Vertebral bone marrow perfusion evaluated with dynamic contrast-enhanced MR imaging: significance of aging and sex

PURPOSE

To investigate blood perfusion of nonfractured, normal-appearing vertebral bodies with regard to age and sex.

MATERIALS AND METHODS

Dynamic magnetic resonance imaging (160 images obtained in 80 seconds) was performed from T10 to L5 in 66 patients. Patients were assigned to three groups: group 1, those 50 years or younger without compression fracture; group 2, those older than 50 years without compression fracture; or group 3, those older than 50 years with compression fracture. Peak enhancement percentage and enhancement slope were determined from the time-intensity curve of normal (nonfractured) vertebral body. Comparisons were made between groups, and the effect of age and sex interaction was analyzed.

RESULTS

Higher peak enhancement percentage was demonstrated for group 1 compared with group 2 (58.21 +/- 44.65 [SD] vs 21.88 +/- 14.77, P <.005). Group 1 women revealed a higher enhancement percentage compared with group 1 men (87.17 +/- 54.13 vs 38.16 +/- 21.69, P <.05), which significantly decreased in those older than 50 years (from 87.17 +/- 54.13 to 17.98 +/- 13.80, P <.005). For men, this decrease in those older than 50 years was not as pronounced (from 38.16 +/- 21.69 to 25.38 +/- 15.43, P >.05). Presence of compression fracture at other levels of the spine (group 3) was not associated with a different enhancement percentage for normal vertebrae.

CONCLUSION

Rate of vertebral bone marrow perfusion revealed a significant decrease in subjects older than 50 years. Women demonstrated a higher marrow perfusion rate than men younger than 50 years and a more marked decrease than men older than 50 years.

Polyclonal anticardiolipin antibodies purified from sera of patients with active systemic lupus erythematosus induce apoptosis of the cultured glomerular mesangial cells

OBJECTIVE

To test the effect of anticardiolipin antibodies (aCL) on cultured glomerular mesangial cells with regard to their expression of apoptosis-related genes.

METHODS

aCL purified from active lupus sera by cardiolipin micelles were incubated with cultured rodent mesangial cells (RMC). Morphological changes of the RMC were observed. The genomic DNA was extracted for the detection of apoptosis. The total cell RNA was extracted for detection of Fas, c-myc, p53, and bcl-2 transcripts by reverse transcription-polymerase chain reaction.

RESULTS

aCL (100 GPL-U/0.1 mg protein/ml) bound to RMC more prominent than human IgG (100 microg/ml). The antibodies suppressed RMC proliferation in a dose-dependent manner. The RMC were undergoing apoptosis as evidenced by morphologic changes, fluoresceinannexin V staining and appearance of nucleosome-sized DNA fragments. RMC spontaneously express p53 and c-myc but not Fas or bcl-2. aCL (100 GPL-U/ml) enhanced the expression of Fas but not other apoptosis-related genes and suppressed the intracellular tyrosine phosphorylation.

CONCLUSIONS

Binding of aCL can induce apoptosis of the RMC. The aCL may be implicated in the pathogenesis of lupus nephritis.

Apoptosis in rheumatoid arthritis--expression of Fas, Fas-L, p53, and Bcl-2 in rheumatoid synovial tissues

Recent studies have suggested that apoptosis is one of the pathogenetic mechanisms in rheumatoid arthritis (RA). In this study, by using single and double immunohistochemical staining assays, Fas, Fas-L, p53, and Bcl-2 were measured simultaneously in RA and osteoarthritic (OA) and post-traumatic (PT) synovial tissues (ST) in order to understand the distribution of these apoptosis-related proteins. The TdT-mediated dUTP-biotin nick end labelling (TUNEL) method was performed to detect apoptotic cells. There was a significant increase of Fas, Fas-L, and p53 in RA ST, compared with OA or PT, but no significant difference of Bcl-2 expression was detected between patient groups. In RA ST, expression of Fas and p53 was detected in sub-lining layers and the majority of Fas- and p53-expressing cells were fibroblast-like synoviocytes. A positive correlation between Fas and p53 was demonstrated in RA ST. In RA ST, one-third of Fas-positive and 80% of p53-positive cells were also TUNEL-positive. These results indicate that apoptosis in RA is strongly associated with the expression of Fas and p53, but not Bcl-2.

The in vitro immunomodulatory effects of sulfasalazine on human polymorphonuclear leukocytes, mononuclear cells, and cultured glomerular mesangial cells

Sulfasalazine (SSA) was investigated for its effects on phagocytic activity of normal human polymorphonuclear neutrophils (PMN), proliferation of mononuclear cells (MNC) and cultured glomerular mesangial cells. At concentrations from 25 to 100 microM, it inhibited phagocytic activity of PMN and the 3H-thymidine incorporation of phytohemagglutinin (PHA)-stimulated human MNC in a dose-dependent manner. At comparable concentrations, sulfapyridine and 5-aminosalicylic acid, two of its major metabolites, did not show similar effects. SSA exhibited an inhibitory effect on both mouse and rat mesangial cells but at rather higher concentrations (0.5 mM). Excretion of interleukin (IL)-8 by lipopolysaccharide (LPS)-stimulated PMN was also markedly deterred in a dose-dependent manner but excretion of IL-8 by LPS-stimulated MNC was not interfered by SSA. Production of tumor necrosis factor (TNF)-alpha and IL-1beta by mouse mesangial cells was not blocked by SSA but production of IL-4 by these cells was inhibited by it (>0.1 mM). Inhibition of MNC was not due directly to cytotoxic effect of SSA on these cells as shown by fluorescein diacetate stain. Collectively, SSA inhibits phagocytosis and IL-8 excretion by PMN as well as mitogen-stimulated MNC reaction. On the other hand, at high concentrations, it inhibits glomerular mesangial cells and their IL-4 excretion but not TNF-alpha and IL-1beta excretion. These results can account for minimal nephrotoxic characteristic of SSA and suggest that it may be helpful in the treatment of immune-mediated glomerulonephritis.

Lipid abnormalities in Taiwan aborigines with gout

An epidemiologic study to determine lipids and biochemical traits was performed in central Taiwan aborigines with and without gout and in the local Han Chinese. The lipid profile included measurement of serum triglyceride, cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I (apoA-I), and apoB. The results showed no significant difference for body mass index (BMI) and cholesterol between the three groups. Greater alcohol consumption was found in aborigines with gout compared with the other two groups. With univariate analysis, serum triglyceride, uric acid, creatinine, LDL-C, and apoB were significantly higher in aborigines with gout versus aborigines without gout or Han people (P<.001). By contrast, HDL-C and apoA-I were significantly lower in aborigines with gout (P<.001 or .01). However, with multivariate analysis, only serum triglyceride, uric acid, and apoB-1 were significantly different between aborigines with versus without gout. In conclusion, the apparent lipid abnormalities, particularly triglyceride and apoB, in Taiwan aborigines with gout are unlikely secondary to obesity. Instead, excessive alcohol intake or genetic factors may play a role in inducing hyperlipidemia in gout.

Unilateral sacroiliitis as an unusual complication of acupuncture

Septic sacroiliitis is an uncommon disease and is rarely reported as a complication of acupuncture. We present a case of unilateral septic sarcoiliitis, which developed as a complication of acupuncture because of failure to sterilise the skin properly before treatment. Bone scan and computed tomography were positive for sacroiliitis. After a course of antibiotics with oxacillin for 6 weeks, the condition was completely improved. This case report stresses the importance of sterilisation procedures before acupuncture therapy.

The inhibitory effect of common traditional anti-rheumatic herb formulas on prostaglandin E and interleukin 2 in vitro: a comparative study with Tripterygium wilfordii

To understand the clinical efficacy of traditional anti-rheumatic herbal medicines on acute and severe arthritis or immune diseases, four herbal formulas and one herb were tested in vitro to determine their effects on prostaglandin E2 (PGE2) and interleukin 2 (IL2). Peripheral blood mononuclear cells from healthy subjects were incubated with different concentrations of four herbal formulas including Shaur Yau Gan Tsao Tang (SYGTT), Shang Jong Shiah Tong Yong Tong Feng Wan (SJSTY), Shu Jin Lih An Saan (SJLAS), Ma Shing Yih Gan Tang (MSYGT) and one herb, Tripterygium wilfordii (T2) with and without mitogen stimulation. PGE2 and IL2 from culture supernatant were measured by enzyme immunoassay. The results showed that SYGTT, SJSTY, SJLAS at concentration of 100 microg and MSYGT at 500 microg/ml can significantly inhibit PGE2 release (P < 0.05) from mononuclear cells. However, T2 at 2 microg/ml expressed the same response. For the inhibition of IL2, the concentration of SYGTT, SJSTY and SJLAS must exceed 100 symbol microg/ml. MSYGT failed to inhibit IL2 at even concentrations of 500 microg/ml but T2 at a very low concentration (0.6 microg/ml) could strongly inhibit it. The findings suggest that the majority of traditional anti-rheumatic herbal formulas or herbs, except for T2, should not be used to treat acute and critical arthritis or immune diseases.

The epidemiology of hyperuricaemia and gout in Taiwan aborigines

To determine the prevalence of hyperuricaemia, gout and gout-related factors in Central Taiwan Atayal aborigines, 342 subjects over 18 yr old were interviewed and examined. A questionnaire was designed to screen for signs and symptoms of gout and gout-related risk factors. Serum uric acid, triglyceride and creatinine were measured in all subjects. The prevalence of hyperuricaemia was 41.4% and that of gout 11.7% in aborigines. The uric acid level was 7.9+/-1.7 mg/dl in males and 5.7+/-1.5 in females, and differed significantly under age 70 yr (P < 0.001). Significantly increased triglyceride, creatinine and alcoholism was found in gouty patients compared with non-gouty patients. In 40 cases with gout, 54% had tophi and 35% of their first-degree relatives had gout. The high prevalence of hyperuricaemia and gout in Taiwan Atayal aborigines, a significant family predisposition, increased creatinine level and alcoholism suggest multiple factors affecting the hyperuricaemia.

Enterobacterial antibodies in Chinese patients with rheumatoid arthritis and ankylosing spondylitis

OBJECTIVE

To study the role of microbial infection in rheumatic diseases.

METHODS

Sera from 39 Chinese patients with rheumatoid arthritis (RA), 52 patients with ankylosing spondylitis (AS) and 51 healthy subjects (HS) were examined for IgG, IgA, and IgM class antibodies against Proteus mirabilis, Escherichia coli, Campylobacter jejuni, Salmonella typhimurium and enteritidis, Yersinia enterocolitica, and Klebsiella pneumoniae (capsular serotypes 31 and 43), using an enzyme-linked immunosorbent assay.

RESULTS

In patients with RA, IgA class antibodies against all bacterial strains used as the antigen were increased when compared to healthy controls. In patients with AS, significantly elevated IgA levels were observed against Campylobacter and Klebsiella K43. IgM class antibodies were less frequently elevated in RA and in AS than IgA class antibodies. In RA patients, IgG antibodies against Klebsiella K43 and Proteus were significantly increased. No differences were observed in IgG class antibodies between AS patients and healthy controls.

CONCLUSION

Increases in serum bacterial antibodies in RA and AS suggest that in both diseases stimulation of the intestinal immune system by enterobacteria may have a role. However, the question whether this phenomenon is due to increased intestinal permeability and/or represents cross reactions between different enterobacteria remains open.

Familial amyloidosis in one Chinese family: clinical, immunological, and molecular genetic analysis

Three members of a Taiwanese kindred developed severe, systemic, early onset (< age 25 years), biopsy-proven amyloidosis. Clinical features included upper and lower extremity sensorimotor neuropathy, abdominal pain, vomiting, corneal ulcerations, cardiomyopathy, and syncope. Immunohistochemical analysis indicated that the deposits consisted of transthyretin. Molecular genetic studies revealed a heterozygous codon 55 point mutation, resulting in a proline for leucine-substitution, a mutation previously associated with aggressive familial amyloidosis in a US kindred of Dutch and German descent. The clinical courses and echocardiographic findings are typical for many types of amyloidosis; the pathologic data and genetic studies were necessary to establish a precise diagnosis.

Hyperprolactinemia in systemic lupus erythematosus

BACKGROUND

Recent evidence demonstrates that hyperprolactinemia was found in active systemic lupus erythematosus (SLE). This indicates prolactin (PRL) is an important immunoregulator and may play a role in the pathogenesis of SLE. However, study of the prevalence and the clinical significance of hyperprolactinemia in SLE and other rheumatic disease has rarely been carried out.

METHODS

From January 1995 to January 1996, 79 individuals were enrolled in this study. PRL levels of 30 cases of SLE were compared with those in 29 rheumatoid arthritis (RA) and 20 normal healthy volunteers. Moreover, a correlation between levels of PRL and SLE disease activity index (SLEDAI) in SLE patients was studied.

RESULTS

The mean value of serum PRL level in SLE patients (19.35 +/- 11.33 ng/dl) was significantly higher than in RA patients (12.33 +/- 8.30 nd/dl, p < 0.05). The difference was more pronounced between SLE patients and healthy individuals (12.01 +/- 7.53 ng/dl, p < 0.01). However, patients with RA had no significant difference from the control group. Analysis made between SLEDAI and PRL levels in SLE patients revealed no significant correlation (r = 0.537, p = 0.07). Furthermore, no significant correlation was found between antinuclear antibody (ANA), C3, C4, anti-DNA and hyperprolactinemia.

CONCLUSIONS

This study has shown that hyperprolactinemia is prevalent in random SLE patients, but not in RA patients. The elevated PRL levels seem not to be associated with disease activity and ANA positivity.

Polymorphism in the LMP2 gene influences susceptibility to extraspinal disease in HLA-B27 positive individuals with ankylosing spondylitis

OBJECTIVE

To investigate the potential influence of the HLA-linked LMP2 gene on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS).

METHODS

A polymorphic CfoI restriction enzyme site in the coding region of the LMP2 gene was evaluated in genomic DNA samples from 193 white and 49 Chinese B27 individuals with well documented AS, 97 of whom had had acute anterior uveitis (AAU) and 97 peripheral arthritis; 42 samples from normal, white, B27 positive blood donors in whom AS was excluded were also evaluated.

RESULTS

Analysis of B27 white AS individuals with AAU, peripheral arthritis, or both, revealed significant differences in genotypic distribution of this bi-allelic locus compared with B27 AS patients without extraspinal manifestations (p < 0.005) or B27 controls (p < 0.01). Furthermore, homozygosity for one LMP2 gene allele was significantly more prevalent in AS patients with AAU (71.3%) (p < 0.01) or peripheral arthritis (68.3%) (p < 0.02) than in B27 controls (45.2%). A similar genotypic distribution was noted in B27 Chinese AS individuals with extraspinal manifestations compared with those with axial disease alone.

CONCLUSIONS

These findings support the involvement of the HLA linked LMP2 gene in the expression of disease in B27 individuals and represent a novel finding in rheumatic disease.

Matching prevalence of peripheral arthritis and acute anterior uveitis in individuals with ankylosing spondylitis

OBJECTIVE

To study the association between the occurrence of peripheral arthritis and of acute anterior uveitis during the course of ankylosing spondylitis (AS).

METHODS

Retrospective clinical follow up by both chart review and direct patient interview was performed on 271 individuals comprised of 222 local white and 49 Taiwanese individuals with AS.

RESULTS

Of 89 white patients with acute anterior uveitis, 36 (40.4%) also had peripheral arthritis, compared with only 33 (24.8%) having peripheral arthritis among the 133 who did not have acute anterior uveitis (p < 0.02). Thirty seven (78.7%) of 49 Taiwanese individuals with AS had peripheral arthritis and these included all 10 patients with acute anterior uveitis from the entire disease cohort (p < 0.05).

CONCLUSIONS

This cross-sectional survey of AS patients supports the view that patients who develop peripheral arthritis are also more likely to develop acute anterior uveitis.

The anti-inflammatory and anti-hyperuricemic effects of Chinese herbal formula danggui-nian-tong-tang on acute gouty arthritis: a comparative study with indomethacin and allopurinol

The traditional Chinese antirheumatic herb Danggui-Nian-Tong-Tang (DGNTT) was studied comparatively with indomethacin and allopurinol to evaluate its anti-inflammatory and antihyperuricemic effects in patients with gout. Results in this study did not show any significant improvement in reducing the total number of painful and swollen joints, articular index and pain score (P > 0.05) by treatment with DGNTT. Unlike allopurinol, DGNTT did not lower the high serum level of uric acid. In vitro study in rats showed that DGNTT significantly inhibits the activity of beta-glucuronidase (P < 0.05) and lysozyme release (P < 0.01) from neutrophils. In conclusion, despite the effect of inhibition on enzyme release from neutrophils, DGNTT is not effective in treating acute arthritis or hyperuricemia.

Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences

OBJECTIVE

To determine the prevalence of symptomatic rheumatic disease in rural, urban and suburban areas of Taiwan by a 2-staged population survey.

METHODS

Nine thousand subjects over 20 years old were sampled proportional to age and sex for the area from 3 administrative areas in Taiwan. A pretested questionnaire to screen for potential rheumatic disorders and/or disability was administered in the communities by health workers. Subjects who screened positive were examined by a rheumatologist who assigned a final diagnosis based on established criteria.

RESULTS

A total of 8998 persons over age 20 residing in Hen-San (rural area), Sien-Dien (suburban), and Cu-Tien (urban) were studied. Twenty-five percent (2272) of the population indicated rheumatic problems: 1124 of 2271 were evaluated by a rheumatologist with serological and radiological testing. The response rates were 49.7% in Hen-San, 50.7% in Sien-Dien and 48.5% on Cu-Tien. After age and sex adjustment, the prevalence of rheumatic symptoms in Hen-San, Sien-Dien, and Cu-Tien was 24.3, 18.4 and 26.3% respectively. It was significantly higher in rural Hen-San and urban Cu-Tien than in Sien-Dien. The prevalence of rheumatoid arthritis (RA) in Hen-San, Sien-Dien, and Cu-Tien was 0.26, 0.78, and 0.93%, osteoarthritis (OA) was 6.3, 5.8, 5.1%, ankylosing spondylitis (AS) was 0.54, 0.19, 0.4%, gout was 0.16, 0.67, 0.67%, respectively. The prevalence of RA in Sien-Dien and Cu-Tien was significantly higher than in Hen-San (p < 0.05) but were not statistically different for OA, AS and gout among those 3 sites. Only one case of systemic lupus erythematosus (SLE) was found in urban Cu-Tien for a prevalence of 0.033%.

CONCLUSION

Our results suggest that the prevalence of RA and AS is similar to that reported in Caucasians. We could not confirm anecdotal reports that SLE was common or that it is more common than RA in people of Chinese ancestry. The prevalence of OA of the hip is comparatively uncommon in our population. The difference in prevalence of rheumatism, RA, OA and gout in these areas suggests areas of further study.

Efficacy and possible mechanisms of the Chinese herbs suching-huo-hsuei-tang in the treatment of adjuvant-induced arthritis in rats

The Chinese herbal formula suching-huo-hsuei-tang (SHT) was studied to evaluate its efficacy and possible mechanism on adjuvant-induced arthritis (AIA) in rats. SHT was extracted with water, butanol and chloroform into 5 different layers. The top 3 layers of SHT showed a significant suppression of AIA and writhing reaction; the top 2 layers suppressed neutrophil chemotaxis and platelet aggregation. The results suggest that SHT is very promising in the treatment of rheumatoid arthritis (RA) by way of its anti-inflammatory and analgesic action. The possible mechanisms for arthritis are multifactorial.

Systemic lupus erythematosus complicated with cystitis, obstructive uropathy and intractable diarrhea: report of a case

A patient with systemic lupus erythematosus (SLE) displayed an unusual extraglomerular syndrome of cystitis with obstructive uropathy and severe secretory-type diarrhea. She had a history of idiopathic hypothyroidism and thrombocytopenia. The intractable diarrhea and cystitis with severe urinary obstruction regressed with large doses of systemic and intravesical corticosteroid therapy. The possibility of SLE should be considered fin any young female patient who has diarrhea of an unknown cause and cystitis.

Interferon production from peripheral blood, synovial fluid, and synovial tissue lymphocytes in patients with rheumatoid arthritis and ankylosing spondylitis

A previous study demonstrated that interferon was present in the serum of 30% of the patients with systemic lupus erythematosus (SLE), which was significantly higher than the 4.5% found in normal controls. We also recently reported that interferon production was deficient from SLE mononuclear cells, which has been attributed to immunodeficiency of the lymphocytes. In this study, interferon measurement included lymphocytes obtained from peripheral blood (PB), synovial fluid (SF) and synovial tissue (ST) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). PB from normal subjects (NS) was used as a control. The results showed with PHA stimulation, that the interferon level in PBL (L = lymphocyte) in NS (70.0 +/- 67.5) was significantly higher when compared with PBL in RA (27.9 +/- 21.6). However, there was no difference between PBL in NS and AS. With ConA stimulation, the interferon level was significantly higher in the PBL of NS (130 +/- 59) and as compared with the PBL in RA (83.6 +/- 53.5). The SFL in RA (67.8 +/- 31.1) and the STL in RA (77.2 +/- 93.2) were also significantly different. It is concluded that interferon production was deficient not only in PBL in RA, but also in SF and STL in RA. The reduced interferon production from PB, SF and ST lymphocytes in RA patients may be due to previous release or immunodeficiency. Lymphocyte interferon production was normal in AS, which suggests that the lymphocyte abnormality between RA and AS may be different.

[The occurrence and clinical significance of antibodies to type II collagen in sera and synovial fluid of Chinese patients with rheumatoid arthritis]

Antibodies to type II collagen (Col II) in sera and synovial fluid (SF) were measured with an enzyme linked immunosorbent assay (ELISA) using a solid phase sandwich method. The subjects included: 42 patients with rheumatoid arthritis (RA); 31 cases of osteoarthritis (OA); 10 cases of gouty arthritis; 4 cases of ankylosing spondylitis (AS); 5 cases of systemic lupus erythematosus (SLE); and 44 normal controls. The antigens used to detect antibodies against Col II were in native and heat-treated denatured forms, both of which were purified from chicken sternal cartilage by limited enzyme digestion and differential precipitation with salt. The reactivity to native type II collagen was generally higher than the reaction to the denatured collagen. In sera, significant higher levels of Col II were detected in the different arthritis groups when compared with the normal control group, with the exception of AS. In SF, the Col II was significantly higher in RA than it was in OA (p less than 0.001), while no difference was present between gout and OA (p less than 0.05). When native Col II was simultaneously measured in sera and SF among arthritics, positive rates were both higher among RA (65% and 58%, respectively). Positive rates were only higher in sera among OA (59% in sera and 3% in SF) and were both lower among gouty arthritis. The above findings show that the measurement of Col II is more important in SF than in sera.