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Two new nonmetal cation tetrafluoroborate phases [H3tren](BF4)3 (I) and [H3tren](BF4)3 HF (II) were synthesized by microwave-assisted solvothermal and characterized by single crystal X-ray diffraction, IR spectroscopy and thermal analysis DTA-TGA. [H3tren](BF4)3 is cubic (P213) with unit cell parameter a = 11.688(1) Å. [H3tren](BF4)3•HF is trigonal (R3c) with unit cell parameters a = 15.297(6) Å and c = 12.007(2) Å. Both (I) and (II) structures can be described from isolated tetrafluoroborate BF4- anions, triprotonated tris-(2-aminoethyl)amine (tren) [H3tren]3+. Phase (II) contains disordered BF4- tetrahedron and hydrofluoric acid.

Giant cell arteritis with coronary involvement is an uncommon event, often discovered at autopsy after a myocardial infarction. We report the case of a 70–year–old female with unstable angina pectoris persisting despite angioplasty and antianginal treatment, associated with chronically increased erythrocyte sedimentation rate. Temporal artery biopsy was negative but ophthalmic assessment showed sequelae of ischaemic optical neuritis. Response to prednisone therapy was striking, with complete disappearance of angina pectoris, normalization of erythrocyte sedimentation rate and decreased thallium uptake at scintigraphy. This is the first case of giant cell arteritis of the coronary arteries seen after attempted therapy with percutaneous transluminal coronary angioplasty. Such findings justify considering giant cell arteritis each time a case of coronary manifestations with increased erythrocyte sedimentation rate resists medical treatment, or recurs after coronary angioplasty. [ABSTRACT FROM PUBLISHER]

The efficacy of nifedipine and prazosin in the treatment of Raynaud's phenomenon was assessed in a prospective double-blind randomized cross-over trial in 15 patients. Each patient received one week of nifedipine 20 mg TID, one week of prazosin 1 mg TID, and 2 weeks of placebo. Nifedipine was shown to be effective in reducing both the frequency and the severity of Raynaud's phenomenon, whereas prazosin was ineffective. Before initiation of therapy in the 15 patients, pressor responses to the intravenous alpha-agonist phenylephrine were assessed in the basal state, 30 min after 20 mg oral nifedipine, and 30 min after 1 mg oral prazosin; the shift to the right of the log dose-vasopressor response curves to phenylephrine was similar with nifedipine and prazosin. [ABSTRACT FROM PUBLISHER]

We have evaluated the therapeutic effect of the calcium entry blocking agent nifedipine in Raynaud's phenomenon associated with connective tissue diseases and in idiopathic digital vasospasm. In a preliminary study 16 patients with a digital vasospasm that could be induced by hand-immersion in cold water (4°C) were challenged a second time with cold water 1 and 6h after 20 mg oral nifedipine. Nifedipine provided an effective protection against this cold-induced vasospasm in 14 of the 16 patients. Thirty patients were included in a short-term ambulatory study: Raynaud's phenomenon was associated with progressive systemic sclerosis (PSS) in 10 patients, systemic lupus erythematosus (SLE) in five and rheumatoid arthritis (RA) in three: it was idiopathic (I) in 12 patients. Each patient received, in a double- blind manner and random order, on two consecutive weeks, nifedipine (20 mg three times daily) and placebo. Nifedipine proved to be effective: the mean number of digital vasospastic attacks per week decreased from 27·3 to 5·8 (P < 0·01). The results in the SLE and RA groups were similar and were pooled. The improvement (in % decrease) was better in the idiopathic group (90·9) than in the SLE and RA group (78·6, P < 0·02) and the PSS group (64·0, P < 0·01). [ABSTRACT FROM PUBLISHER]

We studied the influence of the radiographic procedure and joint positioning on knee joint space width (JSW) in 10 healthy volunteers, and the intrareader reproducibility of JSW measurements on radiographs performed 2 weeks apart using a standardized procedure. Results show that a 5 or 10° downward inclination of the X-ray beam and 15 or 30° of induced external foot rotation significantly reduced JSW. In contrast, knee flexion increased JSW. The mean differences and s.D. in the measurement of JSW between two sets of radiographs taken 2 weeks apart were not statistically significant, ranging from − 0.07 mm (S.D. 0.38) to 0.020 mm (s.D. 0.38). Our findings indicate that modifications in knee flexion, foot rotation and X-ray beam inclination influence JSW. Therefore, standardization of joint positioning and of the radiographic procedure is necessary to obtain comparable radiographic images on successive X-rays. [ABSTRACT FROM PUBLISHER]

Both genetic and environmental factors probably influence the severity of spondyloarthropathies. Hip involvement, which may be used as a marker of disease severity, is more frequent in spondyloarthropathies developed in North Africa. The objective of this study was to determine the predisposing factors of hip involvement in spondyloarthropathy in North Africa. Patients fulfilled the Amor or European Spondyloarthropathy Study Group (ESSG) criteria of spondyloarthropathy. The study was retrospective, cross-sectional, multicentre and carried out in North Africa. The data collected were demographic data, socio-cultural factors and clinical presentation at onset. The risk of hip involvement with regard to disease duration was estimated using Kaplan—Meier's method. The predictive value of each variable with regard to time to hip involvement was evaluated using a uni- and then a multivariate Cox proportional hazard model. Five hundred and eighteen patients were included. The risk of hip involvement was estimated at 39 ± 3% after 10 yr disease duration. The factors picked up by the multivariate analysis were: diagnostic delay less than 7 yr, age at onset below 24 yr and a combination of ‘lower social class’ and ‘no refrigerator at home’. This study confirms the high prevalence of hip involvement during the course of spondyloarthropathy in North Africa and suggests a role of environmental factors in its appearance. [ABSTRACT FROM PUBLISHER]

The effect of D-Penicillamine (DP) on the in vitro production of anti-DNA antibodies by peripheral blood mononuclear cells (PBMC) from patients with systemic lupus erythematosus (SLE) and from healthy individuals was studied, Anti-DNA antibodies were measured in culture supernatants using a sensitive microenzyme-linked immunoassay technique. The results of this investigation suggest that DP can act as an immunomodulator capable of potentiating or initiating anti-DNA antibodies synthesis as well as suppressing it. Although PBMC from both SLE patients and controls were responsive to this thiol compound, our results indicate that PBMC from patients with SLE were more susceptible to the enhancing effect of DP than did PBMC from controls. The cellular mechanism by which this drug can modulate anti-DNA antibodies production is discussed. [ABSTRACT FROM AUTHOR]

The capacity of D-Penicillamine (DP) to induce or to potentiate the production of antinuclear antibodies (ANA), detected by immunofluorescence (IF), was investigated in vitro, using peripheral blood mononuclear cells (PBMC) from patients with systemic lupus erythematosus (SLE) and normal individuals. Except in one patient with SLE, DP did not enhance ANA synthesis when using unseparated PBMC. In contrast, when B cells were cocultured with irradiated T cells or irradiated enriched T4+ subset, DP induced or potentiated the production of ANA. These results indicate that DP acts by stimulating T4+ helper cells to promote ANA synthesis in the absence of radio-sensitive suppressor T cell function contained within the T4+ population. [ABSTRACT FROM AUTHOR]

Peripheral blood mononuclear cells (PBMC) of 29 patients with systemic lupus erythematosus (SLE) and 14 normal individuals were investigated for the in vitro production of anti-nuclear antibodies (ANA). Twenty-eight of 29 SLE patients but only one control spontaneously produced ANA in unstimulated PBMC. Pokeweed mitogen induced ANA synthesis in six controls. No detectable ANA was observed in B cell enriched fraction except in two cases of SLE. Recombination of B + T cell enriched fractions and PBMC supernatants from SLE patients could induce B cells to synthesize ANA. These results indicate that: (1) SLE patients spontaneously produced ANA in vitro whereas controls rarely did; (2) autoreactive clones exist in normal individuals but are kept under control and (3) T cell help is required for ANA triggering. [ABSTRACT FROM AUTHOR]

The in vitro production of anti-double stranded DNA antibodies (anti-DNA) by peripheral blood mononuclear cells (PBMC) was investigated in 19 patients with systemic lupus erythematosus (SLE) and in 12 normal individuals, using a micro solid phase enzyme immunoassay. PBMC from SLE patients spontaneously produced anti-DNA with a higher frequency (16 of 19) than did PBMC of controls (three of 12). In addition SLE patients produced predominantly IgO antibodies. PWM and DNA enhanced anti-DNA synthesis in spontaneously low and non-producers, but acted as inhibitors in spontaneously high producers. The partial removal of T cells decreased or abolished anti-DNA synthesis in four of nine SLE patients. In contrast the B cell enriched fractions of five of nine SLE and five of seven normal patients produced the same or higher anti-DNA levels than did the corresponding unseparated PBMC. These results suggest evidence for autoreactive B cells in SLE as well as in normals, and therefore the combination of these autoreactive B cells with helper and/or suppressor T cell disorders could lead to the over production of anti-DNA seen in different patients with SLE. [ABSTRACT FROM AUTHOR]

The efficacy of cyclosporin in a double blind, placebo controlled trial of four months' duration has previously been reported by us. To assess the benefit-to-risk of cyclosporin this study was followed by a one year open trial including 49 of the previous 52 patients. Cyclosporin was given at an initial dosage of 5 mg/kg/day and then modulated on the basis of efficacy and renal toxicity. During the study the drug had to be discontinued in 32 patients: because of inefficacy in 10, side effects in 11, both in nine, and in two because of unrelated events. The significant clinical improvement noted at four months persisted through one year in the 17 patients who continued to receive treatment. Nephrotoxicity of the drug (24 patients) required constant and close monitoring as well as modulation of daily drug dosage during the trial. This study indicated that cyclosporin might be valuable in the treatment of patients with advanced rheumatoid arthritis, in whom other second line agents have failed. [ABSTRACT FROM PUBLISHER]

The efficacy and safety of cyclosporin A (CyA) for patients with rheumatoid arthritis were assessed in a four month double blind, placebo controlled study using an initial dosage of 5 mg/kg daily. Six patients withdrew from the study (two in the placebo group because of inefficacy of treatment and four in the CyA group because of side effects). These six patients were considered therapeutic failures. At the end of the trial the study treatment was considered as good or very good by 14 out of the 26 CyA group patients and by only two out of the 26 placebo group patients. Moreover, in the CyA group significant improvement was observed in five of the seven clinical assessment criteria. Clinical improvement was correlated with a decrease in C reactive protein, alpha 1 glycoprotein levels, and platelet count but not with erythrocyte sedimentation rate or rheumatoid factor titres. Renal toxicity (13 cases) remained the major problem in the management of these patients. This study shows that CyA is effective in active rheumatoid arthritis but requires close monitoring for toxicity. [ABSTRACT FROM PUBLISHER]

Two randomised double blind, placebo controlled trials have been carried out to assess the effectiveness of nonathymulin, a synthetic thymic peptide hormone, in the treatment of rheumatoid arthritis (RA) and to compare three different dosage schedules (1, 5, and 10 mg/day). Nonathymulin 5 mg proved to be the most efficient dose, providing significant clinical improvement as evaluated by the global assessment of all patients who entered the trials (56% v 17% in the placebo group) (p less than 0.02) and by four objective parameters. This effect was accompanied with minimal adverse effects and was not associated with clear changes in immunological parameters. A significant correlation was observed, however, in clinical response to nonathymulin, and T cell subset imbalance was assessed using monoclonal anti-T cell antibodies and a functional suppressor T cell assay. [ABSTRACT FROM PUBLISHER]

We evaluated the effect of dipyridamole on thallium-201 myocardial perfusion in 23 patients with progressive systemic sclerosis (PSS) with diffuse scleroderma. Thallium-201 single photon emission computed tomography (SPECT) was performed at rest and after coronary artery vasodilatation with intravenous dipyridamole (0.14 mg/kg/min for four minutes). The left myocardium was divided into nine segments; each segment was graded as 2.0, 1.5, 1.0, 0.5, 0 (zero represents no activity). Dipyridamole significantly improved resting thallium-201 myocardial perfusion: the mean (SD) number of segments with thallium defects decreased from 6.0 (2.1) at rest to 4.1 (2.5) after dipyridamole (p less than 0.0001); the mean (SD) score in segments with resting defects increased from 0.92 (0.24) at rest to 1.13 (0.38) after dipyridamole (p less than 0.0001); the mean (SD) global score per patient increased from 10.2 (1.8) at rest to 11.4 (2.1) after dipyridamole (p less than 0.02); the global score increased by at least 2.0 in 12 patients and worsened by at least 2.0 in three patients only (p = 0.05). The results of this acute study suggest that some drugs with potent vasodilator activity on small coronary arteries may be beneficial in the treatment of PSS patients with thallium-201 myocardial perfusion abnormalities. [ABSTRACT FROM PUBLISHER]

Several immunoregulatory defects of Epstein-Barr virus (EBV) induced B cell activation have been described in patients with rheumatoid arthritis (RA), suggesting that EBV may have a role in the pathogenesis of RA. We assessed EBV specific T cell regulation in 20 patients with progressive systemic sclerosis (PSS) and immune to EBV and in 10 control subjects also immune to EBV by comparing the secretion of IgM into supernatants of 16 day cultures of B cells alone and cocultures of B and autologous T cells. In control subjects autologous T cells mediated a significant decrease in the secretion of IgM by B cells at 12 and 16 days of culture. Analysis of individual responses showed the existence of two subgroups of patients with PSS: group I (10 patients) had a suppressor T cell function similar to that of controls; group II (10 patients) had a defective T cell function. Differences in the duration or severity of the disease, the slow acting therapeutic agents, and anti-inflammatory drugs could not account for these subdivisions. These results suggest that several immunoregulatory defects of EBV induced B cell activation exist in different connective tissue diseases. [ABSTRACT FROM PUBLISHER]

The efficacy of diltiazem in the treatment of Raynaud's phenomenon was assessed in a prospective double-blind randomised cross-over trial in 16 patients (7 progressive systemic sclerosis, 2 rheumatoid arthritis, 1 systemic lupus erythematosus, and 6 idiopathic Raynaud's phenomenon). Each patient received diltiazem 120 mg and placebo three times a day for two weeks. The attack frequency of Raynaud's phenomenon was measured by a diary count; its severity was assessed by means of a 10 cm visual analogue scale with 0 representing minimum and 10 representing maximum severity. Diltiazem significantly decreased the frequency and severity of Raynaud's phenomenon as compared with placebo. This improvement was striking in patients with idiopathic Raynaud's phenomenon but did not reach statistical significance in patients with associated systemic disease. We conclude that diltiazem is effective in the treatment of Raynaud's phenomenon, especially in patients with idiopathic vasospastic disease. [ABSTRACT FROM PUBLISHER]

Clinical and biological manifestations have been studied in 134 patients whose serum had antibodies to soluble extractable nuclear antigens (ENA). 85 of the patients had anti-RNP antibodies, 18 had anti-Sm antibodies, and 31 had antibodies to one or more soluble nuclear antigen. In all groups, the predominant clinical manifestations were polyarthritis, Raynaud's phenomenon, fever, and skin involvement. Renal disease was less common in those patients with anti-RNP antibodies than in the other patients. Most patients with definite renal disease (13 out of 15) also had circulating anti-DNA antibodies. The final diagnoses in these 134 patients were well defined connective tissue disease in 59; overlap syndromes in 34; a limited clinical syndrome made up of polyarthritis Raynaud's phenomenon--often with swollen fingers--and/or hypergammaglobulin-aemia in 31, and various other clinical conditions in 10. [ABSTRACT FROM PUBLISHER]

Objectives: To forecast, on the basis of the past and present position of rheumatologists in Europe, the competence needed in the future to secure and promote the specialty within the healthcare network.Methods: Union Européenne des Médecins Spécialistes/European Board of Rheumatology (UEMS/EBR) questionnaire on (a) training centres in Europe, (b) rheumatologists' skills, (c) UEMS core curriculum.Results: 173 training centres in rheumatology were identified. Reponses to the questionnaire showed both harmony and diversity in the practice of rheumatology. Harmony arises from the need to (a) have an extensive and profound knowledge of, and clinical experience with, all the causes of painful or disabled locomotor apparatus; (b) manage such disorders in the most cost effective way; and (c) promote "shared clinical decision making". The diversity seen both among and within the European countries is due to the different activities of rheumatologists.Conclusion: Rheumatological competence must be based on a common core, as described in the UEMS core curriculum, and on deeper and diverse clinical or scientific knowledge covering the entire field of the specialty, to secure its flexibility and resilience in the market place and to promote its scientific development. [ABSTRACT FROM AUTHOR]

The title compound, (C3H12N2)2[AlF6][AlF4(H2O)2]·4H2O, was obtained by a solvothermal method in ethanol as solvent and with aluminium hydroxide, HF and 1,3-diaminopropane as educts. The asymmetric unit contains a quarter each of two crystallographically independent propane-1,3-diammonium dications, [AlF6]3− and [AlF4(H2O)2]− anions and four water molecules. The cations, anions and three of the independent water molecules are situated on special positions mm, while the fourth water molecule is disordered about a mirror plane. In the crystal, intermolecular N—H...F and O—H...F hydrogen bonds link the cations and anions into a three-dimensional framework with the voids filled by water molecules, which generate O—H...O hydrogen bonds and further consolidate the packing.

Danazol, a C17 alkylated anabolic steroid, has been tried as a hormonomodulator in the management of systemic lupus erythematosus. We report the case of a patient receiving 400 mg of danazol per day who developed mild pancreatitis associated with hepatitis, both induced by danazol. [ABSTRACT FROM AUTHOR]

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