Rheumatoid nodules indicating seronegative rheumatoid arthritis in a patient with gout

 The association of gout and rheumatoid arthritis is rare. We report the case of a patient with gout who presented with rheumatoid nodules indicating seronegative rheumatoid arthritis. Received: 29 July 2002 / Accepted: 4 November 2002     

Multiple peripheral pulmonary nodules preceding rheumatoid arthritis

Summary The case of a young woman is reported, presenting multiple peripheral lung nodules, preceding the onset of classical rheumatoid arthritis 3 months later. The nodules observed seemed to be of pleural origin because they all had contact with the pleura which was partly thickened as demonstrated by computer-assisted tomography. The histopathology of material obtained by an open-lung biopsy revealed rheumatoid necrobiotic nodules. Although very rare, rheumatoid arthritis should be considered as a differential diagnosis of pulmonary nodules of unknown origin.     

A comparative phenotypical analysis of rheumatoid nodules and rheumatoid synovium with special reference to adhesion molecules and activation markers

OBJECTIVES—(1)To analyse the in situ expression of adhesion molecules in rheumatoid nodules. (2) To compare the endothelial expression of adhesion molecules in synovial tissue and subcutaneous nodules obtained from the same patients. (3) To compare the expression of adhesion molecules and activation markers on T cell lines from nodules and synovium.
METHODS—(1) Immunohistochemical analysis by APAAP technique of E selectin, CD44, ICAM-1, PECAM-1, and VCAM-1 was performed on 10 rheumatoid nodules from seven patients with rheumatoid arthritis (RA); nodules and synovium were simultaneously analysed from three patients. (2) T cell lines were generated from RA nodules (n=7) and synovium (n=7) by interleukin 2 expansion, and subsequently characterised by flow cytometry for surface expression of αEβ7, α4β7, CD44, L selectin, LFA-1a, PECAM-1, and CD30.
RESULTS—(1) In rheumatoid nodules, the palisading layer strongly stains for ICAM-1 and PECAM-1, but less pronounced for CD44. VCAM-1 staining was usually negative. ICAM-1 is upregulated in the vessels surrounding the central zone of fibrinoid necrosis. The immunohistological picture in different nodules derived from the same patient was similar. (2) The endothelial expression of adhesion molecules is comparable in RA nodules and synovium on an individual level, except for E selectin, which is overexpressed in nodule endothelium. (3) T cell lines from nodules and synovium display similar adhesion molecule profiles. However, the expression of CD30, a T cell activation marker linked with Th2 subsets, is higher in nodules compared with synovium.
CONCLUSION—These data support a recirculation hypothesis of T cells between articular and extra-articular manifestations in RA, although the activation state of the T cells in each of these localisations may differ.

Keywords: T cells; adhesion molecules; rheumatoid nodules; rheumatoid synovium     

Multiple myeloma masquerading as severe seropositive rheumatoid arthritis with subcutaneous nodules and mononeuritis multiplex

Multiple myeloma can rarely mimic seronegative rheumatoid arthritis (RA). We report a 55‐year‐old woman who presented with longstanding deforming polyarthritis with extensive subcutaneous nodules, tenosynovitis, anti‐cyclic citrullinated peptide positivity and mononeuritis multiplex. Even though the clinical picture was consistent with seropositive RA, the absence of bone erosion or joint space narrowing on hand and knee radiographs led us to question the diagnosis of RA. Further investigation revealed a diagnosis of multiple myeloma with cutaneous amyloid deposits, based on serum immunofixation, bone marrow aspiration and biopsy of a subcutaneous nodule. The only clue to suspect myeloma from the basic investigations and clinical examination was mild hypercalcemia. This case serves to reiterate the need to maintain a heightened suspicion for other diagnoses even when RA appears most likely.     

类风湿关节炎抑郁情况调查

目的　调查中国类风湿关节炎（ Ｒ Ａ） 病人的临床抑郁情况。方法　９５ 例未经治疗的初诊活动性 Ｒ Ａ 病人填写抑郁自评量表（ｓｅｌｆｒａｒｉｎｇ ｄｅｐｒｅｓｓｉｏｎ ｓｃａｌｅ ， Ｓ Ｄ Ｓ） 。结果　５３ ％ Ｒ Ａ 病人具有抑郁临床表现，其中以易激怒、性兴趣减退、能力减退、睡眠障碍、兴趣丧失、绝望、生活空虚感等抑郁症状常见。临床生理指标如关节压痛数／ 指数（ Ｐ＜ ００１） 、关节肿胀数／ 指数（ Ｐ＜ ００１） 、握力（ Ｐ＝００２） 与抑郁临床表现较晨僵（ Ｐ＝ ０３２） 有更密切相关性。抑郁临床表现病人中，以高中以下文化程度者（ Ｐ＝ ００３） 、工人、农民和个体劳动者为主（ Ｐ＝ ００５） 。结论　在 Ｒ Ａ 病人中存在着严重的抑郁症状、提醒我们在今后的治疗方案选择和疗效评定上要关注病人心理和情绪。     

Rheumatoid arthritis, disability and the workplace

Rheumatoid arthritis is a common cause of disability worldwide. The nature of the disability impacts on all areas of life. This chapter focuses on the nature of the disability of rheumatoid arthritis with emphasis on work disability. The various approaches for minimising the disability and rehabilitating those with disability are discussed. The tools for the assessment of disability are described and their strengths and limitations outlined.     

Rheumatoid arthritis associated with ulcerative colitis

This report describes a 58-year-old man with rheumatoid arthritis (RA) and interstitial pneumonia who suffered from low-grade fever, abdominal pain, and bloody diarrhea 16 months after the diagnosis of RA. Ulcerative colitis (UC) was diagnosed, based on endoscopic and histological findings. RA associated with UC is rare and the underlying mechanism is unknown. We discuss here whether vasculitis and HLA class may play some role in the association of RA with UC.     

Prediction of postpartum onset of rheumatoid arthritis

OBJECTIVE—To investigate the prediction of the postpartum onset of rheumatoid arthritis (RA).
METHODS—Two thousand five hundred and forty seven healthy pregnant subjects were examined prospectively and the relation between serum rheumatoid factors (RF) and postpartum onset of RA was observed. Rheumatoid factors were measured in early pregnancy by the antihuman IgG latex agglutination test (Latex test) and antirabbit IgG haemagglutination test (RAHA test).
RESULTS—Latex test and RAHA test were positive in 26 (1.0%) and 64 (2.5%) pregnant subjects, respectively. Four hundred and ten subjects of 2547 pregnant women could be followed up for one year after delivery. None of 401 subjects without RF, or with only one RF on either Latex test or RAHA test, developed RA after delivery. Two (22.2%) of nine subjects with both RFs developed RA at one and three months postpartum, respectively. Transient arthralgia was found within 12 months postpartum in three of nine (33.3%) subjects with both RFs and this prevalence was significantly higher than that in RF negative subjects (8.1%).
CONCLUSION—Postpartum onset of RA was found in at least 2 of 2547 healthy subjects (0.08%) and onset was predicted by positive test for rheumatoid factors.

Keywords: rheumatoid arthritis; pregnancy; postpartum onset; rheumatoid factor     

类风湿关节炎与心血管疾病

<正>类风湿关节炎(rheumatoid arthritis,RA)是最常见的炎性关节炎。近年来,随着临床诊治水平的显著提高,患者预后得到明显改善,但研究发现心脏疾病仍是RA发病和死亡的主要原因之一。炎症在RA发病和加速动脉粥样硬化中起着重要作用。我们就RA的心脏表现和动脉粥样硬化方面做一综述。1 RA的心脏表现1.1心包受累心包炎是RA常见的心脏表现之一。虽然临床症状显     

Managing comorbidity in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease that decreases physical function and imposes substantial medical costs. Comorbid conditions are common in patients with RA and they adversely affect quality of life and RA‐related outcomes such as work disability and mortality. Rheumatologists have the important responsibility to consider comorbidities and their risks when treating patients and to adapt therapies to the specific situation of individual patients. This paper discusses the common comorbidities in patients with RA and management approaches.     

Myelodysplastic features in juvenile rheumatoid arthritis

We have attempted to investigate the dysplastic changes in the hematopoietic system associated with juvenile rheumatoid arthritis (JRA) and its relation to disease activity. The peripheral blood smear and bone marrow aspiration samples of 17 JRA patients were investigated and correlations with laboratory parameters of disease activity sought. The age range was 6–16 years and the duration of disease 1.5–108 months. Abnormal finding of the peripheral smear and bone marrow were scored separately. The score of pathological peripheral blood findings correlated significantly with CRP and ferritin (both P <0.05). In the bone marrow specimens marked changes were noted in the myeloid, erythropoietic, and megakaryopoietic series; however, the score of pathological findings did not correlate with laboratory parameters of disease activity (P > 0.05). We suggest that JRA is associated with marked myelodysplastic changes, also manifested in the peripheral blood smear; these changes may well be the consequence of the inflammatory milieu, including cytokines, during active disease. Am. J. Hematol. 54:166–169, 1997 © 1997 Wiley-Liss, Inc.     

Rheumatoid arthritis and Hailey-Hailey disease treated with methotrexate

We report a rare case of long-standing Hailey-Hailey disease in a Caucasian Portuguese 69-year-old woman, recently diagnosed with rheumatoid arthritis. The patient's skin lesions remained active and exudative despite topical and oral treatments with corticosteroids, tetracyclines, antifungals, and oral treatment with azathioprine. After introduction of methotrexate for rheumatoid arthritis treatment, the skin lesions regressed, with significant impact on the patient's quality of life. This case report supports the clinical evidence of methotrexate's potential role in Hailey-Hailey disease treatment.     

Rheumatoid factors in rheumatoid arthritis and vasculitis

Summary To study the occurrence of rheumatoid factors (RF) in relation to the activity of rheumatoid arthritis and the occurrence of vasculitis, RF of IgM, IgA, and IgG classes were measured in sera from 35 patients with definite or classic rheumatoid arthritis (RA) using ELISA. For 26 patients, the RF levels were studied longitudinally and compared with changes in the articular index. Although IgM RF was occasionally found in patients without RA, IgA and/or IgG RF were almost exclusively associated with RA. The titers of IgM, IgA, and IgG RF were significantly higher in sera from patients with clinically diagnosed rheumatoid vasculitis than in sera from patients without vasculitis. No significant correlation between changes in the articular index and changes in titer of any class-specific RF could be found for the group of RA patients as a whole. However, in individual patients, increases or decreases in IgM and IgG RF titer were significantly correlated with an increase or decrease in the articular index.     

Cardiac involvement in patients with rheumatoid arthritis

Background and aim: In rheumatoid arthritis (RA), although the target organ is the synovium, extra‐articular involvement is also seen. All layers of the heart can be inflamed and pericarditis is the most common type of involvement. The frequency of cardiac involvement in patients with RA and its relation with other patient characteristics were analysed in this study. Methods: One hundred patients with RA were included in the study. Patients were evaluated in terms of their sex, age, disease duration, activity of the disease and history of previous heart disease. Electrocardiography (ECG) and echocardiography were performed. The cardiac abnormalities, laboratory parameters, disease duration and the age of the patient were separately compared. Student t‐test was used for these comparisons and P < 0.05 was accepted to be statistically significant. Results: Ages of the patients, 15 of whom were male and 85 were female, varied between 19 and 78 years (mean 50.5 ± 12.7 years). 23% of the patients were RF‐negative and 77% were RF‐positive. The distribution of the patients according to the Steinbrocker's functional classification was as follows: 16 patients (16%) Class I, 55 patients (55%) Class II, 23 patients (23%) Class III and 5 patients (5%) Class IV. ECG abnormalities were found in 7 patients (7%). Echocardiographic abnormality was detected in 67 of the 100 patients (67%) with minimal pericardial effusion in 15 patients (15%), mitral valvular involvement in 26 patients (26%), aortic valve involvement in 24 patients (24%), ascendant aorta dilatation in 7 patients (7%) and diastolic dysfunction in 57 patients (57%). Conclusions: Cardiovascular system involvement which is an extra‐articular involvement of RA is asymptomatic in most of the patients. Thus, we believe that by a periodical thorough evaluation of patients and aggressive treatment for identified problems can significantly reduce cardiovascular morbidity and mortality in patients with RA.