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The authors examine and describe peripheral blood and joint fluids taken from patients with rheumatoid arthritis, osteoarthritis, and reactive arthritis. Their purpose is to add to the body of data leading to understanding the particulars of the way in which inflammation develops and continues.

Background: For patients with systemic lupus erythematosus (SLE) refractory to conventional treatment, high dose immunosuppression and haemopoietic stem cell transplantation have been suggested as an alternative treatment. Patient: We report [...]

1. Introduction Within the past decade, musculoskeletal ultrasound (US) has become an established imaging technique for the diagnosis and follow up of patients with rheumatic diseases.[1-5] This has been made [...]

The clinical course and severity of inflammatory rheumatic diseases vary considerably. A large proportion of patients have mild to moderate activity of the inflammatory process which can be successfully controlled [...]

Die in den letzten Jahren entwickelten validierten Aktivitätsscores für die chronische Polyarthritis erlauben eine longitudinale Dokumentation der Effektivität der angewendeten Therapiestrategien. Durch Anwendung der Aktivitätsscores in der täglichen Routine und bei jeder Visite könnte unter vergleichsweise geringem Aufwand die Behandlung der Patienten mit chronischer Polyarthritis deutlich verbessert werden. In diesem Überblick wird die Evidenz für einen Nutzen der Anwendung dieser Scores in der klinischen Routine dargestellt. Disease activity scores for rheumatoid arthritis have been developed and validated in recent years. They allow the longitudinal documentation of the effectiveness of treatment. Application of these scores in routine daily practice could significantly improve the effectiveness of therapy with relatively little effort. This review presents evidence for the benefits of the application disease activity scores in clinical routine.

Arthrose ist eine der häufigsten Gelenkerkrankungen. Da sich die Forschungsaktivitäten der letzten Jahre vorwiegend auf die großen Gelenke, wie Hüfte und Knie, konzentriert haben, sind die wissenschaftlichen Resultate bezüglich der Hand- und Fingergelenke derzeit noch immer sehr limitiert. Um den Effekt einer therapeutischen Maßnahme zu messen oder auch Aussagen über den Verlauf der Erkrankung zu treffen, werden in der Rheumatologie üblicherweise Ergebnismessgrößen verwendet. Ergebnismessgrößen sind messbare Variablen, die sowohl aus der Sicht des Arztes/Angehörigen eines Gesundheitsberufes als auch aus der Sicht des Patienten definiert werden können. Das Ziel dieses Artikels ist es, klinische Ergebnisvariablen und die zugehörigen Instrumente, die derzeit für Patienten mit Arthrose der Hand- und Fingergelenke verwendet werden, darzustellen und zu evaluieren, inwieweit diese Ergebnisvariablen und Instrumente die Perspektive der Patienten abbilden. Bei Patienten mit Arthrose der Hand- und Fingergelenke wird die Messung und Erfassung der folgenden Ergebnisvariablen von Experten empfohlen: Krankheitsaktivität und Ausmaß der Entzündung, Alltagsfunktion, Schmerz, Mobilität und Steifigkeit, sowie Deformität und ästhetische Veränderung. Für die meisten dieser Ergebnismessgrößen existieren entsprechende Instrumente, wobei viele dieser Instrumente die Perspektive der Patienten nicht in ausreichendem Maß reflektieren und eine geringe Reliabilität aufweisen, da keine standardisierten Erfassungsprotokolle existieren. Osteoarthritis (OA) is the most common joint disease. While research activities in OA have concentrated on the knee and hip in recent years, knowledge and research results in the field of hand OA are still limited. In order to measure the effects of treatment or to obtain information on the course of a disease and the health status of a patient, outcome measures are commonly used in rheumatology. Such measures are variables which can be quantified and which represent either the perspective of health professionals or the perspective of patients or both. The aim of this article is to evaluate clinical outcome measures and corresponding instruments which are currently used for patients with hand OA, and to examine whether these measures and instruments represent the perspective of patients. For hand OA, measurements of disease activity and inflammation, function and performance, pain, mobility and stiffness, deformity and aesthetic damage are recommended by experts. Corresponding instruments are available for most of these outcome measures, but these often do not sufficiently represent the perspective of the patients. Some instruments lack reliability because standardized protocols for measurement have not yet been developed.

Objective. Delay of disease-modifying anti-rheumatic drug (DMARD) therapy is a major contributing factor for poor outcome in rheumatoid arthritis (RA). Although early therapy has been shown to be particularly effective, there is still uncertainty about the optimal time point of DMARD introduction. We wanted to test if a therapeutic window of opportunity may exist within the first few months of the disease.Methods. In this case-control parallel-group study, 20 very early RA (VERA) patients with median disease duration of 3 months were age and gender matched to a group of 20 late early RA (LERA) patients with median disease duration of 12 months until first DMARD initiation. Follow-up time was 36 months. Primary outcome measures were the disease activity score (DAS28) and radiological joint destruction using the Larsen method.Results. Already after 3 months of DMARD therapy we found a significant difference of improvement in favour of the VERA patients in the DAS28. This trend continued over the study period. At study end the DAS28 showed an improvement of 2.8±1.5 in the VERA vs 1.7±1.2 in the LERA group (Pc<0.05). The Larsen scores showed a statistically significant retardation of progression in the VERA compared with the LERA.Conclusion. Our results indicate that there is a window of opportunity for highly successful treatment of RA in the first year, and especially within the first 3 months of therapy. Thus, early diagnosis and therapy may be the crucial step in achieving optimal control of disease progression and prognosis in RA.

For patients with severe forms of autoimmunity, including systemic lupus erythematosus (SLE), purging autoreactive T cells from the immune repertoire by transplanting autologous hematopoietic stem cells (ASCT) is a therapeutic option. We describe an 18-year-old woman with SLE who had been treated with corticosteroids, azathioprine, cyclophosphamide (CYC), and immunopheresis for 4 years, during which time mechanical ventilation for lupus pneumonitis had been repeatedly required. After the patient was conditioned by administration of CYC and antithymocyte globulin, a total of 8.87 × 10⁶ purified CD34+ cells per kg of body weight was infused. Hematopoietic regeneration was observed within 9 days. Twenty-one months after ASCT, the patient continues to be in complete clinical remission, with no signs of SLE-related disease activity and without any immunosuppressive medications. Her pulmonary function has returned to normal. Although a longer followup is required for assessment of the durability of response, the patient's course indicates that ASCT may be a way to reinduce tolerance in patients with SLE.

Zusammenfassung: 1. Bei Stauungsversuchen am Arme bei Normalen und Diabetikern darauf gerichtet, die Glykolyse in vivo zu pr�fen, wird bei Gef��gesunden eine Abnahme des Blutzuckers gefunden; peroral und intraven�s verabreichter Zucker zeigen bei diesen Versuchen kein verschiedenes Verhalten. Die Versuche erweisen sich wegen der nicht einzusch�tzenden Gef��komponente nicht geeignet, eindeutige Ergebnisse zu zeitigen. 2. Bei Versuchen in vitro wird die absolute glykolytische Kraft des Diabetikerblutes nicht vermindert gefunden. Peroral und intraven�s verabreichter Zucker wird im Blute Normaler gleichartig glykolisiert. 3. Beim Vergleiche von Diabetikerblut mit Blut Normaler von gleichem Zuckerspiegel wird die Glykolyse in den ersten 4 Stunden gleich gefunden, sp�ter ist sie im Diabetikerblute verlangsamt.

Article abstract—Hypertrophic chronic pachymeningitis (HCP) is a rare disorder that causes intracranial or spinal thickening of the dura mater. This report describes a patient with progressive HCP in the craniocervical region associated with signs of rheumatic disease. A ventricular-atrial shunt had to be inserted because of increased intracranial pressure. The patient improved after suboccipital craniotomy, C1 to C6 laminectomy, and removal of the thickened dura. Additional therapy with methotrexate stopped progression, which was documented by MRI and PET.

&lt;it>Objective&lt;/it>. To investigate the perception of values of individual core set measures by rheumatologists, and how it differs across measures and across physicians. &lt;it>Methods&lt;/it>. We designed a survey in which 44 international expert rheumatologists explicitly marked positions on the scales of seven core-set measures that in their opinion corresponded to cut-points between remission, low, moderate and high disease activity. The measures comprised swollen and tender joint counts (SJC, TJC), CRP, ESR, patient and evaluator global assessments of activity (PGA, EGA), and the Health Assessment Questionnaire Disability Index (HAQ). &lt;it>Results&lt;/it>. The interpretation of measures across physicians was most consistent for ESR and PGA, while for CRP and joint counts there was most variation. Joint counts and CRP implied active disease at lower relative values (using normalized scales) than did PGA, EGA or ESR (&lt;it>P&lt;/it>&lt;0.01 for most comparisons; Bonferroni-adjusted Wilcoxon signed rank test), and most physicians tended to tolerate higher numbers of tender joints than swollen joints to define similar levels of disease activity. Given these cut-points, more RA patients in a typical cross-sectional cohort would be regarded as being in remission according to joint counts (SJC, 35%; TJC, 55%) than to global scores (PGA, 18%; EGA, 9%), and fewer patients would be regarded as being in remission by physician-derived or laboratory measures than by patient-derived ones. &lt;it>Conclusion&lt;/it>. These data give insights into the integrative process of activity evaluation and will be informative for future survey designs, studies using physician opinion as the gold standard for criterion validity of disease activity, and allow ‘activity mapping’ of values on different scales based on expert opinion.