Electronic Library of Scientific Literature
Electronic Library of Scientific Literature
SELECTED EXTRAINTESTINAL MANIFESTATIONS OF CROHN’S DISEASE
D. ZLNAY, M. PRIKAZSKA, J. LUKAC, J. ROVENSKY
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Vyskumny ustav vyzivy, Bratislava
Riaditel: doc. MUDr. R. Simoncic, CSc.
Suhrn
Pozadie problemu: Crohnova choroba a ulcerozna kolitida sa zaraduju
do skupiny enteropatickych spondartritid, pri ktorych sa moze okrem charakteristickych
enteralnych priznakov objavovat viacero extraintestinalnych prejavov, ktore
sa mozu v urcitych pripadoch vyvijat autonomne, nezavisle od aktivity crevneho
zapalu.
Ciel a vychodiska: Autori v praci upozornuju na vyskyt a frekvenciu
niektorych vybranych extraintestinalnych prejavov Crohnovej choroby, s
ktorymi sa najcastejsie stretavaju reumatologovia v klinickej praxi.
Metody: Prezentuju subor 51 chorych na Crohnovu chorobu (24
muzov a 27 zien), u ktorych sleduju artrologicke prejavy v oblasti chrbtice
a perifernych klbov a niektore vaskularne zmeny, ako erythema nodosum a
poruchu akralnej cirkulacie, ktore davaju do suvislosti so zakladnym ochorenim.
Cievne zmeny objektivizovali kapilaroskopicky a termograficky.
Hlavne vysledky: V zhode s literaturou zistuju 5,9 % vyskyt
ankylozujucej spondylitidy a 25,9 % vyskyt epizodickej artritidy. Pomerne
caste su neurcite zmeny v oblasti sakroiliakalnych klbov (23,5 %), casto
bez rozvoja. Objavenie sa premenliveho erythema nodosum v 13,7 % a poruchy
akralnej cirkulacie v podobe Raynaudovho syndromu v 21,5 % mozu byt v suvislosti
s enteralnymi prejavmi zakladnej Crohnovej choroby, perifernou artritidou
a ankylozujucou spondylitidou.
Zavery: Autori predpokladaju, ze extraintestinalne priznaky
Crohnovej choroby sa vyskytuju na zaklade vaskulitidy, ktora sa moze manifestovat
v spojitosti s enteralnymi prejavmi, a mozu byt v imunologickej zavislosti
zakladnej choroby a jej komplikacii.
Klucove slova: Crohnova choroba, seronegativne spondartritidy,
vaskulitidy.
Summary
Background of the problem: Crohn’s disease and ulcerative colitis
are classified in the group of enteropathic spondarthritides, where besides
characteristic enteral symptoms a number of extraintestinal manifestations
can occur, which can in certain instances develop autonomously, independent
of the activity of the intestinal inflammation.
The aim and the starting points: The authors draw the attention
to the occurrence and frequency of selected extraintestinal manifestations
of Crohn’s disease encountered by the rheumatologists in the clinical practise
most frequently.
The methods: The authors present a group of 51 patients with
Crohn’s disease (24 men and 27 women) in whom they study arthrologic manifestations
in the region of the spine, peripheral joints and some vascular changes,
such as erythema nodosum and the acral circulation disorder, which they
relate to the basic disease. They objectified the vascular changes capilaroscopically
and thermographically.
The main results: Their findings of 5.9 % occurrence of ankylosing
spondylitis and 25.9 % occurrence of episodic arthritis is in accordance
with the literature. Relatively frequent are indefinite changes in the
region of the sacroiliac joints (23.5 %), not rarely without development.
The finding of erythema nodosum migrans in 13.7 % and the acral circulation
disorder under the form of Raynaud’s syndrome in 21.5 % can be in relation
to enteral manifestations of the basic Crohn’s disease, peripheral arthritis
and ankylosing spondylitis.
Conclusions: The authors presume that the extraintestinal symptoms
of the Crohn’s disease develop on the basis of vasculitis which can be
manifested in relation with enteral manifestations and can be in an immunological
relation to the basic disease and its complications.
Key words: Crohn’s disease, seronegative spondarthritides, vasculitides.
pp. 1-4
HYALURONIC ACID IN SYNOVIAL EFFUSION OF PATIENTS WITH RHEUMATIC DISEASES
J. KRAJICKOVA, K. TRNAVSKY
Revmatologicky ustav, Praha
Reditel: doc. MUDr. K. Pavelka, CSc.
Souhrn
Metodou kapalinove chromatografie za vysokych tlaku byl vysetren obsah
kyseliny hyaluronove a stupen jeji polymerizace v synovialni tekutine u
114 nemocnych se zanetlivymi revmatickymi chorobami (revmatoidni artritidou,
juvenilni chronickou artritidou, reaktivni artritidou, dnavou a psoriatickou
artritidou a artritidou u ankylozujici spondylitidy). Dosazene vysledky
byly porovnany s nalezy u 15 nemocnych s osteoartrozou. Koncentrace kyseliny
hyaluronove nebyla odlisna v zanetlivych vypotcich od hodnot v tekutine
z osteoartrotickych kloubu. Celkovy obsah hyaluronove kyseliny se zvysoval
v synovialni tekutine u zanetlivych revmatickych chorob a vyrazne se snizoval
podil kyseliny hyaluronove s vyssi molekularni hmotnosti.
Klicova slova: revmaticke choroby, synovialni tekutina, kyselina
hyaluronova.
Summary
By the method of high performance liquid chromatography under high
pressure the hyaluronic acid content and the grade of its polymerisation
in the synovial fluid was studied in 114 patients with inflammatory rheumatic
diseases (rheumatoid arthritis, juvenile chronic arthritis, reactive arthritis,
gout, psoriatic arthritis and arthritis in ankylosing spondylitis). The
results obtained were compared with fin-dings in 145 patients with osteoarthrosis.
Hyaluronic acid concentration in the inflammatory effusions did not differ
from the values of the fluid from osteoarthrotic joints. The total hyaluronic
acid content in inflammatory rheumatic diseases was increased and the proportion
of the hyaluronic acid with higher molecular weight was decreasing.
Key words: rheumatic diseases, synovial fluid, hyaluronic acid.
pp. 5 – 7
SUBPOPULATIONS OF LYMPHOCYTES IN SYSTEMIC SCLEROSIS
L. RAUOVA, J. LUKAC, J. ROVENSKY
Vyskumny ustav reumatickych chorob, Piestany
riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Systemova skleroza (SSc) je systemova choroba spojiva charakterizovana
zapalovymi fibroproduktivnymi zmenami a poruchou celularnej a humoralnej
imunity. Prietokovym cytometrom boli pomocou dvojfarebnej imunofluorescenie
vysetrene subpopulacie lymfocytov CD3/CD57, CD3/DR, CD5/CD19, CD4/CD45RA,
CD8/CD11b, CD16, CD25 a CD71, ako aj expresia receptorov HLA-DR na monocytoch
u 39 pacientov so SSc, 30 pacientov so systemovym lupus erythematosus (SLE)
a 18 pacientov s reumatoidnou artritidou (RA). 17 pacientov so SSc, vsetci
pacienti so SLE a RA boli lieceni len nesteroidnymi antireumatikami a/alebo
vazodilatanciami. U pacientov so SSc sa zistil vyznamne zvyseny relativny
pocet B-lymfocytov a znizeny pocet lymfocytov CD8+CD11b na zaciatku choroby,
zvysenie poctu lymfocytov CD3+CD57+ a znizenie poctu lymfocytov CD3-CD57+
a zvysenie poctu aktivovanych lymfocytov v perifernej krvi. Zvysenie poctu
lymfocytov CD3+CD57+ korelovalo s produkciou autoprotilatok (ANA a ENA
typu Ro a/alebo U1). U pacientov s ulceraciami boli vyznamne zvysene pocty
lymfocytov CD8+CD11b+. U liecenych pacientov s dlhsie trvajucim ochorenim
sa pozoroval vzostup poctu pamatovych lymfocytov CD4+CD45RA-. U pacientov
s postihnutim plucneho intersticia koreloval pokles difuznej kapacity pre
oxid uholnaty so vzostupom poctu naivnych lymfocytov CD4+CD45RA+. U pacientov
s pritomnou sekundarnou bakterialnou infekciou sa pozorovala znizena expresia
receptorov HLA-DR na monocytoch. Uvedene vysledky potvrdzuju ucast aktivovanych
lymfocytov na patogeneze a rozvoji SSc.
Klucove slova: subpopulacie lymfocytov, DR+ monocyty, systemova
skleroza, systemovy lupus erythematosus, reumatoidna artritida.
Summary
Systemic sclerodermia (SSc) is a systemic connective tissue disease
characterized by inflammatory fibroproductive changes and a cellular and
humoral immunity disorder. Using two colour flow cytometry subpopulations
of lymphocytes CD3/CD57, CD3/DR, CD5/CD19, CD4/CD45RA, CD8/CD11, CD16,
CD25 and CD71 as well as the expression of HLA-DR receptors on monocytes
were examined in 39 SSc patients, 30 patients with systemic lupus erythematosus
(SLE) and 18 patients with rheumatoid arthritis (RA). Seventeen SSc patients
and all the patients with SLE and RA were treated only with non-steroidal
antirheumatic and/or vasodilatant drugs. The SSc patients were found to
have a significant increase of relative number of B lymphocytes, a decrease
of CD8+CD11b- lymphocytes at the onset of the disease, an increase of CD3+CD57+
lymphocytes and a decrease of CD3-CD57+ lymphocytes, and an increase of
activated lymphocytes in the peripheral blood. The increase of CD3+CD57+
lymphocytes correlated with the production of autoantibodies (ANA and ENA
of Ro and/or U1 type). In patients with ulcerations CD8+CD11b+ lymphocytes
were significantly increased. In the treated patients with the disease
of longer duration an increase of memory CD4+CD45RA- lymphocytes was observed.
In patients with involvement of the lung interstitium, there was a correlation
of a decrease of the diffuse capacity for carbon oxide, with an increase
of naive CD4+CD45RA+ lymphocytes. In patients with the presence of secondary
bacterial infection a decreased expression of HLA-DR receptors on monocytes
was observed. The results presented confirm the role of activated lymphocytes
in the pathogenesis and development of SSc.
Key words: subpopulations of lymphocytes, DR+ monocytes, systemic
sclerosis, systemic lupus erythematosus, rheumatoid arthritis.
pp. 9 – 15
HYALURONIC ACID (HYALGAN[^R]) IN THE TREATMENT OF GONARTHROSIS
K. PAVELKA, V. VLASAKOVA, J. VITOVA, H. STEHLIKOVA, J. SLANSKY
Revmatologicky ustav, Praha
Reditel: doc. MUDr. K. Pavelka, CSc.
Interni oddeleni Nemocnice, Ceske Budejovice
Primar: MUDr. Z. Stepanek
Revmatologicke oddeleni Nemocnice, Kolin
Reditel: MUDr. J. Rakusan
Farmakologicky ustav AV CR, Praha
Reditel: RNDr. J. Seifert, CSc.
Souhrn
Cile studie: Prokazat ucinnost a bezpecnost lecby aktivovane
gonartrozy serii intraartikularne aplikovanych injekci kyseliny hyaluronove
(Hyalgan[^R]).
Metody: Otevrena, multicentricka studie v delce trvani 17 tydnu.
Sledovane parametry — bolest na vizualni analogove skale, algofunkcni index
ISK, index pro hodnoceni bolesti, klinicke vysetreni, celkove hodnoceni
lecby pacientem a lekarem, cas chuze na 20 metru a spotreba analgetik.
Pacienti — 30 pacientu (5 muzu a 25 zen) ve II. a III. stadiu gonartrozy,
v aktivovanem stadiu.
Vysledky: Doslo k vysoce signifikantnimu (p=0,001) poklesu vsech
sledovanych subjektivnich i objektivnich parametru vetsinou po 2. injekci.
Tento pokles proti vychozimu stavu byl vyznamny jeste 13 tydnu po skonceni
posledni aplikace. Nezadouci ucinky: 1 pacient udaval silne bolesti po
1. injekci a lecba byla prerusena.
Zaver: Intraartikularne aplikovana kyselina hyaluronova splnuje
kriteria pro tzv. symptomaticky pomalu pusobici lek osteoartrozy (SYSADOA).
Jde o lecbu bezpecnou s priznivym pomerem ucinek/riziko.
Klicova slova: gonartroza, kyselina hyaluronova, intraartikularni
lecba.
Summary
Aims of the study: To demonstrate the efficacy and safety of
the treatment of activated knee osteoarthritis by a series of intraarticularly
applied hyaluronic acid injections (Hyalgan[^R]).
The methods: An open, multicentric study of 17 weeks duration.
The studied parameters — the pain on visual analogue scale, algofunctional
index ISK, pain evaluation index, clinical examination, overall evaluation
of the treatment by the patient and the physician, the time of the walking
for 20 meters and the analgetics consumption. The patients — 30 patients
(5 men and 25 women) in II and III grade of knee osteoarthritis in the
activated stage.
The results: There was a highly significant (p=0.001) decrease
in all the studied subjective as well as objective parameters, mostly after
the second injection. In comparison with the initial state this decrease
was significant even 13 weeks after the finishing of the last application.
The undesirable effects: 1 patient indicated strong pain after the 1st
injection and the treatment was discontinued.
The conclusion: The intraarticularly applied hyaluronic acid
fulfills the criteria for so-called „symptomatically slowly acting drug
for osteoarthritis (SYSADOA)". It is a safe treatment with a favourable
risk/benefit ratio.
Key words: gonarthrosis, hyaluronic acid, intraarticular treatment.
pp. 17 – 21
GLUCOCORTICOID RECEPTORS IN LYMPHOCYTES OF PATIENTS WITH RHEUMATOID ARTHRITIS
S. BLAZICKOVA, M. ALEXANDROVA, J. ROVENSKY
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Ustav experimentalnej endokrinologie SAV, Bratislava
Riaditel: prof. MUDr. L. Macho, DrSc.
Suhrn
Pozadie problemu: Glukokortikoidy su pocas poslednych 40 rokov
liekmi, ktore maju schopnost svojou protizapalovou a imunosupresivnou aktivitou
potlacat zapalove prejavy pri vybranych reumatickych chorobach, najma pri
reumatoidnej artritide a systemovom lupus erythematosus. Predpokladom ucinku
glukokortikoidov je ich vazba so specialnymi receptormi v cielovych tkanivach.
Ciel a vychodiska: V praci sme sledovali glukokortikoidove receptory
v lymfocytoch perifernej krvi u 32 pacientov s reumatoidnou artritidou.
Metody: V izolovanych lymfocytoch sme urcovali vazbu [^3]H-dexa-metazonu
na glukokortikoidove receptory, ich koncentraciu a disociacnu konstantu
sme vypocitali pomocou Scatchardovej grafickej zavislosti.
Hlavne vysledky: Zistili sme preukazne znizenie koncentracie
glukokortikoidovych receptorov u pacientov s reumatoidnou artritidou v
zavislosti od davky prednizonu a od dlzky jeho podavania v porovnani s
kontrolnou skupinou. Vazbova afinita (disociacna konstanta) glukokortikoidovych
receptorov sa u pacientov s reumatoidnou artritidou nelisi od kontrolnej
skupiny a nezavisi ani od davky glukokortikoidov.
Klucove slova: lymfocyty, glukokortikoidove receptory, glukokortikoidy,
reumatoidna artritida.
Summary
Background of the problem: During the last 40 years glucocorticoids
have been the drugs having the capacity by their antiinflammatory and immunosuppressive
action to suppress inflammatory manifestations in selected rheumatic diseases
especially rheumatoid arthritis and systemic lupus erythematosus. The prerequisite
of the effect of glucocorticoids is their binding with special receptors
in the target issues.
The aim and the starting points: We have studied glucocorticoid
receptors in the peripheral blood lymphocytes in 32 rheumatoid arthritis
patients.
The methods: In the isolated lymphocytes we have determined
the binding of [^3]H-dexametasone on glucocorticoid receptors, their concentration
and dissociation constant were calculated according to the method of Scatchard.
Main results: We have found a significant decrease of glucocorticoid
receptors concentration in rheumatoid arthritis patients in relation to
the prednisone dose and the duration of its administration in comparison
with the control group. The binding affinity (dissociation constant) of
the glucocorticoid receptors does not differ in the rheumatoid arthritis
patients from the control group nor is it dependent from the glucocorticoid
dose.
Key words: lymphocytes, glucocorticoid receptors, glucocorticoids,
rheumatoid arthritis.
pp. 23 – 26
CHRONOBIOLOGY OF ACUTE GOUT ARTHRITIS. I.
YEARLY AND WEEKLY CYCLES
A. VALACHOVA, J. ROVENSKY, K. BOSMANSKY, R. MASAROVA, M. MIKULECKY
I. interna klinika LFUK a FN, Bratislava
Prednosta: prof. MUDr. I. Duris, DrSc.
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Ustav preventivnej a klinickej mediciny, Bratislava
Riaditel: doc. MUDr. T. Trnovec, DrSc.
Suhrn
V predlozenej praci sa posudilo casove rozlozenie zachvatov dny v priebehu
roka a tyzdna. Udaje pochadzaju z dokumentacie Vyskumneho ustavu reumatickych
chorob v Piestanoch za roky 1961 az 1994. Spolu sa takto zhodnotilo pomocou
periodogramovej a kosinorovej analyzy 250 zachvatov u 79 chorych. Z nich
pri 126 zachvatoch zaznamenanych u 55 pacientov bolo mozne ziskat aj udaj
o kalendarnom datume prihody. Najviac zachvatov bolo v marci az maji, najmenej
v auguste. V tyzdnovom rozpati bol najfrekventovanejsi stred tyzdna, najpokojnejsi
vikend. Pri vysvetlovani tychto javov sa uvazovalo o vplyve striedania
teplot, najma ochladenia, zvysenej telesnej zataze a "vystrelkov"
v stravovani a piti alkoholu. Ziskane poznatky mozno vyuzit teoreticky
na spresnenie uvah o patogeneze dnaveho zachvatu a azda aj prakticky na
zlepsenie ich prevencie.
Klucove slova: dnavy zachvat, sezonnost, tyzdenny rytmus, analyza
casovych radov, vyvolavajuce cinitele.
Summary
The aim is to evaluate the time distribution of the gout attacks during
year and week. The data have been taken from the files of the Research
Institute of Rheumatology in Piestany for the years 1961 to 1994. Altogether,
250 attacks of 79 patients were analysed with the aid of the periodogram
and cosinor analysis. Of them, for 126 attacks, registered at 55 patients,
also the complete calendar date was available. The highest frequency was
seen between March and May, the lowest one in August. As to the week span,
the middle of week was the most frequented time while weekend was the most
quiet part of week. To understand the mechanisms of these phaenomena, influences
of alternating temperatures, particularly those of getting colder, then
those of increased physical load and of excesses in dietary regimen, including
alcohol consumption, were taken into consideration. The obtained knowledge
can be exploited theoretically in favour of making the ideas concerning
pathogenesis of acute gout arthritis more precise, and perhaps also practically
towards improving the corresponding preventive measures.
Key words: acute gout arthritis, seasonality, weekly rhythm,
time series analysis, precipitating factors.
pp. 27 – 31
THE INFLUENCE OF TRYPSIN ON SELECTED SURFACE ANTIGENS OF PERIPHERAL BLOOD LYMPHOCYTES IN SLE PATIENTS IN VITRO
A. TUCHYNOVA, S. BLAZICKOVA, L. RAUOVA, J. ROVENSKY
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Pozadie problemu: Funkcne poruchy lymfocytov pri autoimunitnych
ochoreniach su predmetom neustaleho sledovania.
Ciel: Cielom predlozenej prace bolo sledovat schopnost spontannej
znovuobnovy diferenciacnych antigenov (CD2, CD4, CD8, CD45RA) na lymfocytoch
perifernej krvi po experimentalnej trypsinizacii.
Metoda: Vysetrovany subor tvorilo 16 pacientov so systemovym
lupus erythematosus (SLE), ktori boli podla aktivity ochorenia rozdeleni
na skupinu s aktivnym SLE (7 pacientov) a neaktivnym SLE (9 pacientov).
Kontrolnu skupinu tvorilo 9 zdravych osob. Lymfocyty po vyizolovani z perifernej
krvi a trypsinizacii boli nasledne inkubovane v kultivacnom mediu. Citlivost
na trypsin a rychlost znovuobnovy jednotlivych antigenov bola vyjadrena
relativnym poctom lymfocytov viazucich prislusnu monoklonovu protilatku.
Vysledky: Zistilo sa, ze lymfocyty perifernej krvi u pacientov
s aktivnym SLE po kultivacii s trypsinom obnovuju schopnost viazat monoklonovu
protilatku CD2 preukazne pomalsie ako lymfocyty pacientov s neaktivnou
formou SLE a zdravych darcov. Dalej sa zistila preukazne vyssia citlivost
antigenu CD8 na trypsin pri aktivnych formach SLE. Znovuobnova antigenu
CD8 bola v tejto skupine rychlejsia ako u chorych s neaktivnym SLE a zdravych
darcov.
Zaver: Nase pozorovania potvrdzuju predchadzajuce zistenie spomalenej
obnovy tvorby E-roziet pri aktivnych formach SLE. Z klini-ckoimunologickeho
hladiska tento nalez umoznuje definovat imunologicke poruchy T-lymfocytov
nielen pri aktivnych formach SLE, ale aj pri prechode klinicky aktivneho
stavu do remisie.
Klucove slova: systemovy lupus erythematosus, znovuobnova antigenov
lymfocytov perifernej krvi.
Summary
Background of the problem: Functional disorders of lymphocytes
in autoimmune diseases are subject of incessant study.
The aim: The aim of the presented work was to study the capacity
of the spontaneous recovery of differentiation antigens (CD2, CD4, CD8,
CD45RA) on peripheral blood lymphocytes after experimental trypsinization.
The method: The group examined included 16 patients with systemic
lupus erythematosus (SLE), divided according to the activity of the disease
into the group with active SLE (7 patients) and with inactive SLE (9 patients).
The control group comprised 9 healthy persons. The lymphocytes after isolation
from the peripheral blood and trypsinization were incubated in the cultivation
medium. The sensitivity to trypsin and the velocity of the recovery of
the individual antigens were expressed by relative numbers of lymphocytes
binding the respective monoclonal antibody.
The results: The peripheral blood lymphocytes in patients with
active SLE after cultivation with trypsin were found to recover their capacity
to bind monoclonal antibody CD2 significantly slowlier than the lymphocytes
of patients with inactive form of SLE and healthy donors. Further, CD8
antigen was found to have a significantly higher sensitivity to trypsin
in active SLE forms. The recovery of CD8 antigen was in this group more
rapid than in the patients with inactive SLE and healthy donors.
Conclusion: Our observations confirm the previous findings of
a slowed down recovery of E-rosettes in active forms of SLE. From the point
of view of clinical immunology this finding enables to define immunologic
disorders of T-lymphocytes not only in active forms of SLE but also in
the transition of the clinically active state into the remision.
Key words: systemic lupus erythematosus, recovery of antigens
of peripheral blood lymphocytes.
pp. 33 – 38
PROBLEM OF THE ANKYLOSING SPONDYLITIS PATIENT EVALUATION
K. TRNAVSKY, Y. SULCOVA, J. KNEBORTOVA
Arthrocentrum, Praha
Lekarsky reditel: prof. MUDr. K. Trnavsky, DrSc.
Souhrn
Je podan prehled nekterych novejsich pristupu k hodnoceni stavu nemocneho
s ankylozujici spondylitidou. Tyto pristupy se zameruji vice na funkcni
stav nemocneho a jeho subjektivni vypoved o kvalite zivota. Nadejny je
funkcni a kloubni index Dougadose a indexy funkce a aktivity nemoci navrzene
Calinem.
Klicova slova: ankylozujici spondylitida, funkcni testy.
Summary
A review of some more recent approaches to the evaluation of the ankylosing
spondylitis patient condition is presented. These approaches are focused
more on the functional state of the patient and his subjective statement
about the quality of his life. Promising is the functional and articular
index according to Dougadose and indexes of the function and the activity
of the disease proposed by Calin.
Key words: ankylosing spondylitis, functional tests.
pp. 39 – 42