Biomedical subjects
Publications and source records attributed to I Parasca.
Ankylosing spondylitis (AS), the prototype of seronegative spondylarthropathies, is in fact a systemic disease, causing numerous extraskeletal manifestations that have a significant influence on patients vital prognostic. This article presents the principal systemic manifestations of AS, pointing out pathogenetic, clinical and therapeutic aspects.
The paper reports on the authors' own experience on the effect of therapy with methotrexate (MTX) in 18 patients with invalidant psoriatic arthritis (PA). The therapeutic scheme was of the weekly "mini-pulse" type (three doses of 2.5 mg administered at 12-hour interval, with a gradual increase to 15 mg/week). The results were very good in 12 cases (66.6%), good in 3 cases (16.6%) and absent in other two cases (11.1%). These results and the data in the literature lead to the conclusion that MTX is a valuable therapeutic alternative for severe P.A. under the conditions of a correct surveillance with the observance of the contraindications.
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Von Willebrand factor (vWf), an endothelial product that arises in plasma in conditions associated with vascular damage and acute phase reaction, was evaluated in paired samples of plasma and synovial fluid obtained from 54 patients with inflammatory joint effusion, 19 patients with osteoarthritis, and from the plasma of 19 controls. Synovial fluid levels of vWf were detected in 36 of the patients. The mean value of vWf in the inflammatory joint effusion group was 18.27 +/- 3.03%, significantly higher than the mean value of 7.7 +/- 4.4% found in the osteoarthritis group (p less than 0.01). The significant difference between these groups was maintained when vWf was expressed as a ratio of albumin. vWf was correlated with synovial fluid levels of alpha-1-antitrypsin (r = 0.83, p less than 0.01) and with the white cell count (r = 0.74, p less than 0.01), but not with the levels of immunoglobulins or C3. vWf in the synovial fluid may reflect the local degree of inflammation.
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Activation of the terminal complement pathway leads to formation of the C5b--9 complex. The main effects of C5b--9 generation are tissue injury by cell lysis or by stimulation of proinflammatory mediators. In a study carried out in 42 patients, using polyclonal antibodies against C5b--9 neoantigens and C9 in an ELISA assay, we found significantly higher levels of SC5b--9 complex in plasma from the 18 patients with active systemic lupus erythematosus than those found in 10 healthy controls (p less than 0.005). In the 18 patients presenting rheumatoid arthritis and the 6 with progressive systemic sclerosis the plasma levels of SC5b--9 complex did not differ significantly from those in controls. The SC5b--9 levels found in the synovial fluid samples from the 16 rheumatoid arthritis patients were higher than the corresponding plasma ones. The ratio between synovial fluid and plasma levels was 1.2. Immunoperoxidase staining for C5b--9 was intense in three rheumatoid synovial membranes and absent in two normal synovial membranes obtained during meniscectomy. Increased levels of plasma and synovial fluid SC5b--9 reflect pathologic systemic or local activation of the complement carcase in systemic lupus erythematosus and respectively rheumatoid arthritis. Synovial membrane deposits of C5b--9 are indicative for the lytic and proinflammatory effects of complement activation.
von Willebrand factor (vWf), an endothelial cell product, was evaluated in 39 patients with rheumatoid arthritis, 19 patients with connective tissue diseases and vasculitis, 21 patients with nonrheumatoid inflammatory arthritides, 14 patients with osteoarthritis and 19 controls. High plasma vWf levels were found in rheumatoid arthritis patients: 196.35 +/- 85.8 (p less than 0.001 versus control) connective tissue diseases and vasculitides: 306.50 +/- 43.4 (p less than 0.001 versus control) and inflammatory nonrheumatoid arthritides: 193.35 +/- 90.6 (p less than 0.01 versus control). Highly increased vWf concentrations of more than 300%, were found in one patient presenting Wegener granulomatosis, 6 patients with vasculitis associated to connective tissue diseases, 7 patients with rheumatoid arthritis and 2 patients with active forms of inflammatory arthritides. vWf was correlated with fibrinogen in the subgroup of systemic lupus erythematosus patients. Elevated vWf levels may reflect vascular damage as well as the acute phase reaction. Highly elevated levels of vWf appear to indicate a poor prognosis.
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Fibronectin is a high molecular weight glycoprotein from plasma and other body fluids, connective tissue matrix and basement membranes. No significant differences in the mean values of plasma fibronectin were found in patients with rheumatic diseases compared to control subjects. The fibronectin in synovial fluids in these patients presented higher levels than in plasma. No other protein from the synovial fluid presented such a peculiar behaviour. The synovial fluid fibronectin/plasma fibronectin ratio is 2.49 in patients with rheumatoid arthritis, 1.56 in those with inflammatory nonrheumatoid arthritides and 1.60 in those with osteoarthritis. Statistically significant higher values of synovial fibronectin were found in patients with rheumatoid arthritis compared to those with osteoarthritis. No significant statistical correlations were found between the synovial fibronectin concentrations and the other clinical or biological parameters of the rheumatoid arthritis patients, but for synovial fluid C3. Immunohistochemical localization of fibronectin in the rheumatoid synovium showed more intense and extended specific deposits than in the control patients. These results suggest a local synthesis of fibronectin related to the chronic inflammatory process.
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