A method to differentiate between anti-C1q antibodies and C1q-binding immune complexes using collagenase-digested solid phase C1q.

A method for the detection of circulating immune complexes in the presence of autoantibodies to C1q is described. Solid phase C1q-digestion with bacterial collagenase results in the elimination of the collagen-like region of C1q. Binding of model immune complexes to this modified solid phase C1q is practically unaltered, while reactivity of anti-C1q antibodies is abolished by this procedure. In conjunction with an ELISA using the collagen-like region of C1q as antigen this modified C1q solid phase assay may be used to determine immune complexes and anti-C1q antibodies in the sera of patients with autoimmune rheumatic diseases.

HLA-DR1-positive patients suffering from rheumatoid arthritis are at high risk for developing mucocutaneous side effects upon gold therapy.

Population studies suggest an association between RA and, depending on the ethnic background, HLA-DR1 and/or -DR4. One standard regimen for the treatment of RA is the use of gold compounds like SATM to arrest progression of the disease. In the present study, the immunogenetic background of RA patients developing side effects upon SATM treatment was determined. A total of 53 patients under SATM therapy were tested for their HLA-DRB and -DQ alleles by DNA typing; a significantly higher frequency of HLA-DR1 (p < 0.004, uncorrected) was observed in patients presenting with mucocutaneous side effects (MCT) when compared with patients without MCT. The RR was 6.85. Thus, HLA-DR1 seems to be a marker for the susceptibility of gold adverse reactions.

Prediction of interstitial lung involvement in rheumatoid arthritis. The value of clinical data, chest roentgenogram, lung function, and serologic parameters.

We initiated the present study to predict interstitial lung involvement in rheumatoid arthritis (RA) by means of logistic regression analysis of clinical data, lung function, chest roentgenogram, and serologic parameters. Fifty-eight nonsmoking patients with RA were randomized from the rheumatologic unit and sent for investigation to the pulmonary department. Bronchoalveolar lavage (BAL) was performed in the middle lobe and the BAL fluid was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis; these findings or combinations thereof were found in 42 (72.4 percent) of 58 cases. The patients' data that had an impact on the normality of BAL were the sex (p = 0.001), vital capacity (p = 0.028), peripheral blood T-helper cells (OKT4+) (p = 0.025), DR(+)-lymphocytes (p = 0.002), and antinuclear antibodies (p = 0.025). By means of the logistic regression analysis, it was possible to reach high significance in the prediction of interstitial lung involvement, with a sensitivity of 92.9 percent and a specificity of 75.0 percent (p less than 10(-6)). The efficiency of prediction was 87.9 percent. From these results, we conclude that interstitial lung involvement in RA is predictable from laboratory findings that have been yielded by noninvasive diagnostic techniques. These data should be used in clinical routine monitoring and they may help to facilitate the assessment of whether bronchoscopy is indicated.

[Baker cysts: an accompaniment of chronic diseases of the knee joint (author's transl)]. / Baker-Zyste: Begleitsymptom chronischer Erkrankungen des Kneigelenkes.

One hundred and twenty one Baker cysts demonstrated by arthrography have been analysed. Morphologically one must distinguish between distension cysts and dissection cysts. Distension cysts are more common with various diseases of the knee joint (68% of all cysts). Dissection cysts (32%) are found particularly with inflammatory-rheumatic diseases and are rarely of degenerative or post-traumatic origin. Acute rupture of the cyst was observed on ten occasions. Repeated rupture, which had only been suspected previously, was demonstrated by arthrography in four patients. It is pointed out that Baker cysts may imitate the features of acute thrombophlebitis.

[Liver scanning in diffuse liver disease (author's transl)]. / Leberszintigraphie bei diffusen Leberparenchymerkrankungen

The results of liver scans performed with 99mTc-sulphur colloid in 169 patients suffering from diffuse liver diseases and in 48 normal controls were evaluated. The patients with reactive hepatitis, acute hepatitis, chronic persistent hepatitis, fatty liver and fibrosis of the liver show only minimal deviations from the scintigraphic pattern. On the contrary, highly increased colloid uptake in the spleen is found in cases of chronic aggressive hepatitis, whilst the intrahepatic distribution of the colloid is approximately normal. In cases of liver cirrhosis, increased colloid uptake is found in the left lobe of the liver as well as in the spleen and in the bone marrow. Either normal findings or cirrhosis-like changes of the colloid distribution are observed in patients with alcoholic hepatitis.

[Technetium uptake in the parotid gland. Value of functional parameters in Sjögren's syndrome]. / Technetiumspeicherung der Parotis. Wertigkeit von Funktionsparametern beim Sjögren-Syndrom

Studies of the parotid function were performed on 22 subjects comprising 11 patients with Sjögren's syndrome and 11 normal controls using an Anger camera with digital data processing facility. After injection of 2 mCi of 99mTc-pertechnetate digital scintigrams of the face region were collected and stored onto magnetic tape. 50 minutes after injection the parotid glands were stimulated by administration of Pilocarpin. By subsequent processing of the data uptake curves were obtained for both parotid glands. In allowing for vascular activity three different methods were compared. The most satisfactory method with respect to discriminating the groups under study was using a background region located in the falx cerebri. From the corrected uptake curves a number of parameters were derived and their respective selectivity was investigated by statistical analysis. It is shown that the most suitable parameter characterizing the parotid function is given by the difference of maximum uptake before Pilocarpin stimulation and minimum uptake after stimulation.

The use of questionnaires in the evaluation of the functional capacity in rheumatoid arthritis.

The functional capacity of 46 patients with rheumatoid arthritis was assessed by means of two systems of investigation. Three different questionnaires were used. One set of each was filled out by the patient himself; the other with the help of the occupational therapist. The results obtained were tested for their reliability. In addition they were also compared to the Ritchie-Index (method of simple measurement of disease activity) of thirty patients. The disability of each patient could be assessed with sufficient precision. A correlation to the Ritchie-Index was also registered.

The efficacy and safety of fentiazac and diclofenac sodium in peri-arthritis of the shoulder: a multi-centre, double-blind comparison.

In a double-blind parallel group comparison of efficacy and safety, 19 patients with peri-arthritis of the shoulder received 200 mg fentiazac twice daily and 19 received 50 mg diclofenac sodium twice daily, with both drugs given orally for 3 weeks. In both groups, observers' verbal rating scales of pain severity at rest and on movement showed decreases that were significant by week 1. Both groups also had significant improvement in abduction, external rotation, retroversion and anteversion. At week 1, the patients reported improvement, on a verbal rating scale, of global effectiveness, but there were no subsequent changes. There were no statistically significant differences between the treatments in any of these variables. Five (26%) fentiazac-treated patients and four (21%) diclofenac sodium-treated patients reported adverse effects, mostly gastro-intestinal. One case of rash in each group and one case of pruritus in a diclofenac sodium-treated patient were severe enough for the patients to be withdrawn from therapy. There were no clinically significant changes in laboratory values. It was concluded that fentiazac (400 mg/day) and diclofenac sodium (100 mg/day) were equally effective within 1 week in decreasing pain severity and improving shoulder mobility.

[Are antinuclear factors a contraindication for penicillamine treatment in patients with rheumatoid arthritis? (author's transl)]. / Das Auftreten antinukleärer Faktoren bei der chronischen Polyarthritis unter D-Penicillamin.

28 patients with rheumatoid arthritis undergoing treatment with penicillamine were investigated over a period of 7 to 72 months. Antinuclear antibodies were detected in 43% of patients before treatment, and 39% when treatment was completed. In all patients anti-native DNA antibodies were within the normal range. Precipitating antibodies to heat-denatured DNA were detected in 3 out of 16 patients at the end of therapy. There was no correlation between the detection of antinuclear antibodies, antibodies to native or denatured DNA and the occurrence of immunological side effects due to penicillamine (1 patient with pemphigus erythematosus, 3 patients with immune-complex nephritis).

[Preliminary results with a new non-steroidal antirheumatic drug (author's transl)]. / Erste Erfahrungen mit einem neuen nichtsteroidalen Antirheumatikum

Thirty patients with classical or definite rheumatoid arthritis were treated over a 4-week period with diftalone, a new non-steroidal antirheumatic drug. The daily dosage ranged from 500 to 1000 mg. A good objective response was achieved in 69% of the patients. Diftalone was well tolerated. Side effects were noted in 11.8% of patients on 500 mg diftalone daily and in 18.8% of cases treated with the highest dosage (1000 mg daily). The optimum daily dosage appears to be 750 mg.

[Lymphocyte response to mitogens in serum-free and serum-containing medium in patients with rheumatoid arthritis (author's transl)]. / Lymphozytentransformation mit Mitogenen in serumfreiem und serumhältigem Medium bei Patienten mit chronischer Polyarthritis.

Mitogenic transformation of lymphocytes from patients with rheumatoid arthritis (RA) has revealed divergent results in different laboratories. Since the sera used for medium supplementation in these previous studies might have influenced the results, we investigated lymphocyte transformation in serum-free medium in 28 RA-patients and 25 controls. It was shown that a majority of patients with RA responded weakly to PHA. Comparing some of these serum-free cultures with cultures that were set in parallel in 10% ABserum, no difference between patients and controls was observed after transformation in supplemented medium. It is concluded that lymphocyte reactivity to PHA (however not to ConA and PWM) is diminished in patients with RA and that this defect--at least partially--is reversible by addition of serum. The use of parallel cultures in serum-free and serum-containing medium is recommended for evaluation of the lymphocyte mitogenic response.

[Clinical experience with levamisole treatment of patients with systemic lupus erythematosus (author's transl)]. / Erste klinische Erfahrungen mit Levamisol bei der Behandlung von Patienten mit systemischem Lupus erythematodes.

Levamisole treatment was started in 8 patients with inactive SLE. Four patients, who have now been followed up for over 12 months, have not shown clinical deterioration. Three of these patients received concomitant maintenance corticosteroid therapy, the dosage of which could be reduced in each case. A decrease in anti-DNA antibodies was observed in all 4 patients. Levamisole had to be withdrawn in the other 4 patients. One patient developed an exacerbation of her LE skin manifestations after two months, whilst in another patient fever and skin rash (probably drug-induced) were observed after one month. The cooperation of the 2 other patients was not satisfactory and the drug had, thus, to be withdrawn. In conclusion, 4 out of 8 patients with SLE showed a beneficial response to levamisole therapy.

Predicting factors for severity of rheumatoid arthritis: a prospective multicenter cohort study of 172 patients over 3 years.

Rheumatoid arthritis may take an unfavourable course leading to rapid functional decline in a certain percentage of patients. Early identification of these patients is desirable. The aim of this study was to evaluate clinical and laboratory parameters for their value in the prediction of bad outcome. A total of 172 patients with early arthritis were followed for 3 years. Higher initial values for erythrocyte sedimentation rate, IgG and IgM rheumatoid factor, serum concentration of cartilage oligomeric matrix protein, Health Assessment Questionnaire score, Larsen score of feet, disease activity score, and swollen and tender joint count predicted worse outcome. An association with the presence of IgA rheumatoid factor or anti-cyclic-citrullinated peptide could not be established. We conclude that prognosis in an individual with rheumatoid arthritis depends on many factors. The determination of independent prognostic factors for progression of rheumatoid arthritis is a valuable tool in early arthritis to select patients for more aggressive therapy.

[Serum ferritin as an indicator for iron substitution in patients with chronic polyarthritis]. / Serumferritin als Indikator für eine Eisensubstitution bei Patienten mit chronischer Polyarthritis.

20 patients with rheumatoid arthritis were treated with oral iron for 6 months and hematological parameters including serum ferritin levels and iron absorption were studied. 13 patients (group 1) had iron deficiency as estimated by low serum ferritin concentration (less than or equal to 30 micrograms/l); the other 7 patients (group 2) revealed normal ferritin levels. After treatment with oral iron, patients of group 1 show a significant increase in serum ferritin, serum iron, hematocrit, erythrocytes, and hemoglobin, a significant decrease in transferrin, and diminished iron absorption. In contrast, in group 2 there was no change in the above-mentioned parameters. The evaluation of iron stores by serum ferritin levels is limited to patients with inactive rheumatoid arthritis. Patients with active disease show hyperferritinemia which no longer represents the iron stores. In this case patients with active rheumatoid arthritis and iron deficiency could reveal normal serum ferritin values.

[Ga-67 citrate scanning in the management of Hodgkin's disease (author's transl)]. / Szintigraphie mit 67Ga-citrat beim Lymphogranulom

159 potential areas of involvement in 26 patients with histologically proven Hodgkin's disease were examined by Ga-67 scanning. 137 areas (86%) were correctly assessed. An uptake was noted in 29 of 48 areas with active diseases, no uptake in 108 of 111 areas without active disease (97%). Best results were obtained from scans of mediastinum and lungs, particularly for differentiating between active disease and fibrosis. Para-aortic and pelvic regions often gave false-positive results because of the elimination of the tracer substance via the large bowel. Results of Ga-67 scanning in other regions were equivalent to those obtained by other diagnostic tests. Ga-67 citrate scanning thus offers an advantageous means of determining the exact stage of the disease and therefore its treatment.

Systemic lupus erythematosus and pulmonary hypertension.

Pulmonary hypertension is one of the complications in the pulmonary manifestation of SLE. Following a two year SLE history a patient developed pulmonary hypertension although his chest radiograph showed neither pulmonary changes nor signs of hypertension. In two other patients, interstitial fibrosis, pleurisy and pulmonary hypertension were the initial manifestations of SLE. They all complained of dyspnoea and respiratory chest pain. Lung function studies showed restrictive changes, reduced lung compliance and, by two patients, reduced diffusion capacity. Lung biopsy performed in one patient revealed interstitial fibrosis, focal lymphocyte infiltrations and intima proliferation of the arterioles. All three patients were treated with anticoagulants in addition to steroids and cytotoxic drugs. After a period of 8 to 42 months examinations were repeated and all three patients showed improved hypertension and less physical ailment. The radiographs from two patients even revealed an improvement of their pulmonary changes.

[A non-steroidal antirheumatic agent (nabumetone): effectiveness and tolerance in short and long-term use]. / Ein neues nichtsteroidales Antirheumatikum (Nabumetone): Wirksamkeit und Verträglichkeit bei Kurz- und Langzeitanwendung.

Nabumetone, a new nonsteroidal antirheumatic drug (NSAD), is chemically a (6-methoxy-2-naphthyl) butan-2-on. This drug was investigated with regard to its effectiveness and tolerability in an open multicenter study of 3 weeks duration, involving 40 patients with osteo-arthrosis and 45 with rheumatoid arthritis. 11 patients with arthrosis of the hip and 8 suffering from rheumatoid arthritis were continuously treated 6-12 months. The evaluation showed a good result in 85% of the patients with osteo-arthrosis and in 80% of the rheumatoid patients therapy of 3 weeks. Side effects were comparable with those of other NSADs. The changes in laboratory findings were not clinically significant. During long-term therapy both good tolerability and persisting efficacy were evidenced.