British journal of rheumatology最新文献

Objective: To determine the frequency of pericardial and pleural effusions in scleroderma.

Methods: Using a case-control format, patients with scleroderma and no known cardiac disease were recruited. Echocardiograms and chest radiographs were performed. Age- and gender-matched controls had echocardiograms performed which were read by a cardiologist, blinded to the diagnosis. The medical records of 60 other scleroderma patients were also reviewed.

Results: Thirty-seven scleroderma subjects were recruited, of whom 18 had diffuse disease. Only eight subjects with diffuse disease and five with limited scleroderma had normal echocardiograms compared to 20 of 37 controls (P < 0.1). Two had pericardial effusions, both with diffuse scleroderma, and none of the controls had effusions present. Pulmonary hypertension occurred in three with diffuse disease and no controls. A chart review of a further 60 patients with scleroderma was performed. Pleural effusions were identified in 7% (4/58) of the cohort of scleroderma patients and were more frequent in diffuse disease (10%). A total of 17% (4/23) of diffuse and 4% (1/23) of limited scleroderma patients had evidence of pericardial effusions.

Conclusions: Pericardial effusions do occur in scleroderma without evidence of clinical cardiac dysfunction and are more common in diffuse scleroderma. Pleural effusions in scleroderma occur less frequently, in 70%.

Objective: The benefit of long-term physical training in patients with chronic polymyositis or dermatomyositis (PM/DM) was studied prospectively.

Methods: Eight patients with chronic PM/DM participated in a training programme for 6 months. A group of five PM/DM patients without any physical training was observed for control purposes.

Results: While there was no significant change in serum creatine phosphokinase (CPK) levels, the 'activities of daily living (ADL)' score improved significantly (P < 0.03), peak isometric torque (PIT) generated by muscle groups in the lower extremities rose significantly (P < 0.03) and there was a statistically highly significant increase in peak oxygen uptake (VO2max) relative to body weight (P < 0.02) due to the long-term training. The patients improved their aerobic capacity by 28%, which is clinically significant. In the untrained patients, no improvement in these target parameters was observed.

Conclusion: In clinically stable DM/PM patients, long-term physical training can safely be performed and is recommended as part of a comprehensive rehabilitation management, particularly in view of the cardiopulmonary risk in these patients.

Hyperglycaemia and/or oxidative stress can cause IgG to be modified by advanced glycation end products (AGE). Three patients with aggressive rheumatoid arthritis (RA) and vasculitis are described who have high titres of IgM antibodies against AGE-modified IgG (IgM anti-IgG-AGE). Diabetics and randomly selected patients with rheumatic diseases, including 50 additional RA patients, were tested for IgM and IgA anti-IgG-AGE by ELISA. AGE-modified proteins were detected using the nitroblue tetrazolium (NBT) colorimetric method. The presence of Nepsilon (carboxymethyl) lysine, an AGE modification, was detected on IgG-AGE by immunoblotting. A total of 20/41 (49%) rheumatoid factor (RF)-positive RA patients tested had IgM anti-IgG-AGE antibodies, 4/12 (33%) RF-positive systemic lupus erythematosus (SLE) patients, 3/5 RF-positive patients with primary Sjogren's syndrome (SS), and 3/5 RF-positive diabetics. All patients with RF-negative RA, SLE, SS, osteoarthritis (24), spondyloarthritis (15), adult-onset Still's disease (8), diabetes (25) and healthy controls (20) were anti-IgG-AGE negative. RF and IgM anti-IgG-AGE appeared to be a linked response. The IgM anti-IgG-AGE, along with IgG-AGE, may contribute to the pathogenesis of RA.

Objective: To investigate the possible predominance of certain Klebsiella pneumoniae capsular types in the pathogenesis of ankylosing spondylitis (AS).

Methods: The prevalence of IgA class antibodies against three different K. pneumoniae strains (with capsular types 21, 30 and 43) was studied in the sera of 177 patients with AS and of 100 healthy blood donors using an enzyme-linked immunosorbent assay.

Results: The median Klebsiella-specific antibody levels were always higher in patients than in controls regardless of the serotype used as antigen. When the prevalence of increased antibody levels was compared between the groups, it was highest against the strain with capsular type 30, whereas against strains 21 and 43 it was similar among patients and controls.

Conclusions: A broad range of Klebsiella serotypes may be involved in the pathogenesis of AS. Thus, it is important to take the different Klebsiella serotypes into particular account in these studies.

Objective: A previous UK evaluation of the Arthritis Self-Management Programme (ASMP) demonstrated 4 month improvements in physical and psychological well-being including increased arthritis self-efficacy and increased use of self-management behaviours such as cognitive symptom management, and reductions in pain, fatigue and anxiety. The purpose of this study was to determine whether these effects were maintained at 12 month follow-up.

Methods: Twelve month data were collected via self-administered questionnaires mailed to participants who had previously responded prior to attending the ASMP and at 4 months follow-up.

Results: The sample (n = 112) comprised 82% women with a mean age of 59.6 (S.D. 12.4) yr and a mean disease duration of 14.9 (S.D. 11.1) yr. The majority of participants had a general practitioner-recorded diagnosis of either rheumatoid arthritis (46%) or osteoarthritis (44%). Many of the changes noted at 4 months were sustained at the 12 month follow-up.

Conclusion: This first long-term evaluation of a community-based patient education intervention delivered in the UK suggests that after participation in the ASMP, persons with arthritis derive substantial and prolonged benefits in terms of perceived ability to manage arthritis, reduction in pain and improved psychological well-being.

The role of microbial lipopolysaccharides (LPS) in the aetiopathogenesis of ankylosing spondylitis (AS) is a matter of continuing debate. In this study, class-specific IgG, IgA and IgM antibodies against Klebsiella pneumoniae, Escherichia coli, Salmonella typhimurium and Salmonella enteritidis LPS were measured by enzyme-linked immunosorbent assay (ELISA) in 100 AS patients, 50 rheumatoid arthritis (RA) patients and 50 healthy control subjects. The AS patients had significantly elevated levels of IgG and IgA antibodies against K. pneumoniae LPS (P < 0.001) and IgA antibodies against E. coli LPS (P < 0.05) compared to healthy controls. There were no significant elevations of antibody levels against S. typhimurium and S. enteritidis in the three study groups. In addition, there was a correlation between IgG and IgA anti-K. pneumoniae LPS antibody levels and the acute-phase reactant C-reactive protein (P < 0.001).