Thyroid involvement in chronic inflammatory rheumatological disorders

Summary The association between rheumatological and thyroid disorders has long been known, the most common being the association of rheumatoid arthritis and autoimmune thyroiditis. Little is known as to possible thyroid involvement in other rheumatological disease of possible autoimmune aetiology, such as psoriatic arthritis and ankylosing spondylitis. We measured thyroid volume and function as well as the prevalence of anti-microsome and anti-thyroglobulin antibodies in 107 consecutive patients with rheumatoid arthritis, 42 patients with psoriatic arthritis, and 12 male patients with ankylosing spondylitis. Fifty-two normal subjects were used as controls. The average thyroid volume, measured at ultrasounds, was increased in all groups of patients, and the prevalence of thyroid enlargement (A-P diameter > 20 mm) was 2–3 fold higher in rheumatological disorders in comparison to controls. Both, patients with rheumatoid arthritis and psoriatic arthritis had higher-than-normal fT₄ levels and an increased prevalence of anti-microsome antibodies. In the rheumatoid arthritis group alterations in thyroid volume and function were present irrespective of disease activity, whereas in psoriatic arthritis thyroid involvement was confined to patients with active disease. Our data are consistent with a significant thyroid involvement in rheumatological disorders, which is not limited to diseases with a definite autoimmune aetiology.     

Diagnostic importance of an elevated erythrocyte sedimentation rate in the elderly

Summary The usefulness of the erythrocyte sedimentation rate (ESR) in elderly individuals has recently been questioned. ESR measurements were obtained on 100 elderly individuals using the Westergren method. In 4% of the patients screened the ESR was responsible for uncovering previously undiagnosed illnesses. Elevated ESR's, while more prevalent in the elderly than in younger individuals, have a similar pathological significance.     

Pain and fatigue in patients with rheumatic disorders

Summary The purpose of the study was to investigate whether fibromyalgia patients (n=50) differed from patients with rheumatoid arthritis (n=22) and ankylosing spondylitis (n=31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p<0.01) and the visual analogue scale (p<0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p<0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p<0.01) and high intensity of fatigue (p<0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.     

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.     

C-reactive protein levels in patients with rheumatoid arthritis: the impact of therapy

Summary C-reactive protein levels were measured in sera of 111 patients with rheumatoid arthritis and were compared with erythrocyte sedimentation rate. The patients were divided into six groups according to drug therapy. Comparison between the groups suggests that CRP correlates best with ESR in patients treated with penicillamine and in patients in clinical remission. Patients treated with gold, NSAID or methotrexate have a weaker correlation between the two parameters, while steroid therapy yields the poorest correlation which is not statistically significant. Our data suggest that although CRP is a sensitive index of disease activity, the specific drug taken by the patient must be considered before interpreting the results.     

Coexisting rheumatoid arthritis and ankylosing spondylitis discussion of 3 cases with review of the literature

Summary Coexisting rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have rarely been reported. We aim to evaluate such association in our RA and AS hospitalized patients during the 5 past years. We selected 130 RA and 87 AS patients and found 3 genuine associations which are here reported, 3 AS patients with positive rheumatoid factors (RF) and 4 HLA B27 RA patients. HLA B27 frequency in our RA patients (6,6%) and positive RF in our AS patients (8,3%) does not differ from the HLA B27 or RF frequency in a control series of 172 osteoarthritis or fibromyalgia patients (respectively 8%-in the Caucasian-and 9,8% in this control series).Coexisting RA and AS is discussed with regard to these 3 cases; 44 similar cases are found in the literature and reviewed here. The mechanisms leading to this curious association are discussed. Besides these patients, the sacroiliac joint involvement in RA is also analyzed as well as the positivity of RF in AS. The low frequency of coexisting RA with AS suggests that these 2 conditions probably occur by chance. A similar explanation can certainly be advanced for positive RF in AS and HLA B27 in RA patients since the same frequency for B27 and RF has been observed in controls. Finally, these different case reports and unusual biological or roentgenographic features in RA or AS demonstrate the possibility of confusion between these two rheumatic conditions.     

Free and serum testosterone levels in 276 males: A comparative study of rheumatoid arthritis,ankylosing spondylitis and healthy controls

Summary A crosssectional study of testosterone levels in 276 males was undertaken. Of these 87 were RA patients, 48 males with AS and 141 were healthy controls. Free and serum testosterone levels were significantly lower in the RA males than in either the AS group or the healthy controls (p < 0.001). This difference was unaffected by age. No differences were seen in testosterone levels between DR1 or DR4 RA patients compared to those without these antigens. No evidence of hyperandrogenicity was seen in the AS group. The finding that males with RA have lower androgen levels than both normal controls and a disease group with inflammatory spondarthritis supports the hypothesis that male sex hormones may be a protective factor against the development of RA.     

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.     

Sthenia,ambition and educational level in patients suffering from ankylosing spondylitis: A controlled study of personality features as compared to rheumatoid arthritis and unspecified low back pain

As compared to control-groups of rheumatoid arthritis and chronic non-inflammatory low back pain, over a hundred polyclinical patients suffering from ankylosing spondylitis were assessed with respect to several personality characteristics by psychological testing and proved to be relatively sthenic and educated. In trying to explain these personality features some disease-related factors seem to be relevant in ankylosing spondylitis: a relatively mild course of disease, the relief of complaints by exercise and a long pre-diagnostic period.     

类风湿关节炎患者血脂紊乱特点及与疾病活动的关系

目的探讨类风湿性关节炎(RA)患者血脂紊乱特点及与疾病活动的相关性。方法选择RA患者62例作为研究对象(RA组),年龄、性别匹配的健康体检者46例为对照组。根据疾病是否处于活动期,将RA组分为活动期RA组和非活动期RA组。记录一般情况及传统心血管病危险因素,计算体质指数,测量收缩压、舒张压,检测血清中甘油三酯、总胆固醇(TC)、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇(HDLC)、高敏C反应蛋白(hsCRP)及红细胞沉降率(ESR)。比较各组血脂、hs-CRP、ESR差异。用Pearson直线相关分析法分析RA患者血脂与hs-CRP、ESR的相关性。结果 RA组体质指数显著高于对照组(P0.05)。血清TC水平活动期RA组、非活动期RA组显著高于对照组(P0.05);血清HDLC水平活动期RA组显著低于非活动期RA组、对照组(P0.01),非活动期RA组显著低于对照组(P0.01);TC/HDLC比值活动期RA组显著高于非活动期RA组、对照组(P0.01),非活动期RA组显著高于对照组(P0.05)。RA患者血清HDLC水平与hs-CRP、ESR呈负相关(r=-0.532,P=0.000;r=-0.508,P=0.000),TC/HDLC与hs-CRP、ESR呈正相关(r=0.321,P=0.001;r=0.246,P=0.030)。结论 RA患者血脂代谢紊乱以HDLC降低为主,活动期RA患者血清HDLC水平显著降低,并与RA疾病活动密切相关。     

Measurement of pain threshold in patients with rheumatoid arthritis,osteoarthritis, ankylosing spondylitis,and healthy controls

Summary Pain threshold was measured using a pressure algometer in 126 subjects, of whom 54 were females and 72 males. These subjects included 18 males and 18 females with rheumatoid arthritis, 18 males and 18 females with osteoarthritis, 18 males with ankylosing spondylitis, and 18 male and 18 female healthy control volunteers. Six points were studied on each side of the body: 2 cm above the eyebrow on the forehead, lateral aspect of the arm at the insertion of the deltoid muscle, midpoint of the ulna, hypothenar eminence in the palm, midpoint of the quadriceps muscle, and midpoint of the anteromedial aspect of the tibia. None of these points corresponded to the trigger points in fibromyalgia. The pain threshold was statistically significantly higher in patients with ankylosing spondylitis than in patients with osteoarthritis, and these in turn were statistically higher than in the normal subjects. Patients with rheumatoid arthritis had significantly lower pain thresholds than the normal subjects. No laterality in pain threshold was identified, but females had in general a lower pain threshold.     

Metabolic abnormalities in patients with inflammatory rheumatic diseases

Patients with rheumatoid arthritis (RA) experience an increased cardiometabolic risk factor burden that is substantially driven by systemic inflammation. This occurs less consistently in patients with ankylosing spondylitis (AS). Psoriatic arthritis most strongly associates with excess adiposity and metabolic risk. RA patients also often have systemic inflammation-induced proinflammatory high-density lipoprotein (HDL) cholesterol particles and lean/muscle mass loss in association with increased adiposity, a condition termed rheumatoid cachexia, which further enhances cardiovascular risk. The presence of proinflammatory HDL and lean mass loss was also reported in patients with AS. Individualized aerobic and resistance exercise programs can improve body composition and metabolic risk factor profiles in RA and AS. Future studies should assess how long-term lifestyle changes can be effectuated and if these can influence cardiovascular events in inflammatory rheumatic diseases. Herein, we review the current evidence on metabolic abnormalities in inflammatory arthritis. We propose management strategies and a research agenda.     

类风湿性关节炎合并冠心病患者的红细胞沉降率与心肌梗死病史的关系

目的：探讨类风湿性关节炎合并冠心病患者的红细胞沉降率与发生心肌梗死的关系。
　　方法：连续入选类风湿性关节炎合并冠心病患者106例,男性46例,女性60例,其中发生过心肌梗死患者46例（心肌梗死组）,未发生过心肌梗死患者60例（非心肌梗死组）。比较两组患者的基线资料。用logistic回归的方法探究类风湿性关节炎合并冠心病患者发生心肌梗死的相关危险因素。
　　结果：胆固醇水平心肌梗死组明显低于非心肌梗死组（P<0.05）。炎症活动性指标红细胞沉降率,高敏C反应蛋白及C反应蛋白水平心肌梗死组均明显高于非心肌梗死组（P<0.05）。两组其它基线资料相比均无统计学差异（P>0.05）。多元logistic回归模型得出该人群发生心肌梗死的相关危险因素为红细胞沉降率（风险比：1.024;95%可信区间：1.007~1.043;P=0.007）。
　　结论：类风湿性关节炎合并冠心病患者红细胞沉降率与心肌梗死的发生有独立关联。     

Activated T lymphocytes,rheumatoid factor and erythrocyte sedimentation rate assays in rheumatoid arthritis

Summary Activated T lymphocytes (Ia⁺ T-cells) in peripheral blood are associated with immune stimulation. We found the percentages of these cells significantly increased in 95% of rheumatoid arthritis (RA) patients. Our studies showed no relation between the percentages of these cells in peripheral blood and concurrent erythrocyte sedimentation rates or rheumatoid factor titers. Circulating immune complex titers determined in a small number of patients conjectured an association with Ia⁺ T-cell levels.     

Lung involvement in inflammatory rheumatic diseases

This chapter describes the involvement of the lung in systemic inflammatory joint disease (IJD) with a particular focus on rheumatoid arthritis, although the topics of pulmonary involvement in ankylosing spondylitis and psoriatic arthritis are also addressed. Interstitial lung disease is the most lethal pulmonary complication of IJD and the chapter describes recent advances in both our understanding of this complication and the therapeutic options that offer real hope for improved outcomes. Although less well recognised, airways disease is just as common and its association with IJD is described in some detail, with a section devoted to the recent surge in interest in bronchiectasis. Acute pulmonary infection is common in IJD and its management is reviewed in some detail. Although pleural disease is less common than it once was, its treatment is explored. We conclude by reviewing the relationship between the drug therapies employed in IJD and their effects on the lung.     

C-反应蛋白与血沉在老年肺部感染中的临床应用价值研究

目的 探讨C-反应蛋白(C-reactive protein,CRP)与血沉(erythrocyte sedimentation rate,ESR)在老年肺部感染中的临床应用价值.方法 老年肺部感染500例,所有病例均在人院的第1天、第3天、第5天、第7天、第14天清晨采静脉血测定CRP、ESR和白细胞计数(WBC).同时对患者入院当天进行临床肺部感染评分(clinical pulmonary infection score,CPIS).结果①经有效治疗后各数值较治疗前均明显下降(P<0.01);②血清CRP较ESR下降迅速(P<0.01);③CRP阳性率明显高于ESR和wBc(P<0.01);④经两参数的相关性分析.CRP、ESR与CPIS均相关,相关程度CRP>ESR.结论 血清CRP与ESR均为临床老年肺部感染诊断和治疗评价的有效指标.CRP有助于老年肺部感染的早期识别及感染严重程度的判定,并且能够迅速准确地反映抗生素的疗效,是明显优于ESR、WBC等的有效炎症指标.     

血沉及C反应蛋白判定强直性脊柱炎病情活动的价值

目的探讨血沉和C反应蛋白(CRP)判定强直性脊柱炎(AS)病情活动的价值。方法采用Cowling法和Bath强直性脊柱炎病情活动指标(BASDAI)评价126例AS患者的病情活动性,分为静止、可疑活动、活动3个水平;患者分为脊柱组和外周关节组。病情静止和活动者纳入受试者工作曲线,以最高敏感性和特异性决定截断点,计算血沉、CRP与病情活动间Spearman相关系数。结果脊柱组血沉和CRP中位数为25·3mm/1h和11·1mg/L,外周关节组为30·0mm/1h和15·0mg/L。两组间血沉和CRP呈正相关(rs=0·325和0·318,P<0·05)。血沉、CRP和两种病情活动评价指标无相关性(0·027~0·282),两者对Cowling法和BASDAI评价病情活动敏感性为39·4%~81·3%,特异性为40·0%~86·7%。结论血沉、CRP与Cowling法和BASDAI评价AS病情活动性之间无联系,其对判定AS病情活动性价值不大。     

离心沉淀对老年人血沉检验结果影响的初步观察

目的观察血液离心沉淀后对老年人血沉检验结果的影响。方法随机选取传染科结核病住院患者23例,静脉抽取新鲜血液常规抗凝后均分2管,第1管常规魏氏法测定血沉值,第2管3000rpm离心5min后,再予悬浮均匀,以同样的方法测定血沉值。结果未作离心沉淀的自然血沉值、离心沉淀后再悬浮的血沉值分别为（37．70土4．29）mm／hr,（52．00±5．40）mm／hr;两者之间差别有统计学意义（t=2．23,P〈0．05）,后者超出前者27．5％;散点图示离心后血沉（Y）与自然血沉（X）呈线性正相关,经回归分析两者关系的回归方程为X=0．75Y-1．45（r=0．94,F=192．35,P〈0．001）。结论老年人新鲜血液离心沉淀再悬浮后测定的血沉值（Y）较自然血沉值（X）明显增快。若不慎对老年人血沉测定管做了离心处理,可按回归方程加以补救,评估其实际的自然血沉值。     

Reliability of articular indices and function tests in a population study of rheumatic disorders

Summary Reliability and method error were assessed for 25 clinical tests by test-retest on 31 subjects with rheumatic disorder (RD) and on 28 consecutive non-RD of a reference group (REF) from a female population sample. Low systematic differences were found for joint mobility tests in the RD group and correlation coefficients were generally above 0.7. A significant difference in the RD group was found only for climbing stairs, and in the REF group for shoulder external rotation and flexion, wrist extension and grip strength. The relative method error of grip strength was large (17%). A new assessment of activities of daily living could not be fully evaluated because the population studies had limited disability, but the error was acceptable. Articular indices (Lansbury, Ritchie, and American Rheumatism Association) showed large method errors (9–25%), acceptable test-retest correlations (> 0.75), and a systematic difference only in the Ritchie index. The analyses showed that a number of clinical tests are adequate for population studies of RD, but the metrical properties of these tests must be considered in the planning of clinical and population studies.