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J W Rachow

Publications and source records attributed to J W Rachow.

13 recordsLinked to original sources
PubMed1996

Methotrexate patient education: a quality improvement study.

OBJECTIVE: To determine patients' knowledge of the safe use and toxicity of methotrexate (MTX) and to define educational interventions implemented by a rheumatology nurse that improved patients' understanding of MTX therapy. METHODS: One hundred eighty-three patients from a university-based rheumatology clinic who were taking MTX completed an initial knowledge questionnaire concerning the proper use and possible toxicity of MTX. Following completion, a nurse reviewed the correct answers with each patient and provided written information on MTX. One hundred thirty-eight of these patients completed a followup questionnaire at the next visit or by mail. The questionnaires were analyzed, and a total MTX knowledge score was calculated. RESULTS: MTX knowledge improved significantly between questionnaires; mean total score (+/- SD) increased from 7.32 +/- 3.99 to 10.23 +/- 3.29 (P < 0.001). After accounting for a person's initial questionnaire score, the addition of a supplemental "MTX pocket-card" was associated with a higher score on the follow-up questionnaire (adjusted odds ration [OR] = 2.37; 95% confidence interval [CI] 1.14, 4.95; P = 0.021). Patients over age 55 were 4 times more likely to have a poorer score compared with patients under age 45 (adjusted OR = 0.23; 95% CI 0.07, 0.73; P = 0.013). CONCLUSION: Knowledge of the toxicity and safe use of MTX was significantly improved by a patient education program utilizing a rheumatology nurse. Older individuals appear to be at higher risk for knowledge deficits. A supplemental MTX pocket-card proved to be a simple but beneficial addition to our MTX educational program.

Aged↗
PubMed1996

Rheumatoid arthritis lung disease. Determinants of radiographic and physiologic abnormalities.

OBJECTIVE: To determine the prevalence and important clinical predictors of radiographic and physiologic abnormalities indicative of rheumatoid arthritis interstitial lung disease (RA-ILD). METHODS: An unselected cohort of patients with a confirmed diagnosis of RA and known lung disease were identified (n = 336) and evaluated for RA disease activity and severity. Outcomes included abnormalities determined by the pulmonary function tests of forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco), and/or chest radiographic findings of interstitial infiltrates. We used multivariable statistical modeling to determine the independent significance of cigarette smoking and other RA-specific factors on the pulmonary abnormalities of interest. RESULTS: At least 1 of the 3 abnormal findings was identified by pulmonary tests in 32.4% of all patients. These abnormal findings included an FVC < 80% of predicted in 42 patients, a DLco < 80% of predicted in 64 patients, and evidence of radiographic interstitial infiltrates in 40 patients. After statistical adjustment for confounding factors, pack-years of cigarette smoking remained a significant predictor of low DLco (beta = -0.07, 95% confidence interval [95% CI] -0.09, -0.04), low FVC (beta = -0.003, 95% CI -0.006, -0.0004), and interstitial abnormalities on chest radiograph (odds ratio for > or = 25 pack-years = 3.76, 95% CI 1.59, 8.88). The Health Assessment Questionnaire (HAQ) Disability Index (DI) was also an important risk factor for the decline in both the DLco (beta = -1.15, 95% CI -2.00, -0.30) and FVC (beta = -0.23, 95% CI -0.32, -0.13). CONCLUSION: Although RA disease activity/severity (particularly as defined by the HAQ DI) was important, smoking was the most consistent independent predictor of radiographic and physiologic abnormalities suggestive of ILD in RA.

Adult↗
PubMed1996

Adenosine triphosphate levels in human plasma.

OBJECTIVE: To quantify extracellular adenosine triphosphate (ATP) levels in human platelet-poor plasma as a potential source of synovial fluid ATP, and to determine variables affecting these levels. METHODS: ATP was measured by the specific luciferase method; platelet beta thromboglobulin was determined by radioimmunoassay. The effects of fasting, feeding, venipuncture, and muscular exercise were determined by serial venipuncture in healthy subjects. Diurnal variation was determined by serial sampling through indwelling venous catheters in 3 healthy subjects and 3 women with knee osteoarthritis. RESULTS: Unlike beta thromboglobulin levels, which did not change, an invariable marked (mean 58%) fall in plasma ATP was noted 15 min after the first venipuncture, whether the subject had eaten or not. Indomethacin treatment had no effect on this phenomenon. Exercise of forearm muscles had no effect on plasma ATP. The drop in plasma ATP occurred between 3 and 15 min, with recovery at about 90 min. A diurnal variation in plasma ATP was found with trough levels at noon and at night during sleep. CONCLUSION: The predictable sharp fall in plasma ATP levels induced by venipuncture and the clear diurnal variation suggest that plasma contains ATP independent of platelet dense body release and endothelial cell needle trauma. Synovial plasma flow at peak (600 nM) levels is insufficient to provide more than one-third of the extracellular ATP needed to generate inorganic pyrophosphate in articular tissues.

Adenosine Triphosphate↗
PubMed1994

Synovial fluid and plasma levels of cartilage matrix glycoprotein in arthritis.

As cartilage matrix glycoprotein (CMGP) is a prominent matrix constituent, we analyzed the relationship of levels in plasma (CMGPP) and synovial fluid (CMGPS) to each other, to clinical diagnosis, and to degree of radiographic cartilage degeneration. CMGP was measured in matched synovial fluid and plasma specimens from 67 patients with various forms of arthritis using an ELISA technique. CMGPS consistently exceeded CMGPP, CMGPP levels correlated significantly with CMGPS levels, and CMGP retention in joint fluid, as calculated by the ratio CMGPS: CMGPP, was significantly higher in patients whose synovial fluids contain basic calcium phosphate crystals. No correlation of CMGPP or CMGPS with diagnosis or degree of cartilage degeneration was observed. CMGP measurements are not useful diagnostically in patients with chronic arthritis and do not predict degree of radiographic degeneration. The association of basic calcium phosphate crystals with intraarticular retention of CMGP warrants further study.

Arthritis, Rheumatoid↗
PubMed1992

Articular cartilage vesicles generate calcium pyrophosphate dihydrate-like crystals in vitro.

OBJECTIVE: To identify the morphology of a mineral-forming of adult porcine hyaline articular cartilage digest and characterize the mineral it forms. METHODS: Electron microscopy, Fourier transform infrared (FTIR) spectroscopy, x-ray microanalysis, compensated polarized light microscopy, and biochemical studies including 14C-labeled UDPG pyrophosphohydrolase radiometric assay. RESULTS: This fraction of articular cartilage digest contained membrane-limited vesicles resembling growth plate cartilage matrix vesicles and formed mineral after only 24 hours in physiologic salt solution containing 1 mM ATP: The mineral contained inorganic pyrophosphate, 95% of which derived from ATP, and phosphate, 93% of which derived from inorganic phosphate in the medium. The FTIR spectrum of this mineral closely resembled the spectrum of standard calcium pyrophosphate dihydrate (CPPD) crystals. Compensated polarized light microscopy showed positively birefringent, rod-shaped crystals morphologically identical to CPPD. Ca:P ratios, defined by energy-dispersive microanalysis, were also consistent with CPPD. CONCLUSION: The articular cartilage vesicle fraction of porcine hyaline cartilage is capable of generating mineral that strongly resembles CPPD.

Adenosine Triphosphate↗
PubMed1991

Synovial fluid 5'-nucleotidase activity. Relationship to other purine catabolic enzymes and to arthropathies associated with calcium crystal deposition.

We measured 5'-nucleotidase (5NT) activity in synovial fluid from 159 patients with various diagnoses. The activity of 5NT was compared with activities of nucleotide pyrophosphohydrolase, alkaline and neutral phosphatases, and adenosine deaminase, in the same samples. Higher levels of 5NT activity occurred in synovial fluid from osteoarthritic joints than from joints of patients with gout, pseudogout, or rheumatoid arthritis. The highest levels of 5NT activity were found in synovial fluid from patients with Milwaukee shoulder syndrome and from osteoarthritis patients in whom deposition of calcium-containing crystals was also present.

5'-Nucleotidase↗
PubMed1991

Synovial fluid ATP: a potential substrate for the production of inorganic pyrophosphate.

The enzyme nucleoside triphosphate pyrophosphohydrolase (NTPPPH) is present in all joint fluids and on intraarticular cells. It generates inorganic pyrophosphate (PPi) from nucleoside triphosphate substrate, thus serving as a potential source of the PPi which forms in the cartilages of patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition. NTPPPH is also important in matrix vesicle induced calcification with basic calcium phosphate (BCP) crystals. An articular substrate for this enzyme was sought. ATP was measured in the joint fluids from 107 patients with various forms of arthritis. Synovial fluid ATP levels were higher in patients with CPPD deposits than in osteoarthritis (p less than 0.02) or rheumatoid arthritis (p less than 0.002). ATP also correlated with PPi concentration (p less than 0.05) and with the presence of BCP crystals (p less than 0.05), but not with cellularity of the fluid, NTPPPH activity, or age of the donor. This substrate for NTPPPH may contribute to CPPD crystal deposition by generating PPi and may stimulate matrix vesicle induced formation of BCP crystals in several forms of arthritis.

Adenosine Triphosphate↗
PubMed1988

Synovial fluid inorganic pyrophosphate concentration and nucleotide pyrophosphohydrolase activity in basic calcium phosphate deposition arthropathy and Milwaukee shoulder syndrome.

Synovial fluid (SF) inorganic pyrophosphate (PPi) concentration is elevated in calcium pyrophosphate dihydrate (CPPD) crystal deposition arthropathy. Since CPPD and basic calcium phosphate (BCP) crystals often are present in the same joints, we determined [PPi] and activity of the PPi-generating enzyme, nucleotide pyrophosphohydrolase (NPPH), in SF from the joints of patients with various arthropathies, including those with BCP crystals. We found elevated SF [PPi] in joints with BCP crystals, as well as in joints with CPPD crystals. The presence of BCP crystals in synovial fluids was also predictive of elevated NPPH activity.

Calcium Phosphates↗
PubMed1988

Inorganic pyrophosphate metabolism in arthritis.

Once thought of as a biosynthetic waste product, over the last 2 decades PPi has become understood as an entity with a variety of biologic roles (see Table 1). Documented roles include participation in intracellular Ca++ traffic, mediation of nucleotide and iron transport, storage of molecules in cellular granules, modification of enzyme function, and modulation of mineralization. Much has been established regarding plasma, urine, and synovial fluid levels (see Fig. 1) and urinary excretion in health and disease. Derangements in intracellular PPi content of skin fibroblasts have been noted in patients with CPPD deposition arthropathy (see Table 2). Mechanisms by which elevated PPi concentration develops in synovial fluid from joints with CPPD deposition and related arthropathies have come under scrutiny. The chondrocyte is now recognized as the probable cellular source of intra-articular extracellular PPi (see Figs. 3 and 4). Special attention has been focused on two basic pathways by which chondrocytes could generate extracellular PPi (see Fig. 2). In the first mechanism, chondrocytes demonstrate a set of ectoenzymes which could work in concert to directly produce extracellular PPi. The second pathway involves the major reactions by which PPi is formed within the cell and how intracellular PPi thus formed could be transported into the extracellular space. Much future research is needed regarding these two pathways and their relative importance in the pathogenesis of CPPD crystal deposition and related arthropathies.

Animals↗
PubMed1985

Adenosine triphosphate pyrophosphohydrolase and neutral inorganic pyrophosphatase in pathologic joint fluids. Elevated pyrophosphohydrolase in calcium pyrophosphate dihydrate crystal deposition disease.

Adenosine triphosphate pyrophosphohydrolase (ATPPPH) and neutral inorganic pyrophosphatase activities were assayed in synovial fluids (SF) from 37 patients with a variety of arthropathies. ATPPPH activity was detected in all fluids, but was highest in patients with chronic chondrocalcinosis; its activity in patients with osteoarthritis was higher than that in patients with rheumatoid arthritis, gout, or pseudogout. ATPPPH activity correlated positively with SF pyrophosphate concentration and negatively with SF white blood cell count. Pyrophosphatase activity did not correlate with diagnosis, pyrophosphate level, or white blood cell count.

Adenosine Triphosphatases↗
PubMed1985

Partial characterization of synovial fluid nucleotide pyrophosphohydrolase.

Synovial fluid adenosine triphosphate pyrophosphohydrolase, an enzyme which manifests increased activity in chondrocalcinosis and osteoarthritis, was partially characterized in synovial fluids from 41 patients who had a variety of arthropathies. Activity was found to be a soluble, heat labile, and divalent cation-dependent nonspecific nucleotide pyrophosphohydrolase with pH optimum 9.0-9.5.

Adenosine Triphosphatases↗