Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis--a pilot study.

OBJECTIVE: To study the effects of Lactobacillus rhamnosus GG (LGG) on rheumatoid arthritis (RA). METHODS: Twenty-one RA patients were randomised to receive 2 capsules of LGG or a placebo twice daily in double-blind fashion for 12 months. Arthritis activity was evaluated by clinical examination, HAQ index, and laboratory tests (e.g. ESR, CRP, pro- and anti-inflammatory cytokines). RESULTS: There were no statistical differences in the clinical parameters, biochemical variables and HAQ index between the study groups over the intervention period. The mean number of tender and swollen joints decreased from 8.3 to 4.6 in the Lactobacillus group and from 5.5 to 4.8 in the placebo group (p = 0.41). According to the global assessment the RA activity was reduced in 71% (LGG group) vs. 30% (controls) (p = 0.15). Serum IL-1 beta increased slightly in the LGG group (p = 0.07), but no differences were seen in IL-6, TNF-alpha, MPO, IL-10 or 1L-12. CONCLUSIONS: Although there were no statistical significant differences in the activity of RA, more subjects in the LGG group reported subjective well being. More studies on the effects of probiotic bacteria in RA are needed.

Changes in the synovial fluid caused by osmic Acid.

27 rheumatic patients with knee joint hydrops were studied for the effect of osmic acid on the synovial fluid. Special interest was taken in synovial leucocyte counts and electrophoretic patterns. A leucopenia preceded the leucocytosis in the synovial samples; both were thought to be induced by osmium. A precipitate formation from hyaluronate was thought to account for the leucopenia and this suggests a new hypothesis of osmic acid action. In the electrophoretic patterns there was a change in the electric charges of proteins. One week after osmic acid injection the pattern was normal.

Comparison of the analgesic effect of ten nonsteroidal anti-inflammatory drugs.

The analgesic effect of 10 anti-inflammatory drugs was compared using a single-blind method in 90 patients with rheumatoid arthritis. Each patient received two different drugs, for three days each and each drug was evaluated in 18 patients. After the trial, the patients considered which of the drugs they preferred. The greatest relief from pain was achieved by diclofenac, indomethacin, naproxen and tolfenamic acid, each of these being preferred by the majority of patients and being significantly (p less than 0.01) better than the least effective drugs ketoprofen and proquazone. Acetylsalicylic acid, azapropazone, carprofen and ibuprofen were considered intermediate in efficacy.

Predicting the outcome of rheumatoid arthritis. A Soviet-Finnish co-operative study.

The prognostically important signs and symptoms in the early stage of rheumatoid arthritis were studied in 136 patients selected and treated in Moscow and in 139 patients in Heinola, Finland. The follow-up time was 3 years. The outcome was poor in patients with early signs of radiological destruction in the joints, with rheumatoid factor in serum, with early functional disability or deficient flexion of the fingers, with multiple affliction of the finger, metatarsophalangeal or wrist joints, with marked morning stiffness, and with CRP in the serum. The age of the patients did not influence the outcome in Moscow, whereas in Heinola the mean age was higher in patients with a poor outcome. Despite the marked differences in the therapeutic methods and the outcome for patients, the prognostically important signs and symptoms were very similar in both centres.

The prediction of radiological destruction during the early stage of rheumatoid arthritis.

A total of 107 patients with definite rheumatoid arthritis of no longer than six months' duration were observed for three years. The radiological destruction of the hand and foot joints after the follow-up time was compared with 65 anamnestic, clinical, laboratory and radiological variables at the onset of the disease. Of the individual variables, early radiological changes in the joints showed the best correlation with the progress of joint destruction. Grip strength, ESR, serum iron, serum C1 esterase inhibitor, rheumatoid factor and old age also had prognostic value. In multiple regression analysis 15 variables explained about 50% of the variance in the progress of joint destruction.

Comparison of three slow-release acetylsalicylic acid preparations in rheumatoid arthritis.

Nine patients suffering from chronic rheumatoid arthritis were each given single doses of 1 g acetylsalicylic acid, in the form of each of the preparations studied: an enteric-coated tablet, a microcrystalline tablet, and a capsule containing enterosoluble granules. Absorption from each preparation was good in all patients. Onset of absorption varied to some degree, but similar salicylate levels were reached within 5 hours with all preparations. In the case of enteric-coated tablets, relatively high salicylate levels persisted 12 hours after dosing, which would seem to permit twice daily dosage, regardless of the total daily dose.

Prognosis of inflammatory joint diseases. A three-year follow-up study.

The prognosis 3 years after the onset of the disease was studied in 107 patients with definite rheumatoid arthritis, 161 with probable RA or non-specific arthritis, 84 with either ankylosing spondylitis, Reiter's disease or reactive arthritis, 14 with psoriatic arthritis and 10 with a systemic connective tissue disease. Prognosis was measured by clinical involvement of joints, radiological erosions in joints, deterioration in joint function, ESR, and working ability. A total of 44% of all patients were symptomless after 3 years. The prognosis was best in patients with an "HLA B 27-associated" disease and non-specific arthritis, and worst in RA. Two patients died during the follow-up of systemic connective tissue disease and one committed suicide with an overdose of hydroxychloroquine. Two HLA B27-positive patients developed systemic amyloidosis.

Reiter's syndrome in association with enteritis due to Campylobacter fetus ssp. jejuni.

An 18-year-old girl with Reiter's syndrome after febrile diarrhoea was found to be infected with Campylobacter fetus spp. jejuni. Excretion of campylobacter into stools was stopped by erythromycin therapy, but active polyarthritis lasted for 6 months. The patient was positive for HLA B27.

Arthritis associated with Campylobacter jejuni enteritis.

Among 342 patients with infection due to Campylobacter fetus ss. jejuni, 8 cases (2.3%) of arthritis were found. Three patients had monoarthritis and 5 oligoor polyarthritis. The arthritis began 4 days - 4 weeks after the onset of diarrhoea; this interval and the synovial fluid findings suggest that the arthritis was reactive. The histocompatibility antigen HLA-B 27 was identified in 5 of the 7 patients tested.

The influence of antirheumatic drugs on the occurrence of peptic ulcers. A controlled study of patients with chronic rheumatic diseases.

46 patients who had an ulcer (verified by X-ray pictures) during treatment at the Rheumatism Foundation Hospital were compared with two patient groups of the same size. The first control group consisted of randomly selected patients who had been examined in the same way for the same indications but where the X-ray pictures did not show any ulcer. The subjects in the second control group were of the same age and sex as the ulcer patients; this control group did not undergo any X-ray examination and had no history of ulcer. The study revealed that although most rheumatic patients were women (as in the first control group) there were significantly more men among the ulcer patients. The use of rapidly dissolving acetylsalicylic acid tablets was more common in the ulcer group; correspondingly the slowly absorbed tablets were used significantly more often by the controls. The risk of ulcer was also increased by the simultaneous use of several anti-inflammatory analgesics and/or corticosteroids.