Seronegative rheumatoid arthritis: a clinical study with HLA typing

We examined both clinically and by determining HLA-A, -B, -C and -DR antigens 50 patients thought to have seronegative erosive polyarticular rheumatoid arthritis (RA) in Finland and the USSR. All the patients fulfilled at least 4 of the 1987 ARA criteria for RA. According to HLA typing and clinical findings, of which a part was collected by followup, the patients fell into 5 groups: HLA-B27 related diseases, putative psoriatic arthritis, putative juvenile chronic polyarthritis, and seropositive and seronegative RA. Our results indicate that most of the patients with seronegative RA had some other disease. In the remaining cases the presence of rheumatoid factors had not been examined adequately, especially at the early phase of disease. The classification of erosive seronegative polyarticular patients is discussed.

Synovial fluid acid phosphatase in seropositive and seronegative arthritides

Synovial fluid acid phosphatase was investigated in 82 arthritic patients with hydropsy in a knee joint. 39 of the patients were seropositive and 43 seronegative. 36 of the seropositive group had erosive rheumatoid arthritis. The mean synovial fluid acid phosphatase in the seropositive group, 11.6 U/l (SD +/- 8.4), was significantly higher (p less than 0.001) than in the seronegative group, 6.5 U/l (SD +/- 4.8).

Hidden psoriatic arthritis in seronegative oligoarthritis: a 14-year follow-up study

Out of a cohort of 64 patients with seronegative oligoarthritis (SO), 8 patients with HLA-B13, 5 with Bw16 and 3 with HLA-B17 were invited to participate in a 14-year check-up. Thirteen patients showed some features of psoriatic arthritis, including 5 with suspected skin or nail disease, 5 with a family history of psoriasis, 3 with DIP joint affliction, and 2 with aortic valve insufficiency. It is concluded that a quarter of the patients with SO may have hidden psoriatic arthritis.

Prognostic significance of synovial fluid analysis in rheumatoid arthritis

Thirty patients with definite rheumatoid arthritis and hydropsy in a knee joint were followed for 42 months in a prospective study. The knee joints were initially aspirated and 15 synovial fluid variables investigated. The patients were split into two groups, those with and those without progress of radiologically detected destruction in the knee joints during the follow-up. Of the synovial fluid variables at the start synovial fluid proteins (P = 0.002) and acid phosphatase (P = 0.03) differed statistically significantly between the groups, both being higher in patients with worsening of knee joint. The results suggest that high synovial fluid proteins and acid phosphatase are predictors of poor prognosis in a joint affected by rheumatoid arthritis.

Is seropositive rheumatoid arthritis becoming less severe?

We have followed a community-based cohort of recent-onset arthritis for eight years. In addition to Waaler-Rose and latex agglutination tests we used class-specific enzyme immunoassay for the determination of rheumatoid factors (RFs). Eighty-seven patients had erosions by the end of the follow-up period. The seropositive cases in each RF assay were divided into three groups of equal size according to the mean strength of RF reactivity for three or four available follow-up specimens. The radiological index values in the high-titer groups were no higher than the values for the seropositive cases on average. Thus, no severity gradient according to RF titer could be demonstrated.

The effect of different indomethacin formulations in young and elderly patients: a comparative controlled clinical trial

In a double-blind, crossover trial a controlled-release multiple-units indomethacin formulation (50 mg twice daily) was compared with conventional capsules (25 mg twice daily with 50 mg in the evening) in 12 young and 18 elderly in-patients with rheumatoid arthritis. Earlier findings that younger patients preferred a slow-release formulation and the elderly a standard formulation could not be confirmed. As a whole, the duration of morning stiffness was reduced more (p = 0.02) with the controlled-release formulation than with the conventional formulation. During the treatment period (7 days), 4 patients reported side-effects from the conventional capsules, 3 from the controlled-release formulation, and 6 from both treatments; 53% of the patients preferred the controlled-release formulation, while 20% preferred the conventional capsule (p = 0.046).

Subjective disease experience in Sjögren's syndrome. A computerized discrimination analysis

A study was made of the ability of a computerized discrimination analysis to distinguish between primary or secondary Sjögren's syndrome on the one hand and, on the other, various rheumatic diseases which may be, but in this study were not, complicated by Sjögren's syndrome. The analysis was based on a questionnaire including 76 two- or three-scale items. Among these 76 questions, five with a maximum potential for distinguishing between various subgroups were selected and obviously represent the questions for the physician to ask when taking the patient's history. As shown by classification matrix tables, computerized analysis of questionnaires might represent a useful way to assess the prevalence of clinical cases of Sjögren's syndrome and to aid health care administrators in assessing the extent of the Sjögren's syndrome problem. In contrast, manual analysis of patients' graded answers did not provide any simple or practicable method for the diagnostic work-up of cases. Therefore it seems that subjective symptoms should not be included in the diagnostic criteria for Sjögren's syndrome, which in clinical work should be based on objective evidence alone.

Significance of rheumatoid factors in an eight-year longitudinal study on arthritis

A community-based cohort comprising 150 patients with recent-onset seropositive arthritis or seronegative oligoarthritis or polyarthritis was monitored for 8 years. Of the different rheumatoid factor (RF) tests, the initial positivity in the most sensitive assays (latex slide test and IgM-RF by enzyme immunoassay) was the most reliable factor when distinguishing between the erosive and nonerosive cases. The individual RF isotypes fluctuated in four serial specimens, but each patient tended to preserve his or her reactivity pattern. Seroconversion from positive to negative within the 1st year of follow-up did not indicate a particularly good long-term prognosis.

Work capacity of patients with inflammatory joint diseases. An eight-year follow-up study

In a prospective study of recent arthritis, 103 patients had rheumatoid arthritis (RA), 63 seronegative oligoarthritis (SO), 67 reactive arthritis (REA), 20 ankylosing spondylitis (AS), and 13 psoriatic arthritis (PA). At the 8-year check-up, 36% of patients with RA were at work, compared with 69% in PA (p less than 0.002), and 85-90% in AS, SO, and REA (p less than 0.001). Correspondingly 43% of the RA patients were disabled by arthritis, compared with 23% in PA (NS), 15% in AS (p less than 0.005), none in SO, and 4% in REA (p less than 0.001). No significant differences in work capacity were noted between patients with PA, AS, SO or REA. In RA, the educational backgrounds of patients unable to work (44 patients) and able to work (37 patients) did not differ from each other or from the overall population of Finland, but a significantly (p less than 0.01) smaller number of patients with arduous work were able to continue at work. The mean age of 49 years for RA patients unable to work differed highly significantly (p less than 0.001) from the 35 years of RA patients at work. However, the weightiest cause of limited work capacity was severity of disease.

Alpha 1-antitrypsin in acute anterior uveitis and rheumatic diseases

To test the pathogenetic role of the phenotype MZ of alpha 1-antitrypsin/alpha 1-protease inhibitor (PI) in acute anterior uveitis (AAU) and in different rheumatic diseases we examined 360 unrelated patients including 93 with AAU alone, 24 patients with AAU and ankylosing spondylitis (AS), 21 patients with AAU and Reiter's disease (RD), 26 patients with AAU, AS, and RD 54 patients with AS alone, 16 patients with RD alone, 115 patients with rheumatoid arthritis (RA) alone, and 11 patients with psoriatic arthritis (PA) alone. Of the 164 AAU patients, 80 had a single attack, and 84 had repeated episodes. There were neither significant differences between different groups of the patients and 120 healthy controls nor between patients with AAU alone and patients with AAU and AS or RD in the frequencies of the PI phenotypes tested. The results indicate that the PI MZ type is not closely associated with AAU, AS, RD, RA and PA and that it does not play any role in determining whether AAU shows a pattern of a single attack or repeated episodes, and whether AAU occurs alone or together with AS or RD.

Incidence of hip involvement and need for total hip replacement in rheumatoid arthritis. An eight-year follow-up study

In an 8-year follow-up of a prospective study of recent arthritis, 103 patients were found to have erosive and 97% seropositive rheumatoid arthritis. A 20% incidence of hip joint involvement was observed among them. Moderate radiological changes could be seen in 10%, severe destruction (Larsen 4 or 5) in 3%, and acetabular protrusion in 1% of the patients. It was estimated that the minimum annual need of total hip replacement in rheumatoid arthritis in Finland would be 470. This is about 100 per million in the overall population. At the end of the follow-up the Larsen X-ray index was highly significantly (p less than 0.001), ESR significantly (p less than 0.005), and CRP clearly (p less than 0.03) higher in the 13 patients with radiologically confirmed hip changes than in the 90 without them. Thus their hip destruction is attributable to a more severe disease condition and not to the glucocorticoids administered. Furthermore, HLA-B27 was positive in 69% of the above-mentioned 13 patients compared with 27% of the rest, and this difference (p less than 0.005) may also explain the poor prognosis for true rheumatoid arthritis patients.

Prognostic factors and diagnostic criteria in early rheumatoid arthritis

The purpose of the present undertaking was to investigate prognosis of patients with non-specific or rheumatoid arthritis and to study the value of different diagnostic criteria for rheumatoid arthritis (RA) at the beginning of the disease. During the years 1973-75, a total of 442 patients with recent (less than or equal to 6 months) arthritis were studied at the Rheumatism Foundation Hospital, Heinola, Finland. In 1982 the outcome of the 200 patients with the diagnosis of RA or non-specific arthritis was established. Their ages at the time of the first hospitalization were 16-77 years, mean 41. There were 63 men and 137 women. The follow-up period was 6-9 years, mean 7.6. The outcome was measured by joint score, function score, the sum of ESR and CRP, X-ray index, outcome index, which was composed of the preceding ones, ESR, and CRP. The outcome was poor in half of the patients. Ninety-eight signs and symptoms registered at the first hospitalization were compared with the seven facets of outcome using Pearson's correlation coefficient r. The significances of the correlation coefficients were tested by Student's t-test. From 10 to 39 variables correlated highly significantly (p less than 0.001) with the measures of outcome; however, most of the variables had only moderate correlations. At best 14 variables showed 0.40 less than r less than 0.58 when correlated with the outcome index. In conclusion, at the onset of an arthritic disease symmetrical polyarthritis in peripheral joints, serum rheumatoid factor, X-ray changes, morning stiffness, high ESR, and old age correlated best with a destructive joint disease. Plasma proteins as indices of non-specific inflammation mattered less. The relationships between 22 entry variables and the seven facets of prognosis were further evaluated by means of stepwise multiple regression analysis. The results were essentially the same as reached above. One or two variables, most often the number of diseased peripheral joints and serum Waaler-Rose test, always explained the variance better than the number of ARA criteria alone. To study the value of the diagnostic criteria, diagnosis of the patients was made in the following three ways: RA with five or more erosive joints (N = 78), RF-positive and erosive RA (N = 93), RF-positive and nonerosive or RF-negative and erosive RA (N = 125). The patients outside each of the diagnostic groups formed the corresponding control groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Tolerability and efficacy of a slow-release indomethacin tablet in ankylosing spondylitis

The efficacy and tolerability of a new formulation of slow-release indomethacin tablet was compared in a double-blind cross-over manner with a conventional indomethacin capsule in 30 patients with ankylosing spondylitis. Gastrointestinal side-effects and dizziness were less frequent during the slow-release tablet period than during the capsule period.

Comparison of the analgesic effect of ten nonsteroidal anti-inflammatory drugs

The analgesic effect of 10 anti-inflammatory drugs was compared using a single-blind method in 90 patients with rheumatoid arthritis. Each patient received two different drugs, for three days each and each drug was evaluated in 18 patients. After the trial, the patients considered which of the drugs they preferred. The greatest relief from pain was achieved by diclofenac, indomethacin, naproxen and tolfenamic acid, each of these being preferred by the majority of patients and being significantly (p less than 0.01) better than the least effective drugs ketoprofen and proquazone. Acetylsalicylic acid, azapropazone, carprofen and ibuprofen were considered intermediate in efficacy.

The prediction of radiological destruction during the early stage of rheumatoid arthritis

A total of 107 patients with definite rheumatoid arthritis of no longer than six months' duration were observed for three years. The radiological destruction of the hand and foot joints after the follow-up time was compared with 65 anamnestic, clinical, laboratory and radiological variables at the onset of the disease. Of the individual variables, early radiological changes in the joints showed the best correlation with the progress of joint destruction. Grip strength, ESR, serum iron, serum C1 esterase inhibitor, rheumatoid factor and old age also had prognostic value. In multiple regression analysis 15 variables explained about 50% of the variance in the progress of joint destruction.

Relationship between clinical synovitis and radiological destruction, in rheumatoid arthritis

The clinical synovitis and radiological destruction of wrist and subtalar joints were followed over a 3-year period in 107 patients with rheumatoid arthritis of no longer than 6 months' duration. The joints were examined clinically and by X-ray on entry to study, at one year and at three years of study. The progress of joint destruction was highly significantly correlated with the frequency of clinical synovitis at the three examinations in both wrist and subtalar joints.

Prognosis of inflammatory joint diseases. A three-year follow-up study

The prognosis 3 years after the onset of the disease was studied in 107 patients with definite rheumatoid arthritis, 161 with probable RA or non-specific arthritis, 84 with either ankylosing spondylitis, Reiter's disease or reactive arthritis, 14 with psoriatic arthritis and 10 with a systemic connective tissue disease. Prognosis was measured by clinical involvement of joints, radiological erosions in joints, deterioration in joint function, ESR, and working ability. A total of 44% of all patients were symptomless after 3 years. The prognosis was best in patients with an "HLA B 27-associated" disease and non-specific arthritis, and worst in RA. Two patients died during the follow-up of systemic connective tissue disease and one committed suicide with an overdose of hydroxychloroquine. Two HLA B27-positive patients developed systemic amyloidosis.

The value of the diagnostic criteria in rheumatoid arthritis

The ARA and the New York diagnostic criteria for rheumatoid arthritis were studied in 411 patients with a recent inflammatory joint disease (100 with RA, 311 with other disease) in order to evaluate their value in distinguishing progressive rheumatoid arthritis from other joint diseases. Rheumatoid factor, symmetrical polyarthritis, morning stiffness, and X-ray changes were of the greatest value in diagnosing RA in the early stage of the disease. Other diagnostic criteria had either a poor specificity or sensitivity, and were thus of less importance as discriminators.