Search

Im Rahmen einer Querschnittsuntersuchung wurden die Punktpravalenzen von Osteoporose und Osteopenie bei Patienten mit rheumatoider Arthritis (RA) ermittelt und die Versorgung mit Osteoporosemedikamenten erfasst. In 9 Studienzentren wurden in den Jahren 2005/2006 insgesamt 532 RA-Patienten (98 Manner, 434 Frauen) im Alter von 23 bis 87 Jahren klinisch untersucht und zu Osteoporoserisikofaktoren befragt. Die Knochendichte wurde mit der Dual-X-ray-Absorptiometrie (DXA) an Lendenwirbelsaule und Hufte gemessen. Osteoporose und Osteopenie wurden nach der Klassifikation der WHO definiert (T-Score ≤-2,5 bzw. T-Score -2,5). Die medikamentose Therapie der Patienten wurde dem Dokumentationsbogen der arztlichen Untersuchung entnommen, der in Anlehnung an die rheumatologische Kerndokumentation der Regionalen Kooperativen Rheumazentren entwickelt worden war. 29% der Patienten hatten an beiden Messorten eine normale Knochendichte. 49% hatten im Bereich von LWS und/oder Schenkelhals eine Osteopenie und 22% eine Osteoporose. 60% der Patienten der Gesamtstichprobe erhielten eine medikamentose Osteoporoseprophylaxe oder -therapie (38% Kalzium/Vitamin D, 20% Kombinationen, uberwiegend Kalzium/Vitamin D + Bisphosphonat, jeweils 1% nur Bisphosphonat bzw. Hormone). Frauen bekamen mit 63% signifikant haufiger eine Osteoporosemedikation als Manner (49%; Chi-Quadrat-Test: p

Im Rahmen einer Querschnittsuntersuchung zur Pravalenz von Osteoporose und Osteopenie bei Patienten mit rheumatoider Arthritis (ORA-Studie) wurden Patienten sowie deren Hausarzte und Rheumatologen zur Einschatzung der Haufigkeit einer Osteoporose bei rheumatoider Arthritis (RA), deren Pravention, Diagnostik und Therapie sowie zur Leitliniennutzung befragt.

Increasing evidence points to a close relationship between the autonomic nervous system and the immune system. To further investigate mechanisms regulating beta2-adrenergic receptor (beta2R) expression in lymphocytes, the influence of cytokines on the density of beta2R on purified CD4+ and CD8+ lymphocytes was determined in vitro. beta2R were determined by means of a radioligand binding assay with (125I)iodocyanopindolol. CD4+ and CD8+ lymphocytes were incubated with catecholamines, interleukin 1beta (IL-1beta) and interleukin 2 (IL-2) for 6-72 h. The results demonstrate declining beta2R numbers on CD4+ and CD8+ lymphocytes in vitro augmented by epinephrine. IL-1beta has no effect on beta2R expression compared to medium. However, incubation with IL-2 resulted in an up-regulation of beta2R on CD8+ lymphocytes. Thus, the study demonstrates a differential regulation of beta2R on T-lymphocyte subpopulations with CD8+ lymphocytes being more susceptible to mechanisms of beta2R modulation than CD4+ lymphocytes. The findings further strengthen the concept of a close interplay between the autonomic nervous system and the immune system.

The guideline "Joint Swelling" is addressed to primary care physicians--general practitioners, internists or orthopedists without special experience in rheumatology. It provides a framework for interviewing patients, as well as for physical, laboratory and imaging examinations and for selection of treatment appropriate to the level of primary care. Situations which call for urgent evaluation and criteria for referral to rheumatologists are described. The appendix contains comments on signs and symptoms to differentiate arthralgia from joint swelling and on the diagnostic value of a history of joint swelling without confirmation by the physician. Further recommendations for the evaluation of patient history and physical and technical examinations are given in a tabular form. The significance of laboratory and imaging procedures is discussed.

Die Leitlinie „Gelenkschwellung” richtet sich an den Hausarzt – Allgemeinarzt oder hausarztlicher Internist – sowie an den nicht spezialisierten Orthopaden. Sie beschreibt die Anamnese, die problemorientierte klinische Untersuchung, die labormedizinische und bildgebende Diagnostik sowie therapeutische Masnahmen, die auf der primararztlichen Ebene einzuleiten sind. Situationen, die sofortiger Abklarung bedurfen und Uberweisungsindikationen zum Spezialarzt werden genannt. Der Anhang enthalt Erlauterungen zur Differenzierung der Symptome von Gelenkschmerz und Gelenkschwellung, zur Wertigkeit der anamnestischen Angabe einer fruheren Gelenkschwellung ohne Nachweis durch den Arzt und zu Gelenkschwellungen aus mechanischer Ursache. In tabellarischer Form werden nahere Hinweise zur Anamnese und Untersuchung gegeben und die Bedeutung der labormedizischen und bildgebenden Diagnostik diskutiert.

Approximately one third of all patients with Crohn's disease and ulcerative colitis suffer from extra-intestinal manifestations of their inflammatory bowel disease. Most commonly those symptoms occur simultaneously with the CED symptoms; they can, however, either precede them or appear later on in the course of the disease. The most frequent extra-intestinal symptoms are arthralgias of peripheral joints and spine, which are usually bland and self-limiting, while ankylosing spondylitis and erosive arthritides are rare. Skin lesion and eye affections can also parallel the bowel condition, but occasionally they precede intestinal manifestations and can be a first diagnostic clue. In addition, different extra-intestinal symptoms tend to simultaneously co-occur more frequently in some patients with CED, while others are not affected at all. Immunogenetic parameters play a role for the manifestations of the pathologic immune response both in the gut and in the musculo-skeletal systems, as indicated by associations with MHC class I alleles. Enteropathic microorganisms are also thought to be involved in the pathogenetic mechanisms.

To investigate whether polymorphisms in the corticotrophin-releasing hormone (CRH) promoter are associated with altered CRH gene regulation, we studied the reactivity of three recently described promoter variants in vitro. The 3625 bp variants A1B1, A2B1 and A2B2 of the human CRH promoter were cloned in the 5' region to a luciferase reporter gene and transiently transfected into both mouse anterior pituitary cells AtT-20D16vF2 and pheochromocytoma cells PC12. Incubation with 8-Br-cAMP alone or in combination with cytokines significantly enhanced the promoter activity in both cell lines studied by up to 22-fold. However, dexamethasone antagonised cAMP effects on CRH expression in AtT-20 cells while showing no effect on PC12 cells, indicating that tissue-specific factors play a crucial role. Among the haplotypes studied, A1B1 exhibited the greatest reactivity on various stimuli. Electric mobility shift assay (EMSA) was performed to study whether the described polymorphic nucleotide sequences in the 5' region of the hCRH gene interfere with binding of nuclear proteins. A specific DNA protein complex was detected at position -2353 bp for the wild type sequence only, possibly interfering with a binding site for the activating transcription factor 6 (ATF6). Taken together, this is the first study to demonstrate that CRH promoter reactivity varies between the compound promoter alleles.

The objective was to assess whether changes of cartilage oligomeric matrix protein (COMP) serum levels can predict the development of osteoarthritis following traumatic knee injury. Sera and synovial fluids were acquired at surgery (T0) and postoperatively during the first (T1) and second (T2) year from 30 knee-injured patients. COMP levels and anti-COMP autoantibodies were quantified by ELISA. Radiographs and patient questionnaires were used to assess outcomes. At T0, compared with controls (1.6 +/- 1.6 micrograms/ml), the serum COMP concentration was significantly elevated (6.5 +/- 2.8 micrograms/ml) with a tendency to further increase (T0 vs. T1, P = 0.076) and subsequently decrease (T1 vs. T2, P = 0.074). However, individual variations are observed, e.g. persistently high (8/30) or increasing (T0 to T2, 8/30) serum COMP. Ten of these patients have elevated COMP at T2 that increased from T0. COMP levels in serum and synovial fluid correlated significantly (P = 0.012). Interestingly, some patients who revealed increasing serum levels of COMP from T0 to T2 displayed anti-COMP autoantibodies. These data suggest that local immune response could contribute to further joint damage. The subgroup of 10 patients (33%) with elevated and increasing serum COMP levels and in particular the patients with antibodies against cartilage matrix molecules appear at increased risk for developing posttraumatic osteoarthritis.

Clinical, laboratory, and scintigraphic features of 16 patients with polymyalgia rheumatica and 23 patients matched for age presenting with classical or definite rheumatoid arthritis (American Rheumatism Association 1958 criteria) of the elderly were compared in order to define features that might distinguish between these two syndromes. The sensitivity of proposed diagnostic criteria for polymyalgia rheumatica was always higher in the group with polymyalgia rheumatica, though only significantly so for morning stiffness. A comparison of 27 different laboratory features showed few significant differences between the diseases, though correlation between laboratory variables within each of the disease groups differed, perhaps suggesting a fundamental pathogenetic difference between them. Scintigraphy of the shoulder joint proved of no value in differential diagnosis. It was concluded that polymyalgia rheumatica and rheumatoid arthritis of the elderly are probably discrete clinical entities. Bilateral upper arm tenderness, lack of positive rheumatoid factor, and a normal caeruloplasmin are the most valuable features for distinguishing polymyalgia rheumatica from rheumatoid arthritis of the elderly.

Diagnosis of a primary functional syndrome requires: 1) the exclusion of an underlying organic condition; 2) the proof of criteria, including symptoms and clinical signs are necessary for positive diagnostics, and include the progression of symptoms, the history, neurotic symptoms, chronological connections with life events, age, and related symptoms as described by von Uexkull: globus sensation in the throat, paresthesia, breathing irregularities, cardiac sensations, restlessness, poor concentration, as well as general fatigue, anxiety, depression, sleep disturbance, as well as constipation and/or diarrhea, headaches, dysuria, and “atypical” pain syndromes. Clinically, we must consider vegetative and functional symptoms: cold hands and feet (Raynauds phenomenon), oral and/or ocular dryness (Sicca syndrome), hyperhydrosis, neurological indications, dermographism, vertigo (and under what conditions), extrasystoles, tenderness of the colon (irritable bowel syndrome), tender points in general, and posture faults (spine).

In patients with rheumatoid arthritis and other joint diseases the knee is frequently involved. There are different factors such as inflammatory, degenerative, periarticular and static mechanisms which may cause pain, effusions, Baker’s cysts and atrophy of the quadriceps muscle. There is particular interest in synovitis and the associated clinical signs such as effusion, hyperthermia and an increase of intra-articular pressure. We are evaluating different non-invasive diagnostic and assessment techniques to examine the different effects of therapy such as surgical synovectomy, intra-articular injection of an anti-inflammatory drug and isometric exercises.Arthrosonography is an imaging technique performed with ultrasound tomographic equipment. It is useful for the examination of liquid cavities such as the suprapatellar recess, arthroceles, Baker’s cysts and their communication with the joint space.Infra-red thermometry has been used to measure spot temperatures compared with contact plate liquid ...

The average time the test feed remains in sheep was determined with ewes during three stages of the reproduction cycle. The feed was labelled with 51Cr2O3. Experiment conditions are described under which the experiments can be carried out within the permissible limits.

Zonulafasern von Kaninchenaugen wurden polarisationsoptisch-histochemisch untersucht. Imbibitionsversuche weisen darauf hin, das eine wesentliche Volumenanderung der Gefugelucken der Zonula durch Quellung und Entquellung nicht moglich ist. Deshalb kommt es bei Phenoleinwirkung im Gegensatz zum Kollagen auch nach maximaler Entquellung nicht zum Auftreten negativer Doppelbrechung. Mit Hilfe der Rivanolreaktion bei abgestuften pH-Werten gelingt der Nachweis einer orientiert in die Fasern eingebauten mukoiden Strukturkomponente. Durch gerichtete Anlagerung des Rivanols erfolgt dabei eine pH-abhangige Umkehr des Vorzeichens der Doppelbrechung. Polarisationsoptische Befunde nach histochemischen Blockierungsverfahren sprechen dafur, das vorwiegend Karboxylgruppen fur die gerichtete Rivanolanlagerung verantwortlich sind. Sulfate lassen sich in den Zonulafasern nach Blockierung aller anderen sauren Gruppen mit Rivanol polarisationsoptisch nicht erfassen, obwohl sie biochemisch nachgewiesen wurden. Als Trager der Karboxylgruppen kommen im Zusammenhang mit den bekannten biochemischen Angaben und auf Grund eigener enzymatischer Versuche neben endstandigen Karboxylgruppen der Eiweisbausteine Hyaluronsaure und Chondroitinsulfat C in Frage.

Pulse prednisolone hemisuccinate therapy (500 mg given intravenously on three occasions over two weeks) has been combined with either intramuscular sodium aurothiomalate or azathioprine in an assessment of 30 patients with rheumatoid arthritis. Significant improvement in a variety of clinical and biochemical assessments was seen in both groups. Both treatments were well tolerated by the patients and prednisolone appeared to accelerate the response to sodium aurothiomalate and azathioprine but there was no great evidence that it enhanced it.

Diclofenac (150 mg/d) and piroxicam (20 mg/d) were compared in a cross-over trial with 12-day periods of double-blind treatment and 3-day wash-out periods. The following open phase of the trial lasted for two months and served to assess the tolerance. For this the dosage of diclofenac was reduced to 100 mg/d. 134 volunteers from 5 departments of rheumatology participated in the study. Statistical analysis showed that the two groups were of homogenous composition and that--with certain limitations--the necessary assumptions for the evaluation as a cross-over experiment were fulfilled. All tests used to determine the efficacy showed approximately parallel improvement with both formulations and in the wash-out phase this was followed by marked deterioration. The sum of the parameters for individual improvement showed a tendency in favour of piroxicam. However, clear superiority of one trial formulation over the other with respect to efficacy or tolerance could not be demonstrated by the statistical analysis.