Akito Tsutsumi, Eiji Matsuura, Kenji Ichikawa, Atsushi Fujisaku, Masaya Mukai, Seiichi Kobayashi, and Takao Koike 1466

Serum samples from 308 SLE patients were examined for the presence of IgG or IgM anti-β2-glycoprotein I antibodies, using a newly developed phospholipid-independent enzyme immunoassay. The evidence obtained suggests that pathogenic "anticardiolipin" antibodies are in fact autoantibodies against structurally altered β2-glycoprotein I and that measurement of theseautoantibodies may be of use in determining the risk of thrombosis and monitoring disease activity in patients with SLE.

Betty D. Pryor, Saba G. Bologna, and Leslie E. Kahl 1475

This report demonstrates the relatively high frequency of serious infections that occur during cyclophosphamide therapy in patients with SLE. It identifies risk factors for infection that the clinical rheumatologist can use to minimize the possibility of infection during therapy.

Kunio Isshi and Shunsei Hirohata 1483

Results of the present study, obtained using a specific ELISA, confirm the significant correlation of serum anti-ribosomal P protein antibodies with lupus psychosis, including organic brain syndrome and nonorganic psychosis. These findings provide a significant contribution to our understanding of the pathogenesis of diffuse central nervous system lupus erythematosus.

F. Rodriguez, J. C. Krayenbuhl, W. B. Harrison, O. Forre, B. A. C. Dijkmans, P. Tugwell, P. A. Miescher, and M. J. Mihatsch 1491

Concern about the potential for cyclosporin A to cause renal dysfunction has limited its use in autoimmune diseases such as rheumatoid arthritis. Data from the International Kidney Biopsy Registry were found to be reassuring, in that when recommended dosing schedules of CSA are used, the risk of developing nephropathy is low.

Xiaowen He, Wanyun Zhong, Timothy G. McCarthy, Cornelia M. Weyand, and Jorg J. Goronzy 1499

The absence of RF in seronegative RA may be due to a hole in the B cell repertoire or lack of T cell help. Alternatively, seropositive and seronegative RA may be fundamentally different diseases. This study shows that RF-secreting B cells are expanded in patients with seronegative RA, but less markedly than in seropositive disease. Thus, seronegative and seropositive RA form a spectrum of disease, in which the frequency of activated B cells secreting RF is likely determined by the effectiveness of T cell help.

Frank C. Arnett, Ira N. Targoff, Tsuneyo Mimori, Rose Goldstein, Noranna B. Warner, and John D. Reveille 1507

Determination of myositis-specific autoantibodies and MHC class II alleles in 224 patients with various forms of myositis revealed only weak HLA associations with disease subsets. Autoantibodies such as anti-Jo-1, anti-PL-12, and other anti-tRNA synthetases, however, were strikingly associated with several HLA-DQA1 locus alleles across ethnic lines.

Carin Vahlquist, Marianne Larsson, Jan Ernerudh, Gosta Berlin, Thomas Skogh, and Anders Vahlquist 1519

This report describes the findings of an open study of combined photopheresis and PUVA as a new treatment for severe psoriatic arthritis. The results indicate that this treatment has the potential to produce long-term suppression of joint symptoms in a subgroup of psoriatic arthritis patients, without causing serious side effects.

Ignazio Olivieri, Libero Barozzi, Lucio Favaro, Antonella Pierro, Massimo de Matteis, Claudio Borghi, Angela Padula, Silvio Ferri, and Pietro Pavlica 1524

This study demonstrates, by use of ultrasonography and MRI, that the "sausage-like" finger observed in patients with seronegative spondylarthropathy is caused by flexor tenosynovitis. Capsule distension was observed in only 1 of the 12 dactylitic fingers studied. Physical examination was found to be a sufficient method for the diagnosis of finger dactylitis.

Robert E. Weibel and David E. Benor 1529

This article describes the review process of the National Vaccine Injury Compensation Program in handling 124 submitted claims of musculoskeletal signs and symptoms associated with rubella vaccine. The classification of clinical findings based on the medical records and category totals were as follows: unspecified arthritis 30, specified arthritis 30, arthralgia 31, fibromyalgia 15, and multiple symptoms 18. Of the 56 subjects with completed claims, 23 have been awarded compensation by the Special Masters and 33 have not. The rate of concordance between the decisions of the Special Masters and the medical recommendations of Program physicians was 91%.

John P. Caron, Julio C. Fernandes, Johanne Martel-Pelletier, Ginette Tardif, Francois Mineau, Changshan Geng, and Jean-Pierre Pelletier 1535

Recombinant human interleukin-1 receptor antagonist has proven, in vitro, to be an effective agent in suppressing the synthesis of metalloproteases and articular cartilage catabolism. The present study demonstrated that rHuIL-1Ra could reduce the progression of lesions and cartilage degradation in experimental canine OA in vivo. These results highlight the importance of control of the activity of proinflammatory cytokines, such as IL-1, in the treatment of OA.

P. L. E. M. van Lent, A. E. M. Holthuysen, L. A. M. van den Bersselaar, N. van Rooijen, L. A. B. Joosten, F. A. J. van de Loo, L. B. A. van de Putte, and W. B. van den Berg 1545

This study indicates that phagocytic lining cells are important in cell influx into the synovial joint. Treatment of these cells with drugs encapsulated in liposomes, which selectively block proinflammatory cytokines and tissue-destroying molecules, might hold promise as a tool for combating the propagation of inflammation during RA.

J. K. Fernihough, M. E. J. Billingham, S. Cwyfan-Hughes, and J. M. P. Holly 1556

Although the clinical rheumatologist is able to treat and to help arthritis patients, the drugs involved often have serious side effects, and tools for early diagnosis and prognosis are very limited. The considerable disruption of the IGF system found in this study may provide an additional tool for identifying those patients who have early-stage RA or OA. Further research may also lead to novel drug therapies that target the IGF system.

Alisa E. Koch, Margaret M. Halloran, Shigeru Hosaka, Manisha R. Shah, Catherine J. Haskell, Steven K. Baker, Ralph J. Panos, G. Kenneth Haines, Gregory L. Bennett, Richard M. Pope, and Napoleone Ferrara 1566

The data obtained in this study indicate that synovial HGF may contribute to the vasculoproliferative phase of inflammatory arthritides, such as rheumatoid arthritis, by inducing HGF-mediated synovial neovascularization. It may be that therapeutic efforts aimed at reducing synovial neovascularization might help halt the progression of rheumatoid arthritis.

Diane Ahrens, Alisa E. Koch, Richard M. Pope, Monica Stein-Picarella, and Michael J. Niedbala 1576

Using reagents that specifically recognize the matrix metalloproteinase gelatinase B, it was observed that gelatinase B levels are elevated in the synovial fluid of patients with RA and inflammatory arthritis, compared with osteoarthritis patient samples. Gelatinase B levels were found to be elevated in the plasma of RA patients, but not in that of patients with inflammatory arthritis or normal subjects. Immunolocalization studies demonstrated the expression of gelatinase B in infiltrating leukocytes (neutrophils and macrophages), endothelial cells, and synovial fibroblasts in RA synovium. These data collectively indicate an association between increased gelatinase B levels and inflammatory RA, implying that connective tissue turnover occurs as a result of excessive MMP activity over TIMP action in the invading pannus, periarticular tissue, or synovial fluid.

Qun Ge, Yajuan Wu, Judith A. James, and Ira N. Targoff 1588

This study identified and localized a major common epitope of the major antigenic protein of the PM-Scl antigen. This may facilitate detection of anti-PM-Scl antibodies, which are closely associated with an overlap syndrome of myositis and scleroderma, and may help in the understanding of the origin of these antibodies.

Egidija Sakiniene, Tomas Bremell, and Andrzej Tarkowski 1596

Bacterial arthritis is a serious, rapidly progressing disease with high morbidity and mortality despite antimicrobial therapy. This study showed that the down-regulation of T and B lymphocyte and macrophage functions caused by corticosteroid administration significantly ameliorated the course of experimental S aureus arthritis and the mortality rate from septicemia. The outcome emphasizes the need for antiinflammatory treatment along with antibiotic therapy to efficiently reduce the sequelae following S aureus infection.