Background: Murine progressive ankylosis (MPA) is a spontaneous arthropathy that produces ankylos... more Background: Murine progressive ankylosis (MPA) is a spontaneous arthropathy that produces ankylosis of peripheral and spinal joints in mice homozygous for the gene ank. This animal model bears a striking resemblance clinically, radiographically, and histologically to ankylosing spondylitis. Phosphocitrate (PC) is the only treatment known to significantly delay disease progression in MPA. Transforming growth factor-beta (TGF-beta) is important for both developmental bone formation and fracture healing, and has been detected in biopsy specimens from sacroiliac joints of patient with ankylosing spondylitis. We hypothesized that TGF-beta might be involved in the pathogenesis of MPA. Methods: We compared the proliferative response of resting fibroblasts from normal and MPA mice to TGF-beta 1 as measured by 3H-thymidine incorporation and the effect of PC on that response. Cells were cultured with 10% serum as a positive control. The mouse fibroblast cell line, BALB/3T3, controlled for culture conditions. Results: MPA and normal fibroblasts responded similarly to serum. MPA fibroblasts proliferated significantly better in TGF-beta 1 than the poorly responsive normal mouse fibroblasts. PC, at 10(-3) mol/L, inhibited the TGF-beta 1-induced proliferation of MPA and 3T3 cells, but had no effect on normal fibroblasts. Conclusions: MPA fibroblasts proliferate excessively to TGF beta 1 in vitro. This effect could be caused by altered TGF receptors, changes in signal transduction, or impaired inhibition of the TGF-beta signal. This excessive response is blocked by PC. These results give further clues as to how PC inhibits the progression of ankylosis in MPA.
Purpose Inflammatory arthritis is not generally considered a risk factor for nephrolithiasis; how... more Purpose Inflammatory arthritis is not generally considered a risk factor for nephrolithiasis; however previous studies have found a higher point prevalence of nephrolithiasis in rheumatoid arthritis than the general population. A 1973 study reported an increased incidence of renal stones in patients with spondyloarthritis (SPA) as compared with rheumatoid arthritis (RA) controls (Mladenovic et al, Rheumatizm 1973;20:106-110). Our objective was to confirm this cross-sectional study with a cohort study comparing lifetime prevalence of nephrolithiasis in patients with (SPA) and (RA). Methods This study was designed as a VA retrospective cohort study. The study group was obtained from patients followed in the Minneapolis VA, with the diagnoses of SPA. Controls were rheumatoid factor positive, RA patients. The sample size was calculated by using an alpha of 0.05, a power of 0.80, an estimated prevalence of nephrolithiasis in the RA group of 5% and a 16% in the SPA patients. Controls are age and sex matched. The prevalence rate for the controls was estimated from the United States National Health and Nutritional Examination Survey II. Each patient was surveyed regarding their rheumatologic diagnosis, relevant coexistent conditions and history of kidney stones. Patient-reported history of kidney stones was confirmed whenever possible by chart review. All patients met ACR criteria for either RA or SPA. Results Forty-nine SPA patients and 27 RA patients have been enrolled. Our goal is to enroll 250 patients (84 SPA patients and 168 RA patients). These results will be discussed at the time of presentation. To date 16/49 (32.7%) SPA patients reported a history of renal stones compared with 4/27 (14.8%) RA patients. Chi square equals 3.95 (p=0.047). Four patients with kidney stones in the SPA group and 2/4 patients in the control group had other risk factors for stones. Conclusion These results show an increase in the prevalence of kidney stones in SPA compared to RA. This is similar to the findings of Mladenovic et al. These results suggest that other studies should be done to ascertain the cause of increased nephrolithiasis in SPA.
A pulmonary vein varix is a localized dilatation of a pulmonary vein that usually is asymptomatic... more A pulmonary vein varix is a localized dilatation of a pulmonary vein that usually is asymptomatic, presenting as a mass on a chest roentgenogram. Pulmonary angiography has been the mainstay of diagnosis. This case is the first in which transesophageal echocardiography was used to diagnose pulmonary vein varix.
Observing Industry trends over time increases our awareness about how economic changes can affect... more Observing Industry trends over time increases our awareness about how economic changes can affect our life’s work in the future. Use this awareness to make plans to develop new skills through on-thejob learning, volunteer work, or by taking a class. In today’s economy, many people increase their job security by continually developing new skills to keep up with rapid changes in their current occupation or to be prepared for the possibility of a future job change.
Mounting evidence suggests that autoimmune mechanisms may underlie the chronic symptoms character... more Mounting evidence suggests that autoimmune mechanisms may underlie the chronic symptoms characteristic of Gulf War Illness (GWI). The presence of antiphospholipid antibodies including Lupus Anticoagulant (LA) are often associated with autoimmune disorders. Here we evaluated and compared blood samples from veterans with GWI and veterans with other autoimmune conditions including relapsing remitting multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome, and lupus for the presence of LA using Silica Clotting Time and dilute Russell’s Viper Venom Time assays. Positive LA was identified in onequarter of veterans with GWI; this proportion was not statistically different from the proportion of positive LA identified in patients diagnosed with the other autoimmune conditions. The present findings add to the literature implicating autoimmune mechanisms in GWI and point to the presence of prothrombotic antiphospholipid antibodies as a common contributing factor in GWI and other autoimm...
To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip streng... more To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function. Thirty-six patients with definite rheumatoid arthritis participated in the randomized, controlled, cross-over design study of 3 commercial wrist extensor orthoses. Dominant-hand dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted. Functional impact was assessed using a written questionnaire. All 3 commercial orthoses reduced grip strength when first donned. After a 1-week adjustment period, one orthosis, the Smith and Nephew Roylan D-Ring (Roylan), afforded splinted grip strength equal to that of the nonsplinted grip strength. The other 2 orthoses continued to reduce grip strength, and afforded splinted grip strength significantly below that of the Roylan. The Roylan was deemed comfortable by more subjects than the other orthoses. The belief that commercial orthotic use increases grip strength, either immediately or after 1 week, is not supported by this study's data. Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength.
Background: Murine progressive ankylosis (MPA) is a spontaneous arthropathy that produces ankylos... more Background: Murine progressive ankylosis (MPA) is a spontaneous arthropathy that produces ankylosis of peripheral and spinal joints in mice homozygous for the gene ank. This animal model bears a striking resemblance clinically, radiographically, and histologically to ankylosing spondylitis. Phosphocitrate (PC) is the only treatment known to significantly delay disease progression in MPA. Transforming growth factor-beta (TGF-beta) is important for both developmental bone formation and fracture healing, and has been detected in biopsy specimens from sacroiliac joints of patient with ankylosing spondylitis. We hypothesized that TGF-beta might be involved in the pathogenesis of MPA. Methods: We compared the proliferative response of resting fibroblasts from normal and MPA mice to TGF-beta 1 as measured by 3H-thymidine incorporation and the effect of PC on that response. Cells were cultured with 10% serum as a positive control. The mouse fibroblast cell line, BALB/3T3, controlled for culture conditions. Results: MPA and normal fibroblasts responded similarly to serum. MPA fibroblasts proliferated significantly better in TGF-beta 1 than the poorly responsive normal mouse fibroblasts. PC, at 10(-3) mol/L, inhibited the TGF-beta 1-induced proliferation of MPA and 3T3 cells, but had no effect on normal fibroblasts. Conclusions: MPA fibroblasts proliferate excessively to TGF beta 1 in vitro. This effect could be caused by altered TGF receptors, changes in signal transduction, or impaired inhibition of the TGF-beta signal. This excessive response is blocked by PC. These results give further clues as to how PC inhibits the progression of ankylosis in MPA.
Purpose Inflammatory arthritis is not generally considered a risk factor for nephrolithiasis; how... more Purpose Inflammatory arthritis is not generally considered a risk factor for nephrolithiasis; however previous studies have found a higher point prevalence of nephrolithiasis in rheumatoid arthritis than the general population. A 1973 study reported an increased incidence of renal stones in patients with spondyloarthritis (SPA) as compared with rheumatoid arthritis (RA) controls (Mladenovic et al, Rheumatizm 1973;20:106-110). Our objective was to confirm this cross-sectional study with a cohort study comparing lifetime prevalence of nephrolithiasis in patients with (SPA) and (RA). Methods This study was designed as a VA retrospective cohort study. The study group was obtained from patients followed in the Minneapolis VA, with the diagnoses of SPA. Controls were rheumatoid factor positive, RA patients. The sample size was calculated by using an alpha of 0.05, a power of 0.80, an estimated prevalence of nephrolithiasis in the RA group of 5% and a 16% in the SPA patients. Controls are age and sex matched. The prevalence rate for the controls was estimated from the United States National Health and Nutritional Examination Survey II. Each patient was surveyed regarding their rheumatologic diagnosis, relevant coexistent conditions and history of kidney stones. Patient-reported history of kidney stones was confirmed whenever possible by chart review. All patients met ACR criteria for either RA or SPA. Results Forty-nine SPA patients and 27 RA patients have been enrolled. Our goal is to enroll 250 patients (84 SPA patients and 168 RA patients). These results will be discussed at the time of presentation. To date 16/49 (32.7%) SPA patients reported a history of renal stones compared with 4/27 (14.8%) RA patients. Chi square equals 3.95 (p=0.047). Four patients with kidney stones in the SPA group and 2/4 patients in the control group had other risk factors for stones. Conclusion These results show an increase in the prevalence of kidney stones in SPA compared to RA. This is similar to the findings of Mladenovic et al. These results suggest that other studies should be done to ascertain the cause of increased nephrolithiasis in SPA.
A pulmonary vein varix is a localized dilatation of a pulmonary vein that usually is asymptomatic... more A pulmonary vein varix is a localized dilatation of a pulmonary vein that usually is asymptomatic, presenting as a mass on a chest roentgenogram. Pulmonary angiography has been the mainstay of diagnosis. This case is the first in which transesophageal echocardiography was used to diagnose pulmonary vein varix.
Observing Industry trends over time increases our awareness about how economic changes can affect... more Observing Industry trends over time increases our awareness about how economic changes can affect our life’s work in the future. Use this awareness to make plans to develop new skills through on-thejob learning, volunteer work, or by taking a class. In today’s economy, many people increase their job security by continually developing new skills to keep up with rapid changes in their current occupation or to be prepared for the possibility of a future job change.
Mounting evidence suggests that autoimmune mechanisms may underlie the chronic symptoms character... more Mounting evidence suggests that autoimmune mechanisms may underlie the chronic symptoms characteristic of Gulf War Illness (GWI). The presence of antiphospholipid antibodies including Lupus Anticoagulant (LA) are often associated with autoimmune disorders. Here we evaluated and compared blood samples from veterans with GWI and veterans with other autoimmune conditions including relapsing remitting multiple sclerosis, rheumatoid arthritis, Sjögren’s syndrome, and lupus for the presence of LA using Silica Clotting Time and dilute Russell’s Viper Venom Time assays. Positive LA was identified in onequarter of veterans with GWI; this proportion was not statistically different from the proportion of positive LA identified in patients diagnosed with the other autoimmune conditions. The present findings add to the literature implicating autoimmune mechanisms in GWI and point to the presence of prothrombotic antiphospholipid antibodies as a common contributing factor in GWI and other autoimm...
To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip streng... more To investigate the immediate and short-term effects of 3 commercial wrist orthoses on grip strength and function. Thirty-six patients with definite rheumatoid arthritis participated in the randomized, controlled, cross-over design study of 3 commercial wrist extensor orthoses. Dominant-hand dynamometric grip strength was assessed at both initial and followup sessions while splinted and nonsplinted. Functional impact was assessed using a written questionnaire. All 3 commercial orthoses reduced grip strength when first donned. After a 1-week adjustment period, one orthosis, the Smith and Nephew Roylan D-Ring (Roylan), afforded splinted grip strength equal to that of the nonsplinted grip strength. The other 2 orthoses continued to reduce grip strength, and afforded splinted grip strength significantly below that of the Roylan. The Roylan was deemed comfortable by more subjects than the other orthoses. The belief that commercial orthotic use increases grip strength, either immediately or after 1 week, is not supported by this study's data. Different styles of commercial wrist orthoses appear to have differing influence on splinted grip strength.
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