Anders Bjelle

Content and Composition of Glycosaminoglycans in Human Knee Joint Cartilage: Variation with Site and Age in Adults

The content and composition of the matrix of human articular cartilage from two sites - the condylar summits and the upper, posterior surfaces of both lateral and medial sides - of the lower femoral epiphysis of 12 autopsy cases (age 18-46 years) were analyzed. A significantly higher content of both chondroitin sulphate and especially of keratan sulphate was found in cartilage of the condylar summits. The solubility profile of keratan sulphate showed changes indicating a difference between the metabolism of cartilage of the two sites. No significant change with side (medial or lateral) was found. A small decrease in the chondroitin sulphate to keratan sulphate ratio without change in the total amount of hexosamines with age was found on the caudal condylar summits in these adult individuals below the age of 50.

HLA B27 in the population of northern Sweden

The frequency of HLA B27 in blood donors born in northern Sweden was found to be 16.6%. This was significantly higher than in southern Sweden or in caucasians generally, with the exception of Finland. A close genetic relationship has been found between the population of northern Sweden and the Finnish. The higher frequency of HLA B27 is particularly interesting in view of the finding of a higher incidence of rheumatic diseases in northern than in southern Sweden. We also found a surprisingly large number of patients with reactive arthritides and ankylosing spondylitis in the patient registers of the rheumatology department, which further indicated a genetic influence on rheumatic disorders in northern Sweden.

Constitutional Variations of Acidic Glycosaminoglycans in Normal and Arthritic BO Vine Articular Cartilage Proteoglycans at Different Ages

Proteoglycans extracted from normal and arthritic bovine articular cartilage of various ages were fractionated and purified under associative and dissociative conditions. After proteolytic digestion, the composition of the acidic glycosaminoglycans (AGAG) in the proteoglycans was determined enzymatically by digestion with chondroitinase-AC II, chondroitinase-ABC, Streptomyces, hyaluronidase and keratanase. Under both associative and dissociative conditions, uniform distribution of chondroitin sulfate (CS) isomers from proteoglycans of different ages was observed: With increasing age, the relative proportion of 4-sulfated disaccharide units in total AGAG decreased, whereas that of 6-sulfated disaccharide units increased. The relative proportion of 4-sulfated disaccharide units in total CS and the ratio of 4-sulfated disaccharide units to 6-sulfated disaccharide units were greater in arthritic cartilages than in normal cartilages of the same ages. At all three ages studied, the relative proportion of 4-sulfated disaccharide units in sequential fractions increased with the decrease of cesium chloride (CsC1) density, as the proportion of 6-sulfated disaccharide units decreased. The relative proportions of hyaluronic acid (HA) and keratan sulfate (KS) increased with age. The AGAG components of cartilage proteoglycans were distributed with a certain regularity in the fractions of CsCl density gradients, but underwent changes with increasing age and in arthritic process.

Regional Distribution of Rheumatic Complaints in Sweden

Regional differences regarding prevalence of rheumatic complaints were found in a nation-wide interview survey of the adult Swedish population. A higher prevalence was found in regions of low population density, the highest being in the North. Osteo-arthritis was more prevalent in Northern Sweden, particularly among men, while back disorders were more common in all regions of low population density. Physically strenuous working conditions were found more frequently in all regions of low population density. Among other possible factors contributing to the regional differences in rheumatic complaints, genetic differences in HLA B27 within the Swedish population and the occurrence of cryophilic arthritogenic microbial flora, are discussed.

Molecular Weight Distribution of Hyaluronic Acid of Human Synovial Fluid in Rheumatic Diseases

New methods to isolate and characterize the molecular weight distribution of hyaluronic acid have been applied to human synovial fluids from arthritic patients. Considerable variations in molecular weight distribution were found between the individual fluids. These methods facilitate a detailed characterization of hyaluronic acid--a prerequisite for understanding the role of hyaluronic acid for normal joint function and to evaluate the therapeutic use of local application in joint diseases.

Eosinophilic fasciitis. Review and report of six cases.

Six patients with eosinophilic fasciitis are presented. This syndrome is characterized by indurative swellings of arms and legs, with rapidly progressing difficulties in extending elbows, wrists, and fingers, and often limited motion of shoulders and ankle joints. Pain when contracting muscles, and weakness of proximal muscles and hand grip are common features. The frequent occurrence of localized skin lesions has presented differential diagnostic difficulties to systemic sclerosis and to polymyositis. Visceral involvement and Raynauds phenomena, however, are absent or mild. Blood eosinophilia, hypergammaglobulinemia, and unspecific signs of inflammation are found. Biopsy of muscle fascia gives characteristic histopathological findings of cell infiltrations (mostly mononuclear cells, frequently eosinophils) and vascular proliferation, in the middle layer of a thickened fascia. Skin changes are prevalent, but not conclusive for the diagnosis, and myositis in some patients might be difficult to distinguish from polymyositis. The importance of the clinical recognition of eosinophilic fasciitis and the inclusion of fascia in diagnostic muscle biopsies, is underlined.

Polymyositis in Eosinophilic Fasciitis

A patient with typical clinical, laboratory and biopsy findings of eosinophilic fasciitis and fulfilling criteria for myositis is reported. Muscular involvement in eosinophilic fasciitis is reviewed a

Rheumatic Disorders in Primary Care: A Study of Two Primary Care Centres and a Review of Previous Swedish Reports on Primary Care

Utilization of care for rheumatic disorders was studied in two primary care units. In both units 12% of visits concerned some form of rheumatic disease. This diagnostic group (chapter XIII of ICD) ranked third after cardiovascular and respiratory diseases. The total number of visits per inhabitant was higher for all diagnoses, as well as for the rheumatic disorders, in the most remote primary care unit. The distribution of rheumatic diagnoses was similar in the two units. Back disorders were most frequent among men, whereas soft tissue rheumatism and back disorders each accounted for one-third of the cases among women. Inflammatory rheumatic diseases and osteo-arthritis played only a minor part. Visits due to rheumatic disorders decreased after retirement age, particularly among men. The findings were representative of primary care in rural areas of Sweden. Only 20% of referrals from primary care to the rheumatology department gave a tentative diagnosis and half of these suggestions were changed after examination. The majority of referred patients without any suggested diagnosis suffered from soft tissue rheumatism or inflammatory rheumatic disorders other than rheumatoid arthritis.

The Cytology of Joint Exudates in Rheumatoid Arthritis: Morphology and Preparation Techniques

The cytology of joint exudates from patients with rheumatoid arthritis was examined by preparation of air-dried smears; a procedure that involved cytocentrifugation of synovial fluids following dilution in a balanced salt solution containing albumin. This procedure provided a monolayer of homogeneously distributed exudate cells with excellent preservation of morphological details. The dominant cell type in the exudates was polymorphonuclear leukocytes, often with signs of necrobiosis. The small and medium-sized mononuclear cells were lymphocyte-like and vital-looking. The large mononuclear cells displayed signs of extensive phagocytosis, especially phagocytosis of polymorphonuclear leukocytes. It is suggested that the granulocytes of the synovial fluid are cells which have reached their function compartment, where they work and die.

Proteoglycans of Articular Cartilage From Bovine Lower Femoral Epiphysis: Extraction and Characterisation of Proteoglycans From Two Sites Within the Same Joint

Bovine articular cartilages from two sites within the lower femoral epiphysis were extracted with GuHCl and purified by CsCl density gradient centrifugation in two steps as described by Hascall and Sajdera1,2. Ninety per cent of the hexosamine containing material was extracted with 4 M GuHCl. The gel chromatographic properties of PGC and of PGS showed no or minor differences between the two sites. The amino acid, neutral sugar, uronic acid and hexosamine compositions were the same for the cartilage from the two sites.