Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis

The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness.

Relation between bone erosions and rheumatoid factor IgA and IgM isotypes in recent onset rheumatoid arthritis

In this prospective study 58 patients with early rheumatoid arthritis were followed up for two years with six-monthly assessments including rheumatoid factors (RF) of IgA and IgM subtypes. Initial and mean serum levels of IgA-RFs were raised in patients with an erosive disease course in comparison to non erosive disease. The cases with initially increased serum levels of RFs of both isotypes developed more eroded joints in their hands and feet during the study period than the rest of the patients. None of the differences, however, were statistically significant. Of the tested parameters only clinical rheumatoid activity (Mallya-index) was significantly related to the number of eroded joints during the follow-up. We conclude that serum IgA-type RFs are raised in erosive RA, but the determination of RFs of any kind cannot be used to prognosticate erosiveness.

Scintigraphy of rheumatoid peripheral joints. Reliability of visual assessment vs. computerized methods

99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy of peripheral joints was studied by visual evaluation (Visual Assessment) of the scintigrams and by a computerized region-of-interest (ROI) method without, or with a reference region (ROI method or Corrected ROI method). Sixteen rheumatoid patients and a total of 477 peripheral joints were studied and the results compared with clinical joint activity evaluated by joint palpation. The ROI method without a reference proved to be insensitive and hence unsuitable for clinical use. The results of Visual Assessment and the Corrected ROI method correlated well with each other and with clinical joint activity. The sensitivity of the methods in detecting a clinically inflamed finger joint was: ROI 6%, Corrected ROI 71% and Visual Assessment 75%. The corresponding figures for peripheral joints of the feet were as follows: 28%, 41% and 58%. We conclude that, for clinical use, Visual Assessment of the scintigram is adequate and the method of choice.

Palindromic rheumatism. A clinical survey of sixty patients

Sixty patients with palindromic rheumatism (PR) with a total follow-up time of 598 years and 295 years prospectively are presented. The study shows that PR is not a rare condition, but the syndrome is often ignored or misdiagnosed by the physician. Most cases of PR appear to evolve into chronic arthritis. PR may precede other kinds of systemic diseases, such as SLE, Wegener's granulomatosis, and multiple myeloma. The presence of PR in patients with fibromyalgia is reported in this paper. Gold appears to be the best drug for the treatment of PR. Cases of fibromyalgia and PR are treated successfully with antimalarial drugs. Our proposed diagnostic criteria for PR are as follows: 1) recurrent attacks of sudden-onset mono or polyarthritis or of periarticular tissue inflammation, lasting from a few hours to one week; 2) verification of at least one attack by a physician; 3) subsequent attacks in at least three different joints; 4) exclusion of other forms of arthritides.

Serum ferritin and free erythrocyte protoporphyrin in rheumatoid arthritis

In this prospective study 20 newly diagnosed patients with definite or classical rheumatoid arthritis were followed with serial measurements of serum ferritin and erythrocyte-free protoporphyrin at the beginning of the trial and at 3 and 6 months. The values were correlated with clinical disease activity ad with various laboratory parameters. It was shown that free erythrocyte protoporphyrin has a constant negative correlation with erythrocyte haemoglobin concentration independent of disease activity, while serum ferritin behaves like an acute phase protein. Initial serum ferritin or free erythrocyte protoporphyrin values or their early changes appeared to have no prognostic value as evaluated by the development of new erosions or by the response of the patient to the therapy.

Urinary neopterin index as a measure of rheumatoid activity

The urinary neopterin index (U-NEOPT-I), expressed as micro-moles of neopterin/moles of creatinine) of 67 patients with definite or classical rheumatoid arthritis was significantly higher than that of sex- and age-matched persons or of 24 non-matched patients suffering from osteoarthrosis or arthralgia (2p less than 0.001). Furthermore, the patients with active disease had statistically significantly increased U-NEOPT-I when compared with patients with a clinically less active disease. In this study, the U-NEOPT-I value was the equal of CRP as a measure of rheumatoid activity. We suggest that neopterin might be involved in the pathogenesis of rheumatoid arthritis.

Dihydroergotamine in the prevention of hypotension associated with extradural anaesthesia

The efficacy of a single dose of dihydroergotamine (DHE) 0.5 mg i.v. in preventing the decrease in arterial pressure resulting from extradural anaesthesia was studied in 47 patients; 24 received DHE and 23 a placebo, in a randomized double-blind manner. Although the decrease in systolic arterial pressure was more pronounced in the placebo group than in the DHE group, the difference was not significant. Diastolic and mean arterial pressures were both significantly lower in the placebo group than in the DHE group during the initial phase of extradural anaesthesia. Administration of DHE did not cause any significant changes in heart rate. In both groups the heart rate decreased significantly during the 5-h period following the induction of extradural anaesthesia. The patients in the placebo group needed additional medication to increase unacceptably low arterial pressures or heart rate more frequently than the patients in the DHE group.

Palindromic rheumatism in two non-identical brothers with identical HLA including DR4

Two brothers, aged 52 and 44, who suffered from palindromic rheumatism (PR) for 12 and 15 years were studied. The disease remained palindromic in the older brother, while chronic deformities developed early in the course of the disease in the younger. Their identical HLA locus was A9,Aw19(29); B12,Bw22; Cw1; DR1, DR4.

Glutathione and selenium in rheumatoid arthritis

The concentration of selenium in serum (S-Se) was studied in 20 patients and glutathione in erythrocytes (E-GSH) in 16 patients with rheumatoid arthritis (RA) at onset and after 3 and 6 months of antirheumatic therapy with aurothiomalate (19 cases) or with D-penicillamine (one case). The values were compared to those of age and sex matched healthy controls. S-Se was significantly (p less than 0.01) lower in RA patients at the onset of the trial, but increased to the level of the controls during the follow-up. On the other hand, there was no difference in E-GSH between the patients and their controls before the onset of antirheumatic medication but the increase in E-GSH of RA patients during the trial was highly significant (p less than 0.001). Nevertheless, neither S-Se nor E-GSH correlated to changes in clinical or laboratory indicators of disease activity or to the development of new erosions in X-ray. It is concluded that changes in rheumatoid activity or disease progress occur independently of changes in S-Se or E-GSH.

Decarboxylation of S-adenosyl-L-methionine in vitamin B6 deficiency in rat liver

The effect of a prolonged diet deficient in B6-vitamin on the activity of adenosylmethionine decarboxylase from rat liver was investigated. In contrast to an earlier report, 12 adenosylmethionine decarboxylase activity was not found to be decreased under these restricted nutritional conditions. Moreover, the addition of pyridoxal phosphate into the standard incubation mixture did not stimulate the activity of adenosylmethionine decarboxylase from the livers of the rats fed the B6-vitamin deficient diet. It is suggested that the contradictory results of Sturman and Kremzner12 might be based on an artificial liberation of carbon dioxide from S-adenosyl-L-methionine in the presence of pyridoxal phosphate. The results of this communication do not support the view that pyridoxal phosphate acts as the prosthetic group of rat liver adenosylmethionine decarboxylase.

Enzymic decarboxylation of s-adenosyl-l-methionine in rat liver: possible interaction of putrescine with the prosthetic group

S-Adenosyl-L-methionine decarboxylase (EC 4.1.1.50) has been purified more than 1000-fold from rat liver. The molecular weight of the decarboxylase was calculated to be 68 000. No evidence was obtained indicating that pyridoxal phosphate acts as the prosthetic group of the enzyme. On the other hand, the decarboxylase apparently contains some carbonyl group(s) participating in the catalysis as supported by the inhibition of S-adenosyl-L-methionine decarboxylation in the presence of NaBH-4, phenylhydrazine or NaCN. Putrescine, the specific activator of mammalian S-adenosyl-L-methionine decarboxylase, might interact, directly or indirectly, with the carbonyl group(s) of the enzyme as suggested by the protection of the decarboxylase activity against borohydride reduction by the diamine.

Effect of methylglyoxal bis(guanylhydrazone) on polyamine metabolism in normal and regenerating rat liver and rat thymus

1. Injections of sublethal doses of methylglyoxal bis(guanylhydrazone), a potent inhibitor of putrescine-activated S-adenosylmethionine decarboxylase in vitro, resulted after a few days in an immense increase in the activity of S-adenosylmethionine decarboxylase in normal and regenerating rat liver and in rat thymus. The increase in the activity of S-adenosylmethionine decarboxylase was at least partly due to a marked lengthening of the half-life of the enzyme. 2. In regenerating liver and thymus there was also a moderate stimulation of the activity of ornithine decarboxylase (EC 4.1.1.17) and a marked accumulation of tissue putrescine. 3. Injection of methylglyoxal bis(guanylhydrazone) into the rat also markedly decreased the activity of diamine oxidase (EC 1.4.3.6) in thymus. 4. In no cases where doses of methylglyoxal bis(guanylhydrazone) close to the LD(50) dose for the rat were used was it possible to lower tissue spermidine content to any significant extent. 5. Methylglyoxal bis(guanylhydrazone) seemed to act as a competitive inhibitor for the substrate S-adenosylmethionine and as an uncompetitive inhibitor for the activator putrescine in the decarboxylation of S-adenosylmethionine in vitro. 6. In the diamine oxidase reaction, with putrescine as the substrate, methylglyoxal bis(guanylhydrazone) was a non-competitive inhibitor for putrescine.