H. Isomäki

Yersinia Antigens in Synovial-Fluid Cells from Patients with Reactive Arthritis

We examined synovial-fluid cells from 15 patients with reactive arthritis after yersinia infection for the presence of yersinia antigens. Extensive bacterial cultures of the synovial fluid were negative. All the samples were studied by immunofluorescence with use of a rabbit antiserum to Yersinia enterocolitica O:3 and a monoclonal antibody to Y. enterocolitica O:3 lipopolysaccharide. Synovial-fluid cells from 41 patients with other rheumatic diseases served as controls. Synovial-fluid cells from 10 patients with reactive arthritis after yersinia infection stained positively on immunofluorescence; rabbit antiserum and the monoclonal antibody yielded similar results. In most patients the percentage of positive cells ranged from 1 to 10 percent, but in one patient nearly all the cells in the sample stained strongly. Most of the positively stained cells were polymorphonuclear leukocytes, but yersinia antigens were also found in mononuclear phagocytes. All the control samples were negative. Synovial-fluid cell deposits from nine patients were also studied by Western blotting with use of the same antibodies. The results were positive in six of the nine cell deposits from patients with reactive arthritis and in none of the 10 cell deposits from control patients with rheumatoid arthritis. We conclude that in patients with reactive arthritis after yersinia infection, microbial antigens can be found in synovial-fluid cells from the affected joints.

Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis

Synovial cells from nine patients with reactive arthritis following Salmonella enteritidis or Salmonella typhimurium infection were examined for salmonella antigens. Extensive bacterial cultures of the synovial fluid were negative. Eight synovial-fluid cell samples stained positively on immunofluorescence with rabbit antisera against heat-killed S enteritidis or S typhimurium or with monoclonal antibodies specific for the causative salmonella lipopolysaccharide (LPS). Synovial tissue from the ninth patient stained positively in the avidin-biotin-peroxidase complex method with the monoclonal antibody. Control samples (synovial-fluid cells from thirteen patients with other rheumatic diseases and synovial tissue from two) were negative. Synovial cells from eight patients and five controls were studied by western blotting with the same monoclonal antibodies. Four of the eight patients but no controls had blots indicating salmonella LPS in the synovial cells. The presence of bacterial LPS in the joint is a common and pathogenetically important feature of reactive arthritis.

Incidence of Inflammatory Rheumatic Diseases in Finland

The incidence of inflammatory joint diseases was estimated by using two patient series. Firstly, the total yearly incidence of all such diseases together was estimated in a population of 15 600 persons of 16 years of age or older. Secondly, this overall incidence was divided by the ratio of different diseases obtained from a larger series of patients. The incidence of all inflammatory joint diseases was 218/100 000/year, 182 in males and 250 in females. The incidence was highest in middle age and lowest in old age. The incidence of ill-defined arthritides was five times that of definite rheumatoid arthritis in the youngest age group but in the oldest their frequencies were equal. In the whole population, the proportion of ill-defined arthritides was 2/5, of definite RA 1/5, of HL-A B27 associated diseases 1/5, and of other diseases 1/5 of the total incidence of inflammatory joint diseases. Because the frequency of HL-A B27 in all patients surveyed was about 40%, only half of the patients with this antigen showed a clinical picture of ankylosing spondylitis, Reiters disease, or reactive arthritis.

Pain intensity in patients with fibromyalgia and rheumatoid arthritis

Three times daily continuously during a three-week inpatient rehabilitation course a visual analogue scale (VAS) was used in the assessment of pain intensity in 20 female patients with primary fibromyalgia (PF) and 20 female patients with rheumatoid arthritis (RA). The pain intensity in PF patients was constantly twice as high as in RA patients. The effect of the rehabilitation course on pain intensity, as assessed by linear regression analysis, was significantly higher in RA than in PF (p < 0.001). In comparison of the first and the last two days, the pain intensity decreased significantly (P < 0.01) in RA, but not in PF. The patients with PF were more depressive than the RA patients, but a positive correlation between depression score and pain intensity was found only in RA patients. Depression was not able to explain the high pain intensity in PF patients. Continuous monitoring of pain by VAS seems to be a useful tool for assessing changes in pain intensity in patients with rheumatic disorders.

Amyloidosis – Incidence and Early Risk Factors in Patients with Rheumatoid Arthritis

In a 15-year follow-up examination, reactive secondary amyloidosis (RSA) was found by subcutaneous fat biopsy in six out of 74 still living patients (8.1%) of an original population of 102 with erosive and seropositive rheumatoid arthritis (RA). Five of the 24 deceased patients had had RSA. Thus the 15-year incidence of RSA in RA was at least 10.9% (11/102). To study early prognostic aspects of RSA, comparison was made of 14 entry variables and the initial treatment in the RSA group (n = 11) and the control group (n = 81) respectively. At onset (< or = 6 months) of RA only serum orosomucoid, but after three years morning stiffness, ESR, serum CRP and orosomucoid were significantly worse in patients whom later developed RSA. Three out of 48 patients treated with gold sodium thiomalate and seven out of 30 treated with chloroquine developed RSA (p = 0.04). It is concluded that continuously active disease was the risk factor underlying RSA. The role of early chloroquine therapy is discussed.

Prospect for an Additional Laboratory Criterion for Rheumatoid Arthritis

The aim of the study was to establish the benefit of an additional hypothetical laboratory criterion for rheumatoid arthritis (RA), comprising positivity for antikeratin antibody (AKA) and/or antiperinuclear factor (APF). The tests were applied to a series of 308 hospital patients with various recent-onset inflammatory joint diseases who were followed for 3 years. The performance of APF and AKA was compared with rheumatoid factor (RF). The most sensitive (.72) but the least specific (.86) test for RA was the latex test. The most specific (.96) but the least sensitive (.33) test was AKA. Waaler-Rose and APF were intermediate. AKA and/or APF positive patients had significantly more erosions than patients negative for these autoantibodies. Despite the impressive performance characteristics of APF and AKA, the actual classification impact achieved, as compared to using RF as the sole laboratory criterion, turned out to be moderate. This is because the criteria proved to be interrelated. Unlike RF, AKA and APF are not suited to the general laboratory, at least not in their present form. Moreover they so far lack the broad data base of RF.

Significance of rheumatoid factors in an eight-year longitudinal study on arthritis

SummaryA community-based cohort comprising 150 patients with recent-onset seropositive arthritis or seronegative oligoarthritis or polyarthritis was monitored for 8 years. Of the different rheumatoid factor (RF) tests, the initial positivity in the most sensitive assays (latex slide test and IgM-RF by enzyme immunoassay) was the most reliable factor when distinguishing between the erosive and nonerosive cases. The individual RF isotypes fluctuated in four serial specimens, but each patient tended to preserve his or her reactivity pattern. Seroconversion from positive to negative within the 1st year of follow-up did not indicate a particularly good long-term prognosis.

Predicting the outcome of rheumatoid arthritis. A Soviet-Finnish co-operative study.

The prognostically important signs and symptoms in the early stage of rheumatoid arthritis were studied in 136 patients selected and treated in Moscow and in 139 patients in Heinola, Finland. The follow-up time was 3 years. The outcome was poor in patients with early signs of radiological destruction in the joints, with rheumatoid factor in serum, with early functional disability or deficient flexion of the fingers, with multiple affliction of the finger, metatarsophalangeal or wrist joints, with marked morning stiffness, and with CRP in the serum. The age of the patients did not influence the outcome in Moscow, whereas in Heinola the mean age was higher in patients with a poor outcome. Despite the marked differences in the therapeutic methods and the outcome for patients, the prognostically important signs and symptoms were very similar in both centres.

Antibody to stratum corneum (antikeratin antibody) and antiperinuclear factor: markers for progressive rheumatoid arthritis

The purpose of this study was to examine the relationship between circulating antibodies to stratum corneum (AKA) and antiperinuclear factors (APF) on one hand, and the x-ray progression of joint damage in chronic poly/oligoarthritis on the other hand. The analysis involved 133 patients with either rheumatoid or nonspecific arthritis derived from a cohort of 442 patients with recent onset arthritis. The patients were followed up for eight years with regular clinical, laboratory, and radiological evaluations. Radiographic evidence of joint destruction was quantitated by a radiographic index based on the Larsen grading. AKA and APF were detected, either at entry or at follow-up, in 26 and 54 patients, respectively. Seventy-six of the 133 patients had developed erosions. All AKA-positive patients had a rheumatoid factor-positive erosive poly-arthritis. The presence of APF was also associated with a progressive arthritis although four APF-positive patients had a non-erosive disease. Neither AKA nor APF were able to distinguish a particularly severe form of progressive RA.

Frequency of Amyloidosis in Estonian Patients with Rheumatoid Arthritis

Occurrence of secondary amyloidosis in hospitalized Estonian patients suffering from rheumatoid arthritis was studied using subcutaneous fat aspiration biopsies. Only 47 out of 59 samples included fat, and amyloidosis deposits were found in 11 of these (23%). The high frequency of amyloidosis may be due to selection of the most severe cases in the hospital.