The effect of preoperative exercise on total knee replacement outcomes.

This study compared the effects of preoperative physical therapy of general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement. Thirty patients were randomly assigned to 1 of 3 groups. Group 1 was the control group.

Reflex sympathetic dystrophy syndrome.

There has been increasing interest in reflex sympathetic dystrophy syndrome (RSDS) over the past decade. This trend has continued over the past 2 years with the publication of a number of reports and studies, many of which are reviewed here. Progress has been made in understanding RSDS, with the demonstration of increased alpha-adrenergic receptor activity in peripheral nerves following injury.

Factors affecting unprescribed remedy use among people with self-reported arthritis.

Objective: The purpose of the study is to determine the frequency and consequences of use of unprescribed remedies by people with self-reported osteoarthritis, and to find methods for predicting such use.

Methods: A random digit telephone survey was used to contact respondents. A 90-item questionnaire evaluated demographic characteristics, type of disorder, area affected, severity of problem, and symptoms encountered.

Reflex sympathetic dystrophy syndrome: a review.

Reflex sympathetic dystrophy syndrome is a serious and potentially disabling condition. Early diagnosis and treatment are essential to control the disorder and restore the patient's quality of life. The cardinal clinical features, radiological changes, etiopathologic advances, and current approaches to proper diagnosis and treatment will be discussed.

Genetic analysis of self-associating immunoglobulin G rheumatoid factors from two rheumatoid synovia implicates an antigen-driven response.

Although much has been learned about the molecular basis of immunoglobulin M (IgM) rheumatoid factors (RFs) in healthy individuals and in patients with mixed cryoglobulinemia and rheumatoid arthritis, little is known about the genetic origins of the potentially pathogenic IgG RFs in the inflamed rheumatoid synovia of patients. Recently, we generated from unmanipulated synovium B cells several hybridomas that secreted self-associating IgG RFs. To delineate the genetic origins of such potentially pathogenic RFs, we adapted the anchored polymerase chain reaction to rapidly clone and characterize the expressed Ig V genes for the L1 and the D1 IgG RFs.

Genetic studies of four highly homologous rheumatoid factor-associated Vk genes in rheumatoid arthritis patients and normal individuals.

Rheumatoid factors (RFs) are autoantibodies directed against IgG molecules. They are present in increased quantity in most patients with rheumatoid arthritis (RA), and are implicated in tissue damage in this disease. Paradoxically, recent studies of RFs have revealed that these autoantibodies are likely a physiological component of the immune system, and may play a role in the development and function of the B cell repertoire.

Medical and surgical treatment of seronegative spondyloarthropathies.

Advances in the treatment of the seronegative spondyloarthropathies are reviewed here. The search for effective disease-modifying agents in this group of disorders has continued. Recent attention has focused primarily on sulfasalazine and different immunosuppressive agents.

Molecular basis of an autoantibody-associated restriction fragment length polymorphism that confers susceptibility to autoimmune diseases.

Recently, combined serological and molecular studies of autoantibodies have revealed that these antibodies play an important role in the normal function of the immune system and in the development of the B cell repertoire. Accordingly, we hypothesized that a homozygous deletion of a critical autoantibody-associated Ig variable (V) gene may alter the immune system and thus predispose the host to autoimmune disorders. Initial experiments revealed several restriction fragment length polymorphisms (RFLP) of the Humhv3005 gene, that is likely to encode heavy chains of rheumatoid factors, and the closely related 1.

Possible deletion of a developmentally regulated heavy-chain variable region gene in autoimmune diseases.

Several autoantibody-associated variable region (V) genes are preferentially expressed during early ontogenic development, suggesting strongly that they are of developmental and physiological importance. As such, it is possible that polymorphisms in one or more of these genes may alter susceptibility to autoimmune disease. We have searched extensively for a probe related to a developmentally regulated V gene that has the power to differentiate among highly homologous V genes in human populations.

Autoantibody production by severe combined immunodeficient mice reconstituted with synovial cells from rheumatoid arthritis patients.

In an attempt to characterize the heterogeneity of the human autoantibody response, mice with severe combined immunodeficiency were reconstituted with synovial or blood lymphocytes from patients with rheumatoid arthritis (RA). Mononuclear cells extracted from synovial fluid or tissue (SMC) were a greatly enriched source of IgM rheumatoid factor (RF)-producing cells compared to the peripheral blood mononuclear cells (PBMC) of rheumatoid arthritis patients or normal donors. Six to nine weeks after reconstitution of mice with synovial mononuclear cells, 0%-39.

The incidence of a new human cross-reactive idiotype linked to subgroup VHIII heavy chains.

Cross-reactive idiotypes (CRI) on human rheumatoid factors (RF), which are identified by murine monoclonal antibodies (mAb), have proved useful in defining both the incidence and the structural characteristics of these autoantibodies. In this study, a new murine anti-idiotypic reagent, mAb B6, has been used to identify and define the expression of a distinct heavy chain CRI. The B6 CRI was found on 20% of monoclonal IgM (16 of 81), but on only 5% of monoclonal IgA (1 of 20) and on no monoclonal IgG.

Prevalence of the use of unconventional remedies for arthritis in a metropolitan community.

Of 1,811 individuals sampled in a metropolitan community, 382 reported having a musculoskeletal complaint. Eighty-four percent of them had used an unconventional remedy within the previous 6 months. Most individuals used inexpensive, unharmful remedies such as exercise, prayer, and relaxation.

The Quality of Well-being Scale. Applications in AIDS, cystic fibrosis, and arthritis.

The Quality of Well-being (QWB) Scale combines preference-weighted measures of symptoms and functioning to provide a numerical point in-time expression of well-being that ranges from zero (0) for death to 1.0 for asymptomatic optimum functioning. The QWB includes three scales of function: mobility, physical activity, and social activity.

Characterization of four homologous L chain variable region genes that are related to 6B6.6 idiotype positive human rheumatoid factor L chains.

A significant proportion of monoclonal IgM rheumatoid factors (RF) from patients with mixed cryoglobulinemia express a KIIIa L chain-associated cross-reactive idiotype, termed 6B6.6. Previously, we reported the isolation from a patient with a monoclonal RF of a Vk gene, termed Humkv328, whose deduced amino acid sequence differs by three and seven residues from the L chains of the 6B6.

Sjögren's syndrome. Proposed criteria for classification.

The term "Sjögren's syndrome" (SS) is frequently used to describe the occurrence of keratoconjunctivis sicca and xerostomia in association with an autoimmune disorder. However, well-defined criteria for the classification of SS have not been established, and this diagnosis is being applied to a wide spectrum of conditions, ranging from clear "autoimmune" disease in some patients, to sicca complaints without evidence of a systemic immune process in elderly patients. Here, we review the clinical and laboratory features of patients referred for evaluation of sicca symptoms.

The radiographic diagnosis of sacroiliitis. A comparison of different views with computed tomograms of the sacroiliac joint.

Conventional radiography is the standard method of objectively identifying sacroiliitis. Single views of the sacroiliac joints can be unequivocally interpreted in 70-80% of patients with low back pain. A series of views usually correctly resolves the ambiguity in the remaining 20-30% of patients (67% correct).

Plasma protein binding by monosodium urate crystals. Analysis by two-dimensional gel electrophoresis.

Using 2-dimensional O'Farrell gel electrophoresis, we have mapped the proteins from undiluted plasma and serum which bind to monosodium urate (MSU) crystals. More than 30 crystal-associated polypeptides were visualized, including anionic and cationic species. Proteins increased on the crystals relative to plasma included C1q, C1-r, C1-s, fibronectin, fibrinogen, and kininogen.

Two unique shoulder disorders. Adhesive capsulitis and reflex sympathetic dystrophy syndrome.

Adhesive capsulitis and reflex sympathetic dystrophy syndrome are unique, but not rare, shoulder disorders that occur most often in persons over 50 who have experienced recent trauma. Although the etiology and nature of the disorders are not fully understood, therapy is often effective when instituted early. Adhesive capsulitis is a self-limited disorder, and patients usually recover in time.

Kinetics of collagenase and neutral protease release by neutrophils exposed to microcrystalline sodium urate.

The rates of release of the various enzymes from PMN leukocytes exposed to MSU crystals were measured. Lysozyme and neutral protease appeared to be released simultaneously and release appeared to be essentially complete by 60 minutes. In contrast, collagenase was detected only after 30 minutes incubation, reached peak concentration at 90 minutes and dropped noticeably by 180 minutes.

Amyloid arthropathy: possible association with chondrocalcinosis.

Three patients with symptomatic articular or periarticular amyloidosis associated with chondrocalcinosis are reported. None of these patients had evidence of dysproteinemia which has been considered the primary predisposing factor in amyloid arthropathy. The clinical features of these patients are described and possible pathogenesis discussed.

Computed tomography in the diagnosis of sacroiliitis.

Computed tomography (CT) and conventional radiography of the sacroiliac joint were compared in 43 patients. CT appeared to be far more sensitive and equally specific in the recognition of sacroiliitis. In a number of patients with sacroiliitis diagnosed by both techniques, CT demonstrated abnormalities that were not demonstrated by conventional radiographs.

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects.

Four women, aged 63 to 90 years old, presented with mildly painful shoulders of decreased mobility or stability. Radiographic evidence of a complete tear of the fibrous rotator cuff was present in 7 of 8 shoulder joints. Microspheroids containing hydroxyapatite crystals were seen by scanning electronmicroscopy in 12 of 13 synovial fluid samples.

Bone scintigraphy in the reflex sympathetic dystrophy syndrome.

Sixty-four consecutive patients were studied for possible reflex sympathetic dystrophy syndrome (RSDS). They were divided into five groups, based upon specific clinical criteria, and the radiographic and scintigraphic findings in each group were examined. Osteoporosis was the most common radiographic abnormality, present in 69% of subjects with definite, probable, or possible RSDS, as compared with 21% opf those with RSDS.

Radiographic changes in the hands following childhood frostbite injury.

Three young adult patients who had sustained severe frostbite of the hands as children were recently evaluated for progressive deformity and joint pain in the fingers. Characteristic radiographic abnormalities including dwarfing of the middle and distal phalanges, irregular and malapposed articular surfaces, malalignments at the proximal and distal interphalangeal joints, and evidence of degenerative arthritis in the interphalangeal joints were observed. The metacarpal phalangeal joints and wrists were spared in all patients, and fingers which had been protected from the initial cold injury were similarly not affected.