In vitro stimulation of lymphocytes by neutral proteinases from human polymorphonuclear leukocyte granules.

Two neutral proteinases from human polymorphonuclear leukocytes (PMN), an elastase and the chymotrypsin-like cathepsin G, were purified, and their actions on lymphocytes in culture were studied. Both PMN proteinases stimulate lymphocytes from human peripheral blood and from mouse spleen in vitro, but do not affect thymic cells from either normal or hydrocortisone-treated mice. In stimulated mouse spleen cell cultures, most of the developing blast cells bear surface immunoglobulins, and subsequently appear to engage in antibody synthesis. In their stimulatory action, the two PMN proteinases thus resemble the classic B-cell mitogen LPS and neutral pancreatic proteinases such as trypsin, chymotrypsin, and elastase. The effects of proteinase inhibitors indicate that lymphocyte stimulation is dependent on the proteolytic activity of the enzymes. This work suggests that PMN proteinases, which are released at sites of inflammation, may modulate the function of lymphocytes.

Lymphocytotoxic antibodies in rheumatoid arthritis: relation to HLA-DR2 and rheumatoid factors.

During a Swiss multicenter study on HLA-antigens in rheumatoid arthritis (RA), the patients sera were tested for cytotoxic, complement fixing antibodies against autologous B- and T-lymphocytes (LCA). LCA were found in about 25% of the patients. Anti-B and cold-reacting LCA were more frequent than were anti-T and LCA reacting at 37 degrees. Most patients with anti-B had anti-T LCA as well. Among patients with LCA, 46.4% had the HLA-DR2 antigen as opposed to 21.2% of the patients without such antibodies (p = 0.0004). There was no difference between the two groups in regard to the other HLA-DR antigens. The patients with LCA had higher titers of rheumatoid factors and of antinuclear antibodies than those without these antibodies. There was no significant difference between the patients with LCA and those without in regard to severity of disease (radiological stage in relation to duration of disease), extra-articular involvement, the amount of circulating immune complexes, and erythrocyte sedimentation rate.

Diet and fatty acids: can fish substitute for fish oil?

As fish oil has been shown to be beneficial in rheumatoid arthritis and in psoriasis, we examined whether a diet rich in fish has a similar effect on membrane and plasma lipids as a dietary fish oil supplement. Volunteers recruited by 2 rheumatology units in Switzerland formed three parallel groups eating respective diets during 2 months: a normal diet without fish; a normal diet including 700 g fish per week; a normal diet without fish but with additional fish oil (7.5 g daily). As outcome measures we determined the lipid composition of platelet-rich plasma, the serum cholesterol and triglycerides before the study and after 1 and 2 months of the designated diet. The relative amounts of both eicosapentaenoic acid and docosahexaenoic acid increased significantly in the fish oil group and in the group with the fish diet; no change was seen in the control group. The effect on triglycerides, which were low at the beginning of the study, was minor and no change in cholesterol was seen. In conclusion, 4 to 6 meals with fish per week without any other dietary changes can induce similar changes in lipids as a supplement of fish oil.

Production of neutrophil activating peptide-1 (NAP-1/IL-8) by blood and synovial fluid mononuclear cells from patients with arthritis.

As polymorphonuclear leukocytes (PMN) are predominant in inflammatory synovial fluids, we investigated the production of neutrophil-activating peptide-1 (NAP-1) by mononuclear cells (MC) from 15 synovial fluids and matched peripheral blood. MC were cultured for 24 h alone or with stimulants (ConA, LPS). NAP-1 was determined in the supernatants by a bioassay (elastase release from normal human PMN) and an immunoassay (sandwich ELISA with a mouse anti-NAP-1 mAb and an alkaline phosphatase labelled goat anti-NAP-1 pAb). The results showed a significant increase in NAP-1 production by synovial fluid MC when compared to peripheral blood MC. Both cell types produced more NAP-1 in the presence of added stimuli. The results obtained with the two methods of detection were in close agreement. No relationship was found between the amount of NAP-1 produced in 24 h and the number of synovial fluid leukocytes, the erythrocyte sedimentation rate, the diagnosis of the underlying arthritis or the treatment of the patients.

Is chronic non-specific low back pain chronic? Definitions of a problem and problems of a definition.

BACKGROUND: Chronic low back pain (LBP) accounts for the majority of the disability and costs for LBP. However, the definition of chronicity is unclear. AIM: To elicit practitioners' definitions of chronic LBP patients, both in general and in the patients they were treating; to assess the most common characteristics of these practitioners' chronic LBP patients; and to assess the stability of chronicity in a sample of the general population. METHOD: Semi-structured interviews were conducted with 33 practitioners working in private practice, 71 LBP patients and their therapists, and 252 employees of a chain store who were assessed yearly in a prospective study. RESULTS: The therapists' definitions of chronic LBP patients generally included psychosocial aspects. Only physical symptoms and signs were stressed in the patients they were treating. These patients displayed common characteristics with reference to pain, functional problems, and contact with health care services. Duration of symptoms was not sufficient to define chronicity. In the employee population, chronicity defined according to pain duration was unstable. However, the same was true when chronicity was measured according to the criteria defined in the patient population. CONCLUSION: There is a discrepancy between theory and practice regarding the definition of chronic LBP. This discrepancy concerns not only the literature but also clinical practice itself. The term 'chronic' LBP as currently used is therefore equivocal.

The gap between back pain patients' prior knowledge and scientific knowledge and its evolution after a back school teaching programme: a quantitative evaluation.

This study presents a method for quantitative evaluation of the congruence between patients' representations and teachers' scientific knowledge, which is used as the standard of assessment. First, the patients' knowledge and the teachers' scientific concepts before a back school (BS) programme were compared (T0). Then the evolution of patients' knowledge at 1 month (T1) and 1 year (T2) after the teaching was evaluated. Patients' knowledge was assessed blind by a multidisciplinary panel of nine independent judges. Mean scores were computed for each set of data (T0,T1,T2); these scores were then submitted to an analysis of variance. The results showed an important gap between patients and teachers before BS with an improvement after the teaching. Knowledge referring to know-how and/or attitudes evolved differently when compared to theoretical knowledge.

Follow-up with OM-8980 after a double-blind study of OM-8980 and auranofin in rheumatoid arthritis.

A 6-month double-blind study of OM-8980 and auranofin in 145 patients with rheumatoid arthritis was followed by an open observation period of 6 months for which 100 OM-8980-treated patients could be assessed. At the end of this second phase, the Ritchie index, number of swollen joints, pain scale, morning stiffness, grip strength and ESR had all improved further with respect to the significant improvements already recorded under OM-8980 and auranofin in the double-blind phase. The statistical analysis of the Ritchie index, pain scale and ESR showed significant changes in these 3 parameters during both the 6-month follow-up phase and the entire 12-month period. As regards the tolerance, 2 patients reported gastrointestinal disorders during the follow-up. The investigators' final assessment of efficacy indicated an improvement in 76% of the patients during the follow-up phase and in 95% during the entire 12-month period.

A randomized, double-blind trial comparing a pulse of 1000 with 250 mg methylprednisolone in rheumatoid arthritis.

We compared, in a double blind, randomized, 3-center study, a pulse of 1000 mg methylprednisolone with a pulse of 250 mg methylprednisolone, in patients with active rheumatoid arthritis. Improvement of patients was similar in both groups and lasted up to 3 weeks. Side effects were minor.

Detection of parvovirus in a patient with "reactive arthritis" by in situ hybridization.

We used in situ hybridization to search for the presence of viruses in synovial fluid cell preparations obtained from patients with various forms of knee arthropathies. One patient, presenting with acute reactive arthritis, was found to replicate parvovirus DNA in cells from synovial fluid whereas six other patients with various other forms of arthritis were negative for parvovirus infection. Five patients with osteoarthritis, constituting a control group in which an infectious etiology would not be expected, were consistently negative. In addition, no hybridization was found when synovial cell preparations of all patients were hybridized in situ with DNA probes specific for Epstein-Barr virus, cytomegalovirus, or enteroviruses.

The representation of the back in idiomatic expressions--do idioms value the body?

OBJECTIVE: Whilst investigating the influence of patients' representations on the impact of teaching in the back school, we took an interest in 1) the place of the back in the French idioms referring to the body; and 2) the meaning these idioms convey about the back. METHODS: The idioms including body part terms were sought on the basis of a compilation of French idioms; it has to be noted that such a compilation, however excellent it may be, can only offer a partial view of lay conversation. Occurrence of body parts and of their connotations were assessed. Idioms were classified as positive, negative or neutral, keeping in mind the difficulties of a strict classification in such a field. Drawings were then performed on the basis of the results of the descriptive analysis. RESULTS: Globally, idiomatic expressions offer a rather negative picture of the body or at least suggest that the body is prominently used to express negative ideas and emotions. This is particularly striking for the idioms associated with the back. CONCLUSION: The analysis of idioms referring to the body allows us to 'see with our own eyes' another aspect of the representations of the body and the back, as they are conveyed in the French language.

Electroacupuncture in fibromyalgia: results of a controlled trial.

OBJECTIVE: To determine the efficacy of electroacupuncture in patients with fibromyalgia, a syndrome of unknown origin causing diffuse musculoskeletal pain. DESIGN: Three weeks' randomised study with blinded patients and evaluating physician. SETTING: University divisions of physical medicine and rehabilitation and rheumatology, Geneva. PATIENTS: 70 patients (54 women) referred to the division for fibromyalgia as defined by the American College of Rheumatology. INTERVENTIONS: Patients were randomised to electroacupuncture (n = 36) or a sham procedure (n = 34) by means of an electronic numbers generator. MAIN OUTCOME MEASURES: Pain threshold, number of analgesic tablets used, regional pain score, pain recorded on visual analogue scale, sleep quality, morning stiffness, and patient's and evaluating physician's appreciation. RESULTS: Seven of the eight outcome parameters showed a significant improvement in the active treatment group whereas none were improved in the sham treatment group. Differences between the groups were significant for five of the eight outcome measures after treatment. CONCLUSIONS: Electroacupuncture is effective in relieving symptoms of fibromyalgia. Its potential in long term management should now be studied.

[Mechanism of action of gold compounds]. / Wirkungsmechanismen der Goldverbindungen.

The mechanisms of action of gold salts are still poorly understood. While Auranofin (AF) has a direct anti-inflammatory action in animal models, Myochrysin (MC) has not. Both gold compounds inhibit various enzymes. Among these, lysosomal enzymes are of particular interest. Gold is known to accumulate in the lysosomes, and gold salts modulate certain macrophage functions in the immune system. The role of organic gold salt ligands containing, like D-penicillamine, a thiol group is still unclear. Positive data characterizing responders versus nonresponders are not yet available. As in other clinically heterogeneous diseases, medical action has mainly been based on clinical empiricism which, although resting on false premises, has helped to find a comparatively efficacious treatment. In fact, the proposals for further studies to shed light on the mode of action presented here may equally be ill conceived. However, these studies would at least expand our understanding of rheumatoid arthritis and thus be beneficial in the long run.

[The study of intra-articular infectious agents in reactive arthritis]. / La recherche d'agents infectieux intra-articulaires dans l'arthrite réactionnelle.

Reactive arthritis is differentiated from infectious arthritis by the lack of intraarticular infectious agents. Recently 2 groups, using different techniques have demonstrated intra-articular antigens in cases of reactive arthritis associated with Chlamydia and Yersinia infections. In this article we report the preliminary results of screening cells from synovial fluid for DNA of certain microorganisms by in situ hybridization. Our findings provide complementary evidence of the intra-articular presence of at least parts of microbes.

[Rheumatic disorders and AIDS]. / Affections rhumatismales et SIDA.

Various rheumatologic diseases were reported in patients infected by the HIV (human immunodeficiency virus); in most cases, they are related to Reiter's syndrome, reactive arthritis and opportunistic germs arthritis. Based on three cases we summarize the present knowledge in this field.

[Rheumatologic complications in patients treated with intermittent hemodialysis]. / Complications rhumatologiques des patients traités par hémodialyse périodique.

Long-term hemodialysis is complicated by rheumatological problems. They can vary from pain syndromes without clinical signs to severe destructive arthritis. The latter is often associated with severe disability. Its origin can be related to deposition of amyloid or synovial overloading with aluminium or iron. Different factors influence its occurrence, such as the type of dialysis membrane used or the quantity of aluminium consumed by these hemodialysed patients. The authors evaluated the frequency and the type of rheumatic disorders in the hemodialysis center of the HCU in Geneva. A comparison of these findings with previous reports is presented and the etiopathogenesis is discussed.

[Superior gluteal nerve entrapment neuropathy]. / Mononeuropathie d'enclavement du nerf fessier supérieur.

We observed two female patients suffering from chronic gluteal pain of mechanical origin, without paresthesia. In the first case, the muscular pain was associated with weakness of hip abduction and with tenderness of the middle gluteal muscle. An electromyography, a principal examination, confirmed a diagnosis of entrapment of the superior gluteal nerve in one case and of the distal branch in the other. The proposed treatment, as in the case of neuropathic entrapment of the median nerve at the wrist, consists of a local infiltration of corticosteroids. If the symptoms persist, surgical intervention to free the nerve is indicated. For our first patient the clinical and electromyography cure has been completed. The neuropathy by chronic compression of a nerve in the gluteal area seems to be rare, but one has to consider further investigations in the case of chronic gluteal pain.

Measurements of humoral immunity during treatment with levamisole in rheumatoid arthritis--a review.

Treatment with levamisole in patients with rheumatoid arthritis reduced significantly titers of rheumatoid factor and the amount of circulating immune complexes as determined by the Clq binding activity. It took between three and six months to observe a significant effect. Levamisole treatment had less effect on the amount of immunoglobulins in serum: the values were rarely abnormal before treatment and the changes were small, but reached statistical significance at six months. The effect on complement and complement components could not be evaluated as properly controlled studies were lacking.