Metastasis in the temporal bone mimicking temporal arteritis.

This report describes a 72-year-old female patient with a previous history of cured breast cancer who presented with acute monocular visual disturbances, intense unilateral headache, painful temporal artery palpation, high erythrocyte sedimentation rate, and pain and weakness of the femoral muscles. These symptoms and signs were suggestive of temporal arteritis, but the finding of the temporal artery biopsy was negative, and the patient did not respond to corticosteroid treatment. Later, whole body bone scintigraphy revealed dissemination of malignancy throughout her skeleton including the skull.

Cost-effectiveness of infliximab in the treatment of rheumatoid arthritis in clinical practice.

Objective: We evaluated the cost-effectiveness of infliximab therapy in Finnish RA patients in a real-life clinical setting and identified factors influencing it, using the national register of biological treatment (ROB-FIN).

Methods: A cost-utility analysis was performed, derived from EQ-5D, and related to HAQ score and disease activity using multiple regression. QALYs were calculated based on these utilities, using patient-level data up to the last control registered.

Mononuclear cell response to enterobacteria and Gram-positive cell walls of normal intestinal microbiota in early rheumatoid arthritis and other inflammatory arthritides.

Objective: To study whether enterobacteria and Gram-positive bacterial cell walls (BCW) derivedfrom normal intestinal microbiota are involved in the etiopathogenesis of early rheumatoid arthritis (RA).

Methods: Peripheral blood mononuclear cells (PBMC) and synovial fluid mononuclear cells (SFMC) were isolatedfrom patients with early RA (the average duration of 5 months) and the controls (other types of inflammatory arthritis). The mononuclear cell proliferation and tumor necrosis factor-alpha (TNF-alpha) responses to heat-killed Salmonella enteritidis (SE).

Female patients tend to alter their diet following the diagnosis of rheumatoid arthritis and breast cancer.

Background: Breast cancer and rheumatoid arthritis are common diseases which change everyday life among women. This study investigated the beliefs and attitudes of female patients regarding diet and their need for dietary counseling in relation to years since diagnosis, age, and education.

Methods: Breast cancer (BC) patients were compared to patients with rheumatoid arthritis (RA) with a validated questionnaire.

Bone mineral density of the lumbar spine in patients with advanced rheumatoid arthritis. Influence of functional capacity and corticosteroid use.

We investigated factors that are related to generalized osteoporosis in advanced rheumatoid arthritis (RA). In this cross-sectional study we measured trabecular bone mineral density (BMD), by quantitative computerized tomography (QCT), in the lumbar spine of 57 patients with RA, most of whom were premenopausal women. In our material, 27 out of 57 patients (47%) had BMD <-1 SD expressed as Z-score and five patients had suffered from fractures.

Somatic serogroups, capsular types, and species of fecal Klebsiella in patients with ankylosing spondylitis.

The purpose of the present study was to find out whether patients with ankylosing spondylitis (AS) carry fecal Klebsiella strains that belong to serotypes or species specific for AS. Somatic serotypes (O groups), capsular (K) serotypes, and biochemically identified species were determined for fecal klebsiellae isolated from 187 AS patients and 195 control patients. The controls were patients with fibromyalgia or rheumatoid arthritis.

Intraosseous fat necrosis simulating septic arthritis and osteomyelitis in a patient with chronic pancreatitis.

A woman with a 20-year history of alcohol abuse and chronic pancreatitis developed an osteoarticular involvement of her right ankle in association with subcutaneous nodules. Histopathological examination of the tissue samples obtained during surgical revision of the ankle showed necrotic fat and connective tissue. Microbiological cultures remained negative.

Interleukin-10 inhibits the capacity of synovial macrophages to function as antigen-presenting cells.

Objective: We have investigated the effects of interleukin (IL)-10, IL-4 + granulocyte/macrophage colony-stimulating factor (GM-CSF) and tumour necrosis factor alpha (TNF-alpha) on the phenotype and antigen-presenting capacity of synovial fluid (SF) macrophages from patients with rheumatoid arthritis.

Methods: The effects of IL-4, IL-10, GM-CSF and TNF-alpha on the expression of surface antigens on SF macrophages were studied using flow cytometry. The effects of these cytokines on the capacity of SF macrophages to activate T cells was investigated using the allogeneic mixed lymphocyte reaction (MLR).

Increased expression of signaling lymphocytic activation molecule in patients with rheumatoid arthritis and its role in the regulation of cytokine production in rheumatoid synovium.

In the present study the expression and function of signaling lymphocytic activation molecule (SLAM) in lymphocytes from patients with rheumatoid arthritis (RA) were investigated. The expression levels of SLAM were significantly up-regulated on synovial fluid and synovial tissue T cells from patients with RA compared with peripheral blood T cells from the same patients or from healthy volunteers. In addition, the expression of SLAM on peripheral blood B cells from patients with RA was elevated compared with that in healthy volunteers.

Aseptic spondylitis as the initial manifestation of the SAPHO syndrome.

We describe the case of a 61-year-old female patient who presented with spondylitis of the lumbar spine. Although the microbiological cultures of the bone biopsy specimens obtained during laminotomy remained negative, the patient was treated with broad-spectrum antimicrobials for 2 months. Eight months later she started to suffer from pain and tenderness in her sternum and the medial portion of her left clavicle.

Detection of parvovirus B19 in skin biopsy, serum, and bone marrow of a patient with fever, rash, and polyarthritis followed by pneumonia, pericardial effusion, and hepatitis.

A previously healthy 33-year-old male patient presented with fever, rash and polyarthritis. Subsequently, he developed pleuropneumonitis, pericardial effusion and hepatitis. The diagnosis of parvovirus B19 infection was based on the detection of parvovirus DNA by PCR in a skin biopsy, bone marrow cells and serum.

Systemic amyloidosis in a patient with hypogammaglobulinaemia.

A 49-year-old patient with an 18-year history of hypogammaglobulinaemia presented with nephrotic syndrome due to systemic amyloidosis. Recurrent infections as a consequence of an inadequate gammaglobulin substitution therapy were regarded as the main reason for the development of amyloidosis. When a high-dose intravenous immunoglobulin therapy was started, the clinical symptoms declined and the patient felt moderately well.

Interleukin-10 functions as an antiinflammatory cytokine in rheumatoid synovium.

Objective: Interleukin-10 (IL-10) is an antiinflammatory cytokine that has been shown to play a role in rheumatoid arthritis (RA). We therefore investigated the effects of IL-10 on the function and phenotype of synovial fluid mononuclear cells (SFMC) derived from patients with RA. In addition, we studied the production of IL-10 in rheumatoid joints, and the role of endogenous IL-10 in the regulation of SFMC function.

An aseptic inflammation of the clavicle in a patient with Crohn's disease. A potential manifestation of the SAPHO syndrome.

A female patient with Crohn's disease developed an septic osteoarticular involvement of the left clavicle and sterno- and acromioclavicular regions. Repeated surgical revisions combined with a broad-spectrum antimicrobial treatment could not prevent the progress of the disease. However, the patient started to improve after the diagnosis of the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteomyelitis) syndrome was made and the dose of her immunosuppressive therapy increased.

Oncogene expression in synovial fluid cells in reactive and early rheumatoid arthritis: a brief report.

Since it has been implied that cellular oncogenes might have a role in the pathogenesis of rheumatoid arthritis (RA), we have examined the expression of c-myc, c-myb, c-fos, c-jun and c-Ha-ras oncogenes in the cells from synovial fluid (SF) and peripheral blood (PB) of patients with reactive arthritis (ReA) and early RA. Oncogene expression was studied using RNA hybridizations with 32P-labelled probes. From the SF, mononuclear and granulocyte cell fractions were used separately.

Yersinia-specific antibodies in serum and synovial fluid in patients with Yersinia triggered reactive arthritis.

Objectives: To further evaluate the role of bacterial antigens in triggering inflammation in the joint in patients with reactive arthritis by studying local antibody synthesis in the joint.

Methods: Yersinia-specific antibodies in paired serum and synovial fluid samples from 29 patients with yersinia triggered reactive arthritis were studied using an enzyme linked immunosorbent assay (ELISA), an inhibition ELISA with six monoclonal antibodies against lipopolysaccharide or released proteins of yersinia and immunoblotting. Antibodies of IgM, IgG and IgA classes, as well as antibodies of IgA subclasses and those containing secretory component were measured against the lipopolysaccharide and the sodium dodecyl sulphate extract of whole Yersinia enterocolitica O:3 bacteria.

Antibody response against 26 and 46 kilodalton released proteins of yersinia in yersinia triggered reactive arthritis.

Using an inhibition enzyme linked immunosorbent assay (ELISA) the serum antibody responses against released proteins of yersinia of molecular weights 26 and 46 kilodaltons were studied in 37 patients with and in 21 patients without reactive arthritis following yersinia infection. Although no difference was seen for the 46 kilodalton released protein, patients with yersinia triggered reactive arthritis had higher levels of antibodies against the 26 kilodalton released protein at the beginning of the disease than patients with uncomplicated yersiniosis. This may indicate an increased production of this protein in the early infection leading to poorer phagocytosis of the bacteria and thereby to the persistence of yersinia organisms within the arthritic host.

Function of terminal ileum in patients with Yersinia-triggered reactive arthritis.

In order to study the function of the intestinal epithelium in the terminal ileum, the Schilling test was performed in 10 patients with Yersinia-triggered reactive arthritis, in 10 patients who had recovered from Yersinia enteritis without complications, and in five patients with rheumatoid arthritis treated with non-steroidal anti-inflammatory agents. The Schilling test indicates absorption of vitamin B12 in the terminal ileum, i.e.