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Biomedical subjects

B Skrifvars

Publications and source records attributed to B Skrifvars.

11 recordsLinked to original sources

A subset of systemic lupus erythematosus with progressive cystic bone lesions.

Clinical and serological findings of 16 patients with systemic lupus erythematosus (SLE) who had progressive cystic bone lesions were compared with a control group of 19 patients with SLE without radiological evidence of bone cysts. Central nervous system manifestations, synovitis, and other radiologically observed skeletal abnormalities were more prevalent in the patients with cysts than in the control group. Higher concentrations of C reactive protein, and a greater incidence of rheumatoid factor positivity were seen in the patients with cysts than in the control patients, but no other serological differences were found. It is suggested that patients with SLE with progressive cystic lesions form a subgroup of the syndrome characterised by an increased acute phase reaction.

Bone Cysts

Cell-mediated immune response in the diseased joints in patients with reactive arthritis.

To evaluate the level of lymphocyte activation in reactive and rheumatoid arthritis, density gradient-isolated, synovial fluid mononuclear cells were stained with a panel of antisera directed at lymphocyte activation markers using an avidin-biotin-peroxidase complex (ABC) method. More specifically, we studied the expression of immune response-associated class II HLA antigen (Ia), of receptors for interleukin 2 (Tac) and transferrin (T9), as well as of gp 40/80 glycoprotein (4F2). Although Ia+ cells formed about 60% of all the synovial fluid mononuclear cells in both disease conditions, the proportion of Tac+ (33 +/- 4% vs 3 +/- 1%, P less than 0.001), T9+ (34 +/- 4% vs 5 +/- 2%, P less than 0.001), and 4F2+ (48 +/- 6% vs 3 +/- 2%, P less than 0.001) cells was high only in reactive arthritis. All the patients who had reactive arthritis followed a favourable clinical course during the 4-month-long prospective follow-up, whereas disease activity was stable in patients with rheumatoid arthritis. These findings suggest that the diseased joints in reactive arthritis are a site for an active, but normally down-regulated, cell-mediated immune response.

Antibodies, Monoclonal

Resolution of renal amyloidosis secondary to rheumatoid arthritis.

A patient with seronegative rheumatoid arthritis developed a nephrotic syndrome. Histological examination of renal biopsy disclosed moderate amyloidosis. Ultrastructurally the glomerular amyloid deposits were seen to be located both within the mesangium and subepithelially in the peripheral capillaries. The patient was treated with prednisone and cyclophosphamide for two years. The nephrotic syndrome remitted and a follow-up biopsy showed almost total disappearance of Congo red positive amyloid substance. Electron microscopy showed abundant finely granular material but only small amounts of fibrillar amyloid in the mesangial regions and intramembranous lucent areas containing few amyloid fibrils but no subepithelial deposits in the peripheral capillaries. We conclude that the mesangial amyloid substance was degraded to granular material and that the subepithelial amyloid deposits were resolved by mechanisms similar to those involved in the resolution of subepithelial immune complex deposits, i.e. through slow washing out and incorporation into the basement membrane.

Amyloidosis

Hypothesis for the pathogenesis of sodium aurothiomalate (Myocrisin) induced immune complex nephritis.

Renal complications associated with gold salt treatment in rheumatoid arthritis occur in fewer than 5% of treated patients. Recent investigations have shown that the renal lesion manifested clinically as membranous glomerulonephritis is caused by immune complexes. This paper presents a hypothesis for the mechanism by which gold causes this lesion: autoimmunization due to released tubular antigen(s). This hypothetical mechanism is strikingly similar to that responsible for autologous autoimmune nephrosis in the rat (Heymann's nephritis).

Animals

Granulomatous glomerulonephritis in a patient with rheumatoid arthritis treated with gold salts.

The clinical course of rheumatoid arthritis in the patient described was characterized by two episodes of microhaematuria, both occurring shortly after the administration of gold salt. The second of these episodes developed into progressive renal failure. Renal biopsy disclosed a rarely described granulomatous glomerulonephritis. Various known pathogenic mechanisms of renal injury are evaluated concerning their applicability in this patient. However, although it is believed that the gold salt therapy was the main agent in the pathogenesis of this fatal renal complication, the mechanism whereby such a pathogenesis proceeded remains unclear.

Aged

Immunofluorescence study of renal biopsies in chronic rheumatoid arthritis.

Renal biopsy specimens from 20 patients, 14 women and 6 men, with rheumatoid arthritis (RA) of at least 6 months' duration were studied by direct immunofluorescence microscopy for the presence of immune deposits. Pathological changes were most prominent in patients with longstanding or malignant disease and in patients previously on gold salt therapy. Staining for IgG and C3 was negative in 4 patients with an arthritis of 2 year's duration or less. Fifteen patients had glomerular deposits containing IgG or C3, or both. In 6 of these patients staining was also positive for IgM and in 3 for IgA. In 8 patients C3 was distributed in irregular deposits along the tubular basement membrane. These results suggest that in patients with RA, immunological processes have an untoward effect on the kidneys. The long-term effects of these processes might contribute, moreover, to the development of late renal complications. There is no evidence, however, that the renal immune deposits documented so frequently in this study derive from the rheumatoid disease itself.

Adult

A long-term double-blind comparative study on proquazone (Biarison) and ibuprofen in rheumatoid arthritis.

The efficacy and tolerance of proquazone, 900 mg, and ibuprofen, 1200 mg, were compared in a randomized, double-blind clinical trial of 6 months' duration, with 44 patients, 21 on proquazone and 23 on ibuprofen. Comparison of proquazone-treated patients with patients treated with iburofen showed a significantly better improvement , as is demonstrated by the significant differences in the Lansbury Index, in nocturnal pain, final assessment of therapeutic effect, and number of interruptions due to lack of efficacy. All differences were in favour of proquazone, proving its therapeutic superiority over ibuprofen. The side effects in the proquazone group were mainly gastrointestinal, and 2 patients broke off treatment prematurely due to diarrhoea (in one patient, lack of efficacy was a contributory cause). A third patient discontinued because of moderate nausea and dizziness. In the ibuprofen group, 4 patients discontinued because of side effects (skin eruptions, dizziness, epigastric discomfort, and one thrombocytopenia) in addition to lack of efficacy. Proquazone seems to be an effective and well tolerated anti-inflammatory analgesic.

Adult

Influence of proquazone (Biarison) on the levels of complement components (C3 and C4) in synovial fluid and on IgM in serum in patients with active rheumatoid arthritis. A preliminary report.

Four patients with erosive rheumatoid arthritis and one with psoriasis arthropathy were treated with 600-900 mg/day proquazone for 4-7 weeks. All patients had acute knee effusions. The complement components C3 and C4, as well as IgG, IgA, IgM and total protein, were measured in both the synovial fluid and serum before and after treatment. In the 4 patients with rheumatoid arthritis, a marked increase in C3 and/or C4 levels in the synovial fluid was found, correlating in 3 cases with a good clinical response. However, no corresponding changes in complement levels were recorded in the serum. The patient with psoriasis arthropathy did not show any reaction. These preliminary results suggest that proquazone may influence the immunological processes in rheumatoid arthritis.

Adult

Acid glycosaminoglycans in plasma. II. Findings in rheumatoid arthritis.

The glycosaminoglycans (GAG) directly adsorbable from undiluted plasma on DE-52 anion-exchange cellulose (free GAG) and the GAG adsorbable on AG 1 X 2 anion exchange resin after papain proteolysis (bound GAG) were determined in 35 patients suffering from active erosive rheumatoid arthritis (RA) and in 50 control subjects. Free GAG levels were significantly elevated in both female (p less than 0.001) and male (p less than 0.05) RA patients. Bound GAG levels were significantly depressed in female (p less than 0.02) but not in male RA patients. Total GAG concentrations in RA patients and in controls were fairly similar. No consistent differences in the electrophoretic patterns of the plasma GAG from RA patients and controls were discernible. The free GAG concentrations in RA plasma samples did not correlate with seropositivity or ESR.

Adult

The development and resolution of glomerular basement membrane changes associated with subepithelial immune deposits.

The morphogenesis of glomerular basement membrane changes associated with subepithelial immune deposits was studied in kidney biopsies from patients with gold-induced membranous glomerulonephoritis. Serial biopsies showed focal accumulations of additional basement membrane material around the deposits, suggesting that the deposited material stimulated the epithelium to increased synthesis. Moreover, the deposits were gradually displaced towards the inner (endothelia) side of the basement membrane during the course of the disease, suggesting that this layer undergoes a slow continuous turnover, with removal at its endothelial aspect. The two processes--increased epithelial synthesis and turnover--are suggested to constitute the basis of a natural healing process resulting in elimination of the deposits and structural restoration of the basement membrane. The epithelial slit membranes were dislocated externally by the deposits or the excessive basement membrane material, indicating that their barrier function is preserved even in this pathologic condition.

Arthritis, Rheumatoid