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Objective: In a cohort of patients with early arthritis, to evaluate how well foot radiographs at study inclusion predicted a diagnosis of rheumatoid arthritis (RA) 2 years later., Methods: A cohort of patients with arthritis of less than one year duration was evaluated in a multicenter study and followed for 30 +/- 11 months. An observer blinded to patient data read all 149 hand and foot radiographs done at study inclusion, using item 7 of the 1987 American College of Rheumatology (ACR) criteria for RA and Sharp's method to score erosions and joint space narrowing., Results: The kappa coefficient for the 1987 ACR item 7 was 0.52 for bony decalcification and 0.87 for erosions. Intra and interobserver correlation coefficients for Sharp's scores ranged from 0.90 to 0.98. Erosions at the feet were significantly associated with RA. The item 7 erosion component at the feet was more specific than the full item 7 (97.5% vs 94%; p = 0.01). Sharp's erosion score at the feet was not better than the erosion component of item 7 (sensitivity 18%; specificity 97.5%). Combined use of radiographs of the hands and feet improved the diagnostic performance of the item 7 erosion component; (sensitivity and specificity of item 7 erosions at the hands combined with the feet were 32.5% and 94.5%, respectively)., Conclusion: The "erosion" criterion at the feet had the best diagnostic performance and was significantly associated with a diagnosis of RA. Combining hand and foot radiographs improved diagnostic performance. more...

Objective: To carry out a cross sectional case-control study of the risk factors for articular destruction in a large sample of patients with a long history of rheumatoid arthritis (RA), presupposing that the variables we measured were unrelated to the duration of disease., Methods: Each inpatient with RA admitted to our department from January 1, 1985, to December 31, 1995, underwent standard examination, laboratory tests, and hand roentgenograms. We carried out a radiographic cross sectional study on 287 of them. Radiographic evaluation was performed by the same observer (correlation coefficient 0.97) using the modified Sharp method. To investigate an association between articular destruction and prognostic variables, a matched analysis of the case-control data and calculation of the odds ratio (OR) with 95% confidence intervals (CI) were carried out. For each patient with severe articular destruction, patients hospitalized during the study period with the same disease duration but without severe articular destruction were included as controls. The sample size was chosen to show an OR > 2 (1-alpha = 95%; 1-beta = 80%)., Results: The risk of articular joint destruction was higher in women than in men (OR 2.72, CI 1.17-7.9, p<0.023), whereas age at onset or the presence of HLA-DR4, antiperinuclear factor, or antikeratin antibodies was not sufficiently strongly associated with the process of articular destruction to be considered relevant prognostic markers., Conclusion: We conclude that female sex is significantly associated with a higher risk of articular destruction. more...

Objective: To document the prevalence of rheumatoid arthritis (RA) and spondyloarthropathy (SpA) in Brittany, France., Methods: (1) Members of rheumatism self-help groups screened cases using questionnaires. (2) Rheumatologists in our unit contacted persons who had possible inflammatory rheumatic diseases and persons who refused the first interview. (3) When diagnosis remained unknown or discordant with the questionnaire, the general practitioner or the rheumatologist of these patients was interviewed. (4) Patients without diagnosis and who had not had a rheumatological examination were examined without charge by a rheumatologist., Results: An overall prevalence rate of 0.62% (0.33-0.91) and 0.47% (0.22-0.72) was found for RA and for SpA, respectively. The prevalence of RA and SpA was 0.86 (0.39-1.33) and 0.53 (0.16-0.9) in women and 0.32 (0.01-0.63) and 0.41 (0.05-0.77) in men. The minimum prevalence of RA and SpA calculated on the estimated initial group (3189 persons) was 0.53 (0.28-0.78) and 0.41 (0.18-0.63), respectively., Conclusion: Our telephone survey revealed that the prevalences of RA and SpA are nearly similar among our population and that SpA is as common in women as in men. more...

Objective: Fc gamma receptor III (Fc gamma RIII) is one of the 3 structurally distinct families of receptors for the Fc domain of IgG, and its Fc gamma RIIIb isoform is exclusively expressed in polymorphonuclear (PMN) cells. We sought to detect anti-Fc gamma RIII autoantibodies in serum from patients with primary Sjögren's syndrome (SS)., Methods: Sixty-six patients with SS and 44 healthy controls were enrolled in the study. ELISA were developed., Results: IgG and IgM autoantibodies were found in 16 (10 IgG+ IgM+ and 6 IgG+ IgM-) and 24 patients (10 IgG+ IgM+ and 14 IgG- IgM+) respectively. Their frequency was higher in patients with nonerosive arthritis (p < 0.02), Raynaud's phenomenon (p < 0.003), and lung involvement (p < 0.02) than in patients without such complications. The levels of IgM and IgG antibody (p < 0.05) correlated with the content of IgA without the circulating immune complex (IC), while there was no relationship between anti-Fc gamma RIII activity and the PMN count., Conclusion: Anti-Fc gamma RIII autoantibodies may act as an acquired additional factor further compromising IC handling in individuals who share HLA-DR3 alloantigen. more...

Objective: The T cell infiltration of the salivary gland of patients with Sjögren's syndrome (SS) has been implicated in the pathogenic process of the disease. We examined the representation of V beta subsets in the blood and salivary tissue of patients with SS., Methods: Circulating T cells from 12 patients and paired samples of blood and labial salivary glands obtained from 8 patients were studied. A panel of monoclonal antibodies directed against the variable region of the T cell receptor was used to enumerate the cells expressing V beta families in the peripheral blood by flow cytometry, and in tissue sections by immunofluorescence., Results: We found an increase of cells bearing V beta 2 family gene products in the circulation, and an increase in both V beta 2 and V beta 8 in the salivary gland infiltrate of patients with SS. No significant difference was noted between the 5 DR3+ patients and 7 DR3- patients studied with regard to the V beta families seen., Conclusion: Our data are consistent with a role for specific T cell families in the pathogenesis of SS. more...

A novel enzyme linked immunosorbent assay has been developed that detects an asialylation change in the IgG molecules from patients with rheumatoid arthritis (RA) by the binding of biotinylated RCA 1 (ricin) to capture IgG. Elevated levels of asialylated IgG were detected in paired serum and synovial fluids (SF) of patients with RA. When compared with healthy controls, particularly in the SF (p less than 0.05) correlations of the asialylation change were found in paired samples (p less than 0.01) and between asialylated IgG and rheumatoid factors (p less than 0.01), C-reactive protein (p less than 0.02) and the Lee and Ritchie indices p less than 0.02 and 0.05, respectively. We found the proportion of asialylated IgG was higher in DR4 positive patients, indicating a possible association of these individuals to a sialyl transferase abnormality. more...

Twenty-three patients with the CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) variant of progressive systemic sclerosis, were clinically, histopathologically and serologically examined for the presence of Sjögren's syndrome (SS). Fourteen were found to be positive. No significant difference could be demonstrated between them and the remaining 9. Characteristics of patients with CREST were compared with those of 29 randomly chosen patients with primary SS. Parotid gland enlargement was more frequently present (p less than 0.01) in the latter than in the former. Virtually no patients with CREST with SS had antibodies to Ro(SSA)/La(SSB). more...

Twenty-five patients with idiopathic Raynaud's phenomenon were followed prospectively for a mean period of 48 months. Clinical and laboratory assessments were performed on admission and on followup. The sera were analyzed for the presence of autoantibodies (antinuclear, antiskeleton and antiorganelle antibodies). Sixteen patients were antinuclear antibody positive and 2 anticentromere antibody positive. Eight patients produced antivimentin, 5 antimitochondrial, 4 anti-Golgi complex, and 3 anticentriol antibodies. Eleven patients produced antidesmosome antibodies. Only one patient (anti-RNP and antidesmosome antibody positive) developed a systemic disease (mixed connective tissue disease) during followup. The initial screening of sera may help to classify Raynaud's phenomenon as idiopathic more accurately. more...

The incidence of monoclonal gammopathy (MG) developing after the onset of rheumatoid arthritis (RA) was found to be 4.1%. Comparison of 12 patients with both diseases and a group of 215 control cases of RA showed the age of onset of RA was higher when MG was going to develop. In such cases, MG was heralded by lower or diminishing serum rheumatoid factor titers. Comparison of these 12 patients with 971 control cases of MG showed the same high frequency of patients with IgM-MG as that recently reported for a series in Western France. An unusually high but not significant incidence of patients with lambda light chains was observed. The reasons for this remain to be elucidated. more...

Various erythrocyte rosette forming cells (ERFC) were quantified in 111 patients with rheumatoid arthritis (RA): total-ERFC (t-RFC), active-ERFC (act-ERFC), autologous-ERFC (auto-ERFC) and high affinity erythrocyte-antibody rosette forming cells (EA-RFC). B lymphocytes were counted using a direct immunofluorescence method. A decrease in act-ERFC and an increase in high affinity EA-RFC was found, but only the levels of the former correlated with the degree of inflammation and may be regarded as an indicator of clinical activity. Conversely, numbers of t-ERFC, auto-ERFC and B lymphocytes were found to be approximately normal. There was no correlation between the level of act-ERFC and the presence of rheumatoid factor, circulating immune complexes or antinuclear antibodies. more...