The effect of pregnancy on functions of inflammatory cells in healthy women and in patients with rheumatic disease

Chemiluminescence (CL) after zymosan stimulated phagocytosis of polymorphonuclear granulocytes (PMN) and mononuclear cells (MNC), random migration of PMN and intra- and extracellular activities of nine lysosomal enzymes were assessed serially in 8 healthy women and 10 women with rheumatic disease during and after pregnancy. A gestational increase of lysosomal enzymes in serum and enhancement of PMN random migration was observed in all women. Significant differences between healthy and rheumatic women were found for CL of phagocytic cells. In healthy women, CL of PMN was slightly enhanced, while it remained unchanged in MNC during pregnancy. In patients, CL of PMN was markedly suppressed, while MNC CL increased during gestation. An inverse relationship between CL and intracellular enzyme activities was noted. Thus, the presence of an inflammatory state seemed to influence the gestational behavior of phagocytic cells.

The Norwegian multicenter study

The largest multicenter, double-blind trial comparing piroxicam with naproxen in the treatment of osteoarthritis has recently been conducted in Norway. More than 2,000 patients were enrolled in the 12-week study. Both drugs showed similar efficacy, and serious gastrointestinal side effects occurred in less than 1 percent of the patients taking either agent. These findings are similar to results with other nonsteroidal anti-inflammatory drugs. This study indicates that in the treatment of osteoarthritis, piroxicam is as effective as naproxen and poses no greater risk of serious gastrointestinal side effects.

Structural studies of a carbohydrate-containing immunoglobulin-lambda-light-chain amyloid-fibril protein (AL) of variable subgroup III

The amino acid sequence of the variable region of a carbohydrate-containing amyloid-fibril protein MOL of immunoglobulin-light-chain type (AL) was elucidated. The sequence determination involved cleaving the protein with CNBr, BNPS-skatole, thermolysin and trypsin. The sequenced protein consisted of about 130 amino acid residues; however, gel-filtration and N-terminal analysis studies revealed AL proteins ranging in Mr from about 10,000 to 25,000. The oligosaccharide chain was found to be bound in the hypervariable region. By sequence homology to other lambda chains the AL protein MOL was shown to be of the V lambda III subgroup.

Piroxicam and naproxen plasma concentrations in patients with osteoarthritis: relation to age, sex, efficacy and adverse events

Piroxicam and naproxen plasma concentrations were obtained after 4 weeks active therapy between 3 and 12 hours post-dose in 640 and 629 patients, respectively. These patients are a subset of 2,035 patients with osteoarthritis on whom we have reported previously (11) in a double-blind multicentre safety and efficacy trial comparing piroxicam 20 mg/day and naproxen 750 mg/day. The purpose of the present study was to look for an association of plasma drug concentration with the variables of: age, sex, adverse events and efficacy. There was a statistically significant increase in plasma concentrations of both drugs with increasing age and females had higher concentrations than males. The increase in plasma concentration seen with increasing age was of a magnitude of 25% for piroxicam and 20% for naproxen when comparing a 50 year old to an 80 year old. However, less than 15% of the variability in plasma concentrations seen between patients is accounted for by age and sex. Within the plasma concentrations achieved with these doses, no association with adverse events, non-serious or serious, and efficacy was noted.

Gastrointestinal peptides in serum and synovial fluid from patients with inflammatory joint disease

The concentrations of immunoreactive vasoactive intestinal polypeptide (ir-VIP), immunoreactive pancreatic polypeptide (ir-PP), ir-somatostatin, and ir-secretin were measured in serum and synovial fluid from patients suffering from various inflammatory joint diseases. One group of patients were not taking any medication, while another group received anti-inflammatory treatment at the time of sampling. High levels of ir-VIP in the synovial fluid were observed in the untreated group of patients, and the concentration of ir-VIP in the synovial fluid was significantly higher than in parallel serum samples. On the other hand, no significant differences in the concentrations of the other peptides were observed either between serum and synovial fluid or between the two groups of patients. It is suggested that VIP is released locally at the inflammatory site and that VIP may be of significance in inflammatory disorders.

Characterization of amyloid protein AA and its serum precursor SAA in the horse

Amyloid was extracted from the liver of a horse that had developed amyloidosis after being used for several years for the production of antibodies to bacterial antigens. The amyloid fibrils were shown to be of the AA type. Two AA proteins with molecular weights of 9000 and 11,000 and with identical partial N-terminal amino acid sequences were identified. Marked structural homology with AA from other species including man was seen, although clear species-related antigenic specificity was observed. SAA isolated from an acute phase (septic abortion) horse serum was identical to AA with respect to antigenicity and the 10 first N-terminal amino acid residues that have been studied up to now. The bulk of SAA was present in the high-density lipoprotein complex in serum. Also SAA was heterogeneous with respect to size, most molecules having a molecular weight of 11,000, and a minority 9000.

Absence of interferons-alpha and -gamma in renal lesions of systemic lupus erythematosus and membranous glomerulonephritis

Frozen kidney biopsy sections from nine patients with systemic lupus erythematosus (SLE) as well as many other renal diseases, including IgA nephropathy, membranous nephritis, and minimal change nephrotic syndrome, were negative for interferons -alpha and -gamma by immunofluorescence. Lupus patients studied included several subjects with marked serum elevations of interferon activity as well as others with low or negative serum interferon levels. Isolated glomerular eluates prepared from normal and SLE kidneys showed no functional interferon activity by virus plaque inhibition assay. Components of normal as well as SLE serum showed no direct binding to interferon -alpha or -gamma by ELISA assays.

The effect of normal and rheumatic pregnancy sera on intracellular cathepsin B activity in human monocytes

In a prospective study of pregnant patients with rheumatic disease and healthy pregnant women, the effect of pregnancy serum on human blood monocytes was investigated. Intracellular activity of the collagen degrading enzyme cathepsin B was found to be significantly depressed in monocyte cultures exposed to pregnancy and cord sera, independent of the presence or absence of an inflammatory state in the pregnant woman. Enzyme inhibition developed in a dose-dependent fashion over 3 days in culture. In contrast to cord and pregnancy sera, non-pregnant serum and serum from oral contraceptive users displayed enzyme stimulating activity. The response of monocytes to the stimulating agent carrageenan was unaffected by inhibitory sera. The nature of possible inhibitory factors in pregnancy and cord serum is discussed.

Immunofluorescence studies of florid rheumatic Aschoff lesions

We studied cardiac tissues of a patient who died of severe rheumatic myocarditis. Multiple Aschoff lesions were present throughout both ventricles and auricles. Immunofluorescence studies showed large monocytoid cells staining with OKM1 and anti-Leu M-3 as well as anti-Ia. Scattered T cells in areas of focal myocarditis stained with OKT3. Parallel staining for cardiac myosin-heavy chain antigens showed patchy dissolution of cardiac muscle fibers and traces of cardiac myosin within large monocytoid Aschoff cells.

Serum amyloid protein A (SAA): an indicator of inflammation in AIDS and AIDS-related complex (ARC)

The acute phase protein serum amyloid A (SAA) and C-reactive protein (CRP) were measured in a group of 30 homo- and bisexual males with AIDS, 31 males with AIDS-related complex (ARC) and 23 healthy male homosexual controls (HC) in Copenhagen. The mean values of SAA and CRP were significantly higher in the AIDS group compared to the two other groups. SAA was elevated also in the ARC group, whereas the mean CRP value was normal. No increase in SAA and CRP was found in the HC group. The AIDS patients with Pneumocystis carinii infections had the highest SAA values, those with Kaposi's sarcoma the lowest. The elevations in SAA and CRP preceded episodes of acute opportunistic infections often by several days before the infectious agents were identified. We conclude that patients with AIDS are able to establish an acute phase response as reflected by elevated SAA and CRP, and that measurement of these proteins may be of diagnostic and prognostic value.

A double-blind multicentre trial of piroxicam and naproxen in osteoarthritis

A multicentre, double-blind study of unprecedented size was conducted to compare the safety and efficacy of piroxicam and naproxen in the treatment of osteoarthritis. The study comprised 2,035 patients and a treatment period of 12 weeks. The dosage was 20 mg piroxicam and 750 mg naproxen daily with the option to reduce to 10 and 500 mg, respectively, at week 4 or 8. No major difference between the drugs was observed with regard to overall incidence of adverse events. The frequency of serious adverse events was about 1% for both drugs. A statistically significant decline of adverse events with age was found in both sexes. Piroxicam was significantly superior to naproxen for pain at rest and pain on movement at 12 weeks and degree of restriction in daily activity at 4 weeks. A significantly increasing beneficial effect was observed with both drugs between 4 and 12 weeks of treatment. The comparable safety observed for the two drugs is in contrast to perceptions based on spontaneous reports to official monitoring systems.

Hyaluronic acid production in vitro by synovial lining cells from normal and rheumatoid joints

Organ cultures and primary cell cultures were established from synovial tissue collected from patients with rheumatoid arthritis. Hyaluronic acid measured by the incorporation of [3H]glucosamine into the polysaccharide was found to be synthesised in the cultures immediately after transfer from in-vivo to in-vitro conditions. This was in contrast to the primary cultures established from cells isolated from normal joints. The latter cells did not synthesise any detectable hyaluronate. 90-100% of the cells in primary culture were found to be esterase positive, indicating their macrophage nature. The molecular weight of the hyaluronate produced by the pathological cells was low (approximately 50 000) compared with the molecular weight of hyaluronate found in joint fluid from normal or rheumatoid joints. Cell lines of fibroblasts established from rheumatoid joints and studied after four or seven passages also produced hyaluronate of low molecular weight. It is known that similar cell lines from normal joints produce a high molecular weight polymer.

The amino-acid sequence of the variable region of a carbohydrate-containing amyloid fibril protein EPS (immunoglobulin light chain, type lambda)

The amino-acid sequence of the variable region of a carbohydrate-containing amyloid fibril protein EPS of immunoglobulin lambda light chain origin has been elucidated. The protein was isolated from the liver of a patient (EPS) with an immunocyte dyscrasia of the IgM type. The molecular mass of this protein was found to be about 20 kDa including an oligosaccharide chain linked to it. The amino-acid sequence determination involved automatic Edman degradation of polypeptides obtained after cleaving the protein with BNPS-skatole, trypsin and thermolysin. The proposed sequence of the variable region of the protein showed that it may be assigned to the V lambda I subgroup. A tryptic and a thermolysinolytic peptide both containing the carbohydrate were isolated and characterized, and the localization of an oligosaccharide chain linked to asparagine was established.

Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromsø, northern Norway

In an epidemiological survey in Tromsø, northern Norway a prevalence of definite ankylosing spondylitis (AS) of between 1.1% and 1.4% was found (males: 1.9-2.2% and females: 0.3-0.6%). The ratio of male to female was between 3.9 and 6.1 in favour of the male sex. It was calculated that 6.7% of the B27 positive individuals had AS, and that 22.5% of the B27 positive subjects with back pain or stiffness suffered from AS.

Spinal ankylosing spondylitis: a variant form of ankylosing spondylitis or a distinct disease entity?

In a population survey of ankylosing spondylitis (AS) seven subjects, six males and one female, had x-ray changes in the lumbar spine typical of AS but without concomitant roentgenological sacroiliitis. The overall prevalence of such cases in the population studied was 0.37%. Four out of these seven subjects carried the tissue antigen HLA-B27 (57%). The clinical and roentgenological features of these subjects are described and it is suggested that the x-ray findings represent a mild and variant form of primary or definite AS.