ankylosing spondylitis. Upward subluxation of the axis has been recognized in up to 8 per cent of patients with rheumatoid arthritis but it is an exceedingly rare complication of ankylosing spondylitis. In this patient psoriasis and then psoriatic dactylitis developed 26 years after the onset of his ankylosing spondylitis. It is tempting to speculate that the unusual destruction of the joints around the atlas might be due to an added effect of psoriasis on idiopathic ankylosing spondylitis.     

Gender,depression, and ankylosing spondylitis

Depression has been established as a common reaction to rheumatoid arthritis but has rarely beeninvestigated among people with other forms of arthritis. The present study examined the prevalence and determinants of depressive symptoms in people with ankylosing spondylitis, focusing on gender differences and set in the context of widely held medical views concerning the psychosocial nature of ankylosing spondylitis patients. Results showed that approximately one third of the ankylosing spondylitis patients reported a high level of depressive symptoms and that women reported more depression than men. No evidence was found to support the stereotype of the “typical” ankylosing spondylitis patient as being less depressed than people with other forms of arthritis. Pain was found to be a major determinant of depression for women, but was of lesser importance for men. The implications of these findings are discussed.     

COEXISTENCE OF RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS AND DERMATOMYOSITIS IN A PATIENT WITH DIABETES MELLITUS AND THE ASSOCIATED LINKED HLA ANTIGENS

A patient is described who had insulin-dependent diabetes mellitusfor 2 years, prior to developing rheumatoid arthritis and thensubsequently ankylosing spondylitis and dermatomyositis. Diagnosticcriteria for all diseases are fulfilled. HLA typing revealedthe presence of HLA A2, A9, B8, B27, DR3 and DR4 antigens. Theconcomitant coexistence of diabetes mellitus, rheumatoid arthritis,ankylosing spondylitis and dermatomyositis appears to have occurredin an individual genetically susceptible to these diseases. KEY WORDS: Connective-tissue disease, Hyperglycaemia, Tissue type, Susceptibility genes.     

Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany

OBJECTIVE: To estimate and compare the direct and indirect costs of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), and to evaluate the effect of sex, disease duration and functional status on the various cost domains. METHODS: Data of outpatients, aged 18-65, with rheumatoid arthritis (n = 4351), ankylosing spondylitis (n = 827), PsA (n = 908) or SLE (n = 844), who were enrolled in the national database of the German collaborative arthritis centres in 2002, were analysed. Data on healthcare consumption, out-of-pocket expenses and productivity losses were derived from doctors and patients. For the calculation of indirect costs, the human capital approach (HCA) and the friction cost approach (FCA) were applied. RESULTS: Mean direct costs amounted to 4737 euros a year in rheumatoid arthritis, 3676 euros in ankylosing spondylitis, 3156 euros in PsA and 3191 euros in SLE. By using the HCA, total costs were calculated at 15,637 euros in rheumatoid arthritis, 13,513 euros in ankylosing spondylitis, 11,075 euros in PsA and 14,411 euros in SLE, whereas with the FCA the numbers were 7899 euros, 7204 euros, 5570 euros and 6518 euros, respectively. Costs increased with disease duration and were strongly dependent on functional status. In patients with the highest disability (<50% of full function), the total costs on applying the HCA were 34,915 euros in rheumatoid arthritis, 29,647 euros in alkylosing spondylitis, 37,440 euros in PsA and 32,296 euros in SLE. CONCLUSION: The costs of illness are high in all four diseases, with a strong effect of functional status on total costs. Indirect costs differ by the factor 3, based on whether the HCA or the FCA is used.     

Increased intestinal permeability in ankylosing spondylitis--primary lesion or drug effect?

We have found increased small intestinal permeability to 51Cr-ethylenediaminetetra acetate in patients with ankylosing spondylitis compared with controls. There is no significant difference between patients with ankylosing spondylitis and patients with rheumatoid arthritis taking non-steroidal anti-inflammatory drugs (NSAID). The increased intestinal permeability in ankylosing spondylitis is independent of disease activity. These findings suggest that the increased permeability is caused by NSAID treatment and is probably not a primary lesion of small bowel mucosa.     

Immunological reactivity in ankylosing spondylitis. Circulating immunoblasts, autoantibodies, and immunoglobulins.

Circulating immunoblasts were studied in 39 cases of ankylosing spondylitis. The results were compared with 20 normal subjects and a group of 39 patients with rheumatoid arthritis, Immunoblasts were found to be increased in 11 patients with ankylosing spondylitis and in 22 patients with rheumatoid arthritis in contrast to the controls who were found to have a normal lymphoid cell population in the peripheral blood. Fifteen patients showed raised levels of one or more class of immunoglobulin. Autoantibodies, including antinuclear factors, were negative in all cases. There was a correlation between raised immunoblasts and plasma viscosity but not with clinical assessment of activity. The increase of immunoblasts in the peripheral blood, together with the raised immunoglobulins supports the suggestion of an immunological basis for ankylosing spondylitis.