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ZfuerKardiologie.9088s030.eng.abstr | ZfuerKardiologie.9088s030.eng.abstr | [
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ZfuerRheumatologie.00590101.eng.abstr | ZfuerRheumatologie.00590101.eng.abstr | [
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"Between January 1983 and December 1987 , metatarsal head-resections were performed on 203 patients , comprising a total of 370 feet , using the Hueter/Mayo and Hoffmann procedure . Seventy-two patients , comprising a total of 126 feet , were available for post-operative review after an average of 11.4 years from the date of the original operations . The information obtained from standardized questionnaires was compared to the information found in each patient's file . In addition , every available pre- and post-operative x-ray taken from 1983 to 1987 was analyzed . Thus , with an average follow-up period of 5.6 years , the changes found in the pre- and post-operative x-rays from a total of 183 feet could be compared . Before the operations , nearly 100% of the examined feet suffered from painful synovial hypertrophy and erosion of the metatarsophalangeal joints with dislocation and subluxation , causing approximately 70% of all patients to have great difficulties in walking . After the operations , however , 90.2% of the patients reported that this condition had noticeably improved or had completely disappeared . In fact , 87.5% of all patients reported a lasting improvement in their ability to walk longer distances . As the main criteria in determining the success of an operation ( namely , the noticeable reduction of pain and increased mobility ) were achieved in 87.5% of the patients , we consider the metatarsal head-resection a reliable method of correcting forefoot deformities in rheumatoid arthritis ."
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"Calcium/vitamin D supplementation is generally used as a first step treatment of glucocorticoid-induced osteoporosis ( GIOP ) . The aim of this trial was to compare the efficacy of the D-hormone alfacalcidol with plain vitamin D in patients with established GIOP with or without vertebral fractures . Patients on long-term glucocorticoid-therapy were treated either with 1µg alfacalcidol plus 5000mg calcium ( group A : n=43) or with 1000 IU vitamin D plus 500mg calcium ( group B : n=42). The two groups were not different in respect to initial characteristics such as age , sex distribution , concomittant diseases , bone mineral density ( mean T-score values at lumbar spine and femoral neck : -3 . 29 and -3 . 25 resp. ) , and in the number of prevalent vertebral and non-vertebral fractures . During the 3 years of treatment we found a significant increase in lumbar spine density in group A ( +2 . 0% , p 0.0001 ) , while no significant changes could be documented in group B at both measuring sites . After 3 years 12 new vertebral fractures had occurred in 10 patients of group A and 21 in 17 patients in group B ( ns ) . Correspondingly we registered a significant decrease of back pain only in group A ( p 0.0001 ) . We conclude that alfacalcidol treatment in superior to plain vitamin D in GIOP ."
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ZfuerRheumatologie.00590233.eng.abstr | ZfuerRheumatologie.00590233.eng.abstr | [
{
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"Background and aim of the study : For many years the treatment of spondylitis and spondylodiscitis has been discussed controversially . The aim of this study is to report on objective and subjective mid-term results of therapy of spondylitis and to present a differentiated concept of treatment . Methods : Between 1988 and 1996 , 58 patients were treated with spondylitis or spondylodiscitis . Nine of these patients had to be operated . A biopsy was taken in all of the cases . According to the antibiogram optained by the biopsy , antibiotics were applied intravenously . The patients were immobilized by a plaster bed for at least 6 weeks and were then treated by a spinal orthosis for another 3 months . Patients were reexamined clinically and radiographically and by a questionnaire ( including Roland-Morris score ) , after 8 years on average . Results : Patients were diagnosed correctly 4 months after the begin of the disease . Spondylitis was predominantly localized in the lumbar spine . A positive bacteriological culture was derived from one third of the biopsies ; none of them was a specific culture . C-reactive protein was revealed as appropriate for diagnosis and follow-up of spondylitis . In 84% of the patients a total or partial bony fusion was demonstrated radiographically . Questionnaire assessment revealed a significant decrease of the Roland-Morris score ( 17.8-7.4) and a significant relief of pain ( 8.9-2.5). Conclusions : We recommend surgical treatment on patients with major vertebral body destruction , epidural abscess and progressive neurological impairment . These indications for operation can be prevented by a rapid diagnosis , so that spondylitis can be successfully treated by consequent immobilization in a plaster bed and approppriate antibiotics ."
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ZfuerRheumatologie.00590330.eng.abstr | ZfuerRheumatologie.00590330.eng.abstr | [
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ZfuerRheumatologie.0059i0i1.eng.abstr | ZfuerRheumatologie.0059i0i1.eng.abstr | [
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ZfuerRheumatologie.0059ii103.eng.abstr | ZfuerRheumatologie.0059ii103.eng.abstr | [
{
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"Interactions between the endocrine and immune systems are well known with special regard to the hypothalamic-pituitary-adrenal axis . Little of the literature focuses on the complex effects of cytokines on tissue responsiveness to glucocorticoids ( GC ) . In bone tissue , osteoblasts represent a valuable model for studying GC-cytokine interactions . Hence , we have studied two human osteosarcoma cell lines ( Saos-2 and MG-63) with different degrees of differentiation and different constitutive IL-6 production ( 3.4 +/- 0.3 ( mean +/- SE ) and 3309 +/- 578 pg/106 cells ) . We measured glucocorticoid receptor ( GR ) number and affinity as a function of the exposure of cells to different amounts of IL-6. Incubation for 20 h with IL-6 at increasing concentrations up to 2000 pg/ml yielded a significant increase of GR binding sites in both cell lines . IL-6 was also able to reverse the inhibitory effect of dexamethasone ( 1 µmol/l) on GR in both cell lines . In MG-63 cells , expressing higher concentrations of GR , IL-6 deprivation via a specific anti-IL-6 antibody ( 100 ng/ml ) significantly decreased GR . In Saos-2 cells , expressing lower concentrations of GR , a 40 h treatment with human IL-1 ( 10 ng/ml ) significantly increased both IL-6 production and GR . This latter effect was completely abolished by co-treating the cells with the anti-IL-6 antibody . Our results provide evidence that IL-6 is an autocrine positive modulator of GR number in human osteoblasts ."
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ZfuerRheumatologie.0059ii12.eng.abstr | ZfuerRheumatologie.0059ii12.eng.abstr | [
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"The adrenal gland combines essential components of the autonomic nervous system and the HPA axis in close contact . From morphological analyses employing immunohistochemistry , in situ hybridization , the novel technique of laser capture microdissection , and electron microscopy , it has been has shown that the chromaffin cells of the adrenal medulla and the steroid-producing cells of the adrenal cortex are extensively intermingled and functionally interrelated . In in vitro studies , a variety of regulatory factors produced and released by the adrenal medulla were identified as playing an important role in modulating adrenocortical function . An isolated adrenocortical cell deprived of its tissue integrity , input from the nervous system , or intercellular communication with chromaffin , vascular , and immune cells of the adrenal gland , loses its normal capacity to produce glucocorticoids and to adequately respond to the homeostatic challenges of stress . Adrenocortical cells in co-culture with chromaffin cells produced ten times more glucocorticoids than the same number of pure adrenocortical cells and demonstrated marked up-regulation in the mRNA expression of cytochrome p450 enzymes and STAR in the co-culture , while this expression was down-regulated in isolated cells . Transgenic animal models of over-expression or deletion of enzymes involved in catecholamine synthesis , as well as of altered function of components of the HPA axis , provide evidence that the mutual interdependence of the sympatho-adrenal system and the HPA axis at the level of the adrenal gland is of physiologic relevance in vivo . Alterations in intercellular communications , local production of neuropeptides , growth factors and cytokines , and aberrant expression of ectopic receptors on adrenal cells have been implicated in adrenal cell growth , development , hyperplasia , tumor formation , autonomous hormone production , and autoimmune disease . Moreover , we described a direct cellular interaction of lymphocytes with adrenal cells as a novel non-cytokine mediated mechanism of immune endocrine interactions ."
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ZfuerRheumatologie.0059ii22.eng.abstr | ZfuerRheumatologie.0059ii22.eng.abstr | [
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] | [] | [] | [
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ZfuerRheumatologie.0059ii26.eng.abstr | ZfuerRheumatologie.0059ii26.eng.abstr | [
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"The gaseous radical nitric oxide ( NO ) is catalyzed by conversion of L-arginine to L-citrulline by one cytokine inducible form ( iNOS ) , which becomes active only within hours after the inducing event , and by two constitutively expressed forms , endothelial ( eNOS ) and neuronal ( nNOS ) , which are regulated by the cytosolic concentration of free Ca2+. Brain nNOS is physiologically present in discrete populations of neurons , which are all excited by glutamate via the ionotropic N-methyl-D-aspartate ( NMDA ) receptor , which controls a Ca2+ channel . After its diffusion into the extraneuronal space , NO may activate in neurons , which as a rule do not stain for NOS , soluble guanylyl cyclase and formation of cGMP as an intracellular messenger . Beyond that , NO is important as a feedback regulator of glutamatergic excitation . NO as a nitrosylating agent enhances disulfide bonding of vicinal sulfhydryl ( thiol ) groups of the redox modulatory site of the NMDA receptor complex and thereby down-regulates its Ca2+ channel activity . Histochemically studies have revealed the presence of large number of NOS containing neurons in the magnocellular and parvocellular subdivisions of hypothalamic nuclei . Numerous studies conform to the view that NO participates in the control of many different neurosecretory processes , especially of the corticotropin-releasing hormone ( CRH ) neurosecretory system . The redox-modulatory site of the NMDA receptor appears , therefore , as a critical structure in the control of the hypothalamic-pituitary-adrenocortical ( HPA ) axis . Moreover , glucocorticoids augment neuronal excitotoxicity by increasing the expression of glutamate receptors and inhibition of glutamate reuptake . In attempting to explain the many conflicting results obtained in studies with NO , it may be worthwhile to consider that the actual redox-environment of distinct loci of the brain may determine the final function of NO , acting either as a transmitter or neuromodulator or , in the worst case , causing neurodestruction . It seems likely that any kind of stress by altering the ratio of reduced vs oxidized thiols within the central nervous system influences neuronal excitability , with NO working either as an amplifier or as a feedback regulator of neuronal excitation or inhibition , which may alter acutely or chronically , among others , the homeostasis of a given neurosecretory system ."
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ZfuerRheumatologie.0059ii75.eng.abstr | ZfuerRheumatologie.0059ii75.eng.abstr | [
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ZfuerRheumatologie.70560008.eng.abstr | ZfuerRheumatologie.70560008.eng.abstr | [
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ZfuerRheumatologie.70560031.eng.abstr | ZfuerRheumatologie.70560031.eng.abstr | [
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"Aim of the study : To develop and evaluate a modification of the Larsen scoring method aimed at a clear definition of the different grades and a better correlation of the numerical scale with the amount of joint destruction . Description of the method : While the original method described by Larsen is based on a comparison with standard reference films the modification defines the different grades semiquantitatively by the amount of destruction of the joint surface : grade II is a destruction ( erosion ) of the joint surface of up to 25% , in grade III it is 26-50% , in grade IV 51-75% and in grade V over 75% . Grade I is characterized by soft tissue swelling and in addition subchondral osteoporosis and remains unchanged compared with the original method . 32 joints of the hands , wrists and forefeet are counted summing up to a total score of 0-160 . Examples for different joints are given . Evaluation of the method : Standard ap-x-rays of hands , wrists and forefeet of 24 patients with early erosive rheumatoid arthritis at baseline ( T0) and after 36 months ( T1) were graded by two investigators ( G.H. and R.R. ) . The difference of the scoring between both observers ( inter-observer-difference ) was related to the difference between the two timepoints ( T0 and T1) in the same patient ( intra-patient-difference ) by means of a hierarchical analysis of variance ( ANOVA ) . The intra-patient variance ( from T0 to T1) was 259.3 , which is 8times greater than the inter-observer-variance of 32.1. The square root of intra-patient-standard deviation ( 16.1 ) and inter-observer-standard deviation ( 5.7 ) is 2.8. These data show that the progression between T0 and T1 is real . - The method was easily applicable to patients in a 2-year-DMARD-trial with x-rays at baseline after 6 , 12 and 24 months , showing a slowing of radiologic progression after month 6 under treatment with parenteral gold and methotrexate . Conclusion : The modification of Larsen's scoring method is a reliable measure to assess radiologic progression in patients with RA . Possibilities for further improvement are discussed ."
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ZfuerRheumatologie.70560136.eng.abstr | ZfuerRheumatologie.70560136.eng.abstr | [
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"27 patients with sternocostoclavicular hyperostosis ( SCC ) and/or pustulotic arthroosteitis ( PAO ) were examined with whole body scintigraphy , conventional radiography , and other imaging modalities , such as CT , MRI . 25 of 27 patients with SCCH showed a characteristic high bullhorn-like uptake of the sternocostoclavicular region with the manubrium sterni representing the skull and the inflamed sternocostoclavicular joints corresponding to the horns ( =bullhorn-sign). Scintigraphy revealed additional skeletal manifestations ( spondylitis , sacroiliitis , osteitis , periostitis ) in 19 of the 27 patients with SCCH and/or PAO . In combination with PPP or psoriasis pustulosa , the typical scintigraphic bullhorn pattern enables the diagnosis of PAO ( 19 patients ) with high confidence . Patients with SCCH but without skin disease at the time of presentation ( 8 of 27 patients ) may develop PPP later and , therefore , it is justified to classify them as incomplete PAO with high risk to develop other skeletal manifestations later in the course of the disease ."
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ZfuerRheumatologie.70560178.eng.abstr | ZfuerRheumatologie.70560178.eng.abstr | [
{
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"text": [
"Cyclophosphamide is a potent immunosuppressive drug which is widely used to treat renal and central nervous system manifestation of Systemic Lupus Erythematosus ( SLE ) . It is employed especially to prevent renal failure in lupus nephritis . Within the last decade intravenous cyclophosphamide bolus therapy has become the standard therapy in severe SLE due to its tendency towards a higher efficacy and fewer side effects as compared to oral application . Studies on the slightly more cost-effective oral cyclophosphamide bolus therapy have recently been published , however , there are no data on long-term results yet . Here , we review the effects and side effects of cyclophosphamide as well as recent clinical studies on cyclophosphamide bolus therapy in SLE . Because of the possible side effects , especially the high risk of malignancies , which sharply increases at a cumulative dose of approximately 60g , cyclophosphamide should be used cautiously . Cyclophosphamide bolus therapy should only be performed in hospitals with special experience ."
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"Resection arthroplasty of the metacarpophangeal joints stabilisized by a Swanson-Silastic-spacer is the golden standard in MP-joint destruction in R.A. 57 ( Gr . I ) , 91 ( Gr . II ) , and 102 ( Gr . III ) arthroplasties of the metacarpophalangeal joint were assessed in three groups of patients 3.5 years ( Gr . I ) , 4.3 years ( Gr . II ) , and 10.1 years ( Gr . III ) , respectively , postoperatively on the average . In patients of group I titanium protectors , called grommets , were used additionally . Nearly all patients reported a marked relief of pain . Ulnar drift was corrected from an average of 22 ° ( Gr . I ) , 23 ° ( Gr . II ) , and 34 ° ( Gr . III ) preoperatively to 8 ° ( Gr . I ) , 7 ° ( Gr . II ) , and 12 ° ( Gr . III ) , respectively , postoperatively . Active range of motion remains unchanged with an average of 33 ° ( Gr . I ) , 38 ° ( Gr . II ) , and 42 ° ( Gr . III ) ROM preoperatively and 42 ° ( Gr . I ) , 37 ° ( Gr . II ) , and 36 ° ( Gr . III ) ROM , respectively , postoperatively . The average extension deficit had improved from 45 ° ( Gr . I ) , 32 ° ( Gr . II ) , and 33 ° ( Gr . III ) at surgery to 18 ° ( Gr . I ) , 11 ° ( Gr . II ) , and 11 ° ( Gr . III ) , respectively , at the time of follow-up . Functional improvement of the hand was found in the medium term in 82% and in the longterm in 75% of the patients . The radiographical findings showed surrounding osteolysis in 45.7% ( Gr . I ) , 63.5% ( Gr . II ) , and 89.4% ( Gr . III ) of the implants and 0% ( Gr . I ) , 16.5% ( Gr . II ) , and 26.9% ( Gr . III ) broken spacers . From the medium to the longterm run there is an increase in radiographical deterioration . The additional use of titanium grommets in MP-joint arthroplasty seems to reduce reactive osteolysis and protects Swanson Silastic-spacers from breakage without substantial influence on the clinical outcome ."
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ZfuerRheumatologie.70560298.eng.abstr | ZfuerRheumatologie.70560298.eng.abstr | [
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ZfuerRheumatologie.80570011.eng.abstr | ZfuerRheumatologie.80570011.eng.abstr | [
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"Leukotrienes and prostaglandines are important mediators of inflammation . While prostaglandine synthesis can be influenced by NSAIDs therapeutical approaches to the 5-lipoxygenase pathway are rare . Resinous extracts of Boswellia serrata ( H15, indish incense ) , known from traditional ayurvedic medicine , decrease leukotriene synthesis in vitro . Case reports suggest a clinical role for that drug . Methods : Outpatients with active RA have been enrolled into a multicenter controlled trial . Patients received 9 tablets of active drug ( 3600 mg ) or placebo daily in addition to their previous therapy . Doses of NSAIDs could be adjusted on demand . Efficacy parameters , Ritchies Index for swelling and pain , ESR , CRP , pain on VAS and NSAID dose were documented at baseline and 6 and 12 weeks after initiation . Mean values and medians were calculated to compare the groups for significant or clinically relevant change from baseline or difference between both groups at any time point of observation . Results : A total of 78 patients were recruited in 4 centers , the data have been published in abstractform . Only 37 patients ( verum 18 , placebo 19 ) , enrolled in Ratingen were available for detailled efficacy and safety analysis . All evaluations in these patients were performed by one investigator ( G.H. ) . There was no subjective , clinical or laboratory parameter showing a significant or clinically relevant change from baseline or difference between both groups at any time point of observation . The mean NSAID dose reduction reached levels of 5.8% ( H15) and 3.1% ( placebo ) . One patient in each group showed a good response in all parameters but 4 patients in each group worsened . The others showed no alteration of their disease . Conclusion : Treatment with H15 showed no measurable efficacy . Controlled studies including a greater patient population are necessary to confirm or reject our results ."
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ZfuerRheumatologie.80570025.eng.abstr | ZfuerRheumatologie.80570025.eng.abstr | [
{
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"text": [
"Therapy of rheumatoid arthritis with a combination of several disease-modifying drugs aims towards better control of the disease than achievable by monotherapy . Based on a broad variety of clinical studies , revealing more or less positive results , several combinations have been suggested : ..."
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"Borrelia burgdorferi specific DNA has been detected by polymerase chain reaction ( PCR ) in different specimens of patients with Lyme disease ( LD ) . The aim of the present study is to evaluate PCR-diagnostic of urine specimens regarding rheumatologic diagnosis of Lyme disease . Urine specimens of 77 patients ( LD , n=34; undifferentiated arthritis ( UA ) , n=25; arthralgia/myalgia ( AM ) , n=18) and 15 controls were investigated . Flagellin gene ( 60 specimens ) or OspA-plasmid ( 32 specimens ) were used as targets . Sensitivity of the flagellin-nested-PCR was 27% , by OspA-nested-PCR only one positive PCR result was found . Despite of low sensitivity PCR enabled the correct diagnosis of LD in two patients classified as UA . Therefore , PCR can give valuable hints in single cases if LD is clinically suspected ."
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"This report will relate our experience with the y-plate , which we used in the treatment of 39 patients ( 32 women and 7 men ) with a mean age of 62.6 years ( range 47 to 79 years ) between 1987 and 1994. All patients had rheumatoid arthritis . Occipitocervical fusion was indicated by instabilities within the occipitocervical region and in cases with additional basilar invagination and/or after transoral dens resection for decompression of the spinal cord . The length of the fusion depended on the pathological changes of the subaxial cervical spine . Before surgery , 35 patients suffered from strong and 4 patients from moderate pain in the neck and/or the back of the head . On a linear scale from 0 to 10 , the pain was rated as 8.1 on average ( range 4 to 10 ) . 31 patients had an instability of the atlantoaxial region and 19 patients a basilar invagination of the odontoid . A cervical myelopathy was found in 20 cases . One surgeon fused the occiput to C2 in 22 cases , to C3-C5 in 8 cases and to C7-T2 in 9 cases . An important factor in this operation is the integration of atlantoaxial screws in order to resist the translational dislocation of C1/C2. In 13 patients a resection of the odontoid had to be performed to adequately decompress the spinal cord . A reduction of C2 without dens resection was performed in cases with reducible instability C1/2. 32 of the patients could be controlled with a minimum follow-up of 12 months ( average 32.2 months , range 12 to 66 months ) . Out of the other 7 , 6 patients had died . At the time of follow-up , the pain was rated as 2.3 on average ( range 0 to 10 ) . A myelopathy was present in 2 cases . Six patients required further operations on the cervical spine ; 4 patients developed an instability at the level ( s ) below the fusion and an enlargement of the fusion to these levels had been performed . The fusion rate was 96.9% , despite breakage of the implant in 3 and a screw loosening in 2 patients . According to the criteria of Conaty , the result was satisfying in 25 ( 75% ) and not satisfying in 8 patients ( 25% ) . These results show the effectiveness of the occipitocervical fusion with the y-plate in rheumatoid arthritis . A transoral dens resection is only indicated in cases with basilar invagination causing a compression of the spinal cord or in such cases where a compression caused by the dens or the retrodental pannus formation cannot be treated by a reduction of the second cervical vertebra alone ."
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"Aim of studies : To determine the optimal dose regimen for i.v. TNFR55-IgG1 in refractory rheumatoid arthritis . Methods : 218 patients with refractory rheumatoid arthritis were enrolled for two double-blind placebo-controlled multicenter trials ( Europe and USA ) . They were treated with monthly i.v. placebo , 0.01 , 0.05 , 0.1 or 0.5mg/kg TNFR55-IgG1 after a 4 week wash-out of DMARDs . An additional German trial compared biweekly i.v. 20mg TNFR55-IgG1 and monthly 50mg following a loading does of 100mg in 60 patients . Results : TNFR55-IgG1 induced a substantial improvement already apparent one day after the first infusion . A maximal , dose dependent effect was reached after two weeks . Later , efficacy declined in parallel to an increase in anti-TNFR55-IgG1 antibodies resulting in an increased drug clearance . The drug was well tolerated with predominantly mild or moderate adverse events . Conclusion : Intravenous TNFR55-IgG1 was well tolerated and effective in refractory rheumatoid arthritis but the treatment schedules tested could not stabilise the initial improvement ."
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"Aim of the study : To investigate the long-term effect of TNFR55-IgG1 in patients with severe rheumatoid arthritis refractory to multiple previous DMARD treatments . Methods : Between 1994 and 1995 we recruited 80 patients for two double blind , placebo-controlled multicenter trials . All patients were treated for 2-30 months with a glycosylated fused protein consisting of two human p55 TNF receptors linked to a human IgG1-Fc. The dose range was 2.5-100mg/month given i.v. with cumulative doses from 40-940mg. All patients were followed-up prospectively for 24-36 months after initiation of therapy . The evaluations included a 48 swollen and tender joint count , ESR , CRP , RF , ANA , ENA , and safety parameters at 6 month intervals . In addition , pharmacokinetics , TNF , and anti-TNFR55-IgG1 antibody levels were available after the first and third injection . Results : Data from 80 patients are available representing an experience of more than 170 patient years ; 11 patients are still being treated . Predominant reasons for treatment withdrawal were restrictions in treatment protocol . Six patients died ( 1 during treatment , 5 in the post-treatment follow-up ) . All deaths were related to preexisting cardiovascular disease except one post-surgery septic arthritis 6 months after the last dosing ( during vacation in another country ) . No malignancies were detected . Anti-TNFR55-IgG1 antibodies correlated with a decrease in drug half-time . Shifts in the TNFR55-IgG1 glycosylation pattern affected pharmacokinetics and efficacy . A lupus nephritis occurred 18 months after the last dosing in one patient with erosive RA ( ANA and dsDNS positive already before TNFR55-IgG1 initiation ) . Continued treatment for 3 years in 11 patients resulted in an 81% reduction in swollen joint count , less morning stiffness , less pain , and a reduction in steroids . Conclusion : Treatment with TNFR55-IgG1 is safe and efficacious over the long-term in patients with severe refractory RA ."
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