Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study.

OBJECTIVE: To make a comparative evaluation of different imaging techniques for studying the craniocervical junction involvement in patients with rheumatoid arthritis (RA). Upper cervical spine involvement was compared with clinical and immunological data. METHODS: Patients (n = 47) underwent plain radiographs and computerized tomography (CT) and magnetic resonance (MR) study of the craniocervical junction. Neurological examination following clinical signs of possible atlantoaxial involvement was performed in all patients following the Ranawat classification. RESULTS: Radiographic and MR images showed craniocervical involvement in 41.3% and 61% of the patients, respectively. Immunological data were not correlated with imaging findings, whereas Ranawat class II and III of neurological involvement seem to be predictive of atlantoaxial alteration. CONCLUSION: Conventional radiography allowed us to detect 41.3% of patients with craniocervical involvement, but only in advanced stages of the disease. MR imaging had the unique potential of direct and detailed synovial visualization, especially in the gadolinium enhanced axial images, resulting in the early diagnosis of craniocervical RA.

Serum zinc and copper in active rheumatoid arthritis: correlation with interleukin 1 beta and tumour necrosis factor alpha.

Serum zinc and copper levels and serum interleukin 1 beta (IL1 beta) and tumour necrosis factor alpha (TNF alpha) levels were evaluated in 57 female patients with active rheumatoid arthritis (RA) to investigate a possible role of IL1 beta and TNF alpha on zinc and copper homeostasis in RA. Serum zinc levels were significantly lower and serum copper levels significantly higher in RA patients when compared with osteoarthritis or asymmetrical psoriatic oligoarthritis patients and with normal controls. No differences were observed in serum IgM rheumatoid factor positive and serum IgM rheumatoid factor negative patients as regards serum zinc and copper concentration. In RA patients the erythrocyte sedimentation rate and acute-phase proteins correlated negatively with serum zinc and positively with serum copper. IL1 beta and TNF alpha were found to correlate negatively with zinc and positively with copper in RA patients. Lower levels of zinc may be due to an accumulation of zinc-containing proteins in the liver and in the inflamed joints in RA. Elevated serum copper levels seem to be linked to the increased synthesis of ceruloplasmin by the liver.

[Integrated role of computerized tomography and magnetic resonance imaging in identifying the early changes in rheumatoid arthritis of the craniocervical junction]. / Ruolo integrato della Tomografia Computerizzata e della Risonanza Magnetica nel rilievo delle alterazioni precoci dell'artrite reumatoide della giunzione cranio-cervicale.

Any cervical spine segment may be affected by rheumatoid arthritis, but destructive changes are most prominent at the craniocervical junction. Cervical involvement is a devastating complication of the disease, because of the risk of a range of neurological complications (paresthesia, cervical myelopathy, vertebro-basilar insufficiency), and even sudden death from medullary compression. However, the incidence of both cervical rheumatoid arthritis and its neurological complications are still debated, being respectively reported in 17-86% and 11-70% of the patients, according to the variability in neurological and radiologic classification systems adopted by the authors. To assess the incidence of cervical rheumatoid arthritis and the integrated role of different imaging techniques in its diagnosis, 38 consecutive patients (29 women and 9 men) with rheumatoid arthritis according to the American Rheumatism Association criteria were examined. The average age was 60 years (range: 27-70 years) with a mean disease duration of 6.6 years (range: 6 months-25 years). All the patients underwent conventional radiography of the cervical spine, unenhanced Computed Tomography (CT) of the craniocervical junction and unenhanced and Gadolinium-enhanced Magnetic Resonance Imaging (MRI) of the cervical spine. Cervical spine involvement was demonstrated in 25/38 (66%) patients 20 women and 5 men, with an average age of 57 years and a mean disease duration of 8.5 years. In 13 of them (mean disease duration: 12.7 years), the diagnosis was made with radiography which showed atlantoaxial and subaxial subluxations and/or erosions. Of the 12 patients with negative conventional radiography (mean disease duration: 2.5 years), 4 were identified with both CT and MRI (synovial pannus and erosions). 3 with MRI only (joint effusion/hypervascularized synovial pannus), and 5 exhibited questionable CT findings which were clarified only by MR demonstration of inflammatory tissue contiguous to suspicious irregularities of the cortical bone of the odontoid process. 52% (13/25) of cervical rheumatoid arthritis patients were identified with plain radiographs, 68% (17/25) with CT and 100% (25/25) with MRI. Our preliminary data show that a specific tool for the diagnosis is recommended even in the early disease phases since rheumatoid arthritis commonly affects the craniocervical junction. Studying the craniocervical region is clinically difficult, and diagnostic imaging assessment is essential. Conventional radiography allowed to detect more than half the patients with cervical rheumatoid arthritis, but only in advanced disease stages. On the contrary, MRI had the unique potential of direct and detailed synovial visualization, thus permitting the diagnosis of cervical involvement even in the early phases of the inflammatory process, when CT findings were still negative or questionable.

[Keratoconjunctivitis sicca in rheumatoid arthritis: correlation with the autoantibody pattern]. / Cheratocongiuntivite secca nell'artrite reumatoide: correlazione con il pattern autoanticorpale.

In order to evaluate the autoantibody pattern of subjects affected by rheumatoid arthritis (RA) with clinical features of keratoconjunctivitis, we studied 32 out- and in-patients (26 women, 6 men, average age 52 years, average disease duration 5.5 years) at the Division of Rheumatology, Catholic University of Rome. We found keratoconjunctivitis sicca and xerostomia in 22 (68.75%) patients with RA. Rheumatoid factor was present in 17 (53.1%) patients, antinuclear antibodies (ANA) were observed in 15 (48.4%) patients, and anti-rheumatoid arthritis nuclear antigens (RANA) in 22 (68.7%) patients; anti-SSA antibodies were confirmed in 3 (9.4%) patients and anti-SSB antibodies in 2 (6.2%) patients. None of the patients evidenced anti-U1RNP. Although keratoconjunctivitis sicca and xerostomia correlated significantly with the presence of rheumatoid factor, we found no relationship between these two conditions and ANA or anti-RANA antibodies. The high frequency of keratoconjunctivitis sicca and xerostomia in our RA patients is the expression of extra-articular involvement in this disease and is correlated with the presence of rheumatoid factor. ANA and anti-RANA antibodies may represent aspecific polyclonal activation in RA.

Microvascular capillaroscopic abnormalities in rheumatoid arthritis patients.

Microvascular circulation was investigated by nailfold capillaroscopy in 32 patients affected by rheumatoid arthritis (RA). In all the patients elongated and tiny capillaries as well as tortuousity were the main shape abnormalities of the capillary loops. Higher subpapilar venous plexus (SPVP) visibility was evidentiated in patients presenting antinuclear and anti-RANA antibodies. No differences in the capillaroscopic pattern were found between rheumatoid factor positive and rheumatoid factor negative patients. In conclusion, elongated and tortuous capillaries seem to be the main alterations in RA, although they are not specific to the disease and are not correlated with the presence of rheumatoid factor. Higher SPVP visibility may be an expression of the endothelial damage induced by antinuclear antibodies in vessel walls.

[Antiphospholipid antibodies in systemic lupus erythematosus: study of a caseload of 120 patients]. / Anticorpi antifosfolipidi nel lupus eritematoso sistemico: studio di una casistica di 120 pazienti.

In order to evaluate the presence of antiphospholipid antibodies (aPL) in patients with systemic lupus erythematosus (SLE), we measured IgG and IgM anticardiolipin antibodies (aCL) in a group of out- and in-patients of the Rheumatology Division at the Catholic University of Rome. Lupus anticoagulant and VDRL were also measured in 30 patients. One hundred thirteen women and 7 men (mean age 38.5 years, mean disease duration 4.27 years) were studied. The control group consisted of 60 age and sex matched healthy subjects. aCL IgG and IgM were positive in 48 (40%) and 49 (40.8%) patients respectively. aCL IgG correlated positively with the activated partial thromboplastin time. aCL IgM correlated positively with immunoglobulins of the G and M classes and with circulating immune complexes, and negatively with the C4 fraction. aCL antibodies did not correlate with spontaneous abortion or neurologic and psychiatric disturbances, although in women with a history of abortion, aCL IgG concentration was correlated with the number of spontaneous abortions. The presence of aPL does not seem to indicate a subgroup of SLE patients. The occurrence of abortion and/or neurologic and psychiatric disturbances in SLE seems to point to a complex pathogenesis with aPL as one of the causative agents.