Population analysis of symmetrical erosive arthritis in Ohio Woodland Indians (1200 years ago)

The antiquity of the symmetrical peripheral erosive arthritis generally classified as rheumatoid arthritis is extended substantially from previous perspectives based on European, Asian, and African studies. New evidence supports its New World origin and the likelihood of subsequent spread to the Old.     

Geographic distribution of rheumatoid arthritis in ancient North America: implications for pathogenesis.

The fifth centennial of Columbus stimulates renewed interest in New World origins of disease. The earliest documentation of rheumatoid arthritis was in the New World. Subsequent study of its distribution in the New World in antiquity defines localization to a very specific geographic region. The absence of rheumatoid arthritis in 63 archaeological sites surrounding the original "catchment area" and in five Old World sites, with documented spread over time, suggests that it is a vector (microorganism or allergen)-transmitted disease.     

Rheumatoid arthritis at a time of passage

OBJECTIVE: To determine the relationship of what has been called pre-Columbian Old World rheumatoid arthritis (RA) to the RA identified in pre-Columbian North America. METHODS: All published claims of pre-Columbian Old World RA were reviewed against the established North American standard for its recognition in archeologic sites. Those characteristics included polyarticular symmetrical marginal erosions [in the absence of subchondral erosions, peripheral joint fusion, or axial skeletal involvement (C1-2 excepted)], but requiring the presence of perilesional osteopenia on radiographic examination. T test and Fisher's exact test were used to assess the significance of the extent of joint distribution and the presence of subchondral erosions, peripheral joint fusion, and axial disease in the Old World cases that some have claimed represent RA. RESULTS: Old World reports of alleged RA often describe isolated bones or isolated "finds" without epidemiologic consideration. Subchondral erosions were present in 95%. The 2 cases without subchondral erosions had peripheral joint fusion and axial joint disease. Peripheral joint fusion and axial joint involvement were present in almost all cases. Perilesional sclerosis was actually quite prominent, as was other evidence of reactive new bone formation, but not perilesional osteopenia. CONCLUSION: As the pre-Columbian Old World erosive arthritis is clearly a different phenomenon from what has been documented in the New World, the issue appears to relate to criteria for naming RA. There clearly are 2 distinct groups that some classify under the broad banner of RA. As the Old World variety is indistinguishable from spondyloarthropathy, it is suggested that the Old World cases should be recategorized with spondyloarthropathy and that only the variety reported in archeologic sites in North America be classified as RA.     

Primate spondyloarthropathy

Spondyloarthropathy is a common occurrence in Old World primates, with only limited presence in New World monkeys. Clearly distinguished from rheumatoid arthritis, this erosive arthritis afflicts 20% of great apes, baboons, and rhesus macaques and had been increasing in frequency. Habitatdependent infectious agent diarrhea-induced reactive arthritis is implicated on a background of genetic predisposition. A gorilla-derived therapeutic preventative approach has possible application in human clinical medicine.     

Primate spondyloarthropathy

Spondyloarthropathy is a common occurrence in Old World primates, with only limited presence in New World monkeys. Clearly distinguished from rheumatoid arthritis, this erosive arthritis afflicts 20% of great apes, baboons, and rhesus macaques and had been increasing in frequency. Habitat-dependent infectious agent diarrhea-induced reactive arthritis is implicated on a background of genetic predisposition. A gorilla-derived therapeutic preventative approach has possible application in human clinical medicine.     

Absence of Rheumatoid Arthritis in Schizophrenia*

Summary: Middle-aged women with a substantiated diagnosis of schizophrenia from Victorian Psychiatric Hospitals were examined for clinical, radiological and serological evidence of rheumatoid arthritis. Clinical or radiological evidence of rheumatoid arthritis was detected in none of the 301 patients studied, where-as the expected prevalences would be 7.7%; this difference is highly significant (p < 0.001). On the other hand, the prevalence of serologically demonstrable rheumatoid factor in the women with schizophrenia was similar to that in subnormal women in hospital under the same conditions and in women from a normal Australian population. The demonstrable polarity of schizophrenia and clinical rheumatoid arthritis in women might be explained either on a genetic basis or through the “protective” effects of one disease, schizophrenia, on the occurrence of the other, rheumatoid arthritis.     

A biochemical comparison of alclofenac and D-penicillamine in rheumatoid arthritis.

In view of the claim that alclofenac has a specific antirheumatoid action a detailed biochemical study has been made over a 6-month period of 2 groups of patients with rheumatoid arthritis receiving either alclofenac or D-penicillamine for the first time. We found no biochemical evidence and little clinical evidence that alclofenac had a 'penicillamine-like' effect in rheumatoid arthritis.     

Hidden bone erosions

The aim of this pictorial essay was to demonstrate the diagnostic efficacy of high-resolution sonography in detecting bone erosions in a patient with rheumatoid arthritis. Standard X-Ray of the feet did not reveal clearly evident erosions. Ultrasonography was able to detect the presence of bone erosions of the metatarsal heads of both the first toes and of the V toe of the left foot. Because the appearance of bone erosions on radiographs of a patient with a recent onset arthritis indicates a poor prognosis, the possibility of demonstrating small hidden erosions at the level of the early targets of the disease is of relevant practical value.     

Rheumatoid vasculitis with multiple intestinal ulcerations: report of a case]

Rheumatoid vasculitis is a relatively uncommon complication of rheumatoid arthritis (RA). It shows wide variety of extra-articular features including skin and neurologic involvement, but rarely shows gastrointestinal involvement. We describe a 79-old-man of rheumatoid vasculitis manifesting as small bowel multiple ulcerations accompanied by perforation of the descending colon diverticulum. The patient was admitted to our hospital with rectal bleeding and severe anemia. He had had rheumatoid arthritis for more than 10 years with treatment of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose prednisone. Upper endoscopy or colonoscopy revealed no evidence of bleeding. Suddenly he developed cramping abdominal pain, and emergency operation was performed. Segments of the descending colon and small bowel were resected to reveal perforation of the descending diverticulum and severe multiple ulcer of small bowel. The pathological examination showed multiple ulcerations of the small intestine was caused by vasculitis.     

Is retardation of radiologic progression of ankylosing spondylitis possible?

In the introduction is the author dealing with problems of early diagnosis of ankylosing spondylitis and he is explaining the advantages of new ASAS/EULAR criteria for diagnosis of axial spondylarthritis. Than he continues with discussion about new "Recommendations for treatment of ankylosing spondylitis", stressing the modification of recommendations for anti-TNF therapy. Despite the fact, that high symptomatic efficacy of anti-TNF therapy was confirmed, there is no clear evidence that anti-TNF drugs delay radiologic progression. On the contrary, study with nonsteroidal antirheumatic drugs in duration 24 months was performed and have documented that patients treated continuously by celecoxib had smaller radiographic progression than patients treated with celecoxib on demand. Anti-TNF therapy delays radiographic progression in rheumatoid arthritis, but not NSAID, in ankylosing spondylitis it is opposite. The differences may be caused by different pathophysiology of rheumatoid arthritis and ankylosing spondylitis as it is explained in the next part of publication. Combination therapy of AS with anti-TNF and continuous celecoxib therapy could be very interesting.     

Manolo Hugué: from sculpture to painting due to arthritis

There are several artists that have suffered rheumatic diseases. Even then, they continued their creative activity. Paul Klee suffered from systemic sclerosis, Dufy and Renoir suffered from rheumatoid arthritis and Gaudí and Boticelli had systemic-onset juvenile idiopathic arthritis. The famous noucentism sculptor, Manolo Hugué, presented chronic polyarthritis that suggested rheumatoid arthritis. Although he underwent several treatments, such as hydrotherapy or diathermic therapy, he had to stop sculpting. Using the chisel was too painful for his hands. He began, then, painting and composing poetry.     

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.     

Immunologic safety of ibuprofen in rheumatoid arthritis: preliminary evidence

Some evidence indicates that ibuprofen and other prostaglandin synthetase inhibitors may have the potential for cellular immune enhancement in addition to their anti-inflammatory activity. If this is true, treatment of rheumatoid arthritis, a disorder of presumed autoimmune pathogenesis, would present a dilemma. These agents are widely used in rheumatoid arthritis for their anti-inflammatory effects. If they are found to enhance cellular immune function, however, the disease might be stimulated over the long term, rather than suppressed. Preliminary evidence from four patients with rheumatoid arthritis show that oral ibuprofen had no significant immunologic effect during sequential "on" and "off" cycles, as assessed by the following measures: delayed hypersensitivity skin testing; lymphocyte transformation to mitogen (phytohemagglutinin) or specific antigen (Candida albicans); T-cell subsets, as determined by monoclonal antibody techniques; or production of the lymphokine, human immune interferon, in response to phytohemagglutinin or to staphylococcal enterotoxin A. Early evidence, therefore, suggests that oral ibuprofen therapy may be 'immunologically safe' in patients with rheumatoid arthritis, but investigations of large series of patients also assessing local immune reaction in diseased joints may be necessary for confirmation.     

Pulmonary Nodule and Aggressive Tibialis Posterior Tenosynovitis in Early Rheumatoid Arthritis

We report the case of a 34-year-old man with a rheumatoid pulmonary nodule preceding the development of articular symptoms of rheumatoid arthritis. Pulmonary nodules are a well known feature of rheumatoid arthritis and are mostly seen in severe established rheumatoid factor-positive cases. To differentiate between benign and malign pulmonary nodules we discuss the use of positron emission tomography (PET). Despite intensive therapy with steroids and methotrexate in our patient, within months he developed a severe tibialis posterior tendinitis, with partial rupture and evolution to a planovalgus deformity requiring surgery. Both these symptoms are rare but demonstrate the need for close follow-up in early rheumatoid arthritis. Received: 18 October 1999 / Accepted: 22 March 2000     

Lifestyle modifications to improve musculoskeletal and bone health and reduce disability – A life-course approach

This review covers the evidence relating to lifestye modification in the big three musculoskeletal conditions: osteoarthritis, osteoporosis and rheumatoid arthritis. Lifestyle is of considerable importance in the first two and there is emerging evidence for rheumatoid arthritis despite it not traditionally being considered a lifestyle disease.     

Development of rheumatoid arthritis after treatment of large granular lymphocyte leukemia with deoxycoformycin

The association of T-cell large granular lymphocyte (LGL) leukemia and rheumatoid arthritis is well described and it is now recognized that these patients and patients with Felty's syndrome represent different aspects of a single disease process. Most patients have rheumatoid arthritis at the time of diagnosis of LGL leukemia. This is the first detailed report of the development of rheumatoid arthritis after the diagnosis and treatment of LGL leukemia as well as the first report of rheumatoid arthritis that occurred in association with deoxycoformycin treatment. It is likely that the beneficial sustained normalization of neutrophil counts as a result of deoxycoformycin treatment played a significant role in the development of this complication. Hematological improvement occurred despite molecular genetic evidence of persistence of the abnormal T-cell clone. The role of the clonally expanded T cells in the pathogenesis of neutropenia and rheumatoid arthritis is discussed. Am. J. Hematol. 57:253–257, 1998. © 1998 Wiley-Liss, Inc.     

Corticosteroids in rheumatoid arthritis

This report has presented evidence to support a disease-modifying role for corticosteroids in rheumatoid arthritis. It would appear that the efficacy of these agents in retarding the destructive course of rheumatoid disease has been substantially underestimated. Consideration for more liberal use of corticosteroids in the management of rheumatoid arthritis is warranted. Further study on new approaches to corticosteroid delivery is proposed.