Evaluation of renal function in patients with rheumatoid arthritis and amyloidosis.
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Adolescent↗
Biomedical subjects
M Kauppi
Publications and source records attributed to M Kauppi.
The cervical spine in mutilant juvenile chronic arthritis.
OBJECTIVE: To describe inflammatory cervical spine disorders in juvenile chronic arthritis (JCA) patients with arthritis mutilans (AM) hand deformity. METHODS: The series consisted of 18 patients affected by AM hand deformity who fulfilled the European League of Associations for Rheumatology criteria for JCA. The patient records and the most recent cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI) and apophyseal joint ankylosis. RESULTS: Seventeen (94%) patients had subluxation, AAI or apophyseal joint ankylosis in the cervical spine. Apophyseal joint ankylosis was noted in 12 (67%) patients and AAI in 10 (56%). Anterior atlantoaxial subluxation was detected in five (28%) patients. CONCLUSION: Almost all of the JCA patients with AM hand deformity evinced some inflammatory changes in the cervical spine. Apophyseal joint ankylosis, AAI and multiplicity of changes in cervical spine may be considered characteristic in this subset of JCA patients. Patients with JCA and AM hand deformity tend to have severe changes also in the cervical spine.
Adolescent↗
Mortality associated with cervical spine disorders: a population-based study of 1666 patients with rheumatoid arthritis who died in Finland in 1989.
OBJECTIVE: To evaluate the mortality associated with cervical spine deformities in rheumatoid arthritis (RA) based on national data. METHODS: The role of rheumatoid disorders of the cervical spine as a cause of death was studied in 1666 subjects who died in Finland in 1989 and had been entitled under the national sickness insurance scheme to receive reimbursed medication for RA. Death certificates and certificates for drug reimbursement of these 1666 patients and the clinical files of 853 patients were examined for the mention of cervical spine disorders. Thereafter, the cervical spine radiographs and detailed clinical histories of patients with diagnosed cervical spine disorder were evaluated separately. RESULTS: According to the official death certificates, cervical spine disorder was not an underlying, contributory or immediate cause of death in any of these patients. Cervical spine abnormalities had been diagnosed only in 38/853 (4.5%) patients. Cervical spine radiographs from 33 patients were available for examination, and in 17 patients cervical spine deformities were found to be severe enough to be a potential cause of fatal complications. Among these 17 cases, four sudden and four postoperative deaths were recorded (one after cervical spine operation) and three patients were suffering from quadriparesis or paraparesis at the time of death. Among the other 16 patients with cervical spine radiographs, the cervical deformities were less severe and their death histories differed from those of the group with more severe deformities. CONCLUSIONS: Cervical spine disorders in RA should be diagnosed early and treated actively to prevent severe and potentially fatal complications. Deaths caused by these disorders are rare, but they should be remembered when the death certificates are written.
Adult↗
Exocrine dysfunction of the pancreas in patients with chronic polyarthritis.
We studied the extent to which exocrine dysfunction of the pancreas is seen among patients with severe chronic polyarthritis and whether it might account for some gastrointestinal symptoms. Our series consisted of 50 such chronic polyarthritis cases; most had rheumatoid arthritis but had neither diagnosed or suspected pancreatitis nor primary Sjögren's syndrome. They were asked about gastrointestinal (GI) and sicca symptoms. The exocrine function of each pancreas was evaluated by the fecal elastase-1-enzyme test. Thirty-two patients had GI symptoms at least weekly. Forty had sicca eye syndrome and 26 had dry mouth. There were two cases (4%; 95% confidence interval, 1-14%) with abnormally low fecal elastase-1-enzyme test level. Chronic GI and sicca symptoms are frequent among patients with severe chronic polyarthritis. Secondary Sjögren's syndrome may cause exocrine insufficiency in the pancreas. That circumstance was not common here, but it is worth remembering because it can be diagnosed by a noninvasive method, and enzyme preparation treatment is available for the symptoms, especially for postprandial pain and distention of the stomach.
Journal Article↗
Effect of daily corticosteroid treatment on CRP response to hip or knee replacement in patients with RA.
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Anti-Inflammatory Agents↗
Rise in serum C reactive protein after hip and knee arthroplasties in patients with rheumatoid arthritis.
OBJECTIVE: Serum C reactive protein (CRP) concentration was evaluated in patients with rheumatoid arthritis (RA) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) to ascertain the postoperative CRP response. METHODS: Thirty seven consecutive patients with RA who had undergone THA or TKA were included in the study. The CRP concentration was measured in every patient once preoperatively and every other day for one week postoperatively. RESULTS: The peak median CRP concentration (94 mg/l) was achieved on the first and second day postoperatively and was seven times higher than the median preoperative concentration (13 mg/l). CRP declined to the preoperative concentration in about one week. The rise of the CRP concentration was significant (p< 0.001). No infection was encountered in this series. CONCLUSION: A rapid rise in the postoperative CRP concentration is normal in patients with RA treated by THA or TKA. The CRP concentration decreases to the preoperative value in about one week. Serial CRP measurements, including at least one preoperative measurement, are needed when the clinical significance of the postoperative CRP values is evaluated. When the postoperative CRP concentration remains raised for several days compared with the preoperative value, or even rises, it may indicate the presence of a complication in these patients.
Adult↗
Type I collagen degradation does not diminish with RA disease duration.
OBJECTIVE: To assess the relation between type I collagen degradation and the duration of rheumatoid arthritis (RA). METHODS: The serum concentrations of cross linked carboxyterminal telopeptide of type I collagen (ICTP) measured earlier in a community based series (90 patients) and a hospital based series (59 patients) were re-evaluated with reference to the duration of RA. RESULTS: The serum ICTP showed a positive correlation with the duration of the disease in the hospital based series (r(s)=0.40, p<0.01) but not in the community based one (r(s)=0.18, p=0.10). CONCLUSIONS: Type I collagen degradation predominantly reflecting pathological bone destruction does not seem to diminish in longlasting RA.
Arthritis, Rheumatoid↗
Munc18-2, a functional partner of syntaxin 3, controls apical membrane trafficking in epithelial cells.
The Sec1-related proteins bind to syntaxin family t-SNAREs with high affinity, thus controlling the interaction of syntaxins with their cognate SNARE partners. Munc18-2 is a Sec1 homologue enriched in epithelial cells and forms a complex with syntaxin 3, a t-SNARE localized to the apical plasma membrane. We generated here a set of Munc18-2 point mutants with substitutions in conserved amino acid residues. The mutants displayed a spectrum of different syntaxin binding efficiencies. The in vitro and in vivo binding patterns were highly similar, and the association of the Munc18-2 variants with syntaxin 3 correlated well with their ability to displace SNAP-23 from syntaxin 3 complexes when overexpressed in Caco-2 cells. Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment. Overexpression of the wild-type Munc18-2 was shown to inhibit the apical delivery of influenza virus hemagglutinin (HA). Interestingly, mutants unable to bind syntaxin 3 behaved differently in the HA transport assay. While one of the mutants tested had no effect, one inhibited and one enhanced the apical transport of HA. This implies that Munc18-2 function in apical membrane trafficking involves aspects independent of the syntaxin 3 interaction.
Amino Acid Sequence↗
Evaluation of the Finnish versions of the functional indices BASFI and DFI in spondylarthropathy.
The aim of the study was to compare and evaluate the usefulness of Finnish versions of two functional indices used in spondylarthropathies. Seventy consecutive inpatients with different kinds of spondylarthropathies filled in self-administered questionnaires: the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index for spondylarthropathies (DFI). Cronbach's alpha as a coefficient of internal consistency was analysed for BASFI and DFI. Test-retest reliability was evaluated in 30 patients. For validity the functional indices were compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), spinal movement measures of chest expansion (CE), Schober S1 test and occiput-to-wall distance (OWD), and radiological changes in the lumbar spine (RTGLS) and sacroiliac joints (RTGSI). The reproducibility of the indices BASFI and DFI was good; the intraclass correlation coefficient (ICC) for reliability was 0.99 and 0.98, and the coefficient of internal consistency (Cronbach's alpha) was 0.94 for both BASFI and DFI. The functional indices correlated well with each other, r = 0.85 (95% CI 0.78-0.90). Validity in terms of correlation coefficients between disease activity index BASDAI and functional indices BASFI and DFI was 0.74 (95% CI 0.60-0.84) and 0.69 (95% CI 0.53-0.80), respectively. BASFI and DFI correlated with spinal mobility measurements and RTGLS, but DFI did not correlate with RTGSI. Neither BASFI nor DFI correlated with ESR and disease duration, and only DFI correlated with age. In conclusion, BASFI and DFI are reliable and valid for Finnish inpatients with spondylarthropathies. It is important to know that cultural differences do not reduce the usefulness of these indices.
Adult↗
Prevalence of radiological changes in the cervical spine--a cross sectional study after 20 years from presentation of rheumatoid arthritis.
OBJECTIVE: To evaluate the prevalence of cervical spine changes in patients with rheumatoid factor (RF) positive rheumatoid arthritis (RA) followed prospectively for 20 years. METHODS: An inception cohort of 103 patients with RF positive RA have been followed at the Rheumatism Foundation Hospital, Heinola. A total of 68 patients attended for the 20 year followup. An additional 28 patients died and 7 were not able to attend due to severe disease or old age. The plain cervical spine radiographs of 69 patients (68 and one received from another hospital) taken after 20 years of RA were evaluated. RESULTS: Anterior atlantoaxial subluxation was found in 16 cases (23%), while 18 patients (26%) had atlantoaxial impaction as judged by the Sakaguchi-Kauppi method. Subaxial subluxations and lateral atlantoaxial subluxations were found in 13 cases (19%) and 3/52 cases (6%), respectively, while 45 patients (65%) had subaxial disc space narrowing. CONCLUSION: Cervical spine changes are common in patients with long lasting RA. They should be diagnosed and treated early to avoid complications. In our patient group no cervical spine surgery was performed, but at least 7 patients (10%) required further evaluation for possible surgery.
Adolescent↗
Sensitivity to change of mobility tests; effect of short term intensive physiotherapy and exercise on spinal, hip, and shoulder measurements in spondyloarthropathy.
OBJECTIVE: To assess the sensitivity to change of 13 spinal, shoulder, and hip measurements and determine correlation between age, disease duration, and radiologic findings in ankylosing spondylitis (AS) and other spondyloarthropathies (SpA). METHODS: We assessed 112 patients with various types of SpA as changes before and after an intensive inpatient course. RESULTS: The most sensitive spinal measurements were finger to floor distance, chest expansion. thoracolumbar rotation (TLR), and lateral flexion, in that order. Cervical rotation, lateral flexion, and intermalleolar distance might also be useful in short term clinical trials, while the Schober tests, thoracolumbar flexion, and occiput-wall distance were not sufficiently sensitive. Hip internal rotation (HRi), shoulder flexion, and abduction measurements were also sensitive, though possibly more suitable for patients with articular symptoms. TLR and HRi were the only measurements that correlated markedly with disease duration, but not with age. Changes in the measurements correlated significantly with radiological spinal changes. CONCLUSION: Finger to floor distance, TLR, and thoracolumbar lateral flexion were the most sensitive to detect improvements in short term clinical trials, while the Schober test, thoracolumbar flexion, and occiput-wall distance were insensitive.
Adult↗
Does improved spinal mobility correlate with functional changes in spondyloarthropathy after short term physical therapy?
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Adult↗
Headmaster collar restricts rheumatoid atlantoaxial subluxation.
STUDY DESIGN: A radiographic study of the effect of a modern orthotic device in the treatment of rheumatoid atlantoaxial subluxation. OBJECTIVE: To study the ability of a new open-type collar to restrict atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA: Atlantoaxial subluxation is common in rheumatoid arthritis, and thus, the development of conservative treatments is important. It has been shown that a custom-made stiff collar significantly restricts atlantoaxial subluxation in approximately half of patients with unstable atlantoaxial subluxation. METHODS: In 30 successive patients with rheumatoid atlantoaxial subluxation, lateral view radiographs were taken in flexion, extension, and neutral positions without a collar and in flexion with the Headmaster collar. RESULTS: The mean atlantoaxial distance during flexion was 7.1 +/- 1.8 mm and during extension was 1.0 +/- 1.0 mm, and the mean instability was 6.1 +/- 2.3 mm. In the 20 cases with the greatest stabilizing effect, the mean atlantoaxial distance during flexion with a collar was 1.1 +/- 1.3 mm, whereas in 10 patients with lesser effect it was 6.7 +/- 2.5 mm (P < 0.0001). The lesser stabilizing effect was associated with the presence of atlantoaxial subluxation in the neutral position. CONCLUSION: The Headmaster collar is an effective and useful tool in the conservative treatment of simple unstable atlantoaxial subluxation, but an ordinary custom-made stiff collar is still often needed. These two collars are complementary, and their selection and use must be determined individually.
Arthritis, Rheumatoid↗
ABO and Rh blood group distribution in seropositive rheumatoid arthritis.
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ABO Blood-Group System↗
The value of synovial fluid analysis in the assessment of knee joint destruction in arthritis in a three year follow up study.
OBJECTIVES: To assess the predictive significance of synovial fluid (SF) analysis for progressive radiological knee joint destruction in arthritis. METHODS: Altogether 55 patients with arthritis and knee joint effusion were included in the study. The diagnosis was rheumatoid arthritis (RA) for 44 of them, chronic seronegative spondylarthropathy for seven and juvenile rheumatoid arthritis for four. The mean age of the patients was 51.8 (SD 14.9, range 19-82) years, and the mean duration of disease 10.9 (SD 9.2, range 0.5-37) years. In addition to the routine laboratory tests, different markers of collagen synthesis and breakdown in serum and SF were assessed. The radiological grade of the knee joint was assessed by Larsen's method at the baseline and after a three year follow up. RESULTS: During the follow up, Larsen's grade deteriorated in 22 (40%) patients. These patients had a significantly higher median level of cross linked carboxyterminal telopeptide of type I collagen (ICTP) in SF at entry than those who had a stable index (p = 0.035). Serum ICTP did not have any predictive value for a specific joint. The median levels of total SF leucocytes (p = 0.012) and the subgroup of polymorphonuclear leucocytes (p = 0.018) were higher in the patients with a stable Larsen's index. However, the relation of SF leucocyte level to radiological progression could not be confirmed in the RA group. CONCLUSION: It is concluded that SF analysis may help in the identification of patients with inflammatory arthritis who are at risk for progressive destruction in a particular joint. A high total SF leucocyte level is not necessarily associated with a poor prognosis. Instead, a high SF ICTP level seems to reflect accelerated bone degradation.
Adult↗
Serum C-reactive protein is rarely lost into urine in patients with secondary amyloidosis and proteinuria.
We studied whether the low serum C-reactive protein (S-CRP) level in patients with inflammatory arthritis and proteinuria was due to the loss of CRP into urine. In 19 patients with secondary amyloidosis (14 with rheumatoid arthritis and five with juvenile chronic arthritis), S-CRP was measured with both immunoturbidimetric and radioimmunoassays. The concentration of urinary CRP was measured with a double-antibody radioimmunoassay. One patient with the most extensive proteinuria (12 g/24 h) excreted CRP at 14 mg/24 h, while in 18 of 19 patients only negligible, if any, amounts of CRP were found in 24-h urine samples. Proteinuria of < 8 g/24 h did not reduce the S-CRP level. Proteinuria exceeding this level may result in increased excretion of CRP into urine and consequently may result in a reduced S-CRP level.
Adolescent↗
Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases.
The value of lateral view cervical spine radiography in various positions of the neck was assessed in patients with rheumatoid atlantoaxial subluxation (AAS). We wanted to find out how much information is lost if only neutral position radiographs are used. The series consisted of 65 rheumatoid patients with unstable AAS. Lateral view cervical spine radiographs were taken in the neutral position and during flexion and extension. Neutral position radiographs would have failed to confirm the diagnosis of AAS in 31 cases (48%) and would have failed to record its true severity in 43 cases (66%); their diagnostic sensitivity was 52%. The sensitivity of the neutral radiographs in showing the reversibility of AAS was 48%. Routine cervical spine radiography of rheumatoid patients should include lateral view radiographs taken during flexion and extension. The result may be applied to magnetic resonance imaging, which is usually performed in the neutral position.
Arthritis, Rheumatoid↗
When does subluxation of the first carpometacarpal joint cause swan-neck deformity of the thumb in rheumatoid arthritis: a 20-year follow-up study.
The aim of our study was to assess the incidence of subluxation of the first carpometacarpal joint (CMC I) and to evaluate which degree of subluxation produces swan-neck deformity of the thumb in rheumatoid arthritis (RA) occurring over 20 years. The hands of 83 rheumatoid factor (RF)-positive RA patients with recent (< or = 6 months) arthritis were evaluated radiographically at onset and at 1, 3, 8 and 15 years; 68 patients were evaluated at 20 years from entry. Subluxation was assessed in millimetres and compared with the MCP-I angle measurement to evaluate the thumb deformity. A statistical end-point analysis was performed between two different grades of subluxation. Subluxation of 2-3 mm was non-specific and only one third of these thumbs showed swan-neck deformity. At the end-point, subluxation of > or = 4mm was present in 17% of the thumbs, 81% of which had the swan-neck deformity; only five thumbs did not show this deformity, but presented deformed and unstable MCP I and interphalangeal joints. The frequency of swan-neck deformity was highly significantly (p < 0.0001) increased in the thumbs with severe CMC I subluxation (> or = 4 mm) compared with lesser subluxation (< 4 mm). When subluxation of the CMC I exceeds 4 mm, the swan-neck deformity of the thumb is a common consequence. This deformity is often progressive, and the hand function of such patients should be followed up carefully, both clinically and radiographically.
Adult↗