Autoantibodies in patients with juvenile chronic arthritis and their immediate family relatives

Article Abstract:

The process by which juvenile chronic arthritis (JCA) develops is unclear. However, the presence of several types of autoantibodies (antibodies formed against the body's own tissues) suggest that an autoimmune process is responsible. In other autoimmune diseases, there is a familial tendency toward autoantibody formation. Although some studies have suggested a familial predisposition toward JCA, the presence of autoantibodies in family members of patients with JCA has not been studied. The presence and specificity of autoantibodies of 66 close relatives of 23 children (19 female and 4 male) with JCA was evaluated. Results revealed that 39 of 66 family members had one or more positive tests of autoantibodies. A total of 20 of 23 JCA patients had positive autoantibody tests, 70 percent of which included antinuclear antibodies, or antibodies against molecules in the cell nucleus. Antinuclear antibodies occurred in 14 percent of the family members, a prevalence much higher than that of the larger population to which the study group belonged. Common patterns of antibody occurrence could not be demonstrated among all or even most patients. Antibodies against cardiolipin, a particular kind of fat found in cell membranes, were found in 30 percent of JCA patients. These antibodies have sometimes been linked with clotting episodes in other rheumatic diseases, but no JCA patient with these antibodies was known to have had such an episode. Although these findings suggest that there may be an inherited predisposition toward autoimmune responses among some relations of JCA patients, further research of the autoimmune nature of JCA is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Autoantibodies, Physiological aspects, Genetic aspects, Rheumatic diseases

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Pulse methylprednisolone therapy in rheumatoid arthritis: unproved therapy, unjustified therapy, or effective adjunctive treatment?

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. Corticosteroids were once widely used to treat RA, but because of their adverse side effects, these drugs are now reserved for treating RA that is resistant to other medications, occurring in elderly patients, affecting sites other than the joints, or as short-term therapy for social, work, or family reasons. Recently, studies have shown that the corticosteroid methylprednisolone given intravenously in intermittent high doses called pulses is effective in treating RA that is resistant to other forms of anti-arthritic therapy. Pulse methylprednisolone therapy may be combined with other anti-arthritic agents and has been associated with few adverse effects when administered over a short-term. Most of the adverse effects occur in RA patients with impaired cardiovascular or immune systems. Pulse therapy did not cause toxic effects on bone metabolism, suggesting that osteoporosis, a condition of loss of bone mass, would probably not result from this treatment. The mechanism of action of pulse therapy is not known but may be related to effects on various immune factors, such as T lymphocytes and immune complexes. The lowest effective dose of methylprednisolone has not been established. Studies are needed to compare the effectiveness of pulse methylprednisolone therapy with that of nonsteroidal anti-inflammatory drugs, which are commonly used to treat arthritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Corticosteroids, Adrenocortical hormones, Dosage and administration

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Does steroid pulsing influence the efficacy and toxicity of chrysotherapy? A double blind, placebo controlled study

Article Abstract:

Chrysotherapy (gold salts treatment) has been a time-honored remedy for rheumatoid arthritis (RA). Up to two thirds of patients respond favorably, but one third of them experience side effects, and treatment may be halted. Monthly intravenous administration of large doses of steroids has also been used to treat RA, but the duration of effect is limited, and disease progression is not altered. A preliminary study suggested that simultaneous steroid pulsing with chrysotherapy had few side effects but good responses. This phenomenon has been further studied in a more rigorous manner. Twenty-eight of 40 patients completed the study. Withdrawal from the study due to drug side effects was not significantly different between a group treated with gold salts and orally-administered steroid and a group treated with gold salts plus placebo. However, the small numbers of patients make such statistical comparisons difficult. Four patients in group one had minor discomfort, while seven patients in group two had side effects such as altered blood cells, mouth ulcers, and hives. All but one patient significantly improved. Extent of improvement tended to be better in the group that received steroids, but the difference was not considered statistically significant. Further evaluation of these effects are continuing, and in a larger population, the effects of steroid treatment may become significant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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