Natural course of joint destruction and fluctuation of serum C1q levels in patients with rheumatoid arthritis

Complement C1s activation in degenerating articular cartilage of rheumatoid arthritis patients: immunohistochemical studies with an active form specific antibody

OBJECTIVE

The first complement component C1s was reported to have novel functions to degrade matrix components, besides its activities in the classic complement pathway. This study explores participation of C1s in articular cartilage degradation in rheumatoid arthritis (RA).

METHODS

Normal articular cartilage (n = 6) and cartilage obtained from joints with RA (n = 15) and osteoarthritis (OA, n = 10) were immunostained using anti-C1s monoclonal antibodies PG11, which recognises both active and inactive C1s, and M241, which is specifically reactive to activated C1s. The effects of inflammatory cytokines on C1s production by human articular chondrocytes were also examined by sandwich ELISA.

RESULTS

In normal articular cartilage, C1s was negative in staining with both PG11 and M241. In contrast, degenerating cartilage of RA was stained with PG11 (14 of 15 cases), and in most of the cases (13 of 15 cases) C1s was activated as revealed by M241 staining. In OA, C1s staining was restricted in severely degrading part of cartilage (5 of 10 cases), and even in that part C1s was not activated. In addition, C1s production by chondrocytes in vitro was increased by an inflammatory cytokine, tumour necrosis factor alpha.

CONCLUSION

These results suggest that C1s activated in degenerative cartilage matrix of RA but not in that of OA. C1s is thought to participate in the pathogenesis of RA through its collagenolytic activity in addition to the role in the classic cascade.

Knee and/or hip joint destruction in rheumatoid arthritis is associated with HLA-DRB1*0405 in Japanese patients

To determine the prognostic factors for knee and/or hip joint destruction in rheumatoid arthritis (RA) patients, we typed 379 RA patients for HLA-DRB alleles and analysed the antigen frequencies. The DRB1*0405 antigen frequency in RA patients who underwent total knee replacement and/or total hip replacement was significantly higher than in those who did not have replacements, which meant that DRB1*0405 was associated with knee and/or hip joint destruction. This finding may be of value for predicting knee and/or hip joint destruction in RA.

Cervical lesions related to the systemic progression in rheumatoid arthritis

STUDY DESIGN

Cross-sectional study of cervical involvement in rheumatoid arthritis.

OBJECTIVES

To clarify the correlation between the deterioration of cervical lesions and the systemic progression of rheumatoid arthritis.

SUMMARY OF BACKGROUND DATA

The natural course of cervical lesions varies. To date, no systemic parameter has been clarified to predict the progression.

METHODS

One hundred seventy-three patients with rheumatoid arthritis participated in this study. The authors studied the progression of cervical lesions and investigated the relation between the types of cervical subluxation at the end of study and the following four variables: the serum level of C-reactive protein, the number of joints with erosion, carpal height ratio, and disease subset (least erosive subset, more erosive subset, and mutilating disease subset).

RESULTS

Of the 173 patients, 55 already had cervical subluxation before entering the study. During the follow-up period, 44 patients deteriorated radiographically, and 77 (45%) had cervical involvement, including involvement of upper cervical lesions in 65 patients, upper lesions combined with subaxial subluxation in 10, and subaxial subluxation alone in 2. The upper cervical subluxation progressed in the order of anterior atlantoaxial subluxation, atlantoaxial subluxation combined with vertical subluxation, and vertical subluxation alone. Deterioration of upper cervical lesion and occurrence of subaxial subluxation were closely correlated with an elevation of serum C-reactive protein level, an increase in the number of joints with erosion, and a decrease in the carpal height ratio. The incidence of cervical involvement and the extent of deterioration were different among the disease subsets.

CONCLUSIONS

The serum level of C-reactive protein, the number of joints with erosion, and the carpal height ratio correlated closely with the extent of the cervical subluxation. The average C-reactive protein values during the follow-up period correlated with progression of the cervical lesions. The classification of rheumatoid disease subset was useful for predicting the terminal feature of the cervical lesions.

Outcomes for patients undergoing one or more total hip and knee arthroplasties

Either total hip arthroplasty (THA), total knee arthroplasty (TKA) or both were performed in 105 patients from 1981 to 1994. These patients were experiencing severe joint destruction in the lower extremities due to rheumatoid arthritis (RA). These patients were followed for more than 2 years after their last operation. Eighty-six patients were alive and 19 patients had died at the time of follow-up. The 86 living patients were divided into four groups based on the number of replaced joints. Their pre- and postoperative conditions, including such factors as pain, mobility and disability for the quality of life (QOL), were compared. All of the four groups showed some reduction in pain and disability, and an improvement in ambulation after the operations. The 19 deceased patients were classified into two groups, one including those with multiple (three or four) arthroplasties and the other, those with only a small number (one or two). The mean age at death was lower (55.7+/-6.2 years) in patients with multiple arthroplasties than that (69.1+/-7.5 years) in patients with only a small number of arthroplasties. Secondary diseases from RA, such as amyloidosis, spinal injury and pulmonary fibrosis, were found to be the primary cause of death in patients with multiple arthroplasties. The most important finding in this study is that although RA patients with multiple arthroplasties in the lower extremities improved their QOL, they were still afflicted with secondary diseases derived from RA and experienced complications that could shorten their lifespan.

An association between the natural course of shoulder joint destruction in rheumatoid arthritis and HLA-DRB1*0405 in Japanese patients

To assess the association between HLA-DRB1 alleles and shoulder destruction due to rheumatoid arthritis (RA) in Japanese, we typed for HLA-DRB1 alleles in 100 Japanese RA patients who could be classified into 5 groups: non-progressive (N) with normal radiographs; erosive (E) showing marginal erosion but no collapse; collapse (C) showing subchondral cysts followed by collapse; arthrosis-like (A) showing osteoarthrotic features; and the mutilating (M) showing mutilating bone destruction. The HLA-DRB1*0405 antigen frequency in N, E, C, A, and M types was 55%, 61%, 33%, 71%, 100%, respectively. That in the M type (100%) was significantly higher than that in the others (the N, E, C, and A types; 57%). These findings suggest that the most severe shoulder joint destruction pattern in RA, the M type, is associated with HLA-DRB1*0405.

Soluble Fas ligand in the joints of patients with rheumatoid arthritis and osteoarthritis

OBJECTIVE

To investigate the expression and function of Fas ligand (FasL),which can be in a membrane-bound or soluble form, in the joints of patients with rheumatoid arthritis (RA) and osteoarthritis (OA).

METHODS

The concentration of soluble FasL (sFasL) in serum and synovial fluid (SF) from 24 OA and 38 RA patients was measured using an enzyme-linked immunosorbent assay. The expression of FasL on SF lymphocytes (SFL) and peripheral blood lymphocytes (PBL) was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. A cytotoxic killing assay of membrane-bound FasL and purified sFasL against cultured synovial cells was also performed.

RESULTS

Soluble FasL was detected in the SF of patients with RA and OA, but not in their serum. The concentration of SF sFasL was remarkably higher in patients with severe RA than in patients with mild RA or with OA. RT-PCR showed that SFL, but not PBL, from RA patients expressed messenger RNA for FasL. Membrane-bound FasL induced apoptosis in cultured synovial cells from the RA and OA patients, but naturally processed human sFasL did not.

CONCLUSION

SFL from RA patients expressed FasL, and cleaved sFasL accumulated in the SF of inflamed joints. The different killing activity of membrane-bound FasL and sFasL against synovial cells may regulate Fas-mediated apoptosis in synovial cells.

Recognition of rheumatoid arthritis synovial antigen by CD4+,CD8- T cell clones established from rheumatoid arthritis joints

OBJECTIVE

To investigate the rheumatoid arthritis (RA)-specific autoantigen(s) recognized by CD4+ T cells in patients with RA.

METHODS

CD4+,CD45RO+ T cell clones were established from the joints of RA patients, and were examined for their proliferative response to synovial cells.

RESULTS

Eight of 146 T cell clones responded to RA synovial cells in a DR-restricted manner. These T cell clones recognized solubilized antigens extracted from RA synovial cells in the presence of DR-matched antigen-presenting cells, but did not respond to those extracted from non-RA synovial cells. The antigens had a molecular weight of 50/25 kd. Five of the 8 T cell clones used T cell receptor BV6, and the remaining clones used BV12.2.

CONCLUSION

The antigens recognized by joint-infiltrating CD4+ T cells are present exclusively in RA synovial cells. The expression of these antigens by synovial cells may trigger the autoreactivity of T cells in RA joints.

Shoulder destruction in rheumatoid arthritis. Classification and prognostic signs in 83 patients followed 5-23 years

We studied the natural course and the possibility of making prognoses about shoulder joint destructions in 83 patients with rheumatoid arthritis (RA) (166 shoulder joints). For this purpose, we used radiographic patterns and 2 indices (upward migration and medial displacement). The patterns of joint destruction were classified into 5 groups: 1) non-progressive type (n 74) with normal radiographs, only osteopenia or small erosions even after 15-20 years of RA; 2) erosive type (n 22) showing marginal erosions but no collapse; 3) collapse type (n 34) showing subchondral cysts, followed by collapse; 4) arthrosis-like type (n 12) showing arthrotic features; 5) mutilating type (n 14) showing mutilating bone destructions. From the radiographic findings and the 2 indices determined at 5-10 years, we could predict the prognosis of shoulder joint destruction after 15-20 years of RA. Our findings may be of value for selecting treatment, including surgery, for the rheumatoid shoulder.

Elevated levels of the soluble form of bone marrow stromal cell antigen 1 in the sera of patients with severe rheumatoid arthritis

OBJECTIVE

Bone marrow stromal cell antigen 1 (BST-1) is a novel glycosyl phosphatidylinositol-anchored ectoenzyme, which is overexpressed on bone marrow stromal and synovial cell lines derived from patients with rheumatoid arthritis (RA). To investigate the pathophysiologic roles of BST-1 in RA, we established an enzyme-linked immunosorbent assay (ELISA) system to detect the soluble form of BST-1 (sBST-1) and examined levels of sBST-1 in the sera of RA patients.

METHODS

Concentrations of sBST-1 in sera from healthy donors and from patients with RA, osteoarthritis, Sjögren's syndrome, and systemic lupus erythematosus were measured with the ELISA.

RESULTS

In 7% of the RA patient samples (10 of 143), concentrations of serum sBST-1 were higher (approximately 30-50-fold) than in non-RA samples. Serum sBST-1 concentrations showed no correlation with age, C-reactive protein level, or rheumatoid factor level. All RA patients with high concentrations of serum sBST-1 had severe disease with involvement of several large joints.

CONCLUSION

We believe the measurement of serum sBST-1 may have prognostic value, but further analysis is necessary to clarify the clinical significance of elevated sBST-1 in RA.

Activity-induced pain in rheumatoid arthritis functional class II and its relations with demographic, medical, functional, psychosocial, and work variables. Result of a survey in Bollnäs Medical District, Sweden, II

One aim of this study was to describe inflammatory activity, joint destruction, work status, and demographic factors in a group of 69 American Rheumatism Association functional class-II rheumatoid arthritis patients: 56 women and 13 men, mean age 54 years (SD 11), mean symptom duration 14 years (SD 11). Another aim was to determine correlations between activity-induced pain and other variables. Patients were assessed with Ritchie's articular index, Larsen's radiologic index, and laboratory tests. Deformity in hands and knee joints, and grip strength, were determined. Results from earlier investigations of functional impairment and psychosocial capacity were also used. Of the patients, 4% had high inflammatory activity. Joint erosions were found in between 4% (knee joints) and 55% (wrists) of the joints examined. Of the patients aged less than 65, 43% were working. Activity-induced pain was related with work status (p = 0.0002). It also correlated significantly (p less than or equal to 0.01) with inflammatory activity (r(s) = 0.34), but not with joint destruction (r(s) = 0.21).

The search for laboratory measures of outcome in rheumatoid arthritis

A large number of laboratory tests have been developed within the past decade to measure factors involved in the immune inflammation of RA. These can be divided into genetic markers, general measures of inflammation, autoantibodies and tissue-specific markers. In general, it is simpler to prove the power of a certain test to measure the disease process than to predict outcome. Apart from RF positivity and CRP/ESR, few, if any, tests have proven to be of importance in independent studies from different centres. Among the promising candidates for future work are detailed analysis of the HLA-D region genes, sulphoxidation status, the autoantibody against RA33 nuclear antigen, soluble IL-2 receptor measuring lymphocyte activity, hyaluronate/hyaluronan or PIIINP from synovial tissue, the combined use of COMP and proteoglycan epitope tests for cartilage matrix, and pyrodinoline cross-linking for collagen from bone and cartilage. The ideal setting for testing such markers are prospective cohort studies starting early in the disease, and since many such studies have been initiated recently, one can expect much new information in coming years. Attention needs to be devoted to the kinetics of marker metabolism, since many are degraded or removed at very fast rates from the circulation, making serum assays less informative.

Clinical correlations with serum C1q levels in patients with rheumatoid arthritis

Previous studies have suggested that serum C1q levels measured during the first 5 years of rheumatoid arthritis (RA) may be predictive of the extent of subsequent joint damage. To further evaluate the clinical significance of this marker in RA, levels of C1q were measured by radial immunodiffusion in serum samples from 107 well-characterized patients with RA. Mean levels of C1q were higher in patients with a disease duration less than or equal to 5 years (173 micrograms/ml) than in patients with a disease duration greater than 5 years (148 micrograms/ml) (P = 0.032). Serum C1q levels were correlated with total joint counts and activities of daily living scores, but no correlation was observed with erythrocyte sedimentation rates or with radiographic scores. The results suggest that C1q may be a useful early marker of disease activity in patients with RA.

Facs analysis of myeloid differentiation stages in epiphyseal bone marrow, adjacent to joints affected with rheumatoid arthritis

To analyze the differentiation stages of myeloids statistically, we adopted a two-color FACS system and used appropriate monoclonal antibodies belonging to CD15, CD16 and CD11b. By using HL60 treated with DMSO or human bone marrow MNCs from patients with rheumatoid arthritis, it was proved that with this system, myeloids could be clearly separated according to differentiation stages. Furthermore, the number of myeloids at certain stages of differentiation in the epiphyseal bone marrow of patients with RA or OA was measured. Nine of 15 samples from RA patients showed immature and relatively mature myeloids, while none of the 8 OA samples did. When the proportions of myeloids in epiphyseal bone marrow MNCs were compared with the clinical features, disease subsets in RA and the degree of synovitis, seemed to be important factors for abnormal myelopoiesis.

Cytokines in chronic inflammatory synovitis

Cytokines likely play a role in the pathogenesis of rheumatoid arthritis and other chronic inflammatory arthritidies. Recent studies on the cytokine profile of inflammatory synovitis have provided insight into the mechanisms of cellular activation in the inflamed joint. Although gamma interferon has been proposed as a major macrophage activating factor and inducer of class II major histocompatibility antigens in the joint, studies using sensitive and specific immunoassays have shown that the concentration of this lymphokine in synovial fluid is probably not sufficient to account for the high level of HLA-DR expression on Type A synoviocytes and macrophages in the joint. In contrast, GM-CSF has recently been identified in synovial effusions of patients with rheumatoid arthritis and is produced by synovial tissue cells in vitro. Like gamma interferon, GM-CSF is a known macrophage activating factor and induces HLA-DR on cells of macrophage lineage. Furthermore, supernatants of cultured synovial tissue cells contain an HLA-DR inducing factor that is neutralized by specific antibodies to GM-CSF but not by antibodies to gamma interferon. These data suggest that GM-CSF plays a significant role in macrophage activation in the synovium.