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Biomedical subjects

F C Breedveld

Publications and source records attributed to F C Breedveld.

At least 343 records · Page 19Linked to original sources
PubMed1993

The diagnostic value of salivary gland scintigraphy in patients suspected of primary Sjögren's syndrome.

The diagnostic value of salivary gland scintigraphy in patients suspected of having primary Sjögren's syndrome (SS) was studied in 149 consecutive patients who presented with joint and/or muscle complaints in combination with dryness of the mouth and/or eyes and in 20 control subjects. The diagnosis primary SS could be established in 26 of these patients. Salivary gland scintigraphy scored by means of analogue pictures was abnormal in 19 out of 26 patients with primary SS but abnormal scintigrams were also found in 57 of the 123 patients without primary SS and in five of the controls. This resulted in a positive predictive value of an abnormal salivary gland scintigram of 25% and a negative predictive value of a normal investigation of 90%. From the high number of false positive test results in the patient population studied it is concluded that salivary gland scintigraphy has only a limited discriminatory value for the diagnosis of primary SS.

Adult↗
PubMed1993

Bone metabolism in rheumatoid arthritis; relation to disease activity.

Biochemical parameters of bone metabolism were investigated in 105 ambulant, non-steroid treated patients with RA and compared with parameters of disease activity. Urinary calcium (Ca) and hydroxyproline (OHP) excretions, as parameters of bone resorption and serum alkaline phosphatase (AP), as a parameter of bone formation, were positively related to parameters of disease activity. Serum osteocalcin, another parameter of bone formation, was not related to parameters of disease activity. Patients with active disease (ESR > or = 28 mm and Ritchie articular index > or = 8) had a significant higher urinary Ca and OHP excretion (62 and 42% higher, respectively) than patients with inactive disease. Serum AP and OC were slightly higher (19 and 16%, respectively) in patients with active disease. These results suggest that in RA patients bone metabolism is related to disease activity. In active disease bone resorption seems to be increased more than bone formation, suggesting that prolonged disease activity may contribute to generalized and/or localized osteopenia.

Adult↗
PubMed1993

The relation between class-specific serum rheumatoid factors and age in the general population.

Class-specific RFs were measured in serum samples obtained from 810 individuals in seven age categories between 20-100 yr old, who were randomly selected from the general population. There was a decline with age of the mean IgG-RF levels in the higher age categories, no change of the mean IgA-RF levels and a clear increase of the mean IgM-RF levels in the higher age categories. In most age categories, the percentage of increased levels of all three RF isotypes was higher in the general population than in the healthy control population, consisting of 100 blood donors. These observations suggest that reference values for serum RF should be age-specific and based on sera of individuals randomly selected from the population.

Adult↗
PubMed1993

99Tcm-labelled polyclonal human immunoglobulin G scintigraphy before and after intra-articular knee injection of triamcinolone hexacetonide in patients with rheumatoid arthritis.

The ability of 99Tcm-labelled polyclonal human immunoglobulin G (99Tcm-IgG) scintigraphy to monitor intra-individual variation in arthritis activity was studied in seven patients with rheumatoid arthritis (RA). These patients were treated with an intra-articular injection of 20 mg triamcinolone hexacetonide. The results of semiquantitative 99Tcm-IgG scintigraphy were compared with the degree of joint swelling and the histological changes observed in synovial biopsies before and 14 days after the injection. In all seven patients the local treatment resulted in a decreased arthritis activity of the treated knee as measured clinically or histologically. This decrease was parallelled, in all patients except one, by a lower uptake of 99Tcm-IgG after the injection when compared to uptake prior to treatment. This study shows that 99Tcm-IgG scintigraphy is able to reflect intra-individual variations in arthritis activity in patients with RA.

Administration, Topical↗
PubMed1993

Rheumatoid factor production by mononuclear cells derived from different sites of patients with rheumatoid arthritis.

To investigate the origin of circulating rheumatoid factor (RF) and the relation between RF production at different sites in patients with rheumatoid arthritis (RA), mononuclear cells derived from bone marrow, synovium and peripheral blood of patients with RA were examined for the presence of plasma cells and for their capacity to produce RF and other immunoglobulins in vitro. Analysis of culture supernatants for the presence of immunoglobulins demonstrated that cells derived from bone marrow, synovium and peripheral blood were all found to be capable of producing every immunoglobulin and RF isotype investigated. No significant correlations were found between concentrations of immunoglobulin isotypes produced by cells derived from different sites of one individual. Significant correlations were found, however, between concentrations of RF isotypes produced by cells derived from the three sites. These results indicate that the production of RF in the different compartments is not an autonomously regulated process. Mononuclear cells derived from bone marrow were found to be able to produce RF in similar quantities to cells dissociated from synovial tissue. In combination with the fact that circulating immunoglobulins are produced mainly in the bone marrow, this observation suggests that bone marrow is also a major source of circulating RF.

Aged↗
PubMed1993

Cellular interactions between synovial T-cell clones from a patient with rheumatoid arthritis.

The aim of this study was to investigate T-T cell interactions that may be involved in the pathogenesis of chronic synovitis. Two CD4+ T-cell clones, termed N16 and N18, sharing similar cytokine profiles were isolated from the synovial tissue of a patient with rheumatoid arthritis. Activated N16 cells induced proliferation of N18 cells in the absence of accessory cells, while the proliferative response of N18 cells to activated N18 cells depended on the presence of accessory cells. Whereas the response of N18 to activated N18 cells could be blocked by MoAbs against HLA class I and LFA-1 molecules, the response of N18 to activated N16 cells was only weakly affected, suggesting that the surface molecules involved in this interaction differed. Indeed, using MoAbs against CD3, CD4 and to a lesser extent CD2, proliferation of N18 to activated N16 cells was abrogated. These data provide a model for T-T cell interactions involved in the development of chronic synovitis.

Antibodies↗
PubMed1993

Predictive value of IgG autoantibodies against C1q for nephritis in systemic lupus erythematosus.

OBJECTIVES: Antibodies against C1q (C1qAb) have been demonstrated in the serum of patients with several immune complex diseases. Patients, particularly those with lupus nephritis, were found to have increased serum titres of IgG C1qAb in a cross-sectional analysis. In the present prospective study correlations were sought between serum titres of IgG C1qAb and clinical as well as laboratory parameters of disease activity in patients with systemic lupus erythematosus (SLE). METHODS: Titres of IgG C1qAb in the serum of 68 SLE patients were measured serially during a three year period. At the same time clinical and laboratory parameters of disease activity were assessed. RESULTS: Increased titres of IgG C1qAb were found in the serum of 56% of SLE patients during the study. Significant correlations were found between increased titres of IgG C1qAb and renal involvement. Clinical signs of renal involvement were found to be associated with significant increases of serum titres of IgG C1qAb in the six months preceding this appearance. Fifty per cent of the increases in serum titres of IgG C1qAb were followed by the development of renal involvement. Elevated serum titres of IgG C1qAb were especially related to proliferative forms of glomerulonephritis. Furthermore, significant correlations were found between serum titres of IgG C1qAb and serum levels of immune complexes, levels of complement components, and titres of antibodies to DNA. CONCLUSIONS: The results suggest that IgG C1qAb play a pathogenic role in the development of lupus nephritis and that serial measurement of serum titres of IgG C1qAb is useful in the management of SLE patients.

Adolescent↗
PubMed1993

Evaluation of joint mobility in rheumatoid arthritis trials: the value of the EPM-range of motion scale.

OBJECTIVE: Evaluation of joint range of motion (ROM) is important in the therapeutic approach to patients with rheumatoid arthritis (RA). The reliability, construct validity and sensitivity to change of the Escola Paulista de Medicina (EPM)--range of motion scale that measures 10 distinct movements of small and large joints were examined. METHODS: Fifty patients with active RA who were participating in an inpatient multidisciplinary treatment program were examined by 2 investigators. Twenty-five of the patients were examined both at admission and at discharge from the hospital. RESULTS: The mean EPM-ROM score at study entry was 11.52 (SD +/- 3.80). The intra and inter-observer reliability of the EPM-ROM scale was high, with correlations of r = 0.91 and r = 0.85, respectively. There was a good correlation between the EPM-ROM scale and measures of functional ability. Correlations with measures of disease activity were poor. After a mean duration of the treatment program of 4.2 weeks, patients generally improved in variables of functional status and disease activity. The improvement of the EPM-ROM score (mean difference 1.58, 95% CI 0.84-2.32) was generally larger than improvement in other variables of functional status. CONCLUSION: The EPM-ROM scale is a reliable instrument, and according to its correlation with measures of functional status, relevant to the performance of activities of daily living. It showed a good response to improvement of functional status and disease activity and was more sensitive to changes than other variables of functional status.

Aged↗
PubMed1993

The clinical spectrum of giant cell arteritis.

Three patients are described with giant cell arteritis (GCA) of multiple medium sized and large blood vessels including the temporal artery and the aorta. The patients presented with malaise, myalgias and different symptoms due to decreased local blood flow. Progression of the disease could be blocked with immunosuppressive drugs in all 3 patients. With this report we want to emphasize that GCA is associated with a wide ranging disease spectrum in which temporal arteritis and Takayasu's arteritis represent two subsets.

Aged↗
PubMed1993

Factors predicting outcome of rheumatoid arthritis: results of a followup study.

OBJECTIVE: To determine prognostic factors in rheumatoid arthritis (RA). METHODS: One hundred thirty-two women with definite RA were followed yearly from an early phase of the disease (symptoms < 5 years) for a mean duration of 6 years. The prognostic value of the first available clinical and laboratory variables and assessments of functional ability was related to several outcome measures (physician's opinion of disease severity, disease activity, radiological abnormalities, functional ability and number of prescribed 2nd-line drugs) by single predictor analysis and by logistic regression. RESULTS: The variables most predictive for one or more of the outcome measures were number of swollen joints, Ritchie score, health assessment questionnaire score, radiographical abnormalities, positive IgM rheumatoid factor (RF), positive IgG-RF, HLA-DR4, and an elevated percentage serum agalactosyl IgG. The accuracy of predicting outcome was calculated from several combinations of these variables, and varied between 70 and 80%. The accuracy based on a combination of the commonly available variables (number of swollen joints, IgM-RF and the erosion score), closely approximated the maximal accuracy that could be achieved. CONCLUSION: The outcome of RA can be predicted by a combination of variables that are commonly available in the clinical setting.

Adult↗
PubMed1993

Withdrawal of longterm antihyperuricemic therapy in tophaceous gout.

OBJECTIVE: To determine the effect of withdrawal of antihyperuricemic therapy on the recurrence of tophi and acute arthritis. METHODS: We performed a retrospective investigation of 21 patients with tophaceous gout who stopped therapy because they had no arthritis for years, and on examination tophi had disappeared. RESULTS: Nine patients (43%) had a recurrence of tophi after an average period of 39.6 months (range 4-107 months). Seventeen patients (81%) had attacks of acute arthritis, 6 patients within 6 months. During a mean period of drug discontinuation of 37.6 months no increase in serum creatinine or deterioration in joint function was observed. CONCLUSION: Based on our data we conclude that intermittent usage of antihyperuricemic drugs will, after a variable period, result in the frequent recurrence of acute arthritis and tophi.

Adult↗
PubMed1993

Which clinical variables contribute to the physician's assessment of medium term outcome in rheumatoid arthritis?

To investigate the clinical variables that contribute to the physician's opinion of the medium term outcome of rheumatoid arthritis (RA), we compared the physician's opinion with statistical modelling of these clinical variables. In 133 young female patients with RA followed yearly (mean followup duration 6 years) from symptom onset, the physician had to state whether the disease course was mild or progressive. Using logistic regression models we concluded that the physician's opinion could be explained by using a compilation of the erosion score, the number of swollen joints, the Ritchie score as measured at the latest visit, in combination with either the mean number of swollen joints during followup, or the number of prescribed second line drugs. Several different models with a common core were equally close to the physician's opinion.

Adult↗
PubMed1993

Outcome of rheumatoid arthritis in relation to age and rheumatoid factor at diagnosis.

Our retrospective followup study reports the outcome of rheumatoid arthritis (RA) in relation to age (under 60 vs 60 years and over) and rheumatoid factor status at diagnosis. A sample of 130 adult patients with RA was assessed at a mean of 5.6 years after diagnosis. At final evaluation disease activity and radiographic damage in seropositive patients were similar in both age groups, but functional capacity was markedly lower in the older onset group, indicating lower functional reserves in this group. In seronegative patients the outcome was favorable in both age groups, especially in the older patients. Seropositive patients in both age groups had more disease activity, a lower functional capacity and more radiographic damage than seronegative patients; these differences were greater in the older onset patients. The mortality in patients with RA compared to the general population (standardized mortality ratio, SMR) was higher in seropositive patients (SMR 2.78, 95% CI 1.70-4.13) but not in seronegative patients (SMR 0.45, 95% CI 0.08-1.13). The relative risk of dying was 6 times higher in seropositive patients than in seronegative patients (95% CI 1.7-20.9).

Aging↗
PubMed1993

IgA anti-dsDNA antibodies in systemic lupus erythematosus: occurrence, incidence and association with clinical and laboratory variables of disease activity.

The relationship between IgA anti-dsDNA antibodies and systemic lupus erythematosus (SLE) disease activity was investigated. IgA anti-dsDNA antibodies were measured using ELISA techniques. Elevated serum levels of IgA anti-dsDNA antibodies were detected in 51% of the patients with SLE (n = 57) and 8% of the diseased controls (n = 214). The presence of IgA anti-dsDNA antibodies was associated with kidney and joint abnormalities, with hypocomplementemia and with circulating immune complexes. We conclude that increased levels of IgA anti-dsDNA antibodies are associated with disease activity in patients with SLE.

Adult↗
PubMed1993

Digital subtraction sialography of the parotid glands in primary Sjögren's syndrome.

Digital subtraction sialography of the parotid glands was performed in 34 patients with primary Sjögren's syndrome (SS) and 78 patients suspected of having primary SS in whom the diagnosis could be excluded (NON-SS). The following sialographic features were found more frequently in the patients with primary SS than in the NON-SS patients: a sparse overall branching pattern of the ducts, progressive widening and irregularity of the duct walls, disappearance of a homogeneous parenchyma blush and the occurrence of peripheral acinar dilations. The most discriminating findings between the 2 patient groups were the presence of acinar dilations and the disappearance of the homogeneous parenchyma blush. The sensitivity and specificity of the presence of acinar dilatations were 79 and 95%, respectively. Both the sensitivity and specificity of the presence of an irregular or absent parenchyma blush were 91%. The concurrent finding of acinar dilatations and an irregular or absent parenchyma blush had a sensitivity of 77% and a specificity of 95%. We conclude that digital subtraction sialography is a useful adjunctive diagnostic procedure for primary SS.

Adult↗
PubMed1992

Depression of tissue-type plasminogen activator and enhancement of urokinase-type plasminogen activator as an expression of local inflammation.

Inflammatory processes are accompanied by extravascular deposition and breakdown of fibrin. We measured fibrinolytic parameters in synovial fluid (SF) and in plasma of 36 patients with rheumatoid arthritis (RA). As a control, SF of 13 patients with blunt knee trauma, and plasma of 17 healthy volunteers were studied. In RA patients, extravascular t-PA mediated plasminogen activation was depressed: mean SF tissue-type plasminogen activator (t-PA:Ag) concentration (2.1 +/- 1.6 ng/ml) was four-fold lower, and plasminogen activator inhibitor (PAI) activity (284 +/- 212%) four-fold higher than the plasma values of the same patients or of healthy donors. In contrast, u-PA related plasminogen activation was strongly enhanced: urokinase-type plasminogen activator (u-PA) antigen (23.1 +/- 12.4 ng/ml) was more than four-fold higher, single-chain u-PA (scu-PA) (5.3 +/- 1.9 ng/ml) three-fold higher than in plasma of the same patients or of healthy donors, and active two-chain u-PA (tcu-PA) was detected in 14 of the 36 SF samples of RA patients. All of these changes in extravascular fibrinolytic parameters correspond with those induced by inflammatory mediators in cell cultures. In joint effusions of patients with a blunt knee trauma, the effects were intermediate: u-PA related parameters showed moderate changes in the same direction as in arthritis; t-PA antigen was also decreased. The only exception was that PAI was not increased. We conclude that the findings in traumatic effusions reflect transient effects as a reaction to trauma. In joint inflammation, the depressed t-PA mediated plasminogen activation, although more than compensated by the enhanced u-PA mediated plasminogen activation, results in protraction of fibrin removal. Besides, the enhanced u-PA activation might lead to proteolytic damage of the cartilage.

Arthritis, Rheumatoid↗
PubMed1992

Antilactoferrin antibodies in patients with rheumatoid arthritis are associated with vasculitis.

OBJECTIVE: To determine the occurrence of antineutrophil cytoplasmic antibodies (ANCA) and the specificity of these antibodies (Ab) in serum from patients with rheumatoid arthritis (RA) and patients with rheumatoid arthritis complicated by vasculitis (rheumatoid vasculitis [RV]). METHODS: ANCA was detected with an indirect immunofluorescence test on ethanol-fixed granulocytes. Ab against the cytoplasmic antigens proteinase-3, elastase, lactoferrin (LF), and myeloperoxidase were measured by enzyme-linked immunosorbent assay. RESULTS: ANCA were found in the serum of 43% of 49 patients with RV and in 36% of 50 patients with RA. Anti-LF Ab occurred more frequently in RV patients (45%) than in RA patients (4%), whereas reactivity against the other cytoplasmic antigens did not differe significantly between these groups. CONCLUSION: Anti-LF Ab in serum of patients with RA may be useful in the diagnosis of vasculitis in RA.

Antibodies↗