[Show abstract][Hide abstract] ABSTRACT: The study investigates pentosidine levels, an advanced glycation end-product, in patients with erosive and non-erosive hand osteoarthritis (HOA) and determine its potential association with clinical findings and imaging-defined joint damage.
Pentosidine was measured by HPLC in serum and urine of 53 females with HOA (31 erosive and 22 non-erosive HOA) and normalised to the total serum protein or urinary creatinine, respectively. Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). The hand radiographs scored according to the Kallman grading scale were assessed to determine a baseline value and reassessed after two years.
The levels of urine pentosidine, but not of serum pentosidine, were higher in patients with erosive HOA than in non-erosive HOA (p=0.039). Urinary pentosidine correlated with CRP (r=0.302, p=0.031), ESR (r=0.288, p=0.041) and AUSCAN (r=0.408, p=0.003). Serum pentosidine, but not in urine, significantly correlated with the Kallman radiographic score in erosive HOA at the baseline (r=0.409, p=0.022) and after 2 years (r=0.385, p=0.032). However, when corrected for age and disease duration, only correlation between urine pentosidine and AUSCAN remained significant (r=0.397, p=0.004).
Our data suggest that serum and urine pentosidine levels may relate to the distinctive clinical and morphological features of HOA.
Full-text · Article · Jun 2012 · The Open Rheumatology Journal
[Show abstract][Hide abstract] ABSTRACT: To compare serum levels of hyaluronic acid (HA) between patients with erosive and non-erosive hand osteoarthritis (HOA), and investigate its association with morphological changes and radiographic progression over 2 years.
Fifty-five women with erosive and 33 women with non-erosive HOA were included in this study. All underwent clinical examination, which included assessment of pain, swelling, deformity and deviation of small hand joints and completed health assessment questionnaires. Serum levels of HA were measured by ELISA. Three-phase bone scintigraphy was performed at baseline. Radiographs of both hands were performed at baseline and after 2 years and scored according Kallman grading scale.
Serum levels of HA were significantly higher in patients with erosive than with non-erosive HOA (P<0.01). It correlated significantly with the number of hand joints with deviations and deformities. HA adjusted for age and disease duration significantly correlated with radiographs at baseline and after 2 years in all patients with HOA (r=0.560 and r=0.542, P<0.01 for both correlations). Although there was an association between HA and radiographic score in erosive disease, after adjustment for confounders it remained no longer significant. HA adjusted for confounders correlated significantly with the late phase in all patients with HOA (r=0.412, P<0.01) and in patients with erosive disease (r=0.320, P<0.05).
HA is increased in patients with erosive HOA and could be proposed as a surrogate marker with a predictive value for further radiographic progression of HOA in general. Further investigation is necessary to confirm these results.
No preview · Article · Jul 2009 · Osteoarthritis and Cartilage
[Show abstract][Hide abstract] ABSTRACT: Background: Hyaluronic acid (HA) is considered a potential biomarker of progression of knee osteoarthritis (OA). The aim of this study was to measure the serum levels of HA in patients with erosive and non-erosive hand OA, and to determine its association with the disease specific structural changes. Methods: Fifty-five women with erosive and 33 with non-erosive OA underwent clinical examination and functional tests. Eighty-one patients underwent three-phase bone scintigraphy in order to determine the inflammation and remodeling of hand joints. Radiographs of hands were performed at baseline and after 2 years. Serum levels of HA were measured by ELISA. Results: Women only were included in this study. Both groups were comparable in terms of age, disease duration, BMI and inflammatory markers. The serum levels of HA correlated with age and disease duration. After adjustment for age and disease duration, HA serum levels were still higher in patients with erosive than non-erosive OA, and correlated with the number of joints with deviations and deformities. Furthermore, the serum levels of HA were associated with joint remodeling as assessed by late phase scintigraphy, and correlated with the severity of radiographic changes at baseline and after 2 years. Conclusion: The serum level of HA is increased in patients with erosive compared to patients with non-erosive hand OA. It is associated with local structural changes and may be regarded as a biomarker with a predictive value for radiographic progression of hand OA.
No preview · Article · Jan 2009 · Ceska Revmatologie
[Show abstract][Hide abstract] ABSTRACT: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease of skeleton characterized by hyperostosis of axial and peripheral skeleton. The association of DISH with type 2 diabetes mellitus and other metabolic alterations (e.g. impaired lipid metabolism) has been known for many years. However, it has not been explained satisfactorily yet. It seems that this pathological process is significantly influenced by hyperglycemia and insulin resistance. Also, it is affected by growth hormone (GH) and its action mediated by insulin-like growth factor (IGF) and its binding proteins (IGFBP2, IGFBP3). From the point of symptomatic therapy, patients should not be given medicaments that aggravate hyperinsulinemia.
No preview · Article · Jun 2006 · Vnitr̆ní lékar̆ství
[Show abstract][Hide abstract] ABSTRACT: AA amyloidosis caused by the chronic inflammation accompanying gouty arthritis is extremely rare and familial occurrence has not been described so far.
We present the case of two brothers (47 and 44 years old) with 7- and 10-year history of hyperuricaemia and chronic tophaceous gout with polyarticular involvement. The enzymatic assay performed in their erythrocytes proved the partial hypoxanthine-guanine phosphoribosyl transferase deficiency (Kelley-Seegmiller syndrome), the genetic defect of purine metabolism. Later on they developed proteinuria and chronic renal insufficiency /CRI/. Renal biopsy disclosed the combination of AA amyloidosis and gouty nephropathy in both the cases. Despite the standard treatment the older brother progressed to chronic renal failure. On the contrary, the younger one being longterm treated with oral colchicin have stabilized CRI.
Only several cases of AA renal amyloidosis until recently, secondary to gout have been reported. Our case represents the first report of familial occurrence of this extremely rare disease.
No preview · Article · Feb 2006 · Nucleosides Nucleotides & Nucleic Acids
[Show abstract][Hide abstract] ABSTRACT: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease characterized by hyperostosis of the axial as well as peripheral skeleton. Its association with diabetes mellitus type II and other metabolic disorders (an impaired lipid profile) has been known for a long time, although the context is not known yet. Hyperglycemia and insulin resistance, then the role of substances that are related to the growth hormones (GF) and mediated by insulin-like growth hormones (IGF) and theirs bindings proteins (IGFBP2, IGFBP3) seem to play an important role in this disease. Genetic factors (collagen type 6 gene COL6A1) could also represent a significant role in the etiology of DISH, such as suggested for a similar entity - ossification of posterior longitudinal ligament (OPLL).
No preview · Article · Jan 2006 · Ceska Revmatologie
[Show abstract][Hide abstract] ABSTRACT: Erosive osteoarthritis of the hands (EOA) is probably subset of OA with more prominent inflammatory component, usually with more severe subjective symptoms and tendency for functional decline. Because of this inflammatory component, different antiinflammatory and immunosuppressive strategies have been tested in this indication. Authors refer about the results of open, pilot study with application of 10 mg of methotrexate p.o. weekly in a group of 21 patients with EOA. There was significant decrease of pain in VAS (54.4±17 vs 39.7±19.6; p=0.01) what was the primary outcome measure. There was also significant decrease of morning stiffness, Functional indeces, number of tender and swollen joints did not change. There was also a trend for decrease of CRP (p=0.08). Tolerance was good, but is was necessary to interrupt therapy by 2 patients, because of elevation of liver tests. On the basis of results of the open study, authors plan to prepare protocoll for double, blind, randomized study.
[Show abstract][Hide abstract] ABSTRACT: To study prognostic value of different biochemical markers for morphological progression of early knee osteoarthritis.
A total of 89 patients with knee osteoarthritis (OA) were enroled into the study. The follow-up period was 2 years. Radiological OA progression was evaluated by measuring joint space width. Pentosidine was detected using the HPLC method described earlier, cartilage oligomeric matrix protein (COMP) using the method published by our team. MMP-9, tissue inhibitors of metalloproteinases (TIMP), YKL-40 and hyaluronic acid were detected using commercially available kits.
In the group of patients suffering from knee OA, higher serum levels of pentosidine (P=0.04), MMP-9 (P=0.02), TIMP (P=0.04) and COMP (P=0.05) were detected compared with healthy control subjects. Using a correlation analysis method, it has been found that the patients with higher basic serum levels of hyaluronic acid had a faster radiological progression (r=0.56, P<0.005), as well as the patients with higher basic serum pentosidine levels (r=0.30, P<0.005). Other biochemical markers had no statistically significant prognostic value.
In our study, serum levels of hyaluronic acid and pentosidine had a predictive value for further development of knee OA in that further joint space narrowing was detected in the patients with knee OA in the next 2 years.
No preview · Article · Apr 2004 · Osteoarthritis and Cartilage
[Show abstract][Hide abstract] ABSTRACT: This is a concise review of basic present information on the structure and function of entheses in norm and disease. Along with fibrocartilagenous and fibrous types of enthesis on extremities are particularly mentioned entheses on the spine. Special attention is given to heterotopic ossifications of entheseal regions.
[Show abstract][Hide abstract] ABSTRACT: The authors discuss in a review publication problems of diagnosis and therapy of hand OA. They stated, that despite the fact that it is a frequent disease affecting up to 72 % of female between 60-70 years of age, there is lack of good publications in this OA location. So that evidence based guidelines of hands OA are not available. Low interest for hand OA was probably caused by fact, that is was generally believed, that decline of function in hand OA is low, what is not necessary true for all patients and part of them can develop even serious deformities. At present time it is possible to recommend for therapy of hand OA: patient education, physical therapy (paraffin wax), prosthetic devices, nesteroidal antirheumatic therapy given per os or locally. Intraarticular applicated corticosteroids are effective especially in OA of CMC joint. From the group of SYSADOA chondroitin sulphate was tested and have shown some structure modifying properties. In erosive OA there are some data about application of corticosteroids and DMARDs (methotrexate, antimalarical drugs, biologic agents), but there are no randomised, controlled studies. It is sure, that OA of the hands will attract more awareness in the future.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate the efficacy and safety of disease-modifying drugs (DMARDs) in everyday clinical practice in Central European States (the Czech and Slovak republics). This was a retrospective, multicentre study. With the help of a special questionnaire, the medical files of 760 patients in 15 centres were analysed looking for reasons for DMARD discontinuation (e.g. insufficient efficacy, toxicity). The secondary endpoints were duration of therapy with individual DMARDs and the influence of other factors (demographic, disease specific, concomitant therapy) on duration of therapy. In 47.1 % of patients therapy was interrupted because of lack of efficacy, in 43.2 % because of adverse events, and in 9 % for undefined reasons. Toxic reactions leading to withdrawal were most common with gold (62.6 %) and methotrexate (62.5 %). Because of insufficient effect, treatment was most frequently interrupted with antimalarials (62.3 %) and penicillamine (53.2 %), but in only 22% treated with methotrexate. The mean duration of one treatment episode with DMARDs was 28.1 +/- 48.9 months. Surprisingly, it was longest for cyclophosphamide (53.5 + 55.1 months) and shortest for cyclosporin (7.0 +/- 6.7 months). The mean duration of treatment with methotrexate was only 14.9; +/- 16.2 months. The mean duration of treatment with one DMARD was statistically longer in patients with positive rheumatoid factor, extra-articular disease and age lower than 50 years. There was no impact of sex, concomitant steroid treatment and high or low sedimentation rate on treatment duration. Considerable differences in everyday clinical practice with DMARDs between Central European states and published data from the US and western Europe have been found. More education about modern strategies in the treatment of RA is probably necessary for practising rheumatologists.
No preview · Article · Jul 2002 · Clinical Rheumatology
[Show abstract][Hide abstract] ABSTRACT: The authors present a report on a quite unique coincidence of three diseases in one female patient. After initial classical juvenile idiopathic arthritis with bilateral ophthalmic triad the patient developed in early adult age ankylosing spondylitis combined with diffuse idiopathic skeletal hyperostosis.
No preview · Article · Jan 2001 · Ceska Revmatologie
[Show abstract][Hide abstract] ABSTRACT: The authors emphasize the crucial importance of radiology in assessment of the diagnosis of DISH, in particular differentiation from ankylosing spondylitis. For differentiation the method of computed tomography proves extremely useful.
[Show abstract][Hide abstract] ABSTRACT: The authors performed an epidemiological study which evaluated treatment of rheumatoid arthritis by different disease modifying drugs (DMARDs) from the aspect of effectiveness and toxicity. It was a retrospective multicentre trial where the documentation of 15 rheumatological out- and in-patient departments in the Czech and Slovak Republic was used. Based on this documentation the physician completed a questionnaire which was processed by computer. A total of 1162 cases of discontinued DMARDs therapy in 760 patients with RA was recorded. Discontinuation of therapy on account of side effects was recorded most frequently in gold therapy and in treatment with methotrexate (in both some 60% of documented cases discontinued treatment). The least frequent discontinuation for side effects was found with antimalarial drugs (less than 25%). On the other hand, due to the insufficient effectiveness, the antimalarials were discontinued most frequently (66%), whereas cyclophosphamide discontinuation was observed in the least number of cases (less than 20%). The mean period of DMARDs therapy was almost 30 months. It is surprising that cyclophosphamide was administered for the longest period (mean 39 months). Cyclosporin was administered for the shortest period (mean 9 months). The period of treatment correlated significantly with the patient's age at the time when treatment was started, with the positivity of the rheumatoid factor, extraarticular symptoms and the patient's education. Conversely no relationship was found between the period of DMARDs administration and other factors such as sex, sedimentation rate, concurrent corticoid administration.