RESUMO
OBJECTIVE: To examine magnetic resonance imaging (MRI) scans for bone lesions typical of rheumatoid arthritis (RA) in the wrist joints of healthy individuals. METHODS: Thirty-one symptomless healthy persons (13/18 men/women), mean age 49 years (range 32-64 years), were included. MRI scans and radiographs of both wrists were obtained (62 wrists). The MRI scans and the radiographs were evaluated by two specialists according to the OMERACT recommendations and the Larsen method, respectively. RESULTS: MRI showed erosive-like lesions in either one or both wrists in 14 [45%, 95% confidence interval (CI) 27-64] out of 31 subjects. Altogether, 24 erosive-like changes were found in the 930 wrist bones evaluated (15 bones in each wrist). No more than two lesions per wrist were detected. All the changes were small (22 were grade 1 and two were grade 2; scale 0-10) and were found more often in the older subjects (55 vs. 43 years, p<0.001). Most lesions (54%) were located on the volar side of the wrist and adjacent to the ligament insertions. Intravenous administration of the contrast medium gadolinium diethylenetriaminepentaacetate (Gd-DTPA) was used in 10 subjects, and mild to moderate Gd-DTPA enhancement in the synovial compartments was seen in six of them: five had enhancement in both wrists and one in one wrist. The plain radiographs showed one erosive-like change in the wrist (pisiforme) that was not recorded with MRI. CONCLUSIONS: A few small bone lesions that could potentially be confused as erosions were detected in about half of the normal volunteers. These findings should always be evaluated with reference to the clinical picture.
Assuntos
Doenças Ósseas/diagnóstico , Ossos do Carpo/patologia , Imageamento por Ressonância Magnética/métodos , Articulação do Punho/patologia , Adulto , Ossos do Carpo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Valores de Referência , Articulação do Punho/diagnóstico por imagemRESUMO
OBJECTIVE: We assessed the long-term outcome of recent reactive arthritis (ReA) during 1973-2007 and ankylosing spondylitis (AS) during 1973-1997 to identify similarities in manifestations of disease. METHODS: Radiographs of the sacroiliac, hand and foot joints were taken at onset and at 8, 20, and in ReA 32 years from entry among recent-onset (<6 months) patients; 60 with ReA and 17 with AS. Sacroiliacal joints using the modified New York 1984 criteria and the Larsen score of 0-100 of 20 joints of hands and feet were assessed. The number of swollen joints, patients with orthopaedic operations or iritis or HLA-B27 or retirement because of spondyloarthritis, and ESR were recorded. RESULTS: The onset age of 60 ReA patients (34 men) was 17-54 years, mean 32 (SD 10) and 51 (85%) were HLA-B27 positive. The number of onset swollen joints was 1-5, mean 2.6 (SD 1.6), while in 40 patients at the 30-year check-up it was 0-3, mean 0.2 (SD 0.6). ESR was at onset mean 55 mm/h (SD 33) and at the 30-year check-up 15 mm/h (SD 11). Yersinia enterocolitica type 3 antibodies were raised in 22 (37%) patients at onset. The end-point Larsen score was 2-6, mean 4 in 6 patients. One ankle joint arthroplasty and five smaller operations had been performed. Bilateral grade 2-3 sacroiliitis developed in 9/60 (15%), and unilateral grade 2-4 in 3. The incidence of iritis was 12/60 (20%). Erosive arthritis or iritis or sacroiliitis developed in 24/60 (40%) participants. Thirteen (22%) retired because of arthritis while five died. Of 17 AS patients (8 men), whose age was initially 21-50 years, mean 33 (SD 10), 11 (65%) had rheumatic symptoms years before our first examination. All were HLA-B27 positive and developed grade 2-4 bilateral sacroiliitis during the 20-year follow-up. The end-point Larsen score was 2-22, mean 9 (SD 8) in 5 patients. Hip arthroplasties were performed in one and small-joint operations in 3. ESR was at onset mean 54 mm/h (SD 29), and at the last measurement mean 26 mm/h (SD 21). Iritis was found in 5/17 (29%); seven (41%) retired due to AS; five died. CONCLUSION: Our community-based inception cohorts show that with time, among a number of similarities most often sacroiliitis, peripheral arthritis and iritis developed in both chronic ReA and AS. These HLA-B27-related diseases would appear to be identical. The differences between patients depend on the chronicity of the sickness. The hypothesis that HLA-B27 is related to chronicity of disease seems to be valid.
Assuntos
Artrite Reativa/diagnóstico , Espondilite Anquilosante/diagnóstico , Adolescente , Adulto , Artrite Reativa/genética , Artrite Reativa/fisiopatologia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Seguimentos , Antígeno HLA-B27/genética , Humanos , Masculino , Pessoa de Meia-Idade , Proibitinas , Índice de Gravidade de Doença , Espondilite Anquilosante/genética , Espondilite Anquilosante/fisiopatologia , Adulto JovemRESUMO
OBJECTIVES: The aim of the current study was to determine the contribution of interleukin (IL)1 gene cluster polymorphisms previously implicated in susceptibility for ankylosing spondylitis (AS) to AS susceptibility in different populations worldwide. METHODS: Nine polymorphisms in the IL1 gene cluster members IL1A (rs2856836, rs17561 and rs1894399), IL1B (rs16944), IL1F10 (rs3811058) and IL1RN (rs419598, the IL1RA VNTR, rs315952 and rs315951) were genotyped in 2675 AS cases and 2592 healthy controls recruited in 12 different centres in 10 countries. Association of variants with AS was tested by Mantel-Haenszel random effects analysis. RESULTS: Strong association was observed with three single nucleotide polymorphisms (SNPs) in the IL1A gene (rs2856836, rs17561, rs1894399, p = 0.0036, 0.000019 and 0.0003, respectively). There was no evidence of significant heterogeneity of effects between centres, and no evidence of non-combinability of findings. The population attributable risk fraction of these variants in Caucasians is estimated at 4-6%. CONCLUSIONS: This study confirms that IL1A is associated with susceptibility to AS. Association of the other IL1 gene complex members could not be excluded in specific populations. Prospective meta-analysis is a useful tool in confirmation studies of genes associated with complex genetic disorders such as AS, providing sufficiently large sample sizes to produce robust findings often not achieved in smaller individual cohorts.
Assuntos
Interleucina-1/genética , Polimorfismo de Nucleotídeo Único , Espondilite Anquilosante/genética , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Interleucina-1alfa/genética , Família Multigênica , Estudos Prospectivos , Espondilite Anquilosante/imunologiaRESUMO
OBJECTIVE: The aim of this study was to investigate whether polymorphism of the mannose-binding lectin 2 (MBL2) gene is related to the occurrence of systemic AA amyloidosis in patients with rheumatoid arthritis (RA). METHODS: MBL2 structural gene polymorphisms at codon 52 (CGT-->TGT, Arg-->Cys; D), codon 54 (GGC-->GAC, Gly-->Asp; B) and codon 57 (GGA-->GAA, Gly--> Glu; C), and MBL2 promoter region polymorphism at position -221 (G-->C) were examined in 57 patients with RA complicated by biopsy-proven reactive amyloidosis and 51 control RA patients without amyloid. RESULTS: A strong association was found between the presence of a structural MBL2 gene variant O (B, D or C) and the occurrence of amyloidosis in RA patients: 29 of 57 (50.9%) of the RA patients with amyloid had a variant allele compared with 12 of 51 (23.5%) of the RA patients without amyloid (OR 3.37, 95% CI 1.47-7.72; P = 0.004). CONCLUSION: We conclude that variant MBL2 structural genotype constitutes a significant risk factor for reactive amyloidosis in RA and that the increased risk is probably related to MBL-mediated impairment of mononuclear phagocyte function.
Assuntos
Amiloidose/genética , Artrite Reumatoide/genética , Hepatopatias/genética , Lectina de Ligação a Manose/genética , Polimorfismo Genético/genética , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença/genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The aim of this study was to investigate sacroiliitis in patients with seronegative oligoarthritis. Thirty consecutive patients with seronegative oligoarthritis and no other signs of spondylarthropathy were included. Sacroiliac (SI) joints were investigated by both radiography and magnetic resonance imaging. HLA B27 antigen was studied and family history was reexamined in 2006. Five patients had sacroiliitis. Additionally, 15 patients had HLA B27 antigen or family history of either psoriasis or ankylosing spondylitis. Our conclusion is that during the first decade of seronegative oligoarthritis, HLA B27 antigen, family history, and especially imaging of SI joints reveal in two thirds of the patients the spondylarthritic nature of their disease.
Assuntos
Artrite Reumatoide/fisiopatologia , Articulação Sacroilíaca/fisiopatologia , Adulto , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/imunologia , Feminino , Antígeno HLA-B27/análise , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Articulação Sacroilíaca/diagnóstico por imagemRESUMO
OBJECTIVE: To determine the influence of HLA-B27 homozygosity and HLA-DRB1 alleles in the susceptibility to, and severity of, ankylosing spondylitis in a Finnish population. METHODS: 673 individuals from 261 families with ankylosing spondylitis were genotyped for HLA-DRB1 alleles and HLA-B27 heterozygosity/homozygosity. The frequencies of HLA-B27 homozygotes in probands from these families were compared with the expected number of HLA-B27 homozygotes in controls under Hardy-Weinberg equilibrium (HWE). The effect of HLA-DRB1 alleles was assessed using a logistic regression procedure conditioned on HLA-B27 and case-control analysis. RESULTS: HLA-B27 was detected in 93% of cases of ankylosing spondylitis. An overrepresentation of HLA-B27 homozygotes was noted in ankylosing spondylitis (11%) compared with the expected number of HLA-B27 homozygotes under HWE (4%) (odds ratio (OR) = 3.3 (95% confidence interval, 1.6 to 6.8), p = 0.002). HLA-B27 homozygosity was marginally associated with reduced BASDAI (HLA-B27 homozygotes, 4.5 (1.6); HLA-B27 heterozygotes, 5.4 (1.8) (mean (SD)), p = 0.05). Acute anterior uveitis (AAU) was present in significantly more HLA-B27 positive cases (50%) than HLA-B27 negative cases (16%) (OR = 5.4 (1.7 to 17), p<0.004). HLA-B27 positive cases had a lower average age of symptom onset (26.7 (8.0) years) compared with HLA-B27 negative cases (35.7 (11.2) years) (p<0.0001). CONCLUSIONS: HLA-B27 homozygosity is associated with a moderately increased risk of ankylosing spondylitis compared with HLA-B27 heterozygosity. HLA-B27 positive cases had an earlier age of onset of ankylosing spondylitis than HLA-B27 negative cases and were more likely to develop AAU. HLA-DRB1 alleles may influence the age of symptom onset of ankylosing spondylitis.
Assuntos
Antígeno HLA-B27/genética , Homozigoto , Espondilite Anquilosante/genética , Adulto , Alelos , Estudos de Casos e Controles , Feminino , Finlândia , Frequência do Gene , Predisposição Genética para Doença , Antígeno HLA-B27/imunologia , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Haplótipos , Teste de Histocompatibilidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Espondilite Anquilosante/imunologiaRESUMO
Several studies have identified the PTPN22 allelic variant 1858 C/T that encodes the R620W amino-acid change as a putative susceptibility factor in autoimmune diseases. The current study was undertaken to examine a large cohort of Finnish rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) subjects using both population control and, importantly, family-based association methods. The latter is particularly important when, as is the case for the 1858 C/T polymorphism, the frequency of the variant allele (T) differs in both major ancestral populations and in subpopulations. The analysis of rheumatoid factor-positive 1030 RA probands from Finland provides strong support for association of this variant in both population studies (allele specific odds ratio (OR)=1.47, 95% confidence interval (CI)=1.27-1.70, P=3 x 10(-7)) and in family studies (P<10(-6)). In contrast, no allelic association was seen with JIA (230 probands) and only weak evidence for a genotypic effect of 1858T homozygotes was observed in this population.
Assuntos
Artrite Juvenil/genética , Artrite Reumatoide/genética , Polimorfismo Genético , Proteínas Tirosina Fosfatases/genética , Fatores de Risco , Alelos , Artrite Juvenil/epidemiologia , Artrite Reumatoide/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Intervalos de Confiança , Finlândia/epidemiologia , Frequência do Gene , Variação Genética , Genética Populacional , Núcleo Familiar , Razão de Chances , Proteína Tirosina Fosfatase não Receptora Tipo 22RESUMO
OBJECTIVE: To ascertain the occurrence of osteoporosis and the development of central bone mineral density (BMD) in long-term rheumatoid arthritis (RA) METHODS: BMD of the lumbar spine (L2-L4) and the femoral neck were measured by dual-energy X-ray absorptiometry in a cohort of 59 patients (49 women and 10 men) with rheumatoid factor-positive RA followed up for 20 years. BMD measurements were obtained at the 15- and 20-year follow-up visits. RESULTS: At the 15-year check-up the mean age was 61 (SD 13)for men and 54 (SD 11) years for women. Bone densitometry of these patients revealed decreased BMD at both lumbar spine and femoral neck, the mean T-scores being -1.1 [95%CI: -1.6 to -0.6] and -1.3 [95%CI: -1.6 to -1], respectively). Eighteen (31 %) patients thus had osteoporosis (BMD T -score < or = -2.5) and 32 (54%) patients were osteopenic (BMD T-score -1.0 to -2.5). However, when compared with reference values, the decreases in central bone mineral in this patient group were of low degree; the mean Z-score -0.2 [95%CI: -0.7 to 0.2] at the lumbar spine and -0.5 [95%CI: -0.8 to -0.3] at the femoral neck, respectively. After the subsequent five years the mean Z-score increased 0.45 [95%CI: 0.32 to 0.58] at the lumbar spine and the mean T-score decreased -0.20 [95%CI: -0.32 to -0.08] at the femoral neck. ESR, Larsen score, gender and cumulative dose of prednisolone during the 5 year follow-up and HAQ-index were used as explanatory parameters of BMD change between the 15- and 20-year follow-ups. None of these parameters explained the BMD change. CONCLUSION: We conclude that in long-term RA central bone densities seemed to be only moderately decreased after 15 years from eruption of RA. No essential change in central BMD was found after the consecutive 5 years.
Assuntos
Artrite Reumatoide/metabolismo , Densidade Óssea , Doenças Ósseas Metabólicas/metabolismo , Osteoporose/metabolismo , Absorciometria de Fóton , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/patologia , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/patologia , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/metabolismo , Nível de Saúde , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/metabolismo , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/patologia , Prednisolona/uso terapêutico , Valores de Referência , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: In amyloid A (AA) amyloidosis the receptor for advanced glycation end products is a target for the circulating amyloid precursor protein (SAA) resulting in upregulation of the proinflammatory cytokine pathway. Besides inducing hepatic SAA synthesis the interleukin-1 cytokine family is involved in the regulation of haematopoiesis. We therefore studied the relationship between the circulating levels of interleukin-1beta (IL-1beta) and interleukin-18 (IL-18), a new member of the IL-1 complex, as well as polymorphisms within the IL-1 cluster with the occurrence of anaemia in patients with AA amyloidosis. DESIGN, SETTING AND SUBJECTS: The study included 54 adult patients with biopsy-proven reactive amyloidosis allocated into three groups on the basis of haemoglobin (Hb) level: group I included all patients with Hb < 110 g L(-1) (n = 16); group II patients (Hb > 110 g L(-1), n = 16) were selected to match group I patients with respect to sex, age, underlying disease (seropositive, erosive rheumatoid arthritis) and renal function; and group III patients (n = 38) represented all patients (unselected) with Hb > or = 110 g L(-1). Gene polymorphisms were studied by polymerase chain reaction restriction length assay and included the base exchange at position-889 of the IL-1alpha gene, the polymorphic region at position-511 and the polymorphic locus at exon 5, position +3954 of the IL-1beta gene, as well as the IL-1 receptor antagonist (IL-1Ra) exon 2 polymorphism caused by the 86-bp tandem repeats. Plasma IL-1beta, IL-1alpha, IL-18, IL-1 Ra, SAA, ferritin, soluble transferrin receptor and erythropoietin levels were studied by enzyme immunoassays. RESULTS: Circulating IL-beta and IL-18 were significantly raised in the anaemic patients with AA amyloidosis when compared with group II patients (matched, Hb > 110 g L(-1)) as well as group III patients (nonmatched, Hb > or = 110 g L(-1)). A significant inverse relationship was found between IL-1beta and haemoglobin levels, as well as between IL-18 and haemoglobin levels. The frequency of allele 2 (T) of the IL-1beta-511 promoter gene was significantly increased and that of allele 1 (C) decreased in anaemic amyloid patients (group I) when compared with group II and III patients. Circulating IL-1beta levels tended to be higher amongst the IL-1beta-511 allele 2 carriers than amongst the noncarriers, as well as amongst the anaemic amyloid patients filling all criteria of anaemia of chronic disease. CONCLUSION: The occurrence of anaemia in patients with AA amyloidosis is associated with allele 2 (T) of the IL-1beta-511 promoter gene and elevated levels of circulating IL-1beta and IL-18. In AA amyloidosis the raised cytokine levels may generate a vicious cycle leading to accelerated amyloidogenesis, suppression of erythropoiesis and aggravation of the underlying inflammatory disorder.
Assuntos
Amiloidose/genética , Anemia/genética , Interleucina-18/sangue , Interleucina-1/sangue , Interleucina-1/genética , Proteína Amiloide A Sérica/metabolismo , Adulto , Idoso , Amiloidose/imunologia , Anemia/imunologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Regiões Promotoras Genéticas , Estatísticas não ParamétricasRESUMO
We have developed and validated a semi-automated fluorescent method of genotyping human leucocyte antigen (HLA)-DRB1 alleles, HLA-DRB1*01-16, by multiplex primer extension reactions. This method is based on the extension of a primer that anneals immediately adjacent to the single-nucleotide polymorphism with fluorescent dideoxynucleotide triphosphates (minisequencing), followed by analysis on an ABI Prism 3700 capillary electrophoresis instrument. The validity of the method was confirmed by genotyping 261 individuals using both this method and polymerase chain reaction with sequence-specific primer (PCR-SSP) or sequencing and by demonstrating Mendelian inheritance of HLA-DRB1 alleles in families. Our method provides a rapid means of performing high-throughput HLA-DRB1 genotyping using only two PCR reactions followed by four multiplex primer extension reactions and PCR-SSP for some allele groups. In this article, we describe the method and discuss its advantages and limitations.
Assuntos
Antígenos HLA-DR/genética , Reação em Cadeia da Polimerase/métodos , Alelos , Sequência de Bases , Primers do DNA/genética , Feminino , Finlândia , Corantes Fluorescentes , Genótipo , Cadeias HLA-DRB1 , Humanos , Masculino , Polimorfismo Genético , Polimorfismo Conformacional de Fita Simples , Espondilite Anquilosante/genética , Espondilite Anquilosante/imunologiaRESUMO
OBJECTIVES: To determine whether genetic polymorphisms in or near the transforming growth factor beta1 (TGFB1) locus were associated with susceptibility to or severity of ankylosing spondylitis (AS). METHODS: Five intragenic single-nucleotide polymorphisms (SNP) and three microsatellite markers flanking the TGFB1 locus were genotyped. Seven hundred and sixty-two individuals from 184 multiplex families were genotyped for the microsatellite markers and two of the promoter SNPs. One thousand and two individuals from 212 English and 170 Finnish families with AS were genotyped for all five intragenic SNPs. A structured questionnaire was used to assess the age of symptom onset, disease duration and disease severity scores, including the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index). RESULTS: A weak association was noted between the rare TGFB1 +1632 T allele and AS in the Finnish population (P = 0.04) and in the combined data set (P = 0.03). No association was noted between any other SNPs or SNP haplotype and AS, even among those families with positive non-parametric linkage scores. The TGFB1 +1632 polymorphism was also associated with a younger age of symptom onset (English population, allele 2 associated with age of onset greater by 4.2 yr, P = 0.05; combined data set, allele 2 associated with age of onset greater by 3.2 yr, P = 0.02). A haplotype of coding region SNPs (TGFB1 +869/+915+1632 alleles 2/1/2) was associated with age of symptom onset in both the English parent-case trios and the combined data set (English data set, haplotype 2/1/2 associated with age of onset greater by 4.9 yr, P = 0.03; combined data set, haplotype 2/1/2 associated with greater age of onset by 4.2 yr, P = 0.006). Weak linkage with AS susceptibility was noted and the peak LOD score was 1.3 at distance 2 cM centromeric to the TGFB1 gene. No other linkage or association was found between quantitative traits and the markers. CONCLUSION: This study suggests that the polymorphisms within the TGFB1 gene play at most a small role in AS and that other genes encoded on chromosome 19 are involved in susceptibility to the disease.
Assuntos
Polimorfismo Genético , Espondilite Anquilosante/genética , Fator de Crescimento Transformador beta/genética , Adulto , Distribuição de Qui-Quadrado , Inglaterra , Feminino , Finlândia , Predisposição Genética para Doença , Antígeno HLA-B27/genética , Haplótipos , Humanos , Desequilíbrio de Ligação , Masculino , Repetições de Microssatélites , Polimorfismo de Nucleotídeo ÚnicoRESUMO
OBJECTIVE: To study tumor necrosis factor alpha (TNFalpha) -308 gene promoter polymorphism and circulating levels of TNFalpha and soluble TNF receptor type I (sTNFRI) in rheumatoid arthritis (RA) patients with and without reactive amyloidosis. METHODS: In a retrospective study, we examined 55 RA patients with biopsy-proven reactive amyloidosis and 55 control RA patients without amyloidosis (matched for age, sex, rheumatoid factor titer, and RA duration). Inflammatory activity was assessed by measuring the erythrocyte sedimentation rate and C-reactive protein level. TNFalpha gene promoter polymorphism was studied using polymerase chain reaction-restriction fragment length polymorphism assay. Cytokine and receptor levels were measured by enzyme-linked immunoassays. RESULTS: Patients with RA and amyloidosis had significantly higher TNFalpha and sTNFRI levels than did the control RA patients. The increased circulating levels of TNFalpha correlated with interleukin-18 levels, but not with the serum amyloid A protein levels or with TNFalpha -308 gene promoter polymorphism (reported to be associated with high TNFalpha levels and certain disease susceptibilities). In the patients with RA and amyloidosis, those with anemia had significantly higher TNFalpha and sTNFRI levels than did those without anemia, and circulating TNFalpha and sTNFRI levels correlated negatively with hemoglobin concentrations. In the patients with RA and amyloidosis, those with nephropathy had significantly higher TNFalpha and sTNFRI levels than did those without nephropathy; in patients with isolated proteinuria (but no creatinine elevation) the TNFalpha level was also significantly increased, indicating that the TNFalpha elevation was not merely a consequence of impaired renal function. CONCLUSION: This study shows that circulating levels of TNFalpha and sTNFRI are significantly increased in RA patients with amyloidosis as compared with control RA patients without amyloidosis and that the increased levels may be implicated in the pathogenesis of certain disease manifestations, including anemia of chronic disease and renal pathology in reactive amyloidosis.
Assuntos
Amiloidose/sangue , Anemia/sangue , Antígenos CD/sangue , Artrite Reumatoide/sangue , Nefropatias/sangue , Receptores do Fator de Necrose Tumoral/sangue , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Idoso , Amiloidose/complicações , Amiloidose/genética , Anemia/etiologia , Anemia/patologia , Antígenos CD/genética , Artrite Reumatoide/complicações , Artrite Reumatoide/genética , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Doença Crônica , DNA/análise , Feminino , Predisposição Genética para Doença , Humanos , Nefropatias/etiologia , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo Genético , Polimorfismo de Fragmento de Restrição , Regiões Promotoras Genéticas/genética , Receptores do Fator de Necrose Tumoral/genética , Receptores Tipo I de Fatores de Necrose Tumoral , Estudos Retrospectivos , Proteína Amiloide A Sérica/metabolismo , Fator de Necrose Tumoral alfa/genéticaRESUMO
OBJECTIVE: To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA. METHODS: An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. RESULTS: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA. CONCLUSIONS: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.
Assuntos
Artrite Reumatoide/patologia , Articulação Atlantoaxial/patologia , Densidade Óssea/fisiologia , Artropatias/patologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Artrite Reumatoide/fisiopatologia , Articulação Atlantoaxial/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Artropatias/complicações , Artropatias/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the role of Pogosta virus as a triggering infection in non-specific arthritis. METHODS: Serum samples of 142 patients with acute arthritis were screened for the evidence of Pogosta virus infection. Serological tests for Chlamydia trachomatis, salmonella, parvovirus B19, and Borrelia burgdorferi were also carried out. As verified later, 78 of the patients had rheumatoid arthritis and 63 seronegative poly- or oligoarthritis, while one had systemic lupus erythematosus. RESULTS: In the early stage of the joint symptoms 4 patients with rheumatoid arthritis, 1 with seronegative polyarthritis and 1 with systemic lupus erythematosus had recent Pogosta virus infection. Four of them had probably had Pogosta disease at the time of the onset of arthritis. In 11 patients with a diagnosis of seronegative arthritis, serological evidence of preceding infection due to salmonella or Chlamydia trachomatis was found, strongly suggesting classical reactive arthritis in these cases. CONCLUSIONS: Our study suggests that also a Sindbis virus infection may be associated both to an acute joint inflammation as a part of Pogosta disease or chronic arthritis. At present, this possibility still needs further research.
Assuntos
Infecções por Alphavirus/imunologia , Artrite Reumatoide/virologia , Artrite/virologia , Sindbis virus/imunologia , Adolescente , Adulto , Idoso , Infecções por Alphavirus/complicações , Infecções por Alphavirus/epidemiologia , Artrite/imunologia , Artrite Reumatoide/imunologia , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , PrevalênciaAssuntos
Antirreumáticos/uso terapêutico , Metotrexato/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Finlândia/epidemiologia , Humanos , Hidroxicloroquina/uso terapêutico , Seguro Saúde , Doenças Reumáticas/epidemiologia , Sulfassalazina/uso terapêuticoRESUMO
Genetic polymorphisms of the IL10 promoter region have been implicated in many autoimmune diseases, including seronegative spondyloarthropathies. We studied three SNPs (IL10-1087, -824, and -597) and two microsatellites (IL10R and IL10G) lying within the promoter region of IL10 for association with susceptibility to and clinical manifestations of ankylosing spondylitis (AS), a common form of spondyloarthritis. Four hundred and sixty-eight individuals from 182 Finnish families affected with AS were studied. No association between individual IL10 promoter region polymorphisms or marker haplotype was observed with susceptibility to AS, but weak association was noted between the IL10-597 and -824 SNPs and age of disease onset (P=0.01 for each SNP). The IL10.G4 allele was associated with BASFI (corrected for disease duration) (P=0.03). We conclude that IL10 promoter polymorphisms have no significant effect on susceptibility to AS, but may play a minor role in determining age of disease onset and disease severity.
Assuntos
Interleucina-10/genética , Polimorfismo Genético/genética , Espondilite Anquilosante/genética , Alelos , Humanos , Repetições de Microssatélites/genética , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
OBJECTIVE: To study the circulating levels of interleukin-18 (IL-18), a proinflammtory cytokine implicated in the T helper I response, in patients with rheumatoid arthrtitis (RA) with or without amyloidosis. METHODS: Plasma IL-18 levels were studied by enzyme-linked immusorbent assay in 55 RA patients with reactive amyloidosis and in 55 RA patients without amyloidosis matched with respect to age, sex, seropositivity, disease duration and inflammatory activity, as well as in 55 healthy control subjects. RESULTS: Plasma IL-18 levels were significantly elevated in RA patients as compared with control subjects. Those RA patients who had amyloid had significantly higher circulating level of IL-18 than those without amyloid (418.1 +/- 32.1 ng/l versus 317.0 +/- 21.3 ng/l, P<0.02). This difference was not due to differences in inflammatory activity, nor was it related to renalfunction. CONCLUSION: RA is associated with increased levels of plasma IL-18, the levels being significantly higher in patients with amyloid than in those without amyloid The increased level in the amyloidosis patients may reflect the interaction ofamyloid with cellular meatbolic pathways or, possibly, suggest a direct role of IL-18 in amyloidogenesis.
Assuntos
Amiloidose/metabolismo , Artrite Reumatoide/sangue , Interleucina-18/sangue , Proteína Amiloide A Sérica/metabolismo , Amiloide/metabolismo , Amiloidose/patologia , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Creatinina/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , História do Século XVI , Humanos , Masculino , Pessoa de Meia-Idade , Células Th1/imunologia , Regulação para CimaRESUMO
The aim of the study was to investigate the long-term outcome of non-specific seronegative oligoarthritis in adults. The study included 64 adult patients with recent (<6 months) seronegative oligoarthritis (rheumatoid factor negative, number of swollen joints 1-4 during the first 6 months). Follow-up examinations were carried out at onset and at 1, 3 and 8 years from entry. A total of 47 patients attended the 23-year follow-up. The endpoint outcome was good. Seven had mild erosions in the hands or feet. Only one patient with HLA-B27 developed bilateral sacroiliitis. Three patients had retired from work because of joint disease. The functional outcome of the patients analysed by HAQ was very good after 23 years: 0 in 33 and 0.1-0.9 in 12 of the 47 patients. Reclassification revealed a certain heterogeneity: one case each of rheumatoid arthritis, SLE and ankylosing spondylitis, two cases of post-traumatic arthritis, four of osteoarthrosis, and six of possible reactive arthritis. Out of the remaining 49 patients 15 were HLA-B27 positive and 16 had at least one of the psoriasis-related HLA antigens (HLA-B13, 17, w16). In conclusion, our 23-year prospective follow-up study of patients with seronegative oligoarthritis confirms their favourable outcome. The reason is that the endpoint diagnoses seemed to be similar to those of mild spondylarthropathies.
Assuntos
Artrite/diagnóstico , Antígeno HLA-B27/análise , Adolescente , Adulto , Idade de Início , Idoso , Artrite/fisiopatologia , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/fisiopatologia , Artrite Reativa/diagnóstico , Artrite Reativa/fisiopatologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Estudos de Coortes , Progressão da Doença , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Testes Sorológicos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The aim of the present study was to evaluate the number and sequence of large joint replacements (LJR) performed in long-term rheumatoid arthritis (RA) from an inception cohort of 103 patients with rheumatoid factor (RF)-positive RA followed over 25 years. METHODS: A total of 83 patients attended the 15-year and 68 patients the 20-year follow-up. Patient documents and radiographs were evaluated in the beginning of 2001 and a complementary interview was arranged to assess the number and sequence (timing) of LJRs performed. RESULTS: The cumulative number of LJRs performed for 22 patients (19 women) during the 25 years of follow-up was 41. Seventeen total hip joint replacements (THR) (42% of the total number of 41 LURs) were performed on 13 patients, median time from the diagnosis to the operation being 14 years; 14 total knee replacements (TKR) (34%) on 11 patients (after a median time of 17 years); 3 total shoulder replacements (TSR) (7%) on 3 patients (median time of 18 years); and 7 total elbow replacements (TER) (17%) on 4 patients (median time of 21 years), respectively. Six patients had undergone three or more LJRs during the follow-up period. CONCLUSION: During our 25 years of follow-up, in 27% of RA patients LUR was needed, and 41% of them needed more than one replacement.