Electronic Library of Scientific Literature
Electronic Library of Scientific Literature
Volume IX / 1995, Number 3
PHAGOCYTE CHEMILUMINISCENCE RESPONSE FROM PATIENTS WITH REACTIVE ARTHRITIS INDUCED IN VITRO WITH BACTERIAL ANTIGENS
O. GREGUSKA, F. MALIS, F. MATEICKA, V. BOSAK
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Cielom prace bolo objasnit priciny zvysenej reaktivnosti buniek
synovialneho prostredia pri reumatoidnej artritide a reaktivnej
artritide.
Produkcia reaktivnych intermediatov kyslika ako vysledok metabolickej
odpovede fagocytujucich buniek sa sledovala chemiluminiscencnou
technikou vyuzitim luminolu. Ako stimulacne faktory fagocytov
in vitro sa vyuzili bakteriove antigeny Enterobacter aerogenes,
Escherichia coli, Klebsiella pneumoniae, Salmonella
typhimurium, Yersinia enterocolitica a Borrelia
burgdorferi. Subor obsahuje 49 pacientov so seropozitivnou
reumatoidnou artritidou, 15 pacientov so seronegativnou reumatoidnou
artritidou, 15 pacientov s reaktivnou artritidou, 11 pacientov
s degenerativnymi chorobami klbov, s bunkami synovialnej tekutiny,
ako aj perifernej krvi a 10 zdravych kontrol buniek perifernej
krvi.
Zistili sme, ze pri osteoartroze bola metabolicka odpoved fagocytov
synovialnej tekutiny velmi nizka - nizsia ako v paralelne vysetrenych
fagocytoch perifernej krvi. Metabolicka odpoved fagocytov synovialnej
tekutiny pri seronegativnej reumatoidnej artritide bola jednoznacne
nizsia ako pri seropozitivnej reumatoidnej artritide. Pri reaktivnej
artritide bola metabolicka odpoved fagocytujucich buniek vyrazne
zvysena, a to tak v bunkach perifernej krvi, ako aj v bunkach
synovialnej tekutiny. Vyrazne zvysenie sa dosiahlo vo vypotkoch
pacientov etiologicky diagnostikovanych ako yersiniova a chlamydiova
reaktivna artritida. Vyskyt antigenu HLA-B27 u pacientov s reaktivnou
artritidou bol 63 % (slovenska populacia = 8,9 %, P[_corr] =<
0,01, relativne riziko = 17).
Dosiahnute vysledky naznacuju, ze studium chemiluminiscencnej
odpovede s bakteriovymi antigenmi moze napomoct pri diferencialnej
diagnostike zapalovych reumatickych chorob.
Klucove slova: luminolom zosilnena chemiluminiscencia,
fagocyty, synovialne bunky, bunky perifernej krvi, bakteriove
antigeny, reaktivna artritida, reumatoidna artritida.
Summary
Aim of study was make clear the reasons of the higher synovial
cells reactivity in rheumatoid arthritis and reactive athritis.
The production of the reactive oxygen intermediates as a result
of metabolic response of phagocyting cells was monitored with
the help of the chemiluminescent technique utilising luminol.
As stimulating factors of fagocytes in vitro, the bacterial antigens
Enterobacter aerogenes, Escherichia coli, Klebsiella
pneumoniae, Salmonella typhimurium, Yersinia enterocolitica
and Borrelia burgdorferi were used. The group consists
of 49 patients with rheumatoid arthritis seropositive, 15 patients
with rheumatoid arthritis seronegative, 15 patients with reactive
arthritis, 11 patients with degenerative joint diseases. In these
patients we examined the cells of synovial fluid as well as peripheral
blood and in 10 healthy controls we examined the cells of peripheral
blood.
It was found that, in osteoarthrosis the metabolic response of
the synovial fluid fagocytes was rather low, lower than in the
parallelly examinated fagocytes of peripheral blood. The metabolic
response of the synovial fluid fagocytes in the seronegative rheumatoid
arthritis was definitely lower than in the seropositive rheumatoid
arthritis. In reactive arthritis the metabolic response of fagocyting
cells was markedly increased in the cells of both peripheral blood
and synovial fluid. Pronounced increase was observed in the effusion
of the patients etiologically diagnosed as yersinia a chlamydia
reactive arthritis. Frequency of the HLA-B27 antigen in the patients
with reactive arthritis was 63 % (Slovak population = 8.9 %, P[_corr]
=< 0.01, relative risk = 17).
The results suggest that, the study of chemiluminiscence response
with bacterial antigens can help in the differentiating diagnostics
of the inflammatory rheumatic diseases.
Key words: Luminol-amplified chemiluminescence, phagocytes,
synovial cells, cells of peripheral blood, bacterial antigens,
reactive arthritis, rheumatoid arthritis.
pp. 137-144
REVISION SURGERIES AFTER CEMENTED AND NON-CEMENTED THP
F. MAKAI, A. SVEC, S. CHLEBOVIC
I. ortopedicka klinika LFUK a FN, Bratislava
Prednosta: prof. MUDr. F. Makai, DrSc.
Suhrn
Autori prezentuju v praci subor 155 pacientov reoperovanych po
totalnych nahradach (TEP) na I. ortopedickej klinike v Bratislave
v rokoch 1990-1994. Hodnotili udaje z kontrolnych vysetreni 118
pacientov s priemernym vekom 59,1 roka, u ktorych od poslednej
kontroly uplynulo viac ako pol roka. Dokumentuju staly narast
reviznych operacii po TEP od roku 1990.
Najcastejsou pricinou reoperacie bolo asepticke uvolnenie acetabula,
potom femoralneho komponenta, alebo oboch komponentov. Na dalsom
mieste bolo septicke uvolnenie nasledovane defektom alebo odlomenim
casti polyetylenoveho acetabula. Pri reoperaciach sa osvedcilo
vlozenie spongioznych implantatov z hlav femorov do acetabula
a Eichlerov, Reimerov a Schneiderov prstenec. Pri reviznych operaciach
bolo relativne vela (35) komplikacii, ktore sa v praci uvadzaju
aj na obrazkoch.
Vysledky reviznych operacii hodnotene podla Merle d'Aubigne a
Postela boli celkovo uspokojive.
Klucove slova: TEP, revizne operacie, uvolnenie acetabula,
Eichlerove a Schneiderove acetabularne prstence.
Summary
The study presents a group of 155 patients re-operated after THP
at the I Clinic of Orthopedics in Bratislava in the years 1990-1994.
The data from the control examinations of 118 patients with the
average age 59.1 years were evaluated, in whom more than 1/2 year
has passed since the last control. A steady increase of THP revision
surgeries since 1990 has been documented.
The most frequent cause of the re-operation was an aseptic acetabular
loosening, followed by the femoral component or both components.
At the second place was a septic loosening, followed by a defect
or breakage of a part of polyethylene acetabulum. In the reoperations,
insertion of sponge grafts from femoral heads into acetabulum
and Eichler, Reimer and Schneider rings proved to be good. Of
the revision surgeries the authors noted complications in 32 %.
These complications are described in the study and are documented
in the figures.
The results of revision surgeries evaluated according to Merle
d'Aubigne and Postel were as a whole satisfactory.
Key words: THP, revision surgeries, acetabular loosening,
Eichler and Schneider acetabular rings.
pp. 145-150
YERSINIA REACTIVE ARTHRITIDES: CLINICAL AND LABORATORY CROSS-SECTIONAL STUDY OF A GROUP OF PATIENTS
F. MATEICKA, M. CHNAPKOVA, V. BOSAK
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Yersiniove reaktivne artritidy su klinicky a epidemiologicky najvyznamnejsimi
druhmi enteroartritid vznikajucich po infekcii Yersinia enterocolitica
a Y. pseudotuberculosis.
Autori v praci podavaju prierezovu charakteristiku klinickych
a vybranych laboratornych ukazovatelov v subore pacientov s diagnostikovanou
yersiniovou reaktivnou artritidou. Typickym prejavom klboveho
postihnutia bola asymetricka oligoartritida a najcastejsie postihnute
klby boli clenok, koleno, drobne klby ruk, zapastia a MTP klby
noh. Chronicky priebeh ochorenia sa pozoroval v mensej miere ako
pri reaktivnych artritidach vznikajucich na zaklade infekcie urogenitalneho
systemu. Z extraartikularnych manifestacii sa pozorovali kozno-sliznicove
afekcie (vyskyt erythema nodosum bol v 6,3 %), ocne prejavy (celkovo
14,5 %), urogenitalne prejavy (18,8 %). Kompletny Reiterov syndrom
sa vyskytoval u 6,3 % pacientov.
Pri diagnostike ochorenia ma velky vyznam urcovanie specifickych
protilatok. Test ELISA ukazal, ze perzistencia protilatok IgA
vo velkej miere koreluje s chronickym priebehom ochorenia a pretrvavanim
aktivity klbovych prejavov.
Klucove slova: reaktivne artritidy, seronegativne spondylartritidy,
yersiniove infekcie, Yersinia sp., diagnostika, diferencialna
diagnostika.
Summary
Yersinia reactive arthritides are clinically and epidemiologically
most important types of enteroarthritides, occurring after infection
by Yersinia enterocolitica and Yersinia pseudotuberculosis.
The authors present a cross-sectional characteristics of clinical
and selected laboratory parameters in a group of patients with
diagnosed yersinia reactive arthritis. A typical manifestation
of the articular involvement was asymmetric oligoarthritis, the
most frequently involved joints were the ankle, the knee, small
joints of the hands, the wrist and the MTP joints. A chronic course
of the disease was observed to a smaller extent than in reactive
arthritides occurring after the urogenital tract infection. Out
of extraarticular manifestations dermato-mucosal affections (occurrence
of erythema nodosum in 6.3 %), eye manifestations (total of 14.5
%), urogenital manifestations (18.8 %) were observed. A complete
Reiter's syndrome was present in 6.3 % of patients.
In the diagnostics of the disease the determination of specific
antibodies is of a great significance. ELISA assessment showed
that the persistence of IgA antibodies to a great extent corelates
with chronic course of the disease and persistence of the activity
of joint manifestations.
Key words: reactive arthritides, seronegative spondyloarthritides,
yersinia infections, Yersinia sp., diagnostics, differential
diagnostics.
pp. 151-155
YERSINIA REACTIVE ARTHRITIDES: AN IMMUNOGENETIC STUDY
V. BOSAK, F. MATEICKA, M. CHNAPKOVA
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Uvod a ciel: Asociacia medzi yersiniovou reaktivnou artritidou
(YeReA) a antigenom HLA-B27 je znama uz viac ako 20 rokov. Potvrdila
sa aj v slovenskej populacii. Cielom prezentovanej prace je preverit
asociaciu medzi YeReA a antigenom HLA-B27 v novej zostave chorych,
doplnit udaje o vyskyte dalsich antigenov HLA-A,B,C pri YeReA
a porovnat priebeh ochorenia pri B27-pozitivnej a B27-negativnej
YeReA. Doraz sa kladie predovsetkym na vyuzitie typizacie HLA-B27
v klinickej praxi.
Metody: Subor chorych, v ktorom sa sledovali antigeny HLA-A,B,C,
tvorilo 45 nepribuznych pacientov s YeReA (32 muzov, 13 zien)
vo veku od 21 do 65 rokov. Urcovalo sa 16 antigenov HLA-A, 26
antigenov HLA-B a 6 antigenov HLA-Cw.
Vysledky: V subore chorych s YeReA sa zistil vyznamne zvyseny
vyskyt antigenov HLA-A2, HLA-B27 a HLA-Cw2 (P[_corr]<0,01).
Vztah s HLA-B27 bol najvyraznejsi. B27-pozitivnu YeReA charakterizoval
castejsi vyskyt polyartritidy, chronickej artritidy, lumbalgii,
sakroileitidy, spondylitidy a enteritid.
Zavery: asociaciu medzi antigenom HLA-B27 a YeReA charakterizuje
v slovenskej populacii hodnota relativneho rizika RR=41 a vyskyt;
pri YeReA sa pozoruje aj zvyseny vyskyt antigenov HLA-A2 a HLA-Cw2,
ako dosledok vazbovej nerovnovahy s HLA-B27; s antigenom HLA-B27
sa pravdepodobne spajaju prognosticky zavaznejsie formy YeReA.
Klucove slova: yersiniova reaktivna artritida, imunogeneticke
aspekty, antigen HLA-B27, priebeh ochorenia.
Summary
Introduction and the aim: The association between yersinia
reative arthritis (YeReA) and HLA-B27 antigen has been known for
more than 20 years. It has been confirmed also in the Slovak population.
The aim of the presented study is to verify the association between
YeReA and HLA-B27 antigen in a new group of patients, to complete
the data on the occurrence of further HLA-A,B,C antigens in YeReA
and to compare the course of the disease in the B27-positive and
B27-negative YeReA. The emphasis is laid especially on the use
of HLA typisation in the clinical practice.
Methods: The group of patients in which HLA-A,B,C antigens
were studied, included 45 non-related patients with YeReA (32
men, 13 women) aged 21-65 years. Sixteen HLA-A antigens, 26 HLA-B
antigens and 6 HLA-Cw antigens were determined.
Results: In the group of YeReA patients a significantly
increased frequency of HLA-A2, HLA-B27 and HLA-Cw2 (P[_corr]<0.01)
was found. Most marked was the relation to HLA-B27. B27-positive
YeReA was characterized by higher frequency of polyarthritis,
chronic arthritic, lumbalgias, sacroiliitis, spondylitis and enterritides.
Conclusions: association between HLA-B27 antigen and YeReA
in the Slovak population is characterized by the relative risk
ratio RR=41 and 80 % frequency in the patients; in YeReA also
an increased HLA-A2 and HLA-Cw2 antigen frequency is observed,
as a consequence of the linkage disequilibrium with HLA-B27; prognostically
more severe YeReA forms are probably associated with HLA-B27 antigen.
Key words: yersinia reactive arthritis, immunogenetic aspects,
HLA-B27 antigen, disease course.
pp. 157-160
OUR EXPERIENCE WITH THE SOFTWARE EQUIPMENT DEVELOPMENT FOR OUT-PATIENT RHEUMATOLOGIC PRACTICE
F. MALIS, J. LUKAC, J. ZON
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Laboratorium biokybernetiky VURCH Piestany v spolupraci so sukromnou
programatorskou firmou SoftProgres dva roky vyvija programove
vybavenie pre ambulantnu prax, ktore nazvali AMBULANCIA. Program
je vytvoreny v databazom prostredi CA Clipper. Jeho obsluha a
ovladanie bolo navrhnute co najjednoduchsie a podoba sa praci
v textovom editore T602.
Za dva roky existencie bola AMBULANCIA okrem VURCH a niektorych
reumatologickych ambulancii vdaka svojej flexibilnej architekture
nainstalovana asi 100 pouzivatelom v celej Slovenskej republike,
ktori ju vyuzivaju v dennej prevadzke.
Novy pouzivatelia programu mavaju casto problemy s prechodom na
pracu v novom prostredi. Autori programu okrem prisposobenia ovladania
AMBULANCIE textovemu editoru T602 zaciatocnu zdrzanlivost novych
pouzivatelov riesia vypracovanou metodou konzultacii s nimi. Najlepsie
sa osvedcil postup dvoch posedeni s buducim pouzivatelom hned
na zaciatku, potom lekari konzultuju s autormi problemy, ktore
sa objavia priamo pocas prevadzky programu.
Klucove slova: ambulantna prax, osobny pocitac, programove
vybavenie.
Summary
The laboratory of biokybernetics of the Research Institute of
Rheumatic Diseases (VURCH) in Piestany in cooperation with the
private software firm SoftProgres has been developing a software
equipment called AMBULANCIA for out-patient practice since 1993.
The programe is created in the CA Clipper database environment.
Its operation and command was designed to be the easiest possible
and is similar to the work in the T602 text editor.
During two years of its existence the AMBULANCIA was installed
in addition to VURCH and some other rheumatologic outpatient departments
due to its flexible architecture also to some 100 users all over
the Slovak republic, using it in their daily practice.
The new program users have often problems with the transition
to the work in a new environment. The authors of the program besides
adaptation of the AMBULANCIA operation to the T602 text editor
overcome the initial reservation of the new users by offering
a method of consultations with them. As a best method, it has
been proved to start with two sessions with the future user right
at the beginning, then the physicians consult with the authors
the problems occuring during the operation with program itself.
Key words: outpatient practice, personal computer, software
equipment.
pp. 161-164
CALCIUM EXTRA TABLETS IN THE TREATMENT OF MALNUTRITION PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES
E. KOSKOVA, P. MASARYK, S. BLAZICKOVA, Z. VESELKOVA
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Chronicke zapalove reumaticke choroby su casto sprevadzane roznymi
poruchami metabolizmu. K najzavaznejsim patri nedostatok bielkovin.
Autori podavali 13 pacientom so zistenou poruchou vyzivy kombinovany
pripravok Calcium extra, ktory obsahuje vitaminy skupiny B, D,
C a mineraly vapnik a zelezo pocas 35 dni v davke 2-krat 1 tabl.
Hodnotili vybrane klinicke a laboratorne ukazovatele a jeho toleranciu.
Pri kontrolnom vysetreni zistili pozitivny efekt na pocit zdravia,
na chut do jedla, zmiernila sa hypochromna anemia a statisticky
preukazne sa zvysili hodnoty seroveho albuminu. Liecbu pacienti
tolerovali velmi dobre a napriek vyssiemu obsahu vitaminu D pri
tomto davkovani nedoslo k naruseniu stability hladin vapnika a
fosforu v sere.
Calcium extra priaznivo ovplyvnuje metabolizmus bielkovin, preto
ho mozno odporucit ako podporny liecebny pripravok aj v liecbe
dlhotrvajucich zapalovych reumatickych chorob.
Klucove slova: malnutricia, zapalove reumaticke choroby,
Calcium extra.
Summary
Chronic inflammatory rheumatic diseases are frequently accompanied
by various metabolism disorders, of which the lack of proteins
belongs to the most severe ones.
The authors administered to 13 patients with detected malnutrition
the combined drug Calcium extra, containing vitamins of B, D,
and C group and minerals Ca and Fe during 35 days in the dosage
2x1 tablet. Selected clinical and laboratory parameters and its
tolerance were evaluated.
During the control examination a positive effect on the well-being
and appetite was found, hypochromic anemia decreased and serum
albumin values statistically significantly increased. The treatment
was tolerated by the patients very well and inspite of a higher
D vitamin content, there was no impairment of the stability of
serum Ca and Ph levels with this dosage.
Calcium extra favourably influences protein metabolism, therefore,
it can be recommended as a supportive therapeutic agent also in
the treatment of chronic inflammatory rheumatic diseases.
Key words: malnutrition, inflammatory rheumatic diseases,
Calcium extra.
pp. 165-168
FIBROMYALGIA AND CHRONIC FATIGUE SYNDROME
Z. HRNCIR
2. interni klinika LF UK, Hradec Kralove
Prednosta: prof. MUDr. V. Pidrman, DrSc.
Souhrn
Podan aktualni prehled vyvoje poznatku o fibromyalgii a chronickem
unavovem syndromu (ChUS). V rozpoznavani obou techto stavu je
zduraznen normativni prinos kriterii American College of Rheumatology
(1990) a kriterii Center for Disease Control (1988) pro diagnozu
fibromyalgie, pro diagnozu ChUS i rozsah prekryvani, az prolinani
obou techto stavu. V kritickem rozboru lecebnych moznosti je venovana
pozornost hlavne psychologickemu vedeni, fyzikalni lecbe a soucasnym
moznostem farmakoterapie. Stat doplnuje prehled vlivu zvazovanych
v etiopatogeneze fibromyalgie a ChUS.
Klicova slova: fibromyalgie, fibromyalgicke body, chronicky
unavovy syndrom, ACR kriteria pro diagnozu fibromyalgie, CDC kriteria
pro diagnozu chronickeho unavoveho syndromu, principy lecby fibromyalgie
a chronickeho unavoveho syndromu.
Summary
A survey of the development of the konwledge of fibromyalgia and
chronic fatigue syndrome (CFS) is presented. In the differentiation
of these two conditions normative contribution of the criteria
of the American College of Rheumatology (1990) for fibromyalgia
diagnosis and that of the criteria of the Center for Disease Control
(1988) for diagnosis of CFS is emphasized, as well as the extent
of their overlapping even permeation of these two conditions.
In a critical analysis of the therapeutic possibilities the attention
is devoted especially to the psychologic guidance, physical therapy
and the present possibilities of pharmacotherapy. A survey of
influences considered in the etiopathogenesis of fibromyalgia
and CFS is included.
Key words: fibromyalgia, fibromyalgic points, chronic fatigue
syndrome, ACR criteria for fibromyalgia diagnosis, CDC criteria
for diagnosis of chronic fatigue syndrome, principles of therapy
of fibromyalgia and chronic fatigue syndrome.
pp. 169-174
EROSIVE ARTHRITIS OF INTERVERTEBRAL DISKS OF LUMBAR SPINE IN RHEUMATOID ARTHRITIS
M. ORLOVSKA, P. SCHULTZ, M. TOTHOVA
Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
Suhrn
Postihnutie intervertebralnych (apofyzarnych) klbov pri reumatoidnej
artritide (RA) destruktivnym zapalovym procesom sa povazuje za
nie prilis caste, a ked sa opisovalo, tak prevazne v krcnom useku.
S rozvojom zobrazovacich metod - komputerovej tomografie a nuklearnej
magnetickej rezonancie sa zlepsili diagnosticke moznosti. Ukazalo
sa, ze destruujuca artritida intervertebralnych klbov sa moze
objavit v ktoromkolvek useku chrbtice.
V nasledovenej kazuistike opisujeme pripad pacientky so seropozitivnou
RA, so skorym zaciatkom, chronickym remitujucim priebehom a lahkym
polyartikularnym postihnutim bez deformit na periferii. Po 22
rokoch trvania ochorenia sa diagnostikovala erozivna artritida
intervertebralnych klbov L4/5 a L5/S1 ako pricina chronickeho
lumboischiadickeho syndromu L5/S1. Diagnoza sa urcila na zaklade
vysetrenia computerovou tomografiou (CT).
Klucove slova: reumatoidna artritida, bedrova chrbtica,
apofyzarne klby.
Summary
In rheumatoid arthritis (RA) the involvement of the intervertebral
(apophyseal) joints by destructive inflammatory process, is considered
to be not too frequent. When it was described, it was mostly in
the cervical segment. With the development of the imaging methods
- computer tomography and nuclear magnetic resonance, the diagnostic
possibilities improved. It was demonstrated that the desctructive
arthritis of the intervertebral joints can occur in any segment
of the spine.
In the following case report we describe a female patient with
seropositive RA, with an early onset, chronic remitting course
and a mild polyaerticular involvement without deformities in the
periphery. After 22 years of the disease duration erosive arthritis
of the intervertebral joints L4/5 and L5/S1 was diagnosed as a
cause of chronic lumboischiadic syndrome L5/S1. The diagnosis
was established on the basis of computer tomography (CT) examination.
Key words: rheumatoid arthritis, lumbar spine, apophyseal
joints.
pp. 175-178