Greater trochanteric pain syndrome (trochanteric bursitis) in low back pain.

The greater trochanteric pain syndrome (GTPS) or trochanteric bursitis is a regional pain syndrome characterized by typical local tenderness over the trochanteric region. Recently this syndrome was found in hospital-referred, chronic low back pain (LBP) patients. To confirm the correlation between GTPS and LBP in different patient settings and to present quantitative data about associated clinical features, we prospectively evaluated consecutive LBP patients from a general practice (n = 40), an occupational health service (n = 124) and a rheumatology outpatient clinic (n = 40).

Alizarin red S staining of synovial fluid in inflammatory joint disorders.

In 153 patients with mainly inflammatory joint disorders alizarin red S staining was used to detect calcium-containing crystals in synovial fluid (SF). The reproducibility of the results of this staining technique in 207 SF samples proved to be fairly good (65% concordant results after two observations). Electron-microscope studies confirmed the presence of apatite or calcium pyrophosphate dihydrate (CPPD) crystals in 92% of the alizarin red S positive samples, and in 27% of the weakly positive samples.

Toxicity of sulfasalazine in systemic juvenile chronic arthritis.

The use of sulfasalazine as a long acting anti-rheumatic drug in patients with systemic JCA was studied in an open trial. Severe toxic side-effects in three of the four patients entered required discontinuation of the trial. These adverse effects included high fevers and a generalised exanthem.

Lifestyle and the risk of rheumatoid arthritis: cigarette smoking and alcohol consumption.

In a search for aspects of behaviour related to oral contraceptive use which might explain the favourable effect of oral contraception on the onset of rheumatoid arthritis (RA), cigarette smoking and alcohol consumption were studied as possible risk factors. Information on cigarette smoking and alcohol consumption was obtained by interview at the first visit to the outpatient clinic of 135 young women with confirmed definite or classical RA of recent onset and 378 control patients with soft tissue rheumatism or osteoarthritis. The diagnosis in all patients was confirmed by at least two years of follow up.

Pregnancy and the risk of developing rheumatoid arthritis.

There have been conflicting reports on, and no plausible biologic explanation for, a protective effect of oral contraceptive (OC) use on the development of rheumatoid arthritis (RA). Therefore, we investigated aspects of behavior related to OC use that could explain the preventive effect of OC on the onset of RA. In the present case-control study, past pregnancy, age at first pregnancy, and pregnancies with adverse outcome were studied as possible risk factors for RA.

Psoriasis and arthritis.

The exact association between psoriasis and arthritis remains an enigma. Some investigators consider that the two disorders constitute a disease entity, psoriatic arthritis, while others support the thesis that psoriasis and arthritis are common diseases and occur simultaneously by chance. The author upholds the latter view as viable.

Diminished incidence of severe rheumatoid arthritis associated with oral contraceptive use.

It has been suggested that the negative association between rheumatoid arthritis (RA) and oral contraceptive (OC) use might be limited to the more severe forms of RA. To investigate this further, we studied 121 consecutive female patients with definite RA, 52 female patients with probable RA, and 378 female controls. All patients had RA symptoms of recent onset.

A clinical epidemiological study in low back pain. Description of two clinical syndromes.

In 100 patients with mainly chronic low back pain (LBP) signs and symptoms were evaluated prospectively and without preconceived expectation of particular findings. Two clinical syndromes were distinguished, both characterized by 'typical local tenderness' and associated with specific clinical features; these syndromes, described previously in the literature but receiving scant attention, were named the greater trochanteric pain syndrome (trochanteric bursitis) and the iliac crest pain syndrome (iliolumbar syndrome), and occurred in 35% and 43% of the patients, respectively. The recognition of these syndromes may enable us to study aetiology, prognosis, and therapy of LBP in more homogeneous groups of patients.

Raised plasma renin and prorenin in rheumatoid vasculitis.

The value of plasma renin and its inactive precursor, prorenin, were examined as a marker for vasculitis in rheumatoid arthritis (RA). Plasma renin and prorenin rise when the renin-angiotensin system is activated; an isolated increase of prorenin may be a marker for microvascular complications in diabetes mellitus. Renin concentrations in plasma obtained from 34 patients with RA (seven with vasculitis, 27 controls) were measured under standard conditions, before and five days after stopping non-steroidal anti-inflammatory drugs; creatinine clearance was also measured.

IgE-containing immune complexes in synovial fluid of patients with rheumatoid arthritis.

The prevalence and composition of IgE-containing immune complexes in paired synovial fluid and serum of 42 patients with classical or definite rheumatoid arthritis were studied. IgE-containing immune complexes were found in 15/42 synovial fluids; 15 sera were also positive. The correlation between serum and synovial fluid complexed IgE levels was high (r = 0.

Reduction of the risk of rheumatoid arthritis among women who take oral contraceptives.

Discrepant results among investigations of the association between oral contraceptive use and rheumatoid arthritis (RA) have been ascribed to shortcomings in the study methods. In the present study, we obtained detailed information on oral contraceptive use in 135 young women with confirmed definite or classic RA of recent onset and in 378 controls with soft tissue rheumatism or osteoarthritis. All patients had at least 2 years of followup to confirm the consistency of the diagnosis.

Subclinical renal dysfunction in rheumatoid arthritis.

We studied renal function in 35 patients with chronic, seropositive rheumatoid arthritis (RA), of whom 7 had vasculitis, 10 had hypergammaglobulinemia, and 18 had neither of these 2 conditions. Findings included a decreased glomerular filtration rate in 8 patients, (micro)proteinuria in 11, a defective urine concentration in 10, and increased urinary tubular enzyme levels in 15. These results indicate that subclinical renal dysfunction is common in patients with chronic, seropositive RA.

Genetics of non-HLA marker genes in HLA-B27-positive and -negative ankylosing spondylitis families.

In families of HLA-B27+ ankylosing spondylitis (AS) patients, the occurrence of secondary cases of sacro-iliitis (SI) among B27+ first degree relatives is more than tenfold higher than expected from the population association of AS with HLA-B27. Secondary cases of SI also occur in relatives of HLA-B27- AS patients. We addressed the question whether other genetic factors than HLA-B27 played a role in the familial occurrence of AS and SI in B27+ and B27- AS cases.

Reversible nephrotoxicity of cyclosporine in rheumatoid arthritis.

Irreversible nephrotoxicity has limited the use of cyclosporine in rheumatoid arthritis (RA). In a randomized clinical trial we compared 26 weeks of cyclosporine (5 mg/kg) and D-penicillamine (250 mg) treatment in 92 patients with RA with a serum creatinine less than 100 mumol/l. We adjusted the starting dose according to clinical response and side effects.

HLA-Bw60 increases susceptibility to ankylosing spondylitis in HLA-B27+ patients.

We examined the distribution of non-B27 alleles of the HLA-B locus among B27+ patients with ankylosing spondylitis (AS), to detect any additional HLA-B locus allele(s) that may act in conjunction with B27 to increase susceptibility to AS. HLA-Bw60 (or B40 when the Bw60,61 split of B40 was not typed for) was shown to be increased among B27+ AS patients in each of 5 independent data sets. This increase was statistically significant in 4 of the 5 data sets studied, and the overall significance was P less than 0.

Humoral immunity and composition of immune complexes in patients with rheumatoid arthritis, with special reference to IgE-containing immune complexes.

IgE-containing circulating immune complexes (IgE-CIC) were determined with a 2.5% PEG-precipitation assay in 98 patients with classical or definite rheumatoid arthritis (RA). Of the 45 IgE-CIC positive sera, only 4 had elevated total serum IgE.

DR4 prevalence related to the age at disease onset in female patients with rheumatoid arthritis.

The prevalence of HLA-DR4 in relation to age at disease onset was calculated in 226 consecutive female patients with definite or classical rheumatoid arthritis (RA). A slight increase in the prevalence of DR4 with age at RA onset was found. This appeared to be due to the low percentage of rheumatoid factor (RF) positivity in the youngest age groups; the DR4 prevalence in the RF positive patients was constant for all decades--that is, approximately 60%.

Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations.

The prevalence of mild and severe radiological osteoarthritis was investigated in a random sample of 6585 inhabitants of a Dutch village. Radiographs were graded 0-4 according to the criteria described by Kellgren and Lawrence. The prevalence of radiological osteoarthritis increased strongly with age and was highest for cervical spine (peak: men 84.

Is MCTD a distinct entity? Comparison of clinical and laboratory findings in MCTD, SLE, PSS, and RA patients.

Eighteen patients diagnosed as suffering from MCTD were reexamined during follow-up (mean duration 4.6 years). The clinical features of these patients were compared with those of 19 patients with systemic lupus erythematosus (SLE), 11 with progressive systemic sclerosis (PSS) and 22 with rheumatoid arthritis (RA).

Diminished clearance of soluble aggregates of human immunoglobulin G in patients with rheumatoid arthritis.

Investigation of the capacity of the mononuclear phagocyte system to remove immune complexes from the circulation was performed by the administration of 125I-labelled aggregates of human immunoglobulin G (AIgG) to patients with seropositive rheumatoid arthritis and healthy volunteers. It was found that the rate at which AIgG disappeared from the circulation was significantly prolonged in patients with RA, t1/2 61 +/- 49 min, versus 26 +/- 8 min in healthy volunteers (p less than 0.01).

Potentiation of the stimulatory capacity of pokeweed mitogen via its binding to autologous erythrocytes.

The effect of human erythrocytes (E) on blastogenesis and immunoglobulin (Ig) production induced by pokeweed mitogen (PWM) in cultures of human peripheral blood mononuclear cells (PBMC) was investigated. The stimulation of PBMC with PWM was markedly enhanced in the presence of E, and PWM bound to E, followed by thorough washing (E-PWM), was even more effective in inducing blast cell formation and Ig production. Blast cell responses after stimulation with E-PWM were on average two times higher than those seen after stimulation with comparable dilutions of fluid-phase PWM.

Oral contraceptive treatment for rheumatoid arthritis: an open study in 10 female patients.

Ten female patients (median age 37 years, range 23-45) with active rheumatoid arthritis (RA) (nine seropositive, one seronegative, seven erosive, three non-erosive) were treated during 6 months with one of the earlier, i.e. higher dosed, oral contraceptives (Lyndiol, each tablet containing 2.