Maarit Wuorela

Infectious Agents as Triggers of Reactive Arthritis

Reactive arthritis was originally defined as a sterile joint inflammation after infection elsewhere in the body, but this view has been challenged in the past decade since different antigens and DNA and RNA of various triggering microbes have been shown to exist at the sites of inflammation in the joints. It has been suggested that microbial antigens, or intact pathogens, are important for the pathogenesis of reactive arthritis, at least in the early phase of the disease, but the exact mechanism of how the pathogens contribute to the development of this usually self-limiting polyarthritis has not been discovered. This article reviews the theories on the role of infectious agents as triggers of reactive arthritis.

Modulation of peripheral blood mononuclear cell activation status during salmonella-triggered reactive arthritis

OBJECTIVE To determine the activation status of mononuclear cells in the peripheral circulation during the acute phase and the recovery phase of Salmonella-triggered reactive arthritis (ReA). METHODS Peripheral blood mononuclear cells (PBMC) were obtained from 8 patients with Salmonella infection (4 with ReA and 4 without) and were studied by reverse transcription-polymerase chain reaction for messenger RNA (mRNA) of proinflammatory and antiinflammatory cytokines, by flow cytometry (FC) for cell surface activation and adhesion molecules, by immunofluorescence (IF) microscopy for bacterial antigens, and by FC, IF, and DNA fragmentation on gel for signs of apoptosis. RESULTS During the acute phase of the infection, PBMC were activated in all patients, as characterized by high levels of expression of CD14, CD11b, and CD11c on monocytes. In the patients with ReA, PBMC also had the capacity to produce interleukin-1beta (IL-1beta), IL-6, IL-8, IL-10, and tumor necrosis factor alpha. During the amelioration of disease, monocyte activation was decreased in all patients. A complete down-regulation of CD14 was detected only in the patients with ReA, whereas the expression of CD14 in the patients without ReA was positive and was similar to that in healthy controls. In addition, cytokine mRNA levels decreased regardless of the presence of Salmonella antigens in blood cells in all 4 patients with ReA. CONCLUSION High levels of expression of some activation and adhesion molecules and elevated levels of mRNA for certain cytokines that are predominantly produced by monocytes were found in PBMC from patients with acute Salmonella-triggered ReA, which suggests that these cells are activated. On the other hand, complete down-regulation of CD14 and a marked decrease in the cytokine production capacity during amelioration of the disease suggest that suppression of PBMC activity might be involved in recovery from ReA.

EXPRESSION OF MHC CLASS II MOLECULES ON HUMAN MONOCYTES IS REGULATED INDEPENDENTLY FROM EACH OTHER AFTER PHAGOCYTOSIS OF BACTERIA

Reactive arthritis is usually self‐limiting polyarthritis which develops in HLA‐B27 positive individuals after certain gastrointestinal or urogenital infections. The pathogenesis of reactive arthritis is unknown but T cells seem to have a crucial role. Most of the antigen‐specific T cells isolated from the synovial fluid have been MHC class II restricted. The role of antigen presentation in the pathogenesis of reactive arthritis has been studied relatively little. In this work the authors studied theeffect of arthritis‐triggering bacterium (Yersinia enterocolitica O:3) on the expression of MHC class II molecules on human monocytes and found that the expression of different MHC class II molecules was regulated independently from each other in half of the individuals after certain incubation periods. In these cases the expression of HLA‐DP was parallel to the expression of HLA‐DQ, while HLA‐DR expression went to the opposite direction or did not change at all. No difference between HLA‐B27negative and HLA‐B27 positive healthy individuals was seen. The authors conclude that independent regulation of the expression of different MHC class II antigens on antigen‐presenting cells is a more common phenomenon than usually thought.

Intracellular Pathogens and Professional Phagocytes in Reactive Arthritis

Reactive arthritis is a postinfectious complication which develops after certain infections, mostly gastrointestinal or urogenital. Antigenic structures of the causative microbes, but no live organisms, have been demonstrated in inflamed joints. The host factors as well as the microbial antigens responsible for the initiation of the arthritic process are unknown. The pathogenesis of reactive arthritis is discussed here with special reference to the intracellular life of the causative microbes and to monocytes/macrophages, which may be involved in early events of the arthritic process as well as in maintenance of the autoimmune type of responses.

Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart

OBJECTIVE to compare cardiovascular morbidity and risk factor profiles of two 70-year-old cohorts of Finns examined in 1991 and 2011 and to describe prevalence of statin use according to cardiovascular risk in the later cohort. METHODS 1920-born cohort of community-dwelling 70-year-old persons (n = 1032) participated in comprehensive health surveys, physical and laboratory examinations in the Turku Elderly Study (TUVA) during 1991-92. In 2011, identical examination pattern was performed, in a 1940-born cohort of 70-year-old persons (n = 956) from the same area. Prevalence of cardiovascular diseases (CVD) and risk factors in the two cohorts was compared. Further, each cohort was divided into three cardiovascular risk groups (high, moderate and low) based on their estimated risk. Prevalence of statin use was calculated among each risk group in the 1940 cohort. RESULTS coronary heart disease (25 versus 11%) and peripheral artery disease (9 versus 2%) were more common in the 1920 than 1940 cohort, respectively. Lipid profile was worse and blood pressure higher in the earlier cohort, whereas use of statins and antihypertensives was more common in the later cohort. Forty-two per cent of the 1920 cohort and 29% of the 1940 cohort were estimated to have high cardiovascular risk. In the 1940 cohort, a total of 36% used statins. Statin use was most common among high-risk persons. CONCLUSIONS seventy-year olds examined in 2011 had less CVD morbidity than their counterparts 20 years earlier, and their cardiovascular risk factors were better controlled which is reflected in higher use of preventive medications, such as statins and antihypertensives.

Prediction of the Future Need for Institutional Care in Finnish Older People: A Comparison of Two Birth Cohorts

Background: More recent birth cohorts of older people have better physical and cognitive status than earlier cohorts. As such, this could be expected to diminish the need for institutional care. The prediction of the future need for institutional care provides essential information for the planning and delivery of future care and social services as well as the resources needed. Objective: To predict the future need for institutional care among older Finnish people born in 1940. Methods: Representative samples of home-dwelling 70-year-olds from Turku, Finland were examined with similar methods in 1991 (those born in 1920) (n = 1,032) and in 2011 (those born in 1940) (n = 956). Predictors of institutionalization rates from the earlier 1920 cohort, together with data of sociodemographic factors, health, psychosocial and physical status, the need for help, and health behavior, were used to predict the future institutionalization rate among the 1940 cohort in this study using Cox regression models. Results: Health as well as psychosocial and physical status were significantly better in the 1940 cohort compared to the earlier cohort. In the 1940 cohort, the predicted rates of institutionalization were 1.8, 10.4, and 26.0% at the ages of 80 (year 2020), 85 (year 2025), and 90 years (year 2030), respectively. At every age (80, 85, and 90 years), the predicted rates of institutionalization by Mini-Mental State Examination (MMSE) were about two-fold among those with MMSE scores 18-26 (3.0-38.8%) compared to those with scores 27-30 (1.6-23.7%) and those with a body mass index (BMI) <25 (2.5-34.3%) compared to those with a BMI of 25-29.9 (1.4-20.9%), and about three-fold among participants with several falls (5.3-57.0%) compared to participants with no falls (1.5-23.1%). Conclusions: The 1940 cohort performed better in health as well as psychosocial and physical status than the 1920 cohort. Nevertheless, the predicted rates of future need for institutional care were high, especially at the ages of 85 and 90 years, among those with a lowered cognitive or physical status.

Corrigendum to ‘Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart’

Corrigendum to ‘Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart’ BY EVELIINA UPMEIER, JENNI VIRE, MAARIT JAANA KORHONEN, HANNU ISOAHO, AAPO LEHTONEN, SEIJA ARVE, MAARIT WUORELA, MATTI VIITANEN Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Finland Statcon Ltd, Salo, Finland Department of Nursing Science, Turku City Hospital and University of Turku, Turku, Finland Division of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden