Elevated level of IgA gliadin antibodies in patients with rheumatoid arthritis

The possibility that dietary antigens contribute to the pathogenesis of rheumatoid arthritis (RA) has been proposed. Moreover, occasional patients have been described in whom coeliac disease and RA coincide. Furthermore, most RA patients are treated with non-steroidal anti-inflammatory drugs (NSAIDs), which are known to increase gut permeability. For these reasons antibodies against gliadin were measured in a group of 43 patients with rheumatoid arthritis (RA) and a group of 43 age- and sex-matched controls. The median IgA antigliadin ELISA index was 7.1 (range 2.1-22.4) for the RA group and 3.1 (range 0.3-34.9) for the controls (p = 0.0001). The median IgG and IgM antigliadin indexes for the RA group didn't differ significantly from those of the controls. In the RA group, the level of antigliadin antibodies did not correlate with the daily dose of NSAIDs. The elevated IgA antigliadin titre in the RA group might be ascribed to the use of NSAIDs, which are harmful to the gut, but the immunological trigger effect of gluten cannot be ruled out.

Infectious arthritis caused by Propionibacterium acnes: a report of two cases

Propionibacterium acnes, a micro-organism with low pathogenicity, rarely causes arthritis in a joint without a prosthesis. This report deals with two cases of P acnes infectious arthritis probably caused by direct penetration of the micro-organism into the joint space during arthrocentesis, despite the use of strict disinfection procedures. P acnes isolated from synovial fluid cannot be dismissed as a bothersome contaminant without due consideration of the clinical status of the individual patient.

Melkersson-Rosenthal syndrome in a patient with sero-negative oligoarthritis

The Melkersson-Rosenthal syndrome is a rare disease consisting of orofacial swellings, facial nerve palsy and plicated tongue. The etiology is unknown. On histopathological examination a characteristic granulomatous inflammation is found. A case of this syndrome in a young white female with seronegative oligoarthritis is described and the possible relationship between the two diseases is discussed on the basis of the literature.

DR4 prevalence related to the age at disease onset in female patients with rheumatoid arthritis

The prevalence of HLA-DR4 in relation to age at disease onset was calculated in 226 consecutive female patients with definite or classical rheumatoid arthritis (RA). A slight increase in the prevalence of DR4 with age at RA onset was found. This appeared to be due to the low percentage of rheumatoid factor (RF) positivity in the youngest age groups; the DR4 prevalence in the RF positive patients was constant for all decades--that is, approximately 60%. A previously reported declining trend of DR4 prevalence in women with RA in relation to age of RA onset may be due to the disease heterogeneity of the patients included in that study.

Elevation of serum aluminium concentrations in patients with rheumatoid arthritis treated with drugs containing aluminium

In a group of 19 rheumatoid arthritis (RA) patients with normal renal function, serum levels of aluminium (AlS) were monitored during treatment with drugs containing this metal (Al). The AlS levels during treatment were significantly higher (0.005 less than p less than 0.01) than those before treatment, i.e. 19.4 (SEM 2.3) micrograms/l and 12.3 (1.7), respectively. This increase in AlS was significantly (0.025 less than p less than 0.05) correlated with the pretreatment serum creatinine level (mean value for the whole group 80.5 (SEM 4.7) mumol/l) but showed no correlation with the predicted creatinine clearance. Although the increase in AlS during therapy with A1 containing drugs is not dramatic in RA patients with normal renal function, the rheumatologist should be aware of the risk of increased AlS concentration in RA patients, especially those with impaired renal function.

Atrioventricular conduction disturbance as an early feature of Reiter's syndrome

Atrioventricular (A-V) conduction disturbances in Reiter's syndrome are usually described in longstanding disease. This report deals with two male patients with Reiter's syndrome who developed an A-V block early in the course of the disease. One of these patients developed a second degree A-V block, Wenckebach type, which has not been described before at an early stage of this syndrome.

Errors in the prediction of creatinine clearance in patients with rheumatoid arthritis

The accuracy of two equations used to predict creatinine clearance was assessed in 27 patients with rheumatoid arthritis (RA) and 34 controls. Both equations were accurate in controls, but overestimated the clearance in RA patients. The degree of overestimation was not related to patient characteristics. Uncritical use of these equations in RA patients may lead to serious error.

Effects of anti-rheumatic drugs on in vitro mitogenic stimulation of peripheral blood mononuclear cells

The efficacy of bromocriptine, chloroquine, and Cs was quantitated in an in vitro system, with the use of mitogen-stimulated human PBMC. A concentration-dependent effect was found for each drug. Based on counts of blast cells, Cs was roughly 70 times more effective than either bromocriptine or chloroquine. Besides quantitative comparison of the effect of the drugs, the in vitro system permits conclusions concerning drug combinations. The effect of the combination of bromocriptine and Cs was equal to the expected effects of the separate drugs. However, the combined effect of chloroquine and Cs exceeded the sum of the effects of the individual drugs, which indicates synergy, not addition.

Human parvovirus B19 DNA in synovial fluid

We describe a 33-year-old woman with a serologically proven human parvovirus B19 infection, who developed synovitis. Using a dot-blot hybridization technique, we detected B19 DNA in her synovial fluid. To our knowledge, this is the first report of the isolation of B19 from synovial fluid.

Comparison of packages for suppositories by patients with rheumatoid arthritis

Ninety-four patients with rheumatoid arthritis were asked via a questionnaire about the convenience of packages containing tablets, capsules, or suppositories for home use. Almost half of the patients stated that they had difficulty in opening packages containing capsules or tablets, and two-thirds had difficulty with the packages used for suppositories. The characteristics of six packages used for suppositories were also compared. Patients were given the packages in random order and were asked to open them and remove a suppository. Many of them were unable to open three of the packages with their hands. The evaluation of the six packages by the patients differed widely.

Antibiotic prophylaxis in craniotomy: a prospective double-blind placebo-controlled study

A prospective double-blind placebo-controlled study was performed to evaluate the efficacy of cloxacillin for the prevention of infections after craniotomy. 310 patients were admitted to the study. 39 died within 90 days after craniotomy without an infection, 20 and 19 of them belonging to the cloxacillin and placebo groups, respectively. In the cloxacillin group 6 neurosurgical infections occurred after 183 operations (3.3%) in 156 patients (3.9%), and in the placebo group 20 after 195 operations (10.3%) in 154 patients (13%). These differences between the 2 groups are statistically significant (p less than 0.01 and p less than 0.05 for patients and operations, respectively). For a craniotomy subgroup, there was no significant difference in infection rate between the cloxacillin and placebo groups. We conclude that cloxacillin significantly reduces the rate of infection after craniotomy, and recommend administration of this antibiotic for prophylaxis in patients undergoing this operation.

Effect of cyclosporin on serum creatinine in patients with rheumatoid arthritis

Serum creatinine levels were measured before, during and after the administration of cyclosporin (Cy) in a double-blind placebo-controlled study in patients with rheumatoid arthritis (RA). The level rose significantly during and after Cy therapy, whereas the initial serum creatinine value did not change in the placebo group. The increase in the Cy group was not correlated with the mean Cy blood level. The rise in serum creatinine during Cy therapy was gradual and was not significantly correlated with the initial creatinine level; relative to the pretreatment value, the post-treatment increase was significantly correlated with the increase during Cy therapy. It is concluded that Cy administration for not more than 6 months, and at a maximum dosage of 10 mg/kg for 2 months, leads to an irreversible loss of more than 10% of renal function in RA patients. The damage may be ascribed to the combination of Cy with other factors compromising the kidneys, e.g., the use of non-steroidal anti-inflammatory drugs in the potentially systemic disorder of RA.

Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies

Renal abnormalities in 132 necropsied patients with rheumatoid arthritis were studied. Clinical findings before death included extra-articular manifestations of the disease (86% of patients), systemic vasculitis (6%), and uraemia (23%). Necropsy findings included nephrosclerosis (90%), systemic vasculitis (14%) with kidney involvement in 8%, amyloidosis (11%), membranous glomerulopathy (8%), and focal glomerular disease (8%). Association with clinical data suggests that both rheumatoid and non-rheumatoid disease may play a part in the cause of these abnormalities.

Predictability of serum concentrations of aminoglycosides after haemodialysis

The study was undertaken to look for a correlation between the measured elimination rate constants (k) of aminoglycosides and creatinine during haemodialysis. The pharmacokinetics of aminoglycosides were studied during 44 courses of haemodialysis in 21 patients. The measured k of gentamicin and tobramycin from the start until 30 min after the end of haemodialysis (mean 0.18 h-1; t1/2 = 3 h 51 min) was significantly correlated with the measured k of creatinine (mean 0.13 h-1; t1/2 = 5 h, 20 min), and also with the gentamicin and tobramycin k during haemodialysis (mean 0.20 h-1, t1/2 = 3 h, 28 min), as predicted by a computer program. Thus, serum concentrations of aminoglycosides 30 min after haemodialysis can be estimated by simple regression equations. However, because the measured and predicted values may diverge considerably in the individual patient, monitoring of aminoglycoside concentrations in serum after haemodialysis remains necessary.

Non-gonococcal infectious arthritis: a retrospective study

In a retrospective study the outcome of non-gonococcal infectious arthritis was evaluated in 76 adult patients admitted to the Leiden University Hospital between 1970 and 1984. The mortality rate was 12%, and complete recovery was achieved in only 19 of the 76 patients (25%). Each of the following had a significantly unfavourable influence on the residual joint function: duration of infection more than 14 days, female sex, presence of rheumatoid arthritis, and presence of a joint prosthesis.