5'-Nucleotidase as a marker of both general and local inflammation in rheumatoid arthritis patients.

OBJECTIVES: To evaluate measurements of serum and synovial fluid 5'-nucleotidase (5'N) activity as a marker of general and local inflammation in arthritis, and to resolve a contradiction in the literature as to whether or not the activity of 5'N in the synovial fluids of rheumatoid arthritis (RA) patients is raised in comparison with that in the synovial fluids of other arthritis patients. METHODS: Assays for 5'N were carried out in the presence of inhibitors of other phosphatases, AMP deaminase and of 5'N itself. RESULTS: The 5'N activity in the synovial fluid of RA patients was both significantly higher (mean 1.7-fold) and had a greater variance than that in the synovial fluids of other arthritis patients, and the contradiction in the literature was resolved. There was a strong correlation between the 5'N activity in the sera of RA patients and their erythrocyte sedimentation rate. There was no significant correlation between the 5'N in the serum and synovial fluid for the RA patients, in marked contrast to the strong correlation between the two 5'N activities shown by the osteoarthritis patients. The 5'N activity was greater in the synovial fluid than in the serum for virtually all the patients, showing that it was being made locally. CONCLUSIONS: The 5'N activity in the serum (which came mostly from the liver) could be used as a marker of general inflammation, whereas the 5'N in the synovial fluid was mostly produced locally, and could be used as a marker of joint inflammation, particularly for the RA patients.

A detailed lectin analysis of IgG glycosylation, demonstrating disease specific changes in terminal galactose and N-acetylglucosamine.

Serum IgG from rheumatoid arthritis patients contains a decreased number of oligosaccharide structures ending in galactose and thus there is an increase in N-acetylglucosamine as the terminal sugar, compared with healthy individuals. The relationship between these two sugars varies depending on the disease examined: IgG from patients with rheumatoid arthritis, juvenile onset chronic arthritis and Crohn's disease are at one extreme, and exhibit a reciprocal galactose:N-acetylglucosamine relationship, while Sjögren's syndrome and osteoarthritis IgG are at the other extreme, exhibiting a parallel increase in the expression of both galactose and N-acetylglucosamine. These results may occur as a consequence of more than one glycosylation site which is differentially glycosylated, but more likely by changes in the level of bisecting N-acetylglucosamine.

Development of a 'Charcot-like joint' in tophaceous gout.

We report an unusually severe case of ulcerating tophaceous gout in which inflammation due to gout, infection and excessive alcohol intake resulted in complete destruction of an ankle joint.

Polymerase chain reaction fails to incriminate exogenous retroviruses HTLV-I and HIV-1 in rheumatological diseases although a minority of sera cross react with retroviral antigens.

OBJECTIVES: To investigate the presence of antibodies to HTLV and HIV retroviral antigens in the rheumatological diseases rheumatoid arthritis (RA), polymyositis/dermatomyositis (PM/DM), primary Sjögren's syndrome (pSS), and systemic lupus erythematosus (SLE), and to use polymerase chain reaction (PCR) to seek these exogenous retroviruses in proviral form in cellular DNA from these patients. METHODS: Thirty patients with active RA, 13 with PM, 14 with pSS and five with SLE were recruited and their sera tested for antibodies to HTLV-I in enzyme linked immunosorbent assay (ELISA) and Western blot analysis. Seropositivity to HIV-1 was also sought. DNA was extracted from peripheral blood lymphocytes, synovial tissue and muscle biopsies and tested by polymerase chain reaction using consensus primers for HTLV-I and HIV-1. RESULTS: In HTLV-I ELISA, nine rheumatological sera (4/30 RA, 3/13 PM/DM and 2/5 SLE patients) were considered positive; 14 from pSS patients and 30 from normal subjects were negative. In a control group which included osteoarthritis, Crohn's disease and bacterial endocarditis patients, only two of 80 proved positive in this system. Validation of these sera by Western blotting generally revealed weak reactivity against a variety of HTLV-I antigens. PCR of genomic DNA derived from patients' peripheral blood mononuclear cells did not reveal the presence of HTLV-I and HIV-1 target sequences. CONCLUSIONS: This study shows that PCR precludes HTLV-I and HIV-1 infection as causative agents in these rheumatological diseases although a minority of patients possess antibodies that are weakly cross-reactive with retroviral antigens.

'Benign thoracic pain' syndrome: role of magnetic resonance imaging in the detection and localization of thoracic disc disease.

The syndrome of 'benign thoracic pain' is seen in young women who have pain and tenderness in the mid-thoracic spine radiating around the chest and aggravated by spinal movement. Ten consecutive patients with this syndrome and 15 controls were evaluated with magnetic resonance imaging (MRI). This showed thoracic intervertebral disc dehydration with no associated prolapse in 90% of the patients and 13% of the controls. We postulate that the clinical features are due to impaired shock absorption of these degenerate discs rather than direct compression of surrounding structures. MRI is non-invasive and does not use ionizing radiation; it allows direct visualization of the entire thoracic spine and cord, and accurate detection of early disc degeneration. Thus, it is the imaging modality of choice for defining the subtle intervertebral disc abnormalities that characterize the 'benign thoracic pain' syndrome.

Synovial amyloid in chronic haemodialysis contains beta 2 microglobulin.

A case of amyloid arthropathy occurring in a patient receiving long term chronic haemodialysis treatment is reported. He was found to have raised serum beta 2 microglobulin (beta 2M). and beta 2M was detected in the synovial amyloid deposits.

Benign thoracic pain.

Seventy-three patients with mid-dorsal and/or unilateral chest pain seen consecutively in the rheumatology clinic by a single clinician over a three-year period were studied, after exclusion of visceral disease. The majority were young women. The pain was dull and continuous, was aggravated by coughing and sneezing and relieved by rest. There was frequently tenderness over the thoracic spine (T4-5) and an adjacent rib, and pain at extremes of thoracic spinal movement in one or two directions was invariable. Cutaneous hyperaesthesia in a radicular distribution was found in 16.4%, but there were no other neurological abnormalities. This clinical picture is probably the result of a thoracic disc prolapse, though confirmation by myelography was not thought to be ethically justified. The condition settled in most of the patients following manipulative treatment and advice on back care. No patient developed spinal cord compression. It is concluded that this is a common benign condition which deserves wider recognition.

Small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs for rheumatoid arthritis.

Evidence is presented for a non-specific ulcerative process in the small bowel of patients with rheumatoid arthritis. All three cases presented with lower gastrointestinal bleeding; on withdrawal of non-steroidal anti-inflammatory drugs no further bleeding occurred. Non-steroidal anti-inflammatory drugs may lead to small bowel ulceration in inhibiting mucosal glycoprotein synthesis and increasing intestinal permeability.

Periostitis in secondary syphilis: a place for bone scintigraphy.

Two cases of secondary syphilis are reported with periostitis as the main presenting feature. Technetium-99m bone scintigraphy was found to be superior to radiography in both defining the extent of involvement and in picking up early lesions.