Pathologic alterations of the heart and the kidney in patients with ankylosing spondylitis.

Background: The occurrence of a variety of pathological lesions of the heart and kidneys have been described in patients with ankylosing spondylitis (AS). The frequency of these alterations and whether they are specific for AS has been discussed controversially. -

Methods: Outpatients with AS were studied to determine the frequency of cardiac and renal alterations and to assess the associated clinical and demographic factors.

Increase in bone mineral density of patients with rheumatoid arthritis treated with anti-TNF-alpha antibody: a prospective open-label pilot study.

Objective: To determine the changes in bone mineral density (BMD) in patients with rheumatoid arthritis (RA; without osteoporosis) treated with infliximab.

Methods: Twenty-six patients (19 women, seven men) aged 54.2 yr (range 27-75), with persistently active RA despite a high dose of non-steroidal anti-inflammatory drugs and/or treatment with methotrexate or leflunomide, were studied.

Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis.

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication in established ankylosing spondylitis (AS). It is known that inflammatory activity in rheumatic diseases (i.e.

Anti-TNF-alpha antibody Infliximab and glucocorticoids reduce serum vascular endothelial growth factor levels in patients with rheumatoid arthritis: a pilot study.

Unlabelled: To compare the effect of oral glucocorticoid (GC) therapy with the effect of intravenous anti-TNF-alpha-therapy on serum VEGF levels of patients with rheumatoid arthritis (RA). Five RA patients (5/8) who had no prior treatment with DMARDs (Disease modifying antirheumatic drugs) or GCs were administered 20 mg prednisolone daily. Three patients who failed more than one DMARD therapy received infusion with Infliximab (200 mg).

Skeletal benefit after one year of risedronate therapy in patients with rheumatoid arthritis and glucocorticoid-induced osteoporosis: a prospective study.

Glucocorticoid therapy is an important risk factor for osteoporosis in rheumatoid arthritis. Reduction in fracture risk is the most important endpoint for osteoporosis treatments. The aim of this study was to evaluate whether skeletal benefit (increases in osteosonogrammetry parameters, reduction in bone turnover and fracture incidence) are maintained during a follow-up of 1 year with risedronate therapy (5 mg/day).

Current knowledge about physiotherapeutic strategies in osteoporosis prevention and treatment.

In treating patients with osteoporosis, one option in physiotherapy is to comply with given physical norms by using physical stimuli to influence biological functions and structures (bone, muscle) for adaptation, stimulation, and regeneration. Serial physical stimuli can also be used for interventions and actions to minimise pain perception by means of biopsychosocial influence. In osteoporosis, physiotherapy has to be rated on a par with pharmacotherapy with respect to prevention, cure, and rehabilitation.

Ankylosing spondylitis and bone mineral density--what is the ideal tool for measurement?

Ankylosing spondylitis (AS) is characterised by chronic inflammation and partial ossification, yet vertebral fractures due to osteoporosis, although common, are frequently unrecognised. The aim of this study was to (1) show the frequency of changes in the progress of osteopenia/osteoporosis in AS depending on duration and stage of the disease and (2) assess the ranking of two different methods of bone density measurement in this clinical pattern. We measured bone density in 84 male and female patients with both dual X-ray absorptiometry (DXA) and single energy quantitative computed tomography (SE-QCT).

Novel ligands: fine tuning the transcriptional activity of the glucocorticoid receptor.

Glucocorticoids are the first line medication used in the therapy of many severe inflammatory disorders. They exert their activity through binding to the glucocorticoid receptor, a ligand-dependent transcription factor, and result in either activation or repression of a large set of glucocorticoid responsive genes. The desired immunosuppressive effect is apparently due largely to the down-regulation of a variety of pro-inflammatory factors, whereas adverse reactions such as corticoid-induced diabetes and osteoporosis could be connected to the inappropriate activation of genes involved in the control of metabolic processes.

A new approach to studying angiogenesis in rheumatoid arthritis by means of power Doppler ultrasonography and measurement of serum vascular endothelial growth factor.

Objective: To evaluate angiogenesis as an essential component of pannus formation and cartilage destruction in rheumatoid arthritis (RA) using power Doppler ultrasonography (PDUS) and serum vascular endothelial growth factor (VEGF) measurement.

Methods: Twenty-one RA patients with a painful and swollen wrist and 12 healthy controls were examined with ultrasound. By means of standard scans, vascularity near and inside the joint capsule was visualized with PDUS.

A pattern of protein expression in peripheral blood mononuclear cells distinguishes rheumatoid arthritis patients from healthy individuals.

We compared the expression levels of proteins in peripheral blood mononuclear cells (PBMCs) of healthy control individuals to those of patients diagnosed with rheumatoid arthritis (RA) using a proteomics approach. Using two-dimensional electrophoresis we identified 18 proteins that were 2-fold or more highly expressed in patients than in controls, and 11 proteins that were 2-fold or more highly expressed in controls than in patients. Some of these differentially expressed proteins, identified by MALDI-TOF spectrometry, have previously been shown to play a potential role in the pathogenesis of RA.

Doppler sonographic findings in the long bicipital tendon sheath in patients with rheumatoid arthritis as compared with patients with degenerative diseases of the shoulder.

Objective: To compare power Doppler sonography (PDS) findings inside the bicipital tendon sheath in patients with rheumatoid arthritis (RA) and degenerative disorders of the shoulder, in order to evaluate the diagnostic value of PDS in distinguishing between inflammatory and noninflammatory shoulder pain.

Methods: The glenohumeral joints of 41 consecutive patients with shoulder pain were examined by ultrasound. Using ventral transverse and longitudinal scanning, the vascularity near and/or inside the bicipital tendon sheath was visualized by PDS.

Whipple arthritis: diagnosis by molecular analysis of synovial fluid--current status of diagnosis and therapy.

Whipple's disease (WD) is an uncommon polysystem infectious disease. In the present report, we describe a patient who presented with a chronic illness consistent with WD and an avascular necrosis of the right hip joint. WD and its proposed causative bacillus, Tropheryma whippelii, was identified by molecular analysis (polymerase chain reaction) in bacterial DNA extracted from the synovial fluid.

Involvement of the glucocorticoid receptor in the pathogenesis of rheumatoid arthritis.

The glucocorticoid receptor (GR) is a ligand-inducible transcription factor which controls the expression of several genes. Its cognate ligand, the glucocorticoids, induces receptor activation by binding to the cytoplasmic located receptor, ultimately leading to translocation of the receptor/hormone complex into the nucleus and the regulation of gene activity. Because glucocorticoids are widely used for suppression of inflammation in rheumatoid arthritis (RA), we investigated whether the expression level of GR is correlated with RA.

Pathogenic mechanisms of fibromyalgia.

The symptomatology characterizing fibromyalgia comprises three systems: the musculoskeletal system with widespread muscular pain, neuroendocrine disorders, and psychological distress including anxiety and depression. Fibromyalgia is predominantly found in middle aged women. Though the most prominent symptom of fibromyalgia is pain in defined regions of the locomotor system, the numerous other somatoform and psychological disorders suppose a common primary disturbance which is considered to originate within higher levels of the central nervous system.

Relationship between disease activity and serum levels of vitamin D metabolites and parathyroid hormone in ankylosing spondylitis.

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication of ankylosing spondylitis (AS) and various factors may contribute to the development of osteoporosis in AS. It is known that inflammatory activity in rheumatic disease (i.e.

Current aspects of colchicine therapy -- classical indications and new therapeutic uses.

Colchicine has been traditionally used for the treatment of gout. At present there is no generally accepted alternative to colchicine for the treatment of acute attacks or for the prevention of further attacks. The complex actions of this substance, which are mainly attributable to its stabilising action on the cytoskeleton and cell membranes, and its special pattern of distribution form the basis for the results presented here regarding the prophylactic or therapeutic actions of colchicine in a whole range of other diseases.

Correlation of IL-6 with the classical humoral disease activity parameters ESR and CRP and with serum cortisol, reflecting the activity of the HPA axis in active rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic inflammatory disease with elevated levels of proinflammatory cytokines in peripheral blood, especially IL-6, but also IL-1 alpha and TNF alpha, for example, in different concentrations, depending on disease activity. A disturbed circadian rhythm of cortisol secretion and an overall elevated cortisol release in active RA, depending on disease activity, is known. The presented study examined correlations of IL-6 as the most important systemic mediator of the acute phase response in active RA with classical humoral disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and with serum cortisol.

Bone mineral density and biochemical markers of bone metabolism in late onset rheumatoid arthritis and polymyalgia rheumatica--a prospective study on the influence of glucocorticoid therapy.

In the present prospective study, bone metabolism was examined in 51 patients at the time of diagnosis and 6-7 months later: 29 patients had definitive diagnosis of late onset rheumatoid arthritis (LORA) and 22 patients had polymyalgia rheumatica (PMR). At the time of diagnosis, the patients had not received any medication; during the 6-7 months of follow-up they were treated with corticosteroids and nonsteroidal-antirheumatic drugs (NSAIDs). Serum levels of osteocalcin, alkaline phosphatase and ostase, as markers for bone formation, were tested.

Dynamic thermography of the knee joints in rheumatoid arthritis (RA) in the course of the first therapy of the patient with methylprednisolone.

Thermography in rheumatology is most often used in a static manner: after having fulfilled the conditions of standardized preparation of the patient in a cold examination room one or more thermograms are taken in standard positions for the respective joints. In our hospital the thermograms are more or less supplementary. The main examination result is a rewarming curve of the skin over the knee joints.

Correlation between plasma TNF-alpha, IGF-1, biochemical markers of bone metabolism, markers of inflammation/disease activity, and clinical manifestations in ankylosing spondylitis.

In patients with established ankylosing spondylitis (AS) and a healthy control group, plasma levels of IGF-1 and TNF-alpha as well as possible connections with biochemical markers of the bone metabolism, humoral inflammatory activity (ESR, CRP), clinical manifestations, and an established clinical activity score (Bath Ankylosing Spondylitis Activity Index = BASDAI) were examined. In AS-patients (men and women) significantly increased TNF-alpha levels were found. Moreover, patients with enthesopathy showed a significantly more frequent increase of CRP and TNF-alpha levels besides an increased urinary pyridinium cross-link excretion.

Neuroendocrine and hormonal perturbations and relations to the serotonergic system in fibromyalgia patients.

The symptomatology of the fibromyalgia syndrome (FMS) often resembles an alteration in central nervous set points at least in three systems. The patients suffer under chronic pain in the region of the locomotor system, presumably reflecting a disturbed central processing of pain. Anxiety and depression often characterizes the clinical picture.

Ultrasonography of the glenohumeral joints--a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica.

In a prospective study, the glenohumeral joints of 51 patients (aged 60 or above) were examined, using ultrasonography. Twenty-two patients were suffering from characteristic polymyalgia rheumatica (PMR) symptoms. In contrast, 29 other patients initially had similar complaints, but were diagnosed as having elderly onset rheumatoid arthritis (EORA, rheumatoid factor negative) upon development of typical symptoms.

Thyroid disorders in female patients with ankylosing spondylitis.

The association between rheumatological and thyroid disorders has long been known, the most common being the association of rheumatoid arthritis and autoimmune thyroiditis. Little is known as to possible thyroid involvement in ankylosing spondylitis (AS). In 22 female patients with AS and 22 healthy age-matched control subjects parameters of thyroid gland function, rheumatic activity, as well as a subtle drug anamnesis of the rheumatic medication, and an ultrasonographic examination of the thyroid gland were determined.