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Official Journal of the American College of Rheumatology

Volume 39, No. 2, January 1996

Special Articles

Guidelines for the Initial Evaluation of the Adult Patient with Acute Musculoskeletal Symptoms

• American College of Rheumatology Ad Hoc Committee on Clinical Guidelines 1

Review: Pathology and Pathogenesis of Vascular Injury in Systemic Lupus Erythematosus: Interactions of Inflammatory Cells and Activated Endothelium

• H. Michael Belmont, Steven B. Abramson, and J. T. Lie 9

Review: The T Cell Enigma in Lupus

• A. K. Dayal and Gary M. Kammer 23

Clinical Science

Development and Validation of the European League Against Rheumatism Response Criteria for Rheumatoid Arthritis: Comparison with the Preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria

• A. M. van Gestel, M. L. L. Prevoo, M. A. van 't Hof, M. H. van Rijswijk, L. B. A. van de Putte, and P. L. C. M. van Riel 34
• EULAR criteria for the assessment of individual treatment response in RA are presented. The validity of the EULAR, ACR, and WHO/ILAR response criteria is examined.

Oral Type II Collagen Treatment in Early Rheumatoid Arthritis: A Double-Blind, Placebo-Controlled, Randomized Trial

• Joachim Sieper, Sonja Kary, Helmut Sorensen, Rieke Alten, Ulrich Eggens, Werner Huge, Falk Hiepe, Andrea Kuhne, Joachim Listing, Norbert Ulbrich, Jurgen Braun, Angela Zink, and Nicholas Avrion Mitchison 41
• This report describes the results of a trial of treatment of RA with oral type II collagen, which is potentially a highly selective and nontoxic therapy. Problems associated with such therapy and further perspectives for the application of oral tolerance therapy are discussed.

Percentage of Anti-CD4 Monoclonal Antibody-Coated Lymphocytes in the Rheumatoid Joint is Associated with Clinical Improvement: Implications for the Development of Immunotherapeutic Dosing Regimens

• Ernest H. S. Choy, Costantino Pitzalis, Alberto Cauli, J. A. Bijl, Allen Schantz, J. Woody, Gabrielle H. Kingsley, and Gabriel S. Panayi 52
• After treatment with the chimeric anti-CD4 monoclonal antibody, cM-T412, the degree of CD4 lymphopenia and the percentage of cM-T412-coated CD4+ cells in the peripheral blood and synovial fluid differed greatly. While peripheral blood CD4 lymphopenia was not associated with therapeutic efficacy, the percentage of cM-T412-coated CD4+ lymphocytes in the synovial fluid correlated with the degree of clinical improvement seen in patients.

Treatment of Xerostomia with Polymer-Based Saliva Substitutes in Patients with Sjogren's Syndrome

• Willy A. van der Reijden, Hanneke van der Kwaak, Arjan Vissink, Enno C. I. Veerman, and Arie V. Nieuw Amerongen 57
• Salivary flow rates were found to influence patients' preferences for the different saliva substitutes, although no treatment was truly effective. It is recommended that individual salivary flow rates be considered in choosing saliva substitutes for Sjogren's syndrome patients. The development of a variety of new polymer-based saliva substitutes with different viscoelastic properties should increase the success of managing oral dryness in such complicated diseases as Sjogren's syndrome.

Relationship of Running to Musculoskeletal Pain with Age: A Six-Year Longitudinal Study

• James F. Fries, Gurkirpal Singh, Dianne Morfeld, Peter O'Driscoll, and Helen Hubert 64
• The rheumatologist needs to understand risk factors for musculoskeletal pain and disability with age, and their relationship to clinical osteoarthritis. This report presents a model for musculoskeletal aging, and longitudinal data relating vigorous physical exercise to these end points. The model strengthens the knowledge base for ``preventive rheumatology.''

Distal Extremity Swelling with Pitting Edema in Polymyalgia Rheumatica: Report of Nineteen Cases

• Carlo Salvarani, Sherine Gabriel, and Gene G. Hunder 73
• Distal extremity swelling with pitting edema is a manifestation of polymyalgia rheumatica. Recognition of this manifestation will help facilitate appropriate diagnosis and therapy.

Association of Radiographically Evident Osteoarthritis with Higher Bone Mineral Density and Increased Bone Loss with Age: The Rotterdam Study

• Huibert Burger, Paulus L. A. van Daele, Else Odding, Hans A. Valkenburg, Albert Hofman, Diederick E. Grobbee, Henry E. Schutte, Jan C. Birkenhager, and Huibert A. P. Pols 81
• This study demonstrated that subjects with osteoarthritis have increased bone mineral density and, therefore, possibly lower fracture risk. However, the accompanying increase in bone loss with age may cancel out this benefit in the long run.

The Epidemiology of Wegener's Granulomatosis: Estimates of the Five-Year Period Prevalence, Annual Mortality, and Geographic Disease Distribution from Population-Based Data Sources

• Mary Frances Cotch, Gary S. Hoffman, Diane E. Yerg, Gerald I. Kaufman, Paul Targonski, and Richard A. Kaslow 87
• A population-based estimate of the prevalence of Wegener's granulomatosis may be useful to clinicians and researchers in identifying communities where prevalence of the disease is high. Conducting in-depth epidemiologic investigations of individuals in such communities may facilitate further studies that attempt to address the issues of etiology and pathogenesis.

Cross-Cultural Adaptation of a Brief Outcome Questionnaire for Spanish-Speaking Arthritis Patients

• Agustin Escalante, Dionisio Galarza-Delgado, Thomas D. Beardmore, Bruce A. Baethge, Jorge Esquivel-Valerio, Ana Laura Marines, and Michelle Mingrone 93
• This report demonstrates the adaptation of the Activities of Daily Living Index of the Modified Health Assessment Questionnaire to the Spanish language. The original English version of this brief quesionnaire has been shown to be valid and reliable, and yet very easy to implement in clinical practice. Questionnaires such as the one presented will prevent the systematic exclusion of a large proportion of Hispanic patients from studies examining the outcome of arthritis and allied conditions.

Barriers to Return to Work Among Persons Unemployed Due to Arthritis and Musculoskeletal Disorders

• Karin V. Straaton, Richard Maisiak, J. Michael Wrigley, Mary B. White, Philip Johnson, and Philip R. Fine 101
• This prospective study determined barriers to work return among a group of persons with established unemployment due to arthritis and musculoskeletal disorders. The results provide insight into potentially modifiable factors influencing return to work among this group.

Basic Science

The Presence of Costimulatory Molecules CD86 and CD28 in Rheumatoid Arthritis Synovium

• Ming Fei Liu, Hitoshi Kohsaka, Hiroshi Sakurai, Miyuki Azuma, Ko Okumura, Ichiro Saito, and Nobuyuki Miyasaka 110
• In rheumatoid synovium, a subset of synoviocytes express CD86 costimulatory molecules, and surround CD28+ lymphoid aggregates. Their interaction might contribute to the aberrant immune activation seen in rheumatoid synovitis.

Synovial Tissue Macrophage Populations and Articular Damage in Rheumatoid Arthritis

• Diarmuid Mulherin, Oliver FitzGerald, and Barry Bresnihan 115
• The relative contribution of individual cell populations in the synovium to polyarticular destruction in RA remains controversial. This study related synovial immunohistologic features in 28 patients with RA to their radiologic course over a mean of 6 years and implicated synovial macrophages as critical mediators of articular destruction in these patients. These results have important implications for the development of new therapies which target synovial macrophages and their products.

Responsiveness of Human T Lymphocytes to Bacterial Superantigens Presented by Cultured Rheumatoid Arthritis Synoviocytes

• Carlene Tsai, Luis A. Diaz, Jr., Nora G. Singer, Lan Lan Li, Antia H. Kirsch, Raj Mitra, Brian J. Nickoloff, Leslie J. Crofford, and David A. Fox 125
• This study demonstrated that synovial fibroblasts from patients with RA can serve as accessory cells for activation of T lymphocytes by superantigens, and also by the lectin phytohemagglutinin. If synovial fibroblasts can mediate initiation of immune responses in vivo as well as in vitro, this mechanism could be important in the pathogenesis of early RA.

Cutaneous Lymphocyte Antigen-Positive T Lymphocytes Preferentially Migrate to the Skin but Not to the Joint in Psoriatic Arthritis

• Costantino Pitzalis, Alberto Cauli, Nicolo Pipitone, Catherine Smith, Jonathan Barker, Antonio Marchesoni, Ghada Yanni, and Gabriel S. Panayi 137
• This study found that CLA+ T cells preferentially accumulate in the skin, but not the joint, of patients with PsA, and also predominate in the delayed-type hypersensitivity skin lesions and epidermal skin blisters of patients with rheumatoid arthritis. This pattern of T cell infiltration is regulated by both organ-specific homing and general inflammation-related mechanisms. These findings have notable pathogenetic implications for the formation of skin and synovial lesions in PsA and, in general, for the generation of the inflammatory/immune cell infiltrate in different tissues.

Autoantibodies to Glycyl-Transfer RNA Synthetase in Myositis: Association with Dermatomyositis and Immunologic Heterogeneity

• Michito Hirakata, Akira Suwa, Yoshihiko Takeda, Yasuo Matsuoka, Shoichiro Irimajiri, Ira N. Targoff, John A. Hardin, and Joe Craft 146
• Antibodies to aminoacyl-tRNA synthetases are the most common autoantibodies found in individuals with polymyositis and dermatomyositis, and are valuable aids in the diagnosis of these diseases. This report describes the presence of novel autoantibodies to glycyl-tRNA synthetase in a patient with dermatomyositis and emphasizes that, based on this finding and a review of published work, this specificity is associated with the illness. Moreover, this work underscores the fact that autoantibodies to aminoacyl-tRNA synthetases may be more immunologically variable than originally recognized, suggesting that there are diverse mechanisms for their genesis.

Clinical Images

Mees' Lines

• David R. Finger and Martin B. Giandoni 151

Case Reports

The Coexistence of Systemic Sclerosis and Rheumatoid Arthritis in Five Patients: Clinical and Immunogenetic Features Suggest a Distinct Entity

• Terumi Horiki, Junko Moriuchi, Masatoshi Takaya, Mitsuaki Uchiyama, Yuichi Hoshina, Kenichi Inada, Hidetoshi Inoko, Kmiyoshi Tsuji, and Yukinobu Ichikawa 152

The Antiinflammatory and Antiviral Effects of Hydroxychloroquine in Two Patients with Acquired Immunodeficiency Syndrome and Active Inflammatory Arthritis

• Matthew H. Ornstein and Kirk Sperber 157

Healing Phenomena of Erosive Changes in Rheumatoid Arthritis Patients Undergoing Disease-Modifying Antirheumatic Drug Therapy

• Rolf Rau and Gertraud Herborn 162

Splinter Hemorrhages Following Arterial Puncture

• Peter B. Martens, James A. Levine, and Gene G. Hunder 169

Complete Remission of Multicentric Reticulohistiocytosis with Combination Therapy of Steroid, Cyclophosphamide, and Low-Dose Pulse Methotrexate: Case Report, Review of the Literature, and Proposal for Treatment

• George C. Liang and Arthur S. Granston 171

Rocky Mountain Spotted Fever Presenting with Acute Monarticular Arthritis

• John S. Sundy, Nancy B. Allen, and Daniel J. Sexton 175

Concise Communication

Evaluation of Two Interventions to Reduce the Ancillary Costs of Outpatient Care for Rheumatoid Arthritis

• Jeffrey N. Katz, Elizabeth A. Wright, Kari D. Lynch, and Michael E. Weinblatt 177

Letters

The Paradoxical Association Between Immunodeficiency and Autoimmunity: Comment on the Article by Atkinson

• Nikolai Petrovsky 179

Reply

• John P. Atkinson 180

Treatment of Scleroderma Lung Disease: Comment on the Article by Steen et al

• Michael J. Fairfax 180

Fibromyalgia or Multi-Organ Dysesthesia?

• Arthur F. Kavanaugh 180

Synovial Tissue Responses Following Treatment of Rheumatoid Arthritis with the Humanized Monoclonal Antibody CAMPATH-1H

• Enrique R. Soriano, Jonathan Dixey, Nicolas D. Hall, Joan Davies, and Peter J. Maddison 181

Fatal Postpartum Vasculitis in Systemic Lupus Erythematosus

• Osvaldo Hubscher, Alicia Eimon, and Roberto M. Arana 182

ACR Announcements 6A

Volume 39, No. 2, February 1996

Special Articles

Review: Presentation of Self Peptides by Dendritic Cells: Possible Implications for the Pathogenesis of Rheumatoid Arthritis

• Ranjeny Thomas and Peter E. Lipsky 183

Viewpoint: Maternal-Fetal Immunology and Autoimmune Disease: Is Some Autoimmune Disease Auto-Alloimmune or Allo-Autoimmune?

• J. Lee Nelson 191

Fifth International Symposium on Sjogren's Syndrome

• Robert I. Fox 195

Basic Science

Activation of Transcription Factor NF-[gk]B in Human Synovial Cells in Response to Tumor Necrosis Factor α

• Koushi Fujisawa, Hiroyuki Aono, Tomoko Hasunuma, Kazuhiko Yamamoto, Shiro Mita, and Kusuki Nishioka 197
• This is the first study to demonstrate activation of transcription factor NF-[gk]B in response to TNFα in synovial cells and to examine the effect of NF-[gk]B inhibitor on TNFα-induced synovial cell proliferation and activation. The results suggest that activation of NF-[gk]B is a possible mechanism of synovial cell proliferation and activation.

Depletion of γ/δ T Cells Does Not Prevent or Ameliorate, but Rather Aggravates, Rat Adjuvant Arthritis

• Carme Pelegri, Petra Kuhnlein, Eberhard Buchner, Carsten B. Schmidt, Angels Franch, Margarida Castell, Thomas Hunig, Frank Emmrich, and Raimund W. Kinne 204
• γ/δ T cells preferentially recognize mycobacterial antigens in humans and mice and are increased in peripheral blood and synovial fluid of patients with rheumatoid arthritis. Treatment of Mycobacterium-induced rat adjuvant arthritis with a monoclonal antibody directed against T cell receptor γ/δ revealed that γ/δ T cells do not promote or perpetuate arthritis, but rather may play a protective role.

Neutrophil Trafficking Into Inflamed Joints in Patients with Rheumatoid Arthritis, and the Effects of Methylprednisolone

• Peter P. Youssef, John Cormack, Charles A. Evill, Daryl T. Peter, Peter J. Roberts-Thomson, Michael J. Ahern, and Malcolm D. Smith 216
• This study investigates the mechanisms of action of pulse corticosteroids, which are potent antiinflammatory agents that are typically prescribed in rheumatology practice. The effects of this treatment on RA, a common rheumatologic condition which may be associated with severe morbidity and mortality, are evaluated.

Inhibition of Lymphocyte Adhesion to Cytokine-Activated Synovial Fibroblasts by Glucocorticoids Involves the Attenuation of Vascular Cell Adhesion Molecule 1 and Intercellular Adhesion Molecule 1 Gene Expression

• Philippe A. Tessier, Paola Cattaruzzi, and Shaun R. McColl 226
• While glucocorticoids are widely used as antiinflammatory agents, their exact mechanism of action is not completely understood. This study shows that glucocorticoids inhibit lymphocyte adhesion to synovial fibroblasts, an effect that is likely mediated, at least in part, by an attenuation of ICAM-1 and VCAM-1 gene expression. Results from this study provide a conceptual basis for the pursuit of new therapeutic avenues such as anti-TNFα and anti-ICAM-1 antibody therapies currently under clinical trials.

Activation of Recombinant Human Neutrophil Procollagenase in the Presence of Doxycycline Results in Fragmentation of the Enzyme and Loss of Enzyme Activity

• Gerald N. Smith, Jr., Kenneth D. Brandt, and Karen A. Hasty 235
• Cartilage destruction in osteoarthritis is due to the action of matrix metalloproteinases (MMP). Doxycycline slows the progression of cartilage destruction in experimental osteoarthritis, presumably by reducing the level of MMP. This study demonstrates, using human recombinant MMP-8 (neutrophil collagenase) as a model, that this reduction may be due in part to enhanced degradation of the enzyme.

Specificity of a Porcine 127-kd Nucleotide Pyrophosphohydrolase for Articular Tissues

• Antonio Cardenal, Ikuko Masuda, Arthur L. Haas, and Daniel J. McCarty 245
• A sedimentable porcine 127-kd nucleotide pyrophosphohydrolase associated with extracellular vesicles was found only in hyaline, fibrous, and elastic cartilage and in ligamentous and tendinous tissues. Since antibodies to this molecule cross-react with a human counterpart, the specificity of this enzyme for cartilage and other joint tissues prompted a search for degradation products in human serum as a potential molecule reflecting connective tissue metabolism.

Identification of a Nucleotide Pyrophosphohydrolase from Articular Tissues in Human Serum

• Antonio Cardenal, Ikuko Masuda, Arthur L. Haas, Wataru Ono, and Daniel J. McCarty 252
• The apparent specificity of a 127-kd NTPPHase for cartilage, ligament, and tendon is described in the accompanying paper. A soluble degradation product of this enzyme is found in normal human serum as well as in serum from patients with joint diseases. The 127-kd enzyme is the only active ecto-NTPPHase in these sera. This human NTPPHase is immunologically and kinetically identical to the porcine enzyme and is immunologically identical to the sedimentable 127-kd protein found in normal and pathologic synovial fluids. Serum levels of this enzyme might reflect changes in the metabolism of connective tissues.

Clinical Science

Recombinant Human Interleukin-1 Receptor Type I in the Treatment of Patients with Active Rheumatoid Arthritis

• Barbara E. Drevlow, Rosa Lovis, Mary Ann Haag, James M. Sinacore, Cindy Jacobs, Consuelo Blosche, Alan Landay, Larry W. Moreland, and Richard M. Pope 257
• An understanding of the immune mechanisms responsible for the initiation and perpetuation of the chronic synovitis of RA is important to all rheumatologists. This study is the first in which soluble IL-1R was administered systemically in an attempt to modulate the chronic inflammation associated with RA.

The Mortality of Rheumatoid Vasculitis Compared with Rheumatoid Arthritis

• Alexandre E. Voskuyl, Aeilko H. Zwinderman, Marie Louise Westedt, Jan P. Vandenbroucke, Ferdinand C. Breedveld, and Johanna M. W. Hazes 266
• In this retrospective cohort study, the first to compare mortality in rheumatoid vasculitis versus rheumatoid arthritis patients, the apparent high mortality rate of RV patients was mainly due to age, male sex, and severity of arthritis. Adjustment for these factors resulted in only a small excess mortality in RV patients when compared with the RA controls. A beneficial effect of prompt immunosuppressive and cytostatic treatment in RV patients with severe organ involvement might have contributed to this favorable outcome of RV.

Pancytopenia Secondary to Methotrexate Therapy in Rheumatoid Arthritis

• Sergio Gutierrez-Urena, Jose F. Molina, Cesar O. Garcia, Marta L. Cuellar, and Luis R. Espinoza 272
• A literature search revealed 70 reports of rheumatoid arthritis patients in whom pancytopenia developed in association with methotrexate treatment. Twelve of the 70 cases were fatal. Serious hematologic toxicity appears to be an underrecognized side effect of methotrexate treatment.

The Systemic Effect of Intraarticular Administration of Corticosteroid on Markers of Bone Formation and Bone Resorption in Patients with Rheumatoid Arthritis

• Ronald D. Emkey, Robert Lindsay, Jane Lyssy, Jerome S. Weisberg, David W. Dempster, and Victor Shen 277
• Intraarticular administration of corticosteroid has only a transient systemic effect on bone turnover markers. This therapeutic mode may be better for bone metabolism than continuous use of orally administered corticosteroid in the treatment of rheumatoid arthritis patients.

Rheumatoid Arthritis in a United States Public Health Service Hospital in Oklahoma: Serologic Manifestations in Rheumatoid Arthritis Vary Among Tribal Groups

• R. Hal Scofield, Mark Fogle, Everett R. Rhoades, and John B. Harley 283
• This work describes the experience with RA in a USPHS hospital serving Native Americans. It was found that the disease is serologically distinct in one group compared with other groups living in the same area. The heterogeneity among patients with RA who are of similar ethnic origin is clinically important to the practicing rheumatologist.

Evaluating Systemic Lupus Erythematosus Disease Activity Using Molecular Markers of Hemostasis

• Masayuki Inoh, Michiaki Tokuda, Hiroyuki Kiuchi, Noriyuki Kurata, and Jiro Takahara 287
• The coagulation-fibrinolysis system is enhanced when disease activity is high. Measuring the sensitive parameters of the coagulation-fibrinolysis system could provide useful information for following the disease activity of SLE.

Sensitivity and Specificity of Anti-Jo-1 Antibodies in Autoimmune Diseases with Myositis

• Dolores Vazquez-Abad and Naomi F. Rothfield 292
• Polymyositis/dermatomyositis and the scleroderma spectrum of diseases are autoimmune diseases characterized by the presence of specific autoantibodies. In both disease groups the autoantibody identifies different clinical subsets and outcomes and may assist in selecting therapeutic strategies. Since myositis is not uncommon in SSc, the presence of SSc was investigated in these patients, and this antibody was found to be absent in this disease group. Thus, anti-Jo-1 does not predict myositis and/or interstitial lung fibrosis in SSc patients, but is highly specific for PM/DM (specificity 100%, sensitivity = 20%).

Long-Term Followup of Patients with Sjogren's Syndrome

• Aike A. Kruize, Ronald J. Hene, Agnes van der Heide, Cliff Bodeutsch, Peter C. M. de Wilde, O. Paul van Bijsterveld, Jan de Jong, T. E. W. Feltkamp, Louis Kater, and Johannes W. J. Bijlsma 297
• In this long-term followup study, primary Sjogren's syndrome generally appeared to be a stable disease with a mild course of glandular and extraglandular manifestations, but with a marked increased risk for development of malignant lymphoma. Since patients with isolated keratoconjunctivitis sicca do not bear this increased risk for the development of malignant lymphoma, the presumptive diagnosis of primary Sjogren's syndrome in these patients should be confirmed.

Polymyalgia Rheumatica in Patients with a Normal Erythrocyte Sedimentation Rate

• Simon M. Helfgott and Raphael I. Kieval 304
• The hallmark laboratory test for the diagnosis of PMR is the elevated ESR. In the present series of 117 patients with PMR, 22% of patients had a normal ESR. Distinguishing features of these patients were a higher incidence of males, normal hemoglobin levels, and a delay in diagnosis. The presence of a normal ESR in a patient with suspected PMR should not necessarily rule out the diagnosis and may not be uncommon.

Numerical Scoring Systems for the Anatomic Evolution of Osteoarthritis of the Finger Joints

• Gust Verbruggen and Eric M. Veys 308
• Systems were developed to score anatomic changes in the finger joints of 46 patients with OA who were followed up for more than 3 years, enabling clinicians to define the rate of progression of OA. From radiographs of the hands, it could be concluded that OA of the finger joints was progressive in nature and went through predictable phases.

Case Reports

Nonsteroidal Antiinflammatory Drug-Induced Enteropathy and Severe Chronic Anemia in a Patient with Rheumatoid Arthritis

• Neal M. Davies, Fakhreddin Jamali, and Kenneth J. Skeith 321

Methotrexate-Associated Lymphoma in Patients with Rheumatoid Arthritis: Report of Two Cases

• Teresa R. Bachman, Allen D. Sawitzke, Sherrie L. Perkins, John H. Ward, and Grant W. Cannon 325

Multiple Myeloma-Associated Systemic Vasculopathy Due to Crystalglobulin or Polyarteritis Nodosa

• Hisashi Hasegawa, Tetsuo Ozawa, Noriyoshi Tada, Youko Taguchi, Koichiro Ohno, Takaaki Chou, Takeshi Watanabe, Takeshi Kuroda, Masaaki Nakano, Hiroyuki Usuda, Iwao Emura, and Masaaki Arakawa 330

Cryocrystalglobulinemia as a Cause of Systemic Vasculopathy and Widespread Erosive Arthropathy

• Thomas Papo, Lucile Musset, Thomas Bardin, Barbara Bucki, Christian Jorgensen, Elisabeth Dion, Alain Quillard, Christian de Gennes, Jacques Sany, Pierre Godeau, and Jean-Charles Piette 335

Gastric Antral Vascular Ectasia (Watermelon Stomach) in Patients with Systemic Sclerosis

• Maria Watson, Robert J. Hally, Peter A. McCue, John Varga, and Sergio A. Jimenez 341

Calcific Constrictive Pericarditis: A Rare Complication of CREST Syndrome

• Prerana Panchal, Elaine Adams, and Annming Hsieh 347

Letters

HLA-DR8 and Susceptibility to Acute Anterior Uveitis in Ankylosing Spondylitis: Comment on the Article by Monowarul Islam et al

• Rafal Ploski, Walter Maksymowych, and Oystein Forre 351

Reply

• S. M. Monowarul Islam, Jiro Numaga, and Hiroo Maeda 351

Fatal postpartum vasculitis in systemic lupus erythematosus

• Osvaldo Hubscher, Alicia Eimon, and Roberto M. Arana 352

Hepatitis C as Another Possible Cause of Porphyria Cutanea Tarda and Systemic Lupus Erythematosus: Comment on the Article by Kutz and Bridges

• Karen Nepveu and Bonita Libman 352

Reply

• Alan J. Bridges 353

Chinese Herbs Can Themselves Be Harmful: Comment on the Article by Gertner et al

• Manuel Macia, Juan Navarro, Victor Garcia-Nieto, and Javier Garcia 354

Reply

• E. Gertner and Peter S. Marshall 355

Book Review 355

ACR Announcements 10A

Volume 39, No. 3, March 1996

Special Articles

Conference Summary: Workshop on Chronic Pain, Pain Control, and Patient Outcomes in Rheumatoid Arthritis and Osteoarthritis

• Nicholas Bellamy and Laurence A. Bradley 357

Clinical Science

The Development and Initial Validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus

• Dafna Gladman, Ellen Ginzler, Charles Goldsmith, Paul Fortin, Matthew Liang, Murray Urowitz, Paul Bacon, Stefano Bombardieri, John Hanly, Elaine Hay, David Isenberg, John Jones, Kenneth Kalunian, Peter Maddison, Ola Nived, Michelle Petri, Martin Richter, Jorge Sanchez-Guerrero, Michael Snaith, Gunnar Sturfelt, Deborah Symmons, and Asad Zoma 363

• An instrument to assess accumulated damage in patients with SLE was developed, and its validity was demonstrated. This index will allow clinicians and researchers to assess accumulated damage in SLE patients, which will be helpful in clinical trials, studies of patient populations, and determination of prognosis in individual patients.

Laboratory Tests As Predictors of Disease Exacerbation in Systemic Lupus Erythematosus: Why Some Tests Fail

• John M. Esdaile, Michal Abrahamowicz, Lawrence Joseph, Todd MacKenzie, Yin Li, and Deborah Danoff 370

• This study demonstrates that changes in the results of commonly available laboratory tests are poor predictors of disease exacerbations in SLE patients who are seen in an academic setting. However, sustained abnormalities in selected test values have been observed in those patients who are destined to have different types of flares.

Disease Severity in Patients with Systemic Lupus Erythematosus Correlates with an Increased Ratio of Interleukin-10:Interferon-γ-Secreting Cells in the Peripheral Blood

• Eri Hagiwara, Mark F. Gourley, Susie Lee, and Dennis M. Klinman 379

• This study examines the production of immunoregulatory cytokines in patients with SLE. Disease severity correlated with increased numbers of cells secreting cytokines that augment humoral rather than cellular immune responses. Both T cells and monocytes were implicated in this process.

Interleukin-10 Functions as an Antiinflammatory Cytokine in Rheumatoid Synovium

• Pia Isomaki, Reijo Luukkainen, Riitta Saario, Paavo Toivanen, and Juha Punnonen 386

• The results of this study indicate that endogenously produced IL-10 functions as an immunoregulatory molecule in rheumatoid synovium. In addition, exogenous IL-10 has potent antiinflammatory effects on SFMC, suggesting that IL-10 may be useful in the treatment of patients with RA.

Increased Bone Mass with Pamidronate Treatment in Rheumatoid Arthritis: Results of a Three-Year Randomized, Double-Blind Trial

• Frank Eggelmeijer, Socrates E. Papapoulos, Henk C. van Paassen, Ben A. C. Dijkmans, Roelf Valkema, Marie Louise Westedt, Jan-Otto Landman, Ernest K. J. Pauwels, and Ferdinand C. Breedveld 396

• In this study, the use of pamidronate as a bone-sparing agent in RA was investigated. Long-term treatment of RA patients with oral pamidronate overcame bone loss and increased bone mass, compared with placebo. These findings indicate that oral bisphosphonate may be a useful bone-sparing agent for patients with RA.

Early Undifferentiated Connective Tissue Disease. IV. Musculoskeletal Manifestations in a Large Cohort of Patients with Undifferentiated Connective Tissue Diseases Compared with Cohorts of Patients with Well-Established Connective Tissue Diseases: Followup Analyses in Patients with Unexplained Polyarthritis and Patients with Rheumatoid Arthritis at Baseline

• Graciela S. Alarcon, Robert F. Willkens, John R. Ward, Daniel O. Clegg, John G. Morgan, Khe-Ni Ma, Joyce Z. Singer, Virginia D. Steen, Harold E. Paulus, Michael E. Luggen, Richard P. Polisson, Carol M. Ziminski, Cheryl Yarboro, and H. James Williams 403

• A cohort of patients with well-established connective tissue diseases (CTD) such as rheumatoid arthritis or with symptoms suggestive of CTD but not diagnostic of a specific disease, with a symptom duration of 1 year or less, were followed up for 5 years. Baseline predictors of the development of RA, the achievement of remission in RA, and other outcomes were assessed. The results have implications with regard to early treatment decisions.

The Effect of Progressive Resistance Training in Rheumatoid Arthritis: Increased Strength without Changes in Energy Balance or Body Composition

• Laura C. Rall, Simin Nikbin Meydani, Joseph J. Kehayias, Bess Dawson-Hughes, and Ronenn Roubenoff 415

• This study demonstrates that high-intensity strength training is both feasible and safe in reversing the weakness and functional impairment of RA, in patients with well-controlled disease. Strength training leads to significant improvements in strength, pain, and fatigue without exacerbating disease activity or joint damage. These findings provide an important additional treatment component for patients with RA.

Gender, Paid Work, and Symptoms of Emotional Distress in Rheumatoid Arthritis Patients

• Judith Fifield, Susan Reisine, T. Joseph Sheehan, and Julia McQuillan 427

• Emotional distress is a major problem for patients with RA. This report offers data as to the social and disease-based factors that contribute to the gender gap in depressive symptoms among RA patients in the paid workforce.

Psychiatric Diagnoses in Patients with Fibromyalgia Are Related to Health Care-Seeking Behavior Rather than to Illness

• Leslie A. Aaron, Laurence A. Bradley, Graciela S. Alarcon, Ronald W. Alexander, Mireya Triana-Alexander, Michelle Y. Martin, and Kristin R. Alberts 436

• Psychiatric diagnoses and psychological distress were assessed among patients with fibromyalgia syndrome (FMS), community residents with FMS who had not seen a physician for their symptoms (``FMS nonpatients''), and healthy controls, to determine the relationship between psychiatric morbidity and FMS. Patients with FMS exhibited significantly higher rates of lifetime psychiatric diagnoses than FMS nonpatients and controls. Nonpatients did not differ from controls in number of diagnoses, suggesting that psychiatric morbidity is more strongly rerlated to health care-seeking behavior than to FMS itself.

Basic Science

High Frequencies of Identical T Cell Clonotypes in Synovial Tissues of Rheumatoid Arthritis Patients Suggest the Occurrence of Common Antigen-Driven Immune Responses

• Yoko Ikeda, Kayo Masuko, Yuta Nakai, Tomohiro Kato, Tomoko Hasanuma, Shin-Ichi Yoshino, Yutaka Mizushima, Kusuki Nishioka, and Kazuhiko Yamamoto 446

• This study demonstrates for the first time that large numbers of identical T cell clones are present in different areas of RA synovial tissues. This suggests that the immune responses in RA lesions are not random and points to the existence of a strong T cell response against common antigens.

Limited Heterogeneity of Rearranged T Cell Receptor Vα and Vβ Trancss in Synovial Fluid T Cells in Early Stages of Rheumatoid Arthritis

• Dagmar-Christiane Fischer, Bertram Opalka, Axel Hoffmann, Wolfgang Mayr, and Hans-Dieter Haubeck 454

• Evidence shows that T cells play a critical role in the etiology and pathogenesis of RA. To identify these T cells, it is essential to analyze the TCR repertoire in the early stages of the disease. The present study uses RT-PCR to amplify TCR Vα and Vβ trancss of synovial T cells in the early stages of RA. The results show a limited heterogeneity of V[ga] and Vβ TCRs in synovial fluid T cells, and a preferential usage of TCR Vα17 in the early stages of RA, which suggests a pathogenetic role for Vα17 T cells.

High Seroprevalence of Anti-HTLV-I Antibody in Rheumatoid Arthritis

• Katsumi Eguchi, Tomoki Origuchi, Hiroyuki Takashima, Kokichi Iwata, Shigeru Katamine, and Shigenobu Nagataki 463

• In this study, the age-adjusted summary odds ratio of HTLV-I infection among female RA patients in an HTLV-I-endemic area, as compared with a general population of blood donors, was 2.8 (95% CI 1.8- 4.6). The etiologic fraction, i.e., the proportion of RA in the study population that is attributable to HTLV-I infection, was estimated to be 13.2% (95% CI 5.1-21.2). These results support the notion that HTLV-I infection is a risk factor for RA.

Regulation of Adhesion Molecule Expression by Human Synovial Microvascular Endothelial Cells In Vitro

• Shing S. T. To, Peter M. Newman, Valentine J. Hyland, Bruce G. Robinson, and Leslie Schrieber 467

• Adhesion molecules play important roles in inflammation. This study demonstrates that the expression of these molecules by synovial microvascular endothelium differs from their expression by neonatal foreskin and human umbilical vein endothelium. Understanding the regulation of adhesion molecules on synovial microvascular endothelium may provide insights into the pathogenesis of rheumatoid arthritis.

The Superficial Layer of Human Articular Cartilage Is More Susceptible to Interleukin-1-Induced Damage than the Deeper Layers

• H. J. Hauselmann, J. Flechtenmacher, L. Michal, E. J.-M.A. Thonar, M. Shinmei, K. E. Kuettner, and M. B. Aydelotte 478

• Development of successful therapy for patients with various forms of arthritis will depend to a large extent on a better understanding of the metabolism of normal human articular cartilage and of how the metabolic processes in diseased joints might be modulated by biochemical and biomechanical factors. The stratified nature of articular cartilage, resulting from variations in chondrocyte metabolism, is critical for the normal properties and load-bearing functions of the tissue. This study demonstrates that cells in the superficial layer of articular cartilage are significantly more responsive to damage induced by IL-1 and are less readily protected by the naturally occurring IL-1 receptor antagonist protein than are cells that lie deeper in the tissue. Since IL-1 may play a role in cartilage damage in the arthritides, these findings of important metabolic differences between chondrocytes from different zones of normal human articular cartilage shed new light on possible disease mechanisms.

The Effect of Methotrexate on Mouse Bone Cells in Culture

• Kimberly P. May, Don Mercill, Michael T. McDermott, and Sterling G. West 489

• This study demonstrates that diminished osteoblastic cell function occurs in mouse bone cells after administration of low mean doses of methotrexate. This finding suggests that methotrexate therapy may contribute to osteoporosis in patients receiving this therapy for rheumatoid arthritis or other inflammatory diseases.

Interleukin-10 Inhibition of the Progression of Established Collagen-Induced Arthritis

• Marita Walmsley, Peter D. Katsikis, Erika Abney, Sarah Parry, Richard O. Williams, Ravinder N. Maini, and Marc Feldmann 495

• This study demonstrates that IL-10, injected after the onset of arthritis in mice with collagen-induced arthritis, induces a dose-dependent amelioration of both joint inflammation and destruction, as assessed histologically. This supports the possibility that IL-10 is a candidate therapeutic agent. Its efficacy needs to be assessed by clinical trial.

Disease-Modifying Activity of SK&F 106615 in Rat Adjuvant-Induced Arthritis: Multiparameter Analysis of Disease Including Magnetic Resonance Imaging and Bone Mineral Density Measurements

• Jeremy N. Bradbeer, Rasesh D. Kapadia, Susanta K. Sarkar, Hugh Zhao, George B. Stroup, Barbara A. Swift, David J. Rieman, and Alison M. Badger 504

• SK&F 106615 is a member of a class of compounds known as the azaspiranes and is currently in phase I clinical trials for rheumatoid arthritis. These compounds demonstrate therapeutic activity in animal models of autoimmune disease and transplantation. Their protective effects on joint integrity in rats with adjuvant-induced arthritis, as demonstrated in the present study, indicate that they may be disease-modifying agents.

The Effect of Leukotriene Synthesis Inhibitors in Models of Acute and Chronic Inflammation

• Cheryl L. Nickerson-Nutter and Eugene D. Medvedeff 515

• This study demonstrates the efficacy of 2 leukotriene synthesis inhibitors, Bay y 1015 and Bay x 1005, in combination with naproxen in the collagen-induced arthritis model in mice. The results indicate that combination therapy with leukotriene synthesis inhibitors and nonsteroidal antiinflammatory drugs may be a more effective treatment, with fewer side effects, than treatment with either class of drugs administered alone.

Some Autoantibodies to Ro/SS-A and La/SS-B are Antiidiotypes to Anti-Double-Stranded DNA

• Wei Zhang and Morris Reichlin 522

• In many systemic lupus erythematosus patients who produce anti-Ro/SS-A and anti-La/SS-B, anti-dsDNA antibodies are rarely seen, even after long followup. Correspondingly, the prevalence of nephritis in these patients is low. This study shows that in such patients, subpopulations of anti-Ro/SS-A and anti-La/SS-B are antiidiotypes to anti-dsDNA and probably down-regulate the production of anti-dsDNA.

Concise Communication

Systemic Pseudovasculitis from Scurvy in Anorexia Nervosa

• Cindy L. Mehta, Derek Cripps, and Alan J. Bridges 532

Letters

Low Shed L-Selectin Levels in Kawasaki Disease with Coronary Artery Lesions: Comment on the Article by Furukawa et al

• Shoko Kanekura, Isao Kitajima, Junichiro Nishi, Masao Yoshinaga, Koichiro Miyata, and Ikuro Maruyama 534

Human T Cell Leukemia/Lymphoma Virus Type I DNA and Polymyositis/Dermatomyositis: Comment on the Article by Sherman et al

• Louis-Jean Couderc, Maria-Pia Flammang, Isabelle Caubarrere, and Jean-Claude Vernant 535

American College of Rheumatology Preliminary Definition of Improvement in Rheumatoid Arthritis: Comment on the Article by Felson et al

• Anke van Gestel and Piet van Riel 535

Reply

• David T. Felson 536

Monoclonal Antiphospholipid Antibodies and Germline VH Genes: Comment on the Article by Harmer et al

• Anisur Rahman, David A. Isenberg, and David S. Latchman 537

Reply

• Ian J. Harmer, Sozos Loizou, Alex K. L. So, Mark J. Walport, Charles Mackworth-Young, and Keith M. Thompson 538

ACR Announcements 9A

Volume 39, No. 4, April 1996

Basic Science

Enhancement of SPARC (Osteonectin) Synthesis in Arthritic Cartilage: Increased Levels in Synovial Fluids from Patients with Rheumatoid Arthritis and Regulation by Growth Factors and Cytokines in Chondrocyte Cultures

TSG-6 Expression in Human Articular Chondrocytes: Possible Implications in Joint Inflammation and Cartilage Degradation

Stimulation of TIMP-1 Production by Oncostatin M in Human Articular Cartilage

Fibronectin Synthesis in Superficial and Deep Layers of Normal Articular Cartilage

src-Related Tyrosine Kinases Regulate Transcriptional Activation of the Interstitial Collagenase Gene, MMP-1, in Interleukin-1-Stimulated Synovial Fibroblasts

Activation of the Transcription Factor Nuclear Factor-[gk]B in Human Inflamed Synovial Tissue

Cell-Type Specificity of Anti-CD45 Autoantibodies in Systemic Lupus Erythematosus

Defective Antigen-Presenting Cell Function in Patients with Systemic Lupus Erythematosus: Role of the B7-1 (CD80) Costimulatory Molecule

Polymyositis, Arthritis, and Uveitis in a Macaque Experimentally Infected with Human T Lymphotropic Virus Type I

Clinical Images

Wegener's Granulomatosis of the Lungs

Yoel Drucker 615

Clinical Science

Reduction in Long-Term Disability in Patients with Rheumatoid Arthritis by Disease-Modifying Antirheumatic Drug-Based Treatment Strategies

A Pilot Trial of Oral Type II Collagen in the Treatment of Juvenile Rheumatoid Arthritis

Elevated Levels of the Soluble Form of Bone Marrow Stromal Cell Antigen 1 in the Sera of Patients with Severe Rheumatoid Arthritis

Epstein-Barr Virus Clonality in Lymphomas Occurring in Patients with Rheumatoid Arthritis

Elevated Nitric Oxide Production in Rheumatoid Arthritis: Detection Using the Fasting Urinary Nitrate:Creatinine Ratio

Do Antioxidant Micronutrients Protect Against the Development and Progression of Knee Osteoarthritis?

Hair Dye Use and the Risk of Developing Systemic Lupus Erythematosus: A Cohort Study

Homozygous Hereditary C1q Deficiency and Systemic Lupus Erythematosus: A New Family and the Molecular Basis of C1q Deficiency in Three Families

Antiribosomal P Antibodies in Pediatric Patients with Systemic Lupus Erythematosus and Psychosis

Thallium Perfusion Defects Predict Subsequent Cardiac Dysfunction in Patients with Systemic Sclerosis

A Prospective Long-Term Study of Fibromyalgia Syndrome

Case Reports

Enhancement of Anti-DNA Topoisomerase I Autoantibody Response After Lung Cancer in Patients with Systemic Sclerosis: A Report of Two Cases

Masataka Kuwana, Takao Fujii, Tsuneyo Mimori, and Junichi Kaburaki 686

Coexistence of Two Antisynthetases in a Patient with the Antisynthetase Syndrome

Carmen Gelpi, Eduardo Kanterewicz, Jordi Gratacos, Ira N. Targoff, and Jose Luis Rodriguez-Sanchez 692

IgA Multiple Myeloma Presenting as Henoch-Schonlein Purpura/Polyarteritis Nodosa Overlap Syndrome

Daniel Birchmore, Christine Sweeney, Devasmita Choudhury, Martin F. Konwinski, Kevin Carnevale, and Vivette D'Agati 698

Concise Communications

Intravenous Immunoglobulin Therapy: Modification of the Immunofluorescence Pattern in the Skin of Six Patients with Systemic Lupus Erythematosus

P. Puddu, O. De Pita, M. Ruffelli, A. M. Bellucci, C. R. Girardelli, M. Galeazzi, and R. Marcolongo 704

Familial Primary Antiphospholipid Antibody Syndrome

Amolak S. Bansal, Patrick G. Hogan, Harry Gibbs, and Ian H. Frazer 705

Mannose-Binding Protein in Chinese Patients with Systemic Lupus Erythematosus

Y. L. Lau, C. S. Lau, S. Y. Chan, J. Karlberg, and M. W. Turner 706

Letters

Chondrocyte Metalloproteinase Activation Through Integrin Receptors and Interleukin-1: Comment on the Article by Arner and Tortorella

Paresh Jobanputra 709

Reply

E. C. Arner and M. D. Tortorella 709

Who Has the Rheumatology Service They Need? Comment on the Article by Yelin et al

Fraser N. Birrell, Adewale O. Adebajo, and Brian L. Hazleman 711

Reply

Edward Yelin, Gerson Bernhard, and Diane Pflugrad 711

Sulfasalazine in Psoriatic Arthritis: A New or Established Indication?

P. Goupille and J. P. Valat 711

ACR Announcements 13A

Volume 39, No. 5, May 1996

Special Articles

Guidelines for the Management of Rheumatoid Arthritis

• American College of Rheumatology Ad Hoc Committee on Clinical Guidelines 713

Guidelines for Monitoring Drug Therapy in Rheumatoid Arthritis

• American College of Rheumatology Ad Hoc Committee on Clinical Guidelines 723

Clinical Science

Cigarette Smoking Increases the Risk of Rheumatoid Arthritis: Results from a Nationwide Study of Disease-Discordant Twins

• Alan J. Silman, Jason Newman, and Alexander J. MacGregor 732
• This study demonstrated that among twin pairs who were discordant for disease, there was a strong association between cigarette smoking and susceptibility to RA. Identification of risk factors such as cigarette smoking is important in understanding the etiology of RA.

Detection of Borrelia burgdorferi by DNA Amplification in Synovial Tissue Samples from Patients with Lyme Arthritis

• Benoit Jaulhac, Isabelle Chary-Valckenaere, Jean Sibilia, Rose-Marie Javier, Yves Piemont, Jean-Louis Kuntz, Henri Monteil, and Jacques Pourel 736
• This prospective study shows that in some cases of Lyme arthritis in which PCR of synovial fluid is negative for B burgdorferi, the spirochete can be detected in synovial tissue. Therefore, negative PCR results must be interpreted cautiously when evaluating a suspected case of Lyme arthritis. Moreover, when using a chromosomal target, B burgdorferi DNA can be detected more easily from synovium than from joint fluid.

Bone Mineralization and Bone Mineral Metabolism in Children with Juvenile Rheumatoid Arthritis

• Peri Hickman Pepmueller, James T. Cassidy, Susan H. Allen, and Laura S. Hillman 746
• Concurrent development of osteopenia and a chronic disease such as juvenile rheumatoid arthritis results in an increased frequency of skeletal growth abnormalities and fractures in the child, and a failure to achieve peak bone mass in the early adult years. The present study investigates the magnitude and pathogenic mechanisms of this osteopenia. Based on the results, proposed therapeutic interventions are discussed.

Anti-Endothelial Cell IgG Antibodies from Patients with Wegener's Granulomatosis Bind to Human Endothelial Cells In Vitro and Induce Adhesion Molecule Expression and Cytokine Secretion

• Nicoletta Del Papa, Luisa Guidali, Marina Sironi, Yehuda Shoenfeld, Alberto Mantovani, Angela Tincani, Genesio Balestrieri, Antonella Radice, R. Alberto Sinico, and Pier Luigi Meroni 758
• Wegener's granulomatosis is a prototype of primary autoimmune vasculitis in which the exact pathogenetic mechanism(s) is still a matter of debate. Wegener's vasculitis is frequently a life-threatening disease; a better knowledge of its pathogenesis could help us determine the best therapeutic approach. Anti-endothelial antibodies are relatively new antibodies frequently found in patients with autoimmune vasculitis; studies on their potential pathogenetic effects offer new insights into their diagnostic and/or prognostic value.

Mixed Monoclonal Cryoglobulinemia and Monoclonal Rheumatoid Factor Cross-Reactive Idiotypes as Predictive Factors for the Development of Lymphoma in Primary Sjogren's Syndrome

• Athanasios G. Tzioufas, Dimitra S. Boumba, Fotini N. Skopouli, and Haralampos M. Moutsopoulos 767
• Patients with Sjogren's syndrome are at increased risk for the development of lymphoma. Previous studies have shown that lymphadenopathy and parotid gland enlargement are associated with lymphoma development. This study demonstrates that mixed monoclonal cryoglobulinemia and monoclonal rheumatoid factor cross-reactive idiotypes may also serve as predictive factors for lymphoma development in Sjogren syndrome patients.

Increased Expression of Human Thioredoxin/Adult T Cell Leukemia-Derived Factor in Sjogren's Syndrome

• Ichiro Saito, Misa Shimuta, Kumiko Terauchi, Kazuo Tsubota, Junji Yodoi, and Nobuyuki Miyasaka 773
• The coexistence of TRX/ADF, a redox regulator capable of inducing lymphocyte activation, and Epstein-Barr virus was detected in the labial salivary glands of patients with SS. These findings suggest that TRX/ADF expression closely reflects the intracellular event of EBV reactivation in SS and might be etiologically associated with the disease.

Aberrant Expression Pattern of the SS-B/La Antigen in the Labial Salivary Glands of Patients with Sjogren's Syndrome

• P. C. M. de Wilde, L. Kater, C. Bodeutsch, F. H. J. van den Hoogen, L. B. A. van de Putte, and W. J. van Venrooij 783
• This study investigated differences in the localization of SS-B/La in labial salivary glands of Sjogren's syndrome patients versus control patients. The consistently enhanced nuclear immunostaining of SS-B/ La in acinic cells from the labial salivary glands of patients with Sjogren's syndrome seems to be a promising tool to improve the diagnosis of this disease using the lip biopsy.

Elevated Serum Level of Soluble HLA Class I Antigens in Patients with Systemic Lupus Erythematosus

• Naoyuki Tsuchiya, Michiko Shiota, Akihiro Yamaguchi, and Koji Ito 792
• This study demonstrated a markedly elevated serum level of soluble HLA class I antigens in patients with SLE and a small, but significant, rise in patients with rheumatoid arthritis. This information may provide a clue for elucidating the pathogenesis of SLE. In addition, soluble HLA class I might potentially be useful as a laboratory marker for active SLE.

Clinical Images

Subcutaneous Calcinosis in Systemic Sclerosis

• Jean-Luc Senecal 796

Basic Science

Anticytokine Treatment of Established Type II Collagen-Induced Arthritis in DBA/1 Mice: A Comparative Study Using Anti-TNFα, Anti-IL-1α/β, and IL-1Ra

• Leo A. B. Joosten, Monique M. A. Helsen, Fons A. J. van de Loo, and Wim B. van den Berg 797
• In this widely used animal model of polyarthritis, the importance of IL-1 in both the induction and perpetuation of collagen-induced arthritis was confirmed. It was found that TNFα is involved in the induction, but plays a minor role in the later stages of this arthritis. Both TNFα and IL-1 should be considered therapeutic targets in humans with RA.

Cellular Adhesion Molecules in Rat Adjuvant Arthritis

• Margaret M. Halloran, Zoltan Szekanecz, Nora Barquin, G. Kenneth Haines, and Alisa E. Koch 810
• Using an animal model of RA, such as adjuvant-induced arthritis, enables one to study the cellular events involved in the early stages of the disease. CD44 expression on macrophages and lymphocytes was found to be up-regulated during the early development of adjuvant arthritis, whereas LFA-1 expression was up-regulated later in the development of the disease. Understanding the interactions between adhesion molecules and endothelium at the earliest stages of adjuvant arthritis could lead to significant advances in the methods used in the treatment of RA.

Direct Gene Delivery to Synovium: An Evaluation of Potential Vectors In Vitro and In Vivo

• I. Nita, S. C. Ghivizzani, J. Galea-Lauri, G. Bandara, H. I. Georgescu, P. D. Robbins, and C. H. Evans 820
• Gene therapy is a promising new approach to the treatment of diseased joints. One way to apply this strategy is to develop methods for the transfer of genes to the synovial lining of joints. This report presents the results of a study in which various vectors have been tested for their ability to deliver a marker gene to the synovia of rabbits' knees.

Prevention and Reversal of Cartilage Degradation in Rheumatoid Arthritis By Interleukin-10 and Interleukin-4

• Joel A. G. van Roon, Johanna L. A. M. van Roy, Frits H. J. Gmelig-Meyling, Floris P. J. G. Lafeber, and Johannes W. J. Bijlsma 829
• IL-10 and IL-4 are important immunoregulatory cytokines which can be produced by type 2 T cells and are capable of down-regulating proinflammatory responses. Furthermore, synergistic activity of IL-10 and IL-4 has been described. The present study shows the ability of IL-10, IL-4, and the combination of the 2 cytokines to control inflammatory responses and subsequently to prevent cartilage damage in RA, which may lead to new treatment strategies.

Accelerated Generation of CD14+ Monocyte-Lineage Cells from the Bone Marrow of Rheumatoid Arthritis Patients

• Shunsei Hirohata, Tamiko Yanagida, Kenji Itoh, Hiroshi Nakamura, Shin'ichi Yoshino, Tetsuya Tomita, and Takahiro Ochi 836
• This study examined the capacity of bone marrow progenitor cells to generate CD14+ cells in patients with RA. The results strongly support the hypothesis that the accelerated generation of CD14+ cells from bone marrow plays a central role in the pathogenesis of RA, possibly through continuous recruitment of inherently abnormal monocytes into the synovium.

Enrichment of Differentiated CD45RBdim,CD27[minus] Memory T Cells in the Peripheral Blood, Synovial Fluid, and Synovial Tissue of Patients with Rheumatoid Arthritis

• Charles L. Kohem, Ruth I. Brezinschek, Heather Wisbey, Cosimo Tortorella, Peter E. Lipsky, and Nancy Oppenheimer-Marks 844
• This study further defines the phenotypic characteristics and differentiation status of T cells present in the peripheral blood and synovium of RA patients. These findings provide insights into the pathogenesis of this immune-mediated disease, and may thus permit a better understanding of the specific T cell subset involved in RA.

An Epitope on Ki Antigen Recognized by Autoantibodies from Lupus Patients Shows Homology with the SV40 Large T Antigen Nuclear Localization Signal

• Yoshinari Takasaki, Tetsuro Yano, Kaoru Hirokawa, Ken Takeuchi, Soichiro Ando, Toshimitsu Takahashi, Kohichiro Shimada, and Hiroshi Hashimoto 855
• Molecular cloning of Ki cDNA revealed that the Ki antigen contained an amino acid sequence that was homologous to the SV40 large T antigen nuclear localization signal (SV40 T NLS). Using a 16-mer Ki synthetic peptide with an amino acid sequence homologous to that of SV40 T NLS, the reactivity of 49 anti-Ki-positive sera to KILT was tested by enzyme-linked immunosorbent assay. The results revealed that the sequence homologous to SV40 T NLS on the Ki antigen is one of the antigenic epitopes recognized by autoantibodies to the Ki antigen in lupus sera.

Detection of Anticentromere Antibodies Using Recombinant Human CENP-A Protein

• Dongxu Sun, Antigona Martinez, Kevin F. Sullivan, Gordon C. Sharp, and Sallie O. Hoch 863
• Anticentromere antibodies are associated with the milder manifestation of scleroderma called limited systemic sclerosis. This report describes the development of a quantitative assay for one of the major centromere antigens, CENP-A, using recombinant protein. This assay has obvious implications for helping to diagnose a major clinical subgroup of patients (with the attendant implications as to treatment) and allowing investigators to explore specific questions about the utility of ACA in predicting disease progression.

Strong Association of Dermatomyositis-Specific Mi-2 Autoantibodies with a Tryptophan at Position 9 of the HLA-DRβ Chain

• Rudolf Mierau, Thomas Dick, Peter Bartz-Bazzanella, Elisabeth Keller, Ekkehard D. Albert, and Ekkehard Genth 868
• Mi-2 autoantibodies are rare but highly specific for dermatomyositis. In 17 Mi-2 antibody-positive dermatomyositis patients, signs of scleroderma, lung involvement, and arthritis were rare or absent. Strong associations with HLA-DR7 and with a tryptophan residue at position 9 of the HLA-DRβ chain are evidence for a common immunogenetic background of Mi-2 antibody production.

Case Report

Chronic Intestinal Pseudoobstruction Associated with Autoantibodies Against Proliferating Cell Nuclear Antigen

• Yoshihisa Nojima, Toshihide Mimura, Ken Hamasaki, Hiroko Furuya, Go Tanaka, Atsushi Nakajima, Nobuyuki Matsuhashi, and Yoshio Yazaki 877

Concise Communications

Prevalence of Human Parvovirus B19 Infection in Children with Henoch-Schonlein Purpura

• Polly J. Ferguson, Frank T. Saulsbury, Scott F. Dowell, Thomas J. Torok, Dean D. Erdman, and Larry J. Anderson 880

Mycobacterium kansasii Septic Arthritis in a Patient with Acquired Immunodeficiency Syndrome

• Maria Luz Garcia Vivar, Santiago Gonzalez de Etxabarri, Eva Galindez Agirregoikoa, and Juan Miguel Santamaria 881

Letters

Tumor Necrosis Factor Receptor p75 Correlates Better than p55 with Disease Activity in Juvenile Rheumatoid Arthritis: Comment on the Article by Mangge et al

• Marco Gattorno, Paolo Picco, Antonella Buoncompagni, Franca Stalla, and Vito Pistoia 883

Reply

• Harald Mangge 884

Serum Pro-Matrix Metalloproteinase 3 in Rheumatoid Arthritis: A Reflection of Local or Systemic Inflammation?

• Nap T. Cheung, Derek L. Mattey, Peter T. Dawes, and David J. Taylor 884

Reply

• Daniel-Henri Manicourt, Noboru Fujimoto, Ken'ichi Obata, and Eugene J.-M. A. Thonar 885

ACR Announcements 7A

Volume 39, No. 6, June 1996

Special Articles

ACR Presidential Address: The American College of Rheumatology as a ``Professional'' Society: An Oxymoron?

• Shaun Ruddy 887

A Remembrance of Fred, The Lowland Gorilla

• John P. Atkinson 891

Review: Nephritogenic Autoantibodies in Lupus: Current Concepts and Continuing Controversies

• James B. Lefkowith and Gary S. Gilkeson 894

Basic Science

Oligoclonal T Cell Proliferation in Patients with Rheumatoid Arthritis and Their Unaffected Siblings

• Inge Waase, Corinna Kayser, Paula J. Carlson, Jorg J. Goronzy, and Cornelia M. Weyand 904
  
• This study reveals that patients with rheumatoid arthritis have a defect in maintaining T cell homeostasis, as demonstrated by oligoclonal expansions of CD4+ T cells in the peripheral blood compartment. Family studies have suggested that there may be a genetic basis for this abnormality.

Expression and Functional Expansion of Fibroblast Growth Factor Receptor T Cells in Rheumatoid Synovium and Peripheral Blood of Patients with Rheumatoid Arthritis

• Victor Byrd, Xiao-Ming Zhao, Wallace L. McKeehan, Geraldine G. Miller, and James W. Thomas 914
  
• Vascular (angiogenic) growth factors such as fibroblast growth factor-1 may be critical determinants of synovial inflammation in rheumatoid arthritis by enhancing mesenchymal proliferation and new blood vessel formation. This study identifies a connection between nonhematopoietic growth factors and T cell activation that suggests growth factor-immune networks may contribute to the pathogenic mechanisms of RA.

Inhibition of Synoviocyte Collagenase Gene Expression by Adenosine Receptor Stimulation

• David L. Boyle, Fereydoun G. Sajjadi, and Gary S. Firestein 923
  
• In this study, adenosine receptor stimulation significantly decreased collagenase gene expression by cultured synoviocytes, with little or no effect on stromelysin or on its natural inhibitor, TIMP-1. This raises the possibility that novel adenosine-based therapies have potential both as antiinflammatory and as chondroprotective agents.

Synergy Between T Cell Receptor β Gene Polymorphism and HLA-DR4 in Susceptibility to Rheumatoid Arthritis

• Hua Mu, Patrick Charmley, Mary-Claire King, and Lindsey A. Criswell 931
  
• Polymorphisms in T cell receptor β (TCRB) genes may play an important role in the formation of the TCR repertoire and in the development of autoimmune disease. Previous studies have shown that a nucleotide sequence shared by allelic variants of HLA-DR4 and DR1 is associated with RA. The findings of this study suggest that TCRB gene polymorphism may contribute to RA susceptibility through an interaction with HLA-DR4.

Clinical Correlations with HLA Type in Japanese Patients with Connective Tissue Disease and Anti-U1 Small Nuclear RNP Antibodies

• Masataka Kuwana, Yutaka Okano, Junichi Kaburaki, and Hidetoshi Inoko 938
  
• HLA-clinical associations were examined in Japanese patients with connective tissue disease and serum anti-U1 RNP antibody. Significant associations included DQB1*0303 with lupus-related symptoms, DR2 with pleuritis, DR4 with swollen hands, and DRB1*0405 with arthritis. These results suggest that HLA genes influence clinical expression in patients with anti-U1 RNP antibody.

A Comparative Study of HLA Genes in HLA-B27 Positive Ankylosing Spondylitis and HLA-B27 Positive Peripheral Reactive Arthritis

• Pia Westman, Marjatta Leirisalo-Repo, Jukka Partanen, and Saija Koskimies 943
  
• Ankylosing spondylitis and reactive arthritis are heterogeneous diseases that have a high association with the genetic marker HLA-B27. Because these diseases clearly differ in their clinical picture, and also in their long-term prognosis, a molecular study of other HLA markers in well-characterized groups of HLA-B27 positive patients was conducted, focusing on certain amino acid residues that are speculated to be functionally relevant and are shared by different HLA specificities. The differences observed support the idea of genetic heterogeneity between HLA-B27 positive patients with ankylosing spondylitis and reactive arthritis.

Molecular Detection of Bacterial DNA in Venereal-Associated Arthritis

• Feng Li, Rula Bulbul, H. Ralph Schumacher, Jr., Thomas Kieber-Emmons, Peter E. Callegari, Joan M. Von Feldt, Daniel Norden, Bruce Freundlich, Bin Wang, Victor Imonitie, Chen Pei Chang, Irving Nachamkin, David B. Weiner, and William V. Williams 950
  
• Venereal-associated arthritis comprises a group of common rheumatologic conditions, the diagnosis of which currently relies on clinical critieria because of a lack of reliable diagnostic tests. This study evaluates patients with venereal-associated arthritis (Neisseria, Chlamydia, and Ureaplasma infections) for evidence of bacterial DNA in their synovial fluid, which would suggest that an infectious process is responsible for the joint lesions. The study is relevant to the pathogenesis of the arthritis as well as to the techniques that may be useful in the diagnosis of venereal-associated arthritis (i.e., PCR or other methods of detecting bacterial DNA).

In Situ Hybridization Analysis of Synovial and Systemic Cytokine Messenger RNA Expression in Superantigen-Mediated Staphylococcus aureus Arthritis

• Yi-Xue Zhao, Ake Ljungdahl, Tomas Olsson, and Andrej Tarkowski 959
  
• The pathogenic mechanisms that operate in infectious arthritides, and which lead to rapid cartilage and subchondral bone destruction despite an adequate antibiotic treatment, are largely unknown. This experimental study reveals synovial cytokine responses as a consequence of joint infection with Staphylococcus aureus. The pattern of cytokine messenger RNA expression observed locally in the joint strongly suggests that not only antibacterial, but also immunomodulatory, treatment should be considered to diminish the risk of sequelae.

Normal Expression of Type 1 Insulin-Like Growth Factor Receptor by Human Osteoarthritic Chondrocytes with Increased Expression and Synthesis of Insulin-Like Growth Factor Binding Proteins

• Ginette Tardif, Pascal Reboul, Jean-Pierre Pelletier, Changshan Geng, Jean-Marie Cloutier, and Johanne Martel-Pelletier 968
  
• This study provides new and valuable information on the mechanism underlying human OA chondrocyte resistance to stimulation by insulin-like growth factor 1. The findings point to a normal expression of type 1 IGF receptor in OA chondrocytes, but an enhancement in the expression and synthesis of 3 of the known IGF binding proteins (IGFBPs 2, 3, and 4).

Clinical Science

Why Health Care Costs More in the US: Comparing Health Care Expenditures Between Systemic Lupus Erythematosus Patients in Stanford and Montreal

• Gail Gironimi, Ann E. Clarke, Vivian H. Hamilton, Deborah S. Danoff, Daniel A. Bloch, James F. Fries, and John M. Esdaile 979
• In this first study comparing health care costs incurred by patients with SLE in the US (Stanford) and Canada (Montreal), the annual direct costs (representing health services utilized) of the American SLE patients exceeded those of their Canadian counterparts by 2-fold ($10,530 versus $5,271). These higher costs are explained by the higher price of health services in the US and the greater disease severity in the patient mix. Canadian SLE patients utilize at least as many, and in some health resource categories, more, services than their American counterparts.

Risk of Osteoarthritis Associated with Long-Term Weight-Bearing Sports: A Radiologic Survey of the Hips and Knees in Female Ex-Athletes and Population Controls

• Tim D. Spector, Pat A. Harris, Deborah J. Hart, Flavia M. Cicuttini, Dalbir Nandra, John Etherington, Roger L. Wolman, and David V. Doyle 988
• In a retrospective cohort study from London, it was found that long-term weight-bearing sports activity in women is associated with a 2-3-fold increased risk of radiologic OA (particularly the presence of osteophytes) of the knees and hip. The risk was similar in ex-elite athletes and in a subgroup from the general population who reported long-term sports activity, suggesting that duration rather than frequency of training is important. Long-term participation in sports at any level increases the risk of OA.

Outcome in Patients with Early Rheumatoid Arthritis Treated According to the ``Sawtooth'' Strategy

• Timo Mottonen, Leena Paimela, Jari Ahonen, Tapani Helve, Pekka Hannonen, and Marjatta Leirisalo-Repo 996
• Since long-term outcome in RA is often poor, it is generally agreed that there is a need for a change in antirheumatic treatment strategy, and more aggressive use of antirheumatic drugs has been proposed. The present study showed that the "sawtooth" strategy approach to antirheumatic drug treatment improved the average 6.2-year outcome in 142 patients with early RA, compared with that in historical controls. This strategy, which entails early, aggressive treatment with antirheumatic drugs, is thus recommended.

Slow Progression of Joint Damage in Early Rheumatoid Arthritis Treated with Cyclosporin A

• Giampiero Pasero, Francesco Priolo, Ettore Marubini, Flavio Fantini, Gianfranco Ferraccioli, Mario Magaro, Roberto Marcolongo, Pasquale Oriente, Vincenzo Pipitone, Italo Portioli, Giuseppe Tirri, Francesco Trotta, and Ornella Della Casa-Alberighi 1006
• Despite numerous trials, there are no definitive data regarding how disease-modifying antirheumatic drugs work in rheumatoid inflammation or whether they are effective in terms of controlling disease progression. This study investigated the impact that low-dose cyclosporin A may have on both the treatment and course of RA, by randomly allocating homogeneous patients with early active RA to CsA or traditional DMARD treatment groups. The 12-month results show that CsA delays and even prevents RA progression, and efficaciously controls symptoms with an acceptable tolerability profile.

Acute Febrile Toxic Reaction in Patients with Refractory Rheumatoid Arthritis Who Are Receiving Combined Therapy with Methotrexate and Azathioprine

• Ricardo Blanco, Victor M. Martinez-Taboada, Miguel A. Gonzalez-Gay, Jose Armona, Jose L. Fernandez-Sueiro, M. Carmen Gonzalez-Vela, and Vicente Rodriguez-Valverde 1016
• This report describes 4 RA patients who developed acute febrile toxic reaction while undergoing treatment with MTX and AZA. The knowledge of this side effect is particularly important since it mimics severe infectious complication related to immunosuppressive therapy. It is suggested that, when AZA is prescribed simultaneously with MTX, the patient should be closely monitored during the first few months.

N-[4-Hydroxyphenyl] Retinamide in Rheumatoid Arthritis: A Pilot Study

• Ellen M. Gravallese, Malcolm L. Handel, Jonathan Coblyn, Ronald J. Anderson, Richard I. Sperling, Elizabeth W. Karlson, Agnes Maier, Eric M. Ruderman, Franca Formelli, and Michael E. Weinblatt 1021
• An uncontrolled, open study was undertaken to determine the efficacy and tolerability of N-[4 hydroxyphenyl] retinamide (4-HPR), a synthetic retinoid, in the treatment of RA. No clinical improvement was observed, and there was no beneficial effect on the laboratory parameters studied, except for a modest decrease in C-reactive protein. Other retinoids may be more efficacious in the treatment of RA.

Failure of Low-Dose Intravenous Immunoglobulin Therapy to Suppress Disease Activity in Patients with Treatment-Refractory Rheumatoid Arthritis

• Keith S. Kanik, Cheryl H. Yarboro, Yaakov Naparstek, Paul H. Plotz, and Ronald L. Wilder 1027
• High doses of intravenous immunoglobulins have shown some efficacy in the treatment of RA, but are very expensive. Low doses of intravenous immunoglobulins are less expensive, but have shown efficacy only in the rat model. The results of this trial suggest that low-dose immunoglobulins do not have benefit in the treatment of RA that has been refractory to standard medications.

Renal Vascular Damage in Systemic Sclerosis Patients Without Clinical Evidence of Nephropathy

• Roberto Rivolta, Barbara Mascagni, Vittorio Berruti, Filippo Quarto Di Palo, Attilio Elli, Raffaella Scorza, and Daniela Castagnone 1030
• In this study, color-flow-Doppler ultrasonography was found to be a very sensitive technique for studying renal vascular damage in patients with SSc. Abnormalities of blood flow were detected even in the presence of normal renal clearance. The use of this technique in the evaluation of SSc patients may allow earlier diagnosis and better monitoring of the renal vascular impairment associated with the disease.

Depressive Symptoms Associated with Scleroderma

• Robert P. Roca, Fredrick M. Wigley, and Barbara White 1035
• The present study was undertaken to assess the prevalence and correlates of comorbid depression in scleroderma. Depressive symptoms among the study cohort were more strongly related to personality, self-rated disability, and adequacy of emotional support than to objective medical indices of illness severity. These findings have important implications for prognosis, management, and future research in scleroderma.

Childhood-Onset Scleroderma: Is it Different from Adult-Onset Disease?

• Rama Vancheeswaran, Carol M. Black, Joel David, Nathan Hasson, John Harper, David Atherton, Premila Trivedi, and Patricia Woo 1041
• This study demonstrates that in childhood-onset scleroderma, the antibody profile, as well as the endothelial activation markers, are different from what one sees in adult-onset scleroderma. The suppression of collagen synthesis is novel and highly relevant in growing children with this disease, and therefore early intervention of the inflammatory phase or progression of fibrosis is imperative to prevent gross deformity.

Malignancy in Systemic Lupus Erythematosus

• Mahmoud Abu-Shakra, Dafna D. Gladman, and Murray B. Urowitz 1050
• The risk of cancer was estimated in a group of 724 patients with SLE and compared with that of the general population of Ontario, as well as with patients with RA and SSc. The overall standardized risk of cancer in the SLE population was not increased compared with the Ontario population. However, the risk for hematologic malignancies was increased 4-fold, mainly due to an increased risk for non-Hodgkin's lymphoma. Risk for cancer was significantly lower in SLE than in RA and SSc.

Utility of Anti-Sm, Anti-RNP, Anti-Ro/SS-A, and Anti-La/SS-B (Extractable Nuclear Antigens) Detected by Enzyme-Linked Immunosorbent Assay for the Diagnosis of Systemic Lupus Erythematosus

• Jorge Sanchez-Guerrero, Robert A. Lew, Anne H. Fossel, and Peter H. Schur 1055
• This study utilized an enzyme-linked immunosorbent assay to test for anti-ENA antibodies among patients with positive antinuclear antibody results. The findings suggest that the presence of anti-ENA antibodies, especially anti-Ro, helps to confirm the diagnosis of SLE among ANA+ patients who lack anti-dsDNA antibodies.

Case Reports

Pyoderma Gangrenosum in Association with Undifferentiated Seronegative Spondylarthropathy

• Ignazio Olivieri, Angela Maria Costa, Fabrizio Cantini, Laura Niccoli, Raffaela Marini, and Silvio Ferri 1062

Monoclonal Cryo-Antifibrinogenemia

• Hans H. Euler, Rainald A. Zeuner, Rosemarie Beress, Hans J. Gutschmidt, Enno Christophers, and Johann O. Schroeder 1066

Clinical Images

Influence of Ballet Season on Radiology Reports

• Peter H. Schur 1069

Concise Communication

Treatment of Systemic Sclerosis with Topical Tretinoin: Report of Two Cases

• Joel M. Kremer 1070

Letters

More on Vasodilatation, Joint Swelling, and Nitric Oxide

• Johan Ahlqvist 1071

Fibroblast Adhesion to Articular Cartilage

• Hugo E. Jasin 1072

Reply

• Warren D. Blackburn, Jr., and W. Winn Chatham 1072

Giant Cell Arteritis and Amyloidosis: Comment on the Article by Salvarani et al

• Miguel A. Gonzalez-Gay, Carmen Gonzalez-Vela, Ricardo Blanco, Maria J. Cereijo, and Fernando Bal 1073

Reply

• Carlo Salvarani, Sherine Gabriel, and Gene G. Hunder 1073

Polymyositis, Lung Fibrosis, and Cranial Neuropathy in a Patient with Hepatitis C Virus Infection

• Clodoveo Ferri, Luca La Civita, Piera Fazzi, Giampiero Pasero, and Anna Linda Zignego 1074

Reply

• Robert W. McMurray 1075

Lack of Radiographic Evidence of Tracheostenosis: Comment on the Clinical Image from Kraus and Valencia

• E.A. McFadden 1075

Erratum 1076

ACR Announcements 15A

Volume 39, No. 7, July 1996

Clinical Science

Decrease in Cellularity and Expression of Adhesion Molecules by Anti-Tumor Necrosis Factor α Monoclonal Antibody Treatment in Patients with Rheumatoid Arthritis

Deactivation of Vascular Endothelium by Monoclonal Anti-Tumor Necrosis Factor α Antibody in Rheumatoid Arthritis

Ewa M. Paleolog, Mary Hunt, Michael J. Elliott, Marc Feldmann, RavinderN. Maini, and James N. Woody 1082

Dose-Range and Dose-Frequency Study of Recombinant Human Interleukin-1Receptor Antagonist in Patients with Rheumatoid Arthritis

A Double-Blind, Placebo-Controlled Study of Anti-CD5 Immunoconjugate in Patients with Rheumatoid Arthritis

Association of Tumor Necrosis Factor Microsatellite Polymorphisms with HLA-DRB1*04-Bearing Haplotypes in Rheumatoid Arthritis Patients

Protein Metabolism in Rheumatoid Arthritis and Aging: Effects of Muscle Strength Training and Tumor Necrosis Factor α

Lack of Association Between Augmentation Mammoplasty and Systemic Sclerosis (Scleroderma)

Pilot Study of Antithymocyte Globulin in Systemic Sclerosis

Comprehensive Noninvasive Assessment of Cardiac Involvement in Limited Systemic Sclerosis

Evidence of Free Radical-Mediated Injury (Isoprostane Overproduction)in Scleroderma

Autoantibodies to Fibrillarin in Systemic Sclerosis (Scleroderma): AnImmunogenetic, Serologic, and Clinical Analysis

Early Expression of E-Selectin, Tumor Necrosis Factor α, and Mast Cell Infiltration in the Salivary Glands of Patients with Systemic Sclerosis

Sicca Syndrome Associated with Hepatitis C Virus Infection

Reactive Arthritis in Patients Attending an Urban Sexually Transmitted Diseases Clinic

Sensitivity and Specificity of Plasma and Urine Complement Split Products as Indicators of Lupus Disease Activity

Familial Aggregation of Primary Raynaud's Disease

Inhibition and Prevention of Monosodium Urate Monohydrate Crystal-Induced Acute Inflammation In Vivo by Transforming Growth Factor β1

Leukocyte Infiltration in Synovial Tissue from the Shoulder of Patients with Polymyalgia Rheumatica: Quantitative Analysis and Influence of Corticosteroid Treatment

Effect of Classification on the Incidence of Polyarteritis Nodosa and Microscopic Polyangiitis

Colchicine in Breast Milk of Patients with Familial Mediterranean Fever

Pediatric Rheumatology in Adult Rheumatology Practices in Washington State

Basic Science

Human Synovial Mast Cells. I. Ultrastructural In Situ and In VitroImmunologic Characterization

A Matrix Metalloproteinase-Generated Aggrecan Neoepitope as a Marker of Skeletal Maturation and Aging in Cartilage

Antibiotic Prophylaxis and Treatment of Reactive Arthritis: Lessons from an Animal Model

Radiologic Vignette

Dorsal Defect of the Patella: An Uncommon Cause of Knee Pain

Javier Narvaez, Jose A. Narvaez, M. TeresaClavaguera, Mabel Gil, A. Sanchez-Marquez, and J. M.Nolla-Sole 1244

Case Reports

Progression of Rheumatoid Arthritis Following Bone Marrow Transplantation: A Case Report with a 13-Year Followup

Robert J. R. McKendry, Lothar Huebsch, and Benoit LeClair 1246

Focal Myositis Presenting as Pseudothrombophlebitis of the Neck in a Patient with Mixed Connective Tissue Disease

Charles Rivest, Frederick W. Miller, Lori A. Love, Pierre-Paul Turgeon,Claude Blier, and Jean-Luc Senecal 1254

Clinical Images

Drummer's Finger

Frank Buttgereit and Gerd R. Burmester 1258

Concise Communications

Pravastatin-Induced Rhabdomyolysis in a Patient with Mixed Connective Tissue Disease

Ikuko Hino, Hideto Akama, Takefumi Furuya, Hiroyuki Ueda, AtsuoTaniguchi, Masako Hara, and Sadao Kashiwazaki 1259

Musculoskeletal Manifestations of Invasive Group A StreptococcalInfection

Mohammad I. Shbeeb, Franklin R. Cockerill, III, and Sherine E. Gabriel 1260

Letters

Finding a Valid Model for Human Wegener's Granulomatosis: Comment on the Article by Tomer et al

Carol A. Langford and Michael C. Sneller 1262

Reply

Y. Tomer and Y. Shoenfeld 1262

Tenidap in Rheumatoid Arthritis: Comment on the Article by Blackburn et al

W. Pruzanski and P. Vadas 1263

Reply

Warren D. Blackburn, Jr. and Leland D. Loose 1263

Cytokines in Polymyalgia Rheumatica

M. Tellus, K. Byron, S. Sachthep, S. Ratnaike, and I. Wicks 1264

Reply

Cornelia M. Weyand and Jorg J. Goronzy 1265

Analysis of Anti-U1 RNA Antibodies in Patients with Connective Tissue Diseases: Comment on the Article by Hoffman et al

Frank H. J. van den Hoogen, Agnes M. T. Boerbooms, and Leo B. A. van dePutte 1266

Reply

Robert W. Hoffman, Gordon C. Sharp, and Susan L. Deutscher 1266

ACR Announcements 14A

Volume 39, No. 8, August 1996

Basic Science

Inhibition of Fas Antigen-Mediated Apoptosis of Rheumatoid Synovial Cells In Vitro by Transforming Growth Factor β1

The CD69 Activation Pathway in Rheumatoid Arthritis Synovial Fluid T Cells

Expression and Function of CD80 and CD86 Costimulator Molecules on Synovial Dendritic Cells in Chronic Arthritis.

The Effects of the Phospholipase A2 Inhibitor, Manoalide, on Cartilage Degradation, Stromelysin Expression, and Synovial Fluid Cell Count Induced by Intraarticular Injection of Human Recombinant Interleukin-1α in the Rabbit

Significance of Anti-Nuclear Matrix Antibodies in Patients with In Vivo Speckled Antinuclear Antibody Staining

Novel Autoantibodies Directed Against the Common Tertiary Configuration of Transfer RNA in a Patient with Interstitial Lung Disease

Detection of Autoantibodies to Nucleolar Transcription Factor NOR 90/hUBF in Sera of Patients with Rheumatic Diseases, by Recombinant Autoantigen-Based Assays

Variation in the Inflammatory Properties of Basic Calcium Phosphate Crystals According to Crystal Type

Degenerative Joint Disease in the Guinea Pig: Use of Magnetic Resonance Imaging to Monitor Progession of Bone Pathology

Heterogeneity of Collagen Synthesis in Normal and Systemic Sclerosis Skin Fibroblasts: Increased Proportion of High Collagen-Producing Cells in Systemic Sclerosis Fibroblasts

Transcriptional Activation of the α1(I) Procollagen Gene in Systemic Sclerosis Dermal Fibroblasts: Role of Intronic Sequences

Clinical Science

The Centromere Kinesin-Like Protein, CENP-E: An Autoantigen in Systemic Sclerosis

Increased Prevalence of Systemic Sclerosis in a Native American Tribe in Oklahoma: Association with an Amerindian HLA Haplotype

Use of a Radiolabeled Monoclonal Antibody Against E-Selectin for Imaging of Endothelial Activation in Rheumatoid Arthritis

Cytokine Messenger RNA Expression in the Labial Salivary Glands of Patients with Sjogren's Syndrome

Juvenile Rheumatoid Arthritis in Rochester, Minnesota 1960-1993: Is the Epidemiology Changing?

Health Outcomes of Two Telephone Interventions for Patients with Rheumatoid Arthritis or Osteoarthritis

Which is the Active Moiety of Sulfasalazine in Ankylosing Spondylitis? A Randomized, Controlled Study

Computed Tomography of the Knee Joint as an Indicator of Intraarticular Tophi in Gout

Review

Human T Lymphotropic Virus Type I in Arthropathy and Autoimmune Disorders

Kusuki Nishioka, Takayuki Sumida, and Tomoko Hasunuma 1410

Dermatologic Vignette

A Young Woman with a Photosensitive Pruritic Rash on her Face and Upper Trunk

Margit Zuber, Stefan John, Michael Pfreundschuh, and Angela Gause 1419

Clinical Images

Vitamin C Deficiency

D. N. Leitch and D. I. Haslock 1422

Case Reports

All-trans-Retinoic Acid in POEMS Syndrome: Therapeutic Effect Associated with Decreased Circulating Levels of Proinflammatory Cytokines

Francois-Jerome Authier, Laurent Belec, Yves Levy, Jean-Pascal Lefaucheur, Gilles-Louis Defer, Jean-Denis Degos, and Romain K. Gherardi 1423

Development of Complete Heart Block in an Adult Patient with Sjogren's Syndrome and Anti-Ro/SS-A Autoantibodies

Lela A. Lee, Michael B. Pickrell, and Morris Reichlin 1427

Concise Communications

Modulation of Human Chondrocyte Integrins by Inflammatory Synovial Fluid

Paresh Jobanputra, Hong Lin, Karen Jenkins, Charles Bavington, Frank R. Brennan, George Nuki, Donald M. Salter, and Jane L. Godolphin 1430

Monocyte Apoptosis in Patients with Active Lupus

Bruce C. Richardson, Raymond L. Yung, Kent J. Johnson, Paul E. Rowse, and Narendra D. Lalwani 1432

Letters

Joint and Connective Tissue Ultrasonography in the Evaluation of Shoulder Pain: Comment on the Article by Manger and Kalden

Jacqueline Uson, Esperanza Naredo, and Lucia Maryordomo 1435

Reply

Bernhard Manger and Joachim R. Kalden 1435

Toxicity of Combination Therapies in Rheumatoid Arthritis: Comment on the Article by Willkens et al

C. Michael Stein 1435

Results of Controlled Study of Combination Therapy with Azathioprine and Methotrexate in the Treatment of Rheumatoid Arthritis Revisited

Daniel J. McCarty 1436

Reply

Robert F. Willkens, Carolly Marks, John T. Sharp, Dan M. Stablein, and Robert Wortmann 1436

The Relationship Between Rheumatoid Arthritis and the Acquired Immunodeficiency Syndrome: Comment on the Article by Ornstein et al

Adewale O. Adebajo and Brian L. Hazleman 1437

Reply

Matthew H. Ornstein, Leslie Dubin Kerr, and Harry Spiera 1438

Watermelon Stomach and Systemic Sclerosis: Localization of Digestive System Involvement?

Isabelle Marie, Nicole Cailleux, and Herve Levesque 1439

Book Review 1440

ACR Announcements 10A

Volume 39, No. 9, September 1996

Special Articles

Editorial: Antiphospholipid Antibodies: New Complexities and New Assays

Woodruff Emlen 1441

Review: Immunology of the Antiphospholipid Antibody Syndrome

Robert A. S. Roubey 1444

Review: Monitoring Collagen Degradation in Patients with Arthritis: The Search for Suitable Surrogates

Robert A. Greenwald 1455

Clinical Science

Antibodies to β2-Glycoprotein I and Clinical Manifestations in Patients with Systemic Lupus Erythematosus

Risk Factors for Serious Infection During Treatment with Cyclophosphamide and High-Dose Corticosteroids for Systemic Lupus Erythematosus

Association of Anti-Ribosomal P Protein Antibodies with Neuropsychiatric Systemic Lupus Erythematosus

Renal Biopsy Findings and Followup of Renal Function in Rheumatoid Arthritis Patients Treated with Cyclosporin A: An Update from the International Kidney Biopsy Registry

Increased Responsiveness of Rheumatoid Factor-Producing B Cells in Seronegative and Seropositive Rheumatoid Arthritis

Interrelationship of Major Histocompatibility Complex Class II Alleles and Autoantibodies in Four Ethnic Groups with Various Forms of Myositis

Treatment of Psoriatic Arthritis with Extracorporeal Photochemotherapy and Conventional Psoralen-Ultraviolet A Irradiation

Dactylitis in Patients with Seronegative Spondylarthropathy: Assessment by Ultrasonography and Magnetic Resonance Imaging

Chronic Arthropathy and Musculoskeletal Symptoms Associated with Rubella Vaccines: A Review of 124 Claims Submitted to the National Vaccine Injury Compensation Program

Basic Science

Chondroprotective Effect of Intraarticular Injections of Interleukin-1 Receptor Antagonist in Experimental Osteoarthritis: Suppression of Collagenase-1 Expression

Phagocytic Lining Cells Determine Local Expression of Inflammation in Type II Collagen-Induced Arthritis

Local Disruption of the Insulin-Like Growth Factor System in the Arthritic Joint

Hepatocyte Growth Factor: A Cytokine Mediating Endothelial Migration in Inflammatory Arthritis

Expression of Matrix Metalloproteinase 9 (96-kd Gelatinase B) in Human Rheumatoid Arthritis

Epitope Analysis of the Major Reactive Region of the 100-kd Protein of PM-Scl Autoantigen

Addition of Corticosteroids to Antibiotic Treatment Ameliorates the Course of Experimental Staphylococcus aureus Arthritis

Erratum 1575

Concise Communication

Comparison of an Enzyme-Linked Immunosorbent Assay for Antibodies to β2-Glycoprotein I and a Conventional Anticardiolipin Immunoassay

Robert A. S. Roubey, Michael A. Maldonado, and Stephanie N. Byrd 1606

Letters

Could the Cytomegalovirus be an Innocent Bystander in Methotrexate-Treated Rheumatoid Arthritis Patients?

Valerie Gangji, Marc Golstein, and Thierry Appelboom 1608

Reply

Ferdinand Aglas, Franz Rainer, and Guenter J. Krejs 1608

Reply

Simon Bowman and Alastair Mowat 1608

Absence of HTLV-I tax in Sjogren's Syndrome

S. P. Rigby, S. P. Cooke, D. Weerasinghe, and P. J. W. Venables 1609

Reply

X. Mariette, P. Cherot, F. Agbalika, and F. Morinet 1610

Reply

Takayuki Sumida and Toshiro Maeda 1611

Use of Sensitive Assays to Detect Soluble Fas in Patients with Systemic Lupus Erythematosus: Comment on the Article by Knipping et al and the Article by Goel et al

John D. Mountz, Tong Zhou, and Jianhua Cheng 1611

Elevated Levels of Soluble Fas in Systemic Lupus Erythematosus: Comment on the Article by Knipping et al

Mitsuo Okubo, Hironori Ishida, and Reiji Kasukawa 1612

Reply

Keith B. Elkon, Peter H. Krammer, David H. Lynch, Nita Goel, and Michael F. Seldin 1613

ACR Announcements 10A

Volume 39, No. 10, October 1996

Special Articles

Editorial: The Silicone Breast Implant Controversy: The Other Courtroom

Noel R. Rose 1615

Review: An Analytical Review of Silicone Immunology

Donald M. Marcus 1619

Review: Fibromyalgia and the Disability Dilemma: A New Era inUnderstanding a Complex, Multidimensional Pain Syndrome

Robert M. Bennett 1627

Basic Science

The Spindle Kinesin-Like Protein HsEg5 is an Autoantigen in Systemic Lupus Erythematosus

Two Major Autoantigen-Antibody Systems of the Mitotic Spindle Apparatus

Selective Antibody Reactivity with Peptides from Human Endogenous Retroviruses and Nonviral Poly(Amino Acids) in Patients with Systemic Lupus Erythematosus

Development of the Anti-Ro Autoantibody Response in a Patient with Systemic Lupus Erythematosus

Identification of Autoantibodies to the I Protein of the Heterogeneous Nuclear Ribonucleoprotein Complex in Patients with Systemic Sclerosis

Nitric Oxide Production During Adjuvant-Induced and Collagen-Induced Arthritis

Adherence of Synovial Cells on EDA-Containing Fibronectin

Clinical Science

The Presence of Interleukin-13 in Rheumatoid Synovium and its Antiinflammatory Effects on Synovial Fluid Macrophages from Patients with Rheumatoid Arthritis

Patterns of Expression of Tumor Necrosis Factor α, Tumor Necrosis Factor β, and their Receptors in Synovia of Patients with Juvenile Rheumatoid Arthritis and Juvenile Spondylarthropathy

Rheumatoid Arthritis Lung Disease: Determinants of Radiographic and Physiologic Abnormalities

Antibodies to Type II Collagen in Early Rheumatoid Arthritis: Correlation with Disease Progression

High Prevalence of Serum Apolipoprotein E4 Isoprotein in Rheumatoid Arthritis Patients with Amyloidosis

Distinct Immunologic Features of Finnish Sjogren's Syndrome Patients with HLA Alleles DRB1*0301, DQA1*0501, and DQB1*0201: Alterations in Circulating T Cell Receptor γ/δ Subsets

Comparison of Synovial Tissue and Synovial Fluid as the Source of Nucleic Acids for Detection of Chlamydia trachomatis by Polymerase Chain Reaction

Elevated Levels of 92-kd Type IV Collagenase (Matrix Metalloproteinase 9) in Giant Cell Arteritis

Clinical Features and Therapeutic Management of Subglottic Stenosis in Patients with Wegener's Granulomatosis

Clinical Images

Value of Magnetic Resonance Imaging in Extensive Pyomyositis

Pascal Claudepierre, Bernadette Saint-Marcoux, Bruno Larget-Piet, Xavier Chevalier, Jerome Allain, and Jean-Luc Montazel 1760

Dermatologic Vignette

Painful, Swollen, and Erythematous Hands and Feet

John J. Hart 1761

Concise Communication

Association of Homozygosity for Glutathione-S-Transferase GSTM1 Null Alleles with the Ro+/La[minus] Autoantibody Profile in Patients with Systemic Lupus Erythematosus

William Ollier, Eric Davies, Neil Snowden, Julie Alldersea, Anthony Fryer, Peter Jones, and Richard Strange 1763

Letters

The American College of Rheumatology Statement on Silicone Breast Implants Represents a Consensus

James Rosenbaum 1765

Prognostic Factors in Sjogren's Syndrome: Comment on the Article by Kruize et al

Abhay Anand, Namrata Anand, and Ajay Anand 1765

Reply

Aike A. Kruize, Ronald J. Hene, Johannes W. J. Bijlsma, and Louis Kater 1766

Role of Sex Hormones in Autoimmune Disease: Comment on the Article by Nelson Alfred D. Steinberg 1766

Reply

J. Lee Nelson 1767

Musculoskeletal Disorders and Iron Overload Disease: Comment on the American College of Rheumatology Guidelines for the Initial Evaluation of the Adult Patient with Acute Musculoskeletal Symptoms

Alex Vasquez 1767

HLA-B Associations of HLA-B27 Negative Ankylosing Spondylitis: Comment on the Article by Yamaguchi et al

Matthew Brown, Michael Bunce, Andrei Calin, Christopher Darke, and Paul Wordsworth 1768

Reply

Akihiro Yamaguchi, Naoyuki Tsuchiya, Michiko Shiota, Koji Ito, Sadayoshi Yoshinoya, Katsushi Tokunaga, Hiroshi Mitsui, Atsuko Ogawa, and Takeo Juji 1769

Two Forms of the Major Antigenic Protein of the Dermatomyositis-Specific Mi-2 Autoantigen

Hans Peter Seelig, Manfred Renz, Ira N. Targoff, Qun Ge, and Mark Barton Frank 1769

Book Reviews 1771

ACR Announcements 13A

Volume 39, No. 11, November 1996

Special Articles

Commentary: Expectation Bias in Rheumatoid Arthritis Clinical Trials: The Anti-CD4 Monoclonal Antibody Experience

Wallace V. Epstein 1773

Review: Invasive Fibroblast-Like Synoviocytes in Rheumatoid Arthritis: Passive Responders or Transformed Aggressors?

Gary S. Firestein 1781

Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

American College of Rheumatology Task Force on Osteoporosis Guidelines 1791

Clinical Science

HLA-DRB1 Genes and Disease Severity in Rheumatoid Arthritis

Gamma-Linolenic Acid Treatment of Rheumatoid Arthritis: A Randomized, Placebo-Controlled Trial

Low-Dose Corticosteroids in Rheumatoid Arthritis: A Meta-Analysis of Their Moderate-Term Effectiveness

Autoreactivity to Human Heat-Shock Protein 60 Predicts Disease Remission in Oligoarticular Juvenile Rheumatoid Arthritis

Ribosomal P Autoantibodies in Systemic Lupus Erythematosus: Frequencies in Different Ethnic Groups and Clinical and Immunogenetic Associations

Impaired Recovery and Cytolytic Function of CD56+ T and Non[minus]T Cells in Systemic Lupus Erythematosus Following In Vitro Polyclonal T Cell Stimulation: Studies in Unselected Patients and Monozygotic Disease-Discordant Twins

A Randomized, Double-Blind Crossover Trial of Fluoxetine and Amitriptyline in the Treatment of Fibromyalgia

Novel Autoantibodies Against Muscle-Cell Membrane Proteins in Patients with Myositis

Abnormal Carnitine Distribution in the Muscles of Patients with Idiopathic Inflammatory Myopathy

Lymphocyte Apoptosis and Apoptosis-Associated Gene Expression in Sjogren's Syndrome

Basic Science

Autoimmunity to RNA Polymerase II is Focused at the Carboxyl Terminal Domain of the Large Subunit

Specificities of Human TAP Alleles for HLA[minus]B27 Binding Peptides

Recombinant Human Osteogenic Protein 1 is a Potent Stimulator of the Synthesis of Cartilage Proteoglycans and Collagens by Human Articular Chondrocytes

Effects of Nitric Oxide on Chondrocyte Migration, Adhesion, and Cytoskeletal Assembly

Synovial Distribution of αd/CD18, A Novel Leukointegrin: Comparison with Other Integrins and Their Ligands

Clinical Images

Albright's Hereditary Osteodystrophy

David R. Finger and Mark J. Jarek 1921

Dermatologic Vignette

Subcutaneous Fat Necrosis and Polyarthritis Associated with Pancreatic Disease

Mohammad I. Shbeeb, Joseph Duffy, Johannes Bjornsson, Arlan M. Ashby, and Eric L. Matteson 1922

Case Report

Behcet-Type Vasculopathy in a Patient Without the Diagnostic Features of Behcet's Disease

Brian D. Golden, Archana Goel, and Hal J. Mitnick 1926

Erratum 1930

Letters

The Economic Cost and Social and Psychological Impact of Musculoskeletal Conditions: Comment on the Article by Yelin et al

Carl Asche, Peter C. Coyte, Gillian Hawker, and Ben Chan 1931

Reply

Edward Yelin and Leigh Callahan 1931

Comparison of Polymyalgia Rheumatica and Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome: Comment on the Article by Salvarani et al

Daniel J. McCarty 1931

Reply

Carlo Salvarani, Sherine Gabriel, and Gene G. Hunder 1932

Development of Amyloidosis as an Unrecognized Side Effect of Gold Therapy: Comment on the Article by Shapiro and Spiera

Hartmut Michels and Reinhold P. Linke 1932

Reply

Deborah L. Shapiro and Harry Spiera 1934

Assessment of Healing Phenomena in Rheumatoid Arthritis: Comment on the Article by Rau and Herborn

Antonio R. Cabral and Donato Alarcon-Segovia 1934

Reply

Rolf Rau and Gertraud Herborn 1935

Geographic Clusters of Systemic Lupus Erythematosus: Comment on the Review by Wallace and Quismorio

Kaye H. Kilburn 1935

Reply

Daniel J. Wallace and Francisco P. Quismorio, Jr. 1936

Prognosis in Rheumatoid Vasculitis: Comment on the Article by Voskuyl et al

Xavier Puechal and Charles J. Menkes 1937

Reply

Alexandre E. Voskuyl, Aeilko H. Zwinderman, Ferdinand C. Breedveld, and Johanna M. W. Hazes 1937

Book Review 1938

ACR Announcements 10A

Volume 39, No. 12, December 1996

Special Articles

Review: Revision Total Hip Arthroplasty: Indications and Outcomes

Nizar Mahomed and Jeffrey N. Katz 1939

Review: Molecular Therapeutics: Methotrexate and its Mechanism of Action

Bruce N. Cronstein 1951

Basic Science

Shift Toward T Lymphocytes with a T Helper 1 Cytokine-Secretion Profile in the Joints of Patients with Rheumatoid Arthritis

Radboud J. E. M. Dolhain, Annette N. van der Heiden, Natalja T. ter Haar, Ferdinand C. Breedveld, and Andre M. M. Miltenburg 1961

Effects of Pulse Methylprednisolone on Cell Adhesion Molecules in the Synovial Membrane in Rheumatoid Arthritis: Reduced E-Selectin and Intercellular Adhesion Molecule 1 Expression

Peter P. Youssef, Sophie Triantafillou, Angela Parker, Mark Coleman, Peter J. Roberts-Thomson, Michael J. Ahern, and Malcolm D. Smith 1970

Common Occurrence of an Antiidiotypic Antibody that Recognizes T14+ Anti-DNA Antibodies in Patients with Systemic Lupus Erythematosus

Pak-Leong Lim, Lawrence W. K. Ng, Danny T. M. Leung, Kong-Chiu Wong, Si-Yang Song, Yiu-Loon Chui, Joseph C. K. Leung, Kar-Neng Lai, and Siu-Fai Lui 1980

Presence of Antibodies to Native G1 Domain of Aggrecan Core Protein in Synovial Fluids from Patients with Various Joint Diseases

Christopher Karopoulos, Merrill J. Rowley, Mirna Z. Ilic, and Christopher J. Handley 1990

Nonsteroidal Antiinflammatory Drugs and Uncoupling of Mitochondrial Oxidative Phosphorylation

Taher Mahmud, Sue S. Rafi, David L. Scott, John M. Wrigglesworth, and Ingvar Bjarnason 1998

Clinical Science

Comparison of Sulfasalazine and Placebo in the Treatment of Ankylosing Spondylitis: A Department of Veterans Affairs Cooperative Study

Daniel O. Clegg, Domenic J. Reda, Michael H. Weisman, Warren D. Blackburn, John J. Cush, Grant W. Cannon, Maren L. Mahowald, H. Ralph Schumacher, Jr., Thomas Taylor, Elly Budiman-Mak, Miriam R. Cohen, Frank B. Vasey, Michael E. Luggen, Edwin Mejias, Stuart L. Silverman, Rama Makkena, F. Paul Alepa, Joel Buxbaum, Clair M. Haakenson, Richard H. Ward, B. J. Manaster, Robert J. Anderson, John R. Ward, and William G. Henderson 2004

Comparison of Sulfasalazine and Placebo in the Treatment of Psoriatic Arthritis: A Department of Veterans Affairs Cooperative Study

Daniel O. Clegg, Domenic J. Reda, Edwin Mejias, Grant W. Cannon, Michael H. Weisman, Thomas Taylor, Elly Budiman-Mak, Warren D. Blackburn, Frank B. Vasey, Maren L. Mahowald, John J. Cush, H. Ralph Schumacher, Jr., Stuart L. Silverman, F. Paul Alepa, Michael E. Luggen, Miriam R. Cohen, Rama Makkena, Clair M. Haakenson, Richard H. Ward, B. J. Manaster, Robert J. Anderson, John R. Ward, and William G. Henderson 2013

Comparison of Sulfasalazine and Placebo in the Treatment of Reactive Arthritis (Reiter's Syndrome): A Department of Veterans Affairs Cooperative Study

Daniel O. Clegg, Domenic J. Reda, Michael H. Weisman, John J. Cush, Frank B. Vasey, H. Ralph Schumacher, Jr., Elly Budiman-Mak, Dominic J. Balestra, Warren D. Blackburn, Grant W. Cannon, Robert D. Inman, F. Paul Alepa, Edwin Mejias, Miriam R. Cohen, Rama Makkena, Maren L. Mahowald, Jean Higashida, Stuart L. Silverman, Nourollah Parhami, Joel Buxbaum, Clair M. Haakenson, Richard H. Ward, B. J. Manaster, Robert J. Anderson, John R. Ward, and William G. Henderson 2021

Cumulative Rate of Relapse of Lupus Nephritis After Successful Treatment with Cyclophosphamide

Elena Ciruelo, Javier de la Cruz, Ignacio Lopez, and Juan J. Gomez-Reino 2028

Analysis of Cognitive and Psychological Deficits in Systemic Lupus Erythematosus Patients Without Overt Central Nervous System Disease

Elizabeth Kozora, Laetitia L. Thompson, Sterling G. West, and Brian L. Kotzin 2035

Mannose-Binding Protein Genetic Polymorphisms in Black Patients with Systemic Lupus Erythematosus

Kathleen E. Sullivan, Candra Wooten, Daniel Goldman, and Michelle Petri 2046

Therapy for the Maintenance of Remission in Sixty-Five Patients with Generalized Wegener's Granulomatosis: Methotrexate versus Trimethoprim/Sulfamethoxazole

Kirsten de Groot, Eva Reinhold-Keller, Efstratios Tatsis, Jens Paulsen, Martin Heller, Bernhard Nolle, and Wolfgang L. Gross 2052

The Effect of Prophylactic Penicillin Treatment on the Course of Arthritis Episodes in Patients with Behcet's Disease: A Randomized Clinical Trial

Meral Calguneri, Sedat Kiraz, Ihsan Ertenli, Mustafa Benekli, Yasar Karaarslan, and Ismail Celik 2062

Case Reports

Hypercalcemia and Systemic Lupus Erythematosus

Leonard J. Deftos, Douglas W. Burton, Stephen M. Baird, and Robert A. Terkeltaub 2066

Preliminary Experience with Low-Dose Methotrexate in Fibroblastic Rheumatism

Olivier Vittecoq, Othmane Mejjad, Fernando da Silva, Pascal Joly, Elizabeth Thomine, Philippe Lauret, Jean Michel Thomine, and Xavier le Loet 2070

Radiologic Vignette

Cervical Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament in Ankylosing Spondylitis

Ignazio Olivieri, Elisabetta Fiandra, Christopher Muscat, Libero Barozzi, Chiara Tomassini, and Roberto Gerli 2074

ACR Slide Competition

Winners of the 1996 American College of Rheumatology Slide Competition and Future Plans for the Clinical Slide Collection on the Rheumatic Diseases

Eric L. Matteson and the American College of Rheumatology Audiovisual Aids Subcommittee 2078

Concise Communication

Lack of Evidence of Mycobacteria in Synovial Tissue from Patients with Rheumatoid Arthritis

Elon Pras, H. Ralph Schumacher, Jr., Daniel L. Kastner, and Ronald L. Wilder 2080

Erratum 2081

Letters

Recertification of Rheumatologists

Robert Daggett and Kenneth Hardy 2082

Reply

Arthur L. Weaver 2082

Comment on the American College of Rheumatology Guidelines for Osteoarthritis of the Knee and Hip

Robert L. Swezey 2083

Laboratory Tests as Predictors of Disease Exacerbations in Systemic Lupus Erythematosus: Comment on the Article by Esdaile et al

Ruud J. T. Smeenk, Lucien A. Aarden, and Tom J. G. Swaak 2083

Reply

John M. Esdaile, Michal Abrahamowicz, Lawrence Joseph, Todd MacKenzie, Yin Li, and Deborah Danoff 2084

Psychiatric Diagnoses in Patients with Fibromyalgia: Comment on the Article by Aaron et al

Eric M. Ruderman and Harvey E. Golden 2086

Reply

Leslie A. Aaron, Laurence A. Bradley, Graciela S. Alarcon, Ronald W. Alexander, Mireya Triana-Alexander, Michelle Y. Martin, and Kristin R. Alberts 2086

Mediterranean Spotted Fever and Arthritis: Comment on the Article by Sundy et al

Juan Carlos Cobeta-Garcia and Juan Antonio Domingo-Morera 2088

Reviewers 2089

Contents, Volume 39, 1996 2092

Indexes 2114

ACR Announcements 9A