Serum aminoterminal type III procollagen peptide in early rheumatoid arthritis: relation to disease activity and progression of joint damage

Serum levels of the aminoterminal type III procollagen peptide (S-PIIINP) have been used as markers of proliferative inflammation in rheumatoid arthritis (RA) and a prognostic significance has been suggested. To test this further we have measured S-PIIINP longitudinally for 2 years in 66 patients with definite RA and a disease duration of less than 2 years, and related the levels to clinical, biochemical, and radiographic findings. In this patient group the correlations between S-PIIINP and ESR and CRP, respectively, were higher than those obtained between S-PIIINP and articular indices, and markedly higher than in patients with RA of longer duration. Patients with normal mean levels of S-PIIINP during the study period had a significantly slower rate of radiographic progression than patients with elevated mean levels of S-PIIINP. ESR yielded in general higher correlations with the joint damage process than did S-PIIINP. The correlations between S-PIIINP and the joint damage scores increased with time. A multiple regression analysis showed that ESR explained most of the variance in joint damage progression over 2 years, but S-PIIINP added independent information. About one third of the variance could be explained by the two variables.

[TMJ morphology after condylar dislocation fractures in childhood]

In a CT- and NMR-study, condylar remodeling after conservative treatment of condylar dislocation fractures in growing individuals was evaluated. The regenerated condyles displayed great similarities. Two condylar parts could be differentiated--one with and one without muscular attachment. The medial part represents the former small fragment and the lateral part a bony outgrowth. One of the patients studied demonstrated a bifid condyle. NMR-records were remarkable in that each of the three patients presented a lateral pterygoid muscle with the two heads oriented one above the other rather than side by side. This does not seem to support the observation made in experiments, that the disc remains fixed to the caput in low condylar fractures.

HC-IgA antibodies of different specificities are normally present in serum: quantitation by ELISA and relationship to the major Ig classes

Enzyme-linked immunosorbent assays (ELISA) were developed for direct measurement of protein HC-IgA complexes (HC-IgA) in serum with antibody specificity for rabbit IgG (rheumatoid factor (RF) activity), lipopolysaccharide from Yersinia enterocolitica serotype O:3 (Y3) and tetanus toxoid (TT). About 80% of patients with rheumatoid arthritis had increased concentrations of HC-IgA-RF. The values were correlated with the concentrations of IgA-RF and IgM-RF. HC-IgA anti-Y3 was measured in 45 sera with anti-Y3 antibodies of IgM, IgG and IgA class. The HC-IgA anti-Y3 levels were correlated with those of anti-Y3 of IgG and IgM class, but not of IgA class. For HC-IgA anti-Y3, the closest correlation was that with the specific IgM antibody concentration, rs = 0.63 (p less than 0.001). In 25 normal sera, significant correlations were observed between HC-IgA anti-TT and specific antibodies of IgG and IgA class, but not of IgM class. In 107 sera containing IgA M-components, the total concentration of HC-IgA correlated poorly with both protein HC and with IgA concentrations. It was concluded that specific HC-IgA antibodies are normal constituents of serum, and that their concentrations are not directly related to the serum content of specific IgA antibodies.

[Short- and long-term results of tuberculosis therapy with a fixed combination of isoniazide, prothionamide and diaminodiphenylsulfone combined with rifampicin]

This is a report on 912 patients treated during 1973 to 1979 for pulmonary tuberculosis and/or extrapulmonary organ involvement. These patients had been treated with a fixed tablet combination of isoniacide, prothionamide and diaphenyl sulfone in association with rifampicin and partly other substances. It was the aim of our study to examine this form of therapy in respect of side effects and effectivity. 535 of these 912 patients were followed up for as long as 13 years (maximum follow-up period). According to the criteria of the American Tuberculosis and Respiratory Diseases Association the patients were suffering from 182 cases of pulmonary tuberculosis of only slight extension, 490 of moderate extension and 130 of large extension, as well as 55 cases of pleuritis, 67 extrapulmonary organ tuberculoses and 1 tuberculosis of the bronchial mucosa. Allergic skin reactions occurred in 0.7% of the cases, and in 0.9% there were neurological disturbances such as vertigo, paroxysms and polyneuropathies. In 7.4% of the patients there was an increase in serum enzyme activities of SGOT, SGPT, Y-GT as a sign of hepatotoxicity. In 5.5% of the patients there were several gastrointestinal concomitant phenomena such as sensation of fullness, nausea, and vomiting. Under IPD therapy the hemoglobin valuedropped on the average by 12% up to the 5th or 6th week of treatment and rose subsequently to almost normal levels. No permanent damage was seen in any of the patients under observation. In the moderately extended tuberculosis cases disinfection occurred on the average between the 6th and 8th week of treatment, in the greatly extended cases on the average in the 9th to 13th week.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of suspected inflammatory joint disease with a new simple self-administered hand test

A self-administered hand test was used to screen 5262 persons aged 40-70 living in a rural district in southern Sweden. It revealed evidence of hand impairment in 13%. The prevalence of RA was 1.1%. At the screening procedure a subgroup of 48 previously unrecognized individuals with inflammatory joint disease was identified. They were assessed by a rheumatologist, who established the following diagnoses: four definite RA, eight probable RA, three psoriatic arthritis, one unclassifiable arthritis, 10 osteoarthritis and 22 non-specific arthralgia. No advanced RA was detected. Two were seropositive and another was erosive. One with RA, one with psoriatic arthritis and three with arthralgic symptoms were unable to work. Most had only a minor need for further medical aid. The test was thus able to identify persons with hand impairment. Follow-up studies will address the practical implications of the screening procedure.

Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire

The validity and reliability under Swedish conditions of a translated and slightly modified version of the Stanford Health Assessment Questionnaire (HAQ), referred to here as the ADL questionnaire, was studied. Sixty-four patients with definite/classical rheumatoid arthritis (RA) participated in the major part of the investigation. In addition, inter-observer reliability was studied in the testing of 15 other patients with RA. The questionnaire was filled in by the patients twice (ADL Tests 1 and 2) with a one-week interval between. A physiotherapist or occupational therapist also assessed each of the patients on a sample of ADL functions (ADL Test 3). Joint mobility, grip-strength, pain, Ritchie index and ESR were likewise checked. Results indicated inter-observer reliability to be high for the ADL (r(S) = 0.98), for joint mobility (r(S) = 0.86), and for the Ritchie index (r(S) = 0.83). The test-retest reliability for the ADL questionnaire which the patients filled in (Tests 1 and 2) was high r(S) = 0.91. Results of the ADL questionnaires the patients completed were found to correlate fairly closely with the observations of the therapists, r(S) = 0.71. The validity of the scoring system was found to be sufficient, using Ward's cluster analysis for comparing the original HAQ scores with scores on all the questions included in the questionnaire. Thus, the translated and somewhat modified version of the ADL questionnaire studied here appears to possess a high degree of reliability and validity in assessing patients with RA.

Prognosis in juvenile rheumatoid arthritis with systemic onset. A follow-up study

Thirty-three patients with systemic onset JRA were followed up for 4 to 24 years (median 10 years). None had positive RF or ANA. Most patients developed polyarthritis. Cardiac involvement occurred in 14 patients (42%). Cardiac prognosis was good for pericarditis but seemed to be worse for myocarditis or perimyocarditis. Three patients contracted renal amyloidosis (9%). Severe growth retardation was observed in 39 per cent. Half of the patients had low activity or were in remission after in average 5.9 years' duration of the disease. Seventy per cent of the patients were in a good functional state. Patients with less than average radiological progression during the first 5 years of disease and those with onset of disease after the age of 5, seemed to have a better functional prognosis.