Bone loss in patients with rheumatoid arthritis — effect of steroids measured by low dose quantitative computed tomography

Summary For 2 years bone density changes in patients with rheumatoid arthritis were monitored to determine the effect of low dose corticosteroid treatment. Sixteen berimenopausal females were studied. Of these nine were treated with 5 to 20 mg prednisone per day and seven had no steroids. The differential effects on trabecular bone density and on cortical bone in the radius and the tibia were examined with high precision peripheral quantitative computed tomography (QCT). Steroid therapy did hot influence cortical bone loss and had only a minor influence on trabecular bone density. Of greater importance was the influence of estrogen depletion. Corticosteroids and estrogen depletion, however, cannot explain fully the yearly loss of 5.7% in the trabecular and 4% in the cortical bone of the radius.     

Factors affecting emotional instability in female rheumatoid arthritis outpatients with limited functional disorder

We attempted to identify which background factors were the most important indicators of such psychological problems as emotional instability, a feeling of hopelessness, and suicidal tendencies in female rheumatoid arthritis (RA) outpatients with limited functional disorder. Among female RA patients aged 20 years and older who visited the outpatient clinic, 101 class I and II patients were selected as subjects for the present study. An original questionnaire and a psychological test (CMI) were given to those subjects who had given their written consent to such testing, and an analysis was carried out on 85 patients who returned all the written forms. Their emotional instability was related to factors such as "not being able to understand the nature of RA disease and its treatment," "sense of value had changed after developing RA," "nonuse of drugs," and "duration of disease." A feeling of hopelessness was related to "smoking," and a suicidal tendency was related to "smoking" and "class I." We identified a characteristic correlation between emotional instability and background factors in this study. Paying close attention to these factors may thus be useful in preventing the appearance of psychological problems as well as in developing effective early treatment strategies. Received: April 5, 2000 / Accepted: July 19, 2000     

Extracorporeal hydrophobic amino acid adsorbent therapy in rheumatoid arthritis

Summary We developed a new adsorbent utilizing hydrophobic amino acids in order to treat severe rheumatoid arthritis patients with extracorporeal adsorption therapy. In in vitro experiment, the new adsorbent selectively removed immune complexes and rheumatoid factors from RA plasma presumably due to hydrophobic adsorption. Six out of elevent patients markedly improved in clinical as well as laboratory parameters of disease activities, particularly in their extra-articular manifestations. We recommend preferential use of this treatment since it can spare the replacement protein solution and is expected to give similar efficacy to simple plasma exchange therapy.     

IgG and IgA antibody titers against human heat-shock protein (hsp60) in sera of rheumatoid arthritis and osteoarthritis patients

 To learn whether heat-shock proteins (HSP) are involved in the pathogenesis of rheumatoid arthritis (RA), antirecombinant human heat-shock protein 60 (hsp60) IgG and IgA in sera of RA and osteoarthritis (OA) patients were investigated. Only the anti-hsp60 IgG titer of seropositive (RF-positive) patients was found to be elevated. Although RF titers of the sera of seropositive RA patients were increased, there was no correlation between the individual anti-hsp60 IgG titer and the corresponding RF titer. In contrast, all the anti-hsp60 IgA titers of the sera of OA, seronegative RA, and seropositive RA patients were found to be elevated. Among them, only the serum IgA concentration of seropositive RA patients was increased. Thus, it was suggested that the increased anti-hsp60 IgG reflects the pathogenesis of RA and its activity. It was also suggested that the increased anti-hsp60 IgA response reflects an involvement of hsp60 in the pathogenesis of arthritides rather than the pathogenesis of RA. Received: August 8, 2001 / Accepted: June 5, 2002 Acknowledgments This study was supported in part by a grant-in-aid from the Japanese Ministry of Education, Science, and Culture. We thank Dr. Yashima for kindly providing normal adult serum samples. We thank Drs. Nishimiya and Hiraoka for technical help. Correspondence to:S. Watanabe     

Analysis of bcl-2+ lymphocyte subpopulations in inflammatory synovial infiltrates by a double-immunostaining technique

We used a double-immunostaining technique to analyze the distribution of bcl-2⁺ B and T lymphocytes within the synovial membranes (SM) of 13 patients with rheumatic diseases: 11 with rheumatoid arthritis (RA), 1 with ankylosing spondylitis (AS), and 1 with osteoarthritis (OA). A high proportion (up to 50%) of the lymphocytes belonged to the B cell subset. Most of both T and B lymphocytes were positive for the bcl-2 protein. In germinal centers B lymphocytes were also negative for bcl-2 protein expression, comparable to the situation in germinal centers of secondary lymphatic organs. We conclude that bcl-2⁺ B lymphocytes are submitted to antigen selection in the inflamed SMs while bcl-2⁺ protein expression provides survival signals for their persistence in the infiltrates. The expression of bel-2 may be an important factor in protecting lymphocytes in SM from apoptosis by glucocorticoids, cytostatic drugs, and irradiation.     

Carpal instability in rheumatoid wrists

This study was conducted to identify patterns of carpal instability in the rheumatoid wrist. One hundred patients with proven rheumatoid arthritis were randomly chosen, and posteroanterior and lateral radiographs of right wrists were taken. The most common isolated pattern was volar intercalated segmental instability, apparent in 16 wrists, while nine wrists had scapholunate dissociations. Larsen grading scores revealed a correlation between disease duration, carpal height ratio, and ulnar translocation index. In the early stages of disease, the scapholunate angle was significantly increased and the lunate rotated volarly due to loosening of the intrinsic carpal ligament. In later phases, the capitolunate angle significantly increased and the capitate rotated dorsally. Patterns of carpal instability in rheumatoid wrists seem to be complicated, involving combined laxity of the intrinsic and extrinsic carpal ligaments.No benefits have been received from a commercial party directly or indirectly related to the subject of this article.An erratum to this article can be found at     

Studies on the expression of the TNFα receptors (p55 and p75) and their relative contributions to prostanoid production and glycolytic rate by rheumatoid synovial fibroblasts in vitro

Summary The effect of monoclonal antibodies against the 55-and 75-kDa (p 55 and p 75) tumour necrosis factor (TNF) receptors on two tumour necrosis factor alpha (TNF ) induced responses was studied in rheumatoid synovial fibroblasts (RSF) in vitro. This provided functional evidence for the expression of both receptor types, which was confirmed by substantial inhibition of ¹²⁵ITNF binding to RSF by both antibodies. TNF stimulation of prostanoid production was found to be a function of ligand binding to both receptor types, wheras the stimulation of cellular glycolysis was largely mediated via the p55 receptor. Thus, we showed that RSF express both types of TNF receptor and functional studies showed that stimulation of each receptor results in both similar and dissimilar cellular responses.     

Rheumatoid arthritis in a population sample in the gulf: Clinical observations

Summary In our practice we had constantly been under the impression that most Arab patients with RA tend to have a non-aggressive and rather nondisabling disease. Therefore, the spectrum of RA was studied in 42 hospital patients with classic or definite forms. Their mean age was 41.2 years and the mean duration of illness was 5.25 years. F:M ratio was 3.6:1. Seropositivity and radiological findings were observed in 59.5% and 45.2% of the patients respectively. They showed a marked lack of nonarticular manifestations with insignificant functional incapacity. The over-all assessment appeared to be in agreement with the initial clinical impression.     

Serum C-reactive protein is rarely lost into urine in patients with secondary amyloidosis and proteinuria

We studied whether the low serum C-reactive protein (S-CRP) level in patients with inflammatory arthritis and proteinuria was due to the loss of CRP into urine. In 19 patients with secondary amyloidosis (14 with rheumatoid arthritis and five with juvenile chronic arthritis), S-CRP was measured with both immunoturbidimetric and radioimmunoassays. The concentration of urinary CRP was measured with a double-antibody radioimmunoassay. One patient with the most extensive proteinuria (12 g/24 h) excreted CRP at 14 mg/24 h, while in 18 of 19 patients only negligible, if any, amounts of CRP were found in 24-h urine samples. Proteinuria of <8 g/24 h did not reduce the S-CRP level. Proteinuria exceeding this level may result in increased excretion of CRP into urine and consequently may result in a reduced S-CRP level.     

Antibodies to 65Kd heat-shock protein were elevated in rheumatoid arthritis

Summary Antibodies to 65Kd heat-shock protein (hsp) of mycobacterium leprae were measured by enzyme-linked immunosorbent assay (ELISA) in the three immunoglobulin classes in paired sera and synovial fluids of patients with rheumatoid arthritis (RA). Titers of anti-hsp antibody were expressed by optical density (OD) values for sera or indexes (OD values divided by amounts of immunoglobulin in each class) for synovial fluids and for their paired sera. Indexes of anti-hsp antibody were higher in synovial fluids than those in sera at 15/18 for IgG, 17/18 for IgA and 16/18 for IgM class. These results suggest the participation of anti-hsp antibodies to synovitis in RA.National Institute for Leprosy Research Higashimurayama, Tokyo, 189, Japan.