Decrease in peripheral type 1 over type 2 T cell cytokine production in patients with rheumatoid arthritis correlates with an increase in severity of disease

OBJECTIVES

To compare peripheral type 1 (T1) and type 2 (T2) T cell activities in rheumatoid arthritis (RA) patients with that found for osteoarthritic (OA) patients and healthy controls and to correlate peripheral T1/T2 cell activity in RA with parameters of the disease.

METHODS

Peripheral blood mononuclear cells were isolated from patients with RA (n = 66), OA (n = 19), and healthy controls (n = 15). Primary T cell activity in these mononuclear cells was enhanced by means of anti-CD3/anti-CD28, which mimicks stimulation of T cells by activation of the T cell receptor and a major co-stimulatory signal. Interferon gamma (IFN gamma) production and interleukin 4 (IL4) production in the three groups were quantified as measures of T1 and T2 cell activity, respectively, and compared. Serum tumour necrosis factor alpha (TNF alpha), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and joint destruction assessed radiographically of RA patients were determined as parameters of disease activity and correlated with T1/T2 cell activity.

RESULTS

Peripheral T cells from RA patients produced significantly less IFN gamma and more IL4 than T cells from both age and sex matched OA patients and healthy controls. Moreover, in RA patients both a decrease in IFN gamma and an increase in IL4 production correlated with an increase in serum TNF alpha, ESR, CRP, and joint destruction.

CONCLUSIONS

These results suggest a role for differential T cell activity in RA. In view of the intra-articular T1 cell predominance the results might be explained by selective T1 cell migration into the joint or peripheral suppression of T1 cell activity.

Androgens as adjuvant treatment in postmenopausal female patients with rheumatoid arthritis

OBJECTIVE

To examine the possible beneficial effect of androgens in postmenopausal women with active rheumatoid arthritis.

METHODS

107 women participated in a double blind placebo controlled trial to evaluate the effect of 50 mg testosterone propionate intramuscularly every two weeks for one year.

RESULTS

An improvement in ESR, Dutch health assessment questionnaire, and pain was noted. In addition, 21% of patients treated with testosterone fulfilled the ACR improvement criteria after one year, versus only 4% of the placebo group. The treatment was well tolerated.

CONCLUSIONS

Testosterone may improve the general wellbeing of postmenopausal women with active rheumatoid arthritis.

Changes in proteoglycans of ageing and osteoarthritic human articular cartilage: an electron microscopic study with polyethyleneimine

BACKGROUND

Ageing and osteoarthritic (OA) cartilage show characteristic alterations in chondrocyte morphology and in the composition and content of matrix proteoglycans (PGs). Data concerning matrix components are mostly of biochemical nature. Ultrastructural histochemistry is needed to gain more information about distribution of these altered matrix components.

METHODS

We used the cationic dye polyethyleneimine (PEI) to visualize at the EM level alterations in the distribution and dimensions of PGs of human healthy young, healthy aged, and OA articular cartilage.

RESULTS

Young cartilage contained PEI-positive granules in the superficial layer and big winding PEI-positive structures in the deeper layers. In the healthy aged tissue, PEI-positive granules were observed throughout the matrix and smaller winding structures were present in the deeper layer. In OA cartilage both types of PEI-positive structures were absent in the superficial layer. Deeper in the matrix PEI-positive granules could be demonstrated. Moreover, PEI-positive angular structures were observed in the deeper zones.

CONCLUSIONS

The differences in PEI-positive structures are a good reflection of the differences in PGs between young, ageing, and OA cartilage as demonstrated in biochemical studies. PEI, used at the EM level, gave more precise information concerning the localized changes in quality, quantity, and location of PGs in articular cartilage during ageing and disease.

Cytokines and proteoglycans

Cytokines play an important regulatory role in the metabolism of proteoglycans. Proteoglycans are found in plasma membranes, but predominantly in the extra-cellular matrix. In the latter they are quantitatively and qualitatively essential components. Especially in a tissue like cartilage without any blood vessels, the cells are dependent on cytokines for the communication among themselves in the extra-cellular matrix and also for communication with the 'outside world'. Various cytokines have been found to be able to penetrate the extra-cellular matrix and inhibit, respectively stimulate the proteoglycan synthesis. Also, the degradation of proteoglycans can be stimulated, respectively inhibited by several cytokines. In addition, some cytokines have been found which regulate the effects of the other cytokines. With respect to proteoglycan metabolism a complex cytokine network is emerging. Furthermore it is becoming increasingly clear that proteoglycans are connected to the cytokine network by their own bioactive functions. First, they possibly possess cytokine activities themselves. Second, they can function as receptors, protectors, inactivators and storage ligands for cytokines. So the proteoglycans are clearly involved in the feedback signalling from the extra-cellular matrix to the cells that are synthesizing this extra-cellular matrix. Together with agonistic or antagonistic cytokines they are involved in the regulation of proteoglycan turnover during balanced or unbalanced metabolism in normal, respectively pathological situations.

Osteoarthritic human cartilage is more sensitive to transforming growth factor beta than is normal cartilage

Osteoarthritis is a degenerative joint disease, characterized by the destruction of the articular cartilage. One of the first changes in the osteoarthritic articular cartilage is a reduction in proteoglycan content. In this study we demonstrate that transforming growth factor beta (TGF beta), a multi-functional growth factor, stimulates the proteoglycan synthesis of explants from human articular knee cartilage dose-dependently in vitro. Osteoarthritic cartilage proved to be much more sensitive to stimulation by TGF beta than normal healthy cartilage. This may indicate that TGF beta plays an important role in the repair of osteoarthritic cartilage.

Articular cartilage explant culture; an appropriate in vitro system to compare osteoarthritic and normal human cartilage

Proteoglycan metabolism of normal and histologically mild to moderate osteoarthritic cartilage explants were studied. Explants were obtained from the human knee of donors aged over 40 years. Proteoglycan content, synthesis and release were very similar in normal cartilage obtained from donors with focal osteoarthritis and cartilage obtained from donors without any sign of osteoarthritis. This suggests that cartilage obtained from donors with focal osteoarthritis indeed can be considered as "normal". The relatively large surface area-compared to their natural setting in the joint- of cartilage explants in culture did not affect the parameters measured, as there was a strong linear correlation between these parameters and the weight of the explants. From our results, we conclude that the use of full depth cartilage tissue explants is a reliable way to assess and compare proteoglycan content, synthesis and release in normal and osteoarthritic cartilage from the same donor.

Intermittent hydrostatic compressive force stimulates exclusively the proteoglycan synthesis of osteoarthritic human cartilage

In paired observations the in vitro proteoglycan turnover was studied of human normal and osteoarthritic cartilage in the absence and presence of intermittent hydrostatic compressive force. Shortly after collection, osteoarthritic cartilage showed a higher proteoglycan synthesis rate than normal cartilage, whereas after culture the reverse was found. Exposure during culture to hydrostatic intermittent compression of a low physiological magnitude enhanced the proteoglycan synthesis rate for osteoarthritic cartilage, whereas normal was unaffected by this hydrostatic intermittent compression. This enhancing effect was reversible. We conclude that human osteoarthritic cartilage is in vivo synthetically more active than normal cartilage, but loses this increased activity in vitro. Enhanced sensitivity of osteoarthritic cartilage to compressive forces may contribute to the increased proteoglycan synthesis of osteoarthritic cartilage.

Local changes in proteoglycan synthesis during culture are different for normal and osteoarthritic cartilage

Proteoglycan synthesis of mild-to-moderate osteoarthritic human knee cartilage was compared with that of normal cartilage of the same donor. Immediately after cartilage was obtained, the synthesis rate of proteoglycans was higher for osteoarthritic cartilage than for normal cartilage. Proteoglycan synthesis was then located, for both normal and osteoarthritic cartilage, in the middle and deep zone. However, after 4 days of culture, proteoglycan synthesis rate was higher for normal cartilage than for osteoarthritic cartilage. The reason for this transition from a lower to a higher proteoglycan synthesis rate was a strong increase in the proteoglycan synthesis in the superficial zone of normal cartilage. This was not observed for the osteoarthritic cartilage. The chondrocytes in the superficial zone of osteoarthritic cartilage, in contrast to normal cartilage, were mainly joined in cell clusters and proliferating. This may explain their inability to contribute to proteoglycan synthesis.

Influence of rheumatoid synovial fluid and cells on proteoglycans in human cartilage explants. Modulation by piroxicam

We have studied the effects of cell-free rheumatoid synovial fluid (RASF) and the conditioned medium (CM) from these cells on the proteoglycans (PGs) of normal human cartilage and the influence which piroxicam might have on these processes. Both RASF and the CM from RASF cells enhanced the PG release from the cartilage explants. The effects of the above mentioned fluids on the cartilage PG content depended on the metabolic state of the cartilage i.e. correlated inversely with the PG synthesis. Whether this was due to the presence of anabolic and catabolic factors in these fluids is discussed. Piroxicam had no adverse effect on the PGs of human cartilage in vitro. Piroxicam prevented the cartilage PG depletion when it was induced by the CM from RASF cells.

Human osteoarthritic cartilage is synthetically more active but in culture less vital than normal cartilage

The proteoglycan turnover of human osteoarthritic (OA) cartilage was compared to that of normal (N) cartilage. The cartilage was obtained postmortem from human femoral knee condyles. Short term cultures were compared to longterm cultures, and proteoglycan synthesis rate, content and release determined. Proteoglycan synthesis rate, determined shortly after collection of the cartilage, was higher in OA cartilage than in N cartilage. After longterm culture, the initially higher proteoglycan synthesis rate of OA cartilage became lower than that of N cartilage. An increased percentage release of proteoglycans from OA cartilage compared to N cartilage was apparent both shortly after collection of the cartilage and after culture. Thus, although OA cartilage in vivo is synthetically more active, in vitro it has an increased catabolic and a decreased anabolic activity, from which we conclude that OA cartilage is less vital than N cartilage.

Role of TNF alpha, in relation to IL-1 and IL-6 in the proteoglycan turnover of human articular cartilage

In both young and old human articular cartilage explants, TNF alpha induced a concentration-dependent, reversible suppression of the proteoglycan (PG) synthesis. Young cartilage was more sensitive to TNF alpha than old cartilage: 50% suppression of PG synthesis was reached at a TNF alpha concentration of 5 U/ml for young and 30 U/ml for old cartilage, whereas at 10(3) U/ml the PG synthesis of young cartilage was blocked and that of old cartilage suppressed by 80%. These inhibition levels of PG synthesis resulted in 25% PG depletion of the explants after 8 days of culture. The release of cartilage PG was not enhanced. TNF alpha induced no detectable amounts of IL-1 (less than 0.01 U) in young or old cartilage but did induce IL-6 production. The induced amounts of IL-6 were higher in young than in old cartilage but no dose-dependency was evident. Antibodies to neither IL-1 nor IL-6 had any influence on the TNF alpha-induced suppression of PG synthesis. The combination of TNF alpha and IL-1 led to an additive inhibition of PG synthesis which had no relationship to induced IL-6. TNF alpha was about 100-fold less active than IL-1.

Relation between patients' own health assessment and clinical and laboratory findings in rheumatoid arthritis

Health status encompasses not only physical aspects, but also psychological and social aspects. A multidimensional health status questionnaire was used in 69 Dutch patients with rheumatoid arthritis to assess their physical, psychological and social well being. The same day clinical and laboratory data were recorded. The health status questionnaire provided additional information to clinical and laboratory findings. The various clinical and laboratory measures of disease activity reflect aspects other than the self-reported measure of physical well being. As such they are not interchangeable. Furthermore clinical and laboratory measures of physical well being appeared to be unrelated with psychological and social measures. In contrast, the patients' self-report of physical well being was related only with depressive mood and to some extent with anxiety.

In vitro influence of ketoprofen on the proteoglycan metabolism of human normal and osteoarthritis cartilage

We investigated the influences of ketoprofen on the proteoglycan (PG) turnover of human articular cartilage explants in three groups: normal young with a high basal PG synthesis, normal adult and osteoarthritis cartilage, both with a low basal PG synthesis. Ketoprofen had no influence on the mean PG synthesis rate of normal adult and OA cartilage after 4 days of culture nor on the cartilage PG content after 8 days of culture. There was no relation between the histological grade of OA and effects of ketoprofen. In normal young cartilage ketoprofen induced an increase of the PG synthesis rate when added to the culture in a concentration of 10(-4) M. No correlation existed between the effect of ketoprofen and the basal PG synthesis of normal cartilage.

No conclusive evidence of an epidemiological relation between Klebsiella and ankylosing spondylitis

Fifty-six patients with ankylosing spondylitis and 87 healthy controls were screened for Klebsiella strains in their stools using a new highly sensitive culture medium. The presence of Klebsiella strains in the patient group was compared with activity of the disease. In a dynamic study changes in Klebsiella quantity over a period of 3 months were compared with changes in disease activity over the same period. The patient and control group showed similar percentages of Klebsiella carriage. In the patient group no temporal relation could be found between activity of the disease and the presence of Klebsiella in the intestinal tract.

Interleukin-1-induced interleukin-6 is required for the inhibition of proteoglycan synthesis by interleukin-1 in human articular cartilage

Cartilage from normal controls, patients with osteoarthritis, and patients with rheumatoid arthritis produced no interleukin-6 (IL-6) in culture. However, IL-1 induced massive production of IL-6 (up to 135 ng/ml) in cartilage from all 3 sources, in a dose-dependent manner (in some cases, a peak value was reached). The levels of induced IL-6 were similar to those found in rheumatoid arthritis synovial fluid. At IL-1 concentrations that induced almost complete inhibition of proteoglycan (PG) synthesis, IL-6 production could still be increased considerably. Exogenous IL-6 inhibited PG synthesis by up to 25%. IL-1-induced inhibition of PG synthesis was reversed by antibodies against recombinant human IL-6. These results suggest that IL-6 is required for the IL-1-induced inhibition of PG synthesis.

The effect of human interleukin 1 on proteoglycan metabolism in human and porcine cartilage explants

Human interleukin 1 (IL-1), up to 100 pg/ml, causes a decrease of the proteoglycan content of human (old and young) as well as porcine cartilage explants, without stimulating the proteoglycan release from the cartilage. The proteoglycan depletion is stronger in young than in old human cartilage and stronger in human than in porcine cartilage. The proteoglycan synthesis is considerably more inhibited by IL-1 in young than in old human cartilage. Our data suggest that an IL-1 induced inhibition of the proteoglycan synthesis, rather than a stimulation of proteoglycan breakdown causes the proteoglycan depletion of the cartilage. The data furthermore suggest a clear difference between young and old human cartilage, with respect to their sensitivity for IL-1. IL-1 in a concentration of 500 pg/ml causes in all 3 kinds of cartilage explants chondrocyte damage that might be relevant in the cartilage destruction during rheumatoid arthritis.

Mycobacterial antigens stimulate rheumatoid mononuclear cells to cartilage proteoglycan depletion

In a coculture with porcine articular cartilage explants unstimulated blood mononuclear cells (BMC) from patients with rheumatoid arthritis (RA), but not from healthy controls, induced proteoglycan depletion of dead cartilage. Specific stimulation of the RA BMC with Mycobacterium tuberculosis (MT), in comparison with concanavalin A (Con-A), strongly enhanced the proteoglycan depletion of living cartilage; this was not found with the BMC of healthy controls. However, the MT induced proliferative responses of the same BMC were similar in healthy controls and patients with RA. Neither the proliferative response nor the proteoglycan depletion was influenced by the presence of HLA-DR4 in the donor, whether patients with RA or healthy control. The proliferative responses of the RA BMC seemed to correlate inversely with the proteoglycan depletion. We conclude that stimulation of RA BMC with mycobacterial antigens may elicit effector pathways that induce proteoglycan depletion, independent of T cell proliferation.

Multiple sites of ischemic necrosis of bone following long term corticosteroid treatment in a patient with auto-immune granulocytopenia

A 36-year-old white male suffering from auto-immune granulocytopenia with recurrent infections and subsequent systemic AA-amyloidosis developed ischemic necrosis of bone (INB) in several joints following long-term corticosteroid treatment. Early signs of INB in one joint were detected by Magnetic Resonance Imaging and joint damage could be prevented by core decompression. The importance of early detection of INB Magnetic Resonance Imaging is stressed. According to the present theory regarding the pathogenesis of INB, amyloidosis might contribute to intra- as well as extra-osseous factors. However, no relation was found between amyloidosis and INB.

Potential influences of ketoprofen on human healthy and osteoarthritic cartilage in vitro

Ketoprofen (Orudis, Rhône-Poulenc) is an anti-inflammatory drug with analgesic properties that is used in diseases such as rheumatoid arthritis and osteoarthritis (OA). It is therefore of interest to know whether ketoprofen has a direct influence on cartilage metabolism. We studied the effects of ketoprofen in therapeutic concentrations, on proteoglycan (PG) turnover in explants of human cartilage. The cartilage specimens were divided into three groups: healthy young (less than or equal to 3 yrs) n = 8, healthy old (mean 56 yrs) n = 13 and OA cartilage (greater than or equal to 65 yrs) n = 15. The rate of PG synthesis at day 4 of the culture was measured by the uptake of 35S sulphate. Cartilage PG content and PG release into the medium were determined over 8 days of culture. Ketoprofen stimulated the rate of PG synthesis of young cartilage, but not of old cartilage. In OA cartilage both stimulation and suppression occurred. Ketoprofen had no influence on cartilage PG content and PG release of healthy or OA cartilage during the 8 days of culture. The cartilage was examined histologically, and graded for severity of OA. There was no relation between the severity of OA and the effect of ketoprofen.

Acute changes in calcium and bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis

Corticosteroids (CS) decrease bone formation and enhance bone resorption and this can lead to osteopenia. Bone metabolism was studied during the administration of huge amounts of CS (1000 mg methylprednisolone) over a short period of time in 10 patients with persistently active rheumatoid arthritis. The effects could be divided into those occurring within 24 h: (a) a decrease in bone resorption (urinary excretion of calcium and hydroxyproline) and bone formation (alkaline phosphatase); (b) a decrease in renal excretion of calcium; (c) an increase in concentration of serum 1,25-dihydroxy-cholecalciferol and those secondary effects arising after 24 h; (d) a decrease in serum calcium due to the decrease in intestinal Ca absorption and the decrease in renal tubular reabsorption of Ca; (e) an increase in serum PTH concentrations. In a previous study it was found that these changes normalized within a few days after completion of the CS treatment.

Effect of oestrogen treatment on clinical and laboratory manifestations of rheumatoid arthritis

The effect of administration of 12.5 micrograms ethinyloestradiol to 10 female patients with active rheumatoid arthritis was investigated in a prospective double blind crossover study. Some improvement during oestrogen treatment was found in 30 m walking time, haemoglobin concentration, and thrombocytosis. Erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) deteriorated in both periods, but less in the oestrogen period. Grip strength improved during both periods. The number of swollen joints decreased, whereas the joint tenderness score increased during the oestrogen period.

Differential responses of old human cartilage explants to synovial- and mononuclear-cell factors

To investigate mechanisms of cartilage destruction that may apply to rheumatoid arthritis, young and old human, and young porcine, articular cartilage was cultured for 8 days and the effects on proteoglycan (PG) metabolism of normal synovium supernatant (NSS), rheumatoid synovial fluid (RFL), and blood mononuclear cell supernatant (MCF) were studied. The effects were chondrocyte-mediated. An inverse correlation was found between baseline net PG synthesis and the effect of NSS on PG synthesis. Responses of young (porcine and human) cartilage were similar. In young cartilage the three agents induced PG depletion by suppression of net PG synthesis. In old cartilage NSS and RFL induced PG depletion, whereas MCF did not. In cartilage of low baseline net PG synthesis, NSS and MCF stimulated both PG release and PG synthesis; NSS stimulated predominantly PG release, and MCF predominantly PG synthesis. In conclusion, young and old human cartilage differ in the quality of their in vitro response to potentially catabolic factors. This may be due to the difference in baseline net PG synthesis. Synovial extracts differ from mononuclear-cell supernatants in their effects on old cartilage. It is suggested that this is caused by the presence, in different relative amounts, of factors that influence either PG synthesis or PG release.

Frequency of infections among rheumatoid arthritis patients, before and after disease onset

The self-reported frequency of genitourinary and bronchopulmonary infections in postmenopausal women with rheumatoid arthritis (RA) and in postmenopausal women with osteoarthritis and/or soft tissue rheumatism was compared. Neither before, nor after the onset of joint disease was a higher frequency reported by the RA patients. The previously established increased mortality from infectious disease among RA patients might be due to a more severe infectious disease course, leading to an increased case-fatality rate.

Changing pattern of drug use in relation to disease duration of rheumatoid arthritis

The prevalent use of antirheumatic drugs in a cohort of 311 middle aged female patients with seropositive and seronegative rheumatoid arthritis (RA) was investigated. Seropositive patients used a greater amount and more aggressive drugs during each decade of disease duration. The overall use of drugs decreased with disease duration, except for a subgroup of seropositive patients with RA who, with increased disease duration, used more aggressive drugs.

Acquired sideroblastic anaemia after aplastic anaemia caused by D-penicillamine therapy for rheumatoid arthritis

A 68 year old man with rheumatoid arthritis developed marrow aplasia during D-penicillamine treatment. Recovery of granulopoiesis and erythropoiesis was ineffective with features of a secondary sideroblastic anaemia. Absence of megakaryopoiesis persisted. Therapeutic measures failed, and the patient finally died. These events illustrate a haematopoietic stem cell injury induced by D-penicillamine.

Methylprednisolone pulse therapy in conjunction with azathioprine in rheumatoid arthritis

In the management of rheumatoid arthritis two potentially useful roles for methylprednisolone (MP) pulse therapy are presently recognised: in patients in whom second line drugs have not led to a satisfactory remission or have caused side effects, and in bridging the gap between the start and the delayed onset of effect of a slow-acting antirheumatic drug. Recently it was shown that MP-pulse therapy was effective in accelerating the response to sulphasalazine and D-penicillamine. Nineteen patients with a persistently active rheumatoid arthritis, who had failed to respond to at least two slow-acting antirheumatic drugs, were treated with MP-pulse therapy in conjunction with azathioprine. Twelve patients continued this treatment for 6 months and 8 for 12 months. MP-pulse therapy resulted in an immediate improvement in Ritchie articular index, grip strength, ESR and CRP. However, this improvement lasted less than six weeks. After 6 months some improvement due to the effect of azathioprine became apparent. Some rather serious side effects were noted. It is concluded that MP-pulse therapy has a (short lasting) beneficial effect in persistently active rheumatoid arthritis. However MP-pulse therapy is not suitable to bridge the gap between the introduction of azathioprine-treatment and the delayed response to this drug.

Bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis

The deleterious effects of corticosteroids (CS) on bone are well known, but probably differ depending on duration and dosage of CS therapy. Presently huge amounts of CS are given over a short period of time in different rheumatic conditions. Not much is known about the effect of this kind of CS treatment on bone metabolism. Twenty patients with persistently active rheumatoid arthritis were treated with 1 g methylprednisolone (MP) three times on alternate days over a five day period. Twenty four hours after the first MP pulse serum calcium was increased and the values of parathyroid hormone and 1,25-dihydroxyvitamin D tended to increase. After the second MP pulse, however, these values had returned to the starting values. The urinary calcium excretion increased during MP pulse therapy and returned to the initial value immediately after the pulse therapy. The hydroxyproline excretion tended to decrease during therapy and stayed decreased immediately afterwards, indicating a decrease in bone resorption. It is concluded that bone metabolism is not seriously affected during MP pulse therapy.

Contrasting in vitro effects of retinol and mononuclear cell factor on young and old human cartilage

Studies with young animal cartilage have shown that retinol and mononuclear cell-factor (MCF) cause in vitro breakdown of the cartilage, mediated by the living chondrocyte (indirect degradation). We studied the effects of retinol and MCF on healthy human articular cartilage of different ages, measuring the effects on proteoglycan (PG) content of the cartilage, and on PG synthesis during 8 days of culture. This study shows: Retinol and MCF induce indirect degradation of young, but not of old human cartilage of the humeral head; Both retinol and MCF suppress PG synthesis of young and stimulate PG synthesis of old cartilage; The effects of retinol and MCF on cartilage PG content and on PG synthesis are related to the metabolic state of the chondrocyte; Therefore mononuclear cell-factor may have a destructive or beneficial effect on cartilage depending on whether proteoglycan synthesizing activity is high or low, respectively.

Noncontraceptive hormones and rheumatoid arthritis in perimenopausal and postmenopausal women

The use of noncontraceptive hormones before onset of joint disease was compared between 490 perimenopausal and postmenopausal women with rheumatoid arthritis and a control group of 659 women with soft-tissue rheumatologic disorders and/or osteoarthritis. Both groups were sampled randomly from the attendees of five rheumatologic clinics. A negative association was found between the onset of rheumatoid arthritis and the previous use of noncontraceptive hormones (odds ratio, 0.32; 95% confidence interval, 0.16 to 0.64). This association persisted on univariate and multivariate control of potentially confounding variables and on subgroup analysis. The protective effect of oral contraceptives on the development of rheumatoid arthritis was confirmed.

Matrix depletion of young and old human articular cartilage by cultured autologous synovium fragments: a chondrocyte-independent effect

Human articular cartilage of different ages was cultured for 8 days and proteoglycan (PG) release into the medium was measured. Retinol and synovial co-culture increased the PG release of cartilage of all ages. The effect of retinol was dose-dependent. Synovium increased also the PG release of dead cartilage, whereas retinol did not. The increased PG release by synovial co-culture is therefore mainly the result of synovial enzymes acting directly on the matrix rather than of a factor inducing chondrocyte-mediated breakdown.

Oral contraceptives and rheumatoid arthritis: further evidence for a preventive effect

To investigate a reported negative association between the use of oral contraceptives (OC) and the development of rheumatoid arthritis, a case-control study was undertaken to compare the histories of OC use between 228 women with a diagnosis of probable or definite rheumatoid arthritis and 302 women with the diagnosis of soft-tissue rheumatism and/or osteoarthritis. The use of OCs before the onset of joint complaints was acknowledged by 31.1% of the rheumatoid arthritis patients and by 55.6% of the controls. After adjustment for possible confounding variables, the rate ratio for ever use became 0.42 (95% confidence interval 0.27--0.65), while it was 0.40 (0.22-0.72) for ex-users and 0.45 (0.28-0.75) for current users. These findings confirm the finding from the Royal College of General Practitioners Oral Contraceptive Study that the incidence rate of rheumatoid arthritis among OC users was halved.