Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome

Clinical Rheumatology - To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS. Fifty-seven...     

Interference with total hemolytic complement assay in rheumatoid arthritis: correlation with disease activity

A subgroup of patients with rheumatoid arthritis (RA) whose sera agglutinated sensitized sheep erythrocytes used for total hemolytic complement determination has been identified. These patients have higher titers of rheumatoid factor (RF) and more severe rheumatoid disease compared to controls. The agglutination of sensitized sheep erythrocytes by sera of some patients with RA may be related to qualitative or quantitative variations in their RF.     

Clinical assessment of disease activity in rheumatoid arthritis.

A new experimental design was developed to study the value of clinical parameters of disease activity in patients with rheumatoid arthritis. Ten patients with classical rheumatoid arthritis were examined by five senior doctors in a department of medical rheumatology. In spite of an attempt to make the clinical examination as uniform as possible the inter-observer variation among the doctors was greater than the variation among the patients, for the following parameters: joint pain at rest, joint tenderness and joint swelling. An acceptable inter-observer variation in relation to patient variation was found for 1) a combined registration of joint pain at rest or on movement, 2) duration of morning stiffness, 3) grip strength, 4) subjective well-being as indicated on a visual analogue scale, 5) fingertip--palm distance, and 6) maximum flexion-extension in elbows, wrists and knees. The variation from morning to afternoon and from day to day was negligible. It is concluded that registration of elaborated articular scores is useless in the daily routine in rheumatological departments when different doctors examine the patients.     

Bilateral carpal tunnel syndrome in Graves' disease

Carpal tunnel syndrome (CTS) may be associated with endocrinopathies, such as hypothyroidism and acromegaly. A direct relationship between CTS and hyperthyroidism has recently been suggested. We now report a case in which bilateral CTS developed after treatment of Graves' disease, thus, questioning the possibility of a relationship between these two disease processes.     

Decreased prolactin response to hypoglycaemia in patients with rheumatoid arthritis: correlation with disease activity

OBJECTIVE: To compare basal and stimulated prolactin levels between patients with rheumatoid arthritis and healthy controls, and to assess the effects of antirheumatic treatment on prolactin concentrations. METHODS: Serum prolactin was assessed under basal conditions and during an insulin tolerance test (ITT) in 20 patients with recently diagnosed active rheumatoid arthritis and 20 age and sex matched controls. The patients were reassessed after two weeks' treatment with naproxen and after six months' additional treatment with either sulfasalazine or methotrexate. Disease activity was assessed by the disease activity score (DAS). RESULTS: Basal levels of prolactin were not significantly different between patients with rheumatoid arthritis and controls. Prolactin responses to hypoglycaemia were less in untreated rheumatoid patients than in controls. DAS scores correlated negatively with the area under the curve (AUC) for prolactin concentrations during the ITT. Treatment with naproxen for two weeks did not influence either basal or stimulated prolactin levels. After six months of antirheumatic treatment, prolactin responses to hypoglycaemia increased significantly to levels observed in controls. At the same time point, DAS had improved considerably. The improvement correlated with the increase in AUC of prolactin during the ITT (r = 0.48; p = 0.05). CONCLUSIONS: Patients with active rheumatoid arthritis have a decreased prolactin response to hypoglycaemia induced stress. The response recovers following treatment with antirheumatic drugs.     

类风湿关节炎患者血清和关节液趋化因子RANTES的测定及其意义

目的：探讨血清、关节液中激活正常T细胞表达和分泌因子（RANTES）水平与类风湿关节炎（RA）病变活动的相关性。方法：有和酶联免疫吸附法（ELISA）测定28例类风湿关节炎患者血清及关节液中RANTES水平,并与骨关节炎（OA）患者对照,结果：RA患者血清RANTES水平明显高于OA,且RA滑液中RANTES水平高于血清,血清RANTES水平与关节肿胀指数,血沉,C反应蛋白呈正相关,结论：RA病变关节组织是RANTES产生的主要部位;血清RANTES水平与RA的活动性病变相关。     

Ultrasonographic measurement of the median nerve in patients with rheumatoid arthritis without symptoms or signs of carpal tunnel syndrome

OBJECTIVES: Ultrasonography (US) has shown increased cross-sectional area of the median nerve in carpal tunnel syndrome (CTS). Knowledge of the normal distribution of the areas is a prerequisite to evaluate pathology. Presently, the distribution of cross-sectional areas of the median nerve was explored in patients with rheumatoid arthritis (RA). METHODS: The median nerves of patients with RA having no symptoms or signs of CTS were examined with bilateral US at the entrance of the carpal tunnel. RESULTS: A total of 154 patients with RA were included. The median nerve was divided in 11.7% of the hands. The mean (SD) cross-sectional areas of the undivided median nerves were not significantly different on either sides (8.3 (1.5) mm(2) on the right side and 8.3 (1.4) mm(2) on the left side). The areas of the examined 308 median nerves ranged from 5.0 to 12.8 mm(2), with the 97.5 centile being 11.1 mm(2). Areas >10.0 mm(2) were found in 10% of the patients. CONCLUSIONS: The mean cross-sectional areas of the median nerve in patients with RA were similar to those reported in healthy controls. However, 10% of the patients had values that overlap with areas commonly reported in patients with mild idiopathic CTS.     

Analysis of lymphocyte subsets in the blood of rheumatoid arthritis patients: correlation with disease activity

Various erythrocyte rosette forming cells (ERFC) were quantified in 111 patients with rheumatoid arthritis (RA): total-ERFC (t-RFC), active-ERFC (act-ERFC), autologous-ERFC (auto-ERFC) and high affinity erythrocyte-antibody rosette forming cells (EA-RFC). B lymphocytes were counted using a direct immunofluorescence method. A decrease in act-ERFC and an increase in high affinity EA-RFC was found, but only the levels of the former correlated with the degree of inflammation and may be regarded as an indicator of clinical activity. Conversely, numbers of t-ERFC, auto-ERFC and B lymphocytes were found to be approximately normal. There was no correlation between the level of act-ERFC and the presence of rheumatoid factor, circulating immune complexes or antinuclear antibodies.