Biomedical subjects
Publications and source records attributed to K Trnavský.
The authors describe the incidence of diffuse idiopathic skeletal hyperostosis in three members of a family--father and two daughters. Some diagnostic problems of the disease are also discussed.
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Salazosulphapyridine is a salicyl derivative of the sulphonamide sulphapyridine. Although its introduction into clinical practice in rheumatology is not recent, only clinical investigations during the last decade proved convincingly its favourable therapeutic effect in rheumatoid arthritis and in some diseases from the group of seronegative spondarthritis. The onset of the therapeutic response after a latency of several weeks, the influence on the laboratory and clinical indicators of the activity of the rheumatic inflammatory response and the concurrent retardation of the development of articular destructive changes on the X-ray picture in some of the patients justify the inclusion of salazosulphapyridine into the group of drugs which modify the course of the disease. The results of hitherto made investigations confirmed also a relatively good tolerance of salazosulphapyridine.
In the submitted review the authors present some new findings and approaches pertaining to the pathogenesis of rheumatoid arthritis (RA). First they describe cells participating in the development of the articular inflammation and mediators which transmit signals between these cells and which may lead to their activation. The authors mention the immune complex role of rheumatoid factors and some new theories on their development. They describe effector substances directly responsible for the resulting damage and emphasize their final role in the entire cycle preceding the inflammatory reaction in which lymphocytes, macrophages, polymorphonuclear leucocytes and dendritic cells participate. The possible role of viruses in the aetiology of RA is also mentioned. In the conclusion the authors present the sequence of mechanisms which lead to the development and maintenance of the chronic inflammatory reaction which develops probably on the background of the persisting autologous mixed lymphocytic reaction.
The authors describe a case of plasmocytic myeloma complicated by the development of systemic amyloidosis. The symptoms were dominated by marked macroglossia and arthropathy which by the objective finding and subjective manifestations imitated rheumatoid arthritis. In the discussion the authors emphasize general manifestations of amyloid arthropathy.
In a brief review the authors present findings on osteoarthritis, a heterogeneous disease with a multifactorial pathogenesis. Knowledge of morphological and biochemical changes of cartilage are the basis for reflections on the perspectives of basal treatment of this disease, i.e. treatment which will arrest progression of pathological changes. Influencing of the enzymatic degradation of cartilage, some cytokines and the inflammatory process are at the contemporary state of knowledge the only target processes which could be affected by treatment and which could lead to a fundamental modification of tissue changes in osteoarthritis.
In a double blind study with hydroxychloroquine sulphate used for treatment of rheumatoid arthritis the correlation of six X-ray criteria of progression of RA, based on calculation of the narrowing of the articular spaces and erosions (Sharp and Amos) and 23 clinical and laboratory criteria was assessed. Before treatment a satisfactory correlation of the majority of clinical and laboratory criteria with X-ray criteria was found. As after one-year treatment the majority of clinical criteria improved significantly and X-ray criteria did not differ significantly before and after treatment, the authors found very few correlations between changes of clinical and X-ray criteria, in particular after a dose of 20 mg/day. The X-ray criteria recommended by Sharp and Amos are not sensitive enough to be used for the evaluation of changes of the X-ray picture after one-year treatment with anti-rheumatic drugs which modify the course of RA. This applies in particular to more advanced cases.
The purpose was to assemble experience with the treatment of rheumatoid arthritis with fish oil and to compare the results with reports from abroad. The investigated group comprised 10 women who suffered from confirmed RA. The patients were treated by nonsteroid antirheumatic drugs. During the trial processed fish oil [Martens'oil], 10 g/day was added. The tolerance of the preparation was good. The investigation period lasted three months. After one-month intervals laboratory and clinical indicators of the activity of the disease were investigated and compared with baseline values before treatment. All investigated values improved, however, only some significantly: the level of C-reactive proteon, pain on movement, the articular index, morning stiffness. The latex-fixation test was in all patients positive at the beginning and at the end of the investigation. Fish oil as a dietetic supplement of treatment with non-steroid anti-rheumatic drugs gives the patients subjective relief, the results of preliminary observations indicate the necessity of further, in particular double blind trials.
A controlled, double blind, parallel group, long term study of hydroxychloroquine sulphate in the treatment of rheumatoid arthritis, comparing daily doses of 200 mg and 400 mg, is described. The trial involved 54 patients with moderate disease activity who had not previously received antimalarial drugs. Forty three patients completed the one year treatment. The groups receiving different doses were homogeneous and did not differ in any of the 25 monitored indicators. Both dose regimens were effective, and a significant reduction of disease activity was observed after one year's treatment. Of the nine laboratory and 11 clinical indices of efficacy monitored, no statistically significant differences were reported, but in the group of patients treated with the 400 mg daily dose the number of side effects was three times greater. As there have been no reports of retinopathy with hydroxychloroquine at daily doses of 200 mg the effectiveness of this dose is of practical importance.
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Basing on the results of radiological, clinical and laboratory examinations of 200 children with juvenile rheumatoid arthritis, we tried to obtain a comprehensive picture of radiological changes in the joints, the spine and the remaining skeleton caused by JRA. The bulk of data was obtained in the period between 1954 and 1972, but for some of the patients, our follow-up continued until 1987. Our main interest were differences in morphological changes caused by JRA and adult RA. We described initial changes and their progress in childhood, adolescence and adulthood, drawing attention to fundamental differences in radiological changes and their progress in patients with an onset of disease in the first half of childhood (up to the age of 8) and in those with an onset in the second half of childhood, where these changes were similar already to those caused by adult RA. Juvenile rheumatoid arthritis affects mainly skeletal growth by either retarding or accelerating various ossification processes. The skeleton of children has a great regenerative capacity, but this, on the other hand, supports various disturbances of growth brought forth by disease. This, apparently, account for differences of changes in the skeleton of the joints observed in JRA patients during childhood and adulthood. Whenever a case is suspected of JRA, a radiological examination of the joints involved ought to be complemented by a radiological examination of the hands because most of our radiographs showed structural changes in the hands. Particular attention should also be given to the knees and hips of children with active disease over a period of 3-6 years. Synostosis of arches and joints of the cervical spine, a typical feature of JRA, was observed in 20-25% of former JRA patients. Synostoses occurred either in the individual segments or in the whole cervical spine, but were never absent at the level of vertebral bodies C2-C3. There were neither objective nor subjective complaints.
In the submitted review the authors summarize briefly knowledge on the mechanism of action of chondroprotective substances and the present state of their use in clinical practice. The authors mention also the chondroprotective action of some non-steroid anti-rheumatic drugs.
The authors tested the therapeutic effectiveness and tolerance of the sulphonamide chemotherapeutic preparation sulfasalazine in 69 patients with active rheumatoid arthritis. A one-year open clinical investigation was completed by 41 patients (59%) where in the course of treatment significant improvement of the majority of clinical and laboratory indicators of the activity of the rheumatic process was recorded. Treatment was terminated prematurely by 28 patients (41%) incl. 16 (23%) where treatment was discontinued because of undesirable side-effects which developed most frequently during the first months of treatment and were not very serious. X-ray evaluation of the joints of the hands after a one-year interval did not reveal deterioration of the X-ray findings in patients who completed the course of treatment.
We describe a woman who suffered for several years from joint pain with subsequent development of arthritis of her left knee. Because of these symptoms she was subjected to repeated studies including arthroscopy and menisectomy. IgG antibodies to Borrelia determined by ELISA were reported to be present and showed an increase of IgG titer to 1:1024. Histology from the last synovial biopsy disclosed only evidence of a nonspecific synovitis and marked inflammatory infiltration with lymphocytes and plasma cells. Borrelia-like structures were detected electron microscopically on semithin Epon sections from the lumen of the strongly infiltrated blood capillary. In our case the detection of Borrelia indicated the basis for increase of antibodies against Borreliae. It established the correct diagnosis and led to specific therapy of the disease after several years of unsuccessful attempts to control it.
A histotopographic study of lumbar spine was made in 27 deceased of the age of 2 to 85 years lacking of any spinal clinical symptomatology. Regressive changes were found in all the intervertebral disks except in infants. A central necrosis was present in 26 cases and pericentral striped necrosis in 19 cases. Other disks showed consequences of necrosis--vascularization, scarring, regenerative proliferation of chondrocytes, ganglion type cavities. A concept of disk lesion as a trigger of further spinal lesions was supported by frequent regressive changes of the disks. Schmorl's (internal) nodes were found in 35 cases, quite often in young persons without clinical symptomatology. The amount of glycosaminoglycans during the disk regression was detected by Safranin O-Fast Green stain with ambiguous results. A hypothetical spontaneous vanishing of the nucleus pulposus in accordance with the age was a topic of discussion. Protrusions of the disks into the spinal canal were not found. Initial osteophytes at ventral margins of vertebral bodies were identified in 49 cases, at dorsal margins in only 3 cases.
60 type MOTORLET knee joint endoprostheses are evaluated in this paper. Endoprostheses were implanted in the years 1984-1986 to 51 patients with rheumatoid arthritis and osteoarthrosis of the knee joint. EULAR knee project questionnaire was used to evaluate the results. In 72% of patients the pain completely disappeared both at rest and in movement. The average range of movement, ability to walk and knee joint stability were significantly improved, with highly favourable evaluation in 90% of operated patients. All parameters were compared with the results of 1569 knee joint operations evaluated within the range of EULAR knee project. At the same follow-up period the endoprosthesis type MOTORLET has been comparable to other widely used knee joint replacements.
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